Children’s Mental Health Crisis Response Services

1. Children’s Mental Health Crisis Response Services Presentation to the Allied Health Caucus, Virginia General Assembly February 24, 2012

2. What it means to be in crisis • “Danger to self or others,” although child may not realize his/her behaviors are dangerous • Significant changes in functioning • May be triggered by catastrophic life events: changes in relationships, living arrangements, school circumstances • Need to address underlying issues not just immediate safety concerns • Affects entire family

3. Examples of Children in Crisis • 17-year-old girl hearing voices, non-compliant with medication, refusing to leave her room, mother concerned she is suicidal • 15-year-old girl who was sexually assaulted at age 10 but never received treatment, now abusing substances, cutting on self, left suicide note for mother • 9-year-old girl with diagnoses of bipolar disorder who becomes violent to her family and threatens to kill herself following a dosage adjustment on her medication

4. Comprehensive Service Array Crisis response services are part of a larger array of mental health services and treatment: • Assessment and evaluation • Outpatient or office-based services • Case management • Home and community based services • Intensive community supports • 24/7 community crisis response services • Residential • Inpatient

5. Types of Community-Based Crisis Response Services • Mobile crisis response to schools homes or other community settings: triage and provide treatment to child and supports to family with goals of averting hospitalization, stabilizing and ensuring safety of child and others, and mobilizing community resources; it is NOT merely assessing for hospitalization or referring a child to the emergency room

6. Types of Community-Based Crisis Response Services 2. Emergency respite care placement: alternative temporary home to diffuse crisis, stabilize child, or provide parents respite, and mobilize community resources for child and family 3. Crisis stabilization unit: local or regional short-term residential service, staffed to provide assessment, treatment and planning

7. Essential Elements of Effective Crisis Response Services • Timely access • Least restrictive environment • Peer support (for child and/or family) • Adequate time spent with child and family • Strength-based plans • Intervention in context of child’s overall treatment plan • Appropriate training and competence of staff • Self- and family referrals accepted • Trauma informed care • Culturally competent • Reduce likelihood of future emergencies Source: SAMHSA, Practice Guidelines: Core Elements in Responding to Mental Health Crises

8. Availability of Crisis Services in VA • Mobile crisis response: 83% of CSBs do not provide (as of 1 year ago, budget cuts have led to further reductions) • Emergency respite care: 95% of CSBs do not provide • Crisis stabilization unit for children: 93% of CSBs do not provide Source: DBHDS Item 304.M Final Report: A Plan for Community-Based Children’s Behavioral Health Services in Virginia, Nov. 1, 2011

9. Recent Trends in Hospitalization at CCCA • Commonwealth Center for Children and Adolescents in Staunton; 48 bed acute care facility • Provides comprehensive diagnostic services, crisis stabilization, and intensive short-term treatment • 780 admissions to CCCA during FY11, which represents a 38% increase over FY10

10. Recent Trends in Hospitalization at CCCA Who goes to CCCA? “…children and adolescents that either have been unsuccessfully treated in less restrictive settings or because the community resources necessary to understand and deal with the presenting crisis situations are not available when and where they are needed.” -Office of Inspector General Report In-Brief: Inspection of the Commonwealth Center for Children and Adolescents , Nov. 2011

11. Recent Trends in Hospitalization at CCCA • Hospital readmission ratesare increasing due to lack of crisis response services in communities:

12. Effectiveness of Existing Services • Mobile crisis response services for children at Central Virginia Community Services: • Jan-June 2011: 111 crisis episodes for 57 children • 81% success rate, based on children transitioning to less restrictive services • Use of CCCA has declined: in FY11, CVCS used 509 bed days, in first half of FY12, CVCS only used 207 bed days (on track for a 19% reduction in CCCA usage)

13. Effectiveness of Existing Services • Fairfax CSB/UMFS Leland House: 8-bed crisis stabilization unit (a house) • In 2009, 79% of the 68 youth who were admitted were discharged to a less intensive environment. • Use of CCCA has declined: in FY11, Fairfax used 1306 bed days, in first half of FY12, Fairfax only used 471 days (on track for a 28% reduction in CCCA usage)

14. Sources • SAMHSA, Practice Guidelines: Core Elements in Responding to Mental Health Crises, 2009 • Office of Inspector General Report In-Brief: Inspection of the Commonwealth Center for Children and Adolescents , Nov. 2011 • DBHDS Item 304.M Final Report: A Plan for Community-Based Children’s Behavioral Health Services in Virginia, Nov. 1, 2011

15. Margaret Nimmo Crowe Policy Director, Voices for Virginia’s Children margaret@vakids.org, 804-649-0184 Coordinator, Campaign for Children’s Mental Health The Campaign for Children’s Mental Health is an advocacy initiative sponsored by Voices for Virginia’s Children and led by Voices, National Alliance on Mental Illness- Virginia, and the Virginia Association of Community Services Boards. More than 60 organizations have partnered with the Campaign statewide. Please go to www.1in5kids.org for more information.