Topic Number2.3.16Effective Date

June 1, 2015 (rev)

March 16, 2016 (rev)

ProcedureMental Health Crisis Intervention for Clients
PurposeTo document standardized protocols governing employee intervention in any mental health crisis that may occur with consumers in residence
Accountability Indicators
  • WWRC employees routinely follow established protocol, standards, and expectations in responding to mental health crisis events for enrolled clients.
  • At all times, WWRC employees demonstrate a respect for client safety and health in responding to any consumer mental health crisis, as observed, reported, and documented.
Policy Reference
Detailed Governance ReferenceN/A
Executive Staff ContactBarb Ostrander, WWRC Division Director, Medical Rehabilitation Services

 

 Every Day in Every Way We….. 

Put Clients First

Work in Teams

Provide It All Under One Roof

Are Organized, Utilized, and Valuable

Preserve Leadership Ethics, Accountability, Center Values, and Public Trust

 

Governance Procedures

WWRC employees are expected to intervene in any mental health crisis that may occur with enrolled clients to maintain their safety and health.  Designated WWRC employees are expected to resolve any mental health crisis through crisis intervention, assessment of risk for potential danger, and implementation of a safe and appropriate disposition. This governance procedure applies to anyone enrolled in a program or services at WWRC.

Staff response to mental health and behavioral crisis may vary according to circumstance, to include factors such as the specific issue and current staffing (during normal business hours, on weekends or late at night). What follows is an outline of specific steps that need to be taken based on behavior and staffing.

Note:  If a mental health emergency occurs during normal business hours, in addition to the stated protocol, the staff member who first learns of the mental health emergency is expected to contact his/her supervisor or higher authority by phone or in person.  The supervisor or higher authority is expected to contact the WWRC Deputy Director & Division Director, Facility Operations, or designee, as well as the Rehabilitation Counseling Manager, or designee, immediately, by phone or in person. Follow After Hours Administrative Access protocol if the mental health emergency occurs during non-routine business hours.   If the mental health emergency necessitates the transportation of a client, follow protocol for transporting clients in a medical emergency, emergency phone numbers are available through Student Health, Rothrock Hall, Behavioral Health Services, and the WWRC Police Department. 

Important!! 

All team communications under this administrative procedure must be made via direct contact through phone or in person. 

Leaving a phone voice mail message or sending an email, even if there is a timely acknowledgement of receipt, does not meet this criteria or the intended level of direct communication. 



Suicide Threat or Decompensation                                  

(such as increased paranoia, agitation, disorganized thought processing, and hallucinations)

                                   Normal Business Hours                                           
                    (7 AM – 5 PM, Monday through Friday)                              
                               After Business Hours (less staff coverage)                
  • Any expressed thoughts of harming self or others must be addressed immediately by staff.
  • Any observations of an individual's behavior decompensation due to mental illness should be addressed immediately by staff.
  • Initial screening for risk can be done by a rehabilitation counselor, behavioral specialist, physician, nurse practitioner, or a clinician in the Behavioral Health Services (BHS) Department.
  • A licensed clinician in the BHS Department should be consulted by the person doing the screening to determine if further evaluation is needed.
  • If it is determined that an evaluation is needed by a licensed clinician, the consumer should be escorted to the BHS Department. The clinician will determine if the consumer can be managed at the Center with a plan, needs further evaluation by the Community Services Board crisis worker regarding involuntary commitment, sent to Augusta Health ER for evaluation and treatment, or transported home.
  • The licensed clinician will work with staff from counseling, nursing, and residential services to implement the appropriate disposition. 

*Note that if a WWRC client is a patient of Dr. Kane, Dr. Kane has authority to admit the client to the hospital directly without involving the Community Services Board (CSB). 

  • Any expressed thoughts of harming self or others must be addressed immediately by staff.
  • Any observations of an individual's behavior decompensation due to mental illness should be addressed immediately by staff.
  • Initial screening may be done by a behavioral specialist. The behavioral specialist may offer crisis intervention and consult with a BHS Department clinician. If the individual sees a clinician in the BHS Department, an attempt should be made to contact that clinician for consultation. If a clinician is not assigned or if the assigned clinician is not available, the on-call clinician should be called for consultation.
  • If a behavior specialist is not available, other residential staff should bring the individual to Student Health or Rothrock Hall.  Nursing staff will then contact the on-call clinician.  The on-call clinician my consult with the treating clinician.  
  • If it is determined that an on-site evaluation is needed by the on-call clinician, WWRC staff are expected to closely monitor the consumer until the clinician arrives to the Center and to inform the WWRC Police.  The participant may be escorted to Rothrock Hall to be cared for until the clinician arrives.
  • The clinician will determine if the consumer can be managed at the Center with a plan, needs further evaluation by the Community Services Board crisis worker regarding involuntary commitment, sent to Augusta Health ER for evaluation and treatment, or transported home. The licensed clinician will work with staff from Residential Services, Police, and Nursing to implement an immediate plan of action to address stabilization and/or transportation until normal business hours. The plan will be documented in an AWARE service note.
  • The rehabilitation counselor, with the assistance from a BHS Department clinician and the rehabilitation team, will initiate plans to address long-term disposition.

 

 

 

Suicide Attempt 

(deliberate suicidal self-injury)

                                     Normal Business Hours                                          
                       (7 AM – 5 PM, Monday through Friday)                             
                                 After Business Hours (less staff coverage)              
  • Call 911, then 540-332-7266 for Rapid Medical Response if the consumer is unresponsive.
  • If responsive, bring the consumer to Student Health.  Medical staff will determine if the consumer should be transported to the ER at Augusta Health.  If so, transportation should be arranged through Student Health.
  • If sent to emergency room, the ER physician will determine disposition. If individual is discharged back to the Center, staff will follow the discharge recommendations. A clinician in the BHS Department will need to be consulted by the counselor and/or nursing staff to address disposition. If the ER physician determines that an individual will be admitted to the hospital, the rehabilitation counselor will have a team meeting within 24 hours to determine disposition.
  • If not sent to ER, a clinician from the BHS Department will determine if the consumer can be managed at the Center with a plan, needs further evaluation by the Community Services Board crisis worker regarding involuntary commitment, sent to Augusta Health for evaluation and treatment, or transported home. The licensed clinician will work with staff from Counseling, Nursing, and Residential Services to implement the appropriate disposition. 

*Note that if a WWRC client is a patient of Dr. Kane, Dr. Kane has authority to admit the client to the hospital directly without involving the Community Services Board (CSB).

  • Call 911, then 540-332-7266 for Rapid Medical Response if the consumer is unresponsive.
  • If responsive, bring the consumer to Student Health or Rothrock Hall for an evaluation. Medical staff will determine if the person needs to be transported to the Augusta Health ER. 
  • If sent to emergency room, the ER physician will determine disposition. If individual is discharged back to the Center, staff will follow the discharge recommendations. A clinician in the BHS Department will need to be consulted by the nursing staff and/or police to address disposition. If the ER physician determines that an individual will be admitted to the hospital, the rehabilitation counselor will have a team meeting the first business day after the admission to determine disposition.
  • If not sent to ER for medical stabilization, the consumer should be closely monitored (individual supervision in a secure area) until the assigned or on-call clinician from the BHS Department arrives to the Center.  The on-call clinician will determine if the consumer can be managed at the Center with a plan, needs further evaluation by the Community Services Board crisis worker regarding involuntary commitment, sent to Augusta Health for evaluation and treatment, or transported home. The licensed clinician will work with staff from counseling, nursing, and residential services to implement an immediate plan of action to address stabilization until normal business hours. The plan will be documented in an AWARE service note.
  • The rehabilitation counselor with the assistance from a BHS Department clinician and the rehabilitation team will initiate plan to address long-term disposition.

 

 

 

Physical Aggression

Immediately contact the Center Police Department by calling 911 AND phone ext. 27317, or cell phone 332-7010.  Direct service staff  are expected to appropriately intervene per Behavior Education Support Training (BEST).    Staff should focus on maintaining the safety of consumers not directly involved in the confrontation.

 

 

 

Disposition Options 

The following disposition options apply to any type of mental health crisis situation:

                                           Minimal or No Restrictions                                                               Higher Level Restrictions Indicated                           

Indicators: 

  • Minimal or no risk of harm
  • Client clearly indicates no intent to harm self or others and is willing to contract for safety
  • May need a plan for periodic observations and check-ins with a specific staff over no more than a 24 hour period 


    Client to Remain in Their Room or a Temporarily Assigned Location
    (Rothrock Hall)

 

  • Screening or assessment indicates minimal or no risk of harm, but there is significant concern that integration back into the WWRC community may have a negative impact on the consumer's health or safety.
  • Consumer agrees to contact a specific staff member if consumer feels like harming self or others.
  • Plan is documented in AWARE service note.
  • If approved by licensed mental health clinician or administrator in charge, request residential staff member and/or Police Officer to provide assistance that may require room search, personal check-ins, documented check-ins, or documented observations at a pre-determined frequency.

WWRC or Augusta County Police may issue an Emergency Custody Order (ECO). The on-call Community Services Board (CSB) crisis worker will need to be contacted by police to evaluate (in a convenient location) the need for hospitalization or treatment. The individual will remain in the custody of the police officer throughout the duration of the ECO. 

 
Any mental health clinician working with the individual may be contacted by police or the CSB to provide needed mental health information. Virginia Law requires full cooperation by mental health professionals to provide information needed by crisis team and/or police to address disposition in an emergency situation.

 

The CSB crisis worker will determine if the individual is a risk to self or others, along with need for hospitalization or treatment. If it is determined the individual can return to the Center, staff will follow the discharge recommendations. A clinician in the psychology department will need to be consulted by the counselor and /or nursing staff to address disposition. If the CSB crisis worker determines that an individual will be hospitalized, the rehabilitation counselor will have a team meeting within 24 hours to determine disposition.

 

*Note that if a WWRC client is a patient of Dr. Kane, Dr. Kane has authority to admit the client to the hospital directly without involving the Community Services Board (CSB).  

 

 

 

Transportation 

In the event that a disposition requires transporting the client, transportation plans are to be made together by the WWRC Police, the On-Call Administrator, the On-Call Clinician, the Nursing Supervisor and Residential Supervisor on duty.    If it is determined that his or her mental, emotional, or behavioral stability is such that an individual cannot safely remain on campus then: 

 

  • That individual cannot be transported or attended by a single staff member alone or in a private vehicle.
  • That individual cannot be left unattended at the emergency department of a hospital or in a private home without a responsible adult present, or in a public place.  

 

Documentation  

As soon as practical the Behavior Specialist, On-Call Clinician, and/or Treating Clinician should create a "Crisis Intervention" note in AWARE describing the precipitating incident, relevant information about the client and mental status, assessment results, intervention, and plan.

 

This AWARE note should be emailed to the client's WWRC Rehabilitation Counselor, all Psychology and Behavioral Health staff, and to the WWRC Director, WWRC Deputy Director and Division Director, Facility Operations, WWRC Dean of Students & Division Director, Residential Services, and WWRC Rehabilitation Counseling Manager