Mental Health Transitional Living Homes

Mental Health Transitional Living (MHTL) Homes are part of a new program that will provide an added layer of services within the Colorado Department of Human Services' behavioral health continuum of care. These homes, which are run by the Office of Civil and Forensic Mental Health, will be used as a transition to a less restrictive setting for individuals with mental health conditions. Clients may stay as long as necessary for stabilization with an ultimate goal of reintegrating clients successfully in the community. The focus is to provide continued support with social and life skills development, as well as assistance with other daily life activities based on the client’s individual needs.

Frequently asked questions about Mental Health Transitional Living Homes

What are the MHTL Homes? 
The Mental Health Transitional Living (MHTL) Homes, established by HB22-1303, are part of a new program that will provide an added layer of services within the Colorado Department of Human Services' (CDHS) behavioral health continuum of care. To ensure this program is successful for both communities and clients, we are engaging in a two-year pilot admissions process, focusing on those individuals who can most safely transition to the MHTL Homes. This means the MHTL homes will not admit populations with a lower likelihood to succeed in MHTL homes, including individuals with a recent history of eloping/escaping from other treatment facilities, individuals with any recent assaultive behaviors, individuals with behaviors that have required restraints or seclusions, any behaviors that may require a locked facility, as well as registered sex offenders. We may then consider, through a community-involved process, an expansion of this program to include other populations. CDHS, however, has decided it will not place registered sex offenders in MHTL homes within 1,000 feet of a school.

These homes will be used as a transition to a less restrictive setting for individuals with mental health conditions. Clients may stay as long as necessary for stabilization, with the ultimate goal of successfully reintegrating clients into the community. The focus is to provide continued support with social and life skills development and assistance with other daily life activities based on the client’s individual needs.

History and purpose of the law
In the bipartisan HB22-1303, sponsored by Rep. Judy Amabile, Rep. Shane Sandridge, Sen. Faith Winter, and Sen. Jim Smallwood, the legislature declared an urgent need for community-based mental health residential beds throughout the state. Because of this gap in services, the bill directed CDHS to create, develop, or contract to add at least 125 beds at mental health residential facilities throughout the state for adults in need of ongoing supportive services.

This is a new initiative that will fill the gap between existing mental health treatment options,  which either include an inpatient hospital stay or outpatient treatment in the community. This initiative offers a unique hybrid approach, offering a less restrictive - but still with 24-7 supervision - and non-time bound alternative to inpatient stays. Often, individuals are discharged from hospitals before they are ready to transition into the community, whereas the MHTL Homes will allow individuals to stay as long as necessary. The homes provide comprehensive residential outpatient treatment, which is different from typical outpatient treatment, where individuals are not provided a place to live while in treatment. Residents will reside full-time with 24-7 supervision at the MHTL Homes, where they will benefit from a range of services aimed at enhancing daily life skills, facilitating job connections, and providing other essential supports to prepare them to transition into the community successfully following their stay at the MHTL Homes. Clinical and psychiatric services will be accessible within the community, forming a cohesive network of care that fosters sustainable long-term transitions back into community living.

Who are the MHTL Homes designed to serve?
Specifically, the MHTL Homes are designed to serve individuals who are ready to transition into the community with a primary diagnosis of mental illness and may also have co-occurring substance use disorder. Clients can either be admitted from hospitals once a medical professional has determined they are ready for release, or they can be admitted from the community if a provider refers them to the program. These clients are mildly acute, meaning they are safe to be in the community with some level of care and supervision. CDHS reviews an individual's history of prior mental health or substance use treatment, and if an individual was successful in those placements, it’s likely they will be successful in the MHTL Homes. CDHS also reviews if an individual has support systems in the community - this could be family and friends that could offer support, or other treatment or service connections.

We use all the information gathered in our admission process to decide whether individuals are able to succeed in the community. If the department can't get the required information, the individual won't be accepted into the MHTL Homes.

How will the residents be supervised? 
The MHTL Homes have staff around 24 hours a day, 7 days a week. These staff members are trained to help individuals who are at-risk with mental illness or substance use disorders.  Staff have different kinds of training, licenses or certifications. Some professionals can provide medicine, some are therapists or social workers, some are managers or supervisors, and some are medical professionals. We adjust the number and type of staff based on what the residents need.

What kind of care do the MHTL Homes provide?
The MHTL Homes offer three different levels of care. Each home focuses on providing just one of these levels, so there's no mixing of clients between them. Here's what each level offers:

• Transitional Living (Level 1): This is the lowest level of care, meaning it's intended for individuals who are almost ready to live independently - they may need additional support in everyday tasks like taking medicine, getting a job, cleaning, and going to appointments. These homes are not for individuals who have significant medical needs, recent substance use or individuals with behaviors that would require a locked facility. These homes help clients transition safely back into the community.
• Supported Therapeutic Transitional Living (Level 2): These homes provide a higher level of care, including clinical services (i.e. - group therapy, individual therapy, family therapy). These homes have intensive case managers,who focus on discharge planning, which means working with the client and the care team to identify what the plan for discharge is and connecting the individual with all necessary and ongoing wrap-around supports (i.e. - therapy services, medication management, housing, etcetera). These homes also have psychiatric professionals onsite who provide ongoing medication management services to the clients. This level is for people who might need more support managing their mental illness and/or substance use disorder.
• ​Nursing Homes (Level 3): These homes provide services including intensive psychiatric and skilled nursing care with coordinated whole-person care. Services include social and life skills activities and training, therapeutic services, group activities and medication management and dispensation in a 24-hour care environment for those who may need nursing or medical care due to ongoing, complex medical condition. 

How do you determine who can be served in these homes?

We have a team that takes care of admitting people and organizing these admissions. This team makes sure that we only accept people who can be successful in the community. This helps us avoid taking in anyone who might not fit well with what we offer. When someone is referred to us, our team, which is comprised of admissions and coordination experts, along with clinical and medical subject experts when required, evaluates a range of information to determine if an individual meets placement criteria . Here is specifically what we look at:

• Their mental health diagnosis and any past problems with drugs or alcohol.
• Any legal charges they've had.
• Whether they've been a danger to themselves or others
  • For example, if they’ve had any recent assaultive behaviors, behaviors that have required restraints or seclusions, and/or any behaviors that may require a locked facility, the individual would be ineligible for our programs.
• The most recent tests or evaluations from psychologists or psychiatrists.
• Their strengths and needs.
• Any medical conditions they have.
• If they've ever had mental health or substance abuse treatment before, and if so, when, where, for how long, and what happened.
• If they've ever run away from treatment.
• If they have any community resources, such as family, friends, etc that could help them.
• We might talk to them, their treatment team, or their family or friends to get more information if needed.
• The services they need and whether those are available at the home.

We use all this information to decide if they are able to be successful in the community. If we don't get all the information we need, or if something seems unclear, we'll follow up. If we can't get the information we need, we won't accept them into our homes.

Do you accept people with criminal records?

Yes, we do consider individuals with criminal backgrounds. We review the information provided by the referring entity and check it against national databases, police reports, and Colorado courts database. We look at their criminal history to make sure it's safe for them, the other people in the home, and the community. If we're unsure if someone can meet our safety requirements, we won't accept them into the homes.

When making admissions decisions, we look at whether or not an individual is ready to be placed in these homes - this means they are not a danger to themselves or others, they don’t have behavioral problems that require restraint, seclusion, and/or a locked facility, they haven’t had a history of  aggressive behaviors in the past 6 months and they don’t require 24/7 nursing/medical care.

Do you have homes where men and women live together?

Yes, some of our MHTL Homes have both men and women living together. Individuals who share rooms are always the same gender. And some people even have their own rooms, so they don't have roommates at all. We offer the options to individuals who are eligible for our services so they have the ability to choose what is best for them and their preferences.

How did you choose where the homes are located?

The state is contracting with providers for some of these homes and issued what’s called a “request for applications” so that vendors could apply to run these programs with the state. The vendor who owns and operates these homes applied for this program.

When reviewing the applications, we chose the vendors we decided to work with carefully. We selected vendors based on their experience working with the individuals we will serve in these homes, reference checks, and background checks. We also had to make sure the proposed physical locations followed all the rules for this kind of program (i.e. - assisted living residence).

Every home we contract with was already being used to serve individuals in need in some way (i.e. - group homes, assisted living residences, sober living homes).

Where will the homes be located?

• Three homes will be in Colorado Springs. One of those is already open and operating.
• Three homes will be in Lakewood. 
• Two homes will be located in Northglenn.
• Two homes will be in Denver. 
• Two homes will be in Pueblo West.
• One home is open in Highlands Ranch.
• One home will be in Westminster.

Levels of care

Level 1 (Transitional living): This level of care is geared toward supporting an individual's transition to full independence. These supports include an intensive case manager, social and recreational activities, such as yoga and meditation, resume building, attending appointments, and support with activities of daily living, such as taking medications, cleaning, laundry, and more. Mental health transitional living homes will support discharge planning with the goal of community reintegration.

Level 2 (Supported therapeutic transitional living): These homes provide whole-person care. This will include in-home clinical services, intensive case management services, and a prescriber to oversee ongoing medication management. These services are geared toward individuals who may need more prompting and support. This level of care may also include increased staffing patterns to provide care and services to individuals.

Level 3 (Nursing Home transitional living): Nursing home transitional living is defined as a therapeutic environment of care and treatment within a residential setting. Services include intensive psychiatric and skilled nursing care alongside coordinated whole-person care. This includes daily social and life skills activities/training, therapeutic services, group activities and medication management and dispensation. This level of care provides 24-hour care for those who may need nursing or medical care due to ongoing, complex medical conditions. 

Resources

Admissions/Referrals

The Mental Health Transitional Living Homes are opening up the referral process to all entities in Colorado for state residents who meet Level 1 placement criteria. The primary goal is to alleviate the waitlist for the mental health hospitals by stepping down the individuals who have been awaiting appropriate community based resources.

MHTL placement criteria

Level 1 — Transitional Living

Responsible for daily living with regular support such as medication dispensation, ongoing minimal therapeutic activities, and regularly scheduled daily activities, and an emphasis on ADL support. Such programming is geared towards supporting the individual's engagement and work towards full independence.

Inclusionary Criteria	Exclusionary Criteria
Age 18 or older	Major medical conditions that require ongoing 24/7 nursing care
Diagnosis of Serious Mental Illness (SMI) consistent with DSM (most current version) criteria, which requires and can reasonably be expected to respond to therapeutic interventions	Primary problem is social, legal, economic, or one of physical health without a concurrent mental health diagnosis or admission is being used as an alternative to incarceration
Individual is unable to be treated outside of a supervised 24-hour transition living environment	Behavioral problems that may require restraint, seclusion, and/or a locked facility
Demonstrates a need for continued medication management	Substance use which requires detoxification and/or inpatient services for stabilization.
Individuals require 24/7 care to develop skills necessary for daily living to assist with successful reintegration into lower level services (i.e. - outpatient) and/or into the community where the focus is working towards full independence.	Individuals with Intellectual Developmental Disabilities (IDD) that do not have a co-occurring SMI
Individual's current/proposed living environment does not provide the support and access to therapeutic services needed
Does not exhibit chronic inappropriate behavior which disrupts the activities of the home and/or is harmful to self or others
Individual is able to function with some independence and participate in community-based activities for limited periods of time that are structured to develop skills for functioning outside of a more controlled residential environment
Potential risk of harm to self or others, aggressive behaviors may have occurred in their life, but no less than 6 months ago
History of substance use disorder, but no use of such substances within the last 3 months and/or no active current substance use and/or not at high risk of relapse.

 

Level 2 — Supported Therapeutic Transitional Living

Coordinated whole person care to include daily social and life skills activities/ training, therapeutic services, group activities, medication dispensation. Programmatic services are geared for those needing more hands-on care due to continued management of mental illness. Services include medication management and dispensation, daily living, social, and life skills activities, therapeutic services, support with ADL’s, etc. May also require enhanced supervision to ensure safety, which may include, but is not limited to, increased staffing patterns and delayed egress systems.

Inclusionary Criteria	Exclusionary Criteria*
Age 18 or older	Major medical conditions that require ongoing 24/7 nursing care
Diagnosis of Serious Mental Illness (SMI) consistent with DSM (most current version) criteria, which requires and can reasonably be expected to respond to therapeutic interventions	Primary problem is social, legal, economic, or one of physical health without a concurrent mental health diagnosis or admission is being used as an alternative to incarceration
Individual is unable to be treated outside of a supervised 24-hour transition living environment	Behavioral problems that may require restraint, seclusion, and/or a locked facility
Demonstrates a need for ongoing medication, psychiatric, and behavior management support	Substance use which requires detoxification and/or inpatient services for stabilization.
Individual requires 24/7 care to develop skills necessary for daily living, where the focus is on continued treatment services, to assist with successful reintegration into lower level services, community based services and/or full independence	Individuals with Intellectual Developmental Disabilities (IDD) that do not have a co-occurring SMI
Individual's current/proposed living environment does not provide the support and access to therapeutic services needed
Individual presents with behavioral concerns that can be adequately managed within the care setting
Individuals require residential supervision and active support to ensure the adequate, effective coping skills necessary to live safely in the community, participate in self-care and treatment. Supervision may be enhanced based on the needs of the individual (i.e. - constant staff supervision, planned structured activities, delayed egress, etc).
Potential risk of harm to self or others, aggressive behaviors may have occurred in their life and within the past 3 months
May require continued outpatient short-term or extended short-term certification pursuant to C.R.S 27-65-111
History of substance use disorder

 

Level 3 — Nursing Home Transitional Living

Coordinated whole-person care to include daily social and life skills activities/ training, therapeutic services, group activities, medication management and dispensation. 24-hour care is provided for those who need nursing or medical care due to ongoing, complex medical conditions. 

INCLUSIONARY CRITERIA	EXCLUSIONARY CRITERIA
Age 18 or older	Primary problem is social, legal, economic or one of physical health without a concurrent mental health dignosis or admission is being used as an alternative to incarceration
Diagnosis of Serious Mental Illness (SMI) consistent with DSM (most current version) diagnosis, which requires and can reasonabily be expected to respond to therapeutic interventions.	Behavioral problems that may require restraint,  seclusion and/or a locked facility
Individual in unable to be treated outside of a supervised 10-hour mental health transitional living home environment.	Substance use which requires detoxification and/or inpatient services for stabilization
Demonstrates a need for continued medication, psychiatric and behavior management support	Individuals with Intellectual Development Disabilites (IDD) that do not have a co-occuring SMI
Individual requires 10/7 care to develop skills necessary for daily living, where the focus is on continued treatment services, to assist with successful reintegration into lower-level services, community based services  and/or full independence.
Individual's current/proposed living environment does not provide the support and access to therapeutic services needed.
Individual presents with behavioral concerns, which may include aggressive, assaultive, history or pattern of elopement, etc. that can be adequately managed within the care setting.
Individuals require residential supervision and active support to ensure the adequate, effective coping skills necessary to live safely in the community, participate in self-care and treatment. Supervision may be enhanced based on the needs of the individual (i.e.-constant staff supervision, planned structured activites, delayed egree, etc.)
Potential risk of harm to self or others, aggressive behaviors may have occured in their life and within the past three (3) months.
May require continued outpatient short-term or extended short-term certification pursuant to C.R.S. 27-65-107 or 108 and long-term pursuant to C.R.S. 27-65-109.
History of substance use disorder
Required 24/7 nursing care services

 

Contact information

Bonnie Wright
Division Director, Mental Health Transitional Living Homes
bonnie.wright@state.co.us

Please direct media inquiries to:

Stephanie Fredrickson
Communications Manager
stephanie.fredrickson@state.co.us

For general questions, email cdhs_transitional.livinghomes@state.co.us or call 303.866.5170.

For questions regarding the referral and admissions process, contact the Admissions and Coordination team:
Lindsay Lucas and RaeAnna Sporrer
cdhs_admissions.mhtl@state.co.us