Crisis SiteTransition Planning: Part 4

1. WV DHHR Bureau for Behavioral Health and Health Facilities Crisis Services Program Crisis SiteTransitionPlanning: Part 4

2. Crisis Support Planning • Proactive planning to prevent & minimize the impact of crisis situations using readiness for mitigation & recovery. - Includes complicated clinical analysis of hypothetical scenarios to prevent or facilitate residential transfers. - Focused efforts to increase feelings of safety, well-being & control using prevention, intervention & recovery.

3. Crisis Respite Site Admission • Admission Criteria for the MR/DD Crisis Respite Units • Documented existence of either a developmental disability or mental retardation. (May have co-existing disorders of mental illness or substance abuse.) • Must be experiencing a crisis situation as a result of behavioral, psychiatric or environmental complications

4. Crisis Resolution • Temporary residential respite can be beneficial, but does not solve triggers leading to crisis situations. • Must identify triggers and work to decrease or remove them. • Teams must have a plan of action for continuity between home and any temporary change of residence.

5. Crisis Planning • Teams must have a plan of action detailing steps for intervention regarding each type of crisis • Emergency evacuation scenarios • Environmental alerts • Behavioral threats to self or others • Medical intervention • Psychiatric support and therapy • Level of care changes • Housing crisis • Supervision and monitoring needs

6. Temporary Residential Options • Substitute housing and services increases provider accountability • Weekly telephonic progress reports to the Crisis Unit Coordinator • State level monitoring of crisis site activity • Staff visits to the person at the crisis site • More meetings to ensure timely progress

7. Admission Screening Process • Crisis Unit Coordinator(s) • receives and reviews referral packet, including nursing plan of action • may be invited to a Critical Juncture Meeting or Crisis Intervention Planning Meeting by primary agency • Crisis Unit Coordinator(s) • may provide objective clinical feedback for team consideration, behavior support technical assistance, regional resource information or referral to an alternative option

8. Admission Screening Process • Crisis Unit Coordinator(s) provides information regarding ability to meet individual needs respective to the crisis setting & capacity • Can provide decision within 24 hours • Greater likelihood of acceptance when given detailed plan for services & discharge

9. Advocacy • OBHS Clinical Policy 8108 –Advocacy - Prevents unnecessary intrusion on rights including the right to refuse treatment • OBHS Clinical Policy 8107 - Linking

10. Meeting Schedules • Special Crisis Prevention & Support Planning Meetings • Occurs on a n ongoing basis until satisfactory back-up plans are created • Should be incorporated into regular meetings • Pre-transfer/screening Crisis Meeting • Involves Crisis Respite Coordinator • Requires team consensus that transfer is the least restrictive intervention • Provision of a Plan of Action for Crisis Site Discharge • Mini Intake Meeting • Provides evidence of team consensus for admission

11. Meeting Schedules • 72 hour Follow-up Pre-Authorization Meeting • Finalizes services provided by Crisis Site • 7 Day Treatment Planning for Life, Health and Safety Meeting • Progress Report for discharge involving entire team • Crisis Respite Discharge Meeting • Must be held by the 30th day • Change of Community Residence Meeting • held 10 days prior to any permanent residential move

12. Applicable Policies • Policy 8102- Emergency Behavioral Health Services • Determine the necessity of a mental competency evaluation and action for emergency custody • If person has a developmental disability make crisis respite referrals first • Requires detailed documentation of all emergency intervention • Date, time, person contacted and their response

13. Treatment Planning • Clinical Policy 8109 -Treatment Planning • Provides for a 7 day assessment period for any new person • Promotes use of natural supports for stabilization • Gives opportunity for referrals to be completed * If person is not able to be safe for the next 7 days then a protective services referral is recommended

14. Change of Residence • Policy 8114- 3181- Change of Residence • Prevents residential changes within 30 days of the Annual IPP update • If an individual is not returning to his prior home then a Residential Change Meeting is necessary 10 days before discharge. • The treatment plan is finalized within 30 days of residency at a new permanent home.

15. Types of Options • General Hospitals if the person has unmet medical needs for medical stabilization. • Mental Retardation/Developmental Disability Crisis Respite Units for persons with developmental disabilities • Mental Health Crisis Stabilization Units for persons with mental health needs

16. Types of Options • Psychiatric hospitals for persons with urgent psychiatric issues • State hospitals for persons who are at risk of imminent harm due to threats to the safety of themselves or others. If this is the case, then filing a mental hygiene petition may be necessary. • General Homeless Shelters for persons who need housing but can survive independently during day time hours

17. Types of Options • Transitional Living Homes for persons with substance abuse issues who are not intoxicated • Home health care providers for persons who need assistance with daily living activities such as personal care • Assisted Living Facilities for persons who may need limited assistance, care and supervision • Intermediate Care Facilities (ICF)/Group Homes and MR/DD Waiver Homes for persons who need constant supervision, assistance, care, monitoring and instruction

18. Types of Options • Skilled Nursing Facilities/Nursing Homes for persons who need frequent medical assistance on a daily basis • Children’s Youth Services for individuals under the age of 18 who need monitoring and supervision • State Foster Care Services for children under the age of 18 who need residential options • Specialized Family Care Services for children under the age of 18 who need residential options with behavioral or medical expertise • Chafee Independent Living Services for youth between ages 15-19 who need transitional housing and futures planning

19. Service Initiation • If emergency admission to one of the above options is not necessary, then complete a 7 day temporary plan for safety, discuss options and provide information regarding collaborative decisions for intervention including development of a series of follow-up meetings to build core support services, provide options, educate the participant and monitor progress in compliance with OBHS Clinical Policy 8106 (Monitoring).

20. Emergency Crisis Services • When emergency services are provided, the center shall have written procedures which include at least the following: • Specification of staff coverage & consultation on call • Instructions relative to contacting the client’s physician, case manager or family • Provision for communication with the nearest emergency medical service, hospital and police; and, • Circumstances under which definitive care should not be provided &procedures which should be followed in referring an individual to a more appropriate facility.

21. Emergency Crisis Services • Walk-in emergencies or other emergencies where the client is present: • Data gathering including clients legal status & clinical presentation • Time of arrival, & time of discharge from emergency intervention noting identities of all involved • Means of transportation to emergency service if necessary • Pertinent history including emergency care • Response including a plan for services or treatment • Condition of the individual on transfer or discharge & plan for follow-up • Signature including credentials of responsible staff

22. Primary Service Coordination Agency Duties • Referral Packet/Crisis Services Plan/Behavior Support Plan and Discharge Plan • Transitional Assistance • Maintenance of Eligibility Determination Processes • Facilitation of Consents for Treatment • Primary Chair Duties for Meetings • Maintenance of Medical Appointment Needs • Back up plan in the event of immediate discharge • Transportation to and from the facility • Provision of Crisis Service Plan/Behavior Support Plan • Weekly telephonic calls, written progress reports and visits as needed • Grievance process review • Transfer of personal belongings • Facilitation of after-care, advocacy, referrals, CED consultation or other needs