Healthcare Providers Policy Planning:The Four Quadrant Model
therapy, psycho-education, brief SA intervention, and limited case management. The BH clinician must be competent in both MH and SA assessment and service planning.
The PCP prescribes psychotropic medications using treatment algorithms and has access to psychiatric consultation regarding medication management.
The consumer of care, by seeking care in primary care, has selected a clinical home. Consistent with appropriate clinical practice, that should be honored. The primary care and specialty BH system should develop protocols, however, that spell out how acute behavioral health episodes or high-risk consumers will be handled.
This will also lead to clarity regarding the clinical home of consumers with SPMI who are currently stable, which should be based upon consumer choice and the specifics of the community collaboration.
QUADRANT II
High BH-low physical health complexity/risk, served in a specialty BH system that coordinates with the PCP.
The PCP provides primary care services and collaborates with the specialty BH providers to assure coordinated care for individuals.
Psychiatric consultation for the PCP may be an element in these complex BH situations, but it more likely that psychotropic medication management will be handled by the specialty BH system. The role of the specialty BH clinician is to provide BH assessment, arrange for or deliver specialty BH services, assure case management related to housing and other community supports, assure that the consumer has access to health 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 BH clinical and support services will vary based upon state and county level planning and financing; some localities may encompass the full range of services offered by specialty BH systems including:
Specialty MH 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-home stabilization
Outreach to homeless shelters
Outreach to jail/corrections
Outreach to other special 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 (ACT teams)
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 building /coaching
Intensive peer support
After school structured services
Summer daily structure and support
Specialty SA 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 BH consumers)
Supports for SPMI / SED Populations
Representative payee/financial services
Time limited transitional groups
Parent support groups
Youth support groups
Dual diagnosis education/support groups
Caregiver/family support groups
Youth after school normalizing activities
Youth tutors/mentors
The BH clinician must be competent in both MH and SA assessment and service planning. A specific standard of practice should be adopted that defines the methods and frequency of communication with PCPs. Note that this quadrant is where most public sector BH