Unity Center for Behavioral Health Christiane Farentinos, VP Unity

Unity Center for Behavioral Health Unique collaboration between Legacy, OHSU, Adventist Health and Kaiser to provide services to the region Community-wide effort (city, counties, state, payers, EMS, police, mental health and addictions providers- more than 30 participating agencies) Facility licensed under Legacy Emanuel Medical Center 102 inpatient beds (80 adult beds, 22 adolescent beds) Adult Psychiatric Emergency Service (45-50 pts/day) Strong Peer support built into structure of Unity Built-in space for Community Providers to help navigate handoffs from Unity to community treatment and resources

Our Mission We deliver excellence in patient care, teaching and discovery, creating a pathway to hope, community and recovery. The right care at the right time. Our Values Patient and family centered Safety for all Trauma informed Collaboration Shared responsibility Compassion Education and innovation 3

Our Leaders Lori Morgan, MD, MBA, President EMC Linda Jones, Chief Nurse EMC Chris Farentinos, MPH, CADC II, VP Unity Greg Miller, MD, MBA, Chief Medical Officer Kari Howard, Director Patient Care Juliana Wallace, LCSW, CADC III, Director Unity Services 5

What is different about our model? Model of hospitality, hope and recovery Trauma informed care/ recovery centered De-criminalization of mental illness Remove police from transporting behavioral health patients 24/7 access to psychiatric care Intentional design for transitions of care Peer support specialists part of the skill mix Culturally competent care 6

Transitions of Care Family or friends bring in Self check-in Legal help Unity Crisis evaluation, stabilization, short-term inpatient care Security officials refer Peer support Housing Community Partners Medical care Transitions of Care Cascadia Behavioral Health, Central City Concern, LifeWorks Northwest, NAMI Oregon, Folktime, Mental Health Assoc of OR, DePaul Treatment Centers, Alliance for Culturally Specific Programs, Albertina Kerr Centers, ColumbiaCare, FamilyCare, TeleCare Corp., Western Psych, Health Share, and others Family counseling Treatment plan & follow up Addiction treatment Ambulance transport Job assistance Inpatient treatment Counseling & therapy

Unity Culture 11

Trauma Informed Care The umbrella over Unity s Culture

What is Trauma Informed Care? Trauma Informed Care recognizes that traumatic experiences can: terrify, overwhelm, and violate an individual Trauma Informed Care is a commitment not to repeat these experiences and in any way possible restore a sense of: safety power self worth 13

Adverse Childhood Events Study https://www.cdc.gov/violenceprevention/acestudy/index.html Household Abuse: Dysfunction Emotional 10% Mother treated Physical 26% violently 13% Sexual 21% Mental illness 20% Neglect: Emotional 15% Physical 10% Substance abuse 28% Parental separation or divorce 24% Household member

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Trauma Informed Policies & Practices at Unity Use of cell phones and personal devices in adult units to give more control Visiting Hours are 9 am to 9 pm Option to keep personal clothes in the PES and units Open Nursing Stations Peer support Harm Reduction Specialists Quality Committee working on culture development and seclusions and restraints reduction 16

INTEGRATION OF PEER SUPPORT AT THE UNITY CENTER

Peer Support Programs at Unity What Programs are available? Peers in the PES Peer Bridgers NAMI 18

Folktime First Quarter 2017 Data Peers in the PES Total number of Individuals supported in PES Program: 271 Total number of individual interactions in the PES program: 566 Average Number of Hours of Peer Support provided per individual served in PES: 1.82 Hours Average Number of Encounters provided per individual served in PES: 2.09 encounters Average Length of Stay for Individuals who interacted with a Peer Support in the PES: 26.12 Hours Number of Groups Held: 22 (Yoga, Games, Drawing, and conversation groups occurred ad hoc as dictated by needs and interests of the milieu) 19 Number of individuals referred to another peer support program: 113

Folktime First Quarter 2017 Data: Peer Bridgers Total number of individuals supported in Bridger Program: 19 Number referred by PES: 4 Number referred by Inpatient: 3 Number self-referred: 12 Number of individuals whose services concluded: 9 Number of individuals referred to another peer support program: 7 Location of Services: 20

Folktime First Quarter 2017 Data Cross-program statistics: Percent of individuals who interacted with a peer that did not return to Unity in the 60 days following their most recent discharge within the quarter: 70.90% Number of Folktime Resource Groups held: 9 21

Unity and our Community 22

Unity Transportation Workgroup Meeting since spring 2015 Members AMR, Metro West, PPB, Project Respond, ED medical directors including Providence, Centerstone, EMS Medical Directors (plus Fire Department, Clackamas EMS and Law Enforcement, Gresham Police) Goals To engage PPD and other districts in changing their work flow to transport individuals in a MH crisis (voluntary and involuntary) by ambulance To develop ambulance dispersal plan post Unity opening To inform OAR rule change to allow ambulances to function as secure transport 23

Law Enforcement and Unity Partnerships with North Precinct (Commander King, and Sargent Phillip Blanchard) and with BH Unit (Lieutenant Tashia Hagar) Early experience Lessons learned Stories Next steps 25

Unity Behavioral Health Forensics Workgroup Started in the summer of 2016 Members: Jean Dentinger (Multco Pre-commitment manager and Forensics Diversion), John McVay (Multco Parole and Probation), Glen Rairden (Lead Security Officer Unity), Sarah Radcliffe (DRO), Barb Snow (Project Respond), Tashia Hager (BH Unit PPB), Greg Miller (CMO Unity), Anne Gross (PES medical director), Juliana Wallace (Director Unity Services), Judge Cheryl Albrecht (Mental Health Court). Goals Understand interface between BH and Forensics system Recognize the best intercept points in the forensics system Test work flows for jail diversion of individuals with BH needs Accomplishments 26

Unity Transitions of Care Workgroup Members Goals To create an intentional design for transitions of care through three models Co-location In reach Coordinated referrals Accomplishments Co-located with CareOregon, Western Psychological, NAMI, Mutco Intensive Transition Team and ABC team, FamilyCare, Kaiser, Columbia Care, Lifeworks NW, Cascadia ED divert team, ICP teams 27 In reach De Paul, NARA, All ACT teams, CCC, Outside In

Bennett Garner, MD Family Care, Medical Director Transitions of Care Workgroup Karissa Smith, LPC, CADC I Family Care, Adult BH Lead Chris Farentinos Legacy VP, Unity Rochelle Pegel Health Share OR, UR Coordinator for Mult County Becky Wilkinson Legacy Outreach Worker Mark Lewinsohn Lifeworks NW, VP Clinical Services Nancy Benner Adventist Social Work Lead Holly Friesz LifeWorks NW, Rapid Respnse Team clinician Naiyana Cruz Adventist, Clinic Administrator, OP Beh Health Emily Parkwell LukeDorf Mult Co, Adult Care Coord Program Sup Sara Hatch Adventist Albertina Kerr Andrea Quicksall Nancy Griffith Holden Leong Asian Health and Service Center, Executive Director Abbey Stamp Mult County, Corrections Health Division Director Mult County, Exec Director, Local Public Safety Coordinating Council Diane Bocking-Byrd CareOregon Barb Snow Cascadia, Manager, Project Respond Charmaine Kinney Leticia Sainz Rhonda White, QMHP Cascadia, Manager, Urgent Walk-in Clinic Patricia TenEyck Mult Co, Crisis Services Manager NAMI Mult Co Executive Director Dave Kohler Cascadia, Senior Director, Outpatient Services Jackie Mercer NARA, Executive Director Alexandra Leichter Cascadia, ITT Program Sup Shannon Farr Jennifer Wilcox Cascadia, Manager, Intake Access Lakeesha Dumas Peer, Folktime Peer, African American Health Coalition Alex Drilling Cedar Hills, Interim Director of OP Services Kristen Downey Providence, (Robin's designee) Kathleen Roy Central City Concern Larry Betcher Providence Alison Noice CODA Brian Thompson, LCSW Providence, UR in IP Psych unit (Emily York's husband) Nirmala Dhar State of Oregon, Older Adult Beh Health Coordinator Ben Solheim Columbia Care, ICM Melinda Howard Telecare, Administrator, CATC & Community Triage Lindsey Maclean De Paul Kathleen Trebb VOA, Division Director Erica Edwards De Paul, ED Outreach Worker Jeff Olsgaard Sarah Radcliffe Disability Rights of Oregon, Staff Attorney Tia Barnes Western Psych Youth Move Oregon Lauren Conn Youth Move Oregon Jennee Edwards Mult County 28

Unity by the Numbers 29

PES LOS May 2017 PES - 5/1-5/31 AVG LOS Median LOS GeoMean LOS All PES Patients 24hr 34min 20hr 24min 12hr 17min Admitted PES Patients 38hr 30min 31hr 53min 31hr 51min Discharged PES Patients 21hr 42min 17hr 27min 10hr 50min Data extracted 6/7/2017 LEGACY HEALTH 30

PES arrivals May 2017 LEGACY HEALTH Day 1-May 2-May 3-May 4-May 5-May 6-May 7-May 8-May 9-May 10-May 11-May 12-May 13-May 14-May 15-May 16-May 17-May 18-May 19-May 20-May 21-May 22-May 23-May 24-May 25-May 26-May 27-May 28-May 29-May 30-May 31-May Grand Total Average ED Arrivals 23 28 27 24 28 27 22 22 29 24 27 25 22 22 28 22 32 31 20 24 21 25 30 30 37 26 26 10 30 17 25 784 25 31

PES May 2017 Dispo and Arrival Method Patient s Discharge 546 Admit 181 LWBS before Triage 26 Transfered to Another Facility 18 LWBS after Triage 8 AMA 3 Registration Error 2 Total 784 Percent Admitted 23% PES Dispo Average daily visits = 25 Discharge from triage = 103 (13%) ALOS 2 hours April average = 21 Data extracted 6/7/2017 LEGACY HEALTH Arrival Method Car Secure Transport Ambulance Walk Taxi Police Public Transportation Other Hospital Transport Total 32 Arrival % s 269 34.31% 158 20.15% 112 71 70 35 14.29% 9.06% 8.93% 4.46% 34 4.34% 31 3.95% 4 0.51% 784

PES May 2017 time of arrival Hour 00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 Grand Total Data extracted 6/7/2017 LEGACY HEALTH Arrivals 19 15 10 16 9 15 8 12 15 22 41 33 35 50 67 48 59 60 54 59 46 36 22 33 784 33 % 2.42% 1.91% 1.28% 2.04% 1.15% 1.91% 1.02% 1.53% 1.91% 2.81% 5.23% 4.21% 4.46% 6.38% 8.55% 6.12% 7.53% 7.65% 6.89% 7.53% 5.87% 4.59% 2.81% 4.21%

Trending PES daily visits 34

PES May 2017 Point of origin Transfer Type ED Visits Origin Location ED Visits Non-Transfer 612 Walk-In/Other 614 Medical ED Hospital medical unit 154 Legacy Emanuel Medical Center 64 Grand Total 784 Data extracted 6/7/2017 18 Legacy Good Samaritan Hospital 26 Legacy Mount Hood Medical Center 18 OHSU Hospitals & Clinics 17 Adventist Medical Center 12 Legacy Meridian Park Hospital 9 Kaiser Sunnyside Medical Center 8 Kaiser Westside Medical Center 6 Tillamook Regional Medical Center 4 Legacy Salmon Creek Hospital 2 Tuality Community Hospital 2 LEGACY HEALTH 1 35

PES Percent admitted for each point of origin Origin Location Legacy Emanuel Medical Center Legacy Good Samaritan Hospital OHSU Hospitals & Clinics Adventist Medical Center Legacy Meridian Park Hospital Legacy Mount Hood Medical Center Kaiser Sunnyside Medical Center Kaiser Westside Medical Center Columbia Memorial Hospital Providence Milwaukie Hospital Tillamook Regional Medical Center Legacy Salmon Creek Hospital Tuality Community Hospital Grand Total Data extracted 6/7/2017 LEGACY HEALTH Admit 29 10 10 9 6 6 2 2 Discharg XFE e R 33 1 15 1 7 0 3 0 3 0 11 1 6 0 4 0 Total % 64 26 17 12 9 18 8 6 45% 38% 59% 75% 67% 33% 25% 33% 100 % 100 % 25% 0% 0% 23% 1 0 0 1 1 0 0 1 1 0 0 181 3 1 2 546 0 1 0 18 4 2 2 784 36

Inpatient LOS and ADC May 2017 May Discharges AVG LOS Median LOS GeoMean LOS All IP Admissions 14d 3hrs 8d 8d 16hrs 91 Unit 6 Admissions 14d 18hrs 11d 11d 15hrs 96 PES - 5/1-5/31 AVG LOS Median LOS GeoMean LOS Inpatient Data May 91.1 ADC A Median LL IP Maxim um Unity Year-to-Date (April 1, 2017 through June 11, 2017) Inpatient Discharges Actual 476 Data extracted 6/7/2017 Budget 839 % 56.7% Average Length of Stay* Actual Budget 14.65 LEGACY HEALTH 7.89 % 185.6% Average Daily Census Actual 93 Budget 94 % 98.9% 37

Adolescent Program Unit 6 6/20/17 LEGACY HEALTH 38

Unt 6 Dispo, ADC and average LOS Adolescent Program DC Dispo Disch to Home or Self Care Other Facility (Step Down, Transitional Housing, Hooper House) Hospital-Acute Care (OHSU, Other Legacy Facility) Grand Total UBH UNIT 6 34 May ADC Median 6 Onl y Maximum 18.4 19 20 5 2 41 May Discharges AVG LOS All IP Admissions 14d 3hrs Unit 6 Admissions Data extracted 6/7/2017 LEGACY HEALTH 14d 18hrs 39 Median GeoMean LOS LOS 8d 8d 16hrs 11d 11d 15hrs

Homelessness and Unity 6/20/17 LEGACY HEALTH 40

Data extracted 6/9/2017

Seven Day Follow-Up P E R C E N T 3/6/2017 6/11/2017 HTP P BH 7-Day Follow-Up Per Unit 3/6/2017 6/4/2017 By Week 45

Thank you! 46