1. Crisis Best Practices Workgroup
September 15, 2017

2. Today’s Agenda Welcome
Program Spotlight: Hope Network (Grand Rapids, MI)
Content Overview: Clinical Services & Training
Review Survey Results/Discussion
Review Project Plan and Timeline
Adjourn
Housekeeping: Using Skype for questions—please mute us, but don’t put our call on hold
Purpose: To develop a comprehensive Best Practice Toolkit for Crisis Residential Services, informed by Crisis Residential providers across the country.

3. Crisis Best Practices Workgroup
TBD Solutions is proud to sponsor the Crisis Best Practices Workgroup.
Crisis Program Development
Quality & Process Improvement
Metrics Development
Integrated Care Coordination
Middle Management Training
Research & Analysis
Interactive Data Visualization
Software Procurement Consulting

4. Crisis Services Map

5. Workgroup Participants
98 Crisis Residential Providers
10 Crisis Providers, Psych Hospitals, or Peer Respites
4 State Behavioral Health Administrations Represented (TX, VA, WA, WI)
44 states
Plus D.C., England and Costa Rica
Approximately 390 crisis homes exist nationwide
Welcome new participants from DC, WV, NJ

6. Behavioral Health Services
Crisis Residential Programs

7. Pivot Crisis Robert Brown Crisis
Grand Rapids, MI
16 beds
Urban/Residential Area
15 Contracts (14 CMH, 1 health plan)
Robert Brown Crisis
Holland, MI
6 beds
Quiet, residential street
15 Contracts (14 CMH, 1 health plan)

8. Philosophy & Values Person-Centered Welcoming
Structured but home-like environment
Start with “How can we adjust to better serve this person?”
Skills focused group and individual sessions daily
Peer Support
Community Collaboration

9. Community Collaboration
Bringing Services In
Communicating Out
Pet Therapy
Art Therapy
Faith Services
AA/NA
StreetREACH
Red Project
Safe Haven
“Dog & Pony Show”
Internal education
Emergency Departments
Sharing outcome data with funders and potential funders
Engaging staff in community events (fund raising, issue awareness)

10. Next Steps Expand payer contracts
Enhance SUD service capacity and competency
Advocate at state and national level for increased use of alternatives to hospitalization
Partner with inpatient and outpatient providers to improve care transitions
Enhance Follow-Up program

11. Content Review: Clinical Services & Training
December 2016: Staffing January 2017: Scope & Function February: Metrics & Outcomes March: Taxonomy & Community Relations April: Treatment Philosophy & Approach
May: Intake
June: Funding
July: The Safety Net
August: Regulations & Governance
September: Clinical Services & Training

12. Clinical Services & Training
Unraveling the Mystery of Crisis Intervention Services
Education and Training
Services Provided
Evidence Based Practices…and Accompanying Challenges
Managing Risk vs. Improving Quality of Life
Supporting Staff in Times of Extreme Need
Helpful & Effective Resources

13. Education & Training
n=25

14. Services within Scope of Practice

15. Evidence Based Practices

16. Evidence Based Practices
Motivational Interviewing
Trauma-Focused Cognitive Behavioral Therapy (TFCBT)
Seeking Safety
Living Room Model
Solution Focused Therapy
Integrated Dual Disorder Treatment (IDDT)
Illness Management and Recovery (IMR)
n=25

17. Challenges to Maintaining Fidelity to EBPs
“Treatment clinicians are also responsible for managing all admissions, so more admissions means less time for group or 1:1 interventions. Plus the average length of stay is only 3-5 days.”
n=25

18. Further Exploration in EBP Fidelity
Exploring partnerships with local universities and researchers
Grant-Funded Research (ex: NIMH)
Collaboratively creating materials with other crisis providers

19. EBP Accommodations
How have you adapted concepts of Evidence Based Practices to adjust to program structure limitations or meet the unique needs of the individuals you serve?
“We introduce skills training groups, skills training manual handouts, we use the language and interventions in individual, group, and milieu interactions as well as our documentation.”
“Shorter and more intense forms of these treatments.”
“Pick and choose Seeking Safety concepts as needed in milieu as opposed to going in order of concepts.”
“Most of our clients are in the Precontemplation or Contemplation stages of change and research shows individuals are not responsive to therapy and even skills training until they reach the Action stage - so the focus is on psychoeducation/building awareness.”
n=25

20. Crisis Services: The Magic Sauce
What are Crisis Stabilization Services about?
Managing risk? or
Improving function?
Not dying? or
Living?

21. Clinical Services: Maintaining Safety and Mitigating Risk

22. Clinical Services: Maintaining Safety and Mitigating Risk
Secure entry
Locked personal and hygiene items
“We have no rules-just expectations that client will work on resolving their crisis and expectations that talk about respect for self and others.”
Being able to decline admissions based on acuity, violence or medical complexity
Panic buttons
Admission/Participation Agreement signed by client

23. Clinical Services: Promoting Recovery and Wellness

24. Clinical Services: Helpful & Effective Resources

25. Clinical Services: Supporting Staff in Times of Need

26. Clinical Services: Supporting Staff in Times of Need
“As a company we have an internal response team designed to respond to any event that may require supporting staff.”
Employee Assistance Programs (EAP)
Peers provide support
Daily huddles
Staff workout room
Quiet room for staff only
Free yoga classes on-site
Self-care days with massage

27. Clinical Services: Maintaining a Thriving & Effective Crisis Program
“Staff recognition and staff support”
“We regularly meet with stakeholders and hold
consumer advisory meetings to improve program development.”
“We encourage all staff to bring innovative group [therapy/psychoeducation group] proposals to the table.”
“We have weekly leadership meetings with the supervisory staff assigned to those areas, to problem solve, exchange ideas, and promote good care of our clients and staff.”
“We have found on our discharge surveys that many individuals found the one-on-ones with Crisis Counselors [to be] the most helpful. We plan to continue this process.”
n=25

28. Survey Participation

29. Survey Participation & Incentives
Average participation is 29% of Crisis Residential Providers
Crisis Residential Providers who complete 80% of surveys or more will have early access to Best Practices Toolkit
Participants who contribute through substantial survey completion will also be recognized as contributors in the Toolkit

30. Survey Participation & Incentives
Missing surveys will be sent to you by 9/30/17
Please complete missing surveys within 30 days of receiving request
Claudia at with any questions

31. Crisis Services Database
Surveying for all Crisis Services in each State
Crisis Residential
23 Hour Crisis Stabilization
Mobile Crisis
Psychiatric Hospitals
State Psychiatric Hospitals
CIT Teams
Peer Respites

32. SAMHSA Webinar Series(es)
4th Monday of each month April-September
1-2:30pm ET/11am-12:30pm PT
3-4pm ET/12-1pm PT

33. Next Steps
Next Conference Calls: Wednesday, October 2pm EDT/11am PDT Group Listserv: Website: (Meeting Slides stored here) Questions: