Mobile Crisis ServicesBEHAVIORAL HEALTH BUREAUMONTEREY COUNTY HEALTH DEPARTMENT
Agenda
Mobile Crisis Program Overview
Seneca Children & Youth Mobile Response
Data Review
Best Practice Standards
Challenges & Strategies
Mobile Crisis Operational PeriodProgram Launched November 2015Pulled from field response March 2020 (Covid)Program Reactivated April 2021Staffing:3.0 FTE PSW licensed / licensed eligible staff and 1.0 Sr. PSW (3 of 4 positions filled)Location:Based out of Peninsula Region (Monterey PD), Salinas Region (BH outpatient clinic on Natividad campus), South County Region (Greenfield PD)Hours of operation:Wednesday – Saturday 12:30 – 10:00pm and alternating Tuesdays Mobile Crisis Program Goals
Provide
crisis intervention services and support to individuals and families in psychiatric distress throughout Monterey County. Provide LE partners and treatment providers with specialized assistance to respond safely and effectively to those in crisis.Collaborate with first responder partners and treatment providers to recognize the signs of psychiatric distress and safely de-escalate a mental health crisis.Increase timely access to available resources and link people to appropriate treatment and community supports as clinically indicated.
Types of Services ProvidedAssess for need for hospitalization (WIC 5150)Liaison with first responders & hospital for continuity of care Brief crisis intervention & de-escalationReferrals & linkage to community resourcesStabilization in community & diversion from emergency resources Non-urgent outreach & follow-up in community Consultation & liaison support for LE, BH and community providers MCBH & Natividad Hospital Crisis Team Changes - Effective April 1, 2022 NATIVIDAD HOSPITAL•For individuals who are in Natividad Hospital Emergency Department (ED) or Mental Health Unit (MHU)•To reach the Natividad Crisis Team or Inpatient MHU, the public and other providers will need to call the hospital operator at 831-755-4111•Request to be connected to the hospital’s Crisis Team for patients in the ED or transferred to the MHU for patients in the inpatient unit.BEHA VIORAL HEALTH•Community facing and responsive BH Crisis Team separate from the hospital & integrated with Mobile Crisis •Public can reach the BH Crisis Team by calling our 24/7 Access number at 888-258-6029,selecting the prompt for the Crisis Team •Hospital Providers can call 888-258-6029and select prompt 6 for BH support with discharge planning for new clients, Short Doyle authorizations for inpatient care, and collateral.•There is also an Internal BH and LE only number •Program went Live July 13, 2020•English & Spanish Services providedServices available for:Children and Youth Ages 0-21 & their FamiliesBehavioral Healthhas contracted with Seneca to provide MRT Services in Monterey County
Service Operations•In-Person crisis support services: •Monday - Friday8am-10pm•Saturday - Sunday11am-9pm•24 hour/7 day a week Phone support•Currently under development: 24/7 In-Personresponse•The MRT teams include:•2 mental health clinicians•1 family partner•Families are engaged though a strength-based & trauma informed approachto assist in de-escalating and stabilizing the situations
What does the MRT do?
Provide crisis counseling and attempt to stabilize out-of-control situationsAssess the need for hospitalization Work with youth and families to develop safety plans to limit current and future crisesWork collaboratively with any existing services team membersLink the youth to further mental health services when appropriate When do families call MRT?The youth is throwing objects at people and seems out of control.The youth is threatening to run away.The youth is a danger to themselves or othersThe youth is severely depressed and at risk of a psychiatric hold
•Add bullets or other graphics•This type of slide has the logo•In the background for effectSeneca MRTSkill BuildingPreventing Hospitalizations Placement StabilizationPreventing 911 or law enforcement involvementPromoting Healthy Families Contacting Seneca MRT
•24-hour support line: 831-687-4379 •Service Providers with Non-Urgent referrals can email [email protected]•Tina Lehman (805) 423-3219 Data
Overall BH System of CareTen-year service trend
•In FY 21/221, our system of care served a total of 13,150 clients for a total service value of $102,851,037.80. •The average service value per client was $7,821.37 •The average age was 30 years old. •There were 4,389 new clients admitted to the system of care and 7,440 discharged
Mobile Crisis Team Program Utilization5641472181848932443183288652842543219182593393123,4841,0101,2111,22884930720432205001000150020002500300035004000All Regions Peninsula Salinas Valley South CountyNumber of Calls for ServiceCY 2016CY 2017CY 2018CY 2019Nov 2015 - Mar 2020April 2021 - June 2022 Mobile Crisis Calls for Service (Pre-Covid & before Seneca MRT)21 and under, 121, 36%22+, 211, 64%CY 2019 Distinct Client Count21 and under22+21 and under, 448, 34%22+, 861, 66%Nov 2015 - March 2020 Distinct Client Count21 and under22+CY 2019 total calls = 918Distinct client count = 332Nov 2015 – March 2020 total calls = 3,484Distinct client count = 1,309 How Calls Are Initiated All Regions Nov. 2015 – June 2022(MCT not operational mid-March to April 2021) 1,129, 26%
1,254, 29%
1,767, 41%
183, 4%4,333 Total Calls for Service
Consultation from LEConsultation from MCBH or OtherAgenciesCADOther Mobile Crisis Team CALLS FOR SERVICE BY REGIONREFERRALS BY AGENCYAgency # Referrals % Of LE ReferralsGreenfield PD779 17%MCSO624 14%Salinas PD48611%Monterey PD357 8%Marina PD196 4%Soledad PD154 3%Seaside PD138 3%King City PD952%Pacific Grove PD82 1%Gonzales PD56 1%Carmel PD32 <1%CSUMB PD10 <1%Other LE 9 <1%Sand City PD8 <1%Del Rey Oaks PD2 <1%Peninsula31%South County36%Salinas Valley33%Nov 2015 – June 2022PeninsulaSouth CountySalinas Valley Mobile Crisis Overall Call Disposition / OutcomeAll Regions Nov. 2015 – June 2022(MCT not operational mid-March to April 2021) 853, 20%
69, 2%
525, 12%
1,049, 24%
716, 16%
465, 11%
425, 10%
231, 5%
5150ArrestBrief Crisis Intervention with SignificantSupport PersonBrief Crisis Intervention with Individualand ReferralsConsultation with LE onlyDiversion by immediate linkage tooutpatient / community resourcesGone on arrival, no contact madeOther Mobile Crisis WIC 5150 Reason Nov. 2015 – June 2022(MCT not operational mid-March to April 2021)406, 43%93, 10%203, 21%63, 7%60, 6%104, 11%17, 2%Total = 815 DTSDTOGDDTS / GDDTO / GDDTS / DTODTS / DTO/ GDCriteria by frequency:1. Danger to Self2. Grave Disability3. Danger to Self & Others4. Danger to Others Calls for Service by Age NOV . 2015 – MAR. 2020
3484300355748144825801000200030004000
Total All Ages
18+
18-24yo
0-17yo
13-17yo
6-12yo
0-5yoAPRIL 2021 – JUNE. 2022
84966711118216020202004006008001000
Total All Ages
18+
18-24yo
0-17yo
13-17yo
6-12yo
0-5yo
Seneca MRTJuly 2020 – June 2022
Time Frame Total Calls # of Crisis Calls *Situation StabilizedTeam Dispatched5585/admitted to Hospital5150/admitted to HospitalJuly 2020 – June 2021 1,502 153 85 12 11 1July 2021 142 23 15 6 0 0August 2021 266 97 70 4 0 2September 2021 257 53 27 3 5 1October 2021 274 31 12 7 6 0November 2021 327 65 33 17 4 0December 2021 308 40 9 12 5 0January 2022 218 41 8 14 8 0February 2022 287 40 19 12 4 0March 2022 421 48 17 14 4 0April 2022 323 57 16 18 2 0May 2022 301 52 14 17 3 1June 2022 159 24 14 9 1 0Grand Total4,785 724 339 145 53 9* Situation Stabilized - The category title varied overtime. Amount is the sum in-person and crisis phone support provided and situation stabilization.
Best Practice StandardsSAMHSA NATIONAL GUIDELINES FOR BH CRISIS CARE
Best Practices: SAMHSA National Guidelines for BH Crisis Care•Crisis services are for anyone, anywhere and any time•Services Include:•Crisis lines accepting all calls and dispatching support based on the assessed need of the caller•Mobile crisis teams dispatched to wherever the need is in the community(not hospital emergency departments)•Crisis receiving and stabilization facilities that serve everyone that comes through their doors from all referral sourceshttps://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-services-executive-summary-02242020.pdfhttps://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf Core Services and Best Practices: SAMHSA National Guidelines for BH Crisis CareEssential Elements within a no-wrong-doorintegrated crisis system:1.Regional Crisis Call Center – 24/7 clinically staffed hub/crisis call center that provided crisis intervention (phone, text, chat) and quality coordination of crisis care in real-time;2.Crisis Mobile Team Response – Mobile crisis teams available to reach any person at their home, workplace or any other community-basedlocation in a timely manner;3.Crisis Receiving and Stabilization Facilities – short term (under 24 hours) observation and stabilization services in a home-like, non-hospital environment Challenges & Strategies
Challenges
WORKFORCE SHORTAGE
FUNDING
988 IMPLEMENTATION & COORDINATION
LACK OF ALTERNATIVE PLACEMENTS, GAPS IN CRISIS CONTINUUM Behavioral Health Workforce Shortage# of Medi-Cal eligible beneficiaries up 16% Average position vacancy rate in CA counties is 20%Source: CalMHSA 29 Big PictureMedi-Cal Enrollment Up12,614,02912,742,44812,865,76613,001,05213,109,24213,205,50513,299,57613,384,31013,539,52713,665,09113,721,20513,824,01813,920,86513,993,76114,059,90514,136,14314,223,88314,296,02414,359,51614,418,84914,491,86714,570,86514,585,18414,603,81211,000,00012,000,00013,000,00014,000,00015,000,000Apr 2020May 2020Jun 2020Jul 2020Aug 2020Sep 2020Oct 2020Nov 2020Dec 2020Jan 2021Feb 2021Mar 2021Apr 2021May 2021Jun 2021Jul 2021Aug 2021Sep 2021Oct 2021Nov 2021Dec 2021Jan 2022Feb 2022Mar 2022 Certified Eligible (Total Enrollment)
Total Medi-Cal Certified Eligible – April 2020 through March 2022 Data Source: DHCS Extracted from MS/DSS 11 Apr2022
30 Staffing – Down•Mental Health•21% of budgeted LPHA positions vacant (957 vacant positions)•23% of counties have MH vacancies over 30% (up to 52%)•SUD•20% of budgeted SUD positions vacant (38 vacant positions)•9% of counties have SUD vacancies over 30% (up to 100%)Data Source: Cost Survey 2021 Cost-Survey Analysis: LPHA VacanciesWhen we look at the workforce shortage numbers, this means;1out of every 5master’s level staffing positions is vacant. 31 Staffing – Down (continued)Cost-Survey Analysis: % Vacancy by Staff Type 0% 10% 20% 30% 40% 50% 60%MD (typically in SUD system of care)Alcohol and Drug Counselor CertifiedMental Health Rehab SpecialistOther Qualified ProviderLPHA (MFT, LCSW, LPCC)/Intern or Waivered LPHARNLVNPsychiatrist/ Contracted PsychiatristAlcohol and Drug CounselorPeer Recovery SpecialistNurse PractitionerPercent Vacancy by Staff Type SUD Vacancy %MH Vacancy %Data Source: CalMHSA Cost Survey 2021 Understanding the different training & expertise of BH cliniciansOutpatient Services Crisis Team Mobile Crisis HNTLicensed or Licensed Eligible StaffX X X Licensed staff onlyOriented to entire BH System of Care & referral processes to providersX X XOriented primarily to assigned program only within Access, ASOC, CSOC XWIC 5150 / 5585 training and certificationX X X XOnly work with open BH clients XRespond to BH clients & non-clientsX (office based) X XOn-Call 24/7 for callout when any of the 3 HNT teams are activated (MCSO, SPD, SRU)XTrained in Natividad ED Crisis Team responsibilities and partnerships* X X XTrained in crisis response in the community in depth X XReceive specific training and guidance on collaborating with LE partnersX XFunction as BH liaisons with LE partnersX XReceive specialized training in Hostage / Crisis Negotiations (Basic, Advanced and Domestic Violence courses)XTrain regularly with LE partners (pre-covid)X*Starting 4/1/2022, MCBH is no longer providers of services in Natividad Hospital Behavioral Health Mobile Crisis Team Program Funding Sources
CHAFFA FUNDS (START UP EQUIPMENT ONLY)MHSA FUNDSMEDI-CAL REIMBURSEMENTCRISIS CARE MOBILE UNITS GRANT (INFRASTRUCTURE) MCBH Mobile Crisis Team ProgramActual Expenditures - 100,000.00 200,000.00 300,000.00 400,000.00 500,000.00 600,000.002015 2016 2017 2018 2019 2020 2021Mobile Crisis Program ExpendituresSalaries & BenefitsOthers MCBH Mobile Crisis Team Program Actual Revenues01000002000003000004000005000006000002015 2016 2017 2018 2019 2020 2021Mobile Crisis Program Revenue Other FFP SGF CHFFA Grant MHSAFFP = Federal Financial Participation (Medi-Cal); SGF = State General Fund; CHFFA = California Health Facilities Finance Authority; MHSA = Mental Health Services Act MCBH Mobile Crisis Team Medi-Cal Reimbursement2015 2016 2017 2018 2019 2020 2021 FFP- 50,112.43 68,113.07 89,882.22 61,784.17 33,146.19 12,710.70 SGF- - 994.50 1,868.80 2,906.86 1,987.39 676.24Total- 50,112.43 69,107.57 91,751.02 64,691.03 35,133.58 13,386.94 - 10,000.00 20,000.00 30,000.00 40,000.00 50,000.00 60,000.00 70,000.00 80,000.00 90,000.00 100,000.00Axis TitleMobile Crisis Medi-Cal ReimbursementFFP = Federal Financial Participation (Medi-Cal); SGF = State General Fund Seneca Mobile Response Team (MRT) Program Funding SourcesCHFFA GRANT FUNDS MEDI-CAL REIMBURSEMENTCHFFA = California Health Facilities Finance Authority Seneca Mobile Response Team ProgramActual Expenditures - 50,000.00 100,000.00 150,000.00 200,000.00 250,000.00 300,000.00 350,000.002020 2021Seneca MRT ExpendituresSeneca Seneca Mobile Response Team Program Actual Revenues0500001000001500002000002500003000003500002020 2021Seneca MRT Revenue Other FFP SGF CHFFA Grant MHSAFFP = Federal Financial Participation (Medi-Cal); SGF = State General Fund; CHFFA = California Health Facilities Finance Authority; MHSA = Mental Health Services Act Seneca Mobile Response Team ProgramMedi-Cal Reimbursement2020 2021 FFP- 24,419.93 SGF- 1,978.63Total- 26,398.56 - 5,000.00 10,000.00 15,000.00 20,000.00 25,000.00 30,000.00Axis TitleSeneca MRT Medi-Cal ReimbursementFFP = Federal Financial Participation (Medi-Cal); SGF = State General Fund What is 988? •America’s first 3-digit number dedicated to suicide prevention and crisis support. It is a national portal for connecting to local service•Beginning July 16, 2022, people can access the Lifeline via 988 or by 1-800-273-TALK•When people call the local line or Lifeline (988), they are connected to trained counselors that are part of the existing National Suicide Prevention Lifeline network. These trained counselors listen, understand how their problems are affecting them, provide support, and connect them to resources. 988
42 988 Vision for Behavioral Health Crisis Care Continuum –Short Term Vision988 will strengthen and expanded access to a network of crisis call centers for Monterey County residents to gain access to community resources.In Monterey County, currently available mobile crisis response and supports will remain the same with a vision to create a more comprehensive system in the next 3-5 years.
988
43 988 Vision for Behavioral Health Crisis Care Continuum –Long Term Goal (3-5 years) The full vision of a transformed crisis care system with 988 at its core will not be built overnight.Transformation of this scale will take time, and we are all working together to make it happen.
Strategies
Grant funding opportunities
BH Crisis Team separate from the hospital & community focused Internal Restructuring to integrate BH Crisis and Mobile Crisis Teams Ongoing Relationship Building & Collaboration
Workforce: Growing Our Own
Stepping Up Initiative
Current Service Gaps
•Mobile Crisis hours are not 24/7/365•Sobering Center hours are not 24/7/365•Lack of Crisis Receiving & Stabilization Units •More alternatives to jail and hospitals are needed https://crisisnow.com/
Projects under development to enhance the crisis continuum of care Child / Adolescent Crisis Stabilization Unit & Crisis Residential Services Facility (Seneca) Crisis Stabilization Unit (CHOMP)
Possible Next Steps
Training for First Responders
Explore City / County collaborations
Consider viability of adding Co-Responder Units (LE, FIRE, AMR) Consider embedding crisis trained staff at County Comm.
Advocate for increased capacity in MSW programs (i.e., CSUMB) Training for First Responders
Mental Health First Aid (8-hour course)•Advocate to add this foundational training to all basic police and fire academies• Specialized MHFA modules for Public Safety; Fire and EMS are available•https://www.mentalhealthfirstaid.org/population-focused-modules/public-safety/•https://www.mentalhealthfirstaid.org/population-focused-modules/fire-and-ems/• Long Beach Fire implemented this in 2018•https://www.longbeach.gov/fire/press-releases/mental-health-first-aid/Crisis Intervention Team (CIT) Training• Currently available for law enforcement/dispatchers (40-hour/one week course)• Pre-covid offering 3 academies per year with max 35 participants per academy• Develop CIT for Fire / EMS (24-hour course)?• CIT now available for 911 dispatchers through CIT International (8-hour online course) in high demand•https://www.citinternational.org/CITST911 Ongoing Collaborative Efforts
Crisis Intervention Team (CIT) Training for LE
Hostage / Crisis Negotiation Team (HNT)
Critical Incident Stress Management (CISM)
BH Mobile Crisis Team Response
Co-Responder Models•“ At its core, the co-responder framework typically features a specially trained team that includes at least one law enforcement officer and one mental health or substance abuse professional responding jointly to situations in which a behavioral health crisis is likely to be involved, often in the same vehicle, or arriving on scene at generally the same time.” Source: https://www.theiacp.org/sites/default/files/SJCResponding%20to%20Individuals.pdf Co-Responder Model Variations•Law Enforcement Calls for After-Event Support•Law Enforcement Obtains Clinical Support Virtually•Fire Department and/or Emergency Medical Services Join Law Enforcement and Clinicians•Multi-Professional Teams, Especially for Substance Abuse Intervention•Law Enforcement Calls for Non-Clinical Support•Peer Support Workers Join Law Enforcement•Clinical Staff Advise from Dispatch Centers•Behavioral Health Navigators Join Law Enforcement at Point of Reentryhttps://www.theiacp.org/sites/default/files/SJCResponding%20to%20Individuals.pdf Additional Resources & Supporting Information•https://bja.ojp.gov/program/pmhc•https://www.theiacp.org/sites/default/files/SJCResponding%20to%20Individuals.pdf•https://whitebirdclinic.org/cahoots/•https://www.denvergov.org/Government/Agencies-Departments-Offices/Agencies-Departments-Offices-Directory/Public-Health-Environment/Community-Behavioral-Health/Behavioral-Health-Strategies/Support-Team-Assisted-Response-STAR-Program•https://www.memphistn.gov/news/alliance-healthcare-services-earns-innovation-award-for-care-team-model/