State Mental Hospital Continuity of Care Study

1. State Mental Hospital Continuity of Care Study Timothy L. Boaz, Ph.D. Keith Vossberg, B.A. Florida Mental Health Institute May 8, 2001

2. Background Conducted at PSRDC Dept of Mental Health Law & Policy FMHI/USFFunded by Agency for Health Care AdministrationRequested by State Human Rights Advocacy Committee

3. Study Purpose Continuity of treatment for persons discharged from the state hospital has been identified as a problem contributing to recidivismThis study used existing administrative data sets to identify factors that may contribute to such problems

4. Methods  Data Sources   Florida State Hospital Database (CIS) DCF Community Services Database (IDS) AHCA Medicaid Data System FDLE Criminal History Database Time Frame   July 1, 1998 through June 30, 2000.

5. Indicators of Problems with Continuity of Care Days to restoration of Medicaid benefits Days until onset of services   first case management appointment first psychiatric/medication appointment first residential treatment service first therapy appointment   Quantity of service received   Indicators of problematic events/outcomes   Readmission to state hospital Community hospital (ER/CSU) events Criminal justice system involvement (i.e., arrests)

6. Subjects Discharges (N=1211) from state hospitals – 7/1/98 - 12/31/99 Average age 43.1 years (16.3% over 55) Gender 55.5% male Race 71.4% white Hospital episodes > 2 Length of episode 708 days (median = 203) Diagnoses schizophrenia 38.8% schizoaffective disorder 25.4% mood disorder 22.9% dementia/cognitive disorder 4.5% other primary diagnoses 8.3%

7. Medicaid Enrollment Never Enrolled 30.0% Previously Enrolled 3.1% Continuously Enrolled 18.7% Discharge Enrollees 39.7% Subsequently Enrolled 8.4%   Limitations --   do not know why subjects were not enrolled have not analyzed Medicaid claims data

8. Days to Medicaid Enrollment

9. IDS Service Events Service events reported to IDS/DCF by all providers who have contracts with DCF for clients funded by DCF/ADM contract local match Medicaid TANF 78.5% of subjects had service events reported in the IDS data. Service categories   Case Management Psychiatric Residential Treatment Therapy Other Medical Crisis Crisis Evaluation

10. Days from Discharge to First IDS Service Event

11. Services Received after Discharge

12. Adverse Events Readmitted to state hospital 16.4% Received crisis services 21.3% Arrested after discharge 14.5% Felony arrest after discharge 6.8% Also note 47.3% had a prior arrest 34.4% had a prior felony arrest

13. Days until Adverse Events

14. Number Receiving IDS Services by Readmission Status

15. Number Receiving IDS Services by Adverse Event Experience Status

16. Outcome Analysis – Case Variables Younger more likely to have adverse events Those with schizoaffective disorder more likely to have adverse events and to be readmitted Those with more episodes more likely to be readmitted Those with prior arrest histories (and felonies only) more likely to have adverse events Not related --   Gender, Race, Length of episode

17. Outcome Analysis – Service Variables Those who experienced adverse events received more case management service (1 month and 6 months) than those who did not experience such events No other intervention variables were related to readmissions or to experience of adverse events Medicaid enrollment status was related to whether a person received services reported in IDS

18. Limitations of the Study Data may not show up in analysis   reporting deficiencies in data systems errors in matching cases across systems people are not available for follow-up moved out of state died institutionalized elsewhere etc. We have not looked at all the data

19. Conclusions – Part 1 Significant numbers experienced adverse outcomes following discharge • Several case variables are associated with the experience of adverse events. • Enrollment in Medicaid (or lack of) was not related to adverse outcomes, but was related to whether the person received services

20. Conclusions – IDS Services Over 25% had no record of non-crisis, mental health treatment services following discharge (including 30% of those readmitted) Most who received services got case management, but fewer received psychiatric, residential treatment or other therapy Services received were not related to adverse outcomes, except those with crisis events were more likely to have received case management