Community Triage Center: Preliminary Baseline Data November 9, 2017 - - PowerPoint PPT Presentation

Community Triage Center: Preliminary Baseline Data

November 9, 2017 suzanne.smith@augie.edu

INTERCEPT 0 COMMUNITY SERVICES

Intercept 0: Community Services

• Helpline
• Lutheran Social Services
• Southeastern Behavioral Health
• Carroll Institute
• Falls Community Health
• Avera and Sanford ERs

Helpline Calls

National Suicide Prevention Lifeline: 1,538 calls

2016 Identified Needs for Mental Health & Addictions (Summary) Triage Services 756 Substance Abuse 1,128 Mental Health 537 Other (counseling, support groups, etc.) 1,666 Suicide Prevention 2,056 Talklines/Warmlines 3,005 Grand Total 9,148

Lutheran Social Services (Counseling)

Total clients served: 667

21 28 53 13 17 24 40 451 434

50 100 150 200 250 300 350 400 450 500

Clients by Service

Southeastern Behavioral Health

Total clients served annually: about 5,000 Top referral sources:

– Department of Social Services – Schools – Family / self / friends – Hospital / medical facilities – Court / criminal justice – Human Services Center

Carroll Institute

Clients served annually: 2,000

Carroll Institute: The Arch

3% 0% 83% 4% 5% 0% 0% 5% 0%

Referral Sources, FY2017

Alcohol/Drug Provider Community Hospital Court/Criminal Justice Department of Social Services Family/Self/Friend Human Services Center Indian Health Services Other Other Social Services

Carroll Institute: The Arch

41.72% 27.51% 26.34% 0.47% 0.47% 1.63% 0.23% 0.00% 0.70% 0.47% 0.23% 0.23% 31.76% 7.62% 26.32% 5.08% 10.89% 9.26% 0.00% 4.36% 1.27% 2.54% 0.54% 0.36%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00%

Discharges, FY16 and FY17

FY16 FY17

New Horizons

2015 2016 Total Admissions 145 63 Average Length of Stay 11.3 9.8 Average Daily Census 6.9 2.4

New Horizons

2015 2016 To Inpatient 51 13 To Slip Slot 27 16 To Outpatient 45 16 IVC Dropped 6 1 Terminated 20 20 Total Discharges 149 66

Falls Community Health

1,998 231 871 543 446 86 292 231 500 1,000 1,500 2,000 2,500 Behavioral health Chemical dependence Substance abuse: Alcohol Substance abuse: Drugs

Encounters and Patients

Encounters Patients

Medical encounters 27,096 Medical patients 8,852

Hospital ERs

6364 6081 2542 2024 556

1000 2000 3000 4000 5000 6000 7000 Encounters (total) Mental health Substance abuse Substance abuse: Alcohol Substance abuse: Drugs

ER Encounters (2016)

Total

Arrival to ER

3929 2341 73 24

500 1000 1500 2000 2500 3000 3500 4000 4500 Walk In EMS Law enforcement Unlisted/Other

Means of Arrival (2016)

Total

Length of ER Stay

Average stay: 190 minutes (3.2 hours) Total ER time: 1,197,973 minutes 832 days 2.28 beds per day

Disposition after ER

4722 593 556 218 199 161 112 500 1000 1500 2000 2500 3000 3500 4000 4500 5000

Disposition (2016)

Total

Intercept 0: Summary

Organization Behavioral Health Clients Served (2016) Helpline > 9,000 calls statewide Falls Community Health 500 to 1,000 behavioral health patients Lutheran Social Services 667 counseling clients Carroll Institute 2,000 clients Southeastern Behavioral Health 5,000 clients Hospital ERs 6,589 behavioral health encounters Adults with SMI (est. 5% MSA) 9,156 Adults with SUD (est. 15% MSA) 27,468

INTERCEPT 1 LAW ENFORCEMENT

Intercept 1: Law Enforcement

• Calls for Service
• Mobile Crisis Team
• Arrests and Charges
• Detox and Sobering Center

Calls for Service

Total calls in 2016: 127,547

Incident Type Calls % of All Calls Disorderly Subjects 12,462 9.77 Accident 8,988 7.05 Larceny 4,594 3.60 Family Dispute 4,416 3.46 24/7 Violation 4,048 3.17 Check Wellbeing 3,946 3.09 Narcotics Violation 3,738 2.93 Intoxicated Subject 2,769 2.17 Prisoner Transport 2,611 2.05 Vandalism 2,537 1.99 Abandoned Vehicles 2,466 1.93 Assault 2,419 1.90

Calls for Service

Most calls are resolved on scene.

127,547 79,114 15,145 9,734 1,326 98

• 20,000

40,000 60,000 80,000 100,000 120,000 140,000 Total calls Necessary Action Taken Arrest / Lodged at Jail Citation Lodged at Detox Lodged at McKennan

Selected Call Outcomes, 2016

Mobile Crisis Team

In 2016, MCT’s diversion rate was 94.7%.

Calls Received 572 Calls Declined 85 Calls Taken 487 Remained Home 417 85.6% Voluntary Admission to Avera Behavioral Health 30 6.2% Detox / Other Placement 14 2.9% Involuntary Hold 26 5.3%

Which calls result in arrest?

Incident Type Calls Resulting in Arrest % of Incident Type Resulting in Arrest % of All Calls Resulting in Arrest 24/7 Violation 2,272 56.13% 15.00% Narcotics Violation 2,014 53.88% 13.30% Disorderly Subjects 1,545 12.40% 10.20% Warrant Service 1,352 59.09% 8.93% Assault 922 38.11% 6.09% Shoplifting 848 44.40% 5.60% DWI 842 61.59% 5.56% Runaway 517 31.51% 3.41% Family Dispute 472 10.69% 3.12% Non Hazardous Moving Violations 371 36.92% 2.45% Traffic 337 47.13% 2.23% Intoxicated Subject 293 10.58% 1.93%

Which calls result in arrest?

12,462 8,988 4,594 4,416 4,048 3,946 3,738 2,769 2,611 2,537 1,545 260 116 472 2,272 62 2,014 293 28 69

2,000 4,000 6,000 8,000 10,000 12,000 14,000 Disorderly Subjects Accident Larceny Family Dispute 24/7 Violation Check Wellbeing Narcotics Violation Intoxicated Subject Prisoner Transport Vandalism

Calls and Arrests by Call Type, 2016

Calls Arrests

Arrests and Charges

Total arrests in 2016: 11,993

2314 986 474 859 160 341 608 886 799 108 492 77

500 1000 1500 2000 2500 3000 3500 Drug/Narcotic Disorderly Conduct DUI Shoplifting Liquor Law Violations Trespassing

SFPD and Sheriff's Office Arrests, 2016 (Selected Charges)

Alone Plus Other Charges

Detox

Clients: 241 (165 IVCs) Bed days: 1,552 Average daily census: 4.25

Sobering Center

Total bookings: 2,621 Bookings per day: 7.18 Average length of stay: 9.7 hours

Intercept 1: Summary

Organization Instances (2016) Calls for service 127,547 calls Necessary action taken 79,114 calls Arrests 15,145 calls MCT calls 572 calls Detox 241 clients Sobering Center 2,621 bookings

INTERCEPTS 2 AND 3 INITIAL DETENTION AND JAIL

Intercepts 2 and 3: Jail

• Bookings
• Mental health and substance abuse

Bookings

24% 76%

All Bookings (2016)

MH or SUD Neither MH nor SUD

Bookings

Bookings % of all bookings MH or SUD 4,201 24.1% SUD alone 1,942 11.1% MH alone 1,465 8.4% Co-occurring 794 4.5% Neither MH nor SUD 13,256 75.9% All bookings 17,454

Bookings

10,308 1,039 1,428 478 3,139 240 468 354

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 Unsentenced (Minnehaha County) Sentenced (Minnehaha County) Contract / Other County All others

Bookings by Legal Status

Neither MH nor SUD MH or SUD

Bookings

10,455 2,798 1,556 419 2,811 1,390 560 274

2,000 4,000 6,000 8,000 10,000 12,000 14,000 Misdemeanor Felony Violent Probation violation

Selected Characteristics

Neither MH nor SUD MH or SUD

Length of Stay

331 353 247 434 180 216

50 100 150 200 250 300 350 400 450 500 MH or SUD SUD MH Co-occurring Neither MH nor SUD All bookings

Average Length of Stay (hours)

Length of Stay

119 757 177 263 279 1,147 264 342

200 400 600 800 1000 1200 1400 Unsentenced (Minnehaha County) Sentenced (Minnehaha County) Contract / Other County All others

Average Length of Stay by Legal Status

Neither MH nor SUD MH or SUD

Length of Stay and Self-Reported MH/SUD

500 1000 1500 2000 2500 3000 3500 4000 4500 5000

< 12 hours 12 to 24 hours 24 to 48 hours > 48 hours

Positive Report by Length of Stay

SUD MH COOC None

Intercepts 2 and 3: Jail

• Next steps:

– Improve data quality with universal mental health screening at intake – Data matching to identify at booking people known to community-based behavioral health providers – Criminogenic risk assessment tool

SUPER UTILIZERS

Super Utilizers

62.1% 17.9% 8.2% 4.2% 2.6% 1.4% 1.1% 0.7% 0.5% 0.2% 0.2% 1.1% 29.4% 16.9% 11.6% 7.9% 6.0% 4.0% 3.5% 2.5% 2.2% 1.1% 1.0% 14.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 1 2 3 4 5 6 7 8 9 10 11 12+ Number of Bookings in 2016

Super Utilizers (All Bookings)

People (%) Bookings (%)

n=9,533 n=20,169 Top 5% 490 people 28.3% of bookings Top 1% 102 people 14.0% of bookings

Super Utilizers

66.9% 12.7% 5.5% 1.7% 2.6% 1.3% 0.6% 0.9% 1.2% 0.3% 0.4% 0.3% 0.1% 0.3% 0.4% 5.1% 19.3% 7.3% 4.8% 1.9% 3.7% 2.2% 1.3% 2.1% 3.0% 0.7% 1.2% 0.9% 0.5% 1.0% 1.7% 48.4%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Number of Bookings in 2016

Super Utilizers (Detox and Sobering Center)

People (%) Bookings (%)

Top 5% 20 people 48.4% of bookings n=782 n=2,708

Super Utilizers

62.6% 17.9% 8.3% 4.2% 2.5% 1.4% 1.0% 0.7% 1.3% 33.0% 18.8% 13.1% 8.9% 6.7% 4.5% 3.6% 2.8% 8.0%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%

1 2 3 4 5 6 7 8 9+

Number of Bookings in 2016

Super Utilizers (Jail Bookings)

People (%) Bookings (%)

n=9,203 n=17,461 Top 5% 638 people 25.6% of bookings Top 1% 123 people 8.0% of bookings

Super Utilizers

18.32% 34.95% 46.93% 54.87% 69.91% 6.52% 13.80% 21.70% 19.49% 29.31% 8.88% 13.01% 12.16% 15.38% 10.66% 2.91% 8.15% 13.07% 20.00% 29.94% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 1 2 3 4 5+ Number of Bookings in 2016

Self-reported SUD and MH Disorders by Number of Bookings

SUD or MH SUD alone MH alone Co-occurring

Super Utilizers

Compared to those who don’t report problems, people who self-report behavioral health problems are:

• 2.14 times as likely to have multiple bookings
• 5.74 times as likely to have 5+ bookings

Multiple (2+) bookings RR RR 95% conf. interval SUD or MH 2.14 2.03 to 2.25 SUD 1.87 1.77 to 1.97 MH 1.26 1.17 to 1.36 COOC 2.18 2.07 to 2.30 5+ bookings RR RR 95% conf. interval SUD or MH 5.74 4.88 to 6.76 SUD 3.28 2.80 to 3.84 MH 1.04 0.82 to 1.33 COOC 5.43 4.68 to 6.31

n=9,203

Takeaway

• Behavioral health problems contribute to

cycling through the criminal justice system.

COSTS AND CAPACITY

Super Utilizers: Jail

Top 1% and self-reported behavioral health problems

• 106 people with 5+ bookings in 2016
• 71 total days in jail per person, on average
• 7,510 bed days annually
• 21 beds per day
• $713,427 annually

Super Utilizers: Jail

Top 5% and self-reported behavioral health problems

• 446 people with 5+ bookings in 2016
• 62 total days in jail per person, on average
• 27,710 bed days annually
• 76 beds per day
• $2,632,518 annually

Cost of Care: Avera and Sanford ERs

• Total charges: $40,037,269
• Average charges per encounter: $6,076

Insurance: Avera and Sanford ERs

4348 2020 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 Insured Uninsured

Insurance Rate for ER Encounters, 2016

Total

Insurance: Falls Community Health

4,299 4,839

1,000 2,000 3,000 4,000 5,000 6,000

Insured Uninsured

Payer

Estimated Cost Summary

Organization Behavioral Health Cost Estimate (2016) Jail (super users) $700,000 to $2.6 million Hospital ER (total) $40 million Uninsured (est.) $9.7 million Medicaid (est.) $6.1 million

Estimated Potential Demand

Source Annual Admissions Daily Admissions Length of Stay (hours) Daily Beds Occupied Detox 241 0.66 155 4.3 Sobering Center 2,621 7.2 9.7 3 Pre-arrest triage 2,656 7.3 279 84.6 Redirected from hospital 636 1.7 3 0.2 Total 6,154 16.86 92.1

Observed length of stay

Estimated Potential Demand

Source Annual Admissions Daily Admissions Length of Stay (hours) Daily Beds Occupied Detox 241 0.66 72 2 Sobering Center 2,621 7.2 9.7 3 Pre-arrest triage 2,656 7.3 72 21.8 Redirected from hospital 636 1.7 3 0.2 Total 6,154 16.86 27

72 hour maximum

Estimated Potential Demand

Source Annual Admissions Daily Admissions Length of Stay (hours) Daily Beds Occupied Detox 241 0.66 155 4.3 Sobering Center 2,621 7.2 9.7 3 Pre-arrest triage 266 0.73 12 0.37 Redirected from hospital 636 1.7 3 0.2 Total 3,764 10.29 7.87

Conservative Pilot

DEMOGRAPHICS

Gender

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Arrests (SFPD & SO) Carroll Institute MCT Falls CH LSS Avera ER Sanford ER Male Female Unknown/Other

Race

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Arrests Carroll MCT Falls CH LSS Population White Native American Black Asian Multiracial Hispanic Other Unknown

Language

Falls Community Health clients best served in another language:

23%

Arrests by Age

100 200 300 400 500 600 700 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 80

Arrests by Age, 2016 (SFPD & SO) 30 years 40 years

POLICY QUESTIONS

Policy Questions

• Goal

– Shift burden from CJ / ED, or – Engage underserved groups?

• Target population

– Super utilizers, or – Unreached, new clients?

• Point of intervention
• Services

suzanne.smith@augie.edu