CBH Continuum of Adult Services
All Services are for age 18 and up. Services marked (*) require preauthorization
Service / Elements of Treatment / Clinical Considerations / Specialty teams and Evidence Based Practices** (available at some providers)Community Treatment Supports
Continuity of Care Team (COC)* / Intense, short term and assertive case management available 24 hours per day. Services include outreach, engagement, assessment, linkages to community resources, intervention and advocacy / For members frequently using inpatient levels of care who do not have active case management services. Works to connect members to appropriate services to prevent unnecessary hospitalizations.
COC will work with members who are not yet CBH eligible or who have lost eligibility and will assist with the enrollment process.
COC is able to work with members with complex medical needs and ensure adequate follow up with physical health appointments.
Rapid Response Team (RRT)* / RRT provides short-term outreach services to adult consumers without case management services who have been identified as having been involuntarily committed 2 or more times in a 12-month period; or who have been seen frequently in Crisis Response Centers, inpatient units, or Mental Health Court; or who have had multiple contacts with the Mental Health Delegate. / Upon meeting with the individual, RRT will discuss available treatment options and psychosocial supports and make referrals as necessary. This may include the completion of a referral for Targeted Case Management.
Designed to be initiated by the Crisis Response Centers in lieu of hospitalization.
Certified Peer Specialist* / Certified Peer Specialists offer peer support, which is a specialized therapeutic interaction, conducted by self identified current or former members of behavioral health services who are trained and certified to offer support and assistance. They help others in their recovery; attain and manage their own home in the community; and pursue employment/and or educational goals. CPS provides opportunities for self-directed services and advocacy; teach and support skills necessary to facilitate the recovery process. / CPS is a Core Service for individuals in Permanent Supportive Housing
The primary objectives of the Peer Support Services are:
Provide opportunities for individuals receiving services to direct their own recovery and advocacy
Teach and support acquisition and utilization of the skills needed to facilitate an individual’s recovery
Promote the knowledge of available service options and choices
Facilitate the development of a sense of wellness and self worth
Peer Support services cannot exceed 20 hours per week of service hours. CPS must work at the convenient of the individual receiving services; and a substantial amount of hours must be outside of normal business hours
Mobile Psychiatric Rehabilitation (MPRS)* / Mobile Psychiatric Rehabilitation Services (MPRS) assist individuals with functional impairments resulting from mental illness to develop, enhance, and/or retain skills and competencies specific to community living so that individual can manage their own home and achieve community integration. The responsibilities of MPR staff include providing in vivo skill development and support in areas of independent living, household management, MH and D&A symptom management and relapse prevention, social skills, education and employment goal setting
Frequency: MPRS must work at the convenience of the individual receiving services; and a substantial amount of hours must be outside of normal business hours. Face to face interactions must occur, at a minimum on a weekly basis between MPRS staff and individuals participating in services, unless otherwise requested by the individual. / MPRS is a Core Service for individuals in Permanent Supportive Housing
The primary objectives of MPRS are composed of three strategies:
Help individuals identify goals
Help individuals develop necessary supports to maintain goals
Help individuals plan strategies and acquire necessary skills to reach and maintain the desired goals
Community Treatment Supports- Targeted Case Management
Resource Coordination* / A community based, short term service for persons with major mental illness who may have also have minor substance abuse issues and mild to moderate difficulty accessing mental health treatment, social, and job-related daily living skills. / For individuals with history of unsuccessful outpatient treatment who are currently in the shelter system or who are defined as “street homeless.”
Eligibility is based on MH diagnosis, MH treatment history and Global Level of Functioning. / Specialty Teams: RHD/Connections—individuals residing in shelters; RHD/FaSST—families residing in shelters; Hall Mercer/Prevention and Recovery Services (PARS)—90 day term of service
Intensive Case Management* / A community based service which is designed to assist members to gain access to community agencies, services and professionals whose functions are to provide the support, training and assistance required for a stable, safe and healthy community life. / For individuals with history of unsuccessful outpatient treatment. Eligibility is based on MH diagnosis, MH treatment history and Global Level of Functioning.
Serious Mental Health Diagnosis. / Specialty Teams: “Street Homeless” and Deaf and Hard of Hearing
Blended Case Management* / A community based service which is designed to assist members to gain access to community agencies, services and professionals whose functions are to provide the support, training and assistance required for a stable, safe and healthy community life.
These programs work in a team model and have the ability to adjust the intensity of the services provided to meet the individual needs of the client without changing service providers. / For individuals with history of unsuccessful outpatient treatment. Eligibility is based on MH diagnosis, MH treatment history and Global Level of Functioning.
BCM is designed to support access and coordination of services for individuals with frequent Crisis Response Center visits and Acute Inpatient Admissions. / Specialty Teams: Forensic; Spanish; Russian; Southeast Asian; Young Adult
Non-Fidelity Assertive Community Treatment (ACT)* / A community based service which is designed to assist members to gain access to community agencies, services and professionals whose functions are to provide the support, training and assistance required for a stable, safe and healthy community life.
These programs are enhanced with a full time Case Manager, Nurse, Psychiatrist, Drug and Alcohol Specialist / For individuals with history of unsuccessful outpatient treatment. Eligibility is based on MH diagnosis, MH treatment history and Global Level of Functioning.
Non Fidelity ACT is designed to support access and coordination of services for individuals with frequent Crisis Response Center visits and multiple Acute Inpatient Admissions, and lack of success in lower levels of Targeted Case Management.
Some teams include a supportive housing component for individuals who meet specific definitions of homelessness. / Specialty Teams:
Forensic; Co-occurring Behavioral Health and Intellectual disability; Complex Medical Needs
Drug and Alcohol Intensive Case Management*
(formerly known as BHSI Case Management) / Case Management service dedicated to providing access to recovery support services to individuals as they journey through their recovery from the disease of addiction and other life challenges with the goal of achieving and maintaining long-term recovery. Provides ongoing needs assessment, assists in goal planning to address any areas of the person’s life that he or she is willing to address, help to build and gain access to a community of resources and recovery supports. / Services are targeted for individuals who are currently receiving substance abuse treatment or who have received services within the last 12 months and are experiencing barriers that are acting as interruptions in their recovery process
Drug and Alcohol Keys to Recovery Case Management* / This team is based on a strengths-based and clinical rehabilitative model to address the complex needs of those requiring 24 hours 7 days per week case management access.
Serves those with primary substance abuse challenges who also experience complex histories of trauma, difficulty managing daily living/social skills, on-going struggles with active addiction and persistent interruptions in the recovery process due to unaddressed or unmanaged mental health challenges, lack of community supports or trusting supportive relationships. / Must have primary substance abuse challenges and must meet ALL of the following:
High Utilization of CRC
Unaddressed mental health symptoms and difficulty engaging in traditional mental health treatment
History of untreated abuse/trauma that interferes with the ability to maintain recovery
The need for specialized housing as a result of continued substance abuse
High utilization of detoxification or residential treatment services
Co-occurring cognitive limitations or physical health challenges
Difficulty accessing recovery resources in the community.
Requires 24 hour 7 day per week case management support
Forensic Intensive Recovery Case Management* / A prison deferral initiative that offers substance abuse treatment to eligible individuals involved in the criminal justice system in lieu of incarceration.
This program works with a team approach to include: Case Manager, Probation officer, Alcohol and Drug treatment provider, Mental Health Professional (if applicable). / Must have a court order from the judge sentencing individual into FIR for Drug and Alcohol treatment.
Assessment Services
Crisis Response Centers (CRC) / Crisis Response Centers provide emergency assessment, referrals and resource linkage to individuals experiencing a behavioral health crisis. These Centers are open 24 hours a day, 7 days a week. / To be used only during a behavioral health crisis.
23 Hour Holding Bed* / Provides continued evaluation over an extended period of time beyond the initial emergency psychiatric evaluation to rule out Substance Induced Mood Disorder or Substance Induced Psychosis and to further evaluate for the most appropriate level of care. This assessment takes place in a Crisis Response Center or Acute Inpatient Setting. / For adults who may require a continued crisis-focused evaluation for an extended period of time in the face of uncertainty that may include:
Resolution of acute intoxication, rapid tranquilization to stabilize meds, intra muscular administration of medications, de-escalation of psychosocial crises by identifying significant others to clarify history, assess their level of support and safe housing, corroborate the client’s claims, precipitating events and to help engage in treatment, further diagnostic testing and monitoring for the emergence of withdrawal.
Substance Abuse Evaluation Center / Provide substance use assessment, referrals and resource linkage to individuals experiencing a substance use related crisis or requiring a higher level of care. / To be used only during a substance use related crisis when the community based provider is unable to complete the assessment and referral or when the member is not connected to services.
Comprehensive Biopsychosocial Evaluation/Re-Evaluation (CBE/CBR) / A complete gathering of ecological information through client interview, discussion with family members and/or caretakers, review of clinical records, and contact with collaborating agencies that leads to a biopsychosocial formulation, diagnoses, and treatment plan. Structured tools are utilized to clarify diagnosis and behaviors / The CBE should consider the comprehensive service needs of the child and family. / Specialty Services: Psychosexual Evaluations
Community Based Treatment Services
Outpatient Therapy / Individual, Family and Group Therapy
A variety of treatment modalities can be used. Modalities should be tailored to the individual needs of the child and family. / Outpatient therapy is the least restrictive community based treatment / Evidence Based Practices: Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Prolonged Exposure (PE)
Community Integrated Recovery Center (CIRC) / To help clients improve their quality of life, provide opportunities for clients to explore and engage in the community, to instill and encourage hope while helping clients meet their goals. Common goals for CIRC participants are living independently, obtaining employment and/or education, engaging in spiritual activities, having meaningful social roles, forming friendships, engaging in leisure activities, volunteering, and participating as a citizen.
The four key pillars are comprised of community inclusion, recovery planning, family inclusion, and peer culture and leadership. All programs have a strong peer culture, peer-led groups, and leadership opportunities. / CIRCs strive to “meet members where they are” and can help them manage a variety of clinical issues (including psychosis, depression, drug & alcohol use). CIRCs are ideal for members whose symptoms are not acute enough for hospitalization or acute partial but who require more support than outpatient treatment. The focus on skill building as well as stabilization. The most important consideration is the member’s willingness to engage in a treatment program and become involved in the community. / Specialty Services:HIV+; Latino Population; LGBTQI; D&A; ID
Evidence Based Practices: Partners for Change Outcomes Management System (PCOMS). Cognitive Behavioral Therapy (CBT)
Assertive Community Treatment (ACT)* / Assertive Community Treatment is a teamtreatment approach designed to providecomprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness suchas schizophrenia.
Among the services ACT teams provide are: case management, initial and ongoing assessments; psychiatric services; employment and housing assistance; family support andeducation; substance abuse services; and other services and supports critical to an individual's ability to live successfully in the community.
ACT services are available 24 hours per
day, 365 days per year. / Eligibility is based on MH diagnosis, MH treatment history and Global Level of Functioning.
ACT is designed to support access and coordination of services and provide treatment for individuals with frequent Crisis Response Center visits and multiple Acute Inpatient Admissions, and lack of success in lower levels of treatment and case management.
ACT is the most intensive community based service and is designed to flexibly work with members who have traditionally experienced multiple acute treatment episodes and who need extensive support to remain in the community.
ACT works as a stand-alone service and is designed to meet an individual’s comprehensive treatment and psychosocial needs. / ACT is an Evidence Based Practice.
Evidence based practices integrated within some ACT programs: Dialectical Behavioral Therapy (DBT), Cognitive behavioral therapy (CBT)
Alcohol and Other Drug Treatment
Outpatient / Individual, Family and Group Therapy
A variety of treatment modalities can be used. Modalities should be tailored to the individual needs of the individual and target substance abuse, and to achieve permanent changes in an individual’s substance using behavior. / Outpatient therapy is the least restrictive community based treatment / Evidence Based Practices: Prolonged Exposure (PE)
Intensive Outpatient Services (IOP) / Designed to provide a minimum of 6 hours of structured counseling and educational services per week.
Provides comprehensive assessments, individualized treatment plans, and has active affiliations with other levels of care to address an individual’s needs. / For individuals who need more support than outpatient therapy can provide.
Psychiatric needs are met by referring to additional services as needed. / Evidence Based Practices: Prolonged Exposure (PE)
Medication Assisted Treatment Programs (MATP) / Designed to provide a minimum of 6 hours of structured counseling and educational services per week along with medication assisted treatment.
Provides comprehensive assessments, individualized treatment plans, and has active affiliations with other levels of care to address an individual’s needs / Psychiatric needs are met by referring to additional services as needed. / Evidence Based Practices: Prolonged Exposure (PE)
Halfway House* /
Community-based residential treatment and rehabilitation facility that provides services for chemically dependent persons in a supportive, chemical-free environment. It is meant to provide a “home-like atmosphere in the local community. While substance abuse treatment is provided, the emphasis is on providing protective and supportive elements of family living, and encouraging and providing opportunities for independent growth and responsible community living. Mutual self-help, assistance in economic/social adjustment, and integration of life skills into daily life are built into the program, along with assisting residents in the development of a solid program of recovery.
/ Specialty Facilities: Homeless Halfway HouseDetoxification* / For clients who are currently exhibiting withdrawal symptoms or withdrawal is imminent. Detoxification is indicated when there is evidence that the client has been using a physically dependent drug (opiates, benzodiazepines, alcohol) on a daily basis for an extended period of time, and the client demonstrates that he has developed tolerance. / There is no established detoxification protocol for Cannabis and/or Cocaine, as use of these drugs does not result in physical dependency. / Specialty: Medically Managed
Short Term Residential* / 24-hour, professionally directed evaluation, care and treatment for addicted clients in acute distress, whose addiction symptomatology is demonstrated by moderate impairment of social, occupational or school functioning. / The goal of short term residential treatment is rehabilitation. / Specialty: Medically Managed
Long Term Residential* / 24-hour professionally directed evaluation and rehabilitation services to substance abusing/dependent clients. The defining characteristic of this level of care is that they service clients who assistance with basic living skills (ie parental skills) in order to develop sufficient recovery skills. / The goal of long-term residential treatment is habilitation. / Specialty: Mother-baby programs; Journey of Hope (homeless)
Evidence Based Practices: Prolonged Exposure (PE), Cognitive Behavioral Therapy (CBT)
Residential Services
Residential Treatment Facility- Adult (RTF-A)* / This is a transitional level of care for aging out youth and/or adults in need of a step-down from a more structured setting, who are working toward family reunification, permanency goals, re-entry into the community and/or independent living. The focus is on the development of social, occupational, educational and vocational supports needed to successfully reintegrate into the community.
Treatment at RTFAs typically includes:
- Individual and Group Therapy 1 to 4 times per week
- Family Therapy
- Specialized Therapy/Skills Building Sessions 1 to 2 times per week
- Psychiatric Services
- A brief, intense, focused treatment program to promote a successful return by the child/adolescent to the community
Deaf and Hard of Hearing, Complex Medical Issues, Co-Occurring MH and
D and A, Co-Occurring MH and ID
Evidence Based Practices: Dialectical Behavioral Therapy (DBT)
Acute Services
Acute Partial Hospital Program (APHP)* / A treatment program that combines elements of the inpatient and outpatient setting in a structured therapeutically intensive treatment program that coordinates clinical services to achieve a stable therapeutic milieu.
Signs and symptoms of behavioral disorders are carefully and continuously monitored to document progress or regression. Prompt and effective intervention is a hallmark of a PHP and often averts hospitalization. / APHP offers an alternative to hospitalization for members that do not represent an imminent danger to themselves or others.
Often utilized as a step down from inpatient units or as a step up from outpatient to prevent further decomposition and/or allow for close monitoring when making medication changes.
Admissions and continued stay is based on a psychiatric evaluation and determination of medical necessity.
Subacute Partial Hospital Program / A treatment program that provides less than 24 hour care for members who are stabilized post-crisis, but require more ongoing support than is available in traditional outpatient or aftercare programs. Members’ signs and symptoms are generally less severe than those requiring an Acute Partial Hospital Program. / Members often step down from an Acute Partial Hospital Program as a natural step in the progression of treatment. Subacute Partial Hospital Programs help members continue the progress they have made in more intensive treatment settings. The goal is to assist with improving members’ level of functioning in the community. / Specialty Services:
Eating Disorders
Subacute Psychiatric Inpatient Program(SAIP)* / Provides short term care to individuals with a mental health diagnosis within a hospital or non-hospital facility. / Member must have a clear discharge plan on admission, must have the capacity to remain safe on an unlocked unit.
Member is awaiting non-hospital placement and there is a demonstrated need for a structured, supportive environment and without such there is a high likelihood for the resumption of acute symptomatology.
Admissions and continued stay is based on a psychiatric evaluation and determination of medical necessity.
Crisis Residence (CR)* / A non-hospital, unlocked facility where the goal of treatment is to re-stabilize after a mild to moderate decompensation period or as a step down from the acute inpatient setting. / Member must have a clear discharge plan on admission
CR is not required to have a physician on site daily, and psychiatric consults are conducted on an as-needed basis.
Crisis Residence is appropriate for: members who are awaiting placement in structured housing or residential treatment and are at demonstrated risk of decompensation without ongoing structure in the interim.
Acute Inpatient Hospital Program (AIP)* / Acute inpatient treatment is designed to meet the needs of adults whose behaviors and thought processes pose a substantial risk to themselves and/or others.
The purpose of AIP is to evaluate, diagnose and stabilize acute symptoms. / The primary consideration for acute care is the type and acuity of symptoms in the clinical presentation. Members in this setting may lack adequate impulse control, the ability to cooperate with staff, the ability to communicate effectively with staff and to accomplish the activities of daily living without significant support.
Admissions and continued stay is based on a psychiatric evaluation and determination of medical necessity.
Extended Acute Care (EAC)* / Long-term psychiatric inpatient level of care for adults diagnosed with chronic and persistent mental illness who, due to the nature of their illness, typically require an extended episode of treatment to return to baseline functioning. / EAC is considered for members with a history of multiple hospitalizations in close succession that suggests that the client could benefit from an extended episode of acute treatment in order to successfully reside in a supportive community setting or for members whose current symptomatology is severe and the member has not responded to trials of psychotropic medication / Evidence Based Practice: Cognitive Behavioral Therapy (CBT)
** Providers who offer these Evidence Based Practices have been trained by DBHIDS and/or have an active relationship with treatment developers.