Glossary

We want our information to be as clear and easy to read as possible. If you find any confusing or unfamiliar words, check this glossary for definitions. Also, if you cannot find what you need to know here, or if you notice information that is outdated, e-mail us at tapestrysoc@cuyahogacounty.us and tell us what we should add or change on this list.

A – B – C – D – E – F – G – H – I – J – K –L – M – N – O – P – Q – R – S – T – U – V – W – X – Y – Z

A
Accessible Services: Services that are affordable, located nearby, and are open during evenings and weekends. Staff is sensitive to and incorporates individual and cultural values. Staff is also sensitive to barriers that may keep a person from getting help. For example, an adolescent may be more willing to attend a support group meeting in a church or club near home, rather than travel to a mental health center. An accessible service can handle consumer demand without placing people on a long waiting list.

Appeal Process: These are the steps you must follow to get a decision about services reviewed and changed. Usually this involves proving why the decision was wrong or how it will harm your child and family. Often, you can appeal to a higher level if the first appeal does not get the result you want. You should be given information about the appeal process when you first start getting services. You should learn how to make an appeal and how to get help doing so.

Appropriate Services: Designed to meet the specific needs of each individual child and family. For example, one family may need day treatment services while another family may need home-based services. Appropriate services for one child or family may not be appropriate for another family. Usually the most appropriate services are in the child's community.

Assessment: Assessment services, sometimes referred to as diagnostic and evaluation services, involve a professional determination of the nature of an individual’s problem, the factors contributing to the problem and the strengths and resources of the individual and family. Recommendations for treatment and services are based on this information. It is important for the provider and family together to decide what kind of treatment and supports, if any, are needed. Comprehensive assessments focus on the child, family and the environment in which they live. They address each child’s individual culture and physical, mental/emotional and developmental condition. Assessment plays a particularly important role for children and youth with serious emotional disturbances because their problems are complex and do not fit established diagnostic categories.

B
Behavioral Health Services and Supports: Coordinated and integrated healthcare with the goal of restoring optimal behavioral health through the treatment of mental health and substance abuse disorders. Includes a broad array of mental health, chemical dependency, forensic, mental retardation, developmental disability, and cognitive rehabilitation services that are not limited to any setting or facility. Incorporates a full continuum of treatment intensities (from emergency and acute care to rehabilitation to stabilization) as well as prevention interventions at individual, family and community levels.

Blended Funding: The process of combining categorical funds from different sources and agencies into a single funding stream or “pool” to gain more flexibility in how these funds can be spent on individualized services. Once blended these funding sources are indistinguishable from each other. Blended funding can allow systems to fund activities that are not reimbursable through specific categorical programs. Systems must track, document and account for the funds they spend, whether using a blended or braided approach.

Braided Funding: Funds from various sources are used to pay for a coordinated package of services for individual children, but tracking and accountability for each pot of money is maintained at the administrative level. The funds remain in separate strands but are joined or “braided” for the individual child and family. Systems must track, document and account for the funds they spend, whether using a blended or braided approach.

C
Capitation Rate: A fixed amount of money paid for every person enrolled in a health plan whether or not they present for services during a specific time. Usually expressed in units of per member per month.

Care Manager or Service Coordinator: This is an individual who keeps track of the services and supports your child and family are receiving and makes sure that they are working together in a manner that is easy for your child and family to use.

Care Management: A process to facilitate individual child and family care at critical treatment junctures to assure their care is coordinated, received when they need it, likely to produce good outcomes, and is neither too little nor too much service to achieve the desired results. This process establishes an identifiable point of accountability between the child and family and all helping systems.

Case Rate: A fixed amount of money paid for each person who presents for covered services. May be expressed differently in different programs, e.g., per child per month or per child per episode of care.

Case Manager: An individual who organizes and coordinates services and supports for children with mental health problems and their families. Also referred to as a care manager.

Child and Family Outcome Data: Data used for determining the impact of programs on the children and families served.

Child and Family Teams: Teams of children, families, providers and others who come together to develop individualized service plans. The team is usually made up of the providers and other agency representatives who work with the family, extended family members, and other support persons, such as neighbors or ministers. The family approves all team members. The team reviews each family’s strengths and needs, identifies and plans for needed services and supports.

Child Find: A component of the Individuals with Disabilities Education Act (IDEA) that requires states to identify, locate, and evaluate all children with disabilities who are in need of early intervention or special education services.

Child Protective Services: Designed to safeguard the child when there is suspicion of abuse, neglect, or abandonment, or where there is no family to take care of the child. Examples of help delivered in the home include financial assistance, vocational training, homemaker services, and day care. If in-home supports are insufficient, the child may be removed from the home on a temporary or permanent basis. The goal is to keep the child with his or her family whenever possible.

Children and Adolescents at Risk for Mental Health Problems: Children at higher risk for developing mental health problems when certain factors occur in their lives or environment. Some of these factors are physical abuse, emotional abuse or neglect, harmful stress, discrimination, poverty, loss of loved one, frequent moving, alcohol and other drug use, trauma, and exposure to violence.

Clinic Option: A Medicaid optional benefit that allows for outpatient services to be provided through a wide variety of health care clinics including community mental health agencies. Services must be based at the clinic (except for services to homeless people) and supervised by a physician.

Co-Occurring Disorder: A term referring to co-occurring substance-related, mental health or developmental disorders. At the individual level, a co-occurring disorder exists when at least one disorder of two types can be established independent of the other and is not simply a cluster of symptoms resulting from a single disorder.

Coordinated Services: Child-serving organizations, along with the family, talk with each other and agree upon a plan of care that meets the child's needs. These organizations can include mental health, education, juvenile justice, and child welfare. Case management is necessary to coordinate services.

Cost Benefit Data: Data on child/family outcomes and on system performance to use in weighing the cost of a service, policy, or procedure against the benefits achieved for children and families.

Cost Neutrality: Refers to the requirement that States applying for Medicaid waivers under sections 5, 5(b) and/or 5(c) must demonstrate that the program does not exceed what the federal government would have spent without approving the waiver. States can do this by showing that the average per capita expenditure estimated by the State in any fiscal year for medical assistance provided with respect to the group affected by the waiver does not exceed 100 percent of the average per capita expenditure that the State reasonably estimates would have been made in that fiscal year for expenditures under the state plan for such individuals if the waiver had not been granted. The concept of cost neutrality applies to other federal waivers also, e.g., Title IV-E.

Cost Shifting: The practice of one agency or system obtaining care for a child at the expense of another agency or system, i.e. shifting the cost of care from one agency to another.

Crisis Residential Treatment Services: Short-term, round-the-clock help provided in a non-hospital setting during a crisis. For example, when a child becomes aggressive and uncontrollable despite in-home supports, the parent can have the child temporarily placed in a crisis residential treatment service. The purpose of this care is to avoid inpatient hospitalization, to help stabilize the child, and to determine the next appropriate step.

Cross-System: Implies that more than one child-serving agency or system participates in a service, a program, a training event, etc.

Cultural Competence: Cultural competence is a developmental process that evolves over an extended period. It requires that organizations:

• Have a defined set of values and principles, and demonstrate behaviors, attitudes, policies and structures that enable them to work effectively cross-culturally
• Have the capacity to value diversity, conduct self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, adapt to diversity and the cultural contexts of the communities they serve
• Incorporate the above in all aspects of policymaking, administration, practice, service delivery and involve systematically consumers, key stakeholders and communities.

D
Day Treatment: Day treatment includes special education, counseling, parent training, vocational training, skill building, crisis intervention, and recreational therapy. It lasts at least 4 hours a day. Day treatment programs work with mental health, recreation, and education organizations and may be provided by them.

Disparities: Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States. Research on health disparities related to socioeconomic status is also encompassed in the definition.

Disproportionality: A situation in which a particular racial/ethnic group of children is represented at a higher percentage than other racial/ethnic groups.

E
Early Childhood Mental Health: The social, emotional, and behavioral well-being of children birth through five and their families, including the developing capacity to: experience, regulate, and express emotion; form close, secure relationships; and explore the environment and learn.

Early Intervention: A process for recognizing warning signs that individuals are at risk for mental health problems and taking early action against factors that put them at risk. Early intervention can help children get better more quickly and prevent problems from becoming worse.

Eligibility Criteria: These are the admission criteria or the basis on which children and families are allowed to get services from an agency or program. These criteria usually include age, disability, and income. They can also include where you live, whether your child is male or female, what kind of medical insurance you have, or what other kinds of problems your family is dealing with.

Emergency and Crisis Services: A group of services that are available 24 hours a day, 7 days a week, to help during a mental health emergency. When a child is thinking about suicide, these services could save his or her life. Examples: telephone crisis hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care. A service available in Cuyahoga County is the 24-Hour Suicide Prevention, Mental Health Information and Referral Hotline for Adults and Children at 216-623-6888.

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment): A Medicaid program that is designed to improve primary health benefits for children with an emphasis on preventive care. States must cover regular and periodic exams for all eligible children; and must provide any medically necessary services prescribed by the exams, even those not covered in a state’s Medicaid plan.

Evidence-Based Practice: The provision of services in a manner that is: consistent with current professional knowledge; supported by careful, systematic, and rigorous research and evaluation; based on best clinical experience; and consistent with child/family values.

F
Family-Driven: A term meaning families have a primary decision-making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation. This includes: choosing supports, services, and providers; setting goals; designing and implementing programs; monitoring outcomes; partnering in funding decisions; and determining the effectiveness of all efforts to promote the mental health and wellbeing of children and youth.

Family Focused: This is an approach to designing and providing services that views the child as a member of a family and recognizes that everyone in a family can be affected by how the others act, what they say, or how they feel or are doing in school or work. Decisions about services are made considering the strengths and needs of the family as a whole as well as the individual child with a mental health problem.

Family of One: The “family of one” option is a basic Medicaid rule (optional for states) that allows children who have been in an out-of-home placement for 30 days or longer (e.g., residential treatment or therapeutic foster care) to become eligible for Medicaid, regardless of their family’s income, while they need and remain in the placement. It does not allow eligibility during the first 30 days in placement and does not allow the use of Medicaid to cover costs during that time. When the child returns home, he/she is no longer eligible as a “family of one.”

Family Organization: An organization with the explicit purpose to serve families who have a child, youth, or adolescent with special physical, mental, emotional, behavioral, developmental or educational needs. It is governed by a board of directors comprised of a majority of individuals who are family members; gives preference to family members in hiring practices; and is incorporated in a State as a private non-profit entity.

H
Home-Based Services: Help provided in a family's home for either a defined time or for as long as necessary to deal with a mental health problem. Examples include parent training, counseling, and working with family members to identify, find, or provide other help they may need. The goal is to prevent the child from being placed out of the home. (Alternate term: in-home supports.)

I
Independent Living Services: Support for a young person in living on his or her own and in getting a job. These services can include therapeutic group care or supervised apartment living. Services teach youth how to handle financial, medical, housing, transportation, and other daily living needs, as well as how to get along with others.

Individualized Service Plans (ISP): The written procedures and activities that are appropriately scheduled and used to deliver services, treatments, and supports to a child and the child’s family. Families help create these plans which guide the work of the care manager. The ISP is created uniquely for each child and family and changed as often as necessary to reflect changes in the child, the family, and/or their circumstances. Such plans treat the family as a unit and seek to coordinate service efforts across all family members.

Individualized Services: Designed to meet the unique needs of each child and family. Services are individualized when the caregivers pay attention to the child's and family's needs and strengths, ages, and stages of development. See appropriate services and family-centered services.

Initial Referral or Intake: This is the process an agency or program uses to first find out about your child and family and determine your eligibility for services.

Inpatient Hospitalization: Mental health treatment in a hospital setting 24 hours a day. The purpose of inpatient hospitalization is: (1) short-term treatment in cases where a child is in crisis and possibly a danger to self or others, and (2) diagnosis and treatment when the patient cannot be evaluated or treated appropriately in an outpatient setting.

Intensive Care Management: Intensive community services for individuals with severe and persistent mental illness designed to improve planning for their service needs. Intensive care management includes outreach, evaluation and support services. Case managers are generally advocates and arrangers of services and supports, but also provide teaching of community-living and problem-solving skills; modeling productive behaviors and helping individuals help themselves.

L
Level of Care Criteria: Guidelines employed to assist in the determination of the appropriate setting and intensity of behavioral health treatment.

Linguistic Competence: The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. Linguistic competency requires organizational and provider capacity to respond effectively to the health literacy needs of populations served. The organization must have policy, structures, practices, procedures and dedicated resources to support this capacity.

M
Managed Care Organization: An organization that either directly provides or arranges managed health care by applying various strategies designed to optimize the value of provided services by controlling their cost and utilization, promoting their quality and measuring performance to ensure cost-effective outcomes.

Management Information System (MIS): A system (almost universally automated or computer based), which collects the necessary information in proper form and at appropriate intervals for managing a program or other activities. The system shall afford indicators, which measure program progress toward objectives, identify discrete costs, and facilitate identifying problems that need attention.

Medicaid Options: Options granted by the federal government to states through which they can provide an expanded range of services to a target group of children.

Medical Necessity Criteria: Criteria used by the managed care entity to determine if requested interventions or services are medically appropriate and necessary to meet the needs for a particular individual.

Mental Disorders: Another term used for mental health problems.

Mental Health: Mental health refers to how a person thinks, feels, and acts when faced with life's situations. It is how people look at themselves, their lives, and the other people in their lives; evaluate the challenges and the problems; and explore choices. This includes handling stress, relating to other people, and making decisions.

Mental Health Problems: Mental health problems are real. These problems affect one's thoughts, body, feelings, and behavior. They can be severe. They can seriously interfere with a person's life. They're not just a passing phase. They can cause a person to become disabled. Some of these disorders are known as depression, bipolar disorder (manic-depressive illness), attention deficit hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia and conduct disorder.

Mental Illnesses: This term is usually used to refer to severe mental health problems in adults.

P
Parent Advocate: These are individuals who have been trained to help other families get the kinds of services and supports they need and want. Parent advocates are usually family members who have raised a child with a behavioral or emotional problem and have worked with the system of care and many of the agencies and providers in your community.

Part C: The Early Intervention Program of the Individuals with Disability in Education Act (IDEA) that focuses on infants and toddlers and requires a range of early intervention services needed as a result of developmental delays affecting cognitive development, physical development, language and speech, or psychological development.

Performance-Based or Outcomes-Based Contracts: Emphasizes that all aspects of an acquisition be structured around the purpose of the work to be performed as opposed to the manner in which the work is to be performed or broad, imprecise statements of work which preclude an objective assessment of contractor performance. It is designed to ensure that contractors are given freedom to determine how to meet performance objectives, that appropriate performance quality levels are achieved, and that payment is made only for services that meet these levels.

Pooled Funding: See definition for Blended Funding.

Practice Based Evidence: A range of treatment approaches and supports that are derived from, and supportive of, the positive cultural attributes of the local society and traditions. Practice based evidence services are known to be effective by the local community, through community consensus. They address the therapeutic and healing needs of individuals and families from a culturally specific framework. Practitioners of practice based evidence models draw upon cultural knowledge and traditions for the treatment and are respectfully responsive to the local definition of wellness and dysfunction.

Practice Based Evidence/Promising Practices: Practice knowledge supported by evidence of effectiveness through the experiences of key stakeholders, such as families and direct-care providers and usually outcome data.

Provider Network: Group of agencies and/or individual providers that agree to provide and are reimbursed for services to members of a managed care plan or an organized system of care.

Psychiatric Rehabilitation Options (Rehabilitation Option): An option in Medicaid services that incorporates rehabilitative, community-based services to persons with psychiatric and co-occurring psychiatric-substance abuse diagnosis. This category is known as the Medicaid Rehabilitation Option or MRO. Medicaid also pays for behavioral health services through the Clinic Option and through Targeted Case Management (TCM).

Psych Under 21: An optional benefit under section 05(a)(6) of the Social Security Act that covers inpatient hospitalization of children under age 21. The benefit must provide any services listed in section 05(a) that is needed to correct or ameliorate defects and physical and mental conditions discovered by EPSDT screening, whether or not the service is covered under the State plan.

Purchasing Collaborative: A collaborative behavioral health services model that brings all agencies tasked with the delivery, funding or oversight of behavioral healthcare services together to create a single behavioral health service delivery system in a state.

Q
Quality Assurance: An approach to improving the quality and appropriateness of medical care and other services. Includes a formal set of activities to review, assess, and monitor care to ensure that identified problems are addressed.

Quality Improvement/Continuous Quality Improvement: A process that continually monitors program performance. When a quality problem is identified, CQI develops a revised approach to that problem and monitors implementation and success of the revised approach. The process includes involvement at all stages by all organizations, and stake holders that are affected by the problem and/or involved in implementing the revised approach.

R
Residential Treatment Centers: Facilities that provide treatment 24 hours a day and can usually serve more than 12 young people at a time. Children with serious emotional disturbances receive constant supervision and care. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually more long-term than inpatient hospitalization. Centers are also known as therapeutic group homes.

Respite Care: This is a service that gives a family a short break—relief—where someone else temporarily takes care of your child for a few hours or a few days. Respite care can be provided in your home, at the respite care provider’s home, or at a special respite care facility.

Risk Adjustment Mechanisms: Various methods that can be used to level the playing field prospectively or retrospectively for at-risk provider systems under situations where voluntary or mandatory enrollees may choose among competing providers. Adjust rates paid to managed care organizations or providers for the cost of caring for populations with known high service costs.

Risk Pool: A grouping of enrollees or contracts by some common factor, (e.g., contract, size, geographic location, services utilization pattern) that allows all revenue and expenses for that group to be aggregated and to distribute risk among participants and thus insure that the losses faced by any one participant are minimized. Used to spread risk for low incident, high cost conditions or to buffer a risk bearing managed care organization or provider from catastrophic cost that are outside provider’s control.

S
Screening: A guideline that recommends periodic interventions be performed for the early detection of behavioral health problems so that appropriate care can be provided early on.

Section 1115 Research & Demonstration Projects: This section provides the Secretary of Health and Human Services broad authority to approve projects that test policy innovations likely to further the objectives of the Medicaid program.

Section 1915 (b) Managed Care/Freedom of Choice Waivers: This section provides the Secretary authority to grant waivers that allow states to implement managed care delivery systems, or otherwise limit individuals’ choice of provider under Medicaid.

Section 1915 (c) Home and Community-Based Services Waivers: This section provides the Secretary authority to waive Medicaid provisions in order to allow long-term care services to be delivered in community settings. This program is the Medicaid alternative to providing comprehensive long-term services in institutional settings.

Serious Emotional Disturbance: Diagnosable disorders in children and adolescents that severely disrupt daily functioning in the home, school, or community. Some of these disorders are depression, attention-deficit/hyperactivity, anxiety, conduct, and eating disorders. Serious emotional disturbances affect 1 in 20 young people.

Service Plan: This is a written document that lists and describes all the services and supports your child and family will receive. Typically, service plans also include information about your child’s and family’s strengths, problems, and needs. Good service plans also spell out what the services and supports are designed to accomplish as well as how and when progress will be assessed. If your child is receiving special education, the service plan is called an Individualized Education Program or IEP. A federal law, the Individuals with Disabilities Education Act (usually called the IDEA), describes who is eligible for special education and exactly what must be in an IEP.

Service Planning Team: This is the group of individuals parents select to help develop a child’s service plan. Parents or caregivers choose the family members, professionals, friends, experts, and support people who will be team members. The team meets when it is convenient and as often as necessary to make sure the child and family are getting the help they want and need.

Service Utilization: A description, usually statistical, of the level, frequency, and necessity of services actually used by consumers. Generally aggregated into population measures, rather than individual consumer measures.

Skilled Professional Medical Personnel/Administrative Medical Case Management: Medicaid funding may be used to reimburse for administrative case management when the case management is provided by Skilled Professional Medical Personnel (SPMP). SPMP may provide services such as administrative medical case management, intra/interagency coordination, collaboration and administration, training, program planning and policy development, and quality management.

State Children’s Health Insurance Plan (SCHIP): Under Title XXI of the Balanced Budget Act of 1997, the availability of health insurance for children with no insurance or for children from low-income families was expanded by the creation of SCHIP. SCHIPs operate as part of a State’s Medicaid program.

Strengths: These are the positive characteristics of a child and family. Everyone, no matter how severe their problems are, has things they do well, people they like, and activities they enjoy.

System/Site: Any state, tribe, territory, region, county, city, community, or organization that is designing a comprehensive financing strategy to build a system of care.

System of Care: This a coordinated network of agencies and providers that make a full range of mental health and other necessary services available as needed by children with mental health problems and their families.

T
Target Population: The specific population of people a particular program or practice is designed to serve or reach.

Targeted Case Management: Medicaid term for case management services covered under Title XIXX of the Social Security Act. Federal law defines Targeted Case Management as services that will assist individuals eligible under the state Medicaid plan in gaining access to needed medical, social, educational and other services.

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA): TEFRA is a specific Medicaid eligibility option available to states that allows the provision of home and community-based services for children who meet SSI disability criteria and who, without the home and community-based services, would require institutional placement. Parental income is not considered in determining the child’s eligibility. If a state uses this option, there is no limit on the number of children who can be served, and it creates an entitlement for all children who qualify based on their disability and care needs. It is also known as the Katie Beckett option in some states.

Telehealth (Telemedicine): Professional services given to a patient through an interactive telecommunications system by a practitioner at a distant site.

Title IV-E Demonstration Waiver (Child Welfare Demonstration Projects): Provides States with an opportunity to design and test a wide range of cost-neutral approaches to improve and reform child welfare by waiving certain requirements of Title IV-E. The general objectives of the waivers include the development of family-focused, strengths-based, community-based service delivery networks that enhance the child-rearing abilities of families, to enable them to remain safely together when possible, or to move children quickly to permanency; and development of better results for children and families.

Transitional Services: Services that help children leave the system that provides help for children and move into adulthood and the adult service system. Help includes mental health care, independent living services, supported housing, vocational services, and a range of other support services.

U
Utilization Management: A system of procedures designed to ensure that the services provided to a specific individual at a given time are cost-effective, appropriate, and least restrictive.

Utilization Review: Retrospective analysis of the patterns of service usage in order to determine means for optimizing the value of services provided (e.g. minimize cost and maximize effectiveness/appropriateness).

W
Wraparound Services: A "full-service" approach to developing help that meets the mental health needs of individual children and their families. Children and families may need a range of community support services to fully benefit from traditional mental health services such as family therapy and special education.

Y
Youth-guided: A term meaning youth having a role in guiding their own care. For older youth, it may mean directing their own care.

These definitions are culled from a variety of sources, including the Center for Mental Health Services (CMHS) Knowledge Exchange Network (KEN) (1-800-789-2647). Inclusion of a service or concept on this list does not guarantee that service or concept is available to all families within the Cuyahoga Tapestry System of Care. The best way to find out about our services is to contact us.