1 Community Care Based Services Leon Evans President and Chief Executive Officer The Center for Health Care Services Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas Maximizing Efficiency and Treatment Effectiveness iversion Initiatives Addressing Challen Of Mental Illness, Substance Use and Homelessness Cuyahoga County, Cleveland, Ohio April 24, 2012 Gilbert Gonzales Director, Communications and Diversion Initiatives The Center for Health Care Services San Antonio, Texas [email protected]
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Community Care Based Services
Leon EvansPresident and Chief Executive OfficerThe Center for Health Care ServicesMental Health and Substance Abuse
An Ounce of PreventionTaxpayer Costs Avoided through Preventing
Crime
Criminal Behavior and Its Cost to Society• 1.7 Trillion including victimless crime – Perazzo 2002
• 674 Billion Federal, State and Local – Shapiro 1999
• 1.0 Trillion (2 million people incarcerated) – Adrienne
2005
Cost Avoided if One Criminal Career is Prevented$ 976,217.81• Average annual adult cost (2004) - $40,865• Average annual juvenile cost (2004) - $32,888
Source: Dr. Victoria Reinhardt, An Ounce of Prevention presentationTo NACo, July 2008
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The Case of Million Dollar Murray
MILLION-DOLLAR MURRAYby MALCOLM GLADWELLThe New Yorker Magazine, Issue of 2006-02-13 and 20, Posted 2006-02-06
News ReleaseEmergency Departments See Dramatic Increase inPeople with Mental Illness Seeking Care Emergency Physicians Cite State Health Care Budget Cuts at Root of Problem
American Psychiatric AssociationHillarie Turner, 703-907-8536 June 2, [email protected] Release No. 04-30Sharon Reis 202-745-5103
“in one study, it had been concluded that one homeless person can cost the City and County about $200,000 in one year”. Philip F. Mangano, Executive Director of the United States Interagency Council on Homelessness (USICH), May 1, 2007.
“It cost us one million dollars not to do something about Murray,”
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Average Per Capita Spending
• In 1995, average monthly spending per capita for clients receiving services in "aged/disabled" home and community-based waivers across all states with these waivers was $485 per month.
• In contrast, average monthly spending per Medicaid-covered nursing home resident was $2,426.14.
Integrating and Strengthening Community-Based Care
• Community-based services, that are readily accessible and convenient, help in the early detection and treatment of mental health problems.
• Will help to reduce the need for hospitalization and increase the chances that patients can fully regain their mental health and help them to live and work successfully within the community.
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Community Care Is better than Institutional Care
Costs less than institutional care Is least restrictive Allows for greater
family involvement Produces better
outcomes
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Community Mental Health Philosophy
“You get better outcomes when treatment is nearer to families, jobs and communities”.
Leon EvansPhilosophy
Point of Contact with Law Enforcement
Magistrate Court
Bexar County Jail
Post-Booking Diversion
Community-based Wraparound Care
CIT/Deputy Mobile Outreach
Team
Genesis Probation, Incarceration,
Parole
Emergency Transport to
Hospital
Pre-Trial Diversion
Referrals to Community Providers
*Pre-Arrest Diversion
Residential Respite
Arrested
The Diversion ProcessThe Diversion Process
Treatment in lieu of Incarceration
24/7 CrisisServices
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Law EnforcementDetention/Jail
CIT
Judicial/CourtsMagistrate, County, District
Mental HealthPublic and Private
Providers
Crisis Care CenterJail DiversionPsychiatric and Medical
ClearanceSpecialty Offender Services
CommunityDynamicCrisis Jail Diversion
Information Exchange
Pol
ice,
She
riff
Pro
batio
n, P
arol
e
Civil and CriminalT
reatment
Continuity of C
are
County City-wide
Emergency Services• Community Collaborative• Crisis Care Center• Crisis Transitional Unit• Crisis Hotline (Nurselink)• CIT/DMOT• SP5• Jail and Juvenile Detention• Statewide CARE Match
System County City-wideEntry Points
System Level
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• Jail Diversion Oversight Committee (34+ Community Agencies/Stakeholders)
• Community Medical Directors Roundtable
• Children’s Medical Directors Roundtable
• Bexar County Children’s Diversion School District Sub Committee
• Bexar County Children’s Diversion Child Protective Services Sub Committee
• Bexar County Children’s Diversion Juvenile Justice Probation Sub Committee
• Community Co-Location Coalition (29 Community Agencies including law enforcement entities meeting to address the homeless & public inebriate)
Stakeholder Collaboration via:
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Show me the DATA !!!
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Emergency Room utilization has dropped 40% since the inception of the Crisis Care Center.
40% of (7619 total seen at CCC) 3048 Persons diverted from the ER (in 2006 first year)
X $1545Cost Savings relative to ER Utilization $4,709,160
Source: University Health System
Emergency Room Utilization (Medical Clearance)
What Works
23Today2012 – The Bexar County Sheriff and San Antonio Police Chief mandate CIT Training
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Then (prior to Sept 2005)• Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 min.
• Wait times for Medical Clearance/ Screening and
Psychiatric Evaluation was between 12 and 14 hours.
Now• The wait time for Medical
Clearance/ Screening at the Crisis Care Center is 45 minutes.
• Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes.
Impact on WAIT TIME for LAW ENFORCEMENT
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Involuntary Outpatient CommitmentProgram
0
50
100
150
# Bed Days Used
1 Yr Prior 132
1 Yr Post 27
State Hospital Bed Day Utilization Rate
PreIOPCProgram
Post
79% Reduction in BedDay Use, Post Program
First Year Evaluation
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CRISIS CARE CENTER• Crisis Line• Crisis Assessment• Mobile Crisis Outreach Team• Crisis Transitional Unit
7137 W. Military 645-1651
• Receives consumers from law enforcement 24/7
• Minor medical clearance • Call ahead preferred
210 225-5481• Can not take violent or
medically compromised individuals
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CIT Mental Health Detail• Mental health professional partners
with a CIT Officer together to respond on calls dealing with a psychiatric crisis.
• Team responds to high utilizer calls for the City providing follow up services to reduce the call volume.
• Goal is to put officers back into service for patrol as soon as possible.
– Reduce inappropriate incarcerations and costly emergency room visits.
– Offer quality training to law enforcement.
• Co-locate officer with the City unit and Sheriff Mental Health Unit for better collaboration and expedited call response
Dispatcher Training for 911 Call Takers and Dispatchers
• In 2007 - decided that dispatchers would also benefit from CIT Instruction and met with SAPD leadership to establish training.
• Provided an abbreviated 12 hour CIT course for call takers and dispatchers in collaboration with CHCS
• The goal of this training is to increase safety by educating caller takers on essential intelligence gathering and dispatching a CIT Trained officer to the scene.
Partnered with Fire and EMS• As of 2007 SAFD has attended
every community training
• has become co trainers with joint PD and Sheriff’s Officers
• Have added a CIT component to their EMS In-service training.
• Partnering for Integrated training with Fire/EMS has extended numerous opportunities for growth:
– Officer and Fire/EMS better communication
– Safety
– Better utilization of resources
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TheRestoration Center
OpenedApril 15, 2008
•
• Public Safety- Sobering Unit• Detoxification Facility• Community Court• Outpatient Substance Abuse Services