Integrated Crisis Response

Questions and Answers

Newest Q&A's are at the bottom

Q.  Where do I call to have a DCR dispatched? A.  You must call the Volunteers of America Crisis Triage Line at 1.800.747.8654 Q.  What is a DCR? A.  A Designated Crisis Responder, formerly Designated Mental Health Professional, is the only Mental Health Professional to detain under RCW 70.96B Q.  Where and when will the 14-day commitment hearings be held? A.  The hearings will be held at the North Cascade Secure Detox Facility on every Tuesday and Thursday. Q.  Where is the facility and is it open? A.  The facility is on the 3rd floor of the Pioneer Center North campus at 24961 Thompson Dr. in Sedro-Woolley, WA. Q.  Will we continue to have meetings regarding the pilot? A.  The Steering Committee will continue to meet monthly for the first few months and quarterly thereafter, the subcommittees will not meet unless a need arises. Q.  Can I call Volunteers of America Crisis Triage to dispatch a DCR? A.  Yes, you can, however, for safety reasons and medical stability you may want to take them to the Emergency Department.  It is important for the individual to have a medical assessment before the detainment evaluation. Q.  If a detainee tests positive for MRSA, can they be admitted to the secure detox facility? A.  Yes, as long as they are being treated with antibiotics. Q.  Which court is conducting the hearings for the secure detox? A.  The Superior Court, the same court that conducts Mental Health ITA hearings. Q.  Are we using 70.96B to detain to both the Secure Detox and E&T?  A.  Yes, use 70.96B to detain to either facility for the 72-hour hold, at the 14-day hearing commitment will be filed under 71.05 or 70.96B.  The only exception is if a detainee is being detained to a facility outside our region, if that is the case, use 71.05. Q.  Do 70.96B rights exclude Saturday, Sunday and legal holidays from the 72-hours? A.  Yes, it is the same as 71.05. Q.  Do persons detained under 70.96B have the right to a continuance for just cause? A.  If the detainee is detained to the E&T for a mental health disorder, they do have the right of a continuance.  However, if they were detained to the Secure Detox facility, the RCW does not allow for a continuance.  We will be seeking legislative relief, if necessary, to address this issue during the next legislative session. Q.  Many people we detain are imminently dangerous to other people.  Is it correct that Skagit Secure Detox will exclude people because they are acting out behaviorally? A.  Please refer tot he Medical Stability Criteria under policy:  "Individuals who are violent and pose a threat to staff and clients will be admitted on a case-by-case basis depending on available resources."  We also have the ability to place clients in the seclusion room, however there are no physical restraints in that room. Q.  Many people we detain are suicidal and are making or have made suicidal gestures.  Is this a rule out for admission to Skagit Secure Detox? A.  Suicidal gestures and ideation are common in the chemical addicted and may occur during chemical withdrawal.  If a client continues to be suicidal beyond withdrawal, or actively making attempts, NCSD would request an evaluation for the appropriate Mental Health Care. Q.  Is it correct that Skagit Secure Detox will not accept dually disordered consumers who are exhibiting psychiatric symptoms? A.  NCSD will accept clients whose primary presenting disorder is chemical dependency and the need to withdrawal, regardless of secondary diagnosis.  As long as the psychiatric symptoms can be managed with existing prescribed psychotropic medications, the client can benefit from detention to the Secure Detox.  If the client has precipitating psychiatric symptoms that require stabilization first, it may be in the client's best interest to have those symptoms stabilized at a Mental Health facility and then transferred to Secure Detox. Q.  Many people who meet criteria for detention might need to be restrained for their safety and the safety of others.  Is it true that Skagit Secure Detox does not have the ability to restrain for safety? A.  This is true; staff are trained to provide minimal containment and verbal de-escalation.  NCSD has seclusion room capability without restraints.  If the client is behaviorally out of control and a risk to self or others, NCSD will not be able to appropriately evaluate for withdrawal symptoms and therefore not appropriately provide for their care. Q.  Let's suppose a person is in the hospital because of serious medical conditions relating to their addiction.  Doctors are willing to testify that if the person continues using he will die.  The patient is now medically clear.  The patient refuses drug/alcohol treatment and tells you, the DCR that he plans to continue using upon discharge knowing his use might kill him but unable to stop.  Is it true that Secure Detox will refuse admission to this patient because he currently is not detoxing?  If this si true, should we not detain from hospitals, jails, detox centers, etc. unless the person is actively going through withdrawal? A.  Recommend Involuntary Treatment under RCW 70.96.A.140. Q.  I work as a social worker at NSE&T, recently we had a pt transfer to us from secure detox in the middle of his 14-day hold due to behavior problems. The 14-day hold has expired the pt does not want to stay voluntary at NSE&T until a bed opens at PCN for him. It does not appear that we have grounds to re-detain him. PCN is willing and able to take this pt once stable and they have a bed. This person clearly needs CD treatment, what plan is in place to "make" this person go to CD treatment? Will there be a 60-day-hold for CD commitment? Thank you. A.  This particular case is an example of the co-operative efforts and possibilities for integrated response that were utilized. This client, is known to MH and High Intensity team case management, was detained to NCSD following chemical use and failure to take psychotropic meds. During detox the client was assessed to be very motivated for treatment, appropriate for detention despite having auditory hallucinations and a well-documented psychiatric diagnosis. He was able to safely detox on the prescribed psychotropic medications, however the use of Benzo’s made him ineligible for Inpatient Treatment. With the co-operation of our medical staff and Compass Health case management/medical staff, client was switched to a mutually agreed medication regime, with appropriate taper protocols. During the taper, client began to de-compensate with marked psychiatric impairment, communication was started w/ your facility and with the agreement of both medical staffs, the client was transferred to treat the mental health de-compensation, not a behaviour problem. You highlight the hole in our current system of integrated response, in that a Co--Occurring facility does not exist and we are treating integrated diseases separately. In addition the lack of a 60-day Involuntary treatment component of this Pilot does hamper our ability to provide appropriate clinically indicated services. We all know that window of therapeutic motivation can be brief. Attempts are underway currently to provide that 60-day Involuntary Treatment component. We will continue to foster collaborative relations with MH facilities to properly provide services as needed. We have only started on this long journey and I’m sure we will learn much more as we all travel along together. Q.  What are the steps/procedures in place for complaints (by consumer or family member) when complainant believes that an investigation was not thoroughly completed. A.  Consumers have the ability to voice a complaint to the provider (DCR employer) by calling the provider and asking for the complaint/grievance contact.  Consumers may also contact the North Sound Ombuds for help with their complaint.  Finally, consumers may contact the NSMHA with their complaint.  We try to resolve the complaint at the lowest level, provider level, whenever possible. Q.  I'm not wanting to make folks into long term patients, however, the grant is substantial and some thought should be given to getting folks into treatment and to their doctors and have contact person to do some case work to help navigate the system be they Medicaid or not.  Why no follow-up contacts with the client? That is a major goal for the staff and case management at Secure Detox.  A review of 2007 discharge records reflect 525 total admissions for the year and a 91% discharge rate with a referral to inpatient or outpatient treatment.  Additionally, discharge plans often include mental health, medical and dental appointments, as well as supportive housing, CPS, and many other social services.  ADATSA assessments are conducted while at Secure Detox, benefits are reinstated or started before discharge, and Catholic Community Services has a contract case manager that follows all clients for at least 30 days post-discharge if they are willing to engage in follow-up services. Q.  Is the issue of no smoking at the facility going to be addressed?  Pts are "acting out" so that they can be discharged or transferred as they cannot smoke at NCSD.  Also, one pt noted the lack of fresh air.  Is there any thoughts about providing a smoking area?  A fenced in area? Secure Detox is situated on the third floor of Pioneer Center North and given the secure nature of the facility; there are no means to "escort" clients to smoking areas.  Nicotine replacement therapy is provided in means of patch or gum during their time of detox.  While having a non-smoking detox facility can be behaviorally challenging, one could also see the health benefits with as medically compromised a population as we serve. As for air circulation, the building meets or exceeds fresh air exchange, windows do open in the day room for fresh air, and an air conditioning/heater is installed in the day room.  Q.  What are the limits of the Secure Detox facility in dealing with medical problems?  For example, can a diabetic patient who uses insulin be treated there?  Can patients who sleep with CPAP machines be treated there?  Can you give us some exclusionary criteria in this area? Diabetic clients are admitted on a regular basis, prompting, testing and education is provided as needed.  Clients do need to be able to draw insulin and inject themselves or be trainable.  CPAP machines can be used with room air not oxygen supplied.  Clients do need to be ambulatory, or shortly after stabilizing in their detox regimen, and need to be able to do their own ADL's and transfers.  Wheel chairs, walkers, canes and crutches are common with the type of medically compromised clients we often get. Limitations on Services include:  No IV medication/solutions therapy.  Oxygen tanks that are not able to be safe or secured.  We can not use.