Crisis Response and Information Services Definition
Purpose
Crisis Response and Information Services operate as part of the community's crisis response system to provide prompt responses and reliable information to promote safety and stability for individuals and families in crisis and avoid unnecessary emergency department visits, psychiatric hospitalizations, law enforcement involvement, and out-of-home placements.Definition
Crisis Call Services establish immediate communication links and provide supportive interventions for individuals and families in critical or emergency situations.
Mobile Crisis Response Services respond to individuals and families in crisis wherever they are and offer on-site assessment, intervention, de-escalation, stabilization, safety planning, and referrals. Services are provided in the least restrictive, community setting possible and can be designed to serve children, youth, and families or adults. Mobile crisis response services typically operate 24 hours a day, 7 days a week; however, hours may be limited in some communities based on funding, staffing, or other challenges.
Crisis Receiving and Stabilization Services provide a safe space for extended observation, de-escalation, and crisis intervention and serve as an alternative to hospitalization for individuals experiencing a behavioral health crisis. Length of stay may vary from several hours to several days. Crisis receiving and stabilization services may be provided within a community mental health clinic, general urgent care office, hospital, or as a stand-alone facility within the community and may be referred to as a crisis stabilization center, crisis observation unit, walk-in crisis clinic, community crisis center, or crisis hub.
Interpretation
Stabilization is a combination of methods used to return the service recipient to his or her pre-crisis level of functioning, including:
- identifying the precipitating event;
- mobilizing support and resources;
- identifying coping skills; and
- developing plans to ensure safety.
Interpretation
Level of family involvement in the crisis response process may vary based on the population served, program model/design, and the expressed wishes of individuals.Currently viewing: CRISIS RESPONSE AND INFORMATION SERVICES
Print-friendly view- PA-CRI - Definition
- PA-CRI 1 - Person-Centered Logic Model
- PA-CRI 2 - Personnel
- PA-CRI 3 - Intake and Assessment
- PA-CRI 4 - Crisis Intervention Service Elements
- PA-CRI 5 - Crisis Call Services
- PA-CRI 6 - Mobile Crisis Response Services
- PA-CRI 7 - Crisis Receiving and Stabilization Services
- PA-CRI 8 - Crisis Receiving and Stabilization Facilities
- PA-CRI 9 - Community Connections and Coordination
VIEW THE STANDARDS
Note: Crisis intervention services reviewed under PA-CRI are distinct from fully peer-delivered crisis services, which provide non-clinical types of counseling that offer guidance, coaching, community support, and skill building to individuals, families, and groups and are separately reviewed under Coaching, Support, and Education Services (PA-CSE).
Note: An agency that provides only Crisis Call Services will complete PA-CRI 1, PA-CRI 2, PA-CRI 3, PA-CRI 4, PA-CRI 5, and PA-CRI 9.
An agency that provides only Mobile Crisis Response Services will complete PA-CRI 1, PA-CRI 2, PA-CRI 3, PA-CRI 4, PA-CRI 6, and PA-CRI 9.
An agency that provides only Crisis Receiving and Stabilization Services will complete PA-CRI 1, PA-CRI 2, PA-CRI 3, PA-CRI 4, PA-CRI 7, PA-CRI 8, and PA-CRI 9.
Note: Please see PA-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.
Crisis Response and Information Services (PA-CRI) 1: Person-Centered Logic Model
Note: Please see the Logic Model Template for additional guidance on this standard.
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 1.01
A program logic model, or equivalent framework, identifies:
- needs the program will address;
- available human, financial, agency, and community resources (i.e. inputs);
- program activities intended to bring about desired results;
- program outputs (i.e. the size and scope of services delivered);
- desired outcomes (i.e. the changes you expect to see in persons served); and
- expected long-term impact on the agency, community, and/or system.
Examples: Please see the W.K. Kellogg Foundation Logic Model Development Guide and COA Accreditation’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:
- needs assessments;
- risk assessments; and
- the best available evidence of service effectiveness.
PA-CRI 1.02
The logic model identifies outcomes in at least two of the following areas:
- change in clinical status;
- change in functional status;
- connection to formal and informal support systems;
- health, welfare, and safety;
- achievement of individual service goals;
- community awareness of services provided or topics relevant to the service population; and
- other outcomes as appropriate to the program or service population.
Interpretation: Outcomes data should be disaggregated to identify patterns of disparity or inequity that can be masked by aggregate data reporting. See PA-PQI 5.02 for more information on disaggregating data to track and monitor identified outcomes.
Interpretation: COA Accreditation recognizes that it may be difficult to track individual outcomes given the nature and duration of some PA-CRI service models. If individual outcomes are not being tracked, the agency 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 agency may speak to how it uses community-wide outcomes data collected by outside entities to make data-informed decisions within its program when appropriate.
Crisis Response and Information Services (PA-CRI) 2: Personnel
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 2.01
Direct service providers are selected for their ability to handle stressful situations and for qualities such as maturity, judgment, empathy, respect for others, and their own personal lived experience.
PA-CRI 2.03
At all times when the program is in operation:
- an individual with an advanced degree in human services and appropriate certification and/or licensure by the designated authority in their state is available to provide clinical supervisory guidance to direct service personnel;
- personnel conducting clinical assessments have immediate access to clinical supervision, when applicable; and
- procedures outline how to access this clinical support.
PA-CRI 2.04
When staff with lived experience provide peer support to individuals and families, the agency:
- clearly defines their roles and responsibilities;
- includes peer support workers as equal partners on the team;
- helps other program personnel understand the position and its purpose at the program;
- establishes guidelines for recruitment and selection;
- ensures peer support workers are trained to perform their roles and responsibilities;
- provides ongoing support and supervision to address any issues that occur, including helping peer support workers manage personal triggers that may arise on the job;
- facilitates opportunities for peer support workers to connect and consult with others performing similar roles; and
- ensures peer support workers are offered opportunities for professional development, career advancement, and program planning activities.
NA The agency does not hire peer support workers.
Examples: Peer support workers can play an important role in welcoming, engaging, empowering, supporting, and advocating for individuals and families. Peer support workers often experience challenges in their employment including stigma from co-workers, inappropriate expectations from non-peer staff, role confusion, triggers from past trauma, and lack of opportunities for support and advancement. When they are viewed and included as full partners who have input into program decisions and are given appropriate support, peer support workers can help agencies ensure their culture and practices prioritize the experience and involvement of persons served and their families.
Examples: Agencies may use other terms to describe peer support workers, such as peer support specialists, peer/family/youth partners, peer/family/youth advocates, peer recovery coaches, family mentors, and/or family liaisons. The inclusion of peer support specialists can lead to increased engagement with the individuals served and can supplement the mental health workforce.
PA-CRI 2.05
There is at least one person on duty at each service delivery location any time persons served are present who has received first aid and age-appropriate CPR training in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.
NA The agency provides technology-based services only and staff never interact with persons served in any physical space.
PA-CRI 2.06
Prior to coming in contact with the service population, direct service personnel are trained on, or demonstrate competency in:
- the principles and practices of person-centered care;
- implementing a range of practices that promote a supportive and noncoercive environment;
- assessing for and responding to suicide risk;
- procedures for making referrals to, or providing information on, community resources;
- interview techniques;
- skills and strategies for engaging, partnering with, and supporting family members, when appropriate;
- 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;
- understanding the definitions of human trafficking (both labor and sex trafficking) and sexual exploitation, and identifying potential victims; and
- specialized skills related to chosen interventions.
Interpretation: Regarding element (i), specialized training should include techniques and best practices when utilizing text and chat functions, if applicable.
PA-CRI 2.07
Supervisors are trained on, or demonstrate competency in:
- helping direct service personnel process and debrief following a crisis or traumatic event;
- building and maintaining morale;
- providing constructive ways for direct service personnel to approach difficult situations with service recipients;
- providing effective supervision for peer support staff, if applicable; and
- facilitating a structure for ongoing communication and collaboration among personnel.
PA-CRI 2.08
Personnel providing services in a group setting are trained on, or demonstrate competency in:
- establishing a supportive, nonjudgmental environment that promotes respectful interactions;
- engaging and motivating group members;
- helping participants develop skills and/or understanding relevant to the group’s area of focus;
- understanding group dynamics;
- leading discussions; and
- facilitating group activities.
NA The agency does not provide services in a group setting.
PA-CRI 2.09
The agency counteracts the development of compassion fatigue by:
- helping personnel understand how they can be impacted by stress, distress, and trauma;
- helping personnel develop the skills and behaviors needed to manage and cope with work-related stressors;
- encouraging respectful collaboration and support among co-workers;
- examining how the agency’s culture and policies can prevent the development of compassion fatigue;
- providing reflective supervision; and
- informing personnel about treatment services, as needed.
Examples: Regarding element (b), agencies can help personnel develop the skills and behaviors that will enable them to: (1) engage in positive thinking; (2) increase their self-awareness; (3) know their limits and needs; (4) practice self-compassion; (5) establish healthy boundaries; (6) effectively communicate about unrealistic and unspoken expectations; (7) identify and manage emotional triggers; (8) have difficult conversations with co-workers and supervisors; (9) practice brain-aware activities to stay regulated; and (10) take time for self-care.
Regarding element (d), areas to consider include, but are not limited to: (1) supervision; (2) caseload assignment; (3) scheduling; (4) training; (5) crisis response; (6) psychological safety; and (7) healthy and realistic staff expectations and boundaries.
PA-CRI 2.10
Employee workloads support the achievement of positive outcomes and are regularly reviewed.
Examples: Factors that may be considered when determining employee workloads include, but are not limited to:
- the qualifications, competencies, and experience of personnel including level of supervision needed;
- the work and time required to accomplish assigned tasks and job responsibilities; and
- service volume, accounting for assessed level of needs of persons served.
Crisis Response and Information Services (PA-CRI) 3: Intake and Assessment
The agency assesses individuals promptly and responsively to efficiently determine urgency of need and ensure access to needed services
Interpretation: As noted in PRG 1, case record documentation in some PA-CRI programs, such as rape crisis or victim services, will typically be limited to essential information. Peer reviewers should take this into account when reviewing records and may rely more heavily on other evidence (e.g., policies, procedures, and/or interviews) when assigning standards ratings.
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 3.01
The agency provides the community with information about:
- what services the agency offers;
- hours of operation;
- how to access the agency's services; and
- whether crisis services have a particular focus (e.g. mental health or rape crisis intervention).
PA-CRI 3.02
The agency provides services with little to no exclusionary criteria in an effort to remove barriers to accessing crisis care.
Interpretation: The agency’s screening and intake procedures should not wholly exclude individuals who are under the influence of substances, agitated, and/or otherwise difficult to engage.
Interpretation: The agency should not universally require all individuals to receive a medical clearance from a hospital emergency department before receiving services or automatically turn away first responders who are attempting to drop off individuals in crisis who have not been medically cleared.
PA-CRI 3.03
Prompt, responsive intake practices:
- gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
- appropriately triage urgent needs and emergency situations; and
- support timely initiation of services or an appropriate referral when individuals cannot be served, or cannot be served promptly.
Interpretation: Regarding element (a), supplementary information may be obtained from the referral source, collaborating providers, family members, and/or others involved with the individual and family, in addition to the individual in need of services, when appropriate.
Interpretation: If an agency is unable to adequately meet the needs of an individual requesting services due to the program model design, the agency has a clear policy on how to properly refer the individual to appropriate services and how to respond or intervene in an emergency.
PA-CRI 3.04
Crisis intervention personnel conduct an individualized, trauma-informed, culturally and linguistically responsive assessment to determine:
- if the individual needs an immediate intervention for a medical need, suicide in progress, or other dangerous situation;
- potential lethality including harm to one’s self or others;
- the individual’s psychosocial needs and crisis precipitants;
- the individual’s strengths, available coping mechanisms, and supports;
- if the individual has co-occurring diagnoses or impairments; and
- if the individual has current and/or previous involvement with the behavioral health system.
Interpretation: Crisis call services may be unable to complete a full assessment of an individual in crisis; however, these services should make every effort to obtain the above information to make informed decisions regarding the appropriate level of care or referral options for the individual. Mobile crisis response services and crisis receiving and stabilization services should conduct a more thorough psychosocial assessment when the treatment provided is more extensive, including the prescribing of medication by a physician.
Interpretation: Regarding element (a), crisis call services with a behavioral health focus, including text and chat models, should specifically ask the individual if they have taken any action to harm themselves at the beginning of the call or text to determine if immediate intervention is needed before continuing the conversation. The intervention may or may not involve an involuntary emergency service intervention, which is only considered as a last resort.
Interpretation: Some crisis intervention programs, such as rape crisis and victim services, may conduct assessments with less emphasis on the individual’s mental health. In these cases, personnel should, at a minimum, understand how to recognize and intervene in a behavioral health emergency as required by PA-TS 2.04.
Interpretation: Personnel that conduct assessments should be aware of the indicators of a potential trafficking victim, including, but not limited to evidence of mental, physical, or sexual abuse; physical exhaustion; working long hours; living with an employer or many people in a confined area; unclear family relationships; a heightened sense of fear or distrust of authority; presence of older significant other or pimp; loyalty or positive feelings towards an abuser; inability or fear of making eye contact; chronic running away or homelessness; possession of excess amounts of cash or hotel keys; and inability to provide a local address or information about parents. Several tools are available to help identify a potential victim of trafficking and determine the next steps toward an appropriate course of treatment. Examples of these tools include but are not limited to, the Rapid Screening Tool for Child Trafficking and the Comprehensive Screening and Safety Tool for Child Trafficking.
Interpretation: The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA Accreditation's Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.
PA-CRI 3.05
The agency completes a comprehensive safety assessment when an individual expresses suicidal ideation using a combination of an assessment tool, the crisis intervention personnel’s professional judgment, and the individual’s input and active involvement, paying specific attention to their:
- suicidal desire;
- intent to die and any identified method and plan;
- suicidal capability, including history of attempts and available means; and
- buffers/protective factors.
Interpretation: Suicide risk assessment should be an engaging, collaborative process between the crisis intervention personnel and the individual that retains the individual’s autonomy and choice to the greatest extent possible. Over-reliance on a single, standardized suicide assessment tool to predict future suicidal behavior and risk level may not provide an accurate assessment of an individual's suicide risk. Individuals do not always accurately report suicidal ideation when asked, and suicidal desire and intent may vary widely at any given moment.
Crisis Response and Information Services (PA-CRI) 4: Crisis Intervention Service Elements
The agency responds immediately and appropriately to individuals or families in crisis situations.
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 4.01
Crisis intervention personnel respond immediately and work with the individual and/or family to:
- provide stabilization using de-escalation techniques;
- create an action plan; and
- develop or revise a safety plan, as needed, that does not include “no suicide contracts” or “no-harm contracts."
Interpretation: A safety plan includes a prioritized, written list of coping strategies and sources of support for individuals navigating a suicidal crisis. Individuals can implement these strategies before or during a suicidal crisis 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 protect against malpractice lawsuits.
PA-CRI 4.02
Written procedures address the provision of treatment and referral when individuals are at risk of imminent harm including situations involving suicide, medical crises, substance overdose or withdrawals, violence, and other emergencies.
Interpretation: When an individual calling a crisis call service 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 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 caller's consent) if the caller remains unwilling or unable to take act on their own behalf.
PA-CRI 4.03
The agency provides individuals, and their families when appropriate, with referrals to appropriate resources and, when the need for a higher level of care is identified, directly connects individuals to the correct level of care through collaboration with community providers.
PA-CRI 4.04
Survivors who wish to report sexual assault, exploitation, or other criminal acts are provided with the resources and support they need to do so.
NA The agency does not provide rape crisis intervention or other victim advocacy services.
PA-CRI 4.05
The agency works with survivors of sexual assault, exploitation, or other criminal acts to manage any legal needs they may have by:
- connecting them to appropriate legal resources;
- ensuring they are informed about their legal rights and options; and
Interpretation: The agency should be careful to ensure that the help it provides would not be classified as “legal advice” unless the personnel providing services are qualified legal professionals.
NA The agency does not provide rape crisis intervention or other victim advocacy services.
Examples: Support related to legal needs may include, for example: (1) facilitating communication between the individual and the courts and/or law enforcement, (2), providing accompaniment to investigation procedures and court proceedings, and (3) assisting with filing for crime victim compensation.
PA-CRI 4.06
The agency works with survivors of sexual assault, exploitation, or other criminal acts to manage any medical needs they request assistance with by:
- ensuring they are informed about their options within the medical system;
- offering accompaniment and emotional support during forensic exams and/or other medical appointments; and
- advocating on their behalf with medical personnel and other service providers and ensuring their rights are upheld.
NA The agency does not provide rape crisis intervention or other victim advocacy services.
PA-CRI 4.07
When services are provided in a group setting, the agency:
- involves participants in establishing agreed-upon guidelines and expectations, including expectations for confidentiality, at the outset;
- provides opportunities for participants to ask questions, share their thoughts and experiences, and learn from the thoughts and experiences of others;
- enables participants to build connections and develop relationships with others in the group;
- responds flexibly to the changing needs of group members; and
- schedules services with participants’ time commitments in mind, to the extent possible and appropriate.
NA The agency does not provide services in a group setting.
Examples: Guidelines and expectations can be designed to foster a non-judgmental environment that promotes trust, respect, and group cohesion.
PA-CRI 4.08
Crisis intervention personnel provide appropriate follow-up within 24 hours, when appropriate and in accordance with agency policy, to confirm that individuals were able to connect with the correct level of care.
Interpretation: In cases of individuals at risk for suicide, every effort should be made to follow up within 24 hours after the initial contact.
Interpretation: Some crisis intervention models, such as mobile crisis response services, may provide post-crisis stabilization services and additional follow-up for an extended period.
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 preferences, and focused on continued assessment of risk.
PA-CRI 4.09
Crisis Response and Information Services (PA-CRI) 5: Crisis Call Services
Crisis call services provide immediate telephonic crisis intervention services to all callers via phone, video call, text, and/or chat capabilities and coordinate connections to additional support and resources based on the individual’s needs and preferences.
NA The agency does not provide crisis call services.
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 5.01
Crisis call services operate 24 hours a day, seven days a week, 365 days a year.
PA-CRI 5.02
PA-CRI 5.03
When individuals need emergency response services, the agency:
- requests emergency response services without disconnecting callers;
- takes steps to ensure contact is made; and
- has procedures outlining what to do when emergency services are unable to contact the individual and how to document when personnel are unable to confirm if contact was made.
Examples: Steps to ensure contact was made may include: (1) remaining on the line with the individual until help arrives; (2) contacting emergency service providers or mobile crisis staff; or (3) contacting the individual’s formal or informal supports when possible and appropriate.
PA-CRI 5.04
When a third party contacts a crisis call service to report that another individual is at imminent risk of suicide, crisis intervention personnel:
- request information on the individual’s risk status, the third party’s relationship to the individual, and how to contact both the caller and the individual;
- offer to facilitate a three-way contact with the caller and the individual to attempt to intervene with the individual directly when appropriate; and
- assist the third party in taking action to reduce risk.
Examples: Regarding element (c), methods to reduce risk can include removing access to lethal means and/or remaining with the individual until they can receive assistance.
Crisis Response and Information Services (PA-CRI) 6: Mobile Crisis Response Services
Qualified mobile crisis response teams provide immediate family- or person-centered interventions in the homes and communities of persons served during and following a crisis.
NA The agency does not provide mobile crisis response services.
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 6.01
Mobile crisis response services provide a timely, in-person response to the location of the crisis, typically within one hour from the time of the request.
Interpretation: COA Accreditation recognizes that there may be instances where response times exceed one hour, particularly in rural and frontier communities. Additionally, while an immediate, in-person response is considered best practice, some agencies may utilize telehealth and other technologies in collaboration with law enforcement to deliver faster responses to individuals in crisis until the mobile crisis response team can arrive.
At the request of the person(s) served, the mobile crisis response team may schedule a response within 1-24 hours for needs the person identifies as non-emergent.
PA-CRI 6.02
Mobile crisis response teams:
- respond in person in teams of two; and
- include a clinician who is qualified by license or training in accordance with law and regulation to conduct clinical assessments, either on the in-person response team or immediately available via a telehealth platform.
Interpretation: The mobile crisis response team may be comprised of two individuals with lived experience responding in person.
Examples: Working in teams of two helps ensure the safety of the team members and individuals served, reduces the chances of law enforcement involvement, and is less likely to overwhelm individuals in crisis. Mobile crisis response teams can be comprised of clinical mental health professionals such as social workers, licensed professional counselors, nurses, and psychiatrists, as well as individuals with lived experience.
PA-CRI 6.03
Mobile crisis response services provide specialized services for children, youth, young adults, and families by:
- responding to a crisis as defined by the parent, caregiver, or youth;
- establishing partnerships with schools, child welfare agencies, legal systems, and other child-serving services;
- employing individuals who have specific training, credentials, and/or lived experience related to child and adolescent behavioral health;
- providing or connecting to ongoing stabilization services, if needed; and
- making a concerted effort to ensure that youth remain in their home when safe and appropriate, and only recommend or coordinate out-of-home placement or hospitalization when necessary to ensure the safety and well-being of the youth and their family.
NA The agency does not provide mobile crisis response services to children and youth.
Examples: Regarding element (d), some models, such as the MRSS model, provide in-home stabilization services for youth and families for up to eight weeks. In-home stabilization services may include components such as safety monitoring, caregiver education programs, family therapy, peer support, systems navigation, care coordination, and communication, conflict management, and coping skill-building. In-home stabilization services for children are considered the ideal, least restrictive intervention that offers services to both youth and caretakers without disrupting the youth’s placement; however, clinical personnel may determine that stabilization in a facility-based setting is in the youth’s best interest.
PA-CRI 6.04
Mobile crisis response services arrange for appropriate post-intervention support and follow-up provided directly and/or by referral.
Examples: Mobile crisis response services may provide post-intervention support and follow-up in several ways, including but not limited to: (1) reviewing options for continued behavioral health support and social service resources including those designed for specific populations as appropriate, such as veterans and LGBTQ individuals; (2) providing continued, short-term clinical interventions in the individual’s home or community; (3) coordinating warm-handoffs to ongoing facility-based care within the least restrictive setting as determined by a professional, clinical assessment; and (4) offering brief, telephonic or in-person check-ins to ensure that the individual has successfully transitioned to the appropriate level of care.
Crisis Response and Information Services (PA-CRI) 7: Crisis Receiving and Stabilization Services
Crisis receiving and stabilization services offer immediate access to crisis observation, monitoring, and short-term counseling delivered by a qualified team in a facility-based setting.
NA The agency does not operate a crisis receiving and stabilization service.
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 7.01
Individuals in crisis are accepted on a 24-hour basis without undue delays or barriers.
PA-CRI 7.02
A collaborative, multidisciplinary team with expertise related to the populations served is available 24 hours a day, seven days a week, and includes:
- a prescribing practitioner who provides medication management;
- clinicians qualified by license or training in accordance with law and regulation to conduct clinical assessments;
- a qualified medical practitioner readily available to conduct an initial health screening; and
- staff with lived experience to provide peer support.
Interpretation: Prescribing practitioners could include psychiatrists, psychiatric nurse practitioners, or physician assistants and may provide services as an employee, contractor, or through another formal arrangement either in-person or using telehealth platforms. There may be more than one psychiatrist providing coverage.
Interpretation: Qualified medical practitioner refers to a licensed physician, registered nurse, nurse practitioner, physician’s assistant, or other healthcare professional who is permitted by law and the agency to provide medical care and services without direction or supervision.
If the agency does not have a qualified medical practitioner on staff, it should research community resources and consider creating a formal arrangement or a memorandum of understanding (MOU) with a local physicians group, local health department, federally-qualified health center, urgent care clinic, community-based health clinic, or telehealth providers.
Interpretation: When providing services for children and youth, personnel should have appropriate pediatric and adolescent clinical expertise.
PA-CRI 7.03
The agency ensures access to needed healthcare services by:
- conducting an initial health screening for all individuals upon intake to identify the need for immediate medical care and assess for communicable diseases;
- providing continued monitoring and medication management;
- providing or arranging for specialized health services to meet the needs of the service population, as appropriate; and
- transferring individuals to a hospital or another appropriate setting if their needs cannot be met.
Interpretation: The crisis stabilization unit is responsible for transferring individuals to a higher level of care when there is a medical need identified and does not shift the responsibility back to the referral source, such as law enforcement or a mobile crisis unit, if applicable.
Examples: Conditions that require immediate or prompt medical attention include but are not limited to (1) signs of abuse or neglect; (2) serious or accidental injury; (3) signs of infection or communicable diseases; (4) hygiene or nutritional problems; (5) pregnancy; and (6) significant developmental or mental health disturbances.
Examples: Specialized health services may be needed by older adults, pregnant and parenting individuals, individuals with eating disorders, individuals with substance-use-related conditions, or children with autism and pervasive developmental disorders. These services may include, for example (1) tobacco cessation programs; (2) fetal alcohol syndrome screening; (3) speech, language, and occupational therapy; (4) prenatal care, well-baby care, and help accessing child and infant health insurance programs; (5) gender identity counseling; and (6) screening for the onset or existence of common cancers.
PA-CRI 7.04
The agency ensures appropriate care and supervision by providing:
- ratios of direct care workers to persons served for daytime and overnight hours that are appropriate to the program model, length of treatment, and risks and needs of persons served;
- enough additional personnel on-site that are qualified to meet special needs during busy/stressful periods, respond to emergencies, and carry out the agency’s emergency response plan; and
- rotating after-hours and holiday coverage when needed.
Interpretation: The agency must demonstrate that based on their program model and the population served, their staffing ratios for daytime and overnight coverage are sufficient to maintain safety, address potential risks, and meet the clinical, developmental, and age-related needs of persons served.
PA-CRI 7.05
To the extent possible and appropriate, families are provided with opportunities to:
- be involved in the care and treatment of the person served; and
- receive information, support services, and/or psychoeducation.
Examples: In addition to formal involvement in admission, assessment, service planning, service delivery, and aftercare planning, families can be actively involved in day-to-day issues and decision-making. For example, families of children and youth can: (1) provide input regarding what strategies may or may not work with their child; and (2) be kept up to date on their child’s daily appointments and activities.
Examples: The agency can minimize barriers to family involvement by (1) providing written information regarding the family’s role in services and the agency’s procedures regarding family contact; (2) allowing participation by phone or video conference; (3) assisting with arranging transportation, as needed and to the extent possible; and (4) providing or arranging services for family members in the family’s home and community, as needed and to the extent possible.
PA-CRI 7.06
The agency describes:
- personal items individuals may keep with them, consistent with a safe, therapeutic setting;
- items that are discouraged or prohibited; and
- any safety procedures the program follows, or consequences that can result, when prohibited items are brought to the program site.
PA-CRI 7.07
The agency establishes a daily routine that:
- provides predictability, stability, and structure;
- is clearly communicated to persons served, including advanced posting of schedules for structured and supervised activities; and
- offers flexibility to support the individualized program and needs of each person served.
NA The agency provides services for 23 hours or less.
PA-CRI 7.08
Therapeutic and educational interventions or activities are designed to address the individual’s immediate behavioral health needs including:
- managing social, emotional, and behavioral challenges;
- developing and utilizing healthy and effective coping and self-regulation strategies; and
- improving functioning; and
- promoting healing and well-being.
Interpretation: The specific areas targeted, and skills developed, will vary based on the needs of the population served.
Examples: Opportunities to participate in activities that promote healing and well-being may include (1) physical exercise; (2) mindfulness activities; (3) creative arts activities; (4) cultural enrichment activities, (5) time outdoors, or (6) religious observances in a faith or spirituality of choice.
PA-CRI 7.09
When individuals have experienced trauma, they are engaged in crisis stabilization services that are designed to help them:
- maximize their sense of safety;
- understand the connection between past experiences and current functioning; and
- identify, anticipate, and manage their responses to trauma reminders.
PA-CRI 7.10
The agency ensures an orderly, thorough discharge process by:
- preparing for discharge upon intake;
- involving all relevant members of the multidisciplinary team, persons served, and others, as appropriate to the needs and preferences of the individual;
- providing individuals and families with a comprehensive discharge plan; and
- notifying any collaborating service providers, as appropriate.
Interpretation: Discharge plans should include, at a minimum: (1) pertinent contact information for service providers; (2) emergency contact numbers; (3) safety plans; (3) details of any follow-up appointments, and (4) a comprehensive list of currently prescribed medications.
Crisis Response and Information Services (PA-CRI) 8: Crisis Receiving and Stabilization Facilities
Crisis receiving and stabilization facilities contribute to a physically and psychologically safe, healthy, homelike, non-institutional, therapeutic, and trauma-informed environment.
NA The agency does not operate a crisis receiving and stabilization service.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 8.01
Facilities meet individuals’ needs by providing the space, supplies, and equipment needed to accommodate:
- provision of on-site services, including therapeutic, educational, and medical services as needed;
- separate spaces for serving families with children if applicable;
- private telephone conversations with families and friends;
- recreational and enrichment activities that support well-being;
- quiet activities, including space specifically designed to encourage comfort, self-soothing, self-reflection, and emotional self-management; and
- access to the outdoors.
PA-CRI 8.02
Crisis receiving and stabilization facilities provide:
- adequate space, supplies, and equipment for food preparation, housekeeping, laundry, maintenance, storage, and administrative support;
- access to a telephone, computer, and the internet, as permitted, for use by personnel and persons served;
- attractively furnished areas with a separate bed for each individual, including a clean, comfortable, covered mattress, pillow, sufficient linens, and blankets when stays last longer than 24 hours;
- a safe place such as a locker to keep personal belongings and valuables;
- at least one room suitably furnished for the use of on-duty personnel; and
- private sleeping accommodations for personnel who sleep at the facility, if applicable.
Interpretation: In regards to element (c), programs that limit stays to 23 hours or less may utilize chairs or recliners instead of beds to create a more home-like environment as well as provide increased capacity.
PA-CRI 8.03
The agency creates a calming and healing physical environment by:
- ensuring the program setting is clean, organized, and maintained in good condition;
- using furniture, artwork, lighting, and acoustics to make living areas inviting, comfortable, calming, and reflective of the interests and diversity of persons served; and
- designing the program space to minimize disruption to the extent possible.
Examples: Agencies can minimize disruption by, for example: (1) decreasing the use of overhead paging systems and (2) establishing routes that minimize unnecessary traffic through resting areas.
Crisis Response and Information Services (PA-CRI) 9: Community Connections and Coordination
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-CRI 9.01
To ensure rapid and efficient access, the agency establishes procedures for working with emergency responders including:
- law enforcement and fire departments;
- hospital emergency rooms;
- mental and physical health crisis teams; and
- child and adult protective services.
PA-CRI 9.02
Procedures for working with law enforcement ensure that:
- crisis responses occur without law enforcement involvement unless a specific, immediate safety concern is identified such as violence, threats of violence, or possession of a weapon;
- officers with Crisis Intervention Team (CIT) or other specialized behavioral health training are requested and dispatched whenever possible;
- law enforcement officials understand how to contact crisis services for assistance; and
- agency leadership and law enforcement partners communicate regularly to monitor role clarity and quality improvement efforts.
NA The agency utilizes a police co-responder intervention model embedded in a police department.
Examples: The agency may offer a dedicated first responder drop-off area within their facility to build trust with, and ease the burden on, law enforcement or responders who may otherwise choose to transport an individual experiencing a crisis to a more restrictive setting such as a hospital or jail.
PA-CRI 9.03
Examples: The agency may collaborate with other service providers through (1) agency relationships; (2) Memorandums of Understanding (MOUs); (3) data sharing; (4) shared GPS-enabled communication systems; and/or (5) electronic bed registries.
PA-CRI 9.04
The agency seeks, develops, or maintains partnerships with non-clinical, supportive resources such as community organizations, social clubs, and faith communities to:
- educate the public on how to access the agency’s crisis services;
- reduce stigma surrounding behavioral health treatment;
- engage communities who have been historically underserved, mistreated, and/or harmed by emergency service providers; and
- provide opportunities for continued support in addition to, or in place of, traditional mental health services.
PA-CRI 9.05
- name, location, and telephone number;
- contact person;
- services offered;
- languages offered;
- fee structure; and
- eligibility requirements.
Interpretation: The agency ensures the community resource list remains up-to-date by evaluating referral resources on an ongoing basis to assess the safety, quality, and availability of services provided.
PA-CRI 9.06
The agency collects and periodically summarizes data on community needs and available resources and makes summaries available to community partners or the public upon request.