Crisis Management Response

-- Offer them feedback on how you can, or cannot, visualize their concept of the response team. 

1. Mapping Out A Plan of Action For An Integrated Agency

The agency is a faith-based private practice located in central Kentucky. The agency has services for individuals of all ages. The agency focuses on treating the whole person. Services include behavioral health treatment, targeted case management, and medication management. I am a Licensed Professional Clinical Counselor Supervisor (LPCC-S).

What this Integrated Agency Looks Like

The agency’s mission statement is to provide quality care to all individuals and their families by treating the whole person. “Evidence demonstrates that physical and behavioral health problems often occur at the same time for people with serious mental illness” (Miller, 2014, p. 2). Due to the combination of physical and behavioral health problems occurring co-morbidly, it is our mission to provide holistic care to the individual through medical and mental health services.

The agency will consist of medical and mental health services with full collaboration. Both services will be located in the same facility and will be sharing the same space (Substance Abuse and Mental Health Services Administration (SAMHSA)-Health Resources and Services Administration (HRSA), n.d., p. 1). The medical and mental health teams will be working together by having “formal and informal meetings to support integrated model of care”, “communicating consistently” at all levels, and “resolving most or all of the system issues” (SAMHSA-HRSA, n.d., p. 1). There will be “one treatment plan for all patients” and “all patient health needs are treated for all patients by a team, who function effectively together” (SAMHSA-HRSA, n.d., p. 2). Collaboration and teamwork between medical and mental health services will be prioritized to ensure quality assurance.

This agency is an outpatient clinic. There are team members who serve in different roles to meet the needs of the whole person. Under the mental health umbrella, there will be three licensed therapists. There will also be two targeted case managers supervised by the LPCC-S.  Under the medical umbrella, there will be two psychiatric nurse practitioners who will perform assessments, diagnose, prescribe medications as needed, and perform medication management services for patients. In the agency, there will be a patient services coordinator who will schedule/reschedule appointments for all patients and will verify that all patient files are up to date. There will also be an insurance claims specialist, a quality assurance manager, an accounting clerk, and a human resources director.

Plan of Action

There are several ways that medical and mental health services will work together to improve patient outcomes. There will be weekly meetings among staff who provide services to the same client. During these meetings, treatment plans will be discussed to ensure that care is consistent among all providers. Patient cases will also be discussed and providers can consult with one another and address any situations. The targeted case managers will work alongside the licensed therapists and the psychiatric nurse practitioners to track patient progress and ensure coordinated care. Medical and mental health providers will also take part in training to educate and enhance an understanding of both health issues.

Essential Strategies For Effective and Efficient Client Care

Some strategies that are essential for effective and efficient client care include interpersonal communication, collaboration and teamwork, and care planning and care coordination. Interpersonal communication involves being able to “establish rapport quickly and to communicate effectively with consumers of healthcare, their family members, and other providers” (Hoge et al., 2014, p. 1). Interpersonal communication enhances staff and patient satisfaction, decreases the likelihood of medical errors, allows the staff to feel respected, and reduces burnout and stress. Collaboration and teamwork involve being able to “function effectively as a member of an interprofessional team that includes behavioral health and primary care providers, consumes, and family members” (Hoge et al., 2014, p. 1). Collaboration and teamwork enhance the quality of patient care, lead to efficient and timely interventions, allow the sharing of ideas and knowledge among staff, and promote problem-solving. Care planning and care coordination involves being able to “create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of information among consumers, family members, and providers” (Hoge et al., 2014, p. 1). Care planning and care coordination ensures that patients will receive care that is tailored to their specific needs, promotes consistency in care among all providers, and reduces the cost of care for patients.

Ensuring Client Understanding of Available Community Resources

            Two strategies that would ensure client understanding of community resources available are a comprehensive resources list and digital platforms. The agency must have a regularly updated comprehensive resource list to provide to patients. Some patients have needs beyond the services offered in the clinic. The resource list will include providers within the agency, local emergency services, local homeless shelters, local food banks, and local crisis centers. Each resource will consist of contact information, hours of operation, and an address if needed. If a patient is requesting resources that are not on this list, a targeted case manager will provide the patient with resources applicable to their needs.

            In this agency, we also make information about community resources more accessible through digital platforms. Each patient has an online portal that they can access via a webpage, or our mobile app. Patients will be able to easily search resources based on their needs. Our agency also frequently updates our social media platforms to share important information about community resources.

Community Outreach Team

            A community outreach team that is a good fit for my interagency design is a Crisis Intervention and Suicide Prevention Team. The team will focus on providing immediate support and intervention for individuals experiencing mental health crises or having suicidal ideations. The team will be equipped to conduct risk assessments and safety plans and will offer follow-up support after an initial crisis.

Responsibilities of the Counselor

            The counselor has many responsibilities during local, regional, or national crises, disasters, or other trauma-causing events. The counselor has the responsibility to be a beacon of hope, a crisis manager, an advocate, a resource, and a resilience builder (Counselor Brief, 2023, p. 1). The counselor works with individuals, families, groups, and communities to provide emotional support and guidance to those affected by a crisis (Counselor Brief, 2023, p. 1). The counselor also assesses a situation, identifies a need, and develops a plan of action (Counselor Brief, 2023, p. 1). The counselor will also “work to ensure that individuals and communities receive the support and resources they need to recover” (Counselor Brief, 2023, p. 1). The counselor also provides resources to help individuals cope with situations and future crises (Counselor Brief, 2023, p. 1).

            A counselor is required to be knowledgeable in quickly assessing an individual’s mental health status, risk of harm, and immediate needs when in a crisis. A counselor must also be knowledgeable in understanding psychological reactions to crises. A counselor must be skilled in providing brief counseling to individuals to help them cope. A counselor must also have effective communication skills for coordinating with other team members.

Training

            A counselor is required to have specific training relevant to emergency management. A counselor should have evidence-based and trauma-informed crisis training (Substance Abuse and Mental Health Services Administration, 2020, p. 31). Evidence-based counseling, such as Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), are both effective approaches in reducing symptoms and trauma (Math et al., 2015, p. 267 – 268). A counselor must also be trained in mental health first aid, suicide training, and HIPPA confidentiality.

            There are certain roles and responsibilities required to be a member of my agency’s emergency management response team. My agency’s emergency response team will provide both crisis and suicide prevention. Supervisees must be trained in mental health first aid. Mental health first aid involves teaching a member “how to identify, understand, and respond to signs of mental illnesses and substance use disorders” (Mental Health First Aid, 2024). A supervisee will also be required to Applied Suicide Intervention Training (ASIST). ASIST is a workshop in suicide first aid that teaches members how to recognize suicidal thoughts and helps individuals create a plan to support their safety (Centre for Suicide Prevention, n.d.). Other training such as crisis intervention and HIPPA Confidentiality will be required for all members.

Questions

· Are there other specific trainings that are required for crisis/suicide prevention?

· Is there a time frame for completing all requirements and training once a member begins training?

· Would it be beneficial for a member of the state’s crisis response team to conduct training/workshops?

References

Centre for Suicide Prevention. (n.d.). ASSIST Applied Suicide Intervention Skills Training. https://www.suicideinfo.ca/workshop/asist/

Counselor Brief. (2023). The Role of a Counselor in Crisis Situations. https://counselorbrief.com/insight/the-role-of-a-counselor-in-crisis-situations/

Hoge M.A., Morris J.A., Laraia M., Pomerantz A., & Farley, T. (2014). Core Competencies for Integrated Behavioral Health and Primary Care. Washington, DC: SAMHSA - HRSA Center for Integrated Health Solutions.

Math, S. B., Nirmala, M. C., Moirangthem, S., & Kumar, N. C. (2015). Disaster Management: Mental Health Perspective.  Indian Journal of Psychological Medicine, 37(3), 261-271. https://doi.org/10.4103/0253-7176.162915

Mental Health First Aid. (2024). What is Mental Health First Aid? https://www.mentalhealthfirstaid.org/about/#:~:text=What%20is%20Mental%20Health%20First,Find%20a%20Course

Miller, J. E. (2014). Integration of Mental Health and Primary Care Services. Alexandria, VA: American Mental Health Counselors Association.

SAMHSA-HRSA Center for Integrated Health Solutions. (n.d.). CIHS’ Standard Framework for Levels of Integrated Healthcare.

2. Emergency Management Response Team

My Agency Design

The agency I will choose is a co-located, for-profit inpatient agency. The agency will treat individuals who have substance abuse and mental health issues. The facility will focus on medication management but also on inpatient counseling to reduce any other mental health issues such as anxiety, depression, stress, etc. The employees in my agency will include two physicians, four nurses, two case workers, two occupational therapists, three mental health counselors, two medication assistants, two front office staff, and a recreational therapist. Patients who are treated in the facility will stay multiple days to achieve improved healthcare. Individuals will be provided with bedrooms and dayrooms for groups and recreation. 

To envision a more integrated system, I am thinking about how all the provider offices and meeting rooms will be laid out. Because it will be a co-located setting, offices for the different employees (medical and mental health staff) will be in different rooms in the same facility. In the center of all provider offices, there will be a room dedicated to group and collaborative meetings. This will provide more collaboration and regular communication between employees but will also allow space for staff members to complete their tasks with patients.  

Community Outreach Team

The type of Community outreach team that would be a good fit for my integrated agency design would be a crisis receiving and stabilization service. This service would be a good fit with my integrated agency because this service also offers access to mental health and substance abuse care in a hospital-like operation. One of the expectations to operate this type of service team is to “design their services to address mental health and substance use crisis issues” ( National Guidelines for Behavioral Health Crisis Care, 2020, Page 22). My agency’s design, as described above, focuses on the medication management of individuals for substance abuse and mental health issues. In addition, counseling will be offered to reduce symptoms of mental health through therapeutic interventions. To add to this, Crisis Receiving and Stabilization services require a “multidisciplinary team capable of meeting the needs of individuals” ( National Guidelines for Behavioral Health Crisis Care, 2020, Page 22). My inpatient agency will have multiple providers in different professions such as nurses, physicians, and counselors. To meet treatment goals, I will make sure that there will be licensed clinicians that can complete assessments and team members who can relate to the experience of individuals to enhance quality care. The design of my agency will also offer services to walk-ins and first responder drop-offs as there will be a place for the individual to stay and get assessed for medical and mental treatment.  

Responsibilities of the Counselor

There is no single role that the counselor has when they are a member of a crisis plan. "They have to play a multi-dimensional role from educating, training, negotiating, administrative, fund raising, collaborative, skill transferring, treating, advocating, and rehabilitating" (Math, S. B., Nirmala, M. C., Moirangthem, S., & Kumar, N. C., 2015, Page 265). Therefore, the functions of a counselor in a crisis plan are to support, to be present, and to be involved for individuals by fulfilling these multiple roles and interventions before, right after the disaster, and later on after the disaster. Counselors need to offer education to individuals about disasters that can happen, such as acts of terrorism, natural disasters, and other traumatic events. Public education that individuals could benefit from include, "Life skills education, educating about the disaster mental health, and psychoeducation regarding mental health in trauma/disaster" (Math, S. B., et al., 2015, Page 266). In addition, counselors should not only educate the public about disasters but also how to prepare for these disasters. Disasters, whether a natural disaster or a human-caused disaster can occur in any community, at any time. Therefore, by training individuals, they will be more prepared, if and when disaster strikes. Such training that can be used includes stress management, community resilience, and life skills training. Right after a disaster occurs, the counselor's role is to be a part of the crisis team and respond to those individuals who were affected. The counselor will assess the situation to see how much it has impacted the community and what community resources individuals need in that moment. Collaboration will take place with administrative and funding agencies to help benefit the community. Counselors will also help the individual affected by providing "medical and psychological first aid, the pre-existing mentally ill patients, substance intoxication and withdrawal in survivors, crisis intervention, and establishing the referral system" (Math, S. B., et al., 2015, Page 266). Several months after a disaster, a person often experiences what is called the Disillusionment Phase. During this phase, it is easy for individuals to slip into substance use and develop mental health issues. It is a critical phase for the counselor to be present with individuals during this phase. Counselors will continue to provide care for those who are mentally ill and will simply be present and involved for individuals who need the support of a professional.

 The responsibility of a counselor regarding relationships with individuals is to try to de-medicalize and de-professionalize services given. Individuals need counselors who they can understand and feel more personal with. Counselors should actively listen and provide resources based on what the person says verbally and physically. Counselors who de-medicalize and de-professionalize their services can reach more people and form better relationships with individuals. By getting more on the level of the community, it "gives us an opportunity to train survivors, lay-public, local administration, community leaders, NGO's, faith healers, religious leaders, community level workers and significant others in providing care to the survivors during disaster" (Math, S. B., et al., 2015, Page 265). To add to this, counselors who have been through a similar experience themselves will help form better relationships with affected individuals. Having a counselor that has been through the same experience will help the individual to relate and will help motivate them to seek help.  

 The specific skills and knowledge required by a counselor include: knowing the difference between traditional psychotherapy and crisis counseling, demonstrating a communication skill set, and implementing self-care techniques as well as stress management. Crisis counseling, especially in the context of the Crisis Counseling Assistance and Training Program (CCP) and traditional psychotherapy are different in many ways. "The CCP is essentially a preventive approach with evidence-based practices and is typically not designed to deliver clinical treatment"(Bellamy, N. D., Wang, M. Q., McGee, L. A., Liu, J. S., & Robinson, M. E., 2019, Page 20). In addition, the counselor's encounter with individuals is brief and covers short-term goals. Counselors are also encouraged to identify individuals with serious distress and diagnosable conditions. Counselors should connect them to other behavioral health professionals. It is important that counselors know the differences and what duties to perform with the little time they have with everyone. In addition, communication skills are essential for a counselor to give effective care. The counselor will need to be able to engage others and actively listen. To add to this, the counselor needs to have the skills to be a calming presence towards the individual. The individual will already be on edge from the traumatic experience that they just witnessed or were involved in. The calming presence of the counselor will help de-escalate the potential erratic behavior of the individual. Normalizing the individual's reaction is another important communication skill as it will help validate the individual's thoughts and emotions. It will also provide the individual with a safe space to vent and express how they feel about their experience. Counselors will also need to know how to implement stress management and self-care techniques. It is easy for counselors to be stressed and traumatized when experiencing the overwhelming process of encountering and referring individuals who are involved in the crisis. “Repeatedly seeing the devastation that the disaster has caused, as well as listening to survivor’s sad and often heart-wrenching disaster experiences can take a toll on crisis counselors”(Bellamy, N. D., et al., 2019, Page 21). Types of stress management and self care that will help the counselor to be an effective crisis plan member include having a supportive crisis team, team building, implementing coping skills that help to ease the mind, and recognizing/discussing normalization of feelings. To add to this, the counselor will also need to know when to take breaks when necessary to prevent burn out. 

Types of Training 

Appropriate training for counselors and other team members is critical.  Important training options include “Mental Health First Aid, Gatekeeper suicide prevention training, Crisis Intervention for Encoubters with Mental Health Crises, Critical Incident Debriefing, Grief recovery/counseling, and HIPPA Confidentiality Training”( Building a community-based Suicide Crisis Response Team, 2018, Page 2-3). In addition, mental health professionals who can apply for CCP grants are required to be trained in different areas. There are six required courses in a CCP grant. These courses “inform program philosophy, goals, and techniques to promote survivor behavioral health and to manage their own stress” (Bellamy, N. D., et al., 2019, Page 20). Skills-based training are also included in the CCP grant. Programs such as the Skills for Psychological Recovery Program intend to “help survivors identify their most pressing current needs and concerns, and then offer skills to address those needs'' (Bellamy, N. D., et al., 2019, Page 21). CCP also offers and requires training on topics such as “suicide prevention, compassion fatigue, and self-care” (Bellamy, N. D., et al., 2019, Page 21). 

Roles and Responsibilities for my Team Members

Roles and responsibilities that my team members (supervisees) need to have in my agency’s emergency response team include being supportive, actively listening, and empathetic in their response to the individual; offering crisis interventions during the individual’s stay; and assessing risk of the individual. Being supportive, empathetic, and an active listener to the individual is essential for an effective crisis team member at an inpatient facility. From my personal experience, I have witnessed counselors become less empathetic in crisis situations, especially if they have been through this process many times. They start to see their time with the individual as more of a check-list rather than being there in the moment. Individuals who are dropped off or do walk-ins when they have dealt with a crisis often have been through an experience that they feel like no one understands. They may resort to substances and alcohol to try to numb the pain. Therefore, being there, listening, and validating the client’s situation will help to empower the individual and to help them to trust the mental health provider. Offering crisis interventions is another responsibility that my team will need to implement. During the individual’s stay at an inpatient facility after a crisis, interventions such as meditation, creating a support system, and healthy coping skills need to be taught to individuals. This will help the individual to learn and apply these types of interventions the next time that they experience a crisis. In addition, assessing the risk of the individual is an essential responsibility for my team members. Individuals who have experienced a crisis whether a natural disaster or other traumatic event can show signs of suicidal ideation and use of substances. The counselor will need to pick up on these signs to prevent further mental and physical issues. The counselor will complete a psychosocial assessment to understand what crisis they experienced and what risks they possess. In addition, the counselor will help the individual develop a detailed safety plan. The safety plan will have a list of coping skills and resources that will help the individual to know what action to take when they are at risk of harming themselves through substances or other other means. Both the psychosocial assessment and safety plan were tools that I had to use at my site during the Internship I course.

Other Agencies and Organizations Involved

 Other agencies and organizations that would be involved in my Emergency Response Team include law enforcement such as police, emergency medical services, and a fire department. The police would be a source of support for the team as they are trained to handle crisis situations and individuals that become too dangerous for the rest of the team to handle. One such situation might be that an individual continues to be erratic and a threat to others even after the attempted de-escalation from the counselor. The police would step in and use appropriate methods to stop the situation. EMS would help the team by transferring individuals who were involved in a crisis to the facility. EMS would also have the tools and skills necessary to possibly resuscitate the individual if they are unresponsive and can help the individual with other temporary medical needs until they get to the facility. EMS can also let the facility know when they respond to someone so that the facility can prepare for their arrival. Firefighters can help my team by rescuing individuals if they are involved in a natural disaster or other crisis situation. They will also have the equipment to reduce the severity of the disaster such as if there is a fire and possess skills in providing first aid if the individual is hurt. 

Questions to Ask An Expert

The questions I would need to ask an expert to fully develop this community outreach include: How would I keep my team members safe in crisis situations? How would I need to protect my business financially? How would I prevent an overload of individuals in the facility without rejecting any walk-ins or drop-offs? 

The first question is: How would I keep my team members safe in crisis situations? There are obviously skills and protocols that my team will need to be trained in before they are qualified to serve as a member of a crisis team. It will help them know what to do and how to handle affected individuals. However, the phrase, “Anything Can Happen” can apply to this case. Crisis situations, whether a natural disaster or other dangerous situations, can often take the life of a crisis team member, especially when they are in the act of helping someone in need. Therefore, I would like to know more in detail the steps I can take to prevent the crisis team members from getting hurt or killed. 

The next question is: How would I need to protect my business financially? Financially managing a business is not an easy task and especially since COVID occurred, it can be a challenge to prevent bankruptcy. In addition, I am not experienced with running a business in general so I would further advice on steps that I would need to take to keep my agency running. To add to this, handling reimbursement would be another area that I would need advice in. Since reimbursement rates are different depending on location and state, this can influence the steps that need to be taken in order to create balance in the workplace. The last question is: How would I prevent an overload of individuals in the facility without rejecting any walk-ins or drop-offs? ​​ “Crisis receiving and stabilization services must accept all referrals” ( National Guidelines for Behavioral Health Crisis Care, 2020, Page 22). If the facility gets overloaded, there will not be enough providers to handle this and to give effective care to the individuals. Many of these providers may experience burn out which will affect their performance. In addition, referring individuals to other agencies when overloaded, causes more stress towards the individual. Therefore, I would like to know what strategies I could take to prevent too many referrals to the agency. 

References  

Bellamy, N. D., Wang, M. Q., McGee, L. A., Liu, J. S., & Robinson, M. E. (2019). Crisis-counselor perceptions of job training, stress, and satisfaction during disaster recovery . Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 19–27.  https://doi.org/10.1037/tra0000338Links to an external site.

Building a community-based Suicide Crisis Response Team. (2018). https://www.samhsa.gov/sites/default/files/nc-oy1-task-3-building-comm-based-suicide-crisis-respons-team-2018-12-06.pdf 

Math, S. B., Nirmala, M. C., Moirangthem, S., & Kumar, N. C. (2015). Disaster Management: Mental Health Perspective.  Indian journal of psychological medicine,  37(3), 261–271. https://doi.org/10.4103/0253-7176.162915

National Guidelines for Behavioral Health Crisis Care. (2020).

https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf