R523-17. Behavioral Health Crisis Response Systems Standards, R523. Human Services, Substance Abuse and Mental Health, Utah Administrative Code

Utah Administrative Code (Current through November 1, 2019)

R523. Human Services, Substance Abuse and Mental Health

R523-17. Behavioral Health Crisis Response Systems Standards

R523-17-1. Authority

Latest version.

(1) This rule establishes procedures and standards for administration of substance use disorder and mental health services as granted by Section 62A-15-1302.

R523-17-2. Purpose

Latest version.

(1) This rule establishes standards of care and practice for statewide behavioral health crisis response system, crisis line services and a certification for crisis workers.

R523-17-3. Intent

Latest version.

(1) Create standards of care and practice and certification of crisis workers for statewide behavioral health crisis response system, statewide and local mental health crisis lines.

(2) Agencies and individuals impacted by this rule have until June 30, 2019 to come into compliance.

R523-17-4. Definitions

Latest version.

(1) "Bridging Strategies" are transition strategies that include brief patient education that helps the patient understand his or her condition and what treatment options exist to facilitate patient and family follow-through;

(a) Provides assistance with understanding and navigating the system of potential supports, preferably from a peer;

(b) May include counseling by staff from a community-based organization who can then see the patient for follow-up care after discharge and giving the patient a copy of their safety plan and making sure it is relevant to their current level of care; and

(2) "Caring Connection" is defined as a follow up phone call, mailed note, text or e-mail checking back in with the caller. This can be done by crisis staff or other support staff.

(3) "Caring Contacts" Caring contacts are brief communications with patients during care transitions such as discharge from treatment or when patients miss appointments or drop out of treatment. These contacts, through which care providers continue to show support for a patient, can promote patient's feeling of connection to treatment and increase their participation in collaborative treatment. Caring contacts may be especially helpful for patients who have barriers to outpatient care or are unwilling to access outpatient care.

(4) "Certified Crisis Worker" means an individual who:

(a) meets the standards of qualification or certification that the Division of Substance Abuse and Mental Health (division) sets, in accordance with Section 62A-15-1302; and

(b) staffs the statewide mental health crisis line or a local mental health crisis line under the supervision of at least one mental health therapist.

(5) "Local Mental Health Crisis Line" means the same as that term is defined in Subsection 63C-18-102(2).

(6) "Mental Health Crisis" is defined as any intense behavioral, emotional, or psychiatric situation perceived to be a crisis by the individual experiencing the crisis, family, or others who closely observe the individual. The crisis may include a mental health condition that manifests itself by symptoms of sufficient severity that a prudent layperson who possesses an average knowledge of mental health issues could reasonably expect the absence of immediate attention of intervention to result in:

(a) serious jeopardy to the individual's health or well-being; or

(b) a danger to others; or

(7) "Mental Health Therapist" is an individual licensed in Utah under the mental health professional practice act as defined in Subsection 58-60-102(5).

(8) "Statewide mental health crisis line" means the same as that term is defined in Subsection 63C-18-102(3).

(9) "Rapid Follow-up and Referral" involves taking steps during an emergency department visit or before discharge from inpatient care to facilitate immediate access to an outpatient treatment appointment for the patient, preferably within 24--48 hours after discharge. To facilitate rapid referral, it may be helpful to establish agreements with outpatient providers to accept rapid follow-up referrals.

(10) "Warm Hand Off" has a goal to increase the likelihood that a patient will follow up on a referral to one provider from another. Rather than simply providing the name and phone number of a provider, a warm hand-off connects the patient with the new provider before the first appointment.

R523-17-5. General Provisions

Latest version.

(1) The Behavioral Health Crisis Response System is based on the following principles:

(a) cultural competence'

(b) strong community relationships,

(d) the use of evidence based practices,

(e) building on existing foundations with an eye towards innovation,

(f) utilization of an integrated system of care,

(g) outreach to students through school-based clinics,

(h) trauma Informed, and

(i) de-escalation.

(2) Each component within the behavioral health crisis response system must be capable of serving individuals in the context of a behavioral health crisis including:

(a) children, adolescents, adults and older adults,

(b) individuals with co-occurring conditions; including:

(i) mental health conditions,

(ii) substance use disorders,

(iii) medical needs,

(iv) intellectual/developmental disabilities,

(v) physical disabilities,

(vi) traumatic brain injuries, and/or

(vii) Dementia and related neurological disorders.

(d) individuals who are uninsured or unable to pay for services, and

(e) individuals who may lack Utah residency or legal immigration status.

(3) Each modality of service within the Behavioral Health Crisis Response System is encouraged to incorporate peer support into the services they provide, when clinically appropriate.

R523-17-6. Certification Requirements of Crisis Workers

Latest version.

(1) The division shall certify that a crisis worker is qualified by training, experience, and certification. Certification will require successful completion of training provided by the division.

(2) Individuals eligible to apply for crisis worker certification include the following:

(a) Individuals licensed under Utah Department of Professional Licensing for any health or behavioral health license;

(b) Individuals with a minimum of bachelors degree in a human service related field;

(d) Individuals certified as Case Managers for a minimum of one year; or

(e) Individuals certified as Family Resource Facilitator for a minimum of one year.

(3) The training curriculum shall provide at least forty (40) hours of training and shall include, didactic information and skill practice using the following components as they relate to crisis intervention:

(a) Attitudinal Outcomes:

(i) acceptance of persons as different from oneself, and a non-judgmental response toward sensitive issues,

(ii) balances and realistic attitude toward self in the helper role meaning not expecting to "save" all potential suicides by one's own single effort, or to solve all the problems of the distressed person,

(iii) a realistic and humane approach to death, dying,

(iv) self-destructive behavior and other human issues, and

(v) coming to terms with one's own feelings about death and dying in so far as these feelings might deter one from helping others.

(b) Knowledge Areas:

(i) basic suicidology, including suicide assessment of desire, intent, capability, and buffers,

(ii) intervention strategies including active engagement, active rescue, and collaboration, emphasize safety and prevention,

(iii) risk of assaulting others,

(iv) community resources,

(v) consultation process,

(vi) record system and program policies,

(vii) cultural/diversity awareness,

(viii) voluntary and involuntary hospitalization criteria and procedures, and

(ix) psychopathology, psychiatric diagnosis, psychotropic medication, and substance abuse.

(i) ability to assess in life-threatening situations, including risk of suicide and/or homicide,

(ii) ability to actively engage,

(iii) ability to mobilize community resources in an efficient and effective manner,

(iv) ability to respond with respect and effectiveness and render assistance to individuals in crisis and distress with appropriate regard to their cultural, racial or ethnic background; their religion or language, their socioeconomic status; or other diversity factors,

(v) provide efficient record keeping and policy implementation (e.g. recording essential notes in succinct form within the same work shift so they are useful to the next worker), and

(vi) use of the consultative process, e.g. knowing who to call under what conditions.

(3) The curriculum methodology shall include but not be limited to:

(a) role playing and other experiential based methods,

(b) use of audiovisual materials, such as simulated recorded calls and videotape,

(c) an opportunity to function as a co-crisis worker with experienced staff before assignment and to work on an independent basis, and

(d) didactic presentation and reading assignments.

(4) In order to maintain crisis worker certification an individual must:

(a) Complete at least 8 hours of continuing education (CEUs) every two (2) years pertaining specifically to crisis services,

(b) shall maintain adequate documentation as proof of compliance with this section, such as a certificate of completion, school transcript, course description, or other course materials,

(c) shall retain this proof for a period of three years after the end of the renewal cycle for which the continuing education is due; and

(d) at a minimum, the documentation shall contain the following:

(i) date of the course,

(ii) name of the course provider,

(iii) name of the instructor,

(iv) course title,

(v) number of hours of continuing education credit; and

(vi) course objectives.

R523-17-7. Corrective Action of Certified Crisis Worker Certification

Latest version.

(1) Each Certified Crisis Worker shall abide by the Provider Code of Conduct pursuant to Section R495-876, and as also found in the Department of Human Services Provider Code of Conduct Policy.

(a) Each employer that becomes aware of a Certified Crisis Worker engaging in unprofessional or unlawful conduct, or has violated the provider code of conduct shall:

(i) immediately take action to review the allegations,

(ii) take steps to ensure that all individuals involved with the allegation are protected, and

(iii) notify the Division within 30 days.

(b) Termination of certification shall be made effective immediately if the alleged violation(s) results in one or more of the following:

(i) personal financial gain through deception, or a business transaction with a client, by the Certified Crisis Worker,

(ii) physical or emotional harm to a person that is caused by the Certified Crisis Worker, or

(iii) a financial loss to a client, the State, or another employee that is caused by the Certified Crisis Worker.

(c) The division shall take the following actions when it becomes aware of a Certified Crisis Worker in violation of the provider code of conduct that does not result in immediate termination:

(i) Within 30 days of becoming aware of the violation(s), the division shall notify the Certified Crisis Worker, in writing, through a Notice of Agency Action specifying the area(s) of noncompliance.

(ii) Within 30 days of receiving a notice of Agency Action, the Certified Crisis Worker shall submit an acceptable written plan to the division explaining how they will achieve compliance.

(iii) All plans shall demonstrate how the Certified Crisis Worker shall be in compliance within 30 days after receiving the Notice of Agency Action.

(iii) If an acceptable plan of action is not received by the division within 30 days of sending the Notice of Agency Action, the Certified Crisis Worker shall be notified that their certification has been suspended until an acceptable plan is submitted to the Division.

(iv) A Certified Crisis Worker shall cease providing any and all case management services until a suspension is lifted.

(d) The division shall revoke the certification of any Certified Crisis Worker for the following reasons:

(i) The Certified Crisis Worker fails to provide the division with written evidence of compliance to a plan of action within 30 days after the receiving a Notice of Agency Action that their certification has been suspended.

(ii) The Certified Crisis Worker continues to provide case management services during the period of a suspension; or

(iii) The Certified Crisis Worker receives more than two notices of noncompliance with the Provider Code of Conduct in a one-year period.

(e) Any Certified Crisis Worker whose certification has been revoked may request an informal hearing with the division director or designee, in writing, within 10 business days of receiving notice of revocation.

(f) The division director or designee shall review the request and determine to uphold, amend or reverse the action within 10 business days, and the division shall inform the Certified Crisis Worker of the decision in writing.

(g) Any Certified Crisis Worker with a revoked certification may not reapply for recertification for a period of twelve months.

(2) If a Certified Crisis Worker fails to complete the requirements for CEUs, their certificate will be revoked or allowed to expire, and shall not be renewed until the required CEUs have been completed and submitted to the division for approval.

(3) The crisis worker's certification status shall be posted and available upon request through the division.

R523-17-8. Standards for Local Authority Mental Health Crisis Lines

Latest version.

(1) If a Local Mental Health Authority (Local Authority) provides for a local mental health crisis line the Local Authority shall:

(a) maintain a 24 hour/7 days per week comprehensive telephonic system capable of assessing any individual experiencing a self-defined crisis situation, leading to appropriate crisis stabilization and making appropriate referrals,

(b) collaborate with the statewide mental health crisis line,

(i) is a mental health therapist and/or Certified Crisis Worker, or

(ii) individuals employed by a Local Authority or the Statewide Crisis Line who is not yet a certified crises worker, and has been hired to provide crisis services as outlined in this rule, can provide crisis services if:

(A) they are working under the supervision of a licensed mental health therapist who is a certified crisis worker, and

(B) they are within 3 months of receiving the certification training required to become a Certified Crisis Worker,

(iii) meets the standards of care and practice established by this rule, and

(iv) has access to a licensed mental health clinician by direct transfer of the call that does not require a call back to the person in crisis if the non-licensed crisis worker cannot stabilize the caller,

(d) ensure that, based on inability to meet needs based on capacity, the calls are immediately routed to the statewide mental health crisis line,

(e) ensure that local authorities have a plan for roll over calls,

(f) ensure that regardless of the time, date, number of individuals trying to simultaneously access the local mental health crisis line, a mental health therapist or crisis worker answers the call:

(i) without the caller waiting on hold,

(ii) being screened by an individual other than a mental health therapist or crisis worker, and

(iii) within 5 rings or 30 seconds, and

(g) ensure the discounted call abandonment rate will not exceed more than 5% of the total volume of calls.

(2) If a Local Mental Health Authority does not provide for a local mental health crisis line they shall use the statewide crisis line as a local resource.

(3) Local Authorities and the statewide crisis line shall develop and implement a plan for collaboration and coordination of care for ongoing support for individuals accessing the statewide crisis line. This plan should:

(a) be created collaboratively between the Local Authority and the statewide crisis line, and

(b) shall include the following components at a minimum:

(i) policies and procedures for coordination,

(ii) timeline for care transitions that includes process for warm hand off, appointment scheduling, and follow up,

(iii) clear expectations of communication between agencies including contact lists and shared resources lists, and

(iv) a plan for regular review of data to ensure collaboration and quality of continuity of care.

R523-17-9. Minimum Standards of Care and Practice

Latest version.

(1) Certification or accreditation standards for crisis lines shall include:

(a) The crisis line providing proof of certification/accreditation from one of the following:

(i) American Association of Suicidology (AAS),

(ii) CONTACT USA,

(iii) Alliance of Information and Referral Systems (AIRS),

(iv) The Joint Commission,

(v) Commission on Accreditation of Rehabilitation Facilities (CARF),

(vi) Council on Accreditation (COA),

(vii) Utilization Review Accreditation Commission (URAC), or

(viii) DNV Healthcare, Inc.

(b) Agencies shall provide State/county licensure, as approved by the division Administrator or designee.

(i) screening and triage,

(ii) psycho-social support,

(iii) connection to appropriate resources,

(iv) follow-up capability to callers as clinically appropriate.

(d) 24 hour/7 days per week telephone crisis services that are staffed by skilled professionals capable of assessing and making culturally competent, appropriate referrals,

(e) the use trauma-informed screenings and assessments, and incorporate this information into safety planning, referrals and follow-up interventions,and

(f) the initiation of mobile crisis services when available that are linked with walk-in crisis service facilities when available.

(2) Suicide Risk Assessment Standards shall include the National Suicide Prevention Lifeline Suicide Risk Assessment Standards minimum requirements.

(3) Imminent Risk Policies shall include:

(a) Crisis lines shall adopt the adoption of the National Suicide Prevention Lifeline Policy for Helping Callers at Imminent Risk of Suicide

(4) Follow Up Policies that shall include:

(a) crisis lines maintaining and implementing a policy detailing follow-up procedures including but not limited to:

(i) safe-care transitions,

(ii) rapid referrals,

(iii) caring contacts, and

(iv) care bridging strategies.

(b) This policy shall detail how crisis lines will work with community partners and the statewide crisis line.

(5) Warm Hand Off Policies shall include:

(a) agencies maintaining written procedure defining and detailing a "warm hand off" process that allows for unique adaptations for each Local Authority crisis service structure, in collaboration with the statewide crisis line.

(b) This initial procedure for a Warm Hand Off shall read as follows:

(i) if clinically indicated, provide a warm handoff to Local Authorities providers or other identified providers of care or care managers with an identified health plan. A warm handoff may include:

(A) a conference call or other direct communication with the Local Authority provider, other provider or care manager to arrange immediate crisis support and scheduling an appointment for follow up support,

(B) if other needs are expressed by callers then additional resources may be offered to help access local recovery oriented support services as needed,

(C) coordination with each local authority, regarding preferred communication and resources access as uniquely adapted to each local community, and

(D) a warm hand off will be done via conference call to facilitate a personal introduction between a Lifeline caller and their local behavioral health treatment providers or care managers, as well as the exchange of pertinent information, to promote the continuity of care.

(ii) The elements of a successful warm hand off shall include:

(A) orienting the caller as to what to expect,

(B) a positive provider to provider communications, and

(C) provision of accurate information regarding the caller's current condition, treatment and service needs, and safety goals.

(iii) The steps to initiate a warm hand off include:

(A) assessing callers for their level of acuity and need,

(B) offer to provide a person to person introduction to a representative in their local area,

(D) contact the predetermined designated number for provider in their local area,

(E) communicate the caller's situation and needs,

(F) introduce the caller and remain on the line as needed to facilitate the conversation, and

(G) in the event that a warm handoff is clinically indicated and the individual is not able to receive a warm handoff for any reason, a minimum of one follow up "Caring Connection" shall be provided within 72 hours of initial contact, if contact information was able to be collected for the caller.

(6) Crisis Line Community Collaboration and Coordination Policies shall include:

(a) a published plan in place that outlines community resources available,

(b) a collaboratively created plan published that outlines the plan for community collaboration with the following partners at minimum:

(i) Law Enforcement,

(ii) hospitals (Emergency Departments),

(iii) local mental health and substance abuse authorities,

(iv) schools, and

(v) any other crisis services in the local community.

R523-17-10. Statewide Mental Health Crisis Line Standards

Latest version.

(1) The 24 hour/7 days per week statewide crisis Line shall adhere to the following standards:

(a) collaborate with Local Authorities running local crisis line,

(b) the statewide crisis line shall develop, and implement a plan for collaboration and coordination of care for ongoing support for individuals accessing services with Local Authorities,

(d) plans shall include the following components at a minimum:

(i) policies and procedures for coordination,

(ii) timelines for care transitions that includes process for warm hand off, appointment scheduling, and follow up,

(iii) clear expectations of communication between agencies including contact lists and shared resources lists,

(iv) a plan for regular review of data to ensure quality of continuity of care.

(v) assurance that each individual who answers calls to the statewide crisis line:

(A) is a mental health therapist and/or Certified Crisis Worker,

(B) meets the standards of care and practice established by this rule, and

(C) has access to a licensed mental health clinician by direct transfer of the call that does not require a call back to the person in crisis if the non licensed crisis worker cannot stabilize the caller.

(vi) assurance that regardless of the time, date, number of individuals trying to simultaneously access the local mental health crisis line a mental health therapist or crisis worker answers the call:

(A) without the caller waiting on hold,

(B) being screened by an individual other than a mental health therapist or crisis worker, and

(vii) the discounted call abandonment rate will not exceed more than 5% of the total volume of calls,

(viii) 90% of statewide crisis line calls shall be answered in state as reported by the National Suicide Prevention Lifeline call data, and

(ix) assurance that the statewide crisis line has the capacity to accept all calls that local mental health crisis lines route to the statewide crisis line.

R523-17-11. Minimum Standards of Care and Practice for the Statewide Crisis Line

Latest version.

(1) Certification or accreditation shall include:

(a) proof of certification/accreditation from one of the following:

(i) American Association of Suicidology (AAS),

(ii) CONTACT USA,

(iii) Alliance of Information and Referral Systems (AIRS)

(iv) The Joint Commission on Accreditation of Rehabilitation Facilities (CARF),

(v) Council on Accreditation (COA),

(vi) Utilization Review Accreditation Commission (URAC), or

(vii) DNV Healthcare, Inc.

(b) State/county licensure, as approved by the division Administrator or designee,

(i) screening and triage,

(ii) psycho-social support, and

(iii) connection to appropriate resources.

(d) follow-up capability to callers as clinically appropriate,

(e) services that are staffed by skilled professionals capable of assessing and making culturally competent, appropriate referrals,

(f) the use of trauma-informed screenings and assessments and incorporating this information into safety planning, referrals and follow-up interventions,

(g) the initiation of mobile crisis services when available that are linked with walk-in crisis service facilities when available.

(2) Suicide Risk Assessment Standards shall include the adoption of the National Suicide Prevention Lifeline Suicide Risk Assessment Standards minimum requirements.

(3) Imminent Risk Policies shall include the adoption of the National Suicide Prevention Lifeline Policy for Helping Callers at Imminent Risk of Suicide

(4) Follow Up Policies shall include:

(a) maintaining and implementing a policy detailing follow-up procedures including but not limited to:

(i) safe-care transitions,

(ii) rapid referrals,

(iii) caring contacts, and

(iv) care bridging strategies.

(b) This policy shall detail how the Statewide Crisis Line will work with community partners and the local crisis lines.

(5) Warm Hand-off Policies shall include:

(a) maintaining written procedure defining and detailing a "warm hand off" process that allows for unique adaptations for each LA crisis service structure, in collaboration with the statewide crisis line.

(b) This initial procedure for a Warm Hand Off shall read as follows:

(i) If clinically indicated, provide a warm handoff to LAs providers.

(ii) A warm handoff may include:

(A) a conference call or other direct communication with the LA provider to arrange immediate crisis support and scheduling an appointment for follow up support,

(B) if other needs are expressed by callers then additional resources may be offered to help access local recovery oriented support services as needed, and

(C) coordination with each local authority regarding preferred communication and resources access as uniquely adapted to each local community.

(iii) A warm hand off will be done via conference call to facilitate a personal introduction between a Statewide Crisis Line caller and their local behavioral health treatment providers, as well as the exchange of pertinent information, to promote the continuity of care.

(iv) The elements of a successful warm hand off include:

(A) orienting the caller as to what to expect,

(B) positive provider to provider communications, and Providing accurate information regarding the caller's current

(v) The steps to initiate a warm hand off includes:

(A) assessing callers for their level of acuity and need,

(B) offer to provide a person to person introduction to a representative in their local area,

(D) contact the predetermined designated number for provider in their local area,

(E) communicate the caller's situation and needs, and

(F) introduce the caller and remain on the line as needed to facilitate the conversation.

(vi) In the event that a warm handoff is clinically indicated and the individual is not able to receive a warm handoff for any reason, a minimum of one follow up "Caring Connection" shall be provided within 72 hours if contact information was able to be collected for the caller.

(6) Crisis Line Community Collaboration and Coordination plan shall include:

(a) a published plan in place that outlines community resources available,

(b) a plan published that outlines the plan for community collaboration with the following partners at minimum:

(i) Local Authorities including Mobile Crisis Outreach Teams,

(ii) law enforcement,

(iii) hospitals (Emergency Departments),

(iv) health plans,

(v) schools, and

(vi) any other crisis services in the local community.

(c) The Statewide Crisis Line shall enter into MOU's with each Local Authority operating a Crisis Line and/or Mobile Crisis Outreach Teams and shall make good faith efforts to enter into MOU's with parties described in R523-17-11 (6b).

R523-17-12. Division Oversight of Program

Latest version.

(1) The division may enter and survey the physical facility, program operation, and review curriculum and interview staff to determine compliance with this rule or any applicable contract to provide such services.

(2) Participating organizations including Local Authorities and the statewide crisis line shall also allow representatives from the division and from the local authorities as authorized by the division to monitor services. Such visits may be announced or unannounced.