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Statewide Quarterly RTC Meeting September 14, 2010

Analyze utilization, demand, capacity data by diagnostic tier in the in-state RTC system. Explore admissions demographics, unique youth trends, diagnosis breakdowns, average length of stay, and state vs. out-of-state admissions. Gain insights into RTC performance and initiatives.

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Statewide Quarterly RTC Meeting September 14, 2010

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  1. Statewide Quarterly RTC MeetingSeptember 14, 2010

  2. Agenda • Utilization Data Review • AWOL/Arrest/Seclusion and Restraint Reduction Data – Risk Management • RTC Performance Initiative

  3. RTC Utilization Analysis Quarterly SummaryQ2 ‘10

  4. Utilization, Demand & Capacity, by Diagnostic Tier

  5. In-State RTC System Overview Beds primarily used by DCF in Connecticut

  6. Five diagnostic tiers/categories are tiered in the following order: Fire Starters &/or Sex Offending MR/PDD Conduct Dx / Explosive / Disruptive / JJ Substance Abuse Psychiatric “Youth in RTC”:The # of youth occupying a bed. In-State Maximum Capacity: Determined by using the maximum # of licensed In-State beds/per quarter available to, and generally used by, DCF (capacity does not include High Meadows or CCP). Capacities are titrated using weighted averages if program partially open during quarter. In-State Average Available Capacity:The average # of available In-State empty bed(s) per quarter per the provider’s weekly census. Utilization, Demand & Capacityby Diagnostic Tier Example: Youth w/MR/PDD and Psych diagnoses will appear in MR/PDD data, as MR/PDD is tiered higher than Psych. Note: The provider’s weekly census may reflect an “available capacity” greater than that which will be used by DCF.

  7. Residential Admissions

  8. Demographics by Tier for Q2 ‘10 Grand Total Admits = 143

  9. Comparison of Admissions In-State & Out of State, By Tier Grand Total Admits = 143

  10. Comparison of Admissions By Age, By Tier Grand Total Admits = 143

  11. Comparison of Admissions By Gender, By Tier Grand Total Admits = 143

  12. RTC Admissions & Discharges YTD 2010 Admits= 280 YTD 2010 Discharges= 324 Discharge count includes d/c’s from Shelter for Women-Gray Lodge

  13. Tier Data

  14. Unique Youth in RTC Q2 ’08, CY 2009 & & Q1& 2 ‘10 • Below is trend line for the number of unique youth in RTC level of care, per Quarter, and by Diagnostic tier. Q2 ’08 is shown for comparison purposes. • Psychiatric and Conduct Disorder / Explosive /JJ tiers continue to remain higher than other tiers. “Unique” = youth counted only once during Quarter even if admitted to RTC x2 or more during same Quarter

  15. Fire Starters / Sex Offending • Unique members in care count is consistent with previous two quarters. • Admission count is low in Q2 ’10 compared with other quarters

  16. MR / PDD • Q2 ’10 Youth in care count is consistent with the previous quarter. • Number of admissions is low in Q2 ’10 but consistent with Q2 counts of previous reporting years. Final beds closure at High Meadow in Feb 2010

  17. Break-out of MR & PDD Diagnosis • 75% to 78% of the total MR/PDD population had an MR diagnosis for each time segment below

  18. Conduct Disorder / JJ • Decrease in youth in care continues for Conduct/JJ tier in Q2 ’10. • Admission count in Q2 ’10 is higher than previous two quarters, however, remains lower than historical numbers.

  19. Substance Abuse • Number of youth in care has returned to historical numbers. • Admissions are down by 41% from Q1 ’10.

  20. Psychiatric • Decrease in average available capacity- Primarily due to decrease of 30 beds assigned to this quarter. • Increase is OOS Admissions- 39% of all admits in Psychiatric tier are to OOS providers.

  21. Youth 0-12

  22. Youth in RTC – 0-12 yrs old • Linear regression line shows a continued decrease since Q3 ’08 to Q2 ’09, with a continued leveling off up to Q2 ’10 for youth 0-12 years old in RTC

  23. Admissions 0 -12 yrs old • Majority of youth in this age range admitted In-State and OOS are 11 & 12 years old • 6.3% of all RTC admissions in Q2 ‘10 are age range 0-12 yrs old

  24. RTC Average Length of Stay by age at admission for YTD 2010 • 40% longer ALOS for 0-12 yr old youth compared to 13-18 yr old youth in Q2 ’10. (CY2008: ALOS for 0-12 yr old youth was 29% longer, CY2009 ALOS was 31% longer) Based on total discharges (313) in YTD 2010. D/C count here excludes discharges from Shelter for Women

  25. RTC Admissions In-State and OOS

  26. Admissions Only – In-State & OOS • Need remains consistent for In-State RTCs to treat currently referred OOS youth, as the trend for OOS admits has remained fairly constant, while In-State admits have decreased overall Q2 ‘10: In-State = 91 admits / 64% OOS = 52 admits / 36% Total = 143 In-State + OOS admits Source: Tier Data

  27. Residential Average Length of Stay Data

  28. RTC In-State ALOS • During Q2 ’10, in-state average length of stay increased nine days or 3% from Q1 ’10. There is minimal change in ALOS when comparing YTD 2010 and CY 2009 (1% decrease). • 2010 ALOS goal is 250 days All diagnostic populations included in ALOS. ALOS based on actual discharges. Shelter for Women has been removed from 2010 data, and Q1 data refreshed. YTD 2010 ALOS value with Shelter for Women included is 282 days.

  29. RTC Out-of-State ALOS • Q2 ’10 ALOS decreased over 100 days (22%) from Q1 ’10 • During Q2 ’10 OOS RTC Acute ALOS decreased 40 days making it the shortest Acute ALOS reported (Q1 ’09 forward) All diagnostic populations included in ALOS ALOS based on actual discharges

  30. In-State and OOS ALOS Frequency Distribution YTD 2010 D/C = 313 Shelter for Women d/c’s removed

  31. In-State RTC Average Length of Stay by Facility Type

  32. In-State RTC ALOS • RTCs are grouped according to the Primary Diagnostic population served by each In-State RTC • The groupings are an approximation (each facility type may treat youth classified in a different group at any given time) • ALOS calculations are based on discharges that occurred during the Quarter • A discharge occurring with an unusually long length of stay may significantly impact the ALOS during a quarter • For CY 2010 data, Shelter for Women-Gray Lodge Data has been removed

  33. Primarily Psychiatric Population Note: ALOS based on actual discharges

  34. Primarily Substance Abuse / Dual Diagnosis Population Note: ALOS based on actual discharges

  35. Primarily JJ Population - Boys Note: ALOS based on actual discharges

  36. Primarily JJ Population - Girls Note: ALOS based on actual discharges

  37. Special Populations Special Populations are for deaf and hearing impaired, MR and PDD Note: ALOS based on actual discharges; 0 ALOS due to no discharges during Quarter

  38. RTC ALOS by Gender • 12% higher ALOS for males compared to females in Q2 ’10; during CY 2009, male ALOS was 40% longer than female ALOS. N’s for male : Q1 ‘09=78, Q2 ‘09=123, Q3 ‘09=109, Q4 ‘09=70, Q1 ’10=89, Q2 ’10=102 N’s for females: Q1 ‘09=75, Q2 ‘09=100, Q3 ‘09=84, Q4 ‘09=59, Q1 ’10=59, Q2 ’10=63

  39. At-a-Glance: ALOS by Dx Tier for YTD 2010 • Consistent with data presented in past RTC analysis, Fire Starter / Sex Offending youth remains the highest length of stay, with the Substance Abuse category remaining the lowest YTD 2010 D/C = 313 Shelter for Women d/c’s removed

  40. In-State and OOS Median Length of Stay • Median LOS for YTD 2010 for all cohorts & in-state and OOS combined : 298 days • Median LOS for: • Fire Starter / Sexually Offending youth: 454 days • MR / PDD youth: 301 days • Conduct Dx / JJ youth: 275 days • Substance Abusing youth: 205 days • Psychiatrically involved youth: 322 days Source: Tier Reports

  41. Discharge Delay

  42. Discharge Delay in In-State RTC’s • 9% decrease in average length of delay from CY 2009 to YTD 2010 • Decrease in percent of cases in delay status during quarter (10B7 report) and cases discharged with delay days (8 in Q2 ’10- lowest # since reporting began Q1 ’08) • Awaiting placement remains the most common reason for delay in RTC, with the majority of members awaiting Group Home placements.

  43. AWOL/Arrest/Seclusion and Restraint Reduction Data Risk Management

  44. Q2 and YTD 2010 Annual Risk Management DataAWOLs, Police calls/EMS, Arrests, Restraints, Suicide Attempts • Calls to Police/Emergency Services do not include routine calls to police to report AWOLs. (Most agencies contact police to report AWOLS) • Each RTC represents 3 months of data, 6 months in the YTD ’10 slide • Risk Management data are primarily obtained through providers' self-reporting • Like providers are shaded similarly in the following slides • CCP is reported, but not part of statewide totals • Shelter for Women has been removed from calculations/reporting Note: the “per bed” calculations on the following slides were based on beds primarily utilized by DCF (337 total beds). The 337 count differs from the 331 count on slide 5 because all JRI beds (DCF and DDS) are included in the 337 count.

  45. RTC Risk Management Data- Q2 ‘10 Numbers are not unduplicated, i.e. more than one event may be attached to 1 youth

  46. RTC Risk Management Data- YTD ‘10 Numbers are not unduplicated, i.e. more than one event may be attached to 1 youth

  47. Number of AWOL’s per Bed – Q2 ‘10

  48. Number of Police/EMS calls per bed- Q2 ‘10

  49. Number of Arrests per bed- Q2 ‘10

  50. Number of Restraints per Bed – Q2 ‘10

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