educators support participation in local school programs and after school programs, including new initiatives such as achieve my plan by the research and training center on family support and children's mental health at portland state university. referrals to residential schools and certification of the personnel involved in the residential schools and campuses have been a multi-decade concern with counties often involved in national efforts to better support these children and youth in local schools, families, homes and communities. psychiatric rehabilitation main article: psychiatric rehabilitation psychiatric rehabilitation, similar to cognitive rehabilitation, is a designated field in the rehabilitation often academically prepared in either schools of allied health and sciences (near the field of physical medicine and rehabilitation) and as rehabilitation counseling in the school of education. both have been developed specifically as preparing community personnel (at the ma and phd levels) and to aid in the transition to professionally competent and integrated community services. psychiatric rehabilitation personnel have a community integration-related base, support recovery and skills-based model of mental health, and may be involved with community programs based upon normalization and social role valorization throughout the us. psychiatric rehabilitation personnel have been involved in upgrading the skills of staff in institutions in order to move clients into community settings. most common in international fields are community rehabilitation personnel which traditionally come from the rehabilitation counseling or community fields. in the new "rehabilitation centers" (new campus buildings), designed similar to hospital "rehab" (physical and occupational therapy, sports medicine), often no designated personnel in the fields of mental health (now "senior behavioral services" or "residential treatment units"). psychiatric rehabilitation textbooks are currently on the market describing the community services their personnel were involved within community development (commonly known as deinstitutionalization). psychiatric rehabilitation professionals (and psychosocial services) are the mainstay of community programs in the us, and the national service providers association itself may certify mental health staff in these areas. psychiatric interventions which vary from behavioral ones are described in a review on their use in "residential, vocational, social or educational role functioning" as a "preferred methods for helping individuals with serious psychiatric disabilities". other competencies in education may involve working with families, user-directed planning methods and financing, housing and support, personal assistance services, transitional or supported employment, americans with disabilities act (ada), supported housing, integrated approaches (e.g., substance use, or intellectual disabilities), and psychosocial interventions, among others. in addition, rehabilitation counselors (phd, ms) may also be educated "generically" (breadth and depth) or for all diagnostic groups, and can work in these fields; other personnel may have certifications in areas such as supported employment which has been verified for use in psychiatric, neurological, traumatic brain injury, and intellectual disabilities, among others. social worker main articles: social work and mental health § social work in mental health social workers in the area of mental health may assess, treat, develop treatment plans, provide case management and/or rights advocacy to individuals with mental health problems. they can work independently or within clinics/service agencies, usually in collaboration with other health care professionals. in the us, they are often referred to as clinical social workers; each state specifies the responsibilities and limitations of this profession. state licensing boards and national certification boards require clinical social workers to have a master's or doctoral degree (msw or dsw/phd) from a university. the doctorate in social work requires submission of a major original contribution to the field in order to be awarded the degree. in the uk there is a now a standardized three-year undergraduate social work degree, or two-year postgraduate masters for those who already have an undergraduate social sciences degree or others and relevant work experience. these courses include mandatory supervised work experience in social work, which may include mental health services. successful completion allows an individual to register and work as a qualified social worker. there are various additional optional courses for gaining qualifications specific to mental health, for example training in psychotherapy or, in england and wales, for the role of approved mental health professional (two years' training for a legal role in the assessment and detention of eligible mentally disordered people under the mental health act (1983) as amended in 2007). social workers in england and wales are now able to become approved clinicians under the mental health act 2007 following a period of further training (likely at postgraduate degree/diploma or doctoral level). historically, this role was reserved for psychiatrist medical doctors, but has now extended to registered mental health professionals, such as social workers, psychologists and mental health nurses. in general, it is the psycho-social model rather than, or in addition to, the dominant medical model, that is the underlying rationale for mental health social work. this may include a focus on social causation, labeling, critical theory and social constructiveness. many argue social workers need to work with medical and health colleagues to provide an effective service but they also need to be at the forefront of processes that include and empower service users. social workers also prepare social work administration and may hold positions in human services systems as administration or executives to administration in the us. social workers, similar to psychiatric rehabilitation, updates its professional education programs based upon current developments in the fields (e.g., support services) and serve a multicultural client base. educational requirements for social workers in the united states, the minimum requirement for social workers is generally a bachelor's degree in social work, though a bachelor's degree in a related field such as sociology or psychology may qualify an applicant for certain jobs. higher-level jobs typically require a master's degree in social work. master's programs in social work usually last two years and consist of at least 900 hours of supervised instruction in the field. regulatory boards generally require that degrees be obtained from programs that are accredited by the council of social work education (cswe) or another nationally recognized accrediting agency for promotion and future collaboration. before social workers can practice, they are required to meet the licensing, certification, or registration requirements of the state. the requirements vary depending on the state but usually involve a minimum number of supervised hours in the field and passing of an exam. all states except california also require pre-licensure from the association of social work boards (aswb). the aswb offers four categories of social work license. the lowest level is a bachelors, for which a bachelor's degree in social work is required. the next level up is a masters and a master's degree in social work is required. the advanced generalist category of social worker requires a master's degree in social work and two years of supervised post-degree experience. the highest aswb category is a clinical social worker which requires a master's degree in social work along with two years of post-master's direct experience in social work. continuing education requirements for social workers most states require social workers to acquire a minimum number of continuing education credits per license, certification, or registration renewal period. the purpose of these requirements is to ensure that social workers stay up-to-date with information and practices in their professions. in most states, the renewal process occurs every two or three years. the number of continuing education credits that is required varies between states but is generally 20 to 45 hours during the two- or three-year period prior to renewal. courses and programs that are approved as continuing education for social workers generally must be relevant to the profession and contribute to the advancement of professional competence. they often include continuing education courses, seminars, training programs, community service, research, publishing articles, or serving on a panel. many states enforce that a minimum amount of the credits be on topics such as ethics, hiv/aids, or domestic violence. psychiatric and mental health nurse main articles: psychiatric and mental health nursing and psychiatric and mental health nurse practitioner psychiatric nurses or mental health nurse practitioners work with people with a large variety of mental health problems, often at the time of highest distress, and usually within hospital settings. these professionals work in primary care facilities, outpatient mental health clinics, as well as in hospitals and community health centers. mhnps evaluate and provide care for patients who have anything from psychiatric disorders, medical mental conditions, to substance abuse problems. they are licensed to provide emergency psychiatric services, assess the psycho-social and physical state of their patients, create treatment plans, and continually manage their care. they may also serve as consultants or as educators for families and staff; however, the mhnp has a greater focus on psychiatric diagnosis (typically the province of the md or phd), including the differential diagnosis of medical disorders with psychiatric symptoms and on medication treatment for psychiatric disorders. educational requirements for psychiatric and mental health nurses psychiatric and mental health nurses receive specialist education to work in this area. in some countries, it is required that a full course of general nurse training be completed prior to specializing as a psychiatric nurse. in other countries, such as the u.k., an individual completes a specific nurse training course that determines their area of work. as with other areas of nursing, it is becoming usual for psychiatric nurses to be educated to degree level and beyond. psychiatric aides, now being trained by educational psychology in 2014, are part of the entry-level workforce which is projected to be needed in communities in the us in the next decades. in order to become a nurse practitioner in the u.s., at least six years of college education must be obtained. after earning the bachelor's degree (usually in nursing, although there are master's entry level nursing graduate programs intended for individuals with a bachelor's degree outside of nursing) the test for a license as a registered nurse (the nclex-rn) must be passed. next, the candidate must complete a state-approved master's degree advanced nursing education program which includes at least 600 clinical hours. several schools are now also offering further education and awarding a dnp (doctor of nursing practice). individuals who choose a master's entry level pathway will spend an extra year at the start of the program taking classes necessary to pass the nclex-rn. some schools will issue a bsn, others will issue a certificate. the student then continues with the normal msn program. mental health care navigator a mental health care navigator is an individual who assists patients and families to find appropriate mental health caregivers, facilities and services. individuals who are care navigators are often also trained therapists and doctors. the need for mental health care navigators arises from the fragmentation of the mental health industry, which can often leave those in need with more questions than answers. care navigators work closely with patients through discussion and collaboration to provide information on options and referrals to healthcare professionals, facilities, and organizations specializing in the patients' needs. the difference between other mental health professionals and a care navigator is that a care navigator provides information and directs a patient to the best help rather than offering diagnosis, prescription of medications or treatment. many mental health organizations use "navigator" and "navigation" to describe the service of providing guidance through the health care industry. care navigators are also sometimes referred to as "system navigators". one type of care navigator is an "educational consultant". workforce shortage behavioral health disorders are prevalent in the united states, but accessing treatment can be challenging. nearly 1 in 5 adults experience a mental health condition for which approximately only 43% received treatment. when asked about access to mental health treatment, two-thirds of primary care physicians reported that they were unable to secure outpatient mental health treatment for their patients. this is due, in part, to the workforce shortage in behavioral health. in rural areas, 55% of us counties have no practicing psychiatrist, psychologist, or social worker. overall, 77% of counties have a severe shortage of mental health workers and 96% of counties had some unmet need. some of the reasons for the workforce shortage include high turnover rates, high levels of work-related stress, and inadequate compensation. annual turnover rate is 33% for clinicians and 23% for clinical supervisors. this is compared to an annual pcp turnover rate of 7.1%. compensation in behavioral health field is notably low. the average licensed clinical social worker, a position that requires a