Community Rehabilitation and Treatment (CRT) Services
Direct services are provided by private, non-profit service providers called Designated Agencies located throughout the state. The Department of Mental Health designates one Designated Agency (DA) in each geographic region of the state as responsible for ensuring needed services are available through local planning, service coordination, and monitoring outcomes within their region.
Vermont’s Community Rehabilitation and Treatment (CRT) programs assist adults that have been diagnosed with a mental illness. Symptoms may be mild or substantially disabling, and long-term or short term.
The programs help individuals and their families to develop skills and supports important to living the life they want for themselves.
There are several documents that can be referred to better understand the CRT Program.
CRT Eligibility for Schizophrenia Memo from Commissioner Hartman - October 16, 2009 (Sent to Designated Agency and Designated Hospital Medical Director's, CRT Directors, Designated Agency Executive Directors and Children Directors)
- Community Rehabilitation and Treatment (CRT) Client Handbook for people who are new to the CRT Program.
- Community Rehabilitation and Treatment (CRT) Provider Manual Sections 1 through 3 and Sections 4 through 8 describes the necessary policies and procedures in detail and contains prototype policies to be adapted by each CRT Program.
Core Community Rehabilitation and Treatment Services
CRT clients are entitled to core services determined to be clinically appropriate for their mental health treatment needs as noted in each cleint's individualized service plan. These core services include:
- Clinical Assessment: Evaluation of individuals’ and families’ strengths, needs, severity of disability, and level of functioning. Assessment may include evaluation of the strengths of an individual’s support system and community and their availability to the individual and family.
- Service Planning and Coordination: Assistance to individuals and their families in planning, developing, choosing, gaining access to, coordinating and monitoring the provision of needed services and supports for a specific individual. Services and supports include discharge planning, advocacy, monitoring the well-being of individuals (and their families), and supporting them to make and assess their own decisions. Services and supports may be formal (provided by the human-services system) or informal (available through the strengths and resources of the family or community).
- Community Supports: Specific, individualized and goal-oriented services to assist individuals (and families) in developing skills and social supports necessary to promote positive growth. These supports may include assistance in daily living, supportive counseling, support to participate in community activities, collateral contacts, and building and sustaining health personal, family and community relationships. Community supports may be provided individually or in a group setting.
- Individual, Group, and Family Therapy: Individual therapy uses the interaction between a therapist and the individual to promote emotional or psychological change and to alleviate distress. Family therapy uses interactions that involve the therapist, an individual, and family members toward the same ends. Group therapy uses interactions that involve the therapist, the individual, and peers for the same ends.
- Medication Evaluation, Management and Consultation with Primary Care: Evaluation of the need for medication, prescribing and monitoring medications, and providing medical observation, support, and consultation for an individual’s health care. These services include consultation with primary care.
- Diagnosis-Specific Practices: When called for in the clinical assessment, such as treatment for co-occurring disorders (mental illness and substance abuse) and dialectical behavioral therapy.
- Emergency Care and Crisis Stabilization: See description under Emergency Services, below.
- Private Practitioner Behavioral Health Services: Obtained outside the public system of designated agencies.
- Inpatient Behavioral Health Services: Based upon clinical determination of need.
Designated agencies may provide alternative services where resource capacity exists and when related to achieving objectives of the individualized service plan, which is based on the assessment of an individual’s needs, clinical appropriateness, and consumer choice. These alternative services include:
Employment Services: To assist individuals in establishing and achieving career and work goals.
- Employment Assessment
- Employer and Job Development
- Job Training
- Ongoing Support to Maintain Employment
- Day Recovery/Psychoeducation, Including Recovery Education: Group recovery activities in a milieu that promotes wellness, empowerment, a sense of community, personal responsibility, self-esteem and hope. These activities are consumer-centered; they provide socialization, daily skills development, crisis support, and promotion of self-advocacy.
Housing and Home Supports: Mental-health services and supports based on the clinical needs of individuals in and around their residences.
- Supervised/Assisted Living: For individuals in their homes
- Staffed Living: For one or two people,
- Group Treatment/Living: For three or more people
- Unlicensed Home Providers: Individualized shared-living arrangements, offered within a person’s home.
- Family Psychoeducation and Support for Families and Significant Others
- Referrals to Specialty Services
Partial Hospitalization: An intensive (4-16 hours a day), time-limited (maximum 21 days) service provided as an alternative to inpatient care to prevent or shorten psychiatric hospitalization and promote recovery. Provided to individuals who would otherwise meet inpatient criteria. Medical personnel (nurse, physician) are accessible to provide services during hours of operation. Services include:
- Diagnosis and Evaluation
- Service Planning and Coordination
- Community Supports
- Individual, Group and Family Therapy
- Medication Services
- Psychoeducational Skill Development for managing symptoms