Targeted Case Management

The referred child must meet specific needs based criteria and are at-risk due to one of the following:

• At high-risk for medical compromise
• Offending or victimization.
• A victim of abuse, neglect or violence.
• Medical complexity that requires frequent care planning.
• Diagnosis of or suspected diagnosis of a developmental delay or a diagnosed physical or mental condition that has a high probability of resulting in developmental delay and/or intellectual disability and are less than age six.
• Children and youth who at any time during the past year have had a mental or behavioral diagnosis and/or diagnostic criterion that meets the coding and definition criteria specified in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

The referred client must be a pregnant women who is at-risk for medical compromise due to one of the following:
• Failure to take advantage of necessary prenatal care or services.
• Non-compliance with a prescribed medical regime.
• Inability to coordinate multiple medical, social or other services due to an unstable medical condition in need of stabilization.
• An inability to understand medical directions because of comprehension barriers
• The at-risk infant is eligible for case management under this population to the second birthday.
• Specific symptoms or disturbances make the member unable to access behavioral health, medical, educational, social, developmental or other supportive services required. 

The referred client must be at-risk of substance abuse, dependency or addiction or diagnosed with a substance disorder, psychoactive substance dependency, or induced organic mental disorders, as defined in the current edition of the DSM or Medicaid eligible individuals who received treatment in an intensive alcohol and drug abuse treatment program or chemical dependence hospital

The referred client must have a suspected diagnosis of intellectual disability. Intellectual disability is defined as significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior or a related disability. Related disability is defined as a severe, chronic condition found to be closely related to intellectual disability and meet the six following conditions:
1. It is manifested before 22 years of age for intellectual disability and related disabilities.
2. It is likely to continue indefinitely.
3. It results in substantial functional limitation in three or more of the following areas of major life activities: self-care, understanding and use of language, learning, mobility, self-direction and capacity for independent living.
4. The person’s needs require supervision due to impaired judgment, limited capabilities, behavior problems, abusive or assaultive behavior, or because of drug effects/medical monitoring. 
5. The person is in need of services directed toward acquiring skills to function as independently as possible or to prevent regression or loss of current optimal functional status.
6. Specific symptoms or disturbances make the member unable to access behavioral health, medical, educational, social, developmental or other supportive services required. 

The referred client must have identified at least two risk factors, one of which involves active substance use in any of the three domains.

Alcohol and Other Drug (AOD) Risk Factors
• Individual early (pre-adolescent) and adult with persistent problem behaviors:
– Risk-taking, high sensation-seeking behaviors (in adolescents, consider developmental stages).
– Antisocial behavior.
– AOD use that does not meet diagnostic criteria (in adolescents, includes experimental use; in adults, increased use when stressed or self-medicating due to other symptoms/problems).

Family
• Low perception of harm (increases likelihood of initiating use).
• Perception of parental/sibling acceptance/approval of substance abuse (a strong predictor of adolescent substance abuse; linked to alcohol initiation during family gatherings).
• Lack of mutual attachment and nurturing by parents/caregivers with a family history of alcoholism.
• Chaotic home environment with substance use in-home.

Peers/School/Community
• Associating with substance-using peers.
• Drinking in social settings or having peers who do. 
• Accessibility to AOD.
• Availability of AOD.
• Misperceptions about extent and acceptability of drug-abusing behavior.
• Beliefs that drug abuse is generally tolerated.

The referred client must have been diagnosed with a genetic disorder, have preliminary laboratory tests showing evidence of a disorder or individuals who have a family member with an illness that is associated with a genetic disorder. The individual must be referred by the doctor of the individual who has been diagnosed with an illness caused by a genetic disorder.