Expedited Joint Response Protocol with the DMH Field Response Operations (FRO)

0070-547.14 | Revision Date: 02/05/21

Overview

This policy guide is a review of the protocol between the Department of Mental Health’s (DMH) Field Response Operations (FRO) and DCFS, when the FRO team responds in person to a child in crisis.

TABLE OF CONTENTS

Policy

Joint Response Protocol between Department of Mental Health (DMH) and DCFS

Field Response Operations (FRO)

DCFS/FRO Joint Response

Follow Up and Case Planning Activities

Non-Hospitalized Chidren and NMDs

Hospitalized Children and NMDs

Psychiatric Hospital Discharge Planning

Hospital Discharge Teleconference Protocol for NMDs

Procedure

FRO Responds to a DCFS Supervised Child and There are No Allegations of Abuse or Neglect

During Regular Business Hours

HRSD Staff Responsibilities

Continuing Services CSW Responsibilities

Continuing Services SCSW Responsibilities

After Regular Business Hours

CPH CSW Responsibilities

CPH SCSW Responsibilities

ERCP CSW Responsibilities

ERCP SCSW Responsibilities

Continuing Services CSW Responsibilities

Continuing Services SCSW Responsibilities

Continuing Services /ER/ERCP CSW Responsibilities

FRO Joint Response Referrals to the DCFS Child Protection Hotline (CPH)

CPH CSW Responsibilities

CPH SCSW Responsibilities

Continuing Services/ER/ERCP CSW Responsibilities

Approvals

Helpful Links

Forms 

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version, to reflect updated protocol for DMH Field Response Operation and DCFS staff.

POLICY

Joint Response Protocol between Department of Mental Health (DMH) and DCFS

Field Response Operations (FRO)

The DMH Psychiatric Mobile Response Teams (PMRT) and the Law Enforcement Teams (LET) are known collectively as Field Response Operations (FRO). They provide a field based response to ACCESS and PMRT referrals in situations where an individual appears to present a danger to themselves, to others, or is gravely disabled as a result of a mental disorder. If it is determined that the individual is in need of hospitalization, FRO prepares the supportive paperwork to initiate the involuntary hospitalization and arrange for ambulance transportation to the receiving hospital, per WIC 5150 (for adults and NMDs) or WIC 5585 (for children).

Emergency psychiatric services are coordinated through ACCESS, which also offers information regarding all types of mental health services available in Los Angeles County. CSWs may request a joint response with FRO by contacting the ACCESS hotline 24 hours per day, 7 (seven) says a week, at (800) 854-7771. When a CSW is not sure if a joint response is necessary, the CSW should consult their SCSW and co-located DMH staff.

FRO operate every day from 8:00 a.m. until 2:00 a.m. The FRO teams are comprised of DMH clinical staff assigned to specific mobile response teams located in the eight Los Angeles County Service Planning Areas (SPAs). FRO staff have legal authority to perform evaluations for the involuntary hospitalization of children and adults determined to be at risk of harming themselves or others or who are gravely disabled as a result of a mental disorder. FRO responds to requests for mobile psychiatric services. Response criteria include, but are not limited to, clients:

• With acute mental illness

• Exhibiting symptoms of harmful behavior to self or others

• Exhibiting violent or assaultive behavior of psychiatric etiology

• Exhibiting functional impairment in their ability to obtain food, clothing, or shelter as result of a mental disorder

Other examples of individuals or situations appropriate for FRO services are:

• Individuals who are decompensating or at risk for suicide

• Homeless persons in crisis or experiencing psychotic symptoms

• Developmentally disabled individuals in crisis due to a mental disorder

• Individuals with co-occurring disorders in crisis due to a mental disorder

• A conservator requesting assistance to hospitalize a conservatee

• Elderly individuals exhibiting psychiatric symptomatology as posing a danger to themselves, others or no longer capable of providing themselves with food, clothing or shelter

• Individuals exhibiting homicidal ideation due to a mental disorder

In some instances, children and youth do not meet criteria for hospitalization, but a field response may indicate a serious need for immediate intervention. In these circumstances, DCFS and FRO will work together to create an appropriate safety plan for the child and family.

DCFS/FRO Joint Response

A joint response protocol was developed between DMH and DCFS to ensure better individualized safety plans for children/NMDs in crisis. This protocol also established a formal process for the timely identification, notification, and response to DCFS children/NMDs experiencing acute mental health episodes. The protocol outlines communication between Field Response Operations (FRO) and DCFS when the FRO team responds face to face to a child who does not meet the criteria for a psychiatric hold.

The purpose of a joint response between DCFS and FRO is to provide for the coordination of services between both agencies and to share information and expertise regarding children with acute mental health needs served by DCFS. The goal of the joint response is to ensure real-time communication, a joint assessment of safety, risk and service needs of the child and family and a mutually agreed upon follow up activities between DMH FRO and DCFS. Following the crisis, DCFS and DMH staff will work with the child, various  team members and each other to evaluate the results of the crisis intervention and, if applicable, to adapt the current case plan in order to enhance the outcome for the child and family.

Back to Policy

Follow Up and Case Planning Activities

Non-Hospitalized Children/NMDs

When FRO determines that a child/NMD does not require hospitalization, FRO will deliver mental health services to intervene and stabilize the crisis, as necessary. Provision of in-home de-escalation, stabilization, and support services include but are not limited to the following:

• Identify triggers and precursors that led to the instability;

• Identify the caregiver interventions attempted;

• Observe the child/NMD and caregiver interaction;

• Diffuse the immediate situation and develop a safety plan;

• Establish a connection to a mental health provider or community support, if necessary;

• Consult with child's current caregiver;

• Consult with DCFS and/or the existing mental health provider

For all non-hospitalized children/NMDs, FRO will notify the DCFS High Risk Division with the intention to identify if:

• There is an existing court order authorizing a mental health assessment and treatment, if necessary;

• There is an existing Child and Family Team so that efforts can be coordinated to address concerns and a plan can be made for ongoing care and support for that relationship in a trusting and healing environment.

At any point DCFS staff are welcomed to with the DMH SFC co-located mental health staff on children/youth who are not hospitalized.

Hospitalized Children/NMDs

Refer to Procedural Guide 0600-505.20, Discharge Planning Conference for DCFS Supervised Children.

Psychiatric Hospital Discharge Planning

A child being discharged from a psychiatric hospital may have special care needs. These needs must be met in the least restrictive, most family-like setting, as appropriate.

The Bureau of Clinical Resource and Services (BCRS) will convene a discharge planning conference for all court-supervised children upon receipt of notification that the child has been hospitalized. DCFS children who are not court-supervised may be subject to a discharge planning conference via the BCRS.

The teleconferece will include the following individuals:

• CSW and/or SCSW

• Residential Care Liaison (RCL)

• Hospital social worker

• Department of Mental Health (DMH) representative

• Child's attorney

• The child/youth, if age appropriate

The the extent it is legally permissible to share Protected Health Information (PHI), the teleconference may also include:

• Regional Center staff

• Community mental health providers

• The child's outpatient therapist, depending on the child's case

• The child's Foster Family Agency (FFA) or STRTP caseworker

• The Family Preservation (FP) In-Home Outreach Counselors or FP Clinical Supervisor

• Court-Appointed Special Advocate (CASA), if authorized by the court to receive PHI

The teleconference discussion includes, but is not limited to, the following:

• The reasons for the hospital hold (i.e., the child/youth/NMD's behavior)

• The child/youth/NMD's behavior during the hospitalization

• The child/youth/NMD's diagnosis, medication(s), and current mental health needs

• Placement needs:

• CSWs should make every effort to safely return a child to their prior placement. If return to the prior placement is not possible for the child, CSWs should consider working with the Accelerated Placement Team (APT) to locate an alternative placement.

• If it is determined that there is a need for more intensive services requiring possible placement in a group home, STRTP, or Community Treatment Facility (CTF), ensure communication with the Child and Family Team (CFT) members as state-mandated and refer the child/youth/NMD for an Interagency Placement Committee (IPC) screening to address such placement recommendations and needs.

• Consideration of services:

• There are a variety of services provide through DMH, the Regional Center, Wraparound, and Family Preservation that may be used by parents, relatives, and foster caregivers to provide needed care and supervision for the child.

Hospital Discharge Teleconference Protocol NMDs

NMDs are hospitalized in adult psychiatric hospitals. Since DCFS' Bureau of Clinical Resource and Services (BCRS) High Risk Division does not have a partnership with the various adult psychiatric hospital settings, BCRS is not often notified of a NMD's hospitalization until a CSW alerts BCRS of the NMD's crisis and stay. Once notified, BCRS will try to coordinate a hospital discharge teleconfence with the adult hospital. However, the adult hospitals usually require the NMD's to consent to BCRS having a hospital discharge teleconference regarding their case since they are legally adults and without the NMD's consent a hospital discharge teleconference cannot occur.

PROCEDURE

FRO Responds to a DCFS Supervised Child and There are No Allegations of Abuse or Neglect

During Regular Business Hours

The FRO will access the Referral Portal to search for the current CSW and SCSW for the child. The FRO and the child’s continuing services CSW will complete a joint response assessing the status of the child.

High Risk Services Division Staff Responsibilities

1. When contacted by FRO, due to the inability to access the Referral Portal for a child's information, gather and exchange identity and contact information regarding the child, caregiver, family, FRO contact person, the CSW and SCSW assigned to the child.

2. When contacted by FRO, due to challenges with receiving a joint response from a SCSW or CSW, immediately email (performing follow up telephone calls, if necessary) to the CSW, SCSW, ARA, RA and the Coordinated Services Action Team (CSAT) Leads for the child’s assigned regional office, regarding the FRO involvement with the child and the need for DCFS to respond jointly, in person or by phone, with FRO to assess the child.

3. Participate in data tracking activities with DCFS Business Information Systems (BIS).

Continuing Services CSW Responsibilities

1. Upon receipt of the notification from HRSD staff requesting a joint response with FRO, immediately consult with the SCSW to determine the type of response. Consultation between CSW and SCSW must take place immediately to determine the ability of the CSW to make a timely, in person or by phone, response with the FRO.

• Every effort should be made to arrange that the CSW is able to make an in person or by phone, joint response. The CSW and/or SCSW will contact the FRO staff and conduct a joint response over the telephone, covering as much required information as possible. Issues to be discussed include, but are not limited to, consideration of and provision of treatment, safety of the child staying in the home and, if not hospitalized, the follow-up services to enact.

2. Team with the FRO staff to take all necessary steps to ensure the child’s safety and that the child’s placement and service needs are met. Collaborate with FRO and any other team members to assess the caregiver’s ability to provide for the child’s well being and to plan the most appropriate crisis intervention.

3. If the FRO is involved in a case, the CSW should notify the child's attorney. This will flag the case for the attorney and make them aware that they may have to request more intense services or other measures, in court.

4. Document all contacts made and actions taken in the Contact Notebook. Clearly describe the events that triggered the crisis, who was present at the time, the name and contact information of the FRO staff, disclosures made by the child and caregivers and the outcome of the joint response with the reasons the child was, or was not, hospitalized and the plan for follow-up mental health care.

5. If the FRO is involved in a case, the CSW should notify the child's attorney. This will flag the case for the attorney and make them aware that they may have to request more intense services or other measures, in court.

6. Review the follow up report submitted by DMH regarding follow-up mental health activities on the case and consult with the DMH staff, the child’s therapist and caregiver, if necessary, to determine next steps.

Continuing Services SCSW Responsibilities

1. Ensure that the CSW responds to the FRO request for a joint response in a timely manner, if possible, and collaborates with the FRO and DMH teams in assessing the child’s safety and well-being.

After Regular Business Hours

The FRO will call the Child Protection Hotline (CPH) after regular business hours (5:00 p.m. to 8:30 a.m., weekends and holidays, when responding in person to a DCFS supervised child experiencing a mental health crisis and there is no suspicion of child abuse or neglect to obtain historic information and/or current CSW/SCSW information when this information is not found in the FRO's Referral Portal search.

CPH CSW Responsibilities

1. When contacted by FRO, gather and exchange identity and contact information regarding the child, caregiver, family, FRO contact person, and the continuing services CSW and SCSW assigned to the child.

2. Complete a CSW Information/Consultation Call form and Expedited Response Alert form to request joint response from Emergency Response Command Post (ERC) CSW.

3. Submit the completed forms to CPH SCSW for review and approval and submit to clerical support staff for faxing to ERCP.

4. Forward the CSW Information/Consultation Call form via email to the continuing services CSW/SCSW and HRSD Division Chief.

CPH SCSW Responsibilities

1. Review and approve the CSW Information/Consultation Call form and Expedited Response Alert form.

ERCP CSW Responsibilities

1. Upon receipt of the Information/Consultation Call form from CPH, immediately contact the FRO staff person or supervisor to discuss the FRO field visit assessment and what follow-up is required.

2. Contact the child and the child’s team as soon as possible to assess the child’s needs, plan any additional interventions needed and adapt the current case treatment plan to better meet the child’s mental health needs. Take all necessary steps to ensure the child’s safety and that their placement and service needs are appropriately met.

3. Document all contacts made and actions taken in the Contact Notebook.

ERCP SCSW Responsibilities

1. Ensure that the CSW makes follow-up contact with the FRO staff and has taken appropriate action to ensure the child’s safety and well-being.

Continuing Services CSW Responsibilities

1. Review the follow up report submitted by DMH regarding follow-up mental health activities on the case and consult with the DMH staff, the child's therapist, and caregiver, if necessary, to determine the next steps.

2. Share the DMH follow up report and consult with the Family Preservation IHOC and FP clinical supervisor to develop next steps, as needed.

Continuing Services SCSW Responsibilities

1. Ensure that the CSW makes follow-up contact with the FRO staff and has taken appropriate action to ensure the child’s safety and well-being.

FRO Joint Response Referrals to the DCFS Child Protection Hotline (CPH)

When making an in person response to a child with acute, urgent mental health needs, the FRO, as a mandated reporter, will contact the Child Protection Hotline (CPH) immediately if they have reason to suspect that a child may be a victim of abuse or neglect. If the referred child is receiving DCFS services, the CSW providing current services to the child will respond jointly, in person or by phone, with FRO. If the referred child is not under DCFS supervision and CPH determines an immediate response is necessary due to the reported allegations of suspected abuse and/or neglect, the ER CSWs should respond jointly with the FRO.

CPH CSW Responsibilities

1. Assess the information to determine whether an in-person response is necessary.

1. If an in-person response is necesarry, determine if it requires an immediate response, 5-day by a specified date, or a 5-day response.

1. Assign the referral in accordance with the Referral Assignment Criteria.

2. All immediate response referrals received after 5:00 p.m. or on weekend and holidays, should be assigned to Emergency Response Command Post (ERCP).

2. If an in-person response is not necessary and the referred child is under DCFS supervision, complete a CSW Information/Consultation Call form and Expedited Response Alert form.

2. When an in-person response is generated:

1. In the screener alert and top of screener narrative, flag the referral as "FRO-Expedited Response".

2. Immediately complete an Expedited Response Alert form to request the joint response from the current assigned continuing services CSW.

3. If the referral requires an Immediate Response, also complete an Expedited Response Alert form to alert an Emergency Response CSW to conduct a joint response with the continuing services CSW.

4. If the referral is generated after hours, complete an Expedited Response Alert form to request the joint response from an Emergency Response Command Post CSW.

2. Obtain SCSW approval to fax the completed Expedited Response Alert form to either the Regional Office continuing services CSW, a Regional office Emergency Response (ER) section, or Emergency Response Command Post (ERCP).

3. Forward the Expedited Response Alert and CSW Information/Consultation Call form to designated support staff and complete the referral on CWS/CMS.

CPH SCSW Responsibilities

1. Review and approve the Expedited Response Alert form and referral. 

Back to Procedure

Continuing Services/ER/ERCP CSW Responsibilities

1. If the referred child is under DCFS supervision, the continuing services CSW will respond jointly with the FRO.

2. Contact FRO staff or assigned contact person to determine the location of the child(ren) and to clarify the nature of the emergency.

3. Make arrangements with the FRO staff to conduct a joint response.

1. ER/ERCP CSW should respond to the FRO-Expedited Response Referral following procedures for conducting the investigation.

4. Collaborate with FRO staff to:

1. Assess the child’s immediate safety, risk and well-being and consider the placement and service needs of the child. 

2. Make all efforts to reach a mutually agreeable resolution with FRO regarding necessary actions to ensure the child’s immediate safety and formulate a safety plan. 

3. Coordinate with the FRO staff regarding follow up activities necessary to ensure continued safety and responsible persons for specific activities, including other team members in this discussion if appropriate.

5. Document contact with the child in the child’s Contact Notebook on CWS/CMS.  Provide:

1. A clear description of the events that triggered the crisis

2. Who was present at the time?

3. The name and contact information of the FRO staff

4. Disclosures made by the child and caregivers

5. The outcome of the joint response

6. The reasons why the child was or was not hospitalized and the plan for follow up mental health care

6. File the FRO-Expedited Response Alert form with the Referral.

7. Review the follow up report submitted by the DMH staff regarding follow up mental health activities on the case and consult with the DMH staff, the child’s therapist and caregiver if necessary.

Back to Procedure

Back to Procedure

APPROVALS

Continuing Services SCSW

• CSW joint response in person or via phone call with FRO staff

CPH SCSW

• Field Response Operations (FRO) Expedited Response Alert Form

HELPFUL LINKS

Forms

CWS/CMS

CPH CSW Information/Consultation Call Form

Expedited Response Alert

Referenced Policy Guides

0050-502.10, Child Protection Hotline (CPH)

0050-503.15, Response Times for Referrals

0050-504.05, Referral Assignment Criteria

0070-548.10, Disposition of Allegations and Closure of Emergency Response Referrals

0100-510.55, Screening and Placement of Children, Youth and Nonminor Dependents (NMDs) in Short-Term Residential Therapeutic Program (STRTP)

0400-503.10, Contact Requirements and Exceptions

0600-505.10, Placing Children with Special Care Needs

0600-505.20, Discharge Planning Conference for DCFS Supervised Children

Statutes

Welfare and Institutions Code (WIC) Section 5150 – Allows for the involuntary hospitalization of an individual found to be gravely disabled or a danger to themselves or others due to a mental disorder.

WIC Section 5585 – is the Children’s Civil Commitment and Mental Health Treatment Act of 1988.

Back to Helpful Links