CRISIS SUPPORT TEAMS (CST)

Transcription

1 CRISIS SUPPORT TEAMS (CST) BLUEBONNET TRAILS COMMUNITY SERVICES Region 7 (Bastrop, Caldwell, Fayette & Lee Counties) Region 8 (Burnet & Williamson Counties)

2 WHERE DID THESE TEAMS COME FROM? Federal government initiative to provide ways to contain or cap costs in Medicaid and services to the insured in more efficient and effective ways This initiative was funded through 1115 Medicaid waiver, DADS general revenue dollars, and local match. DADS has also added some funding targeted to provide these supports to persons moving out of SSLCs into our communities. These supports are provided to improve the person s ability to adjust, live, work and play in their home community more successfully.

3 PURPOSE OF CSTS CSTs offer enhanced and readily accessible services to persons with IDD or Autism who are displaying behaviors that place them at risk for any of the following: Using the emergency room for non-medical emergency care, Using psychiatric hospitalization when their symptoms could be more effectively addressed with specialized care in the community, Repeated criminal or dangerous behavior or threats of same when incarceration is not determined to be an appropriate option, Loss or incapacity of caregiver that may place them at the risk of abuse or neglect, Loss of his or her support system, especially the living arrangement or supports needed to maintain self, Basic health & safety needs are not being met through current supports (including the need for mental health care), or Loss of functional skills that enable them to safely remain in their community.

4 TWO LEVELS OF ACUITY CRISIS Events that have triggered the response of medical, law enforcement, protective services, or a person s (or caregiver on their behalf) request for these emergency services when specialized care through CST can meet their needs more effectively CRISIS PREVENTION A pattern of behaviors or other factors that place the person at risk of crisis, yet are not at that time triggering the response of these emergency services or a request for those services

5 ELIGIBILITY CRITERIA Must reside in one of the Region 7 or 8 counties All ages Presumed to have or determined to have diagnoses of IDD or Autism Displaying the need for crisis or crisis prevention services (screening criteria for crisis prevention referrals) Regardless of an individual s participation in a Medicaid or Medicaid-waiver program or any other funding stream CAN be in an institutional setting initially but must be scheduled to move out within 7 days

6 LENGTH OF SERVICES Services are offered for up to 90 days Can be shorter time frame if: the person wishes to leave, the person is not participating in services the person is not benefiting from services (and a referral to another service or program is more appropriate) the provider of ongoing services has established sufficient supports for earlier exit, or the person has to be hospitalized or otherwise unavailable for service deliver for more than 7 days.

7 CRISIS SUPPORT TEAM SERVICES Triage and assessment Short-term stabilization treatment Service Coordination Nursing Services Behavioral Support Psychiatric Services Skills Training Counseling, and Clinical respite care (in-home and out-of-home options)

8 MOBILE MODEL CST services are designed to be mobile to remove the barriers associated with transportation and costs often encountered by people we serve and their families Psychiatric services do require the person access one of our clinic sites to utilize tele-medicine or in-person care Clinic or office-based services are available if the family is more comfortable with that for some services

9 CAPACITY TO SERVE Based on an ACT (Assertive Community Treatment) model, an evidence-based practice design for persons with severe behavioral health needs that is effective in keeping people with these needs in the community and out of hospitals, the CSTs are limited in the number of people they can serve at one time. Up to 8 persons at a time in crisis prevention with 2 additional spots reserved for crisis, for a total of 10 (max capacity).

10 RANGE OF BEHAVIORAL SUPPORTS Three provider types address needs in this area BCBA-primarily serves persons with presenting behaviors related to autism Psychological Associate/LPC-primarily serves persons whose symptoms are more prominently psychiatric/psychological or behavioral not generally associated with autism. Skills Trainer-works in tandem with the BCBA or Psychological Associate to assist in implementation of individualized behavior plans developed and to supplement with training in the areas of communication, self-regulation, etc. These services are provided to parents as well, including: basic parent training, response to crisis behavior, special needs training.

11 FREQUENCY OF BEHAVIORAL SUPPORT SERVICES These supports are offered several times a week for an average of 1.5 hours at a time. All persons have a behavior modification plan that is operational when they exit the program and a plan for monitoring ongoing effectiveness. These providers spend15-30 hours of service on behalf of each person served during the 90 day period. These supports decline in frequency and intensity over the 90 day period, depending on the response of each person.

12 MEDICAL/PSYCHIATRIC SERVICES A nursing assessment is completed by the team s RN prior to the Crisis Support Plan meeting, or treatment formulation session. If unmet medical needs are identified or if a medical reason for the symptoms needs to be ruled out, this team member takes the lead to support necessary steps. Psychiatric nurse practitioner is available every Monday afternoon to provide psychiatric evaluation and medication management. All team members participate in weekly meetings to review cases and determine if treatment approach remains on target or if objectives should be adjusted.

13 CLINICAL RESPITE CARE Currently this service is being provided through a single contracted provider. Out of home respite is provided in a community home with awake staff that are available as the service needs are requested. Up to 5 days of clinical respite care are allowed per recipient. In home respite is provided in lieu of out of home respite if this works better for the family (popular with the children served). Thus far this has not included overnight stays; but, it could if needed.

14 SERVICE COORDINATION The Crisis Service Coordinator focuses on authorizing and assuring that the services provided to alleviate crisis behavior are provided and effective. Where resources beyond the Crisis Support Team could be helpful in alleviating a person s crisis symptoms or in assisting them to stabilize, the Service Coordinator facilitates access to these services. The Service Coordinator begins discharge planning with the team at the time of admission so that appropriate aftercare services/supports can be available at the time of exit from the CST.

15 INTERSECT WITH HCS, TXHML, AND ICF When a request for CST services is made on behalf of a person in one of these programs, a meeting occurs between the current service providers and representatives of the CST to determine if CST is needed or if a consult would be adequate to address the person s crisis behavior. If it is determined that the current provider cannot address the crisis needs adequately, the person may be admitted to CST. However, only the services not available to them through their HCS, TxHmL or ICF program are authorized.

16 STANDARDIZED MEASURE OF IMPROVEMENT (REISS SCALES/SCREEN) Region 8 REISS Combined Scores Pre-Test Scores Post-Test Scores

17 ADULTS REISS SCREEN FOR MALADAPTIVE BEHAVIOR Pre-Test Score 15 Post -Test Score IND 1 IND 2 IND 3 IND 4 IND 5 IND 6 IND 7

18 YOUTH REISS SCALES FOR CHILDREN S DUAL DIAGNOSIS Pre-Test Score 40 Post-Test Score IND 1 IND 2 IND 3 IND 4 IND 5 IND 6 IND 7 IND 8

19 CASE STUDY: ELLIOT, AGE 9 Presenting crisis behavior: physical and verbal aggression toward his mother; emotional distress (crying, raging) with expressed wishes to die or that he had never been born; recent threats of suicide; occasional self-abuse; lack of social connectedness to others. Admitted for crisis prevention after it was determined he was not acutely suicidal. Had not been receiving any services to meet his needs prior to referral to CST. Recently relocated to the state after his parents separated. Parent also in need of immediate attention for mental health symptoms.