Crisis Services

Monarch’s Crisis Services include several Crisis Centers around the state and Mobile Crisis Management support. These services are for those who are experiencing a crisis and are in immediate need of the proper care. You can find detailed information about our Crisis Services below.

Location & phone number

1810 Back Creek Drive, Charlotte, NC, 28213

Toll Free: (844) 263-0050 // Local: (704) 206-2342

What is the limit on the number of times a child can be admitted in one year?

This is based on the service definition and authorization by Cardinal. There is a 30 day limit within a rolling year.

What data will be collected about the use of the FBC?

Demographics – ages, gender, location of residence, etc.

Admission & Discharge – admitting diagnosis, lengths of stay, referral sources, discharge dispositions, denial reasons, etc.

Will any of this data be made available to the community?

Our Quality Management department will work with anyone requesting data about the FBC to provide as much necessary information as we are able.

Would Monarch consider seeking RFPs to attempt to fill any service gaps that may be identified (i.e., we are consistently denying individuals with higher I/DD than can be managed at FBC, identifying a need for a level of care to accommodate this population)?

We will be communicating with the MCO on all needs that may be identified as a result of compiling data on outcomes, admissions, denials, etc.

What insurance(s) will be accepted at the FBC?

We will primarily be serving children and adolescents with Medicaid through Cardinal.

There will be some IPRS funding available for those who are uninsured o Insurance companies do not recognize the Facility Based Crisis service and therefore aren’t likely to pay for it. Monarch is able to accept payment from any insurance company that is willing to cover it, but we expect this is unlikely. Monarch has recently received Joint Commission Accreditation and will be collecting data on outcomes to make a case to insurance companies for why they should provide coverage for the service, but we don’t anticipate being able to have these conversations until after at least one year of operation. We will provide insurance coverage information to the legal guardian up-front and provide payment options as needed. Monarch strives to help anyone in crisis even when this means incurring certain costs to do so, though we know this can’t be sustained on a regular basis and attempt to help find the most affordable service to meet behavioral health needs.

What is the staffing ratio?

1:3

How should referrals be made for FBC services, and should any information be sent to the FBC ahead of the individual?

We would prefer that referring providers, parents, law enforcement, etc., call the FBC ahead of time to ensure that there is bed availability for the individual in crisis and provide the opportunity to do a quick phone screening for the appropriateness of the referral. Every individual who presents to the FBC will still be given a thorough screening, but this call-ahead approach could help ensure individuals are routed to the most appropriate level of care up front.

If the referring provider has information such as a psychological assessment, IQ testing, current medications prescribed, list of services currently in place, etc., that information could be sent with the child/adolescent or emailed to a staff member at the FBC ahead of time and would definitely be beneficial.

Can undocumented children and adolescents be served by the FBC?

As stated above, we strive to support anyone experiencing a crisis that we are able to help, and will advocate for coverage of FBC services for undocumented individuals who need it. Funds specifically for undocumented individuals are limited, however.

Will there be any Spanish-speaking clinicians at the FBC?

We don’t currently have any bilingual clinicians, but will employ the same translation service that we use for our outpatient and community-based services. A telephone translation service is typically employed, but we do have the ability to schedule an in-person translator if needed.

Will pregnant teens be accepted?

No, all pregnant youth in crisis will need to go to the hospital.

Will our psychiatrist be able to continue providing medication management services post discharge, and what would this process look like?

We are still working internally on identifying the FBC’s Medical Director’s capacity to maintain an outpatient caseload. Everyone served at the FBC will be discharged with referral(s) to any services that are deemed clinically necessary, and this will include referrals to outpatient psychiatry services.

How do we plan to communicate with the individual’s primary care providers?

We will be able to share information with the individual’s primary care provider if a release of information has been provided by the guardian. Part of the discharge process will include discussions with the guardian about who to share the discharge summary and other information with upon discharge from the facility.

If an individual admits to the FBC without an assigned care coordinator will we help to connect he/she with one?

Yes, we will make a referral to the MCO for a care coordinator if one has not already been assigned.

Will DSS and others involved in the youth’s care be able to receive a copy of the discharge plan, and what will this process be?

This will be essentially the same process as outlined above for primary care providers.

Do we plan to schedule discharges at the same times throughout the day, or will discharge times be varied?

The specifics of some of our policies, such as those pertaining to discharges, are still being fine-tuned. Ultimately this will be something that our psychiatrist will determine.

 

What is the ability of the FBC to provide detox?

The FBC will have protocols for supporting individuals with substance use and will be able to provide minimal detox services, barring anything that would prevent our ability to maintain their medical stability and safety (i.e., history of seizures, the presence of DTs, etc.). This will be evaluated on a case-by-case basis. One of our therapists is a LCAS, and another has experience supporting individuals with addiction issues.

If an individual presents to the hospital for detox and, following their treatment there, the hospital feels that the FBC is the most appropriate level of care, we will be able to accept transfers from the hospital that meet FBC admission criteria.

What is meant by mild/moderate intellectual/developmental disabilities when referencing individuals who can be supported by the FBC?

Individuals admitted to the FBC will need to be able to participate in the programming and have a relatively quick turnaround from admission to discharge. This necessitates the ability to communicate with staff and to participate in group and/or individual psychotherapy. If extended behavioral analysis is needed to assess the root cause of behaviors over the course of several weeks, the FBC will not be able to provide such in-depth analysis and would not be the appropriate level of care.

Children and adolescents at the FBC will need to be continent and require limited assistance with activities of daily living such as toileting, bathing and dressing. They will also need to be ambulatory, or able to operate a wheelchair or other assistive device independently.

When the FBC is full where will individuals in crisis be directed for services and what will that process be? Will there be a waitlist for the FBC?

We will not utilize a waitlist, all admissions will occur on a first come, first served basis.

We are working to establish a process for communicating with local hospital s and other partners for both when we are at capacity and when we have beds available. We would be glad to work with community partners to ensure they have this information (such as taking a daily phone call, etc), with the understanding that our availability may change rapidly over the course of the day/night.

Monarch is participating in a project to bring a secure, web-based behavioral health crisis referral system (BH-CRSys) to North Carolina, and hopes that this will one day help to inform our referral sources and community partners of bed availability.

If a child/adolescent presents to our FBC and needs to be transported to another level of care will we provide this transportation?

We are working with G4S on a potential contract to provide transportation.  If this does not pan out, then we would likely need to work with a law enforcement partner to provide transportation, and this might necessitate the completion of specific paperwork requesting a commitment change.

Will we be able to accept admissions from a PRTF or step-downs from an inpatient unit?

Potentially, though they would need to meet admissions criteria. Our MCO partner prefers the FBC not act as a step-down from higher levels of care such as inpatient, however, every referral will be assessed on a case-by-case basis.

Will we be able to take children/adolescents from the hospital as they wait for PRTF or other placement?

Again, ultimately if someone meets the clinical criteria of the service we could potentially support them, but we must keep in mind that this program is designed for short-term stabilization and not as an observation or holding unit.

What is our process for serving children/adolescents in DSS custody?

We are working on having these discussions with Mecklenburg County DSS, and have included them in our Steering Committee from the onset of the project.

Specifically, what will be our process for obtaining consents for individuals with a DSS guardian in light of the law mandating parental consent for psychotropic meds, etc?

In general we would contact the guardian, just like we would a parent, and obtain verbal approval to provide a medication. Again, we are working on having these discussions with Mecklenburg County DSS to ensure we follow proper protocol.

Will a Comprehensive Clinical Assessment (CCA) and Psychiatric Evaluation be part of the admission process at the FBC every time, or will we be able to accept recent CCAs/evaluations from other sources?

The service definition requires a CCA and psych evaluation every time. The fact that an individual is in crisis typically necessitates the need for new assessments and evaluations, regardless of how recent a previous one may have been.

What are our obligations regarding EMTALA in the event that individuals present to the facility who are inappropriate, don’t meet service criteria, etc?

EMTALA is not an issue for our program, but we are working with local Emergency Departments to ensure they feel comfortable transporting appropriate individuals from their ED to our program when the individual meets criteria and would benefit for our service.

What is the process for obtaining authorizations from Cardinal?

We are working with Cardinal to confirm the process for obtaining authorizations.

What will we do to ensure the short lengths of stay that the FBC is designed for in light of the issue of abandonment in Mecklenburg County?

Once a child or adolescent is clinically appropriate to be stepped down to a lower level of care we will work to the best of our ability with Cardinal, DSS and other community partners to ensure this happens. Discharge planning will begin at admission to allow us as much time as possible to prepare an appropriate discharge plan, but we can’t always predict unforeseen obstacles and will rely on our community partners to assist in overcoming these when they arise.

What type of contact will children and adolescents have with legal guardians while at the FBC?

There will be a visitation policy that will be followed for allowing contact via phone and in-person. In-person visits are typically preferred, as these also give us the opportunity to work with the legal guardian(s) on the individuals treatment and discharge plan as well.