P R E S E N T E D BY:K E L LY W O O L D R I D G E , L C S W ; D C FS

C H A R F R O S T , N V P E P

MOBILE CRISIS RESPONSE TEAMS

IDENTIFIED NEED

• In 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).

IDENTIFIED NEED

• In 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).

IDENTIFIED NEED

• Without 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).

IDENTIFIED NEED

• Child 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.

IDENTIFIED NEED

2009 2010 2011 20120

1000

2000

3000

4000

5000

6000

7000

Youth Admitted to an In-Patient Hospi-tal for Behavioral Health

Clark County

Center for Health Information Analysis (CHIA)

IDENTIFIED NEED

Center for Health Information Analysis (CHIA)

IDENTIFIED NEED

Data 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: 3319• Clark County In-patient Admissions: 3496• Washoe County ED Admissions: 1521• Washoe County In-patient Admissions: 1742

MOBILE CRISIS PROGRAM

2013 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.

PLANNING 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.

PLANNING AND DEVELOPMENT PROCESS LOGIC MODEL

Nevada Division of Child and Family Services Mobile Crisis Intervention - January 2014 New Service Implementation

Inputs Outputs Outcomes -- Impact Activities Participation Short Medium Long

Staffing: 12 staff to include CPM I, Qualified Mental Health Professionals, Psychiatric Case Workers- Trained in Solution Focused Brief Therapy, Motivational Interviewing, Wraparound, Trauma Informed Care, Crisis Intervention and Stabilization, and Domestic Violence Response Population: Any child or adolescent in Southern Nevada requiring support and intervention for a psychiatric emergency Hours of Operation: 10:00 pm to 7:00 pm 5 days/week- some Saturdays upon implementation Transportation Method: State Vehicles Program Teams: Mobile Crisis Response Team Mobile Crisis Stabilization Team Partnerships: MOUs with selected community partners such as Clark County School District Clark County Children’s Mental Health Consortium and Clark County University Medical Center Evaluation: DCFS Program and Evaluation Unit

Consultation and Information: -Telephone consultation available to families and providers -Telephone triage and referral -Outcome and Output Data collected at time of call (call log) Crisis Assessment Intervention and Stabilization: -Urgent face-to-face home-based or community-based crisis assessment and intervention -Utilize assessment tool, Intake “Crisis Assessment Tool” (CAT) Facilitation of Community Supports and Care: -Provide the family with information and referral to needed resources -Link the family with Nevada PEP -Short term intensive child and family therapy -Immediate care coordination services including linkage with other involved child service agencies and school district services -Utilize assessment tool, Discharge “Crisis Assessment Tool” (CAT)

Mobile Crisis Response Team Mobile Crisis Stabilization Team

-Immediate restoration of safety -Implementation of safety plan -Child and family connected to local and natural supports -Customer satisfaction (child and family) -Facilitate psychiatric hospitalization when necessary

-Child and family are stabilized -Child and family are connected to additional referral service array and Wraparound services -Reduction in crisis indicators (CAT)

- Reduced Admissions to the Emergency Department for a behavioral health crisis -Reduced length of stay and readmission to in-patient care -Youth remain in their homes and community

Assumptions: Supplies/office equipment available and forms and initial procedures will be established. External Factors: Funding, Referral sources and marketing considerations.

MOBILE CRISIS RESPONSE TEAM

1 Clinical Program Manager 5 Mental Health Counselor II 5 Psychiatric Caseworkers 1 Administrative Assistant Nevada PEP Family To Family Support Specialist

MISSION STATEMENT

MCRT strives to help Clark County children and adolescents live safely in their home and

community.

VALUES

• Respond 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.

GOALS

1. Maintain youth in their home and community environment.

2. Promote and support safe behavior in children in their home and community.

3. Reduce admissions to Emergency Departments due to a behavioral health crisis.

4. Facilitate short term in-patient hospitalization when needed.

5. Assist youth and families in accessing and linking to on-going support and services.

WHO WE SERVE

• The 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

SERVICES PROVIDED

Telephone 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.

SERVICES PROVIDED

Crisis ResponseIf 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.

SERVICES PROVIDED

Crisis StabilizationShort-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.

COMMUNITY PARTNERS

• Clark County Children’s Mental Health Consortium• Clark County School District • University Medical Center Emergency Department• Nevada PEP

NEVADA PEP FAMILY SUPPORT SERVICES

Family Support: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.

NEVADA 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 support• 2 Instructional/skills development support• 3 Emotional and affirmation support• 4 Instrumental support – concrete service• 5 Advocacy support• 6 Leadership skill building at child and family level and as at system levels

MOBILE CRISIS EVIDENCE BASED PRACTICES

• Motivational Interviewing• Crisis Assessment Tool (CAT)-used with

permission from State of Indiana• Mobile Crisis Safety Plan – from Milwaukee MUTT• Brief Solution Focused Family Therapy• Cognitive Behavior Therapy• Crisis Prevention and Response• Wraparound

PROGRAM EVALUATION

Information Collected:

Crisis Assessment Tool ScoresDischarge Crisis Assessment Tool ScoresRisk Behavior Checklist ScoresChild and Adolescent Functional Assessment Score

(CAFAS)Discharge PlanConsumer Satisfaction Survey

PROGRAM EVALUATION

Information collected at:

IntakeDischarge30-Day Post Discharge – Risk Behaviors Only90-Day Post Discharge – Risk Behaviors Only6- Month Post Discharge- Risk Behaviors Only

PROGRAM EVALUATION

Crisis Assessment ToolRated 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

PROGRAM EVALUATION

Crisis Assessment ToolRating 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

PROGRAM EVALUATION

Crisis Assessment ToolRated 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

PROGRAM EVALUATION

Crisis Assessment ToolRated 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

PROGRAM EVALUATION

•Discharge plan: ☐ 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

☐ Other

Intake CAFAS Score and Discharge CAFAS Score

CURRENT STATUSTeam started taking calls January 6, 2014MOU 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

MOBILE CRISIS RESPONSE TEAMS

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