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Older Adult Intensive Program Full Service Partnership

Older Adult Intensive Program Full Service Partnership. Bernice Zaborski, MHA Presented at the Integrated Services Conference April 5, 2006. Objectives. To understand fundamentals of an Older Adult Full Service Partnership

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Older Adult Intensive Program Full Service Partnership

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  1. Older Adult Intensive Program Full Service Partnership Bernice Zaborski, MHA Presented at the Integrated Services Conference April 5, 2006

  2. Objectives • To understand fundamentals of an Older Adult Full Service Partnership • Review of Sacramento County MHSA process and determination of older adult needs • Identify the basic program design of an Older Adult Intensive Program • Identify the core components of an Older Adult Intensive Program • Discuss older adult system of care and relationship to full service partnership program

  3. Sacramento County MHSA Structure • Mental Health Kick-Off May 2, 2005 • Participants included consumers, family members, mental health providers, advocates, senior service providers • Stakeholder Groups • Frail, Homebound, Isolated Elderly • Older Adult Medical and Mental Health Co-Occurring

  4. Successful Stakeholder Groups and System Change • Welcome and manage multiple points of view • Self-interests are minimized; system needs are maximized • Broad and diverse representation • Defined period of time • Facilitated by an objective party

  5. MHSA Planning Process: Key Components • Community Needs Assessment • Training & Stakeholder Input • Task Forces • Steering Committee • Community Services & Support (CSS) Plan • 6 Proposals including the Older Adult Intensive Service Program

  6. Transition Age Adults • Persons age 55-59 • There is increased risk for health related issues • Clients in the 55 to 59 age group are the highest users of Crisis and In-Patient Unit service

  7. Barriers to Older Adults Seeking Mental Health Services • Stigma/myths regarding lack of benefit • Cultural and linguistic barriers • Isolation/transportation issues • Lack of accessibility, availability and usability of services • Lack of geriatric trained staff • Inadequate assessment of mental and physical problems • Physical illness and disabilities

  8. Prevalence of Psychiatric Disorders in Older Adults • According to the Surgeon General: • 20% of persons age 55+ will experience a mental disorder in a 1-year period • 37% in primary care settings suffer depressive symptoms • Clinically significant depression is 25% higher among those with chronic illness • Highest suicide rate relative to other age groups, the consequence of untreated depression

  9. Sacramento County Older Adult Profile • Fiscal Year 2004-2005 • 1,778 Clients • Less than 5% of Sacramento County Mental Health System • Age range 55-104 • Average age is 68.1 years • Underserved/Unserved • Males (69.4% of outpatient clients are female) • Transitional Age Adults • Age 55-59

  10. Ethnicity ComparisonFY 2004-2005 • Caucasian 60% • Asian 11.6% • African-American 11.9% • Spanish/Hispanic 8.0% • Other 8.6%

  11. Older Adult Intensive ProgramEligibility Criteria • Age 60 and over (5% transitional age 55-59) • Must transfer from Regional Support Team • Have complex, co-occurring mental health, physical health, substance abuse, and social service needs • Require intensive case management to coordinate range of services • At risk for emergency room utilization, hospitalization, nursing home care, institutionalization, eviction/homelessness

  12. Older Adult Intensive Program Overview • Program Design Features • Capacity to serve 100 clients from Regional Support Team • 1/15 staff/client ratio • Home-based services • Regular hours with 24/7 on-call service • Culturally and linguistically appropriate

  13. Special Considerations for Older Adults • Increasing cultural and linguistic isolation • Substance abuse and misuse • Sensory loss • Homelessness/displacement • Economic hardship

  14. Special Considerations for Older Adultscontinued… • Cognitive impairments • Physical and biochemical impairments/ co-morbidity • Poor nutrition/dental health issues • Medication issues • Loss of interpersonal, social and family supports

  15. Service Components • Multidisciplinary Assessment Services • Comprehensive culturally competent bio-psycho-social evaluation • Assess mental health, medical, substance abuse and social service needs • Linkage with a primary care physician and other healthcare services

  16. Service Componentscontinued… • Treatment Services • Individual, Group and Family Counseling • Medical and Medication Services • Psycho-Educational Services • Peer Counseling • Linkage with Social, Family and Community Supports

  17. Service Components continued… • Intensive Case Management Services • Clients will be assigned to a personal service coordinator • Work collaboratively to develop individualized service and support plan • Referral to multidisciplinary team members or community service providers

  18. Program Personnel • Multidisciplinary Team Members • Mental Health Program Coordinator (1 FTE) • Clinical and administrative supervision • Mental Health Counselors (7 FTE) • Mental Health Services • Psychiatric Nurse (1 FTE) • Medication management/coordinate with physical healthcare • Psychiatrist (1 FTE) • Medication services (contracted)

  19. Program Personnel continued… • Nurse Practitioner (1 FTE) • Physical healthcare/medication management • Family/Consumer Advocate (.40 FTE) • Education, training, patients rights (contracted) • Senior Peer Counselors (4 FTE) • Volunteers with $85/mo. Stipends/$40 bus passes • Cultural/Linguistic Consultant (.20 FTE) • Cultural/linguistic services (contracted) • Total FTEs = 16.60

  20. Staff Training • Wellness and Recovery Philosophy • Cultural Competency • Language, Race, Ethnicity, Customs, Family Structure, Sexual Orientation and Community Dynamics • Co-Occurring Disorders • Drug/Alcohol • Co-Morbidities • Dementia, Delirium, Depression • Disease prevention/management

  21. Promising and Evidence-Based Practices • Multidisciplinary Assessment and Treatment • Case Management • Mobile Services/Home Visitation • Collaborative Service Planning with Community Providers • Peer Counselors

  22. Quality of Life Clients Strengths/Empowerment Self Help Cultural & Linguistic Competence Assessment & Treatment Protocols Access to Community-Based Services Preventing Inappropriate Hospitalization Preventing Suicide Multidisciplinary Service Coordination Medical/Psychiatric Interface Family & Community Involvement Support Services for Caregivers Education and Prevention Multiple Funding Sources Older Adult System of Care Values

  23. Resources Websites • For a complete copy of Sacramento County MHSA Community Services and Support Plan visit www.sacdhhs.com • For the Older Adult System of Care Framework and Transitional Age Adult Workgroup information visit CMHDAs website at www.cmhda.org • For the California Mental Health Master Plan (Chapter 6 – The Planned System of Care for Older Adults visit www.dmh.ca.gov/mhpc/reports

  24. Thank You • Questions and Answers

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