Navigating the Confusing World of Behavioral Health Levels of Care

Are you overwhelmed with medical and insurance jargon? Finding the right mental health services – while also navigating insurance coverage – can be an extremely complex process for anyone. However, for parents and guardians of children, understanding and accessing mental health services for children can be even more challenging. It’s important that parents and guardians understand the different child therapy levels of care, also known as “Behavioral Health Levels of Care.”

This article will provide a basic breakdown of the different types of mental health services for children. Insurance companies and mental health service providers use the terms described below, so understanding the jargon (and the acronyms) is helpful when making decisions about mental healthcare for kids.

Kid having a temper tantrum requiring specific behavioral health levels of care in Cincinnati Ohio

What are the Different Behavioral Health Levels of Care?

For insurance claims, there are 5 main types of mental health services for children:

  1. Outpatient Services
  2. Intensive Outpatient Program (IOP)
  3. Partial Hospitalization Program (PHP)
  4. Residential Treatment (RTC)
  5. Inpatient Hospitalization

Let’s discuss each of these in more detail.

Teen Counseling as part of mental health services for children

1. Outpatient Services for Children

Outpatient services for children, also known as outpatient therapy, are the least invasive and least intensive level of care. A therapist, psychologist, or counselor typically provides mental health outpatient services in a professional office or telehealth setting. For example, if your child or teenager sees a therapist once a week, this would be considered outpatient therapy.

Outpatient services can include individual therapy, family group therapy, medication management, psychoeducation, or specialized therapeutic services. People usually start by participating in outpatient therapy for 1 to 2 hours per week, but it should never exceed 9 hours per week.

Positive Leaps’s child and teen counseling services at our Eastgate and West Chester locations are considered Outpatient Therapy. These services are covered by most major insurance and Medicaid.

2. Intensive Outpatient Program (IOP):

Intensive outpatient services (IOP) for children refer to a more structured, frequent mental health support model. IOP for children takes place within 3-4 group sessions per week, for 3 hours each session. How many weeks or months a child or teen may participate in IOP services is based on the child’s individualized medical and/or clinical needs (medical necessity criteria) and assessed via clinical assessments facilitated by the treating therapist, counselor, or psychologist.

IOP for children requires at least 9 to a maximum of 12 hours per week. Parents whose children are participating in IOPs should be prepared to support their child’s active engagement in the process.

Positive Leaps has two different Day Treatment Programs: a Daily Program and a Part-Time program. Positive Leaps’ Part-Time Day Treatment program is considered an IOP for children. It is covered by most major insurances and Medicaid. The Part-Time Day Treatment service provides children aged 3-8 years with specialized care at our Day Treatment facility in West Chester 2 to 4 times a week. During this program, Positive Leaps professional child behavior specialists teach children emotional regulation, social skills, and how to improve their communication skills.

Happy kids in Positive Leaps specialized daycare is an IOP for children or a PHP for children based in West Chester Ohio

3. Partial Hospitalization Program (PHP)

Partial Hospitalization Programs (PHP) refer to a higher level of care than the outpatient and intensive outpatient models. PHP for children and adolescents typically includes 20-30 hours per week of individual and group support. Depending on the provider, these services are usually provided 5-6 days per week for 5-6 hours per day.

Positive Leaps’ Daily Day Treatment program is considered a PHP for children. It provides clinical support and educational services to children aged 3-8 throughout the day. This Daily program is offered five days a week, eight hours a day, and is covered by most major insurance.

4. Residential Treatment (RTC)

Residential treatment refers to services provided to children and teenagers in a 24/7 monitored facility. In order for this level of mental health services for children to be covered by insurance, medical necessity must be established by a treating practitioner. Typically, residential treatment programs are designed for children and teens who suffer from severe and chronic mental health diagnoses, behavioral disorders, and/or complex trauma. Residential programs aim to provide children and teens with a safe and structured learning and healing environment.

This is one of the more intensive child therapy levels of care. In RTC, the child or teen will temporarily reside at the residential treatment location while receiving services. The typical amount of time spent in a residential treatment program can vary by child. It can range from weeks to months, depending on the severity and symptomology of the diagnosis and the subsequent support needed. Residential treatment services include 24/7 monitoring and support, up to 8 hours per day of group, individual, and educational interventions, psychiatric support, medication management, and crisis intervention.

5. Inpatient Hospitalization

Inpatient hospitalization is the highest intensity level of care in mental health services for children and teens. Inpatient hospitalization programs provide emergency stabilization services to children and teenagers who have an immediate and/or imminent risk of self-harm or of harming others. Inpatient hospitalization services are provided in a secure hospital setting, with 24-hour-a-day monitoring and support. Inpatient hospitalization programs offer therapeutic, educational, psychiatric, medication management, and recreational support throughout the hospital stay.

Most children and adolescents only remain in an inpatient hospitalization program for a short period of time (often a matter of a few days). Once assessed and medically stabilized, clients are then referred to a lower level of care (RTC, PHP, IOP) to continue receiving behavioral health interventions and support.

Ultimately, choosing the right level of care for your child or teenager requires careful consideration of their needs, diagnosis, symptomology, history, and desired outcomes. Families should actively engage and collaborate with the treating practitioner during the treatment process. Treatment is most impactful when children have continued support and buy-in to the process across every area of their lives. To ensure the best outcomes, parents and guardians should ask about the treatment planning process (such as “What will my child be working on in therapy?”), the case management support, and the discharge planning process.

If your child or teen requires outpatient therapy, or if your child aged 3-8 needs IOP or PHP care, Positive Leaps can help! We provide a full range of mental health services for children and teens to help them succeed, and we accept most major insurance and Medicaid. Reach out to us today!

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