Homeless Mental Health Respite Development and Implementation Based on the Model of the Community...

Homeless Mental Homeless Mental Health RespiteHealth RespiteHomeless Mental Homeless Mental Health RespiteHealth Respite

Development and Implementation Based on the Development and Implementation Based on the Model of the Community Medical Respite Program Model of the Community Medical Respite Program

in Raleigh, NCin Raleigh, NC

Outline Outline Outline Outline

1. Medical Respite Model- Video1. Medical Respite Model- Video

II. Groundwork of the Mental Health II. Groundwork of the Mental Health

Respite-DevelopmentRespite-Development

III. Specifics of programIII. Specifics of program

1V. Hopeful Outcomes1V. Hopeful Outcomes

· A short term specialized program focused on homeless persons who have a medical

injury/illness and may also have mental illness or substance abuse issues

· Comprehensive residential care providing participants the opportunity to rest while

being able to access hospitality, medical and supportive services that assist in their

recuperation

· Length of stay is determined by medical need and progress on an individual treatment

level

· Whole person care through collaboration with other local providers who offer a variety

of services to participants during their stay in respite care and also provide continuity of

care when the participant moves into the community

· Respect for human dignity of all residents and staff

· Active involvement by participants in the process of their recuperation and discharge

planning

· A bridge that closes the gap between acute medical services currently provided in

hospitals/emergency rooms, homeless shelters that do not have the capacity to provide

the needed recuperative care and more permanent housing options

· Low cost, high quality and innovative care which result in emergency room diversion,

additional hospital discharge options and cost avoidance for hospitals and communities

· Diverse service delivery models reflecting unique community needs, priorities, and

resources

· An integral component of the continuum of care for homeless services in any

community

**Note: Though the RCPN has adopted the term “medical respite,” it acknowledges and accepts

programs with these characteristics that use other descriptors (e.g. interim, infirmary, or recuperative

care).

Defining Characteristics of Medical Respite CareDefining Characteristics of Medical Respite CareRCPN RCPN

(Cont’d)(Cont’d)(Cont’d)(Cont’d) · A bridge that closes the gap between acute medical services currently provided in hospitals/emergency rooms, homeless shelters that do not have the capacity to provide the needed recuperative care and more permanent housing options · Low cost, high quality and innovative care which result in emergency room diversion, additional hospital discharge options and cost avoidance for hospitals and communities · Diverse service delivery models reflecting unique community needs, priorities, and resources · An integral component of the continuum of care for homeless services in any community

HistoryHistoryHistoryHistoryIn April 2006, the first respite bed was used in In April 2006, the first respite bed was used in

the Raleigh Rescue Mission in downtown the Raleigh Rescue Mission in downtown

Raleigh, North Carolina.Raleigh, North Carolina.

By the end of 2007, there were 22 beds in the By the end of 2007, there were 22 beds in the

RRM, 8 at Wake County’s men’s emergency RRM, 8 at Wake County’s men’s emergency

shelter, and 3 at a Catholic Worker’s home, and shelter, and 3 at a Catholic Worker’s home, and

1 respite apartment at the county’s transitional 1 respite apartment at the county’s transitional

program.program.

In 2007, we put 30 clients into permanent or In 2007, we put 30 clients into permanent or

supportive housing. supportive housing.

History (cont’d)History (cont’d)History (cont’d)History (cont’d)We started to see more patients show up at the We started to see more patients show up at the

door that were being discharged from the soon door that were being discharged from the soon

to be closing state mental health institution to be closing state mental health institution

with a script and an appointment card in hand.with a script and an appointment card in hand.

Many of these individuals were dually Many of these individuals were dually

diagnosed with complex mental diagnoses and diagnosed with complex mental diagnoses and

in need of stabilization.in need of stabilization.

So...this led to setting the groundwork of MH So...this led to setting the groundwork of MH

Respite!!Respite!!

Setting the groundworkSetting the groundworkSetting the groundworkSetting the groundwork

❀ 1. Why bother? Is this the right time?1. Why bother? Is this the right time?

❀ Medical Respite attracting referrals of Medical Respite attracting referrals of

medical + psychiatric patientsmedical + psychiatric patients

❀ Acute shelter pattern of attracting clients with Acute shelter pattern of attracting clients with

significant untreated mental illness and those significant untreated mental illness and those

discharged from inpatient psych without discharged from inpatient psych without

adequate planningadequate planning

❀ HCH having to assess and bridge recently HCH having to assess and bridge recently

inpatient homelessinpatient homeless


❀ 2. Baseline data to make the case2. Baseline data to make the case

❀ Is the need measurable in your community?Is Is the need measurable in your community?Is

the quantity of need adequate/convincing?the quantity of need adequate/convincing?

❀ What to measure?18 of 122 homeless What to measure?18 of 122 homeless

discharged from state IP psych unit made it discharged from state IP psych unit made it

back into care in 30 daysback into care in 30 days

❀ About 1000 discharges of homeless to the TriangleAbout 1000 discharges of homeless to the Triangle

❀ Only 20 per month with specific referral to shelter of Only 20 per month with specific referral to shelter of

whom 5-6 were not stable enough for open shelter whom 5-6 were not stable enough for open shelter

environmentenvironment


❀ 3. Identifying potential allies3. Identifying potential allies

❀ Start with front line workers: “fire in the belly”Start with front line workers: “fire in the belly”

❀ Shelters, HCH, community providersShelters, HCH, community providers

❀ Who is responsible (Human Services/LME)Who is responsible (Human Services/LME)

❀ Who’s got bad press (Inpatient psych social workers)Who’s got bad press (Inpatient psych social workers)

❀ 4. Convening stakeholders/collaborators4. Convening stakeholders/collaborators

❀ Start with small committed group and buildStart with small committed group and build

❀ Corralling stragglers (LME and WCHS example)Corralling stragglers (LME and WCHS example)

Developing a Program/ProductDeveloping a Program/ProductDeveloping a Program/ProductDeveloping a Program/Product

❀ 1. 1. What pieces are neededWhat pieces are needed

❀ Building on medical respite: Building on medical respite:

❀ Defining population preciselyDefining population precisely

❀ Higher acuity level ADL’s, Continence, post detox, not suicidal …Higher acuity level ADL’s, Continence, post detox, not suicidal …

❀ Medication managementMedication management

❀ Treatment plan/ progression planTreatment plan/ progression plan

❀ Case management and rights & benefits advocacyCase management and rights & benefits advocacy

❀ A better destinationA better destination

❀ What else is neededWhat else is needed

❀ Paraprofessional coverage (De-escalation motif)Paraprofessional coverage (De-escalation motif)

❀ Safe, quiet spaceSafe, quiet space

Developing a Developing a Program/ProductProgram/Product


❀ 1. 1. What pieces are neededWhat pieces are needed❀ External requisitesExternal requisites

❀ Define gaps in local system of careDefine gaps in local system of care❀ Timely psychiatry follow-upTimely psychiatry follow-up❀ Adequate wrap-aroundservices for high Adequate wrap-aroundservices for high

acuity clientsacuity clients❀ Service definition for state funded servicesService definition for state funded services❀ Documentation of cognitive impairmentDocumentation of cognitive impairment❀ Better catalog of discharge destinationsBetter catalog of discharge destinations

❀ StreamlineStreamline



❀ 1. 1. What pieces are neededWhat pieces are needed

• Politics of action: Common ground or Politics of action: Common ground or

embarrassmentembarrassment

• Identify the pressure points-State Identify the pressure points-State

Operated Services, Director of DSS, Operated Services, Director of DSS,

and LMEand LME


❀ 2. Funding mechanisms2. Funding mechanisms

❀ Who’s 501C3 to useWho’s 501C3 to use

❀ Grant moneyGrant money

❀ Local fundraisingLocal fundraising

❀ Room and Board from the Shelter (Mission)Room and Board from the Shelter (Mission)

❀ In kind servicesIn kind services

❀ Medicaid/Medicare decisionMedicaid/Medicare decision


❀ 3. 3. Preparing to launchPreparing to launch

❀ Conversion from exploratory group to work Conversion from exploratory group to work

groupsgroups

❀ Hiring and training staffHiring and training staff

❀ Referral MechanismReferral Mechanism

❀ Referral formReferral form

❀ User educationUser education

❀ Staying flexible, adaptableStaying flexible, adaptable

Staffing Staffing Staffing Staffing ❀ add on 2nd and 3rd shift MH Technicians(NCI, add on 2nd and 3rd shift MH Technicians(NCI,

CPR)CPR)

❀ 2 FT Mental Health Technicians2 FT Mental Health Technicians

❀ 3 PT Mental Health Technicians3 PT Mental Health Technicians

❀ Staff existing from MRP :3 MSW, 2 FT RNs, Admin.Staff existing from MRP :3 MSW, 2 FT RNs, Admin.

❀ Regular shelter staff- 24 hour, another RN, Regular shelter staff- 24 hour, another RN,

psychiatristpsychiatrist

Implementation of ProgramImplementation of ProgramImplementation of ProgramImplementation of Program

❀ Choose a target dateChoose a target date

❀ Assure that existing staff at shelter Assure that existing staff at shelter

understands the new program/ train if understands the new program/ train if

needed-Take time for this!needed-Take time for this!

❀ Start off slow, do not go public until Start off slow, do not go public until

everything is in place. Space out work everything is in place. Space out work

group meetings to once or month, or group meetings to once or month, or

as needed.as needed.

Details of Program in Details of Program in ShelterShelter

Details of Program in Details of Program in ShelterShelter

❀ 4 female beds in one room on Women’s 4 female beds in one room on Women’s

floorfloor

❀ 6 male beds in one room on Men’s floor6 male beds in one room on Men’s floor

❀ Overnight staff in place with added mental Overnight staff in place with added mental

health techs health techs

❀ Layout of shelter may determine bed Layout of shelter may determine bed

placementplacement

Start DateStart DateStart DateStart Date

❀ 1. Referral completed and faxed to RN. 1. Referral completed and faxed to RN.

❀ 2. RN decides if client can be in community 2. RN decides if client can be in community

setting, assures there is 14 days of medication.setting, assures there is 14 days of medication.

❀ 3. Hospital SW communicates with MH Respite 3. Hospital SW communicates with MH Respite

SW to assure there is continuing care plan and SW to assure there is continuing care plan and

mental health provider is in place (CST, ACT, or mental health provider is in place (CST, ACT, or

IDDT team). IDDT team).

❀ 4. 4. Set up transportation(MH team would be the Set up transportation(MH team would be the

best)best)

Up and Running Up and Running Up and Running Up and Running

❀ 5. Set up MH team to meet on site and sign MOA, MSW 5. Set up MH team to meet on site and sign MOA, MSW

works with client on a daily basis to see if daily goals are works with client on a daily basis to see if daily goals are

being met. MH techs are in communication with this point being met. MH techs are in communication with this point

person on client’s needs and goals.person on client’s needs and goals.

❀ 6. CST/ACT /IDDT team works on next placement after 6. CST/ACT /IDDT team works on next placement after

stabilization (assisted living, group home, or Shelter Plus stabilization (assisted living, group home, or Shelter Plus

Care voucher). Medical Respite Program is also a referring Care voucher). Medical Respite Program is also a referring

agent for the vouchers, but does not do the ongoing case agent for the vouchers, but does not do the ongoing case

management.management.

❀ MSW on site is SOAR trained and will continue to work on MSW on site is SOAR trained and will continue to work on

disability or work with local disability advocates. disability or work with local disability advocates.

Up and Running (Cont’d)Up and Running (Cont’d) Up and Running (Cont’d)Up and Running (Cont’d)❀ Continue with shelter schedule, accommodate Continue with shelter schedule, accommodate

clients.clients.

❀ Communication with MH case manager and Communication with MH case manager and

mental health techs should be constant.mental health techs should be constant.

❀ Weekly/bi-weekly meetings should be set up with Weekly/bi-weekly meetings should be set up with

mental health team.mental health team.

❀ Progression Plan should be updated when Progression Plan should be updated when

needed and case notes are important.needed and case notes are important.

Projected OutcomesProjected OutcomesProjected OutcomesProjected Outcomes

❀ Our hope is to put 10 clients in permanent housing by the Our hope is to put 10 clients in permanent housing by the

end of this year. (either Housing First, group home, end of this year. (either Housing First, group home,

family,etc.)family,etc.)

❀ Sustained Funding.Sustained Funding.

❀ With proper data collection: capture numbers of With proper data collection: capture numbers of

admission/discharge date, housing at time of discharge, admission/discharge date, housing at time of discharge,

and any numbers that may apply to grant specifics.and any numbers that may apply to grant specifics.

❀ Compare recidivism rates to prove that this model works.Compare recidivism rates to prove that this model works.

Homeless Mental Health Respite Development and Implementation Based on the Model of the Community...

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