Mayview Service Area Planning Steering Committee

Meeting Summary

September 16, 2005


I.  Introductions


Members Present:  Mary Jo Dickson, Bob Harms, Emily Heberlein, Carol Horowitz, Nancy Jaquette, John Klenotic, Rich Kuppelweiser, Carol Loy, Kevin McElligott, Gerard Mike, Meg Park, Kim Patterson, Brandi Mauck Phillips, Steve Plyler, Janice Taper, Valerie Vicari, Deb Wasilchak, and Linda Zelch


Others Present:  Terry Carik (for Rick Rach), Sherry Snyder, and Tawnya Lewis


Members Absent: Tim Casey, Laverne Cichon, Mary Fleming, Pam Loaskie, Dave McAdoo, Rick Rach, and Patricia Valentine


II. Review of Meeting Summary from August 26, 2005


The minutes were reviewed from the August 26, 2005 meeting and a revision was made to the minutes.  The State Plan amendment is targeted for January 2006, rather than September 1, 2005. 


III. Sherry Snyder Harrisburg State Hospital Closure Experience


Sherry Snyder shared her experience of the Harrisburg State Hospital closure and provided recommendations to the Steering Committee that could be useful in the Mayview Initiative. 


Harrisburg State Hospital Process

The overall goal of the Harrisburg State Hospital (HSH) closure is to significantly decrease the number of patients needing inpatient care. In some form or another, every patient at HSH and their family, when relevant, participated in a thorough and comprehensive assessment and discharge planning process. The primary outcome of the assessment and planning process was a coordinated and individualized community support plan tailored to the needs of each patient. 


The overall process has been heavily facilitated and monitored by OMHSAS.  However, from the start, primary stakeholders, such as PCMHA, PPA, and NAMI were intimately involved particularly around educating patients and families about the project, their rights, and how they as individuals and families would be affected.  In addition, stakeholders such as NAMI, state hospital and community practitioners, and statewide and local C/FST staff participated in the development of the assessment tools, the administration of the tools, and the design of the discharge process.


There were three assessment tools (Family Assessment Tool, a Consumer Needs Assessment Tool, and a Clinical Assessment Tool) developed and simultaneously administered.  The interviews were completed in weeks.  This timeframe was severely compressed due to tight timelines.  Once assessments were completed, a team of people convened to complete a Consumer Support Plan (CSP).  The team consisted of the patient, family if relevant, a facilitator, a recorder, a client advocate, the treating hospital team, any community providers relevant to the discharge plan, and any others the patient might have wanted as part of the team.  The CSP written format is designed to link, into one plan, the information from all three tools.


Since the Assessments and the Consumer Support Plans have been completed, the discharge process has taken on a different form from patient to patient.  The majority of the planning processes have gone smoothly, but some have been long and arduous. But what is important and a primary goal is that each discharge plan is reflective of what the patient needs and wants and what their family needs and wants if appropriate, to ensure a successful transition to the community or transfer to another inpatient facility. Although the primary mission has been to transition patients to the community, there are some who were and will be transferred.  It is important to note that those transferring to another inpatient facility will continue working toward discharge as directed in their HSH discharge plan.


Facilitator/Recorder Roles

The facilitator of the team is a key component of the team.  The facilitator must ensure team consensus and is in charge of coordinating and writing the CSP.  To allow the facilitator to easily and effectively facilitate the planning process, a recorder is also on each team. 


The facilitators were chosen from a pool of seasoned veteran staff within OMHSAS. The facilitator acts as a neutral party, but also is responsible for setting the tone of the meeting.  The key role of the facilitator is to stimulate the team to go beyond what the typical planning process involves.  Challenging traditional thinking as well as ensuring that the team listens to what the patient  needs and wants are two critical tasks to getting consensus on a plan.  Specifically, the facilitator reviews the assessments at the CSP meeting.  During the meeting, the facilitator reviews information from the tools, leads a discussion toward the development of common goals and objectives, and finalizes a plan amenable to all.  The first draft of the CSP document is disseminated to team members, including the patient, to ensure accuracy, and then a final version is written and disseminated for use.  Sherry Snyder will forward an example of a CSP document.


Should disputes arise, an appeal process was in place.  Appeals could go all the way to Estelle Richman for review and consideration. 


Service Identification for Consumers

Some issues/concerns to address when considering new services for consumers include:

         Discussion during CSP meetings should focus on what service components an individual needs, rather than a program name (e.g. 24 hour structured support vs. LTSR).

         For consumers who move to supported housing, the counties need to have a plan to monitor how people are doing, which will not be left up to providers. 

         Consumers have complicated needs involving substance abuse, medical issues, developmental disabilities, and forensics.  Other resources were brought into follow-up CSP meetings to address needs. 

         Every person discharged from the hospital should have 24/7 access of support.  Supported living or group home can be an option as long as the consumer has access to 24 hour support. 

         The resource team can help to determine a support plan for people.  Sometimes as many as four follow-up meetings were planned to determine the needs of individuals.

         Consumer education (peer support) was offered to help consumers think about the process.  Consumer advocates from PMHCA worked with each resident as part of the planning process and conducted the consumer assessments during an interview with the consumer.  Advocates also attended the CSP meetings.  Wherever possible, the same advocate who completed the interview also attended the meetings.  PP&A visited all of the wards of the hospital to educate consumers on the closure and to provide information about the process and their rights.

         Several new programs have been developed: an LTSR, an extended acute facility (maximum stay 180 days), and a forensic CRR.    Forensic CRR services are the most challenging because people have concerns about these consumers living in the community due to felony crimes and/or sexual assaults.  The multi-county initiatives are HealthChoices in-plan services.  Guidelines are available, but are still being developed on these initiatives.


What was learned from the Harrisburg State Hospital process?

         Some families were resistant to having their family member discharged, and preferred a transfer to another State Hospital.

         Trust had diminished.  Families lacked trust in any system outside of the State Hospital.  Families did not believe that history would not repeat itself.

         Involving the families in the planning and review processes greatly helps to rebuild trust.

         A comment was made that there was a need to do more diversions prior to SMH admission.  She suggested that independent assessments be done in community impatient facilities before the SMH referral is done, and that better diversion programs are needed.



Peer Support

         Each county is required to have peer support programs.

         Peer supports meet with consumers teams would be contacted prior to discharge.

         Consumers will develop WRAP and advanced directive plans to include diet, physical and fun activities. 

         Consumer transportation is a concern.  One suggestion is to have a consumer run business that is a transportation company.  Consider contracting with PSAN to handle the business aspects of the transportation company.


Financial Model

Harrisburg has used a number of different funding streams to finance the closure of HSH.  It was challenging, and some community programs are higher and vary by hospital than inpatient psychiatric rates.  Below is a list of some of the funding sources utilized:

         Mental Health base funding will be utilized as well as MR waiver funds.

         Department of Aging funds are used as appropriate.

         The COMCARE waiver funds individuals with traumatic brain injury.  These dollars can be utilized for any support, but not for housing.  Less than ten consumers utilized this funding.

         HealthChoices reinvestment funds can be used to build infrastructure, particularly housing.  Housing is the biggest issue in this process, and its important that each county gets ahead of the process through a housing plan.

         Existing hospital resources may be utilized.

         HealthChoices capitation rates will fund in-plan and supplemental services, including case management, LTSR, and peer supports.  Rate adjustments would be considered prospectively rather than retrospectively.

         Some counties received upfront money (bridge funding) in advance of plans/discharges.

         Counties need to review service utilization in aggregate and individual costing for consideration for unique initiatives.  Some costs will be higher, but the assumption is that the costs will balance in the end.  The state will also conduct an analysis and compare data as well.

         Analysis was conducted of costs/person while considering outliers.  At HSH, they did aggregate and individual costing, while taking into consideration unique initiatives.

         Budgets werent completed until after the assessment and discharge planning process was complete.  OMHSAS didnt want to limit peoples thinking/planning for appropriate interventions.  The MRSAP was encouraged to conduct data analysis on costs and present/discuss with OMHSAS.



In an attempt to prevent adverse events (Failure in the community, readmission to SMH, and tenant eviction) the following should occur:

         Rigorous reporting

         Status reports

         Follow up with psychologist

         Frequent monitoring

         County receives information through case management and provider network

         Recommendation was made to review how counties are monitoring current discharges.  Develop a tracking tool proactively.

         State has monitoring standards and Sherry will provide benchmark statistics available.


Union/Employee/ Issues

         Resource teams were developed, as a way for some SMH staff familiar with these consumers to remain employed in the community.

         OMHSAS agreed to pay salaries of State Hospital staff for two years following the closure.

         Job fairs were set up by the state to transfer state employees to other sites.  The state issued a process by which these employees had priority in the hiring process.



         The media treatment was vocal in Harrisburg.  Editorials, news shows, and bad publicity from unions speaking unfavorably to consumers/families regarding the Harrisburg closure contributed to negative publicity.

         The Deputy Secretary of OMHSAS meets weekly/regularly with local legislators to keep them informed of the process in an attempt to keep them involved and aware of what is going on. 


Sherry Snyder recommended that PMHCA, NAMI, state, counties, providers, and Dave Jones would be able to offer the Steering Committee additional information on the process.  Brandi Mauck Phillips requested that any member of the Steering Committee having additional questions for Sherry Snyder could forward them to AHCI.


IV. County Prioritization of Bed Closures


The Steering Committee agreed to defer the discussion about how to prioritize the bed closures by county until the October 3rd meeting.  The Committee will need to be prepared to address financial concerns/issues related to this during the October 27, 2005 meeting with Joan Erney.


V.  Preparation for the Stakeholders Meetings


October 3, 2005


Mary Fleming/AHCI will facilitate the stakeholders meeting.  The Steering Committee agreed that the following should be addressed during the meeting:


         Provide an overview of this regional project related to the closure of one unit at Mayview State Hospital and describe the Harrisburg State Hospital closure in the context of this process. The overview will include who is involved in this process.

         Highlight the differences between the 2002 SAP and the current initiative. 

         Elicit input/recommendations from people who are currently living in the community and receiving recovery-based services.  The most important question to ask people is what has helped them the most in their recovery.  Identify what challenges people encountered upon discharge from the State Hospital.

         Explain the role of the Steering Committee and the Assessment & Discharge and Finance/Data committees in the planning process. 

         Provide contact information (email address and telephone number) for any follow up questions and/or concerns that people may have after the meeting.

         Provide a handout that describes the many funding streams that will be available to fund this initiative.  Also consider providing handouts or posters that explain acronyms and whos who.  Avoid acronyms and jargon when speaking. 

         Consider the concerns/interests of all stakeholder groups such as: housing, jobs, and transportation.  Also, stakeholders will be concerned about the availability of more intensive services if people get ill again.  One suggestion was to create a list of several questions for different stakeholder groups (clients, families, and providers).

         Stakeholders should be asked how they want to be involved in this process.


The group was reminded that AHCI needs to have RSVPs by September 26, 2005.


October 27, 2005

The Committee agreed on the following:

  For the County Plan Update portion of the agenda, each County will pick one or two key initiatives they want to present.  AHCI will combine these initiatives into one presentation.

  Counties will create a handout with a bulleted list of other initiatives.

  Counties should send a draft of their presentation to AHCI by 9/29.  AHCI will combine the submissions into one presentation.  This draft will be distributed and reviewed at the October 3rd Steering Committee meeting.

  For the SAP Update portion of the agenda, AHCI will develop the presentation as the facilitator of the planning process.  The regional update should include information gained from the 10/3 stakeholders meeting.  The presentation should provide some update on the three state goals.


County Plan Update

  Each county will put together a draft into one document in bullet point format of one or two areas of interest to be discussed during the October 27th meeting.  The County Plan should be 10-15 minutes per county.  The county representatives agreed to submit a draft of the county plan presentation and forward to AHCI within the upcoming week.


VI. Who/Where were the Announcement Distributed


The Steering Committee has not yet distributed the announcement publicly, but will inform AHCI to whom the announcement was forwarded.


VII. Assessment/Discharge Committee Update


Kim Patterson provided an update on the first Assessment/Discharge committee which was held on September 14, 2005.  The meeting was well attended and nearly half of the members were consumers or family members.  The Assessment Committee reviewed the project and developed guiding principles.  The Committee reviewed the consumers assessment in depth.  The family and clinical assessments will be reviewed at the next meeting, scheduled for October 19th.


A request was made that someone from the Steering Committee attend the October 19th                                                                                 Assessment/Discharge meeting to talk about funding and the activities/goals of the finance committee.  A request was made to come up with a new name for the funding proposal (rather than CHIPP.)


VIII. Follow-Up Items/Tasks Needed before Next Meeting


Tawnya Lewis will forward the tracking tool used for involuntary/voluntary admissions to the committee.


Tawnya Lewis will forward an agenda to the committee next week for the October 3rd meeting.


Valerie Vicari offered to assist with an acronym/definition list for the October 3rd stakeholders meeting.  She also reminded the group that a representative of this group needs to attend the October 14th CSP meeting.


Valerie Vicari and Rich Kuppelweiser will take the lead in sending the notice of the October 27, 2005 stakeholders meeting.  The notice will be sent after the October 3, 2005 stakeholders meeting to minimize confusion between the two meetings.  Val/Rich will provide an invitation draft at the October 3, 2005 meeting.


Valerie Vicari will provide a PowerPoint document that can be used as a guide in presenting the SAP goals. AHCI agreed to incorporate the information from each county into one presentation.  AHCI requested to have the information from each county no later than September 29th.


Bob Harms offered to send questions he had used to survey people discharged from the hospital.  CSP survey results would also be helpful.


Rick Tully, the financial consultant to the project, is planning to be in Pittsburgh for two or three days in November and Brandi requested that county administrators send some available dates to meet with Rick within the first two weeks of November to discuss the financial components of the project.