As health care continues to focus on accountability for improved clinical outcomes, usage of lower cost services, improved public safety and a demand for positive client experiences, the importance of crisis services grows. With increasing attention to the value of crisis services, how do we support excellence? Financing, collaborative partnerships, standard operating procedures, current research, use of data and innovative technology are cornerstones of effective intervention delivery for hotlines, mobile teams and crisis stabilization. Come take an in-depth look into the tools and solutions available to quickly build the clinical, administration and financial supports to keep track with the new national focus.

1. Supercharge
Your Crisis Services
David W. Covington, LPC, MBA, Recovery Innovations

2. Supercharge – The Future is Pay for Value
Step 1:
Measure & ReportYour Cost
Impact

3. Innovation Awards

5. Creating a Model
• Data + Frameworks = Model
• Models are a dime a dozen… but you have to
have one.

7. Suicidal
Desire
•Suicidal Ideation- hurting self or others  Perceived burden on others
•Psychological Pain  Feeling Trapped
•Hopelessness/Helplessness  Feeling Alone
Suicidal
Capabilit
y
•History of Attempts  Available means
•Exposure to another person's suicide  Intoxicated/substance abuse
•History / current violence to others  Acute symptoms
Suicidal
Intent
•Attempt in progress  Preparatory Behaviors
•Plan to hurt self/other & method know  Expressed intent to die
Buffers
•Immediate supports  Engagement with helper
•Social supports  Ambivalence for living
•Planning for future/sense of purpose  Core values/beliefs
Are you thinking of suicide?
Have you thought about suicide in the last two months?
Have you ever attempted to kill yourself?
Three Key Questions
SAMHSA Suicide Risk Assessment Standards

8. Acuity Intensity (One or more of the following is present) Offer apt within:
Emergent A life threatening condition exists as caller presents:
 Suicidal/homicidal intent
 Actively psychotic
 Active withdrawal (Alcohol, Benzos, Barbiturates)
 Disorganized thinking or reporting hallucinations which may result in harm to
self/others
 Imminent danger to self/others
 Unable to care for self
For an Emergency Crisis:
 Immediately arrange to be seen
within 2 hours
 If suicidal/homicidal with weapon,
call 911/Police
 If active withdrawal, send to
nearest ER for medical clearance
Urgent  No suicidal/homicidal intent
 Denies suicidal plan/means
 Expresses hopelessness, helplessness, sense of burdensomeness, disconnectedness
disconnectedness or anger
 May develop suicidal intent without immediate help
 Potential to progress to need for emergent services
 May express distress/impairments that compromise functioning, judgment and/or
and/or impulse control
 May have withdrawal signs/symptoms from non-life threatening substances:
Cocaine, Methadone, Heroin
 Dependence on Alcohol, Benzodiazepines or Barbiturates, but not in active
withdrawal and no history withdrawal seizures or DTs
For Severe Situation:
 Offer an appointment within 24
hours (48 hours at the maximum)
 Instruct caller to re-contact CAC if
condition worsens
 May include crisis plan with
available supports
Routine  Impacts caller’s ability to participate in daily living
 Markedly decreased the caller’s quality of life
 Caller acknowledges some distress/concerns
 No evidence of danger of harm to self/others
 No marked impairments in judgment or impulse control
 Severity warrants assessment and possibly services
 SA issues with possibility of substance dependence
For Distressed Caller:
 Offer first available appointment
within five days
 Re-contact CCA if condition
worsens
Referral Only
(Non-Core
Customer)
 Presenting problems do not rise to clinical acuity required for state-funded services
services (which require Severe & Persistent Mental Illness)
 Offer appropriate referral or
resource
Warm-Line
(Support Only)
 Caller is already linked with community services and does not have urgent or
or emergent needs
 Encourage to contact current
provider
Information Only  No identified consumer for clinical triage; simply a request for basic information  Provide requested information
Business Call  Request for an administrative staff person or in regard to an administrative matter  Link to appropriate CAC staff

10. Research Assumptions #1
• In 2002, Hugo et al studied the difference
between hospitalization rates comparing a
community-based mobile emergency
service and a hospital ER-based emergency
service.
• They concluded, “Hospital-based
emergency service contacts were found to
be more than three times as likely to be
admitted to a psychiatric inpatient unit
when compared with those using a mobile
community-based emergency service,
regardless of their clinical characteristics.”

11. Research Assumptions #2
• In Roger Scott’s 2000 study in Psychiatric
Services, entitled, “Evaluation of a Mobile
Crisis Program: Effectiveness, Efficiency and
Consumer Satisfaction,” the conclusion
stated:
• “Fifty-five percent of the emergencies
handled by the mobile crisis team were
managed without psychiatric
hospitalization…, compared with 28 percent
of the emergencies handled by regular
police intervention, a statistically significant
difference.”

12. Mobile Crisis July 07
The Word Problem
N = 374

13. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374

14. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
$375 Per
Day

15. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
$375 Per
Day
Avg. 8 Days Per
Episode

16. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25%
$375 Per
Day
Avg. 8 Days Per
Episode

17. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
Day
Avg. 8 Days Per
Episode

18. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
Day
Avg. 8 Days Per
Episode
= Cost $804k

19. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
Day
Avg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
55

20. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
Day
Avg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585%

21. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
Day
Avg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585% = Cost $158k

22. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
Day
Avg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585% = Cost $158k

23. Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
Day
Avg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585% = Cost $158k
Savings $646k

27. Mix and Match
• Avoiding Costs Based Upon Baseline
Assumptions
– Escalations to Higher Levels of Care
– Lack of Throughput/Accessibility Prevents
Front-End Admissions (ED Costs)
– Lack of Capacity Due to Frequent
Readmissions

28. Supercharge – The Future is Pay for Value
Step 2:
ShowcaseYour Outcomes

34. Supercharge – The Future is Pay for Value
Step 3:
Use Recovery Language

35. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest

36. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room

37. Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat

38. Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby

39. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center

40. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity

41. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership

42. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Assessment Getting to Know Each
Other

43. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Assessment Getting to Know Each
Other
Psychosocial History Telling My Story

44. Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Assessment Getting to Know Each
Other
Psychosocial History Telling My Story