Crisis Services Continuum Margaret Obilor, Interim Division Director - - PowerPoint PPT Presentation

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Crisis Services Continuum Margaret Obilor, Interim Division Director

AUGUST 2016

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Crisis Services Continuum Plan:

Fill gaps to improve near & long term

• utcomes for individuals experiencing

behavioral health crisis in Santa Clara County; thereby, avoiding unnecessary hospitalizations and making available appropriate community-based resources.

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Mobile Crisis Services Urgent Care Services Crisis Stabilization Services Emergency Psych Services Crisis Residential Services 24-Hour Crisis Telephone Line

• Often first point of

entry

• Available 24/7
• Screen for

appropriate level of crisis intervention

• Connect to

community resources

• Staffed with Close to

50 Volunteers

• Two Teams
• South County
• San Jose
• 24/7 Quick Response
• Face-to-face

Intensive Services

• “Wellness Checks”

for at risk individuals.

• Link to Support

Services

• Often placement

prior to contracted residential placement

• Available 24/7
• Monitor for

continued need for placement

• Support discharge to

Community Services

• Brief support could

connect individual with appropriate service.

• Available 24/7
• Screen for

appropriate level of crisis intervention

• Connect to

community resources

• Often first point of

entry

• Available 24/7
• Screen for

appropriate level of crisis intervention

• Often step prior to

hospitalization.

• Stabilization due to

danger to self/others

• Crisis requires

temporary removal from current environment

• Non-hospital setting
• Supervised
• Connect to

community resources

DESCRIPTION

GAP:

• Electronic phone

system that connects county resources

• Available licensed

staff GAP:

• Mobile services: 24/7
• Diversionary Services
• Preventive Support
• Linkage to Services

GAP:

• Available psychiatrists

for medication services.

• Services for transition

to appropriate care GAP:

• Medication
• Counseling
• Referrals, and
• Linkage to Ongoing

Services.

GAP:

• Coordination of Crisis

Services

• Additional modes of

transportation

• Placements for

Medically Fragile Clients

GAP:

• Only 35 beds

available for entire SCC BHS System (not enough)

• Researched new

phone system

• RFP: Selected

Provider(s)

• Coordinating Services
• Integrating with

SCCBHD Electronic Health Records

• Former EVP is been

renovated through CHAFFA

• Improve Care

Coordination

• Smoother transitions

to crisis services as needed

• Increase beds

available

• Expand service area
• Emergency medical

vehicle for transportation

PLAN TO IMPROVE CURRENT SERVICE GAPS 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).

Santa Clara County Behavioral Health Services – Crisis Services Continuum

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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

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EPS Activity

150 200 250 300 350 400 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

2012-2016 EPS Admits from Law Enforcement

Admits Median

Growth in EPS Admissions in recent years Recent spike – signs of even greater growth?

20 40 60 80 100 120 140 160 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

EPS Minor Census 2013-Present

Age 0-11 Age 12-17 Total 0-17 Median

Sustained drop in Youth EPS Admissions in the last year

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Current Situation: BAP Activity

• Over 50% of BAP Inpatient Days are

“Administrative” (no longer acute)

• Step-down services are frequently not

available

• Individuals linger in the hospital

unnecessarily for a longer period of time

• Contract Hospitals are experiencing

the same challenge with stepping patients down into lower levels of care

800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

BAP Inpatient Days: % Administrative

% Admin Median Total Days

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Readmissions: The Good News

2000 4000 6000 8000 10000 12000 14000 16000 18000 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 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

BAP & Contract Hospital Discharged Clients Readmitted with 30 Days (all cause)

% of Discharged Clients Readmitted within 30 Days Median Clients Readmitted # Open Consumers

Hospital Readmission Rate may be dropping

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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

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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

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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

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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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Progress

• Mobile Crisis Services
• Two mobile teams, South Region and San Jose, expected to launch in late Fall 2016
• New capacity to intervene quickly, day or night, at multiple county locations
• Will include preventive services such as “wellness checks” (for individuals deemed fragile or at risk of

hospitalization)

• Crisis Stabilization Services
• 8 new slots in an unlocked facility on East Region, will provide immediate crisis stabilization in a client friendly

environment – expected to launch in October 2016. Crisis Residential: 30 new beds

• Coordination/Linkages
• A stakeholder Workgroup is been developed, ready to launch in September, the group will work to develop a

fluid system that ensures appropriate transition across the continuum in a timely organized manner, 24/7

• Work group includes: MHUC, Mobile Crisis Providers, Crisis residential providers, EPS, Law Enforcement & 24

Hour Care, NAMI & Consumer representative

• Improved use of 5150s
• 5150 Work Group is developing guidelines and policies to support and maintain certification of 5150 capable

staff

• Monitoring through data and clinical supervision that individuals placed on 5150 hold, or utilizing other crisis

continuum services, are placed in an appropriate level of care.

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Comments & Questions

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