Transcript Mayview Regional Service Area

Mayview Regional Service Area Plan
Steering Committee New Member Orientation
April 9, 2010
Agenda
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Background, Goals, and Timeline
Community Support Plan (CSP) Process
Resource Development
Steering Committee Overview and Focus
Ongoing Post-Closure Activities
Outcomes
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Background
• 1999 Supreme Court upholds ADA ‘Integration Mandate’ in
Olmstead decision which affirmed the right of individuals with
disabilities to live in their community
• The five counties in the Mayview service area, including
Allegheny, Beaver, Greene, Lawrence, and Washington
counties had all been involved individually in bed reduction
efforts over the past several years
• Key opportunity with the MRSAP effort was the potential for
collaborative planning and regional service development
• In 2005, the five Counties, Allegheny HealthChoices, Inc.
(AHCI) and the Department of Public Welfare (DPW) started a
Steering Committee to regionally plan for the gradual
downsizing of Mayview
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Goals
Build stronger community support systems so people can return
to their home communities from the state hospital and remain in
their home communities pursing their hopes and dreams.
– Develop a recovery-based assessment and discharge planning
process (Community Support Plan, or CSP) to make sure people
discharged are successful
– Move resources used to fund Mayview State Hospital to the community
system
– Use these resources to develop new services/supports,
improve/expand existing services/supports
– Develop a process to make sure people are receiving what they need
AFTER discharge
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Mayview Project Timeline
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Community Support Plan (CSP)
• Services and Supports are based on needs and strengths, not
program focused
• Individual assessments and plans inform system infrastructure
and resource development
• Shared responsibility between County, MCO, IP team,
community providers, consumer, and other supports
• Disciplined and highly facilitated process to ensure
accountability and collaboration
• Use of an independent/non-biased facilitator and recorder
• Consumers get to where they need to be rather than following
a continuum of care
• Avoid ‘one size fits all’ approach to discharge planningindividualized
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New/Expanded Resource Development
Peer Support:
• Peer Mentors, Warmline, Drop-In Centers, Peer Specialists, Recovery Specialists
Community Services:
• Community Treatment Teams (CTT), also known as Assertive Community Treatment (ACT)
• Enhanced Clinical Case Management (ECCM)
• Mobile Medication Teams/Mobile Mental Health
Residential Options
• Permanent Supportive Housing (PSH)
• Comprehensive Mental Health/Enhanced Personal Care Homes
• Long-term Structured Residences (LTSR)
• Specialized Supportive Housing (aka long-term residences)
• Extended Acute Services (EAC),
• Residential Treatment Facility for Adults (RTF-A)
State Operated Services (operating for two years after the closure)
• Quality Management and Clinical Consultation (QMCC) Team
• Community Support Team (CST)
• Monarch Springs Long Term Structured Residence (LTSR)
• Specialized Support Homes
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Steering Committee: Overview
• Broad stakeholder representation
– Staff from all five counties
– Consumers and Advocates (National Alliance on
Mental Illness (NAMI), Peer Support Advocacy
Network (PSAN), Disability Rights Network (DRN)
– Behavioral health professionals and Community
providers
– State hospital staff
– Managed care companies
– DPW Office of Mental Health and Substance
Abuse Services (OMHSAS) representatives
• Has been meeting since 2005
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Steering Committee: Focus
• Quality monitoring and service development to
enhance overall community system
• Planning for sufficient and stable long-term funding
to support services
• Regional problem solving to maintain individuals in
the community – only region without a state hospital
• Meets 3rd Friday of every other month (Feb, April,
June, Aug, Oct, Dec)
• Includes updates on State activities and ongoing
work groups
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Ongoing Post-Closure Activities
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Comprehensive Monthly CSP Tracking
Annual CSP Reviews/Updates
Quality Improvement and Outcomes (QIO) Committee
Regional Reporting of Critical Incidents and Early
Warning Indicators
Root Cause Analysis (RCA) Process
Lessons Learned White paper
Ongoing CSPs for Individuals Transferred to Torrance
State Hospital
CSP Evaluation Study with the University of
Pittsburgh
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Outcomes
269 People were discharged from Mayview with a CSP
– 79% Allegheny County, 10% Beaver County, 2% Lawrence
County, and 9% Washington County. None from Greene.
– The majority of individuals were between the ages of 45-55
(37%) at the time of their discharge.
– 61% are male and 39% are female; 60% are Caucasian,
38% African-American, and 2% another race.
– For more than half of the group, this stay was at least their
second admission to Mayview
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December 2009 QIO Report
• Report reviewed recommended services and supports,
actual services received, housing, and critical incidents
• Changes represent a more realistic understanding of the
services and levels of contact that are needed in the
community to best support individuals.
• Most people receive CTT services, others receive case
management / service coordination. Contact frequency
indicates a high level of support.
• All individuals included in the report had a crisis plan.
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December 2009 QIO Report
• While 97% of individuals had seen a physical health
doctor within the past year, behavioral health issues
continue to be an area of focus.
December
2009
QIO
Report
• Housing remains relatively stable with approximately
75% of individuals not having changed their housing
arrangement since their discharge (no one became
homeless).
• Challenges remain as individuals continue to work on
their recovery in the community. Social and leisure
activities, employment, education, and other quality of
life areas require ongoing effort and attention as
community integration continues to develop and mature.
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Hospitalizations, Incarcerations, and
Deaths
• About 22% of individuals had experienced an
inpatient hospitalization since their discharge
• 8% had an incarceration
• 10 people (3%) had died since the beginning of the
MRSAP initiative in 2005 through September 2009,
including six from natural causes, two accidental
deaths, and two suicides.
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Housing: At Discharge, Recommended in the Updated
CSP, and as of August 31, 2009
Housing Type
PCH, EPCH, CMHPCH
LTSR
Level
Supervised
Restrictive
At
Discharge
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58 24%
As of
8/31/09
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%
58 24%
61
25%
55
23%
44
22
18%
9%
29
26
12%
11%
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7%
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7%
Independent
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5%
15
6%
Mental Retardation (MR) Housing
Supervised
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5%
13
5%
Nursing Home
Restrictive
7
3%
12
5%
Independent
6
2%
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3%
Permanent Supportive Housing
Dependent
3
1%
7
3%
Community Inpatient
Domiciliary Care
State Mental Hospital
Restrictive
0
1
1
0%
0%
0%
2
1
0
1%
0%
0%
CRR
Specialized Supportive Housing
Supportive Housing
Living Independently
Family
Supervised
Supervised
Dependent
Supervised
Restrictive
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Summary of Changes in Housing Type by Level of
Restrictiveness: Housing at Discharge and as of August 31, 2009
Level of Restrictiveness
Independent
Moved
From
Dependent
Supervised
Restrictive
Increase in Restrictiveness
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
Moved To
Independent Dependent Supervised Restrictive
2
6
7
0
6
1
7
3
Decrease in Restrictiveness
1
4
8
6
1
1
7
2
Neutral Change
29 people (47%) moved to a less restrictive setting
20 people (32%) moved to a more restrictive setting
13 people (21%) moved to a setting with the same
level of restrictiveness
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University of Pittsburgh- Mayview
Discharge Study: December 2009 Update
• Conducted Observations, Surveys, Interviews
• Subjects are from a random sample of 66 individuals
discharged from the hospital with CSPs
• As of November 2009, about mid-way through, 268 of
458 total time points in the protocol completed
• Summary of preliminary findings:
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People tell us they are really happy to have left Mayview
We see people in settings that are comfortable and pleasant
People were mostly satisfied with the discharge process
People see providers often
Some people are more active socially than others
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Allegheny HealthChoices, Inc.
• Our mission:
– To assure equitable access to quality, cost-effective behavioral health care that
promotes positive clinical outcomes, recovery, and resiliency.
• We are:
– An innovative non-profit that supports the provision of high-quality behavioral
health care by offering:
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Fiscal and Clinical Oversight and Monitoring of Managed Care Initiatives
Program Development and Planning Services
Information Systems Design and Consultation
Housing Services Consultation
CTT/ACT Consulting and Technical Assistance
Community Support Planning Services
Training and Technical Assistance
• AHCI website: http://www.ahci.org
• MRSAP website: http://www.mayview-sap.org/
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