The Four Quadrant Model for Integrating Health Care for Mental Health and Substance Abuse Patients

coordinated service planning, especially in regard to medication management.

Specialty behavioral health 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 behavioral health systems including:

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-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
>    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 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 health consumers)

Supports for Serious Persistent Mental Health 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 behavioral health clinician must be competent in both mental health and substance abuse assessment and service planning. A specific standard of practice should be adopted that defines the methods and frequency of communication with principle care providers. Note that this quadrant is where most public sector behavioral health consumers currently can be found.

QUADRANT III

Low behavioral health – high physical health complexity/risk, served in the primary care/medical specialty system with behavioral health staff on site in primary or medical specialty care, coordinating with all medical care providers including disease managers.

The principle care providers provides primary care services, works with medical specialty providers and disease managers (e.g. diabetes, asthma) to manage the physical health issues of the individual and uses standard behavioral health screening tools and practice guidelines to serve most individuals in the primary care practice. Use of standardized behavioral health tools by the principle care providers and a tracking/registry system focuses referrals of a subset of the population to the behavioral health clinician. The role of the primary care or medical specialty based behavioral health clinician is to provide behavioral health triage and assessment, consultation to the principle care providers or treatment services to the patient, referral to community and educational resources, and health risk education. Behavioral health clinical and support services may include individual or group services, use of

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