Section 441.24.38. Crisis stabilization community-based services (CSCBS).

The goal of CSCBS is to stabilize the individual within the community. CSCBS is designed as a voluntary service for individuals in need of a safe, secure location that is less intensive and restrictive than an inpatient hospital. Individuals receive CSCBS services including, but not limited to, psychiatric services, medication, counseling, referrals, peer support and linkage to ongoing services. The duration for CSCBS is expected to be less than five days.

         24.38(1) Eligibility. To be eligible, an individual must:

            a.               Be determined appropriate for the service by mental health assessment; and

            b.               Be determined not to need inpatient acute hospital psychiatric services.

         24.38(2) Staffing requirements.

            a.               A designated director or administrator is responsible for the management and operation of the CSCBS.

            b.               At least one licensed nurse practitioner, physician assistant, or psychiatrist is available for consultation 24 hours a day, 365 days a year.

            c.               Mental health professionals with expertise appropriate to the individual’s needs provide services.

            d.               Contact between the individual and a mental health professional occurs at least one time a day.

            e.               Additional services are provided by crisis response staff at a minimum of one hour per day, including, but not limited to, skill building, peer support or family support peer services. The goal of CSCBS is to stabilize the individual within the community. CSCBS is designed for voluntary services for individuals in need of a safe, secure location that is less intensive and restrictive than an inpatient hospital.

            f.                Crisis response staff must be awake and attentive 24 hours a day.

         24.38(3) Performance benchmark. The individual using CSCBS is provided safe, secure and structured crisis stabilization services in the least restrictive location meeting the needs of the individual. The CSCBS can be for youth aged 18 and under or adults aged 18 and older.

         24.38(4) Performance indicators.

            a.               The individual can provide consent for treatment providers, family members and other natural supports to be contacted within 24 hours of admission.

            b.               Daily crisis stabilization services include, at minimum, daily contact with a mental health professional and one hour of additional crisis stabilization services from crisis response staff.

            c.               The numbers of days an individual receives crisis stabilization services are documented. The documentation records specific reasons for the delivery of services beyond five days.

            d.               Individual records are maintained to document the following:

             (1)             Daily contact with a mental health professional.

             (2)             Additional services provided including, but not limited to, skill building, peer support or family support peer services.

             (3)             Medication record.

            e.               Individual choice is verified including, but not limited to, treatment participation and discharge plan options.

            f.                Readmission data is tracked, including an analysis of data trends looking at effectiveness, and appropriate corrective action taken. The information is documented in the performance improvement system files.

         24.38(5) Crisis stabilization incident reporting.

            a.                Performance benchmark. An incident report is filed when staff are notified an incident has occurred.

            b.                Performance indicators.

             (1)             The incident report documents:

            1.      The name of the individual involved in the incident.

            2.      Date and time the incident occurred.

            3.      A description of the incident.

            4.      Names and signatures of all staff present at the time of the incident.

            5.      The action the staff took to handle the situation.

            6.      The resolution or follow-up to the incident.

             (2)             A copy of the incident report is kept in a centralized file and a copy given to the individual, the mental health and disability services region, and the parent or guardian when appropriate.

         24.38(6) Service requirements.

            a.                Stabilization plan. The individual in crisis is involved collaboratively in all aspects of crisis stabilization services including, but not limited to, admission, treatment planning, intervention, and discharge. The involvement of family members and others is encouraged.

Within 24 hours of an individual’s admission to crisis stabilization services, a written short-term stabilization plan is developed, with the involvement and consent of the individual, and is reviewed frequently to assess the need for the individual’s continued placement in CSCBS. At a minimum, this plan includes:

             (1)             Criteria for discharge, including referrals and linkages to appropriate services and coordination with other systems.

             (2)             Description of any physical disability and any accommodations necessary to provide the same or equal services and benefits as those afforded nondisabled individuals.

             (3)             Evidence of input by the individual, including the individual’s signature.

             (4)             Goal statement. Goals are consistent with the individual’s needs and projected duration of service delivery and include objectives which build on strengths and are stated in terms allowing measurement of progress.

             (5)             Rights restrictions.

             (6)             Names of all other persons participating in the development of the plan.

             (7)             Specification of treatment responsibilities and methods.

            b.                Performance benchmark. A stabilization plan is completed within 24 hours of the individual’s admittance.

            c.                Performance indicators.

             (1)             Individual records include a written short-term stabilization plan developed with the involvement and consent of the individual within 24 hours of admittance and reviewed frequently to assess the need for continued placement in CSCBS.

             (2)             Individual records indicate a crisis stabilization plan is completed within the 24-hour time frame.

             (3)             Reasons for crisis stabilization plans not meeting the criteria are documented.

             (4)             A follow-up appointment with the individual’s preferred provider will be made, and crisis response staff will follow up with the individual and document contact or attempt to contact on a periodic basis until the appointment takes place.

         24.38(7) Treatment summary. Prior to the individual’s discharge from CSCBS, a treatment summary is completed. A copy of the summary is provided to the individual and shared with the individual’s treatment team of providers, if applicable.

            a.                Contents. At a minimum, the treatment summary includes:

             (1)             Course and progress of the individual with regard to each identified problem.

             (2)             Documented note of a mental health professional contact one time daily.

             (3)             Evolution of the mental status to inform ongoing placement and support decisions.

             (4)             Final assessment, including general observations and significant findings of the individual’s condition initially while services were being provided and at discharge.

             (5)             Recommendations and arrangements for further service needs.

             (6)             Signature of the mental health professional.

             (7)             Stabilization plan.

             (8)             Reasons for termination of service.

             (9)             Treatment interventions.

            b.                Performance benchmark. A treatment summary is completed during the length of stay in CSCBS.

            c.                Performance indicators.

             (1)             Records include a written treatment summary developed with the involvement of the individual. A copy of the summary is provided upon discharge.

             (2)             Incidents in which a treatment plan was not completed within the length of stay and any corrective action necessary to alleviate this issue are documented.

         24.38(8) Health and safety.

            a.                Performance benchmark. Emergency preparedness policies and procedures include health and safety measures.

            b.                Performance indicators.

             (1)             Emergency preparedness plans are designed to provide effective utilization of available resources for care to continue during a disaster event including, but not limited to, cases of severe weather or fire.

             (2)             Crisis services comply with rule 441—24.39(225C).

[ARC 1660C, IAB 10/15/14, effective 12/1/14]