Tier 3: Intensive Community-Based Services and Supports

Tier 3 services are designed to help children and youth with significant mental health or substance use concerns and their families so that the child can remain at home and in the community. Staying at home with their family and in their community is best for a child or youth. However, there are complex situations where families, other caregivers, extended family members, and providers are doing what they can, and it is not working. Tier 3 services are meant to bring your family and youth together with the people in your support network and providers who support your child to work towards your goals and meet your unique needs. These approaches “wrap around” your family. Tier 3 services are intensive, so you need to go through an assessment and an intake through a state agency:

  • Contact the NH Bureau for Children’s Behavioral Health to talk with a staff member about your situation and find out if you are eligible. 
  • If you have one, talk with your Division of Children, Youth, and Families (DCYF) caseworker. Contact your primary care or behavioral health provider about accessing Tier 3 support.

Tier 3 Care Is Provided by:

  • NH Care Management Entities (CMEs) for Enhanced Care Coordination:
  • Intensive In-Home Support Providers
  • Multisystemic Therapy Providers 
  • Intensive Outpatient Programs

What Are Tier 3 Services?

Sometimes, a family or youth needs more than outpatient treatment or case management to address their mental health concerns or substance use. In those situations, the child or youth struggles in multiple aspects of their life. For example, a child may receive special education services for concerns at school plus treatment by a mental health clinician, but things are not improving. These families or youth often need help sorting through and managing the various support systems in their lives. The primary goal at Tier 3 is for the child or youth to stay at home while receiving an organized set of intensive services and treatments matched to what they want and need.

Tier 3 Supports and Services

Early Childhood Wraparound is a family-driven planning and team-based care coordination process for families experiencing significant challenges while raising a young child, from birth through 5, with or at risk of developing an emotional or behavioral concern. Early Childhood Wraparound is structured to help the family understand their strengths, create goals, figure out what they need, bring their existing support network and providers together, and help them connect them to new services they need (including essential services such as housing, food, and crisis supports). Children need a caring and consistent environment for healthy development, so that Early Childhood Wraparound can be an important service for families with young children in high-risk situations.

Families and Systems Together (FAST) Forward is New Hampshire’s version of a proven family-centered planning and care coordination process to support children and youth aged 5-21 with mental health or substance use concerns. FAST Forward is for families that have tried less intensive treatments or have complex situations requiring them to be involved in more than one “system” (such as special education, mental health, child protection, and juvenile justice). Wraparound helps the family and youth identify their strengths and needs. Then it brings together a team of helpers (including other family members and service providers) to support the family’s plan so the child can remain at home. FAST Forward was established in New Hampshire in 2012 and has helped hundreds of families support their children or youth.

Learn more about NH FAST Forward Wraparound

In-Home Supports and Services are provided by trained staff members who support the family in learning proven ways to support their child because of mental health issues in the home. Typically, In-Home Supports are accessed through a referral from a state or local agency or through FAST Forward or Early Childhood Wraparound.

Learn more about these supports

Intensive Outpatient treatment programs are for people with significant mental health or substance use challenges that require more than Tier 2 community-based outpatient treatment alone, but are not so immediate that they require detoxification or round-the-clock supervision. The programs require the youth to go to the providers' space for several hours a day, where individual and group treatment is provided. Programs differ in who they serve, age ranges, and what treatments they provide. There are only a handful of IOPs in New Hampshire for people under the age of 18.

Psychology Today list of IOPs in New Hampshire 

Multisystemic Therapy (MST) is a proven, intensive community-based treatment for youth aged 12 – 17 who are involved or at risk for involvement with the juvenile justice system and have significant substance abuse issues or mental health concerns. MST services are provided in the youth’s home or other community setting and can only be accessed through a referral through the NH Division of Children, Youth, and Families. Services are provided at least once per week (up to daily), with clinical services available to youth and their family 24 hours a day for an average of three to five months. The program aims to promote prosocial behavior and reduce criminal activity by addressing the core causes of delinquent and antisocial conduct. The program works on the reasons for the youth’s antisocial behavior by assessing what happens in the home, school, and community settings. MST is provided in New Hampshire by Community Solutions Inc. (CSI)