From Triage to Treatment

04/09/23 1

From Triage to Treatment

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Who are we:

David Cozadd, Director of Operations with the Burke Center

Thomas Kerss, Sheriff of Nacogdoches County; Current President of the Sheriff’s Association for Texas

Anne Bondesen, Project Director for the Rural East Texas Health Network (RETHN)

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The region we represent:

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The “lay of the land”:

12 Counties 11,000 square miles Population - 370,000 Rural communities – (money &

transportation issues)

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The Problem

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Contributing challenges:

Deinstitutionalization of the 60”s Funding cuts Limited Healthcare resources Rising costs Greater than 20% uninsured System at capacity

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Shortage of Resources:

Medically and Psychiatrically Underserved Area

Health Care Professional Shortage Mental Health Care Professional

Shortage No other comprehensive providers Lost 84 inpatient beds 1996-2001 No psych beds !!!!

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Burden placed on Hospitals and Law Enforcement

Lufkin to El Paso Hurricanes Katrina & Rita 20% increase in hospitalization Psychiatric beds stay full Overflow to hospitals and jails Heavy workload on hospitals & law

enforcement departments Frustrated and outraged

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Addressing the Problem

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The Rural East Texas Health Network Created in 2006 through a federal

HRSA Network Planning Grant

In 2007, received Mental Health Transformation grant through the Texas Health Institute.

In 2008, received HRSA Network Development Grant

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Purpose of RETHN: Line of communication between stakeholders

Line of communication between community and mental health provider

Educate community on issues and needs

Create a united voice working towards common goals

Provide a mechanism for collaborative problems solving

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RETHN Boards Local Advisory Boards

Regional Board of Directors

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In 2007, our request proposal to the state for Crisis Services Redesign funds for a regional Psychiatric Emergency Service Center (PESC)

Already organized and poised for action Need already identified 25% financial match received from community Support letters from stakeholders Pledge from Temple Foundation

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The Result

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PESC established: Protocols and Procedures were created

Trainings were held across the region

Opened on December 8, 2008

Opened in temporary location in Nacogdoches

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PESC: What it is: Locked Extended Observation Unit: 10

beds; 24-48 hour observation for crisis stabilization

Unlocked Voluntary Respite Unit: 14 beds; up to two week stay

Have admitted over 1,500 clients since opening in December 2008.

Staffing Pattern

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PESC - What we do: Triage Accept people for evaluation 24/7 Staff will screen for appropriateness Do a comprehensive evaluation Telemedicine Begin to work quickly to alleviate symptoms

and stabilize Move to a lesser level of care within 48 hours

(higher level in limited cases) Transporting to inpatient facilities Work to return people to their homes and

community

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PESC - Who we serve: Persons 18 years of age or older

AND Persons coming from any of our 12

counties AND Persons who have a mental illness

AND Persons who are in imminent

danger of harming themselves or others due to their mental illness

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PESC - What we are not:

We are not a hospital We are not a jail We are not a drunk tank, detox

facility or alcohol/drug treatment facility

We are not a homeless shelter We are not an Alzheimer or

dementia treatment facility

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New PESC in Lufkin:

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Other projects: Telemedicine/conferencing Web-site for RETHN Patient Information Index Mental Health Awareness

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Outcomes &

Continuing Challenges