Easterseals creates Crisis Services and Treatment Program to address complex needs of people with disabilities and behavioral health concerns
Written by Lucas Evans , VP of Clinical Services at Easterseals Midwest
Too often, individuals with the most complex support needs, including behavioral health concerns, fall through the cracks of service systems and community life. They end up disconnected from friends and family, lack a home to call their own, struggle to obtain and maintain a meaningful career, and aren’t offered self-determination.
I have witnessed it first-hand across multiple vantage points, from a maximum-security state forensic psychiatric hospital to home and community-based settings, from boots-on-the-ground to executive leadership. I’m not the only one. Constantino and colleagues (2020) noted that while sufficient information for best practice support exists in each discipline’s literature, it is frequently not considered holistically (across disciplines), leading to suboptimal care.
Historically, individuals with the most complex support needs were relegated to institutions. The deinstitutionalized movement culminated in the March 2014 Home and Community-Based Settings rule to ensure that all individuals with disabilities had a reasonable opportunity to remain members of the community by bringing services and support to them in their own homes. Unfortunately, the infrastructure to adequately support individuals with complex behavioral health concerns and disabilities has never been fully developed, widely accessible, or available. Rather than receive the appropriate type and intensity of whole-person treatment and support, individuals with complex support needs end up languishing in inappropriate settings such as boarding in hospitals or jails or receiving suboptimal care.
That is, yesterday’s chronic challenges lead to today’s crisis situations, and today’s crisis situations perpetuate chronic challenges into tomorrow.
These aren’t theoretical or hypothetical concerns. Currently, around 50 Missourians are experiencing a placement emergency (homeless, boarding in hospitals or jails) and require immediate support from a specialized residential treatment program. An additional 300+ people need specialized clinical support and are looking for another residential service provider. Finally, more than 1,000 Missourians currently experience high-risk outcomes. This leads people to frequently encounter multiple transitions, suboptimal care, and inappropriate placements that perpetuate further trauma and disillusionment with the home and community-based care system for individuals and families. This ultimately leads to adverse health outcomes, poorer quality of life, and shorter lifespans (Krahn & Fox, 2014, aaidd’s page on health disparity).
What is needed is a continuum of care that integrates physical health, behavioral health, home—and community-based supports, and habilitative support by design and outcome. Such a continuum of care should provide no wrong door into support and services and be flexible to meet the person as their needs change. The continuum should span from independent community living through inpatient services, recognizing that acute, intensive needs require subsequent matched intensity short-term clinical supports. Furthermore, transitions between levels of care should be seamless and minimize disruptions.
While we have a ways to go, we aren’t starting from scratch.
Missouri’s Department of Mental Health (DMH) has demonstrated extraordinary leadership and vision toward fully integrating care for individuals with intellectual and developmental disabilities. Whether it was the development of the Missouri Association for Dual Diagnosis (MOADD) in 2019, the formation of a Task Force to define best practice parameters for supporting individuals with behavioral health concerns and disabilities (Guidebook), or strategic initiatives to build capacity and disseminate best-practice information and training, DMH has established itself as a national leader in this space. Missouri has a large independent supported living network and a small capacity for inpatient treatment services. What’s missing is the middle of the continuum. That is, Missouri lacks robust, integrated, intensive community-based treatment and enhanced community living that includes embedded clinical supports for individuals with complex behavioral health concerns and intellectual and developmental disabilities.
There is reason to hope.
I feel tremendously grateful to have been able to contribute to this mission over the 10+ years I spent at DMH, including program development and clinical services, being a founding member of MOADD, and most recently co-leading DMH’s BHIDD crisis/system initiative with DMH’s Chief Medical Officer to identify and address the system challenges and root causes of crises. It became clear to me that part of what was needed was a program that could work in concert with local behavioral and medical health providers to provide whole-person treatment from crisis stabilization through community living while minimizing the number of transitions and being flexible to the person's changing needs. Moreover, I wanted to be the person to build such a program.
Enter Easterseals Midwest. As the largest provider of disability services in Missouri, they certainly had the resources and infrastructure to tackle this problem. However, that isn’t what sold me on joining up. I have gotten to know Tec Chapman (Chief Program Officer) over the last couple of years. One thing that always struck me was Tec's articulation of a vision for community support wrapped around people to help them achieve their goals and desires. Based on how he kept showing up to problem-solve and collaborate, it was also clear that he felt Easterseals needed to be a part of the solution. This was coupled with Easterseals’s values of empowering, connecting, innovating, and advocating for and with people with disabilities, a network with 100 years (50+ years in Missouri) of experience walking this walk.
When Easterseals announced that they were investing in solving this problem by developing new positions and a new service line, I thought, this is the real deal! I applied, and Tec, Wendy Sullivan (CEO), and the rest of the executive leadership welcomed me to join them on this journey. Every day, I wake up and work to earn their faith in my ability.
领英推荐
Easterseals is engaged in a multifaceted initiative to address the urgent needs of individuals with disabilities and complex behavioral health needs and to keep people connected to the community through the Crisis Services and Treatment Program. I have assumed the newly created Vice President of Clinical Services position to lead this initiative. The keystone of this initiative is the development of a new service line that emphasizes the provision of holistic, whole-person health, trauma-informed care that supports individuals through immediate crises and onto a path of increased self-direction, long-term wellness, and stability. Through strategic collaborations and innovative service delivery, the initiative aims to establish a continuum of care that is both accessible and effective, ensuring that individuals most at risk of being institutionalized receive the support they need to navigate challenges successfully.
Easterseals is at the forefront of creating a comprehensive, therapeutic, community-based support program.
Easterseals will provide whole-person, trauma-informed support at various support intensity levels, including phases of crisis support, intensive behavioral treatment, and enhanced community living. In collaboration with our partners, including Community Mental Health Centers/Certified Community Behavioral Health Organizations, individuals supported by Easterseals will receive care that maximizes autonomy and self-sufficiency, builds resiliency, addresses behavioral health concerns, and optimizes pharmacological intervention. To minimize the need for transitions between settings, treatment and support intensity will ramp up and down around the person, ensuring that they can remain connected to the community while accessing the level of care needed.
Together, Easterseals will become the highest quality provider of behavioral services in the Midwest, across all levels of community support. Easterseals will be a model of functioning continuum of community-based care in Missouri and nationally.
We will accomplish this by:??
I couldn’t be happier in my new role and in what Easterseals Midwest is building. My sleeves are rolled up. Let’s get to work.
Lucas Evans joined Easterseals Midwest to develop the Crisis Services and Treatment Program from the ground up, enhance clinical services across Easterseals, and develop a standard framework of clinical excellence. He comes to Easterseals with more than a decade of experience supporting people with co-occurring intellectual and developmental disabilities and behavioral health concerns (BHIDD), including program development and clinical services.
He is a founding member of the Missouri Alliance for Dual Diagnosis and, most recently, co-led the Missouri Department of Mental Health's BHIDD crisis system initiative to identify and address the systemic challenges and root causes of crises.
Easterseals Midwest is a nonprofit organization leading the way to 100% equity, inclusion, and access through life-changing disability and community services. Easterseals provides essential services and on-the-ground support to nearly 7,000 people each year across Missouri, Kansas, and parts of Illinois through four divisions: Autism, Community Living, Early Childhood, and Employment Services. Together, we’re empowering people with disabilities, families, and communities to be full and equal participants in society. To learn more, visit www.easterseals.com/midwest.