WELLBEING

Mental Health Program Approval

Section I. Mental Health Services

“Mental Health Services” are defined as assessment, diagnoses, and treatment in a professional relationship to assist an individual or group in dealing with their mental health issues in a positive environment. The Berhe Group has provided services to youth and Non-Minor Dependents (NMD) under a contract with the San Bernardino County Department of Behavioral Health (DBH) since 2017. The program is Medi-Cal Certified.

Mental Health Services are provided for the resident and ancillary services in the context of the family. Services are trauma informed and provided with sensitivity to their cultural needs. During the resident's assessment process and treatment, the assigned mental health professional will discuss with the resident as part of the Child and Family Team (CFT) any culturally relevant factors or preferences, including language preference, which will guide treatment. The Berhe Group Mental Health Services, have and will continue to, address the special needs of our residents who have been neglected, have been exposed to or have a substance abuse concern, runaway behaviors, been sexually exploited (CSEC), abused because of sexual orientation (LGBTQ), multiple foster care placements, gang associations, and emotional difficulties.

Services include Individual and Group Therapy, Assessments, Plan Development, Collateral, Targeted Case Management Services, Intensive Care Coordination, Medication Support Services, Crisis Intervention Service. All services are to be individualized to the youth, and, all services are to be reviewed and determined through the Child and Family Team process.

Section II. The Integrated Core Practice Model (ICPM)

The Integrated Core Practice Model (ICPM) is a comprehensive model for serving children and youth in need. This model defined as the ICPM is “a set of practices and principles for children/youth served by both the child welfare and the mental health system that promotes a set of values, principles, and practices that is meant to be shared by all who seek to support children/youth and families involved in the child welfare system. The ICPM requires collaboration between child welfare and mental health staff, service providers, and community/tribal partners working with the children, youth, and families.”

The Berhe Group operates from a Trauma-Informed approach that is a strengths-based service delivery approach and is rooted in an understanding of and responsiveness to the impact of trauma. Further, The Berhe Group emphasizes the physical, psychological, and emotional safety for both staff and residents. We implement this model from a trauma-informed approach, which aims to: (a) Engage all of our youth/NMDs who have histories of trauma: (b) Recognize the presence of trauma symptoms; and (c) Acknowledge the role that the trauma has played in the resident’s lives

This means that at The Berhe Group, we assess and provide mental health services that take into account any trauma that may have happened to a client and/or his family system. It is a shift from “What is wrong with you?” to “What has happened to you and how can I support you?” We recognize that traditional service approaches can re- traumatize those we serve. The Berhe Group’s Trauma-Informed approach is a resident-centered response focused on improving each youth/NMDs all around wellness rather than simply treating mental illness. Collectively, this Trauma-Informed approach along with maintaining cultural sensitivity is vital to the successful CFT interactions and positive treatment outcomes. To ensure our clinical staff is properly trained in Trauma-Informed care, we offer ongoing trainings in the areas of assessment of needs and behavior, diagnostics, evidence-based practices, as well as diversity and cultural sensitivity.

Section III. Assessment

This is a service that evaluates the current status of a resident’s mental, emotional, and behavioral health. Assessment includes the following: mental status determination, analysis of the resident’s relevant clinical history, analysis of relevant cultural issues, risk factors, indicators of functional impairment, developmental history, substance use (current & history), treatment history, current psychological/medical condition, legal history, trauma history, and diagnosis. Assessment data will be collected and treatment recommendations will be developed. This will allow collaboration with appropriate individuals and services that will support and help guide the youth/NMD on their path to enhanced self-sufficiency and mental health.

Section IV. Plan Development

A service that consists of development of client plans and approval of client plans. All of these services are conducted by Berhe clinicians.

Section V. Therapeutic Services

Therapeutic services are delivered by a Berhe professional clinician, and includes individual, family, and group therapy as needed. These services are designed to provide an increase in mental health wellness, improvement and maintenance of functioning consistent with the goals of learning, development, independent living and self- sufficiency.

Individual Therapy

This therapy refers to a service activity that is a therapeutic intervention that focuses primarily on symptom reduction as a means to improve individual functional impairments. Some examples include: (a) Exploring with the client how to handle disclosure or non-disclosure of the client’s mental problems; (b) Helping client learn stress management methods relating to community functioning; (c) Helping clients identify strengths/weaknesses regarding functioning in the community related to his mental disorder.

Individual Family Therapy

This therapy is a service activity that is a therapeutic intervention that focuses primarily on symptom reduction as a means to improve functional impairments of the individual in the context of their family. Therapy may be delivered to an individual or group of beneficiaries and may include family therapy at which the beneficiary is present.

Group Therapy

This therapy describes a service activity that is a therapeutic intervention that focuses primarily on symptom reduction as a means to improve functional impairments. Therapy may be delivered to an individual or group of beneficiaries and may include family therapy at which the beneficiary is present. If the group is one family, this is “Family-Group.” An example of Group Therapy: Group Therapy for more than one client together.

Rehab/ADL

Rehabilitation is a service activity which includes, but is not limited to assistance in improving, maintaining, or restoring a beneficiary’s or group of beneficiaries’ functional skills, daily living skills, social and leisure skills, grooming and personal hygiene skills, meal preparation skills, and support resources. and/or medication education. Some examples could include: (a) Helping client make appearance publicly acceptable; (b) Helping client understand job related requirements, such as timeliness and dependability; (c) Exploring with client how to handle disclosure or non disclosure of client’s mental problems; and (d) Helping child develop greater self-control and self management skills.

The rehabilitation component will also allow treatment staff to assist residents in many areas in an effort to restore or maintain functional skills, daily living skills, social skills, leisure time, grooming and personal hygiene skills, where an insufficiency in these areas prevent them from achieving normal development and social acceptance.

"Rehabilitation ADL (Counseling)” is defined as using the client's current traits and resources to help that person to feel better and/or overcome current problems, without purposely trying to change the client's basic personality features.

Section VI. Collateral

Collateral refers to a service activity to a significant support person in a beneficiary’s life for the purpose of meeting the needs of the beneficiary in terms of achieving the goals of the beneficiary’s client plan. Collateral may include but is not limited to: (a) Consultation and training of the significant support person(s) to assist in better utilization of specialty mental health services by the beneficiary; and (b) Consultation, and training of the significant support person(s) to assist in better understanding of mental illness. A service that involves a significant support person may include; the biological and foster parents, siblings, relatives, and support persons to assist the client in understanding his condition and needs. These individuals in the service plan may best assist the client in achieving their treatment goals. This service will be provided by any mental health services staff member operating within their scope of practice.

Section VII. Targeted Case Management

This means services that assist a beneficiary to access needed medical, educational, social, prevocational, vocational, rehabilitative, or other community services. The service activities may include, but are not limited to, communication, coordination, and referral: monitoring service delivery to ensure beneficiary access to service and the service delivery system;; monitoring of the beneficiary’s progress; and plan development. This service will be provided by The Berhe Group staff member operating within their scope of practice. All staff, including those providing Targeted Case Management Services are trained at new hire orientation and ongoing to provide trauma informed and culturally relevant services. The resident's initial assessment informs and guides the treatment team in making any program adjustments to ensure that services provided are culturally relevant, trauma informed and specific to each resident's need. The clinician, staff, resident, and other CFT members discuss and determine, based on the assessment, which specialty mental health services will be incorporated in the resident's treatment plan. Throughout treatment, clinical staff, discuss with the resident as part of the CFT any culturally relevant factors or preferences, including language preference.

Section VIII. Intensive Care Coordination (ICC)

This is a service that facilitates assessment of care planning for and coordination of services, including urgent services for EPSDT youth and the Katie A. Subclass members that are determined that would benefit from the service. An ICC Coordinator serves as the single point of accountability to: (a) Ensure that medically necessary services are accessed, coordinated, and delivered in a strength-based, individualized; family/youth driven and culturally and linguistically relevant manner and that services and supports are guided by the needs of the child/youth; (b) Facilitate a collaborative relationship among the child/youth, his/her family and involved child-serving systems; (c) Support the parent/caregiver in meeting their child/youth’s needs; (d) Help establish the child and family team (CFT) and provide ongoing support; (e) Organize and match care across providers and child serving systems to allow the child/youth to be served in his/her home community.

The Berhe Group ICC Coordinator assists the resident and the family in establishing objectives and plans that will support the progress towards their goals. Through the services provided the ICC Coordinator will regularly meet with the CFT to review the plan and discuss modifications. Inclusive in that plan will be a comprehensive assessment of the child and the family's strengths, needs and the development of individual care plans.

Section IX. Intensive Home Based Mental Health Services (IHBS)

Intensive home-based mental health services (IHBS) are mental health rehabilitation services provided to members of the Katie A. Subclass and EPSDT youth that are determined to benefit from the service. IHBS are individualized, strength-based interventions designed to ameliorate mental health conditions that interfere with a child/youth’s functioning and are aimed at helping the child/youth build skills necessary for successful functioning in the home and community and improving the child/youth’s family ability to help the child/youth successfully function in the home and community.

Section X. Medication Support Services

The Berhe Group uses the resources of one of the Department of Behavioral Health clinics that are responsible for the monitoring of resident’s medication that is necessary for the youth to achieve wellness. Berhe is also looking into the option of using our own internal Psychiatric care in the future. In the interim we continue to use the DBH clinics. Their operating hours are 8:00 am – 5:00 pm, daily. The DBH clinics in our area are:

• San Bernardino - Phoenix Community Counseling Center - 820 E. Gilbert Street, San Bernardino, California, 92415 - 1 (909) 387-7200

• Rialto - Mesa Counseling Center - 850 E. Foothill Boulevard, Rialto, California 92376 - 1 (909) 421-9301

• Fontana - Vista Community Counseling - 17053 E. Foothill Boulevard, Fontana, California, 92335 - 1 (909) 347- 1300

When a child is prescribed medication the following procedures shall be followed: (a) Resident(s) and caregiver(s) will be educated by the psychiatrist on the prescribed medications including the positive and negative effects; (b) No resident(s) is forced to take medication; (c) No consequences will be given for refusing to take prescribed medications; (d) Ongoing education/counseling is offered on the necessity of taking medications; (e) Resident(s) will have explained to them the risks of not taking the medications; (f) Every resident is evaluated by a psychiatrist once a month, or as needed, and (g) A copy of the following notes/documentation will be maintained in the residents’ Medi-Cal case file: (1) Interdisciplinary Treatment; (2) Medication recommendations; (3) Mental Status Examination, and (4) Psychotropic medication recommendations may be initiated by a clinician based on CANS-SB assessments, collateral reports, and information given in CFTMs.

Section XI. Crisis Intervention Services (CIS)

CIS is an immediate and short-term psychological care aimed at assisting youth/NMDs in a crisis situation in order to restore balance to their bio-psychosocial functioning and to minimize the potential of long-term psychological trauma. Crisis services are used by Berhe treatment staff when a child is displaying immediate danger to self-and/or others.

Section XII. Other Mental Health Services

The following are services that youth are entitled to, as medically indicated, but will not be provided by our program:

Intensive Day Treatment Services (IDT) 

“Day Treatment Intensive” means a structured multi-disciplinary program of therapy which may be an alternative to hospitalization, avoid placement in a more restrictive setting, or maintain placement in a more restrictive setting, or maintain the individual in a community setting which provides services to a distinct group of individuals.

Day Treatment Rehabilitation (DTR) 

Day Treatment Rehabilitation provides evaluation, rehabilitation, and therapy to maintain or restore personal independence and functioning consistent with the individual’s needs for learning and development. It is an organized and structured program that provides services to a distinct group of individuals identified to receive the service.

Therapeutic Behavioral Services (TBS) 

Therapeutic Behavioral Services (TBS) are one-to-one therapeutic contacts for a specified short-term period of time between a mental health provider and a child or youth who are with serious emotional disturbances (SED). TBS is designed to maintain the child/youth’s residential placement at the lowest appropriate level by resolving target behaviors and achieving short-term treatment goals.

Psychological Testing

If the need for psychological testing arises due to a complex diagnostic presentation or a lack of treatment progress, the decision to refer will be made in the CFT process. The Intensive Care Coordination Coordinator or the Clinical Director will consult with DBH-CYCS on possible referrals. The Child and Family Team will review and plan how to implement the results and the recommendations from the Psychological Testing Report. Psychological testing (includes psycho diagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI, Rorschach, WAIS). This may also include both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report. The Berhe residential unit, through a CFTM request, will contact DBH Children and Youth Collaborative Services and consult with them for the need for Psychological testing as needed.

When the Child and Family Team reviews the status of a youth and determines that the youth may benefit from any of these services, including IDT, DTR, and TBS, the ICC Coordinator will contact DBH Access line to arrange for an evaluation by that provider. The DBH Consumer Information: Access & Referral is available 24 hours a day, 7 days a week and can be reached by calling (888) 743-1478 or 711 for TTY users.