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Service Delivery Innovation Profile

24-Hour Mobile Mental Health Crisis Team Reduces Hospitalization for Children with Complex Behavioral and Emotional Needs


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Snapshot

Summary

The Mobile Urgent Treatment Team is a multidisciplinary team that provides 24-hour crisis intervention services to families in the Milwaukee area. The team defuses crisis situations and helps to find community services for the child and family as an alternative to institutionalization. The program, which is popular among both police and parents, has significantly reduced the need for hospitalization for children and adolescents after a crisis situation.

Evidence Rating (What is this?)

Moderate: The evidence consists of before and after comparisons of hospitalizations, length of stay, and hospital costs, along with survey reports from parents and police who have used the program.
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Developing Organizations

WrapAround Milwaukee
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Use By Other Organizations

  • MUTT and WrapAround Milwaukee have been in contact with other counties across the United States to help implement similar programs.
  • Dr. Morano now serves as the consultant to the newly formed mobile crisis team in Erie County, NY, called CARES. The CARES team has served families in the Buffalo, NY, area since July, 2009, and adopted much of the philosophy and strategies of MUTT. Other communities, including Chautauqua County, NY, and Saginaw, MI, are in the development phase of similar teams.
  • In the past year, MUTT has worked with several communities to help develop similar programs in their communities. Most notably, MUTT has partnered with Baltimore, MD, and Syracuse, NY, in their efforts to provide crisis services to youth.

Date First Implemented

2001
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Patient Population

Mobile Urgent Treatment Team (MUTT) sees youth of all ages, under age 18 years, for evaluation and assistance.Vulnerable Populations > Childrenend pp

Problem Addressed

Children with complex emotional, behavioral, and mental health needs are frequently given expensive, institutional-based care that provides little or no benefit.
  • Institutional-based facilities, such as residential treatment centers or inpatient psychiatric hospitals, often fail to provide cost-effective care.1
  • Many managed care programs are not designed to allow for community-based services for children with complex needs, and instead focus on residential or institutional-based treatment centers.
  • Children with untreated mental health disorders are more likely to perform poorly in school (or drop out), engage in drug abuse and violent behavior, and commit suicide.2 As a result, the financial and social consequences of untreated disorders can be quite severe for the families involved, their communities, and the overall health system.
  • Effective resources for families and communities, including child welfare education, school-based programs, the juvenile justice system, and various mental health resources and agencies, are often not utilized, especially in crisis situations.1

What They Did

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Description of the Innovative Activity

MUTT is a multidisciplinary team that provides 24-hour crisis intervention services to families in the Milwaukee area who have children with complex needs. The team defuses crisis behavioral and mental health situations and helps to find community services for children and their families. Key elements of the program include the following:
  • The 24-hour team: MUTT consists of 2 psychologists, 18 master's level crisis clinicians, social workers, case managers, a psychiatric nurse, and a psychiatrist on call for consultation. The team is available 24 hours a day to families in the WrapAround Milwaukee Program. If families are not enrolled in WrapAround Milwaukee, the team also provides services to any family in Milwaukee county when a child's crisis threatens removal from home or school.
  • Accessing the team: The availability of the team is highlighted in crisis safety plans as an appropriate public health resource for dealing with emergencies involving children. When a child in crisis is at school, a police station, or anywhere else in the community, MUTT is known as the team to contact.
  • Crisis intervention services: Once called, the MUTT immediately travels to the location where a crisis may be occurring. The team assesses the situation, including the potential for danger that the child poses to himself or others. Based on the assessment, the team weighs intervention options, including keeping the child home (with adequate support services), temporary placement in a crisis group home or other emergency setting, or hospitalization in a psychiatric facility. The team also can provide short-term case management services as necessary and frequently acts as a liaison between the family and available community services.
  • Oversight of crisis group home: MUTT oversees a crisis group home as a plausible alternative to hospitalization and as a transition facility for those who have been discharged from an inpatient setting.
  • Expansion of program:
    • In addition to families enrolled in WrapAround Milwaukee, the program is contracted to serve youth in Milwaukee County who are enrolled in Kinship Care. Kinship Care is a court-ordered system of legal supervision, monitored by the state's welfare system, which place youth with relatives other than biological parents. Their primary goal is to maintain the integrity of the current placement through crisis intervention, risk assessment, safety planning, and followup. Services available to these youth include a crisis plan and 24-hour crisis intervention. A one-on-one "Crisis Stabilizer" is also available on request by the child and family. A Crisis Stabilizer will prevent, deescalate, and stabilize clients during crisis situations and will also make weekly meetings with clients for one-on-one outings.
    • In 2010, they received additional funding from the state of Wisconsin to assist youth in Treatment Foster Care. MUTT now has a three-person team to assess, intervene, and consult, regarding the needs of Treatment Foster Care youth. This team also provides training in issues related to youth with complex behavioral and emotional needs, who are placed outside of the home.

Context of the Innovation

WrapAround Milwaukee is a county-run managed care organization that focuses on serving children and adolescents with complex mental health and emotional disorders. In addition to the MUTT program, WrapAround provides care coordination and an integrated provider network of physicians for 700 families in Milwaukee County. The organization has become well known as a source of information and support for children and families with behavioral problems. WrapAround began from a Federal grant to develop more comprehensive, community-based care for children with serious emotional needs and their families.

Did It Work?

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Results

MUTT has significantly reduced the use and costs of inpatient psychiatric facilities for children with complex needs who face a crisis situation; both police and parents are satisfied with the program.
  • Use and costs of hospitalization: Since implementation of the program in 1994, the annual costs of hospitalization for adolescents fell by more than 50 percent, from $10.5 to $5.0 million. In the third quarter of 2007, nearly four in five (79 percent) MUTT crisis cases were diverted from hospitalization. In addition, those children who are hospitalized through MUTT have significantly lower lengths of stay than do similar children who are not seen by the team (2.2 vs. 5.1 days).
  • User satisfaction: MUTT has received positive consumer satisfaction data from caregiver guardians, police, schools, and foster parents.
In 2010, MUTT received the Community Field Agency of the Year award from the University of Wisconsin-Milwaukee School of Social Welfare.

Evidence Rating (What is this?)

Moderate: The evidence consists of before and after comparisons of hospitalizations, length of stay, and hospital costs, along with survey reports from parents and police who have used the program.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Establishing the need: WrapAround Milwaukee staff went into the community to meet with key stakeholders (e.g., families, community agencies, schools) to determine their needs with respect to caring for children with complex mental health and emotional needs. Staff also examined utilization data (e.g., hospitalizations) to determine the areas of greatest need.
  • Partnering with the community: WrapAround Milwaukee staff canvassed the community to see what resources were available and then developed partnerships with these organizations.
  • Looking for external models: Staff examined the experiences of other communities with respect to crisis intervention, with a particular focus on effective models for mobile crisis intervention that deemphasize the need for hospitalization.

Resources Used and Skills Needed

  • Personnel: MUTT consists of 25 full-time staff, including all types of health care professionals. In addition, MUTT trains five upper level graduate students each semester. These trainees are primarily MSW Social Welfare students with one child psychiatry fellow also supervised each year. Team members need to have empathy, dedication, and creativity to be successful.
  • Training: Team members complete 40 hours of training before they come in contact with families. The training includes the shadowing of established team members, instruction on methods to resolve crises, therapeutic options, and other family-centered solutions.
  • Costs: The total costs for the program are between $1.5 and $2 million annually.
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Funding Sources

WrapAround Milwaukee
MUTT is funded through contracts with public schools and other child welfare organizations in Milwaukee. Medicaid also provides funding through title 19, which covers emergency mental health services.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Develop a comprehensive, community-wide plan for how to effectively manage children with complex needs, including various options during crisis situations.
  • Elicit community support by making the public aware of the availability and potential usefulness of the mobile crisis team.
  • Consider targeting urban areas, where the need for this type of service may be greatest.

Sustaining This Innovation

  • Continually promote the availability of the team within the community as a way to generate both ongoing funding and referrals. The team needs to be highly regarded and utilized if it is to maintain support.
  • Emphasize the program's ability to reduce costs for the community by being a viable alternative to expensive treatments, including institutionalization.
  • MUTT partners with families to help them realize their agency, authority, and ability in dealing with their child's behavioral health.

Use By Other Organizations

  • MUTT and WrapAround Milwaukee have been in contact with other counties across the United States to help implement similar programs.
  • Dr. Morano now serves as the consultant to the newly formed mobile crisis team in Erie County, NY, called CARES. The CARES team has served families in the Buffalo, NY, area since July, 2009, and adopted much of the philosophy and strategies of MUTT. Other communities, including Chautauqua County, NY, and Saginaw, MI, are in the development phase of similar teams.
  • In the past year, MUTT has worked with several communities to help develop similar programs in their communities. Most notably, MUTT has partnered with Baltimore, MD, and Syracuse, NY, in their efforts to provide crisis services to youth.

Additional Considerations

  • Include the families in the decisionmaking process regarding a child's status and needs. This type of communication can help to defuse a crisis situation.
  • Evaluate the total situation in which a child lives, including family issues, the neighborhood, and the like.
  • Recognize that what is "normal" for a child changes over time, and that normalcy is constantly being challenged, especially in adolescent girls.

More Information

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Contact the Innovator

Chris Morano, PhD
Director, Mobile Urgent Treatment Team
WrapAround Milwaukee
(414) 257-7212
E-mail: cmorano@wrapmilw.org

Innovator Disclosures

Dr. Morano has not indicated whether they he has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

Pires SA. Managed care design & financing. Promising approaches for behavioral health services to children and adolescents and their families in managed care systems. Health Care Reform Tracking Project (HCTRP): 2002. Available at: http://www.chcs.org/usr_doc/Promising_Approaches_in_Behavioral_Health.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)

Wraparound Milwaukee background and history [Web site]. Available at: http://wraparoundmke.com/

Wraparound Milwaukee mobile urgent treatment team [Web site]. Available at: http://county.milwaukee.gov/WraparoundMilwaukee.htm

Footnotes

1 Pires SA. Managed care design & financing. Promising approaches for behavioral health services to children and adolescents and their families in managed care systems. Health Care Reform Tracking Project (HCTRP): 2002. Available at: http://www.chcs.org/usr_doc/Promising_Approaches_in_Behavioral_Health.pdf
2 Child and adolescent mental health. National Mental Health Information Center. Center for Mental Health Services. Nov 2003.
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: April 18, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: April 09, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: March 07, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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