Issue 7: The Absence of Crisis Respite Services in Most Rural Communities

Goal: Increase crisis respite capacity in rural regions throughout the state.

Discussion

Crisis respite services play a vital role in the continuum of care for children, adolescents and adults. In a crisis respite setting, clients receive stabilization and safety monitoring services which may prevent and forestall more costly and restrictive institutional and out-of-community care. In addition, crisis respite is an important service for youth and adults who are transitioning back to less restrictive care after receiving intensive institutional services. Increased grant funding for local crisis respite services has been a long-standing Alaska Mental Health Board priority and has been universally endorsed as an essential service by consumers, families, advocates and providers.

Current crisis respite services exist primarily in urban communities, with a limited number of crisis respite beds available in rural hub communities. The need for crisis respite services, however, is particularly acute in rural Alaska, due to the lack of other available mental health services. In many cases, a person with a mental health crisis in a rural village has no other service option other than respite care or psychiatric hospitalization in an urban community. In some cases, clients are transported in restraints to urban hospitals (including Alaska Psychiatric Institute) and then are not admitted because they no longer meet the criteria for civil commitment or the crisis has otherwise diminished. This disruption, additional anguish, and transportation cost could be avoided or decreased if respite care were more readily available in rural communities.

There are two basic models of crisis respite care. The first model is a traditional crisis respite program which is facility-based and has staffing on a 24-hour per day, seven day per week basis. This model is more appropriate in urban communities where the number of clients needing respite care justifies the full time nature of the program.

The second model is "client and family centered" crisis respite care which maximizes the use of existing community services. This model promotes innovative approaches including respite within emergency foster care homes, small facility-based crisis respite in rented homes with on-call staff, and adding a crisis respite component to existing community residential programs (substance abuse, women's shelters, youth homes, etc.); this last approach has been successfully implemented in Kotzebue. In smaller villages, respite care could take the form of a paid attendant to provide 24-hour support to residents experiencing mental health crises.

Due to its emphasis on using existing community and family resources, the client and family centered care model is a much more appropriate model for rural Alaska communities. This model allows the possibility of expanding crisis respite services in rural hub communities as well as providing respite care directly in appropriate village settings.

Actions

165. Expand existing crisis respite services in rural hub communities to function as an intermediate step between villages and urban centers.

166. Provide funding for client and family centered crisis respite services in villages and rural hub communities.

167. Provide training and technical assistance to rural communities in the development of client and family centered crisis respite services.
Responsible party (actions 1-3): Division of Mental Health and Developmental Disabilities, Alaska Mental Health Board, Alaska Mental Health Trust Authority

168. Ensure that Medicaid funds are appropriately used as a funding source for crisis respite services for eligible clients.
Responsible party: Division of Mental Health and Developmental Disabilities, Division of Medical Assistance