1. Let’s Tango: Crisis Intervention Team and Emergency Department Nurses
Introductions of each presenter
Roles within CIT/Agency
Candace Allen, MS CIT Coordinator
Beckye Dalton, RN, MSN, APRN, CEN
Lori Shipley, RN, ASN

3. Mission Statement
It is the mission of the Knoxville/Knox County/University of Tennessee CIT to work in collaboration with our community to ensure safety while providing quality, compassionate care to individuals experiencing a mental health crisis.
Beckye

4. History of Our Tango
How the largest hospital in Knoxville, Tennessee embraced CIT
Crisis Intervention Training v Crisis Intervention Team
Background of whole continuum for care from start to finish with consumer in crisis (last year’s presentation)
Brian hitch
Identified as gap in advisory board
Beckye on board
Police bring in consumer to the ED and RNs re-escalate situation

5. The Perspective
Police Officers and Health Care Staff are trained very different.
“We are all in this together”
Police Officers/Hospital Security Officers-
ED RN-
Social Workers-
There are some of us that shouldn’t be in this job!
BUT CIT brings all of those disciplines and trainings together for a common goal. (ROADMAP for a common goal)
We are all in helping professions. Every person that touches someone in crisis is in the helping profession, but each is trained to complete different tasks in order to best assist the person in crisis.

6. The collaboration and partnerships are essential for the people in our community.
Need a continuum of services for a win-win for the consumers and for the staff involved.

7. The Value Pre-CIT Post-CIT
Before CIT, the goal of the ED visit was for medical clearance and placement to a psychiatric facility. Remember most ED’s do not offer any type of psychiatric treatment beyond continuing the patient’s home medications. With the continuing length of stay for these patients, the patients may stay in the ED for up to 5 days on average.
After CIT, the goal of the ED visit is not only for medical clearance but to continue the same crisis de-escalation that occurred from the CIT in the field. What could be worse for the people in the field that have spent hours trying to deescalate someone to have the EMS and ED staff escalate the person again.
From start to finish, we are all using the same language.

8. The Sale
Staff Safety
Decreased length of stay for patients with behavioral health disorders
CIT offers valuable de-escalation training for EMS, Hospital Security and the ED RN = staff safety.
During the current state of the ED, the main sell to administration to get on board is both staff safety and decreased length of stay for behavioral health patients in the ED.

9. Workplace Violence Data

11. Workplace Violence Data
Type of UTMC Assault Victims
2017
2018
2019
% Change (from 2017)
Security
55 (28%)
73 (30%)
60 (35%)
+5%
RN (ED)
43 (12%)
24 (10%)
17 (10%)
-12%
RN (Floor)
28 (14%)
60 (25%)
32 (18%)
+4%
Redo this table ELAINE with a different color

12. Patient Story Lori- what I did before; “LG”/SALLY-
How security interacts with her during dayshift/working in tandem (our team); night shift doesn’t have the same impact due to non-cit trained officers

13. WHO ARE THE CHAMPIONS? How do you identify a champion?
How to help establish a resource person from EMS, Hospital Security or the ED? Look for that one EMS person, Hospital Security Officer and one RN who is always ready to take action when you, the officer, presents with someone in a crisis. Talk to them. It only takes one person with a passion to lead you to where you want to be. Transport officers are key champions.
HAVE OFFICERS THAT INTERFACE WITH SECURITY OR ED STAFF DAILY…
CIT IN THE ED CAN DECREASE INCIDENTS WHERE SECURITY HAVE TO ANSWER CALLS FOR DE-ESCALATING A PERSON IN MENTAL HEALTH CRISIS.
ALL TALK
If you don’t have a champion, the ship will sink.
More than training.

14. The Future Continued attendance of ED nurses in CIT Courses
Increased partnership with police, mental health workers and emergency department nurses
Helen Ross and UTMCK are actively involved in two grants:
1. Helen Ross provides a psychiatrist and social worker 4 hours/ day -5 days/ week
2. United Health Care Grant
Patient Navigators to assist with the opioid epidemic in our region
Have to have keys players; right mental health agency, right hospital, the right people.
Passionate people about the care of people with mental illness
Leadership
Position in Organization

15. Questions
???
Mental health patients are becoming more and more prominent, while resources are becoming more and more scarce. Providing crisis interventions in the community has been a long-standing intervention for many years with the police departments, while the emergency departments provide crisis intervention on a different level. While teams across the nation have paired up police officers and mental health workers in the field, there has always been a gap from this point till the patient is admitted into a mental health facility. The gap is while the patient is getting medical clearance in the emergency department. So why not, bring CIT to the emergency departments where the patient can be met with CIT trained nurses. Imagine what happens in many emergency departments today. CIT trained officers respond to a client that is having a mental health issue, they get the client calm using CIT training and then they are dropped off in the emergency department for medical clearance to a provider and nurse that has limited training on dealing with mental health patients. By providing a continuum of care for the patients while in the emergency department, our department has seen results in training nurses in CIT.

16. Contact Information
Candace Allen, MS
Sr. Director of Intensive Adult Services
(865)
(865)
Beckye Dalton, MSN,RN,APRN,CCNS-BC,CEN
Emergency Department Clinical Nurse Specialist
University of Tennessee Medical Center
(865)
Lori Shipley, ASN, RN
Emergency Department Charge Nurse
(865)