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  1. FAQ

  2. What is a Co-occurring Disorder?

    What is Co-occurring Disorder Capability?

    What is the AC-OK Screen for Co-Occurring disorders (Mental Health, Trauma Related Mental Health Issues & Substance Abuse?)

    What is the Florida System of Care?

    What can be done to help persons with COD?

    What is the website of the most current list of medications used for COD?

    How many people in the United States suffer from COD?

    What are common problems of Co-occurring Disorder?

    What are causes of co-occurring disorders?

    What are the most common co-occurring disorders?

    What are the most effective treatments for COD?

    What is integrated treatment?

    What is effective therapy?

    What is Dual Recovery Anonymous?

    What is AA? What is Alanon and Alateen

    What is NA?

    What is NAMI?

    What are some Co-occurring Disorder red flags?

    What is relapse prevention?

    What signs or symptoms do most families experience when their youth is struggling that lead them to decide to seek help?

    What is the difference between screening and assessment for COD?

    What exactly is Psychosis?

    What is Delusion?

    What is Hallucination?

    What is Thought Disorder?

    What are Club Drugs?

    Is smoking a gateway drug?

    What are the signs of Adolescent Alcohol and Drug Use?

    What are the Consequences of Adolescent Alcohol and Drug Use?

    What is the percentage of substance use disorders by ethnicity?

    What is the relationship between mental illness and substance use disorders?

    What are some websites where I can learn more about COD?

    How can family members support recovery?

    What is drug abuse?

    What is drug dependence?

    What is the Role of the Patient’s Family in Treatment?

    How Can Family and Friends Help with Recovery from the Substance Abuse?

    How Common is Dual Diagnosis?

    What Kind of Mental or Emotional Problems are Seen in People with Co-Occurring Disorder?

    What are Basic Needs?

    What is a Case Manager?

    What is Case Management?

    What is Cultural Competence?

    What is Wraparound Process?

    What are Wraparound Services?

    What is Community?

    What is Community Based?

    What is Family?

    What is Family Centered?

    What is Family Driven?

    What is Family Preparation?

    What is Flexible?

    What is Home?

    What is Individualized?

    What is Natural Support?

    What is Need?

    What is Non-Compliance?

    What is Out of Home Placement?

    What are Outcomes?

    What is a Plan?

    What is Serious Emotional Disturbance?

    What is At Risk for Serious Emotional Disturbance?

    What are Strengths?

    What is Strengths Chat?

    What is a Team?

    What is Unconditional Care?

    What is the System of Care Approach?

    What is Assessment?

    What is Crisis Stabilization?

    What is Crisis Support/Emergency?

    What are Drop in/Self Help Centers?

    What is Inpatient?

    What is Intensive Case Management?

    What is Intervention?

    What are Medical Services?

    What is Outpatient-Individual?

    What is Outreach?

    What is Prevention?

    What are Residential Services Levels I, II, and III?

    What is Residential Level I?

    What is Residential Level II?

    What is Residential Level III?

    What is Sheltered Employment?

    What is Substance Abuse Detoxification?

    What is Supported Employment?

    What is Supported Housing/Living?

    What is Aftercare/Follow-up?

    What is Information and Referral?

    What is Outpatient-Group?

    What are Mental Health Clubhouse Services?

    What is Intervention-Group?

    What is Comprehensive Community Service Team – Individual?

    What is Comprehensive Community Service Team – Group?

    What is Substance Abuse Recovery Support Services – Individual?

    What are the criteria for a diagnosis of substance abuse?

    What are the criteria for a diagnosis of substance dependence?

  3. What is a Co-occurring Disorder?

    Co-Occurring disorder (COD) means any combination of mental health and substance use in any individual, whether or not they have been already diagnosed. Co-occurring disordered family is characterized by a family where one member has one kind of problem, like a child with an emotional disturbance, and another member has another kind of problem, like a family member or caregiver with a substance use issue.

    What is Co-occurring Disorder Capability?

    Co-occurring Disorder Capability means the ability of any program to organize every aspect of its program infrastructure (policies, procedures, practices, documentation, and staff competencies), within its existing resources, to be able to provide appropriately matched, integrated services to the individuals and families with co-occurring disorders that are routinely presenting for care in that program.

    What is the AC-OK Screen for Co-Occurring disorders (Mental Health, Trauma Related Mental Health Issues & Substance Abuse?)

    The AC-OK Screen for Co-Occurring Disorders (Mental Health, Trauma Related Mental Health Issues & Substance Abuse) was designed to determine if a person who asks for help from either a mental health agency or a substance abuse treatment agency needs to be assessed for the possible co-occurring disorders of Mental Health, Trauma Related Mental Health Issues and Substance Abuse.

    What is the Florida System of Care?

    Florida System of Care means the department’s initiative to integrate substance abuse and mental health service structures to promote co-occurring capable services throughout the system of care from the initial point of client contact at assessment through conclusion of services.

    What can be done to help persons with COD?

    Like primary health settings, other settings can also serve as gatekeepers for the Substance Abuse / Mental Health (SA/MH) system. These settings provide an opportunity to recognize persons who may have COD and to engage them in a process that leads to referral for further assessment and integrated treatment. This recognition, engagement, and referral approach requires strong partnerships with community SA/MH providers. These approaches typically require the oversight of a multidisciplinary community planning group, training for frontline staff, the development of specific referral guidelines, and easy access to welcoming clinical settings.

    What is the website of the most current list of medications used for COD?
    http://www.nimh.nih.gov/health/publications/mental-health-medications/alphabetical-list-of-medications.shtml
    How many people in the United States suffer from COD?

    More than ten million people in the United States suffer from a substance use disorder along with one or more mental health disorders.

    What are common problems of Co-occurring Disorder?

    Common problems relating to co-occurring disorders include:

    • Use of alcohol or other drugs to reduce the difficulty or pain associated with health problems, which may work in the short term but usually backfires in the long run.
    • A mental health disorder that is worsening because of alcohol or drug use.
    • A substance use disorder that is worsening because of mental health problems.
    • Difficulty getting treatment for both disorders, or difficulty benefiting from treatment.
    • Difficulty finding supportive people who understand both disorders.
    What are causes of co-occurring disorders?

    There appears to be common genetic risk factors for substance use and certain mental health disorders, but genes along cannot explain all cases of co-occurring disorders. Others include:

    • Family
    • Environment
    • Traumatic life events
    • Poverty
    • Early loss of significant others
    What are the most common co-occurring disorders?

    Some of the most common mental health disorders found in chemically dependent people are:

    Mood Disorders:

    • Major depression
    • Dysthymia
    • Bipolar disorder
     

    Anxiety Disorders:

    • Post-traumatic stress disorder
    • Panic disorder
    • Social Anxiety
    • Generalized anxiety disorder
    • Obsessive-compulsive disorder
     

    Thought Disorders:

    • Schizophrenia
    • Schizoaffective disorder
     
    What are the most effective treatments for COD?

    Integrated treatment can stabilize the symptoms of co-occurring disorders and provide a foundation for lasting recovery from substance use and psychiatric disorders. A variety of options are available for treating co-occurring disorders. These include support, engaging in therapy, and taking appropriate prescription medication.

    What is integrated treatment?

    In integrated treatment, providers work together to develop a single treatment plan to address both disorders. Integrated treatment is a collaborative approach to providing treatment for co-occurring disorders. One clinician or treatment team provides both mental health and substance abuse treatment services, with each applied at appropriate times and situations according to the client’s needs. The ideal provider team consists of individuals from varied clinical backgrounds who have been cross-trained to work together. Co-occurring disorders are inherently complex, and clients require multiple services across several systems. For this reason, integrated treatment programs are specially designed to take into account the full range of each client’s symptoms and needs. Treatment must also take into account the client’s age, culture, level of severity, and stage of recovery. Treatment plans are customized to individual clients, utilizing the strategies from mental health and substance abuse treatment fields that are most appropriate for each client’s unique situation.

    What is effective therapy?
    • Discussing substance use:
      Clinicians ask clients about their substance use throughout treatment

    • Discussing psychiatric symptoms:
      Clinicians ask clients about their psychiatric symptoms throughout treatment

    • Shared decision making:
      Clinicians and clients examine problems and go on to consider interest and strategies for change

    • Client education:
      Clinicians provide clients with basic information about their disorder and related problems

    • Developing coping skills:
      Clients learn strategies to minimize their compulsion to use substances and strengthen their relationships and recreational lives.

    • Developing peer recovery supports:
      Clinicians help clients find peer recovery support and fellowship

    • Recovery checkups:
      Clinicians and clients consider whether ongoing monitoring is needed.

    Prescription Medication:

    Medications are widely used in the treatment of people with co-occurring disorders. The medications prescribed can play an important role in reducing symptoms and prevent relapses of the psychiatric disorder. Medications can also be useful in maintaining abstinence from substances in the addiction.

    Finding Support:

    Peer support groups, such as Alcoholics Anonymous, Narcotics Anonymous, Dual Recovery Anonymous, and other Twelve Step groups, can help a person cope with his/her substance use disorder.

    What is Dual Recovery Anonymous?
    See http://draonline.org/dra_q_and_a.html
    What is AA? What is Alanon and Alateen

    See http://www.aa.org/

    See wso@al-anon.org

    See http://www.al-anon.alateen.org/

    What is NA?
    See http://www.lblna.org/links.htm
    What is NAMI?
    See http://www.nami.org/
    What are some Co-occurring Disorder red flags?
    • Nasal irritation (Substance Use Disorder only)
    • Unexplained bruises (Substance Use Disorder only)
    • Enlarged liver or spleen, abnormal liver function, hepatitis, or cirrhosis in later stages (Substance Use Disorder only)
    • Withdrawal symptoms (Substance Use Disorder only)
    • Headaches
    • Chest pain or cardiac arrhythmia
    • Gastrointestinal symptoms
    • Hypertension
    • Sexual dysfunction
    • Fatigue
    • Apathy or flat affect
    • Social withdrawal
    • Changes in concentration, mood , activity level, sleeping, appetite, or weight
    • Feeling of worthlessness or inappropriate guilt
    • Fear, worry, or repetitive, intrusive thoughts or actions
    • Problems with cognition or impulse control
    • History of physical or mental trauma
    What is relapse prevention?

    Immediate determinants are the high risk situations (the external or internal triggers that lead to picking up substances), as well as individual coping skills. Covert antecedents are the urges, cravings, and lifestyle habits already in place that lead to negative behaviors. An example of a covert antecedent is a family fight that leads to anger. The immediate external trigger might be the six pack of beer in the refrigerator, but the actual relapse began when the family fight created anger and a subsequent craving and urge to medicate with alcohol. The model suggests that if the individual or child had developed a healthy way to express anger, maybe even using physical activities and developing some friendships, the anger would not lead to the urge to smoke but rather the use of the healthier stress outlet.

    What signs or symptoms do most families experience when their youth is struggling that lead them to decide to seek help?
    • Verbal/physical aggressiveness – threats, screaming, pushing, kicking, and hitting others.
    • Academic Difficulties – missing many classes, sent out of the classroom, not turning in assignments, or being very distracted and not able to focus like others their own age.
    • Impulsivity – reacting quickly in ways that get them in trouble; choosing to act without thinking.
    • Hyperactivity – not being able to sit still, or not being able to wait for their turn; feeling fidgety most of the time; or always being on the go.
    • Depressed Mood – irritable, angry, sad, loss of energy, no excitement over activities that once made them happy, isolation, feeling like it isn’t worth going on.
    • Poor Social Skills – not getting along with others, not being able to keep friends over time, appears always quiet because he or she is scared to express what’s inside.
    • Substance Abuse – change in mood, attitude, energy, peers, clothes, and desire to be involved with the family.
    • Frequent Disobedience – yelling, fighting, not listening, seeking attention in hurtful ways, opposing rules.
    What is the difference between screening and assessment for COD?

    Screening for a COD is a quick way to either “rule-in” or “rule-out” the need for an assessment. An assessment is a more thorough evaluation that usually leads to a diagnosis.

    What exactly is Psychosis?

    Psychosis is a mental disorder in which there is a significant disturbance in a person’s ability to think clearly, respond emotionally, communicate effectively, understand reality, and behave appropriately.

    What is Delusion?

    Delusion is a false, fixed, odd, or unusual belief firmly held by the individual. The belief is not ordinarily accepted by other members of the person’s culture or subculture. There are delusions of paranoia (others are plotting against them), grandiose delusions (exaggerated ideas of one’s importance or identify), and somatic delusions (a healthy person believing that he/she has a terminal illness).

    What is Hallucination?

    Hearing, seeing, feeling, smelling, or tasting something that is not actually there.

    What is Thought Disorder?

    Confused or blocked thinking. The person may have difficulty concentrating, following a conversation, or remembering things. Thoughts sometimes seem to race or slow down.

    What are Club Drugs?

    The term “club drugs” refers to a wide variety of drugs that are often used by teens and young adults at night clubs and all-night dance parties called “raves.” The most widely used club drugs are Gamma-Hydroxybutyric acid (GHB), Ketamine, Rohypnol, and MDMA (Ecstasy).

    Is smoking a gateway drug?

    Yes, studies have shown that teenagers who smoke are more likely than those who don’t to use other drugs. Teenagers who smoke are three times more likely to use alcohol, 14 times more likely to use marijuana, and 22 times more likely to use cocaine. Not only are teens who smoke more likely to try or even regularly use these drugs, they are also much more likely to become habitual smokers. Eighty-nine percent of current adult smokers started smoking before they were 19 years old. While many teenagers don’t see any harm in trying a cigarette, the fact is that teenagers become addicted to nicotine at a faster rate than adults, and statistically have a harder time quitting. Once addicted to nicotine, the body begins to crave a stronger stimulant which can lead youths to try other, more “hard core” drugs. Smoking has also been linked to causing depressive episodes, suggesting that nicotine affects the central nervous system.

    What are the signs of Adolescent Alcohol and Drug Use?
    • Getting drunk or high on drugs on a regular basis
    • Lying about alcohol or other drug use
    • Avoiding others to get drunk or high
    • Giving up activities once enjoyed to drink or use drugs
    • Planning drinking in advance, hiding alcohol or drinking or using drugs alone
    • Having to drink more to get the same high
    • Drinking and driving
    • Believing that to have fun, drinking or drug use are necessary
    • Experiencing frequent hangovers
    • Blacking out
    • Pressuring others to drink or use drugs
    • Taking risks, including sexual risks
    • Becoming victims to perpetrators of violence
    • Feeling run-down, hopeless, depressed or even suicidal
    • Acting selfish and not caring about others
    • Talking excessively about drinking or using drugs
    • Getting in trouble with the law
    • Getting suspended from school for an alcohol – or other drug-related incident
    What are the Consequences of Adolescent Alcohol and Drug Use?
    • Difficulty concentrating
    • Personality changes
    • General lack of motivation and energy
    • Sleep disturbances
    • Appetite changes
    • Oversensitivity
    • Moodiness
    • Nervousness
    • Having unplanned and unprotected sex
    • Declining grades and school failure
    • Depression
    • Loss of interest in family and friends
    • Depression
    • Loss of interest in family and friends
    • Excessive need for privacy, secretive or suspicious behavior
    • Suffering serious injuries from driving under the influence or engaging in other risky behavior
    What is the percentage of substance use disorders by ethnicity?
    • American Indians and Alaska Natives 21%
    • Pacific Islanders 11%
    • Whites 9.4%
    • Hispanics 9.3%
    • Blacks 8.5%
    • Asians 4.5%
    What is the relationship between mental illness and substance use disorders?

    Mental illness often is linked to substance abuse because people with mental illnesses often use alcohol and/or drugs to “self-medicate.” An estimated 5.2 million people who have substance use disorders also have a mental illness. Eighty-nine percent of people with a co-occurring disorder developed a mental illness before they had a substance use disorder. On average, mental illness precedes a substance use disorder by six years. If people with mental illness are diagnosed and treated shortly after their symptoms begin, they are much less likely to self-medicate with alcohol and illicit drugs.

    What are some websites where I can learn more about COD?
    How can family members support recovery?
    • Help you follow all treatment recommendations
    • Encourage total abstinence from alcohol and other drugs
    • Help you build good coping skills
    • Reduce family friction and provide social support
    • Encourage participation in peer support groups
    • Help you create a sober peer network
    • Know the signs of relapse
    • Support your involvement in meaningful, structured activities
    What is drug abuse?

    Drug abuse is diagnosed when substance use persistently interferes with functioning at work, at school, or in social relationships. It is also diagnosed when substance use creates or worsens a medical condition, or when substance use occurs in dangerous situations.

    What is drug dependence?

    Drug dependence is a more severe condition than alcohol or drug abuse. In addition to facing more negative consequences, people with dependence have also failed to abstain from or control their use of substances. In some cases, physiological dependence may also exist, which is indicated by tolerance (needing more of a substance to get the same effect) and withdrawal (experiencing symptoms such as tremors or nausea when substance use has stopped.)

    What is the Role of the Patient’s Family in Treatment?

    With both rehabilitation for substance abuse and treatment for a psychiatric problem, education, counseling sessions, and support groups for the patient’s family are important aspects of overall care. The greater the family’s understanding of the problems, the higher the chances the patient will have a lasting recovery.

    How Can Family and Friends Help with Recovery from the Substance Abuse?

    They need to learn to stop enabling. Enabling is acting in ways that essentially help or encourage the person to maintain their habit of drinking or getting high. For instance, a woman whose husband routinely drinks too much, might call in sick for him when he is too drunk to go to work. That’s enabling. Likewise, family members or friends might give an addict money which is used to buy drugs, because they’re either sorry for him or afraid of him. That’s enabling also.

    How Common is Dual Diagnosis?

    Dual diagnosis is more common than you might imagine. According to a report published by the Journal of the American Medical Association*:

    37% of alcohol abusers and fifty-three percent of drug abusers also have at least one serious mental illness. Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

    What Kind of Mental or Emotional Problems are Seen in People with Co-Occurring Disorder?
    • Depressive disorders, such as depression and bipolar disorder.
    • Anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobias.
    • Other psychiatric disorders, such as schizophrenia and personality disorders.

    The following table based on a National Institute of Mental Health study, lists seven major psychiatric disorders and shows how much each one increases an individual’s risk for substance abuse.

    Psychiatric Disorder Increased Risk for S/A
    Antisocial personality disorder 15.5%
    Manic episode 14.5%
    Schizophrenia 10.1%
    Panic disorder 4.3%
    Major depressive episode 4.1%
    Obsessive-compulsive disorder 3.4%
    Phobias 2.4%

     

    What are Basic Needs?

    Needs that everyone has in order to live including but not limited to, transportation, food, shelter, clothing, heat, phone, gas, lights, sleep, respite, after school programs, and recreation. Basic needs of the family need to be met before anything else is done with the family.

    What is a Case Manager?

    An individual who organizes and coordinates services and supports for clients with mental health issues and their families.

    What is Case Management?

    A service that helps people arrange appropriate family-driven services and supports. Different agencies have different titles for these workers, e.g. service coordinator, family outreach specialist, family support worker.

    What is Cultural Competence?

    Help that is sensitive and responsive to cultural differences. Caregivers need to be aware of the impact of their own culture and possess skills that help them provide services that are appropriate in responding to people’s unique cultural differences, such as race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability. Providers adapt their skills to fit a family’s values and customs.

    What is Wraparound Process?

    The process of working with families to develop wraparound services. This process includes strengths chat with families and other family preparation, efficient meeting facilitation, maintaining a feeling of safety for participants, and reflects family centered values and attitudes.

    What are Wraparound Services?

    “Interventions that are developed and/or approved by (a multidisciplinary) services team (which includes the family and their supports), are community based and unconditional, are centered on the strengths of the client and family, and include the delivery of coordinated, highly individualized services in three or more life domain areas of a client and family.

    What is Community?

    A group of individuals living in the same area as the child and family; the place where interventions for the wraparound process occur, the natural setting of the client/family. The community must be invested in order for wraparound to be successful.

    What is Community Based?

    Community Based means that services and supports happen in the community where the family lives, works, goes to school, and recreates. Services are provided in places that support the needs of the family versus the service providers.

    What is Family?

    For the purpose of wraparound, family is ideally a person or group of people that provides for the emotional, physical, and financial support of the client. Members of a family may or may not be related.

    What is Family Centered?

    Help designed for the unique needs of each individual and his or her family. Clients and families should not be expected to fit into services that don’t meet their needs.

    What is Family Driven?

    Family centered services that reflect family expectations and preferences and are ultimately approved by the family.

    What is Family Preparation?

    Work that needs to be done prior to the initial Wraparound meeting including identifying the strengths and needs of the family.

    What is Flexible?

    Looking beyond just the available or traditional service array and not working from preconceived notions. Never saying “no” without thinking of what the “yeses” could be. Adapting to the evolving strengths and needs of a family in a responsive and timely manner. Families function 24 hours a day, 7 days a week, 365 days a year and being flexible recognizes this.

    What is Home?

    The place where the family attempts to meet the basic needs of all, where the family lives and should feel comfortable.

    What is Individualized?

    Specifically tailored to meet unique needs of a child and family’s strengths, values, norms, and preferences. It also means doing whatever it takes to succeed.

    What is Natural Support?

    Family, friends, neighborhood and community resources that a family can draw on for support. These include supports that are already identified as a part of a family’s support system or can be developed into a support system.

    What is Need?

    Something required or desirable to achieve highest level of functioning in an individual and his or her family. A need is a possible solution to a “problem”; needs are described and identified from the client/family’s perspective rather than from the professional’s perspective; all needs are identified in the wraparound process regardless of whether or not services are available.

    What is Non-Compliance?

    Labeling a family as non-compliant is counterproductive and should not be used. The term is judgmental as it justifies failure at the expense of the family. Services shall not be denied because a family has been labeled as non-compliant.

    What is Out of Home Placement?

    When a child/adolescent is not living with their family. Out of home placements can include therapeutic foster care, living with other relatives, or residential placement.

    What are Outcomes?

    The effects of services and supports provided to a family. The family determines whether the services implemented in the plan are meeting their needs and the team will readjust the plan accordingly.

    What is a Plan?

    A plan is a document that is family-driven, strengths-based, culturally competent and has measurable actions designed to address the needs identified by the client and family.

    What is Serious Emotional Disturbance?

    A term used by the Diagnostics and Statistics Manual revision IV (DSM-IV) to describe clients with emotional or behavioral disorders who also have difficulty functioning within their family or community. For the purposes of this wraparound process these clients should have multi-agency needs involving two or more agencies.

    What is At Risk for Serious Emotional Disturbance?

    A term used to describe clients with emotional or behavioral disorders under DSM IV who may, without appropriate supports, develop a more intense level of need.

    What are Strengths?

    Family identified knowledge, skills, and resources that are used in the development of plans. Services and supports should be built on the client and family’s strengths.

    What is Strengths Chat?

    A necessary step in the wraparound process is performing an informal strengths assessment with the client and family (and sometimes with the extended family network and neighborhood) as part of preparing the family for the actual wraparound planning session. A family’s strengths drive the planning process.

    What is a Team?

    A group consisting of the client, family, family identified friends and supports, service providers, and other natural community supports as appropriate to the family’s needs. Ideally, team membership should consist of at least 50% family, friends, and natural supports.

    What is Unconditional Care?

    Doing whatever it takes to support the family and meet the family’s needs. Unconditional care means not blaming the client or family.

    What is the System of Care Approach?
    • For clients to have access to a comprehensive array of services that address the physical, emotional, social and educational needs.
    • Clients will receive individualized services in accordance with the unique needs and potentials of each, and guided by an individualized treatment plan.
    • Clients will receive services within the least restrictive, most normal environment that is clinically appropriate.
    • Families/surrogate families, if release if given, will participate in all aspects of the planning and delivery of services.
    • Clients will receive services that are integrated with linkages between serving agencies and programs and mechanisms for planning, developing and coordinating services.
    • Clients will obtain or have choice for case management or similar mechanisms to ensure that multiple services are delivered in a coordinated and therapeutic manner and that they can move through the system of services in accordance with their changing needs.
    • Early identification, screening and intervention will be promoted by the system of care in order to enhance the likelihood of positive outcomes.
    • Children who are emotionally disturbed will be assured of smooth transitions to the adult service system as they reach maturity.
    • The rights of clients will be promoted.
    • All services shall be provided without regard to race, religion, national origin, sex, physical disability or other characteristics.
    What is Assessment?

    Assessment services assess, evaluate, and provide assistance to individuals and families to determine level of care, motivation, and the need for services and supports to assist individuals and families identify their strengths.

    What is Crisis Stabilization?

    Acute care services provided on a twenty-four (24) hours per day, seven (7) days per week basis, provide brief, intensive mental health residential treatment services to meet the needs of individuals who are experiencing an acute crisis and who, in the absence of a suitable alternative, would require hospitalization.

    What is Crisis Support/Emergency?

    Non-residential care services that are generally available twenty-four (24) hours per day, seven (7) days per week, or some other specific time period, to intervene in a crisis or provide emergency care.

    What are Drop in/Self Help Centers?

    Centers that are intended to provide a range of opportunities for persons with severe and persistent mental illness to independently develop, operate and participate in social, recreational, and networking activities.

    What is Inpatient?

    Services that are provided in hospitals, licensed under chapter 395, Florida Statutes, as general hospitals and psychiatric specialty hospitals. They are designed to provide intensive treatment to persons exhibiting violent behaviors, suicidal behaviors and other severe disturbances due to substance abuse or mental illness.

    What is Intensive Case Management?

    Case management services that consist of activities aimed at assessing recipient needs, planning services, linking the service system to a recipient, coordinating the various system components, monitoring service delivery and evaluating the effect of services received.

    What is Intervention?

    Intervention services focus on reducing risk factors generally associated with the progression of substance abuse and mental health problems. Intervention is accomplished through early identification of persons at risk, performing basic individual assessments, and providing supportive services, which emphasize short-term counseling and referral.

    What are Medical Services?

    Medical services provide primary medical care, therapy and medication administration to improve the functioning or prevent further deterioration of persons with mental health or substance abuse problems. Included is psychiatric mental status assessment.

    What is Outpatient-Individual?

    Outpatient services that provide a therapeutic environment that is designed to improve the functioning or prevent further deterioration of persons with mental health and/or substance abuse problems.

    What is Outreach?

    Services that are provided through a formal program to both the community at large and to individuals. Community services include education, identification and linkage with high risk groups.

    What is Prevention?

    Services that involve strategies that prevent, delay, or hinder the development of substance abuse and mental health problems, and include increasing public awareness through information, education, and alternative-focused activities.

    What are Residential Services Levels I, II, and III?

    Residential Services Levels I, II, and III are considered bundled services which cover all costs for the client that day. No other discrete services may be reported or invoiced that day for that client unless the contract allows it specifically, even if the service is in another program (MH or SA).

    What is Residential Level I?

    Licensed services provided in structured, live-in, non-hospital settings with supervision on a twenty-four (24) hours per day, seven (7) days per week basis. There is a nurse on duty in these facilities at all times. For adult mental health, these services include group homes, which are for longer-term residents. These facilities offer nursing supervision provided by, at a minimum, licensed practical nurses on a twenty-four (24) hours per day, seven (7) days per week basis.

    What is Residential Level II?

    These are licensed, structured rehabilitation-oriented group facilities that have twenty-four (24) hours per day, seven (7) days per week, supervision. Level II facilities are for persons who have significant deficits in independent living skills and need extensive support and supervision.

    What is Residential Level III?

    Licensed facilities that provide twenty-four (24) hours per day, seven (7) days per week supervised residential alternatives to persons who have developed a moderate functional capacity for independent living. For adults with serious mental illness, this cost center consists of supervised apartments.

    What is Sheltered Employment?

    Sheltered employment service is non-competitive employment within a work-based facility; it requires federal exemption from the Minimum Wage Act.

    What is Substance Abuse Detoxification?

    Detoxification programs use medical and clinical procedures in a residential setting to assist adults, children and adolescents with substance abuse problems in their efforts to withdraw from the physiological and psychological effects of substance abuse.

    What is Supported Employment?

    Supported employment is community-based employment services in an integrated work setting, which provides regular contact with non-disabled co-workers or the public. A job coach provides long-term, ongoing support for as long as it is needed to enable the person served to maintain employment.

    What is Supported Housing/Living?

    Supported housing/living services assist persons with substance abuse or psychiatric disabilities in the selection of housing of their choice. These services also provide the necessary services and supports to assure their continued successful living in the community and transitioning into the community.

    What is Aftercare/Follow-up?

    Aftercare includes but is not limited to relapse prevention, and are a vital part of recovery in every treatment level. Aftercare activities include client participation in daily activity functions, which were adversely affected by mental illness and/or substance abuse impairments.

    What is Information and Referral?

    Services that maintain information about resources in the community, link people who need assistance with appropriate service providers, and provide information about agencies and organizations that offer services.

    What is Outpatient-Group?

    A therapeutic environment that is designed to improve the functioning or prevent further deterioration of persons with mental health and/or substance abuse problems.

    What are Mental Health Clubhouse Services?

    Structured, community-based services designed to strengthen and/or regain the cline’s interpersonal skills, provide psycho-social therapy toward rehabilitation, develop the environmental supports necessary to help the client thrive in the community and meet employment and other life goals and promote recovery from mental illness.

    What is Intervention-Group?

    Services focused on reducing risk factors generally associated with the progression of substance abuse and mental health problems.

    What is Comprehensive Community Service Team – Individual?

    Comprehensive Community Service Team (CCST) renders assistance in identifying goals and making choices to promote resistance to relapse and help with recovery to adults and children with mental illness.

    What is Comprehensive Community Service Team – Group?

    Comprehensive Community Service Team (CCST) renders assistance in identifying goals and making choices to promote resistance to relapse and help with recovery to adults and children with mental illness. The services take place in either an outpatient or community based setting.

    What is Substance Abuse Recovery Support Services – Individual?

    Services that are designed to strengthen and/or regain the person’s skills, and to assist the person in developing the environmental support necessary to help him or her thrive in the community and meet life goals which promote recovery and resiliency.

    What are the criteria for a diagnosis of substance abuse?
    • A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period.
    • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g. repeated absences or poor work performance related to substance use; substance related absences, suspensions, or expulsions from school; neglect of children or household).
    • Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use).
    • Recurrent substance related legal problems (e.g., arrests for substance related disorderly conduct).
    • Continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).
    • The symptoms have never met the criteria for Substance Dependence for this class of substance.
    What are the criteria for a diagnosis of substance dependence?
    • A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
    • Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    • Markedly diminished effect with continued use of the same amount of the substance.
    • Withdrawal, as manifested by either of the following:
    • The characteristic withdrawal syndrome for the substance (refer to the DSM-IV-TR, Criteria A and B of the criteria sets for withdrawals from the specific substances).
    • The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
    • The substance is often taken in larger amounts or over a longer period than was intended.
    • There is a persistent desire or unsuccessful efforts to cut down or control substance use.
    • A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects.
    • Important social, occupational, or recreational activities are given up or reduced because of substance use.
    • The substance use is continued despite knowledge of having a persistent or recurrent physical or mental health problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).What are the criteria for a diagnosis of substance dependence?