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Innovations : Residential Crisis Services

Clinical Innovations

Title: Residential Crisis Services  


Organization Name: Mosaic Community Services  

Innovation type: Care Transitions  

What They’re Doing: Diverting individuals in psychiatric crisis from emergency departments and shortening psychiatric inpatient lengths of stay. 

Clinical Innovation: This program serves individuals who are in or at imminent risk of psychiatric crisis. Mosaic operates 20 of these beds in two homes located on the grounds of Sheppard Pratt Hospital in Towson. Referrals come from hospital inpatient units, emergency departments, or directly from the community, and are accepted from various county entities as well as Baltimore City.

A thorough mental health assessment is performed within 24 hours of admission by a psychiatrist and/or psychiatric nurse practitioner. Mosaic staff also assesses for other needs, such as housing, eligibility for government assistance, and the need for somatic health care. All clients are seen frequently throughout their stay by a clinician. This clinical team is enhanced with bi-weekly visits from our somatic nurse practitioner, who does a thorough physical examination of any client experiencing health problems. Mosaic offers Wellness Self-Management (WSM) groups daily. (WSM comes from the Center for Practice Innovations at Columbia Psychiatry, and is based on Illness Management and Recovery, a nationally recognized evidence-based practice). A certified drug and alcohol counselor also runs groups for those who have co-occurring addictions disorders.

Following intervention, individuals referred to Mosaic’s integrated care program (MIH) to manage their psychiatric and somatic needs following crisis.

Supportive Financing Mechanism: This program is funded through the state Mental Hygiene Administration and limited commercial contracts.

Evaluation Type: Non-Experimental/Qualitative Support

Evaluation Plan: Data are collected on a quarterly basis, including: Utilization Number of Admissions Average Length of Stay (Days) Uninsured Admissions Homeless Upon Admission/Homeless Upon Discharge Source of Referral (ED, Inpatient Step-Down, Community) Percent of Admission with Co-Occurring (Mental Health and Addictions) Disorders

Patient Health and Cost Outcomes (Dec'11): In FY11 Mosaic residential crisis services admitted 415 individuals, about 40% of whom were uninsured. Of total admission, 157 came to us homeless. Of this 157, we were able to find decent, affordable housing for 113 individuals. Homeless Upon Admission = 157/Homeless Upon Discharge = 44 Average length of stay= 10 days or less Per diem cost = $256.11, much less than the cost of an ED visit, which runs close to $1500 or daily inpatient charge overnight stays in the hospital cost about $1100 for the bed alone. Of total admissions, an average of 55% had a co-occurring addiction disorder

Referral source:ED – 42 Community – 42 Inpatient – 331

Updated Data will be available in April 2012

Publications:None (although the model was based on a 1998 article from the American Journal of Psychiatry entitled “Randomized Trial of General Hospital and Residential Alternative Care for Patients with Severe and Persistent Mental Illness”)

Target Population:Individuals in or at imminent risk of a psychiatric crisis that would impair the individual’s ability to function in the community.

Date of Implementation:1998

Contact: Lori Doyle, email:

Multimedia: No

Web site:

Where to learn more:









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