19000, Crisis Intervention Specialist

Revision 20-3; Effective August 21, 2020

The 84th Session of the Texas Legislature provided local intellectual and disability development authorities (LIDDAs) with funds to support persons with intellectual and developmental disabilities (IDD) with significant behavioral and psychiatric challenges. These persons often exhibit significant needs requiring additional support beyond the array of services typically provided within community programs. The funds expanded resources to address crisis situations with persons who have IDD.

19100 Definitions

Revision 20-3; Effective August 21, 2020

In this section, the terms below have the following meanings.

Crisis – A situation in which:

• the person presents an immediate danger to self or others; or
• the person’s mental or physical health is at risk of serious deterioration; or
• a person believes he or she presents an immediate danger to self or others; or
• that his or her mental or physical health is at risk of serious deterioration.

Crisis respite – Means short-term (up to 14 calendar days) respite for intellectual and developmental disabilities (IDD) as follows:

• Out-of-home crisis respite provides therapeutic support in a safe environment with staff on-site providing 24-hour supervision for a person who is demonstrating a crisis that cannot be stabilized in a less intensive setting. Out-of-home crisis respite is provided in a setting for which the state provides oversight (for example, an intermediate care facility (ICF), a Home and Community-based Services (HCS) group home, a Department of State Health Services (DSHS)-authorized crisis respite facility or crisis residential facility); and
• In-home crisis respite provides therapeutic support to a person who is demonstrating a crisis in the person’s home when it is deemed clinically appropriate for the person to remain in his or her natural environment and it is anticipated the crisis can be stabilized within a 72-hour period.

CMBHS – Clinical Management for Behavioral Health Services is a web-based software application designed specifically for documentation of community substance use services in an electronic health record format and submission of mental health services data for client eligibility determination, service planning and authorization. Substance use disorder services and mental health service providers submit claims for payment through CMBHS. CMBHS allows HHSC to fulfill responsibilities such as state and federal data reporting, contract oversight, clinical quality improvement and compliance monitoring.

MBOW – Mental and Behavioral Health Outpatient Warehouse that standardizes reporting and analysis across the state funded community-based mental health service network. Reports are available via a web interface and focus on utilization management and contract compliance.

MCOT – Mobile Crisis Outreach Team funded by HHSC to provide a combination of crisis services including emergency care, urgent care and crisis follow-up and relapse prevention to the child, youth or adult in the community.

Therapeutic support – A flexible array of services, including behavioral support provided for persons with IDD who require varying therapeutic and habilitative levels of intervention to holistically address the stressors that result in challenging behaviors. Support may include training in:

• Activities to strengthen appropriate developmental functioning in areas of socialization, self-advocacy and rights;
• Developing coping skills; and
• Reducing or avoiding stressors to prevent crisis events.

TLETS – Texas Law Enforcement Telecommunication System is a statewide telecommunications network composed of computer terminals, interfaces and databases representing city, county, state, federal, military law enforcement and criminal justice agencies in Texas. This network is controlled by a computerized electronic message switching system located at the Texas Department of Public Safety in Austin.

Transition Support Team – (formerly referred to as the "Medical, Behavioral, and Psychiatric Support Team") means a team of professionals, regionally constituted, to provide educational activities, technical assistance, and de-identified case-specific peer review support to local intellectual and disability development authorities (LIDDAs) and IDD providers within a region.

19200 Duties of a Crisis Intervention Specialist

Revision 20-3; Effective August 21, 2020

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist provides information about intellectual and developmental disability (IDD) programs and services to:

• person’s with IDD and their families; and
• IDD providers in the local service area.

The LIDDA must ensure the specialist collaborates with appropriate LIDDA staff and Transition Support Team members to identify persons with IDD in the LIDDA’s local service area who are at risk of requiring crisis services, such as persons who exhibit repeated and severe behavior disturbances that jeopardize the person’s safety or current living arrangement.

The LIDDA must ensure that for a person identified in the above paragraph:

• collaborates with the service coordinator, other members of the service planning team, and paid provider, if any, to identify:
  • prevention strategies to avoid potential crisis events and to promote the person’s coping skills; and
  • training and support needs that provide the greatest chance of success of living in the community, such as scheduled respite services or planned crisis respite to avoid a potential crisis event; and
• supports the service coordinator’s provision of ongoing follow-up and monitoring activities, including assisting the service coordinator, other members of the service planning team and paid provider, if any, in addressing concerns and issues identified during follow-up and monitoring visits, such as involvement with law enforcement or emergency room visits.

The LIDDA must ensure a crisis intervention specialist (CIS) provides education about the manner in which to engage persons with IDD and their unique needs to:

• members of a Mobile Crisis Outreach Team (MCOT) to increase the competency of the members;
• law enforcement; and
• others as appropriate.

The LIDDA must ensure a CIS:

• is available to provide consultation to an MCOT as needed or as clinically indicated regarding a crisis event involving a person with IDD;
• collaborates with an MCOT to develop criteria for referring a person with IDD in crisis to crisis respite;
• for a person referred to crisis respite, develops a crisis respite service plan describing the therapeutic support needed by the person;
• collaborates with local law enforcement by utilizing the Mental and Behavioral Health Outpatient Warehouse (MBOW) to review jail match reports and assisting in discharge planning for persons processed into correctional institutions who have been identified as receiving services from the LIDDA in the past three years;
  • there is no three-year cutoff for persons who are under the age of 18 (youth);
• collaborates with the service coordinator, other members of the service planning team, paid provider, if any, and natural supports regarding crisis follow-up and relapse prevention activities, including;
  • assisting with a person’s transition from a crisis respite back to his or her home or other appropriate setting; and
  • addressing concerns and issues identified during follow-up and monitoring visits, such as involvement with the law enforcement or emergency room visits; and
• documents all activities, collaboration and consultation provided in accordance with this section.

Note: LIDDAs may continue to use existing agency staff to collaborate with law enforcement on discharge planning, as long as the CIS is involved/aware in some manner

19210 Continuity of Care for Persons in Jail

Revision 20-3; Effective August 21, 2020

The 86th Legislature appropriated funding for exceptional Item 44 to add information related to persons with a history of receiving services from a local intellectual and developmental disability authority (LIDDA) into the Department of Public Safety (DPS) Texas Law Enforcement Telecommunication System (TLETS).

When a person who has previously received services from a LIDDA is processed into a correctional institution, facility personnel will run a continuity of care query in the TLETS system to identify if the person has a history of receiving intellectual and/or developmental disability (IDD) services from a LIDDA. If an exact or probable match is made, facility personnel will contact the LIDDA.

19220 Jail Match Report and Data Exchange Process

Revision 20-3; Effective August 21, 2020

A jail match report is created and identifies persons who have been processed into a correctional institution, and for whom facility personnel used the Department of Public Safety (DPS) Texas Law Enforcement Telecommunication System (TLETS) to determine whether a person has received intellectual and/or developmental disability (IDD) services for the purposes of establishing continuity of care.

The DPS TLETS system uses an electronic data exchange process with the Texas Health and Human Services Commission (HHSC) Clinical Management Behavioral Health System (CMBHS) to search for matches based on the following demographic data:

• last name;
• first name;
• date of birth;
• Social Security number;
• gender; and
• race.

The results are compared against CMBHS, which searches for persons who within the last three years have been:

• hospitalized in a state psychiatric hospital;
• admitted to an HHSC-funded, contracted psychiatric hospital bed; or
• assessed, authorized and received services by a LIDDA, to include the grid codes identified below:
  • Service Coordination:
    • 351, Basic Service Coordination;
    • 341, Continuity of Services; and
    • 355, Service Authorization and Monitoring.
  • Habilitation Coordination:
    • 361, Habilitation Coordination; and
    • 362, Refusal Habilitation Coordination Services.

Note: There is no three-year cutoff for persons under the age of 18 (youth).

CMBHS provides an immediate response to the TLETS system indicating if an exact or probable match was located within CMBHS. CMBHS provides an additional piece of information that identifies the name of the LIDDA that provided the services that serves that county.

The jail match report is produced and available to LIDDAs as soon as the next day and identifies the persons whom the match occurred with. The jail match report separates searched persons into those served within the LIDDA’s catchment area, and persons who were last served outside of the LIDDA’s catchment area.

Note: Notification of a match will be sent via email to the chosen mailbox identified by the LIDDA.

The LIDDA responsible for continuity of care efforts is the LIDDA last authorized to provide services to the person. However, the LIDDA last authorized can coordinate with the LIDDA that serves the county in which the person is jailed to assist in continuity of care efforts.

Jail match reports are located in the following folders:

Public Folders ─ MBOW_Production ─ Enterprise ─ CA Continuity of Care ─ Jail Match
The jail match report process details folder contains screen shots on how to navigate the jail match report. This folder is located in the following folder:

Public Folders ─ MBOW_Production ─ Enterprise ─ CA Continuity of Care ─ Jail Match Report Process Details

The information in these reports is designed to assist the LIDDAs with the operation of local continuity of care and service activities and to divert persons from the criminal justice system into appropriate community-based treatment alternatives.

The jail match cross-reference and continuity of care report contains state fiscal year, query begin and end date, match type prompts and a multitude of drillable variables. The first two tabs of the jail match report (i.e., “Client Count by Match Type” and “Request Count by Match Type”) contain actuarial data. The last two tabs (i.e., “Detail by Responsible Component” and “Detail by Request”) contain details relevant to determining appropriateness for diversion. A detailed description of all variables is identified in the table below.

Questions regarding the MBOW jail match report should be directed to CMBHS by emailing CMBHSTrainingTeam@hhsc.state.tx.us or calling 866-806-7806.

19230 Matching Criteria

Revision 22-2; Effective July 22, 2022

One of the following are used to match people in a Texas Law Enforcement Telecommunication System (TLETS) query to a people in Clinical Management for Behavioral Health Services (CMBHS):

• Exact match: The data inquiry matches last name, first name, date of birth, Social Security number, gender and race.
• Probable match: The data inquiry matches one of the following match criteria options listed below:
  • Option 1: Last name, first name, date of birth, and gender;
  • Option 2: Last name, first name initial, date of birth, and Social Security number;
  • Option 3: Last name, first name, date of birth (current age calculation is within five years), gender and Social Security number; or
  • Option 4: Seven or more digits of the Social Security number. 

19240 Duties of a LIDDA Related to TLETS

Revision 20-3; Effective August 21, 2020

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist (CIS) and/or designee as determined by the LIDDA:

• accesses the jail match reports upon notification of an exact or probable match. The jail match reports are housed in the Mental and Behavioral Health Outpatient Warehouse (MBOW) and may be accessed via the Data Warehouse Web Portal;
  • Notification of a match will be sent via email to the chosen mailbox identified by the LIDDA.
• confirms the matched person received the specific services tied to the grid codes that TLETS identified and determines if the person is currently open to services or if they were served in the past three years;
  • There is no three-year cutoff for persons under the age of 18 (youth).
• coordinates with the person’s service coordinator, if applicable; and
• collaborates with the correctional institution to:
  • clarify the status of the person;
  • pull the person from the general population, if not already separated;
  • identify treatment or service needs; and
  • coordinate collaborative post release diversion initiatives to assist the person in discharging from the correctional institution.

Notes:

• Local mental health authorities/local behavioral health authorities (LMHAs/LBHAs) have jail diversion staff who work in collaboration with local law enforcement agencies. Many LMHAs/LBHAs have staff co-located with the LMHA/LBHA or in the correctional institution. The CIS and/or designee, as determined by the LIDDA, should establish a relationship with the staff to further support the continuity of care for people with IDD.
• Health and Safety Code Chapter 614 states “a LIDDA shall accept and disclose information relating to a special needs offender for the purposes of continuity of care and services.” This information includes data about the person’s identity, needs, treatment, social, criminal and vocational history.

19300 Communicating to Stakeholders

Revision 19-5; Effective September 27, 2019

The local intellectual and developmental disability authority (LIDDA) is responsible for communicating to stakeholders, including intellectual and developmental disability providers, advocacy organizations, law enforcement and schools about the creation of the crisis intervention specialist (CIS) position and the general duties of the position.

19400 Required Training for a CIS and Staff

Revision 19-5; Effective September 27, 2019

The local intellectual and developmental disability authority (LIDDA) must ensure a crisis intervention specialist (CIS) completes the training modules available on the Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities website within 30 calendar days after being assigned as a CIS. The LIDDA must ensure the CIS completes additional training modules within 45 days of the posting of new modules on this site.