National Guidelines for Behavioral Health Crisis Care

National Guidelines for Behavioral Health Crisis Care ? A Best Practice Toolkit Knowledge Informing Transformation

National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit

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National Guidelines for Behavioral Health Crisis Care ? 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 ? A Best Practice Toolkit Knowledge Informing Transformation

The National Guidelines for Crisis Care ? 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 ? 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 ? 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 ? Wesley Sowers, MD............................................... Page 59 Interview 2 ? Sandra Schneider, MD, FACEP ................................ Page 61 Interview 3 ? Shelby Rowe ......................................................... Page 65 Interview 4 ? Ron Bruno ............................................................ Page 67 Interview 5 ? John Draper, PhD .................................................. Page 70 Interview 6 ? 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 ? Crisis Resource Need Calculator .................................. Page 44 Figure 2 - Crisis Facility Staffing Calculator................................... Page 46 Figure 3 ? Reliability Indicators Framework ................................. Page 55 Figure 4 ? Law Enforcement Drop-offs ........................................ Page 57 Figure 5 ? Fusion Model Centers Across States ............................ Page 58 Figure 6 ? Law Enforcement/Crisis Triage Tree ............................ Page 69

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

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