ATTACHMENT I
STATE OF GEORGIA
Department of Behavioral Health and Developmental Disabilities
Guidelines
For
Mobile Crisis Response Services (MCRS)
Mobile Crisis Response Services System Philosophy
Although it is recognized that an established emergency crisis service system includes a full array of
services along a continuum of care, this component of the procurement is limited to the development,
management, expansion or enhancement of MCRS.
The MCRS component will make time-limited crisis intervention services available to reduce
escalation of crisis situations, relieve the immediate distress of individuals experiencing a crisis
situation, reduce the risk of individuals in a crisis situation doing harm to themselves or others, and
promote timely access to appropriate services for those who require ongoing mental health or cooccurring mental health and substance abuse services. Key to MCRS is the important function of
closing gaps in the service delivery system that currently defaults people to more intensive areas of
the behavioral health service system. These interventions are intended to resolve/abate the crisis
without resort to the more intensive levels of service. Performance will be measured by a significant
reduction in the volume of psychiatric and addictive disease inpatient and crisis stabilization unit
admissions, and emergency room visits and contacts with local law enforcement agencies due to
behavioral health matters. MCRS will be available 24 hours per day, seven days per week.
The established emergency mental health crisis service system will be based on a recovery
philosophy that contains the following ten (10) components:
1. Self-Direction: Consumers lead, control, exercise choice over, and determine their own
path of recovery by optimizing autonomy, independence, and control of resources to
achieve a self-determined life. By definition, the recovery process must be self-directed
by the individual, who defines his or her own life goals and designs a unique path
towards those goals.
2. Individualized and Person-Centered: There are multiple pathways to recovery based on
an individual’s unique strengths and resiliencies as well as his or her needs,
preferences, experiences (including past trauma), and cultural background in all of its
diverse representations. Individuals also identify recovery as being an ongoing journey
and an end result as well as an overall paradigm for achieving wellness and optimal
mental health.
3. Consumers have the authority to choose from a range of options and to participate in
all decisions—including the allocation of resources—that will affect their lives, and
are educated and supported in so doing. They have the ability to join with other
consumers to collectively and effectively speak for themselves about their needs,
wants, desires, and aspirations. Through empowerment, an individual gains control of
his or her own destiny and influences the organizational and societal structures in his
or her life.
4. Holistic: Recovery encompasses an individual’s whole life, including mind, body,
spirit, and community. Recovery embraces all aspects of life, including housing,
employment, education, mental health and healthcare treatment and services,
complementary and naturalistic services (such as recreational services, libraries,
museums, etc.), addictions treatment, spirituality, creativity, social networks,
community participation, and family supports as determined by the person. Families,
providers, organizations, systems, communities, and society play crucial roles in
creating and maintaining meaningful opportunities for consumer access to these
supports.
5. Non-Linear: Recovery is not a step-by step process but one based on continual growth,
occasional setbacks, and learning from experience. Recovery begins with an initial
stage of awareness in which a person recognizes that positive change is possible. This
awareness enables the consumer to move on to fully engage in the work of recovery.
6. Strengths-Based: Recovery focuses on valuing and building on the multiple capacities,
resiliencies, talents, coping abilities, and inherent worth of individuals. By building on
these strengths, consumers leave stymied life roles behind and engage in new life roles
(e.g., partner, caregiver, friend, student, employee). The process of recovery moves
forward through interaction with others in supportive, trust-based relationships.
7. Peer Support: Mutual support—including the sharing of experiential knowledge and
skills and social learning—plays an invaluable role in recovery. Consumers encourage
and engage other consumers in recovery and provide each other with a sense of
belonging, supportive relationships, valued roles, and community.
8. Respect: Community, systems, and societal acceptance and appreciation of
consumers —including protecting their rights and eliminating discrimination and
stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in
one’s self are particularly vital. Respect ensures the inclusion and full participation
of consumers in all aspects of their lives.
9. Responsibility: Consumers have a personal responsibility for their own self-care and
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journeys of recovery. Taking steps towards their goals may require great courage.
Consumers must strive to understand and give meaning to their experiences and
identify coping strategies and healing processes to promote their own wellness.
10. Hope: Recovery provides the essential and motivating message of a better future—
that people can and do overcome the barriers and obstacles that confront them. Hope is
internalized; but can be fostered by peers, families, friends, providers, and others.
Hope is the catalyst of the recovery process.
ServiceComponents
An established emergency mental health services system should include service components
that will provide people a seamless system of care in which crisis services and routine
mental health services can be accessed with ease.
To operate a successful emergency mental health crisis services, the provider will be part of an
established community partnership with stakeholder organizations that serve the community
and have stake in establishing and maintaining a seamless system of care. Organizations such
as, but not limited to, the following are recommended members of such a partnership:
Primary Customers:
o Local law enforcement
o Hospitals - emergency rooms and inpatient psychiatric units
o DHS child welfare workers
o Child welfare providers, including emergency shelters
System of Care Partners:
o Substance abuse treatment centers
o Juvenile justice system
o Georgia CORE provider
o Care Management Entities
o Primary care providers
o Area Agencies on Aging
o School districts
o Youth centers
o Other behavioral health providers
o Housing organizations
o Crisis Respite Providers
o Crisis Stabilization Units
o Other identified community providers/organizations
DesiredOutcomes
The established mobile crisis response system will be able to achieve the following desired
outcomes:
• Commitments filed by Emergency Room Doctors and Probate Judges and actual
commitments for persons with mental health and substance abuse disorders are
reduced.
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• Inpatient psychiatric hospitalizations (Psychiatric Residential Treatment
Facilities, Private Psychiatric hospitals and state hospitals) are reduced.
•
Persons with mental illness and co-occurring disorders are diverted from jail
when a mental health service is the more appropriate and indicated service.
• Suicides and attempted suicide rates are reduced.
• Crisis Stabilization Unit placements are reduced.
• Unnecessary, out-of-home placements for older adults with mental illness and
substance abuse disorders are avoided.
•
Children served in the child welfare or juvenile justice system will
remain at home or in a family setting and avoid placement in a
treatment or other congregate care facility.
The emergency mental health crisis services system described is the overall system
vision for the State of Georgia.
1.0
Mobile Crisis Response Services (MCRS)
1.1
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Service Delivery Guidelines
Provider must have professional capacity to serve children and adults with mental
health, addictive diseases and co-occurring disorders aged 5 and older who are
experiencing a behavioral and/or emotional health crisis.
Provider must submit and maintain written protocols for responding to and managing
behavioral health crisis situations.
Provider must maintain telephone, text and email capacity, as well as mobile response
services 24/7/365.
Provider must provide face-to-face response within an average of 1 hour 10 minutes for
FY13, 1 hour and 5 minutes for FY14 and 1 hour for FY15 of initial dispatch call from
GCAL.
Provider must link consumers to current or appropriate medical and/or behavioral health
providers.
MCRS must be provided in community settings which include, but are not limited to
homes, schools, hospital emergency departments, and social service settings.
MCRS includes a post crisis call within 24 hours of the crisis to all consumers for follow
up to the crisis to ensure linkage with recommended services. If the consumer is not
available, attempts must be made to follow-up for up to 72 hours.
MCRS ensures coordination and/or provision of safe transportation for those who may be
at risk of self to harm or others to the necessary medical or psychiatric facility.
MCRS can be accessed by any individual, their family members, legal guardians, law
enforcement, school personnel, medical facility staff, and other social service agencies.
Provider must have the capacity for completing Emergency Physicians Certificates.
Provider must utilize a two person team for community responses (outside of emergency
rooms, schools, agency locations etc. where other personnel are accessible for safety or
in situations where law enforcement is already present).
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l. For the purposes of MCRS services, Provider must have access to peer support services
and psychiatrists 24/7/365.
m. Provider must ensure that consumers with limited English proficiency and/or sensory
impairment (LEPSI) have meaningful access to services by offering communication
assistance at no cost to the consumer through interpreters, translators, and other
necessary communicative resources 24/7/365.
n. Provider must have the ability to respond to Georgia Crisis and Access Line (GCAL)
within 5 minutes and electronically report back to the dispatch both time arrived at the
location of the crisis and the time departing the location of the crisis.
o. Provider must utilize assessment tools determined by the Department
p. Provider must have partnerships with community system of care partners, to include but
not limited to, peer wellness centers, community service boards, other community
behavioral healthcare organizations, law enforcement personnel, crisis stabilization units,
emergency rooms, Department of Family and Children Services, state hospitals, private
psychiatric hospitals.
q. MCRS must be provided in a culturally and linguistically competent manner.
r. Provider will work with DBHDD to finalize the submitted project plan with the
Department’s approval within seven (7) days of contract award.
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Target Population
a. Admission Criteria:
The target population is an individual, family or group of persons that is
experiencing a behavioral health crisis or is in a situation likely to turn into a
behavioral health crisis if supportive services are not provided. For purposes of
the Request For Proposal, a crisis is defined as an acute response to an event or
situation, whether real or perceived, wherein one’s regular level of functioning is,
or is perceived to be, disrupted; one's usual coping mechanisms have, or have been
perceived to have, failed; and there is evidence of significant distress or functional
impairment.
The target population is not to be limited due to age, except children under the age
of 5, income, insurance coverage or severity of crisis.
b. Clinical Exclusions:
i.
ii.
Individuals with the following conditions are excluded from MCRS
because the severity of cognitive impairment precludes provision of
services in this level of care:
• Severe and Profound Mental Retardation
Individuals with the following conditions are excluded from MCRS unless
there is an identified mental illness that is the foremost consideration for
this psychiatric intervention:
• Mild Mental Retardation
• Moderate Mental Retardation
• Autistic Disorder
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The provider will be expected to link the caller with an appropriate provider in cases
where clinical exclusions apply.
** If a consumer is determined to have any of the above and the MCRS team is
on-site, they will assist in the appropriate intervention and plan for the individual
and will NOT refer to a DD Mobile Crisis Team for intervention, however may
contact the DD Mobile Crisis Team for assistance and consultation.
3.
Priority Population Tracking
The Successful Provider will track the number of individuals referred and
served who meet the ADA target population. The criteria for determining the
ADA target population can be found at,
http://www.files.georgia.gov/DBHDD/Files/Settlement%20Agreement.pdf
4.
Community Network
The Successful Provider will establish and maintain relationships with community
providers and/or crisis providers as well as other public service agencies within
local communities to ensure adequate connectivity to and smooth transition of
services for consumers.
Establishment and maintenance of relationships with community providers will
require routine outreach with local partners, including community behavioral healthcare
providers, peer wellness centers, peer support programs, emergency room staff, local
law enforcement agencies and social service agencies. Outreach should include
attention to growth of and adequate access to local resources that enhance the
delivery and coordination of mental health crisis services within the community
being served by Successful Provider. Provider will need to establish a relationship,
with all Emergency Rooms and law enforcement agencies in each county served.
Community Partnership Collaborative
The community partnership collaborative component will create a formalized
network of providers working together as an established community system of
care that includes formalized inter-agency agreements and fosters positive
outcomes for individuals in crisis which cannot be achieved by community
stakeholders acting singly or, at a minimum, cannot be reached as efficiently.
The partnership development should include development of a service delivery
with a timeline for implementation of the community partnership collaborative
services.
The intention of the community partnership collaborative is to provide a
structure in which community service providers, whose individual
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organizations serve people in crisis situations, come together to plan,
coordinate and deliver services within a seamless community system of
care for people in crisis in the provider-designated service areas that
fosters positive outcomes for individuals in crisis.
1.
The Contractor will provide leadership in the organization of
the Community Partnership Collaborative.
2.
The Contractor will define the following key elements of the
Community Partnership Collaborative:
a. Mission of the partnership
b. Membership of the partnership, including role of
member organizations in serving persons in crisis
c. Process for ensuring additional stakeholders can be
added and that group is inclusive
d. Organizational chart of partnership, including
subcommittees, advisory groups etc.
e. Mechanism for frontline staff and consumers to provide meaningful
input
5.
3.
The Contractor will assure the group meetings occur
regularly and keep detailed minutes of each meeting.
4.
The Contractor will provide quarterly reports to the
Department regarding activities and accomplishments of the
partnership.
Tracking and Reporting
The Contractor will comply with reporting requirements as specified in the DBHDD
Provider Manual:
http://dbhdd.georgia.gov/community-provider-manuals
The Contractor will maintain the ability to track the following data elements and
provide reports to the Department as requested:
1)
2)
3)
4)
5)
6)
7)
8)
9)
Referrals to state hospitals;
Referrals to CSUs;
Referrals to private psychiatric hospitals
Referrals to medical facilities;
Referrals to law enforcement agencies, i.e. jails, RYDC, ;
Average, range and median response time from dispatch to arrival on site;
Average time from arrival on site to crisis resolution;
Volume of calls by county of location of MCRS delivery;
Volume of on- site responses based on category. (i.e. emergency rooms,
homes, schools, etc.);
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10) The number of responses by disability category (e.g. mental health,
substance abuse, co-occuring);
11) The number of responses by location category (home, Emergency room,
school, street, etc.)
12) Individual consumer demographic information;
13) Outpatient behavioral healthcare and medical providers to whom
consumers are referred;
14) Priority Populations (e.g. ADA target population) ratio.
Provider will comply with encounter and/or claim-based reporting mechanisms
as required by DBHDD.
Provider will respond to ad hoc report requests from DBHDD within 5
business days or in a time period as is mutually agreed upon by both entities.
6. Performance Measures
Providers are expected to achieve the following performance indicators that will be
measured through data collected using designated crisis event tracking forms and a client
satisfaction survey:
1. The mobile crisis team will respond to 95% of calls within 5 minutes of receiving
contact from GCAL;
2. The mobile crisis team will provide documentation of face-to-face contact with 100%
of dispatched cases.
3. 100% of cases will receive a follow-up phone call within 24 hours to verify follow
through with services;
4. 75% of clients surveyed within 30 days of their crisis event will indicate satisfaction with
crisis services provided
5. The mobile crisis team will provide face-to-face response for 100% of dispatched calls within
an average of 1 hour 10 minutes for FY13, 1 hour and 5 minutes for FY14 and 1 hour for
FY15 of initial dispatch call from GCAL.
7. MonitoringClause
The Department will monitor the data reports and performance of the bidder monthly to ensure
that the Bidder is meeting the deliverables under the contract and achieving the specified
results. The Bidder will be required to satisfactorily provide the services described in this RFP
in order to meet the desired outcomes throughout the duration of the contract.
8. ReviewClause
The bidder will provide the Department with evidence of the continuous quality improvement
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process that their agency uses to monitor quality on a monthly basis. This will include all
activities that the bidder engages in with the purpose of assuring quality services, results of
this process, and ongoing efforts at assuring quality. The bidder(s) and DBHDD Regional
Offices will have face-to-face meetings on a regular basis, no less than every 60 days, to
review progress toward achieving deliverables, identify any barriers, provide technical
assistance to the bidder, address any deficiencies in the bidder’s performance, and identify
actions to remediate any deficiencies.
9. Payment Process
MCRS must be fully operational no later than June 1, 2013.
Contractors will be required to submit an invoice statement monthly for 1/12 of the
contracted amount as well as an expense report documenting all true expenses for the
service.
Contractors are required to be able to bill third party payers for all reimbursable services
provided within 12 months, but may bill earlier when possible. (It may be possible that an
individual’s insurance may cover some of the provided services).
Contractors will be required to provide billing and collection records to third party payers to
the Department on a quarterly basis. Funds generated through billing third party payers for
crisis services billing are required to be applied to the provider’s emergency mental health
crisis services.
Project funds cannot supplant existing programs funded by other sources such as Medicaid,
private insurance, or county funding, but rather are to be used to support the provision of
services that are not currently available, and to pay for available services that are otherwise
not funded.
Each budget item must be fully justified. Contractor is financially responsible for outstanding
project-related debt once funding is no longer available or is fully expended.
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