DAR File No. 43213

Human Services, Substance Abuse and Mental Health

Rule R523-17

Behavioral Health Crisis Response Systems Standards

Notice of Proposed Rule

(New Rule)

DAR File No.: 43213
Filed: 09/14/2018 03:07:59 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is designed to create standards of care and practice for statewide behavioral health crisis response system, crisis line services, and a certification for crisis workers.

Summary of the rule or change:

This new rule includes: a) definitions are provided for uncommon/industry specific terms used in this rule; b) standards established and defined for the "Behavioral Health Crisis Response System" that is being created through this rule; c) certification requirements, standards, and the certification process for Certified Crisis Workers are established for professionals who will be working in the Behavioral Health Crisis Response System; d) a process for revoking an individual's crisis worker certification, and appeals process are established; e) standards are established for mental health crisis lines that are created and maintained by local authorities; f) standards of care and services provided by entities that maintain mental health crisis lines to individuals who use that service are established; g) standards are established for the Statewide Mental Health Crisis Line; h) standards of care and services provided by the Statewide Mental Health Crisis Line to individuals who use that service are established; and i) the Division of Substance Abuse and Mental Health (DSAMH) oversight activities and responsibilities over the Behavioral Health Crisis Response System are established and defined.

Statutory or constitutional authorization for this rule:

• Section 62A-15-1302

Anticipated cost or savings to:

the state budget:

The Department of Human Services' (DHS) DSAMH was allocated $2,380,000 in FY 2019 to administer this program that includes: expansion of mental health crisis line services i.e. contracting for a central line provider and improve telecommunications infrastructure, developing training materials, hiring a program administrator, and advertising. Contracting for a Central Emergency Mental Health Crisis Line: The DHS/DSAMH is contracting with the University Neuropsychiatric Institute (UNI) to develop and maintain the statewide crisis phone line at approximately a cost of $1,910,800 per annum. This cost includes setup of the telecommunications system, maintenance of referral resources statewide, personnel that meet the requirements of this rule, and all overhead and administrative costs. Additional costs to DHS/DSAMH: The remainder of the costs, $469,200 per annum, will be used to administer the certification of crisis works statewide, develop a training curriculum, provide annual training and oversee the monitoring of the statewide emergency response system, plus any additional administrative costs. Cost of Administrative Oversite: DHS/DSAMH has hired a Program Administrator I to oversee and coordinate efforts to develop a statewide crisis response system, whose job duties include all the cost identified in this analysis. This position will be responsible to create a curriculum for Certified Crisis Workers, assist with advertisement, and monitor provider crisis services. This position is funded through another bill so the cost of this salary will not be stated in this analysis. Cost of Processing Certifications: These cost include printing and mailing certificates, and time in reviewing applications and providing certificates. DSAMH does not have clear understanding of how many potential applications will be received, but the cost to create a certificate is about $0.90 per certificate which includes bonded paper, gold seal, printing, signature, and mail costs. Per-event time costs can be set at around 17 minutes per application. This calculation includes review of the application, receipt of information that a passing score was achieved, recording of the certification in the Division database, production of the certificate, signing the certificate, and mailing the certificate. Based on these calculations, it will cost DSAMH an additional $0.90 and 17 minutes to process all new crisis management certifications that are generated by this rule. This rule requires the Director or designee to review the application, and the Director to make a determination if certain training can be waived based on the applicants' past experience and training. The time needed to review applications is not estimable nor is the time needed to review a waiver. Financial costs would be the reviewing and making a determination on applications seeking waivers will be a minimum cost of $83.84 per hour based on the Director's compensation salary including benefits. Currently, 250 individuals work in the crisis system as it stands today, so there is an assumption that all financial costs reported in this section could initially be multiplied by 250 which will equal: 1) for certificates $225 and roughly take 1 hour and 10 minutes, and 2) it is unknown how long the review of each application will take so the salary costs cannot be added at this time. Training Costs: At this point the DHS/DSAMH is unable to give a fully accurate accounting for these costs, especially since the actual curriculum has not been developed. This rule will require 40 hours of training, but it is unclear how much the materials will cost, but DSAMH does provide similar training for another type of certification and those current materials costs are $2,000 per year. Un-estimable Portion of Remaining $466,975 is advertising costs. These costs have not been fully researched at this time, and there are no similar cost to the DHS/DSAMH to compare; therefore, these costs are un-estimable at this time.

local governments:

This rule will require local governments to adapt their crisis line program to upgrade to a statewide crisis line if they choose to have a certified crisis line. These costs will include setting up a dedicated phone line that meets the standards of this rule, staffing the crisis response system in a manner commensurate with the standards of this rule, and maintaining a crisis response program. Some of these costs are startup and onetime in nature, i.e. setup and development of the system, and others are ongoing i.e. maintaining the system in accordance with the standards set-forth in this rule. It is unknown which local governments will participate in this certification and the level of sophistication already existing within their current 24-hour crisis systems, so these costs are un-estimable at this time. This rule will require all local authorities to have certified crisis workers to man their crisis response system. It is anticipated that the local authorities will pick up all costs associated with the certification process. The potential costs to individuals who receive a Crisis Worker Certification, are both time and financial. Anticipated time costs include the amount of time it will take an individual to attend and participate in training which will be at least 40 for initial training and then at least 40 hours every 2 years after that, and the amount of time needed to complete, document, and report the 8 hours of CEUs to maintain certification. The anticipated financial costs include the costs of CEU courses, costs associated with certifying i.e. travel, food and salary while taking the training, and salaries paid to employees who are required to certify as crisis workers including the funds associated with the loss of 40 billable hours. The DHS/DSAMH has been unable to estimate these costs because there are too many variables such as distance traveled, the need for overnight stays, and per diem rates offered by each local authority.

small businesses:

It is anticipated that no small businesses will participate in the certification or development of a crisis line as described in this rule. This rule mostly affects local governments, employees of local governments, and possibly businesses contracted with local governments to provide substance use and/or mental health treatment services (none of which are small businesses at this time).

persons other than small businesses, businesses, or local governmental entities:

It is anticipated that these cost will be picked up by the local authorities in the state, and since this rule pertains to local governments only, there is no reason to believe that other persons will be affected by this rule.

Compliance costs for affected persons:

There are compliance cost associated this new rule to local governments, if these entities choose to create a crisis program with a mental health crisis phone line and response program. These cost are not estimable, but depending on the sophistication of each entity's current crisis response programs, these cost will include: setting up a dedicated phone line that meets the standards of this rule, staffing the crisis response system in a manner commensurate with the standards of this rule, and maintaining a crisis response program. Some of these costs are startup and onetime in nature, i.e. setup and development of the system, and others are ongoing i.e. maintaining the system in accordance with the standards set-forth in this rule. Also, costs associated with manning their crisis response system with Certified Crisis Works. These costs include productivity, certification reimbursements, and loss of billable hours by employees engaged in the certification process. None of these costs are estimable because there are too many variables such as distance traveled, the need for overnight stays, and per diem rates offered by each local authority and the number of billable hours that will be lost.

Comments by the department head on the fiscal impact the rule may have on businesses:

After conducting a thorough analysis, it was determined that this proposed rule will not result in a fiscal impact to businesses.

Ann Williamson, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Human Services
Substance Abuse and Mental Health
195 N 1950 W
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Thomas Dunford at the above address, by phone at 801-538-4181, by FAX at 801-538-4696, or by Internet E-mail at tdunford@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/31/2018

This rule may become effective on:

11/07/2018

Authorized by:

Doug Thomas, Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2019	FY 2020	FY 2021
State Government	$1,913,025	$1,913,025	$1,913,025
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$1,913,025	$1,913,025	$1,913,025
Fiscal Benefits	$0	$0	$0
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$(1,913,025)	$(1,913,025)	$(1,913,025)

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non-Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non-Small Businesses

There are no estimable or inestimable costs or benefits to non-small businesses in this rule. The statute and funding associated with this rule only effect state and local government agencies and budgets, and those cost have been described in the attached new rule analysis.

 

 

R523. Human Services, Substance Abuse and Mental Health.

R523-17. Behavioral Health Crisis Response Systems Standards.

R523-17-1. Authority.

(1) This rule establishes procedures and standards for administration of substance use disorder and mental health services as granted by Section 62A-15-1302.

 

R523-17-2. Purpose.

(1) This rule is designed to create standards of care and practice for statewide behavioral health crisis response system, crisis line services and a certification for crisis workers.

 

R523-17-3. Intent.

(1) Create standards of care and practice and certification of crisis workers for statewide behavioral health crisis response system, statewide and local mental health crisis lines.

(2) Agencies and individuals impacted by this rule have until June 30, 2019 to come into compliance.

 

R523-17-4. Definitions.

(1) "Bridging Strategies" are transition strategies that include brief patient education that helps the patient understand his or her condition and what treatment options exist to facilitate patient and family follow-through;

(a) Provides assistance with understanding and navigating the system of potential supports, preferably from a peer;

(b) May include counseling by staff from a community-based organization who can then see the patient for follow-up care after discharge and giving the patient a copy of their safety plan and making sure it is relevant to their current level of care; and

(c) Sometimes called peer-or community bridging. Also providing onsite counseling.

(2) "Caring Connection" is defined as a follow up phone call, mailed note, text or e-mail checking back in with the caller. This can be done by crisis staff or other support staff.

(3) "Caring Contacts" Caring contacts are brief communications with patients during care transitions such as discharge from treatment or when patients miss appointments or drop out of treatment. These contacts, through which care providers continue to show support for a patient, can promote patient's feeling of connection to treatment and increase their participation in collaborative treatment. Caring contacts may be especially helpful for patients who have barriers to outpatient care or are unwilling to access outpatient care.

(4) "Certified Crisis Worker" means an individual who:

(a) meets the standards of qualification or certification that the Division of Substance Abuse and Mental Health (division) sets, in accordance with Section 62A-15-1302; and

(b) staffs the statewide mental health crisis line or a local mental health crisis line under the supervision of at least one mental health therapist.

(5) "Local Mental Health Crisis Line" means the same as that term is defined in Subsection 63C-18-102(2).

(6) "Mental Health Crisis" is defined as any intense behavioral, emotional, or psychiatric situation perceived to be a crisis by the individual experiencing the crisis, family, or others who closely observe the individual. The crisis may include a mental health condition that manifests itself by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention of intervention to result in:

(a) serious jeopardy to the individual's health or well-being; or

(b) a danger to others; or

(c) significantly reduced levels of functioning in primary activities of daily living.

(7) "Mental Health Therapist" is an individual licensed in Utah under the mental health professional practice act as defined in Subsection 58-60-102(5).

(8) "Statewide mental health crisis line" means the same as that term is defined in Subsection 63C-18-102(3).

(9) "Rapid Follow-up and Referral" involves taking steps during an emergency department visit or before discharge from inpatient care to facilitate immediate access to an outpatient treatment appointment for the patient, preferably within 24--48 hours after discharge. To facilitate rapid referral, it may be helpful to establish agreements with outpatient providers to accept rapid follow-up referrals.

(10) "Warm Hand Off" has a goal to increase the likelihood that a patient will follow up on a referral to one provider from another. Rather than simply providing the name and phone number of a provider, a warm hand-off connects the patient with the new provider before the first appointment.

 

R523-17-5. General Provisions.

(1) The Behavioral Health Crisis Response System is based on the following principles:

(a) cultural competence'

(b) strong community relationships,

(c) the use of peer supports,

(d) the use of evidence based practices,

(e) building on existing foundations with an eye towards innovation,

(f) utilization of an integrated system of care,

(g) outreach to students through school-based clinics,

(h) trauma Informed, and

(i) de-escalation.

(2) Each component within the behavioral health crisis response system must be capable of serving individuals in the context of a behavioral health crisis including:

(a) children, adolescents, adults and older adults,

(b) individuals with co-occurring conditions; including:

(i) mental health conditions,

(ii) substance use disorders,

(iii) medical needs,

(iv) intellectual/developmental disabilities,

(v) physical disabilities,

(vi) traumatic brain injuries, and/or

(vii) Dementia and related neurological disorders.

(c) individuals demonstrating aggressive behavior;

(d) individuals who are uninsured or unable to pay for services, and

(e) individuals who may lack Utah residency or legal immigration status.

(3) Each modality of service within the Behavioral Health Crisis Response System is encouraged to incorporate peer support into the services they provide, when clinically appropriate.

 

R523-17-6. Certification Requirements of Crisis Workers.

(1) The division shall certify that a crisis worker is qualified by training, experience, and certification. Certification will require successful completion of training provided by the division.

(2) Individuals eligible to apply for crisis worker certification include the following:

(a) Individuals licensed under Utah Department of Professional Licensing for any health or behavioral health license;

(b) Individuals with a minimum of bachelors degree in a human service related field;

(c) Individuals certified as a Certified Peer Support Specialist for a minimum of one year;

(d) Individuals certified as Case Managers for a minimum of one year; or

(e) Individuals certified as Family Resource Facilitator for a minimum of one year.

(3) The training curriculum shall provide at least forty (40) hours of training and shall include, didactic information and skill practice using the following components as they relate to crisis intervention:

(a) Attitudinal Outcomes:

(i) acceptance of persons as different from oneself, and a non-judgmental response toward sensitive issues,

(ii) balances and realistic attitude toward self in the helper role meaning not expecting to "save" all potential suicides by one's own single effort, or to solve all the problems of the distressed person,

(iii) a realistic and humane approach to death, dying,

(iv) self-destructive behavior and other human issues, and

(v) coming to terms with one's own feelings about death and dying in so far as these feelings might deter one from helping others.

(b) Knowledge Areas:

(i) basic suicidology, including suicide assessment of desire, intent, capability, and buffers,

(ii) intervention strategies including active engagement, active rescue, and collaboration, emphasize safety and prevention,

(iii) risk of assaulting others,

(iv) community resources,

(v) consultation process,

(vi) record system and program policies,

(vii) cultural/diversity awareness,

(viii) voluntary and involuntary hospitalization criteria and procedures, and

(ix) psychopathology, psychiatric diagnosis, psychotropic medication, and substance abuse.

(c) Skill Areas:

(i) ability to assess in life-threatening situations, including risk of suicide and/or homicide,

(ii) ability to actively engage,

(iii) ability to mobilize community resources in an efficient and effective manner,

(iv) ability to respond with respect and effectiveness and render assistance to individuals in crisis and distress with appropriate regard to their cultural, racial or ethnic background; their religion or language, their socioeconomic status; or other diversity factors,

(v) provide efficient record keeping and policy implementation (e.g. recording essential notes in succinct form within the same work shift so they are useful to the next worker), and

(vi) use of the consultative process, e.g. knowing who to call under what conditions.

(3) The curriculum methodology shall include but not be limited to:

(a) role playing and other experiential based methods,

(b) use of audiovisual materials, such as simulated recorded calls and videotape,

(c) an opportunity to function as a co-crisis worker with experienced staff before assignment and to work on an independent basis, and

(d) didactic presentation and reading assignments.

(4) In order to maintain crisis worker certification an individual must:

(a) Complete at least 8 hours of continuing education (CEUs) every two (2) years pertaining specifically to crisis services,

(b) shall maintain adequate documentation as proof of compliance with this section, such as a certificate of completion, school transcript, course description, or other course materials,

(c) shall retain this proof for a period of three years after the end of the renewal cycle for which the continuing education is due; and

(d) at a minimum, the documentation shall contain the following:

(i) date of the course,

(ii) name of the course provider,

(iii) name of the instructor,

(iv) course title,

(v) number of hours of continuing education credit; and (vi) course objectives.

 

R523-17-7. Revocation of Certified Crisis Worker Certification.

(1) Certified Crisis Workers shall abide by the Provider Code of Conduct pursuant to Section R495-876, and as also found in the Department of Human Services Provider Code of Conduct Policy.

(2) Each employer shall notify the division within 30 days, if a certified crisis worker engages in unprofessional or unlawful conduct.

(3) The division shall revoke, refuse to certify, or renew a certification to an individual who is substantiated to have engaged in unprofessional or unlawful conduct.

(4) An individual who has been served a Notice of Agency Action that the certification has been revoked, or will not be renewed may request a Request for Review to the division Director or designee within 30 days of receipt of notice.

(5) The division Director or designee will review the findings of the Notice of Agency Action and shall determine to uphold, amend or revise the action of denial or revocation of the certification.

(6) If a certified crisis worker fails to complete the requirements for CEUs, their certificate shall be revoked or allowed to expire and shall not be renewed.

(7) The crisis workers certification shall be posted and available upon request.

 

R523-17-8. Standards for Local Authority Mental Health Crisis Lines.

(1) If a Local Mental Health Authority provides for a local mental health crisis line the Local Mental Health Authority shall:

(a) maintain a 24 hour/7 days per week comprehensive telephonic system capable of assessing any individual experiencing a self-defined crisis situation, leading to appropriate crisis stabilization and making appropriate referrals,

(b) collaborate with the statewide mental health crisis line,

(c) ensure that each individual who answers calls to the local mental health crisis line:

(i) is a mental health therapist and/or certified crisis worker, and

(ii) meets the standards of care and practice established by this rule,

(iii) has access to a licensed mental health clinician by direct transfer of the call that does not require a call back to the person in crisis if the non licensed crisis worker cannot stabilize the caller

(d) ensure that, based on inability to meet needs based on capacity, the calls are immediately routed to the statewide mental health crisis line,

(e) ensure that local authorities have a plan for roll over calls,

(f) ensure that regardless of the time, date, number of individuals trying to simultaneously access the local mental health crisis line, a mental health therapist or crisis worker answers the call:

(i) without the caller waiting on hold,

(ii) being screened by an individual other than a mental health therapist or crisis worker, and

(iii) within 5 rings or 30 seconds, and

(g) ensure the discounted call abandonment rate will not exceed more than 5% of the total volume of calls.

(2) If a Local Mental Health Authority does not provide for a local mental health crisis line they shall use the statewide crisis line as a local resource.

(3) Local Authorities and the statewide crisis line shall develop and implement a plan for collaboration and coordination of care for ongoing support for individuals accessing the statewide crisis line. This plan should:

(a) be created collaboratively between the Local Authority and the statewide crisis line, and

(b) shall include the following components at a minimum:

(i) policies and procedures for coordination,

(ii) timeline for care transitions that includes process for warm hand off, appointment scheduling, and follow up,

(iii) clear expectations of communication between agencies including contact lists and shared resources lists, and

(iv) a plan for regular review of data to ensure collaboration and quality of continuity of care.

 

R523-17-9. Minimum Standards of Care and Practice.

(1) Certification or accreditation standards include:

(a) The crisis line must provide proof of certification/accreditation from one of the following:

(i) American Association of Suicidology (AAS),

(ii) CONTACT USA,

(iii) Alliance of Information and Referral Systems (AIRS),

(iv) The Joint Commission,

(v) Commission on Accreditation of Rehabilitation Facilities (CARF),

(vi) Council on Accreditation (COA),

(vii) Utilization Review Accreditation Commission (URAC), or

(viii) DNV Healthcare, Inc.

(b) Agencies shall provide State/county licensure, as approved by the division Administrator or designee.

(c) The telephone crisis service must provide:

(i) screening and triage,

(ii) psycho-social support,

(iii) connection to appropriate resources,

(iv) follow-up capability to callers as clinically appropriate.

(d) The 24 hour/7 days per week telephone crisis service must be staffed by skilled professionals capable of assessing and making culturally competent, appropriate referrals.

(e) The telephone crisis service must use trauma-informed screenings and assessments, and incorporate this information into safety planning, referrals and follow-up interventions.

(f) The telephone crisis service must initiate mobile crisis services when available and be linked with walk-in crisis service facilities when available.

(2) Suicide Risk Assessment Standards include:

(a) Crisis centers shall adopt the National Suicide Prevention Lifeline Suicide Risk Assessment Standards minimum requirements.

(3) Imminent Risk Policies include:

(a) Crisis centers shall adopt the National Suicide Prevention Lifeline Policy for Helping Callers at Imminent Risk of Suicide

(4) Follow Up Policies include:

(a) Crisis Centers shall maintain and implement a policy detailing follow-up procedures including but not limited to:

(i) safe-care transitions,

(ii) rapid referrals,

(iii) caring contacts, and

(iv) care bridging strategies.

(b) This will detail how crisis centers will work with community partners and the statewide crisis line.

(5) Warm Hand Off Policies include:

(a) Agencies shall maintain written procedure defining and detailing a "warm hand off" process that allows for unique adaptations for each LA crisis service structure, in collaboration with the statewide crisis line.

(b) This initial procedure for a Warm Hand Off will be as follows:

(i) If clinically indicated, provide a warm handoff to LAs providers or other identified providers of care or care managers with an identified health plan. A warm handoff may include:

(A) a conference call or other direct communication with the LA provider, other provider or care manager to arrange immediate crisis support and scheduling an appointment for follow up support,

(B) if other needs are expressed by callers then additional resources may be offered to help access local recovery oriented support services as needed,

(C) Coordination with each local authority, regarding preferred communication and resources access as uniquely adapted to each local community, and

(D) a warm hand off will be done via conference call to facilitate a personal introduction between a Lifeline caller and their local behavioral health treatment providers or care managers, as well as the exchange of pertinent information, to promote the continuity of care.

(ii) The elements of a successful warm hand off include:

(A) orienting the caller as to what to expect,

(B) a positive provider to provider communications, and

(C) provision of accurate information regarding the caller's current condition, treatment and service needs, and safety goals.

(iii) The steps to initiate a warm hand off include:

(A) assessing callers for their level of acuity and need,

(B) offer to provide a person to person introduction to a representative in their local area,

(C) explain the conference call process to the caller

(D) Contact the predetermined designated number for provider in their local area

(E) Communicate the caller's situation and needs,

(F) Introduce the caller and remain on the line as needed to facilitate the conversation, and

(G) in the event that a warm handoff is clinically indicated and the individual is not able to receive a warm handoff for any reason, a minimum of one follow up "Caring Connection" shall be provided within 72 hours of initial contact, if contact information was able to be collected for the caller.

(6) Crisis Line Community Collaboration and Coordination Policies include:

(a) Crisis Centers shall have a published plan in place that outlines community resources available.

(b) The Crisis Centers shall have a collaboratively created plan published that outlines the plan for community collaboration with the following partners at minimum:

(i) Law Enforcement,

(ii) hospitals (Emergency Departments),

(iii) local mental health and substance abuse authorities,

(iv) schools, and

(v) any other crisis services in the local community.

 

R523-17-10. Statewide Mental Health Crisis Line Standards.

(1) The 24 hour/7 days per week statewide crisis Line shall adhere to the following standards:

(a) collaborate with Local Authorities running local crisis line,

(b) the statewide crisis line shall develop, and implement a plan for collaboration and coordination of care for ongoing support for individuals accessing services with Local Authorities,

(c) plans should be created collaboratively between the Local Authority and the statewide crisis line,

(d) plans shall include the following components at a minimum:

(i) policies and procedures for coordination,

(ii) timelines for care transitions that includes process for warm hand off, appointment scheduling, and follow up,

(iii) clear expectations of communication between agencies including contact lists and shared resources lists,

(iv) a plan for regular review of data to ensure quality of continuity of care.

(v) assurance that each individual who answers calls to the statewide crisis line:

(A) is a mental health therapist and/or certified crisis worker

(B) meets the standards of care and practice established by this rule

(C) has access to a licensed mental health clinician by direct transfer of the call that does not require a call back to the person in crisis if the non licensed crisis worker cannot stabilize the caller.

(vi) assurance that regardless of the time, date, number of individuals trying to simultaneously access the local mental health crisis line a mental health therapist or crisis worker answers the call:

(A) without the caller waiting on hold,

(B) being screened by an individual other than a mental health therapist or crisis worker, and

(C) within 5 rings or 30 seconds,

(vii) the discounted call abandonment rate will not exceed more than 5% of the total volume of calls,

(viii) 90% of statewide crisis line calls shall be answered in state as reported by the National Suicide Prevention Lifeline call data, and

(ix) assurance that the statewide crisis line has the capacity to accept all calls that local mental health crisis lines route to the statewide crisis line.

 

R523-17-11. Minimum Standards of Care and Practice for the Statewide Crisis Line.

(1) Certification or accreditation include:

(a) The crisis line must provide proof of certification/accreditation from one of the following:

(i) American Association of Suicidology (AAS),

(ii) CONTACT USA,

(iii) Alliance of Information and Referral Systems (AIRS)

(iv) The Joint Commission on Accreditation of Rehabilitation Facilities (CARF),

(v) Council on Accreditation (COA),

(vi) Utilization Review Accreditation Commission (URAC), or

(vii) DNV Healthcare, Inc.

(b) State/county licensure, as approved by the division Administrator or designee,

(c) The telephone crisis service must provide:

(i) screening and triage,

(ii) psycho-social support, and

(iii) connection to appropriate resources.

(d) follow-up capability to callers as clinically appropriate, and

(e) The 24 hour/7 days per week telephone crisis service must be staffed by skilled professionals capable of assessing and making culturally competent, appropriate referrals.

(f) The telephone crisis service must use trauma-informed screenings and assessments and incorporate this information into safety planning, referrals and follow-up interventions.

(g) The telephone crisis service must initiate mobile crisis services when available and be linked with walk-in crisis service facilities when available.

(2) Suicide Risk Assessment Standards shall include:

(a) Statewide Crisis Line shall adopt the National Suicide Prevention Lifeline Suicide Risk Assessment Standards minimum requirements.

(3) Imminent Risk Policies shall include:

(a) Statewide Crisis Line shall adopt the National Suicide Prevention Lifeline Policy for Helping Callers at Imminent Risk of Suicide

(4) Follow Up Policies shall include:

(a) Statewide Crisis Line shall maintain and implement a policy detailing follow-up procedures including but not limited to:

(i) safe-care transitions,

(ii) rapid referrals,

(iii) caring contacts, and

(iv) care bridging strategies.

(b) This will detail how Statewide Crisis Line will work with community partners and the local crisis line.

(5) Warm Hand-off Policies shall include:

(a) Agencies shall maintain written procedure defining and detailing a "warm hand off" process that allows for unique adaptations for each LA crisis service structure, in collaboration with the statewide crisis line.

(b) This initial procedure for a Warm Hand Off shall be as follows:

(i) If clinically indicated, provide a warm handoff to LAs providers.

(ii) A warm handoff may include:

(A) a conference call or other direct communication with the LA provider to arrange immediate crisis support and scheduling an appointment for follow up support.

(B) If other needs are expressed by callers then additional resources may be offered to help access local recovery oriented support services as needed.

(C) coordination with each local authority regarding preferred communication and resources access as uniquely adapted to each local community.

(iii) A warm hand off will be done via conference call to facilitate a personal introduction between a Statewide Crisis Line caller and their local behavioral health treatment providers, as well as the exchange of pertinent information, to promote the continuity of care.

(iv) The elements of a successful warm hand off include:

(A) orienting the caller as to what to expect,

(B) positive provider to provider communications, and

Providing accurate information regarding the caller's current

(C) condition, treatment and service needs, and safety goals.

(v) The steps to initiate a warm hand off includes:

(A) assessing callers for their level of acuity and need,

(B) offer to provide a person to person introduction to a representative in their local area,

(C) explain the conference call process to the caller,

(D) contact the predetermined designated number for provider in their local area,

(E) communicate the caller's situation and needs; and

(F) introduce the caller and remain on the line as needed to facilitate the conversation.

(vi) In the event that a warm handoff is clinically indicated and the individual is not able to receive a warm handoff for any reason, a minimum of one follow up "Caring Connection" shall be provided within 72 hours if contact information was able to be collected for the caller.

(6) Crisis Line Community Collaboration and Coordination plan shall include:

(a) Statewide Crisis Line shall have a published plan in place that outlines community resources available.

(b) The statewide Crisis Line shall have a plan published that outlines the plan for community collaboration with the following partners at minimum:

(i) Local Authorities including Mobile Crisis Outreach Teams,

(ii) law enforcement,

(iii) hospitals (Emergency Departments),

(iv) health plans,

(v) schools, and

(vi) any other crisis services in the local community.

(c) The Statewide Crisis Line shall enter into MOU's with each Local Authority operating a Crisis Line and/or Mobile Crisis Outreach Teams and shall make good faith efforts to enter into MOU's with parties described in R523-17-11 (6b).

 

R523-17-12. Division Oversight of Program.

(1) The division may enter and survey the physical facility, program operation, and review curriculum and interview staff to determine compliance with this rule or any applicable contract to provide such services.

(2) Participating organizations including Local Authorities and the statewide crisis line shall also allow representatives from the division and from the local authorities as authorized by the division to monitor services. Such visits may be announced or unannounced.

 

KEY: crisis response services, crisis worker certification, statewide crisis line standards

Date of Enactment or Last Substantive Amendment: 2018

Authorizing, and Implemented or Interpreted Law: 62A-15-1302(2)