Health Home. Criminal Justice Tiger Team CJ Acuity Score Sub-Committee

Transcription

1 Health Hme Criminal Justice Tiger Team CJ Acuity Scre Sub-Cmmittee

2 CJ Acuity Tiger Team Charges PURPOSE: T assess and determine acuity scres fr individuals being released frm jail and r prisn, and t assess and determine acuity scres fr the CJ ppulatin residing in the cmmunity wh have been recently released in rder t minimize recidivism RESPONSIBILITIES: 1. Develp referral criteria fr determining health hme service eligibility which includes assessing ptential members 2. Create a standardized set f Risk Categries t be utilized fr assessment f the apprpriateness f the referrals 3. Utilize acuity created fr bttm up/ cmmunity referral prcess as the pssible baseline fr determining acuity fr this ppulatin 4. Determining a base line acuity scre 5. Integrate this infrmatin with the Cnslidated wrkgrup and criminal Justice Wrkgrup

3 CJ Acuity Tiger Team Members C-Chairs: Rsemary Cabrera (Cmmunity Healthcare Netwrk) Rbert Lebman (Huther Dyle Memrial Institute, HHUNY) Cmmittee Members Dn Kamin Karen Nelsn Shari Suchff Virgilina Gnzalez Michelle Cln Ellen Breslin

4 CJ HEALTH HOME REFERRALS STEP 1- ASSESS ELIGIBLITY: Must meet eligibility fr Health Hme Services as described in the New Yrk State Health Hme State Plan Amendment (claims data shuld be used whenever available t verify medical and psychiatric diagnses) Tw chrnic cnditins (e.g., mental health cnditin, substance use disrder, asthma, diabetes, heart disease, BMI ver 25, r ther chrnic cnditins, OR One qualifying chrnic cnditin (HIV/AIDS) and the risk f develping anther, OR One serius mental illness STEP 2-ASSESS APPROPRIATENESS FOR HEALTH HOME AND CATEGORIZE RISK/ACUITY. i.e high risk individuals with significant behaviral, medical r scial risk factrs which can be mdified thrugh care management services 4

5 IDENTIFIED CATEGORY RISKS There are tw categry risks under the Criminal Justice ppulatin CATEGORY Risk # 1: HEALTH HOME CATEGORY FOR INDIVIDUALS IN THE CRIMINAL JUSTICE SYSTEM RESIDING IN JAIL/PRISON CATEGORY Risk # 2: HEALTH HOME CATEGORY FOR INDIVIDUALS IN THE CRIMINAL JUSTICE SYSTEM RESIDING IN THE COMMUNITY

6 HEALTH HOME CATEGORY FOR INDIVIDUALS IN THE CRIMINAL JUSTICE SYSTEM RESIDING IN JAIL/PRISON CATEGORY # 1: Identified Risks: Members at Risk are identified as being part f the higher risk bucket where as they are likely t use mre inpatient services N Prvider Cnnectivity ut side f the CJ system i.e PCP, Specialty Prviders, MH prviders, etc Hmelessness r n scial/family supprt Nn-adherence t treatments r medicatin(s) Repeated ffenders Cgnitive deficits r deficits in activities f daily living such as dressing, eating, etc 6

7 HEALTH HOME CATEGORY FOR INDIVIDUALS IN THE CRIMINAL JUSTICE SYSTEM RESIDING IN THE COMMUNITY CATEGORY Risk # 2: Identified Risks: Members at Risk are identified as being part f the higher risk bucket where as they are likely t use mre inpatient services N Prvider r inadequate Prvider Cnnectivity i.e PCP, Specialty Prviders, MH prviders, etc Nn-adherence t treatments r medicatin(s) r difficulty managing medical appintments Inapprpriate ED use OR Repeated recent hspitalizatin fr preventable cnditins either medical r psychiatric High Risk individuals that meet the HH Criteria under The Department f Crrectin s Cmmunity Supervisin Unit Hmelessness Repeated Offenders 7

8 Definitins f the categries and Risks At Risk: Members at Risk are identified as being part f the higher risk bucket where as they are likely t use mre inpatient services. Fr the CJ ppulatin the term At Risk is used t Statistically validated factrs that predict the prbability f an ffender cmmitting assaultive and prperty crimes while n parle N Prvider r inadequate Cnnectivity.: Members withut a prvider are thse members that have n PCP r specialist linkage. Members with inadequate prvider cnnectivity culd be classified as thse individuals that might have an identified PCP r specialist prvider but because f a ptential barrier, members lse cnnectivity i.e language barriers, lcatin, pr care being received as perceived by the member Nn-adherence t treatments r medicatin(s)r difficulty managing medical appintments : The mst cmmn definitin f nn-adherence refers t chrnic under-use, i.e. patients use less medicatin than prescribed, r prematurely stp the therapy when the persn have difficulties managing sppintments culd be a secndary result f any f the ther risks factrs listed here Inapprpriate ED use OR Repeated recent hspitalizatin fr preventable cnditins either medical r psychiatric. Unnecessary repeated use f the ER r hspitalizatin leading t higher MA cst Repeated ffenders: A repeat ffender is a persn wh has already been cnvicted fr a crime, and wh has been caught again fr cmmitting the crime and breaking the law fr which he had been prsecuted earlier. The definitin f the term and requirements related t a repeat ffender vary depending upn the crime that is cmmitted Cgnitive deficits: is an inclusive term t describe any characteristic that acts as a barrier t the cgnitin prcess [1] The term may describe deficits in glbal intellectual perfrmance, such as mental retardatin, it may describe specific deficits in cgnitive abilities (learning disrders, dyslexia) deficits in activities f daily living such as dressing, eating: Everyday rutines generally invlving functinal mbility and persnal care, such as bathing, dressing, tileting, and meal preparatin. An inability t perfrm these renders ne dependent n thers, resulting in a self-care deficit High Risk individuals that meet the HH Criteria under The Department f Crrectin s Cmmunity Supervisin Unit Hmelessness r n scial/family supprt: A hmeless individual is defined in sectin 330(h)(4)(A) as an individual wh lacks husing (withut regard t whether the individual is a member f a family), including an individual whse primary residence during the night is a supervised public r private facility (e.g., shelters) that prvides temprary living accmmdatins, and an individual wh is a resident in transitinal husing. A hmeless persn is an individual withut permanent husing wh may live n the streets; stay in a shelter, missin, single rm ccupancy facilities, abandned building r vehicle; r in any ther unstable r nn-permanent situatin

9 CJ Ppulatin Baseline Acuity Scre Acuity shuld be assigned based n the eligibility criteria and the additinal risk factrs. Baseline acuity fr bth categries f the Criminal Justice Ppulatin is 9 pints, each additinal risk factr equates t ne r mre pints f additinal acuity (specified n the next slides), additively.

10 HEALTH HOME ACUITY SCORES FOR INDIVIDUALS IN THE CRIMINAL JUSTICE SYSTEM RESIDING IN JAIL/PRISON CATEGORY Risk # 1: Identified Risks and Assigned Acuity Scres: N Prvider Cnnectivity ut side f the CJ system= 1 additinal pint f acuity Hmelessness r n scial/family supprt=2 additinal pints f acuity Nn-adherence t treatments r medicatin(s) 2 additinal pints f acuity Repeated ffenders= 2 additinal pints f acuity Cgnitive deficits = 2additinal pints f acuity Individuals with deficits in activities f daily living such as dressing, eating, lack f mbility etc = 1additinal pints f acuity Maximum ttal acuity scre fr the highest needs individual meeting all risk categries under this bucket and meeting all acuity pints is 19

11 HEALTH HOME ACUITY SCORES FOR INDIVIDUALS IN THE CRIMINAL JUSTICE SYSTEM RESIDING IN THE COMMUNITY CATEGORY Risk # 2: Identified Risks and Assigned Acuity Scres: N Prvider r inadequate Prvider Cnnectivity= 1 additinal pint f acuity Nn-adherence t treatments r medicatin(s) r difficulty managing medical appintments = 2 additinal pint f acuity Recent Inapprpriate ED use OR Repeated recent hspitalizatin fr preventable cnditins either medical r psychiatric=2 additinal pints f acuity High Risk individuals that meet the HH Criteria under The Department f Crrectin s Cmmunity Supervisin Unit= 1 additinal pint f acuity Hmelessness= 2 additinal pints f acuity Repeated Offenders= 2 additinal pints f acuity Maximum ttal acuity scre fr the highest needs individual meeting all risk categries under this bucket and meeting all acuity pints is 19