GCAL Standard Operating Procedures
Can people with insurance or veterans receive a mobile assessment?
Absolutely, they have access to the BMCRS services as all callers
Should I document my attempts to follow-up with a caller?
Absolutely, we want to note the day and time and if contact was made.
If I think an active rescue is necessary, do I need to tell anyone?
Absolutely, you need to notify a supervisor who will advise you on next steps while you remain on the phone with the caller. These next steps may include getting a colleague to engage 911 or to conference in 911 with the caller on the line.
What are the dispatch levels for MCRS?
Level 1 - Law Enforcement Leads (with Mobile Crisis Team Accompanying or Following Behind) Level 2- Mobile Crisis Team Leads (with Law Enforcement in the Background or Following Behind but on the Scene) Level 3- Mobile Crisis Team Lifeline (Law Enforcement on Standby by Phone) Level 4- Mobile Crisis Team Alone (With no Law Enforcement) Level 5- Dispatch to a Safe-Setting
Does the caller (or individual in need have to consent for an active rescue)?
No, if their life (or someone else's) is in danger we have an obligation to intervene.
What is the typical time a mobile assessor has to arrive at the location of the person in need of an assessment?
All transit times for the month are expected to average out to an hour, but arrival times will vary due to the number of dispatches at any given time, complications that may arise with a dispatch that could lengthen the time or cancelation of a dispatch that could shorten the arrival time - GCAL has no control of arrival times, and should tell callers only that the Mobile team will be reaching out them to let them know what to expect in terms of arrival time.
What is Active Rescue?
An active rescue involves calling 911 and getting the help of police or EMS because the caller or an individual the caller is calling for is having a medical emergency (overdose, withdrawal, or other medical emergency) or is at imminent risk of harm to themselves or others, which includes, but not limited to, suicide or homicide.
What if a caller shares they were recently sexually or physically abused and/or have been exploited?
GCAL staff are "mandated reporters" which means you must follow the protocol to notify the appropriate protective services if under 18, physically/mentally disabled, or over the age of 65.
What is a BHCC?
A BHCC is a Behavioral Health Crisis Center that allows 24/7 walk in capacity and is used for people needing urgent care.
What is considered a non-safe/secure setting?
A home, park, on the street, a restaurant, bus/train station, and a parking lot/car lot among others.
What is considered a safe/secure setting?
A safe setting is setting where a person in crisis is unable to leave without a plan for next steps for example - Jail/hospital staff, schools, and law enforcement (LE) requesting BMCRS when LE informs will remain on scene
Should I call law enforcement to do a "wellness check"?
We do not initiate wellness checks but we can encourage TPCs to call for one on their own or we can offer to connect them with LE dispatch per their request so they can make that request.
Does the Mobile Assessment require the individual to be voluntary and consent for care?
While consent and participation is desired, a team can be dispatched based on report of third party who can provide access to individual if risk is present.
Are there other behavioral health providers in addition to CSBs in Georgia?
Yes, the Georgia department of Behavioral Health funds many other providers but they may not serve all of the same populations or provide all the services offered by a CSB.
If a family member of an adult caller (that you or another staff just helped) asks you for information about the call what can you provide?
You cannot confirm that GCAL had contact with the caller (unless the caller is a parent of a minor), but you can explain processes, and what happens when GCAL gets a call.
If a caller is engaged in services but calls GCAL after hours for support or due to a crisis what actions do I take?
a. Proceed with the call screening and (and risk assessment if needed) and follow the same protocol to determine if active rescue or mobile assessment is needed. b. If the person is seeking support until they can get to their provider, offer support over the phone and also refer them to peer warm lines.
Secure and Unsecure Settings
a. Professional (Law Enforcement, provider, school, jail) b. Non-Professional (Family, Friends, etc.)
What is a CSB?
CSB's (Community Service Boards) are behavioral health centers (over 20) across the state with a comprehensive array of community-based outpatient and crisis services.
If a caller answers Yes to any of the risk screening questions what action would the crisis counselor take?
Complete a more thorough risk assessment to determine acuity of crisis and appropriate linkage.
If a caller says Yes to the suicide screening question, and says they have a gun or a bottle of pills nearby, what actions do you take?
Consult a supervisor immediately for assistance with a possible Active Rescue, however, it is also important to ask additional questions to determine the necessity of an AR.
How will I know if Active Rescue is Appropriate?
If the caller answers yes to any of the screening questions below or is suicidal with immediate access to lethal means (gun, pills, jumping etc): a. Do you (or the person you are calling about) need an ambulance/immediate medical attention? b. Have you (or the person you are calling about) hurt yourself or taken anything - pills, poison, etc. - that would require immediate medical attention? c. Are you (or the person you are calling about) experiencing urgent medical problems associated with the use of or withdrawal from drugs or alcohol (examples may include Hallucinations, confusion, chest pain, seizures? d. Are you alone at this moment? If they say to any of the questions above but are not alone then are we saying an active rescue is not warranted?
A parent calls about their child/adolescent requesting a return to school assessment. What actions would the care/peer supporter take?
If the child/adolescent is NOT in an acute crisis that would warrant an active rescue or BMCRS referral, refer them to the local CSB or core provider for assistance.
Once a risk screening or risk assessment has been completed, why is it important to ask the caller if they have insurance or if they are a Veteran before making a referral to services?
Individuals with insurance or veterans have access to additional Behavioral Health services that a person without insurance or with Medicaid does not.
When is a caller referred to outpatient Behavioral health services what usually happens?
The provider or agency will conduct a thorough assessment and make recommendations for one or several of the following interventions: i. Medication management ii. Individual counseling iii. Group counseling iv. Case Management v. Peer Supports vi. Potentially housing services vii. If appropriate, admission to a Crisis Stabilization Unit
When is the risk assessment completed?
The risk assessment is completed when a caller answers Yes to any of the screening questions asked by the crisis counselor.
What is the purpose of the risk assessment?
To provide a more in-depth assessment weighing current presentation with supports, history, and risk to best determine next steps for that caller.
What is the purpose of the risk screening?
To rapidly identify a medical emergency or imminent risk of harm to self or others and initiate actions based on their responses.
If a caller from a safe/secure setting calls for help for placement (to a crisis bed) what action should the Crisis Counselor take?
Transfer the call to the PPOE queue for bed board placement.
Are BHCC's available to all callers?
Unfortunately, there is a limited number of BHCC's and typically will serve only consumers who live in the county where it is located, so they are not available to every caller unless they want to travel a longer distance, but you should attempt to find one near a caller with urgent needs. Not available to IND's with private insurance that has MH benefits.
If you are not sure if someone needs active rescue, mobile dispatch, or an urgent outpatient appointment, what information should you be prepared to present for a case consultation?
Your recommendation based on the mobile dispatch and/or active rescue decision tree and the following information may also be needed o Name/Age/Sex of individual needing services o If TPC is calling, what is their relationship to the individual they are calling about o Region o Risk Factors (SI/HI/Psychosis/SIB/SA) o Current MH behaviors/symptoms/Dx o Past suicide attempts (when/method) o Previous episodes of HI/psychosis relating to current crisis o OP resources/Supports o Any intervention/linkage attempted
What does AIM stand for and when should it be done?
a. Action Items Monitor b. Follow up is appropriate for a caller who hangs up or gets disconnected if there is concern for risk but they do not meet criteria for an AR c. Follow up is appropriate for a person who is having thoughts to harm themselves or others or having active psychosis. d. Invite them to call back if they change their mind
Following a risk assessment by a crisis counselor list at least 6 possible dispositions based on the acuity of the individual (emergent, urgent and routine).
a. Active Rescue b. Walk in to Emergency Room c. CSU/BHCC or Inpatient d. Mobile Assessment e. Outpatient walk-in or urgent appointment f. Peer warm support lines g. 211 or other ancillary supports h. Support only -no linkage if caller declines and AR is not indicated
If a caller answers "yes" to questions asked on a risk screening what three actions could occur (depending on the questions)?
a. Active rescue b. Mobile dispatch and create a safety plan c. Conduct a risk assessment and create a safety plan
How do I handle callers who want to make a complaint?
a. Any call agent can process a complaint call b. All complaints are viewed by Quality Management c. All complaints are tracked and documented in CCID d. If not resolvable on a direct level, the complaint is addressed by a supervisor e. Confidentiality and privacy rules always apply f. Search the consumer record in CCID. Ensure that the caller episode retrieved is the one the person is complaining about g. Be sure to give confidentiality statement and follow standard procedures for taking a call h. In the note section of CCID, document: "View linked complaint."
"Appropriate disposition" for the Crisis Counselor completing the risk assessment consists of 3-4 components, what are they?
a. Based on screening and assessment, the level of acuity was accurately assigned resulting in a referral to: Active Rescue, Referral to ER, Mobile Dispatch, BHCC, Urgent walk in at clinic, Routine walk in at clinic, or Individual refuses options above. b. Safety steps were identified for individuals presenting with urgent acuity and waiting for BMCRS Dispatch, refused crisis services, waiting for urgent walk-in appointment or detox awaiting in the community. c. If safety steps were necessary, they were clearly documented?
Where do I find behavioral health outpatient referral options?
a. CCID Choice Tab b. https://www.georgiacollaborative.com/ i. Select "Individuals & Families" from the menu bar to access the options ii. Select "Find a Provider" iii. Enter zip code and click the magnifying glass to start the search iv. Refine the list by selecting applicable options from the filters on the left-hand side navigation panel
What is the three-step process of gathering information to help a caller that starts and ends with the crisis counselor?
a. Call Screening b. Risk Screening c. Risk Assessment
A TPC calls about an individual with an intellectual disability requesting mobile assessment. What actions would the Crisis Counselor take?
a. Complete Call Screening Risk Screening and Risk assessment b. Complete Mobile Crisis assessment questions c. Indicate the DD Diagnosis (ASD or IDD) in Disability and/or Primary Presentation d. Dispatch Mobile Assessment e. Ensure that the primary presentation is selected as ASD (if autism dx is present) if another developmental disability then select IDD as primary presentation
A parent calls about their child/adolescent requesting a mobile assessment. What actions would the Crisis Counselor take?
a. Complete Risk assessment b. Dispatch Mobile Assessment
A parent calls about their child/adolescent due to one or several of the following: behavioral issues, mood (depression/anxiety), substance use, etc. What actions would the Crisis Counselor take?
a. Complete Risk screening and follow Yes/No protocol in order to determine if a risk assessment is necessary. b. If parent/adolescent answers No to all screening questions, go through the Behavioral Problem in the triage section in the clinical mental health tab in CCID, describe mobile assessment, offer mobile assessment and Dispatch Mobile Assessment if caller requests it. c. If parent/adolescent answers No to all screening questions and declines mobile assessment then provide outpatient referral.
A TPC calls the unknown queue about an individual with an intellectual disability due to behavioral issues What actions would Crisis Counselor take?
a. Complete Risk screening and follow Yes/No protocol in order to determine if a transfer to a Crisis Counselor is appropriate. b. If TPC answers No to all screening questions, describe mobile assessment, offer mobile assessment and Dispatch Mobile Assessment if caller requests it. c. If the TPC answers No to all screening questions and declines mobile assessment then provide outpatient referral and provide DBHDD Regional contact number to see about completing an application for additional services. d. If they request mobile dispatch follow the normal protocol for dispatching mobile. e. If the TPC declines mobile assessment then provide outpatient referral.
If law enforcement/911 dispatcher calls requesting help for an individual in the community, what actions would the crisis counselor take?
a. Complete as much of the risk screening as possible based on information provided by the TPC (Law Enforcement/911 dispatcher may not have many details). b. Document who you are receiving the information from and the relationship to the IND. c. Dispatch Mobile if LE/911 dispatcher requests.
How do I handle prison calls?
a. Complete the call screening only (noting a prison call), unless the caller is expressing thoughts of suicide then complete the risk screening as well. b. If they are expressing thoughts of suicide, follow the protocol to notify prison authorities. Since any intervention will occur by prison staff, we would not perform active rescue or dispatch mobile assessment team. c. It is not uncommon that individuals are looking for "someone to talk to". We can provide a number to the Georgia Peer lines, but your time on the phone with them should be limited since this may prevent other people in crisis from getting help. d. We do not, under any circumstances, transfer prison inmates to other numbers. e. When an inmate requests a transfer, please attempt to assess risk and advise them that we cannot transfer them to another number. f. A sample response would be: "I cannot transfer you to another number, but I will be happy to see how I can assist you today.
Before dispatching a mobile team what actions do I need to take?
a. Complete the mobile dispatch risk assessment which gathers information about the safety of the environment and can determine the dispatch level. b. Confirm contact information (phone # and name of individual to be contacted) and location address to ensure the Mobile Team receives the correct information for where to go and who to contact c. Go over safety steps to ensure the caller/IND knows what steps to take to manage the scene until the team arrives or if they need to call back. d. If dispatching to a location other than the home address listed on the Demographics tab, make sure the crisis location address is filled out on the TPC tab and the button: "Is the individual who is needing service at this location (check if yes)' is checked BEFORE you hit dispatch on the Choice Tab
If a TPC calls about a person in crisis in a non-safe setting (doctors office, home, BH provider, in the community (street, park etc) what action should the Crisis Counselor take if the person in crisis is available?
a. Crisis Counselor attempts to speak to the individual in crisis in order to complete the risk screening. In the case that IND is a minor, experiencing psychosis, violent, intoxicated, etc., assessment with TPC is preferred to determine if AR, MCT, or other linkage is appropriate. b. If individual in crisis does not need active rescue but provides yes answers to risk screening ask additional risk assessment questions as appropriate c. Crisis Counselor completes risk assessment to determines mobile dispatch or referral to local provider.
If a TPC is calling about an individual whose location is unknown/can't be confirmed and there is no contact information for individual what actions does the crisis counselor take?
a. Crisis Counselor keeps the call b. Do not complete the risk screening c. Provide support and information about how we can help the individual once they are located (either by a phone assessment or mobile dispatch).
If a TPC calls about an individual that is physically out of state and the location is unknown or can't be confirmed, what action would the Crisis Counselor take?
a. Crisis Counselor keeps the call b. Provides information on Call Center in that area or state, if applicable c. Provide support and information about how we can help the individual once they are located
"Appropriate disposition" for the Crisis Counselor completing the risk screening consists of 4-5 components, what are they?
a. Did staff follow appropriate protocol based on responses to Screening? b. If any "Yes" responses, a brief description was documented. c. If TPC, was call handled as per instructions for Third Party Callers? d. If call resulted in linkage to outpatient services or supports, staff reinforced benefits of treatment or referral
"Good contact" consists of 4-5 components, what are they?
a. Did staff obtain Name and Ph #, DOB, and create new Consumer OR Episode as appropriate? b. Did staff elicit or allow caller to provide brief reason for call using open ended questions? c. At least one empathetic statement is made reflecting the emotions of the caller. d. Staff makes a statement that instills hope through the use of an affirmation. e. Staff conveyed a compassionate and caring attitude in their tone of voice and words.
What happens if a caller states they are not interested in seeking treatment for a BH issue?
a. One of the most important things you do is provide support by listening in a non-judgmental way and educating the caller about options for help. Sometimes it takes callers time to think about their options before they are willing to act on them and it is OK if they chose to decline treatment. b. The only exception to this would be if a person was imminently suicidal, homicidal, or unable to care for themselves which could result in an active rescue.
What if I am just not sure what to recommend for a caller?
a. Don't underestimate the support you provide by listening and collaborating with the caller, even if they refuse to provide their name or other information. For many people, your support is all they want and need. b. If risk screening questions are all No, ask them if they are interested in receiving treatment, if yes refer to the nearest provider. c. Refer them to the Peer warm lines in addition to treatment. d. If they have other needs not related to Behavioral Health refer them to 211, travelers aid or other resources. e. If they said yes to risk screening questions (and the person is not in need of an active rescue) consider mobile assessment if they are willing. If they are not willing ask them for permission to speak to family or friends nearby who might be able to help convince them to obtain a mobile assessment or take them to a nearby provider for an outpatient assessment and treatment. f. If they have said Yes to screening questions consider a safety plan that removes anything they could use to harm themselves or others and elicit the support of family and friends that they can call. g. If the person is high risk for harming themselves and refuses all referrals consult a supervisor to determine if Active Rescue is appropriate. h. Offer them the option of calling back. i. Consult a supervisor after following the steps above.
What do I talk about with the caller during an Active Rescue?
a. Find ways help them talk about protective factors or things that would prevent them from taking their life. These include faith/religion, family/children, even pets. b. Ask them how they have overcome other challenges in their life and focus on those strengths and coping skills. c. Literally almost anything that will distract them and keep them engaged. This could be talking about their hobby or the latest episode of their favorite TV show or movie. Focus on topics that are either positives in the person's life or at least neutral. d. Show that you are listening by utilizing active listening techniques like mirroring and reflecting.
If a caller has insurance, what actions should I take?
a. If the case requires active rescue or mobile assessment provide services regardless of insurance. b. If the case is urgent offer to connect caller to local private inpatient hospitals c. If the case is not emergent, encourage them to access services by calling the number on the back of their insurance card. d. If case is routine offer to connect to outpatient providers on choice tab. If there are no providers in the area listed or the distance is too far, advise of ability to contact insurance company and to look on psychologytoday.com to locate private providers.
If a TPC calls about a person in crisis in a non-safe setting (doctors office, home, BH provider, in the community (street, park etc) what action should the Crisis Counselor take if the person in crisis is NOT available?
a. If the individual in crisis is not able or available to answer screening questions, Crisis Counselor completes risk screening based on information provided by the TPC. b. If TPC response to screening questions is a yes AND individual location is known dispatch mobile. Staff need to ensure that the TPC is an adult and is with the individual or that staff are able to speak with an adult who is with the individual c. If TPC is unable to answer screening questions or provides no answers encourage TPC to engage person in crisis to call GCAL or contact LE if the person is in danger or a threat of harm to themselves or other.
"Setting up the call" consists of two components, what are they?
a. Informed of monitoring and recording, confidentiality and consent requested b. Informs caller what will happen/Explains the process
"Accurate Assessment" for the Crisis Counselor completing the risk assessment consists of 3 components, what are they?
a. Minimum necessary assessment questions are completed. (Less than 24 hours since last call - If risk screening was not previously completed then all screening questions are asked. If screening questions were asked, complete lethality assessment and/or substance abuse assessment completed, if indicated as necessary by screening questions.) b. Additional clinical questions asked to better understand current circumstances/presentation based on caller's responses to the minimum necessary assessment questions." c. Documentation is accurate, reflective of the call, and correctly organized.
If an individual calls requesting detoxification or treatment from substances what actions would you take?
a. Provide education about withdrawal symptoms listed below. b. Encourage them to go to the nearest emergency room or call 911 if they are experiencing withdrawal symptoms such as fast heart rate, headache, insomnia, agitation, sweating, nausea, vomiting, blood in stool or vomit, feeling things that are not there such as skin crawling or insects, shaking so bad unable to hold a glass of water, disorientation, DT's, seizures, and hallucinations. c. Refer them to a BHCC if one is in their area. d. Refer them to the nearest CSB or provider for an assessment and potential admission to their CSU (Crisis stabilization unit). e. Refer them to the CARES warm line for peer support.
If a caller answers No to all of the risk screening questions what action would the crisis counselor take?
a. Provide support but a risk assessment would not be necessary b. Refer to outpatient services, c. Provide ancillary support services such as the Peer Warm lines or 211.
Crisis Counselor calls are monitored using a quality review document, what are the four domains that are reviewed?
a. Setting up the call b. Good Contact c. Assessment d. Appropriate Disposition
What are the five life-threatening risks a person in crisis can experience?
a. Suicide/Self Harm b. Homicide/Harm to Others c. Psychosis or voices that instruct the person to harm self or others. d. Withdrawal from alcohol and certain drugs e. Medical emergency (e.g. Cardiac Arrest, Stroke, Diabetic Ketoacidosis, etc.)
The American Association of Suicidology describes three primary functions of a crisis call center as?
a. Support b. Screen/Assess c. Refer
If the caller refuses to answer the screening questions, or is vague about their response, how should the Crisis Counselor proceed?
a. Take the time to listen to the caller's needs b. Make reflection and mirroring statements to clarify how are they feeling and why. c. Ask them what they are seeking from today's call? d. Be flexible, but circle back to the questions (asking them in a slightly different way) after the caller has had time to share their story. For instance, "I can understand you are going through a difficult time, for some people experiencing similar challenges suicide can become an option, are you thinking about suicide now?" e. After first attempting all of the above, if still concerned about caller, consult with Supervisor.
What is the purpose of the call screening?
a. To determine if GCAL staff can help the caller. b. To screen out wrong numbers, administrative calls, etc. c. To increase efficiency by providing a quick exit ramp while still gathering some information.
How many times should I attempt to follow up with a person who meets the criteria for AIM?
a. Typically, around 3 attempts depending on the level of risk/acuity. b. Depending on level of acuity, we may want to consult with a supervisor to consider mobile dispatch if location is known.
What should guide my decision to dispatch mobile versus refer to local outpatient services?
a. When the condition of a person in crisis warrants rapid intervention (may be outside of business hours when an outpatient clinic is closed). b. When Active Rescue is not required and the person in crisis can be supported by third party for a dispatch time frame of up to one hour. c. Certain populations (such as IDD and Children/Adolescents) are offered mobile when on site de-escalation is necessary. d. A caller may have been previously referred to outpatient care but failed to follow through and is in crisis again. e. Refer to outpatient, if the person is engaged with a provider telephonic support may be sufficient until they can get back to the clinic. f. In Georgia, a mobile team is not dispatched for someone with only drug or alcohol intoxication or requesting detox. In this case either a referral to an emergency room and local provider occurs along with education.
