psychiatry rehabilitation

1. PSYCHIATRIC
REHABILITATION
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2. 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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3. 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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4. 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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5. 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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6. 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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7. 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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8. 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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9. 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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10. 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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11. 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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12. Community Support Services
• Is defined as those activities designed to
ease an individual’s immediate and
continued community adjustment
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13. 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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14. 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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15. 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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16. 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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17. 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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18. 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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19. 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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20. 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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21. 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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22. 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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23. 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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24. 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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25. 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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26. 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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27. 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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28. 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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29. Disability
1. 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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30. 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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31. 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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32. 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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33. 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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34. 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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35. 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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