Rule 24-2-19.9 - ID/DD Waiver Crisis Intervention ServicesA. Crisis Intervention Services provide immediate therapeutic intervention, available to a person on a 24-hour basis, to address personal, social, and/or behavioral problems which otherwise are likely to threaten the health and safety of the person or others and/or may result in the person's removal from their current living arrangement.B. Crisis Intervention Services are used in situations in which the need is immediate and exceeds the scope of Behavior Support Services.C. This service is provided on a one-to-one (1:1) employee to person ratio.D. There are three (3) models and primary service locations: (1) Crisis Intervention in the person's home; (2) Crisis Intervention provided in an alternate community living setting; or(3) Crisis Intervention provided in the person's usual day setting. 1. Person's home: The agency provider will provide or coordinate support services with the person's community living and day services provider(s). These services will, to the greatest extent possible, allow the person to continue to follow their daily routine in the service setting, with accommodations consistent with the Crisis Intervention Plan and the person's current behaviors. The Crisis Intervention Plan indicates any adaptations/changes needed in the environments in which the person typically spends their days.2. Alternate residential setting: In the event a person needs to receive Crisis Intervention Services in a setting away from the primary residence, the agency provider must have pre-arranged for such a setting to be available. This may be an apartment, hotel/motel, or a bedroom at a different DMH-certified residence. The Crisis Intervention personnel, to the greatest extent possible, maintain the person's daily routine and follow the Crisis Intervention Plan to transition the person back to their primary residence. The Crisis Intervention Plan indicates any adaptations/changes needed in the environments in which the person typically spends their days.
3. Person's usual day setting: Crisis Intervention personnel will deliver services in such a way as to maintain the person's normal routine to the maximum extent possible, including direct support during Day Services-Adult, Prevocational Services, or Supported Employment.E. The agency provider must develop policies and procedures for relocating someone to an alternate residential setting(s). This includes the type of location, whether people will be alone or with others, and plans for transporting people. The policies and procedures must include a primary and secondary means for providing an alternate residential setting(s). These settings must be equipped with all items necessary to create a home-like environment for the person.F. The agency provider must have an on-call system that operates 24 hours a day, seven (7) days per week to ensure there are sufficient employees available to respond to crises.G. The following positions are required for Crisis Intervention Teams; the specific requirements for the positions listed below are outlined in Chapter 11:1. A professional who meets the criteria under Rule 11.5.B.1 for an IDD Crisis Intervention Team director.2. An ID/DD Waiver Behavior Specialist.3. Direct service personnel for IDD Services.H. Crisis Intervention Services may be indicated on a person's Plan of Services and Supports prior to a crisis event when there is a reasonable expectation, based on past occurrences or immediate situational circumstances in which the person is at risk of causing physical harm to self, causing physical harm to others, damaging property, eloping, or being unable to maintain self-control in a manner that allows participation in usual activities of daily life. The agency provider will be chosen at the time the service is approved on the Plan of Services and Supports; therefore, if a crisis arises, the agency provider can be dispatched immediately.I. Upon receiving information that someone is in need of Crisis Intervention, the agency provider immediately sends trained personnel to the person to assess the situation and provide direct intensive support when a person is physically aggressive or there is concern that the person may take actions that threaten the health and safety of self and others.J. As soon as is feasible, the person must be evaluated by medical personnel to determine if there are any physical/medication factors affecting their behavior.K. When the immediate crisis is stabilized, appropriately qualified personnel:1. Continue analyzing the psychological, social, and ecological components of the extreme dysfunctional behavior or other factors contributing to the crisis.2. Assess which components are the most effective targets of intervention for the short-term amelioration of the crisis.3. Develop and write a Crisis Intervention Plan.4. Consult and, in some cases, negotiate with those connected to the crisis in order to implement planned interventions, and follow-up to ensure positive outcomes from interventions or to make adjustments to interventions.5. Continue providing intensive direct supervision/support.6. Assist the person with self-care when the primary caregiver is unable to do so because of the nature of the person's crisis situation.7. Directly counsel or develop alternative positive experiences for people while planning for the phase out of Crisis Intervention Services and return of the person to their living arrangement, if applicable.8. Train employees and other caregivers who normally support the person in order to remediate the current crisis as well as to support the person long-term once the crisis has stabilized in order to prevent a reoccurrence.L. Crisis Intervention personnel may remain with the person 24 hours a day, seven (7) days a week until the crisis is resolved. Crisis Intervention is authorized for up to 24 hours per day in seven (7) day segments with the goal being a phase out of services in a manner which ensures the health and welfare of the person and those around them. Additional seven (7) day segments can be authorized by DMH, depending on a person's need and situational circumstances.M. Episodic Crisis Intervention is provided in short-term (less than 24 hours) segments and is intended to address crises such as elopement, immediate harm to self or others, damage to property, etc., that can be managed through less intensive measures than daily Crisis Intervention. The maximum amount that can be approved is 168 hours. Additional hours can be authorized by DMH, depending on the person's need and situational circumstances.N. If a person requires a higher level of supervision/support than can be safely provided through Crisis Intervention Services, then the person will be appropriately referred to other more intensive services.