October 26, 2017 Bucks, Chester, Delaware, Montgomery and - - PowerPoint PPT Presentation

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October 26, 2017 Bucks, Chester, Delaware, Montgomery and - - PowerPoint PPT Presentation

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October 26, 2017 Bucks, Chester, Delaware, Montgomery and Philadelphia 2 State Hospitals closed Philadelphia State (1989) & Haverford State (1997) Closed approximately 1550 state hospital beds since 1990 via Community Hospital

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October 26, 2017

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 Bucks, Chester, Delaware, Montgomery and

Philadelphia

 2 State Hospitals closed – Philadelphia State

(1989) & Haverford State (1997)

 Closed approximately 1550 state hospital

beds since 1990 via Community Hospital Integration Project Programs(CHIPPs)

 First in PA to begin HealthChoices (1996)  First to develop Regional CHIPPs Model

(2000/01)

5/22/17 SE REGION SAP Presentation

2

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 Supports recovery and inclusion in the community  Provides a continuum of treatment options and

array of support services

 Is dynamic and tailored to individual needs  Supports inclusion and recovery  Supports opportunities for wellness Source: SE Regional MH Services Office 2017

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OUTREA REACH CH SERV RVIC ICES ES

A service designed to locate, engage, assess, intervene and link individuals. Outreach services are fundamentally mobile and may focus on persons in specific settings or with complex needs such as personal care boarding homes, shelters, or dual issues such as mental illness and drug & alcohol or mental illness and a history of incarceration

CRISI SIS S INTERVENTI ERVENTION N SERVI VICES CES

Services available 24 hours a day by phone, walk-in or mobile to intervene when individuals are in crisis or in a psychiatric emergency. Emergency services are provided if the person needs inpatient care, crisis facilitates those arrangements

CRISIS SIS RESIDEN IDENTI TIAL

Very short term residential service, generally about five (5) days, intended for non-hospital stabilization and as an alternative to admission to an inpatient psychiatric hospital

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Source: SE Regional MH Services Office 2017

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 CASE MANAGEME

GEMENT NT

 A service designed to assure the consumer and his/her needs are matched with appropriate services  Continuity of care ensuring that when there is a shift from one service to another, or needs change or from

  • ne service network to another occurs, that the

consumer and/or his/her needs are not lost in the shift.  Monitoring to ensure that appropriate services are being provided to the consumer.  Types vary in intensity of support and are matched to individual needs.

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Source: SE Regional MH Services Office 2017

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 OUTPAT

PATIENT IENT

Provides clinical assessment and treatment to persons living in the community. Individual, group and family psychotherapy as well as psychiatric services (evaluation & medication monitoring). Intensive Outpatient treatment (IOP) is a combination of services delivered each week

 PARTI

TIAL L HO HOSPIT ITAL

Provides comprehensive therapeutic & rehabilitation services to persons living in the community. Programs include medication monitoring, individual & group psychotherapy, & activity-focused therapy. 2-5 days/week

 PSYCHIAT

HIATRIC C REHA HABILI BILITA TATI TION/CL N/CLUBHOUS UBHOUSE E SERV RVIC ICES ES

Programs geared toward enhancing skills, training and prevocational services, and socialization to help persons live more productive lives in the community. Facility based or

  • mobile. Self-directed & goal-oriented

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Source: SE Regional MH Services Office 2017

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 COMMUNITY

NITY TREAT EATMENT MENT TEAM (CTT) TT) or ASSERTI ERTIVE VE COMMUNITY NITY TREATM EATMEN ENT T (ACT) T)

 All inclusive  Primarily Mobile  Multidisciplinary team  On call 24/7

 PEER

R SUPPORT PORT SERVI VICES CES

 Certified Peer Specialists (CPS)  Consumer operated agency, group, or drop-in center  Common ground

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Source: SE Regional MH Services Office 2017

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 EMPLO

LOYMENT MENT RELATED ATED SERVI VICES CES

 Focus on a supported employment model to get persons into competitive employment rather than lengthy job training and pre-vocational skill training  Office of Vocational Rehabilitation

 Pre-employment skills and training

 Employment specialist, benefits counseling services, and job coaching while on the job

 PSYCHIAT

HIATRIC C INPATI TIENT ENT CARE

 For acute stabilization and short-term hospital based treatment  Offers psychiatric and clinical services in a secure setting  Could be voluntary or involuntary

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Source: SE Regional MH Services Office 2017

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 Ge

Generic ric Housin ing

 Su

Support

  • rted

ed Liv ivin ing g Se Servic ices es

 Receive in-home support where the individual lives  Varies in level of needs  Varies in ancillary supports the individual receives

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Source: SE Regional MH Services Office 2017

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 Lic

icens nsed d and nd Spe peciali ialized ed Ment ntal al Health lth Resi sident dential ial Sup uppo port rts s

 Based on MH needs for support in the community  Various types and levels of care  Limited availability  By application through the County MH Offices

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Source: SE Regional MH Services Office 2017

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 Type

pes s of Spe peciali cialized d Ment ntal l Health lth Resi sident dential ial Pro rogra rams ms

 Community Residential Rehabilitation (CRR)  All Inclusive Residential Treatment Facilities (RTFA)  Long Term Structured Residence (LTSR)  Specialized Personal Care Homes (SPCH)  Specialized CRRs, Regional Programs (varies)

 Ava

vailabil ability ty and d capacity acity differs ers in each h County nty

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CIVIL Census as

  • f 10/24/2017

In CIVIL with Legal restriction/CJ HOLD Forensic Census as 10/24/17 Civil wait list from Forensics/CJ ** eff 10/15/17 Bucks 17 1 3 1 Chester 10 4 3 Delaware 16 7 22 1 Montgomery 24 5 or 6 18 1 Philadelphia 53 42 62 11 TOTAL 5 County 120 54 108 14

  • thers

2(York, Butler) TOTAL 122 *** Based on Regional MHSvc Civil population CJ related Status Update as of 07/2017 Census POPULATION AT NSH effective 10/24/2017

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 October 2015 ACLU – filed against DHS “delays

exceeding seven days in transferring Plaintiffs and Class A members to the state hospitals for treatment violate the laws”

 January 2016 – DHS 1st Settlement  January 2017 – NSH Civil Section Closure

Announcement

 May 2017 – ACLU filed injunction vs DHS (118 persons discharged and new placements developed)  May 2017 – DHS 2nd Settlement terms

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 May 2017 – DHS 2nd Settlement terms  2017/18 SE Regional Forensic Treatment

Center

  • a. By 12/15/17: Create a new "minimum security" unit at Norristown State Hospital, which will consist
  • f 50 new forensic beds for mentally ill defendants. (28 new and 22 existing civil will be converted for

forensic use)

  • b. 12/15/17 Add an additional 29 community mental health beds within the next six months, divvied

between Allegheny County (7 + 12) and Philadelphia (10).

  • c. By March 15, 2018, 30 "civil beds" at Norristown State Hospital, meaning beds for mentally ill people
  • utside of the criminal justice system, will move into the community as specified in their CSP and will

be converted to forensic beds (provided that no patient who is currently in a civil bed that the services have not yet been developed for that patient)

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 January 2017 – NSH Civil Section Closure

Announcement

 Clinical Assessment process = July 2016-June

2017

 PHASE 1, 2, 3 community planning for closure  NSH CIVIL CLOSURE by 12/31/2018

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115 102 13 20 40 60 80 100 120 140

Clinical ical Risk Assessme ment t project ct Total Total assessme assessments nts assigne assigned Assessments nts comp completed leted Decli Declined/R ned/Refus used/Re d/Re move moved fro d from asse assessme ment t list ist

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9%

71%

8% 12%

Assessment ment Reco commended mmended LOC

24 24/7 S /7 Str tructu cture red N d Non

  • n Secur

cure Re Reside sidential Tr Trea eatme tment

Sec Secure 24/7 ure 24/7 reside esidential ial treatmen treatment Inpat Inpatient ient Hos Hospital pital LO LOC CRR o RR or Su r Supported pported Livin Living

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PHASE 1 PERIOD 8/1/17-12/1/17 PHASE 2 PERIOD 12/1/17 - 3/15/18 PHASE 3 PERIOD 3/15/18 - 12/31/18 PHASE 4 PERIOD 1/1/19 - post Civil Closure

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PHASE 2 PERIOD PHASE 4 Period - Post Civil Bed Closure - NEW SERFTC COUNTY

12/1/17 - 3/15/18 3/15/18 – 6/30/18 7/1/18 – 12/31/18 (FY 18/19)

1/1/2019

PROPOSED DISCHARGES "CIVIL- CIVIL" POPULATION AS OF 9/11/17 CJ POP IN CIVIL

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# dependant on how many persons in FTC

PROGRAM TYPE E-RTFA E-CRR OTHER NEW / EXPANDED DEVELOPMENT

NEW SE Forensic Treatment Center

Bucks 16 1 4 3

1 (ID Waiver) 8 or 9

Chester 6 4 4 1 2 Delaware 6 9 4 1 6 or 8 Montgomery 18 5 4 2 12 Philadelphia 9 45 10 2 or 3

10 6

10 to 15

TOTAL 55 64 16 6 11 22

CURRENT CIVIL POPULATION AS OF 9/11/17 PHASE 1 PERIOD PHASE 3 PERIOD

TABLE #1 BED CLOSURES/ DISCHARGES CHART

8/1/17-12/1/17

22

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CHIPP Plan per County

PHASE 2 PERIOD PHASE 4 Period - Post Civil Bed Closure - NEW SERFTC

BUCKS

LTSR, increase capacity to Medically Enhanced services Enhanced LTSR

CHESTER

Trauma based ISLA, Increase Capacity to medically enhanced services

DELAWARE

  • Supp. Housing(Medical)6-8

MONTGOMERY

Enhanced LTSR

PHILADELPHIA

Co-Occurring Sex.Off. (2/3) Neuro-cog/TBI (6), DBT/Pers. Disorder (6), Sex Off Step-Down (4), risk aggression (3-5), aging adults (10)

TABLE #2 PROGRAM DEVELOPMENT BY COUNTY / PROGRAM DESCRIPTION

Enhanced -Residential Treatment Facility Adult (E-RTFA) , Enhanced CRR E-RTFA , Trauma based Intensive SLA

Program Type (new develoment, Enhanced existing prgm, existing prgm with expansion/Adding new beds in County)

Each County is individually enhancing &/or expanding capacity and/or working on New Development of services. In addition, The Suburban Counties are collaboratively developing Regional Services (Enhanced RTFA and Enhanced CRR)

PHASE 3 PERIOD PHASE 1 PERIOD E-RTFA, ECRR E-RTFA , ECRR Recovery House (6), CRR expansion (4)

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PHASE 1

  • NEW: Enhanced Residential Treatment Facility for

Adult

  • NEW: Enhanced CRR

PHASE 2/3

  • Increase capacity to medically fragile services
  • Possible expansion to other regional programs or step

down models

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 NEW: Enhanced RTFA – Regional (4)  NEW: Enhanced CRR – Regional (3+2)

Phase 2/3 (based on braided anticipated funding):

  • New Enhanced LTSR to support 16 individuals
  • Increase Psychiatric Rehabilitation capacity to

provide Mobile PRS in Central/Lower Bucks County to support up to 95 additional individuals

  • Increased Peer Support capacity to support an

additional 45 individuals with county funding

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 NEW: Enhance RTFA (Regional) (4)  NEW: Trauma-Based Intensive Supported

Living (1) Phase 2

 Increase capacity to Medically fragile services  Forensic Peer Support

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 NEW: Enhance RTFA (Regional) – (4)  NEW: Enhanced CRR (Regional) – (1)

Phase 2 & 3

 Proposed new development – for 6-8 persons

for “Aging in Place” medically supported residential.

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 NEW: Enhanced RTFA (Regional) (4)  NEW: Enhanced CRR (Regional) (2)

Phase 2 & 3-

  • Enhanced LTSR to serve individuals from NSH

civil and provide for future state hospital diversion

  • Enhancement to Regional NOVA II program
  • Develop support services to enhance flow in

existing residential programs

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 Existing “new” Services already in place

  • Residential Treatment Facility-Adults
  • Girard Recovery Center
  • 33 Supported Housing slots per year – next 3 years

PHASE 2&3 -New services in Development

  • Dialectical Behavioral Therapy Program
  • Traumatic Brain Injury /Neuro-Cognitive Program
  • “STAR” Step-down
  • Other Community Services to support Diversion of the

Forensic Population PHASE 4

  • Risk-Aggressive program
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 Clinical needs of population  Timeframe is very abbreviated  Benefits and Entitlements are not guaranteed  Payer Mix (Medicaid HealthChoices and

Medicare) and CHIPPs funding must be braided to support development

 Willingness of individuals/families  Community Readiness

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 Program/Service/Resource development  Community Support Planning (CSP) Meetings

  • Community Inclusion Activities
  • Individual transition Activities

“Progress is impossible without change”

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Thank You!

And questions?

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Source: SE Regional MH Services Office 2017

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 www.parecovery.org  www.dhs.pa.gov  www.fivecountymh.org  http://www.nami.org/  County MH Directors  SE Regional MH Services

Coordination Office

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Source: SE Regional MH Services Office 2017