Robert S. Brown Crisis Center

Full Program Description

Robert S. Brown Crisis Center is a 6-bed co-ed specialized facility, which provides an alternative to inpatient hospitalization for adults who are experiencing an emotional or mental health crisis.  The program serves individuals in an acute crisis who require 24-hour support services for behavioral concerns in a supervised environment that allows freedom of movement in the community. Admission to the crisis program is voluntary.

Trained staff provides in-house programming, centering on psycho-educational groups and leisure activities. Staff consult with residents and use assessment skills to identify resident needs and plan groups that encourage involvement and participation.
Clinical groups provide education to residents on a variety of topics such as mental illness, substance abuse, medication management, social skills, anger and stress management, safety and symptom management. 

Brown Crisis Center is directly supervised by a Clinical Program Manager who works with the Program Director in coordinating the overall administration of services to residents and ensures that optimum licensing standards and regulations are followed.  There is also 24-hour on-call coverage for staffing and administrative concerns, shared amongst the management staff. 

In addition to management responsibilities, the Clinical Program Manager is a Masters-level clinician, providing 1:1 guidance to residents and referring residents to appropriate community resources to help overcome acute barriers to recovery. This individual also works as a liaison to the respective CMH's and provides clinical direction to the staff.

The psychiatrist is on site two times per week and provides an initial assessment and medication review for each resident. Residents are seen additionally as it is deemed necessary. The psychiatrist is also available to assist the resident and program staff in identifying the resources necessary for discharge.

Nursing coverage is provided in the program seven days a week, up to eight hours day and 24-hour on-call coverage is available evenings and weekends for both nursing and psychiatric care.  LPN's also provide educational training on health-related issues.  The clinicians and case managers from the referring agencies provide clinical on-call assistance.  The purpose of clinical on-call is to act as a consultant to help make clinical decisions with staff regarding residents and to provide back up support in an emergency. 

Program Philosophy

The mission of Hope Network is to empower people with disabilities or disadvantages to achieve their highest level of independence.  The purpose of Hope Network is to enhance the ability of individuals and families to achieve full community participation through comprehensive behavioral health services.  At Brown Crisis we support and work together to promote and fulfill this mission.

Brown Crisis Center also follows Hope Network's commitment to providing a welcoming, accessible, integrated, continuous, and comprehensive model of services for residents with mental illness and co-occurring disorders.

Program Goals

1. To provide a safe, recovery-oriented environment which enhances the resident's ability to achieve individual treatment plan goals and objectives.
2. To assist residents in goal attainment, promoting discharge to the least restrictive environment possible.
3. To foster an environment where the dignity and respect of each resident is maintained.

Services Provided

• 24 hour on-site staff support
• Staff/resident ratio sufficient to adequately and safely meet resident needs
• A psychiatrist who meets with residents twice per week
• Co-occurring education and support
• Other services adequate to meet Medicaid regulations for this service, including on-site nursing services (RN or LPN under appropriate supervision).  Treatment services are provided under the supervision of a psychiatrist who is available by telephone at all times.

Admission Criteria

Admission Criteria has been defined by CMH and by Medicaid Guidelines.  The Severity of Illness/Intensity of Service criteria for admission presume that, while the individual generally meets the basic criteria for inpatient care (i.e. - displaying significant signs and symptoms of a psychiatric disorder, demonstrating serious functional impairments, some level of risk), he/she is not (at the time of admission) exhibiting as severe a degree of clinical instability (not at imminent risk of self/other harm) as those persons who require inpatient care, nor are there serious medication or medical complications which would necessitate treatment in a medical facility.

CRITERIA - Must meet all three (A, B, C)

A. Diagnosis:  The resident must have a primary and validated DSM-IV or ICD-10 Diagnosis (not including V Codes).

B. Severity of Illness:  (signs, symptoms, functional impairment and risk potential)

1. Psychiatric Signs and Symptoms

   1. A substantial disturbance of thought processes, perception, affect, memory or consciousness (due to a mental illness) exists and is severe enough to cause disordered/bizarre behavior, diminished impulse control, significantly flawed judgment, moderate psychomotor acceleration or retardation, impaired capacity to recognize reality and/or impairments in activities of daily living.  The disordered/bizarre behavior or level of agitation are not so severe or extreme as to require frequent restraints or to pose a danger to others receiving services at the residence.

   2. Disruptions of Self-Care and Independent Functioning

      1. The person has insufficient capability to adequately attend to basic self-care tasks and/or to maintain adequate nutrition, shelter, or other essentials of daily living, due to a psychiatric disorder.

      2. The person's interpersonal functioning is seriously impaired or dysfunctional, necessitating temporary separation from the natural support system and living arrangement.

      3. The person is acutely incapacitated in educational/occupational role performance due to an active psychiatric disorder.

   3. Danger to Self

      1. There is some danger to self.  Reflected in self-harm ideations with or without a plan, recent gestures with low lethality/intent, or minor, non-severe, self-injurious behavior.

      2. There are intermittent expressions/verbalizations or self-harm inclinations, thoughts of self-mutilation, passive wishes to die, but no persistent or unrelenting self-harm preoccupations, and no recent significant physical actions (deliberate or reckless endangerment behavior) involving actual, direct, serious harm to the self.

      3. There may have been recent significant self-harm actions, but these inclinations/behaviors are now clearly under control, and the individual is not considered to be at imminent or serious risk if monitored in a 24-hour program with adequate supervision and supports.

   4. Danger to Others

      1. The person has expressed a wish to harm others, but has not made any plans or acquired the means to carry this out and there is evidence of some impulse control and reality orientation.

      2. The person may have threatened others verbally, but there have been no assaultive actions, no preparation for such actions, and there is nothing in the person's recent behavior to suggest these treats will be carried out

      3. There may have been minor destructive behavior toward property that has not materially endangered others.

   5. Drug/Medication Compliance

      1. Stabilization of symptoms related to the psychiatric crisis requires adherence to a medication regimen, and initial compliance cannot be reliably assured (due to impaired condition, consciousness, memory or judgment) without recurrent monitoring and supervision.

      2. For example, a person new to the area, or a person previously served returning to the county without any support in place.  "Support" may include but not be limited to need for shelter, food, access to medication and linkage assistance.  This person is not in need of inpatient care and does not possess the skills necessary for a successful placement in an unsupervised community setting.

   6. Intensity of Service:  The person meets the intensity of service requirements, crisis residential services are considered medically necessary and the person requires at least one of the following:

      1. The recipient requires a highly structured, supervised care setting to prevent elevation of symptom acuity, to recover functional living skills and to strengthen internal coping resources.

      2. Consistent observation and supervision of behavior is needed to compensate for impaired reality testing, temporarily deficient internal control, and/or faulty self-preservation inclinations.

      3. The recipient has reached a level of clinical stability (diminished risk) obviating the need for restrictive inpatient care, but continues to require a structured and supervised 24-hour program to consolidate inpatient progress.

      4. Frequent monitoring of medication regimen and response is necessary and compliance is doubtful without consistent supervision and support.

      5. The recipient needs to be temporarily separated from his/her natural environment, current living situation and/or support systems due to severely impaired interpersonal functioning and the risk of further deterioration of the condition and of support circumstances if an alternative setting is not utilized.

      6. A concentrated, comprehensive, program of treatments, services and supports is indicated by the complexity and/or the severity of the recipient's signs and symptoms.

Additional Admission Criteria:
 

1. Residents must be eighteen years of age or older
2. Must be willing to be involved in and cooperate with a voluntary treatment program.
3. Completion of AFC Resident Care Agreement, AFC Assessment, and Health Care Appraisal (within 30 days) as required by the Department of Resident and Industry Services, Adult Foster Care Licensing Division.

Exclusion Criteria

1. Individuals who require continuous nursing care.
2. Individuals whose primary problem is not a psychiatric disorder.
3. Must not require isolation or restraint as specified in the AFC licensing rules (R400.14308).

The Crisis Program is intended to be flexible in meeting the needs of individuals requiring our services. Crisis Staff are instructed to notify the Crisis Program Director for consultation whenever they receive a questionable referral.  The Crisis Program Director must be consulted and in agreement with the decision to deny services prior to refusing an admission to any individual.

Discharge Criteria

1. An individual has met the goals outlined in their initial treatment plan which is developed in concert with the person served, case manager, program staff, and referral source.
2. Authorization for continuing stay is denied.
3. Development of health problems that require intensive skilled nursing.
4. Development of behaviors that are threatening to the well being of self or others.