1. Crisis Residential Best Practices Toolkit
June 21, 2017

2. Today’s Agenda Welcome
Crisis Program Spotlight: Netcare Access Crisis Stabilization Unit- Miles House (OH)
Content Overview: Funding
Review Survey Results/Discussion
Review Project Plan and Timeline
Adjourn
Housekeeping: Using Skype for questions—please mute us, but don’t put our call on hold
Purpose: To develop a comprehensive Best Practice Toolkit for Crisis Residential Services, informed by Crisis Residential providers across the country.

3. www.TBDSolutions.com Crisis Program Development Quality Improvement
Research & Analysis
Integrated Care Coordination
Data Analytics
System Redesign
Middle Management Training
Metrics Development

4. www.TBDSolutions.com Save the Date!
Innovative Practices in Effective Management Tuesday, July 18th 1pm-2pm EST Free Webinar
/Meeting Invitation Week of June 26

5. Workgroup Participants
115 participants from 35 states
Plus England and Costa Rica
Approximately 300 crisis homes exist nationwide
Welcome new participants from KY, MN, SD, VA, TX, CA, and PA

6. Crisis Program Spotlight: Netcare Access CSU
Legislative efforts in California and Colorado have brought about significant improvements and funding in the Crisis Services Continuum.

7. Netcare Access Crisis Stabilization Unit Miles House
Carrie Wirick, LPCC-S
Director, Community and Residential Treatment

8. Netcare Access Crisis Services for Franklin County
Franklin County is 1.32 million
City of Columbus is 832,000 of that
Most populated city in Ohio

9. Netcare Access Emergency Response Service (Crisis Phone/Chat line)
Crisis (Psychiatric Emergency Services)
Crisis Stabilization Unit
Miles House

10. Netcare Crisis Stabilization Unit (CSU)
10 beds
Up to 5 hours group per day
Adult men and women
Primary Mental Health
Alternative to psychiatric hospitalization
Max 7 day stay, ALOS 3.5 days

11. Netcare Crisis Stabilization Unit (CSU)
680 clients served per year
Gym, Courtyard, Yoga
Daily MD/NP,
24/7 nurses (LPN and RN)
Social Workers, Counselors, Peers, Techs
Illness Management and Recovery
Skills from DBT

12. Netcare Miles House 9 beds Group 4 hours per day Adult Men and Women
Primary Mental Health
Step down from CSU and psych hospital
Max stay up to 16 days, ALOS 13 days
233 clients served per year

13. Netcare Miles House
Come and go, on bus line, get 5 bus passes per stay
Link to opportunity for transitional housing
Illness management and recovery
Connect with supports in community
Daily part time RN
24/7 staff
Social Workers, Counselors, Peers, Techs

14. Funding for Netcare CSU and Miles House
Ohio has a system where county boards run tax levies based on property taxes. Voters approve tax levies.
Our county board funds treatment for individuals without insurance, and pays some for what insurance won’t pay for.

15. Funding for Netcare CSU and Miles House
Netcare has negotiated contracts with some managed care providers.
In flux because of Medicaid Expansion

16. ACA and how it affects Netcare
Ohio was a Medicaid Expansion state.
Lots of Medicaid subscribers, too few hospital beds caused gridlock in Netcare’s Crisis center, spilling into CSU.

17. ACA and how it affects Netcare
Now hospitals are adding approx 200 beds.
Netcare is getting in contract with some Managed Care Medicaid.
Congress may cut Medicaid expansion

18. Challenges for Netcare
Staffing, turnover
Opiate epidemic
Housing shortage

19. New exciting things for Netcare
Use of Peers
New hospitals will mean more choices for clients.
Funder to rehab the appearance of CSU
Zero Suicide Initiative

20. Questions?
Carrie Wirick

21. Content Review: Funding
December 2016: Staffing
January 2017: Scope & Function
February: Metrics & Outcomes
March: Taxonomy & Community Relations
April: Treatment Philosophy & Approach
May: Intake
June: Funding

22. Funding Survey Results: Sources of Funding
Other Funding Sources (32%)
Regional Funding
Consulting Fees
Commissioner’s Court
Private Insurance
1115 Waiver
Self-Pay Clients at sliding scale rate
n=28

23. Funding Survey Results: Referral Sources
“We bundle all we can, but if an individual doesn't get prior approval for Crisis Residential we bill Medicaid for the services we can.”
“We maintain a per diem rate with some managed medicaid providers.”
n=28

24. Funding Survey Results: Cost Settling
Yes = 5
No= 12
n=28

25. Funding Survey Results: Contracting with Private Health Plans
Private Health Plans contracting for Crisis Residential Services:
Magellan Carefirst BCBS
Kaiser
Anthem Blue Cross Blue Shield
n=28

26. Funding Survey Results: Diversifying Funding Streams
Other Responses:
“Direct admissions from several referral sources by bypassing the screening assessment”
“Initially supported with county funds, and have recently used state non-Medicaid and Medicaid funds to support the program services.”
n=28

27. Funding Survey Results: Decreasing Costs

28. Funding Survey Results: Decreasing Costs
“Consulting Services helps fund additional services”
“Closely managing all expenses”
“We operate on a shoestring budget and always have”
“Furlough days for all staff; plan to increase use of interns”
“Purchasing, including food service products, is now centralized and monitored from our main office.”
“Applied for local grants for food, hygiene products, clothing items.”
n=28

29. Funding Survey Results: Sustainability Amidst Challenges
“Our Center has deemed the CRU a “core program” in our crisis services. This helps ensure that we will receive funding in the future. We are also CARF accredited and this carries weight with the county and state in their funding decision-making”
Managing overtime, monitoring inventory and supplies, contracted with a community hospital partner and got our space rent-free.”
“Using grants to pay for capital improvement.”
“Required service to provide due to contract and mental health code.”
Improvise—plus we try to do as much of the routine maintenance as possible.”
“Outcome incentives.”
“Collaboration to promote positive relationships.”

30. Funding: Part 2- Private Health Plans & Crisis Services
Private Health Plans & Crisis Programs: Developing Lasting Partnerships
Webinar
2nd Week in July- Date TBD

31. Upcoming Webinar Training: SAMHSA
4th Monday of each month April-September
Monday June 26th
3pm EST/12pm PST

32. Next Steps
Next Conference Calls: Friday, July 1pm EST/10am PST (Topic: Crisis Programs & The Safety Net) Wednesday, August 2pm EST/11am PST Group Listserv: Website: (Meeting Slides stored here) Questions: