community care based services
DESCRIPTION
Maximizing Efficiency and Treatment Effectiveness.TRANSCRIPT
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Community Care Based Services
Leon EvansPresident and Chief Executive OfficerThe Center for Health Care Services
Mental Health and Substance Abuse AuthorityBexar County
San Antonio, Texas [email protected]
Maximizing Efficiency and
Treatment Effectiveness
NAMI Utah State Conference2010
Salt Lake City
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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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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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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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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, $320
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Community
Institutional
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Four Good ReasonsWhy States Shouldn’t Cut Home and
Community Based Services in Medicaid
1. Cutting home and community based services can cost the state more in the long run. Home and community based care costs less than institutional care. (Kate Becket Waiver)
2. Cutting home and community based services can be bad for state economies. Cutting home and community based services can reduce or eliminate jobs and hurt economic growth.
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This could save money in the long term, provide economic benefits, and better serve state residents.
4. Cutting home and community based services may violate the Supreme Court’s Olmstead decision. States must have a plan for placing individuals with disabilities in the least restrictive care setting.
http://www.familiesusa.org/assets/pdfs/long-term-care/Five-Good-Reasons.pdf
3. Cutting home and community based services runs counter to consumer preferences.
Most consumers who need long-term care prefer to remain in their homes or in the community.
Four Good Reasons (cont)
Families USA 2010 (original source listed 5 Reasons, see link)
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An Ounce of PreventionTaxpayer Costs Avoided through Preventing
Crime
Criminal Behavior and Its Cost to Society• 1.7 Trillion including victimless crime – Perazzo 2002
• 674 Billion Federal, State and Local – Shapiro 1999
• 1.0 Trillion (2 million people incarcerated) – Adrienne
2005
Cost Avoided if One Criminal Career is Prevented$ 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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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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Collaboration: It’s an unnatural act between…
…two or more unconsenting adults.
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Building a System of Care for Children and Youth
• Bexar Cares – Collaborative Linkages• Extended Crisis Access• Children’s Crisis Intervention Training for Police
and School Administrators• Mobile Outreach Teams• Youth Empowerment Services• HB 1232 Enhanced Service Coordination• Therapeutic Foster Care• Texas Youth Suicide Prevention• Head Start MH Services
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Children Adult
• Children’s Community Medical Directors Roundtable• Children's Crisis Intervention Team• Extended Children's Crisis Services Mobile Outreach Team• Judges Diversion Initiatives• Bexar Cares System of Care• Therapeutic Foster Care• Youth Empowerment Services Waiver• Texas Youth Suicide Prevention• Head Start Mental Health Services• Future – looking for placement opportunities
Criminal Justice
• Co-Location• Community Medical Directors Roundtable• Crisis Care Center
Crisis Services Minor Medical ClearanceCrisis LineCrisis Transitional Unit MCOT-DMOT
• Hope Transitional Unit • Restoration Center
Sobering Detoxification Intensive Outpatient Substance Abuse Services Supportive Outpatient Services
• Crisis Intervention Team (CIT) Training – Law Enforcement
• MIOF, Probation & CHCS Step Down Facility• SA Treatment Facilities1&2• Felony Drug Court• Misdemeanor Drug Court• DWI Court• Community Reintegration Program Involuntary Outpt Commitment Mental Health Court• Substance Abuse Court• Outpatient Competency Restoration• NGRI Court• Forensic Assertive Community Txt• Outpatient Sub Abuse Treatment for Probationers• Sub Abuse Services for Zero Tolerance Group• Veterans Court• Veterans Diversion Pilot
Public Safety Net
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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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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
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Federal State Probation CHCS
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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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• IPP youth committed fewer serious crimes than the institutional youths, performed better on self-report tests, and were less likely to commit violent crimes measured both by court records and self-reported data.
• It was concluded that IPP was as effective as incarceration at less than one third the cost. The program saved an estimated $8.8 million over 3 years.
http://www.healthymarin.org/modules.php?op=modload&name=PromisePractice&file=promisePractice&pid=1022
Wayne County Intensive Probation Program, Michigan
Community Based Juvenile Treatment
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Involuntary Outpatient CommitmentProgram
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# 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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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