PCHS Steve Day Presentation for 04-23 Work Group.ppt

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  • 1. Presented by Technical Assistance Collaborative, Inc. April 23, 2009
  • 2.
    • Des Moines is developing a long range action plan for people who are homeless.
    • Access to health, substance abuse, and mental health services is critical to the success of permanent supportive housing and other strategies to end and prevent homelessness.
    • There are three steps in the planning process:
      • Define essential elements of a good services system based on what people actually need.
      • Use the above definition to identify and document gaps and problems in the current service system
      • Develop strategies and action steps to close the gaps and move towards the defined good services system. This includes definition of the roles, responsibilities, and interrelationships among the components of the system, and the access points to benefits and services.
  • 3.
    • Same as everyone else, but more serious because of health risks of homelessness and inadequate access to care
    • Also more serious because of multiple and long-term disabilities requiring multiple different interventions and supports
    • Health risks made more serious by:
      • Poverty
      • Substance abuse
      • Mental illness – 25 year difference in life expectancy
      • Trauma
      • Exposure to bad weather – damp, cold, etc.
      • Poor diet
      • Systemic barriers to access to health, mental health and substance abuse care
  • 4.
    • People who are homeless need access to:
      • Psychiatric treatment and mental health supports
      • Substance abuse treatment and on-going supports
      • primary health care (prevention, screening for risk factors, assessment, wellness)
      • Acute care (health emergencies, trauma care)
      • specialty health care (OBGYN, Orthopedics, Endocrinology)
      • Long term care for chronic health conditions (Diabetes, COPD)
      • Rehabilitative care (PT, OT, etc.)
      • May need community supports to facilitate access to and utilization of any of the above
  • 5.
    • Crisis response and stabilization
    • Inpatient treatment
    • Outreach/engagement
    • Case management
    • Psychiatric evaluation and treatment
    • Medications
    • Outpatient counseling
    • Community supports – skill building
    • Peer supports – peer counseling
    • Employment supports
  • 6.
    • Crisis response and stabilization
    • Detoxification (social, non-medical, and medical)
    • Motivational interviewing and engagement
    • Intensive outpatient
    • Residential treatment
    • Opiate treatment – methadone
    • Other medications (Naltrexone)
    • Employment supports
    • Oxford house
    • Peer supports, AA, NA, etc.
  • 7.
    • Need different services and approaches for children, youth, parents, single adults
    • Need competency in co-occurring conditions
    • Need competency in trauma
    • Need cultural/linguistic competence
    • Need services geared to difficult to reach people, including those who are homeless (outreach and engagement, mobile services, harm reduction, flexible community supports, etc.)
    • Need immediate/timely access to services
  • 8.
    • Primary Health Care – Health Care for Homeless
      • Best source of primary and specialty health
      • Provides screening, care coordination, follow up
      • Could assist with access to benefits
    • Emergency Departments (MH and SA, as well as general acute health conditions and trauma care)
      • Iowa Lutheran
      • Mercy
      • Broadlawns
  • 9.
    • MECCA
      • OP, IOP
      • Transitional housing
    • Center for Behavioral Health
      • Opiate treatment
      • Methadone
    • Bernie Lorenz Recovery House for Women
    • Powel Center
  • 10.
    • Crisis team – 20/7/365 phone + limited mobile response
    • Broadlawns (inpatient, psychiatry, outpatient, psychiatric emergency response)
    • Eyerly-Ball (psychiatry, outpatient)
    • Child Guidance Center (psychiatry, outpatient)
    • MH presence in jail
    • Assertive Community Treatment (Medicaid only)
    • Residential services
    • Case management – service management
    • Employment services
    • Skills building – community living supports
  • 11.
    • Mental Health
      • Medicaid – Magellan
        • Medicaid primary health and mental health are separate
        • State bills county non-federal share of many disability services
      • Non-Medicaid – Polk County Health Services
        • No formal funding or administrative linkages to either primary health or substance abuse
      • DHS – MH block grant + assuming funding for mobile crisis
    • Substance abuse
      • Separate funding and management system from Mental health and primary health
      • Magellan manages funding for substance abuse, but not integrated with MH within the Magellan contract
    • Few reliable mechanisms for transitioning youth to the adult system (PCHS has team and services for small number of transitioning youth)
    • Potential disconnect at re-entry from jail/prison
  • 12.
    • For mental health, wait list for uninsured (non-Medicaid) for any types of services except crisis, outpatient, meds, and inpatient
    • Same for substance abuse – long waits, particularly for residential treatment
    • Services narrowly targeted – difficult to establish priority for people with DV or other trauma, family adjustment issues, other mental health issues not related to serious diagnoses, etc.
    • Hospital emergency departments are overwhelmed (and perhaps unwelcoming…)
    • Some providers are not geared up to serve people who are homeless or who have multiple disabilities – do not have applicable competencies
    • Some providers do not deliver mobile services – expect people to come to the service site
  • 13.
    • Little housing – no foundation for care/treatment/follow-up
    • Lack of benefits - uninsured (MA, SCHIP [HAWK-I], VA, etc.)
    • Severely limited resources for MH and SA treatments and on-going services
    • Few clear access points and “rules” for eligibility or priority for service access
    • Poor communications between systems (foster care, juvenile justice, substance abuse, mental health, etc.)
    • Lack of transportation
    • Prior bad experiences with system
    • Service models and approaches that are not tailored to people who are homeless
  • 14.
    • Access to benefits – eligibility?
    • Access to primary and specialty health services?
    • Access to Substance Abuse services?
    • Access to Mental Health services?
    • Access to transitional services for youth?
    • Coordination of service access and follow-up across multiple services and payer sources?
  • 15.
    • Primary health?
    • Crisis response and stabilization?
    • Tenancy supports?
    • Substance abuse?
    • Mental Health?
    • Case Management and care coordination?
    • Peer supports?
  • 16.
    • Health?
    • Substance abuse?
    • Mental health?
    • Housing supports?
    • Other community resources?
    • Mechanisms to facilitate and support to access to multiple benefits and services?
  • 17.
    • Engagement – harm reduction, motivational strategies
    • Mobile services
    • Assignment of medical/clinical home – lead agency
    • Cross system case management
    • Housing support teams
    • Defined priority access to limited resources
    • Interagency agreements and cross system protocols
    • Cross system competency building on co-occurring disabilities, co-morbidity of medical conditions, trauma, cultural competence, transitioning youth, etc.
  • 18.
    • Single “front door” to multiple benefits and services: “no wrong door”
    • One stop and be defined as a set of functions that could be implemented in several places, including shelters, rather than in a single building or location (PCHS does this with designated access points)
    • The functions might include: facilitation of multiple benefit eligibility determinations; facilitation of access to service resources from multiple agencies and funding sources; direct support for people going through the application process; advocacy for priority status for access to community services and other resources; etc.