1. 1 Mayview Regional Service Area Plan Quality Improvement/Outcomes (QIO) Committee November 19, 2008

2. Agenda for Today’s Meeting Update on the closure and resource development Discussion of County responses to our feedback Discussion of interviewing families Wrap-up and recommendations

3. Mayview Update 47 people in Mayview (as of 11/14/08) 197 people have been discharged since the closure announcement 2 units remain open

4. Resource development As Mayview has downsized, the counties have invested funds in: Residential options Treatment services Supports and resources

5. New Residential Options Permanent Supportive Housing (PSH) and related services Comprehensive Mental Health/Enhanced Personal Care Homes (CMHPCH and EPCH) Long-term Structured Residences (LTSR) Specialized Supportive Housing (aka long-term residences) Extended Acute Services (EAC), both hospital and community-based Residential Treatment Facility for Adults (RTF-A) Other county-specific options

6. New Residential Options AlleghenyBeaverWashingtonLawrenceGreene Perm. SH CMHPCH/ EPCH ‡ LTSR † Spec. SH/ long-term res. † Ext. Acute * * * * RTF-A * * * * Other * Regional resources are being developed by the suburban counties † State operated services that all counties will have access to ‡ While not all counties are developing, counties will have access to resources

7. New/Expanded Community Services Community Treatment Teams (CTT), also known as Assertive Community Treatment (ACT) Enhanced Clinical Case Management (ECCM) Expanded Case Management/Service Coordination Mobile Medication Teams/Mobile Mental Health Expanded Outpatient Expanded Psychiatric Rehabilitation Crisis Services

8. New/Expanded Community Services AlleghenyBeaverWashingtonLawrenceGreene CTT/ACT ECCM Case mgmt./ Svc. Coord. Mobile Meds, Mobile MH Outpatient Psych Rehab * Crisis Svcs * Through a new Clubhouse program

9. New/Expanded Peer Support Peer mentors Warmline Peer specialists Recovery specialists (County staff)

10. New/Expanded Peer Support AlleghenyBeaverWashingtonLawrenceGreene Peer Mentors Warmline Peer Specialists Recovery Specialists Drop-in Center

11. Process of Using Data for Evaluation Analyze data: What does it mean? Distribute data, talk about it Make changes based on data Collect data

12. Recap: QIO Feedback for Counties In August, we reviewed survey data for 62 people discharged from Mayview who had been living in the community for at least six months We talked about the positive comments and experiences in the responses, and the areas we thought people needed more assistance in

13. Our Priority Areas 1. Social life, family connections, community integration, activities 2. Work and education 3. Physical health, including coordination with mental health

14. County Responses for Priority 1: social life, activities, community integration Allegheny County staff facilitate discussion and monitor provider activities through: Follow-up on individual surveys, update CART Completing a rating report with consumers monthly CSP meeting 1 month, 6 months, then annually Consulting with Community Care Beaver County Recovery Coordinators meet with consumers to: Review community integration part of CSP Discuss changes, needs Discuss use/interest in peer mentors and peer specialists Provide information to County staff for follow-up Other County staff also review entire CSP for accuracy

15. County Responses for Priority 1 (cont.): social life, activities, community integration Washington County staff will discuss with CTT and case management the importance of community participation and the development of natural supports Each CTT/case manager will be responsible to revisit the topic with the consumer and report back to county representative monthly detailing progress and/or barriers in this area Lawrence The Drop-in Center is available to all people. The Drop-in Center offers a wide variety of activities. Greene The Drop in Center and AMI (social rehabilitation) are available as social organizations The Community Support Program, health fairs and senior centers are also options and the County is developing a Psychiatric Rehabilitation Program.

16. Discussion of Priority Area 1 The Counties had different approaches to addressing this area. Their strategies fall into two categories: 1. Individual monitoring of people’s CSPs, their changing interests, and provider actions to support people 2. Listing what is available to consumers to access Do these strategies meet your expectations for addressing this priority area? What is missing? (Discuss Committee’s responses to questions sent prior to meeting)

17. County Responses for Priority 2: Work and Education Allegheny County staff facilitate discussion and monitor provider activities through: Follow-up on individual surveys, update CART Completing a rating report with consumers monthly CSP meeting 1 month, 6 months, then annually Consulting with Community Care Beaver County will make sure CTT/case management review work and education interest/goals with individuals CSPs will be updated as necessary System-wide training on employment opportunities using a Supported Employment grant

18. County Responses for Priority 2 (cont.): work and education Washington County staff will discuss with CTT and case management the need to provide intensified efforts to assist people in exploring meaningful opportunities. Immediate assistance will be offered to consumers. Each CTT/case manager will report back to county representative monthly detailing progress and/or barriers. System-wide training on Supported Employment Lawrence Existing services to support interest in work and education: Drop-in-Center-(DIC) Lark Enterprises Lawrence County Social Services Career Link Community Mental Health Center-(CMHC)

19. County Responses for Priority 2 (cont.): work and education Greene Through our recovery trainings, workshops and Community Support program we encourage individuals to volunteer or become employed, if only on a part time basis. We support our consumers through peer specialist trainings and referrals to OVR.

20. Discussion of Priority Area 2 The Counties had different approaches to addressing this area. Their strategies fall into three categories: 1.Individual monitoring of people’s CSPs, their changing interests, and provider actions to support people 2.System-wide training on Supported Employment, other options 3.Listing what is available to consumers to access Do these strategies meet your expectations for addressing this priority area? What is missing? (Discuss Committee’s responses to questions sent prior to meeting)

21. County Responses for Priority 3: physical health, coordination with mental health Allegheny County staff facilitate discussion and monitor provider activities the same as with the first two priority areas The County also will distribute “Being a Proactive Patient: A Guide to Person-Centered Care” from the Consumer Health Coalition Beaver County will make sure CTT/case management are addressing physical health/coordination with individuals through: Verifying documentation on when each person last visited their PCP, psychiatrist, dentist, eye doctor, gynecologist, other specialists, etc. Verifying documentation that coordination between the PCP and psychiatrist is occurring CSPs will be updated as necessary

22. County Responses for Priority 3 (cont.): physical health, coordination with mental health Washington County staff will discuss with CTT/case management CTT/case management will intensify efforts to offer assistance for the following: PCP visits, Specialist Care, Dental and Vision Care, Nutrition Counseling and opportunities for physician approved exercise. CTT/case management will also provide direct linkage between the various practitioners when necessary. Lawrence The Drop-in Center has a weight/exercise room, and also offers free health screenings and some vaccinations. Case management and mobile medications services already assist in addressing this priority area. Greene All provider agencies are engaged in this. Opportunities for consumer education occur during recovery events, workshops, Community Support Program meetings. Health Fairs and screenings are held throughout the year.

23. Discussion of Priority Area 3 The Counties had different approaches to addressing this area. Their strategies fall into three categories: 1.Individual monitoring of people’s CSPs, their changing interests, and provider actions to support people 2.Listing what is available to consumers to access 3.Distributing information to consumers Do these strategies meet your expectations for addressing this priority area? What is missing? (Discuss Committee’s responses to questions sent prior to meeting)

24. Quality Improvement Plan Basics How will we measure the impact of the counties’ strategies? What is a reasonable expectation for improvement, and when?

25. QI Plan: Example ActivityImprove the rate of satisfaction with employment and education for people discharged from Mayview Why is this activity important? Employment and education can be very important in individual’s recovery, and also help people become more independent. MeasurementsPercent of people working, percent of people satisfied with work opportunities, etc. Data sourcesCFST surveys Current rate27% working or volunteering (first round of surveys) GoalIncrease the rate of people working from 27% to ? by the end of 2009 Analysis of the rates Why are people not working? InterventionsBased on the analysis, what interventions will counties do to improve the rates?

26. Next steps for priority areas What recommendations do we have for the counties on their plans? Can we establish one most important priority area?

27. Family Interviews According to our data, about 80% of people discharged have some involvement with their family. During the community support plan process (discharge planning), people’s families are asked to complete assessments and come to the meetings. We don’t have a way to ask people’s family members how things are going for them in the community. The QIO Committee recommended that a process for interviewing family members be developed.

28. Family Interviews Discussion How do we get in touch with family members while respecting the privacy of people discharged? Who should do the interviews? What questions should we ask family members?