WV DHHR Bureau for Behavioral Health and Health Facilities Crisis Services Program

 Proactive planning to prevent & minimize the impact of crisis situations using readiness for mitigation & recovery. - Includes complicated clinical analysis of hypothetical scenarios to prevent or facilitate residential transfers. - Focused efforts to increase feelings of safety, well-being & control using prevention, intervention & recovery.

Admission Criteria for the MR/DD Crisis Respite Units Documented existence of either a developmental disability or mental retardation. (May have co-existing disorders of mental illness or substance abuse.) Must be experiencing a crisis situation as a result of behavioral, psychiatric or environmental complications

 Temporary residential respite can be beneficial, but does not solve triggers leading to crisis situations.  Must identify triggers and work to decrease or remove them.  Teams must have a plan of action for continuity between home and any temporary change of residence.

 Teams must have a plan of action detailing steps for intervention regarding each type of crisis ▪ Emergency evacuation scenarios ▪ Environmental alerts ▪ Behavioral threats to self or others ▪ Medical intervention ▪ Psychiatric support and therapy ▪ Level of care changes ▪ Housing crisis ▪ Supervision and monitoring needs

 Substitute housing and services increases provider accountability  Weekly telephonic progress reports to the Crisis Unit Coordinator  State level monitoring of crisis site activity  Staff visits to the person at the crisis site  More meetings to ensure timely progress

Crisis Unit Coordinator(s) receives and reviews referral packet, including nursing plan of action may be invited to a Critical Juncture Meeting or Crisis Intervention Planning Meeting by primary agency Crisis Unit Coordinator(s) may provide objective clinical feedback for team consideration, behavior support technical assistance, regional resource information or referral to an alternative option

 Crisis Unit Coordinator(s) provides information regarding ability to meet individual needs respective to the crisis setting & capacity  Can provide decision within 24 hours  Greater likelihood of acceptance when given detailed plan for services & discharge

 OBHS Clinical Policy 8108 –Advocacy - Prevents unnecessary intrusion on rights including the right to refuse treatment  OBHS Clinical Policy Linking

 Special Crisis Prevention & Support Planning Meetings  Occurs on a n ongoing basis until satisfactory back-up plans are created  Should be incorporated into regular meetings  Pre-transfer/screening Crisis Meeting  Involves Crisis Respite Coordinator  Requires team consensus that transfer is the least restrictive intervention  Provision of a Plan of Action for Crisis Site Discharge  Mini Intake Meeting  Provides evidence of team consensus for admission

 72 hour Follow-up Pre-Authorization Meeting  Finalizes services provided by Crisis Site  7 Day Treatment Planning for Life, Health and Safety Meeting  Progress Report for discharge involving entire team  Crisis Respite Discharge Meeting  Must be held by the 30 th day  Change of Community Residence Meeting  held 10 days prior to any permanent residential move

 Policy Emergency Behavioral Health Services  Determine the necessity of a mental competency evaluation and action for emergency custody  If person has a developmental disability make crisis respite referrals first  Requires detailed documentation of all emergency intervention  Date, time, person contacted and their response

 Clinical Policy Treatment Planning  Provides for a 7 day assessment period for any new person  Promotes use of natural supports for stabilization  Gives opportunity for referrals to be completed * If person is not able to be safe for the next 7 days then a protective services referral is recommended

 Policy Change of Residence  Prevents residential changes within 30 days of the Annual IPP update  If an individual is not returning to his prior home then a Residential Change Meeting is necessary 10 days before discharge.  The treatment plan is finalized within 30 days of residency at a new permanent home.

General Hospitals if the person has unmet medical needs for medical stabilization. Mental Retardation/Developmental Disability Crisis Respite Units for persons with developmental disabilities Mental Health Crisis Stabilization Units for persons with mental health needs

Psychiatric hospitals for persons with urgent psychiatric issues State hospitals for persons who are at risk of imminent harm due to threats to the safety of themselves or others. If this is the case, then filing a mental hygiene petition may be necessary. General Homeless Shelters for persons who need housing but can survive independently during day time hours

Transitional Living Homes for persons with substance abuse issues who are not intoxicated Home health care providers for persons who need assistance with daily living activities such as personal care Assisted Living Facilities for persons who may need limited assistance, care and supervision Intermediate Care Facilities (ICF)/Group Homes and MR/DD Waiver Homes for persons who need constant supervision, assistance, care, monitoring and instruction

Skilled Nursing Facilities/Nursing Homes for persons who need frequent medical assistance on a daily basis Children’s Youth Services for individuals under the age of 18 who need monitoring and supervision State Foster Care Services for children under the age of 18 who need residential options Specialized Family Care Services for children under the age of 18 who need residential options with behavioral or medical expertise Chafee Independent Living Services for youth between ages who need transitional housing and futures planning

If emergency admission to one of the above options is not necessary, then complete a 7 day temporary plan for safety, discuss options and provide information regarding collaborative decisions for intervention including development of a series of follow-up meetings to build core support services, provide options, educate the participant and monitor progress in compliance with OBHS Clinical Policy 8106 (Monitoring).

 When emergency services are provided, the center shall have written procedures which include at least the following:  Specification of staff coverage & consultation on call  Instructions relative to contacting the client’s physician, case manager or family  Provision for communication with the nearest emergency medical service, hospital and police; and,  Circumstances under which definitive care should not be provided &procedures which should be followed in referring an individual to a more appropriate facility.

Walk-in emergencies or other emergencies where the client is present: Data gathering including clients legal status & clinical presentation Time of arrival, & time of discharge from emergency intervention noting identities of all involved Means of transportation to emergency service if necessary Pertinent history including emergency care Response including a plan for services or treatment Condition of the individual on transfer or discharge & plan for follow-up Signature including credentials of responsible staff

Referral Packet/Crisis Services Plan/Behavior Support Plan and Discharge Plan Transitional Assistance Maintenance of Eligibility Determination Processes Facilitation of Consents for Treatment Primary Chair Duties for Meetings Maintenance of Medical Appointment Needs Back up plan in the event of immediate discharge Transportation to and from the facility Provision of Crisis Service Plan/Behavior Support Plan Weekly telephonic calls, written progress reports and visits as needed Grievance process review Transfer of personal belongings Facilitation of after-care, advocacy, referrals, CED consultation or other needs