Intensive In-Home Services Criteria
Mental Health Skill-Building Services Criteria
Eastern Virginia Advanced Care, LLC
Does the client have difficulty due to a mental, behavioral, or emotional illness in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or out-of-home placement because of conflicts with the family/community?
“Out of home” is defined as: Level A or B group home, regular foster home, treatment foster care placement, level C residential facility, emergency shelter, psychiatric hospitalization, juvenile justice/incarceration placement
Does the client exhibit such inappropriate behavior due to mental, behavioral, or emotional illness that repeated interventions by the mental health, social services, or judicial system are necessary?
Does the client exhibit difficulty in cognitive ability due to mental, behavioral, or emotional illness such that they are unable to recognize personal danger or recognize significantly inappropriate social behavior?
Individuals ages 21 and older shall meet all of the following criteria in order to be eligible to receive mental health skill-building services.
- The individual shall have one of the following as primary Axis I DSM diagnosis:
- Schizophrenia or other psychotic disorder as set out in the DSM
- Major Depressive Disorder Recurrent; Bipolar I, or Bipolar II
- Any other Asix I mental health disorder that physician has documented specific to the identified individual within the past year to include all the Following:
- Serious mental illness
- Results in severe and recurrent disability
- Produces functional limitations in the individual's major life activities which are documented in the individual's medical record
- Requires individualized training in order to achieve or maintain independent living in the community.
- Required 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.
- 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 decomposition 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. Have a prescription for anti-psychotic, mood-stabilizing, or anti-depressant 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 antidepressants medications are medically contraindicated for the individual, the provider shall obtain medical records signed by the physician or the licensed prescriber detailing the contraindication. This documentation shall be maintained in the individual's mental health skill-building records, and the provider shall document and describe how the individual will be able to actively participate in the benefit from services without the assistance of medication. This criterion shall be met upon admission to services, and not for subsequent authorization of service.