Child Mental Health
Service Delivery System

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The Department of Mental Health (DMH) provides a wide range of treatment services to children, adolescents and their families. These services are provided through the department’s network of 17 local community mental health centers.

The department seeks to make these services accessible to families by "meeting families where they are." Consequently, many of the services are provided in those natural environments–such as in the school or home–that are most comfortable for the child and his or her family.

The vision is to develop a state-wide system of services which is child centered, family focused, community based, and culturally competent.

Assessment

An assessment is a diagnostic and evaluative service. It is a professional determination of an individual's or family's problems taking into consideration factors contributing to the problems as well as the assets and resources available to the individual or family. It is the basis from which recommendations for treatment and other services is generated. Although typically appropriate at the onset of mental health intervention, an assessment can be conducted at any point during the course of treatment. The assessment is an integral part of the diagnostic and treatment planning process.

Case Management Services

Case Management is the ongoing, dynamic process of linking children and families to needed treatment and support resources. Families are involved in the formulation of an individualized treatment plan, which guides the case manager's efforts. Case management spans a number of service delivery systems and is not limited to DMH resources only. Components of this service include the following core activities: assessment of children's needs; development of individualized treatment plans; referral to service providers; monitoring of service provision; coordinating service delivery; the provision of supportive counseling; advocacy; and the documentation and tracking of client progress. The goal of case management is the improved emotional and social functioning of children and their families.

Day Treatment

Day Treatment programs, which are also referred to as Clinical Day Programs (CDP), are school-based programs that provide children with specialized educational services which are integrated with other related support services such as counseling, family interventions, etc. Day Treatment can be accessed while the child is in residential treatment or as an external school resource once the child transitions home. Making this intensive psycho-educational service available to children, prior to out-of-home placement, can help to alleviate the need for an out-of-home placement.

This service represents a collaborative effort between the Department of Mental Health and local school districts. All enrolled students must meet the South Carolina Department of Education's criteria for special education services.

Intensive Family Services Initiative

The purpose of intensive family services is to stabilize and strengthen the child/family's socio-emotional functioning, coping skills and overall adjustment in the community, in order to prevent children from going into an out-of- home placement and/or to facilitate their return from placement. Another major purpose is to link the child and family with critically needed community resources and supports. Intensive Family Preservation Services are appropriate for families who are at risk of having at least one child removed from the home. This is a home-based service intervention delivered primarily in the family's home. Workers provide intensive family- focused services. Small caseloads enable professionals to work intensively with each family. Home-based services are multifaceted and include individual, group and family therapy, anger management, stress management, individual and family goal setting/problem solving, accessing and utilizing community resources, vocational counseling, etc.

Multi-Systemic Therapy (MST) Initiative

MST is a family-and home-based treatment that strives to change how youth function in their natural settings-home, school, and neighborhood-in ways that promote positive social behavior while decreasing antisocial behavior.  This “multisystemic” approach views individuals as being surrounded by a network of interconnected systems that encompass individual, family, and extra familial (peer, school, neighborhood) factors and recognizes that intervention often is necessary in a combination of these systems.  Most significantly, the conceptual framework of MST fits closely with the known causes of delinquency and substance abuse.  MST addressed these factors in an individualized, comprehensive, and integrated manner.  Based on the philosophy that the most effective and ethical route to help youth is through helping their families, MST views caregivers as valuable resources, even when they have serious and multiple needs of their own. MST typically uses the family preservation model of service delivery, where therapists have small caseloads (4-6 families); are available 24 hours a day, 7 days a week; and provide services in the family’s home at times convienent to them. The average length of treatment is about 60 hours of contact provided during a 4-month period. The family preservation model reduces the barriers that keep families from accessing services.  MST therapists focus on empowering parents by using identified strengths to develop natural support systems (e.g.; extended family, neighbors, friends, and church members) and remove barriers (e.g.; parental drug abuse, high stress, and poor relationships with mates) to improve their capacity to function as effective parents.  The primary goals of MST are to (a) reduce youth criminal activity; (b) reduce other types of antisocial behavior such as drug abuse; and (c) achieve these outcomes at a cost savings by decreasing rates of incarceration and out-of-home placement (Consortium on Children, Families, and the Law; Fact Sheet MST: An Overview).

Futures

This program serves children who have at least one psychiatrically impaired parent and their families. National statistics show that children of psychiatrically impaired parents have a higher incidence of psychiatric disturbance than children whose parents do not have psychiatric impairments. These statistics also show that early intervention with children of psychiatrically impaired parents decreases the occurrence and chronicity of psychiatric symptoms in these children. Consequently, the purpose of this initiative is to intervene early in the lives of these families by providing supportive services to include teaching coping skills, addressing educational concerns and dealing with issues relative to the parent's illness. Parenting skills and educational services are provided to the parents. Special work is done with the children to help them understand and cope with their parent's disorder. The intent of this initiative is to work with the psychiatrically impaired parent to improve the developmental outcome for his or her children and, therefore, lessen the impact of the parent's illness upon the child.

Inpatient Hospital Services

Inpatient hospitalization is reserved for extreme situations for children and adolescents who exhibit acute disturbances such as psychosis or suicidal ideation/gesturing. These children may be considered a danger to themselves or others. They require structure and supervision in a therapeutic milieu. Inpatient hospitalization is typically short-term and used for crisis stabilization. However, inpatient hospitalization is also appropriate for comprehensive evaluations or when special testings is required such as a competency evaluation or to identify neurological or biochemical components of a child's problem and for long-term treatment of these disorders.

Outpatient Treatment Services

Outpatient treatment is typically the initial approach used to assist a child or adolescent and his or her family. This is the most basic service. It offers a broad array of services including individual, group and family therapies. The intent is to address the problems or challenges in the least intensive/restrictive, most cost-effective manner possible. Regularly scheduled appointments are held at the local mental health center. Appointments may also consist of medication prescription and review. The department also provides outpatient services in homes, DSS offices and schools.

Other Residential Treatment Services

DMH operates two in-patient general psychiatric units and one substance abuse unit at the William S. Hall Psychiatric Institute. The Options Residential Treatment Center is a 20-bed facility for seriously mentally ill adjudicated adolescent males. In addition to the general psychiatric track, the program offers a sexual offender treatment track. The Directions Residential Treatment Unit is an 11-bed general psychiatric unit for adolescent females. The Adolescent Recovery Program is a 20- bed co-ed chemical dependency /dual diagnosis program. When clinically indicated, the department also purchases an array of residential treatment services from qualified private providers.

School-Based Services

School-based Services provides mental health services to individuals and families in a more comfortable, less restrictive, less stigmatizing environment in the local community schools. This service provides school staff with consultative services for their at-risk student population. Additionally, school-based services provide preventive services to the surrounding communities, promoting positive mental and emotional health while educating the community on the benefits of the local mental health center and school-based services. This program provides: individual, family and group treatment, crisis intervention appointments, home visits, teacher/school staff consultations, teacher in services, classroom education groups, summer camps, after school programs and consultation on student assistant teams.

Wraparound Services

The Wraparound Program consists of an array of flexible, treatment-based, goal-directed support services which are designed to prevent an out-of-home therapeutic residential placement, or to enable children in such placements to successfully transition home. Wraparound services are dynamic and responsive to the changing needs of children and their families, and are rendered at the frequency, intensity, time periods and locales appropriate to the family. These services are typically rendered in the child's home or surrounding community, and are available to families on a 24-hour basis. Services include behavior managers, positive role models, transportation, etc. Wraparound services maximize family participation in the treatment process. The department provides many of these services directly, as well as contracts with qualified private providers as the child/family needs dictate.

Youthful Sexual Offenders Program

The purpose of this program is to provide intense treatment services to those youth who have sexually offended others. Services are provided to the youthful offender and his or her family. This program provides preventive services in an effort to reduce the likelihood of subsequent sexual offenses. Professionals, trained according to the guidelines set forth by the National Task Force on Juvenile Sexual Offending, provide sexual offender specific treatment for sexually aggressive youth via individual, group and family therapy. Other services include, self esteem workshops, sex education classes and prevention services. Therapists also provide sexual offender aftercare services for juvenile offenders who have been released from residential sexual offender treatment programs and DJJ facilities. Services are provided on an outpatient basis and include specialized sexual offender assessments for the court system and DSS, as well as workshops and training on related issues.

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