Need to Know: Crisis Resolution Centers & Services
What is a Crisis Resolution Center?
A Crisis Resolution Center (CRC) is a facility that provides an important link in the continuity of care between hospitalization and exclusive reliance on outpatient mental health supports. It can serve as a less restrictive and more clinically appropriate treatment option for persons who are in psychiatric crisis but who do not need the medical capabilities of an acute care hospital, and it can result in significant cost savings.
A CRC is:
An immediate alternative to acute hospitalization in an emergency situation
An early intervention option for a person who is showing signs of decompensation
A “cooling off” place for persons whose home situations have become intolerable
A step-down from a period of acute psychiatric hospitalization facilitating smoother community integration or and for hospital cost reduction
A place to monitor a person during medication changes or times of environmental flux.
After-care for persons with suicide attempts or ideation.
Treatment is intended to keep the person safe, stabilize the person’s acute psychiatric symptoms, and return the person to their familiar living situation and treatment as soon as possible. Treatment usually entails a combination of Milieu Therapy, Psychotropic Medications, Solution Focused Brief Therapy, and Assertive Case Management, and Motivational Interviewing.
What does a Crisis Resolution Center Offer?
Flexibility in Facility & Program Design. CRCs can offer a great deal of flexibility to a community mental health program or other regional mental health entity. The first is size. Laws and regulations for facilities vary from state to state, and in some states, no applicable requirements exist. In Oregon, a facility for up to five residents is licensed as a Residential Treatment Home (OAR 309-035-0250). Facilities of six beds or more require licensing as a Residential Treatment Facility (OAR 309-035-0100). These facilities are commonly limited to 16 residents, as this is the maximum number of residents permitted to still qualify for Medicaid reimbursement. Ideally a CRC is built that will run just about full but rarely full. This allows for the most efficient use of staff and physical plant resources while still maximizing availability.
A second area of flexibility is the level of security for which the facility is built. The State of Oregon has rules for different “Classes” of facilities (OAR 309-033-0520) based on the level of restriction permitted on the person’s freedom of movement. Class 1 facilities allow for a locked facility and permit seclusion and restraint, including chemical restraints and the use of a state-certified hold room. Class 2 facilities do not allow for seclusion and restraint, but the facility is permitted to lock the exterior doors. Class 3 facilities are not locked; admission and discharge are voluntary on the part of the person, and the person must be released upon the person’s request (unless this presents a danger to themselves or others, at which time other legal means must be utilized). Each of these levels of security bring with them their own sets of rules on physical plant, staffing, and staff training.
A third area of flexibility is the length of stay. Crisis respite stays in Oregon are limited to 30 days by OAR. In our experience, the typical length of stay is around three to five days, and extensions may be granted when it is clinically appropriate and no less restrictive alternative is available. A safe and low stimulation environment coupled with close medication supervision, solution focused treatment and case management is ideal for re-stabilizing acute psychiatric emergencies or serving as a professionally staffed support through domestic transitions.
A fourth area of flexibility can be built into the physical design of the facility. With the right design, a facility can be built as a “free-standing” unit with a singular purpose or it can have different areas or “pods” for different populations and treatment issues.
A Less Restrictive, Safe & More Appropriate Treatment
Approach. Any discussion of CRCs would be incomplete without serious consideration of treatment philosophy and practices, staff training, and supervision. ColumbiaCare Services takes the “treatment” part of “residential treatment facility” seriously, and does not separate day-to-day operations of the facility from treatment. CRCs are staffed 24 hours per day to support the recovery of Individuals because we recognize that treatment and teachable moments can happen at any time, and that supervision is a necessary component during the crisis stabilization process. Close, accessible oversight provided by experienced mental health professionals at the management level help guide these activities and assures quality.
Security structure and procedures affect treatment milieu and staff approach,
which can dramatically affect the level of physical security necessary. Close cooperation with community mental health providers, hospital emergency rooms, hospital psychiatric units, and law enforcement is a hallmark for the planning and operations of a CRC.
Using a structured treatment environment described in more detail below, CRCs enable Individuals to exert more control over their environment and their own behavior. Clinical interventions are individualized, using the beliefs and behaviors that are strengths of the Individual to decrease the crisis and reduce risks they may present to themselves or other people in their environment. These risks will be continually reviewed through standard assessment instruments (e.g. START, BPRS) or procedures such as the Suicide Intervention Model within Applied Suicide Intervention Skills Training (ASIST).
Depending on the Individual’s cognitive level, evidence based practices can be provided either in groups or in 1:1 therapeutic interactions with the Peer Support Specialist and other clinical and medical staff.
Psychiatric care is consistent with evidence-based interventions such as those contained in the American Psychiatric Association’s Practice Guidelines for psychiatric diagnoses likely to be seen in Consumers of a CRC. Whenever medically appropriate the most cost-effective medications are selected. Service Plan Interventions are developed jointly by the Individual, significant others (including Family, Advocates, and representatives of community agencies), and the treatment team through the identification of goals, strengths, target behaviors and methods for change.
CRC clinical programming addresses the wide range of human concerns that present in a crisis facility....clinical, health, social, cultural, trauma, and spiritual. We have built an initial program on the strength of decades of experience and many hundreds of successful outcomes.
Partnership As A Solution. ColumbiaCare has worked with persons experiencing severe psychiatric distress and suicidal and homicidal feelings and actions. Our experience indicates that none of our partner organizations believe that locking up Individuals with a mental health crisis in a hospital hold room or a jail is the most effective, safest, or most preferable option. Hospital emergency room staff, mental health crisis workers, and police officers are under enormous pressure to resolve severe crisis issues rapidly and effectively. However, when there is a safer, more effective, and accessible option for Individuals experiencing a severe mental health crisis such as a CRC, these essential community partners are very appreciative of these resources.
ColumbiaCare’s experience indicates that this mutual problem solving process forms the basis for developing a shared partnership strategy that is focused on an Individual’s safety in the least restrictive, most effective environment. ColumbiaCare data and experience prove that diverting people from hospitals effectively reduces police involvements in facilities where that has been an issue. Statistics are indicative of this success, given that ColumbiaCare CRCs show a minimum 94% of individuals admitted through referrals from crisis workers, hospital emergency rooms, or law enforcement have been diverted from more restrictive hospital or jail placements. We do not accomplish these outcomes alone. We have written protocols outlining our interdependence on, and relationships with law enforcement agencies serving our Individuals.
ColumbiaCare CRCs play a pivotal role in each community’s system of care, and our professional relationships with partnering agencies help keep citizens experiencing a serious mental illness where they belong when they are in crisis.
And last but not least... Cost Savings.
Crisis Services are Less Expensive. Hospital bed day rates can vary anywhere from $900 to upwards of $1500 per day. While CRC daily rates may vary according to the specific programming being requested (security level of the facility, professional psychiatric services and staffing level); Crisis Resolution Center bed day rates range from $250 to $500 per day. Not only does a CRC offer a more clinically appropriate treatment approach, but CRCs also reduce the cost of sub-acute mental health services by over HALF! One very conservative savings example is Wasco County, who by investing in Crisis Resolution Center services saved over $257,000 in just 381 days. In most cases, the savings is substantially higher. CRCs are an effective clinical and cost-effective resource.
A Little More About ColumbiaCare~
History and Experience. ColumbiaCare Services is a not-for-profit organization whose mission is to “Promote the mental health and welfare of individuals by developing a progressive regional system of behavioral health care facilities and affiliated service programs in collaboration with public and private providers of social, judicial, and health care services”. ColumbiaCare has been providing a full range of mental health and residential services for citizens of Oregon since its inception in 2003, and has since expanded services into Idaho.
ColumbiaCare has extensive history and experience in designing, developing (building or remodeling), and/or operating residential treatment programs including 13 licensed treatment facilities providing 24-hour residential services to adults with a primary diagnosis of mental illness. ColumbiaCare also owns and operates 6 supportive housing apartment buildings; owns a children’s foster home-based crisis respite home and has 2 other facilities under development.
Prior to forming ColumbiaCare beginning in 1995, the current principles of ColumbiaCare managed the community mental health program in Josephine County, giving them almost 15 years of professional experience developing and providing short- term crisis resolution services.
Projects have included the following:
Crisis Resolution Center, Josephine County (Oregon): A licensed Class 2 (locked) 15-bed secure, short term crisis residential center with 5 non-hospital hold rooms
Coos Crisis Resolution Center, Coos County (Oregon): A licensed Class 3 (non-locked) 6 bed crisis resolution facility serving Coos, Curry, Douglas, and Jackson County clients
Creekside Residential Treatment Facility, Wasco County (Oregon): A licensed Class 3 (non-locked) 12-bed, residential treatment facility that includes 3 short-term crisis respite beds
Columbia River Ranch, Morrow-Wheeler County (Oregon): a licensed Class 3 (non-locked) 12-bed residential treatment facility that includes 3 short-term crisis respite beds
ColumbiaCare has been hired as an expert consultant by other agencies to provide a combination of services which include design, construction and staff recruitment and training for their facilities:
McNary Place, Umatilla County (Oregon): A licensed Class 2 (locked) 16-bed secure residential treatment facility that includes 4 short-term crisis respite beds
Phoenix Place, Klamath County (Oregon): A licensed Class 2 (locked) 16-bed secure residential treatment facility that includes 3 short-term crisis respite beds
Last but not least, ColumbiaCare is the proud owner of one of the very first children’s foster home-based crisis respite homes in the state. Pony Creek serves youth in their own community and eliminates the need for them to be separated from their families and support systems on a long-term basis which can be very difficult on all involved. This is currently a 2-bed home that has future capacity for 4 children.
ColumbiaCare has a proven track record of providing quality services that produce positive outcomes for residents, safety for residents and community members, and positive professional relationships with partnering agencies in multiple locations. As evidenced by our credentials below, ColumbiaCare is an established state-wide provider and has the ability to deliver care according to the needs of each community.
ColumbiaCare is licensed to operate Residential Treatment Homes and Facilities for Adults with Mental Illnesses in 6 Oregon counties (Clackamas, Coos, Curry, Morrow, Multnomah, Wasco)-State of Oregon Addictions and Mental Health Division.
ColumbiaCare has a Certificate of Approval to provide Adult Mental Health Outpatient Services in 5 Oregon counties (Clackamas, Coos, Curry, Wasco, Multnomah)-State of Oregon Addictions and Mental Health Division.
ColumbiaCare has developed and is operating the first Supportive Housing program and respite bed for the State of Idaho Mental Health Services, Region V.
ColumbiaCare is an approved Community Rehabilitation Provider of high Fidelity Supported Employment Services statewide- State of Oregon Office of Vocational Rehabilitation Services and State of Oregon Addictions and Mental Health Division.
ColumbiaCare is licensed to provide Secure Transportation Services-State of Oregon.
ColumbiaCare has developed a Center for Suicide Prevention which offers consultation, training and curricula development services with the goal of creating suicide-safer communities. ColumbiaCare sponsors ASIST and RESPONSE programs.
ColumbiaCare has under its employ 2 certified Oregon Intervention Services Trainers-Oregon Intervention System
We believe that our agency’s many years of contracting and coordinating with multiple agencies in various locations to establish service linkages and advocate for the treatment needs of clients reflects our ability to meet the needs of your agency and your community. We strongly feel that our depth of experience in providing stable living environments, basic daily living support services, milieu therapy, and mental health stabilization services in the short-term setting are only enhanced by our expanded experience with other residential programs and affiliated services.
We would love work with you directly to explore Crisis Resolution Center options for your community. For more information or to schedule a tour, please contact Gary McConahay, Ph.D. at 541.858.8170 or firstname.lastname@example.org.