Best Practices Manual for Discharge Planning
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Best Practices Manual for Discharge Planning: ¾ Mental Health & Substance Abuse Facilities ¾ Hospitals ¾ Foster Care ¾ Prisons and Jails August 20 08 Funded by a grant from The California Endowment Co‐ Authored By: Mary Baron Bob Erlenbusch Carlos F. Moran Kelly O’Connor Kevin Rice Jose Rodriguez J C Sl Discharge Planning Manual 2 Table of Contents Foreword………………………………………………………………………………………………………………………………..4 Executive Summary…………………………………………………………………………………………………………………..6 Chapter 1: Discharge Planning for Mental Health, Substance Abuse and Co-Occurring MH and SA Introduction.................................................................................................................................................................8 Scope of Problem & Data Elements ...........................................................................................................................9 Mental Health....................................................................................................................................................9 Substance Abuse…………………………………………………………………………………...…………………10 Scope of Problem in Los Angeles County ................................................................................................................12 Value of Conducting Discharge Planning..................................................................................................................14 Discharge Planning Model........................................................................................................................................15 Who Should be Involved in Discharge Planning?.....................................................................................................16 Elements of Successful Discharge Planning….........................................................................................................16 Examples of Model Programs...................................................................................................................................19 Recommendation for Providers.................................................................................................................................20 Chapter 2: Hospital Discharge Planning Introduction……….…………………………………………………………………………………………………..................21 Scope of Problem & Data Elements .............................................................................................................................22 Scope of Problem in Los Angeles County ....................................................................................................................22 Value of Conducting Discharge Planning......................................................................................................................26 Discharge Planning Model............................................................................................................................................27 Who Should be Involved in Discharge Planning?.........................................................................................................28 Elements of Successful Discharge Planning ……........................................................................................................29 Examples of Model Programs.......................................................................................................................................30 Implications…………………………………………………………………………………………………………….32 Recommendations for Providers...................................................................................................................................35 Building a Perfect Model……………………………………………………………………………...………………36 Barriers………………………………………………………………………………………………….……………...36 Chapter 3: Foster Care Discharge Planning Introduction……………………………………………………………………….……………………..…………………….37 Scope of Problem & Data Elements………………………………………………………………………………………..38 National…………………………………………………………………………………………….. …………………38 California……………………………………………………………………………………………………………….38 Challenge: Cycle of Services……………….…………………………………………………………..……………38 Challenge: Housing and Homelessness………………………………………………………………….………...39 Challenge: LGBTQ Concerns…………………………………………………………………………..……………40 Scope of Problem in Los Angeles County…………………………………………………………………….……………41 Value of Conducting Discharge Planning……………………………………………………………………..……………42 Discharge Planning Model…………………………………………………………………………………………………...43 2008 Who Should be Involved in Discharge Planning?…………………………………………………………………………44 Elements of Successful Discharge Planning ………………………………………………………………………………45 Examples of Model Programs…………………………………………………………………………………..…………...47 Recommendations for Providers………………………………………………………... …………………….…………...47 August Discharge Planning Manual 3 Chapter 4: Discharge Planning for Prisons and Jails Introduction…………………………………………………………………………………….………………………………48 Scope of Problem & Data Elements………………………………………………………………………….................…49 Scope of Problem in Los Angeles County………………………………………………………………….………………50 Value of Conducting Discharge Planning…………………………………………………………………………………..52 Discharge Planning Model………………………………………………………………………………….………………..53 Who Should be Involved in Discharge Planning?…………………………………………………………..……………..53 Elements of Successful Discharge Planning…………………….………………………………………….……………..54 Examples of Model Programs…………………………………………………………………………………..…………...55 Recommendations for Providers………………………………………………………………………………...................56 Appendix Appendix A Mental Health: Template of Discharge Plan........................................................................................58 Appendix B Mental Health: Discharge Plan Checklist ...........................................................................................63 Appendix C Hospitals: KFH Regional Protocol on Homeless Discharge Planning…………………………………..64 Appendix D Hospitals: California Discharge Plan Laws……………………………………………….………………..68 Appendix E Foster Youth: Discharge Plan Checklist…………………………………………………….……………...72 Appendix F Foster Youth: Exemplary Discharge Plan………………………………………………..………………...74 Appendix G Foster Youth: It’s My Life Logic Model……………………………………………….………...................75 Appendix H Prison and Jails: Program Contact Information ……………………………………………………….....76 Appendix I Prison and Jails: West Virginia Division of Corrections Appendix ……………………………………...77 Annotated Bibliography General……………………………………………………………………………………………………………………………84 Mental Health and Substance Abuse………………………………………………………………………………………….97 Hospitals and Health Care…………………………………………………………………………………………………….109 Foster Youth…………………………………………………………………………………………………………………….125 Prisons and Jails………………………………………………………………………………………………………………..134 2008 August Discharge Planning Manual 4 Foreword A significant majority of the homeless population in California and specifically, Los Angeles County are individuals who have recently been discharged from an institution or care facility. Specifically, according to the Los Angeles-based Economic Roundtable, 60% of homeless individuals and over 50% of families self report that they were discharged into homelessness either by a shelter, jail, hospital or other care facility. These individuals have been admitted to a system that has poor and inadequate planning for their release. Consequently, they are “discharged to the streets,” either returned to homelessness or become homeless and their health and stability soon begins to deteriorate. According to the U.S. Interagency Council on Homelessness, “Institutional discharge is the process to prepare a person for return or reentry to the community by connecting the individual to essential community treatment, housing, and human services.”1 The U.S. Interagency Council on Homelessness found in their 1994 report, Priority Home!, that persons with low-income and persons of color are more likely to “experience homelessness upon departure from a hospital, treatment facility, penal institution, or the foster care system.”2 These systems all lack comprehensive planning strategies which result in an increased likelihood that individuals exiting the system will become homeless. Equipped with little or no tools to ensure their successful reentry, they often become overwhelmed and have difficulty maintaining the gains made throughout treatment and placement. 2008 1 Interagency Council on Homelessness (IHC). Priority Home: The Federal Plan to Break the Cycle of Homelessness. 1994. 2 August Institutional Discharge Policy Statement, National Health Care for the Homeless Council, 2008. Discharge Planning Manual 5 The National Health Care for the Homeless Council outlined six recommendations for providers of mental health, health, penal institutions and foster care for the successful implementation of discharge and aftercare planning: 1. The plan should prevent consumers from falling into homelessness. 2. Identification of appropriate housing is critical. • Discharges to emergency shelters are inappropriate for any situation. • Discharges to homeless programs that have 24-hour transitional programs may be made on a case-by-case basis. • Discharges to supportive housing and/or halfway houses are beneficial. 3. Planning must be individualized, comprehensive and coordinated with community based services. 4. Consumers must participate in the planning. 5. Institution staff (inclusive of professional staff) and community partners should be included. 6. For consumers who abuse substances, appropriate treatment must be included. As important as it is