WELCOME Allegheny HealthChoices, Inc. 1 Celebrating Life in the Community

2 Mayview Regional Service Area Plan Stakeholder’s Meeting Allegheny HealthChoices, Inc. December 18, 2009

Overview of Today’s Presentation Part 1: How have recommended/planned services changed over time as reflected in the Community Support Plans (CSPs)? Part 2: Summary of Mayview Discharge Study Progress Report—How are people doing? 3

Part 1 – We Asked Four Questions 1. Are the recommended services and supports that were identified at discharge different from current recommendations? 2. What services are people actually accessing? 3. What types of early warning signs and critical incidents are occurring for individuals? 4. Are people maintaining their housing? Have there been changes to the level of restrictiveness since their discharge? 4 Allegheny HealthChoices, Inc.

Data Sources Baseline Community Support Plans (CSPs) (297) Updated CSPs (244) Monthly CSP tracking reports Data on the actual services delivered based on provider claims AHCI CTT application The Mayview residential tracking system The early warning/critical incident tracking system 5 Allegheny HealthChoices, Inc.

Q1: Are the recommended services and supports that were identified at discharge different from current recommendations? Overview – Recommendations generally remain consistent from discharge – Some changes in the recommended use of CTT and CM/SC in Allegheny and the suburban counties – Shifts in recommended frequency of contact represent a better understanding of needed and desired support – All individuals have a crisis plan – Other services and supports indicate small changes Allegheny HealthChoices, Inc. 6

7 CTT: Shift from Daily to 4-6 and 2-3/wk CM/SC: Shift from Weekly to 2-3/wk, semi-monthly, and monthly

Benefits, income, and representative payees Few changes in areas related to employment and education Interest in hobbies and leisure activities remains high, with an increase in people who want to pursue activities on their own Social supports – families and peers Transportation – mostly providers Allegheny HealthChoices, Inc. 8 Other Supports and Services

Q2: What services are people actually accessing? Other than a slight reduction when “Daily” is recommended, actual CTT contacts are consistent with recommendations Actual CM/SC contacts often occurred more frequently than recommended Most people received CTT services, with others receiving CM/SC CTTs provide a wide array of services, including psychiatric services and supports, crisis services, drug and alcohol therapy, peer support, med management, and vocational rehabilitation 97% of people had at least one visit with a medical doctor. Allegheny HealthChoices, Inc. 9

CTTs provide crisis services – 64 people totaling 662 events Individuals receiving CM/SC had lower utilization of crisis services – 7 people totaling 48 events. CTTs – Work with individuals who may need more support – Provide on-call coverage 24/7 – including when a person goes to hospital Similar contacts may not be “crisis” contacts for CM/SC Allegheny HealthChoices, Inc. 10 Summary of Crisis Services from January 1, 2009 through June 30, 2009 for People Receiving CTT and CM/SC

Q3: What types of early warning signs and critical incidents are occurring for individuals? From January 1, 2009 through September 30, 2009 Most common early warning signs – Refusal to Take Medications-Posing Risk: 21.6 avg/month – Atypical Behavior–Change from Baseline: 16.9 avg/month – E/R Visit-Behavioral/Physical Health: 16.3 avg/month Most common critical incidents – Medical Hospitalization: 11.2 avg/month – Community Hosp–Involuntary: 8.0 avg/month – Other Incident-Serious Nature: 7.4 avg/month Allegheny HealthChoices, Inc. 11

Other Critical Incidents Psychiatric hospitalizations – 69 (22%) people, 195 hospitalizations – ALOS 28 days (3 outliers excluded) Incarcerations – 24 (8%) people, 42 events – ALSO 35.9 days (1 outlier excluded) Deaths – 10 (3%) people: 6 from natural causes, 2 accidental, and 2 suicides Allegheny HealthChoices, Inc. 12

Q4: Are people maintaining their housing? Have there been changes to the level of restrictiveness since their discharge? 62 of 244 people (25%) changed their type of housing between their discharge date and August 31, 2009 No one became homeless 29 people moved to less restrictive housing 20 people moved to more restrictive housing 13 people moved to same level of restrictiveness in housing Allegheny HealthChoices, Inc. 13

Summary, Discussion, and Recommendations CM/SC in suburban counties – although there are often multiple contacts per week Level of interest in employment and education Social and community integration beyond residential programs Families and peers continue to provide support Mobility within community beyond using providers for primary transportation Crisis utilization for those receiving CM/SC Ongoing emphasis on physical health needs Assessment of quality of life and general satisfaction 14 Allegheny HealthChoices, Inc.

Mayview Discharge Study Progress Report Part 2 15 Allegheny HealthChoices, Inc.

Mayview Discharge Study “Eyes-on” procedures supplement administrative data – Observations, “check-ins” and interviews – Small set of well-accepted standardized surveys 16 Allegheny HealthChoices, Inc.

Design Visit participants every three months until two years after their discharge – Observations every visit – Surveys every other visit (every six months) – Interviews when the participant prefers 17 Allegheny HealthChoices, Inc.

Qualitative and Quantitative Data Observations Interviews Scales 18 Allegheny HealthChoices, Inc.

Participants Random sample of 90 people involved in CSP process – Recruited 66 (73%) Discharge dates from 8/07 – 12/08 Some people recruited in the hospital, some people recruited after discharge 19 Allegheny HealthChoices, Inc.

How are people doing? What they tell us, and what we see People tell us they are really happy to be out of Mayview We see people in settings that are comfortable and pleasant People were mostly satisfied with the discharge process People see providers often Some people are more active socially than others 20 Allegheny HealthChoices, Inc.

“The Freedom Factor” Participants consistently express the view that discharge represented emancipation, not eviction – Interviewer: Compare where you are now with being at Mayview. – Participant: No comparison. It’s better…it’s the freedom factor. I don’t like Mayview. It is like a penitentiary almost. – Interviewer: what do you think about when you see these pictures [of Mayview]? – Participant: It reminds me of the penitentiary. – Interviewer: What changed for you when you came here? – P: You have more freedom. 21 Allegheny HealthChoices, Inc.

View of Discharge Process The CSP process, when it is remembered, is seen as generally positive, though people did not always feel deeply involved – Did you get to pick this place or did someone pick it for you? – Someone picked it for me. – Did you have any say in whether you wanted to live here? – No I didn’t. But I knew when I came here I was going to like it. I said “Hallelujah! I am getting the hell out of here”. – Did you have CSP meetings? – Yeah. I had 3 or 4 of them. – Interviewer: How was that for you? – It was alright. It was at my last CSP meeting that I was told I was coming here. – Did you feel like you got to say what you wanted in those meetings? – Yeah. – Did you feel like they took account of what you said? – Yes they did. 22 Allegheny HealthChoices, Inc.

Contact with Service Providers Participants report regular and generally satisfactory contact with providers – I just saw him [psychiatrist] recently and will see him again in another month. [I see my case manager] just about every day. I like seeing my case manager. Some days, they don’t come. The staff [at the PCH] says I get to see my case manager more in a week than some people do in a month. I have 24 hour access to my case manager. I can call her whenever I need help or need to talk. 23 Allegheny HealthChoices, Inc.

Social Networks Some people report very active social lives. Others report that most social contact is with providers, but not everyone seems dissatisfied with this – Who helps you the most/best? – These people here [staff]. – Do you have a peer mentor? Have you seen your peer mentor? – Yes – ….. I’ve seen her several times. She comes twice a week. – Has anyone visited you? – My mother was here once. It was all right. I would like to get visitors. 24 Allegheny HealthChoices, Inc.

Quantitative Findings Quantitative analyses show a consistent pattern that levels are maintained over time. This is true for symptoms (BPRS), Quality of Life (WHOQOL) and Recovery (RAS). 25 Allegheny HealthChoices, Inc.

Summary Qualitative data suggest people are doing well. Quantitative data show that symptoms and quality of life are maintained, if not improved, over time – Do you miss anyone from Mayview? – That’s not even on my mind. I don’t even think of Mayview any more. … I’m cool, calm, and collected. 26 Allegheny HealthChoices, Inc.