1. Innovation in Technology: Efficient Access to Quality Services
Jennifer Armstrong, Director of Crisis Care Services- Centerstone of TN
Liam Barry, Director of IT Infrastructure-Centerstone of TN
Jennifer Smith, Team Lead, Northern Region Mobile Crisis- Centerstone of TN

2. Centerstone
Nation’s largest non-profit provider of community-based behavioral health services
Annually serves over 60,000 children, adolescents, adults, seniors and their families in Tennessee
Mission: To prevent and cure mental illness and addiction
Part of a national collaboration promoting the Zero Suicide Initiative
Recent mergers with other states including KY, IL, IN, FL
Provide an array of services from outpatient services to residential
Have used telepsychiatry for medication svcs, televideo for therapy with commercial payers,

3. Centerstone Crisis Services
Crisis Center
9 local and national partners- crisis lines
Crisis Call Team
Crisis Follow-up Team (High Risk services available across all crisis lines, BCBS grant, NSSP grant, GLS grant)
Crisis Chat/Text Team- NSPL Crisis Chat, Hopeline Chat
25 masters level clinicians
AAS, CARF, CUSA, OES accredited
Team office: Nashville, TN.

4. Centerstone Crisis Services
Mobile Crisis Services- 3 regions across 21 counties
Crisis Management Strategies team- local and national training; critical incident response
Create a culture committed to dramatically reducing deaths by suicide
Provide training for clinical staff to enhance knowledge and skills in the area of suicide prevention
Consistently assess suicide risk levels among people in our care by using a suicide severity screening tool (C-SSRS). This tool must be completed by a clinical staff member at intake and at each contact with the client
Ensure every person has a pathway to care that is both timely and adequate to meet their needs
Provide continuing contact and support, especially after discharge from inpatient care

5. Remote Services- Crisis Call Center
Why?
2009: Program cuts that reduced staff size from 15 to 6
3600 total calls per month; crisis call services only; 3 crisis lines managed
Per TDMH contract, must have 24/7 access to live person: Centerstone Crisis Line and TN Statewide Crisis Line
IT team research with current vendor (Cisco)- security, HIPAA concerns, etc..

6. Remote Services Equipment and Tools (approx. $2K per staff) Laptop
Cisco Phone & Headset
Home Internet Connection
Cisco ASA
Battery Back-up
Private home office set up and monitored by IT staff

7. Remote Services

8. Remote Services
Centerstone uses a Cisco ASA – Model 5505 to secure the connection.
What is a Cisco ASA?
The Cisco ASA is a device that creates a private connection from one location to another.
The connection (or tunnel) is secure and private
The tunnel is encrypted
Quick and easy to set up
The connection is monitored by our Network Operations center
The cost of an ASA is approximately $
What does ASA stand for?
ASA is simply a marketing term by Cisco. It’s an acronym for: Adaptive Security Appliance

9. Remote Services Now what? Cc-Modeler Professional Software:
Kooltoolz (
Workforce Management
Improving Service Performace
Projects needed staffing/where in meeting access standards
Utilizes call volume and staffing patterns
Staffing truly by volume

10. Remote Services Phase in: SLOWLY! Overnight, afterhours, then all day
Daily IT correspondence; staff communication and monitoring
Shift in service:
Crisis intervention services only
No I and R
Afterhours functions for Centerstone of TN
NSPL- relinquished regional services to backup for TN only
-all outpatient locations move to vm afterhours/press 1 for crissi
-automated referrals for Cstone outpatient services -

11. Remote Services Guidelines:
Remote office must be set up in a private location in the home as assessed by IT staff.
Access to an assigned Centerstone office location (all assigned sites must be within one hour of home office).
Internet access provided by staff member.
Staff will use equipment issued and installed by Centerstone Information Systems.
Must attend all clinical supervision and team meetings.
Monthly team meetings; bi-weekly (in-person) meetings; weekly phone supervision
PROBLEMS: (i.e. home internet or electricity down, problems with server).

12. Remote Services Emergency Back-up Plan: Service disruptions:
Determine if back-up coverage is warranted
Utilize on-call staff
Utilize back-up on-call staff as needed
If outage exceeds 20 minutes, relocation to assigned Centerstone location for completion of shift.
ISP outage; server down- outage;

13. Remote Services: Monitoring and QA:
Monitor staff efficiencies as if on site
Can only pull team asa and ar, but can use this to determine how time is spent, nature of services provided/calls taken
Can for both incoming and outgoing calls- so for crisis call team and follow-up team

14. Remote Services
Monitoring/QA:

15. Remote Services
Monitoring/QA:

16. Remote Services
Monitoring/QA:

17. Remote Services
Monitoring/QA:

18. Remote Services
Monitoring/QA:

19. Remote Services
Communication:

20. Remote Services Pros Cons Right sized staffing
Built in emergency back-up plan
Staff retention
Same monitoring capabilities
Staff communication
Coverage nationally during disasters
Cons
Agent Status/Availability
Staff connectedness- ongoing struggle

21. Centerstone’s Mobile Crisis
Funded by Tennessee Department of Mental Health & TennCare (state Medicaid)
Overall contractual goal is to act as a diversionary resource to most appropriate, least restrictive setting
Response is to any location requested in 20 county catchment area
-Services under contract specifically reimburse for uninsured and TennCare insured but will not refuse Crisis assessment regardless of payer.
-3 separate teams covering 20 counties
-TN has O/P, iOP, respite, crisis stabilization units, partial hospitalization, MMCD, and voluntary treatment as alternatives to involuntary hosp
-majority of assessments (~80%) occur in ED setting

22. Mobile Crisis: The Northern Region
Seven county catchment area
Average 250 assessments per month
Response time average- 90 minutes
Up to 98 miles roundtrip
Average mileage per assessment- 54 miles
-3 outpatient clinics

23. Implementation of Televideo
The beginning
2012: Pilot project with HCA/TriStar and Cisco
Remote connection from laptop to cart placed in ED using Movi/Jabber
Response time averaged 30 minutes
1st six months averaged four assessments per month
Next steps
2013: Two more HCA affiliations
Cisco Movi/Jabber replaced with InTouch equipment
-HCA/TriStar owns multiple ED’s in Middle TN as well as inpatient psych hospitals
-issues with connectivity
-issues with technology being user friendly -

24. Implementation of Televideo
Currently
Initial Assessment:
Emergency Department: iPad to ED cart via InTouch
Centerstone O/P Clinics: iPad to iPad/laptop via Cisco
427 assessments to date
Average response time to date- 27 minutes
Evaluation component for client feedback
Involuntary Hospitalization:
1st Certificate of Need
2nd Certificate of Need to RMHI

25. Questions?
Contact Information:
Jennifer Armstrong, LPC-MHSP
Liam Barry
Jennifer Smith, LMSW