s enior e mpowerment for l ife f ulfillment

LENAPE VALLEY FOUNDATION

BUCKS COUNTY AREA AGENCY ON AGING

BUCKS COUNTY MENTAL HEALTH/ DEVELOPMENTAL PROGRAMS

Senior Empowerment for Life Fulfillment

What is SELF

• The goal of the SELF program is to provide therapeutic intervention that facilitates an individual’s acceptance of traditional mental health services and/or drug and alcohol treatment.

• The SELF program provides outreach, treatment, peer support, and case management to individuals 60 yrs and older; that are experiencing mental health and/or drug and alcohol problems; and are unable to access needed BHS services.

Why SELF

The “silo”-style ports of entry in the current behavioral health system can limit access to services for older adults.

Altering traditional ways of delivering behavioral health needs.

Decrease stigma and increase acceptance among aging adults of mental health treatment.

Attention to medical needs and physical capability to receive recommended services.

An ever growing need to provide older adults with mental health supports in their homes.

By 2030, there will be about 72.1 million older persons, over twice their number in 2000. Department of Health & Human Services, 2012

Collaborative Beginning

AAA and MH/DP began collaborating to meet this need in 2004.

Deputies from Aging, Mental Health, and early on, a representative from the County’s BHS contractor came together to develop a means to engage those 60+ older adults with unmet BHS needs and assisting them with developing connections to appropriate providers.

Collaborative cross-training of Aging & MH workers including BSU staff, and later including D/A staff

The AAA and MH/DP were pleased to bring Lenape Valley Foundation (LVF) into the collaboration in July, 2009 for the SELF program.

Staffing

Clinical Executive Program DirectorClinical CoordinatorPsychiatry CRNPCase ManagerCertified Peer

Support

AAA CM Supervisor AAA Deputy Director

for Long-Term Care Bucks County MH/DP

Deputy or representative

Program Services

Referral & Intake Outreach Assessment and Goal PlanningPsych Evaluation/Medication ManagementNursing assessment Therapeutic InterventionCase Management Peer SupportDischarge Planning

Clinical Charting

Consent for TreatmentTreatment Planning Clinical Documentation ( DAP Note)Release of Information Medication Management Documentation Case Management ActivitiesCertified Peer Support Recovery PlanningCertified Peer Support Activities

Collaboration

LVF Weekly / Bi-Weekly Clinical Team Meetings

LVF, AAA, MH/DP Bi-Monthly Administrative Meetings

LVF, AAA, MD/DP Quarterly Case Conference Review

LVF, AAA, MD/DP Yearly QA Audit

Monthly Reporting

Tracking Forms

Statistical Report/Quarterly/ YTD

Case Notes

Tracking List

Collaborative Funding

Annual Budget of $150,000.00 from MH/DP (90%) and Aging ( 10%)

LVF Billable Services /Collection of Co-Pays

Program Challenges

C0-Pays

Caseload size- The impact of Severe and Persistent Mental Illness (SPMI)

Closure/ Discharge Planning

Impact of Hoarding

Closing

Program is continually evolving

Benefits of cross-training

Communication as a key element

Collaborative attitude in providing the program and addressing challenges.