WV DHHR

Bureau for Behavioral Health and Health Facilities

Crisis Services Program

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.

• 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

  

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.

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

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

• 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

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

OBHS Clinical Policy 8108 –Advocacy

- Prevents unnecessary intrusion on rights

including the right to refuse treatment

OBHS Clinical Policy 8107 - Linking

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

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

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

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

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.

• 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

• 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

• 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

• 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

• 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).

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.

• 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

• 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