Clinical Reference Systems: Pediatric Advisor 10.0
The Continuum of Care for Children and Adolescents
with Mental Illness
Communities provide different types of treatment programs
and services for children and adolescents with mental
illnesses. A complete range of programs and services is
called the continuum of care. Not every community has every
type of program on the continuum.
Some psychiatric hospitals and other organized systems of
care now provide many of the services on the continuum.
When several of the services are provided, the organization
may be called a health care system.
You should discuss concerns about your child's behavior or
emotions with your child's physician. He or she may then
refer you to a qualified mental health professional for an
evaluation. After the evaluation, the professional may
recommend a certain type of program from the continuum
available in the community.
The professional is then usually required to get approval
from the insurance company or organization managing mental
health benefits (such as a managed care organization). In
the case of programs funded publicly, a specific state
agency must authorize the recommended programs or services.
If the program or service is not authorized, it will not be
Many of the programs on the continuum offer several forms
of treatment, such as individual psychotherapy, family
therapy, group therapy, and medication. The different
programs on the continuum of care are:
- Office or outpatient clinic: Visits are usually under
1 hour. The number of visits per week depends on a
- Intensive case management: Specially trained individuals
coordinate or provide psychiatric, financial, legal, and
medical services to help the child or adolescent live
successfully at home and in the community.
- Home-based treatment program: A team of specially
trained staff go into a home and develop a treatment
program to help the child and family.
- Family support services: Services, such as parent
training or a parent support group, to help parents care
for their child.
- Day treatment program: This intensive treatment program
provides psychiatric treatment with special education.
The child usually attends 5 days each week.
- Partial hospitalization (day hospital): This provides
all the treatment services of a psychiatric hospital, but
the patients go home each evening.
- Emergency/crisis services: 24-hour-per-day services for
emergencies (for example, hospital emergency room, mobile
- Respite care: A patient stays briefly away from home
with specially trained individuals.
- Therapeutic group home or community residence: This
therapeutic program usually includes 6 to 10 children or
adolescents per home. It may be linked with a day
treatment program or specialized educational program.
- Crisis residence: This setting provides short-term
crisis intervention and treatment (usually lasting fewer
than 15 days). Patients receive 24-hour-per-day
- Residential treatment facility: Seriously disturbed
patients receive intensive and comprehensive psychiatric
treatment in a campuslike setting on a longer-term basis.
- Hospital treatment: Patients receive comprehensive
psychiatric treatment in a hospital. Treatment programs
should be specifically designed for either children or
adolescents. Length of treatment may be acute (a few
days to 30 days) or intermediate (30 to 120 days).
You should ask questions whenever a mental health
professional recommends psychiatric treatment for your child
or adolescent. For instance, which types of treatment are
provided and by whom? You should also ask about the length
of time, the cost and how much of the cost is covered by
insurance or public funding. What are and the advantages
and disadvantages of the recommended service or program?
Feel free to obtain a second opinion about the best type of
program for your child or adolescent.