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.