24/7 Access to Crisis Services

(757) 788-0011

757-315-3650

1-855-807-8278

Hampton-Newport News Community Services Board

Proudly Serving the Communities of Hampton and Newport News since 1971

ADULT CARE COORDINATION

 

Adult Mental Health Case Management

Manager, Case Management, 757-788-0335

 

The Hampton-Newport News Community Services Board Case Management services enable individuals with a Serious Mental Illness, or Serious Mental Illness and Co-occurring Substance Use Disorders, to achieve and maintain optimal functioning in the least restrictive, most normative community setting.  We achieve our mission by assessing our individuals’ needs and strengths, linking our individuals with community services and supports, monitoring our individuals’ response to treatment and the quality of care provided, facilitating adjustments to our individuals’ Individual Service Plans in response to changing needs, and ensuring effective crisis stabilization services if needed.  All Case Management services are focused on individual needs and are carefully crafted to be sensitive to cultural values and preferences. Case Management serves individuals 18 years and older who have a Serious Mental Illness, or Serious Mental Illness and Co-occurring Substance Use Disorders. Individuals typically served by Case Management have complex behavioral health needs requiring multiple services and supports.  Case Management services are provided without regard for sex, race, color, creed, religion, political affiliation, or national origin.

 

 

Homeless Services

Homeless Services Supervisor, 757-240-5288

 

PATH (Projects for Assistance in Transition from Homelessness)

PATH provides services to individuals who are homeless or at imminent risk of becoming homeless and who suffer from serious mental illness (SMI) or SMI and co-occurring substance use disorders (SUDs). PATH provides services and supports to the target population to outreach, identify and engage such persons into services with the end goal of transitioning from homelessness or risk of homelessness into behavioral health, social services and housing in order to promote recovery and self-determination. Outreach is the process of identifying and engaging individuals into treatment who do not access traditional services. Often these individuals heave experienced chronic homelessness and untreated mental illness/substance abuse for many years and are not engaged in services. Outreach results in increased access to and utilization of community services by individuals who are homeless and have SMI and or co-occurring SMI/SUDs.

 

Safe Harbors

Safe Harbors Program is to reduce homelessness by providing housing first, maximize consumers’ opportunities and independence by providing quality supports, training and individualized services to consumers who are homeless with mental health and possible co–occurring substance abuse. Safe Harbors Program will support consumers in their personal choices and encourage them to engage in services to maximize their independence. Safe Harbors Program performs assessment and support services, independent living skills training, medication monitoring, money management training, along with leisure and social skills training. Services are individualized based on each consumer’s goals, needs, and desires.  Must be 18 years of age or older and a resident of Hampton or Newport News. Must be a single adult who has been homeless for the past year or numerous episodes of homelessness over the years and not currently engaged in any treatment or community services. Documentation of homelessness is required.

 

Project Onward

Project Onward provides housing first, maximize consumers’ opportunities and independence by providing quality supports, training and individualized services to consumers who are homeless, have reached maximum benefit from Safe Harbors housing, with mental health and possible co–occurring substance abuse. Project Onward supports consumers in their personal choices and encourage them to engage in services to maximize their independence. Project Onward performs assessment and support services, independent living skills training, medication monitoring, money management training, along with leisure and social skills training. Services are individualized based on each consumer’s goals, needs, and desires.  Must be 18 years of age or older and a resident of Hampton or Newport News. Must be a single adult who has reached maximum benefit from Safe Harbors housing or who has been homeless for the past year or numerous episodes of homelessness over the years and not currently engaged in any treatment or community services.

 

Newport News (NN) PORT Outreach

NN PORT Outreach provides services to individuals who are homeless or at imminent risk of becoming homeless and who suffer from serious mental illness (SMI) or SMI and co-ccurring substance use disorders (SUDs). NN PORT Outreach provides services and supports to the target population to outreach, identify and engage such persons into services with the end goal of transitioning from homelessness or risk of homelessness into behavioral health, social services and housing in order to promote recovery and self-determination. Outreach is the process of identifying and engaging individuals into treatment who do not access traditional services. Often these individuals heave experienced chronic homelessness and untreated mental illness/substance abuse for many years and are not engaged in services. Outreach results in increased access to and utilization of community services by individuals who are homeless and have SMI and or co-occurring SMI/SUDs.

 

 

Enhanced Care Coordination (ECC) Case Management

Case Management Supervisor, 757-788-0336

 

•ECC is a specialized service that would utilize an integrated coordination approach to primary and behavioral health care.

•ECC places EQUAL emphasis on the individual’s health, medical issues and needs; not just on the individual’s behavioral health or developmental needs.

•ECC is an intensive service, averaging 4-6 hours a month per individual.

•This includes an expanded range of allowable supportive service interventions.

•More comprehensive and integrated screening of person’s needs

•Provides more “hands on” assistance with coordinating, transporting and attending appointments

•Health education and promotion

•Linkage to community resources that support whole health and wellness

•More assertive/active collaboration with PCP and specialty providers

•Provides assistance to individuals with severe mental disabilities to obtain the services they need to live productively in the community.

 

ELIGIBILITY CRITERIA FOR ECC

Anthem Healthkeepers, Virginia Premier, & Humana Beacon Dual  Eligibility

Must have SMI and/or ID (as defined by DBHDS/DMAS criteria) AND primary health/medical conditions (one or more serious and chronic medical conditions) such as:

•Hypertension

•Asthma

•Diabetes

•High cholesterol

•Heart disease

•Arthritis

•COPD

•Obesity

•Cancer

 

 

Mental Health Regional Supervised Housing Program (Transcend Place)

Residential Services Manager, 757-596-4926

 

The MH Regional Supervised Housing Program is to reduce the length of stay in local and state psychiatric facilities by providing a living environment that will maximize the individual’s opportunities and independence by providing quality supports, training and individualized services to individuals with mental health and possible co–occurring substance abuse. The MH Regional Supervised Housing Program will support individuals in their personal choices and will work closely with them to engage them in services to maximize their independence and reduce hospital admissions.

The MH Regional Housing Program is voluntary with a length of stay dependent upon the individual’s goals, needs, and desires. Staff will work closely with the individual to engage them in treatment such as psychiatric, substance abuse, medical and any other treatment the individual may need. Staff will assist with applications for benefits both financial and medical, assist with obtaining a day activity such as psychosocial day, partial hospitalization, vocational, volunteer or employment, and other community agencies that will meet their needs.

 

ADMISSION CRITERIA:

•Must be 18 years of age or older

•Must be a resident of Hampton Roads / Tidewater area.

•The individual has a primary DSM IV-TR psychiatric diagnosis that determines the need for this level of care and it is the    focus of intervention.

Individuals will be prioritized based on the following:

First priority: individuals who are from HPRV and on the discharge ready list at ESH or ready for discharge whose needs could be met in a community setting

Second priority: individuals who are from HPRV and are currently in local psychiatric hospitals pending transfer to ESH.

Third priority: individuals in a Community Expansion program will be considered by the Hampton - Newport News CSB clinical discharge planning team on a case by case basis.

 

 

Road 2 Home / Cooperative Agreement to Benefit Homeless Individuals (CABHI)

Homeless Services Supervisor,  757-240-5276

 

This project is designed to help individuals, including veterans, who are experiencing homelessness and the devastating effects of untreated behavioral health disorders to regain their health and their home. This project is a partnership among the Governor’s cabinet secretaries, state agencies, local public behavioral health and homeless service providers, and the individuals and their peers all working together to provide person-centered and responsive services leading to decent, affordable housing with tailored and flexible supports. The project will deploy interdisciplinary teams of trained and experienced staff to seek out and engage individuals into behavioral health and primary care, and find and retain permanent housing. Staff will conduct assertive outreach and engagement, provide direct and purchased services, and transition enrolled participants into housing using trauma informed and evidenced – based practices of Critical Time Intervention and Permanent Supportive Housing. The project will also employ the strategies and approaches of the SSI/SSDI Outreach, Access and Recovery (SOAR) model of benefits acquisition, the Supported Employment model of Individual Placement and Supports, and PEER Recovery Support provided by and for people with lived experience of either addiction or behavioral health challenges.

 

The identified population of individuals to be served are those who experience chronic homelessness and have a substance use disorder (SUD), serious Mental illness (SMI), or co-occurring mental and substance use disorders (COD); and veterans who experience homelessness and have SUD, SMI, or COD.

 

 

Reinvestment Case Management Services

Reinvestment Discharge Planning and Case Management: This program is a function of the Regional Reinvestment Project, which was developed and implemented to reduce the amount of inpatient beds at state psychiatric facilities and to develop community supports. This program funds indigent local psychiatric hospitalizations and has aided in the development of three local Crisis Stabilization Units. The case management staff are assigned individuals that are admitted to a local psychiatric hospital or one of the Crisis Stabilization Units. The staff monitor inpatient treatment, develop discharge plans and provide linkage to community resources upon discharge. The cases are managed short-term, usually less than ninety days, and are linked to the larger CSB service delivery system.

 

 

Mobile Crisis Stabilization Services

Mobile Crisis Response Team: The team provides crisis support services to individuals identified who could benefit from more intensive outpatient services in the community. The team provides on-going monitoring of safety, coping skills education, recovery tools, and linkages to CSB and community resources.  One of the team’s goal is to assist individuals with maintaining stabilization in the community upon discharge from a psychiatric facility. This team assists individuals enrolled in the CSB system and is an excellent support to the Reinvestment Case Management Team and Emergency Services. The team utilizes case management and peer support staff.  The peer support specialist is a vital component to the team; sharing real life recovery experiences which benefit the served individuals on their recovery journey.

 

 

State Hospital Discharge Planning

The State Hospital Discharge Planning team provides case management and discharge planning services to individuals admitted to State psychiatric facilities. The team, comprised of Discharge Planners and Case Managers, advocates for individual needs, monitors individuals’ progress with treatment goals, and coordinates optimal transition to the community. The staff serves individuals with serious mental illnesses, persons with intellectual developmental disabilities, and individuals with substance abuse concerns. Staff also work with individuals on Not Guilty by Reason of Insanity status (NGRI) and closely monitor their progress throughout admission to the hospital. Staff, including the NGRI Coordinator, collaborate with the legal system and mental health providers to develop appropriate discharge plans to assist with individuals’ recovery and reintegration to the community. The HNNCSB State Discharge Planning Team is routinely viewed as one of the best in the State. Staff are compassionate towards individual needs and knowledgeable of community resources.

 

 

300 Medical Drive, Hampton, VA 23666 - (757) 788-0300