1. WELCOME Building Community Connections: Regional Stakeholders Meeting June 17, 2011 1

2. Agenda for Meeting Update from DPW A two year view post closure Initial results from evaluation by University of Pittsburgh Strategies for Community Inclusion Discussion, questions, ….. 2

3. Update From DPW 3

4. Overview of Two Year Report Outcomes for People Discharged during the Mayview Closure – Housing – Services – Community Hospitalizations, EAC, RTFA – Work / Volunteer – Physical Health Service System Redesign – Planning and Oversight – Service Utilization and Cost Implications Conclusion and Future Directions 4 4

5. Housing at 12/31/2010 5 Housing Category Percent of People Living Independently or with Family 16% Supported Housing Programs 12% Supervised Group Settings 44% Long-Term Structured Residences 13% Nursing Homes 6% Community Psychiatric Hospital 2% Criminal Justice Facility 1% Source: monthly tracking reports completed by County monitors.

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7. Housing Stability and Satisfaction About 50% are living in same location as two years ago when the hospital closed 25% have moved once 25% have moved two or more times 73% of those who have moved, moved to a less restrictive setting Of those who completed a CFST satisfaction survey – 82% rate their housing as excellent – 73% are satisfied with their housing location 7

8. Satisfaction / Community Connections High levels of satisfaction with services and a higher quality of life compared to the state hospital Some people report needing additional services and supports to become more independent and increase connections to the community Peer support services have been helpful for many individuals 8

9. Case Management and CTT Use CTT – 190 Individuals – average 2.8 contacts per week All other Case Management – average 1 contact per week 19 people have administrative case management 9 people have no case management 9

10. Other Community Services - 2010 29% Outpatient services 17% Crisis services 11% Social rehabilitation services 10% Housing support services < 5% – Drug and alcohol – Partial hospitalization – Respite 10

11. HealthChoices (non-MRSAP) IP Admission Rates, 2006-2010 11

12. Community Inpatient, EAC, RTFA About 20% of people discharged from Mayview had community hospitalizations in either 2009 or 2010 The average length of stay in 2009 was 37 days, decreasing to 30 days in 2010; the number of days associated with inpatient stays decreased 14% from 2009 to 2010 Eight people (3%) discharged from Mayview have had an admission to EAC services in 2009 or 2010 Thirteen people (5%) discharged from Mayview have had an admission to a RTFA There’s been one civil commitment to Torrance State Hospital Half of the 21 people transferred to Torrance State Hospital have been discharged back to the community 12

13. HealthChoices IP Length of Stay, 2006-2010 (Includes MRSAP and non MRSAP) 13

14. Criminal Justice Involvement 22 people (8%) have been arrested since the closure, totaling 40 separate incidents In 35 of these incidents, people were incarcerated for varying amounts of time, and charges ranged from probation violation to disorderly conduct to more serious offenses like robbery Five arrests did not result in an incarceration 14

15. Work / Volunteer Activities 20% reported some work or volunteer activity. Many of these activities were informal employment or volunteer activities 50% of those not working reported being interested in working, and most feel ready to work A smaller proportion (23%) reported being interested in volunteering Counties have a number of initiatives to increase supported employment opportunities for their populations 15

16. Physical Health People discharged report good overall physical health and access to physical health care: 83% of people report they are in average or excellent physical health 75% report receiving regular routine physical health checkups, and 82% report having average or excellent access to physical health care 48% report receiving regular dental care, perhaps reflecting both accessibility issues and personal preferences for seeking regular dental care 16

17. Physical Health 19 people have died from natural causes/medical reasons since January 2009, and four other individuals have died from accidental causes Many people were discharged with complicated, chronic health conditions, and the median age at discharge was 48 years Many people in this population need significant medical care, and all need physical health care that is closely coordinated with behavioral health Only 46% of consumers report that their mental health provider communicates with their physical health provider 17

18. Service Utilization and Cost Implications Average costs per individuals range from $16,400 to $29,000 per year Provided services to approximately 1600 people in 2010 who potentially could have used MSH at an average cost of $32,000 annually 18

19. Conclusion Generally a successful transition to the community Higher quality of life and stable, community-based housing with varying amounts of support and access to mental and physical health treatment Fears that community hospitals and jails would become the new Mayview have been disproven Connections to the community – whether through employment, personal relationships, or activities – remains an unmet goal for many Physical health of many individuals, particularly as they age, must continue to be a priority 19

20. Future Directions As the region looks ahead, priorities will include: – Continuing to assure that people get the services they need, and that these services focus on recovery and achieving positive outcomes – Assuring ongoing funding to maintain adequate financial resources for the system – Maintaining the regional focus on recovery, quality monitoring and improvement, and data-driven decision-making – Improving cross-system planning and collaboration for special populations and those individuals with particularly complicated situations 20

21. Mayview Discharge Study Katie Greeno, University of Pittsburgh Sue Estroff, University of North Carolina Courtney Colonna Kuza, University of Pittsburgh 21

22. Outcomes after discharge It is valuable to know how people fare after discharge from long-stay hospitals – Understand the recovery process – Quality assurance for providers and policy makers This study used rigorous methods to document two-year outcomes for people discharged from Mayview 22

23. Method We followed 65 people over two years – They represented the whole group – Not every one participated at every time point We saw people every 3 months – Standardized assessments every other visit – Other visits focused on interviews 23

24. Study personnel Two senior faculty members and a very experience project director 10 interviewers – Pitt graduate students with direct practice experience – Extensive training from the project director – Supervised, then independent visits to participants – Weekly staff meetings Interviewers stayed with the same participants 24

25. Data collected 225 standardized assessments 138 interview based “check-ins” 41 in-depth “relocation interviews” Over 500 visits made to participants’ residences for these observations 25

26. Standardized measures Psychiatric symptoms – Improve over two years Social Contacts – Improve over two years Quality of Life – Stays the same – compares favorably to other groups Recovery assessments – Stays the same – about the same as other groups Perceptions of Care – Do not change over time – lower than other groups 26

27. Percent with at least moderate illness (BPRS >41) 27

28. Criteria for remission Remission of BRPS-rated psychotic symptoms – Seven symptoms related to psychosis Grandiosity, suspiciousness, unusual thought content, hallucinations, conceptual disorganization, blunted affect – Rated 3 (mild) or less for six months Additional criterion: – Overall BPRS < 31 for six months 28

29. Symptom Remission 50 participants had at least two standardized assessments in Year 2 of the study – We examined their last two observations 30 participants (60%) met this criterion for remission 24 participants (48%) met this criterion, and also had an overall BPRS score of 31 or less 29

30. See friends regularly (percent) 30

31. WHO Qol: Psychological Well-Being 31

32. WHOQol compared to other samples 32

33. WHOQol compared to other samples 33

34. POC: Interpersonal aspects of care 34

35. Would you recommend this facility? 35

36. Rate services from 1-10 (percent) 36

37. Interview and observational findings Participants prefer their new residences to Mayview Community integration is complex and longer term Housing will be an on-going concern 37

38. People are satisfied with their new residences New residences are preferred to the hospital – No comparison. It’s better. It’s the freedom factor – I’m free. I go more places. I do what I want to do. People feel safe and comfortable – Here, I am much more relaxed – I am much more comfortable – There are less people. If residents don’t get along, it gets taken care of by staff 38

39. Progress needed on community integration Many participants would welcome more varied activities – Q: What do you do? A: Sleep. Get up and watch TV. Come out here and smoke. – Q: What is there to do? A: Sleeping. Groups. That’s about all. – I don’t go anywhere. I don’t have any money. Some participants are very active – I am in the process of getting prepared to get a job. I’ll see what kinds of things I want to do. 39

40. Housing is a continuing concern Some people adjust well to supervised housing situations designed for short stays (e.g., CRRs), and find the need to relocate again problematic Most participants have limited financial resources, and will rely on public housing as they become more independent – Public housing is not always available – When available, the quality and safety of public housing is variable 40

41. Conclusions People discharged from Mayview are doing well in their new residences Continued attention to services will be useful. “The best experience has been knowing that I can make it in the real world. Not as hard as I projected it to be.” 41

42. Study Design Hospit al 3 mo6 mo9 mo12 mo15 mo18 mo21 mo24 mo QCI IW QCI IW QCI IW QCI IW Q FN 42

43. Strategies for Community Inclusion Panel – Kevin Trenney – Austin Lee – David Bolgert – Gary Seuhr – Joe Burgess – Gabe Chantz 43

44. What does recovery mean to you? What kinds of things have you done, or that you suggest others do, to lessen isolation and improve one’s connection to the community? If there’s one thing that you would recommend people do to take the first step – what would it be? What can the community, providers, and/or counties do to help people better connect with their communities? 44 Strategies for Community Inclusion