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Intervention program that diverts people experiencing a behavioral health crisis to medical care instead of arresting them earns international recognition.
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PHOENIX, AZ (February 14, 2021) The voices in Arthur Jackson's head told him to take off his clothing, because it was evil. So, he did. Then he walked naked into the middle of the busy street to direct traffic. He recalls several police officers start to surround him. One officer stopped them and calmly said, “Hold on, I got this.”
Arthur was experiencing a mental health crisis. That Phoenix police officer knew how to deescalate these types of situations because he’d been through Crisis Intervention Team (CIT) training. He didn’t arrest Arthur that day. Instead, he coaxed him out of the street and took him to a psychiatric hospital for treatment.
“CIT saved my life,” said Arthur, who now shares his story to educate other law enforcement officers.
In 2020, there were 27,437 incidents in which people with mental health concerns and/or substance use disorders in Maricopa County were also diverted away from the criminal justice system and into treatment.
This approach is part of the CIT program, which aims to help persons with police contact to get on a path to appropriate health care. Thanks to increased CIT training of approximately 300 officers per year from 30 local, county, state, federal, and tribal law enforcement agencies, through training in one of the CIT programs, in and surrounding Maricopa County, the number of people diverted to treatment has grown steadily year over year. In 2019, police redirected 23,447 individuals into the behavioral health system for services and supports, up from 22,541 individuals in 2018.
These positive results are now getting international attention.
Central Valley CIT, a regional program that includes Phoenix and Tempe police departments and Mercy Care, received gold level certification from CIT International for their “robust crisis response system, comprehensive training program,” and collaboration with behavioral health providers.
Mercy Care manages crisis services for Maricopa County’s 4 million residents. Mercy Care is actively involved in the planning, instructing, implementation, and funding of the Central Valley CIT training, as well as the ongoing community collaboration with law enforcement.
The Crisis Intervention Team program is a community partnership of law enforcement, mental health and addiction professionals, individuals who live with mental illness and/or addiction disorders, their families, and other advocates.
CIT International noted in its report: “It is rare to find a crisis response system that includes so many services, available 24/7, that are clearly funded and prioritized by the mental health system. To have this system coordinated with law enforcement to reduce involvement in the justice system is a key goal of CIT programs.”
“Members of our community and first responders agree that mental health-related issues are rising and present a significant challenge. Specialized training is an important part of addressing these situations effectively,” said Phoenix Mayor Kate Gallego. “I’m proud of this recognition for CIT unit officers in Phoenix.”
Tenasha Hildebrand, Crisis and Veteran Services Administrator and CIT training facilitator at Mercy Care, said: “No one plans to have a crisis. But all too often, people find themselves or their loved ones in distress, and turn to law enforcement for help. We’ve trained hundreds of officers in Maricopa County on CIT, and we’ll continue to do so, because the data show it’s working.”
CIT training promotes the safety of the individual in crisis and the officers or other first responders. The current program has been in place since 2001.
“This combination of training, collaboration and meaningful services has transformed how our community and police department aid individuals experiencing crises and those with behavioral health needs,” said Tempe Police Sgt. Robert Ferraro. “We are proud of our Gold Certification acknowledging nearly two decades of hard work.”
The central Arizona collaborative is the first regional program certified by CIT International and awarded the gold certification level in acknowledgement of the strength of the program.
“We have partnered with the Regional Behavioral Health Authority (RBHA) to work with community stakeholders as part of a CIT program since 2001. Mercy Care has been one of our most important partners in RBHA since 2014,” said Phoenix Police Sgt. Mercedes Fortune. “Together, Mercy Care, Tempe Police and Phoenix Police Departments are proud of the work we continuously improve on, in an effort to provide the best service possible to our community.”
Contacts:
Monica Alonzo, Mercy Care
602-370-4275
alonzom@mercycareaz.org
Steven Carbajal, Tempe Police Dept.
steven_carbajal@tempe.gov
Sgt. Mercedes Fortune, Phoenix Police Dept.
Mercedes.Fortune@phoenix.gov
July 28, 2020
Mercy Care Health Equity and Community Intervention
At Mercy Care we are committed to helping our members live a healthier life and achieve their fullest potential. Our work has focused on addressing social determinants of health with a comprehensive approach to improve outcomes in the areas of housing, school-based services, women’s health and addictions.
With this work as our foundation, we also recognize that health disparities remain widespread among people of color. We are building a strategy that will allow us to confront these disparities through health equity and community intervention.
Through this work we will develop, implement and lead our initiatives to build equity within Mercy Care and the communities we serve by abolishing systemic racism, including inherent and unconscious bias, that contributes to health disparities. These include social determinants of health that impact the health and well-being of our colleagues, members, providers and communities.
The announcement of our commitment is not the conclusion of a process but an ongoing, dedicated effort that will be embedded in our culture. Together with our community, we will help our members live a healthier life and achieve their full potential.
October 7, 2019
Positive expectations for Arizona's Direct Care Workforce efforts
Twenty-four states have implemented Medicaid managed long-term services and supports (MLTSS) programs to promote quality and care coordination as well as curb rising Medicaid spending. However, for these states to be successful, they will need a stable, competent workforce to fulfill an estimated 4.2 million direct (attendant) care jobs over the next 6 years. Currently, these states face immense challenges in workforce recruitment and retention of attendant care workers.
Current situation
The attendant care workforce has more than doubled in the past decade. Yet, despite progress, economic stability among workers remains poor:
- Turnover at private-pay agencies remains over 80 percent1
- 2 out 5 work part time
- Median annual income is $16,200
- 1 in 5 lives in poverty
- Over half rely on some form of public assistance
Future situation
Over the next six years the attendant care workforce will rank among the top five occupations in the U.S. and will grow more than any other single occupation.
However, according to the Institute for the Future of Aging Services:
“…the quality of long-term care—the recipients’ clinical and functional outcomes and quality of life—is significantly influenced by the attributes these workers bring to their caregiving jobs, the education and training they receive, and the quality of their jobs. The attitudes, values, skills and knowledge of these workers, how they are compensated and rewarded, and the way their jobs are organized and managed, all have a role to play in determining long-term care quality. Workforce development activities designed to increase the capacity of these individuals to participate effectively in long-term care settings should be integrated into all ongoing and new long-term care quality improvement and quality assurance initiatives.”
Local efforts in Arizona
Mercy Care, Aetna’s Medicaid health plan serving the State of Arizona, is currently exploring how they can offer opportunities to collaborate with attendant care leaders to strengthen the attendant care workforce and improve outcomes. These opportunities include collaborative training programs, new data-collection systems, and value-based payment initiatives, among others.
According to Sarah Hauck, Workforce Development Administrator for Mercy Care, “Mercy Care is implementing seven Workforce Training and Development pilot initiatives that will support the creation of 6,000 - 10,000 new attendant worker positions in the field of long term care and enhance the recruitment, retention and training of contracted providers in their network.”
To prepare for the implementation of these pilots, Mercy Care selected Practical Training Solutions and the United Way of Tucson and Southern Arizona to identify people in the community who want to be direct care workers, train them to become certified, and then connect them with attendant care agencies in the community awarded contracts with Mercy Care.
Mercy Care also put out a Request for Information to attendant care agencies to serve as contracted providers that will hire the pipeline of direct care workers identified by the two organizations above. Out of the 15 provider agencies that submitted proposals, Mercy Care selected five for contract awards starting in January 2020. The selected agencies showed highly innovative and creative approaches to recruitment, retention and training, with a high focus of allocating funds directly to employee initiatives.
The Road ahead
Mercy Care will collect, monitor and analyze the outcomes of these initiatives with the hope that the pilots will help drive future statewide projects.
January 10, 2018
Partnership and Promise: Improving the health of a community
Integrated health care works. Supporting people with serious mental illness designations to address the social determinants of health—stable housing, employment, food security— has a positive impact on their path to recovery. See how Mercy Care does this every day with the results from research conducted by NORC at the University of Chicago.
Three research studies of programs and services offered by Mercy Care (formerly Mercy Maricopa Integrated Care), a Medicaid managed care plan, to address social determinants of health found some components of the programs can reduce cost and improve quality of care for people with serious mental illness in Maricopa County, Arizona.
Mercy Care is a not-for-profit 501(c)(3) organization. Mercy Care is sponsored by Dignity Health, Ascension Care Management.
The studies were conducted by the independent research institution, NORC at the University of Chicago.
The NORC studies looked at the experience of members enrolled in supportive housing, supported employment, and Assertive Community Treatment services, as well as the applicable program’s effect on the cost and quality of care and the utilization of services by adults with serious mental illness. The services in Maricopa County are combined at single community provider locations to make sure members have access to supportive services, as well as physical and behavioral health care.
The research findings suggest shifting services from more intensive inpatient and residential stays to outpatient and routine behavioral health care focused on chronic illness can affect cost and quality of care.
“Working collaboratively with providers, local stakeholders, the City of Phoenix, Valley of the Sun United Way, and the state of Arizona, we have shown that fully integrated care addressing social factors is the right way to meet the needs of Medicaid members with complex conditions,” said Mark Fisher, CEO of Mercy Care.
Addressing social determinants of health leads to positive health outcomes
The research found that members enrolled in the Supportive Housing intervention experienced decreases in total cost of care of 24 percent after enrolling in the program, while members in the Assertive Community Treatment intervention experienced significant reductions in certain costs, including a 6 percent relative decrease in per member per quarter costs in behavioral health professional services, an 11 percent relative decrease in health facility costs, and an 8 percent reduction in emergency department visits. [1] Members enrolled in the Scattered Site housing program had an average health care cost of about $20,000 per member per quarter in at least one quarter before starting in the supportive housing program. [2] After enrolling in the supportive housing program, members experienced a $4,623 reduction per member per quarter in total cost of care. These members also had fewer psychiatric hospitalizations than they had before enrolling in the program. While Supported Employment led to an increase in overall costs for enrolled members, likely because of the cost of the supported employment services and increases in other services, members who received supported employment services experienced varying degrees in reduction in both inpatient medical and psychiatric hospital stays, including a 35 percent decrease in inpatient medical hospitalizations.[2]
View an infographic that displays the study's compelling results.
Continuing support for better community health
Mercy Care and its partners showed a commitment to prioritizing member needs and a dedication to working with community stakeholders to ensure those needs were identified and addressed. Qualitative findings from this research suggests, that the increase in social support led to increased focus by members to obtain and regularly use sources of care – decreasing the need for emergency or inpatient services. Integrated care streamlines the process of accessing care for members with serious mental illness. Having services within the clinics, for example, allows clinical teams to send a direct referral to a supported employment provider – enabling members to access these services immediately and reducing the interruption that occurs when members need to seek care somewhere else. Continued education among clinicians and staff is also important to ensure they’re familiar with changes, additions, or new programs to help them provide better care to members. Mercy Care created educational toolkits, known as Placemats or decision trees, to inform its staff of the discharge referral process. This way, members are provided with support and resources to help them remain healthy. [1] These reductions were per member per quarter and represent the approximate difference in total cost before and after the receipt of supportive housing services and are not necessarily directly attributable to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. For housing, this analysis found that there was a reduction in total cost of care of $5,002 per member per quarter relative to a comparison group.
[2] These reductions were per 1,000 members per quarter and represent the difference in total cost of cost before and after the receipt of services and may not be directly attributed to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. Members in the Assertive Community Treatment program, averaged 187 fewer outpatient emergency department visits per 1,000 members per quarter relative to those who did not receive the services, which was a significant decrease in utilization.