2024 15th Annual NUBE Conference

As the promise of 988 and other elements of a full crisis continuum have advanced, the realization of an ideal system of immediate access to care for anyone, anytime, anywhere has advanced. This emerging crisis continuum of services favors utilizing front-line crisis workers through crisis call centers, mobile behavioral health teams, and behavioral health crisis stabilization units (CSU's) rather than law enforcement and hospital emergency department (ED) use.

This presentation will explore this evolution of systems and the tension present in crisis care at all levels, involving balancing safety with minimizing trauma by using the least restrictive supports for an individual’s needs. It will explore innovations and best practices helping advance this shift in roles and partnerships of caring for higher acuities related to imminent risk of harm to self and others, substance use, and physical health challenges that often automatically connect those in crisis to law enforcement and Emergency Departments as the front-line care option. The session will examine (1) 911/988 coordination and management of risks other than harm to self with crisis call centers, (2) the coordination of law enforcement and emergency medical services with mobile behavioral health teams and mobile dispatch, (3) Emergency behavioral health CSU's infrastructure of medical tools, staff and training in triaging and managing medical, psychiatric, and substance use needs safely and effectively (4) and the balance of the opportunity for a near zero sequential intercept, inclusive coordinated system for all in crisis with care that feels like care in the face of challenges in overcoming barriers to this change.

The presentation will reflect on real-life examples of challenges, successes, and opportunities encountered in managing high acuity situations, derived from ten years of experience in diverse crisis service levels and leadership positions. It will highlight the significance of effective high acuity management in fostering inclusive environments that welcome all, thereby reducing implicit bias in healthcare access and restricting law enforcement's role in crises to instances of immediate risk to public safety.

Learning Objectives:
The audience will understand how managing higher acuity at each crisis level is important to creating access to all that feels like care and minimizing Emergency Department boarding and legal involvement.

The audience will learn about current tensions in safety vs. creating access to care at each of the three major crisis levels with real-live examples and discussion with the audience.

The audience will learn about tools, training, and systems that support managing high acuity levels safely in this model.