Transcript Slide 1
Community Care Based Services
Maximizing Efficiency and
Treatment Effectiveness
Diversion Initiatives Addressing Challenges
Of Mental Illness, Substance Use
and Homelessness
Rapid City, South Dakota
February 22, 2011
Leon Evans
President and Chief Executive Officer
The Center for Health Care Services
Mental Health and Substance Abuse
Authority
Bexar County
San Antonio, Texas
[email protected]
Gilbert Gonzales
Director, Communications
and Diversion Initiatives
The Center for Health Care Services
San Antonio, Texas
[email protected]
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Why ?
Poor communication
Poor system design
Silos
No strategic
improvement plan
Little use of prevailing best
practices
Lack of leadership and overview
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The Problem
The Problem gets worse:
Poor and or reduced
funding
Scant, limited and
rationed services
Reduction of State Hospital
treatment beds
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An Ounce of Prevention
Taxpayer Costs Avoided through Preventing
Crime
Criminal Behavior and Its Cost to Society
• 1.7 Trillion including victimless
crime – Perazzo 2002
• 674 Billion Federal, State and Local – Shapiro 1999
• 1.0 Trillion (2 million people incarcerated) – Adrienne
2005
Cost Avoided if One Criminal Career is Prevented
$ 976,217.81
• Average annual adult cost (2004) - $40,865
• Average annual juvenile cost (2004) - $32,888
Source: Dr. Victoria Reinhardt, An Ounce of Prevention presentation
To NACo, July 2008
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The Case of Million
Dollar Murray
MILLION-DOLLAR MURRAY
by MALCOLM GLADWELL
The New Yorker Magazine, Issue of 2006-02-13
and 20, Posted 2006-02-06
“It cost us one million dollars not to do something about
Murray,”
News Release
Emergency Departments See Dramatic Increase in
People with Mental Illness Seeking Care Emergency
Physicians Cite State Health Care Budget Cuts at Root
of Problem
American Psychiatric Association
Hillarie Turner, 703-907-8536 June 2, 2004
[email protected] Release No. 04-30
Sharon Reis 202-745-5103
“in one study, it had been concluded that one homeless person can cost the City
and County about $200,000 in one year”. Philip F. Mangano, Executive Director of the
United States Interagency Council on Homelessness (USICH), May 1, 2007.
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Average Per Capita Spending
• In 1995, average monthly
spending per capita for clients
receiving services in
"aged/disabled" home and
community-based waivers
across all states with these
waivers was $485 per month.
• In contrast, average monthly
spending per Medicaidcovered nursing home resident
was $2,426.14.
Community Based vs Institutional Cost Per Day
Institutional,
$320
$350
$300
$250
$200
Community
$150
Institutional
$100
$50
Community, $42
$0
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http://aspe.hhs.gov/daltcp/reports/costeff.htm
(per episode cost)
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Collaboration: It’s an unnatural act between…
…two
or more unconsenting adults.
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Integrating and Strengthening
Community-Based Care
• Community-based services, that are readily accessible
and convenient, help in the early detection and
treatment of mental health problems.
• Will help to reduce the
need for hospitalization
and increase the chances
that patients can fully regain
their mental health and help
them to live and work
successfully
within the community.
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Community Care
Is better than Institutional Care
Costs less than institutional care
Is least restrictive
Allows for greater
family involvement
Produces better
outcomes
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Community Mental
Health Philosophy
“You get better
outcomes when
treatment is
nearer to families,
jobs and
communities”.
Leon Evans
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Civil and Criminal
System County City-wide
Entry Points
System Level
Judicial/Courts
City-wide
County
Law Enforcement
Detention/Jail
CIT
Crisis Care Center
Jail Diversion
Psychiatric and Medical
Clearance
Specialty Offender Services
Emergency
Dynamic
Crisis Jail Diversion
Information Exchange
Services
Community
Mental Health
Public and Private
Providers
Treatment
Continuity of Care
Police, Sheriff
Probation, Parole
Magistrate, County, District
• Community Collaborative
• Crisis Care Center
• Crisis Transitional Unit
• Crisis Hotline (Nurselink)
• CIT/DMOT
• SP5
• Jail and Juvenile Detention
• Statewide CARE Match
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Stakeholder Collaboration via:
• Jail Diversion Oversight Committee
(34+ Community Agencies/Stakeholders)
• Community Medical Directors Roundtable
• Children’s Medical Directors Roundtable
• Bexar County Children’s Diversion School District Sub Committee
• Bexar County Children’s Diversion Child Protective Services Sub
Committee
• Bexar County Children’s Diversion Juvenile Justice Probation Sub
Committee
• Community Co-Location Coalition (29 Community Agencies including law
enforcement entities meeting to address the homeless & public inebriate)
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Show me the DATA !!!
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Impact on WAIT TIME
for LAW ENFORCEMENT
Then (prior to Sept 2005)
• Wait times for Medical
Clearance/ Screening at
UHS ER - 9 hours, 18 min.
• Wait times for Medical
Clearance/ Screening and
Psychiatric Evaluation was
between 12 and 14 hours.
Now
• The wait time for Medical
Clearance/ Screening at the
Crisis Care Center is 45
minutes.
• Wait time for Medical
Clearance/Screening and
Psychiatric Evaluation is
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60-65 minutes.
What Works
Emergency Room
Utilization (Medical Clearance)
Emergency Room utilization has dropped 40% since
the inception of the Crisis Care Center.
40% of (7619 total seen at CCC)
3048
Persons diverted from the ER (in 2006 first year)
X $1545
Cost Savings relative to ER Utilization
$4,709,160
Source: University Health System
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Involuntary Outpatient Commitment
Program
First Year
Evaluation
# Bed Days
Used
150
100
Pre
IOPC
Program
50
0
79% Reduction in Bed
Day Use, Post Program
Post
State Hospital Bed Day Utilization
Rate
1 Yr Prior
132
1 Yr Post
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Texas Department of Criminal Justice
MHMR Match Statistics
October, 2007
C.I.D.
Parole
Probation
Total
Total TDCJ
Population
152,661
77,755
432,359
662,775
# of Care Matches*
40,883
19,763
54,727
115,373
% of Total Population
26.78%
25.41%
12.65%
17.40%
*Represents all Clients served since 1985, including those whose diagnosis is no longer eligible for MHMR
Source: Texas Correctional Office on Offenders with Mental and Medical Impairments
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Revocation Rates 2007
Federal Revocation Rate: 66%
Two-thirds of returning prisoners are re-arrested for new crimes within
3 years or their release. Second Chance Act, 110TH CONGRESS REPORT to US HOUSE OF REPRESENTATIVES
State Revocation Rate:
Texas Felony Revocation Rate = 15.8%
Top 5 Largest Community and Corrections
Departments = 16.1 %
Rearrest Rate
70
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Local Revocation Rate:
Bexar County Mentally Impaired
Caseload Department
Probation Department = 8%
Manos Diversion Program, CHCS = 6.2%
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30
20
10
0
Federal
State
Probation
CHCS
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Therapeutic Justice Partnerships
with Bexar County Community
Supervision and Corrections Dept.
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Two-100 Bed Substance Abuse Treatment Facilities (SATF-1 &
SATF-2,
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60 Bed Young Adult “boot camp” residential facility- Zero
Tolerance)
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One- 60 Bed Dual Diagnosis Unit (MH/SA) Mentally Ill Offender
Facility
Outpatient Substance Abuse Treatment Program (lH 10)
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Dual Diagnosis Outpatient Substance Abuse Program (Palo Alto)
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Drug Court Treatment Services, Dual Diagnosis Drug Court
Treatment Services, Mental Health Court Services, and
Veteran Drug Court Services.
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Combined CCC and Restoration Documented and Immediate Cost Avoidance
Cost Category
City of San Antonio
Bexar County
Direct Cost Avoidance
Public Inebriates Diverted from Detention
Facility
$435,435
$925,015
A.
$1,983,574
$2,818,755*
B.
$2,419,009
$3,743,770
Injured Prisoner Diverted from UHS ER
$528,000
$435,000
C.
$1,267,200
$1,044,000
D.
$1,795,200
$1,479,000
Mentally Ill Diverted from UHS ER Cost
$322,500
$283,500
E.
$774,000
$676,000
F.
$1,096,500
$959,500
Mentally Ill Diverted from Magistration Facility
$208,159
$179,833
G.
$371,350
$322,300
H.
$579,509
$502,133
Reduction in Competency Restoration Wait
Time in Jail for Hosp Admission
0
$255,055
$1,020,000
I.
$255,055
$1,020,000
Reduction in Wait Time in Jail for Outpatient
Competence/Wait Time for Restoration
compared to Inpatient
0
$137,898
$900,000
J.
$137,898
$900,000
Reduction in Jail Time for Competency
Restoration on Bond and on Return
0
$385,522
$221,000
K.
$385,522
$221,000
$1,494,094
$1,823,348
$3,317,442
$5,174,599
$7,002,055
$12,176,654
$6,668,693
$8,825,403
$15,494,096
Total Year 1
Total Year 2
TWO YEAR TOTALS
Documented and Immediate Cost Avoidance, Two Year Analysis April 16, 2008 – March 31, 2010
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The End Result
• Comprehensive service for most in need
• Increased availability of comprehensive
coordinated services
• Reduced barriers to service access and
increase motivation with treatment
compliance
• Employ evidence based practices known
to be effective
• Utilization of system tracking and outcome
based treatment
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The Center for
Health Care Services
Leon Evans, President/CEO
The Center for Health Care Services
Mental Health Authority
210 731-1300
www.chcsbc.org
[email protected]
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