What Is “Mental Health Treatment”?

As parents resolving divorce or paternity issues attempt to state precisely their intent about “mental health treatment” for their child, definitions may guide their Florida collaborative practice team and them.

Florida Juvenile Justice System – Techniques That Constitute “Mental Health Treatment” of Children

For prevention, early intervention, control, and rehabilitative treatment of delinquent behavior, Florida Administrative Code, Rule 63N-1.0081 is among regulations implementing the Florida juvenile justice system, Chapter 985, Florida Statutes. Rule 63N-1.0081 lists techniques that constitute “mental health treatment” of children, including Individual therapy or counseling, group therapy or counseling, family counseling or therapy, behavior therapy, psychosocial skills training, and juvenile sexual offender therapy and treatment:

(a) Individual therapy or counseling, which is one-to-one counseling between a youth with a diagnosed Mental Disorder and a Licensed Mental Health Professional or a Mental Health Clinical Staff Person working under the direct supervision of a Licensed Mental Health Professional. Individual counseling or therapy shall be a planned and structured face-to-face therapy session designed to address the youth’s symptoms and accomplish the goals and objectives in the youth’s Initial or Individualized Mental Health Treatment Plan. Individual counseling or therapy shall be based on evidence-based therapy models such as cognitive behavioral therapy, reality therapy, gestalt therapy or rational emotive therapy, or identified as promising practices in published quantitative research showing positive outcomes and demonstrated effectiveness in mental health treatment.

(b) Group therapy or counseling, which is an assembly of youths who have a diagnosed Mental Disorder and a Licensed Mental Health Professional or a Mental Health Clinical Staff Person working under the direct supervision of a Licensed Mental Health Professional for the purpose of using the emotional interactions of members of the group to help them get relief from distressing symptoms and to modify their behavior.

1. Group therapy/counseling shall be a planned and structured face-to-face therapy session designed to address the youths’ symptoms and accomplish the goals and objectives in the youths’ Initial or Individualized Mental Health Treatment Plans.

2. Group therapy/counseling shall be based on evidence-based treatment models such as cognitive behavioral therapy, reality therapy, gestalt therapy or rational emotive therapy and evidence-based curricula or curricula identified as promising practices in published quantitative research showing positive outcomes and demonstrated to be effective in mental health treatment.

3. Group therapy/counseling provided in DJJ residential commitment programs designated for Specialized Treatment Services shall not exceed a group size of 10 youths with mental health diagnoses.

(c) Family counseling or therapy, which is an assembly of a youth with acute or chronic Mental Disorder, his/her family members such as the youth’s parents or guardians and siblings, and a Licensed Mental Health Professional or a Mental Health Clinical Staff Person working under the direct supervision of a Licensed Mental Health Professional for the purpose of improving the youth’s and family’s functioning in areas which appear to impact his/her Mental Disorder. Family counseling or therapy must be based on effective treatment approaches such as family systems therapy, functional family therapy and multi-systemic therapy or identified as promising practices in published quantitative research showing positive outcomes and demonstrated to be effective in family counseling.

(d) Behavior therapy, which is a mode of treatment provided by a Licensed Mental Health Professional or a Mental Health Clinical Staff Person working under the direct supervision of a Licensed Mental Health Professional, for the purpose of modifying the behavior of a youth with a diagnosed Mental Disorder by assisting him/her in learning new, more acceptable and adaptable forms of behavior.

1. Behavior therapy shall be designed to address the effects of the youth’s symptoms on his/her behavior and accomplish the goals and objectives in the youth’s Individualized Mental Health Treatment Plan.

2. Behavior Analysis Services must be provided by a Licensed Mental Health Professional, Board Certified Behavior Analyst or Certified Behavior Analyst.

(e) Psychosocial Skills Training, which is a face-to-face therapeutic activity designed to address specific skill deficits or maladaptive behaviors and promote skill development and improved functioning of youths with Mental Disorder. Psychosocial Skills Training must be provided by a Licensed Mental Health Professional or a Mental Health Clinical Staff Person working under the direct supervision of a Licensed Mental Health Professional. Psychosocial Skills Training must address the specific deficits or maladaptive behaviors identified in the youth’s Initial of Individualized Mental Health Treatment Plan.

(f) Juvenile sexual offender therapy and juvenile sexual offender treatment shall be conducted, managed or supervised in accordance with Sections 490.012(8) or 491.012(1)(n), Florida Statutes.

Requirements for “mental health treatment services” include:

  1. Mental health treatment services must be provided by a Licensed Mental Health Professional or a Mental Health Clinical Staff Person working under the direct supervision of a Licensed Mental Health Professional. – Fla. Admin. Code R.  63N-1.0081(1)
  2. Mental health treatment services must be based on the youth’s symptoms and DSM diagnosis(Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association) identified by:
  • a Comprehensive Assessment, as defined in Fla. Admin. Code R. 63D-8.001. – See Fla. Admin. Code R. 63N-1.002(14), also defined in section 985.03(11), Florida Statutes as, “the gathering of information for the evaluation of a juvenile offender’s or a child’s physical, psychological, educational, career and technical education, and social condition and family environment as they relate to the child’s need for rehabilitative and treatment services, including substance abuse treatment services, mental health services, developmental services, literacy services, medical services, family services, and other specialized services, as appropriate.”
  • a Comprehensive Mental Health Evaluation or updated Comprehensive Mental Health Evaluation, which is an in-depth assessment conducted by a Licensed Mental Health Professional or a non-licensed Mental Health Clinical Staff Person working under the direct supervision of a Licensed Mental Health Professional to determine the presence of, or nature and complexity of, a Mental Disorder. – See Fla.Admin. Code R. 63N-1.002(15).
  • Mental health treatment services must seek to reduce the youth’s symptoms of Mental Disorder (See Fla. Admin. Code R. 63N-1.002(50)) and the negative effects of symptoms on the youth’s behavior and accomplish the measurable goals and objectives specified in the youth’s Initial or Individualized Mental Health Treatment Plan (See Fla. Admin. Code R. 63N-1.002(34) and (36)). The Mental Treatment Plan is a written guide which contains goals and objectives of mental health treatment and structures the focus of a youth’s ongoing mental health treatment, including treatment with Psychotropic Medication, defined as “Medications capable of affecting the mind, emotions and behavior that are used to treat mental illness. The medications, include, but are not limited to the following major categories: antipsychotics, antidepressants, antianxiety drugs, mood stabilizers and stimulants.” – See Fla. Admin. Code R. 63N-1.002(69).

Definition of “Mental Illness” under the Florida Mental Health Act (Baker Act)

The Florida Mental Health Act (also known as The Baker Act), section 394.455(28), Florida Statutes, covers involuntary mental health examination and placement for persons with mental illness. The Act defines “mental illness”:

Mental illness” means an impairment of the mental or emotional processes that exercise conscious control of one’s actions or of the ability to perceive or understand reality, which impairment substantially interferes with the person’s ability to meet the ordinary demands of living. For the purposes of this part, the term does not include a developmental disability as defined in chapter 393, intoxication, or conditions manifested only by antisocial behavior or substance abuse.

Definition of “Mental Health Services” under the Florida Community Substance Abuse and Mental Health Services Act

Florida’s Community Substance Abuse and Mental Health Services Act, section 394.67(15), Florida Statutes defines “Mental health services”:

Mental health services” means those therapeutic interventions and activities that help to eliminate, reduce, or manage symptoms or distress for persons who have severe emotional distress or a mental illness and to effectively manage the disability that often accompanies a mental illness so that the person can recover from the mental illness, become appropriately self-sufficient for his or her age, and live in a stable family or in the community. The term also includes those preventive interventions and activities that reduce the risk for or delay the onset of mental disorders. The term includes the following types of services:

(a) Treatment services, such as psychiatric medications and supportive psychotherapies, which are intended to reduce or ameliorate the symptoms of severe distress or mental illness.

(b) Rehabilitative services, which are intended to reduce or eliminate the disability that is associated with mental illness. Rehabilitative services may include assessment of personal goals and strengths, readiness preparation, specific skill training, and assistance in designing environments that enable individuals to maximize their functioning and community participation.

(c) Support services, which include services that assist individuals in living successfully in environments of their choice. Such services may include income supports, social supports,housing supports, vocational supports, or accommodations related to the symptoms or disabilities associated with mental illness.

(d) Case management services, which are intended to assist individuals in obtaining the formal and informal resources that they need to successfully cope with the consequences of their illness. Resources may include treatment or rehabilitative or supportive interventions by both formal and informal providers. Case management may include an assessment of client needs; intervention planning with the client, his or her family, and service providers; linking the client to needed services; monitoring service delivery; evaluating the effect of services and supports; and advocating on behalf of the client.

Mental health services may be delivered in a variety of settings, such as inpatient, residential, partial hospital, day treatment, outpatient, club house, or a drop-in or self-help center, as well as in other community settings, such as the client’s residence or workplace. The types and intensity of services provided shall be based on the client’s clinical status and goals, community resources, and preferences. Services such as assertive community treatment involve all four types of services which are delivered by a multidisciplinary treatment team that is responsible for identified individuals who have a serious mental illness.

How might parents and the collaborative practice team consider and use these definitions when creating a workable parenting plan for the family?  The next section gives example language the team might consider.

⇒ Next: Example Language for Collaborative Practice Team Using Definitions of “Mental Health”

⇐ Previous: Collaborative Process: Clarifying Parents’ Intent About “Mental Health Treatment”

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