1. Statewide Quarterly RTC Meeting September 14, 2010

2. Agenda Utilization Data Review
AWOL/Arrest/Seclusion and Restraint Reduction Data – Risk Management
RTC Performance Initiative

3. RTC Utilization Analysis Quarterly Summary Q2 ‘10

4. Utilization, Demand & Capacity, by Diagnostic Tier

5. In-State RTC System Overview
Q1’10 was 361 beds: loss of Grey Lodge psych beds (18) by 6/30/10 and effective 4/1/10 decreased CHOC psych to 37 (from 49)
Beds primarily used by DCF in Connecticut

6. Utilization, Demand & Capacity by Diagnostic Tier
Five diagnostic tiers/categories are tiered in the following order:
Fire Starters &/or Sex Offending
MR/PDD
Conduct Dx / Explosive / Disruptive / JJ
Substance Abuse
Psychiatric
“Youth in RTC”: The # of youth occupying a bed.
In-State Maximum Capacity: Determined by using the maximum # of licensed In-State beds/per quarter available to, and generally used by, DCF (capacity does not include High Meadows or CCP). Capacities are titrated using weighted averages if program partially open during quarter.
In-State Average Available Capacity: The average # of available In-State empty bed(s) per quarter per the provider’s weekly census.
Example: Youth w/MR/PDD and Psych diagnoses will appear in MR/PDD data, as MR/PDD is tiered higher than Psych.
Note: The provider’s weekly census may reflect an “available capacity” greater than that which will be used by DCF.

7. Residential
Admissions

8. Demographics by Tier for Q2 ‘10
Total
Admits
Total Male
Admits/%
Total Female Admits/%
Ave Age At Admit/ Youth in Care
Male
Female
0-12 yr old
Fire Starters/
Sex Offending 8
8 /100% OOS
8/ 100%
0 / 0%
15.0 / 14.9
n/a / 13.2 2
2 OOS
MR/PDD
5 / 63% OOS
7 / 88%
1 / 13%
13.9 / 14.5
13.0 / 14.7
Conduct Dx/ JJ 53
13 / 25%
OOS
36 / 68%
17 / 32%
15.3 / 15
15.1 / 14.9 1
0 OOS
Substance
Abuse 10
1 / 10% OOS
3 / 30%
7 / 70%
16.3 / 15.6
15.6 / 15.4
Psychiatric 64
25 / 39% OOS
29 / 45%
35 / 55%
14.8 / 14.3
14.9 / 14.7 6
3 Instate
3 OOS
Grand Total Admits = 143

9. Comparison of Admissions In-State & Out of State, By Tier
Grand Total Admits = 143

10. Comparison of Admissions By Age, By Tier
Grand Total Admits = 143

11. Comparison of Admissions By Gender, By Tier
Grand Total Admits = 143

12. RTC Admissions & Discharges
YTD 2010 Admits= 280
YTD 2010 Discharges= 324
Discharge count includes d/c’s from Shelter for Women-Gray Lodge

13. Tier Data

14. Unique Youth in RTC Q2 ’08, CY 2009 & & Q1& 2 ‘10
Below is trend line for the number of unique youth in RTC level of care, per Quarter, and by Diagnostic tier. Q2 ’08 is shown for comparison purposes.
Psychiatric and Conduct Disorder / Explosive /JJ tiers continue to remain higher than other tiers.
“Unique” = youth counted only once during Quarter even if admitted to RTC x2 or more during same Quarter

15. Fire Starters / Sex Offending
Unique members in care count is consistent with previous two quarters.
Admission count is low in Q2 ’10 compared with other quarters

16. MR / PDD
Q2 ’10 Youth in care count is consistent with the previous quarter.
Number of admissions is low in Q2 ’10 but consistent with Q2 counts of previous reporting years.
Final beds closure at High Meadow in Feb 2010

17. Break-out of MR & PDD Diagnosis
75% to 78% of the total MR/PDD population had an MR diagnosis for each time segment below

18. Conduct Disorder / JJ
Decrease in youth in care continues for Conduct/JJ tier in Q2 ’10.
Admission count in Q2 ’10 is higher than previous two quarters, however, remains lower than historical numbers.

19. Substance Abuse
Number of youth in care has returned to historical numbers.
Admissions are down by 41% from Q1 ’10.

20. Psychiatric
Decrease in average available capacity- Primarily due to decrease of 30 beds assigned to this quarter.
Increase is OOS Admissions- 39% of all admits in Psychiatric tier are to OOS providers.

21. Youth 0-12

22. Youth in RTC – 0-12 yrs old
Linear regression line shows a continued decrease since Q3 ’08 to Q2 ’09, with a continued leveling off up to Q2 ’10 for youth 0-12 years old in RTC

23. Admissions yrs old
Majority of youth in this age range admitted In-State and OOS are 11 & 12 years old
6.3% of all RTC admissions in Q2 ‘10 are age range 0-12 yrs old

24. RTC Average Length of Stay by age at admission for YTD 2010
40% longer ALOS for 0-12 yr old youth compared to yr old youth in Q2 ’10. (CY2008: ALOS for 0-12 yr old youth was 29% longer, CY2009 ALOS was 31% longer)
Based on total discharges (313) in YTD 2010.
D/C count here excludes discharges from Shelter for Women

25. RTC Admissions
In-State and OOS

26. Admissions Only – In-State & OOS
Need remains consistent for In-State RTCs to treat currently referred OOS youth, as the trend for OOS admits has remained fairly constant, while In-State admits have decreased overall
Q1 ’10 was: In-State = 81 admits / 59% , OOS = 56 admits / 41% , total = 137 In-State + OOS admits
Q2 ‘10: In-State = 91 admits / 64%
OOS = 52 admits / 36%
Total = 143 In-State + OOS admits
Source: Tier Data

27. Residential
Average Length
of Stay Data

28. RTC In-State ALOS
During Q2 ’10, in-state average length of stay increased nine days or 3% from Q1 ’10. There is minimal change in ALOS when comparing YTD 2010 and CY 2009 (1% decrease).
2010 ALOS goal is 250 days
All diagnostic populations included in ALOS. ALOS based on actual discharges.
Shelter for Women has been removed from 2010 data, and Q1 data refreshed. YTD 2010 ALOS value with Shelter for Women included is 282 days.

29. RTC Out-of-State ALOS
Q2 ’10 ALOS decreased over 100 days (22%) from Q1 ’10
During Q2 ’10 OOS RTC Acute ALOS decreased 40 days making it the shortest Acute ALOS reported (Q1 ’09 forward)
All diagnostic populations included in ALOS
ALOS based on actual discharges

30. In-State and OOS ALOS Frequency Distribution
YTD 2010 D/C = 313
Shelter for Women d/c’s removed

31. In-State RTC Average Length of Stay by Facility Type

32. In-State RTC ALOS
RTCs are grouped according to the Primary Diagnostic population served by each In-State RTC
The groupings are an approximation (each facility type may treat youth classified in a different group at any given time)
ALOS calculations are based on discharges that occurred during the Quarter
A discharge occurring with an unusually long length of stay may significantly impact the ALOS during a quarter
For CY 2010 data, Shelter for Women-Gray Lodge Data has been removed

33. Primarily Psychiatric Population
Note: ALOS based on actual discharges

34. Primarily Substance Abuse / Dual Diagnosis Population
Note: ALOS based on actual discharges

35. Primarily JJ Population - Boys
Note: ALOS based on actual discharges

36. Primarily JJ Population - Girls
Note: ALOS based on actual discharges

37. Special Populations
Special Populations are for deaf and hearing impaired, MR and PDD
Note: ALOS based on actual discharges; 0 ALOS due to no discharges during Quarter

38. RTC ALOS by Gender
12% higher ALOS for males compared to females in Q2 ’10; during CY 2009, male ALOS was 40% longer than female ALOS.
Discharged facilities not included in ALOS info- therefore d/c are 698 for CY 2009
N’s for male : Q1 ‘09=78, Q2 ‘09=123, Q3 ‘09=109, Q4 ‘09=70, Q1 ’10=89, Q2 ’10=102
N’s for females: Q1 ‘09=75, Q2 ‘09=100, Q3 ‘09=84, Q4 ‘09=59, Q1 ’10=59, Q2 ’10=63

39. At-a-Glance: ALOS by Dx Tier for YTD 2010
Consistent with data presented in past RTC analysis, Fire Starter / Sex Offending youth remains the highest length of stay, with the Substance Abuse category remaining the lowest
YTD 2010 D/C = 313
Shelter for Women d/c’s removed

40. In-State and OOS Median Length of Stay
Median LOS for YTD 2010 for all cohorts & in-state and OOS combined : 298 days
Median LOS for:
Fire Starter / Sexually Offending youth: 454 days
MR / PDD youth: 301 days
Conduct Dx / JJ youth: 275 days
Substance Abusing youth: 205 days
Psychiatrically involved youth: 322 days
Source: Tier Reports

41. Discharge Delay

42. Discharge Delay in In-State RTC’s
9% decrease in average length of delay from CY 2009 to YTD 2010
Decrease in percent of cases in delay status during quarter (10B7 report) and cases discharged with delay days (8 in Q2 ’10- lowest # since reporting began Q1 ’08)
Awaiting placement remains the most common reason for delay in RTC, with the majority of members awaiting Group Home placements.

43. AWOL/Arrest/Seclusion and Restraint Reduction Data Risk Management

44. Each RTC represents 3 months of data, 6 months in the YTD ’10 slide
Q2 and YTD 2010 Annual Risk Management Data AWOLs, Police calls/EMS, Arrests, Restraints, Suicide Attempts
Calls to Police/Emergency Services do not include routine calls to police to report AWOLs. (Most agencies contact police to report AWOLS)
Each RTC represents 3 months of data, 6 months in the YTD ’10 slide
Risk Management data are primarily obtained through providers' self-reporting
Like providers are shaded similarly in the following slides
CCP is reported, but not part of statewide totals
Shelter for Women has been removed from calculations/reporting
Note: the “per bed” calculations on the following slides were based on beds primarily utilized by DCF (337 total beds). The 337 count differs from the 331 count on slide 5 because all JRI beds (DCF and DDS) are included in the 337 count.

45. RTC Risk Management Data- Q2 ‘10
Provider Name
Bed Capacity (DCF only)
AWOLS
AWOLS per bed
Police/ EMS Calls
Police Calls per bed
Arrests
Arrests per bed
Restraints
Restraints per bed
Suicide Attempts
Suicide Attempts per bed
CCOH 38 25
0.7 17
0.4 6
0.2 57
1.5 3
0.1
CHOC 49 8 29
0.6
0.0
JRI 21 51
2.4
KLINGBERG 42 15 12
0.3 5 23
0.5 2
MCCA 9 4 1
NEW HOPE MANOR 20 10
RUSHFORD
TLC
WATERFORD 40 37
0.9
WELLSPRING 14
MOUNT SAINT JOHN 32 7 18
NATCHAUG 13
2.5
STEPPING STONE 22 84
3.8
TOUCHSTONE 16
Statewide
337
110 77 34
345
1.0
CCP 48
0.8 19 11
183
Numbers are not unduplicated, i.e. more than one event may be attached to 1 youth

46. RTC Risk Management Data- YTD ‘10
Provider Name
Bed Capacity (DCF only)
AWOLS
AWOLS per bed
Police/ EMS Calls
Police Calls per bed
Arrests
Arrests per bed
Restraints
Restraints per bed
Suicide Attempts
Suicide Attempts per bed
CCOH 38 40
1.1 30
0.8 8
0.2 92
2.4 3
0.1
CHOC 49 35
0.7 14
0.3 7 96
2.0 1
0.0
JRI 21 89
4.2
KLINGBERG 42 23
0.5 6 76
1.8
MCCA 15 22
1.5 9
0.6
0.4
NEW HOPE MANOR 20 32
1.6
1.2 10
RUSHFORD 12
TLC
1.0
WATERFORD 85
2.1 2
WELLSPRING
MOUNT SAINT JOHN 11 41
1.3
NATCHAUG: JOURNEY HOUSE 13 4 33
2.5
STEPPING STONE
160
7.3
TOUCHSTONE 16 5 52
3.3
Statewide
337
186
146 62
741
2.2
CCP 48 63
383
8.0
Numbers are not unduplicated, i.e. more than one event may be attached to 1 youth

47. Number of AWOL’s per Bed – Q2 ‘10

48. Number of Police/EMS calls per bed- Q2 ‘10

49. Number of Arrests per bed- Q2 ‘10

50. Number of Restraints per Bed – Q2 ‘10

51. RTC Outcome Initiative

52. RTC Outcome Initiative
Site visits to share outcome and UM information were completed 7/29/10
Development of Provider Analysis and Outcome Incentive Programs

53. Questions