Accessible services
Services that are affordable, located nearby, and open during evenings and weekends. Staff is sensitive to and incorporates individual and cultural values. Staff is also sensitive to barriers that may keep a person from getting help. For example, an adolescent may be more willing to attend a support group meeting in a church or club near home than to travel to a mental health center. An accessible service can handle consumer demand without placing people on a long waiting list.

Accreditation
An official decision made by a recognized organization that a health care plan, network, or other delivery system complies with applicable standards.

Activity Therapy
Includes art, dance, music, recreational and occupational therapies, and psychodrama.

Addition
The number of persons admitted, readmitted, or transferred to a specified service during the reporting period.

Administrative Costs
Costs not linked directly to the provision of medical care. Includes marketing, claims processing, billing, and medical record keeping, among others.

Alternative Therapy
An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial.

Alzheimer's Disease (AD)
A slowly progressive form of dementia, which is a progressive, acquired impairment of intellectual functions. Memory impairment is a necessary feature for the diagnosis. Change in one of the following areas must also be present for any form of dementia to be diagnosed: language, decision-making ability, judgment, attention, and other related areas of cognitive function and personality. The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course. The cause of Alzheimer's disease (AD) is not known, but it is not a part of normal aging. Prior theories regarding the accumulation of aluminum, lead, mercury, and other substances in the brain have been disproved. A diagnosis of AD is made based on characteristic symptoms and by excluding other causes of dementia. It can be confirmed by microscopic examination of a sample of brain tissue after death. By causing both structural and chemical problems in the brain, AD appears to disconnect areas of the brain that normally work together. There are two types of AD -- early onset and late onset. In early onset AD, symptoms first appear before age 60. Some early onset disease runs in families and involves autosomal dominant, inherited mutations that may be the cause of the disease. So far, three early onset genes have been identified. Early onset AD is less common, resulting in about 5-10% of cases. Late onset AD, the most common form of the disease, develops in people 60 and older and is thought to be less likely to occur in families. Late onset AD may run in some families, but the role of genes is less direct and definitive. These genes may not cause the problem itself, but simply increase the likelihood of formation of plaques and tangles or other AD-related pathologies in the brain. In the early stages, the symptoms may be very subtle. Symptoms may often include: repeating statements frequently, frequently misplacing items, trouble finding names for familiar objects, getting lost on familiar routes, personality changes, becoming passive and losing interest in things previously enjoyed. AD cannot be cured and the impaired functions cannot be restored. Currently, the progression can be slowed but not stopped. Treatment focuses on attempting to slow the progression; managing the behavior problems, confusion, and agitation; modifying the home environment; and most importantly, supporting the family. As the disease progresses, it may take a greater toll on the family than the patient.

American Indian or Alaska Native
A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliations or community attachment.

Anorexia
An eating disorder characterized by refusal to maintain a minimally accepted body weight, intense fear of weight gain, and distorted body image. Inadequate calorie intake or excessive energy expenditure results in severe weight loss. The exact cause of this disorder is not known, but social attitudes towards body appearance and family factors are believed to play a role in its development. The condition usually occurs in adolescence or young adulthood. It is more common in women, affecting 1-2% of the female population and only 0.1-0.2% of males. Anorexia is seen mainly in Caucasian women who are high academic achievers and have a goal-oriented family or personality. However, this eating disorder is not more common in higher socioeconomic groups. Some experts have suggested that conflicts within a family may also contribute to anorexia. It is thoughts that anorexia is a way for a child to draw attention away from marital problems, for example, and bring the family back together. Other psychologists have suggested that anorexia may be an attempt by young women to gain control and separate from their mothers. The causes, however, are still not well understood. The purpose of treatment is first to restore normal body weight and eating habits, and then attempt to resolve psychological issues. Hospitalization may be indicated in some cases (usually when body weight falls below 30% of expected weight). Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require intravenous feeding.

Anxiety
Anxiety is an emotion that can signal just the right response to a situation. It can spur you on, for example, to add the finishing touches that transform an essay, painting, or important work document from good to excellent. However, if you have an anxiety disorder, exaggerated anxiety can stop you cold and disrupt your life. Like many other illnesses, anxiety disorders often have an underlying biological cause and frequently run in families. Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Symptoms range from chronic, exaggerated worry, tension, and irritability and appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms. Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.

Anxiety Disorders
Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.

Any willing provider
A requirement that a health plan contract for the delivery of health care services with any provider in the area who would like to provide such services to the plan's enrollees.

Appropriate services
Designed to meet the specific needs of each individual child and family. For example, one family may need day treatment, while another may need home-based services. Appropriate services for one child and family may not be appropriate for another. Appropriate services usually are provided in the child's community.

Appropriateness
The extent to which a particular procedure, treatment, test, or service is clearly indicated, not excessive, adequate in quantity, and provided in the setting best suited to a patient's or member's needs. (See also, medically necessary)

Asian
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Assertive Community Treatment
A multi-disciplinary clinical team approach of providing 24-hour, intensive community services in the individual's natural setting that help individuals with serious mental illness live in the community.

Assessment
A professional review of child and family needs that is done when services are first sought from a caregiver. The assessment of the child includes a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community. The assessment identifies the strengths of the child and family. Together, the caregiver and family decide what kind of treatment and supports, if any, are needed.

Attention Deficit Hyperactivity Disorder(ADD-ADHD)
Attention Deficit Hyperactivity Disorder (ADD-ADHD) is a neurobiological condition characterized by developmentally inappropriate level of attention, concentration, activity, distractability, and impulsivity. The symptoms typically begin by 3 years of age-Attention deficit: does not pay close attention to details; may make careless mistakes at work, school, or other activities; failure to complete tasks; has difficulty maintaining attention in tasks or play activities; does not listen when spoken to directly; has difficulty organizing tasks; is easily distracted; unable to follow more than one instruction at a time. Many different methods of treatment have been used for ADD including psychotropic medications, psychosocial interventions, dietary management, herbal and homeopathic remedies, biofeedback, meditation, and perception stimulation/training. Of these treatment strategies, the most research has been done on stimulant medications and psychosocial interventions. Overall, these studies suggest stimulants to be superior relative to psychosocial interventions. However, there is no long term information comparing the two. The primary medications used to treat attention deficit disorder include: Dexedrine (dextroamphetamine), Ritalin (methylphenidate), Cylert (magnesium pemoline), tranquilizers (such as thioridazine), alpha-adrenergic agonist (clonidine), and others. Psychosocial therapeutic techniques include: contingency management (e.g., point reward systems, time out...), cognitive-behavioral treatment (self monitoring, verbal self instruction, problem solving strategies, self reinforcement), parent counseling, individual psychotherapy.

Autism
Autism, also called autistic disorder, is a complex developmental disability that appears in early childhood, usually before age 3. Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development.

Auto-enrollment
The automatic assignment of a person to a health insurance plan (typically done under Medicaid plans).

Average Length of Stay
This represents the average time a client receives a specified service during a specified time period. This is generally computed by counting all the days that clients received the service during the time period and dividing by the number of clients that received the service during the same period. (Days a person was on furlough or not receiving are not counted.)

Behavioral heath care firm
Specialized (for-profit) managed care organizations focusing on mental health and substance abuse benefits, which they term "behavioral healthcare." These firms offer employers and public agencies a managed mental health and substance abuse benefit.

Behavioral Therapy
As the name implies, behavioral therapy focuses on behavior-changing unwanted behaviors through rewards, reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior.

Beneficiary
A person certified as eligible for health care services. A beneficiary may be a dependent or a subscriber.

Binge Eating
Binge Eating is an eating disorder characterized by eating more than needed to satisfy hunger. It is a feature of bulimia, a disorder that also includes abnormal perception of body image, constant craving for food and binge eating, followed by self- induced vomiting or laxative use.

Biofeedback
Biofeedback is learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin temperature; it can be a path to mastering one's fears. It is used in combination with, or as an alternative to, medication to treat disorders such as anxiety, panic, and phobias.

Biomedical Treatment
Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of emotional, behavioral, and mental disorders. Any treatment involving medicine is a biomedical treatment. The kind of medication a psychiatrist prescribes varies with the disorder and the individual being treated.

Bipolar Disorder
A chronic disease affecting over 2 million Americans at some point in their lives. The American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" describes two types of bipolar disorder, type I and type II. In type I (formerly known as manic depressive disorder), there has been at least one full manic episode. However, people with this type may also experience episodes of major depression. In type II disorder, periods of "hypomania" involve more attenuate (less severe) manic symptoms that alternate with at least one major depressive episode. When the patients have an acute exacerbation, they may be in a manic state, depressed state, or mixed state. People who suffer from bipolar disorder, however, have pathological mood swings from mania to depression, with a pattern of exacerbation and remission that are sometimes cyclic. The manic phase is characterized by elevated mood, hyperactivity, over-involvement in activities, inflated self-esteem, a tendency to be easily distracted, and little need for sleep. The manic episodes may last from several days to months. In the depressive phase, there is loss of self-esteem, withdrawal, sadness, and a risk of suicide. While in either phase, patients may abuse alcohol or other substances which worsen the symptoms. The disorder appears between the ages of 15 and 25, and it affects men and women equally. The exact cause is unknown, but it is a disturbance of areas of the brain which regulate mood. There is a strong genetic component. The incidence is higher in relatives of people with bipolar disorder. Hospitalization may be required during an acute phase to control the symptoms and to ensure safety of individuals. Medications to alleviate acute symptoms may include: neuroleptics (antipsychotics), antianxiety agents (such as benzodiazepines), and antidepressant agents. Mood stabilizers, such as lithium carbonate, and anticonvulsants (including carbamazepine and valproic acid) are started as maintenance therapy to relieve symptoms and to prevent relapse.

Black or African American
A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

Borderline Personality Disorder
Symptoms of borderline personality disorder, a serious mental illness, include pervasive instability in moods, interpersonal relationships, self-image, and behavior. The instability can affect family and work life, long-term planning, and the individual's sense of self-identity.

Bulimia
An illness characterized by uncontrolled episodes of overeating usually followed by self-induced vomiting or other purging. In bulimia, eating binges may occur as often as several times a day. Induced vomiting known as purging allows the eating to continue without the weight gain; it may continue until interrupted by sleep, abdominal pain, or the presence of another person. The person is usually aware that their eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. The behavior is usually secretive, although clues to this disorder include overactivity, peculiar eating habits, eating rituals, and frequent weighing. Body weight is usually normal or low, although the person may perceive themselves as overweight. The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, maladaptive behavior, self- identity conflict, and cultural overemphasis on physical appearance. Bulimia may be associated with depression. The disorder is usually not associated with any underlying physical problem although the behavior may be associated with neurological or endocrine diseases. The disorder occurs most often in females of adolescent or young adult age. The incidence is estimated to be 3% in the general population; but 20% of college women suffers from it. Treatment focuses on breaking the binge-purge cycles of behavior since the person is usually aware that the behavior is abnormal. Outpatient treatment may include behavior modification techniques and individual, group, or family counseling. Antidepressant drugs may be indicated for some whether or not they have coincident depression.

Caregiver
A person who has special training to help people with mental health problems. Examples include social workers, teachers, psychologists, psychiatrists, and mentors.

Case manager
An individual who organizes and coordinates services and supports for children with mental health problems and their families. (Alternate terms: service coordinator, advocate, and facilitator.)

Child protective services
Designed to safeguard the child when abuse, neglect, or abandonment is suspected, or when there is no family to take care of the child. Examples of help delivered in the home include financial assistance, vocational training, homemaker services, and daycare. If in-home supports are insufficient, the child may be removed from the home on a temporary or permanent basis. Ideally, the goal is to keep the child with the family whenever possible.

Children and adolescents at risk for mental health problems
Children are at greater risk for developing mental health problems when certain factors occur in their lives or environments. Factors include physical abuse, emotional abuse or neglect, harmful stress, discrimination, poverty, loss of a loved one, frequent relocation, alcohol and other drug use, trauma, and exposure to violence.

Claim
A request by an individual (or his or her provider) to that individual's insurance company to pay for services obtained from a health care professional.

Clinical Psychologist
A clinical psychologist is a professional with a doctoral degree in psychology who specializes in therapy.

Clinical Social Worker
Clinical social workers are health professionals trained in client-centered advocacy that assist clients with information, referral, and direct help in dealing with local, State, or Federal government agencies. As a result, they often serve as case managers to help people "navigate the system." Clinical social workers cannot write prescriptions.

Cognitive/Behavioral Therapy
A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.

Cognitive Therapy
Cognitive therapy aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or even self- destructive. The goal is to replace such thinking with a more balanced view that, in turn, leads to more fulfilling and productive behavior.

Collateral Services
Services that include contacts with significant others involved in the client's/patient's life for the purpose of discussing the client's/patient's emotional or behavioral problems or the collateral's relationship with the client/patient.

Community Services
Services that are provided in a community setting. Community services refer to all services not provided in an inpatient setting.

Conduct Disorders
Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when these symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools.

Consolidated Omnibus Budget Reconciliation Act (COBRA)
An act that allows workers and their families to continue their employer-sponsored health insurance for a certain amount of time after terminating employment. COBRA imposes different restrictions on individuals who leave their jobs voluntarily versus involuntarily.

Consumer
Any individual who does or could receive health care or services. Includes other more specialized terms, such as beneficiary, client, customer, eligible member, recipient, or patient.

Consumer Run Services
Mental health treatment or support services that are provided by current or former mental health consumers. Includes social clubs, peer- support groups, and other peer-organized or consumer-run activities.

Continuous quality improvement (CQI)
An approach to health care quality management borrowed from the manufacturing sector. It builds on traditional quality assurance methods by putting in place a management structure that continuously gathers and assesses data that are then used to improve performance and design more efficient systems of care. Also known as total quality management (TQM).

Continuum of care
A term that implies a progression of services that a child moves through, usually one service at a time. More recently, it has come to mean comprehensive services. Also see system of care and wraparound services.

Coordinated services
Child-serving organizations talk with the family and agree upon a plan of care that meets the child's needs. These organizations can include mental health, education, juvenile justice, and child welfare. Case management is necessary to coordinate services. Also see family-centered services and wraparound services.

Couples Counseling and Family Therapy
These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist-sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a family member with a mental illness- such as how to deal with feelings of anger or guilt.

Creditable Coverage
Any prior health insurance coverage that a person has received. Creditable coverage is used to decrease exclusion periods for pre- existing conditions when an individual switches insurance plans. Insurers cannot exclude coverage of pre-existing conditions, but may impose an exclusion period (no more than 12 months) before covering such conditions. (See also, Health Insurance Portability and Accountability Act)

Crisis residential treatment services
Short-term, round-the-clock help provided in a nonhospital setting during a crisis. For example, when a child becomes aggressive and uncontrollable, despite in-home supports, a parent can temporarily place the child in a crisis residential treatment service. The purposes of this care are to avoid inpatient hospitalization, help stabilize the child, and determine the next appropriate step.

Cultural competence
Help that is sensitive and responsive to cultural differences. Caregivers are aware of the impact of culture and possess skills to help provide services that respond appropriately to a person's unique cultural differences, including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability. They also adapt their skills to fit a family's values and customs.

Day treatment
Day treatment includes special education, counseling, parent training, vocational training, skill building, crisis intervention, and recreational therapy. It lasts at least 4 hours a day. Day treatment programs work in conjunction with mental health, recreation, and education organizations and may even be provided by them.

Deductible
The amount an individual must pay for health care expenses before insurance (or a self- insured company) begins to pay its contract share. Often insurance plans are based on yearly deductible amounts.

Delusions
Delusions are bizarre thoughts that have no basis in reality.

Dementia
Refers to a group of symptoms involving progressive impairment of all aspects of brain function. Disorders that cause dementia include conditions that impair the vascular (blood vessels) or neurologic (nerve) structures of the brain. A minority of causes of dementia are treatable. These include normal pressure hydrocephalus, brain tumors, and dementia due to metabolic causes and infections. Unfortunately, most of the disorders associated with dementia are progressive, irreversible, degenerative conditions. The two major degenerative causes of dementia are Alzheimer's disease, which is a progressive loss of nerve cells without a known cause or cure and vascular dementia, which is loss of brain function due to a series of small strokes. Dementia may be diagnosed when there is impairment of two or more brain functions, including language, memory, visual-spatial perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually appears first as forgetfulness. Other symptoms may be apparent only on neurologic examination or cognitive testing. Loss of functioning progresses slowly from decreased problem solving and language skills to difficulty with ordinary daily activities to severe memory loss and complete disorientation with withdrawal from social interaction.

Depression
A term that people commonly use to refer to states involving sadness, dejection, lack of self-esteem, and lack of energy. Feelings of depression are synonymous with feeling sad, blue, down in the dumps, unhappy, and miserable. Most feelings of depression are a reaction to an unhappy event. It is natural to have some feelings of sadness after a loss such as the death of a relative, or after a major disappointment at home or at work. Depression is more prevalent in women than men and is especially common among adolescents. Mild depression comes and goes and is characterized by downheartedness, sadness, and dejection. Short-term episodes of depression or other mood changes can occur with hormone changes, including those that accompany pregnancy or premenstrual syndrome (PMS), and those occurring shortly after the birth of a baby (postpartum "blues"). Sleep disruption and lack of sunlight during the winter months are other biological factors that can precipitate depressive symptoms. Distorted thought patterns, characterized by feelings of worthlessness, helplessness, and hopelessness are part of the "cognitive triad of depression," and can be a risk factor for depression. It appears that a tendency toward depression is often genetic, but that stressful life circumstances usually play a major role in bringing on depressive episodes. Problems with depression usually begin in adolescence, and are about twice as common in women as in men. Noticeably disturbed thought processes, poor communication and socialization, and sensory dysfunction indicate moderate depression. People with severe depression are withdrawn, indifferent toward their surroundings, and may show signs of delusional thinking and limited physical activity.

Diagnostic Evaluation
The aims of a general psychiatric evaluation are 1) to establish a psychiatric diagnosis, 2) to collect data sufficient to permit a case formulation, and 3) to develop an initial treatment plan, with particular consideration of any immediate interventions that may be needed to ensure the patient's safety, or, if the evaluation is a reassessment of a patient in long-term treatment, to revise the plan of treatment in accord with new perspectives gained from the evaluation.

Discharge
A discharge is the formal termination of service, generally when treatment has been completed or through administrative authority.

Drop-in Center
A social club offering peer support and flexible schedule of activities: may operate on evenings and/ weekends.

Drug Formulary
The list of prescription drugs for which a particular employer or State Medicaid program will pay. Formularies are either "closed," including only certain drugs or "open," including all drugs. Both types of formularies typically impose a cost scale requiring consumers to pay more for certain brands or types of drugs.

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
An official manual of mental health problems developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other health and mental health care providers use this reference book to understand and diagnose mental health problems. Insurance companies and health care providers also use the terms and explanations in this book when discussing mental health problems.

Dyslexia
A reading disability resulting from a defect in the ability to process graphic symbols. There are about 2 to 8% of elementary-age children that have some degree of reading disability. Developmental reading disorder (DRD) or dyslexia is not attributable to eye problems but instead is a defect of higher cortical (brain) processing of symbols. Children with DRD may have trouble rhyming and separating the sounds in spoken words. These abilities appear critical in the process of learning to read. Initial reading skills are based on word recognition. More developed reading skills require the linking of words into a coherent sentence (thought). DRD children may be unable to form images from the meanings of the words or to process the words into an idea which is understandable. At this level, reading may fail at its primary function, which is to convey information. Dyslexia or developmental reading disorder may appear in combination with developmental writing disorder and developmental arithmetic disorder. All of these processes involve the manipulation of symbols and the conveyance of information by their manipulation. These conditions may appear singly or in any combination. Other causes of learning disability and, in particular, reading disability, must be ruled out before a diagnosis of DRD can be made. Cultural and educational shortfalls, emotional problems, mental retardation, and diseases of the brain (for example AIDS) can all cause learning disabilities. Remedial instruction has remained the best approach to this type of reading disorder.

Education Services link
Locating or providing a full range of educational services from basic literacy through the General Equivalency Diploma and college courses. Includes special education at the pre-primary, primary, secondary, and adult levels.

Electroconvulsive Therapy
Also known as ECT, this highly controversial technique uses low voltage electrical stimulation of the brain to treat some forms of major depression, acute mania, and some forms of schizophrenia. This potentially life- saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines, and anesthesia have significantly reduced the possibility of side effects.

Emergency
A planned program to provide psychiatric care in emergency situations with staff specifically assigned for this purpose. Includes crisis intervention, which enables the individual, family members and friends to cope with the emergency while maintaining the individual's status as a functioning community member to the greatest extent possible.

Emergency and crisis services
A group of services that is available 24 hours a day, 7 days a week, to help during a mental health emergency. Examples include telephone crisis hotlines, suicide hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care.

Emergency Medical Treatment and Labor Act (EMTALA)
EMTALA, also referred to as the Federal Anti- patient Dumping Law link An act pertaining to emergency medical situations. EMTALA requires hospitals to provide emergency treatment to individuals, regardless of insurance status and ability to pay (EMTALA, 2002).

Employed
This is a broad category of employment that includes competitive, supported, and sheltered employment.

Employment/Vocational Rehabilitation Services
A broad range of services designed to address skills necessary for participation in job- related activities.

Enrollee
A person eligible for services from a managed care plan.

Family-centered services
Help designed to meet the specific needs of each individual child and family. Children and families should not be expected to fit into services that do not meet their needs. Also see appropriate services, coordinated services, wraparound services, and cultural competence.

Family-like arrangements
A broad range of living arrangements that simulate a family situation. This includes foster care and small group homes.

Family support services
Help designed to keep the family together, while coping with mental health problems that affect them. These services may include consumer information workshops, in-home supports, family therapy, parenting training, crisis services, and respite care.

Fee for Service
A type of health care plan under which health care providers are paid for individual medical services rendered.

Foster Care
Provision of a living arrangement in a household other than that of the client's/patient's family.

Gatekeeper
Primary care physician or local agency responsible for coordinating and managing the health care needs of members. Generally, in order for specialty services such as mental health and hospital care to be covered, the gatekeeper must first approve the referral.

General Hospital
A hospital that provides mental health services in at least one separate psychiatric unit with specially allocated staff and space for the treatment of persons with mental illness.

General Support
Includes transportation, childcare, homemaker services, day care, and other general services for clients/patients.

Group Therapy
This form of therapy involves groups of usually 4 to 12 people who have similar problems and who meet regularly with a therapist. The therapist uses the emotional interactions of the group's members to help them get relief from distress and possibly modify their behavior.

Hallucinations
Hallucinations are experiences of sensations that have no source. Some examples of hallucinations include hearing nonexistent voices, seeing nonexistent things, and experiencing burning or pain sensations with no physical cause.

Health Insurance Portability and Accountability Act (HIPAA)
This 1996 act provides protections for consumers in group health insurance plans. HIPAA prevents health plans from excluding health coverage of pre-existing conditions and discriminating on the basis of health status.

Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino."

Home-based services
Help provided in a family's home either for a defined period of time or for as long as it takes to deal with a mental health problem. Examples include parent training, counseling, and working with family members to identify, find, or provide other necessary help. The goal is to prevent the child from being placed outside of the home. (Alternate term: in-home supports.)

Homeless
A person who lives on the street or in a shelter for the homeless.

Horizontal consolidation
When local health plans (or local hospitals) merge. This practice was popular in the late 1990s and was used to expand regional business presence.

Housing Services
Assistance to clients/patients in finding and maintaining appropriate housing arrangements.

In Home Family Services
Mental health treatment and support services offered to children and adolescents with mental illness and to their family members in their own homes or apartments.

Indemnity plan
Indemnity insurance plans are an alternative to managed care plans. These plans charge consumers a set amount for coverage and reimburse (fully or partially) consumers for most medical services.

Independent living services
Support for a young person living on his or her own. These services include therapeutic group homes, supervised apartment living, and job placement. Services teach youth how to handle financial, medical, housing, transportation, and other daily living needs, as well as how to get along with others.

Individual Therapy
Therapy tailored for a patient/client that is administered one-on-one.

Individualized services
Services designed to meet the unique needs of each child and family. Services are individualized when the caregivers pay attention to the needs and strengths, ages, and stages of development of the child and individual family members. Also see appropriate services and family-centered services.

Information and Referral Services
Information services are those designed to impart information on the availability of clinical resources and how to access them. Referral services are those that direct, guide, or a client/patient with appropriate services provided outside of your organization.

Inpatient hospitalization
Mental health treatment provided in a hospital setting 24 hours a day. Inpatient hospitalization provides: (1) short-term treatment in cases where a child is in crisis and possibly a danger to his/herself or others, and (2) diagnosis and treatment when the patient cannot be evaluated or treated appropriately in an outpatient setting.

Intake/Screening
Services designed to briefly assess the type and degree of a client's/patient's mental health condition to determine whether services are needed and to link him/her to the most appropriate and available service. Services may include interviews, psychological testing, physical examinations including speech/hearing, and laboratory studies.

Intensive case management
Intensive community services for individuals with severe and persistent mental illness that are designed to improve planning for their service needs. Services include outreach, evaluation, and support.

Intensive Residential Services
Intensively staffed housing arrangements for clients/patients. May include medical, psychosocial, vocational, recreational or other support services.

Interpersonal Psychotherapy
Through one-on-one conversations, this approach focuses on the patient's current life and relationships within the family, social, and work environments. The goal is to identify and resolve problems with insight, as well as build on strengths.

Legal Advocacy
Legal services provided to ensure the protection and maintenance of a client's/patient's rights.

Length of Stay
The duration of an episode of care for a covered person. The number of days an individual stays in a hospital or inpatient facility.

Living Independently
A client who lives in a private residence and requires no assistance in activities of daily living.

Local Mental Health Authority
Local organizational entity (usually with some statutory authority) that centrally maintains administrative, clinical, and fiscal authority for a geographically specific and organized system of health care.

Medicaid
Medicaid is a health insurance assistance program funded by Federal, State, and local monies. It is run by State guidelines and assists low-income persons by paying for most medical expenses.

Medicaid client
Mental health clients to whom some services were reimbursable through Medicaid.

Medical group practice
A number of physicians working in a systematic association with the joint use of equipment and technical personnel and with centralized administration and financial organization.

Medical review criteria
Screening criteria used by third-party payers and review organizations as the underlying basis for reviewing the quality and appropriateness of care provided to selected cases.

Medically necessary
Health insurers often specify that, in order to be covered, a treatment or drug must be medically necessary for the consumer. Anything that falls outside of the realm of medical necessity is usually not covered. The plan will use prior authorization and utilization management procedures to determine whether or not the term "medically necessary" is applicable.

Medicare
Medicare is a Federal insurance program serving the disabled and persons over the age of 65. Most costs are paid via trust funds that beneficiaries have paid into throughout the courses of their lives; small deductibles and some co-payments are required.

Medication Therapy
Prescription, administration, assessment of drug effectiveness, and monitoring of potential side effects of psycho-tropic medications.

MediGap
MediGap plans are supplements to Medicare insurance. MediGap plans vary from State to State; standardized MediGap plans also may be known as Medicare Select plans.

Member
Used synonymously with the terms enrollee and insured. A member is any individual or dependent who is enrolled in and covered by a managed health care plan.

Mental disorders
Another term used for mental health problems.

Mental Health
Refers to how a person thinks, feels, and acts when faced with life's situations. It is how people look at themselves, their lives, and the other people in their lives; evaluate the challenges and the problems; and explore choices. This includes handling stress, relating to other people, and making decisions.

Mental health
How a person thinks, feels, and acts when faced with life's situations. Mental health is how people look at themselves, their lives, and the other people in their lives; evaluate their challenges and problems; and explore choices. This includes handling stress, relating to other people, and making decisions.

Mental Health Parity (Act)
Mental health parity refers to providing the same insurance coverage for mental health treatment as that offered for medical and surgical treatments. The Mental Health Parity Act was passed in 1996 and established parity in lifetime benefit limits and annual limits.

Mental health problems
Mental health problems are real. They affect one's thoughts, body, feelings, and behavior. Mental health problems are not just a passing phase. They can be severe, seriously interfere with a person's life, and even cause a person to become disabled. Mental health problems include depression, bipolar disorder (manic-depressive illness), attention-deficit/ hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia, and conduct disorder.

Mental illnesses
This term is usually used to refer to severe mental health problems in adults.

MHA Administration
Activities related to the planning, organization, management, funding, and oversight of direct services.

MHA Data collection/reporting
These are activities to obtain, analyze, and report data for planning, management or evaluation purposes.

MHA Other Activities
Other specific non-direct service activities of State MHAs that further the provision of mental health services in the State.

MHA Planning Council Activities
All activities that comply with the mandate of State MHAs to form and operate a planning council to support the development of a strategic plan for mental health services and assess ongoing operations.

MHA Technical Assistance
Provision or sponsorship of training, education, or technical support in the planning, operation or management of public mental health programs in the State.

MI and MR/DD services
Services designed to address the needs of people with both psychiatric illness and mental retardation or developmental disabilities.

Mobile Treatment Team
Provides assertive outreach, crisis intervention, and independent-living assistance with linkage to necessary support services in the client's/patient's own environment. This includes PACT, CTTP, or other continuous treatment team programs.

More Than One Race
A category of racial grouping for a person who reports multiple racial origins.

Native Hawaiian or Other Pacific Islander
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Network
The system of participating providers and institutions in a managed care plan.

Network adequacy
Many States have laws defining network adequacy, the number and distribution of health care providers required to operate a health plan. Also known as provider adequacy of a network.

New Generation Medications
Anti-psychotic medications which are new and atypical.

Non-Institutional Services
A facility that provides mental health services, but not on a residential basis, other than an inpatient facility or nursing home.

Non-Medicaid Services
Services other than those funded by Medicaid.

Nurse Practitioner (NP)
A nurse practitioner is a registered nurse who works in an expanded role and manages patients' medical conditions.

Nursing Home
An establishment that provides living quarters and care for the elderly and the chronically ill. This includes assisted living outside a nursing home.

Obsessive-Compulsive Disorder (OCD)
One of the anxiety disorders, OCD is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home. Obsessions are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness. In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Mental problems, such as mentally repeating phrases, listmaking, or checking are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary. People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity. OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Co-existing disorders can make OCD more difficult both to diagnose and to treat.

Outcomes
The results of a specific health care service or benefit package.

Outcomes research
Studies that measure the effects of care or services.

Panic Disorder
Panic Disorder is when people experience white-knuckled, heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment. Most panic attacks last only a few minutes, but they occasionally go on for ten minutes, and, in rare cases, have been known to last for as long as an hour. They can occur at any time, even during sleep. The good news is that proper treatment helps 70 to 90 percent of people with panic disorder, usually within six to eight weeks. Symptoms include pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy. Cognitive behavioral therapy and medications such as high-potency anti-anxiety drugs like alprazolam can be used to treat panic disorders. Several classes of antidepressants (such as paroxetine, one of the newer selective serotonin reuptake inhibitors) and the older tricyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered "gold standards" for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms.

Pastoral Counseling
Pastoral counselors are counselors working within traditional faith communities to incorporate psychotherapy, and/or medication, with prayer and spirituality to effectively help some people with mental disorders. Some people prefer to seek help for mental health problems from their pastor, rabbi, or priest, rather than from therapists who are not affiliated with a religious community.

Pharmacy Benefit Manager (PBM)
PBMs are third party administrators of prescription drug benefits.

Phobias
Irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms. Specific phobia is an unfounded fear of a particular object or situation-such as being afraid of dogs, yet loving to ride horses, or avoiding highway driving, yet being able to drive on city and country roads. Virtually an unlimited number of objects or situations- such as being afraid of flying, heights, or spiders-can be the target of a specific phobia. Agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Many people who have agoraphobia become housebound. Others avoid open spaces, standing in line, or being in a crowd. Many of the physical symptoms that accompany panic attacks - such as sweating, racing heart, and trembling - also occur with phobias. Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking. Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as anti-anxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.

Physician Assistant
A physician assistant is a trained professional who provides health care services under the supervision of a licensed physician.

Plan of care
A treatment plan especially designed for each child and family, based on individual strengths and needs. The caregiver(s) develop(s) the plan with input from the family. The plan establishes goals and details appropriate treatment and services to meet the special needs of the child and family.

Play Therapy
Geared toward young children, play therapy uses a variety of activities-such as painting, puppets, and dioramas-to establish communication with the therapist and resolve problems. Play allows the child to express emotions and problems that would be too difficult to discuss with another person.

Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) affects people of all ages if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, or war or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person's ability to hold a job or to develop intimate relationships with others. The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. In addition, people with PTSD typically avoid situations that remind them of the traumatic event, because they provoke intense distress or even panic attacks. A rape victim with PTSD, for example, might avoid all contact with men and refuse to go out alone at night. Many people with PTSD also develop depression and may, at times, abuse alcohol or other drugs as "self-medication" to dull their emotional pain and to forget about the trauma. Psychotherapy can help people who have PTSD regain a sense of control over their lives. Many people who have this disorder need to confront what has happened to them and, by repeating this confrontation, learn to accept the trauma as part of their past. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Another focus of psychotherapy is to help people who have PTSD resolve any conflicts that may have occurred as a result of the difference between their personal values and how behaviors and experiences during the traumatic event violated them. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and anti- anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.

Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder is an anxiety disorder that develops as a result of witnessing or experiencing a traumatic occurrence, especially life threatening events. PTSD can cause can interfere with a person's ability to hold a job or to develop intimate relationships with others.

Prader-Willi Syndrome
A congenital (present from birth) disease characterized by obesity, decreased muscle tone, decreased mental capacity, and hypogonadism. Prader-Willi is caused by the deletion of a gene on chromosome 15. For unkown reasons, only the copy of this gene on chromosome 15 that is received from the father is active. The maternal copy of this gene is turned off in all people. When there is a deletion of this gene on the copy received from the father, the disease occurs. This is because the patient is left with only the maternal copy -- which is inactive in all people. Signs of Prader-Willi may be seen at birth. New infants with the condition are often small and very floppy (hypotonic). Male infants may have undescended testicles. The growing child exhibits slow mental and delayed motor development, increasing obesity, and characteristically small hands and feet. Rapid weight gain may occur during the first few years because the patient develops uncontrollable hunger which leads to morbid obesity. Mental development is slow, and the IQ seldom exceeds 80. However, children with Prader-Willi generally are very happy, smile frequently, and are pleasant to be around. Affected children have an intense craving for food and will do almost anything to get it. This results in uncontrollable weight gain. Morbid obesity (the degree of obesity that seriously affects health) may lead to respiratory failure with hypoxia (low blood oxygen levels), cor pulmonale (right- sided heart failure), and death.

Pre-existing condition
A medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to the individual obtaining a policy from the insurance company. Many insurance companies now impose waiting periods for coverage of pre-existing conditions. Insurers will cover the condition after the waiting period (of no more than 12 months) has expired. (See also, HIPAA)

Prior authorization
The approval a provider must obtain from an insurer or other entity before furnishing certain health services, particularly inpatient hospital care, in order for the service to be covered under the plan.

Psychiatric Emergency Walk- in
A planned program to provide psychiatric care in emergency situations with staff specifically assigned for this purpose. Includes crisis intervention, which enables the individual, family members and friends to cope with the emergency while maintaining the individual's status as a functioning community member to the greatest extent possible and is open for a patient to walk-in.

Psychiatrist
A psychiatrist is a professional who completed both medical school and training in psychiatry and is a specialist in diagnosing and treating mental illness.

Psychoanalysis
Psychoanalysis focuses on past conflicts as the underpinnings to current emotional and behavioral problems. In this long-term and intensive therapy, an individual meets with a psychoanalyst three to five times a week, using "free association" to explore unconscious motivations and earlier, unproductive patterns of resolving issues.

Psychodynamic Psychotherapy
Based on the principles of psychoanalysis, this therapy is less intense, tends to occur once or twice a week, and spans a shorter time. It is based on the premise that human behavior is determined by one's past experiences, genetic factors, and current situation. This approach recognizes the significant influence that emotions and unconscious motivation can have on human behavior.

Psychosocial Rehabilitation
Therapeutic activities or interventions provided individually or in groups that may include development and maintenance of daily and community-living skills, self-care, skills training includes grooming, bodily care, feeding, social skills training, and development of basic language skills.

Registered Nurse (RN)
A registered nurse is a trained professional with a nursing degree who provides patient care and administers medicine.

Report Card
An accounting of the quality of services, compared among providers over time. The report card grades providers on predetermined, measurable quality and outcome indicators. Generally, consumers use report cards to choose a health plan or provider, while policy makers may use report card results to determine overall program effectiveness, efficiency, and financial stability.

Residential Services
Services provided over a 24-hour period or any portion of the day which a patient resided, on an on-going basis, in a State facility or other facility and received treatment.

Residential treatment centers
Facilities that provide treatment 24 hours a day and can usually serve more than 12 young people at a time. Children with serious emotional disturbances receive constant supervision and care. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually more long- term than inpatient hospitalization. Centers are also known as therapeutic group homes.

Respite care
A service that provides a break for parents who have a child with a serious emotional disturbance. Trained parents or counselors take care of the child for a brief period of time to give families relief from the strain of caring for the child. This type of care can be provided in the home or in another location. Some parents may need this help every week.

Respite Residential Services
Provision of periodic relief to the usual family members and friends who care for the clients/patients.

Retired
Clients who are of legal age, stopped working and have withdrawn from one's occupation.

Risk
Possibility that revenues of the insurer will not be sufficient to cover expenditures incurred in the delivery of contractual services. A managed care provider is at risk if actual expenses exceed the payment amount.

Risk adjustment
The adjustment of premiums to compensate health plans for the risks associated with individuals who are more likely to require costly treatment. Risk adjustment takes into account the health status and risk profile of patients.

Schizophrenia
A serious brain disorder. It is a disease that makes it difficult for a person to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses to others, and to behave normally in social situations. Schizophrenia is a complex and puzzling illness. Even the experts in the field are not exactly sure what causes it. Some doctors think that the brain may not be able to process information correctly. Genetic factors appear to play a role, as people who have family members with schizophrenia may be more likely to get the disease themselves. Some researchers believe that events in a person's environment may trigger schizophrenia. For example, problems during intrauterine development (infection) and birth may increase the risk for developing schizophrenia later in life. Psychological and social factors may also play some role in its development. However, the level of social and familial support appears to influence the course of illness and may be protective against relapse. There are five recognized types of schizophrenia: catatonic, paranoid, disorganized, undifferentiated, and residual. Features of schizophrenia include its typical onset before the age of 45, continuous presence of symptoms for six months or more, and deterioration from a prior level of social and occupational functioning. People with schizophrenia can have a variety of symptoms. Usually the illness develops slowly over months or even years. At first, the symptoms may not be noticed. For example, people may feel tense, may have trouble sleeping, or have trouble concentrating. They become isolated and withdrawn, and they do not make or keep friends. No single characteristic is present in all types of schizophrenia. The risk factors include a family history of schizophrenia. Schizophrenia is thought to affect about 1% of the population worldwide. Schizophrenia appears to occur in equal rates among men and women, but women have a later onset. For this reason, males tend to account for more than half of clients in services with high proportions of young adults. Although the onset of schizophrenia is typically in young adulthood, cases of the disorder with a late onset (over 45 years) are known. Childhood- onset schizophrenia begins after five years of age and, in most cases, after relatively normal development. Childhood schizophrenia is rare and can be difficult to differentiate from other pervasive developmental disorders of childhood, such as autism.

School attendance
Physical presence of a child in a school setting during scheduled class hours. "Regular" school attendance is attendance at least 75% of scheduled hours.

School Based Services
School-based treatment and support interventions designed to identify emotional disturbances and/or assist parents, teachers, and counselors in developing comprehensive strategies for addressing these disturbances. School-based services also include counseling or other school-based programs for emotionally disturbed children, adolescents, and their families within the school, home and community environment.

Seasonal affective disorder (SAD)
Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced. Researchers have found that people who have SAD can be helped with the symptoms of their illness if they spend blocks of time bathed in light from a special full-spectrum light source, called a "light box."

Section 1115 Waiver
A statutory provision that allows a State to operate its system of care for Medicaid enrollees in a manner different from that proscribed by the Centers for Medicare and Medicaid Services (CMS), in an attempt to demonstrate the efficacy and cost- effectiveness of an alternative delivery system through research and evaluation.

Section 1915(b) Waiver
A statutory provision that allows a State to partially limit the choice of providers for Medicaid enrollees; for example, under the waiver, a State can limit the number of times per year that enrollees can choose to drop out of an HMO.

Self-help
Self-help generally refers to groups or meetings that: involve people who have similar needs; are facilitated by a consumer, survivor, or other layperson; assist people to deal with a "life-disrupting" event, such as a death, abuse, serious accident, addiction, or diagnosis of a physical, emotional, or mental disability, for oneself or a relative; are operated on an informal, free-of-charge, and nonprofit basis; provide support and education; and are voluntary, anonymous, and confidential. Many people with mental illnesses find that self-help groups are an invaluable resource for recovery and for empowerment.

Serious emotional disturbances
Diagnosable disorders in children and adolescents that severely disrupt their daily functioning in the home, school, or community. Serious emotional disturbances affect one in 10 young people. These disorders include depression, attention- deficit/hyperactivity, anxiety disorders, conduct disorder, and eating disorders. Pursuant to section 1912(c) of the Public Health Service Act "children with a serious emotional disturbance" are persons: (1) from birth up to age 18 and (2) who currently have, or at any time during the last year, had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM- III-R. Federal Register Volume 58 No. 96 published Thursday May 20, 1993 pages 29422 through 29425.

Serious Mental Illness
Pursuant to section 1912(c) of the Public Health Service Act, adults with serious mental illness SMI are persons: (1) age 18 and over and (2) who currently have, or at any time during the past year had a diagnosable mental behavioral or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM-IV or their ICD-9-CM equivalent (and subsequent revisions) with the exception of DSM-IV "V" codes, substance use disorders, and developmental disorders, which are excluded, unless they co-occur with another diagnosable serious mental illness. (3) That has resulted in functional impairment, which substantially interferes with or limits one or more major life activities. Federal Register Volume 58 No. 96 published Thursday May 20, 1993 pages 29422 through 29425.

Service
A type of support or clinical intervention designed to address the specific mental health needs of a child and his or her family. A service could be provided only one time or repeated over a course of time, as determined by the child, family, and service provider.

Single-stream funding
The consolidation of multiple sources of funding into a single stream. This is a key approach used in progressive mental health systems to ensure that "funds follow consumers."

State Children's Health Insurance Plan (SCHIP)
Under Title XXI of the Balanced Budget Act of 1997, the availability of health insurance for children with no insurance or for children from low-income families was expanded by the creation of SCHIP. SCHIPs operate as part of a State's Medicaid program (Centers for Medicare and Medicaid Services, 2002).

State Coverage
The total unduplicated count of mental health patients/clients served through State programs, exclusive of Medicaid and Other Coverage.

State Hospital
A publicly funded inpatient facility for persons with mental illness.

State Mental Health Authority or Agency
State government agency charged with administering and funding its State's public mental health services.

Stress
Defined as a feeling of tension that can be both emotional and physical. Emotional stress usually occurs when situations are considered difficult or unmanageable. Therefore, different people consider different situations as stressful. Physical stress refers to a physiological reaction of the body to various triggers. The pain experienced after surgery is an example of physical stress. Physical stress often leads to emotional stress, and emotional stress is frequently experienced as physical discomfort (e.g., stomach cramps). Stress management refers to various efforts used to control and reduce the tension that occurs in these situations. The attitude of an individual can influence whether a situation or emotion is stressful or not. Negative attitude can be a predictor of stress, because this type of person will often report more stress than a person with a more positive attitude. Stress is not a disease and is a normal part of everyone's life. Stress in small quantities is good: it makes us more productive. For example, the fear of a bad grade can make the a student study more attentively. However, too much stress is unhealthy and counterproductive. The same student, if he was recently mugged and or is getting over the sudden death of a friend will not be able to study as well. Persistent and unrelenting stress is called anxiety.

Subcapitation
An arrangement whereby a capitated health plan pays its contracted providers on a capitated basis.

Subscriber
Employment group or individual that contracts with an insurer for medical services.

Suicide
A successful or unsuccessful attempt to intentionally kill oneself. Suicidal behaviors indicate that a person wishes to, intends to, or actually attempts to commit suicide. Suicidal behaviors can accompany many emotional disturbances, including depression, schizophrenia, and other psychotic illnesses. In fact, more than 90% of all suicides are related to an emotional or psychiatric illness. Suicidal behaviors occur as a response to a situation that the person views as overwhelming, such as social isolation, death of a loved one, emotional trauma, serious physical illness, growing old, unemployment or financial problems, guilt feelings, drug abuse, and alcohol abuse. In the U.S., suicide accounts for about 1% of all deaths each year. The highest rate is among the elderly, but there has been a steady increase in the rate among young people (particularly adolescents). Suicide is now the third leading cause of death for those 15 to 19 years old (after accidents and homicide). The incidence of reported suicides varies widely from country to country in the world; however, this may be in part related to reporting (especially in cultures where suicide is considered sinful or shameful). Suicide attempts (where the person tries to harm him- or herself but the attempt does not result in death) far outnumber actual suicides. The method of suicide attempt varies from relatively nonviolent methods (such as poisoning, overdose, or inhaling car exhaust) to violent methods (such as shooting or cutting oneself). Males are more likely to choose violent methods, which probably accounts for the fact that suicide attempts by males are more likely to be successful. Many unsuccessful suicide attempts are carried out in a manner or setting that makes rescue possible. They must be viewed as a cry for help.

Supported Employment
Supportive services that include assisting individuals in finding work; assessing individuals' skills, attitudes, behaviors, and interest relevant to work; providing vocational rehabilitation and/or other training; and providing work opportunities. Includes transitional and supported employment services.

Supported Housing
Services to assist individuals in finding and maintaining appropriate housing arrangements.

Supportive Residential Services
Moderately staffed housing arrangements for clients/patients. Includes supervised apartments, satellite facilities, group homes, halfway houses, mental health shelter- care facilities, and other facilities.

System of Care
A system of care is a method of addressing children's mental health needs. It is developed on the premise that the mental health needs of children, adolescents, and their families can be met within their home, school, and community environments. These systems are also developed around the principles of being child-centered, family- driven, strength-based, and culturally competent and involving interagency collaboration.

Telephone Hotline
A dedicated telephone line that is advertised and may be operated as a crisis hotline for emergency counseling, or as a referral resource for callers with mental health problems.

Therapeutic Foster Care
A service which provides treatment for troubled children within private homes of trained families. The approach combines the normalizing influence of family-based care with specialized treatment interventions, thereby creating a therapeutic environment in the context of a nurturant family home.

Third party payer
A public or private organization that is responsible for the health care expenses of another entity.

Unable to Work
This on-line forum was created especially for the nation's jobless and underemployed workers. This resource is available to help the unemployed learn more about the unemployment system, to share their experiences and concerns, and to participate in the national debate over aid to the jobless.

Underwriting
The review of prospective or renewing cases to determine their risk and their potential costs.

Unduplicated Counts
Counting a client/patient and their services uniquely. Unduplicated counts can exist at different levels: a program, a local system of care, or at the State level.

Unemployed
Not currently employed. This could include people looking for work, or people engaged in other activities such as homemakers, students or volunteers.

Unmet Needs
Identified treatment needs of the people that are not being met as well as those receiving treatment that is inappropriate or not optimal.

Utilization
The level of use of a particular service over time.

Utilization risk
The risk that actual service utilization might differ from utilization projections.

Vertical disintegration
A practice of selling off health plan subsidiaries or provider activities. Vertical disintegration was a trend in the late 1990s.

Vocational Rehabilitation Services
Services that include job finding/development, assessment and enhancement of work-related skills, attitudes, and behaviors as well as provision of job experience to clients/patients. Includes transitional employment.

White
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.