Older Adult Intensive Program Full Service Partnership

Bernice Zaborski, MHA

Presented at theIntegrated Services Conference

April 5, 2006

Objectives

To understand fundamentals of an Older Adult Full Service Partnership Review of Sacramento County MHSA process

and determination of older adult needs Identify the basic program design of an Older

Adult Intensive Program Identify the core components of an Older Adult

Intensive Program Discuss older adult system of care and

relationship to full service partnership program

Sacramento County MHSA Structure

Mental Health Kick-Off May 2, 2005 Participants included consumers, family members,

mental health providers, advocates, senior service providers

Stakeholder Groups Frail, Homebound, Isolated Elderly Older Adult Medical and Mental Health Co-Occurring

Successful Stakeholder Groups and System Change

Welcome and manage multiple points of view

Self-interests are minimized; system needs are maximized

Broad and diverse representation

Defined period of time

Facilitated by an objective party

MHSA Planning Process: Key Components

Community Needs Assessment

Training & Stakeholder Input

Task Forces

Steering Committee

Community Services & Support (CSS) Plan 6 Proposals including the Older Adult Intensive Service

Program

Transition Age Adults

Persons age 55-59

There is increased risk for health related issues

Clients in the 55 to 59 age group are the highest users of Crisis and In-Patient Unit service

Barriers to Older Adults Seeking Mental Health Services

Stigma/myths regarding lack of benefit

Cultural and linguistic barriers

Isolation/transportation issues

Lack of accessibility, availability and usability of services

Lack of geriatric trained staff

Inadequate assessment of mental and physical problems

Physical illness and disabilities

Prevalence of Psychiatric Disorders in Older Adults

According to the Surgeon General: 20% of persons age 55+ will experience a mental

disorder in a 1-year period

37% in primary care settings suffer depressive symptoms

Clinically significant depression is 25% higher among those with chronic illness

Highest suicide rate relative to other age groups, the consequence of untreated depression

Sacramento County Older Adult Profile

Fiscal Year 2004-20051,778 Clients

Less than 5% of Sacramento County Mental Health System

Age range 55-104Average age is 68.1 years

Underserved/UnservedMales (69.4% of outpatient clients are female)

Transitional Age AdultsAge 55-59

Ethnicity ComparisonFY 2004-2005

Caucasian 60%

Asian 11.6%

African-American 11.9%

Spanish/Hispanic 8.0%

Other 8.6%

Older Adult Intensive ProgramEligibility Criteria

Age 60 and over (5% transitional age 55-59)

Must transfer from Regional Support Team

Have complex, co-occurring mental health, physical health, substance abuse, and social service needs

Require intensive case management to coordinate range of services

At risk for emergency room utilization, hospitalization, nursing home care, institutionalization, eviction/homelessness

Older Adult Intensive Program Overview

Program Design Features Capacity to serve 100 clients from Regional

Support Team 1/15 staff/client ratio Home-based services Regular hours with 24/7 on-call service Culturally and linguistically appropriate

Special Considerations for Older Adults

Increasing cultural and linguistic isolation

Substance abuse and misuse

Sensory loss

Homelessness/displacement

Economic hardship

Special Considerations for Older Adults

continued…

Cognitive impairments

Physical and biochemical impairments/ co-morbidity

Poor nutrition/dental health issues

Medication issues

Loss of interpersonal, social and family supports

Service Components

Multidisciplinary Assessment Services Comprehensive culturally competent bio-psycho-social evaluation

Assess mental health, medical, substance abuse and social service needs

Linkage with a primary care physician and other healthcare services

Service Components continued…

Treatment Services Individual, Group and Family Counseling Medical and Medication Services Psycho-Educational Services Peer Counseling Linkage with Social, Family and Community

Supports

Service Components continued…

Intensive Case Management Services Clients will be assigned to a personal service

coordinator

Work collaboratively to develop individualized service and support plan

Referral to multidisciplinary team members or community service providers

Program Personnel

Multidisciplinary Team Members Mental Health Program Coordinator (1 FTE)

Clinical and administrative supervision

Mental Health Counselors (7 FTE) Mental Health Services

Psychiatric Nurse (1 FTE) Medication management/coordinate with physical

healthcare

Psychiatrist (1 FTE) Medication services (contracted)

Program Personnel continued…

Nurse Practitioner (1 FTE) Physical healthcare/medication management

Family/Consumer Advocate (.40 FTE) Education, training, patients rights (contracted)

Senior Peer Counselors (4 FTE) Volunteers with $85/mo. Stipends/$40 bus passes

Cultural/Linguistic Consultant (.20 FTE) Cultural/linguistic services (contracted)

Total FTEs = 16.60

Staff Training

Wellness and Recovery Philosophy

Cultural Competency Language, Race, Ethnicity, Customs, Family Structure,

Sexual Orientation and Community Dynamics

Co-Occurring Disorders Drug/Alcohol

Co-Morbidities Dementia, Delirium, Depression Disease prevention/management

Promising and Evidence-Based Practices

Multidisciplinary Assessment and Treatment

Case Management

Mobile Services/Home Visitation

Collaborative Service Planning with Community Providers

Peer Counselors

Older Adult System of Care Values

Quality of Life

Clients Strengths/Empowerment

Self Help

Cultural & Linguistic Competence

Assessment & Treatment Protocols

Access to Community-Based Services

Preventing Inappropriate Hospitalization

Preventing Suicide

Multidisciplinary Service Coordination

Medical/Psychiatric Interface

Family & Community Involvement

Support Services for Caregivers

Education and Prevention

Multiple Funding Sources

Resources Websites

For a complete copy of Sacramento County MHSA Community Services and Support Plan visit www.sacdhhs.com

For the Older Adult System of Care Framework and Transitional Age Adult Workgroup information visit CMHDAs website at www.cmhda.org

For the California Mental Health Master Plan (Chapter 6 – The Planned System of Care for Older Adults visit www.dmh.ca.gov/mhpc/reports

Thank You

Questions and Answers