Mindstrong Escalation Procedures

Escalation Pathway

Therapist Only

Escalating a Member

When a member reports active suicidal or homicidal ideation which includes clear plans, means, and intent, the request should be escalated to emergency services in the area (see here for Hospitalization Workflow). If you require consultation, contact the lead on call.

 Use clinical judgment to determine if it is appropriate to place the member on hold while you call 911 or call while still on the phone with the member using either your laptop or phone. If it is not appropriate to place the member on hold and assistance is needed, reach out to the on-call lead via Slack (during business hours) and/or text/call; if you do not receive an immediate response, please contact the manager on call. The on-call lead/manager will assist you with contacting 911 while you stay on the line with the member.

While anyone despite licensure status can escalate a case to 911 and/or use crisis interventions to manage a member's crisis, there may be times when a consult is needed with a clinician licensed in the state of the member for reasons including, but not limited to (1) consult on challenging case and available resources (2) legal/ethical considerations. It is the person on call’s responsibility to manage the crisis start to finish. Member handoffs to someone licensed in their state is not necessary. If the member is not in immediate danger, reach out via slack during business hours on the team-mhs channel using @here to see if anyone licensed in that state is available for a consult.

Trained Mindstrong Personnel Only

Escalating a Member

When a member reports active suicidal or homicidal ideation which includes clear plans, means, and intent, the request should be escalated to emergency services in the area (see here for Hospitalization Workflow). If you require consultation:

  1. Send a message on cp-urgent-support Slack Channel with @here requesting support.
  2. Contact the on-call Clinical Lead either in slack or call them directly.
    1. You can locate the on-call Clinical Lead by reviewing Mindstrong On-Call Calendar or on Slack in the team-mhs channel at the very top.
  3. If no response, then contact the on-call Manager either in slack or call them directly.
    1. You can locate the on-call Manager by reviewing Mindstrong On-Call Calendar or on Slack in the team-mhs channel at the very top.

Use professional judgment to determine if it is appropriate to place the member on hold while you call 911 or call while still on the phone with the member using either your laptop or phone. If it is not appropriate to place the member on hold and assistance is needed, reach out to the on-call lead via Slack (during business hours) and/or text/call; if you do not receive an immediate response, please contact the manager on call. The on-call lead/manager will assist you with contacting 911 while you stay on the line with the member.

While anyone despite licensure status can escalate a case to 911 and/or use crisis interventions to manage a member's crisis, there may be times when a consult is needed with a clinician licensed in the state of the member for reasons including, but not limited to (1) consult on challenging case and available resources (2) legal/ethical considerations. It is the person on call’s responsibility to manage the crisis start to finish. Member handoffs to someone licensed in their state is not necessary. If the member is not in immediate danger, reach out via slack during business hours on the team-mhs channel using @here to see if anyone licensed in that state is available for a consult.

On-call Lead

Role of the On-call Lead

The on-call lead serves as clinical support and back-up to the on-call clinician and is responsible for being available and ready to assist the on-call clinician in meeting member needs. Examples of reasons an on-call clinician may contact the on-call lead include, but are not limited to:

  1. The clinician has received multiple pages simultaneously and has determined that it is not possible to handle them on their own.
  2. To consult on a high-acuity case that the clinician is unsure how to handle.

In addition, in the case of an on-call clinician who has not acknowledged one or more pages, Pager Duty will page the on-call lead starting 10 minutes after the member requested an urgent session. The on-call lead will attempt to contact the on-call clinician so that they can take the page. If such attempts are unsuccessful, the on-call lead will contact team MHS to see if someone is available or respond to the page themselves, ensuring that someone responds within 20 minutes of the member requesting the urgent session. If the missed pages occur, it is the responsibility of the on-call lead to inform the clinician’s manager so that the manager can follow up with the clinician regarding the missed page.

On-call Manager

Role of the On-call Manager

The on-call manager serves as support and back-up to the on-call lead and is responsible for being available and ready to assist the on-call lead/clinician in meeting member needs. Examples of reasons an on-call clinician may contact the on-call manager include, but are not limited to:

  1. The clinician has attempted to contact the on-call lead for clinical support and has not received a response.
  2. The on-call lead determines a manager’s input is needed on a high acuity case or unusual circumstance.

Typically, the decision to call the on-call manager will be made by the on-call lead. However, if a clinician has attempted to call the on-call lead and been unsuccessful, they should call the on-call manager for clinical support.

In addition, in the case where both the on-call clinician and on-call lead have not acknowledged one or more pages, Pager Duty will page the on-call manager starting 16 minutes after the member requested an urgent session. The on-call manager will take the page as there is not time to find someone else to take it at this point.

Documentation and Care Coordination Expectations

Documentation

Inbound clinician will submit documentation as soon as possible, but within 24 hours.

Documentation should include:

  • Assessment administered + outcome
  • Interventions used
  • Any consultations and escalation
  • Any referrals made

Anyone who directly or indirectly supports member should also document steps taken. For example, if on-call lead helps the inbound clinician located Crisis Centers, the on-call lead should document that they provided the resources to the inbound clinician.

Care Coordination

Inbound clinician will send an email to the assigned-providers (therapist, Trained Mindstrong Personnel, and/or psychiatrist) and their respective managers informing them of the urgent session and if any follow-up is needed. See Contact List for list of clinicians and respective managers

Referring Member to Services

During an urgent session, it may be appropriate to schedule the member with a sooner appointment with their Care Team. If the assigned-provider has availability, proceed with scheduling the sooner appointment. If not, then contact the provider and their manager via email.

If the member does not have an assigned Care Team, you can refer to the Changes in Service on steps to get the member re-enrolled in services (see Section “Service Re-enrollments” → “During an urgent session”)