Key documents for the National Action Alliance for Suicide Prevention Crisis Services Task Force are found below.
The Background Materials
“Models are a dime a dozen, but you have to have one,” the saying goes. In 2010, the Milbank Memorial Fund published the landmark “Evolving Models of Behavioral Health Integration in Primary Care,” which included a continuum from “minimal” to “close fully integrated” that would establish the gold standard for effective planned care models and change the views of acceptable community partnership and collaboration.
Prior to this, coordination among behavioral health and primary care providers had frequently been minimal or non-existent and it would have been easy to accept any improvement as praiseworthy.
In fact, the Milbank report portrayed close agency-to-agency collaboration (evidenced by personal relationships of leaders, MOUs, shared protocols, etc.) at the lowest levels of the continuum and insufficient. They described these community partnerships and their coordination as minimal or basic, citing only sporadic or periodic communication and inconsistent strategies for care management and coordination. They called for frame-breaking change to the existing systems of care, and their report continues to reverberate throughout the implementation of integrated care.
The Crisis Services Task Force has similarly modified the Milbank collaboration continuum (original citation Doherty, 1995) for the purposes of raising the bar in crisis system community coordination and collaboration (see table below).
The highest level 5 “Close and Fully Integrated” system should include the following:
- Intensive Service Referral Tracking with Warm Hand-off Accountability
- Electronic Crisis Bed Inventory Coordination
- 24/7 Community Based Mobile Crisis and Integrated Dispatch
- 24/7 Outpatient Behavioral Health Scheduling Capacity
- Online Outcomes Dashboard Demonstrating Effectiveness
- Introduction: Rationale for the Task Force
- Chapter One. Now is the time: the case for crisis care as a core element of health care transformation.
- Chapter Two. Peers, Recovery and Trauma-Informed Care
- Chapter Three. “Air Traffic Control” (including the Milbank adapted model)
- Chapter Four. Integration with First Responders
- Chapter Five. Community-based Mobile Crisis (including a full-continuum of crisis services)
- Chapter Six. Safety/Security for Individuals, Family and Staff
- Chapter Seven. Financing and ROI in the Pay for Value Era
- Chapter Eight. Summary and Call to Action
- Addendum: Crisis Services Time-Line
Topic 1: Peers & Recovery – Living Rooms, peers and new models for crisis alternatives (Steve Miccio) and trauma informed care (Cheryl Sharp)
Topic 2: Air Traffic Control – Senator Creigh Deeds story, the Air Traffic Control metaphor, the Milbank continuum adaptation (David Covington) and the Georgia Department of Behavioral Health and Disabilities Georgia Crisis and Access Line electronic suite (Wendy Schneider)
Topic 3: Being Indispensable to First Responders – Harris County (Barbara Dawson & Jennifer Battle) and CIT International (Nick Margiotta)
Topic 4: Community-based Mobile Crisis – Centerstone (Becky Stoll) and Behavioral Health Response (Bart Andrews)