American Association of Community Psychiatrists' Principles for Managing Transitions in Behavioral Health Services

Continuous engagement in treatment and recovery services is one of the most important aspects of addressing acute episodes of severe behavioral health problems and the ongoing disabilities associated with them. Traditionally, fragmentation in systems of care has been common, and the transition from one provider, location, or intensity of service to another has not been prioritized in treatment planning. The authors describe a set of guidelines for maintaining continuity of care that was developed by the American Association of Community Psychiatrists. These guidelines embrace a progressive conceptualization of an integrated service system. For each element of the guidelines, a sample outcome indicator is presented that could be used to measure implementation. These guidelines can be used to help form transition plans, quality improvement initiatives, and program evaluations.