1998 Minnesota Statutes

     245.4871 Definitions. 

    Subdivision 1.    Definitions.  The definitions in this 
 section apply to sections 245.487 to 245.4888. 

    Subd. 2.    Acute care hospital inpatient treatment.  
 "Acute care hospital inpatient treatment" means short-term 
 medical, nursing, and psychosocial services provided in an acute 
 care hospital licensed under chapter 144.  

    Subd. 3.    Case management services.  "Case management 
 services" means activities that are coordinated with the family 
 community support services and are designed to help the child 
 with severe emotional disturbance and the child's family obtain 
 needed mental health services, social services, educational 
 services, health services, vocational services, recreational 
 services, and related services in the areas of volunteer 
 services, advocacy, transportation, and legal services.  Case 
 management services include assisting in obtaining a 
 comprehensive diagnostic assessment, if needed, developing a 
 functional assessment, developing an individual family community 
 support plan, and assisting the child and the child's family in 
 obtaining needed services by coordination with other agencies 
 and assuring continuity of care.  Case managers must assess and 
 reassess the delivery, appropriateness, and effectiveness of 
 services over time.  

    Subd. 4.    Case manager.  (a) "Case manager" means an 
 individual employed by the county or other entity authorized by 
 the county board to provide case management services specified 
 in subdivision 3 for the child with severe emotional disturbance 
 and the child's family.  A case manager must have experience and 
 training in working with children. 

    (b) A case manager must: 

    (1) have at least a bachelor's degree in one of the 
 behavioral sciences or a related field from an accredited 
 college or university; 

    (2) have at least 2,000 hours of supervised experience in 
 the delivery of mental health services to children; 

    (3) have experience and training in identifying and 
 assessing a wide range of children's needs; and 

    (4) be knowledgeable about local community resources and 
 how to use those resources for the benefit of children and their 
 families. 

    (c) The case manager may be a member of any professional 
 discipline that is part of the local system of care for children 
 established by the county board. 

    (d) The case manager must meet in person with a mental 
 health professional at least once each month to obtain clinical 
 supervision. 

    (e) Case managers with a bachelor's degree but without 
 2,000 hours of supervised experience in the delivery of mental 
 health services to children with emotional disturbance must: 

    (1) begin 40 hours of training approved by the commissioner 
 of human services in case management skills and in the 
 characteristics and needs of children with severe emotional 
 disturbance before beginning to provide case management 
 services; and 

    (2) receive clinical supervision regarding individual 
 service delivery from a mental health professional at least once 
 each week until the requirement of 2,000 hours of experience is 
 met. 

    (f) Clinical supervision must be documented in the child's 
 record.  When the case manager is not a mental health 
 professional, the county board must provide or contract for 
 needed clinical supervision. 

    (g) The county board must ensure that the case manager has 
 the freedom to access and coordinate the services within the 
 local system of care that are needed by the child. 

    (h) Until June 30, 1999, an immigrant who does not have the 
 qualifications specified in this subdivision may provide case 
 management services to child immigrants with severe emotional 
 disturbance of the same ethnic group as the immigrant if the 
 person:  

    (1) is actively pursuing credits toward the completion of a 
 bachelor's degree in one of the behavioral sciences or related 
 fields at an accredited college or university; 

    (2) completes 40 hours of training as specified in this 
 subdivision; and 

    (3) receives clinical supervision at least once a week 
 until the requirements of obtaining a bachelor's degree and 
 2,000 hours of supervised experience are met. 

    (i) The commissioner may approve waivers submitted by 
 counties to allow case managers without a bachelor's degree but 
 with 6,000 hours of supervised experience in the delivery of 
 services to children with severe emotional disturbance if the 
 person: 

    (1) meets the qualifications for a mental health 
 practitioner in subdivision 26; 

    (2) has completed 40 hours of training approved by the 
 commissioner in case management skills and in the 
 characteristics and needs of children with severe emotional 
 disturbance; and 

    (3) demonstrates that the 6,000 hours of supervised 
 experience are in identifying functional needs of children with 
 severe emotional disturbance, coordinating assessment 
 information and making referrals to appropriate service 
 providers, coordinating a variety of services to support and 
 treat children with severe emotional disturbance, and monitoring 
 to ensure appropriate provision of services.  The county board 
 is responsible to verify that all qualifications, including 
 content of supervised experience, have been met. 

    Subd. 5.    Child.  "Child" means a person under 18 
 years of age.  

    Subd. 6.    Child with severe emotional disturbance.  
 For purposes of eligibility for case management and family 
 community support services, "child with severe emotional 
 disturbance" means a child who has an emotional disturbance and 
 who meets one of the following criteria: 

    (1) the child has been admitted within the last three years 
 or is at risk of being admitted to inpatient treatment or 
 residential treatment for an emotional disturbance; or 

    (2) the child is a Minnesota resident and is receiving 
 inpatient treatment or residential treatment for an emotional 
 disturbance through the interstate compact; or 

    (3) the child has one of the following as determined by a 
 mental health professional:  

    (i) psychosis or a clinical depression; or 

    (ii) risk of harming self or others as a result of an 
 emotional disturbance; or 

    (iii) psychopathological symptoms as a result of being a 
 victim of physical or sexual abuse or of psychic trauma within 
 the past year; or 

    (4) the child, as a result of an emotional disturbance, has 
 significantly impaired home, school, or community functioning 
 that has lasted at least one year or that, in the written 
 opinion of a mental health professional, presents substantial 
 risk of lasting at least one year.  

    The term "child with severe emotional disturbance" shall be 
 used only for purposes of county eligibility determinations.  In 
 all other written and oral communications, case managers, mental 
 health professionals, mental health practitioners, and all other 
 providers of mental health services shall use the term "child 
 eligible for mental health case management" in place of "child 
 with severe emotional disturbance." 

    Subd. 7.    Clinical supervision.  "Clinical supervision"
 means the oversight responsibility for individual treatment 
 plans and individual mental health service delivery, including 
 that provided by the case manager.  Clinical supervision does 
 not include authority to make or terminate court-ordered 
 placements of the child.  Clinical supervision must be 
 accomplished by full-time or part-time employment of or 
 contracts with mental health professionals.  The mental health 
 professional must document the clinical supervision by cosigning 
 individual treatment plans and by making entries in the client's 
 record on supervisory activities. 

    Subd. 8.    Commissioner.  "Commissioner" means the 
 commissioner of human services.  

    Subd. 9.    County board.  "County board" means the 
 county board of commissioners or board established under the 
 joint powers act, section 471.59, or the human services board 
 act, sections 402.01 to 402.10.  

    Subd. 9a.    Crisis assistance.  "Crisis assistance" 
 means assistance to the child, the child's family, and all 
 providers of services to the child to:  recognize factors 
 precipitating a mental health crisis, identify behaviors related 
 to the crisis, and be informed of available resources to resolve 
 the crisis.  Crisis assistance requires the development of a 
 plan which addresses prevention and intervention strategies to 
 be used in a potential crisis.  Other interventions include:  
 (1) arranging for admission to acute care hospital inpatient 
 treatment; (2) crisis placement; (3) community resources for 
 follow-up; and (4) emotional support to the family during 
 crisis.  Crisis assistance does not include services designed to 
 secure the safety of a child who is at risk of abuse or neglect 
 or necessary emergency services. 

    Subd. 10.    Day treatment services.  "Day treatment," 
 "day treatment services," or "day treatment program" means a 
 structured program of treatment and care provided to a child in: 

    (1) an outpatient hospital accredited by the joint 
 commission on accreditation of health organizations and licensed 
 under sections 144.50 to 144.55; 

    (2) a community mental health center under section 245.62; 

    (3) an entity that is under contract with the county board 
 to operate a program that meets the requirements of section 
 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 
 9505.0475; or 

    (4) an entity that operates a program that meets the 
 requirements of section 245.4884, subdivision 2, and Minnesota 
 Rules, parts 9505.0170 to 9505.0475, that is under contract with 
 an entity that is under contract with a county board. 

    Day treatment consists of group psychotherapy and other 
 intensive therapeutic services that are provided for a minimum 
 three-hour time block by a multidisciplinary staff under the 
 clinical supervision of a mental health professional.  The 
 services are aimed at stabilizing the child's mental health 
 status, and developing and improving the child's daily 
 independent living and socialization skills.  Day treatment 
 services are distinguished from day care by their structured 
 therapeutic program of psychotherapy services.  Day treatment 
 services are not a part of inpatient hospital or residential 
 treatment services.  Day treatment services for a child are an 
 integrated set of education, therapy, and family interventions. 

    A day treatment service must be available to a child at 
 least five days a week throughout the year and must be 
 coordinated with, integrated with, or part of an education 
 program offered by the child's school. 

    Subd. 11.    Diagnostic assessment.  "Diagnostic 
 assessment" means a written evaluation by a mental health 
 professional of: 

    (1) a child's current life situation and sources of stress, 
 including reasons for referral; 

    (2) the history of the child's current mental health 
 problem or problems, including important developmental 
 incidents, strengths, and vulnerabilities; 

    (3) the child's current functioning and symptoms; 

    (4) the child's diagnosis including a determination of 
 whether the child meets the criteria of severely emotionally 
 disturbed as specified in subdivision 6; and 

    (5) the mental health services needed by the child. 

    Subd. 12.    Mental health identification and intervention 
 services.  "Mental health identification and intervention 
 services" means services that are designed to identify children 
 who are at risk of needing or who need mental health services 
 and that arrange for intervention and treatment. 

    Subd. 13.    Education and prevention services.  (a) 
 "Education and prevention services" means services designed to: 

    (1) educate the general public and groups identified as at 
 risk of developing emotional disturbance under section 245.4872, 
 subdivision 3; 

    (2) increase the understanding and acceptance of problems 
 associated with emotional disturbances; 

    (3) improve people's skills in dealing with high-risk 
 situations known to affect children's mental health and 
 functioning; and 

    (4) refer specific children or their families with mental 
 health needs to mental health services.  

    (b) The services include distribution to individuals and 
 agencies identified by the county board and the local children's 
 mental health advisory council of information on predictors and 
 symptoms of emotional disturbances, where mental health services 
 are available in the county, and how to access the services. 

    Subd. 14.    Emergency services.  "Emergency services" 
 means an immediate response service available on a 24-hour, 
 seven-day-a-week basis for each child having a psychiatric 
 crisis, a mental health crisis, or a mental health emergency.  

    Subd. 15.    Emotional disturbance.  "Emotional 
 disturbance" means an organic disorder of the brain or a 
 clinically significant disorder of thought, mood, perception, 
 orientation, memory, or behavior that: 

    (1) is listed in the clinical manual of the International 
 Classification of Diseases (ICD-9-CM), current edition, code 
 range 290.0 to 302.99 or 306.0 to 316.0 or the corresponding 
 code in the American Psychiatric Association's Diagnostic and 
 Statistical Manual of Mental Disorders (DSM-MD), current 
 edition, Axes I, II, or III; and 

    (2) seriously limits a child's capacity to function in 
 primary aspects of daily living such as personal relations, 
 living arrangements, work, school, and recreation.  

    "Emotional disturbance" is a generic term and is intended 
 to reflect all categories of disorder described in DSM-MD, 
 current edition as "usually first evident in childhood or 
 adolescence." 

    Subd. 16.    Family.  "Family" means a child and one or 
 more of the following persons whose participation is necessary 
 to accomplish the child's treatment goals:  (1) a person related 
 to the child by blood, marriage, or adoption; (2) a person who 
 is the child's foster parent or significant other; (3) a person 
 who is the child's legal representative.  

    Subd. 17.    Family community support services.  "Family 
 community support services" means services provided under the 
 clinical supervision of a mental health professional and 
 designed to help each child with severe emotional disturbance to 
 function and remain with the child's family in the community.  
 Family community support services do not include acute care 
 hospital inpatient treatment, residential treatment services, or 
 regional treatment center services.  Family community support 
 services include:  

    (1) client outreach to each child with severe emotional 
 disturbance and the child's family; 

    (2) medication monitoring where necessary; 

    (3) assistance in developing independent living skills; 

    (4) assistance in developing parenting skills necessary to 
 address the needs of the child with severe emotional 
 disturbance; 

    (5) assistance with leisure and recreational activities; 

    (6) crisis assistance, including crisis placement and 
 respite care; 

    (7) professional home-based family treatment; 

    (8) foster care with therapeutic supports; 

    (9) day treatment; 

    (10) assistance in locating respite care and special needs 
 day care; and 

    (11) assistance in obtaining potential financial resources, 
 including those benefits listed in section 245.4884, subdivision 
 5. 

    Subd. 18.    Functional assessment.  "Functional 
 assessment" means an assessment by the case manager of the 
 child's:  

    (1) mental health symptoms as presented in the child's 
 diagnostic assessment; 

    (2) mental health needs as presented in the child's 
 diagnostic assessment; 

    (3) use of drugs and alcohol; 

    (4) vocational and educational functioning; 

    (5) social functioning, including the use of leisure time; 

    (6) interpersonal functioning, including relationships with 
 the child's family; 

    (7) self-care and independent living capacity; 

    (8) medical and dental health; 

    (9) financial assistance needs; 

    (10) housing and transportation needs; and 

    (11) other needs and problems.  

    Subd. 19.    Individual family community support plan.  
 "Individual family community support plan" means a written plan 
 developed by a case manager in conjunction with the family and 
 the child with severe emotional disturbance on the basis of a 
 diagnostic assessment and a functional assessment.  The plan 
 identifies specific services needed by a child and the child's 
 family to: 

    (1) treat the symptoms and dysfunctions determined in the 
 diagnostic assessment; 

    (2) relieve conditions leading to emotional disturbance and 
 improve the personal well-being of the child; 

    (3) improve family functioning; 

    (4) enhance daily living skills; 

    (5) improve functioning in education and recreation 
 settings; 

    (6) improve interpersonal and family relationships; 

    (7) enhance vocational development; and 

    (8) assist in obtaining transportation, housing, health 
 services, and employment.  

    Subd. 20.    Individual placement agreement.  
 "Individual placement agreement" means a written agreement or 
 supplement to a service contract entered into between the county 
 board and a service provider on behalf of a child to provide 
 residential treatment services.  

    Subd. 21.    Individual treatment plan.  "Individual 
 treatment plan" means a written plan of intervention, treatment, 
 and services for a child with an emotional disturbance that is 
 developed by a service provider under the clinical supervision 
 of a mental health professional on the basis of a diagnostic 
 assessment.  An individual treatment plan for a child must be 
 developed in conjunction with the family unless clinically 
 inappropriate.  The plan identifies goals and objectives of 
 treatment, treatment strategy, a schedule for accomplishing 
 treatment goals and objectives, and the individuals responsible 
 for providing treatment to the child with an emotional 
 disturbance. 

    Subd. 22.    Legal representative.  "Legal 
 representative" means a guardian, conservator, or guardian ad 
 litem of a child with an emotional disturbance authorized by the 
 court to make decisions about mental health services for the 
 child.  

    Subd. 23. Repealed, 1991 c 94 s 25 

    Subd. 24.    Local system of care.  "Local system of 
 care" means services that are locally available to the child and 
 the child's family.  The services are mental health, social 
 services, correctional services, education services, health 
 services, and vocational services.  

    Subd. 25.    Mental health funds.  "Mental health funds" 
 are funds expended under sections 245.73 and 256E.12, federal 
 mental health block grant funds, and funds expended under 
 sections 256D.06 and 256D.37 to facilities licensed under 
 Minnesota Rules, parts 9520.0500 to 9520.0690. 

    Subd. 26.    Mental health practitioner.  "Mental health 
 practitioner" means a person providing services to children with 
 emotional disturbances.  A mental health practitioner must have 
 training and experience in working with children.  A mental 
 health practitioner must be qualified in at least one of the 
 following ways:  

    (1) holds a bachelor's degree in one of the behavioral 
 sciences or related fields from an accredited college or 
 university and has at least 2,000 hours of supervised experience 
 in the delivery of mental health services to children with 
 emotional disturbances; 

    (2) has at least 6,000 hours of supervised experience in 
 the delivery of mental health services to children with 
 emotional disturbances; 

    (3) is a graduate student in one of the behavioral sciences 
 or related fields and is formally assigned by an accredited 
 college or university to an agency or facility for clinical 
 training; or 

    (4) holds a master's or other graduate degree in one of the 
 behavioral sciences or related fields from an accredited college 
 or university and has less than 4,000 hours post-master's 
 experience in the treatment of emotional disturbance. 

    Subd. 27.    Mental health professional.  "Mental health 
 professional" means a person providing clinical services in the 
 diagnosis and treatment of children's emotional disorders.  A 
 mental health professional must have training and experience in 
 working with children consistent with the age group to which the 
 mental health professional is assigned.  A mental health 
 professional must be qualified in at least one of the following 
 ways:  

    (1) in psychiatric nursing, the mental health professional 
 must be a registered nurse who is licensed under sections 
 148.171 to 148.285 and who is certified as a clinical specialist 
 in child and adolescent psychiatric or mental health nursing by 
 the American nurses association or who has a master's degree in 
 nursing or one of the behavioral sciences or related fields from 
 an accredited college or university or its equivalent, with at 
 least 4,000 hours of post-master's supervised experience in the 
 delivery of clinical services in the treatment of mental 
 illness; 

    (2) in clinical social work, the mental health professional 
 must be a person licensed as an independent clinical social 
 worker under section 148B.21, subdivision 6, or a person with a 
 master's degree in social work from an accredited college or 
 university, with at least 4,000 hours of post-master's 
 supervised experience in the delivery of clinical services in 
 the treatment of mental disorders; 

    (3) in psychology, the mental health professional must be a 
 psychologist licensed under sections 148.88 to 148.98 who has 
 stated to the board of psychology competencies in the diagnosis 
 and treatment of mental disorders; 

    (4) in psychiatry, the mental health professional must be a 
 physician licensed under chapter 147 and certified by the 
 American board of psychiatry and neurology or eligible for board 
 certification in psychiatry; 

    (5) in marriage and family therapy, the mental health 
 professional must be a marriage and family therapist licensed 
 under sections 148B.29 to 148B.39 with at least two years of 
 post-master's supervised experience in the delivery of clinical 
 services in the treatment of mental disorders or emotional 
 disturbances; or 

    (6) in allied fields, the mental health professional must 
 be a person with a master's degree from an accredited college or 
 university in one of the behavioral sciences or related fields, 
 with at least 4,000 hours of post-master's supervised experience 
 in the delivery of clinical services in the treatment of 
 emotional disturbances. 

    Subd. 28.    Mental health services.  "Mental health 
 services" means at least all of the treatment services and case 
 management activities that are provided to children with 
 emotional disturbances and are described in sections 245.487 to 
 245.4888. 

    Subd. 29.    Outpatient services.  "Outpatient services" 
 means mental health services, excluding day treatment and 
 community support services programs, provided by or under the 
 clinical supervision of a mental health professional to children 
 with emotional disturbances who live outside a hospital.  
 Outpatient services include clinical activities such as 
 individual, group, and family therapy; individual treatment 
 planning; diagnostic assessments; medication management; and 
 psychological testing.  

    Subd. 30.    Parent.  "Parent" means the birth or 
 adoptive mother or father of a child.  This definition does not 
 apply to a person whose parental rights have been terminated in 
 relation to the child. 

    Subd. 31.    Professional home-based family treatment.  
 "Professional home-based family treatment" means intensive 
 mental health services provided to children because of an 
 emotional disturbance (1) who are at risk of out-of-home 
 placement; (2) who are in out-of-home placement; or (3) who are 
 returning from out-of-home placement.  Services are provided to 
 the child and the child's family primarily in the child's home 
 environment.  Services may also be provided in the child's 
 school, child care setting, or other community setting 
 appropriate to the child.  Services must be provided on an 
 individual family basis, must be child-oriented and 
 family-oriented, and must be designed using information from 
 diagnostic and functional assessments to meet the specific 
 mental health needs of the child and the child's family.  
 Examples of services are:  (1) individual therapy; (2) family 
 therapy; (3) client outreach; (4) assistance in developing 
 individual living skills; (5) assistance in developing parenting 
 skills necessary to address the needs of the child; (6) 
 assistance with leisure and recreational services; (7) crisis 
 assistance, including crisis respite care and arranging for 
 crisis placement; and (8) assistance in locating respite and 
 child care.  Services must be coordinated with other services 
 provided to the child and family.  

    Subd. 32.    Residential treatment.  "Residential 
 treatment" means a 24-hour-a-day program under the clinical 
 supervision of a mental health professional, in a community 
 residential setting other than an acute care hospital or 
 regional treatment center inpatient unit, that must be licensed 
 as a residential treatment program for children with emotional 
 disturbances under Minnesota Rules, parts 9545.0900 to 
 9545.1090, or other rules adopted by the commissioner. 

    Subd. 33.    Service provider.  "Service provider" means 
 either a county board or an individual or agency including a 
 regional treatment center under contract with the county board 
 that provides children's mental health services funded under 
 sections 245.487 to 245.4888. 

    Subd. 33a.    Culturally informed mental health 
 consultant.  "Culturally informed mental health consultant" is 
 a person who is recognized by the culture as one who has 
 knowledge of a particular culture and its definition of health 
 and mental health; and who is used as necessary to assist the 
 county board and its mental health providers in assessing and 
 providing appropriate mental health services for children from 
 that particular cultural, linguistic, or racial heritage and 
 their families. 

    Subd. 34.    Therapeutic support of foster care.  
 "Therapeutic support of foster care" means the mental health 
 training and mental health support services and clinical 
 supervision provided by a mental health professional to foster 
 families caring for children with severe emotional disturbance 
 to provide a therapeutic family environment and support for the 
 child's improved functioning. 

    Subd. 35.    Transition services.  "Transition services" 
 means mental health services, designed within an outcome 
 oriented process that promotes movement from school to 
 postschool activities, including post-secondary education, 
 vocational training, integrated employment including supported 
 employment, continuing and adult education, adult mental health 
 and social services, other adult services, independent living, 
 or community participation. 

    HIST: 1989 c 282 art 4 s 38; 1990 c 568 art 5 s 11,34; 1991 c 
 292 art 6 s 13-15,58 subd 1; 1992 c 526 s 2; 1992 c 571 art 10 s 
 11; 1993 c 339 s 3; 1Sp1993 c 1 art 7 s 8; 1995 c 207 art 8 s 
 2-4; 1996 c 451 art 5 s 5; 1998 c 407 art 4 s 4