From Triage to Intervention: A Crisis Care Model for Persons with IDD Alton Bozeman, Psy.D., Clinical Psychologist Amanda Willis, LCSW-S
Examples of Barriers Lack of information Access to professionals Limited financial resources Limited resources (nonfinancial) Limited communication between providers
Diversity of Community Language Diversity Cultural Diversity Ethnic Diversity Spiritual Diversity Opportunities to learn more to assist families
DADS (HHSC) Definitions Crisis Presents an immediate danger to self or others; or Mental or physical health is at risk of serious deterioration; or Believes he/she presents an immediate danger to self or others or that his/her mental or physical health is at risk of serious deterioration. Crisis out-of-home respite Short term (up to 14 days) Provides therapeutic support in a safe environment (ICF/HCS group home, etc.) with staff on-site providing 24-hour supervision to an individual who is demonstrating a crisis that cannot be stabilized in a less restrictive setting
Crisis Intervention Specialist & Additional Staff Licensed master level clinicians with IDD experience CIS & additional staff duties: 1. Provides information about IDD programs and services to consumers and their families and local IDD providers 2. Collaborates with and provides support to LIDDA staff regarding individuals with IDD who are at risk of requiring crisis services 3. Provides education about how to engage individuals with IDD and their unique needs to MCOT, law enforcement (CIRT), and others as appropriate 4. Provides consultation to MCOT as needed 5. Collaborates with agency staff about referrals for IDD crisis out-of-home respite 6. Develops crisis respite service plans including therapeutic support needed 7. Collaborates with agency staff, etc. about crisis follow-up and relapse prevention
Expansion of IDD Crisis Care Triage Added 2 licensed master level clinicians (3 total including Clinical Team Leader/CIS) Provide more intense crisis services (lower case load size) Move from primarily phone based crisis triage to more face-to-face assessments Provide more consultation and education Ability to do brief psychotherapy Consultation with psychiatrist, nurse, and psychologist
Connection to Resources Determination of Intellectual Disability (DID)/Interest List NeuroPsychiatric Center (NPC) Mobile Crisis Outreach Team (MCOT) Crisis Intervention Response Team (CIRT) Community Based Supports (CBS) Clinical Out-of-Home Respite (COR) Feeding Clinic (STARS) Psychiatrists/other doctors Other community agencies
Expansion of IDD (Crisis) Clinical Out-of-Home Respite Continue to contract with a local HCS group home Able to accept both children and adults Expand bed capacity from 2 to 6 Face-to-face contact with individual in COR to monitor crisis respite service plan and provide therapeutic support at least 2 times/week
Outcomes of IDD (Crisis) Clinical Out-of-Home Respite To provide a therapeutic environment Prevent unnecessary hospitalization and assist the individual in maintaining residence in the community Provide structure and support for individuals to facilitate symptom stabilization Assist the individual, and caregivers if needed, to develop appropriate coping skills to help identify, reduce, or prevent stressors Provide crisis assessment, individual planning, and family needs assessment
Outcomes of IDD (Crisis) Clinical Out-of-Home Respite (Cont) Provide linkage to appropriate community mental health resources Facilitate a smooth transition back home Provide short-term assistance to caregivers of the individual to minimize the need for a more restrictive service setting Provide the individual with appropriate supervision and assistance in a non-stressful environment To improve behavioral and mental health outcomes, stop deterioration and/or restore the individual to usual or improved functioning
Psychologist Registered Nurse ABA Specialists (Direct Care Technician) Case Manger Community Based Supports Assessment: Development History of current diagnosis Mental Health Substance use/abuse Medical history and screen Schooling/ employment/ day habilitation Home environment: safety, stimulation, family dynamics Maladaptive Behavior
Criteria for Level One and Level Two CBS Referrals Level One (to be seen between 1 to 2 business days): Hospitalization/Emergency Respite Pending discharge from hospital with lingering behavioral concerns Assessment of need for Clinical Out of Home Respite (COR) Self Injurious Behavior (SIB): frequent or high intensity Physical Aggression: frequent or high intensity Elopement: with a history of successful elopement Escalating Psychiatric Condition Individual with Intellectual or Developmental Disability Individual is demonstrating worsening signs of mental distress, including: excessive pacing or rocking, extreme social isolation, sleep deprivation or refusal to eat. Symptom presentation should not rise to the level of hospitalization, but symptoms should be severe enough to interfere with daily functioning
Criteria for Level One and Level Two CBS Referrals Level Two (to be seen within 7 business days): Self Injurious Behavior (SIB): infrequent and low intensity Physical Aggression: infrequent and low intensity Elopement: with little chance or history of successful elopement or individual is easy to secure after successful elopement Property Destruction Frequent and highly inappropriate social behavior Behavior should rise to the level of what would be considered disruptive in a classroom setting or at home. Behavior should be frequent and resistant to feedback or redirection. Examples include: Undressing in public, verbal aggression, person directed profanity, sexual touching, and public masturbation.
What we Do Assess and refer Assess and consult Assess, intervene, and refer/close Link to services and community resources Intervention Psychotherapy Family consultation on education and social service systems ABA
Indirect Interventions Multidisciplinary case staffings Clinician s meetings weekly Trainings for community partners and conference presentations Training/consultation with physicians
Crisis Care Model Crisis Care Model CBS Team A Few Stats
Gender Total number of consumers seen from 9/1/11-6/6/12: 32% 47 consumers Gender: 68% Males- 68% Females- 32% Male Female
Ethnicity 2 2 2 2 2% 2 Black/ African American 26% White 28% 40% Hispanic Chinese Filipino Multiracial
CBS Team Percentage of Autism cases: 71% Percentage of ID cases: 75% Mild: 50% Moderate: 18% Severe: 25% 1 profound diagnosis Percentage of cases with co-occurring diagnoses: 61%
Major Depressive Schizoaffective 2% 4% Schizophrenia Intermittent Explosive 4% Learning NOS 1% Anxiety 3% Dysthymic 1% 3% PTSD OCD 3% 2% Secondary Diagnoses Cannabis Tourettes Alcohol Abuse Abuse 1% Pica 1% 1% 1% Bipolar 6% ADHD 17% Disruptive Behavior Disorder 7% Impulse Control 3% Depressive NOS 4% Adjustment 1% Mood NOS 28% Psychotic NOS 7% ODD 3%
Referral Sources IDD Service Coordination Harris County Psychiatric Center (HCPC) Neuropsychiatric Center (NPC) Community referrals Private HCS referrals Crisis Intervention Response Team (CIRT) Collaboration between Harris County Sherriff's Dept., Houston Police Dept. & The Harris Center
Treatment Outcomes 66% Stable referred to lower intensity services or issue resolved 18% the family or individual declined assistance of failed to follow through on recommendations 5% were ineligible for services 5% moved/could not locate/died 3% had no need for services 2% were incarcerated (2 cases) 1% limited progress
Additional Considerations Expectations improve satisfaction Families will seek therapy from whoever is providing the service Family dynamics and mental health of caregivers will impact cases Culture will impact cases
Case Examples
Q&A Any questions?
Contact Information Alton Bozeman, Psy.D. P: 713-970-7626 E: Alton.Bozeman@TheHarrisCenter.org Amanda Willis, LCSW-S P: 713-970-7254 E: Amanda.Willis@TheHarrisCenter.org