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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