The Colorado Division of Mental Health is proposing a research demonstration project designed to test the relative effectiveness of specific community-based program models in improving mental health crisis/emergency services for residents of rural areas. The primary aim of the project is to determine the most effective, efficient method(s) for delivering psychiatric emergency services in rural communities.
A second aim i s to determine whether various combinations of services are differentially effective for different types of clients in psychiatric crises. The project will examine the delivery of two models of crisis care in rural communities, as well as the combination of both of these models, which will be used as alternatives to acute hospital care for psychiatric emergencies. These interventions include: 1. a community-based psychiatric crisis network consisting of: a coalition of human service providers and """"""""natural helpers"""""""" who have been trained to deal with psychiatric crises; a family-based crisis residence; and a mental health team that provides coordination and clinical back-up, and support for other elements of the network. 2. a regional Acute Treatment Unit, located near the rural community, which provides intensive residential treatment for individuals in acute psychiatric crisis. These interventions may be combined with state hospital admission to produce seven different service conditions to be analyzed. The main experimental design will be a four (client type) by four (crisis type) by seven (service conditions) non-equivalent control, pre and post measurement design. The study will also employ a process evaluation and an assessment of client outcome and system impact. The project design is based on the belief, supported by research, that services provided in settings which are the least restrictive and closest to the client's natural environment will be both more effective and less costly than other more disruptive interventions. Accordingly, the major hypothesis for this research demonstration project is: Expansion of the rural/crisis emergency services delivery system to include alternatives to hospitalization will make it possible to more effectively meet the needs of clients in crisis, resulting in improvements in client outcomes and service system utilization.
