1. Crisis Best Practices Workgroup
October 24, 2017

2. Today’s Agenda Welcome Program Spotlight: RHD (Philadelphia, PA
Content Overview: Managing Admissions & the Milieu
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
@TBDSolutions

4. Crisis Services Map

5. Workgroup Participants
138 Crisis Residential Providers
10 Crisis Providers, Psych Hospitals, or Peer Respites
6 State Behavioral Health Administrations Represented (MN, NY, TX, VA, WA, WI)
43 states
Plus D.C., England and Costa Rica
Approximately 410 crisis homes exist nationwide
Welcome new participants from MN, OK, MA, GA

6. Resources for Human Development
Crisis Services
Hope House and New Perspectives
Michael Usino, Crisis Services Director

7. Brief History
Resources for Human Development is a national human services nonprofit with the broadest possible service mission, and specializes in creating innovative, quality services that support people of all abilities and any challenges wherever the need exists. Founded in 1970, RHD supports more than 160 human service programs across the country, serves tens of thousands of people every year with caring and effective programs addressing intellectual and developmental disabilities, behavioral health, homelessness, addiction recovery and more.

8. Our Reach Programs in: Missouri Connecticut Nebraska Delaware
New Jersey
Florida
North Carolina
Iowa
Pennsylvania
Louisiana
Rhode Island
Massachusetts
South Dakota
Tennessee
Virginia

9. Our Mission
RHD’s mission is to provide caring, effective, and innovative services that empower people of all abilities as they work to achieve the highest level of independence possible and build better lives for themselves, their families and their communities.

10. Crisis Programs Hope House Founded in 1995
Provides short-term residential accommodations and continuous supervision for eight individuals in psychiatric crisis.
Licensed by the commonwealth of Pennsylvania Department of Public Welfare, the program provides mental health and stabilization services as a voluntary alternative to hospitalization.
Individuals enter the program for up to a maximum of ten days until they stabilize or other arrangements can be made for them.
Primarily funded through contracts with Magellan Behavioral Health, Northampton County MH/MR/D&A, and Lehigh County MH/MR/D&A.

11. Crisis Programs (Cont.)
New Perspectives:
Eight-bed, short-term residential program for adults in Carbon, Monroe and Pike counties.
Provides supervised mental health stabilization services as an alternative to psychiatric hospitalization for individuals who are in psychiatric crisis, or who may need to be removed from a stressful environment while supports are identified to ensure stability.
Founded in 1998

12. What We Do and Where We Do It
In PA, we have two Crisis Residences serving a total of 5 counties.
Carbon
Monroe
Pike
Lehigh
Northampton

13. Our Services Crisis Residence – 8 bed; short term (5-7 days)
Mobile Crisis Interventions (medical, team and individual)
Facilitation of Petitions for Involuntary Commitments (302s)
Crisis Phones

14. What we are proud of… Trauma Informed Care Crisis Resolution Plans
Seeking Safety
TREM
Crisis Resolution Plans
72 hour post admission meeting
Trainings
Sign Language
De-escalation Techniques
DBT & CBT

15. What we are proud of (cont.)
Staff Recognition and training
Our Corporate Values
Community Relationships and Continuity of Care
RHD Values
Respect for the dignity and worth of each individual
Multi-level thinking
Empowerment of groups
Decentralization of authority
Safe and open environment
Creativity
Honesty and trust
Diversity
Organizational integrity
Ongoing growth and development
Personal and professional enrichment
Quality service

16. Questions

17. 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
October: Managing Admissions & the Milieu

18. Managing Admissions & the Milieu

19. Managing Admissions & the Milieu
Medical Clearance
Handling Complex Medical Needs
Approving Referrals
Exclusionary Criteria
Legal System Involvement
Safety Plans

20. Medical Clearance “Recent overdose or poor vitals.”
“Untreated medical conditions—seizure, blood pressure, diabetes.”
“If there is a communicable disease and medications have not been started.”
“Drowsiness, confusion, or cognitive impairment; acute cardiac symptoms; active PICA diagnosis; major organ dysfunction that could present as psych symptoms”
n=31

21. Medical Clearance Specifics
Journal of Psychosocial Nursing, 2010

22. Medical Clearance Specifics
“We typically do the Urine Drug Screen on site, but request it anyway.”
“Preferrably a PPD/TB test.”
“Labs only required if the patient needs a withdrawal bed.”
“We tell the ERs that we require no labs, but ER MDs typically order the usual panels
n=26

23. Where Medical Clearance is Provided

24. Handling Complex Medical Needs
“Accepted as long as individuals can tend to ADLs.”
“We will facilitate a more appropriate referral to a psychiatric hospital.”
“Our licensing board prohibits certain types of complex medical conditions, such as requiring a medical device to stabilize conditions.”
n=29

25. Handling Complex Medical Needs

26. Approving Referrals n=26
“A team approach, which may include the program director, nursing staff, or program psychiatrist, depending on nature of concern, happens with every admission”
“Our psychiatrist approves ALL referrals.”
“Individuals with a history of sexual impropriety in our program.”
“History of suicide attempts.”
n=26

27. Exclusionary Criteria for Crisis Services
“For sexual perpetrators, we make a clinical decision related to the nature of the offense and the clinical make-up of the house at the time.”
“Client must sign release to Parole Officer or we will not admit them.”
“Only exclude if violence or CSC occurred within the past month.”
n=21

28. Legal System Involvement
“We do not confirm or deny the presence of a client. We then approach the client and ask them to speak to the officers, leaving the choice up to them.”
“We cooperate fully and do not hinder but do not inform without consent.”
“We only communicate with law enforcement if given permission by client.”
n=25

29. Creating Safety Plans
“Restrict access to items and increase safety checks.”
“Safety planning informing by zero suicide initiatives.”
“Clients are stepped up to psych hospital or discharged.”
“Increased safety checks.”
n=28

30. Managing Admissions
“We are able to transfer clients between our 3 locations if the milieu issue is directly related to conflicts between certain clients.”
“We keep a record of all denials and review them monthly with leadership to see patterns where more education and training may be needed for the unit. After a year we’ve seen a major decrease in denials, and a 99% drop in denials that we should have accepted.”
“Focusing on frequent utilizers to our walk-in crisis services, as these individuals also frequent jails, hospital ED’s, and shelter system. We’re working to address the root cause (homelessness, SUD, etc.)”
“We have been able to move people to other parts of our building with staff support, if there are issues or challenges that cannot be managed within another part of the unit (sexual inappropriateness, language barrier, matching clients based on gender, etc).”
“Our personal, trauma-informed approach results in clients respecting the rules and the CSU, even when extremely sick. We assist in getting them to the appropriate level of care. It is unethical for us to treat someone beyond our scope of practice.”

31. Survey Participation & Incentives
Missing surveys will be sent to you by 10/31/17
Please complete missing surveys within 30 days of receiving request
Claudia at with any questions

32. 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

33. Next Steps
Next Conference Calls: Friday, November PDT Group Listserv: Website: (Meeting Slides stored here) Questions: