CLTS FS Instructions Module #4: Mental Health

Contents

4.1 Severe Emotional Disorders Diagnoses Summary
4.2 Is child currently an adjudicated delinquent?
4.3 Duration of Diagnosed Emotional Disability
4.4 Mental Health Symptoms/Minimum Frequency
4.5 Mental Health Services 
4.6 Rare and Extreme Conditions 


4.1 Severe Emotional Disorders Diagnoses Summary

This information listed here is pulled directly from the Diagnoses Page. This provides the screener an opportunity to confirm that they have selected the following mental health conditions for the child. The rest of the questions on this page refer to symptoms or needs directly related to these mental health diagnoses.

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4.2 Is child currently an adjudicated delinquent?

This question reflects long-standing policy to avoid cost shifting from the Department of Justice to the Family Support Program. If a child is an adjudicated delinquent, then the justice system is responsible for providing whatever assistance the child and family needs, and the child is not eligible for the Family Support Program. This includes youth being tried as adults.

"Adjudicated delinquent" means that a child-currently or within the past year-is or has been under supervision of the juvenile justice system because they violated the law, misbehaved, or posed a threat to others due to their conduct (Chapter 938 of Wisconsin State Statute). This does not include court orders for treatment, or a Child in Need of Protective Services (CHIPS) petition (Chapter 48 of Wisconsin State Statute).

The expanded clarifications below further define the applicability of "adjudicated delinquent" to the Family Support Program:

  1. The juvenile has been found as an "adjudicated delinquent" and is currently placed on a dispositional court order. The dispositional court order signed by a Judge means that a Judge determined that there is something the child must actively do, some change in behavior or self correction that will be reviewed at a later date. In addition, services may be ordered for the child whether or not the county system has adequate funding for such services. Services may include assigning a case worker to oversee the court order, as well as more involved services such as treatment, detention, out of home placement, etc.

  2. If a child has been given a ticket, charged a fine, required to complete restitution or community service they are not considered an "adjudicated delinquent." The child may have committed a crime and is under the supervision through a Deferred Prosecution Agreement (DPA), Consent Decree or Juvenile In need of Protective Services (JIPS), but these types of supervision do not meet the threshold of an "adjudicated delinquent." Even if the child has to return to court at a later date to document that they have not gotten into any further trouble, this does not rise to the definition of "adjudicated delinquent" unless the Judge finds the child violated the agreement and determines the child is now an "adjudicated delinquent." The Judge will then sign a dispositional court order and item 1 above applies.

If item 1 is true, then the child is an "adjudicated delinquent." If item 2 is true, then the child is not an "adjudicated delinquent." When meeting with the family, ask to see documents related to the crime and subsequent decision.

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4.3 Duration of Diagnosed Emotional Disability

If the child has a clinical diagnosis of an emotional disability, has the diagnosis, or symptoms related to that diagnosis, persisted for at least six months?

  • Yes
  • No
  • Child does not have an emotional disability

If the child has a clinical diagnosis of an emotional disability, is the disability expected to last a year or longer?

  • Yes
  • No

Many of the questions on this CLTS FS page reflect current duration requirements for a Psychiatric Level of Care (LOC). Note that the Autism Spectrum Disorders are Mental Health diagnoses; the screener may check this box for children with those diagnoses. These include Asperger's, Autism and Pervasive Developmental Disability. Likewise, ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder) are Mental Health diagnoses. All of these are diagnoses of an emotional disability and you must answer this question on this page for children with these diagnoses from a qualified professional (MD or Psychologist). Many people identify these diagnoses as developmental in nature. However, they are also considered a clinical mental health diagnosis and you must therefore answer this question accurately. Answering this question correctly will increase the likelihood of an appropriate functional eligibility determination for these children.

Regardless of the answer to these questions, complete the Mental Health section for every child who has a mental health diagnoses. In addition, if a child does not have a mental health diagnosis but is exhibiting mental health symptoms or receiving mental health services, the screener can indicate that on this page. Every question on this page relate directly to mental health issues or concerns.

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4.4 Mental Health Symptoms/Minimum Frequency

The minimal frequency of mental health and behavioral symptoms is lower than the criterion used for ADLs and IADLs. For the mental health symptoms, the screener should check the box if:

  • Child currently has symptoms as defined, or
  • Child had the symptoms as defined within the past three months, or
  • Child had the symptoms as defined at least twice in the past year.

Does child have any of the following symptoms? (Check all that apply and enter notes below)

  • Anorexia/ Bulimia - Life-threatening syptomology.
  • Psychosis - Serious mental illness with delusions and/or hallucinations.
  • Suicidality - Suicide attempt in past three months or significant suicidal ideation or plan in past month.
  • Violence - Life-threatening acts.

For Anorexia/Bulimia - Life-threatening Syptomology the effects of the eating disorders must include at least one of the following:

  • Malnutrition diagnosed by a physician.
  • Electrolyte imbalances diagnosed by a physician. Electrolytes are body salts like sodium, potassium and chloride.
  • Body weight or development below 20th percentile due to the eating disorder as determined by a physician.

For Anorexia or Bulimia and Psychosis, there should be a corresponding diagnosis in the Diagnosis table of the CLTS FS.

Psychosis occurs only with severe mental conditions resulting in loss of contact with reality through delusions or hallucinations. A delusion is defined to be a belief that is pathological (the result of an illness or illness process) and is held despite evidence to the contrary. A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. Hallucinations can occur in any sensory modality - visual, auditory, olfactory, tactile, and many others.

Violence is defined as life threatening acts that endanger another person's life. This life-threatening act must result in one of the following:

  • Cause other person to require hospitalization (does not include an ER visit).
  • Use of weapons against someone (e.g., gun, knife, chains, switch blade).
  • Arson (purposeful fire setting) or bomb threats.

If the behavior does not meet this requirement, the screener may be able to check one of the behaviors listed under the category: Aggressive or Offensive Behaviors on the Behavior Page of the CLTS FS.

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4.5 Mental Health Services

Does child currently require services from any of the following? (Check all that apply.)

  • Clinical Case Management and Service Coordination across Systems, this is case management or service coordination specifically for services rendered through the mental health system.

  • Criminal Justice System, this includes Juvenile and Adult Justice Systems.

  • Mental Health Services (check all that apply):
    • Psychiatric Medication checks with Psychiatrist or other Physician
    • Counseling Sessions with Psychologist or Licensed Clinical Social Worker
    • Inpatient Psychiatric Treatment
    • Day Treatment – either partial or full day
    • Behavioral Treatment for Children with Autism Spectrum Disorders under the supervision of a mental health professional
    • In Home Psychotherapy under the supervision of a mental health professional
       
    • If a child is participating in on-going treatment once they have completed the intensive program then treatment is only listed as Mental Health Services if the specific intervention is overseen by a psychiatrist or psychologist.
    • This excludes treatment for substance abuse only, which is captured below.

  • Substance Abuse Services, this includes day treatment and outpatient services.

  • In-school Supports for Emotional and/or Behavioral Problems
    "In-school supports" includes special education classes, one-on-one assistance, or a Behavioral Intervention Plan (BIP) in an Individualized Educational Plan (IEP). This is for emotional or behavioral problems; do not check it for children with only cognitive and/or physical disabilities.

    This item is checked in the following situations:
    -- Child has an Individualized Educational Plan (IEP) for Emotional/Behavioral Disorders (EBD) programming. This is not applicable if the support is only for issues related to focusing, staying on task or organization.
    -- Child has an active Behavioral Intervention Plan (BIP) in an Individualized Educational Plan (IEP).

    Sometimes children have behavioral plans that are essentially inactive because the child has not had the behavioral problems for a long time. If the child is not in special education classes and does not have one-on-one assistance, check this item only if the behavioral plan has actually been used. In this situation, check the box if interventions are needed at least three times per week. "Interventions" here means a school staff must verbally and/or physically provide or assist the child with behavioral controls. The staff person may have to interrupt or prevent the behavior, remove the child from the situation, or respond in ways to help the child cope and avoid harm. This does not include children who need to have someone help them to stay focused, stay on task or assistance to maintain organization in the classroom.

    Some children will have an item in their IEP that states that their behavior impedes his/her learning and/or the learning of others. This, by itself, is not enough evidence to select In School Supports for this child.

"Require" is based on the qualified, treating professional's recommendation that a specific service is essential to address the child's identified mental health need. The professional recommendation must be made within the past year. It cannot be solely based on parental desire for services. Most children who require these services will be receiving them, but on occasion a parent or child cannot, or will not, participate in recommended services or the recommended services are not available. If the parent or child has refused to access recommended services for over 12 months, then this recommendation is considered no longer valid.

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4.6 Rare and Extreme Conditions

These three conditions are rare and extreme and usually don't cause physical harm to the child or others. They are directly associated with mental health disorders and the child's ability to function throughout their day, every day, all day and night. They are usually not considered overt behaviors and are often better described as a lack of behavior or action. There are limited interventions because the condition appears to be a direct result of their mental health status. They are a measure of the severity of a child's mental health condition. Consideration needs to be given to these rare and extreme conditions as the severity of these circumstances is significant. The following three questions address these unique situations.

  • Does this child exhibit disruptive behaviors in structured settings on a daily basis that require redirection from an adult at a frequency of every 3 minutes or more often AND this behavior has been demonstrated consistently for the past 6 months (do not count summer months)? Disruptive behaviors may include sliding around a room in a chair, screaming out inappropriate words or phrases, sitting in the center of a room and refusing to move.
    • Yes
    • No

This question will only be answered in the affirmative in extremely rare situations. It is imperative that the screener confirm that the frequency of this disruptive behavior occurs "every 3 minutes or more often" all day, every day. The redirection must be for a disruptive behavior not simply lack of focus or off task behaviors. The disruptive behavior must be a direct result of their mental health condition. If a child has been removed from the regular classroom due to this behavior, check "no" unless they exhibit disruptive behaviors of this same intense frequency in alternative classrooms or school settings as well.

  • Does this child experience nightmares or night terrors at least 4 times a week AND this sleep interruption has been consistent for the past 6 months? These nightmares or night terrors must be characterized by repeated frightening episodes of intense anxiety that may be accompanied by screaming, crying, confusion, agitation, and/or disorientation.
    • Yes
    • No

All children may have nightmares or even the occasional night terror. This question is intended for the child who has these intense experiences at least 4 nights a week, for months. If the condition does not meet this frequency, then check "no" and describe the situation in the note section.

  • Is this child unable to complete routine events (hygiene tasks, leaving the house, walking on certain pavements, or sharing community equipment with others) throughout the day, every day, consistently for the past 6 months due to an obsession? An obsession is a thought, a fear, an idea, an image, or words that a child cannot get out of his/her mind. It does not include self stimulating or compulsive behaviors. The child experiencing the obsession must be aware of the obsession but not be able to control the influence of his/her own thought patterns.
    • Yes
    • No

In general, this question will be most appropriately answered in the affirmative if the child has a diagnosis of a severe Obsessive Compulsive Disorder or a severe Anxiety Disorder. Again, this is only going to be answered "yes" in rare and extreme cases. This does not apply to a child with sensory needs that cause them to engage in repetitive behaviors. Keep in mind that the question indicates that the child must be aware of the obsession but not be able to control the influence of their own thought pattern. They would be able to express their awareness of their own behavior and their desire to stop this behavior but an inability to due to their mental health condition.

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Last Revised: April 24, 2014
Wisconsin Department of Health Services
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