Next Steps: Critical Time Transition Program

About this Program

Hillside’s Next Steps: Critical Time Transition Program (CTTP) provides post-hospital discharge services to youth who have been boarding for at least 72 consecutive hours within a hospital’s emergency psychiatric or inpatient psych/medical setting. This program is ideal for youth who have experienced high utilization of hospital acute care settings and have not been able to access other community programs. Next Steps: CTTP is intended to serve youth with complex needs, including mental health conditions, co-occurring substance abuse and/or intellectual or developmental disabilities, who have otherwise been unable to achieve psychosocial and clinical stabilization via identified available options.

Once accepted to the program, youth can be discharged from the hospital to their home; directly into a transitional residential services bed (TRS), if available and appropriate; or to a community location, such as a group home. Youth can remain in the Next Steps program for up to 9 months, receiving care management services, with the option to occupy a TRS bed for up to 120 days any time during enrollment in the program and based on TRS bed availability and assessment.

While in the program, youth will have access to care management services and transitional beds (if available) including:

• Care coordination
• Family and youth peer advocacy
• Educational and vocational coordination
• Recreation services
• Mental health counseling
• Nursing care management
• Behavioral support
• Supervision and assistance from direct care staff

Referrals to Next Steps: CTTP are only accepted directly from a hospital. The following criteria are necessary for a referral to the program:

• The youth must have an identified residence other than CTTP for their discharge disposition (e.g., return home, group home).
• The youth must have already been referred to other community service providers resulting in denials or the youth/family declining services.
• The youth and their family must be willing to regularly and actively engage with the Next Steps: CTTP team, as well as all identified community-based service providers.
• The youth must not require a higher level of care than a community-based setting, and/or have been accepted to a higher level of care but is awaiting admission to that program (e.g., RTF).
• The youth must not have been ordered to detention or for court-ordered clinical assessment or placement by Family or Criminal Court, or require medical withdrawal management/medical detox or inpatient medical or psychiatric care.
• The youth must have health insurance.

The following criteria apply to the eligibility of youth to utilize a transitional residential services bed (TRS) during enrollment in CTTP:

• The youth must be able to self-administer all of their medication with minimal supervision and support.
• The youth must be independent with ADLs and not require 1:1 supervision to complete ADLs.
• The youth must not require 24/7 nursing care or monitoring due to a medical or psychiatric condition.
• The youth must not be assessed to be at high risk for violence or aggression, fire-setting or elopement, or require a locked facility.
• The youth must not be assessed to be actively at risk for suicidal or significant self-harming behaviors.
• The youth must be able to be safely served in a restraint-free setting.
• The youth must be verbal and not reliant on assistive technology in order to communicate.

Locations

Monroe Campus

1183 Monroe Avenue
Rochester, NY 14620

Contact Information

For details about this or any Hillside program, contact us 24 hours a day at 585-256-7500 or info@hillside.com

This Program is Supported by the Office of Mental Health