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Statewide line improves access

July 1, 2010
by Pamela Schuble, Gregg Graham, and David Covington
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Georgia's Crisis and Access Line triages crises, cuts emergency-treatment costs, and links people to services-fast

Just a few years ago, Georgians in crisis or in need of behavioral health services had two options: find a provider on their own or call one of 25 “single-point-of-entry” lines serving portions of Georgia to get provider information. Both options required individuals to make their own appointments, which often weren't immediately available. Many who sought help ended up in hospital emergency rooms, state hospitals or local jails, significantly increasing the cost of care, or not receiving care at all. Efforts to improve this system were limited by the lack of quantifiable information about ease and speed of client access to services. And, in 2005, the problem got worse as Georgia's resources were further stretched by the arrival of over 120,000 Hurricane Katrina survivors, many of whom were suffering from serious depression, PTSD, or addictive disorders.

In response to these challenges, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) used a competitive bid process in 2006 and selected Behavioral Health Link (BHL) to develop and manage a statewide toll-free crisis and access line, now called the Georgia Crisis and Access Line (GCAL). Statewide, GCAL would provide a “no wrong door” approach to access, offering telephonic crisis intervention, 24/7 service scheduling with consumer choice, real-time data and reporting for strategic planning, and a new degree of consistency and transparency. BHL is a private, Georgia-based company whose approach to integrated crisis intervention coordinates brief screening, triage/linkage, mobile crisis, and disaster outreach.

GCAL was launched statewide on July 1, 2006, with a tagline of “A Crisis Has No Schedule.” To date, it remains the only statewide crisis and access line in the U.S. that can actively link callers, 24/7, to service providers. GCAL was the first U.S. crisis line to integrate the Substance Abuse and Mental Health Services Agency's (SAMHSA) Suicide Risk Assessment Standards (SRAS) into its call center protocols, enabling staff to view SRAS protocols on database screens during a call to help determine the appropriate level of care. It also earned the Commission on Accreditation of Rehabilitation Facilities' (CARF) first-ever accreditation as a Crisis and Information Call Center. Because BHL provides no direct services, GCAL operates as an honest broker, offering consistency, support, and service choices to those who call for help.

GCAL referral outcomes

Referral outcomes, by fiscal year

2007

2008

2009*

(Projected) 2010

*In FY 2009, about 128,000 referrals were made.

Agency referrals (routine appointments)

78%

76%

79%

80%

Mobile crisis referrals (statewide)

5%

11%

10%

9%

Intensive services referrals

  • Private psychiatric hospitals

  • Crisis stabilization programs

  • State hospitals

17%

13%

11%

11%

More than a hotline: a crisis safety net

GCAL's services go beyond those of a “hotline” because it offers callers standardized, statewide access to a comprehensive and coordinated system of care. It functions as a safety net for individuals, communities, and the state by linking people to routine mental health, addiction treatment, and other services while providing emergency intervention when needed. Thus, it functions as an integral component of Georgia's comprehensive mental health system, ensuring access to and continuity of care. The recent economic downturn, which drove budget cuts for a variety of behavioral health and substance abuse prevention services even as demand for services increased, highlighted GCAL's value. For many, it was the only place they could turn to for help.

Strong connections to mental health, substance abuse, and related providers across Georgia are critically important to the ability of GCAL staff to link callers to appropriate services. At present, relationships have been established with over 140 public or private agencies at about 240 sites. These include six inpatient state hospitals, 26 crisis stabilization programs, many law enforcement and 911 access centers statewide, three sub-acute detoxification programs, 30 private inpatient psychiatric hospitals, mobile crisis teams that serve 40 of Georgia's 159 counties, and 141 hospital emergency rooms. At times, GCAL staff will dispatch a mobile crisis team directly to a hospital ER when, based on established relationships and practices, ER staff wish to “divert” a patient seeking admission for services to community-based crisis or behavioral care.

On average, GCAL staff and systems manage more than 1,000 calls daily. To accomplish its mission, GCAL's operations coordinate knowledge, data, technology, and tracking systems to support licensed clinical staff (LCSWs, LPCs, and RNs) who provide callers with prompt, first-line triage and emergency/crisis support as well as other support staff who manage caller access and referrals to routine or non-emergency services.

Through the process of handling a single phone call, GCAL staff:

  • Conduct screenings to quickly assess callers' needs and risks, while engaging them, offering them choices, and using the least invasive interventions possible.

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