Nevada’s Crisis Initiative Webinar #1: Nevada’s Crisis Care Initiative and National Guidelines for Crisis Care    

6/16/2020

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June 16, 2020

Nevada’s Crisis Response System Webinar Series

Webinar #1: Nevada’s Crisis Care Initiative and National Guidelines for Crisis Care 01

Webinar #1 Nevada’s Crisis Care Initiative & National Guidelines for Crisis Care

Review Nevada’s progress to date in a crisis care initiative

Orient participants to best practices and the national guidelines for crisis care

Provide peer perspectives on crisis care as a system

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Objectives

This webinar series is funded and coordinated by the Nevada Department of Health and Human Services Transformation Transfer

Initiative.

Webinar #1Overview

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Welcome and OrientationKelly Marschall, Social Entrepreneurs, Inc.

Nevada’s Progress and National Best Practices Stephanie Woodard, PhD, State Mental Health Authority, Department of Health and Human Services (DHHS)

Immersion Experience Immersion Participants

Peer PerspectivesSandy Stamates, Executive Director, National Alliance on Mental Illness (NAMI) Northern Nevada

Overview of the Crisis Response Model

Kelly Marschall, SEI

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It’s Been a Bad DayCrisis Now: Transforming Crisis Services

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https://www.youtube.com/watch?v=GWZKW8PLIgQ

Nevada’s Progress and National Best Practices

Dr. Stephanie Woodard, State Mental Health Authority, Department of Health and Human

Services (DHHS)

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Nevada’s Crisis Initiative Webinar #1: Nevada’s Crisis Care Initiative and National Guidelines for Crisis Care    

6/16/2020

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Responsive & ResilientNevada’s Solution to Addressing Crisis

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Moving Beyond “Beds”

• Full continuum of Care• Terminology• Criminal/Juvenile

Justice Diversion• Emergency Care

Standards• Psychiatric Beds• Transitions in Care• Community Resources• Data • Technology• Workforce

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Individuals waiting in Emergency Rooms for Behavioral Health Services

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Insurance Status

Uninsured54%

Tricare (Military)0%

Medicaid Fee for Service

7%

Medicaid Managed Care

3%

Pending Medicaid14%

Medicare9%

Private Insurance4%

Other9%

INSURANCE STATUS--SFY20 YTD

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Impact of COVID-19 on Mental Health in Nevada

• According to the CDC Household Pulse Survey, 8.2% of adults aged 18 and over had symptoms of anxiety disorder, 6.6% had symptoms of depressive disorder, and 11.0% had symptoms of anxiety disorder or depressive disorder

• In the week of May 28 through June 2, 2020, the percent of Nevadans with symptoms of anxiety disorder or depressive disorder was three times greater than the same time period last year

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Crisis Now

Crisis mental health care in the United States is inconsistent and inadequate. This is tragic in that good crisis care is a known effective strategy for suicide prevention, a preferred strategy for the person in distress, a key element to reduce psychiatric hospital bed overuse, and crucial to reducing the fragmentation of mental health care.

Crisis Services Task ForceAction Alliance

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Nevada’s Crisis Initiative Webinar #1: Nevada’s Crisis Care Initiative and National Guidelines for Crisis Care    

6/16/2020

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Crisis Now

National Association of State Mental Health Program DirectorsNational Action Alliance for Suicide PreventionCrisis Now, RI International

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Crisis in Nevada• Services are reactive; often only

available to those in greatest need• The absence of access to intermediate

levels of care increase utilization of L2K• Increase trauma, stigma, asking for help

leads to victimization• Unnecessary incarceration,

institutionalization, hospitalization, and placement; ER’s and jails

• Paradigm of scarcity of resources vs. building upon natural support

• Lack of access to evidence-based care for individuals with suicidality

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Crisis in Nevada• Poor discharge planning, connectivity to

community resources• Dependence on cost resources such as

police and ambulance • Perpetuates the “revolving door” or

alienation from services• Does not take into account treatment

matching• Leads to ER boarding, creating a

bottleneck for admission for those who need access to timely inpatient care

• And the list could go on…..15

Now is the time

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Nevada’s Ideal Crisis Continuum

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Acuity and Severity

Residential/Sub-acute Crisis Stabilization (Peer-

led, Respite, Crisis Stabilization Centers)

23 hour Outpatient Crisis Stabilization (CCBHC, Crisis Stabilization Centers,

Observation Units, Crisis Triage Centers), Outpatient Walk-in Crisis Services, Ambulatory Withdrawal

Management

24/7 Mobile Crisis (CCBHC, Rural Clinics, DCFS Children’s Mobile Crisis, MOST, Civil

Protective Custody, Mobile Recovery Outreach Teams, Crisis Intervention Training)

Crisis Counseling and Supportive Service, 24/7 Crisis Call Line

Community Based Crisis Screening, Prevention, Early Intervention and Support (ASSIST, SAFE-TALK, Mental

Health First Aid, Psychological First Aid, NAMI Warm-Line, Zero Suicide Screening, Collaborative Assessment and

Management of Suicidality, Signs of Suicide, 2-1-1 Information and Referral)

Acu

ity a

nd S

ever

ity

Inpatient Psychiatric Stabilization (Psychiatric Advanced Directives)

Efforts Supporting a Crisis Response System• Governor’s Council on Behavioral Health and

Wellness (2014)• Community Integration Planning (2016-2018)• TTI (2018)• Crisis Now Summit I (October 2019)• Phoenix Immersion (January 2020)• Assets and Gaps Mapping (March/April 2020)• SAMHSA COVID-19 Emergency Behavioral

Health Grant (Present)• FEMA/SAMHSA Crisis Counseling Assistance

and Training Grant (Present)• Virtual Immersion Series (Present)

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Nevada’s Crisis Initiative Webinar #1: Nevada’s Crisis Care Initiative and National Guidelines for Crisis Care    

6/16/2020

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Efforts Supporting a Crisis Response System• Governor’s Council on Behavioral Health and

Wellness (2014)• Community Integration Planning (2016-2018)• TTI (2018)• Crisis Now Summit I (October 2019)• Phoenix Immersion (January 2020)• Assets and Gaps Mapping (March/April 2020)• SAMHSA COVID-19 Emergency Behavioral

Health Grant (Current)• FEMA/SAMHSA Crisis Counseling Assistance

and Training Grant (Current)• Virtual Immersion Webinar Series (Current)

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Regional Behavioral Health Coordinators

• Stacy Burns, Southern Region• Esmeralda, Lincoln, Nye, Mineral

• Valerie Cauhape, Rural Region• Elko, Eureka, Humboldt, Lander,

Pershing, White Pine

• Dorothy Edwards, Washoe County• Teresa Etcheberry, Clark County

• Jessica Flood, Northern Region• Carson City, Churchill, Douglas, Lyon,

Storey

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CHURCHILL

CLARK

DOUGLAS

ELKO

ESMERALDA

EUREKA

HUMBOLDT

LANDER

LINCOLN

LYON

MINERALNYE

PERSHING

STOREY

WASHOE

WHITE PINE

CARSON CITY

Crisis Now

National Association of State Mental Health Program DirectorsNational Action Alliance for Suicide PreventionCrisis Now, RI International

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Nevada’s Crisis Continuum:From Fragmented to Integrated

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• Fully fund Crisis Call Center to be the hub for “air traffic control”

• Crisis Call Center deploys 24/7 mobile crisis

• Crisis Call Center to have scheduling access to same day/next day appointments for state-run and community providers

• Full participation in on-line bed registry (OpenBeds) for all inpatient, residential, crisis stabilization beds

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• Design “living room model” crisis stabilization centers

• Optimize community paramedicine programs for evaluation, triage, and step-down support

• Train and implement core evidence-based practices across the continuum (CAMS, Zero Suicide, Columbia, trauma informed services, LOCUS/ASAM)

• Develop peer and community-based volunteers, including faith-based organizations to deploy

• Fund tele-psychiatry for statewide access for consultation and evaluation

Nevada’s Crisis Continuum:From Fragmented to Integrated

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• Grow outpatient stabilization programs• Educate community and law

enforcement on options for referral instead of ER

• Establish additional Assertive Community Treatment teams for step-down and outpatient crisis stabilization

• Utilize Assisted Outpatient Treatment statewide

• Establish Comprehensive Care Teams for Early Serious Mental Illness Statewide (ESMI)

Nevada’s Crisis Continuum:From Fragmented to Integrated

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Nevada’s Crisis Initiative Webinar #1: Nevada’s Crisis Care Initiative and National Guidelines for Crisis Care    

6/16/2020

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• Train primary care and psychiatry providers on ESMI

• Move away from “bed-based” care models at levels below Residential, 3.7 Withdrawal Management, and Inpatient Psychiatry

• Explore Medicaid 1115(a) Demonstration Waiver for SUD and SMI/SED IMD exclusion to reimburse for residential services and expand access to inpatient psychiatry

• Utilize Medicaid Long-Term Services and Supports (LTSS) to provide medically necessary supports for individuals with disabilities

Nevada’s Crisis Continuum:From Fragmented to Integrated

Developing the Road Map

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Immersion Experience• Rick Caldeira, Chief of Staff to Mayor Schieve• Brandon Cassinelli, Embedded Resource Officer, Reno Police Department• Oscar Delgado, Councilmember, Reno City Council• Grant Denton, Operations Manager, Downtown Reno Partnership and

Executive Director, Karma Box Project, Inc. • Dean Dow, President and CEO, REMSA• Erik Olson, CEO, Renown• Julia Ratti, Nevada State Senator • Steve Shell, CEO, Reno Behavioral Healthcare Hospital• Hillary Schieve, Mayor, City of Reno• Joseph Turner, Rate Analysis & Development Unit, Department of Healthcare

Financing and Policy (DHCFP)• Stephen Wood, Division of Public and Behavioral Health (DPBH)• Dr. Stephanie Woodard, DHHS• Dawn Yohey, Clinical Program Planner III, DPBH

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Imm

ersio

n Pa

rtici

pant

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Peer PerspectivesSandy Stamates, Executive Director, National Alliance on Mental

Illness (NAMI) Northern Nevada

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Questions,Comments,

& Ideas

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Next Up

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Funding Crisis CareJune 23, 2020 │9:00-10:30 am

Facility-Based Crisis StabilizationJune 30, 2020 │9:00-10:30 am

The Roles and Function of Crisis Call CentersJuly 7, 2020 │9:00-10:30 am

Mobile Crisis TeamsJuly 14, 2020 │9:00-10:30 am

Essential Principles and PracticesJuly 21, 2020 │9:00-10:30 am

Drafting Priorities for Crisis Response in NevadaJuly 28, 2020 │9:00 am-1:00 pm *There will be a break from 10:30-11:00 am

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Nevada’s Crisis Initiative Webinar #1: Nevada’s Crisis Care Initiative and National Guidelines for Crisis Care    

6/16/2020

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Thank You

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This Virtual Summit is supported with funding by Substance Abuse & Mental Health Services Administration under Contract HHSS283201200021I, Task HHSS28342003T, Reference 283-12-2103; and

the National Association of State Mental Health Program Directors (NASMHPD), Inc. under Subcontract Number SC-3011.3-NV-01

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