Ohio Administrative Code|Rule 5122-29-28 | Intensive home based treatment (IHBT) service.

                                                
(A) In addition to the definitions in rule 5122-24-01 of
		  the Administrative Code, the following definitions apply to this
		  rule:
(1) "Caseload"
			 means the individual cases open or assigned to each full-time equivalent IHBT
			 staff.
(2) "Continued stay
			 review" means a review of a child/adolescent's functioning to
			 determine the need for further services to achieve or maintain service goals
			 and objectives.
(3) "Crisis
			 response" means the immediate access and availability, by phone and
			 face-to-face, as clinically indicated, to the child/adolescent and family,
			 which may include crisis stabilization, safety planning, and the alleviation of
			 the presenting crisis.
(4) "Face-to-face
			 contacts" means in-person IHBT provided in the home, school, and community
			 working directly with the person served and his or her family, or on the
			 child/adolescent 's behalf.
(5) "Home"
			 means any long-term family living arrangement including biological, kinship,
			 adoptive, and non-custodial families who have made a long-term commitment to
			 the child/adolescent.
(6) "Out-of-home
			 placement" means any removal of the child/adolescent from his or her home.
			 Planned respite, where the child's main residence remains his or her home,
			 is not considered out-of-home placement.
(B)  Intensive home based treatment
		  (IHBT) service is a comprehensive behavioral health service provided to a
		  child/adolescent and his or her family that provides coordination and support
		  for persons with serious emotional disturbance for a person enrolled in the
		  service and integrates assessment, crisis response, individual and family
		  psychotherapy, service and resource coordination, and rehabilitative skill
		  development with the goal of either preventing the out-of-home placement or
		  facilitating a successful transition back to home. These intensive,
		  time-limited behavioral health services are provided in the
		  child/adolescent's natural environment with the purpose of stabilizing and
		  improving his/her behavioral health functioning.
The purpose of IHBT is to enable a
		  child/adolescent with serious emotional disturbance (SED) to function
		  successfully in the least restrictive, most normative environment. IHBT
		  services are culturally, ethnically, racially, developmentally and
		  linguistically appropriate, and respect and build on the strengths of the
		  child/adolescent and family's race, culture, and ethnicity.
(C) The following describes the activities and components
		  of IHBT:
(1) IHBT is an intensive
			 service that consists of multiple face-to-face contacts per week with the
			 child/adolescent and family, which includes collateral contacts related to the
			 behavioral health needs of the child/adolescent as documented in the ICR. The
			 frequency of contacts may fluctuate based on the assessed needs and unique
			 circumstances of the child, adolescent, and family.
(2) IHBT is
			 strength-based and family-driven, with both the child/adolescent and family
			 regarded as equal partners with the IHBT staff in all aspects of developing the
			 service plan and service delivery;
(3) IHBT is provided in
			 the home, school, and community where the child/adolescent lives and
			 functions;
(4) Provided by staff
			 with a caseload that averages over any six month period and per full time
			 equivalent staff:
(a) Fourteen or less when provided by a team of two,
				or
(b) Seven or less when provided by an individual
				staff;
(5) Crisis response is
			 available twenty-four hours a day, seven days a week. Crisis response, at a
			 minimum, may be provided by the providers on-call system after business
			 hours and weekends, as long as at least one IHBT staff is accessible to the
			 on-call staff, and is available to the client and family as
			 needed;
(6) Each child/adolescent
			 and family receiving IHBT is assessed for risk and safety issues. When
			 clinically indicated, a jointly written safety plan shall be developed that is
			 provided to the child/adolescent and family;
(7) Collaboration occurs
			 with other child-serving agencies or systems, e.g., school, court,
			 developmental disabilities, job and family services, and health care providers
			 that are providing services to the child/adolescent and family, as well as
			 family and community supports identified by the child/adolescent and
			 family;
(8) The service is
			 flexible and individually tailored to meet the needs of the child/adolescent
			 and family. Appointments are made at a time that is convenient to the
			 child/adolescent and family, including evenings and weekends if
			 necessary;
(9) The service is
			 time-limited, with length of stay matched to the presenting mental health needs
			 of the child/adolescent. IHBT certified providers must have clearly written
			 guidelines for granting extensions and procedures for continued stay of each
			 individual. A continued stay review must be documented for each
			 child/adolescent receiving IHBT beyond six months, and every forty-five days
			 thereafter. The continued stay review must include the criteria in paragraph
			 (F) of this rule; and
(10) The child/adolescent
			 and family's IHBT aftercare service needs are addressed. Continuing care
			 planning shall be collaborative between the child/adolescent, family and IHBT
			 staff.
(D) Practitioner(s) on an IHBT team that provides services
		  to a youth with a co-occurring substance use disorder shall have appropriate
		  credentials from the state licensing board(s) to provide both mental health and
		  substance use treatment.
(E) The provider shall determine who is eligible to receive
		  the service and must document how the child/adolescent meets the following
		  criteria necessary to receive IHBT services:
(1) Is clinically
			 determined to meet the "person with serious emotional disturbance"
			 (SED) criteria in rule 5122-24-01 of the Administrative Code;
(2) Meets one or more of
			 the following criteria as documented in the ICR:
(a) Is at risk for out-of-home placement due to his/her
				behavioral health/mental health condition;
(b) Has returned within the previous thirty days from an
				out-of-home placement or is transitioning back to their home within thirty
				days; or
(c) Requires a high intensity of mental health
				interventions to safely remain in or return home; and,
(3) IHBT may also be
			 provided to transitional age youth between the ages of eighteen and twenty-one
			 who have had an onset of serious emotional and mental disorders at an age
			 younger than eighteen.
(F) The provider must demonstrate that the following staff
		  requirements and qualifications are met:
(1) A minimum of two
			 full-time equivalent staff provide the service. Services may be provided by a
			 single person, or team of staff clearly sharing various responsibilities for
			 the same child/adolescent and family. Each child/adolescent shall have a staff
			 assigned with lead responsibility. IHBT direct care staff must be fully
			 dedicated to the IHBT program and cannot have mixed service
			 caseloads.
(2) The provider must have a documented
			 plan for clinical supervision, which includes:
(a) The IHBT supervisor shall have a designated
				responsibility to IHBT;
(b) Each staff person shall receive clinical supervision
				that is appropriate for the staff person's expertise and caseload
				complexity; and
(c) Consideration of the staff person's assessed
				training needs.
(3) The IHBT supervisor
			 shall have primary responsibility for providing supervision to the IHBT staff
			 twenty-four hours a day, seven days a week. If the IHBT supervisor is
			 unavailable, then supervision must be provided by staff qualified according to
			 rule 5122-29-30 of the Administrative Code.
(G) The provider must demonstrate that each IHBT staff has
		  an individualized training plan based on an assessment of his/her specific
		  training needs. The following professional training and development criteria
		  must be met:
(1) Each staff receives
			 an assessment of initial training needs based on the skills and competencies
			 necessary to provide IHBT service prior to providing IHBT service;
			 and
(2) The agency shall have
			 a written description of the skills and competencies required to provide IHBT
			 service, which include, at a minimum, the following:
(a) Family systems;
(b) Risk assessment and crisis stabilization;
(c) Parenting skills and supports for children/adolescents
				with SED;
(d) Cultural competency;
(e) Intersystem collaboration with a focus on schools,
				courts, and child welfare:
(i) Knowledge of other
				  systems;
(ii) System advocacy;
				  and
(iii) Roles,
				  responsibilities, and mandates of other child/adolescent-serving
				  entities;
(f) Trauma-informed care;
(g) Educational and vocational functioning:
(i) Assessment and
				  intervention strategies for resolving barriers to successful educational and
				  vocational functioning;
(ii) Knowledge of special
				  education laws; and
(iii) Strategies for
				  developing positive home-school partnerships and connections;
(h) IHBT philosophy, including strength-based assessment
				and treatment planning; and
(i) Differential diagnosis with special needs
				children/adolescents, including co-occurring substance use disorders and
				developmental disabilities, for staff credentialed to diagnose.
(H) The provider's training plan must include
		  provisions for ongoing training specific to the identified training needs of
		  the staff as it relates to the population served, including attention to
		  cultural competency, changing demographics, new knowledge or research, and
		  other areas identified by the agency.
(I) The provider must demonstrate that each IHBT supervisor
		  receives training specific to the clinical and administrative supervision of
		  the service.
(J) The provider shall obtain at least
		  one fidelity review of the provider's entire IHBT service every twelve
		  months by an individual or organization external to the provider, utilizing the
		  IHBT fidelity rating tool (dated September 23, 2016) avaialbe at
		  www.medicaid.ohio.gov. The provider shall incorporate the results of the
		  fidelity review into the provider's performance improvement program, if
		  indicated.
(K)  Intensive home based treatment service shall be
		  provided and supervised by staff who are qualified according to rule 5122-29-30
		  of the Administrative Code.


Last updated January 13, 2022 at 11:22 AM