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FAQs for Professionals

1.      What are the referral criteria for admission to the Day Treatment Program for very young children?

     

        The Day Treatment Center (partial hospital) referral criteria reflect the criteria for admission into partial hospitalization for other populations, modified to reflect symptoms in young children. These are:

 

·         Age 18 months through the end of the 8th year of age

 

·         Significant social-emotional functional impairment in at least one of three major environmental settings: home, “school,” or/and while out in the community. This means that the child is struggling to be successful in key relationships (parent/child, teacher/child, peer/child). It is not unusual for a child to be experiencing severe difficulty in one functional setting, but not others.

  

·         Is at risk of, or has lost “vocational” placement due to behavior. For young children, this means that the child may soon lose, or has been suspended or expelled from day care, preschool, early grade school, foster care or parental care. The child’s behavior may or may not be affecting the child’s grades.

  

·         Has failed, or is likely to fail, outpatient or other lower level intervention services secondary to frequency or intensity of behavior.

 

·         Child may or may not yet have been identified with a psychiatric diagnosis. As part of its process for determining appropriate level of treatment, Positive Leaps performs a complete bio-psycho-social assessment and mental status examination to identify underlying mental health problems.

  

·         The child is not significantly developmentally delayed or intellectually challenged.

 

·         The child is not medically fragile.

 

·         The child atypically misbehaves. That is, the child misbehaves in ways that are developmentally inappropriate, or the frequency, intensity and duration of behaviors are indicative of emotional distress:

 

o   Physical aggression (hits, kicks, punches, scratches, throws objects, overturns furniture, intentionally destroys property)

 

o   Verbal aggression (cursing, swearing, screaming, yelling, threatening, name calling)

 

o   Spitting, biting

 

o   Tantrums

 

o   Poor peer relations

 

o   Bossy and controlling

 

o   Defiant, oppositional, non-compliant with adult directive

 

o   Indiscriminate sociability

  

o   Poor impulse control

 

o   Violent play themes

 

o   Symptoms of severe ADHD (impulsivity, inattentiveness, hyperkinesia)

 

o   Angry, irritable, labile

 

o   Anxious

 

o   Depressed

 

o   Stealing, hoarding

 

o   Sleep problems

 

o   At-risk behavior, such as removing safety restraints in automobile, running and hiding while in public, or running from day care/preschool/school/home.

 

2.      How do I make a referral to Positive Leaps?

 

Referral to Positive Leaps could not be easier. Call Sheree at 513-777-2428 Option 3, with the name of the child and parent and contact information. So you can complete your own referral plan, Sheree will let you know when your client makes contact with Positive Leaps, the mental health assessment date, and admission date.

 

3.      Will I receive information regarding my client’s progress?

 

Assuming your client signs a Release of Information, Positive Leaps will provide medical and mental health professionals with care coordination services. Positive Leaps will forward to you the child’s plan of treatment, called an Individualized Service Plan, every thirty days or sooner if the document is revised sooner. The ISP contains treatment goals and summary of progress toward treatment goals. At your request, Positive Leaps will also share the Bio-Psycho-Social Assessment and Mental Status Exam. At discharge, a Discharge Summary will also be provided to you. Typically, these documents come to your office by means of our secure fax machine.

 

4.      What are the Goals of the Day Treatment Center at Positive Leaps?

 

Positive Leaps Day Treatment Center program goals are to prevent the need for inpatient treatment, to prevent development of later antisocial behavior, and to improve the probability of future success in three major functional domains: home, school, and community.  Day treatment also will optimize the successful transition of a child from a more restrictive setting (e.g. in-patient psychiatric hospital) to day treatment, the next less restrictive level of care, or from Day Treatment to Out Patient treatment), and the successful reintegration of a child into a typical setting .

Objectives of our day treatment program are to:

·         Provide early intervention, intensive, mental health treatment services to children and their families

·         Employ evidence-based treatment modalities, with fidelity to the researched model

·         Monitor program integrity and assess program outcomes

 

In short, Positive Leaps seeks to eliminate or significantly decrease symptoms of presenting mental health problems, increase social competencies, and reintegrate children back into their home, school, preschool, or child care program.

 

5.      What are the criteria for discharge from Day Treatment?

 

Each child receiving treatment services in the Day Treatment Center will have an Individualized Treatment Plan (aka Individualized Service Plan) that addresses their educational, functional, psychological, social and physical needs. Discharge from the program will be recommended when the goals of an ISP have been successfully met and the treatment team (including the parent) is in agreement that the child is prepared to successfully transition to the placement identified in the discharge/transition plan developed at admission. The discharge/transition plan is reviewed on a weekly basis. In addition to the identified treatment goals, standard discharge goals for children and parents include: Parent self-report of a child’s improved functioning at home and in the community, as evidenced by the responses on the Child Behavior Checklist and the Parent Daily Behavior Summary; and parent’s demonstration of working successfully with their child, as documented through Family Therapy. Children are not considered ready for discharge until the child has met and maintained goals for the elimination of aggression or other at-risk behaviors, and measured competence in developmentally appropriate pro-social skills.

 

6.      What theoretical foundations form the basis for the Methods used at Positive Leaps?

 

Positive Leaps programs are based on two theoretical perspectives. Bio-ecological and social interactional theory provides the foundation for the program treatment interventions. Bio-ecological theory (Bronfenbrenner, 1977, 2005) provides an understanding of the individual, peer, family, community, and societal influences on children’s daily functioning. Social interactional theory (Patterson, Reid, & Dishion, 1992) emphasizes the influence of adult and peer interactions on children’s acquisition of prosocial skills, and establishes the basis for changing interactions to influence the social behavior of clients, and improve functional impairment.

 

Following functional analysis of behavior (Baggett & Carta, 2006; Derby et al, 1992; Derby, et al 1992; Freeman et al, 2002), the Day Treatment Program focuses on building behavioral competencies through a combination of intensive verbal reinforcement (Maag, 2001), modeling (Bandura & McDonald, 1963), problem solving and prosocial skill instruction (Gresham, Sugai, & Horner, 2001), and a contingency-based system (Axelrod, 1971; Christopherson, Arnold, Hill, & Quilitch, 1972; Wolf, Giles, & Hall, 1968).

  

A time-out hierarchy is used to respond to attention-maintained inappropriate behavior (e.g. Larzelere & Kuhn, 2005). Social skill development is a critical program component, and begins with the skills of accepting negative and positive consequences from adults, and continues with building adaptive replacement skills that are based on skill deficits specified by the parent, and confirmed through functional assessment of behavior by Positive Leaps professional staff, and subsequently identified in each child’s Individualized Treatment Plan (aka Individualized Service Plan or ISP).

  

 Positive Leaps also employs Pivotal Response Treatment, an intervention model derived from ABA approaches, which targets pivotal areas of developmental need, such as motivation and self-management, and includes the use of child play and intentful reward using natural reinforcers to decrease disruptive behavior. (Baker-Ericzen, et al, 2007).

 

7.      Do parents participate in treatment at Positive Leaps?

 

Yes, as mental health professionals, we understand that children are part of a family system, and in order to achieve successful and sustained improvements to client functioning, it is critical that parents participate in their child’s treatment. For this reason, parents commit to engaging in Family Therapy at least once weekly, for an hour. Parents are asked to commit to learning and employing the Methods we teach at home and when out in the community with their child. Parents are also asked to commit to assuring their child attends Day Treatment five days weekly, for a minimum of eight hours daily. The rationale for this attendance requirement rests in outcome data related to empirical treatment methodologies employed at Positive Leaps.

 

Family Therapy is conducted by licensed pediatric therapists consisting of a treatment encounter between the client, the nuclear and/or extended family and the Therapist. Family sessions focus on the family as a system, and include a comprehensive assessment. The objective of Family Therapy is to increase the functional level of the identified client (the child) and all family members.

 

8.      Does Positive Leaps provide medication management?

 

Positive Leaps employs a board-certified pediatric psychiatrist. The psychiatrist provides consultation and medication management to children in need of psychotropic medications. Positive Leaps administers prescribed medications to children during the day, under the order of a licensed prescriber.

 

9.      I am referring a school-aged child to Positive Leaps. Do you work with his school?

 

Positive Leaps collaborates with an admitted child’s school. Schools send a child’s school work to Positive Leaps, where the child completes his school work. The school work is returned to the school for credit. Positive Leaps welcomes visits by school personnel at any time. During transition back to school, Positive Leaps invites the child’s school to a Planning Meeting, to discuss the transition process, and to plan for support services to facilitate a successful return to school. Schools that have not yet toured Positive Leaps are invited to email Sheree to schedule a tour at slynch@positiveleaps.org

 

10.  What is the mean length of stay in Day Treatment?

 

Positive Leaps’ mean length of stay is consistent with, or less than that, of other Day Treatment (partial hospital) programs, using similar treatment modalities, targeted to early childhood populations with severe behavior. Our mean length of stay is 72 to 85 treatment days.

 

11.  What are the predictors of long-term success of children successfully discharged from Day Treatment?

 

Predictors of a child’s long term success following successful completion of Day Treatment include, but may not be limited to, the following variables:

·         Regular and active parental participation in Family Therapy sessions during treatment.

·         Parental consistency in application of Methods taught during Family Therapy

·         Parent follow-through with Out Patient therapy, following discharge

·         Behavior management skill set of child care providers caring for child or school teacher behavior management skill set.

   
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