Home   |    Contact Us   |    Frequently Asked Questions   |    Search   |    Site Map
CRISIS RESPONSE SYSTEM

Crisis System

Of the many programs provided through the AACMHA, the Crisis Response System (CRS) stands out as one of the most innovative crisis systems throughout the State. Individuals with mental health and substance use disorders who are experiencing a crisis have traditionally been treated in hospital emergency departments or have become incarcerated. Both options are not only costly, but their staff often cannot provide the specialized treatment and aftercare needed by someone with a behavioral health issue. In response to the growing need for crisis services and the desire to serve individuals in the least restrictive setting, AACMHA developed the CRS to provide an array of behavioral health options and supports for individuals in distress.

 

Care Coordinator

Care Coordination is the most effective component of Anne Arundel County’s CRS, an element that also makes it stand out from other systems. This is the follow-up that is conducted with individuals after their immediate crisis is resolved. Warm-line operators conduct follow-up calls to individuals who call for services and resources. The operators also contact providers to coordinate care. In addition, there is a care coordination element of CRS that can offer more than a follow up call if the situation requires intense support. Follow-up is also conducted for individuals seen by the MCT. These short-term crisis stabilization visits are an important aspect to ensuring that individuals are able to remain stable and mitigate additional crises.

Critical Time Intervention

Information on Critical Time Intervention (CTI) from the Center for the Advancement of Critical Time Intervention:

“The CTI model was developed in New York City during the mid-1980s when many people with psychiatric disorders were becoming homeless. In response to the homelessness crisis, a number of clinicians, researchers and other advocates began meeting to discuss how to alter services and housing to accommodate people who were homeless and mentally ill. Many “good practices” of community mental health care, which we take for granted today and were not in wide use at the time, evolved during those years of collaboration and innovation.

It was in this context that the idea for CTI was conceived. While working on an onsite mental health team in a large municipal men’s shelter in the South Bronx, the developers of CTI (Ezra Susser, Elie Valencia, Sarah Conover) observed that many of the men who had been placed into housing became homeless again. Discharge planning helped the men up until placement in housing, but it did not provide the type of assistance they needed to remain in housing. Transitional periods like the move from shelter to permanent community housing, when clients have to navigate a complex and fragmented system of care, are especially challenging.

CTI was designed as a short-term intervention for people adjusting to a “critical time” of transition in their lives. The developers hypothesized that the men in the shelter would meet with more sustainable success if they were connected to long-term support from community resources. Thus, if the CTI team maintained continuity of care during the first nine months of the transition while simultaneously passing responsibility on to community supports, then this support would remain in place after the end of the intervention and would enable the effects of a time-limited intervention to last long after its actual endpoint. From the beginning, CTI was thought of as an intervention that could be applied to other contexts.”

Mobile Crisis Teams

The MCTs were designed to respond primarily to calls from police officers and are on police radios. In addition, if the OPS receives a call regarding an individual who is in severe crisis, they have the ability to refer calls to one of the county’s MCTs. The MCT can then be dispatched to assist in stabilizing the individual and connect them to the most appropriate services. During FY17, the MCTs were dispatched 1,912 times. The agency serves the entire county on a 24/7/365 basis. On days when there are sudden surges, AACMHA employs contingent part time staff (CPT) to assist.

Mobile Treatment

People Encouraging People provides Assertive Community Treatment in Anne Arundel County.

Information on Assertive Community Treatment from the Center for Evidence-Based Practices:

“Assertive Community Treatment (ACT) is an evidence-based practice that improves outcomes for people with severe mental illness who are most at-risk of psychiatric crisis and hospitalization and involvement in the criminal justice system. ACT is one of the oldest and most widely researched evidence-based practices in behavioral healthcare for people with severe mental illness.

ACT is a multidisciplinary team approach with assertive outreach in the community. The consistent, caring, person-centered relationships have a positive effect upon outcomes and quality of life. Research shows that ACT reduces hospitalization, increases housing stability, and improves quality of life for people with the most severe symptoms of mental illness.”

Hospital Diversion

Diversion is another tool available to the CRS. Under the Hospital Diversion Program, a clinician is co-located at Anne Arundel Medical Center and Baltimore Washington Medical Center to follow-up on any individuals entering an Emergency Department under emergency petitions the previous day. This clinician consults with hospital staff to determine if there is an alternative to an inpatient stay for the individual. When it is determined that the individual could be safely discharged, the clinician works with the individual to connect them to community services. Should the individual need more intensive services, placement in a crisis bed is an option. A crisis bed allows the individual to be discharged from a more restrictive hospital inpatient unit while receiving crisis stabilization services. Individuals are able to remain in the crisis bed for up to 10 days. Should additional days be needed to stabilize the person in crisis, the clinician works with the provider to obtain authorization from the State’s ASO.

Jail Diversion

A Jail Diversion program was established in January 2015 to augment the AACMHA Crisis Response System. The program was initiated at the Jennifer Road Detention Center where pre-trial individuals are detained. The focus of this program is individuals who are: in pre-trial status, charged with a misdemeanor, and have screened positive for a behavioral health disorder. Individuals who participate in the program must be willing to receive community-based services upon release.

Once the individual is referred to the program, the Jail Diversion Specialist screens them. If the individual is accepted in the program, a plan of care is developed and submitted to the judge for review at the 1:00 p.m. docket. If the attorney and the judge approve the plan, the individual is released the same day and the plan of care is implemented. This plan includes strategies to address housing needs, mental health and substance use disorder treatment, physical health, and attainment of benefits. The individuals can receive services for up to 90 days post-release and they are then transitioned into services in the PBHS or other programs if they are privately insured.

In-Home Intervention Teams

The In-Home Intervention Program for Children (IHIP-C) is a family-focused, community based, in-home intervention program utilized in Anne Arundel, Calvert, Charles, Prince George’s, and St. Mary’s Counties. It provides services for children and adolescents with behavioral health issues, who are at risk of out-of-home placement. IHIP-C utilizes a strengths-based, family-centered approach providing individualized, coordinated treatment and skill building to the child and their family. As part of an integrated approach, the team often engages not only the child and family but other key participants that may influence the child’s overall well-being, including school staff, probation officers, psychiatrists, or extended family. This program allows youth to remain in their homes thereby significantly reducing the need for institutional care or out of home placement.

The In-Home Intervention Prevention for Adults (IHIP-A) is an intensive community-based treatment approach for individuals with chronic and severe mental illnesses available in Calvert, Charles and St. Mary’s Counties. This program was developed meet the needs of individuals for whom less intensive outpatient treatment has been ineffective. IHIP-A targets rural communities where Assertive Community Treatment (ACT) Programs have been found to not be as cost effective as in urban and suburban communities.

IHIP-A participants are often in acute emotional crisis and at-risk for psychiatric hospitalization due to potentially dangerous behaviors, socially and/or legally unacceptable behaviors, or the inability to access appropriate mental health services. Interventions and supports provided under IHIP-A include 24-hour crisis availability which allows the individual to be stabilized within their current living situation thereby reducing harmful behaviors, recurring visits to emergency departments, and the use of inpatient or other institutional-based care.

Transportation

Transportation is also a key impediment to individuals who are willing to accept treatment but often lack the means to get there. CRS minimizes this barrier with intensive care coordination, including transporting individuals to treatment, if necessary. Once they are engaged, a “warm” hand-off is made to the provider. Transportation is also problematic for persons with behavioral health issues who are involved in the criminal justice system. An individual may be willing to meet with their parole officer, but if they are unable to get to the appointment they are at risk for re-arrest. CRS is able to assist the individual with making transportation arrangements so that these appointments can be kept and reduce the possibility of re-arrest.

Emergency Departments

Anne Arundel Medical Center

Baltimore Washington Medical Center

Crtical Incident Stress Management

Most Crisis Response Staff receive this specialized training.

Information on Critical Incident Stress Management from Critical Incident Stress Management International.

“Critical Incident Stress Management or CISM, is an intervention protocol developed specifically for dealing with traumatic events. It is a formal, highly structured and professionally recognized process for helping those involved in a critical incident to share their experiences, vent emotions, learn about stress reactions and symptoms and given referral for further help if required. It is not psychotherapy. It is a confidential, voluntary and educative process, sometimes called 'psychological first aid'.

First developed for use with military combat veterans and then civilian first responders (police, fire, ambulance, emergency workers and disaster rescuers), it has now been adapted and used virtually everywhere there is a need to address traumatic impact in people’s lives.

There are several types of CISM interventions that can be used, depending on the situation. Variations of these interventions can be used for groups, individuals, families and in the workplace.”

Residential Crisis Services

Two providers are licensed for Residential Crisis Services in Anne Arundel County.

Harbour House

Pascal Youth and Family Services

Crisis Intervention Teams

A vital component of the CRS has been the partnership with the Anne Arundel County Police to implement Crisis Intervention Teams (CITs). The CITs consist of an officer trained in CIT and an independently licensed, behavioral health clinician. The advantage of having a CIT is that they are able to respond in situations where MCTs are not, such as when weapons or barricades are involved, or as first arrival at schools until a parent/guardian can be reached. These teams also provide a comfort to county residents, as a police officer can go onto someone’s property to perform a “well-being” check, where no other component of CRS is able to do this.

Urgent Care

Licensed Outpatient Mental Health Centers in Anne Arundel County:

Anne Arundel County Department of Health

Arundel Lodge

Associated Catholic Charities/Villa Maria

Board of Child Care of the United Methodist Church

Committed to Change

Interventions, LLC

Omni House

Thrive

Vesta

Safe Stations

On April 20, 2017, a new pilot program, “Safe Stations”, was implemented in response to the growing opioid epidemic and the Governor’s declared State of Emergency. Safe Stations allows persons with substance use disorders, who are looking for treatment, to walk into a police or fire station and request assistance. Once at the station, the individual will be given a medical assessment by emergency medical services (EMS) personnel. If they do not need immediate medical attention, a Crisis Response team is contacted to provide further access to SUD treatment and follow-up care. If the individual does require immediate medical attention, they are transported to the emergency department (ED) by EMS and a MCT will meet the individual in the ED.

Suicide Prevention Resources 

Hotlines for families and youth

Call 911 for immediate assistance in any emergency

CRISIS WARMLINE
410-768-5522
24 hours a day, 7 days a week

Maryland Youth Crisis Hotline
1-800-422-0009
24 hours a day, 7 days a week

National Suicide Prevention Hotlines

1-800-SUICIDE (784-2433)

1-800-273-TALK (8255)

Anne Arundel County Public Schools Student Safety Hotline
1-877-676-9854
24 hours a day, 7 days a week

SAMHSA Disaster Distress Helpline
1-800-985-5990
Text: "TalkWithUs" to 66746

More Information 

Grievances/Appeals

RFP/RFI

Donate

Employment Opportunities

Contact Us

Programs/Services 

Adults

Children and Adolescents

Elderly

Housing

Minority Outreach

People with Disabilities

Veterans

©Anne Arundel County Mental Health Agency Inc - 1 Truman Parkway, Suite 101, Annapolis MD 21401 - P 410.222.7858 F 410.222.7881 info@aamentalhealth.org