an innovative community collaboration to enhance the continuum
DESCRIPTION
Presented by:Cecile Tebo, LCSW, Program Administrator New Orleans Police Department Crisis Transportation Service and Lisa Romback, M.A., Program Director NAMI New Orleans (National Alliance on Mental Illness)TRANSCRIPT
An Innovative Community Collaboration to Enhance the
Continuum of Care
Presented by:
Cecile Tebo, LCSW, Program Administrator
New Orleans Police Department
Crisis Transportation Service
and
Lisa Romback, M.A., Program Director
NAMI New Orleans
(National Alliance on Mental Illness)
History of the NOPD CTS
NOPD: New Orleans Police Department
CTS: Crisis Transportation Service• CTS began in 1983 as a collaborative effort
between the Louisiana Office of Mental Health and the New Orleans Police Department.
• The director of the Suicide Hotline, Rick Wagner and Sgt. Ben Glaudi of the NOPD developed the curriculum and program of services that now exist.
• The idea for the program was to have a volunteer group trained in mental health crisis intervention to respond with NOPD officers to calls from the 911 system; in essence, responding as a Psych EMS for mental health calls.
• The current CIT curriculum used by many programs is very similar to the one that was created for this program, with the exception that the NOPD crisis unit utilizes civilian volunteers in lieu of officers.
Description of CTS:
• CTS is a mobile crisis unit utilizing trained civilian volunteers (crisis technicians) that are dispatched through the 911 system on calls for service that involve a person having a mental health crisis. These technicians respond along with commissioned officers.
• The training for this program is a 9 week (40 hours) of training that includes mental health diagnosis, crisis intervention, active listening, radio procedures, emergency driving, searching and restraint application, legal procedures, First Aid and CPR.
• Currently, this program is funded by Metropolitan Human Service District (the area human service authority).
Description Continued
• The current budget is $83,600.00. It is estimated that the use of volunteers saves the NOPD over $350,000 per year in man power hours.
• This is due to the fact that once the scene is secured by the police, the volunteers can take over and provide transport and admitting of consumers to the hospitals (usually a 1.5 hr. procedure per consumer).
CTS ContinuedCTS currently has 42 active volunteers that are required to work two 6-hour shifts per month. The hours and days of service are 7 days a week, Monday-Sunday, 8am – 12 midnight.
The volunteer uniform resembles medical personnel and no volunteers carry weapons.
CTS technicians attempt to resolve the crisis on the scene and can refer consumers to programs within the area. Technicians will transport and assist with triage in the emergency room if warranted. CTS also transports for Coroner’s Emergency Certificates (CEC’s) and Physician’s Emergency Certificates (PEC’s).
If CTS is not available, then the NOPD officer responding to the scene will handle the situation.
CIT training is available to NOPD officers with the hopes that if CTS is not available, a CIT officer will be dispatched to handle the call for service.
NOPD/CTS Stats• 1,498 Calls for service during fiscal year 08/09• 917 shifts• 5,853 hours in service Commitment type:• None 5.2%• OPC 18.2%• PEC 15.6%• Voluntary 61.1%
Stats Continued
• Shift goals for period: 730• Actual number of shifts: 917• Percent shift unit operating: 126.6%
• Hours goal for period: 4,380• Actual number of hours in service: 5,853• Percent hours unit operating: 133.6%• Estimated man hours unit saved NOPD: 4,494• Estimated dollars saved for NOPD: $359,5290
History of NAMI New Orleans
NAMI New Orleans began as a psychosocial program. The agency was incorporated as Friends of the Psychologically Handicapped in 1978. Its mission at that time (and still today) was to provide psychosocial supports for persons with mental illness and to be a family support and advocacy program for the community.
The program started as a volunteer run drop in center. The volunteers were family/board members. At that time, the program sought a model for the organization and ultimately decided to model the services after the Fountain House Clubhouse in New York.
Clubhouse Model• The origins of Fountain House lie in the idea
which inspired a small group of people back in the early 1940s – the belief that people with mental illness are capable of helping each other.
• Then in 1979, National NAMI (National Alliance on Mental Illness) began seeking out programs that could affiliate with the national branch. The board of directors for Friends of the Psychologically Handicapped agreed to be affiliated with NAMI National.
The organization changed its name in 1980 to Friends Alliance for the Mentally Ill.
Years later, all NAMI affiliates were asked to again change their names to NAMI plus your city or state.
Today, the program is called NAMI New Orleans. The psychosocial clubhouse model has been the core of service provision for persons with mental illness for more than 30 years now.
Services Provided for 500+ Consumers and Family Members per Month
• Medicaid Mental Health Rehabilitation• Community Based Case Management Services• Housing Assistance and Apartment Complexes• Psychosocial Clubhouse Services• Consumer-Run Drop-In Centers• Hospital Discharge Transitional Services• Representative Payee Services• Crisis Transportation Services• Supported Employment Services• Family Education Courses and Family Support Groups
Hurricane Katrina
In August 2005, Hurricane Katrina hit the New Orleans area causing tremendous devastation.
The mental health services community and mental health consumers were in a state of crisis.
The main public hospital, Charity Hospital, was closed. Other hospitals and mental health clinics were not functioning.
The few emergency rooms available were literally turning away mental health patients. Psychiatric emergencies and calls to 911 increased dramatically.
CTS responded to calls but had nowhere to take patients.
NAMI New Orleans re-opened within 2 weeks and shortly thereafter began collaborating with CTS and the human service authority to develop a solution for the ongoing mental health crisis in the city.
The police were spending countless man hours dealing with 911 psych emergencies. CTS would transport to hospitals and the patients would be dischargerde right away.
• Community mental health centers could not handle outpatient needs.• Consumers were getting
rehospitalized and incarcerated repeatedly. • This started the idea for the
collaboration.
The Collaboration Begins
NAMI New Orleans and CTS developed a proposal for the human service authority and requested funding for the Assertive Community Outreach Program (ACO).
The program was implemented in December of 2006. There is currently an interagency agreement between the NOPD Crisis Transportation Service and NAMI New Orleans.
When a consumer calls 911 and receives assistance from CTS, a referral is made to ACO for intensive case management services.
ACO
• ACO serves a minimum of 50 persons per month. Last fiscal year, 104 persons were served by the program.
• Eligible participants in the program are persons over the age of 18 with mental illness who recently required Crisis Transportation Services for a psychiatric disturbance in the community that required police intervention.
• This includes persons who require an Order of Protection or Physician’s Emergency Certificate.
• Approximately 40% of those served also have a substance abuse diagnosis. Presenting problems include medication non-compliance, family stressors, housing problems, drop-out from mental health services, decrease in level of ability to care for self, and increased symptoms leading to need for hospitalization.
Basic Demographics:• The majority of ACO consumers have a
diagnosis of schizophrenia, followed by schizoaffective disorder, followed by bipolar disorder.
• The age range served is 18 years and older. The majority of those in service (50+%) are 40-55 years old.
• Of those served, about 40% are male and 60% are female.
Co-Occurring Issues
• For 104 consumers served during fiscal year 2008-2009:
• 51% had a history of substance abuse.• 35% currently using - self report or family report
as follows: • 35% alcohol • 18% marijuana• 20% crack cocaine• 14% polysubstance use
Program Model• This program is unique to the New Orleans area
because it provides outreach to persons and their families that have recently had a mental health crisis situation, but may not have knowledge of behavioral health services and community resources available.
• Additionally, the program model allows for instant referral based on the CTS trip sheets, reducing the wait time and paperwork involved that accompanies more traditional case management programs.
Consumer Access and Services
• After the Crisis Transportation team provides the consumer information to the Intake Case Manager, outreach attempts are begun within 24 hours to locate the consumer and schedule an intake. When possible, the intake is completed within one week of locating the consumer.
• Following the intake, which includes a needs assessment, the consumer begins services with the assigned case manager. At the initial meeting with the case manager, a service plan is developed to define strategies and goals for the consumer’s recovery. The consumer can expect to be in contact with their assigned case manager once a week at a minimum, and more if necessary.
• The consumer receives assistance with attending mental health appointments, securing medication, and gaining access to other resources which are needed to improve quality of life and reduce the likelihood of crisis or further hospitalization.
• The consumer and case manager review the service plan at three months for progress, and new plans are developed at six months or as needed. When consumers have met all goals in their recovery and are able to independently take care of their mental health needs, a 60-90 day transition plan is completed, and then the case is successfully closed.
ACO Outcomes• For Fiscal Year 2008/2009, 104 consumers
received ACO services.• Total cost of the ACO Program was $264,000.• Average cost is $2,500 per consumer per year.• Of the 104 served, 35 required hospitalization
while receiving service (34%).• 66% remained out of the hospital during their
service period.
Program Outcomes• At least 80% of consumers will obtain and maintain
ongoing mental health services. Goal met. 92 % obtained or continued to receive mental health services.
• At least 60% of consumers will remain in the community and not require psychiatric hospitalization. Goal met. 66% of the clients have stayed out of the hospital since beginning the program.
• 80% of consumers will obtain and/or maintain stable housing. Goal met. 90% of the clients maintained stable housing.
Outcomes Continued
• At least 60% of consumers will participate in day treatment services, drop-in center services, volunteer work, and/or paid employment. Goal met. 71% of consumers participated in some type of daily structured activity.
• At least 80% of consumers will report satisfaction with services received as indicated on the annual consumer satisfaction survey. 25 persons surveyed. Goal met. 100% of consumers had a favorable rating. 68% gave an “excellent” and 32% gave a “good” rating.
Further Expansion of the Continuum
• While the program was successful for consumers and provided much relief for the police and emergency rooms/hospitals, some of the volunteer shifts were difficult to fill.
• In particular, the day shifts (when people are at work) and on Saturdays.
• In an effort to expand services to cover 75% or more of the 911 mental health related calls, NAMI and CTS added 2 paid technicians to the program of services.
Technicians
• 2 full time paid technicians are now part of the CTS Program.
• The shifts worked by the paid technicians are the ones with the most calls and the fewest number of volunteers.
• The day shift is Monday through Friday, 8:00 a.m. to 4:00 p.m. or 10:00 a.m. to 6:00 p.m.
• The second shift is Tuesday through Saturday, 3:00 p.m. to 11:00 p.m.
Results
• All shifts are now covered by the paid technicians or volunteers 7 days a week from 8:00 a.m. to midnight.
• Approximately 70% of 911 mental health calls to the NOPD are being handled by CTS. This should continue to increase.
• The cost of the 2 paid technicians is $99,706 per year to serve a minimum of 40 consumers per month.
• Most months, 60 or more consumers receive assistance costing an average of $138 per transport and/or on-scene resolution.
