A Cost Avoidance Analysis
A Cost Avoidance Analysisof theDavid Romprey Oregon WarmlineJune 2012Community Counseling SolutionsDavid Romprey Oregon WarmlinePO Box 469120 S MainHeppner, OR 97836
Cost Avoidance Analysis prepared byTammy Ray, M.Ed/Ed.Sunder the direction ofGrant County Economic DevelopmentandGREAT, Corp.John Day, OR 97845
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineTable of ContentsSummary. 1Data and Analysis. 3History and Array of Mental HealthServices in Oregon . 10Cost Avoidance. 11Cost Benefit Methodology. 11National Costs of Hospitalizationfor Mental Health . . 12Oregon Costs of Hospitalizationfor Mental Health. 13Costs of Incarceration. 14Rural and Frontier Cost Comparison. 15Rural and Frontier Cost ComparisonDefinition. 16Recommendations. 17Community Solutions. 17Conclusion. 18Notes. 19iii
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineSummaryThe David Romprey Oregon Warmline is a freeservice to all. Anyone may call toll-free to receiveconfidential support from a trained Peer SupportSpecialist.and the wisdom of lived experience. They can helpreduce costly and often re-traumatizing psychiatrichospitalization, and help people to recover a senseof hope and purpose in their lives.The David Romprey Oregon Warmline isdesigned to help callers through a tough time orsituation, in an informal environment. The intent isthat clients can benefit from talking with someonewho’s been through the same things they aregoing through. It is staffed by people with variouslife experiences, challenges and big feelings(including but not limited to) mental health,addictions, hospitalizations, feelings of suicide,learning differences, homelessness, loneliness,challenges of having low income and more.The David Romprey Oregon Warmline consistsof peer to peer support for anyone who needssomeone to listen, offer encouragement and buildon a person’s strength. The line is targeted topersons who have mental health and/or addictionconcerns but is open to anyone who needssupport.The David Romprey Oregon Warmline providesa payback for the community and state. It isdifficult to put a price on keeping someone outof the hospital or jail, but the Warmline may helpkeep someone functioning and in the communityfor just a few dollars a day.Warmlines are moving away from the traditionalmedical model and are based on the principles ofmutual support, healing through relationships,The David Romprey Oregon Warmlineis grounded in the principles of personalresponsibility, mutuality, reciprocity, respectingothers thoughts and beliefs as valid and important,growth beyond stigma, shame, and limits placedupon those living with mental illness. In a mutualand respectful conversation, peers discovertogether how they have developed their beliefsabout themselves and the world in which theylive. Each person has the opportunity to challengethemselves to learn how they might change theirmental illness story and crisis story to one of mentalwellness and an avoidance of crisis altogether.The David Romprey Oregon Warmline’s philosophy is to learn and grow together: To fulfill an unmet need in the community by providing support to peers from people who havebeen through the system and can empathize with a caller’s situation; To provide help to a peer through a difficult time or situation or to share in a caller’s positiveexperiences; To listen and provide support when there may be no other source of support by helping a callerin getting through a day; to encourage a caller to find resolution to his or her own problemwithout infringing on the caller’s entitled right to make a decision, and; To treat callers with respect and dignity, respecting the trust that someone places in a PeerSupport Specialist when sharing the personal details of their lives. The use of the David Romprey Oregon Warmline may help people decrease the need for frequentdoctor’s visits, emergency room treatment, involvement with law enforcement, utilization ofthe crisis line, and the need for more intensive care such as psychiatric hospitalization.1
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineAnecdotal evidence clearly shows that thevast majority of mental health consumers preferpeer-run services to inpatient hospitalization, anda growing number of studies are confirming this.After learning about the benefits, successes andease of which mental health consumers respondto peer to peer run Warmlines, many researchersrecommend a call to action on a variety of topicssuch as: Mental Health programs. Service provider organizations and otheradvocates should make peer support anintegral part of mental health and substanceabuse service delivery. Consumers must be involved at multiplelevels of planning and implementation ofpeer support services. Federal funding for the increased use ofpeer support services and peer supporttraining should be a priority area for theSubstance Abuse and Mental Health ServicesAdministration. States should set aside an appropriatepercentage of state funds for peer supportprograms. Federal, state, and local governments shouldclarify that trained, certified peer advocatesbe included among the groups of peoplepermitted to provide crisis counseling inemergency preparedness and responseplans. Mental Health Programs should supportthe evolving role of peers trained for wholehealth recovery to help reduce the 25-yearaverage premature death of those served bypublic mental health services.This report evaluates and documents thebenefits and efforts of the David Romprey OregonWarmline and provides the opportunity for objectiveplanning, evaluation, and research to advancecommunity health and human services. As a resultof collaborative efforts, key evaluation questionswere designed and implemented, which resultedin successful tracking of a variety of data points.It is the work of the Peer Support Specialists whostaff the David Romprey Oregon Warmline on adaily basis that has enabled the writer to capture,track, and trend information to describe theirservices, successes, and the challenges that theyface as an organization.A number of important lessons were learnedduring the analysis of the informationobtained from the David Romprey OregonWarmline evaluation questions and calls. Thekey areas that emerged are:1. What is known about the David RompreyOregon Warmline services and callers?(Data gathered from Warmline call logs,caller interviews, and interviews withmental health system representatives).2. How do callers experience the DavidRomprey Oregon Warmline and the valueof its services? (Was the call helpful?Was the caller interested in outreachprograms?)3. Is the David Romprey Oregon Warmlinecost effective? (Was the person referredto Crisis Line? Would more costly serviceshave been used?).As a result, this paper will present data on theabove three components.2
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineData and AnalysisThe following data was gathered from theDavid Romprey Oregon Warmline call logs andcaller interviews for 2010 and 2011.Calls by Year:During the two years sampled, there were atotal of 19,599 calls to the David Romprey OregonWarmline. In 2010, a total of 8,329 calls werelogged. In 2011, a total of 11,270 calls were logged.An increase of 2,941 calls in a one-year time frame(2010 to 2011) was 010,0008,0008,3296,0004,0002,00002010 Calls2011 CallsTotal CallsCalls by Type:During the two years sampled (2010 & 2011),there were a total of 19,599 calls to the Warmline.Tracking of “calls by type” began April 1, 2010.4,844 of these calls were classified as “not acall back”, i.e. actual calls that were not simplyhang-up calls, which involved some degree ofpeer interaction with callers. 2,115 of these callswere classified as a call-back, in which contactwas made and the Peer Support Specialist wasable to talk with a caller. 259 of these calls wereclassified as “called back–ok now”. Thus, 7218calls provided the focus for the Warmline call dataanalysis. The remainder of categories for “call bytype” were classified as the following:Called Back – Could Not Take CallCalled Back – Left VoicemailCalled Back – No Answer or VoicemailCalled Back – Left Voicemail3595393991Missed Calls:From January 1, 2010 through December 31, 2011the Warmline received missed calls in the form of avoicemail or a voicemail hang up.Voicemail: 5,347Voicemail Hang Up: 3,964Additionally, the following numbers werethe total number of calls that came into theDavid Romprey Oregon Warmline 800 numberaccording to the “Missed Calls Report”. This reporttracks all calls which were unanswered or receiveda busy d calls orreceived a busy tone20,00010,000020102011The total number of calls for 2010: 45,485The total number of calls for 2011: 57,763Analysis: The David Romprey Oregon Warmlinedisplayed a 21.2% increase in incoming calls from2010 to 2011.3
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineCalls by Month:The table(s) below display the number of calls received per month to the David Romprey 55Nov.895Dec.397The top three (3) high volume call months for 2010 were; December, June, and 51Jul.1153Aug.1181Sep.983Oct.950The top three (3) high volume call months for 2011 were; August, July, and February.Calls by Day of Week:The table(s) below displays the number of calls received by day of week to the David Romprey 4Fri.1088Sat.1230Sun.1182The top three (3) high volume calls for 2010 as it relates to days of the week were; Tuesday, Thursday,and 14Sat.1755Sun.1469The top three (3) high volume calls for 2011 as it relates to days of the week were; Tuesday, Monday,and Thursday.4
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineCaller DemographicsThe David Romprey Oregon Warmline staffwas interested in understanding more about callerdemographics, without violating confidentiality oranonymity or the peer to peer relationship. As a resultthe staff recorded information on caller state, county,gender, and whether or not the caller is a 6002744172520002985200010002010 Calls by gender4000VeteransStatus:Status (April 1, 20102010 Veteran2010VeteranStatus (April1, 2010throughDecember31, 2011)through December 31, 2011)609No2011 Veteran Status0FemaleMaleUnknown800060002011 Calls by gender617540004000609YesOf the callsstatus wasYesknown inNo that VeteranUnknown2010, 17% of the callers were Veterans (609/3594)and 83% (2985/3594) were not 20No2000UnknownYesOf the calls that Veteran status was known in2011, 6% of the callers were Veterans (392/6567)and 94% (6175/6567) were not Veterans.10000FemaleMaleUnknownFor the two years of data sampled, it was notpossible to determine the caller’s gender on 100%of the calls. Of the calls that gender identity wasknown in 2010, 58.4% (3,860/6604) of the callerswere male and 41.6% (2744/6604) of the callerswere female. Of the calls that gender identitywas known in 2011, 52.8% (4,360/8,262) of thecallers were male and 47.2% (3,902/8,262) of thecallers were female.5
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineCalls by County, January 1, 2010through December 31, 2011The top six (6) counties in order, as it relates tovolume of calls for 2010 and 2011 were:Multnomah (1,768)Coos (1,607)Lincoln (1,129)Clackamas (1,116Baker (582)Lane (538)There were 10,225 calls in which the countythe caller was calling from was d nWheelerYamhillNumber 6
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineCalls by State, January 1, 2011through December 31, 2011The top six (6) states as it relates to volume ofcalls for 2010 and 2011 were:Oregon (9,898)California (1,687)Iowa (332)Ohio (242)Maryland (194)North Carolina (133)There were 6,798 calls in which the state thecaller was calling from was MinnesotaMissouriMontanaNevadaNew HampshireNew JerseyNew YorkNorth CarolinaOhioOklahomaOregonPennsylvaniaRhode Number 19,89861126,79889477
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineHow Did Callers Learn about the Reasons for Calling:The types of calls the David Romprey OregonDavid Romprey Oregon Warmline?How Callers Learned About WarmlineParent8Newspaper9Advertisement79211 Resource93Support rovider1469Flyer2630Crisis Line2864Unknown7180The David Romprey Oregon Warmline beganlogging how callers heard about the Warmline onApril 1, 2010. The data above is from April 1, 2010through December 31, 2011.There were 16,350 calls logged during thistime that related to how the callers heard aboutthe Warmline. Of these, 7,180 were classified asunknown with regards to how the caller learnedabout Warmline. The top six (6) ways in whichcallers learned about Warmline were:Crisis Line (2864)Flyer (2630)Provider (2630)Friend (483)Internet (415)Therapist (327)Warmline received were examined by looking atdata from April 1, 2010 through December 31,2011. The following categories for “reason forcall” are listed below along with the number ofcallers classified in each category.Reason for CallDomestic Violence22Thank Warmline44Family Challenges55Grief/Loss97Drug/Alcohol114Feeling Suicidal122Hearing/Seeing Things122Resources (Housing,Financial, Mental Health)Hang Up150Relationship ted/Shut In788Anxious/Scared/Happy/ Afraid/MadJust to Talk9902703The top six (6) call reasons were:Just to talk (2703)Anxious/scared/happy/afraid/mad (990)Lonely/Isolated/Shut In (788)Depression (619)Other (582)Relationship Challenges (282)8
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineInterested in Outreach Program:Was the Call Helpful?The David Romprey Oregon Warmline staffwas curious to know if callers were interested inoutreach programs and resources. Beginning April1, 2010 the Warmline staff began tracking thisdata to see if Peer Support Specials offered callersinformation on outreach programs during the call.The David Romprey Oregon Warmline staffwas interested in attempting to document callers’perceptions of the helpfulness of the Warmline.As a result, the question was included in theevaluation of rather the call as a whole, was ahelpful experience. The following answers wereobtained from January 1, 2010 through December31, 2011.OutreachProgram0NoUnknownYes4/1/10 to12/31/101839344920881/2/11 to12/31/11093256874651TOTAL1177191366739 38% (6739/17647) of callers were interestedin some sort of Outreach Program 10% (1771/17647) of callers were notinterested in an Outreach Program(s) 19.5% (3449/17647) of callers werecategorized as “unknown” on whether ornot they were interested in an outreachprogram.Was the Caller Referred to the Crisis Line?In addition to specific reason(s) for calls, suchas feeling depressed, anxious, lonely, etc. theDavid Romprey Oregon Warmline received callsthat were “hot” or known as crisis calls. Thesecalls are immediately referred to the Crisis Lineand/or 911.The following chart depicts the number of callsthat were immediately referred to the Crisis Line.The information was gathered from January 1,2010 through December 31, 2011. 96.3% (6177/6411) of callers reported thatthe call was helpful to them 3.6% (234/6411) of callers reported that thecall was not helpful to themWould Have Used a More Costly Service:A question regarding whether or not a callerwould have used a more costly service was asked.The answers to this question were tracked fromApril 1, 2010 through December 31, 2011. Resultsare below.Service911Crisis LineHospital Emergency RoomMaybeNoOtherPrimary Care 6284299% (19,465/19,599) of the callers were notreferred to the Crisis Line or 9111% (134/19,599) of the callers were referred tothe Crisis Line or 9119
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineHistory and Array of Mental Health Services in OregonThe Comprehensive Community MentalHealth Program Act was passed to integrateOregon State Hospitals with community programsinto a regional system; in addition, the Act waspassed to encourage counties to expand basicmental health services and to develop alternativesto hospitalization.Despite this, escalating health care costsnecessitated new strategies to provide a rationalmethod for allocating public resources for healthcare.Thus, the Oregon Health Plan was developedto provide a rational method for allocating publicresources for health care. The key points of theplan were to devote resources to services that hadthe greatest impact on the lives of consumers,to develop an alternative incentive structure topromote cost effective and appropriate serviceprovision and to provide coverage for all whoneeded it.Through a number of initiatives in the late1980’s and early 1990’s, Oregon’s public mentalhealth system developed to its current system.Some notable achievements during this timein addition to the Oregon Health Plan, weredeinstitutionalization, development of a systemof care for children, and improved funding for allmental health services.This history of public mental health in Oregonand the recent developments listed abovedemonstrate the shift from institutionalizationtowards a continuum of intensive communityplacements, short-term acute psychiatric care, andstate hospital services when needed. Since 1989,the number of adults served in state hospitals hasdeclined 9.8% annually.During this same timeframe, the number ofadults served in acute care units and intensivecommunity and residential programs hasincreased at an annual rate in excess of 50%.Because of the flourish of initiatives in Oregon,nearly 400 individuals have left state hospitalssince 1995. Sixty-two percent of those peoplehave lived in the community without needing anyform of emergency hospitalization for psychiatricconditions. Only 80 people have returned to statehospitals for extended stabilization and treatment.Of the 80, 38 returned to the community.These trends have assured stabilization ofconsumers nearer their homes with less disruptionto their lives and have allowed communityresources, wrap around services and supports,such as the David Romprey Oregon Warmline, forconsumers to flourish.10
A Cost Avoidance Analysis of the David Romprey Oregon WarmlineCost AvoidanceThe David Romprey Oregon Warmline staffwanted to begin the work of creating informationon the cost benefit of Warmline’s. The statisticsabove, such as 400 individuals in the past fifteen(15) years being discharged from Oregon’s statehospitals clearly outline evidence that the numb
8,329 11,270 19,599 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000 2010 Calls 2011 Calls Total Calls type” were classified as the following: Missed Calls: From January 1, 2010 through December 31, 2011 the Warmline received missed calls in the form of a voicemail or a
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