Placer County Glossary of Mental Health and Substance Abuse Terms

Glossary taken from the American Academy of Pediatrics webpage

• Chapter Action Kit at - http://www2.aap.org/commpeds/dochs/mentalhealth/

The following is a list of key concepts and terms that are commonly used in the fields of mental health and substance abuse. Many of these terms have been defined by federal agencies, particularly the Substance Abuse and Mental Health Services Administration. This is not an exhaustive list, but it represents many of the concepts, services, and models of care that are used by mental health and substance abuse programs, services, and systems that serve children, adolescents, and their families.

Assessment

• An assessment is a professional, comprehensive, and individualized review of child* and family needs that is conducted when services are first sought from a mental health professional (e.g. psychiatrist, psychologist, or social worker). The assessment of the child includes a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community. An assessment also evaluates the strengths and resources of the child and family. Any decisions about treatment and supports should be made by the family and mental health professional together.

Case Management

• Case management is a service that helps people arrange for appropriate services and supports (e.g. health, mental health, educational, vocational, transportation, respite care, and recreational). Case managers typically organize and coordinate services and supports for children with mental health problems and their families. While numerous case management models exist, case management can involve assessment of child and family needs, development of service plans, contact with service providers on a child or family’s behalf, and work with the child and/or family to facilitate access to needed services.

Co-location

• Co-location is one strategy for integrating primary and behavioral health care services to address issues of access, quality, and fragmented delivery systems in children’s mental health. Generally, this term refers to models whereby mental health professionals are co-located within primary care settings, or primary care clinicians are co-located within mental health programs, typically public programs. In cases where primary care settings co-locate mental health professionals, examples of models include large co-located multispecialty group practices (e.g. behavioral care and primary care), community governed nonprofit health centers, and traditional private primary care offices. In the latter, business arrangements may include an employee of a mental health agency who is “out-stationed” in the primary care office, a self-employed mental health professional who is renting or using space in the primary care office, or a mental health professional who is employed by the primary care practice. (See Resources for Further Information for information on co-location models in primary care settings.)
  * For purposes of this Glossary, the term “child” is used to refer to children and adolescents from birth through 21 years of age.

Consumer

• “Consumer” is the term used in the mental health system to describe a person who is a client or user of mental health services. This term embodies principles of self-determination, choice, and child/family-centered care—central to the recent movement toward “reform” or “transformation” of the public mental health system. Mental health consumers often convey these principles in the expression, “Nothing about us without us.”

Crisis residential treatment services

• This term refers to short-term, 24-hour care provided in a nonhospital setting during a mental health crisis. For example, when a child becomes aggressive and uncontrollable, despite in-home supports, a parent can temporarily place the child in a crisis residential treatment service. This care is designed to avoid inpatient hospitalization, help stabilize the child, and determine the next appropriate step.

Cultural competence

• Cultural competence refers to a set of congruent practice skills, attitudes, policies, and structures that come together in a system, in an agency, or among professionals and enable that system or those professionals to work effectively in cross-cultural situations. Cultural competency is the acceptance and respect for difference, continuing self-assessment regarding one’s own or another culture, attention to the dynamics of difference, ongoing development of cultural knowledge and resources, and flexibility within service models to work toward better meeting the needs of diverse populations. These areas can be along the dimensions of race, ethnicity, gender, gender identity, sexual orientation, socioeconomic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies.

Culturally competent organizations

• Culturally competent organizations have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally. The organizations have the capacity to value diversity, conduct self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to diversity and the cultural contexts of the communities they serve. They incorporate these components into policy-making, administration, practice, service delivery, and systematically involve consumers, key stakeholders, and communities.

Day treatment

• Day treatment includes special education, counseling, parent training, vocational training, skill building, crisis intervention, and recreational therapy, lasting at least 4 hours a day. These programs work in conjunction with, and may be provided by, mental health, recreation, and education organizations.

Diagnostic evaluation

• The goals of a diagnostic evaluation (general psychiatric evaluation) are:
• To establish a psychiatric diagnosis.
• To collect data that are sufficient to permit a case formulation.
• To develop an initial treatment plan, with particular consideration of any immediate interventions that may be needed to ensure the patient's safety, or, if the evaluation is a reassessment of a patient in long-term treatment, to revise the plan of treatment in accord with new perspectives gained from the evaluation.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)

• The DSM-IV is the official manual of mental health problems developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other health and mental health care providers use this reference book to understand and diagnose mental health problems. Insurance companies and health care providers also use the terms and explanations in this book when categorizing or describing mental health problems.

Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version

• DSM-PC Child and Adolescent Version provides a step-by-step guide for the primary care clinicians to help assess, diagnose, and refer mental health conditions. It includes symptom listings for simple, comprehensive diagnoses, mental/physical disorder differential diagnosis for psychosocial problems, enhanced communication between colleagues by DSM-IV compatibility, and easy-to-use charts, tables, and text.

Dual diagnosis

• A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis.

Early intervention

• Early intervention is a process used to recognize mental, emotional, behavioral, and/or learning problems and to respond to factors that put individuals at risk of developing mental health problems before they become established and more difficult to treat. Early intervention can help children get better in less time and can prevent problems from developing or becoming worse. Early intervention processes use validated screening tools to identify children with or at risk for mental health problems; include consultation by trained professionals with parents, teachers and other caregivers; and work with children in their natural environments to provide needed supports and guidance.

Early intervention (EI) program

• The Early Intervention program was created as a result of the Individuals with Disabilities Education Act (IDEA), originally passed by Congress in 1986. States subsequently passed legislation to support and operationalize the system.
• There are two separate EI programs for young children who have or are at risk of having a disability or other special need that may affect their development, health, or education: the Infant-Toddler program covers children from birth through age two. The Preschool program covers children from three to five (or until the child enters kindergarten). Primary responsibility for each of these programs is assigned to a lead agency; these assignments vary from state to state. Children participating in the Infant-Toddler Program are eligible for such services as a multi-disciplinary evaluation, service coordination, individualized family service plan (IFSP), and an array of assistive and supportive services. Agencies may render a charge for some of these services, though services cannot be denied because of a family’s inability to pay. Children participating in the Preschool Program are entitled to free and appropriate special education service in the least restrictive environment through the local school system. Services may include a multi-disciplinary evaluation, individualized education program (IEP), and an array of assistive and supportive services.

Emergency and Crisis Services

• Crisis intervention services are used in emergency situations to provide immediate intervention or care when children are, or are at high risk of becoming, a danger to themselves or others, or are experiencing acute psychotic episodes or other emergency events (e.g. suicide). Such services are available 24 hours a day, 7 days a week, and provide screening, psychiatric evaluation, emergency intervention and treatment, stabilization services, and referral to community services and resources. Examples include telephone crisis hotlines, suicide hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care.

Evidence-based programs

• Evidence-based programs incorporate significant and relevant practices based on scientifically based research that obtains reliable and valid knowledge by (1) employing systematic, empirical methods that draw on observation or experiment; (2) involving rigorous data analyses that are adequate to test the stated hypotheses and justify the general conclusions drawn; (3) relying on measurements or observational methods that provide reliable and valid data across evaluators and observers, across multiple measurements and observations, and across studies by the same or different investigators.

Evidence-based practices

• These are practices that research has shown to produce consistently good outcomes and applicable across varied populations.

Family-centered care

• Family-centered care means that families have a primary decision-making role in the care and education of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory, and nation. The term typically is used when describing mental health systems of care. Family-driven care includes the following.
• Choosing supports, services, and providers.
• Promoting the inclusion of current, innovative treatments and therapies.
• Setting goals.
• Designing and implementing programs.
• Supporting the youth/consumer to guide care as appropriate.
• Monitoring outcomes.
• Determining the effectiveness of all efforts to promote the mental health of children and youth.

Family self-help

• Self-help groups are based on the premise that people who share a condition have similar concerns, or have a family member with a condition also share common experiences and, therefore, can help each other by providing information, as well as practical and emotional support. Self-help groups are peer led and range from small, informal groups to well-organized national networks. Family-run organizations may include drop-in centers and case management, employment, housing, crisis, and family support programs.

Family Support Services

• Family support services refer to help designed to keep the family together, while coping with the mental health problems that affect them. These services may include consumer information workshops, in-home supports, family therapy, parenting training, crisis services, and respite care.

Inpatient hospitalization

• This term refers to intensive mental health treatment that is provided in a hospital setting 24 hours a day.
• Inpatient hospitalization provides.
• Short-term treatment in cases where a child is in crisis and may be a danger to self or others.
• Diagnosis and treatment when the patient cannot be evaluated or treated appropriately in an outpatient setting.

Intake/Screening

•  These services are designed to briefly assess the type and degree of a child’s mental health condition to determine whether services are needed and to link a child to the most appropriate and available service. Services may include interviews, psychological testing, physical examinations, including speech/hearing, and laboratory studies.

Integrated care

• This term refers to a range of strategies and models to integrate primary and behavioral health care in to improve children’s access to mental health services and supports, reduce duplication and fragmentation of services, and improve the quality of care.
• These models can include, but are not limited to, the following.
• Initiatives to improve collaboration between independent, office-based primary care clinicians and mental health professionals
  (e.g. referrals by primary care clinicians to mental health professionals).
• Embedding primary care clinicians within public mental health programs; comprehensive programs that offer primary and
  behavioral health care through one administrative entity.
• Co-location of behavioral health providers in primary care offices. (See Resources for Further Information for information on
  integrated care).

Linguistic competence

• Linguistic competence is the capacity of an organization and its personnel to communicate effectively, and convey information in a way that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities.
•  Linguistic competence involves policy, structures, practices, procedures, and dedicated resources, including the following.
• Bilingual/bicultural or multilingual/multicultural staff.
• Sign language interpretation services.
• TTY and other assistive technology devices.
• Print materials in easy-to-read, low-literacy, picture and symbol formats.

Mental Health

• Mental health is the state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity.

Mental Health parity

• Mental health parity refers to providing the same insurance coverage for mental health treatment as that offered for medical and surgical treatments. The federal Mental Health Parity Act was passed in 1996 and established parity in lifetime benefit limits and annual limits. Many mental health advocates have recently substituted the term “equity” for parity.

Mental illness

• Mental illness collectively refers to all mental disorders, defined as health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination) associated with distress and/or impaired functioning. Mental disorders feature abnormalities in cognition, emotion or mood, and the highest integrative aspects of human behavior, such as social interactions.

Mental Health Problems

• This term refers to signs and symptoms of insufficient intensity or duration to meet the criteria for any mental disorder.

Person-centered plan (PCP)

• This term, or such similar terms as plan of care and plan of service, refers to a document that is developed through a process focused on and directed by the individual (consumer) and his or her family or advocate. It identifies the consumer’s desired outcomes and determines the supports and services needed to achieve the desired outcomes (Michigan Mental Health Code, 1995). In the case of child and adolescent consumers, the PCP is developed with input from the child, family, mental health professional(s), and representatives of involved agencies and schools. Many public mental health systems require development and documentation of such a plan and incorporate a review of the plan into periodic audits of service providers.

Residential treatment centers

• Residential treatment centers provide services 24 hours a day for children with serious emotional disturbances who require constant supervision and care, and can usually serve more than 12 children at a time. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually more long-term than inpatient hospitalization. Residential treatment centers also are known as therapeutic group homes. The primary purpose of residential treatment is to improve overall functioning, including social and behavioral skills, so the individual can function adequately in the community, either at home or independently.

Respite care

• Respite care is a service that provides a break for families who have a child with a serious emotional disturbance. Trained parents or counselors take care of the child for a brief period of time to give families relief from the strain of caring for the child. This type of care can be provided in the home or in another location. These services may be offered to families on a periodic or routine basis.

Screening

• Screening is a process used to inform parents and professionals about the physical, cognitive, and emotional strengths and needs of a child. It is designed to determine whether children may be at-risk of having behavioral or emotional conditions that warrant further review and/or intervention. Mental health screening is designed to identify social and emotional development needs in children as early as possible to prevent potential mental health problems from developing or worsening.
• Screening is conducted by an adequately trained professional (e.g. health care provider, social worker, psychologist, or counselor) and uses objective, accurate, reliable, and validated instruments and methods.
• Screening does not result in definitive statements about a child’s problem nor does it draw a conclusion about a mental health disorder or diagnosis.

Serious emotional disturbances

• Serious emotional disturbances are diagnosable disorders in children and adolescents that severely disrupt their daily functioning in the home, school, or community. Serious emotional disturbances may include depression, ADHD, anxiety, bipolar disorder, conduct disorder, eating disorders, or other conditions contributing to severe functional impairment.

System of Care

• System of Care is an evidence-based approach to the care of children and adolescents with serious emotional disturbances and their families. It incorporates a broad array of services and supports that are organized into a coordinated network, integrate care planning and management across multiple levels, are culturally and linguistically competent, and build meaningful partnerships with families and youth at service delivery and policy levels.
• Guiding principles in a System of Care specify that services should be.
• Comprehensive, incorporating a broad array of services and supports.
• Individualized.
• Provided in the least restrictive, appropriate setting.
• Coordinated both at the system and service delivery levels.
• Involve families and youth as full partners.
• Emphasize early identification and intervention.

Treatment

• Treatment is a type of service, support, or clinical intervention that is designed to address identified emotional, psychological, and social needs of a child and/or family. The term often refers to therapy and counseling that is repeated over a course of time, as determined by the child and/or family (depending on the age of the child) together with a service provider. Treatment includes, but is not limited to, hospitalization, partial hospitalization, outpatient services, evaluation, various psychotherapies, and medication monitoring.

Treatment plan

• A treatment plan is a plan of care that is designed especially for each child and family, based on individual strengths and needs. Ideally, mental health professionals develop the plan with input from a child’s family. (See Person-centered plan.) The plan establishes goals and summarizes appropriate treatment and services to meet the special needs of the child and family.

Wrap-around services

• Wrap-around services refer to a package of unique community services and natural supports that are flexible and tailored to meet the unique needs of children with serious emotional disturbances.
• Wrap-around services are based on a definable planning process and are designed for children and their families to achieve a positive set of outcomes in the home setting.
• Services are provided by multidisciplinary teams that may include case managers, psychiatrists, nurses, social workers, vocational specialists, substance abuse specialists, community workers, and family members or caregivers.