Community Support Programs: Provider Resources

ACT is a team-based approach to providing treatment, rehab, and support services. ACT models of treatment are built around a self-contained, complete team. They are the fixed point of responsibility for patient care, serving a set group of clients. This approach is often used with clients who have severe mental illnesses. The treatment team provides all services with a highly integrated approach to care.

With ACT, there are low caseloads and many services in a range of settings. ACT is different from Intensive Case Management.

View the ACT EBP Kit.

Critical elements of ACT include:

• 24-hour coverage for psychiatric crises.
• A client to provider ratio of 10:1 or fewer.
• A team of at least three full-time employees. The team may include a psychiatrist, nurse, and substance use specialist.
• Case management, plus these direct services:
  • Counseling/psychotherapy
  • Employment/rehab services
  • Housing support
  • Psychiatric services
  • Substance use treatment
• Efforts to monitor status and enhance community living skills in the community instead of an office.

As described by Stanford University’s Department of Psychiatry and Behavioral Sciences: “Cognitive Behavioral Therapy for psychosis (CBTp) was initially developed as an individual treatment, and later as a group-based intervention, to reduce the distress associated with the symptoms of psychosis and to improve functioning. Studies have demonstrated that CBTp can result in decreased positive symptoms, improvement in negative symptoms, and improved functioning. In addition, there is evidence to suggest CBTp can be effective in preventing, or delaying, the transition to full psychosis when used with individuals identified as being at risk of developing psychosis.”

Critical elements of CBTp include:

Creation of the therapeutic alliance establishing rapport between client and clinician and agreeing on treatment goals.

View more information on the routine administration of CBTp as the standard of care for individuals seeking treatment for psychosis.

Dialectical Behavioral Therapy (DBT) is an evidence-based psychotherapy that combines Cognitive Behavioral Therapy with Zen Buddhism. Created by Marsha Linehan, it was originally used to treat borderline personality disorder. Today, it is used to treat many different emotional dysregulation and impulse control disorders and symptoms.

DBT is made up of skills that help individuals regulate emotions, improve relationships, and withstand times of distress without impulsivity. The learned skills take practice to incorporate into one’s daily life. The goal of DBT is to build a life worth living.

Critical elements of DBT include:

• Mindfulness
• Distress tolerance
• Emotional regulation
• Interpersonal effectiveness

E-IMR is a newer model. It combines care for mental health and substance use disorders using two established EBPs:

• Integrated Dual Disorder Treatment (IDDT)
• Illness Management and Recovery (IMR)

With this EBP, providers share language and proven strategies when giving care to people with co-occurring disorders. E-IMR helps find the interaction between substance use and mental illness. It gives the provider and client skills to address both disorders. It can take place in either mental health or substance use treatment settings.

E-IMR is different from advice related to self-care. It is a full, systematic approach. This EBP helps people understand and gives them skills to be an agent in their own recovery.

View E-IMR Foundations Training.

Critical elements of E-IMR include a specific curriculum with modules on:

• Coping strategies.
• The effective use of medicines.
• Facts about mental illness and substance use disorders.
• A plan for staying well.
• Recovery strategies.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

Family psychoeducation is offered as part of an overall clinical treatment plan. It’s meant to help people with mental illness achieve the best possible outcomes. This happens through active involvement of the family in treatment and management. Families also get support in their efforts to aid the recovery of their loved one. This program may be either multifamily or single-family focused.

Core features of family psychoeducation programs include:

• Education.
• Emotional support.
• Problem-solving skills.
• Resources during times of crisis.

Critical elements of family psychoeducation include:

• Using a structured curriculum.
• Including psychoeducation as part of clinical treatment. 

The EBP of family psychoeducation must involve a clinician as part of clinical treatment. This sets this EBP apart from others like it.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

IMR, also called illness management or wellness management, is a set of rehabilitation methods. The goal is to teach people with mental illness effective strategies for working actively with professionals to manage their illness. This helps:

• Improve social support.
• Lower risk of relapse and going back to the hospital.
• Lower severity and distress from symptoms.

IMR is different from advice that relates to self-care. It’s a comprehensive, systematic approach to helping a person be an agent for their own recovery.

View the Illness Management and Recovery EBP Kit.

Critical elements of IMR include:

• Coping skills.
• Medicines.
• Mental illness facts.
• Recovery strategies.
• Stress management.

More specific EBRs that fall under IMR include:

• “Behavioral tailoring” to help people fit taking medicine in their daily routine.
• Cognitive behavioral therapy for psychosis.
• Psychoeducation about the nature of mental illness and its treatment.
• Relapse prevention planning.
• Social skills training.
• Teaching of coping strategies to manage distressing, lasting symptoms.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

IPS refers to the EBP of supported employment. This helps people living with behavioral health conditions work regular jobs they choose. IPS is based on the principle that work promotes recovery and wellness. IPS is not prevocational training, sheltered work, or employment in enclaves. Instead, it:

• Focuses on each person’s strengths.
• Customizes services that last as long as the person needs and wants them.
• Uses a team approach with different experts. Includes practitioners and state vocational rehabilitation counselors.

View the Supported Employment Fidelity Review Manual (PDF).

Critical elements of IPS include:

• Benefits planning—Helps people get correct information about their Social Security, Medicaid, and other government benefits. Information is personalized and easy to understand.
• Competitive employment—Finds opportunities for job seekers that are inclusive. These are jobs that anyone can apply for. They also pay at least minimum wage or the same pay as coworkers with similar duties. They don’t have artificial time limits set by a social service agency.
• Integration services—Is part of mental health and substance use treatment programs. Employment specialists work with a job seeker’s treatment team to support the job seeker’s goals.
• Rapid job search—Doesn’t require assessments, training, or counseling before looking for a job. The first face-to-face contact between a job seeker and business happens within 30 days.
• Systematic job development—Has IPS employment specialists regularly visit businesses to learn about their needs and who they’re looking to hire. This is based on the job seeker’s interests.
• Time-unlimited supports—Keeps up services as long as each person served wants and needs support.
• Worker preferences—Focuses on each job seeker’s goals and wishes.
• Zero exclusion—Helps all job seekers who get services for mental health and substance use disorders.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

IDDTs mix mental health and substance use interventions at the clinical level. This means the same clinicians or team of clinicians, in the same setting, provide the right mental health and substance use interventions all at once. For the patient, this makes services appear seamless. There’s a consistent approach, philosophy, and recommendations. IDDT removes the need to negotiate with separate teams or programs. The goal of IDDT is to help the patient recover from two illnesses. It differs from coordination of clinical services across provider agencies.

View Integrated Treatment for Co-Occurring Disorders EBP Kit

View clinical guide for IDDT

Critical elements of IDDT include:

• A complete team—Offer a team of clinical professionals working in one setting. The team provides and coordinates mental health and substance use interventions.
• Stagewise interventions—Give treatment that fits with each patient’s stage of recovery (engagement, motivation, action, or relapse prevention).

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

There’s not an explicit definition of medication management. It’s different than medication prescription administration that happens without the minimum critical elements (outlined below). Core features include:

• Objective measures of outcomes.
• Shared decision-making between consumers and providers.
• Thorough and clear documentation.
• Use of a systematic plan to manage medicines.

MedTEAM is one example of an EBP for medication management.

Critical elements of medication management include:

• A treatment plan that denotes an outcome for each medicine.
• Tracked desired outcomes, Tracking method must use standard instruments to inform treatment decisions.
• Sequencing of antipsychotic medicine. Changes must be based on clinical guidelines.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

MI is a “collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.” MI differs from stages of change, a manipulative way of tricking people into change, and client-centered therapy.

Fidelity is measured through the direct coding of practice samples. It’s defined in terms of basic and advanced standards for skills measures. These include:

• Percent of open questions (out of total questions).
• Percent of complex reflection (out of total reflection).
• Ratio of reflections to questions.
• Percent of MI-adherent behaviors (out of total behaviors).

There also are global measures to look at overall MI practice.

MI resources include:

• Miller, W. R., & Rollnick, S. (2013, p. 29, p. 400). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.
• Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37(2), 129-140.

Critical elements of MI include:

• A spirit or way of being with people that is collaborative and compassionate. You must be accepting and respectful of a person’s autonomy.
• Core skills, which include:
  • Asking open-ended questions.
  • Looking for strengths and affirming them.
  • Listening and reflecting carefully.
  • Summarizing.
  • Providing information using the “elicit-provide-elicit” procedure.
• Core skills that are applied within four processes:
  • Engaging the person and building the relational foundation.
  • Focusing on an agenda that’s developed as a team to talk about with a listed specific “target behavior.”
  • Exploring the person’s ideas and motivations for change. The practitioner listens for change talk, draws it out, and responds to it to enhance motivation.
  • Planning and creating a goal and support plan as a team.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

PSH includes services to help people find and keep suitable housing. This EBP was founded on the idea that some people can live by themselves in the community only if they have support staff for monitoring or helping with residential responsibilities. Staff help clients find, get, and keep safe, decent, affordable housing. At the same time, they keep clients linked to other essential services in the community. PSH differs from residential treatment services and a component of case management.

PSH is a specific program model. The client lives in a house, apartment, or similar setting, alone or with others. They are in charge of most residential maintenance, but they get regular visits from mental health staff or family. These visits help monitor and/or help with residential responsibilities.

View PSH EBP Kit.

Critical elements of PSH include:

• Target population—Focus on people who wouldn’t have practical housing arrangements without this service.
• Staff assigned—Assign specific staff to give supported housing services.
• Integrated housing—Provides supported housing in settings that are also available to people who don’t have mental illness.
• Consumer right to tenure—Makes ownership or lease documents in the name of the client.
• Affordability—Assures that housing is affordable. Clients pay no more than 30–40% on rent and utilities through rent subsidies and other services.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

Seeking safety therapy is an evidence-based treatment that helps people with trauma, posttraumatic stress disorder, and substance use. Seeking safety can be provided individually or in a group setting.

Critical elements of seeking safety include:

• Safety as the priority of treatment Eliminating unsafe behaviors and creating a safe environment for oneself is the essential first step.
• Integration of treatment for trauma and substance use Treating both symptoms of PTSD and substance use together by enhancing coping skills.
• A focus on ideals: focusing on the potential for a better future improves motivation and outcomes in recovery.
• Focusing on four content areas: cognitive, behavioral, interpersonal, and case management.
• Attention to clinician processes: maintaining empathy and compassion for consumers while maintaining a balance of praise and accountability.

Mental health SE promotes rehabilitation and a return to productive employment for people with serious mental illnesses. SE programs use a team approach for treatment. Employment specialists carry out all vocational services, from intake through follow-along. SE differs from prevocational training, sheltered work, and employment in enclaves.

Job placements are:

• Community-based (not sheltered workshops or on-site at SE or other treatment agency offices).
• Competitive and open to the public.
• In normal settings.
• Used with more than one employer.

The SE team has a small client to staff ratio. SE contacts happen in the home, at the job site, or in the community. The SE team is assertive in engaging and keeping clients in treatment, especially with face-to-face visits instead of contact by phone or mail. They work with family and others when needed. Services are often coordinated with vocational rehabilitation benefits.

View SE EBP Kit

Critical elements of SE include:

• Competitive employment—Provides job options that have a permanent status instead of temporary or time-limited. Possible applicants include people in the general population.
• Integration with treatment—Shared decision-making between employment specialists and mental health treatment teams. Employment specialists attend treatment team meetings and have regular contact with the treatment team members.
• Rapid job search—Offers fast job search after program entry.
• Eligibility based on consumer choice (not client characteristics)—Does not have requirements, such as job readiness, lack of substance use, no history of violent behavior, minimal intellectual functions, or mild symptoms.
• Follow-along support—Provides personal follow-along supports to employer and client without time limits. Employer supports may include education and guidance. Client supports may include crisis intervention, job coaching, job counseling, job support groups, transportation, treatment changes (medicine), and network supports (family/friends).

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

TCBA was developed at University of Wisconsin Center for Tobacco Research and Intervention with the NAMI Wisconsin. It’s a set of tobacco reduction interventions tailored to how willing the client is to move towards quitting. TCBA is an interventional approach based on the established stages of change model. It can help people with mental illness make progress and stop using tobacco.

Each client who currently uses tobacco products (cigarettes, cigars, pipes, snuff, chew, snus, and e-cigarettes) is assigned to only one bucket. The bucket is based on their stage of change defined at the end of the survey year:

• Quit—Client quit using tobacco and stayed quit during the survey year. Don’t assign this category if the client says they’ve quit, but there’s clear evidence they haven’t.
• Quit Now—Client is actively trying to quit fully.
• Talk and Prepare—Client is not trying to quit fully but is making efforts towards their goal. For example, reducing, practicing quit attempts, using cessation medicines, or recording smoking.
• Just Talk—Client isn’t willing to make efforts towards quitting, but they are willing to talk about their tobacco use.
• Not Right Now—Client isn’t willing to talk about their tobacco use at this time.

Each client who has never used tobacco or quit previously is assigned to one of these categories:

• Never used tobacco—Client never smoked or used any tobacco products.
• Ex-users of tobacco—Client stopped using tobacco before involvement in CSP or CCS, or before the current survey year.
• Other smoking—Client smoked other chemicals that aren’t tobacco products during the survey year. For example, marijuana, crack, cocaine, heroin, or methamphetamine. You can assign this category with other categories.

TCBA resources include:

• UW-CTRI’s “Bucket Approach” to Help Patients with Severe Mental Illness Quit Smoking
• Addressing Tobacco Dependence in the Behavioral Health System: Training in the “Bucket Approach”

Critical elements of TCBA include:

• Inquiry and assessment of each client’s readiness for change based on the Bucket Approach.
• Proper application of interventions that fit with each client’s bucket.
• Systematic tracking of outcomes using standard definitions to measure progress.
• Treatment and recovery plans that identify a person’s assessed need for specific interventions. Includes designed outcomes in line with the client’s bucket assignment.
• Use of a systematic plan for program-wide implementation of the Bucket Approach.

ACT: If this EBP is used as part of ACT, report it in the CSP survey under both ACT and this EBP.

MHSIP Adult Satisfaction Survey, F-01389—Select the link to access the survey in English, Spanish, Hmong, or Khmer.

Select the link to download a Word template cover letter. Send the cover letter with the survey.

• English—Sample Adult Cover Letter (Word)
• Spanish—Sample Adult Cover Letter (Word)
• Hmong—Sample Adult Cover Letter (Word)
• Khmer—Sample Adult Cover Letter (Word)