NORTHWEST REGION

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NORTHWEST REGION

• CHILDRENS SERVICES

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WESTERN MO MENTAL HEALTH CENTER

• Child and Adolescent Unit
• Designed for 10 beds, but staffed for fewer
• Acute psychiatric inpatient
• Front Door Emergency Room typically, frequently
  Central or Regional Office recommendation

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WMMHC Stats

• Approximately 200 admissions in a year
• Mood Disorder, Not Otherwise Specified by far the
  most frequent diagnosis (7x more frequently given
  than the next diagnosis which was Psychotic
  Disorder, NOS)
• Approximately 45 referred by family/relatives
• Approximately 25 referred by courts/law
  enforcement
• 10 were involuntary commitments

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WMMHC Stats

• 17 had dual diagnoses of MI/DD
• Payor Sources
• 38 Medicaid
• 33 MC Managed Care
• 17 guest of the state
• 12 private insurance

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WMMHC Statistics

• Average Length of Stay 11.5 days with a range
  from 2-126 days (10 exceeded 30 days)
• Of the 10, the classic presentation was
• Dually diagnosed with MI/DD
• Extreme Behavioral Presentations (typically
  aggression)
• Co-occurring medical conditions
• Multiple admissions to inpatient services

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Complicated Medical Conditions

• One youth had the following medical conditions on
  Axis III
• HYPOTHYROIDISM UNSPEC
• OBESITY UNSPEC
• TEAR FILM INSUFFIC UNSPEC
• ALLERGIC RHINITIS UNSPEC
• ESOPHAGEAL REFLUX
• UNSPEC CONSTIPATION
• ACUTE DERMATITIS SOLAR RAD
• OBSTRUCTIVE HYDROCEPHALUS
• STEVENS-JOHNSON SYNDROME
• OTHER CONVULSIONS
• OTHER DRUG ALLERGY

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NW Region Inpatient Bed Capacity for Children and
Adolescents

• Crittenton 41
• Research Psychiatric 25
• Heartland St. Joseph 0
• St. Lukes Northland 6
• Two Rivers 20
• ___________________________
• Total Beds 102
• Royal Oaks 33

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Capacity Development

• Based on model developed by Robert Friedman out
  of Southern Florida in 1987 updated through
  discussions in 2003
• Balanced system of care excess or deficit in
  any area, impacts all other areas
• Does not include services for prevention or early
  intervention
• Public mental health services and funding, so
  would include schools, juvenile courts, child
  welfare and Medicaid

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NW Region Capacity Development
Category Total Slots Specific Service Specific Slots
Hospitalization/ Stabilization less than 6 months 43 Non-Medical Crisis Bed 4
Hospitalization/ Stabilization less than 6 months 43 Medical Crisis Bed 4
Hospitalization/ Stabilization less than 6 months 43 Residential 9
Hospitalization/ Stabilization less than 6 months 43 Inpatient 26
Hospital/Residential Treatment Centers greater than 6 months 43 Transitional/Independent Living 37
Hospital/Residential Treatment Centers greater than 6 months 43 Residential 5
Hospital/Residential Treatment Centers greater than 6 months 43 Inpatient greater than 6 months 1
Treatment Family Homes/Group Homes 340 Treatment Family Homes 255
Treatment Family Homes/Group Homes 340 Group Homes 86

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NW Region Capacity Development
Category Total Slots Specific Service Specific Slots
Home -Based 851 Respite 247
Home -Based 851 Family Assistance 238
Home -Based 851 In-home Therapy 247
Home -Based 851 Intensive CPR 119
Day Treatment 851 Full Program 153
Day Treatment 851 Individual Therapy1 247
Day Treatment 851 Group Therapy1 451
Outpatient 3404 Physician Services 2247
Outpatient 3404 Access/Intake 511
Outpatient 3404 Evaluation Services 34
Outpatient 3404 Therapy Services 613
1 Individual services added to existing program 1 Individual services added to existing program 1 Individual services added to existing program 1 Individual services added to existing program
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NW Region Capacity Development
Category Service Slot Specific Service Specific Slot
Case Management with WrapAround2,3 5504 POS CM 1021
Case Management with WrapAround2,3 5504 TCM Bachelors 613
Case Management with WrapAround2,3 5504 TCM Masters 340
Case Management with WrapAround2,3 5504 Maintenance CPR 545
Case Management with WrapAround2,3 5504 Rehab CPR 885
Case Management with WrapAround2,3 5504 WrapAround3 2100
Parent Support4 1260 Support and Educational Groups
Total Service Slots 8396
Total Youth 6300
Peer to Peer case management and parent partner models of cm would be included in this category WrapAround was calculated based on access for 70 of the youth receiving CM or home-based services Based on 20 of children served Peer to Peer case management and parent partner models of cm would be included in this category WrapAround was calculated based on access for 70 of the youth receiving CM or home-based services Based on 20 of children served Peer to Peer case management and parent partner models of cm would be included in this category WrapAround was calculated based on access for 70 of the youth receiving CM or home-based services Based on 20 of children served Peer to Peer case management and parent partner models of cm would be included in this category WrapAround was calculated based on access for 70 of the youth receiving CM or home-based services Based on 20 of children served
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Current Utilization
Current Service Current Utilization or Slots Capacity Development Slots Recommended
Acute Inpatient 102 26
Residential under 6 months 129/67 9
Crisis Beds (TFH) 8
Inpatient over 6 months 1
Residential over 6 months 50 5
Transitional/ Independent Living 37
Group Homes 86
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Current Utilization
Current Service Utilization/Slots Capacity Development Slots Recommended
Treatment Family Homes 9 (27) 255
Respite 133 247
Family Assistance 238
In-home Therapy 247
Intensive CPR 230 119
Rehab CPR 226 885
Maintenance CPR 545
POS CM 2555 1021
Bachelor level TCM 1656 613
Master level TCM 1045 340
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Current Utilization
Current Service Current Utilization/Slots Capacity Development Slots Recommended
WrapAround 188 2100
Day Treatment-Full Program 49 153
Individual Therapy Enhancement 247
Group Therapy Enhancement 81 451
Physician Services 3216 2247
Access/Intake 1458 511
Evaluation Services 377 34
Therapy Services 499 613
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Current Utilization

• Total of 4921 youth served (unduplicated within a
  service but may be duplicated across services)
• Total billings not included inpatient and
  residential 10,838,534
• In a year, on average approximately 5 youth
  exceed 6 months in residential

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Profiles

• 15 year old female Truman/Kansas City Regional
  Office
• Currently at Mid Mo since 2/09 (2nd transfer from
  WMMHC upon closing)
• Childrens Division custody
• 10 hospitalizations at Western Mo MHC
• 2 KCRO placements
• 1 Private sector In-patient Acute Hospitalization
• Physical health issues prohibit SCL psychiatric
  placements
• Has been denied out of state placements
• 12 year old male Swope/Kansas City Regional
  Office
• Currently at (DMH/CPS)Hawthorn Childrens
  Hospital in St. Louis since 10/08
• Childrens Division custody
• 2 hospitalizations at Western Mo MHC In-patient
  Unit
• No community placement prospects with SCL or KCRO

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Profiles

• 16 year old male Comprehensive MHS
• Parents custody
• Crossed 3 Jackson Co Administrative Agents
• Placed in SCL psychiatric placement at the
  States most elevated rate no other statewide
  options
• 9 year old female - Tri-County MHS
• Parents custody
• In SCL psychiatric placement for over 15 months
  in St. James, MO as there are no closer
  placements that will accept her

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Profile

• 15 year old male Comprehensive MHS/Kansas City
  Regional Office
• Grandparents custody
• Currently in JAG Unit - no other SCL/VPA
  Placement options
• 4 combined SCL/MRDD placements
• 14 year old male ReDiscover MHS
• Parents custody
• Currently in JAG Unit no other SCL/VPA
  Placement options
• Has been denied SCL psychiatric and Childrens
  Division placements statewide

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Profiles

• 14 year old female Family Guidance
  Center/Albany Regional Office
• Parents custody
• Currently in SCL/MRDD Interdivisional Agreement
  in St. Louis only placement that would accept
  her with very rigid conditions
• 3 hospitalizations at Western Mo MHC
• 1 hospitalization at Hawthorn Childrens Hospital
  in St. Louis
• 4 SCL placements
•  
• 12 year old female Swope/Kansas City Regional
  Office
• Childrens Division custody
• Currently in Childrens Division placement
• 4 hospitalizations at Western Mo MHC
• 1 SCL psychiatric placement
• 1 KCRO community placement