Glossary of Mental Health and Substance Abuse Terms
The following is a list of key concepts and terms that are commonly used in the fields of mental health and substance abuse. Many of these terms have been defined by federal agencies, particularly the Substance Abuse and Mental Health Services Administration. This is not an exhaustive list, but it represents many of the concepts, services, and models of care that are used by mental health and substance abuse programs, services, and systems that serve children, adolescents, and their families.
An assessment is a professional, comprehensive, and individualized review of child* and family needs that is conducted when services are first sought from a mental health professional (e.g. psychiatrist, psychologist, or social worker). The assessment of the child includes a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community. An assessment also evaluates the strengths and resources of the child and family. Any decisions about treatment and supports should be made by the family and mental health professional together.
Case management is a service that helps people arrange for appropriate services and supports (e.g. health, mental health, educational, vocational, transportation, respite care, and recreational). Case managers typically organize and coordinate services and supports for children with mental health problems and their families. While numerous case management models exist, case management can involve assessment of child and family needs, development of service plans, contact with service providers on a child or family’s behalf, and work with the child and/or family to facilitate access to needed services.
Co-location is one strategy for integrating primary and behavioral health care services to address issues of access, quality, and fragmented delivery systems in children’s mental health. Generally, this term refers to models whereby mental health professionals are co-located within primary care settings, or primary care clinicians are co-located within mental health programs, typically public programs. In cases where primary care settings co-locate mental health professionals, examples of models include large co-located multispecialty group practices (e.g. behavioral care and primary care), community governed nonprofit health centers, and traditional private primary care offices. In the latter, business arrangements may include an employee of a mental health agency who is “out-stationed” in the primary care office, a self-employed mental health professional who is renting or using space in the primary care office, or a mental health professional who is employed by the primary care practice. (See Resources for Further Information for information on co-location models in primary care settings.)
* For purposes of this Glossary, the term “child” is used to refer to children and adolescents from birth through 21 years of age.
Crisis residential treatment services
This term refers to short-term, 24-hour care provided in a nonhospital setting during a mental health crisis. For example, when a child becomes aggressive and uncontrollable, despite in-home supports, a parent can temporarily place the child in a crisis residential treatment service. This care is designed to avoid inpatient hospitalization, help stabilize the child, and determine the next appropriate step.
Day treatment includes special education, counseling, parent training, vocational training, skill building, crisis intervention, and recreational therapy, lasting at least 4 hours a day. These programs work in conjunction with, and may be provided by, mental health, recreation, and education organizations.
The goals of a diagnostic evaluation (general psychiatric evaluation) are:
- To establish a psychiatric diagnosis.
- To collect data that are sufficient to permit a case formulation.
- To develop an initial treatment plan, with particular consideration of any immediate interventions that may be needed to ensure the patient's safety, or, if the evaluation is a reassessment of a patient in long-term treatment, to revise the plan of treatment in accord with new perspectives gained from the evaluation.
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition DSM-IV
The DSM-IV is the official manual of mental health problems developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other health and mental health care providers use this reference book to understand and diagnose mental health problems. Insurance companies and health care providers also use the terms and explanations in this book when categorizing or describing mental health problems.
Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent
DSM-PC Child and Adolescent Version provides a step-by-step guide for the primary care clinicians to help assess, diagnose, and refer mental health conditions. It includes symptom listings for simple, comprehensive diagnoses, mental/physical disorder differential diagnosis for psychosocial problems, enhanced communication between colleagues by DSM-IV compatibility, and easy-to-use charts, tables, and text.
A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis.
Early intervention (EI) program
Early intervention is a process used to recognize mental, emotional, behavioral, and/or learning problems and to respond to factors that put individuals at risk of developing mental health problems before they become established and more difficult to treat. Early intervention can help children get better in less time and can prevent problems from developing or becoming worse. Early intervention processes use validated screening tools to identify children with or at risk for mental health problems; include consultation by trained professionals with parents, teachers and other caregivers; and work with children in their natural environments to provide needed supports and guidance.
The Early Intervention program was created as a result of the Individuals with Disabilities Education Act (IDEA), originally passed by Congress in 1986. States subsequently passed legislation to support and operationalize the system.
There are two separate EI programs for young children who have or are at risk of having a disability or other special need that may affect their development, health, or education: the Infant-Toddler program covers children from birth through age two. The Preschool program covers children from three to five (or until the child enters kindergarten). Primary responsibility for each of these programs is assigned to a lead agency; these assignments vary from state to state. Children participating in the Infant-Toddler Program are eligible for such services as a multi-disciplinary evaluation, service coordination, individualized Family Service Plan (IFSP), and an array of assistive and supportive services. Agencies may render a charge for some of these services, though services cannot be denied because of a family’s inability to pay. Children participating in the Preschool Program are entitled to free and appropriate special education service in the least restrictive environment through the local school system. Services may include a multi-disciplinary evaluation, Individualized Education Program (IEP), and an array of assistive and supportive services.
Emergency and Crisis Services
Crisis intervention services are used in emergency situations to provide immediate intervention or care when children are, or are at high risk of becoming, a danger to themselves or others, or are experiencing acute psychotic episodes or other emergency events (e.g. suicide). Such services are available 24 hours a day, 7 days a week, and provide screening, psychiatric evaluation, emergency intervention and treatment, stabilization services, and referral to community services and resources. Examples include telephone crisis hotlines, suicide hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care.
These are practices that research has shown to produce consistently good outcomes and applicable across varied populations.
Family Support Services
Family support services refer to help designed to keep the family together, while coping with the 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.
This term refers to intensive mental health treatment that is provided in a hospital setting 24 hours a day.
Inpatient hospitalization provides:
- Short-term treatment in cases where a child is in crisis and may be a danger to self or others.
- Diagnosis and treatment when the patient cannot be evaluated or treated appropriately in an outpatient setting.
These services are designed to briefly assess the type and degree of a child’s mental health condition to determine whether services are needed and to link a child to the most appropriate and available service. Services may include interviews, psychological testing, physical examinations, including speech/hearing, and laboratory studies.
Mental health is the state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity.
Mental illness collectively refers to all mental disorders, defined as health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination) associated with distress and/or impaired functioning. Mental disorders feature abnormalities in cognition, emotion or mood, and the highest integrative aspects of human behavior, such as social interactions.
Mental Health Problems
This term refers to signs and symptoms of insufficient intensity or duration to meet the criteria for any mental disorder.
Residential treatment centers
Residential treatment centers provide services 24 hours a day for children with serious emotional disturbances who require constant supervision and care, and can usually serve more than 12 children at a time. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually more long-term than inpatient hospitalization. Residential treatment centers also are known as therapeutic group homes. The primary purpose of residential treatment is to improve overall functioning, including social and behavioral skills, so the individual can function adequately in the community, either at home or independently.
Screening is a process used to inform parents and professionals about the physical, cognitive, and emotional strengths and needs of a child. It is designed to determine whether children may be at-risk of having behavioral or emotional conditions that warrant further review and/or intervention. Mental health screening is designed to identify social and emotional development needs in children as early as possible to prevent potential mental health problems from developing or worsening.
Screening is conducted by an adequately trained professional (e.g. health care provider, social worker, psychologist, or counselor) and uses objective, accurate, reliable, and validated instruments and methods.
Screening does not result in definitive statements about a child’s problem nor does it draw a conclusion about a mental health disorder or diagnosis.
Serious emotional disturbances
Serious emotional disturbances are diagnosable disorders in children and adolescents that severely disrupt their daily functioning in the home, school, or community. Serious emotional disturbances may include depression, ADHD, anxiety, bipolar disorder, conduct disorder, eating disorders, or other conditions contributing to severe functional impairment.
System of Care
System of Care is an evidence-based approach to the care of children and adolescents with serious emotional disturbances and their families. It incorporates a broad array of services and supports that are organized into a coordinated network, integrate care planning and management across multiple levels, are culturally and linguistically competent, and build meaningful partnerships with families and youth at service delivery and policy levels.
Guiding principles in a System of Care specify that services should be.
- Comprehensive, incorporating a broad array of services and supports.
- Provided in the least restrictive, appropriate setting.
- Coordinated both at the system and service delivery levels.
- Involve families and youth as full partners.
- Emphasize early identification and intervention.
Wrap-around services refer to a package of unique community services and natural supports that are flexible and tailored to meet the unique needs of children with serious emotional disturbances.
Wrap-around services are based on a definable planning process and are designed for children and their families to achieve a positive set of outcomes in the home setting.
Services are provided by multidisciplinary teams that may include case managers, psychiatrists, nurses, social workers, vocational specialists, substance abuse specialists, community workers, and family members or caregivers.