ROADMAP TO THE IDEAL CRISIS SYSTEM Essential Elements, Measurable Standards and Best Practices for Behavioral Health Crisis Response March 2021 ROADMAP TO THE IDEAL CRISIS SYSTEM: Essential Elements, Measurable Standards and Best Practices for Behavioral Health Crisis Response March 2021 Authored by Committee on Psychiatry and the Community for the Group for the Advancement of Psychiatry Published by National Council for Behavioral Health CONTRIBUTORS: Kenneth Minkoff, MD (co-chair) Judge Steven Leifman Jacqueline Maus Feldman, MD (co-chair) Stephanie LeMelle, MD, MS Curtis Adams, MD Mark Munetz, MD Sarah E. Baker, MD, MA Keris Jän Myrick, MBA, MS Margie Balfour, MD, PhD Fred Osher, MD XinLin Chen, MD Paula G. Panzer, MD Dianna Dragatsi, MD Joseph Parks, MD Michael Flaum, MD John Santopietro, MD Ann Hackman, MD, MA Yvonne Yang, MD For additional information, consultation or technical assistance please contact [email protected]. 2 ROADMAP TO THE IDEAL CRISIS SYSTEM TABLE OF CONTENTS Forewords ................................................................................................................................................................................................................................6 Introduction ............................................................................................................................................................................................................................11 Ideal Crisis Systems: A Framework for Design and Implementation .....................................................................................................23 SECTION I: Accountability and Finance .................................................................................................................................................................36 • Introduction ............................................................................................................................................................................................................37 • Structure for Coordination, Collaboration and Accountability .....................................................................................................40 • Financing .................................................................................................................................................................................................................42 • Eligibility (All-payer) ..........................................................................................................................................................................................46 • Geographic Access and Network Adequacy .........................................................................................................................................48 • Quality Metrics ......................................................................................................................................................................................................51 • Performance Incentives ....................................................................................................................................................................................54 • Flow and Throughput ........................................................................................................................................................................................56 • Comprehensive Client Flow Monitoring Data System .......................................................................................................................58 • Formal Assessment of Customer Satisfaction ......................................................................................................................................59 • Standardized Utilization Management and Level of Care Determination ...............................................................................60 • Relationship to the Rest of the Service System ...................................................................................................................................61 SECTION II: Crisis Continuum: Basic Array of Capacity and Services ...................................................................................................62 • Introduction ............................................................................................................................................................................................................63 • Overall Design Elements ..................................................................................................................................................................................64 » Value-based System and Program Design .....................................................................................................................................64 » Services Address the Continuum of the Crisis Experience ....................................................................................................66 » Creating Safe Spaces That Are Warm, Welcoming and Therapeutic ................................................................................68 » Safety and Security Practices That Are Both Safe and Welcoming ..................................................................................69 » Treating Law Enforcement as a Preferred Customer ................................................................................................................70 • Population Capacities ........................................................................................................................................................................................71 » Age: The Ideal Crisis System Provides a Comprehensive Continuum of Crisis Services for Children/Youth, Adults and Older Adults. ......................................................................................................................................71 » Crisis Continuum for People With Co-occurring Conditions.................................................................................................73 » Crisis Continuum for People With Cultural/Linguistic Challenges .....................................................................................76 • Service Components ..........................................................................................................................................................................................78 » Description of Continuum of Services ..............................................................................................................................................78 » Continuity of Care and Seamless Vertical and Horizontal Flow ..........................................................................................79 » Effective Information Sharing Capacity ...........................................................................................................................................81 National Council for Behavioral Health 3 » Client Tracking Through the Crisis Continuum and Beyond ..................................................................................................82 » Family and Collateral Outreach and Engagement .....................................................................................................................84 » Outreach and Consultation to Community Providers ..............................................................................................................85 » Telemedicine, Telehealth and Telepsychiatry ...............................................................................................................................86 • Elements of the Continuum ............................................................................................................................................................................88 » Crisis Center or Crisis Hub ......................................................................................................................................................................88 » Call Centers and Crisis Lines .................................................................................................................................................................92 » Deployed Crisis-trained Police and First Responders ...............................................................................................................94 » Medical Triage and Screening ...............................................................................................................................................................96 » Mobile Crisis ...................................................................................................................................................................................................98 » Behavioral Health Urgent Care .............................................................................................................................................................100 » Intensive Community-based Continuing Crisis Intervention .................................................................................................102 » 23-hour Evaluation and Extended Observation ..........................................................................................................................104 » Residential Crisis Program Continuum ...........................................................................................................................................108