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By Sun Vega, MBA

Is your organization thinking about delivering home-based services? There is certainly a lot of current attention to home-based services, and for a number of reasons.  First, the Federal government is granting more home- and community-based waivers to states for their Medicaid plan (see Home & Community-Based Services Toolkit, How The New HCBS Rules Will Reshape Community-Based Services). Secondly, states are focused on closing state hospitals and moving consumers to the community (see The Emerging Community-Based Market Niche).  Then, there is the concern about readmissions – and the need to support newly-discharged consumers (see One Hospital’s Readmission Penalty Is Someone’s Opportunity and The 4:1 ROI Of Hospital Discharge Transition Programs).

cons-evans-jon-tiiBut developing and managing a non-clinic based service takes some unique planning.  That is what I learned from Jonathan Evans, President & Chief Executive Officer, Safe Harbor Behavioral Health in his presentation at the 2014 OPEN MINDS Planning & Innovation Institute session – Mastering The Art Of Delivering Home-Based Services: Changing Management Models & Consumer Engagement.  Mr. Evans described the Crisis Services Acute Needs and Diversion Service (C-SANDS) program, their 30-day program designed to assist clients who interface with Crisis Services by helping to divert them from unnecessary hospital stays, incarceration, job loss, or other negative events. The program consists of five components:

Psychiatric –Clients developing schizophrenia have been kept from the hospital, and clients experiencing significant symptoms have been able to keep their jobs.

Therapy – During the 30-day program clients are offered a psychosocial assessment and eight therapy sessions, at home, in the office, or in the community.

Follow-Up – C-SANDS therapists work closely with Crisis Services follow-up and telephone staff, who assist in ensuring support, case management, and referral needs are met.

Peers – All clients have access to the peer-run Warm Line, and may access this additional resource or be referred to the line at case closure.

Emphasis on Outcomes – Pre and post testing help to identify needs and also to track outcomes. These measures include Global Assessment of Functioning scales, smoking and cessation referral, drug and alcohol concerns and referrals (National Institute of Drug Abuse), depression evaluations (Center for Epidemiological Studies Depression Inventory), and mania evaluations (Goldberg).

C-SANDS has helped Safe Harbor expand its services to a population with more acute needs, while emphasizing community integration. They have been able to receive referrals from emergency rooms diverting clients from inpatient, and from inpatient units who are able to discharge clients sooner.  And, Safe Harbor has been able to negotiate an enhanced rate for the program with managed care organizations. Why? Because the program has been successful in reducing the use of emergency room visits and hospital stays – and preventing incarceration.

My take-away from his presentation of the Safe Harbor model?  Consumer-focused communication and service delivery is key – with a big focus on measuring both service costs and service outcomes. Where to begin? Check out these resources from the OPEN MINDS Industry Library:

  1. Enhancing Remote Supervision Practices Essential for Moving to Community-Based Care
  2. The Emerging Community-Based Market Niche
  3. Budgets & Technology Drive Shift Towards Community-Based Treatment
  4. The 4:1 ROI Of Hospital Discharge Transition Programs
  5. How The New HCBS Rules Will Reshape Community-Based Services

For a deep dive into C-SANDS, check out Safe Harbor Community Mental Health Center: Crisis Services Acute Needs & Diversion Services Outpatient Program. And for more on HCBS, be sure to join me at the 2014 OPEN MINDS Technology & Informatics Institute, November 5-6, for the session, Community-Based Treatment Through Technology: Remote Monitoring, SmartHomes & More.

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