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Lafayette County aims to increase the percentage of emergency detentions leading to probable cause from 73% to 80%. The project includes data collection, staff engagement, reducing expenditures, and improving crisis services. The impact includes financial savings and enhanced safety measures.
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Lafayette CountyHuman Services DepartmentDarlington, WI 2012 NIATx Project April 1, 2012 to September 30, 2012
AIM • From 2000-2010, a review of our Emergency Mental Health Services or “Crisis” services indicated a baseline measure of an average of 41% of our emergency detention (ED) placements led to probable cause. That is, “probable cause" means that the individual is believed to be mentally ill or drug dependent or developmentally disabled and a danger to self and/or danger to others and/or unable to care for themselves. Risk must be imminent. So, less than half the time, we did not possess sufficiently trustworthy facts that led to probable cause. • Our AIM is to implement change that promotes effective transitions and increases continuation to the most appropriate level of care. • In 2010, we improved to 73% of ED placements that led to probable cause. • Lafayette County would like to improve to 80% of ED placements that lead to probable cause. • How will you COLLECT DATA to measure the impact of change? • We gathered the number of eligible emergency detentions, the number of diversions, reviewed organizational structure and capacity, and reviewed individual cases for antecdotal information. • What is the expected FINANCIAL IMPACT of this change project? How will the Executive Sponsor know? • To improve quality of services (e.g., make better decisions, provide community based services, etc.) • Staff are engaged around the urgency of placements, that is, the importance of connecting with clients and stakeholders. • To reduce the amount of expenditures on high end placements.
CHANGES - PDSA • Plan: In 2011 we began reviewing and planning around improvements to our Emergency Mental Health Services (“Crisis”). • Do: A crisis coordinator responsibilities were defined and the role implemented. • Trained or updated staff around emergency mental health or “crisis” services and assessment. • We added additional support and quality by improving the telephone service in our crisis system. • We added a optional stabilization bed and made arrangements with other adult family homes to offer additional resources. • Study: The quality of the process and how decisions were being made about the emergency detentions and diversions. • Act: In most cycles, we have adopted or adapted the work
Emergency Detentions (E.D.’s) Percent of hospital placements that led to probable cause
Diversions Definition: 1. A law enforcement officer has identified that a person should go to a hospital behavioral health unit and after intervention by a crisis worker the person does not go to the hospital. 2. A person in crisis or a family member expresses that the person needs to go to a hospital behavioral health unit and after intervention by a crisis worker the person does not go to the hospital. 3. A person expresses suicidal intention and after intervention by a crisis worker the person does not go to the hospital. 4. A person presents with unstable behavior/emotions and crisis worker believes that the person would have gone to the hospital if they had not provided intervention.
Impact • In 2011, we realized over $100,000 dollars in savings. And, with more formalized approach, believe to save more in 2012 • We implemented additional safety measures and resources for citizens experiencing a mental health crisis.
