Community Care Based Services

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

Community Mental Health Philosophy “ You get better outcomes when treatment is nearer to families, jobs and communities”. Leon Evans Philosophy

Community Care Is better than Institutional Care
Costs less than institutional care
Is least restrictive
Allows for greater
family involvement
Produces better
outcomes

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.

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)

Four Good Reasons
Why States Shouldn’t Cut Home and Community Based Services in Medicaid
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.

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)

An Ounce of Prevention Taxpayer 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 presentation To NACo, July 2008

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.

Collaboration: It’s an unnatural act between… … two or more unconsenting adults.

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

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 Clearance
Crisis Line
Crisis 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

Therapeutic Justice Partnerships with 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.

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
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%

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

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.
Wayne County Intensive Probation Program, Michigan Community Based Juvenile Treatment http://www.healthymarin.org/modules.php?op=modload&name=PromisePractice&file=promisePractice&pid=1022

Involuntary Outpatient Commitment Program Pre IOPC Program Post 79% Reduction in Bed Day Use, Post Program First Year Evaluation

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

The Center for Health Care Services Leon Evans, President/CEO The Center for Health Care Services Mental Health Authority 210 731-1300 www.chcsbc.org [email_address]

Community Care Based Services

by Gilbert Gonzales on Oct 14, 2010

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Community Care Based Services — Presentation Transcript