Episode 21: How Grassroots Crisis Intervention Center Supports A Crisis

On this episode of “What’s the 211?”, Quinton Askew speaks with Dr. Mariana Izraelson with Howard County’s Grassroots Crisis Intervention Center. They talk about behavioral health support for people in crisis, including homeless services and food support offered by the organization.

Show Notes

• 1:58 About Howard County Grassroots Crisis Intervention
• 3:09 How Grassroots started as a “grassroots” effort
• 4:13 Expanded crisis services
• 5:39 How to connect
• 7:02 What to expect when you call for help
• 8:02 Signs of crisis
• 9:40 Crisis misconceptions
• 11:51 Call specialist training
• 13:21 Partnerships
• 15:00 How they prioritize crisis services
• 16:09 Challenges of crisis work
• 20:02 People need to know that help is always available
• 21:33 Success stories

Transcript

Quinton Askew, President & CEO of the Maryland Information Network and 211 Maryland (1:31)

Good morning, everyone. Welcome to What’s the 211? podcast. My name is Quinton Askew, President and CEO of the Maryland Information Network and 211 Maryland. I am excited to have our special guest today, Mariana Izraelson, Executive Director of Grassroots Crisis Intervention Center. Dr. Marianna, how are you?

01:49

I’m doing well. Thank you. I’m very excited to be here today.

Quinton Askew (1:52)

Thank you for joining us. Could you tell us a little about Howard County’s Grassroots Crisis Intervention Center?

About Howard County Grassroots Crisis Intervention Center

Dr. Mariana Izraelson, Executive Director of Grassroots Crisis Intervention Center (1:58)

So, Howard County’s Grassroots Crisis Intervention Center is a 24/7 crisis center.

• We offer homeless services.
• We offer crisis services in-house.
• We have a walk-in center that is 24/7 Urgent Care.
• We have an Urgent Care for substance use disorders.
• We offer withdrawal management for opioid use disorders and stimulant use disorders as well if an individual suffers from substance use disorders, they can come here anytime.
• We have an individual, single gender male, female or identified for individuals as well as a family shelter for individuals and their children, anyone under 18 years old.

We have a homeless program for anyone who is experiencing homelessness. We provide an assessment and enter them into the system for Howard County. Then, we identify resources if the shelter can accommodate at that time.

Our crisis center encompasses in-house services plus community services. We partner with our county police department, offer mobile crisis team responses to the entire county, and partner with the school system. So, we respond to every organization in the county and all of the school systems.

How Grassroots started as a “grassroots” effort

Quinton Askew(3:09)

For someone who’s worked in the county and understands the great work you all do, why was Grassroots needed in our county?

Dr. Mariana Izraelson (3:20)

Grassroots was created 50 years ago. Grassroots was created by a group of college students who started a volunteer organization when they realized there were very limited resources for individuals experiencing substance use disorders and crisis. Individuals have nowhere to go, they have no resources, they were without treatment.

A group of college students started the program in the 1970s, thinking about having a crisis center from their Grassroots group to having a hotline.

At the beginning, they thought, well, if people can know where we are, they can have a phone number and contact us quickly. So, they can come to Grassroots, and it has been growing and developing throughout the years.

It started with a group saying there’s a need in the community, nobody’s doing these services, and we should get together. And they were all volunteers. And it was like that for many years.

Expanded crisis services

Quinton Askew (4:13)

Wow. That’s amazing. I know that, over the years, crisis services have grown and expanded. Can you touch on a couple of the new crisis services or expanded crisis services you’ve been providing?

Dr. Mariana Izraelson (4:24)

So, one of the major projects that we started doing was the 211 Health Check. That program started about two years ago; where individuals can sign up for a telephone program in which we will do a check-in once a week at the time desired by the individual.

That is open to anyone in Maryland who wishes to connect with an individual on their terms. We call them 24/7, any given day and check with somebody who may be struggling with any crisis.

So, that program is very interesting. It has been very, very successful. We receive about 2600 calls a month, and the individuals are quite pleased with the response of that program.

We have also been part of services in the community. We have expanded to have an urgent care program that is helpful for people who can walk in and receive services.

We have peer recovery specialists that are here to be able to provide that session with clients and have that level of empathy and understanding of what the individual is experiencing.

As well as substance use disorders have grown tremendously throughout the years. And now we’re working on implementing a crisis stabilization program for mental health disorders.

How to connect

Quinton Askew (5:39)

For the wide range of services you provide, how do individuals know how to connect to Grassroots? So you mentioned that hotline number, but how do folks know how to get there?

Dr. Mariana Izraelson (5:46)

What is beautiful about Grassroots is that there are many ways to connect.

• So, we’re part of the 211 system – 211 Health Check. [Editor’s Note: Call 2-1-1 or learn more.]
• Our internal number is very well known by the community because we have been here 50 years.
• Our local number. [Editor’s Note: 410-531-6677]
• We are also part of 988. [Editor’s Note: Call 9-8-8 to connect.]

We also have our main number, which is a business number that is publicized everywhere. So, Grassroots is very well known to Howard County and is also well known to other individuals outside of Howard County because of the many different lines that they can connect with us.

Quinton Askew (6:19)

We know it’s embedded in Howard County. Are folks accessing the services coming from all across Maryland or mostly in our county for services?

Dr. Mariana Izraelson (6:29)

So, it depends. Our homeless services are very specific, and priority is given to Howard County residents. However, we receive individuals from all across Maryland, sometimes from other states.

The mission of Grassroots is to provide services to anybody who walks in without any terms of discrimination. We’re trying to help everybody that comes on board.

In terms of the hotline, we receive calls from the entire state of Maryland, depending on the program; some programs are divided into wide regions, but we tend to reach out to an extended audience across the state.

What to expect when you call for help

Quinton Askew (7:02)

We know that your team handles various types of crisis. What is the experience like when someone calls? What happens when someone calls the center in order to get help?

Dr. Mariana Izraelson (7:11)

So, the first thing that we are going to hear is a very warm greeting because it takes a lot of courage to call a hotline. It’s not an easy process.

Do you pick up the phone and talk to a stranger, or do you text a line or chat with somebody? So, we try to be a very warm greeting, telling individuals, “Thank you for calling.” Or, “We’re here. How can we help you? What would you like to discuss today?”

So, the warm greeting gets the person to feel comfortable, and then we listen.

• We listen to what the person has to say.
• We listen to how they feel.
• We give them a space for silence.

Some people call and want to share how they’re feeling that day. Some other individuals may call in a significant level of distress.

Our goal is to de-escalate as much as possible and also provide a level of comfort and empathy. So, the individual can deal with the crisis they’re experiencing at that moment and be able to reconnect with the world on a daily basis that they live in.

Signs of crisis

Quinton Askew (8:02)

As you said, having someone on the other line that’s empathetic helps. Are there common signs that might indicate someone is in crisis? Or how does a typical individual know that you know I should be calling Grassroots because I may need help?

Dr. Mariana Izraelson (8:16)

Crisis is different for every person. I think COVID-19 escalated things, where people before may not have reached out to a crisis line. During COVID, people felt very isolated, scared and terrified. And so it led to a lot of people having to connect with somebody.

Every individual has a different reason for calling a crisis line.

What we see on a typical day are individuals that are:

• exhausted with life
• exhausted with daily stress
• adjusting to the world that we’re in with COVID

COVID never went away. Now, we have all gone to a normal life. But COVID is still here, and dealing with all the stresses that come with that. Every individual sees their crisis. They determine exactly when the time is that they need to call for help. Having called Grassroots before makes the individual a lot more comfortable to call again.

So, they feel that once they call and receive that warmth and empathy, it’s easier to call them again.

What has expanded services tremendously is text and chat. And that allows a significantly higher level of confidentiality because they feel they don’t have to release any information. You can be completely anonymous on text or a chat, and still receive the same warmth and empathy from another person on the other side.

Crisis misconceptions

Quinton Askew (9:40)

There are multiple ways to connect. So, are there any misconceptions or myths about crisis that you might hear or hear folks tend to talk through?

Dr. Mariana Izraelson (9:55)

Myth #1

The first misconception is that people don’t appreciate that if they call the hotline and intervention was sent during the call because the crisis could not be de-escalated. And there’s a sense that if you call a crisis line, they will send the police to your home immediately. That is very rare, very rare! It only occurs in maybe 3% of the cases.

We try to de-escalate, and we try to work with the individual. And we try to engage with the individual. And we always try the least invasive method of intervention. So, we will work with them to:

• engage with the mobile crisis team
• to engage with urgent care
• to engage with a provider
• to connect with resources

All before intervention and emergency services are sent.

But, there’s the sense that people fear that if they call a crisis hotline, the police will immediately show up at your door. And that is a very big misconception because it is the minority of the calls in which this happens. And only when it is absolutely necessary.

Myth #2

The other misconception is that we can solve everything under the sun, which is not the case. Some individuals may think oh, well, I’ll call the hotline, and they’ll give me a place to live, or they’ll talk about my problems in a phone call. And it takes a lot of work. It takes time.

Sometimes, we require individuals to come in to sign releases of information to connect to other people. We do a lot of warm handoffs to other organizations and are mostly open 9 to 5. So, if they call at three in the morning, that’s not an easy process. So, there’s this sense that, well, okay, I call the hotline, they didn’t solve my problem. And I’m done.

We work with individuals to say, yes, you called the hotline, but give us time to resolve your situation because it will take time to connect with our individuals to provide you with the resources that you need.

Call specialist training

Quinton Askew (11:51)

Yeah, it’s a good place to start to call. Right, that first step is taking that call. We know Grassroots is 24/7/365. As you mentioned, people who are answering the calls are empathetic, but what type of training or qualifications do these call specialists have?

Dr. Mariana Izraelson (12:10)

Grassroots requires that all call takers, text takers, and chat takers have a bachelor’s degree. We require 48 hours of initial training; there is a structure. It is face-to-face, and we also have very specific training that is designed by professionals working in crisis services programs.

As part of a 988 program, we also have to follow the regulations of the national association that manages 988. There are very specific training stores on:

• How to answer a phone call.
• How to respond to crisis.
• How to intervene when it is necessary.
• What are the specific steps?

We have very specific rigid protocols designed by the American Association of Suicidology and the International Council of Helplines. And, Grassroots requires that individuals who work at Grassroots after a year obtain a crisis counselor certification. So that’s a very specific program. It takes about eight months to get the certification. So, our counselors here are very well trained. After the 48-hours of structured training they have a shadowing period, and there is scoring that they have to pass to work independently.

Partnerships

Quinton Askew (13:21)

Wow, that’s great. And that shows the experience and the training, which is important.

So, we always appreciate that partnership here with 211 Maryland. We know that the county and various partners that healthcare providers you work with. So, what of those other collaborations you do have in the county that help support some of the work?

Dr. Mariana Izraelson (13:39)

We collaborate with almost every agency in the county. We have very strong partners. We work with Howard County Public School System; Howard County offers a partnership, Howard County Executive Office Government.

We work closely with the Health Department. Grassroots is the only crisis center for Howard County. So, the Health Department and Grassroots work extremely closely.

We work with our county’s Local Health Authority and many other partners within our county that refer clients. Our county is a single point of entry for the county. Grassroots receives referrals from almost every nonprofit organization in the county because they know if their clients are experiencing any crisis or homelessness crisis, the place to go to resolve the situation is Grassroots.

We are the point of entry for anyone in need. And we are the connection. So, as much as we receive referrals, we refer clients to every resource available in the county and outside of the county, depending on where that individual is calling from. So, suppose an individual is in Baltimore County. In that case, we assure you that we have partners and connections in Baltimore County to connect and refer them.

We also have an extensive network of mental health providers and substance use disorders providers. So, we have a locator in which we will connect the individual depending on the geographic location of the service access they need.

How they prioritize crisis services

Quinton Askew (15:00)

Wow, that’s great. You mentioned the shelter and that you are providing crisis intervention. How do you balance the two with supporting some immediate shelter needs while also addressing some of the other underlying causes for the individuals you serve?

Dr. Mariana Izraelson (15:16)

Well, we are very specific with an assessment. First, the individual will complete a housing assessment in a crisis services assessment. We use an evidence-based form for social determinants of health. We use a prepared form. That form allows us to identify the needs of the individual at that particular time. We do a priority based on what is the immediate need at that particular time.

Then, we follow that prioritization to make sure that we address what is needed. There is an urgency at present, and we determine which one is taking priority. So, if the crisis the individual exists is too significant, and they will not be able to function in a shelter environment. Then, we need to make sure of an intervention that will address that specific crisis at that specific time. When that is resolved, we can move on to thinking about congregate living type that will support the individual.

Challenges of crisis work

Quinton Askew (16:09)

What are the challenges to providing all of these valuable services? You know, there’s staffing, shelter space and some of the other resources that are needed. Are there additional challenges to providing all of these crisis intervention services?

Dr. Mariana Izraelson (16:24)

There’s every challenge known to man.

Being that we’re a nonprofit, funding is always a big challenge. Funding to be able to support all the services that we provide is very limited.

There is an understanding that you can stretch $1 in 50 million ways. And before COVID, that was true to a point. After the pandemic, it has been even more difficult for us to do that.

Staffing is a significant concern for us. We have been open through the pandemic. We offer in-house services and walk-in crisis services. We need individuals on site, which is difficult because most people prefer a different type of environment.

We have a very challenging population that we work with. Sometimes, during a crisis, individuals tend to express themselves in different ways, which can be very difficult for others to try to help accept these. The staff is one of our major challenges, and having individuals that want to do this kind of work and want to dedicate their life to this kind of work.

And having individuals that really want to work with others who are always struggling. It’s one thing to, you know, have one call a day when the person is struggling. It’s another thing to receive 50 calls a day where everybody’s just struggling. So, it takes a special person to want to do this work.

Also, spaces for congregate living are very limited. All of Maryland’s emergency shelters and emergency programs are typically very busy and, if not at capacity. So, finding space for people in these types of crises is difficult.

Quinton Askew (18:02)

Yeah. And how have you been able to be creative with overcoming these challenges?

Dr. Mariana Izraelson (18:16)

Grassroots is a nonprofit. So, we do a lot of fundraising work. And we do. We have a very active fundraising team, a developing team, and a marketing team.

We depend deeply on the generosity of individuals in Howard County. Grassroots is well off in Howard County, and the Howard County residents are very invested in ensuring that our county continues to exist, which is very important for us. Grassroots will not exist without the generosity of the Howard County community. There is no way.

We receive donations of every kind. Food is one very important aspect of the donations that receive. The meals that we serve in the evening are all donated by Howard County communities and sometimes outside of county communities.

We have a large number of volunteers that come to Grassroots to provide services. We have very invested congregations that care to assure that Grassroots continues to provide services, and they have been integral to providing for us to continue to serve.

We have created some virtual jobs for individuals who don’t want to be in the office. So, we invested in our technology to ensure we can provide those services virtually. And we have also created hybrid positions to ensure that there’s coverage on-site. Still, there’s also the opportunity for individuals to work from home.

Quinton Askew (19:38)

Because Grassroots is a nonprofit, you don’t have to be from our county to make any donation or contribution to help support the efforts. You can be from anywhere across the state. Right?

Dr. Mariana Izraelson (19:49)

Correct. So, we accept them and we are very invested. We receive a lot of grants. We apply for grants in Maryland and outside of Maryland. We apply for grants. There is a large community outside of Howard County. They also support Grassroots efforts.

People need to know that help is always available

Quinton Askew (20:02)

That’s good. And your experience, what do you wish more people knew about? Is it mental health or crisis intervention or just seeking help in general?

Dr. Mariana Izraelson (20:10)

Crises come and go for people. And sometimes, they don’t realize there’s help out there. Sometimes, they undermine their feelings, and if they feel well, they shall pass. And I have to feel miserable for this period of time. When in reality, at that particular time, there’s always somebody ready to listen to help to help you navigate through that process.

It is important to connect with others. Having another person who will listen to you, be empathetic, and help you through these very difficult times in your life is important.

Everybody at Grassroots is ready and able to provide that listening ear, that time for the individual. We always invite people to take that first step to connect with us to take that first step.

From my perspective of 211 Health Check, for example, You don’t have to make that call. All you have to do is make one connection, sign up for the program and we will contact you weekly. The first step is just signing up for a program or connecting with us at whatever time the individual wants.

I think people wait until the crisis is, you know, to the point that they cannot handle it. It would be helpful to call when you are starting to feel stressed, starting to feel devastated or starting to feel overwhelmed. That is a good time to connect with someone on the other side. We’re waiting to hear from you.

Success stories

Quinton Askew (21:33)

That is great advice. And I’m sure you have many success stories. Is there anything that stands out that you guys have supported someone, and there was great success, excitement, and happiness?

Dr. Mariana Izraelson (21:45)

We had an individual come to us directly from the detention center. That was an individual that was sentenced for a very significant charge. They had spent over 20 years in the justice system. And they came to Grassroots once they were released, with absolutely nothing, They called Grassroots, and we asked them to come over.

They had nothing. They were in the system for over 20 years. They didn’t have a place to live. They were released with nothing.

Unfortunately, even though they were in the justice system for so many years, their mental health concerns were not being addressed appropriately when they were discharged from the system.

They were discharged just as they came in, with no follow-up or medication.

And again, there are many reasons for this. The system does what it can, and it attempts to connect people to services, but the person needs to say yes, I want to connect.

First of all, getting a provider that is going to see somebody with that type of history within hours because we need medications, understanding the person is struggling, they had spent a few days outside, and then attempting to find housing for somebody that comes with such a strong legal background. In months, we connected them with housing and mental health resources. And they are now doing well. There have been challenges like everybody else, but they’re safe. They’re in an individual place. They connect with a mental health provider and are doing well.

Quinton Askew (23:19)

Well, that’s great. That’s a great story to hear. In closing, is there anything else you would like to share?

Dr. Mariana Izraelson (23:23)

Everyone needs to know the great work that gets done at the crisis lines and the crisis programs across Maryland. We need everyone’s support for us to continue to exist and function. We’re here to help anybody at any time. We don’t ask questions. All we care about is that the individual connects with us and that we are able to provide the assistance they need.

Quinton Askew (23:44)

Again, thank you so much, Dr. Mariana Izraelson. I appreciate you being a wonderful partner and all the great things that Grassroots is doing. Thank you so much for joining us.

Dr. Mariana Izraelson (23:53)

It is my pleasure. Thank you so much for having me today.

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