WELCOME
Building Community Connections:
Regional Stakeholders MeetingJune 17, 2011
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Agenda for Meeting
Update from DPW A two year view post closure Initial results from evaluation by University of
Pittsburgh Strategies for Community Inclusion Discussion, questions, …..
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Update From DPW
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Overview of Two Year Report
Outcomes for People Discharged during the Mayview Closure
– Housing– Services– Community Hospitalizations, EAC, RTFA– Work / Volunteer– Physical Health
Service System Redesign– Planning and Oversight– Service Utilization and Cost Implications
Conclusion and Future Directions
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Housing at 12/31/2010
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Housing CategoryPercent of
People Living Independently or with Family 16%
Supported Housing Programs 12%Supervised Group Settings 44%
Long-Term Structured Residences 13%Nursing Homes 6%
Community Psychiatric Hospital 2%Criminal Justice Facility 1%
Source: monthly tracking reports completed by County monitors.
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Housing Stability and Satisfaction
About 50% are living in same location as two years ago when the hospital closed
25% have moved once 25% have moved two or more times 73% of those who have moved, moved to a less
restrictive setting Of those who completed a CFST satisfaction
survey– 82% rate their housing as excellent– 73% are satisfied with their housing location
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Satisfaction / Community Connections
High levels of satisfaction with services and a higher quality of life compared to the state hospital
Some people report needing additional services and supports to become more independent and increase connections to the community
Peer support services have been helpful for many individuals
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Case Management and CTT Use
CTT – 190 Individuals – average 2.8 contacts per week
All other Case Management – average 1 contact per week
19 people have administrative case management
9 people have no case management
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Other Community Services - 2010
29% Outpatient services 17% Crisis services 11% Social rehabilitation services 10% Housing support services < 5%
– Drug and alcohol– Partial hospitalization– Respite
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HealthChoices (non-MRSAP) IP Admission Rates, 2006-2010
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Community Inpatient, EAC, RTFA
About 20% of people discharged from Mayview had community hospitalizations in either 2009 or 2010
The average length of stay in 2009 was 37 days, decreasing to 30 days in 2010; the number of days associated with inpatient stays decreased 14% from 2009 to 2010
Eight people (3%) discharged from Mayview have had an admission to EAC services in 2009 or 2010
Thirteen people (5%) discharged from Mayview have had an admission to a RTFA
There’s been one civil commitment to Torrance State Hospital Half of the 21 people transferred to Torrance State Hospital have
been discharged back to the community
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HealthChoices IP Length of Stay, 2006-2010(Includes MRSAP and non MRSAP)
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Criminal Justice Involvement
22 people (8%) have been arrested since the closure, totaling 40 separate incidents
In 35 of these incidents, people were incarcerated for varying amounts of time, and charges ranged from probation violation to disorderly conduct to more serious offenses like robbery
Five arrests did not result in an incarceration
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Work / Volunteer Activities
20% reported some work or volunteer activity. Many of these activities were informal employment or volunteer activities
50% of those not working reported being interested in working, and most feel ready to work
A smaller proportion (23%) reported being interested in volunteering
Counties have a number of initiatives to increase supported employment opportunities for their populations
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Physical Health
People discharged report good overall physical health and access to physical health care: 83% of people report they are in average or excellent physical health75% report receiving regular routine physical health checkups, and 82% report having average or excellent access to physical health care48% report receiving regular dental care, perhaps reflecting both accessibility issues and personal preferences for seeking regular dental care
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Physical Health
19 people have died from natural causes/medical reasons since January 2009, and four other individuals have died from accidental causes
Many people were discharged with complicated, chronic health conditions, and the median age at discharge was 48 years
Many people in this population need significant medical care, and all need physical health care that is closely coordinated with behavioral health
Only 46% of consumers report that their mental health provider communicates with their physical health provider
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Service Utilization and Cost Implications
Average costs per individuals range from $16,400 to $29,000 per year
Provided services to approximately 1600 people in 2010 who potentially could have used MSH at an average cost of $32,000 annually
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Conclusion
Generally a successful transition to the community Higher quality of life and stable, community-based
housing with varying amounts of support and access to mental and physical health treatment
Fears that community hospitals and jails would become the new Mayview have been disproven
Connections to the community – whether through employment, personal relationships, or activities – remains an unmet goal for many
Physical health of many individuals, particularly as they age, must continue to be a priority
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Future Directions
As the region looks ahead, priorities will include:
– Continuing to assure that people get the services they need, and that these services focus on recovery and achieving positive outcomes
– Assuring ongoing funding to maintain adequate financial resources for the system
– Maintaining the regional focus on recovery, quality monitoring and improvement, and data-driven decision-making
– Improving cross-system planning and collaboration for special populations and those individuals with particularly complicated situations
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Mayview Discharge Study
Katie Greeno, University of Pittsburgh Sue Estroff, University of North Carolina Courtney Colonna Kuza, University of
Pittsburgh
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Outcomes after discharge
It is valuable to know how people fare after discharge from long-stay hospitals– Understand the recovery process– Quality assurance for providers and policy makers
This study used rigorous methods to document two-year outcomes for people discharged from Mayview
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Method
We followed 65 people over two years– They represented the whole group– Not every one participated at every time point
We saw people every 3 months– Standardized assessments every other visit– Other visits focused on interviews
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Study personnel
Two senior faculty members and a very experience project director
10 interviewers– Pitt graduate students with direct practice
experience– Extensive training from the project director– Supervised, then independent visits to participants– Weekly staff meetings
Interviewers stayed with the same participants
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Data collected
225 standardized assessments 138 interview based “check-ins” 41 in-depth “relocation interviews” Over 500 visits made to participants’
residences for these observations
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Standardized measures
Psychiatric symptoms– Improve over two years
Social Contacts– Improve over two years
Quality of Life– Stays the same – compares favorably to other groups
Recovery assessments– Stays the same – about the same as other groups
Perceptions of Care– Do not change over time – lower than other groups
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Percent with at least moderate illness(BPRS >41)
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Criteria for remission
Remission of BRPS-rated psychotic symptoms– Seven symptoms related to psychosis
Grandiosity, suspiciousness, unusual thought content, hallucinations, conceptual disorganization, blunted affect
– Rated 3 (mild) or less for six months
Additional criterion:– Overall BPRS < 31 for six months
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Symptom Remission
50 participants had at least two standardized assessments in Year 2 of the study– We examined their last two observations
30 participants (60%) met this criterion for remission
24 participants (48%) met this criterion, and also had an overall BPRS score of 31 or less
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See friends regularly (percent)
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WHO Qol: Psychological Well-Being
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WHOQol compared to other samples
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WHOQol compared to other samples
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POC: Interpersonal aspects of care
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Would you recommend this facility?
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Rate services from 1-10 (percent)
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Interview and observational findings
Participants prefer their new residences to Mayview
Community integration is complex and longer term
Housing will be an on-going concern
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People are satisfied with theirnew residences
New residences are preferred to the hospital– No comparison. It’s better. It’s the freedom factor– I’m free. I go more places. I do what I want to do.
People feel safe and comfortable – Here, I am much more relaxed– I am much more comfortable– There are less people. If residents don’t get along,
it gets taken care of by staff
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Progress needed on community integration
Many participants would welcome more varied activities– Q: What do you do? A: Sleep. Get up and watch
TV. Come out here and smoke.– Q: What is there to do? A: Sleeping. Groups.
That’s about all. – I don’t go anywhere. I don’t have any money.
Some participants are very active– I am in the process of getting prepared to get a job.
I’ll see what kinds of things I want to do.
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Housing is a continuing concern
Some people adjust well to supervised housing situations designed for short stays (e.g., CRRs), and find the need to relocate again problematic
Most participants have limited financial resources, and will rely on public housing as they become more independent– Public housing is not always available– When available, the quality and safety of public
housing is variable
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Conclusions
People discharged from Mayview are doing well in their new residences
Continued attention to services will be useful. “The best experience has been
knowing that I can make it in the real world. Not as hard as I projected it to be.”
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Study Design
Hospital
3 mo 6 mo 9 mo 12 mo 15 mo 18 mo 21 mo 24 mo
Q CIIW
Q CIIW
Q CIIW
Q CIIW
Q
FN FN FN FN FN FN FN FN FN
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Strategies for Community Inclusion
Panel– Kevin Trenney– Austin Lee– David Bolgert– Gary Seuhr– Joe Burgess– Gabe Chantz
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What does recovery mean to you? What kinds of things have you done, or that you
suggest others do, to lessen isolation and improve one’s connection to the community?
If there’s one thing that you would recommend people do to take the first step – what would it be?
What can the community, providers, and/or counties do to help people better connect with their communities?
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Strategies for Community Inclusion