Current through all regulations passed and filed through September 16, 2024
(A)
Mobile response
and stabilization service (MRSS) is a structured intervention and support
service provided by a mobile response and stabilization service team that is
designed to promptly address a crisis situation; with young people who are
experiencing emotional symptoms, behaviors, or traumatic circumstances that
have compromised or impacted their ability to function within their family,
living situation, school, or community.
(B)
MRSS is provided
to people who are under the age of twenty-one.
(C)
MRSS is intended
to be delivered in-person where the young person or family is located, such as
their home or a community setting. There are instances where MRSS can be
delivered using a telehealth modality. Common times that telehealth would be
appropriate are:
(1)
When the young person or family requests MRSS service
delivery using telehealth modalities,
(2)
There is a
contagious medical condition present in the home, or
(3)
Inclement weather
that prevents or makes it dangerous for the MRSS team to travel to the young
person or family.
(D)
The initial
mobile response is expected to occur within sixty minutes from the end of the
initial call and immediate linkage of the caller to the MRSS provider, with a
de-escalation period up to seventy-two hours and a stabilization period for up
to six weeks. If the caller requests mobile response later than sixty minutes,
the response will occur within forty-eight hours. The de-escalation period
begins when the initial mobile response occurs. In instances where the initial
mobile response occurs greater than sixty minutes from the time of dispatch,
the MRSS team will maintain documentation that supports the extended response
time was an appropriate response.
(E)
In order to be
certified for the MRSS service, a community mental health services or addiction
services provider will also hold and maintain certification from the Ohio
department of mental health and addiction services (OhioMHAS) for all the
following:
(1)
General services as defined in rule
5122-29-03 of
the Administrative Code.
(2)
SUD case management services as defined in rule
5122-29-13
of the Administrative Code.
(3)
Peer recovery
services as defined in rule
5122-29-15
of the Administrative Code.
(4)
Community
psychiatric supportive treatment as defined in rule
5122-29-17
of the Administrative Code.
(5)
Therapeutic
behavioral services and psychosocial rehabilitation as defined in rule
5122-29-18
of the Administrative Code.
(F)
The community
mental health services or addiction services provider will be able to provide
all allowable services by telehealth as defined in rule
5122-29-31 of the
Administrative Code.
(G)
Definitions:
(1)
Crisis means a
situation defined by the young person, their family or those responsible for
the welfare of the youth that is causing stress or discordance to the person or
their family or the community.
(2)
Family means any
individual or caregiver related by blood or affinity whose close association
with the person is the equivalent of a family relationship as identified by the
person including kinship and foster care.
(3)
Young person
means a child, youth or young adult under the age of
twenty-one.
(H)
MRSS team staff.
(1)
A MRSS team will
consist of at least:
(a)
A clinician identified in rule
5122-29-30
of the Administrative Code who holds a valid and unrestricted certification or
license issued by any of the Ohio professional boards that includes a scope of
practice for behavioral health conditions. This provider will also demonstrate
and maintain competency in the under twenty-one years of age population. The
independently licensed supervising practitioner will also be considered a
member of the MRSS team. A qualified behavioral health specialist (QBHS) as
defined in rule
5122-29-30
of the Administrative Code does not meet the standards of this paragraph;
and
(b)
One of the following:
(i)
A family peer or
youth peer supporter who holds a valid and unrestricted certification from
OhioMHAS issued in accordance with rule 5122-29-15.1 of the Administrative
Code. The peer supporter will also demonstrate competency in the care and
services of individuals in the under twenty-one years of age population and has
scope of practice for persons age twenty-one and under with mental health
disorders and substance use disorders.
(ii)
A QBHS as
defined in rule
5122-29-30
of the Administrative Code. This QBHS will also demonstrate competency in the
care and services of individuals in the under twenty-one years of age
population and has scope of practice for persons age twenty-one and under with
mental health disorders and substance use disorders.
(2)
The
MRSS team will have ready access to a psychiatrist or certified nurse
practitioner or clinical nurse specialist for consultation purposes as needed,
and this person is not necessarily a member of the MRSS team. The psychiatrist
or certified nurse practitioner or clinical nurse specialist will hold a valid
and unrestricted license to practice in Ohio.
(I)
MRSS providers
will have an initial fidelity review no more than twelve months from the date
of initial certification. MRSS providers will have regular repeat fidelity
reviews, no more than twelve months from the report date of the previous
fidelity review, by an independent validation entity recognized by the
department.
(J)
For continuing certification, each MRSS provider will
achieve and maintain a minimum benchmark score of twenty-six as a component of
overall fidelity within three years of initial certification as determined by
an independent validation entity recognized by the department. The provider
will maintain fidelity in all fidelity reviews after the first three
years.
(K)
Providers will participate in MRSS quality improvement
activities including data collection and submission.
(L)
Providers will
complete OhioMHAS's approved initial and ongoing MRSS trainings as appropriate
to their role.
(M)
Providers of MRSS will assure the service meets the
following:
(1)
Within one year from the date of initial certification from
OhioMHAS, have the MRSS available twenty-four hours a day, seven days a
week.
(2)
Provided on a mobile basis. MRSS is provided where the
young person is experiencing the crisis or where the family requests services,
not at a static location where the person will present
themselves.
(3)
The initial mobile response occurs in accordance with
paragraph (D) of this rule.
(4)
Provided by
eligible providers and supervisors identified in rule
5122-29-30
of the Administrative Code and who are MRSS team members described in paragraph
(H)(1) of this rule."
(N)
MRSS provides
immediate de-escalation, delivers rapid community-based assessment, and
stabilization services to help the young person remain in their home and
community. MRSS consists of three activities: screening/triage, mobile
response, and stabilization. Some young people do not need all three MRSS
activities but are still considered MRSS participants.
MRSS will be initiated through
screening/triage and progress in the order listed in this
paragraph.
(1)
Screening/triage MRSS screening/triage includes, at a
minimum, the following:
The MRSS service may be initiated
through direct connection with the MRSS provider or the statewide MRSS call
center. When the service is initiated through direct connection with the
provider:
(a)
An initial triage screening is done to gather
information on the crisis or crises, identify the parties involved, and
determine an appropriate response or responses. The initial triage screening is
performed remotely.
(b)
All calls with a young person or family in crisis where
911 is not indicated, are responded to with a mobile response.
(c)
If a young person
or family is already involved with an intensive home-based service (i.e. IHBT,
wraparound) the mobile response team is dispatched to de-escalate the
presenting crisis. Once the family is stabilized, the family is re-connected
with the existing service.
(2)
Mobile
response
(a)
The mobile response team will mobilize to arrive at the
location of the crisis or a location specified by the young person or family
within the designated response time, as determined by the end of the triage
assessment. If the initial response is done by a single team member, that team
member will meet the standards of paragraph (H)(1)(a) of this
rule.
(b)
The MRSS mobile response team will provide
de-escalation services for up to seventy-two hours until the young person and
family are stable; deescalation services will include the following:
(i)
An urgent
assessment of the following elements for de-escalation: understanding what
happened to initiate the crisis and the young person's and their family's
response or responses to it; risk assessment of lethality, propensity for
violence, and medical/ physical condition including alcohol or drug use, mental
status, and information about the young person's and family's strengths, coping
skills, and social support network.
(ii)
Development of
an initial safety plan to be provided to the youth and family at the end of the
first face-to-face contact.
(iii)
Crisis
intervention and de-escalation with the young person or family using strategies
as appropriate to meet the unique needs of the youth and family. Such
strategies may include, but are not limited to: ongoing risk assessment and
safety planning, teaching of coping and behavior management skills, mediation,
parent support, and psychoeducation.
(iv)
Telephonic
psychiatric consultation initiated when indicated.
(v)
Administration of
the Ohio children's initiative brief child and adolescent needs and strengths
(CANS) tool prior to entry into the ongoing stabilization phase of services,
and for youth who do not continue into stabilization, complete the CANS when
adequate information is known. This will be performed by a provider who is a
qualified CANS assessor.
(vi)
Consult with the young person or family to define goals
for preventing future crisis and the need for ongoing
stabilization.
(vii)
Initiate an individualized MRSS plan, prior to the
stabilization phase, which is inclusive of the safety plan. An individualized
MRSS plan is valid for up to forty-two days or until the end of the MRSS
episode of care and should be updated or modified as indicated during this time
period.
(3)
Stabilization
(a)
Stabilization services are provided by the MRSS team as
documented in the individualized MRSS plan. The stabilization services
immediately follows the seventy-two hours of mobile response.
(b)
Continued
monitoring, coordination, and implementation of the individualized MRSS
plan.
(c)
The MRSS team provides stabilization services that are
defined in the individualized MRSS plan to achieve goals as articulated by the
young person or family. Stabilization services are to build skills of the young
person and family, to strengthen capacity to prevent future crisis, facilitate
an ongoing safe environment, link the young person and family to natural and
culturally relevant supports and build or facilitate building the young person
and family's resilience. Stabilization activities include but are not limited
to:
(i)
Psychoeducation: young person or family individual coping
skills; behavior management skills, problem solving and effective communication
skills;
(ii)
Referral for psychiatric consultation and medication
management if indicated;
(iii)
Advocacy and
networking by the provider to establish linkages and referrals to appropriate
community-based services and natural supports;
(iv)
Coordination of
services to address the needs of the young person or family.
(d)
Linkage to the natural and clinical supports and services to
maintain engagement and sustain the young person's or their family's
stabilization post MRSS involvement.
(e)
Convene or
participate in planning meeting(s) with the young person, family, and cross
system partners for the purpose of developing and coordinating linkages to
ongoing services and supports when family need indicates.
(f)
Service
transition
(i)
The MRSS team and the young person or their family will work
on moving from stabilization to ongoing support through identified supports,
resources, and services, which are consistent with their unique needs and
documented in the individualized MRSS plan.
(ii)
With the young
person's or family's permission, the MRSS team will share the most recent
individualized MRSS plan and supporting information with other service
providers in person, including by video or telephone, and with the young person
or family present when possible.
(iii)
Review with the
young person or their family newly formed coping skills and how future crisis
can be managed; emphasizing the role of the young person and the
family.
(iv)
Prepare and finalize a transition plan with the young
person and their family. The transition plan will include the most recent
version of the individualized MRSS plan with safety plan.
