| A strong family and caregiver support system is | | | | management models and chronic care models and |
| important to the continued treatment of mental | | | | can include: assertive community treatment, |
| health patients after they leave the hospital. In fact, | | | | multi-systemic therapy, and Dialectical Behavioral |
| it is critical in assisting with medication adherence to | | | | Therapy (DBT). Hospital payment methods assume |
| ensure consumers appear for their appointments with | | | | linkage with step-down, aftercare, and outpatient |
| service providers, particularly during transition | | | | services, similar conceptually to Medicare Part A that |
| between inpatient and outpatient settings. However, | | | | covers hospital stays and 100 days of nursing home |
| when discussing family support systems, some | | | | or home health rehabilitation as follow-up, when |
| physicians contest that less than half of consumers | | | | necessary. |
| have an "adequate" social support system to meet | | | | Levels of communication between various clinicians |
| their daily needs. | | | | and other staff in inpatient and outpatient settings |
| Because a strong family support system cannot be | | | | can vary greatly, impacting continuity of therapy. |
| "manufactured" or bought through funding, it is | | | | Typically, there is very little communication between |
| important to focus on other controllable issues that | | | | psychiatrists in inpatient and outpatient facilities and |
| can create a positive impact on the continuity of care | | | | this applies as well to nursing staff in these two |
| for mental illness patients. A recent mental health | | | | settings. The most frequent communications occur |
| study identified three factors that positively influence | | | | between inpatient discharge planners and outpatient |
| the efficiency of the transition process between | | | | intake coordinators. Three specific models of |
| inpatient facility discharge and intake with a | | | | interaction between inpatient and outpatient facilities |
| community-based program. | | | | have been identified: |
| These include: | | | | * "Push" Model: In this model, the outpatient setting is |
| * when communication occurs "within system" | | | | highly dependent on the inpatient setting and/or the |
| * when computer systems/consumer records are | | | | consumer for receiving documents. |
| shared | | | | * "Integrated" Model: With this model, the sharing of |
| * when an ACT (or similar) team is involved | | | | resources provides a continuum of care for |
| Of course, in addition to having a strong family and | | | | consumers, so there is never really a "gap" between |
| care support, there are other issues involved. Public | | | | discharge and intake. |
| policy and government funding are two particularly | | | | * "Pull" Model: For this model, a member of the |
| impactful issues. From a mental healthcare systems | | | | outpatient treatment team actively participates in the |
| perspective, matters involving policy and financing | | | | discharge process, which leads to the timely receipt |
| issues impacting continuity of care can be | | | | of appropriate/relevant documents, as well as |
| conceptualized along two broad approaches: | | | | increased consumer participation. |
| 1.) Building service coordination into the payment | | | | Despite the link between positive consumer |
| rates and expectations for certain services. | | | | outcomes and continuity of therapy, it remains |
| This approach is conceptually similar to what is | | | | unclear, in many cases, how referrals are made |
| referred to as Primary Care Case Management in | | | | throughout the system of care; how hospital and |
| some disease management or chronic care programs. | | | | program admission criteria are developed and applied; |
| 2.) Defining certain consultation and care coordination | | | | how consumers are discharged from hospital settings |
| services as covered benefits. | | | | and into the community; and who is responsible for |
| Under the first approach, consultation and care | | | | their care. Data regarding who is going to hospital |
| coordination would be a defined benefit with its own | | | | emergency departments for acute psychiatric care |
| billing codes and defined coverage limits, eligible | | | | and why they are in that setting rather than in |
| providers, allowed situations, and limitations and | | | | community mental health program are scarce, as are |
| exclusions. For example, situations where this might | | | | data about individuals who could be moved out of |
| be applicable include: hospital discharge planning and | | | | hospital emergency rooms if consumers were |
| short-term transition support; developmental | | | | provided with better transition services or if |
| transitions (e.g. child to adult); coordination between | | | | appropriate acute psychiatric care were available in |
| primary care and mental health providers; consultation | | | | other settings. The same observation can be made |
| with primary care; consultation with other | | | | regarding those individuals who could be moved out |
| professionals to implement treatment plans (e.g. | | | | of state psychiatric hospitals if appropriate services |
| schools, residential programs); clinical coordination | | | | such as care management, medication management, |
| among multi-disciplinary teams, especially home-based | | | | housing, and employment supports were available in |
| services. | | | | the community. Obtaining these observations and |
| Under the second approach, coordination of care is | | | | data of this kind is a big and important step in |
| built into programs of mental healthcare or episodes | | | | ensuring a continuity of care for all mental illness |
| of care. This concept is seen in current disease | | | | patients. |