May 22, 2017 Norristown State Hospital Bucks, Chester, Delaware, - PowerPoint PPT Presentation

May 22, 2017 Norristown State Hospital

 Bucks, Chester, Delaware, Montgomery and Philadelphia  2 State Hospitals closed – Philadelphia State (1989) & Haverford State (1997)  Closed approximately 1550 state hospital beds since 1990 via Community Hospital Integration Project Programs(CHIPPs)  First in PA to begin HealthChoices (1996)  First to develop Regional CHIPPs Model (2000/01) 2 SE REGION SAP Presentation 5/22/17

 OMHSAS’ “Fred L” lawsuit began in FY 2007 and concluded in FY 2012/ 12/13 13  210 BEDS closed as a result the “Fred L”  From FY 2 2006/ 06/07 07 to FY FY 2013/ 3/14 14, the regional onal bed cap dropped from 294 4 to 8 81 civil beds  Forens nsic c to c civil transfers fers 40+ beds NOW W  The average rage regional onal civil census betwe ween n FY 13-FY 17 has been n 120 0 beds 3 SE REGION SAP Presentation 5/22/17

SE REGION SAP Presentation  From m FY 2012 to curren rent, t, on ave verage, rage, 74% of total admis missions sions to the e civi vil units ts are e crimi minal nal ju justi tice e invo volved ved indi divid viduals uals  Of the curren rent t civi vil populat ulation, ion, 75% of the Ph Philad adelp elphia a County nty popul pulation ation have ve crimin minal al ju justi tice e ove versig sight. ht.  28% of the suburba burban n Counti nties es curren rent popul pulation ation have ve crimi minal nal ju justi tice e ove versigh sight 4 5/22/17

SE REGION SAP Presentation 5 5/22/17

Total Admits Total Discharges* 80 74 70 60 51 50 40 29 29 31 30 30 29 27 20 28 18 28 13 10 0 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 (up to 4/30/17) 6 SE REGION SAP Presentation 5/22/17

Civil Censu sus s as o of County FY 2 2016/1 /17 7 CIVIL BED D CAP 5/8/1 /17 7 Bucks 18 18 17 17 Chester ter 4 11 11 Delaware e 13 13 13 13 Montg tgom omer ery 22 22 23 23 Philadel elphia 18 18 55 55 Total 75 75 119 119 7 SE REGION SAP Presentation 5/22/17

• Gender: 92 men; 30 women • Age: 18 – 64 = 111; 65 and over = 11 • Diagnosis: (Primary) • Schizophrenia – 52 • Schizoaffective – 37 • Major Depressive – 11 • Psychosis – 6 • Bipolar - 6 • Impulse Disorder – 2 • Autistic Disorder - 1 8 SE REGION SAP Presentation 5/22/17

Ot Other r Clinica cal Fact ctors ors • Substance Abuse • Trauma • Traumatic Brain Injury • Dementia • Intellectual Disability SE REGION SAP Presentation 5/22/17 9

• Admission/readmission rates • 2014 – 11 admissions, 6 were readmissions • 2015 – 12 admissions, 4 were readmissions • 2016 – 10 admissions, 4 were readmissions • 2017 – 3 admissions, 4 were readmissions 10 SE REGION SAP Presentation 5/22/17

• Insura surance nce Status: tus: • Medicare Coverage • Benefits Source • SSD – 27% • Part A & B – 32% • SSD Suspended – 16% • Part A only – 10% • VA only – .008% • Private Pension – .016% • Private Ins. – .025% • Multiple Sources – .03% • No coverage – 56% • None – 53% • Past MA Eligibility • Yes – 81% • No – 19% SE REGION SAP Presentation 5/22/17 11

◦ Under 2 years - 19 ◦ 2- 5 years - 39 ◦ 5 – 10 years - 37 ◦ 10 – 20 years - 17 ◦ 20 – 30 years - 7 ◦ 30 – 40 years - 2 ◦ 40 – 50 years - 1 SE REGION SAP Presentation 5/22/17 12

Historically used fewer beds =   3.8 per 100,000 population for state hospital utilization (about 80 beds for over 3.1 million adults in the SE Region) According to the SAMHSA Uniform Reporting System (URS)  Pennsylvania State Hospital Adult Admissions rate is: .13 per 1000 population Con onclu lusio ion: : the e SE Regio gion only nly uses es the e state e hos ospit pital al  resour ources ces when hen all l other her com ommu munit ity resour ources ces have e been en exhau haust sted ed. . Howev owever er, , some me of the e Counti ounties es do cur urrentl rently y use e and d will ll con onti tinue e to need ed Civil vil SMH H beds. . 13 SE REGION SAP Presentation 5/22/17

Involves persons waiting in County Jails for psychiatric treatment and persons  waiting to transfer from forensics (Bldg51) to civil sections at NSH DHS Settlement in January 2016  14 SE REGION SAP Presentation 5/22/17

 Throughout the SE Region, a total of 93 persons have been discharged – CHIPP ( As of April 2017)  We continue to assess every person for any community vacancy and appropriateness for the community placement  Thus far, development of new services and enhancing existing services ….STILL MORE TO COME…. 15 SE REGION SAP Presentation 5/22/17

1. Repurposing beds from civil to forensic 2. Clinical Assessment of current civil population 3. Assess need for long term care in community 4. Develop supports to reduce demand for long term care and provide alternatives to the state hospital level of care 16 SE REGION SAP Presentation 5/22/17

• Step Down Units: Restor oring ing Hope- Build lding ing Skills s fo for a Better r Tomorrow row • Ultimately 3 step down units will have a maximum of 20 consumers on each unit, with a staffing complement suitable for 30 • Currently 2 Step Down Units • Help individuals develop skills and knowledge that can be utilized in their personal recovery by promoting self- confidence and respect for self and others which is integral in the safe and successful re-entry into the community. • Re- entry may not mean discharge to community living but rather for some to return to court to face legal situation/issues. 17 SE REGION SAP Presentation 5/22/17

 Utilizing a validated clinical tool by independent outside assessors  The assessments are used to inform the counties and the hospital of the treatment services and residential supports necessary for successful community inclusion  To inform mental health and criminal justice authorities of the relative clinical risks associated with release of those individuals under judicial oversight 18 SE REGION SAP Presentation 5/22/17

• WHERE: • NSH civil units, forensic treatment units (as identified by Counties) and in County jails • HOW/WHO?: • Regional 4 Suburban Counties & Philadelphia Process (separate) • WHAT THEN?: • Assessments & recommendations are then shared with the NSH clinical team and become an integral part of the Community Support Plan (CSP) for each individual 19 SE REGION SAP Presentation 5/22/17

• Assessment & discharge planning process • Goals: • Identify individuals for potential discharge • Identify supports needed for individual to be successful in the community • Provide support and continuity of care throughout discharge planning process • Process • Outcomes • Challenges SE REGION SAP Presentation 5/22/17 21

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Norristown State Hospital 54 Philadelphians discharged since 1/27/16 NSH Forensic NSH Civil Unit Unit 29 25 Data as of SE REGION SAP Presentation 5/22/17 23 4/30/17

NSH Civil Unit 56 Philadelphians Of the remaining Currently 29, we are Assessed and working with our engaged in CJ and DBHIDS discharge partners planning 27 Extra-ordinary legal To be assessed barriers 4 25 Data as of SE REGION SAP Presentation 5/22/17 24 4/30/17

 Over 150 (95 suburban counties and 56 Philadelphia) assessments assigned and approximately 70% completed to date  Individuals need intensive therapeutic support which includes: ◦ psychiatric medication management, intensive staff support, community and clinical supports to maintain stability, assistance with managing and achieving goals in the community, medical and physical healthcare monitoring, etc.  Some individuals may require intensively staffed, secure, 24/7 residential supports that have a clinical component  Some individuals need specialized clinical supports (TBI, Cognitive impairments, community risk and safety issues, physical and medical supports, etc.) 25 SE REGION SAP Presentation 5/22/17

Legal Barriers Clinical Barriers  Special needs  High level open ◦ Medical charges ◦ Psychiatric  Concerned about ◦ Cognitive community safety  Co-occurring from Courts, needs objections from  Don’t want to District Attorney leave NSH SE REGION SAP Presentation 5/22/17 26

 Current rrent St State e Ho Hospit ital al Po Popul ulation ation  Current rrent Forens ensic c Wa Wait List t popu pulation ation  Extended ended Acute te Care e (EAC) C) Utilization ation  Acute e Inp npatient atient Ho Hospit itali alizati zations ons – Hi High gh Utilization ation popu pulation ation 27 SE REGION SAP Presentation 5/22/17

• Phila ladelp delphia hia an and S d Subu burban ban Cou ounti ties es ha have e ~90 ~90 be beds ds for or EAC • On average the length of stay for EAC is between 170-277 days inpatient* • Managed Care funded - HEALTHCHOICES ONLY • Typical discharge to structured community treatment supports and structured housing * Philadelphia’s Average Length of stay days ~ 277 days and suburban ~170 days 28 SE REGION SAP Presentation 5/22/17