Critical Time Intervention

The Mental Health Services Act is designed to accumulate and distribute funds to county mental health programs (upon program plan approval). There are five different areas that the act helps with funding in mental health. The first is Community Services & Support (CSS) which helps fund the pairing of mental health care with primary health care settings. CSS also provides mental health support services to people that aren’t able to receive the services elsewhere (Dchs.ca.gov 2015). CSS has some main objectives including reduction of homelessness, justice and child welfare system

Mental Health coverage prior to the Affordable Care Act was far to none. With about nearly one-third of currently covered individuals having no coverage for substance abuse disorder services and approximately 20% having no coverage for mental health services. Services such as outpatient therapy visits, impatient crisis intervention and stabilization were among many that were not offered. Since the Affordable Health Care Act has been passed more individuals are able to afford health insurance that were once uninsured. It has helped many individuals in being able to obtain medical services that were once inaccessible.

After doing much research, I have learned that to develop awareness and interventions to be able to help the homeless population, we must understand their mental health and behavioral needs. The information they all share in common are the factors why a specific type of population became homeless. The interrelation of homelessness and mental illness are informed by many factors such as; the lack of support, extreme poverty, substance abuse, lack of affordable health insurance, and lack of affordable housing. The homeless population shares different struggles when dealing with homelessness and mental illnesses because there are not enough resources for them to be able to come back to their normal self. When it comes to their struggles, they

Growing up in a small town in Iowa I was unaware of the many situations involving hardship or misfortune that were around me. Therefore, it was not till college when I received the opportunity to work for a reentry program called the Transformative Justice Initiative that I became aware of the multiple factors lead to incarceration, drug use, homelessness, and other areas of hardship. The longer I was involved with the program the more I learned how mental health is convoluted in all of these situations and in all populations. Consequently, my experiences with the Transformative Justice Initiative helped me develop my future aspirations as a professional, which include a desire to work with individuals that have mental illness.

The Affordable Care Act (ACA) has made a significant impact on the U.S health care landscape. One facet of health care that has greatly benefitted from the ACA is mental health. A research article published by Saloner and Le Cook, (2014) on the effects of the ACA on young adults with possible mental health and substance abuse disorders reflect how much this population gained from this program. The researchers wanted to find out if the ACA coverage expansion of dependents to the age of 26 would improve accessibility to mental health and substance abuse care. They performed the research by reviewing data files from the 2008–12 rounds of the National Survey of Drug Use and Health (Saloner and Le Cook, 2014). The researchers analyzed mental health

“The Mental Health Parity and Addiction Equity Act of 2008, also known as MHPAEA is defined as a federal law that prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical or surgical benefits” (Centers for Medicare and Medicaid Services, para 1). Originally, MHPAEA applied only to group health plans and group health insurance coverage, but was “amended by the Patient Protection and Affordable Care Act” to also apply to individual health insurance coverage (Centers for Medicare and Medicaid Services, para 2). “The Mental Health Parity Act of 1996 (MHPA) defined that large group health plans could not impose annual dollar limits on mental health benefits that are less favorable than any limits imposed on medical or surgical benefits” (Centers for Medicare and Medicaid Services, para 6).

Cheryl has been diagnosed with Generalized Anxiety Disorder, Major Depressive Disorder, and Alcohol Use Disorder. When asked about her concerns for post discharge she states that she has been heavily reliant on her parents and their health benefits for her treatment and that she is nervous that she may not have coverage to continue therapy. She reports that she felt safe knowing that “Obamacare” would be in place to help her afford the treatment she needs to stay mentally healthy and sober. She states that she is concerned about the possible repeal of the Affordable Care Act because she will need help paying for her mental health expenses. The Affordable Care Act made a giant leap in extending the work of the Mental Health Parity and Addiction Equity Act. These two acts work together to ensure that treatment for mental illness is accessible to many Americans that need treatment. Throughout this paper I

The original purpose of the Affordable Care Act (ACA) was to address the rising amount of healthcare cost in the United States, and substantially increase the amount of Americans insured with access to affordable healthcare. The ACA allows for the expansion of Medicaid; the government health insurance program, which is designed to increase enrollees for low income families in Medicaid. With this new legislation people who are under the age of 65 who are at or below 133 percent of the poverty line will have access to Medicaid. Anyone who earns below 400 percent of the poverty line will qualify for subsidies for health insurance. (Cockburn, 7) Americans who earn above this level must either buy insurance, or use their employer’s coverage. This is a huge implication because the estimated of new enrollees in 2014 estimated by the Congressional Budget Office is between 16 and 17 million. The federal government has agreed to finance this expansion of Medicaid for the first three years of implementation, for states that agree to the program. After these three years the states will have to start to pay a small portion of Medicaid. Many people with substance abuse problems, and mental disorders without insurance, are low income earning childless adults. (Bainbridge, 5)Under the ACA these Americans now have access to behavioral health treatment, in the 26

Critical time intervention (CTI) was designed to be bridge that filled the gap between institutionalization and transition into the community. The hope of CTI is to prevent homelessness among individuals suffering from mental illness as well as develop a step- by- step initiative that could combat the growing problem (Critical Time Intervention, 2012). Buchanan (2006) estimates that 3.5 million individuals are likely to experience homelessness in a given year (Sadowski, 2009). The epidemiology of homelessness suggest that serious mental illness is neither a necessity nor sufficient enough for homelessness. It suggests; however, that individuals suffering from socioeconomically difficulties could inevitably accompany serious mental illnesses to form the abundance of homeless individuals, considering the majority of homelessness is attributed to mental illness cases (Montgomery, 2013). The purpose of this EBP is to integrate critical time intervention with programs simulated by Medicaid and already established initiatives of the Affordable Care Act of 2014.

It has particularly helped in response to the currently increasing costs associated with the rapidly increasing growth of mental health care problems. As mental health care cost continues to increase at a bigger rate compared to other healthcare areas, managed care has made efforts to contain this rising costs. Managed care programs have helped in containing reimbursed mental health care costs offered to employees and their families/dependents (Pires, Armstrong & Meyers, 1998). Managed care for mental health services is usually provided to its providers on a fee-for-services making providers paid on every service billed. Managed care has, therefore, reduce substance abuse care, psychiatric cost, implicitly and hospital use of mental

The Refuge Transition Team (RTT) is a program currently being provided through Mental Health Care, Inc. in the Tampa Bay area. The program is designed with the evidenced based model of Critical Time Intervention. Refuge transition team targets adult individuals who are chronically homeless, diagnosed with a serious mental illness, have histories of public inebriation by the Substance Abuse and Mental Health Services Administration’s (SAMSHA) definition with priority enrollment given to veterans. The program services 36 individuals per year and services begin in shelter facility and transition to the community as the individual progresses in recovery and independent living. The Critical time Intervention model is time-limited intervention that last up to nine months. The model provides the additional support and assistance this population needs to secure a stable independent life.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted on October 3, 2008 as sections 511 and 512 of the Tax Extenders and Alternative Minimum Tax Relief Act of 2008. MHPAEA amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHS Act), and the Internal Revenue Code of 1986 (Federal Register, 2013). The MHPAEA is an extension of the Mental Health Parity Act of 1996, which prohibited annual or aggregate lifetime financial limits on mental health coverage by addressing other restrictions, such as limits on outpatient visits or inpatient days (DOL, 2010). MHPAEA expands parity requirements to treatment limitations, financial requirements, and in- and out-of-network covered benefits (Smaldone, 2010). It also expands the opportunity of mental health parity requirements at the federal level and includes substance use disorders within its scope. Prior to 1996, health insurance coverage for mental illness had historically been less generous than that of other physical illness (Sarata, 2011). Mental health parity is a response to this disparity in insurance coverage, and generally refers to the concept that health insurance coverage for mental health services should be offered equally with covered medical and surgical benefits (Smaldone, 2010).

Furlong, Leddy, Ferguson, and Heart’s (2009), “Assertive Community Treatment and Recovery at Thresholds”, reports in detail the principles of Assertive Community Treatment (ACT). For example, ACT teams include: psychiatrists; nurses; peer counselors; employment and housing specialists; mental health counselors; case managers and substance abuse counselors. The team of diverse professions all work together with small caseloads to deliver intensive care. Next, they explain how ACT was developed after deinstitutionalization to decrease re-hospitalization rates. In fact, Act model outcomes show it reduces the rates of re-hospitalization, improves symptomology, and decreases incarcerations of individuals with serious mental illness. Last, the

The community mental health population is one that is comprised of individuals of different ethnicities, backgrounds, cultures, diagnoses, worldviews, and many other diversity variables. Unfortunately, working with this population often occurs in short-term care settings whereby the clinician may only have several days or weeks to work with a client. Similarly, the following conceptualization will be based off of a client who the writer treated in a residential program whereby clients can stay for up to 25 days. At this site, most clients are homeless, have a serious mental illness (SMI) determination, and suffer from substance abuse, severe depression and/or anxiety, and psychotic disorders. Therefore, an in-depth analysis of this client’s

The evaluation on “Peer Support, Group Intervention to Reduce Substance use and criminality among persons with severe mental illness” was conducted by staff from the department of Psychiatry, Yale School of Medicine. The study compared the effectiveness of two interventions in reducing alcohol use, drug use and criminal justice charges for person with server mental illnesses: first, a community-oriented group intervention with citizenship training and peer support that was combined with standard clinical treatment, including jail division services, and second, standard clinical treatment with jail diversion services alone (Rowe & Bellany 2007, pg. 955). The evaluation used citizenship framework with peer support to help individuals with severe mental illness and substance abuse issues who could not participate affectively in society. The citizenship framework with integrated peer support to develop an intervention for person who mental illnesses, alcohol and drug use, and criminality posed serious barriers for their community stability and participation (Rowe & Bellany 2007, pg 956).