1 Crisis Residential Best Practices ToolkitJune 21, 2017

2 Today’s Agenda WelcomeCrisis Program Spotlight: Netcare Access Crisis Stabilization Unit- Miles House (OH) Content Overview: Funding Review Survey Results/Discussion Review Project Plan and Timeline Adjourn Housekeeping: Using Skype for questions—please mute us, but don’t put our call on hold Purpose: To develop a comprehensive Best Practice Toolkit for Crisis Residential Services, informed by Crisis Residential providers across the country.

3 www.TBDSolutions.com Crisis Program Development Quality ImprovementResearch & Analysis Integrated Care Coordination Data Analytics System Redesign Middle Management Training Metrics Development

4 www.TBDSolutions.com Save the Date!Innovative Practices in Effective Management Tuesday, July 18th 1pm-2pm EST Free Webinar /Meeting Invitation Week of June 26

5 Workgroup Participants115 participants from 35 states Plus England and Costa Rica Approximately 300 crisis homes exist nationwide Welcome new participants from KY, MN, SD, VA, TX, CA, and PA

6 Crisis Program Spotlight: Netcare Access CSULegislative efforts in California and Colorado have brought about significant improvements and funding in the Crisis Services Continuum.

7 Netcare Access Crisis Stabilization Unit Miles HouseCarrie Wirick, LPCC-S Director, Community and Residential Treatment

8 Netcare Access Crisis Services for Franklin CountyFranklin County is 1.32 million City of Columbus is 832,000 of that Most populated city in Ohio

9 Netcare Access Emergency Response Service (Crisis Phone/Chat line)Crisis (Psychiatric Emergency Services) Crisis Stabilization Unit Miles House

10 Netcare Crisis Stabilization Unit (CSU)10 beds Up to 5 hours group per day Adult men and women Primary Mental Health Alternative to psychiatric hospitalization Max 7 day stay, ALOS 3.5 days

11 Netcare Crisis Stabilization Unit (CSU)680 clients served per year Gym, Courtyard, Yoga Daily MD/NP, 24/7 nurses (LPN and RN) Social Workers, Counselors, Peers, Techs Illness Management and Recovery Skills from DBT

12 Netcare Miles House 9 beds Group 4 hours per day Adult Men and WomenPrimary Mental Health Step down from CSU and psych hospital Max stay up to 16 days, ALOS 13 days 233 clients served per year

13 Netcare Miles House Come and go, on bus line, get 5 bus passes per stay Link to opportunity for transitional housing Illness management and recovery Connect with supports in community Daily part time RN 24/7 staff Social Workers, Counselors, Peers, Techs

14 Funding for Netcare CSU and Miles HouseOhio has a system where county boards run tax levies based on property taxes. Voters approve tax levies. Our county board funds treatment for individuals without insurance, and pays some for what insurance won’t pay for.

15 Funding for Netcare CSU and Miles HouseNetcare has negotiated contracts with some managed care providers. In flux because of Medicaid Expansion

16 ACA and how it affects NetcareOhio was a Medicaid Expansion state. Lots of Medicaid subscribers, too few hospital beds caused gridlock in Netcare’s Crisis center, spilling into CSU.

17 ACA and how it affects NetcareNow hospitals are adding approx 200 beds. Netcare is getting in contract with some Managed Care Medicaid. Congress may cut Medicaid expansion

18 Challenges for NetcareStaffing, turnover Opiate epidemic Housing shortage

19 New exciting things for NetcareUse of Peers New hospitals will mean more choices for clients. Funder to rehab the appearance of CSU Zero Suicide Initiative

20 Questions? Carrie Wirick

21 Content Review: FundingDecember 2016: Staffing January 2017: Scope & Function February: Metrics & Outcomes March: Taxonomy & Community Relations April: Treatment Philosophy & Approach May: Intake June: Funding

22 Funding Survey Results: Sources of FundingOther Funding Sources (32%) Regional Funding Consulting Fees Commissioner’s Court Private Insurance 1115 Waiver Self-Pay Clients at sliding scale rate n=28

23 Funding Survey Results: Referral Sources“We bundle all we can, but if an individual doesn't get prior approval for Crisis Residential we bill Medicaid for the services we can.” “We maintain a per diem rate with some managed medicaid providers.” n=28

24 Funding Survey Results: Cost SettlingYes = 5 No= 12 n=28

25 Funding Survey Results: Contracting with Private Health PlansPrivate Health Plans contracting for Crisis Residential Services: Magellan Carefirst BCBS Kaiser Anthem Blue Cross Blue Shield n=28

26 Funding Survey Results: Diversifying Funding StreamsOther Responses: “Direct admissions from several referral sources by bypassing the screening assessment” “Initially supported with county funds, and have recently used state non-Medicaid and Medicaid funds to support the program services.” n=28

27 Funding Survey Results: Decreasing Costs

28 Funding Survey Results: Decreasing Costs“Consulting Services helps fund additional services” “Closely managing all expenses” “We operate on a shoestring budget and always have” “Furlough days for all staff; plan to increase use of interns” “Purchasing, including food service products, is now centralized and monitored from our main office.” “Applied for local grants for food, hygiene products, clothing items.” n=28

29 Funding Survey Results: Sustainability Amidst Challenges“Our Center has deemed the CRU a “core program” in our crisis services. This helps ensure that we will receive funding in the future. We are also CARF accredited and this carries weight with the county and state in their funding decision-making” Managing overtime, monitoring inventory and supplies, contracted with a community hospital partner and got our space rent-free.” “Using grants to pay for capital improvement.” “Required service to provide due to contract and mental health code.” Improvise—plus we try to do as much of the routine maintenance as possible.” “Outcome incentives.” “Collaboration to promote positive relationships.”

30 Funding: Part 2- Private Health Plans & Crisis ServicesPrivate Health Plans & Crisis Programs: Developing Lasting Partnerships Webinar 2nd Week in July- Date TBD

31 Upcoming Webinar Training: SAMHSA4th Monday of each month April-September Monday June 26th 3pm EST/12pm PST https://tinyurl.com/mezytde

32 Next Steps Next Conference Calls: Friday, July 1pm EST/10am PST (Topic: Crisis Programs & The Safety Net) Wednesday, August 2pm EST/11am PST Group Listserv: Website: (Meeting Slides stored here) Questions: