MassHealth Commonwealth of Massachusetts Executive Office of Health and Human Services www.mass.gov/masshealth Medical Necessity Criteria Family Support and Training Family Support and Training is a service provided to the parent/caregiver of a youth (under the age of 21), 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 is a service that 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 for resolving or ameliorating 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 a goal(s) established in an existing behavioral health treatment plan/care plan for Outpatient or In-Home Therapy, or an Individual Care Plan, 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. Delivery of ICC may require care coordinators to team with Family Support and Training Partners. In ICC, the care coordinator and Family Support and Training Partner work together with youth with SED and their families while maintaining their discrete functions. The Family Support and Training Partner works one-on-one and maintains regular frequent contact with the parent(s)/caregiver(s) in order to provide education and support throughout the care planning process, attends 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. Criteria Admission Criteria All of the following criteria are necessary for participation in this level of care. 1. A comprehensive behavioral health assessment inclusive of the MA Child and Adolescent Needs and Strengths (CANS) 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. If the member has MassHealth as a secondary insurance and is being referred to services by a provider who is paid through the member’s primary insurance, the provider must conduct a comprehensive behavioral health assessment. A CANS is not required. 2. 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/ICP, for those youth enrolled in ICC, and to support the youth in the community. 3. Outpatient services alone are not sufficient to meet the parent/caregiver’s needs for coaching, support, and education. 4. The parent/caregiver gives consent and agrees to participate. 5. 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. 6. The youth resides with or has a current plan to return to the identified parent/caregiver. Psychosocial, Occupational, and Cultural and Linguistic Factors These factors may change the risk assessment and should be considered when making level-of-care decisions. Exclusion Criteria Any one of the following is sufficient for exclusion for this level of care: 1. There is impairment with no reasonable expectation of progress toward identified treatment goals for this service. 2. 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. 3. 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. 4. The youth is placed in a residential treatment setting with no current plans to return to the home setting. 5. The youth is in an independent living situation and is not in the family’s home or returning to a family setting. 6. The service needs identified in the treatment plan/ICP are being fully met by similar services from the same or any other agency. Continued Stay Criteria All of the following criteria are required for continuing treatment at this level of care. 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/ ICP, for those youth enrolled in ICC, and to support the youth in the community. 2. Care is rendered in a clinically appropriate manner and focused on the parent/caregiver’s need for support, guidance, and coaching. 3. All services and supports are structured to achieve goals in the most time efficient manner possible. 4. For youth in ICC, with required consent, informal and formal supports of the parent/caregiver are actively involved on the youth’s team. Continued Stay Criteria (cont.) 5. With required consent, 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. 6. 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 evident. Discharge Criteria Any one of the following criteria is sufficient for discharge from this level of care. 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. 2. The youth’s treatment plan/ICP indicates the goals and objectives for Family Support and Training have been substantially met. 3. The parent/caregiver is not engaged in the service. The lack of engagement is of such a degree that this type of support becomes ineffective or unsafe, despite multiple, documented attempts to address engagement issues. 4. The parent/guardian/caregiver withdraws consent for treatment. 5. The youth is placed in a residential treatment setting with no plan for return to the home setting. 6. The youth has moved to an independent living situation and is no longer in or returning to the family setting. MNC-FST (Rev. 07/12)