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COLLABORATING FOR EFFECTIVE COMMUNITY CRISIS INTERVENTION

Jason Scheck, LSCSW

WSU POWER Conference

2/24/2017

OBJECTIVES

1. Recognize ethical risks and dilemmas in crisis intervention

2. Apply ethical principles in crisis care and policy

3. Better understand and access local crisis resources

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RECOGNIZE ETHICAL RISKS AND DILEMMAS IN CRISIS INTERVENTION

RULES

• What we “have to do”

• Types of law

• Statutes & regulations

• Case law

• Constitutional law

• Executive orders

• Agency policies & procedures

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ETHICS

• What we “ought to do”

• Values and principles

• Application of moral reasoning

• Judgment about obligations and duties

• NASW Code of Ethics

CRISIS

“A subjective response to a stressful or traumatic life event or a series of events that are perceived by the person as hazardous, threatening, or extremely upsetting, which do not resolve using traditional coping methods.”

-Roberts, 2009

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WHAT IS THE ROLE OF A CRISIS THERAPIST?

Psychoanalysis Brief intervention Crisis interventionGoal Restructuring the

personalityRemoval of specific symptoms

Resolution of immediate crisis

Focus Past Past as it relates to current situation

Present and restoration of pre-crisis level of functioning

Therapist activity ExploratoryNondirective

SupportiveIndirect

SupportiveDirective

Adapted from Aguilera, 1998

CLIENT CRISES OPPORTUNITIES

• Increase motivation for change

• Openness to more treatment options

• Identify new strengths & resources

• Learn new coping skills

• Increase confidence in navigating future crises

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ETHICAL RISKS IN CRISES?

• Emotionally charged situations

• Conflicting values (e.g. self-determination vs safety)

• Competence

• Less time for reflection

• Client impairment

• High stakes outcomes

• Confidentiality violations

Roberts, 2005

Roberts’ 7 Stages of Crisis Intervention

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APPLY ETHICAL PRINCIPLES IN CRISIS CARE AND POLICY

ETHICAL STANDARDS

1.02 Self-Determination - Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals.

1.07 Privacy and Confidentiality - Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons.

1.14 Clients Who Lack Decision-Making Capacity - When social workers act on behalf of clients who lack the capacity to make informed decisions, social workers should take reasonable steps to safeguard the interests and rights of those clients.

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ETHICAL STANDARDS

6.04 Social and Political Action - Social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully.

Social workers should act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups.

PREPARING TO RESPOND ETHICALLY

• Pursue training to enhance competence

• Know crisis resources

• Understand applicable laws, policies, procedures

• Know ethical code

• Develop reference kit and/or checklists

• Practice mindfulness skills

• Plan for emergency consultation or supervision

• Plan for effective communication

• Advocate for necessary resources

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HOSPITAL DILEMMA

• Limited beds

• Limited psychiatrists

• Limited indigent care

• Move patients out of ER’s quickly

COMMUNITY CRISIS DILEMMA

• Not equipped/licensed to provide detox services

• Limited access to hospitals

• Limited detox options

• Limited funding

• Limited space

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DETOX DILEMMA

• Not equipped to provide mental health services

• Low staffing ratio not conducive to monitoring suicidal individuals

• Limited funding

• Limited capacity

• If not treated, may not get any treatment

ETHICAL DECISION MAKING MODEL

1. Identify the ethical issues

2. Identify those affected by decision

3. Identify possible courses of action

4. Examine options

5. Consult

6. Make the decision and document decision-making process

7. Monitor, evaluate, and document the decisionReamer, 2002

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ETHICAL RULES SCREEN

• Review Code of Ethics (Code takes precedence over personal values)

• If one or more Code rules apply, follow them.

• If the Code does not address the specific problem, or if several Code rules provide conflicting guidance, use the Ethical Principles Screen.

from Loewenberg, F.M. & Dolgoff, R. (2000). Ethical Decisions for Social Work Practice (6th ed.).Itasca, Il.: FE Peacock

ETHICAL PRINCIPLES SCREEN

• Principle of the protection of life • Principle of equality and inequality • Principle of autonomy and freedom • Principle of least harm • Principle of quality of life • Principle of privacy and confidentiality • Principle of truthfulness and full disclosure

from Loewenberg, F.M. & Dolgoff, R. (2000). Ethical Decisions for Social Work Practice (6th ed.).Itasca, Il.: FE Peacock

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BETTER UNDERSTAND & ACCESS LOCAL CRISIS RESOURCES

ETHICAL STANDARDS2.06 REFERRAL FOR SERVICES

(a) Social workers should refer clients to other professionals when the other professionals’ specialized knowledge or expertise is needed to serve clients fully or when social workers believe that they are not being effective or making reasonable progress with clients and that additional service is required.

(b) Social workers who refer clients to other professionals should take appropriate steps to facilitate an orderly transfer of responsibility. Social workers who refer clients to other professionals should disclose, with clients’ consent, all pertinent information to the new service providers.

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The Community Crisis Center provides 24/7,

single-point-of-entry access to an integrated array

of community based crisis mental health and

substance use disorder services.

CONTINUUM OF CRISIS SERVICES

• 24/7 crisis hotline

• 24/7 walk-in crisis intervention

• 23-hour adult outpatient crisis observation

• Adult Crisis Stabilization Unit

• Children’s Crisis Beds

• Mobile crisis services

• Sobering/detox services

• Inpatient services

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24/7 CRISIS HOTLINE

• Hotline: 660-7500

• 70,000 Crisis calls per year

• Answer for Sedgwick, Butler, & Sumner Counties

• National Suicide Prevention Lifeline Crisis Center for Sedgwick County (1-800-273-8255)

• Goal to add “chat” service

24/7 CRISIS INTERVENTION

• 8,000 Unscheduled crisis visits

• Walk-in & law enforcement referrals

• All ages

• Sedgwick, Sumner, Butler Counties

• Televideo crisis intervention

• State hospital screening

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CRISIS OBSERVATION UNIT

• 6 recliners

• Up to 23 hours of supervised care

• Assists with deescalating the severity of crisis

• Assessment for higher levels of care

• Engagement in follow-up care

• Medication management

• SOAR specialist

CRISIS STABILIZATION UNIT

• 10 beds

• Located at 1720 East Morris

• 3 to 5 days of supervised crisis care to stabilize crisis in lieu of hospitalization

• Plan for transitions to ongoing supports

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CHILDREN’S CRISIS BED

• 2 beds with supervised care at Wichita Children’s Home

• Assists with stabilizing crisis and reducing acute symptoms

• Avoids higher levels of care and travel to other communities/states

• Engagement in follow-up services

MOBILE CRISIS UNIT

• Assessment in the community when there is therapeutic need and benefit

• Crisis diversion resource• Available 8am to 10pm• QMHP, Case Manager and security (or police)• Available in Sedgwick County

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SOBERING/DETOX UNIT

• Operated by Substance Abuse Center of Kansas (SACK)

• 15 detox and 6 sobering beds

• Accept referrals 24/7

SACK

• The Substance Abuse Center of Kansas (SACK) provides services that are focused on the addiction needs of clients

• Detoxification/sobering beds

• Case management and care coordination

• Peer mentors

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SOBERING/DETOX UNIT GOALS

• Divert clients not appropriate for detention, and hospital thus reducing inappropriate admissions and/or reducing length of stay;

• Assist clients in achieving abstinence from alcohol and other drugs;

• Assist in safely addressing withdrawal; and • Engage clients in treatment and engage them in ongoing

care.

SOBERING UNIT CRITERIA

Blood Alcohol Content (BAC) between 0.04 to 0.30

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DETOX UNIT CRITERIA

• Requires 24/7 support for withdrawal management

• Blood Alcohol Content (BAC) may not exceed 0.30

CONTACT SACK

SACK Sobering/Detox Units

635 N Main (Use Pine Street entrance)

Phone: (316) 633-4705

Fax: (316) 633-4706

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NOT EQUIPPED TO SERVE

1. Too intoxicated to communicate or ambulate for self-care

2. Those requiring emergency medical care

3. Combative/involuntary

PLANNING PARTNERS

• COMCARE of Sedgwick County

• Kansas Department of Aging and Disability Services

• National Alliance on Mental Illness – Wichita

• Robert J. Dole VA Medical Center

• Sedgwick County Department on Aging

• Sedgwick County Community Developmental Disability Organization

• Sedgwick County Sheriff ’s Office

• Substance Abuse Center of Kansas (SACK)

• South Central Mental Health Counseling Center

• Sumner County Community Mental Health Center

• Via Christi

• Wichita Children’s Home

• Wichita Police Department

• Wichita State University

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IMPROVED CARE

• More voluntary, local treatment options

• Enhanced transitions from one level of care to another

• Better coordination among agencies working with this population

• Integrated care that holistically addresses clients’ needs

CRISIS CONTINUUM GRANT SERVICES

2015 2016

Crisis Observation Unit 1059 1096

Children's Crisis Unit 91 58

Sobering Unit 338 379

Detox Unit 411 762

Grant Services Totals 1899 2295

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SEDGWICK COUNTY STATE HOSPITAL BED DAYS

SEDGWICK COUNTY STATE HOSPITAL ADMISSIONS

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PROBATE CARE & TREATMENT CASES

WSU POST IMPLEMENTATION STUDY 2016

ACTUAL COST AVOIDANCE

LOW HIGH AVERAGE

$5,931,217 $10,275,631 $8,103,425

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REFERENCES

• Aguilera, D. C. (1998). Crisis intervention theory and methodology (8th ed.). St. Louis, MO: Mosby.

• Loewenberg, F.M. & Dolgoff, R. (2000). Ethical Decisions for Social Work Practice (6th ed.).Itasca, Il.: FE Peacock.

• National Association of Social Workers. (2008). Code of ethics of the national association of social workers. Retrieved from: https://www.socialworkers.org/pubs/code/code.asp

• Reamer, F. G. (2002). Eye on ethics. Social Work Today. Retrieved from: http://www.socialworktoday.com/news/eoe_101402.shtml

• Roberts, A. R. (Ed.) (2005). Crisis intervention handbook: Assessment, treatment, and research (3rd ed.) New York, NY: Oxford University Press.

• Roberts, A. R. , & Yeager, K. R. (2009). Pocket guide to crisis intervention: A complete crisis intervention toolkit. New York, NY: Oxford University Press.