Tufts Health Plan defines family stabilization treatment (FST) as a short term, intensive and flexible service that assists with the stabilization of children and adolescents in their home environment during an acute psychiatric crisis.

It is a structured treatment modality that is designed to work with all Members of a family, not just the identified child/adolescent at risk. FST services can be used as an independent level of care or as an adjunct to other levels of care. FST services are designed to prevent repeated hospitalizations and/or out of home placement by providing intensive in-home services and arranging successful linkages for the family with outpatient providers.

Clinical Guideline Coverage Criteria

The Plan considers Family Stabilization Treatment as reasonable and medically necessary when ALL of the following is met:

1. The Member has a diagnosed psychiatric or substance-related disorder consistent with the most recent Diagnostic and Statistical Manual™ (DSM) or with the most recent International Classification of Diseases (ICD); and
2. The Member is at high risk for hospitalization or out of home placement; and
3. The home environment and primary support system are important components to stabilization and management of the presenting problem; and
4. FST services are required for reasons other than convenience; and
5. The identified Member is a child/adolescent under the age of nineteen (19)

Limitations

The Plan does not cover FST under the following circumstances:

1. The Member's benefit plan does not permit Individual Care Management (ICM).
2. The Member is assessed to be at risk for harming self or others, and/or has a significant mental illness that requires a more intensive level of care.
3. The Member and/or family have not made progress towards treatment goals, or the treatment interventions available have been exhausted and there is no reasonable expectation of progress at this level of care.
4. The Member’s home environment presents a safety risk to the family stabilization clinician(s).
5. The Member and the Member’s family and/or legal guardian do not agree to be involved with the FST treatment plan.
6. The Member can be safely and effectively treated at a less intensive level of care.