Latino Behavioral Health Institute Conference 2012
-
Upload
gilbert-gonzales -
Category
Health & Medicine
-
view
828 -
download
2
description
Transcript of Latino Behavioral Health Institute Conference 2012
1
Juan RamosBoard Vice Chair
The National Center for Behavioral Health Solutions
Maximizing Efficiency and Treatment Effectiveness al Estillo San Anto
Centers for Medicare and Medicaid Services (CMS) Grant with
Diversion Initiatives Addressing ChallengesOf Mental Illness, Substance Use
and HomelessnessSeptember 2012
Gilbert GonzalesDirector, Communications
and Diversion InitiativesThe Center for Health Care Services
San Antonio, Texas [email protected]
2
The Centers for Medicare and Medicaid Services (CMS) Grant
• Project Title: “A recovery-oriented approach to integrated behavioral and physical health care for a high-risk population”
• Geographic Reach: San Antonio, Texas
• Funding Amount: $4,557,969
• Estimated 3-Year Savings: $5 million
Integration: Health and Behavioral Health
• Will serve adults severe mental illness or co-occurring mental illness and substance abuse disorders, at high risk of chronic physical disease, through a CHCS multi-disciplinary care team to coordinate behavioral, primary, and tertiary health care.
• Project includes collaborations of leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations and patients’ advocacy groups among others.
• The aim of this innovation award is to deliver better health, improved care and lower costs to those enrolled in Medicare and Medicaid, particularly those with the highest chronic health care needs
6
7
Poor communication Poor system design Silos No strategic improvement plan Little use of prevailing best practices Lack of leadership and overview
Why ?
8
The Problem gets worse:
Poor and or reduced funding
Scant, limited and rationed services
Reduction of State Hospital treatment beds
The Problem
9
An Ounce of PreventionTaxpayer Costs Avoided through Preventing
Crime
Criminal Behavior and Its Cost to Society• 1.7 Trillion including victimless crime – Perazzo 2002
• 674 Billion Federal, State and Local – Shapiro 1999
• 1.0 Trillion (2 million people incarcerated) – Adrienne
2005
Cost Avoided if One Criminal Career is Prevented$ 976,217.81• Average annual adult cost (2004) - $40,865• Average annual juvenile cost (2004) - $32,888
Source: Dr. Victoria Reinhardt, An Ounce of Prevention presentationTo NACo, July 2008
10
The Case of Million Dollar Murray
MILLION-DOLLAR MURRAYby MALCOLM GLADWELLThe New Yorker Magazine, Issue of 2006-02-13 and 20, Posted 2006-02-06
News ReleaseEmergency Departments See Dramatic Increase inPeople with Mental Illness Seeking Care Emergency Physicians Cite State Health Care Budget Cuts at Root of Problem
American Psychiatric AssociationHillarie Turner, 703-907-8536 June 2, [email protected] Release No. 04-30Sharon Reis 202-745-5103
“in one study, it had been concluded that one homeless person can cost the City and County about $200,000 in one year”. Philip F. Mangano, Executive Director of the United States Interagency Council on Homelessness (USICH), May 1, 2007.
“It cost us one million dollars not to do something about Murray,”
11
Average Per Capita Spending
• In 1995, average monthly spending per capita for clients receiving services in "aged/disabled" home and community-based waivers across all states with these waivers was $485 per month.
• In contrast, average monthly spending per Medicaid-covered nursing home resident was $2,426.14.
http://aspe.hhs.gov/daltcp/reports/costeff.htm
(per episode cost)
Community Based vs Institutional Cost Per Day
Community, $42
Institutional, $320
$0
$50
$100
$150
$200
$250
$300
$350
1
Community
Institutional
12
Collaboration: It’s an unnatural act between…
…two or more unconsenting adults.
13
Integrating and Strengthening Community-Based Care
• Community-based services, that are readily accessible and convenient, help in the early detection and treatment of mental health problems.
• Will help to reduce the need for hospitalization and increase the chances that patients can fully regain their mental health and help them to live and work successfully within the community.
14
Community Care Is better than Institutional Care
Costs less than institutional care Is least restrictive Allows for greater
family involvement Produces better
outcomes
15
Community Mental Health Philosophy
“You get better outcomes when treatment is nearer to families, jobs and communities”.
Leon EvansPhilosophy
Point of Contact with Law Enforcement
Magistrate Court
Bexar County Jail
Post-Booking Diversion
Community-based Wraparound Care
CIT/Deputy Mobile Outreach
Team
Genesis Probation, Incarceration,
Parole
Emergency Transport to
Hospital
Pre-Trial Diversion
Referrals to Community Providers
*Pre-Arrest Diversion
Residential Respite
Arrested
The Diversion ProcessThe Diversion Process
Treatment in lieu of Incarceration
24/7 CrisisServices
17
Law EnforcementDetention/Jail
CIT
Judicial/CourtsMagistrate, County, District
Mental HealthPublic and Private
Providers
Crisis Care CenterJail DiversionPsychiatric and Medical
ClearanceSpecialty Offender Services
CommunityDynamicCrisis Jail Diversion
Information Exchange
Pol
ice,
She
riff
Pro
batio
n, P
arol
e
Civil and CriminalT
reatment
Continuity of C
are
County City-wide
Emergency Services• Community Collaborative• Crisis Care Center• Crisis Transitional Unit• Crisis Hotline (Nurselink)• CIT/DMOT• SP5• Jail and Juvenile Detention• Statewide CARE Match
System County City-wideEntry Points
System Level
18
• Jail Diversion Oversight Committee (34+ Community Agencies/Stakeholders)
• Community Medical Directors Roundtable
• Children’s Medical Directors Roundtable
• Bexar County Children’s Diversion School District Sub Committee
• Bexar County Children’s Diversion Child Protective Services Sub Committee
• Bexar County Children’s Diversion Juvenile Justice Probation Sub Committee
• Community Co-Location Coalition (29 Community Agencies including law enforcement entities meeting to address the homeless & public inebriate)
Stakeholder Collaboration via:
19
Show me the DATA !!!
20
21
22
Top Ten CSCD’s with Most Offenders Served and Recidivism Rates 2012
6.6%
11.3%12.7% 13.6%
17.7% 18.4%20.6% 21.3%
24.2%
30.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Recidivism Rates for Top Five Community Supervision and Correction
Departments 2012
6.6%
12.7%
17.6%
20.6%
22.6%
30.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Bexar Harris Average Tarrant Dallas* Travis
Bexar
Harris
Average
Tarrant
Dallas*
Travis
24
25
Emergency Room utilization has dropped 40% since the inception of the Crisis Care Center.
40% of (7619 total seen at CCC) 3048 Persons diverted from the ER (in 2006 first year)
X $1545Cost Savings relative to ER Utilization $4,709,160
Source: University Health System
Emergency Room Utilization (Medical Clearance)
What Works
26Today2012 – The Bexar County Sheriff and San Antonio Police Chief mandate CIT Training
27
Then (prior to Sept 2005)• Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 min.
• Wait times for Medical Clearance/ Screening and
Psychiatric Evaluation was between 12 and 14 hours.
Now• The wait time for Medical
Clearance/ Screening at the Crisis Care Center is 45 minutes.
• Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes.
Impact on WAIT TIME for LAW ENFORCEMENT
28
29
Involuntary Outpatient CommitmentProgram
0
50
100
150
# Bed Days Used
1 Yr Prior 132
1 Yr Post 27
State Hospital Bed Day Utilization Rate
PreIOPCProgram
Post
79% Reduction in BedDay Use, Post Program
First Year Evaluation
30
CRISIS CARE CENTER• Crisis Line• Crisis Assessment• Mobile Crisis Outreach Team• Crisis Transitional Unit
7137 W. Military 645-1651
• Receives consumers from law enforcement 24/7
• Minor medical clearance • Call ahead preferred
210 225-5481• Can not take violent or
medically compromised individuals
30
CIT Mental Health Detail• Mental health professional partners
with a CIT Officer together to respond on calls dealing with a psychiatric crisis.
• Team responds to high utilizer calls for the City providing follow up services to reduce the call volume.
• Goal is to put officers back into service for patrol as soon as possible.
– Reduce inappropriate incarcerations and costly emergency room visits.
– Offer quality training to law enforcement.
• Co-locate officer with the City unit and Sheriff Mental Health Unit for better collaboration and expedited call response
Dispatcher Training for 911 Call Takers and Dispatchers
• In 2007 - decided that dispatchers would also benefit from CIT Instruction and met with SAPD leadership to establish training.
• Provided an abbreviated 12 hour CIT course for call takers and dispatchers in collaboration with CHCS
• The goal of this training is to increase safety by educating caller takers on essential intelligence gathering and dispatching a CIT Trained officer to the scene.
Partnered with Fire and EMS• As of 2007 SAFD has attended
every community training
• has become co trainers with joint PD and Sheriff’s Officers
• Have added a CIT component to their EMS In-service training.
• Partnering for Integrated training with Fire/EMS has extended numerous opportunities for growth:
– Officer and Fire/EMS better communication
– Safety
– Better utilization of resources
34
TheRestoration Center
OpenedApril 15, 2008
•
• Public Safety- Sobering Unit• Detoxification Facility• Community Court• Outpatient Substance Abuse Services
35
Haven for Hope Homeless Facility CNN Video Clip
• http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html
“Texas officials hope a massive new facility will keep the homeless
out of jail, emergency rooms and re-integrated into society”.
36
Haven for Hope Homeless Transitional Facility
www.havenforhope.org
37
1,600
38
39
40
Funding• Jail Diversion Planning and Oversight Committee - Judge Poly Jackson Spencer
• Changing the Law - Senate/House Bills Madla/Uresti,HB 2292 Mandated Jail Diversion
• SAMHSA Jail Diversion Grant
• Police Chief Ortiz Funding - Drug Bust Money
• University Health System Partnership- Care Link & New Generation Medications Program
• Texas Correctional Office on Offenders with Mental and Medical Impairments (TCOOMMI)
• Genesis Outpatient Services - Probation and Parole• Mentally Impaired Offenders Program-Probation • Substance Abuse Treatment Facilities (SATF I and II)
• Texas Crisis Redesign - $82 million State-wide
• Bill Greehey/Bexar County - Transformation Center
• Medicaid Administrative Claiming
• Medicaid Eligibility and Carelink Workers• Third Party Billing
41
Cost Category City of San Antonio Bexar County Direct Cost Avoidance
Public Inebriates Diverted from Detention
Facility
$435,435
$925,015
$1,322,685
A.
$1,983,574
$2,818,755*
$4,372,128
B.
$2,419,009
$3,743,770
$5,694,813
Injured Prisoner Diverted from UHS ER
$528,000
$435,000
$421,000
C.
$1,267,200
$1,044,000
$1,010,400
D.
$1,795,200
$1,479,000
$1,431,400
Mentally Ill Diverted from UHS ER Cost
$322,500
$283,500
$276,500
E.
$774,000
$676,000
$663,600
F.
$1,096,500
$959,500
$940,100
Mentally Ill Diverted from Magistration
Facility
$208,159
$179,833
$126,893
G.
$371,350
$322,300
$191,125
H.
$579,509
$502,133
$310,018
Combined CCC and Restoration Documented and Immediate Cost AvoidanceYear One April 16, 2008 – March 31, 2009Year Two April 16, 2009 – March31, 2010
Year Three April 16, 2010 – March 31, 2011
Summary next slide
42
Summary
BEXAR COUNTY DETENTION CENTERSYSTEM POPULATIONMONTHLY AVERAGES
(Main, Annex)
4222
3743
4133
40153987
3941 39464015
40814095
4171 4156
4094
38453807
3897
3981
4109
42634253
4040
3993
40624033
4066
3960
4079
4096
4084
4094
4095
41394173
4208 4261
4289
4225
4124
4158
4337
4272
4292
4197
421042544179 4193
4280
4357
43004300 4302
4053
4130
4001
4260
40284077
4231
4190
4017
379137903854
3982
3700
3800
3900
4000
4100
4200
4300
4400
JAN
FE
B
MA
R
AP
R
MA
Y
JUN
JUL
AU
G
SE
P
OC
T
NO
V
DE
C
SY
ST
EM
PO
PU
LA
TIO
N
2006 2007 2008 2009 2010 2011
On May 2011, there were 883 empty beds in the jail
44
The End Result
• Comprehensive service for most in need• Increased availability of comprehensive
coordinated services• Reduced barriers to service access and
increase motivation with treatment compliance
• Employ evidence based practices known to be effective
• Utilization of system tracking and outcome based treatment
45
46
The Center for Health Care Services
Leon Evans, President/CEOThe Center for Health Care Services
Mental Health Authority210 731-1300