harris county behavioral health policy efforts david s. buck, md, mph karen love, mha
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Harris County Behavioral Health Policy Efforts David S. Buck, MD, MPH Karen Love, MHA February 2007. The Need. Harris County jail processed 93,921 unduplicated inmates in the year ending November 2006 - PowerPoint PPT PresentationTRANSCRIPT
Harris County Behavioral Health Policy Efforts
David S. Buck, MD, MPHKaren Love, MHA
February 2007
Harris County Behavioral Health Policy Efforts
David S. Buck, MD, MPHKaren Love, MHA
February 2007
The NeedThe Need
Harris County jail processed 93,921 unduplicated inmates in the year ending November 2006
24% of inmates have a diagnosable mental illness – about half of whom have a serious, disabling mental illness
2.5% of inmates (~2500) are homeless and half of them also have a mental illness
Harris County jail processed 93,921 unduplicated inmates in the year ending November 2006
24% of inmates have a diagnosable mental illness – about half of whom have a serious, disabling mental illness
2.5% of inmates (~2500) are homeless and half of them also have a mental illness
The NeedThe Need
Inmates are often released without advance notice to case managers, making discharge planning problematic
Inmates are often released in the middle of the night with no medication
Inmates are often released without advance notice to case managers, making discharge planning problematic
Inmates are often released in the middle of the night with no medication
The NeedThe Need
Upon release, MHMRA patients may be referred to the Eligibility Center for assessment and continuation of care, but often do not follow through due to various circumstances including:
Lack of transportationLack of ID (TDL, Birth Certificate, SS
etc.)Lack of proof of income and/or
insurance
Upon release, MHMRA patients may be referred to the Eligibility Center for assessment and continuation of care, but often do not follow through due to various circumstances including:
Lack of transportationLack of ID (TDL, Birth Certificate, SS
etc.)Lack of proof of income and/or
insurance
The NeedThe Need
An inmate with mental illness and/or disability is more likely to be subsequently arrested and charged with another offense, face a more serious charge, stay twice as long in jail and incur more jail time for an equivalent offense (Nguyen, 2005).
An inmate with mental illness and/or disability is more likely to be subsequently arrested and charged with another offense, face a more serious charge, stay twice as long in jail and incur more jail time for an equivalent offense (Nguyen, 2005).
Silos of CareSilos of Care
County JailMHMRAHarris County Hospital DistrictSocial Service AgencesCPSCommunity ClinicsPrivate BH Providers
County JailMHMRAHarris County Hospital DistrictSocial Service AgencesCPSCommunity ClinicsPrivate BH Providers
Other FactorsOther Factors
Harris County growing rapidly – resources not keeping pace
30% uninsuredThe behavioral health care system
strainedchanges in reimbursement
requirementsprivate insurance prioritiesreduction in psychiatric beds &
services…
Harris County growing rapidly – resources not keeping pace
30% uninsuredThe behavioral health care system
strainedchanges in reimbursement
requirementsprivate insurance prioritiesreduction in psychiatric beds &
services…
Community ConsensusCommunity Consensus
Patients with high priority needs face increasing difficulty in accessing services
Government, social services, public safety, physical and BH providers and advocates agree – access and service delivery system must be addressed
Change is a priority for the community
Patients with high priority needs face increasing difficulty in accessing services
Government, social services, public safety, physical and BH providers and advocates agree – access and service delivery system must be addressed
Change is a priority for the community
Identifying Principles for Improving the Harris County Behavioral Health SystemIdentifying Principles for Improving the Harris County Behavioral Health System
Phase I: Health IndicatorsPhase I: Health Indicators
Model for interventions to improve population health
Can serve as a basis for developing community goals
Adopted by the Council in November 2005
Model for interventions to improve population health
Can serve as a basis for developing community goals
Adopted by the Council in November 2005
Phase I: Health IndicatorsPhase I: Health Indicators
www.hcphsc.hctx.net/ReferenceMaterial.aspwww.hcphsc.hctx.net/ReferenceMaterial.asp
Phase I: Health Indicators (cont’d)
Phase I: Health Indicators (cont’d)
Phase I: Health Indicators (cont’d)
Phase I: Health Indicators (cont’d)
BH Performance IndicatorsBH Performance Indicators
Overview:Interviews
To identify principles, expectations, standards of care, and outcomes
Literature reviewInvestigate literature referenced in
interviews Create Harris County Behavioral
Healthcare Report Card Create mechanism for reporting
modeled from healthcare indicator project
Overview:Interviews
To identify principles, expectations, standards of care, and outcomes
Literature reviewInvestigate literature referenced in
interviews Create Harris County Behavioral
Healthcare Report Card Create mechanism for reporting
modeled from healthcare indicator project
Phase II: Provider Interviews
Phase II: Provider Interviews
What are the principles, expectations, standards of care, and outcomes important to evaluating and defining an accountable behavioral healthcare system?
Summary of themes that emerged from these interviews:
What are the principles, expectations, standards of care, and outcomes important to evaluating and defining an accountable behavioral healthcare system?
Summary of themes that emerged from these interviews:
Harris County Interviews
Access
Social acceptability of mental illnesses
Use of community psychiatry literature that identifies principles and ways to measure outcomes
Prevention / Screening
Need for evaluation
Assess quality of care
Several outcomes measures
Parity for mental and physical treatment
Methodologies in the Literature
Methodologies in the Literature
Literature search conducted in community & adolescent psychiatry to look for systems of care that have evaluation tools on behavioral health
MHSIP (Mental Health Statistics Improvement Program): Specifically designed to assess consumer concerns with treatment, not merely global satisfaction with mental health services. Report card with domains, concerns, indicators, and
measures Indicators included:
1) objective measures of provider's commitment to mental healthcare
2) consumer assessment of the convenience, appropriateness, and outcomes of the services the system supports
Literature search conducted in community & adolescent psychiatry to look for systems of care that have evaluation tools on behavioral health
MHSIP (Mental Health Statistics Improvement Program): Specifically designed to assess consumer concerns with treatment, not merely global satisfaction with mental health services. Report card with domains, concerns, indicators, and
measures Indicators included:
1) objective measures of provider's commitment to mental healthcare
2) consumer assessment of the convenience, appropriateness, and outcomes of the services the system supports
Phase II: BIG THANKSPhase II: BIG THANKS
Jack Callahan, JD Sarah Flick, MD Thomas Gavagan, MD Mary Lou Heater, RN,
NP Sylvia Muzquiz, MD Fred Ramirez Pauline Rosenau, PhD John Sargent, MD Kim Szeto Stephen Williams
Jack Callahan, JD Sarah Flick, MD Thomas Gavagan, MD Mary Lou Heater, RN,
NP Sylvia Muzquiz, MD Fred Ramirez Pauline Rosenau, PhD John Sargent, MD Kim Szeto Stephen Williams
John Burruss, MD Avrim Fishkind, MD Sylvia Fitzgerald Andrew Harper, MD Lois Moore, PhD Tuan Nguyen, PhD Sonja Randle, MD Joe Rubio, PhD Steve Schnee, PhD Mel Taylor, MSW
John Burruss, MD Avrim Fishkind, MD Sylvia Fitzgerald Andrew Harper, MD Lois Moore, PhD Tuan Nguyen, PhD Sonja Randle, MD Joe Rubio, PhD Steve Schnee, PhD Mel Taylor, MSW
Draft PrinciplesDraft Principles
Selected Implications of Report Card:
Selected Implications of Report Card:
Explore options for aligning resources more effectively Common eligibility Common set of utilization management
tools consumer and family involvement in
treatment planning and treatment decisions
effective strategies for reducing admissions and long term use of incarceration and institutionalization and their offsetting costs
Explore options for aligning resources more effectively Common eligibility Common set of utilization management
tools consumer and family involvement in
treatment planning and treatment decisions
effective strategies for reducing admissions and long term use of incarceration and institutionalization and their offsetting costs
Phase III: Structuring for Success
Phase III: Structuring for Success
Technical Assistance Collaborative engaged:
On-site environmental scan/system review
Develop strategic option analyses Develop legislative proposal for
transformation? Initial Report Due March 1st
Technical Assistance Collaborative engaged:
On-site environmental scan/system review
Develop strategic option analyses Develop legislative proposal for
transformation? Initial Report Due March 1st
David Buck [email protected] Love [email protected]
David Buck [email protected] Love [email protected]
Contact Information