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Departments / Area Mental Health / Glossary

Glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 1,2,3 All

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	122C NC Statues for public behavioral healthcare

	42 CFR Federal Statues for substance abuse confidentiality

	AA Alcoholics Anonymous

	ABI Acquired Brain Injury

	Abuse The willful or grossly negligent infliction of physical pain, injury or mental anguish, unreasonable confinement, or the willful or grossly negligent deprivation by the administrator or staff of an adult care home of services which are necessary to maintain mental and physical health.

	ACCEPT Advocacy Center for Children's Education and Parent Training

	Access An array of available treatments, services and supports; consumers know how and where to obtain them; and there are no system barriers or obstacles to getting what they need, when they are needed.

	Accreditation Certification by an external entity that an organization has met a set of standards. In NC, LMEs and providers are required to have national accreditation.

	ACT Assertive Community Treatment

	Action Tremor A tremor that occurs during the performance of voluntary movements such as postural, isometric, kinetic, and intention tremors.

	Activities of Daily Living (ADL) Functions that are typically performed as part of a person's daily routine, such as dressing, bathing, eating, toileting, leisure activities, socialization, and other functions of daily living.

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

	ACTT Assertive Community Treatment Team (provides intensive response for high risk consumers). A research-based, multi-disciplinary team providing community-based treatment, rehabilitation and support services to consumers who are at risk of frequent decompensation and hospitalization, arrest or homelessness. ACT Teams maintain primary clinical responsibility and provide services 24 hours a day, seven days a week on a long-term basis. This allows for continuity of caregivers, and thus for increased stability in community living.

	Acuity (or Acuity Level) Used, most often in hospital settings, to describe the intensity of a person's needs for care.

	Acute Referring to symptoms of abrupt onset, often of marked severity or intensity.

	Acute Abstinence Syndrome A group of withdrawal signs and symptoms that occur shortly after a person who is physically dependent on a drug stops taking it.

	Acute Care Committee One of three standing committees of the North Carolina State Health Coordinating Council. This committee has lead responsibilities for General Acute Care Hospital Beds, Inpatient Rehabilitation Services, Ambulatory Surgical Facilities, and Technology.

	ADA American with Disabilities Act

	ADATC Alcohol/Drug Addiction Treatment Centers

	ADD US Administration on Developmental Disabilities -OR also used for Attention Deficit Disorder

	ADHC Adult Day Healthcare OR also used for Attention Deficit Hyperactivity Disorder

	ADL Activities of Daily Living

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

	Administrative Services Organization (ASO) An arrangement under which an insurance carrier or an independent organization will, for a fee, manage claims, benefits and other administrative functions for a public or private sector client.

	Administrator Administrator means a person approved by the Department of Health and Human Services who has the responsibility for the total operation of a licensed domiciliary home.

	ADTP Alcohol Dependence Treatment Program

	Adult Care Home Adult care home is an assisted living residence in which the housing management provides 24-hour scheduled and unscheduled personal care services to two or more residents, either directly or, for scheduled needs, through formal written agreement with licensed home care or hospice agencies. Some licensed adult care homes provide supervision to persons with cognitive impairments whose decisions, if made independently, may jeopardize the safety or well-being of themselves or others and therefore require supervision. Medication in an adult care home may be administered by designated, trained staff. Adult care homes that provide care to two to six unrelated residents are commonly called family care homes. Adult care homes and family care homes are subject to licensure by the Division of Facility Services.

	Advance Directive A legal document that allows consumers to plan their own mental health care in the event the individual loses the capacity to effectively make decisions. The individual can name a friend and/or an agent (friend or family) to act on his/her behalf to give guidance to the professionals involved in care, treatment according to his/her preferences. Completing an advance directive is an opportunity for the person with disabilities to learn more about the illness and have more control what happens.

	Advocacy Activities in support of, or on behalf of, people with mental illness, developmental disabilities or addiction disorders including protection of rights, legal and other service assistance, and system or policy changes.

	ADVP Adult Day (or Developmental) Vocational Program

	Aftercare Supervision or treatment given to individuals for a limited time after they are released from a treatment program.

	Ageism Stereotyped and often negative perceptions of older people.

	Agonist A muscle whose contraction executes an intended movement or a drug that effectively mimics the action of a natural chemical messenger within the body

	Agoraphobia The fear of public places or open spaces; agoraphobics try to avoid being in situations from which they think escape would be difficult or help and safety are not readily available; this is often diagnosed in conjunction with panic disorder

	AHEC Area Health Education Center

	Akathisia A neurological condition of motor restlessness, manifested by a sensation of muscular quivering, an urge to constantly move about, and an inability to sit still.

	Akinesia Absence of movement or loss of the ability to move such as temporary or prolonged paralysis or freezing in place.

	Akinetic Referring to absence or poverty of voluntary movement; loss of the ability to move all or part of the body.

	Alcohol or Drug Treatment (AOD) Substance abuse treatment.

	ALE Alcohol Law Enforcement

	Allowable Costs Charges for services rendered or supplies furnished by a mental health professional that qualify as covered expenses.

	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 A progressive degenerative disease of the brain of unknown cause. Alzheimer's disease is characterized by widespread loss of nerve cells, particularly in the outer region of the brain (cerebral cortex), with distinctive neurodegenerative changes (including senile plaques and neurofibrillary tangles) and reduced activity of acetylcholine and other neurotransmitters of the brain. The disease is the most common cause of dementia or progressive deterioration of thought processing and acquired intellectual abilities. Associated symptoms include initial forgetfulness with increasingly severe memory impairment; disorientation and confusion; loss of the ability to recognize familiar people or objects through sensory stimuli (agnosia); and speech disturbances. The disorder may also be characterized by restlessness and agitation; an increasingly impaired ability to conduct purposeful movements; personality disintegration; and symptoms of psychosis, such as the perception of sights, sounds, or other sensations in the absence of external stimuli (hallucinations) and false beliefs of persecution despite evidence to the contrary (paranoid delusions).

	AMA American Medical Association

	Ambulant (Ambulatory) Able to walk; may be used to describe patients who do not require a wheelchair or are not confined to bed.

	Ambulatory Care All types of health services that are provided on an outpatient basis, in contrast to services provided in the home or in hospitals.

	Ambulatory Detoxification Service An outpatient, medically supervised detoxification service. See DETOXIFICATION

	Amenities Amenities means services such as meals, housekeeping, transportation, and grocery shopping that do not involve hands-on personal care.

	American Society of Addiction Medicine (ASAM) An international organization of physicians dedicated to improving the treatment of people with substance use disorders. In 1991, ASAM published a set of patient placement criteria that have been widely used and analyzed in the alchohol, tobacco and other drug (ATOD) field.

	AMHA Area Mental Health Authority

	AMI Alliance for the Mentally Ill

	AMIS Automated Medical Information System

	Amplitude The size or height of a tremor; the extent or breadth of a tremor's range.

	Anorexia Nervosa Anorexia nervosa is an eating disorder characterized by unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small amounts, weighing food, and counting the calories of all foods. Individuals with anorexia nervosa may also exercise excessively.

	Antagonist (1) A drug that blocks a receptor, preventing stimulation. (2) A muscle whose contraction opposes an intended movement.

	Anxiety A sense of apprehension and fear often marked by physical symptoms (such as sweating, tension, and increased heart rate)

	Anxiety Disorders A group of serious yet treatable health problems affecting one in 10 Americans; anxiety disorders are caused by a combination of biological and environmental factors

	Anxiolytics The medications that reduce the symptoms of anxiety

	AP Area Program

	APA American Psychiatric Association

	Appeals Panel The state MH/DD/SA appeals panel established under NC. G.S. 371.

	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.

	Apraxia Loss of the ability to sequence, coordinate, and execute certain purposeful movements and gestures in the absence of motor weakness, paralysis, or sensory impairments. Apraxia is thought to result from damage to the cerebral cortex, such as due to stroke, brain tumors, head injury, or infection. It may also occur as a result of impaired development of the cortex as in certain neurodevelopmental disorders, including Rett syndrome. Apraxia may affect almost any voluntary movements, including those required for proper eye gaze, walking, speaking, or writing.

	Arc Formerly ARC, Association for Retarded Citizens

	Area Director The executive who is responsible for mental health, developmental disability, and substance abuse services in a county/area program. This person has at least a master's degree in a behavioral health services discipline and is responsible for developing a system of care in his/her local area that brings all possible public and private services into a network. The network must meet the needs of service consumers in that region and conform to the requirements of the DMH/DD/SAS.

	Area Program A program that is certified by the DHHS Secretary to manage, oversee and sometimes directly provide mental health, developmental disabilities and substance abuse services in a specified geographic area. See also, COUNTY PROGRAM.

	Array Of Services Group of services available to a consumer.

	ASAM American Society of Addiction Medicine

	ASANC Association of Self-Advocates of NC

	ASI Addiction Severity Index

	ASNC Autism Society of North Carolina

	Assessment A comprehensive examination and evaluation of a person's needs for psychiatric, developmental disability or substance abuse treatment, services and/or supports according to applicable requirements.

	Assisted Living Residence Assisted living residence means any group housing and services program for two or more unrelated adults, by whatever name it is called, that makes available, at a minimum, one meal a day and housekeeping services and provides personal care services directly or through a formal written agreement with one or more licensed home care or hospice agencies. The Department may allow nursing service exceptions on a case-by-case basis. Settings in which services are delivered may include self-contained apartment units or single or shared room units with private or area baths. Assisted living residences are to be distinguished from nursing homes subject to provisions of G.S. 131E-102. Effective October 1, 1995, there are two types of assisted living residences: adult care homes and group homes for developmentally disabled adults. Effective July 1, 1996, there is a third type, multiunit assisted housing with services.

	Asterixis Involuntary, jerking or flapping movements, especially of the hands. Extending the patient's arm with the wrist bend in a backward position may induce this form of tremor, which may be associated with advanced liver disease.

	AT Assistive Technology

	Ataxia A condition characterized by an impaired ability to coordinate voluntary movements. Ataxia may result from damage to the cerebellum, cerebellar pathways, or the spinal cord due to various underlying disorders, conditions, or other factors. These may include infection, head injury, stroke, brain tumors, neurodegenerative disorders, alcohol or drug intoxication, or certain hereditary diseases (e.g., Friedreich's ataxia, ataxia-telangiectasia). Associated symptoms may vary, depending upon the site of damage within the central nervous system. However, the condition is often characterized by in coordination, postural imbalance, and a lurching, unsteady manner of walking (gait). Additional findings may include slurred speech (dysarthria); rapid, involuntary, rhythmic eye movements (nystagmus); and/or other abnormalities.

	ATOD Alcohol, tobacco and other drugs

	Atrophy Wasting away or loss of a cell, tissue, or organ due to disease, malnutrition, insufficient blood supply, or other causes, such as loss of skeletal muscle mass due to peripheral nerve damage.

	Attention- Deficit/Hyperactivity Disorder (ADHD) Attention-deficit/hyperactivity disorder, sometimes called ADHD, is a chronic condition and the most commonly diagnosed behavioral disorder among children and adolescents. It affects between 3 and 5 percent of school-aged children in a 6 month period (U.S. Department of Health and Human Services, 1999). Children and adolescents with attention-deficit/hyperactivity disorder have difficulty controlling their behavior in school and social settings. They also tend to be accident-prone. Although some of these young people may not earn high grades in school, most have normal or above normal intelligence.

	AU Autism

	Auditory Pertaining to the sense of hearing or the organs involved in hearing.

	Augmentation A phenomenon that may occur as a result of the use of certain medications (particularly levodopa). Augmentation is characterized by the emergence of worsening symptoms earlier in the day (e.g., early evening, afternoon, or morning). Many people who take levodopa and some who take other dopamingeric agents develop augmentation, especially those who have severe symptoms or are taking high doses of the drug.

	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.

	Autonomy An ethical principle that requires policy-makers, advocates, planners, administrators, providers and family members of adult service consumers to respect the right of legally competent individuals to make decisions about the course of their lives.

	Average Daily Census (ADC) Measurement of the number of people residing in a residential program, usually hospitals.

	Basic Services Mental health, developmental disability or substance abuse services that are available to North Carolina residents who need them whether or not they meet criteria for target or priority populations. See also, CORE SERVICES.

	BD Bipolar Disorder

	Bed Day Allocation A system in which the DMH/DD/SAS sets the number of state psychiatric hospital beds or mental retardation center admissions county/area programs may buy in a particular time period. These allocations take into account past usage and private beds available in each geographic area.

	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.

	Benchmark An established standard of achievement used as a point of reference to assess performance.

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

	Benefit Design A plan that describes the services to be offered, the degree that service consumers will be expected to share the costs of such benefits, and how consumers can access the services that are available.

	Benefit Package Or Plan An array of treatments, services and/or supports intended to meet the needs of target or priority populations. Also, a selection of treatments, services and/or supports included in a care or service plan for an individual.

	Best Practice(s) Interventions, treatments, services or actions that have been shown to generate the best outcomes or results. The terms, evidence-based, or research-based may also be used.

	BHC Behavioral Health Center-Randolph

	BIANC Brain Injury Association of NC

	Binge-Eating Disorder Binge-eating is an eating disorder characterized by frequent episodes of compulsive overeating, but unlike bulimia, the eating is not followed by purging. During food binges, individuals with this disorder often eat alone and very quickly, regardless of whether they feel hungry or full.

	Bipolar Disorder (BD) Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder. Bipolar disorder tends to run in families. This disorder typically begins in the mid-twenties and continues throughout life. Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide.

	Block Grant Funds received from the federal government (or others), in a lump sum, for services specified in an application plan that meet the intent of the block grant purpose. See also, CATEGORICAL FUNDING.

	Borderline Personality Disorder (BPD) 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.

	Brief Intensive Therapy A limited number of visits with a therapist by people with serious mental illness or by people experiencing overwhelming difficulties that may lead to the person becoming dangerous to self or others. This therapy is often focused on immediate concerns that are expected to improve fairly quickly.

	Bulimia Nervosa Bulimia nervosa is an eating disorder characterized by excessive eating. People who have bulimia will eat an excessive amount of food in a single episode and almost immediately make themselves vomit or use laxatives or diuretics (water pills) to get rid of the food in their bodies. This behavior often is referred to as the binge/purge cycle. Like people with anorexia, people with bulimia have an intense fear of gaining weight.

	Buy-In Options A recent federal Medicaid reform that allows states to modify Medicaid eligibility rules. The changes allow people with disabilities who are returning to work to secure extended Medicaid coverage. The changes also require such persons to partial payment for such coverage according to rules established by the state.

	C&F Child & Family

	CA or C/A Children and Adolescents

	CAFAS Child/ Adolescent Functional Assessment Scale

	CALOC Child & Adolescent Level of Care

	CAP Community Alternatives Program

	CAP/MR-DD (Waiver) Waiver of Medicaid regulations that allow one-to-one staff to consumer care for developmental disabilities

	CAPAC Child & Adolescent Policy Advisory Committee

	Capitation A method of paying for services based on a flat rate regardless of the number of people using that service. A fee paid per-member-per-month (pmpm) is an example.

	Capitation Payment A payment made by a state Medicaid agency under a risk contract, generally to a managed care organization (MCO). The payment is usually made on a monthly basis at a fixed amount on behalf of each Medicaid beneficiary enrolled in the MCO. In exchange for the capitation payment, the MCO agrees to provide (or arrange for the provision of) services covered under the contract with the state Medicaid agency to enrolled Medicaid beneficiaries. See Fee-For-Service, MCO.

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

	CARF Originally Council on Accreditation of Rehabilitation Facilities, International - now CARF; one of the agencies recognized by the Division of MHDDSA Services and the Division of Medical Assistance to accredit providers of mental health, developmental disability and substance abuse services and to accredit systems management functions of Local Management Entities (LMEs)

	Case Management The activities of a professional with a great deal of knowledge of the services and programs supported by the public MH/DD/SA system who assists individuals in accessing and coordinating services.

	Case Manager A clinician who works with consumers, providers and insurers to coordinate services. This term also is applied to MCO employees who conduct utilization review. (Alternate terms: service coordinator, advocate, and facilitator.)

	Catchment Area The geographic part of the state served by a specific area or county program.

	Categorical Funding Funds provided for specific purposes or for services to specific people.

	Categorically Needy A term that describes the group of individuals that states are generally required to cover under Medicaid in order to receive Federal funds. This group includes people who receive assistance through Temporary Aid for Needy Families (TANF) and Supplemental Security Income (SSI), as well as other Federally assisted income maintenance payments.

	CBI Client Behavior Intervention

	CBS Community Based Services

	CC Closed Captioned

	CCD Consortium of Citizens with Disabilities

	CDC Child Development Center

	CDDC Consortium of Developmental Disabilities Councils

	CDS Child Developmental Services

	CDSA Child Development Services Agency

	CDW Consumer Data Warehouse (required reporting of consumer data to the state)

	CEC Council for Exceptional Children

	Center For Medicaid And State Options (CMSO) The agency within the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration, HCFA) responsible for administering Medicaid and the Children's Health Insurance Program (CHIP).

	Center For Medicare And Medicaid Services (CMS) The federal agency in the U.S. Department of Health and Human Services (HHS) responsible for the administration of Medicaid, Medicare, and CHIP (formerly the Health Care Financing Administration, HCFA. http://www.hcfa.gov).

	Center For Substance Abuse Prevention (CSAP) A federal organization that provides national leadership in development of policies, programs, and services to prevent the onset of illegal drug use, to prevent underage alcohol and tobacco use, and to reduce the negative consequences of using substances. CSAP is one of three Centers in the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. Department of Health and Human Services (HHS).

	Center For Substance Abuse Treatment (CSAT) CSAT of the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS), was created in October 1992 with a congressional mandate to expand the availability of effective treatment and recovery services for alcohol and drug problems. CSAT's initiatives and programs are based on research findings and the general consensus of experts in the addiction field that, for most individuals, treatment and recovery work best in a community-based, coordinated system of comprehensive services. Because no single treatment approach is effective for all persons, CSAT supports the nation's effort to provide multiple treatment modalities, evaluate treatment effectiveness, and use evaluation results to enhance treatment and recovery approaches.

	Certification A statement of approval granted by a certifying agency confirming that the program/service/agency has met the standards set by the certifying agency. CMS is an example of a certifying agency. See also ACCREDITATION.

	CFAC Consumer and Family Advisory Committee

	CFR Code of Federal Regulations

	CFT Child & Family Team

	Child And Adolescent Functional Assessment Scale (CAFAS) Measurement system to determine the level of functioning of a child or adolescent.

	Child And Adolescent Level Of Care Utilization System (CA LOCUS) System used to determine the appropriate level or intensity of services/supports for children and adolescents.

	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.

	Children's Health Insurance Program (CHIP) Enacted in the 1997 Balanced budget Act as title XXI of the Social Security Act, CHIP is a federal-state matching program of health care coverage for uninsured low-income children. In contrast to Medicaid, CHIP is a block grant to the states; eligible low-income children have no individual entitlement to a minimum package of health care benefits. Children who are eligible for Medicaid are not eligible for CHIP. States have the option of administering CHIP through their Medicaid programs or through a separate program (or a combination of both). The federal matching rate for CHIP services (on average, 70 percent) is higher than that for Medicaid (on average at least 57 percent), but the federal allotment to each state for CHIP services is capped at a specified amount each year.

	CI Community Inclusion

	CIL Center for Independent Living

	Civil Rights Of Institutionalized Persons Act (CRIPA) Federal law intended to assure that persons involuntarily detained in state psychiatric hospitals or mental retardation centers are treated safely, humanely and with adequate due process as required under the U.S. Constitution. CRIPA investigations are undertaken and litigated by the Department of Justice, Civil Rights Division.

	Civilian Health And Medical Program Of The Uniformed Services, (CHAMPUS) A program of medical benefits available to inactive military personnel, military spouses, dependents and beneficiaries through the Military Health Services System of the Department of Defense.

	Claim An itemized statement of services, performed by a provider network member or facility, which is submitted for payment.

	Claims Management The process of receiving, reviewing, adjudicating, paying, and otherwise processing service claims submitted by network and facility providers.

	Client An individual who is admitted to or receiving public services. Client includes the client's personal representative or designee. See also CONSUMER.

	Client Outcomes Inventory (COI) Department of MH/DD/SAS measurement system for assessing treatment/services outcomes of consumers with developmental disabilities.

	Clinical Best Practice Consumer-focused, evidenced-based interventions and/or clinical services that demonstrate the best outcomes for consumers.

	Clinical Criteria Criteria by which managed care organizations decide whether a specific treatment setting is the appropriate level of care for a given consumer.

	Clinical Pathways Multidisciplinary plans of best clinical practice for groups of people with a particular diagnosis.

	Clinical Practice Guidelines Utilization and quality management mechanisms designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case.

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

	Clinical Services In MH/DD/SA services, this usually means activities of medical and related professionals. These professionals generally include psychiatrists, social workers, psychologists, nurses and counselors.

	Clinical Social Worker (CSW) 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.

	Clinical Status A type of outcome measure that relates to improvement, control or suppression of the active symptoms of serious and persistent mental illness.

	Clinical Supervision Intermittent face to face contact between a clinical supervisor and treatment staff to ensure that each person being served has an individualized treatment plan and is receiving quality care. It also includes auditing patient files, review and discussion of active cases and direct observation of treatment. In substance abuse treatment, it also means applying supervisory responsibility over substance abuse counselors in regard to at least the following: counselor development, counselor skill assessment and performance evaluation, staff management and administration, and professional responsibility, problem identification and resolution, referral for screening, specialized education, alternative activities development, social policy development, environmental change, training and development of risk reduction skills.

	Closed Panel A managed healthcare arrangement in which covered persons are required to select providers only from the plan's participating providers. Also called an Exclusive Provider Organization (EPO).

	CM Case Management or Case Manager

	CMA Center for Medical Assistance (Federal Medicaid)

	CMI Chronically Mentally Ill

	CNH Community Nursing Home

	CNR Continued Need Review

	Co-Morbidity The state of having two or more disorders at one time.

	Co-Occurring Disorders The presence of two or more disorders at the same time (e.g. substance abuse and mental illness; developmental disability and mental illness; substance abuse and physical health conditions). See also, DUAL DIAGNOSIS.

	Co-payment The portion of the cost of services that is to be paid by the service consumer.

	COA Council on Accreditation; one of the agencies recognized by the Division of MHDDSAS and the Division of Medical Assistance to accredit providers of mental health, developmental disability and substance abuse services and to accredit systems management functions of Local Management Entities (LMEs).

	Cognition Cognition involves thinking skills such as perception, memory, awareness, reasoning, judgment, intellect, and imagination.

	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.

	COI Consumer Outcome Inventory (state required survey)

	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 Mental Health Center (CMHC) Community-based, mental healthcare centers that provide a variable range of services, including inpatient, outpatient, emergency, partial hospitalization, consultation, education, case management, drop-in centers and vocational rehabilitation programs.

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

	Compensatory Agent Compensatory agent means a spouse, relative, or other caretaker who lives with a resident and provides care to a resident.

	Competence The capacity to function effectively. Also a legal term (i.e. competency to stand trial or competency to make decisions in one's own best interest). An individual must be judged incompetent in a court of law or found dangerous to self or others before the person's civil rights may be restricted.

	Complementary And Alternative Medicine Complementary and alternative medicine, as defined by National Institutes of Health, is a group of diverse medical and health-care systems, practices, and products that are not presently considered to be part of conventional medicine

	Composite Autonomic Scoring Scale The Composite Autonomic Scoring Scale is a battery of validated, sensitive, and specific tests for the assessment of autonomic nervous systems, resulting in a 10-point composite score.

	Computerized Tomography (CT) Imaging Or Scanning An advanced diagnostic scanning technique during which cross-sectional images of tissues and organs are produced by passing x-rays through the body at various angles. In some cases, a contrast medium, which is opaque on x-rays, may be injected intravenously to produce enhanced images of certain tissues, organs, or blood vessels.

	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.

	Conflict Of Interest A situation where self interest could negatively impact the best interests of the person being served or the system.

	Congenital Existing at birth.

	Consensus General agreement toward a group decision. It is not the same as total agreement.

	Consent Decree A contract between a state and the court, usually federal that contains a plan for improving conditions in state programs. See also SETTLEMENT AGREEMENT.

	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.

	Consultation Information shared between or among peers or professionals to increase the ability to manage challenging circumstances. Psychiatric consultation to a cardiologist who is treating a depressed patient is an example. A social worker might consult with another on the best residential placement for an individual with severe and persistent mental illness.

	Consumer An individual who has been or is receiving publicly funded mental health, developmental disability or substance abuse services or supports. See also CLIENT.

	Consumer and Family Advisory Committee A state mandated advisory committee composed solely of consumers and family members of consumers whose role is to advocate for the interests of consumers by advising local Mental Health Boards, Local Managment Entities and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

	Consumer Outcomes The extent to which individuals receiving services and supports that are designed to assist in the process of reaching their life goals. For example, an adult consumer is competitively employed or a child with severe emotional disturbance who attends school regularly.

	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) Programs and activities designed to constantly improve the safety and effectiveness of services.

	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.

	Contract Discounts An economic incentive offered to consumers to encourage them to use providers belonging to a group or organization preferred by a health plan. Usually, the out-of-pocket expenses incurred by the patient are reduced.

	Contractor A person or entity that contracts to provide 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.

	Core Services Services such as screening, assessment, crisis or emergency services available to any person who needs them whether or not they are a member of a target or priority population. Also, universal services such as education, consultation and prevention activities intended to increase knowledge about mental illness, addiction disorders, or developmental disabilities, reduce stigma associated with them and/or prevent avoidable disorders. See also, BASIC SERVICES.

	Cost Per Patient Day An accounting method that determines the actual cost of providing care to individuals.

	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.

	Council on Accreditation Council on Accreditation; one of the agencies recognized by the Division of MH/DD/SAS and the Division of Medical Assistance to accredit providers of mental health, developmental disability and substance abuse services and to accredit systems management functions of Local Management Entities (LMEs).

	County Program A single county or multi-county program that manages, oversees and sometimes directly provides mental health, developmental disabilities and substance abuse services in a specified geographic area. Under mental health reform, all county programs must become single county or multi-county LMEs. See also, AREA PROGRAM

	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.

	Covered Expenses Hospital, medical and other healthcare expenses paid for under a health insurance policy.

	CP Cerebral Palsy

	CPDMI Coalition for Persons Disabled by Mental Illness

	CPT Current Procedural Terminology

	CQI Customer/Continuous Quality Improvement

	CQL Council on Quality and Leadership; one of the agencies recognized by the Division of MHDDSAS and the Division of Medical Assistance to accredit providers of mental health, develomental disabilites and substance abuse services.

	CRC Community Residential Care

	Credentialing The process of approving providers for membership in a network to provide services to consumers. This term can also refer to a peer competency-based credential similar to a license for professionals.

	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 Response to internal stressers or stressful life events that may seriously interfere with or compromise a person's ability to manage his life. A crisis may be emotional, physical, or situational in nature. The crisis is the perception of and response to the situation, not the situation itself.

	Crisis Intervention Services and supports aimed at helping a person manage a crisis safely and return to his or her regular life.

	Crisis Residential Treatment Services Short-term, round-the-clock help provided in a non-hospital 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.

	Crisis Response Immediate response to assess for acute MH/DD/SA service needs, to assist with acute symptom reduction, and to ensure that the person in crisis safely transitions to appropriate crisis stabilization services. These services are available 24 hours per day, 365 days per year.

	Crisis Stabilization Services and supports following crisis response that are intended to assist the person in crisis to return to his/her regular life.

	Cross Tolerance Lower response to a drug that affects the mind because of previous use of another, similar type of drug.

	CRP Community Rehabilitation Program

	CRPAC Client Rights Policy Advisory Committee

	CSAC Certified Substance Abuse Counselor

	CSAT Center for Substance Abuse Treatment

	CSC Child Service Coordinator

	CSDW Client Services Data Warehouse

	CTSP Comprehensive Treatment Services Program (At-Risk Children/Adolescents)

	Cultural A group of learned behaviors that a certain group of people have in common, They include thoughts, communications, actions, customs, beliefs, values and institutions of different racial, ethnic, religious, age or social groups.

	Cultural Competence A process that promotes development of skills, beliefs, attitudes, habits, behaviors and policies which enable individuals and groups to interact appropriately, showing that we accept and value others even when we may disagree with them (University of San Diego). 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.

	DA Division of Aging

	Day Treatment Service A medically monitored and structured non-residential treatment service provided by an interdisciplinary team for a scheduled number of sessions per day and week that usually includes counseling, case management, group or individual therapy, medical services and mental health services.

	Day/Night Services Services provided over 3 hours a day. (Differs from periodic services and 24-hour services.)

	DCD Division of Child Development

	DD Developmental Disabilities

	DDA Development Disabilities Adult (Residential)

	DDTP Drug Dependency Treatment Program

	DDWG Developmental Disabilities Work Group

	De-Institutionalization Release of people, especially mental health patients, from institutions to care, treatment and supports in communities. , De-institutionalization became national policy with the Community Mental Health Centers Act of 1963. The 1997 Supreme Court decision in OLMSTEAD V. LC has given new momentum to development of community based services for individuals who have remained in state hospitals and mental retardation centers because community services were not available.

	DEC Developmental Evaluation Center

	Decompensation A fairly rapid decline in the overall ability of a person to function.

	Deductible A specified amount of money a consumer must pay before insurance benefits begin. Usually expressed in terms of an annual amount.

	Degenerative Marked by or pertaining to deterioration; particularly, deterioration of the function or structure of tissue or changes from a higher to a lower or less functionally active form.

	Delirium A state of frenzied excitement or wild enthusiasm.

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

	Dementia Dementia is a problem in the brain that makes it hard for a person to remember, learn and communicate; eventually is becomes difficult for a person to take care of himself or herself. This disorder can also affect a person's mood and personality.

	Department Of Health And Human Services (DHHS) NC agency that oversees state government human services programs and activities.

	Depression A biologically-based psychological disorder marked by sadness, inactivity, difficulty with thinking and concentration, significant increase or decrease in appetite and sleep, feelings of dejection and hopelessness, and sometimes suicidal thoughts or actions. Depression is a mood disorder characterized by intense feelings of sadness that persist beyond a few weeks. Two neurotransmitters-natural substances that allow brain cells to communicate with one another are implicated in depression: serotonin and norepinephrine.

	Detoxification (detox) A medically supervised treatment program for alcohol or other drug addiction designed to purge the body of intoxicating or addictive substances. It is often used as a first step in overcoming physical or psychological addiction.

	Developmental Disability A severe, chronic disability of a person which: a) is attributable to a mental or physical impairment or combination of mental and physical impairments; b) is manifested before the person attains age 22, unless the disability is caused by a traumatic head injury and is manifested after age 22; c) is likely to continue indefinitely and, d) results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive and expressive language, capacity for independent living, learning, mobility, self-direction and economic self-sufficiency; and e) reflects the person's need for a combination and sequence of special interdisciplinary, or generic care, treatment, or other services which are of a lifelong or extended duration and are individually planned and coordinated; or f) when applied to children from birth through four years of age, may be evidenced as a developmental delay. GS131D-2

	Developmentally Disabled Adult Developmentally disabled adult means a person who has attained the age of 18 years and who has a developmental disability defined as a severe, chronic disability of a person which: a. Is attributed to a mental or physical impairment or combination of mental and physical impairments; b. Is manifested before the person attains age 22; c. Is likely to continue indefinitely; d. Results in substantial functional limitations in three or more of the following areas of major life activity: (i) self-care, (ii) receptive and expressive language, (iii) learning, (iv) mobility, (v) self-direction, (vi) capacity for independent living, and (vii) economic self-sufficiency; and e. Reflects the person's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services which are of lifelong or extended duration and are individually planned and coordinated.

	DFS Division of Facility Service

	DHHS Department of Health and Human Services

	Diagnostic And Statistical Manual (DSM IV) A book, published by the American Psychiatric Association, of special codes that identify and describe MH/DD/SA disorders.

	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.

	Differential Diagnosis Distinguishing between two or more diseases and conditions with similar symptoms by systematically comparing and contrasting their clinical findings, including physical signs, symptoms, as well as the results of laboratory tests and other appropriate diagnostic procedures.

	Dimension A term used in the ASAM (American Society of Addiction Medicine) patient placement criteria referring to one of six patient problem areas that must be assessed when making placement decisions.

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

	Discounted Fee For Service A contracted payment rate that is discounted from the provider's customary fee. This agreement may be between the MCO and the provider or between the consumer and the provider

	Dispensing Or Prescribing Limits Restrictions on the number of prescriptions per month, or the amount of medication that may be prescribed in a given time frame (e.g., a 90-day limit at each pharmacy).

	Disproportionate Share Hospital (DSH) Payments Payments made by a state's Medicaid program to hospitals that the state designates as serving a disproportionate share of low income or uninsured patients. These payments are in addition to the regular payments such hospitals receive for providing inpatient care to Medicaid beneficiaries. States have some discretion in determining which hospitals qualify for DSH payments and how much they receive. The amount of federal matching funds that a state can use to make payments to DSH hospitals in any

	Diuretics Medications that promote the excretion of urine. Such medications are often prescribed to help reduce excess fluid levels in the body, such as associated with chronic heart failure, high blood pressure (hypertension), or certain kidney (renal) or liver (hepatic) disorders. Diuretics help to remove excess water from the body by increasing the amount that is excreted as urine.

	Diversion Choosing lower cost and/or less restrictive services and/or supports. For example, choosing a community program instead of sending a person to a state hospital. The term is also used when preventing arrest or imprisonment by placing the individual in treatment. See also, UTILIZATION REVIEW and PRE-AUTHORIZATION.

	Diversion Programs Programs designed to screen people out of the criminal justice system and into appropriate treatment services before they are imprisoned. In North Carolina diversion programs are in place in response to SB859 which prohibits admission of persons with mental retardation to public

	Division Of Mental Health, Developmental Disabilities And Substance Abuse Services (DMH/DD/SAS) A division of the State of North Carolina, Department of Health and Human Services responsible for administering and overseeing public mental health, developmental disabilities and substance abuse programs and services.

	DJJDP Division of Juvenile Justice and Delinquency Prevention

	DMA Division of Medical Assistance (Medicaid)

	DMH Division of Mental Health

	DMH/DD/SAS NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services

	DOC Department of Correction

	DOD Department of Defense

	DOM Domiciliary

	Domains Major areas of concern to the NC public MH/DD/SA system and its mission, goals, and strategies and for which indicators and measures are developed. Examples include access to services and quality of care. The term may also refer to major areas of functioning in life, such as personal relationships, work, school and living arrangements.

	Double-Blind Trial A double-blind trial is a clinical experiment in which neither the patients nor the researchers are aware of which patients are receiving the active treatment and which are receiving placebo.

	DPH Division of Public Health

	DPI Department of Public Instruction

	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.

	Drug Utilization Review (DUR) Efforts to control drug utilization and costs by a facility or a health plan. Common methods include the use of a formulary (see above), substitution of generic products for more expensive name brands and encouraging use of drugs that will trigger rebates or discounts.

	DS Down Syndrome

	DSB Division of Services for the Blind

	DSDHH Division of Services for the Deaf and the Hard of Hearing

	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.

	DSS Department of Social Services

	DTC Day Treatment Center

	Dual Diagnosis Having more than one disorder or condition such as physical illness and mental illness, mental illness or developmental disability and substance abuse. Since the word dual implies two and it is possible for an individual to have many conditions or disorders, CO-OCCURRING DISORDERS is the more accurate term.

	Dual Eligibles A term used to describe an individual who is eligible both for Medicare and for full Medicaid coverage, including nursing home services and prescription drugs as well as payments of Medicare premiums, deductibles, and co-insurance. Some Medicare beneficiaries are eligible for Medicaid payments for some of all of the Medicare premiums, deductibles, and co-insurance requirements, but not for Medicaid nursing home or prescription drug benefits.

	Dually Diagnosed A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis.

	DVRS Division of Vocational Rehabilitation Services

	DYS Division of Youth Services

	Dysarthria Disordered or impaired articulation of speech due to disturbances of muscular control, usually resulting from damage to the central or peripheral nervous system. Dysarthria is associated with certain neurodegenerative disorders, such as Parkinson's disease or Huntington's disease; cerebral palsy; brain tumors or stroke; or certain types of brain surgery.

	Dyskinesias Abnormal neuromuscular conditions characterized by disorganized or excessive movement (also known as hyperkinesia). Forms of dyskinesia include sudden, brief, shock-like muscle contractions (myoclonus); involuntary, rhythmic, oscillatory movements of a body part (tremor); rapid involuntary jerky movements (chorea); relatively slow writhing motions (athetosis); or abrupt, purposeless, simple or complex muscle movements or vocalizations (motor or vocal tics).

	Dyskinesias While Awake (DWA) Uncontrolled, sporadic movements of the legs and, in some cases, the arms. These movements may be very rapid (myoclonic) or quite slow and prolonged (dystonic); they usually disappear upon voluntary action. Some researchers suspect that these movements may represent a wakeful form of periodic limb movements in sleep (PLMS).

	Dysphagia Difficulty in swallowing. Dysphagia may be associated with esophageal obstruction as well as certain neurodegenerative or motor disorders involving the esophagus.

	Dyspraxia Partial loss of the ability to coordinate and perform certain purposeful movements and gestures in the absence of motor or sensory impairments.

	Dystonia A neurological movement disorder characterized by sustained muscle contractions, resulting in repetitive, involuntary, twisting or writhing movements and unusual postures or positioning. Dystonia may be limited to specific muscle groups (focal dystonia), such as dystonia affecting muscles of the neck (cervical dystonia or spasmodic torticollis) or the eyes, resulting in closure of the eyelids (blepharospasm). Dystonia is associated with certain underlying genetic disorders, such as dystonia musculorum deformans, dopa-responsive dystonia, and paroxysmal kinesigenic and paroxysmal non-kinesigenic dystonic choreoathetosis. The condition may result from the use of certain medications, lack of oxygen during or immediately after birth, or other causes of brain trauma.

	EANC Epilepsy Association of North Carolina

	EAP Employee Assistance Program

	Early Intervention A process used to recognize warning signs for mental health problems and to take early action against factors that put individuals at risk. Early intervention can help children get better in less time and can prevent problems from becoming worse.

	Early Periodic Screening, Diagnostic And Treatment Services (EPSDT) Services provided under Medicaid to children under age 21 to determine the need for mental health, developmental disabilities or substance abuse services. Providers are required to provide needed service identified through screening.

	EAVC Eligible Assaultive and Violent Children

	EBT Evidence-Based Treatment

	EBTPU Evaluation and Brief Treatment PTSD Unit

	ECAC Exceptional Children's Assistance Center

	ECI Early Childhood Intervention

	Education Activities designed to increase awareness or knowledge about any and all aspects of mental health, mental illness, developmental disability or substance abuse to individuals and/or groups. See also, PREVENTION. Also, activities or programs designed to ensure that service providers are competent to provide services; identified as best practices.

	EI Early Intervention

	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), also referred to as the Federal Anti-Patient Dumping Law 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).

	Emergency Services Services designed to assist individuals in an acute crisis who are, or are likely to become, dangerous to themselves or others. Emergency Rooms of general hospitals are one example. See also, CRISIS SERVICES.

	Employee Assistance Program (EAP) A service provided to employees by an employer that aim to identify, motivate to seek help and refer for assistance employees whose job performance is impaired or is at risk of impairment because of personal problems, such as medical, family, marital, financial, legal, emotional and substance abuse or dependency problems.

	Employee Retirement Income Security Act (ERISA) Enacted in 1974, this is a group of Federal statutes that, among other things, prohibits states from regulating the employee welfare benefit plans, including health plans, of self-insured businesses. ERISA does, however, establish certain regulations related to reporting and disclosure, fiduciary standards, claims review and enforcement. It also provides limited protection against discrimination to ERISA health plan participants.

	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.

	Enrollment The total number of covered persons in a health plan. Also refers to the process by which a health plan enrolls groups and individuals for membership or the number of enrollees who sign up in any one group.

	Entitlement A program that creates a legal obligation on the federal government to any person, business, or unit of government that meets the criteria set in law. Federal spending on an entitlement program is controlled through the program's eligibility criteria and benefit and payment rules, not by the appropriation of a specific level of funding in advance. Entitlement programs such as Medicare and Medicaid are also referred to (for federal budget purposes) as direct or mandatory spending. Medicaid is both an individual entitlement and an entitlement to the states that elect to participate.

	EPSDT Early Periodic Screening & Diagnostic Testing

	ER Emergency Room (medical or behavioral health)

	ERADC Eastern Region Assistive Device Clinic

	Exclusive Provider Organization (EPO) See Closed Panel

	Exploitation Exploitation means the illegal or improper use of an aged or disabled resident or his resources for another's profit or advantage.

	Exposure Therapy A type of treatment that includes gradually bringing patients into contact with a feared object or situation; patients learn that the object or situation can be faced and that avoidance is unnecessary

	External Quality Review Organization (EQRO) States are required to contract with an entity that is external to and independent of the State and its managed care contractors to perform a review of the quality of services at least annually.

	FAE Fetal Alcohol Effects

	Family Care Home Family care home means an adult care home having two to six residents. The structure of a family care home may be no more than two stories high and none of the aged or physically disabled persons being served there may be housed in the upper story without provision for two direct exterior ground-level accesses to the upper story.

	Family Support Persons identified by the consumer as either family members or significant others who provide the necessary support for furthering quality of life, attainment of personal life goals or recovery.

	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.

	Family Therapy The efforts aimed at helping a patient's family understand and cope with the patient's disorder and help in the patient's recovery

	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.

	FAS Fetal Alcohol Syndrome

	Federal Confidentiality Law Governing Alcohol And Drug Abuse Patient Records, 42 CFR, Part 2 A federal statute regulating the release of alcohol and drug abuse patient records and patient identifying information.

	Federal Financial Participation (FFP) The technical term for federal Medicaid matching funds paid to states for allowable expenditures for Medicaid services or administrative costs. States receive FFP for expenditures for services at different rates, FMAPs, depending on their per capita incomes. FFP for administrative expenditures also varies in its rate, depending upon the type of administrative cost. See FMAP.

	Federal Medicaid Assistance Program (FMAP) The statutory term for the federal Medicaid matching rate i.e., the share of the costs of Medicaid services or administration that the federal government bears. In the case of covered services, FMAP varies from 50 to 83 percent depending upon a state's per capita income; on average, across all state, the federal government pays at least 57 percent of the costs of Medicaid. FMAPs for administrative costs vary not by state, but by function. The general FMAP for administrative costs is 50 percent; some functions (e.g., survey and certification, fraud control units) qualify for enhanced FMAPs of 75 percent or more.

	Federal Poverty Level (FPL) The federal government's working definition of poverty that is used as the reference point for the income standard for Medicaid eligibility for certain categories of beneficiaries. Adjusted annually for inflation and published by the Department of Health and Human Services in the form of Poverty Guidelines, the FPL in calendar year 2001 was $14, 630 for a family of 3 in the U.S., $18, 290 in Alaska, and $16,830 in Hawaii.

	Federally Qualified Health Center (FQHC) States are required to include services provided by FQHCs in there basic Medicaid benefits package. FQHC services are primary care and other ambulatory care services provided by community health center and migrant health center funded under section 330 of the Public Health Service Act, as well as by look alike clinics that meet the requirements for federal funding but not actually receive federal; grant funds. FQHC status also applies to health programs operated by Indian tribes and tribal organizations or by urban Indian organizations.

	Fee For Service The most-used method of payment for health care. A payer pays a service provider for each reimbursable treatment, upon submission of a valid claim, and according to agreed upon business rules.

	Financial Eligibility In order to qualify for Medicaid, an individual must meet both categorical and financial eligibility requirements. Financial eligibility requirements vary from state to state and from category to category, but they generally include limits on the amount of income and the amount of resources an individual is allowed to have in order to qualify for coverage.

	Financial Management and Accountability Carrying out business functions in an efficient and effective manner.

	FMLA Family Medical Leave Act

	Follow-Up Checking on the progress of a person who has completed treatment or other services, has been discharged or has been referred to other services and supports.

	Food And Drug Administration (FDA) The FDA is a federal agency charged with ensuring that the food supply in the United States is safe and wholesome, that cosmetics are not harmful, and that medicines, medical devices, and radiation-emitting consumer products are safe and effective.

	Forensic Term used to describe a person with mental illness, developmental disability or substance abuse who is involved in the criminal justice system. This includes persons found Not Guilty by Reason of Insanity (NGRI), those who are Incompetent to Stand Trial, or who are in jails or prisons or referred to the mental health system by criminal courts for evaluation and treatment.

	Forensic Psychiatry Branch of psychiatry that decides regarding fitness to stand trial, the need for commitment, or responsibility for criminal behavior in a court of law.

	Formulary A list of drugs that are considered preferred therapy for a given condition and are to be used by providers in prescribing medications.

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

	FSN Family Support Network (UNC-CH)

	FTE/FTEE Full Time Equivalent / Full Time Employee Equivalent (denoting staff positions)

	Functional Status A service consumer's ability to perform the activities of daily living.

	G&L Gains and Losses

	GACCY Governor's Advocacy Council on Children and Youth

	GACPD Governors Advocacy Council for Persons with Disabilities

	GAF Global Assessment of Functioning

	Gag Clause A clause within a contract that restricts the ability of a provider to discuss treatment options with a consumer that may be beneficial but are not covered by the health plan.

	GAO General Accounting Office

	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.

	GEM Geriatric Evaluation and Management

	General Fund State funds used by the General Assembly for public programs and initiatives.

	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.

	Generic Substitution The practice of substituting a cheaper, generic, medication for a brand-name medication. This can be mandated by the state to occur at the point of sale or can occur at consumer request. NMHA is not opposed to the use of generic medication, as this is a reasonable mechanism that can be used to cut costs to the pharmacy budget when appropriate for specific individuals. However, clinicians and consumers must be aware when such policies are in place. The key factor is the ability for clinicians and consumers to choose the best option for all available types of medication therapies.

	Geographic Accessibility A measure of access to services, generally determined by drive/travel time or number and type of providers in a service area.

	Grievances A formal complaint by a service recipient that must be resolved in a specified manner.

	Group Home for Developmentally Disabled Adults Group home for developmentally disabled adults means an adult care home which has two to nine developmentally disabled adult residents.

	Group or Network HMO An HMO that contracts with one or more independent group practices to provide services to its members.

	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.

	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.

	GS General Statute

	Habilitation Activities, treatments, services and/or supports that assist the individual to effectively accomplish activities of daily living.

	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.

	HBPC Home Based Primary Care

	HC Health Choice

	HCBS Home and Community Based Services

	HCFA Health Care Financing Administration

	HCHV Health Care for Homeless Veterans

	HCMI Homeless Chronically Mentally Ill (veterans program)

	Health Care Personnel Unlicensed personnel providing hands-on care (to residents or patients), working in adult care homes, hospitals, home care agencies, nursing pools, hospices and nursing facilities. Unlicensed health care personnel are defined as an adult care personal aide or supervisor, a nurse aide, an in-home nurse aide or an in-home personal care aide. Reference NC General Statute 131E-256(b)(c).

	Health Care Personnel Registry A registry containing the names of unlicensed health care personnel working in adult care homes, home care agencies, hospitals, nursing homes, hospices and nursing pools who have substantiated findings or investigations pending pertaining to abuse or neglect of a resident, misappropriation of resident or facility property, fraud against a resident or a facility or diversion of drugs belonging to a resident or a facility. This registry also contains the names of nurse aides listed on the Nurse Aide I Registry with substantiated findings.

	Health Care Power of Attorney A legal document that gives the person you designate (your health care agent) broad powers to make health care decisions, including mental health treatment decisions, for you should you become unable to make informed healthcare decisions for yourself.

	Health Choice The health insurance program for children in North Carolina that provides comprehensive health insurance coverage to uninsured low-income children. Financing comes from a mix of federal, state, and other non-appropriated funds.

	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 Flexibility And Accountability (HIFA) A Medicaid and States Children's Health Insurance Program (SCHIP) demonstration waiver that offers States greater flexibility in setting benefits and cost-sharing for some groups of Medicaid beneficiaries. Under this policy, States can use section 1115 waivers to cut benefits and/or increase cost-sharing for certain Medicaid beneficiaries and invest resulting saving into expanding coverage of uninsured individuals through the Medicaid and SCHIP programs.

	Health Insurance Portability And Accountability Act (HIPAA) A federal Act that protects people who change jobs, are self-employed, or who have pre-existing conditions. The Act aims to make sure that prospective or current service consumers are not discriminated against based on health status.

	Health Insuring Organization (HIO) An entity that contracts on a prepaid, capitated risk basis to provide comprehensive health services to recipients.

	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.

	Heat Pain Heat pain arises from warm or hot temperatures.

	HEDIS The Health Plan Employer Data and Information Set is a set of performance measures developed to assess the quality of managed care across public and private sectors. It is a product of the National Committee on Quality Assurance.

	HHS Health and Human Services

	HI Hearing Impairment

	HIPAA Health Insurance Portability and Accountability Act (affects confidentiality and data security)

	HIS Health Information System

	HIV Human Immune-deficiency Virus

	HMI Homeless Mentally Ill

	HMO Health Maintenance Organization

	Home And Community Based Services (HCBS) Refers to a federal waiver of Medicaid requirements permitted under the Social Security Act that permits payment for services not ordinarily covered by the Medicaid state plan or to be delivered in a different amount, duration, and scope than services offered by the Medicaid state plan. Federal regulations under the waiver may target specific groups of individuals, such as persons with developmental disabilities, traumatic brain injury, or chronic mental illness, or target specific geographic areas of a state. It also permits the state to set different financial eligibility limits so that additional persons may become eligible for Medicaid through the waiver.

	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.

	Hospital Affiliation A contract between an MCO and a hospital in which the hospital agrees to provide inpatient benefits to the MCO's beneficiaries according to terms negotiated and a (usually discounted) payment schedule.

	Hours Per Patient Day (HPPD) Term used to show hours of nursing staff per patient per day on inpatient care units. HPPD may change from day to day, based on intensity of patient needs, numbers of patients on a ward, average number of admissions/discharges and any other factors that impact the amount of direct care staff needed to provide safe and effective care to patients in hospitals.

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

	HRI High Risk Intervention

	HRI-P High Risk Intervention � Periodic

	HRI-R High Risk Intervention -Residential

	HUD Housing and Urban Development

	HUD Section 8 Vouchers Federal government's major programs for assisting very low income families, elderly and people with disabilities to rent decent, safe and sanitary housing in the private market.

	HUD-VASH Department of Housing and Urban Development VA Supportive Housing program

	IAC Interagency Council

	IAPRS International Association of Psychosocial Rehabilitation Services

	Iatrogenic a disease or disorder that is induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures.

	ICCM Intensive Community Case Management

	ICF Intermediate Care Facility

	ICFMR Intermediate Care Facility for Mental Retardation

	ICFMR/DD Intermediate Care Facility serving persons with Mental Retardation/Developmental Disabilities

	IDEA Individuals with Disabilities Education Act

	IEP Individualized Education Program

	IFP Individual Family Plan

	IFSP Individualized Family Service Plan

	IHP Individualized Habilitation Plan

	ILC Independent Living Center

	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.

	Indicators Measurable evidence of the results of activities related to a particular area of concern. Examples include the percent of adult consumers employed or the percent of children with serious emotional disturbance attending school regularly.

	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 A person who is hospitalized.

	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.

	Institution For Mental Disorders (IMD) Federal rules expressly prohibit Medicaid reimbursement to freestanding IMDs for inpatient services to people between the ages of 22 and 64.

	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.

	Integrated Payment And Reporting System (IPRS) An electronic, web-based system for reporting services and making payments that will eventually replace the Willie M., Thomas S., and Pioneer systems of claims processing. The IPRS system will be built on the existing Medicaid Management Information System (MMIS) currently processing Medicaid claims for the Division of Medical Assistance, (DMA). The goal of the IPRS project is to replace the existing UCR systems with one integrated system for processing and reporting all MH/DD/SAS and Medicaid claims.

	Intensity Of Need A measurement of the amount, duration, scope, frequency and cost of a benefit package for a specific individual.

	Intensity Of Service The degree or extent to which a treatment or service is provided, depending on a patient level of need. Some treatments and services are considered more intensive than others. For example, medically managed inpatient treatment is more intensive than outpatient treatment, or a halfway house. Other services, such as vocational training, can be more or less intense, depending on patient needs. See also LEVELS OF CARE.

	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.

	Intermediate Care Facility (ICF) An institution licensed under state law to provide health related care and services to individuals who do not require the degree of care or treatment that a hospital or skilled nursing facility (SNF) provides.

	Intermediate Care Facility For Persons With Mental Retardation Or Developmental Disabilities (ICFMR/DD) A facility that provides ICF level of care to eligible persons who have mental retardation or developmental disabilities.

	Intervention Activities aimed at interrupting an action or a behavior that is harmful to progress and recovery.

	Involuntary Civil Commitment A medical, social and legal process that permits states to hospitalize persons against their will if, because of a mental disability, they pose a danger to themselves or others.

	Involuntary Outpatient Commitment State law enabling courts to require outpatient treatment for people with mental illness or substance abuse who need treatment but who are incapable of deciding voluntarily to seek it.

	IOM Institute of Medicine

	IOP Intensive Outpatient Program

	IPCC Intensive Psychiatric Community Care

	IPRS Integrated Payment and Reporting System (State's payment system for Area Programs)

	IQ Intelligence Quotient

	IT Information Technology

	IVR Interactive Voice Response

	JCAHO Joint Commission for Accreditation of Healthcare Organizations; one of the agencies recognized by the Division of MHDDSAS and the Division of Medical Assistance to accredit systems management functions of Local Management Entities (LMEs).

	JJC Juvenile Justice Council

	Joint Commission On Accreditation Of Healthcare Organizations (JCAHO) A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations that provide mental healthcare, home care, ambulatory care and long-term care services.

	Kbps Kilobytes per second

	LAAM Levo-alphacetyl methadol (a long acting derivative of methadone)

	LCSW Licensed Clinical Social Worker

	LD Learning Disability

	LDA Learning Disabilities Association of North Carolina

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

	Length Of Stay (LOS) The amount of time that a person remains in a residential program, including hospitals, expressed in days.

	Level Of Care (LOC) A structured system of types of care. For substance abuse programs, as used in the ASAM criteria for substance abuse, this term refers to four broad areas of treatment placement, ranging from inpatient to outpatient.

	LICC Local Interagency Community Council

	Licensure A state or federal regulatory system for service providers to protect the public health and welfare. Licensure of healthcare professionals and hospitals are examples.

	Linkage/Brokerage Usually a case management activity of assisting individuals to access needed services in various agencies or from multiple providers.

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

	LME Local Management Entity

	LOC 1. Level of Care (types of services that can be provided based on consumer functioning). OR 2. Legislative Oversight Committee of the NC legislature.

	Local Business Plan In the reformed MH/DD/SA system, a comprehensive plan required of local management entities for mental health, developmental disabilities and substance abuse services in a certain geographical area.

	Local Managing Entity (LME) The local agency that plans, develops, implements and monitors services within a specified geographic area according to requirements of the DMH/DD/SAS. Includes developing a full range of services that provides inpatient and outpatient treatment, services and/or supports for both insured and uninsured individuals.

	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.

	LOE Level of Eligibility

	Long-Term Care A range of healthcare services that are regularly used over a long period of time; sometimes over the course of a lifetime. Residence-based services, such as nursing home care, are one of the most common forms of long-term care and are what most individuals and policy makers have in mind when they speak of this type of care.

	LOS Length of Stay (time from admission to discharge)

	LP Licensed Psychologist

	LPA Licensed Psychological Associate

	LPC Licensed Professional Counselor

	LRE Least Restrictive Environment

	LTC Long Term Care

	Magnetic Resonance Imaging (MRI) A diagnostic scanning technique during which radio waves and an electromagnetic field are used to help create detailed, cross-sectional images of specific organs and tissues. MRI is often considered a particularly valuable imaging technique for studies of the brain and spinal cord because of the MRI's ability to scan images from various angles and provide strong contrast between healthy and abnormal tissues.

	Managed Behavioral Healthcare Organization (MBHO) An MCO that specializes in the management, administration and/or provision of behavioral healthcare benefits.

	Managed Care A health care delivery system that attempts to keep costs down by managing the care to eliminate unnecessary treatment and reduce expensive hospital care. The most familiar models are health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

	Managed Care Entity (MCE) The federal statutory term for managed care plan participating in Medicaid. There are two types of MCEs: managed care organization (MCOs) and primary care case managers (PCCMs). MCEs may be public or private.

	Managed Care Organization (MCO) An MCO is an entity that has entered into a risk contract with a state Medicaid agency to provide a specified package of benefits to Medicaid enrollees in exchange for a monthly capitation payment on behalf of each enrollee. See Capitation Payment.

	Managing Entity The local agency that plans, develops, implements and monitors services within a specified area. See also, COUNTY PROGRAM and AREA PROGRAM.

	Mandatory State participation in the Medicaid program is voluntary. However, if a state elects to participate, as do all, the state must at a minimum offer coverage for certain services to certain populations. These eligibility groups and services are referred to as mandatory in order to distinguish them from the eligibility groups and services that a state may, at its option, cover with federal Medicaid matching funds. See Optional.

	MD Muscular Dystrophy & Medical Doctor

	MDD Major Depressive Disorder

	Measures Methodologies applied to derive and calculate indicators. Examples: 1. Adult consumer performs paid work for at least 20 hours per week. 2. SED child attends at least 90% of regularly scheduled school days.

	Medicaid Medicaid is a health insurance program for certain low-income and needy people paid with federal, state, and county dollars. It covers more than 1 million people in North Carolina, including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments. Medicaid funds some Mental Health, Developmental Disabilities and Substance Abuse services based on the consumer's diagnosis and medical necessity. Consumers with Medicaid, or who believe they may be eligible for Medicaid, should discuss this with their service provider. Application for Medicaid can be made through the Department of Social Services.

	Medicaid Disincentives Eligibility rules in the Medicaid and Social Security programs that get in the way of people with disabilities being able to return to work. A number of recent legislative reforms now permit some of these disincentives to be overcome.

	Medicaid Match Federal government rule requiring that the state/local government match the federal government funds for Medicaid reimbursement services. In North Carolina, this is approximately 60% federal/40% state/local match.

	Medical Co-Morbidity Presence of two serious illnesses at once; for example, drug addiction and acquired immunodeficiency syndrome.

	Medical Director A qualified physician responsible for establishing and overseeing medical policy throughout the system.

	Medically Managed Services Services provided or directly managed by a physician.

	Medically Monitored Residential Detoxification Service A 24 hour per day service in a residential setting providing detoxification service and monitoring, with care provided by a multidisciplinary team of service personnel including 24 hour nursing care under the supervision of a physician.

	Medically Monitored Services Services provided under the direction and supervision of a physician. The physician may or may not directly administer care to the patient.

	Medically Necessary or Medical Necessity Criteria established to ensure that treatment is necessary and appropriate for the condition or disorder for which the treatment is provided. Review methods include retrospective, concurrent and pre-treatment reviews. See UTILIZATION REVIEW.

	Medicare A federal government hospital and medical expense insurance plan primarily for elderly people and people with disabilities.

	Medicare Part A The part of Medicare that provides basic hospital coverage automatically for most eligible persons over sixty-five or for people with disabilities.

	Medicare Part B A voluntary program that is part of Medicare and provides benefits to cover the costs of physician services.

	Medicare Part D The part of Medicare that provides prescription drug benefits for most eligible persons over sixty-five or for people with disabilities.

	Medicare Supplement A private medical expense insurance that supplements Medicare coverage. Also known as a Medigap policy.

	Medicare+Choice An expansion of the traditional Medicare program that will augment the fee-for-service and HMO health plans currently available to participants to include a variety of new managed care and fee-for-service options.

	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.

	Memorandum of Agreement (MOA) A written document, signed by two or more parties, containing policies and/or procedures for managing issues that impact more than one agency or program.

	Memorandum Of Understanding (MOU) Same as MOA

	Mental Disorders Another term used for mental health problems.

	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 Illness Collective term for all mental disorders. See also, MENTAL HEALTH, SERIOUS MENTAL ILLNESS, and SERIOUS AND PERSISTENT MENTAL ILLNESS.

	MH Mental Health

	MH/SA PAC Mental Health/Substance Abuse Policy Advisory Committee

	MHA Mental Health Association

	MHTF Mental Health Trust Fund

	MI Mental Illness

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

	MICA Medically Ill Chemical Abusers

	MMIS Medicaid Management Information System

	MOA Memorandum of Agreement (written document for how two or more agencies will work together)

	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.

	Most In Need The most severely disabled individuals with mental illness, developmental disabilities or substance abuse. Also, the basis for establishing target or priority populations.

	Motor Fluctuations Motor fluctuations occur when levodopa is used to treat Parkinson's disease. As the disease becomes worse, the number of cells in the brain that store dopamine decreases, the symptoms of Parkinson's disease worsen, and levodopa is not as effective in controlling the symptoms. When this happens, a person is said to have off episodes.

	MOU Memorandum of Understanding (see MOA)

	MPD Multiple Personality Disorder

	MR Mental Retardation

	MR/MI Mental Retardation/Mental Illness or co-occurring disorders, formerly Thomas S. class consumers illness) formerly Thomas S.

	MS Multiple Sclerosis

	Multiple Sclerosis (MS) A progressive disease of the central nervous system characterized by destruction of myelin (demyelination), the fatty substance that forms a protective sheath around certain long nerve fibers (axons). Myelin serves as an electrical insulator, enabling the effective transmission of nerve signals. Patients with MS may develop paresthesias, such as numbness or tingling; muscle weakness and stiffness; impaired coordination; abnormal reflexes; an inability to control urination (urinary incontinence); slurred speech; visual disturbances; and/or other symptoms and findings.

	Multisystemic Therapy (MST) A best practice intensive family and community-based treatment model for serious, violent and chronic juvenile offenders who are at-risk for out of home placement.

	NA Narcotics Anonymous

	NACBHD National Association of County Behavioral Health Directors

	NADDC National Association of Developmental Disabilities Councils

	NAMI National Alliance for the Mentally Ill

	NAPAS National Association of Protection and Advocacy Services

	NASDDDS National Association of State Directors of Developmental Disabilities Services

	National Practitioner Data Bank (NPDB) A database maintained by the federal government that contains information on physicians and other medical practitioners against whom medical malpractice claims have been settled or other disciplinary actions that have been taken.

	Natural Supports Places, things and, particularly, people who are part of our interdependent lives and whose relationships are reciprocal in nature.

	NC-SNAP NC Support Needs Assessment Profile

	NCACC North Carolina Association of County Commissioners

	NCAD North Carolina Association of the Deaf

	NCAIANMHR National Center for American Indian and Alaska Native Mental Health Research

	NCARF North Carolina Association of Rehab Facilities

	NCATP North Carolina Assistive Technology Project

	NCCCP North Carolina Council Of Community Programs

	NCCDD North Carolina Council on Developmental Disabilities

	NCDBA North Carolina Deaf-Blind Associates

	NCGS North Carolina General Assembly Statues (State Law)

	NCHC North Carolina Health Choice

	NCPA North Carolina Psychological Association

	NCQA National Committee for Quality Assurance; one of the agencies recognized by the Division of MHDDSAS and the Division of Medical Assistance to accredit systems management functions of Local Management Entities (LMEs).

	Needs Assessment A process by which an individual or system (e.g., an organization or community) examines existing resources to determine what new resources are needed or how to reallocate resources to achieve a desired goal.

	Neglect Neglect means the failure to provide the services necessary to maintain a resident's physical or mental health.

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

	Neurosis A long-term disorder featuring anxiety and/or exaggerated behavior dedicated to avoiding anxiety; sufferers understand that the condition is abnormal.

	NHCU Nursing Home Care Unit

	NIAAA National Institute on Alcohol and Alcoholism

	NIDA National Institute on Drug Abuse

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

	North Carolina Support Needs Assessment Profile (NC-SNAP) Assessment instrument used to determine the care or supports needed by a person with developmental disabilities.

	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) Obsessive Compulsive Disorder is a chronic, relapsing illness. People who have it suffer from recurrent and unwanted thoughts or rituals. The obsessions and the need to perform rituals can take over a person's life if left untreated. They feel they cannot control these thoughts or rituals.

	ODD Oppositional Defiant Disorder

	OIG Office of Inspector General

	Olmstead v. LC A recent U.S. Supreme Court decision that found that people with disabilities have a right to choose services in the least restrictive environment. North Carolina has an OLMSTEAD Plan in place to develop more community-based services for many people who currently reside in state institutions.

	Ombudsman A person or program responsible for investigating and seeking to resolve consumer complaints. An ombudsman should also collect and analyze information that will enable health plans to correct systemic problems in collaboration with consumers, clinicians, purchasers and regulators.

	Open Enrollment Period A period during which consumers have an opportunity to select among health plans, usually without evidence of insurability or waiting periods.

	OSAT Outpatient Substance Abuse Team

	OSHA Occupational Safety/Health Administration

	OT Occupational Therapy

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

	Outcomes Improvement A quality improvement process to assure that services produce expected results for consumers.

	Outcomes Measures At the individual level, events used to determine the extent to which service consumers improve their levels of functioning, improve their quality of life, or attain personal life goals as a result of treatments, services and/or supports provided by the public and/or private systems. At the system level, these are events used to determine if the system is functioning properly.

	Outpatient Services A collection of services for persons with mental illness or addiction disorders. They may include any of the following but are not limited to assessment, medication management, psychotherapies, family therapy, care coordination or case management, supportive employment programs, housing assistance, rehabilitation programs and activities, Assertive Community Treatment (ACT), Homeless Outreach, prevention programs, and others. Outpatient services can be provided in a variety of settings, including the person's home, and contain a few or any number of service elements.

	PA Physician's Assistant

	PACT Program of Assertive Community Treatment (see ACTT)

	PADs Psychiatric advance directives (PADs) are relatively new legal instruments that may be used to document a competent person's specific instructions or preferences regarding future mental health treatment, in preparation for the possibility that the person may lose capacity to give or withhold informed consent to treatment during acute episodes of psychiatric illness.

	Paid Supports The people, places and things that are part of our lives because we purchase them in order to achieve specific outcomes.

	Panic Disorder A condition marked by episodes of immediate and intense anxiety at inappropriate times; sufferers may experience palpitations, feelings of faintness, chest pains, and a sensation that death is imminent, even when there is no apparent threat or danger; individuals who experience four or more unexplained attacks in a month, as well as individuals who have fewer attacks but live in constant fear of such an episode, may be suffering from the disorder

	Paranoia And Paranoid Disorders Symptoms of paranoia include feelings of persecution and an exaggerated sense of self-importance. The disorder is present in many mental disorders and it is rare as an isolated mental illness. A person with paranoia can usually work and function in everyday life since the delusions involve only one area. However, their lives can be isolated and limited.

	Parity A series of initiatives at the national and local levels for private and public health insurers to provide equitable coverage for treatment of mental disorders compared to physical illnesses.

	Partial Hospitalization Programs that provide care and treatment for individuals several hours per day but not overnight. More structured and therapeutic than the clubhouse model.

	Participant-Driven An approach to care in which the consumer, with assistance from family members, friends, and other persons when necessary, determines the services and supports that are needed to enhance his/her quality of life.

	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.

	Patient Identifying Information The name, address, social security number, fingerprints, photograph, or similar information by which the identity of a patient can be determined with reasonable accuracy and speed, either directly or by reference to other publicly available information. See division Web site. Patient identifying information* (42 C.F.R. 2.11).

	Patient Placement Criteria (PPC) Standards of, or guidelines for, alcohol, tobacco and other drug (ATOD) abuse treatment that describe specific conditions under which patients should be admitted to a particular level of care (admission criteria), under which they should continue to remain in that level of care (continued stay criteria), and under which they should be discharged or transferred to another level (discharge / transfer criteria). PPC generally describe the settings, staff, and services appropriate to each level of care and establish guidelines based on ATOD diagnosis and other specific areas of patient assessment.

	Payer The public or private organization that is responsible for payment for health care expenses.

	PCG Public Consulting Group

	PCP Person-centered plan

	PDD Pervasive Developmental disorder

	Peer Review The analysis of clinical care by a group of that clinician's professional colleagues. The provider's care is generally compared to applicable standards of care, and the group's analysis is used as a learning tool for the members of the group.

	Peer Support Services offered by mental health consumers, persons with addictions or others to provide support to one another. Peer support services can include drop-in centers, warm lines, peer respite care or support groups. Peer support services are often a part of rehabilitation and recovery programs.

	PERC Program Evaluation Resource Center

	Performance Improvement A Quality improvement process of measuring and improving system performance, especially regarding key domains of interest.

	Performance Measures Quantitative measures of the quality of care provided by a provider that consumers, payers, regulators and others can use to compare the care or provider to other care or providers.

	Periodic Services Short-term re-occurring visits over time. (Differs from day/night services and 24-hour services.)

	Person-Centered Planning A process concerned with learning about the individual's whole life, not just the issues related to the person's disability. The process involves assembling a group of supporters, on an as-needed basis, who are selected by the individual with the disability and who have the closest personal relationship with them and are committed to supporting the person in pursuit of real life dreams. The planning process is interested in learning who the person is as an individual and what he/she desires in life. The process is interested in identifying and gaining access to supports from a variety of community resources, one of which is the community MH/DD/SA system, that will assist the person in pursuit of the life he/she wants. Person-centered planning results in a written individual support plan.

	Personal Care Services Personal care services means any hands-on services allowed to be performed by In-Home Aides II or III as outlined in Department rules.

	PH Partial Hospitalization

	Pharmaceutical Benefits Manager (PBM) An entity that is responsible for managing prescription benefits.

	Physiatrist A physician specializing in physical medicine and rehabilitation.

	Physical Dependence A condition in which the brain cells have adapted as a result of repeated exposure to a drug and consequently require the drug in order to function. If the drug is suddenly made unavailable, the cells become hyperactive. The hyperactive cells produce the signs and symptoms of drug withdrawal.

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

	PICU Psychiatric Intensive Care Unit

	PID Personal Identification Number (unique to consumer)

	PL Public Law (federal law)

	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.

	PMI Psychiatric and Medically Infirm

	POC Plan of Care

	POD Partnership for Outreach & Development

	Point-Of-Service (POS) A health plan arrangement in which consumers may choose to receive a service from a participating or a non-participating provider or facility. Generally, the level of coverage is reduced, or the consumer pays more out-of-pocket, for services associated with the use of non-participating providers.

	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.

	PPO Preferred Provider Organization

	Pre-Authorization The process of approving use of certain resources in advance rather than after the service has been provided. Approval for admission to hospitals is one example.

	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)

	Preferred Provider Organization (PPO) An organized network of healthcare providers, typically reimbursed on a discounted fee-for-service basis. Coverage may or may not be available outside of the network for a higher co-payment.

	Prepaid Health Plan (PHP) An entity that either contracts on a prepaid, capitated risk basis to provide services that are not risk-comprehensive services, or contracts on a non-risk basis. Additionally, some entities that meet the above definition of HMOs are treated as PHPs through special statutory exemptions.

	Pressure Sore Pressure sores are red areas on the skin; they are also called bed sores, pressure sores, and decubitus ulcers. They can occur over any bony part of the body, but for the wheelchair bound, the ischial tuberosities and sacrum are the major risk areas. There are four degrees of severity of pressure sores with the most severe causing tissue necrosis, or damage to muscle, bone or supporting structure. (wound care communications network)

	Prevention Activities aimed at teaching and empowering individuals and systems to meet the challenges of life events and transitions by creating and reinforcing healthy behaviors and lifestyles and by reducing risks contributing mental illness, developmental disabilities and substance abuse. Universal prevention programs reach the general population; selective prevention programs target groups at risk for mental illness, developmental disabilities and substance abuse; indicated prevention programs are designed for people who are already experiencing mental illness or addiction disorders.

	Prevention Record Documentation of prevention activities and strategies directed to targeted populations.

	Primary Care Case Manager (PCCM) PCCMs are physicians, physician groups, or entities having arrangements with physicians that contract with state Medicaid agencies to coordinate and monitor the use of covered primary care services by enrolled beneficiaries. State Medicaid contracts with PCCMs tend to be less comprehensive in their coverage of benefits and involve less financial risk than those with MCOs.

	Primary Source Verification A process through which an organization validates credentialing information from the organization that originally issued the credential to the practitioner.

	Prior Authorization A managed care process that approves the provision of services before they are delivered.

	Priority Populations Groups of people within target populations who are considered most in need of the services available within the system.

	Privileging Process for determining, usually through training and supervision that an individual provider has the necessary skills and knowledge to offer designated services.

	Program A fixed and defined arrangement of services most typically provided within a particular building or narrowly scoped model of practice. These include day programs and residential programs with entrance and exit criteria and a specified set of services.

	Program For All-Inclusive Care For The Elderly (PACE) A federally initiated program for elderly persons that is funded with both Medicaid and Medicare dollars. The program attempts to integrate the services that are traditionally divided between these two programs and is designed to assist elderly individuals who may qualify for nursing home placement, but who live in the community.

	Program Of Assertive Community Treatment (PACT) A highly structured, multidisciplinary program of intensive treatment, rehabilitation and support services to individuals in their homes, on the job, and in social settings. See also, ASSERTIVE COMMUNITY TREATMENT.

	Prompt Services Services provided when needed. For target or priority populations, routine appointments within 14 days, initial hospital discharge visits within 3 days, urgent visits within 2 days, emergent visits immediately and no later than 24 hours qualify as prompt. See also, TIMELY SERVICES.

	Provider A person or an agency that provides MH/DD/SA services, treatment, supports.

	Provider Endorsement All providers of enhanced Medicaid covered mh/dd/sa services must directly enroll in the Medicaid program through the Division of Medical Assistance. In order to ensure providers have the appropriate qualifications prior to enrollment, providers must apply to and be endorsed by the Area Program / Local Management Entity(LME) as a prerequisite to Medicaid enrollment.

	Provider Profiling The process of compiling data on individual provider patterns of practice and comparing those data with expected patterns based on national or local statistical norms. The data may include medication prescribed, hospital length of stay, size of caseload, and other services.

	PRRTP Psychosocial Residential Rehabilitation Treatment Program

	PRTF Psychiatric Residential Treatment Facilities

	PRWG Provider Relations Work Group

	PSR Psychosocial Rehabilitation

	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.

	Psychosocial Rehabilitation A variety of social, learning, vocational and community living skill-building programs. Programs that focus on principles of recovery often achieve very successful outcomes.

	PT/OT/Speech Physical therapy/Occupational Therapy

	PTSD Post Traumatic Stress Disorder

	Public Mental Health, Developmental Disabilities And Substance Abuse Services System The network of managing entities, service providers, government agencies, institutions, advocacy organizations, commissions and boards responsible for the provision of publicly funded services to consumers.

	Public Services Publicly funded mental health, developmental disabilities, and substance abuse services delivered by public and private providers.

	QA/QI Quality Assurance/Quality Improvement (compliance with standards)

	QDDP Qualified Development Disabilities Professional

	QI Quality Improvement (continuous improvement of services, outcomes, processes)

	QIP Quality Improvement Program

	QM Quality Management (frame work for assessing and improving services, operations, etc.)

	QMHP Qualified Mental Health Professional

	QP Qualified Professional (QDDP, QPHP)

	QSAP Qualified Substance Abuse Professional

	Qualified Medicare Beneficiary (QMB) Program A public program that pays the premiums, deductibles and coinsurance for individuals who are on Medicare and at or below the Federal poverty level.

	Qualified Provider A provider who meets the provider qualifications as defined by rules adopted by the Secretary of Health and Human Services.

	Quality Assurance (QA) Process to assure that services are minimally adequate, client rights are protected, and organizations are fiscally sound. QA involves periodic monitoring of compliance with standards. Examples include: 1. Establishment of minimum requirements for documentation and service provision. 2. Licensure and certification of individuals, facilities, and programs. 3. Investigation of allegations of fraud and abuse. See also, QUALITY MANAGEMENT.

	Quality Improvement (QI) Process to assure that services, administrative processes, and staff are constantly improving and learning new and better ways to provide services and conduct business. The goals of QI are consistent with the mission and vision of the Division. As distinct from QA, the purpose of QI, also referred to as continuous quality improvement (CQI), is to continuously improve the process and outcome (quality) of treatments, services, and supports provided to consumers. QI consists of the regular and systematic assessment of vital indicators of organizational performance (i.e., data), the identification and evaluation of trends, and when problems are identified, systematic problem-solving to develop solutions to the identified problems. Special teams may be developed to further investigate and propose solutions to identified problems. Solutions to organizational problems are implemented by quality improvement teams and are systematically evaluated for effectiveness and on-going problem solving until a satisfactory resolution is reached. QI is proactive, seeking opportunities to continually improve processes to achieve better outcomes. Examples include: 1. Forming teams to identify data to be collected, retrieve the data, analyze it and design improvements in the system. 2. Development and implementation of evidence-based practice guidelines. 3. Conducting targeted studies to determine how to improve service delivery.

	Quality Management (QM) Framework for assessing and improving services and supports, operations, and financial performance. Processes include: quality assurance, quality improvement, utilization review, utilization management.

	Quality Service Convenient, comprehensive services that meet individual needs and are delivered in a clinical and culturally competent manner.

	R & D Resource and Development

	Rebound The return of original symptoms when treatment stops

	Recovering Staff Counselors with and without educational degrees working in the substance abuse treatment field who are in recovery.

	Recovery A personal process of overcoming the negative impact of a disability despite its continued presence. Like the victim of a serious accident who undergoes extensive physical therapy to minimize the impact of damaging injuries, people with active addictions as well as serious, disabling mental illnesses and developmental disabilities can also make substantial recovery through symptom management, psychosocial rehabilitation, other services and supports, and encouragement to take increasing responsibility for self.

	Referral Establishing a link between a person and another service or support by providing authorized documentation of the person's needs and recommendations for treatment, services, and supports. It includes follow up in a timely manner consistent with best practice guidelines.

	Register The process of gathering initial data and entering an individual into the service system.

	Relapse Prevention Any strategy or activity designed to assist an alcohol or other drug user who has become abstinent from returning to active alcohol or drug use. Relapse prevention also refers to specific cognitive-behavioral treatment that combines behavioral skill-training procedures with cognitive intervention techniques to help individuals maintain desired behavioral changes. It draws from both health psychology and social-cognitive therapy and uses a psycho educational self-management approach to substance abuse designed to teach patients new coping responses (e.g., alternatives to addictive behavior), to alter unhelpful beliefs and expectations concerning substance abuse, and to change personal habits and lifestyles.

	Relapse Prevention Plan A shared understanding between the consumer, clinicians, and significant others of behaviors, feelings and thoughts that indicate the onset of symptom destabilization and those actions and activities that will prevent the continued progress of symptom destabilization. A formal written acknowledgement of this plan is an ADVANCE DIRECTIVE.

	Request For Proposals (RFP) A request for bids to provide specific services, such as mental health benefits, to a specific population. They are issued by both public and private payors.

	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 designed to provide temporary care for a person with a disability who ordinarily lives with family or friends, or to assume temporary responsibility for care of the person in his/her own home. This service provides back-up support and in some cases relief to persons responsible for care of ill or people with disabilities who ordinarily live in their household.

	Retrospective Authorization Authorization to provide services after the services have been delivered.

	Revenues Money earned through reimbursements paid for covered services.

	RFI Request for Interest

	RFP Request for Proposals

	Rx Prescription

	S/A CWT/TR Substance Abuse Compensated Work Therapy and Transitional Residence

	SA Special Assistance or Substance Abuse

	SAC Substance Abuse Counselor

	SAD Substance Abuse Disorder - child

	Safety Net The responsibility of the public mental health, developmental disability and substance abuse services system to serve, treat and support seriously ill people who, no matter how needy, would not otherwise receive services.

	SAMHSA Substance Abuse and Mental Health Administration (federal government agency)

	SAPTBG Substance Abuse Prevention and Treatment Block Grant

	SBA Spina Bifida Association

	SBI State Bureau of Investigation

	Schizophrenia Schizophrenia is a mental disorder characterized by positive and negative symptoms. Psychotic, or positive, symptoms include delusions, hallucinations, and disordered thinking (apparent from a person's fragmented, disconnected and sometimes nonsensical speech). Negative symptoms include social withdrawal, extreme apathy, diminished motivation, and blunted emotional expression.

	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.

	Screening An abbreviated assessment or series of questions intended to determine whether the person needs referral to a provider for additional services. A screening may be done face-to-face or by telephone, by a clinician or paraprofessional who has been specially trained to conduct screenings. Screening is a core or basic service available to anyone who needs it whether or not they meet criteria for target or priority populations.

	SE Supported Employment

	Seamless Treatment system without gaps or breaks in service, such that persons being served transition smoothly and with ease from one treatment component to another.

	SED Severely Emotionally Disturbed (18 or less who are at greatest risk for needing services)

	Sedation An induced state of quiet or sleep

	Seizures Episodes of uncontrolled electrical activity in the brain. These abnormal electrical disturbances may lead to involuntary jerking, spasms, or rhythmic contraction and relaxation of certain muscle groups and impaired control of involuntary functions such as breathing or bladder or bowel control. There may also be loss of consciousness or sensory or behavioral abnormalities.

	Selected Prevention See PREVENTION

	Self-Determination The right to and process of making decisions about one's own life. The best practice for persons with developmental disabilities.

	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.

	Senior Care Organization (SCO) A Federal program designed to assist the dually eligible population by providing a wide range of medical and social services.

	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.

	Seriously And Persistently Mentally Ill (SPMI) Refers to people whose mental disorder is so severe and chronic that it prevents or erodes development of their functional capacities in primary aspects of daily life such as personal hygiene and self care, decision-making, interpersonal relationships, social transactions, learning and recreational activities. Same as SERIOUS, DISABLING MENTAL ILLNESS AND CHRONIC MENTAL ILLNESS.

	Service A fixed and defined arrangement, such as social work services or nursing services, which are delivered within a scope of professional practice.

	Service Management At the consumer level, this means a professional, with a great deal of knowledge of the services and programs supported by the public system, managing a set of services by advocating for access and linking the person to the services. At the system level, this means activities such as implementing and monitoring a set of standards for access to services, supports, treatment; making sure that people receive the appropriate level and intensity of services; management of state facilities' bed days, making sure that networks create consumer choice in service providers.

	Severely Emotionally Disturbed (SED) A designation for people under 18 years of age who, because of their diagnosis, the length of their disability and their level of functioning, are at the greatest risk for needing services.

	Severely Mentally Ill (SMI) Refers to adults with a mental illness or disorder that is described in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, that impairs or impedes functioning in one or more major areas of living and is unlikely to improve without treatment, services and/or supports. People with serious mental illness are a target or priority population for the public mental health system for adults.

	SH Supportive Housing

	Side Effect An effect of a drug that is not the main or intended effect. Side effects may be of no concern, or they may be bothersome or even dangerous, in which case they may limit the upper dose a patient can tolerate. Side effects are also called adverse effects.

	SIL State Independent Living Council

	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.

	SIPU Specialized Inpatient PTSD Unit

	SIS Supports Intensity Scale

	SL Supported Living

	SL/P Speech Language Pathologist

	SMI Severe Mental Illness / Seriously Mentally Ill

	SOC System of Care

	Social Phobia An intense anxiety of being judged by others and/or publicly behaving in a way tat could lead to embarrassment or ridicule; perhaps most common is fear of public speaking

	Social Security Administration (SSA) The federal income security agency that administers the Federal retirement, survivors and disability insurance programs, and the program of supplemental security income (SSI) for the aged, blind and disabled. It is the agency designated by the governor and the state government to coordinate state substance abuse services across government lines.

	Social Security Disability Insurance (SSDI) A Social Security program that pays disability benefits to blind or disabled workers, widow(er)s, or adults disabled since childhood, who are otherwise eligible. The amount of the monthly disability benefit is based on Social Security earnings record of the insured worker.

	SOS State Operated Services

	Specialty Services Services provided to people with disabilities that affect relatively few people.

	Specific Phobia An illogical but real and intense fear of an object, such as dogs or insects, or a situation, such as flying or closed spaces; also known as single phobia or simple phobia.

	SPMI Severe and Persistent Mental Illness

	SRIS (Serotonin Reuptake Inhibitors) A class of anti-depressants used to treat anxiety disorders; they are thought to work by boosting the amount of serotonin (a neurotransmitter linked to mood regulation) available to the brain; the most common side effect associated with SRIs is mild nausea that generally diminishes after a few weeks. Sexual dysfunction, primarily ejaculatory delay, also has been reported

	SSA (Social Security Administration) The agency designated by the governor and the state government to coordinate state substance abuse services across government lines.

	SSBG Social Services Block Grant

	SSDI Social Security Disability Insurance

	SSI Supplemental Security Income

	Standard Of Care A diagnostic and/or treatment process that a clinician should follow for a certain type of patient, illness or clinical circumstance.

	Standards Activities generally accepted to be the best method of practice. Also, the requirements of licensing, certifying, accrediting, or funding groups.

	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 Consumer and Family Advisory Committee The state mandated, state level volunteer committee composed of consumers and family members of consumers whose role is to advocate for the best interests of consumers across the state and advise the Secretary of the Division of Health and Human Services and the Director and management team of the Department of Mental Health, Developmental Disabilities and Substance Abuse Services.

	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 Medicaid Plan Under Title XIX of the Social Security Act, no federal Medicaid funds are available to a state unless it has submitted to the Secretary of HHS, and the Secretary has approved, its state Medicaid plan (and all amendments to the state plan). The state Medicaid plan must meet over 60 federal statutory requirements.

	State Mental Health Authority The single state agency designated by each state's governor to be responsible for the administration of publicly funded mental health programs in the state. In North Carolina that agency is the Department of Health and Human Services.

	State Mental Health, Developmental Disabilities And Substance Abuse Services Plan or State Plan State Plan or State Mental Health, Developmental Disabilities and Substance Abuse Services Plan - first published in 2001 and each thereafter as a report to the NC legislature on the progress toward reforming the public system for delivering mental health, developmental disability and substance abuse services across the state. The State Plan forms the basis and framework for services provided across North Carolina.

	State Or Local Consumer Advocate The individual carrying out the duties of the state Local Consumer Advocacy Program Office

	State Plan Amendment (SPA) A state that wishes to change its Medicaid eligibility criteria or its covered benefits or its provider reimbursement rates must amend its state Medicaid plan to reflect the proposed change. Similarly, states must conform their state plans to changes in federal Medicaid law. In either case, the state must submit a state plan amendment (SPA) to HCFA for approval.

	Stigma In this case, negative attitudes towards people with mental illness, developmental disabilities or addiction disorders.

	Substance Abuse The DSM IV defines substance abuse as occurring if the person 1) uses drugs in a dangerous, self defeating, self destructive way and 2) has difficulty controlling his use even though it is sporadic, and 3) has impaired social and/or occupational functioning all within a one year period.

	Substance Abuse And Mental Health Administration Of The Federal Government (SAMHSA) SAMHSA is an agency of the U.S. Department of Health and Human Service. It is the federal umbrella agency of the Center for Substance Abuse Treatment, Center for Substance Abuse Prevention, and the Center for Mental Health Services.

	Substance Abuse And Mental Health Services Administration (SAMHSA) Under the U.S. Department of Health and Human Services, SAMHSA is responsible for improving the quality and availability of prevention, treatment and rehabilitation services for substance abuse and mental illnesses.

	Substance Abuse Prevention and Treatment Block Grant (SAPTBG) A federal program to provide funds to states to enable them to provide substance abuse services.

	Substance Dependence DSM IV defines substance dependence as requiring the presence of tolerance, withdrawal, and/or continuous, compulsive use over a 1year period.

	Supplemental Security Income (SSI) A Social Security program that pays disability benefits to adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, and are otherwise eligible.

	Support Broker A staff person who acts as an intermediary between the individual who needs supports and the agencies or programs that actually provide the supports.

	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.

	Supports Any of a large number of flexible activities or material resources intended to assist people to gain and maintain meaningful lives as citizens of their communities. See NATURAL SUPPORTS, PAID SUPPORTS

	SUPT Substance Use PTSD Treatment Program

	SYNAR Amendment Section 1926 of the Public Health Service, is administered through the Substance Abuse Prevention and Treatment (SAPT) Block Grant and requires states to conduct specific activities to reduce youth access to tobacco products. The Secretary of the US Department of Health and Human Serrvices is required by statute to withold SAPT Block Grant Funds (40% penalty) from states that fail to comply with the SYNAR Amendment.

	System Of Care Principles The best practice principles for children's services: 1. Array of appropriate services that assist a whole child/family; 2. Individualized, integrated service plan; 3. Services are clinically appropriate, delivered in least restrictive and most normal environment; 4. The family fully participates in planning and delivery of services; 5.There is integration among all systems involved in child/family's life. such as schools and courts; case manager ensures this happens; 6. Early identification with positive outcome anticipation; 7. Smooth transition to adult service systems; 8. Rights protected and effective advocacy; 9. Receive services without regard to race, religion, national origin, sex, physical disability or other characteristics, and services should be sensitive and responsive to cultural differences and special needs.

	System Of Care Values Children's services that are child centered, family focused, community based, culturally competent.

	System Performance The extent that a system achieves its goals. The goals of the state MH/DD/SA system are found in the DMH/DD/SAS mission, vision and guiding principles.

	System Performance Measurement The process of assessing progress toward achieving state MH/DD/SA system goals and whether or not its principles have been applied and upheld.

	TA Technical Assistance

	TANF Temporary Assistance for Needy Families

	Target Populations Groups of people with disabilities with attributes considered most in need of the services available within the system; populations as identified in federal block grant language. See also, PRIORITY POPULATIONS.

	TASC Treatment Accountability for Safer Communities

	TBI Traumatic Brain Injury

	TD Tourette's Disorder

	TDD Telecommunication device for persons who are deaf or hard of haring

	TEACCH Treatment and Education of Autistic and Related Communication Handicapped Children. TEACCH is public health program available in NC for children with autism.

	Temporary Assistance For Needy Families (TANF) A grant program to states that seeks to keep children in their own homes or homes of relatives; end parental dependence on welfare by promoting job preparation, work, and marriage; discourage pregnancy outside of marriage, and encourage formation and maintenence of two-parent families.

	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 nurturing family home.

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

	Thomas S. Program A court-ordered program of services for persons with mental retardation and a co-occurring mental illness or substance abuse disorder, which was created in response to a class action lawsuit. The State of North Carolina was relieved from the court-ordered program in 1999.

	Tics Involuntary, compulsive, stereotypic muscle movements or vocalizations that abruptly interrupt normal motor activities. These repetitive, purposeless motions (motor tics) or utterances (vocal tics) may be simple or complex in nature; may be temporarily suppressed; and are often preceded by a foreboding sensation or urge that is temporarily relieved following their execution. Simple tics include abrupt, isolated movements, such as repeated facial twitching, blinking, or shoulder shrugging, and simple sounds, including grunting, throat clearing, or sighing. Complex tics may involve more sustained, complex movements, such as deep knee bending or leg kicking, or complex vocalizations, including repeating another person's words or phrases (echolalia) or, rarely, explosive cursing (coprolalia). Tourette syndrome is defined as the presence of multiple motor and vocal tics for at least one year, changes in the nature of the tics (e.g., complexity, severity, anatomical location) during the course of the disorder, and symptom onset before age 21.

	Tiered Co-Payment Structure Different co-payments are set for brand and generic medications.

	Timely Services Access to services in a timeframe appropriate to their needs. Appointment with a physician within 72 hours of discharge from an acute psychiatric hospital unit is an example. See also, PROMPT SERVICES.

	TIP Treatment Improvement Protocol

	Title XIX Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., is the federal statute that authorizes the Medicaid program. Related titles of the Social Security Act are Title IV-A (TANF), Title IV-E (Foster Care and Adoption Assistance), Title XVI (SSI), Title XVIII (Medicare), and Title XXI (CHIP).

	Toxin A toxin is a poisonous substance that is produced by a plant or animal

	TPP Therapeutic Printing Plants

	Transfer of Assets Refers to the practice of disposing of countable resources such as savings, stocks, bonds, and other real or personal property for less than fair market value in order to qualify for Medicaid coverage. When such transfers occur, it is usually in connection with the anticipated or actual need for long-term nursing home care. Federal law limits (but does not entirely prohibit) such transfers as a means of qualifying for Medicaid coverage.

	Transient Temporary; transitory; not lasting or enduring.

	Transition The time in which an individual is moving from one life/development stage to another. Examples are the change from childhood to adolescence, adolescence to adulthood and adulthood to older adult. An important transition in MH/DD/SAS services is from adolescent to adult.

	Treatment The planned provision of services that are sensitive and responsive to a patient's age, disability, if any, gender and culture, and that are conducted under clinical supervision to assist the patient through the process of recovery.

	Tremor Rhythmic, involuntary, oscillatory (or to-and-fro) movements of a body part.

	Triage One name for a process by which people are assessed to determine the type of services and level of care they will require.

	TS Tourette Syndrome or Tuberous Sclerosis & Thomas S.

	TTY Teletext Device Typewriter

	Tx Treatment

	UCP United Cerebral Palsy

	UM Utilization Management (regulation of services in relation to system capacity)

	Unbundled Services A method of accounting or reimbursing for services on the basis of individual service components instead of using an all-inclusive rate covering all specified services. Fee for service is an example of unbundled rates.

	Uniform Portal Access The standardized process and procedures used to ensure consumer access to, and exit from, public services in accordance with the State Plan.

	Universal Prevention Activities aimed at the general population to teach and empower individuals and systems to meet the challenges of life events and transitions by creating and reinforcing healthy behaviors and lifestyles and by reducing risks contributing mental illness, developmental disabilities and substance abuse.

	UR Utilization Review (case review to assess medical necessity and appropriateness of care)

	URAC Utilization Review Accreditation Commission, now called URAC; one of the agencies recognized by the Division of MHDDSAS and the Division of Medical Assistance to accredit the systems management functions of Local Management Entities (LMEs).

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

	Utilization Management (UM) A process to regulate the provision of services in relation to the capacity of the system and needs of consumers. This process should guard against under-utilization as well as over-utilization of services to assure that the frequency and type of services fit the needs of consumers. UM is typically an externally imposed process. UTILIZATION REVIEW (UR) -an analysis of services, through systematic case review, with the goal of reviewing the extent to which necessary care was provided and unnecessary care was avoided. UR is typically an internally imposed process.

	Utilization Review (UR) An analysis of services, through systematic case review, with the goal of reviewing the extent to which necessary care was provided and unnecessary care was avoided. UR is typically an internally imposed process.

	VA Veterans Affairs (Department of Veterans Affairs)

	VASH VA Supported Housing programs

	VCT Veterans Construction Team

	VHA Veteran Health Administration

	VI Vision Impairment

	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.

	Volume Of Services Method of representing the amount of services provided by a service provider.

	VR Vocational Rehabilitation

	VRS Video Relay Service

	VRT Vocational Rehabilitation Therapy

	Waiver States may request federal officials to waive or release the state from some statuatory and regulatory requirements of federal programs to allow local flexibility with funds, such as Medicaid.

	WCH Women's and Children's Health

	Willie M. Program A court-ordered program of services for children, who were aggressive, had emotional or behavioral disorders and for whom the state was not providing appropriate services. The State of North Carolina was relieved from the court-ordered program in 1999.

	Withdrawal A psychological and / or physical syndrome caused by the abruptly stopping or reducing substance use that has been heavy and prolonged. The symptoms include clinically significant distress or impairment in social, occupational or other important areas of functioning and are not due to a general medical condition or accounted for by another mental disorder.

	WM Willie M.

	WOM Women with substance abuse disorders - child or adult

	WRAP Wellness Recovery Action Plan - a mental health self-management and recovery system.

	Youth Development Center A specialized residential service for adolescents.

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