Textbook of Community Psychiatry: American Association for Community Psychiatry

Contents
About the Authors
Part I: Introduction and Background
	Introduction: Community Psychiatry on the Move
		How the Book Is Organized
			Part I: Introduction and Background
			Part II: The Basics: Central Pillars of Community Psychiatry
			Part III: Core Competencies for Community Psychiatrists
			Part IV: Effective and Established Interventions
			Part V: Creating Healthy Communities
			Part VI: Supportive Services for Community Living
			Part VII: Special Populations
			Part VIII: The Development and Administration of Services
			Part IX: Shaping the Future
		References
	History of Community Psychiatry
		Introduction
		References
Part II: The Basics: The Pillars of Community Psychiatry
	Recovery and Person-Centered Care: Empowerment, Collaboration, and Integration
		Introduction
		Brief Historical Perspective
		The Elements of Recovery
		The Aims of a Recovery Process
			Change
			Growth
			Autonomy and Resilience
			Purpose and Meaning
		Development of Enabling Qualities
			Acceptance and Responsibility
			Desire and Determination
			Hope and Faith
			Courage, Diligence, and Tolerance
			Integrity, Honesty, and Trust
			Tolerance, Humility, and Forgiveness
		Characteristics of a Mature Recovery
		Resiliency and Recovery
		Universal Aspects of Recovery
		The Value of the Recovery Paradigm
			Developing Person-Centered, Recovery-Oriented Services
			Implementation and System Transformation
		Evidence, Quality, and Recovery-Oriented Services
		References
	Population Health, Prevention, and Community Psychiatry
		Introduction
		Population Mental Health
		Social Determinants of Mental Health
		Mental Illness Prevention
		Mental Health Promotion
		Supporting a Shift Toward Population Health
			Training
			Culture and Identity
			Reimbursement
		Conclusion: Relevance to Community Psychiatry
		References
	Exercising Effective Leadership
		Introduction
		The Case for Psychiatric Leadership in Community Behavioral Health
		What Is Leadership?
		Personal Attributes and Skills of Effective Leaders
		Transactional Versus Transformational Leadership
		Leadership Development and Training
		Conclusion: Transforming Leadership in Community Psychiatry
		References
	Advocacy in Evolution: The Push and Pull of Psychiatrists
		Who Advocates?
		Methods of Advocacy
		Points of Impact: Advocacy in History
		Advocacy at the Beginning of the Twenty-First Century
		Recovery
		Empowerment
		Treatment and Treatment Resources
		Involuntary/Coercive Treatment
		Housing
		Employment
		Peer Support
		Advocacy Trends of the Last Decade
		Conclusion
		Historical Appendix
		References
	Comprehensive Integrated Systems of Care
		Introduction
		Person-Centered Design of Integrated Systems
			Begin with the Basics
			Service Design Fundamentals
			Basic Service Elements
		How Do We Start the Planning Process and Move Forward
			Self-Assessment Questions for Readers
			Moving Toward Complexity Capability as a Community BH Organization
		Comprehensive Integrated Systems of Care for Communities and Populations
			How Do We Get There?
			Comprehensive Integrated System of Care for a Community
		Conclusion
		References
Part III: Core Competencies for Community Psychiatrists
	Inspiring a Welcoming, Hopeful Culture
		Introduction: Welcoming, Hope, and the Vision of Community Psychiatry
		The Challenge of Welcoming
			What Would “Welcoming” Look Like in This Situation?
		Welcoming Systems and Welcoming Practice
			Comprehensive Continuous Integrated Systems of Care (CCISC)
		Strategies to Implement Welcoming, Hopeful Environments and Practices
			Creating a Welcoming Environment
			Defining and Implementing Welcoming Practice
			Welcoming and Safety
		Creating a Welcoming Organizational Culture
		Creating Welcoming Communities
		Conclusion: Carlos, Revisited
		References
	Motivational Interviewing as a Core Communication Style
		Introduction
			A Brief Review of the Development and Evidence Base of MI
			Key Concepts of MI: Ambivalence, the “Paradoxical Effect of Coercion” and “Resisting the Righting Reflex”
		The Spirit of MI
		Core Skills of MI
		The “Meta-Processes” of MI: Engagement, Focusing, Evoking, and Planning
		Issues of Particular Relevance to Community Psychiatry
			Does MI “Work” with Those with Serious Mental Illness?
			Other Applications and Advantages of MI
			When Is MI Not Appropriate?
			Learning and Teaching MI
		References
	Person-Centered Recovery Planning as a Roadmap to Recovery
		Introduction and Framing the Problem
		Functions of the Recovery Plan
		What Is PCRP and How Is It Different?
		Quality Process in PCRP
			Defining and Gathering the Team
		Person-Centered Assessment and Plan Documentation
			Strengths and Resources
			Stage of Change
		The Importance of Understanding
		The Role of Culture in PCRP and Person-Centered Understanding
		Core Elements of the PCRP
			Prioritization
			Goals
			Strengths and Resources
			Barriers
			Objectives
			Services/Interventions
		Evaluating Progress and Updating the Plan
		The Role of a Psychiatrist in PCRP
		Summary
		PCRP Illustration: Roma Example
		Assessment
			History, Demographics, and Presenting Issue
			Family Background/Early Childhood
			Education/Employment
			Health Status
			Mental Health Symptoms and Treatment
			Alcohol/Drug Use
			Strengths, Interests, and Goals
		Integrated Summary
		Roma Traditional Treatment Plan
		Roma’s Person-Centered Recovery Plan
			Recovery Goal
			Objective 1 (Targeting Conflicts with Daughter)
			Objective 2: (Targeting Alcohol Use Which Complicates Serious Medical Issues)
			Objective 3 (Targeting Budgeting)
		References
	Cultural and Linguistic Competence
		Introduction
			Stigma, Recovery, and Cultural Competence
		Definitions
		Federal Policies and National Standards
		Clinical Approaches
			Staff Training: Diversity Training Versus Cultural Competence Training
			DSM- IV and DSM-5 Outline for Cultural Formulation (OCF)
				Part A: Cultural Identity of the Individual
				Part B: Cultural Conceptualizations of Distress
				Part C: Psychosocial Stressors and Cultural Features of Vulnerability and Resilience
				Part D: Cultural Features of the Relationship Between the Individual and the Clinician
				Part E: Overall Cultural Assessment
			DSM-5 Cultural Formulation Interview (CFI)
			Applications of Culturally Effective Treatment
				Southeast Asian Communities
				Hispanic Communities
				Using Systems to Aid Culturally Competent Services
				Ethnopsychopharmacology
			Culturally Competent Interventions at State and Local Levels
		Conclusions
		References
	Context-Specific Assessment
		Introduction
		Initial Considerations for an Assessment
			Establishing the Interview Ambience
			Safety Issues/Physical Space
			The Nature of the Assessment and the Expected Product
			Types of Assessments, Contextual Considerations
		Key Information to Be Elicited in All Assessments
			Demographics (Which Will Often Underscore Contributing Social Determinants of Mental Health and Resilience)
			Chief Complaint
			Salient Mental and Medical Health Symptoms
			Who Else Is There?
			Past Psychiatric History
			Past Medical History
			Review of Systems
			Family/Social/Developmental History: The Importance of Understanding Social Determinants
			Mental Status Examination
		Cultural Attributes and Structural Competence
		Conclusion
		References
	Team Leadership: Promoting Diversity and Inclusion in the Aftermath of COVID-19
		Introduction
		The Trauma That Is COVID-19
			Risk Factors, Predictive Factors, and Protective Factors
		The Value and Pitfalls of Multidisciplinary Teams in Community Mental Health Settings
		Managing the Process of Conflicts on Multidisciplinary Treatment Teams
		Team Leadership
		The Role of the Community Psychiatrist on Community Mental Health Teams
			Leadership in the Wake of COVID-19
			How Behavioral Health Teams Can Redefine Community
			Five Dysfunctions of a Team
				The Absence of Trust
				Fear of Conflict
				Lack of Commitment
				Avoidance of Team Accountability
				Inattention to Team Objectives
		References
	Community Education
		Family Psychoeducation
		Community Education in Law Enforcement
		Community Education in Schools
		Additional Target Audiences for the Community Psychiatrist Educator
			Psychiatrist as Educator to Non-mental Health Providers
			Psychiatrist as Educator to Other Mental Health Professionals
			Psychiatrist as Educator on Social Media
			Psychiatrist as Educator in Mental Health Advocacy
			Psychiatrist as Educator in Sharing Tasks and Power with Community Members
		Conclusions
		References
	Collaborative Medication Management and Discontinuation
		Collaboration, Shared Decision-Making, and Using Medication to Support Recovery
		References
	Traumatic Stress in the Community: Identification and Intervention
		Introduction and Definitions
		Epidemiology
			Resilience and Risk Factors
			Neurobiological Correlates
		Assessment
		Interventions
			Intervention Selection
			Treating PTSD and Comorbid Behavioral Health Disorders
			Debriefing
			Pharmacological Treatment
		The Patient’s Role
		Implementation Issues
		Self-Care and Secondary Trauma Prevention
		References
	Integrated Care and Community Psychiatry
		Introduction
		Providing Behavioral Health Services in Primary Care Settings (BH in PC)
			Primary Care Behavioral Health
			Collaborative Care Model
			Real-World Considerations
			Workplace Culture Considerations
		Financing Integrated Care
		Primary Care in Behavioral Health (PC in BH)
		Examples to Date of PC in BH Programs
			Primary Care Access, Referral, and Evaluation (PCARE)
			Primary Behavioral Health Care Initiative (PBHCI)
			Behavioral Health Homes
			Certified Community Behavioral Health Centers (CCBHCs)
		Evidence for the Effectiveness of PC in BH
		Financial Barriers and Opportunities in PC in BH
		The Role of the Psychiatrist in Integrated Care
		Conclusion
		Citations
	Group Appointments in Psychiatry+
		Introduction
		History
		Efficacy
		Advantages of Psychiatric Group Medication Visits
			Reduced Stigma and Balance of Power
		Focus on Rehabilitation, Recovery, and Psychosocial Issues
		Socialization and Recovery
			Improved Adherence to Medication Plan
			Shared Group Leadership
		Barriers and Limitations
		How to Start a Group
			Recruitment, Intake, and Preparation
			Group Composition, Membership, Exclusionary Criteria
			Acute Transition Groups
			Flexibly Bound-Model
		How to Run a Group
			Content, Setting, and Duration
			Universalizing: Combating Stigma
			“Go Rounds”
			Addressing Poor Adherence
			Individual Appointments
		Conclusion
		References
	Treatment Techniques for Co-occurring Substance Use and Mental Disorders
		Introduction
		Definitions
		Basic Concepts
			Treatment Techniques Differ from Evidence: Or Consensus-Based Practices
		Engagement Strategies
			Establishing and Maintaining a Therapeutic Alliance
				Engaging Significant Others and Families
				Facilitating Adherence to a Treatment Plan
				Maintaining Engagement in Treatment
				Maintaining Long-Term Care
		Psychosocial Treatment Strategies
			Monitoring the Patient’s Clinical Status
			Providing Patient Education
			Preventing Relapse
		Medical Strategies
			Managing Intoxication and Withdrawal States
			Using Medication
			Reducing the Morbidity of Substance Use Disorders
		Implementing Techniques
			Techniques to Convey Information to Patients
			Increasing the Validity and Impact of Feedback Provided to Patients
			Using Techniques to Help Address the Social Consequences of Co-occurring Illnesses
			Making an Appropriate and Effective Referral
		Summary and Future Directions
		References
	Women’s Mental Health: Core Concepts for Community Psychiatry
		Introduction
		Women’s Mental Health Across the Reproductive Lifespan
			Sexual Health
			Contraceptive Care
				Approach to Contraceptive Counseling
				Contraceptive Methods and Considerations
				Psychotropic and Contraceptive Drug Interactions
				Contraceptives and Mood Symptoms
			Preconception Counseling
				Impact of Psychiatric Illness on Fertility
				Pharmacologic Treatment Planning
			Perinatal Psychiatry
				Schizophrenia
					Prognosis in Perinatal Period
					Risks of Not Treating
					Medication Treatments
				Depression
					Prognosis in Perinatal Period
					Risks of Not Treating
					Medication
				Bipolar Disorder
					Prognosis in Perinatal Period
					Risks of Not Treating
					Mood Stabilizers in Pregnancy
				Parenting While Living with SMI
			Perimenopause
				What Is Perimenopause and Menopause?
				Depression During Perimenopause
				Perimenopause and Women Living with Severe Mental Illness (SMI)
		Gender-Linked Violence
			Intimate Partner Violence
			Sexual Assault
			Sex Trafficking
		Conclusion
		References
Part IV: Effective and Established Interventions
	Developing, Evaluating and Implementing Evidence-Based Interventions in Real World Practice.
		Introduction
		Stages of Intervention Development
		Pilot Trials
		Efficacy Trials
		Effectiveness Trials
		Implementation Trials
		Intervention Fidelity
		Fidelity-Adaptation Tension
		Balancing Adaptation and Fidelity
		Summary
		References
	Cognitive Behavioral Therapy
		Background and Core Concepts
		Basic CBT Tools
		Depression and Mood Disorders
			Depression
			Bipolar Disorder
		Anxiety Disorders
		Panic Disorder
		Psychosis
		Insomnia
		Suicide
			The Treatment Outline
		Conclusion
		References
	Psychiatric Rehabilitation
		Introduction
		Social Skills Training
			Rationale for Social Skills Training
			Description of the Social Skills Training Approach
			Treatment Outcome Research for Social Skills Training
		Cognitive Remediation
			Rationale for Cognitive Remediation
			Description of Cognitive Remediation
			Treatment Outcome Research on Cognitive Remediation
		Social Cognitive Training
			Rationale for Social Cognitive Training
			Description of Social Cognitive Training
			Treatment Outcomes Research on Social Cognitive Training
		Physical Health Management
			Rationale for Physical Health Interventions
			Description of Physical Health Interventions
			Treatment Outcome Research for Physical Health Interventions
		Summary
		Bibliography
	Family Systems Care in Public Sector Settings
		Introduction
		Case Example #1
			Family Assessment with Ms. Smith and Her Psychiatrist, Primary Care Doctor (PCP), DBT Therapist, Eating Disorders Program Therapist, Dietician, and AA Sponsor
			Problem-Solving
			Communication
			Roles
			Affective Responsiveness
			Affective Involvement
			Behavior Control
			Case Formulation
			Learning Points
		Family Inclusion
		Case Example #2
		Barriers to Collaborating with Family Members and Incorporating Families into Their Work with Patients
		Family Assessment
		Case Example #3
			Family Assessment with Mr. Cadie and His Mother and Stepfather, Case Manager, and Psychiatrist
			Problem-Solving
			Communication
			Roles
			Affective Responsiveness
			Affective Involvement
			Behavior Control
			Case Formulation
			Learning Points
		Cultural Considerations to Family Assessment
		Family Psychoeducation
		Other Family Considerations
		Parenting as a Patient with Serious Mental Illness
		Case Example #4
			Family Assessment with Ms. Talia and Her Mother
			Problem-Solving
			Communication
			Roles
			Affective Responsiveness
			Affective Involvement
			Behavioral Control
			Case Formulation
			Learning Points
		Children as Caregivers to Parents with Serious Mental Illness
		Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Families
		Case Example # 5
			Family Assessment with Ms. Sharon, Ms. Anna, the Psychiatrist, and the Social Worker
			Problem-Solving
			Communication
			Roles
			Affective Responsiveness
			Affective Involvement
			Behavioral Control
			Case Formulation
			Learning Point
		Conclusion
		References
	Evidence-Based Practices for Co-occurring Addiction and Mental Illness
		Introduction
		Scope of Co-occurring Disorders (COD) in the Community
		Prognosis and Complications of Comorbid Disorders
		Screening and Assessment of Substance Use Disorders in Community Mental Health
		Principles of Integrated Treatment
			Critical Components of an Integrated Co-occurring Disorder Program
		Evidence-Based Psychosocial Treatments for Co-occurring Addiction and Mental Illness
			Case
			Abstinence Support Groups
		Evidence-Based Psychopharmacological Treatment of COD
			Pharmacotherapy for Affective Disorders with Co-occurring Addiction
			Pharmacotherapy for Anxiety Disorders with Co-occurring Addiction
			Pharmacotherapy for Schizophrenia/Psychotic Disorders
			Pharmacotherapy for Select Other Disorders with Co-occurring Addiction
			Use of Addiction Pharmacotherapy in Patients with Psychiatric Illness
			Pharmacotherapy for Alcohol Use Disorder
			Pharmacotherapy for Opioid Use Disorder
			Pharmacotherapy for Stimulant Use Disorders
			Pharmacotherapy for Tobacco Dependence in People with Co-occurring Disorders
		Conclusions
		References
	Case Management and Assertive Community Treatment
		Introduction
		History
		Intensive Case Management
		Assertive Community Treatment (ACT)
		Strengths Model
		Research on Case Management
		Assertive Community Treatment
		Strengths Model
		Optimizing Key Elements of Effective Case Management
		Level of Care Supports (Finding a Good Fit)
		Conclusions
		References
	Crisis and Emergency Services
		Introduction
		Defining Crisis Services
		The Crisis Continuum
			Someone to Call: Crisis Lines, 988, and “Care Traffic Control”
			Someone to Respond: Mobile Crisis Teams (MCTs)
			Somewhere to Go: Specialized Crisis Facilities
			After the Crisis: Post-Crisis Care
		Intersection with Law Enforcement
			The Crisis Intervention Team (CIT) Model
			Co-responder Models
			911 Integration
		Putting it All Together: Crisis System Versus Crisis Services
			Cost Savings Across Systems
		Financing
		Data and Quality Improvement
		Research Considerations
		Addressing Racism and Inequity via a “Health-First” Approach
		Improving Crisis Care in Your Community via Stakeholder Engagement
		Role of Psychiatrists
		References
Part V: Creating Healthy Communities
	Epidemiology in Community Psychiatry
		Incidence and Prevalence
			Prevalence of Common Mental Disorders
				The Burden of Proof: The Midtown Manhattan and Stirling County Studies
				The Proof of Burden: The Next Generation of Epidemiologic Studies
					The Epidemiologic Catchment Area Study
					The National Comorbidity Surveys and the Collaborative Psychiatric Epidemiology Surveys
					World Mental Health Surveys
				Limitations of Cross-Sectional Studies of Common Mental Disorders
			Incidence Studies
				Limitations of Incidence Studies
		Observational Studies of Causes
			Natural Experiments
				Limitations of Natural Experiments
			Cohort Studies
				Strengths and Limitations of Cohort Studies
			Case-Control Studies
			Case Study: Evaluating the Mental Health Impacts of the COVID-19 Pandemic During the First Six Weeks of the National Lockdown in Soweto, South Africa
		Conclusion
		References
	Social and Political Determinants of Health and Mental Health
		Introduction
		Framework for the Social Determinants of Mental Health
		The Social Determinants of Mental Health Evidence Base
			Exposure to Violence
			Unemployment and Job Insecurity
			Homelessness and Housing Instability
			Climate Change
		Points of Intervention to Address the Social Determinants of Mental Health
			Discrimination and Racism
			Adverse Early Life Experiences
		The Moral Determinants of Mental Health
		Conclusion
		References
	Mental Health Services Research and Community Psychiatry
		Introduction
		Defining Health Services Research
		Putting Research into Practice
			The Science-to-Practice Gap
			Barriers to Success of Evidence-Based Practices
			Community-Based Participatory Research
		Mental Health Services Research: Examples and Impact
			Understanding the Impact of Policies
			Understanding Service Utilization
			Understanding Inequities
			Understanding Costs
			Understanding Practice Patterns
			Understanding Effective Implementation
		New Directions in Health Services Research: Informatics and Machine Learning
		Summary
		References
	Climate Change: Implications for Community Mental Health
		Introduction
		Climate Change and Mental Health
			Direct and Indirect Impacts
				Heat
				Air Pollution
				Wildfires and Extreme Weather Events
				Droughts
				Vector-Borne Diseases
				Nutrition and Water Security
		Psychological Effects
		Subpopulations Most Vulnerable in the Context of Climate Change
			Individuals Experiencing Homelessness
			Children and Adolescents
			Older Adults
			Ethnic/Racial Minorities
			Rural Communities
			Indigenous Peoples
		Community Psychiatry, Climate Change, and Social Justice
			Recovery and Person-Centered Care
			Population Health and Prevention
			Leadership and Collaboration
			Advocacy and Social Justice
			Integrated and Comprehensive Systems
		Conclusion
		References
	Disaster Victims and the Response to Trauma
		Introduction
		Defining the Problem
			Disasters
			The Mental Health Effects of Disasters
			Vulnerable Populations
		The Mental Health Interventions in the Disaster Setting
			Prevention
			Before the Event
			During or Soon After the Event: Psychological First Aid and Primary Prevention
			One Week to One Month After Traumatic Events: Acute Stress Disorder and Secondary Prevention
			Months After the Trauma: Treatment of PTSD and Tertiary Prevention
			COVID-19 Pandemic
		Conclusion
		References
	The Role of the Psychiatrist in Community Consultation and Collaboration
		Introduction
		Brief History of Consultation and Collaboration in Community Psychiatry
		Community Psychiatry for the Twenty-First Century and Beyond
		Reimagining Community Consultation and Collaboration
		The Psychiatrist as Consultant and Collaborator
		The Psychiatrist as Consultant
		The Psychiatrist as Collaborator
		Conclusion
		References
	Collaborative Reduction of Criminal Justice Involvement for Persons with Mental Illness
		Introduction and Background
		Why Are There So Many People with Mental Illnesses in Jail and Prison?
		What Can Be Done to Reduce the Likelihood that They Will End Up There?
			Police-Based Responses
			Jail- and Court-Based Strategies
			Specialized Courts
			Transition Planning
			Specialized Community Supervision
		Comprehensive, Effective Community-Based Care: The Ultimate Intercept
		Integrated Mental Health and Substance Use Services
		Supportive Housing
		Trauma Interventions
		Supported Employment
		Illness Management and Recovery
		Case Management and Forensic Assertive Community Treatment
		Cognitive-Behavioral Interventions
		Accessible and Appropriate Medication
		Conclusion
		References
Part VI: Supportive Services for Community Living
	Housing First and the Role of Psychiatry in Supported Housing
		Introduction
		The Need for a New Model of Housing
		Two Approaches to Supported Housing
		Practicing Psychiatry in Supported Housing
			Role and Activities of an On-Site Psychiatrist in Supported Housing
				Outreach and Engagement
				Evaluation
				Treatment
				Consultation
				Liaison
				Tenant and Staff Education
				Technical Assistance
			Coordinating the Work of an On-Site Psychiatrist
				The Schedule
				Communication with the Psychiatrist
			Making the Team Approach Work: Managing the Collaboration
			Psychiatry in Supported Housing: Community Psychiatry in Action
		References
	Health Self-Management: The Emerging Importance of Trauma and Resilience
		Introduction
		Key Self-Management Behavioral Health Programs in Use Today
			Illness Management and Recovery (IMR)
			Wellness Self-Management (WSM)
			Wellness Recovery Action Planning (WRAP)
		Trauma and Overall Health Self-Management
		Resilience: A Holistic Perspective
		What Does Science Tells Us About the Relationship Between Resilience and Overall Health?
		Learning to Be Resilient: Features of Resilience-Building Programs
		Next Generation of Self-Management Programs: The Brite Program
		Conclusion
		References
	Supported Employment
		Introduction
		Principles of Individual Placement and Support
			Zero Exclusion Criteria
			Focus on Competitive Work
			Integration of Vocational and Clinical Services
			Benefits Counseling
			Client Preferences
			Targeted Job Development
			Rapid Job Search
			Follow-Along Supports
			Other Features of IPS Programs
		The Organization of IPS Services
		Research on the Effectiveness of Supported Employment
			Randomized Controlled Trials
			Long-Term Outcome Studies
		Growth of IPS
		Costs of IPS
		Conclusions and Future Directions
		References
	Peer Service Providers as Colleagues
		Introduction
		Evidence for Peer-Provided Services
		Roles and Settings for Peer Providers
		Working with Peer Providers
			Peer Specialists in Clinical Treatment
			Decision Support
			Information Access
			Advocacy and Quality Improvement
		Administrative Issues
		Challenges and Solutions
			Stigma
			Relationship to the Team
			Professionalization of Peer Specialists
			Technology
			Special Populations
			Over-identification with “Provider” Role
		Conclusion
		References
	Fountain House and the Clubhouse Movement
		The Beginnings of Fountain House
		Fountain House Today
		The Void in the Community Mental Health Service System
		Model Effectiveness
		Future Implications
		Clubhouses Working with Community Psychiatry
		Conclusion
		References
	Service Coordination and Health Homes
		Introduction
			Collaboration and Information Sharing
				Information Sharing Technology and Confidentiality
				Population Management Data and Tracking
			Advanced Models of Care Coordination
		Primary Care Case Management (PCCM)
		Health Homes for Chronic Conditions (Section 2703 of ACA)
			Selecting Patients: Eligibility and Enrollment
			Health Home Service Definitions
		Certified Community Mental Health Centers
		Medicare Care Management Bundled Payments
		Conclusion
		References
Part VII: Special Populations
	Community-Based Psychiatric Care for Individuals with Intellectual and Developmental Disabilities
		Terminology, Classification, and Epidemiology
		The Concept of Dual Diagnosis
		History: Past, Present, and Future
		Systems of Care
			Evolution of Treatment Settings
			Dueling Systems of Care
		Outpatient Care
			Best Practices and Model Programs
			Coordinating Care Across Different Systems
			Special Populations Within a Special Population
		Care in the Emergency Department
			Barriers to Quality Care in the ED
			Patterns of ED Utilization
			Outcomes Associated with ED Visits
			Interventions to Decrease ED Utilization and Improve Patient Care
		Inpatient Psychiatric Hospitalization
			Utilization, Presentation, and Risk Factors for Admission
			Quality of Care and Stakeholder Experiences
			Hospital Course
			Specialized Versus Generic Psychiatric Units
			Improving Inpatient Psychiatric Care
		Impact of Ideological Factors on Community Psychiatry
		Educating and Training a Skilled Psychiatric Workforce
		Conclusion
		References
	Psychiatric Care for People Experiencing Homelessness
		Contemporary Homelessness
			Epidemiology
			Basic Causes
		The Development of Services
		A Compass for Work with People Experiencing Homelessness
			A Phasic Model
				First Dimension: Stages of Change
				Second Dimension: Recovery
				Third Dimension: Clinical Behavior
					Engagement
					Intensive Care
					Ongoing Rehabilitation
			Some Key Principles
			Effective Interventions
				Street Psychiatry or Homeless Outreach
				Critical Time Intervention (CTI)
				Assertive Community Treatment (ACT)
				Pathways to Housing
				Pharmacotherapeutic Approaches
				Employment and Education: Supported and Transitional
				Integrated Dual Disorder Treatment
				Modified Therapeutic Communities (MTCs)
				Peer Workers
			Promising Practices
				Intensive Mobile Treatment (IMT)
				Trauma-Informed Services and Treatment
				Primary Care Behavioral Health Integration (PCBHI)
		Conclusion
		References
	Early Psychosis and the Prevention and Mitigation of Serious Mental Illness
		Relationship Between DUP and Outcomes
		Impact of Social Determinants of Mental Health Care on Pathways to Care in Psychosis
		Strategies for Reducing DUP
		Evidence for the Early Treatment for Early Psychosis
		Evidence-Based Treatment for Early Psychosis
		National Expansion of Coordinated Specialty Care
		References
	Cognitive Behavior Therapy for Psychosis
		Evidence
		CBTP in Practice
		Engagement
		Working with Voices
		Working with Delusions
		Negative Symptoms
		Relapse Prevention and Medication Management
		The Third Wave of CBT Interventions
		Summary
		References
	Veterans’ Services
		Introduction
			History and Evolution of the VA
			Patient Demographics
		Clinical Services: Mental Health
			Clinical Services: Inpatient Psychiatric Care
			Clinical Services: Residential Rehabilitation and Treatment Programs
			Clinical Services: Ambulatory Care
			Clinical Services: Minority-Specific Programs
			Clinical Services: Post-traumatic Stress Disorder Programs
			Clinical Services: Military Sexual Trauma Treatment
			Clinical Services: Suicide Prevention Programs
			Clinical Services: Substance Use Treatment Programs
			Clinical Services: Social Determinants of Mental Health
		Medical Research
		Education
		Disaster Preparedness: “Fourth Mission”
		Conclusion
		References
	Child and Adolescent Psychiatric Services
		Introduction
		Primary Prevention
		Secondary Prevention
		Tertiary Prevention
			Providing Treatment
			Systems Serving Special Populations and Needs
			The Systems of Care Concept
		Empowerment Programs for Families
		Balancing the Many Roles of the Child and Adolescent Community Psychiatrist
		References
	Serving Elders in the Public Sector
		Basic Principles of Geriatric Psychiatry for Community Practitioners
		Meeting the Service Needs of Older Adults
		Community Resources and Care
		Description of Community Services
		Model Innovative Programs
		Technology and Community-Dwelling Older Adults
		Primary Prevention
		Guiding Principles of Psychogeriatric Care for the “Ideal” Individual Program and Service System
		Conclusions
		References
	Rural Populations
		Introduction
			Demographics
		Culture
		Economics
		Rural Mortality and the Psychiatric Service Response
			Opiate SUD
			Alcohol SUD
			Methamphetamine SUD
			Suicide
		Serious Mental Illness Considerations
		Child and Adolescent Population Considerations
		Models of Financing Rural Mental Health
			Medicaid Expansion Through the Affordable Care Act (ACA)
			Collaborative Care
			Grants
		Models of Care for Rural Mental Healthcare Delivery
			Telemedicine
			Certified Community Behavioral Health Center
			Outreach and Assertive Community Treatment Teams
		Mental Health Professional Workforce Development
			Rural Psychiatry Programs and Tracks in Psychiatry Residency
			University-Based Programs
				The University of Alabama School of Medicine, Tuscaloosa Campus, Behavioral Health Fellowship for Family Medicine
				University of California at Davis (UC-Davis) Integrated Program
				The University of New Mexico (UNM)
		Conclusion
		References
	Clinical Issues and Programming for Sexual and Gender Minority Populations
		Introduction
		Sexual and Gender Minorities
		SGM Prevalence
		Prevalence of Mental Disorders in the SGM Population
		Suicidality
		Intersectionality
		Education and Training
		LGBT Cultural Identity and Mental Illness
		Clinical Cultural Communication with SGM People
			SGM Identity Development
			Assessing Sexual Identity, Sexual Practices, and Marital and Familial Status
			General SGM Issues for the Community Psychiatrist
		Building Effective Programs for SGM Patients
			Practical Programming Suggestions
		Conclusion
		References
	Migrant and Refugee Mental Health
		Defining the Populations: Migrant, Asylum Seeker, Refugee, and Other Important Populations
			Hemispheric and Regional Migration: Central America’s Northern Triangle
		Sociocultural Factors Impacting the Mental Health of Immigrant Communities
			Immigration and Sociopolitical Factors
			Sociocultural Factors
		Mental Health Needs, Community Psychiatry, and Treatments That Work
			The Mental Health Needs of Migrants and Refugees
			Access to Care in Community Psychiatry
			High Rates of Trauma and Variable Clinical Presentations: The Need for Cultural Humility
			Culturally Tailored Treatments
		Practical Applications in Community Mental Health Care
			Addressing the Social Determinants of Health for Immigrants and Refugees
			Clinical Applications and Advocacy
			Optimizing Clinical Skills: Sociopolitical Countertransference and Vicarious Trauma
		Conclusion
		References
Part VIII: Development and Administration of Services
	Transforming Mental Health Systems and Programs
		Introduction
		A Framework for Leading Change: First, Identify Changes That Should Be Made That Can Be Made
			Engage Shareholders in Return for Their Support
			Engage Key Administrators and Decision-Makers in Advance of the Recommendations
		Managing the Change Process: Timing, Process, and Organization
			The Beginning or Opening Phase of a Change Process
			The Middle Game
			The End Game
		Group Process as a Vehicle and Metaphor of Change
		Implementation
		Contemporary Opportunities for Transformation
		Conclusion
		References
	Program Evaluation
		Introduction
		The CDC Framework for Program Evaluation
		Considerations
			Community Mental Health
			Cultural Competency
		Review of Purpose and Theory of Program Evaluation
		Common Types of Program Evaluation
			Implementation Evaluation and Program Fidelity
			Outcome-Based Evaluation
			Goal-Free Evaluation
		Data Sources
		Data Analysis
		Conclusion
		Additional Resources
		References
	Creating Value: Resource and Quality Management
		Introduction
		The Scope and Evolution of Resource Management
			Defining Value
		The Evolution of Value Management
		Medical Necessity Criteria
		Utilization Management
		Instruments for Management of Services and Resources
		The Design of LOCUS and CALOCUS
			Assessment Dimensions
			Levels of Care
			Placement Decisions
		Child and Adolescent Level of Care Utilization System (CALOCUS)
		Extended Applications
		Conclusion
		References
	Telehealth and Technology
		Advantages of Telehealth
		Achieving the Triple Aim: Three Telehealth Examples
		Telemedicine Technology and Environment
			Consulting Room Environment
		Legal and Ethical Considerations
			Licensure and Credentialing
			E-security, Privacy, and Confidentiality
			Informed Consent
			Prescribing Medications
			Emergencies
			Supervision and Quality Assurance
		Clinical Considerations
		Other Modalities of E-Mental Health
		Conclusion
		References
	The Medical Director in Community-Based Mental Healthcare
		Introduction
		The History of the Medical Director Role
		Current Requirements for a Medical Director as the Standard of Care
		The Medical Director Responsibilities and Subtypes
			Informal Authority in the Role of Medical Director
			Medical Director for Governmental Authorities
		The Medical Director Role in Managed Behavioral Healthcare
		Value-Based Care and the Future of the Medical Director Role
		References
	Financing of Community Behavioral Health Services
		Introduction
		Behavioral Healthcare Financing in the USA: A Complex Conundrum
		The Role of Psychiatrists in Community Settings
		How Mental Health and Addiction Treatment Services Are Funded
		Government Funding of Mental Health Services
			Federal Funding
				Medicare
				Veterans Administration (VA)
				Indian Health Service
				Federal Block Grants
				Insurance Exchanges
				Federal Safety Net Programs
			State Funding
				Medicaid
				The Children’s Health Insurance Program (CHIP)
				State General Funds
			Local Government Funding
		Private Health Insurance
		Insurance of Last Resort
		Behavioral Health Financing Today
			Foundational Concepts in Behavioral Health Financing
			Alternative Payment Models (APMs)
			APMs for Behavioral Health
		Next-Generation Healthcare Financing Models
		A Look at the Future of Behavioral Health Financing
		Conclusion
		References
	Workforce Development in Community Psychiatry
		Case Study, Part 1: Mountain Behavioral Health
		Systemic Barriers to Workforce Development in Community Psychiatry
			Supply and Demand Gap in Psychiatry
			Effects of Reimbursement Limitations
			Physician Burnout and the Quadruple Aim
			Health Inequity, Representation, and Implications for Workforce Development
		Case Study: Part 2
		Definitions and a Simple Strategic Framework
		Recruitment Approaches
			A Consistent Plan
			Position Review
			Internal and External Partnerships
			Utilizing an Equity Lens
			The Right Candidate Versus Any Candidate
			Role of Technology
			Scope of Practice and the Development of a Psychiatry Team: Partnership with Advanced Practice Professionals (APPs) in Workforce Development
			Recruitment-Retention Interrelationships
		Retention Factors
			Compensation
			Leadership
			Work-Life Balance
			Recognition and Appreciation
			Participation in Decision-Making
			Opportunity for Growth
			Training and Development
		Case Study: Part 3
		Calls to Action
		References
	Practical Ethics for Practicing Clinicians
		Introduction
		Not All Ethical Problems Are Difficult
			90% of Ethical Issues Are Simple
			8–9% of Ethical Issues Are Complex
			1–2% of Ethical Issues Are Unsolvable
		Preliminary Considerations
			Bias Check
			Work Smarter, Not Harder
		Case Study: When to Write a Letter
		Who Has Decision-Making Authority?
		An Ersatz Approach to Ethical Decision-Making
			First, Clarify the Question
			Second, Use Rules and Tools
				Legal Rules and Tools
				Professional Rules and Tools
				Policy Rules and Tools
		Case Study: Pharm for Thought
			When in Doubt, Use the Core Four
		Case Study: Peeking Behind the Curtains
		Advanced Planning and Mental Health Advanced Directives
		Case Study: Mental Health Advance Directives
		Ethical Outcomes Are Not Necessarily Clinically Optimal Outcomes
		Conclusion
		References
Part IX: Shaping the Future
	Medical Student and Resident Education in Community Psychiatry
		The Need for More Clinicians and Enhanced Education in Community Psychiatry
		Community Psychiatry in Medical Schools
		Folding Community Psychiatry Into the Psychiatry Residency Curriculum
			Community Psychiatry at Case Western Reserve University
				Structure and Operation of the CWRU Community Psychiatry Curriculum
					Patient Care
					Medical Knowledge
					Practice-Based Learning and Improvement
					Interpersonal and Communication Skills
					Professionalism
					Systems-Based Practice
		Future Directions in Medical Student/Resident Education in Community Psychiatry
		Conclusion
		References
	Public/Community Psychiatry Fellowships
		Introduction
		Phase 1: Early History of Public and Community Psychiatry Fellowships 1960s–1970s
		Phase 2: Columbia Public Psychiatry Fellowship 1980s–2000
		Phase 3: 2000–2010 Growth and Collaboration Between Fellowships
		The Core Elements of a Public Psychiatry Fellowship
		AACP Guidelines for Community Psychiatry Fellowships
			Other Elements of Fellowship Program Design
		Phase 4: 2011 to 2020 Continued Increase in Number and Diversification of Fellowships
			Models of Funding and Diversification of Fellowships
		Collaboration of Public/Community Psychiatry Fellowships
		Conclusion: A Growing Network of Public/Community Psychiatry Fellowships
		References
	Mentoring and Supervision in Community Psychiatry
		Introduction
		Mentoring
		A Base for Mentorship: Clinical Supervision of Residents
		The Active Ingredients of Successful Mentoring
			Availability
			Career Guidance
			Work and Life Balance
		Research Mentorship
		Benefits for Mentors
		Challenges to the Mentor-Mentee Relationship
		Conclusion
		References
	International Trends in Community Mental Health Services
		Introduction
		Oceania
			Australia
			New Zealand
		Britain and Ireland
			The UK
				Assertive Community Treatment
				Rehabilitation Research
				The Early Intervention in Psychosis (EIP) Program
				Crisis Intervention
			Ireland
			Italy
				A Short History of Law 180
				Trieste: An Exemplary Model Fully Implemented
		North America and the Caribbean
			Cuba
			Caribbean
			Mexico
			Canada
		Global Community Mental Health Practices of the Future
		Conclusion
		References
	Community Psychiatry: Past, Present, and Future
		Introduction
		Historical Factors: Past to Present
			Culture
			Costs of Care
			Demographics
			Politics
			Science
			Professional Identity
		A Vision for the Future of Community Mental Health and Psychiatry
			Clinical Care
			Systems of Care
			Prevention and Community Health
			Public Policy and Social Justice
		A Contemporary Perspective on the Environment of Community Psychiatry
			Weaknesses
			Threats
			Strengths
			Opportunities
		Realizing the Vision: Strategies for Progress
			First-Person Strategies
			Local Systems Strategies
			Larger System Strategies
		Closing the Book
		References
Index