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 to enable them to live successfully in community settings. Through aggressive community based clinical case management CSP promotes, helps maintain, and/or restores the mental health of this Veteran population.
The overarching goal is to help these veterans begin their own road to recovery and have a life that is successful and satisfying.
Currently the Veterans are admitted through inpatient status after being identified as some of the highest users of inpatient services. The CSP also focuses on level of functioning in community settings. It is important to note that without this program many of these Veterans would be homeless, living in hospitals, or other institutions. The CSP helps Veterans to live as independently as possible.
How the Program Operates
Treatment Model and Services
Upon entry to the CSP, the Veterans are people that have had significant in-patient hospitalizations and have had difficulty functioning on a daily basis. These Veterans averaged 95 days per year of in-patient psychiatric hospitalization.
The CSP team uses what is known as an “intensive clinical case management model.” This means that members of the team are closely and frequently involved with the CSP Veterans on a day to day basis and with respect to most aspects of their lives. This includes traditional individual and family therapy, pharmacologic therapy, and crisis intervention.
Team members play a large role in skills training and education in day-to-day life activities, and provide assistance to Veterans in obtaining benefits, resources, and homes, as well as rehabilitation counseling.
The CSP team becomes a Veteran’s primary outpatient psychiatric provider, collaborating 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, and generally assisting with daily activities of all kinds.
The CSP interaction and relationship with Veterans enables them to understand their needs as individuals and to know them well.
The members of the team interact with Veterans frequently. As a result, the team knows how the Veterans are doing on an ongoing basis and what factors in their lives are affecting them.
Because these Veterans have spent time in the hospital, CSP can utilize their history of medical information to individually and effectively tailor its role for each Veteran participant.
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 are 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 psychiatric care and tenaciously maintain contact with Veterans.
Screening and treatment services are provided by an interdisciplinary team of mental health providers consisting of social work, nursing and psychiatry staff.
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).
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.
1. Veterans with a significant Substance Abuse diagnosis or Organic Brain Syndrome;
2. Those Veterans for whom community outreach or ongoing community treatment would be 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 would be 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 are admitted for a minimum of one year, but can be indefinite, as clinically indicated.
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 is a case manager 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 can provide well rounded treatment and recovery options.
In 1987, pilot programs were established in nine locations in the Northeast United States for community work to assist Veterans with serious mental illnesses. The idea of this mental health initiative was to design and test nine different programs that could help people stay out of the hospital, and see which approach proved to be more effective. Errera Community Care Center was one of the nine locations.
Laurie Harkness PhD and her team chose to format their pilot proposal, using the ACT (Assertive Community Treatment) model used in Madison Wisconsin. The ACT model involved intensive in-vivo community case management. This approach was chosen because it was an evidence-based model with data that indicated this approach was effective. Each program chose its own name and the name chosen for the Errera pilot was Community Support Program (CSP).
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 CSP 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 as of December 2010 is utilized in approximately 115 locations throughout the VA system. Nationally, this program is now known as MHICM (Mental Health Intensive Case Management).
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.
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”