Submitted by the Hospital and Home Team, May 3, 2013 Mercer Study Review and Recommendations for Alternative Use of Rainbow MHF Submitted by the Hospital and Home Team, May 3, 2013

The Hospital and Home Team Vision: Consumers experience recovery and satisfaction with themselves, their world, and their dreams/aspirations by living safe healthy self-determined lives in their community as evidenced by continuity in maintaining and enhancing their homes, occupation, financial stability, & personal relationships. Mission: The Hospital and Home Team will recommend action steps for the purpose of improving access to an array of mental health services and supports that promote recovery and community integration. November 17, 2018

The Hospital & Home Team overview statements In FY13 KDADS contracted with Mercer to conduct an actuarial analysis of hospital and community based services utilization. The Hospital & Home Team (H&H) team was charged with reviewing the report issued by Mercer and developing recommendations for reducing reliance on the state hospitals for public safety net services that could be provided elsewhere. The recommendations set forth here are specific to the development of alternative services at Rainbow Mental Health Facility, but have implications for future work and the development of similar services across the state. These recommendations cover what service options need to be available, but do not include recommendations for the management and operation of such services. Although the H&H team had rich discussions and strong opinions about the management and operation of the services at Rainbow, it was felt that those decisions should be made by the local workgroup rather than by the H&H team.

Conclusions Drawn from Mercer as they relate to Rainbow MHF Rainbow is serving as a safety net There are systems and other factors that affect the data that we do not have control over There appears to be a correlation between availability and utilization of community services and hospital admission rates. 70 % of admissions to all SMHFs were involuntary and 30% voluntary 40.8% were non-SPMI admissions and had co-occurring SUD Johnson County MHC and Wyandot Center have highest volume of voluntary admissions Median Length of Stay for voluntary admits is 9.0 days. 40% of all admissions lasted less than 10 days. Northeast region had highest percentage of readmission rates There appears to be a need to improve fidelity of screens; validity and reliability of voluntary vs. involuntary admissions

Populations that could be impacted Voluntary admissions Involuntary admissions who are likely to stabilize quickly Non-SPMI with co-occurring SUD Those with placement issues, coming from jail, self care failure, homelessness

Actions Identified in Discussion Allow sufficient time at intake/admission for a thorough assessment to be made Provide triage, including capability to assess and refer for medical care, Assure fidelity to screening protocols Provide medical coverage and medical clearance Employ security personnel so law enforcement officers are not unduly delayed (stop and drop) Offer support services Use self directed wellness tools Be recovery oriented Demand systematic connection/interface with community based services

Assumptions People should be able to come directly to Rainbow. SMHH Screens will not be required for this initial contact and triage. Services at Rainbow will serve as a community option to determine appropriate and effective services at the time of contact. Rainbow serves as secondary level of care while OSH is tertiary . (H&H’s Access to Community Services and Supports Work team defined tertiary care as a facility that provides longer and potentially more complex course of inpatient mental health treatment). Rainbow must have capacity to treat involuntary admissions Rainbow will provide short-term, acute inpatient treatment and will have the capacity to connect potential admissions to lower levels of care and treatment in the community. Between 30 and 40 percent of people referred for inpatient treatment at the present time may be appropriately served by outpatient providers. A seamless system of mental health care and treatment requires close coordination between community and inpatient providers

Recommendations Implement the past work group recommendation to make RMHF a secondary/regional resource for people whose immediate needs go beyond the capacity of CMHCs and other community resources. The function of such a facility is three-fold: crisis response and stabilization, referral to appropriate levels of service within the community, or brief inpatient treatment. People admitted to RMHF for inpatient treatment should have access to all the services necessary to make a timely transition to alternate services. RMHF should include crisis stabilization that is similar in purpose, design, and operation to the former KU Crisis Stabilization Center. This program should use evidence-based and promising values-based services designed to assure a through evaluation, appropriate treatment, and access to the resources necessary to assure a timely and successful return to the community.

Recommended Services Services should include the following: 24/7 access to crisis response, triage, and treatment Short-term crisis stabilization, including the capacity to access mobile crisis response Detoxification services and connection to a continuum of needed addiction services Short-term inpatient regional beds Referral to and coordination with community based services and resources Coordination with OSH to facilitate access to tertiary level of care, and as a resource for patients at OSH who may be better served at the secondary level of care.

Recommended Services Con’t Services should be delivered within a framework that includes: Peer support and Peer specialists Intensive Case Management (as exemplified by Heartland RADAC) Board certified/eligible physicians, licensed nurses, and mental health professionals Adequate number of trained staff to serve involuntary admissions The ability to provide transportation as necessary for a person to get to other services and resources. Except in very rare cases, this does not include the use of law enforcement transport. Approval/Certification by TJC or CARF, etc. as appropriate, with accountability for those “Standards” of Care, and Good Business Practices. November 17, 2018

Recommended Services Con’t Should be delivered in a physical environment that is: Safe Secure (presence of sufficient in-house security personnel) Welcoming Promoting recovery November 17, 2018

Rainbow must provide coordination with community services An essential strategy for preventing mental health crisis and reducing the need for higher levels of care, is the development and support of community-based rehab services. Intensive case management, peer support services, and mobile crisis will be essential resources to the success of this program. In order to assure a seamless system of care it is essential that provision of services and referral to or reconnection with community resources be main functions of the new design