supercharge crisis services - david covington (natcon15)
TRANSCRIPT
Supercharge Your Crisis Services
David W. Covington, LPC, MBA, Recovery Innovations
Supercharge – The Future is Pay for Value
Step 1: Measure & Report Your Cost
Impact
Innovation Awards
Creating a Model
• Data + Frameworks = Model
• Models are a dime a dozen… but you have to
have one.
Suicidal Desire
• Suicidal Ideation- hurting self or others Perceived burden on others
• Psychological Pain Feeling Trapped
• Hopelessness/Helplessness Feeling Alone
Suicidal Capabilit
y
• History of Attempts Available means
• Exposure to another person's suicide Intoxicated/substance abuse
• History / current violence to others Acute symptoms
Suicidal Intent
• Attempt in progress Preparatory Behaviors
• Plan to hurt self/other & method know Expressed intent to die
Buffers
• Immediate supports Engagement with helper
• Social supports Ambivalence for living
• Planning for future/sense of purpose Core values/beliefs
Are you thinking of suicide?
Have you thought about suicide in the last two months?
Have you ever attempted to kill yourself?
Three Key Questions
SAMHSA Suicide Risk Assessment Standards
Acuity Intensity (One or more of the following is present) Offer apt within:
Emergent A life threatening condition exists as caller presents:
Suicidal/homicidal intent
Actively psychotic
Active withdrawal (Alcohol, Benzos, Barbiturates)
Disorganized thinking or reporting hallucinations which may result in harm to
self/others
Imminent danger to self/others
Unable to care for self
For an Emergency Crisis:
Immediately arrange to be seen
within 2 hours
If suicidal/homicidal with weapon,
call 911/Police
If active withdrawal, send to
nearest ER for medical clearance
Urgent No suicidal/homicidal intent
Denies suicidal plan/means
Expresses hopelessness, helplessness, sense of burdensomeness, disconnectedness
disconnectedness or anger
May develop suicidal intent without immediate help
Potential to progress to need for emergent services
May express distress/impairments that compromise functioning, judgment and/or
and/or impulse control
May have withdrawal signs/symptoms from non-life threatening substances:
Cocaine, Methadone, Heroin
Dependence on Alcohol, Benzodiazepines or Barbiturates, but not in active
withdrawal and no history withdrawal seizures or DTs
For Severe Situation:
Offer an appointment within 24
hours (48 hours at the maximum)
Instruct caller to re-contact CAC if
condition worsens
May include crisis plan with
available supports
Routine Impacts caller’s ability to participate in daily living
Markedly decreased the caller’s quality of life
Caller acknowledges some distress/concerns
No evidence of danger of harm to self/others
No marked impairments in judgment or impulse control
Severity warrants assessment and possibly services
SA issues with possibility of substance dependence
For Distressed Caller:
Offer first available appointment
within five days
Re-contact CCA if condition
worsens
Referral Only
(Non-Core
Customer)
Presenting problems do not rise to clinical acuity required for state-funded services
services (which require Severe & Persistent Mental Illness)
Offer appropriate referral or
resource
Warm-Line
(Support Only) Caller is already linked with community services and does not have urgent or
or emergent needs
Encourage to contact current
provider
Information Only No identified consumer for clinical triage; simply a request for basic information Provide requested information
Business Call Request for an administrative staff person or in regard to an administrative matter Link to appropriate CAC staff
Research Assumptions #1
• In 2002, Hugo et al studied the difference
between hospitalization rates comparing a
community-based mobile emergency
service and a hospital ER-based emergency
service.
• They concluded, “Hospital-based
emergency service contacts were found to
be more than three times as likely to be
admitted to a psychiatric inpatient unit
when compared with those using a mobile
community-based emergency service,
regardless of their clinical characteristics.”
Research Assumptions #2
• In Roger Scott’s 2000 study in Psychiatric
Services, entitled, “Evaluation of a Mobile
Crisis Program: Effectiveness, Efficiency and
Consumer Satisfaction,” the conclusion
stated:
• “Fifty-five percent of the emergencies
handled by the mobile crisis team were
managed without psychiatric
hospitalization…, compared with 28 percent
of the emergencies handled by regular
police intervention, a statistically significant
difference.”
Mobile Crisis July 07
The Word Problem
N = 374
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374$375 Per
Day
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374$375 Per
DayAvg. 8 Days Per
Episode
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25%
$375 Per
DayAvg. 8 Days Per
Episode
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
DayAvg. 8 Days Per
Episode
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
DayAvg. 8 Days Per
Episode
= Cost $804k
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
DayAvg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
55
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
DayAvg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585%
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
DayAvg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585% = Cost $158k
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
DayAvg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585% = Cost $158k
Acute Care EscalationMobile Crisis July 07
The Word Problem
N = 374
Projected
Natural Rate
of Diversion
25% 280
$375 Per
DayAvg. 8 Days Per
Episode
= Cost $804k
Actual Rate
with
Program
Intervention
5585% = Cost $158k
Savings $646k
Mix and Match
• Avoiding Costs Based Upon Baseline
Assumptions
– Escalations to Higher Levels of Care
– Lack of Throughput/Accessibility Prevents
Front-End Admissions (ED Costs)
– Lack of Capacity Due to Frequent
Readmissions
Supercharge – The Future is Pay for Value
Step 2: Showcase Your Outcomes
Supercharge – The Future is Pay for Value
Step 3: Use Recovery Language
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Assessment Getting to Know Each Other
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Assessment Getting to Know Each Other
Psychosocial History Telling My Story
Green 80, Green 80, Hut-Hut.
Crisis Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Assessment Getting to Know Each Other
Psychosocial History Telling My Story
Treatment Plan Recovery Solutions