STRENGTHENING TRANSITIONS

Transcription

1 STRENGTHENING TRANSITIONS PROVEN STRATEGIES FROM THE KING COUNTY PEER BRIDGER PROGRAM 2016 WASHINGTON STATE BEHAVIORAL HEALTHCARE CONFERENCE JUNE 23, 2016

2 PRESENTERS Harborview Medical Center Navos Inpatient Services Topher Jerome Peer Support Programs Supervisor Cindy Spanton, LICSW Director of Hospital Extension Services Lisa Lovejoy Peer Support Specialist Den Villas Peer Bridger/Analyst

3 OUTLINE 1. Introduction 2. Program Need 3. Program Strategy 4. The Peer Bridger Relationship 5. Inpatient Clinical Teams 6. Outpatient/Community 7. Outcome Data/Proven Strategies 8. Patient Stories 9. What s Next? 10.Questions

4 INTRODUCTION HOW WE GOT STARTED Navos Mental Health Solutions Harborview Medical Center

5 INTRODUCTION In 2013 King County contracted with Harborview Medical Center and Navos Mental Health Solutions to implement the Peer Bridger Program. This grant-funded intervention aimed at reducing hospitalization and improve quality of life after discharge from psychiatric hospitals. Program staff are state Certified Peer Support Specialists. Peer Bridgers in the King County program are sited within the hospital setting, working collaboratively on discharge planning and engaging participants in community-based services and supports. 5

6 INTRODUCTION The program has statistically proven to: increase enrollment in outpatient services shorten length of stay reduce number of hospital episodes/days increase enrollment in Medicaid reduce re-hospitalizations 6

7 INTRODUCTION Anecdotally, program participants overwhelmingly report improvement in their quality of life through the increased support they received. Working with the Peer Bridgers saved my life. Without their support I would have given up. - Pete 7

8 Too often, people hospitalized for inpatient psychiatric care experience difficultly after discharge. They have the sensation of falling off the cliff of support into the community where they can feel alone and overwhelmed. PROGRAM NEED

9 PROGRAM NEED People are expected to pick up the pieces of their life and move to the next stages of their recovery without support Apathy, hopelessness, suicidal ideation, depression, chemical dependency relapse, isolation and for many, homelessness are some of the barriers to following up with outpatient care

10 PROGRAM NEED People use emergency rooms and inpatient services more often when they are not connected to outpatient services Connecting to outpatient care can be overwhelming and confusing. People often don t make it to their outpatient appointments post discharge. This can lead to further hospitalizations and use of the emergency room

11 PROGRAM NEED With costs of inpatient hospitalizations as high as $1000 to $1500 a day and severe shortage of beds, there is a critical need to help people stay out of the hospital Recovery principles may not be fully understood and supported by traditional inpatient psychiatric facilities staff experience burnout and don t hold hope that people can, and do, recover with the appropriate support

12 STRATEGY King County provided extensive training prior to program implementation Priority status is given to patients who have no existing benefits or have Medicaid Peer Bridgers are sited within the hospital setting Peer Bridgers work collaboratively within the clinical teams 12

13 STRATEGY A key to the King County program strategy is the utilization of the same Peer Bridgers who work with participants throughout the program duration (both in the hospital and post discharge) Peer Bridgers work with people up to 90 days post discharge Provide slush fund for basic services and essential needs such as bus passes, cell phones, clothing, food, engagement activities, etc. 13

14 THE RELATIONSHIP Vital to program success has been the use of Certified Peer Support Specialists who share their lived experiences openly. This helps to build meaningful, trusting relationships that have depth and weight. The quality of these relationships is paramount and cannot be underestimated in producing successful outcomes. 14

15 THE RELATIONSHIP Trusting relationships enable participants to: Learn how to communicate openly and honestly with providers and other people in their lives Reduce internalized stigma, providing role models that demonstrate recovery is truly possible 15

16 THE RELATIONSHIP Trusting relationships enable participants to: Recognize their own strengths and develop personal goals Feel like someone is truly on their side, who will advocate for them and help them overcome overwhelming stressors in their lives 16

17 INPATIENT CLINICAL TEAMS Peer Bridgers are fully integrated within the clinical interdisciplinary teams (psychiatry, nursing, social work, rehab therapy, and addictions) and as such: Demonstrate that recovery is possible for clinical staff through their own success stories and professionalism increasing the adoption of recovery principles across the disciplines Model compassionate, open relationships that inspire hope 17

18 INPATIENT CLINICAL TEAMS Bring the participant perspective to the team and help to communicate and explain clinical strategies back to the participant Advocate for the participant and challenge staff to consider alternative perspectives Assist with the discharge planning process 18

19 OUTPATIENT/COMMUNITY Once discharge takes place, the range of services provided by Peer Bridgers is customized to the individualized need of the participant. Peer Bridgers often provide temporary case management until the participant is successfully connected with outpatient services. 19

20 OUTPATIENT/COMMUNITY In the community, Peer Bridgers: Focus first on the crisis needs hope begins to emerge as overwhelming tasks begin to be systematically addressed Connect with, (and successfully utilize) their outpatient services often sitting in on intake sessions with case managers and psychiatrists 20

21 OUTPATIENT/COMMUNITY In the community, Peer Bridgers help people: Connect with natural supports & recovery communities Learn to manage a multitude of appointments while also prioritizing fun Talk about medications Navigate complex social service systems Cope with life changes (everything from diagnosis to challenging living situations) 21

22 OUTPATIENT/COMMUNITY Obtain housing Follow-up with obtaining and understand benefits Connect with recovery communities (12-step, CD treatment, etc.) Practice skills learned while in the hospital (DBT, CBT, WRAP, etc.) Learn self-advocacy Ultimately, Peer Bridgers get the joy of witnessing people as they start to put their recovery into action. 22

23 PEER BRIDGERS AGENTS OF CHANGE Changing culture some people who work on inpatient units may not always believe in recovery they see the same people come back over and over again. Staff can default to the idea that people just can t or don t want to get better. Peer Bridgers not only exemplify that recovery is possible, they can communicate successes back to the units the PB staff also help educate other staff on the importance of language change and recovery concepts.

24 KING COUNTY OUTCOME DATA The current analysis provides outcomes of Peer Bridger participants examined against a comparison group. Outcomes include: change in hospitalization, Medicaid enrollment, and enrollment in outpatient mental health services.

25 COMPARISON GROUP - COUNTY The comparison group includes individuals with a hospitalization at Harborview or Navos prior to the start of the Peer Bridger Program. This admission is considered their index hospitalization. We examined outcomes for a year following the index hospitalization for the comparison group.

26 PARTICIPANT GROUP COUNTY Clients are identified for Peer Bridger services during a hospitalization at Harborview or Navos. The hospital episode that launches Peer Bridger services is considered their index hospitalization. For analysis purposes, this hospitalization is counted within the year prior ( pre ) to Peer Bridger enrollment. Analysis compared pre year hospitalizations with the year following Peer Bridger enrollment ( post ).

27 CHANGE IN HOSPITAL UTILIZATION

28 CHANGE IN HOSPITAL UTILIZATION

29 Likelihood of engagement CHANGE IN HOSPITAL UTILIZATION IN $ S (BASED ON $1,125 AVERAGE DAILY RATE) 100% 90% Out-Patient Engagement 80% 70% 60% 72% Comparison Group 50% 40% 30% 20% 10% 33% 26% 48% County Participant Group Navos Participant Group 0% Admission Engaged 90 day post d/c

30 HOSPITAL UTILIZATION LOS

31 HOSPITAL UTILIZATION LOS IN $ S (BASED ON $1,125 AVERAGE DAILY RATE) $30, Change in Average Cost per Hospitalization $28, $25, $20, County Participant Group Comparison Group $15, $14, $10, Pre Hosp Ave Post Hosp Ave

32 RECIDIVISM Individuals re-hospitalized within Participant (N=197) Comparison (N=1690) 30 days 90 days N & N % % % % % 32

33 CHANGE IN MEDICAID ENROLLMENT

34 CHANGE IN OUTPATIENT MENTAL HEALTH SERVICE ENROLLMENT

35 PROVEN STRATEGIES LEARNED Drilling down a little further Navos took a look at other aspects of Peer Bridger Services, here is what we learned.

36 PARTICIPANT GROUP This group consisted of all participants enrolled in the program from June, 2013 through August, 2014 at Navos. Participants that went to Western State Hospital or that moved out of state at hospital discharge were removed from analysis as they were unable to participate in the program after hospital discharge. 127 participants are included in the analysis.

37 Likelihood of engagement CHANGE IN OUTPATIENT SERVICE ENROLLMENT Out-Patient Engagement 100% 90% 80% 70% 72% 60% 50% 40% 48% 30% 20% 10% 0% 33% 26% Admission Engaged 90 day post d/c Comparison Group County Participant Group Navos Participant Group

38 AVERAGE PB INTERVENTION EXPERIENCE Intervention Engagement Medicaid Active DSHS or SSI Outpatient Link (in conjunction with discharge plan) Peer Equivalent Introduce support and set up rapport; ascertain basic needs and barriers Continued support and obtain a benefit for client at point of contact, builds trust Get to know client better, set up a plan, introduce more benefits and possibly cash help Relating how being in out-patient can set up long term success; Telling personal story of agency help; You won't be alone!

39 AVERAGE PB INTERVENTION EXPERIENCE Intervention Meds at Discharge Transport at Discharge Client chosen barrier removed Taking client on first appointment Psych Provider Appt. Hand Off to CM Peer Equivalent Discussing the importance of meds, relating personal med story, navigate pharmacy and Provider One system Showing client that we are serious about support once out of hospital; setting up plan for outside; set next meeting Binds us to client; we are on their team; shows we are listening to their needs; makes the support something they value Help in completing intake paperwork; expanding support network and starting the handoff. Checking out groups, resources, getting comfortable with showing up Doing recovery together, modeling self-advocacy and the importance of showing up for recovery. Get med continuity, Meet Provider, work out kinks. Hand over existing issues and concerns to active CM.

40 DATA What are the characteristics of the 72% who were successfully handed off to out-patient? Assured Med coverage % Actie DSHS or SSI 94.51% O/P link set-up % Intake or First Appt % Med at d/c 95.60% Barriers 85.71% Transport at d/c 59.34%

41 Assured Med Coverage WE LEARNED ABOUT EACH INTERVENTION S IMPACT Barriers 100% Assured Med Coverage Transport at d/c 100% Active DSHS or SSI 97% Active DSHS or SSI 97% O/P link set-up 100% Intake or First App 98% Intake or First Appt 90% Prescriber/ Handoff 85% Prescriber Hand Off 88% Med at d/c 83% Med at d/c 94% Barriers 98% Transport at d/c 64% Client Disengaged 88% Client Disengaged 12% 17%

42 DIFFERENT COMBINATIONS Assure Med Pickup and Barrier 90.48% Assure Med Pickup and Barrier and Transport All interventions including first appointment (53 out of 53 who received all interventions remained engaged post 90 day discharge) 92.86% % (When combined with assuring medical coverage, active DSHS, having an o/p provider )

43 Likelihood of engagement THE POTENTIAL 100% 90% 80% Out-Patient Engagement 100% 70% 72% 60% Comparison Group 50% 40% 30% 20% 33% 26% 48% County Participant Group Navos Participant Group The Potential with ALL Interventions 10% 0% Admission Engaged 90 day post d/c

44 PATIENT STORIES

45 The Challenges of Peer Support 45

46 Kim Kim discharged from the hospital with a diagnosis of major depression and Borderline Personality Disorder. She also had a history of some opioid use, and she was newly homeless. Helped her get a bus card, took her to DSHS and SSA, her outpatient appointments, and visited her often. Kept in touch with her family. Because resources for housing are increasingly scarce, Kim was unable to leave the shelter for 4 months. In that time, she was in and out of the hospital 3 times. She finally she got into housing. A couple weeks later she told me that she had tried heroin and that a man who had been inpatient with her was staying with her. I didn t want her to fail. Anger Struggling with wanting to rescue her How to support her feeling the way that I did? And how to stay peer? What did she get? Radical Acceptance. 46

47 Jack My whole life I didn t fit in. My whole life I didn t fit in wherever I was. Not in school. Not in my family. Not with any friends. And then in my teens, I found alcohol. 47

48 Alcohol took all of that away. Suddenly I fit in with the kids, I became somebody, I was always the drunkest and I got everybody in trouble. I was always a very sensitive person with big feelings that I couldn t control. I started skipping school. By 17, I was drinking everyday. My dad knew about it and just told me to hide it from mom. Also, my dad died from alcoholism. In adulthood, I stole from mom so I could get alcohol. Nothing else mattered. 48

49 I started working with Robie when I was at Harborview for 14 days. I really felt like I can t live like this. I wanted to destroy myself. I got out of the HMC and went back to drinking. I was on the bridge and ended up back in the hospital. I had a couple of hospitalizations. Robie never gave up on me. She was always there. She helped me make decisions and shared her story. Teri Jo got me shoes. They BOTH got me shoes. I love those shoes. Robie would take me to goodwill and get me clothes and things. Those were good times. 49

50 Now I am so much better. I eat every day. I eat breakfast and I read pages 86, 87, and 88 in the big book. I m working now full time and I LOVE it. 50

51 WHAT S NEXT? 51

52 CURRENTLY Sustainable System Funds Seem Likely Currently funded through 2017 Permanent funding options being investigated Private Philanthropy Respect for the Program Doctors, social workers, nurses, and other hospital personnel have come to respect Peer Bridgers as a valuable part of the clinical team 52

53 CURRENTLY Community Partnerships Peers have developed strong interagency relationships with both public and private entities covering areas such as funding, housing, and treatment Community Leaders Committee for Alternatives to Boarding Task Force WA State Senate Personnel Private Philanthropy 53

54 PROGRAM EXPANSION POSSIBILITIES Washington State Hospitals Governors Budget: 22 Peer Bridgers to be employed statewide (Possible BHO Employees) Emergency Departments Community Alternatives to Boarding task force recommendations (Draft) Assisted Outpatient Treatment (AOT) Long-term partnering with individuals on Less Restrictive Orders (LRO s) 54

55 STILL ON THE WISH LIST Possible MIDD Strategies High Utilizer Programs Peer Bridgers for Medically Hospitalized Expansion for people on Medicare and Private Insurance Housing Assistance More Peers in the Labor Force! 55

56 QUESTIONS?

57 CONTACT INFORMATION Harborview Medical Center NAVOS Inpatient Services Topher Jerome Peer Support Programs Supervisor (206) Cindy Spanton, LICSW Director of Hospital Extension Services (206) Lisa Lovejoy Peer Support Specialist (206) Den Villas Peer Bridger/Analyst (206)