Enhancing Community Connections: Regional Stakeholders' Meeting Update

1. WELCOME Building Community Connections: Regional Stakeholders Meeting June 17, 2011

2. Agenda for Meeting • Update from DPW • A two year view post closure • Initial results from evaluation by University of Pittsburgh • Strategies for Community Inclusion • Discussion, questions, …..

3. Update From DPW

4. Overview of Two Year Report Outcomes for People Discharged during the Mayview Closure Housing Services Community Hospitalizations, EAC, RTFA Work / Volunteer Physical Health Service System Redesign Planning and Oversight Service Utilization and Cost Implications Conclusion and Future Directions 4

5. Housing at 12/31/2010 Source: monthly tracking reports completed by County monitors.

7. Housing Stability and Satisfaction • About 50% are living in same location as two years ago when the hospital closed • 25% have moved once • 25% have moved two or more times • 73% of those who have moved, moved to a less restrictive setting • Of those who completed a CFST satisfaction survey • 82% rate their housing as excellent • 73% are satisfied with their housing location

8. Satisfaction / Community Connections • High levels of satisfaction with services and a higher quality of life compared to the state hospital • Some people report needing additional services and supports to become more independent and increase connections to the community • Peer support services have been helpful for many individuals

9. Case Management and CTT Use • CTT – 190 Individuals – average 2.8 contacts per week • All other Case Management – average 1 contact per week • 19 people have administrative case management • 9 people have no case management

10. Other Community Services - 2010 • 29% Outpatient services • 17% Crisis services • 11% Social rehabilitation services • 10% Housing support services • < 5% • Drug and alcohol • Partial hospitalization • Respite

11. HealthChoices (non-MRSAP) IP Admission Rates, 2006-2010

12. Community Inpatient, EAC, RTFA • About 20% of people discharged from Mayview had community hospitalizations in either 2009 or 2010 • The average length of stay in 2009 was 37 days, decreasing to 30 days in 2010; the number of days associated with inpatient stays decreased 14% from 2009 to 2010 • Eight people (3%) discharged from Mayview have had an admission to EAC services in 2009 or 2010 • Thirteen people (5%) discharged from Mayview have had an admission to a RTFA • There’s been one civil commitment to Torrance State Hospital • Half of the 21 people transferred to Torrance State Hospital have been discharged back to the community

13. HealthChoices IP Length of Stay, 2006-2010(Includes MRSAP and non MRSAP)

14. Criminal Justice Involvement • 22 people (8%) have been arrested since the closure, totaling 40 separate incidents • In 35 of these incidents, people were incarcerated for varying amounts of time, and charges ranged from probation violation to disorderly conduct to more serious offenses like robbery • Five arrests did not result in an incarceration

15. Work / Volunteer Activities • 20% reported some work or volunteer activity. Many of these activities were informal employment or volunteer activities • 50% of those not working reported being interested in working, and most feel ready to work • A smaller proportion (23%) reported being interested in volunteering • Counties have a number of initiatives to increase supported employment opportunities for their populations

16. Physical Health People discharged report good overall physical health and access to physical health care: • 83% of people report they are in average or excellent physical health • 75% report receiving regular routine physical health checkups, and 82% report having average or excellent access to physical health care • 48% report receiving regular dental care, perhaps reflecting both accessibility issues and personal preferences for seeking regular dental care

17. Physical Health • 19 people have died from natural causes/medical reasons since January 2009, and four other individuals have died from accidental causes • Many people were discharged with complicated, chronic health conditions, and the median age at discharge was 48 years • Many people in this population need significant medical care, and all need physical health care that is closely coordinated with behavioral health • Only 46% of consumers report that their mental health provider communicates with their physical health provider

18. Service Utilization and Cost Implications • Average costs per individuals range from $16,400 to $29,000 per year • Provided services to approximately 1600 people in 2010 who potentially could have used MSH at an average cost of $32,000 annually

19. Conclusion • Generally a successful transition to the community • Higher quality of life and stable, community-based housing with varying amounts of support and access to mental and physical health treatment • Fears that community hospitals and jails would become the new Mayview have been disproven • Connections to the community – whether through employment, personal relationships, or activities – remains an unmet goal for many • Physical health of many individuals, particularly as they age, must continue to be a priority

20. Future Directions • As the region looks ahead, priorities will include: • Continuing to assure that people get the services they need, and that these services focus on recovery and achieving positive outcomes • Assuring ongoing funding to maintain adequate financial resources for the system • Maintaining the regional focus on recovery, quality monitoring and improvement, and data-driven decision-making • Improving cross-system planning and collaboration for special populations and those individuals with particularly complicated situations

21. Mayview Discharge Study • Katie Greeno, University of Pittsburgh • Sue Estroff, University of North Carolina • Courtney Colonna Kuza, University of Pittsburgh

22. Outcomes after discharge • It is valuable to know how people fare after discharge from long-stay hospitals • Understand the recovery process • Quality assurance for providers and policy makers • This study used rigorous methods to document two-year outcomes for people discharged from Mayview

23. Method • We followed 65 people over two years • They represented the whole group • Not every one participated at every time point • We saw people every 3 months • Standardized assessments every other visit • Other visits focused on interviews

24. Study personnel • Two senior faculty members and a very experience project director • 10 interviewers • Pitt graduate students with direct practice experience • Extensive training from the project director • Supervised, then independent visits to participants • Weekly staff meetings • Interviewers stayed with the same participants

25. Data collected • 225 standardized assessments • 138 interview based “check-ins” • 41 in-depth “relocation interviews” • Over 500 visits made to participants’ residences for these observations

26. Standardized measures • Psychiatric symptoms • Improve over two years • Social Contacts • Improve over two years • Quality of Life • Stays the same – compares favorably to other groups • Recovery assessments • Stays the same – about the same as other groups • Perceptions of Care • Do not change over time – lower than other groups

27. Percent with at least moderate illness(BPRS >41)

28. Criteria for remission • Remission of BRPS-rated psychotic symptoms • Seven symptoms related to psychosis • Grandiosity, suspiciousness, unusual thought content, hallucinations, conceptual disorganization, blunted affect • Rated 3 (mild) or less for six months • Additional criterion: • Overall BPRS < 31 for six months

29. Symptom Remission • 50 participants had at least two standardized assessments in Year 2 of the study • We examined their last two observations • 30 participants (60%) met this criterion for remission • 24 participants (48%) met this criterion, and also had an overall BPRS score of 31 or less

30. See friends regularly (percent)

31. WHO Qol: Psychological Well-Being

32. WHOQol compared to other samples

33. WHOQol compared to other samples

34. POC: Interpersonal aspects of care

35. Would you recommend this facility?

36. Rate services from 1-10 (percent)

37. Interview and observational findings • Participants prefer their new residences to Mayview • Community integration is complex and longer term • Housing will be an on-going concern

38. People are satisfied with theirnew residences • New residences are preferred to the hospital • No comparison. It’s better. It’s the freedom factor • I’m free. I go more places. I do what I want to do. • People feel safe and comfortable • Here, I am much more relaxed • I am much more comfortable • There are less people. If residents don’t get along, it gets taken care of by staff

39. Progress needed on community integration • Many participants would welcome more varied activities • Q: What do you do? A: Sleep. Get up and watch TV. Come out here and smoke. • Q: What is there to do? A: Sleeping. Groups. That’s about all. • I don’t go anywhere. I don’t have any money. • Some participants are very active • I am in the process of getting prepared to get a job. I’ll see what kinds of things I want to do.

40. Housing is a continuing concern • Some people adjust well to supervised housing situations designed for short stays (e.g., CRRs), and find the need to relocate again problematic • Most participants have limited financial resources, and will rely on public housing as they become more independent • Public housing is not always available • When available, the quality and safety of public housing is variable

41. Conclusions • People discharged from Mayview are doing well in their new residences • Continued attention to services will be useful. • “The best experience has been knowing that I can make it in the real world. Not as hard as I projected it to be.”

42. Study Design

43. Strategies for Community Inclusion • Panel • Kevin Trenney • Austin Lee • David Bolgert • Gary Seuhr • Joe Burgess • Gabe Chantz

44. Strategies for Community Inclusion • What does recovery mean to you? • What kinds of things have you done, or that you suggest others do, to lessen isolation and improve one’s connection to the community? • If there’s one thing that you would recommend people do to take the first step – what would it be? • What can the community, providers, and/or counties do to help people better connect with their communities?