Title Subtitle 1 1 Health Commission Director of Health - PowerPoint PPT Presentation

Jail Health Services Lisa A. Pratt, MD, MPH Director / Medical Director Jail Health Services Title Subtitle 1 1

Health Commission Director of Health Information Coordination of Compliance & Finance Policy & Planning Human Resources Security Communications Technology Division Initiatives Privacy Affairs Community Health Equity Managed Care & Patient Environmental Health Ambulatory Care & Promotion Finance Zuckerberg San Francisco Disease Prevention & Public Health Emergency Primary Care General Preparedness & Response Control Emergency Medical Laguna Honda Hospital Office of Equity & Quality Behavioral Health Services Office of Ops, Finance & Center for Learning & Transitions Jail Health Grants Mgmt. Innovation Applied Research, Community Center for Public Health Maternal, Child & Health Epidemiology & Research Surveillance Adolescent Health Bridge HIV 2

JHS Organizational Structure Jail Health Services Behavioral Re-Entry & Medical Dental Pharmacy Health HIVIS 3

JHS Budget FY 2014-2015 Operating Budget Salaries & Benefits 23,967,272 Professional & Specialized Services 3,641,078  Includes BHS, X-RAY, Podiatry, UCSF OBGYN Pharmaceuticals 2,478,792 Material & Supplies 624,680 Other Expenses 297,102 $ 31,008,924 4

JHS Staffing 163 FTE Nurse Managers 3.0 Psychologist 1.0 RNs 61.6 Therapists 20.0 LVNs 25.0 Counselors 4.0 MD/NPs 12.6 Pharmacists 3.0 Administration 4.0 Pharm Technicians 5.0 Support Staff 14.0 Dentist 1.4 5

Who is in the SF Jail? Total unique patients in 2015: 15,000 Current average daily census: 1,250  86% of people in SF Jail have not been sentenced  14% are serving a sentence  7-14% Seriously mentally ill Average length of stay  65% less than 7 days  18% 7-30 days  16% 30 days or more Sex and Gender Identity  86% are men; 14% are women (SFSD)  78% men, 13% women, 10% declined to answer (JHS)  Trans Women 61, Trans Men 17 Source: Jail Information Management System 6

SF Jail Entry 2009-2016 35000 28,776 30000 25,037 24,233 23,741 25000 23,695 21,033 21,029 20,032 20000 17,912 17,249 16,566 16,402 15,005 14,441 15000 10000 5000 0 FY 09-10 FY 10-11 FY 11-12 FY 12-13 FY 13-14 FY14-15 FY15-16 Triage Intake 7

Race/Ethnicity 2015 Native American 1% Other 2% Unknown 3% Asian/Pacific Islander 8% African American 36% Latino 16% White 34% 8

Care in the Jail Triage →  Acute: ZSFG ED/PES Intake →  Subacute: BHS evaluation, psychiatry referral, substance use detox, primary care -> specialized housing  Chronic care: primary care, psychiatry and mental health services, dental services Referral →  RN assessment 9

2015 JHS Encounters Medical Services Triage 20,333 - ED Referrals 613 Intake screening 14,417 Nursing visits 31,144 Clinician visits 25,187 Dental visits 2,016 Pharmacy fills 194,000 10

Behavioral Health Services  Evaluation  Evidence-based individual and group therapy  Medication management  Assessment and referrals to community treatment  Substance abuse assessment and treatment  Reentry Services  Crisis Intervention 11

Behavioral Health Services Stabilization and Reentry:  Comprehensive mental health evaluation 6,567  Psychiatry visits 4,258  Group therapy visits 27,397  Individual therapy visits 18,810  Reentry planning visits 6,894 Crisis Intervention:  5150 hold at the jail 465  Admission to 7L 330 12

HIV & Integrated Services Screening and Prevention 2015  8,900 tests done  PrEP and PEP overdose education  Condom and naloxone distribution Center of Excellence 2015  HIV Medical Care – 339 patients  Medical Case Management – 127 patients  Psychosocial assessment  Medication adherence support  Discharge planning 13

JHS Innovative Programs Substance Use Treatment  Methadone and Buprenorphine Prenatal, Intrapartum and Post-Partum Support  UCSF OB/GYNs  Birth Justice Project Clinical Pharmacist-Managed Clinics Hepatitis C treatment with direct-acting antivirals Reentry Programming  Misdemeanor Behavioral Health Court  Mentoring and peer support program (MAPS)  Transitional Age Youth services 14

Opportunities - BHS Medication Management  Continuity of medication  Increased number of prescribers Stratification Tools  Screening instrument to determine level of care  Validated suicide assessment tool Psychiatric Sheltered Living Units  Strengthen stabilization and community transition programs  Develop individual treatment plans for group therapy 15

Opportunities  Expand public health surveillance and treatment  Initiate and coordinate medication-based relapse prevention therapies  Expand HIVIS model to medically complex patients  Medical case management and supported continuity  Integrate HIVIS and BHS re-entry programs  Sharing resources and best practices  Formalize linkage opportunities across healthcare and social service entities 16