Crisis Residential Best Practices Toolkit November 17, 2016

Welcome Agenda Review Purpose Roll Call Project and Survey Responses Determine Contents of Best Practices Toolkit Review Project Plan and Timeline Adjourn Housekeeping: Using Skype for questions

Why We’re Here Create a resource for Crisis Residential providers promoting best practices and shared experiences with operating crisis homes Establish a community of providers for support, empathy, and encouragement Advocacy for Crisis Residential Services Balanced focus on operations and experience. Crowdsourcing knowledge & resources. While this project will focus on Crisis Residential services for adults, adolescent providers are welcome to participate as there may be many parallels between the programs. Providers of other crisis services, such as 23-hour crisis stabilization, peer respite, psychiatric emergency services, and others, are welcome to engage or participate, but should have a basic knowledge of the function and structure of Crisis Residential services so as to provide meaningful and contextual contributions. Scope: Crisis Residential Services in the USA (and neighboring countries). These services go by many different names (Crisis Residential Unit, Crisis Stabilization Unit, Crisis Respite, etc.), but refer to a short-term, community-based, homelike setting with multi-day lengths of stay, often serving as a stepdown from, or alternative to, psychiatric hospitalization.

Toolkit Participants Access Services (IA) Firelands Counseling & Recovery Services (OH) Polk County Health Services (IA) Access: Supports for Living (NY) Frontier Health (TN) Presbyterian Medical Services New Mexico (NM) American Association for Emergency Psychiatry Hegira Programs (MI) Region 4 MHS (MS) Arizona State Hospital (AZ) Hope Network (MI) Region 6 Life Help (MS) Bert Nash Community Mental Health Center (KS) Human Development Services of Westchester (NY) RI International (AZ) Burke (TX) Kitsap Mental Health Services (WA) River Edge Behavioral Health Center (GA) Candeo (IA) Maine Behavioral Healthcare (ME) Riverbend Community Mental Health (NH) The Center for Health Care Services (TX) Mental Health Center of Denver (CO) Rosecrance Ware Center (IL) Mental Health Cooperative (TN) START Programs (CA) COMCARE of Sedwick County (KS) MHMR Tarrant (TX) The Harris Center for Mental Health and IDD (TX) Common Ground (MI) Mosaic Community Services (MD) The Progress Foundation (CA) Community Reach Center (CO) Netcare Corporation (OH) Turning Point (IA) Crisis Intervention & Recovery Center, Inc. (OH) Network180 (MI) Universidad Latina de Costa Rica Crisis Response Center and Connections AZ (AZ) New Alternatives (CA) Wisconsin Department of Health Services (WI) Downtown Emergency Services Center (WA) New River Valley Community Services (VA) Dupage County Health Department (IL) Pathways Behavioral Health (TN) Easter Seals of Iowa (IA) PEOPLe, Inc. (NY) Any programs that are not represented on this list?

Group Make-up 50 participants 20 states +Costa Rica

Group Make-up Client owned homes (HCBS funded) Observation Beds Mobile Crisis and Inpatient Services as well 16 bed withdrawal management IDD/MH high acuity, challenging behaviors, autism Participation is open to any interested parties—potential providers, complementary providers

CR Best Practices Toolkit: Topics

CR Best Practices Toolkit: Topics Crisis Residential Toolkit: Potential Topics Staffing: Defined Roles/ Size/ Staffing Patterns/ Interns 92.9% Treatment: Programming/ Group Therapy/ Peer engagement Defining & Distinguishing Crisis Residential Services 89.3% Philosophy of Care Treatment Environment & Milieu 85.7% Discharge Intake 78.6% Metrics/Outcomes: Measuring Success Training: Initial & Ongoing 75.0% Peer Supports 71.4% Holistic Care: Co-occurring Conditions/ Integrated Care 67.9% Community Relations: Social Media Presence/ Marketing/ PR Care Coordination (Internal/External): MDT/ Engaging Providers 64.3% Client Outreach: Engagement Post-Discharge Physical Environment 60.7% Challenges and Barriers: Utilization/ Reputation/ Funding Technology in Treatment: EMRs/ Data Sharing 42.9% Additional Ideas: Style of Treatment (Medical vs. Social model) Payment methods and sustainability Understanding suicide screening and managing non-suicidal self-injury; Intervention protocols Vetting of programs

Project Participation Meeting participation: Monthly phone calls geared towards specific crisis topics to be included in the toolkit, engage in dialogue with providers from other areas to understand nuances in state policy and provider practice while building consensus for best practices. Content submission: Each month, all participants will be polled about their crisis home’s policies, procedures, and practices, which will be used to inform the toolkit Content/editorial review: With 40+ crisis homes participating (and 250+ homes across the country), the amount of input for each topic could be staggering. Assist in the review and refinement of input into best practice language. State policy research: Seek out crisis residential statutes in your state, as well as other governing bodies (e.g. Adult Foster Care, Recipient Rights) We recognize that engagement can be difficult, especially for those working in positions directly supporting the crisis homes.

Project Plan: Structure Conference Calls 3rd Wednesday of the month beginning in December Information Requests Sent by the 1st Wednesday of each month Submissions will be compiled and then reviewed during the conference call that month Participants send responses back within 10 days Reviewers consolidate responses Group reviews responses in conference call Responses are edited and finalized Topic questions sent to group Participants send responses back within 10 days Reviewers consolidate responses Group reviews responses in conference call Responses are edited and finalized Topic questions sent to group

Project Plan & Timeline Content Example Home Environment (Dec. 2016) Safety Trauma-Informed Mental, Spiritual, and Emotional Considerations Milieu Structure Approximately 15 topics 1-2 topics/month = 9-12 months to complete Projected Completion: December 2017 Finished product will be an electronic document available publicly Reached out to SAMHSA

Project Plan: Contributors Meeting Facilitation: Travis Atkinson / Lyndsay McGarry Meeting Minutes: Mallory Tanis / Lyndsay McGarry Content Inquiries: Myranda Green / Charlene Cobb Monthly Conference Calls: 25 Content submission of policies/procedures/practices: 16 Review and editing of best practice drafts: 18 State policy or best practices research: 11

Questions? Questions about: Content Structure Engagement …anything?

Next Steps Next Conference Call: Wednesday, December 14th @ 2pm EST/11am PST Group Listserv: CrisisResidentialNetwork@TBDSolutions.com Website: www.CrisisResidentialNetwork.com Questions: TravisA@TBDSolutions.com