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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, the need for somatic care, and enhanced substance abuse treatment. The clinical team is enhanced by a registered nurse and a certified medical assistant that assess and assist with 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).
Following intervention, individuals receive referrals to comprehensive services ranging from ACT team, primary care treatment, outpatient mental health clinics, psychiatric rehabilitation programs, intensive outpatient substance abuse treatment, or whatever linkage the specific client requires to be successful in the community.

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 (Jan'15): In FY14 Mosaic residential crisis services admitted 390 individuals, about 25% of whom were uninsured.  Of total admission, 146 came to us homeless.  Of this 146, we were able to find decent, affordable housing for 104 individuals.  Homeless Upon Admission=146/ Homeless Upon Discharge=42, Average length of stay=10 days or less per diem cost=$275.52, much less than the cost of an ED visit, which runs close to $1500 or daily inpatient charge overnight stays in the hospital which cost about $1100 for the bed alone.  Of total admissions, an average of 55% had a co-occurring addiction disorder.

Referral source:ED – 35, Community – 55, Inpatient – 330

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: Lori Doyle















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