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The core service provided through
the Support Coordination Services unit is supports
coordination services. To meet criteria for services through the unit, a
consumer must have a documented need for supports
coordination. This need is determined through the
assessment process.
Supports coordination is a service
that assists consumers through the person-centered
planning process to design and implement strategies for
obtaining services and supports that are goal-oriented
and individualized.
The core components of supports
coordination are assessment, planning, linking,
advocacy, coordination and monitoring. Once a consumer
has been assessed to need supports coordination and a
supports coordinator has been chosen, the
person-centered planning process begins. Through the
person-centered planning process, the consumer needs and desires are
established and the plan for meeting these is
developed. Linking needs are established through the
plan and the person responsible for each component of
the plan is established. It is then the role of the
supports coordinator to coordinate the identified
services and link the consumer to needed services. The
supports coordinator is then responsible to monitor
progress toward the goals at intervals defined through
the person-centered planning process or as the need arises. This monitoring
includes the review of the consumer’s satisfaction with
the services provided.
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Though the Support Coordination
Services unit services adults
with development disabilities, many also are diagnosed
with psychiatric disorders. These dually diagnosed
individuals also receive psychiatric services. These
services include psychiatric evaluation and medication
review.
Psychiatric evaluation: A
comprehensive evaluation, performed face-to-face by a
psychiatrist, that investigates a consumer’s clinical
status, including the presenting problem; the history of
the present illness; previous psychiatric, physical, and
medication history; relevant personal and family
history; personal strengths and assets; and a mental
status examination. This examination concludes with a
written summary.
Medication review: The
process of evaluating and monitoring medications, their
effects, and the need for continuing or changing the
medication regimen. In the Support
Coordination Services unit this service is
typically provided by a psychiatrist but on occasion may
also be provided by an RN.
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When a consumer is dually diagnosed
and receiving services from the psychiatrist, they
receive clinic health services that are typically
provided by an RN and include an initial review of the
consumer’s health-related needs. Additional services
provided by the RNs include:
- Injection Clinic – The nurse give injections of
Haldol and Prolixin as are prescribed by agency
physicians.
- Clozaril Clinic – The nurse run a Clozaril
clinic for clients who have been prescribed Clozaril. These clients are seen on a weekly basis for
monitoring of their response to Clozaril.
- Lab Tests – Along with the physicians, the nurse
monitor the results of lab tests ordered for CSS
clients.
- Monitoring – When clients are seen for
medication reviews, the nurse checks their vitals
and educates the clients, family members and AFC
providers about expected results and possible side
effects of the prescribed medications.
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On occasion, it is assessed that a
Support Coordination Services consumer might also benefit from individual or group
therapy. This is a treatment activity designed to
reduce maladaptive behaviors, maximize behavioral
self-control or restore normalized psychological
functioning, reality orientation, remotivation and
emotional adjustment, thus enabling improved functioning
and more appropriate interpersonal and social
relationships. Individual/group therapy is performed by
a mental health professional.
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A variety of other services is
available to consumers of the Support Coordination
Services unit through referral
to the SCCMHA Enhanced Health Services unit. These
services include occupational therapy assessment,
physical therapy assessment, physical therapy
assessment, speech therapy assessment, dietary and
behavioral services.
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Crisis services are provided on an
ongoing basis through the continued monitoring and
outreach to consumers of the Support Coordination
Services unit. However, after
outreach efforts and other efforts to stabilize the
consumer (e.g., medication review, increased contacts)
have proven ineffective the consumer is referred to the
SCCMHA Crisis unit, which is available 24 hours a day, 7
days a week.
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