	Psychiatric Rehabilitation Services: Psychosocial Rehabilitation Services; Assertive Community Outreach Services

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

PSR 5: Service Elements

The program encourages individuals to achieve their highest level of functioning by helping enhance coping abilities and create a supportive community in which to learn and grow.

PSR 5.01

The program offers the following services:

case management;
pre-vocational and vocational training;
housing/residential care;
peer support services;
individual supportive therapy;
social rehabilitation services; and/or
educational services.

Note: Psychosocial rehabilitation programs may provide any combination of at least three of the services outlined in the standard.

PSR 5.02

The program works with service recipients to identify and use natural resources and peer support to create a supportive community.

PSR 5.03

Core service components focus on helping individuals improve and manage the quality of their lives through:

development of self care and independent living skills;
medication adherence and an understanding of how to manage their illness;
socialization and use of leisure time;
housing, education, and family support services; and
vocational development.

Research Note: Research has suggested that psychoeducation and skills training lead to acquisition of targeted skills, and are associated with reduced relapse, improved social functioning, and decreased family stress.

Research Note: Studies conducted to examine the impact of placing individuals with mental illness in real world settings and then providing them with the necessary training and supports to successfully maintain those placements indicated positive outcomes in the areas of employment, education, and independent living. Such outcomes include return to work; job tenure; and improvement in hospitalization rates, symptoms, housing stability, and educational and vocational functioning.

PSR 5.04

The program offers service recipients a variety of opportunities to achieve service goals through individual, group, and/or milieu activities, within a culturally sensitive framework that allows each individual to:

learn how to relate to others;
anticipate and control behaviors that interfere with inclusion in the community;
experience peer support and feedback;
build on strengths and enhance self-reliance and productivity; and
celebrate competence and success.

PSR 5.05

The organization directly provides, coordinates, or formally arranges for:

24-hour crisis intervention;
crisis residential and other emergency services;
inpatient and outpatient psychiatric services;
medical and dental services;
medication management;
integrated mental health and substance use services;
substance use education and treatment;
public assistance and income maintenance;
work-related services and job placements;
financial services;
legal advocacy and representation; and
transportation.

Research Note: Assertive community outreach programs provide a majority of treatment, support, and rehabilitation services with minimal referral to outside providers to allow for full integration of services.

Research Note: Collaboration between agencies and settings can help improve the community functioning of individuals with serious and persistent mental illness.

PSR 5.06

Service recipients are engaged in crisis planning and helped to develop advanced mental health directives, when appropriate and in accord with applicable law or regulation.

Interpretation: Advanced mental health directives, also known as advanced psychiatric directives, enable a person with a mental illness to make decisions about the mental health care they wish to receive when they may be incapacitated. An advanced directive goes into effect when the person is unable to make decisions and is revocable. Advanced directives frequently address such issues as: preferred hospitals, medications, and specific interventions, and designation of a person to make decisions about their care.

PSR 5.07

The families or significant others of service recipients are offered services, including:

family psychoeducation;
emotional support and therapy;
linkage to community services;
self-help referrals; and
care coordination, as needed.

Research Note: Studies of psychoeducation services provided to families consistently show positive outcomes for the service recipient, including reduced relapse, decreased psychiatric symptoms, and increased self-efficacy.

PSR 5.08

The organization provides most of its services in the community.

Research Note: Literature points to the importance of providing services in the community regardless of the program approach, including skills building, peer support, vocational services, or consumer community resource development.

Research Note: Most individuals with long-term mental illness can live successfully in the community.

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	PURPOSE: Adults with serious and persistent mental illness who participate in Psychiatric Rehabilitation Services achieve their highest level of self-sufficiency and recovery through gains in personal empowerment, hopefulness, and competency.

RELATED FILES


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	EMPOWERMENT The process of helping individuals, families, groups, or communities to increase their personal, interpersonal, political, social, and/or economic strength or position and to develop influence that may impact their circumstances.


	PROGRAM A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.


	COMMUNITY A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.


	CASE A general term used to designate clients (including individuals, families, and groups) served by an organization for purposes of monitoring the provision of services. A foster care case is generally based on the placement of an individual child, although casework for the child may include services to the child's family. A child protective services case is based on an entire family household if a family assessment model is used; otherwise a case is defined as a child.


	TRAINING Instruction so as to make fit, qualified, or proficient in a skill or body of knowledge.


	SERVICE RECIPIENT The individuals, groups, organizations, or communities that use, receive, or benefit from programs and services. Service recipients can include consumers, patients, family members, legal guardians, advocates, public/private organizations, employers, and purchasers. All are regarded as significant stakeholders served in a variety of agencies and practice settings.


	QUALITY In this context, the extent to which contemporary and generally recognized standards for professional practice are met and exceeded, and desirable service outcomes achieved.


	MEDICATION A prescribed or over-the-counter drug that is injected, taken orally, applied topically, or otherwise administered.


	FAMILY Two or more people who consider themselves family and who assume obligations, functions, and responsibilities generally essential to healthy family life. Child care and child socialization, income support, long-term care, and other caregiving are among the functions of family life. The definition of "family" will rest with an individual's indication of who plays a family member role, including current or former foster family, adoptive family, extended family members, fictive kin, or significant others. Organizations that believe family is the central constellation in a child's life, and that family attachments are of primary importance for human development, will strive to work with professional staff to develop a common understanding of "family."


	MANAGEMENT See ADMINISTRATION


	RESEARCH For purposes of COA accreditation, all forms of internal or external research involving persons served except internal program evaluation and outcomes research, or educational projects performed by students and interns that are part of their professional training.


	SERVICE GOALS Broad, issue-oriented statements that reflect the realistic achievements to be accomplished in the short or long term. Goals are achieved through the accomplishment of specific quantifiable objectives.


	CRISIS INTERVENTION The immediate response to the acute needs of a person in crisis including referral to appropriate community resources, advocacy, support, or direct assistance.


	SOCIAL FUNCTIONING The degree to which individuals, families, and groups are able to cope with social and psychological problems affecting their day-to-day functioning.


	MEDICATION MANAGEMENT Ongoing review and oversight of a client's use of prescribed or over-the-counter medications by a physician or other prescribing clinician.


	ADVOCACY An act performed with or on behalf of others through direct intervention, empowerment, or representation. Case advocacy refers to actions taken in relation to a particular individual consumer. Cause, social, or systems advocacy refers to actions taken in relation to a common issue affecting a group of persons.


	OUTREACH Contact initiated by a provider to identify persons in need of services, to provide information to them about services and benefits, and to encourage the use of appropriate services.


	PLANNING The process of specifying objectives, evaluating the means for their achievement, and exercising deliberate decision making about appropriate courses of action.


	REFERRALS Resource suggestions provided to consumers to address problems or needs that are beyond the scope of the organization's mission.


	CONSUMER The individual, family, group, or community that seeks or receives services.