NC START Lisa Wolfe NC START East Director August 9 2010 Reinventing Quality Conference Baltimore MD
Who is eligible for NC START? At least 18 years of age Confirmed developmental disability diagnosis Co-occurring mental illness and/or challenging behaviors NC START services are provided based on the team s review of individual needs, situation, and assessment information.
Regional NC START Program Staff Regional Director 1.0 FTE Community-Based Clinical Team 2.0 FTE Regional Respite Director 1.0 FTE Community-Based Clinical Team 2.0 FTE Psychologist 0.5 FTE Psychiatrist 0.1 FTE Respite Counselors
Where NC START Services are available Cherokee NC-START WEST Provider RHA LME Western Highlands Graham Clay Swain Macon Haywood Jackson Trans Madison Buncombe Yancey Mitch Avery McDowell Henderson Rutherford Polk Watauga Ashe Caldwell Burke Cleve land Alleg. Wilkes Alex. Catawba Lincoln Gaston Iredell Meck. Surry Yadkin Davie Rowan Cabarrus Union Stokes Forsyth Davidson Stanly NC-START CENTRAL Provider Easter Seals UCP LME Durham Center Anson Rockingham Guilford Randolph Granville Montgomery Moore Richmond Caswell Alam. Scotland Chatham Orange Hoke Lee Person Durham Harnett Cumberland Wake Warren Vance Franklin Johnston Sampson Nash Wilson Greene Wayne Duplin Halifax Northampton Edgecombe Lenoir NC-START WEST Provider RHA LME ECBH Pitt Jones Onslow Hertford Martin Bertie Craven Gates Beaufort Pamlico Wash. Carteret Tyrrell Hyde Dare Robeson Bladen Pender - NC START Clinical Teams - Mobile - NC START Respite Homes Columbus Brunswick New Han
Interface with LME Affiliation Agreements with all LMEs in each region Problem solving and brainstorming interventions and resources around challenging individuals Review challenging cases and incidents
Interface with community providers Case Management support for both DD and MH services Resources Connections and Relationships Processes for accessing services First Responder consultation Creation of Crisis Plans with interventions to prevent and respond to crises for enhancement of PCP Training around interventions and services
Interface with MCM Training for supporting challenging individuals with DD Consultative support in intervening in a crisis Consultative assistance in locating the appropriate LOC Assistance in development of the crisis plan Best Practice: routine meeting/conversations between MCM and NC START and LME reps
Interface with community hospitals 2010-2011 Goal for NC START Teams Provide information (behavior, interventions, and placement options for discharge) about individual which may impact willingness to admit Need assistance from the LME s to enhance these relationships
Interface with state hospitals NC START involvement requested but not required prior to exception being granted. Hospital and NC START communicate and plan regarding any new admission with IDD Clinical and Case Management interface and communication during LOS Discharge planning Respite may assist with transition/step down from hospital
Interface with DD Center Affiliation Agreements in process NC START can assist with completing admission process/paperwork Participation in Clinical Team Meetings Assist with transition and discharge planning to link with community resources (ideally refer to NC START 60 90 days prior to discharge date)
Key Points START is not a separate system, but focuses on establishing integrated service linkages START does not replace current First Responder services (or any element of system), but serves as a secondary clinically-based support for individual, First Responders and other providers START emphasizes crisis prevention through knowing high-risk individuals, involvement in developing crisis plans, and training and technical assistance
Active Caseload 350 300 250 332 200 281 150 100 158 50 58 0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Quarterly Updates (Calendar Year)
Gender 39% Male Female 61%
Individuals Age at time of Referral 1% 17% 24% 18-21 years of age 22-45 years of age 46-65 years of age 66 + years of age 57%
Residential Setting at Time of Referral 35% 30% 25% 33% 32% Percentag 20% 15% 10% 10% 9% 5% 0% 5% Community ICF/MR Supervised Group Living Supported Living 3% AFL Independent Living Apartment/Ho 5% Family Home Foster Care Home 1% 1% 1% Homeless, Sheltered Homeless, Unsheltered Other Type of Residence
Funding Source 5% 1% 39% CAP MR/DD Waiver Medicaid (Non-CAP) State Funds Other 56%
Level of Intellectual Disability 2% 4% 4% 11% 45% Mild Moderate Severe Profound Not Specified None 35%
Psychiatric Diagnosis at time of Percent of Individuals Ser 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Depressive Disorder 12.05% 9.64% Psychotic Disorder/Schizophren Mood Disorder (not depressive or bipolar 30.42% Referral Bipolar Disorder 14.16% Anxiety Disorder Pervasive Developmental Disor 7.53% 9.34% 7.53% Personality Disorder Diagnosis Substance Abuse 1.51% Impulse Control Disorde 20.18% 20.48% Other
Medical Diagnosis at time of 25.00% Referral 20.00% 20.48% 19.28% Percentag 15.00% 10.00% 9.94% 10.24% 7.53% 15.06% 14.16% 6.63% 5.72% 5.00% 4.22% 3.31% 0.00% Allergies Constipation Dental Problems Diabetes GERD High Cholesterol 2.11% Hypertension Medication Reaction 0.60% 0.00% Obesity Pregancy Seizure Disorder Sleep Disorder Thyroid Disease Other Undetermined 0.90% Medical Diagnosis
Prior Psychiatric Hospitalizations 36% 43% One or More in the Past Year One or More in the Past One to Five Years None in the Past Five Years 21%
Reason for Referral 25.00% 21.91% 20.00% 17.79% 17.13% Percentage of Even 15.00% 10.00% 13.67% 12.36% 6.10% 7.25% 5.00% 2.14% 0.00% Physical Aggression Verbal Aggression Thereats of Physical Aggressio Mental health Symptoms Sucidal Behavior Reason for Referral Property Destruction Self-Injurious Behavio Other
Time Crisis Call Received 6.67% 20.56% Business Hours After Hours Weekends/Holidays 72.78%
Disposition of Crisis Calls Link to Community Resource 2.22% Referral out for Services 2.22% Disposition of Ca State Psychiatric Hospital Community Psychiatric Unit 3.89% 10.56% Crisis Respite 15.56% Maintain Current Setting 65.56% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% Percentage of Total Crisis Calls
Individualized Planned Services and Supports Other 3.47% Clinical Team Staffing 3.36% Psychiatric Hospital Transition Support 3.27% Planned Respite - Community 4.78% Type of Service Phone Consultation Person Centered Planning Meeting Support Comprehensive Assessment Information Gathering Individualized Non-Family Caregiver Education 3.70% 3.91% 22.68% 29.67% Family Support and Education 2.55% Developmental Center Transition Support 0.89% Behavior Support Planning Meeting 2.47% Cross Systems Crisis Planning Meeting 19.26% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% Hours of Service
Systems Outreach and Training 60.00% 56.23% 50.00% Hours of Service 40.00% 30.00% 20.00% 10.00% 0.00% LME Mobile Crisis Targeted Case Management 11.65% 7.23% 8.34% 5.72% 2.70% 2.97% 1.99% 0.47% 1.04% 0.39% 0.37% 0.79% 0.10% MH Provider DD Provider Developmental Center Hospital ED Psychiatric Inpatient Provider Other Health Care Provider Family Members Other Natural Supports Police/Emergency Responder DSS/Social Services Other Community Partner Audience
Reason for Crisis Respite Admission Other 11.65% Step Down/Transition from Acute Care/Higher Level of Care 10.68% Reason for Admiss Self-Injurious Behavior Property Destruction Suicidal Behavior 4.85% 4.85% 9.71% Threats of Physical Aggression 17.48% Physical Aggression 40.78% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% Percentage
Reason for Crisis Respite Admission 9% 11% Hosptial Diversion Transition from Hospital Other 80%
Thank you very much! Questions????