Program 4 - Crisis Intervention Services
Crisis intervention policies and procedures for Bonita House emergency response services.
Service Overview
Crisis Intervention Services provides immediate, short-term emergency response to individuals experiencing acute psychological distress or psychiatric emergencies. Our goal is to stabilize, assess, and connect individuals to appropriate ongoing services.
Crisis Response Team
Team Composition
Core Team Members:
- Crisis Intervention Specialist (Lead)
- Licensed Clinical Social Worker
- Psychiatric Nurse
- Peer Support Specialist
- On-call Psychiatrist
Response Availability
| Service Type | Availability | Response Time |
|---|---|---|
| Phone Crisis Line | 24/7 | Immediate |
| Mobile Crisis Response | 24/7 | Within 60 minutes |
| Walk-in Crisis | Business hours | Immediate |
| Telehealth Crisis | 24/7 | Within 30 minutes |
Crisis Assessment
Immediate Safety Assessment
Primary Questions:
- Are you thinking about killing yourself?
- Have you attempted to harm yourself?
- Do you have a plan?
- Do you have means available?
- Are you thinking about hurting someone else?
Risk Stratification
High Risk (Immediate Response)
- Current suicidal ideation with plan
- Recent suicide attempt
- Homicidal ideation
- Psychosis with agitation
- Severe self-harm
Moderate Risk (Urgent Response)
- Suicidal ideation without plan
- Significant depression/anxiety
- Substance use crisis
- Moderate self-harm
- Family crisis
Low Risk (Scheduled Response)
- Passive suicidal thoughts
- Mild-moderate symptoms
- Adjustment difficulties
- Relationship problems
- Medication issues
Response Protocols
Phone Crisis Intervention
-
Establish Rapport
- Introduce yourself
- Express concern
- Use calming tone
- Active listening
-
Assess Situation
- Current location
- Safety status
- Presenting problem
- Support available
-
Develop Safety Plan
- Remove means
- Identify supports
- Coping strategies
- Follow-up plan
-
Determine Disposition
- Self-management with follow-up
- Mobile team dispatch
- Emergency services activation
- Voluntary hospitalization
Mobile Crisis Response
Pre-Response
- Gather information
- Assess scene safety
- Coordinate with dispatch
- Review history if available
- Plan approach
On-Scene Protocol
- Ensure safety
- Introduce team
- Conduct assessment
- De-escalate situation
- Determine appropriate intervention
- Implement plan
- Ensure follow-up
Post-Response
- Complete documentation
- Team debriefing
- Follow-up contact
- Referral completion
- Quality review
De-escalation Techniques
Verbal De-escalation
Core Principles:
- Remain calm
- Respect personal space
- Simple, clear communication
- Avoid arguing
- Set clear limits
- Offer choices
- Debrief when calm
Environmental Modifications
- Reduce stimulation
- Remove audiences
- Provide space
- Adjust lighting
- Minimize noise
- Remove triggers
Safety Protocols
Staff Safety
Personal Safety Measures:
- Never respond alone
- Maintain exit access
- Position strategically
- Carry communication device
- Wear identification
- Follow scene assessment
Scene Safety Assessment
Evaluate for:
- Weapons presence
- Environmental hazards
- Other individuals present
- Substance use evidence
- Animal threats
- Escape routes
5150 Evaluation Criteria
Grounds for Involuntary Hold
California Welfare & Institutions Code 5150:
Danger to Self
- Suicidal ideation with plan/means
- Recent attempt
- Severe self-harm
- Unable to provide self-care
Danger to Others
- Homicidal ideation
- Threatening behavior
- History of violence
- Command hallucinations to harm
Gravely Disabled
- Unable to provide food
- Unable to provide clothing
- Unable to provide shelter
- Severe cognitive impairment
Hold Procedures
- Complete assessment
- Document criteria met
- Contact approved facility
- Complete 5150 application
- Arrange transportation
- Provide client rights
- Notify designated contact
Special Populations
Children and Adolescents
Special considerations:
- Parent/guardian involvement
- Mandatory reporting requirements
- Age-appropriate communication
- School coordination
- Specialized placement options
Elderly Clients
Modifications needed:
- Medical evaluation priority
- Medication review
- Cognitive assessment
- Adult protective services
- Family involvement
Veterans
Resources available:
- VA crisis line
- VA mobile crisis
- Veteran peer support
- VA emergency services
- Military OneSource
Documentation Requirements
Crisis Contact Record
Document within 24 hours:
- Date/time/duration
- Contact method
- Presenting issue
- Risk assessment
- Interventions provided
- Disposition
- Follow-up plan
Required Forms
- Crisis assessment form
- Safety plan
- Release of information
- 5150 application (if applicable)
- Incident report
- Transportation form
Follow-up Protocols
Standard Follow-up
| Timeframe | Risk Level | Contact Method |
|---|---|---|
| 24 hours | High | Phone or in-person |
| 48 hours | Moderate | Phone |
| 72 hours | Low | Phone or text |
| 7 days | All | Phone |
| 30 days | All | Phone or letter |
Follow-up Components
- Safety check
- Service linkage confirmation
- Appointment reminders
- Medication compliance
- Support system check
- Additional needs assessment
Quality Assurance
Performance Metrics
Monitor:
- Response time compliance
- Hospitalization rates
- Client satisfaction
- Successful diversions
- Follow-up completion
- Staff safety incidents
Critical Incident Review
Review all:
- Hospitalizations
- Police involvement
- Injuries
- Complaints
- Deaths
- Media involvement
Training Requirements
Initial Training
40-hour curriculum including:
- Crisis theory
- De-escalation techniques
- Risk assessment
- Safety planning
- Legal requirements
- Cultural competence
- Trauma-informed care
Ongoing Training
- Monthly case consultation
- Quarterly skills practice
- Annual recertification
- Critical incident debriefing
- Peer consultation
Collaboration
System Partners
Maintain relationships with:
- Law enforcement
- Emergency departments
- Psychiatric facilities
- Fire/EMS
- Child protective services
- Adult protective services
Communication Protocols
- Warm handoffs
- Written summaries
- Follow-up confirmation
- Shared safety plans
- Regular meetings
Self-Care for Crisis Staff
Support Systems
- Regular supervision
- Peer support
- Employee assistance program
- Debriefing protocols
- Workload management
- Rotation schedules
Signs of Burnout
Watch for:
- Emotional exhaustion
- Cynicism
- Reduced empathy
- Physical symptoms
- Performance issues
- Increased absences