Direct Care and Treatment

Transcription

1 Direct Care and Treatment Chuck Johnson Deputy Commissioner 1 Direct care and treatment Most mental health services in Minnesota are provided in the community by a variety of health care organizations. But for people who need a higher level of care and cannot be served by other providers, DHS provides safety net services. Minnesota Department of Human Services mn.gov/dhs 2 1

2 Who we are Direct Care and Treatment includes: Mental Health and Substance Abuse Treatment Services (MHSATS) Community Based Services (CBS) Forensic Services Minnesota Sex Offender Program (MSOP) The $56 million Phase I expansion of the Minnesota Security Hospital in St. Peter is now complete. Funding for a planned $70.3 million Phase II is included in Governor Dayton s 2017 bonding request. 3 Facilities statewide Community Behavioral Health Hospitals (CBHHs) Anoka Metro Regional Treatment Center (AMRTC) Minnesota Security Hospital (MSH) Community Based Services (CBS) 4 2

3 Organization chart 5 Who we serve Individuals with complex, co existing conditions, including: Severe and persistent mental illness Personality disorders Substance abuse disorders Developmental disabilities, traumatic brain injuries and related conditions Other serious illnesses and physical health conditions Individuals whose conditions have brought them in contact with the criminal justice system Individuals participating in court ordered sex offender treatment DCT staff help clients to live and work in the most integrated settings possible. 6 3

4 Budget narrative pages Mental Health and Substance Abuse Treatment Services Community Based Services Forensic Services Minnesota Sex Offender Program Direct Care and Treatment Operations 7 Mental health services We provide mental health services in inpatient hospitals and residential settings Programs include: Anoka Metro Regional Treatment Center (AMRTC) Community Behavioral Health Hospitals (CBHHs) Child and Adolescent Behavioral Health Services (CABHS) Intensive Residential Treatment Services (IRTS) Minnesota Intensive Therapeutic Homes (MITH) Forensic Services including: MN Security Hospital (MSH) Forensic Transition Services Forensic Nursing Home Competency Restoration Program Number of Individuals Served FY2016 MITH, 24 Forensics, 531 IRTS, 226 AMRTC, 345 CBHHs, 496 CABHS,

5 Substance abuse services We provide inpatient and outpatient substance abuse treatment across the state Number of Individuals Served FY2016 Locations include: Anoka Brainerd Carlton Fergus Falls St. Peter Willmar Willmar, 206 St. Peter, 107 Fergus Falls, 238 Anoka, 194 Brainerd, 194 Carlton, 80 9 Community based services We provide community based services for individuals with developmental disabilities Services include: Residential group/individual homes Number of Individuals Served FY2016 Residential, 505 Vocational, 798 CSS, 450 Vocational services Community Support Services (CSS) Dental services Dental,

6 Sex offender treatment We administer the Minnesota Sex Offender Program Programs include: Secure treatment located at Moose Lake and St. Peter Community Preparation Services (CPS) located at St. Peter Number of Individuals Served CPS, 89 Program discharges: 7 clients provisionally discharged and living in the community 6 clients have provisional discharge orders and are awaiting housing 1 client has been fully discharge St. Peter, 301 Moose Lake, Spending in FY 2016 $416.1 million Mental Health & Substance Abuse Treatment Services $103.0 million Community Based Services $114.6 million Minnesota Security Hospital and other Forensic Services $82.2 million Minnesota Sex Offender Program (MSOP) $82.9 million DCT Operations $33.4 million 12 6

7 DCT Goals for Funding in the 2016 Session 2. Aid movement through the system 1. Improve clinical capacity and quality Strengthen DCT system 3. Stabilize funding 4. Other DCT priorities 13 Improving capacity, quality and movement 1. Improve clinical capacity and quality Increase psychiatric beds within DCT Improve safety and treatment at MSH MSOP reforms 2. Aid movement through the system Expand Transitions to Community initiative Manage corporate foster care 14 7

8 Stabilize funding 3. Stabilize funding DCT operating adjustment Fund MSOCS deficiency 15 Improving capacity, quality and movement Priority Requested Received Requested Received More DCT psychiatric beds $28.1 million $19.8 million $64.7 million $47.9 million Improved safety and $22.3 million 0 $76.6 million 0 treatment at MSH MSOP Reforms $4.4 million 0 $3.8 million 0 Expand Transitions to $1.1 million 0 $6.3 million 0 Community Initiative Manage corporate foster care $1.7 million 0 $10.7 million

9 Stabilize funding Priority Requested Received Requested Received DCT operating adjustments $14.9 million $14.9 million $22.9 million $22.9 million Fund MSOCS deficiency $28.0 million $28.0 million Funding request for FY $165.2 Million What we requested last session $70.7 Million What we received last session 18 9

10 Progress at MSH The problem Placed on a conditional license on Dec. 22, 2011 Conditions extended in 2013 and 2014, following other incidents 19 Progress at MSH The progress Fully licensed New licensing standards More patient centered focus Better staff training Improved safety for patients and staff 20 10

11 Progress at AMRTC The problem Out of compliance with federal regulations involving patient, care, safety and hospital operations At risk of losing federal funding 21 Progress at AMRTC The progress Hired an SIA project manager Hired an expert consultant to analyze problems and develop a corrective action plan. Hired a compliance consultant to implement the plan and monitor progress 22 11

12 Progress on capacity and quality Staffing six regional CBHHs to maximize bed capacity at 16 beds/cbhh Opening new Competency Restoration Program in St. Peter, MN Staffing up CABHS facility in Willmar, MN. Moving patients to more integrated settings Increasing efforts to recruit and retain health care professionals Improving orientation onboarding and ongoing staff training 23 Progress on staff safety 24 12

13 MSOCS funding stability Operating deficiency for : $28 million Factors driving budget overruns Banded rates cannot be adjusted up or down more than 0.5 percent annually. Residential vacancies Low vocational services rates 25 MSOCS funding stability Steps we re taking Increasing rates residential crisis homes Converting intermediate care facilities to adult foster care Consolidating group homes Consolidating vocational programs Targeted discharges 26 13

14 Fiscal trends, drivers and pressures 48 hour law requiring our mental health facilities to accept clients from jail Overtime costs system wide Increased Workers Compensation costs system wide Clinician turnover, which results in increased costs for contract staff Requirements under Olmstead, Positive Support Rule, Jensen Settlement and three year review of all individuals civilly committed as mentally ill and dangerous Staffing at the Minnesota Security Hospital in St. Peter remains below staffing levels maintained in similar facilities in other states 27 Overtime AMRTC 35,000 AMRTC OT Hours Pay Period End Dates to OT Hours Total Hours Worked % of OT Hours of Total Hours Worked Linear (% of OT Hours of Total Hours Worked) 12.00% 30, % 25,000 20,000 15,000 10,000 5, % 5.72%5.77% 5.46%5.47%5.40% 4.49% 4.20% 4.64% 3.53% 2.71% 3.05% 3.15%2.58% 2.00% 2.24%2.31% 1.83% 1.24% 2.90% 10.00% 8.00% 7.53% 6.00% 6.31% 6.17% 5.81% 5.26% 4.00% 1/12/2016 1/26/2016 2/9/2016 2/23/2016 3/8/2016 3/22/2016 4/5/2016 4/19/2016 5/3/2016 5/17/2016 5/31/2016 6/14/2016 6/28/2016 7/12/2016 7/26/2016 8/9/2016 8/23/2016 9/6/2016 9/20/ /4/ /18/ /1/ /15/ /29/ /13/ /27/ % 0.00% 28 14

15 Overtime forensics 70,000 60,000 50, % 6.42% 6.69% 40,000 30,000 20,000 10,000 Forensic Treatment Services OT Hours Pay Period End Dates to OT Hours Total Hours Worked % of OT Hours of Total Hours Worked Linear (% of OT Hours of Total Hours Worked) 5.48% 5.62% 5.45% 4.79% 5.01% 4.93% 4.73% 4.32% 4.07% 7.63% 6.18% 7.01%7.01% 6.77%6.43% 5.52% 4.52% 6.19% 5.81% 7.97% 5.56% 5.73% 9.00% 8.00% 7.00% 6.68% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% % 1/12/2016 1/26/2016 2/9/2016 2/23/2016 3/8/2016 3/22/2016 4/5/2016 4/19/2016 5/3/2016 5/17/2016 5/31/2016 6/14/2016 6/28/2016 7/12/2016 7/26/2016 8/9/2016 8/23/2016 9/6/2016 9/20/ /4/ /18/ /1/ /15/ /29/ /13/ /27/ Fiscal trends, drivers and pressures Staff recruitment and retention is a persistent problem Community Preparation Services program at MSOP requires more staff, bed capacity and placement alternatives to meet steadily growing demand as clients move into the final stages of treatment Much needed security upgrades to facilities Phase II bonding projects at MSH and MSOP Electronic health records systems upgrades 30 15

16 Questions? 31 16