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). | 
