Crisis Planning For all levels of care Presented by PerformCare Quality Improvement Department
Purpose of this Training The purpose of this training is to provide a general overview of Crisis Plans components as part of a standard Treatment Record Review completed by PerformCare. Please note that there may be additional expectations based on the individual Caregiver/Family and Member needs and presenting symptoms. Some providers include other components on the crisis plan, which is acceptable. PerformCare does not require the use of a template (and does not offer a template). 1
Introduction PerformCare regularly reviews Crisis Plans in Treatment/Service Record Reviews (TRRs) and as a part of requests for certain services (CCM review). PerformCare expects that all Members in all levels of care be offered the opportunity to create a crisis/safety plan. If a Member is noted to have a WRAP (Wellness Recovery Action Plan), and elects not to provide this document to the Provider, PerformCare will score the crisis plan as n/a, if the record contains documentation noting this information. 2
General Overview Crisis/Safety Plans should be: Recovery-oriented and strengths-based, and must be individualized to the Member. Written with the Member/family, and in language that they can understand. Working documents that are updated with the treatment plan, and as necessary (i.e. if a significant change occurs in the Member s needs, the plan should be updated). The plan itself can be called whatever the provider chooses (alternate options sometimes used: Wellness Plan, Recovery Plan, Safety Plan, etc.) For Members in RTF/CRR-HH, the crisis plan should be applicable both in the RTF or CRR-HH, and while on therapeutic leaves; which may mean including various resources in the location in which the leave occurs. 3
Basic Components of Crisis/Safety Plans (review of each indicator) 4
Does the plan identify antecedents and triggers to a crisis for the member? Antecedents and triggers are factors that may impact the Member s internal or external crisis behaviors. May include items such as (but not limited to): Environmental factors (loud noises such as fire alarms) Dates/times (anniversary of loss of loved one, Valentine s Day) Specific triggers that remind Member of a traumatic events (may include sensory triggers such as smells or sounds) Specific actions/requirements (e.g. enforcing bedtime/chores/homework) Changes to routines/transitions without warning 5
These are the specific feelings or actions exhibited that those around the Member would be able to observe. Examples of Warning signs Red face Clenched fists Raised voice/increased silence Isolating in room Listening to sad music Spending large amounts of money Coming home late from work multiple times a week Not getting out of bed/going to work Not taking medications Does the plan identify early warning signs of what could be a crisis for the member (i.e. specific feelings or actions the member may exhibit prior to a crisis)? 6
Does the crisis plan include steps the Member can take in order to prevent escalation of behaviors? These should be individualized and specific to the Member (i.e. not all Members should have the same steps to take). Examples of Member steps: Request a break Play soothing music Journal Take a walk Practice Yoga Cuddle Lambie (stuffed animal) Take deep breaths 7
The Member steps should be specific to the Member, and individualized. Ensure that identification of strengths is done fully, and updated once relationship has developed. Examples of strengths that may be used: Preferred music/cuddle Journaling Religious/spiritual connections Walking/running Meditation Does the crisis plan actively incorporate Member strengths and interests as a means to prevent escalation of behaviors? 8
Is a contact number to be used in crisis situations present? This should include more than 911. Numbers that may be included: Providers (if appropriate) Natural supports Local Crisis Number Hotlines
As noted previously, not all crisis plans should have the same steps (such as make the environment safe or remove any weapons ) If necessary, may require detail specific to the natural supports (i.e. Dad should, Friend should, Teacher should) Some examples of steps for natural supports: Dad should proceed lowly and slowly (lower voice, talk slowly, and crouch/kneel) Mom should offer to take a walk outside with Donald. Teacher should offer a break Prompt me to utilize my coping skills toolbox Sit quietly with me, allowing me to talk Does the crisis plan outline steps natural supports can take prior to contacting provider, crisis intervention, or police should a crisis arise? 10
Does the record contain evidence that, following a crisis, the treatment team has reviewed the crisis plan for effectiveness, and made changes, as clinically appropriate? This indicator will be scored as N/A if no crises occur while Member is in treatment. Evidence may be located throughout the record (such as progress notes, updated crisis plan, team meeting notes). This is expected to occur with the next few sessions following a crisis, and should not wait an extended period (such as the next treatment plan update or ISPT meeting). 11
References PerformCare Provider Manual: https://pa.performcare.org/pdf/providers/resources-information/providermanual.pdf Individual Level of Care TRR Tools: https://pa.performcare.org/providers/resources-information/forms-quality.aspx PerformCare Policies: http://pa.performcare.org/providers/resources-information/policies.aspx PerformCare Wellness Information: http://pa.performcare.org/members/health-wellness/toolkit.aspx 055 PA Code 1101.51: http://www.pacode.com/secure/data/055/chapter1101/s1101.51.html 12
Questions? Comments? Feedback? Thank you for your participation! Any additional feedback related to the requirements for Crisis/Safety Plans can be submitted to: Kristen Kennedy, M.S,. N.C.C, L.P.C., Quality Performance Specialist in the Capital region kkennedy1@performcare.org Rebecca Rager, M.S.W., Quality Performance Specialist in the Capital region at rrager@performcare.org Maria Bakner, M.S., L.P.C., Quality Care Manager in the Franklin/Fulton region at mbakner@performcare.org Allison Krause, MHSc, R.N., Quality Care Manager, Sr. in the Bedford/Somerset region at akrause@performcare.org 13