First Responder Training January 27, 2009

1. First Responder Training January 27, 2009 Presented by: Wake Provider Network and the Wake LME

3. What We Know about Crisis Response by 1st Responders Presenter: Miki Jaeger Wake LME Quality Management Team

4. November 2007 � Data from 14 LME�s 14 LME�s participated in a statewide test of 1st Responder 120 providers were called 23% never answered their crisis line

5. Consumers Use of 1st Responder System Of Consumers who came to Wake CAS between July 1 and December 31, 2008 And were receiving services from a Provider 55% Had called their Provider prior to coming to CAS (less than 50% of them were called back)

6. Results from January 2008 after-hours test by Wake LME Total Number of Providers Contacted In January 2008 61 Fulfilled responsibilities 32 48% of Wake Providers failed after-hours 1st Responder test

7. Results from December 2008 after-hours test by Wake LME Total Number of Providers Contacted in December 2008 57 Fulfilled Responsibilities 41 28% of Wake Providers failed after-hours 1st Responder test

8. CONGRATULATIONS Wake Providers 20% MORE PROVIDERS PASSED THIS TIME

9. Expectations of 1st Responders Presenter: Wendy Wenzel Wellness Supports

10. Who is Required to serve as a 1st Responder? Based on Service Definitions Community Support (including Team) Intensive In-Home Multisystemic Therapy SA Intensive Outpatient Program SA Comprehensive Outpatient Treatment SA Non-Medical Community Residential Tx. SA Medically Monitored Community Residential Tx.

11. Medicaid MOA Definition forFirst Responder for Crisis/Emergency �If Provider is delivering a service with defined first responder responsibilities or who are designated in the Person Centered Plan (PCP) (which will include a comprehensive crisis plan) shall act as first responder to individuals��

12. Wake LME Provider Operations ManualDefinition of 1st Responder SECTION VI.13 Quality Improvement and Performance Monitoring First Responder Capacity

13. What�s New in Section VI.13 of the Wake LME Provider Manual? Respond to consumers on a face-to-face basis within 2 hours. First Responder on-call numbers available after hours to anyone calling the main agency phone line.

14. What�s New in Section VI.13 of the Wake LME Provider Manual cont�d? Provide consumers with contact information for an alternate source of assistance in the eventuality that Provider is not available Offer information of the process for accessing crisis/emergency services 24 hours a day, 7 days a week, 365 days a year, both orally and in writing at initial contact.

15. What�s New in Section VI.13 of the Wake LME Provider Manual cont�d? Refer only those who present a clear & present danger to self or others, and/or whose level of distress remains after reasonable efforts (including face-to-face intervention) to CAS or hospital emergency departments. Be available to provide information and support if a consumer is referred to CAS.

16. Table Exercise What tools should a 1st Responder have to handle 1st Responder calls?

17. Questions and Answers

18. Comprehensive Crisis Plans Presenter: Betty Murchison, WEB Dubois CDC

19. Standards for a Crisis Plan Proactive plan � supports and interventions to prevent crisis Reactive plan � supports and interventions to use if there is a crisis

20. When to Complete a Crisis Plan Introductory PCP PCP

21. Who completes a Crisis Plan Consumer and Family and/or Supports QP

22. When to Review Crisis Plans Crisis occurs Change in a person�s needs Providers change New goal is added New service is added Annually at the very least!

23. Table Exercise Development of crisis plan What works in crisis planning? Report Out

24. How To Set Up A 1st Responder System Presenter: Wes Caldwell Easter Seals/UCP

25. Table Exercise What are two current challenges to setting up a First Responder System? Report out

26. How to assure Consumers & the LME can reach your 1st Responder contact after hours. Intake process should include discussion of crisis situations and how to access your after-hours crisis phones. The crisis phone number should be in writing on the intake information. Provider�s main phone should include all crisis phone numbers in case the person being served has to resort to the phone book to call for help. LME, STR, and CAS staff should also be able to access your crisis phone as they may need to reach the crisis line for assistance with after hours emergencies.

27. What should your message say? Name of provider Numbers to crisis phones and to which service line they belong. When to call 911 instead of the 1st Responder How long the person can expect to wait for a return call. (no more than 15 minutes)

28. Cell phone? Answering Service? Pager? What are the advantages and disadvantages of each? Which has worked best for your agency?

29. How to Access Crisis Plans Some agencies have crisis plans in a notebook which is carried by the staff responding Others have laptop computers with PCP�s and Crisis Plans on them A few agencies have computer systems that can be accessed through the web

30. Expectations for 1st Responder Systems Quick response as the call must be returned within fifteen minutes by rule. The sooner the better. Stay calm. Ability to assess the situation for a clear and present danger to self or others. Face-to-face response capacity within two hours if necessary.

31. Expectations for 1st Responder Systems cont�d Provider staff should be able to give the consumer & their support system information to access CAS IF clear and present danger to self or others or if the level of distress is not alleviated following reasonable efforts. (On call staff should call CAS to assist with crisis and provide information.) Responding staff must have knowledge of the person�s PCP and crisis plan. Staff from CAS may call the crisis phone for assistance if the individual goes there first before calling on call staff.

32. Table Exercise What solution to the two challenges have you found so far? Do some challenges remain?

33. Questions and Answers

34. When is a Crisis an Emergency? Presenter: Karen Gall Resources for Human Development

35. Define �Emergency� Most of the time mental health emergencies are those involving the threat of suicide or the occurrence of an actual suicide attempt.

36. Table Exercise Write down two emergencies that you have faced or are worried could happen. Report out

37. Emergencies that a Provider Should Handle Providers should be able to handle non-life threatening emergencies For example: �I don�t think my medication is working��The provider could call the psychiatrist for guidance Non mental health emergencies: example toilet overflowingNon mental health emergencies: example toilet overflowing

38. What other emergencies should Providers be able to handle?

39. Emergencies that require 911 intervention Life and Death Emergencies Situations where the person is a threat to themselves or others Situations where the person is unsafe for the provider to transport

40. When to call 911 If the person is in a severe emotional crisis and unwilling to go to the emergency room voluntarily. If providers feel that the person is unsafe to transport ALWAYS request that a CIT Officer respond

41. When to initiate an After Hours Face to Face To assess if the individual meets the criteria for involuntary commitment To provide support during and after a mental health emergency (Remember this must be within two hours of initial call)

42. Legal Requirements for Involuntary Commitment Chapter 122C of NC General Statutes requires that the respondent be mentally ill and a danger to himself or others or in need of treatment to prevent further deterioration that would predictably result in dangerousness

43. What a 1st Responder should do if they have assessed the consumer as requiring hospitalization and the consumer refuses to go to CAS Complete a petition for involuntary commitment. Once the petition is completed, call CAS and remain available either by phone or go to CAS to meet your consumer

44. Safety for the First Responder Ask for assistance from the local police if you are going into a dangerous situation Use common sense Let others know where you are going Take your cell phone with you

45. When should you refer a Consumer to Wake County for Crisis and Assessment Services ONLY WHEN HOSPITALIZATION IS REQUIRED 1st responders are to provide all the support possible to divert consumers from hospitalization

46. Wake CountyCrisis and Assessment 3000 Falstaff Road, Raleigh 919-250-3133 (24 hours/day) 1-866-518-6784 (toll free) TTY 919-250-1499

47. What you should do if you accompany a consumer to CAS or the consumer requests hospitalization Call ahead and tell CAS to expect the consumer (insurance info, current medication is useful) Tell CAS what you have already done to avert the crisis Assure that CAS has a copy of the current Crisis Plan Give your phone number to CAS so they can contact you if needed

48. What CAS needs from you in case a consumer arrives unannounced at CAS A copy of the Crisis Plan needs to be be on hand at CAS Why? CAS Staff can assist the consumer and/or family members in making contact with you as the 1st responder.

49. What will happen if Hospitalizationis not determined to be needed CAS will contact you for assistance in developing a safety plan for the consumer which may include: an alternative place to stay in the short term an appointment to see the psychiatrist the next day

50. Table Exercise Hand your two earlier identified emergencies to a different table Develop strategies to resolve the emergencies you now have Report out: Each table will share one emergency and the solution with the large group

52. QUESTIONS AND ANSWERS

53. THANKS FOR ATTENDING THIS TRAININGOther Wake LME trainings can be found at www.wakegov.com/lme/training.htm