Assisted Outpatient Treatment (W&I Code 5345~5349) (AB 1421) Laura s Law

Transcription

1 Assisted Outpatient Treatment (W&I Code 5345~5349) (AB 1421) Laura s Law ~April 23, 2015~ The Nevada County Experience 1

2 Objectives Explain Assisted Outpatient Treatment (AOT) in the context of Assertive Community Treatment (ACT). Demonstrate how recovery oriented approaches and court monitoring combine to improve outcomes among treatment participants. Examine strategies used to engage people in treatment who historically elect not to participate in services and supports. 2

3 Assisted Outpatient Treatment Also referred to as AOT, AB 1421, W&I Code , or Laura s Law Categories of outpatient services and supports that have been ordered by a court pursuant to Section 5346 or 5347 A process of determining an individual s need for mental health treatment. Treatment model for AOT is Adult Assertive Community Treatment (AACT) 3

4 January 1st, 2003 California enacted court-ordered outpatient treatment, known as Assisted Outpatient Treatment (AOT), as an option for Counties Modeled after Kendra s Law in New York 45 states have similar laws Resulted from a collaboration with Treatment Advocacy Center, parents of victim, and state legislators 4

5 Stigma Not our intention to promote stigma of persons with mental illness We embrace recovery principles and the belief that all individuals can recover and live satisfying and productive lives We recognize that a small subset or persons with untreated mental illness, especially those with a co-occurring substance use disorder, may have a high potential to be dangerous to themselves or others 5

6 Issues to Consider & Dispel AOT is too expensive AOT violates civil rights Voluntary treatment is more effective than AOT AOT is not needed because we already have other interventions (e.g and 5350) 6

7 Issues to Consider & Dispel AOT allows forced medication AOT is not effective because you can t force medication AOT outcomes are not documented AOT won t work in counties with diverse cultural and ethnic populations 7

8 AOT Criteria Lack of compliance with treatment, indicated by : 2/36 months; hospital, prison, jail or 1/48 months; serious and violent act, threat, attempt to harm self/other (The element of dangerousness is a lower threshold than 5150 or 5350, not an imminent threat, not gravely disabled.) 8

9 AOT Criteria The person has been offered an opportunity to participate in treatment and refused (Therefore, voluntary services are not an alternative to AOT, as AOT requires that voluntary services have already been offered and refused). 9

10 AOT Criteria County resident, minimum age 18 Serious Mental Disorder (WIC ), (may include co-occurring disorders) The person is unlikely to survive safely in the community 10

11 AOT Criteria Condition is deteriorating Least restrictive placement Necessary to prevent 5150 condition Will benefit from treatment 11

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13 Who Can Request AOT? Any person 18 and older with whom the person resides The person s parent, spouse, sibling or child, who is 18 or older A peace officer, parole or probation officer 13

14 Who Can Request AOT? The director of a public or private agency providing mental health services to the person The director of a hospital where the person is being treated A licensed mental health provider who is supervising or treating the person 14

15 AOT Program Requirements Community-based, multi-disciplinary treatment, 24/7 on-call support, mental health teams that use staff to client ratios of no more than 10 clients per 1 staff person Must include a Personal Service Coordinator (PSC) for full service coordination Team approach and capacity for frequent contacts For Example: Assertive Community Treatment (ACT) 15

16 AOT Program Requirements Services that are client directed and employ recovery principles Integrated services that include mental health, substance abuse, physical health Self management of illness, personal choice, self determination Benefit Advocacy 16

17 Court & Legal Process 3 components - Pre-hearing notice of investigation and hearing Court hearings and due process requirements Collaborative supervision of AOT after the court order 17

18 Court & Legal Process County files a petition and the licensed mental health treatment provider may testify The petition must be served on: o Person who is subject to the petition o Patient Rights Advocate o Current health care provider The petition must determine there is no appropriate/feasible less restrictive option 18

19 Court & Legal issues Closed, civil court Client may be ordered or settle pursuant to Section 5346 or 5347 AOT Judge may dismiss if determines criteria are not met Client is represented by counsel Process empowers client to make choices that improve overall health 19

20 Court & Legal Process County provider must file an affidavit with the court at 60-day (typically less) Affidavit (status summary) reflects level of participation and continued criteria Includes individualized recommendations or modifications that may be discussed in court. 20

21 Court and legal process The court may order hospitalization under two (2) conditions: The person who is the subject of the petition has refused to be examined by an LMHT provider and the court finds reasonable cause that criteria are met~ Exam is completed in the community or hospital setting to confirm eligibility requirements are met. W&I Code 5346 (d). The person who is the subject of the petition is in need involuntary admission to a hospital for evaluation for up to 72 hours. W&I Code 5346 (f). Determination is made if the person is in need of treatment pursuant to Section

22 Court & Medication Medication may be part of the courtordered, individualized service plan Medications are not forced, but are court-ordered Court-ordered treatment is commonly provided throughout the California mental health system Almost all participants take medication 22

23 Outreach & Engagement An ongoing process of reaching & identifying unserved or underserved individuals/families Included are homeless, frequently incarcerated, repeatedly hospitalized or having frequent emergency contacts Supports access to emergency needs Court allows outreach to be possible to this population 23

24 Outreach & Engagement The foundation of a partnership Provider skills: recruit team members that reflect the components of recovery and from multiple disciplines Select PSC, Peer Specialist best suited Determine key issues and barriers Appreciate ways in which culture affects the client s willingness to seek help Respect person and place 24

25 Outreach & Engagement Strategies Welcome, offer, invite, encourage client to be equal partner in decisions (provides choice and promotes empowerment) Promote positive interdependence (drives engagement and cooperation) Consistently show up, follow up, have and express hope and care Envision what is possible 25

26 More Engagement Strategies Emphasize partnership, client/family centered services, individualized quality of life goals, no limitation on the engagement phase, no fail; support is not withdrawn based on expectations of response (this increases the likelihood of engagement) Listen & don t underestimate the power of kindness, positive attitude, congruent behaviors and impeccable manners (culturally responsive Use peer specialists and expertise of team members (This phase includes monitoring person for increased risk or increased participation in services offered) 26

27 Provider Role Prepares documents for County Counsel in support of petition Provides AACT treatment following court order Provides status reports to the AOT court team at 60 day intervals (typically more often). Reports include: level of engagement, successes, challenges and recommendations. 27

28 Additional Provider Tasks Collaboration: with law enforcement, probation and public defenders/private lawyers, conservator, County Counsel, other County Departments Support: in court and/or hospital settings, correctional facilities and in successfully completing all steps required of the individual by the court Data collection MHSA and Milestones Of Recovery Scales (MORS), data to measure outcomes~ quarterly Annually~ submit specific data required to DHCS 28

29 Providence Center AOT Data Since May 2008: 97 referrals for AOT evaluations 39 individuals with AOT court orders 6 incomplete orders due to hospitalization, incarceration, or death About 6 people per year have received treatment pursuant to an AOT order 29

30 Providence Center AOT Data 5 adversarial hearings (i.e. where the person appeared with counsel and challenged the petition.) 4 hearings where the person did not appear; an evidentiary hearing was held before the judge to present the evidence that the person met criteria. 30

31 Costs and Savings Actual cost per individual varies; budget for Fiscal Year 14/15 projected at $20,736/year/individual = same as ACT Team cost Average length of stay is 180 days $1.81 is saved for every $1 invested Bill Medi-Cal, Medicare, private insurance, patient fees for allowable services AOT costs are similar to ACT costs 31

32 AOT Outcomes Are Similar to ACT Outcomes Fewer hospital days Fewer jail days Higher employment rates Less homelessness Overall cost savings Better treatment engagement Higher Milestones of Recovery scores 32

33 Outcomes for 19 Unduplicated Participants ~12 months pre-treatment vs.12 months post-treatment~ Psychiatric Hospital Days 510 days vs. 290 days post-treatment = 43.1% Incarceration Days 687 days vs. 327 days post-treatment = 52.4% Homeless Days 254 days vs. 117 days post-treatment = 53.9% 33

34 Outcomes: For 19 unduplicated individuals, for the most recent 12 months pre-treatment vs. 12 months post-treatment Client Satisfaction Survey: 72.4% Family Satisfaction Survey: 82 % MORS Extreme Risk 38.9% 6.5% (high symptom distress, often taken to hospitals) MORS Coping/Rehabilitating 0.0% 40.0% (succeeding, contemplating employment/education generally satisfied with their lives) 34

35 Final Thoughts Nevada County is the first California County to fully implement Assisted Outpatient Treatment. 45 states have AOT programs AOT saves lives, protects civil rights, increases public safety, and improves the quality of life for the individual Provides treatment before an individual becomes gravely disabled, or does harm to self or others Nine (9) California counties now have BOS approval to implement AOT including: Nevada, Yolo, Orange, Los Angeles, San Francisco, Placer, Mendocino, San Diego and Contra Costa 35

36 More Final Thoughts AOT fills a gap in the treatment continuum AOT allows for a treatment option that is less restrictive than Conservatorship and locked inpatient care AOT is not a panacea, but does support the possibility of engaging some individuals in treatment that would not otherwise be possible It is possible to create a recovery based AOT program within the context of AACT 36

37 Contact Information Michael Heggarty, MFT Nevada County Behavioral Health Carol Stanchfield, MS, LMFT Turning Point Providence Center (530) ext Honorable Judge Thomas Anderson Nevada County Superior Court 37

38 Laura Wilcox 38