Coordinated Specialty Care (CSC) for First Episode Psychosis (FEP)

Center of Excellence: Early Psychosis Intervention California (EPI-CAL)

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Summary

CSC is a community-based service designed for members experiencing first episode psychosis (FEP). By providing timely and integrated support during the critical initial stages of psychosis, CSC reduces the likelihood of psychiatric hospitalization, emergency room visits, residential treatment placements, involvement with the criminal justice system, substance use, and homelessness.

CSC is a comprehensive, team-based service in which multidisciplinary teams provide a wide range of individualized supports to members exhibiting initial signs of psychosis.

Target Population

Eligibility Criteria:

Appropriate for: Individuals who are experiencing initial signs of psychosis or attenuated psychosis symptoms, including individuals that have:

Exhibited onset of psychotic symptoms within the past five years.
Exhibited attenuated psychosis symptoms that meet criteria for clinical high-risk syndrome.

Age:

12 through 40 years. May be appropriate for individuals outside of the target age population as determined by clinician.

Other Considerations:

May not be appropriate for: Individuals whose psychotic-like experiences are better attributed to an intellectual/developmental disability (I/DD) or secondary to physical health condition (e.g., traumatic brain injury, delirium, dementia).

CSC is also not typically indicated for members who experience substance-induced psychosis; however, if a member presents symptoms of psychosis induced primarily by a substance use disorder (SUD), a clinician may recommend CSC if they determine the comprehensive CSC model is appropriate to support the member’s recovery.

Key Components of Model

Recovery-oriented, healing support for personal wellness goals, such as education, employment, and meaningful relationships within one’s community. Services are provided in a variety of settings, including the home, telehealth, schools, and the community.

Proactive, person-centered, and timely transition planning, including (1) active step-down services as wellness goals are met, and (2) post-crisis or hospitalization.

Key components of the CSC for FEP model:

Community outreach and education.
Family support services.
Case management.
Collaborative team meeting.
Assessment.
Crisis intervention.
Employment and education support services.
Medication support services.
Peer support services.
Psychosocial rehabilitation.
Referral and linkages.
Therapy.
Treatment planning.

Team Structure/Staffing Model

CSC is a collaborative, multidisciplinary, team-based service. CSC teams include a diverse array of behavioral health practitioners. All CSC team members are expected to be available to support the members in their treatment and engage in regular communication and collaboration with the team.

CSC is a comprehensive outpatient service. Services are provided by a community-based multidisciplinary CSC team that includes:

Psychiatrist or psychiatric prescriber.
Peer support specialist.
Other licensed and credentialed practitioners.

A fully staffed team typically serves a caseload of 35-40 service users, with adaptations based on program capacity and/or local needs.