The Families' Child Advocacy Network

The Families' Child Advocacy Network Dictionary

Children with special needs
are requently diagnosed with
conditions that are difficult
to understand. A list of some
of these diagnoses is provided
to help you and your family
better understand your
child’s special needs.

DISORDERS & SYMPTOMS,
defined below for quick reference

-A-

Adjustment Disorder
A type of mental disorder defined as a reaction to identifiable psychosocial stressor(s).

Affective Disord

A disorder of mood which may be characterized by depression, mania, or cycles of both.

Anorexia Nervosa
An eating disorder marked by severe and prolonged refusal to eat, weight loss, and a disturbance in perception of body size or shape.

Anixety Disorder
Exaggerated or inappropriate responses to the perception of internal or external dangers. Includes panic disorders, phobias, obsessive-compulsive disorders, post-traumatic stress, and generalized anxiety disorders.

Attachment Disorder
An attachment disorder is a condition in which individuals have difficulty forming loving, lasting, intimate relationships.

Attention Deficit Disorder ( ADD)
The essential features of this disorder are developmentally inappropriate degrees of inattention, impulsiveness and sometimes hyperactivity.

Autistic Disorder
A disorder (usually appearing by age 3) characterized by lack of communication, lack of social skills, withdrawal and developmental delays.

-B-

Behavioral Disorder
Displaying disruptive behavior in home, school or other settings. A disorder characterized by displaying behaviors over a long period of time, which significantly deviate from socially acceptable norms for the individual's age and situation.

Bipolar Disorder
A mood disorder with elevated mood, usually accompanied by a major depressive episode.
Also knownas manic depression.

Bulimia Nervosa

An eating disorder that includes binge eating, often followed by self-induced purging, and persistent over-concern with body size, shape and weight.

-C-

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

Carve-in
A generic term that refers to any of a continuum of joint efforts between clinicians and service providers; also used specifically to refer to health care delivery and financing arrangements in which all covered benefits (e.g., behavioral and general health care) are administered and funded by an integrated system.

Carve-out
A health care delivery and financing arrangement in which certain specific health care services that are covered benefits (e.g., behavioral health care) are administered and funded separately from general health care services. The carve-out is typically done through separate contracting or sub-contracting for services to the special population.

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.)

Case management
A service that helps people arrange for appropriate services and supports. A case manager coordinates mental health, social work, educational, health, vocational, transportation, advocacy, respite care, and recreational services, as needed. The case manager makes sure that the changing needs of the child and family are met. (This definition does not apply to managed care.) Managed care definition: A system requiring that a single individual in the provider organization is responsible for arranging and approving all devices needed under the contract embraced by employers, mental health authorities, and insurance companies to ensure that individuals receive appropriate, reasonable health care services.

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 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.

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.

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.

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.

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.

Cost-sharing
A health insurance policy provision that requires the insured party to pay a portion of the costs of covered services. Deductibles, coinsurance, and co-payment are types of cost sharing.

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.

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.

-D-

Depression
A type of mood disorder characterized by low or irritable mood or loss of interest or pleasure in almost all activities over a period of time.

Developmental Disorders
Disorders that have predominate disturbances in normal development of language, motor,
cognitive and/or motor skills.

-E-

Eating Disorders
Disorders that are manifested by gross disturbances in eating behavior, including anorexia nervosa and bulimia.

Emotional Disorder
A disorder exhibiting emotional, behavioral and/or social impairments that interfere with a child's academic, developmental and social progress and family or other relationships.

Encoopresis
A psychophysiological disorder characterized by defecation at inappropriate times.

Enuresis
A psychophysiological disorder characterized by involuntary bed-wetting or lack of control over urination.

-F-

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

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

-G-

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-model Health Maintenance Organization (HMO)
A health care model involving contracts with physicians organized as a partnership, professional corporation, or other association. The health plan compensates the medical group for contracted services at a negotiated rate, and that group is responsible for compensating its physicians and contracting with hospitals for care of their 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.

-H-

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 Employer Data and Information Set (HEDIS)
A set of HMO performance measures that are maintained by the National Committee for Quality Assurance. HEDIS data is collected annually and provides an informational resource for the public on issues of health plan quality.

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.

Health Maintenance Organization (HMO)
A type of managed care plan that acts as both insurer and provider of a comprehensive set of health care services to an enrolled population. Services are furnished through a network of providers.

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.

-I-

Identity Disorder
Severe subjective distress caused by child's inability to achieve an integrated sense of self.

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.

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.

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

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.

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.

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 strength

-L-

Learing Disorder
A chronic condition that interferes with development, integration and/or demonstration of
verbal and/or non-verbal abilities.

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.

-M-

Managed Care
An organized system for delivering comprehensive mental health services that allows the managed care entity to determine what services will be provided to an individual in return for a prearranged financial payment. Generally, managed care controls health care costs and discourages unnecessary hospitalization and overuse of specialists, and the health plan operates under contract to a payer.

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 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 disorders
Another term used for mental health problems.

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.

-N-

Narcissism

A disorder characterized by a grandiose sense of self-importance, need for constant attention and admiration, and disturbances in interpersonal relationships.

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.

-O-

Obessive Compulsive Disorder
An anxiety disorder manifested by intrusive and persistent thoughts (obsessions) or impulses and compulsive behaviors or rituals (compulsions).

Oppositional Disorder
The covert display of underlying aggression by patterns of obstinate, but generally passive behavior.
Children with this disorder often provoke adults or other children by the use of negativism,
stubbornness, dawdling, procrastination, and other behaviors.

-P-

Personality Disorder
A deeply ingrained disorder of which maladaptive patterns of relating, perceiving and thinking cause distress or impairment in functioning.

Pervasive Developmental Disorder
Extreme distortions or delays in the development of social behavior and language.

Phobic Disorders
Disorders that cause extreme and irrational anxiety when encountering particular situations, objects or activities.

Post-Traumatic Stress Disorder (PTSD)
Anxiety disorder following a traumatic event.

-Q-

Quality Assurance
An approach to improving the quality and appropriateness of medical care and other services. Includes a formal set of activities to review, assess, and monitor care to ensure that identified problems are addressed.

-R-

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

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.

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.

Risk sharing
Situation in which the managed care entity assumes responsibility for services for a specific group but is protected against unexpected high costs by a pre-arranged agreement for higher payments for those individuals who need significantly more costly services. Risk is usually shared by the managed care entity and the State.

-S-

Schizo-Affective Disorder
A syndrome distinct from, but with similarities to, both schizophrenia and mood disorders. May include a manic or depressive episode, hallucinations or delusions.

Schiziphrenia
A serious mental disorder characterized by verbal incoherence, severely impaired interpersonal relations, disturbance in thought processes, cognitive deficits, and inappropriate or blunted affect. The child may also exhibit hallucinations or delusions.

Serious Emotional or Behavioral Disability/Disorder
Emotional and/or social impairment in a child or adolescent that consequently disrupts the child's/ adolescent's academic and/or developmental progress, family high severity. and/or interpersonal relationships and has impaired functioning that has continued for at least one year, or has an impairment of short duration.

Somatization Disroders
A symptom found in a number of childhood disorders in which psychological or social facts
contribute to physical symptoms.

-T-

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.

-U-

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 Management (UM)
A system of procedures designed to ensure that the services provided to a specific client at a given time are cost-effective, appropriate, and least restrictive.

Utilization review
Retrospective analysis of the patterns of service usage in order to determine means for optimizing the value of services provided (minimize cost and maximize effectiveness/appropriateness).

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

-V-

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.

-W-

Wraparound Services
A unique set of community services and natural supports for a child/adolescent with serious emotional disturbances based on a definable planning process, individualized for the child and family to achieve a positive set of outcomes.