Mobile crisis response teams
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Mobile Crisis Response Teams. Presented By: Kelly Wooldridge, LCSW; DCFS Char Frost, NV PEP. Identified need.

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Mobile Crisis Response Teams

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Mobile crisis response teams

Mobile Crisis Response Teams

Presented By:

Kelly Wooldridge, LCSW; DCFS

Char Frost, NV PEP


Identified need

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 need1

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 need2

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 need3

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 need4

Identified need

Center for Health Information Analysis (CHIA)


Identified need5

Identified need

Center for Health Information Analysis (CHIA)


Identified need6

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

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

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

Planning and development process logic model


Mobile crisis response team

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

Mission Statement

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


Values

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

Goals

  • 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.


Who we serve

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

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 provided1

Services Provided

Crisis 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.


Services provided2

Services Provided

Crisis 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.


Community partners

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

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 services1

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

  • 6Leadership skill building at child and family

    level and as at system levels


Mobile crisis evidence based practices

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

PROGRAM EVALUATION

Information Collected:

  • Crisis Assessment Tool Scores

  • Discharge Crisis Assessment Tool Scores

  • Risk Behavior Checklist Scores

  • Child and Adolescent Functional Assessment Score (CAFAS)

  • Discharge Plan

  • Consumer Satisfaction Survey


Program evaluation1

Program evaluation

Information collected at:

  • Intake

  • Discharge

  • 30-Day Post Discharge – Risk Behaviors Only

  • 90-Day Post Discharge – Risk Behaviors Only

  • 6- Month Post Discharge- Risk Behaviors Only


Program evaluation2

Program evaluation

Crisis 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


Program evaluation3

Program Evaluation

Crisis 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


Program evaluation4

PROGRAM EVALUATION

Crisis 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


Program evaluation5

PROGRAM EVALUATION

Crisis 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


Program evaluation6

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 status

Current status

Team started taking calls January 6, 2014

MOU with UMC Completed February 3, 2014

Numbers 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 teams1

Mobile crisis response teams

Questions????


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