Portal of Entry and Communications Presenters: Sandra Hernandez, - - PowerPoint PPT Presentation

Portal of Entry and Communications

Presenters: Sandra Hernandez, LCSW Mikelle Le, LMFT

Mental Health Full Board Meeting July 8, 2013

PORTAL OF ENTRY

 Key programs and clinics that serve as

entry points to SCCMH Services:

 Call Center (CC)

• 1-800-704-0900

 Mental Health Urgent Care (MHUC)

• 408-885-7855

 Central Wellness and Benefit Center (CWBC)

• 408-885-6220

 Suicide and Crisis Hotline (SACS)

• 1-855-278-4204

Call Center (1-800-704-0900)

 Hours:

• 8 a.m. - 5 p.m. Monday – Friday
• After 5 p.m. on weekdays/weekends/holidays, the main

Call Center number is a Crisis Line only.

 Staff

• 11 Licensed Clinicians

 Roles/responsibilities:

• Screening (crisis eval., clinical eval., mandated reports)
• Linkage and resources
• Verify benefits
• UniCare Documentation
• Refer to Providers based on clinical needs, age,

culture, language, benefit status, capacity, proximity

Screening criteria:

 Levels of acuity:

• Level 1 : hospital discharged, crisis (seen in 5

business days)

• Level 2: Significantly impaired; need support (seen

in 10 business days)

• Level 3: Minimally impaired; minimal support

(seen in 15 business days)

Referral determination

 Immediate Crisis, Hospital Discharge, Crisis Residential,

FSP Project 90 (Level 1)

 MediCal or MediMedi adult callers needing MD or

counseling services (L 1-3)

 Parents/guardians calling for children w/ MediCal or

Healthy Kids (L 1-3)

 Uninsured adult callers with history of SMI or current

severe symptoms (L 1,2)

 Uninsured children at risk of losing placement or

• decompensating. (L 1,2)

Current Timeliness to access

 Past years average wait time = 45:00 minutes, to

25-30 minutes

 5/2013 Average wait time Eng Adult =1:36  5/2013 Average wait time Eng Child = 1:12  5/2013 Average wait time Spanish Adult = 4:09  5/2013 Average wait time Spanish Child = 1:01  Overall Average wait time all callers = 2:08

Call Volumes:

 5/2013:

• Calls received = 2, 567
• Calls answered = 2,050
• Of the 2,050 calls

 982 referred (48% referred) = (530 kids, 452 adults)  1,068 calls = information/referral calls (opened, returned calls to follow up, resources/referrals, no capacity, etc.)

• Level 1 = 161
• Level 2 = 528
• Level 3 = 294
• Paper referrals = 250-300/per month, all age groups all levels

 4/2013:

• Calls received = 2,744
• Calls answered = 1, 980

 1,004 referred (575 kids, 429 adults)

• Level 1 = 151
• Level 2 = 523
• Level 3 = 330

Referral Volume:

Culture/Languages served:

 Threshold languages served: English,

Spanish, Vietnamese, Tagalog and Cantonese

 T

• p 3 language calls: English, Spanish,

Vietnamese

 Others: Mandarin, Farsi, Portuguese

Population served:

Obligations to Medi-Cal Beneficiaries/Managed Care

 MHD serves Medi-Cal beneficiaries.  Must meet the Title 9 medical necessity criteria

• Axis I Dx, Impairment/life functioning, able to benefit

from treatment.

• Specialty services not available by PCPs

 Coordinate care among providers for appropriate

treatment

 MHD provides:

• 1) Choice of providers
• 2) Culturally competent treatment
• 3) Ease of access
• 4) Best possible care

Table on MediCal/NonMediCal info

Fiscal Year (FY) MediCal Non MediCal FY 09 13,112 5,087 FY 10 12,680 5,781 FY 11 13,457 5,087 FY 12 13,817 5,948

Mental Health Urgent Care (MHUC) 408-885-7855

 Hours:

• 8am-10pm everyday/7 days a week
• Walk-in clinic

 Staff:

• 2 Psychiatrists
• 5 LMFTs/LCSWs
• 2 LPTs
• 2 MH Workers
• 4 HSRs

Roles/Responsibilities:

 Crisis/clinical assessment & interventions  Bridge medications  5150 Legal hold  Clinical consultations/Calls from community  Visitor areas for EPS families  Resources/referrals

• NAMI and Family Affairs resource tables

 Linkage/Transfer

• CWBC/Call Center

 Mobile Crisis

Mobile Crisis:

 Provide consults to Law Enforcement  Field/home visit with Crisis Intervention

T eam (CIT) officers

 Nov. 2012- current: 15

Visits

 Communication/Linkage/Continuation of

care/After care

Volume Served:

 Urgent Care Results: Fiscal Year 2009 to 2012

• Data Source: Unicare (Ucode: U-777)

Age Group FY09 FY10 FY11 FY12 All Fiscal Year Total All Fiscal Year Total % Child & Youth (0-15) 18 36 46 40 140 2.00% Transition Age Youth (16-25) 187 384 301 365 1237 17.30% Adult (26-59) 740 1477 1346 1805 5368 75.30% Older Adult (60+) 43 101 100 144 388 5.40% Total 988 1998 1793 2354 7133 100.00%

Volume Served:

 Urgent Care Results: Fiscal Year 2009 to 2012

• Data Source: Unicare (Ucode: U-777)

Ethnicity FY09 FY10 FY11 FY12 All Fiscal Year Total All Fiscal Year Total % Asian/Pacific Islander 94 221 220 203 738 10.30% Black/African American 62 160 127 154 503 7.10% Hispanic 294 565 542 695 2096 29.40% Mixed Race 1 8 6 6 21 0.30% Native American 14 21 20 41 96 1.30% Other 30 69 57 79 235 3.30% Unknown 77 126 153 313 669 9.40% White 416 828 668 863 2775 38.90%

Total 988 1998 1793 2354 7133 100.00%

Central Wellness and Benefits Center (CWBC) 408-885-6220

 Hours:

• 8 a.m. - 5 p.m. Monday – Friday
• Assist Adult and Older Adult consumers to

access health benefits

• Underserved and uninsured
• Manage their medication needs
• Once qualified for benefits assistance or health

coverage…..

• Linkage to more extensive mental health
• utpatient services within Santa Clara County

Goal of CWBC

 Basic mental health services  Ongoing medication services  Crisis intervention  Benefit Enrollment – Access to a Financial

Counselor

 CWBC is not a traditional Service T

eam

Types of Coverage Assistance Provided

 APD,

Valley Care II, Medi-Cal, SSI, Medicare

 Assistance with Medicare Part D  Minor Consent Medi-Cal  Low Income Subsidy (LIS)

Staffing

 Multidisciplinary

• Psychiatrists
• LCSW/LMFT
• Rehab. Counselors
• Community Workers
• MH Peer Support Workers
• SSI Advocates
• Financial Counselors
• Health Services Rep.’s

Culturally and Linguistically Competent Staff

 Languages served

• English
• Spanish
• Vietnamese
• Russian
• Portuguese
• Farsi
• Tamil
• Telugu

Current Caseload – as of 7/1/13

 1,943 open cases  2,204 closed cases  Average open caseload per clinical staff

person – 243

 (7 clinical staff and 1 clinical Lead)

Benefits

 UMDAP/Self-Pay  APD  Valley Care II  Minor Consent Medi-Cal  Medicare A

Benefits Enrollment Data

 1,960 clients are open to CWBC as of 07/02/13

60% 30% 10%

Type of Benefits

Valley Care II APD - Undocumented & Restricted M/C Medi-Cal, Minor Consent M/C

SSI/SSDI

 SSI Approvals  SSI Denials  SSI Pending  SSI Appeals  SSI Presumptive  SSI Reconsideration  SSI Administrative Law Judge  SSDI - Medicare

When an individual files for SSI/SSDI two applications are taken:

 1) SSI which is Title 16 benefits, this benefit is based on need,

meaning the individual has never worked or does not have enough work history, has no resources above $2000 and is disabled. When they are approved for SSI they get MediCal. There is no waiting period, they will receive their benefits the following calendar month.

 2) SSDI which is Title 2 benefits. This is when an individual has

work history and is considered “insured” because they have paid into the system. They do not have a resource limitation meaning they can own a home and a car. When they are approved they will receive MediCare 2 years from the date found disabled. Their waiting period to receive benefits is 5 months from when the decision has been made.

The following are the SSI/SSDI “steps”:

 Initial Application: client files for SSI/SSDI this decision takes 4

to 6 months.

 Reconsideration Appeal: If client is denied SSI/SSDI this is the

first “appeal” step which must be filed within 60 days of the denial date, again this decision takes 4 to 6 months.

 Administrative Law Judge or ALJ Hearing: If client is denied

• nce again at the Reconsideration Appeal level then they have 60

days from the denial date to file for a Hearing before an Administrative Law Judge. This is when they obtain a SSI

• attorney. A hearing date can take up to 1 year.

 Initial→ Reconsideration Appeal→ Hearing

SSI Advocacy at CWBC

 10/2009- started referrals only, no

approvals or denials were initially tracked.

• Applications initiated at CWBC
• Clients can apply on their own
• Clients can contact an attorney to

process application

Numbers Served at CWBC

 CWBC

Age Group FY07 FY08 FY09 FY10 FY11 FY12 All Fiscal Year Total All Fiscal Year Total % Transition Age Youth 34 173 196 237 640 12.80% Adult (26-59) 214 1026 1248 1643 4131 82.40% Older Adult (60+) 14 56 73 97 240 4.80% Total 262 1255 1517 1977 5011 100.00%

Numbers Served at CWBC

 CWBC

Ethnicity FY07 FY08 FY09 FY10 FY11 FY12 All Fiscal Year Total All Fiscal Year Total % Asian/Pacific Island 40 244 257 275 816 16.30% Black/African American 14 65 85 102 266 5.30% Hispanic 79 405 471 634 1589 31.70% Missing 1 1 0.00% Mixed Race 2 2 2 6 0.10% Native American 2 9 12 21 44 0.90% Other Race 16 52 66 84 218 4.40% Unknown 9 40 78 156 283 5.60% White 102 438 545 703 1788 35.70% Total 262 1255 1517 1977 5011 100.00%

CWBC Highlights

 Streamlined process of transfers to CWBC

from MHUC

 At time of transfer, consumers receive 30 days

• f medication plus two refills

 Consumers are seen at CWBC within 14 days  On a quarterly basis, CWBC closes

approximately 150 – 200 inactive cases a quarter

 Added a 0.5 FTE extra help MH Peer Support

Worker

CWBC Highlights continued

 CWBC receives the highest number of

referrals on a monthly basis of any

• utpatient county or contract clinic

 CWBC receives at minimum 50% total of

all referrals in any given month of all Level I referrals a month

CWBC Highlights continued

 In process to hire a 1.0 FTE Health care

Program Manager II

 In beginning stages of merging CWBC and

MHUC programs

• Benefits to merging the two programs – enhance

existing staffing,

• Provide for improved workflow and efficiencies

re: client care

• Create and provide flexibility for client care
• Improve timely access, benefit assistance,

collaborative care

MHSAC

MHSAC FY07 FY08 FY09 FY10 FY11 FY12 All Fiscal Year Total Child & Youth (0-15) 1 1 Transition Age Youth (16-25) 59 93 88 65 2 307 Adult (26-59) 3 739 821 742 737 42 3084 Older Adult (60+) 96 92 107 97 5 397 Total 3 894 1006 937 900 49 3789

Ethnicity

Ethnicity FY07 FY08 FY09 FY10 FY11 FY12 All Fiscal Year Total All Fiscal Year Total %

Asian/Pacific Island 1 175 177 200 183 12 748 19.70% Black/African American 56 61 60 44 1 222 5.90% Hispanic 222 238 253 204 9 926 24.40% Mixed Race 3 5 1 1 10 0.30% Native American 8 11 7 7 1 34 0.90% Other Race 34 42 35 31 5 147 3.90% Unknown 23 79 85 90 5 282 7.40% White 2 373 393 296 340 16 1420 37.50% Total 3 894 1006 937 900 49 3789 100.00%

SUICIDE AND CRISIS HOTLINE SERVICES (1-855-278-4204)

 Hours: 24 Hours/7 days a week  Staff: 1 Manager, 1 Supervisor, 101

contacted/Volunteers

 MFTs/MSWs = 16  Hours of training = 80  Roles/Responsibilities:  Crisis assessment/interventions/referrals

Call Volume and Types of Calls

 Call

Volume/Calendar year:

• 2013 = 12,923 (up to date)
• 2012 = 26, 573

 T

ypes of calls:

• Suicide in Progress – caller presenting with such high warning signs

for suicide that it is very likely he may kill himself after he/she hangs up.

• High Risk - caller who may have had prior suicide attempts and is

strongly considering attempting again.

• Medium Risk - caller may have long-term depression and some form
• f mental illness, has frequent thoughts of death but has never

attempted suicide.

• Low Risk - caller does not want to live but would not do anything to

end his/her life, usually just needs someone to talk with to feel connected

• Crisis only (non suicidal) - caller is not suicidal but may be struggling

with some forms of relationship, emotional, financial, or other issues

• Informational (Triage, Referrals/Resources) – caller wants resource

information such as counseling, legal services, housing, employment

SUICIDE AND CRISIS HOTLINE SERVICES

 Tracking of information:

• ACCESS database system- gather caller’s demographic information,

document/record types and number of calls, and generate statistical reports.

 Accreditation:

• SACS crisis hotline was accredited by the American Association of Suicidology

(AAS) in November 2012. Accreditation was for November 2012 – November 2015.

• SACS hotline clinical supervisor and a Suicide Prevention associate attended the

required annual AAS conference in April 2013, Houston, T exas.

 Future plan:

• Ethnic community outreach – SACS hotline ads will appear in 6 ethnic

community newspapers that serve the Latino, Vietnamese, Chinese, and the Filipino community.

• Increase community outreach to Latino community – a part – time

extra help bilingual Spanish community worker will be hired

• Improved tracking technology - issue RFP to procure a web-based software

solution to manage SACS hotline’s caller data. It provides Live-Chat and T ext.

Performance measured through audits and External Quality Review Organization (EQRO):

 State audit every three years:

• 1) Covers 16 domains
• 2) Determines non-compliance
• 3) Requires correction plan for re-imbursement

 External Quality Review Organization

(EQRO) audit yearly:

• 1) Reviews MHD operations
• 2) Makes recommendation for improvement
• 3) Rates improvement effort

MHUC/EPS/CC/CWBC TRIAGE FLOWCHART

CWBC CWBC MHUC EPS/Hospital Specialty Clinic

Call Center

Un-insured Insured 5150 Un-insured

EPS/Hospital