Community stabilization services are direct mental health care to non-hospitalized individuals 18 years and older experiencing an acute crisis of a psychiatric nature that may jeopardize their current community and living situation. The goals are to avert hospitalization; provide normative environments with a high assurance of safety and security for crisis intervention; stabilize individuals in psychiatric crisis; and mobilize the resources of the community support system, family members, and others for ongoing maintenance, rehabilitation, and recovery.

Community Stabilization services are available 24 hours a day, seven days a week, to provide for short-term assessment, crisis intervention, and care coordination to individuals who have recently experienced a behavioral health crisis. Community Stabilization is a bridge service that supports an individual as they are making a transition between certain levels of care when there is a gap in availability of services. Services may include brief therapeutic and skill building interventions, engagement of natural supports, interventions to integrate natural supports in the de-escalation and stabilization of the crisis, and coordination of follow-up services. Services involve advocacy and networking to provide linkages and referrals to appropriate community-based services and assisting the individual and their natural support system in accessing other benefits or assistance programs for which they may be eligible.

Program Goals: The goal of Community Stabilization services is to stabilize the individual within their community and support the individual and natural support system during the following: 1) between an initial Mobile Crisis Response and entry in to an established follow-up service at the appropriate level of care if the appropriate level of care is identified but not immediately available for access 2) as a transitional step-down from a higher level of care if the next level of care is identified but not immediately available or 3) as a diversion from a higher level of care.

Critical Features of Community Stabilization include:

• Recovery-oriented, trauma-informed, culturally congruent and developmentally appropriate provision of services, integrating the Zero Suicide/Suicide Safer Care principles;
• Assessment and screening, including explicit screening for suicidal or homicidal ideation.
• Care Coordination:
  • Linkage and referral to ongoing services, supports and resources (examples: housing, peers, chaplaincy), as appropriate and least restrictive level of care.
  • Coordination of specialized services to address the needs of co-occurring intellectual/developmental disabilities and substance use.
  • Engaging peer/natural and family support to strengthen the individual’s participation and engagement.
• Crisis Intervention:
  • Brief Therapeutic Interventions.
  • Crisis education, safety, prevention planning, and support.
  • Interventions to integrate natural supports in the de-escalation and stabilization of the crisis.
• Skills Restoration:
  • Skill Building
  • Psychoeducation

Covered Services components of Community Stabilization include:

• Assessment, including telemedicine assisted assessment
• Care Coordination
• Crisis Intervention
• Health Literacy Counseling
• Individual and Family Therapy
• Peer Recovery Support Services
• Skills Restoration
• Treatment Planning

Population Served:  The individual must be aged 18 years or older and VA Medicaid eligible. Individuals must meet the following criteria:

1. Documentation indicates evidence that the individual currently meets criteria for a primary International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis that correlates to a Diagnostic and Statistical Manual diagnosis; and
2. The individual is at risk of repeat admissions to crisis services, emergency departments, or psychiatric inpatient services or dangerous decompensation in functioning and additional support is required to prevent inpatient admission; and

Prior to admission, the individual must meet either #3 or #4:

3. The individual is transitioning from one of the following services and the necessary service is not immediately available:

4. The individual is transitioning from one of the following services and the necessary service is not immediately available:
i. 23-Hour Crisis Stabilization
ii. Acute Psychiatric Inpatient Services
iii. ASAM levels 3.1 – 4.0
iv. CSB Emergency Services
v. Hospital Emergency Department
vi. Mobile Crisis Response
vii. Partial Hospitalization Program (Mental Health or
ARTS)
viii. Psychiatric Residential Treatment Facility (Mental
Health or ARTS)
ix. Residential Crisis Stabilization Unit
x. Short-term detention or incarceration
xi. Therapeutic Group Home and

If the individual meets criteria #4, then the following additional criteria must be met:

5. Without immediate access to the identified community-based service, there is evidence that the individual would be at risk for a higher level of care during the transition to the next service; and
6. Clinically appropriate behavioral health service referral(s) has been identified and a plan for the timeline of transition from Community Stabilization to that provider has been established. If the timeline for transition exceeds 2 weeks, the Community Stabilization provider should initiate referrals to additional follow-up service providers.

Exclusion Criteria: Individuals who meet any of the following criteria are not eligible to receive Community Stabilization Services (with exception for transitions, see billing requirements section):

1. The individual is receiving behavioral health services (MHS and ARTS) more intensive than standard outpatient psychotherapy/psychiatric services for mental health and substance use disorders or targeted case management service, unless approved by the individual’s MCO or FFS contractor;
2. The individual is receiving inpatient or specific residential treatment services including psychiatric residential treatment facility (PRTF) or ASAM levels 3.3 – 4.0, unless for the purposes of service transition or approved by the individual’s MCO or FFS contractor.
3. The individual’s psychiatric condition is of such severity that it cannot be safely treated in this level of care;
4. The individual’s acute medical condition is such that it requires treatment in an acute medical setting.

Termination/discharge of services: Services will be terminated if individuals no longer meet criteria for services. At least one of the following discharge criteria is met:

1. The individual no longer meets admission criteria.
2. A safe discharge plan has been established and an appropriate level of care has been initiated.
3. An effective safety plan has not been established and the individual requires a higher level of care.
4. The individual and/or support system is not engaged in treatment. The lack of engagement is of such a degree that treatment at this level of care becomes ineffective or unsafe, despite multiple, documented attempts to address engagement issues.
5. The individual’s physical condition necessitates transfer to an acute, inpatient medical facility.

Referrals sources include managed care organizations, community partners, self-referrals, physicians, other behavioral health agencies, Department of Social Services, and court system.