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 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 member’s 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.
4.2.6 The contractor shall notify
the Government Designated Authority (GDA) 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.