Intensive (Out-of-Home) Services
The Department of Mental Health supports a child/youth in out-of-home placements through their community mental health center when the current treatment plan is unable to meet the child/youth/family’s treatment needs in the home. The Department of Mental Health and its provider system have a strong dedication to serving children, youth and their family in their home and community. Home and community based services are provided by all Designated Agencies, however there are times when an out-of-home placement is necessary in order to achieve specific skill development and provide more intensive treatment options.
When an out-of-home placement is necessary there are two main options: Therapeutic Foster Care or Residential Care. Both options are short term, typically 6 months, and provide intensive treatment to work in conjunction with the child, youth and family’s current treatment needs.
The Department of Mental Health has the philosophy that, whenever possible, families should be supported to remain together. Research has shown that the effectiveness of treatment services for children is significantly strengthened when families are actively involved in the treatment process. The family is the cornerstone of treatment; they are not only involved in developing the treatment plan, but are active participants in the treatment and evaluation of services. Active family involvement helps to ensure that treatment services are individualized to the family’s needs, are culturally sensitive and appropriate, and support a focus on the family’s strengths, resources, and natural supports.
Treatment teams are strongly encouraged to use the Act 264 Coordinated Services Planning process to explore the child and family’s strengths, needs, goals and supports/services.
Out-of-home placements may be provided through the Enhanced Family Treatment (EFT) plan for home and community based treatment. The EFT is a funding mechanism that allows a Designated Agency or Special Service Agency to provide a package of services in an intensive manner. The major difference between the EFT and other treatment plans is the ability to provide out-of-home community-based therapeutic care. These included:
- Therapeutic Foster Care or Shared Parenting
- Extensive Respite (including overnight)
- Small group home settings with 3 or less children
- Mentorship for older adolescents.
Eligibility determination for intensive services must be initiated with the local Designated Agency or Special Service Agency. A child or youth must meet the eligibility criteria for Out-of-Home placements.
Residential care provides 24-hour awake night staffing, 24-hour medical and psychiatric back-up, in house crisis back-up, and an array of psychological assessment and treatment services. Residential services include:
- Short-term residential assessments (30-60 days) – is for intensive assessment in order to develop a more specific treatment plan and answer specific questions regarding a child, youth and family’s needs.
- Long-term residential placements (3 to 12 months) – addresses psychiatric and/or multiple mental health needs when other less intensive services have not produced the necessary gains in the community.
Eligibility determination for residential care services must be initiated with the local Designated Agency, as outlined in the policy “Referrals to Case Review Committee for Residential Treatment or Assessment for Children/Youth in the Custody of Their Parents or Guardians”
The guidelines for Residential Care placements are described in “Residential Placements: For Children and Adolescents in Need of Residential Mental Health Treatment”.
The Case Review Committee Policy and Procedures describes the process for making referrals to residential care programs through the public system of care.
Emergency or hospital diversion beds are community-based programs that provide a very high level of care and have the ability to divert youth from in-patient hospitalization. Typically, youth who do not require around-the-clock medical monitoring can be stabilized in a smaller treatment setting.
Emergency/Hospital Diversion programs have 24-hour awake night staff, 24-hour psychiatric and in-house crisis back-up, and may have the ability to conduct psychological, and other specialized testing as needed. The typical length of stay in these services is one to ten days.
Screening for Emergency/ Hospital Diversion beds is conducted by the local Designated Agency Crisis Services.
In-patient hospitalization may be required for children and youth with a mental illness and who:
- Require around-the-clock medical monitoring for such things as drug overdoses, suicide attempts, or other complicating medical conditions
- Have complex and uncontrollable behaviors such as harm to themselves and/or others
- Cannot be stabilized in a smaller and more individualized hospital diversion treatment setting and/or
- Meet the criteria for an emergency examination. An Emergency Examination (EE) is the first step towards an involuntary psychiatric admission. In order to hold a person for an EE, there must be sufficient reason to believe that the individual meets the Vermont statutory definition of 'a person in need of treatment'.
Three hospitals provide psychiatric in-patient services for Vermont children and youth, the in-state option is always considered first:
- Brattleboro Retreat in Brattleboro, Vermont
- Cheshire Medical Center in Keene, New Hampshire
- Champlain Valley Psychiatric Hospital in Plattsburgh, New York
A child or youth meeting the criteria for an emergency examination (EE) may be placed only at the Brattleboro Retreat.
Screening for Hospital Inpatient services is conducted by the local Designated Agency Crisis Services.