Intensive Community Support Services – General

Intensive Community Support Services – General A. Intensive Community Support Services (ICSS) are designed to be a key part of the continuum of mental health services and supports for people (adults and children/youth) with serious mental illness or emotional disturbance. B. ICSS must promote independence and quality of life through the coordination of appropriate services and the provision of constant and on-going support as needed by the person. C. The Intensive Community Support Specialist must have direct involvement with the person and must attempt to develop a caring, supportive relationship with the person. D. ICSS must be responsive to a person’s multiple and changing needs, and must play a pivotal role in coordinating required services across systems to decrease the need for inpatient treatment/hospitalization. E. ICSS must help the person function in the least restrictive, most natural community environment and achieve an improved quality of life by helping the person to achieve their recovery goals. F. ICSS must be provided according to fidelity, as determined by DMH. G. ICSS is a comprehensive and complex service that involves: 1. Outreach and referrals; 2. Frequent assessment and planning; 3. Frequent direct services provision/intervention; 4. Frequent monitoring, evaluation and follow-up; and 5. Information, liaison, advocacy, consultation, and collaboration. H. Staffing Requirements: 1. There must be at least one (1) full-time (40 hours per week) Intensive Community Support Specialist providing services. Additional staff, if needed, can be part-time to the service. 2. ICSS must be provided by a Mental Health Professional who holds a DMH Certified Community Support Specialist credential and has at least two (2) years of mental health direct care experience. ICSS may also be provided by an employee who holds either: (1) a DMH therapist credential (as appropriate to the population served); or (2) a professional license. 3. Overall supervision of the ICSS staff must be carried out only by a mental health professional who holds either: (1) a DMH Mental Health Therapist credential; or (2) a professional license, and has at least three (3) years of mental health direct care experience. 4. A full-time (40 hours per week) Intensive Community Support Specialist’s caseload must not be more than 20 people. A part-time (at least 20 hours per week) Intensive Community Support Specialist’s caseload must not be more than 10 people. I. Service Provision Requirements: 1. The Intensive Community Support Specialist must have seventy-five to eighty-five percent (75-85%) of Intensive Community Support work and contact time in a community setting. ICSS are for adults and children and youth with intensive needs which traditional outpatient services have not been successful in treating. 2. The Intensive Community Support Specialist must coordinate with the people, family, and the facility personnel while people are in inpatient psychiatric care (which includes state operated facilities, private facilities, crisis stabilization units, designated holding facilities, detention centers, or jail), to develop and coordinate an aftercare plan. 3. The agency’s Intensive Community Support Specialist will act as the primary contact (“single-point-of-entry”) for the inpatient facility discharging someone into the agency’s catchment area. 4. The Intensive Community Support Specialist must identify unmet needs of the person in the community and develop a plan to address those identified needs. 5. The Intensive Community Support Specialist must coordinate very closely with Crisis Response Services and Mobile Crisis Response Teams and attend the MAP Team and AMAP team meetings for the agency to ensure continuity of care. Attendance should only be required if a person on their caseload is being reviewed by the MAP/AMAP Team. The Intensive Community Support Specialist will assist with the development of a Crisis Support Plan, as required by DMH. 6. When the person is ready to be discharged from ICSS, the Intensive Community Support Specialist must coordinate with typical mental health services in the person’s community to transition the person using the “warm hand-off method” into less intensive mental health services.