1 BHRs A Guide to Behavioral Health Rehabilitation Services (BHRS) Planning Planning Created to help members and their families understand Behavioral Health Rehabilitation Services (BHRS) planning including how a BHRS plan builds on strengths and uses community services and supports, and how a treatment team works together to identify the best combination of resources for each unique child and family.
2 2012 Community Care Behavioral Health Organization
3 -1- What are Behavioral Health Rehabilitation Services (BHRS)? Behavioral Health Rehabilitation Services, sometimes referred to as BHRS, are services often prescribed for children/youth with serious emotional or behavioral disorders. These services are usually provided where the problem behaviors or difficulties with managing emotions occur, such as in the home, school or community. BHRS activities can promote health and wellness and prevent more restrictive services, such as residential BHRS can promote health and wellness and prevent more restrictive services. treatment. However, BHRS should not be provided when less intensive services can meet the child/youth s medical needs. It is just one of many treatment services in Pennsylvania s public mental health system for children and youth. A BHRS plan is developed and delivered by an Interagency Service Planning Team (ISPT). The team is made up of the child and family, mental health professionals, the school, and other community helpers, such as friends or mentors. A good BHRS plan is based on all of the child s important goals, not just behavioral health problem and treatments. Teams work to make sure that every child s life has personal meaning, purpose, and hope. What types of services and supports are used in BHRS? All Medicaid behavioral health services, including BHRS, are provided because there is a medical need (also referred to as a medical necessity ) for them. Like physical health services, BHRS are based on a medical diagnosis and a prescription for that diagnosis. The planning team works with a psychologist or psychiatrist to diagnose the behavioral health medical problems and prescribe a treatment. The ISPT identifies and coordinates the needed services and supports. Combining medical and non-medical interventions is part of good treatment for both behavioral health and physical health problems. Physical and behavioral health care practitioners provide treatment and can help determine what non-medical care should be provided by the family and the family s helpers. For example, a pediatrician would not make chicken soup for a child with a cold even though it might make the child feel better. A family member or friend can and should provide the non-medical care related to a child s medical problems. Just like a good plan for treating physical health problems, a good BHRS plan includes non-medical things that the family can do to care for the child/youth.
4 -2- Examples of how BHRS staff can support ISP goals and a child s and well-being and growth: 1. A BSC or MT can help a child/youth who is having panic attacks that cause him or her to be chronically absent from school by: Helping the child to develop strategies and coping skills that reduce fears and increase feelings of safety. Helping the child s parents and teachers learn how to assist and support the child with new behaviors and skills. 2. A BSC or MT can design activities with the child and family that help the child to have better and ageappropriate self-control. A TSS can use these activities to help the child/ youth learn self-control and can show the family ways to support the child s new skills. However, the TSS cannot provide care or supervision for the child/ youth because the parent or teacher is away or busy. What should BHRS staff provide when following an Interagency Service Plan (ISP)? BHRS staff should provide planned therapy that builds skills related to BHRS treatment goals, such as improving social or selfmanagement skills. BHRS staff, including a Mobile Therapist (MT) or Behavioral Specialist Consultant (BSC), work directly with the child/youth and family on the BHRS goals. The MT or BSC guides everything that a Therapeutic Staff Support (TSS) worker does with the child and family for a behavioral health medical need. All BHRS staff follow the ISP developed by the team. What other resources can families and their helpers use to support children/youth s wellness? Children/youth and families need access to experiences and resources that support their well-being and growth. Children/youth with emotional or behavioral challenges and their families may need extra help in order to participate in these experiences and resources. Case managers and other providers can help children and families identify personal and community resources that will help them reach their treatment and life goals. For example, the child/youth may need the help of a tutor. BHRS staff cannot tutor a child who is catching up on school work due to multiple absences, help a child stay on task throughout the school day, or assist a child with school assignments. Support for academic activities is the shared responsibility of the school, family, and community resources. Ideally, the child/youth and family will stay connected to these resources even after formal behavioral health services end.
5 -3- Many services and activities that help a child/youth with emotional or behavioral challenges are not considered behavioral health treatment, but they are still important for a child or youth s well-being. It does take a community to raise a child! The family, child, and community will all benefit as they strengthen their bonds through shared contributions and relationships. Community Care s Role in BHRS Community Care Behavioral Health Organization (Community Care) is the organization that manages the Medicaid-funded behavioral health services in your county. Community Care works with families, the state, counties, and providers to make sure that appropriate and effective high quality behavioral health services, including BHRS, are delivered to children/youth enrolled in Medicaid and their families. Families of children/youth receiving BHRS work with a Community Care care manager and their provider to plan services. The care manager and provider are available to answer questions and discuss concerns about behavioral health services. Families with questions may contact any of these individuals. Choosing the Right Resources The chart on the following pages has examples of how to use behavioral health treatment and community resources to help children with serious emotional or behavioral needs and their families develop a plan for addressing some common childhood issues, problems, and concerns. Since medical and/or behavioral health services can only be used when there is a medical need, family and community supports and resources should be used to provide non-medical care. Combining resources enhances a child s progress and ability to maintain skills. These approaches can be used when developing an ISP for BHRS or any other behavioral health services. A good BHRS plan includes concrete goals for the child s behavioral and emotional problems. Building on a child and family s strengths is a key part of promoting wellness. It is important to remember that a key part of promoting wellness includes building on the child and family s strengths. The ISPT should work with the county and Community Care to identify a full menu of resources and supports that best meet the unique needs of the child/youth and family, including cultural needs.
6 RESOURCES THAT SUPPORT A CHILD S NEEDS The following chart provides examples of how to combine behavioral health treatment and community resources to help children with serious emotional or behavioral needs and their families develop a plan for addressing some common issues. If help is needed with getting schoolwork done in school... Identify the behavioral health factors contributing to school difficulties and address them in the treatment plan. Provide information on school rights/resources and links to family support projects. Support the child/youth s needs regarding school demands and assist with the school s response to those needs, e.g., explain any instructional accommodations needed. -4- Work with the school to determine if the level of instruction and demand is appropriate. Get help from educational advocacy and rights resources, such as: (Spanish line: ). Local family advocacy projects. Visit for videos about rights at school. If help is needed with getting homework done at home... Same as above. Help families connect with local colleges for volunteer student tutors to help with homework. Ask the school how to support their child s homework tasks and to work with them to determine if the level of instruction and demand is appropriate for the student. Get help from educational advocacy resources (see above). Visit for a helpful guide about homework. If help is needed with finding or taking part in recreational/social activities... Link the child and family to existing community resource guides. Support the child and family with developing an understanding of meaningful, healthy, and safe activities, and how they might independently access and participate in them. This should be reflected in the treatment plan as a wellness/recovery goal. Participate in activities with community groups, e.g., faith-based groups, camps, community colleges, recreational centers, and county recreational bureaus. Use providers strategies to support the extra needs of the child. Schedule activities with other children/families and form groups with common interests. If help is needed with finding childcare for personal demands, such as work and relaxation... Determine if the child has a medical need for a short-term respite outside the home. If so, decide if this should be in the treatment plan, as needed or on a regularly scheduled basis. Link the youth and family to the County Office of Mental Health s respite resources.
7 -5- If help is needed with finding childcare for personal demands... (continued) Join community groups that offer supervised activities, including faith-based groups, local camps, community colleges, and recreational centers, and participate in community groups that support children with behavioral health challenges and their families. Link with other families to establish respite sharing, ideally under the mentorship of a recognized community group. If help is needed with community services, such as housing and legal services... Provide a list of community resources. Determine with the youth and family if any of these needs are impacting the child s behavioral health medical needs and should be further addressed in the treatment plan. Ensure that the family is connected to at least one resource that provides needed ongoing support, e.g., family member, friend, or family support/ faith-based/community group. Follow-up with the resources offered by the provider and care manager. Identify community partners, friends, and other family members that can help them access and use resources and supports. Contact PA Families Incorporated for help with resources, including advocates that support families of children/youth with emotional or behavioral disorders: If behavioral health help is needed for a sibling or parent... Refer the sibling or parent to appropriate resources, matching strengths, needs, and ability to afford. Participate in non-medical supports, such as Alcoholics Anonymous or resiliency/ wellness-building activities like karate. If help is needed with other medical or self-care needs... Make referrals to appropriate resources, matching strengths, needs, and ability to afford. Determine with the youth/family if these needs are impacting the child s behavioral health medical needs and should be further addressed. Contact Easter Seals, rehabilitation hospitals, or other resources for physical health care. Contact the PA Health Law Project if they cannot access needed health care: If help is needed with concerns about the level of care/amount of services and supports... Inform the youth and family (verbally and in writing) of their rights to disagree with the provider and care manager s decisions and explain the grievance/complaint process. Assist with getting a second opinion for BH treatment recommendations. Assist with changing providers if the youth/family wants to switch. Follow the complaint/grievance process provided by their provider and/or care manager. Contact the PA Health Law Project for information about their rights and coverage:
8 A Guide to Behavioral Health Rehabilitation Services (BHRS) Planning MA
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