2022 advocacy expanded edition

Andrea found herself in a crisis when she got into an argument with her family that escalated into a restraining order. Andrea was now homeless and began experiencing suicidal thoughts. She reached out to Legacy Treatment Services’ Screening and Crisis Intervention Program for support. Legacy provided a mobile crisis outreach and was able to assist Andrea in getting admitted to Kairos House, a local short-term residential program that aims to prevent hospitalization and emergency room use. Since admission, Andrea has not only been able to avoid homelessness, but psychiatric hospitalization, as well. She continues to participate in groups while looking forward to connections with long- term service providers and housing. ANDREA 10 Advanced Systems Crisis Services vs. Crisis Systems While each of the various programs described thus far is likely to improve outcomes in isolation, the impact is multiplied when an array of programs and services work together as a coordinated system to achieve common goals. This approach is illustrated in Figure 1, which is based on the crisis system in Tucson, Arizona. In this model system, healthcare and LE stakeholders agree on a common goal of preventing avoidable jail, ED, and hospital use by providing care in the least restrictive setting that can safely meet the needs of an individual experiencing a BH crisis. Because less restrictive settings tend to be less costly, clinical and financial goals are aligned. In Arizona, a Regional Behavioral Health Authority (RBHA) contracts with multiple BH agencies to create an array of services organized along a continuum of intensity, restrictiveness, and cost. At all points along the continuum, which in this case includes co-location of crisis call center staff within 9-1-1, co-responder teams, and crisis facilities, easily accessible handoffs by LE facilitates connection to treatment instead of arrest. To further incentivize coordination, some contracts confer a “preferred customer” status to LE, so that, for example, response time targets for MCTs are faster for calls that involve LE. Governance and accountability are key to ensuring that crisis services operate as an organized and coordinated system. In the Arizona model, the RBHA serves this function via its role as the single payer and regulator for the crisis system. Other systems may be governed by counties, cities, or formalized stakeholder groups. Regardless of the convener, advanced crisis systems should have governance and accountability structures that align the various services towards common goals, foster collaboration between a broad array of community stakeholders (e.g., LE, health systems, schools, etc.), operate with a “no wrong door” approach where components collaborate to deliver services without restrictive entry or exclusion criteria, and use data to measure outcomes, make decisions, and improve performance. Figure 1. Alignment of crisis services towards a common goal. In a high functioning system, the individual services in the continuum work together to achieve a common goal, in this case, stabilization in I will forever be grateful to Legacy Treatment Services for helping me. I am getting healthy and working toward other goals! 12 Balfour, M.E., Hahn Stephenson, A., Winsky, J., & Goldman, M.L. (2020). Cops, Clinicians, or Both? Collaborative Approach s to Responding to Behavi ral Health Emer encies . Alexandria, VA: National Association of State Mental Health Program Directors.