This resource was developed by SMI Adviser content partners and approved by the SMI Adviser clinical expert team for inclusion in the knowledge base.
CSC is a structured, intensive, and time-limited intervention, which means that most individuals who had a first episode of psychosis will ultimately “graduate” and need to make a transition to a different level of care. But, research is showing that an extension of services for an additional 1-3 years can maintain gains or at least not lead to a loss of gains previously achieved. Depending upon their preferences and needs, clients may transition to other forms of treatment typically within 2 to 3 years of starting a CSC program. Research on this topic has shown that there is significant variability among psychiatric/clinical programs in their policies and practices regarding when and how to transition clients. An important component of CSC is knowing how to facilitate transitions from one phase of care to the next.
Proponents of the CSC approach believe that there are a set of best practices that represent an ideal approach to transitioning clients. These proponents emphasize the importance of practical strategies for assessing readiness for transition such as identifying post-CSC goals and needs, finding appropriate community resources to meet those needs, making referrals to formal services, managing the actual transition, and conducting follow-up. A critical step in the transition process is to educate receiving providers about CSC services and address their misconceptions, if any exist. Periodic in-person or phone check-ins between the client and the CSC team can provide reassurance, enable safety assessments, and facilitate problem-solving around transitional issues. An assessment of the client’s clinical and functional status, as well as sensitivity to his or her self-identified goals and needs, are also essential components of the transition process. Shared decision-making that involves a collaborative review of client options and their likely outcomes, according to the model, will help foster a successful transition. One scenario is that clients transfer from a higher level of CSC to a less intense level with a greater emphasis on independent living. However, recognizing that not all clients will need or want ongoing mental health services following their graduation from CSC services is important.
For a comprehensive guide on CSC, see Transitioning Clients from Coordinated Specialty Care: A Guide for Clinicians.
Also see this webinar series on Discharge and Step-Down in CSC for Persons with a First Episode of Psychosis: