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Children's Therapeutic Supports & Services

Overview

CTSS are services for children who require varying therapeutic and rehabilitative levels of intervention to address conditions of mental illness or emotional disturbance that impair and interfere with development and functioning.

The goal of CTSS is to

  • restore a child or adolescent to an age-appropriate developmental trajectory that had been disrupted by a psychiatric illness;
  • enable the child to develop psychosocial skills; and
  • overcome deficits or maladaptive skills acquired over the course of a psychiatric illness.

CTSS begins with Psychotherapy services that identify areas for skill development and teach children skills. CTSS Skills Training are practitioner-delivered services that support the work of Psychotherapy in helping a child master the skills learned in the psychotherapy setting.

This guide is always under construction. Please check back soon for updates.

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What are Children's Therapeutic Supports and Services?

Children's Therapeutic Supports and Services, as described in the MHCP manual here, are:

Psychotherapy to address a child's underlying mental health disorder;

Skills Training to teach/reinforce behavioral and psychosocial skills developed and taught in psychotherapy;

and

Behavioral Aide services to practice, repeat, reintroduce and master these skills.

CTSS also includes Crisis Assistance services, described in more detail below to help the child, the child’s family and all providers of services to the child to successfully prepare for and prevent or respond to potential crises.

Referral and Eligibility

Children and young adults up to age 21 are eligible for CTSS. Generally, we would recommend ARMHS for young adults.

To be eligible for CTSS, recipients must:

Before CTSS services can begin, we must


Initiating Services and Start Date

Once all of the above are complete, initiate services immediately. Mark the Start Date for CTSS services for the child as the first date Skills Training services are providedm and change the status of the child in CTSS services directly to Active.

While assessment and planning is occurring, the status should remain Referral.

Assessment & Planning

Assessment and planning in CTSS is a child- and family-centered process that begins with the DA, but that continues with learning a child's current strengths. What does the child do well? Where is he or she succeeding? With whom, and in what environments are the child's functioning and behavior most optimal?

Identifying problems and possible delays in development, behavior and functioning is next. As with strengths, what differences exist in different environments?

Identifying both strengths and deficits, and environmental differences in behavior can give us insight into underlying causes for a child's behavior, and influences on functioning, and inform the treatment plan.

Functional Behavior Assessment

While not required for CTSS services, a Functional Behavior Assessment is a useful tool for identifying potential functions of an undesired behavior. The function of a behavior means, simply, what is the person attempting to achieve by demonstrating the undesirable behavior. By developing a hypothesis about the function, FBA is then used to identify an alternative, adaptive replacement skill a person might learn to meet the same need.

Standardized Outcome Measures for Children’s Mental Health

CASII and ECSII

While Minnesota Department of Human Services (DHS) no longer requires children’s mental health treatment providers to utilize the Child & Adolescent Service Intensity Instrument (CASII) or Early Childhood Service Intensity Instrument (ECSII) The CASII or ECSII remain useful assessments.

Lacking a better tool for determination of eligibility for CTSS, use the CASII or ECSII as a part of the Child DA to determine Level of Care. A service level rating of 3 or higher justifies CTSS.

Strengths and Difficulties Questionnaire

The Strengths and Difficulties Questionnaire (SDQ) is no longer required, but is an optional measure that may be helpful in some circumstances.The SDQ, asks the child's parents/caregivers, teachers, and children 11 years and older about their behavior and functioning.

Treatment Planning

Use the Child Intake Assessment and Plan for all new admissions.

Use the Integrated Child Service Plan for assembling subsequent CTSS Treatment Plans.

Either plan can be used for any combination of the following services:

*Child Psychotherapy is differentiated from CTSS Psychotherapy and is intended for children who are not CTSS-eligible.

Write goals and objectives using those tools, and make sure all goals and objectives you intend to put in the plan are approved. (CTSS Psychotherapy Goals and Objectives are developed in the CTSS service category, no longer in Child Pscychotherapy.)

To build the plan, navigate in the child's file to plan and review services > service plans. Enter an anticipated start date and then choose Template and then Integrated Child Service Plan.

Treatment Domains in CTSS

Take Note

It is the Department of Human Services position that treatment of other domains (e.g. hygiene and personal care, independent living skills, etc.) do not fall under the definition of CTSS and are not appropriate for treatment using this service, regardless if the reason the child lacks age-appropriate skills in these domains is tied to behavioral health conditions.

Domains for treatment in the CTSS Plan are:

Requirements and Deadlines for CTSS Assessment and Planning

Requirement Required Item Admission Requirement Update Required
Diagnostic Assessment Internal Standard or Extended DA
Review of External DA		 One year or less prior to admission Reviewed annually and a new DA conducted if identified by the conclusions of the review.
Treatment Plan Tabs Treatment Plan Prior to admission Every 6 months if reviewed every 2 months, and the review recommendation is to continue the plan as written.
Progress Review Integrated Child Service Plan Review None Every 60 days.

Service Delivery

What do CTSS Skills Training Look Like?

CTSS services should be characterized by practice and repitition of skills identified in the treatment plan and CTSS progress notes should reflect this.

As described in the MCHP Manual: Unlike a thought, feeling or perception, a skill is observable by others. It is an activity that must be practiced in order to be mastered and maintained. There are right ways and wrong ways to perform the skill. Typically, a skill is performed for a reason and a skill can be generalized and adapted to many different situations.

As such, using the specific resources, skills, techniques and methods in the Individual Treatment Plan, CTSS Behavior Aides and Practitioners identify the specific skills taught during the session, the child's response and success in demonstrating the skill.

Interventions during the CTSS session include: demonstrating or modeling a skill, prompting a child to complete a skill, providing feedback or correction on the skill, praising effort accomplishment. Avoid interventions during CTSS charactarized by exploring or processing feelings (although emotion-identification can be a skill), advising or coaching on relationships (although teaching a specific communication skill is appropriate), or other activities that resemble talk therapy.

What is CTSS Crisis Asistance?

Provide crisis assistance with prior approval from your Treatment Supervisor, Team Lead, or the Program Director. Crisis assistance is for the child, the child’s family and all providers of services to the child to:

Crisis assistance requires the development of a written plan that addresses prevention and intervention strategies in a potential crisis, including plans for:

Documenting CTSS Services

Assessment and Planning Activities

This work is to be done by mental health professionals and clinical trainees only.

Service Name Description of Activity Target Time
CTSS Standardized Outcome Measurement Activities associated with administering the CASII and ECSII if administered not associated with a Diagnostic Assessment. (Rare).
 Yes
CTSS Treatment Planning All treatment planning work completed in interviews or observation of children and/or their parents, Progress Review, and Treatment Plan writeup. Limit is 24 sessions per year. Yes

Child Psychotherapy

CTSS Pscyhotherapy is found in the separate "CTSS Psychotherapy" category. Use the folowing service types for child psychotherapy.

Service Name Use for Target Time
Psychotherapy CTSS
Psychotherapy EL Trainee CTSS		 All sessions. Tabs will determine the billing rate from the duration. Yes
Psychoeducation Family Providing Psychoeducation Services as defined above to family members. Use meeting type to identify if child was present. Yes
Psychotherapy Crisis Child Crisis psychotherapy as defined above. Yes
Family Psychotherapy CTSS Family psychotherapy Yes
Psychotherapy Group Child Group psychotherapy Yes
Psychotherapy Multi Family Child Group psychotherapy to families Yes

Child Psychotherapy Add-Ons

Use the folowing service types for add-ons to child psychotherapy.

Service Name Use For Target Time
Psychotherapy Child Int Complexity Interactive complexity as defined above No
Psychotherapy Crisis Extended Child Extending a crisis therapy session by 30 minutes or more. Yes
Psychotherapy Extended Child
Psychotherapy Extended Child by Trainee 		Extending a therapy session by 30 minutes or more. Yes
Therapy Travel Child Travel to a therapy session in a home or community-based setting. Yes

Skills Training and Behavioral Aide Services

Use the following service types to document CTSS Skills Training and Behavioral Aide services:

Service Name Use for: Target Time
CTSS Crisis Assistance Face-to-face work with children, their parents and family members to develop a crisis plan. Yes
CTSS Family Skills Training Face-to-face skills training with a child and family members, implementing a Family Skills Training objective from the child's Treatment Plan. Yes
CTSS in Hospital or Facility Face-to-face skills training with a child who is in a hospital or facility. *This is rare and requires prior-authorization. Yes
CTSS Skills Training Direct treatment services provided by a Mental Health Practitioner Yes
CTSS Skills Training Group Direct treatment services provided by a Mental Health Practitioner in a group setting of 3 to 8 children Yes

Other Miscellaneous Services and Notes (For Use by All Providers)

Service Name Use for: Target Time
CTSS - Cancellation By Provider Cancellation of a CTSS service by the provider staff. No
CTSS Client Initiated Cancellation Cancellation of or no-show for a CTSS service by a child or parent No
Therapy Child CCN Travel Travel to a cancelled therapy session in a home or community-based setting. No
CTSS Contact and Scheduling Calling or communicating with children or parents to arrange services/appointments No
CTSS File Note Making a note in a child's file No
Insurance Advocacy Assisting parents in maintaining health care insurance coverage for children. No
CTSS Service Coordination Coordination of treatment activities, including communicating with other providers of services to the child or parent/family by telephone, face-to-face, or or written communicaiton. No

Progress Review & Quality Assurance

Overall Quality Outcomes of CTSS Services

Overall quality in CTSS services is measured by these broad outcomes:

Progress Defined

Progress in CTSS services is defined as any of the following:

Progress Review

Per Mn Statute 245I: Every two months, a mental health professional must complete a case review of each client assigned to the mental health professional when the client is receiving clinical services from a mental health practitioner or clinical trainee. The case review must include a consultation process that thoroughly examines the client's condition and treatment, including: (1) a review of the client's reason for seeking treatment, diagnoses and assessments, and the individual treatment plan; (2) a review of the appropriateness, duration, and outcome of treatment provided to the client; and (3) treatment recommendations.

Our method to ensure quality, and compliance with this requirement is that Progress Reviews shall be required every two months. Provider staff shall complete a Progress Review that includes:

The supervising mental health professional will review and approve the Progress Review and discuss the case as necessary, or recommend changes to the plan, methods, etc. and an update to the Plan as necessary.

Updates to the Treatment Plan

CTSS treatment plans must be updated every six months or more often as determined necessary by the Progress Review. Updates must be based upon a review of progress on the previous plan. Where a child has made progress, but has not acheived the targets identified in the previous plan, it is acceptable to continue these objectives into the subsequent plan. Each time required assessments (Diagnostic, SDQ, or CASII/.ECSII are updated, consider the results of these assessments in the plan update as well.

Where a child has not made progress on the defined target outcomes in a previous plan, review the factors that may be impeding progress. These might include:

Make modifications to the plan to respond to any of the above.

Discharge Planning

Adminstrative Discharge

Administrative discharge from CTSS services should occur when:

Clinical Discharge

Clinical discharge from CTSS services should occur when:

Discharge Process

Follow these steps for all discharges:

  1. Complete a final discharge review, noting the reasons for discharge, cosigned by the supervision mental health professional.
  2. Meet with the family to make recommendations for and referrals to any other needed services and offer support with the transition. Document these in a final File or Service Coordination note.
  3. Change the child's status for CTSS in TabsTM to Previous, and identify the reason for discharge.

Feedback or Questions about this Chapter

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Questions, Feedback & Suggestions

Resources & References

MCHP Manual: CTSS

Mn Statute 245I

Updates to this Chapter


May 29, 2023:

SDQ clarified as an optional assessment.

Progress Review requirements updated to match 245I.

Resource added: link to Mn Statute 2451.


August 23, 2023:

Clarification of service types to use while documenting CTSS services, including Psychotherapy and Treatment Planning.


January 29, 2024:

Language added to use the CASII/ECSII during the child DA to determine eligiblity for CTSS.