Chapter Eight: Contexts for Professional Practice
Chapter Overview
Clinical mental health counselors are employed in the full range of settings along the
mental health care continuum. Services are arranged on the continuum of mental health care
from the least to the most restrictive. These include: psychoeducation and consultation; crisis
The classroom experience of this material can be greatly enhanced by inviting a panel of
your program graduates, agency-based mental health counselors, or site supervisors discuss their
professional practice and the specific contours of the contemporary context. Students can also
present power point reports can greatly expand awareness of the many ways clinical mental
health counselors contribute to the well-being of persons by delivering preventive and remedial
services to individuals and their related systems within and across relevant ecological contexts.
Learning Objectives
By the end of this chapter, students should be able to:
• Understand the traditional continuum of mental health care and its expanding settings of
professional practice
• Know and explain the difficulties and efforts being done to help provide services to
special populations
• Know the several specific settings where mental health and community counselors work
and their associated responsibilities
o Crisis/Emergency Management
o Agency/Community Mental Health Centers
o Private Practice
• Understand the transition to integrated behavioral health in primary health care settings
Key Words/Terms
• Assertive Community Treatment– therapy that is offered via a multidisciplinary team
approach and typically involves low client-staff ratios, caseloads shared among team
members, 24-hour availability, and community based context; often used when treating
homeless population
• Co-morbidity-the presence of both substance-related and psychiatric conditions in clients
(dual disorders, dually diagnosed client)
• Continuum of mental health care- the provision of five essential services with the least
amount of restriction according to the client’s needs.
• Critical incident stress debriefing (CISD)– a small-group psychoeducational intervention
designed to mitigate the psychological impact of a traumatic event, prevent future
posttraumatic disorders, and serve as an early screening to identify those who might
• Prebooking diversion program-program that intervenes for individuals with mental
illness who break the law but whose behavior is deemed nonviolent and related to an
existing psychiatric condition.
• Postbooking diversion program-a more common program implemented after formal
charges have been filed where person is given the option of participating in mental health
the community
• Trauma-informed care-a strength-based approach that recognizes the widespread
incidence and impact that trauma has on those served and integrates three key elements of
awareness, understanding, and provision of trauma-specific services
• Wrap–around philosophy-the use of culturally competent, community-based supports and
Lecture Outline for Chapter Eight
Appraisal and Research in the Practice of Clinical Mental Health Counseling
I. Mental Health Counselors Setting
A. Community Mental Health Centers Act of 1963
2.Required to provide five essential services: impatient, outpatient,
B. Continuum of mental health care
1.Arranged services from least to most restrictive
C. Settings employed: private practice, outpatient settings, public and private
agencies, inpatient mental health centers, hospitals, in-home, substance treatment
facilities
II. Clinical Mental Health Counselors on the Job: Special Populations
A. Homelessness and Mental Health
1.Difficulties assessing the mental health needs in this population
2.Overlap with other populations
3.Barriers:
4. Case management
5. Models of service delivery
a. Residential continuum (Train/Place model)
i. Based on medical and clinical models in which persons are
trained to managed symptoms of mental health and
substance abuse
ii. Mental health and substance abuse services provided on
site
b. Other approaches: based on Train/Place model
i. Placement in independent housing comes first with
professional and peer support augmented later
B. Severe and Persistent Mental Illness
2.Assumption that a systematic mix of community-based services can
demonstrate effectiveness equal to or greater than institutionalization
4.Failure gave way to the emerging evidenced-based practice movement
5.To ensure that chronic clients receive all necessary services to remain and
C. Co-occurring Mental Illness and Substance Use Disorders
2.Two-thirds of clients presenting with substance abuse disorders have a
coexisting condition
4.Often psychiatric disorder precedes a substance abuse disorder
6.Diagnostic process:
a. Diagnosis of a substance use disorder and co-occuring mental
7.Treatment approaches
a. Inpatient dual-diagnosis programs in psychiatric hospitals
b. Modified 12-step program
c. Cognitive framework approach
d. Integrated dual disorders treatment (IDDT)
D. Community Mental Health and Corrections
1.United States ranks highest in rate and number of incarcerated persons
3. Five categories of persons with mental illness
4.Barriers:
a. Difficult to be on sight for assessment and counseling
6.Jail diversion programs
a. Pre-booking: divert those with psychiatric conditions to special
7.Re-entry programs
E. Community Mental Health, Disaster Response, and Emergency Management
Systems
1.CACREP provided graduate programs with training guidelines by infusing
2.Disaster Response
a. Generally, those encountering disasters usually move through three
overlapping phases
i. Impact
b. Three phase intervention model
c. Critical Incident Stress Debriefing (CISD): a small-group
psychoeducational intervention designed to mitigate the
psychological impact of a traumatic event, prevent future post-
traumatic disorders, and serve as an early screening to identify
those who might benefit from follow-up professional mental health
services
i. Introduction stage
ii. Facts phase
iii. Thoughts phase
d. Psychological First Aid (PFA): evidence-informed practice that
aims to reduce initial post-trauma distress and facilitate the short-
and-long term adaptive functioning of trauma survivors
i. Contact and engagement
ii. Safety and comfort
3.Trauma-Informed Care
a. A strength-based approach that recognizes the widespread
incidence and impact that trauma has on those we serve
b. Grounded on an understanding of trauma and its impact and
c. Goal: facilitate resilience and restore sense of intrinsic control and
empowerment
d. Three Key Elements
i. Awareness of the types and prevalence of trauma
ii. Understanding the impact of trauma
iii. Provision of trauma-specific services
4.Emergency Management Systems
a. Disaster response should fit within larger, community-based
emergency management plan
b. Development of plan begins with a hazard vulnerability analysis
c. Other considerations include establishing a leadership hierarchy,
III. Clinical Mental Health Counselors on the Job: Selected Work Settings
A. Agency/Community Mental Health Centers
B. Private Practice
C. Substance Use Treatment Programs
IV. Conclusion
A. Timing has to be right
B. Patience with unexpected twists and turns
C. Take care of yourself
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