Behavioral Health Division JPS Health Network

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Felix Shaw
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1 Behavioral Health Division JPS Health Network

2 Macro Trends 1 in 5 Adults in America experience a mental illness Diversion of Behavioral Health patients from jail Federal Prisons Mental Illness State Prison Local Jail 45% 45% 56% 56% 64% 64% Workforce Shortage Inpatient psychiatric bed capacity

JPS Behavioral Health JPS Health Network offers robust Behavioral Health

2016 Behavioral Health volumes: 20,000 psychiatric emergency visits 2,800

(4,126) 39,000 psychiatric inpatient days (43,093) 5,900 partial

80,000 depression screenings PCP Our Behavioral Health Team: 525 Team Members

Psychiatric NP s / PA s 18 Psychiatry Residents 5 Psychologists Seven

Two psychiatric hospitals (96 and 36 beds) Integrated Medical Unit Six

health schoolbased clinic Four partial hospitalization programs Day rehab for

3 JPS Behavioral Health JPS Health Network offers robust Behavioral Health services Behavioral Health volumes: 20,000 psychiatric emergency visits 2,800 psychiatric observation days (2,526) 3,700 inpatient psychiatric admissions (4,126) 39,000 psychiatric inpatient days (43,093) 5,900 partial hospitalization days (6,468) 28,500 psychiatric outpatient visits (36,396) 80,000 depression screenings PCP Our Behavioral Health Team: 525 Team Members 60 Master s Level Clinicians 9 Peer Support Specialists 20 Psychiatrists 17 Psychiatric NP s / PA s 18 Psychiatry Residents 5 Psychologists Seven Behavioral Health focused 1115 Waiver Projects Psychiatric Emergency Center Two psychiatric hospitals (96 and 36 beds) Integrated Medical Unit Six behavioral health clinics Walk in behavioral health clinic Three behavioral health schoolbased clinic Four partial hospitalization programs Day rehab for the homeless Virtual Behavioral Health Clinical Guidance Eight primary care clinics with embedded behavioral health specialists Eight Peer Support Specialists Psychiatry residency program

4 JPS Behavioral Health Services

Psychiatric Emergency Center Emergency Psychiatric Services : 24 hours a day, seven days a week Psychiatrist on site at all times Voluntary and involuntary patients Psychiatric evaluation Short term

5 Psychiatric Emergency Center Emergency Psychiatric Services : 24 hours a day, seven days a week Psychiatrist on site at all times Voluntary and involuntary patients Psychiatric evaluation Short term interventions including observation, stabilization, and monitoring 23 Hour Psychiatric Observation Admission to JPS inpatient services Referral services CONTACT:

6 Psychiatric Emergency Center (continued) 4,000 Psychiatric Observation Days PEC Arrivals ,500 3,000 2,500 3,064 3, ,000 1,500 Voluntary % Involuntary % 1,

TSP - Adult Inpatient Services 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 43626 38938 29125 30839 31453 24354 21721 21999 20073 22024 13261 13513 2006 2007 2008 2009 2010 2011 2012

7 TSP - Adult Inpatient Services *2017 Crisis intervention and individualized, structured treatment are provided to patients in need of an intensive and safe setting. Three units totaling 80 acute adult beds

TSP Adolescent Inpatient Services 900 Adolescent Inpatient Admissions 800 700 600 500 400 542 721 726 810 736 594 645 529

8 TSP Adolescent Inpatient Services 900 Adolescent Inpatient Admissions The Adolescent Inpatient Unit is a 16 bed acute care unit.

Trinity Springs North JPS originally opened 20 beds under contract with MHMR/DSHS for to offset the reduction in NTSH beds available in Tarrant County.

9 Trinity Springs North JPS originally opened 20 beds under contract with MHMR/DSHS for to offset the reduction in NTSH beds available in Tarrant County. In December the number of contracted beds increased to 30. Trinity Springs North is a new 36 bed inpatient psychiatric facility that opened in January In April the number of contracted beds increased to 32. In September the number of contracted beds decreased to 28.

10 Mental Health Court Mental Health Court is held in TSP twice weekly. MHMR provides two staff members who serve as court liaisons between TSP, MHMR, the North Texas State Hospital, to ensure the transfer of patients and the commitment process occurs smoothly for all parties involved.

11 Behavioral Health Discharge Management Reducing psychiatric hospital readmission 2014 Bill Aston Quality Award 12% 10% Annual Percent 30 Day Readmissions 11.6% 11.2% 10.4% Community needs addresses Increase access to mental health services Improve integration of mental health treatment in primary care Reduce inappropriate use of emergency department services Increase care coordination 8% 6% 4% 6.6% 8.0% 7.6% 7.8% 7.4% 6.6% Triple Aim Improve quality of care Improve populations health Reduce cost 2% Research outcomes to be presented at the American Public Health Association Annual Conference in October 0% State 30 Day Readmits Tarrant County 30 Day Readmits 2012* * JPS Readmits 9

12 Patient and Family Centered Care Peer support specialists are increasingly involved in behavioral health services. JPS has eight peer support specialists in the psychiatric emergency center, inpatient, and rehab settings. The JPS Patient and Family Advisory Council is a group of people who express interest in helping JPS improve our services. These partners assist with: identifying priority areas for JPS to address partner in performance improvement projects assist in setting policy and giving input into the impact current policies have on patients and families.

13 Pop Quiz What is the average time between the experience of the first symptoms of a mood disorder to initiation of treatment? Wang, et al., Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry Oct; 6(3): y

14 Behavioral Health Outpatient Services Partial Hospitalization Medication Management Assessment Psychological Testing Psychology Counseling Vocational Rehab Central Arlington Behavioral Health Northeast Health Center Stop Six Health Center Viola Pitts Health Center School Based Health Center Hemphill Behavioral Health HEB Behavioral Health Day Rehab for the Homeless Healing Wings Medical Home Southeast Tarrant Centralized Behavioral Health Scheduling:

15 JPS Behavioral Health Outpatient Visits *2017

16 JPS Behavioral Health PHP Patient Days * PHP Patients 2015 PHP Patients PEC Visits 12 Months Pre PHP Admit 115 PEC Visits 12 Months Post PHP Admit Inpatient Admits 12 Months Pre PHP Admit 11 Inpatient Admits 12 Months Post PHP Admit

17 Pop Quiz What percent of suicide victims had contact with primary care providers within 1 month of suicide? Luoma, J., Martin, C. E., and Pearson, J. L. Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence. American Journal of Psychiatry June; 159(6):

18 JPS Behavioral Health Integration Model Monthly Information Packets Practice Agreements Best Practice Advisories Face to Face CME s Evidence based library Shared care plan Multidisciplinary Case Conference Shared Patient Lists Information Sharing Integrated Planning Integrated JPS Integrated Service Delivery Bi Directional Screening Group Visits Embedded BH Specialists Virtual Psychiatric and Clinical Guidance Diabetes Education Classes PHQ 9 SBIRT Tobacco Use HbA1c LDL

19 Integrated Service Delivery Locations

20 Depression Screening in Primary Care 90,000 80,000 Over 200,000 Depression Screens!! 80,927 70,000 71,777 60,000 50,000 55,399 40,000 30,000 20,000 23,398 10,

21 Depression Remission at Twelve Months Baseline 2015 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 Jun 16 Jul 16

22 JPS Behavioral Health Locations What percent of patients with mood disorders receive minimally adequate treatment in general medical settings? Wang, P. S., et al., Adequacy of Treatment for Serious Mental Illness in the United States. American Journal Public Health. 92(1):

23 Virtual Psychiatric and Clinical Guidance

Virtual Psychiatric and Clinical Guidance Primary care providers

practice medication algorithms within 30 minutes.

Education Treatment Plan Recommendations Community Resources

Health Expertise Use of Evidence Based Protocols 100% 100% 80% 91.

24 Virtual Psychiatric and Clinical Guidance Primary care providers can speak with a psychiatrist about evidence based and best practice medication algorithms within 30 minutes. 12% 12% 6% 6% Medication Information 24% 40% Differential Diagnosis Education Treatment Plan Recommendations Community Resources Therapy Resources Provider Satisfaction with Access to Behavioral Health Expertise Use of Evidence Based Protocols 100% 100% 80% 91.60% 95.45% 80% 94.3% 93.5% 60% 60% 40% 40% 20% 0% 18.20% Baseline % 0% 6.3% Baseline

25 Behavioral Health Teaching Mission JPS Health Network is a teaching hospital training ~700 students yearly Residents: 18 Psychiatric Residents, Family Practice and Emergency Medicine Behavioral Health Clinical Rotation/Internship Site for Psychiatric Nurse Practitioner Students PhD Psychology Interns PhD Health Psychology UNTHSC Med Students Nursing Students MSW Students Counseling Students Physician Assistant Students EMT Students

Local Commitment Alternative Beds Jail MH Services Jail High Utilizer Pilot MH Court Liaisons PEC Liaison Embedded

26 MHMR Tarrant County We have a unique and close partnership with MHMR to, not duplicate, but to ensure there are no gaps in the continuum of care between our agencies. Local Commitment Alternative Beds Jail MH Services Jail High Utilizer Pilot MH Court Liaisons PEC Liaison Embedded Substance Abuse Counselors Home Visits for patients at high risk for readmission 1115 Waiver Billy Gregory Behavioral Health Day Rehab Location Integrated Care - Cypress Clinic and Circle Drive Clinic

27 Community Engagement We strive to serve Tarrant County as leaders in the community by connecting mental health resources with like minded agencies. Our team members have board/leadership roles with: Psychiatric and Substance Abuse Governing Council Behavioral Health Advisory Committee

28 What questions can I answer?

PSYCHIATRY SERVICES UPDATE

PSYCHIATRY SERVICES UPDATE Mark Leary MD, Interim Chief Kathy Ballou RN, Director of Nursing Anton Nigusse Bland MD, PES Medical Director Emily Lee MD, Inpatient Psychiatry Medical Director TRUE NORTH