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Welcomes TriWest for a

LC3 Community Presentation

September 17, 2024

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�

LC3 Community Presentation

September 17, 2024

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Presentation Overview

Review of crisis needs assessment scope of work
Review and discuss best practices in crisis care
Review and discuss Doña Ana County’s crisis continuum
Discuss findings and opportunities for improvement in the current crisis system

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Crisis Assessment Scope of Work

Review best practices in crisis care for children, youth, and adults
Reviewed U.S. Census Bureau population estimates and estimated behavioral health needs for Doña Ana County
Analyze service utilization throughout the crisis system

Analyze available data to determine how people move through the system
Conduct key informant interviews
Focused on provider capacity and perspective

Identify key performance indicators
Develop findings and recommendations

Purpose

Learn more about the county’s current service system and what services and supports are needed to strengthen Doña Ana County’s crisis continuum for children, youth. And adults.
Reviewed current U.S. Census Bureau population estimates for Doña Ana County
Estimated county-level behavioral health needs by applying the most local and recent epidemiological data
Gathered qualitative information from a variety of child, youth, and adult behavioral health providers and community stakeholders
Analyzed behavioral health call and service utilization data
Estimated service use where data was not available.

This assessment of Doña Ana County is not designed to be an exhaustive analysis of all behavioral health crisis providers, services, and supports available to residents of Doña Ana County. It is a time-limited review of strengths, gaps, and opportunities within Doña Ana County’s continuum of care for individuals of all ages.

The findings and considerations are based on interviews with a sample of key informants, a review of publicly available documents, and an examination of available and estimated behavioral health crisis data and prevalence estimates.

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Adult Crisis Care – �Comprehensive Crisis Service Continuum

Substance Abuse and Mental Health Services Administration (SAMHSA) National Guidelines for Behavioral Health Crisis Care:

Regional crisis call center (“someone to call/talk to”)
Crisis mobile team response (“someone to respond”)
Crisis receiving and stabilization facilities (“a place to go”)

Additional resources that support the crisis system include intensive home and community-based services • short-term residential crisis program • peer crisis respite • sobering support • psychiatric hospitalization • intensive outpatient • transportation

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Child and Youth Crisis Care – �Mobile Response and Stabilization Services

Mobile Response and Stabilization Services continuum of care

Single point of access (“someone to contact”)
Mobile response (“someone to respond”)
System of support – stabilization (“a safe place to be”)-home or in community

Stabilization services include parent/caregiver education • positive youth development and recreational programs • family and youth peer support • in-home services • systems navigation • linkages to home, school, and community-based services • linkages to psychiatric or primary care services for medication management or evaluations • clinical treatment • respite care • care coordination with other family- and youth-serving systems

MRSS Continuum

crisis prevention - screening and assessment, home and community-based services and supports, safety planning, planned respite,
crisis response - single point of access, in-person mobile response, s
Crisis stabilization – up to 8 weeks – intensive in-home services, care coordination, crisis respite care, short-term residential crisis

Psychiatric consultation telehealth

Stabilization Service Need

A percentage of families will need ongoing services after 6-8 weeks of stabilization services

In 2021, Connecticut referred 33% to outpatient services

8% To intensive in-home services

1% to care coordination

Less than 1% to residential treatment

Intensive in-home services – Intensive In-Home Child and Adolescent Psychiatric Service (IICAPS), Family Centered Treatment (FCT), Fuctional Family Therapy (FFT), Multidimensional Family Therapy (MDFT), and Multisystemic Therapy (MST)

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Children’s Ideal Continuum of Care

MRSS Continuum

crisis prevention - screening and assessment, home and community-based services and supports, safety planning, planned respite,
crisis response - single point of access, in-person mobile response, s
Crisis stabilization – up to 8 weeks – intensive in-home services, care coordination, crisis respite care, short-term residential crisis

Psychiatric consultation telehealth

Stabilization Service Need

A percentage of families will need ongoing services after 6-8 weeks of stabilization services

In 2021, Connecticut referred 33% to outpatient services

8% To intensive in-home services

1% to care coordination

Less than 1% to residential treatment

Intensive in-home services – Intensive In-Home Child and Adolescent Psychiatric Service (IICAPS), Family Centered Treatment (FCT), Fuctional Family Therapy (FFT), Multidimensional Family Therapy (MDFT), and Multisystemic Therapy (MST)

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Doña Ana County Demographic Estimates

Doña Ana County	#	%
Total Population	223,337	100%
Age
0-17	53,172	24%
18 and older	170,164	76%
Hispanic or Latino Self-identification
Not Hispanic or Latino	68,960	31%
Hispanic or Latino	154,377	69%
LGBTQ+	12,252	7.2%
Veterans	13,880	6%

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Doña Ana County Prevalence Estimates

Conditions	Children/Youth (6-17)		Young Adults (16-25)		Adults (18+)		Total
Total Population (ages 6+)	Total	38,024	Total	42,834	Total	170,164	208,189
	Ages 6-11 17,516		Ages 16-17 7,492		Ages 18-64 132,731		--
	Ages 12-17 20,508		Ages 18-25 35,342		Ages 65+ 37,433		--
Mental Health Conditions
Serious Mental Illness (18+)	Not Applicable		3,089		7,538		7,538
Serious Emotional Disturbance	3,840		Not Applicable		Not Applicable		3,840
Major Depressive Episode (12+)	3,134		5,662		12,437		15,571
Attempted Suicide (12+)	1,446		1,067		1,378		2,824
Substance Use Disorder (12+)	880		5,204		12,111		12,991

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Crisis Now Model

Aligns with SAMHSA’s National Guidelines for Behavioral Health Crisis Care

The Crisis Now model does not break out crisis episodes by children, youth, and adults and assumes that 10–20% of crisis line calls will require in-person support.

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Crisis Now – Doña Ana County

In-Person Crisis Services	ED/Inpatient Only Model Capacity	Model With Crisis Receiving Chairs Capacity	Crisis Now Model Capacity
Mobile crisis team (assuming a 40-hour work week)	N/A	N/A	3
Crisis receiving chairs	N/A	14	12
Short-Term crisis beds	N/A	N/A	10
Acute psychiatric inpatient beds	93	50	27

The estimated prevalence of crisis episodes in Doña Ana County for all ages is 514 per month or 6,165 per year.

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Doña Ana County – Someone To Call

Estimated prevalence of crisis episodes in Doña Ana County for all ages is 514 per month or 6,165 per year
Existing calls totaled ~203 calls per month which may not accurately reflect behavioral health crisis needs in Doña Ana County
The Warmline and NMCAL data sets of Doña Ana County residents’ calls

Warmline: 1,278 calls from Doña Ana County in 16 months (NM 56,076)

An average of 87 calls per month

NMCAL: 1,947 calls from Doña Ana County in 15 months (NM 96,023)

An average of 130 calls per month

Project LIGHT dispatch data

Project LIGHT was dispatched 1,034 times by 911 in 12 months

Average of 86 calls per month

Regional Call Center or Single Point of Access

NMCAL calls for LGBTQ+ individuals, Spanish speakers, and Veterans answered nationally and not included in the data –

Only 2% of the calls with County Data are from Doña Ana County – Doña Ana County’s population makes up more than 10% of NM’s population

More than 50% of the call data for the warmline (56%) and NMCAL ( lines included any county information and only 2% of the calls with a recorded county were from Doña Ana County

Warmline 87 per month
NMCAL 130 per month
NMCAL 18% of the callers were under 22 years of age (170)
NMCAL 83% of adults and 87% of children’s call did not require a higher level of care

Project LIGHT is dispatched for six reason, only three are related to behavioral health needs – only dispatches that occur during the teams operating hours.

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Doña Ana County – Someone To Respond

National benchmark: 10–20% of individuals will require an in-person response

Does not take into consideration the Mobile Response and Stabilization Services “just go” approach for children and youth

90% receive an in-person response for MRSS nationwide

Limited crisis call data makes it difficult to precisely estimate mobile crisis capacity needs
Project LIGHT mobile crisis co-responder model

371 individuals were served in a 12-month period
270 (73%) were over the age of 19, and 96 were 18 and under
37% of the individuals who were transported were taken to an ED

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Doña Ana County – Someplace To Go

The Crisis Triage Center (CTC), when in operation, adequately addresses the behavioral health crisis needs of Doña Ana County
1,267 adults were voluntarily admitted to the CTC in a 12-month period

40% of admissions were walk-ins
22% were brought in by the police or jail
2% resulted from a crisis line call
The remaining 36% were brought in by friends, family, outpatient providers, or other

34% were discharged to an inpatient psychiatric facility

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Doña Ana County – Continuum of Care

FYI+ CCBHC. Same-Day access for walk-ins

Approximately 15% screen positive for suicide

Southwest Family Guidance Center. Same-Day crisis assessments for Las Cruces Public School students

150 during a 10-month school year

Peak Behavioral Health and Mesilla Valley. Partial hospitalization, day treatment, and intensive outpatient services for youth and adults
Peak Behavioral Health and La Clinica de Familia. ACT/ Assertive Community Treatment services

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Doña Ana County – Inpatient Beds

Doña Ana County has adequate inpatient bed capacity

220 acute inpatient psychiatric beds for children, youth, and adults
31 residential treatment beds for youth

Crisis Now capacity estimates 93 beds needed for an emergency room/psychiatric inpatient only-scenario
Considerations

Peak Behavioral Health sits on the New Mexico/Texas boarder and admits patients from El Paso, Hudspeth, and Doña Ana as well as from Arizona
University Behavioral Health and Rio Vista Behavioral Health hospitals in El Paso serve Doña Ana County residents
Inpatient providers do not report significant wait times for services
Inpatient providers do not report significant issues with boarding

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Doña Ana County – Inpatient Beds

Mesilla Valley Hospital

A total of 4,112 individuals were admitted in a 12-month period

1,634 children and youth
2,478 adults

Emergency department – 55%, n = 2,279

1,097 children and youth
1,182 adults

Self-Referral/walk-in/brought by a friend – 33%, n = 1,354

318 children and youth
1,036 adults

Police or school resource officers – 4%

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Doña Ana County – Inpatient Beds

Peak Behavioral Health (estimates)

Approximately 6,000 individuals are assessed for admission in a 12-month period
Approximately 9 out of every 10 are admitted (5,400 estimated admissions)

Estimated 3,240 adults
Estimated 2,160 children and youth

An estimated 35–40 youth per year are admitted directly to the residential treatment center
Emergency department – 85% are transported from area EDs

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Where Is the Front Door?

Single Point of Access

Children and Youth

Regional Call Center

Adults

80-90% of adults calling call centers can have their concerns addressed with someone to call.

For children and youth, a different system may be needed.

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Doña County Crisis System

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Adult Crisis Service Findings

Doña Ana County behavioral health service providers believe that the current crisis continuum (including the CTC) is adequate
There appears to be limited coordination between 988 and the region’s behavioral health providers
Mobile crisis response team services are limited to the City of Las Cruces and non-existent in Doña Ana County
The CTC, when open, diverted the majority of adults from EDs. But it continued to refer more than one third of adults to acute inpatient psychiatric services

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Adult Crisis Service Findings

In the absence of a regional call center and sufficient mobile crisis team capacity, EDs and acute psychiatric facilities have become the primary crisis service access points for Doña Ana County residents

This has resulted in an overreliance on EDs and acute psychiatric services

The number of available acute psychiatric beds exceeds the estimated need, suggesting that for many in crisis, the level of intensity and restrictiveness of available services far exceeds the service need

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Children's Crisis Service Findings

There is no single point of access for children and youth in crisis

EDs and acute psychiatric hospitals appear to be the front door to care for many in crisis

Available crisis services are not youth focused and not aligned with best practices for crisis care in children, youth, and young adults

Someone to contact, someone to respond, and someplace safe to be
Ideally with minimum disruption to school and home life

The community prioritizes the use of stabilization centers, acute psychiatric centers, and residential treatment over in-home stabilization
The community lacks a robust continuum of crisis stabilization that is anchored in a strong continuum of care outside of partial hospitalization programs

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Children's Crisis Service Findings

There was limited recognition of the value of in-home crisis stabilization and intensive in-home and community-based services in preventing out-of-home placements

Intensive home and community-based services are supported in the New Mexico Medicaid State Plan

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Considerations for the Community

System Considerations – Adults

Education – Educate Doña Ana County on recommended best practices for crisis care for adults.
Messaging – Promote 988. Continue to share information on Crisis Triage Center. Craft and disseminate messaging on the current adult crisis system’s strengths, gaps, and barriers to access and its potential impact on Doña Ana County residents.
Convening and Planning – Engage Doña Ana County behavioral health consumers, crisis care providers, and other community partners to revise Doña Ana County’s plan for a comprehensive crisis continuum so that it aligns with national best practice standards and meets the behavioral health crisis needs of Doña Ana County residents. The plan should focus on increasing coordination with 988, expanding mobile crisis to the county, increasing the city’s mobile crisis capacity, and better aligning acute psychiatric facility capacity with community crisis needs.

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Considerations for the Community

System Considerations – Children and Youth

Best Practice – Remember that youth crisis and adult crisis situations are often different in terms of time, location, and situations.
Best Practice – Recognize that a co-responder model with law enforcement is not a best practice for children and youth. Law enforcement officer involvement can increase the number of children and youth of color who end up in the juvenile justice and child welfare systems.
Best Practice – Identify communities with a majority Hispanic/Latinx population that have adapted best practices for delivering crisis care to children, youth, and families in a manner that meets the cultural needs, immigration status concerns, and funding inequities of the community.

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Considerations for the Community

System Considerations – Children and Youth

Education – Educate Doña Ana County on the ideal crisis continuum for children, youth, and families; and how needs for adults in a crisis and those of children, youth, and families.
Messaging – Craft and disseminate messaging on the current children’s crisis system’s strengths, gaps, and barriers to access and its potential impact on Doña Ana County’s children, youth, and families. Promote prevention and early interventions.
Convening – Engage community stakeholders to develop a plan for building a crisis continuum specific to the needs of children, youth, and families that includes mobile response, home and community-based crisis stabilization services, and crisis triage and respite options. This plan should include strategies to decrease the community’s reliance on acute psychiatric hospitalization and increase intensive home and community-based programming.

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Invitation to Question, Reflect, and Act

Wrap-up questions and general discussions, recommendations for action

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Meeting Goals

Compare and contrast existing crisis continuum components with best practices and the ideal continuum
Validate and expand on crisis needs assessment findings
Identify priorities and opportunities for targeted improvements to Doña Ana County’s crisis system

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Where Is the Front Door?

Single Point of Access

Children and Youth

Regional Call Center

Adults

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FYI+ Convening Project—Youth Voices

System Considerations – Children and Youth

Convening – Gather information from young people and families in Doña Ana County to better understand their behavioral health crisis needs, concerns, perceptions of care, opinions on the effectiveness of the current crisis system, and ideas regarding system change

Availability and Accessibility of Services –increasing access and resources