The single biggest practical change in US psychosis care over the last decade has been the spread of Coordinated Specialty Care (CSC) — a team-based, integrated model for treating people in the first two to three years of a psychotic illness. CSC programmes now exist in every US state, supported by federal block-grant funding under SAMHSA. This article explains what CSC is, what it includes, and how to find it.
Coordinated Specialty Care is a multidisciplinary, team-based programme for young people in the first 2–3 years of a psychotic illness, combining medication, therapy, family work, and education or employment support.
Where the model came from
CSC was modelled on early intervention services first developed in Australia (the EPPIC clinic, founded by Patrick McGorry) and the UK (where EIP teams have been part of NHS standard care since 2001). In the US, the federally funded RAISE trial tested two CSC programmes — NAVIGATE (a clinic-based model led by John Kane and Delbert Robinson) and OnTrackNY (a New York State programme led by Lisa Dixon) — and found significantly better outcomes than usual community care.
Following RAISE, the federal government required states to use a portion of their SAMHSA Mental Health Block Grant for early intervention services. Today, CSC programmes operate under names including OnTrackNY, EASA (Oregon), Headway (Maryland), STEP (Connecticut), EDIPPP (multiple states), and dozens of others.
The core CSC team
Most CSC programmes share the same staffing structure:
- Team leader — coordinates care across disciplines
- Psychiatrist or psychiatric prescriber — manages medication with a focus on lowest effective dose
- Individual therapist — typically delivers CBT for psychosis or related psychotherapy
- Family clinician — provides family education and support
- Supported employment / education specialist — helps the young person stay in or return to school or work
- Peer specialist (in many programmes) — someone with lived experience of psychosis
- Case manager — handles practical needs like benefits and housing
Team caseloads are kept relatively small (typically 25–35 clients per team) to allow intensive contact in the first months.
What is delivered
The CSC service package usually includes:
- Frequent contact in the first six months — sometimes weekly or more
- Low-dose antipsychotic medication, with shared decision-making
- Cognitive Behavioural Therapy for psychosis (see our CBTp guide)
- Family psychoeducation and support
- Supported employment / supported education
- Crisis planning and 24/7 contact with the team
- Connection to physical health care (cardiovascular and metabolic monitoring)
- Substance use treatment when needed
Who CSC is for
Most programmes accept young people (typically ages 15–30, sometimes wider) who:
- Have experienced their first episode of psychosis within the last 1–3 years
- Have a primary psychotic disorder (schizophrenia, schizoaffective, schizophreniform, or first-episode of bipolar with psychotic features in some programmes)
- Are willing to engage with at least some elements of the team
Most programmes accept clients regardless of insurance, with sliding-scale fees or block-grant coverage. CSC is intended to be a 2–3 year programme; after that, clients are typically transitioned to community care.
What the evidence says
The original RAISE-ETP trial (Kane et al., American Journal of Psychiatry, 2016) showed that participants in the NAVIGATE CSC programme had significantly greater improvements in quality of life, symptoms, school and work participation, and treatment engagement than usual care over two years. Effects were strongest in those with shorter duration of untreated psychosis.
OnTrackNY's published data (Dixon et al.) and EASA's outcomes (Oregon) have shown similar patterns: lower hospitalisation rates, higher rates of school or work participation, and high client satisfaction.
How CSC differs from "usual care"
What makes CSC distinctive is not any single ingredient but the coordination. In a typical fragmented care system, a young person sees a psychiatrist for 15 minutes once a month, sees a therapist if they happen to find one, has no one helping with school or work, and is contacted by their care team only when something goes wrong. CSC inverts this: a coordinated team is in regular, proactive contact, and the elements of care reinforce each other.
How to find a CSC programme
SAMHSA maintains a directory of first-episode psychosis programmes by state on the NIMH RAISE site. Other useful steps:
- Call your state's mental health authority and ask for "first-episode psychosis" services
- Search "[your state] coordinated specialty care" or "first-episode psychosis"
- Ask any psychiatric inpatient discharge team — they typically know local programmes
- Contact NAMI's HelpLine (nami.org/help)
What to expect in the first weeks
A CSC intake usually involves an extended assessment over 1–3 visits, meeting with multiple team members, a discussion of medication options including low-dose antipsychotic strategies, and the early formation of a treatment plan that includes school, work, and family. The pace is intense at the start and gradually steps down as stabilisation occurs.
Limitations of the model
CSC is not perfect. Programmes vary in quality. Geographic coverage is uneven, especially in rural areas. The 2–3 year duration means clients face a transition to less intensive care just as they may be hitting their stride — and that handoff is one of the hardest parts of the model. Engagement remains a challenge for some young people, especially those with significant cognitive symptoms or anosognosia.
Where CSC is heading
Several developments are reshaping the field: extending CSC duration beyond 3 years, integrating digital tools (apps like Frida and others) for between-visit monitoring, embedding peer specialists more centrally, expanding services to youth at clinical high risk, and reaching populations historically excluded from early intervention research.
The bottom line
For a young person in their first episode of psychosis, finding a CSC programme is one of the most consequential things a family can do. It does not promise a cure — but it dramatically increases the chance of a recovery trajectory that includes school, work, relationships, and a meaningful life.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.