Intensive and Sustained Engagement Teams

The Intensive and Sustained Engagement Teams (INSET) program is administered by the New York State Office of Mental Health (OMH) and provides voluntary, peer-led, community-based engagement and support for adults with complex or serious mental health needs. INSET was created in response to the challenges faced by individuals who are underserved, unserved, or disengaged from traditional mental health systems, including those at risk of involuntary treatment such as Assisted Outpatient Treatment (AOT), repeated hospitalizations, or criminal justice involvement. The program is overseen by OMH’s Office of Advocacy and Peer Support Services, with teams operating in designated regions across New York State. These teams provide intensive engagement, outreach, and flexible 24/7 support, with a strong emphasis on trauma-informed, culturally responsive, and peer-driven care. The primary goal of INSET is to support participants in identifying and pursuing their personal life goals while fostering trust, hope, and social connection. The program focuses on reducing avoidable hospitalizations, lengths of stay, and criminal justice interactions, while lowering health care costs associated with unmanaged conditions. Teams build and strengthen social networks, connecting participants with chosen supports, services, and community resources. INSET services are delivered through a holistic, strengths-based approach, centered on each participant’s voice, choice, and self-determination. Peer specialists play a critical role by helping individuals navigate systems, co-facilitating social network meetings, and providing consistent support rooted in shared lived experiences. Each INSET team consists of a multidisciplinary staff that includes a Peer Team Leader, four full-time Peer Support Specialists, a Family Liaison, a licensed clinician, a nurse practitioner, and administrative staff. Teams are required to provide 24/7 phone support and flexible in-person engagement, meeting participants at times and locations convenient to them. Teams must also be governed by organizations where at least 51 percent of staff and leadership are individuals with lived experience. Services are non-billable, meaning that eligibility for Medicaid or insurance is not a prerequisite for participation, and engagement is not restricted by rigid timelines. Eligibility is limited to adults aged 18 or older who are identified as high risk or with complex mental health needs. This includes individuals with histories of repeated hospitalizations, emergency department use, crisis interventions, or court-ordered AOT involvement. Participants must also express willingness to engage voluntarily with the program. INSET is not available statewide but is regionally implemented, with designated teams serving specific counties: Suffolk County, Kings County, Westchester, Rockland, Putnam, Orange, Sullivan, and Monroe. Applicants interested in operating an INSET team must comply with OMH standards and work collaboratively with the OMH INSET Program Team. Teams are expected to submit monthly, quarterly, and annual reports covering baseline assessments, outreach logs, participant characteristics, success stories, and evaluations. Reports are due monthly on the 15th, quarterly by the 15th of the month following the quarter, and annually within 15 days of the contract start date. Data must be exported from electronic health records and submitted to OMH for analysis and quality assurance. Spending rules are determined in collaboration with OMH, with guidance provided by a sample budget that includes salaries for staff, administrative support, peer specialist compensation, program supplies, training, transportation, and participant-centered wraparound supports. Costs are not borne by participants, and services are designed to prioritize recovery and independence. INSET funding does not require a local cost-share or match contribution. The program emphasizes collaboration with counties, AOT providers, hospitals, and other community partners to ensure effective engagement and system navigation. A unique feature of INSET is its ability to serve as part of Enhanced Voluntary Agreements (EVA), which divert individuals from restrictive treatment settings. By operating with a trauma-informed, culturally curious, and peer-led model, INSET advances OMH’s mission to promote recovery, justice, equity, diversity, and inclusion across New York State’s behavioral health system.