Community Continuum of Care Program
Fellowship Health Resources’ Delaware Community Continuum of Care Program (CCCP) is a unique model that allows individuals to retain their “clinical home” as they progress through their recovery. As with all FHR’s programs, the system is built around the belief that consumers can recover and become independent. Often, as a person begins to move through the stages of recovery, they risk losing their current clinical services in exchange for a new set of faces and places. In essence, they lose their “clinical home.” The CCCP continues to be successful in supporting consumers as they move through recovery, providing treatment and support for mental illness according to three levels of care depending on the client’s needs at any stage of their recovery.
The CCCP currently provides services to two hundred and thirty-one individuals with a serious persistent mental illness or dual diagnosis in Sussex County Delaware. In order to provide the most comprehensive services, the program is run out of two locations with two parallel teams. Each team is comprised of a Master’s Level Team Leader, Master’s Level Clinicians, Case Managers (who must have at least an Associate’s Degree), RNs, a psychiatrist, and support personnel. Staff provides person-centered services, which may include one-on-one services, psycho-educational groups, medication management, and social activities.
The consumers of the CCCP are assigned to a level based on the severity of their symptoms and their stability in the community. Level one is for consumers who require more interventions and support from the team to maintain community tenure. These consumers meet with a staff member at least once a week and are oftentimes seen daily for medication monitoring. Services provided could include education regarding their diagnosis/symptoms, coping skills training, vocational/educational support, assistance with ADLs, assistance with money management, etc.
Consumers move to level two after they have had a period of stability and the CCCP team feels that they can maintain that stability with a visit every two weeks. Staff will continue to work with consumers in the same areas as level one. Level three is a transition phase, which prepares the consumer to move to outpatient services. A consumer at this level will obtain their medication independently, regain control of their Social Security Income, and take any other steps needed to manage without intervention from a case manager. Consumers can move up or down levels as their symptoms/circumstances dictate.
Fellowship Health Resources developed a “level four” program by opening A New Vision Counseling in February 2005, which is now part of the Counseling Center. The intent of this program was to allow the consumers that have been served by the CCCP the option of retaining their clinical home once they transition to outpatient services. The CCCP consumers are often apprehensive about leaving the program, and the fact that they can remain with FHR makes the progression through recovery less anxiety-provoking.
To learn more about the CCCP or any of the Delaware Programs contact Laura Marvel at (302) 424-7448.