Intro to FU
The 4 types of specialist we can offer to a caller when setting a FU
Crisis Specialist, Peer Specialist, Veteran Specialist, Opioid Specialist
What are the indicators to offer a FU?
ongoing crisis or safety concern
caller questions ability to call back
CS using clinical judgment believes it would benefit Cl
ongoing substance use
CO or TPP's expressing concern for someone
True or False
Ongoing Follow Ups can only be scheduled if the caller is specifically looking for long-term support.
FALSE
An ongoing support follow up can include single and ongoing follow ups.
True or False:
HFU referrals are for patients who present to the ED with or were evaluated for: SI/SH, SU, Overdose.
TRUE!
If SI/SH, SU, or an overdose is involved with the patient's whole situation past, present, or future (something the ED staff would assess), then the ED could offer the HFU program.
True or False:
You can always jump into the Follow Up Spark chatroom for any questions about anything that is FU-related.
True!
Your leadership is always here to support, if you have any doubt, then ask about it! Spark out that you need a "Consult", select "Consult" pause code and jump into Leads chatroom or Follow Up chatroom at anytime for questions.
True or False
CO or TPP's requesting outreaches can provide consent for staff to leave a vague VM.
TRUE
we can leave a vague and brief VM with our callback number.
True or False
If a caller is presenting high risk with imminency, and unexpectedly disconnects the call, we cannot FU since we do not have consent.
FALSE
The exception to our consent rule of FU is in cases of high risk callers where safety cannot be confirmed, these cases we can follow up immediately to attempt to reach a caller back, consult with a lead on next steps if that caller does not answer.
Put these in order of LEAST to MOST restrictive interventions (1Least-3Most):
Walk In Crisis (WIC)
Welfare Check (WC)
Ongoing Follow Up
1. Ongoing Follow Up
2. Walk In Crisis
3. Welfare Check
Follow ups are one of the least restrictive interventions we can provide, it is "non-demand", no obligation on the callers part--they can decline/stop at anytime and do not have to answer our call. Whereas there are barriers when it comes to accessing a WIC and obviously a WC is always our LAST RESORT. Always go for the Least Restrictive Intervention possible!
Callers can only be enrolled by the hospital at discharge and ONLY on this RMCP incoming Line Type.
Hospital Follow Up - RMCP Line Type
Callers can not enroll into the HFU program from CCSL/LL or any contract calls. HFU programming is only enrolled at discharge by ED staff. If a TPP calls on any other line other than HFU line type, please refer them to the HFU phone line# 888-211-7766 to enroll their patient.
This protocol is when a CS will join the Follow Up chatroom to inform the FU team of the MPI, Time of the FU, is it Time Sensitive (t/s)? Is it High Risk (HR)? And whether or not the CS will complete the FU or will be unable to complete the FU.
The creation of the FU will be verified by the FU Team/Leads for any COCO tech support or other need for clarification about the FU. CS may also stay in the Follow Up chatroom for the duration of the FU call completion.
What is a Real-time Hand off?
The primary purpose of this hand off is to communicate the level of urgency about the FU being scheduled and ensured that it is completed.
If not for this Hand off protocol, it's possible that an FU team member may call it inappropriately, call it In Addition to the CS (double calling), or overall providing less efficient/effective service than if the CS called it themselves.
Why are disposition Follow Ups important?
They close the communication loop on the outcome of referrals and help us to know if next steps are needed on our end.
A caller shares they just moved to a new town and are experiencing heightened anxiety and feelings of isolation as a result, with no suicidal ideation. They share they struggle to know how to manage their anxiety and don't have many resources in place. Is this an appropriate time to offer an ongoing support FU?
As always, use your clinical judgment, but yes! There are not requirements on what a Cl has to be experiencing or a certain level of risk in order to offer ongoing support. this could be a good time to explore this option with the caller.
ONGOING Follow Ups may be scheduled when Opioids or Stimulants are indicated as long as the caller has some level of desire to change their drug use for the better--no abstinence is required. These FUs will be completed by This type of specialist.
What are Opioid Specialists?
True or False: RMCP provides HFU calls to a person for up to one month.
False, there is no real time limit, can be shorter or longer than a month. This only depends on if we are still providing a beneficial service.
If the caller does not outright decline further calls, we will always call for At Least one month.
FUs that need to be completed within a 15‐minute window of the scheduled time. An example of when this is indicated would be when a caller has a specific time when they intend to act on their thoughts of suicide (I intend to kill myself after work at 8pm). High Risk Caller follow‐ups are likely to be selected as these types of FUs.
What are FUs that are appropriate to mark as Time Sensitive (t/s)?
Please consult with your leads to gain more knowledge and experience of when to designate a call t/s. Whenever in doubt about a follow up, consult with a lead!
What must be documented in a disposition FU to a walk in clinic?
who the follow up is with.
Important details from the call on risk level, timeline of when the caller is supposed to arrive at the walk in clinic, etc.
Communication about next steps: if caller did not arrive, do we need to call them back and check on safety? Do we leave it and let the caller call us if they need? You can consult with a lead before setting the FU about what the next best steps are if needed.
True or False
Staff should offer FU in cases where the specialist is unsure if caller is being honest about their safety and wants to FU with caller to check on them and re-assess SI.
FALSE
FU as a service should benefit the caller, it is not to make staff "feel better". These are the moments where it is important to meet the caller where they are at and trust their autonomy when they tell us they can call in or utilize us for support when needed.
Use of 24 hour crisis teams and 7 day follow-up programs show a significant reduction in suicide within 3 months of a patient’s discharge from inpatient services
Telephone follow-up of outpatients after suicide attempt is a protective factor against repeated suicide attempt/s and possible consequent suicide and could be applied in all psychiatric emergency departments.
//Peer-reviewed studies//
What are Benefits of providing a crisis follow up service?
There is no debate! There are many studies that all conclude that there is, without a doubt, immense benefit to be had from "simple" follow up programming provided by a crisis center.
22% of suicide fatalities occur within 4 weeks of a visit to an emergency department
40% of suicide fatalities occur within 1 year of a visit to an emergency department
(answer in the form of a question)
What are the reasons why Hospital Follow Up is indicated as a life-saving/invaluable service?
//The Joint Commission Journal on Quality and Patient Safety, 2019 vol 45: 725-732//
SI intent high with plan of using gun, means of gun is not easily accessed but emotionally dysregulated AEB crying and then screaming during the call.
Please check on safety, plan for evening, consider WIC or MC as appropriate.
If no contact made, please attempt additional FU one hour from now... -This is an example of?...
What are the "Instructions for Follow Up" section when scheduling the follow up?
Always provide ESSENTIAL COMMUNICATION information for whoever will be completing the follow up to know. They are going into the call "blind", be brief in your description but instruct on exactly what they need to know and what to do to conduct a successful Follow Up.
Your caller wants a follow up because their partner is in town and they want you [CS] to talk to the partner as a way to vouch for caller's honesty and truth to their side of the conflict between them. You don't know if there is DV involved or not. They are safe, no SI, no SU, just relationship conflict. How do you approach this situation and still offer a Follow Up during planning with the caller?
There are many ways to approach this situation.
Consider: 1. We won't talk to someone without consent (partner). 2. We don't know what will happen in the future (situation can change better or worse). 3. If caller is safe, would they actually benefit from an FU?
Can offer an FU but explain your concerns (above). Explore HOW CS talking to their partner is going to help. Follow your intuition--if it does not seem like it will benefit the caller, you can always just ask them to call back at a later time.
In your own words, describe what gatekeeping is and how that relates to follow up as a service.
general answer: Gatekeeping is the power the specialist holds in terms of knowledge they have with access to information and services (in this case FU as the service). This power and responsibility should be acknowledged by the specialist, FU is not a service that is limited in who we can serve and every caller deserves the opportunity to utilize this service if wanted.
In your own words, tell us how you would describe and offer an ongoing support FU.
We offer free telephonic follow up services to establish ongoing support, assist with supporting goals, help connect to resources, and problem solve around challenges and barriers to treatment. Does this sound like something that would be helpful for you?
We also have Veteran Specialists for any military experiences and Opioid Specialists who may have more insight into recovery from addiction.
This is how you would explain the Hospital Follow Up program to a patient (during incoming HFU enrollments)...
•“Rocky Mountain Crisis Partners provides free telephonic follow-up calls 1x a week, for at least 1 month to provide ongoing support following your discharge. In these calls, we can revisit your safety plan to make any needed adjustments, discuss short term goals, problem solving navigation around challenges to treatment, help connect you with resources, and provide ongoing support that is meaningful to you. These calls are voluntary, and you can discontinue them at any time. Do theses calls sound like they would be helpful for you?”
I have already established rapport with this caller and they feel an FU would be beneficial. It could be a shock to the caller to hear another CS' voice completing the follow up later on tonight.
Why is it important that the CS complete their own Follow Up (ongoing or outreach) if possible?
When talking about Best Practices, all of RMCP protocols are made with clear intention to provide support, trauma-informed, and caller-centered. This is not always possible, but please complete your own follow up call during your shift unless otherwise determined through consult with a lead/supervisor. Dispositions are an exception and do not need to be called by the same CS.