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Mayview Regional Service Area Plan
Quality Improvement/Outcomes
(QIO) Committee
August 26, 2009
1 Allegheny HealthChoices, Inc.
Agenda for Today’s Meeting
MRSAP Steering Committee updates
Review of survey results
Overview of the Southwest Regional SOS
Update on family interviews
Summary of findings from quality
assurance activities
Wrap-up
2 Allegheny HealthChoices, Inc.
MRSAP Steering Committee Updates
Lessons Learned
Land Reuse Task Force
Inpatient Utilization
Pitt Evaluation Study
Service Development
– Community EAC
– Suburban RTFA
– ACSP
3 Allegheny HealthChoices, Inc.
August 2009 Report
Data sources
– Monthly tracking reports
– Early warning and critical incident system
Compares services and supports used in January 2009 - right after the
hospital closed , and June 2009 – six months after the closure
Covers the following areas
– Use of Community Treatment Team (CTT) and case management/service
coordination
– Use of behavioral health treatment services
– Housing
– Benefits, income sources, and guardianship
– Rehabilitation and employment activities
– Social supports
– Transportation
– Physical health care visits
– Early warnings and critical incidents
4 Allegheny HealthChoices, Inc.
People Discharged by County
5 Allegheny HealthChoices, Inc.
Use of CTT, Case Management, and
Service Coordination
June 2009
Allegheny
– 81% (181 or 223)
received CTT
Beaver
– 63% (17 of 27)
received CTT
Lawrence
– 100% (7 of 7) received
CM (CTT not available)
Washington
– 59% (13 of 22)
received CTT
6 Allegheny HealthChoices, Inc.
Frequency of Contact: CTT
7 Allegheny HealthChoices, Inc.
Frequency of Contact:
Case Management, Service Coordination
8 Allegheny HealthChoices, Inc.
Behavioral Health Treatment Services
76% used CTT services
19% had mental health services through their LTSR
12% had outpatient mental health services.
– A larger percentage of people in Washington County (27%, 6
individuals) accessed outpatient in comparison to Allegheny
County (11%, 25 people) or Beaver County (15%, 4 people).
A small number had mobile medication teams or
mobile mental health services
Substance abuse treatment:
– Only one person used drug and alcohol detoxification services.
– Substance abuse treatment is included in CTT services.
– AA/NA are included in “Social Supports”.
9 Allegheny HealthChoices, Inc.
Housing
10 Allegheny HealthChoices, Inc.
Housing by County – June 2009
Allegheny Beaver Lawrence Washington
Long-term structured residence (LTSR) 17% 26% 43% 18%
39 people 7 people 3 people 4 people
Personal care home 22% 18% 0% 23%
(PCH, EPCH, CMHPCH) 50 people 5 people 5 people
Community Residential Rehabilitation 12% 11% 29% 5%
(CRR) 26 people 3 people 2 people 1 person
Specialized supported housing 12% 0% 0% 0%
27 people
Living independently 5% 11% 0% 9%
12 people 3 people 2 people
Living with family 2% 4% 14% 14%
4 people 1 person 1 person 3 people
Supported housing 5% 22% 0% 14%
12 people 6 people 3 people
All other housing categories 25% 7% 14% 9%
(inpatient, MR housing, Nursing Homes, 53 people 2 people 1 person 4 people
TSH)
11 Allegheny HealthChoices, Inc.
Benefits
47 Dually eligible individuals – Medicaid/Medicare: AC – 30, BC – 7, WC - 10
12 Allegheny HealthChoices, Inc.
Sources of Income
13 Allegheny HealthChoices, Inc.
Guardianship, Rep Payee, and Power of Attorney
14 Allegheny HealthChoices, Inc.
Rehabilitation and Employment
15 Allegheny HealthChoices, Inc.
Social Supports
16 Allegheny HealthChoices, Inc.
Transportation Supports
17 Allegheny HealthChoices, Inc.
Physical Health Care
18 Allegheny HealthChoices, Inc.
Early Warning Indicators
Jan- Feb- Mar- Apr- May- Jun-
09 09 09 09 09 09
Attempts At Elopement 0 1 1 2 2 2
Atypical Behavior - Change From Baseline 25 18 13 18 18 8
Complaints - Property Destruction/Eviction 4 2 4 2 0 0
Consumer Not Responding to Contact 2 0 0 0 0 0
E/R Visit - Behavioral/Physical Health 18 12 17 18 15 15
Inability to Locate Consumer 0 2 6 5 3 0
Indications For Increased Service/Supports 3 5 14 9 4 8
Police Involvement 5 11 6 6 6 4
Refusal to Take Medications Posing Risk 30 17 29 19 16 15
Sleep Pattern Change From Baseline 0 0 1 0 0 0
Unexcused Missed Appts 4 3 2 0 0 0
Total Number of Early Warning Signs 91 71 93 79 64 52
Unduplicated Number of Consumers 48 42 49 47 37 35
Number of people being followed post- 288 282 286 283 278 279
discharge
19 Allegheny HealthChoices, Inc.
Critical Incidents
Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09
Physical/Sexual Abuse 0 0 0 1 1 0
Arrest 1 2 0 0 2 2
Attempted Suicide 0 1 0 0 0 0
Client Injury - Accident/Intentional 1 1 2 0 1 0
Community Hosp - Involuntary 13 4 7 5 8 9
Community Hosp - Voluntary 8 4 4 4 3 5
Death 1 1 1 1 0 0
Fire 1 0 0 0 0 0
Housing Change 2 7 13 1 3 2
Medical Hospitalization 15 14 14 10 8 9
Medical Treatment Error 1 1 2 1 3 0
Missing Person 1 1 1 1 2 0
Other Incident - Serious Nature 11 4 6 3 8 13
Total Number of Critical Incidents 55 40 50 27 39 40
Unduplicated Number of Consumers 39 36 35 24 30 31
Number of people being followed 288 282 286 283 278 279
post-discharge
20 Allegheny HealthChoices, Inc.
Quality Management and Clinical Consultation
(QMCC) Team
Works collaboratively with counties and providers
Monitors service quality, effectiveness, and
coordination
Assists community providers in
Implementing supports through monitoring benchmarks of
recovery
Providing indirect support and education to community
providers, and
Providing direct support when necessary/appropriate and in
coordination with the counties.
Monthly consumer visits have increased from 19 in
January to 179 in July 2009
QMCC team includes: RN, Clinical Nurse Specialist,
SW, D&A Specialist, Pharmacist and Peer Specialist.
21 Allegheny HealthChoices, Inc.
Community Support Team (CST)
Resource for counties in offering additional supports to individuals
as they transition from Mayview State Hospital to the community.
Provides direct services to consumers and works to assist the
community providers in implementing optimal supports for the
consumers.
Requests have increased from 2 in January to over 50 in July
2009
Highest areas of support requested thus far have been:
– Spiritual Support
– Life Style Improvement
– Purposeful Recreation
CST Team includes: RN, SW, D&A Specialist, Vocational,
Recreation, Spiritual, and Peer Specialists.
22 Allegheny HealthChoices, Inc.
Monarch Springs Long Term Structured
Residence (LTSR)
15 bed – LTSR providing residential and treatment
services in a structured setting for individuals who
have demonstrated severe and persistent psychiatric
disorders and can reasonably be expected to respond
to therapeutic intervention.
The facility is licensed and secure.
Managed in partnership with the SOS transitional
provider, Mercy Behavioral Health, who is the licensed
provider for this facility.
The location of the LTSR moved from MSH grounds to
Glen Hazel – 3000 Naomi Drive, Pittsburgh on June
30, 2009.
23 Allegheny HealthChoices, Inc.
Two Specialized Support Homes
Small specialized support homes providing 24
hours/day, 7 days/week supervision.
Each home serves 3 residents
Activities take place in the community with the
expectation that residents will become fully
integrated into the community system of care
and supports over time.
Homes are managed in partnership with the
SOS transitional provider, Mercy Behavioral
Health.
24 Allegheny HealthChoices, Inc.
Update on Family Interviews
Response rates from June/July pilot
Next steps
25 Allegheny HealthChoices, Inc.
Summary of Findings from Quality
Assurance Activities
Objective of these activities is to ensure that
system issues are readily identified and
communicated to relevant stakeholders
Common concerns and similar issues among
treatment systems
– System fragmentation
– Engagement / re-engagement
– Family involvement / education
– Other issues
MRSAP steering committee approach to QA
26 issues Allegheny HealthChoices, Inc.
