|Supported Housing: Residential Care|
Behavioral Health (BH)
|BCBST last reviewed June 25, 2020*|
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Clinical Indications for Admission to Residential Care
- Admission to residential housing may be appropriate if ALL of the following are met:
- Housing is judged appropriate as indicated by ALL of the following:
- Age 18 or older
- Is medically stable
- Current primary DSM-IV-TR or DSM-5 diagnosis with 1 or more of the following:
- Current DSM-IV-TR Global Assessment of Functioning (GAF) score below 50
- DSM-5 severity level specified as moderate or severe
- Patient presents with 1 or more of the following criteria:
- Transitioning from a higher level of care, such as inpatient/subacute care and requires supervision in a structured setting due to mental
- Health symptoms that prevent independent living and personal and community safety [B]
- Transitioning from incarceration where significant mental health issues have been noted
- Transitioning from child and adolescent residential services to adult behavioral health services and is in need of structured housing services to maintain tenure in the community
- Has lost all means of caregiver support within the community and cannot independently sustain a safe living environment due to mental illness
- Has had numerous, extended inpatient treatment attempts with one occurring within the last 6 months and has demonstrated failed community tenure with maximum effort of natural and community supports
- Has capacity to respond favorably to rehabilitative counseling and training and other psychosocial rehabilitation services in order to meet 1 or more of following:
- Maximize his or her ability to independently participate in community, home, school or work activities
- Prevent relapse to lower levels of functioning
- Housing is required for 1 or more of the following:
- A need for Supported Housing [A] (1)(2)(3) and the patient is able to safely and adequately self-administer medications without 1:1 supervision
- Complexity of the patient requiring special subsets of treatment as indicated by 1 or more of the following:
- A need for Enhanced Supported Housing [C] and patient presents with 1 or more of the following criteria:
- Has a medical condition requiring additional assistance (e.g., eating disorder, diabetes, cancer, TB, etc.)
- Has a co-occurring condition such as lower cognitive functioning and cognitive decline that necessitates additional assistance
- Requires a more secure setting due to elopement and wandering behaviors
- Is not able to be maintained in regular Supported Housing services due to a lack of medication adherence, increased symptomology and problematic behaviors in the community
- A need for Medically Fragile Supported Housing [D] and patient presents with 1 or more of the following criteria:
- Has a medical condition requiring daily medical assistance in the form of specialized care (e.g., nursing, health technicians, durable medical equipment, etc.)
- Is not able to be maintained in regular Supported Housing or Enhanced Supported Housing services due to the needs arising from a medical condition
- Absence of ALL the following exclusions:
- Can be safely maintained and effectively treated with less intensive services.
- Symptoms are the result of a non-covered condition
- Does not voluntarily consent to treatment and there is no court order requiring such treatment
- Not exclusively based on homelessness and/or incarceration
- Primary problem cannot be social, economic, or of a physical nature without a concurrent major psychiatric condition
- Manifests behavioral and/or psychiatric symptoms that require a more intensive, structured, or supervised level of care.
- Is an imminent danger to self or others
- Medical conditions or impairments that would prevent beneficial utilization of services, or not stabilized on medications.
- Has moderate to severe intellectual disabilities that require alternative levels of care and support.
- Is younger than 18 years of age.
- Needs custodial care with little or no expectation of movement to community placement.
- Tsemberis, S., Eisenberg R. Pathways to housing: Supported Housing for street-dwelling homeless individuals with psychiatric disabilities; 2000. Retrieved May 22, 2014 from http://ps.psychiatryonline.org/data/Journals/PSS/3540/487.pdf.
- Owen C, Rutherford, V,Jones, M, Wright, C,Tennant C, Smallman, A. Housing accommodation preferences of people with psychiatric disabilities. Psychiatric Services 1996; 4(6), 628.
- McCarthy, J., Nelson, G. An evaluation of supportive housing for current and former psychiatric patients. Hospital and Community Psychiatry 1991; 42(12), 1254-56.
- Goering, P., Tolomiczenko, G., Sheldon, T., Boydell, K. , Wasylenki, D. Characteristics of persons who are homeless for the first time. 2002; retrieved May 22, 2014 from http://ps.psychiatryonline.org/data/Journals/PSS/3591/1472.pdf.
- Morrell-Bellai, T. Becoming and remaining homeless: a qualitative investigation. Mental Health Nursing 2000; 21(6), 581-604.
- Goldfinger, SM, Schutt, RK, Tolomiczenko, GS, Seidman, L, Penk, W, Turner,W, Caplan,B. Housing placement and subsequent days homeless among formerly homeless adults with mental illness. Psychiatric Services 1999;50: 674- 678.
- Diamond, R.J. The psychiatrist’s role in Supported Housing. Hospital and Community 1993; Retrieved May 22, 2014 from http://ps.psychiatryonline.org/article.aspx?articleid=76782.
- Substance Abuse and Mental Health Services Administration. Permanent supportive housing: evaluating your program. HHS Pub. No. SMA-10-4509, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services 2010. http://store.samhsa.gov/shin/content/SMA10-4510/SMA10-4510-05-EvaluatingYourProgram-PSH.pdf.
[A] Supported Housing refers to residential settings staffed twenty four hours a day, seven days a week with associated mental health staff supports for seriously and persistent mentally ill (SPMI) individuals who are 18 years or older, who require services in a structured setting to maintain successful community tenure. Supported Housing does not include room and board payment. Supported Housing utilizes a strengths model to assist individuals to remain in the community, functioning and progressing toward individualized recovery goals. It also provides an environment that allows individuals to live in a structured community setting with appropriate mental health supports. Comprehensive services focus on rehabilitation and include multidisciplinary, multimodal therapies to fit the needs of the resident. Medical and nursing services are generally available on a consultative basis. Typically, coordinated treatment services include individual, group, and family counseling, rehabilitation, vocational training, and skill building. Active family/significant other involvement is important unless contraindicated and should occur based on individual needs. Residents may go into the community for work, school, and/or outside activities. The expectation is that individuals will be integrated into the community at a level commensurate with the strengths and abilities of the individual as documented in the individuals’ treatment plan. Community resources are used in a planned, purposeful, and therapeutic manner that encourages residents' autonomy. Supported Housing services are also effective in transitioning individuals with SPMI from child/adolescent services to adult continuum of services and assist them to remain in the community while accessing community based services. The expectation is that individuals will develop skills that foster independence and support the individual’s recovery plan. Case Management Note: The receipt of Supported Housing and Case Management (Level 1 or 2) is considered a duplication of service and should not occur concurrently; however, Case Management is allowed and encouraged in order to assist with transition out of the Supported Housing Services no more than 90 days prior to discharge.
[B] Supervision in a structured setting for these members includes areas such as: health care and personal hygiene, finances, healthy diet and food preparation, home maintenance, and community services needs (e.g., legal, transportation, housing)
[C] Enhanced Supported Housing is equipped with additional safety precautions such as locks or alarms and more direct staff availability than regular Supported Housing.
[D] Medically Fragile Supported Housing is equipped with additional medical staff and accommodations such as wheelchair accessible showers and other accommodations over and above regular or Enhanced Supported Housing.