Frontline Initiative: DSPs Responding to Crisis

Person Centered Incident Matrix:
A Community Collaboration to use Person-Centered Responses for Determining if a Situation is a Crisis

Authors

Kim Hoffmockel and Kyle Heyesen both work St. Louis County Public Health and Human Services. Kim Hoffmockel can be reached at: HoffmockelK@StLouisCountyMN.gov.

Nick Lepak is with the City of Duluth Police Department.

Jennifer Klaas, Jenn Prichard and Tony Klass all work for Heartland Homes of Duluth, LLC. They are part of the Person-centered Community Collaboration in southern St. Louis County, Minnesota.

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Many people in our community who receive and provide supports in our adult foster program were using 911 in non-emergency situations. In some cases, people we support received the attention that they wanted in the wrong way. It reinforced an inappropriate way for them to ask for help, rather than learning how to communicate appropriately what they need. This worked against the positive supports that direct support professionals (DSPs) were trying to provide! In other cases, people with higher support needs were not getting what was needed because 911 was not always prepared to provide individualized supports.

In 2017, our community came together to address high 911 call volume from adult foster care homes. Our goal was to better coordinate services that support the people we collectively serve when they are in crisis. Some people with high barriers and high needs living in adult foster care homes were over utilizing the 911 calls for police due to not having a better system in place. We wanted to solve this problem by building a more coordinated system of care.  Our community team included staff from county human services, law enforcement, crisis stabilization, Emergency Departments, and DSPs and staff who work in adult foster care. Meeting face-to-face, developing relationships, and inviting different community entities helped open the discussion. Our discussion started by voicing concerns, although we avoided blaming. The forum was an open dialogue that gave all parties the opportunity to share their dilemmas, practices, and frustrations. We found comfort in the fact that we shared very similar issues among the different parties involved, as well as a shared passion about working together to find a solution.

Prevention: Be proactive, recognize early warning signs, deescalate, active listening, work to understand the underlying need to help support the individual’s well-being. 

  1. Incident occurs, assess whether it is a physical health or mental health situation. 
    1. Physical health, Universal precautions 
  2. Emergency 
    1. Supports call 9-1-1 
    2. Administer CPR or emergency first aid. 
    3. Monitor and follow-up according to plan. 
    4. Document, debrief, internal review and contact necessary parties. 
  3. Non-emergency contact internal. 
    1. Apply first aid. 
    2. Monitor and follow-up according to plan. 
    3. Document, debrief, internal review and contact necessary parties. 
    4. Mental health 
  4. Recognize & respond to WARNING SIGNS. Contact internal supports. 
    1. De-escalation psychological first aid, referral to external natural supports. 
    2. Manage the CRISIS phase safety techniques. 
      1. De-escalation psychological first aid, referral to external natural supports. 
    3. NOT in immediate danger. 
      1. De-escalation psychological first aid, referral to external natural supports. 
      2. Monitor and follow-up according to plan. 
      3. Document, debrief, internal review and contact necessary parties. 
    4. In IMMEDIATE danger. 
      1. Emergency intervention protocol. 
      2. Emergency call 9-1-1. 
      3. Monitor and follow-up according to plan. 
      4. Document, debrief, internal review and contact necessary parties. 

Emergency is a time of a critical and dangerous circumstance requiring immediate assistance/action/relief due to imminent threat to life or health of a person or group of people. 

  1. Health relates to physical and psychological. 
  2. All emergencies are a crisis, but not all crises are an emergency. 

Download PDF of the Person Centered Incident Matrix

When we understood the issues, we set goals together. By collaborating, we developed a shared definition of emergency, a process for responding to crises, and a way to improve communication across systems of care. With shared goals and aims, we formed The Person-centered Community Collaboration within St Louis County. We created a Person-centered Incident Matrix (PCIM) that detailed this process. It was intended to communicate to everyone when a situation was truly an emergency and deserved a 911 call. The matrix details other community supports that people could contact for different types of crises.

Given that there are numerous organizations in our community and hundreds of direct support professionals (DSPs) working in adult foster care homes, we needed to create tools to communicate about the PCIM and the Person-centered Community Collaboration. Some of the methods we created are:

  • A training about the PCIM and emergency response.
  • An educational video that was shared across services.
  • A group to review and assess call volume data to provide training when there is inappropriate use of law enforcement resources.

One adult foster care organization in St Louis County—Heartland Homes of Duluth, LLC—shared how they introduced the PCIM in training and orientation. Heartland Homes of Duluth provides direct support services to 16 adults with disabilities. Some of their staff participated in creating the PCIM.

All emergencies are crises, but not all crises are emergencies.

The PCIM was included in initial orientation training for DSPs. We love to use the phrase, “All emergencies are crises, but not all crises are emergencies.” One DSP who received the training was asked if they felt confident deciding when to contact 911, or when to handle the situation internally? The DSP replied, “When I think of a crisis versus an emergency, emergencies are something that needs immediate response beyond staff intervention.” Staff are more confident in responding to crises with this training. They also have better relationships across agencies, knowing that they are working together. Medical Coordinator Jenn Pritchard said, “I like the amount of increased communication between all entities involved with the committee. It’s nice to have a resource to contact for problem-solving.”

The Person-centered Community Collaboration within St. Louis County has now worked together for several years. We add more community partners and expand our knowledge and relationships. The PCIM supports DSPs to use a tool in difficult situations. It supports handling different situations that may arise in an adult foster care home. The relationships that have been built have benefitted everyone. Our system is not perfect, but now we have a well-established network that supports our work with people receiving services during stress, as well as our partners in the community!