Description of the Basic Service Level

The Basic Service Level consists of a supportive setting, preferably in a family, that is designed to maintain or improve the child's functioning, including:

  • Routine guidance and supervision to ensure the child's safety and sense of security;
  • Affection, reassurance, and involvement in activities appropriate to the child's age and development to promote the child's well-being;
  • Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child to maintain a sense of identity and culture; and
  • Access to therapeutic, habilitative, and medical intervention and guidance from professionals or paraprofessionals, on an as-needed basis, to help the child maintain functioning appropriate to the child's age and development.

Characteristics of a child who needs Basic Services

A child needing basic services is capable of responding to limit-setting or other interventions.

The children needing basic services may include:

  • A child whose characteristics include one or more of the following:
    • Transient difficulties and occasional misbehavior;
    • Acting out in response to stress, but episodes of acting out are brief; and
    • Behavior that is minimally disturbing to others, but the behavior is considered typical for the child's age and can be corrected.
  • A child with intellectual or developmental disabilities whose characteristics include minor to moderate difficulties with conceptual, social, and practical adaptive skills.

Description of the Moderate Service Level

  • The Moderate Service Level consists of a structured supportive setting, preferably in a family, in which most activities are designed to improve the child's functioning including:
    • More than routine guidance and supervision to ensure the child's safety and sense of security;
    • Affection, reassurance, and involvement in structured activities appropriate to the child's age and development to promote the child's well-being;
    • Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child to maintain a sense of identity and culture; and
    • Access to therapeutic, habilitative, and medical intervention and guidance from professionals or paraprofessionals to help the child attain or maintain functioning appropriate to the child's age and development.
  • In addition to the description in subsection (a) of this section, a child with primary medical or habilitative needs may require intermittent interventions from a skilled caregiver who has demonstrated competence.

Characteristics of a child who needs Moderate Services

A child needing moderate services has problems in one or more areas of functioning. The children needing moderate services may include:

  • A child whose characteristics include one or more of the following:
    • Frequent non-violent, anti-social acts;
    • Occasional physical aggression;
    • Minor self-injurious actions; and
    • Difficulties that present a moderate risk of harm to self or others.
  • A child who abuses alcohol, drugs, or other conscious-altering substances whose characteristics include one or more of the following:
    • Substance abuse to the extent or frequency that the child is at-risk of substantial problems; and
    • A historical diagnosis of substance abuse or dependency with a need for regular community support through groups or similar interventions.
  • A child with intellectual or developmental disabilities whose characteristics include:
    • Moderate to substantial difficulties with conceptual, social, and practical adaptive skills to include daily living and self-care; and
    • Moderate impairment in communication, cognition, or expressions of affect.
  • A child with primary medical or habilitative needs, whose characteristics include one or more of the following:
    • Occasional exacerbations or intermittent interventions in relation to the diagnosed medical condition;
    • Limited daily living and self-care skills;
    • Ambulatory with assistance; and
    • Daily access to on-call, skilled caregivers with demonstrated competence.

Description of the Specialized Service Level

  • The Specialized Service Level consists of a treatment setting, preferably in a family, in which caregivers have specialized training to provide therapeutic, habilitative, and medical support and interventions including:
    • 24-hour supervision to ensure the child's safety and sense of security, which includes close monitoring and increased limit setting;
    • Affection, reassurance, and involvement in therapeutic activities appropriate to the child's age and development to promote the child's well-being;
    • Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child to maintain a sense of identity and culture; and
    • Therapeutic, habilitative, and medical intervention and guidance that is regularly scheduled and professionally designed and supervised to help the child attain functioning appropriate to the child's age and development.
  • In addition to the description in subsection (a) of this section, a child with primary medical or habilitative needs may require regular interventions from a caregiver who has demonstrated competence.

Characteristics of a child that needs the Specialized Services

A child needing specialized services has severe problems in one or more areas of functioning. The children needing specialized services may include:

  • A child whose characteristics include one or more of the following:
    • Unpredictable non-violent, anti-social acts;
    • Frequent or unpredictable physical aggression;
    • Being markedly withdrawn and isolated;
    • Major self-injurious actions to include recent suicide attempts; and
    • Difficulties that present a significant risk of harm to self or others.
  • A child who abuses alcohol, drugs, or other conscious-altering substances whose characteristics include one or more of the following:
    • Severe impairment because of the substance abuse; and
    • A primary diagnosis of substance abuse or dependency.
  • A child with intellectual or developmental disabilities whose characteristics include one or more of the following:
    • Severely impaired conceptual, social, and practical adaptive skills to include daily living and self-care;
    • severe impairment in communication, cognition, or expressions of affect;
    • Lack of motivation or the inability to complete self-care activities or participate in social activities;
    • Inability to respond appropriately to an emergency; and
    • Multiple physical disabilities including sensory impairments.
  • A child with primary medical or habilitative needs whose characteristics include one or more of the following:
    • Regular or frequent exacerbations or interventions in relation to the diagnosed medical condition;
    • Severely limited daily living and self-care skills;
    • Non-ambulatory or confined to a bed; and
    • Constant access to on-site, medically skilled caregivers with demonstrated competencies in the interventions needed by children in their care.

Description of the Intense Service Level

  1. The Intense Service Level consists of a high degree of structure, preferably in a family, to limit the child's access to environments as necessary to protect the child. The caregivers have specialized training to provide intense therapeutic and habilitative supports and interventions with limited outside access, including:
    1. 24-hour supervision to ensure the child's safety and sense of security, which includes frequent one-to-one monitoring with the ability to provide immediate on-site response.
    2. Affection, reassurance, and involvement in therapeutic activities appropriate to the child's age and development to promote the child's well-being;
    3. Contact, in a manner that is deemed in the best interest of the child, with family members and other persons significant to the child, to maintain a sense of identity and culture;
    4. Therapeutic, habilitative, and medical intervention and guidance that is frequently scheduled and professionally designed and supervised to help the child attain functioning more appropriate to the child's age and development; and
    5. Consistent and frequent attention, direction, and assistance to help the child attain stabilization and connect appropriately with the child's environment.
  2. In addition to the description in subsection (a) of this section, a child with intellectual or developmental disabilities needs professionally directed, designed and monitored interventions to enhance mobility, communication, sensory, motor, and cognitive development, and self-help skills.
    (c) In addition to the description in subsection (a) of this section, a child with primary medical or habilitative needs requires frequent and consistent interventions. The child may be dependent on people or technology for accommodation and require interventions designed, monitored, or approved by an appropriately constituted interdisciplinary team.

Characteristics of a child that needs Intense Services

A child needing intense services has severe problems in one or more areas of functioning that present an imminent and critical danger of harm to self or others. The children needing intense services may include:

  • a child whose characteristics include one or more of the following:
    • Extreme physical aggression that causes harm;
    • Recurring major self-injurious actions to include serious suicide attempts;
    • Other difficulties that present a critical risk of harm to self or others; and
    • Severely impaired reality testing, communication skills, cognitive, affect, or personal hygiene.
  • A child who abuses alcohol, drugs, or other conscious-altering substances whose characteristics include a primary diagnosis of substance dependency in addition to being extremely aggressive or self-destructive to the point of causing harm.
  • A child with intellectual or developmental disabilities whose characteristics include one or more of the following:
    • Impairments so severe in conceptual, social, and practical adaptive skills that the child's ability to actively participate in the program is limited and requires constant one-to-one supervision for the safety of self or others; and
    • A consistent inability to cooperate in self-care while requiring constant one-toone supervision for the safety of self or others.
  • A child with primary medical or habilitative needs that present an imminent and critical medical risk whose characteristics include one or more of the following:
    • Frequent acute exacerbations and chronic, intensive interventions in relation to the diagnosed medical condition;
    • Inability to perform daily living or self-care skills; and
    • 24-hour on-site, medical supervision to sustain life support.

Description of the Intense-Plus Service Level

The Intense-Plus Service Level is only available in Residential Treatment Centers and consists of a high degree of structure to support the child in his or her environment while intervening as necessary to protect the child. The caregivers have specialized training specific to the child’s characteristics. The therapists on staff have professional licensure or graduate level education to provide therapeutic services, intense therapeutic supports and interventions, including:

  • 24-hour supervision to ensure the child's safety and sense of security, including constant one-to-one monitoring during waking hours by an employee trained on the child’s therapeutic interventions and able to provide immediate on site response.
  • Participation in individual and group therapy sessions that are research-supported, reimbursable by Medicaid, and readily available in the community. These include but are not limited to specialized therapies such as Eye Movement Desensitization and Reprocessing Therapy, Applied Behavior Analysis (certified), Treatment for Anorexia/Bulimia/Eating Disorders, and others as appropriate.
  • Use therapeutic programs that are documented as either well supported, supported, promising practice or evidence based and are appropriate to the child's age and development to promote the child's well-being. Therapy must address trauma and the behaviors resulting in the need for Intense-Plus level of care.
  • Contact, in a manner that is deemed in the best interest of the child, with siblings, family members, and other persons significant to the child in order to maintain a sense of identity and culture.
  • Services to help the child learn or improve skills and functioning for daily living.
  • Medical intervention and therapy that is structured daily, and professionally designed and supervised to help the child attain functioning more appropriate to the child's age and development and to address the behaviors resulting in the need for Intense-Plus services.
  • Consistent and constant direction, intervention, and structured support to help the child attain stabilization and connect appropriately with the child's environment.
  • Professionally directed, designed, and monitored interventions for a child with intellectual or developmental disabilities, to enhance mobility, communication, sensory, motor, cognitive development, behavioral and self-help skills.

Characteristics of a child that needs Intense-Plus Services

A child needing Intense-Plus services has severe problems in two or more areas of functioning that present an extreme, imminent and critical danger of harm to self or others. The children needing intense-plus services may include:

  • A child whose characteristics may include more than one of the following:
  • has extreme and reoccurring episodes of physical aggression that causes harm;
  • has extreme and reoccurring episodes of sexually aggressive behaviors;
  • has assaultive, homicidal, suicidal, recurring major self-injurious actions;
  • has chronic runaway behaviors;
  • has severely impaired reality testing, communication skills, and cognition.
  • A child who abuses alcohol, drugs, or other conscious-altering substances whose characteristics include a primary diagnosis of substance dependency or abuse in addition to being extremely aggressive or self-destructive to the point of causing harm.
  • A child who has eating disorders causing concerns for health and well-being.
  • A child with intellectual or developmental disabilities whose characteristics include one or more of the following:
  • impairments so extreme in conceptual, social, and practical adaptive skills that the child's ability to actively participate in the program is limited and requires constant one-to-one supervision for the safety of self or others; and
  • a consistent inability or unwillingness to cooperate in self-care while requiring, constant one-to-one supervision for the safety of self or others;
  • A child who is actively psychotic and has acted out on the psychosis.
  • A child who is a survivor of human or sex trafficking.
  • A child who has chronic criminal behaviors that result in current or recent involvement with the justice system.
  • A child who has displayed animal cruelty in the last 90 days.