Crisis and Transition Services

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Irene Roberts
5 years ago
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1 Crisis and Transition Services The Evolution of a Program for Suicidal Youth in EDs from a Pilot to a Statewide Standard Amanda Ribbers MS, Rebecca Marshall MD MPH, Julie Magers CFSS, Dan Thoma LPC March 14, 2019

2 2 Introductions

3 The state of mental health care EDs are overwhelmed with patients experiencing a mental health crisis There is a statewide shortage of inpatient beds Communities are unable to support high-risk youth and families after discharge Payers don t have sufficient contracts with acute outpatient services Families in crisis aren t getting their needs met 3

4 Legislation and advocacy efforts Work group created to address ED transition of care Legislative and ED Diversion Summit Team established to measure outcomes and provide technical assistance 7 more counties added Commercial insurance stakeholders group assembled November 2014 July 2016 January 2017 By end of 2017 September 2018 Spring 2015 By end of 2016 July 2017 January 2018 March 2019 Pilot programs launched in 4 counties 3 more counties added New ED mental health laws passed Sites began reporting electronically for outcomes study First data analysis of outcomes study 4

Youth presents to ED or Crisis Center Essential Elements Assessment and Referral to CATS CATS Intake and ED Discharge CATS Program CATS Closure Care Coordination Connection to ongoing mental health

5 Youth presents to ED or Crisis Center Essential Elements Assessment and Referral to CATS CATS Intake and ED Discharge CATS Program CATS Closure Care Coordination Connection to ongoing mental health care School and other social supports Insurance enrollment Intensive Mental Health Support In-home therapy Psychiatric assessment 24-hour crisis support (phone or in-person) Safety planning and CALM Family Peer Support Systems navigation Barrier reduction Destigmatize mental health care Skill development 5

6 Families will leave CATS with... A copy and understanding of treatment recommendations and safety plans Connectivity and scheduled appointments with community providers and supports Acquired skills and information to effectively address barriers to care, access services and support Acquired skills and information for safe crisis management and de-escalation 6

7 Expected outcomes INCREASE safety and confidence in managing crises access to behavioral health care knowledge about suicide risk, warning signs, and protective factors 7 DECREASE repeat ED visits suicidality

8 8 Sites that report in REDCap

9 Youth presents to ED or Crisis Center 644 youth and families served Assessment and Referral to CATS CATS Intake and ED Discharge CATS Program CATS Closure 9

10 Youth presents to ED or Crisis Center 644 youth and families served Assessment and Referral to CATS CATS Intake and ED Discharge CATS Program CATS arrived at ED within 1 hour for 66% of cases CATS arrived at ED within 3 hours for 89% of cases CATS Closure 10

11 Youth presents to ED or Crisis Center 644 youth and families served Assessment and Referral to CATS CATS Intake and ED Discharge CATS Program 68% of youth discharged within 24 hours 90% of youth discharged within 48 hours CATS Closure 11

12 Youth presents to ED or Crisis Center Assessment and Referral to CATS 644 youth and families served Age CATS Intake and ED Discharge and under CATS Program Male 39% Female 58% 12 CATS Closure Trans: Feminine, <1% Trans: Masculine, 2% Non-Binary, 1% Other, <1%

13 Youth presents to ED or Crisis Center 644 youth and families served Assessment and Referral to CATS 400 Insurance CATS Intake and ED Discharge CATS Program 0 OHP Commercial 42 Uninsured 28 Other CATS Closure 13

14 Youth presents to ED or Crisis Center 644 youth and families served Assessment and Referral to CATS CATS Intake and ED Discharge CATS Program 8% are currently or previously in foster care 9% are currently or previously involved with juvenile justice 56% have a history of trauma 32% have previous ED mental health visits 14% have previous psych inpatient admissions 29% have previously attempted suicide CATS Closure 14

15 Youth presents to ED or Crisis Center Assessment and Referral to CATS 644 youth and families served Preseneng Referral Issue(s) CATS Intake and ED Discharge Mental Health Suicidality CATS Program Behavioral Issue Developmental Disability Substance Abuse 49% with ideation CATS Closure 24% with a plan/intent 15 27% who attempted

16 Youth presents to ED or Crisis Center Assessment and Referral to CATS CATS Intake and ED Discharge CATS Program Average length of clinical care is 27 days Average length of family peer support is 56 days CATS Closure 16

17 17 Outcomes study sites

18 Outcomes study Does your current care meet your child s needs? Are you confident about what to do in a crisis? No 17% No 9% Yes 83% Yes 91% n = 101 n =

19 Outcomes study Is youth currently seeing an outpatient therapist? Is youth currently seeing an outpatient prescriber? No 34% Yes 66% No 45% Yes 55% n = 101 n =

20 Outcomes study Since finishing the program, has youth had a suicide attempt? Since finishing the program has youth gone to ED or been admitted to inpatient/subacute? Yes 9% Yes 22% No 91% No 78% n = 99 n = 99 20

21 From pilot to statewide standard The model s development and expansion has been in response to the needs of the community Legislation is helping bring private insurers and hospitals to the table HB 3090 Hospitals must take suicide prevention measures before discharging a patient in behavioral health crisis HB 3091 Payers must cover care coordination and case management for patients presenting in behavioral health crisis

22 The vision Every Oregon youth and their family in need of immediate crisis services will have access to responsive and effective community-based, rapidly-accessible mental health crisis care and transitional supports Reliable and equitable funding from public and private payers will ensure the ongoing viability of Crisis and Transition Services 22

23 The process CATS Learning Collaborative is providing a space for team development and training Outcomes study is measuring effectiveness and identifying core elements The model is adapting to meet the needs of the community and private sector 23 Commercial insurance work group is developing plan language and a proposal for a covered service

24 Areas for further growth Further integration of EDs into the program Develop tiers of care based on acuity Improve re-engagement of CATS families that are in crisis at follow-up Further standardize the model of care Clarify roles and coordination of family support specialists and clinical teams 24

25 Questions & Discussion

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