1 community care based services leon evans president and chief executive officer the center for...
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Community Care Based Services
Leon EvansPresident and Chief Executive OfficerThe Center for Health Care ServicesMental Health and Substance Abuse
AuthorityBexar County
San Antonio, Texas [email protected]
Maximizing Efficiency and Treatment Effectiveness
Diversion Initiatives Addressing ChallengesOf Mental Illness, Substance Use
and HomelessnessRapid City, South Dakota
February 22, 2011
Gilbert GonzalesDirector, Communications
and Diversion InitiativesThe Center for Health Care Services
San Antonio, Texas [email protected]
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Poor communication Poor system design Silos No strategic improvement plan Little use of prevailing best practices Lack of leadership and overview
Why ?
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The Problem gets worse:
Poor and or reduced funding
Scant, limited and rationed services
Reduction of State Hospital treatment beds
The Problem
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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
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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,”
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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
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Community
Institutional
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Collaboration: It’s an unnatural act between…
…two or more unconsenting adults.
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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.
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Community Care Is better than Institutional Care
Costs less than institutional care Is least restrictive Allows for greater
family involvement Produces better
outcomes
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Community Mental Health Philosophy
“You get better outcomes when treatment is nearer to families, jobs and communities”.
Leon EvansPhilosophy
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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
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• 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:
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Show me the DATA !!!
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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
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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
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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
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Texas Department of Criminal JusticeMHMR Match Statistics
October, 2007
C.I.D. Parole Probation Total
Total TDCJ Population 152,661 77,755 432,359 662,775
# of Care Matches* 40,883 19,763 54,727 115,373
% of Total Population 26.78% 25.41% 12.65% 17.40%
*Represents all Clients served since 1985, including those whose diagnosis is no longer eligible for MHMR Source: Texas Correctional Office on Offenders with Mental and Medical Impairments
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Revocation Rates 2007Federal Revocation Rate: 66%
Two-thirds of returning prisoners are re-arrested for new crimes within 3 years or their release. Second Chance Act, 110TH CONGRESS REPORT to US HOUSE OF REPRESENTATIVES
State Revocation Rate: Texas Felony Revocation Rate = 15.8% Top 5 Largest Community and Corrections Departments = 16.1 %
Local Revocation Rate: Bexar County Mentally Impaired Caseload Department Probation Department = 8% Manos Diversion Program, CHCS = 6.2%
Rearrest Rate
0
10
20
30
40
50
60
70
Federal State Probation CHCS
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Therapeutic Justice Partnershipswith Bexar County Community
Supervision and Corrections Dept.
• Two-100 Bed Substance Abuse Treatment Facilities (SATF-1 & SATF-2,
• 60 Bed Young Adult “boot camp” residential facility- Zero Tolerance)
• One- 60 Bed Dual Diagnosis Unit (MH/SA) Mentally Ill Offender Facility• Outpatient Substance Abuse Treatment Program (lH 10)
• Dual Diagnosis Outpatient Substance Abuse Program (Palo Alto)
• Drug Court Treatment Services, Dual Diagnosis Drug Court Treatment Services, Mental Health Court Services, and Veteran Drug Court Services.
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Combined CCC and Restoration Documented and Immediate Cost AvoidanceCost Category City of San Antonio Bexar County Direct Cost Avoidance
Public Inebriates Diverted from Detention Facility
$435,435$925,015
A.
$1,983,574$2,818,755*
B.
$2,419,009$3,743,770
Injured Prisoner Diverted from UHS ER $528,000$435,000
C.
$1,267,200$1,044,000
D.
$1,795,200$1,479,000
Mentally Ill Diverted from UHS ER Cost $322,500$283,500
E.
$774,000$676,000
F.
$1,096,500$959,500
Mentally Ill Diverted from Magistration Facility $208,159$179,833
G.
$371,350$322,300
H.
$579,509$502,133
Reduction in Competency Restoration Wait Time in Jail for Hosp Admission
0 $255,055$1,020,000
I.
$255,055$1,020,000
Reduction in Wait Time in Jail for Outpatient Competence/Wait Time for Restoration compared to Inpatient
0 $137,898$900,000
J.
$137,898$900,000
Reduction in Jail Time for Competency Restoration on Bond and on Return
0 $385,522$221,000
K.
$385,522$221,000
Total Year 1Total Year 2
TWO YEAR TOTALS
$1,494,094$1,823,348$3,317,442
$5,174,599$7,002,055$12,176,654
$6,668,693$8,825,403$15,494,096
Documented and Immediate Cost Avoidance, Two Year Analysis April 16, 2008 – March 31, 2010
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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
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The Center for Health Care Services
Leon Evans, President/CEOThe Center for Health Care Services
Mental Health Authority210 731-1300