Table 1.

Texas 2004-2006 Youth Mental Health Service Packages

Service Package	Disorder	Intensity Level	Service Package Description
1.1	Externalizing Disorders (e.g., ADHD, Conduct or Oppositional Defiant Disorder)	Low	Skills Training. Youths with externalizing disorders and a moderate level of functional impairment. The focus of intervention is on psychosocial skill development and the enhancement of parenting skills, especially in child behavior management… This package is generally considered short-term and time-limited.
1.2	Internalizing Disorders (depressive or anxiety disorders)	Low	Therapy. Youths with depressive or anxiety disorders and a moderate level of functional impairment. The focus of intervention is on using Cognitive Behavioral Therapy (CBT). This package is generally considered short-term and time-limited.
2.1	Externalizing Disorders (MST option)	High	Skills Training-Multi-Systemic Therapy. Youths with externalizing disorders and high levels of severe disruptive or aggressive behaviors who are in the juvenile justice system and at high risk for out of home placement or further penetration in the juvenile justice system due to presenting behaviors. Intensive parent-to-parent peer support is available to the family. The family service plan is developed using a wraparound planning approach. Multi-Systemic Therapy is recommended if available.
2.2	Externalizing Disorders	High	Skills Training + wrap around service. Youths with externalizing disorders and moderate to high functional impairment at home, school or in the community. The need for intensive case management and significant caregiver support is indicated. The family service plan is developed using a wraparound planning approach. Multi-Systemic Therapy is either not appropriate (due to lack of juvenile justice involvement) or unavailable.
2.3	Internalizing Disorders	High	Therapy + wrap around services. Youths with depressive or anxiety disorders and a moderate to high level of problem severity or functional impairment. The focus of intervention is on CBT… Multiple family concerns and significant parental stress indicate the need for intensive case management and the availability of parent-to-parent peer support. The family service plan is developed using a wraparound planning approach.
2.4	Major Disorders: Bipolar, Schizophrenia, Major Depression with Psychosis, or other psychotic disorders	High	Medication + wrap around services. Youth with severe disorders who are not yet stable on medication. The major focus is on stabilizing the youth and providing information and support to the family.
3	Treatment Foster Care	High	Wrap around services. Youth at imminent risk of residential treatment placement. Parents retain custody although the youth may be at high risk of relinquishment of legal custody to the State to access residential mental health treatment or residential placement by the juvenile justice system. It is clinically determined that the child and family can progress with intensive community treatment, including treatment foster placement for the child, in lieu of residential treatment. Extensive training and support are available to the custodial parent or caretakers through clinicians and/or the treatment foster parent. The family service plan is developed throughout a wraparound planning approach.
4	Aftercare Services	Low	Medication Management. Youths who have stabilized in terms of problem severity and functioning and require only medication management to maintain their stability. Service package 4 can only be authorized if: 1) the caregiver refuses the recommended package, wants medication-only services and medication is clinically indicated; or 2) if the youth is NOT Medicaid eligible and the recommended service package is not available due to limited resources, but severe presenting problems that are responsive to medication suggest an authorization for service package 4 during the waiting period.
9	Not Eligible for Services	Low	Client is not eligible for services due to various findings from initial intake assessment. *This is not an official service package*