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Mental Health & Disability Services

Regional Crisis Services

Mental Health Conference

October 6, 2015

Julie Jetter, DHS, MHDS Jan Heikes, DHS, MHDS Anne Uetz, Polk County Health Services Jennifer Vitko, South Central Behavioral Health Region

Iowa’s MHDS Regions

• 14 Regions (as of 11/1/15)

• Size varies from 1 to 22 counties

• Population ranges from 29,988 to

582,074

(2014 National Census Estimate)

• Officially began operations on 7/1/14

Approved MHDS Regions Lyon Osceola Sioux Grundy Dubuque Jackson Mitchell Worth

Dickinson Emmet Winnebago Howard Winneshiek Allamakee O’Brien Clay Palo Alto

Kossuth

Hancock Cerro Gordo Floyd Chickasaw

Woodbury

Plymouth Cherokee Buena Vista Pocahontas Humboldt Franklin Butler Bremer Fayette Clayton

Ida Sac Calhoun

Black Hawk Buchanan Delaware Monona Crawford Carroll Greene Story Marshall Tama Benton Linn Jones

Clinton Harrison Shelby AudubonGuthrie Dallas Polk Poweshiek Iowa Johnson

Cedar Scott Muscatine Pottawattamie Cass Adair Madison Warren * Marion * Mahaska Keokuk Washington

Louisa Mills Montgomery Adams Clarke Lucas Monroe Wapello Jefferson Henry

Des Moines Fremont Page Taylor Ringgold Decatur Wayne AppanooseDavis Van Buren

Lee Boone Wright Hardin Hamilton Webster Jasper Union September 8, 2015

North West Iowa

Care Connection County Social Services

MHDS of East Central Region

Sioux Rivers MHDS Rolling Hills Community Services Southwest Iowa MHDS Heart of Iowa Southern Hills Regional Mental Health County Rural Offices of Social Services South Central Behavioral Health Eastern Iowa MHDS

Southeast Iowa Link

Central Iowa Community Services

*Effective 11/1/2015 the Mid Iowa Region (Marion & Mahaska Counties) will Join regions reflected on this map.

Core Service Domain:

Basic Crisis Response

24 Hour Access to Crisis Response • Definition: Services are available 24

hours a day, 365 days a year providing access to crisis screening and

assessment and linkage to mental health services.

• Access Standard: 24 hours/365 days a year.

Core Service Domain:

Basic Crisis Response

Crisis Evaluation/Assessment

• Definition: Face to face clinical interview to ascertain an individual’s current and previous level of functioning, potential for dangerousness, physical health, and psychiatric and medical condition. The crisis assessment becomes part of the individual’s action plan

Core Service Domain:

Basic Crisis Response

Personal Emergency Response System • Definition: The personal emergency

response system is an electronic device that transmits a signal to a central monitoring station to summon assistance in the event of an emergency.

• Access Standard: first unit of service within 4 weeks of request.

(2)

Core Services Domain: Crisis

Services

• Regional Overview

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

24 Hour Crisis Hotline

• Definition: A crisis line providing information and referral, counseling, crisis service coordination, and linkage to crisis screening and mental health services 24 hours a day

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

24 Hour Crisis Hotline

• Regional Overview

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

Warm Line

• Definition: A telephone line staffed by individuals with lived experience who provide

nonjudgmental, nondirective support to an individual who is experiencing a personal crisis.

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

(3)

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

23 Hour Crisis Holding and Observation

• Definition: A level of care provided for up to 23

hours in a secure and protected, medically staffed, psychiatrically supervised treatment environment

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

Community Based Crisis Stabilization

• Definition: Short-term services designed to

de-escalate a crisis situation and stabilize

an individual following a mental health

crisis and provided where the individual

lives, works, or recreates.

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

Residential Crisis Stabilization

• Definition: A short-term alternative living

arrangement designed to de-escalate a

crisis situation and stabilize an individual

following a mental health crisis and is

provided in organization-arranged settings

of no more than 16 beds.

Additional Core Domain:

Comprehensive Facility and

Community-Based Crisis Services

Residential Crisis Stabilization

• Regional Overview

(4)

Mobile Crisis Response

Team

Developing Polk County’s Model

• Convene work group

– Police from city, suburbs, & county sheriff – Mental health providers

– Mental health consumers, family members, advocates

– County manager – State Representative

– PCHS staff and board members – National Alliance for Mental Illness staff • Facilitated by Technical Assistance

Collaborative (TAC)

Developing Polk County’s Model,

Cont’d…

• System has to be…

– Responsive – ½ hour response time or less, ability to access information quickly (are they in the county mental health system)

– Have defined protocols – rules that define when mobile crisis is appropriate – Have a point of referral – will calls come

from the police, will there be a “hot line”, direct access to the community, etc.

Polk County’s MCRT

• Responsibility of MCRT – Mental health assessments

– On-site counseling and problem solving – Crisis plan development

– Coordinate hospitalizations

– Provide medication in consultation with psychiatric consultant

– Arrange/provide temporary respite services as needed

Polk County’s MCRT, Cont’d…

• Care Coordination

Polk County’s MCRT, Cont’d…

(5)

MCRT Cost Avoidance

July 2014 – June 2015

– 850 people treated in field would have cost

• $2.4 million if taken to jail

• $850,000 if taken to Emergency Room • $3.4 million if taken to hospital

– 509 taken to hospital for treatment would have cost $1.4 million if taken to jail

25

• Becoming the ‘experts’ in many areas that are not typically considered a mental health issue • Providing education to medical providers on how

to respond to patients who present in crisis • Officer’s increased awareness and ability to

interact well with individuals who has a mental illness

• The lack of linkage to services and the need for greater access to mental health treatment

Lessons Learned

Crisis Observation Center

• November 2010: visited Bexar County, Texas • April and August 2011: held Community

Conversations

• November 2011- March 2012: held 3 Stakeholder Meeting

• March 2012 to late fall 2013: Waited • Very late fall 2013: Identify site • January 2014: Begin Weekly Meetings

Developing the Crisis

Observation Center

• February 2014: Site Visit to Bexar County

• April 2014: Site visit

• April 2014: Begin workflow and service

design

• May 2014: Begin remodeling site

• June 2014 Begin hiring and training staff

• Open July 2014

Developing the Crisis

Observation Center

• Mental health crisis assessment

• Observation

• Crisis therapy

• Crisis planning/begin WRAP

• Telemedicine

• Substance abuse assessment

• Discharge planning

• Follow along warm hand-off

(6)

• Four key pieces

– How did people get there – How long did they stay – Where did they go to

– Where would the person have gone

Data Collection-Regional System

Crisis Observation Center Cost

Avoidance

July 2014 - June 2015

– 363 people treated at COC would have cost • $363,000 if an Emergency Room Visit • $1.4 million if admitted to the hospital – 24 brought by police

• $68,640 if taken to jail

32

• Fewer issue with substance use disorders

• People with children at home

• Missing person in another state

• Rightsizing expectations

• Partners

Lessons Learned

Crisis Stabilization Center

• November 2010: visited Bexar County, Texas

Developing the Crisis

Stabilization Center

• February 2014: Site Visit to Bexar County

Developing the Crisis

Stabilization Center

(7)

• Crisis stabilization – Treatment focus

• Intensive outpatient format is the vision

• Current group work with emphasis on

WRAP

• Connectivity as needed

Service

• 9 Beds available

• Served 45 people

• Average 56 days

• Referred from: All 45 from Crisis

Observation

• 74% were on the streets or homeless

• Collecting LOCUS Scores at admission

and discharge

People Served

September 15 through July 30

• 95% are in stable housing

• 95% are stable with their medications

• 95% are active in therapy

• 89% are involved in Integrated Health

Homes or Service Coordination

In September 2015, follow up calls

were made to those who have been

discharged

• First 48-72 hours is rest to get better

engagement

• Over train on boundaries

• First come, first served policy

• Evening relaxation group

• Educate on community resources

Lessons Learned

South Central Behavioral Health

Region

Wapello

Appanoose Davis Mahaska

Crisis Mental Health

Bridging the Gap in a rural Community

(8)

Who are we?

The Appanoose County Mental Health Coalition

• South Central Behavioral Health Region/Appanoose-Davis-Wapello Counties

• Mercy Medical Center

• Appanoose County & Centerville Law Enforcement • Centerville Community Betterment

• 8thDistrict Court

• Community Health Centers of Southern Iowa

Purpose

To improve mental health access in Appanoose, Davis and Wapello Counties through the cooperative efforts of local providers to intervene with existing resources, providing the appropriate crisis stabilization and ensure follow up mental health care and treatment.

The Need

• Appanoose Community Health Needs Assessment ranked mental health as the #1 community health issue.

• The coalition came together to talk about the problems taking care of mentally ill in the county. • Fractured system - frustrations for all involved.

building understanding of how the process affects each of those involved.

• Identified that no crisis intervention resources locally, waiting list for therapy appointments, with no option but committal

South Central Behavioral Health Region – Appanoose, Davis & Wapello Counties • Providing payment for the licensed social workers on call as well as providing payment for ER and hospital services when utilized. • Developed an Emergency Prescreening

option now offered to families who access the courts – an alternative to committal. There is an option for the loved one to see a therapist within 24 hours.

• Providing seed funding for crisis stabilization house

Grant Funding

July 1, 2014

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Stabilization House

• Identify and address immediate needs – food, clothing, shelter, sleep, etc.)

• Intervention by therapist – medication management, therapy

• Develop care plan

• Referral to other services as needed.

• Evidence Based Practices (The WRAP program)

Therapists

• Participating in a call schedule utilized by law enforcement, county, court and hospital. • Providing assessments, assisting with

placement of patient when a bed is needed. • Making referrals to each other’s

organizations when needed.

• Providing individual follow up treatment with patients.

• Opened up an appointment daily for crisis assessment if needed.

Impact Since July 1, 2013

• 123 pre-screens completed 90 seen in the ER • 33 diverted from the ER

19 seen at the jail

14 seen in office or other setting • 26 referred to Inpatient

• 44 voluntary admission to Oak Place • 48 received community services

0 10 20 30 40 50 60 CY 2012 CY 2013 CY 2014 CY215

Mental Health Committals

Cost Savings

CY 2013 CY 2014 Inpatient $714,000.00 $204,000.00 Law Transfers 19,250.00 10,250.00 Court Cost 42,848.00 12,240.00 ER Committal 30,800.00 25,176.00 Pre-screenings 0.00 36,900.00 Stabilization House 0.00 360,000.00

Model for the State

• Initiative is being viewed as a rural model for the state of Iowa that can be replicated.

• Design a model that utilizes local resources and fits the needs of the individual location.

• Demonstrate that investment in intervention: - More effective

- Less Costly

- Less restrictive alternative

• Mental health crisis resolved through support and care coordination rather than intensive medical interventions.

References

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