TAO Discharges and the MORS (2/1/10-1/31/11)

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1 Is TAO (Telecare and Orange) providing the appropriate services to the members that it serves? What evidence based practices or interventions can be put into practice to better serve the members? Was there a high level of engagement between the program and discharged members? These are a few of the crucial questions that can be answered when analyzing the discharges at the program. As Graph A illustrates, out of the 29 discharges for quarter 1 and 2 of fiscal year 2010/2011 (July-December) at TAO 6 members were return admissions, partnership has been re-established with 2 and they are current members. The tenure amongst each discharged member varies but for the period that was analyzed the average tenure was 446 days. During the period analyzed, TAO had an average enrollment of 230 members per month.

2 When analyzing discharges by month, it is important to look for any variances from month to month. If any are discovered the program can develop strategies to implement so that it can better prepare for when its members might be going through difficult times. For example, as Graph B illustrates there were 19 discharges in quarter 2 with 9 of those in the month of November. Why were the majority of discharges during this quarter? Could it be due to the holidays? Do members tend to be more symptomatic around this time? Most important of all is what can the program do to improve its services and provide better support to its members around this time? A high level of engagement by the program s staff, as well as TAO s Peer Mentor Group is a strategy that the program will implement in the future to better prepare to provide support to its members. During the period analyzed, TAO served an average of 235 members per month including discharges and admissions.

3 For discharged members, the Discharge Reason options that the program has available are set by the State. There are 7 options varying from a member being deceased to a member serving a jail sentence. Some of the categories along with the tenure that are important for the program to analyze are Partner Decided to Discontinue FSP Partnership, MIA (missing in action), and Target Population Criteria Are Not Met. TAO has a 60-day assessment period for new admissions; Graph C illustrates what the average tenure was for members discharged for each reason. For members that were discharged due to the reason Target Population Criteria Are Not Met as Graph C illustrates, these members were in the program almost 3 times as long (186 days) on average. This is important because the program is able to determine if the services that can be provided at TAO are the services that the member needs. Along with a discharge reason, TAO also tracks what the discharge destination was upon discharge. For the 4 members that decided to discontinue partnership, the program was able to link them to a private psychiatrist upon discharge so that they may still receive mental health services. This is also important for members that move to another county or service area. The program was able to link 4 out 5 members that fell into this category to mental health services in their new service area. The 5th member that falls in this category was incarcerated before he or she was linked to mental health services in their new service area.

4 During a member s tenure at TAO their diagnosis may change. In some cases when the diagnosis changes the program is able to determine if TAO can provide the proper services that a member needs. As Graph D illustrates there were 6 members that had a primary substance abuse diagnosis at discharge. These members were discharged with the reason Target Population Criteria Are Not Met because the program is designed to serve adults with a severe mental illness diagnosis.

5 Table A: MORS Scores for Discharged Members During FY 10/11 Quarter 1 and 2 MORS Category MORS Score 1. Extreme risk 2 2. High risk/not engaged 6 3. High risk/engaged 7 4. Poorly coping/not engaged 9 5. Poorly coping/engaged 0 6. Coping/rehabilitating 1 7. Early recovery 2 8. Advanced recovery 0 MIA - N/A - Other 2 The Milestones of Recovery Scale (MORS) is a tool that TAO utilizes to try to get an idea of where a member is along his or her recovery journey. The MORS is an assessment that is administered on a monthly basis. It is based on the 2 weeks prior to when the assessment is being administered. As Table A illustrates the MORS has 8 categories or scores ranging from 1 - Extreme risk to 8 - Advanced recovery. The further along a member is in the recovery journey the higher the MORS score they tend to have.

6 How does TAO get a sense of where a member is along their recovery journey upon discharge? One of the ways that TAO tries to answer this very important question is by giving a MORS assessment to members upon discharge. As Graph E illustrates the majority of members that were discharged during the period analyzed had MORS Scores of 3 High risk/ engaged (7 members) and 4-Poorly coping/not engaged (9 members).

7 With a full-time Substance Abuse Specialist on staff, TAO has the ability to provide services to members with co-occurring disorders of severe mental illness and substance abuse diagnosis. As Graph F illustrates 66% or 19 of the members that were discharged during the period analyzed had a co-occurring disorder diagnosis. This information is very important because TAO is able to track not only how many members are have a co-occurring disorder but also if they are utilizing substance abuse services to help them on their recovery journey. By analyzing this data TAO is also to determine what evidence based practices can be implemented to better serve these members.

8 As Graph G illustrates 38% or 11 members were receiving SSI or SSDI benefits at discharge for the period analyzed. Out of the 18 that were not receiving SSI or SSDI benefits, 3 had secured a protected date meaning that a decision on whether they qualified or not was pending.