Crisis Residential Best Practices Toolkit January 18, 2016

Welcome Agenda Roll Call Review Content Submissions- Scope & Function Discussion Review Project Plan and Timeline Adjourn Housekeeping: Using Skype for questions Purpose: To develop a comprehensive Best Practice Toolkit for Crisis Residential Services, informed by Crisis Residential providers across the country.

Anyone else joining the call today? Roll Call Jeff Allen (OH) Cicely Alvis (TN) Courtney Beardon (TX) Sherry Blyth (TX) Mark Boschelli (NM) Jeff Bracken (MD) Ross Buitendrop (MI) Lori Carnahan (IL) Brenda Clark (TX) Char Cobb (MI) Jessica Coburn (IA) Susan Cromwell (MD) Chrystal Davis (TX) Carol DiGiuseppe (MI) Kelly Gluszewski (MI) Adamn Graham (TN) Myranda Green (MI) Dawn Handley (TX) Courtney Harvey (TX) Andrea Kocsis (NY) Rosa Chan Lopez (Costa Rica) Sara Lupkes (IA) Dan Maccia (CA) Eilean MacKenzie (TX) Meghann McCluskey (ME) Lyndsay McGarry (MI) Shelley Mohang (IA) Laura Newsome (TX) Anna Richardson (TX) Jamie Sellar (AZ) Micah Smith (IA) Mende Snodgress (TX) Sheryl Stiffler (TX) Gwen Summers (MI) Mallory Tanis (MI) JoAnn Toney (CO) Dana Townsend (TN) Diane van Lier (TX) Mark Ware (TX) Amy Warren (KS) Jaime Webster (CO) Randy Weeks (MS) Sharon Wilcox (NC) Karen Wheelock (ME) Anyone else joining the call today?

Workgroup Participants 70 homes from 25 states participating Appprox. 290 crisis homes nationwide

Content Submissions: Scope and Function History of Crisis Homes Function of Service Community Access Participation in Treatment Services Offered Average Length of Stay Funding & Per Diem Rate Threats to Sustainability 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 and Function Results: History Ranges from 1 year to 30+ years of service Reasons for forming Reduce state hospital admissions Reduce psych hospital admissions Reduce unnecessary ER admissions Divert from jail Dan Maccia (CA)- History of START CRU; No restrictions Carrie Wirick (OH)- History of Netcare CRU; No restrictions Mende Snodgress (CA)- History of Harris County CR; No restrictions

Scope and Function: Service Recipients

Scope and Function Results: Function of Service Scope 82% of crisis homes surveyed are unlocked

Scope and Function Results: Community Access & Treatment Participation Netcare (OH), START (CA), Mende Snodgress (TX) How much risk do programs bear? What is the environment of risk management vs. dignity, respect, and empowerment?

Scope and Function Results: Treatment & Services Offered 38% of homes prohibit smoking Additional Responses: Detox as needed Relapse prevention Substance abuse screenings & counseling Peer counseling

Scope and Function Results: Average LOS Subsets of Crisis Residential Services can vary in length Example: Texas Extended Observation Units (EOUs) Crisis Respite Units Crisis Residential Units

Scope and Function: Funding & Per Diem Rate Per diem rates range from $250-$800 per day 32% of crisis homes responding (6/19) reported their homes are funded outside of a per diem arrangement

Scope and Function: Threats to Sustainability Homes expanding in California, Colorado in the past 3 years Two homes closed in Michigan in 2016 Challenges of running a free-standing, low-bed home with limited revenue opportunities and consistent overhead costs

Tips for Sustainability Company donations and fundraising Sponsorship- local business, grocery stores Food pantry access Interns Volunteers for activities (yoga) Negotiating with managed care organizations Purchasing in bulk Co-locating programs Grants Flexible staff Subcontracting Consulting/Training Fees

Project Participation: Update 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: Initial content reviews will now be completed by the planning team. 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.

Questions? Comments?

Next Steps Next Conference Call: Wednesday, February 15th @ 2pm EST/11am PST OR Friday, February 17th @ 1pm EST/10am PST Group Listserv: CrisisResidentialNetwork@TBDSolutions.com Website: www.CrisisResidentialNetwork.com Questions: TravisA@TBDSolutions.com