Crisis Stabilization & Alternatives to Hospitalization

Abstract

The Delaware Department of Health and Social Services, Division of Alcoholism Drug Abuse and Mental Health, is proposing to expand its existing 24-hour mobile crisis services in two rural counties to include a more systematic and comprehensive array of community-based crisis stabilization alternatives to hospitalization. Further, we have designed a controlled trial with random assignment to contrast both the effectiveness and costs of hospitalization versus community alternatives. Participants in the study will be community support program (CSP) consumers of the Division-operated Kent & Sussex Counties Community Mental Health Center (K/S CMHC) and those of two private CSPs which operate under contract with the CMHC. The demonstration project will be administered by the K/S CMHC's Mobile Crisis Unit (MCU). MCU is a self-contained emergency service within the CMHC. It has comprehensive capability in terms of crisis intervention, but only limited capacity for community-based crisis stabilization. Grant funds will be used by the MCU to expand its capacity for community-based crisis stabilization through a combination of additional staff and crisis stabilization living arrangements. A functional sub-team will be organized within MCU, the Crisis Stabilization Support Team (MCU-CSST). In collaboration with a network of existing community agencies, the MCU-CSST will expand the array of crisis stabilization alternatives to hospitalization. These will include in-home, host home and other non-congregate arrangements. The MCU-CSST's role will be systematically tailored to complement the capability of each CSP, thereby enhancing the CSP's capacity to serve its consumers during crisis periods rather, than fragmenting service provision. The project will compare the outcomes of community-based and hospital-based crisis stabilization, employing a risk assessment measure that matches a consumer's needs to a crisis stabilization alternative. Consumers who volunteer to participate in the study will be randomly assigned to hospital-based or community-based treatment conditions at the time of their enrollment in the study. The relative efficacy and cost effectiveness of the alternatives will be examined using six measurement domains. Repeated measures across domains will be obtained for 24 months prior to, and 6-18 months following, a consumer's first crisis intervention where hospitalization is imminent. The research will be directed by Frederick Newman, Ph.D., of Florida International University, with George Johnson, Ph.D., of the Delaware State College School of Social Work, as field director of a research team at Delaware State.