Kaiser Telecare Program for Intensive Community Support 12-Month Customer Report, January to December, 2005

Transcription

1 Kaiser Telecare Program for Intensive Community Support 12-Month Customer Report, January to December, 2005 Intensive Case Management Exclusively for Members within a Managed Care System

2 Kaiser Telecare Program for Intensive Community Support The Kaiser Telecare Program for Intensive Community Support (KPFICS) has been an integral part of Kaiser Permanente s behavioral health continuum of care since KPFICS is an intensive case management program specifically for Kaiser members, age 18 and over, in San Diego County, that are high-utilizers of acute inpatient services or are at risk for inpatient hospitalization. Many of these individuals are also dually diagnosed with co-occurring substance abuse disorders. The program is client-centered and client-driven. Clients set their own goals and determine what is important to them. Staff support the recovery process, assist clients to improve quality of life, and collaborate with Kaiser psychiatrists and clinical staff to ensure that clients are successfully engaged, making optimal use of available Kaiser services. KPFICS is unique among Kaiser s mental health programs in that services are provided in the community, at locations of the client s choice, resulting in strong partnerships and client/staff trust. Service Goals The program was established to support Kaiser in accomplishing the following: Reduce inpatient hospitalization Enhance access to community-based services Provide crisis intervention and support Increase client functioning Expand housing options Promote education and vocational goals Major Accomplishments In 2005, KPFICS successfully: Reduced inpatient hospitalizations (down 919 days) Reduced acute inpatient admissions (down 37% over the last two years) Increased client functioning and improved behavioral problems Achieved 68% staff productivity rate Moving Forward During this past year, the Kaiser PFICS enrollment has grown to an average census of 54, one less than the contract maximum of 55 enrolled members. At the time of this report, the program had a waiting list of four members. Telecare looks forward to working with Kaiser administration on setting enrollment priorities and the program s role in serving members who are admitted to Alpine Special Treatment Center. Acknowledgements Telecare would like to thank and acknowledge Dr. Dennis Cook, MD, Dr. Marcia Kagnoff, EdD, Werner Spitzfaden, LCSW, and all staff of the Kaiser Psychiatry and Addiction Medicine Department for their support, partnership and contributions to the program s success. We look forward to many more years of successful collaboration in the support of individuals in recovery. KPFICS Services Include: In 2005, the following services were provided by four full-time staff members including two mental health rehabilitation specialists, one RN and one clinical director. Assistance navigating Medical and psychiatric services provided by Kaiser physicians 24-hour crisis response from Telecare team staff via crisis phone line Case management and advocacy Transitional case management for Kaiser members who have lost their benefits Intervention to prevent and manage crises outside the hospital Substance abuse intervention and counseling Support/education of family and significant others Assistance in development of peer relationships Connection to self-help groups/community resources Assistance with entitlements Vocational services

3 Demographics Enrollments/Disenrollments Enrolled Disenrolled Total members on 12/ Maximum enrollment Average census Length of Stay (Current Members) Average length of stay Ethnicity Caucasian % African American % Latino/Hispanic % Asian % Pacific Islander % Client Satisfaction Age % % % % Over % Gender Male % Female % Primary Diagnosis Schizophrenia % Bipolar disorder % Depression % Other % 98%+ Liked the services they received and would still choose to receive services from KPFICS 90%+ Believed staff worked well with them, were involved, and believed in and aided them in their recovery 80%+ Believed they were better able to deal more effectively with daily problems and crises Member Comments When Asked What They Would Like to See Changed About KPFICS I love (my case worker), she is great. I look forward to seeing her every week and being able to discuss anything and everything with her. No changes! It s a wonderful program as it is. Lower case load. More resources. Expansion. services. Would like to see this program covered for me in the future. Small, self-help projects to work on to be determined by client and social worker. Something significant to take me out of myself and into helping others. Clinical Outcomes Reduced acute psychiatric hospitalization days by 1,119 days over baseline of 1,789 days Reduced acute psychiatric inpatient admissions over the last two years by 37% Reduced psychiatric hospital days by 51% (annualized using combined acute, Alpine, Crisis House and PHP days) % Improvement in Global Assessment of Function (GAF) scores over three administrations 10% Overall average improvement on the California Quality of Life, as reported by our members. Significant improvement in the areas of physical health, response to stress and anxiety, social acceptability, social effectiveness, and cooperation with treatment providers as measured by the Multnomah Community Ability Scale. After Hours Crisis Calls 292 Number of after hours crisis calls recorded by team Service Utilization KPFICS provided 4,743 hours of direct client services, which represents a 68% level of productivity

4 Real-Life Success Stories Jill s Story: Jill (fictitious name) has an Axis I diagnosis of schizoaffective and an Axis II diagnosis of borderline personality disorder. In September 2004, Jill re-entered the Telecare program for the third time. Early on, Jill was hospitalized multiple times. As an undergraduate university student, it was often the stress of midterms that would trigger her mental health issues and suicidality. More than once, she had to withdraw from the academic term as a result. On one occasion, Jill called the Kaiser/Telecare crisis line from the top of her school library stating that she was ready to jump, but was persuaded to not follow through. Jill was a frequent user of the crisis line; however, she was often very inappropriate with it, getting angry, yelling at the case manager and hanging up on him/her. Jill was also having severe relational problems. She was estranged from her family and had great difficulty getting along with her friends. Kaiser/Telecare staff stood by Jill during these times by listening to her and supporting her. At the same time Kaiser/Telecare staff would offer Jill suggestions and teach her techniques on how to manage her distressing feelings. Currently, Jill is doing extremely well and has not been hospitalized in over nine months. While she still frequently uses the crisis line, she is now much more appropriate with it. She has reestablished a very good relationship with her family and now enjoys their support. She has a very strong circle of friends. In the last academic term, Jill earned two As and a B. This current quarter will be Jill s last before graduating with a Bachelor s degree in mathematics; going forward, she plans to take a little time off and then enter a credentialing program. Over the last eighteen months, Jill has met consistently with Kaiser/Telecare case management staff and is always willing to attempt new interventions to aid in her recovery. It is her opinion that that the support of the Telecare staff and program has helped her to move forward in her life. Telecare got me through school. Jill

5 Patrick s Story: Patrick (fictitious name) is a 26-year old male with a psychiatric diagnosis of Bipolar I Disorder and Amphetamine-Induced Psychotic Disorder, with delusions. Patrick s primary problem was his substance abuse. Patrick s current case manager began working with Patrick s in October 2005, after his previous case manger relocated to another state. He was referred to the Kaiser/Telecare Program for support with his struggle to remain clean from drugs. It was also apparent that his family needed support in their struggle to help their son who was dually diagnosed. When his case manager began working with Patrick, he was using drugs regularly. His drug usage exacerbated his auditory hallucinations. He verbally responded to these hallucinations by yelling on the balcony of his parents condo. He also became aggressive and physically violent toward them. They repeatedly called police to have him removed from the home. This was the vicious cycle that Patrick and his parents continued to repeat. In an effort to better connect with Patrick, his case manager, began to focus on what was important to Patrick by looking at his future goals. He stated that he wanted to return to school to achieve a nursing degree. He and his case manager worked together to develop this goal. They attended appointments with his Job Vocational Rehabilitation Counselor. Additionally, they completed the process to get enrolled into Southwestern Community College and attended appointments with the Office of Disabled Students. While this was happening, Patrick repeatedly rebuffed any recommendation from his parents or case manager to enter a drug rehabilitation facility, stating that he wanted to work on remaining drug free independently. The situation escalated one weekend: Patrick was kicked out of his parents home, then decompensated and went on weekend drug binge. He returned to the home and became physically violent. His parents called Telecare s Crisis Line and requested assistance to get psychiatric hospitalization for Patrick, which Kaiser/Telecare staff helped them accomplish. When hospital staff were ready to discharge him back to the community, Kaiser/Telecare staff saw an opportunity. They intervened and advocated for his admission to a drug rehabilitation facility which he was able to enter last November. To date, Patrick has refrained from using drugs. He attends two NA meetings a day. He started classes at Southwestern College January Patrick reported that since he has been drug free, his auditory hallucinations are minimal and less intrusive. He is earning his family s trust and their strained relationship is healing. His family and case manager are assisting, encouraging, and supporting him through this period of his life. He and his case manager meet weekly to check on his progress, attend other necessary appointments, have family meetings and encourage him in his recovery. Telecare Corporation 1080 Marina Village Parkway, Suite 100 Alameda, CA (510) / (510) (fax) (800) Kaiser PFICS 3250 Wing Street, Building C. San Diego, CA (619) (619) (fax) Telecare s Mission: We exist to help people with serious mental impairments realize their full potential