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.
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.”
On January 20, 2015, the NC Practice Improvement Collaborative and the Crisis Solutions Initiative sponsored a conference on crisis services, inviting four leaders in the field to present. Speakers included David Covington, CEO and president of Recovery Innovations; Mary Smith, Executive Director, REAL Crisis Intervention, Inc.; Larry Villano, Chief Operations Officer of Terros and the Clinic Operations Director for the Choices Network of Arizona; and Becky Stoll; Vice President, Crisis and Disaster Management of Centerstone. In addition, Dr. Aldona Wos, Secretary, North Carolina Department of Health and Human Services, presented her vision for the State: to eliminate stigma; to embrace the use of technology to its fullest extent; to promote community-based services at the time and place care is needed; to provide inpatient care as close to home as possible, combined with appropriate transitional services; and to support the recovery model for all people with mental illness.
One hundred sixty-three providers, LME/MCO staff, state agency staff, consumers, and advocates attended the meeting and evaluated it highly. PowerPoint presentations are available for download and videos of each session may be viewed on the NC PIC website.