What Works: Statewide crisis intervention initiative

The Crisis Intervention Center was founded in 1970 as a student organization on the campus of Louisiana State University to assist students facing emotional distress through its help line, The Phone. Today, the CIC is answering the call for a statewide need, developing a crisis response and care management service. The Crisis Response Network fills in gaps in Louisiana’s healthcare system by delivering a continuum of behavioral healthcare through its three components:

• Crisis intervention, available 24/7 through talk, text and chat platforms
• Care management, in the form of continual care oversight through measures including wellness check-ins, follow-up contact and care coordination
• Mobile crisis activation, with coordination, scheduling and management of mobile outreach teams, allowing the teams to focus on going directly to individuals in crisis to provide support

Four years ago, the Crisis Intervention Center, which is based in Baton Rouge, Louisiana, began to see two trends in Louisiana healthcare emerge. First there was a shift across the state toward a privatization of services and facilities that provided behavioral and mental health services, Crisis Intervention Center CEO Aaron Blackledge says. As part of that shift, facilities in certain parts of the state would close. The second trend observed by CIC officials was that traditional revenue streams in the non-profit space had begun to dry up.

“We knew, ultimately, the state wasn’t as well positioned as it could be to handle people in crisis,” Blackledge says.

The CIC teamed with a national consulting firm on a three-year research project studying successful – and unsuccessful – crisis response and care management services in other states. The value of a centralized statewide network became clear, Blackledge says. State funding, however, wasn’t in the cards.

To that end, the CIC partnered with several organizations across the state to form the Crisis Response Network. Fully operational since February, after a soft launch with a small number of partners last fall, the CRN’s startup and operations have been funded by grants from private foundations and its partner organizations. The CRN now has 15 partner organizations that provide points of entry for those in need. The partners in the CRN fall into two categories – private groups, such as health plans and managed care organizations, and public entities, including municipalities and universities. Partnering organizations include: Bayou Health Plans, LSU Health Sciences Center, the Louisiana Department of Health & Hospitals/Department of Children & Family Services, and AmeriHealth Caritas Louisiana.

The cost for a partner to join the network varies based on the size of the population it serves and the services it requires. Blackledge expects the network to add an average of six partners per year moving forward, he says.

For the private groups, the statewide network model fills in gaps in care that can otherwise drive up costs.

“What is missing oftentimes in that [private health plan] model is what happens between appointments,” Blackledge says. “A lot of times, those folks are not being managed at all between the time they’re released from an inpatient facility or between the 30, 60 or 90 days they see their psychiatrists. A lot of times, those folks because of chronic mental health issues are in some sort of crisis every day. These folks have to have access to some mechanism that de-escalates them. Absent crisis intervention services, people end up in emergency rooms, inpatient facilities and jails. Oftentimes, they just need to be de-escalated.

“That’s the core issue with these private organizations, especially if they’re a payer like a private health insurance company. If their mechanism to de-escalate is to go to the emergency room every time there’s a problem, it’s going to be very costly over time for that health plan. What we have really focused on doing is bringing an alternative solution to the market.”

The CIC reports that in 92% of instances where someone reaches out because they are violent or suicidal, the center is able to successfully de-escalate without the use of emergency services.

For municipalities and other public partners, the de-escalation services provided by the CIC through the CRN can reduce jail populations and strain on police departments, as well as help reduce risk for police officers by limiting exposure to potentially violent situations, Blackledge says. Three times in the past nine months, for example, active shooter situations were successfully de-escalated by the network’s responders.

“It’s a risk mitigation tool,” Blackledge says. “If you’ve got police officers going out and dealing with folks that are escalated and [officers are] not de-escalating but using force to address… Anytime someone uses force, there’s always a risk there’s going to be a lawsuit or someone could die or be severely injured.”

Blackledge has three pieces of advice for organizations in other states evaluating the merits of launching a statewide crisis network of their own:

Don’t wait for state funding or think the only solution is public money. Blackledge says the CIC hopes to eventually partner with the state, but that the Crisis Response Network’s long-term viability is not dependent on it.

“We do have a longer term public policy agenda to bring awareness and encourage the state to invest in this type of model [of] standardization and centralization of crisis intervention and care management throughout the state,” he says. “[But] we know finances in the state are tight and it will take a few years to get that done.”

When approaching potential partners, emphasize the many aspects of care provided by the network. “When people think of crisis intervention, people’s minds jump to suicide,” Blackledge says. “When organizations invest in a service like this, they are investing in a mechanism that not only protects individuals from themselves, but also from potentially inflicting violence on others.”

Look outside the box for partners. In developing its statewide network, Blackledge says the CIC initially expected to work largely with municipalities, but that hasn’t been the case.

“We thought there would be more traction and movement within local governments. We thought that would be the bulk,” Blackledge says. “We learned the biggest consumers so far of our model are private health plans, managed care organizations, and more private entities.”

Tom Valentino is Senior Editor of Behavioral Healthcare.