Mental Health Skill-Building

1. Service Definition

2. Services Provide

3. Eligibility Requirement #1

4. Eligibility Requirement #2

These Services Provide

Individualized goal-directed training in

• Functional Skills and Appropriate Behavior related to the individual’s Health and Safety
• Activities of Daily Living (ADL’s)
• Use of Community Resources
• Assistance with Medication Management
• Monitoring Health, Nutrition, and Physical Condition
• Symptom Management
• Adherence to Psychiatric and Medication Treatment Plans
• Development and Appropriate Use of Social Skills and Personal Support System
• Personal Hygiene
• Food Preparation
• Money Management
   

Service Definition

 
Mental Health Skill-Building Services shall be defined as goal directed training to enable individuals to achieve and maintain community stability and independence in the most appropriate, least restrictive environment.  

Eligibility Requirement #1

Effective September 1, 2011, a completed Independent Clinical Assessment will be required for those individuals up to the age of 21 through their local Community Services Board or Behavior Health Authority. For adult members 21 and older an Independent Clinical Assessment is not required.

1. Individuals qualifying for Mental Health Skill-Building Services must demonstrate a clinical necessity for the service arising from a condition due to mental, behavioral, or emotional illness that results in significant functional impairments in major life activities. Services are provided to individuals who require individualized training to achieve or maintain stability and independence in the community.

Eligibility Requirement #2

Individuals age 21 and over shall meet ALL of the following criteria in order to be eligible to receive Mental Health Skill-Building Services:

a. The individual shall have one of the following as a primary Axis I DSM diagnosis:
(i) that is a serious mental illness;
(ii) that results in severe and recurrent disability;
(iii) that produces functional limitations in the individual’s major life activities that are documented in the individual’s medical record, AND;
(iv) that the individual requires individualized training in order to achieve or maintain independent living in the community.

b. The individual shall require individualized training in acquiring basic living skills such as symptom management; adherence to psychiatric and medication treatment plans; development and appropriate use of social skills and personal support system; personal hygiene; food preparation; or money management.

c. The individual shall have a prior history of any of the following: psychiatric hospitalization; residential crisis stabilization, Intensive Community Treatment (ICT) or Program of Assertive Community Treatment (PACT) services; placement in a psychiatric residential treatment facility (RTC Level C); or Temporary Detention Order (TDO) pursuant to the Code of Virginia §37.2-809(B) evaluation as a result of decompensation related to serious mental illness. This criterion shall be met in order to be initially admitted to services, and not for subsequent authorizations of service.

d. The individual shall have had a prescription for anti-psychotic, mood stabilizing, or antidepressant medications within the 12 months prior to the assessment date. If a physician or other practitioner who is authorized by his license to prescribe medications indicates that anti-psychotic, mood stabilizing, or antidepressant medications are medically contraindicated for the individual, the provider shall obtain medical records signed by the physician or other licensed prescriber detailing the contraindication. This documentation shall be maintained in the individual’s Mental Health Skill-Building Services record, and the provider shall document and describe how the individual will be able to actively participate in and benefit from services without the assistance of medication. This criterion shall be met upon admission to services, and not for subsequent authorizations of service.

Individuals younger than 21 years of age shall meet ALL of the above criteria in order to be eligible to receive Mental Health Skill-Building Services and the following:

The individual shall be in an independent living situation or actively transitioning into an independent living situation. (If the individual is transitioning into an independent living situation, Services shall only be authorized for up to six months prior to the date of transition). Independent living situation means a situation in which an individual, younger than 21 years of age, is not living with a parent or guardian or in a supervised setting and is providing his own financial support.

Individuals eligible for this service may have a dual diagnosis of either mental illness and developmental disability or mental illness and substance abuse disorder. If an individual has co-occurring mental health and substance abuse disorders, integrated treatment for both disorders is allowed within Mental Health Skill-Building Services as long as the treatment for the substance abuse condition is intended to positively impact the mental health condition.