CA-CRI Standard. Generated 12/04/2022. ©2022 Council on Accreditation.
2022 Edition

Crisis Response and Information Services Definition

Purpose

Crisis Response and Information Services operate as part of the community's crisis response system to provide immediate, dependable responses and reliable information to promote safety and stability for the individual in crisis.

Definition

Crisis Response and Information Services are immediate methods of intervention that can include stabilization of the person in crisis, counselling and advocacy, and information and referral, depending on the assessed needs of the individual. Services may be provided via telephone 24-hours a day, on a walk-in basis during regular business hours, by mobile unit, or by telephone referral. Crisis Hotline Services establish immediate communication links and provide supportive interventions for people in critical or emergency situations.

Interpretation

Stabilization is a combination of methods used to return the service recipient to his or her pre-crisis level of functioning, including:
  1. identifying the precipitating event;
  2. mobilizing support and resources;
  3. identifying coping skills; and
  4. developing plans to ensure safety.
Note: An organization that provides education and support groups as part of its Crisis Response and Information Service will also complete the Counselling, Support, and Education Services section.

Note: Please see CA-CRI Reference List for the research that informed the development of these standards.

Note: For information about changes made in the 2020 Edition, please see the CRI Crosswalk.
 
2022 Edition

Crisis Response and Information Services (CA-CRI) 1: Person-Centered Logic Model

A program logic model, or equivalent framework, identifies:
  1. needs the program will address;
  2. available human, financial, organizational, and community resources (i.e. inputs);
  3. program activities intended to bring about desired results;
  4. program outputs (i.e. the size and scope of services delivered); 
  5. desired outcomes (i.e. the changes you expect to see in service recipients); and
  6. expected long-term impact on the organization, community, and/or system.

Interpretation

COA recognizes that it may be difficult to track client outcomes given the nature and duration of CRI services. If client outcomes are not being tracked, the organization must be prepared to demonstrate how program-level outputs are being used to build capacity, improve programs, and have a positive impact on persons served. Additionally, the organization may speak to how it uses community-wide outcomes data collected by outside entities to make data-informed decisions within its program when appropriate.
Examples: Please see the W.K. Kellogg Foundation Logic Model Development Guide and COA’s PQI Tool Kit for more information on developing and using program logic models.

Examples: Information that may be used to inform the development of the program logic model includes, but is not limited to: 
  1. needs assessments;
  2. risk assessments; and
  3. the best available evidence of service effectiveness.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.

Logic models have been implemented for all programs and the organization has identified at least two outcomes for all its programs.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • Logic models need improvement or clarification; or
  • Logic models are still under development for some of its programs, but are completed for all high-risk programs such as protective services, foster care, residential treatment, etc.; or
  • At least one client outcome has been identified for all of its programs; or
  • All but a few staff have been trained on use of therapeutic interventions and training is scheduled for the rest; or
  • With few exceptions the policy on prohibited interventions is understood by staff, or the written policy needs minor clarification.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Logic models need significant improvement; or
  • Logic models are still under development for a majority of programs; or
  • A logic model has not been developed for one or more high-risk programs; or
  • Outcomes have not been identified for one or more programs; or
  • Several staff have not been trained on the use of therapeutic interventions; or
  • There are gaps in monitoring of therapeutic interventions, as required; or
  • There is no process for identifying risks associated with use of therapeutic interventions; or
  • Policy on prohibited interventions does not include at least one of the required elements.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • Logic models have not been developed or implemented; or
  • Outcomes have not been identified for any programs; or
  • There is no written policy or procedures for the use of therapeutic interventions; or 
  • Procedures are clearly inadequate or not being used; or
  • Documentation on therapeutic interventions is routinely incomplete and/or missing; or
  • There is evidence that clients have been harmed by inappropriate or unmonitored use of therapeutic interventions.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • See program description completed during intake
  • Program logic model that includes a list of outcomes being measured
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
 
2022 Edition

Crisis Response and Information Services (CA-CRI) 2: Personnel

Program personnel have the competency and support needed to provide services and meet the needs of persons served.

Interpretation

Competency can be demonstrated through education, training, or experience. Support can be provided through supervision or other learning activities to improve understanding or skill development in specific areas.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,  
  • With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised; or
  • Supervisors provide additional support and oversight, as needed, to the few staff without the listed qualifications; or 
  • Most staff who do not meet educational requirements are seeking to obtain them; or 
  • With few exceptions, staff have received required training, including applicable specialized training; or
  • Training curricula are not fully developed or lack depth; or
  • Training documentation is consistently maintained and kept up-to-date with some exceptions; or
  • A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies when needed; or
  • With few exceptions, caseload sizes are consistently maintained as required by the standards or as required by internal policy when caseload has not been set by a standard; or
  • Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services and are adjusted as necessary; or
  • Specialized services are obtained as required by the standards.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards.  Service quality or program functioning may be compromised; e.g.,
  • A significant number of staff (direct service providers, supervisors, and program managers) do not possess the required qualifications, including education, experience, training, skills, temperament, etc.; and as a result, the integrity of the service may be compromised; or
  • Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur; or 
  • Supervisors do not typically provide additional support and oversight to staff without the listed qualifications; or
  • A significant number of staff have not received required training, including applicable specialized training; or
  • Training documentation is poorly maintained; or
  • A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies; or
  • There are numerous instances where caseload sizes exceed the standards' requirements or the requirements of internal policy when a caseload size is not set by the standard; or
  • Workloads are excessive, and the integrity of the service may be compromised; or 
  • Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or
  • Specialized services are infrequently obtained as required by the standards.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • List of program personnel that includes:
    • Title
    • Name
    • Employee, volunteer, or independent contractor
    • Degree or other qualifications
    • Time in current position
  • See organizational chart submitted during application
  • Procedures for accessing supervisory support
  • Table of contents of training curricula
  • Debriefing procedures
  • Sample job descriptions from across relevant job categories
  • Formal agreements with necessary professionals, as applicable
  • Documentation tracking staff completion of required trainings and/or competencies
  • Training curricula
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files

 

CA-CRI 2.01

Direct service providers are selected for their ability to handle stressful situations and for qualities such as maturity, judgement, and alertness to warning signs of potential crisis.

 

CA-CRI 2.02

Direct service providers work under the supervision of trained professionals who meet the applicable legal requirements for practice within their professions.

 

CA-CRI 2.03

At all times when the program is in operation:
  1. an individual with an advanced degree in human services and appropriate certification and/or licensure by the designated authority in their province is available to provide clinical supervisory guidance to direct service personnel; 
  2. crisis hotline personnel have immediate access to clinical supervision, when applicable; and
  3. procedures outline how to access this clinical support.

Interpretation

This support may be available on staff, through on-call consultation, or through a formal arrangement with a social service organization.

 

CA-CRI 2.04

Prior to coming in contact with the service population, direct service personnel are trained on, or demonstrate competency in:
  1. assessing for and responding to suicide risk;
  2. special issues regarding age, substance use and mental health conditions, developmental disabilities, and other needs typically presented by the service population;
  3. prevention of compassion fatigue or “burn-out;"
  4. procedures for making referrals to, or providing information on, community resources;
  5. interview techniques;
  6. handling emergencies including assessing needs in crisis situations, de-escalation techniques, and situations that may require consultation with supervising or cooperating professionals or the police; 
  7. laws governing disclosure of suspected abuse or other criminal behaviour; 
  8. organization policy reconciling the principles of consumer confidentiality and the requirements of the law; and
  9. documentation requirements.

 

CA-CRI 2.05

Supervisors are trained on, or demonstrate competency in: 
  1. helping direct service personnel process and debrief following a crisis or traumatic event;
  2. building and maintaining morale;
  3. providing constructive ways for direct service personnel to approach difficult situations with service recipients; and 
  4. facilitating a structure for ongoing communication and collaboration among personnel.

 

CA-CRI 2.06

To minimize compassion fatigue and rapid turnover, the organization offers a standardized debriefing process for all service personnel.

 

CA-CRI 2.07

Employee workloads support the achievement of service recipient outcomes and are regularly reviewed.
Examples: Factors that may be considered when determining employee workloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker including level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of needs of persons served.
 
2022 Edition

Crisis Response and Information Services (CA-CRI) 3: Intake and Assessment

The organization screens and assesses individuals promptly and responsively to efficiently determine urgency of need and ensure access to needed services.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • In a few rare instances, urgent needs were not prioritized; or
  • For the most part, established timeframes are met; or
  • Culturally responsive assessments are the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Urgent needs are often not prioritized; or 
  • Services are frequently not initiated in a timely manner; or
  • Applicants are not receiving referrals, as appropriate; or 
  • Assessment and reassessment timeframes are often missed; or
  • Assessments are sometimes not sufficiently individualized; 
  • Culturally responsive assessments are not the norm, and this is not being addressed in supervision or training; or
  • Several client records are missing important information; or
  • Client participation is inconsistent; or
  • Intake or assessment is done by another organization or referral source and no documentation and/or summary of required information is present in case record. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • There are no written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Screening and intake procedures
  • Risk assessment procedures
  • Copy of risk assessment tool
  • Copy of comprehensive suicide risk assessment tool
  • Outreach and informational materials
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-CRI 3.01

The organization provides information about:
  1. hours of operation; 
  2. how to access the organization’s services; and
  3. whether crisis services have a particular focus (e.g. mental health or rape crisis intervention).

 

CA-CRI 3.02

Individuals are screened and informed about how well their request matches the organization’s services.
NA Another organization is responsible for screening, as defined in a contract.

 
Fundamental Practice

CA-CRI 3.03

Prompt, responsive intake practices:
  1. gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary; and
  2. support timely initiation of services or an appropriate referral when individuals cannot be served, or cannot be served promptly.

 
Fundamental Practice

CA-CRI 3.04

An ongoing, rapid risk assessment is conducted in a culturally and linguistically responsive manner to determine:
  1. if the individual is in imminent danger;
  2. potential lethality including harm to one’s self or others and risk for suicide;
  3. the individual’s emotional status and imminent psychosocial needs;
  4. individual strengths and available coping mechanisms; and
  5. resources that can increase service participation and success.

Interpretation

Some crisis intervention services, such as mobile crisis units, should include a more thorough psychosocial assessment. This is likely to occur when the treatment provided is much more extensive including the prescribing of medication by a physician.

Interpretation

The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.

 
Fundamental Practice

CA-CRI 3.05

The organization uses a comprehensive, evidence-based suicide risk assessment tool to assess the following when suicide risk is identified: 
  1. suicidal desire;
  2. capability;
  3. intent; and
  4. buffers/protective factors.
 
2022 Edition

Crisis Response and Information Services (CA-CRI) 4: Crisis Intervention Services

The organization responds immediately and appropriately to individuals in crisis situations.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Action planning procedures
  • Safety planning procedures
  • Treatment and referral procedures
  • Supervisory review procedures
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

CA-CRI 4.01

Crisis intervention personnel respond immediately and:
  1. provide intervention and stabilization;
  2. work with the person to develop an action plan;
  3. work with the person to develop a safety plan, as needed, once it has been determined that no immediate emergency intervention is required;
  4. never utilize “no suicide contracts” or “no-harm contracts;"
  5. refer or connect individuals with appropriate resources; and
  6. follow up with each person within 24 hours, when appropriate.

Interpretation

A safety plan includes a prioritized written list of coping strategies and sources of support that individuals who have been deemed to be at high risk for suicide can use. Individuals can implement these strategies before or during a suicidal crisis in order to prevent a suicide attempt or possibly death. Components of a safety plan can include: recognition of warning signs, internal coping strategies, socialization strategies for distraction and support, family and social contacts for assistance, professional and agency contacts, and lethal means restriction.

Interpretation

No-suicide contracts are based on a verbal or written agreement by the service recipient to not engage in self-harm or suicidal acts during a specific timeframe. Research does not support this practice or show that these agreements are effective at preventing suicides, nor have they been found to provide protection against malpractice lawsuits.

Interpretation

In cases of individuals at risk for suicide, every effort should be made to follow up within 24 hours after the initial contact.
Examples: Follow-up can be by telephone, non-identifiable postcards, emails, or text messages. Contacts can be brief, tailored to the individual’s needs, and focused on continued assessment of risk.

 
Fundamental Practice

CA-CRI 4.02

Written procedures address the provision of treatment and referral when individuals are at risk of imminent harm, including situations involving victims of violence, individuals at risk for suicide, medical crises, and other emergencies.

Interpretation

When an individual calling a crisis hotline is considered to be at imminent risk for suicide, staff should have a written procedure directing them to: (1) practice “active engagement” to promote the caller’s collaboration in securing his/her own safety, (2) use the least invasive intervention and consider involuntary emergency interventions as a last resort, and (3) initiate “active rescue” (i.e., immediately dispatching emergency rescue interventions with or without the callers consent) if the caller remains unwilling and/or unable to take action on their own behalf. 

 

CA-CRI 4.03

Supervisory personnel review service interventions within 24 hours.
 
2022 Edition

Crisis Response and Information Services (CA-CRI) 5: Additional Requirements for Crisis Hotline Services

A functional system operates to provide an immediate response to individuals in crisis.
NA The organization does not provide crisis hotline services.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
No Self-Study Evidence
  • Coverage schedules for the previous six months
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Observe hotline operations including back up answering and dispatch system

 
Fundamental Practice

CA-CRI 5.01

Crisis hotlines operate 24 hours a day, seven days a week.

 
Fundamental Practice

CA-CRI 5.02

A live back-up answering service, or equivalent mechanism, is used when all incoming lines are busy.

 
Fundamental Practice

CA-CRI 5.03

The organization dispatches rescue and other services without disconnecting calls.
 
2022 Edition

Crisis Response and Information Services (CA-CRI) 6: Community Connections and Coordination

The organization establishes formal agreements with members of the community’s crisis response system, and procedures for service coordination in crisis situations.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Service coordination procedures
  • Written service agreements
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
    4. Community partners

 

CA-CRI 6.01

To ensure rapid and efficient access, the organization establishes procedures for working with emergency responders including:
  1. police and fire departments;
  2. hospital emergency rooms;
  3. mental and physical health crisis teams; and
  4. child and adult protective services.

 

CA-CRI 6.02

The organization has established protocols for working with local social service, mental health, and medical resources to facilitate referrals and service coordination and ensure rapid or priority access to services.

 

CA-CRI 6.03

The organization maintains, or has access to, a comprehensive and up-to-date list of community resources that includes:
  1. name, location, and telephone number;
  2. contact person;
  3. services offered;
  4. languages offered;
  5. fee structure; and
  6. eligibility requirements.
 
2022 Edition

Crisis Response and Information Services (CA-CRI) 7: Community Needs Assessment

The organization tracks information on community needs and the quality and availability of community resources.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for collecting and summarizing community needs
  • Procedures for evaluating referral resources
  • Summaries provided to the community during the previous six months
  • Data on service use for the previous six months
  • Quarterly reviews of quality data for the previous six months
  • Interviews may include:
    1. Program director

 

CA-CRI 7.01

The organization collects and periodically summarizes data on community needs and available resources, and shares summaries with the community.

 

CA-CRI 7.02

The organization monitors service quality by:
  1. collecting data on service use; 
  2. evaluating referral resources on an ongoing basis to assess the safety, quality, and effectiveness of services provided; and 
  3. reviewing quality data quarterly.
Examples: Evaluations of referral resources may be conducted through site visits or inquiries of the referral resource's reputation in the community.
Copyright © 2022 Council on Accreditation