Division of Child Mental Heath (DCMH) - Crisis Services

  

Crisis Services- Child Priority Response

Crisis Response and Intervention Services are 7 day per week, 24 hours per day coverage with in-person crisis assessment and intensive intervention and case management for youth in behavioral health crisis.  Crisis works primarily with children and adolescents who are experiencing a serious emotional disturbance or mental illness which presents a serious risk to them or others. 

When Crisis is called to respond to a mental health crisis, the crisis worker will ask specific questions.  While it may seem frustrating to be answering questions during an emergency, it is critical for the individual staffing the crisis lines to gather enough information to make decisions about the level of risk a child presents and the most responsible course of action. 

Things to Consider when Calling Child Priority Response:

 

Injured/Intoxicated Child - If a child is injured or appears to be under the influence of drugs or alcohol, the school should deal with the situation as a medical emergency.  DCMH Crisis Services will assist after the child is medically cleared. 

 

Child's Mental Health History - If you know a child has a mental health provider, try to contact that provider before calling crisis. A mental health provider will have information that could help assess the crisis.  Their experience with the child could be valuable for ending the crisis.  If Crisis is still needed, let crisis know if the child is connected to a mental health provider for therapy and if the child is taking any psychotropic medications. 

 Response Time - Crisis workers are located geographically to assure minimum in-person response time.  Efforts are made to keep response time under 60 minutes.  Information provided assist Crisis staff to determine appropriate triage. 

Parent/Custodian Notification - A parent or custodian should be called prior to calling crisis and the parent/custodian should be asked to come to the school.  Crisis is a voluntary service.  Crisis can not provide an assessment or services to a child without parental or custodial permission.  Additionally, parental or custodial involvement is essential for factual historical information and affective intervention services.  Exception:  If a child is at imminent risk of harming themselves or others and a parent/custodian can not be reached, crisis can do an assessment without parental consent.  Crisis will determine if the child needs to be taken directly to the ER for a doctor's assessment. 

A Physically Violent Child or Potentially Dangerous Situation - If a child is being physically aggressive or posing a potentially dangerous situation (weapons), the POLICE (911) should be called.  Crisis staff will not restrain a child.  They will assist after the situation has been secured. 

Financial Eligibility - If possible, know if the child has insurance.  Insured children, children with Medicaid, and children with no insurance coverage are eligible to be seen for the initial assessment.  However, insurance companies (not including Medicaid) will not accept the assessment from Crisis Services.   It is often more effective and timelier for a child with insurance coverage to be assessed by providers approved by the family's insurance company. 

Custody and Transportation - DCMH does not have the authority to take custody of a child nor are they permitted to transport a child. 

  

FAQ Crisis Services

 What is the age range served by the Crisis Priority Response?

0 to 18 years of old.

 What is the purpose of Crisis Services?

The therapist will respond to mental health emergencies, assess the risk potential, and will determine the most appropriate treatment needs.  Crisis staff will then assist the child and family with transition to the next level of treatment.  

What steps should I take if the child in crisis has private insurance, Medicaid/DHCP (Delaware Healthy Children's Program), or no insurance?

-If the child has private insurance:

 1. The private insurance company can be contacted to see who their approved providers are.

 2. Then, the child can be transported to the approved provider (probably Rockford if living in New Castle county or Dover Behavioral Health if living in Kent or Sussex county) to get a risk assessment done to determine if child needs to be hospitalized.  Note:  While CMH can do a risk assessment on a child with private insurance, private insurance companies will want their own provider to do one as well - so to prevent the child from going through two assessments (one by CMH and one by the provider), it is better to take the child to the approved provider initially.

-If the child has Medicaid/DHCP or no insurance:

1. Contact the Crisis Priority Response to have them do the risk assessment to see if child needs to be hospitalized.

2. Take the child to the approved facility (assuming the assessment was done at a different location).

 What are the indicators that a child is in crisis?

A crisis situation is a more intense and immediate intervention and is required in order to insure the safety of the child:

• 1. Obvious indicators are direct and indirect statements of suicidal intent or depression.
• 2. Presenting imminent danger to others due to aggressive behaviors, gestures, or threats related to serious emotional disturbance or mental illness
• 3. Self -mutilation
• 4. Exhibiting symptoms of psychotic disorder - responding to internal stimuli or stating that they hear or see things that are physically not present.

 What are the indicators that child is having a behavioral episode and not a psychiatric emergency (crisis)?

Frequently a child or adolescent may act out behaviorally to manipulate a situation to his/her advantage.   This is usually an on-going behavioral problem.

If the child's goal is to avoid something, then this can be an indicator of a behavioral problem rather then an immediate Mental Health emergency (Crisis situation).

Who should be contacted initially if a child meets the criteria for a crisis?

The parent or guardian of the child should be contacted initially because the parent has to give permission before an assessment can be done and their signature is necessary in order for a child to be signed into a hospital.

What specific information should be told to parent regarding current or recent behavior of child, what information should be asked of parent regarding current or recent behavior of child?

1. The parent should be informed about all of the behaviors currently occurring or that have occurred recently.

2. Parent should be asked their name, address, and phone number and if they are willing to come to the school for they will be contacted by Crisis Services

3. Parent should be asked if the child has a therapist or if the child is on any medication for mental health issues. If child is seeing therapist or Doctor (if recently seen), ask the parent to contact therapist or Doctor so that permission may be given to school to speak with them. (Important due to therapist or Doctor knowing the child better than crisis services does)

4. What insurance the parent has-this information will be used to efficiently direct the family to the most appropriate service if more than crisis intervention is needed.

What information would be useful to crisis worker when contacting crisis services?

• Child & Parent's name, address, and phone number - has the parent/custodian been called and are they coming to the school
• Date of birth or an approximate age of the child.
• What behaviors are you observing -Is the child threatening to hurt themselves or harm someone else - Is the child injured--deal with this as a medical emergency.
• Do you know if the child has a therapist/is on medication for mental health issues - have you spoken with that therapist? Calling the child's therapist or Doctor (if recently seen) may be more productive then DCMH as the therapist knows the child provided a current release of information to the school is on file with the doctor or therapist.
• Does the child have insurance -this is used to efficiently direct the family to the most appropriate service if more than crisis intervention is needed.

What sequential steps should a school staff member take to ensure the safety of child?

If a child is being physically assaultive and posing a potentially dangerous situation, the POLICE should be contacted.  DCMH Child Priority Response Services will assist when the situation has been secured.  DCMH cannot respond as quickly as the Police can nor can DCMH legally restrain or transport a child. DCMH prefers not to involve the Police however; there are times when their services as first responders are required. The Crisis Priority Response service can advise on this issue.

What steps should school personnel take to ensure immediate safety of child while parent/Crisis Priority Response is being contacted?

If a child is being physically aggressive or posing a potentially dangerous situation, the POLICE should be called.

If the situation warrants, it is often best to isolate the child away from peers and under the supervision of a capable adult.

What is considered to be parental consent, i.e. verbal, in-person contact, signature?

If at all possible, a parent/custodian should be present for an assessment.  They are essential for factual historical information and affective intervention services. A verbal consent is acceptable and should be well documented.

What can Crisis Priority Response do:

• Respond to behavioral health emergencies in which the child or adolescent presents a serious risk to self or others due to serious emotional problems.
• Conduct a Mental Health Assessment by a crisis service provider
• Work with child, family, school, and any significant persons to relieve the immediate problem
• Provide intensive short term interventions
• Identify the necessary follow-up for the child and family
• Assist with the transition of the child and family to the next level of treatment

What Crisis Priority Response cannot do:

• Assess or provide services to a child without the permission of a parent/custodian. An exception can be made if the parent is unavailable and the Child is experiencing a Mental Health emergency and is a significant risk to themselves or others.
• Transport children
• Perform Restraint Procedures
• Take Custody of a child - only DFS or Police can take custody of a child. 

How do I contact Crisis Priority Response (Crisis Services)?

Call one of the following phone numbers during the incident involving the child: 

• In Northern New Castle County (North of canal) 1-302-633-5128
• In Southern New Castle County (South of canal) 1-800-969-HELP
• In Kent and Sussex Counties 1-302-424-HELP (1-302-424-4357)