1 Mayview Regional Service Area Plan Quality Improvement/Outcomes (QIO) Committee QIO Data Report Allegheny HealthChoices, Inc. December 9, 2009

December 2009 Report 1. Are the recommended services and supports that were identified at discharge different from current recommendations? 2. What services are people actually accessing? 3. What types of early warning signs and critical incidents are occurring for individuals? 4. Are people maintaining their housing? Have there been changes to the level of restrictiveness since their discharge? 2 Allegheny HealthChoices, Inc.

Data Sources Baseline Community Support Plans (CSPs) Updated CSPs Monthly CSP tracking reports Data on the actual services delivered based on provider claims AHCI CTT application The Mayview residential tracking system The early warning/critical incident tracking system 3 Allegheny HealthChoices, Inc.

4 Most of the report focuses on the 244 people who have both plans. Baseline and Updated CSPs: Distribution among the Mayview Counties County Baseline CSPUpdated CSP # of People % of People # of People % of People Allegheny23980%19379% Beaver289%2611% Lawrence 72%5 Washington 238%208% Total297100%244100% Allegheny HealthChoices, Inc.

Q1: Are the recommended services and supports that were identified at discharge different from current recommendations? Overview – Recommendations generally remain consistent from discharge – Some changes in the recommended use of CTT and CM/SC in Allegheny and the suburban counties – Shifts in recommended frequency of contact represent a better understanding of needed and desired support – All individuals have a crisis plan – Other services and supports indicate small changes Allegheny HealthChoices, Inc. 5

6 Allegheny: 6% shift to CTT Suburban: 19% shift to CM/SC

Allegheny HealthChoices, Inc. 7 CTT: Shift from Daily to 4-6 and 2-3/wk CM/SC: Shift from Weekly to 2-3/wk, semi-monthly, and monthly

Benefits, income, and representative payees Few changes in areas related to employment and education Interest in hobbies and leisure activities remains high, with an increase in people who want to pursue activities on their own Social supports – families and peers Transportation – mostly providers Allegheny HealthChoices, Inc. 8 Other Supports and Services

Q2: What services are people actually accessing? Other than a slight reduction when “Daily” is recommended, actual CTT contacts are consistent with recommendations Actual CM/SC contacts often occurred more frequently than recommended Most people received CTT services, with others receiving CM/SC CTTs provide a wide array of services, including psychiatric services and supports, crisis services, drug and alcohol therapy, peer support, med management, and vocational rehabilitation 97% of people had at least one visit with a medical doctor. Allegheny HealthChoices, Inc. 9

10 In 24 hour staffed residence? YesNo Recommended CTT Contact Frequency # of People Actual Avg. Wkly Contacts # of People Actual Avg. Wkly Contacts Daily (7 / wk) / wk / wk Wkly (1 / wk) Totals Comparison of Recommended and Actual CTT Contact Frequencies from January 1, 2009 through June 30, 2009 by Residential Staffing Level Actual is less than recommendedActual is greater than or equal to recommended

Allegheny HealthChoices, Inc. 11 In 24 hour staffed residence? YesNo Recommended CM/SC Contact Frequency # of People Actual Avg. Wkly Contacts # of People Actual Avg. Wkly Contacts 4-6 / wk 12.70n/a 2-3 / wk Wkly (1 /wk) Semi-monthly (0.5 / wk) Monthly (0.25 / wk) 22.40n/a Totals Actual is less than recommendedActual is greater than or equal to recommended Comparison of Recommended and Actual CM/SC Contact Frequencies from January 1, 2009 through June 30, 2009 by Residential Staffing Level

Allegheny HealthChoices, Inc. 12 Service Category# of People Outpatient (includes med checks)59 Community Support Team (CST) (SOS)39 Other behavioral health services *33 Inpatient Mental Health31 Crisis Services **30 Social Rehabilitation26 Family Support Services23 Housing Support Services22 Emergency Services12 Respite8 Residential Treatment Facility for Adults (RTF-A)6 Extended Acute Care (Inpatient)3 * Includes Partial, Mobile MH, Adult Outpatient, Psychiatric Rehabilitation, Lab, Consults, Community Vocational Rehab, Facility Based Vocational Rehab, Inpatient DA Detoxification, MH Justice-Related Services. Totals for each of these services were small so they were combined into one category. ** Crisis services include walk-in crisis, mobile crisis, and telephone crisis services. Number of People Who Received Other Behavioral Health Services from January 1, 2009 through June 30, 2009, not Including CTT & CM/SC

CTTs provide crisis services – 64 people totaling 662 events Individuals receiving CM/SC had lower utilization of crisis services – 7 people totaling 48 events. CTTs – Work with individuals who may need more support – Provide on-call coverage 24/7 – including when a person goes to hospital Similar contacts may not be “crisis” contacts for CM/SC Allegheny HealthChoices, Inc. 13 Summary of Crisis Services from January 1, 2009 through June 30, 2009 for People Receiving CTT and CM/SC

Allegheny HealthChoices, Inc. 14

Q3: What types of early warning signs and critical incidents are occurring for individuals? From January 1, 2009 through September 30, 2009 Most common early warning signs – Refusal to Take Medications-Posing Risk: 21.6 avg/month – Atypical Behavior–Change from Baseline: 16.9 avg/month – E/R Visit-Behavioral/Physical Health: 16.3 avg/month Most common critical incidents – Medical Hospitalization: 11.2 avg/month – Community Hosp–Involuntary: 8.0 avg/month – Other Incident-Serious Nature: 7.4 avg/month Allegheny HealthChoices, Inc. 15

Other Critical Incidents Psychiatric hospitalizations – 69 (22%) people, 195 hospitalizations – ALOS 28 days (3 outliers excluded) Incarcerations – 24 (8%) people, 42 events – ALSO 35.9 days (1 outlier excluded) Deaths – 10 (3%) people: 6 from natural causes, 2 accidental, and 2 suicides Allegheny HealthChoices, Inc. 16

Q4: Are people maintaining their housing? Have there been changes to the level of restrictiveness since their discharge? 62 of 244 people (25%) changed their type of housing between their discharge date and August 31, 2009 No one became homeless Allegheny HealthChoices, Inc. 17

Allegheny HealthChoices, Inc. 18 Level of Restrictiveness Moved To IndependentDependentSupervisedRestrictive Moved From Independent 2611 Dependent 6141 Supervised 7787 Restrictive 0362 Increase in Restrictiveness Decrease in Restrictiveness Neutral Change Summary of Changes in Housing Type by Level of Restrictiveness: Housing at Discharge and as of August 31, people (47%) moved to a less restrictive setting 20 people (32%) moved to a more restrictive setting 13 people (21%) moved to a setting with the same level of restrictiveness

Allegheny HealthChoices, Inc. 19 Housing TypeLevel At Discharge Updated CSP As of 8/31/09 #%#%#% PCH, EPCH, CMHPCH Supervised 5824%5924%5824% LTSR Restrictive 6125%5523%5523% CRR Supervised 4418%3414%2912% Specialized Supportive Housing Supervised 229%2510%2611% Supportive Housing Dependent 177%198%187% Living Independently Independent 125%125%156% Mental Retardation (MR) Housing Supervised 125%135%135% Nursing Home Restrictive 73%104%125% Family Independent 62%83%8 Permanent Supportive Housing Dependent 31%83%7 Community Inpatient Restrictive 00%0 21% Domiciliary Care Supervised 10%1 1 State Mental Hospital Restrictive 10%0 0 Housing: At Discharge, Recommended in the Updated CSP, and as of August 31, 2009

Summary, Discussion, and Recommendations CM/SC in suburban counties – although there are often multiple contacts per week Level of interest in employment and education Social and community integration beyond residential programs Families and peers continue to provide support Mobility within community beyond using providers for primary transportation Crisis utilization for those receiving CM/SC Ongoing emphasis on physical health needs Assessment of quality of life and general satisfaction 20 Allegheny HealthChoices, Inc.