Beaver County Single Point of Accountability Emergency Department (ED) Diversion Protocol

2 SPA ED Diversions Crisis – Follow up Timeframes Crisis – Monitoring

3 Emergency Department Diversions Keys to diversion – Think creatively or outside the box at all possible options that may be utilized to prevent disruption to the person’s recovery and community based tenure. – Interventions that divert people in crises to the least restrictive level of care, where they and the community can be reasonably assured of safety.

4 Emergency Department Diversions ED's or Payers must notify SPA’s prior to admission in a timely manner (preferably within one hour) so that opportunities for diversion can be looked at more closely. On call, 24-hour SPA crisis response staff will respond and connect with the person within an ED for possible diversion within one (1) hour of being notified of an individual’s arrival at an ED EDs need to be educated about how SPA’s can be helpful to them and what the alternatives are (ex. RTFA). – Agencies must demonstrate in writing reasonable attempts to educate EDs about their services. SPA’s need to be identified for people who present at EDs to provide high quality continuity of care and seamless system handoffs SPA agencies must be able to provide empirical data that demonstrate SPA face-to-face contacts with people at the ED, including while staff were on-call.

5 Crisis: Follow up Timeframes SPA teams should be actively involved in the discharge planning process for the people they serve, including working as a team member with Crisis and ED staff to determine if someone can be safely diverted to a lesser level of care. Discharge planning should begin on the day of admission. As soon as feasible, the SPA staff must be integral in assisting in a person’s discharge back to a recovery oriented community setting that is least restrictive. When a consumer is admitted to either a psychiatric inpatient unit or diversion, SPA staff are expected to be in regular contact with the consumer and staff (every other business day), unless approved otherwise by supervisor.

6 Crisis: Follow up Timeframes For consumers that are actively involved in CTT, the SPA will – See them during the crisis – Make a follow up face-to-face contact within 1 business day of any admission – Make a minimum of 5 face-to-face contacts the week following the crisis – Have daily face to face or telephone contacts for the first two weeks For consumers that are involved in Blended Case Management, the SPA will – See them during the crisis – Make a follow up face-to-face contact within 1 business day of any admission – Make a minimum of 3 face to face contacts the week following the crisis – Make a minimum of 8 face to face or telephone contacts for the first two weeks * Consumers unknown to the system that have contact with walk-in, mobile, or telephone crisis will have a follow up phone call within 2 days; and will be seen by a psychiatrist, nurse, or therapist within 7 days. Consumers known to the system who have contact with walk-in, mobile, or telephone crisis will have a follow up phone call within 2 days; and will be seen face-to-face within 3 business days by a psychiatrist, nurse, or therapist. * The number of visits or calls by the BCM can vary according to individual need and supervisory approval

7 Crisis: Monitoring Agencies have a responsibility for having a Quality Improvement or Management Plan that includes Crisis Agencies must demonstrate a manner for collecting data on: – whether or not on-call staff are responding to the ED or other facilities after hours. – Notification to team if on-call case manager went out to the consumer Assuring SPA Response: – Supervisors should review on-call sheets to assure contact was made in ED, and document that a diversion was attempted, if applicable – VBH-PA Daily Census can be reviewed – VBH-PA CASSP Coordinator calls can be reviewed for children.

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