Family Fact Sheet for old BHRS to new IBHS regulations in Mental Health
Services
Family Fact Sheet Transitioning from Behavioral Health Rehabilitation Services (BHRS) to Intensive Behavioral Health Services (IBHS)
Why can my child no longer receive BHRS? BHRS is being replaced by IBHS.
BHRS began in 1994 and since then the services have changed.
The recently promulgated IBHS regulations capture the changes in services.
Where can I find the IBHS regulations?
The main part of the regulations, which includes the requirements for IBHS, can be found at https://www.pabulletin.com/secure/data/vol49/49-42/1554b.html
The preamble of the regulations, which includes the history of the services, the purpose of the regulations, and other important items such as questions and answers about the regulations can be found at https://www.pabulletin.com/secure/data/vol49/49-42/1554.html
What is IBHS?
Intensive Behavioral Health Services, or IBHS, are interventions and supports
for children, youth or young adults under the age of 21
with mental, emotional or behavioral health needs.
They can be provided in the home, school or other community settings.
IBHS include Individual Services,
Applied Behavior Analysis Services, or ABA Services,
Group Services,
and Evidence-Based Treatment, or EBT,
provided through Individual Services, ABA Services or Group Services.
What are Individual Services?
Individual Services are therapeutic interventions and supports that are used to reduce and manage a child’s, youth’s or young adult’s needs that are identified in the individual treatment plan (ITP). They help increase coping strategies and support skill development to promote positive behaviors. Individual Services include Behavior Consultation services, Mobile Therapy services, and Behavior Health Technician services.
Behavior Consultation (BC) Services: BC services include assessment of a child’s, youth’s or young adult’s needs and development of an ITP that includes the interventions that will be used to meet the identified needs.
Both the assessment and the ITP are based on discussions with important people in the child’s, youth’s or young adult’s life.
BC services also include coordination and consultation with other service providers regarding behavior plans and interventions and discussion with the child’s, youth’s or young adult’s treatment team about the behavioral interventions that should be used and when they should be used.
The treatment team includes people who are involved in the child’s, youth’s or young adult’s treatment.
BC services can be used to address behaviors in the school, home, or any other place where a child, youth or young adult needs behavior supports and to learn strategies to better succeed.
Mobile Therapy (MT) Services: MT services are used to provide therapy to a child, youth, or young adult and family members to work on identified goals for the child, youth or young adult.
It is provided in the child’s, youth’s or young adult’s home or other appropriate community settings. MT services include conducting assessments to determine a child’s, youth’s or young adult needs and developing an ITP that includes the interventions that will be used to meet the identified needs. Both the assessment and the ITP are based on discussions with important people in the child’s, youth’s or young adult’s life.
MT services can also be used to help a child, youth or young adult process emotional difficulties, trauma or behavioral health problems.
Behavioral Health Technician (BHT) Services:
BHT services are used to implement a child’s, youth’s or young adult’s ITP.
What are ABA Services?
ABA Services involve the review of a child’s, youth’s or young adult’s behavior within his or her environment.
ABA Services explore why a behavior occurs and then uses specific interventions based on why a behavior occurs.
ABA Services seek to increase useful or desired behaviors.
ABA Services include Behavior Analytic services, Behavior Consultation-ABA services, Assistant Behavior Consultation-ABA services and Behavior Health Technician-ABA services.
Behavior Analytic (BA) Services or Behavior Consultation–ABA (BC-ABA) Services:
BA services and BC – ABA services include assessment of a child’s, youth’s or young adult’s needs and development of an ITP that includes the interventions that will be used to meet the identified needs.
Both the assessment and the ITP are based on discussions with important people in the child’s, youth’s or young adult’s life.
BA and BC-ABA services also include overseeing the other services provided to a child, youth or young adult and consultation with the child’s, youth’s or young adult’s treatment team.
BA services and BC-ABA services can be used to address behaviors in the school, home, or any other place where a child, youth or young adult needs ABA services to succeed.
Assistant Behavior Consultation-ABA (Asst. BC-ABA) Services:
Individuals who provide Asst. BC-ABA services assist staff who provide BA services or BC-ABA service.
Asst BC-ABA services may also be used to provide direct ABA interventions as part of implementing a child’s, youth’s or young adult’s ITP.
Behavioral Health Technician-ABA (BHT-ABA) Services:
BHT-ABA services are used to implement a child’s, youth’s or young adult’s ITP that includes ABA interventions.
What are Group Services?
Group Services are intensive therapeutic interventions that are provided mostly in a group format. They can be provided in a school, community or community-like setting.
Community like settings mimic an environment a child might typically be in such as a school, daycare or afterschool program.
The following are examples of Group Services: Group ABA:
A group of children, youth or young adults participate in treatment activities, which include ABA interventions.
The treatment activities are designed to help the children, youth or young adults develop individual skills.
School-Based Programs:
Treatment programs that happen while children, youth or young adults are at school.
School-based programs use primarily group activities and some individual interventions to target the behavioral health needs of groups of children, youth or young adults.
Each child, youth or young adult will have his or her own treatment plan.
In addition, all school-based programs will have a family involvement component to ensure families are involved and knowledgeable about their child’s program.
School-based programs are different from outpatient services provided in schools or behavioral programs developed by the school.
After School Programs:
Afterschool programs are used to help groups of children, youth or young adults develop specific skills or address behavioral health needs in the hours after school.
The children, youth or young adults may work in a group on activities that will increase their behavioral success in school or focus on a specific therapeutic purpose such as addressing trauma or anxiety.
After school programs are different from outpatient services provided in schools or behavioral programs developed by the school.
Summer Therapeutic Activities Program (STAP):
STAP is a behavioral health program that occurs during the summer.
Most STAPs are several weeks long and meet for several hours a day.
Children, youth or young adults that participate in a STAP work on developing skills and strategies that will help them be more successful in dealing with their behavioral health disorder.
What is EBT?
EBT can be provided through Individual Services, ABA Services or Group Services.
EBTs are behavioral health therapies that use scientifically established methods.
The following are examples of EBT:
Multi-Systemic Therapy (MST):
MST is an evidence-based treatment for youth or young adults and their families, which targets behaviors that lead to criminal activity and other juvenile offenses.
It is used to addresses all environments that impact high-risk youth - homes and families, schools and teachers, neighborhoods and friends.
Individuals who provide MST are on call 24/7.
MST is used to help empower parents and caregivers, work with parents and caregivers on focusing the youth or young adult on school or gaining job skills, and introducing the youth or young adult to recreational activities as an alternative to hanging out with antisocial peers.
Functional Family Therapy (FFT):
FFT is an evidence-based treatment for at-risk adolescents who are 11 to 18 years old and their families and is used to address delinquent behavior.
FFT is a short-term intervention program that includes about 12 to 14 sessions and lasts 3 to 5 months.
It is primarily for adolescents referred by the juvenile justice, mental health, school or child welfare system because of behavioral or emotional problems
Parent Child Interaction Therapy (PCIT):
PCIT is an evidence-based treatment for young children and their parents.
PCIT is conducted through "coaching" sessions.
During these sessions, the child and his or her parents are in a playroom and the therapist is in an observation room.
The therapist watches the parent interact with his or her child through a one-way mirror and/or live video feed.
The parent wears a "bug-in-the-ear" device through which the therapist provides in-the-moment coaching on skills the parent needs to learn to manage his or her child's behavior.
Can a child who lives in a Community Residential Rehabilitation (CRR) Host Home receive IBHS?
Children, youth or young adults who live in a CRR Host Home may receive Individual Services or ABA Services as part of the treatment provided in the CRR Host Home.
My child is currently receiving BHRS. Can he or she continue to receive BHRS?
If your child has a current authorization for BHRS, your child can continue to receive services. BHRS can be provided until January 17, 2021.
Prior to your child’s authorization for BHRS expiring, someone will discuss with you transitioning the services your child receives to IBHS.
What will happen to my child’s BHRS program?
Each BHRS provider needs to decide if they would like to provide IBHS.
The process of BHRS providers becoming IBHS providers will happen throughout 2020.
When do IBHS services start?
The IBHS regulations were effective on October 19, 2019.
This was the first-day IBHS could be provided.
Providers will be working on becoming licensed throughout 2020.
The next year will be a year of transition with BHRS ending and IBHS beginning.
What is needed for my child to receive IBHS?
In order to receive IBHS, your child will need a written order from an individual with a qualifying license.
This could be a physician or physician’s assistant, such as your family doctor, a psychologist or psychiatrist or another licensed individual such as a licensed clinical social worker, a licensed professional counselor or a licensed marriage and family therapist.
You need to give the written order to an IBHS provider for the IBHS provider to begin providing services to your child.
IBHS will begin with the assessment of your child.
The assessment provides information on your child’s strengths and needs, the strengths and needs of your family, existing and needed supports for your child and what you need to help your child. Both the written order and assessment will be used to develop your child’s ITP.
Your child’s ITP will include the goals of your child’s services and the people responsible for helping to implement the ITP goals.
What is the difference between a written order and an assessment?
A written order is valid for 12 months and orders one or more IBHS for your child.
It includes the maximum number of hours of each service per month and the settings, such as home, school or community, where services may be provided.
An assessment is completed following the written order by an individual who is qualified to conduct assessments.
The assessment is done in settings where your child normally is, such as your home or the child’s school or daycare.
The assessment will include more specific treatment recommendations for the number of hours of service recommended in the order and where those services should be delivered.
It will also identify areas of focus for treatment goal development.
Can my child receive Group Services in addition to Individual Services or ABA Services?
Yes, your child can receive Group Services while receiving Individual Services or ABA Services. The Individual Services or ABA Services may not be provided during the time of the Group Service.
Will my child have a treatment team if my child receives IBHS?
Yes, in order to effectively provide services to a child in a setting that is normal for the child such as the home, school, or other community location, there needs to be coordination between the staff providing IBHS and others involved with the child, youth or young adult including family, teachers, and other individuals.
Your child’s treatment team would include those people needed to make the coordination possible.
Are Individual Service Planning Team (ISPT) meetings still required?
ISPT meetings are not a requirement for a child, youth or young adult to receive IBHS.
However, it is still expected that the IBHS treatment team communicates with each other.
This could be done in a variety of ways, such as treatment team meetings or phone calls.
My provider said they do not provide IBHS because they only accept private insurance. Is this correct?
A provider may choose not to participate in the Medical Assistance program, but if the provider is providing IBHS, the provider must be licensed by the state.
My child does not have autism, can my child still receive ABA Services?
ABA Services are not limited to children with a diagnosis of autism.
Children with other behavioral health diagnoses may receive ABA Services.
What if I have a concern about the IBHS my child is receiving?
Sharing any concerns you have about your child’s services is important.
Your ideas may help identify what interventions may best help your child.
You should share your concerns with the staff providing services, the agency providing services or whoever is covering the cost of the services.
Where can I get more information on IBHS?
The following website includes more information on IBHS: http://www.healthchoices.pa.gov/providers/about/behavioral/inbehavioralhs/index.htm
Service Area
Statewide