MHICM (Mental Health Intensive Case Management)

 Mission

The CSP (Community Support Program) at Errera Community Care Center is one of the national VA MHICM programs whose mission is to work with Veterans who have serious mental illness enabling them to live successfully in community settings. Through aggressive community based clinical case management, CSP promotes, maintains, and/or restores the mental health/community functioning of this Veteran population. 

The overarching goal is to help Veterans begin their own road to recovery and have a life that is satisfying. 

Currently Veterans are admitted while an inpatient after being identified as high users of inpatient services. The CSP also focuses on level of functioning in community settings. Therefore Veterans must be open to learn psychosocial rehabilitation skills and apply these to everyday living.  The CSP helps Veterans to live as independently as possible.

How the Program Operates

Treatment Model and Services

Using an “intensive clinical case management model,” members of the team are the primary therapists and are closely involved with CSP Veterans on a day to day basis assisting with most aspects of their lives.  Services include traditional, individual and family therapy, pharmacologic therapy, and crisis intervention as well as community living skills building through the case management piece of the model.

Team members play a large role in skills training and education in day-to-day life activities. Collaboratively with the Veteran staff provide assistance in obtaining benefits, resources, and housing, as well as rehabilitation training in housing maintenance, budgeting, shopping, banking, development of leisure activities, as well as interacting in the community.

As the Veterans’ primary outpatient mental health providers, the team coordinates care with all other providers as appropriate.  CSP assists Veterans with activities, including: going to appointments or family meetings, making sure they have access to medications and know how to take them, helping them look for housing, exploring interest in work, and generally assisting with daily activities of all kinds. 

The regular frequency of CSP interactions and strong relationships with  Veterans enables staff to understand their needs as individuals and collaborate with them to achieve self-identified goals.

The four clinical characteristics of the CSP are: 

¨Intensity - Veterans are seen as frequently as clinically indicated (one to five times/week). 

¨Flexibility and Community Orientation - The majority (95%) of Veteran contacts occur in community settings where access to community networks is available and maximum clinical benefit may be obtained. 

¨Practical Problem Solving - Clinical contacts emphasize practical problem solving, crisis resolution, and adaptive skill building using community and clinical resources.

¨Continuity of Care.  The CSP team is the focal point of clinical responsibility.  They are the primary providers of mental health care and tenaciously maintain contact with Veterans. Additionally they work with Veterans to coordinate their care with VA and non-VA systems.

An interdisciplinary team of mental health providers provides screening and treatment services. 

Availability - CSP staff members are available both at ECCC and in the field Monday through Friday, 8 A.M. to 4:30 P.M.  During evenings, weekends, and holidays, VA Connecticut's Psychiatric Emergency Room provides crisis intervention coverage.  There is also a 24 hour 7day a week Crisis Prevention Hotline which is available to all Veterans.  That number is 1 800 273 TALK (8255).

   

Requirements

The program serves Veterans who are eighteen years of age and older. 

1.    Veterans must have greater than thirty days of inpatient psychiatric hospitalization and/or three or more admissions within the previous calendar year. 

2.    Admissions occur when Veterans are on the inpatient unit prior to their discharge. 

3.    A diagnosis of a serious mental illness must be present. Diagnoses are reviewed at time of referral for appropriateness to the treatment model.

 

Exclusion criteria

1.    Veterans with a significant Substance Abuse history or Cognitive Impairment which impedes ability for psychosocial rehabilitation.

2.    Those Veterans for whom community outreach or ongoing community treatment is contraindicated. 

3.    Veterans who live greater than thirty minutes travel time from VA CT. 

4.    Veterans with significant histories of violence and/or those who are better served by more institutional or structured settings.

 

Duration of Participation in the Program

The length of involvement in CSP is assessed regularly and based on a Veteran’s mental status and community functioning.  Veterans remain in the program as long as clinically indicated which is negotiated with the Veteran and MHICM team and determined by their level of independent functioning.

 

MHICM – Staffing and Organization

The Director of the program oversees the programs activities along with other senior staff members.  However, the operating model of the program is that of shared roles in an interdisciplinary team that recognizes the expertise of the individual disciplines.  

 Every staff member in the group provides case management as well as being an expert in his or her field of training.

Other disciplines will join rounds and team meetings as necessary.  For example, members of the Housing and Job team join CSP team meetings to provide help with individual housing or job needs. 

The disciplines of the current core staff include nurses, social workers, paraprofessional staff, Certified Peer Specialists, and psychiatrists.  These individuals bring their own educational backgrounds, expertise, and experiences to make this a rich and effective team that provides well-rounded treatment and recovery options.

History

In 1987, pilot mental health programs were established in nine locations in the Northeast of the United States to determine the effectiveness of a community-based clinical case management model for Veterans with serious and persistent mental health issues.  Laurie Harkness PhD and her team designed their pilot on the ACT (Assertive Community Treatment) model that was developed in Madison, Wisconsin. The ACT model is intensive in-vivo community case management that is evidence-based with outcomes supporting its effectiveness. 

The pilot phase started as a controlled randomized study, with separate “treatment” and “control” groups. The controlled phase ran for approximately five years, and data collected and analyzed from this phase indicated that this is an effective approach that helps keep Veterans out of the hospital and increases their community functioning.  This model, based on the ACT program, has become the national model for such programs at the VA and is utilized in approximately 170 VA medical centers throughout the country. Nationally, this program is now known as MHICM (Mental Health Intensive Case Management).

Update November 2016

 



Contacts

The location of the program is:

                        Errera Community Care Center

                        115-52 Boston Post Road

                        West Haven, CT 06516

The main program number is:  203 479 8008



“I would have been dead if I did not get hooked up with the VA, or in some gutter lying there.  I’m lucky to be in America where they help veterans with mental illness”
 
 
 

This is a website maintained by Veterans and volunteers. While the contents of this site have been developed in cooperation with VA personnel, it is not an official site of the Department of Veterans Affairs.