Iowa s MHDS Regions Mental Health & Disability Services Regional Crisis Services Mental Health Conference October 6, 2015 Julie Jetter, DHS, MHDS Jan Heikes, DHS, MHDS Anne Uetz, Polk County Health Services Jennifer Vitko, South Central Behavioral Health Region 14 Regions (as of 11/1/15) Size varies from 1 to 22 counties Population ranges from 29,988 to 582,074 (2014 National Census Estimate) Officially began operations on 7/1/14 North West Iowa Care Connection Rolling Hills Community Services Approved MHDS Regions County Social Services Lyon Osceola Dickinson Emmet Kossuth Winnebago Worth Mitchell Howard Winneshiek Allamakee Sioux O Brien Clay Palo Alto Hancock Cerro Gordo Floyd Chickasaw Fayette Clayton MHDS of East Central Region Plymouth Cherokee Buena Vista Pocahontas Humboldt Wright Franklin Butler Bremer Webster Black Hawk Buchanan Delaware Dubuque Sioux Woodbury Ida Sac Calhoun Hamilton Hardin Grundy Rivers MHDS Tama Benton Linn Jones Jackson Monona Crawford Carroll Greene Boone Story Marshall Heart of Clinton Iowa Cedar Harrison Shelby Audubon Guthrie Dallas Polk Jasper Poweshiek Iowa Johnson Scott Central Iowa Community Muscatine Services Pottawattamie Cass Adair Madison Warren * Marion * Mahaska Keokuk Washington Louisa Eastern Iowa MHDS Southwest Iowa MHDS Mills Montgomery Adams Union Clarke Lucas Monroe Wapello Jefferson Henry Des Moines Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren Lee Southeast Iowa Link Southern Hills Regional *Effective 11/1/2015 the Mid Iowa County Rural South Central Mental Health Region (Marion & Mahaska Counties) Offices Behavioral will Join regions reflected on this map. of Social Services Health Core Service Domain: Basic Crisis Response 24 Hour Access to Crisis Response Definition: Services are available 24 hours a day, 365 days a year providing access to crisis screening and assessment and linkage to mental health services. Access Standard: 24 hours/365 days a year. September 8, 2015 Core Service Domain: Basic Crisis Response Crisis Evaluation/Assessment Definition: Face to face clinical interview to ascertain an individual s current and previous level of functioning, potential for dangerousness, physical health, and psychiatric and medical condition. The crisis assessment becomes part of the individual s action plan Access Standard: within 24 hours Core Service Domain: Basic Crisis Response Personal Emergency Response System Definition: The personal emergency response system is an electronic device that transmits a signal to a central monitoring station to summon assistance in the event of an emergency. Access Standard: first unit of service within 4 weeks of request. 1
Core Services Domain: Crisis Services Regional Overview 24 Hour Crisis Hotline Definition: A crisis line providing information and referral, counseling, crisis service coordination, and linkage to crisis screening and mental health services 24 hours a day 24 Hour Crisis Hotline Regional Overview Warm Line Definition: A telephone line staffed by individuals with lived experience who provide nonjudgmental, nondirective support to an individual who is experiencing a personal crisis. Mobile Response Definition: A mental health service which provides on-site, face-to-face mental health crisis services for an individual experiencing a mental health crisis. Crisis response staff providing mobile response have the capacity to intervene wherever the crisis is occurring. Mobile Response Regional Overview 2
23 Hour Crisis Holding and Observation Definition: A level of care provided for up to 23 hours in a secure and protected, medically staffed, psychiatrically supervised treatment environment Community Based Crisis Stabilization Definition: Short-term services designed to de-escalate a crisis situation and stabilize an individual following a mental health crisis and provided where the individual lives, works, or recreates. Residential Crisis Stabilization Definition: A short-term alternative living arrangement designed to de-escalate a crisis situation and stabilize an individual following a mental health crisis and is provided in organization-arranged settings of no more than 16 beds. Residential Crisis Stabilization Regional Overview Polk County Health Services 3
Mobile Crisis Response Team Developing Polk County s Model Convene work group Police from city, suburbs, & county sheriff Mental health providers Mental health consumers, family members, advocates County manager State Representative PCHS staff and board members National Alliance for Mental Illness staff Facilitated by Technical Assistance Collaborative (TAC) Developing Polk County s Model, Cont d System has to be Responsive ½ hour response time or less, ability to access information quickly (are they in the county mental health system) Have defined protocols rules that define when mobile crisis is appropriate Have a point of referral will calls come from the police, will there be a hot line, direct access to the community, etc. Polk County s MCRT Responsibility of MCRT Mental health assessments On-site counseling and problem solving Crisis plan development Coordinate hospitalizations Provide medication in consultation with psychiatric consultant Arrange/provide temporary respite services as needed Polk County s MCRT, Cont d Care Coordination Coordinating care with community providers who serve the individual Link the individual to community services necessary for long term stability Assist individual with follow through on treatment recommendations Contact with family members and other natural supports with relevant assessment information to assist in the individual s stability Polk County s MCRT, Cont d Role of law enforcement To maintain safety of the scene Gather necessary information prior to MCRT arrival Consult with MCRT regarding disposition DMPD Liaison Assigned to the MCRT Is a team member with additional training and goes out on MCRT calls 4
MCRT Cost Avoidance July 2014 June 2015 850 people treated in field would have cost $2.4 million if taken to jail $850,000 if taken to Emergency Room $3.4 million if taken to hospital 509 taken to hospital for treatment would have cost $1.4 million if taken to jail Lessons Learned Becoming the experts in many areas that are not typically considered a mental health issue Providing education to medical providers on how to respond to patients who present in crisis Officer s increased awareness and ability to interact well with individuals who has a mental illness The lack of linkage to services and the need for greater access to mental health treatment 25 Crisis Observation Center Developing the Crisis Observation Center November 2010: visited Bexar County, Texas April and August 2011: held Community Conversations November 2011- March 2012: held 3 Stakeholder Meeting March 2012 to late fall 2013: Waited Very late fall 2013: Identify site January 2014: Begin Weekly Meetings Developing the Crisis Observation Center February 2014: Site Visit to Bexar County April 2014: Site visit April 2014: Begin workflow and service design May 2014: Begin remodeling site June 2014 Begin hiring and training staff Open July 2014 Service Mental health crisis assessment Observation Crisis therapy Crisis planning/begin WRAP Telemedicine Substance abuse assessment Discharge planning Follow along warm hand-off 5
Data Collection-Regional System Four key pieces How did people get there How long did they stay Where did they go to Where would the person have gone Crisis Observation Center Cost Avoidance July 2014 - June 2015 363 people treated at COC would have cost $363,000 if an Emergency Room Visit $1.4 million if admitted to the hospital 24 brought by police $68,640 if taken to jail 32 Lessons Learned Crisis Stabilization Center Fewer issue with substance use disorders People with children at home Missing person in another state Rightsizing expectations Partners Developing the Crisis Stabilization Center November 2010: visited Bexar County, Texas April and August 2011: held Community Conversations November 2011- March 2012: held 3 Stakeholder Meeting March 2012 to late fall 2013: Waited Very late fall 2013: Identify site January 2014: Begin Weekly Meetings Developing the Crisis Stabilization Center February 2014: Site Visit to Bexar County April 2014: Site visit April 2014: Begin developing startup work plan July 2014: Set start up in motion August 2014: hiring and training staff Open September 15, 2014 6
Service Crisis stabilization Treatment focus Intensive outpatient format is the vision Current group work with emphasis on WRAP Connectivity as needed People Served September 15 through July 30 9 Beds available Served 45 people Average 56 days Referred from: All 45 from Crisis Observation 74% were on the streets or homeless Collecting LOCUS Scores at admission and discharge In September 2015, follow up calls were made to those who have been discharged 95% are in stable housing 95% are stable with their medications 95% are active in therapy 89% are involved in Integrated Health Homes or Service Coordination Lessons Learned First 48-72 hours is rest to get better engagement Over train on boundaries First come, first served policy Evening relaxation group Educate on community resources South Central Behavioral Health Region Mahaska Appanoose Wapello Davis Crisis Mental Health Bridging the Gap in a rural Community Mahaska to Join 11/1/2015 7
Who are we? Purpose The Appanoose County Mental Health Coalition South Central Behavioral Health Region/Appanoose- Davis-Wapello Counties Mercy Medical Center Appanoose County & Centerville Law Enforcement Centerville Community Betterment 8 th District Court Community Health Centers of Southern Iowa To improve mental health access in Appanoose, Davis and Wapello Counties through the cooperative efforts of local providers to intervene with existing resources, providing the appropriate crisis stabilization and ensure follow up mental health care and treatment. The Need Appanoose Community Health Needs Assessment ranked mental health as the #1 community health issue. The coalition came together to talk about the problems taking care of mentally ill in the county. Fractured system - frustrations for all involved. building understanding of how the process affects each of those involved. Identified that no crisis intervention resources locally, waiting list for therapy appointments, with no option but committal South Central Behavioral Health Region Appanoose, Davis & Wapello Counties Providing payment for the licensed social workers on call as well as providing payment for ER and hospital services when utilized. Developed an Emergency Prescreening option now offered to families who access the courts an alternative to committal. There is an option for the loved one to see a therapist within 24 hours. Providing seed funding for crisis stabilization house Grant Funding July 1, 2014 $221,000 Catholic Health Initiatives Mission and Ministry Grant through Mercy - subsidize 50% of direct staff cost - specialized staff training - development of mental health programming Crisis Stabilization House Opened Oak Place April 1, 2014 3-5 bed/ 5-7 days stay Managed by Centerville Community Betterment, Inc., non-profit operates group homes since 1982. Funded by Appanoose County until 7/1/2014, then by South Central Behavioral Health Region 8
Stabilization House Therapists Identify and address immediate needs food, clothing, shelter, sleep, etc.) Intervention by therapist medication management, therapy Develop care plan Referral to other services as needed. Evidence Based Practices (The WRAP program) Participating in a call schedule utilized by law enforcement, county, court and hospital. Providing assessments, assisting with placement of patient when a bed is needed. Making referrals to each other s organizations when needed. Providing individual follow up treatment with patients. Opened up an appointment daily for crisis assessment if needed. Impact Since July 1, 2013 60 Mental Health Committals 123 pre-screens completed 90 seen in the ER 33 diverted from the ER 19 seen at the jail 14 seen in office or other setting 26 referred to Inpatient 44 voluntary admission to Oak Place 48 received community services 50 40 30 20 10 0 CY 2012 CY 2013 CY 2014 CY215 Cost Savings Model for the State CY 2013 CY 2014 Inpatient $714,000.00 $204,000.00 Law Transfers 19,250.00 10,250.00 Court Cost 42,848.00 12,240.00 ER Committal 30,800.00 25,176.00 Pre-screenings 0.00 36,900.00 Stabilization House 0.00 360,000.00 Total $1,224,294.00 $ 648,566.00 Initiative is being viewed as a rural model for the state of Iowa that can be replicated. Design a model that utilizes local resources and fits the needs of the individual location. Demonstrate that investment in intervention: - More effective - Less Costly - Less restrictive alternative Mental health crisis resolved through support and care coordination rather than intensive medical interventions. 9