in home outreach team north (ihot) - mental health systems · 2015-08-27 · 92111 linda vista...
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In Home Outreach
Team North (IHOT)
Description of IHOT North
• Short-term intervention designed to provide in-home outreach
and engagement services to individuals with behavioral health
challenges and their family members.
• Link participants with outpatient mental health services,
community resources, avoid unnecessary hospitalizations
and/or interaction with the criminal justice system and reduce
the effects of untreated mental illness.
Relationship building is the “key”
to successful linkage.
IHOT Composition
• Three agency collaboration made up of:
– Mental Health Systems (MHS)
– National Alliance of Mental Illness (NAMI)
– Union of Pan Asian Communities (UPAC)
• Teams consists of:
– Peer Support Specialist
– Family Specialist
– Case Manager
• Support Staff:
– Lead Clinician
– Consulting Psychiatrist
Eligibility Criteria for IHOT
Eligibility Criteria
• Adult individuals, 18 years and older, residing in San Diego
County. Family may live out of region.
• Identified person has serious mental health symptoms that
contribute to functional impairment in activities of daily living,
social relations and/or ability to sustain housing.
• Declines mental health services, may have sporadic contact
with an outpatient mental health program, but has discontinued
recommended treatment.
Eligibility Criteria Cont…
• Identified person had one, or more, of the following events in the
past year:
– Psychiatric hospitalization
– Psychiatric Emergency Room visit
– Police/PERT involvement
– Incarceration
IHOT North Coverage Area
IHOT North Coverage Areas
North Central
92037 La Jolla/Torrey Pines
92093 La Jolla East
92106 Point Loma
92107 Ocean Beach
92108 Mission Valley
92109 Pacific Beach
92110 Midway District/Linda Vista
92111 Linda Vista
92117 Clairemont
92119 San Carlos/Navajo
92120 Grantville/Del Cerro
92121 Sorrento Valley
92122 University City
92123 Serra Mesa
92124 Tierrasanta
92126 Mira Mesa
92130 Carmel Valley
92131 Scripps Ranch
92140 Marine Corp Recruit Depot
92145 MCAS Miramar
92161 UCSD/La Jolla
North Inland
92003 Bonsall
92004 Borrego Springs
92025 Escondido South
92026 Escondido North
92027 Escondido East
92028 Fallbrook/Rainbow
92029 Escondido West
92036 Julian
92059 Pala
92060 Palomar
92061 Pauma Valley
92064 Poway
92065 Ramona
92066 Ranchita
92069 San Marcos
92078 San Marcos
92096 San Marcos
92070 Santa Ysabel
92082 Valley Center
92086 Warner Springs
92127 Rancho Bernardo West
92128 Rancho Bernardo
92129 Rancho Penasquitos
92259 Ocotillo
92536 Agunda
North Coastal
92007 Cardiff by the Sea
92008 Carlsbad North
92009 La Costa
92010 Carlsbad East
92011 Carlsbad South/La Costa
92014 Del Mar
92024 Encinitas
92054 Oceanside
92055 Camp Pendleton
92056 Oceanside
92057 Oceanside
92058Oceanside/Camp Pendleton
South
92067 Rancho Santa Fe
92091 Rancho Santa Fe
92075 Solana Beach
92081 Vista South
92083 Vista Central
92084 Vista North
92672 San Clemente
Stages
• Referral
• Accepted into the IHOT program
• Outreach
• Engagement
• Short term intensive case management
– Needs assessment
– Service planning and coordination
– Individual and family goal planning
– Referrals and linkage to community resources, benefits and entitlements
Referrals
• This is the entry
point into the
program, the referral
is received, further
information gathered
and referred
individual is
assessed for
eligibility.
• Family member or loved ones
• Law Enforcement
• Jail System
• Las Colinas Detention Center
• Behavioral Health Units
• Hospital Emergency Departments
• Mental Health Programs
• Adult Protective Services / Senior
Teams
• NAMI or other advocacy agencies
• Optum Access and Crisis Line
Accepted & Outreach
• Accepted – Individual has been determined
to meet eligibility criteria.
• Outreach - Services begin to family (if
involved) and initial attempts are made to
engage individual.
Engagement
• Individual agrees to participate in IHOT services
– Successful outcomes of IHOT participants and their families include:
• Accessing and maintaining behavioral health treatment
• Obtaining safe and stable housing
• Obtaining employment assistance, medical care and benefits
• Enhanced boundary and limit setting
• Reconnecting with family or social supports
• Improved family communication skills
• Connecting to family support services (i.e. NAMI)
• Enhanced knowledge and ability to access emergency services
Whole Person Approach
• IHOT is based on a whole person approach which
recognizes that physical, mental and spiritual health
are interconnected, and recovery involves the whole
person.
• Alongside the participant, the team coordinates
participant’s care, including a primary care provider.
Whole Person Cont…
• IHOT teams also assist in identifying alternative
treatment options, if medication is not the chosen
method of treatment.
– Acupuncture
– Natural healing
– Spiritual healing
– Art therapies
– Other options dependent on beliefs and desires of the
participant
Psycho-education
• Clinical staff will lead medication groups and provide self-care
education.
– psychiatric symptoms
– treatment interventions
– techniques for relaxation and management of symptoms
– medication management strategies.
• Case Managers will lead resource groups.
• Upcoming… “Meet the Dr.” group that will meet monthly and be
at different locations throughout the county.
Psycho-education
• Peer Specialist facilitate monthly Peer lead support groups.
• Family Specialist run a bi-weekly family support group in English
and Spanish.
• Upcoming… Peer Specialist will be trained to provide weekly
WRAP classes for participants.
Goals of Service Delivery
• Participants and family members receive education about
mental illness, recovery, and accessing services and resources.
• Participants receive a substance abuse assessment during in-
home outreach.
• Participants receive an assessment of domestic violence issues
during in-home outreach.
• Participants shall be screened to determine the need for referral
to a primary care physician and referred for services when
appropriate.
Goals of Service Delivery
• 50% of family members will be linked the NAMI F2F class.
• 80% of family members will be able to identify one or more
coping mechanisms learned through the education provided.
• 75% of participants who complete enrollment phase will
experience greater satisfaction with life than at the beginning of
services.
Contact Information
Phone: 760-591-0100
Fax: 760-591-0101
Location: 365 Rancho Santa Fe,
San Marcos 92078
Office Hours 7am-7pm (everyday)
24 hour phone line
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