About 100,000 individuals experience symptoms of first episode psychosis each year. First-episode psychosis (FEP) refers to the period following the initial onset of symptoms such as delusions and hallucinations. These symptoms are associated with serious mental illnesses in adults, including schizophrenia, bipolar disorder, and other serious mental disorders. When symptoms of psychosis are untreated, as they often are for a year or longer, individuals may face adverse outcomes, such as substance use disorder, self-harm, homelessness, and unemployment.

Coordinated specialty care (CSC) is an evidence-based, team-based care model that provides early intervention and comprehensive support services for people experiencing FEP. Participation in CSC has been shown to reduce symptoms, improve quality of life, and enhance capacity to engage in personal, social, and vocational activities. CSC promotes stability, recovery, and lowers the likelihood of relapse and other risks. Despite these benefits, only 10-25 percent of people with FEP receive care in a CSC program.

How does coordinated specialty care work?

People with FEP may self-refer or be referred to a CSC program by a family member, primary care provider, school, community-based provider, or another organization within an established referral network. Once admission criteria are met, the individual and their family complete an intake assessment to understand current symptoms, functioning, needs, and treatment goals. Family engagement plays a key role in sustaining the individual’s participation in services. This process is guided by a team of behavioral health professionals, such as social workers, psychiatrists, case managers, and peer support specialists.

CSC services include five evidenced-based components organized into a personalized care plan: psychotherapy; medication management; family education; case management; and support with education and/or employment. Services can be delivered in the home, community, or an outpatient setting. The intensity of services varies based on the individual’s health and functional status, but most begin with weekly sessions, with frequency adjusted during periods of stability or relapse. CSC is time-limited, with most individuals participating for two to five years while developing a transition plan to an appropriate level of care following discharge.

What is the policy and funding landscape surrounding coordinated specialty care?

National attention for CSC grew following the Recovery After an Initial Schizophrenia Episode (RAISE) initiative, which was launched by the National Institute of Mental Health (NIMH) in 2008 to evaluate early intervention approaches for FEP. Findings showed that programs implementing the core components of CSC improved treatment duration, quality of life, and engagement in school and work compared with traditional treatment from providers without CSC training.

The Consolidated Appropriations Act of 2014 required states to set aside five percent of their Substance Abuse and Mental Health Services Administration (SAMHSA) Mental Health Block Grants (MHBG) to support evidence-based programs for FEP. This requirement led to rapid growth in the number of CSC programs, prompting CMS to issue a 2015 informational bulletin outlining how CSC programs could be designed and financed through federal funding, including Medicaid. In 2016, SAMHSA increased the MHBG set-aside amount for evidence-based FEP treatment to 10 percent. In 2019, NIMH established the  Early Psychosis Intervention Network to support programs nationwide and advance research and data collection on the model’s effectiveness.

As of 2023, more than 430 CSC programs were operating across the country. Most states rely on MHBG allocations, which vary greatly by state, to support both the direct service and administrative costs, but may also blend and braid funds from Medicaid and state and local sources. States can authorize Medicaid coverage for CSC through Section 1905(a) state plan and Section 1915(c) and 1915(i) home- and community-based services authorities. In 2023, CMS introduced two billing codes to cover the full scope of CSC services, simplify billing, and reduce administrative burden for Medicaid and private insurers that previously lacked reimbursement mechanisms for CSC services.

What is the evidence on coordinated specialty care?

A substantial body of evidence published on CSC programs, including randomized controlled trials, demonstrates that CSC reduces symptoms of psychosis and improves functional and social outcomes for individuals experiencing FEP. Subsequent studies reinforce these findings while examining fidelity, engagement, and implementation at scale.

• Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes from the NIMH RAISE Early Treatment Program – In a study of 404 individuals in coordinated specialty care clinics, the NAVIGATE CSC model was associated with improved quality of life, reduced symptom severity, and greater educational and vocational engagement over two years compared with traditional provider-managed care.
• Fidelity to Common Elements of Coordinated Specialty Care: Outcomes of Clients with First-Episode Psychosis – Clinical and functional outcomes improved among CSC program participants in 22 states. The programs studied adhered to core CSC components, including case management, psychotherapy, and designed care team leads, with greater alignment associated with improved participant symptoms and functioning.
• Impact of Family Engagement on Client Participation in Coordinated Specialty Care for First Episodes of Psychosis – Family engagement in any CSC services was associated with increased overall participant visit attendance in the first six months of program participation, as well as increased participation in medication management, resiliency, and supported employment and education visits.
• Pennsylvania Coordinated Specialty Care Programs for First-Episode Psychosis: 6- and 12-Month Outcomes – A review of 230 participants in CSC programs in Pennsylvania showed decreases in reported psychosis symptoms and psychiatric hospitalizations, and improvements in quality of life and recovery following six and 12 months after service initiation.
• Results of a Coordinated Specialty Care Program for Early Psychosis and Predictors of Outcomes – Participants in New York’s statewide CSC program, OnTrackNY, experienced fewer hospitalizations and improvements in self-reported functioning, as well as better connections to education and employment opportunities within 12 months of starting services.

What does coordinated specialty care look like in practice for people with FEP?

The following resources offer states insights into the implementation and financing of CSC for individuals experiencing FEP.

• Coordinated Specialty Care for First Episode Psychosis Manual II: Implementation – A NIMH resource, developed from the RAISE Initiative, guiding mental health clinic providers and staff in building and delivering CSC services. A companion manual is available to support program outreach and recruitment activities.
• Coordinated Specialty Care for First Episode Psychosis: Costs and Financing Strategies – A SAMHSA resource describing core funding sources for CSC services, including Medicaid, Mental Health Block Grants, and state and local funds, as well as case studies illustrating state adoption strategies.
• Scaling Coordinated Specialty Care for First-Episode Psychosis: Insights from a National Impact Model – A framework from the National Alliance on Mental Illness outlines projected program costs and savings associated with CSC participation, as well as estimated impacts on employment, housing, and justice system involvement, among other outcomes.
• State Medicaid & CHIP Toolkit for Children’s Behavioral Health Services and the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Requirements – A CMS toolkit provides an overview of CSC and recommends strategies, along with a state example, for financing these services through Medicaid.
• Use of Medicaid to Finance Coordinated Specialty Care Services for First Episode Psychosis – A report from the National Association of State Mental Health Program Directors Research Institute outlines strategies states can use to sustainably finance CSC through Medicaid, drawing on insights from interviews with state leaders.