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TBS is an adjunct, intensive, individualized, one-to-one behavioral mental health service available to children/youth with serious emotional challenges and their families, who are under 21 years old and have full-scope Medi-Cal.
TBS is short-term and never a primary therapeutic intervention; it is always used in conjunction with a primary specialty mental health service.
TBS is available for children/youth who are being considered for placement in an RCL 12 or above or who meet the requirements of at risk of hospitalization in an acute care psychiatric facility.
TBS is designed to help children/youth and their parents/caregivers (when available) manage behaviors utilizing measurable goals based on the child’s and family’s needs.
TBS is available to help children avoid being placed in a higher level of care such as a residential treatment facility or to help children make a successful move to a lower level of care such as returning home after residential treatment.
TBS in conjunction with a Specialty Mental Health Service can help children/youth and parents/caregivers, foster parents, group home staff, and school staff or others to learn new ways of reducing and managing challenging behaviors as well as strategies and skills to increase the kinds of behavior that will allow children/youth to be successful in their current environment.
TBS can be provided anywhere in the community: at home, school, other places such as after-school programs,and other environments where the child's behaviors occur.
TBS is not appropriate for “suicide watch” consisting solely of supervision.
TBS is a short-term program that focuses on changing a child's behavior while emphasizing the child's strengths.
TBS works in collaboration with the child, the child's caregivers and the primary mental health provider to address 1 to 3 behaviors that jeopardize the child's ability to remain in his or her current home.A trained behavioral specialist will work intensively with a client to achieve the specific behavioral goals established.Services are approved for 30-60 days at a time and are expected to produce the desired changes within a few months.
When needed, the TBS staff's first objective is to help respond to safety issues. After that, TBS unfolds in three phases:
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TBS staff begins by gaining an understanding of the child's behavior. TBS then develops replacement behaviors for the child to use as alternatives to the undesirable behaviors. Strategies may include the development of a behavioral plan, such as a step-by-step process in which caregivers follow a guideline to manage specific behaviors as they occur, or an incentive plan where the child is rewarded for choosing productive replacement behaviors
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Next, TBS staff works directly with the child and those who care for the child. During this time, TBS staff, child and the child's caregivers are learning together and taking responsibility for their parts of the child's behavior plan. Interventions and strategies focus on improved self-management, self-awareness, and communication skills as well as positive reinforcement of desirable behaviors
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During the final phase, TBS staff oversees a transition plan to ensure that the positive behavioral changes will continue. A child graduates from TBS once the frequency, duration, and intensity of the 1 to 3 targeted behaviors have been reduced and interventions and strategies have been transitioned to support persons. TBS may also need to stop services if the child does not appear to be benefiting from services or progress has reached a plateau
There are specific criteria which must be met in order to be eligible for TBS services. More information on the eligibility criteria is available from Ettie Lee’s mental health department.
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What are examples of TBS interventions?
The TBS staff person provides behavior modeling, structure and support, and immediate, frequent, one-to-one behavior interventions which assist the child/youth in engaging in appropriate activities, minimizing impulsivity, and increasing social and community competencies by building or reinstating those daily living skills that will assist the child to live successfully in the community. The TBS provider also serves as a positive role model. Examples of TBS assistance are:
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Behavior/Impulse Control Interventions
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Reminding a child to take a time out when he/she becomes distressed
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Helping a child develop self-calming skills
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Offering praise and supporting self-recognition when a child controls himself
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Communication Skills Interventions
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Helping a child identify feelings he/she wants to communicate with parent
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Role-playing communication skills for child and for child and parent
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Modeling social interactions with others
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Going with a child on a youth group trip and discussing conflict resolution issues afterward
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Increasing child’s motivation to use good personal hygiene through praise and recognition, discussion of aspects of dress, hygiene, etc.
For additional information please contact:
Mental Health Services 626-620-2521
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