Jail Health Services Lisa A. Pratt, MD, MPH Director / Medical Director Jail Health Services Title Subtitle 1 1
Health Commission Director of Health Finance Policy & Planning Human Resources Information Technology Coordination of Division Initiatives Security Communications Compliance & Privacy Affairs Managed Care & Patient Finance Ambulatory Care Environmental Health Community Health Equity & Promotion Zuckerberg San Francisco General Primary Care Disease Prevention & Control Public Health Emergency Preparedness & Response Laguna Honda Hospital Behavioral Health Emergency Medical Services Office of Equity & Quality Transitions Jail Health Office of Ops, Finance & Grants Mgmt. Center for Learning & Innovation Maternal, Child & Adolescent Health Applied Research, Community Health Epidemiology & Surveillance Center for Public Health Research Bridge HIV 2
JHS Organizational Structure Jail Health Services Medical Behavioral Health Re-Entry & HIVIS Dental Pharmacy 3
JHS Budget FY 2014-2015 Operating Budget Salaries & Benefits 23,967,272 Professional & Specialized Services 3,641,078 Includes BHS, X-RAY, Podiatry, UCSF OBGYN Pharmaceuticals 2,478,792 Material & Supplies 624,680 Other Expenses 297,102 $ 31,008,924 4
JHS Staffing 163 FTE Nurse Managers 3.0 Psychologist 1.0 RNs 61.6 Therapists 20.0 LVNs 25.0 Counselors 4.0 MD/NPs 12.6 Pharmacists 3.0 Administration 4.0 Pharm Technicians 5.0 Support Staff 14.0 Dentist 1.4 5
Who is in the SF Jail? Total unique patients in 2015: 15,000 Current average daily census: 1,250 86% of people in SF Jail have not been sentenced 14% are serving a sentence 7-14% Seriously mentally ill Average length of stay 65% less than 7 days 18% 7-30 days 16% 30 days or more Sex and Gender Identity 86% are men; 14% are women (SFSD) 78% men, 13% women, 10% declined to answer (JHS) Trans Women 61, Trans Men 17 Source: Jail Information Management System 6
SF Jail Entry 2009-2016 35000 30000 28,776 25000 25,037 24,233 23,741 23,695 20000 15000 21,033 17,912 16,402 16,566 17,249 21,029 20,032 15,005 14,441 10000 5000 0 FY 09-10 FY 10-11 FY 11-12 FY 12-13 FY 13-14 FY14-15 FY15-16 Triage Intake 7
Race/Ethnicity 2015 Unknown 3% Native American 1% Other 2% Asian/Pacific Islander 8% African American 36% Latino 16% White 34% 8
Care in the Jail Triage Acute: ZSFG ED/PES Intake Subacute: BHS evaluation, psychiatry referral, substance use detox, primary care -> specialized housing Chronic care: primary care, psychiatry and mental health services, dental services Referral RN assessment 9
2015 JHS Encounters Medical Services Triage 20,333 - ED Referrals 613 Intake screening 14,417 Nursing visits 31,144 Clinician visits 25,187 Dental visits 2,016 Pharmacy fills 194,000 10
Behavioral Health Services Evaluation Evidence-based individual and group therapy Medication management Assessment and referrals to community treatment Substance abuse assessment and treatment Reentry Services Crisis Intervention 11
Behavioral Health Services Stabilization and Reentry: Comprehensive mental health evaluation 6,567 Psychiatry visits 4,258 Group therapy visits 27,397 Individual therapy visits 18,810 Reentry planning visits 6,894 Crisis Intervention: 5150 hold at the jail 465 Admission to 7L 330 12
HIV & Integrated Services Screening and Prevention 2015 8,900 tests done PrEP and PEP overdose education Condom and naloxone distribution Center of Excellence 2015 HIV Medical Care 339 patients Medical Case Management 127 patients Psychosocial assessment Medication adherence support Discharge planning 13
JHS Innovative Programs Substance Use Treatment Methadone and Buprenorphine Prenatal, Intrapartum and Post-Partum Support UCSF OB/GYNs Birth Justice Project Clinical Pharmacist-Managed Clinics Hepatitis C treatment with direct-acting antivirals Reentry Programming Misdemeanor Behavioral Health Court Mentoring and peer support program (MAPS) Transitional Age Youth services 14
Opportunities - BHS Medication Management Continuity of medication Increased number of prescribers Stratification Tools Screening instrument to determine level of care Validated suicide assessment tool Psychiatric Sheltered Living Units Strengthen stabilization and community transition programs Develop individual treatment plans for group therapy 15
Opportunities Expand public health surveillance and treatment Initiate and coordinate medication-based relapse prevention therapies Expand HIVIS model to medically complex patients Medical case management and supported continuity Integrate HIVIS and BHS re-entry programs Sharing resources and best practices Formalize linkage opportunities across healthcare and social service entities 16