Ocean State Outreach Program
A Community Outreach program, based on a Health Home Service Model (IHH) and Assertive Community Treatment (ACT), offering specialized clinical care and comprehensive care coordination for adult individuals diagnosed with severe and persistent mental illness in Rhode Island. Ocean State Outreach is an open-referral program that utilizes the DLA-20 to determine program eligibility. As part of a network of programs Ocean State Outreach supports individuals through these service categories: Comprehensive Care Management, Care Coordination, Health Promotion, Comprehensive Transitional Care, Individual and Family Support Services, and Referral to Community and Social Support Services. Programming centers on recovery and resiliency with an emphasis on rehabilitation and person- centered care to manage co-occurring behavior health needs, improve activities of daily living, and increase independence in order to transfer to a lower level of care. OSO workforce members work with individuals and their stakeholders through a combination of community-based and office-based services indicated by their comprehensive assessment and person-centered plan.
Hours of Operation: Mon-Friday., 8:00a.m. to 5:00p.m. Weekend hours available. 24 hour on call capacity.
Admission: Referred by Community Mental Health Centers, BHDDH, area hospitals, and private
Practitioners in accordance with Fellowship admission guidelines.
An initial assessment, based on input from individual, family, and other caregivers is incorporated into the planning process. A complete discharge plan is also an integral component of this plan.
Staff coordinates financial, medical, and psychiatric services as well as assist individuals in achieving their desired goals, and locating and maintaining affordable housing.
Access to furthering education or employment may be incorporated into treatment plans and/or pursued through community based programs.
Regular in-house and community activities are jointly planned.
Available through Fellowship staff intervention and emergency services.
As needed, transportation provided via program vehicle and public transportation.
Team Leader, Master’s Level Clinician, Registered Nurse, Psychiatrist, Substance Abuse Specialist, Vocational Specialist, Peer Specialist, Hospital liaison and CPST Specialist.
Contracted and Funded through the Rhode Island Department of Behavioral Health, Developmental Disabilities, and Hospitals (BHDDH); additional program fees are based on individual's income. Contact Director for details.