Version 1.0 –March 2022
The Mobile Response and Stabilization Service (MRSS) Practice Manual is authorized by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and serves as the basis for process improvement and expansion of MRSS to improve behavioral health services for the state’s young people. The intent of this manual is to establish expectations for operational components and to guide implementation, while allowing ample flexibility to accommodate county/regional needs and practice innovation.
The Practice Manual outlines the goals, guiding principles, eligibility criteria, service components, implementation models, best practices, roles and responsibilities, metrics and resources recommended for MRSS. The Practice Manual has been developed through a consensus process including OhioMHAS staff, County Board Authorities, service providers, peer supporters, parents, youth and Ohio and national professionals with expertise in children’s crisis services and mobile response and stabilization. The practice manual is based on best and promising practices from Ohio and other statewide MRSS programs including Connecticut, Michigan, Maryland, and Nevada.
MRSS Within the System of Care
MRSS was developed in 2018 as a new service in Ohio’s youth behavioral health system of care. MRSS is integrated as an essential service within Ohio’s system of care to fill a gap for families seeking services for urgent behavioral situations before they become unmanageable emergencies. Available to all young people and their families across the state, MRSS is instrumental in averting unnecessary ED visits, out-ofhome placements, and placement disruptions, and in reducing overall system costs. Operating within a high quality, culturally and linguistically competent children’s crisis continuum, MRSS works to keep a child, youth, or young adult safe at home, in the community, and in school whenever possible. MRSS is a
viable alternative to acute care and youth mobile crisis programs across the country have consistently demonstrated cost savings, while simultaneously improving outcomes and achieving higher family satisfaction.
As part of its effort to launch the next generation of its managed care program, the Ohio Department of Medicaid (ODM) will implement OhioRISE (Resilience through Integrated Systems and Excellence), a specialized managed care program for youth with complex behavioral health and multi-system needs. OhioRISE services include intensive care coordination, Intensive Home-Based Treatment (IHBT), Psychiatric Residential Treatment Facility (PRTF), MRSS and behavioral health respite.
MRSS is a structured community based, in-person, intervention and support service for youth and families, provided by a mobile response and stabilization service team. It is a prevention-focused emergency program that serves as a gateway to other services across the system of care.
MRSS is designed to promptly address situations in which young people are experiencing emotional symptoms, behaviors, or traumatic circumstances that compromise or impact their ability to function within their family, living situation, school, or community. The youth and family guide MRSS interventions, with the strengths and needs of the young person and family determining the types and mix of services and supports provided
Because options for assistance can be limited when young people experience a behavioral health crisis, families often utilize the options available to them, such as, law enforcement, hospital emergency departments and inpatient treatment for help. The MRSS service delivery model is designed to prevent: 1) the unnecessary use of emergency departments or acute care services; 2) placement disruptions; and/or 3) involvement in the juvenile justice system. MRSS is more than a mental health service as it can intercede proactively with any young person experiencing distress due to acute trauma, placement disruption, conflict within the family, or other events in the school or community.
MRSS is different than traditional services. It provides an effective alternative to more restrictive services or inpatient treatment when it is safe to do so. MRSS services are initiated in response to young people who are experiencing significant emotional and behavioral distress. It should be noted that families and other referrers may define “crisis” or the need for services differently than traditional behavioral health professionals.
MRSS provides rapid intervention at the time the youth or family needs help. MRSS is not an officebased service. Services are provided where the crisis occurs or at a community location requested by the family or other referrer. The MRSS-trained team, which includes independently licensed MRSS supervisor(s), licensed clinical staff, peer supporters and/or Qualified Behavioral Health Specialists, work closely with the young person, family and other supports (such as schools) to provide immediate, on-site response and de-escalation, followed by up to six weeks of stabilization. The MRSS team works collectively with the youth, family and/or supporters to create a safety plan, set and achieve short-term goals and develop resources, including formal, informal, and natural supports (see page 20 for definitions), to assist the family after the MRSS episode of care is complete. Ready access to a psychiatrist or certified nurse practitioner or clinical nurse specialist for consultation purposes is available as needed.
When families are part of youths’ lives, MRSS works with young people to resolve their distress in the context of their family, and engages the whole family in planning, skill building and resource development to prevent future crises from occurring.