Arizona State Hospital annual report fiscal year 1988-1989 |
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HES 9.1: 1988/89 ./ ( ( ( ( ( ( ( { ( ( ARIZONA STATE HOSPITAL ANNUALREPORT FISCAL YEAR 1988 - 1989 ROSE MOFFORD, GOVERNOR STATE OF ARIZONA TED WILLIAMS, DIRECTOR ARIZONA DEPARTMENT OF HEALTII SERVICES BOYD DOVER, ASSISTANT DIRECTOR DMSION OF BEHAVIORAL HEALTII SERVICES GLENN LIPPMAN, M.D., SUPERINTENDENT/CHIEF MEDICAL OFFICER ARIZONA STATE HOSPITAL ( ( ( { ( ( t · ( ( ( Pursuant to Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975, Arizona Department of Health Services does not discriminate on the basis of race, color, national origin, handicap or age. For further information or to file a complaint contact: The Department of Health Services Office of Affirmative Action 1740 West Adams Phoenix, AZ 85007 (602) 542-1030 T.T.D. (602) 256-7577 An Equal Employment Opportunity Agency ( ( ( ( ( l ( ARIZONA STATE HOSPITAL ANNUAL REPORT FISCAL YEAR 1988 - 1989 TABLE OFCONTENTS IN1R.ODUCI10N ........................................................................................................................................ 1 Organiza.tional Structure ............................................................................................................................... 2 Cli.nical Services .... · .......................................................................................................................... 2 The General Adult Program (GAP) .............................................................................. 2 The Psychosocial Rehabilitation Program (PSR) ........................................................ 3 The Extended Care Program (ECP) .............................................................................. 3 The Geropsychiatry Program (GPP) ............................................................................. 3 The Behavior Management Program (BMP) ............................................................... 4 The Youth Services Program (YSP) .............................................................................. 4 Hospital Administration ................................................................................................................ 5 Hospital Information, Planning, Evaluation and Research ...................................................... 5 MAJOR CUNICAL ACCOMPUSHMENl'S .......................................................................................... 6 MAJOR ADMINIS1RATIVE ACCOMPUSHMENl'S ......................................................................... 6 MAJOR PERSONNEL ACCOMPUSHMENl'S ..................................................................................... 7 PATIENT DEMOGRAPHICS AND STATISTICAL SUMMATION ................................................. 9 Admission Statistics...................................................................................................................... 9 Discharge Statistics ....................................................................................................................... 10 CONCLUSION ..................................................................................... !' ••••••••••••••••••••••••••••••••••••••••••••••••••••••• 11 EXHIBITS, GRAPHS, AND TABLES ( Exhibit 1 ASH Financial Summary FY 1988-89 ........................................................... 12 Exhibit 2 ASH Total Full Time Equivalents (FfE) .................................................... 14 Graph 1 Inpatient Monthly Census July 1985 - June 1989 ........................................ 15 Graph 2 A Comparison of Admission and Discharge Rates FY 1988-89 ............... 16 Graph 3 ASH Legal Status at Admission FY 1988-89 ............................................... 17 ( Table 1 ASH Admissions by Ethnicity ........................................................................ 17 Table 2 ASH Admissions by Age ................................................................................. 18 Table 3 ASH Admissions by Gender .......................................................................... 18 ( Table 4 ASH Total Number and Percentage of Admission by County .................. 19 Table 5 ASH Admission Rates per 100,000 Population by County ........................ 20 Table 6 ASH Admission Type by County ................................................................... 21 Table 7 ASH Number and Percent of Admissions by Diagnostic Grouping ......... 22 Table 8 ASH Length of Stay for Discharges .............................................................. 23 ( Table 9 ASH Discharge Type by County .................................................................... 24 ( ( ( ( ( ( (. . ( ARIZONA STATE HOSPITAL ANNUAL REPORT FISCAL YEAR 1988-1989 INTRODUCTION The Arizona State Hospital is a publicly funded facility dedicated to the restoration and preservation of emotional health for the residents of the State of Arizona. The Hospital strives to provide contemporary and quality inpatient mental and physical health care. Further, the Hospital's administration is committed to the concept that all patients and staff members must be treated with the dignity and respect required to maximize personal and professional growth. The Arizona State Hospital provides psychiatric inpatient hospitalization and treatment for any person who meets the admission criteria and is presently living in the State of Arizona. The Hospital completes an individualized evaluation and develops a treatment plan designed to meet the patient's personal needs. While providing evaluation and treatment, the Hospital is continually cognizant of the rights and privileges of each patient, particularly the patient's right to confidentiality and privacy. A patient's treatment is directed by a multi-disciplinary team which includes Hospital staff, the patient, the patient's family, and the appropriate community mental health system representatives. This team is responsible for the development of a comprehensive, individualized treatment plan that addresses the biological, psychological, spiritual and socioeconomic needs of the patient. A psychiatrist, who provides clinical leadership for the team, has the ultimate authority for the patient's care and is also responsible for the development and strengthening of the interdisciplinary relationships within the team itself. Throughout a patient's treatment, the Hospital advocates placing the patient in the least restrictive therapeutic treatment environment. In advocating this goal, patient placement within the Hospital is made after assessment and consideration of all treatment factors to assure the chosen placement will provide maximum therapeutic benefit. Additionally, the Hospital recognizes its responsibility to provide patients required sanctuary and to safeguard the community. In order to provide quality care for the patients, the Hospital's staff actively participates in the statewide continuum of mental health care and assists the community treatment agencies when developing treatment and discharge plans with the patients. 1 ( ( Organizational Structure The Arizona State Hospital is structurally organized into three major components: Clinical Services Hospital Administration Hospital Information, Planning, Evaluation and Research Clinical Services: Clinical Services, under the direction of the Chief Medical Officer, includes the following: Department of Psychiatry Department of Medicine Nursing Services ( Psychology Services Social Work Services Rehabilitative Therapy Services ( Patients are placed on a treatment unit based on their treatment needs, level of functioning, chronicity of illness and age. Each clinical service is provided to the patients through treatment units which are grouped into treatment programs as follows: ( (. ( The General Adult Pro~am (GAP) Units: Kachina 1, Kachina 2, Juniper 5 The General Adult Program serves as the primary reception and admission area for adult patients and is designed to provide diagnostic and assessment services as well as shortterm treatment services (90 days or less). Patients are anticipated to have a shorter hospitalization and may have less institutional experience, more characterologic disturbances and higher incidents of drug abuse or legal involvement. Major treatment modalities include psychotropic medication, group or individual psychotherapy focusing on acceptance of treatment and specific discharge plans and goals, vocational rehabilitation, chemical dependency intervention, intensive preparation for community reintegration and aftercare, leisure and recreational activities, physical care, and reality focusing. While Kachina 1 is primarily a secure treatment unit with limited off-unit privileges granted, Kachina 2 is a "semi-open" unit with many patients having full grounds privileges and Juniper 5 is an open unit utilizing an active therapeutic community approach to care. 2 ( ( ( ( < ( ( ( ( ( The Psychosocial Rehabilitation Program (PSR) Units: Juniper 6, Juniper 10, Transitional Living Unit The Psychosocial Rehabilitation Program serves as the primary treatment program for patients with chronic, less refractory mental disorders. Most patients in this program will require a moderate period of hospitalization ( 90 to 365 days). Patients tend to have more hospitalizations and require more structured aftercare. Major treatment modalities include psychotropic medications, psychotherapy to . develop insight into reasons for admission, occupational therapy, recreational therapy and chemical dependency interventions. Juniper 10 serves as the secure treatment unit for the PSR Program, Juniper 6 as a "semiopen" unit, and the Transitional Living Unit as the open unit. The Transitional Living Unit, funded by special appropriations, is specifically designed to assist patients in making the transition from the Hospital to the community environment. The Extended Care Program (ECP) Units: Juniper 2, Juniper 4, Juniper 8 The Extended Care Program serves as the primary treatment program for patients who require an extended period of hospitalization (over 365 days). The Developmentally Disabled/Mentally Ill Day Treatment Program, developed jointly between ADHS and ADES, is an extension of this program. Treatment emphasis is placed on the activities of daily life skills ( e.g. hygiene, dressing, eating) since many patients suffer from coexistent organic mental disturbances. Treatment modalities include medications, reality orientation group, current events group, structured unit activities leisure planning and recreational therapy. Each of these treatment units is designed to provide a safe and secure environment for the patients; therefore, access to off-unit activities is limited, based on the individual patient's functioning level. The Geropsychiatcy Program (GPP) Units: Juniper 3, Juniper 7, Juniper 9, Granada The Geropsychiatry Program serves as the primary treatment program for older adult patients ( over 55 years of age) with special needs due to severely disabling mental and physical disorders. Many of these patients require an indefinite period of hospitalization. Families are involved in placement planning and receive assistance with bereavement, loss acceptance· and coping skills. 3 ( l ( { ( (. ( ( Primary treatment modalities include supportive care, psychotropic medication, selfcare skills, reminiscence groups, community orientation, current events and unit community meetings. Specialized groups in music and art therapy, gardening, cooking and nutrition, and reality orientation are also provided. Medical care is also a vital treatment modality for this population. Juniper 3 is an open unit designed to meet the needs of higher functioning, older adults. The remaining treatment units provide a safe, secure environment for the patients with limited off-unit access due to the severely disabling mental disorders of the patients. The Behavior Management ProiJ'am (BMP) Units: Cholla, Juniper 1 The Behavior Management Program serves as the primary treatment .program for patients with recent histories of dangerous behavior, patients believed to be dangerous, patients with a high escape risk, and patients with legal requirements on placement ( determination of competency to stand trial or commitment for treatment after being found not guilty by reason of insanity). Most patients require a moderate to extended period of hospitalization (over 90 days). Treatment modalities include psychotropic medications, psychotherapy focusing on participation with treatment, specific discharge planning, interpersonal skills training, personal care and rehabilitation. Intensive liaison for community reintegration and aftercare treatment, leisure and recreational activities, reality focusing and modification of pathologic behaviors are also important components of care. Both Cholla and Juniper 1 provide a secure environment for the patient and limited offunit privileges are granted on an individual basis. The Youth Services Proil'am (YSP) Units: Adolescent Treatment Unit (ATU), Child Treatment Unit (CTU) The Youth Services Program serves as the admission, assessment and treatment program for children and adolescents ( ages 6 through 17 years of age) requiring intermediate term care (90- 180 days) as a result of a substantial mental disorder. Major treatment modalities include individual, group and family therapy, academic rehabilitation, occupational, recreational, and speech/hearing therapy, and psychotropic medication, as appropriate. Aftercare planning for the patient and family is an essential component of treatment. Active liaison between staff and community also exists to assist families and outpatient caregivers in placement of treatment referrals. 4 ( { ( ( ( ( ( Both treatment units provide a safe, secure environment for the patients. Patients are given off-unit privileges based on their behavioral functioning level and ability to accept personal responsibility. Hospital Administration: Hospital Administration, under the direction of the Administrator, includes the following: Fiscal Services Religious Services Medical Records Laboratory Services Pharmacy Services Radiology Services Dental Services Hospital Personnel Services Engineering Services Dietetic Services Housekeeping Services Laundry Services Security Services Hospital Administration is responsible for the operation of the Hospital through distribution and monitoring the allocated budget, ensuring adequate numbers of staff, ensuring a safe and therapeutic environment, maintaining the patients' medical records, providing administrative/supervisory functions for selected clinical services, and providing "day-to-day" needs of the patients, e.g. dietary, laundry and housekeeping needs. Hospital Information, Planning, Evaluation and Research: Hospital Information, Planning, Evaluation and Research includes the following: Clinical Quality Assurance Staff Training and Education Public Information Office Hospital Information System Program Evaluation Patient Education Services Volunteer Services Hospital Policies and Procedures Hospital Information, Planning, Evaluation and Research is responsible for evaluating the quality of clinical care provided by the Medical Staff, evaluating the quality of services provided by the various program areas, training and education provided Hospital staff, providing educational services for patients (primarily children and adolescents), computerizing Hospital data, developing Hospital policies and procedures, providing general Hospital information and coordinating the services of volunteers at the Hospital. 5 ( ( ( ( ( ( ( ( MAJOR CLINICAL ACCOMPLISHMENTS Throughout FY 88-89 clinical services for the patients were expanded and improved. New services for the patients included: An Occupational Therapy Independent Living Skills Program for Spanish speaking patients; An Occupational Therapy Work Program; A Human Sexuality Program; Psychiatric evaluations for bilingual/bicultural Hispanic patients; and Psychological services for Spanish speaking patients, including a Spanish version of the Concise N europsychological Scale. Through the joint efforts of the Hospital, the Office of Community Behavioral Health, and the Division of Behavioral Health Services; ADHS, re-entry facilities were established making it possible for the Hospital to transition many of the longer-term, chronic patients to community living. By the end of FY 88-89 there were 47 re-entry facility beds available and utilized for placement of Hospital patients. Surveying regulatory agencies also noted an improvement in the quality of care provided the patients. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) completed a focused-survey in September 1988 which resulted in each of the remaining deficiencies being removed. After re-application for participation in the Medicare Program in February 1989, the Health Care Financing Administration (HCF A) completed the initial survey and found the Hospital to be in compliance with the two required conditions - staffing patterns and medical records. A follow-up survey conducted by HCF A in March 1989 found that the Hospital had continued to remain in compliance with the two conditions of participation. The Hospital was able to submit billings to the Medicare provider as of March 26, 1989. This will result in reimbursement of approximately $2 million to the State's general fund. MAJOR ADMINISTRATIVE ACCOMPLISHMENTS Fiscal Year 1988-89 proved to be an exciting year for administrative accomplishments, highlighted by the initiation of a Master Plan for Hospital re-construction. Although not totally completed in this fiscal year, the majority of the research and planning meetings were completed with Anderson DeBartello Pan, Inc., a major architecture and engineering firm. Fina1ization of the Master Plan for Hospital re-construction will occur early in FY 1989-90. 6 ( ( ( ( ( ( ( ( ( ( Another major accomplishment was the initiation and completion of major roadway re-surfacing scheduled during this fiscal year. The completion of this project was a significant enhancement to the safety and welfare for the Hospital patients and staff. Throughout FY 88-89 administrative services were continually challenged to repair the continuing deterioration of patient housing units, treatment areas, laundry facilities, cooling and heating systems, and the main dietary preparation facilities. The Hospital was required to implement the Internal Disaster Plan on two occasions - one related to a major water line break and one related to a natural gas line leak. Each occurrence was handled without major incident or treatment disruption for the patients. Additionally, Medical Records Services increased automation of transcription services to meet increased requests for such services. Dietetic Services completed some necessary service equipment replacement projects and underwent an organizational modification of c1.dministrative personnel. Engineering Services renovated the Hospital Chapel, implemented asbestos control projects, and began a Hospital-wide building painting program. The Hospital's Financial Summary (Exhibit 1) reveals a total funding of $31,352,690 and a total cost of operations of $30,862,218. The Hospital's collections, which are deposited to the State's General Fund, amounted to $2,362,316. The daily cost per patient by treatment program ranged from $121/day (Geropsychiatry Program) to $403/day (Childrens' Treatment Unit, Youth Services Program). The average cost per patient per day was $157. MAJOR PERSONNEL ACCOMPLISHMENTS Personnel accomplishments were highlighted by the Hospital's ability to successfully recruit and maintain sufficient clinical staff to meet the psychiatric and therapeutic requirements of the patients. These efforts were recognized by the Medicare program, Health Care Financing Administration (HCFA), which re-certified the Hospital indicating that although the Hospital was minimally staffed, the patients were receiving adequate mental health and medical care. To more adequately meet the nursing needs of the patients, the Hospital developed an in-house nursing pool composed of twenty-five Registered Nurses, ten Licensed Practical Nurses, and twenty-five Psychiatric Technicians. Many of the psychiatric physician staff members began the process of becoming Board Certified which is an indication of the Medical Staff's dedication to providing quality psychiatric services to the patients at the Hospital. Hospital Training and Education Services provided staff training related to non-aggressive management of the violent patient, self-defense, and asbestos training. 7 ( In an effort to improve internal communications and more quickly answer questions staff might · have, Hospital Administration implemented the "Superintendent's Notes" and the "Lippline Response" which are extensively distributed twice monthly. The Superintendent's weekly "Open- < Door" hour has continued throughout this fiscal year and has provided employees the opportunity to discuss issues of concern directly with the Superintendent. The Hospital was staffed by a total of 932.25 full time equivalent (FTE) positions. Direct patient care staff accounted for 691. 75 or 74.2% of the allocated positions and support staff accounted for ( 24050 or 25.8% of the allocated positions (see Exhibit 2). Additionally, the Hospital individually contracts with psychiatric physicians, medical physicians, and consultants. These contracted positions are not included in the total allocated positions. ( ( ( ( ( ( 8 ( ( PATIENT DEMOGRAPHICS and ( STATISTICAL SUMMATION < FISCAL YEAR 1988-89 The Arizona State Hospital began this fiscal year on July 1, 1988 with a patient census of 501. ( · Throughout the fiscal year, the Hospital admitted 760 patients, discharged 753 patients, and ended the fiscal year June 30, 1989 with a census of 508, a net increase of 7 patients. The average daily census for the fiscal year was 502. A total of 1,121 individual patients (unduplicated count) accounted for a total of 183,473 patient days. The inpatient end of month census is depicted in Graph 1, covering July 1985 through June 1989. A comparison of admissions and discharges by month < for FY 88-89 is provided in Graph 2. ( ( ( ( Admission Statistics: Of the 760 patients admitted this fiscal year, 81 % were admitted by court order; the remaining 19% were admitted on a voluntary status (Graph 3). The ethnicity distribution of the admissions were 75% Caucasians, 13% Hispanic, 9% Black, 2% American Indian, and 1% Other (fable 1). Individuals admitted to the Hospital were primarily between the ages of 19 - 64 (83% ). Children under the age of 19 accounted for 11 % and adults over 65 years of age accounted for 6% (fable 2). Analysis of admissions by gender indicated 449 (59%) were male and 311 ( 41 % ) were female (fable 3). Each of these percentages remained virtually unchanged when compared to the previous fiscal year (1987-88). It is particularly important to note the Hospital's recidivism rate which is the readmission of a patient who was discharged from the Hospital within 180 days prior to readmission. The recidivism rate for FY 88-89 was 21.2% compared to 19.3% in FY 87-88*. The recidivism rate for FY 88-89 (21.2%) includes the readmission of approximately sixteen (16) longer term, chronic patients discharged to re-entry facilities. Longer term, chronic patients discharged to re-entry facilities are more likely to have a higher re-hospitalization rate due to their lengthly dependency on the Hospital; therefore, there has been a slight increase in the annual recidivism rate. The recidivism rate of approximately 20% continues to be favorable when compared to reports from other state mental health facilities. • The recidivism rates presented are determined by dividing all of the fiscal year readmiwons with lengths of stay out of the Hospital less than 180 days by the total admissions for the fiscal year. This new formula provides more accurate and useful data. The previously reported recidivism rate for FY 87-88 (11.1 % ) was determined by dividing the latest six ( 6) months readmissions with lengths of stay out of the Hospital less than 180 days by the total admissions for the latest twelve (12) months. 9 ( ( ( ( ( ( ( ( ( ( ( Maricopa County continued the historic trend of the highest number of admissions - 523 ( 68.8% ). Pima County accounted for 98 (12.9%) of the admissions. It is also important to note that not all patient admissions through a county are actually a resident of the admitting county but may be, in fact, a resident of a neighboring county (Table 4). When comparing admission rates per 100,000 population, it was noted Graham County had an admission rate of 60.5, Yavapai County had 27.6, Yuma County had 27.4, and Maricopa County had 25.3 (Table 5). The State's average was 21.1 admissions/100,000. · Individuals admitted to the Hospital for the first time accounted for 45.8% of all admissions. Readmissions accounted for 43.01 %, readmissions from conditional discharge for 2.77%, and readmission from combined inpatient/outpatient treatment for 8.42% (Table 6). The diagnostic groupings (reason for admission) were essentially unchanged when compared to the previous fiscal year. Schizophrenic disorders accounted for 39.61 % of all admissions while affective disorders accounted for 37.10% The reason for the increase in disturbance of conduct diagnosis, from 9 (1.29%) in FY 87-88 to 21 (2.76%) in FY 88-89, is a consequence of additional children being treated at the Hospital (Table 7). Discharge Statistics: The Hospital discharged 753 patients during FY 88-89. The median length of stay (WS) was 99 days (unchanged from FY 87-88), while the mean was 307 days (up 84 days from FY 87-88). The incre~e in the mean is attributed to the Hospital's ability to discharge an increased number of patients who had been hospitalized for more than five (5) years (22 discharges in FY 88-89 compared to 12 discharges in FY 87-88). The increase of discharges for patients with lengths of stay greater than five (5) years is attributed to the availability of 47 re-entry facility beds. Approximately one-third of the patients discharged who had lengths of stay greater than five (5) years were discharged to re-entry facilities. Additional highlights in Table 8 include patients discharged after a hospitalization of 31-60 days accounted for 113 discharges (15%), those hospitalized 61-90 days accounted for 147 discharges (19%), and those hospitalized 91-180 days accounted for 242 discharges (32%). These percentages have remained fairly stable when compared to previous fiscal years. Patients discharged from voluntary status accounted for 29.7% of the total discharges. Patients discharged to outpatient treatment accounted for 20.9% and those discharged under conditional status accounted for 12.6% (Table 9). 10 ( ( ( ( ( ( ( ( ( CONCLUSION The Hospital, in its continuing efforts to serve the mentally ill residents of the State of Arizona, has established various milestones during Fiscal Year 1989-1990. These include, but are not limited to: 1. Providing contemporary psychiatric inpatient hospitalization and treatment for any person who meets the Hospital's admission criteria and is presently living in the State of Arizona; 2. Establishing a methodology for providing adequate staff-to-patient ratios to meet the changing needs of the Hospital's inpatients; 3. Maintaining participation in the Medicare Program, Health Care Financing Administration (HCF A); 4. Maintaining accreditation by the Joint Commission on Accreditation of Healthcare Organizations; 5. Participating in the development of an enhanced statewide mental health program; 6. Finalizing the Hospital's Master Plan for reconstruction and presenting the plan to the Division of Behavioral Health Services, the Arizona Department of Health Services, and the State Legislature; · 7. Planning, developing, and implementing community relations projects that will enhance the image of the Hospital; 8. Encouraging and supporting a high degree of competency, professionalism and continuing education for the Hospital's staff; 9. Addressing staff issues related to recruitment, morale, absenteeism and turnover; and 10. Re-establishing associations with the University of Arizona, College of Medicine, enhancing the Hospital's research activities, and increasing the public sector resident physician's exposure. Attaining each of these major milestones will measure the Hospital's commitment and successful completion of FY 1989-1990. The Hospital's administration is dedicated to attaining these milestones, but it is only through the support of the Hospital's staff, the Division of Behavioral Health Services, the Arizona Department of Health Services, the mental health advocacy groups, the State Legislature, and the citizens of the State of Arizona that these milestones will be reached and the mentally ill residents of the State of Arizona served. 11 ( ( ( ( ( ( ( ( ( EXHIBIT 1 ARIZONA STATE HOSPITAL FINANCIAL SUMMARY FISCAL YEAR 1988 - 1989 Funding Sources (General Operations): State General Fund Allocations (net) including the Transitional Living Unit Personnel Services and Related Benefits Operating Expenses Rental Income Endowment Earnings Patient Benefit Fund Donations Total Funding Expenditures: * Personnel Services and Related Benefits Professional and Outside Services Travel (In-State) Travel (Out~of-State) Food Other Operating Capital Equipment Assistance to Others Total Cost of Operations Collections (Deposited to the General Fund): Medicare Family, Guardian, or Patient Insurance Counties - Rule 11 Social Security, VA, or Railroad Retirement Military Service Connected Neuropsychiatric Total Collections $23,671,678 6,505,333 602,396 433,483 135,700 4,100 $31,352,690 $23,634,729 2,961,473 40,189 4,759 709,670 3,163,524 328,795 19,079 $30,862,218 $ 674,624 869,486 209,262 296,904 293,424 18,616 $2,362,316 * Contract Physicians, Nursing Registries, and Outside Hospitalization Costs ( continued) 12 ( ( ( ( ( ( ( ( ( ( EXHIBIT 1 (cont.) ARIZONA STATE HOSPITAL FINANCIAL SUMMARY FISCAL YEAR 1988-1989 Daily Costs by Treatment Program: General Adult Program Behavior Management Program Psychosocial Rehabilitation Program Transitional Living Program Extended Care Program Geropsychiatry Program Youth Services Program Adolescent Treatment Childrens' Treatment Average 13 $179 203 134 212 131 121 291 403 $157 ( ( (" ( ( ( ( ( ( EXHIBIT 2 ARIZONA STATE HOSPITAL TOTAL FULL TIME EQUIVALENTS (Fl'E)* JUNE 30, 1989 DIRECT SERVICES STAFF SUPPORT STAFF Psych Nurse Trtmt. Mgr. 15.0 Superintendent 1.0 Psych Nurse 80.0 Adm. Svs. Off. ill 1.0 Psych Nurse Director 1.0 Physical Plant Dir. 1.0 Psych Nurse Asst. Director 2.0 Finance 4.0 Psych Treatment Unit Coord. 9.0 Clerical 24.0 PsychLPNil 26.0 Adm.in. Assistant 14.0 Therapist 27.0 Clerk (Diet) 3.0 Teacher 7.0 Hskpg. Attendant 43.0 Psychologist 12.0 Bldg. Maint. Supv. 4.0 Psychology Intern 2.0 Maintenance 26.0 Social Worker 30.5 Groundskeeper 6.0 Psychiatric Technician 353.5 laundry Worker 10.0 Medical Records 35.0 Training Officer 4.0 Psych Nurse Instructor 2.0 laborer 1.0 Librarian 2.0 Custodial Supv. 5.0 Dentist 2.0 Food Service Dir. 1.0 Pharmacy 8.0 Dietitian 2.0 laboratory 6.5 Food Supervisor 6.0 Radiology 1.0 Cook 8.0 Behav. Health Tront Unit Mgr. 1.0 Food Svs. Worker 27.5 Beautician 1.0 Driver 8.0 Lifeguard .25 Security Officer 20.0 Chaplain 2.5 Sewing Supervisor 2.0 Barber 1.0 Quality Assur. Mgr. 1.0 Psych Nurse Shift Supervisor 33.0 Pts' Rights Rep. 1.0 Therapy Technician 23.0 Res/Stat. Analyst 2.0 Psych Nurse Coordinator 4.5 Vol.Svs.Coord. 1.0 Public Health Nurse 1.0 Adm.in. Svc. Off.IT 2.0 Audiometrist 1.0 Qual. Assur. Analyst 2.0 · Psych Nurse Clinical Mgr. 1.0 Prog/Proj. Spec. Il 3.0 Dental Assistant 1.0 Exec. Staff Asst. 1.0 Clinical Director 1.0 Switchboard Oper. 4.0 Investigator 1.0 SUBTOTALS 691.75 240.50 TOTAL 932.25 •To ere were approximately 15 psychiatric physicians and 6 medical physicians on staff with the Arizona State Hospital during this period. These positions are not included in the FfE total. 14 ( GRAPH 1 ( INPATIENT CENSUS ( JULY 1985 THROUGH JUNE 1989 560 ( 540 CENSUS 520 500 ( 480 460 ( 440 420 400 * * * * ( FY 1985-86 FY 1986-87 FY 1987-88 FY 1988-89 MONTHS (. END OF MONTH CENSUS MONTH FY 1985-86 FY 1986-87 FY 1987-88 FY 1988-89 July 471 496 551 524 ( August 462 528 544 502 September 466 537 542 494 October 475 547 520 505 November 488 536 510 . 491 December 505 538 520 487 January 502 545 526 494 February 514 544 525 515 March 515 542 508 511 { ~rll 519 546 510 500 ay 499 550 511 507 June 492 544 501 508 15 (. ( ( ( ( ( ( ( ( (_ GRAPH 2 A COMPARISON OF ADMISSION AND DISCHARGE RATES FY 1988-89 100,---------------------, 801--- 40 20 0 JUL SEP N AUG OCT MONTH MONTH ADMISSIONS DISCHARGES July 70 47 August 62 84 September 60 68 October 70 58 November 53 68 December 56 60 January 60 53 February 68 47 March 58 62 April 63 74 May 72 65 June 68 67 TOTAL 760 753 16 ~ ADMISSIONS - DISCHARGES ( ( ( ( ( ( ( ( ( ( l GRAPH 3 ARIZONA STATE HOSPITAL LEGAL STATUS AT ADMISSION FY 1988-89 VOWNTARY (19%) INVOLUNTARY (81%) TABLE 1 ARIZONA STATE HOSPITAL ADMISSION BY ETHNICITY EY 1988-89 EY 1987-88 FY 198§-S7 ENTHNICITY NUMBER ~ NUMBER '2 NUMBER ~ White 566 75 505 72 528 73 Hispanic 102 13 102 15 118 16 American Indian 12 2 14 2 14 2 Black 69 9 66 9 57 8 Other 11 1 11 2 3 1 TOTALS 760 698 720 17 ( TABLE 2 ( ARIZONA STATE HOSPITAL ADMISSIONS BY AGE ( FY 1988-89 FY1987-88 FY1986-87 AGE NUMBER ~ NUMBER ~ NUMBER ~ Under 12 years 23 3 29 4 0 0 ( 13- 18 years 64 8 70 10 81 11 19-29 years 228 30 196 28 209 29 . 30-39 years 208 27 180 26 200 28 40-64 years 194 26 185 27 194 27 ( 65 + years 43 6 38 5 36 5 TOTALS 760 698 720 ( TABLE3 ( ARIZONA STATE HOSPITAL ADMISSION BY GENDER ( FY 1988-89 FY 1987-88 FY1986-87 GENDER NUMBER ~ NUMBER ~ NUMBER ~ Male 449 59 399 57 428 59 ( Female 311 41 299 43 292 41 TOTALS 760 698 720 ( 18 TABLE 4 ( ARIZONA STATE HOSPITAL TOTAL NUMBER AND PERCENTAGE OF ADMISSION BY COUNTY* ( ~OUNTYOF FY 1988-89 Eil98Z-88 EY 198§-87 ADMISSIO~ Number ~ Number ~ Number ~ Apache 5 .66 4 .57 4 .56 ( Cochise 9 1.19 12 1.72 4 .56 Coconino 18 2.37 19 2.72 18 2.50 Gila 7 .92 12 1.72 11 1.53 Graham 15 1.97 8 1.15 7 .97 Greenlee 0 .00 0 .00 0 .00 la Paz 0 .00 0 .00 1 .13 Maricopa 523 68.80 447 64.04 475 65.97 Mohave 9 1.19 14 2.01 6 .83 Navajo 5 .66 13 1.86 13 1.81 ( Pima 98 12.90 69 9.89 71 9.86 Pinal 16 2.11 39 5.59 40 5.56 Santa Cruz 1 .13 1 .14 0 .00 ( Yavapai 27 3.55 26 3.72 37 5.14 Yuma 25 3.29 34 4.87 31 4.31 Out-of-State/ 2 .26 0 .00 2 .28 ( Unknown TOTALS 760 698 720 • Admissions through a county in which the individual was not a resident occurred as follows: ( Maricopa 15 Gila 5 Mohave 1 Pima 10 Coconino 3 Navajo 1 Pinal 7 Graham 3 Santa Cruz 0 Yavapai 7 Apache 1 Greenlee 0 Yuma 6 Cochise 1 LaPaz 0 19 ( ( ( ( ( ( ( ( TABLES ARIZONA STATE HOSPITAL ADMISSION RATES PER 100,000 POPULATION BY COUNTY* COUNTVOF FY ]988-89 FY 1987-88 FY 1986-87 ADMISSION Apache 7.8 6.4 6.7 Cochise 8.8 12.0 4.1 Coconino 19.0 20.7 20.2 Gila 17.3 29.9 27.5 Graham 60.5 32.4 28.0 Greenlee 0.0 0.0 0.0 La Paz 0.0 0.0 7.1 Maricopa 25.3 22.5 24.8 Mohave 11.1 17.7 7.8 Navajo 5.6 14.9 17.6 Pima 14.3 10.5 11.0 Pinal 14.5 36.4 38.5 Santa Cruz 3.3 3.4 0.0 Yavapai 27.6 27.4 40.2 Yuma 27.4 38.0 35.2 STATEWIDE RATES 21.1 20.1 21.4 • FY 1988-89 Admission Rates per 100,000 Population by County based on "Arizona Population Projections - Counties and Places, 1986-2035" prepared by the Arizona Department of Economic Security, Population Statistics Unit, April 1988 and approved by the Population Technical Advisory Committee on March 11, 1988. 20 ( ( TABLE 6 ARIZONA STATE HOSPITAL ADMISSION TYPE BY COUNTY ( FY 1988-89 COUNTY EIRST BEADMISSIOf:j CONDITIONAL BETURN FROM TOTALS ( ADMISSION DISCl:(ARGE INPATIENTL SUM % OUTPATIENT Apache 1 4 0 0 5 .66 Cochise 4 5 0 0 9 1.19 ( Coconino 8 9 1 0 18 2.37 Gila 4 2 0 1 7 .92 Graham 6 9 0 0 15 1.97 ( Greenlee 0 0 0 0 0 .00 La Paz 0 0 0 0 0 .00 Maricopa 224 229 12 58 523 68.80 ( Mohave 7 2 0 0 9 1.19 Navajo 3 2 0 0 5 .66 Pima 55 37 4 2 98 12.90 ( Pinal 9 7 0 0 16 2.11 Santa Cruz 1 0 0 0 1 .13 Yavapai · 11 13 0 3 27 3.55 Yuma 14 8 3 0 25 3.29 Out of State 1 0 1 0 2 .26 TOTAL: SUM 348 327 21 64 760 100.00 ( % 45.80 43.01 2.77 8.42 21 ( TABLE 7 ( ARIZONA STATE HOSPITAL NUMBER AND PERCENT OF ADMISSIONS BY DIAGNOSTIC GROUPING ( FY 1988-89 FY 1987-88 FY 1986-87 DIAGNOSTIC ( GROUPING Number Number Number ~ Schizophrenic Disorders 301 39.61 253 36.25 273 37.92 Affective Disorders 282 37.10 269 38.54 249 34.58 ( Paranoid States 5 .66 6 .86 2 .28 Other Psychoses 12 1.58 4 .57 8 1.11 Neurotic Disorders 11 1.45 11 1.57 14 1.94 Senile & Presenile Organic Psychotic Conditions 11 1.45 19 2.72 12 1.67 Alcoholic Psychoses . 3 .39 1 .14 2 .28 Other Organic Mental Disorders 25 3.29 25 3.58 23 3.19 Drug Related Disorders 7 .92 5 .72 5 .69 ( Personality Disorders 5 .66 0 .00 4 .56 Adjustment Disorders 1 .13 5 .72 8 1.11 Disturbance of Conduct 21 2.76 9 1.29 6 .83 (_ Mental Illness/ Mental Retardation 0 .00 0 .00 4 .56 Substance Abuse 2 .26 2 .29 2 .28 ( Other 74 9.74 89 12.75 108 15.00 TOTALS 760 698 720 22 ( ( TABLE 8 ( ARIZONA STATE HOSPITAL LENGTH OF STAY FOR DISCHARGES ( FY 1988-89 FY 1987-88 FY 1986-87 DAVS IN HOSPITAL Number ~ Number ~ Number ~ Under7 days 6 1 10 1 32 5 ( · 7 :.13 days 12 2 14 2 23 3 14-20 days 22 3 9 1 23 3 21 -30 days 31 4 39 5 35 5 ( 31 -60 days 113 15 130 18 82 12 61 -90 days 147 19 141 19 105 16 91 -180 days 242 32 218 29 191 29 ( 181 - 365 days 91 12 90 12 100 15 1 - 5 years 67 9 78 11 69 10 5+ years 22 3 12 2 8 1 TOTAL 753 741 668 MEAN 307 days 223 days 198 days MEDIAN 99 days 99 days 104 days ( ( { 23 - - ,... ,-. -- ..... .-. TABLE 9 ARIZONA STATE HOSPITAL DISCHARGE TYPE 8Y COUNTY FISCAL YEAR 1988-89 fnJI To o.ttlalt To To Other TOTAL Fna Prior ID r.a.ttlalt ~leased"' "11e Title QnH- Olt- Other Heilltlare Title Fna Yoltatt."Y !!e!_ration ~ "" rart~ 11 13 11' Death ttonal 111tfent tbspital ~ 36 .lM!nfle fal>lete SM ..! ~£ 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 3 0.4 CWUSE 2 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 5 0.7 IDIJilt() 1 0 0 0 0 1 0 1 0 12 1 0 3 0 0 0 19 2.5 GILA 3 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 6 0.8 SWffl 1 3 0 0 0 0 0 0 0 5 0 0 5 0 0 0 14 1.8 IHEK.EE 0 0 0 0 0 0 0 0 0 . 0 0 0 0 0 0 0 0 .o LA PA! 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .o NIRICXl'A lfiO 29 18 15 8 13 2 3 13 49 132 15 29 8 2 0 496 65.9 KIM 0 2 0 0 0 1 0 0 0 2 1 0 0 0 0 0 6 0.8 M\'i\l) 1 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 3 0.4 Pllt\ 37 g 2 4 0 10 0 0 1 10 12 0 7 0 1 0 93 12.4 PltW.. 4 1 2 0 0 1 0 0 0 4 2 0 0 0 0 0 14 1.8 SNfm OlJZ 0 0 0 0 0 0 0 0 0 3 2 0 1 0 0 0 6 0.8 YAVN>AI 4 1 0 2 1 0 0 0 0 0 7 0 2 0 0 0 17 2.3 ll.M 3 1 1 0 0 0 0 0 1 6 0 0 2 0 0 0 14 1.8 WT CF STA'II 7 14 1 2 1 0 2 0 0 1 0 1 0 0 2 1 32 4.3 lNWAIIA!l.E 1 0 0 4 0 0 1 19 0 0 0 0 0 0 0 0 25 3.3 lUL'l.: SUI m 61 25 28 10 26 5 23 15 !I; 157 16 54 8 5 1 753 liD.O I 'l'J.7 8.1 3.3 3.7 1.3 3.5 0.7 3.0 z.o lZ.6 20.9 Z.1 7.2 1.1 0.7 0.1 100 100.0 24 liil\[\111\lllliil ~f ~~~I ~lllllmf 1i11is 20223990 6
Object Description
TITLE | Behavioral Health Services and Arizona State Hospital annual report |
CREATOR | Arizona. Dept. of Health Services. |
SUBJECT | Mental health services--Arizona; Psychiatric hospitals--Arizona; Arizona. Division of Behavioral Health Services; Arizona State Hospital; |
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Science and technology |
DESCRIPTION | This title contains one or more publications. |
Language | English |
Publisher | Arizona. Dept. of Health Services. Division of Behavioral Health Services. |
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RIGHTS MANAGEMENT | Copyright to this resource is held by the creating agency and is provided here for educational purposes only. It may not be downloaded, reproduced or distributed in any format without written permission of the creating agency. Any attempt to circumvent the access controls placed on this file is a violation of United States and international copyright laws, and is subject to criminal prosecution. |
Source Identifier | HES 9.1: |
Location | 37595794 |
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PDF (Portable Document Format) |
REPOSITORY | Arizona State Library, Archives and Public Records. |
Description
TITLE | Arizona State Hospital annual report fiscal year 1988-1989 |
DESCRIPTION | 30 pages (PDF version). File size: 2388 KB. |
TYPE |
Text |
Acquisition Note | Scanned from physical copy January 5, 2018 |
RIGHTS MANAGEMENT | Copyright to this resource is held by the creating agency and is provided here for educational purposes only. It may not be downloaded, reproduced or distributed in any format without written permission of the creating agency. Any attempt to circumvent the access controls placed on this file is a violation of United States and international copyright laws, and is subject to criminal prosecution. |
DATE ORIGINAL | 1989 |
Time Period | 1990s (1990-1999) |
ORIGINAL FORMAT | Paper |
Source Identifier | HES 9.1: 1988/1989 |
Location | 37595794 |
DIGITAL FORMAT |
PDF (Portable Document Format) |
REPOSITORY | Arizona State Library, Archives and Public Records. |
Full Text | HES 9.1: 1988/89 ./ ( ( ( ( ( ( ( { ( ( ARIZONA STATE HOSPITAL ANNUALREPORT FISCAL YEAR 1988 - 1989 ROSE MOFFORD, GOVERNOR STATE OF ARIZONA TED WILLIAMS, DIRECTOR ARIZONA DEPARTMENT OF HEALTII SERVICES BOYD DOVER, ASSISTANT DIRECTOR DMSION OF BEHAVIORAL HEALTII SERVICES GLENN LIPPMAN, M.D., SUPERINTENDENT/CHIEF MEDICAL OFFICER ARIZONA STATE HOSPITAL ( ( ( { ( ( t · ( ( ( Pursuant to Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975, Arizona Department of Health Services does not discriminate on the basis of race, color, national origin, handicap or age. For further information or to file a complaint contact: The Department of Health Services Office of Affirmative Action 1740 West Adams Phoenix, AZ 85007 (602) 542-1030 T.T.D. (602) 256-7577 An Equal Employment Opportunity Agency ( ( ( ( ( l ( ARIZONA STATE HOSPITAL ANNUAL REPORT FISCAL YEAR 1988 - 1989 TABLE OFCONTENTS IN1R.ODUCI10N ........................................................................................................................................ 1 Organiza.tional Structure ............................................................................................................................... 2 Cli.nical Services .... · .......................................................................................................................... 2 The General Adult Program (GAP) .............................................................................. 2 The Psychosocial Rehabilitation Program (PSR) ........................................................ 3 The Extended Care Program (ECP) .............................................................................. 3 The Geropsychiatry Program (GPP) ............................................................................. 3 The Behavior Management Program (BMP) ............................................................... 4 The Youth Services Program (YSP) .............................................................................. 4 Hospital Administration ................................................................................................................ 5 Hospital Information, Planning, Evaluation and Research ...................................................... 5 MAJOR CUNICAL ACCOMPUSHMENl'S .......................................................................................... 6 MAJOR ADMINIS1RATIVE ACCOMPUSHMENl'S ......................................................................... 6 MAJOR PERSONNEL ACCOMPUSHMENl'S ..................................................................................... 7 PATIENT DEMOGRAPHICS AND STATISTICAL SUMMATION ................................................. 9 Admission Statistics...................................................................................................................... 9 Discharge Statistics ....................................................................................................................... 10 CONCLUSION ..................................................................................... !' ••••••••••••••••••••••••••••••••••••••••••••••••••••••• 11 EXHIBITS, GRAPHS, AND TABLES ( Exhibit 1 ASH Financial Summary FY 1988-89 ........................................................... 12 Exhibit 2 ASH Total Full Time Equivalents (FfE) .................................................... 14 Graph 1 Inpatient Monthly Census July 1985 - June 1989 ........................................ 15 Graph 2 A Comparison of Admission and Discharge Rates FY 1988-89 ............... 16 Graph 3 ASH Legal Status at Admission FY 1988-89 ............................................... 17 ( Table 1 ASH Admissions by Ethnicity ........................................................................ 17 Table 2 ASH Admissions by Age ................................................................................. 18 Table 3 ASH Admissions by Gender .......................................................................... 18 ( Table 4 ASH Total Number and Percentage of Admission by County .................. 19 Table 5 ASH Admission Rates per 100,000 Population by County ........................ 20 Table 6 ASH Admission Type by County ................................................................... 21 Table 7 ASH Number and Percent of Admissions by Diagnostic Grouping ......... 22 Table 8 ASH Length of Stay for Discharges .............................................................. 23 ( Table 9 ASH Discharge Type by County .................................................................... 24 ( ( ( ( ( ( (. . ( ARIZONA STATE HOSPITAL ANNUAL REPORT FISCAL YEAR 1988-1989 INTRODUCTION The Arizona State Hospital is a publicly funded facility dedicated to the restoration and preservation of emotional health for the residents of the State of Arizona. The Hospital strives to provide contemporary and quality inpatient mental and physical health care. Further, the Hospital's administration is committed to the concept that all patients and staff members must be treated with the dignity and respect required to maximize personal and professional growth. The Arizona State Hospital provides psychiatric inpatient hospitalization and treatment for any person who meets the admission criteria and is presently living in the State of Arizona. The Hospital completes an individualized evaluation and develops a treatment plan designed to meet the patient's personal needs. While providing evaluation and treatment, the Hospital is continually cognizant of the rights and privileges of each patient, particularly the patient's right to confidentiality and privacy. A patient's treatment is directed by a multi-disciplinary team which includes Hospital staff, the patient, the patient's family, and the appropriate community mental health system representatives. This team is responsible for the development of a comprehensive, individualized treatment plan that addresses the biological, psychological, spiritual and socioeconomic needs of the patient. A psychiatrist, who provides clinical leadership for the team, has the ultimate authority for the patient's care and is also responsible for the development and strengthening of the interdisciplinary relationships within the team itself. Throughout a patient's treatment, the Hospital advocates placing the patient in the least restrictive therapeutic treatment environment. In advocating this goal, patient placement within the Hospital is made after assessment and consideration of all treatment factors to assure the chosen placement will provide maximum therapeutic benefit. Additionally, the Hospital recognizes its responsibility to provide patients required sanctuary and to safeguard the community. In order to provide quality care for the patients, the Hospital's staff actively participates in the statewide continuum of mental health care and assists the community treatment agencies when developing treatment and discharge plans with the patients. 1 ( ( Organizational Structure The Arizona State Hospital is structurally organized into three major components: Clinical Services Hospital Administration Hospital Information, Planning, Evaluation and Research Clinical Services: Clinical Services, under the direction of the Chief Medical Officer, includes the following: Department of Psychiatry Department of Medicine Nursing Services ( Psychology Services Social Work Services Rehabilitative Therapy Services ( Patients are placed on a treatment unit based on their treatment needs, level of functioning, chronicity of illness and age. Each clinical service is provided to the patients through treatment units which are grouped into treatment programs as follows: ( (. ( The General Adult Pro~am (GAP) Units: Kachina 1, Kachina 2, Juniper 5 The General Adult Program serves as the primary reception and admission area for adult patients and is designed to provide diagnostic and assessment services as well as shortterm treatment services (90 days or less). Patients are anticipated to have a shorter hospitalization and may have less institutional experience, more characterologic disturbances and higher incidents of drug abuse or legal involvement. Major treatment modalities include psychotropic medication, group or individual psychotherapy focusing on acceptance of treatment and specific discharge plans and goals, vocational rehabilitation, chemical dependency intervention, intensive preparation for community reintegration and aftercare, leisure and recreational activities, physical care, and reality focusing. While Kachina 1 is primarily a secure treatment unit with limited off-unit privileges granted, Kachina 2 is a "semi-open" unit with many patients having full grounds privileges and Juniper 5 is an open unit utilizing an active therapeutic community approach to care. 2 ( ( ( ( < ( ( ( ( ( The Psychosocial Rehabilitation Program (PSR) Units: Juniper 6, Juniper 10, Transitional Living Unit The Psychosocial Rehabilitation Program serves as the primary treatment program for patients with chronic, less refractory mental disorders. Most patients in this program will require a moderate period of hospitalization ( 90 to 365 days). Patients tend to have more hospitalizations and require more structured aftercare. Major treatment modalities include psychotropic medications, psychotherapy to . develop insight into reasons for admission, occupational therapy, recreational therapy and chemical dependency interventions. Juniper 10 serves as the secure treatment unit for the PSR Program, Juniper 6 as a "semiopen" unit, and the Transitional Living Unit as the open unit. The Transitional Living Unit, funded by special appropriations, is specifically designed to assist patients in making the transition from the Hospital to the community environment. The Extended Care Program (ECP) Units: Juniper 2, Juniper 4, Juniper 8 The Extended Care Program serves as the primary treatment program for patients who require an extended period of hospitalization (over 365 days). The Developmentally Disabled/Mentally Ill Day Treatment Program, developed jointly between ADHS and ADES, is an extension of this program. Treatment emphasis is placed on the activities of daily life skills ( e.g. hygiene, dressing, eating) since many patients suffer from coexistent organic mental disturbances. Treatment modalities include medications, reality orientation group, current events group, structured unit activities leisure planning and recreational therapy. Each of these treatment units is designed to provide a safe and secure environment for the patients; therefore, access to off-unit activities is limited, based on the individual patient's functioning level. The Geropsychiatcy Program (GPP) Units: Juniper 3, Juniper 7, Juniper 9, Granada The Geropsychiatry Program serves as the primary treatment program for older adult patients ( over 55 years of age) with special needs due to severely disabling mental and physical disorders. Many of these patients require an indefinite period of hospitalization. Families are involved in placement planning and receive assistance with bereavement, loss acceptance· and coping skills. 3 ( l ( { ( (. ( ( Primary treatment modalities include supportive care, psychotropic medication, selfcare skills, reminiscence groups, community orientation, current events and unit community meetings. Specialized groups in music and art therapy, gardening, cooking and nutrition, and reality orientation are also provided. Medical care is also a vital treatment modality for this population. Juniper 3 is an open unit designed to meet the needs of higher functioning, older adults. The remaining treatment units provide a safe, secure environment for the patients with limited off-unit access due to the severely disabling mental disorders of the patients. The Behavior Management ProiJ'am (BMP) Units: Cholla, Juniper 1 The Behavior Management Program serves as the primary treatment .program for patients with recent histories of dangerous behavior, patients believed to be dangerous, patients with a high escape risk, and patients with legal requirements on placement ( determination of competency to stand trial or commitment for treatment after being found not guilty by reason of insanity). Most patients require a moderate to extended period of hospitalization (over 90 days). Treatment modalities include psychotropic medications, psychotherapy focusing on participation with treatment, specific discharge planning, interpersonal skills training, personal care and rehabilitation. Intensive liaison for community reintegration and aftercare treatment, leisure and recreational activities, reality focusing and modification of pathologic behaviors are also important components of care. Both Cholla and Juniper 1 provide a secure environment for the patient and limited offunit privileges are granted on an individual basis. The Youth Services Proil'am (YSP) Units: Adolescent Treatment Unit (ATU), Child Treatment Unit (CTU) The Youth Services Program serves as the admission, assessment and treatment program for children and adolescents ( ages 6 through 17 years of age) requiring intermediate term care (90- 180 days) as a result of a substantial mental disorder. Major treatment modalities include individual, group and family therapy, academic rehabilitation, occupational, recreational, and speech/hearing therapy, and psychotropic medication, as appropriate. Aftercare planning for the patient and family is an essential component of treatment. Active liaison between staff and community also exists to assist families and outpatient caregivers in placement of treatment referrals. 4 ( { ( ( ( ( ( Both treatment units provide a safe, secure environment for the patients. Patients are given off-unit privileges based on their behavioral functioning level and ability to accept personal responsibility. Hospital Administration: Hospital Administration, under the direction of the Administrator, includes the following: Fiscal Services Religious Services Medical Records Laboratory Services Pharmacy Services Radiology Services Dental Services Hospital Personnel Services Engineering Services Dietetic Services Housekeeping Services Laundry Services Security Services Hospital Administration is responsible for the operation of the Hospital through distribution and monitoring the allocated budget, ensuring adequate numbers of staff, ensuring a safe and therapeutic environment, maintaining the patients' medical records, providing administrative/supervisory functions for selected clinical services, and providing "day-to-day" needs of the patients, e.g. dietary, laundry and housekeeping needs. Hospital Information, Planning, Evaluation and Research: Hospital Information, Planning, Evaluation and Research includes the following: Clinical Quality Assurance Staff Training and Education Public Information Office Hospital Information System Program Evaluation Patient Education Services Volunteer Services Hospital Policies and Procedures Hospital Information, Planning, Evaluation and Research is responsible for evaluating the quality of clinical care provided by the Medical Staff, evaluating the quality of services provided by the various program areas, training and education provided Hospital staff, providing educational services for patients (primarily children and adolescents), computerizing Hospital data, developing Hospital policies and procedures, providing general Hospital information and coordinating the services of volunteers at the Hospital. 5 ( ( ( ( ( ( ( ( MAJOR CLINICAL ACCOMPLISHMENTS Throughout FY 88-89 clinical services for the patients were expanded and improved. New services for the patients included: An Occupational Therapy Independent Living Skills Program for Spanish speaking patients; An Occupational Therapy Work Program; A Human Sexuality Program; Psychiatric evaluations for bilingual/bicultural Hispanic patients; and Psychological services for Spanish speaking patients, including a Spanish version of the Concise N europsychological Scale. Through the joint efforts of the Hospital, the Office of Community Behavioral Health, and the Division of Behavioral Health Services; ADHS, re-entry facilities were established making it possible for the Hospital to transition many of the longer-term, chronic patients to community living. By the end of FY 88-89 there were 47 re-entry facility beds available and utilized for placement of Hospital patients. Surveying regulatory agencies also noted an improvement in the quality of care provided the patients. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) completed a focused-survey in September 1988 which resulted in each of the remaining deficiencies being removed. After re-application for participation in the Medicare Program in February 1989, the Health Care Financing Administration (HCF A) completed the initial survey and found the Hospital to be in compliance with the two required conditions - staffing patterns and medical records. A follow-up survey conducted by HCF A in March 1989 found that the Hospital had continued to remain in compliance with the two conditions of participation. The Hospital was able to submit billings to the Medicare provider as of March 26, 1989. This will result in reimbursement of approximately $2 million to the State's general fund. MAJOR ADMINISTRATIVE ACCOMPLISHMENTS Fiscal Year 1988-89 proved to be an exciting year for administrative accomplishments, highlighted by the initiation of a Master Plan for Hospital re-construction. Although not totally completed in this fiscal year, the majority of the research and planning meetings were completed with Anderson DeBartello Pan, Inc., a major architecture and engineering firm. Fina1ization of the Master Plan for Hospital re-construction will occur early in FY 1989-90. 6 ( ( ( ( ( ( ( ( ( ( Another major accomplishment was the initiation and completion of major roadway re-surfacing scheduled during this fiscal year. The completion of this project was a significant enhancement to the safety and welfare for the Hospital patients and staff. Throughout FY 88-89 administrative services were continually challenged to repair the continuing deterioration of patient housing units, treatment areas, laundry facilities, cooling and heating systems, and the main dietary preparation facilities. The Hospital was required to implement the Internal Disaster Plan on two occasions - one related to a major water line break and one related to a natural gas line leak. Each occurrence was handled without major incident or treatment disruption for the patients. Additionally, Medical Records Services increased automation of transcription services to meet increased requests for such services. Dietetic Services completed some necessary service equipment replacement projects and underwent an organizational modification of c1.dministrative personnel. Engineering Services renovated the Hospital Chapel, implemented asbestos control projects, and began a Hospital-wide building painting program. The Hospital's Financial Summary (Exhibit 1) reveals a total funding of $31,352,690 and a total cost of operations of $30,862,218. The Hospital's collections, which are deposited to the State's General Fund, amounted to $2,362,316. The daily cost per patient by treatment program ranged from $121/day (Geropsychiatry Program) to $403/day (Childrens' Treatment Unit, Youth Services Program). The average cost per patient per day was $157. MAJOR PERSONNEL ACCOMPLISHMENTS Personnel accomplishments were highlighted by the Hospital's ability to successfully recruit and maintain sufficient clinical staff to meet the psychiatric and therapeutic requirements of the patients. These efforts were recognized by the Medicare program, Health Care Financing Administration (HCFA), which re-certified the Hospital indicating that although the Hospital was minimally staffed, the patients were receiving adequate mental health and medical care. To more adequately meet the nursing needs of the patients, the Hospital developed an in-house nursing pool composed of twenty-five Registered Nurses, ten Licensed Practical Nurses, and twenty-five Psychiatric Technicians. Many of the psychiatric physician staff members began the process of becoming Board Certified which is an indication of the Medical Staff's dedication to providing quality psychiatric services to the patients at the Hospital. Hospital Training and Education Services provided staff training related to non-aggressive management of the violent patient, self-defense, and asbestos training. 7 ( In an effort to improve internal communications and more quickly answer questions staff might · have, Hospital Administration implemented the "Superintendent's Notes" and the "Lippline Response" which are extensively distributed twice monthly. The Superintendent's weekly "Open- < Door" hour has continued throughout this fiscal year and has provided employees the opportunity to discuss issues of concern directly with the Superintendent. The Hospital was staffed by a total of 932.25 full time equivalent (FTE) positions. Direct patient care staff accounted for 691. 75 or 74.2% of the allocated positions and support staff accounted for ( 24050 or 25.8% of the allocated positions (see Exhibit 2). Additionally, the Hospital individually contracts with psychiatric physicians, medical physicians, and consultants. These contracted positions are not included in the total allocated positions. ( ( ( ( ( ( 8 ( ( PATIENT DEMOGRAPHICS and ( STATISTICAL SUMMATION < FISCAL YEAR 1988-89 The Arizona State Hospital began this fiscal year on July 1, 1988 with a patient census of 501. ( · Throughout the fiscal year, the Hospital admitted 760 patients, discharged 753 patients, and ended the fiscal year June 30, 1989 with a census of 508, a net increase of 7 patients. The average daily census for the fiscal year was 502. A total of 1,121 individual patients (unduplicated count) accounted for a total of 183,473 patient days. The inpatient end of month census is depicted in Graph 1, covering July 1985 through June 1989. A comparison of admissions and discharges by month < for FY 88-89 is provided in Graph 2. ( ( ( ( Admission Statistics: Of the 760 patients admitted this fiscal year, 81 % were admitted by court order; the remaining 19% were admitted on a voluntary status (Graph 3). The ethnicity distribution of the admissions were 75% Caucasians, 13% Hispanic, 9% Black, 2% American Indian, and 1% Other (fable 1). Individuals admitted to the Hospital were primarily between the ages of 19 - 64 (83% ). Children under the age of 19 accounted for 11 % and adults over 65 years of age accounted for 6% (fable 2). Analysis of admissions by gender indicated 449 (59%) were male and 311 ( 41 % ) were female (fable 3). Each of these percentages remained virtually unchanged when compared to the previous fiscal year (1987-88). It is particularly important to note the Hospital's recidivism rate which is the readmission of a patient who was discharged from the Hospital within 180 days prior to readmission. The recidivism rate for FY 88-89 was 21.2% compared to 19.3% in FY 87-88*. The recidivism rate for FY 88-89 (21.2%) includes the readmission of approximately sixteen (16) longer term, chronic patients discharged to re-entry facilities. Longer term, chronic patients discharged to re-entry facilities are more likely to have a higher re-hospitalization rate due to their lengthly dependency on the Hospital; therefore, there has been a slight increase in the annual recidivism rate. The recidivism rate of approximately 20% continues to be favorable when compared to reports from other state mental health facilities. • The recidivism rates presented are determined by dividing all of the fiscal year readmiwons with lengths of stay out of the Hospital less than 180 days by the total admissions for the fiscal year. This new formula provides more accurate and useful data. The previously reported recidivism rate for FY 87-88 (11.1 % ) was determined by dividing the latest six ( 6) months readmissions with lengths of stay out of the Hospital less than 180 days by the total admissions for the latest twelve (12) months. 9 ( ( ( ( ( ( ( ( ( ( ( Maricopa County continued the historic trend of the highest number of admissions - 523 ( 68.8% ). Pima County accounted for 98 (12.9%) of the admissions. It is also important to note that not all patient admissions through a county are actually a resident of the admitting county but may be, in fact, a resident of a neighboring county (Table 4). When comparing admission rates per 100,000 population, it was noted Graham County had an admission rate of 60.5, Yavapai County had 27.6, Yuma County had 27.4, and Maricopa County had 25.3 (Table 5). The State's average was 21.1 admissions/100,000. · Individuals admitted to the Hospital for the first time accounted for 45.8% of all admissions. Readmissions accounted for 43.01 %, readmissions from conditional discharge for 2.77%, and readmission from combined inpatient/outpatient treatment for 8.42% (Table 6). The diagnostic groupings (reason for admission) were essentially unchanged when compared to the previous fiscal year. Schizophrenic disorders accounted for 39.61 % of all admissions while affective disorders accounted for 37.10% The reason for the increase in disturbance of conduct diagnosis, from 9 (1.29%) in FY 87-88 to 21 (2.76%) in FY 88-89, is a consequence of additional children being treated at the Hospital (Table 7). Discharge Statistics: The Hospital discharged 753 patients during FY 88-89. The median length of stay (WS) was 99 days (unchanged from FY 87-88), while the mean was 307 days (up 84 days from FY 87-88). The incre~e in the mean is attributed to the Hospital's ability to discharge an increased number of patients who had been hospitalized for more than five (5) years (22 discharges in FY 88-89 compared to 12 discharges in FY 87-88). The increase of discharges for patients with lengths of stay greater than five (5) years is attributed to the availability of 47 re-entry facility beds. Approximately one-third of the patients discharged who had lengths of stay greater than five (5) years were discharged to re-entry facilities. Additional highlights in Table 8 include patients discharged after a hospitalization of 31-60 days accounted for 113 discharges (15%), those hospitalized 61-90 days accounted for 147 discharges (19%), and those hospitalized 91-180 days accounted for 242 discharges (32%). These percentages have remained fairly stable when compared to previous fiscal years. Patients discharged from voluntary status accounted for 29.7% of the total discharges. Patients discharged to outpatient treatment accounted for 20.9% and those discharged under conditional status accounted for 12.6% (Table 9). 10 ( ( ( ( ( ( ( ( ( CONCLUSION The Hospital, in its continuing efforts to serve the mentally ill residents of the State of Arizona, has established various milestones during Fiscal Year 1989-1990. These include, but are not limited to: 1. Providing contemporary psychiatric inpatient hospitalization and treatment for any person who meets the Hospital's admission criteria and is presently living in the State of Arizona; 2. Establishing a methodology for providing adequate staff-to-patient ratios to meet the changing needs of the Hospital's inpatients; 3. Maintaining participation in the Medicare Program, Health Care Financing Administration (HCF A); 4. Maintaining accreditation by the Joint Commission on Accreditation of Healthcare Organizations; 5. Participating in the development of an enhanced statewide mental health program; 6. Finalizing the Hospital's Master Plan for reconstruction and presenting the plan to the Division of Behavioral Health Services, the Arizona Department of Health Services, and the State Legislature; · 7. Planning, developing, and implementing community relations projects that will enhance the image of the Hospital; 8. Encouraging and supporting a high degree of competency, professionalism and continuing education for the Hospital's staff; 9. Addressing staff issues related to recruitment, morale, absenteeism and turnover; and 10. Re-establishing associations with the University of Arizona, College of Medicine, enhancing the Hospital's research activities, and increasing the public sector resident physician's exposure. Attaining each of these major milestones will measure the Hospital's commitment and successful completion of FY 1989-1990. The Hospital's administration is dedicated to attaining these milestones, but it is only through the support of the Hospital's staff, the Division of Behavioral Health Services, the Arizona Department of Health Services, the mental health advocacy groups, the State Legislature, and the citizens of the State of Arizona that these milestones will be reached and the mentally ill residents of the State of Arizona served. 11 ( ( ( ( ( ( ( ( ( EXHIBIT 1 ARIZONA STATE HOSPITAL FINANCIAL SUMMARY FISCAL YEAR 1988 - 1989 Funding Sources (General Operations): State General Fund Allocations (net) including the Transitional Living Unit Personnel Services and Related Benefits Operating Expenses Rental Income Endowment Earnings Patient Benefit Fund Donations Total Funding Expenditures: * Personnel Services and Related Benefits Professional and Outside Services Travel (In-State) Travel (Out~of-State) Food Other Operating Capital Equipment Assistance to Others Total Cost of Operations Collections (Deposited to the General Fund): Medicare Family, Guardian, or Patient Insurance Counties - Rule 11 Social Security, VA, or Railroad Retirement Military Service Connected Neuropsychiatric Total Collections $23,671,678 6,505,333 602,396 433,483 135,700 4,100 $31,352,690 $23,634,729 2,961,473 40,189 4,759 709,670 3,163,524 328,795 19,079 $30,862,218 $ 674,624 869,486 209,262 296,904 293,424 18,616 $2,362,316 * Contract Physicians, Nursing Registries, and Outside Hospitalization Costs ( continued) 12 ( ( ( ( ( ( ( ( ( ( EXHIBIT 1 (cont.) ARIZONA STATE HOSPITAL FINANCIAL SUMMARY FISCAL YEAR 1988-1989 Daily Costs by Treatment Program: General Adult Program Behavior Management Program Psychosocial Rehabilitation Program Transitional Living Program Extended Care Program Geropsychiatry Program Youth Services Program Adolescent Treatment Childrens' Treatment Average 13 $179 203 134 212 131 121 291 403 $157 ( ( (" ( ( ( ( ( ( EXHIBIT 2 ARIZONA STATE HOSPITAL TOTAL FULL TIME EQUIVALENTS (Fl'E)* JUNE 30, 1989 DIRECT SERVICES STAFF SUPPORT STAFF Psych Nurse Trtmt. Mgr. 15.0 Superintendent 1.0 Psych Nurse 80.0 Adm. Svs. Off. ill 1.0 Psych Nurse Director 1.0 Physical Plant Dir. 1.0 Psych Nurse Asst. Director 2.0 Finance 4.0 Psych Treatment Unit Coord. 9.0 Clerical 24.0 PsychLPNil 26.0 Adm.in. Assistant 14.0 Therapist 27.0 Clerk (Diet) 3.0 Teacher 7.0 Hskpg. Attendant 43.0 Psychologist 12.0 Bldg. Maint. Supv. 4.0 Psychology Intern 2.0 Maintenance 26.0 Social Worker 30.5 Groundskeeper 6.0 Psychiatric Technician 353.5 laundry Worker 10.0 Medical Records 35.0 Training Officer 4.0 Psych Nurse Instructor 2.0 laborer 1.0 Librarian 2.0 Custodial Supv. 5.0 Dentist 2.0 Food Service Dir. 1.0 Pharmacy 8.0 Dietitian 2.0 laboratory 6.5 Food Supervisor 6.0 Radiology 1.0 Cook 8.0 Behav. Health Tront Unit Mgr. 1.0 Food Svs. Worker 27.5 Beautician 1.0 Driver 8.0 Lifeguard .25 Security Officer 20.0 Chaplain 2.5 Sewing Supervisor 2.0 Barber 1.0 Quality Assur. Mgr. 1.0 Psych Nurse Shift Supervisor 33.0 Pts' Rights Rep. 1.0 Therapy Technician 23.0 Res/Stat. Analyst 2.0 Psych Nurse Coordinator 4.5 Vol.Svs.Coord. 1.0 Public Health Nurse 1.0 Adm.in. Svc. Off.IT 2.0 Audiometrist 1.0 Qual. Assur. Analyst 2.0 · Psych Nurse Clinical Mgr. 1.0 Prog/Proj. Spec. Il 3.0 Dental Assistant 1.0 Exec. Staff Asst. 1.0 Clinical Director 1.0 Switchboard Oper. 4.0 Investigator 1.0 SUBTOTALS 691.75 240.50 TOTAL 932.25 •To ere were approximately 15 psychiatric physicians and 6 medical physicians on staff with the Arizona State Hospital during this period. These positions are not included in the FfE total. 14 ( GRAPH 1 ( INPATIENT CENSUS ( JULY 1985 THROUGH JUNE 1989 560 ( 540 CENSUS 520 500 ( 480 460 ( 440 420 400 * * * * ( FY 1985-86 FY 1986-87 FY 1987-88 FY 1988-89 MONTHS (. END OF MONTH CENSUS MONTH FY 1985-86 FY 1986-87 FY 1987-88 FY 1988-89 July 471 496 551 524 ( August 462 528 544 502 September 466 537 542 494 October 475 547 520 505 November 488 536 510 . 491 December 505 538 520 487 January 502 545 526 494 February 514 544 525 515 March 515 542 508 511 { ~rll 519 546 510 500 ay 499 550 511 507 June 492 544 501 508 15 (. ( ( ( ( ( ( ( ( (_ GRAPH 2 A COMPARISON OF ADMISSION AND DISCHARGE RATES FY 1988-89 100,---------------------, 801--- 40 20 0 JUL SEP N AUG OCT MONTH MONTH ADMISSIONS DISCHARGES July 70 47 August 62 84 September 60 68 October 70 58 November 53 68 December 56 60 January 60 53 February 68 47 March 58 62 April 63 74 May 72 65 June 68 67 TOTAL 760 753 16 ~ ADMISSIONS - DISCHARGES ( ( ( ( ( ( ( ( ( ( l GRAPH 3 ARIZONA STATE HOSPITAL LEGAL STATUS AT ADMISSION FY 1988-89 VOWNTARY (19%) INVOLUNTARY (81%) TABLE 1 ARIZONA STATE HOSPITAL ADMISSION BY ETHNICITY EY 1988-89 EY 1987-88 FY 198§-S7 ENTHNICITY NUMBER ~ NUMBER '2 NUMBER ~ White 566 75 505 72 528 73 Hispanic 102 13 102 15 118 16 American Indian 12 2 14 2 14 2 Black 69 9 66 9 57 8 Other 11 1 11 2 3 1 TOTALS 760 698 720 17 ( TABLE 2 ( ARIZONA STATE HOSPITAL ADMISSIONS BY AGE ( FY 1988-89 FY1987-88 FY1986-87 AGE NUMBER ~ NUMBER ~ NUMBER ~ Under 12 years 23 3 29 4 0 0 ( 13- 18 years 64 8 70 10 81 11 19-29 years 228 30 196 28 209 29 . 30-39 years 208 27 180 26 200 28 40-64 years 194 26 185 27 194 27 ( 65 + years 43 6 38 5 36 5 TOTALS 760 698 720 ( TABLE3 ( ARIZONA STATE HOSPITAL ADMISSION BY GENDER ( FY 1988-89 FY 1987-88 FY1986-87 GENDER NUMBER ~ NUMBER ~ NUMBER ~ Male 449 59 399 57 428 59 ( Female 311 41 299 43 292 41 TOTALS 760 698 720 ( 18 TABLE 4 ( ARIZONA STATE HOSPITAL TOTAL NUMBER AND PERCENTAGE OF ADMISSION BY COUNTY* ( ~OUNTYOF FY 1988-89 Eil98Z-88 EY 198§-87 ADMISSIO~ Number ~ Number ~ Number ~ Apache 5 .66 4 .57 4 .56 ( Cochise 9 1.19 12 1.72 4 .56 Coconino 18 2.37 19 2.72 18 2.50 Gila 7 .92 12 1.72 11 1.53 Graham 15 1.97 8 1.15 7 .97 Greenlee 0 .00 0 .00 0 .00 la Paz 0 .00 0 .00 1 .13 Maricopa 523 68.80 447 64.04 475 65.97 Mohave 9 1.19 14 2.01 6 .83 Navajo 5 .66 13 1.86 13 1.81 ( Pima 98 12.90 69 9.89 71 9.86 Pinal 16 2.11 39 5.59 40 5.56 Santa Cruz 1 .13 1 .14 0 .00 ( Yavapai 27 3.55 26 3.72 37 5.14 Yuma 25 3.29 34 4.87 31 4.31 Out-of-State/ 2 .26 0 .00 2 .28 ( Unknown TOTALS 760 698 720 • Admissions through a county in which the individual was not a resident occurred as follows: ( Maricopa 15 Gila 5 Mohave 1 Pima 10 Coconino 3 Navajo 1 Pinal 7 Graham 3 Santa Cruz 0 Yavapai 7 Apache 1 Greenlee 0 Yuma 6 Cochise 1 LaPaz 0 19 ( ( ( ( ( ( ( ( TABLES ARIZONA STATE HOSPITAL ADMISSION RATES PER 100,000 POPULATION BY COUNTY* COUNTVOF FY ]988-89 FY 1987-88 FY 1986-87 ADMISSION Apache 7.8 6.4 6.7 Cochise 8.8 12.0 4.1 Coconino 19.0 20.7 20.2 Gila 17.3 29.9 27.5 Graham 60.5 32.4 28.0 Greenlee 0.0 0.0 0.0 La Paz 0.0 0.0 7.1 Maricopa 25.3 22.5 24.8 Mohave 11.1 17.7 7.8 Navajo 5.6 14.9 17.6 Pima 14.3 10.5 11.0 Pinal 14.5 36.4 38.5 Santa Cruz 3.3 3.4 0.0 Yavapai 27.6 27.4 40.2 Yuma 27.4 38.0 35.2 STATEWIDE RATES 21.1 20.1 21.4 • FY 1988-89 Admission Rates per 100,000 Population by County based on "Arizona Population Projections - Counties and Places, 1986-2035" prepared by the Arizona Department of Economic Security, Population Statistics Unit, April 1988 and approved by the Population Technical Advisory Committee on March 11, 1988. 20 ( ( TABLE 6 ARIZONA STATE HOSPITAL ADMISSION TYPE BY COUNTY ( FY 1988-89 COUNTY EIRST BEADMISSIOf:j CONDITIONAL BETURN FROM TOTALS ( ADMISSION DISCl:(ARGE INPATIENTL SUM % OUTPATIENT Apache 1 4 0 0 5 .66 Cochise 4 5 0 0 9 1.19 ( Coconino 8 9 1 0 18 2.37 Gila 4 2 0 1 7 .92 Graham 6 9 0 0 15 1.97 ( Greenlee 0 0 0 0 0 .00 La Paz 0 0 0 0 0 .00 Maricopa 224 229 12 58 523 68.80 ( Mohave 7 2 0 0 9 1.19 Navajo 3 2 0 0 5 .66 Pima 55 37 4 2 98 12.90 ( Pinal 9 7 0 0 16 2.11 Santa Cruz 1 0 0 0 1 .13 Yavapai · 11 13 0 3 27 3.55 Yuma 14 8 3 0 25 3.29 Out of State 1 0 1 0 2 .26 TOTAL: SUM 348 327 21 64 760 100.00 ( % 45.80 43.01 2.77 8.42 21 ( TABLE 7 ( ARIZONA STATE HOSPITAL NUMBER AND PERCENT OF ADMISSIONS BY DIAGNOSTIC GROUPING ( FY 1988-89 FY 1987-88 FY 1986-87 DIAGNOSTIC ( GROUPING Number Number Number ~ Schizophrenic Disorders 301 39.61 253 36.25 273 37.92 Affective Disorders 282 37.10 269 38.54 249 34.58 ( Paranoid States 5 .66 6 .86 2 .28 Other Psychoses 12 1.58 4 .57 8 1.11 Neurotic Disorders 11 1.45 11 1.57 14 1.94 Senile & Presenile Organic Psychotic Conditions 11 1.45 19 2.72 12 1.67 Alcoholic Psychoses . 3 .39 1 .14 2 .28 Other Organic Mental Disorders 25 3.29 25 3.58 23 3.19 Drug Related Disorders 7 .92 5 .72 5 .69 ( Personality Disorders 5 .66 0 .00 4 .56 Adjustment Disorders 1 .13 5 .72 8 1.11 Disturbance of Conduct 21 2.76 9 1.29 6 .83 (_ Mental Illness/ Mental Retardation 0 .00 0 .00 4 .56 Substance Abuse 2 .26 2 .29 2 .28 ( Other 74 9.74 89 12.75 108 15.00 TOTALS 760 698 720 22 ( ( TABLE 8 ( ARIZONA STATE HOSPITAL LENGTH OF STAY FOR DISCHARGES ( FY 1988-89 FY 1987-88 FY 1986-87 DAVS IN HOSPITAL Number ~ Number ~ Number ~ Under7 days 6 1 10 1 32 5 ( · 7 :.13 days 12 2 14 2 23 3 14-20 days 22 3 9 1 23 3 21 -30 days 31 4 39 5 35 5 ( 31 -60 days 113 15 130 18 82 12 61 -90 days 147 19 141 19 105 16 91 -180 days 242 32 218 29 191 29 ( 181 - 365 days 91 12 90 12 100 15 1 - 5 years 67 9 78 11 69 10 5+ years 22 3 12 2 8 1 TOTAL 753 741 668 MEAN 307 days 223 days 198 days MEDIAN 99 days 99 days 104 days ( ( { 23 - - ,... ,-. -- ..... .-. TABLE 9 ARIZONA STATE HOSPITAL DISCHARGE TYPE 8Y COUNTY FISCAL YEAR 1988-89 fnJI To o.ttlalt To To Other TOTAL Fna Prior ID r.a.ttlalt ~leased"' "11e Title QnH- Olt- Other Heilltlare Title Fna Yoltatt."Y !!e!_ration ~ "" rart~ 11 13 11' Death ttonal 111tfent tbspital ~ 36 .lM!nfle fal>lete SM ..! ~£ 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 3 0.4 CWUSE 2 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 5 0.7 IDIJilt() 1 0 0 0 0 1 0 1 0 12 1 0 3 0 0 0 19 2.5 GILA 3 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 6 0.8 SWffl 1 3 0 0 0 0 0 0 0 5 0 0 5 0 0 0 14 1.8 IHEK.EE 0 0 0 0 0 0 0 0 0 . 0 0 0 0 0 0 0 0 .o LA PA! 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .o NIRICXl'A lfiO 29 18 15 8 13 2 3 13 49 132 15 29 8 2 0 496 65.9 KIM 0 2 0 0 0 1 0 0 0 2 1 0 0 0 0 0 6 0.8 M\'i\l) 1 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 3 0.4 Pllt\ 37 g 2 4 0 10 0 0 1 10 12 0 7 0 1 0 93 12.4 PltW.. 4 1 2 0 0 1 0 0 0 4 2 0 0 0 0 0 14 1.8 SNfm OlJZ 0 0 0 0 0 0 0 0 0 3 2 0 1 0 0 0 6 0.8 YAVN>AI 4 1 0 2 1 0 0 0 0 0 7 0 2 0 0 0 17 2.3 ll.M 3 1 1 0 0 0 0 0 1 6 0 0 2 0 0 0 14 1.8 WT CF STA'II 7 14 1 2 1 0 2 0 0 1 0 1 0 0 2 1 32 4.3 lNWAIIA!l.E 1 0 0 4 0 0 1 19 0 0 0 0 0 0 0 0 25 3.3 lUL'l.: SUI m 61 25 28 10 26 5 23 15 !I; 157 16 54 8 5 1 753 liD.O I 'l'J.7 8.1 3.3 3.7 1.3 3.5 0.7 3.0 z.o lZ.6 20.9 Z.1 7.2 1.1 0.7 0.1 100 100.0 24 liil\[\111\lllliil ~f ~~~I ~lllllmf 1i11is 20223990 6 |