DSHS Residential Care Services (RCS) Behavioral Health ... · Training for RCS Staff and providers on special behavioral health topics, trends and best practices Responds to provider

DSHSResidential Care Services (RCS)

Behavioral Health Support Team

Residential Care ServicesBehavioral Health Support Team (BHST)

• Washington State has identified a gap in community options for individuals with behavioral challenges and personal care needs, particularly for those ready for discharge from the state psychiatric hospitals.

• A new law was enacted in 2016, and as part of the Governor-directed Mental Health Transformation, ALTSA received additional funding to increase community alternative options that prioritize the transition of individuals who have long term care needs and are ready for discharge from state psychiatric hospitals.

• In response to this need, ALTSA is increasing the types and capacity of specialized community options available to Washington State citizens using home and community-based services.

• RCS developed a new Behavioral Health Support Team to provide technical assistance to RCS staff and our community residential providers.

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Where are individuals currently living upon discharge from the state psychiatric hospitals?

Discharge fromWestern State Hospital

Discharge fromEastern State Hospital

#1-Adult Family Homes #1-Assisted Living Facilities

#2-Private Homes #2-Private Homes

#3-Assisted Living Facilities #3-Adult Family Homes

#4-Nursing Homes #4-Nursing Homes

#5-Enhanced Services Facilities #5-Enhanced Services Facilities

#6-Other #6-Other

ALTSA is looking to expand the capacity for individuals moving or diverting from psychiatric hospitals who:

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Have been deemed as ready for discharge

Are eligible for ALTSA services

Need high staffing levels or the specialized services

Have complex personal and behavioral care needs that exceed the capacity of the long-term service and supports available through other contracts

There is a current RFI focusing on providers who are interested in providing services and supports to those who are:

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Younger adults (18-55) with needs for personal care

assistance and behavioral challenges related to

chronic behavioral health issues

Adults of any age with neurological or cognitive

issues such as Huntington’s Disease, Traumatic Brain

Injury, or signs of Developmental Disabilities

Older adults with dementia or dementia and mental

health conditions who have complex personal care and/or medical needs

Resource Needs Include:

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Pilot Specialized Services Contract

• Within a facility licensed as or converting to Assisted Living Facility (ALF) to provide supports to an identified population(s)

Enhanced Services Facility (ESF)

• Focusing on counties that do not have an ESF and

• Have a large number of people who need to move or divert from state hospitals

Expanded Community Services (ECS) Plus

and Respite

• Added to a current Nursing Facility (NF) contract

What are the GOALS of our Behavioral Health Support Team?

• Support the success for those in transition to a new living arrangement;

• Long-term success for people with behavioral challenges in home and

community-based settings;

• Success for providers within the regulatory structure, by promoting

expertise within community settings and assisting them in meeting unique

and complex needs in an individualized and person-centered approach;

• Robust coordination across agencies for system success in transitioning

individuals from state and community psychiatric hospitals into community

settings;

• Supports for providers in giving high-quality care to individuals with complex

needs who are able to relocate out of institutional settings; and

• Proactively provide the necessary training and consulting education on behavioral health topics that assists providers in being successful in serving this population.

The BHST is comprised of the following FOUR positions:

• 1x Policy Program Manager

• 1x Training and Best Practice Specialist

• 2x Behavioral Health Quality Improvement Consultants (BQIC)

Behavioral Health Policy Program Manager

Acts as the unit lead for RCS’s Behavioral Health Support

Team.

Create/alter long-term care rules, policies and

regulations that make sense for behavioral challenges in

RCS settings.

Works with community partners to create successful

transitions and help create successful community living.

Training and Best Practice Specialist:

Training for RCS Staff and providers on special behavioral health topics, trends and best practices

Responds to provider training needs and conducts “clinics” and small support groups

Improve systems coordination and develop partnerships between residential providers and community based resources.

Behavioral Health Training Survey Results

• Survey conducted in June 2018

• Responses from:• 138 RCS Staff• 181 Residential Providers

• Among RCS Staff and Residential Providers-questions:• What behavioral health topics are high priority for education and

training?

• What behavioral health diagnostic categories are of highest importance for education and training?

23.89%

44.25%

69.91%

63.72%

46.02%

13.27%

36.28%

64.60%

26.55%

37.17%

32.17%

41.74%

67.83%

73.91%

27.83%

16.52%

41.74%

57.39%

35.65%

51.30%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00%

Trauma Informed Care (Sensitivity to Trauma

History)

Behavioral health “recovery” concepts (for

example: Peer supports, Wellness Recovery …

Related to Behavioral Health Needs -

Individualized Assessments and Care Planning

Documentation Best Practice For Individuals with

behavioral challenges and/or mental health…

Legal issues in behavioral health care -

Implications for care planning and coordination…

Confidentiality - Improving Communication with

the Behavioral Health Treatment Community

Coaching to improve patient insight and

partnership (for example: Motivation…

Crisis planning: Response, Suicide Risk,

Assessment, and Intervention

WA State Behavioral Health System – Current and

Future States

Integrated Physical and Behavioral Health Care

RCS Staff and Residential Provide Behavioral Health Topical Training Priorities – July 6, 2018

Staff N = 138

Provider N = 181

Behavioral Health Training Survey

Training Interest by Diagnostic Category for RCS Staff & Residential Providers (Data points reflect number of responses to that item.)

Behavioral Health Training Survey

7677

44

66

50

34

71

30

58

64

71

76

43

70

62

15

0

10

20

30

40

50

60

70

80

90

Schizophreniz and Psychotic Disorders

Bipolar Illness Depression Dementia Personality Disorders

Anxiety Dual Diagnosis Substance Use Disorders

RCS Staff

Residential Provider

Behavioral Health Quality Improvement Consultants(BQIC)

Offers consultations to providers to help improve

quality of care for individuals with behavioral

challenges.

Consultation examples could include: Troubleshooting situations such as resident rights

Helping access community resources

Helping providers navigate regulations while addressing

difficult behavioral challenges in each setting;

Brief, specific training for a resident situation that impacts

a large number of staff.

BQICs Have Begun Providing Consults!

• Some common challenges seen so far include:• Disconnection between a provider and care team (case manager,

mental health provider, medication prescriber, etc.);

• Challenging care plans (especially behavior support/crisis plans);

• Individual residents who don’t quite ‘fit into’ the general population of the facility.

• Some solution options provided by BQICs:• Reaching out to members of care teams to help bridge the gaps;

• Developing fresh ideas to expand intervention creativity and improve care plan quality;

• Identifying ways to make care more person centered.

How we triage referrals

Our focus is on increasing success for providers who have residents with significant behavioral health needs.

• As we triage cases these are situations may cause us to rule out a referral:• Case management need (including assistance with finding alternative

housing/facility placement);

• Immediate crisis response;

• Training or consultation if the resident is currently hospitalized without a clear discharge plan;

• Long term provider assistance;

• Support for issues that are not related to behavioral health (i.e. diabetes management, skin breakdown, etc).

Considerations for Referral

• Some examples of an ideal referral include having a resident with significant behavioral health needs AND:• The provider has run out of ideas on how to provide care and services or…

• The resident is at risk of being discharged due to behaviors …

• The provider is concerned about regulatory compliance regarding a client with behavioral health challenges….or

• There are no/very limited mental health supports involved…

• Etc.

Some examples of a less ideal referral:

• There are already multiple mental health supports involved and there is good communication between them and the provider.

• Behaviors are infrequent, predictable and staff are well prepared to respond to them.

• Resident’s problem is more simple or situational in nature (i.e. they don’t like the food, don’t like their roommate, wish their family visited more, etc.).

Things to consider!• We can’t call the provider to convince them to receive a

training or consultation. This is a voluntary resource for that provider.

• What if a client is hospitalized??!! • The BHST can’t be written in as part of the POC, but can

be part of the plan.• Our consult isn’t part of the consult which may be

written on a citation. We are a voluntary support resource for the provider and our consult is an additional support.

• We don’t do a joint visit with RCS investigator or survey/inspection team. Although the investigator/ or survey/inspection team may make a referral to us.

Not Sure If You Should Refer?

That’s Ok!

We Encourage You To Reach Out

and We Can Figure It Out Together!

What happens after a referral is made to the BHST?

1. Referral is Received

2. Referral is Staffed With Team to Answer These Questions:• Does the situation rise to such a level that assistance is warranted?

• Would provider benefit most from a Training, a Consult, or both?

• Is an on site visit needed, or can assistance be provided via teleconference?

3. Information Gathering – BHST Member May Reach Out to the Following, Depending On The Situation:

• Case Manager (If One Is Involved With The Resident)

• RCS Staff (Such as Field Managers)

• The Resident’s Family and/or Guardian

• Facility Staff

4. Consult• Schedule Time To Provide BHST Assistance • BHST Member Provides Assistance

• 2-3 Weeks After Assistance Is Provided, BHST Member Calls Provider to do the Following:

• Check in to see how things are going

• Answer ongoing questions

• Schedule additional short term assistance if warranted

• Case is Closed

How to make a BHST referralIf the concern is identified by someone other than the provider please discuss our service with the provider and if it is agreed that this may be a good resource, either person can make the referral.

We just need minimal info by phone or email to include:• Referent name and contact info• Facility name and type (NH, ALF, AFH, ESF, CCRSS, or ICF/IID)

• Client name• Brief info regarding concernBHST would then connect with the referent to gather additional information within a few business days.

BHST Referral Message Line: 360-725-3445BHST Email: [email protected]

What are we doing NEXT?

• Community meetings with providers

• Community meetings with Ombuds

• Meet and greet with field offices

• Moving forward to develop trainings

• Continuing to build BHST program!

The Bottom Line:

• The BHST will be available to provide support to RCS staff and providers through Behavioral Health Trainings

• The BHST will be available as a resource to RCS staff and providers by offering Behavioral Health Consultations

• Our focus will be on success for individuals with behavioral health needs, within the regulations

Small team, focused work

Questions?

BHST Message Line: 360-725-3445BHST Email: [email protected]

or

Penny RarickBehavioral Health Policy Program Manager

Residential Care Services360-725-3210

[email protected]