214 R.I. Code R. 214-RICR-40-00-6.1

Current through December 3, 2024

Section 214-RICR-40-00-6.1 - GENERAL PROVISIONS

A. Purpose

1. The purpose of these regulations is to comply with R.I. Gen. Laws § 40.1-5-6, which requires any child who is under the age of eighteen whose health insurance is publicly funded to have an emergency service intervention by a provider licensed by the Department of Children Youth and Families (the Department) as a condition for admission to an inpatient psychiatric facility. These regulations set forth the standards for certifying providers and include standards for child and family competent Clinicians.

2. These regulations do not apply to emergency service interventions that result in emergency hospitalizations under R.I. Gen. Laws § 40.1-5-7. This statute provides that when an emergency hospitalization needs to occur, the preauthorization procedure required for authorization by the insurance company may be waived by the certified emergency service provider to protect the safety and well-being of the child and family.

B. Legal Basis

1. These regulations are issued pursuant to:

a. R.I. Gen. Laws § 42-72-5, Power and Scope of Activities of the Department of Children, Youth and Families

b. R.I. Gen. Laws §§ 40.1-5-5. 40.1-5-6 and 40.1-5-8, Mental Health Law

c. R.I. Gen. Laws § 42-72-5.2, Development of a Continuum of Children's Behavioral Health Programs

d. R.I. Gen. Laws § 42-72.1, Licensing and Monitoring of Child Care Providers and Child-Placing Agencies

2. These regulations are consistent with the provisions of Utilization Review of Health Care Services (216-RICR- 40-10-20).

3. These regulations include children with Serious Emotional Disturbances (SED) as defined by R.I. Gen. Laws § 42-72-5.

C. Philosophy

1. In accordance with R.I. Gen. Laws § 42-72-5, the Department is responsible for the delivery of appropriate mental health services that match the needs of children.

2. Appropriate behavioral health services may include psychiatric hospitalization, residential treatment and community-based mental health services, including emergency service interventions.

3. The Department has established a service delivery system based on System of Care values to work with families with a child with severe emotional disturbance(s). It is the objective of the Department to develop a culturally and linguistically competent, community based, youth guided and family driven service system, which is responsive to needs and built on strengths.

4. These regulations further reinforce the Department's values by establishing standards for a child-family competent Clinician (hereinafter, Clinician) who is providing emergency service interventions for children and families. These standards require that the Clinician is knowledgeable of the full range of follow up services and resources including:

a. Community supports and neighborhood resources

b. Community mental health services such as outpatient mental health, intensive outpatient and in-home services

c. In-home supports such as respite and crisis de-escalation

d. Twenty-four hour community-based programs such as shelters, respite, crisis stabilization and acute residential treatment

e. Twenty-four hour Inpatient psychiatric hospitalization

D. Definitions

1. "Child-family competency" means proficiency in clinical practice skills with children with severe emotional disturbance and their families, knowledge of research on child development, application of the knowledge in a clinical context and familiarity and experience with community resources that benefit children and families, including knowledge of the cultural beliefs and practices of the diverse communities served.

2. "Child-family competent clinician" means a Registered Nurse, Masters Level Clinician, licensed Master's Level Mental Health Clinician, M.D., Ph.D., Ed.D. or Psy.D. Psychologist, Master's Level Nurse, or Clinical Nurse Specialist. The Child- Family Competent Clinician (hereinafter, Clinician) must have at least two years of clinical experience with children and adolescents who have behavioral health problems. This clinical experience must have been supervised by an independently licensed mental health Clinician. The Clinician must meet the standards of Child-Family Competency as described in the standards below.

a. Each certified Provider must determine the child-family competency of all staff providing children's emergency services.

3. "Crisis evaluation" means a comprehensive assessment by the Clinician to evaluate the seriousness of the mental health crisis based on the child's functioning and risk to self and others and the family/caregiver's potential, skill level and capacity, with appropriate supports, to manage the behaviors that put the child at risk.

4. "Cultural and linguistic competency" means a core competency within the practice of behavioral health services. It includes the understanding that perception of severe emotional disorders, crises and their causes vary by culture. Culture influences help-seeking behaviors and attitudes toward mental health services and emotional well-being. Linguistic competency includes:

a. Phone lines and web sites that assure access for people who are deaf or hearing impaired

b. Interpretation services available within the two (2) hour time period for Emergency Services

c. Translated materials/forms for persons who do not speak or read English in the communities served by the Emergency Services Program

5. "Family support worker" means a person who has first-hand family experience with mental health emergency service interventions as a parent, sibling or consumer and who is available to the family as part of the follow up service plan developed by the Clinician and the family.

6. "Follow up service plan" means the resolution to the mental health crisis that is developed by the Clinician in partnership with the parent or legal guardian of the child. The plan considers the strengths of the family and child, considers all available community services and matches the services to the needs of the child and family.

7. "Mental health emergency" means a situation perceived by a child, adolescent, caretaker, relative, friend, school professional, healthcare professional, police, or other public safety personnel in the care of, or directly involved with, a child or adolescent that poses a risk of harm to the child, family or other person due to a mental illness.

8. "Mental health emergency service interventions" means steps that are taken by a mental health provider to address a mental health crisis including telephone contact, crisis evaluation in the community and follow up service planning and implementation. These interventions take place in a community setting, including a school, police station, residential program, shelter, day care center, community mental health center, community health center, hospital emergency room or other community setting that the family and the Clinician agree is safe and clinically appropriate to resolve the mental health crisis.

9. "Pre-certification" means the process of obtaining approval from the third-party payer, which is required as a condition of payment for a specific benefit prior to the service being provided. This regulation requires the Clinician involved in the crisis evaluation to seek approval from the payer, as required by RIte Care, for the services that the family and Clinician determine appropriate for the mental health needs of the child.

10. "System of Care (SOC)" means core principles and values that are strength- based, child-centered and family-driven. SOC involves establishes and supports a range of easily accessible services for children and adolescents with serious emotional disturbances. The services are culturally and linguistically competent and emphasize natural and community-based supports that complement mental health services provided by professionals in agency and hospital settings.

11. "Utilization review" means prospective, concurrent or retrospective assessment of the medical necessity and appropriateness of the allocation of health care services of a provider, given or proposed to be given to a patient or group of patients, as defined in the Utilization Review of Health Care Services (216-RICR- 40-10-20) cited above.

214 R.I. Code R. 214-RICR-40-00-6.1