Mayview Regional Service Area PlanSteering Committee New Member Orientation

April 9, 2010

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Agenda

• Background, Goals, and Timeline

• Community Support Plan (CSP) Process

• Resource Development

• Steering Committee Overview and Focus

• Ongoing Post-Closure Activities

• Outcomes

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Background• 1999 Supreme Court upholds ADA ‘Integration Mandate’ in

Olmstead decision which affirmed the right of individuals with disabilities to live in their community

• The five counties in the Mayview service area, including Allegheny, Beaver, Greene, Lawrence, and Washington counties had all been involved individually in bed reduction efforts over the past several years

• Key opportunity with the MRSAP effort was the potential for collaborative planning and regional service development

• In 2005, the five Counties, Allegheny HealthChoices, Inc. (AHCI) and the Department of Public Welfare (DPW) started a Steering Committee to regionally plan for the gradual downsizing of Mayview

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Goals

Build stronger community support systems so people can return to their home communities from the state hospital and remain in their home communities pursing their hopes and dreams.

– Develop a recovery-based assessment and discharge planning process (Community Support Plan, or CSP) to make sure people discharged are successful

– Move resources used to fund Mayview State Hospital to the community system

– Use these resources to develop new services/supports, improve/expand existing services/supports

– Develop a process to make sure people are receiving what they need AFTER discharge

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Mayview Project Timeline

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• Services and Supports are based on needs and strengths, not program focused

• Individual assessments and plans inform system infrastructure and resource development

• Shared responsibility between County, MCO, IP team, community providers, consumer, and other supports

• Disciplined and highly facilitated process to ensure accountability and collaboration

• Use of an independent/non-biased facilitator and recorder

• Consumers get to where they need to be rather than following a continuum of care

• Avoid ‘one size fits all’ approach to discharge planning-individualized

Community Support Plan (CSP)

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New/Expanded Resource Development

Peer Support: • Peer Mentors, Warmline, Drop-In Centers, Peer Specialists, Recovery Specialists

Community Services:• Community Treatment Teams (CTT), also known as Assertive Community Treatment (ACT)• Enhanced Clinical Case Management (ECCM)• Mobile Medication Teams/Mobile Mental Health

Residential Options• Permanent Supportive Housing (PSH) • Comprehensive Mental Health/Enhanced Personal Care Homes • Long-term Structured Residences (LTSR)• Specialized Supportive Housing (aka long-term residences) • Extended Acute Services (EAC), • Residential Treatment Facility for Adults (RTF-A)

State Operated Services (operating for two years after the closure)

• Quality Management and Clinical Consultation (QMCC) Team

• Community Support Team (CST)

• Monarch Springs Long Term Structured Residence (LTSR)

• Specialized Support Homes

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Steering Committee: Overview

• Broad stakeholder representation– Staff from all five counties – Consumers and Advocates (National Alliance on

Mental Illness (NAMI), Peer Support Advocacy Network (PSAN), Disability Rights Network (DRN)

– Behavioral health professionals and Community providers

– State hospital staff– Managed care companies– DPW Office of Mental Health and Substance

Abuse Services (OMHSAS) representatives• Has been meeting since 2005

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Steering Committee: Focus

• Quality monitoring and service development to enhance overall community system

• Planning for sufficient and stable long-term funding to support services

• Regional problem solving to maintain individuals in the community – only region without a state hospital

• Meets 3rd Friday of every other month (Feb, April, June, Aug, Oct, Dec)

• Includes updates on State activities and ongoing work groups

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• Comprehensive Monthly CSP Tracking• Annual CSP Reviews/Updates• Quality Improvement and Outcomes (QIO) Committee• Regional Reporting of Critical Incidents and Early

Warning Indicators• Root Cause Analysis (RCA) Process• Lessons Learned White paper• Ongoing CSPs for Individuals Transferred to Torrance

State Hospital• CSP Evaluation Study with the University of

Pittsburgh

Ongoing Post-Closure Activities

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Outcomes

269 People were discharged from Mayview with a CSP

– 79% Allegheny County, 10% Beaver County, 2% Lawrence County, and 9% Washington County. None from Greene.

– The majority of individuals were between the ages of 45-55 (37%) at the time of their discharge.

– 61% are male and 39% are female; 60% are Caucasian, 38% African-American, and 2% another race.

– For more than half of the group, this stay was at least their second admission to Mayview

December 2009 QIO Report

• Report reviewed recommended services and supports, actual services received, housing, and critical incidents

• Changes represent a more realistic understanding of the services and levels of contact that are needed in the community to best support individuals.

• Most people receive CTT services, others receive case management / service coordination. Contact frequency indicates a high level of support.

• All individuals included in the report had a crisis plan.

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December 2009 QIO Report

• While 97% of individuals had seen a physical health doctor within the past year, behavioral health issues continue to be an area of focus.

• Housing remains relatively stable with approximately 75% of individuals not having changed their housing arrangement since their discharge (no one became homeless).

• Challenges remain as individuals continue to work on their recovery in the community. Social and leisure activities, employment, education, and other quality of life areas require ongoing effort and attention as community integration continues to develop and mature.

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December 2009 QIO Report

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Hospitalizations, Incarcerations, and Deaths

• About 22% of individuals had experienced an inpatient hospitalization since their discharge

• 8% had an incarceration

• 10 people (3%) had died since the beginning of the MRSAP initiative in 2005 through September 2009, including six from natural causes, two accidental deaths, and two suicides.

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Housing Type Level

At Discharg

e

As of 8/31/09

# % # %PCH, EPCH, CMHPCH Supervised 58 24% 58 24%LTSR Restrictive 61 25% 55 23%CRR Supervised 44 18% 29 12%Specialized Supportive Housing

Supervised22 9% 26 11%

Supportive Housing Dependent 17 7% 18 7%

Living Independently Independen

t 12 5% 15 6%Mental Retardation (MR) Housing

Supervised12 5% 13 5%

Nursing Home Restrictive 7 3% 12 5%

Family Independen

t 6 2% 8 3%Permanent Supportive Housing

Dependent3 1% 7 3%

Community Inpatient Restrictive 0 0% 2 1%Domiciliary Care Supervised 1 0% 1 0%State Mental Hospital Restrictive 1 0% 0 0%

Housing: At Discharge, Recommended in the Updated CSP, and as of August 31, 2009

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Level of Restrictiveness

Moved ToIndepende

ntDepende

ntSupervise

dRestricti

ve

Moved From

Independent 2 6 1 1Dependent 6 1 4 1Supervised 7 7 8 7Restrictive 0 3 6 2

  Increase in Restrictiveness   Decrease in Restrictiveness   Neutral Change

Summary of Changes in Housing Type by Level of Restrictiveness: Housing at Discharge and as of August 31, 2009

29 people (47%) moved to a less restrictive setting 20 people (32%) moved to a more restrictive setting 13 people (21%) moved to a setting with the same

level of restrictiveness

University of Pittsburgh- Mayview Discharge Study: December 2009 Update

• Conducted Observations, Surveys, Interviews• Subjects are from a random sample of 66 individuals

discharged from the hospital with CSPs• As of November 2009, about mid-way through, 268 of

458 total time points in the protocol completed• Summary of preliminary findings:

– People tell us they are really happy to have left Mayview– We see people in settings that are comfortable and pleasant– People were mostly satisfied with the discharge process– People see providers often– Some people are more active socially than others

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Allegheny HealthChoices, Inc.• Our mission:

– To assure equitable access to quality, cost-effective behavioral health care that promotes positive clinical outcomes, recovery, and resiliency.

• We are:– An innovative non-profit that supports the provision of high-quality behavioral

health care by offering:

• Fiscal and Clinical Oversight and Monitoring of Managed Care Initiatives• Program Development and Planning Services• Information Systems Design and Consultation• Housing Services Consultation• CTT/ACT Consulting and Technical Assistance• Community Support Planning Services• Training and Technical Assistance

• AHCI website: http://www.ahci.org

• MRSAP website: http://www.mayview-sap.org/