1. Submitted by the Hospital and Home Team, May 3, 2013
Mercer Study Review and Recommendations for Alternative Use of Rainbow MHF
Submitted by the
Hospital and Home Team, May 3, 2013

2. The Hospital and Home Team
Vision: Consumers experience recovery and satisfaction with themselves, their world, and their dreams/aspirations by living safe healthy self-determined lives in their community as evidenced by continuity in maintaining and enhancing their homes, occupation, financial stability, & personal relationships.
Mission: The Hospital and Home Team will recommend action steps for the purpose of improving access to an array of mental health services and supports that promote recovery and community integration.
November 17, 2018

3. The Hospital & Home Team overview statements
In FY13 KDADS contracted with Mercer to conduct an actuarial analysis of hospital and community based services utilization. The Hospital & Home Team (H&H) team was charged with reviewing the report issued by Mercer and developing recommendations for reducing reliance on the state hospitals for public safety net services that could be provided elsewhere.
The recommendations set forth here are specific to the development of alternative services at Rainbow Mental Health Facility, but have implications for future work and the development of similar services across the state.
These recommendations cover what service options need to be available, but do not include recommendations for the management and operation of such services. Although the H&H team had rich discussions and strong opinions about the management and operation of the services at Rainbow, it was felt that those decisions should be made by the local workgroup rather than by the H&H team.

4. Conclusions Drawn from Mercer as they relate to Rainbow MHF
Rainbow is serving as a safety net
There are systems and other factors that affect the data that we do not have control over
There appears to be a correlation between availability and utilization of community services and hospital admission rates.
70 % of admissions to all SMHFs were involuntary and 30% voluntary
40.8% were non-SPMI admissions and had co-occurring SUD
Johnson County MHC and Wyandot Center have highest volume of voluntary admissions
Median Length of Stay for voluntary admits is 9.0 days. 40% of all admissions lasted less than 10 days.
Northeast region had highest percentage of readmission rates
There appears to be a need to improve fidelity of screens; validity and reliability of voluntary vs. involuntary admissions

5. Populations that could be impacted
Voluntary admissions
Involuntary admissions who are likely to stabilize quickly
Non-SPMI with co-occurring SUD
Those with placement issues, coming from jail, self care failure, homelessness

6. Actions Identified in Discussion
Allow sufficient time at intake/admission for a thorough assessment to be made
Provide triage, including capability to assess and refer for medical care,
Assure fidelity to screening protocols
Provide medical coverage and medical clearance
Employ security personnel so law enforcement officers are not unduly delayed (stop and drop)
Offer support services
Use self directed wellness tools
Be recovery oriented
Demand systematic connection/interface with community based services

7. Assumptions
People should be able to come directly to Rainbow. SMHH Screens will not be required for this initial contact and triage.
Services at Rainbow will serve as a community option to determine appropriate and effective services at the time of contact.
Rainbow serves as secondary level of care while OSH is tertiary . (H&H’s Access to Community Services and Supports Work team defined tertiary care as a facility that provides longer and potentially more complex course of inpatient mental health treatment).
Rainbow must have capacity to treat involuntary admissions
Rainbow will provide short-term, acute inpatient treatment and will have the capacity to connect potential admissions to lower levels of care and treatment in the community.
Between 30 and 40 percent of people referred for inpatient treatment at the present time may be appropriately served by outpatient providers.
A seamless system of mental health care and treatment requires close coordination between community and inpatient providers

8. Recommendations
Implement the past work group recommendation to make RMHF a secondary/regional resource for people whose immediate needs go beyond the capacity of CMHCs and other community resources. The function of such a facility is three-fold: crisis response and stabilization, referral to appropriate levels of service within the community, or brief inpatient treatment.
People admitted to RMHF for inpatient treatment should have access to all the services necessary to make a timely transition to alternate services.
RMHF should include crisis stabilization that is similar in purpose, design, and operation to the former KU Crisis Stabilization Center. This program should use evidence-based and promising values-based services designed to assure a through evaluation, appropriate treatment, and access to the resources necessary to assure a timely and successful return to the community.

9. Recommended Services Services should include the following:
24/7 access to crisis response, triage, and treatment
Short-term crisis stabilization, including the capacity to access mobile crisis response
Detoxification services and connection to a continuum of needed addiction services
Short-term inpatient regional beds
Referral to and coordination with community based services and resources
Coordination with OSH to facilitate access to tertiary level of care, and as a resource for patients at OSH who may be better served at the secondary level of care.

10. Recommended Services Con’t
Services should be delivered within a framework that includes:
Peer support and Peer specialists
Intensive Case Management (as exemplified by Heartland RADAC)
Board certified/eligible physicians, licensed nurses, and mental health professionals
Adequate number of trained staff to serve involuntary admissions
The ability to provide transportation as necessary for a person to get to other services and resources. Except in very rare cases, this does not include the use of law enforcement transport.
Approval/Certification by TJC or CARF, etc. as appropriate, with accountability for those “Standards” of Care, and Good Business Practices.
November 17, 2018

11. Recommended Services Con’t
Should be delivered in a physical environment that is:
Safe
Secure (presence of sufficient in-house security personnel)
Welcoming
Promoting recovery
November 17, 2018

12. Rainbow must provide coordination with community services
An essential strategy for preventing mental health crisis and reducing the need for higher levels of care, is the development and support of community-based rehab services.
Intensive case management, peer support services, and mobile crisis will be essential resources to the success of this program.
In order to assure a seamless system of care it is essential that provision of services and referral to or reconnection with community resources be main functions of the new design