On April 23rd of 2007 the Addictions and Mental Health Division (AMH) initiated the Co-Management directive to Local Mental Health Authorities (LMHA) throughout Oregon. The over arching principles are to "effectively manage the valuable resources of the state hospital and facilitate re-integration of patients from the state hospital into the community".
To that end the Co-Management Plan necessitates very close collaboration and timely communication between both county and state representatives responsible for the plan's implementation. To ensure accountability to the over arching principles LMHA's are held financially liable for daily cost of state hospital care based on a formula of hospital bed day usage and civil commit data. AMH sends monthly reports to LMHA's for review and planning.
In Marion County a Co-management group was formed in the fall of 2006 to begin the process of using state hospital census data, state hospital wait list data and AMH data to respond to the Co-Management directive. Community and Provider Services (CAPS) staff, Adaptive Community Integration and Support Team staff, Marion County Residential Coordinator and a Marion County Division Director make up the group. The group meets weekly to review Marion County adult residents who are in:
- acute care that are waiting for transfer to the state hospital.
- acute care that could be appropriately diverted to a lower level of care.
- the state hospital who are ready to place in the community.
- the state hospital who are not ready to place yet but need treatment review.
- state funded Extended Care Management placements in/outside Marion County.
During the weekly meeting the group addresses client/patient recovery goals around hospital discharge, clinical/environmental supports that would aid successful discharges from hospital care, over-coming system barriers and administrative/resource issues.
Outside the weekly Co-management meeting the CAPS Adult Care Coordinator reviews Acute Care Unit's requests for state hospital transfer. If, after on site review, the patient is found to meet medical necessity for state hospital level of care, approval is given to the Acute Care Unit. If not, the CAPS Adult Care Coordinator reviews the case(s) at the weekly Co-Management meeting and with the ACU treatment team for final disposition. All work is carried out in a collaborative manner among IDS, CAPS and hospital partners.
For those adult patients who are approved for state hospital level of care, but could be diverted to state funded Post Acute Intensive Treatment Services, the Co-Management Group would also be responsible for clinical reviews, discharge planning and teaming with the client's outpatient provider (if enrolled).