I believe seeing clients more frequently for shorter periods of time creates more of a dependency on the service. We work hard to introduce skills that clients can then practice on their own between sessions and report back about their progress. Shortening the time that can be spent with clients but increasing the number of days they can be seen will not allow time for this individual practice.

A clinician may be working with a client through a 3-hour session and during the appointment, the client may be having difficulty with heightened symptoms.  In spite of the clinician’s attempts to de-escalate whatever situation has caused this, they determine the client should be assessed at the hospital.  The clinician works hard to encourgae the client to seek emergency services. If they clinician goes with the client to the emergency room to provide ongoing support and advocacy,  this appointment could easily stretch beyond the 5 hours allowed for 2 units.

There are times, especially when a client initially comes into services, that a client requires more time as there are significant needs that may take longer than 3 hours to address. For example, a client who is homeless, has no natural supports, no income, serious medical needs, and is experiencing heightened symptoms may require a burst of intensive mental health skill building to meet the immediate needs and stabilize in the community. Clients may come into services without any supports.  There may be situations in which clients require linkage to several different community agencies.  They may need assistance accessing those resources, completing applications, etc. that may take an extended amount of time.

A client may finally agree to see a specialist and have extreme anxiety around the situation.  The clinician may have to practice how the client will interact with the specialist and take them to the appointment to provide support and on-the-spot training.  Following the appointment, the clinician may help the client obtain needed medication and provide skills training on following through with the specialist’s instructions.  Such an appointment may take more than 5 hours. 

Clinicians providing services in rural areas may need 5 or more hours to help client meet all of their needs.  For example, resources in rural areas are more spread out. Clients may need to receive services in a larger town or city that is several miles away from home.