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Guidelines for Best Practice in Child and Adolescent Mental Health ServicesPage 5 2001violence, as assessment tool related to this topic is included (“Child and Adolescent Readiness forNonviolent Problem-Solving: Assessment Parameters”).Practice:“Practice” here refers to all processes other than evaluations and assessments that involvequalitative aspects of treatment interventions with the child and family, collaboration, treatmentmonitoring, and the use of natural supports. Case-specific efforts at sound practice, as important as theyare, cannot sustain our important behavioral health initiative unless accompanied by efforts at all levels tocreate a positive public sector culture. Each of us is obliged to make this effort, and to enlist the supportof others in this endeavor.It needs to be recognized that most procedures within these documents for sound practice withBHRS apply also to other services, including traditional outpatient treatment. The focus on so-called“wraparound services” emerged in recent years because these were the newest and potentially mostflexible services. However, the guidelines in this packet apply to other services and levels of care. Itshould also be appreciated that the availability of BHRSCA in no way renders traditional outpatienttreatment obsolete. Outpatient therapy remains the least intrusive, most normalized, behavioral healthservice, and should be used when clinically best suited to the child’s needs.The Practice section also delineates some aspects of strengths-based treatment and discusses theuse of natural supports. Other topics include: the clinical interview; methods for achieving collaboration;specific aspects of cultural competence; the interagency team meeting; guidelines for home-basedtreatment (e.g., BHRSCA and Family-Based Mental Health Services); use of Therapeutic Staff Support(TSS), when medically necessary; use of psychotropic medication; and a self-assessment document topromote the implementation of genuine biopsychosocial treatment.Behavioral Health Submissions:Since a funding source typically does not observe actual evaluation and clinical practice, there isreliance on documentation to determine medical necessity for initial care and continued care requests,respectively. We presume that the provider who comprehensively documents need and treatment isoffering comprehensive treatment as well. While this is not always the case, the frequent associationbetween documentation and practice should not come as any surprise. For example, comprehensiveevaluations, progress notes linked to an individualized treatment plan, and evidence of frequentcommunication and collaboration, including team meetings convened as clinically indicated, all representsound work efforts likely to result in positive outcomes and satisfied clients.The Behavioral Health Submission section includes guidelines for behavioral health submissionsto any funding source, and to behavioral health managed care under HealthChoices in Pennsylvania. Hereagain, although the identified focus may be on “wraparound services,” the suggestions are clinically basedand apply to a full range of service requests.The packet closes with an original “Rap for Pennsylvania CASSP Principles” and Pennsylvania’sformal description of CASSP Principles. Given the centrality of CASSP principles to our children’ssystem, it is important that these principles be understood by as many stakeholders as possible. This rap,playful yet serious, is intended to offer another vehicle to reinforce these principles, and to promote apositive public sector culture.

Guidelines for Best Practice in Child and Adolescent Mental Health ServicesPage 6 2001Conclusion:The Guidelines for Best Practice in Child and Adolescent Mental Health Services is a collectionof documents that broadly addresses, through qualitative standards, many of the challenges facingagencies and practitioners in daily work. The scope includes Assessment, Practice, and Behavioral HealthSubmissions. Although often pitched to BHRS, the guidelines in fact are more generic and apply to therange of services for children and adolescents and their families.Given the breadth of behavioral health assessment and service provision, these guidelines are notfully inclusive. Choices had to be made. The documents, however, are the end product of a series ofissues identified statewide as being important to clinicians, children and families. I hope they will helpyou in your efforts to support children and families.Gordon R. Hodas, M.D.Statewide Child Psychiatric ConsultantOffice of Mental Health and Substance Abuse ServicesApril 2001

Guidelines for Best Practice in Child and Adolescent Mental Health ServicesPage 7 2001CHARACTERISTICS OFA POSITIVE PUBLIC SECTOR CULTURE1.Clear values for system of care.2.Clear practice expectations.3.Facilitative regulations.4.Empowered families and advocates, with participation in policy development.5.Preparation and dissemination of guidelines for best practice.6.Emphasis on training and technical assistance.7.Use of newsletters to communicate new ideas, share experiences, and celebrate success.8.Presence in every county.9.Decentralized structures for decision-making.10.Cross-systems initiatives.11.Using managed care and welfare as tools for positive systems change.12.Careers and prestige for public sector clinicians and workers.

Guidelines for Best Practice in Child and Adolescent Mental Health ServicesPage 8ASSESSMENT 2001

Guidelines for Best Practice in Child and Adolescent Mental Health ServicesPage 9 2001PARAMETERS OF STRENGTHS-BASEDSYSTEMIC ASSESSMENTIN CHILD AND ADOLESCENT MENTAL HEALTHA.B.C.Strengths Within System1.Strengths of individual child or adolescent2.Family strengths: individuals, relationships, resources, goals/aspirations3.Cultural strengths: expectations, rituals, other practices4.Interagency strengths: resources and relationships5.Community strengths: resources and relationshipsPossible Needs/Concerns1.Economic factors/concrete service needs2.Racism or other types of discrimination3.Individual vulnerabilities: child/adolescent, other family member4.Family vulnerability: fragile relationships5.Cultural variation6.Interagency vulnerability: limitations of resources, agency conflict, family-agencyconflictDesired Outcomes1.Active child and family participation during assessment and treatment—treatmentplanning, implementation, monitoring. Family as full partner in treatment team.2.Development of respectful, trusting relationships among providers, child and family.3.Development of consensus within interagency treatment team re: strengths/needs, goals,treatment plan, specific services.4.Services fully consistent with CASSP principles.

Guidelines for Best Practice in Child and Adolescent Mental Health ServicesPage 10 2001PSYCHIATRIC/PSYCHOLOGICAL EVALUATION FORWRAPAROUND OR RESIDENTIAL TREATMENTDiscussion of Goals and FormatThe goals of the Life Domain Format for Psychiatric/Psychological Evaluations: Initial andContinued Care are:a.To help the evaluator implement a strengths-based interview and written report thatidentify competencies and resources as well as needs, so that each child and adolescentcan be understood biologically, psychologically, and socially (e.g., understood withinvarious life domains), resulting in a comprehensive understanding of the child andfamily.b.To help the evaluator identify crisis situations, and ascertain when a child requires ahighly restrictive level of care such as inpatient psychiatric hospitalization or RTF.c.To help the evaluator to obtain core information, so that the interagency team is free topromote an envisioning of positive, future outcomes and to develop a creative treatmentplan, rather than engage in a recitation of past failures.d.To assist the evaluator in recommending individualized services and natural supportsconsistent with CASSP Principles, which support the child’s remaining in the naturalfamily or elsewhere in the community, when possible, or the child’s successful return tothe community.e.To support the inclusion of parents/caregivers and other treatment team members in aportion of the evaluation process.f.To encourage participation by the psychiatrist or psychologist as an active member of theinteragency and treatment teams, helping to achieve consensus regarding needs andservices, and monitoring progress.g.To create a comprehensive document that serves as a baseline for future evaluations, andas a source of reference for a subsequent review of the child’s progress over time.This recommended format guides the systematic collection of core information about a child oradolescent with a serious emotional disorder, and assists the evaluator in prescribing medically necessarybehavioral health services and in making relevant recommendations.The LIFE DOMAIN DORMAT makes use of seven primary categories or sections: IdentifyingInformation, Reason for Referral, Relevant Information, Interview, Discussion, Diagnosis, andRecommendations.I.Identifying Information: This section immediately places the individual child in the context of thefamily, community, and treatment team. It is not possible for a reviewer to determine medicalnecessity for behavioral health services if the child’s basic living situation and life context are notidentified.

Guidelines for Best Practice in Child and Adolescent Mental Health ServicesPage 11 2001II.Reason for Referral: This is an opportunity to clearly establish the reason for your involvement asevaluator. When there is more than one reason (e.g., the psychiatric prescriber is evaluating forBHRSCA and also monitoring psychotropic medications), this should be clearly identified.III.Relevant Information: In an effort to promote understanding of the whole child, this section isfurther divided into the following lCommunityDrug and AlcoholServices (All human services, including but not limited to behavioral health):1.2.H.Services and Service History (for initial request)Services and Services Update (for continued care request)Other (Based on age of the child, presenting concerns, and relevant history)Note: For continued care requests, the Relevant Information section begins with a sectionentitled, Brief Update. The Brief Update section provides an opportunity to highlight keydevelopments during the most recent service period. These changes are further elaborated, underrelevant categories, A-H.Note: Although there is a discrete section for “Strengths,” it is expected that the recognition ofstrengths/competencies is reflected throughout the entire report.IV.Interview: The written summary of a time-specific, face-to-face interview describes the child’sinteractions/relationship with you and any other participating adults. It also describes the child’sunique thoughts and wishes, along with other formal mental status categories. It is only bydescribing a real person that a report can be individualized.V.Discussion: This section integrates information provided by the child, family, treatment team,interview, and medical record, from a strengths-based perspective, and offers a hypothesis toexplain the situation. Begin with the presumption that the child can be maintained in thecommunity. If you recommend RTF placement, justify this in terms of the severity of thedisorder, and explain the need for 24-hour treatment. Discuss the rationale for recommendedservices, and for the diagnosis

monitoring, and the use of natural supports. Case-specific efforts at sound practice, as important as they are, cannot sustain our important behavioral health initiative unless accompanied by efforts at all levels to create a positive public sector culture. Each of us is obliged to make this effort, and to enlist the support