Glossary

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A

Accreditation is a “seal of excellence” that a healthcare program has demonstrated quality, value, and optimal outcomes of services.

Advanced directives are documents written while a person is competent specifying how decisions about treatment should be made if the person becomes incompetent.1

Alternative therapies are treatments toward mental health through programs other than the traditional hospitalization and institutional care options for patients.  These programs include various community-implemented treatment programs and facilities.2

Assertive case management is an intensive form of case management intended to help patients to increase daily-task functioning, residential stability, and independence, and to reduce their hospitalizations.  Assertive case management substantially reduces inpatient service use, promotes continuity of outpatient care, and increases community tenure and residence stability for people with serious mental illness.3

Assertive Community Treatment (ACT), sometimes referred to as Program of Assertive Community Treatment (PACT), is a team-based approach to the provision of treatment, rehabilitation, and support services.  ACT/PACT models of treatment are built around a self-contained multidisciplinary team that serves as the fixed point of responsibility for all patient care for a fixed group of patients.  In this approach, normally used with clients with severe and persistent mental illness, the treatment team typically provides all patient services using a highly integrated approach to care.4

Assessment is a test or other way of measuring something, such as a person’s mental health, or goals, or needs; often the first test in a series of tests, or a test given before treatment starts.

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Behavioral health care is an encompassing term including assessment and treatment of mental and/or psychoactive substance abuse disorders.6

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Capitation is a dollar amount established to cover the cost of all health care services delivered per person during a specified period of time.  This term may refer to either the amount paid to a managed care organization by its private and public sector clients or a negotiated per capita rate to be paid periodically to a health care provider by a managed care organization.8

Carve-in refers to a model of delivering and financing healthcare services in which mental health and/or substance abuse services are provided under the same delivery system as physical healthcare.9

Carve-out refers to the practice of having a specific benefit, such as mental health or substance abuse, operated as a distinct program, separate from the general health program. 10

Case management is a range of services provided to assist and support patients in developing their skills to gain access to needed medical, behavioral health, housing, employment, social, educational, and other services essential to meeting basic human services; linkages and training for patient served in the use of basic community resources; and monitoring of overall service delivery.  This service is generally provided by staff whose primary function is case management.11

Center for Mental Health Services (CMHS) is part of the Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services. CMHS works with state and local mental health authorities, service providers, consumers and their families to improve and increase the quality and range of mental health treatment and support services.

Certification is a workforce assessment process that fosters the growth of a qualified, ethical, and culturally diverse workforce through test-based certification and/or a licensing program and the enforcement of a code of ethics.

Community mental health system is the system intended to provide public mental health services directly to those in need of assistance in the communities where they reside.  Development of the community mental health system can be traced to enactment of the Community Mental Health Centers Act of 1964.  Intended to provide a community-based alternative to institutional care for many people with mental illness, implementation of the community mental health system rested on expansion of outpatient services in the community, particularly in federally funded community mental health centers.  In many jurisdictions, the community mental health system has yet to meet the expectations of its designers or those who work within it, primarily because funding did not materialize to provide needed services.13

Concept mapping describes a method of grouping ideas or results based on how similar they are, and then showing the groups in picture form.

Consumer-operated programs are peer-to-peer services that are administratively controlled and operated by consumers and that emphasize self-help as their operational approach.

Continuum of care describes the entire service array including institutional and community mental health services, social supports groups, and volunteer services that can be customized to meet a consumer’s needs.

Control group describes the participants being studied who are not receiving the “intervention”/change that the participants in the “experimental” group are receiving.

Co-occurring disorder refers to two or more disorders occurring simultaneously.  Generally refers to mental health and substance abuse disorders but can refer to mental health, physical health, developmental, or other disorders.15

Copayment is a cost-sharing arrangement in which a consumer pays a specified charge for a specified service (e.g., $10 for an office visit).  The consumer is usually responsible for payment at the time the service is rendered.16

Crisis Intervention Team (CIT) is a police program developed in Memphis, Tennessee.  A CIT is comprised of designated officers who are called upon to respond to mental disturbance calls and crises, such as attempted suicides.  These officers participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups.  Officers trained under this program are skilled in de-escalating potentially volatile situations, gathering relevant history, and assessing medication information and the individual's social support system.  The CIT is recognized as a national program and has been replicated in communities such as Portland, Oregon; Albuquerque, New Mexico; Seattle, Washington; San Jose, California; and Waterloo, Iowa.17

Cross-training is the implementation of a training program to educate individuals from both the criminal justice and the mental health communities on the issues and concerns each confronts, cross-training attempts to build awareness in both communities to help develop a more coordinated approach to the needs of people with mental illness involved with the criminal justice system.18

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Data collection is the gathering of information through surveys, tests, interviews, experiments, library records, etc. 

Data is information compiled from study records, questionnaires, interviews, etc.

Data processing is the process of recording, storing, and analyzing information with a computer program.

Databases are groups of information recorded in a standardized method.

Decompensation is a temporary return to a lower level of psychological adaptation or functioning, often occurring when an individual is under considerable stress or has discontinued psychiatric medication against medical advice.20

Deductible is a specified amount of money a consumer must pay before insurance benefits begin. Usually expressed in terms of an annual amount.21

Developmental disability is a substantial handicap in mental or physical functioning, with onset before the age of 18 and of indefinite duration.  Examples are autism, cerebral palsy, uncontrolled epilepsy, certain other neuropathies, and mental retardation.22

Discharge plan is a written plan that provides an inmate with guidance to help him/her make a successful transition from institution to community.  Typically includes concrete plans in several areas such as housing, employment or education, transportation, continued counseling or social services, required supervision (i.e., probation/parole), and the like.23

Disproportionate Share Hospital (DSH) payments are payments made by a state’s Medicaid program to hospitals that the state designates as serving a “disproportionate share” of low income or uninsured patients.  These payments are in addition to the regular payments such hospitals receive for providing inpatient care to Medicaid beneficiaries.24 

Diversion is a dispositional practice is considered diversion if:  (1) it offers persons charged with criminal offenses alternatives to traditional criminal justice or juvenile justice proceedings; and (2) it permits participation by the accused only on a voluntary basis; and (3) it occurs no sooner than the filing of formal charges and no later than a final adjudication of guilt; and (4) it results in a dismissal of charges, or its equivalent, if the divertee successfully completes the diversion process.25

Diversion program is a treatment program that addresses the specific needs of a person with mental illness who has been "diverted" from the criminal justice system either before arrest or before trial.26

Drop-in center is a peer-run program model of peer services that are housed at a central location and focus on social skills development and support within an informal setting.

Drug formulary is a listing of medications that consumers may readily access through their health plans.  Non-formulary medications may not be accessible or may be accessible only if prior authorization is obtained.  Often, the medications on the formulary tend to be the cheapest, rather than the most effective.27

Dual eligibles is a term used to describe an individual who is eligible both for Medicare and for full Medicaid coverage, including nursing home services and prescription drugs as well as payments of Medicare premiums.  Some Medicare beneficiaries are eligible for Medicaid payments for some of all of the Medicare premiums, deductibles and co-insurance requirements, but not for Medicaid nursing home or prescription drug benefits.28

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Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) is one of the services that states are required to include in their basic packages for all Medicaid-eligible children under age 21.  EPSDT services include periodic screening to identify physical and mental conditions as well as vision, hearing and dental problems.  EPSDT services also include follow-up diagnostic and treatment services to correct conditions identified during a screening, without regard to whether the state Medicaid plans covers those services with respect to adult beneficiaries.29

Emergency Medical Treatment and Labor Act (EMTALA) is a statute which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when he is in an unstable medical condition.  EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), and it is sometimes referred to as "the COBRA law."30

Employee Retirement Income Security Act (ERISA) is a group of federal statutes enacted in 1974 that, among other things, prohibits states from regulating the employee welfare benefit plans, including health plans, of self-insured businesses. ERISA does, however, establish certain regulations related to reporting and disclosure, fiduciary standards, claims review and enforcement. It also provides limited protection against discrimination to ERISA health plan participants.31

Empowerment occurs when a person gains rights and authority in addition to feeling a sense of personal independence and competence.

Entitlements are benefits provided by the federal government for individuals with disabilities (disability is defined as "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months").  Entitlements available to people with mental illness include income support through the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs, and health coverage under Medicaid and Medicare.32

Evaluation is a face-to-face interview of the patient and a review of all reasonably available health care records and collateral information.  Evaluation includes a diagnostic formulation and, at minimum, an initial treatment plan.33

Evaluation research is a study to see whether a program or a project is achieving its goals.

Evidence-based practices are interventions for which there is consistent scientific evidence showing that they improve client outcomes.

Experimental group describes the participants who receive the intervention being studied.  This group is compared with the control group, in which participants are as much like the experimental group as possible, except that the control group participants do not receive the treatment.

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Face validity is the measure of whether a study’s results are understandable.

Fee-for-service is a traditional method of paying for medical services under which providers are paid for each office visit, treatment, procedure, or other service rendered.  See capitation.35

Feedback describes the comments, reviews, ratings, or other responses from the study participants or from the people who will receive/review the results of the study.

Fidelity measures are tools to assess the adequacy of implementation of program models. Specifically, fidelity measures quantify the degree to which the elements in a program model have been adequately implemented.

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Health Insurance Portability and Accountability Act (HIPAA) is legislation intended to provide portability of employer-sponsored insurance from one job to another in order to prevent what has become known as "job lock" or the inability to change jobs because of the fear of losing health insurance.  This act also makes it illegal to exclude people from coverage because of preexisting conditions and offers some tax deductions to self-employed people who pay their own health insurance premiums.  The act also directs the federal government to standardize billing codes and to develop privacy standards related to individually identifiable health care information.36

Health Maintenance Organization (HMO) is the most common form of managed care.  All health services are delivered and paid for through one organization, often under one roof. An HMO requires its participants to use only certain health providers and hospitals, usually those within its own network.

HUD Section 8 Housing and Community Voucher Program, now known as the Housing Choice Voucher program (HCV), is a tenant-based program which assists low-income families, older persons, and people with disabilities to rent decent, safe and sanitary housing in the community.37

HUD Section 8 Moderate Rehabilitation Single Room Occupancy (SRO) Program is a federal grant program authorized under the McKinney/Vento Homeless Assistance Act.  Through the Section 8 Mod Rehab SRO program, a Public Housing  Agency (PHA) makes rental assistance payments to landlords on behalf of a person who is homeless and rents the rehabilitated unit.38

HUD Section 232 Program insures mortgage loans which facilitate the construction and substantial rehabilitation, acquisition or refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities.39

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Illness self-management is a growing trend within the mental health field in which clients educate themselves to recognize symptoms of their illness as well as factors that exacerbate or ameliorate them.  By managing those factors and taking remedial steps when symptoms become acute, some find they are able to avoid more intrusive interventions by professionals.  Those consumers who are successful in managing their illness gain confidence in their ability to achieve recovery.40

Inpatient facility is any medical facility - usually a hospital - where patients stay for a period of time to receive treatment.  Most mental health systems differentiate between acute care (short-term) facilities and long-term care facilities.41

Individuals with Disabilities Education Act (IDEA) provides states with funding as well as mandates to provide a free and appropriate education and procedural safeguards for all children ages 3 through 21 with disabilities without regard to costs incurred by states and localities.

Institutions for Mental Disease (IMD) is a facility of more than 16 beds that is primarily engaged in providing treatment services for individuals diagnosed with mental illness. The Federal Medicaid program does not provide for payment of services for any individual who is age 21-64 who is a patient in an IMD (42 CFR 440.1008).

Instruments are ways to gather and measure information (e.g., surveys, tests, scales, or ratings).

Integrated services generally refer to providing an array of services through a single agency or entity.  Often requires discretionary or blended funding to cover the cost of multiple services.  A term most frequently used in the mental health field when referring to services for co-occurring mental illness and substance abuse disorders.42

Intermediate Care Facility for the Mentally Retarded (ICF/MR) is a public or private facility, the primary purpose of which is to provide health or rehabilitative services to individuals with mental retardation or related conditions (e.g., cerebral palsy).  State Medicaid programs may at their option cover services provided by ICFs/MR.43

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Managed care represents an approach to funding health care services.  Generally, managed care provides a specific level of funding to serve a population of people.  Managed care programs often restrict clients to seeing providers from an approved list and may limit available services.44

Managed Care Organization (MCO) is an entity that has entered into a risk contract with a state Medicaid agency to provide a specified package of benefits to Medicaid enrollees in exchange for a monthly capitation payment on behalf of each enrollee. 45

Management Information System (MIS) is a computer network for storing, accessing, and managing data in electronic form; also the database of that information.

Medicaid is a jointly funded, federal/state health insurance program for low-income and disabled people who meet needs-based eligibility requirements.  Nationally, it covers approximately 36 million individuals including children, the aged, the blind, and/or disabled and people who are eligible to receive federally assisted income maintenance payments.46

Medicaid Home and Community-Based (HCB) waivers allow states to provide a range of home and community-based services for people who would otherwise be in Medicaid covered institutions (children under the age of 22 or adults over the age of 64).

Medicaid Rehabitation Option is a model that allows for certain services that support recovery to be billed and reimbursed through the Centers for Medicaid and Medicare Services.

Medical necessity refers to the determination that a specific health care service is: medically appropriate; necessary to meet a consumer’s health needs; consistent with the diagnosis; the most cost-effective option; and consistent with clinical standards of care.47

Medicare is a federal health insurance program primarily for older Americans and people who retired early due to disability.48

Medicare Supplement Policy (Medigap) – is a policy that pays coinsurance, deductibles and copayments for Medicare recipients.  It also guarantees additional coverage for services up to a predefined benefit limit (the portion of the cost of services not covered by Medicare).49

Mental health client is a term used by mental health professionals referring to a person with whom they have a clinical relationship.

Mental health consumer is a term referring to a person who is receiving mental health services.

Mental health survivor is a term referring to a person who has survived the mental health system and/or mental illness.

Mental illness is a term that refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.50

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Outcomes measure is a tool that systematically evaluates the impact that services have on the health and mental health of consumers and their families. The measure typically focuses on functioning issues.52

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Parity laws are federal and state laws that remove limits imposed by insurance providers on access to mental health care that are more restrictive than limits imposed on access to physical health care.  Legislation requiring insurers to cover access to mental and physical health care under equivalent terms and conditions is referred to as parity legislation.54

Peer service is a generic reference to any service that is provided by a consumer.

Performance measure is an indicator to help determine the quality of services provided by the health plan, facility or clinician. Many are process measures, such as how many times a phone rings before it is picked up, rather than outcomes measures that deal with a consumer’s functioning.55

Practices are a collection of services designed to improve service recipient outcomes.

Projects for Assistance in Transition from Homelessness (PATH) is a formula grant program established in 1990 to address the multiple needs of people who are homeless and have a mental illness. 

Protection and Advocacy for Individuals with Mental Illness (PAIMI) is a formula grant program which supports Protection and Advocacy (P&A) systems designated by the Governor of each state, the District of Columbia, territories and the American Indian Consortium to protect and advocate for the rights of persons with disabilities.56

Protocol describes the correct way a study should be implemented or how it was implemented.  This term can also refer to the test or other measurement used.

Psychosocial rehabilitation is professional mental health services that bring together approaches from the rehabilitation and the mental health fields.  These services combine pharmacological treatment, skills training, and psychological and social support to clients and families in order to improve their lives and functional capacities.57

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Quality assurance is a formal methodology designed to assess the quality of services provided. Quality assurance includes formal review of care, problem identification, corrective actions to remedy any deficiencies and evaluation of actions taken.60

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Recovery is a value that reinforces the concept of mental illness as a temporary condition.

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Self-help refers to a movement within the mental health field in which clients develop and provide mental health services to other clients to promote recovery.62

Serious Mental Illness(SMI) is a term defined by federal regulations that generally applies to mental disorders that interfere with some area of social functioning. This term is used to describe adults over the age of 18.63

Serious Emotional Disturbance (SED) is a term used in various federal statutes in reference to children under the age of 18 with a diagnosable mental health problem that severely disrupts their ability to function socially, academically, and emotionally.64

Services research describes studies of places or groups, like a mental health center, that offer services to people. The research usually focuses on effectives of services.

Severe and Persistent Mental Illness (SPMI) is a term that incorporates the concepts of chronicity or recurrence with the definition above, often used to describe clients with a high level of need.65

Severe Mental Illness (SMI) is a term that applies to more seriously affected individuals.  This category includes schizophrenia, bipolar disorder, other severe forms of depression, panic disorder, and obsessive-compulsive disorder.66

Social Security Disability Income (SSDI) is for individuals who worked and are "insured" by the Social Security taxes (F.I.C.A.) that are withheld from their earnings to replace part of a person's earnings upon retirement, disability, or for survivors when a worker dies.  If insured workers (and, in some cases, their dependents or survivors) become disabled, they may become eligible for SSDI benefits.  The amount received is dependent upon how many years an individual has worked and the individual must apply to determine if (s)he is eligible for benefits.67  See also entitlements.

Supplemental Security Income (SSI) is a federal income supplement program funded by general tax revenues. It provides cash to meet basic needs for food, clothing, and shelter for older persons and persons with disabilities who have little or no income.70

Substance Abuse and Mental Health Services Administration (SAMHSA) is an organization of the federal government, within the U.S. Department of Health and Human Services, which focuses on substance abuse (issues related to drug or alcohol dependence) and on mental health.

Suicidality is a term that encompasses suicidal thoughts, ideation, plans, suicide attempts, and completed suicide.71

Support services are rehabilitative services that are not strictly medical but are nonetheless considered to be necessary to the recovery process for many clients.  Such services are designed to develop and/or restore a patient's functional capacities and may include support to enable clients to maintain independent housing, education, employment, or other activities associated with community integration.72

Supported employment is an evidence-based service that matches and trains persons with severe developmental, mental, or physical disabilities to jobs where their specific skills and abilities make them valuable assets to employers.73

Supportive housing is a system of professional and/or peer supports that allows a person with mental illness to live independently in the community. Such supports may include regular staff contact and assistance as needed with household chores, as well as the availability of crisis services or other services designed to prevent relapse, such as mental health, substance abuse, and employment.  Also known as supported housing.74

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Technical Assistance (TA) is a term to describe manuals, instructions, consultations, etc. that give information or support for learning a technical task or method.

Telemedicine/telepsychiatry are provisions of health care or psychiatry via telecommunications, typically utilizing medical computer sciences.  A qualified mental health professional is able to interview and examine the detainee through the use of closed-circuit television or telephone.75

Temporary Assistance for Needy Families (TANF) provides assistance and work opportunities to needy families, including persons with mental illnesses by granting states the federal funds and wide flexibility to develop and implement their own welfare programs.

Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) is a voluntary program which provides improved access to employment training and placement services for people with disabilities who want to work.  TWWIIA is administered by the Social Security Administration (SSA).

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Vocational Rehabilitation (VR) is a term that covers a wide range of services designed to assist individuals with disabilities in regaining skills needed to function in the workplace.  It is generally delivered under the auspices of a state department of vocational rehabilitation and supported by state and federal appropriations.  Eligibility for VR programs is established under the federal Rehabilitation Act.  Programs offered by state VR agencies may include supported employment, Ticket to Work, Pathways to Independence, and work-readiness programs.77

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Waviers are various authorities under which the Secretary of the Department of Health and Human Services (HHS) may, upon the request of a state, allow the state to receive federal Medicaid matching funds for its expenditures even though it is no longer in compliance with certain requirements or limitations of federal Medicaid statute.78