Unity Center for Behavioral HealthChristiane Farentinos, VP Unity

Unity Center for Behavioral Health

• Unique collaboration between Legacy, OHSU, Adventist Healthand Kaiser to provide services to the region

• Community-wide effort (city, counties, state, payers, EMS,police, mental health and addictions providers- more than 30participating agencies)

• Facility licensed under Legacy Emanuel Medical Center• 102 inpatient beds (80 adult beds, 22 adolescent beds)• Adult Psychiatric Emergency Service (45-50 pts/day)• Strong Peer support built into structure of Unity• Built-in space for Community Providers to help navigate

handoffs from Unity to community treatment and resources

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Our MissionWe deliver excellence inpatient care, teaching anddiscovery, creating a pathwayto hope, community andrecovery.

The right care at the right time.

Our Values• Patient and family centered• Safety for all • Trauma informed • Collaboration • Shared responsibility• Compassion• Education and innovation

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Our Leaders

• Lori Morgan, MD, MBA, President EMC• Linda Jones, Chief Nurse EMC• Chris Farentinos, MPH, CADC II, VP Unity• Greg Miller, MD, MBA, Chief Medical Officer• Kari Howard, Director Patient Care• Juliana Wallace, LCSW, CADC III, Director Unity Services

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What is different about our model?

• Model of hospitality, hope and recovery

• Trauma informed care/ recovery centered

• De-criminalization of mental illness

• Remove police from transporting

behavioral health patients

• 24/7 access to psychiatric care

• Intentional design for transitions of care

• Peer support specialists part of the skill mix

• Culturally competent care

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UnityCrisis

evaluation,stabilization,short-term

inpatient care

Selfcheck-in

Ambulancetransport

Family orfriends bring in

Securityofficials refer

Community PartnersCascadia Behavioral Health,

Central City Concern, LifeWorksNorthwest, NAMI Oregon,

Folktime, Mental Health Assoc ofOR, DePaul Treatment Centers,Alliance for Culturally Specific

Programs, Albertina KerrCenters, ColumbiaCare,

FamilyCare, TeleCare Corp.,Western Psych, Health Share,

and others

PeersupportLegal

help

Addictiontreatment

Jobassistance

Inpatienttreatment

Treatmentplan &

follow up

Counseling &therapy

Medicalcare

Housing

Familycounseling

Transitions of Care

Transitions of Care

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UnityCulture

Trauma Informed Care

The umbrella over Unity’sCulture

What is Trauma Informed Care?

• Trauma Informed Care recognizes that traumaticexperiences can:

• terrify,

• overwhelm,

• and violate an individual

• Trauma Informed Care is a commitment not to repeat theseexperiences and in any way possible restore a sense of:

• safety

• power

• self worth 13

Abuse:• Emotional 10%• Physical 26%• Sexual 21%

Neglect:• Emotional 15%• Physical 10%

• Two-thirds had at least one ACE• ACEs tend to occur in clumps

HouseholdDysfunction• Mother treated

violently 13%• Mental illness 20%• Substance abuse

28%• Parental separation

or• divorce 24%• Household member• imprisoned 6%

Adverse Childhood Events Studyhttps://www.cdc.gov/violenceprevention/acestudy/index.html

Change the questionfrom…

Trauma Informed Policies & Practicesat Unity• Use of cell phones and personal devices in adult units to give

more control• Visiting Hours are 9 am to 9 pm • Option to keep personal clothes in the PES and units• Open Nursing Stations• Peer support• Harm Reduction Specialists• Quality Committee working on culture development and

seclusions and restraints reduction

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INTEGRATION OF

PEER SUPPORT AT THE UNITY CENTER

Peer Support Programs at Unity

• What Programs are available?• Peers in the PES

• Peer Bridgers

• NAMI

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Folktime First Quarter 2017 Data – Peers in thePES• Total number of Individuals supported in PES Program: 271• Total number of individual interactions in the PES program: 566• Average Number of Hours of Peer Support provided per individual

served in PES: 1.82 Hours• Average Number of Encounters provided per individual served in

PES: 2.09 encounters• Average Length of Stay for Individuals who interacted with a Peer

Support in the PES: 26.12 Hours• Number of Groups Held: 22 (Yoga, Games, Drawing, and

conversation groups occurred ad hoc as dictated by needs andinterests of the milieu)

• Number of individuals referred to another peer support program: 11319

Folktime First Quarter 2017 Data: Peer Bridgers

• Total number of individuals supported inBridger Program: 19

• Number referred by PES: 4• Number referred by Inpatient: 3• Number self-referred: 12• Number of individuals whose services

concluded: 9• Number of individuals referred to another

peer support program: 7• Location of Services: • Inpatient Unit: 36• PES: 11• Community: 7• Phone: 3• Number of Hours worked by Peer

Bridgers: 159• Hours worked at Unity: 141• Hours worked in Community: 18• Average Number of Hours of Peer

Support provided per individual in Bridger:2.13

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Folktime First Quarter 2017 Data

• Cross-program statistics:• Percent of individuals who interacted with a peer that did not

return to Unity in the 60 days following their most recentdischarge within the quarter: 70.90%

• Number of Folktime Resource Groups held: 9

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Unity and ourCommunity

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Unity Transportation Workgroup• Meeting since spring 2015• Members – AMR, Metro West, PPB, Project Respond, ED

medical directors including Providence, Centerstone, EMSMedical Directors (plus Fire Department, Clackamas EMS andLaw Enforcement, Gresham Police)

• Goals • To engage PPD and other districts in changing their work flow to

transport individuals in a MH crisis (voluntary and involuntary) byambulance

• To develop ambulance dispersal plan post Unity opening

• To inform OAR rule change to allow ambulances to function as securetransport

• To identify payment methodology for new work flows

• To create and implement a field medical triage instrument to guidetransport of individuals to Unity Center or Medical EDs

• To foster collaboration and cross training insofar dealing with individualsin a BH crisis

• Accomplishments

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Law Enforcement and Unity

• Partnerships with North Precinct (Commander King, andSargent Phillip Blanchard) and with BH Unit (Lieutenant TashiaHagar)

• Early experience• Lessons learned• Stories • Next steps

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Unity Behavioral Health ForensicsWorkgroup

• Started in the summer of 2016

• Members: Jean Dentinger (Multco Pre-commitment manager and ForensicsDiversion), John McVay (Multco Parole and Probation), Glen Rairden (Lead SecurityOfficer Unity), Sarah Radcliffe (DRO), Barb Snow (Project Respond), Tashia Hager(BH Unit PPB), Greg Miller (CMO Unity), Anne Gross (PES medical director), JulianaWallace (Director Unity Services), Judge Cheryl Albrecht (Mental Health Court).

• Goals

• Understand interface between BH and Forensics system

• Recognize the best “intercept” points in the forensics system

• Test work flows for jail diversion of individuals with BH needs

• Accomplishments

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Unity Transitions of Care Workgroup• Members • Goals

• To create an intentional design for transitions of care through threemodels

• Co-location

• In reach

• Coordinated referrals

• Accomplishments • Co-located with CareOregon, Western Psychological, NAMI, Mutco

Intensive Transition Team and ABC team, FamilyCare, Kaiser,Columbia Care, Lifeworks NW, Cascadia ED divert team, ICP teams

• In reach – De Paul, NARA, All ACT teams, CCC, Outside In

• Soon to start a “Patients with multiple visits task force”

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Transitions of Care Workgroup

Chris Farentinos Legacy VP, Unity

Becky Wilkinson Legacy Outreach Worker

Nancy Benner Adventist Social Work Lead

Naiyana Cruz Adventist, Clinic Administrator, OP Beh Health

Jennee Edwards Adventist

Sara Hatch Albertina Kerr

Holden Leong Asian Health and Service Center, Executive Director

Diane Bocking-Byrd CareOregon

Barb Snow Cascadia, Manager, Project Respond

Rhonda White, QMHP Cascadia, Manager, Urgent Walk-in Clinic

Dave Kohler Cascadia, Senior Director, Outpatient Services

Alexandra Leichter Cascadia, ITT Program Sup

Jennifer Wilcox Cascadia, Manager, Intake Access

Alex Drilling Cedar Hills, Interim Director of OP Services

Kathleen Roy Central City Concern

Alison Noice CODA

Ben Solheim Columbia Care, ICM

Lindsey Maclean De Paul

Erica Edwards De Paul, ED Outreach Worker

Sarah Radcliffe Disability Rights of Oregon, Staff Attorney

Bennett Garner, MD Family Care, Medical Director

Karissa Smith, LPC, CADC I Family Care, Adult BH Lead

Rochelle Pegel Health Share OR, UR Coordinator for Mult County

Mark Lewinsohn Lifeworks NW, VP Clinical Services

Holly Friesz LifeWorks NW, Rapid Respnse Team clinician

Emily Parkwell LukeDorf

Andrea Quicksall Mult Co, Adult Care Coord Program Sup

Nancy Griffith Mult County, Corrections Health Division Director

Abbey StampMult County, Exec Director, Local Public SafetyCoordinating Council

Charmaine Kinney Mult County Leticia Sainz Mult Co, Crisis Services Manager

Patricia TenEyck NAMI Mult Co Executive Director

Jackie Mercer NARA, Executive Director

Shannon Farr Peer, Folktime

Lakeesha Dumas Peer, African American Health Coalition

Kristen Downey Providence, (Robin's designee)

Larry Betcher Providence

Brian Thompson, LCSW Providence, UR in IP Psych unit (Emily York's husband)

Nirmala Dhar State of Oregon, Older Adult Beh Health Coordinator

Melinda Howard Telecare, Administrator, CATC & Community Triage

Kathleen Trebb VOA, Division Director

Jeff Olsgaard Western Psych

Tia Barnes Youth Move Oregon

Lauren Conn Youth Move Oregon

Unity by theNumbers

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PES LOS May 2017

PES - 5/1 - 5/31 AVG LOS Median LOS GeoMean LOS

All PES Patients 24hr 34min 20hr 24min 12hr 17min

Admitted PES Patients 38hr 30min 31hr 53min 31hr 51min

Discharged PES Patients 21hr 42min 17hr 27min 10hr 50min

Data extracted 6/7/2017 LEGACY HEALTH 30

PES arrivals May 2017Day ED Arrivals

1-May 232-May 283-May 274-May 245-May 286-May 277-May 228-May 229-May 2910-May 2411-May 2712-May 2513-May 2214-May 2215-May 2816-May 2217-May 3218-May 3119-May 2020-May 2421-May 2122-May 2523-May 3024-May 3025-May 3726-May 2627-May 2628-May 1029-May 3030-May 1731-May 25

Grand Total 784Average 25LEGACY HEALTH 31

PES May 2017 Dispo and Arrival Method

Arrival MethodArrival

s%

Car 269 34.31%SecureTransport

158 20.15%

Ambulance 112 14.29%Walk 71 9.06%Taxi 70 8.93%Police 35 4.46%PublicTransportation

34 4.34%

Other 31 3.95%HospitalTransport

4 0.51%

Total 784

Data extracted 6/7/2017 LEGACY HEALTH 32

PES DispoPatient

sDischarge 546

Admit 181LWBS before Triage 26

Transfered to Another Facility 18LWBS after Triage 8

AMA 3Registration Error 2

Total 784Percent Admitted 23%

Average daily visits = 25Discharge from triage =103 (13%) ALOS 2 hoursApril average = 21

PES May 2017 time of arrival Hour Arrivals %

00:00 19 2.42%

01:00 15 1.91%

02:00 10 1.28%

03:00 16 2.04%

04:00 9 1.15%

05:00 15 1.91%

06:00 8 1.02%

07:00 12 1.53%

08:00 15 1.91%

09:00 22 2.81%

10:00 41 5.23%

11:00 33 4.21%

12:00 35 4.46%

13:00 50 6.38%

14:00 67 8.55%

15:00 48 6.12%

16:00 59 7.53%

17:00 60 7.65%

18:00 54 6.89%

19:00 59 7.53%

20:00 46 5.87%

21:00 36 4.59%

22:00 22 2.81%

23:00 33 4.21%

Grand Total 784

Data extracted 6/7/2017 LEGACY HEALTH 33

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Trending PES daily visits

PES May 2017 Point of origin

Transfer Type EDVisits

Origin Location ED Visits

Non-Transfer 612 Walk-In/Other 614

Medical ED 154 Legacy Emanuel Medical Center 64

Hospital medicalunit

18Legacy Good Samaritan Hospital

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Grand Total 784 Legacy Mount Hood Medical Center 18

OHSU Hospitals & Clinics 17

Adventist Medical Center 12

Legacy Meridian Park Hospital 9

Kaiser Sunnyside Medical Center 8

Kaiser Westside Medical Center 6

Tillamook Regional Medical Center 4

Legacy Salmon Creek Hospital 2

Tuality Community Hospital 2

Columbia Memorial Hospital 1

Providence Milwaukie Hospital 1

Grand Total 784

Data extracted 6/7/2017 LEGACY HEALTH 35

PES Percent admitted for each point oforigin

Origin Location Admit Discharge

XFER

Total %

Legacy Emanuel Medical Center 29 33 1 64 45%Legacy Good Samaritan Hospital 10 15 1 26 38%OHSU Hospitals & Clinics 10 7 0 17 59%Adventist Medical Center 9 3 0 12 75%Legacy Meridian Park Hospital 6 3 0 9 67%Legacy Mount Hood Medical Center 6 11 1 18 33%Kaiser Sunnyside Medical Center 2 6 0 8 25%Kaiser Westside Medical Center 2 4 0 6 33%

Columbia Memorial Hospital1 0 0 1

100%

Providence Milwaukie Hospital1 0 0 1

100%

Tillamook Regional Medical Center 1 3 0 4 25%Legacy Salmon Creek Hospital 0 1 1 2 0%Tuality Community Hospital 0 2 0 2 0%Grand Total 181 546 18 784 23%

Data extracted 6/7/2017 LEGACY HEALTH 36

Inpatient LOS and ADC May 2017

Data extracted 6/7/2017 LEGACY HEALTH 37

Inpatient DataMay Discharges AVG LOS

MedianLOS

GeoMeanLOS

ALLIP

MayADC

91.1 All IP Admissions 14d 3hrs 8d 8d 16hrs

Median 91 Unit 6 Admissions 14d 18hrs 11d 11d 15hrs

Maximum 96 PES - 5/1 - 5/31 AVG LOS

MedianLOS

GeoMeanLOS

Unity Year-to-Date (April 1, 2017 through June 11, 2017)

Inpatient Discharges Average Length of Stay* Average Daily Census

Actual Budget % Actual Budget % Actual Budget %

476 839 56.7% 14.65 7.89 185.6% 93 94 98.9%

Adolescent ProgramUnit 6

6/20/17 LEGACY HEALTH 38

Unt 6 – Dispo, ADC and average LOS

Adolescent Program DC DispoUBH

UNIT 6Disch to Home or Self Care 34Other Facility (Step Down, Transitional Housing,Hooper House)

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Hospital-Acute Care (OHSU, Other LegacyFacility)

2

Grand Total 41

Data extracted 6/7/2017 LEGACY HEALTH 39

6Only

May ADC 18.4Median 19

Maximum 20

May Discharges AVGLOS

MedianLOS

GeoMeanLOS

All IP Admissions 14d 3hrs 8d 8d 16hrs

Unit 6 Admissions 14d18hrs

11d 11d 15hrs

Homelessness andUnity

6/20/17 LEGACY HEALTH 40

Data extracted 6/9/2017

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Seven Day Follow-Up3/6/2017 – 6/11/2017

HTPP BH 7-Day Follow-Up Per Unit By Week3/6/2017 – 6/4/2017

PE

RC

EN

T

Thankyou!

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