A significant amount of psychiatric acute care need is already addressed via existing services in the Region 1 South area. The Region 1 South Crisis Care System will build on existing community hospital emergency departments and inpatient psychiatric units, along with existing DHS community provider programs. Many of the existing hospitals and providers draw support from State funding streams. Going forward, it will be essential for applications to clearly define the existing resources to be built upon, as well as the new capacities being developed.
The RFI also strives to promote strategic systems integration by:
- building alliances among existing service providers;
- leveraging other funding streams; and,
- engaging stakeholders in system planning throughout Phase I and Phase II.
To promote good planning, this RFI contains a map of current key service providers in Region 1 South, inclusive of community mental health and SUD service providers, as well as community hospitals. To see Region 1 South map -
The link (http://maps.google.com/maps/ms?msa=0&msid=201434494408819946232.0004bb4c0309650a7304b)
Submissions that propose alliances between two or more providers shall contain a Memorandum of Understanding (MOU) or letters of intent for such collaborations. In describing your proposed program, both in the narrative and in the budget pages, please make sure to highlight any of the key components below, and explain how existing elements will be used in conjunction with the proposed enhancements or additions to your program array.
A. Crisis Telephone Services
Many IDHS providers provide some form of crisis telephone service. These will play an ongoing important role in the Region 1 South Crisis Care System. The telephone is often the first point of contact with the professional care system for a person in crisis or a member of his/her support system. During Phase One, these services will remain intact. However, during our planning for Phase Two, we will explore ways to use the new Region 1 South Crisis Care System to engage people before they reach the ED.
B. Crisis Intervention Services
Crisis Intervention is defined as: Activities or services provided to a person who is experiencing a psychiatric crisis. The services are designed to interrupt a crisis, and include: assessment, brief supportive therapy or counseling and referral and linkage to appropriate community services to avoid more restrictive levels of treatment. The goal of crisis intervention is symptom reduction, stabilization and restoration to the previous level of functioning. (See Community Mental Health Services Service Definition and Reimbursement Guide, page 29, at:
Several IDHS providers in the Region 1 South catchment area already operate crisis intervention services, using a blend of state grant funding, fee for service billing, and other private or governmental funding streams to support the delivery of actual crisis intervention services. The program description appears at Appendix 10 titled Sample Prices Program and Budget Document features an example of crisis services attached to a crisis telephone line. This may be useful as a guide to designing your proposal.
C. Access to Community-based Rule 132 Services
Currently, individuals with serious mental illnesses who are not eligible for Medicaid have access to some of the community-base Rule 132 (Medicaid Community Mental Health Services Program) services. For the Rule 132 services definitions - at:(http://www.hfs.illinois.gov/assets/cmhs.pdf). Services now available for individuals who do not have Medicaid at funded DMH provider agencies in Region 1 South are detailed at Appendix 9.
D. Substance Use Disorder (SUD) Services
For the person with a qualifying diagnosis, a range of SUD services, from outpatient to residential, will be available. The services include:
- Case management
- Community intervention
- Intensive outpatient services
- DASA early intervention
- Outpatient services
- Residential rehabilitation
- Residential rehabilitation-extended
Useful information about DASA services can be found at:
DASA Contractual Policy Manual FY2012 (pdf)
and at Joint Committee on Administrative Rules - Administrative Code.
E. Client Transitional Subsidies
In order to effectively manage individuals in crisis and firmly link them to the appropriate level of service, a number of barriers and needs may be encountered that have to be efficiently and effectively managed. Emergency housing, food, clothing or transportation may be required, as well as medications. Accessing psychotropic and other medications is critical for averting unnecessary inpatient admissions or ED, presentations and also for maintaining stability for some individuals post discharge. We would like providers to consider the Client Transitional Subsidy needs that may be associated with the particular role they wish to play in the new Region 1 South Crisis Care System.
F. Access to Psychiatry
Several IDHS providers have grant funding that allows a measure of psychiatry services for uninsured individuals. This service will be vital feature to the Region 1 South Crisis Care System and will likely be enhanced by this RFI. Additions to this funding stream can be proposed to reflect the added needs of the ACARES certified Region 1 South Crisis Care System recipient.
G. Supportive Housing
The successful use of supportive housing to help people with mental illnesses stabilize their lives and reduce the use of costly inpatient psychiatric services is well documented. In an Illinois study of the effectiveness of supportive housing, the number of users and uses of mental health hospitals decreased 90% from pre- to post-supportive housing, and the use of Inpatient/Acute Medicaid services decreased 82% 4. The Substance Abuse and Mental Health Services Administration recognizes only ten evidence-based practices for serving adults with mental illnesses. Supportive housing is one of the ten.
Many DMH and DASA providers already use supportive housing as part of a comprehensive approach to achieving better outcomes for the persons experiencing repeat mental health crises or for persons with dual disorders.
For Region 1 South Crisis Care System recipients who are homeless, participating providers will be expected to initiate contact with any available Continuum of Care (CoC) planning body. These committees come together to work on the issues surrounding homelessness, from prevention to permanent housing and everything in between. There are several Continua of Care that cover Region I South:
- Will County CoC
- The Alliance to End Homelessness in Suburban Cook County
- DeKalb CoC
- CoC of Kane County
- DuPage County CoC
- McHenry County CoC
These entities develop and operate homeless prevention programs, emergency shelters, transitional housing and permanent supportive housing, as well as other supportive services for persons experiencing homelessness
H. Warm Line 5
IDHS/DMH currently operates a Warm Line for the state's public mental health service system. The Warm Line is staffed by peers, and it is designed to provide social support to callers in emerging, but not necessarily urgent, crisis situations. Peers are current or former consumers of services who are trained to provide non-crisis supportive counseling to callers. The Line focuses on the following:
- Building peer support networks and establishing relationships,
- Active listening and respect for consumer boundaries, and
- Making sure callers are safe for the night
Participating providers should consider weaving the Warm Line into their existing and expanded crisis care services.
I. Peer Support -Services (e.g., Living Room Models) 6
Peer support services provide social connectedness and support by former or current consumers of mental health services in a home-like setting. In times of crisis, people feel alone with their anxiety, panic, anger, frustrations and depression. One of the goals of peer-run crisis respite is to provide connections and relationships that can lessen the intensity of these feelings. These non-medical alternative programs offer a comfortable, non-judgmental environment in which one might be able to process stresses as well as explore new options. The hope is that these interactions will result in fresh, short-term solutions and a wider array of options for handling future crises.
As people have an opportunity to stay connected to peers while moving through challenging thoughts, feelings and impulses, the need for external intervention is diminished. This alternative approach to handling crisis teaches people healthier attitudes about themselves and others. With increased skills, individuals can reduce or even eliminate their susceptibilities to the pressures that cause overwhelming emotional distress.
A peer respite site can include facilities for overnight stays of up to seven days. It is anticipated that on-line training program for certification as substance abuse recovery specialist being developed by Governor's State University may enhance the potential pool of peer support specialists.
4 Social IMPACT Research Center (2009). Supportive Housing in Illinois: A Wise Investment.
5 Pudlinski, P. Contrary Themes of Three Peer-Run Warm Lines: Psychiatric Rehabilitation Journal, Spring 2001.
6 Peer Respite Services: Transforming Crisis to Wellness. Teleconference by Substance Abuse and Mental Health Services Administration's Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health. August 4, 2011.
National Empowerment Center web site (http://www.power2u.org/crisis-alternatives.html)