Collaborative Care Management
Collaborative Care Management is comprised of two separate programs; Behavioral Health Community Partners (BH CP) and Community Support Program (CSP).
Behavioral Health Community Partners (BH CP) Riverside Team
Riverside Community Care is a provider within Riverside Community Partners BH CP (Behavioral Health Community Partner). This is a no-cost, voluntary program for nearly 700 MassHealth members who have been referred by their providers or current case management agencies.
Each enrollee in the Riverside Community Care BH CP is assigned a Care Coordination Team, which consists of a Clinical Care Manager/Team Leader, Nurse Care Manager, Care Coordinator, and a Medical Director. Many team members are multi-lingual, and some services can be done in the enrollee’s home. Care Coordinators may be peers who have had similar experiences as the enrollee (for example, a mental health diagnosis or issues with substance use).
Services provided include:
- Comprehensive assessment and person-centered treatment planning
- Care coordination and care management
- Care transitions
- Medication assistance
- Health and wellness coaching and connection to the community
- Connections to services including housing, transportation, benefits, and community supports
Person-centered planning and shared decision-making are at the forefront of the Riverside Community Care BH CP team. The goal is for enrollees to improve their overall health more quickly and fully, prevent avoidable future health problems, decrease hospitalizations, and improve the quality of their lives.
Community Support Program
Our Community Support Program (CSP) is typically short-term and supports individuals being discharged from a psychiatric hospitalization or detox, or who are at risk of repeated psychiatric hospitalizations. Staff can provide day-to-day check-ins in the community, help with daily living skills, transportation, and coordination with other providers including medical care.
Our Community Support Programs are for those with MassHealth Managed Care Plans. To submit a referral, please complete this form: CSP Referral Form
We are pleased to share comments from the people we serve:
"We were vulnerable and in pain, and here’s someone who shows up at our door, eager and able to help." - Sonia