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Mayview Regional Service Area Planning

Process

Stakeholder’s Meeting

February 15, 2008

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Today’s Agenda

Welcome Update from the Office Mental Health and

Substance Abuse Services, Department of Public Welfare

Progress Report on the Mayview Closure Overview of the State Operated Services

Initiative County Highlight:

– Washington County Peer Mentor Services Questions and Answers with Audience

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Welcome

Goals

– Share updates on the progress of the CSP process

– Show how we are keeping track of everybody, and how we use this information to:

Develop new services: Community based and State Operated Strengthen interventions

– Hear your questions and opinions

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Mayview State Hospital Update

4 Units Closed 6 Units Remaining 180 individuals are currently in the hospital 118 Total Discharges

– 102 discharges as of December 31, 2007– 16 discharges have occurred in January and

February, 2008

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Mayview Closure Progress Report

Demographics Services Inpatient Utilization Profile of Residential Placements Profile of Consumer Community Supports

– Rehabilitation; Employment; Educational, Leisure, and Spiritual Activities; Benefits, Income, and Guardianship

6

50

1

11

38

0 10 20 30 40 50 60

65 and Over

45 - 64

22 - 44

18 - 21

Demographics: Discharged Individuals By Age Group

Discharged Individuals

Age

7

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Black /Female

Black /Male

White /Female

White /Male

Other /Female

Other /Male

SMH

MRSAP

HC

Demographics: Discharged Individuals By Race and Gender

Race and Gender Data Across State Mental Hospitals (SMH), MRSAP Discharges, and HealthChoices (HC)

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Services Received After Discharge: All Counties - HealthChoices

24.2%3.0%

40.9%1.5%

6.1%

21.2%33.3%

4.5%3.0%

1.5%

1.5%

9.1%

18.2%

9.1%

48.5%

18.2%

0% 10% 20% 30% 40% 50% 60%

Acute OutpatientC ons ultation

C ris is S ervicesC ommunity Treatement Teams

E lectro-C onvuls ive Therapy

Inpatient - Mental HealthL ab

Medication C heckOutpatient - Mental Health

P artial Hos pitaliz ation - Mental HealthP s ychiatric R ehabilitation

R es pite/DASR es idential Treatment F ac ility-Adult

S ervice C oordinationS upport S ervices - DA

S upport S ervices MH

Service Coordination includes all case management services except Community Treatment Teams and Administrative Case Management.

9 Service Coordination includes all case management services except Community Treatment Teams and Administrative Case Management.

Services Received After Discharge: Allegheny County - Base

1.6%

45.3%

3.1%

3.1%

4.7%

9.4%

4.7%

1.6%

1.6%

42.2%

10.9%

75.0%

35.9%

15.6%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Administra tive C a se Ma na g ement

Ac ute Outpa tient

C ommunity R esidentia l

C risis S ervic es

C ommunity T rea tement T ea ms

E merg enc y R oom

F a mily S upport S ervic es

Housing S upport S ervic es

Inpa tient - Menta l Hea lth

Outpa tient - Menta l Hea lth

P a rtia l Hospita liz a tion - Menta l Hea lth

P syc hia tric R eha bilita tion

S ervic e C oordina tion

S oc ia l R eha bilita tion

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Community Inpatient Utilization: Length of Stay (LOS)

MRSAP Discharges: 17 members, 36 IP Admits, Max LOS = 124 days (Inflates AVG)

MRSAP Discharges, 8.5 Days

MRSAP Discharges, 22 Days

HealthChoices Population,

6 Days

HealthChoices Population,

10 Days

0

5

10

15

20

25

Average LOS Median LOS

Day

s

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Community Inpatient Utilization: Readmissions

MRSAP Discharges, 13.9 %

MRSAP Discharges, 8.3 %

HealthChoices, 10.2 %

HealthChoices, 9.2 %

0%

2%

4%

6%

8%

10%

12%

14%

16%

Readmitted in 1-30 Days Readmitted in 31-90 Days

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Residential Placement Type

Comprehensive MH Personal Care

Home, 20%

Comnunity Residential

Rehabilitation, 18%

Domiciliary Care, 1%

Enhanced Personal Care Home, 13%

Living with Family, 7%

Long-Term Structured

Residence, 22%

Nursing Home, 1%

Specialized Supportive Housing,

9%

Supportive Housing, 11%

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Supports: Use of Natural Supports By People Discharged

40%

1%

4%

6%

39%

9%

76%

9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

AA/NA

Family

Friends/peers

Drop-in center

Peer Supports

Social Rehab

Warmline

Other

Co

mm

un

ity-B

ased

Su

pp

ort

s

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Supports: Individuals in Rehabilitation, Employment-Related, or Educational Activities

21%

7%

15%

0% 5% 10% 15% 20% 25%

Rehabilitation

Employment-Related

Education

15

Supports: Individuals with Leisure or Spiritual Activities

23%

86%

75%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Group leisure activities orhobbies

Individual leisureactivities or hobbies

Spiritual support

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Supports: Individuals with Guardianship, Income, or Benefits

53%

5%

12%

5%

6%

4%

58%

48%

48%

9%

88%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Rep Payee

Other

SSI

SSDI

Cash Assistance

Other

Private Insurance

Medicare

Medicaid

Food Stamps

Other

Gu

ard

ian

ship

Inco

me

Ben

efit

s

Guardianship

Income

Benefits

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Update on the CSP Process

Number of CSP Meetings Held For People discharged in Phases 2 or 3

(through December 2007)

# of People # of MeetingsAverage #

Meetings per Person

Initial Information

61 81 1.3

Options 52 119 2.3

Transition 30 41 1.4

Total 72 259 3.6

Note: Because the dates of CSP meetings weren’t tracked in a database until the start of phase 2, only those individuals discharged during Phase 2 or Phase 3 are included in Table 4.

Less than 60 Days

60 to 90 Days

90 to 120 Days

More than 120 Days

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

% of Consumers

Days Between Earliest CSP Meeting And Discharge

Date

• 102 discharges as of 12/31/2007

• 118 Total (16 in Jan & Feb)

• Currently, 90 of the 180 total patients are involved in the CSP process

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Community CSP Initiative

Community CSP Initiative

– Proactive use of CSP process in community inpatient settings and extended acute care

– Currently being piloted at WPIC

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Overview of Tracking Process

What we do with the information– On going monitoring– Service development– Strengthen interventions– Quality Improvement and Outcomes Committee– University of Pittsburgh Evaluation of Closure

Allegheny

Beaver

Greene

Lawrence

Washington

250 Pieces of Information

For each person discharged

Every month

AHCI Secure Database OMHSAS

MRSAP Counties

MRSAP Steering Comm

Stakeholders

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Other Tracking

Early Warning Indicators

Incidents

Allegheny

Beaver

Greene

Lawrence

Washington

Investigation, Determination of Required Action

Implementation of

Recommendations

DPW

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Quality Assurance

The Failure Mode & Effects Analysis (FMEA) process proactively evaluates activities associated with the closure and works to develop contingencies to minimize risk to consumers, staff, and the community at large.

The Root Cause Analysis (RCA) process 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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State will provide services for 40 – 60 individuals in a variety of settings, including:

1. LTSR

2. 2 Small Residences of 3 – 4 beds

3. CTT

4. Mobile In-Home Crisis

5. Quality Management and Clinical Consultation

State Operated Services: What Is It?

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The State and Counties are working together to identify the target population

High intensity of services / supervision Individuals with significant criminal background High risk medical co-morbidity

State Operated Services: Who Is Eligible?

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LTSR site not determined at present Offices for Mobile Services will be in

Washington County Total staff of 92 for all areas combined Staff will be highly mobile and be available as

needed throughout the 5 County area

State Operated Services: Staffing Locations

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All services will be collaborative with the Counties and provider network

As consumers transition out of residential programs, the State anticipates admissions and discharges from all services

Services are intended initially to help transitions out of MSH, but will be available as needed to non-CSP consumers as well

State Operated Services: Integration of Services

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Developed and delivered by AMI, Inc. AMI, Inc. contracted with the Peer Support & Advocacy

Network (PSAN) Develop ongoing relationships with Peer Mentors This service offers numerous benefits:

– Comfort– Consistency – Stability

Video– Enhanced Personal Care Home– Clubhouse– Consumer Interviews

County Highlight: Washington County Peer Mentor Service

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Discussion