4.2 Special Considerations Involving Partial Hospitalization
and Residential Treatment Center (RTC) Care.
4.2.1 Family Therapy involving Partial Hospitalization
and RTC Admissions. In accordance with the appropriate medical care
standard, discharge planning should start with the day of admission.
The goal should be to restore the patient’s ability to function
in one or more major life activities. In the case of a child under
age 21, the environment to which the patient is to be discharged
is a major consideration. To be authorized, RTCs and partial hospitalization
programs are required to address the feasibility of family therapy
as part of the treatment plan.
4.2.1.1 Standards. A compliance requirement of the
RTC standards (see
32 CFR 199.4(b)(4)(vii)) and the partial hospitalization
standards is that the admission process must include the family’s
(or responsible relative’s or legal guardian’s) understanding of
residential or partial hospitalization treatment and of their involvement
in treatment as well as the probable Length-of-Stay (LOS) of the patient.
The RTC standards dictate that if the patient is not returning to
the family, appropriate documentation in the clinical record should
indicate the type of preparation made with other persons who will
be involved with the patient upon discharge. The RTC and partial
hospitalization standards require that all specific therapeutic
modalities be spelled out in the treatment plan, including family therapy.
4.2.1.2 Under the accrediting
body’s standards by an accrediting organization approved by the Director,
Defense Health Agency (DHA), a specific plan for
involving the family in the treatment plan, when indicated. There
is also a requirement that the patient’s record shall contain documentation
of family members involvement in the patient’s treatment program.
If appropriate, a separate record may need to be maintained on each
family member involved in the patient’s treatment program.
4.2.2 Detailed Description of Family Therapy in Treatment
Plan. Family therapy is an integral part of the treatment of children
and adolescents and should be included in all mental health treatment plans
unless circumstances exist which make such treatment contraindicated.
Treatment plans must provide rationale
for why such therapy is not being provided. In all cases, this is
an issue subject to medical review, dependent on the needs of the
individual patient.
4.2.3 Family is Geographically Distant from the Child.
If the family is not in the area, the patient may not be a candidate
for partial care as individuals in this program return to their
home setting daily, and effective family interaction is essential.
If an RTC accepts a child for admission whose parents are geographically
distant, the facility must document its plans for including the
family in therapy, in accord with RTC standards and the appropriate
medical care standard. If one or both parents reside a minimum of
250 miles from the RTC, the RTC has the flexibility of setting up
therapy with the parents at the distant locality, while the child
is in treatment in the RTC.
Additionally, the RTC
may elect to provide family therapy via Telemedicine in accordance
with existing Telemedicine requirements (see Section 22.1). The
parent’s therapist and child’s therapist must collaborate in all
cases. Collaboration between therapists is the responsibility of
the RTC and must be documented in the medical records.
4.2.4 Geographical distance of the patient’s family
is not considered an appropriate reason to exclude the family from
the treatment plan. By accepting a child for admission, the RTC
or Partial Hospitalization Program (PHP) is acknowledging that it
can provide the specific treatment appropriate to the individual
child’s needs and is responsible for taking only those children
whom it feels it can help through the development of an appropriate
treatment program designed to maximize the patient’s ability to
function in one or more major life activities.
4.2.5 Circumstances Where Family Therapy is Inappropriate.
If family therapy is inappropriate due to the particular circumstances
of the case, supporting documentation and rationale must be provided
in the treatment plan. An example of such circumstances might include
not returning to the family unit following treatment. Authorization
shall be denied for RTC care if the
patient’s treatment plan does not address the provision of family
therapy. The contractor shall notify the DHA via the TRICARE
Regional Office (TRO) if it finds that a facility’s treatment planning
demonstrates a pattern of failure to provide for family therapy,
as this constitutes a violation of the standards and may reflect domiciliary
care.