Steven J. Forrester, M.S. Ed. Director of Service Coordination

UPMC Western Psychiatric Hospital Pittsburgh, PA

Steve Forrester received his bachelor’s degree in Psychology from the University of Pittsburgh. He went on to get his master’s degree from Duquesne University. Steve Began his career at UPMC Western Psychiatric Hospital as a nursing assistant while attending the University of Pittsburgh. Steve has remained at WPIC since then and has worked in both inpatient and outpatient settings. Steve has presented at the National Case Management Conference, the Pennsylvania Case Management Conference, has been awarded the WPIC ACES award and the Hospital & Health System Association of Pennsylvania (HAP) award for implementation of the Housing First Model with the homeless and mentally ill population. Steve had the opportunity to create an entirely new team of Blended Service Coordinators dedicated to exclusively supporting homeless individuals with a mental illness using the Housing First model. Steve became the Program Coordinator of the Neighborhood Living Programs at WPIC and was responsible for the day to day operations of the program and the coordination of the grants managed by the program that served the homeless and mentally ill population in Allegheny County. Steve became the Director of the Blended Service Coordination Program and is responsible for the daily operations of eight teams of Blended Service Coordinators. Steve is also the Director of the Service Coordination Unit and the Administrative Service Coordination Program. Steve also works as a part time college instructor teaching General Psychology, Human Growth and Development and Abnormal Psychology. As a Psychology instructor he works to further educate students about the challenges facing those with intellectual and mental health disabilities and the opportunities to find careers supporting these individuals. Abstract: The Impact of Blended Service Coordination on Clinical Outcomes Achieved by Persons with a Mental Illness: It’s All About the Relationship (Introductory) Blended Service Coordinators use the widely accepted Recovery Principles of to guide their interventions with the persons they serve that have a diagnosed mental illness and struggle with accomplishing their goals in the community. The Blended Service Coordinator is a partner with the person served on their recovery journey. Wherever that journey takes them the Blended Service Coordinator will be there to support them on the journey through the good and the bad. The Blended Service Coordinator uses motivational interviewing and follows the principles required to develop a therapeutic relationship to assist the person served in assessing their current situation, reviewing their needs and their strengths, as well as using their strengths to identify goals that are important to them.

The Blended Service Coordinator develops a therapeutic relationship with the person served. It is this relationship that helps the person to achieve their goals and assists them with clinical outcome achievements such as (1) decreasing the frequency of inpatient psychiatric hospitalizations, (2) decreasing the length of stay in an inpatient psychiatric hospitalization, and (3) decreasing the frequency of psychiatric Emergency Department visits. Learning Objectives By the completion of this session, participants should be able to:

1. Identify the recovery principles 2. Identify the elements of a therapeutic relationship 3. Identify the impact that Blended Service Coordination has on clinical outcomes

References 1. Cochrane Database Syst Rev. 2017 Jan 6;1:CD007906. doi:10.1002/14651858.CD007906.pub3. 2. Intensive case management for severe mental illness. Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. 3. Psychiatr Q. 2013 Mar;84(1):103-14. doi: 10.1007/s11126-012-9231-5. Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration. Mohamed S1.

71

The Impact of Blended Service Coordination on Clinical Outcomes Achieved by Persons

with a Mental Illness

It’s all about the relationship

• Presented by Steve Forrester M.S. Ed.• Director of WPIC Service Coordination Unit• Director of WPIC Service Coordination

Program

2

3

Eligibility for Blended Service Coordination

• A behavioral health disability diagnosed by adoctor. The document that verifies this mustbe signed by the doctor and dated less than12 months ago.

3

72

4

• In addition to the behavioral health diagnosisthe person also needs to have identified areasof need in the community that they need helpconnecting to or achieving.

4

5

UPMC Western Psychiatric Hospital Blended Service Coordination

• 8 BSC Teams• 1 Specialized Child team.• 2 Specialized teams that serve the homeless

population• 5 Adult teams• 3 of the adult teams participate in the Behavioral

Health Home program5

6

Behavioral Health Home

• Joint program with CCBHO• Focuses on providing services to Individuals with

both a behavioral health diagnosis and a seriouscomorbid physical health issue.

• Focus is on education, goal planning andexecution of goals and coordination of servicesbetween pcp and behavioral health team

6

73

7

Vulnerable Populations

• We serve a vulnerable population.• Priority is given to those that have multiple

system involvement; behavioral health,homeless, forensic, medical, D&A, etc.

• Priority is also given to discharges from aninpatient level of care.

7

8

Assessment

• We begin with an assessment using the CANSor ANSA assessment tool.

• If the person served does not want to work onthe needs identified in the assessment they donot have to do so.

8

9

Service Plan

• We work with the person served to create aservice plan that is made up of measurablegoals that the person served identified.

• The goals are to be written in the “Voice” ofthe person served. However, by ourregulations they are required to bemeasurable

9

74

10

WPIC BSC PROGRAM USES PERSON CENTERED SERVICES TO FRAME ALL OF OUR SERVICES

• Person Centered Service places the person servedand their needs at the center of the servicesprovided.

• Person Centered Services focuses on the goalsidentified by the person served.

• Assessment tools may identify many needs butthe only goals developed are the ones identifiedby the person served

10

11

• The person served needs your help. Theseneeds are clearly documented in the BSCreferral and our assessment.

• Regardless of the needs identified in thereferral or the assessment; only the goalsdeveloped by the person served are workedon in the BSC program.

11

12

Person Centered Services is all about the relationship

• The development of a good therapeuticrelationship is the key to success in BSC and isthe cornerstone of Person Centered Services.

• We are a part of each participants recoveryjourney.

• Recovery is not a linear path from a startingpoint to an end point.

12

75

13

Recovery is different for each individual served

• BSC will use their motivational interviewingskills and the therapeutic relationship theyhave developed with the person served toencourage participation in outpatientbehavioral health services.

13

14

Ongoing Assessment

• An Assessment and Service Plan are created inthe first 30 days of services. Both of thesemust be updated every 6 months.

• Each time these are updated the goals can becontinued or changed to reflect where theperson is at on their recovery journey.

14

15

PCS Relationship Building

• A BSC must be adept in a few core concepts inorder to establish a therapeutic relationship:

1. Trust: Do what you said, when you said youwould; all of the time.

2. Genuine Interest: Show the person served youhave an interest in what is important to them.

15

76

16

3. Empathy: Acknowledge the feelingsexpressed by the person served.4. Good Communication: Seek first tounderstand then to be understood.5. Accessibility: Return calls quickly andreschedule as soon as possible.

16

17

6. Confidentiality: Show through actions thatthis is sacred.7. Non Judgmental Attitude: It must be obviousto the person served that you accept them asthey are in the current stage of their recoveryjourney.

17

18

Recovery is Possible & a BSC can assist in your recovery Journey

• BSC program staff interventions follow the 10principle of recovery. These principles wereincorporated by SAMHSA in 2010.

• SAMHSA is Substance Abuse and MentalHealth Administration www.SAMHSA.gov

18

77

19

10 GUIDING PRINCIPLES of RECOVERY

1. Hope2. Person Centered3. Many Pathways To Recovery4. Holistic5. Peer Support

19

20

6. Relational7. Culture8. Address Trauma9. Strengths & Responsibilities10. Respect

20

21

UPMC Western Psychiatric HospitalBSC CONSUMER ADVISORY BOARD

• PEER-WAY • WE ARE YOU • PEER • EDUCATION • EMPOWERMENT • REPRESENTATION • We Are You • We are the Consumer Advisory Board for the Blended Service Coordination

program of UPMC Western Psychiatric Hospital. The focus of our board is asfollows:

• PEER, EDUCATION, EMPOWERMENT & REPRESENTATION.

21

78

22

PEERWAY LOGO

22

23

DOES BSC HAVE AN IMPACT ON INPATIENT STAYS?

• BSC’s are very involved when a person servedhas an exacerbation of their symptoms thatmay lead to an inpatient hospitalization.

• Review of data to show the impact of BSC onInpatient hospitalizations.

23

24

• Allegheny HealthChoices, Inc. assisted withresearch design

• ACHI used deidentified claims data to analyzeBSC participant hospitalizations.

• WPIC Quality Dept used data from ElectronicMedical Records to do the same thing.

24

79

25

Methodology (AHCI)

• 2,539 patients had 1 or more BSC service during the Analysis Period.

1/1/2013 Analysis Period 12/31/2014

Step 1: Identify BSC patients in the 2 year Analysis Period.

Step 2: Determine Index Dates during the Analysis Period.• A patient’s first BSC service date is the Index Date for that patient.

1/15/2013

10/22/2014

One Index Date per Patient

Note: Applied AHCI methodology to the data.

Index Dates are unique for each patient.

25

26

Methodology (AHCI) ContinuedStep 3: Keep “new patients” to the BSC Program.

• Exclude patients with a BSC service date within 2 years of their Index Date.

• 1,129 patients were retained.

1/15/20132 Years

Keep patient; no BSC services in 2 year period

1/15/2011

Index Date

10/22/20142 Years

Exclude patient; BSC services in 2 year period

10/22/2012

Index Date

Index Dates are unique for each patient.26

27

Methodology (AHCI) ContinuedStep 4: Identify actively engaged patients for the analysis.

• 301 patients in the Continuous Segment; 2 or more years of services with 90 days or less between appointments. Less than 2 years were not included.

1/15/20131/15/2015 or

More

90 Days or Less

90 Days or Less

90 Days or Less

90 Days or Less

90 Days or Less

90 Days or Less

90 Days or Less

Index Date

Step 5: Compare utilization between Before and After periods.

1/15/2013Index Date

Before Period (2 years) After Period (2 years)

Inpatient Hospitalizations

ED Visits without Admission

Inpatient Hospitalizations

ED Visits without Admission

27

80

28

Key Summary Points – UPMC Data• Inpatient hospitalizations.– Number of patients with a discharge; – ↓ 65.1% (1-2 discharges)– ↓ 54.5% (3 or more discharges).– Average discharges; ↓ 44.1% (1-2 discharges) ↓ 72.8% (3 or more discharges).– ALOS; ↑ *6.9% with outlier and ↓ 12.2% without outlier (1-2 discharges) ↓ 20.5%

(3 or more discharges).

• ED visits without an admission.– Number of patients with an ED visit; ↓ 72.3% (1-2 ED Visits) ↓ 47.1% (3 or more ED visits).– Average ED visits; ↓ 61.3% (1-2 ED Visits) ↓ 73.0% (3 or more ED Visits).

* Increase due to an outlier. Without outlier, ALOS ↓ from 26.2 to 23.0.28

29

Thank You

Questions?

29

81

“My Mask” PF

You will not

Recognize me.

This time, I put back

My pieces back differently.

Malia Makana

82