At the end of November in 2013, Virginia State Senator Creigh Deeds told CNN that he was alive for just one reason: to work for change in mental health. After tragic events like the death of Deeds' son Guss, we wring our hands and assume nothing can be done. Utilizing technology and the lessons of air traffic control can help drive innovative solutions to improve both the effectiveness and safety of crisis systems.

1. DAVID COVINGTON, LPC, MBA
How to Avoid Tragedies
and Near Misses
DAVID COVINGTON, LPC, MBA—
RECOVERY INNOVATIONS, INC.
http://davidwcovington.com

2. EXCELLENCE IN HEALTH INFORMATION TECHNOLOGY
Supported by Qualifacts, Inc.
Behavioral Health Link
Atlanta, GA

3. Wide Cracks in the Safety Net
At the end of November following the suicide of his
son “Guss,” Virginia Senator Creigh Deeds told CNN
that he was alive for a reason and that he would
work for change in mental health.

4. Polling Question #1
Virginia Tech, Columbine, Tucson, Aurora,
Newtown… We should do the following:
A. Double Mental Health System Capacity
B. Ban Assault Rifles Immediately
C. Dramatically Expand MH First Aid
D. Create Robust, Integrated Crisis Systems
E. All of the Above
F. None of the Above, as Tragedies Are
Unavoidable

5. Polling Question #2
99.9% is a good target for aviation safety:
A. True
B. False

6. If US airports
settled for a
99.9% success
rate for
commercial
flights, there
would be 300
unsafe take-offs
and/or landings…
per day!

7. Keeping Individuals from
Falling through the Cracks
Individuals walk out of an Emergency Department
“Against Medical Advice,” for example, and crisis
services shift their focus away to others.

8. We accept the
current system as
the best that can
be done… It is
not.

9. A Safety Net Requires
Accountability
Every time there is a Columbine, Tucson or Sandy Hook,
we grieve… and we wring our hands and consider
whether there is a better way. It is time to raise the bar
and innovate with solutions that will drive a different
set of results.

10. Learning from Air Traffic
Control Safety
“Flight 93” chronicled the heroic passengers of a
hijacked plane. It also gave an up close view of the
way air traffic control works to ensure the safety of
nearly 30,000 commercial flights… per day!

11. Two Key Principles of Safety
Goal #1: always
know where the
aircraft is and
never lose
contact;
Goal #2; verify the
hand-off has
occurred and the
airplane is safely
in the hands of
another.

12. Without Air Traffic Control
Principles
 Referrals are shotgun faxed to multiple facilities at once,
bogging down w/ paperwork when most will not admit
 The first facility giving acceptance is where the individual
goes without regard to how far away from family supports
 No accountability - no way to know if someone is stuck in
an ED unless the staff make noise (squeakiest gets grease)
 No one knows how many are being sent home w/o care
 Receiving facility staff may sift through all referrals, and
pick out the ones that will be easier in the milieu

13. Without Air Traffic Control
Principles (Continued)
 Almost all individuals are sent to the ED for medical
clearance, even if not indicated. No accountability for
using the ED as a holding cell
 Communication depends on numerous phone calls, faxes.
ED staff and crisis facility staff make and field numerous
phone calls about each case. If nurses at either facility are
busy, the other must wait for call backs. No time frames
are set for receiving facilities to give referral decisions
 There is no transparency around the census for inpatient
 Costly, invasive and time consuming medical tests are
often required unnecessarily

14. Referrals, 347Referrals, 261
Referrals,
3216
Referrals,
4360
Referrals,
4392AMTD, 592
AMTD, 547
AMTD, 316
AMTD, 277
AMTD, 166
FY2010 FY2011 FY2012 FY2013 FY2014

15. Modifying the Milbank Continuum
for Crisis Coordination
“Flight 93” chronicled the heroic passengers of a
hijacked plane. It also gave an up close view of the
way air traffic control works to ensure the safety of
nearly 30,000 commercial flights… per day!
Crisis Access, LLC has modified the Milbank
collaboration continuum (original citation Doherty,
1995) for the purposes of evaluating crisis system
community coordination and collaboration (see
table above).

16. A Level 5 Crisis System: Close
& Fully Integrated
In our model, the highest level requires shared
protocols for coordination and care management
that are “baked into” electronic processes, not
simply add-ons.

17. Polling Question #3
Which of the following elements are
required in a Level 5 Crisis System (select all
that apply):
A. Intensive Referral Tracking
B. 24/7 Scheduling
C. Crisis Bed Inventory Tools
D. High-tech Mobile Crisis Dispatch
E. Real-time Online Outcomes Dashboards

18. The Five Components of a
Level 5 Crisis System
For a crisis service system to provide Level 5 “Close
and Fully Integrated” care, it must implement an
integrated suite of software applications that
employ online, real-time, and 24/7:
Status
Disposition
for
Intensive
Referrals
24/7
Outpatient
Scheduling
Shared Bed
Inventory
Tracking
High-tech,
GPS-
enabled
Mobile
Crisis
Dispatch
Real-time
Perform-
ance
Outcomes
Dashboards

19. Polling Question #4
Without community based mobile crisis
services law enforcement and ERs will
hospitalize individuals:
A. The Same Amount as if Those Services
Were Available
B. Less Likely to Hospitalize
C. 2x More Likely
D. 3x More Likely

20. http://bhlweb.com incorporates
all five elements into a single
shared online application

21. http://bhlweb.com
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

22. #1 – Intensive Referral Tracking
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

23. #2 – 24/7 Scheduling
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

24. #3 – Bed Inventory Census
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

25. #4 – High Tech Mobile Dispatch
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

26. #5 – Outcomes Dashboards
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

27. #1 – Intensive Referral Tracking
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

28. #2 – 24/7 Scheduling
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

29. #3 – Bed Inventory Census
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

30. #4 – High Tech Mobile Dispatch
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

31. #5 – Outcomes Dashboards
Level 5
Crisis
Intensive
Referral
Status
24/7
Outpatient
Scheduling
Bed
Inventory
Tracking
High-tech,
Mobile
Dispatch
Outcomes
Dashboards

32. Polling Question #5
What are the benefits of a Level 5 Crisis
System (select all that apply):
A. Reduce Burden on ERs/Law Enforcement
B. Actionable Intelligence for Funders
C. Improve Transparency/Efficiency of
Referral Process
D. Reduce Unnecessary Phone Calls, Faxes
E. Informed Clinical Decision-making

33. Contact Us
CEO & President
David.Covington@recoveryinnovations.org
Social Networking
http://davidwcovington.com
http://davidwcovington.com