Table 2.
Phase 1: Engagement and needs assessment (Months: 1–3) | Phase 2: Ongoing intervention and monitoring (Months: 3–18) | Phase 3: Transition (Months: 18–24) |
---|---|---|
Activities: • Introduction to all team members • Description of OTCH program • Intake assessment • Needs assessment (e.g., housing, income, etc.) • Risk and trauma assessment • Building rapport and getting to know the participant and their support network • Identification of individual goals (e.g., employment, education, relationships) • Introduction of shared decision making • Deciding on level and type of family involvement • Development of a treatment plan |
Activities: • Delivery of core psychoeducation sessions • Delivery of psychosocial interventions to help achieve goals and build resiliency (e.g., social skills training, CBTp, substance use treatment, illness self-management, coping skills, and behavioral activation) • Suicide prevention • Review and revise treatment plan • Actively pursue work and school goals • Delivery of psychoeducation and support to family • Relapse prevention • Explore transition readiness |
Activities: • Determine gains made and goals attained • Decrease frequency of services delivered • Develop a transition plan • Identify and connect to mental health services in the community • Identify and connect to community-based supports • Engage family in transition plan and identify their role • If possible, test whether these new services align with participant’s preferences |