1. KARE Center NIATx Beds
Change Leaders: Andrea Buckley & Lauren Giannakopoulos
Niatx team: Eunice Boatin, Kristin Palmer, Jeni Parkinson, & tarus Griffin

2. AIMS and Baseline data
Reduce amount of Emergency Detentions that do not result in court orders. In 2017, approximately 36% of EDs did not result in court orders.
Reduce the amount of EDs on consumers who initially present seeking voluntary hospitalization but no voluntary beds available (In 2017, 25% of all unnecessary EDs were on consumers initially seeking voluntary. This accounted for approximately 7% of all EDs)
Baseline Measure: 304 total EDs in 2017, 110 of 304 did not result in court orders. 30 of the 110 were conversions, change of venues or legal drops leaving 80 EDs that were deemed unnecessary. 20 of those 80 EDs originally presented to ER seeking voluntary hospitalization but no beds were available.
Total Emergency Detentions: 304
Move to More Restrictive: 29
New Orders: 163
Unknown: 2
Remaining (not placed on orders): 110
55/non-resident/legal drop: 30
Remaining: 80
Attempted Voluntary, no beds available: 20
Refused Voluntary: 32
Not Appropriate/jail: 12
Unknown: 16

3. Baseline Data Continued: 2018
2018 (January 1, 2018-May 31, 2018)
Total Emergency Detentions: 109
Move to More Restrictive: 19
New Orders: 56
Remaining (not placed on orders): 34
Non-resident/change of venue/co. to WI/conversions to 55/legal drop: 10
Remaining: 24
Attempted Voluntary, no beds available: 4
Refused Voluntary: 7
Not appropriate/jail: 8
Unknown: 5

4. THE CHANGE  NIATx BEDS (June 1, 2018-June 30, 2018)
Utilized two additional “emergency” NIATx beds for individuals who sought voluntary hospitalization but no beds were available and would then be at risk for being detained
Implemented NIATx bed procedure and script for Adult Crisis Workers
Implemented mandatory psychiatric provider visit at the KARE Center the next business day
Offered crisis case management referral, and, if refused, Adult Crisis follow up
Crisis NIATx Bed Procedure
Resources: 2 additional KARE Center beds to utilize as an “emergency” bed effective from 06/01-06/30
Bed 1-11: “general” bed, Bed 12-13: “NIATx” bed
Who Can use NIATx Beds
adults who have been assessed by AC to be KC appropriate
attempted to seek voluntary hospitalization but no voluntary beds were available, now risk ED
Excludes individuals seeking social detox, step down, or who were otherwise diverted to KC
Adult Crisis Procedure:
AC received crisis call. Proceed as normal with assessment using normal diversion techniques. Consumer may agree to go voluntary. Consumer should be directed to ER if not already there.
AC may then receive request from ER to do an assessment or re-assess for possible chapter for consumer who sought voluntary hospitalization but no voluntary beds were available.
AC will contact on-call supervisor to staff case and get permission to utilize NIATx bed.
AC responds to ER with script (see back) to present new option of using NIATx bed and to discuss other “option” of being ED.
If consumer is agreeable to using NIATx bed, proceed with normal KC admission procedure but clarify that this will be an admission to the NIATx bed. If consumer is not agreeable, continue with assessment.
KARE Center Procedure:
Crisis staff (AC and KC) will staff consumer’s case daily at Debriefing to determine when they can be moved to general bed or go home with safety plan. Data will be recorded by Kristin Palmer.
Prescribers (APNP Brenda Stallbaum and Dr. McCarthy) prioritize consumers in the NIATx beds
Consumer will be referred to Crisis case management by KC staff and will be assigned by Jeni Parkinson. AC Tarus Griffin will act as back up to crisis case management as needed.

5. The Results NIATx Beds Utilized: 11
Emergency Detentions from NIATx consumers: 1
Average Length of stay: 3.4 days
9 of 11 saw providers next business day
5 referred to CCM, 1 already in CCS, 1 was detained, 3 refused and had AC follow up
One family care referral
Total Emergency Detention: 30
Move to More Restrictive: 4
New Orders: 19
Remaining: 7
Change of venue/medical drop/legal drop: 6
Remaining: 1
Attempted voluntary, no beds available: 0
Refuse Voluntary: 1
Engagement for CCM: 4 with engagement with CCM, plus CCS consumer already engaged

6. Next Steps: Adopt
KARE Center scheduled to received funding for 16 beds. KHDS should consider implementing at least 1 permanent reserved bed as an alternative to emergency detention.
Since April 2018, there were 6 instances where 5 or more consumers were unable to utilize KARE Center services due to beds being full.

7. Emergency Detentions Data since June 2018
July
August
September
Total Detentions: 35
New orders: 22
1 of 22 presented seeking voluntary admission
MTMR: 4
Non-residents: 2
No orders: 7
Refused voluntary: 4
Unknown: 2
Sought voluntary but not bed available: 1
Total Detentions: 29
New Orders: 11
MTMR: 8
Non Residents/Conversion to 55: 1
No Orders: 9
Refuse voluntary: 5
Unknown: 1
Sought voluntary but no bed available: 3
New Orders: 18
MTMR: 3
No Orders: 13
Refuse voluntary: 7
Sought voluntary but no bed available: 5
Total Detentions: 29
New Orders: 11
MTMR: 8
Non Residents/Conversion to 55: 1
No Orders: 9
Refuse voluntary: 5
Unknown: 1
Sought voluntary but no bed available: 3
9 unnecessary Emergency Detentions since June

8. Impact
Costs
Benefits
Average cost per day at WMHI: $1,000+
Congestion
Court scheduling
Emergency Rooms
Cost to law enforcement
Transport at time of emergency detention
Transport to court
KHDS discharge planning for consumers not on orders
Reimbursement for KARE Center clients who have MA
Uphold right of consumer who initially sought voluntary by keeping them in the least restrictive environment
Referred to KHDS programs and other community resources, additional revenue
Can build trust in the agency and make consumers aware of services offered
PER DAY INPATIENT RATE MENDOTA WINNEBAGO
Adult Psychiatric Services $1,039 $1,039
Geropsychiatric 1,052 NA
Child/Adolescent NA 1,100
Forensic (all security levels) 1,039 1,039
Emergency Detention Add-On
First three days of service (plus intervening
weekends and legal holidays)
Non-typical Services Add-On

9. Next steps
Obtain approval for adoption of permanent reserved bed as an alternative to emergency detention
Continue to provide alternatives to emergency detention/hospitalization
Reviewing KHDS’ use of crisis plans as second project
***in 2019 proposed budget to go form 11 to 16!!!