Children’s Mental Health
Crisis Response Services
Presentation to the Allied Health
Caucus, Virginia General Assembly
February 24, 2012
What it means to be in crisis
• “Danger to self or others,” although child may
not realize his/her behaviors are dangerous
• Significant changes in functioning
• May be triggered by catastrophic life events:
changes in relationships, living arrangements,
school circumstances
• Need to address underlying issues not just
immediate safety concerns
• Affects entire family
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Examples of Children in Crisis
• 17-year-old girl hearing voices, non-compliant
with medication, refusing to leave her room,
mother concerned she is suicidal
• 15-year-old girl who was sexually assaulted at age
10 but never received treatment, now abusing
substances, cutting on self, left suicide note for
mother
• 9-year-old girl with diagnoses of bipolar disorder
who becomes violent to her family and threatens
to kill herself following a dosage adjustment on
her medication
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Comprehensive Service Array
Crisis response services are part of a larger array of
mental health services and treatment:
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Assessment and evaluation
Outpatient or office-based services
Case management
Home and community based services
Intensive community supports
24/7 community crisis response services
Residential
Inpatient
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Types of Community-Based Crisis
Response Services
1. Mobile crisis response to schools homes or
other community settings: triage and provide
treatment to child and supports to family
with goals of averting hospitalization,
stabilizing and ensuring safety of child and
others, and mobilizing community resources;
it is NOT merely assessing for hospitalization
or referring a child to the emergency room
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Types of Community-Based Crisis
Response Services
2. Emergency respite care placement:
alternative temporary home to diffuse crisis,
stabilize child, or provide parents respite, and
mobilize community resources for child and
family
3. Crisis stabilization unit: local or regional
short-term residential service, staffed to
provide assessment, treatment and planning
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Essential Elements of Effective Crisis
Response Services
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Timely access
Least restrictive environment
Peer support (for child and/or family)
Adequate time spent with child and family
Strength-based plans
Intervention in context of child’s overall treatment plan
Appropriate training and competence of staff
Self- and family referrals accepted
Trauma informed care
Culturally competent
Reduce likelihood of future emergencies
Source: SAMHSA, Practice Guidelines: Core Elements in Responding to Mental Health Crises
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Availability of Crisis Services in VA
• Mobile crisis response: 83% of CSBs do not
provide (as of 1 year ago, budget cuts have led
to further reductions)
• Emergency respite care: 95% of CSBs do not
provide
• Crisis stabilization unit for children: 93% of
CSBs do not provide
Source: DBHDS Item 304.M Final Report: A Plan for Community-Based Children’s Behavioral Health
Services in Virginia, Nov. 1, 2011
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Recent Trends in Hospitalization
at CCCA
• Commonwealth Center for Children and
Adolescents in Staunton; 48 bed acute care
facility
• Provides comprehensive diagnostic services,
crisis stabilization, and intensive short-term
treatment
• 780 admissions to CCCA during FY11, which
represents a 38% increase over FY10
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Recent Trends in Hospitalization
at CCCA
Who goes to CCCA?
“…children and adolescents that either have
been unsuccessfully treated in less restrictive
settings or because the community resources
necessary to understand and deal with the
presenting crisis situations are not available
when and where they are needed.”
-Office of Inspector General Report In-Brief: Inspection of
the Commonwealth Center for Children and Adolescents ,
Nov. 2011
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Recent Trends in Hospitalization
at CCCA
• Hospital readmission rates are increasing due
to lack of crisis response services in
communities:
Percentage of total children admitted
to CCCA…
FY11
FY12 (1st six
months)
Who had a prior admission to CCCA in
last 12 months
25%
34%
Who had a prior admission to CCCA
ever
34%
38%
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Effectiveness of Existing Services
• Mobile crisis response services for children at
Central Virginia Community Services:
– Jan-June 2011: 111 crisis episodes for 57 children
– 81% success rate, based on children transitioning
to less restrictive services
– Use of CCCA has declined: in FY11, CVCS used 509
bed days, in first half of FY12, CVCS only used 207
bed days (on track for a 19% reduction in CCCA
usage)
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Effectiveness of Existing Services
• Fairfax CSB/UMFS Leland House: 8-bed crisis
stabilization unit (a house)
– In 2009, 79% of the 68 youth who were admitted
were discharged to a less intensive environment.
– Use of CCCA has declined: in FY11, Fairfax used
1306 bed days, in first half of FY12, Fairfax only
used 471 days (on track for a 28% reduction in
CCCA usage)
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Sources
• SAMHSA, Practice Guidelines: Core Elements in Responding to
Mental Health Crises, 2009
• Office of Inspector General Report In-Brief: Inspection of the
Commonwealth Center for Children and Adolescents , Nov.
2011
• DBHDS Item 304.M Final Report: A Plan for Community-Based
Children’s Behavioral Health Services in Virginia, Nov. 1, 2011
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Margaret Nimmo Crowe
Policy Director, Voices for Virginia’s Children
margaret@vakids.org, 804-649-0184
Coordinator, Campaign for Children’s Mental Health
The Campaign for Children’s Mental Health is an advocacy initiative
sponsored by Voices for Virginia’s Children and led by Voices, National
Alliance on Mental Illness- Virginia, and the Virginia Association of
Community Services Boards. More than 60 organizations have partnered
with the Campaign statewide. Please go to www.1in5kids.org for more
information.
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