Served Population Definition

Target Population Definition (SMI)

Target Population Definition (SED)

Eligible Population Definition

DHS/DMH Designation of Target Population:  Serious Mental Illness (SMI) for Publicly Funded MH Services

AGE: Must be 18 years of age or older

Individuals with serious mental illness are adults whose emotional or behavioral functioning is so impaired as to interfere with their capacity to remain in the community without supportive treatment. The mental impairment is severe and persistent and may result in a limitation of their capacities for primary activities of daily living, interpersonal relationships, homemaking, self-care, employment or recreation. The mental impairment may limit their ability to seek or receive local, state or federal assistance such as housing, medical and dental care, rehabilitation services, income assistance and food stamps, or protective services.

Must meet I+(II or III):

  1. Diagnoses:
    The client must have one of the following diagnoses that meets DSM-5 criteria and which is the focus of the treatment being provided:

    • Delusional Disorder (F22)
    • Brief Psychotic Disorder (F23)
    • Schizophreniform Disorder (F20.81)
    • Schizophrenia (F20.9)
    • Schizoaffective Disorder (F25.x)
    • Catatonia Associated with Another Mental Disorder (Catatonia Specifier) (F06.1)
    • Other Specified Schizophrenia Spectrum and Other Psychotic Disorder (F28)
    • Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (F29)
    • Bipolar I Disorder (F31.xx)
    • Bipolar II Disorder (F31.81)
    • Cyclothymic Disorder (F34.0)
    • Unspecified Bipolar and Related Disorder (F31.9)
    • Disruptive Mood Dysregulation Disorder (F34.8)
    • Major Depressive Disorder Single episode (F32.xx)
    • Major Depressive Disorder, Recurrent episode (F33.xx)
    • Obsessive-Compulsive Disorder (F42)
    • Posttraumatic Stress Disorder (F43.10)
    • Anorexia Nervosa (F50.0x)
    • Bulimia Nervosa (F50.2)
    • Postpartum Depression (F53.0)
    • Puerperal Psychosis (F53.1)
    • Factitious Disorder Imposed on Another (F68.A)
  2. Treatment History
    (Treatment history covers the client's lifetime treatment and is restricted to treatment for the DSM-5 diagnosis specified in Section I.)

    To qualify under this section, the client must meet at least ONE of the criteria below:

    1. Continuous treatment of 6 months or more, including treatment during adolescence, in one, or a combination of, the following modalities: inpatient treatment, day treatment or partial hospitalization.
    2. Six months continuous residence in residential programming (e.g., long-term care facility or assisted, supported or supervised residential programs)
    3. Two or more admissions of any duration to inpatient treatment, day treatment, partial hospitalization or residential programming within a 12-month period.
    4. A history of using the following outpatient services over a 1 year period, either continuously or intermittently: psychotropic medication management, case management, outreach and engagement services.
    5. Previous treatment in an outpatient modality, and a history of at least one mental health psychiatric hospitalization.
  3. Functional Criteria
    (Functional criteria has been purposely narrowed to descriptors of the most serious levels of functional impairment and are not intended to reflect the full range of possible impairment.)

    To qualify under this section, the client must meet at least TWO of the criteria, A1 through A7, or B1 as a result of the DSM-5 diagnosis specified in Section I.

    1. The client:
      1. Has a serious impairment in social, occupational or school functioning.
      2. Is unemployed or working only part-time due to mental illness and not for reasons of physical disability or some other role responsibility (e.g., student or primary caregiver for dependent family member); is employed in a sheltered setting or supportive work situation, or has markedly limited work skills.
      3. Requires help to seek public financial assistance for out-of-hospital maintenance (e.g., Medicaid, SSI, SSDI, other indicators).
      4. Does not seek appropriate supportive community services, e.g. recreational, educational or vocational support services, without assistance.
      5. Lacks supportive social systems in the community (e.g., no intimate or confiding relationship with anyone in their personal life, no close friends or group affiliations, is highly transient or has inability to co-exist within family setting).
      6. Requires assistance in basic life and survival skills (must be reminded to take medication, must have transportation to mental health clinic and other supportive services, needs assistance in self-care, household management, food preparation or money management, etc., is homeless or at risk of becoming homeless).
      7. Exhibits inappropriate or dangerous social behavior which results in demand for intervention by the mental health and/or judicial/legal system.
    2. The client does not currently meet the functional criteria listed above, however, the client:
      1. Is currently receiving treatment, has a history within the past 5 years of functional impairment meeting TWO of the functional criteria listed above which persisted for at least 1 months, and there is documentation supporting the professional judgement that regression in functional impairment would occur without continuing treatment.

FOR CHILDREN

Target Population:  Serious Emotional Disturbance (SED) for Publicly Funded MH Services

Age:  Birth through 17 years of age

Individuals determined on the basis of a mental health assessment to have a serious emotional disturbance and display serious cognitive, emotional, and behavioral dysfunctions.

Must meet I+(II or III):

  1. Diagnoses:
    One of the following DSM-5 diagnoses which is the focus of the treatment being provided:
    • Attention-Deficit/Hyperactivity Disorder (F90.x)
    • Other Specified Attention-Deficit/Hyperactivity Disorder (F90.8)
    • Unspecified Attention-Deficit/Hyperactivity Disorder (F90.9)
    • Tourette's Disorder (F95.2)
    • Delusional Disorder (F22)
    • Brief Psychotic Disorder (F23)
    • Schizophreniform Disorder (F20.81)
    • Schizophrenia (F20.9)
    • Schizoaffective Disorder (F25.0)
    • Catatonia Associated with Another Mental Disorder (Catatonia Specifier) (F06.1)
    • Other Specified Schizophrenia Spectrum and Other Psychotic Disorder (F28)
    • Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (F29)
    • Bipolar I Disorder (F31.xx)
    • Bipolar II Disorder (F31.81)
    • Cyclothymic Disorder (F34.0)
    • Disruptive Mood Dysregulation Disorder (F34.8)
    • Major Depressive Disorder Single episode (F32.xx)
    • Major Depressive Disorder, Recurrent episode (F33.xx)
    • Obsessive-Compulsive Disorder (F42)
    • Posttraumatic Stress Disorder (F43.10)
    • Anorexia Nervosa (F50.0x)
    • Bulimia Nervosa (F50.2)
    • Intermittent Explosive Disorder (F63.81)
    • Postpartum Depression (F53.0)
    • Puerperal Psychosis (F53.1)
    • Factitious Disorder Imposed on Another (F68.A)
  2. Treatment History

    Treatment history cover's the client's lifetime treatment and is restricted to treatment for a DSM I diagnosis specified in Section I.

    The youth must meet at least ONE of the criteria below:

    1. Continuous treatment of 6 months or more in one, or a combination of, the following: inpatient treatment; day treatment; or partial hospitalization.
    2. Six months continuous residence in a residential treatment center.
    3. Two or more admissions of any duration to inpatient treatment, day treatment, partial hospitalization or residential treatment programming within a 12 month period.
    4. A history of using the following outpatient services over a 1 year period, either continuously or intermittently: psychotropic medication management, case management or SASS/intensive community based services. 
    5. Previous treatment in an outpatient modality and a history of at least one mental health psychiatric hospitalization.
  3. Functional Criteria

    (Functional criteria has been purposely narrowed to descriptors of the most serious levels of functional impairment and are not intended to reflect the full range of possible impairments.)

    The youth must meet criteria for functional impairment in TWO of the following areas. The functional impairment must: 1) be the result of the mental health problems for which the child is or will be receiving care and 2) expected to persist in the absence of treatment.

    1. Functioning in self care - Impairment in age-appropriate self care skills is manifested by a person's consistent inability to take care of personal grooming, hygiene, clothes and meeting of nutritional needs.
    2. Functioning in community - Impairment in community functioning is manifested by a consistent lack of age appropriate behavioral controls, decision-making, judgment and value systems which results in potential involvement or involvement the juvenile justice system.
    3. Functioning in social relationships - Impairment of social relationships is manifested by the consistent inability to develop and maintain satisfactory relationships with peers and adults.
    4. Functioning in the family - Impairment in family functioning is manifested by a pattern of 1) disregard for safety and welfare of self or others, e.g., fire setting, serious and chronic destructiveness, 2) significantly disruptive behavior exemplified by repeated and/or unprovoked violence to siblings and/or parents, or 3) inability to conform to reasonable limitations and expectations. The degree of impairment requires intensive (i.e. beyond age appropriate) supervision by parent/caregiver and may result in removal from the family or its equivalent.
    5. Functioning at school - Impairment in functioning at school is manifested by the inability to pursue educational goals in a normal time frame - e.g. consistently failing grades, repeated truancy, expulsion, property damage or violence towards others --that cannot be remediated by a classroom setting (whether traditional or specialized).