WELCOME

Building Community Connections:

Regional Stakeholders MeetingJune 17, 2011

1

Agenda for Meeting

Update from DPW A two year view post closure Initial results from evaluation by University of

Pittsburgh Strategies for Community Inclusion Discussion, questions, …..

2

Update From DPW

3

Overview of Two Year Report

Outcomes for People Discharged during the Mayview Closure

– Housing– Services– Community Hospitalizations, EAC, RTFA– Work / Volunteer– Physical Health

Service System Redesign– Planning and Oversight– Service Utilization and Cost Implications

Conclusion and Future Directions

44

Housing at 12/31/2010

5

Housing CategoryPercent of

People Living Independently or with Family 16%

Supported Housing Programs 12%Supervised Group Settings 44%

Long-Term Structured Residences 13%Nursing Homes 6%

Community Psychiatric Hospital 2%Criminal Justice Facility 1%

Source: monthly tracking reports completed by County monitors.

6

Housing Stability and Satisfaction

About 50% are living in same location as two years ago when the hospital closed

25% have moved once 25% have moved two or more times 73% of those who have moved, moved to a less

restrictive setting Of those who completed a CFST satisfaction

survey– 82% rate their housing as excellent– 73% are satisfied with their housing location

7

Satisfaction / Community Connections

High levels of satisfaction with services and a higher quality of life compared to the state hospital

Some people report needing additional services and supports to become more independent and increase connections to the community

Peer support services have been helpful for many individuals

8

Case Management and CTT Use

CTT – 190 Individuals – average 2.8 contacts per week

All other Case Management – average 1 contact per week

19 people have administrative case management

9 people have no case management

9

Other Community Services - 2010

29% Outpatient services 17% Crisis services 11% Social rehabilitation services 10% Housing support services < 5%

– Drug and alcohol– Partial hospitalization– Respite

10

HealthChoices (non-MRSAP) IP Admission Rates, 2006-2010

11

Community Inpatient, EAC, RTFA

About 20% of people discharged from Mayview had community hospitalizations in either 2009 or 2010

The average length of stay in 2009 was 37 days, decreasing to 30 days in 2010; the number of days associated with inpatient stays decreased 14% from 2009 to 2010

Eight people (3%) discharged from Mayview have had an admission to EAC services in 2009 or 2010

Thirteen people (5%) discharged from Mayview have had an admission to a RTFA

There’s been one civil commitment to Torrance State Hospital Half of the 21 people transferred to Torrance State Hospital have

been discharged back to the community

12

HealthChoices IP Length of Stay, 2006-2010(Includes MRSAP and non MRSAP)

13

Criminal Justice Involvement

22 people (8%) have been arrested since the closure, totaling 40 separate incidents

In 35 of these incidents, people were incarcerated for varying amounts of time, and charges ranged from probation violation to disorderly conduct to more serious offenses like robbery

Five arrests did not result in an incarceration

14

Work / Volunteer Activities

20% reported some work or volunteer activity. Many of these activities were informal employment or volunteer activities

50% of those not working reported being interested in working, and most feel ready to work

A smaller proportion (23%) reported being interested in volunteering

Counties have a number of initiatives to increase supported employment opportunities for their populations

15

Physical Health

People discharged report good overall physical health and access to physical health care: 83% of people report they are in average or excellent physical health75% report receiving regular routine physical health checkups, and 82% report having average or excellent access to physical health care48% report receiving regular dental care, perhaps reflecting both accessibility issues and personal preferences for seeking regular dental care

16

Physical Health

19 people have died from natural causes/medical reasons since January 2009, and four other individuals have died from accidental causes

Many people were discharged with complicated, chronic health conditions, and the median age at discharge was 48 years

Many people in this population need significant medical care, and all need physical health care that is closely coordinated with behavioral health

Only 46% of consumers report that their mental health provider communicates with their physical health provider

17

Service Utilization and Cost Implications

Average costs per individuals range from $16,400 to $29,000 per year

Provided services to approximately 1600 people in 2010 who potentially could have used MSH at an average cost of $32,000 annually

18

Conclusion

Generally a successful transition to the community Higher quality of life and stable, community-based

housing with varying amounts of support and access to mental and physical health treatment

Fears that community hospitals and jails would become the new Mayview have been disproven

Connections to the community – whether through employment, personal relationships, or activities – remains an unmet goal for many

Physical health of many individuals, particularly as they age, must continue to be a priority

19

Future Directions

As the region looks ahead, priorities will include:

– Continuing to assure that people get the services they need, and that these services focus on recovery and achieving positive outcomes

– Assuring ongoing funding to maintain adequate financial resources for the system

– Maintaining the regional focus on recovery, quality monitoring and improvement, and data-driven decision-making

– Improving cross-system planning and collaboration for special populations and those individuals with particularly complicated situations

20

Mayview Discharge Study

Katie Greeno, University of Pittsburgh Sue Estroff, University of North Carolina Courtney Colonna Kuza, University of

Pittsburgh

21

Outcomes after discharge

It is valuable to know how people fare after discharge from long-stay hospitals– Understand the recovery process– Quality assurance for providers and policy makers

This study used rigorous methods to document two-year outcomes for people discharged from Mayview

22

Method

We followed 65 people over two years– They represented the whole group– Not every one participated at every time point

We saw people every 3 months– Standardized assessments every other visit– Other visits focused on interviews

23

Study personnel

Two senior faculty members and a very experience project director

10 interviewers– Pitt graduate students with direct practice

experience– Extensive training from the project director– Supervised, then independent visits to participants– Weekly staff meetings

Interviewers stayed with the same participants

24

Data collected

225 standardized assessments 138 interview based “check-ins” 41 in-depth “relocation interviews” Over 500 visits made to participants’

residences for these observations

25

Standardized measures

Psychiatric symptoms– Improve over two years

Social Contacts– Improve over two years

Quality of Life– Stays the same – compares favorably to other groups

Recovery assessments– Stays the same – about the same as other groups

Perceptions of Care– Do not change over time – lower than other groups

26

Percent with at least moderate illness(BPRS >41)

27

Criteria for remission

Remission of BRPS-rated psychotic symptoms– Seven symptoms related to psychosis

Grandiosity, suspiciousness, unusual thought content, hallucinations, conceptual disorganization, blunted affect

– Rated 3 (mild) or less for six months

Additional criterion:– Overall BPRS < 31 for six months

28

Symptom Remission

50 participants had at least two standardized assessments in Year 2 of the study– We examined their last two observations

30 participants (60%) met this criterion for remission

24 participants (48%) met this criterion, and also had an overall BPRS score of 31 or less

29

See friends regularly (percent)

30

WHO Qol: Psychological Well-Being

31

WHOQol compared to other samples

32

WHOQol compared to other samples

33

POC: Interpersonal aspects of care

34

Would you recommend this facility?

35

Rate services from 1-10 (percent)

36

Interview and observational findings

Participants prefer their new residences to Mayview

Community integration is complex and longer term

Housing will be an on-going concern

37

People are satisfied with theirnew residences

New residences are preferred to the hospital– No comparison. It’s better. It’s the freedom factor– I’m free. I go more places. I do what I want to do.

People feel safe and comfortable – Here, I am much more relaxed– I am much more comfortable– There are less people. If residents don’t get along,

it gets taken care of by staff

38

Progress needed on community integration

Many participants would welcome more varied activities– Q: What do you do? A: Sleep. Get up and watch

TV. Come out here and smoke.– Q: What is there to do? A: Sleeping. Groups.

That’s about all. – I don’t go anywhere. I don’t have any money.

Some participants are very active– I am in the process of getting prepared to get a job.

I’ll see what kinds of things I want to do.

39

Housing is a continuing concern

Some people adjust well to supervised housing situations designed for short stays (e.g., CRRs), and find the need to relocate again problematic

Most participants have limited financial resources, and will rely on public housing as they become more independent– Public housing is not always available– When available, the quality and safety of public

housing is variable

40

Conclusions

People discharged from Mayview are doing well in their new residences

Continued attention to services will be useful. “The best experience has been

knowing that I can make it in the real world. Not as hard as I projected it to be.”

41

Study Design

Hospital

3 mo 6 mo 9 mo 12 mo 15 mo 18 mo 21 mo 24 mo

Q CIIW

Q CIIW

Q CIIW

Q CIIW

Q

FN FN FN FN FN FN FN FN FN

42

Strategies for Community Inclusion

Panel– Kevin Trenney– Austin Lee– David Bolgert– Gary Seuhr– Joe Burgess– Gabe Chantz

43

What does recovery mean to you? What kinds of things have you done, or that you

suggest others do, to lessen isolation and improve one’s connection to the community?

If there’s one thing that you would recommend people do to take the first step – what would it be?

What can the community, providers, and/or counties do to help people better connect with their communities?

44

Strategies for Community Inclusion