Psychiatric rehabilitation services for youth with serious mental illness and/or emotional disturbances are referred by a licensed professional of the healing arts, based on a screening, assessment, or ongoing treatment of the youth. The services must be goal-directed and outcome-focused. The services are time-limited interventions provided only as long as they continue to be medically necessary to reduce symptoms of the youth’s mental illness and to restore the youth to an appropriate functional level.
All referred youth clients must:
- Have a PMHS Specialty Mental Health DSM-IV-TR diagnosis that is the cause of serious dysfunction in one or more life domains (i.e., home, school, community);
- Eligible to receive Medical Assistance in the state of Maryland;
- Meet the diagnostic criteria and functional limitations of MHA’s priority population;
- Have an impairment that results in either:
- A clear, current threat to the individual’s ability to live in his or her customary setting;
- An emerging/pending risk to the safety of the youth and others; or
- Other evidence of significant psychological or social impairments such as inappropriate social behavior causing serious problems with peer relationships and/or family members.
- Have an impairment or functional behavior that can reasonably be expected to improve or be maintained via PRP services;
- Be at risk for requiring a higher level of care, or returning from a higher level of care;
- Requires an integrated program of rehabilitation services to develop and/or restore independent living skills to support the individual’s recovery;
- Not require a more intensive level of care and is judged to be in enough behavioral control to be safe in the rehabilitation program and benefit from the services provided;
- A documented crisis response plan for the youth is in progress or completed;
- An Individual Rehabilitation Plan (IRP) is in progress or completed;
- There is clinical evidence that the current intensity of outpatient treatment will not be sufficient to reduce the youth’s symptoms and functional behavioral impairment resulting from the mental illness and restore him/her to an appropriate functional level, or prevent clinical deterioration, or avert the need to initiate a more intensive level of care due to current risk to the individual or others; or
- For the youth transitioning from an inpatient, day hospital, or residential treatment setting to a community setting, there is a clinical evidence that PRP services will be necessary to prevent clinical deterioration and support successful transition back to the community, or avert the need to initiate or continue a more intensive level of care.
Severity of Need & Intensity of Service
Medical necessity for admission to PRP services must be documented by the presence of all criteria. The length and frequency of the services varies based on the Individual’s needs and medical necessity. Professional and/or social supports must be identified and available to the individual outside of program hours, and the individual must be capable of seeking them as needed. Active involvement of the individual, family, caretakers, or significant others involved in the Individual’s treatment should be sought.