AN INITIATIVE OF THE NC DEPARTMENT OF HEALTH AND HUMAN SERVICES - DIVISION OF MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES
Healthcare, government, law enforcement, and community leaders in North Carolina have come together to find better ways to help people in a mental health or substance abuse crisis. The Crisis Solutions Coalition is working to decrease the use of emergency departments and to increase the use of other services to help individuals quickly resolve the crisis and get back to their homes, families, friends, and work.
The Crisis Solutions Initiative is addressing the numbers of avoidable visits and the long stays in emergency departments for people who are looking there for help in a behavioral health crisis. The initiative is focusing on Identifying and implementing the best known strategies for crisis care. The initiative is building partnerships between hospitals, service providers and other community responders. With earlier intervention strategies that prevent crisis altogether, each community in North Carolina can benefit from strengthened supports to help people.
June 18, 2015 — Four Local Management Entities/Managed Care Organizations (LME/MCOs) and their provider partners will pilot Critical Time Intervention, a program that assists adults with mental illness who are going through a transition phase in their recovery process.
Critical Time Intervention is a focused, time-limited approach to case management that connects people with community supports as they transition into housing from homelessness, or from institutional settings, such as prisons and hospitals, into ongoing community-based services. Critical Time Intervention teams include licensed clinicians and certified peer-support specialists. The evidence-based practice supports people with a serious mental illness, or who have experienced chronic homelessness. It focuses on recovery, psychiatric rehabilitation and full community inclusion, and is recognized by behavioral health professionals across the United States and internationally as a cutting edge case management model.
“DHHS understands the importance of an evidence-based case management support system to assist individuals going through critical transitions,” said DHHS Secretary Aldona Wos, M.D. “This patient-centered approach gives people increased likelihood for successful transitions back to their communities.”
Federal block grant funds, dedicated to the Crisis Solutions Initiative, have been awarded to the four LME/MCO’s in the amount of $365,000 each for State Fiscal Year 2015 and 2016 to establish the service.
Selected programs and a brief description of funded services are:
The Division of Mental Health/Developmental Disabilities/Substance Abuse Services has contracted with the UNC-Behavioral Healthcare Resources Program for training and technical assistance for Critical Time Intervention.
May 14, 2015
The Division of Mental Health/Developmental Disabilities/Substance Abuse Services (DMH/DD/SAS) and the NC Office of Emergency Medical Services (OEMS) are collaborating on an innovative strategy that will improve care for individuals in a behavioral health crisis.
Local Emergency Medical Services (EMS) personnel are frequently the first responders providing assessment and intervention for a person in a behavioral health crisis. EMS departments who have developed advanced training for their paramedics and partnerships with community providers that specialize in treating mental illness and substance use are able to successfully divert individuals in crisis from avoidable visits to hospital emergency departments to behavioral health crisis centers.
This Community Paramedicine Behavioral Health Crisis Response model benefits everyone involved. The person in crisis is able to access specialized behavioral health services more quickly and easily, and the emergency department has more time available to assist patients requiring an acute level of medical attention. This has been successful in Wake County for the past five years and in a similar model in Onslow County since the fall of 2014.
The DMH/DD/SAS and OEMS completed the first round of funding in the second quarter of 2015, providing grants of $5,000 each to 11 departments across the state to conduct advanced training for paramedics and purchase equipment. Upon full implementation, these departments, along with existing programs in Wake and Onslow counties, will have the ability to divert more than 2,500 individuals a year from emergency departments to crisis centers.
“We were thrilled with the response”, said Dave Richard, Deputy Secretary of Behavioral Health and Developmental Disabilities Services. “This funding gives local EMS agencies the necessary resources to formalize training, relationships and community infrastructure that will help serve individuals in crisis in a new and improved way.”
A substantial community partnership is needed to implement Community Paramedicine Behavioral Health Crisis Response. EMS agencies, crisis provider agencies and Local Management Entities/Managed Care Organizations (LME/MCOs) were required to collaborate and identify how the funds would be used to increase the community’s capacity to provide this service.
Funds were allocated to the LME-MCOs, who will reimburse local EMS agencies for advanced paramedic training in behavioral health crisis response or for equipment needed to support the project. The selected communities were also required to have a willing and available crisis center provider that will function as an alternative destination instead of an emergency department.
The EMS programs participating are from the following counties: Durham, Forsyth, McDowell, Rockingham, Brunswick, Guilford, Franklin, Lincoln, Orange, Stokes and Halifax.
The next goal for the partnership is to identify a sustainable funding strategy as insurers typically do not cover this service. Transporting a patient to an emergency department is the only service that most will pay for.
“The reimbursement sectors of our industry have not yet caught up to the best clinical practices that can be implemented in community paramedicine”, said Regina Godette, Chief, OEMS. “The existing programs and several of the start-ups are committed to operating with grant and local funds because they already see the clinical benefits to their patients and community stakeholders.”
The DMH/DD/SAS and OEMS are working with Wake and Onslow counties to develop clinical policies, which include standards and requirements for: agencies, individual paramedics, provision of the service, contracting strategies, reimbursement rates and data collection.
“We are breaking ground here, and there are many logistical mechanisms to work through,” said Crystal Farrow, Crisis Solutions Initiative Project Manager, DMH/DD/SAS. “Our internal partnership and the dedication we have from our local communities will keep us working on this until we have a successful model that can be replicated in any county across the state.”