Mobile Crisis Response Team - Nevada Public Health Foundation

Report
MOBILE CRISIS RESPONSE
TEAMS
PRESENTED BY:
KELLY WOOLDRIDGE, LCSW; DCFS
CHAR FROST, NV PEP
IDENTIFIED NEED
• In Nevada, studies have suggested that 19.3% of
elementary school children have behavioral health
care needs and over 30% of adolescents selfreported significant levels of anxiety or depression
(CCCMHC, 2010).
IDENTIFIED NEED
• In 2009, almost one-quarter of Nevada’s public
middle school students seriously thought about
killing themselves, more than 30% had used alcohol
or illegal drugs, and over 13% had attempted
suicide (CCCMHC, 2010).
IDENTIFIED NEED
• Without easy access to crisis intervention and
stabilization services, families have been forced to
utilize local emergency rooms in order to obtain
behavioral health care for their children. The
National Center for Children in Poverty has
identified youth emergency room visits for
behavioral health care as a national problem
(Cooper, 2007).
IDENTIFIED NEED
• Child behavioral health-related visits to hospital
emergency rooms have increased steadily in
Nevada over the last five years. There is also an
increasing trend of children requiring a costly inpatient admission to a hospital due to a behavioral
health crisis.
• Data collected by the Center for Health Information
Analysis (CHIA) through the University of Nevada Las
Vegas demonstrates both trends.
IDENTIFIED NEED
Youth Admitted to an In-Patient Hospital
for Behavioral Health
Clark County
7000
6000
5000
4000
3000
2000
1000
0
Total
Center for Health Information Analysis (CHIA)
2009
2010
2011
2012
4974
5587
5869
6250
IDENTIFIED NEED
Center for Health Information Analysis (CHIA)
IDENTIFIED NEED
Data for the first two quarters of 2013 continues to
show an increase in the number of youth admitted to
emergency rooms for a mental health crisis.
• Clark County ED Admissions: 3319
• Clark County In-patient Admissions: 3496
• Washoe County ED Admissions: 1521
• Washoe County In-patient Admissions: 1742
MOBILE CRISIS PROGRAM
2013 Legislative Session approved funding for a “mini
mobile crisis program” in Clark County.
• Clark County Children’s Mental Health Consortium,
Nevada PEP, and the Division of Child and Family
Services developed and implemented the Mobile
Crisis Response Team.
PLANNING AND DEVELOPMENT
PROCESS
Establish the Need
Collect and analyze
data from the Center for Health Care Analysis and
local Emergency Departments.
Partner with the Community
Develop
memorandum of understanding with the Clark County
School District and the University Medical Center in Clark
County. Utilize NV PEP contract to implement Family to
Family Support.
Looked for External Models
Reviewed Mobile
Crisis Programs in other states. Developed a contract with
Milwaukee Wraparound Mobile Crisis Urgent Treatment
Team (MUTT) to provide training and consultation.
PLANNING AND DEVELOPMENT
PROCESS LOGIC MODEL
Nevada Division of Child and Family Services
Mobile Crisis Intervention - January 2014 New Service Implementation
Inputs
Staffing:
12 staff to include CPM I,
Qualified Mental Health
Professionals, Psychiatric
Case WorkersTrained in Solution Focused
Brief Therapy, Motivational
Interviewing, Wraparound,
Trauma Informed Care, Crisis
Intervention and
Stabilization, and Domestic
Violence Response
Population: Any child or
adolescent in Southern
Nevada requiring support
and intervention for a
psychiatric emergency
Hours of Operation:
10:00 pm to 7:00 pm 5
days/week- some Saturdays
upon implementation
Transportation Method:
State Vehicles
Program Teams:
Mobile Crisis Response Team
Mobile Crisis Stabilization
Team
Partnerships:
MOUs with selected
community partners such as
Clark County School District
Clark County Children’s
Mental Health Consortium
and Clark County University
Medical Center
Evaluation: DCFS Program
and Evaluation Unit
Outputs
Activities
Consultation and
Information:
-Telephone consultation
available to families and
providers
-Telephone triage and
referral
-Outcome and Output Data
collected at time of call (call
log)
Crisis Assessment
Intervention and
Stabilization:
-Urgent face-to-face homebased or community-based
crisis assessment and
intervention
-Utilize assessment tool,
Intake “Crisis Assessment
Tool” (CAT)
Facilitation of Community
Supports and Care:
-Provide the family with
information and referral to
needed resources
-Link the family with Nevada
PEP
-Short term intensive child
and family therapy
-Immediate care
coordination services
including linkage with other
involved child service
agencies and school district
services
-Utilize assessment tool,
Discharge “Crisis
Assessment Tool” (CAT)
Participation
Mobile Crisis Response
Team
Short
-Immediate restoration of
safety
-Implementation of safety
plan
-Child and family connected
to local and natural supports
-Customer satisfaction (child
and family)
-Facilitate psychiatric
hospitalization when
necessary
Outcomes -- Impact
Medium
-Child and family are
stabilized
-Child and family are
connected to additional
referral service array and
Wraparound services
-Reduction in crisis
indicators (CAT)
Long
- Reduced Admissions to
the Emergency Department
for a behavioral health
crisis
-Reduced length of stay
and readmission to inpatient care
-Youth remain in their
homes and community
Mobile Crisis Stabilization
Team
Assumptions: Supplies/office equipment available and forms and initial procedures
will be established.
External Factors: Funding, Referral sources and marketing considerations.
MOBILE CRISIS RESPONSE TEAM
 1 Clinical Program Manager
 5 Mental Health Counselor II
 5 Psychiatric Caseworkers
 1 Administrative Assistant
 Nevada PEP Family To Family Support Specialist
MISSION STATEMENT
MCRT strives to help Clark County children and
adolescents live safely in their home and community.
VALUES
• Respond immediately to children and families
during times of crisis.
• Provide services that are family-driven, culturally
competent, community based and consistent with
Nevada System of Care principles.
• Assure safety and continuity of care through
individualized strategies implemented by a
wraparound-based, team approach.
GOALS
1. Maintain youth in their home and community
environment.
2. Promote and support safe behavior in children in
their home and community.
3. Reduce admissions to Emergency Departments
due to a behavioral health crisis.
4. Facilitate short term in-patient hospitalization when
needed.
5. Assist youth and families in accessing and linking to
on-going support and services.
WHO WE SERVE
• The Mobile Crisis Response Team provides crisis
intervention services for families of youth under the
age of 18 who are having a behavioral health crisis
and the behavior threatens the child’s removal
from the home, school, and/or community.
• Youth who are uninsured, under-insured or have
Medicaid Fee For Services are eligible for services
SERVICES PROVIDED
Telephone Triage:
Crises staff are available to provide support over the
phone to assist in resolving or preventing a crisis
situation. After an intervention screening, a referral will
either be made to a community resource or the MCRT
will respond.
SERVICES PROVIDED
Crisis Response
If it is determined that further care and support is
needed, a response team will be dispatched to the
youth and family in crisis. The response team includes
a Mental Health Counselor and a Psychiatric Case
Worker. They will work to de-escalate the crisis by
providing behavioral health intervention and support.
The team will develop a crisis plan with the family and
youth to facilitate safety.
SERVICES PROVIDED
Crisis Stabilization
Short-term behavioral health intervention provided in
or outside of the youth and family home. It is
designed to assess, manage, monitor, stabilize and
support the youth and families well-being. The team
will develop an on-going safety plan with the child,
family, and other support services.
COMMUNITY PARTNERS
•
•
•
•
Clark County Children’s Mental Health Consortium
Clark County School District
University Medical Center Emergency Department
Nevada PEP
NEVADA PEP
FAMILY SUPPORT SERVICES
Family Support:
Nevada PEP’s Family Support Service is a program devoted to
supporting families in advocating for their children that have
behavioral healthcare concerns.
This national model utilizes the System of Care Framework to deliver
family driven, youth guided supports and services to increase
successful outcomes at home, in school and in the community.
Family Specialists:
Family Specialists have gone through many of the same
experiences as the families being served.
All of Nevada PEP’s Family Specialists are family members of
children with mental, emotional and/or behavioral health care
needs.
NEVADA PEP
FAMILY SUPPORT SERVICES
Family Specialists…
Provide compassion and understanding of the unique
experiences and needs of their child and family.
•
•
•
•
•
•
•
Effective Family Support Components:
1 Informational/educational support
2 Instructional/skills development support
3 Emotional and affirmation support
4 Instrumental support – concrete service
5 Advocacy support
6 Leadership skill building at child and family
level and as at system levels
MOBILE CRISIS EVIDENCE BASED
PRACTICES
• Motivational Interviewing
• Crisis Assessment Tool (CAT)-used with permission
from State of Indiana
• Mobile Crisis Safety Plan – from Milwaukee MUTT
• Brief Solution Focused Family Therapy
• Cognitive Behavior Therapy
• Crisis Prevention and Response
• Wraparound
PROGRAM EVALUATION
Information Collected:
 Crisis Assessment Tool Scores
 Discharge Crisis Assessment Tool Scores
 Risk Behavior Checklist Scores
 Child and Adolescent Functional Assessment Score (CAFAS)
 Discharge Plan
 Consumer Satisfaction Survey
PROGRAM EVALUATION
Information collected at:
 Intake
 Discharge
 30-Day Post Discharge – Risk Behaviors Only
 90-Day Post Discharge – Risk Behaviors Only
 6- Month Post Discharge- Risk Behaviors Only
PROGRAM EVALUATION
Crisis Assessment Tool
Rated on a scale: 0 – No Evidence, 1 – History,
watch/prevent, 2 – Recent, act, 3- acute, act
immediately
Risk Behaviors: Suicide Risk, Self-Mutilation, Other Self
Harm, Danger to Others, Sexual Aggression, Runaway,
Judgment, Fire setting, Social Behavior, Bullying
Risk Behavior/Emotional Symptoms: Psychosis,
Impulse/Hyperactivity, Depression, Anxiety, Oppositional
Behavior, Conduct, Adjustment to trauma, Anger Control,
Substance Use
PROGRAM EVALUATION
Crisis Assessment Tool
Rating Scale: 0 - No evidence, 1 – History,
watch/prevent, 2- Causing problems consistent with
a diagnosable disorder, 3 – Causing severe and
dangerous problems
Risk Behavior/Emotional Symptoms: Psychosis,
Impulse/Hyperactivity, Depression, Anxiety,
Oppositional Behavior, Conduct, Adjustment to
trauma, Anger Control, Substance Use
PROGRAM EVALUATION
Crisis Assessment Tool
Rated on a scale of 0 – 3
(No evidence, history/mild, moderate, severe)
Functional: Living Situation, Community, School, Peer,
Developmental, Sleep, Medication Compliance
Juvenile Justice: Juvenile Justice status, Community
Safety, Delinquency
Child Protection: Abuse or Neglect, Domestic Violence
PROGRAM EVALUATION
Crisis Assessment Tool
Rated on a scale of 0 – 3
(No evidence, history/mild, moderate, severe)
Caregiver Strengths and Needs: Health, Supervision,
Involvement with Care, Social Resources, Residential
Stability, Access to Child Care, Family Stress
PROGRAM EVALUATION
• Discharge plan:
☐ Sent to Stabilization Team
☐ Referred to Insurance
☐ Referred to Community Out-patient Provider
☐ Referred to Nevada PEP
☐ Referred to DCFS Provider
☐ Hospitalized
☐ Family Declined Additional Services
☐ No Services Needed
☐ Other
Intake CAFAS Score and Discharge CAFAS Score
CURRENT STATUS
Team started taking calls January 6, 2014
MOU with UMC Completed February 3, 2014
Numbers Served as of April 30, 2014
 # of Telephone Triage Calls: 124
 # of Crisis Response youth/families: 76
 # of Stabilization youth/families: 43
 # of Families receiving Family to Family Support: 39
 # of In-Patient Psychiatric Hospitalizations: 6
MOBILE CRISIS RESPONSE TEAMS
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