Coordinated Specialty Care

Coordinated Specialty Care (CSC) is a recovery-oriented treatment program designed for people with first episode psychosis (FEP).U.S. Department of Health and Human Services. (n.d.). What is Coordinated Specialty Care (CSC)? National Institute of Mental Health. Retrieved April 15, 2022, from CSC consists of collaborative treatment planning between the client and the client's care team, consisting of mental health clinicians, psychiatrists, and case managers. CSC includes individual and family therapy, medication management, psychoeducation and support, case management, and support surrounding education and employment goals. The program is considered an early psychosis intervention and is intended to be used shortly after symptoms onset.U.S. Department of Health and Human Services. (n.d.). What is Coordinated Specialty Care (CSC)? National Institute of Mental Health. Retrieved April 15, 2022, from

History The first CSC's in the United States started in the early 2000s and did not expand nationally until after the Recovery After an Initial Schizophrenia Episode (RAISE) study, which was publicly funded by the National Institute of Mental Health.Read, H., & Kohrt, B. A. (2021). The History of Coordinated Specialty Care for Early Intervention in Psychosis in the United States: A Review of Effectiveness, Implementation, and Fidelity. Community mental health journal, 10.1007/s10597-021-00891-w. Advance online publication. https://doi.org/10.1007/s10597-021-00891-w The goal of the initiative was to identify whether or not CSC's worked better than care typically available in community settings.U.S. Department of Health and Human Services. (n.d.). What is raise? National Institute of Mental Health. Retrieved April 15, 2022, from Some examples of established CSC's include NAVIGATE, the Connection Program, OnTrackNY, Specialized Treatment Early in Psychosis (STEP), and Early Assessment and Support Alliance (EASA).

CSC programs provide six essential functions for younger individuals experiencing a first episode of psychosis. Ensuring that clients have access to clinicians that are trained in FEP is critical. Straightforward admission to the FEP treatment program through ongoing outreach and involvement makes it easier during the transition. During treatment care teams can also arrange to have in-home treatment and other community or clinical resources made available as needed. CSC program providers are profoundly attentive in the course of, and/or after a clinical crisis. The care teams and the client collaboratively plan for aftercare or stepping down to a lower level of care, and/or discharging from treatment is upon completion of treatment and the client demonstrates increased functional abilities.Heinssen, R. K., Goldstein, A. B., & Azrin, S. T. (2014, April 14). Evidence-Based Treatments for First Episode Psychosis: Components of Coordinated Specialty Care. National Institute of Mental Health. Retrieved June 6, 2022, from https://www.nimh.nih.gov/sites/default/files/documents/health/topics/schizophrenia/raise/nimh-white-paper-csc-for-fep.pdf

Components of Coordinated Specialty Care Although individual programs have different approaches in their clinical model, there is a standard that must be followed in order to meet the criteria of a CSC. This includes psychopharmacological treatment, or medication management, psychotherapy, family education and support, supported employment and education, and case management.U.S. Department of Health and Human Services. (n.d.). What is Coordinated Specialty Care (CSC)? National Institute of Mental Health. Retrieved April 15, 2022, from

Psychopharmacological Treatment Psychopharmacological treatment, or medication management, is the process of assessing and prescribing medication for symptom management, and is a pivotal component of CSC.Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., Keefe, R. S., Davis, S. M., Davis, C. E., Lebowitz, B. D., Severe, J., Hsiao, J. K., & Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. The New England journal of medicine, 353(12), 1209–1223. https://doi.org/10.1056/NEJMoa051688 Long-term therapy with antipsychotics, however, is often associated with negative side-effects, low adherence, and high levels of medication discontinuation.Guo, X., Zhai, J., Liu, Z., Fang, M., Wang, B., Wang, C., Hu, B., Sun, X., Lv, L., Lu, Z., Ma, C., He, X., Guo, T., Xie, S., Wu, R., Xue, Z., Chen, J., Twamley, E. W., Jin, H., & Zhao, J. (2010). Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Archives of general psychiatry, 67(9), 895–904. https://doi.org/10.1001/archgenpsychiatry.2010.105 Medication noncompliance is one of the many variables that lead to poorer outcomes among individuals with mental health issues and is even more so of an issue for individuals with schizophrenia, of which a third are noncompliant.Haddad, P. M., Brain, C., & Scott, J. (2014). Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient related outcome measures, 5, 43–62. https://doi.org/10.2147/PROM.S42735 Furthermore, studies have shown that medication alone is not enough, and is most successful in conjunction with psychosocial intervention: including psychoeducation, family interaction, skills training, and cognitive behavioral therapy.Guo, X., Zhai, J., Liu, Z., Fang, M., Wang, B., Wang, C., Hu, B., Sun, X., Lv, L., Lu, Z., Ma, C., He, X., Guo, T., Xie, S., Wu, R., Xue, Z., Chen, J., Twamley, E. W., Jin, H., & Zhao, J. (2010). Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Archives of general psychiatry, 67(9), 895–904. https://doi.org/10.1001/archgenpsychiatry.2010.105Lehman, A. F., Kreyenbuhl, J., Buchanan, R. W., Dickerson, F. B., Dixon, L. B., Goldberg, R., Green-Paden, L. D., Tenhula, W. N., Boerescu, D., Tek, C., Sandson, N., & Steinwachs, D. M. (2004). The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophrenia bulletin, 30(2), 193–217. https://doi.org/10.1093/oxfordjournals.schbul.a007071 Medication management in CSC uses a shared-decision-making process combined with a harm reduction approach to encourage the individual to collaborate with their psychiatrist regardless of whether or not they choose to take medication.Robinson, D. (2020). Quick Guide to NAVIGATE Psychopharmacological Treatment. Retrieved April 15, 2022, from http://navigateconsultants.org/2020manuals/prescribers_2020.pdf

Psychotherapy Psychotherapy in a CSC is a cooperative and recovery-oriented process that aims to address various deficits that plague individuals with schizophrenia by focusing on attaining personal goals that lead to a meaningful life. NAVIGATE's Individual Resiliency Training Manual, for example, includes modules on goal setting, healthy lifestyles, wellness and relapse prevention, processing of the psychotic episode, strengths building, teaching coping skills for negative feelings, psychotic, non-psychotic and PTSD symptoms, as well as suicidal ideation and behavior, substance abuse, reintroduction to pleasant activities, and increasing social connections.Robinson, D. G., Correll, C. U., Kurian, B., Miller, A. L., Pipes, R., & Schooler, N. R. (2020, April 29). Navigate individual resiliency training manual. NAVIGATE Consultants. Retrieved April 16, 2022, from http://navigateconsultants.org/2020manuals/irt_2020.pdf Home practice is highly encouraged in CSC.

Family Education and Support A critical component of CSC is the emphasis on the client's family and their home environment. Families that have a loved one experiencing first episode psychosis often display heightened levels of despair, distress, conflict, and anxiety.NAMI Marin County (2019). Cognitive Behavioral Therapy Informed Care for Psychosis for Families and Caregivers: Workshop Materials. NAMI Marin County. Retrieved June 6, 2022, from https://www.namimarin.org/cognitive-behavioral-therapy-for-psychosis Most CSC clients request some form of family involvement. Family involvement is beneficial because it has been shown to help with relapse prevention,Fleischhacker, W. W., Arango, C., Arteel, P., Barnes, T. R., Carpenter, W., Duckworth, K., Galderisi, S., Halpern, L., Knapp, M., Marder, S. R., Moller, M., Sartorius, N., & Woodruff, P. (2014). Schizophrenia--time to commit to policy change. Schizophrenia Bulletin, 40(Suppl 3). https://doi.org/10.1093/schbul/sbu006 reduces hospitalizations,Pfammatter, M., Junghan, U. M., Brenner, H. D. (2006). Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophrenia Bulletin, 32(Suppl 1):S64-80. https://doi : 10.1093/schbul/sbl030 better treatment outcomes,Glick, I. D., Stekoll, A. H., Hays, S. (2011). The Role of the Family and Improvement in Treatment Maintenance, Adherence, and Outcome for Schizophrenia. Journal of Clinical Psychopharmacology, 31(1) https://doi : 10.1097/JCP.0b013e31820597fa greater employment outcomes,Brekke, J. S., & Mathiesen, S. G. (1995). Effects of parental involvement on the functioning of noninstitutionalized adults with schizophrenia. Psychiatric Services, 46(11), 1149–1155. https://doi.org/10.1176/ps.46.11.1149 overall increase in quality of life,Connell, J., Brazier, J., O’Cathain, A. et al. Quality of life of people with mental health problems: a synthesis of qualitative research. Health Qual Life Outcomes 10, 138 (2012). https://doi.org/10.1186/1477-7525-10-138 lower rates of substance abuse,Clark, R. E. (2001) Family support and substance use outcomes for persons with mental illness and substance use disorders. Schizophrenia Bulletin, 27(1):93-101. https://doi : 10.1093/oxfordjournals.schbul.a006862 and less deaths.Revier, C. J., Reininghaus, U., Dutta, R., Fearon, P., Murray, R. M., Doody, G. A., Croudace, T., Dazzan, P., Heslin, M., Onyejiaka, A., Kravariti, E., Lappin, J., Lomas, B., Kirkbride, J. B., Donoghue, K., Morgan, C., & Jones, P. B. (2015). Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study. The Journal of nervous and mental disease, 203(5), 379–386. https://doi.org/10.1097/NMD.0000000000000295

Supported Employment and Education (SEE) FEP disrupts daily tasks and responsibilities such as school or work. It also can impact one's ability to get back to the routine and have stability as they once did. An SEE Specialist works with the client to figure out how they can offer support in working with clients on achieving vocational goals. Supported employment and education involves collaboratively figuring out personal preferences, employment history, training or credentials that the client has or may need. The client will receive the SEE services as a part of their clinical treatment goals.Lynde, D. W., Gingerich, S., McGurk, S. R., Mueser, K. T., Glynn, S. M. (n.d.). Navigate Supported Education and Employment (SEE) Manual- April 2020 Revised Version. NAVIGATE Consultants. Retrieved June 6, 2022, from http://navigateconsultants.org/2020manuals/see_2020.pdf