Community Support ProgramNIATx Change Project 2012

State Focus:◦ Reduce psychiatric inpatient readmission rates

(30 days and 180 days) Big Aim:

◦ Increase the involvement ACSS clients have regarding their discharge from a psychiatric hospital.

Small Aim: ◦ Adult Community Support Services (ACSS) social

workers will speak with CSP clients, via telephone, during their hospitalization and attend a Discharge Care Conference at the psychiatric hospital (3 separate modes)

Prior to implementation of the small aim:◦ A process on how to educate psychiatric hospitals

of the small aim◦ A process on how to implement the small aim

within ACSS and Behavioral Health◦ A tool to measure of the effectiveness of the small

aim The small aim was implemented on

08.21.2012!◦ From 08/21/12 - 10/15/12

10 CSP clients hospitalized via an Emergency Detention or voluntarily

Hospitalization Overtime by Client

1 1

0 0

1 1

0 0

1 1

0 0

1 1

0 0

1

2

0 0

1 1

0 0

1

0 00

1

2

3

4

5

Initial 30-60 Readm. 61-90 readm 91- 120 readm

Hospitalization Type

# of

hos

pita

lizat

ions

client 1

client 2

client 3

client 4

client 5

client 6

avg

Next 2 to 4 months:◦ Continue to collect data to determine if the small

aim is successful◦ Based on data; decide to adapt, adopt or abandon

4 months and beyond:◦ Develop additional aims to impact recidivism

rates

Impact Clients’ have reported favorably in regards

to having an active voice in their own discharge care conference.

Clients’ who have been hospitalized in the past report that they have been more involved with their discharge planning than with previous hospitalizations.

Long term impact: financial gains for St. Croix County (hopefully)