Mental Health Counseling Options

This post  offers a quick comparison between traditional outpatient counseling, in-home counseling, and residential counseling.

Counselors provide professional guidance and advice to their clients to help them resolve personal issues. Counseling services  can be provided in a variety of settings and be offered by utilizing countless techniques.  People seek counseling for many reasons including help with substance abuse, behavioral management, marriage and depression. 
Counseling professionals are trained in specific areas of treatment. Counselors usually have a minimum of a four -year degree in psychology, counseling, or a related area of study. Counselors at the undergraduate level often work in residential treatment centers and provide more direct care services.  Counselors at this level also provide services in youth detention centers and psychiatric centers.

Counselors who have graduate degrees provide a more clinical level of services.  In some cases, counselors with graduate degrees can conduct groups and individual therapy under the supervision of a licensed therapist.

There are also counselors who have graduate degrees and are licensed to practice in their state. These counselors provide a higher level of service and are often in private practice. Counselors at this level are typically licensed as professional counselors (LPC), clinical social workers (LCSW), and licensed clinical psychologists. Counselors may also become certified in specific treatment areas such and practice as certified substance abuse counselors (CSAC) or certified addictions counselors (CAC).

Evolution of Counseling Services
When people think of counseling they usually think of therapy in the clinician’s office.  The patient visits the counselor for 45 minutes to an hour and then follows up on a weekly, bi-weekly, or a monthly basis. Some still prefer the traditional counseling setting where they go to the facility receive the services in an outpatient office.  Group counseling and substance abuse treatment is also most appropriate for the outpatient setting. 

The counseling field has expanded and evolved in the last few years. This evolution has led to the development of the in-home counseling.  In-home counseling is an effective treatment option for children and adolescents. In-home counseling offers counseling services in a variety of settings including the home. In-home counselors also assist the client in community activities such as going the park, store, etc. These activities yield more positive results with younger clients, as they tend to open up and be more responsive to counseling when it is combined with other supportive activities.

Residential treatment is often considered a last resort for counseling and treatment. Parents often turn to residential treatment when all efforts for community –based treatment options have been unsuccessful. Residential treatment for children can range from a few days to several years depending on the situation and of course, funding.   Adults may seek residential treatment for substance abuse or other additions when all other options have either failed or there is a severe relapse.
I have listed just a few differences in outpatient, in-home, and residential counseling. I based my comparison on the four basic criteria: the population served, specific service setting, clinician qualifications, and funding sources.

Traditional Outpatient Counseling
1. Children, adolescents, and adults are usually referred for outpatient counseling. Outpatient counseling typically includes services that provide support in the areas of behavioral management, depression, marriage counseling, and substance abuse counseling.
2. Outpatient services typically occur in an office or hospital setting.  Outpatient services are provided in private practice and in public social service agencies.
3. Outpatient clinicians are usually licensed by the state. Clinicians are licensed in areas of professional counseling, social work, substance abuse counseling, addiction counseling, and clinical psychology.
4. Outpatient services are usually accepted by a number of insurance companies.

In-Home Counseling
1. In-home counseling is primarily recommended for children and adolescents.
2. Services may occur in the home or other areas in the community.
3. In-home counselors do not always have to be licensed. However, they are usually supervised by a licensed clinical social worker, licensed professional counselor, or other clinician. In-home counselors have a minimum of an undergraduate degree but are usually not required to have a state license.
4. In-home counseling is funded primarily through Medicaid insurance. Intensive in-home counseling funded through Medicaid allows five hours of counseling a week over a six month period. There are usually other community resources available through social services or community services boards to assist with funding these services for those who do not have Medicaid. In some states, Medicaid will not cover intensive in-home counseling and case management services at the same time. Therefore, another funding source is needed to cover the in-home counseling if both services are needed.

Residential Counseling
1. Residential services are utilized for children, adolescents and adults. Residential services are typically viewed as a last resort for children with oppositional behaviors and for adults with substance abuse issues. Residents receive individual and/or group therapy in a supervised residential setting.
2. Residential services occur in a hospital or treatment center setting.
3. Clinicians are usually licensed therapists or certified substance abuse counselors.
4. Residential treatment may be covered by Medicaid or other private health insurance plans. Funding through community services boards and social services may be available to cover the cost of residential treatment for children and adolescents.

This is just a sample of some of the counseling services that can be offered. There are several options to choose from as either a career path or for anyone seeking counseling for themselves or a loved one. It's important to explore each option to determine the best fit for you.


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Martin Gardner
Thanks for visiting Case Management Basics! Martin Gardner is the founder of and Case Management Basics, LLC. Gardner is a mental health professional with over 20 years of experience in the human services field.

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