Northwest Crisis Care System (NCCS) Overview

Illinois Department of Human Services
Division of Mental Health

September 10, 2012

Guiding Principles

  • Services are Recovery-Oriented
  • Services are Trauma-Informed
  • Services and system must be outcome-validated
  • Individuals can recover more fully in their communities
  • Region 2W and 3N providers are best informed to plan the system of care for its residents
  • State hospital has a continuing role in the continuum of care

Planning Approach and Method

  • Extensive data review and analysis
  • Community and stakeholder engagement
  • Clinical Focus groups
  • Requests for Information
  • Implementation protocol
  • Systems monitoring protocol

Community & Stakeholder Engagement was directed by DMH, the Governor's office and The Mental Health Rebalancing Advisory Workgroup

Hospitial Engagement

  • Dan Neal (formerly FHN)
  • David Deopere (Trinity Medical Center)
  • Michael Pelletier (DMH)
  • Dennis Beedle, MD (DMH)

Service Models & Innovation

  • Jim Sarver (Sinnissippi) 
  • Don Miskowiec (North Central Behavioral Health Services)
  • Dan Wasmer (DMH)
  • Amparo Lopez (DMH)
  • Jordan Litvak (DMH)

Community Education & Support

  • John Shustitzky (The Chgo School of Psychology)
  • Lora Thomas (NAMI)
  • Gustavo Espinosa (DMH)
  • Amparo Lopez (DMH)
  • Patricia Reedy (DMH)

Service Financing & Payment Methodology

  • Ben Stortz (Cornerstones Services, Inc)
  • Lynn O'Shea (AID)
  • Brock Dunlap (DMH)

Systems Performance & Outcomes Assessment

  • Mary E. Smith (DMH)

Messaging Media & Legislative Liaison

  • Janet Stover (IARF)
  • Pat Knepler (DMH)
  • Debra Ferguson (DMH)

SINGER MENTAL HEALTH CENTER VOLUME INDICATORS FY06 ~ FY12

FY Budgeted Beds Adms Homeless Adms. Unfunded Adms. First Time Adm to State Hosp. Unduplicated Served Patient Days Average Daily Census Patient Days/ Avg Daily Census ALOS
# % # % # % # % %
2006 76 869 167 19.2% 554 63.8% 330 38.0% 640 73.6% 29,434 80.59 106.0% 29.9
2007 76 734 125 17.0% 515 70.2% 301 41.0% 584 79.6% 26,739 73.21 96.3% 37.4
2008 76 724 137 18.9% 478 66.0% 298 41.2% 577 79.7% 26,815 73.42 96.6% 55.4
2009 76 858 155 18.1% 598 69.7% 381 44.4% 682 79.5% 26,432 72.37 95.2% 34.0
2010 76 861 122 14.2% 615 71.4% 438 50.9% 708 82.2% 26,892 73.63 96.9% 30.0
2011 76 845 118 14.0% 557 65.9% 430 50.9% 788 93.3% 25,910 70.99 93.4% 25.2
2012 76 396 82 20.7% 257 64.9% 183 46.2% 368 92.9% 20,263 55.52 73.0% 31.3

Governor's Rebalancing Advisory Workgroups

Six strategic Committees were formed and empanelled. The committees and their mission/function are as follows:

  1. Hospital Engagement - Mission: Assist the state in determining the scope, types, amounts, locations and rates for hospital based care.
  2. Service Models & Innovations - Mission: Assist the state in determining the appropriate scope, types, amounts and locations of services for enhancement in the region. In addition, assist the state in developing and planning for the implementation of innovative service interventions.
  3. Community Education & Support - Mission: Assist the state in planning for the education of consumers and providers as the system changes, and to identify and plan for workforce development needs.
  4. Service Financing & Payment Methodology - Mission: Assist the state in defining new payment models for financing the community service enhancements and innovations recommended by Committees 1 & 2.
  5. System Performance & Outcomes Assessment - Mission: Assist the state in determining the most appropriate methodology and metrics for evaluating effectiveness of system reforms and restructuring efforts.
  6. Messaging, Media & Legislative Liaison - Mission: Assist the state in developing appropriate messages, and interface with the members of the General Assembly on restructuring issues.

Workgroups informed plan elements required for rebalancing

  • Community-based hospital inpatient psychiatric services (CHIPs);
  • Enhanced Crisis Response Services
  • Centralized 800 line for authorization and utilization management;
  • Intensive Mental Health Crisis Residential services;
  • Enhanced Community treatment services (Rule 132);
  • Community Support Team (CST) services;
  • Transportation;
  • Safety Net State-operated inpatient services.

Expert Clinical Focus Groups: Method

  • Convened multidisciplinary team of experts in community mental health and substance abuse treatment;
  • Identified top 10 diagnostic groupings and presented clinical case studies of each;
  • Team of experts identified optimal service array for each grouping.

Expert Clinical Focus Group Results:

  • Approximately 65 % of the individuals represented by the clinical typologies used for the clinical review team service projections met admission criteria for inpatient level of care.
    • Of these, approximately 40% would require longer term community based inpatient care which was defined as 30 or more days.
  • Approximately 71% of the individuals represented by thetypologies who were not projected to require inpatient care would require observation (up to 48 hours); and the majority of these individuals would require crisis residential services followed by an intensive level of outpatient ambulatory care (within the rule 132 array).

Requests for Information (RFI)

  • Published on July 26, 2012 with purpose of purchasing community-based inpatient and outpatient alternatives to services provided at
  • Singer Mental Health Center.
  • Responses were due August 13, 2012.
  • 16 proposals received
    • 6 Hospital providers (two both CMHC & Hospital)
    • 9 DMH community mental health providers (two both CMHC & Hospital)
    • 1 Transportation provider
  • 14 proposals accepted
    • 8 DMH community mental health providers
    • 5 Hospital providers

Hospital Providers for CHIPs

  • Swedish American Hospital, Rockford
  • Rockford Memorial Hospital Rockford
  • OSF St. Elizabeth's, Ottawa
  • Trinity Medical Center, Moline
  • Provena Mercy Center, Aurora

Awarded Mental Health Providers for :

Enhanced Crisis response (EDAs) & Acute Community Service Providers (ACS)

  • Ben Gordon Center, DeKalb
  • Bridgeway, Inc, Galesburg
  • FHN- FCC, Freeport
  • Stepping Stones, Rockford - Awarded for special services
  • North Central Behavioral Health, LaSalle
  • Robert Young Center, Rock Island
  • Rosecrance, Rockford
  • Sinnissippi Center Inc., Dixon

A Team Approach to Recovery

Goals

Develop a crisis system to engage individuals presenting at all Northwest Crisis Care Systems Emergency Departments (EDs) and select community sites

  • Provide timely and accessible assessment - Enhanced Crisis Response (aka EDAs) to EDs and utilizing mobile teams for in-community evaluations MHCs;
  • Provide community treatment alternatives to the consumers - Leverage and/or purchase access to MH Crisis residential, Community based Inpatient care (CHIPs), community based mental health services Acute Community Services (ACS), entry to state operated hospital;
  • Rapidly triage and transport consumers to appropriate levels of care

Authorization Protocol

  • After evaluation and consultation, Evaluator contacts authorizing agent (ACCESS line)
  • Evaluator describes clinical condition and makes level of care recommendation
  • Level of care determination is made based on medical necessity ;
  • If there is concurrence with ACCESS on LOC determination, ACCESS authorizes service and
  • transportation as appropriate;
  • If there is a denial by ACCESS, the Evaluator and the ED re-assess options;
  • If Evaluator and ED appeal the denial, ACCESS has @1 hour to arrange for MD final review.

Levels of care: service definitions:

CHIPS - Access to Inpatient beds; For acute psychiatric conditions;

Crisis Residential - Community Crisis stabilization;MD/RN supervised; 24/7/365; 

Enhanced Community Supports Full access to Rule 132 services Post ED care w/in 24 hours; Post discharge care w/in 72 hours

Eligibility Criteria

Level of Care Critieria
General
  • Present in an Emergency epartmetn or in the definded geographic area of Region 1 South
  • Be an Illinois Resident
  • Be uninsured, with o other resource for needed treatment interventions;
  • Have a prelininary diagnosis of mental illness or mental illness and substance abuse;
  • Have a Level of Care recommendation of 4 or higher based on a Level of Care Utilization System (LOCUS) assessment completed following presentation in the ED and based on psychiatric presenting condition;
  • Be athorized for services through the DHS/DMH or its agent.
CHIPs
  • A Level of Care recommendation of 4 or higher based on a Level of Care Utilization System (LOCUS);
  • Diagnosed with seriouse mental illness (SMI);
  • Exhibit acute behaviors or symptoms requireing the imeediat services of an impatient setting;
  • Those Illinois residents meeting clinical eligibility requiremenst and in specific financial need as defined as under 200% Federal poverty level (FPL) as found at http://aspe.hhs.gov/poverty/12poverty.shtml;
  • Agre to the Level of Care recommendation or evaluated as meeting the criteria for an involuntary psychiatric admission.
Crisis Residential
  • A level of Care recommendation of 4 or higher based on a Level of Care Utilization System (LOCUS);
  • A primary psyhchiatric diagnosis or symptoms requiring crisis stabilization services;
  • Requires short-term continuous supervision, tratment and residential support activities in a Provider controlled facility operating 24 hour, seven days a week crisis beds;
  • Provides a rapid response service focused on assessment, diagnosis, therapeutic, intervention and stabilization of the presenting psychiatiric crisis.
Acute Community Service (ACS)
  • Have a preliminary diagnosis of mental illness or mental illness with co-0ccuring substance abuse;
  • Can benefit from enhanced community-based mental health services tailored to meet the unique needs of the individuals for avoiding more restrictive and expensive mental health services, such as hospitialization or residential treatment;
  • Agree to the Level of Care recommendation;
  • Authorized for services through DHS/DMH or its agent.

Behavioral health consultative expertise to EDs

Collaboration by Community Providers to ED's and select community sites:

  • Evaluate and recommend the appropriate level of care;
  • Assist in crisis intervention and case management;
  • Determine eligibility for Northwest Crisis Care System (NCCS) program;
  • Facilitate authorization to appropriate level of care as purchased for the Northwest Crisis Care
  • System (NCCS);
  • Facilitate safe transportation to next level of care as purchased by DMH;
  • Facilitate registration and enrollment into Northwest Crisis Care System (NCCS) to insure Acute
  • Community Services (ACS) package.

Acute Community Services - ACS

All enrolled and authorized persons discharged from Inpatient or Residential services are eligible to receive ACS.

Persons may be determined eligible for ACS as a diversion

service from the ED or community site.

ACS provides:

  • Grant Payment structure
  • Allows agency to directly provide or subcontract services to most appropriate treatment agency
  • Full provider flexibility to deliver clinically indicated treatment service which could include: any 132 service, any 2060 service, medications, transitional services, as determined by agency MHA

Role of State Hospitals

  • SOH admissions for significant targeted population groups as examples
    • persons with extended acute care needs.
    • persons with readmission profiles.
    • persons who are experiencing homelessness.
  • Access to purchased inpatient, residential levels of care and ACS;

Implementation Protocol

  • Reorganized internal project management structures corollary to Advisory Group structure (SPRINT)
  • Implementation Committees
    • Contracts
    • Policy
    • Workforce Development
    • Roll out (Communications)
    • Hospitals and Operations

Implementation

  • Singer Mental Health Center closure
  • Admissions close October 1, 2012;
  • Purchased Community Services will commence;
  • Recent Medical records will move to Elgin MHC;
  • Finalization of securing inventory and buildings.

Systems Monitoring Protocol

DMH to take "snapshot" of systems performance currently measuring:

  1. Admission rates
  2. Readmission rates
  3. Consumer Perception of Care
  4. Emergency Department wait times
  5. Deflection Rate
  6. Transportation response times

DMH will track these and other indicators at 6, 12, 18 months.

Advisory group structure will transition to DMH Systems Re-Balancing Quality Improvement Committee

Provider issues phone line and email established (312) 814-0930dhs.R2CCS@illinois.gov

Training Opportunities

MEETING TITLE: Region 2 West Crisis Care System Consumer & Family Education

DATE: Tuesday September 11, 2012

TIME: 1:00pm-2:30pm. Please dial in no earlier than 12:45pm

DIAL-IN NUMBER: (866) 871-4877

CONFIRMATION NUMBER: 259493

INTENDED AUDIENCE: CONSUMERS and FAMILIES

The purpose of this call is to provide individuals who might previously have been served by Singer Mental Health Center in a time of psychiatric crisis with information on the new Northwest Crisis Care System. This will include a description of services available as well as instructions on how to access those services.