Assisting People with Developmental Disabilities in Acute Crisis

Rapid Response Guidelines and Procedures

Each year a handful of individuals with developmental disabilities end up in need of emergency housing and support. Some of these individuals have no home to return to and cannot have their needs met within the existing crisis response system or safe house. Failure to respond quickly often results in expensive and inappropriate institutionalizations or hospitalizations. To minimize and shorten these institutionalizations or hospitalizations, the county has added a rapid response component to its existing crisis response and safe house.

When DD Intake learns of someone experiencing an emergency institutionalization or hospitalization or is at imminent risk of emergency institutionalization and has no home to return to, a County Manager will take the lead in convening a “rapid response” team. This team may include a Broker, ASAP worker or County Case Manager, Waisman Center staff, DD Intake, Supported Living and Vocational Providers. Using a combination of e-mail, phone calls and face-to-face meetings, this team will work as quickly as possible to find suitable temporary housing for the person in crisis. Once the County Manager has convened a rapid response team, they will seek to turn leadership over to the Broker, County Case Manager or ASAP worker as soon as possible. This will likely occur once a supported living provider has committed to provide crisis support.

Funded vacancies:

The rapid response team will systematically explore existing, funded vacancies within the DD system for an appropriate, temporary placement. County intake staff will maintain a list of funded vacancies and seek to identify safe and appropriate options. “Funded vacancies” are households where the County is paying a time-limited, exceptional expense request (EER) after a housemate dies or moves.

  • The County will require agencies with funded vacancies to rapidly assess and when appropriate, provide interim support to people who are experiencing emergency institutionalization or hospitalization.
  • As a condition of receiving an EER, the County expects individuals with funded openings will accept individuals in need of emergency housing as temporary housemates. Temporary placements will typically last between 30 and 120 days. When a reasonable threat to health or safety exists, a person or their team may decline to accept a temporary housemate.
  • Initial Rapid Response negotiations will occur between Supported Living Provider Executive Directors and County Managers with the knowledge of the Support Broker, County Case Manager or ASAP staff. The intention is to identify an appropriate emergency placement in less than 72 hours with an actual placement occurring within 10 days.
  • The Supported Living Program Specialist will take the lead in making initial contact with the Supported Living Executive Director. When the Supported Living Program Specialist is not available, the assigned County Manager for the individual in crisis will contact the Support Living Executive Director.
  • A County Manager will always contact the Supported Living Executive Director prior to a Broker, County Case Manager or ASAP worker making contact. After the initial contact between the County Manager and Supported Living Executive Director, the person’s Support Broker, County Case Manager or ASAP worker will work with the individual in crisis, their interim housemate and the Supported Living Agency to transfer historic information when available, complete an assessment and transition plan. The goal is to transition a person to an interim placement as soon as safely possible, ideally within 10 days.
  • To encourage rapid transitions, the county will pay agencies based on the individual’s support costs in excess of the existing EER plus an emergency placement stipend of $100/day for 30 days. This emergency stipend attempts to compensate agencies for short-term, additional costs such as overtime and training. If needed, a County Manager can approve an emergency stipend extension for an additional 30 days. The emergency stipend will end after a maximum of 60 days.
  • When a person does not have an SDS rate, DD Intake will determine a rate based on the individual’s support needs. A County Manager will use this as a guideline in negotiating with the Supported Living Director to determine an individual’s interim rate.
  • After an interim rate is set, the County Manager for the person in crisis will send an authorization e-mail to the SDS fiscal crew. The Support Broker, County Case Manager or ASAP worker will take the lead in completing the necessary fiscal paperwork to ensure provider payment.

When no “funded” capacity exists:

  • If a person needing emergency, interim housing and support cannot safely live with anyone who has a funded vacancy (EER), the Supported Living Program Specialist will send an urgent e-mail to all Supported Living and Support Broker Agency Directors. This e-mail will provide a brief profile of the person in crisis as well as a summary of their housing and support needs. The intention is to identify an appropriate emergency placement in less than 72 hours with an actual placement occurring within 10 days.
  • The County will encourage agencies to provide emergency, interim housing and support to individuals in crisis. As noted above, the County will pay the person’s support cost (as determined by their SDS rate and negotiation between County Manager and Support Living Executive Director) plus an emergency placement stipend of $100/day for 30 days (with a potential extension for 30 additional days).
  • The County will encourage people with disabilities to open their homes to individuals in acute crisis. They will be eligible for a grant up $500 per household. Assuming their purchase is legal, individuals may use the grant however they choose. The person’s Broker, County Case Manager or ASAP worker will apply for the grant on the person’s behalf and complete the necessary EER and Voucher form. Payments will go to the provider of the goods or services. There will be no direct cash payments to individuals.
  • A household can request their Brokers; County Case Managers or ASAP workers apply for a $500 emergency placement grant one time for each placement.
  • In some circumstances, teams may decide that a person should not receive an emergency placement grant. For example, it may be inconsistent with a person’s support plan or conditions of probation. The Broker will take the lead in conveying this information to the County Manager.

Discharge and Long-Term Planning:

  • Once a person in acute crisis moves to an emergency interim placement, long-term planning will immediately begin. The Support Broker will lead this process, working collaboratively with the individual’s rapid response team. County staff will determine an on-going SDS rate based on the individual’s long-term support needs. The Broker will complete SDS paperwork needed to ensure provider payment.
  • If an interim placement turns out to be a suitable long-term living arrangement, County staff will establish a permanent SDS rate for the individual. The Broker will in turn complete SDS fiscal paperwork to ensure long-term payment to the Supported Living Agency.
  • An individual’s on-going support will likely be quite different than their interim crisis support. The rapid response team will work to ensure the individual has post-crisis support in place as soon as quickly as possible. The rapid response team will make every effort to identify permanent home and long-term support providers within 60 days. Ideally a person should move within 60-120 days, although sometimes transitions may take longer.
  • Every effort will be made to ensure high levels of communication and coordination during these potentially time-consuming and challenging transitions.