National Crisis Continuum Conference 2023

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. BH crisis services in the US are significantly underdeveloped, especially in comparison to other safety net services like EMS, fire, and police, and people experiencing BH emergencies too often end up boarding in EDs, incarcerated, or dying in fatal police encounters instead of getting the care they need. The presenters - a psychiatrist and police sergeant - will provide an overview of national trends in crisis care and how multiple catalysts - the new 988 crisis number, police reform movements, the pandemic and its associated relief packages - have converged to create an unprecedented opportunity for transformative change. To help clinical and policy leaders respond to this challenge, the presenters will provide an overview of the National Council for Mental Wellbeing’s Roadmap to the Ideal Crisis System: Essential Elements, Measurable Standards, and Best Practices and companion report Quality Measurement in Crisis Services. The presenters will provide an overview of the Roadmap using the Arizona crisis system as a real-world example of the principles in action including 1) core elements of the crisis continuum, 2) governance, financing, and accountability, 3) examples of collaboration with law enforcement and other community partners, and 4) strategies for using data to drive continuous system improvement.

Less than 20% of behavioral health practitioners use Measurement-Based Care. This is alarmingly low. It's unlikely you would choose to go to a cardiologist who treats people based on what they feel is best. You would choose a cardiologist who uses evidence-based, researched interventions to treat your heart condition. This presentation will highlight why behavioral health practitioners must commit to legitimizing behavioral health treatment through strategic implementation of Measurement-Based Care. MBC increases legitimacy of the field, reduces stigma, reduces readmissions, aligns with payor requirements which results in fewer claw backs, enhances the clinical decision-making process, is feasible to implement on a large scale, and most importantly improves patient health outcomes. Participants will leave the presentation with ideas on how to contribute to the legitimacy of the behavioral health field and implement MBC into their practice.

The essence of 'continuum of care' thrives on the understanding and application of historical lessons, on-going care methodologies, and the anticipation of future needs. "Before their time: Lessons in Crisis Intervention from The Great War to Coconut Grove" embraces this ethos, focusing on the evolution of crisis intervention strategies and how they continue to shape the crisis care continuum.

The presentation will weave through a historical narrative, starting from the crisis intervention methods applied to soldiers during The Great War (WW1) and culminating at the disastrous Coconut Grove nightclub fire in 1942. We aim to dissect the strategies used, and how they have since influenced the crisis intervention landscape.

Our presentation will provide an in-depth analysis of these events, extracting crucial lessons that can enhance the understanding and capability of current crisis service providers. Moreover, we'll discuss how these past events have contributed to the development of modern intervention strategies that underpin the crisis continuum of care."

With the advent of 988 and continuing expansion of the service and continuum of crisis care, the need for counselors has exploded. Many of them are newer and will frequently encounter opportunities for growth. Feedback can be challenging to accept and occasionally more difficult to offer, especially to newer staff who care deeply about and take responsibility for client outcomes. As one of the largest 988 National Backup centers, CommUnity has maintained high quality assurance outcomes through the expansion, largely due to the culture of feedback we have developed and maintained. This workshop will give crisis service providers a framework for developing a similar culture of feedback and counselor improvement by exploring the philosophy behind this culture, the core values of centers, and the challenges to maintaining such a culture.

According to a research summary published by the National Deaf Center (2019) Deaf people are at increased risk for a number of mental health concerns compared to hearing individuals. In a 2016 Brief issued by the National Association of State Mental Health Program Directors, one study cited that more than 4 out of every 10 people who are deaf will attempt suicide a one point in their life and more than half will consider it. Among the risk factors cited in the National Deaf Center summary, a lack of communication access within the family and medical and behavioral healthcare settings, and within other traditional social support systems, are barriers that start at a young age and become pervasive throughout life. These barriers are also present within the fields of crisis and suicide prevention. Suicidality within the Deaf community is vastly under-studied, and crisis services specific to supporting Deaf or Hard of Hearing children, youth, and adults are rare and can be difficult to access throughout the U.S. People who are Deaf or Hard of Hearing represent a significant portion of the American population. The National Institutes of Health reports that approximately 15% of American adults aged 18 and over report trouble hearing, while the Hearing Loss Association of America estimates that approximately 48 million Americans of all ages have some degree of hearing loss. Within these figures, according to the 2011 American Community Survey (the most recent year for which data is available from the U.S. Census Bureau) about 3.6% of the U.S. population (11 million people) consider themselves Deaf or have serious difficult hearing. According to Gallaudet University, up to 500,000 youth and adults in America use American Sign Language (ASL) as their primary or preferred language. The exact number of ASL users is unknown, as ASL is not included in the enumeration of languages of the U.S. Census. The American Community Survey estimated that ASL is in the top third of all languages used in the United States. In response to these identified needs, Vibrant Emotional Health, with funding from the U.S. Substance Abuse and Mental Health Services Administration and in partnership with crisis center DeafLEAD, launched the Disaster Distress Helpline Videophone (DDH VP) in May 2021, offering a 24/7 direct connection to trained DDH crisis workers fluent in American Sign Language (ASL). In over two years since the launch of the DDH VP, Vibrant and DeafLEAD have worked to establish best practices in providing emotional care, crisis support, and suicide prevention over videophone, and to reaching the Deaf and Hard of Hearing (HH) communities through strategic marketing and communication strategies. This presentation will feature an overview of DDH VP operations, including lessons learned and identified best practices that is being applied to scaling the service to the 988 Suicide and Crisis Lifeline and which crisis and suicide prevention providers across the U.S. can apply to their own models of accessible, comprehensive service delivery. DeafLEAD, the crisis center partner that receives and responds to DDH VP calls 24/7, will present case scenarios from crisis contacts related to various mental health concerns and the Vibrant Marketing and Communications team will present on challenges and identified solutions to connecting with Deaf/HH communities in promoting the service as a trusted resource for crisis counseling and emotional support.

Benchmark Human Services is excited to propose an engaging panel discussion offering valuable insights into the complexities of operating crisis services from the perspective of mobile crisis teams. This session will bring together three distinctive mobile crisis programs operating in Georgia (GA), Oklahoma (OK), and Indiana (IN). Each program represents a different state, size, stage, and set of challenges, providing a rich and diverse perspective on starting and running mobile crisis services.

Our panel of experts will highlight the unique challenges and successes faced by each mobile crisis team, offering valuable insights and practical strategies for providers across various contexts. They will provide attendees with valuable insights into staff structures, team operations, and leadership practices. Furthermore, panelists will suggest approaches to adapt to technological advancements, emerging trends, and evolving needs. By examining the similarities and differences among the teams, participants will gain a deeper understanding of the complexities involved in the provision of mobile crisis care.

In addition to these key themes, our panel discussion will also delve into serving special populations in crisis, including individuals with intellectual and developmental disabilities (IDD), tribal populations, veterans, and residents of rural areas. Attendees will gain insights into tailored approaches and best practices for delivering crisis care that is inclusive, culturally sensitive, and accessible to diverse populations.

Our goal is to deliver a panel discussion that is dynamic and interactive, featuring engaging discussions, real-world examples, and opportunities for participants to ask questions. Discover innovative strategies, gain practical insights, and connect with fellow professionals in a collaborative environment. Participants will leave with actionable ideas to elevate their crisis care provision and hopefully make a lasting impact in the crisis care community!

The essence of 'continuum of care' thrives on the understanding and application of historical lessons, on-going care methodologies, and the anticipation of future needs. "Before their time: Lessons in Crisis Intervention from The Great War to Coconut Grove" embraces this ethos, focusing on the evolution of crisis intervention strategies and how they continue to shape the crisis care continuum.

The presentation will weave through a historical narrative, starting from the crisis intervention methods applied to soldiers during The Great War (WW1) and culminating at the disastrous Coconut Grove nightclub fire in 1942. We aim to dissect the strategies used, and how they have since influenced the crisis intervention landscape.

Our presentation will provide an in-depth analysis of these events, extracting crucial lessons that can enhance the understanding and capability of current crisis service providers. Moreover, we'll discuss how these past events have contributed to the development of modern intervention strategies that underpin the crisis continuum of care.

Crisis event case management and care coordination are critical elements of crisis response service provision. There is an inherent risk of cyclical crisis recurrence for service recipients if we are mistargeting, mistiming, and making “wrong-fit” referrals driven by system availability.
Abstract:
This session will invite the exploration of innovative approaches to crisis intervention by focusing on strategies for providing comprehensive care coordination and closed-loop referrals across the Sequential Intercept Model. Crisis intervention service providers are crucial in helping individuals navigate acute distress. However, to truly support individuals in crisis, it is imperative to ensure they receive continuous, coordinated care across the entire spectrum of services, including a focus intervention as key to prevention through appropriately identified response and referrals, commitment to least-restrictive and co-engaged/co-created service models, and solid post-crisis support. Building systems of care that utilize a targeted and applied service model to fit the needs of individuals as opposed to one size, “bulk” service application can see reductions in crisis re-emergence and find gains in quality of care through increased client stability. This presentation will explore practical strategies and best practices for delivering full-range care coordination and closed-loop referrals within the context of the Sequential Intercept Model."
Part one will explore the philosophical considerations that help counselors be readily able and willing to accept and implement feedback, namely the Hegelian Dialectic and Epistemic Humility. These foundational considerations make consistent application of a feedback process possible while simultaneously allowing for rapid identification of program needs and implementing change as needed.

In part two, participants will identify cultural values central to their organization, and discuss strategies for consistently utilizing those values when offering feedback. We will describe our key values of humility, curiosity, and collaboration and how they are implemented into a feedback process.
Finally, we will discuss challenges that appear during a feedback process, share our experience maintaining quality over the expansion in spite of these difficulties, and brainstorm with participants ways to navigate challenges to feedback acceptance and upholding chosen values.

By having a thoughtful and consistent framework, a culture of commitment to acceptance of feedback can emerge, fostering improved outcomes for clients and increased competence and confidence for staff.

Peer respites have tripled in numbers over the last decade. Nonetheless, going from 12 to around three dozen scattered across a handful of states means peer respite remains inaccessible to the vast majority of people across the nation. Furthermore, in the absence of recognized national standards, adequate information and resources, well-intended funders have frequently proposed "peer respites" that bear little resemblance to the original vision and lack the framework to fully realize their potential as crisis alternatives.

This session will explore the importance of continuing to expand the availability of peer respite while also establishing national standards and fidelity tools that will help ensure the best possible outcomes and avoid co-optation. This will include an overview of the basic anatomy of a peer respite as presented by individuals operating exemplary peer respite models in North Carolina, Massachusetts, and Wisconsin. It will also include a discussion of common pitfalls, lessons learned, steps taken to reach marginalized communities that are most impacted by disparities in access, tips for allies, and how supporting peer respites to meet fidelity stands to benefit us all.

Peer Respite is becoming an essential part of building systems of hope and healing. In the words of Pat Deegan, "Help isn't help if it doesn't help."

This session is an invitation for us all to come together to ensure our help not only helps, but that we are truly doing all we can to make a difference in the lives of people who are struggling most."

The focus of this presentation will be on the structure of a follow-up conversation and clinical best practices for supporting individuals in the moment during a follow-up contact with particular attention to the aspects of care coordination. Engaging in care coordination with persons enrolled in a follow-up program is an integral part of helping individuals connect to and navigate the crisis care continuum. We will aim to explore what a conversation about care coordination looks like in the context of a short-term intervention such as the follow-up program of a crisis contact center and special considerations for connecting youth and other populations to appropriate care. We will also discuss how to overcome challenges when attempting to connect individuals to other services within the crisis care continuum and look at how monitoring these connections can inform the need for increases or adjustments to funding.

Austin's diversion program started in December 2019 through a partnership with Integral Care, the Local Mental Health Authority, and Austin Police Department under the direction of Austin's City Council to place a Mental Health Triage Specialist on the 911 floor at Austin's 911 Call Center. The Mental Health Triage Specialist is an integral part of a collaborative team at the 911 call center working closely with Austin Police Department, Travis County Sherrif's Office, and Austin Travis County EMS (ATCEMS). The program's mission is to divert police by connecting individuals who call 911 in a mental health crisis to appropriate community-based resources. The Mental Health Triage Specialist is embedded on the floor of the 911 Call Center and plays a key role in the implementation of this mission. The primary responsibilities of the position include screening, assessment, triage, consultation, de-escalation, follow-up telephone calls, and provision of referrals. The Mental Health Triage Specialists also have an option to provide face-to-face crisis assessments alongside the Expanded Mobile Crisis Outreach Team response team and/or ATCEMS Community Health Paramedic team. Clinicians are trained to use evidenced-based interventions and utilize a trauma-informed, person-centered, and equitable approach when speaking with callers. This is a 24/7 program, and employees are considered essential staff. Employees work under the supervision of licensed clinicians. In February 2021, Austin added "Mental Health" as the 4th option when calling 911 allowing the community to directly advocate and request mental health support. Please join us as we share the planning, implementation, challenges, data and successes of this program.

Crestwood Behavioral Health is a California leader in peer services and Freise Hope House in Bakersfield, one of our 28 sites, stands out as a flagship for peer-operated crisis residential services. We are committed to creating innovative recovery programs and developing compassionate communities. Our services support each guest to recover with an enhanced sense of resilience by providing a wide range of wellness tools, peer providers, behavioral health providers, and natural supports. Our unique approach focuses on a deeply personal and self-directed process, empowering our guests to move through a crisis and maximize their lives and obtain a sense of balance well-being and fulfillment. We have adapted Dialectical Behavior Therapy to our peer-operated program. Honoring the preservation of each person's self-respect and dignity, Crestwood's culture strongly embraces the values of family, compassion, commitment, enthusiasm, collaboration, flexibility, character, and creativity. These values drive the work we do daily on all our campuses. Our peer staff members embody these values and serve as the foundation for our programs and services. We strongly believe that our partnerships with guests, their families, our staff, and the community are vital to the success of our programs and services. And ultimately, are the seeds of recovery to help our clients develop the skills they need to build resiliency and thrive in their lives.

Dialectical Behavior Therapy is part of Crestwood's Recovery Treatment Model. It is an evidence-based practice that has been adapted to residential settings and has been proven effective with a broad range of behaviors that can interfere with reaching personal goals. Crestwood has done a further adaptation to provide DBT treatment in our Crisis Residential program delivered by Crestwood Peer Counselors. We will review our adaptation and training model.

In 2020 in the United States, there was a suicide every 11 minutes. The COVID-19 pandemic and social justice reckoning continue to exacerbate previous vulnerabilities among underserved youth and adults and have resulted in new suffering for individuals; all of which culminates in a mental health crisis that demands a 24 hours/7 days a week /365 days a year mobile crisis solution. Crisis Response Programs are growing and developing all over the nation.

Communities are quickly realizing that services like mobile crisis response are not only beneficial to communities but are as essential as traditional emergency services such as police, EMS, and firefighters. As Crisis programs continue to gain traction as a necessary service, the
landscape of crisis service provision also continues to change. This workshop will share two providers’ perspectives from Baltimore County, Maryland (The Sante Group) and Los Angeles County, California (Sycamores) on how they have adapted crisis services to meet the needs of their respective communities. Because every community has different needs, focal areas, target populations, and available funding; crisis care models must be flexible, varied, inclusive, and responsive. This workshop will explore tools and techniques that can be utilized to scale a mobile crisis program quickly, while ensuring quality care and measurable outcomes. Sante and Sycamores will share their lessons learned and growth strategies used to operate their crisis programing.

Austin's diversion program started in December 2019 through a partnership with Integral Care, the Local Mental Health Authority, and Austin Police Department under the direction of Austin's City Council to place a Mental Health Triage Specialist on the 911 floor at Austin's 911 Call Center. The Mental Health Triage Specialist is an integral part of a collaborative team at the 911 call center working closely with Austin Police Department, Travis County Sherrif's Office, and Austin Travis County EMS (ATCEMS). The program's mission is to divert police by connecting individuals who call 911 in a mental health crisis to appropriate community-based resources. The Mental Health Triage Specialist is embedded on the floor of the 911 Call Center and plays a key role in the implementation of this mission. The primary responsibilities of the position include screening, assessment, triage, consultation, de-escalation, follow-up telephone calls, and provision of referrals. The Mental Health Triage Specialists also have an option to provide face-to-face crisis assessments alongside the Expanded Mobile Crisis Outreach Team response team and/or ATCEMS Community Health Paramedic team. Clinicians are trained to use evidenced-based interventions and utilize a trauma-informed, person-centered, and equitable approach when speaking with callers. This is a 24/7 program, and employees are considered essential staff. Employees work under the supervision of licensed clinicians. In February 2021, Austin added "Mental Health" as the 4th option when calling 911 allowing the community to directly advocate and request mental health support. Please join us as we share the planning, implementation, challenges, data and successes of this program.

The State of Georgia transformed its crisis system using technology to streamline assessment, treatment, and referrals as well as maximizing our workforce to meet the rising demand in services related to 988. The system ensures collaborative interaction from the call center, mobile crisis teams, and crisis beds or chairs to ensure individuals have access to available resources when needed. Utilization of this system has created a rich source of data that is being used to inform a crisis bed study which is expected to project crisis services needs across the state for years to come.