1. 1 Mayview Regional Service Area Plan Quality Improvement/Outcomes (QIO) Committee August 26, 2009 Allegheny HealthChoices, Inc.

2. Agenda for Today’s Meeting MRSAP Steering Committee updates Review of survey results Overview of the Southwest Regional SOS Update on family interviews Summary of findings from quality assurance activities Wrap-up 2 Allegheny HealthChoices, Inc.

3. MRSAP Steering Committee Updates Lessons Learned Land Reuse Task Force Inpatient Utilization Pitt Evaluation Study Service Development – Community EAC – Suburban RTFA – ACSP 3 Allegheny HealthChoices, Inc.

4. August 2009 Report Data sources – Monthly tracking reports – Early warning and critical incident system Compares services and supports used in January 2009 - right after the hospital closed, and June 2009 – six months after the closure Covers the following areas – Use of Community Treatment Team (CTT) and case management/service coordination – Use of behavioral health treatment services – Housing – Benefits, income sources, and guardianship – Rehabilitation and employment activities – Social supports – Transportation – Physical health care visits – Early warnings and critical incidents 4 Allegheny HealthChoices, Inc.

5. People Discharged by County Allegheny HealthChoices, Inc. 5

6. Use of CTT, Case Management, and Service Coordination Allegheny HealthChoices, Inc. 6 June 2009 Allegheny – 81% (181 or 223) received CTT Beaver – 63% (17 of 27) received CTT Lawrence – 100% (7 of 7) received CM (CTT not available) Washington – 59% (13 of 22) received CTT

7. Frequency of Contact: CTT Allegheny HealthChoices, Inc. 7

8. 8 Frequency of Contact: Case Management, Service Coordination

9. Behavioral Health Treatment Services 76% used CTT services 19% had mental health services through their LTSR 12% had outpatient mental health services. – A larger percentage of people in Washington County (27%, 6 individuals) accessed outpatient in comparison to Allegheny County (11%, 25 people) or Beaver County (15%, 4 people). A small number had mobile medication teams or mobile mental health services Substance abuse treatment: – Only one person used drug and alcohol detoxification services. – Substance abuse treatment is included in CTT services. – AA/NA are included in “Social Supports”. Allegheny HealthChoices, Inc. 9

10. Housing Allegheny HealthChoices, Inc. 10

11. Housing by County – June 2009 Allegheny HealthChoices, Inc. 11 AlleghenyBeaverLawrenceWashington Long-term structured residence (LTSR) 17% 39 people 26% 7 people 43% 3 people 18% 4 people Personal care home (PCH, EPCH, CMHPCH) 22% 50 people 18% 5 people 0% 23% 5 people Community Residential Rehabilitation (CRR) 12% 26 people 11% 3 people 29% 2 people 5% 1 person Specialized supported housing 12% 27 people 0% Living independently 5% 12 people 11% 3 people 0% 9% 2 people Living with family 2% 4 people 4% 1 person 14% 1 person 14% 3 people Supported housing 5% 12 people 22% 6 people 0% 14% 3 people All other housing categories (inpatient, MR housing, Nursing Homes, TSH) 25% 53 people 7% 2 people 14% 1 person 9% 4 people

12. Benefits Allegheny HealthChoices, Inc. 12 47 Dually eligible individuals – Medicaid/Medicare: AC – 30, BC – 7, WC - 10

13. Sources of Income Allegheny HealthChoices, Inc. 13

14. Guardianship, Rep Payee, and Power of Attorney Allegheny HealthChoices, Inc. 14

15. Rehabilitation and Employment Allegheny HealthChoices, Inc. 15

16. Social Supports Allegheny HealthChoices, Inc. 16

17. Transportation Supports Allegheny HealthChoices, Inc. 17

18. Physical Health Care Allegheny HealthChoices, Inc. 18

19. Early Warning Indicators Allegheny HealthChoices, Inc. 19 Jan- 09 Feb- 09 Mar- 09 Apr- 09 May- 09 Jun- 09 Attempts At Elopement011222 Atypical Behavior - Change From Baseline25181318 8 Complaints - Property Destruction/Eviction424200 Consumer Not Responding to Contact200000 E/R Visit - Behavioral/Physical Health1812171815 Inability to Locate Consumer026530 Indications For Increased Service/Supports3514948 Police Involvement5116664 Refusal to Take Medications Posing Risk301729191615 Sleep Pattern Change From Baseline001000 Unexcused Missed Appts432000 Total Number of Early Warning Signs917193796452 Unduplicated Number of Consumers484249473735 Number of people being followed post- discharge 288282286283278279

20. Critical Incidents Allegheny HealthChoices, Inc. 20 Jan-09Feb-09Mar-09Apr-09May-09Jun-09 Physical/Sexual Abuse000110 Arrest120022 Attempted Suicide010000 Client Injury - Accident/Intentional112010 Community Hosp - Involuntary1347589 Community Hosp - Voluntary844435 Death111100 Fire100000 Housing Change2713132 Medical Hospitalization1514 1089 Medical Treatment Error112130 Missing Person111120 Other Incident - Serious Nature11463813 Total Number of Critical Incidents554050273940 Unduplicated Number of Consumers393635243031 Number of people being followed post-discharge 288282286283278279

21. Quality Management and Clinical Consultation (QMCC) Team Works collaboratively with counties and providers Monitors service quality, effectiveness, and coordination Assists community providers in Implementing supports through monitoring benchmarks of recovery Providing indirect support and education to community providers, and Providing direct support when necessary/appropriate and in coordination with the counties. Monthly consumer visits have increased from 19 in January to 179 in July 2009 QMCC team includes: RN, Clinical Nurse Specialist, SW, D&A Specialist, Pharmacist and Peer Specialist. Allegheny HealthChoices, Inc. 21

22. Community Support Team (CST) Resource for counties in offering additional supports to individuals as they transition from Mayview State Hospital to the community. Provides direct services to consumers and works to assist the community providers in implementing optimal supports for the consumers. Requests have increased from 2 in January to over 50 in July 2009 Highest areas of support requested thus far have been: – Spiritual Support – Life Style Improvement – Purposeful Recreation CST Team includes: RN, SW, D&A Specialist, Vocational, Recreation, Spiritual, and Peer Specialists. Allegheny HealthChoices, Inc. 22

23. Monarch Springs Long Term Structured Residence (LTSR) 15 bed – LTSR providing residential and treatment services in a structured setting for individuals who have demonstrated severe and persistent psychiatric disorders and can reasonably be expected to respond to therapeutic intervention. The facility is licensed and secure. Managed in partnership with the SOS transitional provider, Mercy Behavioral Health, who is the licensed provider for this facility. The location of the LTSR moved from MSH grounds to Glen Hazel – 3000 Naomi Drive, Pittsburgh on June 30, 2009. Allegheny HealthChoices, Inc. 23

24. Two Specialized Support Homes Small specialized support homes providing 24 hours/day, 7 days/week supervision. Each home serves 3 residents Activities take place in the community with the expectation that residents will become fully integrated into the community system of care and supports over time. Homes are managed in partnership with the SOS transitional provider, Mercy Behavioral Health. Allegheny HealthChoices, Inc. 24

25. Update on Family Interviews Response rates from June/July pilot Next steps 25 Allegheny HealthChoices, Inc.

26. Summary of Findings from Quality Assurance Activities Objective of these activities is to ensure that system issues are readily identified and communicated to relevant stakeholders Common concerns and similar issues among treatment systems – System fragmentation – Engagement / re-engagement – Family involvement / education – Other issues MRSAP steering committee approach to QA issues Allegheny HealthChoices, Inc. 26