Supercharge Crisis Services - David Covington (Natcon15)

Supercharge Your Crisis Services

David W. Covington, LPC, MBA, Recovery Innovations

Supercharge – The Future is Pay for Value

Step 1: Measure & Report Your Cost

Impact

Innovation Awards

Creating a Model

• Data + Frameworks = Model

• Models are a dime a dozen… but you have to

have one.

Suicidal Desire

• Suicidal Ideation- hurting self or others Perceived burden on others

• Psychological Pain Feeling Trapped

• Hopelessness/Helplessness Feeling Alone

Suicidal Capabilit

y

• History of Attempts Available means

• Exposure to another person's suicide Intoxicated/substance abuse

• History / current violence to others Acute symptoms

Suicidal Intent

• Attempt in progress Preparatory Behaviors

• Plan to hurt self/other & method know Expressed intent to die

Buffers

• Immediate supports Engagement with helper

• Social supports Ambivalence for living

• Planning for future/sense of purpose Core values/beliefs

Are you thinking of suicide?

Have you thought about suicide in the last two months?

Have you ever attempted to kill yourself?

Three Key Questions

SAMHSA Suicide Risk Assessment Standards

Acuity Intensity (One or more of the following is present) Offer apt within:

Emergent A life threatening condition exists as caller presents:

Suicidal/homicidal intent

Actively psychotic

Active withdrawal (Alcohol, Benzos, Barbiturates)

Disorganized thinking or reporting hallucinations which may result in harm to

self/others

Imminent danger to self/others

Unable to care for self

For an Emergency Crisis:

Immediately arrange to be seen

within 2 hours

If suicidal/homicidal with weapon,

call 911/Police

If active withdrawal, send to

nearest ER for medical clearance

Urgent No suicidal/homicidal intent

Denies suicidal plan/means

Expresses hopelessness, helplessness, sense of burdensomeness, disconnectedness

disconnectedness or anger

May develop suicidal intent without immediate help

Potential to progress to need for emergent services

May express distress/impairments that compromise functioning, judgment and/or

and/or impulse control

May have withdrawal signs/symptoms from non-life threatening substances:

Cocaine, Methadone, Heroin

Dependence on Alcohol, Benzodiazepines or Barbiturates, but not in active

withdrawal and no history withdrawal seizures or DTs

For Severe Situation:

Offer an appointment within 24

hours (48 hours at the maximum)

Instruct caller to re-contact CAC if

condition worsens

May include crisis plan with

available supports

Routine Impacts caller’s ability to participate in daily living

Markedly decreased the caller’s quality of life

Caller acknowledges some distress/concerns

No evidence of danger of harm to self/others

No marked impairments in judgment or impulse control

Severity warrants assessment and possibly services

SA issues with possibility of substance dependence

For Distressed Caller:

Offer first available appointment

within five days

Re-contact CCA if condition

worsens

Referral Only

(Non-Core

Customer)

Presenting problems do not rise to clinical acuity required for state-funded services

services (which require Severe & Persistent Mental Illness)

Offer appropriate referral or

resource

Warm-Line

(Support Only) Caller is already linked with community services and does not have urgent or

or emergent needs

Encourage to contact current

provider

Information Only No identified consumer for clinical triage; simply a request for basic information Provide requested information

Business Call Request for an administrative staff person or in regard to an administrative matter Link to appropriate CAC staff

Research Assumptions #1

• In 2002, Hugo et al studied the difference

between hospitalization rates comparing a

community-based mobile emergency

service and a hospital ER-based emergency

service.

• They concluded, “Hospital-based

emergency service contacts were found to

be more than three times as likely to be

admitted to a psychiatric inpatient unit

when compared with those using a mobile

community-based emergency service,

regardless of their clinical characteristics.”

Research Assumptions #2

• In Roger Scott’s 2000 study in Psychiatric

Services, entitled, “Evaluation of a Mobile

Crisis Program: Effectiveness, Efficiency and

Consumer Satisfaction,” the conclusion

stated:

• “Fifty-five percent of the emergencies

handled by the mobile crisis team were

managed without psychiatric

hospitalization…, compared with 28 percent

of the emergencies handled by regular

police intervention, a statistically significant

difference.”

Mobile Crisis July 07

The Word Problem

N = 374

Acute Care EscalationMobile Crisis July 07

The Word Problem

N = 374


The Word Problem

N = 374$375 Per

Day


The Word Problem

N = 374$375 Per

DayAvg. 8 Days Per

Episode


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25%

$375 Per

DayAvg. 8 Days Per

Episode


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25% 280

$375 Per

DayAvg. 8 Days Per

Episode


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25% 280

$375 Per

DayAvg. 8 Days Per

Episode

= Cost $804k


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25% 280

$375 Per

DayAvg. 8 Days Per

Episode

= Cost $804k

Actual Rate

with

Program

Intervention

55


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25% 280

$375 Per

DayAvg. 8 Days Per

Episode

= Cost $804k

Actual Rate

with

Program

Intervention

5585%


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25% 280

$375 Per

DayAvg. 8 Days Per

Episode

= Cost $804k

Actual Rate

with

Program

Intervention

5585% = Cost $158k


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25% 280

$375 Per

DayAvg. 8 Days Per

Episode

= Cost $804k

Actual Rate

with

Program

Intervention

5585% = Cost $158k


The Word Problem

N = 374

Projected

Natural Rate

of Diversion

25% 280

$375 Per

DayAvg. 8 Days Per

Episode

= Cost $804k

Actual Rate

with

Program

Intervention

5585% = Cost $158k

Savings $646k

Mix and Match

• Avoiding Costs Based Upon Baseline

Assumptions

– Escalations to Higher Levels of Care

– Lack of Throughput/Accessibility Prevents

Front-End Admissions (ED Costs)

– Lack of Capacity Due to Frequent

Readmissions


Step 2: Showcase Your Outcomes


Step 3: Use Recovery Language

Green 80, Green 80, Hut-Hut.

Crisis Language Recovery/Opportunity

Consumer Guest



Consumer Guest

Sub-acute Psych Inpatient Living Room


Consumer Guest


23 Hour Observation Retreat


Consumer Guest



24/7 Crisis Walk-in Front Lobby



Consumer Guest




Crisis Center Recovery Response Center



Consumer Guest





Crisis Opportunity



Consumer Guest





Crisis Opportunity

Intake Recovery Partnership



Consumer Guest





Crisis Opportunity


Assessment Getting to Know Each Other



Consumer Guest





Crisis Opportunity



Psychosocial History Telling My Story



Consumer Guest





Crisis Opportunity



Psychosocial History Telling My Story

Treatment Plan Recovery Solutions

Supercharge Crisis Services - David Covington (Natcon15)

Health & Medicine

emergency crisis

withdrawal signssymptoms

policeif active withdrawal

mobile emergency service

community services

contact cac

history withdrawal seizures

crisis services david