Presented By: Kelly Wooldridge, LCSW; DCFS - PowerPoint Presentation

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Presented By:Kelly Wooldridge, LCSW; DCFSChar Frost, NV PEP

Mobile Crisis Response TeamsSlide2

Identified need In Nevada, studies have suggested that 19.3% of elementary school children have behavioral health care needs and over 30% of adolescents self-reported significant levels of anxiety or depression (CCCMHC, 2010). Slide3

Identified needIn 2009, almost one-quarter of Nevada’s public middle school students seriously thought about killing themselves, more than 30% had used alcohol or illegal drugs, and over 13% had attempted suicide (CCCMHC, 2010). Slide4

Identified needWithout easy access to crisis intervention and stabilization services, families have been forced to utilize local emergency rooms in order to obtain behavioral health care for their children. The National Center for Children in Poverty has identified youth emergency room visits for behavioral health care as a national problem (Cooper, 2007). Slide5

Identified needChild behavioral health-related visits to hospital emergency rooms have increased steadily in Nevada over the last five years. There is also an increasing trend of children requiring a costly in-patient admission to a hospital due to a

behavioral health crisis.

Data collected by the Center for Health Information Analysis (CHIA) through the University of Nevada Las Vegas demonstrates both trends. Slide6

Identified need

Center for Health Information Analysis (CHIA) Slide7

Identified need

Center for Health Information Analysis (CHIA)Slide8

Identified needData for the first two quarters of 2013 continues to show an increase in the number of youth admitted to emergency rooms for a mental health

crisis.Clark County ED Admissions: 3319Clark County In-patient Admissions: 3496Washoe County ED Admissions: 1521

Washoe County In-patient Admissions: 1742Slide9

MOBILE CRISIS PROGRAM2013 Legislative Session approved funding for a “mini mobile crisis program” in Clark County.

Clark County Children’s Mental Health Consortium, Nevada PEP, and the Division of Child and Family Services developed and implemented the Mobile Crisis Response Team.Slide10

Planning and Development Process

Establish the Need Collect and analyze data from the Center for Health Care Analysis and local Emergency Departments

.

Partner with the Community Develop memorandum of understanding with the Clark County School District and the University Medical Center in Clark County. Utilize NV PEP contract to implement Family to Family Support.

Looked for External Models Reviewed Mobile Crisis Programs in other states. Developed a contract with Milwaukee Wraparound Mobile Crisis Urgent Treatment Team (MUTT) to provide training and consultation. Slide11

Planning and development process logic modelSlide12

Mobile crisis response team1 Clinical Program Manager

5 Mental Health Counselor II

5

Psychiatric Caseworkers

1 Administrative Assistant

Nevada PEP Family To Family Support SpecialistSlide13

Mission Statement

MCRT strives to help Clark County children and adolescents live safely in their home and community.Slide14

ValuesRespond immediately to children and families during times of crisis.

Provide services that are family-driven, culturally competent, community based and consistent with Nevada System of Care principles.Assure safety and continuity of care through individualized strategies implemented by a wraparound-based, team approach.Slide15

Goals

Maintain youth in their home and community environment.Promote and support safe behavior in children in their home and community.

Reduce admissions to Emergency Departments due to a behavioral health crisis.

Facilitate short term in-patient hospitalization when needed.

Assist youth and families in accessing and linking to on-going support and services.Slide16

Who We ServeThe Mobile Crisis Response Team provides crisis intervention services for families of youth under the age of 18 who are having a behavioral health crisis and the behavior threatens the

child’s removal from the home, school, and/or community.Youth who are uninsured,

under-insured

or have Medicaid Fee For Services are eligible for servicesSlide17

Services ProvidedTelephone Triage:

Crises staff are available to provide support over the phone to assist in resolving or preventing a crisis situation. After an intervention screening, a referral will either be made to a community resource or the MCRT will respond.Slide18

Services ProvidedCrisis Response

If it is determined that further care and support is needed, a response team will be dispatched to the youth and family in crisis. The response team includes a Mental Health Counselor and a Psychiatric Case Worker. They will work to de-escalate the crisis by providing behavioral health intervention and support. The team will develop a crisis plan with the family and youth to facilitate safety.Slide19

Services ProvidedCrisis Stabilization

Short-term behavioral health intervention provided in or outside of the youth and family home. It is designed to assess, manage, monitor, stabilize and support the youth and families well-being. The team will develop an on-going safety plan with the child, family, and other support services.Slide20

Community PartnersClark County Children’s Mental Health ConsortiumClark County School District

University Medical Center Emergency DepartmentNevada PEPSlide21

Nevada PEP family support Services

Family Support:

Nevada PEP’s Family Support Service is a program devoted to supporting families in advocating for their children that have behavioral healthcare concerns.

This national model utilizes the System of Care Framework to deliver family driven, youth guided supports and services to increase successful outcomes at home, in school and in the community.

Family Specialists:

Family Specialists have gone through many of the same experiences as the families being served.

All of Nevada PEP’s Family Specialists are family members of children with mental, emotional and/or behavioral health care needs.Slide22

Nevada PEP family support Services

Family Specialists…Provide compassion and understanding of the unique experiences and needs of

their

child and family

.

Effective Family

Support

Components:

1

Informational/educational support

2

Instructional/skills development support

3

Emotional and affirmation support

4

Instrumental support – concrete service

5

Advocacy support

6

Leadership skill building at child and family

level and as at system levelsSlide23

Mobile Crisis Evidence Based Practices

Motivational InterviewingCrisis Assessment Tool (CAT)-used with permission from State of IndianaMobile Crisis Safety Plan – from Milwaukee MUTTBrief Solution Focused Family Therapy

Cognitive Behavior Therapy

Crisis Prevention and Response

Wraparound Slide24

PROGRAM EVALUATIONInformation Collected:

Crisis Assessment Tool Scores

Discharge Crisis Assessment Tool Scores

Risk Behavior Checklist Scores

Child and Adolescent Functional Assessment Score (CAFAS)

Discharge Plan

Consumer Satisfaction SurveySlide25

Program evaluation

Information collected at:Intake

Discharge

30-Day Post Discharge – Risk Behaviors Only

90-Day Post Discharge – Risk Behaviors Only

6- Month Post Discharge- Risk Behaviors OnlySlide26

Program evaluationCrisis Assessment Tool

Rated on a scale: 0 – No Evidence, 1 – History, watch/prevent, 2 – Recent, act, 3- acute, act immediately

Risk Behaviors

: Suicide Risk, Self-Mutilation, Other Self Harm, Danger to Others, Sexual Aggression, Runaway, Judgment, Fire setting,

Social Behavior, Bullying

Risk Behavior/Emotional Symptoms

: Psychosis, Impulse/Hyperactivity, Depression, Anxiety, Oppositional Behavior, Conduct, Adjustment to trauma, Anger Control, Substance Use Slide27

Program EvaluationCrisis Assessment Tool

Rating Scale: 0 - No evidence, 1 – History, watch/prevent, 2- Causing problems consistent with a diagnosable disorder, 3 – Causing severe and dangerous problems

Risk

Behavior/Emotional Symptoms

: Psychosis, Impulse/Hyperactivity, Depression, Anxiety, Oppositional Behavior, Conduct, Adjustment to trauma, Anger Control, Substance Use Slide28

PROGRAM EVALUATIONCrisis Assessment Tool

Rated on a scale of 0 – 3

(No evidence, history/mild, moderate, severe)

Functional

: Living Situation, Community, School, Peer, Developmental, Sleep, Medication Compliance

Juvenile Justice

: Juvenile Justice status, Community Safety, Delinquency

Child Protection

: Abuse or Neglect, Domestic ViolenceSlide29

PROGRAM EVALUATIONCrisis Assessment Tool

Rated on a scale of 0 – 3 (No evidence, history/mild, moderate, severe)

Caregiver Strengths and Needs

: Health, Supervision, Involvement with Care, Social Resources, Residential Stability, Access to Child Care, Family StressSlide30

Program Evaluation

Discharge plan:

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Sent to Stabilization Team

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Referred to Insurance

☐

Referred to Community Out-patient Provider

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Referred to Nevada PEP

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Referred to DCFS Provider

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Hospitalized

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Family Declined Additional Services

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No Services Needed

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Other

Intake CAFAS Score and Discharge CAFAS ScoreSlide31

Current statusTeam started taking calls January 6, 2014

MOU with UMC Completed February 3, 2014Numbers Served as of April 30, 2014

# of Telephone Triage Calls: 124

# of Crisis Response youth/families: 76

# of Stabilization youth/families: 43

# of Families receiving Family to Family Support: 39

# of In-Patient Psychiatric Hospitalizations: 6Slide32

Mobile crisis response teams

Questions????