Crisis Solutions Coalition Meeting Minutes

Crisis Solutions Coalition Meeting Minutes

March 16, 2015

Workgroup Discussion: The Future of Crisis Response in NC –

1. Staff and Training-

- Re-educate staff on 911 centers and on the caller side (including EMS and MCM), however, it should be a one point of entry into the mental health system versus trying to decide which number to call

- Having enough warm bodies available (live) that can provide assistance during a crisis

2. Call Centers –

- Utilization of a locally based, well-known number with trained clinical volunteers and with clinical back-up if needed to elevate to a higher level

- MCO call centers should be utilized as crisis response centers

- 24/7 Access - Eastpointe – is not limited to Medicaid or State funded services – warm-transferred to a clinician - then can be connected to MCM and law enforcement if needed

- Linkage to both primary care and mental health services – warm link to primary care with clinical

- Call 911 à get a physical assessment; call 24/7 access/mental health – will not receive a physical assessment à integrate towards addressing needs of whole person

- Protocol considerations including a list of questions that are mandatory (have-to-ask) with regard to engagement with the callers – then asking questions more specific to issue

- Review self-stigma when discussing attaching crisis contacts with 911

- Call center staff cannot create or destroy time, can only move time around

- Having enough warm bodies available (live) that can provide assistance during a crisis

- One number that anyone can call, 24/7 live person access, (i.e. air controller example), suicide prevention

- Consumers in Behavioral health crisis will either call 911 or go to EDs – we may want to build on that

3. Dispatch Options –

- Embed 911 response into the mental health systems

- MCO call centers should be utilized as crisis response centers

- Advertised well known number in the local level – dispersed within the mental health community - leave it at doctor’s offices, libraries, places in the community

- Embedding mental health clinicians in police departments – worked well with ride alongs together – Charlotte clinicians were embedded in police departments – had civilian badges – still going on strong – County funded

- Provide the numbers to the LME-MCOS onto the back of the Medicaid cards

- Partner with United Way (211) in order to better advertise the crisis numbers

- EMS is on the scene on average of 12 minutes

4. Integrated Technology and Data Management –

- Use text messages, chatting and software (i.e. Fed Ex systems)

- Download client information that they’re capturing into a main system

- Computers working the same during the daytime and at night as well

- iPad should be introduced (with encryption) as a way to integrate medical and mental health assessment with technology; learn from others within other states

- Develop an interface with access to records (i.e. hx of visits for consumer and consumer information)

- Improve Telepsych connections/machines – even with HIPPA regulations can utilize iPads and tablets (3G and 4G) for flexibility and availability around rural areas

- Utilization of a tool by National Dispatch ; technology is already there and being used

- Cell phones – can track where person is located, but track phones – people will call EMS/911 each time

5. Comments –

- Physical care, behavioral care and dental care should be offered within facilities such as UNC Wakebrook

- Involve and integrate more volunteers into the crisis system

- Expand MCM service definition to include a minor medical component

- MCM took too long to respond when someone is in crisis (i.e. Cumberland to Wake example) – 2 hours standard in definition should be re-visited/reviewed

- May want to consider changing the reimbursement model

- LME – MCO Follow up after the crisis call – on each call (urgent, emergent and routine)

- Consumers may be hesitant to see 911 as helpful when reaching out for help during crisis based on previous IVC experience (i.e. may not want an ambulance to come or a police car)

- Taking assessment questions out of the picture when speaking with law enforcement

Workgroup Discussion: Proposed changes in the Involuntary Commitment Statutes

è Section 7 (b) Part 8 of Article 5

1. Electronic and facsimile transmission of custody orders (if it is a necessity then we will need to use it)

- Fascimile is outdated, use more current forms of transmission

- Use Dropbox and send a link for purpose of confidentiality

- Violation of human rights – IVC – focus on how people have the right to be committed or not

- Make an amendment - (i.e. EDs can’t place a patient until that’s addressed)

- Hospitals would support this change

- Magistrates are already embedded in some hospitals , which means they wouldn’t have to be concerned about this statue(i.e. Mission Hospital)

2. Promote best practice standards for transportation of respondents when the city or county contracts that responsibility

- CIT training should get the training

- What kind of restraints would be used by the contracting agency (i.e. shackles)

- This is for both to cover mental health and substance abuse IVC; mental health à change to behavioral health

3. Provide clarity about each county’s preferred location for first examinations. Establish a preferred site and provide for a well understood community-wide plan when the preferred site is unavailable or at capacity

- Will there be timing included with review of these proposals?

- Will these also address to areas where the EDs are full and cannot get any off to other hospitals in the area? May address a rotation idea so that others are not caught all in the same place/bed availability – will force entities not to shuffle!

- Designating a place for the first evaluation

- There are certain places that are more satisfactory for law enforcement to migrate to when evaluating the consumer

- CIHS – likes localized plan – ensure that there is a plan for where the consumer will be placed, would also recommend a behavioral clinician available and embedded into the hospital –they have an obligation to deescalate the crisis and to ensure a reduction of wait time

- Therapists embedded in the hospital - can de-escalate consumers and move them out – hospitals are losing money, however, this service allows patients to get out of the ER beds and into psychiatric beds

- MCOs need to be an integral part of this strategy

- Maintain focus on how patients/consumers are treated in the system

- Are LME-MCOs able to bring the ability to coordinating care within the system?

4. Allow officers of the opposite sex to transport the respondent

- Did the language result due to problems from interactions with males and females in the past? à Answer: No

- Should not matter who the transport is in order to avoid delays

- Tremendous advantage in have the opposite sex involved – can prevent additional crisis from occurring

5. Modernize/clarify the language related to who may perform a first examination

- Would LCSW be able to do this part? They are able currently

- Great cleanup of existing language

- Any expansion on eligibility for the individual professional (i.e. LPCs and LPAs)?

- Would this allow for Telepsychiatry exams in the EDs? - Just added 2 million into telepsychiatry, and that eligible physicians or professionals can provide this - LCSWs can do this already, licensing associations already have approved different types of professional s providing this service