Learning Objectives
By the end of this section, you will be able to:
- Understand the goals of community-based programs
- Understand the goals of programs in treatment settings
- Evaluate the appropriateness of using a community program or a program within a treatment setting
Treatment setting and community-based programs offer different types of benefits for individuals with mental health concerns. Treatment setting programs can be beneficial for clients who need closer monitoring or treatments, while community services allow clients to retain more independence. The goal in mental health treatment is always to offer the most beneficial, least restrictive possible treatment while prioritizing the client’s safety. Whether community or treatment setting, a projected outcome of care for all community-based programs is for clients to maintain that important social bond with others that is so important to good mental health.
Community Services: Community Programs
Community services programs include support groups, home visiting services, and school-based programs. Diagnosis and age of the client can determine which program or programs are right for the client and their family. See 5.3 Community Support Systems for an in-depth discussion of community-based support groups.
Home Visiting Services
A nursing-related home visiting service represents a valuable approach to providing mental health care that is personalized, convenient, and tailored to the client’s needs within the comfort of their own home environment. Home visiting nurses offer a range of specialized services to individuals with mental health concerns, promoting early intervention, treatment adherence, and overall well-being.
Home visiting nurses play a vital role in assessing clients’ mental health status, identifying potential risks, and developing personalized care plans. They collaborate with other health-care professionals to ensure a holistic approach, addressing both the physical and emotional aspects of client care needs. These nurses provide education on coping strategies, medication management, and lifestyle modifications that can positively impact mental health. Importantly, home visiting services offer a level of convenience that traditional clinical settings may not, facilitating consistent engagement and reducing barriers that might stop clients from seeking care.
By providing care in a safe and familiar environment, nurses establish a foundation of trust that can lead to more open and honest discussions about mental health concerns. This approach is particularly valuable for vulnerable populations, such as older adults, new parents, and individuals with chronic illnesses, who may be at greater risk for mental health challenges.
Home visiting nurses also offer vital support for family members and caregivers, providing education and guidance on how to effectively assist and support individuals with mental health conditions. This collaborative approach fosters a comprehensive support network that extends beyond the individual, enhancing their overall quality of life.
Home visiting services can be particularly helpful in identifying and assisting with behavioral health issues in young children (Child Welfare Information Gateway, 2021). Home visiting programs focus on building social and emotional competence in young children and their parents. These programs typically provide early intervention services in family homes and prevention efforts to improve overall mental health outcomes for children and their families.
School-Based Programs
Youth and adolescents receive much of their mental health support in schools. Studies have shown that the availability of comprehensive school mental health programs has a positive effect on students’ academic success as well as their social skills, leadership, and self-awareness. By helping to create a favorable learning environment that enables students to be successful in school and in the community, schools with collaborative, community-based partnerships also demonstrate improved attendance and graduation rates (Youth.gov, n.d.-a). Depending on the school, resources can include early interventions, counseling, nursing, educational workshops for students, teacher education, and referrals to outside professionals.
Some students may need an individualized education program (IEP) to support their learning. IEPs are created by a multidisciplinary team for any public school student aged three to twenty-one with a qualifying disability, including emotional or behavioral disorders or developmental delays. The team includes the student’s parent or legal guardian, general and special education teachers, a school system representative, and often other specialists, such as social workers, nurses, physicians, or others. IEPs are tailored to the individual students’ needs and are designed to provide them with the appropriate resources to obtain a free public education. The plan is evaluated and updated regularly and the student usually joins the IEP team at age fourteen to give their own input. Services provided for a student with an IEP include specially designed or modified instruction, supplementary aids and services, parental or professional involvement, or classroom accommodations.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Client-Centered Care
Definition: The nurse will recognize the importance of treating clients as partners in their health-care journey, promoting their autonomy, and ensuring their values and needs are at the center of decision-making.
Knowledge: The nurse will be able to utilize evidence-based screening tools to identify adolescents at risk for suicide. The nurse will understand the epidemiology, risk, and protective factors associated with suicide in the adolescent population.
Skill: The nurse will administer a validated suicide screening tool in the school setting to identify adolescents at risk for suicide. The nurse will establish rapport and trust with the adolescents to engage and participate in the screening. The nurse will collaborate with team members to conduct appropriate assessment and interventions for adolescents who screen at risk.
Attitude: The nurse will demonstrate empathy and compassion for adolescents who may be at risk for suicide. The nurse will provide for privacy and maintain confidentiality at all times, respect diversity and support cultural differences in a professional manner, and focus on the adolescent and incorporate them in the decision-making.
(QSEN Institute, n.d.)
Community Services: Treatment Setting Programs
Treatment setting programs in mental health care refer to stays in acute hospital or residential settings where clients receive intensive mental health treatment and support within their community. These programs are designed to provide a safe and supportive environment for individuals experiencing acute mental health symptoms or crises while allowing them to benefit from remaining in their own community. See Therapeutic Settings for additional details.
Identifying the Appropriate Services
There are several factors to consider when determining if community or treatment setting mental health care is more appropriate for a client. Safety is the key determining factor, as is using the least restrictive setting to maintain the client’s safety. Clients at risk for self-harm or harm to others would likely be admitted to a hospital treatment setting until stabilized.
As always, the first step is a thorough assessment that will help identify the client’s current mood, symptoms, and level of functioning, as well as their goals and preferences for care. Nurses should try to familiarize themselves with the various mental health resources available in the client’s community, and encourage the client to research options as well. Consider reaching out to case management, or contact the public health services in the client’s community for assistance in locating information on crisis lines, support groups, treatment settings, private therapy, and more. Information should also be available online, or at the local public library.
When developing the plan of care for the client and determining the appropriate services, it is always important to collaborate with the client on their own preferences and advocate for them to receive timely, appropriate care. The focus should be client-family centered and include the interprofessional team to provide the most realistic, attainable, and appropriate treatment plan.