In the past, individuals or families who may be faced with high-risk adverse events were often given a list of providers who may be able to help address their concerns and issues. However, because crises can interfere with the ability to process anything above survival, these individuals/families often did not reach out and get connected to services unless law enforcement, child protective services, or other outside agencies were involved. The innovation behind the Panhandle Situation Table is an actionable process that has proven successful in removing the barriers and disconnection between those individuals and families at-risk for crisis and the ability to obtain assistance and services before a crisis occurs. The Situation Table puts the initiation of services on the agencies, not the AER individuals and families. It is a deeply collaborative, multi-agency, risk-driven initiative that allows agencies to work together and mobilize in new ways, to rapidly triage situations of Acutely Elevated Risk to connect individuals/families to the support they need.
The Panhandle Situation Table is unique in that we cover a rural and sizeable geographical area comprised of many small towns and villages that lack resources to tackle acutely elevated-risk individuals. Because of the area we encompass, we meet weekly via virtual meetings, which has allowed partners to be present at times; in-person meetings would not have been possible. Another unique feature of our Table is that several service sectors in attendance provide nearly identical services. We have engaged these partners as critical players because each service provider covers predetermined areas. For example, one of our service providers in Scottsbluff can assist "situations" in behavioral and mental health, substance abuse, dual diagnosis, and emergency housing. Another service provider in our Northern Panhandle region can also provide behavioral and mental health services and referrals for housing assistance. Each of these entities provides some of the same services; however, our reliance on them at the Table is essential to ensure all areas of the Panhandle have the same level of access.
New situations are brought to the Virtual Table from partners across the Panhandle through a four-filter process that protects the individual/families confidentiality as well as ensures that each situation meets the acute-elevated risk criteria:
1. Significant interest - Significant interest refers to the broad array of potential situations that practitioners in any sector may encounter, presenting as accumulating risks to the immediate well-being of individuals or families. This first criterion essentially reinforces the Table's limited role in recognizing and acting collectively only in those situations where service gaps and system failings have brought individuals and/or families to the AER threshold. It also underscores the unique and continuing opportunity to recognize and advance opportunities for systemic reform while providing immediate solutions and connections to reduce the AER in any specific situation.
2. Probability of harm occurring - There is a reasonable expectation of harm to individuals if nothing is done.
3. Severe intensity of harm - The harm would constitute damage or detriment and not a mere inconvenience to the individual. It is reasonable to assume that consideration at the Situation Table might help to minimize or prevent the anticipated harm.
4. Multidisciplinary nature of elevated risk - The risk factors are beyond the Originating Agency's scope or mandate to mitigate the elevated level of risk. Evident, operating risk factors cut across multiple human service disciplines, and traditional inter-agency approaches have been considered or attempted.
Filter One is the initial assessment done outside the Table by the group introducing the individual/family situation so they are prepared to introduce the situation to the Table. Filter Two is the situation being brought to the Table's attention. During filter two, only unidentifiable information is introduced (male/female, age range, etc.), including articulation of risk factors (alcohol/drug use, unemployment, housing needs, domestic abuse, truancy, physical violence, basic needs, etc.) and any known prior efforts to mitigate risks. At this point, Table consensus must be reached that we are crossing several service sectors, and the individual/family is at acutely elevated risk to move on to filter three. Filter three provides the identification of the individual/family, as well as any necessary demographic information. During filter three, the group is asked for recognition and whether current or past services are in place. Service sectors identified as being able to assist the situation begin taking notes. After all situations are brought to the Table, a filter four meeting is held for each situation, with only those service sectors bringing assistance participating in filter four meetings. During this phase, initial plans are made to contact the at-risk individuals in person or by phone and initiate services.
The Situation Table is unique in that it treats the whole situation, encompassing dozens of risk factors that can impact the health and well-being of an individual, family, and community. Service providers, including law enforcement involvement, differ from their traditional role, focusing on offering support, and reinforcing community trust and legitimacy.
Of the 20 closed situations brought to the Table, 65% have been connected to services and have a lowered risk. With limited current data and the complexity of the risk factors, it is unclear precisely how many individuals' needs can be met by implementing the Panhandle Situation Table. As discussed above, our area is considered at high-risk for overdose and overdose deaths. The root cause of this consideration is likely a correlation between mental and behavioral health issues, poverty, and a lack of available resources, as well as cultural beliefs, attitudes, and stigma.
PPHD has provided and continues to provide substance abuse prevention efforts, including education on substances and their abuse, education to combat stigma, medication disposal systems, lockboxes, Narcan training and dispensing, and mental health and suicide awareness. Though these efforts have all had success, we knew that as a region, we could still not address the need for near-crisis individuals to be met where they were with services needed to prevent a crisis. It truly is the collaboration that allows us to meet the needs of acutely elevated-risk individuals and families; we have minimal resources and do not have detox or crisis stabilization in the Panhandle.
By design, implementing the Panhandle Situation Table has allowed us to collaborate with community and regional partners and service providers and focus our efforts on individuals and families who are most at risk for experiencing health inequities. Through focused and intentional efforts, the Table has grown to represent vast service sectors, community groups, public agencies, and mental health providers. The filter four process introduces families and individuals anonymously, taking away the opportunity for any negativity that may be associated with the situation through past experiences.
The Table is a weekly collaborative, actionable meeting between several service sectors and public officers. These include but are not limited to: law enforcement and justice systems, first responders, hospital systems, social service agencies, family/child abuse advocacy agencies, housing assistance agencies, transportation services, schools, mental and behavioral health providers, alcohol and drug counselors, employment services, veterans assistance services.
PPHD directly coordinates the Situation Table, including all planning, invites, meeting outlines and processes, data collection, and post-meeting information hub. The Panhandle Situation Table's training and implementation were based on the Centre of Responsibility Model and Community Safety and Well-Being (CSWB) model, introduced initially in Canada in 2011 and in the United States in Chelsea, Massachusetts, in 2014. Since its inception, this evidence-based application of the CSWB has consistently led to sustainable changes in multi-sector collaboration in service of at-risk individuals, families, and communities. Measurement data obtained on Canadian outcomes exist in qualitative and quantitative forms and is reviewed and endorsed by several committees, such as the Parliamentary Standing Committee on Public Safety and National Security. (Source: globalcommunitysafety.com)