NADD Bulletin Volume VIII Number 6 Article 1

Complete listing

COMPONENTS OF CRISIS LINKS AS SUBMITTED IN QUEENS OPTIONS FOR PEOPLE THROUGH SERVICES (OPTS) PROPOSAL

Mobile Crisis Intervention Team (MCIT)

This team would be comprised of core professional staff (a psychiatrist, psychologist, clinical social worker, and a secretary) and initially a team of three mobile crisis intervention specialists who have received intensive training to work directly with consumers, caregivers, and agency staff providing services to individuals in crisis. Funding for additional crisis intervention specialists will be requested if the current number is insufficient to meet the need for acute crisis services in Queens.

Members of the core professional team will be available to evaluate the need for crisis services of individuals referred. The team will also be available to coordinate the immediate services provided by the mobile crisis intervention specialists who respond to crises that don't require a response from 911 or referral to a psychiatric in-patient unit. Eligibility for services by the MCIT will be determined by the Queens BDSO in those cases where the consumer has not already been determined to be developmentally disabled.

The Mobile Crisis Intervention Team (MCIT) is also available to consult directly with psychiatric in-patient units to help with behavioral programming and outcome monitoring while consumers are residing there and also to help consumers make a smooth transition from the in-patient unit back to their residential and day programs. The Mobile Crisis Intervention Team (MCIT) will also work closely with staff assigned to a Partial Hospitalization day program (if one is established) to provide continuity of services for consumers living in the IRI Crisis Residence who are not able to attend their regularly scheduled programs and who may be enrolled in the Partial Hospitalization Program.

Staffing for the Mobile Crisis Intervention Team (MCIT)

1. The psychiatrist assigned to the Mobile Crisis Intervention Team (MCIT) will be board certified in child and adolescent psychiatry and will have extensive experience in providing pharmacological treatment as part of an interdisciplinary treatment team using a comprehensive bio-psychosocial approach to diagnosis and treatment planning. This will be a ½-time assignment. This position could be expanded to a full-time position if the psychiatrist also worked at the Partial Hospitalization Program mentioned above. This dual assignment would enhance the collaborative working relationship between these two programs and would ensure that decision made concerning admission to either the IRI Crisis Residence or the Partial Hospitalization program were made according to the same criteria.

2. The psychologist assigned to the Mobile Crisis Intervention Team (MCIT) will have a PhD in psychology and at least 5 years progressively responsible supervisory experience for staff assigned to provide services for individuals with a dual diagnosis who exhibit challenging behaviors. Preference in hiring will be given to those qualified psychologists who are licensed (or license eligible) in NY State and who have formal training and extensive clinical experience in providing crisis intervention services. This will be a full-time position with responsibilities divided between 20 hours per week working with Mobile Crisis Intervention Team (MCIT) and 20 hours per week spent working in the Crisis Residence.

3. A project coordinator will be assigned to Crisis Links on a full-time basis. This person will have a CSW and extensive (at least 3 years) experience working with individuals who are developmentally disabled and exhibit challenging behaviors. The person will perform intake services for the Crisis Residence, the Mobile Crisis Intervention Team (MCIT) and the Transitional Living Center as well as coordinate the entire project.

4. The Mobile Crisis Intervention Team (MCIT) will include 3 full-time crisis intervention specialists, skilled in the support to individuals experiencing challenging behavior as well as in working with the focus person's family or support team.

5. A secretary will be assigned to the Mobile Crisis Intervention Team (MCIT) half time. (This individual will also have assigned secretarial duties for both the Crisis Residence and the Transitional Living Center.)

Crisis Residence

This proposal also requests funding to staff and operate a 24-hour, 7 day per week Crisis Residence for 6 consumers whose crisis is severe enough to require temporary relocation to another residence but does not necessitate immediate placement in a psychiatric in-patient unit or in a partial hospitalization program if one is funded. Determination regarding the suitability for relocation to the Crisis Residence will be based on a comprehensive evaluation by the Mobile Crisis Intervention Team (MCIT) and in accordance with following admission criteria:

INCLUSION CRITERIA

" Enrollment in the NY State Medicaid Waiver Program, as evidenced by a current TABS number, or a favorable eligibility determination by representative from the Queens BDSO for those individuals who do not have a TABS number

" A history of severe and persistent challenging behaviors that exceed the capacity of other service providers to respond in a timely and effective manner.

" Informed consent from the consumer (if deemed capable) or from legal guardian/designated advocate for evaluation and treatment.

" At least 17 years old.

" If referred form an OMRDD certified provider, a commitment to reintegrate the person back in to his/her previous residence, or to develop a suitable residential alternative within the designated time frames of the Crisis Residence (9 months), or the Transitional Living Center (2 years); OR

" If referred from a family, a commitment from the BDSO to develop a suitable residential alternative within the designated time frames of the Crisis Residence (9 months), or the Transitional Living Center (2 years).

" A service coordinator selected by the consumer and/or family members prior to admission to the Crisis Residence.

 

EXCLUSION CRITERIA

 

" Need for immediate referral to a psychiatric hospital or a partial hospitalization Program

" Determination that existing crisis services (in absence of IRI's Crisis Residence services) can adequately address the presenting problems

" Ambulation difficulties that restrict access to and from the Crisis Residence

" Medical issues/needs require nursing care beyond that available in the Crisis Residence.

" Failure to obtain consent from the consumers MHLS attorney for temporary relocation to a more restrictive setting to obtain treatment for challenging behaviors.

 

Every effort will be made to prevent unnecessary disruption in the consumer's life by having the Mobile Crisis Intervention Team (MCIT) work with staff and caregiver's in the person's day and residential programs to the skills necessary to resolve crises in those settings so that relocation on the Crisis Residence is truly a last resort. During residency in the Crisis Residence, every effort will also be made to sustain and strengthen connections between the consumer and significant people in his/her life by involving them in treatment planning meetings and encouraging them to participate in implementation of the treatment plan. Where possible, this participation will include having these significant assignments and planned interventions implemented under the supervision of Crisis Residence staff, which will also be available to model these interventions and assignments.

 

The beds in the Crisis Residence will be available for acute admissions lasting up to 9 months if necessary, but we anticipate that the average length of stay will be 4 months based on the experiences of agencies providing residential crisis services. This will allow for a thorough assessment (e.g. a comprehensive functional analysis and a psychiatric diagnosis, when indicated) and enough time to implement a treatment plan based on that assessment. Treatment outcomes will be based on feedback provided by completion of a person-centered, Valued Outcome Scale, developed for each consumer according to procedures described in the attached article. The goals of treatment during this stabilization phase of residency in the Crisis Residence will be to promote community inclusion and participation by teaching socially appropriate replacement skills for those challenging behaviors that limit or restrict access to the community and which have necessitated temporary relocation to a more secure and structured environment.

 

Every effort will be made to control for both male and female consumers as well as addressing their behavioral issues and psychiatric disorders in a safe, dignified and respectful manner.

 

As noted previously, members of the Mobile Crisis Intervention Team (MCIT) will also be available to promote generalization of skills learned in the Crisis Residence to the consumer's day and residential program when he/she is ready to leave the Crisis Residence by accompanying the person to those settings and modeling recommended interventions for staff and caregivers.

 

The Crisis Residence is also designed to function as a "step-down" program for those individuals who no longer require the acute psychiatric services of an in-patient hospital program but who have not yet been adequately stabilized for a safe return to their regular home or residential program. In the absence of intensive behavioral supports, these consumers often quickly relapse to such an extent that they require a financially costly and emotionally disruptive re-admission to the psychiatric in-patient units from which they were prematurely discharged. Staff from the Mobile Crisis Intervention Team (MCIT) will be available to work closely with staff from local psychiatric in-patient units at to reduce the costs associated with this all too prevalent revolving door admission/discharge policy.

 

It can be anticipated that some consumers will not be able to return to their previous residences or day program after they have completed the allotted length of stay in the Crisis Residence. A thorough assessment of the "goodness of fit" between the persons' optimal day and residential services and the programs currently available will be conducted as part of the person-centered treatment plan for each person who moves into the Crisis Residence. This information will be used to develop alternative living arrangements in those cases where the discrepancy between optimal and currently available services is most glaring. In those cases where these arrangements cannot be completed before the person is ready to leave the Crisis Residence, we will refer these people to a Transitional Living Center operated by IRI. If a partial hospitalization program is funded, MCIT staff will be available to help consumers adjust to the demands of that setting, if requested to do so by staff from the partial hospitalization program.

 

Transitional Living Center (TLC)

 

This 4-person residence is designed to function as a step-down residence for consumers living in the Crisis Residence who no longer present emergent behavioral crisis and are awaiting permanent housing, as well as for other individuals identified by the BDSO who require immediate residential placement because of emergency situations necessitated by issues not necessarily related to challenging behavior. A Person-Centered Focus is the treatment approach utilized throughout this proposal. When a person moves into the TLC, this focus continues throughout the planning for the permanent residential and life supports that will address each persons interests, allow for each person in their own way to become part of their community, and establish for each person what supports are necessary and who, be they paid staff, volunteers, or family members, are best to provide them.

 

INCLUSION CRITERIA

" Enrollment in the NY State Medicaid Waiver Program as evidenced by a current TABS number, or a favorable eligibility determination by a representative from the Queens BDSO for those individuals who do not have a TABS number

" At least 17 years old

" Completion of time in the Crisis Residence, but lacking a permanent home, OR

" Need for immediate residential supports due to life circumstances as identified by the BDSO.

" Informed consent from the consumer (if deemed capable) or from legal guardian/designated advocate

" If referred form an OMRDD certified provider, a commitment to reintegrate the person back in to his/her previous residence, or to develop a suitable residential alternative within the designated time frames of the Transitional Living Center (2 years); OR

" If referred from a family, a commitment from the BDSO to develop a suitable residential alternative within the designated time frames of the Transitional Living Center (2 years).

 

EXCLUSION CRITERIA

" Need for immediate referral to a psychiatric hospital or a partial hospitalization program, if one is funded.

" Determination that existing services can adequately address the presenting problems

" Ambulation difficulties restrict access to and from the Transitional Living Center

" Medical issues/needs require nursing care beyond that available in the Transitional Living Center

 

Individuals residing in the Transitional Living Center will be a Queens BDSO priority for residential services. The BDSO will include this group as their "top priority" consumers for such placement and actively recruit agencies to provide permanent residential services. Consequently, the BDSO, IRI and these other agencies will work collaboratively to insure that the IRI Crisis Residence does not become the permanent home for difficult to place individuals, at the expense of its ability to provide much needed crisis services. We will accomplish this objective by ensuring that diligent activities by the sending facility, IRI, and the MSC take place throughout the entire duration of the consumer's residency.

 

PROGRAM OBJECTIVES AND MEAUSREABLE OUTCOMES

Our proposal has been developed to achieve the following desired outcomes:

1. To achieve better coordination among existing elements of the crisis network in Queens so that consumers (the individuals in crisis, as well as their families and the agencies supporting them) receive the services they need in a more timely and cost-effective manner.

2. To supplement existing crisis services by forming a Mobile Crisis Intervention Team (MCIT) that can prevent unnecessary use of psychiatric in-patient hospital bed for consumers who can benefit from on-site support and services.

3. To operate a Crisis Residence that provides short-term (up to 9 months) intensified behavioral treatment for individuals experiencing acute, emergent crises severe enough to necessitate temporary, out of home placement in a setting not as restrictive as a psychiatric in-patient unit. This Crisis Residence will also functional as step-down programs for individuals who no longer need psychiatric hospitalization but who are not yet stable enough to return to their previous residential and day program.

4. To operate a Transitional Living Center designed to provide long term intermediate residential support (up to two years) for individuals who have completed their length of stay in the Crisis Residence and for individuals who require immediate residential placement because of emergency situations necessitated by issues not necessarily related to challenging behavior as identified by the BDSO.

CONGRUENCE OF OUR PROPOSAL WITH OPTS GUIDING PRINCIPLES

An examination of the characteristics of our proposed Crisis Links network with OPTS guiding principles will show a high degree of congruence in the following areas:

A) Individual choice through person-centered services is enhanced by involving the consumer and caregivers in the selection of treatment outcomes and by ensuring that these represent personal needs and preferences as determined by our evaluation instruments.

B) Addressing challenging behaviors that often restrict the attainment of independence and Community Inclusion.

C) Funding our proposed budget will allow for services by the Mobile Crisis Intervention Team (MCIT), the Crisis Residence, and the Transitional Living Center to be tailored to the service needs of each consumer, reflecting the principles of flexible funding and individualized services.

D) Our evaluation instruments have been chosen to provide information which will be used to ensure that all individuals receive the highest quality of services as determined by pre and post treatment measurements of quality of life, consumer satisfaction surveys, and measurement of the extent to which our Crisis Residence and the Transitional Living Center incorporates indicators of "person-centeredness" into their organizational climates.

E) Involvement of our quality assurance expert on the Evaluation Committee, together with input from other committee members based on analysis of data derived from our comprehensive array of evaluation instruments, will help ensure that the health and safety of all crisis services recipients are protected according to the highest standards of operation.

F) Provision of crisis services not currently available helps to ensure that consumer's access to needed services and supports is not unnecessarily restricted by psychiatric hospitalizations by helping them to remain in their current day and residential programs whenever possible.

G) Likewise, the availability of our proposed crisis services promotes greater flexibility within our system by providing a wider range of alternatives available to meet the unique needs of each individual.

H) Using the results of the Person-Centered Organizational Climate Survey to create a climate within the Crisis Residence and the Transitional Living Center, which is conducive to person-centered planning, will enhance user friendly and effective operations.

I) One of the primary functions of Crisis Links is to promote open communication among all people in the consumer's social network (caregivers, service providers, etc.,) and to encourage their active participation in treatment planning and program evaluation