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Northwest Crisis Care System (NCCS) Illinois Department of Human Services Division of Mental Health September 10, 2012 1 Northwest Crisis Care System Guiding Principles Services are Recovery-Oriented Services are Trauma-Informed Services and system must be outcome-validated Individuals can recover more fully in their communities Region 2W and 3N providers are best informed to plan the system of care for its residents State hospital has a continuing role in the continuum of care 2 Northwest Crisis Care System Planning Approach and Method Extensive data review and analysis Community and stakeholder engagement Clinical Focus groups Requests for Information Implementation protocol Systems monitoring protocol 3 Northwest Crisis Care System Community & Stakeholder Engagement was directed by DMH, the Governor’s office and: The Mental Health Rebalancing Advisory Workgroup Hospital Engagement Service Models & Innovation Dan Neal (formerly FHN) & David Deopere (Trinity Medical Center) Jim Sarver (Sinnissippi) & Don Miskowiec (North Central Behavioral Health Services) Michael Pelletier (DMH) Dennis Beedle, MD (DMH) Dan Wasmer (DMH) Amparo Lopez (DMH) Jordan Litvak (DMH) Community Education & Support John Shustitzky (The Chgo School of Psychology) Lora Thomas (NAMI) Gustavo Espinosa (DMH) Amparo Lopez (DMH) Patricia Reedy (DMH) Service Financing & Payment Methodology Ben Stortz (Cornerstones Services, Inc) & Lynn O’Shea (AID) Brock Dunlap (DMH) Systems Performance & Outcomes Assessment Mary E. Smith (DMH) Messaging Media & Legislative Liaison Janet Stover (IARF) Pat Knepler (DMH) Debra Ferguson (DMH) 4 Northwest Crisis Care System FY Budgeted Adms Homeless Adms. Unfunded Adms. First Time Adm Beds to State Hosp. % % Unduplicated Served % % Patient Days/ Avg Daily Census Days ADC ALOS % 2006 76 869 167 19.2% 554 63.8% 330 38.0% 640 73.6% 29,434 80.59 106.0% 29.9 2007 76 734 125 17.0% 515 70.2% 301 41.0% 584 79.6% 26,739 73.21 96.3% 37.4 2008 76 724 137 18.9% 478 66.0% 298 41.2% 577 79.7% 26,815 73.42 96.6% 55.4 2009 76 858 155 18.1% 598 69.7% 381 44.4% 682 79.5% 26,432 72.37 95.2% 34.0 2010 76 861 122 14.2% 615 71.4% 438 50.9% 708 82.2% 26,892 73.63 96.9% 30.0 2011 76 845 118 14.0% 557 65.9% 430 50.9% 788 93.3% 25,910 70.99 93.4% 25.2 2012 76 396 82 20.7% 257 64.9% 183 46.2% 368 92.9% 20,263 55.52 73.0% 31.3 5 Northwest Crisis Care System Governor’s Rebalancing Advisory Workgroups Six strategic Committees were formed and empanelled. The committees and their mission/function are as follows: Hospital Engagement - Mission: Assist the state in determining the scope, types, amounts, locations and rates for hospital based care. Service Models & Innovations - Mission: Assist the state in determining the appropriate scope, types, amounts and locations of services for enhancement in the region. In addition, assist the state in developing and planning for the implementation of innovative service interventions. Community Education & Support - Mission: Assist the state in planning for the education of consumers and providers as the system changes, and to identify and plan for workforce development needs. Service Financing & Payment Methodology - Mission: Assist the state in defining new payment models for financing the community service enhancements and innovations recommended by Committees 1 & 2. System Performance & Outcomes Assessment - Mission: Assist the state in determining the most appropriate methodology and metrics for evaluating effectiveness of system reforms and restructuring efforts. Messaging, Media & Legislative Liaison - Mission: Assist the state in developing appropriate messages, and interface with the members of the General Assembly on restructuring issues. 6 Northwest Crisis Care System Workgroups informed plan elements required for rebalancing Community-based hospital inpatient psychiatric services (CHIPs); Enhanced Crisis Response Services Centralized 800 line for authorization and utilization management; Intensive Mental Health Crisis Residential services; Enhanced Community treatment services (Rule 132); Community Support Team (CST) services; Transportation; Safety Net State-operated inpatient services. 7 Northwest Crisis Care System Expert Clinical Focus Groups: Method Convened multidisciplinary team of experts in community mental health and substance abuse treatment; Identified top 10 diagnostic groupings and presented clinical case studies of each; Team of experts identified optimal service array for each grouping. 8 Northwest Crisis Care System Expert Clinical Focus Group Results: Approximately 65 % of the individuals represented by the clinical typologies used for the clinical review team service projections met admission criteria for inpatient level of care. Of these, approximately 40% would require longer term community based inpatient care which was defined as 30 or more days. Approximately 71% of the individuals represented by the typologies who were not projected to require inpatient care would require observation (up to 48 hours); and the majority of these individuals would require crisis residential services followed by an intensive level of outpatient ambulatory care (within the rule 132 array). 9 Northwest Crisis Care System Requests for Information (RFI) Published on July 26, 2012 with purpose of purchasing communitybased inpatient and outpatient alternatives to services provided at Singer Mental Health Center. Responses were due August 13, 2012. 16 proposals received 6 Hospital providers (two both CMHC & Hospital) 9 DMH community mental health providers (two both CMHC & Hospital) 1 Transportation provider 14 proposals accepted 8 DMH community mental health providers 5Hospital providers 10 Northwest Crisis Care System Hospital Providers for CHIPs Swedish American Hospital, Rockford Rockford Memorial Hospital Rockford OSF St. Elizabeth’s, Ottawa Trinity Medical Center, Moline Provena Mercy Center, Aurora 11 Northwest Crisis Care System Awarded Mental Health Providers for : Enhanced Crisis response (EDAs) & Acute Community Service Providers (ACS) Ben Gordon Center, DeKalb North Central Behavioral Health, LaSalle Bridgeway, Inc, Galesburg Robert Young Center, Rock Island FHN- FCC, Freeport Stepping Stones, Rockford Awarded for special services Rosecrance, Rockford Sinnissippi Center Inc., Dixon 12 A Team Approach to Recovery 13 Northwest Crisis Care System Goals: Develop a crisis system to engage individuals presenting at all Northwest Crisis Care Systems Emergency Departments (EDs) and select community sites Provide timely and accessible assessment – Enhanced Crisis Response (aka EDAs) to EDs and utilizing mobile teams for in-community evaluations MHCs; Provide community treatment alternatives to the consumers Leverage and/or purchase access to MH Crisis residential, Community based Inpatient care (CHIPs), community based mental health services Acute Community Services (ACS), entry to state operated hospital; Rapidly triage and transport consumers to appropriate levels of care. 14 Northwest Crisis Care System Authorization Protocol After evaluation and consultation, Evaluator contacts authorizing agent (ACCESS line) Evaluator describes clinical condition and makes level of care recommendation Level of care determination is made based on medical necessity ; If there is concurrence with ACCESS on LOC determination, ACCESS authorizes service and transportation as appropriate; If there is a denial by ACCESS, the Evaluator and the ED re-assess options; If Evaluator and ED appeal the denial, ACCESS has @1 hour to arrange for MD final review. Levels of care: service definitions: CHIPS Crisis Residential Enhanced Community Supports Access to Community Crisis Full access to Rule 132 services Inpatient beds; stabilization; Post ED care w/in 24 hours; For acute psychiatric MD/RN supervised; Post discharge care w/in 72 hours; conditions; 24/7/365; 15 Region 2W 3N; 16 Northwest Crisis Care System Behavioral health consultative expertise to EDs Collaboration by Community Providers to ED’s and select community sites: Evaluate and recommend the appropriate level of care; Assist in crisis intervention and case management; Determine eligibility for Northwest Crisis Care System (NCCS) program; Facilitate authorization to appropriate level of care as purchased for the Northwest Crisis Care System (NCCS); Facilitate safe transportation to next level of care as purchased by DMH; Facilitate registration and enrollment into Northwest Crisis Care System (NCCS) to insure Acute Community Services (ACS) package. 17 Northwest Crisis Care System Acute Community Services - ACS All enrolled and authorized persons discharged from Inpatient or Residential services are eligible to receive ACS. Persons may be determined eligible for ACS as a diversion service from the ED or community site. ACS provides: Grant Payment structure Allows agency to directly provide or subcontract services to most appropriate treatment agency Full provider flexibility to deliver clinically indicated treatment service which could include: any 132 service, any 2060 service, medications, transitional services, as determined by agency MHA 18 Northwest Crisis Care System Role of State Hospitals SOH admissions for significant targeted population groups ◦ ◦ persons with extended acute care needs. persons with readmission profiles. ◦ persons who are experiencing homelessness. as examples Access to purchased inpatient, residential levels of care and ACS; 19 Northwest Crisis Care System Implementation Protocol Reorganized internal project management structures corollary to Advisory Group structure (SPRINT) Implementation Committees Contracts Policy Workforce Development Roll out (Communications) Hospitals and Operations 20 Northwest Crisis Care System Implementation: Singer Mental Health Center closure Admissions close October 1, 2012; Purchased Community Services will commence; Recent Medical records will move to Elgin MHC; Finalization of securing inventory and buildings. 21 Northwest Crisis Care System Systems Monitoring Protocol DMH to 1. 2. 3. 4. 5. 6. take “snapshot” of systems performance currently measuring: Admission rates Readmission rates Consumer Perception of Care Emergency Department wait times Deflection Rate Transportation response times DMH will track these and other indicators at 6, 12, 18 months. Advisory group structure will transition to DMH Systems ReBalancing Quality Improvement Committee Provider issues phone line and email established 312-814-0930 [email protected] 22 Training Opportunities MEETING TITLE: Region 2 West Crisis Care System Consumer & Family Education DATE: Tuesday September 11, 2012 TIME: 1:00pm-2:30pm. DIAL-IN NUMBER: (866) 871-4877 CONFIRMATION NUMBER: 259493 INTENDED AUDIENCE: CONSUMERS and FAMILIES Please dial in no earlier than 12:45pm The purpose of this call is to provide individuals who might previously have been served by Singer Mental Health Center in a time of psychiatric crisis with information on the new Northwest Crisis Care System. This will include a description of services available as well as instructions on how to access those services. Training Opportunities All providers, persons served, and other stakeholders are invited. Registration is required (see below). Wednesday September 12, 2012 10AM – 12PM System of Care Overview/Policies and Procedures For everyone who delivers, uses, administers, or supervises services in NCCS.. Location: Rosecrance Griffith Williams Center 1601 N. University Rockford, IL Wednesday September 12, 2012 1PM - 5PM Evaluation/Disposition Assessments LOCUS/USARF Location: Rosecrance Griffith Williams Center 1601 N. University Rockford, IL 24 Training Opportunities All providers, persons served, and other stakeholders are invited. Registration is required. Friday September 14, 2012 10AM – 12PM System of Care Overview/ Policies and Procedures For everyone who delivers, uses, administers, or supervises services in NCCS. Location: Bridgeway, Inc. 2323 Windish Dr. Galesburg, IL Friday September 14, 2012 1PM- 5PM Evaluation/Disposition Assessments LOCUS/USARF Location: Bridgeway, Inc. 2323 Windish Dr. Galesburg, IL 25 Training Opportunities All providers, persons served, and other stakeholders are invited. Registration is required. Wednesday September 19, 2012 10AM – 3PM Recovery Training For everyone who delivers, uses, administers, or supervises services in NCCS. Location: Rosecrance Griffith Williams Center 1601 N. University Rockford, IL Friday September 21, 2012 10AM – 3PM Recovery Training For everyone who delivers, administers, or supervises services in NCCS, and for persons served. Location: Bridgeway, Inc. 2323 Windish Dr. Galesburg, IL 26 Registration Information For Training Opportunities All providers, persons served, and other stakeholders are invited. To Register: Please call Kelly Dee (847) 742-1040, Ext. 2002, or e-mail [email protected] If you require certain accommodations, please inform Kelly when you register. Please be as specific as possible. CEUs available for LCSW and LSWs. These are transferable to LCPC staff. Certificates of attendance are also available. If you would like to get CEUs or Certificates of Attendance for your participation, please inform Kelly when you register. Lunch: Rockford Trainings: Lunch will be provided at $5 per person. If interested, please inform Kelly. Galesburg Trainings: Lunch on your own; a listing of fast food/restaurants will be provided. 27 Thank you Questions? http://www.dhs.state.il.us/page.aspx?item=61113