St. Clare's Health Systems, an affiliate of Catholic Health Initiatives, operates a community mental health program that sponsors the NAVIGATE site in Denville, NJ. It also operates a hospital and other behavioral health services in the area. St. Clare's is the dominant behavioral health provider in Morris County. It has a staff of approximately 150 professionals of all specialist types, serving 2400 clients in 2009, the most recent year of complete data. They serve adults and children with the full range of behavioral problems and diagnoses. Although they did not have a first-episode psychosis service prior to RAISE and NAVIGATE, the state and St. Clare's have an emphasis on early intervention services, which includes emergency response services and medications. This emphasis on early intervention services set the groundwork for participating in RAISE.
NAVIGATE is located within the same program that supports the ACT teams at St. Clare's. The NAVIGATE program is embedded within this program area and is entirely funded by categorical mental health resources provided by the state mental health authority. Those state funds have made it possible for St. Clare's to finance NAVIGATE and participate in the RAISE study.
The catchment area for St. Clare's is suburban and not very densely populated. Recruitment was limited, and only four individuals of the 24 screened are participating in the study. Only ten people consented, and of them, three were found ineligible for the study, and three withdrew consent, deciding not to participate. The participants are considered uninsured for the purpose of the study, as St. Clare's pays for all of their services from public mental health services resources. The site did not consider it worth the effort to bill for any insured services for this small number of participants, when they were able to use public resources to cover all of the NAVIGATE services.
The NAVIGATE program, and the community program in which it is embedded, is surrounded by a service system operated by St. Clare's, delivering a wide range of non-NAVIGATE services. The non-NAVIGATE,other behavioral health programs, include hospital and partial hospital services, outpatient services, and supported housing services. These services are financed entirely with state funds, while any other behavioral health services are financed through a $650,000 grant from the local Morris County Mental Health Administration.
St. Clare's provides all of the services listed in the NAVIGATE service matrix in one form or another, as needed, to NAVIGATE participants, funded by state mental health authority resources. The larger program of enhanced outpatient and support services is also funded in this manner with an $8.5 million grant from the State of New Jersey and serves 100-120 clients. Supported education and supported employment (SEE) services are included in this package of services, which includes some support from the state Division of Vocational Rehabilitation services.
Unlike any of the other sites, New Jersey discussed some training activities that they had initiated in response to questions concerning training in evidence-based practices, such as those included in the NAVIGATE intervention. The only training resources mentioned by the other sites were those provided by the central RAISE project itself. The state behavioral health agency also provides financial support for training practitioners and programs in evidence-based practices, including ACT and SEE. In addition, the state funds training in Illness Management and Recovery, which has some similarity to IRT. Prior to site involvement in RAISE, training was provided both by the University of Medicine and Dentistry of New Jersey and by out-of-state trainers from Dartmouth and Boston University. With respect to SEE, staff members have been trained in both Individual Placement and Support and Choose-Get-Keep approaches. During RAISE, of course, the training in the various NAVIGATE service elements has been provided by the RAISE study team.
The NAVIGATE team is currently comprised of four FTE staff members. Their salaries are covered by the state behavioral health agency grant, and they serve many more clients in addition to the four NAVIGATE participants. The NIMH grant supplement for SEE covers the cost of SEE services not covered by the state grant.
|TABLE 3.5. St. Clare's Behavioral Health, Denville, NJ: RAISE NAVIGATE Early Treatment Components and Funding Sources|
(e.g., VA, Tricare)
|Outreach and engagement||X||X|
|Alcohol and substance use treatment||X||X|
|Other outpatient visits||X||X||X|
|Inpatient care as needed||X||X|
|Planning (e.g., treatment and/or recovery plans)||X|
|Job coaching and other vocational supports||X|
|Individual resilience training|
|Benefits counseling (e.g., WIPA)||X||X|
|Treatment and primary care coordination||X||X|
|Other (e.g., occupational or psychosocial therapy, groups, etc.)||X||X|