County of San Diego, Health and Human Services Agency IN HOME OUTREACH TEAM PROGRAM REPORT (IHOT)

Transcription

1 County of San Diego, Health and Human Services Agency IN HOME OUTREACH TEAM PROGRAM REPORT (IHOT) Annual Report January 1, 2012 to December 31, 2012

2 County of San Diego, Health and Human Services Agency IN HOME OUTREACH TEAM PROGRAM REPORT (IHOT) January 1, 2012 December 31, 2012 Table of Contents I. Executive Summary of the In-Home Outreach Team Program i-ii Annual Report II. In-Home Outreach Team Program Summary 1-2 III. Characteristics of Persons Accepted into the IHOT Program 3-6 IV. Source of IHOT Referrals 6 V. Referrals from IHOT for Additional Services 7 VI. IHOT Services, by Type 8-9 VII. Comparisons between Potential Laura s Law Candidates 9-13 and Non Potential Laura s Law Candidates VIII. Conclusion 14

3 EXECUTIVE SUMMARY IN-HOME OUTREACH TEAM PROGRAM ANNUAL REPORT I. Executive Summary This annual report of the IHOT Program provides an update of the program and participant characteristics and outcomes for the period of service between January 1, 2012 and December 31, Below are select key findings: A total of 402 persons were referred to the IHOT program from across San Diego County. Of those, 174 (43.3%) were determined to be eligible and accepted into the Outreach Phase of the IHOT program. Of those who entered into the Outreach Phase, 73 (42.0%) transitioned into the Engaged Phase of the IHOT Program. Of those who entered into the Engaged Phase, 14 (19.2%) successfully completed their participation in the IHOT program and were connected to ongoing community supports. 402 Referrals to IHOT from across San Diego County 174 (43%) Determined to be eligible and accepted into the Outreach phase of IHOT 73 (42%) Transitioned into the Engaged phase 14 (19.2%) Connected to ongoing BHS services and community supports The IHOT participant characteristics from the annual report are consistent with those previously reported. Males comprised the majority of the persons accepted into IHOT (58.6%). Caucasian was the most common racial/ethnic category reported (62.1%), followed by African American (12.1%), and Latino (10.9%). Approximately three quarters (75.6%) of the IHOT participants were between years old, with some representation among both transitional age youth and older adults. Schizophrenia/Schizoaffective Disorder represented the most common diagnostic impression for the IHOT participants (52.3%) followed by Bipolar Disorder (17.2%). i

4 Slightly over a third (36.8%) was identified as likely having a substance abuse related disorder. Referrals to IHOT came from many sources, but referrals from family members were most common (54.6%). Comparisons between Participants who were Potential Laura s Law Candidates (s) versus those not likely to be Laura s Law Candidates () While the overall number of participants was relatively small at this stage in the program, a similar percentage of s and have accessed outpatient programs (25.0% and 26.4%, respectively) after engaging with IHOT. Given the substantially higher incidence of incarceration prior to IHOT among s (30.4% to 12.5%), it is not surprising that a greater percentage of participants received jail-based mental health services (30.0%) following engagement with IHOT as compared to (5.7%). The s appear to be a high risk group that is particularly in need of the connections to longer term supports that the IHOT program attempts to establish. As further evidence of this dynamic, more s received temporary or permanent conservatorship (15.0%) than (1.9%). The participants identified as s consistently demonstrated higher psychiatric hospitalizations and incarcerations prior to participating in IHOT as well as during their IHOT participation. Overall, 19.2% (n=14) of those entering the Engaged Phase had connected with ongoing community services and supports and successfully concluded their active involvement in the IHOT program. IHOT staff had established connections to ongoing community services and supports for both Engaged Phase s and (15.0% and 20.8%, respectively). Changing one s living situation to one that provides greater supports (e.g., move to board and care or residential treatment center) was the most common activity achieved through IHOT participation (57.1%). Other common accomplishments were establishing direct linkages with psychiatric treatment and/or AOD services (50.0%) and getting connected to ongoing community supports such as SSI, and Medi-Cal (28.6%). ii

5 II. IN-HOME OUTREACH TEAM PROGRAM SUMMARY Telecare s In Home Outreach Team (IHOT) is a centralized program that offers a mobile team of staff comprised of Family Coaches, Personal Service Coordinators and Peer Support Specialists to provide in home outreach to adults with serious mental illness who are reluctant or resistant to receiving mental health services. The IHOT program also provides extensive support and education to family members who are dealing with the mental illness of a loved one within their family. A particular challenge experienced by such families is when their loved one with mental illness declines or refuses any mental health support, yet is very clearly struggling with daily life. The IHOT program provides mobile outreach to such individuals and their families in the North Coastal, East and Central Regions of San Diego County. Services include empathic support, psychoeducation, behavioral health needs screening, outreach and engagement, crisis management, transitional case management, and linkage assistance to a multitude of community resource and entitlement programs. Program Goals To connect participants and family members with education, support and community resources. To connect participants with appropriate medical and mental health care as is feasible. To increase family member satisfaction with the Mental Health System of Care To reduce the effects of untreated mental illness in individuals with Serious Mental Illness (SMI) and their families Eligibility Criteria 18 years or older. Presence of serious mental illness with functional impairment. Resides within North Coastal, Central or East Regions of San Diego County. Not currently enrolled in mental health treatment and resistant to mental health treatment. PHASES OF IHOT INVOLVEMENT Referral Phase - This is the initial entry point into the program. Referrals can come from numerous referral sources such as Psychiatric Emergency Response Teams (PERT), hospitals, jails, National Alliance on Mental Illness (NAMI), families, Recovery Innovations of California (RICA), etc., to target the most acute and difficult-to-engage. Referrals are primarily done by phone whereby an IHOT team member will take the information; consult with the IHOT program Team Lead and Administrator; and determine whether or not an individual meets the criteria to be accepted into the program. If staff determines that an incoming referral does not meet program criteria, Telecare will provide referrals for other appropriate community resources. Accepted into Program - When an individual is determined to meet criteria, they are considered accepted into the program and Telecare staff provides outreach services to the individual and family with the goal of engagement. Outreached Phase - In this phase, IHOT staff members will contact and meet with those families who have requested services. At the same time, Telecare attempts to make contact and build trust and rapport with the individual identified as having mental illness but who is not engaged or interested in receiving any type of help or mental health treatment. If no family is involved, the IHOT team will make numerous efforts to outreach the referred individual by contacting them by phone, stopping by their place of residence as many times as needed to connect, build trust and rapport with them and to initiate initial discussions with them about their needs and wants. Engaged Phase - A participant is defined as engaged with IHOT services when they agree, subsequent to IHOT team outreach efforts, to meet regularly with IHOT staff and are open and receptive to receiving IHOT support services. In this phase, the IHOT team strives to connect the 1

6 participants with as many resources as they are interested in receiving, and if they are willing, to assist them in linking to medical and/or mental health care. Successful IHOT Completion - A participant is considered to have successfully completed the IHOT program when they have met those goals that he or she has identified as important with collaborative assistance from IHOT staff. Successful completion involves the individual being linked and established in ongoing community services that further help the participants reach their long-term goals. Such goals serve the purpose of increasing overall support for participants and/or increasing participants level of independence and self-sufficiency. IHOT Program Service Delivery Characteristics The following sections present a brief overview of the IHOT program services and characteristics of the persons accepted into the IHOT program between January 1, 2012 and December 31, Cumulative IHOT Program Participation As of December 31, 2012: A total of 402 persons were referred to the IHOT program from across San Diego County. Of those, 174 (43.3%) were determined to be eligible and accepted into the Outreach Phase of the IHOT program. During the Outreach Phase, IHOT staff connects with and supports the family of the participant and attempts to develop a relationship with the potential IHOT participant. The primary reason for being found ineligible for IHOT services was residing outside of the allowable catchment area (n=130, 32.3%). Of those who entered into the Outreach Phase, 73 (42.0%) have already transitioned into the Engaged Phase of the IHOT Program. The Engaged Phase begins when the intended recipient of IHOT services agrees to have an ongoing relationship with the IHOT staff. During this phase the IHOT staff continues to provide support services to the family members. Of those who entered the Engaged Phase, 14 (19.2%) have successfully completed their participation in the IHOT program. All participants who successfully completed the IHOT program were connected to ongoing community supports. The San Diego County public mental health system was a component of the ongoing supports for 4 (28.6%) of the individuals who completed the program. Other common accomplishments were establishing direct linkages with psychiatric treatment and/or Alcohol or Other Drug (AOD) services (21.4%) and getting connected to ongoing community supports such as Supplemental Security Income benefits, and Medi-Cal (28.6%). Of the 174 persons who were accepted into the Outreach Phase of the IHOT program, 67 (38.5%) were from the Central Region, 45 (25.9%) were from the East Region, and 62 (35.6%) were from the North Coastal Region. 2

7 III. Characteristics of Persons Accepted into the IHOT Program The following tables reflect data for the 174 participants who entered the IHOT program during the reporting period (1/1/2012 to 12/31/2012). For each participant characteristic overall totals and the distribution by IHOT region are reported. Gender As shown in Figure 1, males comprised the majority of the persons accepted into IHOT (58.6%). Figure 1. Gender of Persons Accepted into the IHOT Program 41.4% 58.6% Male Female As shown in Table 1, males were particularly prevalent in the North Coastal Region (72.6%). Table 1. Gender by Region for Persons Accepted into the IHOT Program Total Central East North Coastal # % # % # % # % Female Male Total Race/Ethnicity The majority of persons accepted into IHOT were Caucasian (62.1%), followed by African American (12.1%), and Latino (10.9%). Other/Multi category includes Filipino; Asian/Asian American; African; Vietnamese; Middle-Eastern; Multiracial and Other. Figure 2. Race/Ethnicity of Persons Accepted into the IHOT Program 10.9% 12.1% 14.9% 62.1% Caucasian African Amer. Latino Other/Multi. Table 2 illustrates that the majority of IHOT participants in each region were Caucasians. However, the Central Region had substantially greater representation of African Americans and Latinos relative to the East and North Coastal regions. 3

8 Table 2. Race/Ethnicity by Region for Persons Accepted into the IHOT Program Age Groups Total Central East North Coastal # % # % # % # % Caucasian African Amer Latino Other/Multi Total Approximately three quarters (74.1%) of the IHOT participants were between years old. Figure 3. Age Groups of Persons Accepted into the IHOT Program 11.5% 14.4% 74.1% The results presented in Table 3 indicate that while the age group contained the vast majority of persons accepted into IHOT, each region included at least some persons from the transitional age youth (18-24) and older adult (60+) age groups. The overall numbers were relatively small, but almost a quarter (24.2%) of North Coastal IHOT participants were in the transitional age youth category. Table 3. Age Groups by Region for Persons Accepted into the IHOT Program Total Central East North Coastal # % # % # % # % Total

9 Diagnostic Impressions Schizophrenia/Schizoaffective Disorder represented the most common diagnostic impression for the IHOT participants (52.3%) followed by Bipolar Disorder (17.2%). Figure 4. Diagnostic Impressions of Persons Accepted into the IHOT Program Other Disorders include Other Depression; Anxiety Disorders; Personality Disorders; Other; and Unknown. 14.4% 6.9% 9.2% 17.2% 52.3% Schizophrenia/ Schizoaffective Bipolar Major Depression Other Psychotic Other Disorders As shown in Table 4, relatively similar diagnostic impression prevalence patterns were found in each region. Table 4. Diagnostic Impressions by Region for Persons Accepted into the IHOT Program Total Central East North Coastal # % # % # % # % Schizophrenia/ Schizoaffective Bipolar Major Depression Other Psychotic Other Disorders Total As shown in Figure 5, slightly over one-third of the persons accepted into the IHOT program (36.8%) were identified as likely having a substance abuse related disorder. Figure 5. Substance Abuse Related Diagnostic Impressions for Persons Accepted into the Program IHOT 36.8% Yes 63.2% No 5

10 As shown in Table 5, relatively similar percentages of IHOT participants in each region were thought to have a substance abuse related disorder. Table 5. Substance Abuse Related Disorder Diagnostic Impressions by Region for Persons Accepted into the IHOT Program Total Central East North Coastal # % # % # % # % Yes No Total IV. Source of IHOT Referrals Family members were the most common source of referrals into IHOT overall (54.6%). Figure 6. Source of IHOT Referrals for Persons Accepted into the IHOT Program 4.0% 5.8% 6.9% Family Member Protective Svcs. (APS) 6.3% 10.9% 11.5% 54.6% Emergency Psych. Svcs. MH Inpatient Svcs. Jail/Detention Fac. Friend/MH Support (e.g., NAMI) Other As shown in Table 6 below, within each region, the majority of referrals for persons accepted into IHOT came from family members. The regions differed to some extent in their distribution of the other common referral sources. For example, in the North Coastal, 19.3% percent of the referrals originated from Emergency Psychiatric Services (e.g., Psychiatric Emergency Response Team), compared to 4.5% and 11.1% for Central and East, respectively. However, the relatively small numbers of referrals, particularly for some of the referral source categories, suggest caution when interpreting the differences by regions. Table 6. Source of IHOT Referrals by Region for Persons Accepted into the IHOT Program Total Central East North Coastal # % # % # % # % Family Member Emergency Psych. Svcs Protective Svcs. (APS) MH Inpatient Svcs Jail/Detention Fac Friend/MH Support Group (e.g., NAMI) Other Total

11 V. Referrals from IHOT for Additional Services As the IHOT staff become familiar with the specific circumstances of those accepted into the IHOT program they often make additional referrals for recommended services. As indicated in Table 7, the five most common referrals were: 1. MH Support Groups (e.g., NAMI) 2. Housing Assistance 3. MH Outpatient Services 4. Employment Assistance 5. Medical Care Table 7. Additional Referrals for Persons Accepted into IHOT Total Central East North Coastal # # # # MH Support Groups (e.g., NAMI) Housing Assistance MH Outpatient Employment Assistance Medical Care Social/Recreational Emergency/Crisis Services (e.g., PERT) Case Mgmt. Services Entitlements (e.g., SSI) MH Inpatient Legal Counsel Comm. Resources/Social Support Protective Services Food Banks Substance Abuse Residential Education Assistance Substance Abuse Counseling Healthcare Benefits (e.g., Medi-Cal) Financial/Payee Services Transportation Services Caretaker Other Services (e.g., aging svcs., outreach svcs., etc.) Total Referrals

12 VI. IHOT Service, by Type Service for Those Accepted Into the Program As reflected in Figure 7 below, IHOT staff had an extensive amount of contact with both the family members and the persons accepted into the IHOT program (a total of 4008 service contacts by December 31, 2012). The vast majority of service contacts were related to Outreach (44.0% with family and 13.8% with participants) and Engagement (31.2% of contacts) activities. When needed, IHOT staff also helped manage crisis situations (1.3% of contacts) and facilitated linkages to resources (2.9% of contacts). Figure 7. Service Contact Types for Persons Accepted into the IHOT Program 2.9% 1.3% 6.8% 31.2% 13.8% 44.0% Outreach to Family Outreach to Participants Engagement w/ Participant Other Contact (e.g., Friend) Linkage to Resource Crisis Intervention Progression through the IHOT Program In the following series of tables we present information regarding the typical duration and contact with IHOT staff for those who have successfully progressed through one or more phases of the IHOT program. Table 8 provides information about the length of time of contacts with staff during the Outreach Phase for those participants who had transitioned into the Engaged Phase by December 31, Table 8. Outreach Phase Duration and Contact Information for Participants who Transitioned to the Engaged Phase (n=73) Days in Outreach Phase Number of Face-to-Face Total Contact Time (hours) Average Min / Max 1 / / 35 0 / / 18.9 The results from Table 8 indicate that the average time spent in the Outreach Phase is approximately one month (27 days), however the wide range (1 to 149 days) suggest much variability in the speed with which one progresses through the Outreach Phase. The contact information provides a measure of the typical number of interactions between IHOT staff and participants and/or family during the Outreach Phase. Overall, staff spent about 3.5 hours with participants and/or family members prior to their transition to the Engaged Phase. Substantial variation is evident in the number and total contact time. Table 9 provides the same type of information related to the Engaged Phase for participants who successfully concluded their active involvement with the IHOT program. Table 9. Engaged Phase Duration and Contact Information for Participants who Successfully Concluded the IHOT Program (n=14) 8

13 Days in Engaged Phase Number of Face-to-Face Total Contact Time (hours) Average Min / Max 23 / / 99 0 / / 43.3 The results in Table 9 indicate that participants typically take a substantially longer time to successfully progress through the Engaged Phase (average duration of days). Extensive variability was evident with a range of 23 to 287 days to successful IHOT completion. The number and nature of the contacts also revealed substantial involvement of the IHOT staff in the lives of the IHOT participants and families. Overall, staff invested an average of 15.2 hours of direct contact time during the Engaged Phase for each successful IHOT completion. Table 10 provides the total time and contact information while in IHOT for the 14 participants who successfully completed the program. Table 10. Total Outreach and Engaged Phase Duration and Contact Information for Participants who Successfully Concluded the IHOT Program (n=14) Days in IHOT Program Number of Face-to-Face Total Contact Time (hours) Average Min / Max 29 / / / / 43.3 The main findings of substantial time commitments overall and wide variation between participants were evident in Table 10 as well. VII. Comparisons between Potential Laura s Law Candidates (s) and Non Potential Laura s Law () A. Percentage of Persons Accepted into IHOT who may be Potential Laura s Law Candidates (s) Of the 174 persons accepted into IHOT as of December 31, 2012, 26.4% (n=46) appear to fit the criteria for consideration as s. B. Percentage of Persons Accepted into IHOT who have Transitioned to the Engaged Phase Of the 174 persons accepted into IHOT as of December 31, 2012, 42.0% (n=73) have already transitioned from the Outreach Phase to the Engaged Phase. o o Of the 46 s, 43.5% (n=20) have already transitioned from the Outreach to the Engaged Phase. Of the 128, 41.4% (n=53) have already transitioned from the Outreach to the Engaged Phase. C. Comparison of the Progression through IHOT between Participants who were Potential Laura s Law Candidates (s) versus those not likely to be Laura s Law Candidates () The following series of three tables reexamines the duration and contact information presented above, but separates the s from the to assess whether there is evidence that they progress through the IHOT program differently. As indicated above, approximately similar percentages (43.5% of s and 41.4% of ) transitioned into the Engaged Phase. Table 11 provides a comparison of the length of time and contacts received during the Outreach Phase. 9

14 Table 11. Outreach Phase Duration and Contact Information for Participants who Transitioned to the Engaged Phase by s and Days in Outreach Phase Number of Face-to-Face Total Contact Time (hours) (n=20) (n=53) (n=20) (n=53) (n=20) (n=53) (n=20) (n=53) Average Min / Max 2 / / 94 1 / 35 1 / 34 0 / 7 0 / / / 18.9 The results from Table 11 suggest longer duration for s in the Outreach Phase relative to. s also tended to receive more contacts overall (although face-to-face contacts were almost the same) and a somewhat greater amount of contact time than. Overall, 19.2% (n=14) of the 73 participants who entered the Engaged Phase successfully completed the IHOT program prior to December, 31, While numbers are small, the distribution across s and suggests that IHOT has the potential to achieve successful outcomes with all participations since 15% of s (n=3) and 20.8% (n=11) of were successfully closed. In Table 12 the differences in duration and contacts between the two groups of persons who successfully completed the IHOT program are explored. Table 12. Engaged Phase Duration and Contact Information for Participants who Successfully Concluded the IHOT Program by s and Days in Engaged Phase Number of Face-to-Face Total Contact Time (hours) (n=3) (n=11) (n=3) (n=11) (n=3) (n=11) (n=3) (n=11) Average Min / Max 75 / / / 57 6 / 99 0 / 16 1 / / / 43.3 Findings from Table 12 should be interpreted cautiously given the small sample sizes, but the results suggest that it is feasible for s and to have relatively similar progression patterns through the Engaged Phase. As with the preceding tables, the results show that it typically takes 3-4 months to complete the Engaged Phase and that substantial variation is evident across all the duration and contact measures within the and Non groups. Table 13 presents similar information for the 14 participants who successfully completed regarding their entire time in the IHOT program. Table 13. Total Outreach and Engaged Phase Duration and Contact Information for Participants who Successfully Concluded the IHOT Program by s and Days in IHOT Program Number of Face-to-Face Total Contact Time (hours) (n=3) (n=11) (n=3) (n=11) (n=3) (n=11) (n=3) (n=11) Average Min / Max 102 / / / 61 6 / / 17 3 / / / 43.3 Again, small sample sizes inhibit our capacity to derive solid conclusions, but at least to date, there is evidence that s can complete the IHOT program in a similar timeframe as the and may not require more contacts. We will continue to examine progression through the IHOT Program in future reports. 10

15 D. Involvement with San Diego County Public Mental Health System following Participant Engagement with IHOT Table 14 provides an overview of the utilization of the San Diego County public mental health system by IHOT participants after they have entered the Engaged Phase of the IHOT program (n=73). While preliminary due to the relatively small number of participants, we also examine service utilization separately for s and. As of 12/31/2012, 26.0% of the IHOT participants had accessed outpatient programs after entering the Engaged Phase of the IHOT program. Similar percentages of s and participants had accessed outpatient programs (25.0% and 26.4%, respectively) after engaging with IHOT. A potential difference between the two groups is the greater frequency of participants receiving jail-based mental health services (30.0%) following engagement with IHOT as compared to (5.7%). Another area of potential difference is that more s received temporary or permanent conservatorship (15.0%) than (1.9%). As more persons enter the Engaged Phase we will continue to monitor the public mental health service utilization patterns of all IHOT participants. Table 14. Utilization of San Diego County MHS Services After Entering the IHOT Engagement Phase by s and Total Participants (n=73) Mean for Users Participants (n=20) Mean for Users Participants (n=53) Mean for Users n % Visits n % Visits n % Visits Outpatient Services Outpatient Programs Emergency Services PERT EPU Forensic Services Jail n % Admits n % Admits n % Admits 24-Hour Services Crises Residential IMD Residential FSPs Inpatient Services Hospital Admissions Conservatorship Conservatorship (Temp./Perm.) n % Consrv n % Consrv n % Consrv E. Psychiatric Hospitalizations during the 12 Months Prior to Acceptance into IHOT Of the persons accepted into IHOT as of December 31, 2012, 32.2% (n=56) had at least one psychiatric related hospitalization in the 12 months prior to acceptance into IHOT. For those with a hospitalization, the average number was 3.8 with a range of 1 to 25. A greater percentage of s had at least one psychiatric related hospitalization in the 12 months prior to acceptance into IHOT relative to (56.5% compared to 23.4%). 11

16 Of the s, 56.5% (n=26) had at least one psychiatric related hospitalization in the 12 months prior to acceptance into IHOT. For those with a hospitalization, the average number was 4.2 with a range of 1 to 25. Of the, 23.4% (n=30) had at least one psychiatric related hospitalization in the 12 months prior to acceptance into IHOT. For those with a hospitalization, the average number was 3.5 with a range of 1 to 16. F. Incarceration during the 12 Months Prior to Acceptance into IHOT A total of 23.4% (n=30) of persons accepted into IHOT reported at least one incarceration following acceptance into IHOT. For those with an incarceration, the average number was 2.2 with a range of 1 to 8. A greater percentage of s reported at least one incarceration in the 12 months prior to acceptance into IHOT relative to (30.4% compared to 12.5%). Of the s, 30.4% (n=14) had at least one incarceration in the 12 months prior to acceptance into IHOT. For those with an incarceration, the average number of incarceration was 2.2 with a range of 1 to 7. Of the, 12.5% (n=16) had at least one incarceration in the 12 months prior to acceptance into IHOT. For those with an incarceration, the average number of incarcerations was 1.5 with a range of 1 to 8. G. Psychiatric Hospitalizations since Acceptance into IHOT A total of 21.8% (n=38) of persons accepted into IHOT experienced at least one psychiatric related hospitalization following acceptance into IHOT. For those with a hospitalization, the average number was 1.4 with a range of 1 to 5. A greater percentage of s had at least one psychiatric related hospitalization since acceptance into IHOT relative to (50.0% compared to 11.7%). The difference in hospitalization is not necessarily a negative finding, as the experience of IHOT staff is suggesting that for some, hospitalization is an important step for obtaining the treatment and services they need. This will be an area of continued examination throughout the IHOT Program evaluation. Of the s, 50.0% (n=23) had at least one psychiatric related hospitalization since acceptance into IHOT. For those with a hospitalization, the average number was 1.3 with a range of 1 to 5. Of the, 11.7% (n=15) had at least one psychiatric related hospitalization since acceptance into IHOT. For those with a hospitalization, the average number was 1.4 with a range of 1 to 4. H. Incarceration since Acceptance into IHOT A total of 12.5% (n=16) of persons accepted into IHOT reported at least one incarceration following acceptance into IHOT. For those with an incarceration, the average number was 1.5 with a range of 1 to 4. A greater percentage of s had at least one incarceration since acceptance into IHOT relative to (23.9% compared to 3.9%). Of the s, 23.9% (n=11) had at least one incarceration since acceptance into IHOT. For those with an incarceration, the average number was 1.5 with a range of 1 to 4. Of the, 3.9% (n=5) had at least incarceration since acceptance into IHOT. For those with an incarceration, the average number of was 1.6 with a range of 1 to 3. 12

17 I. Connections to Ongoing Community Services and Supports Of the 73 participants who have transitioned from the Outreach to the Engaged Phase, 19.2% (n=14) have already successfully connected with additional services and supports through IHOT staff involvement and concluded their active involvement in the IHOT program. As discussed above, the IHOT staff has been able to make connections for additional services and supports for both Engaged Phase s and (15.0% and 20.8%, respectively). Through participation in the IHOT Program, participants develop one or more goals in conjunction with the IHOT staff. The nature of the accomplishments is individualized to the interests and needs of the specific participant. As illustrated in Table 15, the 14 participants who successfully completed the IHOT program achieved a wide range of beneficial outcomes, with most accomplishing multiple goals. Table 15. Primary Outcome Areas for Participants Successfully Completing the IHOT Program (n=14) n % Living Situation Mental Health Care Connection to Resources (SSI, medical ins., Section 8, etc.) Employment Family Restoration Substance Abuse Treatment Social Support/Engagement Physical Health Care As shown in Table 15, a wide range of outcomes were achieved by the 14 participants who successfully completed their participation in the IHOT program as of 12/31/2012. Most participants experienced tangible improvements in more than one category. Changing one s living situation was a common activity that was achieved through IHOT participation (57.1%), often with the goal of providing a stable and safe living arrangement that offered greater supports to the individual such as transitioning to board and care or skilled nursing facilities, residential substance abuse treatment centers or even modifying family dynamics to allow for sharing a home with relatives. Over one third (35.7%) established direct linkages with psychiatric treatment resources (in addition to those related to their housing) to help with their ongoing care and support. A substantial portion (28.6%) also were connected to community resources including SSI, Medi-Cal, a payee to help manage their finances, and other forms of tangible support. Other goals that were facilitated through IHOT program participation included restoration of relationships with family that allowed for local and inter-state relocations, assistance with finding employment, and the initiation of substance abuse treatment. The San Diego County public mental health system was a component of the ongoing supports for 4 (28.6%) of those who successfully completed the IHOT program. We anticipate that the percentage of Engaged Phase participants who will successfully conclude their active involvement with the IHOT program due to establishing linkages with ongoing services and supports will increase since most (69.9%) of the participants and their families were still in the active Engaged Phase as of December 31,

18 J. Conclusion This report presented an empirical assessment of the initial year of implementing and operating IHOT within three select regions in San Diego County. Based on the first year of IHOT implementation, there has been strong interest by the community in accessing services with over 400 referrals received during the first year. Nearly a third of all referrals were for participants residing outside of the three regions currently participating in IHOT services, suggesting that substantial demand for IHOT services exists throughout San Diego County. Referrals came from many different organizational and individual sources, but family members represented the majority of referrals for all persons accepted into the Outreach Phase. Furthermore, family members often actively participated in the IHOT services throughout the Engaged Phase which speak to the importance of supporting and working with families of participants through the entire IHOT process. In addition to linking families and individuals with mental health resources, the IHOT program has connected individuals and families with a variety of services to promote participant s well-being, particularly resources related to housing, employment and health care assistance. The wide variation in the length of time required for participants to successfully transition through the IHOT Phases (i.e., 1 to 149 days from Outreach to Engaged and 23 to 287 days from Engaged to Successful Completion) highlights the unique and often challenging circumstances of each participant. The IHOT program appears to require substantial flexibility in the duration of time that IHOT team members work with participants in order to bring about the desired positive outcomes. During the first year of IHOT, we estimated that approximately ¼ (26.4%) of the persons accepted into IHOT may have also been potential Laura s Law candidates (s). Consistent with expectations that the s may demonstrate more disruptive outcomes, s exhibited higher incidences of psychiatric hospitalization and incarceration prior to entry into IHOT than those not likely to be Laura s Law candidates (). However, it is promising to note that similar percentages of s and (>40%) had successfully transitioned from the Outreach to the Engaged Phase. This indicates that the IHOT team was consistently able to establish direct working relationships with both s and. By the end of the first year, approximately 20% of those who had entered the Engaged Phase had successfully completed the IHOT program and had connected with other ongoing supports in the community. Relatively similar percentages of both s and successfully completed the IHOT program, another promising indication that the IHOT can bring about positive outcomes for persons who may otherwise qualify for involuntary intervention through Laura s Law. Results from the first year indicate that the IHOT program has brought positive outcomes for individuals who are receptive to services, as well as those that are more resistant, including those who may otherwise qualify for involuntary interventions. In the upcoming year, we will continue to monitor, evaluate, and improve the IHOT program in order to achieve the overall goal of connecting individuals with ongoing community supports. 14