PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:

Amendment of Parts 501, 507 and 587 of Title 14 NYCRR.

Mental Health Services - General Provisions; Community Based Service System for Children; Operation of Outpatient Programs.

To add a definition of "serious emotional disturbance".

A new subdivision (g) is added to Section 501.2 of Title 14 NYCRR as follows:

Section 507.4 of Title 14 NYCRR is amended to read as follows:

(a) Expanded children's services is a program established to provide new and expanded community based services to [seriously emotionally disturbed] children and adolescents with serious emotional disturbance and to provide grants for 100 percent net deficit costs for those services.

(b) [Seriously emotionally disturbed means persons under the age of 18 who have serious, persistent disability which:

(1) is caused by a medically determined mental illness as evidenced by primary psychiatric diagnosis made by a physician, or is caused by other serious emotional disturbance as defined by the regulations of the commissioner;

(2) has continued or is likely to continue for a period of at least one year;

(3) would cause substantial risk of psychiatric hospitalization in the absence of community based mental health services; and

(4) results in substantial functional limitations in two or more of the following areas:

(i) self-care at an appropriate developmental level;

(ii) receptive and expressive language;

(iii) learning;

(iv) self-direction; and

(v) capacity for living in a family environment.]

(1) ability to care for self (e.g., personal hygiene; obtaining and eating food; dressing; avoiding injuries); or

(2) family life (e.g., capacity to live in a family or family like environment; relationships with parents or substitute parents, siblings and other relatives; behavior in family setting); or

(3) social relationships (e.g., establishing and maintaining friendships; interpersonal interactions with peers, neighbors and other adults; social skills; compliance with social norms; play and appropriate use of leisure time); or

(4) self-direction/self-control (e.g., ability to sustain focused attention for a long enough period of time to permit completion of age-appropriate tasks; behavioral self-control; appropriate judgment and value systems; decision-making ability); or

(5) ability to learn (e.g., school achievement and attendance; receptive and expressive language; relationships with teachers; behavior in school).

Paragraph (8) of subdivision (a) of Section 587.4 of Title 14 NYCRR is amended to read as follows:

(8) [Extended impairment in functioning due to] Serious emotional disturbance means a child or adolescent has a designated mental illness diagnosis according to the most current Diagnostic and Statistical Manual of Mental Disorders (DSM) and has experienced functional limitations due to emotional disturbance over the past 12 months on a continuous or intermittent basis. The functional problems must be moderate in at least two of the following areas or severe in at least one of the following areas:

(i) [self-care] ability to care for self (e.g., personal hygiene; obtaining and eating food; dressing; avoiding injuries); or

(ii) family life (e.g., capacity to live in a family or family like environment; relationships with parents or substitute parents, siblings and other relatives; behavior in family setting); or

(iii) social relationships (e.g., establishing and maintaining friendships; interpersonal interactions with peers, neighbors and other adults; social skills; compliance with social norms; play and appropriate use of leisure time); or

(iv) self-direction/self-control (e.g., ability to sustain focused attention for a long enough period of time to permit completion of age-appropriate tasks; behavioral self-control; appropriate [judgement] judgment and value systems; decision-making ability); or

(v) [learning] ability to learn (e.g., school achievement and attendance; receptive and expressive language; relationships with teachers; behavior in school).

Nonsubstantive changes were made in section 587.4(a)(8)(v).

Joyce Donohue, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, (518) 474-1331, email: [email protected]

A Job Impact Statement is not submitted with this notice because this consensus rule merely clarifies the definition of “serious emotional disturbance” and provides consistency with other Office regulations. There will be no impact on jobs and employment opportunities as a result of this rulemaking.

The agency received one letter of comment regarding the amendments to Part 501, 507 and 587 of Title 14 NYCRR.

Issue: The writer stated that his agency was strongly supportive of the creation of one definition of "serious emotional disturbance" that is based on the child's behavior over the past 12 months. Further, the writer supports the concept of the definition applying to all OMH children's programs and services. The writer felt that it would be helpful for OMH to ensure that all children's providers are made aware of this definition, and he suggested that OMH provide written communication of this change.

Response: OMH believes the writer makes a good point in this suggestion. It is the policy of the agency, when adopting a rule as final, to not only publish the Notice of Adoption in the State Register, but also to post the text of the rule and the adoption on the OMH website at http://www.omh.state.ny.us/omhweb/policy_and_regulations/. Providers of mental health services are strongly encouraged to visit this site to keep up to date on regulatory changes. In addition, this regulatory change will be shared via e-mail with providers.

Issue: The writer stated that the proposed definition of serious emotional disturbance does not reference an age. The writer further stated that he understands that the eligible ages will continue to be defined in each program, and he encourages OMH to clearly define the age limits in each of the program's guidance documents and regulations.

Response: The Office of Mental Health agrees conceptually with this suggestion and will continue to make every effort to ensure that the age of the children to be served appears in the various programs' guidance documents and regulations.

Issue: The writer is seeking clarification of the services under the category of "expanded community based services".

Response: The language referencing "expanded children's services" and "expanded community based services" is existing language in Section 507.4(a) and was not modified by this rule making. The reference within that subdivision that was modified referred to the term "seriously emotionally disturbed children and adolescents", which, as a result of this rule making, was changed to "children and adolescents with serious emotional disturbance" in keeping with the agency's policy of using respectful, "person-first" language. Any questions regarding agency policies or programs can always be addressed to appropriate agency personnel.