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Crisis Center Grantee Profile

Crisis Center: Centerstone Crisis Services

Emergency Department: Southern Tennessee Regional Health System – Lawrenceburg

Location: Nashville/Lawrenceburg, Tennessee

Year 1, Months 1-6

Interviews with Jane Bolin & Christy East of Centerstone Crisis Services and Brittani Webb & Stacey Young of Southern Tennessee Regional Health System – Lawrenceburg

What steps did you have to take to get your program off the ground?

Centerstone: As a very large program, Centerstone has existing relationships with many emergency departments (EDs) across the state and have a lot of contact with the EDs as a result of their mobile crisis team.  Lawrenceburg was chosen due to their pre-existing relationship and their familiarity with the concepts of Zero Suicide and follow-up. Additionally, Lawrenceburg is a smaller ED in a more rural part of the state with limited resources, and Centerstone is hoping to help expand resources across the state.  The Centerstone Director approached the hospital Director, established the partnership, and then Centerstone helped to provide training and suggestions to hospital ED staff regarding assessment. They needed to work closely with their IT department and that of the hospital to make changes to the electronic health record (EHR), adding customized notes and data sets.  Training was provided for the hotline team, with a separate clinical team trained specifically in follow-up contacts, as well as training for the mobile crisis team members.

Lawrenceburg: Centerstone approached the ED and discussed the program.  They needed to get approval from the hospital CEO and CFO, so a packet of all of the necessary documents, including a budget, were provided and signed off on.  Hospital leadership was supportive of the project from the start, and as a result, gaining approval was relatively simple.  Centerstone assisted in creating the documents needed for the program, and they have worked together on developing ways to collect data and roll the program out to staff.

First Successes:

Centerstone: Benefits to crisis line callers have been substantial! They have been collecting qualitative data from callers who have completed the full 30-day follow-up program and they are reporting many positive testimonials about the life-saving potential of these contacts and how the support is helping people move forward past their current suicidal crisis and establish resources that will support them currently and in the future.  Centerstone has been able to meet the goals of the grant for crisis line callers and team members are incredibly enthusiastic about the project and about the results they are getting.

Lawrenceburg: Being able to build the partnership with Centerstone has been a success, as well as the support they have received in fine-tuning the referrals and referral process.  Everyone has been supportive and patient throughout the development of the project.

First Challenges & Solutions:

Centerstone: There have been challenges with meeting the goals for ED follow-up, so they have been working to support the relationship with the ED, offering assistance, and making changes and adjustments to the referral process to make it easier to make referrals.  All involved are very busy and doing so much, so getting staff on board is an ongoing time commitment.  A meeting was set up for the ED with another ED with a follow-up partnership to offer peer support and guidance.

Lawrenceburg: Generating the referrals has been a work in progress as the ED team has had to buy-in to the program, and as a result of being a smaller ED where staff “wear a lot of hats,” changing the workflow has been challenging at times. Getting clarity from Centerstone and ironing out expectations, refining the referral process, rolling out the program to the Intensive Care Unit for people who have attempted suicide, and doing more training and education with the ED team have helped to increase buy-in and generate more referrals.

Emerging guidelines and best practices:

Centerstone: “Follow-up is, in and of itself, a best practice” and is imperative at crisis lines.  The programs work to help people stay safe and link to needed services.

What advice would you give to others who are looking to establish a follow-up program and partnership?

Centerstone: It is vital that everyone at the crisis center and the hospital as a whole are ready to accept the changes system-wide.  Having high quality training on assessment of risk is incredibly important as it allows the crisis line team and ED team to share the same language when it comes to the project and completing high-quality, collaborative, and caring assessment of patients. There are a lot of little details that are important and take patience.

Lawrenceburg: You need to have a good process from the beginning and anticipate spending a significant amount of time on the planning phase regarding obtaining referrals, training and educating the team about follow-up and process of consent and referral, a clear way of collecting data, and making sure you have a good team on hand to help with various aspects of the project.