National Guidelines for Behavioral Health Crisis Care

National Guidelines for Behavioral Health Crisis Care ¨C A Best Practice Toolkit

Knowledge Informing Transformation

National Guidelines for Behavioral Health Crisis Care

Best Practice Toolkit

Page 1 of 80

National Guidelines for Behavioral Health Crisis Care ¨C A Best Practice Toolkit

Knowledge Informing Transformation

Acknowledgments

This document was produced for the Substance Abuse and Mental Health Services

Administration (SAMHSA), U.S. Department of Health and Human Services (HHS).

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced or copied

without permission from SAMHSA. Citation of the source is appreciated. However, this

publication may not be reproduced or distributed for a fee without the specific, written

authorization from the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at . Or, please call

SAMHSA¡¯s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English and

Espa?ol).

Originating Office Center for Mental Health Services Substance Abuse and Mental Health Services

Administration 5600 Fishers Lane, Rockville, MD 20857

Printed 2020

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National Guidelines for Behavioral Health Crisis Care ¨C A Best Practice Toolkit

Knowledge Informing Transformation

The National Guidelines for Crisis Care ¨C A Best Practice Toolkit advances national guidelines in

crisis care within a toolkit that supports program design, development, implementation and

continuous quality improvement efforts. It is intended to help mental health authorities, agency

administrators, service providers, state and local leaders think through and develop the structure

of crisis systems that meet community needs. This toolkit includes distinct sections for:

? Defining national guidelines in crisis care;

? Tips for implementing care that aligns with national guidelines; and

? Tools to evaluate alignment of systems to national guidelines.

In preparing this information, we could think of no one better to advise you than people who

have worked successfully with crisis systems of care. Therefore, we based the information in this

toolkit on the experience of veteran crisis system leaders and administrators as well as the

individuals and families who have relied on these supports on their worst days. The interviews in

this report¡¯s addendum showcase the diversity and richness of this expertise and experience.

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National Guidelines for Behavioral Health Crisis Care ¨C A Best Practice Toolkit

Knowledge Informing Transformation

Table of Contents

Forward ............................................................................................Page 7

Introduction .....................................................................................Page 8

Overview ........................................................................................Page 10

Core Services and Guidelines for Care ...........................................Page 12

Core Elements .......................................................................... Page 13

Crisis Call Hub Services .............................................................. Page 14

Mobile Crisis Team Services ....................................................... Page 18

Crisis Receiving and Stabilization Services.................................... Page 22

Additional Elements of a System of Care ..................................... Page 24

Crisis System Coordination......................................................... Page 25

Essential Principles.................................................................... Page 26

Unique Challenges Rural and Frontier............................................Page 35

Funding Crisis Care ......................................................................... Page 36

Crisis Service Coding.......................................................................Page 39

Assessing Adequacy of System Capacity ........................................Page 42

Care for All Populations Throughout Lifespan .............................. Page 42

Crisis Resource Need Calculator ................................................. Page 42

Indicators of Insufficient Capacity............................................... Page 43

Tips for System Implementation ....................................................Page 45

Workforce Development............................................................ Page 45

Technology in Crisis Care ........................................................... Page 47

System Evaluation Tools.................................................................Page 48

Monitoring System and Provider Performance............................. Page 49

Marketing and Communication Efforts ..........................................Page 51

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National Guidelines for Behavioral Health Crisis Care ¨C A Best Practice Toolkit

Knowledge Informing Transformation

Conclusion ......................................................................................Page 52

Continuous Quality Improvement..................................................Page 53

Case Study #1: ConnectionsAZ.................................................... Page 53

Case Study #2: RI International................................................... Page 56

Addendum......................................................................................Page 58

Interview 1 ¨C Wesley Sowers, MD............................................... Page 59

Interview 2 ¨C Sandra Schneider, MD, FACEP ................................ Page 61

Interview 3 ¨C Shelby Rowe ......................................................... Page 65

Interview 4 ¨C Ron Bruno ............................................................ Page 67

Interview 5 ¨C John Draper, PhD .................................................. Page 70

Interview 6 ¨C Nick Margiotta, Retired Detective........................... Page 72

Interview 7 - Anonymous Peer Recovery Coach ........................... Page 75

Visuals

Table 1 - Continuum to Evaluate Crisis Systems ........................... Page 25

Table 2 - Health Crisis Response Analogies .................................. Page 39

Table 3 - Crisis Service Coding .................................................... Page 40

Figure 1 ¨C Crisis Resource Need Calculator .................................. Page 44

Figure 2 - Crisis Facility Staffing Calculator................................... Page 46

Figure 3 ¨C Reliability Indicators Framework ................................. Page 55

Figure 4 ¨C Law Enforcement Drop-offs ........................................ Page 57

Figure 5 ¨C Fusion Model Centers Across States ............................ Page 58

Figure 6 ¨C Law Enforcement/Crisis Triage Tree ............................ Page 69

Contributors ...................................................................................Page 79

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