Continuity of Care SPOE October 24, 2006

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Continuity of Care / SPOEOctober 24, 2006
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Arthur Ashe

• What is the secret to becoming a Great Tennis
  Player ?
• Start where you are.
• Use what you have.
• Do what you can.

3
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
4
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
5
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
6
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
7
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
8
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
9
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
10
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
11
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
12
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
13
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
14
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
15
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
16
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
17
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
18
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
19
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
20
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
21
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
22
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
23
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
24
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
25
CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
26
Earlier comments

• Common Purpose
• Give and Take
• Bending and Adpating
• More Coordination
• We are all share responsibility for persons with
  Psychiatric issues in ERs despite structural /
  organizational barriers
• Improve the hand off

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OMH Continuity of Care Policy

• http//www.laomh.org/ContinuityofCare/index.htm

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Continuity of Care

• Informational Continuity Information is the
  common thread linking care from one provider to
  another and from one healthcare event to another.
  Information can be disease focused or person
  focused. Documented information tends to be on
  the medical condition, but knowledge about the
  patients preferences, values, and context is
  equally important for bridging separate care
  events and ensuring that services are responsive
  to needs.
• Management Continuity is especially important
  in chronic or complex clinical diseases that
  require management from several providers who
  could potentially work at cross purposes.
  Continuity is achieved when services are
  delivered in a complementary and timely manner.
  Shared management plans or care protocols
  facilitate management continuity, providing a
  sense of predictability and security in future
  care for both consumers and providers. In mental
  health care, continuity of contact (expressed as
  access) embodies the notion that regular contact
  is needed to ensure management goals are adapted
  and met and that providers must often facilitate
  access to a broad range of services. Flexibility
  in adapting care to changes in an individuals
  needs and circumstances is an important aspect of
  management continuity. When care is long term,
  both consistency and flexibility are critical for
  management continuity.

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Continuity of Care

• Relational Continuity bridges not only past to
  current care but also provides a link to future
  care. This is most valued in primary and mental
  health care. Even in contexts where there is
  little expectation of establishing ongoing
  relationships with multiple care givers, a
  consistent core of staff provides patients with a
  sense of predictability and coherence.
• Continuity of Care is achieved by bridging
  discrete elements in the care pathway whether
  different episodes, interventions by different
  providers, or changes in illness status as well
  as by supporting aspects that endure
  intrinsically over time, such as consumers
  values, sustained relationships, and care plans.
  Processes designed to improve continuity do not
  themselves equate to continuity. For continuity
  to exist, care must be experienced as connected
  and coherent.
• For consumers and their families, the experience
  of continuity is the perception that providers
  know what has happened before, that different
  providers agree on a management plan, and that a
  provider who knows them will care for them in the
  future.

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(No Transcript)
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• The significant role of SPOE is the management
  and integration of inpatient services within the
  array of community service alternatives. As
  such, it provides a geographic and administrative
  focus for service determination and appropriate
  utilization of resources.
• The SPOE is in the community, accessible 24 hours
  a day and seven days a week. Its role is to
  provide for prompt review of screenings,
  evaluations and assessments provided by multiple
  referral sources including private providers,
  Community Mental Health Centers and public
  agencies.
• The SPOE Coordinator will screen and provide
  referrals for admission to the OMH Distinct Part
  Psychiatric Beds and the OMH free-standing
  inpatient facilities.

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SPOE Coordinators

• Single Point of Entry
• Reg. 3 Pam Marcel
• Reg. 4 Adofo Harmon
• Reg. 5 Jenny Mills / Jaquita Jordan
• Reg. 6 Bart Liles
• Reg. 7 Amy Creel
• Reg. 8 Suzanne Hatcher
• MHSD Tom Elliott
• CAHSD Janet Roy
• FPHSA Sherry Sigler
• JPHSA Julie Burke

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CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
34
19
CMHC / SPOE
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Drop In Center
Home / Community Based Treatment
Assertive Community Treatment
Educational Services
35
19
CMHC / SPOE
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Drop In Center
Home / Community Based Treatment
Assertive Community Treatment
Educational Services
16
Private Facility
36
19
CMHC / SPOE
ER
Case Management
Acute Unit
Respite
11
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Drop In Center
Home / Community Based Treatment
Assertive Community Treatment
Educational Services
16
Private Facility
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19
CMHC / SPOE
ER
Case Management
Acute Unit
Respite
11
11
Housing
Mobile Assessment
Intermediate Care Hospital
Employment Assistance
Financial Assistance
Drop In Center
Home / Community Based Treatment
Assertive Community Treatment
Educational Services
16
Private Facility
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SPOE (based on 2005 survey)

• 19 CMHC to Acute Unit
• 16 Private Facility to Acute Unit
• 11 CMHC to Private Facility
• 11 Private Facility to Intermediate Hospital
• 9 Private referral to CMHC
• 9 Hospital to CMHC
• 7 CMHC to Intermediate Hospital
• 18 Other

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SPOE

• HANDOUTS
• What you need to provide to the SPOE when calling
  with a referral ?
• What can you expect the SPOE to do ?
• What will the SPOE do if no beds are available
  within the OMH system ?
• Who to call if there are problems or
• concerns ?

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SPOE

• Problem solving process
• Many SPOE issues can best be resolved at the
  local level
• Handouts indicate who to call if there are issues
  to be worked out if working with the SPOE has not
  proven successful
• Problem resolution should follow a progressive
  process moving up the chain of authority only as
  attempts at the local, regional, levels are
  unsuccessful in order to ensure that there is
  local ownership or responsibility, continuity of
  information, communication of concerns, efficient
  use of limited resources, timely local solutions
  and empowerment of local decision makers.

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CMHC
ER
Case Management
Acute Unit
Respite
Housing
Mobile Assessment
Employment Assistance
Financial Assistance
Home / Community Based Treatment
Drop In Center
Assertive Community Treatment
Educational Services
42
(No Transcript)
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Earlier SPOE Comments / Questions

• Cross regional coordination
• Common standards across regions
• Individuals referred to ER at 430 pm
• Issues with Private Hospitals relationships,
  communication, procedures / protocols.

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To Be Continued...

• Continuous engagement in treatment and
• recovery services is one of the most important
  aspects of addressing acute episodes of severe
  behavioral health problems and the ongoing
  disabilities associated with them.
• Processes designed to improve continuity do not
  themselves equate to continuity.
• For consumers and their families, the experience
  of continuity is the perception that providers
  know what has happened before, that different
  providers agree on a management plan, and that a
  provider who knows them will care for them in the
  future.
• Please work with and through your SPOE and
  Administrative structure to resolve issues
  locally when at all possible.