Continuity of Care / SPOE
October 24, 2006
Arthur Ashe
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What is the secret to becoming a Great
Tennis Player ?
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Start where you are.
Use what you have.
Do what you can.
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
Earlier comments
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Common Purpose
Give and Take
Bending and Adpating
More Coordination
We are all share responsibility for persons
with Psychiatric issues in ER’s despite
structural / organizational barriers
Improve the hand off
OMH Continuity of Care Policy
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http://www.laomh.org/ContinuityofCare/index.htm
Continuity of Care
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Informational Continuity – Information is the common thread linking
care from one provider to another and from one healthcare event to
another. Information can be disease focused or person focused.
Documented information tends to be on the medical condition, but
knowledge about the patient’s preferences, values, and context is equally
important for bridging separate care events and ensuring that services are
responsive to needs.
Management Continuity – is especially important in chronic or complex
clinical diseases that require management from several providers who could
potentially work at cross purposes. Continuity is achieved when services
are delivered in a complementary and timely manner. Shared management
plans or care protocols facilitate management continuity, providing a sense
of predictability and security in future care for both consumers and
providers. In mental health care, continuity of contact (expressed as
access) embodies the notion that regular contact is needed to ensure
management goals are adapted and met and that providers must often
facilitate access to a broad range of services. Flexibility in adapting care to
changes in an individual’s needs and circumstances is an important aspect
of management continuity. When care is long term, both consistency and
flexibility are critical for management continuity.
Continuity of Care
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Relational Continuity – bridges not only past to current care but also
provides a link to future care. This is most valued in primary and mental
health care. Even in contexts where there is little expectation of
establishing ongoing relationships with multiple care givers, a consistent
core of staff provides patients with a sense of predictability and coherence.
Continuity of Care is achieved by bridging discrete elements in the care
pathway – whether different episodes, interventions by different providers,
or changes in illness status – as well as by supporting aspects that endure
intrinsically over time, such as consumer’s values, sustained relationships,
and care plans. Processes designed to improve continuity do not
themselves equate to continuity. For continuity to exist, care must
be experienced as connected and coherent.
For consumers and their families, the experience of continuity is the
perception that providers know what has happened before, that different
providers agree on a management plan, and that a provider who knows
them will care for them in the future.
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The significant role of SPOE is the management and
integration of inpatient services within the array of community
service alternatives. As such, it provides a geographic and
administrative focus for service determination and appropriate
utilization of resources.
The SPOE is in the community, accessible 24 hours a day and
seven days a week. Its role is to provide for prompt review of
screenings, evaluations and assessments provided by multiple
referral sources including private providers, Community
Mental Health Centers and public agencies.
The SPOE Coordinator will screen and provide referrals for
admission to the OMH Distinct Part Psychiatric Beds and the
OMH free-standing inpatient facilities.
SPOE Coordinators
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Single Point of Entry
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Reg. 3 Pam Marcel
Reg. 4 Adofo Harmon
Reg. 5 Jenny Mills / Jaquita Jordan
Reg. 6 Bart Liles
Reg. 7 Amy Creel
Reg. 8 Suzanne Hatcher
MHSD Tom Elliott
CAHSD Janet Roy
FPHSA Sherry Sigler
JPHSA Julie Burke
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
19%
CMHC / SPOE
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
19%
CMHC / SPOE
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Private Facility 16%
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
19%
CMHC / SPOE
Case Management
ER
Acute Unit
11%
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Private Facility 16%
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
19%
CMHC / SPOE
Case Management
ER
Acute Unit
11%
Respite
Housing
Mobile
Assessment
Intermediate
Care Hospital
Employment
Assistance
Financial
Assistance
Drop In
Center
Private Facility 16%
11%
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
SPOE
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19%
16%
11%
11%
9%
9%
7%
18%
(*based on 2005 survey)
CMHC to Acute Unit
Private Facility to Acute Unit
CMHC to Private Facility
Private Facility to Intermediate Hospital
Private referral to CMHC
Hospital to CMHC
CMHC to Intermediate Hospital
Other
SPOE
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HANDOUTS
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What you need to provide to the SPOE when
calling with a referral ?
What can you expect the SPOE to do ?
What will the SPOE do if no beds are available
within the OMH system ?
Who to call if there are problems or
concerns ?
SPOE
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Problem solving process
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Many SPOE issues can best be resolved at the local
level
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Handouts indicate who to call if there are issues to be
worked out if working with the SPOE has not proven
successful
Problem resolution should follow a progressive
process moving up the chain of authority only as
attempts at the local, regional, levels are unsuccessful
in order to ensure that there is local ownership or
responsibility, continuity of information,
communication of concerns, efficient use of limited
resources, timely local solutions and empowerment of
local decision makers.
CMHC
Case Management
ER
Acute Unit
Respite
Housing
Mobile
Assessment
Employment
Assistance
Financial
Assistance
Drop In
Center
Home / Community
Based Treatment
Assertive
Community
Treatment
Educational
Services
Earlier SPOE Comments / Questions
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Cross regional coordination
Common standards across regions
Individuals referred to ER at 4:30 pm
Issues with Private Hospitals –
relationships, communication, procedures
/ protocols.
To Be Continued...
Continuous
engagement in treatment and
recovery services is one of the most important aspects of
addressing acute episodes of severe behavioral health problems
and the ongoing disabilities associated with them.
Processes
designed to improve continuity do not themselves
equate to continuity.
For
consumers and their families, the experience of continuity is
the perception that providers know what has happened before, that
different providers agree on a management plan, and that a
provider who knows them will care for them in the future.
Please
work with and through your SPOE and Administrative
structure to resolve issues locally when at all possible.