In 2010 Mercy Hospital sought community partnerships to assist in meeting the needs of individuals presenting to the hospital’s emergency room repeatedly who, due to their substance use disorders, mental health disorders, and/or co-occurring disorders, were not able to successfully access and engage in community-based services to address needs. This webinar will chronicle the process of development of the project by community stakeholders, implementation, highlight challenges and successes, delineate measurable one-year outcome data and return on investment.

2. This presentation will:
 Chronicle the process of development and implementation of the
project by community stakeholders.
 Identify and share how barriers were addressed.
 Present outcome data after one year of operation.

3. After attending this presentation participants will be able to:
 Identify two key components of community outreach that
successfully engages individuals at high risk for multiple
emergency room visits.
 Identify two key components for a successful partnership
between emergent health care system and the substance
use disorder treatment system.
 Identify return on investment to communities supporting
community outreach projects, financially and in terms of
improved healthcare outcomes.

4. Mercy Hospital reached out to community partners in 2010
asking for assistance in meeting the needs of individuals
presenting to the hospital’s emergency room repeatedly who
due to their substance use disorders, mental health disorders
and/or co-occurring disorders were not able to successfully
access and engage in community-based services to address
needs.

5. A wide array of community stakeholders were invited to attend meetings to help
develop and implement a number of initiatives related to the health and well
being of the communities served by Mercy Hospital in Cadillac, Michigan.
Anyone who had an interest was allowed access to these meetings. A sampling
of stakeholders involved included:
 Community Mental Health
 NMSAS (the regions Substance Use Disorders Coordinating Agency)
 Public Health
 Catholic Human Services (a provider of both SUD and Mental Health services
in the area)
 Representatives from the area Homeless Coalition
 Clergy
 Wexford/Missaukee ISD
 Mercy Hospital - Medical Social Workers, Nurses and ER staff

6. Issues of concern to the community that were discussed during the coalition meetings were:
 homelessness
 poverty
 mental illness
 substance use
 public transportation
 medical care of low income indigent individuals and families
 school attendance/truancy
Of particular concern to the coalition was the lack of coordination of care for individuals who
frequented the hospital emergency room for issues that could and should be handled in a Primary
Care setting. Care Coordination occurs routinely for individuals who have commercial insurance
providers, but rarely occurs for uninsured or under-insured individuals and families. The coalition
decided to concentrate efforts in this area and were able to secure funding for the Community
Outreach Practitioner in October 2011.

8.  Costs to families
 75% domestic violence
 50% homicide
 Productivity
 Child abuse
 20% of all suicides

9.  Suicide and substance abuse and;
 Suicide and mental illness (particularly depression)
 90% of people who die by suicide have a mental illness
or substance abuse disorder.

10. Mission: To improve the care to people with mental health and substance use
disorders.
Vision: To provide an informed, coordinated, comprehensive community system of
services for individuals with mental health and/or substance use disorders.
Goal: Establish a bridge from the ED to community for clients/patients to interface
with community services or establish community services resulting in improved
mental stability and/or longer periods of sobriety and reduced inappropriate
accessions of ED services.

11. Results/Accomplishments:
 Interagency collaboration.
 Establishment of resource lists for the ED and local providers.
 NMSAS funding for a Community Health Worker (practitioner –
CHP) secured.
 Community Benefit Ministry support for CHP for the poor.

12. Outcome Evaluation:
 20% of patients contacted without a medical home will have a PCP.
 50% of appointments are kept.
 Appropriate health utilization: reduction in inappropriate ED visits.
 Medication compliance.
 Demonstrates knowledge change.
Process Evaluation:
 Numbers contacted.
 Numbers served.

13.  Improve care transitions.
 Reduce preventable hospital admissions.
 Reduce readmissions.
 Avoidable ED visits.
 Improved problem solving; stable mental health, improved
quality of life.
 Sobriety, not using for longer periods of time.

15.  Referrals 105
 Number served 66
 Provider contacts 971
 Number of referrals provided 418
 Medication assistance 23
 Transportation assistance 23
 Co‐pay assistance 6

16. 45
40
35
30
25
20 42
15
24
10
5
0
Inhouse ‐ 64% Community ‐ 36%

17. 50
45
40
35
30
25
47
20
15
10
15
5
4
0
Co‐Occurring Primary Mental Primary Substance
71% Health 23% Abuse 6%

18.  Female ‐ 58%
 Male ‐ 42%
 Homeless ‐ 22%
 Pregnant, just gave birth ‐ 6%

19. 35
30
25
20
15 29
26
10
15 16
5 11
6
0 2
18‐20 21‐25 26‐30 31‐40 41‐50 51‐60 11% 61 and
2% 14% 15% 28% 25% older 6%

20.  Face to face/phone contacts
 Case coordination
 Empathic listening
 Modeling
 Motivational interviewing
 Advocacy
 Validation

21.  51% had a Primary Care Provider
 24% obtained with Community Outreach Practitioner
 5% pending
 15% dropped out/moved
 5% unable to obtain

22.  Kept healthcare appointments ‐ 73%
 Medication compliance
 56% ‐ compliant
 19% ‐ zero prescriber
 Unaffordable
 13% ‐ non‐compliant
 13% ‐ unknown
 SUD
 65% ‐ annual average not using
 28% ‐ still using
 11% ‐ unknown

23.  Year‐to‐date = 132
Examples of “Appropriate Healthcare Utilization” include:
 Medical and psychiatric appointments kept.
 Free clinic utilized.
 Medications obtained through outpatient provider.
 Accessing homecare services.
 Detox accessed through SA treatment provider.
 Emergency MH services accessed through CMH.

24.  89 x 650 = $57,850
 Utilization of a primary care provider, urgent care or
specialist instead of the Emergency Room.
 Procurement of necessary medications, especially
psychotropics.
 Meeting with patients in crisis and developing a stabilized
plan.
 Utilization of public dental clinics for urgent needs.
 Pursuit of residential substance abuse treatment.
 Sustained sobriety and/or mental health stability
resulting in reduced ED/IP visits.
 Referrals to Mercy Homecare and/or Hospice.

25.  Year‐to‐date = 148
“Demonstrated Knowledge Change” refers to
behaviors indicative of increased
knowledge/understanding regarding the
availability of healthcare and community
resources, and/or of improved self‐care with
regard to medical, MH and/or SA diagnoses.

26.  Northern Michigan Substance Abuse Services
 Catholic Human Services