CRISIS BEST PRACTICES WORKGROUP November 18, 2017 Todays Agenda Welcome Program Spotlight: RI International Content Overview: Technology in Crisis Programs Review Survey Results/Discussion Review Project Plan and Timeline

Adjourn Connection issues? Email [email protected] Purpose: To develop a comprehensive Best Practice Toolkit for Crisis Residential Services, informed by Crisis Residential providers across the country. Crisis Best Practices Workgroup TBD Solutions is proud to sponsor the Crisis Best Practices Workgroup. Crisis Program Development Metrics Development Middle Management Training Interactive Data Visualization Quality & Process Improvement Integrated Care Coordination Research & Analysis Software Procurement Consulting @TBDSolutions Crisis Services Map Workgroup Participants 164 participants 136 Crisis Residential Providers 10 Crisis Providers, Psych Hospitals, or Peer Respites 8 State Behavioral Health Administrations Represented (GA, KY, MN, NY, TX, VA, WA, WI) 43 states Plus D.C., England and Costa Rica Approximately 435 crisis homes

exist nationwide (Adult & Youth) Welcome new participants from CA, CO, MT RI INTERNATIONAL Recovery Crisis Respite Program Christopher Magee RI International Brief History RI International was founded in 1990 (formerly known as Recovery Innovations and META Services). Today RI International projects revenues of $75 million (in 2015) with Recovery Programs in five States (Arizona, California, Delaware, North Carolina, and Washington) and Auckland, New Zealand.

RI Internationals key business lines include: Advanced Crisis, Transition management, Integrated Health and Recovery (outpatient and peer support services), Consulting/Training services. About RI International RI International has trained more than 9,500 Peer Professionals since the year 2000 across the globe and provided speaking and consulting services in more than 38 Countries. RIs crisis stabilization programs became known as Recovery Response

Centers, using a peer-driven integrated recovery model and offering welcoming, non-threatening spaces referred to as Living Rooms and Retreats. Were dedicated to deep change and making a difference in the lives of all those we serve. In addition we are championing three clinical initiatives: suicide prevention through Zero Suicides healthcare training; Crisis Now, helping regions and states elevate their crisis services; and Peer 2.0 which seeks to move from anecdotal reports regarding steps to recovery to a proven framework grounded in research and outcomes. RI International Current Community Partnerships Recovery Programs in: Arizona California Delaware North Carolina

Washington New Zealand RI International Mission and Vision Mission Empowering people to recover, succeed in accomplishing their goals, find meaning and purpose in life, and reconnect with themselves and others. Vision Activating the next generation of frame-breaking healthcare innovation to support people beyond their behavioral health needs and succeed in the community where they live, work, and play. RI International Crisis Respite Recovery Crisis Respite Program

Located in Peoria, AZ (approximately 20 miles Northwest of Phoenix) First Crisis Respite within Maricopa County (County approximately the size of the State of Connecticut, 5th largest City within U.S., only State Capitol with population of 1 million plus) Opened on 9/28/15 Licensed by the State of Arizona Department of Health Services as a 10 bed Residential Facility Provides short-term transitional residential accommodations with 24/7 continuous peer support

Admitted individuals enter the Program for up to a maximum of 14 days. Primarily funded by Mercy Maricopa Integrated Care. Incentive, outcome based contract. RI International Crisis Respite Intentional Recovery Service Philosophy Design: - Peer Living Room Concept - Primarily Peer Support Team - No Force First, No Seclusion/Restraint -

Trauma Informed Care, Do No Harm - Healing Spaces - Home Away From Home - Independence versus Dependence - Golden Rule - Resort, Hospitality Customer Service Mindset RI International Crisis Respite

Basic Admission Criteria: - Voluntary Adult - Able to safely self-administer all medications as prescribed - Not an imminent threat to harm self and/or others - No recent substance use requiring detox protocols - No current medical support needs - Able to independently care for all daily living skills/care needs

- Individual not stepping down from an acute Level 1 facility - Current open and active Mercy Maricopa Integrated Care member RI International Crisis Respite Peer Support Services Offered/Provided: 10 bed short-term transitional residential facility. Co-ed facility. Five total bedrooms with two beds apiece (roommate living environment). All basic needs provided for (i.e., meals, clean linens,

laundry facility, computer/phone/TV access, showers, bathrooms, kitchen area, personal hygiene items, bedrooms, beds, etc.). Daily individual and group peer support services. Three Peer groups per day (i.e., meditation, yoga, arts and crafts, games, educational, community resources, etc.). Daily safe discharge planning starting day of admission. Counselor/Social needed. Worker/Nurse service availability as RI International Crisis Respite 24/7 cleaning service for health and

wellness as well as camera monitoring for safety. Discharge referrals for community resources: additional support systems, employment, more permanent housing, education, reconnecting to family and/or friends, ongoing Peer/Clinical services, Medical/Dental/Vision, smoking cessation, etc.. Connection to Care = 72 hour follow-up for each and every discharged individual. RI International Crisis Respite Unique Program Characteristics: Individuals keep and self administer their own medications as prescribed.

Individuals can go out into the community on Counselor/Social Worker approved day passes for recovery/sobriety treatment plan goal related activities. Incentive, outcome based contract. Average length of stay less than 10 days and less than 30% of individuals transferred to a higher level of care. Keep any and all 30 day readmissions to the bare minimum. Maintain a minimum daily census of 85% or above. Maintain a minimum average customer service satisfaction score of 85% or above. Promote smoking cessation to increase overall health and wellness. The vast majority of the Crisis Respite Team primarily consists of Peer Professionals (over 90%).

Entry and exit point for Maricopa County Crisis System. Hospital Emergency Room diversion facility. RI International Crisis Respite Program Outcomes: 96.2% overall customer service satisfaction score since opening. 36% of total admissions diverted from Hospital Emergency Rooms/Level 1 Facilities (325 total individuals). 8.26 days average length of stay. 9.8%

higher level of care transfer rate since opening. 8.5 average daily census. 7.7% Our total readmission rate within 30 days since opening. website = Thank you! Questions Content Review: Clinical Services & Training December 2016: Staffing July:

January 2017: August: Regulations & Governance Scope & Function February: Metrics & Outcomes March: Taxonomy & Community Relations April: & Treatment Philosophy Approach May:

Intake June: Funding The Safety Net September: Clinical Services & Training October: Managing Admissions & the Milieu November: Technology Technology in Crisis Programs Web presence Social

Media Presence Accessible Technology for Employees & Clients Email Access Telehealth Opportunities for Improvement Technology in Crisis Programs Website Does your crisis program have a website or a page on your company's website? 34%

Yes No 66% n=35 Social Media Where does your crisis program have a social media presence, either independently or as a part of your organization's account(s)? We do not have a social media presence 62% Facebook 29% Twitter 15% LinkedIn 12%

Glassdoor 6% Youtube Instagram 6% 0 0% 0% n=34 10% 20% 30% 40%

50% 60% 70% 80% 90% 100% Technology Provided for Employees What type of technology is provided for employees within your crisis program? Internet Access 97% Fax machine 97%

Desktop Computers 94% Electronic Medical Record 80% Encrypted email (for PHI-sensitive information) 80% Scanner 71% Laptop Computers 71% Electronic signature pads 51%

Instant messaging (internal to organization) 34% Shared Heath Systems access (inter-program sharing) Tablets Other (please specify) 0% n=35 31% 17% 14% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Technology Provided for Clients What technology do clients have regular access to in your crisis program? Computer 65% Internet access Cell phones

Other (please specify): Symptom tracking apps 3% Their own cell phones. Landlines. 61% 48% 39% Mystrength App Public Wifi None Pay Phone n=31 Email Access Which employees have email accounts? Managers/Administra... 100%

Clinical Professionals 97% Direct Care Provi... 94% Support Staff/Ancillary Staff 91% Int Volunt... Other (please speci... 51% 9% 6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% n=35 Using Telehealth

In what ways does your program use telehealth technology to provide treatment? Point-to-point or other secured videoconferencing 46% We do not use telehealth 34% Teleconferencing 34% Other (please specify): Unsecured Video Conferencing (i.e. Skype, Oovoo, Facetime, etc) 0% n=35 17% 6% 20%

40% 60% 80% 100% Using Technology in Clinical Treatment In what ways is your program using technology to provide clinical treatment? We do not use technology to provide clinical treatment. Other (please specify): 0% Virtual Reality 0% Neurostimulation devices 0% Biofeedback n=33

85% 15% Our NPs, psychiatrists do telemedicine for 2 local ERs Providing internet access for clinical resources. TED Talks, YouTube videos, Vimeo. Technology Lacking? Tablets Too many paper forms Interactive website for completing forms, surveys, etc. Computers for residents use Lack of access to EMR outside of work Future Directions in Crisis

Technology Electronic Bed Board Secured Sharing of Client Information Collaborative Tools Across Health Care/Social Services Real-Time Metrics Survey Participation & Incentives Please complete missing surveys by 11/30/17 Email Claudia at [email protected] with any questions Crisis Services Database Surveying for all Crisis Crisis Residential

Services in each State 23 Hour Crisis Stabilization Mobile Crisis Psychiatric Hospitals State Psychiatric Hospitals CIT Teams Peer Respites Email [email protected] Next Steps Steering Committee: Updates coming in January Group Listserv: [email protected] Website: (Meeting Slides stored here) Questions: [email protected]

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