Continuity of Care / SPOE October 24, 2006

Continuity of Care / SPOEOctober 24, 2006

Arthur Ashe • What is the secret to becoming a Great Tennis Player ? • Start where you are. • Use what you have. • Do what you can.

CMHC ER Case Management Acute Unit Respite Housing Mobile Assessment Employment Assistance Financial Assistance Drop In Center Home / Community Based Treatment Assertive Community Treatment Educational Services

Earlier comments • Common Purpose • Give and Take • Bending and Adpating • More Coordination • We are all share responsibility for persons with Psychiatric issues in ER’s despite structural / organizational barriers • Improve the hand off

OMH Continuity of Care Policy • http://www.laomh.org/ContinuityofCare/index.htm

Continuity of Care • Informational Continuity – Information is the common thread linking care from one provider to another and from one healthcare event to another. Information can be disease focused or person focused. Documented information tends to be on the medical condition, but knowledge about the patient’s preferences, values, and context is equally important for bridging separate care events and ensuring that services are responsive to needs. • Management Continuity – is especially important in chronic or complex clinical diseases that require management from several providers who could potentially work at cross purposes. Continuity is achieved when services are delivered in a complementary and timely manner. Shared management plans or care protocols facilitate management continuity, providing a sense of predictability and security in future care for both consumers and providers. In mental health care, continuity of contact (expressed as access) embodies the notion that regular contact is needed to ensure management goals are adapted and met and that providers must often facilitate access to a broad range of services. Flexibility in adapting care to changes in an individual’s needs and circumstances is an important aspect of management continuity. When care is long term, both consistency and flexibility are critical for management continuity.

Continuity of Care • Relational Continuity – bridges not only past to current care but also provides a link to future care. This is most valued in primary and mental health care. Even in contexts where there is little expectation of establishing ongoing relationships with multiple care givers, a consistent core of staff provides patients with a sense of predictability and coherence. • Continuity of Care is achieved by bridging discrete elements in the care pathway – whether different episodes, interventions by different providers, or changes in illness status – as well as by supporting aspects that endure intrinsically over time, such as consumer’s values, sustained relationships, and care plans. Processes designed to improve continuity do not themselves equate to continuity. For continuity to exist, care must be experienced as connected and coherent. For consumers and their families, the experience of continuity is the perception that providers know what has happened before, that different providers agree on a management plan, and that a provider who knows them will care for them in the future.

The significant role of SPOE is the management and integration of inpatient services within the array of community service alternatives. As such, it provides a geographic and administrative focus for service determination and appropriate utilization of resources. • The SPOE is in the community, accessible 24 hours a day and seven days a week. Its role is to provide for prompt review of screenings, evaluations and assessments provided by multiple referral sources including private providers, Community Mental Health Centers and public agencies. • The SPOE Coordinator will screen and provide referrals for admission to the OMH Distinct Part Psychiatric Beds and the OMH free-standing inpatient facilities.

SPOE Coordinators • Single Point of Entry • Reg. 3 Pam Marcel • Reg. 4 Adofo Harmon • Reg. 5 Jenny Mills / Jaquita Jordan • Reg. 6 Bart Liles • Reg. 7 Amy Creel • Reg. 8 Suzanne Hatcher • MHSD Tom Elliott • CAHSD Janet Roy • FPHSA Sherry Sigler • JPHSA Julie Burke

19% CMHC / SPOE ER Case Management Acute Unit Respite Housing Mobile Assessment Employment Assistance Financial Assistance Drop In Center Home / Community Based Treatment Assertive Community Treatment Educational Services

19% CMHC / SPOE ER Case Management Acute Unit Respite Housing Mobile Assessment Employment Assistance Financial Assistance Drop In Center Home / Community Based Treatment Assertive Community Treatment Educational Services 16% Private Facility

19% CMHC / SPOE ER Case Management Acute Unit Respite 11% Housing Mobile Assessment Employment Assistance Financial Assistance Drop In Center Home / Community Based Treatment Assertive Community Treatment Educational Services 16% Private Facility

19% CMHC / SPOE ER Case Management Acute Unit Respite 11% 11% Housing Mobile Assessment Intermediate Care Hospital Employment Assistance Financial Assistance Drop In Center Home / Community Based Treatment Assertive Community Treatment Educational Services 16% Private Facility

SPOE (*based on 2005 survey) • 19% CMHC to Acute Unit • 16% Private Facility to Acute Unit • 11% CMHC to Private Facility • 11% Private Facility to Intermediate Hospital • 9% Private referral to CMHC • 9% Hospital to CMHC • 7% CMHC to Intermediate Hospital • 18% Other

SPOE • HANDOUTS • What you need to provide to the SPOE when calling with a referral ? • What can you expect the SPOE to do ? • What will the SPOE do if no beds are available within the OMH system ? • Who to call if there are problems or concerns ?

SPOE • Problem solving process • Many SPOE issues can best be resolved at the local level • Handouts indicate who to call if there are issues to be worked out if working with the SPOE has not proven successful • Problem resolution should follow a progressive process moving up the chain of authority only as attempts at the local, regional, levels are unsuccessful in order to ensure that there is local ownership or responsibility, continuity of information, communication of concerns, efficient use of limited resources, timely local solutions and empowerment of local decision makers.

Earlier SPOE Comments / Questions • Cross regional coordination • Common standards across regions • Individuals referred to ER at 4:30 pm • Issues with Private Hospitals – relationships, communication, procedures / protocols.

To Be Continued... Continuous engagement in treatment and recovery services is one of the most important aspects of addressing acute episodes of severe behavioral health problems and the ongoing disabilities associated with them. Processes designed to improve continuity do not themselves equate to continuity. For consumers and their families, the experience of continuity is the perception that providers know what has happened before, that different providers agree on a management plan, and that a provider who knows them will care for them in the future. Please work with and through your SPOE and Administrative structure to resolve issues locally when at all possible.

Continuity of Care / SPOE October 24, 2006