Family Support & Training (FS&T): Massachusetts Products

Family support and training is a service provided to the parent/caregiver of a youth (under the age of 19), in any setting where the youth resides, such as the home (including foster homes and therapeutic foster homes), and other community settings. Family support and training provides a structured, one-to-one, strength-based relationship between a family support and training partner and a parent/caregiver. The purpose of this service is to resolve or ameliorate the youth’s emotional and behavioral needs by improving the capacity of the parent/caregiver to parent the youth so as to improve the youth’s functioning as identified in the outpatient or in-home therapy treatment plan or individual care plan (ICP) for youth enrolled in intensive care coordination (ICC), and to support the youth in the community or to assist the youth in returning to the community.

Services may include education, assistance in navigating the child serving systems (DCF, education, mental health, juvenile justice, etc.); fostering empowerment, including linkages to peer/parent support and self-help groups; assistance in identifying formal and community resources (e.g., after-school programs, food assistance, summer camps, etc.) support, coaching, and training for the parent/caregiver.

Family support and training is delivered by strength-based, culturally and linguistically appropriate qualified paraprofessionals under the supervision of a licensed clinician. Family support and training services must achieve goal(s) established in an existing behavioral health treatment plan/care plan for youth enrolled in outpatient or in-home therapy, or an ICP for youth enrolled in ICC. Services are designed to improve the parent/caregiver’s capacity to ameliorate or resolve the youth’s emotional or behavioral needs and strengthen their capacity to parent.

Clinical Hub providers

Clinical Hub providers are responsible for coordinating behavioral health services for children and adolescents and collaborating with other service providers (e.g., making regular phone calls to collaterals, holding meetings with the family and other treatment providers, or convening care planning teams for ICC). Clinical Hub services in order of intensity are: intensive care coordination (ICC), in-home therapy and outpatient therapy. When more than one Clinical Hub service provider is involved with a family, care coordination is provided by the most intensive service. Clinical Hub providers may also refer for services that require a hub (i.e., “hub dependent” services). Hub dependent services include: therapeutic mentoring, in-home behavioral services, and family support and training.

ICC and Family Support & Training Cooperation

ICC may recommend care coordinators to team with family support and Training partners. When appropriate, the ICC care coordinator and family support and training partner work together with youth with serious emotional disorders (SED) and their families while maintaining their individual functions. The family support and training partner works one-on-one with and maintains regular frequent contact with the parent(s)/caregiver(s) in order to provide education and support throughout the care planning process, attends Care Planning Team (CPT) meetings, and may assist the parent(s)/caregiver(s) in articulating the youth’s strengths, needs, and goals for ICC to the care coordinator and CPT. The family support and training partner educates parents/caregivers about how to effectively navigate the child-serving systems for themselves and about the existence of informal/community resources available to them and facilitates the parent’s/caregiver’s access to these resources.

Clinical Guideline Coverage Criteria

Admission Criteria

1. The youth is under age 19; and

2. The Clinical Hub provider’s treatment plan and comprehensive assessment indicates that the youth’s clinical condition warrants this service in order to improve the capacity of the parent/caregiver in ameliorating or resolving the youth’s emotional or behavioral needs and strengthen the parent/caregiver’s capacity to parent so as to successfully support the youth in the home or community setting; and
3. The parent/caregiver requires education, support, coaching, and guidance to improve their capacity to parent in order to ameliorate or resolve the youth’s emotional or behavioral needs so as to improve the youth’s functioning as identified in the outpatient or in-home therapy treatment plan or ICP, for those youth enrolled in ICC, and to support the youth in the community; and
4. Outpatient services for the youth alone are not sufficient to meet the parent/caregiver’s needs for coaching, support, and education; and
5. The parent/caregiver gives consent and agrees to participate; and
6. A goal identified in the youth’s outpatient or in-home therapy treatment plan or ICP for those enrolled in ICC, with objective outcome measures, pertains to the development of the parent/caregiver capacity to parent the youth in the home or community; and
7. The youth resides with or has a current plan to return to the identified parent/caregiver.

Continuation Criteria

Continuation Criteria The Plan considers the continuation of family support & training as reasonable and medically necessary when ALL of the following are met:

1. The parent/caregiver continues to need support to improve his/her capacity to parent in order to ameliorate or resolve the youth’s emotional or behavioral needs as identified in the outpatient or in-home therapy treatment plan or ICP for those youth enrolled in ICC, and to support the youth in the community; and
2. Care is rendered in a clinically appropriate manner and focused on the parent/caregiver’s need for support, guidance, and coaching; and
3. All services and supports are structured to achieve the youth’s treatment plan or ICP goals in the most time efficient manner possible; and
4. For youth in ICC, with required consent, informal and formal supports of the parent/caregiver are actively involved on the youth’s team; and
5. Continued consent from the parent/caregiver or youth, as applicable, is received; and
6. There is evidence of active coordination of care with the youth’s care coordinator (if involved in ICC), and/or other services and state agencies; and
7. Progress in relation to specific behavior, symptoms, or impairments is evident and can be described in objective terms, but goals have not yet been achieved, or adjustments in the treatment plan/ICP to address lack of progress are necessary.

Discharge Criteria

The Plan considers termination of family support & training when ONE of the following is met:

1. The parent/caregiver no longer needs this level of one-to-one support and is actively utilizing other formal and/or informal support networks; or
2. The youth’s treatment plan/ICP indicates the goals and objectives for family support and training have been substantially met; or
3. The parent/caregiver is not engaged in the service and the lack of engagement is of such a degree that the support becomes ineffective or unsafe despite multiple, documented attempts to address engagement issues; or
4. The parent/guardian/caregiver withdraws consent for treatment; or
5. The youth is placed in a residential treatment setting with no plan for return to the home setting; or
6. The youth has moved to an independent living situation and is no longer in or returning to the family setting.

Please note that psychosocial, occupational, and cultural and linguistic factors may change the risk assessment and should be considered when making level-of-care decisions.

Limitations

Coverage for services is available to children and adolescents that meet the foregoing clinical coverage criteria until the Member’s 19th birthday. The Plan will continue coverage for services for Members age 19 and beyond when services are medically necessary and part of an ongoing treatment plan pursuant to the criteria outlined above.

The Plan will not cover family support and training services for ONE of the following:

1. The youth is no longer authorized to receive outpatient, in-home therapy or intensive care coordination services through a Clinical Hub.
2. There is impairment with no reasonable expectation of progress toward identified treatment goals for this service.
3. There is no indication of need for this service to ameliorate or resolve the youth’s emotional needs or to support the youth in the community.
4. The environment in which the service takes place presents a serious safety risk to the family support and training partner making visits, alternative community settings are not likely to ameliorate the risk and no other safe venue is available or appropriate for this service.
5. The youth is placed in a residential treatment setting with no current plans to return to the home setting.
6. The youth is in an independent living situation and is not in the family’s home or returning to a family setting.
7. The service needs identified in the treatment plan/ICP are being fully met by similar services from the same or any other agency.

Codes

The following code(s) are associated with this services:

Table 1: CPT/HCPCS Codes

• H0038 | | Self-help/peer per 15 minutes