Comprehensive Continuum of Care in Mental Health: Today and Tomorrow

1. Chapter 8Continuum of Care

2. Continuum of care involves an integrated system of care that guides and tracks clients over time through a comprehensive array of health services spanning all levels of intensity of care. PubMed.com, 2009

3. Learning Objectives After studying this chapter, you should be able to • Explain the meaning of the phrases, continuum of care, case management, and managed care • Differentiate the roles of the utilization review nurse, quality assurance nurse, and discharge planner • Identify the implications of managed care for both psychiatric clients and nurses • Construct the continuum of care available to a client with the diagnosis of major depression

4. Learning Objectives (cont.) • Articulate how the components of community-based health care compare with those of community mental health • Identify the types of community mental health services that are available to psychiatric clients • Analyze the role of the community mental health nurse • Discuss the concept or model of medical home coalition • Describe the role of the nurse informaticist as it relates to continuum of care

5. Inpatient Care • Acute care facilities • Subacute care units • Long-term care (LTC) facilities

6. Community Mental Health • Emergency psychiatric care and crisis intervention • Partial hospitalization • Day-treatment programs • Case management • Community-based residential treatment programs • Aftercare and rehabilitation • Consultation and support • Psychiatric home care

7. Major Ideological Beliefs Influencing Community Mental Health • Involvement and concern with the total community population • Emphasis on primary prevention • Orientation toward social treatment goals • Comprehensive continuity of care • Belief that community mental health should involve total citizen participation in need determination, policy establishment, service delivery, and evaluation of programs

8. Types of Community Mental Health Services • Psychiatric emergency care • Day-treatment programs • Residentialtreatment programs • Psychiatric home care • Aftercare and rehabilitation

9. Criteria for Psychiatric Home Care Services Established by the Health Care Financing Administration (HCFA): • A psychiatrist must certify that the client is homebound. • The client must have a DSM-IV-TR psychiatric diagnosis that is acute or an acute exacerbation of a chronic illness. • The client must require the specialized knowledge, skills, and abilities of a psychiatric registered nurse.

10. The psychiatric nurse practicing in the community provides counseling, support, and coordination of care and health teaching. The role is comprehensive and challenging and requires adaptability and flexibility.

11. Role of the Community Mental Health Nurse Areas of concern to community mental health nurses include the following: • The quality of direct client care • Societal and community conditions that could contribute to health problems

12. The Continuum of Care in the 21st Century • Internet resources for clinicians • Direct therapeutic resources • Cybertherapy • Primary care practice • Medical home coalition

13. Case management Community-based health care Community mental health Community Mental Health Centers Act Continuum of care Cybertherapy Deinstitutionalization Discharge planner Managed care Managed care nurse National Mental Health Act Programs for Assertive Community Treatment (PACT) Pre-admission Screening and Annual Resident Review (PASARR) Prospective payment system (PPS) Subacute care unit Utilization review nurse Key Terms

14. Interview a client in your present clinical practice setting. Assess the client’s medical and mental health needs. What health care service(s) should be used to ensure an effective continuum of care for the client? Are such services available in the community? If not, what alternative interventions could be employed? ? Reflection