CART
Child–Adolescent Response Team
Procedure for Management of
Process Measures
Procedure for Management of Phase I
Process Measures
Phase I – Screening
Event I – Triage Contact
CART Triage Screener responds immediately to
Hotline call or Clinic walk-in.
If crisis is resolved, then Triage Screener will fax
or deliver (by 9am next business day) a copy of
the Triage Contact to the CART Crisis System
Manager (CSM) in the region from which the call
originated. The CSM will follow-up with the family
the same day he/she receives the Triage Packet.
Procedure for Management of Phase I
Process Measures
Phase I – Screening
Event II – Triage Interview
If crisis is not resolved with Triage Contact, then
Triage Screener completes the Triage Interview. If
results of interview indicate a need for a Face-to-
Face Assessment, the Triage Screener (within 15
minutes of receiving Hotline call or Clinic walk-in)
contacts the CART Crisis Care Coordinator (CCC) or
CSM to alert him/her of crisis situation.
Procedure for Management of Phase I
Process Measures
Phase II – Assessment
Event III – Face-to-Face Assessment, cont.
(After Hours) CCC makes contact with the family, and
makes contact with the Face-To-Face Assessor (within
15 minutes of receiving referral from Triage Screener).
(Clinic Hours) CART Clinician may perform the Face-
to-Face Assessment (immediately), or contact the
provider agency (within 15 minutes of completing the
Triage Packet) to perform the Face-to-Face
Assessment.
Procedure for Management of Phase I
Process Measures
Phase II – Assessment
Event III – Face-to-Face Assessment, cont.
(After Hours) or (Non-Clinic Based)
Face-to-Face Assessor (immediately) calls family to
confirm meeting location and let the family know
estimated arrival time. Assessor arrives at the
predetermined location within 90 minutes (120
minutes in rural areas) of receiving referral from
the CCC.
Procedure for Management of Phase II
Process Measures
Phase II – Assessment
Event III – Face-to-Face Assessment, cont.
(After Hours) or (Clinic Hours)
Face-to-Face Assessor notes the departure time
on the travel log. Assessor calls CCC upon arrival
at predetermined location and briefs CCC on
crisis situation.
Procedure for Management of Phase II
Process Measures
Phase II – Assessment
Event III – Face-to-Face Assessment, cont.
The Screening Consent form is signed by the
family BEFORE the to Face-to-Face Assessor
can proceed with HIPPA’s Notice of Privacy of
Practices form and HIPPA’s Acknowledgement
of Receipt form. The assessment may not begin
until all three forms are signed by parent or
legal guardian.
Procedure for Management of Phase II
Process Measures
Phase II – Assessment
Event III – Face-to-Face Assessment, cont.
Upon completion and scoring of CART’s Assessment
and Screening Tool (or within 60 minutes,
whichever comes first) the Face-to-Face Assessor
contacts the CCC to discuss Immediate
Stabilization. All available natural resources are
considered first before proceeding to more
restrictive stabilization measures.
Procedure for Management of Phase II
Process Measures
Phase II – Assessment
Event III – Face-to-Face Assessment, cont.
Together, the family and Face-to-Face Assessor
create the Safety Plan, which will get the family
through until the next business day. The Safety
Plan is reviewed (at least) every 24 hours.
Modifications are made and levels of Immediate
Stabilization are adjusted as frequently as
necessary to maintain the child in the least
restrictive environment.
Procedure for Management of Phase III
Process Measures
Phase III – Resolution
Event IV – Next Day Follow-up
The CSM follows-up with family either by phone or in
person, by the next business morning to determine if
Extended Stabilization services are needed.
If Extended Stabilization is warranted, a Crisis
Resolution Meeting is held the same day the follow-up
call or visit is made. Any agency involved with the child
is invited to attend the Crisis Resolution Meeting. At this
time, it may be determined that Extended Stabilization
is needed.
Procedure for Management of Phase III
Process Measures
Phase III – Resolution
Event V – Crisis Resolution Meeting
Extended Stabilization is not to exceed 7 days
from the date the Safety Plan was signed. All
dispositions of Extended Stabilization are reviewed
every 24 hours, insuring the child remains in the
safest, least restrictive, most natural setting
available.
Procedure for Management of Phase III
Process Measures
Phase III – Resolution
Event VI – Discharge
After the crisis is stabilized, CART will facilitate a
Discharge and Referral Meeting. At this time,
recommendations and referrals are made for
follow-up services.
At minimum, the child and family will receive an
individualized two-part prevention plan, which
includes a Behavior Strategy and Resource/Action
Strategy.
Procedure for Management of Phase III
Process Measures
Phase III – Resolution
Event VI – Discharge
Throughout the stabilization process, the family
receives education and support from CART
professionals.
Upon discharge, family is more knowledgeable on
how to prevent and manage future crises.
Procedure for Management of Phase IV
Process Measures
Phase IV – Follow-Up
Event VII – 7 Day
7 days following discharge from CART services, the
family is asked to participate in an initial
satisfaction survey.
Data collected from this survey is used to conclude
overall success of CART’s crisis stabilization
measures.
Procedure for Management of Phase IV
Process Measures
Phase IV – Follow-Up
Event VII – 30 Day
30 days following discharge from CART services,
the family is asked to participate in a final
satisfaction survey.
Data collected from survey is used to determine
if recommended referrals were followed through
with by the family and agency.
CART
Child–Adolescent Response Team
Anticipated Outcomes
Population Outcomes to Service
Access
The number of children, adolescents and their families
seeking access to mental health crisis services will increase
by 50% in FY 2004 and 70% in FY 2005 as compared to
base year FY 2002.
The number of children, adolescents and their families
utilizing crisis services shall increase by 30% in FY 2004 and
50% in FY 2005 as compared to base year FY 2002.
The number of children, adolescents and their families
admitted to Community Mental Health Center services shall
increase by 10% in FY 2004 and 20% by FY 2005 as
compared to base year FY 2002.
Population Outcomes of Service
Intensity
100% of persons seeking access to services, either by
telephone or by visit to a mental health clinic, shall receive
a Triage Screening.
60% of persons who receive a Triage Screening shall also
receive a Face-To-Face Assessment.
40% of persons who receive a Triage Screening shall have
Crisis Plans initiated.
20% of persons who receive a Triage Screening shall have
Crisis Plans which result in hospitalization.
Office of Mental Health
CART
Crisis System Screenings
= (100%)
CART Clients Receiving
Face-to-Face Assessments
= (75%)
Staffed for
Additional Services
(in-home, out of home,
intensive respite)
= (25%)
Hospitalized
= (10%)
Child-Adolescent Response Team:
Conceptual Model
Office of Mental Health
CART
Crisis System Screenings
= 2628(100%)
CART Clients Receiving
Face-to-Face Assessments
= 816(37%)
Staffed for
Additional Services
(in-home, out of home,
intensive respite)
= 457(17%)
Hospitalized
= 92 (4%)
Child Adolescent Response Team:
6 Month Statewide Implementation January-June, 2007