Mark Boschelli, LPCC, LADAC, ACS Mark.Boschelli@pmsnm

1. Mobile Crisis Response Team (MCRT) with Same Day Access to MAT2018 National Crisis Center Conference Mark Boschelli, LPCC, LADAC, ACS Mark.Boschelli@pmsnm.org Boschelli Behavioral Health Consulting, LLC Mark.Boschelli@gmail.com

2. Mobile Crisis Response Team (MCRT) with Same Day Access to MAT Objective: Design of MCRT enhances staff, increases longevity in the behavioral health field Enhances skill levels of clinical staff Partners case management with licensed therapists

3. Mobile Crisis Response Team (MCRT) with Same Day Access to MAT Objective: Combines expertise across numerous systems of care How to utilize your dissertation proposal in the real world: Investigating the Relationship of the Effectiveness of Group Clinical Supervision in Helping Mental Health Counselors gain Skills and Subsequently Stay on the Job Longer at Community Mental Health Centers Immediate access to MAT to combat Opiates

4. Mobile Crisis Response Team (MCRT) with Same Day Access to MATThemes: Crisis means Opportunity Success is going from failure to failure without any loss of enthusiasm- Winston Churchill “That Guy” pretty much forgettable, but somehow memorable

5. Located in Northern New Mexico Approximately 1900 square miles Rural community Santa Fe largest city of 70,000 in county population of 123,000 Tri-cultural (Hispanic, Anglo, Native American) You are always from somewhere else….. NM Psychiatric beds: 7:79 per 100,000 Santa Fe County, New Mexico

6. Presbyterian Medical Services Since 1969, we've been there for the people of communities large and small, providing care and services to New Mexicans of all ages and backgrounds. We provide a diverse range of services, including primary care, dental, behavioral health, childhood education, home care & hospice, developmental disabilities, residential treatment center, senior centers and veterans' support.

7. MCRT @ Santa Fe Community Guidance Center-Presbyterian Medical Services Presbyterian Medical Services is JCAHO accredited Presbyterian Medical Services operates 58 combined medical and behavioral health clinics throughout New Mexico with an integrated EHR SFCGC is a Federally Qualified Health Care Facility (FQHC)

8. Santa Fe On July 3, 1993, police in Santa Fe, New Mexico, responded to a call regarding a naked man who was wielding a knife. Upon arrival at the scene, police encountered Francisco “Pancho” Ortega, an individual well known to police and emergency rescue personnel. Mr. Ortega had a long history of emotional problems and had, on several occasions, injured himself during outbursts of self-destructive rage. On that evening, Ortega had been drinking. He was waving a steak knife, slashing at his own flesh, and challenging officers to shoot him. When Ortega lurched forward in what was interpreted as a menacing action, two of the officers discharged their weapons, firing seven rounds into Ortega. He was pronounced dead at St. Vincent Hospital, where he had recently signed up for an outpatient mental health program. Included among his possessions at home was an unfilled prescription for anti-depressant medication.

9. City of Santa Fe identified potential funders A 4-year Robert Wood Johnson Community Initiative grant written by city with consultation from the community mental health center and NAMI-SF in 1994 Local Frost and McCune Foundations and Buckaroo Ball Foundations grants secured 4 member Mobile Crisis Response Team started at SFCGC 1994 Modeled after the Mclean County Center for Human Services of Bloomington, IL Original Funding

10. Lessons Learned from PMS-CRSF Mobile Teams 1994 – 2000 Mobile F to F contact is the key Hotline is effective to diffuse and support Crisis alleviation takes more work than one intervention Could not bill un-enrolled consumers Mobile Crisis Team did not decrease ED/BHU experiences Crisis intervention = successful linkage Primary Care should be included Substance Abuse Issues

11. Santa Fe County Community Needs Assessment of 2012 • Decrease suicides • Crisis Services including Mobile Crisis Response Team for behavioral health emergencies

12. Mobile Crisis Response Team What Is MCRT?  While the goal of the MCRT is to enlist the individual’s cooperation and develop the least restrictive treatment options, the MCRT is authorized to recommend and facilitate involuntary psychiatric hospitalization and treatment when necessary. The MCRT specializes in responding to referrals from the Santa Fe County Sheriff, Fire and Rescue, Santa Fe Police and Fire Departments on cases where mental health consultation and intervention are needed.

13. Mobile Crisis Response Team What Services Does the MCRT Provide? Psychiatric Crisis- evaluation, intervention and treatment planning including hospitalization, if needed. Suicide Threat or Attempt- assessment, prevention and intervention with individuals exhibiting suicidal behavior. Substance Abuse Crisis- assessment, intervention, and treatment planning when imminent danger is the result of, or exacerbated by alcohol and drug abuse.

14. Mobile Crisis Response Team What Services Does the MCRT Provide? Domestic Disturbance- intervention and mediation of parent/child, marital and other interpersonal conflicts. Linkage to Services- follow-up case management services to the individuals to needed behavioral health services in order to establish a continuum of care which will dissipate further crisis incidents.

15. Mobile Crisis Response Team Making a Referral to MCRT:  The MCRT is located at the Santa Fe Community Guidance Center-PMS and accepts referrals from families, individuals, public agencies, and private organizations. The MCRT responds to cases in the County of Santa Fe, including the City of Santa Fe and Edgewood. MCRT is dispatched 24/7 from the Crisis Response of Santa Fe Hotline at (505) 820-6333 or 1-888-920-6333. Referrals are triaged by the CRSF Hotline according to imminence of risk to life. Priority is given to referrals from police/sheriff and other public safety agencies.

16. Mobile Crisis Response Team Who Pays for the SFCGC Mobile Crisis Response Team? MCRT is funded from a $450,000 grant through the County of Santa Fe. This is a four year grant renewed each year, thus PMS’ best effort must be evident in each and every mobile experience. Currently celebrated year 4. Other funds include Medicaid and BHSD. $90,000.00 of mobile crisis services billed to MCOs and BHSD and $11,000.00 collected 12% reimbursement

17. Staffing Plan of MCRT What does MCRT look like? Separate team vs. integrated team (dissertation proposal results) 2.0 FTE Independently licensed therapist 8:00 AM-5:00 PM Monday – Friday 1.0 FTE Independently licensed therapist Intake Coordinator 8:00 AM-5:00 PM Monday – Friday 1.0 FTE Case Manager 8:00 AM-5:00 PM Monday – Friday One therapist + One Community Support Worker (CSW) on-call 5:00 PM-8:00 AM Monday – Friday One therapist + One CSW on-call 24 hours Saturday One therapist + One CSW on-call 24 hours Sunday

18. MCRT response into the community: 20 minutes SFCGC @ 2960 Rodeo Park Drive West MCRT dispatched from SFCGC Monday – Friday 8:00 AM – 5:00 PM and link to First responders and Law Enforcement at the scene After-hours MCRT staff dispatched from their home and link to First Responders and Law Enforcement at the scene and utilize a teachable moment. CRSF Hotline will log time of call MCRT will log time of dispatch and evacuation from scene into EHR

19. Staffing Plan of MCRT How does MCRT Retain Staff? All MCRT staff are already employees of PMS Licensed therapists enter data into Electronic Health Record (EHR) Vested into the PMS model of helping behavioral health consumers in the community by working at a community health center. Agree with a continuum of service delivery via increasing community tenure and linkage to services Benefits include: enhancing skills in crisis services, awarded Continuing Education Units (CEUs) On-call stipend $60.00 week nights, $75.00 Weekends Crisis pay for dispatch ($45.00 Minimum 2 hours of salary for therapists, Time ½ CM) Current enrollees include 9 therapists; 2 with child/adolescent specialties, 4 Community Support Workers from two sites.

20. Staffing Plan of MCRT How does MCRT Retain Staff? In 2015 the Health Resources and Services Administration (HRSA) announced more than $94 million in awards to train the next generation of health care providers. These grants support education and training to help enhance health care delivery and improve access to high-quality care. Independent licensed therapists qualify for HRSA grants due to FQHC

21. MCRT Accomplishments 7 Rounds of clinical training held at SFCGC resulting in 22 licensed clinicians and 7 community support workers qualified to be on MCRT 39 presentations to shifts of Santa Fe Sherriff’s, Santa Fe County Fire, City of Santa Fe Police, Santa Fe Fire, NAMI-SF, and BHSD of NM. Article published in Crisis Magazine published by the National Council for Behavioral Health 2016 Issue 1. MCRT is now an internship host for universities in order to increase workforce development in behavioral health PMS MCRT presented at Head2Toe Conference April, 2016, NM PSR Conference. Average 60 Call outs per month, Total of 1079

22. Mobile Crisis Response Team • Provide immediate aid to people in a behavioral health crisis• Stabilize as quickly as possible• Assess need and link to community-based services • Act as resource for first responders, community agencies and schools• Train law enforcement and EMS on how to work with people in crisis• Reduce use of the hospital emergency room for these type of cases• Reduce the number of suicides in Santa Fe County July 2015 to February 2017

23. MCRT ACCESS: Navigation tHRU SYSTEM Immediate Access to Psychiatry (3 prescribers) Immediate Access to Open Access CCSS (case management) Immediate Access into Psychotherapy Groups

24. MCRT ACCESS: Navigation tHRU SYSTEM Immediate Access to Medication Assisted Treatment with Opiate replacement medication Suboxone: Use of NM Pharmacy Monitoring Program Must participate is PSR Skills Groups Family members given Narcan kit