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2012 04-24 cuyahoga county ohio

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Cuyahoga PPT

Cuyahoga PPT

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  • 7.3 List the mental health facilities in your area that can be utilized as a resource when encountering a subject/suspect you identify as having possible mental health issues Instructor Note: Use MHMR or comparable entity for state referral sources per region. Have students compile a referral list and research appropriate contact numbers.
  • Transcript

    • 1. Community Care Based Services Maximizing Efficiency and Treatment EffectivenessDiversion Initiatives Addressing Challenges Of Mental Illness, Substance Use and Homelessness Cuyahoga County, Cleveland, Ohio April 24, 2012 Leon Evans President and Chief Executive Officer Gilbert Gonzales The Center for Health Care Services Director, Communications Mental Health and Substance Abuse and Diversion Initiatives Authority The Center for Health Care Services Bexar County San Antonio, Texas San Antonio, Texas ggonzales@chcsbc.org 1 levans@chcsbc.org
    • 2. 2
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    • 5. 5
    • 6. Why ? Poor communication Poor system design Silos No strategic improvement plan Little use of prevailing best practices Lack of leadership and overview 6
    • 7. The Problem The Problem gets worse: Poor and or reduced funding Scant, limited and rationed servicesReduction of State Hospitaltreatment beds 7
    • 8. An Ounce of Prevention Taxpayer Costs Avoided through Preventing CrimeCriminal 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 2005Cost 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 8 To NACo, July 2008
    • 9. The Case of Million MILLION-DOLLAR MURRAY by MALCOLM GLADWELLDollar Murray The New Yorker Magazine, Issue of 2006-02-13 and 20, Posted 2006-02-06“It cost us one million dollars not to do something aboutMurray,” News Release Emergency Departments See Dramatic Increase in People with Mental Illness Seeking Care Emergency Physicians Cite State Health Care Budget Cuts at Root of Problem American Psychiatric Association Hillarie Turner, 703-907-8536 June 2, 2004 hturner@psych.org Release No. 04-30 Sharon Reis 202-745-5103 “in one study, it had been concluded that one homeless person can cost the City and County about $200,000 in one year”. Philip F. Mangano, Executive Director of the United States Interagency Council on Homelessness (USICH), May 1, 2007. 9
    • 10. Average Per Capita Spending• In 1995, average monthly spending per capita for clients receiving services in Community Based vs Institutional Cost Per Day "aged/disabled" home and $350 Institutional, $320 community-based waivers $300 across all states with these $250 waivers was $485 per month. $200 Community $150 Institutional $100• In contrast, average monthly $50 Community, $42 spending per Medicaid- $0 covered nursing home resident 1 was $2,426.14. http://aspe.hhs.gov/daltcp/reports/costeff.htm (per episode cost) 10
    • 11. Collaboration: It’s an unnatural act between… …two or more unconsenting adults. 11
    • 12. 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 theneed for hospitalizationand increase the chancesthat patients can fully regaintheir mental health and helpthem to live and worksuccessfullywithin the community. 12
    • 13. Community Care Is better than Institutional Care Costs less than institutional care Is least restrictive Allows for greater family involvement Produces better outcomes 13
    • 14. Community MentalHealth Philosophy“You get betteroutcomes whentreatment isnearer to families,jobs andcommunities”. y h op il os Ph 14 Leon Evans
    • 15. The Diversion ProcessPoint of Contact with CIT/Deputy 24/7 Crisis Emergency Law Enforcement Mobile Outreach Services Transport to Team Hospital *Pre-Arrest Diversion Referrals to Community Arrested Magistrate Post-Booking Diversion Providers Court Pre-Trial Bexar Community-based Diversion County Jail Wraparound Care Genesis Probation, Incarceration, Treatment in lieu of Parole Incarceration Residential Respite
    • 16. Civil and CriminalSystem County City-wide System Level Entry Points Judicial/Courts Magistrate, County, District Probation, Parole County City-wide Continuity of Care Police, Sheriff Treatment Law Enforcement Crisis Care Center Detention/Jail Jail Diversion Mental Health CIT Psychiatric and Medical Public and Private Providers Clearance Specialty Offender Services Emergency Services • Community Collaborative • Crisis Care Center • Crisis Transitional Unit • Crisis Hotline (Nurselink) Dynamic • CIT/DMOT Community • SP5 Crisis Jail Diversion • Jail and Juvenile Detention Information Exchange • Statewide CARE Match 16
    • 17. Stakeholder Collaboration via:• Jail Diversion Oversight Committee (34+ Community Agencies/Stakeholders)• Community Medical Directors Roundtable• Children’s Medical Directors Roundtable• Bexar County Children’s Diversion School District Sub Committee• Bexar County Children’s Diversion Child Protective Services Sub Committee• Bexar County Children’s Diversion Juvenile Justice Probation Sub Committee• Community Co-Location Coalition (29 Community Agencies including law enforcement entities meeting to address the homeless & public inebriate) 17
    • 18. Show me the DATA !!! 18
    • 19. 19
    • 20. 20
    • 21. 21
    • 22. What Works Emergency Room Utilization (Medical Clearance)Emergency Room utilization has dropped 40% sincethe inception of the Crisis Care Center.40% of (7619 total seen at CCC) 3048Persons diverted from the ER (in 2006 first year) X $1545Cost Savings relative to ER Utilization $4,709,160 Source: University Health System 22
    • 23. Today 232012 – The Bexar County Sheriff and San Antonio Police Chief mandate CIT Training
    • 24. Impact on WAIT TIME for LAW ENFORCEMENTThen (prior to Sept 2005) Now• Wait times for Medical • The wait time for Medical Clearance/ Screening at Clearance/ Screening at the UHS ER - 9 hours, 18 min. Crisis Care Center is 45 minutes.• Wait times for Medical • Wait time for Medical Clearance/ Screening and Clearance/Screening and Psychiatric Evaluation was Psychiatric Evaluation is between 12 and 14 hours. 60-65 minutes. 24
    • 25. 25
    • 26. Involuntary Outpatient Commitment Program First Year Evaluation 150 79% Reduction in Bed Pre Day Use, Post Program 100 IOPC # Bed Days Program Used 50 Post 0 State Hospital Bed Day Utilization Rate 1 Yr Prior 132 1 Yr Post 27 26
    • 27. CRISIS CARE CENTER• Crisis Line• Crisis Assessment • Receives consumers• Mobile Crisis Outreach Team from law enforcement• Crisis Transitional Unit 24/7 7137 W. Military 645-1651 • Minor medical clearance • Call ahead preferred 210 225-5481 • Can not take violent or medically compromised individuals 27
    • 28. CIT Mental Health Detail • Mental health professional partners with a CIT Officer together to respond on calls dealing with a psychiatric crisis. • Team responds to high utilizer calls for the City providing follow up services to reduce the call volume. • Goal is to put officers back into service for patrol as soon as possible. – Reduce inappropriate incarcerations and costly emergency room visits. – Offer quality training to law enforcement. • Co-locate officer with the City unit and Sheriff Mental Health Unit for better collaboration and expedited call response
    • 29. Dispatcher Training for 911Call Takers and Dispatchers • In 2007 - decided that dispatchers would also benefit from CIT Instruction and met with SAPD leadership to establish training. • Provided an abbreviated 12 hour CIT course for call takers and dispatchers in collaboration with CHCS • The goal of this training is to increase safety by educating caller takers on essential intelligence gathering and dispatching a CIT Trained officer to the scene.
    • 30. Partnered with Fire and EMS • As of 2007 SAFD has attended every community training • has become co trainers with joint PD and Sheriff’s Officers • Have added a CIT component to their EMS In-service training. • Partnering for Integrated training with Fire/EMS has extended numerous opportunities for growth: – Officer and Fire/EMS better communication – Safety – Better utilization of resources
    • 31. The Restoration Center Opened• April 15, 2008 • Public Safety- Sobering Unit • Detoxification Facility • Community Court • Outpatient Substance Abuse Services 31
    • 32. Haven for Hope Homeless Facility CNN Video Clip “Texas officials hope a massive new facility will keep the homeless out of jail, emergency rooms and re-integrated into society”. • http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html 32
    • 33. Haven for Hope Homeless Transitional Facility 33 www.havenforhope.org
    • 34. 1,600 34
    • 35. 35
    • 36. 36
    • 37. Funding• Jail Diversion Planning and Oversight Committee - Judge Poly Jackson Spencer• SAMHSA Jail Diversion Grant• Changing the Law - Senate/House Bills Madla/Uresti,HB 2292 Mandated Jail Diversion• Police Chief Ortiz Funding - Drug Bust Money• University Health System Partnership- Care Link & New Generation Medications Program• Texas Crisis Redesign - $82 million State-wide• Bill Greehey/Bexar County - Transformation Center• Texas Correctional Office on Offenders with Mental and Medical Impairments (TCOOMMI) • Genesis Outpatient Services - Probation and Parole • Mentally Impaired Offenders Program-Probation • Substance Abuse Treatment Facilities (SATF I and II)• Medicaid Administrative Claiming• Medicaid Eligibility and Carelink Workers• Third Party Billing 37
    • 38. Combined CCC and Restoration Documented and Immediate Cost Avoidance Year One April 16, 2008 – March 31, 2009 Year Two April 16, 2009 – March31, 2010 Year Three April 16, 2010 – March 31, 2011 Cost Category City of San Antonio Bexar County Direct Cost Avoidance Public Inebriates Diverted from Detention $435,435 $1,983,574 $2,419,009 Facility $925,015 $2,818,755* $3,743,770 $1,322,685 $4,372,128 $5,694,813 A. B. Injured Prisoner Diverted from UHS ER $528,000 $1,267,200 $1,795,200 $435,000 $1,044,000 $1,479,000 $421,000 $1,010,400 $1,431,400 C. D. Mentally Ill Diverted from UHS ER Cost $322,500 $774,000 $1,096,500 $283,500 $676,000 $959,500 $276,500 $663,600 $940,100 E. F. Mentally Ill Diverted from Magistration $208,159 $371,350 $579,509 Facility $179,833 $322,300 $502,133 $126,893 $191,125 $310,018 G. H. 38 Summary next slide
    • 39. Summary 39
    • 40. BEXAR COUNTY DETENTION CENTER SYSTEM POPULATION MONTHLY AVERAGES (Main, Annex) 4400 4357 4337 4292 4300 4302 4300 4280 4289 4300 4260 4263 4253 4272 4222 4231 4225 4254 4210 4208 4261 4193SYSTEM POPULATION 4179 4200 4173 4171 4158 4156 4130 4139 4197 4190 4109 4133 4124 4095 4095 4094 4079 4084 4081 4100 4062 4094 4053 4040 4096 4028 4033 4015 4017 4077 4066 3987 4001 3993 4000 3981 4015 3960 3941 3946 3982 3897 On May 2011, there were 883 3900 empty beds in the jail 3845 3807 3854 3790 3791 3800 3743 3700 FEB DEC MAY SEP APR JAN MAR JUN AUG OCT JUL NOV 2006 2007 2008 2009 2010 2011
    • 41. 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 41
    • 42. 42
    • 43. The Center forHealth Care Services Leon Evans, President/CEOThe Center for Health Care Services Mental Health Authority 210 731-1300 43 www.chcsbc.org levans@chcsbc.org

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