Lafayette County Human Services Department Darlington, WI 2012 NIATx Project April 1, 2012 to September 30, 2012

AIM From , a review of our Emergency Mental Health Services or “Crisis” services indicated a baseline measure of an average of 41% of our emergency detention (ED) placements led to probable cause. That is, “probable cause" means that the individual is believed to be mentally ill or drug dependent or developmentally disabled and a danger to self and/or danger to others and/or unable to care for themselves. Risk must be imminent. So, less than half the time, we did not possess sufficiently trustworthy facts that led to probable cause. –Our AIM is to implement change that promotes effective transitions and increases continuation to the most appropriate level of care. –In 2010, we improved to 73% of ED placements that led to probable cause. –Lafayette County would like to improve to 80% of ED placements that lead to probable cause. How will you COLLECT DATA to measure the impact of change? –We gathered the number of eligible emergency detentions, the number of diversions, reviewed organizational structure and capacity, and reviewed individual cases for antecdotal information. What is the expected FINANCIAL IMPACT of this change project? How will the Executive Sponsor know? –To improve quality of services (e.g., make better decisions, provide community based services, etc.) –Staff are engaged around the urgency of placements, that is, the importance of connecting with clients and stakeholders. –To reduce the amount of expenditures on high end placements.

CHANGES - PDSA Plan: In 2011 we began reviewing and planning around improvements to our Emergency Mental Health Services (“Crisis”). Do: A crisis coordinator responsibilities were defined and the role implemented. –Trained or updated staff around emergency mental health or “crisis” services and assessment. –We added additional support and quality by improving the telephone service in our crisis system. –We added a optional stabilization bed and made arrangements with other adult family homes to offer additional resources. Study: The quality of the process and how decisions were being made about the emergency detentions and diversions. Act: In most cycles, we have adopted or adapted the work

Emergency Detentions (E.D.’s) Percent of hospital placements that led to probable cause YEARE.D.'s% to Probable Cause (Jan-June)140.86

Diversions Definition: 1. A law enforcement officer has identified that a person should go to a hospital behavioral health unit and after intervention by a crisis worker the person does not go to the hospital. 2. A person in crisis or a family member expresses that the person needs to go to a hospital behavioral health unit and after intervention by a crisis worker the person does not go to the hospital. 3. A person expresses suicidal intention and after intervention by a crisis worker the person does not go to the hospital. 4. A person presents with unstable behavior/emotions and crisis worker believes that the person would have gone to the hospital if they had not provided intervention.

Impact In 2011, we realized over $100,000 dollars in savings. And, with more formalized approach, believe to save more in 2012 We implemented additional safety measures and resources for citizens experiencing a mental health crisis.