Presentation on theme: "Mobile Crisis Response Teams"— Presentation transcript:
1Mobile Crisis Response Teams Presented By:Kelly Wooldridge, LCSW; DCFSChar Frost, NV PEP
2Identified needIn Nevada, studies have suggested that 19.3% of elementary school children have behavioral health care needs and over 30% of adolescents self-reported significant levels of anxiety or depression (CCCMHC, 2010).
3Identified needIn 2009, almost one-quarter of Nevada’s public middle school students seriously thought about killing themselves, more than 30% had used alcohol or illegal drugs, and over 13% had attempted suicide (CCCMHC, 2010).
4Identified needWithout easy access to crisis intervention and stabilization services, families have been forced to utilize local emergency rooms in order to obtain behavioral health care for their children. The National Center for Children in Poverty has identified youth emergency room visits for behavioral health care as a national problem (Cooper, 2007).
5Identified needChild behavioral health-related visits to hospital emergency rooms have increased steadily in Nevada over the last five years. There is also an increasing trend of children requiring a costly in-patient admission to a hospital due to a behavioral health crisis.Data collected by the Center for Health Information Analysis (CHIA) through the University of Nevada Las Vegas demonstrates both trends.
6Identified needCenter for Health Information Analysis (CHIA)
7Identified needCenter for Health Information Analysis (CHIA)
8Identified needData for the first two quarters of 2013 continues to show an increase in the number of youth admitted to emergency rooms for a mental health crisis.Clark County ED Admissions: 3319Clark County In-patient Admissions: 3496Washoe County ED Admissions: 1521Washoe County In-patient Admissions: 1742
9MOBILE CRISIS PROGRAM2013 Legislative Session approved funding for a “mini mobile crisis program” in Clark County.Clark County Children’s Mental Health Consortium, Nevada PEP, and the Division of Child and Family Services developed and implemented the Mobile Crisis Response Team.
10Planning and Development Process Establish the Need Collect and analyze data from the Center for Health Care Analysis and local Emergency Departments.Partner with the Community Develop memorandum of understanding with the Clark County School District and the University Medical Center in Clark County. Utilize NV PEP contract to implement Family to Family Support.Looked for External Models Reviewed Mobile Crisis Programs in other states. Developed a contract with Milwaukee Wraparound Mobile Crisis Urgent Treatment Team (MUTT) to provide training and consultation.
12Mobile crisis response team 1 Clinical Program Manager5 Mental Health Counselor II5 Psychiatric Caseworkers1 Administrative AssistantNevada PEP Family To Family Support Specialist
13Mission StatementMCRT strives to help Clark County children and adolescents live safely in their home and community.
14ValuesRespond immediately to children and families during times of crisis.Provide services that are family-driven, culturally competent, community based and consistent with Nevada System of Care principles.Assure safety and continuity of care through individualized strategies implemented by a wraparound-based, team approach.
15Goals Maintain youth in their home and community environment. Promote and support safe behavior in children in their home and community.Reduce admissions to Emergency Departments due to a behavioral health crisis.Facilitate short term in-patient hospitalization when needed.Assist youth and families in accessing and linking to on-going support and services.
16Who We ServeThe Mobile Crisis Response Team provides crisis intervention services for families of youth under the age of 18 who are having a behavioral health crisis and the behavior threatens the child’s removal from the home, school, and/or community.Youth who are uninsured, under-insured or have Medicaid Fee For Services are eligible for services
17Services ProvidedTelephone Triage: Crises staff are available to provide support over the phone to assist in resolving or preventing a crisis situation. After an intervention screening, a referral will either be made to a community resource or the MCRT will respond.
18Services ProvidedCrisis Response If it is determined that further care and support is needed, a response team will be dispatched to the youth and family in crisis. The response team includes a Mental Health Counselor and a Psychiatric Case Worker. They will work to de-escalate the crisis by providing behavioral health intervention and support. The team will develop a crisis plan with the family and youth to facilitate safety.
19Services ProvidedCrisis Stabilization Short-term behavioral health intervention provided in or outside of the youth and family home. It is designed to assess, manage, monitor, stabilize and support the youth and families well-being. The team will develop an on-going safety plan with the child, family, and other support services.
20Community Partners Clark County Children’s Mental Health Consortium Clark County School DistrictUniversity Medical Center Emergency DepartmentNevada PEP
21Nevada PEP family support Services Nevada PEP’s Family Support Service is a program devoted to supporting families in advocating for their children that have behavioral healthcare concerns.This national model utilizes the System of Care Framework to deliver family driven, youth guided supports and services to increase successful outcomes at home, in school and in the community.Family Specialists:Family Specialists have gone through many of the same experiences as the families being served.All of Nevada PEP’s Family Specialists are family members of children with mental, emotional and/or behavioral health care needs.
22Nevada PEP family support Services Family Specialists…Provide compassion and understanding of the unique experiences and needs of their child and family.Effective Family Support Components:1 Informational/educational support2 Instructional/skills development support3 Emotional and affirmation support4 Instrumental support – concrete service5 Advocacy support6 Leadership skill building at child and familylevel and as at system levels
23Mobile Crisis Evidence Based Practices Motivational InterviewingCrisis Assessment Tool (CAT)-used with permission from State of IndianaMobile Crisis Safety Plan – from Milwaukee MUTTBrief Solution Focused Family TherapyCognitive Behavior TherapyCrisis Prevention and ResponseWraparound
25Program evaluation Information collected at: Intake Discharge 30-Day Post Discharge – Risk Behaviors Only90-Day Post Discharge – Risk Behaviors Only6- Month Post Discharge- Risk Behaviors Only
26Program evaluationCrisis Assessment Tool Rated on a scale: 0 – No Evidence, 1 – History, watch/prevent, 2 – Recent, act, 3- acute, act immediately Risk Behaviors: Suicide Risk, Self-Mutilation, Other Self Harm, Danger to Others, Sexual Aggression, Runaway, Judgment, Fire setting, Social Behavior, Bullying Risk Behavior/Emotional Symptoms: Psychosis, Impulse/Hyperactivity, Depression, Anxiety, Oppositional Behavior, Conduct, Adjustment to trauma, Anger Control, Substance Use
27Program EvaluationCrisis Assessment Tool Rating Scale: 0 - No evidence, 1 – History, watch/prevent, 2- Causing problems consistent with a diagnosable disorder, 3 – Causing severe and dangerous problems Risk Behavior/Emotional Symptoms: Psychosis, Impulse/Hyperactivity, Depression, Anxiety, Oppositional Behavior, Conduct, Adjustment to trauma, Anger Control, Substance Use
28PROGRAM EVALUATIONCrisis Assessment Tool Rated on a scale of 0 – 3 (No evidence, history/mild, moderate, severe) Functional: Living Situation, Community, School, Peer, Developmental, Sleep, Medication Compliance Juvenile Justice: Juvenile Justice status, Community Safety, Delinquency Child Protection: Abuse or Neglect, Domestic Violence
29PROGRAM EVALUATIONCrisis Assessment Tool Rated on a scale of 0 – 3 (No evidence, history/mild, moderate, severe) Caregiver Strengths and Needs: Health, Supervision, Involvement with Care, Social Resources, Residential Stability, Access to Child Care, Family Stress
30Program Evaluation Discharge plan: ☐ Referred to Insurance ☐ Sent to Stabilization Team☐ Referred to Insurance☐ Referred to Community Out-patient Provider☐ Referred to Nevada PEP☐ Referred to DCFS Provider☐ Hospitalized☐ Family Declined Additional Services☐ No Services Needed☐ OtherIntake CAFAS Score and Discharge CAFAS Score
31Current status Team started taking calls January 6, 2014 MOU with UMC Completed February 3, 2014Numbers Served as of April 30, 2014# of Telephone Triage Calls: 124# of Crisis Response youth/families: 76# of Stabilization youth/families: 43# of Families receiving Family to Family Support: 39# of In-Patient Psychiatric Hospitalizations: 6