Transcript Crisis Services Redesign Implementation Overview Texas Department of State Health Services Mental Health & Substance Abuse Division August 2, 2007

Crisis Services
Redesign
Implementation Overview
Texas Department of State Health Services
Mental Health & Substance Abuse Division
August 2, 2007
Crisis Services Funding

REQUESTED: DSHS requested $82 million from the
80th Legislature to make significant progress toward
improving the response to behavioral health crises

AWARDED: Through the Legislature and Rider 69, $82
million was appropriated over the FY08-09 biennium to
redesign the crisis system
Crisis Services Funding, cont’d.

$27.3 million will be allocated in FY 08

$54.7 million will be allocated in FY 09

Additional funds will be requested to the 81st Legislature

It is expected that new funds will be used to improve
the current crisis services provided and not replace the
current services
Allocation of Crisis Services Funding

Equity Contribution: Approximately 32% of the funds
will be used to improve equity in state funds among
LMHAs that have below average per capita funding
levels

Proportional Allocation: Approximately 36% will be
divided proportionally among LMHAs based primarily on
local service population.
Allocation of Crisis Services Funding,
cont’d.

Community Investment Incentive:
Approximately 30% of the funds will be offered
through a competitive process to communities
willing to invest significant local resources in the
development of Psychiatric Emergency Hub
Sites (26%) and Outpatient Competency
Restoration Services (4%).
Initial Crisis Services: Hotline

Every LMHA will be required to provide a
continuously available telephone service
staffed by trained crisis counselors that
provides information, screening and
intervention, and support to callers 24
hours per day, 7 days per week.

Hotlines must be accredited by the
American Association of Suicidology
(AAS)
Initial Crisis Services:
Mobile Outreach

Mobile Outreach Services are a combination of
crisis services that provide emergency care,
urgent care, and crisis follow-up in the child,
adolescent, or adult’s community location

Current mobile outreach services can be
improved with new crisis funds to add team
members, to work with law enforcement (MH
Deputy/Crisis Intervention Team programs), or
provide transportation (as needed)
Enhanced Crisis Services
Once initial crisis service requirements are satisfied, additional
services may be developed or improved upon, to include:
Children’s Outpatient Crisis Services:
Community-based outpatient services tailored to the needs of
children and adolescents, providing immediate screening and
assessment and brief, intensive interventions focused on
resolving a crisis and preventing admission to a more restrictive
level of care
Walk-In Services:
Office-based outpatient services for adults, children and
adolescents providing immediate screening and assessment and
brief, intensive interventions focused on resolving a crisis and
preventing admission of a more restrictive level of care
Enhanced Crisis Services, cont’d.
Extended Observation Services (up to 48 hours):
Emergency and crisis stabilization services provided to individuals in a
secure and protected, clinically staffed (including medical and nursing
professionals), psychiatrically supervised treatment environment with
immediate access to urgent or emergent medical evaluation and
treatment
Crisis Stabilization Units (CSUs):
Short-term residential treatment (up to a stay of 14 days) designed to
reduce acute symptoms of mental illness provided in a secure and
protected, clinically staffed, psychiatrically supervised treatment
environment that complies with a CSU licensed under Chapter 577 of
the Texas Health and Safety Code and Title 25, Part 1, Chapter 411,
Subchapter M of the Texas Administrative Code
Enhanced Crisis Services, cont’d.
Crisis Residential/Respite (Child and Adult):
Crisis residential services treat individuals with high risk of harm and
severe functional impairment who need direct supervision and care but
do not require hospitalization. Length of stay is generally less than one
week.
Transportation:
Funding used to help defray transportation costs incurred by local law
enforcement agencies related to behavioral health crises
Mental Health Deputies/Crisis Intervention Teams:
Funding used to assist local law enforcement agencies in providing
specialized training for deputies on the recognition of mental illness and
de-escalation of volatile situations
Community Investment Incentive
Community Investment Incentive Funds will be available through a
competitive process to provide:
Psychiatric Emergency Centers (Hub Sites)
Outpatient Competency Restoration Services
Psychiatric Emergency Centers
(Hub Sites)

All LMHAs or communities will be eligible to apply for funds to
establish “Hub Sites”

Up to 6 sites will be funded and selected in Q3 FY08;
operational in Q4 FY08

Elements of Hub Sites will include:

Extended Observation Services (up to 48 hours)

Inpatient services in a Crisis Stabilization Unit (CSU) or
hospital for up to 14 days
Outpatient Competency Restoration
Services

Senate Bill 867 allows for development and implementation of an
Outpatient Competency Restoration program to enhance the ability
of local communities to provide effective treatments and competency
restoration programming to appropriate individuals with mental
illness identified by the courts as incompetent to stand trial

Funds will be allocated for up to 4 sites by Q3 FY 08

All LMHAs will be eligible to compete for services

Design and implementation will be based on local and state needs
related to providing alternatives to competency restoration and the
demand for services to individuals that do not require inpatient
settings.
Competency Restoration Services, cont’d.

Outpatient competency restoration allows some individuals
determined Incompetent to Stand Trial receive evidence-based
and necessary services from community providers. Proposed
goals are:

Providing alternatives to inpatient competency restoration
services for persons who do not need inpatient care

Decreased costs of housing forensic patients/inmates in state
hospital system and jails

An effective, evidence-based program providing stabilization of
symptoms for individuals and less recidivism into inpatient
levels of care or jail system
Crisis Service Local Planning

The Crisis Service Plan will require a detailed description of the
current crisis response systems in addition to details of how any
additional funding will enhance the current systems.

Community stakeholders are a vital part of the local planning
process and will be key in successful implementation of crisis
services.
Community Stakeholders Involved

Client representatives
 Probation and parole

Client family member
representatives
 Judicial representatives from

Child and adult advocates

Mental health service
providers

Emergency healthcare
providers

local public healthcare
providers (i.e., Federally
Qualified Health Centers, local
health departments, etc)

Law enforcement
representatives from each
jurisdiction in the local service
area
department representatives
each county in the local
service area
 Outreach, Screening,
Assessment and Referral
(OSAR) provider(s) serving the
counties in the local service
area
 Substance abuse service
providers
 Others deemed appropriate by
the LMHA. (e.g. concerned
citizens, representatives from
the private sector)
Crisis Services Implementation: Timeline

Release of Performance Contract Amendment to LMHAs:
 September 2007

Return of Crisis Service Plan to DSHS from LMHAs:
 October 2007

New local crisis redesign services begin:
 December 2007
Measuring Accountability

Rider 69 outlines the options of reporting requirements from DSHS to
the Legislative Budget Board (LBB) and the Governor on the
implementation of crisis services

DSHS will add Performance Measures to the Performance Contract
Amendment on Crisis Services for all LMHAs
Proposed LBB Measures
No.
LBB Measure
Definition
1
Number of New Psychiatric
Emergency 23/48 Hour
Observation Sites
The number of new psychiatric emergency 23/48 hour
observation sites at Community Mental Health Centers paid
from DSHS funding sources.
2
Number of Persons
Receiving 23/48 Hour
Observation, Mobile
Outreach, and/or Children’s
Crisis Outpatient Services
The number of persons receiving 23/48 hour observation,
mobile outreach, and/or children’s crisis outpatient services at
Community Mental Health Centers. This is a duplicated
number, since persons may receive one or more of these
services.
3a
Percent of Persons
Receiving Crisis Services
Who Relapse
The percent of persons receiving front door or community
crisis services at Community Mental Health Centers who
experience another crisis within 30 days. This includes hourly
services.
3b
Percent of Persons
Receiving Crisis Services
that Result in a Psychiatric
Hospitalization
The percent of persons receiving front door or community
crisis services at Community Mental Health Centers that result
in a psychiatric hospitalization at a State or Community Mental
Health Hospital within 30 days.
Proposed LBB Measures, cont’d
No.
LBB Measure
Definition
4
Number of Community
Mental Health Center Staff
with AAS Hotline Training
The number of Community Mental Health Center staff trained
to support certification of the hotline per American Association
of Suicidology (AAS).
5
Percent of Stakeholders
Satisfied with Crisis
Services
The percent of stakeholders, including law enforcement and
hospital staff, who agree that Community Mental Health
Center staff are competent to resolve crises or that there is
good coordination between law enforcement and Community
Mental Health Centers.
6
Percent of Persons
Receiving Crisis Services
Who Have a Criminal Justice
Contact
The percent of persons receiving community crisis services
who had a complete assessment 90 or more days after their
crisis service which showed an arrest within the past 90 days.
Proposed Performance Contract Measures
No.
Contract Performance Measure
Definition
1
Percent of Persons Receiving
Crisis Services Who Relapse
The percent of persons receiving front door or
community crisis services at Community Mental Health
Centers who experience another crisis within 30 days.
This includes hourly services.
2
Percent of Persons Receiving
Crisis Services that Result in a
Psychiatric Hospitalization
The percent of persons receiving front door or
community crisis services at Community Mental Health
Centers that result in a psychiatric hospitalization at a
State or Community Mental Health Hospital within 30
days.
3
Percent of Crisis Client Episodes
Linked with DSHS-Funded Mental
Health Community and/or
Substance Abuse Treatment
Services.
The percent of front-door mental health crisis episodes
that are followed by a community level of care
authorization at the LMHA, and/or OSAR or DSHSfunded Substance Abuse Treatment service encounter,
no later than 14 days after the first day of their front-door
mental health crisis episode.
Proposed Performance Contract Measures,
cont’d.
No.
Contract Performance Measure
Definition
4
Percent of Persons Receiving
Crisis Services Who Have a
Criminal Justice Contact
The percent of persons receiving community crisis
services who had a complete assessment 90 or more
days after their crisis service which showed an arrest
within the past 90 days.
5
Percent of Clients with an Initial
Crisis Screening who have a
Subsequent Crisis Service
The percent of Clients with a level of care of 0 who have
a crisis service within 30 days of the initial crisis
screening. Excluding clients who are admitted to a
community or State hospital after the initial crisis
screening and clients who are determined to be noncrisis.
6
Percent of Hospitalizations
without a Crisis Assessment
The percent of clients who have a community or State
hospitalization and who do not have a crisis assessment
within 5 days prior to their hospitalization