Crisis Best Practices Workgroup

1. Crisis Best Practices Workgroup September 15, 2017

2. Today’s Agenda • Welcome • Program Spotlight: Hope Network (Grand Rapids, MI) • Content Overview: Clinical Services & Training • Review Survey Results/Discussion • Review Project Plan and Timeline • Adjourn Purpose: To develop a comprehensive Best Practice Toolkit for Crisis Residential Services, informed by Crisis Residential providers across the country.

3. Crisis Best Practices Workgroup TBD Solutions is proud to sponsor the Crisis Best Practices Workgroup. • Crisis Program Development • Metrics Development • Middle Management Training • Interactive Data Visualization • Quality & Process Improvement • Integrated Care Coordination • Research & Analysis • Software Procurement Consulting www.TBDSolutions.com

4. Crisis Services Map

5. Workgroup Participants • 141 participants • 98 Crisis Residential Providers • 10 Crisis Providers, Psych Hospitals, or Peer Respites • 4 State Behavioral Health Administrations Represented (TX, VA, WA, WI) • 44 states • Plus D.C., England and Costa Rica • Approximately 390 crisis homes exist nationwide • Welcome new participants from DC, WV, NJ

6. Behavioral Health Services Crisis Residential Programs

7. Pivot Crisis • Grand Rapids, MI • 16 beds • Urban/Residential Area • 15 Contracts (14 CMH, 1 health plan) Robert Brown Crisis • Holland, MI • 6 beds • Quiet, residential street • 15 Contracts (14 CMH, 1 health plan)

8. Philosophy & Values Person-Centered Welcoming Structured but home-like environment Start with “How can we adjust to better serve this person?” Skills focused group and individual sessions daily Peer Support Community Collaboration

9. Community Collaboration Communicating Out “Dog & Pony Show” Internal education Emergency Departments Sharing outcome data with funders and potential funders Engaging staff in community events (fund raising, issue awareness) Bringing Services In • Pet Therapy • Art Therapy • Faith Services • AA/NA • StreetREACH • Red Project • Safe Haven

10. Next Steps • Expand payer contracts • Enhance SUD service capacity and competency • Advocate at state and national level for increased use of alternatives to hospitalization • Partner with inpatient and outpatient providers to improve care transitions • Enhance Follow-Up program

11. Content Review: Clinical Services & Training May: Intake June: Funding July: The Safety Net August: Regulations & Governance September: Clinical Services & Training December 2016: Staffing January 2017: Scope & Function February: Metrics & Outcomes March: Taxonomy & Community Relations April: Treatment Philosophy & Approach

12. Clinical Services & Training • Unraveling the Mystery of Crisis Intervention Services • Education and Training • Services Provided • Evidence Based Practices…and Accompanying Challenges • Managing Risk vs. Improving Quality of Life • Supporting Staff in Times of Extreme Need • Helpful & Effective Resources

13. Education & Training n=25

14. Services within Scope of Practice n=25

15. Evidence Based Practices n=25

16. Evidence Based Practices • Motivational Interviewing • Trauma-Focused Cognitive Behavioral Therapy (TFCBT) • Seeking Safety • Living Room Model • Solution Focused Therapy • Integrated Dual Disorder Treatment (IDDT) • Illness Management and Recovery (IMR) n=25

17. Challenges to Maintaining Fidelity to EBPs “Treatment clinicians are also responsible for managing all admissions, so more admissions means less time for group or 1:1 interventions. Plus the average length of stay is only 3-5 days.” n=25

18. Further Exploration in EBP Fidelity • Exploring partnerships with local universities and researchers • Grant-Funded Research (ex: NIMH) • Collaboratively creating materials with other crisis providers

19. EBP Accommodations How have you adapted concepts of Evidence Based Practices to adjust to program structure limitations or meet the unique needs of the individuals you serve? “We introduce skills training groups, skills training manual handouts, we use the language and interventions in individual, group, and milieu interactions as well as our documentation.” “Shorter and more intense forms of these treatments.” “Pick and choose Seeking Safety concepts as needed in milieu as opposed to going in order of concepts.” “Most of our clients are in the Precontemplation or Contemplation stages of change and research shows individuals are not responsive to therapy and even skills training until they reach the Action stage - so the focus is on psychoeducation/building awareness.” n=25

20. Crisis Services: The Magic Sauce What are Crisis Stabilization Services about? Managing risk? or Improving function? Not dying? or Living?

21. Clinical Services: Maintaining Safety and Mitigating Risk n=25

22. Clinical Services: Maintaining Safety and Mitigating Risk • Secure entry • Locked personal and hygiene items • “We have no rules-just expectations that client will work on resolving their crisis and expectations that talk about respect for self and others.” • Being able to decline admissions based on acuity, violence or medical complexity • Panic buttons • Admission/Participation Agreement signed by client

23. Clinical Services: Promoting Recovery and Wellness

24. Clinical Services:Helpful & Effective Resources n=25

25. Clinical Services: Supporting Staff in Times of Need

26. Clinical Services: Supporting Staff in Times of Need • “As a company we have an internal response team designed to respond to any event that may require supporting staff.” • Employee Assistance Programs (EAP) • Peers provide support • Daily huddles • Staff workout room • Quiet room for staff only • Free yoga classes on-site • Self-care days with massage

27. Clinical Services: Maintaining a Thriving & Effective Crisis Program “Staff recognition and staff support” “We regularly meet with stakeholders and hold consumer advisory meetings to improve program development.” “We encourage all staff to bring innovative group [therapy/psychoeducation group] proposals to the table.” • “We have weekly leadership meetings with the supervisory staff assigned to those areas, to problem solve, exchange ideas, and promote good care of our clients and staff.” “We have found on our discharge surveys that many individuals found the one-on-ones with Crisis Counselors [to be] the most helpful. We plan to continue this process.” n=25

28. Survey Participation

29. Survey Participation & Incentives Average participation is 29% of Crisis Residential Providers Crisis Residential Providers who complete 80% of surveys or more will have early access to Best Practices Toolkit Participants who contribute through substantial survey completion will also be recognized as contributors in the Toolkit

30. Survey Participation & Incentives • Missing surveys will be sent to you by 9/30/17 • Please complete missing surveys within 30 days of receiving request • Email Claudia at claudiav@tbdsolutions.com with any questions

31. Crisis Services Database • Surveying for all Crisis Services in each State • Crisis Residential • 23 Hour Crisis Stabilization • Mobile Crisis • Psychiatric Hospitals • State Psychiatric Hospitals • CIT Teams • Peer Respites • Email claudiav@tbdsolutions.com

32. SAMHSA Webinar Series(es) 4th Monday of each month April-September 1-2:30pm ET/11am-12:30pm PT https://tinyurl.com/y9wpvu6a 3-4pm ET/12-1pm PT https://tinyurl.com/mezytde

33. Next Steps Next Conference Calls: Wednesday, October 25th @ 2pm EDT/11am PDT Group Listserv: CrisisResidentialNetwork@TBDSolutions.com Website: www.CrisisResidentialNetwork.com (Meeting Slides stored here) Questions: TravisA@TBDSolutions.com