Houston STRIDES 15-Month Report October 2001-December 2002

Houston STRIDES 15-Month Report October 2001-December 2002

Houston STRIDES team members: Terronica, Business Office Manager; Mark, Qualified Mental Health Professional; Wendy, Qualified Mental Health Professional; Michael, Administrator; Jacob, Qualified Mental Health Professional and Clayton, Registered Nurse. Telecare Houston STRIDES: 15-month Review Telecare Houston STRIDES (Steps Toward Recovery, Independence, Dignity, Empowerment and Success) joined the Houston community in October 2001, as a contract provider for Comprehensive Behavioral Care, Inc. (CompCare), a behavioral health managed care organization. The program serves people in Harris County who would otherwise need to seek services through the public sector. CompCare sought a new solution for these individuals, and partnered with Telecare to implement an Assertive Community Treatment (ACT) program. With over 37 years of experience serving individuals with serious mental illness and over eight years delivering ACT services, Telecare brought proven skills to the collaboration. The resulting program, Houston STRIDES, delivers 24-hour, 7-day-a-week wraparound support and services to high-risk individuals. Houston STRIDES was originally contracted to serve 20 members. By the end of one year, the program was expanded to 30 members. Its primary goal was to reduce acute and state hospital usage. That goal was achieved. After one year of participation in the program, all Houston STRIDES members have dramatically reduced their use of high-cost emergency psychiatric services, with an overall reduction of 88% from the previous year. CompCare also outlined additional measures of success at the program s inception. Houston STRIDES generated strong outcomes in all of these areas. The program: 1) decreased the severity of factors associated with clinical risk, including homelessness; 2) increased members quality of life and levels of satisfaction in this area; 3) provided culturally competent services; 4) maintained low levels of critical incidents; 5) provided recovery-oriented services; 6) held system costs down; 7) provided accessible services, as well as brokerage, placement and linkage; and 8) increased overall levels of member and family satisfaction. In the coming year, Houston STRIDES will increase its focus in the following areas: Decreasing acute psychiactric hospital days Strengthening the member/family advisory board Increasing independent living situations Increasing staff training Continuing to establish and grow relationships with Houston-based community programs and hosptials Houston STRIDES would like to acknowledge CompCare staff members Sandy Holmes, Jan Sopas and Troy Eubank, for their consistent support, partnership, and contribution to the program s achievements. We look forward to even greater successes in the future. Key Distinctions: Houston STRIDES Dramatically reduced annual hospital bed days from 967 days in the previous year to 247 days in the first contract year. First CARF-certified ACT Team in Houston. Growth of 50% in first year. Increased member satisfaction. Increased member independence. Increased member skills to enable independent living in the community. Provided services that are recovery-oriented.

Mark and Richard, working together for development and success. Member Demographics As of December 2002 Beginning enrollment.......... 8 Added enrollments............. 36 Graduates and disenrollments.... 14 Currently enrolled........... 30 Female.................. 57% Male.................... 43% Age Range 18-20....................... 0% 21-29...................... 18% 30-39...................... 25% 40-49...................... 30% 50-55...................... 18% 56+........................ 9% Ethnicity Caucasian.................. 47% Hispanic.................... 9% African American............ 44% Other....................... 0% Primary Diagnosis Schizophrenic Disorder....... 22% Bipolar Disorder............. 20% Major Depression............ 20% Schizoaffective Disorder...... 24% Other Disorder.............. 14% Houston STRIDES Program Purpose Statement The purpose of Houston STRIDES is to provide excellent services for adults with complex mental illness, assist them in living in the community during their recovery process, and support them in achieving their full potential. Members of Houston STRIDES are adults with serious mental illness (SMI), who often have co-occuring disorders such as substance abuse. Houston STRIDES provides wraparound services and supports, 24-hours-a-day, 7-days-a-week, 365-days-a-year. The program complies with accepted ACT standards and has received accreditation by CARF, a national accrediting body. Some of the services provided to help members attain their goals include: Clinical risk assessments Medication management and training Individual service planning Psychiatric services and individual therapy Psychosocial rehabilitation and social skills training Symptom education 24-hour crisis care services for members and families Housing services, including support in finding and maintaining chosen Real-Life Successes housing environments, and support in daily living Employment services, including skills-development training and job placement assistance Linkage to community services Substance abuse services and supports Support if incarcerated Money management and support Special activities and social outings Support in strengthening family relationships, developing friendships, and pursuing social activities Steven had been homeless and living on the streets and in an abandoned hotel for about 13 years. The Houston STRIDES team worked to engage him and to help him learn new skills, but he insisted on living where he was. Then, one very hot day, Steven was located behind a convenience store by a team member. He was shaking violently and appeared severely dehydrated. Luckily, with help and intervention from the STRIDES team, he recovered. After this, Steven decided that he was ready for more stable housing. A few weeks later, the Houston STRIDES team was able to locate a personal care home in the area of Houston that Steven felt to be his home. After being on the streets for over 13 years, Steven has now been living in this home for over three months. David had a history of high inpatient psychiatric hospital services usage. In addition to his mental illness, David suffered from diabetes. In the year prior to enrollment in the Houston STRIDES program, he used 156 psychiatric hospital bed days. Part of the reason was that once in crisis, Steven had little support. However, once enrolled in STRIDES, staff provided crisis call support to him and his family, which usually helped him to calm down. Staff used the Harm Reduction model to help him keep his symptoms in check, educate him about his substance abuse issues, and help him understand that he needed to keep his diabetes under control. David used 48 hosptial bed days in his first year at Houston STRIDES, which is a 69% reduction.

Stephen and Michael have a check-in visit and go over goals and challenges. Responses to the survey question: How has Houston STRIDES helped you? They have helped me with my medicine. They helped me find a place to live after 13 years on the street. Being there, one on one. The type of people that work here. Everyone has something they are good at here. They help me take my medications, visit me, talk nice to me and treat me nice. STRIDES takes me to my appointments, helps me keep up with my medicine, and are very concerned about me. Ya ll try to regulate my mind so I can get well. STRIDES has taught me that running to the hospital is not the thing I need to do. I can solve my problems by using the tools that you all have given me. You have helped me with my self esteem. It is coming up. You all have helped me with my behavior. Housing Results & Independent Living As of December 2002 Independent living.......... 19% Living with family.......... 24% Personal care home......... 47% Hospital................... 5% Shelter or homeless.......... 5% Most members have transitioned directly from acute psychiatric hospitals to personal care homes, often back to the same personal care home they left when hospitalized. Recovery Team The recovery team at Houston STRIDES consists of a Team Leader/ Administrator, a Registered Nurse, three Qualified Mental Health Professionals (QMHPs), a Business Office Manager, and contracted psychiatrist services. Team members support the belief that recovery is personal and unique to each individual and is a process of changing attitudes, values, feelings and goals. Houston STRIDES exists to help each member live a satisfying, hopeful and contributing life and develop meaning and purpose as they learn to manage their illness. Vocational and Educational Services The Houston STRIDES team works to link members with many vocational and educational services in the community. Members are linked with the Texas Rehabilitation Commission when looking for employment. When members are interested in education, they can be linked to a community college for information on returning to school. The program provides study- and job-skills training, interview training, help with writing resumes, and many other individualized services, such as GED training and Internet job searches, to help meet the needs of members. Currently, no Houston STRIDES members are working; however, skill-building is underway. Housing Services All Houston STRIDES team members have contacts and relationships with personal care homes and independent living facilities in the community, which are used to locate appropriate housing for members. Some members have been placed in semi-independent living situations, with their own room, refrigerator and microwave, and receive support in building community-living skills. The program works with members who are homeless to help them secure stable living situations. Some members live with family. Houston STRIDES provides support to both members and family members to work out issues such as responsibilities, stress management and crisis care. Co-Occuring Disorders Services Houston STRIDES follows a Harm Reduction model when working with members with co-occuring disorders. The Harm Reduction model is a highly individualized course of treatment which emphasizes choice and awareness of the consequences of life choices. Using the Stages of Change model, staff work with clients where they are at in their striving to change harmful behaviors. Rather than requiring strict abstention from drugs or alcohol, the Harm Reduction model helps members to understand the consequences of the choices they make, as well as how to make better choices that will benefit their lives. The program also links members with Alcoholics Anonymous and Narcotics Anonymous and other community services. Family Involvement and Group Services Family can be a vital support and provide stability for members. It is important that the family feel supported and a part of the recovery process. Houston STRIDES has established a member and family advisory council to provide a supportive forum for ongoing involvement. The program also provides ongoing

support for family members. For example: a Houston STRIDES member was calling his family frequently, at inappropriate and inconvenient times for the family members. The family contacted the program and asked what they could do. Team members helped the family set up a schedule with the member for phone calls, and helped to establish some boundaries that were effective for everyone. Jacob takes a break at Houston STRIDES. Responses to the survey question: What has been your favorite moment at STRIDES? When me and Jacob rode together and had a long talk. The picnic was great. Going to the food bank and visiting. When we went to the movies. When we went bowling. Impact on Acute Psychiatric Hospitalization The following is baseline hospitalizations data on 24 clients who have been with Houston STRIDES since the program opened. It compares Houston STRIDES data for the first year in operation to the 12 months prior. Hospitalizations for 12 months prior to opening of Houston STRIDES Total claims................. 113 Total hospital days............ 967 Average days per month...... 80.58 Hospitalizations for 12 months (annualized) after opening of Houston STRIDES Total claims.................. 39 Total hospital days............ 248 Average days per month...... 20.64 Nursing and Counseling The nursing staff provides medication training and support, assistance in securing necessary medical lab tests and coordination of overall general health care. The nursing also assists members to determine their medical needs and manage appointments. Licensed Professional Counseling (LPC) services are provided as needed. Houston STRIDES has one LPC on staff. Challenges and Initial Outcomes Houston STRIDES actively works toward continuous improvement in service quality, data collection and program operations. The following are the challenges addressed during the first fifteen months. Developing and Maintaining Continuity of Services Houston STRIDES is a new program in a new market for Telecare. In starting up the program, there was a necessary period of staff development and adjustment. In its first fifteen months of operation, Houston STRIDES built an ACT team, implemented Telecare s system of clinical accountability, and built relationships with members. Throughout this time, the program provided uninterrupted services to members, and dramatically decreased the number of inpatient psychiatric hospital bed days of members. Relationships with Hospitals A necessary component of the success of Houston STRIDES is a good working relationship with area hospitals. The first fifteen months have been spent in getting to know the five primary psychiatric hospitals and developing mutually beneficial relationships. Houston STRIDES has continuously illustrated to the hospitals how it can assist in transition planning and be of use in decreasing psychiatric bed days, thus freeing up beds for more acute cases. The program has developed relationships between inpatient and outpatient services, ensuring a continuity of care for members. Relationships have also been developed with hospital discharge planners, intake counselors and social workers in order to maintain quality of care and wraparound services for members. Houston STRIDES provides hospitals with current medication information, housing status and any other relevant information about members in order to make the transition back to the community easier for the member. Co-Occuring Disorders Treatment Many of the program s members are diagnosed with co-occuring disorders, primarily substance abuse issues in addition to serious mental illness. Resources for substance abuse rehabilitation in Houston have not been readily available

to the program s members. Houston STRIDES, along with Dr. Joel Feiner, Telecare s Medical Director of Texas, has developed a system for working with members who have co-occuring disorders, using the Harm Reduction model. Terronica, concentrating on keeping records and documents up-to-date. Client Satisfaction Results Houston STRIDES surveyed the 24 members that have been at the program since it opened. These are results from the client satisfaction survey. 100% I like the services I received here. 100% I would recommend this agency. 100% I decided my treatment goals. 100% I planned my treatment with staff. 100% I deal more effectively with daily problems. 95.5% Staff was willing to help. 95.5% Staff helped me manage my life and recover. 95.4% I could understand the written information. 95.4% I would choose this agency. 90.9% I feel comfortable asking about my treatment and meds. 86.4% Staff believed I could grow, change and recover. Houston STRIDES 5850 San Felipe, Suite 500 Houston, TX 77057 (713) 706-6180 / (713) 706-6178 (fax) Telecare Corporation 1100 Marina Village Parkway Alameda, CA 94501 (510) 337-7950 / (510) 337-7969 (fax) (800) 977-7471 www.telecarecorp.com Risk Assessments Clinical risk information is collected throughout the year for STRIDES members. Risk data is integrated into program operations, including service and care planning, program management, and where appropriate, increasing member motivation. The Telecare Clinical Risk Assessment measures the following domains: suicide, alcohol and other drugs, violence, self-neglect, medical risk barrier, communicable disease risk, victimization, child abuse/neglect, and problems following the psychiatric medication plan. These assessments provide an opportunity to sit down with the member and talk openly about areas where they have risk. Risk is defined as the harm that has come from poor choicemaking skills. One aspect of recovery depends on making choices that increase a person s strengths and decrease the amount of harm in their lives, allowing them to attain what they want in life. The assessments also identify areas in a member s life that may require attention. This could be a need for case management, education or a clinical intervention. Assessments allow staff to monitor a person s progress in the reduction or increase of risk. CARF Accreditation The Rehabilitation Accreditation Commission (CARF) is a national accreditation body specifically for ACT services, and sets rigorous standards for program accreditation. Houston STRIDES was surveyed in spring 2002 under CARF s new ACT standards. The program was accredited by CARF for a three year period, which will extend until 2005. As an organization, Telecare was commended in numerous areas, including: its caring, dedicated and enthusiastic staff members, who demonstrate obvious pride in both their programs and the progress of members; its strong emphasis on member input; and the fact that access to services is provided in a timely and uncomplicated manner. Outcomes Tracking Houston STRIDES has adopted an ACCESS-based software program called Caminar as the principal means for documenting both clinical and billing information. Caminar is specifically designed for use in delivering services in community-based programs and has improved the efficiency and productivity of the program in three areas: task completion, efficiency and analysis. These areas have historically presented challenges in similar programs. Caminar enables staff members to automate and streamline the documentation of the clinical services provided, as well as capture basic member demographic and diagnostic information. Reports can be produced in multiple formats to meet the needs of different audiences. Caminar also facilitates the collection of member outcome information in the following domains: hospitalization, residential, employment, education, incarceration, conservatorship, payee, legal and financial. STRIDES is currently evaluating how these capacities can be used to establish baseline information to evaluate individual and aggregate member progress and improvement in these functional areas.