1. EXTENDED OBSERVATION: A CASE FOR DIVERSION Beth Lawson, MBA Associate CEO for Administrative Operations September 23, 2015 RHP12 Regional Learning Collaborative

2. September 23, 2015 Extended Observation: A Case for Diversion Community Needs Assessment ID# Critical Need 2: Lack of mental health services, inability to get an appointment, lack of insurance, need to use emergency rooms for initial contact When a person lacks resources, first responders are limited in options to assist, often an ER, Jail or Inpatient Hospitalization are the only choices.

3. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion OPTIONS?

4. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Why Diversion? Top 10 Complaints in Primary Care Clinics 40% of ALL visits: chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain and numbness In only 26% of these visits, practitioner can identify a biological cause. Info from www.integratedprimarycare.com/patients%20present.htm

5. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Why Diversion? *Refers to all adults with and without chronic conditions. Information from US Dept Health & Human Services. 2002/2003 MEPS, AHRQ, Rockville, MD Chronic Condition Annual Medical Cost WITHOUT a Mental Health Condition Annual Medical Cost WITH a Mental Health Condition All Adults*$1,913$3,545 Heart Condition4,6976,919 High Blood Pressure3,4815,492 Asthma2,9084,028 Diabetes4,1725,559

6. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Why Diversion? Source: March 20, 2013 Correctional News Daily Cost to House an Inmate in the Lubbock County Jail WITHOUT a Mental Health Condition Daily Cost to House an Inmate in the Lubbock County Jail WITH a Mental Health Condition $65$137

7. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Why Diversion? Source: www.hindawi.com/journals/emi/2012/360308/www.hindawi.com/journals/emi/2012/360308/ Wake Forest University Health Sciences, Winston-Salem, NC. June 2002 Cost to Serve a Person in a Mental Health Crisis in an Emergency Room Cost to Serve a Person NOT in a Mental Health Crisis in the Emergency Room $2,264$1,198

8. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Services and Target Population WALK-IN & FIELD-BASED CRISIS SERVICES Purpose: Psychiatric Crisis Resolution and linkage to appropriate after care for ALL ages. Diversion from emergency room, jail, inpatient hospitalization Description: 24/7/365 availability of behavioral health professionals (most are licensed) to provide face-to-face assessment, evaluation and crisis resolution services, including emergent/urgent care, crisis follow-up and relapse prevention

9. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Walk-In & Field-Based Crisis Services 1115 Transformation Waiver Expanded StarCare’s Existing Mobile Crisis Outreach by: Adding 24/7/365 On-Site, Awake Staff Adding Capability to see Walk-ins DY4 = 1 Year of Operations = 321 After Hours Contacts = 172 Total Diversions (no higher level of care)

10. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Walk-In & Field-Based Crisis Services Director: Bobby Carter Crisis HOTLINE: 806-740-1414 800-687-7581

11. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Services and Target Population 23-hour Extended Observation Purpose: Psychiatric Crisis Resolution Diversion from Emergency Room and/or Inpatient Hospital Adults (18yrs or older) only Description: 24/7/365 availability Psychiatric assessment, medication administration, supervision and monitoring, discharge to community care

12. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation Repurposed Existing Space

13. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation Repurposed Existing Space

14. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation Repurposed Existing Space

15. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation Repurposed Existing Space

16. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation Ribbon Cutting!

17. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation Ribbon Cutting!

18. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation 1115 Transformation Waiver Made NEW Service Possible DY4 = 1 Year of Operations = 525 Admissions = 431 Unique People Helped To Access (Crisis Team): 806-740-1414 800-687-7581

19. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion 23-Hour Extended Observation Annette Gary, Assoc. CEO Clinical Programs Leonard Valderaz, Director Crisis/Forensic Services Rhonda Trent, Program Director

20. RHP12 Regional Learning Collaborative September 23, 2015 Extended Observation: A Case for Diversion Services and Target Population 14-Day Extended Care for Adults Purpose: Treatment monitoring for people discharged from a more intense level of care (ie, inpatient hospital or 23-hr extended observation) Description:So far – Total Pipe Dream

21. EXTENDED OBSERVATION: A CASE FOR DIVERSION Beth Lawson, Associate CEO for Administrative Operations StarCare Specialty Health System P.O. Box 2828 Lubbock, TX 79408-2828 c: 806-441-1542 blawson@starcarelubbock.org RHP12 Regional Learning Collaborative September 23, 2015

22. EXTENDED OBSERVATION: A CASE FOR DIVERSION Beth Lawson, MBA Associate CEO for Administrative Operations September 23, 2015 RHP12 Regional Learning Collaborative