Standards for private organizations

2020 Edition

Residential Treatment Services (RTX) 13: Crisis Stabilization

The organization 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 organization does not operate a crisis stabilization unit.
2020 Edition

Currently viewing: RESIDENTIAL TREATMENT SERVICES (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
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
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

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

RTX 13.02

Organizations 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. Organizations can also address these services in RTX 9.

RTX 13.03

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

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 organization 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. Organizations that operate a crisis stabilization unit will also complete the applicable service planning and monitoring standards in RTX 6.

RTX 13.05

The organization 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.

RTX 13.06

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

Fundamental Practice

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 RTX 18.02.