Youth Mental Health And Substance Use Disorder Continuum

**For all services described below, please see North Carolina DMA Clinical Coverage Policies, Behavioral Health section for complete service requirements.

The youth mental health and substance use disorder continuum of care is designed to meet the needs of individuals with a range of symptoms from mild symptoms and functional impairments to serious emotional disturbances and substance use disorders, for whom wraparound and residential supports are required to help achieve recovery and return to meaningful lives within their family and school support systems. This continuum includes specialized crisis services to assist with crisis stabilization when necessary. The appropriate level of care is to be selected by the clinician based upon community standards, level of care assessment tools (CALOCUS), and clinical coverage policy criteria. The continuum is composed of the following supports and services:​


  • Universal Supports consist of assistance and interventions generally available to anyone through their existing connections within his or her community. Universal Supports include:

    • Natural Supports, which include unpaid resources in the community that enhance and help sustain recovery. Examples are family members, governmental supports and non-profit community agencies.

    • Primary Medical Homes are a front door for the full range of medical issues, including mental health issues.

    • Prevention services are most commonly provided in school settings, but can be available in other settings to assist with preventing trauma and other stressors from leading to diagnosable mental health conditions.

       
  • Basic Services consist of specialty, office-based assessments, therapy, testing and medication management tailored to meet the diagnostic and treatment needs of those with mild to moderate mental illnesses. They can be used alone, in combination with each other, and can sometimes be used in combination with support, enhanced and residential services. Basic Services include:

    • Comprehensive Clinical Assessments: These assessments provide the groundwork for selecting the right service, in the right quantity and in the right setting. They should assure highly accurate diagnostic formulations and recommendations for both paid services and unpaid supports.

    • Basic Psychotherapies (individual, group and family): Evidence-based psychotherapies are the staple of the mental health system and offer time-limited, problem focused interventions by licensed clinicians.

    • Psychiatric Medication Management: Psychiatrists and other psychiatric prescribers provide specialized medication-based treatments for all ranges of adult mental health conditions. Medication management can be an essential component of any treatment plan and can be time-limited or long-term.

    • Psychological Testing: Licensed psychologist and psychological associates typically provide this service for those who need additional diagnostic and treatment recommendations and clarification after an initial assessment. There are a wide array of testing options available.

       
  • Support Services are typically add-on services which augment the basic service array and assist with treatment engagement and supporting community integration for those with more serious mental health conditions. Support Services within the Cardinal Innovations youth mental health and substance use disorder service array include:

    • Psychiatric Consultation: provides psychiatric consultation by telephone directly to primary care providers to assist them in managing behavioral health conditions in that setting.

    • Planned Respite services provide periodic support and relief to the primary caregiver(s) from the responsibility and stress of caring for youth. This service enables the primary caregiver to meet or participate in planned or emergency events, and to have planned time for him/her and/or family members. Respite may include in-home or out-of-home services, including overnight and weekend care. Emergency care (family emergency based, not to include out-of-home crisis) or continuous care up to 10 consecutive days is also available.

    • Transitional Living: This service is for youth up to the age of 21 who will be transitioning into independent living situations (e.g., out of foster care) and need support in acquiring; retaining; and improving self-help, socialization, and adaptive skills necessary to be successful. This service helps youth access the resources they need for transportation, housing, continuing education, and employment, with the ultimate goal of being able to reside successfully in home and community-integrated settings.

    • Supported Employment services provide assistance to members with behavioral health conditions as they choose and acquire a job and maintain employment.

 

  • Enhanced Services are typically community-based, team-led interventions with both therapeutic and case management components to assist members with more severe behavioral health conditions. Enhanced Services within the Cardinal Innovations youth mental health and substance use disorder service array include the following:

    • Intensive In-Home (IIH) is a time-limited (typically six-month) intervention performed by a team of professionals under the direction of a licensed clinician serving as team leader. IIH is available 24/7 to the youth and family who require intensive clinical interventions to address chronic symptoms, crisis episodes, and coordination with other services/support resources. The team uses a variety of clinical rehabilitative interventions based on the provider agency's selected evidence-based practice model.

    • Multisystemic Therapy (MST) is a nationally certified, evidence-based team treatment model designed for youth who have significant behavior problems and who frequently engage in willful misconduct and/or illegal activities. The goal of MST is to maintain the youth in his/her home using intensive therapeutic and rehabilitative interventions with the youth and his/her family within the home/school/community.

    • Child and Adolescent Day Treatment (DT) is a time-limited service with mental health or substance abuse interventions provided in the context of a therapeutic treatment milieu within a licensed facility, often integrated within a local school. Because these youth have difficulty making progress with traditional school-based services, the interventions are designed to achieve functional gains that support integration back into traditional educational settings. Individualized Education Plans (IEPs) and Behavior Intervention Plans must have been attempted by the local school before a member would be eligible for this service.

    • Substance Abuse Intensive Outpatient Program (SAIOP) – Structured similarly to the adult version, this service is available for adolescents with substance use disorders with an ASAM level of 2.1.

    • Partial Hospitalization is a short-term, intensive day program designed to prevent hospitalization or service as a step-down from an inpatient hospitalization for those with acute, severe mental health disorders.

       
  • Residential Services: Basic and enhanced behavioral health interventions for children and adolescents are designed to attempt to keep the member in his/her natural setting. At times, due to the severity of symptoms at presentation or due to failure of lower levels of care to stabilize the child's behavioral health condition, out-of-home placement may be necessary for safety and stabilization. Cardinal Innovations' health plan provides the following residential services for children and adolescents with more severe behaviors, including sexually aggressive behaviors:
    • Level I/Family Type: This level is similar to DSS (Department of Social Services) foster care, but with a behavioral health trained therapeutic parent figure in the home. Generally, Level I is used as a step-down from Level II/Family Type prior to the member returning to his/her natural environment. Support needs are minimal and the primary focus is on mentoring and behavioral interventions for mildly disruptive behaviors.

    • Level II/Family Type: This service is similar to foster care, but with a behavioral health trained therapeutic parent figure in the home. Generally, Level II is the first step for out-of-home placement if lower levels of care have failed, or as clinically indicated. It is the same as Level I, but at a higher intensity of therapeutic intervention, and can address more moderate to severe problems. Support needs for most life domains are expected.

      • Intensive Alternative Family Treatment (IAFT): IAFT is a specialized form of Level II/Family Type Therapeutic Foster Care. IAFT specializes in serving youth with particularly severe behavioral problems in an effort to prevent use of more restrictive levels of care. IAFT uses a one child per family ratio combined with specialized case management by the agency providing the service, including daily contact with foster care parents. The model also has psychiatric oversight and specialized crisis management.

    • Level II/Program Type: This service is similar to Level II/Family Type, but is in a group home setting rather than a family setting.

    • Level III: This service is in a group home setting and has 24/7 awake staff in a non-locked facility. Member behaviors are expected to be severe. There must be a constant need for direct supervision but without the need for a locked setting. Level III requires that a licensed therapist oversee care and provide therapy directly to youth at the facility.

    • Level IV: This services is a structured facility-based program setting with staff present and available at all times of the day, including overnight awake with a minimum of two staff per six residents. This level of care is rarely used in North Carolina.

    • Psychiatric Residential Treatment Facility (PRTF): This service is typically in a locked or staff-secure facility-based setting with low staff-to-consumer ratios and is intended for members with the most severe behaviors requiring 24/7 supervision and a locked environment, but who do not require inpatient hospitalization. Significant psychiatric oversight is expected and programming is highly structured.​

Members in out-of-home placements require monthly Child and Family Team (CFT) meetings attended by treatment, family, community and Cardinal Innovations staff. The meetings occur before and during residential treatment to increase the likelihood of a successful return home and to minimize the length of stay in a highly restrictive intervention.

  • Crisis Services​ are designed to address acute symptom exacerbations for those with behavioral health disorders in an effort to either avert an inpatient crisis admission or to facilitate such an admission. Crisis Services range from brief interventions provided by the member's existing provider to intensive 24/7 stabilization and treatment provided in an inpatient setting. The full range of crisis services can be found here