510-RTLR Regions The Living Room

Executive Summary
• The Living Room Program (LRP) is for individuals in need of a crisis respite program with services and supports designed to break the cycle of psychiatric hospitalization. The LRP provides a safe, inviting, home-like atmosphere where individuals can calmly process the crisis event, as well as learn and apply wellness strategies which may prevent future crisis events. The LRP is staffed by Peer Recovery Support Specialists and is based on a philosophy that crises are an opportunity for learning. Peer Recovery Support Specialists are individuals with their own Lived Expertise in recovery from mental illness or co-occurring mental illness and substance use.

Individuals experiencing behavioral health crises may self-refer, or may be referred by police, fire, emergency departments or other organizations with which an individual experiencing such a crisis may come into contact. The LRP emphasizes the voluntary nature of its services, ensuring that individuals, including those in contact with outside referring entities during a crisis, cannot be compelled to participate in the program. Participation in the LRP will be voluntary and based on the individual’s choice, allowing individuals the autonomy to choose the level of involvement that aligns with their preferences and needs.

Funding Purpose
• The general purpose of this program’s funding is to divert individual 18+ years of age from in-patient psychiatric hospitalization when that level of care is not necessary, and it is safe to serve the individual in a lesser structured setting.
Funding Priorities or Focus Areas
• IDHS is working to counteract systemic racism and inequity, and to prioritize and maximize diversity throughout its service provision process. This work involves addressing existing institutionalized inequities, aiming to create transformation, and operationalizing equity and racial justice. It also focuses on the creation of a culture of inclusivity for all regardless of race, gender, religion, sexual orientation, or ability. Program Description
The Grantee will subcontract for or directly operate a Living Room Program (LRP), providing short-term crisis respite within a safe, inviting, home-like atmosphere that offers non-clinical services provided by peer recovery support specialists, designed to proactively divert individuals in crisis from emergency departments and jails.
The Living Room Program is based on a philosophy that crises are an opportunity for growth and learning. The Living Room Program operates from the Crisis Now (https://crisisnow.com) approach, designed to divert individuals in self-defined crises from emergency departments and jails by developing services that match people’s needs. The Crisis Now approach promotes services built on recovery-oriented practices, trauma-informed care, significant use of peer recovery support staff, a commitment to Zero Suicide/Suicide Safer Care, strong commitments to safety for individuals served and staff providing services, and collaboration with law enforcement.
Although Living Room Programs do not fulfill all necessary criteria to be considered Crisis Stabilization Centers according to SAMHSA’s “National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit (https://library.samhsa.gov/sites/default/files/national-guidelines-crisis-care-pep24-01-037.pdf),” they serve as an important component of the crisis continuum in Illinois.
Program components and expectations
1. Individuals served.
The Living Room Program serves individuals (herein after referred to as guests) 18 years and older who are experiencing crises. Crisis is defined broadly as a situation in which an individual feels their current circumstances have overwhelmed their resources and/or ability to cope. Therefore, each guest defines the crisis they’re experiencing within those broad parameters. Guests may self-refer (walk-in) to the program or may be referred by outside entities, including but not limited to other components of the crisis continuum (e.g., 988, hotlines, warm lines, mobile crisis response teams, etc.), first responders (police, fire, EMT, etc.), medical personnel (primary care physicians, emergency departments, etc.), and other social service organizations.

2. Physical Plant Requirements
The physical environment provided throughout the Living Room Program must be designed to create a safe space for guests to calmly process a crisis event, learn and apply wellness strategies, give and receive peer support, and prevent future crisis events.

The Living Room Program must establish policies that ensure the physical safety of the environment. This includes providing guests with a safe and comfortable setting that includes a supportive, physical staff presence. The Grantee will determine the maximum safe operating capacity for the program.

The physical environment will be designed in a manner that contributes to soothing and supports emotional healing. Living Room Programs are expected to be equipped with comfortable furniture (e.g., recliners in common areas) and soft lighting. Walls are to be painted with soothing colors and include inspirational artwork or quotes reflective of the community served. There is to be an absence of excessive stimuli (e.g., televisions or sharp/bright lighting).

Both private and common spaces will be provided. Guests will be provided private space to calm down, relax, or have a private conversation. Private spaces must be distinctly separate from communal areas. Any Living Room Program accommodating guests for more than 23 hours will have distinctly separate private sleeping rooms available to guests. Guests will also be provided communal areas for interaction in which all guests at the same time can receive support through the physical presence of staff members. Guests will also be encouraged to use common areas to participate in mutual learning and peer support. Snacks and beverages will always be available to guests.

At no time is a Living Room Program to contain more than 16 beds. A Living Room Program cannot be created within any building, under one continuous roof, in which residential treatment is being provided, which in total would exceed 16 beds, including but not limited to, houses, apartment buildings, and duplexes.

3. Hours of Operations
The Living Room Program must be staffed to operate 24 hours a day, 365 days a year. Staffing plans must be based on safely managing real time guest volume and include provisions to ensure the continuation of 24/7 operations in the event of unexpected circumstances (call outs, resignations, surge in volume, etc.).

4. Staffing Requirements
The Living Room must always be staffed by a minimum of two people, at least one of whom must be a Certified Recovery Support Specialist (CRSS) who is providing services from the peer perspective. Additional staff must be either Certified Peer Recovery Specialist(s) (CPRS) or staff who meet the qualifications of Peer Support Worker (PSW) or Mental Health Professional (MHP).
The demographics of the Living Room Program staff are expected to reflect the demographics of the guests, including race/ethnicity and sex/gender identity.

The Living Room Program staff must always have immediate access to a Qualified Mental Health Professional (QMHP) (https://ilga.gov/commission/jcar/admincode/059/059001320A00250R.html), including ability to respond via phone or in person for consultation with Living Room Program staff, to ensure adequate and appropriate service and support provision to all guests.

All personnel costs for the Living Room Program should be billed to the 510-RTLR grant.

5. Training Requirements
Any person working in the Living Room Program, regardless of title or role, must complete two-hour DBHR video-based training and obtain a passing score prior to beginning work in the Living Room Program.
Any person working in the Living Room Program, regardless of title or role must complete a minimum of 16 hours of CRSS/CPRS training annually and be expected to follow the National Practice Guidelines for Peer Support Specialists and Supervisors (https://www.peersupportworks.org/wp-content/uploads/2021/07/National-Practice-Guidelines-for-Peer-Specialists-and-Supervisors-1.pdf).
The Living Room Program Coordinator must work collaboratively with DBHR subject matter experts to identify and meet training needs related to substance use in order for Living Room Program staff to ensure guest needs are met.

The Grantee may arrange for additional training through any of the following DBHR-approved organizations:
• RI International (https://riinternational.com/consulting-and-training)
• Humannovations (https://www.humannovations.net/growing-through)
• People, USA (https://people-usa.org/consulting)
• Emotional CPR (https://emotional-cpr.org)
• Peer Power (https://www.peer-power.net)

6. Service Requirements
All guests who contact the Living Room Program must be served in some way by the Program. LRP services include but are not limited to (a) peer welcome, (b) screening, (c) referral/linkage, (d) on-site services and support, (e) transportation, and (f) short-term follow-up.

a. Peer Welcome
Upon arrival at the Living Room a guest must be greeted by a peer recovery support specialist who is responsible for providing a sense of welcome, explaining the program in simple terms, and describing what the guest can expect during their stay. Peer recovery support specialists will respect the guest’s right to choose the pathway(s) to recovery the guest believes will work best for them. Peer recovery support specialists are expected to engage in candid, honest discussions about the guest’s current experience of crisis, striving to build non-hierarchical relationships with guests based on integrity, honesty, respect, and trust.

b. Screening
Following the initial peer welcome, guests will be screened for substance use, suicide (https://zerosuicide.edc.org/resources/resource-database/columbia-suicide-severity-rating-scale-c-ssrs) and homicide risk (https://socialwelfare.berkeley.edu/sites/default/files/assessing_client_dangerousness_to_self_and_others_stratified_risk_management_approaches_fall_2013.pdf) to consider the suitability of the Living Room Program to the guest’s needs. Screenings must be completed by staff who meet the qualifications for Mental Health Professionals (MHP) and should take into consideration the safety of the arriving guest as well as other guests and staff occupying the Living Room. The Grantee is free to determine which assessment tool(s) to use. Any guest who is known to have alcohol or drugs, including prescription medication, on their person will be expected to abide by relevant policies identified by the organization.

c. Referral/Linkage
To prevent future crisis events and facilitate sustained recovery, guests are to be supported in identifying natural supports in the community. LRP staff will work with guests to identify referral needs and support guests in obtaining the necessary information.
Referrals include providing guests with information about where to access services not provided by the LRP. To meet the broad variety of guests’ needs, the LRP will develop a robust catalogue of local resources to which guests may be referred, including but not limited to food, shelter, healthcare, childcare, transportation, domestic violence services, and refugee/immigrant services.
Linkages include actively supporting guests in connecting to a needed service and conducting follow-up to ensure the linkage has successfully occurred.
Any guest who is determined through the screening process to not be suitable for the Living Room Program will be served through referral and/or linkage to appropriate services, supports, and/or another level of care.

Any guest who is determined to be in need of substance use treatment and recovery support services will be linked to the Illinois Helpline for Opioids and Other Substances at 1-833-2FINDHELP (833-234-6343). LRP staff will speak directly with a trained professional for support and advice or direct the guest to customized resources. If a guest has immediate medical or other emergent needs related to intoxication or withdrawal, LRP staff will contact Emergency Medical Services.

d. On-Site Services and Supports
On-site services and supports will be provided for guests who stay for any length of time beyond the peer welcome and screening. On-site services and supports must minimally include peer recovery support provided in a manner that adheres to the following core values as described in the National Practices Guidelines for Peer Supporters and Supervisors:

1. Voluntary
2. Hopeful
3. Open minded
4. Empathetic
5. Respectful
6. Facilitate change
7. Honest and direct
8. Mutual and reciprocal
9. Equally shared power
10. Strengths-focused
11. Transparent
12. Person-driven

Additionally, all on-site services and supports are expected to follow the principles of trauma-informed care (https://www.traumainformedcare.chcs.org/wp-content/uploads/Fact-Sheet-What-is-Trauma-Informed-Care.pdf), be versatile and adaptable, culturally responsive, and allow support to be provided in a way that meets the guest where they are at in their recovery.

On-site services and supports provided to guests of the LRP are to be designed and delivered by the Peer Recovery Support Specialist staff who work in the Living Room Program, in a manner that considers the cultural and linguistic needs of guests and can be provided in either individual or peer group modality. Peer-to-peer support groups are to be facilitated by LRP staff and provided only for current guests of the LRP. Current guests are those individuals who come to the LRP for a self-defined crisis episode. Prior guests visiting the LRP for any reason who are not currently experiencing a self-defined crisis episode are not considered current guests. On-site services and supports provided in a peer group setting shall not exceed one full-time peer recovery support specialist to five guests.
Examples of on-site services and supports include but are not limited to:

– Creative expression (art, crafting, music, movement, writing, storytelling, etc.).
– Sensory support (fidgets, weighted items, etc.).
– Peer-to-peer support among guests.
– Wellness Recovery Action Planning (WRAP).
– Whole Health Action Management (WHAM).

Additionally, Naloxone must be immediately available to staff and guests of the LRP.

e. Transportation

Grant funds may be utilized to support guests’ short-term transportation needs (e.g., get to the LRP, get to a safe place following time spent at the LRP, etc.). Grantees must develop specific policies and procedures that provide clear guidance for LRP staff to determine under what circumstances guests may be provided short-term transportation support.

The Grantee must assess all transportation options available within the area served by the LRP and determine the most economical means of transportation, including but not limited to public transportation (buses, trains, etc.), taxi’s, ride shares, etc.

Living Room Program staff are not authorized to leave the LRP for the purpose of transporting guests to or from the LRP if doing so results in less than two direct care staff on-site in the LRP.

f. Short-Term Follow-Up
According to Follow-Up Matters (https://followupmatters.org/follow-up-starts-here), short-term follow-up has the potential to reduce the use of emergency services, particularly for guests who have experienced a suicidal crisis.
Short-term follow-up should be conducted within five days of a guest’s departure from the LRP and primarily focused on reducing utilization of emergency services through relational connection with peer recovery support. Short-term follow-up can be conducted by phone, video chat, or text. When conducted by phone or video chat, short-term follow-up should be kept brief (15 minutes average).

7. Guest Feedback
Prior to the conclusion of any service-related contact, each guest will be given the opportunity to provide feedback on their experience with the Living Room, including but not limited to positive feedback and suggested areas for improvement.

8. Outreach and Engagement
The Living Room Program will develop and implement an outreach and engagement plan for (a) direct connection with guests from diverse communities who would benefit from access to the Program and (b) increasing community awareness of the Program.

The outreach and engagement plan must include, at minimum, the development of materials and other resources (flyers, videos, public service announcements, etc.) for marketing and promoting the LRP.

Additionally, the outreach and engagement plan must be designed to build and maintain relationships with other social service organizations, including but not limited to other components of the crisis continuum (e.g., 988, hotlines, warm lines, the Illinois Helpline, and mobile crisis response teams), first responders (police, fire, EMT, etc.), and medical personnel (primary care physicians, emergency departments, etc.).

Community members and prior guests who participate in outreach and engagement activities are not to be counted as guests. For reporting purposes, outreach and engagement activities are to be counted as single units of occurrence.

9. Policies and Procedures
The provider and any subcontractors must develop standard operating policies and procedures that define the Living Room Program consistent with the model described above.

The Living Room Program must develop a quality improvement policy and procedure that incorporates guest feedback.

A minimum of one Living Room Program staff per site is expected to participate in the DBHR Living Room Program (LRP) Learning Collaborative and Technical Assistance (TA) Sessions.

Performance Requirements
1. New Living Room awardees without prior DBHR grant funding for a Living Room Program will need to have the program operational and 24/7 beginning 10/1/26.
2. The physical environment of the Living Room will be designed in a manner that is safe, welcoming, and inviting, with both private and common spaces for guests.
3. The Living Room must be staffed to operate 24 hours a day, 365 days a year.
4. The Living Room must always be staffed by a minimum of two people, at least one of whom must be a Certified Recovery Support Specialist (CRSS) who is providing services from the peer perspective. Additional staff must be either Certified Peer Recovery Specialist(s) (CPRS) or staff who meet the qualifications of Peer Support Worker (PSW) or Mental Health Professional (MHP).
5. The Living Room Program staff must always have immediate access to a Qualified Mental Health Professional (QMHP).
6. Any person working in the Living Room Program must complete a two-hour DBHR video-based training prior to beginning work in the Living Room Program.
7. Any person working in the Living Room Program must complete 16 hours of CRSS/CPRS training within one year of date of hire and annually.
8. Any person working in the Living Room Program must follow the National Practice Guidelines for Peer Support Specialists and Supervisors.
9. All guests who contact the Living Room will be served by the Program.
10. All guests will be screened for substance use, suicide and homicide risk.
11. Services and supports will be based on the strengths of the guest served and address whole health, wellness, and life in the community.
12. Services and supports will be designed and delivered by the Peer Recovery Support Specialist staff who work in the Living Room Program.
13. Participation in any services and supports offered is to be voluntary and entirely based on the guest’s choice.
14. All guests will be given the opportunity to provide feedback on their experience at the conclusion of the service contact.
15. The Grantee and any subcontractor will develop and implement an outreach and engagement plan for direct connection with guests who would benefit from access to the Living Room Program.
16. The Grantee and any subcontractor will build and maintain relationships with other social service organizations, including but not limited to other components of the crisis continuum (e.g., 988, hotlines, warm lines, Illinois Helpline, and mobile crisis response teams), first responders (police, fire, EMT, etc.), medical personnel (primary care physicians, emergency departments, etc.).
17. The Grantee and any subcontractors must develop standard operating principles and procedures that define the Living Room Program.
18. The Living Room Program must develop a quality improvement policy and procedure that incorporates guest feedback.
19. A minimum of one Living Room Program staff per site is expected to participate in the DBHR-led Living Room Program (LRP) Learning Collaborative.

Performance Measures
1. Number of days (12:00 a.m. – 11:59 p.m.) during the reporting period in which the program experienced a Living Room closure lasting more than a total of 30 minutes.
2. Number of unduplicated guests who accessed the Living Room in this reporting period.

(Do not include Guests returning solely to attend groups or participate in outreach/marketing activities).

(“Unduplicated” refers to the first visit in this reporting period by a guest; any additional visits by the same guest, in this reporting period, are duplicates.)
3. Total number of guest visits to the Living Room in this reporting period (Referrals + Walk-ins).

(Each individual visit by a guest should be counted toward this measure. Do not include individuals returning solely to attend groups or participate in outreach/marketing activities).
4. Number of guest visits seen by a Peer Recovery Support Specialist, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
5. Number of guest visits contacted for short-term follow-up, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
6. Number of guest visits screened for suicide and homicide risk, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
7. Number of guest visits screened for substance use, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
8. Number of visits where the guest was noticeably under the influence, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
9. Number of guest visits referred and/or linked for substance use assessment, treatment, or recovery services, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
10. Number of guest visits that were provided on-site support, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
11. Number of guest visits linked to a level of care other than inpatient hospitalization, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
12. Number of guest visits voluntarily referred out for inpatient hospitalization, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
13. Number of guest visits involuntarily referred out for inpatient hospitalization, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
14. Number of visits where the guest completed a guest feedback survey, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
15. Number of visits where the guest indicated having visited a Living Room Program prior to this reporting period, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
16. Number of visits where the guest accessed the Living Room as a walk-in, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
17. Number of visits where the guest was referred to the Living Room, out of the total number of guest visits to the Living Room in this reporting period (PM #3.)
18. Number of guest visits referred by law enforcement, out of the total referrals to the Living Room in this reporting period (PM #17.)
19. Number of visits where the guest was referred by Mobile Crisis Response Teams, out of the total referrals to the Living Room in this reporting period (PM #17.)
20. Number of visits where the guest was referred by 988, out of the total referrals to the Living Room in this reporting period (PM #17.)
21. Number of visits where the guest was referred by other referral sources, out of the total referrals to the Living Room in this reporting period (PM #17.)
22. Number of outreach and engagement activities, with focus on the Living Room Program, that were conducted during this reporting period.
23. Number of LRP Peer Support staff who participated in the DBHR-led LRP Learning Collaborative.

Performance Standards
1. 100% of days in the reporting period during which the Living Room Program operated 24 hours.
2. 50 or more unduplicated guests accessed the Living Room during this reporting period.
3. 100 or more total guest visits to the Living Room during this reporting period (including referrals and walk-ins). Each guest visit must be counted.
4. 100% of total guest visits to the Living Room were seen by a Peer Recovery Support Specialist.
5. Three or more outreach and engagement activities focused on the Living Room Program were conducted during this reporting period.

Cooperative Agreements
• Not Applicable. Pre-Award Costs
A. Pre-award costs are not allowable.
B. IDHS grants are governed by 2 CFR. Part 200, Subpart E-Cost Principles and 30 ILCS 708 which include information on allowable costs, audit requirements, and financial records. Beneficiaries: NA Administered by the Illinois Department of Human Services via the Illinois GATA Catalog of State Financial Assistance (CSFA 444-42-3824).