Recovery-Oriented Community Inclusion (ROCI): A Holistic Approach to Healing and Empowerment

At CrossBridge Clinical Associates, we use the Recovery-Oriented Community Inclusion (ROCI) model to support individuals living with serious mental illness—and their families—on the journey to healing, independence, and a meaningful life.

ROCI is more than a treatment approach. It’s a philosophy of care rooted in the belief that mental health recovery is not just about symptom management—it’s about restoring hope, building skills, and helping people thrive in their own communities.

What is the ROCI Model?

The Recovery-Oriented Community Inclusion model supports individuals in reclaiming valued roles in society—whether through work, school, volunteerism, creative expression, or reconnecting with family and friends. It promotes recovery by addressing every part of a person’s life:

• Emotional wellness

• Social connection

• Occupational engagement

• Freedom, independence, and self-determination

By increasing access to community-based resources, stable housing, and supportive social environments, ROCI helps clients move beyond just surviving—and begin to flourish in everyday life.

ROCI is aligned with the American Psychiatric Association’s (APA) treatment guidelines and the Substance Abuse and Mental Health Services Administration (SAMHSA) recovery principles. At CrossBridge, our recovery goals mirror SAMHSA’s four key domains:

• Health – Supporting physical and emotional well-being

• Home – Promoting safe, stable, and supportive living environments

• Purpose – Encouraging meaningful daily activities (work, school, hobbies)

• Community – Fostering strong relationships and social inclusion

We believe that recovery from serious mental illness—such as schizophrenia, bipolar disorder, severe depression, or co-occurring substance use disorders—is not only possible but deeply personal. Every individual deserves the opportunity to live a life filled with dignity, meaning, and connection.

Why Community Inclusion Matters

True inclusion means more than simply being physically present in a workplace or classroom—it means being welcomed, valued, and engaged in meaningful roles. According to research (Salzer, 2021), participation in purposeful activities like employment, education, recreation, and spiritual practices is essential for recovery from severe mental illness.

At CrossBridge, we help individuals and their families break through isolation, overcome stigma, and build lasting connections. We work collaboratively with clients to create a life that reflects their strengths, values, and goals.

Whether you or your loved one is just starting your recovery journey—or has been living with serious mental health challenges for years—CrossBridge is here to provide expert, compassionate care every step of the way.

Inclusion means more than just the mere presence of people in recovery in certain settings, such as work and community. It means that they are engaged in valued social roles and integrated into the community. Participation in meaningful activities such as education, occupation, recreation, and spiritual activities is an imperative part of recovering from serve mental illness (Salzer, 2021). There is a need for the establishment, support, and protection of significant roles for people who are at risk of being devalued. 

Understanding the Role of a Mental Health Case Manager

At its core, the role of a Mental Health Case Manager is to ensure that clients receive the necessary services and support they need. CCA utilizes an Assertive Community Treatment (ACT) model in addition to the Recovery-Oriented Community Inclusion Treatment Model.

This often involves coordinating care across multiple providers, such as psychiatrists, psychologists, medical doctors, half-way house managers, schools, and social workers. Case managers monitor and provide guidance to clients throughout the course of treatment.

CCA utilized the Interdisciplinary Integrated Care Team Model as outlined in the Primary Care Behavioral Health and Collaborative Care Model (Collaborative Family Healthcare Association, 2023) for case management and care planning with clients and their families.

The Benefits of Mental Health Case Management Services

Mental health case management services can play a crucial role in helping individuals with mental illness access the resources and support they need to manage their condition and improve their quality of life.

Our Services Include: 

• Clinical Records Review & Needs Assessment
• Treatment Placement & Planning Ongoing Care
  • Coordination and adjunct care with your loved ones' treatment center 
  • Discharge/aftercare planning, including locating housing, transportation, and crisis management
  • Sober transportation, if needed 
• Crisis Response Coordination 24/7 
  • Responses within 3 hours. 
  • Overnight 24/7 staffing, as needed 
  • On-call nursing, as needed 
• Care Advocacy and Expert Independent Guidance 
• Transitional & Supported Living Planning and Placement (i.e., sober living, setting up a client’s apartment)
• Job Placement and Academic Support 
• Ongoing Oversight & Evaluation of Care 
  • Weekly Team meeting with clients and loved ones
• Exposure-Based Therapies
• Sober Meetings (i.e., AA or SMART meeting support)
• Neuropsychological Testing
  • For Diagnostic Clarification
  • For College or Standardized Testing Accommodations

Personalized Mental Health Case Management: Guiding You Through Every Step of the Journey

Navigating the mental health care system can be overwhelming—especially when you or your loved one is facing serious mental health challenges. At CrossBridge Clinical Associates, our mental health case management services are designed to provide structure, clarity, and ongoing support during every phase of treatment and recovery.

Whether you're dealing with bipolar disorder, schizophrenia, co-occurring substance use, or another complex mental health condition, our dedicated case managers are here to coordinate care, advocate for your needs, and ensure your entire treatment team is working together toward one goal: your well-being.

Benefits of Mental Health Case Management

1. Coordinated, Comprehensive Care
Our case managers act as the central hub for all aspects of care—connecting individuals with psychiatrists, therapists, support groups, residential programs, and outpatient providers. We ensure a seamless, unified approach to mental health treatment so no detail is overlooked.

2. Improved Access to Resources
Struggling to find housing, employment, or financial assistance? Our case managers know how to navigate these systems. They help clients access essential mental health resources, from therapy and medication management to vocational support and housing stabilization.

3. Continuous Advocacy and Emotional Support
Mental health recovery isn’t linear. Our case managers provide ongoing support through every up and down, helping clients stay engaged in treatment, communicate with their care team, and find stability in times of crisis.

4. Better Outcomes and Fewer Crises
Clients who work with case managers are more likely to stay on their treatment plans, avoid hospitalization, and build long-term independence. Our case managers are often the first to notice subtle signs of relapse or mood shifts—giving the clinical team a chance to intervene before a crisis occurs.

5. Lower Overall Costs of Care
By reducing emergency room visits, inpatient stays, and treatment disruptions, mental health case management is a cost-effective way to maintain consistent, quality care. Prevention and early intervention save time, money, and emotional distress.

Support Through Every Level of Care

At CrossBridge, we understand that many clients move through multiple levels of care—from residential treatment to intensive outpatient programs and eventually to community-based support. Our team of male and female case managers ensures continuity across every transition, helping with:

• Step-down care coordination

• Medication and appointment management

• Family communication

• Insurance navigation and financial assistance

• Multi-provider scheduling and unified treatment planning

Whether you're just beginning treatment or need help stabilizing after a hospital stay, our case management services can bring order to the chaos—and guide you or your loved one toward a more stable, empowered future.

What Is Mental Health Case Management?

Mental health case management is a comprehensive, person-centered approach to supporting individuals living with serious mental illness, substance use disorders, or dual diagnoses. At CrossBridge Clinical Associates, our case managers serve as trusted guides—helping clients and their families navigate the complex behavioral healthcare system with clarity, compassion, and coordination.

Whether you're dealing with bipolar disorder, schizophrenia, psychosis, eating disorders, or addiction recovery, case management provides a structured and consistent support system to promote stability, recovery, and long-term well-being.

Why Is Case Management Important?

Our case managers act as the communication bridge between treatment providers, family members, legal representatives, and the client. They ensure that:

• Accurate medical and mental health records are shared across providers

• Care plans are unified and coordinated across various treatment teams

• Clients receive advocacy and emotional support, especially during crises

• The client’s individual needs and goals stay at the center of care

Think of a case manager as your anchor during stormy times—someone who brings calm, organization, and confidence when everything feels overwhelming.

Connecting Clients to Higher Levels of Care

When more intensive support is needed, case managers at CrossBridge help clients transition into appropriate levels of care, including:

• Detox and stabilization programs

• Residential Treatment Centers (RTC)

• Partial Hospitalization Programs (PHP)

• Intensive Outpatient Programs (IOP)

We coordinate with probation offices, Marchman Act attorneys, legal guardians, and other agencies to reduce stress and ensure rapid, effective communication. We understand that clients and families facing legal, clinical, or emotional turmoil need clarity and guidance—not confusion.

Long-Term, Personalized Support

Each case management plan is customized based on your needs. Engagement typically lasts 6 to 18 months, though we continue services as long as they are helpful. Our goal is to help each individual achieve the highest level of sustainable independence while feeling supported and empowered.

Led by Dr. Arthur Chen, PsyD, our team has deep clinical experience working with:

• Eating disorders

• Schizophrenia and psychotic disorders

• Substance abuse and dual diagnosis recovery

• Bipolar disorder and mood instability

• Social Skills / Career Development

Assertive Community Treatment (ACT)

We also offer services under the Assertive Community Treatment (ACT) model—an evidence-based approach to supporting individuals with severe mental illness (SMI) who require frequent, hands-on care. ACT teams include psychiatrists, nurses, case managers, and therapists who provide:

• 24/7 crisis support and smaller caseloads for individualized attention

• Medication management and symptom monitoring

• Integration of social, vocational, and housing support

• Reduced hospitalizations and emergency interventions

• Improved functioning and greater likelihood of independent living

Take the First Step

If you or your loved one is overwhelmed by the complexity of mental health care, you’re not alone. Let CrossBridge Clinical Associates be your partner in recovery. Our mental health case management services are here to bring structure, relief, and real progress—so you can focus on what truly matters: healing, growth, and connection.

SAMHSA’s 10 Guiding Principles of Recovery

Recovery emerges from hope: An important principle in recovery is the motivating message that a better future is possible. People must believe they can and will overcome internal and external challenges, barriers, and obstacles.

Recovery is person-driven: Creating personalized goals and encouraging self-determination and self-direction can help people design their unique path which is a foundation of recovery.

Recovery occurs via many pathways: An individual’s pathways to recovery are specific to the person and affected by culture, background, and trauma experiences. An individual’s needs, strengths, preferences, and goals are also taken into consideration. 

Recovery is holistic: Integrated and coordinated services are required to address all aspects of an individual’s life. These aspects are reflected in SAMHSA’s eight dimensions of wellness, which include emotional, spiritual, intellectual, physical, environmental, financial, occupational, and social parts of life.

Recovery is supported by peers and allies: There are programs and services run by and for persons with SMI. Peer support is considered an essential part of recovery-oriented care.

Recovery is supported through relationships and social networks: When others who surround an individual believe in the person’s ability to recover, those people are able to offer hope, support, and encouragement. Those same people can also suggest strategies and resources for change.

Recovery is culturally based and influenced: A person’s unique path to recovery is impacted by aspects of culture and cultural backgrounds that need to be acknowledged and supported, including values, traditions, and beliefs.

Recovery is supported by addressing trauma: It is important for trauma-informed care to be a part of services and support which fosters emotional and physical safety and trust. Trauma-informed care will also promote an individual’s choice, empowerment, and collaboration with the provider.

Recovery involves individual, family, and community strengths and responsibility: A foundation for recovery is found in the strengths and resources provided by individuals, families, and communities.

Recovery is based on respect: It is imperative that people affected by mental health and substance use disorders feel that their community, systems, and society are working to protect their rights and eliminate discrimination. It is important for individuals to feel acceptance and appreciation as they work toward recovery.