community psychiatric rehabilitation

PSYCHIATRIC REHABILITATION

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The goal of today’s presentation is to answer questions such as:

• What is the community psychiatric rehabilitation (CPR) program?

• Who is eligible for services?• What services are available through CPR?

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Community Psychiatric Rehabilitation

• Established in Missouri in 1989• Funded by both the Missouri Department of

Mental Health (DMH) and by Medicaid • Part of the rehabilitation option to the

Missouri State Medicaid Plan

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Community Psychiatric Rehabilitation

• CPR programs provide a range of mental health services to adults with serious and persistent mental illness and children and youth with serious emotional disturbances

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Services are designed to: • maximize independent functioning • promote the recovery and self-determination

process• increase interagency coordination and

collaboration in all aspects of the treatment planning process and

• reduce inpatient hospitalizations and out-of-home placements

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The core services that must be provided in a CPR program are:

• Evaluation• Community Support• Crisis Intervention• Medication Administration• Medication Services• Consultation and• Psychosocial Rehabilitation

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Evaluation

• Assessment and evaluation are crucial to the delivery of quality services since the findings of the assessment provide a foundation for determining service delivery needs and developing strategies for intervention and level of care

• Evaluation occurs at intake and annually after that

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The intake evaluation focuses on:• presenting problems • history of treatment • history in areas such as family, vocation,

education and community• current functional strengths and weaknesses • physical and medical complaints and• recommendations for treatment

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Annual evaluations focus on:

• changes over the past year in all areas of assessment

• update of diagnostic formulation and • recommendations for treatment

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Treatment Planning

• Treatment plans and treatment plan reviews are part of the evaluation package

• Treatment plans are developed from the assessment and in partnership with the consumer in order to have goals that are individualized and realistic

• Treatment plan reviews summarize progress toward goals for a three month period

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Community Support Services

• Many individuals with mental illness experience difficulty being included in the community and accessing community resources

• This is due in part to the segregation and isolation that they may have experienced, and in part to the disabilities associated with their mental illness

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Community Support Services

• Is defined as those activities designed to ease an individual’s immediate and continued community adjustment

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Community support activities include:• teaching community living skills • advocating for individuals and families• coordinating delivery of mental health

services with services provided by other agencies

• providing individualized guidance and support and

• monitoring progress in organized treatment programs

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Community Support Services

• Community support workers (CSW) are responsible to assure that appropriate resources are available to individuals and to support them in attaining their highest level of functioning in their families and in the community

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Community Support Services

• In order to be included in the community, individuals are assisted in filling legitimate, valued social roles such as worker, student, neighbor, voting citizen, church member, volunteer, spouse and parent

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A typical day for a team of CSWs might include:

• helping a person with a medical or psychiatric appointment

• monitoring a person’s mental health • developing or reviewing a treatment plan• providing support to someone in the hospital

and participating in hospital discharge planning

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A typical day (continued)• training/coaching in daily living skills such as

housekeeping, cooking, grooming, budgeting• training/coaching in community living skills

such as paying bills, taking the city bus, shopping for groceries within a budget or within special dietary constraints

• helping someone with an appointment at DFS, the housing authority or vocational rehabilitation

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A typical day (continued)

• For example, with vocational rehabilitation, CSW’s can help their client remember and keep appointments, complete paper work, and understand what is required when receiving services

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Crisis Intervention

• Crisis intervention services include telephone access and face-to-face emergency response. Interventions are available to the consumer 24 hours a day, 7 days a week

• Services are provided by Access Crisis Intervention (ACI) providers regionally (see handout) with back-up by program staff locally

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Crisis Intervention• Crisis personnel have access to a physician for

consultation purposes 24 hours a day• Crisis personnel assist clients in utilizing

natural supports or perhaps, if needed, in admission to an inpatient psychiatric facility

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Crisis Intervention

The goals of crisis service are to:• Provide immediate response, intervention and

referral for persons experiencing mental health crisis, whether in a rural, urban or metropolitan area

• Respond to crisis by providing community-based intervention in the least restrictive environment, e.g. home, school

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Crisis Intervention

• Avert the need for hospitalization to the greatest extent possible

• Stabilize persons in crisis and refer them to appropriate services to regain an optimal level of functioning and

• To mobilize and link individuals with services, resources and supports needed for ongoing care following a crisis, including natural support networks

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Medication Services

• Psychiatrists or Advanced Practice Nurses assess individuals in the need for medication as well as e ongoing management of the medication regimen.

• Services also include reviewing for side effects and providing education about medications

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Medication Administration

Medication administration services provide for: • coordination with pharmacies and indigent

drug programs • setting up medication boxes • monitoring of medication compliance • consumer and family education • therapeutic injection of medication

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Consultation Services CPR personnel often consult with human

service and other government agencies as well as natural and professional supports

The goals of consultation services are to: • provide direction to treatment • promote effective working relationships • heighten awareness of the characteristics and

needs of the population • advocate for an individual or group

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Psychosocial Rehabilitation Services

• Psychosocial rehabilitation services (PSR) are defined as a combination of goal-oriented rehabilitative services provided in a group setting as outlined in the person’s treatment plan

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Psychosocial Rehabilitation Services

Services focus on development of behaviors and abilities that allow the person to:

• fully participate in community living • maximize independence • enhance interpersonal relationships • develop support systems • Participate in meaningful recreation and

socialization activities that are appropriate to the age and interest of the person

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Psychosocial Rehabilitation Services

Some agencies may include pre-vocational services as part of PSR. These services are designed to assist a person in preparing for employment, including:

• interview and job application skills• therapeutic work opportunities• temporary employment opportunities• referral to a community-based agency that

specializes in the provision of vocational services

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Disability1. Social role functioning/family life – the ability to

sustain functionally the role of worker, student, homemaker, family member or a combination of these.

For children, consider their play and leisure activities, ability to establish or maintain satisfactory relationships with peers and adults, capacity to live in a family or the equivalent of a family, learning ability, self expression or ability to communicate effectively with others, and their ability to function in school.

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Disability

2. Daily living skills/self-care skills – the ability to engage in personal care (grooming, personal hygiene, etc.) and community living (handling individual finances, using community resources, performing household chores, interacting with peers, etc.), learning ability/self-direction and activities appropriate to the individual’s age and social role development.

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Diagnosis

A physician, advanced practice nurse, or licensed psychologist shall certify a primary diagnosis of any of the following, which may coexist with other psychiatric or medical diagnoses:

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Diagnosis• Schizophrenia (7 types)• Delusional disorder• Bipolar I disorders (4 types)• Bipolar II disorders • Psychotic disorders NOS• Major Depressive disorder – recurrent• Obsessive-Compulsive Disorder• Post Traumatic Stress Disorder• Borderline personality disorder• Anxiety disorders (5 types)

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Diagnosis(for children and youth only)

• Major depressive disorder, single episode• Bipolar disorder, not otherwise specified• Reactive attachment disorder of infancy or

early childhood

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Duration

is evidenced by one or more of the following occurrences:

• Psychiatric treatment more intensive than outpatient and received more than once in a lifetime (crisis services, alternative home care, partial hospital, inpatient)

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Duration

• Continuous residential care other than hospitalization, for a period long enough to disrupt the normal living situation

• Psychiatric disability has been present for one year or more and/or

• Treatment of a psychiatric disorder has been or will be required for longer than six months

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