Transcript Mayview Regional Service Area Planning Process Allegheny

Mayview Regional Service Area Plan
Stakeholder’s Meeting
February 20, 2009
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Agenda
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Update on the Mayview Regional Service Area Plan
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Mary Fleming, Allegheny HealthChoices, Inc.
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Overview of Closure and Services for Discharged Individuals
Inpatient Trends
Resource Development
Quality Oversight
Panel of Individuals Discharged from Mayview
Lessons Learned Exercise (we hear from you)
Mayview Project Timeline
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Persons Discharged from Mayview
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269 people were discharged with a community
support plan
41% had a length of stay of 2 years or less
29% had a length of stay between 2 and 5
years
30% had a length of stay longer than 5 years
For more than half of the group, this stay was
at least their second admission to Mayview
Housing Arrangements at Discharge
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84% of people were discharged to residences
with 24-hour staff:
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16% were discharged to community settings
without 24-hour staff
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26% to long-term structured residences (LTSRs)
22% to different types of personal care homes
19% to community residential rehabilitation (CRR)
group homes or apartments
17% other categories combined
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independent housing, living with family
permanent supported housing, supported housing
Housing Stability
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19% of people who have been discharged at
least three months have moved since their
discharge.
About two-thirds of persons moved to a less
restrictive setting or setting with fewer
supports.
Single Point of Accountability
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72% of people were recommended for
Community Treatment Teams (CTTs) in their
CSPs
28% of people were recommended for case
management/service coordination in CSPs
CTTS and case managers are designated as the single point of
accountability for individuals in the community
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CTTs Are Providing Frequent Contacts
For people receiving CTT services,
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26% of people had 6-7 average contacts per
week with CTT
33% had 4-5 average contacts per week
32% had 2-3 average contacts per week
…during their first three months in the
community.
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Case Management/Service
Coordinators Also Provide Frequent
Contacts
For people receiving case management/service
coordination,
 14% had contact with their case manager 4-5
times per week on average
 41% had contact 2-3 times per week on average
 26% had contact at least once per week on
average
…during their first three months in the community.
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Use of Other BH Services
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Use of other behavioral health services with
the exception of outpatient mental health has
been low
Given that CTT is a team-delivered
comprehensive service, people with CTT
should generally not need other behavioral
health services
Access to Supports and Activities During
First Three Months in Community
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75% of people had contact with their peer
mentor after discharge. Many peer mentors
were involved during the CSP process.
20% of people visited drop-in centers
80% had some type of contact or support
from family
40% used spiritual supports
Very few people were either recommended
or accessed vocational or educational
activities
Incarcerations and Hospitalizations
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During people’s first three months in the
community:
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After the first three months in the community:
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3% were incarcerated
6% had some psychiatric hospital days
7% of people were incarcerated
17% had some psychiatric hospital days
Early Warning Signs and Critical Incidents
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New online database for reporting early
warning signs and critical incidents began in
June 2008. Since then:
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29% have had an early warning sign report.
29% have had a critical incident.
While it is premature to identify trends,
providers are reporting incidents and counties
are proactively working to address situations.
Inpatient Trends
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For the region, inpatient admissions have
slowly decreased over the period.
For the region, Average Length of Stay is rising
slightly.
Length of Stay in Extended Acute is
approximately 115 days.
Length of Stay on the Extended Acute Waiting
List is about 73 days
RTF-A Average Length of Stay is trending
upward.
EAC and RTF-A Trends
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Length of Stay in Extended Acute is
approximately 115 days
Length of Stay on the Extended Acute Waiting
List is about 73 days
RTF-A Average Length of Stay and Median
Length of stay are trending upward
RTF-A Average Days on the Waiting List has
dropped recently due to several discharges
Resource Development
The counties have planned for the Mayview
closure by investing funds in:
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Residential options
 Treatment services
 Supports and resources
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New/Expanded Peer Support
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Peer mentors
Warmline
Peer specialists
Recovery specialists (County staff)
New/Expanded Peer Support
Allegheny
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Beaver Washington
Peer
Mentors
Warmline
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Peer
Specialists
Recovery
Specialists
Drop-in
Center
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Lawrence
Greene
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Note: These programs may already exist in the Counties, just not new or expanded with MRSAP
New/Expanded Community Services
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Community Treatment Teams (CTT), also known
as Assertive Community Treatment (ACT)
Enhanced Clinical Case Management (ECCM)
Expanded Case Management/Service
Coordination
Mobile Medication Teams/Mobile Mental Health
Expanded Outpatient
Expanded Psychiatric Rehabilitation
Crisis Services
New/Expanded Community Services
CTT/ACT
ECCM
Case mgmt./
Svc. Coord.
Mobile Meds,
Mobile MH
Outpatient
Allegheny
Beaver
Washington
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Psych Rehab
Crisis Svcs
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Lawrence
Greene
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* Through a new Clubhouse program.
Note: These programs may already exist in the Counties, just not new or expanded with MRSAP
New Residential Options
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Permanent Supportive Housing (PSH) and related
services
Comprehensive Mental Health/Enhanced Personal
Care Homes (CMHPCH and EPCH)
Long-term Structured Residences (LTSR)
Specialized Supportive Housing (aka long-term
residences)
Extended Acute Services (EAC), both hospital and
community-based
Residential Treatment Facility for Adults (RTF-A)
Other county-specific options
New Residential Options
Perm. SH
CMHPCH/
EPCH‡
LTSR†
Spec. SH/
long-term res.†
Ext. Acute
RTF-A
Other
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Allegheny
Beaver
Washington
Lawrence
Greene
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* Regional resources are being developed by the suburban counties
† Includes state operated services that all counties will have access to
‡ While not all counties are developing, counties will have access to resources
Quality Assurance and Oversight Initiatives
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Quality Improvement and Outcomes (QIO) SubCommittee
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Quality Management and Clinical Consultation (QMCC)
Team
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Includes consumers, family members, and professionals from
the MRSAP Counties and State
Monitors and reviews data related to the MRSAP project,
including but not limited to assessments, CSPs, satisfaction /
quality of life surveys, and other evaluation components
Works collaboratively and in consultation with counties and
providers to monitor the quality and effectiveness of services,
the effective coordination of services, and development of staff
expertise to meet the complex and changing clinical needs of
consumers.
Quality Assurance and Oversight Initiatives
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Comprehensive Monthly CSP Tracking
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Care Management Collaboration with CCBH
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Follows identified high risk consumers – both HealthChoices and
non-HealthChoices
Works closely with Allegheny County’s community integration team
and the QMCC from the SOS
Regional Reporting of Critical Incidents and Early Warning
Indicators with Automated Notification Capability
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Tracks 22 categories including benefits, housing, services, and social
supports on a monthly basis for all CSP consumers
Provides regional perspective of critical incidents
Integrates with other CSP tracking data
Offers ability to notify Counties and State immediately once entered
into the system
Quality Assurance and Oversight Initiatives
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Failure Mode Effects Analysis (FMEA)
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Root Cause Analysis (RCA)
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Proactively evaluates activities associated with the closure and works
to develop contingencies to minimize risk to consumers, staff, and the
community at large
Process that objectively and systematically reviews the contributing
factors associated with certain critical incidents deemed “sentinel
events” involving individuals within the Mayview Service Area
What have we learned from the closure?
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What is your general assessment of the
closure?
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What were the issues of greatest concern
What issues require the most attention
What worked? How can things be improved?
If stakeholders from another state hospital area
were thinking about a closure or big
downsizing, what should they be most
concerned about or pay extra attention to?
Ground Rules
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May use cards to write on or speak from mike
Wait until you are called on
Identify yourself before you speak
Will call on folks who haven’t spoken as first
priority
Can’t discuss individual cases