Correctional Health Services (6300B)

Transcription

1 5-80 Program Locator County Health Heath Services Agency Correctional Health Services Headline Measures 80% 60% 40% 20% 0% 80% 60% 40% 20% 0% Percent of Mentally Ill Inmates Engaging in Treatment by Receiving Medications 63% % 40% 40% 40% Estimate Percent of Offenders Receiving Timely Historicals and Physicals Estimate Juv eniles 80% Adults 94% Program Outcome Statement Correctional Health Services provides comprehensive and timely physical health, mental health and chemical dependency treatment services to the incarcerated population of San Mateo County, thus contributing to the health and safety of the community as a whole. Services and Accomplishments Correctional health services provided to residents of the Maguire jail system and Hillcrest juvenile hall include physical health, which begins with an initial health assessment including screenings for communicable and chronic diseases and mental illness; mental health care services including evaluation, treatment and crisis intervention services; and chemical dependency treatment services. The Lifeskills program and Options project are two primary programs for work with the seriously mentally ill inmates. Lifeskills provides sub-acute day treatment services for the incarcerated mentally ill, and Options provides intensive community support to mentally ill offenders who are released with supervised probation. The Choices program, which provides intensive chemical dependency treatment in a therapeutic community, has been very successful in reducing the rate of recidivism among participants. A study conducted in 2000 revealed that females completing Choices were 2.7 times less likely to have been arrested, convicted, incarcerated or picked up for probation violations than those who dropped out of the program. A similar study for the men s facility is in progress. The following are major accomplishments in the current year: Maintained accreditation in the adult detention facility services beyond State Title 15 requirements by the Institute of Medical Quality (IMQ) since 1998, distinguishing San Mateo County as one of the best correctional health programs in California Successfully completed intensive case management and dual diagnosis clinical services in the three-year Options project funded by a Board of Corrections grant Expanded Choices total beds from 104 to 126 with no additional counseling staff Developed a suicide prevention program for the Sheriff s correctional facilities Decreased Emergency Room usage from 179 visits in 2001 to 79 visits in 2003 Decreased the number of inpatient hospital days from 316 in 2001 to 198 in 2003 Story Behind Baseline Performance The mentally ill are protected by law from involuntary treatment except for the rare patients who meet strict criteria as gravely disabled pursuant to the Lanterman Petris Short Act (LPS). A major goal of working with this population in the correctional facilities is to engage them in voluntary treatment that will continue when they are

2 5-81 released. Headline Measure 1 indicates that approximately 40% of mentally ill inmates are currently engaging in treatment by receiving medications. Budgetary reductions will result in the loss of two to three acute care beds currently leased from Santa Clara County. These beds have allowed initiation of treatment for many mentally ill inmates who are reluctant to comply. The impact is that the current performance level will be difficult to maintain. An important program goal is to complete medical histories and screenings within 96 hours of incarceration for juveniles and by the 14 th day of incarceration for adults, which is being achieved of the time as shown in Headline Measure 2. From this initial assessment, a plan of care that includes consideration of all aspects of the patient s health-related needs is initiated. The number of seriously mentally ill inmates continues to increase in fact, the Maguire facility is now considered the largest treatment facility for the seriously mentally ill in the County. This in turn drives up the cost of providing services due to the cost of medications and the increased intensity of services required. In addition, the majority of services provided by Correctional Health Services are not reimbursable by health insurance or other State and Federal funding. In FY , approximately 86% of the Correctional Health Services budget represented Net County Cost. Continuing budget reductions have had a tremendous impact on the level of physical and mental health services Correctional Health is able to provide to inmates. This includes the possibility of losing accreditation for health services in the Maguire facility, and termination of the Options program for seriously mentally ill inmates beginning April 1, 2004 due to elimination of State funding. Major challenges over the next two years will be: To maintain Institute of Medical Quality (IMQ) accreditation while absorbing additional budget reductions Develop methods of reducing time necessary to complete required physicals Develop methods of reducing time necessary to complete required TB assessments Review accreditation standards to determine which nonessential standards can be avoided without jeopardizing overall accreditation Participate in the Development of New Juvenile Facility Attend planning meetings and provide input to architects and program planners Increase Community and Funding Support for Therapeutic Community, Jail-Based Programs Continue to present educational workshops at State forensic health conferences Continue to invite correctional staff from other counties to visit the Choices program Continue to offer information and assistance to other counties wanting to start similar programs Program Priorities Correctional Health Services will meet performance targets by doing the following: Perform of Histories and Physicals in a Timely Manner Complete juvenile exams within 96 hours of incarceration Complete adult exams by the 14 th day of incarceration Maintain the Number of Mentally Ill Inmates Engaging in Treatment by Receiving Medications At a Minimum of 40% Increase efforts within the Lifeskills program to encourage acceptance of medications by mentally ill participants Increase efforts to engage mentally ill inmates in treatment Maintain 80% Completion Rate in Choices Program Monitor completion rate and provide periodic feedback to counselors to maintain 20% turnover rate Maintain Jail Accreditation Meet the health care component of Title 15 standards at both facilities Continue to prepare Hillcrest for accreditation

3 5-82 Performance Measures Summary Table Performance Measures FY FY FY Estimate FY FY What/How Much We Do Number of histories and physical screenings 3,917 3,906 3,820 3,672 3,700 Number of mentally ill inmates 1,100 1,585 1,785 1,500 1,500 How Well We Do It (Quality) Percent of participants who complete the Choices Program 80% 83% 80% 80% 80% Is Anyone Better Off? (Outcome) Number and percent of mentally ill inmates engaging in treatment by receiving medications 693 / 63% 668 / 42% 718 / 40% 725 / 40% 725 / 40% Percent of offenders receiving timely histories and physicals: - Juveniles (within 96 hours of incarceration) - Adults (by the 14 th day of incarceration) 80% 94% Number and percent of aggressive incidents in Choices Program compared to overall jail population: - Choices - Maguire 291 / 2% 293 / 2% 272 / 2% 300 / 2% 0/0% 300/2% Resource Allocation Summary Revised Change Salary Resolution (1.0) 54.0 Funded FTE (2.6) 50.7 Total Requirements 5,016,775 5,271,316 5,249,797 5,325,320 75,523 5,503,184 Total Sources 1,453, , , ,409 75, ,409 Net County Cost 3,562,928 4,387,162 4,409,911 4,409,911 4,587,775 NCC Breakdown Mandated Services 4,191,428 4,191,428 4,263,655 Non-Mandated Services 218, , ,119

4 Program Net County Cost The portion of this program s FY which is funded by the General Fund or Net County Cost (NCC) is $4,409,911 or 82.8%. Of this amount, 93% is Mandated Services with no specified maintenance-of-effort (MOE) requirements. FY Program Funding Adjustments The following are significant changes from the FY Revised Budget to the FY : 1. Adjustments to Provide Current Level of Services Budget adjustments have been made as follows: inclusion of merit increases and negotiated labor increases; increase in Extra Help and Overtime to reflect actual use requirements in a 24/7 operation; adjustments in contracts including an increase in the Santa Clara inpatient psychiatric contract; decrease in the cost of drugs and pharmaceuticals assuming implementation of the 340B program; savings realized from lower than anticipated inpatient and outpatient clinic utilization; and decreased revenue from Inmate Welfare Trust accounts , ,862 0 (117,472) 242, Adjustments to Fund Balance Fund Balance has been increased based on updated year-end projections. 51, (51,017) 0 3. Reductions in Staffing A filled Medical Service Assistant II (MSA) position has been deleted and FTE decreases for a Senior Psychologist and a Supervising Mental Health Clinician have been made. The MSA position provides direct patient care and support for the nursing staff; eliminating this position will preclude assistance to inmate patients who require assistance with activities of daily living, place greater burden on the nursing staff for routine work, and cause delays in responding to routine health service requests from inmates. The FTE reductions (a total of 0.4 FTE reduction for the two positions combined) will result in less oversight and supervision for the CHOICES program and 0.2 FTE less staff availability for mental health services. 23,112 (121,599) 0 0 (144,711) (1) 4. Reductions in Dental Services The dental services contract is reduced from two days per week to one, which will cause delays in providing care and reduce dental services to an emergency care basis only. 0 (47,268) 0 0 (47,268) 0 TOTAL FY PROGRAM FUNDING ADJUSTMENTS 75, ,995 0 (117,472) 0 (1)

5 5-84 FY Program Funding Adjustments The following are significant changes from the FY to the FY : 5. Adjustments to Provide Current Level of Services Budget adjustments have been made as follows: inclusion of merit increases and higher benefit costs ,329 (44,465) 0 177,864 0

6 5-85 General Fund FY and Budget Unit Summary Revised Change SOURCES Intergovernmental Revenues 831, , , , , ,141 Charges for Services Interfund Revenue 431, , , ,048 (78,606) 366,048 Miscellaneous Revenue 24,658 60,602 39,302 39,302 39,302 Total Revenue 1,287, , , ,920 24, ,920 Fund Balance 166, , , ,489 51, ,489 TOTAL SOURCES 1,453, , , ,409 75, ,409 REQUIREMENTS Salaries and Benefits 5,123,782 5,360,795 5,380,041 6,032, ,022 6,254,392 Services and Supplies 1,499,929 1,779,732 1,652,287 1,469,850 (182,437) 1,469,850 Other Charges 193, , , ,599 (276,590) 441,599 Gross Appropriations 6,817,004 7,248,813 7,750,517 7,943, ,995 8,165,841 Intrafund Transfers (1,817,177) (1,994,446) (2,618,192) (2,618,192) (2,662,657) Net Appropriations 4,999,827 5,254,368 5,132,325 5,325, ,995 5,503,184 Contingencies/Dept Reserves 16,948 16, ,472 (117,472) TOTAL REQUIREMENTS 5,016,775 5,271,316 5,249,797 5,325,320 75,523 5,503,184 NET COUNTY COST 3,562,928 4,387,162 4,409,911 4,409,911 4,587,775 AUTHORIZED POSITIONS Salary Resolution (1.0) 54.0 Funded FTE (2.6) 50.7

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