Chapter 4 Treatment Settings

Question 1

Assertive community treatment (ACT)

Answer 1

Intensive type of case management, (1970’).
Creative problem solving and interventions by mobile teams.
Multidisciplinary teams
Case manager supervised by APRN or MD
Length of time may be years. p. 67

Question 2

Clinical or care pathway
integrated pathways

Answer 2

Used by inpatient units.
Task-oriented plans
decreased costs, length of stay, complications
(See p. 72 suicide risk screening pathway)

Question 3

community mental health centers

Answer 3

emergency services
community/home based services
outpatient services
across lifespan.
(ie medication rx and admin, indiv therapy, psychoeduational and therapy groups, family groups, and dual-dx treatment.
multi-disciplinary APRN hold sig role

Question 4

continuum of psychiatric-mental healthcare

Answer 4

Least to most restrictive Fluid and can go in either direction

Primary care

speciality care

patient-centered medical homes

community mental health centers

psychiatric home care assertive

community treatment

intensive outpatient programs

partial hospitalization programs

emergency care

crisis stabilization/observation units

general and private hospitals

state hospital p. 64

Question 5

decompensation

Answer 5

deterioriation of mental health p. 65

Question 6

elopement

Answer 6

leaving before being discharged p 70

Question 7

least restrictive environment

Answer 7

the setting that provides the necessary care while allowing the greatest personal freedom p.64

Question 8

Mileu

(MEEL-YOO)

Answer 8

middle and place

in therapeutic context overall environment and interactions within that environment…

Peplau - therapeutic mileu P

atient, staff, setting, structure, emotional climate.

Question 9

patient-centered medical home (PCMH)
or primary-care medical home

Answer 9

supported by affordable care act
Homes have 5 key characteristics
1. Patient centered
2. Comprehensive care
3. Coordination of care
4. Improved access
5. Systems approach

Question 10

prevention
treatment based on
3 levels

Answer 10

Primary - prevention before the problem manifests reduces new cases. (support groups for vulnerable)

Secondary - early id of problems, screening, prompt effective treatment. Does not stop disorder from beginning, but can divert or delay progression.

Tertiary - treatment of disease with focus on progression to severe course, disability, or death.

Question 11

psychiatric case management

Answer 11

may be part of community mental health centers
help find housing or entitlements

Question 12

recovery

Answer 12

“process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach full potential.” SAMHSA, 2019
Substance Abuse Mental Health Services Admin.

Question 13

stabilization

Answer 13

resolution of immediate crisis

Question 14

stigma

Answer 14

sense of responsibility, shame, and being flawed associated with mental health disorders.

Question 15

triage

Answer 15

Determining the severity of the problem and the urgency of the response.

Question 16

Anosognosia

Answer 16

patient has inability to recognize need for care
major depressive disorder

Question 17

What is the OLMSTEAD decision of 1999

Answer 17

SC decreed that keeping people in state mental hospitals was unjustified isolation.
Mental illness is a disability, violates the ADA, and they have a right to live in the community.
Many state hospitals closed.

Question 18

First antipsychotic medication

Answer 18

chlorpromazine

thorazine 1950”s

Question 19

Outpatient Care Settings

Answer 19

Primary care providers Specialized Psychiatric Providers (MD, APRN, PA)

Patient Centered Medical Homes Community Mental

Health Centers Psychiatric Home Care - homebound

Assertive Community Treatment (ACT) Intensive

Outpatient Programs (IOP) Partial Hospitalization

Programs (PHP) Telepsychiatry

Mobile mental health

Emergency Care

Question 20

Inpatient Care Settings

Answer 20

Suicidal, homicidal, extremely disabled.

Crisis Stabilization/Observation Units
General and private hospitals
State Psychiatric Hospitals (NGRI)

Question 21

Joint Commission Patient Safety Goals, 2019

Answer 21

ID patients correctly (ID patient 2 identifiers when drawing bloods)

Use medicines safely (performing a medication assessment on each new patient)

Prevent infection (appropriate hand washing techniques)

Identify patient safety risk (suicide risk) use Beck Scale (Admin Beck scale on each patient at time of admission)

Question 22

What is the Beck Scale?

Answer 22

Beck Scale for Suicide Ideation

21 items 5-10 minutes

on admission

Question 23

BioPsychoSocial Assessment

Answer 23