The Adult Continuum of Care Committee’s Vision of a transformed continuum of care 12
List of Recommendations 14
I.Inpatient Care recommendations 17
II.Community Based Services Recommendations 22
III.Workforce Development / Policy and Funding Recommendations 28
Appendix A: Adult Continuum of Care Committee Charter 33
Appendix B: Gaps / Suggested opportunities for improvement that were generated during facilitated roundtable discussions 35
Appendix C: SYNOPSIS: THE CURRENT ROLE OF THE STATE HOSPITAL, VISIONS FOR THE FUTURE 40
Appendix D: Medicaid IMD Exclusion Rule 44
Appendix E: Transitional Care Services Needs Assessment 2015 45
Adult Continuum of Care Committee Description
At the request of the Secretary of the Kansas Department for Aging and Disability Services, a diverse group of stakeholders was convened to review the current behavioral health system and make recommendations for how to transform this system. The Adult Continuum of Care Committee was formed to build upon the work of the Governor’s Mental Health Task Force and Hospital and Home Committee to review and make recommendations for transforming the behavioral health system to ensure an effective array of behavioral health services were available to promote recovery and community integration. This review included the current capacity of both state mental health hospitals as well as resources available in the communities.
The Adult Continuum of Care Committee met five times from May 21, 2015 through July 16, 2015. Staff from the Kansas Department for Aging and Disability Services facilitated the meetings and provided support to the committee. Through a series of facilitated discussions, the Adult Continuum of Care Committee examined the current behavioral health continuum of care, identified current resources, gaps, barriers, and opportunities for improvement. For the purposes of these facilitated discussions, the continuum of care system was split into the following categories; state mental health hospitals, community inpatient facilities, Nursing Facilities for Mental Health (NFMH), integrated care, community based housing, and community based services. The Adult Continuum of Care Committee was split off into smaller groups to discuss each category in detail. Each small group identified top barriers and recommendations in each category. A list of barriers and the identified opportunities are included as an appendix B. KDADS provided previous reports and data to the Adult Continuum of Care Committee to aid in their assessment of the continuum of care system and to aid in the development of the recommendations. It should be noted that the assessment of the continuum of care system and the corresponding recommendations were made during a limited number of meetings that were held in a short time period. With a more thorough review of the continuum of care system additional recommendations could be identified.
Kansas has identified the need to move beyond a mental health system that is stretched beyond its ability to provide the right care at the right time in the right place for Kansas citizens since 2006. The health and safety of our citizens, families and communities are at risk in a system where we must desperately seek alternative placements in order to avoid unacceptable hospital census numbers.
Recovery and independence are best achieved through an array of psychiatric and SUD services and supports that provide quality care, individual choice, and treatment options that are specific to the needs of the individual. As the public mental health system struggles to meet the critical needs of increasing numbers of Kansans, we must address the available continuum of care now rather than later.
Why do we need a continuum? Providing the right care in the right setting at the right time enhances patient care and improves health outcomes for Kansans. It assures the effective use of resources and promotes individual recovery. It is this committee’s unanimous assessment that the continuum in Kansas is insufficient to serve the needs of the population and makes it impossible for the state mental health hospitals to reduce capacity or pursue a more specialized role than as a broad safety net setting. The 60 beds at Osawatomie State Hospital must come back into service as soon as the federally ordered renovations are complete.
While the current shortage of state mental health hospital beds has placed a significant strain on state hospitals, community hospitals, community mental health centers, and housing resources; it also presents an opportunity for Kansas to evaluate the strengths and weaknesses of our current adult continuum of care.
The committee endorses the report and recommendations of the Hospital and Home Core Team and asserts that the gaps in our continuum of care present a past, present and future barrier to achieving the Core Team goals for the state hospitals. One of those goals is for the state mental health hospitals to become more of a tertiary care hospital setting with a focus on treatment of chronic mental illness. The Hospital and Home Core Team also developed recommendations regarding screening and discharge processes. This committee did not attempt to repeat that work in the short time available, but hopes to build on that report with further recommendations focusing on the continuum.
To move our mental health system toward better health outcomes and the best chance of recovery for Kansans facing behavioral health issues, particularly chronic mental illness and chronic substance use disorders, we must bridge some of the gaps in our continuum of care. The State’s innovation and investment in Rainbow Services Inc. (RSI) is an excellent step forward to strengthen at least one level of the continuum that has needed attention. The successes of RSI to date can be replicated in other communities if we can stimulate the partnerships and community support established there. But there is more work to be done to assure the sustainability of RSI, through funding, policy and statutory initiatives. The committee encourages the Department to lead those efforts and transfer lessons learned to invest in RSI model services in other Kansas communities.
In addition to recommending expansion of the RSI model to other communities, the committee recommends strategies to boost other levels of the continuum. When the continuum of care offers multiple levels of treatment addressing varied individual needs, such as those with chronic mental illness co-occurring with substance use disorders, developmental disabilities, and traumatic brain injuries, people are less likely to require referral to treatment at a state mental health hospital. Further, Kansas lacks appropriate treatment for transitional age youth, forensic, and geriatric populations, which are sometimes grouped together.
Within the body of this report, the committee has included a number of recommendations to strengthen the Adult Continuum of Care and recommends reconvening the committee periodically to monitor progress, revise the recommendations, and provide input regarding more specific circumstances.