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Mental Health System Transformation Initiative Implementation PACT and Beyond

Mental Health System Transformation Initiative Implementation PACT and Beyond. Washington State Department of Social & Health Services. 2SSB 6793 and Budget Initiatives. Andrew Toulon Mental Health Division Health & Recovery Services Administration

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Mental Health System Transformation Initiative Implementation PACT and Beyond

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  1. Mental Health System Transformation Initiative Implementation PACT and Beyond Washington State Department of Social & Health Services 2SSB 6793 and Budget Initiatives Andrew Toulon Mental Health Division Health & Recovery Services Administration Department of Social & Health Services Phone: (360) 902-0818 Email: touloan@dshs.wa.gov

  2. Presentation Overview • Part 1: Background • Part 2: Key Provisions of 2SSB 6793 & Budget Initiatives • Part 3: Psychiatric Inpatient Capacity Changes • Part 4: Development of New Community Resources • Part 5: Long Term Planning Activities • Part 6: STI Task Force Washington State Department of Social & Health Services

  3. Part 1: Background • Challenges Facing the 2006 Legislature • Decreasing community psychiatric inpatient capacity • State hospital waiting lists • Court rulings in September 2005 • No wait for transfer of 90/180 ITA patients • Failure to follow proper procedures for assessing “liquidated damages” Washington State Department of Social & Health Services

  4. Part 1: Background (cont’d) Legislative Approach • Clarified roles of State & RSNs related to community and state hospital care • Time limited investment in State Hospital capacity to deal with inpatient access issues • Investment in enhanced community resources to reduce reliance on state hospitals • Long term planning Washington State Department of Social & Health Services

  5. Part 2: Key Provisions of 2SSB 6793 & Budget Initiatives Responsibility for 90/180 Commitments • Increased state hospital beds to meet court ruling • Requires state hospital bed allocation to RSN • State is financially responsible up to funded capacity • Directs RSNs pay for exceeding allocated bed days • Re-directs portion of funds collected by RSNs to other RSNs using less beds than allocated Washington State Department of Social & Health Services

  6. Part 2: Key Provisions (cont’d) Community Based Care • Re-states Leg. intent for services to be provided in the community • Requires RSN to ensure discharge of state hospital patients who no longer require inpatient care • Raises RSN requirement to manage short term detentions locally from 85-90% • By January 2008, requires RSNs to pay for individuals at PALS Washington State Department of Social & Health Services

  7. Part 3: Inpatient Capacity Psychiatric Inpatient Bed Reductions • 180 State Hospital Beds closed 01-03 (ECS) • Community Hospital Beds ↓ by 14% - Between 2000 and 2005 • Involuntary Treatment Beds ↓ by 10% Between 2000 and 2005 • Additional Closures Continue the Downward Trend • 48 Pierce County Beds Closed in January 2006 • 6 Beds Closed at Fairfax in 2006 Source of Community Bed Data: Washington State Hospital Association Washington State Department of Social & Health Services

  8. 30 30 Part 3: Inpatient Changes (cont’d) State Hospital Increases 2005-2006 30 30 30 30 Forensic 30 Bed Temporary Pierce Contract WSH 12 Forensic ESH 2005 2006 Washington State Department of Social & Health Services

  9. Part 3: Inpatient Capacity (cont’d) State Hospital Census Trends Sept 2006 WSH census is 11% Increase over FY04 Washington State Department of Social & Health Services

  10. Part 3: Inpatient Capacity (cont’d) Community Inpatient ITA Bed Increases • 61 E&T Beds Will be Opened Between 2005 and 2006 • Thurston County- 15 Beds Opened in April 2005 • Pierce County- 30 Beds Opened in May 2006 • Clark County- 16 Beds Scheduled to Open in September 2006 (also used for Acute Detox) • 32 Secure Detox Beds Opened in 2006 • Pierce County- 16 Beds Opened in March 2006 • Skagit County- 16 Beds Opened in April 2006 Washington State Department of Social & Health Services

  11. Part 1- 3 Questions • Part 1: Background? • Part 2: Key Provisions of 2SSB 6793? • Part 3: Psychiatric Inpatient Capacity? Washington State Department of Social & Health Services

  12. Part 4: Community Resources Program of Assertive Community Treatment (PACT) Teams • An evidenced based mental health service delivery model • $2.2 million for PACT development/training in FY 07 • $10.4 Million Per Year to Implement PACT Teams Statewide • Gradual reduction of recently added state hospital beds Washington State Department of Social & Health Services

  13. Part 4: Community Resources (Cont’d) PACT is for individuals who…? • Have the most severe & persistent symptoms of mental illness (e.g. schizophrenia, schizoaffective, bipolar) • Have high use of psych. hospitalization & crisis services • Have difficulty meeting basic needs (ADLs, housing, medical, nutrition, budget, employment) • Have difficulty benefiting from traditional services • May have co-occurring disorders • May have high risk or history of arrest and incarceration Washington State Department of Social & Health Services

  14. Part 4: Community Resources (cont’d) How is PACT different from other service models? • Multi-disciplinary Team Approach • Team provides most services rather than referring- team members are cross trained • Staff share responsibilities for addressing the needs of consumers • Low caseloads allow for individualized care and frequent contacts (1-10 staffing ratio) • Services available 24/7 & directed to consumer needs • Outreach- 75%+ services delivered outside of the office • Ongoing services to support recovery Washington State Department of Social & Health Services

  15. Part 4: Community Resources (cont’d) PACT Recommended Clinical Staffing per National Standards Note: 1 or more members expected to have training and experience in vocational and substance abuse services Source: National Program Standards for ACT Teams; Deborah Allness M.S.S.W & William Knoedler, M.D.; June 2003 Washington State Department of Social & Health Services

  16. Part 4: Community Resources (cont’d) What Types of Services Are Provided by PACT Teams? Washington State Department of Social & Health Services

  17. Part 4: Community Resources (cont’d) ◆= Full Team ▲= Half Team 13 Regional Support Networks (RSNs) Effective 9/2006 Okanogan Ferry Stevens Whatcom Pend Oreille San Juan North Central Skagit North Sound ◆ Chelan Clallam Island Spokane Peninsula ▲ Douglas Snohomish Chelan-Douglas ▲ Jefferson Lincoln Spokane ◆ Grant King ◆◆ Kitsap Mason Grays Harbor Grays Harbor King Adams Kittitas Whitman Thurston Mason ▲ Pierce ◆ Thurston Pierce Yakima Franklin Timberlands Garfield Benton Walla Walla Pacific Lewis Columbia Asotin Southwest Greater Columbia ◆ Wahkiakum Cowlitz Klickitat Clark ▲ Skamania Washington State Department of Social & Health Services Clark

  18. Part 4: Community Resources (cont’d) PACT Implementation Timeline Train West Teams Monitor and Evaluate Outcomes & Fidelity Recruit West Teams West Teams Operational Develop Training Curriculum Train East Teams Development Activities Recruit East Teams East Teams Operational Washington State Department of Social & Health Services

  19. Part 4: Community Resources (cont’d) PACT Outcomes Being Considered for Review • Consumer Satisfaction • State Hospital Utilization • Community Inpatient Utilization • Crisis Service Utilization • ER Utilization • Housing • Employment • Arrests and Incarcerations Washington State Department of Social & Health Services

  20. Part 4: Community Resources (cont’d) PACT Keys to Success • 90 percent+ fidelity (external fidelity reviews) • Treatment plans are client centered • Services are recovery oriented • Non-coercive and non-paternalistic • Incorporate EBPs and promising practices into individualized service planning • Cultural competency Washington State Department of Social & Health Services

  21. Part 4: Community Resources (cont’d) PACT Resources • National Program Standards for ACT Teams (Allness & Knoedler)- handout • Dartmouth Assertive Community Treatment Fidelity Scale (Teague, Bond & Drake)- handout • PACT Toolkit- www.samhsa.gov • “PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illness: A Manual for PACT Start–up” by D. Allness & W. Knoedler: www.nami.org • Washington Institute for Mental Illness Research and Training (WIMIRT): • Maria Monroe-DeVita (206) 384-7372 or mmdv@u.washington.edu Washington State Department of Social & Health Services

  22. Part 4: Community Resources (cont’d) PACT Comments & Concerns • What issues do you think the state should consider in implementing PACT teams? • PACT Questions? Washington State Department of Social & Health Services

  23. Part 4: Community Resources (cont’d) Expanded Community Services • Additional funding for other services which reduce dependence on state hospitals • $650,000 for development in FY 07 • $6.5 million per year for ongoing operating costs • Process for allocating and selecting services still being determined Washington State Department of Social & Health Services

  24. Part 4: Community Resources (cont’d) Expanded Community Services • In addition to PACT, what types of services are most needed in your community to support recovery and reduce dependence on state hospitals • ECS Questions? Washington State Department of Social & Health Services

  25. Part 4: Community Resources (cont’d) Children’s Mental Health EBP Pilot Program • $450,000 for FY ’07 • RFP open to counties / groups of counties & or Indian Nations released August 2006 • Expert panel convened to rank EBPs, report available • Community planning process and EBP selection by Dec. 2006 • WSIPP separately funded to conduct evaluation Washington State Department of Social & Health Services

  26. Part 5: Long Term Planning Overview of Long Term Planning • $600,000 for consultants and planning activities • Four areas of focus • Mental Health Benefits Package • Involuntary Treatment Act Study • External Utilization Review • State Mental Health Housing Plan Washington State Department of Social & Health Services

  27. Part 5: MH Benefits Package MH Services Included in Current Medicaid Benefits Package Washington State Department of Social & Health Services

  28. Part 5: MH Benefits Package (cont’d) Scope of Planning Activities • Review current menu of required clinical services and supports • Identify EBPs & Promising Practices for inclusion • Consider cultural relevance issues • Develop rate methodology • Prioritize new benefits menu within allocated resources Washington State Department of Social & Health Services

  29. Part 5: MH Benefits Package (cont’d) Expected Benefits • Recovery oriented benefits design • Transparent rate structure • Prioritize EBPs & Promising Practices / culturally relevant • More efficient use of service dollars Washington State Department of Social & Health Services

  30. Part 5: ITA Study Mental Health ITA Statutes Included • RCW 71.05 (Adults) • RCW 71.34 (Children) • RCW 70.96B (Integrated Crisis Response Pilots) Excluded from scope of review • RCW 10.77 (Forensic) • RCW 70.96A (CD ITA) • Sexual Offender Commitment Statutes Washington State Department of Social & Health Services

  31. Part 5: ITA Study (cont’d) Scope of Planning Activities • Review and comparison of Washington MH commitment laws with other states • Objective review of hot button issues (e.g. Grave Disability, Age of Consent) • Develop Options for Reform Washington State Department of Social & Health Services

  32. Part 5: ITA Study (cont’d) Expected Benefits • Improve balance of civil liberty and public safety • Improve consistency across the state • Ensure best use of inpatient and community based care to support recovery • Identify best use of State Hospitals Washington State Department of Social & Health Services

  33. Part 5: External Utilization Review What is Utilization Review? • Process of assessing delivery of services to determine if care provided is • Appropriate • Medically necessary • High quality • Includes review of appropriateness of • Admissions • Services ordered and provided • Length of stay • Discharge practices • Concurrent and retrospective basis. Washington State Department of Social & Health Services

  34. Part 5: External UR (cont’d) Current External UR for Psychiatric Inpatient Services • RSNs required by contract to do UR for community inpatient days • No external UR for State Hospital days (State Hospitals conduct their own UR process) Washington State Department of Social & Health Services

  35. Part 5: External UR (cont’d) Scope of Planning Activities • Establish acuity levels to be supported in community settings • Develop sampling methodologies & processes for independent review of 90 and 180 day commitments • Include State and community inpatient settings • Identify resources required for statewide implementation • Draft RFP for External UR services Washington State Department of Social & Health Services

  36. Part 5: External UR (cont’d) Expected Benefits • Prevent over and under utilization of inpatient care • Increase RSN & provider accountability • Improve consistency for consumers throughout the state • Identify state and local community resource gaps Washington State Department of Social & Health Services

  37. Part 5: State MH Housing Plan Scope of Planning Activities • Review RSN housing collaboration plans • Identify best practices and areas of need • Develop guidelines for future RSN contracts • Technical assistance Washington State Department of Social & Health Services

  38. Part 5: State MH Housing Plan (cont’d) Expected Benefits • Improve collaboration with existing planning groups • Prioritize independent housing which supports recovery • Increase access to available housing stock by leveraging PACT & ECS services • Action plan for further housing development Washington State Department of Social & Health Services

  39. Part 5: Long Term Planning (cont’d) Implementation Timeline Evaluate RFPs & Contract for Services Final Consultant Reports Options For Policy Makers RFPs for Consultant Initial Consultant Draft Reports Washington State Department of Social & Health Services

  40. Part 5: Long Term Planning (cont’d) Questions • Mental Health Benefits Package? • Involuntary Treatment Act Study? • External Utilization Review? • State Mental Health Housing Plan? Washington State Department of Social & Health Services

  41. Part 6: STI Task Force Process • Standing Representative Task Force • 35-40 members from variety of interested parties • Monthly meetings beginning in Oct 06 • Consumer, family, and advocate representatives • Public Forums • 2-3 large forums (approx 150 people) over the next 9 months • 1st forum scheduled for November 15, 2006 • Stipends for up to 40 consumers, family, and advocate representatives Washington State Department of Social & Health Services

  42. Part 6: STI Task Force Goals • Share information regarding STI implementation • Gather input & shape implementation activities • Provide ongoing input on consultant reports Washington State Department of Social & Health Services

  43. Part 6: STI Task Force Values • Participatory Process • Recovery Oriented • Evidence Based & Promising Practices/ Cultural Relevance • Consumer Preferences • Build on Strengths • Work within Existing Resources • Local Governance • Strive For Consensus • Address Needs of All Ages Washington State Department of Social & Health Services

  44. Part 6: STI Task Force Contact Information for STI Public Forums: Gaye Jensen Phone: (360) 902-7789 e-mail jensegf@dshs.wa.gov Contact Information for STI Implementation: Andy Toulon Phone: (360) 902-0818 e-mail: touloan@dshs.wa.gov Washington State Department of Social & Health Services

  45. Questions? Washington State Department of Social & Health Services

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