How to Build a Level 5 Crisis System for Safer Communities
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Presentation for the National Action Alliance for Suicide Prevention Crisis Services Task Force, highlighting the Milbank Memorial Fund collaboration continuum modification for crisis systems.
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How to Build a Level 5 Crisis System for Safer Communities
- 1. DAVID COVINGTON, LPC, MBA How to Avoid Tragedies and Near Misses DAVID COVINGTON, LPC, MBA— RI INTERNATIONAL http://davidwcovington.com WENDY MARTINEZ SCHNEIDER, LPC— BEHAVIORAL HEALTH LINK
- 2. EXCELLENCE IN HEALTH INFORMATION TECHNOLOGY Supported by Qualifacts, Inc. Behavioral Health Link Atlanta, GA
- 3. 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% is a good target for aviation safety: A. True B. False
- 6. If US airports settled for a 99% 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. 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! The above continuum has been modified from the Milbank collaboration framework (original citation Doherty, 1995) for the purposes of evaluating crisis system community coordination and collaboration.
- 15. 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
- 16. 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
- 17. 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
- 18. http://bhlweb.com incorporates all five elements into a single shared online application
- 20. #1 – Intensive Referral Tracking Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 21. #2 – 24/7 Scheduling Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 22. #3 – Bed Inventory Census Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 23. #4 – High Tech Mobile Dispatch Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 24. #5 – Outcomes Dashboards Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 25. #1 – Intensive Referral Tracking Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 26. #2 – 24/7 Scheduling Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 27. #3 – Bed Inventory Census Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 28. #4 – High Tech Mobile Dispatch Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 29. #5 – Outcomes Dashboards Level 5 Crisis Intensive Referral Status 24/7 Outpatient Scheduling Bed Inventory Tracking High-tech, Mobile Dispatch Outcomes Dashboards
- 30. Referrals, 347Referrals, 261 Referrals, 3216 Referrals, 4360 Referrals, 4392AMTD, 592 AMTD, 547 AMTD, 316 AMTD, 277 AMTD, 166 FY2010 FY2011 FY2012 FY2013 FY2014
- 31. 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
- 32. Contact Us RI International CEO & President David.Covington@riinternational.com BHL CEO WSchneider@ihrcorp.com Social Networking http://davidwcovington.com http://davidwcovington.com
Editor's Notes
- Just a week earlier, his son “Guss” stabbed him 10 times and then ended his own life by suicide, an event that occurred the day following a mental health evaluation determined Guss needed more intensive services.
- The answer is E, all of the above. Mental health advocates have called for the first three (see Ron Manderscheid’s letter, for example). F is the wrong answer. Handwringing will no longer cut it. We must create robust, integrated crisis systems, and policy makers are requiring and funding it in increasing numbers. http://www.usatoday.com/story/news/nation/2013/01/07/newtown-shooting-mental-health-reform/1781145/
- Mental health and crisis intervention services feel an obligation to keep pressing forward, with great need in front of them, and a feeling they have neither the time nor resources to look back.
- The success of aviation safety is just not complicated.
- Often it takes several hours to get a denial even if the facility does not have any beds available- unnecessarily prolonging a referral
- The answer is D, 3x more likely. Scott (2000) and Hugo et al (2002) alongside data from the BHL Georgia Crisis & Access Line and mobile crisis response services suggest that diversion is 25% away from intrusive and costly higher end services without mobile crisis response, and 75% and higher with those services in place.