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Transcript of Unity Center for Behavioral Health Christiane Farentinos ... · PDF fileUnity Center for...
Unity Center for Behavioral HealthChristiane Farentinos, VP Unity
Unity Center for Behavioral Health
• Unique collaboration between Legacy, OHSU, Adventist Healthand Kaiser to provide services to the region
• Community-wide effort (city, counties, state, payers, EMS,police, mental health and addictions providers- more than 30participating agencies)
• Facility licensed under Legacy Emanuel Medical Center• 102 inpatient beds (80 adult beds, 22 adolescent beds)• Adult Psychiatric Emergency Service (45-50 pts/day)• Strong Peer support built into structure of Unity• Built-in space for Community Providers to help navigate
handoffs from Unity to community treatment and resources
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Our MissionWe deliver excellence inpatient care, teaching anddiscovery, creating a pathwayto hope, community andrecovery.
The right care at the right time.
Our Values• Patient and family centered• Safety for all • Trauma informed • Collaboration • Shared responsibility• Compassion• Education and innovation
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Our Leaders
• Lori Morgan, MD, MBA, President EMC• Linda Jones, Chief Nurse EMC• Chris Farentinos, MPH, CADC II, VP Unity• Greg Miller, MD, MBA, Chief Medical Officer• Kari Howard, Director Patient Care• Juliana Wallace, LCSW, CADC III, Director Unity Services
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What is different about our model?
• Model of hospitality, hope and recovery
• Trauma informed care/ recovery centered
• De-criminalization of mental illness
• Remove police from transporting
behavioral health patients
• 24/7 access to psychiatric care
• Intentional design for transitions of care
• Peer support specialists part of the skill mix
• Culturally competent care
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UnityCrisis
evaluation,stabilization,short-term
inpatient care
Selfcheck-in
Ambulancetransport
Family orfriends bring in
Securityofficials refer
Community PartnersCascadia Behavioral Health,
Central City Concern, LifeWorksNorthwest, NAMI Oregon,
Folktime, Mental Health Assoc ofOR, DePaul Treatment Centers,Alliance for Culturally Specific
Programs, Albertina KerrCenters, ColumbiaCare,
FamilyCare, TeleCare Corp.,Western Psych, Health Share,
and others
PeersupportLegal
help
Addictiontreatment
Jobassistance
Inpatienttreatment
Treatmentplan &
follow up
Counseling &therapy
Medicalcare
Housing
Familycounseling
Transitions of Care
Transitions of Care
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UnityCulture
Trauma Informed Care
The umbrella over Unity’sCulture
What is Trauma Informed Care?
• Trauma Informed Care recognizes that traumaticexperiences can:
• terrify,
• overwhelm,
• and violate an individual
• Trauma Informed Care is a commitment not to repeat theseexperiences and in any way possible restore a sense of:
• safety
• power
• self worth 13
Abuse:• Emotional 10%• Physical 26%• Sexual 21%
Neglect:• Emotional 15%• Physical 10%
• Two-thirds had at least one ACE• ACEs tend to occur in clumps
HouseholdDysfunction• Mother treated
violently 13%• Mental illness 20%• Substance abuse
28%• Parental separation
or• divorce 24%• Household member• imprisoned 6%
Adverse Childhood Events Studyhttps://www.cdc.gov/violenceprevention/acestudy/index.html
Change the questionfrom…
Trauma Informed Policies & Practicesat Unity• Use of cell phones and personal devices in adult units to give
more control• Visiting Hours are 9 am to 9 pm • Option to keep personal clothes in the PES and units• Open Nursing Stations• Peer support• Harm Reduction Specialists• Quality Committee working on culture development and
seclusions and restraints reduction
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INTEGRATION OF
PEER SUPPORT AT THE UNITY CENTER
Peer Support Programs at Unity
• What Programs are available?• Peers in the PES
• Peer Bridgers
• NAMI
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Folktime First Quarter 2017 Data – Peers in thePES• Total number of Individuals supported in PES Program: 271• Total number of individual interactions in the PES program: 566• Average Number of Hours of Peer Support provided per individual
served in PES: 1.82 Hours• Average Number of Encounters provided per individual served in
PES: 2.09 encounters• Average Length of Stay for Individuals who interacted with a Peer
Support in the PES: 26.12 Hours• Number of Groups Held: 22 (Yoga, Games, Drawing, and
conversation groups occurred ad hoc as dictated by needs andinterests of the milieu)
• Number of individuals referred to another peer support program: 11319
Folktime First Quarter 2017 Data: Peer Bridgers
• Total number of individuals supported inBridger Program: 19
• Number referred by PES: 4• Number referred by Inpatient: 3• Number self-referred: 12• Number of individuals whose services
concluded: 9• Number of individuals referred to another
peer support program: 7• Location of Services: • Inpatient Unit: 36• PES: 11• Community: 7• Phone: 3• Number of Hours worked by Peer
Bridgers: 159• Hours worked at Unity: 141• Hours worked in Community: 18• Average Number of Hours of Peer
Support provided per individual in Bridger:2.13
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Folktime First Quarter 2017 Data
• Cross-program statistics:• Percent of individuals who interacted with a peer that did not
return to Unity in the 60 days following their most recentdischarge within the quarter: 70.90%
• Number of Folktime Resource Groups held: 9
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Unity and ourCommunity
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Unity Transportation Workgroup• Meeting since spring 2015• Members – AMR, Metro West, PPB, Project Respond, ED
medical directors including Providence, Centerstone, EMSMedical Directors (plus Fire Department, Clackamas EMS andLaw Enforcement, Gresham Police)
• Goals • To engage PPD and other districts in changing their work flow to
transport individuals in a MH crisis (voluntary and involuntary) byambulance
• To develop ambulance dispersal plan post Unity opening
• To inform OAR rule change to allow ambulances to function as securetransport
• To identify payment methodology for new work flows
• To create and implement a field medical triage instrument to guidetransport of individuals to Unity Center or Medical EDs
• To foster collaboration and cross training insofar dealing with individualsin a BH crisis
• Accomplishments
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Law Enforcement and Unity
• Partnerships with North Precinct (Commander King, andSargent Phillip Blanchard) and with BH Unit (Lieutenant TashiaHagar)
• Early experience• Lessons learned• Stories • Next steps
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Unity Behavioral Health ForensicsWorkgroup
• Started in the summer of 2016
• Members: Jean Dentinger (Multco Pre-commitment manager and ForensicsDiversion), John McVay (Multco Parole and Probation), Glen Rairden (Lead SecurityOfficer Unity), Sarah Radcliffe (DRO), Barb Snow (Project Respond), Tashia Hager(BH Unit PPB), Greg Miller (CMO Unity), Anne Gross (PES medical director), JulianaWallace (Director Unity Services), Judge Cheryl Albrecht (Mental Health Court).
• Goals
• Understand interface between BH and Forensics system
• Recognize the best “intercept” points in the forensics system
• Test work flows for jail diversion of individuals with BH needs
• Accomplishments
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Unity Transitions of Care Workgroup• Members • Goals
• To create an intentional design for transitions of care through threemodels
• Co-location
• In reach
• Coordinated referrals
• Accomplishments • Co-located with CareOregon, Western Psychological, NAMI, Mutco
Intensive Transition Team and ABC team, FamilyCare, Kaiser,Columbia Care, Lifeworks NW, Cascadia ED divert team, ICP teams
• In reach – De Paul, NARA, All ACT teams, CCC, Outside In
• Soon to start a “Patients with multiple visits task force”
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Transitions of Care Workgroup
Chris Farentinos Legacy VP, Unity
Becky Wilkinson Legacy Outreach Worker
Nancy Benner Adventist Social Work Lead
Naiyana Cruz Adventist, Clinic Administrator, OP Beh Health
Jennee Edwards Adventist
Sara Hatch Albertina Kerr
Holden Leong Asian Health and Service Center, Executive Director
Diane Bocking-Byrd CareOregon
Barb Snow Cascadia, Manager, Project Respond
Rhonda White, QMHP Cascadia, Manager, Urgent Walk-in Clinic
Dave Kohler Cascadia, Senior Director, Outpatient Services
Alexandra Leichter Cascadia, ITT Program Sup
Jennifer Wilcox Cascadia, Manager, Intake Access
Alex Drilling Cedar Hills, Interim Director of OP Services
Kathleen Roy Central City Concern
Alison Noice CODA
Ben Solheim Columbia Care, ICM
Lindsey Maclean De Paul
Erica Edwards De Paul, ED Outreach Worker
Sarah Radcliffe Disability Rights of Oregon, Staff Attorney
Bennett Garner, MD Family Care, Medical Director
Karissa Smith, LPC, CADC I Family Care, Adult BH Lead
Rochelle Pegel Health Share OR, UR Coordinator for Mult County
Mark Lewinsohn Lifeworks NW, VP Clinical Services
Holly Friesz LifeWorks NW, Rapid Respnse Team clinician
Emily Parkwell LukeDorf
Andrea Quicksall Mult Co, Adult Care Coord Program Sup
Nancy Griffith Mult County, Corrections Health Division Director
Abbey StampMult County, Exec Director, Local Public SafetyCoordinating Council
Charmaine Kinney Mult County Leticia Sainz Mult Co, Crisis Services Manager
Patricia TenEyck NAMI Mult Co Executive Director
Jackie Mercer NARA, Executive Director
Shannon Farr Peer, Folktime
Lakeesha Dumas Peer, African American Health Coalition
Kristen Downey Providence, (Robin's designee)
Larry Betcher Providence
Brian Thompson, LCSW Providence, UR in IP Psych unit (Emily York's husband)
Nirmala Dhar State of Oregon, Older Adult Beh Health Coordinator
Melinda Howard Telecare, Administrator, CATC & Community Triage
Kathleen Trebb VOA, Division Director
Jeff Olsgaard Western Psych
Tia Barnes Youth Move Oregon
Lauren Conn Youth Move Oregon
Unity by theNumbers
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PES LOS May 2017
PES - 5/1 - 5/31 AVG LOS Median LOS GeoMean LOS
All PES Patients 24hr 34min 20hr 24min 12hr 17min
Admitted PES Patients 38hr 30min 31hr 53min 31hr 51min
Discharged PES Patients 21hr 42min 17hr 27min 10hr 50min
Data extracted 6/7/2017 LEGACY HEALTH 30
PES arrivals May 2017Day ED Arrivals
1-May 232-May 283-May 274-May 245-May 286-May 277-May 228-May 229-May 2910-May 2411-May 2712-May 2513-May 2214-May 2215-May 2816-May 2217-May 3218-May 3119-May 2020-May 2421-May 2122-May 2523-May 3024-May 3025-May 3726-May 2627-May 2628-May 1029-May 3030-May 1731-May 25
Grand Total 784Average 25LEGACY HEALTH 31
PES May 2017 Dispo and Arrival Method
Arrival MethodArrival
s%
Car 269 34.31%SecureTransport
158 20.15%
Ambulance 112 14.29%Walk 71 9.06%Taxi 70 8.93%Police 35 4.46%PublicTransportation
34 4.34%
Other 31 3.95%HospitalTransport
4 0.51%
Total 784
Data extracted 6/7/2017 LEGACY HEALTH 32
PES DispoPatient
sDischarge 546
Admit 181LWBS before Triage 26
Transfered to Another Facility 18LWBS after Triage 8
AMA 3Registration Error 2
Total 784Percent Admitted 23%
Average daily visits = 25Discharge from triage =103 (13%) ALOS 2 hoursApril average = 21
PES May 2017 time of arrival Hour Arrivals %
00:00 19 2.42%
01:00 15 1.91%
02:00 10 1.28%
03:00 16 2.04%
04:00 9 1.15%
05:00 15 1.91%
06:00 8 1.02%
07:00 12 1.53%
08:00 15 1.91%
09:00 22 2.81%
10:00 41 5.23%
11:00 33 4.21%
12:00 35 4.46%
13:00 50 6.38%
14:00 67 8.55%
15:00 48 6.12%
16:00 59 7.53%
17:00 60 7.65%
18:00 54 6.89%
19:00 59 7.53%
20:00 46 5.87%
21:00 36 4.59%
22:00 22 2.81%
23:00 33 4.21%
Grand Total 784
Data extracted 6/7/2017 LEGACY HEALTH 33
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Trending PES daily visits
PES May 2017 Point of origin
Transfer Type EDVisits
Origin Location ED Visits
Non-Transfer 612 Walk-In/Other 614
Medical ED 154 Legacy Emanuel Medical Center 64
Hospital medicalunit
18Legacy Good Samaritan Hospital
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Grand Total 784 Legacy Mount Hood Medical Center 18
OHSU Hospitals & Clinics 17
Adventist Medical Center 12
Legacy Meridian Park Hospital 9
Kaiser Sunnyside Medical Center 8
Kaiser Westside Medical Center 6
Tillamook Regional Medical Center 4
Legacy Salmon Creek Hospital 2
Tuality Community Hospital 2
Columbia Memorial Hospital 1
Providence Milwaukie Hospital 1
Grand Total 784
Data extracted 6/7/2017 LEGACY HEALTH 35
PES Percent admitted for each point oforigin
Origin Location Admit Discharge
XFER
Total %
Legacy Emanuel Medical Center 29 33 1 64 45%Legacy Good Samaritan Hospital 10 15 1 26 38%OHSU Hospitals & Clinics 10 7 0 17 59%Adventist Medical Center 9 3 0 12 75%Legacy Meridian Park Hospital 6 3 0 9 67%Legacy Mount Hood Medical Center 6 11 1 18 33%Kaiser Sunnyside Medical Center 2 6 0 8 25%Kaiser Westside Medical Center 2 4 0 6 33%
Columbia Memorial Hospital1 0 0 1
100%
Providence Milwaukie Hospital1 0 0 1
100%
Tillamook Regional Medical Center 1 3 0 4 25%Legacy Salmon Creek Hospital 0 1 1 2 0%Tuality Community Hospital 0 2 0 2 0%Grand Total 181 546 18 784 23%
Data extracted 6/7/2017 LEGACY HEALTH 36
Inpatient LOS and ADC May 2017
Data extracted 6/7/2017 LEGACY HEALTH 37
Inpatient DataMay Discharges AVG LOS
MedianLOS
GeoMeanLOS
ALLIP
MayADC
91.1 All IP Admissions 14d 3hrs 8d 8d 16hrs
Median 91 Unit 6 Admissions 14d 18hrs 11d 11d 15hrs
Maximum 96 PES - 5/1 - 5/31 AVG LOS
MedianLOS
GeoMeanLOS
Unity Year-to-Date (April 1, 2017 through June 11, 2017)
Inpatient Discharges Average Length of Stay* Average Daily Census
Actual Budget % Actual Budget % Actual Budget %
476 839 56.7% 14.65 7.89 185.6% 93 94 98.9%
Adolescent ProgramUnit 6
6/20/17 LEGACY HEALTH 38
Unt 6 – Dispo, ADC and average LOS
Adolescent Program DC DispoUBH
UNIT 6Disch to Home or Self Care 34Other Facility (Step Down, Transitional Housing,Hooper House)
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Hospital-Acute Care (OHSU, Other LegacyFacility)
2
Grand Total 41
Data extracted 6/7/2017 LEGACY HEALTH 39
6Only
May ADC 18.4Median 19
Maximum 20
May Discharges AVGLOS
MedianLOS
GeoMeanLOS
All IP Admissions 14d 3hrs 8d 8d 16hrs
Unit 6 Admissions 14d18hrs
11d 11d 15hrs
Homelessness andUnity
6/20/17 LEGACY HEALTH 40
Data extracted 6/9/2017
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Seven Day Follow-Up3/6/2017 – 6/11/2017
HTPP BH 7-Day Follow-Up Per Unit By Week3/6/2017 – 6/4/2017
PE
RC
EN
T
Thankyou!
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