Missouri Department of Social Services,

Children’s Division

INTENSIVE COMMUNITY PSYCHIATRIC REHABILITATION SERVICES

INPATIENT DIVERSION

Introduction:

This document is to establish an agreement between the Missouri Department of Social Services, Children’s Division, and Burrell Behavioral Center to provide Inpatient Diversion for children whose mental health needs cannot be met in a home-like or community-based setting.

The goal of the treatment intervention is to manage the mental health crisis, restore the child to his/her previous level of functioning, and decrease risk of harm.

Burrell Behavioral Center is certified through a national accrediting board and is licensed by DMH. Burrell Behavioral Center is enrolled as a Mo HealthNet inpatient diversion service provider.

Agreement:

Burrell Behavioral Center agrees to the following:

The youth is between 6 to 18 years of age with a serious emotional disorder, and meets eligibility criteria for a rating of Level 6 on the Child and Adolescent Level of Care Utilization System.

The youth is placed within a secure 24 hour service environment designed to provide clinical services at the highest level of service intensity and restrictiveness for the protection of the child. There shall be a maximum of two (2) children to one (1) staff for waking hours and six (6) children to one (1) staff for night time.

The youth has a comprehensive individualized care plan developed by the family, child, natural supports, agencies and community partners.

The youth has a well defined crisis plan that anticipates and accommodates complications during transition to lower levels of care.

Emergency medical services shall be available on-site or in close proximity.

A child and adolescent psychiatrist shall supervise the care provided by a multi-disciplinary treatment team.

There shall be daily availability of licensed nursing personnel.

Licensed occupational and recreational therapists shall be available.

Burrell Behavioral Center and the Children’s Division agree to the following:

Except in emergency situations, no change in placement is to be made without prior notice to the Children’s Division. Burrell shall notify the Children’s Division within 24 hours of an emergency change in placement.

Both parties agree to participate in Family Support Team Meetings. The parties will comply with provisions of the permanency/treatment plan and will maintain regular contact as a means of staying apprised of the course of treatment and discharge coordination.

Failure to follow the conditions of this agreement and/or the permanency/treatment plan could result in termination of this agreement.

This agreement may be terminated by either party upon ten days notice or sooner if mutually agreed upon.

Both parties must agree to the placement prior to placement. This agreement is effective the date the child is placed.

Child’s full name ________________________________________________________________

Child’s date of birth ________________________

Child’s DCN _______________________________

Child’s date of placement ___________________

This agreement must be signed by both the Burrell Behavioral Center’s designee and the local Children’s Division designee before it will be considered officially approved, and a placement made.

Sign-off of Parties:

_________________________________________________________Date:________________

Burrell Behavioral Center designee

_________________________________________________________Date:________________

Children’s Division designee

A signed copy of this agreement must be sent to the Children’s Division Central Office designee (Randy Yancey, P.O. Box 88, Jefferson City, Mo. 65103) within 10 days from the placement date.