East and West Valley Access Point & Transition Point. Facility-Based Alternatives

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1 East and West Valley Access Point & Transition Point Facility-Based Alternatives

2 Systemic Gap 1. The Access Point and Transition Point Facilities help bridge the facility gap 2. Crisis Transition Navigator program helps bridge the community gap

3 Access Point Outpatient & Intake Clinic (24/7) Front door to the behavioral health system assess for ongoing services, provide brief intervention, group and individual sessions, as needed Provide support and resources Coordinate ongoing care through contracted network providers

4 Brief Assessment (EMT/Nurse) Access Point Basic Flow Urgent Assess CCC/PSS Review Immediate Med Tx Wrap Support Coordination of Care Referral/Placement

5 ATC Triage RNs 24/7/365 review of Brief Assessments as well as coordination with Medical Team Facilitate medical staffings Phone and telemed support to all CBI sites and in field mobile teams. Triage patients from Hospital Emergency Rooms and Level I Sub-Acutes.

6 Integrated Medical Team Medical Practice consists of a mixture of Family Practice, Addiction Medicine, Psychiatrists, Psychiatric and Family Nurse Practitioners available in person and via telemedicine 24/7/365. Medical Care and PCP Coordination 76% present with a medical condition Blood Pressure Asthma/COPD Wound/Infection Care Diabetes Urgent Psychiatric Assessment and Medication Management Addiction Medicine Services

7 Community-Connection CASS Tribes Probation/ Parole DRC Community- Based Service Linkage Recovery Homes Faith- Based Healthcare for Homeless

8 Co-Located Supportive Housing

9 Transition Point Level III time-limited residential 16 beds 3-5 day length of stay for people who need targeted overnight support or transition planning back to the community. Applicable for individuals from the community who need more targeted support, but do not meet medical necessity for a costly inpatient stay or intensive crisis service. Can prevent many individuals from being discharged to the community while they are at a high risk of substance/psychiatric relapse. Anyone can access services (Titled and non-titled) as a drop-in, but individuals can also be referred there or be discharged to the facility from a hospital.

10 What these programs won t do: Replace medically necessary crisis stabilization, observation and inpatient care Serve DTS/DTO recipients with plans and means Serve involuntary recipients

11 Magellan Health Services of Arizona Crisis Facility Geographical Access Detox Center RRC Psych Urgent Care Crisis Inpatient UPC CCARC CRU CRU I&II EVARC 358 E. Javelina Ave. Mesa, AZ

12 Magellan Health Services of Arizona Crisis Facility Geographical Access Detox Center RRC Psych Urgent Care Crisis Inpatient Sweet Spot UPC CCARC CRU CRU I&II EVARC 358 E. Javelina Ave. Mesa, AZ

13 Magellan Health Services of Arizona Crisis Facility Geographical Access Detox Center RRC Psych Urgent Care Crisis Inpatient Access Point/ Transition Point AP/ TP 824 N 99 th Ave. Avondale, AZ UPC CRU CRU I&II CCARC EVARC 358 E. Javelina Ave. Mesa, AZ AP/ TP

14 West Valley Access Point & Transition Point Progress Report: Data through May 2012

15 Opened September 7, 2011

16 West Valley Campus Aerial View Transition Point Access Point Access Point Main entrance 99 th Ave. Transition Point Entrance Access Point Police & After-hour entrance

17 East Valley Access Point & Transition Point

18 East Valley Access Point & Transition Point Transition Point Entrance Access Point 1 st Responder/ after hours Entrance Access Point Main Entrance

19 Access Point and Transition Point Volume to Date Jul 2012 May 2013 Access Point: 14,762 admissions Average Length of Stay: 17 hours Level I Diversion 92% Transition Point: 4,052 admissions Average Length of Stay: 2.0 days Level I Diversion 95%

20 4500 Access Point Referrals by Source July June % % 95% stabilization rate <15% 30-day readmission rate % 16% 2, % 9% 500 3% 0 Walk In Crisis Provider Outpatient Provider Hospital & ED Police/1st Responder Level I Psych/Detox Shelter/Comm Living 0.7% Criminal Justice

21 Access Point & Transition Point Hospitals Referring to Access Point Facilities Arizona Regional Maryvale Hospital Arrowhead Hospital Mayo Clinic Banner Baywood Mercy Gilbert Banner Boswell Mountain Vista Banner Del Webb Paradise Valley Hospital Banner Desert* Phoenix Baptist Hospital* Banner Estrella Phoenix Indian Medical Center Banner Gateway Phoenix St. Luke s* Banner Good Samaritan Scottsdale Osborn Banner Ironwood Scottsdale Shea Banner Thunderbird* Scottsdale Thompson Peak Chandler Regional St. Joseph's* Florence Hospital Tempe St. Luke s Gilbert Hospital VA Hospital John C. Lincoln Deer Valley West Valley Hospital John C. Lincoln N. Mountain Wickenburg Comm. Hospital Maricopa Medical Center* *Hospital with more than 100 transfers since June 2012

22 70% Access Point Utilization by Population Type (July 2012 to June 2013) 63% 60% 50% 40% 30% 20% 18% 10% 11% 8% 0% Non-SMI T19 Non-SMI NT19 SMI T19 SMI NT19

23 Benefits to Regional Stakeholders First responders encountering an individual in need of behavioral health assistance in the community can immediately transport the individual to this facility for assessment, treatment and/or transition to the appropriate level of care and not tie up expensive police/fire/rescue assets. These facilities will help to decrease emergency room operating costs by decreasing the numbers of people waiting for behavioral health services, reducing the wait time, and increasing ER availability to address true emergencies.

24 Transportation Services To assist the community, transportation services are available to move individuals from their current location to one of the Access Point facilities

25 What these programs will do: These facilities will fill the gap between inpatient and crisis services on one hand and routine behavioral health care on the other These facilities will provide early intervention, support services and assessment services to ensure people have the appropriate level of treatment yet avoid higher, more costly and restrictive levels of care when they are not necessary. Each of the two 24/7 facilities will have an intake and assessment component known as Access Point and a time-limited residential component (Level III) known as Transition Point.

26 What these programs will do, cont.: Provide an alternative for first responders (Police and Firefighters), from transporting lower acuity individuals directly to the Level I Sub-Acute facilities and emergency departments for psychiatric and detoxification related crisis services. Provide a direct discharge point for hospital emergency rooms thereby decreasing their emergency room wait times. Serve as an entry point for transfers and drop-offs (24-hour triage, assessment, treatment, and transition) Provide transitional care for individuals who have been stabilized and yet need continued detoxification, psychiatric medication, and counseling for 3 to 5 days beyond the initial stabilization period. The Transition Point facility will prevent many individuals from being discharged to the community while they are at a high risk of substance/psychiatric relapse.

27 Justification Summary Low development and operating costs High use of peers as the primary therapeutic provider Supports recovery model approach to treatment Fills systemic gap in service availability Similar model has been extremely effective in other parts of Arizona (A6) Most states offer a similar program to fill the systemic gap There are no requirements to change OBHL Rules or obtain special AHCCCS or CMS permission

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