(1) Extraordinary needs aide (ENA) services are prior-authorized additional one-to-one, face-to-face, intensive short-term behavior management, and stabilization services provided in the TGH by TGH staff, for youth with serious emotional disturbance (SED). Short-term generally means 90 days or less. Additional days may be authorized if the youth continues to meet the criteria specified in (2).

(2) ENA services are provided for youth in a TGH who exhibit extreme behaviors that can not be managed by the TGH staffing required by licensure found in ARM Title 37, chapter 97 and who do not require services in a higher level of care.

(a) Extreme behaviors need to be current, at least, moderately severe, and consist of documented incidents that are symptoms of the youth's SED. These behaviors are either frequent in occurrence, at risk of becoming a serious occurrence, and include one or more of the following:

(i) harming self or others;

(ii) destruction of property; or

(iii) a pattern of frequent extreme physical outbursts.

(3) To request prior authorization of ENA services, the lead clinical staff (LCS) member must complete the department's ENA request form and document the medical need for such services. The LCS is defined in the licensure rule found in ARM Title 37, chapter 97. The form may be obtained from the Department of Public Health and Human Services, Developmental Services Division, Children's Mental Health Bureau, P.O. Box 4210, Helena, MT 59604-4210 or on the department’s web site at www.dphhs.mt.gov/mentalhealth/children/index.shtml.

(a) The ENA request form requires a behavior assessment, and a detailed description of the youth's behavior problems including date(s) of occurrence(s), and frequency of behavior problems to justify the number of ENA hours being requested. The form also requires measurable ENA treatment plan goals and objectives.

(b) If continued prior authorization is requested, a new ENA request form must be completed prior to the end of the authorization period with an updated behavior assessment, plus a description of the behavior problems with new goals and objectives.

(c) ENA requests are reviewed and approved on a case-by-case basis by the department or it's designee to determine the medical need for the service and the number of units requested. One unit of ENA service equals one hour.

(d) The dates and frequency of behavior problems must be included on the request form. If the information on the ENA request form is incomplete, the request will not be reviewed.

(4) ENA services must be provided according to measurable goals and objectives identified in the TGH treatment plan.

(5) ENA staff are supervised by the TGH LCS.