ICYMI: Elements of Effective Crisis Management

From Certified Community Behavioral Health Clinic (CCBHC) programs, the 988 National Suicide Prevention Hotline, mobile crisis-teams and co-responder support, there’s a lot of initiatives and discussion brewing around crisis management. As the demand for crisis behavioral health services continues to rise, there’s never been more urgency around implementing outcomes-focused initiatives.

But what does effective crisis management entail and how can organizations implement a strategy that works for their community?

In a recent webinar, Medical Director of the National Council for Mental Wellbeing, Dr. Joe Parks, and Director of Operations at Rappahannock Area Community Services Board, Brandie Williams, joined Senior Director of Population Health, Julie Hiett, in discussing the elements of an effective crisis system including a population health management approach paired with technology that supports care coordination and seamless information sharing.

What makes an ideal crisis system?

Parks kicked off the webinar by introducing a report from the Group for the Advancement of Psychiatry regarding the roadmap to an ideal crisis system. The document builds on the work of the Crisis Now Group, SAMHSA and National Association of State Mental Health Program Directors to set a conceptual framework to create a great crisis management system.

The report notes that behavioral health care needs to be seen as an essential community service, just like police, fire and emergency medical services. It should also be accessible to individuals and families with a welcoming, whole-person, recovery-oriented approach. Parks also highlighted the importance of centralized data system for assessment of care, which Williams explores further later in the presentation (32:25).

There are also some basic practices of an optimal crisis system laid out in the report. An ideal behavioral health crisis system has guidelines for utilization of the best practices for intervention with associated processes for practice improvement, developing workforce competency and quality care. This includes screening and intervention efforts, assessing population-specific best practices as well as collaboration, coordination and continuity of care.

“Once a crisis is over, if we just walk away thinking ‘great, that’s done’ then you’re likely to have another crisis in a week to 30 days,” Parks said. “There needs to be ongoing care, support and treatment to prevent repeat situations.”

Finally, the report includes tools to help organizations implement, including 10 steps for communities, 10 steps for system leaders and advocates, as well as successful crisis system local implementation examples. To hear the full discussion of the roadmap report, including accountability and finance, the important role of CCBHCs, and adopting measurable 988 criteria, check out the webinar from 4:45 – 21:05.

Navigating the crisis landscape

It’s important to remember the path to an ideal crisis system is not always smooth for providers. We must work together where the rubber meets the road at the intersection of what is the ideal and implementation reality. Let’s take a look at Virginia and Rappahannock’s response.

For the past five years, the state has embarked down a path to build a comprehensive behavioral health crisis system to ensure individuals get the care they need, when they need it and in the least restrictive placements. Rappahannock is working to navigate multiple programs for crisis management (discussed further at 29:20), which can be challenging based on varying requirements and consumer needs.

“There are many roads, many requirements with many expectations for these initiatives and movements for community health organizations,” Williams said. “At the end of the day, we are tasked with providing informed, quality care for individuals we are privileged to serve.”

The nature of crisis services doesn’t really allow us to take the system down to rebuild and launch, so the question is how do providers manage divergent expectations and initiatives and keep flying the plane as we build it?

For Rappahannock, the solution has been leveraging technology and embracing collaboration. As one of 40 community service boards, Williams said the Virginia-based organization is able to streamline disparate systems and different requirements, helping forge ahead on a path toward more integrated care.

Eliminating siloes through technology

Siloed data is an issue, especially in crisis situations. However right now most client information is stored in disparate settings. In order to move toward a more comprehensive system of care, providers need an efficient way to quickly obtain vital information in the moment to support a quality, whole-person, informed response to the person in crisis.

“This is where we can use technology to get the information we need when we need it,” Williams said. “In fact, we have a requirement and duty to share that important health information, leading us toward the interoperability we need. The more information we know about the individual, the better we can serve them and help reduce risk.”

By implementing a population health platform, Virginia is working to centralize information stored electronically and truly connect various systems of care such as crisis call center hubs, emergency departments, hospitals and behavioral health providers. Using a centralized crisis call center integrated with the Netsmart population health platform, Virginia will gain a more holistic view of an individual’s care journey by bringing in data from different provider organizations.

Through the platform’s interoperability capabilities, information from electronic health records, HIEs, hospitals or jails can be consumed, while also looking at social determinants of health and resource identification to help stratify risk, empower closed-loop referrals and overall best serve the individual during and after the crisis.

While there are lots of different models to connect care, the foundation lies with sharing data across disparate systems. This includes the ability to action information quickly and at your fingertips, especially surrounding a crisis situation as there typically isn’t a lot of time to run reports in the moment. Plus, a population health platform is integral in helping facilitate coordinated services post crisis to reduce the risk of future crisis and improve outcomes for each individual.

Knowing the full story at the scene will make the best impact for both the individual and your community. Watch the full webinar here.