2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Crisis Respite: An Effective Intervention in the Continuum of Recovery

Think about your work with a client with a psychiatric diagnosis in emotional crisis. Did your client get what they needed at an emergency room? Or, after hours of waiting, were they told they were well enough to deal with it at home, perhaps by themselves? A peer-run Crisis Respite stay is an alternative to emergency room visits and hospitalization or a step-down from hospitalization back into the community. Short-term Crisis Respite is getting increased attention from providers and insurers as a proven and cost-effective intervention.

ACMH’s Garden House Crisis Respite, an Enriched Crisis and Transitional Housing pilot funded by NYSOMH as a Medicaid Redesign Team (MRT) initiative, serves three guests, typically for a seven–day stay. Co-located with OMH licensed units for singles in an apartment building located in Manhattan’s East Village, Crisis Respite is staffed 24/7 by Peer Counselors with lived experience as consumers of mental health services who are certified by the Academy of Peer Service (APS) and supervised by a licensed mental health counselor. Certified Peer Counselors must meet continuing education requirements on a yearly basis in order to maintain their certification. AW, a Respite guest, noted, “What was most helpful during my stay was speaking to other peers about my depression and finding support groups with the community.”

Staff members work closely with guests and their treatment team to establish goals for their stay and for their return to their community setting. Peer Counselors follow up with guests after they leave to reinforce the skills they learned during their stay. AW, a Respite guest, further comments, “I did the Wellness Recovery Action Plan which was extremely helpful. I also did worksheets on assertiveness and learned how to put myself first.” The work of learning and practicing coping skills is at the core of the Respite model.

In operation since April 1, 2015, ACMH’s Garden House Respite has demonstrated that peer services in conjunction with mental health treatment, prevents escalation of a problem into a full-blown crisis. So far, 83 guests out of a total of 191 served through June 20, 2017 (43%) reported that they would have gone to the emergency room if Respite was not available. Sixteen guests came to Respite directly following psychiatric hospitalization, as an interim step before returning home, using their Respite stay as a time to sharpen coping strategies and learn new ones. Respite guest SA went on to note, “If Respite wasn’t available, I would have turned to drugs and alcohol. This place is better than a hospital, jail, or any institution.”

During their stay at Garden House Respite guests develop a Wellness and Recovery Action Plan (WRAP) that tailors services and supports to their individual needs. The WRAP is designed to support protocols that guests have established, or establish during their stay, with their treatment team. According to SB, one of the six Crisis Respite Peer Counselors, “The beautiful part is seeing someone that may have come in crying without a vision of wellness leaving Respite uplifted, and not only visualizing their wellness, but planning for their next steps.”

Over the course of their stay, guests identify impediments to recovery and develop specific plans to address them. Some types of services delivered since April 1, 2015 through June 20, 2017 for 191 guests: Daily Living Skills 1,091 contacts; Symptom Management 1,002, Socialization 810, Supportive Counseling 735, Community Integration and Resource Development 253, Self-Advocacy Training 199, Stress Reduction 196, Skills Development 112, Health 104, Conflict Resolution 90, Mental Illness Education 87, Job Assistance 78, Medication Management 54, Substance Abuse Treatment Referral 25.

At the beginning and at the end of their stay guests complete several assessments including, most recently, the Patient Health Questionnaire (PHQ-9) to monitor depression and level of safety risk. Since mid-April 2017 to June 20, 2017, of the thirty guests during that period, 56% had a decrease in risk level from admission to discharge. The average guest decreased the risk by 4 points, and 100% moved from Severe Risk to a lower level when assessed at check-out. A Comprehensive Assessment and a Goals sheet are also completed at check-in to establish the work for the stay. SA, the Respite guest, said “I was able to talk with all staff on my issues at hand. I was able to learn coping skills from Respite staff. Thank God!!!

Out of 191 guests served from April 1, 2015 through June 20, 2017, only three guests required emergency medical attention, and one needed emergency psychiatric services. All three guests requiring emergency medical care returned to Respite by the following day.

During their Respite stay, guests are encouraged to avail themselves of community supports which they may previously considered but not used. Guests are given information on club houses, LGBTQ networks, smoking cessation and harm reduction services, housing resources, self-esteem and self-care enhancements like free haircuts and low-cost gym memberships, among other options. Guests who acknowledged during their stay that substance use is a problem they would like to address have been linked to treatment programs.

With round the clock Peer Counselor support serving only three guests at a time in a normalized community residential setting, both staff and guests report that remarkable progress is made on crafting and fine-tuning wellness and recovery plans. And Garden House Crisis Respite has enjoyed remarkably low staff turnover. The staff says they are dedicated to teaching others what they have learned: how to thrive in recovery. According to Respite guest WM, “I feel like I can think straight because of this program. Thank You!”

To obtain more information about ACMH’s Garden House Crisis Respite, or to make a referral or schedule a tour, contact Kearyann Austin, LMHC at kaustin@acmhnyc.org. Or, please visit www.acmhnyc.org and download a referral form.

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