The Four Quadrant Model is a proposed model for the clinical integration of mental well being and behavioral wellness services. A focus on the prevalence of co-occurring disorders (i.e. depression and alcoholism) is paramount in this model. The Four Quadrant Model builds on the 1998 consensus document for mental well being and substance abuse/addiction service integration. This model for a comprehensive, continuous and integrated program of care describes differing levels of mental health and substance abuse integration and clinician competencies based on the four-quadrant model, divided into severity for each disorder:
>?? ?Quadrant I: Low mental wellness ? low substance abuse, served in primary care
>?? ?Quadrant II: High mental well being ? low substance abuse, served in the mental health system by staff who have substance abuse competency
>?? ?Quadrant III: Low mental wellness ? high substance abuse, served in the substance abuse program by staff who have mental health competency
>?? ?Quadrant IV: High mental health ? high substance abuse, served by a fully integrated mental health and substance abuse program
The Four Quadrant model is not intended to be prescriptive about what happens in every quadrant, but to serve as a conceptual framework for collaborative planning in each local program. Ideally it would be employed as a component of collaborative planning for each new behavioral well being and community mental healthcare internet site, with the local provider(s) of public behavioral health services utilizing the framework to choose who will do what and how coordination for each and every individual served will be assured.
The use of the Four Quadrant Model to consider subsets of the population, the significant system elements and clinical roles would result in the following broad approaches:
QUADRANT I
Low behavioral wellness ? low physical well being complexity/risk, served in primary care with behavioral wellness care staff on website very low/low people served by the principle care provider, with the behavioral health care staff serving those with slightly elevated health or behavioral well being risk.
The principle care providers give primary care services and uses regular behavioral wellness screening tools and practice guidelines to serve most individuals in the primary care practice. Use of standardized behavioral well being tools by the principle care providers and a tracking/registry program focuses referrals of a subset of the population to the behavioral wellness clinician. The role of the primary care based behavioral wellness clinician is to provide formal and informal consultation to the principle care providers as nicely as to offer behavioral health triage and assessment, brief treatment services to the patient, referral to community and educational resources, and well being risk education. Behavioral well being clinical and support services may possibly contain individual or group services, use of cognitive behavioral therapy, psycho-education, brief substance abuse intervention, and limited case management. The behavioral health clinician need to be competent in both mental wellness and substance abuse assessment and service planning. The principle care provider prescribes psychotropic medications utilizing treatment algorithms and has access to psychiatric consultation concerning medication management.
The consumer of care, by seeking care in primary care, has selected a ?clinical home.? Consistent with proper clinical practice, that really should be honored. The primary care and specialty behavioral health program need to develop protocols, nonetheless, that spell out how acute behavioral health episodes or high-risk customers will be handled. This will also lead to clarity concerning the ?clinical home? of customers with significant persistent mental illness who are presently stable, which need to be based upon consumer option and the specifics of the community collaboration.
QUADRANT II
High behavioral wellness ? low physical health complexity/risk, served in a specialty behavioral wellness system that coordinates with the principle care providers.
The principle care provider provides primary care services and collaborates with the specialty behavioral wellness providers to assure coordinated care for individuals. Psychiatric consultation for the principle care providers might be an element in these complex behavioral well being situations, but it more likely that psychotropic medication management will be handled by the specialty behavioral wellness system. The role of the specialty behavioral wellness clinician is to offer behavioral health assessment, arrange for or deliver specialty behavioral wellness services, assure case management related to housing and other community supports, assure that the consumer has access to wellness care, and create a primary care communication approach (e.g., e-mail, v-mail, face to face) that assures coordinated service planning, especially in regard to medication management.
Specialty behavioral well being clinical and support services will vary based upon state and county level planning and financing some localities may encompass the full range of services provided by specialty behavioral well being systems which includes:
Specialty Mental Health Services
>?? ?Crisis respite facilities
>?? ?24/7 crisis telephone
>?? ?Crisis residential facilities
>?? ?Mobile crisis team
>?? ?Crisis observation 23 hour beds
>?? ?Urgent care walk in clinic
>?? ?Locked sub-acute residential
>?? ?Inpatient (voluntary and involuntary)
>?? ?Dual diagnosis inpatient
>?? ?Hospital discharge planning
>?? ?Partial hospitalization
>?? ?In-property stabilization
>?? ?Outreach to homeless shelters
>?? ?Outreach to jail/corrections
>?? ?Outreach to other unique populations
>?? ?Individual/family treatment /counseling
>?? ?Group treatment/counseling
>?? ?Dual diagnosis treatment groups
>?? ?Multifamily groups
>?? ?Psychiatric evaluation/consultation
>?? ?Psychiatric prescribing/management
>?? ?Advice nurse (medication issues)
>?? ?Psychological testing
>?? ?Services for homebound frail or disabled
>?? ?Specialized services for older adults
>?? ?Brokerage case management
>?? ?24/7 intensive home /community case management
>?? ?School-based assessment and treatment
>?? ?Supported classroom
>?? ?Stabilization classroom
>?? ?Day treatment (adult, adolescent, child)
>?? ?Supported employment /supported education
>?? ?Transitional services for young adults
>?? ?Individual skill creating /coaching
>?? ?Intensive peer support
>?? ?After school structured services
>?? ?Summer every day structure and support
Specialty Substance Abuse Services
>?? ?Sobering sites
>?? ?Social detoxification/residential
>?? ?Outpatient medical detoxification
>?? ?Inpatient medical detoxification
>?? ?Pre-treatment groups
>?? ?Intensive outpatient treatment
>?? ?Outpatient treatment
>?? ?Day treatment
>?? ?Aftercare/12 step groups
>?? ?Narcotic replacement treatment
Residential Services
>?? ?Boarding homes
>?? ?Adult residential treatment
>?? ?Child/adolescent residential treatment
>?? ?Transitional housing
>?? ?Adult family homes
>?? ?Treatment foster care
>?? ?Low income housing (dedicated to behavioral wellness customers)
Supports for Serious Persistent Mental Wellness Populations
>?? ?Representative payee/monetary services
>?? ?Time limited transitional groups
>?? ?Parent support groups
>?? ?Youth support groups
>?? ?Dual diagnosis education/support groups
>?? ?Caregiver/family members support groups
>?? ?Youth right after school normalizing activities
>?? ?Youth tutors/mentors
The behavioral wellness clinician must be competent in both mental wellness and substance abuse assessment and service planning. A certain standard of practice ought to be adopted that defines the strategies and frequency of communication with principle care providers. Note that this quadrant is where most public sector behavioral well being customers currently can be discovered.
QUADRANT III
Low behavioral wellness ? high physical wellness complexity/risk, served in the primary care/medical specialty system with behavioral wellness staff on site in primary or medical specialty care, coordinating with all medical care providers such as illness managers.
The principle care providers provides primary care services, works with medical specialty providers and illness managers (e.g. diabetes, asthma) to manage the physical wellness problems of the individual and uses regular behavioral health screening tools and practice guidelines to serve most individuals in the primary care practice. Use of standardized behavioral wellness tools by the principle care providers and a tracking/registry program focuses referrals of a subset of the population to the behavioral health clinician. The role of the primary care or medical specialty based behavioral well being clinician is to provide behavioral well being triage and assessment, consultation to the principle care providers or treatment services to the patient, referral to community and educational resources, and well being risk education. Behavioral health clinical and support services might incorporate individual or group services, use of cognitive behavioral therapy, psycho-education, brief substance abuse intervention, and limited case management. The behavioral well being clinician need to be competent in both mental well being and substance abuse assessment and service planning. The principle care provider prescribes psychotropic medications using treatment algorithms and has access to psychiatric consultation regarding medication management.
Depending on the setting, the behavioral well being clinician may also serve as a health educator regarding way of life and chronic well being conditions found in the general public (diabetes, asthma) or conditions discovered in at-risk populations (Hepatitis C, HIV). These population-based services, as articulated by Bob Dyer, would include: patient education, activity planning prompting skill assessment skill constructing and, mutual support. In addition to these disease management services, the behavioral well being clinician may possibly serve as a physician extender, supporting effective use of physician time by problem solving with acute or chronic patients, as nicely as working with patients on medication compliance problems.
Specialty healthcare and illness management programs could also integrate depression screening into a wide array of self management and rehabilitation programs, building on present study findings concerning the frequency and impact of depression in cardiovascular or diabetes populations.
QUADRANT IV
High behavioral well being ? high physical health complexity/risk, served in both the specialty behavioral wellness and primary care/medical specialty systems in addition to the behavioral well being case manager, there might be a illness manager, in which case the two managers work at a high level of coordination with one yet another and other members of the team.
The principle care providers works with medical specialty providers and disease managers (e.g. diabetes, asthma) to manage the physical health issues of the individual, although collaborating with the behavioral wellness program in the planning and delivery of behavioral health clinical and support services, which incorporate those listed in Quadrant II. Psychiatric consultation is a key element in these most complex situations. The role of the specialty behavioral well being clinician is to offer behavioral well being assessment, arrange for or deliver specialty behavioral wellness services, assure case management related to housing and other community supports, and collaborate at a high level with the healthcare program team. The behavioral wellness clinician ought to be competent in both mental well being and substance abuse assessment and service planning.
In some settings, behavioral health services may be integrated with specialty provider teams (for example, Kaiser has behavioral wellness clinicians in OB/GYN working with substance abusing pregnant girls). With the extension of illness management programs into Medicaid health plans, there is the likelihood of coordinating with disease managers in addition to healthcare providers. The behavioral wellness clinician and disease manager need to assure they are not duplicating tasks, but working together to support the needs of the consumer. A distinct regular of practice should be adopted that defines the approaches and frequency of communication.
sandusky interview with bob costas sandusky interview with bob costas live oak mark kelly mark kelly jeff goldblum uc berkeley
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.