NAVIGATING THE CRISIS SYSTEM. For Individuals Experiencing Homelessness

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1 NAVIGATING THE CRISIS SYSTEM For Individuals Experiencing Homelessness

2 Agenda Introductions National data Description of crisis services and how individuals experiencing homelessness or providers can access these services Crisis lines, dispatch services, warm line/peer support What to expect Considerations and limitations Resources

3 Homelessness Across the Nation According to the National Alliance to End Homelessness, State of Homelessness 2014 Report: National rate of homelessness is 19 for every 10,000 people (from point-in time counts) Homelessness overall is decreasing Despite progress, challenges remain Lack of affordable housing cannot be overcome by the homeless assistance system Communities, states, and the federal government need to invest in affordable housing so households are able to obtain and maintain housing independently in their communities

4 Homelessness & Suicide In a cross-sectional survey completed in Canada in 2002 Of 330 homeless adults 61% reported suicidal ideation n 56% men n 78% women 34% had attempted suicide n 28% men n 57% women Psychiatric diagnoses were associated with suicidality in this sample Childhood homelessness of at least 1 week w/o family members and period of homelessness longer than 6 months were found to be associated with suicidal ideation

5 Homelessness & Substances Two-thirds of individuals experiencing homelessness report that drugs and/or alcohol were a major reason for their becoming homeless (Didenko & Pankratz, 2007) In many situations though, substance abuse is a result of homelessness rather than a cause Coping mechanism Substance abuse exacerbates an individuals problems, decreasing their ability to cope, gain employment, housing and stability

6 Homelessness & Mental Illness Homelessness is a crisis in itself Compounding crises and trauma while experiencing homelessness From 1/3-1/2 of individuals who are homeless experience a mental health problem (Substance Abuse and Mental Health Services Administration, 2009) Lack of stability often prevents treatment Consider how stigma may be a barrier to accessing or receiving support and/or services

7 How Does Connection Happen? Individuals experiencing homelessness become connected to services in various ways throughout Arizona. Some of which may include but are not limited to: Homeless outreach providers Walk-in centers Emergency departments Shelters Heat relief centers Crisis and/or information and referral lines

8 Crisis Line Services James Brady

9 What Are They? Crisis line services are available 24/7, 365 throughout the state of Arizona A crisis is self identified and specialists are trained to assist in any situation a caller presents with In the event the crisis line is not the appropriate resource the crisis specialist will assist in connecting the caller to the proper resource Some of the most common reasons individuals reach out include: suicidal or homicidal thoughts or desires, medication stabilization, detox services or substance abuse services, community resources for rental assistance, food banks, utility assistance, navigator referrals, shelter resources and coordination with police and fire.

10 Using a Crisis Line When you contact a crisis line you can expect to be asked immediately for some basic demographic info and triage questions Full name, date of birth, phone number If you are safe or having thoughts to harm yourself or someone else The crisis specialist might answer directly or in the event all crisis specialist s are on a call you may speak to an operations specialist first who will complete a triage and assess for safety

11 What to Expect A caller usually speaks to a live person within a matter of seconds. If that person is an operator and the caller is safe to wait, they may wait for the next available specialist. Who are these crisis workers? The crisis specialist will aid the caller in resolving the presented crisis. Crisis calls typically last less than 10 minutes

12 What to Expect Crisis specialists are able to speak with third parties, gather information and provide general information and recommendations for the third party to assist the identified individual Conference calls Follow up or outreach calls Dispatch mobile teams Crisis specialists cannot provide client specific protected health information to third party callers Exceptions are for coordination of care under certain contracted integrated care providers

13 For Individuals Who Are Homeless Crisis specialists are able to connect callers to shelter resources Set up transportation for shelter services Provide confidential transportation services to individuals in domestic violence situations Request mobile teams to community locations Assist in de-escalating a situation related to mental health issues

14 Self-Reporting Homelessness Monthly Numbers in Arizona Northern Arizona Approx. 25/600 self report as homeless 25/600 report housing problems as the primary reason they called *only reflective of two months of data that CRN has provided services in Northern AZ Maricopa County Approx. 1,050/20,000 self report as homeless 600/20,000 report housing problems as the primary reason they called Southern Arizona Approx. 120/10,000 self report as homeless 25/10,000 report housing problems as the primary reason they called

15 Crisis or 911? If you or another party is experiencing a life threatening emergency or cannot remain safe to wait for a specialist, transportation or a mobile team. Call 911. If you or another party is experiencing mental and physical health issues and will need medical attention we will coordinate with the fire department for medical clearance prior to sending transportation or a mobile team Keep in mind mobile team response times can vary from 35 minutes 2 hours

16 Requesting Mobile Services When requesting transportation or mobile team services via the crisis line consider Do I need face to face intervention Do I need assistance or transportation to get to a higher level of care? Am I safe and able to ride in a van n Wheelchair assistance? Expect to be asked for a description, if you are carrying weapons or have any pets. This is strictly for the safety of our team members. The crisis specialist will collect the information and provide it to the transportation or mobile team service

17 Considerations & Limitations Crisis lines collaborate with area resources Crisis specialists can provide brief, time limited assistance and support to callers; however the intervention should never take the place of ongoing treatment or therapy If an individual receives services at a provider (clinic, site, RA) location with case management, the crisis specialist will coordinate care and if during business hours attempt to connect the caller to their provider if appropriate

18 Resources Northern Arizona Health Choice Integrated Care Crisis Response Network Maricopa County Mercy Maricopa Integrated Care Crisis Response Network ; Southern Arizona Cenpatico Integrated Care Nursewise (as of 10/1/2015) ;

19 Dispatch & Mobile Team Services Todd Habeger

20 Using Dispatch & Mobile Team Services To access transportation or mobile team services, first call the crisis line. After completing a risk and needs assessment, transportation or a mobile team may be provided. Transportation to safe shelter Escaping domestic violence situations Access to emergent mental health providers and hospitalization Access to substance abuse detoxification facilities Coordination of care, outside referrals Face to face intervention in times of emergent mental health crises

21 What to Expect Non-judgmental team members Many have experienced crisis situations in their own lives and are willing to take the extra mile to help a community member in need Mobile teams have at least one licensed clinician Teams develop a plan of action for each individual Ability to accommodate individual needs For Example: Female team members or Spanish speaking teams

22 Most Frequented Locations Northern Arizona Not available n Mobile team services have only recently became available Maricopa County Community Bridges Central Arizona Shelter Services and Lodestar Day Resource Center Connections AZ and Recovery Innovations of AZ Southern Arizona Crisis Response Center Pasadera n Mental Health n Detox

23 Considerations & Limitations? There are geographic limitations depending on the county The individual must be willing to engage in services There has to be an accepting party Meaning someone who will receive the individual at the shelter, hospital, or home. It must be considered crisis transportation Bringing individuals to a higher level of care Not regular transportation (work or other ongoing appointments)

24 Transport & Mobile Team Resources Northern Arizona Mobile Teams (Terros) for Flagstaff, Williams and Munds Park Maricopa County Mobile Teams (Terros and Empact) Transportation (Comtrans) Southern Arizona Mobile Teams (Pasadera) Transportation (Kords)

25 Warm Line/Peer Support Vanessa Williams

26 What is a Warm Line? Telephonic support line (non-crisis in nature) We offer support, not solutions. State certified peer support specialists Individuals with lived mental health experience that completed extensive training and taken a state exam to become certified to provide support to others Services are confidential and non-judgmental Services are time limited and have varying parameters depending on the service area

27 Warm Line/Peer Support Services Focus is to support the caller in their personal recovery journey As the individual their recovery is defined by them Assistance with crisis prevention and de-escalation of personal issues Provide post crisis support Resource assistance and connection

28 Reaching Out: Stages of Homelessness Facing homelessness Connecting to resources to prevent homelessness and exploration of options Safe space to vent frustrations and express fears Temporary or chronic homelessness Available to listen, provide non-judgmental support, explore options and resources Transitional housing or recently housed When homeless you are a part of a close knit community, losing that support when gaining housing can be a difficult transition Additional support may be necessary to maintain successful housing

29 Personal Experience First week in transitional housing It was in Phoenix, I only knew the East Valley My apartment had everything I needed but I spent most of the time outside I spent a lot of time walking around the neighborhood because I was used to that It was strange to be in a new place with no one it was too quiet It took me a month to be able to sleep more than a few hours a night. If I had known about the Warm Line service, I would have called

30 Housing Success I would have welcomed the opportunity to tell someone how alone I felt and how badly I just wanted to go back to the streets where I felt safe, secure and where I had a sense of belonging. Vanessa Williams

31 Moving Forward Individuals recently housed can utilize warm line services as part of the transition process Often providers have wraparound services in place, but sometimes a person may only want to talk Warm lines can also share in caller s successes JOYS SHARED = JOYS MULTIPLIED SORROW SHARED = SORROWS DIVIDED Peer support via warm lines is an authentic human connection during a time when connecting with people is difficult

32 Considerations & Limitations Each warm line has different parameters and hours If it is your first time calling, you should be provided with educational information about using that particular warm line The warm line is a supportive service, not for crisis resolution. The warm line is not in the department of fixing things, but of holding hope for others who may have forgotten their strengths Most warm lines work closely with the crisis line in their community. Warm lines and crisis lines frequently transfer calls to one another based on presenting needs

33 Warm Line Resources NAZCARE (statewide) 5:00-10:30PM; 7 days a week CRN Warm Line Monday-Friday: Noon-Midnight Saturday & Sunday: 4:00pm-Midnight Tucson HOPE Inc. Warm Line 24 hours per day; 7 days a week

34 Thank You!

35 Presenter Contact Info Vanessa Williams Warm Line Supervisor Todd Habeger Dispatch Specialist James Brady Crisis Specialist

36 References Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. (2009). Practice Guidelines: Core Elements for Responding to Mental Health Crises. Retrieved from: Didenko E. and Pankratz N. (2007). Substance Use: Pathways to homelessness? Or a way of adapting to street life? Visions: BC s Mental Health and Addictions Journal, 4(1), Retrieved from:

37 References Eynan R., Langly J., Tolomiczenko G., Rhodes AE., Links P., Wasylenki D., Goering P. (2002). The association between homelessness and suicidal ideation and behaviors: results of a cross-sectional survey. Retrieved from: National Alliance to End Homelessness. (2014). The state of homelessness in America. Retrieved from: state-ofhomelessness-2014

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