Crisis Response Toolkit: Responding to Children, Youth and Families

About

This toolkit is designed to ensure that Colorado's crisis response system is readily available and responsive to children, youth and families in the state by providing timely crisis assessment and interventions tailored to the individual and family system’s needs.

  Print Pause Point Cards

How to Use the Toolkit

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The toolkit is divided into four sections, or pause-points, each with corresponding resources. The pause-points represent times during a mobile crisis response (and are also relevant to a walk-in center response) that are crucial to ensuring the clinician understands the individual or family and their presenting concern well enough to engage in a meaningful, culturally and trauma-informed way. Pause-point one, the hand-off from hotline to mobile, has two notecards, each relevant to the respective team. Pause-points two, three, and four are intended for use by the mobile teams, with some relevant information for other aspects of the crisis continuum. The responding clinician should use these to proactively address any barriers to an effective response. The clinician may also utilize the pause points as quick-reference notecards in real time while preparing to respond or with the individual/family in crisis. The toolkit website contains supporting resources corresponding with some of the questions in the pause points to enhance clinicians’ understanding of the issues.

Please note the emphasis on brief intervention and stabilization, rather than the use of mobile response as a level-of-care assessment. Think of this as an investment of time up-front, emphasizing a transformational rather than transactional interaction, where the individual/family is empowered to manage future crises with skills and resources gleaned from the interaction with the mobile team.

Pause Point #1 Handoff from crisis hotline to mobile team

HOTLINE STAFF

  1. Provide summary of the presenting problem and status of the caller.
  2. Let the receiving team know that safety concerns have been addressed and that you have already eliminated all rule-out criteria.
  3. Provide relevant identifying information, location and contact information.
  4. Provide rationale for sending mobile and not using lower- or higher-level response.

MOBILE TEAM

  1. Have you asked about all relevant identifying and contact information?
  2. Do you feel like you fully understand the presentation?
  3. Do you know who is on site?
  4. The hotline has already done an assessment, intervention, and risk mitigation, which does not need to be repeated; however, if there is other information you need, collect it before hanging up with the dispatcher to avoid redundant calls and information-gathering with the individual/family in crisis.

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Resources

Improving the Child and Adolescent Crisis System: Shifting from a 9-1-1 to a 9-8-8 Paradigm (National Association of State Mental Health Program Directors): This article makes the case for shifting away from a law enforcement response for young people toward a clinician- or peer-led intervention.

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Pause Point #2: Things to consider while en route

  1. Have you notified the individual of upcoming arrival time?
  2. If the individual in crisis is not interested or available, are there other people on-site who need/want support, to provide collateral, or help to alleviate the crisis in any way?
  3. Who is the other professional or paraprofessional accompanying you on this call?

Resources

Legal Issues in Crisis Services (National Association of State Mental Health Program Directors) - On identifying and overcoming potential barriers in crisis service delivery.

Several articles outlining the rationale for and appropriate deployment of peer support specialists, to consider as part of a paired response:

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Pause Point #3: Intervention

  1. Columbia Suicide Severity Rating Scale and 20-point assessment are contractually and regulatorily required; what other screeners/assessments/tools are relevant for this individual/family?
  2. Intervention and triage should occur based on results of assessment.
  3. Focus on brief intervention, not just level of care assessment, with intention to stabilize crisis in the community.
  4. Who else on-site needs support? Can caregivers, educators, natural supports or other individuals at the location benefit from skills/support?
  5. Is other system involvement identified? Does a referral need to be made? (i.e., CPS, APS, Juvenile Justice/legal involvement)
  6. Is this individual diagnosed with or expressing symptoms of DD/ID or TBI? What needs does the person have related to this? 
  7. Is the person in crisis pregnant, trying to conceive, or pregnant in the last year and what was the result of pregnancy?

Resources
Screeners, Assessments, Tools
  • SBIRT ‐ Screening, Brief Intervention and Referral to Treatment
  • The CRAFFT ‐ Substance use screening tool for adolescents ages 12-21
  • The Columbia ‐ Suicide Risk Assessment suitable for all ages
  • The PHQ9 ‐ Quick depression assessment ages 12-18
  • The GAD7 ‐ Assessing for Anxiety ages 13+
Formal Interventions
  • Safety Planning: The Brown Stanley Safety Plan: Patient Safety Plan Template
  • Things to keep in mind during the intervention:
    • When working with children/youth, sometimes it isn’t only about their ability to safety plan but the parents’/caregivers’ ability to help keep their child/youth safe. How are they controlling the environment? Can the parents/caregivers identify their child’s triggers? How can they intervene at each trigger? Who are the parent’s resources (natural supports)? Can other children in the home access natural supports temporarily? What plans are needed to help ensure safety?
    • Other interventions should focus on building trust and can incorporate non-traditional treatment approaches including but not limited to assistance in meeting basic needs, teaching and practicing de-escalation and calming techniques, using art and other creative therapy approaches, engaging in culturally relevant conversations and practices, the use of somatosensory approaches, and incorporating peers in recovery conversations with the young person and/or family.
    • “Too often, public systems respond as if a mental health crisis and danger to self or others were one and the same. In fact, danger to self or others derives from common legal language defining when involuntary psychiatric hospitalization may occur at best, this is a blunt measure of an extreme emergency. A narrow focus on dangerousness is not a valid approach to addressing a mental health crisis. To identify crises accurately requires a much more nuanced understanding and a perspective that looks beyond whether an individual is dangerous or immediate psychiatric hospitalization is indicated” -SAMHSA practice guidelines
  • For more information, please visit the following sites:
Needs of Others in the Home
  • Who are the parent's resources (natural supports)?
  • Can other children in the home access natural supports temporarily?
Traumatic Brain Injury
Intellectual Disabilities/Developmental Disabilities

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Pause Point #4: Mobile - What’s next

  1. Is a higher level of care referral necessary? Do you know your referral sources and what information they require?
  2. Is referral to outpatient or any other services needed? Do you know your referral sources and what information they require? Feel free to get creative here, does not need to be a traditional treatment referral.
  3. If the individual is diagnosed with DD/ID or TBI, do you know appropriate resources or referrals to higher level of care?
  4. Is an emergency commitment or involuntary hold required for anyone in the household or at the individual’s current location?
  5. Could the caregiver benefit from a parenting class or other in-home options?
  6. Does the caregiver have case management needs? 
  7. Other system involvement/referral? (i.e., DHS, CPS, APS)
  8. 1-, 3-, and 10-day follow-up?
  9. Recovery Services needed for anyone in the family system/household?
  10. Does anyone onsite need resources for pregnancy or postpartum-related issues?

Resources
Higher Level of Care Referrals
Outpatient referrals
  • Providers should create and reference their guides with community resources, including non-traditional supports.
  • Momentum: Services to support the transition from a mental health institute or hospital to a community setting.
Intellectual/Developmental Disabilities/Dual Diagnosis; TBI resources:
Emergency Commitment/Involuntary Hold
  • The Emergency Commitment (EC): A 5-day hold intended for persons who are deemed to be under the influence of or incapacitated by substances and clearly dangerous to the health and safety of themselves or others (C.R.S. 27-81-111). ECs are usually initiated by law enforcement officers, physicians, or other responsible persons in the community or at a Withdrawal Management facility.
  • 27-65 Procedure Manual
Parenting class or other in-home option
  • Circle of Parents: Peer-led support groups for parents in recovery across the state.
  • Parentline: Free telebehavioral health services for pregnant/parenting people with kids under age 5, through the University of Denver's School of Professional Psychology
  • Head Start Colorado: Head Start programs provide wide-ranging services for low-income children from birth to elementary school at no cost. The program is child-centered, family-focused and community-based. Head Start encourages the role of parents as their child's first and most important teachers. 
  • Family Support Programs: Provide expectant parents and families with the necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn. Promote safe, stable and nurturing environments allowing children and families to reach their full potential. Help families achieve their goals, reduce stress and provide referrals to other services such as child care assistance or social-emotional supports.
  • Early Childhood Mental Health Consultation: A free, voluntary caregiver support program for parents and caregivers caring for children ages six and under who desire extra support to foster the social-emotional development and mental health of the children in their care. ECMH services vary based on the needs and goals of the clients. Services may be very brief, but on average take about 4-6 months to complete and each session lasts 1 to 1.5 hours. ECMH Consultation is typically delivered in early childhood settings including child care, home visiting, medical home, and other settings as appropriate both in-person or via telehealth by trained mental health professionals.​
Recovery Services
  • CRAFT: Home-based or group intervention for family members of someone with substance use disorder.
  • Oxford Vacancies: Sober living residences. Search by gender and child status.
  • Opirescue: SAMHSA's buprenorphine provider locator, including OTP providers and medical providers who treat with Vivitrol.
  • The Phoenix Center: Free fitness classes. Live, in-person, on-demand for those who are at least 48 hours abstinent from substances.
  • Young People in Recovery: Life skills, peer support, recovery services for youth and teens.
  • Harm Reduction Action Center: Syringe access, free Narcan, Fentanyl test strips, HIV/HCV testing
  • Lift The Label: Statewide Stigma Reduction Campaign
  • Stop the Clock Colorado - Access Free Narcan
  • Alcoholics Anonymous: Find a 12-step AA meeting near you
  • Al-Anon: Find a 12-step Al-Anon meeting near you
Pregnancy or Postpartum or Pregnancy Loss
  • 211 Colorado: Pregnant & New Parents: Vetted "new parent" resource hub.
  • Prenatal Plus: Integrated wraparound prenatal/postpartum care for pregnant people with Medicaid. There are programs embedded in local health departments, hospitals and clinics across the state.(Department of Health Care Policy & Financing)
  • Right Start: A mental health program for pregnant women and families with children ages birth to 5 years. Provides help when there are concerns about a child’s emotions, behavior or development, or when parenting becomes difficult.
  • MotherWise: Empowers women and their families to thrive during pregnancy and after a new baby is born. Its core program includes six weeks of workshops plus one-on-one coaching for mothers on knowing themselves, what healthy relationships are to them, communication and relationship skills for all kinds of relationships, and connecting with a newborn baby. Services in English/Spanish.
  • Parentline: Free telebehavioral health services for pregnant/parenting people with kids under age 5, through the University of Denver's School of Professional Psychology
  • Postpartum Support International: Perinatal mood and anxiety disorder support groups, warm line, access to PSI coordinators across Colorado. Available in English/Spanish.
  • Young Mother's Clinic: Multidisciplinary prenatal and postnatal services for young parents.
  • Tough as a Mother: A statewide initiative providing resources for providers and clients- specific to pregnant and parenting women with substance use disorder.
Domestic Violence Services and Resources

Contact

Megan Lee

Manager, Crisis Services

Office of Behavioral Health

megan.lee@state.co.us