Transitioning from BHRS to IBHS
by Jaime Friedman
June 16, 2022
Behavioral Health Rehabilitation Services (BHRS) are Switching to Intensive Behavioral Health Services (IBHS)
The Office of Mental Health and Substance Abuse Services (OMHSAS) recently established new regulations for IBHS to replace BHRS. New regulations have been made by OMHSAS to replace BHRS with IBHS for children and young adults in need of treatment for Autism Spectrum Disorder (ASD) or Behavioral Disorders. If your child is receiving behavioral health services, keep reading to find out more information. There are also resources about the switch to IBHS available through the Pennsylvania Department of Human Services.
About the Change
BHRS are being replaced by IBHS in order to improve the quality of behavioral health care provided to children and young adults, and to make these services more accessible. The decision to transition to IBHS was determined by analyzing feedback provided by targeted focus groups. The sources of this feedback included school district principals, service providers, or family members living with the child or young adult.
Defining Intensive Behavioral Health Services
IBHS is a broad term for a variety of treatment types (i.e., individual, ABA, or group) available to children and young adults with ASDr or Behavioral Disorders. The goals of these services are to (1) identify skill deficits, (2) understand why an individual may be displaying challenging behavior, and (3) develop individualized treatment plans to promote success.
Intensive Behavioral Health Services support children under the age of twenty-one in a home, school or community setting.
The IBHS Annex is the body of regulations which contains the requirements to provide and bill for IBHS.
The IBHS Preamble contains an overview of the regulations, including the purpose, background, accomplishments, and benefits. It also answers questions from the public using a question-and-answer format. Some of these questions are summarized below.
Questions & Answers About the Change and IBHS in General
Can a child who lives in a Community Residential Rehabilitation (CRR) Host Home receive IBHS?
Children or young adults who live in a CRR Host Home may receive Individual or ABA Services as part of the treatment provided in the CRR Host Home.
My child is currently receiving BHRS. Can he or she continue to receive BHRS?
If your child has a current authorization for BHRS, your child can continue to receive services. BHRS can be provided until January 17, 2021. Prior to your child’s authorization for BHRS expiring, someone should discuss your child’s transition from BHRS to IBHS.
What will happen to my child’s BHRS program?
Each individual BHRS provider needs to decide if they will become an IBHS provider. This process/ transition will happen throughout 2020.
What is needed for my child to receive IBHS?
In order to receive IBHS, your child will need a written order from a professional with a qualifying license, which may include: (a) a physician or physician’s assistant, such as your family doctor, (b) a certified registered nurse practitioner, (c) a psychologist or psychiatrist, (d) or another licensed individual such as a licensed clinical social worker, a licensed professional counselor or a licensed marriage and family therapist. You will need to provide the written order to an IBHS provider for them to begin the process of onboarding and providing services to your child. IBHS will begin with an assessment of your child’s behavior. The assessment provides information on your child’s strengths and needs, the strengths and needs of your family, and existing and needed supports for your child. If recommended, an assessment can also come in the form of a Functional Behavior Assessment (FBA). This assessment allows the behavior specialist to understand factors which contribute to your child’s challenging behavior. Both the written order and assessment will be used to develop your child’s Individualized Treatment Plan (ITP). Your child’s ITP will include your child’s goals, and the plan to achieve those goals.
What is the difference between a written order and an assessment?
A written order is valid for 12 months and recommends which type of IBHS is best for your child. It includes the maximum number of hours of each service per month and the settings, such as home, school or community, where services may be provided. An assessment is completed following the written order by an individual who is qualified to conduct assessments. The assessment is done in settings where your child normally is, such as your home or the child’s school or daycare. The assessment will include more specific recommendations for the number of service hours needed and where those services should be delivered. It will also identify areas of focus for treatment goal development.
Can my child receive Group Services in addition to Individual Services or ABA Services?
Yes. Your child can receive Group Services while receiving Individual Services or ABA Services. The Individual Services or ABA Services may not be provided during the time of the Group Service.
Will my child have a treatment team if my child receives IBHS?
Yes. Collaboration between IBHS staff and other providers (e.g., teachers, OTs, PTs, SLPs, etc.), is required to ensure that treatment is delivered effectively and consistently. Your child’s treatment team would include those providers needed to make the collaboration possible.
Are Individual Service Planning Team (ISPT) meetings still required?
No. ISPT meetings are no longer a requirement to receive IBHS; however, it is still expected that the IBHS treatment team communicates with each other. This could be done in a variety of ways, such as a treatment team meetings or phone calls.
My provider said they do not provide IBHS because they only accept private insurance. Is this correct?
No. IBHS are regulated on the state level; however, a provider may choose not to participate in the Medical Assistance (MA) program.
My child does not have autism, can my child still receive ABA Services?
ABA Services are not limited to children with a diagnosis of autism. Children with other behavioral health diagnoses may receive ABA Services.
What if I have a concern about the IBHS my child is receiving?
Sharing concerns regarding your child’s services is very important. In fact, your ideas could assist with identifying effective interventions.
Finding the Right Behavioral Health Services
To find effective IBHS for your child, it is important to understand which supports your child needs. Your child’s written order (to be obtained by a qualifying licensed professional) will include which type of services are deemed medically necessary for your child. For example, if ABA services are recommended, narrow your search to providers that can offer these services. Likewise, if group services are recommended, identify which providers can meet this need. Once you have identified some providers, it is a good idea to do some research on the directors and clinical administrative staff to scope out their qualifications and training. Naturally, you will want to identify the most qualified behavior specialists available; therefore, you should check to see if behavioral services are overseen by a Board Certified Behavior Analyst (BCBA). You can also ask about the type of training the behavioral health technicians (BHTs) and Registered Behavior Technicians (RBTs) receive before they work 1:1 with your child.
IBHS providers can have vastly different certifications and experience levels. Understanding career accolades in an unfamiliar field can be difficult, so here are some pointers to get you started. First, experience is obviously important- not only the length of experience but the type. It is important to look for providers that employ staff with diverse behavioral backgrounds so they can match the right staff to your child’s needs. It is also important to ask what type of supports the providers can provide to family members. For example, you could ask about how the providers go about training caregivers on individualized treatment plans. Another necessity should be the use of evidence-based practice. The provider and their staff should keep current on empirically-based procedures and only include scientifically-backed procedures in your child’s treatment plans.
IBHS Services Glossary
About Individual Services
Each individual treatment plan (ITP) is individualized to meet the child’s behavioral needs. A Behavioral Consultant (BC) will conduct an assessment to identify behavioral goals. The BC will then use the results of the assessment to develop treatment strategies to effect behavior change (e.g., reduction of challenging behavior, etc.). All intervention components incorporated into the treatment plan will be evidence based, that is, based in research and empirically validated. A Behavioral Health Technician (BHT) will be responsible for implementing the treatment plan with your child in the home, school, or community (or community-like) setting. Your BC will overlap with your child and the BHT weekly to monitor behavioral progress and to make modifications to the treatment plan as needed to drive further success.
About ABA Services
Applied Behavioral Analysis (ABA), is an evidence-based treatment approach which focuses on creating behavior change by manipulating environmental variables. Like individual services, each individual treatment plan (ITP) is individualized to meet the child’s behavioral needs; however, all treatment components are based on the principles of ABA. A Behavioral Consultant (BC-ABA) will conduct behaviorally-based assessments (e.g., a Functional Behavior Assessment, FBA, Verbal Behavior Milestones Assessment and Placement Program, VB-MAPP, etc.) to identify skill deficits and to understand why an individual may be displaying challenging behavior. A Behavioral Health Technician (BHT-ABA) will be responsible for implementing the treatment plan with your child in the home, school, or community (or community-like) setting. Your BC-ABA will overlap with your child and the BHT-ABA weekly to monitor behavioral progress and to make modifications to the treatment plan as needed to drive further success. As of October 2019, individuals receiving ABA Services through Medical Assistance (MA) must have a diagnosis of ASD or a behavioral disorder.
About Group Services
Group Services are used to meet the needs of multiple individuals simultaneously in community-like, social settings. Group services often take place in schools or in programs which mimic group settings, such as a summer camp. The activities included in group services revolve around mutually beneficial skill acquisition programming and peer relationships.
Aspire’s IBHS Coverage
Aspire offers Intensive Behavioral Health Services (IBHS) for individuals up to 21 year of age who have been diagnosed with Autism Spectrum Disorder (ASD) or behavioral disorders, like ADHD or Oppositional Defiant Disorder (ODD). Our Director of IBHS is a Board Certified Behavior Analyst (BCBA) and has a wealth of experience practicing ABA across a variety of settings. Aspire CFS offers ABA, individual, and group services in the home, school, and community settings throughout the greater Philadelphia area. Aspire accepts most commercial insurances, and we are in network with Medical Assistance in Montgomery, Bucks, and Delaware Counties.