Statewide dissemination of the training in community living program

Abstract

Wisconsin, Delaware, and Rhode Island have found the TCL approach to providing community support services to be effective in retaining the more severely ill of clients in ongoing community care and, consequently, in reducing their utilization of psychiatric hospital services. Tying standards regulating the staffing (credentials and intensity); productivity (direct client hours); organization (team structure and process); and operation (assertive outreach, treatment, rehabilitation, and support) to financing has worked well in disseminating the TCL model in these three states. Each state has experienced greater stability in their overall mental health systems as the number of certified programs and clients served have increased. Despite its demonstrable benefit to persons with severe mental illness, TCL program growth on a national scale has been slow. The self-interest of established community mental health systems and the substantial per client cost of TCL programs represent real challenges to interested state mental health agencies. However, the availability and flexibility of Medicaid financing for TCL services and the potential of TCL to reduce problems of homelessness and state hospital overcrowding are compelling reasons for state mental health agencies to consider adopting the approach.