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CAMINO REAL COMMUNITY SERVICES

CRISIS SERVICE PLAN 2010-2011

3/1/2010




Mental Health Service Department
Veronica Sanchez, MA, LPC
Director of Mental Health Services




GOAL:
  • Enhance crisis response system

OBJECTIVES:
  • Rapid response
  • Local stabilization when possible
  • Reduced burden on law enforcement, and
  • Decrease utilization of emergency healthcare resources.

Camino Real Community Services consists of a 9 county service area, which serves approximately 2686 adults and 871 children annually.  Of those served during fiscal year 2009 approximately 1089 (unduplicated count) were provided crisis services.  This was a significant increase from 2007 data which was 750 when the 2008 center crisis plan was submitted. The FY2009 24 Hour Crisis Hotline data indicates 2486 calls were received through the hotline and of those 763 contacts were considered Emergent calls requiring a 1 hour face to face assessment by a Qualified Mental Health Professional-Community Services (QMHP-CS).  Out of the 763 persons assessed a total of 317 consumers were hospitalized by the local mental health authority during fiscal year 2009. This is a decrease from the FY2007 data during which time a total of 340 persons were hospitalized and a decrease from FY2008 when 359 hospitalizations were documented.

Overall since the implementation of the initial Crisis Plan the center is showing a decrease in the utilization of inpatient hospitalization as well as utilization of state hospital beds. This information was gathered from our database. 


DESCRIPTION OF PLANNING WITH COMMUNITY STAKEHOLDERS

When initially developing the crisis service plan, stakeholder meetings and discussion groups were organized through the leadership of the executive director who worked in collaboration with the local county officials. A goal was established by the group and the group moved forward through many discussions in developing agreements that could improve the crisis response system. The Crisis Task Force Group met formally three times between May and August 2007. During 2008 and 2009 the group remains active and continues to meet to address community needs related to Crisis Services.

In Maverick County where the MCOT was established meetings are held every quarter with the Crisis Task Force stakeholders noted in Table 1. The focus of the meetings remain consistent with the goal of ensuring citizens have access to the best crisis response system. During 2008 3 suicides heightened awareness around the issues related to mental health crisis services causing a renewed effort, on the part of the community, to work with the center on awareness and prevention projects. Since these incidents a Suicide Prevention Task Force has been formed. The group meets monthly and has moved forward in investing time and resources.

Through sharing of information and resources the task force groups intend to enhance access to the community services and supports as well as identify a way to address the various gaps in services. The task force groups also intend to enhance services to persons experiencing a behavioral health crisis by focusing on educating the public. The Center staff will continue to work diligently to participate in existing workgroups and will work towards holding ongoing stakeholder meetings throughout the year for purposes of securing feedback related to crisis response services as well as other services.

Table 1

LIST OF COMMUNITY STAKEHOLDERS

Name Title
Emma Garcia Executive Director
Moises Pena Jr. Police Sergeant
Tony Castaneda Chief of Police
Sheriff Tom Herrera County Sheriff
Honorable Judge Jose Aranda County Judge
Rene Lopez Hospital Administrator
Ricardo Ramos County Attorney
Wilma Carbonel Hospital Director of Nursing
Elsa Vetancort ER Nurse
June Edwards Justice of the Peace
Veronica Nunez Team Leader, Children's Services
Erwin Jaloway Deputy Executive Director
Maria Roman Mental Health Clinic Director
Salome Lopez MCOT, Team Leader
Veronica Sanchez Director of Mental Health Services

Through the various discussions and meetings the following community needs remain highlighted as priorities:
  • Need to reduce the length of time officers wait in hospital waiting rooms once they have taken someone into custody.
  • Need to relax the medical clearance requirements of the state hospital to reduce the time it takes to get a consumer to the hospital.
  • Need to reduce the length of time a police or sheriff officer is out of the community due to transporting the individual to a state mental health facility.
  • Need to reduce the length of time it takes to get the legal documents to send someone for inpatient hospitalization.
  • Need for law enforcement education.

The most significant barrier to addressing the gaps in services in the nine county region served by Camino Real, remains a lack of financial resources at the local level. In addition, there is a significant lack of service agencies who can address the local demand. The area is designated as medically underserved with a severe shortage of healthcare professionals, which has forced agencies to work together.


Section A.

DESCRIPTION OF CONTRACTOR'S EXISTING CRISIS SERVICE SYSTEM

Camino Real Community Services contracts with an external agency, Avail Solutions, Inc., to operate a 24 Hour Crisis Hotline (1-800-543-5750). Avail Solutions, Inc. is operated by Qualified Mental Health Professionals, who are trained in telephone crisis screening and intervention. Individuals in crisis or persons needing assistance with a mental health crisis contact the 1-800-543-5750 Crisis Hotline Number. Upon completion of a brief telephone screening the Crisis Hotline Consultants are able to make a determination regarding the need for a face-to-face assessment of a person in crisis. A Face-to-Face Assessment will be conducted by Camino Real Community Services QMHP-CS staff within 1 hour of the request from Avail Solutions in emergent situations. Presently, referrals are also received directly from the local law enforcement offices, local hospitals, as well as juvenile detention offices and other community residents through direct contact with the local mental health clinics.

As mentioned earlier in this plan the fiscal year 2009 data indicates that a total of 2486 brief QMHP-CS screenings were conducted over the telephone thru the Crisis Hotline. A total of 763 of these calls were considered emergent and On-Call QMHP-CS staff provided the face to face assessment immediately (within 1 hour). In total, the QMHP-CS on-call staff facilitated a total of 317 hospitalizations for persons in need of inpatient psychiatric care. Of the 317 hospitalizations 173 were at a State Mental Health Facility and 144 were Private Hospitalizations.


Section B.

DESCRIPTION OF COMPONENTS OF THE CRISIS SERVICES SYSTEM

Camino Real Community Services has a current crisis response system staff make-up as follows:

       39 QMHP-CS (Rotate Day/After Hour On-Call Responsibility)
       4 LPHAs (Rotate On-Call Responsibility)
       4 Physicians (Rotate emergency on-call responsibility)
       1 24-hour/7 days/week Crisis Hotline (external contract)
       1 MCOT-Maverick County (4 staff)

The QMHP-CS employees located throughout the service area provide face to face assessments in consultation with an LPHA. As needed the QMHP-CS may consult with a psychiatrist. If hospitalization is required as the least restrictive treatment setting the center utilizes the state mental health facilities as well as private psychiatric hospitals. During 2009 the center contracted with a private psychiatric hospital to ensure quick access to hospital beds since the State Mental Health Facilities remain on diversion a fair amount of time.

Hotline

Camino Real Community Services contracts with an external agency, Avail Solutions, Inc., for management the Crisis Hotline, which operates 24 hours/day/7 days/week. In October 2007, Avail Solutions, Inc. secured accreditation by the American Association of Suicidology as required by DSHS.

Mobile Crisis Outreach Team (MCOT) Maverick County

Camino Real Community Services in response to the various issues and priorities identified by the Crisis Task Force during the planning meetings held in the summer of 2007, developed and implemented a Mobile Crisis Outreach Team (MCOT) in Maverick County. Of the 9 county service area, Maverick is the most densely populated and has the corresponding intensity of activity that justified the cost and utility of a mobile crisis outreach team. The data for FY 2006 & 2007 consistently reflected that the highest number of crisis calls to the hotline, highest number of face to face assessments, and the highest number of inpatient hospitalizations occurred in Maverick County. Trending information for this same period (2007) revealed that there was a steady increase in the volume of in-patient hospitalizations that corresponded with the population growth in this county. Maverick County is the service site furthest (3 hours) from the SMHF facility resulting in an average of 8 hours of Deputy and City Police travel time related to detainment and transportation of individuals in need of inpatient hospitalization.

In Fiscal 2010 the team is staffed with 3 QMHP-CS and one LPHA with oversight by the Medical Director. The team has been effective in diverting individuals from inpatient hospitalization as well as incarceration when this was an option. In working closely with law enforcement that has been educated about available MCOT services in the community, Maverick County was able to demonstrate a decrease in the utilization of state hospital beds. With the efforts put forth by the team and with increased education and collaboration within the community the crisis response system appears to be showing the positive impact of the enhanced Crisis Response System and diverting individuals from the state mental health hospital.

The tables below demonstrate the trend for the service area related to SMHF versus Private hospitalizations over the past few years. This illustrates the centers continued efforts around diverting individuals from State Mental Health Facilities when at all possible. Basically, 45% of individuals recommended for hospitalization last year were diverted to private hospitals.


Table 2

State Mental Health Facility Utilization 2007-2009

County FY2007
SMHF Utilization
FY2008
SMHF Utilization
FY2009
SMHF Utilization
Atascosa 34 35 28
Dimmit 16 19 26
Frio 10 6 13
Karnes 9 15 5
LaSalle 6 4 1
Maverick 76 77 65
McMullen 0 0 0
Wilson 30 34 18
Zavala 28 23 17
TOTAL 209 213 173


Table 3

Private Hospital Utilization 2007-2009

County FY2007 Private
Hospital Utilization
FY2008 Private
Hospital Utilization
FY2009 Private
Hospital Utilization
Atascosa 39 42 31
Dimmit 3 9 10
Frio 11 10 14
Karnes 8 11 10
LaSalle 2 5 4
Maverick 25 22 25
McMullen 0 0 0
Wilson 33 33 33
Zavala 10 14 17
TOTAL 131 146 144
GRAND TOTAL
TABLES 2 & 3
340 359 317


The attached flowchart describes the current crisis response system from the first call or contact with the center through crisis resolution and follow-up (Attachment A & B).

Training

Critical to a successful crisis response system is training of involved stakeholders; although, as a priority, focus will be placed on ensuring that first responders such as jail staff and law enforcement are trained in the area of recognizing mental illness, recognizing high risk individuals, and suicide assessment. Camino Real Community Services plans to provide Crisis Intervention Training at least twice each year. In August 2009 the center provided training to 15 officers from the Maverick, Dimmit, and Zavala county area.

In addition, the center has two certified Mental Health First Aid Instructors and one certified QPR Instructor who will provide training throughout the service area in order to improve people's knowledge around mental health and around suicide. This plan will lead to a natural enrichment of understanding of each stakeholder's role with crisis response and ultimately improve relationships with law enforcement, juvenile/adult probation, schools, hospitals, judiciary, and local medical health centers who are key stakeholders in assuring that their community has a strong and effective crisis response system.


Section C.

DESCRIPTION OF SOURCE OF FUNDS FOR CRISIS RESPONSE SYSTEM

Camino Real Community Services funds the crisis response system with funds provided by DSHS through Crisis Redesign as well as other general revenue. In addition, the center has been able to access in-kind contributions such as use of training rooms to host training events which has been at no cost to the center. Some of the crisis related services are billed to Medicaid Rehabilitation. In addition, the county sheriff's departments and city police continue to provide transportation which is a major contribution to the crisis response system. Camino Real has maintained its pre-crisis funding” level of effort related to hotline services, after hours crisis follow-up, and day time crisis response using local and state dollars. The center has continued the funding related to the clinical oversight provided by the LPHA'S AND Psychiatrists.

DESCRIPTION OF HOW THE LMHA WILL COORDINATE WITH OTHER LOCAL CRISIS RESPONSE SYSTEMS

The center will continue to collaborate with the local counties to find additional funding opportunities to support the local communities in improving services in the various areas to include crisis intervention, domestic violence services and services for substance abusers and juveniles. The center refers individuals to the domestic violence shelters in the areas as appropriate. In Eagle Pass, Texas the local substance abuse coalition of which the center is a member, is actively pursuing grants in order to better serve the community needs. An interagency group in Eagle Pass is collaborating with the center to host a series of trainings on Mental Health First Aid. The center will provide the instructor while the Interagency Group will provide the funds to sponsor attendees and cover overhead costs.

In order to improve and develop the local crisis response system's ability to divert individuals from incarceration the Center has worked over the years to improve relationships with local law enforcement, a main crisis response entity in our various communities as well as with the judges. In response to feedback from the Jail Diversion Task Force members the center implemented a plan to include ongoing education for law enforcement as well as other stakeholders in the community (hospital, school, probation, etc). Most recently over 15 law enforcement individuals participated in Crisis Intervention Training sponsored by Camino Real Community Services and the local Maverick County Sheriff's Department. To make certain the community has knowledge of how to access crisis services and routine services the center aggressively increased its marketing efforts by advertising weekly in the local newspapers to ensure the toll free Crisis Hotline is published.


Section D.

A DESCRIPTION OF HOW SPECIAL POPULATIONS ARE SERVED

The center has a contract with TCOOMMI which is specific to serving special needs offenders with the intent to improve the offender's opportunity to avoid relapse and incarceration and address the person's mental health issues. This has resulted in over 103 individuals served with special needs. Local probation and parole offices are directly communicated with and are aware of the crisis response system as well as how to access crisis services through the crisis hotline.

The center works with local agencies such as the Winter Garden Women's Shelter and the Atascosa Family Crisis Center to address needs related to Domestic Violence. All sites have pamphlets available for the National Domestic Violence Hotline Number in areas visible to consumers. In one county the Executive Director of the Atascosa Family Crisis Center is the chairperson for the Interagency Meeting which is hosted monthly and provides a forum for addressing multiple needs in the community. Camino Real Community Services is a participant of these meetings.

With regards to children and adolescents the visibility of children's services staff is high in the local school districts and contacts are made with school counselors and teachers who are familiar with crisis services as well as our routine services available to children and their families. The MCOT is available to respond to calls from the schools. The center participates in Safe Schools Grant in partnership with the 4 school districts where 3 Camino Real Community Services mental health counselors have been based at the school to address some of the mental health needs of school aged children in these school districts.

With regards to veterans the center has developed relationships over the years with County Veteran Service Officers. In addition the center executive director and mental health service director has participated in bi-annual meetings hosted by the Veterans Administration which has provided an opportunity to strengthen relationships between the entities to address needs of veterans. Of recently the Veterans Administration has employed Veterans Justice Officers to tend to the veterans who come in contact with the justice system and who may need services. If veterans are seen through the crisis response system QMHP-CS are familiar with veteran resources and understand the process for accessing the VA emergency services department if hospitalization is warranted. Basically, if a veteran is encountered in crisis the veteran will receive crisis services just as any other community member that accesses the crisis response system. The plan is to continue building the relationships within the veteran community and to continue working to enhance services to veterans in the service area.

DESCRIPTION OF PROCESS TO ENSURE PLAN IS WORKING

Ongoing scheduled quarterly meetings in the local communities will allow for oversight and review to ensure there is a mechanism for mutual feedback. Most importantly the center will have the opportunity to quickly address any barriers to accomplishing the goals of the Crisis Plan.

Successful crisis services are dependent on an ongoing dynamic communication between the center and the local agencies and stakeholders.



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