The number of steps in the mental health continuum of care is as numerous as the clients served and the mental health issues they struggle with daily. The client’s case manager is ultimately responsible for ensuring that there is no drop or gaps in services. The case manager coordinates services to ensure that the client’s needs are being met throughout the continuum of care. The services covered in this paper include Early Intervention services, case management, residential services, family support services, respite care services, day treatment and school-based day treatment, group home and residential treatment facilities, crisis intervention services, and hospitalization. Unfortunately, all these services are not available in every locale. Some additional services exist that are not covered here.
Early Intervention Services
Ideally, mental health care would begin with early intervention services. Early Intervention has been federally mandated since 1986; the federal government provides grants to each state to provide a variety of services for children from infancy to the age of three and their caregivers. Each state is allowed to set their own criteria for eligibility; however, the parameters of eligibility have been set by the federal government. Infants or toddlers who have disabilities or delays in physical, adaptive, social, cognitive, communication, and/or emotional development or who are at risk for developing disabilities or delays qualify for Early Intervention, usually at no cost to the family. (First Signs, 2009)
Early Intervention begins with the child’s primary care physician, who upon recognizing the delay would contact the local Department of Social Services (or the state’s equivalent branch of the Department of Health and Human Services). A social worker will be assigned who will explain the child and family’s rights, assist with setting up an evaluation, explain how insurance or Medicaid is used to access the services, and what an individual services plan is, how it will be developed, and coordinate services if immediate help is needed. Early Intervention can include any or all of the following services: speech therapy, feeding therapy, occupational therapy, physical therapy, group therapy, language pathology, audiological services, psychological services, respite services, assistive technology (devices and services that assist the individual with living as independently as possible with their disabilities, such as a hand-held computer to assist in communication), environmental modification (devices and technology that adapt the individual’s environment to meet the needs, such as a fence, security, or video/audio monitoring system to ensure the individual’s safety), nutritional education and services, transportation, counseling, support groups, vision services, case management and service coordination, and some medical, nursing, and health services. (Advocates for Children, n.d.)
Approximately six months before the child turns three, the child’s Early Intervention team comprised of the child, the child’s parents or caregiver, the case manager, an Early Intervention Official, a school/preschool official, and perhaps other individuals involved in the child’s Early Intervention such as therapists, physicians, or other professionals will meet to review the options for service transition or to determine if the child no longer needs services. At this time, the parents or caregiver will be informed of their options and the pros and cons of the options available to them. In most cases, if it is determined that the child needs continuing services, the child will begin preschool special education services such as Head Start, in-home residential services, and respite services, as well as continuing family support services. (Advocate for Children, n.d.)
Case management is provided by specially trained individuals who assist clients in accessing psychiatric, educational, social, vocational, legal, financial, and medical services. Case managers coordinate services that help the individual live successfully in the community and at home. The case manager must complete an annual assessment for each client to draw up a plan of care that identifies the client’s needs, support the client’s strengths, maintain and grow the client’s personal support systems and resources and work with the client or client’s family to set goals and objectives to address in the following year. The case manager plays a key role in the continuum of care for mental health clients by assisting the client in developing and discovering the client’s own personal community, networks, and support systems and by providing referrals or associations as the need arises. (Liberty Resources, n.d.)
Residential services are services that are received in the client’s home setting or within the client’s community of support. Residential services include in-home residential services and mental health support services; the primary differences in these two services are the intensity of services, the level of education needed for the service providers, and the rate of reimbursement, because mental health support services are more clinical in nature, often involving the monitoring of medical care and medication administration, mental health support providers need additional education to meet the client’s needs. With in-home residential services, service providers go to the home(s) of clients and work with the client on achieving specific goals outlined in a treatment program that are designed to assist the client with becoming more independent, self-sufficient, develop new social, behavioral, and recreational skills, as well as learning personal management and household maintenance skills with the goal of the client remaining in his or her community as a contributing member. (Community Support Services, n.d.)
Family Support Services
The job of being a caregiver can be tenuous, stressful, and non-thankful at times. Family support services are offered to provide support to the family or caregivers with the goal of strengthening the adults and supporting them in the roles they play with the client: nurturer, provider, and parent. The supports offered often involve group support (i.e. Autistic Parent’s Support Group), counseling, assistance in accessing information, improving problem-solving skills, supporting the positive view of parenting through difficult behavior, and education that assist parent and other care givers to cope with the constant demands on time, emotions, and stressors. (Surgeon General, n.d.)
Respite Care Services
Respite care services provide respite or relief to families and other care providers. The patient or client may have a short stay away from their home with individuals who are specially trained to provide care to these individuals. Respite care may be provided one-on-one in the client’s home or the home of the respite provider or may be available in a group-home setting with others receiving the same service or with others who live in a group home. The average amount of time for respite services varies per client, location, funding available, and level of need. Many families will have extended family members or friends who will attend required trainings to provide this service to their loved ones. (Surgeon General, n.d.)
Day Treatment Programs/School-based Day Treatment
Day treatment programs provide psychiatric treatment, group activities, and special education. It is designed to provide a fun, comfortable, and inviting atmosphere for individuals to socialize, access the community, and develop new skills. The staff ratio is generally state mandated but usually is equal to one staff person for every four clients. A client may access day treatment programs anywhere from one to seven days a week. School-based day treatment occurs in the school setting to assist students with dysfunctional behaviors or difficulty transitioning with functioning appropriately or increasing resilience to smooth transitions.
Group Home/Residential Treatment Facilities
Group homes typically have a resident total of approximately 10 people per home. Group homes provide 24 hour supervision and may be linked to day treatment programs, sponsored work programs, and specialized education programs. Group homes provide nutritional assistance, medication administration, and mental health monitoring with a strong emphasis on community. Group homes are frequently used as stopping place after discharge from a mental health hospital before beginning the transitioning process into the community and for those individuals who have difficulty or are unable to live fully independent lives.
Crisis Intervention Services
Clients may go into crisis due to any number of causes; the death of a family member, ineffective medication treatment, sickness, and trauma are three of the most frequent reasons for a person to go into crisis. Crisis intervention provides 24 hour supervision and intense therapeutic approaches with the goal of stabilizing the individual to prevent hospitalization. Crisis residence is also available; a crisis residence is a group home type of setting that provides short-term crisis intervention. Treatment usually lasts fewer than 15 days, and patients receive 24 hour supervision.
Hospitalization is the treatment of last resort. When all other services have failed, then hospitalization is the only option to get a patient stable enough to reenter society. To qualify for hospitalization, one must be deemed to be a danger to oneself or to others by a qualified mental health professional. Hospitalization is all too often initiated by the police department being called for domestic disturbances in which one or more persons are threatening to do harm to oneself or to others. In a psychiatric hospital, the patient will receive comprehensive services that are specifically designed for that individual including intense counseling, group therapy, medication therapy, among others. The length of time a patient is hospitalized has many variables that may include the success of treatments, medication effectiveness, and behavioral analysis (do they continue to pose a threat). Also available are partial or day hospitalization and outpatient clinics. Partial or day hospitalization provides the same care an individual would receive through hospital admission but the patient is allowed to return home every evening. Outpatient clinics provide counseling and psychiatric sessions that last 30 to 60 minutes each visit.
Different types of treatments and services are available in different communities, and some services may be the same but be called by a different name. Several of the programs on the continuum of care will offer the same or similar treatments and some offer very different treatments. No one treatment is right for every client; the most effective treatment will be those that are need-specific. The mental health care team is a valuable asset in deciding which service should be the next in the continuum of care.
Advocates for Children. (n.d.). The steps to Early Intervention: A guide for New York City parents. Advocates for Children of New York Organization. Retrieved from http://www.advocatesforchildren.org/pubs/ei2.html.
Community Support Services. (n.d.). Residential services. Community Support Services, Inc. Retrieved from http://www.css-md.org/residential.htm.
First Signs. (2009). Early Intervention. First Signs Organization. Retrieved from http://www.firstsigns.org/treatment/EI.htm.
Liberty Resources. (n.d.). Mental health case management. Liberty Resources. Retrieved from http://www.liberty-resources.org/programs/showprogram.crm?program=35.
Surgeon General. (n.d.). Mental health: A report of the Surgeon General: Support and assistance for families. Surgeon General. Retrieved from http://www.surgeongerneral.gov/library/mentalhealth/chapter3/sec8_1.htmo….