Community Crisis Response (2007-2008)
Focus Area: Plan for a Comprehensive Community Crisis Response System in Jackson County
Project Title: Community Crisis Response Center
The JRHA Community Crisis Project will improve crisis response services available in Jackson County and reduce the use of emergency departments as the primary site for crisis response. The current plan has three main goals:
- Establish a Community Crisis Center which will provide information and rapid access to a wide variety of crisis resources and support.
- Develop a full continuum of coordinated crisis prevention, early intervention, acute intervention, crisis treatment and post-crisis stabilization at multiple agencies and throughout the community.
- Establish a data and outcome monitoring system to determine the impact of the project.
Community partners will establish policies and procedures regarding governance of the system, the business and financial relationships among partners and the policies, procedures and protocols for clinical and service-oriented decision-making necessary for the project. A Project Manager will be hired to lead the implementation of the plan. The Project Manager will convene a group of designees from the partner agencies constituted as a Community Crisis Project Steering Committee. The Committee will meet on a regular basis to steer the project, monitor outcomes and evaluate the quality and efficiency of the crisis system.
Establish a Community Crisis Center
- A Community Crisis Center will be established at a central location in the community that allows for convenient access to medical clearance and coordination with law enforcement.
- The Center will provide a safe, secure location for crisis intervention and response.
- The Center will operate a 24/7 phone crisis response system. Walk-in access to the center will be available during maximum usage hours. Call staff will be available when walk-in services are closed.
- Qualified mental health and substance abuse professionals (at least masters-level clinicians) will be available to confer with persons who contact the center by phone or in person to assess, triage and refer to community resources, or to offer immediate crisis intervention as needed.
- The police will take people to the Center for evaluation when there is no obvious non-psychiatric medical risk. Assessment will be aimed toward immediate intervention on site and/or referral to an appropriate service. Access to varied respite resources throughout the community will be provided.
- The Crisis Center will be available to persons presenting a wide range of precipitating problems. A diversity of populations will be able to access assistance including, at a minimum, children and adolescents, substance users, persons with mental health problems, seniors and others experiencing dementia or other neurologically driven problems, and persons with developmental disabilities.
- Access to the center will be neutral with respect to insurance coverage. The center will welcome the entire community including persons with Medicaid, Medicare, private insurance or no sponsorship at all.
- The Crisis Center will have the ability to access behavioral health and primary care services and arrange next day appointments (urgent care).
- Additional mobile crisis response capacity and transportation will eventually be based in the Crisis Center. Mobile crisis services may include in-home and alternative intervention sites in the community. In the future it may also be possible to locate short term respite care on site, the pros and cons of which will be weighed.
Competencies required of Center staff who offer services will include: Risk Assessment; Ability to maintain a calm environment; Crisis De-Escalation; Assessment of the contribution of both mental health and alcohol and other drug problems in precipitating a crisis; Basic screening of both psychiatric and somatic medication issues; Knowledge of community resources; Ability to work with medical providers to coordinate care; Ability to use and provide consultation; and Knowledge of issues related to drug-seeking in emergency departments. Training in these areas will also be available to staff from participating agencies.
- Policies and protocols will be established for the Center to address: Safety and security; Consumer Rights; Informed Consent; The Role of Advance Directives; Confidentiality and the Sharing of Information; Level of Care Criteria; Continuity of Care; Securing Medical Clearance; Handling Medications and Documenting Medication Administration; Documentation of Consumer Contact and Services Delivered; and Responding to Grievances and Complaints.
Develop a Comprehensive and Coordinated Continuum of Services
- An effective crisis response continuum for all levels of a crisis episode includes prevention, early intervention, acute intervention, crisis treatment and re-integration. The success of the Community Crisis Center requires a full array of services on the crisis continuum to prevent escalation and to offer follow-up care and recovery-oriented services. Jackson County has many of the resources needed to respond to persons in crisis as well as excellent working relationships among agencies. However, uneven utilization of resources indicates a need for better coordination in planning and service delivery and some major gaps in services have been identified.
- Policies, protocols and procedures for crisis management across partner agencies will be developed to ensure more coordinated crisis response.
- Systems and procedures for communication and coordination of crisis services and resources throughout the community and across multiple agencies will be established.
- Coordinated transportation options will be developed so that resources can be effectively accessed.
- Respite resources in the community will be coordinated.
- More comprehensive responses to intoxication including ambulatory detoxification and residential detoxification in a structured, medical environment will be developed.
- Case-specific tailored services that can be organized on short notice will be designed for individual crisis situations. For example, lodging a person or family in a motel with the services of a well-prepared skills trainer can achieve good outcomes at reduced cost.
- Resources to improve access to adequate psychiatric medications and medical care will be sought and developed.
- Staff at all agencies will be trained in coordinated methods of crisis prevention, early intervention and ongoing stabilization and support services appropriate to their specific settings and responsibilities.
Establish a Data and Outcome Monitoring System
- To know if the Community Crisis Plan is successful, a consistent collection of basic data elements and the analysis of trends will be required. The following data will be collected as the basis for an effective information system.
- Basic demographics: age, gender, marital status, housing status, etc.
- Cost trends: What has the community been spending and how do we know what the community is saving?
- Agency satisfaction: For example, is there an increase or decrease in police officer time spent dealing with behavioral health problems? Does 24/7 system work as a dispatch system for behavioral health?
- Number and frequency of agency and individual phone contacts and walk-in requests for assistance.
- Rates of suicide attempts and completions.
- Rates of significant incidents indicating trends in staff and consumer safety.
- Timeliness of response and disposition.
- Number of people screened in EDs and their disposition.
- Number of referrals to A&D and length of time from initial request to intervention.
- Percent of people receiving crisis services who relapse and are admitted to a psychiatric hospital.
- Percent of people who have criminal justice and or mental health contact.
- Percent of people receiving crisis services who follow up with further services.
2. Once the data elements and variables are well understood, the plan will establish goals, or deliverables, for the crisis system. These will include reduced use of inpatient care, improved functional levels of those served, reduced frequency of repeat episodes, consumer and family satisfaction, redistribution of costs within the system and/or other changes sought from improved response.
3. Methods for data collection, analysis and reporting will be developed so that all community partners are aware of their roles in developing the crisis system, the effect of their efforts and the achievement of outcomes. Regular reports will be published to increase knowledge of needs, resources and services available throughout the community. Input from consumers and families will be solicited.