Specialized Community Support Services Major Components & Sub-Components
Checklist
Current Practice Yes No 1. Consumer Focused:
o Advocates for consumer rights X
2. Delivery Approach: Community-based X
3. Crisis Response/Emergency Services o 24-hour hotline
o Emergency room services o EMT services X X X 4. Consumer Self-Help o Volunteer based o Training provided X X 5. Family Self-Help o Volunteer based o Training provided X X 6. Vocational Services o Supportive Employment o Recovery philosophy o Volunteer participation o Empowering participants o Holistic philosophy sometimes case-by-case X X X
The following definitions of the major components are offered to provide context to the discussion. In addition to being community-based and community-driven, the literature indicates that most community mental health and substance abuse providers agree that the following components are critical in the delivery of SCSS:
y Crisis Response/Emergency Services: examples include 24-hour crisis hotline, emergency room, and EMT. Crisis services should be in place and function as a “triage unit” and provide consumers with services and resources to resolve the crises utilizing minimally intrusive options.
y Consumer Self-Help and Consumer Initiatives: consumers are trained to facilitate self- help programs such as peer led support groups that provide mutual support, advocacy, cultural activities, knowledge development and skills training, public education, educating professionals, economic development; consumer usually acts in a volunteer capacity.
y Family Self-Help: similar to consumer self-help, family members of consumers are trained as facilitators in providing family self-help groups (as individual or joint consumer-family initiatives); used as a resource in the planning and evaluation of care delivery.
y Vocational Services: shifting from traditional methods of providing vocational services to supported employment. Supported employment focuses on the person’s abilities and provides the supports needed for them to be successful on a long-term basis. The goals of supported employment are: pay at least minimum wage; people with and without disabilities work in an integrated environment; ongoing support, provided as needed; individualized services; job selection based on person’s preferences and skills; and competitive employment (NMHA, 2004). Key elements of supported employment are (NMHA, 2004):
o Recovery philosophy: believe individuals with mental illness can and do recover o State-of-the-art services: provide high quality services including latest treatments o Voluntary participation: services are optional and clients get to choose
o Empowering participants: encourage choice and self-determination
o Holistic philosophy: maximize individuals strengths and abilities during treatment o Embraces true community integration: provide services in client’s environment o Community supported: collaborate with service providers, community support o Effective administration: system of accountability, responsibility & fiscal success o Culturally competent: serve diverse populations reflecting local community o Measurable program outcomes: evaluate services to determine effectiveness
CURRENT LOCAL PRACTICE
In Orange County, two organizations exist that provide elements of SCSS: (1) the National Alliance for the Mentally Ill (NAMI) Greater Orlando and (2) the Mental Health Association of Central Florida (MHACF). Both are national organizations with local offices in Orlando and provide SCSS, usually through the utilization of consumers and volunteers. Both organizations have a wealth of information available for consumers, families of consumers and professionals via online and printed
materials. Both organizations, as well, triage emergency crisis calls, provide information and referral, and facilitate support groups and services.
Michael Mathes, President of NAMI Florida, stated in a recent interview (May 7, 2004) that NAMI relies greatly on volunteers to facilitate support groups. NAMI offers volunteer training to parents of consumers, consumers and other individuals interested in volunteer opportunities to facilitate parent, family and/or peer support groups. NAMI Greater Orlando currently offers monthly
support groups for families of consumers, parents of consumers, consumers, and a joint families and consumers support group. NAMI receives consumer referrals through their website, newsletter, agencies, and word of mouth.
In a separate interview (May 12, 2004), this time with Juanita Hernandez Black and Bob Decker from MHACF, it was learned again that the utilization of consumers and volunteers is a major component of providing SCSS. Some of the programs MHACF offers include: Medical Security Program (MSP), PRIDE Program, I Can Problem Solve, Guardian Advocate, education and prevention, information and referral, People, Inc.! Group, and newsletter.
The Medical Security Program (MSP) is designed to provide crisis assistance to consumers through program registration and identification. The program is specifically for mental health consumers who tend to wander or become disoriented. Registration is completely voluntary and the enrollee or legal guardian must give consent. The registration form and a photo will be sent to the County Sheriff's Office Communications Center to be entered into the County computer for access to law enforcement agencies only. MHACF will retain one copy and the other copies of the enrollment from are sent to emergency care providers in the area. The enrollment form will contain personal and physical characteristics of the mental health patron, along with any pertinent medical data and habits that will help law enforcement identify and assist individuals in receiving appropriate attention. This program was designed in mutual cooperation with Orange County Sheriffs
Department, Lakeside Alternatives, Florida Hospital, Orange County Corrections Department, and Pathways Drop-In Center (MHACF, 2004).
Florida Mental Health Law (Baker Act) outlines a bill of rights for persons with mental illness and provides a system of due process for persons receiving treatment in designated mental health facilities. A Guardian Advocate is appointed when the court determines that a person is incompetent to make decisions for them self. The Guardian Advocate works directly with the treatment team and consumer to determine treatment options and to ensure their rights are not being violated. MHACF provides training to individuals interested in serving as guardian advocate. MHACF, in partnership with Lakeside Alternatives, Florida Hospital, Osceola Mental Health, Human Rights Advocacy Committee, and the Department of Children and Families produced this training program. Funding for training development was provided by a grant from Dr. Phillips, Inc., to serve the counties of Orange, Seminole, and Osceola. This program is currently funded through the Florida Department of Children and Families (MHACF, 2004).
SECTION SUMMARY
Specialized community support services (SCSS) constitutes an emerging practice (EP). In Orange County, most of the major components and sub-components of SCSS are available, albeit in limited numbers.