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Therapeutic Behavioral Services

What is TBS?

Therapeutic Behavioral Services (TBS) is available for eligible children who need short-term behavioral support in addition to any other mental health services they are receiving. The goal of TBS is 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 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, the child’s school, 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. TBS is provided in the child's home and other environments where the child's behaviors occur. Services are approved for 30 days at a time and are expected to produce the desired changes within a few months.

How does TBS work?

The TBS Specialist working with the child develops and implements a plan that smooth the fit between a child's behavior and the child's environment. When needed, the TBS Specialist’s first objective is to help respond to safety issues. After that, TBS unfolds in three phases:

The TBS Specialist begins by gaining an understanding of the child's behavior. The TBS Specialist then develops adaptive 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 or school staff follow a guideline to manage specific behaviors as they occur, or an incentive plan where the child is rewarded for choosing productive replacement behaviors.

Next, the TBS Specialist works directly with the child and those who care for the child. During this time, the TBS Specialist, the child, people in the environment where the behavior occurs, 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.

During the final phase, the TBS Specialist 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 targeted behaviors have been reduced and interventions and strategies have been transitioned to support persons. TBS may also need to stop if the child, caregiver, or persons in their environment (school, group home, etc.) are not compliant with TBS, or if the child does not appear to be benefiting from services or progress has reached a plateau.

How do I receive TBS through COFY?

To receive TBS, a child must be referred to Contra Costa County’s TBS team by another mental health provider. COFY is not able to receive clients/referrals directly. If you believe that your child or a child you know or work with may be eligible and would benefit from TBS, please contact the TBS Coordinator at Contra Costa County at: 925-521-5742.

TBS accepts referrals from many sources, such as probation officers, therapists, schools, day treatment programs, and psychiatrists, as long as the child is receiving other mental health services and meets the following eligibility requirements:

Eligible child or youth:

  1. Must have full-scope Medi-Cal.
  2. Must meet medical necessity criteria (or have a qualifying mental health diagnosis).
  3. Must be a member of a certified class by meeting one of the following criteria:

    • Currently living in a group home facility, RCL (Rate Classification Level) 12 or above and/or locked treatment facility
    • Has undergone at least one emergency psychiatric hospitalization related to his/her current presenting disability within the past 24 months
    • Is being considered for placement in a group home facility, RCL 12 or above, and/or a locked treatment facility
    • Has previously received TBS services
    • Must be receiving other mental health services