Innovation in Technology: Efficient Access to Quality

ServicesJennifer Armstrong, Director of Crisis Care Services- Centerstone of TN

Liam Barry, Director of IT Infrastructure-Centerstone of TN

Jennifer Smith, Team Lead, Northern Region Mobile Crisis- Centerstone of TN

Nation’s largest non-profit provider of community-based behavioral health services

Annually serves over 60,000 children, adolescents, adults, seniors and their families in Tennessee

Mission: To prevent and cure mental illness and addiction

Part of a national collaboration promoting the Zero Suicide Initiative

Centerstone

Crisis Center ◦ 9 local and national partners- crisis lines◦ Crisis Call Team◦ Crisis Follow-up Team (High Risk services

available across all crisis lines, BCBS grant, NSSP grant, GLS grant)

◦ Crisis Chat/Text Team- NSPL Crisis Chat, Hopeline Chat

◦ 25 masters level clinicians◦ AAS, CARF, CUSA, OES accredited◦ Team office: Nashville, TN.

Centerstone Crisis Services

Mobile Crisis Services- 3 regions across 21 counties

Crisis Management Strategies team- local and national training; critical incident response

Centerstone Crisis Services

Why?◦ 2009: Program cuts that reduced staff size from

15 to 6◦ 3600 total calls per month; crisis call services

only; 3 crisis lines managed◦ Per TDMH contract, must have 24/7 access to live

person: Centerstone Crisis Line and TN Statewide Crisis Line

◦ IT team research with current vendor (Cisco)- security, HIPAA concerns, etc..

Remote Services- Crisis Call Center

Equipment and Tools (approx. $2K per staff)• Laptop • Cisco Phone & Headset• Home Internet Connection• Cisco ASA • Battery Back-up• Private home office set up and monitored by IT

staff

Remote Services

Remote Services

Secure & Private Connection from Home to Office

Home Corporate Office

Centerstone uses a Cisco ASA – Model 5505 to secure the connection.

What is a Cisco ASA?

The Cisco ASA is a device that creates a private connection from one location to another.

• The connection (or tunnel) is secure and private• The tunnel is encrypted• Quick and easy to set up • The connection is monitored by our Network Operations center

The cost of an ASA is approximately $400.00.

What does ASA stand for?

ASA is simply a marketing term by Cisco. It’s an acronym for: Adaptive Security Appliance

Remote Services

Now what?◦ Cc-Modeler Professional Software:

Kooltoolz (www.kooltoolz.com) Workforce Management Improving Service Performace Projects needed staffing/where in meeting access

standards Utilizes call volume and staffing patterns Staffing truly by volume

Remote Services

Phase in: SLOWLY! Overnight, afterhours, then all day Daily IT correspondence; staff

communication and monitoring Shift in service:

Crisis intervention services only No I and R Afterhours functions for Centerstone of TN NSPL- relinquished regional services to

backup for TN only

Remote Services

Guidelines:

◦ Remote office must be set up in a private location in the home as assessed by IT staff.

◦ Access to an assigned Centerstone office location (all assigned sites must be within one hour of home office).

◦ Internet access provided by staff member.◦ Staff will use equipment issued and installed by

Centerstone Information Systems.◦ Must attend all clinical supervision and team meetings.

Remote Services

Emergency Back-up Plan:◦Service disruptions: Determine if back-up coverage is

warranted Utilize on-call staff Utilize back-up on-call staff as needed If outage exceeds 20 minutes,

relocation to assigned Centerstone location for completion of shift.

Remote Services

Monitoring and QA:

Remote Services:

Monitoring/QA:

Remote Services

Monitoring/QA:

Remote Services

Monitoring/QA:

Remote Services

Monitoring/QA:

Remote Services

Monitoring/QA:

Remote Services

Communication:

Remote Services

Pros◦ Right sized staffing◦ Built in emergency back-up plan◦ Staff retention◦ Same monitoring capabilities◦ Staff communication◦ Coverage nationally during disasters

Cons◦ Agent Status/Availability

Remote Services

Funded by Tennessee Department of Mental Health & TennCare (state Medicaid)

Overall contractual goal is to act as a diversionary resource to most appropriate, least restrictive setting

Response is to any location requested in 20 county catchment area

Centerstone’s Mobile Crisis

Seven county catchment area Average 250 assessments per month Response time average- 90 minutes Up to 98 miles roundtrip Average mileage per assessment- 54 miles

Mobile Crisis: The Northern Region

The beginning◦ 2012: Pilot project with HCA/TriStar and Cisco◦ Remote connection from laptop to cart placed

in ED using Movi/Jabber◦ Response time averaged 30 minutes◦ 1st six months averaged four assessments per

month Next steps

◦ 2013: Two more HCA affiliations◦ Cisco Movi/Jabber replaced with InTouch

equipment

Implementation of Televideo

Currently◦ Initial Assessment:

Emergency Department: iPad to ED cart via InTouch Centerstone O/P Clinics: iPad to iPad/laptop via Cisco 427 assessments to date Average response time to date- 27 minutes Evaluation component for client feedback

◦ Involuntary Hospitalization: 1st Certificate of Need 2nd Certificate of Need to RMHI

Implementation of Televideo

Contact Information:

◦ Jennifer Armstrong, LPC-MHSP jennifer.armstrong@centerstone.org

◦ Liam Barry liam.barry@centerstone.org

◦ Jennifer Smith, LMSW jennifer.smith@centerstone.org

Questions?