SERVICE POLICY GUIDELINES
COUNSELING SERVICES
Tri-Counties Regional Center enhances the quality of life for persons with developmental disabilities by working with individuals and their families to secure assessment and treatment supports and services that maximize their opportunities and choices for living, learning, working, and pursuing recreational activities in their community.
Tri-Counties Regional Center will coordinate, support and advocate for persons served to obtain appropriate counseling services in their community. Tri-Counties Regional Center works and advocates within the communities it serves to develop and identify appropriate mental health services provided by professionals experienced with and sensitive to the needs of individuals with developmental disabilities. Such services maximize the potential for individuals to develop and/or prevent deterioration in areas of their development.
Counseling services are psychotherapeutic treatment provided by a licensed psychologist, psychiatrist, licensed clinical social worker or a marriage and family therapist. On occasion, counseling services may form a necessary part of a comprehensive intervention program, which may include medication, behavioral management and other related treatments. Counseling services may be provided when a person served and/or his/her family member require a deeper understanding of social or psychological problems that are associated with the developmental disability and that adversely affect the individual’s living arrangements or other supports and services.
Access to specialized mental health care services directly related to the developmental disability of the individual may be necessary for the mental health and functional ability of some individuals. Tri-Counties Regional Center may authorize funding for short-term and crisis counseling services related to the individual’s developmental disability when the Planning Team determines that the counseling service is required and that there are no generic or private resources, including health insurance, available or responsible to meet the need.
The provision of counseling services requires a clinical assessment that identifies the presenting problem, the expectations and the time lines for a therapeutic outcome and with an identified method for deciding whether or not that outcome is being achieved. Any referral or provision of counseling services is made by the Planning Team and is contingent on the willingness of the person served and family to participate in the counseling services. The Planning Team will determine whether the counseling service will be provided by clinical consultants on contract with Tri-Counties Regional Center or by an outside source. Tri-Counties Regional Center may authorize short term and crisis counseling services.
When the need is directly related to, or is the direct result of, a developmental disability and all generic and private resources, including private health insurance, deny a necessary specialized health care, Tri-Counties Regional Center may authorize funding for the purchase of specialized counseling services.
For children under the age of three (3), Tri-Counties Regional Center shall use private insurance as a generic service resource for specialized counseling. Tri-Counties Regional Center may pay the cost of accessing private insurance (for example, deductible or co-pay amounts), if this is cost effective.
For children in public school programs and individuals who reside in health care facilities, counseling services are expected to be provided as part of the individual’s program, rather than as a separately funded service. Tri-Counties Regional Center service coordinators will actively advocate with California Children’s Services, local education agencies, health care facility providers and mental health agencies to ensure the delivery of required and mandated counseling services.
Tri-Counties Regional Center will advocate for and work with individuals and their family members to ensure that generic and private mental health service providers discharge their obligations to meet the needs of persons with developmental disabilities. It is the financial responsibility of persons served or their families to pay premiums and meet any required deductible amount or co-payment liabilities as determined by generic resources and/or private insurance carriers. Except as legally prohibited by the terms of a Special Needs Trust, trust funds established for the care or benefit of a person served are considered a private resource, and therefore it is expected that this source of funds be used prior to regional center funds.
Tri-Counties Regional Center will pursue private resources, including trusts, court-ordered settlements and payments, only to the extent that they are liable for the costs of services, aid, insurance or medical assistance for the person served. Parental resources will be pursued only to the extent provided by the Lanterman Act.
If a generic or private resource initially denies a required mental health service that Tri-Counties Regional Center has determined to be their responsibility, that denial will be appealed. Tri-Counties Regional Center may authorize funding for a counseling service while an individual or family member appeals a denial of service by a generic or private resource under the following circumstances:
Tri-Counties Regional Center will not authorize funding of any counseling service that is considered experimental, optional or elective in nature. The expected result from the provision of a mental health service must meet measurable outcomes as stated on the person’s Individual Program Plan. The provision of any counseling service must be both clinically and fiscally an effective use of public funds.
Exception Policy:
Tri-Counties Regional Center recognizes that some individual needs are so unique that they may not be addressed in this Service Policy and may require an exception. Such requests for an exception to a Service Policy will be made through the Planning Team process.
Approvals:
