Therapeutic Crisis Respite ProgramMichelle L. Monnat, LMHCJeremy Felice

“Creating Opportunities to Enhance Lives, One Relationship at a Time”

Children’s Home of Jefferson CountyFounded as an orphanage in 1859 Transitioned to a Residential Treatment Center in 1970sExpansion of Foster Care in 1990s and 2012Addition of several community based services through the 1990s and 2000sUpdated Residential Model of Care in 2009Establishment of OMH Article 31 Mental Health Clinic in 2011 – Community Clinic of Jefferson CountyBalancing Incentive Program 2014

Therapeutic Crisis Respite Program

Tri-County InitiativeYouth ages 10* through 17Short Term Respites Aftercare

Respite PhaseCANS Assessment Referral to Mental Health ServicesSchool Partnership and AdvocacyFamily Support and Supported VisitationPsychiatric Assessment and NeurofeedbackPsychological EvaluationConnection to Community Services

Ongoing ServicesClinical GroupFamily Support GroupParenting EducationLife Skills Crisis InterventionTherapeutic Recreation

Yoga, Meditation, Deep Breathing, etc.PsychoeducationAcademic Support including tutoringSupported Visitation

Family EngagementParenting Group

Six Week ProgramTopics Include:

Three C’s: Caring, Consistency and ConsequencesDiscipline Versus PunishmentParent and Youth Relaxation TechniquesSelf-CareBehavioral Support TechniquesRules and RoutinesParenting Styles

Treatment Team Meetings InitialReturn HomeFinal Discharge

Aftercare Phase

90 Day Connection to ServicesPhase Out “Warm Hand Off” MethodContinuous Crisis Intervention Services

Staffing ModelProgram DirectorCare Coordinator – Outreach and Engagement24/7 Awake Staff

Bachelor’s or Master’s degree in psychology, education or a related fieldMinimum of two staff per shift at all times

Registered NurseLicensed CliniciansPsychiatristPsychologist

Staff On-Boarding and TrainingThree Week Intensive Training

Week One:Team Building – Project AdventureClinical Training - Building Positive AttachmentsClinical Training - Working with Traumatized ChildrenClinical Training – Why It Matters – Advanced attachment trainingChild Sexual AbuseMedication TrainingSupported Visitation TrainingBehavior Management Training

Training Cont’d

Week TwoTherapeutic Crisis Intervention

Week ThreeStaff Observations Columbia –Suicide Severity Rating Scale (C-SSRS) training

Ongoing TrainingContinuous staff development at least monthly

Neurosequential Model of Therapeutics (NMT)

Child Trauma Academy (CTA)Trauma Informed “Way of thinking about youth”Brain MappingInformed Clinical Practice

Community ConnectionsCommunity Services BoardsLocal Departments of Social ServicesLocal Probation DepartmentsSt. Lawrence Psychiatric Center (SLPC) and Mobile Integration TeamCommunity Clinic of Jefferson CountySamaritan Medical Center and Carthage Area HospitalNorthern Regional Center for Independent Living (NRCIL)YMCA and SoZo Teen CenterNorth Country Family Health CenterSchool DistrictsNorth Country Prenatal/Perinatal CouncilVolunteer TransportationCommunity Action Planning Council (CAPC)Single Point of Access (SPOA)Cornell Cooperative ExtensionMany More…

Data-Driven Decision Making

Feb Mar Apr May Jun Jul Aug Sep Oct Nov02468

101214161820

Data by Month

Referrals

Admin

CCJC10%

CHJC11%

JRC1%School

13%TLS /Waiver4%Probation

1%

Danser&Knudsen1%

SMC13%

DPAO1%

LDSS13%

Parent/Guardian30% Other

3%

Referral Source

Data-Driven Decision Making2/

1/20

152/

7/20

152/

13/2

015

2/19

/201

52/

25/2

015

3/3/

2015

3/9/

2015

3/15

/201

53/

21/2

015

4/4/

2015

4/10

/201

54/

16/2

015

4/22

/201

54/

28/2

015

5/4/

2015

5/10

/201

55/

16/2

015

5/22

/201

55/

28/2

015

6/3/

2015

6/9/

2015

6/15

/201

56/

21/2

015

6/27

/201

57/

3/20

157/

9/20

157/

15/2

015

7/21

/201

57/

27/2

015

8/2/

2015

8/8/

2015

8/14

/201

58/

20/2

015

8/26

/201

59/

1/20

159/

7/20

159/

13/2

015

9/19

/201

59/

25/2

015

10/1

/201

510

/7/2

015

10/1

3/20

1510

/19/

2015

10/2

5/20

1510

/31/

2015

11/6

/201

511

/12/

2015

11/1

8/20

1511

/24/

2015

0

5

10

15

20

25

Respite / Aftercare Roster

ACS TCRP

Data-Driven Decision Making

Feb Mar Apr May Jun Jul Aug Sep Oct Nov0

5

10

15

20

25

Respite / Aftercare Gender Stats

Female RespiteMale RespiteRespite AverageFemale After CareMale After CareAfter Care Average

Project Outcome MetricsGoal 1: Assist families in identifying their strengths and needs through administration of the Child and Adolescent Needs and Strengths (CANS) assessment tool:

Performance Target Compliance Rate

Staff Training 100% - Target Met

CANS-NY Utilization at admission 93% - Target Met

Benefit of CANS-NY to family 100% - Target Met

Project Outcome MetricsGoal 2: Decrease recidivism of emergency room and preventable hospital utilization:Performance Target Compliance Rate

Client specific historical data collected

92% - Target Met

Youth will be offered intensive intervention/ youth participation

100% offered / 100% Participation - Target

Met

“High Risk” youth offered aftercare services

100% - Target Met

“High Risk” youth aftercare participation

86% - Target Met

Post Discharge Emergency Room Visits

7% - Target Met - Therefore 93% of

youth have not had a mental health

emergency encounter with the ED.

Project Outcome MetricsGoal 3: Decrease symptoms and behaviors, family stress and functional impairment from the time of admission through discharge:

Performance Target Compliance Rate

Offering of family engagement services 100% - Target Met

Family participation in family engagement services

89% - Target Met

Demonstration of improved behaviors at discharge

90% - Target Met

Success Stories

“What a simple idea!”

We brought our son to you and you cared for him as we would, and you may very well have saved his future. I could see my son heading towards a darker place - maybe self harm or rebelling into deeper trouble. We were able to participate in the two week respite program. I'm unsure of your official verbiage for the program but I call it a savior! By allowing our family time to decompress, we were able to reset. What a simple idea!”

In the words of a youth…

“TCRP helped me with my addiction to tobacco products. It helped me realize there is more to life then being a mess up. TCRP helped with my depression by doing rec and activities. TCRP helped me with my social skills because I made multiple friends there and it helped my life at home with my parents. My parents and I get along much better now.”

“Consolation, Validation and Support”“When the behaviors started, I often felt isolated, embarrassed and helpless. I didn't know who to turn to for help. The Children's Home Respite staff offered me consolation, validation and support. I was given several agencies and professionals to contact and seek help from. I was able to share information with the rest of my family providing comfort and a direction for us all to move in.”

“Well-Planned”

“The Care Coordinators and staff kept excellent contact with our family and pointed us in the right direction for psychological assessments, medical attention and counseling. The transition back into our home was well planned beginning with short supervised home visits and then an occasional overnight until our family could regroup.”

Lessons Learned

FAMILY ENGAGEMENTIncorporate Groups Initial AssessmentsRemain flexible - but never lose site of the vision!

QUESTIONS?