Home-based therapy is also called home-based psychotherapy, home-based counseling, or in-home therapy. It takes place when a therapist provides counseling in a person’s home. Home-based therapy has helped many people reach their treatment goals.
What Is Home-Based Therapy?
Home-based therapy takes place at the home of a person in therapy rather than in an office. It can help people who have difficulty getting to private practices or mental health facilities. Factors that could keep someone from getting care include money issues, age, chronic medical issues, agoraphobia, and responsibilities at home or work.
Community health organizations and child protective agencies provide many home-based therapy programs. Private practice therapists may offer in-home sessions if it seems to be the most beneficial form of treatment, whether access to care is a problem or not.
What to Expect in Home-Based Therapy
An in-home therapist may be joined by another therapist who acts as a partner during treatment. This can provide both the person in therapy and the therapist with more support and resources. Not all home-based therapists work in a team, but many do. For instance, therapists may work in teams when responding to a crisis-line phone call.
Home-based counseling is usually provided at the kitchen table or in a living room. In these settings, children and teenagers may feel more comfortable. They might allow the therapist to see their room or belongings. The ability to see a home environment and observe how people use their space can help therapists build good connections quickly. This personalized approach may not be as easy to achieve in an office.
Home-based therapy sessions typically take place at the houses of people in treatment. But, they may also be held in other locations. The counselor and person in therapy can decide to have sessions in the park or discuss treatment during a walk on the beach.
If you think home-based therapy is right for you, meet with a therapist who practices it to find out how to proceed. Choosing when and how often in-home therapy sessions will occur depends on what works for you and your therapist. Home-based therapy can be used occasionally, as a supplement to office sessions, or as your main approach.
Types of Home-Based Therapy
Psychologists, psychiatrists, marriage and family therapists, counselors, social workers, and other mental health professionals can practice home-based therapy. A range of approaches may be used in a session. These include individual therapy, couples therapy, play therapy, and family therapy. Home-based therapy can treat many concerns, including:
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- Personal and emotional issues: Examples of these include anxiety, depression, and posttraumatic stress.
- Juvenile delinquency: Home-based therapy can be useful when working on unhealthy coping mechanisms and behaviors.
- Family issues: At-home family therapy can help with relationship building, communication, conflict management, and problem-solving. It may also reduce stress and build up a family’s strengths.
- Marriage counseling: Home-based marriage counseling may improve intimacy and help resolve conflicts.
- Developmental issues or brain injury: Therapists may provide home-based therapy for families of a person with developmental issues or a brain injury. These therapists can help create strategies for supporting a child’s development at home and in their community.
- Intensive psychiatric care: Some therapists offer intensive in-home psychiatric care for children and teenagers. They support young people who have been discharged from residential treatment facilities or psychiatric hospitals.
Why Therapists Offer Home-Based Therapy
Home-based therapists know it can be hard for some people to get to an office for an appointment. Illness, disability, personal crisis, lack of funds, transportation issues, or childcare are all reasons a person might not be able to get to therapy. Home-based therapy can address many of these obstacles.
When treatment is provided at home, the therapeutic relationship may develop more quickly. This is because people in therapy can be more relaxed in their own homes than in an office. Instead of relying on self-reporting, therapists may get deeper insights from seeing how and where people live. As a result, effective treatment can progress, and healing may happen more easily.
Home-based therapy can also be helpful for therapists. They may be able to transition more smoothly between personal, family, and work duties, especially if they also work from home. Therapists who work from home and offer home-based therapy may have less workplace stress, more family time, and no regular commute.
People who are homebound can benefit from different forms of distance therapy. However, they may also prefer face-to-face interaction. Since they are never seen at a therapist’s office, people who choose home-based therapy ensure that their privacy is protected. Home-based therapy makes mental health services more accessible to a wider range of people. It may also be less expensive than traditional therapy at an office.
Home-Based Therapy for Families
Home-based therapy can be effective when teaching skills used at home. For example, parenting and communication skills can be greatly improved or fine-tuned. This type of therapy allows therapists to observe interactions between family members as they occur naturally. Because of this, therapists may find out more quickly how to approach treatment. The therapist can also confirm that basic needs are being met at home and share local resources.
A therapist may be more successful at lowering the defenses of teenagers by meeting them in their own territory. Home-based therapy can also increase the chances that all family members wil attend and participate in treatment.
Parents at risk of losing custody of their children may be targeted for home-based counseling. This type of counseling focuses on family preservation. One of its goals is to help prevent a child from going into foster care.
Ethics of Home-Based Therapy
Therapy that takes place in the home may raise ethical concerns. These concerns could be about boundaries, confidentiality, or role confusion. Factors that can benefit treatment, such as observing a family in action, may also make treatment challenging.
Role confusion can occur in a few ways. As a guest in another person’s home, a therapist may not know how to treat the person in therapy. Also, children with parents using in-home therapy may feel confused if they do not understand why the adults are unavailable at home.
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Therapists might have difficulties maintaining the focus of a session due to an active dog, a fussy child, or other distractions. If other family members, friends, or neighbors are present, it may make maintaining confidentiality difficult. It may even hinder a person’s ability to speak openly. Concerns beyond the scope of therapy can arise if the therapist unintentionally witnesses activities such as underage drinking or animal cruelty. Boundary issues can come up if the therapist is asked to loan money, answer the door, or run an errand for the person in treatment.
Finances must also be considered when considering home-based therapy. For example, should a therapist include travel in the cost of treatment? Should they stop the clock or keep it going when distractions pop up? These concerns should be addressed before treatment begins.
In addition, some people may not be good candidates for home-based therapy. Some may feel unsafe or uncomfortable in their own home. Others in treatment may be volatile and hard to control. They may try to override the therapist because they feel empowered by the fact that treatment is being provided in their home. Therapists accustomed to maintaining control of a therapy session may find these aspects of home-based therapy challenging.
Home-based therapy is becoming more common. But, there are concerns about the qualifications of therapists who offer this form of treatment. Many colleges do not offer training in home-based therapy. As a result, inexperienced therapists may not be able to provide the quality of care needed by those in treatment.
Therapists who provide home-based therapy must keep professional boundaries during home visits. People who wish to use home-based therapy may find it helpful to be mindful of its limits.
References:
- Cortes, L. (2004, April 1). Home-based family therapy: A misunderstanding of the role and a new challenge for therapists. The Family Journal, 12(2), 184-188. doi: 10.1177/1066480703261980
- Friedman, D. (2012, September 1). Home is where the client is. Counseling Today. Retrieved from http://ct.counseling.org/2012/09/home-is-where-the-client-is
- Home based counseling. (n.d.). Child and Family Agency of Southeastern Connecticut. Retrieved from https://www.childandfamilyagency.org/what-we-do/home-based-counseling
- Home office: When the therapy office is at home. (n.d.). Zur Institute. Retrieved from http://www.zurinstitute.com/homeoffice_clinicalupdate.html
- Lafleur, C. & Henry, U. (n.d.). Foundations of in-home therapy. Retrieved from http://www.aamft.org/handouts/510.pdf
- Stivers, C. (2015, August 31). 7 reasons why clients and counselors prefer home-based counseling. The Family Therapy Blog. Retrieved from https://thefamilytherapyblog.com/2015/08/31/7-reasons-why-clients-counselors-prefer-home-based-counseling
- Zur, O. (2015). In-home therapy and home visits. Retrieved from http://www.zurinstitute.com/home_based_mental_health.html
Select Amedisys home health agencies offer mental health home care for eligible patients. Our behavioral health nurses provide specialized care for home health patients with depression, anxiety and other mental health disorders. In-home mental health therapy services range from education to emotional support, to help you manage your health at home.
WHAT IS MENTAL HEALTH HOME CARE?
Mental health home care is specialized in-home care for people with mental health disorders such as depression and anxiety. Also called behavioral health home care or psychiatric home care, mental home care blends high-quality mental health care with the comfort of home.
Depending on your needs and doctor’s orders, you may receive psychiatric and mental health nursing as well as other home health services such as occupational therapy, speech therapy or social work services. Psychiatric home health care is typically covered by Medicare, Medicaid and many major insurance plans for patients who meet eligibility criteria.
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IN-HOME MENTAL HEALTH THERAPY SERVICES
We work closely with your doctor to monitor your progress and manage your symptoms. Depending on your needs, at-home mental health services may include:
- Psychiatric evaluations
- Physical assessments to manage medical issues
- Help managing symptoms
- Monitoring progress and response to treatment
- Education for patients and family members about behavioral symptoms, medications and management
- In-home mental health counseling with a social worker to improve coping, communication and other skills
- Medication management
- Administer injections, if needed
- On-call services
- Coordinating care with the patient’s healthcare providers and the home health team
- Referrals to helpful community resources
At Amedisys, we treat patients who have both psychiatric and medical conditions. Getting care for these issues at the same time can make it easier for you to take your medications as directed by your doctor and reduce the risk of going to the hospital.
THE ROLE OF THE PSYCHIATRIC HOME CARE NURSE
Psychiatric nurses have special training beyond the standard curriculum required for registered nurses. Our psychiatric home care nurses serve several roles, including educator, advocate and consultant to your healthcare team. In addition to assessment skills, our mental health nurses are patient, caring and experienced.
A psychiatric nurse collaborates with you, your caregiver and your doctor to create a personalized plan of care. We’ll get to know your needs and challenges and identify opportunities that will help you stay safe at home. After an initial assessment, you’ll receive visits from your mental health home care team based on your doctor’s orders.
WHO IS ON THE MENTAL HEALTH HOME CARE TEAM?
With Amedisys, your mental health home care team will be led by a registered nurse who specializes in psychiatric mental health nursing. You may also receive visits from other members of the home health team including physical, occupational and speech therapists, medical social workers and home health aides, depending on your needs and physician’s orders. Our team works closely with your physician to meet your needs.
WHO CAN BENEFIT FROM PSYCHIATRIC HOME CARE SERVICES?
There are certain eligibility criteria you must meet to qualify for mental health home health care. For example, you must:
- Have a mental health diagnosis; and
- Have a need for teaching or other skilled care; and
- Have a doctor’s order for home health; and
- Be considered homebound, which means your illness is manifested in part by a refusal to leave the home or is of such a nature that it wouldn’t be considered safe for you to leave home unattended.
Some patients meet the eligibility requirements based on their psychiatric diagnosis alone. Others are eligible because they have both mental health needs and a medical condition. At Amedisys, we provide home-based treatment for mental health patients who meet the eligibility criteria and are dealing with issues such as:
- Depression, anxiety, schizophrenia, bipolar disorder, PTSD, dementia with behaviors and other behavioral health conditions
- Progressive and chronic illnesses such as Parkinson’s disease, heart failure, multiple sclerosis or COPD, with depression or anxiety complicating treatment
- A newly diagnosed terminal or chronic condition with co-morbid depression, anxiety or grief
- Chronic pain complicated by depression
- Difficulty managing a medical condition related to underlying depression, anxiety or other psychiatric illness
- Unresolved grief and depression related to the death of a loved one
- Dementia with hallucinations, delusions, agitation or combative behavior (mental home care includes teaching caregivers how to manage behaviors and care for their loved one)
- Hallucinations, delusions or recent psychotropic medication changes related to schizophrenia
99% of Amedisys home health care centers are rated 4+ Quality Stars.
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GOALS OF BEHAVIORAL HOME CARE
Our patients receive a personalized mental health care plan tailored to their specific goals and needs. Some common goals of mental home care are to:
- Reduce the need for emergency room visits and inpatient psychiatric care
- Improve independent functioning
- Improve overall well-being
- Build your understanding of your condition(s) and medications to make it easier to follow your treatment plan
- Re-engage with daily activities
- Enhance coping, communication and self-management skills
BENEFITS OF MENTAL HEALTH HOME SUPPORT
In-home mental health therapy services make it easier for patients to access quality care. Some of the benefits of psychiatric home care with Amedisys include:
Easy Access to Psychiatric Mental Health Nursing Care
With mental home care, behavioral health nurses travel to your home. This makes it easier to access care, especially if you don’t have transportation or local treatment options.
Relationship Building
Since we come to patients’ home, our psychiatric nurses are experienced in quickly building strong therapeutic relationships with patients. We can identify and meet needs by using tools like containers and calendars to manage medications, that make it easier for you to follow your treatment plan.
Skilled Care for Both Emotional and Physical Conditions
Medical conditions like diabetes, heart disease, COPD and liver disease affect many patients with mental illness. Our home health psych nurses help with mental illness as well as other conditions that impact your health and quality of life.
Care Coordination
The psych nurse and home health team work closely with your healthcare providers, which can help minimize unnecessary emergency room and hospital visits.
Expertise in Psychiatric Illness
Our mental health nurses have specialized training and experience in helping people with mental illness.
Access to Other Supports
In addition to working with a home health psych nurse, your care plan may include physical therapy, occupational therapy, speech therapy, social work and home health aides, depending on your doctor’s orders.
IS BEHAVIORAL HEALTH HOME CARE RIGHT FOR YOU?
You may benefit from home-based treatment for mental health if you:
- Need education about how to manage a mental health disorder
- Have difficulty managing your condition, or find yourself frequently visiting the doctor or hospital
- Are unable to safely complete self-care tasks like bathing or dressing
- Have difficulty moving around
- Are unable to express wants and needs effectively
- Have caregivers who need help managing your care at home
- Have a mental health condition that is complicating treatment for another illness or condition
- Need help managing symptoms before they become severe or require hospitalization
- Frequently call your healthcare provider with questions about your condition, medications or symptoms
- Have difficulty managing your medications
- Have other needs, such as healthy meals or transportation to appointments, that impact your health
- Suffer from depressive or anxious symptoms that are affecting your daily activities
- Feel isolated and have feelings of worthlessness and hopelessness
- Feel overwhelmed caring for a dementia patient with hallucinations and delusions or aggressive behavior
