EXTENDING THE REACH: Collaborations with Emergency Departments and Approaches for Hospital Diversion

EXTENDING THE REACH: Collaborations with Emergency Departments and Approaches for Hospital Diversion

Crisis Services Buffalo, NY Erie County s Safety Net since1968 Crisis Counseling Program Advocate Program Emergency Mental Health Response Services One-stop shop for crisis intervention services

Crisis Services Diversionary Services Emergency Mental Health Response Services Mobile Outreach Program CIT Training Project CIT Crisis Case Management Mobile Transitional Support Team Crisis Residential and Interim Visits Partnering with Emergency Department Law Enforcement Mental Health Agencies Inpatient Peers - Shelters

Mobile Outreach Program Provide emergency mental health evaluations for individuals at risk of psychiatric hospitalization Symptoms of mental illness + Danger to self of others Hospital diversion program Designees for involuntary transport Teams of two, partnered with law enforcement about 30% of the time Diversion rates 71% Admission rates 72% Response times 30 minutes 20% Four hours 36% Same day 68%

Mobile Outreach Program Diversion Diversion Diversion

Mobile Outreach Program Partnership with ED Contractual funding arrangement Biweekly Operational Meetings PMHCP representation Data sharing Transfer process at ED Access to hospital EMR

Crisis Intervention Team (CIT) Training Project Mental health training Communication and de-escalation training Focus on collaboration with community partners Collaboration with Crisis Services

Crisis Intervention Team (CIT) Training Project Goals of Project Reduce involuntary transports by police to ED Increase collaboration between law enforcement and community Reduce stigma of mental illness Increase trust between law enforcement and community Reduce injuries sustained during crisis for law enforcement and civilians

Crisis Intervention Team (CIT) Training Project Accomplishments Reduction of involuntary transports to ED

Crisis Intervention Team (CIT) Training Project Statistics 262 Sworn Officers 26 Peace Officers (ECPD and SPCA) 27 Corrections Officers 94 Dispatchers 10 Retired or Left Department Total Trained in Basic CIT (4 Day Training) 325 Total Trained in Basic Dispatch (1 Day) 94 27 Departments Involved in CIT

Crisis Intervention Team (CIT) Training Project Challenges Not all police departments are the same High number of departments to interface with Grassroots, hard to find funding Funding is often not sustainable NYS CIT Program

Crisis Intervention Team (CIT) Crisis Case Management Services Focus on individuals with mental illness that have frequent interactions with law enforcement Focus on diversion from ED and jail Work to stabilize individuals in the community and prevent future law enforcement contacts

Crisis Intervention Team (CIT) Crisis Case Management Services Statistics Length of stay three months Case Manager holds case load of 30 people at a time One peer, focusing on providing peer services and focusing on independence and self-sufficiency Case Management worked with 174 clients in 2016 During linkage, so far in 2017.. 78% of clients linked to services 88% of clients diverted from hospitalization 94% of clients stayed out of jail

Crisis Intervention Team (CIT) Crisis Case Management Services Accomplishments Strong collaboration with police Crisis Services is written into policy and procedure at police departments Able to reach clients in community usually only dealt with by law enforcement 83% of clients linked

Crisis Intervention Team (CIT) Crisis Case Management Services Challenges Funding Population requires intensive case management; often time consuming All police departments operate differently

Mobile Transitional Support Team (MTS) Staffing Program Director Program Supervisor Three licensed mental health professionals Three certified peer specialists and a strong reliance on our local hospital

Mobile Transitional Support Team (MTS) 8am-6pm, seven days per week On-call coverage 6pm-8am 24/7 availability Shared caseload of 30-45 clients Average length of stay is three months Referrals from inpatient discharge planners, but can also be identified by Mobile Outreach Staff as clients are brought into the ED

Mobile Transitional Support Team (MTS) Services The team becomes a bridge for clients transitioning from an inpatient psychiatric unit back to community living Clinical intervention services Mini-Mobile Outreach during this bridging

Mobile Transitional Support Team (MTS) Success= No ED presentations and a diversion of inpatient hospitalizations Linkage with a community mental health agency as evidenced by three attended sessions confirmed by the agency Diversion of incarceration

Crisis Residential Visits and Interim Visits Crisis Residential Visits Why? Overcrowded ED.recidivism.homelessness Approached by our ED in 2015 to become compliant with NYS Regulations For individuals discharged from our local ED who are homeless at the time of discharge Crisis Services, ECMC, and local shelters (Buffalo City Mission and Cornerstone Manor) partnered with one another

Crisis Residential Visits and Interim Visits Crisis Residential Visits Goal of these visits is to reduce recidivism rates by making in-person contact with the client for five consecutive days upon discharge Team identifies any needs of the client that may keep them from successful linkage with community mental health services and re-presenting at the ER. Simultaneously, caseworkers at the shelters work toward meeting the clients basic needs (housing, food, clothing, etc.)

Crisis Residential Visits and Interim Visits Crisis Residential Visits Successes: 94% of individuals referred to the service do not return to the ED while receiving services Challenges: Making and retaining contact with the client can pose challenges; coordination with multiple partners is challenging, particularly with transient individuals ED CS Shelters

Crisis Residential Visits and Interim Visits Interim Visits Implemented in 2016 for individuals discharged from the ED to home Clients are referred by psychiatrists at ED Contact is made with the client within 24 hours and one visit is completed within five days of discharge from the ED Interim visits focus on diversion and successful linkage to outpatient services

Crisis Residential Visits and Interim Visits Interim Visits During the Interim visit, the team completes a lethality assessment, safety assessment, review of medication compliance, mental status examination, and discusses outpatient referrals. Team identifies needs of the client and works to resolve needs in order for clients to follow-through with outpatient linkages.

Crisis Residential Visits and Interim Visits Interim Visits Successes: Relationship building allows for prevention education; intercepting before future crisis/breaking the pattern of the crisis continuum Challenges: Making and retaining contact with the client can pose challenges; people accepting this service as a ticket out of ED; referral numbers are low.

Q &A

Crisis Services Contact Information Tracie Bussi, LMSW Emergency Mental Health Response Services - Program Director Police Mental Health Coordination Project - Coordinator tbussi@crisisservices.org Kristin Adduci, LMHC CIT Crisis Case Management Program Program Supervisor CIT Training Project Coordinator kadduci@crisisservices.org Shelly Marabella, LMHC Mobile Transitional Support Program Program Supervisor smarabella@crisisservices.org Caren Higgins, LMSW Mobile Outreach Program Program Supervisor chiggins@crisisservices.org