TRAINING MANUAL FOR

CASE MANAGEMENT
CERTIFICATION

UTAH DEPARTMENT OF HUMAN

SERVICES DIVISION OF SUBSTANCE
ABUSE & MENTAL HEALTH

FOURTH EDITION

UPDATED & APPROVED

June 2019
 TABLE OF CONTENTS

I. INTRODUCTION ......................................................................................................1
Why A Case Management Training Manual? .......................................................................1
What is Case Management? ...................................................................................................1
Qualified Providers of Case Management Services...............................................................2
Case Management Training Curriculum ................................................................................2

II. WHO IS ELIGIBLE FOR CASE MANAGEMENT SERVICES ......................3

Impact of Mental Illness and Substance Use Disorder ..........................................................3

III. THE CASE MANAGEMENT PROCESS ..................................................................4

Critical Functions ...................................................................................................................4
The Professional Relationship ...............................................................................................6
The Needs Assessment ..........................................................................................................9
Conducting a Needs Assessment ...........................................................................................9
The Assessment Discussion ...................................................................................................10
The Service Plan ....................................................................................................................12
Implementing the Service Plan ..............................................................................................13
Monitoring the Service Plan ..................................................................................................14
Public Entitlement Programs .................................................................................................17
Federally Administered Entitlement Programs ......................................................................17
State of Utah Entitlement Programs through the Department of Workforce Services ..........18

IV. Description of the Levels of Case Management and Caseload Size ....................19
Description of the Three Levels of Case Management ..........................................................20

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V. OTHER CHALLENGES .........................................................................................24
Crisis Intervention .................................................................................................................24
Problem Behaviors That May Precipitate a Crisis ................................................................24
Illegal Behaviors ...................................................................................................................24
Alcohol and Street Drug Use ................................................................................................24
Threatening, Violent, or Homicidal Behavior ......................................................................25
Suicidal Thoughts and Behaviors .........................................................................................25

VI. TAKING CARE OF YOURSELF .........................................................................26

Time Management ................................................................................................................26
Stress Management ...............................................................................................................27
Recognize the stages of burnout. ...........................................................................................27

VII. GLOSSARY............................................................................................................28

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 ACKNOWLEDGEMENTS

These Guidelines have been developed by: The Utah Preferred Practice Consensus Panel under
the auspices of the Utah Department of Human Services/Division of Substance Abuse and
Mental Health (DHS/DSAMH), the Utah Behavioral Health Care Committee, the State
Homeless Coordinating Committee and the Utah Department of Workforce Services/Housing
and Community Development Division (DWS/HCDD)

Initial Adoption December 1998

Revised December 2003
2nd Revision January 2012
3rd Revision September 2017
4th Revision June 2019

iv.
I. INTRODUCTION

Why a Case Management Training Manual?

This guidebook was written to help prepare you for one of the most important jobs in community
behavioral health and homeless services. This training manual will be a study guide as you
prepare to take the formal examination required by the Division of Substance Abuse and Mental
Health to become certified as a provider of case management services. It will also be a resource
manual for you during your training and throughout your career.
This training manual is a companion in your work. Like any new textbook or course of study,
this field guide should be considered one of your resources. Providers of case management
(hereafter referred to as CM) must also be familiar with the Utah Medicaid’s Targeted Case
Management Provider Manual(s) and understand how targeted case management services differ
from other behavioral health and homeless services such as psychosocial rehabilitative services
and personal services.

What is Case Management?

In Utah, the Local Mental Health Authorities are responsible to provide or contract for case
management in their local areas as defined by the State of Utah Administrative Code. Homeless
service providers are responsible to provide Case Management services to eligible individuals
that present at their agency. CMs should be familiar with the State of Utah’s Division of
Substance Abuse and Mental Health Program Standards, R523-7-4 and the State of Utah’s scope
of Medicaid-covered mental health services outlined in the Utah Medicaid Provider Manual for
Mental Health Centers/Prepaid Mental Health Plans, and the Utah Medicaid Provider Manual for
Targeted Case Management for Individuals with Serious Mental Illness.
Case management services help individuals access needed medical healthcare, behavioral
healthcare, basic needs, housing, educational, social, and other services. CMs assess individual
needs and develop a service plan designed to help the individual obtain access to a coordinated
array of services and to facilitate the achievement of goals. Providers of case management
services provide the energy and organization to see that the case management service plan results
in real benefits to individuals. Case management services can be provided by one person or a
team of providers. The overall goal of case management services is to help individuals to access
needed services, and ensure that services are coordinated among all agencies and providers. Case
management is usually done in the community as opposed to an office setting. The frequency of
contact may be more intensive or less intensive based on the individual’s needs.
Individuals that experience homelessness are also eligible for case management services. In this
document when referring to the person receiving case management services, the term “individual
experiencing homelessness”, is defined as: literally homeless persons, those at risk of

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homelessness and formerly homeless persons who are housed through homeless programs.
Individuals receiving behavioral health and homeless services have the ability to live as
productively as possible and to receive the treatment they need with a minimum of interference
and a maximum of support. A well-conceived recovery/treatment plan, case management needs
assessment, and service plan will match the individual’s strengths and needs to specific
community resources. For many individuals in Utah, access to behavioral health and homeless
case management services can make the difference between isolation and productive community
connections.

Qualified Providers of Case Management Services

Qualified Providers of case management services are:
• Licensed behavioral health professional practicing within the scope of their license in
accordance with Title 58 of the Utah Code and the Utah Medicaid Provider Manual.
• A non-licensed individual who does not meet the qualifications above under the
supervision of a licensed mental health therapist identified in #1. A CM that fits this
definition is eligible to bill Medicaid for Targeted Case Management Services.
• A non-licensed individual who will not bill Medicaid for their case management services
and does not meet the qualifications above under the supervision of a person who meets
one of the following:
o a Bachelor’s Degree in human services or a related field and two years of
experience in human services;
o an Associate’s Degree in human services or a related field and three years of
experience in human services; or
o five years of experience in human services.
Supervision of case management providers must be delivered in accordance with the
requirements set forth in Title 58 of the Utah Code, and the applicable profession’s practice act
rule as set forth by the Utah Code.

Case Management Training Curriculum

To meet the State Division of Substance Abuse and Mental Health’s (DSAMH) training
standards, all non-licensed individuals will be required to:
• Successfully pass a written examination which tests basic knowledge, attitudes, ethics,
and case management skills;
• Successfully complete a case management practicum; and
• Successfully complete all requirements outlined in R523-7-4.

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II. WHO IS ELIGIBLE TO RECEIVE CASE MANAGEMENT SERVICES?

Any individual with a behavioral health disorder and/or experiencing homelessness may be
eligible for case management services. Targeted case management services are contracted
through a Local Authority and provided when there is a Serious Mental Illness (SMI), Severe
Emotional Disturbance (SED), and/or a Substance Use Disorder (SUD) present.
Targeted case management services must be medically necessary and are eligible for Medicaid
billing. Targeted case management services are considered medically necessary when a targeted
case management needs assessment documents that the individual requires treatment and there is
a reasonable indication that the individuals will only access the needed treatment if assisted by a
qualified CM. Treatment services may come from a variety of agencies and providers to meet the
documented medical, social, educational and other needs identified in the case management
needs assessment.
Individuals experiencing homelessness who have a mental illness, substance use, and/or a
possible co-occurring disorder do not require a diagnosis to receive case management services.
Case management services for people experiencing homelessness are provided in the community
and at local homeless resource centers/shelters. The preferred practice guidelines for homeless
service providers can be found on the Department of Workforce Services website at:
jobs.utah.gov
Whether or not a CM provides services to people experiencing homelessness, CMs should be
familiar with and trained on the Service Prioritization Decision Assistance Tool (SPDAT). The
SPDAT tool helps determine the acuity of individuals experiencing homelessness. Homeless
service providing communities statewide use the SPDAT to help identify the needs of an
individual, determine eligibility for specific programs, and prioritize available housing units.
OrgCode, the agency that developed the SPDAT tool, briefly describes it as, “The SPDAT helps
identify who should be recommended for each housing and support intervention, moving the
discussion from simply who is eligible for a service intervention to who is eligible and in greatest
need of that intervention. While the SPDAT is an assessment tool, the VI-SPDAT is a survey
that anyone could complete to help prioritize clients.” For more information on the SPDAT tools,
please go to www.orgcode.com

Impact of Mental Illness and Substance Use Disorders

Individuals are generally referred for case management services because mental illness,
substance use disorders, and/or homelessness has caused significant disruptive episodes in their
life. Their symptoms may have led to one or more hospitalizations, incarceration, homelessness,
or may have affected their ability to manage aspects of their life independently. They may
require ongoing treatment with psychotropic medications and or substance use medications.

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This is referred to as medication assisted treatment (MAT) or Opioid Maintenance Therapy
(OMT).
One important function of case management services is providing sufficient monitoring and
support of a person’s recovery. Through careful monitoring the CM can help the individual
access appropriate treatment and services as early as possible and hopefully prevent the episode
from becoming so severe that a higher level of care such as residential treatment or
hospitalization is needed. It is important that the CM be able to recognize symptoms and report
the symptoms to their supervisor and/or the individual’s clinician/service provider. However, it
is important to remember that CMs do not diagnose.
It is also important to remember that individuals with behavioral health disorders are not
symptomatic all the time. If not entirely symptom free, they may have fewer symptoms or be
able to manage them in such a way that it does not cause personal distress or a significant
disruption in their daily life. Consequently, they may be able to access needed services more
independently. The intensity, frequency and duration of targeted case management services may
vary as a result.
Providers of case management services are often in a unique position to assist the individual with
recognizing early signs that show the individual is showing an increase in symptoms. Therefore,
it is important to have some awareness of and knowledge about the various types of behavioral
health disorders and systems. For specific questions, it is important to always consult with your
supervisor and/or the individual’s clinician/service providers.

III. THE CASE MANAGEMENT PROCESS

Critical Functions
Case management can be thought of as filling eight critical functions. These functions are
summarized below.
1. Building Rapport
• An integral part of all case management activities is building rapport with the individuals
you serve. This can be done by:
o Developing a supportive relationship with the individuals;
o Maintaining regular contact with individuals, depending upon individual needs
and wherever they reside, i.e., hospital, jail, independent apartment, etc; and
o Providing case management services to individuals on a continuous basis for as
long as medically or clinically necessary.
2. Assessing and Developing a Formal Case Management Needs Assessment
• This is done by assessing the need for any medical (including behavioral health and
homeless), educational, social, or other services.
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 • Assessment activities include:
o Taking individual history;
o Identifying the needs with the individual (Needs Assessment);
o Identifying individual strengths and preferences; and
o Gathering information from other sources such as family members, medical
providers, behavioral health and homeless professionals, other providers, and
educators, as available.
3. Planning and Development of a Formal Service Plan
• This is typically done by developing a written, individualized, case management service
plan with the individual, based on the information collected through the needs
assessment.
• Setting specific goals related to filling those needs through available resources.
4. Coordination
• Coordination is essential to positive outcomes. In most settings, the CM is responsible to
coordinate multiple services and help streamline access to services.
• The CM should be knowledgeable about the individual’s medical providers, medical
needs, and other community supports. These resources could be public and private
treatment providers, advocacy and self-help groups, low-income housing, employment
and training programs, financial benefits and other services.
5. Linking/Assisting Individuals to Access Needed Services
• This involves linking the individuals or family members to:
o Needed health care services as well as regularly scheduled physical examinations
o Behavioral health and homeless social services programs
o Appropriate treatment programs within community
o Educational programs, employment training and/or work opportunities
o All benefits for which they are eligible
o The National Alliance on Mental Illness (NAMI) Utah Chapter, Utah Support
Advocates for Recovery Awareness (USARA), Latino Behavioral Health Services
(LBHS), Al-Anon, local affiliates and/or family support groups
• Assisting individuals to:
o Develop a range of social and natural supports in the community, i.e.,
community support groups, family, connect with peers and other supports
o Obtain a satisfactory living situation, including basic living needs
o Obtain referrals and related activities, including scheduling appointments
6. Monitoring
• Monitoring and follow-up activities, including activities and contacts that are necessary
to ensure the case management service plan is effectively implemented and adequately

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 addresses the needs of the individual (i.e. drug testing results, medication management,
etc.)
• Monitoring the individual’s progress and continued need for services
7. Documenting
• It is extremely important the provider accurately and carefully documents the services
provided to an individual. Providers of targeted case management services must follow
the documentation requirements outlined in the Utah Medicaid Provider Manual.
• The targeted case manager (TCM) must also follow the rules in Utah Medicaid Provider
Manual for determining the amount of time spent in a day providing targeted case
management to an individual. The TCM provider is responsible to ensure amounts of
time billed to Medicaid are accurate and fully documented in accordance with Medicaid
requirements.
8. Advocating
• Providers of case management services should intercede with and on behalf of the person
to ensure access to timely and appropriate services.

The Professional Relationship

A primary factor in providing case management services is the development and maintenance of
a professional working relationship. A good case management relationship is based upon trust,
mutual respect, and a willingness to work together to attain agreed-upon objectives. The CM
does not attempt to change or judge the individual’s beliefs, values or emotions, but works with
the individual to access needed services. The CM can help the individual increase skills, gain
improved attitudes, and expand the individual’s horizons. CMs attempt to bring about solutions
to barriers that individuals experience including discrimination or actions that impose on their
civil rights. The CM develops a network of community supports for advocacy. Community
supports or natural supports are resourceful, caring, and responsible individuals who are
committed to the growth and development of the individual. Often these natural supports are
family members, friends, neighbors, and community agency personnel. A strong partnership,
when it is conscientiously pursued, can assist individuals to succeed in their recovery. The case
management relationship, like any other, thrives on consistency, openness, honesty and the
careful building of trust.
Familiarity with Trauma Informed Care (TIC) can help with developing a strong partnership.
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) six key
principles of a Trauma Informed Approach are as follows:
• Safety
• Trustworthiness and Transparency
• Peer support
• Collaboration and mutuality

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 • Empowerment, voice and choice
• Cultural, Historical, and Gender Issues
TIC creates a safe and proactive environment for an individual to grow and recover.
A variety of factors can make development of the professional relationship especially difficult.
Sometimes individuals find it difficult to develop this kind of relationship due to the nature of
their situation and history of difficulty accessing agencies and institutions. Other obstacles may
include housing issues, lack of transportation, and communication problems that prevent
anything other than occasional or irregular contacts.
Individuals experiencing symptoms of their mental health or substance use disorder may have
trouble separating what is real from what is not real as a result of delusions or hallucinations.
These factors can mean that the individual may not accurately interpret their environment and
may not know the socially appropriate behaviors that go along with the situation. The CM,
parents, and friends can confirm what is real. Individuals may need assistance to understand
accurate information about their world. This is especially true for individuals who may hear
"voices" competing for attention with real voices and perceptions from the outside world. The
CM should consistently provide clear and accurate communications to the individual about what
is going on in the environment.
Another important aspect of consistency and reality testing in the case management relationship
is that of setting limits and boundaries. It is important that these limits and boundaries be
established between the individual and the CM. Some limits originate with the agency’s policy
and Code of Conduct, Ethical guidelines, and the Department of Human Services Provider Code
of Conduct and Division of Occupational and Professional Licensing. These should be studied
and understood by each provider. Supervisors and other staff members should be sought out by
the provider for appropriate supervision and consultation in establishing and setting appropriate
boundaries. See the Utah Department of Human Services Provider Code of Conduct
https://rules.utah.gov/publicat/code/r495/r495-876.htm.
If CMs should have any reason to believe that any vulnerable adult has been the subject of abuse,
neglect, or exploitation they shall immediately notify the nearest peace officer, law enforcement
agency, or Adult Protective Services intake worker within the Department of Human Services,
Division of Aging and Adult Services. In order to address these situations appropriately, CMs
should be familiar with the Utah Code 76-5-111.1.
The case management approach to helping people is anchored in the following values:
• The work of case management focuses on individual strengths and needs using Trauma
Informed principles.
• The work of case management is based upon the principle of individual self-
determination
• Outreach to the individual is the preferred method of case management
• The community is the primary resource for attaining the goals of the individual

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One of the strengths of a CM is the ability to see individuals as people, not "cases". A CM
values the individual’s skills, abilities, hopes and dreams, and recognizes they may have barriers
that prevent them from reaching some of their goals. The CM's job is to help them overcome and
adjust to those barriers so that they can meet their goals and live as independently as possible.
When the focus is on abilities rather than disabilities, then the individual is strengthened. The
CM must be aware of the danger of confusing their goals with those of the individual. If this
happens, the CM and the individual will likely become frustrated and disappointed. Providers of
case management services do not impose their values and do not restrict the individual’s right to
self-determination.
An important concept in the field of behavioral health and serving individuals experiencing
homelessness is the idea that people can recover. Guiding principles of recovery include hope,
empowerment, meaningful roles in life, and personal responsibility. The individual is able to
maintain or regain social roles and activities within their community. It is essential that
providers of case management services have an understanding and support these principles of
recovery. Recovery often depends on the individual finding someone who believes in them.
CMs can be an important part of an individual’s recovery capital. SAMHSA explains recovery
capital as, “internal and external resources (at personal, family and community levels) that can be
mobilized to initiate and sustain long-term recovery.” When a CM is able to take that type of
supportive and encouraging role with an individual, it is empowering and can be instrumental in
that individual’s success.
Key Concepts in Recovery
• Hope – Individuals need to feel they can recover.
• Personal Responsibility – Individuals need to feel they can control their own lives and
take responsibility for their own care.
• Education – Individuals need information about their illness and treatment options.
• Self-Advocacy – Individuals need support from others, including: family, peers,
professionals, and the community.
Recovery is defined by SAMHSA as, “A process of change through which individuals work to
improve their own health and wellness, live a self-directed life, and strive to achieve their full
potential.”
Through the Recovery Support Strategic Initiative, SAMHSA has identified four major
dimensions that are essential to a life in recovery:
• Health: overcoming or managing one’s disease(s) as well as living in a physically and
emotionally healthy way;
• Home: a stable and safe place to live;
• Purpose: meaningful daily activities, such as a job, school, volunteerism, family
caretaking, or creative endeavors, and the independence, income and resources to
participate in society; and

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 • Community: relationships and social networks that provide support, friendship, love, and
hope

The Needs Assessment

The CM should assess the individual to determine service needs, such as medical, educational,
social, or other services. Activities include: taking the individual's history, identifying the needs
of the individual and completing related documentation, gathering information from other
sources such as family members, medical providers, social workers, other providers and
educators, to develop a case management needs assessment.
The Daily Living Assessment (DLA-20) is perhaps the most commonly used needs assessment at
Utah’s Local Mental Health Authorities. Service plans such as the DLA-20 allow CMs to use
hard data examine an individual's progress or lack of progress and to partner with the individual
towards recovery. Other examples of service plans include: the SPDAT, VI-SPDAT, American
Society of Addiction Medicine (ASAM) Assessment, among others.
The needs assessment documents whether an individual needs assistance in obtaining services
from a variety of agencies and providers to meet their documented needs. Once this needs
assessment is completed, the CM develops a service plan that outlines short and long-term goals
and the objectives that must be taken to achieve those goals.

Conducting a Needs Assessment

There are several areas the CM should assess and document in the Case Management Needs
Assessment (CMNA). Formal Needs Assessment tools are available, such as the Daily Living
Activities-20 (DLA-20), to ensure that the assessment is systematic and thorough. Individuals are
active participants in the CMNA. The CMNA should take into account the behavioral health
and/or homeless services being provided through the individual’s Recovery/Treatment plan
completed by the licensed behavioral health and/or homeless professional. The CMNA identifies
assets, strengths, and capacities of individuals to help them maintain a sense of identity, dignity
and self-esteem. The assessment procedure should be natural and flexible. Some important
principles that apply to all assessment areas are:
• Start with active listening and allow individuals to express their needs and desires.
• A relationship is built on mutual respect and having open and honest conversations.
• Focus on strengths.
• Select a comfortable environment for the needs assessment.
• All of the needs areas should be addressed and prioritized, as per the individual’s ability
to participate.
• Ask open-ended questions.
• Involve family members and other significant social resources and natural supports in the
assessment and case management process, with the individual’s signed authorization.

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Introduction, Exploration, and Engagement: In this initial phase, the CM will introduce
themselves to the individual. They will explain the case management process and the goals of
this service. The CM will begin to assess the individual’s current ability to independently access
needed services and whether they want case management services. It should be kept in mind that
willingness to participate in case management services is closely associated with individual
choice. Individuals may be temporarily satisfied with their lives and circumstances, not desiring
to begin work on more progressive goals and objectives. Engagement must be cautiously
evaluated by the CM and must not be used as an "excuse" for under-serving.
The individual is the expert about their own unique strengths, interests, and aspirations.
Providers of case management services can positively influence engagement by fostering hope
and belief in the individual receiving services. The Needs Assessment should recognize
individual’s natural supports. This principle allows the individual to share in the recovery
process to the greatest extent possible.
Active listening, reflection and verbal support are critical to the acceptance and empowerment of
the individual. In this process the CM may respond to the information presented by the
individual by restating what they have heard the individual say. The CM should encourage
individuals to explore their situation to identify their own personal strengths. For example, “You
said you'd like to live in an apartment; tell me what kinds of things you can do to live on your
own."

The Assessment Discussion

The CM responds to the individual by moving in whatever sequence is natural throughout the
discussion. It could begin with living arrangements and then move to finances. There is no
prescribed sequence in gathering the information. The responses of the individual are used to
determine their level of need in the Needs Assessment. It is important to collect and record
details regarding individual responses.
An assessment of the individual’s situation and circumstances may include but is not limited to:
• Wellness (Medical, psychiatric, substance use)
• Housing/homelessness
• Vocational/educational and productivity
• Family/social support
• Benefits/financial resources
• Leisure/recreational activities
• Legal
• Communication
• Safety
• Time management
• Problem solving
• Tobacco use

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 • Community resources
• Coping skills (safe and unsafe)
• Instrumental activities of daily living (preparing meals, managing money, shopping,
housework, laundry and using a phone)
• Activities of daily living skills (eating, bathing, dressing, toileting, and transferring)
A case management needs assessment of each area is based upon:
• Social history
• Individual’s current circumstances
• Stated personal goals
• Internal and external resources
• Priority of needs
• Information from others including family, friends, service providers with individual
release of information
The following may help guide the needs assessment process when meeting with the individual:
• Asking what kinds of experiences the individual has had in receiving community and
other services up to this time;
• Asking what services are most important now for the individual;
• Reviewing the behavioral health and/or Recovery/Treatment plan
• Asking what resources could help the individual make the desired changes;
• Asking what strengthens or experiences the individual can use to meet the desired goals;
• Asking what steps the individual needs to take to make the changes
• The needs assessment is an ongoing working document and is to be updated when the
individual’s status is altered, goals change, or new services and resources are needed.
Since a needs assessment is ongoing, the CM may stop the needs assessment process at
any point to:
o Respond to an individual’s restlessness or unwillingness to continue;
o Start the prioritization of needs to move into the development of a service plan;
o Set a continuation date/time to gather further information prior to developing
service plan.
After completing the needs assessment, the individual and CM work together to identify which
areas should be chosen as priorities for goal setting. Typically these are based primarily on
critical survival needs (food, shelter, clothing, medical, and behavioral health and homeless care)
and then less critical needs. Once the needs have been prioritized, the individual and CM are
ready to develop a service plan to accomplish one or more of the goals.

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 The Service Plan
Once a needs assessment is completed, the individual’s identified goals are recorded in a service
plan.
A service plan is a set of action steps designed to achieve one or more of the individual’s goals
as stated during the needs assessment. It is a plan that contains:
• Measurable short term goals or action steps
• Long term goals
• Parameters of service delivery
• Review date
• Signatures or other indications that show participation of the individual, the CM, and
supervisor, if needed.

The Role of the Provider of Case Management Services in Designing a Service Plan:
The role of the CM is to assist the individual to prioritize their needs, establish a goal
statement(s) from their needs assessment, identify the necessary action steps to accomplish the
goal(s), and to design a plan that will support the individual’s progress. Throughout this process
the CM educates and reinforces the individual’s right and responsibility to identify and make
choices.
Each goal must be broken down into a set of action steps. These steps are listed along with
whom, how, and when the step will be accomplished. The art of designing a service plan is to
develop the sequential steps to help the individual obtain their goals. The following is a checklist
for writing quality action steps:
• Are the action steps stated in positive terms?
• Are the action steps realistic, measurable and achievable?
• Are the action steps observable and behavioral?
• Are the action steps stated in specific terms-not global terms?
• Are the action steps individually-oriented?
• Is the initial action step short term with a high probability of success?
• Are the action steps set in sequential order and serve to accomplish the goal?
• Are the number of action steps appropriate to set a direction for the individual?
Once the service plan has been developed the plan needs to be reviewed, approved and signed by
a supervisor. The CM and the individual begin the process of implementing the plan. The CM
should expect that the service plan will need to be changed and revised from time to time. The
CM must formally review the service plan (and update as needed) at least every one hundred and
eighty days.

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 Implementing the Service Plan:
The next step is implementation. The CM will offer both practical support and encouragement
throughout this process. The ultimate attainment of individual-based goals rests with the
individual, but the CM is critical in helping to overcome barriers to the individual’s progress.
Growth and movement are supported by helping an individual attain goals by reviewing goals
and being sensitive in offering assistance. The CM's’ job is to help in a way that strengthens the
individual and helps them to become independent. Active outreach to the individual is a
cornerstone of case management. The CM should maintain contact with the individual whether
or not the individual is in crisis, acute care, or hospitalization.
While it may seem basic, effective coordination is critical to positive outcomes. The CM is
responsible to work with the individual and coordinate all needed services, as required on the
service plan. The CM coordinates multiple services in such a way that they are not duplicative,
nor do they conflict with one another. Coordination with behavioral health, homeless service
providers, primary care providers and other service providers can make the critical difference
between positive and negative outcomes. CMs must establish a strong collaborative partnership
between the individual and other service providers.
The CM must be familiar with the services, resources, and key contact persons within service
providers/agencies, because a crucial task of the CM is linking individuals with services and
resources.
It will be helpful for the CM to view behavioral health and homeless services on a continuum.
The continuum allows an individual to receive services according to their need. If the
individual’s acuity level is low, they may only need a referral to outpatient services. However, if
their acuity level is high, they may need to be referred to more intensive services such as
residential support.
The CM must be familiar with the behavioral health and homeless service continuum. The
following are the key categories of services:
• Emergency Services
• Inpatient Hospitalization:
• State institutions
• Nursing facilities
• Residential Services
• Outpatient services
• Supported Housing and In Home Skills Housing Services
• Permanent supportive housing
• Rapid rehousing
• Sober living homes

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 Monitoring the Service Plan
Monitoring involves active observation of the service plan to make sure it is being properly
implemented and continues to fit the needs of the individual. Monitoring also involves consistent
help identifying problems, modifying plans, ensuring the individual has resources to complete
goals, and in some cases, monitoring treatment participation of the individual. For example, the
CM may identify the need for additional medication management services, housing issues, or a
change in service needs.
Case management includes monitoring and follow-up activities, including activities and contacts
that are necessary to ensure the case management service plan is effectively implemented and
adequately addresses the needs of the individual. These activities may be with the individual,
family members, providers or other entities, and conducted as frequently as necessary to help
determine: whether services are being furnished in accordance with the individual’s case
management service plan, whether the services in the case management service plan are
adequate, and whether there are changes in the needs or status of the individual. If the needs of
the individual change, the CM and the individual will make necessary adjustments in the service
plan. The CM will continue to monitor the individual’s progress. When the CM is monitoring an
individual’s progress towards meeting the service plan goals, they will be attempting to answer
these questions:
• Is the individual getting the services established by the service plan?
• Are the services provided in such a way that benefits the individual?
• Are the services provided to the individual meeting the objectives of the service plan?
• Are the plan’s objectives appropriate to the individual’s current needs, skills, and
abilities?
• Will meeting the plan’s interventions give the individual the ability to live in the
community?
• Does the individual need additional services or intervention to be able to continue making
progress?
The above questions point to the effectiveness of the service plan. The answers to the questions
will lead to the next action. If the current service plan is not helping the individual, a revised
assessment and service plan may be in order.
Case management is a fluid activity; providers of case management services are community
bound – not office-based. To monitor service delivery, the CM must actively watch, listen and
interact with both the individual and all the treatment/service providers.
It is difficult to anticipate all the service needs that might be encountered in case management
work but certain issues seem to arise frequently. These include: monitoring medications,
behavioral health and homelessness, transportation, money management, hygiene, wellness,
medical care, dental care, housing, education, and employment. The individual’s Case
Management Needs Assessment should assess their strengths, interests, skills and abilities.
Services should be identified as goals/objectives in the Case Management Service Plan. Below
are some examples of the most common service needs.
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For many individuals, medication management may be essential to help alleviate and/or prevent
the recurrence of symptoms of mental illness. These medications work to stabilize functioning
and help control symptoms.
Many individuals view medications as a benefit and as a necessary part of treatment, and actively
engage with their prescriber. Other individuals may not see the benefits of medication.
Medications used to treat mental illness may help individuals in their recovery by stabilizing
symptoms which empowers them to live independently in the community and attain their goals.
The role of the CM may include monitoring and supporting an individual in their medication
treatment. The decision to use medications is carefully considered between the individual and the
prescriber. The CM can be supportive in that decision. The CMs may collaborate with the
individual and the prescriber to communicate any of the individual’s concerns and/or
observations with medications, and may discuss the need for medication, its effects and possible
side effects with each individual. This responsibility may also include requesting a routine
appointment or an urgent appointment with the prescriber and helping the individual fill
prescriptions. The prescriber, and not the CM, is responsible for the assessment, prescription and
monitoring of psychiatric medicine when prescribed for individuals.
CMs should also be familiar with Naloxone, or Narcan. According to the Substance Abuse and
Mental Health Services Administration (SAMHSA), “Naloxone is a medication approved by the
Food and Drug Administration (FDA) to prevent overdose by opioids such as heroin, morphine,
and oxycodone. It blocks opioid receptor sites, reversing the toxic effects of the overdose.
Naloxone is administered when a patient is showing signs of opioid overdose. The medication
can be given by intranasal spray, intramuscular (into the muscle), subcutaneous (under the skin),
or intravenous injection.” More information and training on the use of Naloxone kits can be
found at http://www.utahnaloxone.org/
A basic knowledge of psychiatric medicines and their proposed benefits and possible side effects
will help the CM monitor the individual’s behavioral health status. Providers of case
management services should consult with their supervisor, the prescriber and other treatment
team members.
One of your duties may be to transport individuals. Some points to keep in mind are:
• Know and follow your agency policies about transporting individuals. Discuss these
policies with your supervisor.
• Transportation by itself is not billable to Medicaid. In order to bill Medicaid for
transportation, a billable service must be concurrently provided.
• If you are able to drive personal vehicles for case management, check with your agency
and your own personal insurance company to ensure proper coverage.
• DO NOT transport individuals alone when their behaviors appear unstable or
unpredictable.
Providers of case management services must carefully assess hygiene needs being careful to not
push their own values on individuals. A nonjudgmental and thoughtful assessment of the

15
possible reasons for poor hygiene and grooming should be made. Hygiene and grooming issues
may be the result of financial barriers, or symptoms of medical or behavioral health needs and/or
homelessness.
Adequate, timely medical and dental care may be a problem for individuals. Providers of case
management services should be familiar with what medical and dental care can be obtained for
the individual. For individuals with Medicaid and/or other insurance benefits, the CM must
understand the details of the plan the individual is on and whether they are enrolled in a physical
health plan for their medical care. For individuals who do not have insurance, sometimes low-
cost or no-cost services can be obtained from local professionals or service organizations.
The CM must ensure that an authorization to release information is signed by the individual
before approaching and including family members or other natural supports. Natural supports
may know the individual's history of mental and physical health problems, the treatments that
have been received, and the responses to treatment. They can be a resource in managing the
needs of the individual, and are encouraged to work with the individual and treatment team,
when it is appropriate.
Education may be suitable for individuals. Providers of case management should assess an
individual’s desire to reach educational goals. If there is a desire for education, the provider of
case management should link individuals to services and resources to pursue educational
opportunities, including supported education programs.
Individuals may have a desire to gain employment. Some key questions for individuals and CM
are:
• Has the individual expressed a desire to work?
• How can they acquire skills, abilities, and learn to apply them in a work setting?
• How can the individual minimize barriers?
• Where can the individual get a job in a competitive work environment?
Each of these major questions deserves attention. Like other inseparable aspects of effective
case management, the answers to these questions depend on many things including: the
individual’s desire, skills and strengths, and the availability of work.
Individuals who desire to be employed may benefit from transitional employment (TE),
Supported Employed (SE), and Individual Placement and Support (IPS). TE, SE, and IPS models
offer social, educational, pre-vocational, and vocational opportunities to individuals. Full-time,
part-time, and volunteer work may provide significant benefits to individuals. The CM can assist
the individual by linking them to employment specialists within their agency or, as necessary,
linking the individual to Utah State Office of Rehabilitation (USOR). USOR can also link
individuals to a Benefits Specialist, to provide education on how employment may impact
benefits that they are already receiving or have applied for.

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 Public Entitlement Programs
Individuals may need case management to obtain entitlements. The most important kinds of
assistance available are income support (SSI, SSDI- GA or TANF) and special services for
people without money or insurance, such as donated medical or legal assistance. In most
communities, the public and private social welfare system is characterized by complex intake
and reporting procedures. A CM can assist the individual to gain access to public entitlements.
It is also the CM’s responsibility to develop the expertise and understand the eligibility process.

Applications for Social Security benefits may be turned down; however, often times individuals
are eligible to appeal. It is the CM responsibility to inform the individual of the appeal process
in the event of unfavorable decisions. To obtain state entitlements such as General Assistance
(GA) or Temporary Aid to Needy Families (TANF), applicants will need to provide the
following:
• Birth certificate or a tribal or church record of birth
• Picture identification (Driver's License or Utah State ID Card)
• Social Security Card
• Other documentation as required (refer to Social Security Administration’s website for
details)

Federally Administered Entitlement Programs:

Medicare - Medicare is a federal health insurance program. Turning 65 is one way you can be
eligible for Medicare. You can also be under 65 years old and still qualify for Medicare because
you are receiving Social Security Disability Insurance (SSDI). In most cases, you qualify for
Medicare due to a disability if you have been receiving SSDI checks for more than 24 months.
Social Security Disability Insurance (SSDI) -This is a federally funded insurance program for the
blind and disabled, funded by deductions from the applicant's payroll wages. Eligibility is based
upon medical documentation of a disabling physical or mental illness. As with other insurance
programs, a person must have contributed to it to receive payments later.
Supplemental Security Income (SSI) - This is a federal benefits program for the needy, aged,
blind, and disabled. Eligibility is based upon medical documentation of a disabling physical or
mental illness together with financial need. A thorough medical assessment and diagnosis with
laboratory findings and other supporting evidence is required to support a successful application.
It is the responsibility of the CM to inform the individual of the appeal process with any findings
of ineligibility, particularly at the first step. When awarded, entitlements are retroactive to the
original date of application.

17
 State of Utah Entitlement Programs through the Department of Workforce Services
Medicaid - This is a federal program that assists low-income citizens with disabilities obtain
medical care. Individuals who qualify for SSI will qualify for Medicaid, but they must apply for
each program separately. Not all providers of medical services accept Medicaid, so you will
need to become familiar with the providers in your area who accept this insurance. It is important
to remember that only Targeted Case Management services are billable to Medicaid.
If an individual earns money or receives SSDI, they may qualify for Medicaid; however, they
may have to pay for this benefit, called a spend-down, depending on their income. CMs must
become familiar with the regulations regarding spend-down as the amount of the spend-down
varies depending on the individual’s income. In addition, Targeted Case Management services
can NOT be billed when assisting the client to establish and maintain eligibility for Medicaid.
General Assistance (GA) - This is financial assistance for individuals who have not qualified for
federal assistance programs such as Social Security and/or who have a short-term disability.
Applicants must provide a completed medical form from a physician that describes the extent,
duration and medical diagnosis of the applicant's claimed disability.
Supplemental Nutrition Assistance Program, SNAP (Food Stamps) - Food stamps are used to
supplement income to help purchase food. Most households must spend some of their own cash
along with their food stamp benefits to buy the food they need.
Temporary Assistance to Needy Families (TANF) - This program is designed to meet the
minimal needs of children through payments to parents. Application for this program is by
completing the same state application form used for all state programs listed above including the
SNAP program. Individuals have the right to special assistance, foreign language translators,
and sign language assistance to complete the application process.
Unemployment Benefits: Unemployment insurance is a temporary assistance for people who are
unemployed through no fault of their own while they are seeking other work. It is a partial, short-
term replacement of lost wages and is not intended to be a permanent source of income. Benefits
are not based on financial need.
Day Care: The State of Utah is responsible to license day care providers who offer childcare to
eligible parents. Many times, individuals will be eligible to use these services while they receive
treatment, participate in vocational training, and/or participate in other services.
Community Resources: Aside from the behavioral health and homeless services an individual
may need, each community has a variety of other services that will be crucial in assisting the
individual in fulfilling their goals. Providers of case management services are responsible to
know about the services, service providers, and resources in their community.

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IV. Description of the Levels of Case Management and Caseload Size
These guidelines present three levels of case management which were developed in collaboration
with individuals, providers, and the National Association of Case Management (NACM) and
acknowledge the great variability of behavioral illness, homelessness, and associated periods of
need. Level I CM provides extensive supports for those whose present need and disability are the
greatest. Level II CM provides an intensity of case management focused on recovery and
rehabilitation. Level III case management provides a basic linking and crisis prevention service
for people who are largely able to self-manage their lives, or who do not choose to be presently
involved in a more intensive service. While formal assessment findings and individual choice are
key indicators for case management assignment, there are many factors to be considered in the
selection of the level of case management for each individual. Among these considerations are:
• Individual choice must be a primary factor in the assignment decision. Choices may be
related to determining the level of case management as well as selecting the case
management site (if services are available at more than one site). Once there is
agreement about the assignment to case management, there is a continuing need for
sensitivity to individual choice about the intensity of service and privacy.
• Willingness is closely associated with individual choice. Individuals may be temporarily
satisfied with their lives and circumstances, not desiring to begin work on more
progressive goals. Willingness must be cautiously evaluated by providers of case
management and must not be used as an “excuse” for under-serving. It is important to
note that providers of case management services can positively influence willingness
through demonstration of hope and belief in the individual, while working to enable the
individual to have the ability to manage themselves and live successfully in the
community.
• Social resources and natural supports available to individuals are a very important factor
in a decision about the intensity of case management. Individuals who are living in
supervised housing/group homes or residences associated with psychosocial
rehabilitation and/or attending Clubhouses may well require a less intensive case
management service. Individuals who live with family or significant others may not need
or choose an intensive case management service. However, care must always be taken
not to make the family or significant others the “de facto” CM.
• Safety may play a role in the case management assignment decision. People who are
vulnerable to violence or abuse, or who are themselves prone to abusive behavior, may
require a more intensive level of case management. Providers of case management
services should always work with their supervisor and follow agency policy when safety
may be an issue.
• Culture is also a critical determinant for case management. All providers of case
management services must be aware of the ethnicity and heritage of the individuals they
serve. Agencies are encouraged to employ case managers who are representative of the
various cultures in the service area, to help ensure culturally sensitive case management
services. Specific training in cultural competence should be required for all providers.
When working with individuals with Limited English Proficiency, agencies must provide

19
 access to interpreter services. Family members should not be used as interpreters, if at all
possible.
• Co-occurring conditions or situations will also affect assignment. Individuals with a
mental illness and a co-occurring substance use disorder problem should work with
providers who are trained in the provision of substance use disorder services to ensure
comprehensive care is provided. Individuals who live with mental illness, older adults,
physically or developmentally disabled, experience homelessness and/or are involved
with the criminal justice system may require specialized services.
• Legal issues are a factor in the selection of case management intensity. Individuals with
guardians or those who are involuntarily committed should be assigned a level of case
management intensity that reflects acuity and presence of a support system. Individuals
with involvement in the criminal justice system require case management coordination
with that system.

Description of the Three Levels of Case Management

(Case Management Services allow for Blended Caseloads of Level I, II, and III)
Level I CM Level II CM Level III CM
Description Level I CM is the most Level II CM Level III CM is the
intensive level of provides a least intensive level
support. moderate level of mode of support.
support.

Through frequent, This adult

comprehensive CM,
This adult population is
support is given to the
population has somewhat satisfied
most severely disabled
symptoms which with their life
adults. Crisis coverage is
accessible 24 hours per are at least situation, or are
day, seven days per partially largely able to self-
week. (Crisis services controlled. Crisis manage much of
may be provided by other coverage is their progress.
behavioral health and accessible 24 Services are
homeless service hours per day, provided pending
providers.) seven days per the individual’s
week. (Crisis needs with on-call
services may be crisis intervention,
provided by other or other crisis
MH providers). intervention
arrangements.

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Admission - Meets Severity: Past Severity: Past Severity: Extended
State Case hospitalization and hospitalizations, but period with no
Management recent major crisis no recent major crisis hospitalizations or
eligibility for activity activity or major crisis episodes.
behavioral health hospitalization. Largely able to
and/or homeless Symptoms are independently
Assessment: Will partially controlled. manage symptoms
services (found in show severe deficits and medication. Some
Part II). in skills and resources satisfaction with
needed for current life and able
Assessment: Will
community living. to make significant
show skill and
resource deficits progress towards
goals with occasional
which somewhat
assistance.
impair the person’s
ability to achieve
personal goals Assessment: May
independently. show moderate
dysfunction.
Level I CM Level II CM Level III CM
Focus/Activities Focuses on linking Focuses on obtaining Focuses on
the individual to recovery outcomes maintaining stability
agencies that provide and maximizing and independence by
basic human needs strengths by providing a link to
and supports; monitor implementing and services and interface
symptoms and side coordinating services with psychiatric and
effects of medication; and resources to meet medication services,
encouraging periods their needs; teaches crisis prevention and
of independence; independent living intervention.
building support skills.
networks; minimizing
or eliminating periods
of crisis. Advocate
for individuals to re-
establish sense of self
and personal
aspirations.

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Caseload Recommended Recommended Recommended
average of 15 persons average of 24 average of 50 persons
per caseload. persons per caseload. per caseload.
Depending on the Depending on the Depending on the
needs of persons needs of persons needs of persons
served and team served and team served and team
availability, the range availability, the range availability, the range
could be from 5 to 15 could be from 15 to could be from 30 to
persons per caseload 30 persons per case 80 persons per case
except in rural areas, manager, except in manager. Usually this
due to transportation rural areas. involves individual
limitations. Teams Caseloads can be practice in office with
provide 24-hour carried by an some team features.
coverage with mutual individual or a team. The CM will
support caseloads. Best Practice collaborate with
Assisted Outpatient includes access to medication service.
Treatment (AOT), nursing services and Available crisis
ACT and ACOT a psychiatric prevention/
teams are evidence- prescriber, a job intervention Monday
based practices and specialist and a through Friday, 8:00
ideal at this level. a.m. to 5:00 p.m.,
housing specialist.
Utah ACOT with back up
guidelines can be A face-to-face arrangements at other
found here. assessment of needs times. A face-to-face
should be conducted assessment of needs
A face-to-face at least once should be conducted
assessment of needs monthly. at least one time
should be conducted a every 90 days.
minimum of four Additionally, at least
times per week, with two face-to-face and
at least once weekly eight telephone
contact at place of contacts should be
residence. conducted each year.

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 Level I CM Level II CM Level III CM
Internal Review of Reauthorization in Reauthorization in Reauthorization in 180
Services For 180-day intervals. 180- day intervals. days, and thereafter as
Medicaid Continued CM at Continued CM at person chooses to have
Reimbursement Level I is based on Level II is based on continued CM linkage
degree of symptoms, progress with to behavioral health
crisis reduction and/or rehabilitation goals and/or homeless
positive progress and desire for systems.
further services
Expected Outcomes Increased: Increased: Increased:
-community tenure and - community tenure; -individual satisfaction
reductions in the with personal life
-time spent
frequency or length of domains;
employed or in
crisis or hospital
school; -personal independence
services; -housing
in any life domain.
stability; increased -social contacts;
social integration; -stability as measured
-independence or
-individual satisfaction; by rare, brief,
semi- independent hospitalizations; and
-independence or semi- living arrangement;
independent living and -episodes of recovery
arrangement. from mental health and
-individual substance use.
Decreased: satisfaction.
Decreased:
- symptoms and Decreased:
medication side - frequency and
-crisis episodes; and- duration of crisis
effects; impairment from
episodes;
- impairment from substance use; and
substance use; - -episodes of
decrease in level of homelessness.
care needed; and
-episodes of
homelessness.

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V. OTHER CHALLENGES

Crisis Intervention
A crisis intervention is a planned response to a variety of situations, which can range from
suicidal ideations to non-lethal problems such as eviction, divorce, or death of a loved one. A
crisis is not necessarily always negative and the CM can help the individual understand and even
benefit from many apparent crises of daily living. An individual crisis, such as the loss of
entitlements or the loss of a job, may ultimately have a positive outcome in that it helps the
individual to learn and grow. The CM should consult with their supervisor and other team
members to plan appropriate interventions when encountering a crisis situation.

Behaviors That May Precipitate Violence

Popular culture and the media have helped to portray individuals with mental illness and/or
experiencing homelessness as violent and unpredictable. These false images perpetuate stigma.
However, individuals experiencing mental illness and/or homelessness are responsible for no
more than 5% of violent episodes in the United States. In fact, people with mental illness and
those experiencing homelessness are more likely to be the victims of violence than to be the
perpetrator, and are citizens who share the predominant values of their home communities. Some
factors that may increase the likelihood of violence include substance use, difficulty maintaining
consistent medication management, financial stressors, trauma, and low insight into their illness.

Illegal Behaviors
Most individuals with behavioral disorders and those experiencing homelessness are law abiding
citizens, although some individuals may act against property, other people, or themselves. This
may involve law breaking, or impulsive reactions to stressful situations or to their own thoughts
and feelings. It is impossible for anyone, including behavioral health and homeless service
providers, to reliably predict how someone else is going to behave. It is not the CM’s job to
protect individuals from the consequences of their illegal behavior. The motives behind illegal
behaviors, whether deliberate or not, are a matter for legal authorities to determine. The CM
should consult their supervisor before reporting illegal behaviors to ensure privacy laws are
protected. All abuse of vulnerable persons must be reported.

Alcohol and Street Drug Use

Individuals will sometimes choose to use alcohol and/or street drugs for a variety of reasons.
Individuals are free to use alcohol in accordance with applicable laws in their communities.
However, they should be informed of the dangers associated with both drug and alcohol use,
along with the possibility of dangerous interactions that these substances may have with

24
psychiatric medications. Individuals will sometimes stop taking their medication and prefer to
“self-medicate” with alcohol or street drugs to relieve their symptoms. The CM can monitor and
assess individuals for substance use. The prescriber and treatment team should be notified, and
all should work with the individual to address the individual’s alcohol and/or street drug use.
Remember that a release of information is required before disclosing substance use to anyone
outside of the individual’s treatment team and/or agency.
The individual can be linked to public and private treatment programs and facilities when
appropriate. A list of treatment programs for Substance Abuse is maintained by the Utah
Division of Substance Abuse and Mental Health and can be accessed online at
https://hslic.utah.gov/db-search

Threatening, Violent, or Homicidal Behavior

When someone’s life or well-being is threatened, endangered, or violated, the CM should initiate
several actions. First, imminent or immediate threats must be respected for what they are—a
potentially dangerous situation. Immediately reduce the threat if possible by withdrawing,
leaving, or removing whatever may be causing anxiety, agitation, or fear. Speak in a normal tone
and a calming voice to the individual. Ask for and provide verbal clarification of the situation.
Avoid trapping or backing someone into a corner, or getting too close to someone. Leave all
exits open. If the danger does not diminish, physically remove yourself and others from the
situation and contact the police.
The law (Tarasoff Law) requires that CMs inform anyone who has been threatened by another
that his or her safety is jeopardized and by whom. The threat must be a credible threat of bodily
harm. Utah state law also specifically requires all behavioral health and homeless service
providers to report known or suspected situations of child abuse to Child Protective Services or
to the police, and known or suspected situations of abuse to a vulnerable adult to Adult
Protective Services. You should never hesitate to call the police for assistance when you perceive
an immediate threat to the physical safety of an individual. It is the job of the police, not yours,
to physically restrain people who are out of control.
Situations involving potential harm to individuals or property should always be discussed with
your supervisor at the earliest possible time so that plans can be implemented to protect the
safety of the individual, the CM, and others in the community. These types of situations should
also be carefully documented.

Suicidal Thoughts and Behaviors

Suicidal thoughts and behaviors can occur with individuals who are struggling with the
symptoms of their mental illness and who may also lack the connections of work, family, and
friends to provide support during the difficult time. Thoughts of suicide may arise from
desperation and discouragement or more rarely may result from “command hallucinations.”

25
Command hallucinations are “voices” instructing the individual to harm themselves (or others)
or take their own life during a psychotic episode.
All suicide threats must be taken seriously. It is essential that you consult with and remain in
close contact with your supervisor throughout the period when there is a danger. Safety is the
number one priority during these times. CMs should ensure that individuals are aware of the
availability of 24-hour Crisis Services in their area and how to access these services when
needed; this information is reviewed with the individual on a regular basis.
In general, suicidal risk is higher when: there is a specific and detailed plan for committing
suicide, the chosen method is lethal, and the method of suicide is available. For example, the
individual who is discussing suicide, has access to a loaded gun, and intends to use it tonight, is
generally in more immediate danger than another person who has declared plans to starve
her/himself or swallow pills soon. All suicidal thoughts and behaviors should be carefully
documented. Never hesitate to involve your supervisor, crisis services, or the police when there
is an immediate threat to the physical well-being of somebody.

VI. TAKING CARE OF YOURSELF

Working with people can sometimes be stressful. It is important to take care of yourself –
physically, emotionally, and socially. Utilize opportunities to attend time management and stress
management workshops as this may be helpful in coping with the challenges of your job.

Time Management
• Make a daily plan of tasks.
• Prioritize the list. Identify those tasks that have to be done today (A’s), from those which
should be done, but could be done tomorrow (B’s), and those which are not that
important (C’s). You will find that you often have to adapt and revise your list. There
may also be times when reviewing your list with your supervisor is beneficial.
• Be sure to do your “A” tasks first.
• Keep lists simple and realistic.
• Carry your list with you – consult it often.
• Let your list be your guide.
• Let individuals know when you will have time to provide case management services for
them. Set appointments with them and stick with it. If they are not there for the
appointment, make another appointment for another time. They will soon know they can
rely on you if they will make their appointment times with you.
• Be on time. Treat individuals the way you want to be treated.
• Always ask “what is the best use of my time right now?”
• Do not always work on other peoples “A” tasks at the expense of your own.

26
 Stress Management
• Talk with staff and your supervisor about your experiences and feelings. Sharing with
others helps to reduce the tension and find humor in difficult situations.
• Learn how to use relaxation exercises.
• Use humor appropriately.

Recognize the stages of burnout.

• Stage I – Early Warning Signs: vague anxiety, constant fatigue, feelings of depression,
boredom with one’s job, apathy
• Stage II – Initial Burnout: lowered emotional control, increasing anxiety, sleep
disturbances, headaches, diffuse back and muscle aches, loss of energy, hyperactivity,
excessive fatigue, and moderate withdrawal from social contact
• Stage III – Burnout: skin rashes, generalized physical weakness, strong feelings of
depression, increased alcohol intake, increased smoking, high blood pressure, ulcers,
migraines, severe withdrawal, loss of appetite for food, loss of sexual appetite, excessive
irritability, emotional outbursts, irrational fears (phobias), rigid thinking
• Stage IV – Burnout: asthma, coronary artery disease, diabetes, cancer, heart attacks,
severe depression, lowered self-esteem, inability to function on the job and personally,
severe withdrawal, uncontrolled crying spells, suicidal thoughts, muscle tremors, severe
fatigue, over-reaction to emotional stimuli, agitation, constant tension, accident proneness
and carelessness, feelings of hostility
• Take action to deal with your burnout if you recognize it.
• Talk to your supervisor for assistance.
• Take time-outs. These can be mini time-outs, such as taking the afternoon off, or longer
vacations.
• It is okay to say you are having a difficult time. We all do at times. It is not okay to
ignore the stress symptoms and do nothing about them.
• Cultivate pleasurable activities and hobbies that will offer you balance and peace.
• Develop a positive, nurturing support system.
• Set limits with yourself and others. Know your own boundaries.
• Exercise regularly.

“Often the person who identifies himself as the curer or fixer-type healer is vulnerable to
burnout.” (Rachel Naomi Remen, M.D.)
“Perhaps the most important thing I have learned from my work is that I can be a friend and
supporter of healing; I can be a guide to people; but it is not I who does the healing. I try to heal
by creating situations that seem to allow or foster healing – calmness, faith, hope, enthusiasm –
and sometimes just the idea that healing is a possibility.” (Martin Rossman, M.D.)

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VII. GLOSSARY

Acute phase of illness: A period of time during which the person suffers increased
intensity of symptoms. It may last from a few days to several weeks.
Assertive Community Treatment (ACT) Team: A multidisciplinary team acting as the
primary provider individualized treatment, rehabilitation, and support services to an
identified population of high risk individuals with Serious and Persistent Mental Illness
(SPMI) to assist those persons live successfully in the community.
Assertive Community Outreach Treatment (ACOT) Team: ACOT teams provide time
unlimited services to individuals who have SPMI, SUD, or co-occurring SPMI/SUD.
Services are delivered by a group of multidisciplinary staff that operates as a team that
shares (by assignment) in the provision of individually tailored treatment, rehabilitation,
and support services each client needs per each client’s comprehensive assessment and
individualized treatment plan.
Addiction: Addiction is a primary, chronic disease of brain reward, motivation, memory and
related circuitry. Dysfunction in these circuits leads to characteristic biological,
psychological, social and spiritual manifestations. This is reflected in an individual
pathologically pursuing reward and/or relief by substance use and other behaviors.
Adjustment disorder: A poorly suited response to life stress that usually disappears when the
stress stops.
Adult Protective Services (APS): An entity responsible for the investigation of possible abuse,
neglect, or exploitation of disabled adults and elderly.
Affect (flat): Absence of the common signs of normal emotions, such as smiling,
laughing, etc.
Affect (inappropriate): Display of emotion that is out of place and does not relate to events.
Affect (labile): Abrupt, unpredictable shifts of emotion.
Akathisia: Common, unpleasant side effects of major tranquilizers that make a person feel
jittery and agitated.
Alogia: Poverty (reduction in quantity) of thinking evidenced either by poverty of speech or by
poverty of content of speech. (See also mutism)
Alzheimer’s Disease: A common and irreversible form of dementia in which the brain
atrophies. Death usually follows in six to ten years.
Ambivalence: The presence of strong opposing feelings that make it difficult for a
person to reach a decision.
AMI: Alliance for the Mentally Ill (National)
Amphetamine: A stimulant drug with effects similar to cocaine.
Analgesics: A group of medications that reduce pain.

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Anorexia nervosa: A common and serious eating disorder generally found in young women
in which they gradually decrease the amount of food they eat until their weight
becomes dangerously low.
Anti-anxiety drugs: Medications used to help relieve tension and feelings of nervousness.
Antidepressant drugs: Medications used to treat serious depression.
Antipsychotic drugs: Medications used to treat schizophrenia and other psychotic disorders.
Antisocial personality disorder: A diagnosis generally applied to individuals with long histories
of continuous and chronic antisocial behavior, such as disregard for and violation of the
rights of others.
Atypical psychosis: A diagnosis sometimes used when psychosis is observed but its causes are
not understood.
Avoidant Personality Disorder: Characterized by hypersensitivity to rejection, and feelings of
inadequacy and low self-esteem.
Avolition: Absence of initiative or motivation to begin and maintain behavior in pursuit of a
goal.
Barbiturate: A type of central nervous system (CNS) depressant often prescribed to promote
sleep.
Bath salts: An emerging family of drugs containing one or more synthetic chemicals related to
cathinone, an amphetamine-like stimulant found naturally in the khat plant
Benzodiazepine: A type of Central Nervous System (CNS) depressant often prescribed to
relieve anxiety. Valium and Xanax are among the most widely prescribed
benzodiazepine medications.
Bipolar Disorder: A mood disorder in which a person experiences episodes of intense feelings
of euphoria, and excitement, or irritability, followed by episodes of depression
Borderline Personality: A personality disorder characterized by instability of personal
relationships, self-image, moods, and impulsivity.
Bulimia: Binge eating often accompanied by vomiting caused by concern over appearance and
weight. This problem is related to anorexia nervosa and, in its severe form, can be life
threatening.
Buprenorphine: Medication approved by the U.S. Food and Drug Administration in October
2002 for the treatment of opioid addiction.
Cannabidiol (CBD): A non-psychoactive cannabinoid that may be useful in reducing pain and
inflammation and in controlling epileptic seizures.

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Cannabinoid receptor: The receptor in the brain that recognizes and binds cannabinoids that
are produced in the brain (anandamide) or outside the body (for example,
Tetrahydrocannabinol/THC and cannabidiol).
Cannabinoids: Chemicals that bind to cannabinoid receptors in the brain. They are found
naturally in the brain (anandamide) and are also chemicals found in marijuana (for
example, THC and CBD). They are involved in a variety of mental and physical
processes, including memory, thinking, concentration, movement, pain regulation, food
intake, and reward.
Cannabis: The botanical name for the plant that produces marijuana.
Carcinogen: A substance that may cause cancer.
Cardiovascular system: The heart and blood vessels.
Catatonic schizophrenia: A type of schizophrenia characterized by pronounced motor
symptoms ranging from rigid immobility to extreme excitement and excessive motor
activity.
Central nervous system (CNS): The brain and spinal cord
Chronic phase of illness: Refers to the persistence of illness or symptoms over a long period
of time.
Civil Commitment (also called involuntary commitment): A judicial process whereby
someone may be committed to a hospital or Local Mental Health Authority against their
will if the person is judged to be mentally ill and one or more of the following conditions
also applies: 1) danger to self, 2) danger to others, 3) there is no less restrictive treatment
available. Additional information on civil commitment in Utah can be found here.
Clinical case management – a more intensive form of case management that may include
clinical interventions. Clinical case management meets the required activities of case
management, with the additional specialization of provide clinical services.
Clubhouse: May refer to individual self-help clubs developed and organized by individuals
themselves, or psychosocial clubs such as Alliance House in Salt Lake City, which are
program components of community mental health centers. As the term implies, a club
emphasizes belonging, social connections and common purposes.
Central Nervous System (CNS) depressants: A class of drugs (also called sedatives and
tranquilizers) that slow CNS function; some are used to treat anxiety and sleep
disorders (includes barbiturates and benzodiazepines).
Coca: The plant, Erythroxylon, from which cocaine is derived. Also refers to the leaves of this
plant.
Cocaine: A highly addictive stimulant drug derived from the coca plant that produces profound
feelings of pleasure.

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Cognitive-behavioral treatments: A set of treatments that focus on modifying thinking,
motivation, coping mechanisms, and/or choices made by people.
Community Mental Health Centers (CMHC): Organizations located in communities
throughout the state that assist individuals to live as productively and satisfactorily as
possible by providing individualized treatment for mental illness and/or substance use
disorders.
Community Support Projects Programs: The range of programs, agencies and services in any
given geographic area which may be utilized by individuals to live as comfortably and
productively as possible in the community. This includes traditional behavioral health
and homeless agencies and other services.
Confidentiality: A principle of medical practice that requires behavioral health and homeless
treatment providers to keep private treatment matters confidential (not discuss with other
people) without authorization from the individual involved.
Counseling: Listed as an eligible activity under case management for some Department of
Housing and Urban Development (HUD) programs, it needs to be clarified that
counseling provided by case managers does not include any form of specialized
counseling, which should only be exercised by licensed professionals.
Delusion: A false belief, which dominates a person's thinking despite evidence to the contrary.
Delusional Disorder: A disorder characterized by a system of non-bizarre delusions (i.e.,
involving situations that occur in real life, such as being followed, poisoned, infected,
loved at a distance, or deceived by spouse or lover, or having a disease).
Dependent Personality Disorder: Characterized by an excessive need to be taken care of and
submissive and clinging behavior, as well as feelings of panic or discomfort at having to
be alone.
Dependence: A physiological state that can occur with regular drug use and results in
withdrawal symptoms when drug use is abruptly discontinued.
Depression: An emotional state characterized by extreme sadness, feelings of low self-worth
and may include thoughts of death and suicide.
Depressants: Drugs that relieve anxiety and promote sleep. Depressants include barbiturates,
benzodiazepines, and alcohol.
Detoxification (“Detox”): A process that enables the body to rid itself of a drug. Medically
assisted detoxification may be needed to help manage an individual’s withdrawal
symptoms. Detoxification alone is not treatment but is often the first step in a drug
treatment program.
Diagnosis: The assignment of a specific illness based on standardized symptoms assessed by a
doctor, licensed behavioral health and homeless provider, or other qualified personnel.
Disability Law Center (DLC): A private non-profit organization to protect the rights of people
with disabilities in Utah.

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Disorganized Type Schizophrenia: A type of Schizophrenia characterized by a prominence of
disorganized speech, disorganized behavior, and inappropriate affect.
Dopamine: A brain chemical, classified as a neurotransmitter, found in regions of the brain
that regulate movement, emotion, motivation, and pleasure.
Diagnostic and Statistical Manual for Mental Disorders (DSM):. Provides a definition of all
recognized mental disorders.
Due process: A legal term meaning the right to an official court hearing before an individual’s
freedom is restricted in any way, such as before involuntary hospitalization or treatment
of any kind.
Ecstasy (3,4-methylenedioxy-methamphetamine, MDMA): A mood- and perception-altering
drug that is chemically similar to hallucinogens and stimulants.
Food stamps: Public welfare program administered by the State Department of Human Services
offices in Utah also referred to as Supplemental Nutrition Assistance Program (SNAP).
General Assistance (GA): Public welfare, available to those who meet requirements.
Guardianship: A legal term describing the assignment of legal authority and responsibility
from one person to another. This is done in a court of law and only in situations where
the judge is convinced that the individual, whose guardianship is proposed, needs a
guardian to protect their interest and rights.
Hallucinations: A perception in which things are seen or heard that are not real or present.
Hallucinations usually arise from a disorder of the nervous system or as an effect of a
hallucinogenic drug, such as lysergic acid diethylamide (LSD).
Hallucinogens: A diverse group of drugs that alter perceptions, thoughts, and feelings.
Hallucinogenic drugs include lysergic acid diethylamide (LSD), mescaline,
phencyclidine (PCP), and psilocybin (magic mushrooms).
Health Plan: A federally defined plan under contract with the Utah Department of Health to
provide specified physical health care services to a specific group of Medicaid enrollees.
Home Energy Assistance Training (H.E.A.T.): Federally funded program that helps
qualified, low-income individuals pay the high cost of winter heating bills.
Heroin: A synthetic opioid related to morphine. It is more potent than morphine and is highly
addictive.
HHS: Department of Health and Human Services (federal government).
Histrionic Personality Disorder: Characterized by excessive attention seeking behavior and
emotional instability.
HUD: Department of Housing and Urban Development (federal government).
ID/RC: Intellectual Disability/Related Condition

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Inhalant: Any drug administered by breathing in its vapors. Inhalants are commonly organic
solvents, such as glue and paint thinner, or anesthetic gases, such as nitrous oxide.
Inhalation: Taking air or a substance into the lungs by breathing it in through the nose or
mouth. Nicotine in tobacco smoke enters the body by inhalation.
Injection: Taking a substance into the skin, subcutaneous tissue, muscle, blood vessels, or
body cavities - usually by means of a needle.
Injection drug use: Taking drugs directly into blood vessels using a hypodermic needle and
syringe. Also called intravenous drug use.
Informed consent: The informed, conscious and willful agreement of an individual. A
behavioral health and homeless professional cannot assume that an individual has
given informed consent unless the individual has been provided a full and complete
explanation of the situation and their legal rights.
Inpatient: Refers to a treatment status of a person within a hospital or other medical facility.
Kratom: A tropical tree native to Southeast Asia, with leaves that contain compounds that can
have psychotropic (mind-altering) effects.
Limbic system: Area of the brain that is involved with feelings, emotions, and motivations. It
is also important for learning and memory.
LSD (lysergic acid diethylamide): A hallucinogenic drug that acts on the serotonin receptor.
Manic Depressive Illness (MDI): See bipolar disorder.
Marijuana: A psychoactive drug, usually smoked but sometimes vaporized or ingested, that is
typically made from the flowers, leaves, and stems of the female cannabis plant. The
main psychoactive ingredient is THC.
Medicaid: A health insurance program for low income people. It pays medical costs for eligible
individuals who cannot afford the cost of health care. People who qualify for
Supplemental Security Income (SSI) may be eligible for Medicaid.
Medical case management – a collaborative process that facilitates recommended treatment
plans to ensure that appropriate medical care is provided to disabled, ill or injured
individuals. A medical case manager meets the required activities of case management,
with the additional specialization of working closely with medical providers to provide
a full range of health, medical and social services to those individuals identified as
needing specialized and resource-intensive services. Medical case managers focus on
“patient-centered care” that incorporates the individual’s active participation in their
health care.
Medicare: Insurance program of medical services for the elderly or those who have received
SSD for a period of time.

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Medication: A drug that is used to treat an illness or disease according to established medical
guidelines. If the medication contains one or more controlled substances, it must be
prescribed by a licensed physician.
Medication, Psychiatric: Medicines prescribed by psychiatrists for the control of symptoms of
various kinds.
Mental illness: A condition in which an individual’s mental processes, including thoughts,
feelings, and perceptions, are disrupted or dysfunctional in helping the person to adapt
to his surroundings.
Methadone: A long-acting synthetic opioid medication that is effective in treating pain and
opioid addiction.
Methamphetamine: An addictive, potent stimulant drug that is part of the larger class of
amphetamines.
Methylphenidate (Ritalin/Concerta): A CNS stimulant that has effects similar to, but more
potent than, caffeine and less potent than amphetamines. It has a notably calming and
“focusing” effect on patients with ADHD, particularly children.
Mood Disorders: Disorders in which the primary feature is an intense disturbance in mood.
Mutism: Refusal or failure to speak when speech is expected or demanded.
NAMI: National Alliance for Mental Illness
Narcissistic Personality Disorder: Characterized by grandiosity, need for admiration, and
lack of empathy.
Needs assessment: A tool to obtain and represent the ongoing growth and changing needs of
the individual.
Negative symptoms: These symptoms involve the absence of normal behaviors. They include
affective flattening, alogia, apathy, avolition and social withdrawal.
Neuron (nerve cell): A unique type of cell found in the brain and throughout the body that
specializes in the transmission and processing of information.
Neurotransmitter: A chemical produced by neurons to carry messages to adjacent neurons.
Nicotine: The addictive drug in tobacco. Nicotine activates a specific type of acetylcholine
receptor.
NIMH: National Institute of Mental Health
Noradrenaline: A neurotransmitter that is made in the brain and influences, among other
things, the function of the heart.
Nucleus accumbens: A part of the brain reward system, located in the limbic system, that
processes information related to motivation and reward. Nearly all addictive drugs act
directly or indirectly on the nucleus accumbens to reinforce drug taking.

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Obsessive Compulsive Personality Disorder (OCD): Characterized by excessive concern with
maintaining order, control, perfectionism and adherence to rules.
Outpatient: Refers to a treatment status or a person receiving treatment in the community and
outside of a mental hospital or other medical facility.
Outreach – to attempt to engage and enroll persons not currently accessing services.
Opioids (or opiates): Controlled substances most often prescribed for the management of pain.
They are natural or synthetic chemicals similar to morphine that work by mimicking the
actions of enkephalin and endorphin (endogenous opioids or pain-relieving chemicals
produced in the body).
Paranoid Type Schizophrenia: A type of Schizophrenia characterized by a preoccupation with
one or more delusions or frequent auditory hallucinations, which are often experienced
as threatening to the person. Does not include prominent symptoms of disorganized
speech, behavior or inappropriate affect.
Paranoid Personality Disorder: A pervasive distrust and suspiciousness of others.
Personality disorder: Refers to patterns of maladaptation, inflexibility, or impairment in an
individual’s basic pattern of perceiving and relation to others.
Positive symptoms: These prominent or added symptoms include delusions, hallucinations,
thought disorder, and aberrant behaviors.
Prepaid Mental Health plan: (PMHP) means the Department of Health’s mental health
freedom-of-choice waiver approved by CMS that allows the Department to require
Medicaid Eligible Individuals in certain counties of the state to obtain Covered
Services from specified contractors. PMHP contactors are responsible to provide
covered inpatient and outpatient mental health mental health services to Medicaid
eligible individuals.
Prevocational services: Activities intended to help an individual prepare for employment by
teaching work related skills.
Preferred Practice Guidelines: Uniform and consistent guidelines for people with mental
illness
Prefrontal cortex: Located in the frontal lobe (one of the four divisions of each cerebral
hemisphere) of the brain. This area is important for decision making, planning, and
judgment.
Prescription drug abuse: The use of a medication by someone other than for whom it is
prescribed, in ways or amounts other than intended by a doctor, or for the experience or
feeling it causes.
Primary therapist: The person in a behavioral health and/or homeless center who has primary
responsibility for providing treatment and managing the individuals file.
Provider of case management services: A behavioral health and/or homeless service provider
who assists individuals access various resources and assistance to meet their needs and
live as independently as possible. Referred to in this document as CM.
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Psychedelic drug: A drug that distorts perception, thought, and feeling. This term is typically
used to refer to drugs with hallucinogenic effects like those of LSD.
Psychoactive: Having a specific effect on the brain.
Psychological Screening: The use of psychological procedures or tests to detect psychological
problems.
Psychopharmacological drugs: Drugs used in the treatment of mental disorders.
Psychosis: A term that is used to describe major distortions or interpretations of reality. For
example, the notion that one can control others or be controlled through brainwaves
transmitted via radio receivers.
Psychosocial Rehabilitation Services (also called PRS or SDS): Psychosocial rehabilitative
services are medical or remedial services designed to reduce the individual’s mental
health symptoms and restore the individual’s maximum functional level, through the use
of face-to-face interventions such as cueing, modeling and role modeling of appropriate
life skills. These services are aimed at maximizing the individual’s social and behavioral
skills in order to prevent the need for more restrictive levels of care and include services
to: (1) eliminate or reduce symptomatology related to the individual’s diagnosis; (2)
increase compliance with the medication regimen, as applicable; (3) avoid psychiatric
hospitalization; (4) eliminate or reduce maladaptive or hazardous behaviors and develop
effective behaviors; (5) improve personal motivation and enhance self-esteem; (6)
develop appropriate communication, and social and personal interactions; and (7) regain
or enhance the basic living skills necessary for living in the least restrictive environment
possible. Services are provided in either an individual or group setting.
Psychotherapeutics: Therapeutic drugs that have an effect on brain function; some are used to
treat psychiatric disorders. They include antidepressants, mood stabilizers, CNS
depressants, stimulants, and opioids.
Psychotherapy: Treatment of mental disorders using psychological methods.
Rapport: Interpersonal relationship developed and characterized by a spirit of cooperation,
confidence, and harmony.
Rationalization: Mechanism created by an individual to justify his or her actions.
Recovery – is defined by the Substance Abuse and Mental Health Services Administration
(SAMHSA) as a process of change through which individuals work to improve their own
health and well-being, live a self-directed life and strive to achieve their full potential.
Through the Recovery Support Strategic Initiative, SAMHSA has defined the following
four major dimensions that are essential to a life in recovery: Health: overcoming or
managing one’s disease(s) as well as living in a physically and emotionally healthy way
Home: a stable and safe place to live Purpose: meaningful daily activities, such as a job,
school, volunteerism, family caretaking, or creative endeavors and the independence,
income and resources to participate in society Community: relationships and social
networks that provide support, friendship, love and hope.

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Psychotherapeutics: Therapeutic drugs that have an effect on brain function; some are used to
treat psychiatric disorders. They include antidepressants, mood stabilizers, CNS
depressants, stimulants, and opioids.
Remission of symptoms: The reduction or disappearance of symptoms of an illness.
Residual Type Schizophrenia: A type of schizophrenia that often follows the acute phase.
Residual symptoms may include social isolation or withdrawal, major impairment in
daily work roles, an apparent lack of feelings or expressiveness, or peculiar and strange
ideas.
Resistive to treatment: From the point of view of a treatment provider, the characteristic of
someone who directly or indirectly refuses treatment. In spite of this viewpoint,
individuals have the right to willfully choose or not choose treatments, except and
unless that right is altered by a court of law.
Reward: The process that reinforces behavior or increases its likelihood of recurrence. It is
mediated, at least in part, by the release of dopamine into the nucleus accumbens. Human
subjects report that reward is associated with feelings of pleasure.
Reward system (or brain reward system): A brain circuit that, when activated, reinforces
behaviors. The circuit includes the dopamine-containing neurons of the ventral tegmental
area, the nucleus accumbens, and part of the prefrontal cortex.
Route of administration: The way a drug is taken into the body. Drugs are most commonly
taken by eating, drinking, inhaling, injecting, snorting, or smoking.
Rush: A surge of pleasure (euphoria) that rapidly follows the administration of some drugs.
Salvia: An herb in the mint family native to southern Mexico that is used to produce
hallucinogenic experiences.
Schizoaffective disorder: Mental disorder characterized by a person’s experiencing severe but
highly episodic disturbances of psychological functioning, such as mood-incongruent
delusions and hallucinations.
Schizoid personality disorder: Personality disorder characterized by shyness, seclusiveness,
over sensitivity, and eccentricity.
Schizophrenia: A serious and sometimes disabling mental illness. Symptoms include so-called
positive symptoms, such as hearing voices and developing false, unconfirmed ideas as
well as negative symptoms, like withdrawing from friends and family.
Schizotypal Personality Disorder: A pervasive pattern of social and interpersonal deficits
marked by acute discomfort with, and reduced capacity for close relationships and well
as by cognitive or perceptual distortions and eccentricities of behavior.

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Sedatives: Drugs that promote sleep, suppress anxiety, and relax muscles; the National Survey
on Drug Use and Health (NSDUH) classification includes benzodiazepines, barbiturates,
and other types of CNS depressants.
Serotonin: A neurotransmitter that regulates many functions, including mood, appetite, and
sensory perception.
Severe Emotional Disturbance (SED): The term serious emotional disturbance (SED) is
used to refer to children and youth who have had a diagnosable mental, behavioral, or
emotional disorder in the past year, which resulted in functional impairment that
substantially interferes with or limits the child’s role or functioning in family, school, or
community activities.
Self-esteem: Overall feeling of self-worth.
Self-identity: An individual’s delineation and awareness of his or her continuing identity as a
person.
Self-monitoring: The observation and recording of one’s own behavior.
Serotonin: A neurotransmitter that regulates many functions, including mood, appetite, and
sensory perception.
Service Plan: A formal agreed upon plan for support and assistance provided to individuals.
Serious Mental Illness (SMI): A diagnosable mental, behavior, or emotional disorder that
causes serious functional impairment that substantially interferes with or limits one or
more major life activities.
Social Security Administration: The federal organization that administers SSA-DI, SSI and
Medicare. These are all referred to as entitlement programs.
Somatic: Pertaining to one’s body.
Spice: Dried plant material containing synthetic (or designer) cannabinoid compounds that
produce mind-altering effects as well as other compounds that vary from product to
product.
SSA-DI: Social Security Administration Disability Insurance
SSI: Supplemental Security Income
State Vocational Rehabilitation: A state government organization mandated to serve those
who are unemployed by reason of some handicapping condition. Traditionally, “voc
rehab” has served mainly physical disabilities, but some individual voc rehab
counselors (VRCs) may have a special interest in assisting individuals recovering from
mental illness.
Stimulants: A class of drugs that elevates mood, increases feelings of well-being, and increases
energy and alertness. Some stimulants, such as cocaine and methamphetamine, produce
euphoria and are powerfully rewarding. Other stimulants, such as methylphenidate

38
 (Ritalin and Concerta) or Adderall (a mix of amphetamine salts), are often prescribed to
treat ADHD.
Stress: Internal responses caused by the application of a stressor.
Substance use disorder: Patterns of maladaptive behaviors centered around the regular and
consistent use of the substance(s) involved.
Symptom: Particular evidence of illness, such as hallucinations, sleeplessness or changes in
personality.
TANF: See Temporary Assistance for Needy Families
Targeted Case Management (TCM): Targeted case management is a service that assists
eligible Medicaid recipients with serious mental illness to gain access to needed
medical, social, educational, vocational and other services.
Temporary Assistance for Needy Families (TANF): A federal block grant administered by
states in ways to assist needy families.
Tetrahydrocannabinol: See “THC.”
Thalamus: The key relay station for sensory information flowing to the cortex, which is located
deep within the brain. It filters important messages out from the background noise,
produced by the many signals entering the brain.
THC: Delta-9-tetrahydrocannabinol; the main psychoactive ingredient in marijuana, which acts
on the brain to produce marijuana’s psychoactive effects.
Tobacco: A plant widely cultivated for its leaves, which are used primarily for smoking; the
tabacum species is the major source of tobacco products.
Tolerance: A condition in which higher doses of a drug are required to produce the same effect
achieved during initial use, which often leads to dependence.
Transference: The process whereby an individual projects attitudes and emotions
applicable to another significant person onto the therapist; emphasized in
psychoanalytic therapy.
Undifferentiated Type Schizophrenia: A type of Schizophrenia in which the major symptoms
are present but criteria for paranoid, disorganized, or catatonic types are not present.
USARA: Utah Support Advocates for Recovery Awareness
Ventral tegmental area: The group of dopamine-containing neurons that make up a key
part of the brain reward system. This region is part of the brain reward pathways that
also include the nucleus accumbens and prefrontal cortex.
VRC: Vocational Rehabilitation Counselor

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Vulnerable Adult: An adult (18 years of age and older) who is or may be in need of
community care services by reason of disability, age or illness; and is or may be unable
to take care of unable to protect him or herself against significant harm or exploitation.
Withdrawal: Symptoms that occur after regular use of a drug has been abruptly reduced or
stopped. Symptom severity depends on the type of drug, the dosage, and how long and
how frequently it has been taken.

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