Several times in the manual it notes that referral must come from Crisis Hotline, I believe this language does not allow for services to be initiated locally by individuals who are familiar with providers in their community.  This seems like it could be an additional barrier to helping individuals access care if they are told that they need to contact the Crisis Hotline to receive the referral. 

In addition, due to the fact that many regions do not have the call centers operating and most likely will not have them operationalize by the time this manual goes into effect, additional consideration should be given for providers to begin providing services without engagement or referrals from the Crisis Hotline.