Glossary of terms used in mental health and substance abuse treatment
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Communication works best when we all understand the same terminology.
Access: The extent to which an individual who needs care and services is able to receive them. Access is more than having insurance coverage or the ability to pay for services. It is also determined by the availability of services, acceptability of services, cultural appropriateness, location, hours of operation, transportation needs, and cost.
Sometimes, people lack access simply because they can’t find help. The National Treatment Access Project helps remedy this by providing the Treatment and Support Directory, a comprehensive directory of every helping service in the U.S. and Canada.
Access to Care: A serious unresolved issue in American health care. Many people who do not have generous health insurance programs find that primary medical care, including treatment for mental health or substance abuse problems, is very difficult to find or use. Despite the many improvements in the U.S. health care system brought about by the Affordable Care Act (“Obama-Care”), large numbers of people in the U.S. still have limited or no access to care.
Accessible Services: Services that are affordable, located nearby, and open during evenings and weekends. Providers of accessible services are sensitive to differences in individual and cultural values, and actively work to reduce barriers that may keep a person from getting help. For example, an adolescent may be more willing to attend a support group meeting in a church or club near home than to travel to a mental health center. An accessible service can handle consumer demand without placing people on a long waiting list.
Accreditation: An designation by a recognized accrediting organization that indicates a health care organization or program complies with certain standards.
Activity Therapy: Programs of personal growth and skill development for people recovering from mental health or substance abuse problems. Activity therapy engages the individual in creative endeavors that help to positively alter a person’s thinking. May include expressive treatments such as writing a journal, art, dance, music, psychodrama, or recreational therapy, or treatments designed to recover or build self-care, daily living, or work skills through various occupational therapies.
Acute Stress Disorder: A mental health disorder with similar symptoms to post-traumatic stress disorder, but its onset is experienced immediately after the traumatic event. If this acute stress reaction persists longer than one month, it may be considered a post-traumatic stress disorder.
Administrative Costs: These are expenses that in some businesses are called “overhead.” In treatment programs, administrative costs are expenses not linked directly to providing of care or support. Includes marketing, claims processing, billing, and medical record keeping.
Affordable Care Act (ACA): Complex federal legislation signed into law in March 2010 that began dramatic changes in the way health care is provided in the United States. Political opponents of the ACA have tried to gain partisan support for their opposition by calling it “Obamacare.”
Among the ACA’s benefits: people with “pre-existing conditions” may not be denied health insurance; health insurance premiums will be subsidized by the state and federal governments so that more people can buy insurance; more people will become eligible for Medicaid; groups of medical providers and hospitals called “Accountable Care Organizations” will be help responsible for providing care for more people while reducing costs of that care.
Alcoholics Anonymous (AA): A self-help, peer-operated, organization designed to help people who are addicted to alcohol or other drugs recover. When a person engages in “recovery” in AA, he or she follows a program of Twelve Steps: structured behavior change activities that each individual completes at her or his own pace. The Twelve Steps aim to rebuild the individual’s relationships with oneself, family, friends, and a “Higher Power” to help support complete abstinence from alcohol or street drugs.
In some communities, there are AA or Twelve Step groups specifically for people with other addictions, such as gambling, narcotics, sex addictions, Internet addictions.
Alternative Therapy : An approach to mental health care that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial. Some alternative therapies are not considered evidence-based practices; some alternative therapies are based on knowledge gained from historical or cultural practices (“folk medicine”) rather than scientific studies.
AMH: An acronym meaning “addictions and mental health.”
Anorexia Nervosa: (Pronounced “ann-oh-REX-ee-uh nerr-VOSE-uh.”) An eating disorder characterized by extremely low body weight, distorted body image, an obsessive fear of gaining weight, and unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small amounts, weighing food, and counting the calories of all foods. Individuals with anorexia nervosa may also exercise excessively. Some people experiencing anorexia may also experience bulimia.
Antidepressant Medications: Medicine that is used to help reduce the symptoms of depression. Most antidepressant medications produce their beneficial effects by increasing or reducing levels of certain neurotransmitters, primarily serotonin, norepinephrine and dopamine.
Anxiety Disorders: Anxiety disorders range from feelings of uneasiness to immobilizing terror. Most people experience anxiety at some point in their lives. Nearly everyone has had nervousness in anticipation of a real situation.
If a person cannot “shake off” unwarranted worries, or if the anxious feelings are upsetting to the point that the person can’t sleep for an extended period, or avoids everyday activities or obligations, he or she may have an anxiety disorder.
Anxiolytic Medications: Medicine that is used to help reduce the symptoms of anxiety. Some anxiolytics, or anxiety medicines, are designed to suppress the body’s “fight-or-flight response”—those drugs may be called “tranquilizers.” Sometimes, antidepressant medications, because they modify the levels of certain neurotransmitters involved in regulating mood (serotonin, norepinephrine, dopamine) can be used to help people with anxiety.
AOD: An acronym meaning “alcohol and other drugs.”
Appropriateness: The extent to which a particular procedure, treatment, test, or service is clearly indicated, not excessive, adequate in quantity, and provided in the setting best suited to a client’s needs.
Appropriate Services: Services designed to meet the specific needs and strengths of each individual and family. For example, one person may need psychotherapy, while another may need work supports. Appropriate services for one client may not be appropriate for another. Appropriate services usually are provided in the client’s community.
Asperger’s Syndrome: Asperger’s Syndrome is considered an autism-spectrum disorder. See Autism. People with Asperger’s Syndrome often have well-developed language and thinking skills (unlike many people with autism), but may have significant difficulties in social interaction. For some individuals, these difficulties seem to be related to a restricted ability to perceive or effectively use non-verbal communication. Some people with Asperger’s Syndrome may have unusually intense interests in one or a few areas and may have restricted or repetitive patterns of behavior and speech.
Assertive Community Treatment (ACT): A multi-disciplinary clinical team approach of providing 24-hour, intensive treatment services in the individual’s natural community setting. ACT has been proven as an effective way to help people with serious and persistent mental illness live successfully in the community.
Assertive Community Treatment includes the client, a multidisciplinary treatment team, and the family as partners in treatment to create a home- and community-based (non-hospital, non-institutional), individualized program of recovery for the adult with mental illness. When an ACT-type service is provided as a program for children and adolescents, it may be called a wraparound service.
Assessment: A professional review of an individual’s needs and strengths. Usually it is conducted at the onset of treatment, and on an ongoing basis during the course of treatment. The assessment of a child, for example, may include a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community.
Attention-Deficit/Hyperactivity Disorder (ADHD) : Attention-deficit/hyperactivity disorder, sometimes called ADHD, is a chronic condition and the most commonly diagnosed behavioral disorder among children and adolescents. People with ADHD struggle with inattentiveness, over-activity, impulsiveness, or combinations of these issues. Attention deficit disorder (ADD) involves issues similar to ADHD, but without over-active behavior.
Children and adolescents with attention-deficit/hyperactivity disorder or attention deficit disorder may have difficulty controlling their behavior in school and social settings. Although some young people with ADD or ADHD may not earn high grades in school, most have normal or above-normal intelligence.
Autism: Autism, also called autistic disorder, is a complex developmental disability that appears in early childhood, usually before age three. Autism often prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development. Because symptoms of autism appear in different ways and cause differing kinds of challenges for different individuals, some people prefer to use the term “autism spectrum disorders.”
Behavioral Healthcare : Behavioral healthcare means the continuum of services for individuals at risk of, or suffering from, mental, addictive, or other “behavioral health” disorders. Behavioral healthcare services include assertive community treatment, individual or group psychotherapy, activity therapy, medications, support groups.
“Behavioral health” is sometimes useful shorthand, but of course it is an inaccurate term—we know that mental health and recovery from substance use disorders are more complex than “behavior”—recovery and health actually involve one’s whole experience, emotionally, cognitively, socially, spiritually, behaviorally, etc.
Behavioral Healthcare Organizations (BHO): Specialized (often for-profit) managed care organizations focusing on mental health and substance abuse insurance or insurance-type benefits, which they call “behavioral healthcare.” These firms offer employers, insurance companies, and public funders a means of managing payment for mental health and substance abuse treatment.
Under the Affordable Care Act, some BHOs have joined with with primary care providers and hospitals to become partners in ACOs or CCOs.
Behavioral Therapy: As the name implies, behavioral therapy focuses on changing unwanted behaviors. It involves identifying objectionable, maladaptive behaviors and replacing them with healthier types of behavior. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior.
Binge-Eating Disorder: Binge-eating is an eating disorder characterized by frequent episodes of compulsive overeating, but unlike bulimia, the excessive eating is not followed by purging. During food binges, individuals with this disorder often eat alone, in secrecy, and very quickly, regardless of whether they feel hungry or full. It is likely the most common of all eating disorders, but it usually is not considered a distinct psychiatric condition.
Biofeedback: Biofeedback is a method of learning to control muscle tension and “involuntary” body functioning, such as heart rate and skin temperature. It often uses electronic devices that measure and report (feed back) these normally involuntary functions. Biofeedback may be used in combination with, or as an alternative to, medication to treat disorders such as anxiety, panic, phobias, and physical pain. It is also sometimes used as part of treatment for substance use disorders.
Biomedical Treatment: Any treatment involving medicine is a biomedical treatment. Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of emotional, behavioral, and mental disorders. The kind of medication prescribed varies with the disorder and the individual being treated.
Bio-Psycho-Social Approach: A way of thinking holistically about, and treating mental or substance use disorders, that considers the whole person. “Bio” refers to biology, meaning a person’s physical health and the functioning of the individual’s nervous system. “Psycho” refers to psychology, meaning the thoughts, beliefs, and inner life experiences that form the individual’s personality. “Social” refers to the person’s relationships, role in the family, work, or school, and interactions with others.
Bipolar Disorder: Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder. The manic phase of bipolar disorder may include extreme insomnia, agitation, hyperactivity, serious errors of judgment and self-control, and psychosis. Some people with this disorder “cycle” from mania into a similarly extreme depressive phase. Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide. (Bipolar disorder was formerly called manic-depressive illness.)
Borderline Personality Disorder: Symptoms of borderline personality disorder can include pervasive instability in moods, interpersonal relationships, self-image, and behavior. The instability can affect family and work life, long-term planning, and the individual’s sense of self-identity.
Bulimia Nervosa: Pronounced “bull-EE-mee-uh nerr-VOSE-uh.” Bulimia nervosa is an eating disorder characterized by excessive eating. People who have bulimia will eat an excessive amount of food in a single episode and almost immediately make themselves vomit or use laxatives or diuretics (“water pills”) to get rid of the food in their bodies. This behavior may be referred to as the “binge/purge” cycle. Like people with anorexia, people with bulimia often have an intense fear of gaining weight.
Buprenorphine: Pronounced “beeyou-prenn-ORR-finn.” A medication used to help people who are recovering from opiate (heroin, methadone, oxycodone/Oxycontin) addiction. Buprenorphine treatment is sometimes considered a harm-reduction intervention, because opiate users remain addicted, transferring their addiction to buprenorphine. Buprenorphine can prevent opiate withdrawal symptoms without the usual opiate intoxication effects.
Cachexia: (Pronounced “kuh-CHECK-see-uh”) Cachexia is also called “wasting syndrome.” It is loss of weight, muscle atrophy, fatigue, weakness, and loss of appetite in someone who is not actively trying to lose weight. It is often a symptom of AIDs, cancer, multiple sclerosis, amphetamine abuse, and certain other illnesses.
Cannabis: (Pronounced “KAN-uh-biss”) is a genus of flowering herbs. It is also called “marijuana.” There are three identified species: C. sativa (pronounced “KAN-uh-biss suh-TEE-vuh”), C. indica (pronounced “KAN-uh-biss INN-dick-uh”), and the less common C. ruderalis (pronounced “KAN-uh-biss rood-er-ALL-iss”).
Cannabis plants contain a group of chemicals called cannabinoids (pronounced “Kan-NAH-bin-oids”). More than 85 cannabinoids have been identified in cannabis plants.
Two cannabinoids are usually produced in greatest abundance by the plants: cannabidiol or “CBD” (pronounced “KAN-na-bid-DYE-all”) and delta-nine-tetrahydrocannabinol or “THC.” THC is known as psychoactive, the “high one”; CBD is known as having more physical effects, the “body one.”
Cannabis has been used medicinally and recreationally for at least 3,000 years. C. sativa and C. indica are currently most common in the U.S. Cannabis rudaralis is traditionally used in Russian and Mongolian folk medicine, often for treating depression. It has less THC compared to other cannabis species, but is often high in CBD.
Hemp is the soft fiber made from the cannabis stem or stalk. Varieties of cannabis sativa are usually used to make hemp, because of their long stems and stalks. Hemp has been produced from cannabis plants for over 10,000 years.
About half of U.S. states have partially legalized cannabis for medical uses. A handful of states have partially legalized cannabis for adult use. “Medical marijuana” and “recreational marijuana” are the same herbal products. The only distinction is their legal or regulatory status in some U.S. states.
Under U.S. federal law, both “medical” and “recreational” cannabis use, possession, and transfer by sale or gift are illegal, a vestige of the notoriously failed War on Drugs.
Because of the many years of cannabis prohibition, research on cannabis has lagged behind that of most other medical treatments. Medical use of cannabis in the U.S. remains largely folk medicine, not fully embraced by the scientific medical community.
Some opponents of cannabis decriminalization have characterized cannabis as a “gateway drug,” a concept that has been debunked. There is some scientific evidence to suggest, however, that excessive cannabis use in adolescence may delay cognitive or educational development.
There is also clinical evidence that cannabis can trigger psychotic episodes in people who have schizophrenia or mania in people who have bipolar disorder. Some neophyte cannabis users have been known to experience anxiety symptoms, especially when using high-THC varieties of cannabis.
Capitation: A payment method for health care services. The physician, hospital, or other health care provider is paid a contracted rate for each member assigned, referred to as “per-member-per-month” rate, regardless of the number or nature of services provided.
Carve-Out: A set of Medicaid services (for example, substance abuse or mental health) exempted from the capitation rate set for managed physical healthcare plans. Also, certain populations may be “carved out” from mandatory Medicaid managed care plan enrollment such as seniors or people with disabilities.
Case Manager: An individual who helps arrange services and supports for people with mental health problems. Case management includes five key functions: assessment, planning, linking, monitoring, advocacy.
In some programs, a case manager is part of the treatment team. In others, case managers take the lead to coordinate access to treatment, as well as educational, health, vocational, transportation, advocacy, respite care, and recreational services, as needed.
Some insurance companies employ case managers to arrange and pre-approve services for payment by the insurance plan. Insurance case managers may be responsible for authorizing payment for extended treatment after initial services have been provided. Unfortunately, insurance case managers are sometimes pushed by their companies to reduce costs by denying treatment.
Catchment Area: A geographic area designated as the service area for a particular program or service. For example, a program may be funded to serve only people who live within a particular city. The city boundaries would describe that program’s catchment area.
CBT: See Cognitive-Behavior Therapy.
Child Protective Services: A government-operated program designed to protect children from abuse, neglect, or abandonment. (Some U.S. states have renamed their child protection programs, but “CPS” is the most widely used and known name.)
The goal of CPS is to keep the affected child safe, often along with the goal of “family preservation,” keeping the child in the family home. CPS may arrange help for the family such as parenting classes or anger management training, financial assistance, vocational training, homemaker services, and daycare. If in-home supports are insufficient, the child may be removed from the home on a temporary or permanent basis.
In most states, mental health professionals, physicians, teachers, school counselors, clergy, and certain other professionals are required by law to report suspected child abuse, neglect, or abandonment to the local child protective services office.
Children and adolescents at risk for mental health problems: Children are at greater risk for developing mental health problems when certain factors are present in their lives or environments. Factors include physical abuse, emotional abuse or neglect, harmful stress, discrimination, poverty, loss of a loved one, frequent relocation, alcohol and other drug use, trauma, and exposure to violence.
Chronic Disease: “Chronic” literally means “time.” A chronic disease, illness or disorder is one that produces symptoms over an extended period of time—a period of months or years. Some people define a condition as “chronic” if it lasts more than three months, or if it cannot be cured or eliminated by medication or surgery.
Client: A term that for the person who is receiving treatment from a mental health or substance use professional. The word has an honorable history, meaning “one who is protected by,” and is also the term used for a customer of an attorney, accountant, adviser, or architect. Others feel that the word “client” is un-empowering, suggesting a weak position in an imbalanced power relationship.
Clinical Psychologist: A clinical psychologist is a professional with a doctoral degree in psychology who specializes in treatment for mental health and substance abuse problems.
In most states, you can verify the license of any licensed psychologist online. Click here.
Clinical Social Worker: Social workers are professionals with master’s degrees who are trained in advocacy to assist clients with information, referral, and “navigating the system.” Clinical social workers (not all social workers) are trained in psychotherapy and treatment for individuals and families.
In most states, you can verify the license of any social worker, psychotherapist, marriage and family counselor, professional counselor, or physician online. Click here.
Cognitive-Behavioral Therapy (CBT): A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.
Cognitive Therapy: Cognitive therapy aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or even self-destructive. The goal is to replace such thinking with a more balanced view that, in turn, leads to more fulfilling and productive behavior.
Community Mental Health Center (CMHC): An organization that provides a variety of mental health treatment services, and sometimes substance abuse treatment services, to people who live within certain geographic boundaries, often a single county, or group of adjacent counties. (Some states have renamed these programs, but the most used and known name is “CMHC.”) In most states, CMHCs provide services to people who are enrolled in Medicaid, and often provide services on a sliding fee scale for people who are uninsured.
Conduct Disorders: Children with conduct disorders repeatedly violate the personal or property rights of others and the basic expectations of society. Children with conduct disorders may display defiance, impulsivity, antisocial behavior, drug use, or criminal activity. A diagnosis of conduct disorder is likely when these symptoms continue for six months or longer. Conduct disorder is known as a “disruptive behavior disorder” because of its impact on children and their families, neighbors, and schools.
Confidential: Information that a person shares with a mental health professional during treatment is confidential—it is personal, private, and protected by law. There are federal and state laws, and ethical or licensing standards, that require mental health professionals to protect confidential information from disclosure. There are a few exceptional situations in which professionals are required to release confidential information: credible threat to harm oneself or others, suspected child abuse or neglect; planned violent criminal behavior that is likely to occur; credible threat to national security or against the President of the United States. Professionals may disclose confidential information to the extent necessary to save human life.
Consumer: An individual who receives healthcare services, specifically mental health or substance abuse treatment services. Some people prefer to use other terms, such as client, patient, member, peer, or survivor.
Consumer-Run Services: Mental health support services that are provided by current or former mental health consumers. These may include social clubs, peer-support groups, employment services or day labor crews, and other peer-organized or consumer-run activities.
Cost-Sharing: A health insurance policy provision that requires the insured party to pay a portion of the costs of covered services. Deductibles, coinsurance, and co-payments are types of cost-sharing.
Counselor: A general term for any person who provides counseling, including paraprofessionals, unlicensed treatment providers, and professionals: people who are trained and licensed as school counselors, professional counselors, substance abuse counselors, social workers, psychiatrists, psychologists.
In most states, you can verify the license of any licensed psychologist, social worker, psychotherapist, marriage and family counselor, professional counselor, or physician online. Click here.
Couples Counseling and Family Therapy: These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist, sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. These approaches often focus more on the problems between or among people than on an individual’s symptoms or problems, though these may be resolved as a result of changed relationships.
This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a family member with a mental illness–such as how to deal with feelings of anger or guilt in healthy ways.
Crisis Intervention Team (CIT): A standard for law enforcement response to people in the community who have mental illnesses or substance abuse problems. Includes intensive training (often forty hours or more) for the CIT officers on the causes and symptoms of mental disorders, non-violent intervention, and other topics designed to help officers problem-solve with troubled individuals more effectively and humanely.
CIT was pioneered by the Memphis (Tennessee) Police Department in 1988. The “Memphis Model” has been widely adopted nationwide. Many departments attempt to dispatch a CIT-trained officer whenever there is a call for intervention with a person who seems to have a mental illness. Learn more at this link: Memphis Police
Crisis Residential Treatment Services: Short-term, round-the-clock help provided in a non-hospital setting during a crisis. For example, when an adult with a serious mental illness has a relapse, the individual may stay in this safe setting for a few days of “rapid stabilization” before returning home. Or if a child with a serious emotional disturbance becomes aggressive and uncontrollable, a parent may temporarily place the child in a crisis residential treatment service. The purposes of this care are to avoid inpatient hospitalization, help stabilize the individual, and determine the next appropriate step.
Cultural Competence: Treatment professionals, who are aware of the effect of culture on personality and treatment, learn skills that help them respond appropriately to a person’s unique cultural differences. This is called cultural competence. By using these skills, therapists can be sensitive and responsive to cultural differences, including race, ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability. They can also adapt their treatment approach to fit a particular family’s values and customs.
Day Treatment: Day treatment programs are often recommended for people who have had setbacks in their usual social, occupational, or educational activities because of mental illness or severe emotional disturbance. Day treatment includes education, counseling, vocational training, skill building, crisis intervention, and recreational therapy. Day treatment programs work in conjunction with mental health, recreation, and education organizations and may even be operated by those organizations.
DBT: See Dialectical Behavior Therapy.
Deductible: The amount an individual must pay for health care expenses before insurance begins to pay its share. Often insurance plans have annual deductible amounts, meaning the first $100, $250, or some other amount, of treatment fees each year must be paid by the insured person before the insurance policy will pay anything.
Delirium: Delirium is also called “acute confusional state.” It is a serious disturbance of a person’s mental abilities that causes a decreased awareness of one’s environment, such as not knowing where or who one is, and very confused thinking.
Delirium usually comes on suddenly and usually is temporary. It is always a warning that immediate medical care is required. It may be a symptom of brain injury or stroke, severe medical illness, infection, surgery, adverse medication reaction, or drug or alcohol abuse.
Delusions: Delusions are bizarre or extremely distorted thoughts that have no basis in reality. Delusions are most commonly a symptom of schizophrenia or other mental illness.
Delusions often have paranoid themes, ideas that someone or something outside the person is responsible for imaginary present or future harms. Sometimes, people with dementia or delirium will express delusional ideas as a way of explaining or understanding changes in their own cognitive functioning.
Dementia: Dementia is a problem in brain function that makes it hard for a person to remember, learn and communicate. It may be difficult for a person with dementia to take care of himself or herself. This disorder can affect a person’s mood and personality and can reduce a person’s ability to carry out routine daily activities. Alzheimer’s disease is one kind of dementia. Dementia may also result from circulatory problems, stroke, alcohol or other drug abuse, or a brain injury.
Depression: Depression is a mood disorder characterized by intense feelings of sadness, guilt, fear, inadequacy, loss of interest, loss of energy, inability to accomplish daily tasks, that persist beyond a few weeks. Two neurotransmitters—natural brain chemicals that allow brain cells to communicate with one another—are implicated in depression: serotonin and norepinephrine. Anti-depressant medications alter the levels of these neurotransmitters in the brain or modify the way that they are used by brain cells.
Detox: This word is the short version of “detoxification” or “detoxify.” Detox is a special kind of treatment that involves providing support, supervision, and medication during the first days or weeks after a person stops using addictive drugs such as alcohol. Detox is sometimes provided in inpatient or residential facilities.
Developmental Disability (DD): A lifelong disability occurring before the age of 18 that interferes with a person’s ability to meet normal developmental milestones. An adult person with a developmental disability will have limited capacity in certain domains of daily living such as learning, speech and language, motor control (muscle coordination and mobility), self-care, self-direction, independent living, economic self-sufficiency.
A long list of conditions and causes are included in the term “developmental disability.” People with developmental disabilities may include people who are affected by mental retardation, cerebral palsy, autism spectrum disorders, Down Syndrome, Fragile X Syndrome, genetic problems, metabolism or nutritional problems, fetal alcohol syndrome or other prenatal or birth injuries.
Diagnosis: (Plural is “diagnoses,” pronounced “dye-agg-NO-sees.” A brief technical description, sometimes only one or two words, that serves as a general description of the issue that is the focus of treatment.
A diagnosis is only technical shorthand; it never describes the person or the whole experience of the issue that is the focus of treatment.
Here’s an example. The diagnosis is: fractured tibia (broken leg). The experience is: “I fell down the stairs, the paramedics took me to the hospital and I had surgery and got pins in my leg and I stayed in the hospital for three days and I’ve been walking on crutches for four weeks and it still hurts a lot and I can’t sleep and my cast itches .”
In the same way, a diagnosis of a mental disorder doesn’t describe the whole experience, or the person, and certainly does not describe the individual’s strengths and progress in recovery.
Some people object to diagnosing, or “labeling,” because they believe that diagnostic labeling promotes a narrow perception of people that is blind to individuals’ wholeness and strengths.
Diagnostic Evaluation: The purpose of a diagnostic evaluation is understand the person presently, and the person’s history, using a bio-psycho-social approach, to (a.) determine the nature of the health problem (establish a diagnosis) (b.) collect information about the individual’s strengths and (c.) develop an initial treatment plan, with particular consideration for any immediate interventions that may be needed to ensure the person’s safety.
Dialectical Behavior Therapy (DBT): A form of therapy, originally created for people with borderline personality disorders, in which the therapist acts as an accepting and validating ally, while showing the client alternatives to maladaptive feelings and behaviors.
DBT usually includes brief individual one-on-one therapy sessions and a weekly group in which a client learns to use skills in mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. The individual sessions are used to keep suicidal urges or uncontrolled emotional issues from disrupting group sessions, and the group sessions teach the four sets of skills.
Research has shown that DBT is the first effective treatment for borderline personality disorders. Recent research has shown that DBT may be also an effective treatment for people recovering from certain mood disorders, as well as people recovering from drug addiction or the trauma of sexual abuse. Many therapists incorporate elements of DBT, especially mindfulness and emotional regulation skills, into other treatment approaches for a wide range of issues.
Drop-In Center: A social club, often consumer-run, offering peer support and flexible schedule of activities, often operating on evenings and weekends. Drop-in centers help individuals living with mental illness find peer support and a safe place to socialize.
DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition): Pronounced “DEE-ess-emm-five.”) This reference book is an official manual of mental health diagnoses developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other mental health treatment providers use the tools in this book to understand, diagnose, and communicate about mental health problems. Insurance companies and health care providers also use the terms and explanations in this book when discussing mental health problems.
Dual Diagnosis: A person who has both an alcohol or drug problem and an emotional or mental health problem is said to have a dual diagnosis. Sometimes other terms are used: “co-occurring disorder,” or “MI/SA” (meaning mental illness and substance abuse). In a few east coast states, the terms “MICA,” “MICAA,” or “CAMI,” may be used. See MICA.
The terminology can become more confusing. In some contexts, individuals who have both a developmental disorder and a mental illness are said to have a dual diagnosis (“DD/MI.”) And sometimes in medical contexts, people who have both a serious medical illness and a serious mental illness are described as having a co-occurring disorder.
DUI or DWI or DUII: Driving Under the Influence (of alcohol or drugs) or Driving While Intoxicated or Driving While Impaired or Driving Under the Influence of Intoxicants. These acronyms vary from state to state — in some states, it’s pronounced “dewey.” These acronyms are used in law enforcement and the courts to describe criminal charges related to driving and substance abuse. Sometimes, a DUI or DWI charge is a “wake up call” that pushes a person into treatment and recovery. For this reason. many communities require DUI or DWI defendants to participate in substance abuse assessments or psychoeducational classes about substance use disorders.
Duty-To-Warn: Information that is shared with licensed mental health professionals is generally confidential, or “privileged,” just as it is with lawyers and physicians. In certain instances, when licensed mental health professionals receive information relating to likely potential harm to other people, there is a “duty to warn.” In these instances, the professional will disclose confidential information as necessary to warn and protect the potential victim.
Sometimes, the duty-to-warn is called the “Tarasoff duty-to-warn,” which is a reference to a pivotal lawsuit and court decision which helped to define the issue.
Early Intervention: A process used to recognize warning signs for mental health problems and to take early action against factors that put individuals at risk. This term is often used to describe healthcare programs for young children and families. Early intervention can help children get better in less time and can prevent problems from becoming worse.
Electroconvulsive Therapy (ECT): This treatment uses low voltage electrical stimulation of the brain, under anesthesia, to treat some forms of major depression, acute mania, and some forms of schizophrenia. ECT typically is used only when other therapies have failed, when a person is seriously medically ill and unable to take psychotropic medication, or when a person who is extremely depressed is considered very likely to kill herself or himself.
In the past, ECT was widely prescribed, often with higher voltages than used today, and without the anesthesia protocol presently used. Consequently, it developed a reputation as painful and unwarranted. Though ECT was widely used in the past, today it is rarely used.
Emergency and Crisis Services: Services that are directly and immediately available to individuals, without appointments, 24 hours a day, 7 days a week, to help during a mental health or substance abuse emergency. Examples include telephone crisis hotlines, suicide hotlines, crisis counseling, crisis residential treatment services, and crisis respite care.
Emergency Medical Treatment and Labor Act (EMTALA): EMTALA is a law that requires hospitals to provide emergency treatment to individuals in need, regardless of their insurance status or ability to pay.
Employee Assistance Program (EAP): Employee Assistance Programs are typically provided by contract to employers as a fringe benefit for their employees. EAPs often provide short-term counseling, referrals to ongoing treatment, and workplace intervention when mental health or substance abuse problems are interfering with job performance.
Employment and Vocational Rehabilitation Services: Services designed to help people in recovery learn, or re-learn, job-seeking and job-performing skills.
Epilepsy: A neurological (neurological means it involves brain cells called neurons) syndrome with recurrent seizures as the most visible symptom. Anti-seizure medications can control the recurrence of seizures for many people with epilepsy, but about 30% of people with epilepsy continue to have seizures despite medications. Some people prefer to use the term “seizure disorder” rather than “epilepsy.”
Episode of Care: Some individuals experience recurring substance abuse or mental health disorders. From the time an individual begins treatment for a problem, until the treatment is completed or ended, that is an episode of care. If the problem comes back, and the individual gets a course of treatment again, that would be another “episode of care.”
EPSDT (Early Periodic Screening, Diagnosis, and Treatment): The child health component of Medicaid—it is required in every state and is designed to improve the health of low-income children, by financing appropriate and necessary pediatric services, particularly the routine screening that can help identify health problems before they become serious. It is one form of early intervention.
Evidence-Based Practices (EBP): Therapeutic approaches, techniques, or programs, that are deemed effective because they show positive results in scientific outcomes research. Most licensed professionals continuously study current published research. When research results (“evidence”) demonstrate that a particular treatment practice is effective or ineffective, the treatment professional modifies his or her practices accordingly.
Family Counseling: A style of counseling that works with family members to help treat with problems experienced by one or more family members or by the whole family group. This may be referred to as treatment of an emotional disorder of a family unit.
Family-Like Arrangements: A broad range of living arrangements that simulate a family situation. This includes foster care and small group homes.
Family Support Services: Help designed to keep the family together, while coping with mental health problems that affect them. These services may include consumer information workshops, in-home supports, family therapy, parenting training, crisis services, and respite care.
Family Therapy and Couples Counseling: These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist, sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a family member with a mental illness–such as how to deal with feelings of anger or guilt.
Fentanyl: is a narcotic analgesic (pain-killer) drug. It is often prescribed for people who have chronic severe pain including people with painful cancer. It works by changing the way the brain and nervous system respond to pain. It is used intravenously in hospital operation rooms and intensive care units as an anesthetic (to “put people out” during surgery) or to prevent control surgical pain. It is also used for pain control during dental procedures.
Fentanyl is often diverted from prescription medical use to people with narcotics addictions.
See oxycodone and hydrocodone.
Foster Care: A supervised living arrangement in a household other than that of one’s own family.
Glue Sniffing: See Inhalant Abuse.
GOMER: A demeaning term used among staff in some hospital emergency departments, often to refer to people with mental illness or substance use issues who have no other access to treatment. It is an acronym for “Get Out of My Emergency Room.”
Group Therapy: This form of psychotherapy involves groups of usually four to 12 people who have similar problems and who meet regularly with a psychotherapist. The therapist observes and guides the interactions of the group’s members to help them get relief from distress and possibly modify their behavior.
Hallucinations: Hallucinations are experiences of sensations that have no external source. Hallucinations may be vivid and clearly perceived. They may be difficult to distinguish from “real” perceptions. For example, certain serious mental illnesses may produce auditory hallucinations—often, as in schizophrenia, the experience of hearing voices of people who are not present. Visual hallucinations are not usually symptoms of mental illness; more often, visual hallucinations result from drug use, medical illness, metabolic or nutritional disorder, lack of sleep, other temporary disturbance of brain chemistry, or of brain injury.
Harm Reduction: Harm reduction is a form of intervention designed to minimize the risk or damage associated with potentially harmful behaviors. Two examples of harm reduction activities: free needle-exchange programs that are intended to reduce the spread of dangerous diseases among users of injectable drugs; programs that offer free taxi rides home from bars for people who are too intoxicated to drive.
Health Home: Another term for Medical Home.
Health Insurance Portability and Accountability Act of 1996 (HIPAA): Pronounced “HIPP-uh.” A large and complex set of Federal laws that regulate part of the health insurance and healthcare industry. One aspect of HIPAA standardizes regulations about the confidentiality of personal health information.
Hepatitis: Pronounced “hepp-uh-TIGHT-uss.” An inflammation of the liver, often caused by viruses. There are three well-known types of hepatitis—hepatitis A, hepatitis B, hepatitis C—each caused by a different virus. Hepatitis may also be caused by other illness, by alcohol, or by environmental toxins.
HIV: Human immunodeficiency virus, the virus that causes AIDS (acquired immune deficiency syndrome.) People who are infected with the virus, but not experiencing the failure of the immune system that indicates AIDS, are said to be “HIV-positive” or “HIV+.” People who are HIV+ and using medications to manage the virus may live many years without developing AIDS.
HIV is often sexually transmitted, an STD. It may also be spread when people share or re-use needles for drug injections. Many communities offer free needle exchanges to people who are addicted to injectable drugs to help prevent the spread of HIV (as well as hepatitis C or other diseases.)
Holistic: A term used to describe certain forms of treatment or ways of thinking about health. Holistic treatment means treatment that is not simply directed at reducing undesirable symptoms, but instead addresses the emotional, physical, social, and spiritual health and well-being of the whole person.
Home-Based Services: Help provided in an individual’s or family’s home by mental health professionals. Examples include support for self-care, nutrition and medication regimens, parent training, counseling, and working with family members to identify, find, or provide other necessary help. The goal is to prevent the individual from being placed outside of the home. Assertive community treatment (ACT) is one form of home-based services.
Homeless Person: An individual who lacks a regular and adequate nighttime residence. Includes a person whose primary nighttime residence is a homeless shelter, a “welfare hotel,” temporary or transitional housing, a halfway house, or re-entry program. It also includes a person whose nighttime residence is not intended as a regular sleeping accommodation for human beings, such as a car, barn, abandoned building, subway tunnel, etc.
Housing Services: Assistance for adults, families, children, in finding and maintaining appropriate housing arrangements. Some mental health or substance abuse treatment programs offer housing services. This is important because some people who have symptoms of certain mental health or substance abuse disorders may have difficulty finding or maintaining a stable place of residence.
Huffing: A slang term for the act of inhaling volatile hydrocarbons in order to get high (to produce an altered state of awareness.) See Inhalant Abuse, and Volatile Hydrocarbons.
Hydrocodone: is a narcotic analgesic drug used to treat pain, and often used to help suppress coughing. It works by changing the way the brain and nervous system respond to pain. Like oxycodone, hydrocodone may be supplied in pills, liquid, or injectable form, and is often combined with acetaminophen, ibuprofen or cough medicine.
The most well-known brand name for hydrocodone is Vicodin, which is a pill that combines hydrocodone and acetaminophen (Tylenol). Vicodin is often proscribed by physicians and dentists to relieve pain.
Hydrocodone is often diverted from prescription medical use to people with narcotics addictions.
See oxycodone and fentanyl.
Illegal alien: A pejorative term sometimes used to describe a person who exists in the United States and does not have papers that establish U.S. government approval for employment (visa, work permit) or U.S. citizenship. The currently preferred term is “undocumented person” or “undocumented immigrant.”
Independent Living Services: Support for a person with symptoms that interfere with independent living. These services include therapeutic group homes, supervised apartment living, and job placement. Services may teach the person how to handle financial, medical, housing, transportation, and other daily living needs, as well as developing appropriate social skills.
Indigent: An outdated term, now considered pejorative, used in the healthcare industry to describe someone with a low income who does not have health insurance. The currently preferred term is “low-income/uninsured.”
Individual Therapy: Psychotherapy for a client that is provided one-to-one and face-to-face, often in a professional office setting. A typical course of individual therapy is a series of weekly appointments. Individual therapy appointments usually are one hour or less—often 50 minutes per session.
Individualized Services: Services designed to meet the unique needs of each person and family. Services are individualized when the treatment providers pay attention to the needs and strengths, ages, and stages of development of the individual and their involved family members.
Information and Referral (I & R): Information and Referral services are designed to help people find service resources and how to access them.
Inhalant Abuse: Some products used in everyday life contain volatile hydrocarbons that emit noxious gases; gasoline, glue, spray paint, nail polish remover, hair spray, are some examples. Some people intentionally inhale the fumes of these products to experience intoxication. This practice may result in brain, kidney, liver, or lung damage, and may be fatal. Inhalant abuse may be called “sniffing” or “huffing.”
In Home Family Services: Mental health treatment and support services that are offered to children and adolescents with emotional disturbance or mental illness and to their family members in their own homes.
Inpatient Hospitalization: Mental health treatment provided in a hospital setting 24 hours a day. Inpatient hospitalization provides: (1) short-term treatment in cases where a person is in crisis and possibly a danger to his/herself or others, and (2) diagnosis and treatment when the person cannot be evaluated or treated appropriately in an outpatient setting.
Years ago, inpatient hospitalization was often long term, spanning years or even a lifetime. Nowadays, the nationwide average length of stay for inpatient hospitalization for adults is less than one week.
Intake/Screening: Services designed to briefly assess the client’s mental health condition to determine whether services are needed and to link the person to the most appropriate and available service. Services may include interviews, psychological testing, physical examinations, and laboratory studies.
Intensive Case Management: Intensive community services for individuals with severe and persistent mental illness that are designed to improve planning for their service needs. In addition to standard case management activities, services include outreach, evaluation, and treatment support.
Intensive Residential Services: Intensively staffed housing arrangements, usually for people with symptoms of mental illness. May include medical, psychosocial, vocational, recreational or other support services.
Interpersonal Psychotherapy: Through one-on-one conversations, this approach focuses on the patient’s current life and relationships within the family, social, and work environments. The goal is to identify and resolve problems with insight, as well as build on strengths.
Kief: Pronounced “keef.” The sticky crystalline-appearing resin glands (or trichomes) of cannabis flower. Kief contains a higher concentration of cannabinoids such as THC than is found in the cannabis flowers from which it comes.
Length of Stay: The number of days an individual stays in a hospital inpatient or residential facility.
LGBTQ (sometimes LGBT or GLBT): An acronym for lesbian, gay, bisexual, transgendered, questioning. This term describes a variety of the ways that individuals may identify their gender or express their predominant sexual orientation.
Living Independently: When a person lives in a private residence and requires no assistance in the usual activities of daily living and caring for oneself.
Managed Care: A way of organizing insurance payment for healthcare services that includes utilization management and quality management activities. Utilization management means active monitoring of the type and intensity of healthcare services used by an individual or an insured group. Quality management means defining specific standards for the healthcare that is eligible for reimbursement and monitoring to ensure that the care meets those standards. Critics of managed care consider it a way of limiting access to necessary care or limiting the choices of treatment options available to individuals and their treatment providers.
Marriage Counseling: Counseling for a couple, whether they are married or not, designed to help them have a more satisfying or less conflictual relationship with each other. Generally not reimbursable by health insurance.
In most states, you can verify the license of any licensed psychologist, social worker, psychotherapist, marriage and family counselor, professional counselor, or physician online. Click here.
Means Restriction: Means Restriction is one of the most important things that people can do to prevent suicide—separating a person who is thinking of killing her or him self from the things that could cause death. For example, if a person is struggling with suicidal thoughts, a friend or loved one might help the person remove guns or un-needed medicines from the home. Restricting access to the means of self-harm is often the key to saving a life.
Medicaid: Medicaid is a program operated by in each state that helps people with low income get necessary medical services. Medicaid rules and procedures vary from state-to-state. In many states, Medicaid has been wrapped into the states’ health insurance exchanges. The funding for Medicaid partly provided by the Federal government and is “matched” by the State government. Here is a brief description of how to learn more about Medicaid.
Medical Home: The concept of an individual forming a relationship with a primary medical care provider (“PCP”), usually a physician specializing in family practice, internal medicine, pediatrics, or gynecology. The individual would visit the Medical Home PCP regularly to receive routine care and health monitoring, to help prevent acute illness or to mange chronic illness. In some managed care systems, the Medical Home PCP acts as a gatekeeper or coordinator of specialty services from other kinds of physicians, or from mental health or substance abuse treatment providers.
Medicare: Medicare is a Federally-operated program that helps people who are disabled (unable to work) or people who are over the age of 65 get necessary medical services. Medicare is designed to be paid for through investments funded by payroll taxes. Most people who use Medicare for health care must pay deductibles and co-payments, which some individuals pay with supplemental commercial insurance plans.
Medication Therapy, in Mental Health Treatment: Medication therapy for people recovering from mental illness means reducing undesirable symptoms by using psychotropic medications. Medication therapy for mental illness is generally provided by physicians, nurse practitioners (NPs), or physician assistants (PAs).
The prescriber of the medication is responsible for administering or providing instruction on self-administration of the medication, as well as assessing the drug’s effectiveness, and monitoring potential side effects of the medication. It is widely understood that medication therapy is most effective when accompanied by psychotherapy or other non-medication forms of treatment.
Medication-Assisted Therapy, in Treatment of Substance-Use Disorders: Medication-assisted therapy is a term for the treatment of people recovering from substance use disorders. Medication-assisted therapy means reducing drug withdrawal symptoms or cravings by using medications such as naltrexone, buprenorphine, Librium (chlordiazepoxide), etc.
The prescriber of the medication is responsible for administering or providing instruction on self-administration of the medication, as well as assessing the drug’s effectiveness, and monitoring potential side effects of the medication. It is widely understood that medication-assisted therapy is most effective when accompanied by non-medication forms of treatment.
Mental Disorders: Mental disorders, or mental health problems, are real. They affect one’s thoughts, body, feelings, and behavior. Mental disorders are not a “passing phase” or sign of weakness. Mental disorders include depression, bipolar disorder (manic-depressive illness), attention-deficit/ hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia, conduct disorder, personality disorders, and others. Untreated mental health problems may be life-threatening, may disrupt families and relationships, and may interfere with school, work, or other activities of living.
Mental Health: How a person thinks, feels, and acts when faced with life’s situations. Mental health is a person’s capacity to achieve goals they set for themselves, to maintain a consistently positive self-image, to have satisfying relationships with other people, to evaluate and respond effectively to life challenges and problems, to explore choices, to handle daily stress and make decisions, to live with minimal fear, anxiety, and distress.
Mental Health Parity: Mental health parity refers to providing the same insurance coverage for mental health treatment as that offered for medical and surgical treatments. The Mental Health Parity Act was passed in 1996 and established parity in lifetime insurance benefit limits and annual insurance limits. The Health Reform Act of 2010 included additional measures designed to make mental health parity a reality in the United States.
Mental Health Problems: Mental health problems are real. They affect one’s thoughts, body, feelings, and behavior. Mental health problems are not a “passing phase” or sign of weakness. Mental health problems include depression, bipolar disorder (manic-depressive illness), attention-deficit/ hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia, conduct disorder, personality disorders, and others. Untreated mental health problems may be life-threatening, may disrupt families and relationships, and may interfere with school, work, or other activities of living.
Mental Health System: This term often refers to publicly-funded treatment organizations, programs, and services that may be available to qualified individuals who are enrolled in them.
Mental Illness: Any of a variety of malfunctions of the brain. This term often refers to severe mental health problems in adults. See Mental Health.
Methadone: Pronounced “METH-uh-doan.” A synthetic opiate medication sometimes prescribed by a physician as a replacement drug for an illegal opiate such as heroin, and sometimes prescribed as part of an opiate withdrawal program.
MI and MR/DD Services: Services designed to address the needs of people with both mental illness (MI) and mental retardation (MR) or developmental disabilities (DD).
MICA: MICA is an acronym for “Mentally Ill Chemical Abuser.” The acronym dates back to the 1980’s. It is most often used in New York, New Jersey, and other eastern states.
Similar acronyms also used primarily in eastern states are MICAA, meaning “Mental Illness, Chemical Abuse and Addiction,” and CAMI, meaning “Chemically Abusing Mentally Ill.”
In the rest of the U.S., people who have both a mental illness and a substance use disorder may be described as having a “co-occurring disorder” or sometimes, a “dual diagnosis,” rather than “MICA” or “MICAA.”
People with a co-occurring disorder often benefit from psychotropic medication to help manage their mental illness; if medication is stopped, specific symptoms of mental illness are likely to emerge or worsen.
For people with a substance-induced mental disorder, or what may, in eastern states, be described as “CAMI,” acute symptoms of mental illness remit (go away) completely after a period of abstinence or detoxification from drug or alcohol use. This period is usually a few days or weeks.
People with a substance-induced mental disorder do not have residual symptoms of mental illness after the acute (temporary) symptoms induced by drug or alcohol use go away.
Monoamine Oxidase Inhibitors (MAOI): Pronounced “mah-noe-AY-meen OX-uh-days inn-HIBB-ah-terrz” or “emm-ay-oh-EYE.” A type of medication sometimes used to treat depression, and sometimes used for certain anxiety disorders, particularly depressive disorders that have not responded well to other types of antidepressant medications. MAOIs are designed to increase the amount of monoamine neurotransmitters that are available to the neurons (nerve cells) of the brain.
IMPORTANT: If you have been prescribed an MAOI, your doctor and your pharmacist have given you lists of certain foods that you must not eat while taking your MAOI. It is very important that you follow these dietary restrictions carefully. If you don’t follow the food restrictions, you could become very sick or die.
Naltrexone: Pronounced “nall-TREX-own.” A medication used to help people who are recovering from alcohol or other drug addiction. For many people, naltrexone helps stop the physical craving for alcohol or other drugs. It is most effective when used with a program that includes counseling and social support such as a Twelve Step program.
Neurotransmitters: A variety of chemicals, normally present in and around neurons, that regulate the transmission of electrical impulses between the neurons.
New Generation Medications: Medications used to manage the psychotic symptoms associated with certain mental illnesses, which have reached the U.S. market in the past 20 years—for example, clozapine (Clozaril), risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), aripiprazole (Abilify).
These are used primarily to treat schizophrenia and other mental illnesses that may cause psychotic symptoms. Most of these medications produce their beneficial effects by increasing or reducing levels of certain neurotransmitters.
Nurse Practitioner (NP): A nurse practitioner is a nurse with advanced training who works in an expanded role and manages patients’ medical conditions. Behavioral health programs that have difficulty recruiting physicians may employ nurse practitioners (NPs) instead. In some settings, NPs can prescribe medications with the authorization of the supervising physician.
In most states, you can verify the license of any nurse practitioner online. Click here.
Obsessive-Compulsive Disorder: Obsessive-Compulsive Disorder is a chronic, often relapsing illness. People who have it suffer from recurrent and unwanted thoughts or rituals which serve as unhealthy and ultimately unsuccessful ways of managing anxiety. The obsessive thinking and the compulsion to perform rituals can take over a person’s life if left untreated.
Outcomes Research: Scientific studies that measure and analyze the effects of services or treatment on individuals’ health, function, or quality of life.
Outpatient Treatment: Treatment for mental health or substance abuse issues that takes place in the office of a therapist or counselor, rather than in a residential or hospital (inpatient) setting. Outpatient treatment may be individual or group, and may be highly structured, or relatively un-programmed.
Oxycodone: is an opiate, or narcotic, analgesic drug. It works by changing the way the brain and nervous system respond to pain. Oxycodone is prescribed by doctors or dentists to treat pain. Oxycodone is supplied in pills, liquid, or injectable form.
Some drug manufacturers produce oxycodone combined with acetaminophen (the drug in Tylenol). Oxycodone combined with acetaminophen may be sold under the brand names Endocet, Percocet, Roxicet, Tylox, or others. When oxycodone is combined with aspirin, is may be sold as Endodan, Percodan, Roxiprin, or others). When combined with ibuprofen (Advil), it may be called Combunox.
Oxycodone is often diverted from prescription medical use to people with opiate addictions.
See hydrocodone and fentanyl.
Panic Disorders: People with panic disorder experience extreme anxiety that strikes suddenly, without warning, and with no apparent situational cause. Symptoms may include pounding heartbeat, sweating, fear, and agitation. Some people worry persistently that another “panic attack” could overcome them at any moment.
Paranoia: Symptoms of paranoia include feelings of persecution and a mistaken sense of self-importance. A person with paranoia can often work and function in everyday life; for some people with paranoia, the paranoid ideas themselves may enable the person to keep them “covered,” or hidden. However, this can lead to an isolated and limited life.
Paranoia rarely occurs as a mental disorder with no other symptoms, but paranoid thoughts occur as a symptom in many mental disorders. Paranoia is sometimes a symptom of dementia.
Paranoid Schizophrenia: This diagnostic label is often used (incorrectly) in movies or television to identify a fictional character whose behavior is dangerous or unpredictable because of a very debilitating mental illness. People who have schizophrenia may, at times, have paranoid thoughts, but it is simply wrong to think that the presence of paranoia makes the person’s schizophrenia a “worse” kind, or makes the person a greater danger.
Parity: The idea that government policy makers, regulators, insurance companies, and treatment providers should apply the same standards for access to mental health and substance abuse treatment as the standards that they follow for general medical care. In the U.S., in the late 1990s and 2000s, “mental health parity” changed access to care for people with commercial health insurance. See Mental Health Parity.
The term “parity” is gradually being replaced by “universal access” or “universal care.”
Pastoral Counseling: Some people prefer to seek help for mental health problems from their pastor, imam, rabbi, priest, or other spiritual leader, rather than from therapists who may not be affiliated with their particular religious community. Pastoral counselors are specially-trained clergy or counselors working within traditional faith communities. Pastoral counselors may incorporate psychotherapy with prayer and spirituality to effectively help some people with mental disorders. Some large religious communities employ their own mental health professionals to care for their members.
Payer: The entity that pays a treatment provider for health care expenses. Payers include commercial insurance companies, self-insured employers, Medicaid, Medicare, Veterans Administration. Medical facilities sometimes refer to people who have no payer other than themselves as “self-pay patients.”
Peer: A term that is sometimes used to refer to a person who acknowledges that he or she is recovering from a mental or substance use disorder. The term is rarely used outside the context of treatment programs that include an element of “peer support” or “peer-delivered services.” It was intended to be a respectful way to distinguish “peers” from “professionals” when they work together. Alternative terms may be “consumer,” “member,” or “client.”
Performance Measure: A measurement that describes the health care services being provided. Performance measures indicate whether services are being provided as expected and planned.
Person-Centered Language: The use of language that emphasizes the person rather than whatever symptoms the person may have; referring to individuals as people rather than “cases.” For example, using person-centered language, we may say “he has symptoms of schizophrenia” rather than “he’s a schizophrenic.” Or, “this is a program for people who have bipolar disorder” instead of “this is a program for bipolars.”
Personal Health Information (PHI): PHI is information that a healthcare professional receives from or about a person who is receiving treatment, during the course of providing treatment. HIPAA requires that PHI be kept confidential.
Personal Health Record (PHR): An electronic file of PHI—identifiable health information about an individual—possibly from multiple treatment providers, that can be shared among providers for the benefit of the individual.
Phobias: Phobias are irrational fears that lead people to avoid specific things or situations that trigger intense anxiety. Common phobias include agoraphobia–literally, “the fear of open space”—which sometimes causes people to fear leaving home. Another is social phobia, the fear of being extremely embarrassed around other people.
Physician: A medical doctor, a person who has completed a graduate degree in allopathic medicine—M.D.—or a graduate degree in osteopathic medicine—D.O. After earning their M.D. or D.O., physicians prepare to work in the mental health or substance abuse treatment field by completing three or four years of specialized training, called a residency, usually in psychiatry or addiction psychiatry.
In most states, you can verify the license of any licensed psychologist, social worker, psychotherapist, marriage and family counselor, professional counselor, or physician online. Click here.
Physician Assistant: A physician assistant (“PA”) is a trained professional who provides health care services under the supervision of a licensed physician. Behavioral health programs that have difficulty recruiting physicians may employ physician assistants (PAs) instead. In some settings, PAs can prescribe medications with the authorization of the supervising physician.
In most states, you can verify the license of any physician assistant online. Click here.
Play Therapy: A therapist may use play therapy with young children to establish communication and resolve problems. Play therapy uses a variety of activities, such as painting, puppets, and dioramas, to enable the child to express emotions and problems that are beyond his or her vocabulary or otherwise too difficult to discuss.
Post-Traumatic Stress Disorder (PTSD) : Post-Traumatic Stress Disorder is an anxiety disorder that develops as a result of witnessing or experiencing a traumatic occurrence, especially life threatening events. PTSD symptoms may include nightmares, flashbacks, exaggerated startle response, easily-triggered “fight-or-flight” response, emotional numbness or a sense of unreality. PTSD can interfere with a person’s ability to hold a job or to develop intimate relationships with others. Many war veterans, as well as survivors of crime, torture, abuse, or other violence, are affected by PTSD.
Premarital Counseling: Counseling for a couple who intends to be married. Before agreeing to officiate at a wedding, some clergy require couples to have a number of premarital counseling sessions, either with the clergy person or a mental health professional. This service is generally not reimbursable by health insurance.
Primary Care Medical Home: Primary Care Medical Home (PCMH) is a healthcare model that has long been practiced by large HMOs such as Kaiser Permanente. An individual consults a primary care physician (pediatrician, internist, family practice doctor) for health concerns, and is referred by that physician to specialists, such as psychologists, psychiatrists, drug treatment providers, as needed. The PCMH model has been spread to many states’ Medicaid programs by the Affordable Care Act.
Primary Care Provider (PCP): PCPs may be Physicians Assistants (PAs), Nurse Practitioners (NPs), or physicians (medical doctors – MDs or DOs) who specialize in family practice, internal medicine, obstetrics/gynecology, and pediatrics may be primary care physicians. The PCP is usually responsible for monitoring an individual’s overall medical care and referring the individual to specialist physicians when needed.
Prior Authorization or Pre-Approval: Some insurance companies and ACOs require individuals or treatment providers to get prior authorization or pre-approval before furnishing certain health services, in order for the service to be covered under the insurance plan.
Psychiatric Emergency Walk-In Clinic: A planned program to provide psychiatric care in emergency situations with staff specifically assigned for this purpose—includes crisis intervention, which enables the individual, family members and friends to cope with the emergency while maintaining the individual’s status as a functioning community member to the greatest extent possible. This is similar to an urgent care clinic where a person might go for sickness or minor injury after doctors’ offices are closed.
Psychiatrist: A psychiatrist is a specialty physician who completed residency training in psychiatry after completing medical school. Psychiatrists specialize in treating mental illness and may write prescriptions for psychotropic medications.
In most states, you can verify the license of any physician or psychiatrist online. Click here.
Psychoanalysis: Psychoanalysis is a form of outpatient psychotherapy that is rare, expensive, slow, and generally considered outmoded in the U.S. It focuses on the relation of past conflicts to current emotional and behavioral problems by gradually “uncovering the past.” An individual meets with a psychoanalyst (usually a psychiatrist or psychologist) three to five times a week, using “free association” to explore unconscious motivations and earlier, unproductive patterns of resolving issues.
Psychoanalysis has been popularized and parodied in movies such as “Analyze This” and movies by Woody Allen. It is usually not covered by health insurance.
Psychodynamic Psychotherapy: Based on the principles of psychoanalysis, this therapy tends to occur once or twice a week, and usually continues for less time than psychoanalysis. It is often covered by health insurance. It is based on the premise that human behavior is determined by one’s past experiences, genetic factors, and current situation. This approach recognizes the significant influence that emotions and unconscious motivation can have on human behavior. This is a mode of psychotherapy that is generally most effective when used for clients who are highly verbal, intelligent, highly motivated, personal growth-oriented, without significantly disruptive symptoms.
Psychosis: Pronounced “sigh-KOE-siss.” A state of mind which may occur as part of a mental illness such as schizophrenia or bipolar disorder, or may result from brain injury or substance abuse. Symptoms of psychosis (“psychotic symptoms”) may include distorted perceptions of events and behavior, delusional thoughts, paranoia, hallucinations (“hearing voices”) or other disruption of the five senses. For most people, the experience of psychosis is terrifying, and often impairs self-care and other activities of daily life. Psychosis can be relieved or stopped with certain psychotropic medications.
Psychosocial Rehabilitation: Therapeutic activities or interventions provided individually or in groups that may include development and maintenance of daily and community-living skills, self-care, skills training includes grooming, bodily care, feeding, social skills training, and development of basic language skills. These services are aimed at long-term recovery and self-sufficiency, rather than reducing or stabilizing acute symptoms of mental illness.
Psychotherapy: A general term for counseling or psychological treatment. When people use this term, they are usually referring to one of the many varieties of “talk therapy.”
Psychotropic Medication: Pronounced “sigh-koe-TROH-pick.” Psychotropic medications are those which are intentionally prescribed for the purpose of altering brain chemistry (usually increasing or reducing levels of specific neurotransmitters) in order to modify a person’s emotional or cognitive (thinking) functions. Psychotropic medications usually are considered successful as a treatment if they reduce or eliminate the targeted symptoms while producing a minimum of undesirable side effects.
Recovery: The idea that people can change, grow, and become more healthy despite having experienced traumatic events, injury, abuse, unfortunate life circumstances, symptoms of mental illness, or patterns of substance abuse.
When used by people who are recovering from substance abuse—as in “I’m in recovery”—it usually suggests that the individual is intentionally abstaining from using alcohol or other drugs, and perhaps is active in treatment follow-up, or AA or similar Twelve Step group.
Recovery-Oriented Treatment: In mental health care, there are ten fundamental qualities of recovery-oriented treatment: self-direction, individualized and person-centered, empowerment, holistic, non-linear, strengths-based, peer support, respect, responsibility, hope.
Registered Nurse (RN): A registered nurse is a professional with a nursing degree who provides patient care and may administer but not prescribe prescription medicine.
Residential Treatment Centers: Facilities that provide treatment 24 hours a day, often in a home-like or dormitory-style setting. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually longer in duration than inpatient hospitalization. For adults, residential treatment may include therapeutic group homes. Children in residential treatment for serious emotional disturbances receive constant supervision and care.
Respite Care: A service that provides a break for families who have a child with a serious emotional disturbance or developmental disability, or an adult family member with a mental illness or developmental disability. Trained counselors, or volunteer parents, take care of the individual for a brief period of time to give families relief from the strain of caring for the family member. This type of care can be provided in the home or in another location. Some families may need this help every week.
SA: An acronym used to refer to substance abuse.
Schizophrenia: Pronounced “skit-so-FRENN-ee-ah.” Schizophrenia is a serious and persistent mental illness (SPMI) characterized by “positive” and “negative” symptoms. Psychotic, or “positive,” symptoms include delusions, hallucinations, and disordered thinking (apparent to others from the individual’s fragmented, disconnected and sometimes nonsensical speech). “Negative” symptoms include social withdrawal, extreme apathy, diminished motivation, and blunted emotional expression. Some people interpret “negative” symptoms as simply the external manifestation of the individual’s extreme distraction, confusion, and fear caused by living with the “positive” symptoms of schizophrenia.
School-Based Services: School-based treatment and support interventions designed to identify emotional and behavioral issues and to assist parents, teachers, and counselors in developing comprehensive strategies for addressing these issues. School-based services also include counseling or other programs for children and adolescents with emotional problems, and their families, within the school, home and community environment.
Seasonal Affective Disorder (SAD): Seasonal Affective Disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced. Some people who have SAD reduce the symptoms of their illness by sitting under a full-spectrum light source indoors.
Section 1115 Waiver: A law that allows a State to operate its system of care for Medicaid enrollees in a manner different from that proscribed by the Centers for Medicare and Medicaid Services (CMS), in an attempt to demonstrate the efficacy and cost-effectiveness of alternative service delivery systems. This law accounts for some state-to-state variations in accessibility of care for Medicaid recipients.
Selective Seratonin Re-Uptake Inhibitor (SSRI): Pronounced “sarah-TOE-nin,” also “ess-ess-are-EYE.” A type of medication often used to treat depression, and sometimes used for certain anxiety disorders and personality disorders. SSRIs are designed to increase the amount of the neurotransmitter chemical serotonin that is available to the neurons (nerve cells) of the brain. (There is a similar group of antidepressant drugs called SNRIs. These medications increase the available amounts of two neurotransmitters: serotonin and norepinephrine.)
Self-Harm: Self-harm means intentionally causing injury to one’s body. Self-harm behaviors—cutting, burning, overdosing—may resemble “suicidal” behaviors, and often occur during episodes of intense emotional distress, but they are usually not intended to cause death (though there is sometimes a risk of accidental fatality.) People who intentionally harm themselves may describe feelings of emotional relief or release as a result.
Self-Help: Self-help refers to things that an individual might do to improve his or her mental, physical, financial or spiritual conditions without the direct assistance of a professional. Self-help may include reading books or reference materials, or attending groups, meetings or classes that:
- involve people who have similar needs;
- assist people to deal with a “life-disrupting” event, such as a death, abuse, serious accident, addiction, or diagnosis of a physical, emotional, or mental disability, for oneself or a relative;
- are operated on an informal, free-of-charge, and nonprofit basis; provide support and education;
- and are voluntary, anonymous, and confidential.
Many people with mental illnesses or with substance use disorders find that self-help groups are helpful for recovery and empowerment.
Serious Emotional Disturbances (SED): In children or adolescents, a diagnosable disorder that severely disrupts their daily functioning in the home, school, or community. These disorders include depression, attention-deficit/hyperactivity, anxiety disorders, conduct disorder, and eating disorders.
Serious Mental Illness (SMI): In an adult, a diagnosable mental disorder that has resulted in functional impairment, and which substantially interferes with or limits one or more major life activities. These illnesses include schizophrenia, schizoaffective disorder, bipolar disorder, major depression, anxiety disorders, eating disorders, and others.
Service: A support activity or clinical intervention designed to address the specific mental health needs of a person and his or her family. A service could be provided only one time or repeated over a course of time, as determined by the person, family, and service provider.
Severe and Persistent Mental Illness (SPMI): This term is sometimes used to describe schizophrenia, schizoaffective disorder, recurrent major depression and bipolar disorder. The word “severe” refers to degree to which the illness may disrupt a person’s normal life activities. The word “persistent” refers to the long duration of these illnesses.
Sexually-Transmitted Disease (STD): Any disease that can be spread through sexual contact. Common STDs include human papillomavirus (HPV), trichomoniasis, chlamydia, gonorrhea, genital herpes, syphilis. Human immunodeficiency virus (HIV, the virus that causes AIDS) is also an STD.
Side Effects: Medications are prescribed to provide certain predictable benefits, to promote greater health or improved functioning. But nearly all medicines (including over-the-counter or herbal medicines) produce undesirable results along with the beneficial effects. These are called “side effects.” Side effects may be minor—slight headache, dry mouth, dull taste, etc. Side effects may be serious—allergic reaction, seizures, dehydration, etc.
Silos: Traditionally, funding for mental health treatment came from different sources than funding for substance abuse treatment. Consequently, programs specializing in services for mental health concerns have been distinct from programs specializing in services for substance abuse issues. Separate funding streams and isolated programs is referred to as “silos.” The existence of silos is a problem because of the reality that many people with mental illness also have a problem with substance abuse, and vice versa, and therefore benefit from treatment that addresses both. (See Single-Stream Funding)
Single-Stream Funding: The “opposite” of silos. The consolidation of multiple sources of funding into a single stream. This is a key approach used in progressive mental health systems to ensure that “funds follow consumers.”
CHIP or SCHIP (Children’s Health Insurance Plan): (Pronounced “ESS-chip”) A special federal and state program, initiated by a federal law in 1997. CHIP, called SCHIP in some states, makes health insurance available for children with no insurance or for children from low-income families in every state of the U.S. CHIP or SCHIP programs operate as part of a state’s Medicaid program.
State Hospital: A publicly-funded inpatient facility for persons with mental illness. State hospitals usually specialize in treating people with serious and persistent mental disorders.
Inpatient care is most appropriately used when intense external controls are needed temporarily to manage behavior. Most people with serious and persistent mental disorders can be treated more effectively, humanely, and rapidly in community and home-based programs, but in the U.S., such programs are only available to a small minority of people affected.
State Mental Health Authority or Agency: State government agency charged with administering and funding a state’s public mental health services.
Stigma: A term that means, in the field of mental health and substance abuse treatment, discrimination and prejudice against people who are affected by mental health or substance use disorders. Though these forms of discrimination are based on ignorance and violate American civil rights laws, stigma can interfere with one’s access to employment, housing, and other forms of public accommodation. Moreover, stigma, and fear of stigma, can keep individuals and families from seeking treatment.
Strengths-Based: Strengths-based treatment acknowledges and honors an individual’s strengths and abilities. Traditionally, mental health treatment has been focused on reducing symptoms or deficiencies. Effective treatment will always respond to needs, relieving pain and distress. But treatment can be more effective when it identifies a client’s strengths and makes those the basis of the treatment plan.
Substance Abuse: Misuse, excessive, or harmful use of prescription medications, alcohol, cigarettes, or other legal or illegal substances.
Substance Dependence: Substance dependence, or addiction, means that a person develops tolerance (meaning that more of the substance is required to produce the same high), leading to withdrawal symptoms, and a compulsion to continue using despite negative health or social consequences.
Substance Use Disorder: A diagnostic term that includes both substance abuse disorders and substance dependence disorders. Substance use disorders are those problems which result from use or abuse of “street drugs,” prescription drugs, herbs including marijuana, alcohol, and volatile hydrocarbons. “Substance use disorders” include addiction, dependence, abuse, excessive use, intoxication, withdrawal, as well as psychological symptoms caused by addiction, dependence, abuse, excessive use, intoxication, and withdrawal.
SUD: An acronym for “substance use disorder.”
Suicide: Suicide is the 8th leading cause of death in the United States, claiming more than 32,000 lives a year. Ninety percent of people who die from suicide have depression or another treatable mental or substance abuse disorder. Suicide attempts are among the leading causes of hospital admissions in persons under 35. Suicide can be prevented.
Supported Employment: Supported employment is a way to help individuals with their recovery by providing a variety of work-related services: assisting individuals in finding work; assessing individuals’ skills, attitudes, behaviors, and interest relevant to work; providing skill training; and providing work opportunities supervised by treatment-oriented managers.
Supported Housing: Services to assist individuals in finding and maintaining appropriate housing arrangements, often by providing nearby or on-call 24-hour housing supervision in rent-subsidized apartments.
Supportive Residential Services: Staffed housing arrangements for people with mental illness. Includes supervised apartments, group homes, halfway houses, mental health shelter-care facilities, and similar facilities.
System of Care: A system of care is a programmatic approach of treating children’s mental health problems. It is community-based, providing care for children, adolescents, and their families in their home, school, and community. A structured “system of care” is child-centered, family-driven, strength-based, and culturally competent, and involves interagency collaboration.
Tarasoff: Refers to a court case that helped establish the principle of Duty-to-Warn, one limitation of confidentiality in mental health treatment.
Telephone Hotline: A telephone-based service for emergency counseling, or for referral resources. A mental health hotline operates 24 hours a day, with mental health and substance abuse professionals answering every call. People call when they are troubled by symptoms of mental illness or substance abuse, or when they are feeling suicidal urges, or when they are having struggles with a family member, or just want to talk to a professional about the challenges of daily living.
Therapeutic Foster Care: A service that provides treatment for children in private homes of trained families. The approach combines the normalizing influence of family life with specialized treatment interventions, thereby creating a therapeutic environment in the context of a nurturing family home.
Therapist: A general term, often used interchangeably with “psychotherapist” or “counselor,” that describes a professional who provides mental health or substance abuse treatment services. A therapist may be licensed as a psychologist, a clinical social worker, a psychiatrist, a licensed professional counselor, or a licensed marriage and family counselor.
Traumatic Brain Injury (TBI): An injury to the brain usually caused by an external force such as a blow to the head. TBIs are often caused by car accidents—a person’s head striking the windshield or the dashboard; bicycle or motorcycle accidents, especially when riders are not wearing helmets; by sports injuries—football concussions, wild baseball pitches or line drives; falls; by work accidents—falling objects; or in warfare—explosions, etc. TBIs can interfere with a person’s memory, spatial orientation, ability to think and solve problems, ability to speak and communicate. People who have had TBIs may develop also depression or anxiety disorders.
Tricyclic Anti-Depressant: Pronounced “try-SIGH-click.” “Tricyclic” describes the three rings of atoms that are connected to make molecules of the drug. Tricyclic medication is sometimes used to treat depression, and sometimes used for a variety of other disorders, particularly disorders that that have not responded well to other types of medications.
Tricyclics were introduced for treating depression in the 1950s. Presently, most doctors will try prescribing newer SSRI antidepressants first, not using tricyclics unless the SSRIs seem to be ineffective.
Unduplicated Counts: Treatment providers may describe their activities in terms of “encounters,” meaning the total number of therapeutic contacts with individual clients, or in terms of unduplicated counts, meaning the number of unique individual people served.
For example: One person might visit a therapist four times in a month. If we want to describe how many individual people have been helped by that therapist in a month, we would count that four-time visitor only once—that is an unduplicated count.
Unmet Needs: Identified treatment needs of the people that are not being met. Unmet needs are one result when there is poor access to care. Unmet needs may also include people receiving treatment that is inappropriate or not optimal for their needs and strengths.
Utilization Management (UM): Procedures designed to ensure that the services provided to a specific client at a given time are cost-effective, appropriate for the person’s needs and strengths, and the least restrictive possible.
Utilization Review (UR): Part of Utilization Management. Analysis of patterns of service usage to determine whether the services delivered were the proper quality and duration for the client’s need—sometimes UR means determining whether the actual duration of treatment matches pre-determined diagnosis-based standards.
V-Codes: The DSM-V includes certain diagnostic codes called V-Codes. They describe conditions that may be the focus of counseling but which are not diagnoses of mental or substance abuse disorders. Generally, when people get treatment for conditions described by V-Codes, those services are not eligible for either health insurance or Medicaid reimbursement.
Vocational Rehabilitation Services (VRS or “Voc Rehab”): Services that include job finding/development, assessment and enhancement of work-related skills, attitudes, and behaviors as well as provision of job experience to clients/patients. Includes transitional employment.
States operates their vocational rehabilitation programs to assist eligible individuals with disabilities to become productive members of the workforce and to live independently. In many states, vocational rehabilitation is notoriously under-funded, leading to impractically long waiting periods, as much as 15-20 years in one state.
Volatile Hydrocarbons: Materials, usually liquids, that produce poisonous fumes, such as gasoline, glue, spray paint, nail polish remover, hair spray. Some people intentionally inhale the fumes of these products to experience intoxication. This practice may result in brain, kidney, liver, or lung damage, and may be fatal. See Inhalant Abuse.
Wellness Recovery Action Plan (WRAP): Plans that people with a mental illness can make to identify what makes them well, and then use their own practical, day-to-day methods to relieve difficult feelings and maintain wellness. The result has been recovery and long-term stability. WRAP is a self-help method that is often used effectively along with professional treatment.
Wraparound Services: A way of providing community services, including mental health and substance abuse treatment and natural supports, for a child or adolescent with serious emotional disturbances. Planning for wraparound services usually engages the identified client, the family, and a multidisciplinary team to create a home- and community-based, individualized program of recovery for the child and family. When wraparound services are provided as a comparable program for adults, it is usually called Assertive Community Treatment.
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