Contents

4.1 Is child currently an adjudicated delinquent?
4.2 Diagnosed Emotional Disability
4.3 Mental Health Symptoms/Minimum Frequency
4.4 Mental Health Services 
4.5 Rare, Extreme Conditions 

4.1 Is child currently an adjudicated delinquent?

This question reflects long-standing policy to avoid cost shifting from the Department of Justice to the Family Support Program. If a child is an adjudicated delinquent, then the justice system is responsible for providing whatever assistance the child and family needs, and the child is not eligible for the Family Support Program. This includes youth being tried as adults.

"Adjudicated delinquent" means that a child-currently or within the past year-is or has been under supervision of the juvenile justice system because they violated the law, misbehaved, or posed a threat to others due to their conduct (Chapter 938 of Wisconsin State Statute). This does not include court orders for treatment, or a Child in Need of Protective Services (CHIPS) petition (Chapter 48 of Wisconsin State Statute).

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If the child has a clinical diagnosis of an emotional disability, has the diagnosis, or symptoms related to that diagnosis, persisted for at least six months?

• Yes
• No
• Child does not have an emotional disability

If the child has a clinical diagnosis of an emotional disability, is the disability expected to last a year or longer?

• Yes
• No
• Child does not have an emotional disability

Many of the questions on this CLTS FS page reflect current duration requirements for a Psychiatric Level of Care (LOC). Note that the Autism Spectrum Disorders are Mental Health diagnoses; the screener may check this box for children with those diagnoses. These include Asperger's, Autism and Pervasive Developmental Disability. Likewise, ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder) are Mental Health diagnoses. All of these are diagnoses of an emotional disability and you must answer this question on this page for children with these diagnoses from a qualified professional (MD or Psychologist). Many people identify these diagnoses as developmental in nature. However, they are also considered a clinical mental health diagnosis and you must therefore answer this question accurately. Answering this question correctly will increase the likelihood of an appropriate functional eligibility determination for these children.

Regardless of the answer to these questions, complete the Mental Health section for every child who has a mental health diagnoses. In addition, if a child does not have a mental health diagnosis but is exhibiting mental health symptoms or receiving mental health services, the screener can indicate that on this page.

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4.3 Mental Health Symptoms/Minimum Frequency

The minimal frequency of mental health and behavioral symptoms is lower than the "needs help one-third of the time" criterion used for ADLs and IADLs. For the mental health symptoms, the screener should check the box if:

• Child currently has symptoms as defined, or
• Child had the symptoms as defined within the past three months, or
• Child had the symptoms as defined at least twice in the past year.

• Psychosis - Serious mental illness with delusions, hallucinations, and/or lost contact with reality.
• Suicidality - Suicide attempt in past three months or significant suicidal ideation or plan in past month.
• Violence - Life-threatening acts.
• Anorexia/ Bulimia - Life-threatening syptomology.

For Psychosis and Anorexia or Bulimia, there should be a corresponding diagnosis in the Diagnosis table of the CLTS FS.

Violence is defined as life threatening acts that endanger another person's life. This life-threatening act must result in one of the following:

• Cause other person to require hospitalization (does not include an ER visit).
• Use of weapons against someone (e.g., gun, knife, chains, switch blade).
• Arson (purposeful fire setting) or bomb threats.

If the behavior does not meet this requirement, the screener may be able to check one of the behaviors listed under the category: Aggressive or Offensive Behaviors on the Behavior Page of the CLTS FS.

Anorexia/Bulimia - Life threatening Syptomology. Effects of eating disorders must include at least one of the following:

• Malnutrition diagnosed by a physician.
• Electrolyte imbalances diagnosed by a physician. Electrolytes are body salts like sodium, potassium and chloride.
• Body weight or development below 20th percentile due to the eating disorder as determined by a physician.

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4.4 Mental Health Services

Does child currently require services from any of the following? (Check all that apply.)

• Mental Health Services: Psychotherapy specific to the child's diagnosis, including day treatment programs. This excludes treatment for substance abuse only, which is captured below. This includes in-home therapies for children with Autism, Asperger Disorder or Pervasive Developmental Disorder. If a child is participating in on-going in-home therapies once they have completed the intensive program then these therapies are only listed as Mental Health Services if the specific therapy is overseen by a psychiatrist or psychologist. Mental Health Services does not include psychiatric medications; however, this may include psychiatric visits on a regular basis for the prescription of those medications.
  
  
• Child Protective Services
  
  
• Criminal Justice System, this includes Juvenile and Adult Justice Systems
  
  
• In-school Supports for Emotional and/or Behavioral Problems
  "In-school supports" includes special education classes, one-on-one assistance, or a Behavioral Intervention Plan (BIP) in an Individualized Educational Plan (IEP). This is for emotional or behavioral problems; do not check it for children with only cognitive and/or physical disabilities.
  
  This item is checked in the following situations:
  -- Child has an Individualized Educational Plan (IEP) for Emotional/Behavioral Disorders (EBD) programming.
  -- Child has an active Behavioral Intervention Plan (BIP) in an Individualized Educational Plan (IEP).
  
  Sometimes children have behavioral plans that are essentially inactive because the child has not had the behavioral problems for a long time. If the child is not in special education classes and does not have one-on-one assistance, check this item only if the behavioral plan has actually been used. In this situation, check the box if interventions are needed at least three times per week. "Interventions" here means a school staff must verbally and/or physically provide or assist the child with behavioral controls. The staff person may have to interrupt or prevent the behavior, remove the child from the situation, or respond in ways to help the child cope and avoid harm. This does not include children who need to have someone help them simply to keep on task in the classroom.
  
  
• Substance Abuse Services, this includes day treatment and outpatient services.

"Require" is based on the qualified, treating professional's recommendation that a specific service is essential to address the child's identified mental health need. The professional recommendation must be made within the past year. It cannot be solely based on parental desire for services. Most children who require these services will be receiving them, but on occasion a parent or child cannot, or will not, participate in recommended services or the recommended services are not available. If the parent or child has refused to access recommended services for over 12 months, then this recommendation is considered no longer valid.

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4.5 Rare, Extreme Conditions

These three conditions are rare and extreme and usually don't cause physical harm to the child or others. They are associated with mental health disorders and the child's ability to function throughout their day, every day, all day and night. They are usually not considered overt behaviors and are often better described as a lack of behavior or action. There are limited interventions because the condition appears to be a direct result of their mental health status. They are a measure of the severity of a child's mental health condition. Consideration needs to be given to these rare and extreme conditions as the severity of these circumstances is significant. The following three questions address these unique situations.

• Does this child exhibit disruptive behaviors in structured settings on a daily basis that require redirection from an adult at a frequency of every 3 minutes or more often AND this behavior has been demonstrated consistently for the past 6 months (do not count summer months)? Disruptive behaviors may include sliding around a room in a chair, screaming out inappropriate words or phrases, sitting in the center of a room and refusing to move.
  • Yes
  • No

This question will only be answered in the affirmative in extremely rare situations. It is imperative that the screener confirm that the frequency of this disruptive behavior occurs "every 3 minutes or more often" all day, every day If a child has been removed from the regular classroom due to this behavior, check "no" unless they exhibit disruptive behaviors of this same intense frequency in alternative classrooms or school settings as well.

• Does this child experience nightmares or night terrors at least 4 times a week AND this sleep interruption has been consistent for the past 6 months? These nightmares or night terrors must be characterized by repeated frightening episodes of intense anxiety that may be accompanied by screaming, crying, confusion, agitation, and/or disorientation.
  • Yes
  • No

All children may have nightmares or even the occasional night terror. This question is intended for the child who has these intense experiences at least 4 nights a week, for months. If the condition does not meet this frequency, then check "no" and describe the situation in the note section.

• Is this child unable to complete routine events (hygiene tasks, leaving the house, walking on certain pavements, or sharing community equipment with others) throughout the day, every day, consistently for the past 6 months due to an obsession? An obsession is a thought, a fear, an idea, an image, or words that a child cannot get out of his/her mind. It does not include self stimulating or compulsive behaviors. The child experiencing the obsession must be aware of the obsession but not be able to control the influence of his/her own thought patterns.
  • Yes
  • No

In general, this question will be most appropriately answered in the affirmative if the child has a diagnosis of a severe Obsessive Compulsive Disorder or a severe Anxiety Disorder. Again, this is only going to be answered "yes" in rare and extreme cases. This does not apply to a child with sensory needs that cause them to engage in repetitive behaviors. Keep in mind that the question indicates that the child must be aware of the obsession but not be able to control the influence of their own thought pattern.


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