About Coordinated Specialty Care
For psychosis, recovery is possible… Help is available
Psychosis, the hallmark feature of Schizophrenia, happens to 1 in 50 people globally, most often starting between the ages of 15 and 30, during the adolescent transition to adulthood. The onset of hallucinations, strange thoughts and beliefs, odd behaviors, and disordered thinking and speech used to be considered the beginning of an inevitably chronic, persistent, and disabling condition with no known cure. Through research and clinical experience, we now know that with the right individualized treatment and support, young people in the early stages of a psychotic illness can, in fact, fully recover, and go on living their lives to the fullest.
A Brief History of Early Psychosis Intervention
In the 1990s, treatment professionals in Australia and Europe began to break from conventional treatment of young people in the aftermath of a first or early episode of psychosis. Where conventional treatment would offer medication management and occasionally case management, these early intervention programs offered an intense coordinated array of outpatient care including comprehensive psychiatric medical care, family support, and individually tailored psychotherapy and clinical case management. These programs found that young people and families who engaged in intensive, comprehensive care had better outcomes both in illness status and in social functional outcomes. Thus, Early Psychosis Intervention Services (EPIs) were born, and spread through Australia and parts of Western Europe.
In the early 2000s, the University of North Carolina Outreach And Support Intervention Services (OASIS) and Oregon’s Early Assessment and Support Alliance (EASA) were the first programs to attempt adoption of the Australian and European EPIs in the context of the United States healthcare marketplace. As these pilot programs grew, they began to demonstrate similar outcomes for clients as that of the Australian and European programs, and were able to develop financial sustainability within their respective local healthcare markets. Because of these outcomes and the need for expanded early psychosis intervention services throughout the United States, in 2009 the National Institutes of Mental Health funded the Recovery After an Initial Schizophrenic Episode (RAISE) studies to examine the impact of broad deployment of what was renamed Coordinated Specialty Care (CSC) and to test its feasibility of implementation. In 2014, the evidence shown by RAISE was that CSC had a consistently positive recovery impact at 34 sites across 21 states, greater than treatment-as-usual, and that these clinical teams could be consistently developed, trained, and deployed to deliver these core Coordinated Specialty Care services. In late 2014 these results influenced Congress to pass an appropriations bill which directed the Substance Abuse and Mental Health Services Administration (SAMHSA) to set aside a percentage of mental health block grants given to states explicitly for the development and expansion of Coordinated Specialty Care programs.
What is Coordinated Specialty Care?
Coordinated Specialty Care, otherwise known as CSC, is a Early Psychosis Intervention configuration of multi-disciplinary outpatient and community-based mental health services for young persons recovering from first and early episode psychosis. These programs include teams of medical providers, family counselors, and individual psychotherapists and drug counselors, and many programs have begun to experiment with the inclusion of peer support staff as well as education and employment recovery specialists. While CSC teams often time resemble Assertive Community Treatment teams in staffing, what is unique to CSC is the focus on family-inclusion, youth and developmentally-appropriate services, psychotherapy provision, and the expectation that full functional recovery is possible and sustainable. In states where CSC is being deployed and expanded, it is available to clinically appropriate clients between the ages of 15 and 30 who have experienced a first psychotic episode within 3 years of referral.
What impacts do CSC programs have on their clients?
While every CSC program is unique, the RAISE-Early Treatment Program study gave a clear picture of the benefits individuals can experience with engagement in CSC services compared to outpatient treatment-as-usual, even when limited to 2-years of care:
- Decreased hospitalizations related to acute psychosis
- Decreased family discord
- Decreased rates of depression
- Decreased rates of suicide
- Decreased rates of applications for disability pension
- Increased return to school and/or gainful employment
- Increased quality of life
Where is there CSC in North Carolina?
While the original UNC OASIS Program continues to operate in Carrboro, NC, there are two other SAMHSA-funded clinics currently in operation: UNC’s OASIS Program in Raleigh in partnership with Alliance Behavioral Healthcare, and RHA’s SHORE Program in Wilmington in partnership with Trillium Health Resources. These two programs are fully operational, and working towards financial sustainability. We anticipate two additional SAMHSA-funded CSC programs to develop in North Carolina within in the next year. We provide all Technical Assistance to these programs as part of our contract with the North Carolina Division of Mental Health.
Additionally, private providers and organizations not receiving SAMHSA funds could independently develop their own CSC programs under a fee-for-service healthcare model (much how the original UNC OASIS clinic operates). We are available to provide Technical Assistance to interested providers and programs as part of our mission to guide and assist the expansion of Early Psychosis Intervention services throughout North Carolina.
Why expansion is important
We know now that engaging individuals who have experienced psychosis in intensive treatment within the first 3 years of a first episode yields far greater therapeutic benefit and recovery effect than does treatment-as-usual. Individuals comprehensively treated during this window of opportunity are able to fully recover, complete adolescent and young adult developmental tasks, stay out of hospitals and jails, and go on to complete school and contribute to the workforce. All of this is projected to improve the well-being of their families and communities, and to reduce lost productivity and the use of public funds for treatment, emergency services, and disability pensions.
Our experience has been that CSC clinics can generally treat people within an hour drive of a clinic office without undue burden on the client or their family, but beyond this catchment engagement at the recommended level becomes difficult to sustain. This leaves many major North Carolina cities and towns currently without access to these life-preserving services. An expansion of CSC clinics to all major urban areas and towns in North Carolina means a less-fragmented, more responsive mental healthcare system for these individuals most at-risk for less than adequate treatment and subsequent devastating outcomes.
OASIS has been a leader from the beginning
The OASIS Program, having been involved in clinical trials, national and international research, and innovative local program development since the beginning of Early Psychosis Intervention services in the United States, knows how to navigate the challenges of establishing these services in the context of our current healthcare market and political systems. With the support of SAMHSA and the North Carolina Division of Mental Health, and collaboration with managed care organizations and treatment providers, the OASIS Program has the adminstrative expertise, clinical experience, programmatic authority, and vision to bring North Carolina into the future of mental health care for young people. Our technical assistance services are focused on creating expertise in Early Psychosis Intervention across the state, and saving the lives of young people in recovery from early psychosis.