1. State of Indiana
Crisis Management System for Persons with Developmental Disabilities
Draft – December 16, 2005
Definition of Crisis:
• A behavioral or psychiatric emergency resulting in the need for immediate,
Persons Served by the Crisis Management System:
• The Crisis Management System will serve individuals ages 18 years and
older who have already been deemed eligible as persons with developmental
disabilities via the system established by the state, or who upon evaluation of
the crisis management vendor, are determined to likely be eligible based on
the state’s definition of developmental disability. This population includes
persons with dual diagnoses (i.e., developmental disability and mental illness
• It is recognized that periodically persons with developmental disabilities who
are younger than 18 years of age may be served by this system. Historically,
in these situations a referral has been made to the Bureau of Developmental
Disabilities Services (BDDS) as the person’s crisis needs were not able to be
met by the Division of Family Resources and/or the Department of Education.
Goal of the Crisis Management System:
• The goal of the Crisis Management System is to establish and implement a
multi-tiered Crisis Management System that is proactive to prevent crisis
situations from occurring, and provides responsive supports and services in
the least restrictive manner, thus enabling individuals with more challenging
issues to remain in the community in a more efficient and cost-effective
manner to the extent that funding is available.
• The Crisis Management System for persons with developmental disabilities
will be implemented by state contracted vendors, one in each of the three
geographical regions of the state of Indiana.
• A single vendor will be selected for each region. It is possible for a vendor to
be selected for more than one region.
• It will be that vendor’s responsibility to establish arrangements with
subcontractors, if necessary, to provide all required crisis management
services needed to serve persons with developmental disabilities in that
• These regions will be referred to as “North” (including the three most northern
Bureau of Developmental Disabilities Services (BDDS) districts in the state),
“Central” (including the three most central BDDS districts), and “South”
(including the two southernmost BDDS districts).
2. • The approved vendor will be selected via a Request for Services (RFS)
process. The term of the awarded contract will be three years, after which the
RFS process will be repeated. Continuation of the contract may be re-
evaluated if the performance measure outcomes are not achieved.
• The approved vendor will be responsible for providing services to the clients
of that region and will be required to meet the core service requirements
determined by the Division of Disability and Rehabilitative Services (DDRS).
• Key expectations for the crisis assistance vendor will include, but are not
limited to, the following:
o Employ or subcontract all personnel to provide the crisis assistance
o Manage the day-to-day operations of the Crisis Management System
for that region.
o Work collaboratively with the State Director of Crisis Assistance for
Persons with Developmental Disabilities. This individual will be
employed by the DDRS.
o Serve all persons with developmental disabilities in that region who
require crisis assistance services, related to both prevention of crisis
and appropriate intervention in the event of crisis. The focus will be to
maximize the opportunity for the client to remain in his or her least
restrictive living environment.
o Coordinate crisis management services with the client’s Individualized
o Provide crisis management services that support the client being
engaged in functional, meaningful, and purposeful activities.
o Provide the core services as required by the state, as well as additional
services deemed necessary by the vendor to successfully execute a
Crisis Management System in that region.
o Collect data required by the state.
o Achieve the quality/performance indicators established by the Division
of Disability and Rehabilitative Services and provide data within the
required timeframes to demonstrate compliance.
o Continually promote the availability of crisis management services
within the region to market how to access the Crisis Management
o Assess all possible funding options for a person in crisis, not only state
line item dollars allocated for crisis management services.
• As mentioned above, the Director of the Crisis Management System for
Persons with Developmental Disabilities will be employed by DDRS. This
position will provide direction, quality monitoring, and oversight to the regional
vendors in the provision of a Crisis Management System to ensure that the
desired outcomes are achieved for the system.
• The regional crisis assistance vendors will also work collaboratively with the
Director of Field Services and the field offices in their region.
3. Services Included:
o The approved vendor will provide training and education to providers,
families, and other community agencies serving persons with
developmental disabilities regarding strategies to appropriately prevent
and address crisis situations with persons who are developmentally
o The approved vendor will be required to offer a comprehensive training
program to all providers within the region. This comprehensive training
program must, at a minimum, cover the curriculum developed by
DDRS for crisis management. This training will focus on developing
the providers’ personnel to more effectively address behavioral needs
of clients with the goal of preventing the escalation of issues potentially
resulting in a crisis situation.
o The vendor will be expected to provide twelve training days in the
region per year.
o A “train the trainer” model is recommended to maximize the
transference of training information to personnel.
o Pre- and post-tests must be offered to participants to assess
competency following the training sessions.
o Focused training topics must include management of persons with dual
diagnoses and medication management.
o The vendor must be willing to offer distance learning and on-site
training options within their respective region.
o Vendors are also encouraged to partner and collaborate with other
agencies providing related training.
o The approved vendor will also serve as a resource of reference
material for providers and family members in that region, including
resource materials developed by the state.
• In-Home Technical Assistance:
o In-home technical assistance must be provided within 24 hours
(preferably sooner) of the request, seven days per week, 365 days per
o In-home technical assistance is required more quickly as deemed
appropriate from assessment of the crisis situation.
o A 24-hour telephone line must be provided by the regional vendor for
behavioral consultation, problem solving, supportive counseling, and
information and referral. If the call is not answered immediately, a
message must be responded to within 30 minutes of the call.
o In-home support visits will be provided by a behavioral clinician,
psychologist, psychiatrist, or other professional approved to
demonstrate the competence, as well as licensure/certification, to
serve in that role as defined in 460 IAC 6 and 7.
o Individuals providing behavioral consultation should have the
necessary expertise to grow and enhance the skills and abilities of
4. providers, assess and develop effective behavioral plans, and facilitate
implementation of such plans.
o Mobile outreach services must also be offered to a variety of settings
serving persons with developmental disabilities in that region including,
but not limited to, family homes, agency homes, the community, and
o Areas of service must include behavioral and psychiatric evaluation
o The approved vendor must employ, or contract with, a qualified
psychiatrist who is experienced in medication management for persons
with developmental disabilities.
• Out-of-Home Crisis Residential Services:
o The approved vendor must directly provide, or subcontract with
another provider in the region, out-of-home placement options. An out-
of-home placement option can be considered when a client is in a
crisis situation that threatens the safety and well-being of the
individual, housemates, persons in the client’s home, or other
individuals. This option should be offered only after other less
restrictive intervention has occurred. This placement is temporary. At
the time of out-of-home placement, a plan must be developed to
address the client’s immediate needs and incorporate strategies for
return to the person’s home environment or appropriate alternative
o This out-of-home placement option may include beds with a provider of
developmental disability services, a psychiatric unit in an acute care
hospital, or other alternative that is appropriately able to meet the
client’s needs. Even though this service may be subcontracted, it is
still the responsibility of the regional vendor to closely manage and
coordinate care for the client during that placement.
o Out-of-home placement options must be available in locked and
o The approved crisis management vendor must guarantee bed
availability in the event of an out-of-home placement need. Therefore,
arrangements with more than one provider may be necessary.
o During the out-of-home placement, care must be coordinated with the
Individualized Support Team (IST).
o As part of the out-of-home option, the vendor must provide transition
services into and out of this placement to facilitate timely transition to a
less restrictive home setting as soon as possible.
o Ongoing treatment and transition planning must also be coordinated
with the person’s provider prior to the out-of-home placement.
o Higher preference for vendor selection will be given to vendors that
offer out-of-home placement options in closer proximity to the person’s
residence and/or family, and that can also offer smaller settings.
5. o Transportation services between the person’s residence and the out-
of-home placement will not be required of the vendor, but will be a
desired optional crisis management service.
o Medication management must be coordinated between the out-of-
home placement, the provider to where the person is returning, and the
crisis management vendor to ensure continuity in the best interest of
the client, particularly if multiple prescribing physicians are involved
with the case.
o In the event that transition from the out-of-home placement to the
previous living environment is not appropriate, placement in a more
restrictive, institutional setting must be approved by the Director of
Crisis Management. The crisis management vendor has the authority
to approve an out-of-home placement for up to five days. This
placement will be reviewed and approved by DDRS within two
• Follow-Along Services:
o The vendor must have a system in place to provide follow-along
support services to a client and his/her support team following an out-
o Follow-along cannot be terminated until there is agreement by the
Individualized Support Team that the person is residing in the least
o Follow-along should also engage family members, as appropriate.
o Follow-along will not be funded beyond 90 days.
Performance Indicators for the Crisis Management Vendors:
• Respond to all “Crisis Hot Line” calls within 30 minutes, 24 hours per day, 7
days per week, 365 days per year
• Provide on-site visits in response to appropriate requests for in-home
behavioral consultation within 24 hours of the requests 100% of the time;
quicker response is required as deemed by the nature of the crisis
• Utilize state approved curriculums of best practice training materials and
implement a comprehensive plan for behavior management training of
providers and families in the region (including all FSSA providers)
• Develop and implement a plan for on-site training for agencies in the region
that experience a higher number of crisis management referrals
• Develop a complaint resolution process that demonstrates resolution of
complaints within 90 days
• Provide out-of-home crisis residential placement 100% of the time, when
• Through effective follow-along services, achieve a return-to-community rate
(following out-of-home placement) that is sustained for at least one year (Year
1 – 60% of total persons served in out-of-home placement; Year 2 – 70%;
Year 3 – 80%); thresholds may be re-evaluated based on data collection
6. • Achieve a satisfaction rating of at least 90% from a survey completed by the
providers and consumers/families in the region
• Develop and implement an outreach plan to promote the Crisis Management
System within the region to promote awareness of the crisis management
• Collect and analyze the cost of crisis services per person served
• Demonstrate compliance with all FSSA auditing procedures, BQIS guidelines,
and other applicable regulations
• Collect requested data and submit to the Director of Crisis Management at
DDRS in accordance with required timelines
• Work in coordination with all providers, case managers, BDDS district staff
and Director of Crisis Management
• Utilize, manage, and maximize resources to support individuals in crisis
• Vendor staff will participate in state approved training to be a provider of crisis
services and demonstrate competency
• Vendor will have staff available with credentials that will enable the vendor to
perform expert, high-quality supports and services that are considered best
practice and state-of-the-art above and beyond what the typical provider can
provide that will enrich the skills and abilities of providers such that they can
serve individuals with challenging issues
Data to be Collected by the Regional Vendors:
• Summary of the number of calls and average time allocated for “Crisis Hot
• Summary of in-home behavioral consultations and average time per
• Average response time between receipt of an in-home behavioral request and
the on-site consultation
• Number of cases, inpatient days per person, and location for out-of-home
• Summary of total units of service and type of services provided to each
• Summary and analysis of referrals, including location of individual, agency
serving individual, reason for referral, recommendations to systemically
resolve, and benefit
• Summary and analysis of outcomes for individuals, including ability to stay in
own home and placements to more restrictive settings that were prevented
• Number of persons referred for crisis services and served in an alternative
setting (not involving the crisis management vendor)
• Dollars spent for crisis management services per person served
• Average number of days in an out-of-home placement (including the setting)
• Collect data for reportable incidents to police/authorities to determine a
reduction in reportable incidents
• Collect data for persons with developmental disabilities who have been
inappropriately placed in jail, a psychiatric unit, or state operated facility
7. • Number of training sessions, including length of sessions and topics covered
• Number and names of persons who participated in training sessions,
including place of employment or family
• Number of persons with developmental disabilities who are in crisis that the
regional vendor is made aware have been (or are being) served by another
provider or agency (not facilitated by the Crisis Management team)
• Consumer satisfaction survey information
• Summary of complaints and associated resolution
• Track reduction in physical and chemical restraints (per client over time) as a
result of crisis management intervention
• Cost benefit information
All data is to be collected on a monthly basis, unless other direction has been
provided by the Director of Crisis Management at DDRS.
The Crisis Management Steering Committee emphasized the need to build a
database, including performance measures data and other data/statistics
collected. Monitoring and analysis of the data on an ongoing basis will be critical
to evaluate the desired outcomes and make modifications to the Crisis
Management System, as indicated.
The state reserves the right to add or delete data collection elements. The
vendors may also suggest data collection modifications.