Crisis Services Continuum Margaret Obilor, Interim Division Director AUGUST 2016
Crisis Services Continuum Plan: Fill gaps to improve near & long term outcomes for individuals experiencing behavioral health crisis in Santa Clara County; thereby, avoiding unnecessary hospitalizations and making available appropriate community-based resources. 2
Santa Clara County Behavioral Health Services – Crisis Services Continuum 24-Hour Crisis Mobile Crisis Urgent Care Emergency Psych Crisis Stabilization Crisis Residential Telephone Line Services Services Services Services Services • Two Teams • Often first point of • Often placement • Often first point of • Brief support could • Crisis requires • South County entry prior to contracted entry connect individual temporary removal DESCRIPTION • San Jose • Available 24/7 residential placement • Available 24/7 with appropriate from current • 24/7 Quick Response • Screen for • Available 24/7 • Screen for service. environment • Face-to-face appropriate level of • Monitor for appropriate level of • Available 24/7 • Non-hospital setting Intensive Services crisis intervention continued need for crisis intervention • Screen for • Supervised • “Wellness Checks” • Connect to placement • Often step prior to appropriate level of • Connect to for at risk individuals. community resources • Support discharge to hospitalization. crisis intervention community resources • Link to Support • Staffed with Close to Community Services • Stabilization due to • Connect to Services 50 Volunteers danger to self/others community resources GAP: GAP: GAP: GAP: GAP: • Coordination of Crisis GAP: CURRENT • Electronic phone • Mobile services: 24/7 • Available psychiatrists • Medication SERVICE Services • Only 35 beds GAPS system that connects • Diversionary Services for medication • Counseling • Additional modes of available for entire county resources • Preventive Support services. transportation • Referrals, and SCC BHS System (not • Placements for • Available licensed • Linkage to Services • Services for transition • Linkage to Ongoing enough) Medically Fragile staff to appropriate care Services. Clients • Increase beds PLAN TO IMPROVE • Improve Care available • Former EVP is been • RFP: Selected • Integrating with Coordination • Researched new • Expand service area renovated through Provider(s) SCCBHD Electronic • Smoother transitions phone system • Emergency medical CHAFFA • Coordinating Services Health Records to crisis services as vehicle for needed transportation TRANSPORTATION & COORDINATION OF CRISIS SERVICES ACROSS PROGRAMS: Transportation is an essential ingredient of the crisis system that ties all the service components together. The ability to transport individuals in need of crisis services in a safe, timely, and cost effective manner is critical to operations. For example, crisis systems may arrange with private Commercial entities, such as taxi companies, to transport individuals who are willing and able to be transported for treatment, but who lack resources to make the trip. GAP : Mobile teams will coordinate transport with local law enforcement PLAN TO IMPROVE : Develop/review requirements for individuals who are authorized to transport persons in crisis vary between communities and may be determined by the legal status (voluntary versus involuntary).
Current Situation: EPS Activity • Admissions from Law Enforcement grew in the last 2- 3 years; recent months suggest admissions may be rising yet again • Children's Admission volume has declined in the last year, in part due to the newly added crisis stabilization unit and their ongoing mobile crisis team utilization • Individuals with 5150 status in Emergency Departments wait for lengthy periods of time until they can be transferred to EPS
EPS Activity Recent spike – 2012-2016 Sustained drop in signs of even Youth EPS Admissions EPS Admits from Law Enforcement greater growth? in the last year 400 Growth in EPS EPS Minor Census Admissions in 2013-Present 350 recent years 160 300 140 250 120 100 200 80 150 Jan-12 Mar-12 May-12 Jul-12 Sep-12 Nov-12 Jan-13 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 60 40 Admits Median 20 0 Jan-13 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 Age 0-11 Age 12-17 Total 0-17 Median
Current Situation: BAP Activity BAP Inpatient Days: % Administrative • Over 50% of BAP Inpatient Days are 70.0% 1800 “Administrative” (no longer acute) 1700 60.0% 1600 • Step-down services are frequently not 50.0% 1500 available 1400 40.0% 1300 • Individuals linger in the hospital 30.0% 1200 unnecessarily for a longer period of 1100 20.0% time 1000 10.0% 900 0.0% 800 • Contract Hospitals are experiencing % Admin Median Total Days the same challenge with stepping patients down into lower levels of care
Readmissions: The Good News Hospital Readmission Rate may be dropping BAP & Contract Hospital Discharged Clients Readmitted with 30 Days (all cause) 25.0% 18000 16000 20.0% 14000 12000 15.0% 10000 10.0% 8000 6000 5.0% 4000 0.0% 2000 Jan 2014 Mar 2014 May 2014 Jul 2014 Sep 2014 Nov 2014 Jan 2015 Mar 2015 May 2015 Jul 2015 Sep 2015 Nov 2015 Jan 2016 % of Discharged Clients Readmitted within 30 Days Median Clients Readmitted # Open Consumers
Summary of the Problem: Gaps in the Continuum • Mobile Crisis Services • Currently there is no adult/older adult mobile team available to provide early intervention in the community to individuals experiencing an acute mental health crisis event • Crisis Stabilization Services • Brief stabilization and voluntary psychiatric and/or drug related services are currently not available in our county for adults and older adults experience an acute mental health crisis event • Crisis Residential Services • There are currently only 35 crisis residential beds for all BHS clients (10 additional beds are available for Criminal Justice only) • More beds are needed to step-down individuals from inpatient to community
Summary of the Problem: Gaps in the Continuum • Connections/linkages between services • Existing services are fragmented causing individuals to end up in higher levels of service than needed – and for longer durations than needed • Successful use of current and new capacity in the crisis continuum will require improved linkages between services (and among organizations) • 5150 Processes • Currently, law enforcement conducts the majority of 5150s and transports • Improvement in 5150 process are being developed to reduce the volume of 5150s by law enforcement and EPS activity
Desired Improvement • Reduce Emergency Department (ED) & Inpatient admission • By creating streamlined alternative crisis services options in the community, clients do not have to wait very long at ED or EPS for crisis beds • Reduced admission to EPS by Law Enforcement • Increased communication and collaboration with law enforcement on referral and transitional options for individuals in crisis will reduce the over reliance on law enforcement to perform 5150 holds • Continue to reduce number of individuals admitted to EPS due to substance use and criminal justice issues • Developing a coordinated treatment approach with SUT, reduces unnecessary admissions of individuals with Co-occurring disorders to EPS
Desired Improvement • Place individuals in lowest level/least restrictive services possible • Provide short-term, face-to-face, crisis intervention & intensive behavioral health services during a behavioral health crisis or emergency. • Create multiple access points available for individuals experiencing behavioral health crisis. • Support transitions between levels of crisis services • Create a transition from services based on need based services, thereby providing appropriate options • Prevent readmissions • Welfare checks and monitoring for individuals returning to lower level of services. • Warm hand off from & during transitions, to create better connections to new services and new providers. • Reduce future crises (volume and severity)
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