Delaware Health and Social Services Department of Health and Social Services Division of Substance Abuse and Mental Health Joint Finance Committee Hearing Fiscal Year 2012 Kevin A. Huckshorn, RN, MSN, CADC Division Director/ DPC Hospital Director Wednesday, March 2, 2011

Delaware Health and Social Services DSAMH MISSION STATEMENT To promote health and recovery by ensuring that Delawareans have access to quality prevention and treatment for mental health, substance use, and gambling conditions.

Delaware Health and Social Services Overview DSAMH: The Single State Agency for prevention and treatment services for substance use, mental health and gambling conditions Provides services regardless of ability to pay Organizational structure consists of the Central Office, the Delaware Psychiatric Center (DPC), community mental health and substance abuse services and gambling services

Delaware Health and Social Services 4 Overview DSAMH: Principles founded on the National Recovery Model Services to be measurable and outcome- based to assure efficiency, accountability, and meet or exceed taxpayer expectations

Delaware Health and Social Services Community Services Overview 3 state-run MH outpatient clinics 1 contracted MH/SA outpatient clinic 4 comprehensive private community programs inc. ACT/intensive teams - Community Continuum of Care Program (CCCP’s) Statewide 24/7 Mobile Crisis 1 psychiatric emergency program in partnership with Christiana Care Health System 2 Peer Drop-in Centers New Targeted Case Management in NCC

Delaware Health and Social Services Community Services Overview Statewide homeless outreach and treatment engagement services Statewide transportation services Statewide medication assisted treatment programs Statewide substance abuse (SA) Prevention services 3 outpt SA clinics including 3 ambulatory treatment programs Statewide gambling prevention and treatment services Statewide MH/SA early intervention and prevention services

Delaware Health and Social Services Statewide community psychiatric inpatient services Statewide HIV/STD outreach, testing and referral for treatment Mental Health Courts and Drug Diversion Courts in each of Delaware’s counties Beginning late February 2011 a new Veterans Mental Health Court in Kent County Statewide specialized case management linking and supporting individuals in the courts and community corrections with community based services (TASC) Community Services Overview

Delaware Health and Social Services 19 24/7 group homes; 166 supported housing units 30 Oxford Houses providing treatment /supportive housing Detox services (up to 50 beds) SA halfway houses and 1 SA shelter 4 specialty SA residential programs (121 beds) Women and custodial children Young adults with opiate addictions Adults with significant mental health and substance use conditions Adults with significant substance use conditions Community Services Overview

Delaware Health and Social Services Accomplishments Community Services Improvements to DSAMH Mobile Crisis Services: addition of psychiatrist, and relocation of southern county crisis service to Ellendale (in process) Implementation of initial Targeted Care Management services in NCC Increased number of individuals served (916) in transformed Newark state-run mental health clinic Expansion of Oxford House from 60 people to 201 people in sober housing in last two years Discharged 16 complex-needs clients from DPC to community Location of CCCP Recovery Care Managers to DPC to assist in discharges

Delaware Health and Social Services Accomplishments Community Services New federal grants to implement Trauma Informed Care statewide and expand peer support specialists programming statewide Expansion of consumer-run Rick van Story Resource Center including an arts program Expansion of medication assisted treatment (Vivitrol and Buprenorphine) Pharmacy savings continue $340,000 in last year Addition of two Mental Health Courts- now in all three counties and the first Veteran’s Mental Health Court

Delaware Health and Social Services Accomplishments DSAMH Performance Improvement DSAMH Performance Improvement Unit to set standards and monitor all community services; state and private Incorporated statewide community Utilization Review Program Implemented an evidence-based Root Cause Analysis (RCA) process to analyze adverse events in community Developed new state standards for co-occurring and ambulatory detoxification services that are best practices

Delaware Health and Social Services DSAMH Services Break-out

Delaware Health and Social Services Mental Health Services State Fiscal Years 2009 and 2010 (duplicated across categories) SFY 09SFY 10 Community Mental Health Clinics 3,3212,969 Individuals Served CCCP 1,5691,543 Individuals Served Mobile Crisis 1,1501,400

Delaware Health and Social Services SFY 2009 and SFY 2010 Inpatient Psychiatric Bed Days Admissions Bed Days Average LOS SFY ,205 10, SFY ,128 9,

Delaware Health and Social Services Substance Abuse Services State Fiscal Years 2009 and 2010 (duplicated across categories) SFY 09SFY 10 Outpatient Substance Abuse (inc. Medication Assisted Treatment) 2,8083,065 Intensive Outpatient and Case Management Substance Abuse Treatment

Delaware Health and Social Services SFY 2009 and SFY 2010 Detoxification Admissions by County

Delaware Health and Social Services Supported Employment Connections Horizon House PSIFHRTotal Day Job Retention Connections Horizon House PSIFHRTotal Day Job Retention

Delaware Health and Social Services Delaware Psychiatric Center US DOJ Findings (2008-present) DE was found out of compliance with the federal Olmstead court decision (1999) that expects people to be served In the community, not institutions. At least 75 people in DPC have been identified to meet this criteria. DSAMH is exploring best practice, cost-effective models to successfully discharge these complex needs clients Funding to discharge the first 25 individuals has been requested Plans include the development of an RFP in early 2011 US DOJ is coming back this month to discuss our settlement agreement and year compliance plan

Delaware Health and Social Services Accomplishments Delaware Psychiatric Center Received full three-year accreditation from the Joint Commission in September 2010 Hosted 53 total external surveys Full accreditation from CMS Revised Mission, Vision, and Values statements Reduced licensed beds from 381 to 200

Delaware Health and Social Services Accomplishments Delaware Psychiatric Center Created and deployed a Geriatric-Psych Outreach Team Developed an ongoing list of clients who are clinically ready for discharge; developing discharge plans with community providers Refocused the social worker’s role outside of DPC Closed the 32 bed psychiatric nursing home in May 2010, with the successful discharge of 30 clients requiring nursing home level care

Delaware Health and Social Services Accomplishments Delaware Psychiatric Center Revised all admission assessments Implemented a comprehensive Performance Improvement (PI) Department at DPC; national Joint Commission ORYX ® measures Implementing two evidence-based risk assessment scales for violence and suicide Implementing the Pyxis Medication Delivery System Developed new 14-bed co-occurring disorder unit for clients Implemented Peer Specialist Program

Delaware Health and Social Services Accomplishments Delaware Psychiatric Center Secured a Labor Relations specialist to track/manage employee performance issues Staff trained by staff from Boston University's (BU) Department of Psychiatric Rehabilitation Key new hires: Director of Nursing Services and Director of Professional Services Initiated MANDT system training that focuses on building positive, stable relationships with clients

Delaware Health and Social Services Average Length of Stay DPC Long-Term Units (community resources lacking) DPC Acute Care Units (community resources available) DPC Unit ALOS Jan 2009 ALOS Jan 2011 Change Kent days32.5 days-37.8 days Sussex 269 days39.8 days-29.2 days Sussex years12.46 years-1.95 years DPC Unit ALOS Jan 2009 ALOS Jan 2011 Change Kent years7.79 years+.45 years Sussex years10.36 years+1.92 years ALOS = Average Length of Stay

Delaware Health and Social Services Delaware Psychiatric Center Seclusion & Restraint Events * The 2010 numbers pictured above do not include 1 outlier (client XX). Of the 39 total seclusion events hospital –wide (2010), client XX accounted for 34 of the 39 events.

Delaware Health and Social Services DPC Average Daily Census by Month January 2007 through December 2010

Delaware Health and Social Services Delaware Psychiatric Center Average Daily Census State Fiscal Year

Delaware Health and Social Services Delaware Psychiatric Center Administration of STAT Medications

Delaware Health and Social Services DPC Admissions

Delaware Health and Social Services DPC Discharges

Delaware Health and Social Services Delaware Psychiatric Center Adverse Events

Delaware Health and Social Services Governor’s Recommended Budget $3.5 million to support community placements for DPC clients Elimination or movement of 14 positions from the privatization of the state-run Newark MH clinic ($70.6 ) in community overtime and casual/seasonal reductions ($785.5) in other community salary savings ($300.0) reduction in community pharmacy due to cost saving initiatives Switch fund $700.0 from GF to ASF for community pharmacy

Delaware Health and Social Services Governor’s Recommended Budget ($455.0) decrease in community contractual services that can mostly be absorbed by federal grants ($277.5) Elimination of the Clinical Care Information System funding ($4,487.4) reduction in DPC operating funds including personnel, contractual, OT, supplies, and 8.0 FTEs due to movement of clients into the community

Delaware Health and Social Services Opportunities A poised and competent community provider network ready to revise, reorganize and get creative to meet state needs Continued strong support from federal partners through grants and technical assistance Growing base of talented Peer Support Specialists who have already improved treatment services at DPC Strong support from DHSS, Deputy Attorney General and the Governor’s office to make change occur New monies will allow DSAMH to develop integrated community homes and services for Delaware citizens

Delaware Health and Social Services Challenges Normalization of the Peer Specialist role within all community provider organizations Need for increased co-occurring, competent community placements Need to identify where the DSAMH system of care can be reorganized to take advantage of federal dollars and built-in incentive based contracting Create community services for current DPC clients that include apartments that are independent with wrap around/peer specialist auxiliary staff; smaller group homes that address higher acuity consumers

Delaware Health and Social Services Challenges Need to prepare for national Health Care Reform Need for Targeted Care Management services statewide Need for continued supervisory staff training at DPC Need to improve/maintain morale and retention of talented staff in all settings Need to implement electronic record keeping and maximize use of technology for providing services in community and at DPC

Delaware Health and Social Services QUESTIONS? Kevin Huckshorn, RN, MSN, CADC (Div Dir) Melissa A. Smith, MA (Dep Div Dir) Steven Dettwyler, PhD (Dir Community Services)

Delaware Health and Social Services Thank you very much!