11 Mayview Regional Service Area Plan Stakeholder’s Meeting February 20, 2009

2 Agenda Update on the Mayview Regional Service Area Plan – Mary Fleming, Allegheny HealthChoices, Inc. Overview of Closure and Services for Discharged Individuals Inpatient Trends Resource Development Quality Oversight Panel of Individuals Discharged from Mayview Lessons Learned Exercise (we hear from you)

3 Mayview Project Timeline

4 Persons Discharged from Mayview 269 people were discharged with a community support plan 41% had a length of stay of 2 years or less 29% had a length of stay between 2 and 5 years 30% had a length of stay longer than 5 years For more than half of the group, this stay was at least their second admission to Mayview

5 Housing Arrangements at Discharge 84% of people were discharged to residences with 24-hour staff: – 26% to long-term structured residences (LTSRs) – 22% to different types of personal care homes – 19% to community residential rehabilitation (CRR) group homes or apartments – 17% other categories combined 16% were discharged to community settings without 24-hour staff – independent housing, living with family – permanent supported housing, supported housing

6 Housing Stability 19% of people who have been discharged at least three months have moved since their discharge. About two-thirds of persons moved to a less restrictive setting or setting with fewer supports.

7 Single Point of Accountability 72% of people were recommended for Community Treatment Teams (CTTs) in their CSPs 28% of people were recommended for case management/service coordination in CSPs CTTS and case managers are designated as the single point of accountability for individuals in the community

8 CTTs Are Providing Frequent Contacts For people receiving CTT services, 26% of people had 6-7 average contacts per week with CTT 33% had 4-5 average contacts per week 32% had 2-3 average contacts per week …during their first three months in the community.

9 Case Management/Service Coordinators Also Provide Frequent Contacts For people receiving case management/service coordination, 14% had contact with their case manager 4-5 times per week on average 41% had contact 2-3 times per week on average 26% had contact at least once per week on average …during their first three months in the community.

10 Use of Other BH Services .. Use of other behavioral health services with the exception of outpatient mental health has been low Given that CTT is a team-delivered comprehensive service, people with CTT should generally not need other behavioral health services

11 Access to Supports and Activities During First Three Months in Community 75% of people had contact with their peer mentor after discharge. Many peer mentors were involved during the CSP process. 20% of people visited drop-in centers 80% had some type of contact or support from family 40% used spiritual supports Very few people were either recommended or accessed vocational or educational activities

12 Incarcerations and Hospitalizations During people’s first three months in the community: – 3% were incarcerated – 6% had some psychiatric hospital days After the first three months in the community: – 7% of people were incarcerated – 17% had some psychiatric hospital days

13 Early Warning Signs and Critical Incidents New online database for reporting early warning signs and critical incidents began in June Since then: – 29% have had an early warning sign report. – 29% have had a critical incident. While it is premature to identify trends, providers are reporting incidents and counties are proactively working to address situations.

14 Inpatient Trends For the region, inpatient admissions have slowly decreased over the period. For the region, Average Length of Stay is rising slightly. Length of Stay in Extended Acute is approximately 115 days. Length of Stay on the Extended Acute Waiting List is about 73 days RTF-A Average Length of Stay is trending upward.

15 EAC and RTF-A Trends Length of Stay in Extended Acute is approximately 115 days Length of Stay on the Extended Acute Waiting List is about 73 days RTF-A Average Length of Stay and Median Length of stay are trending upward RTF-A Average Days on the Waiting List has dropped recently due to several discharges

16 Resource Development The counties have planned for the Mayview closure by investing funds in: Residential options Treatment services Supports and resources

17 New/Expanded Peer Support Peer mentors Warmline Peer specialists Recovery specialists (County staff)

18 New/Expanded Peer Support AlleghenyBeaverWashingtonLawrenceGreene Peer Mentors Warmline Peer Specialists Recovery Specialists Drop-in Center Note: These programs may already exist in the Counties, just not new or expanded with MRSAP

19 New/Expanded Community Services Community Treatment Teams (CTT), also known as Assertive Community Treatment (ACT) Enhanced Clinical Case Management (ECCM) Expanded Case Management/Service Coordination Mobile Medication Teams/Mobile Mental Health Expanded Outpatient Expanded Psychiatric Rehabilitation Crisis Services

20 New/Expanded Community Services AlleghenyBeaverWashingtonLawrenceGreene CTT/ACT ECCM Case mgmt./ Svc. Coord. Mobile Meds, Mobile MH Outpatient Psych Rehab * Crisis Svcs * Through a new Clubhouse program. Note: These programs may already exist in the Counties, just not new or expanded with MRSAP

21 New Residential Options Permanent Supportive Housing (PSH) and related services Comprehensive Mental Health/Enhanced Personal Care Homes (CMHPCH and EPCH) Long-term Structured Residences (LTSR) Specialized Supportive Housing (aka long-term residences) Extended Acute Services (EAC), both hospital and community-based Residential Treatment Facility for Adults (RTF-A) Other county-specific options

22 New Residential Options AlleghenyBeaverWashingtonLawrenceGreene Perm. SH CMHPCH/ EPCH ‡ LTSR † Spec. SH/ long-term res. † Ext. Acute * * * * RTF-A * * * * Other * Regional resources are being developed by the suburban counties † Includes state operated services that all counties will have access to ‡ While not all counties are developing, counties will have access to resources

23 Quality Assurance and Oversight Initiatives Quality Improvement and Outcomes (QIO) Sub- Committee – Includes consumers, family members, and professionals from the MRSAP Counties and State – Monitors and reviews data related to the MRSAP project, including but not limited to assessments, CSPs, satisfaction / quality of life surveys, and other evaluation components Quality Management and Clinical Consultation (QMCC) Team – Works collaboratively and in consultation with counties and providers to monitor the quality and effectiveness of services, the effective coordination of services, and development of staff expertise to meet the complex and changing clinical needs of consumers.

24 Quality Assurance and Oversight Initiatives Comprehensive Monthly CSP Tracking – Tracks 22 categories including benefits, housing, services, and social supports on a monthly basis for all CSP consumers Care Management Collaboration with CCBH – Follows identified high risk consumers – both HealthChoices and non-HealthChoices – Works closely with Allegheny County’s community integration team and the QMCC from the SOS Regional Reporting of Critical Incidents and Early Warning Indicators with Automated Notification Capability – Provides regional perspective of critical incidents – Integrates with other CSP tracking data – Offers ability to notify Counties and State immediately once entered into the system

25 Quality Assurance and Oversight Initiatives Failure Mode Effects Analysis (FMEA) – Proactively evaluates activities associated with the closure and works to develop contingencies to minimize risk to consumers, staff, and the community at large Root Cause Analysis (RCA) – Process that objectively and systematically reviews the contributing factors associated with certain critical incidents deemed “sentinel events” involving individuals within the Mayview Service Area

26 What have we learned from the closure? What is your general assessment of the closure? – What were the issues of greatest concern – What issues require the most attention – What worked? How can things be improved? If stakeholders from another state hospital area were thinking about a closure or big downsizing, what should they be most concerned about or pay extra attention to?

27 Ground Rules May use cards to write on or speak from mike Wait until you are called on Identify yourself before you speak Will call on folks who haven’t spoken as first priority Can’t discuss individual cases