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Mayview Regional Service Area PlanStakeholder’s Meeting

February 20, 2009

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Agenda

Update on the Mayview Regional Service Area Plan– Mary Fleming, Allegheny HealthChoices, Inc.

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)

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Mayview Project Timeline

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Persons Discharged from Mayview

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

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Housing Arrangements at Discharge

84% of people were discharged to residences with 24-hour staff:– 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

16% were discharged to community settings without 24-hour staff – independent housing, living with family– permanent supported housing, supported housing

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Housing Stability

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.

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Single Point of Accountability

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,

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

. 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

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Access to Supports and Activities During First Three Months in Community

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

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Incarcerations and Hospitalizations

During people’s first three months in the community:– 3% were incarcerated– 6% had some psychiatric hospital days

After the first three months in the community:– 7% of people were incarcerated – 17% had some psychiatric hospital days

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Early Warning Signs and Critical Incidents

New online database for reporting early warning signs and critical incidents began in June 2008. Since then: – 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.

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Inpatient Trends

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.

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EAC and RTF-A Trends

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

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Resource Development

The counties have planned for the Mayview closure by investing funds in:

Residential options Treatment services Supports and resources

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New/Expanded Peer Support

Peer mentors Warmline Peer specialists Recovery specialists (County staff)

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New/Expanded Peer Support

Allegheny Beaver Washington Lawrence Greene

Peer Mentors

Warmline Peer Specialists

Recovery Specialists

Drop-in Center

Note: These programs may already exist in the Counties, just not new or expanded with MRSAP

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New/Expanded Community Services

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

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New/Expanded Community ServicesAllegheny Beaver Washington Lawrence Greene

CTT/ACT ECCM Case mgmt./ Svc. Coord.

Mobile Meds, Mobile MH

Outpatient Psych Rehab * Crisis Svcs

* Through a new Clubhouse program.

Note: These programs may already exist in the Counties, just not new or expanded with MRSAP

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New Residential Options

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

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New Residential OptionsAllegheny Beaver Washington Lawrence Greene

Perm. SH CMHPCH/EPCH‡

LTSR† Spec. SH/ long-term res.†

Ext. Acute * * * *RTF-A * * * *Other

* 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

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Quality Assurance and Oversight Initiatives

Quality Improvement and Outcomes (QIO) Sub-Committee

– 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

Quality Management and Clinical Consultation (QMCC) Team

– 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.

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Quality Assurance and Oversight Initiatives

Comprehensive Monthly CSP Tracking– Tracks 22 categories including benefits, housing, services, and social

supports on a monthly basis for all CSP consumers

Care Management Collaboration with CCBH– 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

– 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

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Quality Assurance and Oversight Initiatives

Failure Mode Effects Analysis (FMEA)– Proactively evaluates activities associated with the closure and works

to develop contingencies to minimize risk to consumers, staff, and the community at large

Root Cause Analysis (RCA)– Process that objectively and systematically reviews the contributing

factors associated with certain critical incidents deemed “sentinel events” involving individuals within the Mayview Service Area

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What have we learned from the closure?

What is your general assessment of the closure?– 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?

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Ground Rules

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