Crisis Prevention, Planning and Resources West Virginia Department of Health and Human Resources

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Crisis Prevention, Planning and Resources West Virginia Department of Health and Human Resources

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Title: Crisis Prevention, Planning and Resources West Virginia Department of Health and Human Resources

1
Crisis Prevention, Planning and Resources
West Virginia
Department of Health
and
Human Resources
Division
for Developmental
Disabilities
2
What are Crisis Services?

? Crisis Services Network
? Crisis Services Program

Individualized planning services to improve the
continuity of care, reduce the impact of stress
and increase access to resources according to
person specific needs and choices
3
What are behavioral health goals?

To enhance the quality of life
To maintain strengths of people
To reduce risks to health and safety during
crisis
To increase adaptive responses
To renew hopes and dreams
To support positive communication
To collaborate between individuals, families and
providers

4
What are types of crisis?

Medical
Psychological
Environmental
Social
Behavioral

5
When is a Person having a crisis?

When an individuals behavior is dangerous to
themselves or others
The persons behavior has compromised the ability
of caregivers to provide support
When the person needs relief from their situation

6
What does the Crisis Services Program do?

? Responds to a statewide need for
- more resources
- relief for providers
- stabilization of difficult cases
- transitional assistance
- technical assistance for difficult
cases
- identification of unmet needs

7
What is the role of the State Crisis Services
Coordinator?

Provides oversight and support for crisis sites
Maintains data base regarding crisis resource
utilization
Provides technical assistance
Collaborates for continuity of care among various
providers
Helps build access to resources

8
2007-2008 Changes in WV Crisis Services

Addition of 3 adult beds at the Starlight Orion
facility
Addition of 3 adult beds at REM of Bridgeport
facility
Collaboration with the Bureau for Children and
Families
State level approval for extended stay

9
Crisis Planning

Supports the development of individualized
crisis
plans including elements of
PREVENTION
INTERVENTION
RESPONSE
RECOVERY

10
Crisis Plan Purposes

Reduce impact of stressful situations to assist
with behavioral stabilization or recovery

2. Provide guidelines for organized teamwork to
benefit persons with developmental disabilities

11
Team Guidelines

Focus on the persons needs, hopes and wishes
using observation and inquiry
Use comprehensive assessments
Ground decisions in baseline data
Share ideas with the team before implementation
Gain consensus and ownership of tasks
Facilitate communication and choice

12
Team Guidelines

Respect all team members input
Increase choices and options
Teach positive and adaptive learning and
behavioral support skills
Avoid antecedents and triggers
Create structure and trust to promote success
Set clear boundaries, limits, and expectations
Provide accurate information
Monitor body language
Check for unmet needs

13
Content of a Crisis Plan

The Crisis Plan must be
1) clear and concise (easy to recall
in emergency)
2) easily understood by all
3) mutually agreed upon by all

14
Content of a Crisis Plan

Contains methods for prevention, intervention,
and recovery
Describes roles/chain of command
Sets explicit directives for procedures
Coordinates collaborative responses between
agencies
Provides protocol for consistent intervention
Ensures staff training as per individual needs

15
Content of a Crisis Plan

Prioritizes risk areas
Provides alternatives or replacements to avoid
more restrictive interventions such as mental
hygiene petitions
Specifies what to do if police become involved or
community members try to intervene
Lists strategies to calm person or redirect
Provides call down list of at least 3 numbers for
staff to call in when de-escalation techniques do
not work

16
What is Crisis Prevention?

Proactive and comprehensive planning
Designing ways to protect an individuals current
and future security
Prioritizing areas for readiness
Reducing and eliminating risks

17
Use the Least Restrictive Interventions Possible

Exhaust less restrictive options BEFORE
increasing the restrictiveness or intrusiveness
of an intervention such as referring for a crisis
respite bed.
Determine how order and routine can be recreated
before, during and after the crisis

Refer for routine respite
Ensure safety
? Potomac Center
? Specialized
Family Care
? Natural Supports

18
How can crisis be prevented?

? Listen to the person
? Offer frequent choices
? Look for meanings
? Examine historical patterns
? Be alert during transition
? Train care providers
? Prepare action plans
? Clarify roles

19
How can crisis be prevented?

? Build on strengths
? Consult with therapists
? Recognize antecedents or predictors
? Balance structure with empowerment
? Use evidence based supports
? Avoid power struggles

20
How can crisis be prevented?

? Use positive teaching strategies
? Honor the frequency of positive or adaptive
behaviors with less emphasis on the
less desirable ones
? Use a comprehensive approach
? Use the least restrictive intervention possible
? Teach methods for success
? Focus on what is positive and possible

21
Preventive Action Steps

Schedule special team meetings
Update assessments
Request technical assistance from CED at WVU or
other places like the WV Autism Training Center
Revise the positive behavior support plans

22
Preventive Action Steps

Add in-home supports
Reduce demands
Structure opportunities for relaxation
Add new training, counseling, or resources
Add more functional activities and/or structure
to daily routine

23
Prevention VS. Intervention

Prevention is PROACTIVE.
- keeps the crisis from happening by
implementing
deliberate and positive strategies
Occurs Before and May Replace the Active Crisis
Phase.
Intervention is REACTIVE.
- buys time to reduce the immediate impact of a
situation
Occurs During the Active Crisis Phase.

24
Action Steps for Intervention

Hold emergency team meetings to explore all ideas
and options
Fade intensity or duration of task
Schedule immediate outpatient evaluations
Remove stressors
Divert attention
Look at meanings

25
Active Intervention

Problem Solving depending on situation
Reality Testing
Avoid increasing stress or conflict
Pay attention to detail
Re-establish psychological homeostasis ASAP
Offer palliative care.. Water, warmth...comforts
Treat it as a learning opportunity
Ensure bridges are built

26
Intervention PlanComponents

Measurable description of all four stages.
Deadlines and responsible parties.
Incorporated at all steps of overall planning.
4. May be attached as a stand alone document.
For example, natural disaster, loss of
caregiver, housing issue, seasonal
pattern or holiday.

27
DONT FORGET

? Ask for help look at what can be done
? Consult with the Center for Excellence in
Disabilities and related therapists
? Protect rights
? Human Rights Committee approval
? Review individual histories
? Facilitate communication
? Value all team input
? Plan for Futures Planning

28
Accessing General Behavioral Health and
Crisis Services

Regional behavioral health centers serve as
gateway for general behavioral health services
Begins with assessment for eligibility
Routine services can prevent crisis situations
May begin with Early Intervention/Birth To Three
Providers or protective services

29
Targeted Case Management

Appalachian Community Mental Health Center
Richard Kiley
Autism Service Center Tom Napier
ARC of Three Rivers Sherman Meadows
Eastridge Dena Goetz
Logan Mingo Tahnee Bryant
Potomac Highlands Guild Mike Landiss
Res Care Wayne Halstead
Valley Health Care Chuck Penn

30
Crisis Services Program

If the team can not support the persons
individual needs for health and safety, a
temporary crisis respite house admission may be
available.

31
Who is Eligible for MR/DD Crisis Services?

Anyone (adult or child) with Mental Retardation
or other Developmental Disability
Must be experiencing a crisis situation as the
result of environmental, behavioral, or
psychiatric complications.
May have a co-existing condition of Mental
Illness or Substance Abuse if MR/DD Crisis
Services are deemed appropriate

32
Screening Information

Client name/age
Responsible parties/Guardianship
Diagnoses/Medical Status/History
Level of required supervision
Funding source
All available evaluations
Ensure medical causes have been ruled out
Expected Living arrangement/Discharge Plan is
crucial

33
Key Considerations in Determining Admission

Is there a less restrictive alternative?
Can this site meet the needs of the referred
individual?
Can safety be assured at this site for all?
Will team expectations be met?
Is the discharge plan reliable?
Has adequate information been provided?

34
Plan for Discharge and Recovery

Represents resolution of the crisis situation
Baseline stabilization/steady state
Effective plan for adjustment/transition
Looks at any lessons learned
Recovery is Pre-Planned and adapted as needed
according to specific circumstances of real time
crisis

35
Basic Information for WV MR/DD Crisis Services
Coordinators
36
LENGTH OF STAY?

Maximum 30 day stay
Voluntary only
Not intended for routine respite
DISCHARGE PLANNING MUST BEGIN BEFORE ADMISSION

37
Approval for Extensions Above 30 Days

Only the CRU Coordinator can submit a request for
extension to OBHS.
Time frames for extensions will be based on
Crisis Sites recommendation.
The CRU Coordinator will require evidence that
the discharge plan is proceeding and can be
accomplished.
Requests for extension should not assume
automatic approval.

38
Pre-Admission Arrangements

Behavioral health team and Crisis Site approval
Service plan addendum/crisis plan that identifies
services to be provided during stay
Written behavioral protocol/positive behavior
support plan
Compliance with Change in Community Residence
Policy/8114
Transportation to the Crisis Site

39
Service Coordinator Responsibilities

Tell the person what to expect
Coordinate linkages among all involved
Schedule and facilitate 72 Hour Meeting/Policy
3181
Facilitate Consent for Medical Treatment
Supply proof of funding, and agency contact
information
Call and/or visit the Crisis Site at least weekly
to check on the individuals progress
Ensure emergencies are handled by emergency
services providers

40
CRU Coordinator Responsibilities

Pre-determine suitability for admission
Provide decision within 24 hours
Debrief the participant upon arrival
Maintain a basic routine consistent with the
persons customary routine
Facilitate referral to Center for Excellence in
Disabilities
Provide technical assistance for successful
outcomes discharge
Complete requests for approval of extended stay
when necessary

41
Personal Possession Inventory

30 days worth of medications in original
container
Physicians orders
Copy of medical card/insurance card/billing auths
Change of clothes for 30 days (Will have use of
washer/dryer)
Spending money.
All personal hygiene items.
Specialized medical equipment such as inhaler,
Epi-Pen, sleep apnea machine.
Other comfort items

42
ROLE OF CED at WVU

Provide positive behavioral support consultation
Train agencies, individual teams, and family
members to improve reinforcement, use positive
behavioral support, and futures planning
Facilitate team building skills
Increase cross-environmental consistency

43
MR/DD Crisis Respite Houses

Current Resources include
- 8 childrens beds
-15 adult beds
? Informal and formal statewide systems of
collaboration
? Provides intensive behavioral evaluation,
nursing and oneone ratios as needed

44
Childrens Crisis Services

Potomac Center- 3 beds in Hampshire Co.
EYES Shelter- 5 beds in Raleigh Co.
Services are accessed via each agency, or thru
referral from local DHHRs, your local behavioral
health centers, and hospitals
Behavioral health center assessment is needed

45
Adults Crisis Services

Starlights Orion- 3 beds in Cabell County
Southern Highlands- 3 beds in Mercer County
REM-3 beds in Pleasants County
REM-3 beds in Harrison County
REM-3 beds in Mineral County

46
Discharge Destinations

Begins before admission to any crisis respite
site
Natural Family Homes
Specialized Family Care/Foster Care
Group Homes
Personal Care Homes
Skilled Nursing Facilities
Individualized Support Settings/Assisted Living
Title XIX MR/DD HCB Waiver Program Graduates may
apply for transitional supports

47
DHHR Review Funding Sources

Long Term Care Medical Assistance Children with
Disabilities Community Service Programs
Home and Community Based Waivers
?Aged and Disabled
?Mentally Retarded/Developmentally
Disabled
? CAPS assessment thru DHHR (for kids)
? Family Support Stipends
? Personal Care/Medicaid/Room Board Payments
thru the Bureau for Children and Families

48
Intermediate Care Facilities
Group Home Providers