Transcript Spokane County Regional Support Network

SPOKANE COUNTY COMMUNITY SERVICES,
HOUSING, AND COMMUNITY DEVELOPMENT DEPARTMENT
Spokane County
Regional Support Network
Annual Report 2010
January 2011
Message from the RSN
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The Spokane County Regional Support Network (RSN) Annual Report belongs to every resident of
Spokane County. It represents the efforts of your Regional Support Network to adequately fund and
administer mental health services. The facts, figures, and stories contained herein document how
funding and oversight provided to community-based programs support treatment and recovery for
individuals in need.
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As our state struggled to balance its budget, all public programs experienced substantial budget cuts
and were challenged to do more with less funding. Together with our mental health care providers
and with the advisory direction from our Board of County Commissioners and representative
individuals that we serve, the RSN was able to continue to fund a broad array of community
outpatient services for adults, youth, and children.
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Several new community diversion programs were implemented this past year to benefit children and
youth with acute mental illness. These programs are effectively stabilizing children and youth
experiencing a crisis, so that they may remain in their family home and avoid costly and restrictive
inpatient psychiatric hospitalization.
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Our staff and providers remain committed to maximizing the impact of every dollar spent on the
health and recovery of those in need of mental health services. This report illustrates how our
mission to promote health and improve lives through funding of needed public mental health
services is being accomplished each day in Spokane County.
Thank you for your trust and support.
Christine Barada, Director
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Spokane County Community Services, Housing, and Community Development Department
Our Mission
The mission of the Spokane County Regional
Support Network is to assure that in Spokane
County a choice of flexible and responsive
community resources are available and accessible
to individuals and families experiencing a mental
illness.
These resources will value:
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Safety and health
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Preservation of dignity and empowerment
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Individual and ethnic uniqueness
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Personal growth and enrichment
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Community participation
What We Do
Major responsibilities:
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Plan and recommend how to maximize the mental
health funds
Community participation/assessment of current and
future community needs
Contract with providers and monitor for the expenses
and quality of the programs
Provide for Medicaid and state funded psychiatric
inpatient stays for Spokane County residents
Provide residential care for mental health individuals
Authorize each outpatient and voluntary inpatient
service
Provide quality oversight for existing programs
Eligibility for RSN Services
Eligibility is subject to certain diagnostic criteria and authorization by the RSN
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All persons in Spokane County may receive emergency crisis intervention, disaster mental health services,
and hospitalization
Medicaid enrollees may receive all of the above and outpatient services and residential service
Low income, non-Medicaid persons who are high utilizers of services may also receive outpatient care and
residential services
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Spokane County Community Services, Housing, and Community Development Department
RSN Providers
Outpatient Care Providers
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Catholic Charities Counseling
Children's Home Society
Community Detox Services of Spokane
Excelsior Youth Center
Family Service Spokane
Institute for Family Development
Lutheran Community Services N.W.
N.A.T.I.V.E. Project
Partners with Families & Children
Passages Family Support
Providence Sacred Heart Medical Center
Service Alternatives
Spokane County Jail
Spokane County Juvenile Probation and Detention
Spokane County Supportive Living Program
Spokane Mental Health
Spokane Public Schools
Sunshine Health Facility
Tamarack Center
YFA Connections
Residential Facilities
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Residential Supports
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Other Providers
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Community Colleges of Spokane – Supported
Education and Employment Rehabilitation (SEER)
Spokane Neighborhood Action Program (SNAP)
Bethany Place
Blair House
Carlyle Care Center
Grande Manor
Mallon Place
Mirabeau House
Milford House
Moore’s Boarding Home
Oakhill Home
Sunshine Health Facility
Valley View Living Center
Whitehouse Living Center
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Medicaid Personal Care
Outpatient Provider Case Management
RSN Ombudsman
Quality Review Team (QRT)
Program for Active Community Treatment (PACT)
Phoenix Apartments
Supportive Living Program (SLP)
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Spokane County Community Services, Housing, and Community Development Department
Mental Health Services
OUTPATIENT CARE
INPATIENT CARE
Assessment and Psychiatric Evaluation
Children’s Long-term Inpatient
Program (CLIP)
Individual Treatment, Case
Management, & Group Therapy
Evaluation and Treatment Facility
(Adult)
Psychiatric & Medication Management/Monitoring
Inpatient Diversion Facilities
(Child and Adult)
Residential Services & Resources
Involuntary Detentions
High Intensity Treatment
Crisis Triage and Stabilization
Adult Long-term Hospitalization
(Eastern State Hospital)
Caregiver Respite
Community Hospital Psychiatric
Inpatient
(Child and Adult)
Peer Support and Consumer Clubhouse
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Spokane County Community Services, Housing, and Community Development Department
RSN Individuals Served and Their Services
Unduplicated Individuals by Age
October 2009 – September 2010
Age: 2-17
Children & Adolescent
Services 3,422
28%
Age: 18+ years
Adults 8,833
72%
Total Individuals 12,255
Number of Services by Age
October 2009 – September 2010
Age: 2-17
Children & Adolescent
Services 86,903
28%
Age: 18+ years
Adults 224,423
72%
Total Services 311,326
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Spokane County Community Services, Housing, and Community Development Department
Residential Beds and Step Down Units
October 2009 through September 2010
Bed Days Utilized: 80,482
Number of Bed Placements: 326
300
70,000
250
60,000
200
150
50,000
Number of Step
Down Unit
Placements:
40
100
40,000
Step Down
30,000
Unit Days
Utilized:
7,934
20,000
50
10,000
0
0
Number of Client Placements
Total Clients 366 Placed
Number of Bed & Unit Days
Total Bed and Unit Days 88,416
In 2010, a total of 305 Beds and/or step-down units were funded by the RSN
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Spokane County Community Services, Housing, and Community Development Department
Average State Psychiatric Hospital Bed Census
120
100
Allocation:
80
85 beds
SCRSN
Bed Allocation
97
98
97
95
92
91
92
83
83
88
Maximum
Allocation = 87
Jan - S ep '09
Maximum
Allocation = 86
Oct '09 - Sep '10
40
Beds Allocated
Maximum
Allocation = 101
Jan - Dec '08
81
60
Legend:
89
Beds Occupied
20
Maximum
Allocation = 85
Oct '10 - Present
O
ct
ob
er
N
ov
20
em
09
be
D
r
ec
em 200
9
be
r
Ja
20
nu
09
ar
y
Fe
20
br
10
ua
ry
20
M
10
ar
ch
20
10
Ap
ril
20
10
M
ay
20
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Ju
ne
20
Ju 1 0
ly
20
Au
10
gu
Se
st
pt
em 201
0
be
r2
01
0
0
Oct 09 - Sep 10 Our Census Reimbursement
RSN paid DSHS an Over-Census Reimbursement of $584 per day, per bed, when over 86 beds.
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Spokane County Community Services, Housing, and Community Development Department
Funding
In 2010, Spokane County RSN was funded by:
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Medicaid (64%) ($36,677,000)
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State Funds (20%) ($11,272,000)
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Local 1/10 of 1% Sales Tax (12%) ($7,144,000)
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Property Tax & Interest (2%) ($885,000)
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Federal Programs (2%) ($957,000)
Total Revenue: $56,935,000
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Spokane County Community Services, Housing, and Community Development Department
Mental Health Expenditures
October 2009 through September 2010
ITA Judicial, County Jail, County
Juvenile, $1,430,000
Housing, Residential, and
Homeless, $5,232,000
Community Hospital and E & T,
$7,928,000
PACT $1,695,000
Other Direct Services,
$2,261,000
Mental Health & Drug Therapeutic
Courts $1,154,000
ESH Census Reimbursement,
$1,139,000
Administration, $2,059,000
Crisis & Stabilization Services,
$5,454,000
Outpatient Treatment
$18,883,000
Psych & Medication Services,
$5,114,000
Total Expenditures $52,349,000
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Spokane County Community Services, Housing, and Community Development Department
Leveraged Sales Tax
October 2009 through September 2010
A portion of the sales tax is utilized as local match for federal Medicaid.
The RSN designated $2.2 million sales tax annually to generate approximately $3.7 million in new Medicaid
funds that was utilized for Medicaid mental health programs.
New M ed icaid g enerated
with matched s ales tax
$3 ,70 0 ,0 0 0
Sales tax d es ig nated as
M ed icaid match $2 ,2 0 0 ,0 0 0
Sales tax d es ig nated fo r
res id ential ro o m and b o ard
and therap eutic co urts
$4 ,9 0 0 ,0 0 0
Sales Tax Provides $10.8 Million for Treatment, Residential Beds, and Therapeutic Courts in Spokane County
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Spokane County Community Services, Housing, and Community Development Department
Success Stories
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A new Children’s Intensive Resources Task Force achieved the desired outcome of
improved access to community based care for children and youth with intensive needs.
 Admissions to Children’s Long Term Inpatient Programs reduced by 53% in first year as compared
to 2009 (28 admissions in 2009, 15 admissions in 2010).
 Discharges from Children’s Long Term Inpatient Programs increased by 44% in first year as
compared to 2009 (17 discharges in 2009, 29 discharges in 2010).
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Improved census management at Eastern State Hospital (ESH) was achieved through utilization of adult
hospital diversion resources.
 Spokane Community Detoxification Enhancement program successfully diverted 89% of the 304
individuals served who were chronically mentally ill with chemical addiction, many of whom had
histories of multiple psychiatric hospitalizations.
 An innovative partnership between a high-needs mental health clinic (Family Service Spokane) and
a Chemical Dependency program (YFA Connections) has successfully diverted 96% of the 161
chronically mentally ill individuals.
 Spokane Mental Health’s Hartson Crisis Stabilization, a residential treatment facility (RTF), has
provided effective brief stabilization services to keep 89% of their 285 residents out of the hospital
and in their own community.
 Foothills Evaluation and Treatment (E&T) Hospital has served 172 involuntary admissions for a
fraction of the time as compared to Eastern State Hospital (9.3 days compared to 112 days). This
has helped to reduce costly over-census penalty fines. For example, in October 2010, Spokane
County RSN saved $106,300 in ESH repayment fines by diverting 182 ITA admission days to the
E&T Hospital.
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Spokane County Community Services, Housing, and Community Development Department
Success Stories, continued.
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Implementation of planned and emergent respite care for caregivers of high-needs mentally ill children and
youth in response to a high priority community need.
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Three programs provide facility based or foster-home based respite.
Children ages 4-17 were cared for in intervals from 4 hours to 48 hours.
Joint collaboration between Spokane Mental Health and Providence Sacred Heart Medical Center to
optimize access to day treatment for children has reduced the wait list from four (4) months to four (4)
weeks and successfully treated some children in the community.
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Spokane County Community Services, Housing, and Community Development Department
Little Miracles
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Spokane County RSN salutes our providers for their excellent and compassionate
care to those in need by profiling two of the many, many little miracles that occur
each day within Spokane County’s mental health system of care.
 A teenage boy with chronic mental illness had spent almost half his life residing in locked
institutional care. He and his family truly believed he would never return home to live. A multisystem collaboration implemented a graduated community transition plan. The collaboration met
regularly to evaluate the plan, which included his parents, DSHS Children’s Administration, his
primary RSN mental health provider, his RSN school-based therapist, the RSN day-treatment
therapist, and respite care provider. As a result, he enjoyed this past Christmas season living
permanently in his own home, where he is accessing community-based outpatient services to
maintain his recovery.
 A young adult woman with a persistent and chronic eating disorder, so severe that at one point
Hospice care was considered, is now thriving in her own RSN independent housing and is attending
community college. All this is the result of a community partnership that she directed between
herself, her natural supports, primary RSN mental health provider, medical physician, nutritional
therapist, and RSN funded eating specialist, to meet her unique and individualized treatment goals. A
special thanks goes to the DSHS team that provided medical resources along the way to her
recovery!
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Spokane County Community Services, Housing, and Community Development Department
New Services
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Evaluation and Treatment Facility (16 beds)
Step-down Housing (28 units)
Children’s Inpatient Diversion Services (5 programs)
Adult Inpatient Diversion Services (2 programs)
Expanded Crisis Triage (3 beds) (Spokane Mental
Health)
Expanded Peer Support (2 programs)
Caregiver Respite (3 Programs)
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Spokane County Community Services, Housing, and Community Development Department
Evidence Based Practices (EBPs)
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EBPs are behavioral health interventions, which research has demonstrated statistically
significant effectiveness as treatments for specific problems. EBP promotes evidence that is
consumer-reported, clinician observed, and research driven. Spokane County RSN providers
embrace the use of EBP driven treatment by providing training and supervision for their direct
care providers for the following EBPs:
CHILD
ADULT
Aggression Replacement Therapy
Assertive Community Treatment
Alternatives for Families
Clubhouse
Cognitive Behavior Therapy
Cognitive Processing Therapy
Cognitive Processing Therapy
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy
Family Psycho Education - Multifamily Group Treatment
Functional Family Therapy
Gatekeeper for Older Adults
Gender-Specific Integrated Dual Disorders Treatment
Integrated Dual Diagnosis Treatment (IDDT)
Homebuilders™ Model
Psychoeducational Multifamily Group for adults with Schizophrenia
Motivational Interviewing
Question, Persuade, Refer, Treat
Multisystem Care Planning Team
Supported employment
Parent Child Interaction Therapy
WRAP Groups - Wellness Recovery Action Planning Program
Trauma-Focused Cognitive Behavioral Therapy
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Spokane County Community Services, Housing, and Community Development Department
2010 Spokane County RSN Training
Spokane County RSN supports an environment in which network providers,
consumers, staff, and allied systems share knowledge, expertise, and experiences in
the form of training, workshops, conferences, and other learning opportunities. In
2010, the RSN attended, sponsored, presented, or sent consumers, staff, and
advisory board members to many trainings and conferences. The list below is a
representation of many of the diverse and cutting edge presentations offered in
2010.
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Wraparound Treatment Array
Recovery and Resiliency
Mental Health Recovery & Resiliency
Person Centered Strategies & Medical
Necessity Documentation Linkage Requirements
Respite Services for Caregivers of Mentally Ill Children & Youth
Cultural Competency for Lesbian, Gay, Bisexual & Transgender
Complex Trauma: Approaching Community through Trauma
Sensitive Lens
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Spokane County Community Services, Housing, and Community Development Department
Cultural Competency Training
Addressing Cultural Awareness through Cultural Competency Training
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The Spokane County RSN contracted with the Kalispel Tribe of Indians’ Camas Path Program to provide cultural awareness and cultural competency
training. The 5th Annual Tree of Healing Conference was held on June 3-4, 2010. The conference provided an array of national and locally recognized
speakers and events, which provided in-depth cultural competency awareness, cultural traditions, and evidence based practice applications to 224
participants including mental health professionals, social workers, and consumers ranging from youth to elderly.
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Presentation Topics:
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Early Childhood Trauma-Tribal Community
Trauma Informed Care
Power of Native Spirituality
Suicide
The Indigenous Worldview
Self Care for Service Providers
Mindfulness Psychotherapy and Gambling Addiction
The Impact of Culture on Mental Health
The Importance of Interpersonal Skills and Healthy Relationship Building
How Does Millon Clinical Multiaxial Inventory Findings Relate to Historical Trauma
Native HIV Community Planning
Indian Child Welfare Act of 1978
Two Spirit History: A Personal Journey
Loving the Warrior Home: How to Help the Healing of PTSD
Earth, Wind, Water and Fire; Rediscovering the Healing Power of Nature
What Does ‘Culture’ Really Mean…An Examination of Cultural Distinctiveness
Indian Boarding School: Impact on Native Populations
The Biology of Culture
The Medicine Wheel
The RSN provides services to individuals and families of all ethnic backgrounds. In 2010, the following ethnic backgrounds were self-identified by
individuals receiving services: American Indian, Alaska Native, Asian, Pacific Islander, Black/African American, Cambodian, Chinese, Guamanian
and Chamorro, Hispanic, Japanese, Korean, Laotian, Native Hawaiian, Pacific Islander, Russian, Samoan, Vietnamese, and White.
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Spokane County Community Services, Housing, and Community Development Department
Spokane County RSN Applauds the Outcomes of the
Annual Mental Health Provider Monitoring Results:
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Spokane County RSN funded outpatient programs were extensively monitored in 2010. A total of eighteen (18)
agencies, thirty-two (32) clinical programs, and three hundred eighty-one (381) clinical records were reviewed and
evaluated against sixty-one (61) established criteria that measured the agencies performance in conducting clinical
assessment, individualized treatment plans, provision of services, both crisis and risk management, and discharge
process.
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System-wide, 69% of the clinical criteria were fully met, with 95 – 100% compliance scores. Among the criteria
scored at this high level were those pertaining to services to minors, client needs, strengths, and goals documented in
their own words, treatment plans and goals. These were individualized and specific to the expressed needs, supports,
and desired outcomes of the individual, and progress notes which detailed treatment and outcomes.
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Recommendations were made on 21% of the criteria or those which scored 85 – 94% compliance with the standards.
These scores indicated strengths, which still need growth in areas such as timeliness of conducting assessments and
development and updating treatment plans, establishing treatment goals which are measurable, and identification of
disabilities which may impact client recovery.
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Only 10% of the criteria questions scored compliance at less than 85% and had findings. In response, the agencies
which had findings submitted Corrective Action Plans to Spokane County RSN. Both the provider and the RSN
worked together to enhance documentation and continue to monitor for compliance as part of its system of care
quality improvement process.
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Spokane County Community Services, Housing, and Community Development Department
Provider Spotlight
EXCELSIOR YOUTH CENTER
Established in the early 1960s by the Sisters of Good Shepherd, Excelsior Youth Center has a long
history of helping disadvantaged youth and takes pride in meeting each youth’s individual mental health
and chemical dependency needs with a mission of connecting youth to their future. Excelsior employs
one hundred and twenty (120) treatment staff at their campus located in Northwest Spokane and serves a
primary male Medicaid population by providing psychiatric day treatment and respite care for the
caregivers of acute and chronically ill adolescents. Excelsior’s on- campus school is nationally
accredited, so credits earned transfer to any school district in the U.S.A!
For more information contact, Admissions Coordinator, (509) 328-7041 x 116
FAMILY SERVICE SPOKANE (FSS)
FSS serves all ages at its one (1) Spokane Valley and two (2) downtown Spokane locations.
Approximately 90% of those accessing FSS are funded by Medicaid. FSS also provides mental health
care professionals for children and youth attending the East Valley School District. In 2010, FSS
provided services to more than two thousand, five hundred (2,500) individuals and their families. A tenet
of FSS is to assist individuals with a mental illness and their recovery, drawing upon family supports.
FSS is proud of its long history in Spokane, having been established in 1905 by a group of Spokane civic
leaders.
For more information contact, Clinical Director, (509) 838-4128
INSTITUTE FOR FAMILY DEVELOPMENT (IFD)
Providing an evidence based program, Homebuilders™, that is replicated across the world, IFD brings
trained therapists in to the family home to provide short-term intensive stabilization services for children
and youth at risk for hospitalization. IFD employs four seasoned, masters-prepared therapist staff that
share seventy-six (76) years of combined clinical experience! The families served with RSN funds are all
Medicaid. IFD’s mission is to improve the lives of children and families through the provision of high
quality, cost effective, community-based services and supports.
For more information contact, Program Supervisor, (509)328-3802
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Spokane County Community Services, Housing, and Community Development Department
Special Recognition
SUNSHINE HEALTH FACILITIES
Sunshine provided fifty-four (54) hours of caregiver training in First Line and First Aid to each of their
behavioral health staff in 2010. They expanded their mental health services by adding a new Mental
Health Technician position for around the clock coverage at Sunshine Terrace, their residential treatment
facility. Sunshine ARTF has added a Compliance Officer position to enhance consumer
experience. Sunshine is proud to have achieved an 80% success rate for individuals that transition in a
step down process from residential treatment to board & care to independent housing, some of whom
have now lived on their own now for seven (7) years. The Boarding Home program has provided
ongoing care that allows a client the ability to progress toward a more positive living experience. The
involvement of Sunshine Behavioral Health (SBH) mental health agency has strengthened the transition
of care to enable the client to move forward into a more independent setting.
For more information contact, Administration, (509) 892-4342.
SPOKANE PUBLIC SCHOOLS (SPS)
SPS is one of three school districts in the nation to provide licensed mental health counselors for school
based outpatient mental health services to Medicaid funded children and youth ages 5-18 and their
families. This model has been very effective in reducing barriers to access to care, and it is a cost
effective use of space and resources. In addition, SPS provides five school programs that are designed to
meet the intensive needs of students with chronic and acute mental illness from 4th grade to high school.
For more information contact, Clinical Director, (509) 354-7946.
TAMARACK CENTER
During this year, Tamarack Center made a major clinical commitment of incorporating Dialectical
Behavior Therapy (DBT) into their adolescent resident’s treatment. To accomplish this, Tamarack sent
key clinical leadership staff to two intensive DBT trainings, one week in April 2010 and one week in
September 2010, both facilitated by nationally recognized DBT expert and founder, Dr. Marsha
Linehan. The incorporation of DBT into Tamarack’s milieu programming has proven a useful
compliment to the already high quality programming that Tamarack has been providing to its residents
since 1984.
For more information contact: Clinical Director, (509) 326-8100 Ext 23
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Spokane County Community Services, Housing, and Community Development Department
2010 & 2011 Planning Issues & Challenges
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Planning and maintaining an adequate system of care for Spokane
citizens with a declining state budget.
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Reduced non-Medicaid funding in 2010 and 2011, which currently
pays for Eastern State Hospital penalties. To help people out of the
hospital, we need additional housing and diversion programs for
individuals.
 We have a need for a dementia and developmentally
disabled facility to house stabilized individuals who live at
Eastern State Hospital for lack of adequate placement.
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Maintain and expand existing mental health and chemical dependency
(co-occurring) services.
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Collaboration and planning for Washington State Healthcare Reform in
a manner that addresses the needs of the Spokane community for 2011
forward.
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Forming community stakeholders and healthcare partnerships for
healthcare reform to ensure a regional approach.
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Spokane County Community Services, Housing, and Community Development Department
Benchmarks of Systems Stabilization
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Effective monitoring and review of contracts for cost, services, and programs
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Reduction in Eastern State Hospital use and over-census reimbursement
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Reduction in homelessness
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Strong leadership & community partnerships that are committed to excellent care in our community
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Mental Health Quality Plan: Evaluation of the cost efficiency and effectiveness of all the mental health
children and adult inpatient diversion programs
 Consistent data definitions and data collection, on a timely basis
 Models to track the effectiveness of programs
 Reduced length of stay at psychiatric inpatient facilities
 Method to track cost of treatment of individuals
 Performance based contracts demonstrate improvement or meet the goals
outlined
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Spokane County Community Services, Housing, and Community Development Department