Community Care Based Services


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Maximizing Efficiency and Treatment Effectiveness.

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Community Care Based Services

  1. 1. Community Care Based Services Leon Evans President and Chief Executive Officer The Center for Health Care Services Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas [email_address] Maximizing Efficiency and Treatment Effectiveness NAMI Utah State Conference 2010 Salt Lake City
  2. 3. Community Mental Health Philosophy “ You get better outcomes when treatment is nearer to families, jobs and communities”. Leon Evans Philosophy
  3. 4. Community Care Is better than Institutional Care <ul><li>Costs less than institutional care </li></ul><ul><li>Is least restrictive </li></ul><ul><li>Allows for greater </li></ul><ul><li>family involvement </li></ul><ul><li>Produces better </li></ul><ul><li>outcomes </li></ul>
  4. 5. Integrating and Strengthening Community-Based Care <ul><li>Community-based services, that are readily accessible and convenient, help in the early detection and treatment of mental health problems. </li></ul><ul><li>Will help to reduce the </li></ul><ul><li>need for hospitalization </li></ul><ul><li>and increase the chances </li></ul><ul><li>that patients can fully regain </li></ul><ul><li>their mental health and help </li></ul><ul><li>them to live and work </li></ul><ul><li>successfully </li></ul><ul><li>within the community. </li></ul>
  5. 6. Average Per Capita Spending <ul><li>In 1995, average monthly spending per capita for clients receiving services in &quot;aged/disabled&quot; home and community-based waivers across all states with these waivers was $485 per month. </li></ul><ul><li>In contrast, average monthly spending per Medicaid-covered nursing home resident was $2,426.14. </li></ul><ul><li>http:// </li></ul><ul><li>(per episode cost) </li></ul>
  6. 7. <ul><ul><ul><li>Four Good Reasons </li></ul></ul></ul><ul><ul><ul><li>Why States Shouldn’t Cut Home and Community Based Services in Medicaid </li></ul></ul></ul><ul><li>Cutting home and community based services can </li></ul><ul><li>cost the state more in the long run. </li></ul><ul><li>Home and community based care costs less than </li></ul><ul><li>institutional care. </li></ul><ul><li>(Kate Becket Waiver) </li></ul><ul><li>2. Cutting home and community based services can </li></ul><ul><li>be bad for state economies. </li></ul><ul><li>Cutting home and community based services can reduce </li></ul><ul><li>or eliminate jobs and hurt economic growth. </li></ul>
  7. 8. This could save money in the long term, provide economic benefits, and better serve state residents. 4. Cutting home and community based services may violate the Supreme Court’s Olmstead decision. States must have a plan for placing individuals with disabilities in the least restrictive care setting. 3. Cutting home and community based services runs counter to consumer preferences. Most consumers who need long-term care prefer to remain in their homes or in the community. Four Good Reasons (cont) Families USA 2010 (original source listed 5 Reasons, see link)
  8. 9. An Ounce of Prevention Taxpayer Costs Avoided through Preventing Crime <ul><li>Criminal Behavior and Its Cost to Society </li></ul><ul><li>1.7 Trillion including victimless </li></ul><ul><li>crime – Perazzo 2002 </li></ul><ul><li>674 Billion Federal, State and Local – Shapiro 1999 </li></ul><ul><li>1.0 Trillion (2 million people incarcerated) – Adrienne </li></ul><ul><li>2005 </li></ul><ul><li>Cost Avoided if One Criminal Career is Prevented </li></ul><ul><li>$ 976,217.81 </li></ul><ul><li>Average annual adult cost (2004) - $40,865 </li></ul><ul><li>Average annual juvenile cost (2004) - $32,888 </li></ul>Source: Dr. Victoria Reinhardt, An Ounce of Prevention presentation To NACo, July 2008
  9. 10. Texas Department of Criminal Justice MHMR Match Statistics October, 2007 *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 17.40% 12.65% 25.41% 26.78% % of Total Population 115,373 54,727 19,763 40,883 # of Care Matches* 662,775 432,359 77,755 152,661 Total TDCJ Population Total Probation Parole C.I.D.
  10. 11. Collaboration: It’s an unnatural act between… … two or more unconsenting adults.
  11. 12. Building a System of Care for Children and Youth <ul><li>Bexar Cares – Collaborative Linkages </li></ul><ul><li>Extended Crisis Access </li></ul><ul><li>Children’s Crisis Intervention Training for Police and School Administrators </li></ul><ul><li>Mobile Outreach Teams </li></ul><ul><li>Youth Empowerment Services </li></ul><ul><li>HB 1232 Enhanced Service Coordination </li></ul><ul><li>Therapeutic Foster Care </li></ul><ul><li>Texas Youth Suicide Prevention </li></ul><ul><li>Head Start MH Services </li></ul>
  12. 13. Children Adult <ul><li>Children’s Community Medical </li></ul><ul><li>Directors Roundtable </li></ul><ul><li>Children's Crisis Intervention </li></ul><ul><li>Team </li></ul><ul><li>Extended Children's </li></ul><ul><li>Crisis Services </li></ul><ul><li>Mobile Outreach Team </li></ul><ul><li>Judges Diversion Initiatives </li></ul><ul><li>Bexar Cares System of Care </li></ul><ul><li>Therapeutic Foster Care </li></ul><ul><li>Youth Empowerment Services </li></ul><ul><li>Waiver </li></ul><ul><li>Texas Youth Suicide Prevention </li></ul><ul><li>Head Start Mental Health Services </li></ul><ul><li>Future – looking for placement </li></ul><ul><li>opportunities </li></ul>Criminal Justice <ul><li>Co-Location </li></ul><ul><li>Community Medical Directors </li></ul><ul><li>Roundtable </li></ul><ul><li>Crisis Care Center </li></ul><ul><ul><li>Crisis Services </li></ul></ul><ul><ul><li>Minor Medical Clearance </li></ul></ul><ul><ul><li>Crisis Line </li></ul></ul><ul><ul><li>Crisis Transitional Unit </li></ul></ul><ul><ul><li>MCOT-DMOT </li></ul></ul><ul><li>Hope Transitional Unit </li></ul><ul><li>Restoration Center </li></ul><ul><ul><li>Sobering </li></ul></ul><ul><ul><li>Detoxification </li></ul></ul><ul><ul><li>Intensive Outpatient </li></ul></ul><ul><ul><li>Substance Abuse Services </li></ul></ul><ul><ul><li>Supportive Outpatient </li></ul></ul><ul><ul><li>Services </li></ul></ul><ul><li>Crisis Intervention Team (CIT) </li></ul><ul><li>Training – Law Enforcement </li></ul><ul><li>MIOF, Probation & CHCS </li></ul><ul><li>Step Down Facility </li></ul><ul><li>SA Treatment Facilities1&2 </li></ul><ul><li>Felony Drug Court </li></ul><ul><li>Misdemeanor Drug Court </li></ul><ul><li>DWI Court </li></ul><ul><li>Community Reintegration Program </li></ul><ul><li>Involuntary Outpt Commitment </li></ul><ul><li>Mental Health Court </li></ul><ul><li>Substance Abuse Court </li></ul><ul><li>Outpatient Competency Restoration </li></ul><ul><li>NGRI Court </li></ul><ul><li>Forensic Assertive Community Txt </li></ul><ul><li>Outpatient Sub Abuse Treatment for </li></ul><ul><li>Probationers </li></ul><ul><li>Sub Abuse Services for Zero </li></ul><ul><li>Tolerance Group </li></ul><ul><li>Veterans Court </li></ul><ul><li>Veterans Diversion Pilot </li></ul>Public Safety Net
  13. 14. Therapeutic Justice Partnerships with Bexar County Community Supervision and Corrections Dept. <ul><li>Two-100 Bed Substance Abuse Treatment Facilities (SATF-1 & </li></ul><ul><li>SATF-2, </li></ul><ul><li>60 Bed Young Adult “boot camp” residential facility- Zero </li></ul><ul><li>Tolerance) </li></ul><ul><li>One- 60 Bed Dual Diagnosis Unit (MH/SA) Mentally Ill Offender </li></ul><ul><li>Facility </li></ul><ul><li>Outpatient Substance Abuse Treatment Program (lH 10) </li></ul><ul><li>Dual Diagnosis Outpatient Substance Abuse Program (Palo Alto) </li></ul><ul><li>Drug Court Treatment Services, Dual Diagnosis Drug Court </li></ul><ul><li>Treatment Services, Mental Health Court Services, and </li></ul><ul><li>Veteran Drug Court Services. </li></ul>
  14. 15. Revocation Rates 2007 Federal 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 <ul><li>State Revocation Rate : </li></ul><ul><li>Texas Felony Revocation Rate = 15.8% </li></ul><ul><li>Top 5 Largest Community and Corrections </li></ul><ul><li>Departments = 16.1 % </li></ul><ul><li>Local Revocation Rate: </li></ul><ul><li>Bexar County Mentally Impaired </li></ul><ul><li>Caseload Department </li></ul><ul><li>Probation Department = 8% </li></ul><ul><li>Manos Diversion Program, CHCS = 6.2% </li></ul>
  15. 16. <ul><li>Then (prior to Sept 2005) </li></ul><ul><li>Wait times for Medical </li></ul><ul><li>Clearance/ Screening at </li></ul><ul><li>UHS ER - 9 hours, 18 min. </li></ul><ul><li>Wait times for Medical </li></ul><ul><li>Clearance/ Screening and Psychiatric Evaluation was between 12 and 14 hours. </li></ul><ul><li>Now </li></ul><ul><li>The wait time for Medical Clearance/ Screening at the Crisis Care Center is 45 minutes. </li></ul><ul><li>Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes. </li></ul>Impact on WAIT TIME for LAW ENFORCEMENT
  16. 17. <ul><li>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. </li></ul><ul><li>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. </li></ul>Wayne County Intensive Probation Program, Michigan Community Based Juvenile Treatment
  17. 18. Involuntary Outpatient Commitment Program Pre IOPC Program Post 79% Reduction in Bed Day Use, Post Program First Year Evaluation
  18. 19. The End Result <ul><li>Comprehensive service for most in need </li></ul><ul><li>Increased availability of comprehensive coordinated services </li></ul><ul><li>Reduced barriers to service access and increase motivation with treatment compliance </li></ul><ul><li>Employ evidence based practices known to be effective </li></ul><ul><li>Utilization of system tracking and outcome based treatment </li></ul>
  19. 21. The Center for Health Care Services Leon Evans, President/CEO The Center for Health Care Services Mental Health Authority 210 731-1300 [email_address]