ADVANTAGES OF IN-HOME COUNSELING CLINICAL
• Meet important members of the family who might not attend an office session, or are reluctant to seek psychological treatment for fear of being stigmatized.
• Opportunity to provide intergenerational family therapy.
• Engage the truly significant and powerful figures in the family.
• Get a first hand view of the family living situation. (the neighborhood, overcrowding, presence or absence of food in the cupboards, medication, unused medical supplies, hygiene, and a sense of their organizational abilities.
• Opportunity to observe the dynamics of certain family members, with other family members and friends gives the therapist additional insight to their social relationships and conflict-resolution skills.
• Patients are seen on their own turf rather than what they report to you in the sterile office environment.
• Observe the family culture as it manifests itself in food, icons, rituals, music, etc.
• Learn first-hand the families parenting practices.
ASSESSMENT AND TREATMENT
• The clinician not only observes but “experiences” the client’s home environment in regards to the boundary fluidity, cultural and religious symbols, sleeping arrangements, and how people experience visitors.
• Medically ill patients with co-morbid depression often exhibit multiple medical problems and functional limitations. Thus, the in-home therapist can work with the physician to incorporate antidepressant medications into the overall treatment plan.
• The home-based therapist is able to provide continuation of care for the client who is hospitalized or admitted to a care facility for short- or long-term care. The psychologist is able to consult with client at the hospital or care facility, then follow him or her upon discharge for psychological treatment in the home environment.
• Creative intervention not possible in the office, or co-utilized home/office in treating client with phobias or with those resistance to change, (ie: taking a brisk walk with a depressed or isolated client, utilizing both home and office for agoraphobic clients, accompanying a client to their doctor’s visit, accompany a grieving patient to a funeral or the cemetery, playing basketball with a despondent youth, zoo for a fear of snakes, etc.)
• Highly effective for parenting issues interventions.
• Highly effective for Postpartum Depression.
• Health Psychology. Changing behaviors and lifestyle in the home environment often generalizes to the outside world.
• Home visits often breaks-the-ice, thus reducing suspiciousness and increasing trust.
• Additional clinical exchanges environments can provide an adjunct to the home environment such as hospital visits, the working office environment, a park, or under a bridge.
INCREASING GERIATRIC POPULATION
• The geriatric population comprises 12% of the population in the U.S., and expecting to rise to 30% by 2030.
• The elderly population is most affected by depression. Late-life depression doubles the risk of
developing cardiac disease, reduces the ability to rehabilitate, and increases the chances of dying from illnesses.
• Suicide rates for individuals over the age of 85 are almost twice as high as the overall national rate.
Adults over age 65 represent 13 percent of the U.S. population yet accounts for 18 percent of all suicides in 2000.
• Studies of older persons who have committed suicide indicate few were receiving mental health
treatment or treatment that was deemed adequate. Both stigma and the belief that there is no help as a reason for why many elderly do not seek treatment for depression.
• Too often senior adults have other physical disabilities that distract them from addressing psychiatric needs.
• Growing number of aging adults who have histories of schizophrenia, bipolar disorder, and other severe chronic mental disorders. In-home therapists are able to provide services such as monitoring clients’ medication adherence, the clinical status and side effects of their medications, evaluating clients capacity to stay in their home environments, or referring them to skilled nursing, rehabilitative, or social services.
CUTTING ER AND HOSPITALIZATIONS COSTS
• ER and hospitalizations are very expensive in comparison to home visits.
• Home visits can prevent ER visits and hospitalizations by dealing with the problems before crisis occurs.
• There is a surge in home-based therapy in the 21st century due to the increased demand from the aging population, advanced radiology and lab technologies, and pressure to decrease the cost of mental health and medical treatments.