Standards for public agencies

2020 Edition

Residential Treatment Services (PA-RTX) 13: Crisis Stabilization

The agency provides residents in crisis with structured, trauma-informed stabilization and treatment services in order to help them return to their previous level of functioning.
NA The agency does not operate a crisis stabilization unit.
2020 Edition

Currently viewing: RESIDENTIAL TREATMENT SERVICES (PA-RTX)

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Purpose

Residential Treatment Services provide individualized therapeutic interventions and a range of services, including education for residents to increase productive and pro-social behavior, improve functioning and well-being, and return to a stable living arrangement in the community.
Examples: Children and adults seeking crisis stabilization services may be experiencing an acute psychiatric crisis, a substance use related crisis, or severe emotional or mental distress.
1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for delivering crisis stabilization services
  • Supervision and scheduling criteria
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Residents
  • Review case records

PA-RTX 13.01

Crisis stabilization services focus on crisis resolution and are delivered in a trauma-informed, developmentally appropriate, and culturally and linguistically responsive manner by qualified personnel.

Fundamental Practice

PA-RTX 13.02

Agencies that offer crisis stabilization provide the following services on a 24/7 basis:
  1. emergency reception;
  2. assessment and evaluation;
  3. observation and monitoring;
  4. crisis counseling;
  5. medication management;
  6. structured, therapeutic activities;
  7. support services and psycho-education for family members; and
  8. referrals to specialists and other community-based services, as needed.

Interpretation

In regards to element (a), emergency reception means that individuals in crisis are accepted on a 24-hour basis without undue delays or barriers.
Examples: Structured, therapeutic activities may be recreational, social, and/or educational in nature in accordance with the resident’s service plan. Agencies can also address these services in PA-RTX 9.

PA-RTX 13.03

Residents receive a crisis assessment within 24 hours of admission to determine the appropriate level of care.
Note: Agencies that operate a crisis stabilization unit will also complete the applicable assessment standards in PA-RTX 4.

PA-RTX 13.04

Residents participate in the development of an initial service plan within 24 hours of admission and a comprehensive service plan within five days.

Interpretation

When care extends beyond thirty days the agency must review and update the resident’s service plan according to the change in the individual’s clinical condition.
Note: This standard is specific to service planning timeframes. Agencies that operate a crisis stabilization unit will also complete the applicable service planning and monitoring standards in PA-RTX 6.

PA-RTX 13.05

The agency engages individuals and involved family members in crisis and/or safety planning that:
  1. is appropriate to individual needs and centered around individual strengths;
  2. identifies individualized warning signs of a crisis; and
  3. specifies interventions that may or may not be implemented in order to help the individual de-escalate and promote stabilization.

Interpretation

A safety plan includes a prioritized written list of coping strategies and sources of support that individuals who have been deemed to be at high risk for suicide can use. Individuals can implement these strategies before or during a suicidal crisis. A personalized safety plan and appropriate follow-up can help suicidal individuals cope with suicidal feelings in order to prevent a suicide attempt or possibly death. The safety plan should be developed once it has been determined that no immediate emergency intervention is required. Components of a safety plan can also include: internal coping strategies, socialization strategies for distraction and support, family and social contacts for assistance, professional and agency contacts, and lethal means restriction.

Interpretation

The plan can be part of, and reviewed with, the resident’s overall service or treatment plan.

PA-RTX 13.06

Agencies arrange educational services and supports, as appropriate, to ensure that residents can pursue their educational goals once they achieve a crisis resolution.

Fundamental Practice

PA-RTX 13.07

During the first 48 hours a resident is in care, a minimum of two staff members are on-duty 24 hours per day to ensure that adequate care and supervision are provided.
Note: For care ratio requirements, please see PA-RTX 18.02.