Adult Mental Health Continuum

​​​**For all services described below, please see North Carolina DMA Clinical Coverage Policies, Behavioral Health section for complete service requirements.

The adult mental health continuum of care is designed to meet the needs of individuals with mild symptoms and functional impairments, as well as individuals with serious and persistent mental illness. This includes individuals for whom wraparound and residential supports are required to help them achieve recovery according to their preferences and live fulfilling lives in their communities. This continuum includes specialized crisis services to assist with crisis stabilization when necessary. The appropriate level of care is to be selected by the clinician based upon community standards, level of care assessment tools (LOCUS), and clinical coverage policy criteria. The continuum is composed of the following supports and services:

  • Universal Supports consist of as​sistance and interventions generally available to anyone through their existing connections within his or her community. Universal Supports include the following:

    • Natural Supports include unpaid resources in the community which enhance and help sustain recovery. Examples are family members, governmental supports and non-profit community agencies.

    • Primary Medical Homes are a front door for the full range of medical issues, including mental health issues.

    • Prevention services are most commonly provided in school settings, but can be available in other settings to assist with preventing trauma and other stressors from leading to diagnosable mental health conditions.
  • Basic Services consist of specialty, office-based assessments, therapy, testing and medication management tailored to meet the diagnostic and treatment needs of those with mild to moderate mental illnesses. They can be used alone, in combination with each other, and can sometimes be used in combination with support, enhanced and residential services. Basic Services include the following:

    • Comprehensive Clinical Assessments: These assessments provide the groundwork for selecting the right service, in the right quantity and in the right setting. They should assure highly accurate diagnostic formulations and recommendations for both paid services and unpaid supports.

    • Basic Psychotherapies (individual, group and family): Evidence-based psychotherapies are the core of the mental health system and offer time-limited, problem-focused interventions by licensed clinicians.

    • Psychiatric Medication Management: Psychiatrists and other psychiatric prescribers provide specialized medication-based treatments for all ranges of adult mental health conditions. Medication management can be an essential component of any treatment plan and can be time-limited or long-term.

    • Psychological Testing: Licensed psychologist and psychological associates typically provide this service for those who need additional diagnostic and treatment recommendations clarification after an initial assessment. There are a wide array of testing options available.
  • Support Services are typically add-on services that augment the basic service array and assist with treatment engagement and supporting community integration for those with more serious mental health conditions. Support Services within the Cardinal Innovations adult mental health service array include:

    • Individual Support: Individual support is a service that teaches independent living skills to adults with severe and persistent mental illness (SPMI) who reside in, or who have recently left, non-independent living (often institutionalized) settings. Teaching focuses on daily living skills such as shopping, cooking, social and financial management skills.

    • Peer Support: Peer support is an evidence-based practice that employs consumers of care who are in recovery to help engage adults with mental health and substance use disorders. This service promotes the development of wellness self-management, personal recovery, natural supports, coping skills and self-advocacy skills. Peer support is also used to assist an individual while he or she is receiving outpatient or other services, following a crisis event, with housing transitions and with community reintegration following hospitalization or completion of jail/prison sentences.

    • Psychiatric Consultation: provides psychiatric telephonic consultation directly to primary care providers to assist them in managing behavioral health conditions in that setting.

    • Transitional Living: This service is for youth up to the age of 21 who will be transitioning into independent living situations (e.g., out of foster care) and need support in acquiring, retaining, and improving self-help, socialization and adaptive skills necessary to be successful. This service helps youth access the resources they need for transportation, housing, continuing education and employment, with the ultimate goal of being able to reside successfully in home and community-integrated settings.

    • Supported Employment services provide assistance to members with behavioral health conditions as they choose and acquire a job and maintain employment.
  • Enhanced Services are typically community-based, team-led interventions with both therapeutic and case management components to assist members with more severe behavioral health conditions. Enhanced Services within the Cardinal Innovations adult mental health service array include the following:
    • Community Support Team (CST) is a three-person team led by a licensed therapist. CST provides therapy and case management services together in a short-term, intensive format. This service is intended for those with moderate to severe MH/SA issues AND who have serious social and/or legal life complications requiring a coordinated treatment approach.
    • Psychosocial Rehabilitation (PSR) is a long-term clubhouse or community center for those with severe mental illness (SMI) or SPMI where independent living, pre-vocational and social skills are developed on a daily basis to promote greater community integration, independence and recovery. Members cannot be in ACTT and receive this service concurrently.
    • Assertive Community Treatment Team (ACTT) is a wrap-around long-term service with a psychiatrist leading the effort to provide psychiatric and nursing services, individual and group therapy; case-management, and peer, housing and vocational support services. This service is intended for those with serious and persistent mental illness (SPMI), who may have comorbid substance use problems and require wrap around care to remain out of inpatient or other institutionalized settings.

    • Partial Hospitalization is a short-term, intensive day program designed to prevent hospitalization or service as a step-down from an inpatient hospitalization for individuals with acute, severe mental health disorders.
  • Residential Services are state (non-Medicaid) funded, supervised living supports for individuals with severe mental illnesses, who have substantial deficits in maintaining community integration and attending to their activities of daily living. Funding for adult behavioral health residential supports is very limited. Residential Supports range from low to moderate to high.

    In 2011, North Carolina settled with the U.S. Department of Justice (DOJ) regarding warehousing of disabled populations in adult care home and other non-integrated settings, and new services/supports were made available or were improved. These services include
    tenancy supports (non-Medicaid funded), supported employment and long-term vocational supports, peer supports, individual supports, and high-fidelity ACT teams. For those who are not subject to DOJ settlement requirements, the state also provides capitated (non-Medicaid funded, non-entitlement) funding for adult residential group homes for those with severe MH/SA problems, some of whom may have comorbid ID/DD. It is important to note that these funding streams are highly limited.

    Cardinal Innovations employs In-Reach Specialists to assist its SMI and SPMI members, housed in group/family-care home settings, who wish to live in community-based, integrated or independent housing. In-Reach Specialists assist individuals throughout the housing transition and will connect them to additional supportive services such as Individual Supports, Supported Employment, Tenancy Supports, high-fidelity ACT teams and any other necessary services.​
  • Crisis Services are designed to address acute symptom exacerbations for those with behavioral health disorders in an effort to either avert an inpatient crisis admission or to facilitate such an admission. Crisis Services range from brief interventions provided by the member's existing provider to intensive 24/7 stabilization and treatment provided in an inpatient setting. The full range of crisis services can be found here. ​​