Systems Transformation: Toward a Unified System SERVICE AREA PLANNING Mayview SPRING 2008

Service Area Planning, 2008 OMHSAS guiding principles and major objectives Service Area Planning Goals: What Progress has been made? Statewide What does the future hold? Harrisburg State Hospital Update Closure of Mayview State Hospital: Status Forensics Transformation Other News and Notes 11/6/2018

OMHSAS: Guiding Principles The Mental Health and Substance Abuse Service system will provide quality services that: Facilitate recovery for adults and resiliency for children; Are responsive to individuals’ unique strengths and needs throughout their lives; Focus on prevention and early intervention; Recognize, respect, and accommodate differences as they relate to culture/ethnicity/race, religion, gender identity and sexual orientation; Ensure individual human rights and eliminate discrimination and stigma; Are provided in a comprehensive array by unifying programs and funding building on natural and community supports unique to each individual and family; Are developed, monitored and evaluated in partnership with consumers, families and advocates; Represent true collaboration with other agencies & service systems. 11/6/2018

OMHSAS Objectives Transform the children’s behavioral health system to a system that is family driven and youth guided. Implementation of services and policy to support recovery and resiliency in the Adult Behavioral Health System. Assure that behavioral health services and supports recognize and accommodate the unique needs of older adults. 11/6/2018

Service Area Planning (SAP) Implementation of services and policy to support recovery and resiliency in the Adult Behavioral Health System Service Area Planning (SAP) State Plan developed 2002 SAP Goals Developed SAP meetings 2004 -2008 Summary reports, April 2006 and February 2007 SAP requests and updates incorporated into county planning documents 11/6/2018

Service Area Planning GOALS Implementation of services and policy to support recovery and resiliency in the Adult Behavioral Health System Service Area Planning GOALS Goal 1: Within five years no person will be hospitalized at a State Mental Hospital for more than two years. Goal 2: Within five years no person will be involuntarily committed to a community hospital more than twice in one year. Goal 3: Within five years the incarceration rate of the target population will be reduced. 11/6/2018

SAP: Objective 1 Statewide General : FY 2003/2004 to FY 2007/2008 The percentage of individuals staying in our facilities more than 2 years dropped from 53% to 49%, the overall census dropped by 14%. 11/6/2018

SAP: Objective 2 Statewide (HC) average of involuntary commitments - 3.4 per 1000 adults (4Q 2007) Allegheny - 4.2 Beaver - 2.6 Greene - 1.3 Washington County - .9 Lawrence - 2.8 Washington County has decreased its number of persons involuntarily committed and sustained for several quarters in HealthChoices. 11/6/2018

SAP: Objective 2 HealthChoices target: 10% (or less) of readmissions within 30 days of a discharge from 2007 Statewide average for readmission rates within 30 days for inpatient services for adults (HC) was 17% (4Q 2007). Progress in many counties; statewide range is 10% - 31%. Substance abuse impacts readmission rates; higher readmission rates for individuals with co-occurring disorders. 11/6/2018

SAP: Objective 3 Forensic Picture Statewide Census: Average Length of Stay < 90 days; 40% individuals served have been found incompetent to stand trial. Norristown: 120 Mayview: 70 Warren: 27 Mayview DPW has withdrawn the RFP to privatize the forensic units; the Mayview forensic unit will move to Torrance State Hospital. 11/6/2018

SAP: Objective 3 Forensic service developments include: Additional training for law enforcement, county jail staff, parole officers, probation officers and other first responders Use of Sequential Intercept Model for Justice-related services Participation in Criminal Justice Advisory Boards Implementation of diversion and re-entry programs Continued use of forensic case managers 11/6/2018

Mayview State Hospital Update Forensic Services Commonwealth has decided not to pursue privatizing of the MSH Forensic Center. MSH Forensic Center will be moved to Torrance State Hospital by 12/31/08. Forensic Transition Team has been selected and transition planning has begun. 11/6/2018

State Hospitals/CHIPPS 8 state hospitals and 1 long term nursing care facility; Mayview State Hospital to close 12/31/08 Since FY 1994-95 – A 65% reduction in state hospitals’ census (projected through June 30, 2009) Staff complement will decrease by 53% CHIPP (through June 30, 2008) – 2,792 individuals discharged 13,116 individuals received diversionary services Community funding of $212,078,029 State Hospitals as community partners: PRRT team, CRT teams, consultation and respite (Danville) 11/6/2018

CHIPP Funding History (Cumulative) 11/6/2018

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Mayview State Hospital Update Current census is 160 individuals; 440 civil section staff. Census at the time of announcement was 225. Community Support Planning continues to occur for every individual who currently resides at Mayview. Every individual residing at the hospital will have had at least one planning meeting by May 1, 2008. Downsizing of the patient units has been delayed by a month. 11/6/2018

Mayview State Hospital Update More community supports being developed-- extended acute services, Assertive Community Treatment teams and supported housing. County/OMHSAS track all serious incidents provide medical consultation review any death from a natural cause participate in Root Cause Analysis (RCA) as appropriate provide increased physical health coordination engage with providers in training 11/6/2018

Mayview State Hospital Update RN team from Mayview State Hospital has partnered with the Counties to assess each patient discharged from the hospital since Wave 1 to assure that medical needs are being met. 60 Assessments are completed to date. 11/6/2018

Mayview State Hospital Update Mayview team’s assessments: Majority of consumers have progressed significantly in their recovery process since their discharge from Mayview. The team is impressed with the consistent follow up in medical care that they have observed. Three consumers have developed relationships with their families that did not exist at Mayview. Two consumers have jobs; two others expressed interest in employment. Ten consumers either in their own apartments or supportive housing are involved with groups or Clubhouse activities. Twenty consumers enthusiastically discussed their current life in the community and their satisfaction with living arrangements as well as services provided by the community. 11/6/2018

Residential Placement Since 8/15/07 Nursing Home 4 Independent Living 11 Transferred to NC hospital 1 Transferred to NJ & living independently 1 Discharged & returned to Canada 1 Died while still at MSH 2 CRR 14 Enhanced PCH 21 Family Setting 4 LTSR 7 Personal Care Home 2 Supported Housing 12 Criminal Detention 1 11/6/2018

Mayview State Hospital Update State Operated Services Staff are being selected. Search Team is touring various potential locations for the CTT, LTSR and small homes. 11/6/2018

A Call to Change…. A call for transformation in the Adult system Recovery supporting system Peer delivered, consumer operated services Housing Other Employment Centers of Excellence -- Raise the Bar! Children’s Transformation Transitional Age Youth Older Adults 11/6/2018

OMHSAS: FY 2008-09 Budget Unified System Strategy Community MH Services $1.011 B total state and federal funds, net increase of $7.577 M; state funds increase $10.937 M No Cost of Living Adjustment CHIPP funding of $11.515 M for the discharge of 166 individuals from the state hospitals 5 Warren * 75 additional discharges from Mayview 10 Torrance 60 Norristown 16 Clarks Summit Transfer $10.847 M from Medical Assistance for Structured Treatment Services Elimination of funding for Psychiatric Services in Eastern PA 11/6/2018

OMHSAS: FY 2008-09 Budget Unified System Strategy Drug and Alcohol Services FY 2008-09 Act 152 budget is $16.227 M BHSI IGT funding of $12.107 M BHSI funding is $45.3 M (MH: $20.130 M, D&A: $25.170 M) No Cost of Living Adjustment Sexual Responsibility and Treatment Program (SRTP, Act 21) Implemented April 2004 on grounds at Torrance State Hospital 17 men are now being served SRTP program operation was transferred to the Commonwealth and operated by Torrance State Hospital (July 1, 2006) 11/6/2018

Behavioral Health HealthChoices 67 HealthChoices Counties 28 counties accepted right of first opportunity 1 direct state contract with BH-MCO (Greene County) 23 counties contract directly with state 15 counties accepted right of first opportunity for 7/01/07 implementation Incorporates broad behavioral mandates Variety of models including full risk county contracts, subcontracts with Administrative Services Organization and full risk subcontracts 11/6/2018

OMHSAS: HealthChoices 1.590 M people enrolled in HealthChoices (1/1/08) Projected enrollment for SFY 2008-09 is 1.618 M Funding FY2008-09 is projected to be $2.397 B statewide: Southeast Zone total $958.5 million Southwest Zone total $449.1 million Lehigh/Capital Zone total $384.9 million Northeast Zone total $128.1 million NCSO 23 county expansion zone $203.1 million NCOO 15 county expansion zone $273.4 million Mental Health portion* $2.137 billion Substance Abuse portion* $259.8 million *(includes admin.) 11/6/2018

HealthChoices Reinvestment Statewide: $298M in reinvestment Southwest Zone - $61M Mayview SAP includes Allegheny, Beaver, Lawrence, Washington and Greene Peer Support, D&A Outreach and Treatment; Start-up including Family Based and Crisis Services Housing, mobile medication, psychiatric rehab, other supplemental 11/6/2018

Housing Update OMHSAS Housing Policy – Plan requirements for any current housing activities (Reinvestment, CHIPP, Base Funds; CRR Conversion); 2009-2012 County Plan requirement Housing Plan Training Sessions and Technical Assistance Close to 50 counties attended first training session; next session this month Approved Housing Plans Beaver, Delaware, Lehigh, Montgomery, Northampton, Philadelphia, York/Adams, Allegheny Capital and Operating (PHFA partnership, local Housing Authority partnerships); Bridge Subsidies; Contingency Funds; have committed over $30 M Supportive Housing works! Service system MUST rise to the occasion: Mobile – c.m., peer, crisis, rehab, ACT. Housing authorities & developers are counting on behavioral health system response. 11/6/2018

Certified Peer Specialists General update: Number of trained CPS: 794 Number of trained CPSS: 540 Over half of our trained peers are working! Number of service descriptions submitted: 48 Number of approved service descriptions: 40 Number of programs current enrolled in MA: 15 17 in process Southwest region: Most counties have peers 11/6/2018

You Are The Evidence !!!!!! I’m The Evidence For how belief inspires How hope transforms and How giving heals the soul I’m The Evidence For what can be achieved How feeling connected can ground and How there is invaluable worth in an act of faith For how an example can lead How far encouragement can take you and How one step begins a journey towards endless possibilities 2008 Transformation Designs 11/6/2018

Support The Journey Recovery Recovery Recovery is remembering who you are through the darkness and using your strengths to become all that you were meant to be. Support The Journey 11/6/2018