Bucks County Mental Health Plan For Fiscal Year

Transcription

1 Bucks County Mental Health Plan For Fiscal Year Bucks County Department of Mental Health/Developmental Programs 600 Louis Drive, Suite 101 Warminster, PA (215) Mary Beth Mahoney, MS Administrator Bucks County Commissioners: ROBERT G. LOUGHERY, Chairman CHARLES H. MARTIN, Vice Chairman DIANE M. ELLIS-MARSEGLIA, LCSW

2 Table of Contents 1. Executive Summary Vision & Mission Statements Process Used for Completing the Plan Overview of the Existing County Mental Health Service System Identification and Analysis of Service System Needs Identification of the Recovery - Oriented Systems Transformation Priorities. 17 Attachment A: Local Authority Signatures Attachment B: Proof of Publication Notice Attachment C: PATH Plan Attachment D: CSP Plan Attachment E: Existing County Mental Health Services Attachment F: Evidenced-Based Practices Survey Attachment G: Development of Recovery-Oriented/Promising Practices Attachment H: Service Area Plan Chart Attachment I: Older Adults Program Initiative Attachment J: Top Five Transformation Priorities Attachment K: Expenditure Tables and Charts Attachment L: Housing Plan Attachment M: Forensic Plan Attachment N: Employment Plan Attachment O: Feedback Form (Optional) Attachment P: Review Form (Completed by OMHSAS)

3 1. Executive Summary The Bucks County Mental Health (MH) Plan for Fiscal Years includes various highlights that capture our dedication to providing quality mental health services for Bucks County residents as well as underscores the partnerships between systems that support individuals with mental health and co-occurring substance use disorders. The plan demonstrates Bucks County s commitment to providing services, addressing the unique needs of adults, older adults, and transition-age youth. We must continue to promote individuals strengths and improve support services in order to better support one s recovery. This document includes five distinct plans: 1) the MH Plan, 2) the Projects for Assistance in Transition from Homelessness (PATH) Intended Use Plan, 3) the Housing Plan, 4) the Forensic Plan, and 5) the Employment Plan. Each document is a stand-alone plan that involves its own planning process and includes varied stakeholder input. Although the plans can be stand-alone documents, we fully integrate aspects of each plan as appropriate into our daily work, ensuring that the outcomes of each complement the overall direction of our system planning. All attachments referenced throughout the plan are located after the narrative. The Transformation Priorities are targeted to not only move the mental health system forward in its recovery orientation but also enhance our collaboration and coordination with other systems in order to achieve the highest quality service delivery. We strive to more effectively blend funding streams to support necessary change. The identified Priorities include: 1. Outpatient (OP) Treatment - This initiative will be a multi-year project. Initial work is focusing on the core foundation issues that will support a system that provides access, quality, and efficiency. The goals are as follows: Meeting Access Standards: The focus is on ensuring that participating agencies meet access standards for initial routine appointments and first clinical follow-up appointment. Ensuring Quality and Efficiency: The focus is building on gains made toward consistently meeting access standards and will broaden in focus to improve quality and efficiency in clinical treatment standards. Core Competencies: An integral element of the initiative will be the expectation of and support for outpatient professionals achieving and maintaining competencies in order to respond effectively to individual s unique needs. 2. Peer Support (PS) - The expansion of Certified Peer Specialist (CPS) services has been a priority for Bucks County for the past several years. It is our intention to infuse peer support into all services, both existing and newly Page 1

4 developed. By December 2011, Bucks County anticipates its first freestanding CPS program to be operational. The Mental Health Association of Southeastern PA (MHASP) has been instrumental in making this goal a reality. The new program will be named PeerNet and will support Bucks County in its goal to increase peer support activities throughout the System. There are also other activities that support this transformation, including a discreet CPS program at Penn Foundation, ongoing trainings for CPS, an inpatient in-reach initiative through Magellan Behavioral Health (MBH), as well as ongoing support meetings for CPS and CPS Supervisors. We acknowledge our need to stay focused on and create a vision for full utilization of peers throughout our System. 3. Crisis We will be taking a multi-pronged approach to examining the current delivery of crisis services in Bucks County. In keeping with the goal of the Office of Mental Health and Substance Abuse Services (OMHSAS) for improving crisis intervention and emergency services, Bucks County has created a crisis workgroup that includes varied stakeholder representation: MH and Drug and Alcohol staff, consumer and family membership, police, and providers of crisis services. We will be gathering information from various stakeholders (people who have utilized crisis services, family members, treatment providers, law enforcement, and crisis service providers). The goal is to create service options that will support individuals in crisis and minimize the need for inpatient hospitalization. We are in the initial stages of identifying gaps, the effectiveness of the service, and creating a vision for the future. We will be utilizing a survey process through Voice and Vision s Consumer and Family Satisfaction Team (CFST) as well as public forums and focus groups. 4. Behavioral Health and Physical Health (BH/PH) Coordination - The HealthChoices/Health Connections (HCHC) initiative provides a unique opportunity to achieve better outcomes for individuals with a Serious Mental Illness (SMI) by testing new approaches to improving access to healthcare, integrating physical and behavioral healthcare, and promoting more healthy lifestyles, while at the same time reducing costs associated with the use of emergency, inpatient, and other acute services. Members who participate in this initiative are assigned staff (navigators) who are responsible for encouraging members to complete BH/PH evaluations, coordinate care across BH/PH systems, advocate for individual perspective/preference, provide clinical guidance, and establish a wellness plan with members based on members health interests and needs. Smoking cessation and outcomes related to reducing risk factors associated with metabolic syndrome (i.e. weight reduction through improved nutrition and increased exercise) have been major areas of wellness focus. Page 2

5 5. Transitional Age Youth Traditional services do not meet young adults where they are and there is a severe lack of resources for these young people. There is also a significant difference in the intensity of services available in the children s system as opposed to the adult system. In many instances, if provided the appropriate supports, these young adults could minimize their use of behavioral health services and be successful in the community. The goal of this transformation priority is to enhance the supports and resources available for transition age youth so that their goals are attainable. We must bridge the gap between the adolescent and adult serving systems in order to develop a broad array of support services that promote wellness and recovery for youth and young adults. As a county, we continue to move forward with our transformational priorities. We have been successful in utilizing creative options in addressing the needs of transition age youth, adults, and older adults. Although Bucks County remains committed to moving forward in supporting systems transformation, the current proposed state budget for FY 2012/2013 will have very serious financial ramifications. The proposed state budget for FY will have an impact on all of the proposed strategies for meeting the needs listed in the plan. This plan reflects Bucks County s intention to continue our planning efforts. If this allocation changes significantly, we anticipate our planning strategies w`ill need to be adjusted. 2. Vision & Mission Statements Bucks County s Vision and Mission Statements have been ever-evolving. There was broad stakeholder involvement in the development, consisting of peers, family members, behavioral health staff, and providers who represent young adults, adults and older adults. Vision Bucks County will be a community of hope, acceptance, and understanding and provide a seamlessly integrated system of support that focuses on people rather than programs, life in the community rather than in the system, the whole person rather than diagnosis or behaviors, partnership rather than prescription, promotion of ownership, responsibility, and accountability rather than dependency. Mission Statement As a State leader, Bucks County will provide access to and delivery of quality holistic and integrated behavioral health services to all individuals with mental Page 3

6 health challenges and co-occurring disorders, including older adults and youth in transition. Values Services are based on Recovery and Resiliency principles. Services are based on Community Support Program (CSP) and Child and Adolescent Service System Program (CASSP) principles. People will treat each other with dignity and respect. Everyone will have the opportunity for: o Personal development. o Community Integration. o Easy access to services and supports of his/her choice to realize an improved quality of life. o Integrated and coordinated behavioral health services. 3. Process Used for Completing the Plan The MH Plan Committee is the driving force behind the development of the Annual MH Plan. There is broad stakeholder involvement, including consumers and family members. The group is representative of the various service systems including mental health, substance abuse, older adults, advocacy groups, and provider staff. The MH Plan Committee also provides input into the various activities and initiatives taking place throughout the county. The committee reviews the mission statements and goals of various county initiatives to ensure they are consistent with the direction and values that have been established. In order to determine our five priorities, the MH Plan Committee took into consideration the various initiatives and activities that were occurring throughout the county and identified the areas that were transformative in nature. Other groups that have been involved in this process include the Transitional Age Youth workgroup, Crisis Initiative workgroup, the Behavioral Health Coordination Committee, the Criminal Justice Advisory Board, Behavioral Health Subcommittee, MHASP, providers, and staff from the county representing mental health and drug and alcohol. Broad stakeholder input was solicited in the development of this year s plan update. OMHSAS feedback pertaining to the FY 2014/2015 annual plan was provided to the Behavioral Health System through the Network of Care. There were few responses, but the information gathered provided insight into the various needs of the system and focused on support services that could/should be developed in Bucks County. The specific areas that OMHSAS highlighted were discussed including the various activities that support the integration of behavioral health services. Page 4

7 During the Annual Advancing In Recovery (AIR) Event, a survey was distributed in order to gather information regarding the Community Support Program (CSP) in Bucks County. Membership had dwindled, and the committee struggled to maintain consistent attendance. On March 15, 2012, Bucks County held a forum in order to re-energize CSP in Bucks County. Broad stakeholder participation was solicited. The results of the survey were distributed, and the group was able to brainstorm ideas of how to re-establish CSP in Bucks County. The meeting was well attended and an energized group of participants brainstormed for potential ideas for CSP along with some challenges past committees have faced. 4. Overview of the Existing County Mental Health Service System This section of the plan includes Attachments E (Existing County MH Services), F (Evidence-Based Practices Survey), and G (County Development of Recovery- Oriented/Promising Practices). Attachment E categorizes the various services in the county using the article authored by William Anthony A Recovery-Oriented System: Setting Some System Level Standards. Services are delineated by service category and provide a description of what the category entails along with the intended outcome. Attachment F describes services throughout the county that are evidence-based and utilize the fidelity review measurements through the various Substance Abuse and Mental Health Services Administration (SAMHSA) toolkits. Attachment G outlines the various services in Bucks County that either falls into the category of recovery-oriented/promising practices or that are in the development stages. There are many great examples of collaboration throughout the county that have contributed in supporting individuals who have a mental illness or a co-occurring substance use disorder. Below are some highlights of achievements that have enhanced the system. Case Management Transformation Initiative (CMTI) CMTI was initiated in 2007 as a collaborative effort to upgrade Case Management (CM) services in Bucks County. The CMTI initiative involves monthly meetings to focus on outcomes, training needs, state or county changes affecting CM, and satisfaction survey responses. A focal point of the CMTI has been the development and revision of a training curriculum. Level I training is held every six months and includes all of the OMHSAS requirements for new Case Managers, with an emphasis on engagement. Level II training is held at least annually and incorporates Cooccurring Education and Motivational Interviewing. All of the Level II training provides a framework for working with those with a substance use diagnosis. Page 5

8 CMTI accomplishments for 2010 include the inclusion of individuals, who receive CM services, as participants in the trainings. This has enriched the training experience by providing the participant s perspective. There was also collaboration in the development of a revised CMTI satisfaction survey for CM as well as individuals receiving CM services that focused on engagement, motivational interviewing, and the quality of service. Another accomplishment focused on the County and MBH staff jointly participating in agency visits in order to improve relationships between the county, the funding agency, and the providers. It also provided an opportunity to learn about each agency s strengths and how best to support staff in providing a much valued support service. The 2011 focus continues to be on ensuring the delivery of training to meet ongoing identified needs, as well as the following: Incorporate survey results into future planned activities. During 2011 at CMTI Management Meetings, survey results were reviewed and plans were developed to focus future trainings and supervision related to CM expressed concerns. As mentioned previously, a focal point of the trainings is to ensure that they address mental health and substance abuse needs and issues. Level II training is held at least annually and provides an overview of substance use disorders including recognition of signs and symptoms, the disease of addiction, and appropriate treatment interventions. It also provides a general overview of co-occurring disorders and highlights the importance of integrated treatment approaches. Concrete skill building activities are included to ensure ICM s have competency in assessing stages of change, developing stage matched interventions, and utilizing motivational interviewing strategies in their encounters. Include Trauma-Informed Care into the training series. Trauma-Informed Care has been integrated into the Level 1 training. The CM trauma training is also being connected to the large County Trauma Initiative. A training was piloted on March 9, 2012 with nonclinical staff, and feedback will be utilized to enhance future training and supervision of staff around trauma-informed care. Coordinate MBH and County CM audit expectations. During 2011, a joint MH, MBH, BHS audit tool was developed, and all three organizations collaborated in the auditing process. This proved to enrich our efforts through focusing the expectations of CM for all three systems. Providers were engaged in the process and provided valuable feedback that will be incorporated into future audits. Track agreed upon outcomes using a newly designed CM database. A county database has been developed to collect data specific to identified outcome measures. The CMTI Management Meeting was used as a forum to incorporate input from Supervisors and County staff on relevant data and outcomes to be measured. Reports are Page 6

9 Code Blue now being refined and will be reviewed regularly in CMTI Management Meetings. Facilitate strengths-based crisis planning/management. The new audit tool includes questions related to strengths-based crisis planning, and agencies have been actively engaged in incorporating this information into their required documentation. CMTI Management Meetings were used to facilitate discussion around agency crisis planning tools, and participants used the opportunity to learn from each other in order to strengthen their documentation and processes. Provide individualized segments of training to address the specific needs of adults and children. CMTI Level I training will continue to be an integrated training in order to allow CM to fully support the family system. Specific sections of training will offer both a focus on adults or children s perspectives. This is the second year of a county coordinated effort to support individuals who are homeless during extreme cold weather conditions. The goal of a Code Blue declaration is to prevent Bucks County citizens who are homeless from suffering and possibly dying. The season began on December 1 st and ended on March 31 st. The behavioral health system has coordinated with the Advocates for Homeless and Those in Need (AHTN), a volunteer organization that coordinates with local churches to provide temporary shelter during a Code Blue declaration. The goal is to ensure that both emergency and routine behavioral health services are available and easily accessible to anyone requesting or needing services. A formal Code Blue is defined as one declared by the Bucks County Emergency Services Department and the Bucks County Health Department. While the system should respond to needs regardless of weather conditions, in a formal Code Blue the behavioral health system is officially notified and advised to be on alert and ready to respond to behavioral health issues. The County will declare a formal Code Blue when the temperature falls below 20 F for two consecutive nights. Temporary Code Blue shelters are organized and hosted by the AHTN. The Reach Out Foundation (ROF), a consumer run drop-in center, provides peer assistance at Code Blue shelters as well as a place for individuals to stay during the day when a Code Blue is declared and the weather is too inclement for individuals to return to their living arrangements. ROF also assists in making referrals for more permanent housing and behavioral health support services when appropriate. Page 7

10 Another linkage that has been developed as part of this initiative includes partnering with the Bucks County Society for the Prevention of Cruelty to Animals (SPCA). It is common for individuals not to seek shelter because they do not want to be separated from their pets. The SPCA will temporarily house these pets so that their owners can receive shelter. This year we have also been maintaining statistics in order to determine where additional supports and resources may need to be expanded or developed in order to engage with individuals who may not have traditionally sought services. During the winter season, efforts have been made to bring the Code Blue response to Central and Northern Bucks County. While all major behavioral health agencies participate in a Code Blue declaration, the only formal volunteer organization to host temporary shelters was the AHTN that is predominantly in Southern Bucks County. In 2011, a group of churches in Central Bucks County organized to provide temporary shelter in that geographic region taking their cue from the AHTN that is most active in Southern Bucks County. The Central Bucks volunteer group is the Coalition to Shelter and Support the Homeless (CSSH). Although only one formal Code Blue was declared in Bucks County during this winter season, the AHTN provided shelter for the majority of the season. In the Northern region, a group recently formalized called Outreach Care. This is an interfaith group whose mission, although broader than Code Blue, will result in welcoming individuals/families who are homeless during extreme weather conditions. Outreach Care s mission is to partner with the local community to offer temporary emergency shelter and resources to meet the daily living needs of those who are homeless in the Upper Bucks County area. The group is now working on achieving this mission by locating space to provide shelter. Currently, any person presenting to a behavioral health agency during a Code Blue will be provided shelter, whether it be via an informal arrangement with a local church or transportation to another part of the County. The formation of volunteer Code Blue organizations in other areas will enable people to stay closer to their own communities. Peer support has also been part of the Code Blue response. We believe that there is great potential for the use of peers in building supportive relationships with shelters, eventually leading to other forms of support or treatment options if desired or requested. Crisis Intervention Team (CIT) The Bucks County CIT Taskforce was established in April It is a community partnership consisting of law enforcement officers, behavioral health providers, consumers, and family members. All community partners work together to understand mental illness, substance use and other disabilities, invest Page 8

11 time and effort to avert a crisis, work to de-escalate a crisis situation, and direct individuals to appropriate care. The program is implemented through Bucks County law enforcement agencies with the objective to stabilize the crisis and help individuals access appropriate resources for support. The Bucks County CIT training is offered in several versions. The full program consists of a 40-hour training curriculum including exercises such as Hearing Distressing Voices, a consumer perspective module, role-playing scenarios, and a recently added veterans round table component. The first of these trainings was held in September of 2009, with five completed trainings thus far. In the county, 126 law enforcement personnel are certified CIT officers. Bucks County CIT also offers two shortened versions of the training: a 6-hour Introduction to CIT class and a 4-hour training directed at 911 call takers. The 6-hour version focuses on officer and consumer safety and includes an overview of CIT, descriptions of several psychiatric disorders, a review of the Mental Health Procedures Act, and a consumer component. Over the past year and a half, Bucks County has provided the Introduction to CIT training to 409 individuals representing law enforcement, corrections, crisis workers, security personnel, and ambulance crews. Included in the 409, are forty-eight 911 calltakers that have completed the 4-hour training. Bucks County CIT is currently in the process of expanding trainings from the Lower portion of the county to Central and Upper Bucks, with a goal of having 20% of all Bucks County law enforcement patrol division s certified in crisis intervention practices. Updates for this highlighted area are included in the Forensic Plan. Cross-Systems Mapping On September 29 & 30, 2010, Bucks County participated in a 1½-day workshop on the Cross-Systems Intercept Mapping through the Pennsylvania Mental Health and Justice Center of Excellence. Participants represented multiple stakeholder systems including mental health, drug and alcohol, human services, corrections, advocates, family members, consumers, law enforcement, and the court system. The purpose of the mapping was to: Develop a comprehensive picture of how people with mental illness and/or substance use disorders and/or intellectual disabilities (ID) move through or interface with the Bucks County criminal justice system along the five distinct intercept points: Law Enforcement and Emergency Services, Initial Detention/Initial Court Hearings, Jails and Courts, Re-entry, and Community Corrections/Community Support. Page 9

12 Identification of gaps, resources, and opportunities at each intercept for individuals. Development of priorities for activities designed to improve system and service level responses for individuals. Bucks County has a long history of collaboration between the criminal justice system and the behavioral health system, and we were able to build upon those relationships through this process. A report was developed highlighting the various gaps and opportunities that will now be used as the basis for identifying further areas for collaboration, opportunities to improve communication, and development of support services. Updates for this highlighted area are included in the Forensic Plan. Promotion of Competitive Employment In 2010, the Bucks County Department of Mental Health/Developmental Programs (MH/DP) submitted its first Plan to Promote Competitive Employment. This plan, developed by a stakeholder workgroup, prioritized the following actions: Provide Supported Employment (SE) and evidence-based training and technical assistance. Provide training regarding the integral role employment plays in recovery to all levels of service and support in the mental health system, individuals in recovery, and family members. Identify additional funding sources for employment including federal and local grants/initiatives. Utilize employed people in recovery and CPS s in trainings as the evidence. Identify current employment outcomes relative to the SE Fidelity Scale. The Competitive Employment workgroup continues to meet on a monthly basis. They are a cohesive and energetic group that continues to look at ways to increase information sharing and resources that will lead to successful employment opportunities. Updates for this highlighted area are included in the Employment Plan. Transition Age Youth (TAY) Workgroup On February 10, 2011 the TAY Work Group successfully launched the Magellan Youth Leaders Inspiring Future Empowerment (MY LIFE) project for Bucks County. The project provides an empowering leadership group for youth between the ages of that have experience with mental health, substance misuse, child welfare, and/or juvenile justice issues. Led by Magellan s Youth Empowerment Director, Greg DiCharry, the forum was a tremendous success Page 10

13 with over 100 youth, professionals, and family members in attendance. A followup meeting was held on March 10, 2011 with a very large turnout of youth and young adults. The meetings provide an opportunity for youth to focus on important issues and listen to key presenters with the emphasis on turning youth voice into action to transform our programs and services. The TAY Work Group intends to host monthly meetings and will incorporate MY LIFE planning and program development as an integral component of Countywide TAY opportunities. A TAY Provider Forum was facilitated by the TAY Work Group on February 22, Seventeen (17) providers shared pertinent information to family and professional partners regarding services and supports available to transition age youth. Providers covered a broad array of resources including housing, community integration, employment, drug and alcohol supports/treatment, mentoring opportunities, peer advisory boards, MY LIFE, post-secondary education, and family support. The information was compiled and distributed to key stakeholders, and there are plans for improving web-based resources and developing future networking meetings. Updates for this highlighted area are included in the Transformational Priority Section. Shared Living Program In 2009, Bucks County had the opportunity to hire a Housing Specialist whose goal was to increase the permanent housing stock for individuals receiving services from the behavioral health system. The emphasis was on transition age youth and individuals involved in the criminal justice system. The Shared Living Program was developed in 2010 as a scattered site apartment program, located in each of the three geographical areas of the County. Nine (9) individuals have been provided housing through this program. Each individual pays his/her own rent and is supported by a case manager or peer specialist. Individuals who have benefitted from the program to date have been involved in multiple systems including MH, Developmental Programs, TAY, Substance Use, and Criminal Justice. The program has been successful in creatively partnering with landlords in order to support individuals in the behavioral health system that need minimal assistance to live in their community. Future plans include accessing the current provider network in order to sustain the program. To date, eleven program participants have benefitted from access to safe affordable housing, housing counseling, guidance with rental responsibilities, and the opportunity to establish positive rental histories through leases with landlords. Page 11

14 In addition to the Shared Living Program, MH/DP has also partnered with the Bucks County Housing Group in the provision of the two units which house the PATH Shelter Plus Care Project for It is anticipated that the Housing Group will also be the landlord for the additional two units for the HUD PATH Shelter Plus Care Project for 2011 that Bucks County was awarded in March The Bucks County Affordable Housing Apartment Locator website is maintained by a rental specialist at the Bucks County Housing Group. This popular website is funded through HealthChoices reinvestment funding and is utilized as a resource for consumers and service providers to find affordable rentals in a very competitive market. 5. Identification and Analysis of Service System Needs This section not only outlines the direction we believe the system must forge but also the various networks that have been developed in order to address gaps in services. Examples of these include the work with older adults through the collaboration with the Area Agency on Aging (AAA) and the Service Area Plan that addresses individuals who are inpatient at Norristown State Hospital (NSH) and the collaborative efforts of the counties in the Southeast Region. Bucks County believes that an effective system of care must offer a full spectrum of behavioral health services with a foundation of unimpeded access to quality support services. These services must be provided by professionals and organizations committed to quality care and motivated to respond promptly and effectively to the needs of County residents. Failure to provide quality care and easy access to such care results in poor outcomes and/or the default use of higher levels of care such as crisis/emergency services, residential, or inpatient; services which then become disruptive to the individual s life and recovery. Bucks County embraces recovery as a philosophy and framework for providing services. We believe every individual is resilient and capable of achieving recovery. We strive to do everything possible to assist individuals in their journey of healing and transformation toward living meaningful and purposeful lives and achieving his/her potential. In order to support individuals in their recovery, it is the system s responsibility to provide effective services and ensure the coordination of those services. Recovery is a highly individualized and ongoing process. Some individuals may just be starting their journey, whereas others are entrenched in the system and may need different or additional supports. Bucks County supports a system that continues to transition from fragmented resources and supports to one that partners with, and is responsive to, individuals and communities in a coordinated and collaborative manner. The focus of the system should be to create an Page 12

15 environment in the community of sustained recovery support that is welcoming and engaging, which continuously seeks and develops opportunities beyond the system to enhance the quality of life of individuals as defined by the individual. The development of new and innovative supports is required to facilitate trusting partnerships, choice, and meaningful valued roles. This includes, but is not limited to, peer based recovery supports, in-home supports, community recovery support centers, availability of peer specialists and recovery coaches, response teams, and the exposure to and the inclusion in different skill building and community-based opportunities, especially for individuals who have been in structured or institutional settings. The MH Plan Committee gathered and reviewed data in order to determine the gaps and opportunities of the system. Data included services/supports currently available in the county (residential, treatment, mental health, drug and alcohol, vocational, etc.), Bucks County s comprehensive 4-year plan that was submitted to OMHSAS in 2006, profiles of individuals currently inpatient at NSH, community inpatient information from MBH, data on the Partial Hospital Transformation initiative through Voice and Vision, and paid claims for people diverted from a NSH admission. Diversionary information was also analyzed, recognizing the various supports that were put in place in order to negate state hospital admissions. Bucks County MH/DP also recognizes that there are mental health and cooccurring challenges specific to the older adult population. We work closely with the Bucks County AAA and the Bucks County Drug and Alcohol Commission (BCDAC) to appropriately address these needs. These efforts are outlined in the current Memorandum of Understanding (MOU) between the noted agencies (see attachment I). In 2009, MH/DP collaborated with AAA to co-fund a demonstration program called Senior Empowerment for Life Fulfillment (SELF). The program is designed to connect older adults who have unmet behavioral health needs, to identified supports. SELF includes outreach to older adults who are homebound, addresses access to treatment issues, methods for payment of services, and linkage to traditional treatment when the individual is ready. Referrals for this program come from a number of sources, AAA care managers, older adults who present at community crisis centers, police departments, primary care physicians, Information and Referral contacts, etc. Representatives from both MH and AAA meet with the SELF staff regularly to review the program s progress and address any emerging challenges. In addition, there are quarterly case conference meetings that are held to discuss the needs and progress of each individual participating in the program. These meetings have facilitated collaboration between the mental health and aging systems and enabled better outreach, systems support, and treatment for older adults. Page 13

16 Another collaborative effort has been cross trainings between Behavioral Health and AAA staff in an effort to better inform and educate one another on resources and philosophies. Trainings have included recovery principles and overviews of each system resulting in networking opportunities between agencies which have fostered better communication. There are also plans to provide a training on hoarding as this has become an increasing area of concern for older adults with a mental illness. There will also be a workshop at our upcoming Cultural Diversity Conference that will focus on older adults and behavioral health challenges. As additional training needs are identified, they will also be considered for joint and integrated training opportunities. However there continues to be a variety of strengths that Bucks County continues to draw upon in order to support an individual with a behavioral health disorder. We continue to have a strong commitment to peer services, looking at creative ways to not only increase the numbers of peers who are working in the system but how peers support individuals recovery journey. Another strength is the relationships that have been built in order to support individuals in the system. These include the criminal justice system, various county agencies (AAA, Children and Youth, Probation and Parole, etc.) and community partners. There are also a variety of unmet needs that still exist within the County. Some issues that are consistent among age groups continue to be safe, affordable housing and the ever-increasing need for county-funded support services such as OP, Psychiatric Rehabilitation, Assertive Community Treatment (ACT), CM, and Residential. Below outlines unmet needs that are specific to the various age groups: Adults (ages 18 and above): Lack of available resources for individuals in the behavioral health system that have criminal justice involvement. Limited jail diversion programs. Limited availability of county funded resources for the increased numbers of individuals who are ineligible for Medical Assistance. Lack of available quality behavioral health services for individuals with ID. Older Adults (ages 55 and above): Increased risk for alcohol-related problems and accidental or intentional misuse of prescription drugs. Stigma that is associated with older adults accessing behavioral health services. Mobility issues that make it difficult to access traditional site-based behavioral health services. Page 14

17 Transition-Age Youth (ages 18 through 26): Lack of the individual s own resources (financial, emotional, and social) as well as available behavioral health services that address this age group s particular needs. Young adults access community services differently more use of technology and social networking sites. The impact of trauma on a young person life has an effect on his/her safety and relationships, which left unaddressed, hinder personal/emotional growth and recovery. There is a strong co-occurring substance use element. Description of Service Area Plan Services and Supports: Please refer to Attachment H: Service Area Plan Chart and narrative for additional information on progress towards meeting the three planning goals. The five counties in the Southeast Region have a long history of working individually and together to enhance the community mental health/behavioral health system. Beginning with the closing of Philadelphia State Hospital in 1990, the closing of Haverford State Hospital in 1998 and continuing through several downsizing initiatives, the Region has reallocated resources that originally supported almost 1200 State Mental Hospital beds to community supports. Counties in the Southeast Region make minimal use of large institutions to support individuals with SMI. Fiscal year (FY) was the first time in many years that the counties in the Southeast Region did not reduce the capacity at NSH. In FY 10-11, the region anticipates closing 28 beds, reducing the civil capacity at NSH to 39 individuals for Bucks County and 176 in total. Additionally, with the release of the Olmstead Plan, Pennsylvania embarked on an initiative to significantly reduce unnecessary institutionalization. The counties have consistently demonstrated their willingness to engage with the OMHSAS in similar Community Hospital Integration Projects Program (CHIPP) initiatives. Over the course of the next five years, the Southeast Region counties envision the following: A significant reallocation of resources from NSH to the community. We can no longer CHIPP away at NSH capacity. The amount of funding provided in the past few years per individual has not been sufficient to impact the cost of the increased demand of the services needed in the community. It has not been adequate to support the necessary community infrastructure. A significant expansion in the types of services available through HealthChoices funding. There are not enough resources to currently support the needed services of ineligible people that need services. We need to increase the amount and variety of available outpatient and inpatient services and supports. Page 15

18 An increase in the number of specialty services that respond to specific needs, such as Dialectic Behavioral Therapy, Trauma Informed Services, and supports for people with co-occurring disorders (substance use, intellectual disabilities, medical complexities, etc.). A restructuring of County MH funded community residential services so that every person with serious and persistent mental illness has a home and mental health residential services are organized to achieve specific outcomes for residents. Improved access to other supports such as housing supplements, aging services, higher education, and other community opportunities. A significant decrease in the number of individuals involved with the criminal justice system diversionary programs. A significant enhancement of the system s infrastructure through training, technical assistance, improved compensation, and other strategies. Each of the five Southeast County MH Programs has a staff person who acts as a liaison with NSH. County staff are responsible for working with NSH staff and community providers around the community support needs of individuals currently hospitalized at NSH. Continuity of Care meetings are held between NSH and each County MH Program routinely throughout the year. The County MH Directors and CHIPP Coordinators continue to meet at least monthly to review issues related to services and supports for people assessed in the Service Area Plan. County staff are active in assessing all referrals to NSH and in developing diversion plans for people who can be served in the community. Additionally, the counties support the Southeast Region Mental Health Services Coordination Office which is responsible to focus on areas identified by the five counties such as regional planning and data collection, oversight and monitoring of the specialty regional services, as well as forensic monitoring for the suburban counties. All counties in the Southeast region have successfully completed Sequential Intercept Mappings. Since this effort, the Regional Mental Health Services Coordination office has continued to assist and work with the Counties to focus on action plans to address the intercept points which will help to improve and develop services and divert persons from the criminal justice system. Presently, all counties have active task forces and are implementing recommendations from the Sequential Intercept Mappings. Finally, the Regional Continuous Quality Improvement Committee (CQI) continues to bring together representatives from the five counties Quality Improvement staff as well as community stakeholders to meet and review the outcomes of the regional programs. In FY 09-10, the UPENN (now Temple University) Collaborative on Community Integration, recognized the Regional Recovery Organizational Review Model and Tool as an Exemplary Community Innovative Initiative. The committee has developed an Annual Regional Quality Improvement plan which focuses on various domains. The development of the Page 16

19 Regional Incident Management Data Project is an ongoing information and data collection project which is useful to the Counties as well as provider staff to identify trends and patterns of incidents that occur in regional programs and to focus on quality improvement objectives within the programs. 6. Identification of the Recovery - Oriented Systems Transformation Priorities Over the years, the mental health system infrastructure has faced multiple challenges and stressors that have impacted access to needed supports. Yet with all challenges, come opportunities. The system needs to be infused with synergy and innovation as it works together to realize the potential of a shared vision for mental health supports and opportunities in Bucks County and eliminates any barriers that prevent the promotion of hope and wellness. Characteristics of an exceptional behavioral health system include a coordinated system of broad-based opportunities and supports that are mobile, flexible, responsive, and holistic. Exceptional practices emphasize engagement and outreach of both the individual and the community. The system must be infused with evidence-based models and interventions, which increase the possibility of recovery. Below are system values and competencies that are integral components in assisting individuals to live full lives and transforming the mental health system: No Wrong Door expectation Good customer service requires everyone to be responsive and take the time to ensure that accurate information is provided to every individual who calls and makes an office visit. The following components of quality customer service are crucial in the provision of a recovery-oriented service: o Access is timely. o Individuals are greeted warmly. o Opportunities and information are offered with an attitude of hope and encouragement. o The physical environment of the agency is clean, comfortable, and in good condition. A view of the whole person Staff must work with individuals holistically. Individuals in recovery need to be supported in building upon their strengths while addressing all their needs physical health, spiritual, financial, etc. A thorough and ongoing strength-based assessment must be completed in partnership with individuals. Dreams and passions as well as needs must be addressed in order for individuals to achieve personal fulfillment and recovery. It is Page 17

20 understood that risks to the person and community cannot be overlooked but should not be the sole focus. True partnership in system planning The behavioral health system must include individuals who utilize the services as collaborators in the development, implementation, and quality improvement. Unless the individuals who need the supports are part of each aspect of service planning and delivery, the resources will not be reflective of, or culturally responsive to, individuals needs. Provision of multi-faceted supports Supports must be multi-faceted to support an individual s unique needs. Services that are successful in supporting individuals have specific characteristics: effective engagement, holistic approach, diverse specialties, skill building opportunities, developmental appropriateness, flexibility, and mobility. There must also be an intentional focus on working with individuals to move beyond system supports and connect to community resources. Core competencies and expertise within the workforce Workforce development is a critical element in supporting individuals in recovery. Core competencies are needed in a variety of areas due to the many complex challenges that individuals encounter. Core competencies are needed in the areas of mental health, substance use, trauma-informed care, cultural diversity, the dignity of risk, etc. These core competencies should be integrated and infused into all levels of treatment and support services, including education at each level of staffing: executive, supervisory, and line staff. Training must address the changing needs of individuals at various stages of recovery and integrated supports across all life domains. Core competencies must include attitudes and values as well as skill building opportunities. Core competencies also need to be linked to outcomes associated with county priorities and be incorporated into individual staff learning plans, which promote and support the application of necessary skills. The assessment of the current value of each program Support services must be assessed in order to determine the value of each service and its contribution to the individual s recovery as well as the overall behavioral health system. Is there evidence of the philosophical underpinnings of a recovery-oriented support? Although changes have occurred over the years to transform existing services, organizations need to assure that there is true enhancement and application of those changes to inspire individuals to flourish and advance in their recovery. Page 18

21 Peer-based recovery support It is essential to incorporate peer support into all facets of the behavioral health system and within all support services. Peer supports, peer specialists, recovery coaches, recovery specialists, and community recovery centers, are critical elements in moving the mental health system forward. Lived experience, and the knowledge that emerges from that experience, is a key component in effective recovery strategies. Training and education of peers must support the diversity and intensity of employment expectations and opportunities that are evolving in this new professional environment. Individual contribution to community Being employed, vocationally involved or having valued social roles is an expectation for all adults in our society and should be no different for individuals who have a mental health challenge. An attitude among all stakeholders that supports the belief and expectation that everyone can and should be a contributing member of society is needed. It is imperative that individuals in recovery, family members, and staff throughout the system be provided the necessary information and tools that will encourage and support individuals who face challenges and fears as they consider enhancing their knowledge and skills through educational pursuits and entering the work or volunteer force. Access to basic needs: o Safe and affordable housing Safe and affordable housing is essential in everyone s life. As with all supports, current housing stock needs to be evaluated to determine opportunities for increased flexibility (e.g. delicensure) and the ability to more effectively meet residents need and desired participation in local communities of their choice. Access to housing should not be dependent upon treatment and individuals should not fear that they will lose their housing if they do not participate in treatment. o Affordable transportation Transportation continues to be an ongoing issue for individuals to get to healthcare appointments, employment, and social opportunities. Historically, Bucks County has had poor access to public transportation and unreliable and costly access to subsidized transportation. Support services are ineffective when a lack of transportation prohibits accessing them. Transportation options or the ability to bring resources to the person must be built in to all future services that are developed. It is also necessary to educate individuals on the eligibility requirements for existing transportation services and how to access them. Page 19

22 o A network of available physical health care resources There is a severe lack of physical health care resources for individuals who receive services through the public mental health system. It is especially difficult to find local dentists who accept Medical Assistance. Dental care is the most disconcerting, as poor oral hygiene can lead to more life threatening illnesses. Outreach to and education of healthcare providers who would potentially accept Medical Assistance recipients with behavioral health challenges is essential. We must also continue to help individuals coordinate BH/PH concerns. Below are five Transformation Priorities that Bucks County has identified in order to move towards a more Recovery-Oriented System and embrace the values listed above: 1. Outpatient Services - Bucks County residents should expect ready access to quality outpatient services. To address issues of access, quality, and efficiency in the adult outpatient behavioral health system and to monitor outcomes and recovery-orientation, Bucks County has begun a multi-year initiative aimed at transforming the existing adult outpatient service delivery network. This initiative is meant to ensure access to routine outpatient services within timeliness standards, improve the quality and efficiency of services provided by raising the competency of clinicians, improving clinical supervision, and ensuring that individuals move on from outpatient care when more appropriate supports or community resources are indicated. The latter will require the development of a range of meaningful alternatives to outpatient treatment. For this initiative to be successful and reach its stated goals, there must be a strong commitment by Bucks County, MBH, and the provider agencies. This must be a collaborative process with strong provider and consumer input provided through a joint planning and monitoring group. Recognizing that this is a large and multi-faceted system transformation, we anticipate that this initiative will be a multi-year project. Initial work will focus on the core foundation issues that will support a system that provides access, quality, and efficiency. The goals are as follows: Meeting Access Standards: In year one, the focus will be on ensuring that participating agencies meet access standards for initial routine appointments and first clinical follow-up appointment. The first clinical follow-up appointment should be individualized based on need, but must occur within thirty days of the initial faceto-face assessment. Ensuring quality and efficiency: In year two, the focus will build on the gains made in consistently meeting access standards and will broaden in focus to improve quality and efficiency. Page 20

23 Core Competencies: An integral element of the initiative will be the expectation and support of the outpatient professionals achieving and maintaining competencies in order to respond effectively to individuals: o With Co-occurring drug and alcohol o With both behavioral health and ID o Impacted by trauma o In need of specific crisis planning o Involved in the criminal justice system o With mental health and physical health risk factors. Objectives: Improvement in service access rates for initial appointment and first clinical appointment Increase in hospital to outpatient access rates Increase in crisis to outpatient access rates Decrease in un-kept appointments Increase in audit scores Decrease in percentage of monthly inpatient (IP) admissions among members assigned to outpatient Bucks County s Adult Outpatient (OP) Enhancement Initiative officially commenced in the summer of Each of the seven provider agencies involved signed a letter of agreement to address and improve areas such as access, supervision, staff credentials, staff competencies, psychiatric evaluations, and medication visits. A formal process was put into place to regularly meet with providers, individually and as a group, in order to gage progress. Liaisons from MH, D&A, BHS, and MBH were assigned to each agency. The liaisons meet monthly with agency staff to provide technical assistance, assess progress toward goals, and to address any challenges the agency may be encountering in meeting the identified outcomes. All stakeholders meet quarterly and report on progress using this opportunity to grow and learn from each other. Agencies were provided the opportunity to engage with organizations that specialize in developing efficiency processes. To date, the majority of participating agencies provide full open access and are concentrating on follow-up appointment as well as access to timely psychiatric evaluations. One of the areas that Bucks County is concentrating on, as part of this initiative, is Trauma-Informed Care (TIC). In August 2011, we were awarded a SAMHSA grant that gave us the opportunity to work with Dr. Joan Gillece and her team from the SAMHSA National Center for Trauma-Informed Care. There was an initial Conference that provided an overview of TIC and an afternoon session where Page 21

24 providers had the opportunity to share ideas for developing expertise within their agencies. Dr. Gillece and her team are continuing to work with the Bucks County behavioral health system to increase our awareness of how trauma impacts treatment and transforms the culture of organization. We are also evaluating how to infuse trauma-informed care into non-treatment settings/system supports (e.g. housing, case management, psychiatric rehabilitation, etc.). Tobacco cessation is another area for improvement, and agencies are being encouraged to become registered tobacco treatment specialists. It is a requirement of the Adult Initiative that each of the providers identify a staff member to attend the University of Medicine and Dentistry of New Jersey s (UMDNJ) training to become a certified tobacco specialist. We have seen several provider agencies embrace the provision of tobacco cessation services and include peer support personnel in treatment options. 2. Peer Support - The expansion of CPS services has been a priority for Bucks County for the past several years. It is our intention to infuse peer support into all programs, both existing and newly developed. For a number of years, many programs have had imbedded peer positions as part of their support services. The first program in Bucks County to offer peer support was the Lower Bucks Crisis Center. This position has had extremely positives results for consumers who have accessed crisis services both during the crisis contact as well as follow-up contact. Other programs that have imbedded positions include residential services, the Community Treatment Team, the Forensic ACT, and the Program for Assertive Community Treatment (PACT). PACT also employs peers for its warm line. This service is offered to PACT participants should they need a supportive phone call to avert a crisis situation. In July 2008, Penn Foundation established a discreet PS Unit which currently provides centralized access to PS services for individuals who reside in Upper Bucks and Montgomery County. Utilizing their shared life experience with serious mental illness and co-occurring substance use disorders, the CPS of this unit work with service participants on an individual and group basis to achieve goals in the living, learning, working, and social areas of participants' lives. Through education, advocacy, skill instruction, development of natural supports, and a focus on community connections, CPS partner with individuals to pursue opportunities and environments that promote a sense of community belonging and the development and recovery of meaningful, participant-chosen daily living and community roles. Page 22

25 In November of 2010, Bucks County expanded our involvement with the MHASP, one of Pennsylvania s leaders in the development and certification training for CPS. MHASP s increased role includes the management of the Lower Bucks Consumer Club, Rainbow House, an unlicensed Psychiatric Rehabilitation Program, and the development of Bucks County PeerNet, a freestanding CPS program. It will also be MHASP s task to merge the two existing programs with the PeerNet program so the existing benefits of both will be maximized and compliment the goals of increasing peer support activities. Bucks County provides support to both the Certified Peers and the Certified Peer Support Supervisors through a variety of networking opportunities. In addition, Bucks County offers Peers convenient opportunities to meet the 18 hours of required education/ training for the 12 month period. Past trainings have included The PS Approach from Recovery Innovations, Person-Centered Planning, TAY, and an Overview of Drug and Alcohol (D&A) and Prevention. Bucks County currently offers Peer Development Network (PDN) meetings every other month. These meetings offer a forum wherein certified peers can come together to discuss common employment issues and offer support and information to one another. Topics such as the role of Peer Support (PS), etc. are discussed. Two PDN meetings are available: one for individuals looking for work and another for individuals employed as PS. The meetings were broken out to better address specific concerns held by each group. At this point, there hasn't been a desire by the individuals not working as PS to come together as a group. We will be attempting to revive this meeting after the next Bucks County PS training scheduled in October As PS is still in its beginning stages of development, peers continue to have challenges that get shared at the PDN meetings. They try to support each other in their various challenges and share in each other s successes. To that end, each meeting ends with individuals sharing their successes. Another form of PS that is occurring is through MBH. Peers that are employed by MBH have been visiting individuals who are on inpatient units. There are a number of goals within this initiative, but the main focus is to offer and sustain hope for individuals who may be struggling. Through bridging to community supports and modeling positive behavior, peers promote the development of relationships among peers. Objectives: By the end of FY 10-11, MHASP will have the ability to invoice CPS services occurring in the PeerNet program through HealthChoices. By the end of Calendar Year 2011, MHASP will be providing CPS services to 20 individuals. Page 23

26 Bucks County staff will examine the current CPS rate to determine its ability to cover the costs associated with free-standing CPS programs. Peer support will be an integral component of the Outpatient Initiative. Individuals with long lengths of stay in outpatient services will be identified for possible connection to peer support. Bucks County will hold its next CPS training by October Our recruitment and training efforts continue to bring peer support to the Bucks County community behavioral health system. There are currently 62 peers that have been certified in the County, 14 behavioral health agencies have employed peers, 17 peers are working part-time, and 18 are working full time. Inclusion within the Bucks County drug and alcohol system is ongoing and trainings are provided to augment the skill sets of the CPS. We continue to encourage participation of individuals with a co-occurring diagnosis to attend the CPS training classes with the recognition that many individuals within the behavioral health system experience a cooccurring diagnosis. People with intellectual disabilities as well as those with lived experience in homelessness, forensics, serious health and substance abuse issues, etc., were certified in the most recent peer certification class that took place in the fall of In February 2012, a two-day certification training was conducted for CPS Supervisors. Twenty-eight supervisors were certified or recertified including certified peer specialists, managed care organization staff, county MH and D&A staff, case managers, and residential supervisors. During the months of April and May 2012, classes will begin for the certification of Recovery Specialists. Many of the CPS s will attend this program to provide a more integrated service for peer recipients. The next CPS training is also scheduled for April We anticipate another 22 peers will graduate and provide additional expertise to the behavioral health system. A pilot project with peers helping consumers to transition from inpatient settings back to the community has begun with Universal Health Systems/Brooke Glenn Behavioral Health Hospital. Hospital staff are currently receiving training on this pilot initiative and a peer s value to staff and individuals involved in the discharge process. Page 24

27 As part of the pilot project, Voice and Vision will be surveying recipients, peer participants, staff, and administration on their experience with this project. In order to gain more of an understanding of the current use of CPS s at Bucks County providers, the Voice and Vision Consumer/Family Satisfaction Team was asked to conduct interviews with CPS s employed in the County, their supervisors, and people receiving peer support services. The first phase of this project entailed interviewing CPS s, followed by interviews with CPS supervisors. Phone interviews with people receiving CPS services are planned for April/May We were able to interview all 20 CPS s and their 12 supervisors currently employed at Bucks County behavioral health providers. Preliminary results of the first phase of this survey are located at the end of this section. Information gathered from both survey processes will be used to inform the system on how to best utilize peers. On a monthly basis, all Bucks County CPS s as well as CPS supervisors meet to discuss common issues, share promising practices, and problem solve. An in-service training is also scheduled every other month. The training is open to all and has focused on topics such as trauma, intellectual disabilities, work etiquette, county resources, forensic issues, and veteran s issues. Topics are determined based on needs identified by peers during their monthly meetings. The County has contracted with the Mental Health Association to begin a freestanding CPS program that will ultimately serve all of Bucks County. The program is now operational and employs two certified peer specialists. The program is currently serving the southern portion of Bucks County, but we anticipate it expanding throughout central Bucks by the end of As previously noted, Bucks County has initiated an effort to raise expectations, standards, and outcomes through outpatient services. As part of this initiative, providers are developing plans for the utilization of peer supports within this service. We anticipate peer support becoming a more effective alternative to long-term therapy. Page 25

28 CERTIFIED PEER SPECIALIST PROJECT PRELIMINARY RESULTS HIGHLIGHTS Demographics: Most Peer Specialists had been at their current agency more than one year. We interviewed 20 CPS and 12 CPS Supervisors. About 50% worked less than 20 hours/week. CPS s were mostly satisfied with the number of hours they worked. 1/3 reported meeting with 10 or fewer people per month. About 50% met with people weekly. The other 50% indicated they met with people as needed or the schedule varied greatly. Most CPS s (and their supervisors) anticipated that CPS s would stay in their current position at least one year or more. Positive results: CPS s and supervisors are satisfied with the Peer Support Specialist roles. Most supervisors indicated they would like to expand the use of Peer Support services in their agency. CPS s and their supervisors indicated that CPS s are respected at their agency. Supervisors saw respect for CPS s increasing over time, with more respect coming from other staff with the most contact with the CPS staff. Peer Support was credited with helping people receiving services to be more receptive to help from other staff (therapists, etc.) Opportunities for Change: Both CPS s and supervisors expressed a need for more training in all areas. Almost all CPS s were interested in more training in Crisis Intervention, including legal procedures such as 302, etc. Several supervisors commented that CPS s trained in the first class were not as well equipped as those in the later class. They felt that both the training and the interview process used to identify candidates were now more effective. Refresher training was suggested for CPS s from the first class. Supervisors sometimes expressed concern with CPS s staff s own recovery. One supervisor suggested that a WRAP Plan be in place for all CPS s and that training emphasize self-care. Page 26

29 3. Crisis Services - Crisis services are mandated as part of the Mental Health and Mental Retardation Act of They are designed to provide a rapid response to crisis situations which threaten the well-being of an individual or others. In many cases, crisis services provide the entrance into the behavioral health system and necessary support services. Crisis services encompass an array of services ranging from site-based to mobile capability. In keeping with OMHSAS goal of improving crisis intervention services, Bucks County has created a crisis workgroup to look at the current delivery of crisis services and provide recommendations to improve upon it. Stakeholder membership includes MH and D&A staff, consumer and family members, police, and providers of crisis services. We will also be looking at ways to maximize our current county allocation in conjunction with HealthChoices funds to develop a more recovery oriented system of crisis services. Objectives: Obtain information from various stakeholders (people who have utilized crisis services, family members, treatment providers, law enforcement, and crisis service providers) as to the helpfulness, gaps, effectiveness, and areas for improvement. We will be utilizing a survey process through Voice and Vision s CFST as well as public forums. Explore the differences in site-based versus mobile services. Examine the components of crisis services to determine if current allocations could be redistributed. Examine current relationships with hospitals and the supports that need to be available. Ensure that both mental health and drug and alcohol crises are addressed. The purpose of enhancing and developing an appropriate continuum of crisis services is to improve intervention services and create service options that will support individuals in order to minimize the need for inpatient hospitalization and divert individuals from the criminal justice system. Voice and Vision was secured to conduct electronic and paper surveys for a wide stakeholder representation including: Individuals who have accessed crisis services This was a month-long process in which paper surveys were provided to individuals during the intake process at our core MH and D&A providers. A focus group was also conducted by Voice and Vision for a small consumer group. Page 27

30 Family members An advertised focus group was held during a NAMI meeting that was well attended. A survey monkey was also distributed electronically to NAMI s list serve. CIT police officers A survey monkey was distributed electronically to Bucks County s officers who are CIT trained. Treatment provider staff A survey monkey was distributed electronically to Bucks County s core MH and D&A providers. Crisis centers staff A focus group was held for crisis directors. A survey monkey was also distributed electronically to all crisis staff. The focus groups were held once for four of the five stakeholder groups. The survey monkeys and paper surveys were completed during a one-month time period. Information was gathered and collated by Voice and Vision and reviewed by the Crisis Initiative Workgroup. There were many strengths that were identified through the survey process of the current crisis system including staff s approach and the support that is offered at difficult times. There were also many opportunities for change identified. The most significant area for improvement was communication. This issue was evident in all the stakeholder groups that were surveyed including family members. Examples include providing information regarding evaluation and recommendations to treatment providers and family members as well as the need for better aftercare follow-up. Additional recommendations for improvement include comprehensive discharge plans and better access to MH and D&A inpatient facilities when needed. Bucks County is proposing a transformation of our existing crisis service with the intended outcome of reducing mental health and substance use hospitalizations, improving quality, embedding peer support, and reducing recidivism by offering consumers more choice in the support options that are available. Services will be dedicated to serving consumers where they are and assuring that they leave with a concrete plan for managing future crisis situations, monitoring wellness, and interventions to prevent future crisis situations. It is our intent to move from the traditional medical model to an environment that will be completely voluntary, warm, and welcoming. Staff will be trained on traditional referral sources as well as how to access natural community and family supports. Individuals will have the ability to move throughout the various levels of service, based on his/her need at any given time. Peer Support will be a fundamental element in the transformation of crisis performing the role of supporting an individual upon arrival to Page 28

31 understand the process and providing the person with some internal resources through modeling. We anticipate that an environment that is more calming and welcoming will have a direct impact on reducing the number of involuntary commitments. Services will include peer engagement, referral to natural and other supports, assessment, education as to the process that s occurring and encouragement. A critical element to Bucks County s crisis continuum of services will include a Crisis Residential program. Services will include medication management, crisis counseling, crisis safety planning, peer support, WRAP, and the support of an individual s MH Advance Directive. It will also have nursing capability to provide physical health assessments, blood draws, urine screens, and breathalyzers. The crisis residence will be a voluntary, non-locked program. While it will focus on stabilization and inpatient diversion, it will also aim to create an opportunity for consumers to begin identifying strengths and resources that lead to recovery and resiliency. The goal for consumers using this service is crisis stabilization and quality discharge planning to decrease future crises. Our vision for Bucks County s crisis system includes site-based services but also relies heavily on a more mobile approach, accessing community-based resources, fully imbedding peers and ensuring that the individual is connected to necessary supports in order to avoid the need for future crisis interventions. 4. Behavioral Health and Physical Health Coordination HCHC is an initiative aimed at improving the health status of individuals living with SMI. Multiple studies have shown that on average, individuals living with SMI can be expected to live up to 25 fewer years than the general public. The apparent reasons for this include poor access to effective healthcare, poverty, smoking, lack of exercise, and other lifestyle issues. There has long been recognition of the importance of addressing the healthcare needs of individuals, in part by ensuring effective communication and coordination between physical health (PH) and behavioral health (BH) systems and providers. At the same time, actual healthcare delivery has seldom met those expectations, though doing so has remained a priority of the Pennsylvania Department of Public Welfare (PDPW), the office responsible for the oversight and management of services funded though the Medicaid program in the State. In 2008, the Center for Health Care Strategies (CHCS) launched a multistate, national effort to improve quality and reduce expenditures for Medicaid beneficiaries with complex medical and behavioral health needs. Pennsylvania was among the states selected to participate in the effort. As an element of the State s effort, Keystone Mercy Health Plan, Bucks, Page 29

32 Montgomery, and Delaware Counties, along with their behavioral health subcontractor, MBH, began a pilot initiative HCHC. The initiative provides a unique opportunity to achieve better outcomes for individuals by testing new approaches to improving access to healthcare, integrating physical and behavioral healthcare, and promoting more healthy lifestyles, while at the same time reducing costs associated with the use of emergency, inpatient, and other acute services. Members who participate in this initiative are assigned staff (navigators) who encourage members to complete PH/BH evaluations, coordinate care across BH/PH systems, advocate for individual perspective/preference, provide clinical guidance, and establish a wellness plan with members based on members health interests and needs. Smoking cessation and outcomes related to reducing risk factors associated with metabolic syndrome (i.e. weight reduction through improved nutrition and increased exercise) have been major areas of wellness focus. Objectives: Increase coordination between behavioral healthcare and physical healthcare. CM HealthChoices rates will be increased to support the continuation of the HCHC pilot project. The navigators will identify training topics that support the BH/PH collaboration. Peers will be trained (e.g. through Magellan s Peer Whole Health program) in order to assist individuals in participating in the HCHC initiative. In July of 2011, the official HealthChoices/Health Connections (HCHC) study came to a close. Although Bucks County agencies continue to employee Nurse Navigators, collaborative efforts with our physical health partner (Keystone) is now limited as the member consent to exchange information has officially expired. Bucks County and the other project partners (Delaware County, Montgomery County, and MBH) continue to pursue efforts aimed at improving physical health / behavioral health coordination of care. We are in conversations with all of the Southeastern Pennsylvania Physical Health HealthChoices Managed Care organizations (including Keystone) and the Department of Public Welfare (DPW) to identify interventions around health information sharing and tobacco cessation interventions that would support access to care for individuals who receive behavioral health services. The official study results are expected to be published this year; however, Bucks County is performing its own HCHC evaluation. The Page 30

33 official study includes members that qualified but may not have consented, and therefore, did not have access to all coordination efforts. We are currently surveying HCHC consented members that have been engaged in services for more than six months. We are also collecting claims utilization information. We anticipate publishing the unofficial study results and analysis of consented members within CY As mentioned earlier in this document, it is a requirement of the Adult Outpatient Initiative that each of the providers identify a staff member to attend the UMDNJ training to become a certified tobacco specialist. Several of our agencies have chosen the HCHC nurse navigator for this training. The nurse navigators have identified tobacco cessation as one of the top concerns for consumers with which they are engaged. We will work this year to identify barriers to access tobacco services and will engage DPW and the Physical Health Managed Care Organizations in these efforts. We will also embrace the inclusion peer of support personnel in tobacco cessation treatment options. Below are the results of Voice and Vision s survey regarding the HCHC project. Preliminary results look positive and support Bucks County s efforts to coordinate behavioral health and physical health care. Purpose To assess whether the Health Choices Health Connection (HCHC) initiative is making a difference in people s health/life. Methodology 118 people who had been an active part of the HCHC initiative for 6 months were identified. Nurse navigators were given a survey in an envelope with each person s name and were asked to distribute the survey to each individual when they met with them during January and February Nurse navigators asked people to complete the survey at the time of their meeting if at all possible. A survey lock box was provided to assure anonymity of survey responses. 49 people (15 men and 34 women) completed a survey. 42 out of 48 respondents indicated that they had a personal care physician (PCP) prior to beginning the HCHC program. 100% of the respondents reported having a PCP currently. Page 31

34 Selected results are presented using signal reporting, wherein green represents a Strength, red Opportunities for Change, and yellow neither Strength nor Opportunity for Change. Responses to open-ended questions on the survey appear in graph form on the signal report. A Comment report listing all responses to open-ended questions and a histogram detailing all responses to closed-ended questions is available upon request. Breakdowns of data by various variables can be provided upon request as well. HCHC Survey Highlights Signal Reporting Key Strength: At least 80% of respondents responded positively to the question... Neither Strength nor Opportunity for Change: Less than 80% and 60% or greater positive response... Opportunity for Change: Less than 60% positive response... Positives: Many people reported improvement in their health. Comments indicated that the nurse navigators assisted people to improve their health with education, support, and practical help All respondents reported that they currently had a PCP. 87% of respondents indicated that they met with the nurse navigator enough. Opportunities for Change: Approximately 25% of people who had an ER visit and 50% of people who had a hospitalization reported that the navigator helped them connect to follow up services. o When people connected with the navigator themselves when experiencing hospitalization or ER visits, navigators were able to be more helpful. o Formerly, case managers were able to notify navigators of hospitalizations/er visits; because case managers are no longer notified, they are unable to pass this information on to the navigators. Because many of the sample who did not complete a survey were those who did not come in as scheduled, there is a possibility that these people may have a different experience than those who did come in. 50% or more reported weight gain and pain as their health problems. Page 32

35 Provider # respondents Demographics # possible at provider % responding at provider % of total responding Aldie % 12% Family Services Assoc % 14% Lenape Valley % 31% Foundation Northwestern Human % 10% Services Penn Foundation* % 12% Penndel Mental Health % 20% Total % 100% *Many Penn Foundation HCHC participants who have been seen for six months or more meet with the navigator less than once every two months; they therefore were not given a survey. Respondent Age Range # Respondents % of Total Respondents % % % % 5 people indicated they had no health problems. Others reported experiencing the following health problems: (question 8) Weight Pain Arthritis High BP Lung Dis Hep C Diabetes Heart Dis Liver Dis Thyroid Dis Cancer HIV/Aids Page 33

36 Overall Satisfaction/Outcomes How would you rate your overall health before becoming involved with HCHC? (question 11) Poor Fair Good Very good Excellent How would you rate your overall health now? (question 12) Poor Fair Good Very good Excellent Since meeting with the nurse navigator, people described their overall health as: (question 23) Much Better A Little Better About the Same A Little Worse Much Worse Page 34

37 43 people indicated they had a plan to improve their physical health/wellness. 1 person reported not having a plan; 4 reported that they didn t need to improve their health. Those with a plan indicated the following about their ability to follow the plan: (question 16) Yes Somewhat No PCP/Behavioral Health Coordination Respondents reported the following regarding the coordination of their physical and behavioral health care: Yes/somewhat No Not sure Don t need/want They currently have a PCP 49 (100%) PCP knows they are seeing BH provider 33 (70%) 6 (13%) 8 (17%) --- PCP & BH provider confer about their care 15 (31%) 12 (24%) 17 (35%) 5 (10%) Nurse Navigator helped them connect w/pcp 22 (45%) 15 (31%) 3 (6%) 9 (18%) Experience with Nurse Navigator Respondents indicated that the nurse navigator helped them a lot or somewhat with the following: 18. Learn importance of seeing a PCP at least once/yr (39/41) 95% 19. Educate about them physical health conditions (43/46) 93% 20. Understand their medication (43/46) 93% 21. Create a wellness plan based on THEIR goals (45/47) 96% 22. *Connect them to a psychiatrist for a thorough psych eval (30/32) 94% *16 people indicated that connecting to a psychiatrist for psych eval was not applicable ; they are not included in the percentage. Page 35

38 In the last 3 months, how often was there contact with the nurse navigator? (question 13) 1-2 times 3-4 times 5 or more times People meet or talk to the nurse navigator*. (question 24) Too little Too much Enough *1/3 of people responding too little vs. 2/3 of people responding enough indicated they had not experienced hospitalization/er visits. 19 people reported being hospitalized and 20 reported going to an emergency room while involved with HCHC. (4 people were unsure if the nurse navigator helped with follow-up services after an ER visit.) People were asked: Did the Nurse Navigator help them connect to followup services after discharge? (questions 14, 15) Hospital ER Yes/Somewhat No Page 36

39 Q10: Please explain how Nurse Navigator is helping you address physical health problems Support/motivation Education Practical help Miscellaneous Experience with Nurse Navigator (con t) Q17: How does the nurse navigator help you follow your health/wellness plan? Support/motivation Education Practical help Miscellaneous Q25: Please share how meeting with your navigator has been helpful to your overall health and wellness Support/motivation Education Practical help Better quality of life Miscellaneous Page 37

40 Q26: Are there any physical health problems that the nurse navigator has not been able to help you with? No Yes Miscellaneous 5. A Transition Age Youth (TAY) work group was developed in 2006 under the auspices of the Children s Coordination Steering Committee (CCSC). The work group engages key stakeholders from both the child and adult service systems in order to assess the development, enhancement, and expansion of critical services for youth with mental health and co-occurring disorders. CASSP in Bucks County has utilized a system of care (SOC) model as the organizational philosophy and framework in creating clinical and natural supports. The SOC model involves partnership across county and private agencies, providers, families, and youth for the purpose of improving access and expanding the array of coordinated communitybased, culturally competent services and supports for children and youth with a serious emotional disturbance and their families. The SOC approach has served as the conceptual and philosophical framework for systemic reform in children s behavioral health. In Bucks County, this is demonstrated through the development of our Integrated Children s Service Plan and the on-going initiatives we have implemented for children, adolescents, and young adults. The intent of CASSP and the CCSC efforts in Bucks has been to build and expand upon the progress achieved in addressing the mental health needs of children, youth, and families. Through collaboration and comprehensive planning with key stakeholders, we strive to utilize resources which reduce the impact of substance abuse and mental illness in our communities. This includes the use of a Mobile Children s Crisis Support, enhanced respite services, High Fidelity Family Teams, enhanced Behavioral Health Rehabilitation Services (BHRS), Blended Case Management, Student Assistance Program (SAP), the Bucks County L.I.F.E. Program, and Multi-Systemic Therapy (MST). Through this integrated approach, we have observed children, youth and families experience both short and long-term benefits, including: improvement in clinical and functional outcomes, reductions in suicide Page 38

41 attempts by youth, improvement in school attendance and performance, reduction in contacts with law enforcement, and reduction of reliance on inpatient/residential Treatment Facilities (RTF) settings for care. Data show that caregivers of children served in well coordinated systems of care experienced reduced strain associated with caring for a child who has a serious mental health condition, more adequate resources, fewer missed days of work, and improvement in overall family functioning. It is our goal to reduce the need for individuals to access intensive treatment services from the adult system, while recognizing that some young adults will benefit from continued services to sustain wellness and recovery. The TAY population requires special consideration and improved coordination of resources to meet their unique needs. Through the TAY work group and MY LIFE, we have developed a structure to evaluate and support the needs of transition age youth. The TAY work group is co-chaired by Magellan s Clinical Officer and the Children s Services Director from the Bucks County Department of MH/DP. The mission of the work group is to enhance the supports and resources available for transition age youth so that their goals are more attainable. The TAY work group membership includes young adults, CPS's, family members, and professionals in the adult and child-serving systems. The TAY work group continues to connect with other systems and community members to bring a wider base of experience and knowledge to the process. This workgroup will be the formal process for identifying the supports that need to be developed in order to support young adults. Since the TAY work group s inception in 2006, formal achievements include the hiring of a system-wide housing specialist, the creation of a TAY ACT Team and the TAY ACT scattered site apartment living program, and the Personal Empowerment and Leadership for Youth train the trainer course in Person-Centered Planning (PCP). PCP is currently available to young adults who enter the TAY ACT program and the Coffeehouse Center, a program for young adults who fall on the Autism Spectrum. We plan to continue formal training in PCP with the goal of increasing awareness of this philosophy and to have additional facilitators available to work with TAY. The TAY work process is grounded in the CASSP and CSP principles, and the goal is to build a continuum of care for TAY in Bucks County that centers on tangible outcomes. Our credo is Believe, Belong, and Become. In 2007, a group, comprised of youth was initiated by the TAY Workgroup and the Bucks County LIFE program. Its purpose was to foster relationships and develop and support a youth panel presentation at the 2008 Annual Resiliency Conference and beyond. This group joined with the TAY group at Voice and Vision in Since that time, Voice and Page 39

42 Vision has supported young adults in developing and presenting skits at the Annual Resiliency Conference, several storytelling ventures to children and teens at a local provider as well as an alternative school. The foundation of a multi-system youth advisory board has been formed comprised of TAY, which will help to inform the system about the desires and needs of youth and young adults in transition. Voice and Vision also conducted focus groups with young adults in 2007, 2009 and The data has been used for various county initiatives and to help shape training. We have assisted in the expansion of housing resources through the development of the Shared Living/Shared Housing model which provides supports for initial rent costs, the acquisition of furniture and household goods, as well as a venue for the matching of housemates through a formal selection process. This model has highlighted some challenges in serving this population, but we believe this to be a viable model and continue to work towards its success. Members of the TAY Work Group have been involved in on-going efforts specific to transition training and forums. This includes the Post- Secondary EXPO for students with disabilities, a conference for successful transition for individuals on the autism spectrum, hosted at the Bucks County Intermediate Unit, the Employability Expo, and participation in the Bristol Township Collaborative. The TAY Work Group has facilitated a successful forum for all non-clinical service providers in order to bring together constituents from adult and the children s system of care. The forum was developed and lead by youth and family members of the TAY work group in order fully integrate consumers and family members into all of the service planning processes. This provides a framework to respond more sensitively and attentively to young persons who are transitioning to adult services and their families. Objectives: Promote wellness and recovery for youth and young adults. Enhance the system to allow youth and young adults to make their own choices about their lives and their support systems. Create an information exchange on existing resources. Develop mentoring and peer-to-peer opportunities. Design an effective model for service planning. Expand housing resources. Bridge the gap between the adolescent and adult serving systems. Develop better treatment and prevention programs for cooccurring mental health and substance abuse issues. Advocate for improved resources for families and/or other key supports. Page 40

43 Provide support in the following areas: mentoring, promoting higher education, employment, career counseling, housing, and transportation. Support opportunities for youth to learn how to build healthy relationships. Encourage active lifestyles involving community exposure to obtain wellness and independent living skills as a foundation for a more productive and fulfilling life. Continue to develop youth leadership through the MY LIFE project. A Transition Age Youth (TAY) Forum occurred on February 28, 2012 and featured presentations from key adult systems and agencies including OVR, Disabilities Right Network, MBH, and County Mental Health staff. The Bucks County LIFE Program co-sponsored this Forum with the Department. LIFE has continued to demonstrate their interest and commitment to providing support to the TAY and Young Adults (YA) as evidenced by strong partnership on the Work Group, MY LIFE, and the recent hiring of a part-time young adult specialist and a full-time administrative multi-system coordinator to focus on the needs of the TAY population. LIFE s administrative coordinator is currently providing direct support to transition age youth at Interagency Team Planning meetings and school IEPs and plays a pivotal role in the monthly Intensive Complex Case Planning meetings. Other TAY activities include partnering with Bucks County s CPS Training. The TAY workgroup supported some transition age youth in applying and receiving certification and several young adults have obtained employment through several Providers. Additional TAY partnerships have occurred through direct planning and participation in the annual Employability EXPO. The EXPO was held on May 6, 2011 at the Bucks County Intermediate Unit, and volunteers from the TAY workgroup attended/presented information to students. In order to provide culturally relevant behavioral health supports to youth in Bucks County, we have created a part-time peer support specialist position through the Bucks County LIFE Program. This position provides direct support to identified youth at their Individual Support Plan Team and IEP meetings with the goal of enhanced youth participation and to bridge the gap between behavioral health providers by working with both adolescent and adult service providers. We have learned that consumer-driven care is greatly enhanced by the youth s ability to actively engage in the planning process and locate resources and options appropriate to their goals. Page 41

44 Peer to peer support has been offered through Voice and Vision s Family and Youth Outreach Program. The Youth Outreach initiative includes two part-time youth partners who support youth and young adults ages to participate in leadership activities and provide education about community resources and resiliency activities. Youth outreach models healthy relationship development through their on-going advisory council meetings and special social activities. Current plans include the creation and implementation of a Person-Centered Planning initiative and the TAY-YA work group will provide direct support at all phases of the project. A systems-of-care approach to working with the multiple needs of this complex population is the crux of developing our model for transition age youth. The challenges of service delivery for individuals involved in multiple systems continue to be addressed and developing creative solutions is the main focus of the TAY-YA work group. This philosophy is evident in our continued efforts to directly support the goals and direction of the Magellan Youth Leaders Inspiring Future Empowerment (MY LIFE) project. MY LIFE is a youth leadership group consisting of members between the ages of 13 and 23 who have had experience with mental health, substance abuse, juvenile justice, and child welfare related issues. Through regular monthly meetings, special events, local workshops, leadership development, and mentoring, MY LIFE focuses on important issues affecting youth. The model is designed to give youth a voice and an active role in planning and implementing youth and adult systems of care transformation and focus on the following objectives: To assist members in developing leadership skills, social skills, and positive social supports. To assist members to learn, utilize, and teach advocacy skills to help facilitate positive change and become community leaders. To provide opportunities for members to share their experiences and provide hope and inspiration to other youth with similar experiences. To reduce stigma associated with mental health, substance abuse, and/or foster care issues by producing youth-led community events. To effect positive change in the systems that support youth and young adults. Page 42

45 The TAY-YA Work Group was instrumental in the launch of MY LIFE and has continued to be the lead in supporting the monthly meetings. Outcomes for included planning the regional MY FEST event that occurred in September The purpose of MY FEST was to promote youth leadership and awareness as a shared effort with Bucks, Montgomery, and Delaware Counties. The event was successful in bringing over 500 community members to an interactive festival that promoted youth and family resiliency. The TAY-YA Work Group has collaborated with youth, family, and professional partners in developing a TAY-YA reinvestment plan for a specialized housing model. We are proposing a specialized transitional living model that will provide a well-structured therapeutic environment where age appropriate, individualized service plans will be developed to address the needs of young adults ages years old, and if appropriate, the individual s family. The program will focus on enabling the individual to engage in regular activities inside and outside the facility, with support and encouragement to pursue the use of age appropriate community based activities when possible. This will require the recruitment and training of specialty staff that are willing to work with this specific age group. There are two distinct components to this initiative: a three-bed primary residence and a mobile psychiatric rehabilitation service. Additionally, we are developing three slots for an interim living arrangement with a Host Home(s) for the purpose of individualized assessment and structure for older adolescents. We have experienced increased housing needs for adolescents. This requires the identification and development of appropriate resources in the adult system. This model will provide a flexible, natural environment and the opportunity to build confidence, skills, and knowledge in preparing for greater independence. Bucks County has developed a comprehensive Quality Assurance process with full stakeholder participation. Voice and Vision and PRO-ACT have been instrumental in developing surveys for the identified county initiatives, which coincide with the Mental Health Plan transformational priorities. Below is Voice & Vision/PRO-ACT Report that trends the various areas of concentration such as Peer Support, Connection to the Community and Co-occurring from 2006 thru Page 43

46 Voice & Vision/PRO-ACT Annual Survey: TRENDS 2006 to 2010 In 2006, the Voice & Vision C/FST first launched an annual survey addressing core issues at eight major Bucks County Mental Health and/or Drug & Alcohol providers. In 2007, a ninth provider was added and PRO- ACT joined the effort to emphasize the importance of co-occurring issues. This collaborative process continued through Survey Methodology: Annual Survey questionnaires were developed collaboratively each year by Voice & Vision and PRO-ACT with input from staff at Bucks County Mental Health, the Bucks County Behavioral Health System, Magellan Health Services, providers, service recipients and family members. During each of the Annual Survey years, persons 14 and older who received services (or family members of children/adolescents under 18) at nine Bucks County providers of Mental Health and/or Drug & Alcohol services were provided an opportunity to complete a written survey. Locked boxes were placed at each provider for one week in spring to collect surveys in order to assure anonymity. The following number of people completed surveys each year: 2006: : : : 1, : 825 Results were presented using signal reporting, wherein green represents a Strength (at least 80% of respondents responded positively to the question); red, Opportunities for Change (less than 60% responded positively to the question); and yellow, neither Strength nor Opportunity for Change (less than 80% and more than 60% responded positively to the question). NA responses were considered null and were not included in percentages. Survey responses provided an indication of recipient and family attitudes towards services. Results were used to identify provider/system strengths and opportunities for change in order to improve practice and were not intended to judge provider effectiveness. Survey data was presented in written reports to County agencies and to each individual provider. Plan of Action meetings were held with each provider to discuss the data and develop action steps in response to one Strength and two Opportunities for Change highlighted by the data. Page 44

47 Survey Outcomes: The Annual Survey process resulted in several positive aspects: Due to the large number of responses across the major providers, the data was given more weight by stakeholders and drew the attention of CEOs and County administrators. Data was able to be reported for each provider that was used by the County and BHS for provider profiling. The aggregate report of the data enabled the Bucks County Quality Management Workgroup to analyze and address systemic trends. Recognizing commonalities across providers enabled the identification of training needs. Many providers included service recipients and family members in the Plan of Action process in response to the survey data. The Plan of Action process often resulted in thoughtful and creative responses to the survey data. Several examples include: o One provider created an intra-agency booklet about the various services available at their agency and which included stories from people who had received those services. o The Bucks County Behavioral Health System sponsored a Family Outreach Center to address the need of families to connect to resources in the community. o Survey data and comments were communicated at various training initiatives. o Many providers have incorporated Crisis plans that emphasize prevention into their service provision. Annual Survey Trends: In lieu of an annual survey in 2011, C/FST reviewed the data from the Annual Surveys over these years. Several factors impacted on the attempt to trend the data: Although all surveys addressed consistent categories, questions did not remain constant from year to year. The same people were not interviewed each year, so changes in response may have reflected a random difference in the population rather than a difference in result. There were varying response rates at individual providers from year to year; when aggregating the results, this could affect the change in results, especially since there were significant differences in the types of services offered by the various providers. Despite these difficulties, we believe some conclusions can be deduced from the Annual Survey data. Based on the advice of our research consultant, we identified broad topic areas and selected the questions from each year, which were most closely linked to each core topic area. The Page 45

48 accompanying tables illustrate these results. A brief discussion/summary of each topic area is provided. Survey Trends by Topic Area: PEER SUPPORT: While the numbers below show a consistent middle of the road result, the aggregate obscures the difference between D&A and MH providers. On these measures, D&A providers score much higher, most likely as a result of their emphasis on participation in 12-step groups. All D&A providers scored above 80% in 2010, while MH providers scored from 50% to 74%. Referrals to other programs, community supports, or self-help groups <provider> helps connect me to others with similar life situations for support <provider> encourages me to use peer run programs (ex: AA, Al-a-teen, Al-Anon and other 12-step groups, support groups, drop-in centers, NAMI, etc.) <provider> helps to connect me to people with similar experiences for support (ex: support groups, NAMI, AA, Al-Anon, etc.) My plan helps connect me to people with similar experiences for support (ex: 12 Step Programs, Peer Specialists, NAMI, AA, NA, Al-Anon, support groups, etc.) % 69% 72% 66% 77% 73% CONNECTION TO COMMUNITY & MEANINGFUL ACTIVITIES: This continues to be an area of emphasis for County agencies. Responses and input from providers and staff surveys indicate that this is an area with which providers struggle. Also, open-ended responses from consumers and families suggest that both providers and people/families receiving services often interpret connection to community to mean connection to other service providers. Connection to Community: Referrals to other programs, community supports, or selfhelp groups (Provider) helps coordinate my treatment with other services/supports <provider> helps connect me to others with similar life situations for support My services at <provider> are coordinated with my other supports in the community (school, church, mentors, welfare, housing, medical providers, other MH/D&A providers) My plan includes ways to connect to resources in my community (activities, organizations, faith communities, etc.) 61% 78% 69% 61% 74% 74% Page 46

49 Meaningful Activities: Provider helps me to use my strengths to connect with 69% activities that are meaningful to me Provider helps me use the things I am good at to connect 63% with activities that are meaningful to me. Provider helps me to connect with activities that are 75% meaningful to me My plan includes my strengths to help me reach my goals 84% TREATMENT PLAN/INCLUSION: This is consistently an area of strength. People report being involved in creating their treatment plans My opinions and ideas are included in my treatment/service plan 93% My treatment/support plan at <provider> includes goals I suggest 76% I am included in making my treatment/support plan 78% 87% <provider> helps me make a clear plan to reach my own recovery goals 87% The goals in my treatment/support plan are ones I have chosen 80% My plan helps me reach out to people I care about who can help me reach my goals 82% My plan includes actions I can take to regain stability when I am experiencing a MH/D&A crisis situation 84% HOPE: Respondents at D&A providers expressed more hope for the future than those at MH providers. Also, responses differed according to the emphasis of the question. When asked about their personal feeling of hopefulness, responses were more positive than when asked to rate the provider s impact on hope. In 2010, to drill down further on the area of hope, people were asked an open-ended question about what hopes/dreams for the future with which they wanted their provider to assist them. Top on the list was their mental health/sobriety; after that, people wanted help with jobs, relationships, education, a meaningful life, autonomy, and housing, in that order. This concurs with C/FST findings on multiple surveys throughout the years; people consistently express the desire for the ordinary things of life. Giving you hope that you will recover from your situation I feel hopeful about my future At <provider> there is an environment of hope % Openended 68% 72% 81% Openended 70% Openended CO-OCCURRING: The trend in this area is ambiguous, particularly because the results vary greatly among individual providers. However, a closer look Page 47

50 at survey responses suggest that D&A providers address MH issues overall more than MH providers address D&A issues during treatment. Responses from the 2010 survey, which drilled down on providers ability to address various issues, indicated that when people shared concerns with the provider their co-occurring issues were addressed The ability of staff to address co-occurring disorders 56% <provider> is able to address both my MH and D&A 83% treatment needs I am given the help I need to understand my MH and/or 79% D&A issues At MH providers: people indicated their D&A symptoms were being addressed (excludes Penn Foundation 51% Recovery Center respondents) At D&A providers: people indicated their MH symptoms were being addressed (includes Penn Foundation 75% Recovery Center respondents) At MH providers: people indicated their D&A issues were being addressed (excludes Penn Foundation 60% Recovery Center respondents) At D&A providers: people indicated their MH issues were being addressed (includes Penn Foundation 76% Recovery Center respondents) STAFF ISSUES: This continues to be an area of great strength. In both closed and open-ended responses, people affirm the helpfulness of provider staff in their recovery. The lower positive responses in 2007 and 2008 were due to responses at an adolescent facility; that provider addressed the issues and positive responses were noted in Courteousness of staff 86% The way staff explained your rights to you 81% I am treated with dignity and respect 94% Staff really listen to me 87% 87% 87% Staff treat me with respect 88% 91% 88% Staff treat me as an equal partner 81% 82% 81% Staff do not raise their voice/use foul language (are not verbally abusive) 74% 88% 95% Staff are not judgmental 71% 73% 89% Staff do not use threats 84% 91% 96% There is at least one staff person at <provider> that you can trust to talk to about anything that affects your 97% recovery journey? Page 48

51 Attachment A County Program FY County Plan Attachment A Page 49

52 Attachment B County Program FY County Plan Attachment B Page 50

53 Attachment C County Program Penndel Mental Health Center Programs for Assistance for Transitioning from Homelessness Intended Use Plan Provide a brief description of the provider organization receiving PATH funds including name, type of organization, services provided by the organization and region served. The current funded agency is the Penndel Mental Health Center (PMHC), a nonprofit agency that provides mental health services to consumers who reside in the southern region of the county. The services provided include residential housing for individuals who are diagnosed with severe and persistent mental illness, outpatient, partial hospitalization treatment, and targeted case management services. Bucks County is located in Southeastern Pennsylvania. The PATH program works with adults over the age of 18, many of whom are literally homeless or in danger of becoming homeless. 2. Indicate the amount of PATH Federal and match (i.e. State and Local) funds the organization will receive. The PATH program will receive $46, in federal funds for fiscal year The above represents 25% of the total budget for PATH that is currently $189, The balance of these funds comes from state, county, and local funds. 3. Describe the organization's plan to provide coordinated and comprehensive services to eligible PATH clients, including: a) The projected number of clients to be contacted using PATH funds. b) Projected number of adults to be enrolled using PATH funds. c) The percentage of adult clients served with PATH funds who are projected to be literally homeless (i.e., living outdoors or in an emergency shelter rather than at imminent risk of homelessness). d) Activities to maximize the use of PATH funds to serve adults who are literally homeless as a priority population. Attachment C Page 51

54 e) Strategies that will be used to target PATH funds for street outreach and case management as priority services. f) Activities that will be implemented to facilitate migration of PATH data into HMIS within 3-5 years. g) Indicate whether the provider provides, pays for, or otherwise supports evidenced-based practices and other training for local PATH funded staff. h) Indicate whether the provider provides, pays for, or otherwise support HMIS training and activities to migrate PATH data into HMIS i) Community organizations that provide key services (e.g., primary health, mental health, substance abuse, housing, employment) to PATH eligible clients and describe the coordination activities and policies with those organizations. j) Gaps in the current service systems. k) Services available for clients who have both a serious mental illness and substance use disorder. l) Strategies for making suitable housing available to PATH clients (i.e., indicate the type of housing usually provided and the name of the agency that provides such housing). A. The projected number of clients to be contacted using PATH funds. The projected number of clients to be contacted by PATH workers in fiscal year 2012 is 300. B. Projected number of adults to be enrolled using PATH funds. We expect to enroll 100 to 150 clients (33% to 50%) of the clients contacted. C. The percentage of adult clients served with PATH funds who are projected to be literally homeless (i.e., living outdoors or in an emergency shelter rather than being at imminent risk of homelessness). We expect about 50 individuals (approximately 30%) to present as literally homeless. D. Activities to maximize the use of PATH funds to serve adults who are literally homeless as a priority population. Attachment C Page 52

55 Serving adults who are literally homeless in Bucks County can be challenging. Unlike in an urban environment where the homeless may be visible, Bucks County is largely rural. Often the homeless may be living in their cars, in encampments in the woods, in abandoned buildings, etc. One of the biggest challenges faced in the PATH program is identifying the places where the homeless congregate and having individuals avail themselves of the services PATH can provide. The PATH program utilizes several strategies and activities designed to help the program identify individuals who are homeless in the county and inform them about the PATH program. These strategies are close collaboration with other agencies/programs that target the impoverished; production of flyers, brochures, and information cards that are distributed to community centers, mental health providers, shelters, etc.; and participation in the annual Bucks County Unsheltered Homeless Point in Time count. With regard to collaboration with other social service providers, PATH works very closely with the Bucks County Emergency Shelter and does daily outreach to individuals who may be experiencing mental illness. PATH also collaborates with Advocates for the Homeless and Those in Need (AHTN), which is a faith based community action organization, that has used their churches to host dinners and emergency shelter during cold nights during the winter season. PATH has been able to have a case worker at the majority of the Code Blue sites that have been hosted and makes contact with shelter guests for outreach and case management. AHTN also has a Homeless Outreach Team (HOT), and it was through this team that PATH was introduced to several encampments in the area and was able to engage many individuals. PATH has also partnered with the Synergy Project which focuses on homeless youth as well as the Sunday Breakfast Mission that has a Bucks County Outreach Specialist. As mentioned previously, PATH has produced a number of flyers, brochures, and information cards which are distributed throughout the community. It is anticipated that PATH will be able to produce an online website and perhaps use social media to promote PATH information and activities to an even broader audience. PATH has also participated in the Bucks County annual Unsheltered Homeless Point in Time Count on January 26, This is the fourth year that PATH has participated in the count. This past year the unsheltered homeless count was 50 individuals countywide. The PATH Program is included on the Point in Time Resource Guide that is provided to those who are identified during the count. There was also coverage in local newspapers that helped inform the community about homelessness and the resources that are available. Attachment C Page 53

56 E. Strategies that will be used to target PATH funds for street outreach and case management as priority services. Again, collaboration is key in providing services. Partnering with other agencies has allowed us entrée into several homeless encampments of which we would not have otherwise been aware. PATH has continued to do in reach to various agencies, presenting on what services the PATH program provides. These presentations have enabled PATH to maximize efforts in educating the community about PATH services. This communication, in turn, has helped identify individuals who might otherwise have fallen between the cracks. PATH is then able to reach out to individuals and engage them in services. Once individuals are identified, the PATH team can provide services such as linkage to emergency housing, assistance in acquiring benefits (social security, health insurance, subsidized housing), debt counseling, and obtaining medications. PATH team workers also assist individuals in linking to needed clinical services such as mental health and substance abuse treatment. In addition to the above, PATH funded services include: Screening and diagnostic treatment Habilitation and rehabilitation Staff training Case management Referrals for primary care health services, job training, educational services, and relevant housing services. Supportive and supervisory services in residential settings. Housing services including: o Minor renovation, expansion, and repair of housing o Planning for housing options o Technical assistance in applying for housing o Improving the coordination of housing o Security deposits o Costs associated with matching eligible homeless individuals with appropriate housing situations. o One time rental payments to prevent eviction F. Activities that will be implemented to facilitate migration of PATH data into HMIS within 3-5 years. The PATH program is working with Bucks County MH/DP to migrate PATH data into the HMIS within the designated timeframe. The Pennsylvania Department of Community and Economic Development (DCED) is the HMIS system provider for Bucks County and is able to provide online training to those county agencies that participate in HMIS data entry. The Bucks County Office of Community and Business Development (OCBD) also provides support in the form of local trainings at no cost to participating agencies. Attachment C Page 54

57 G. Indicate whether the provider, pays for, or otherwise supports evidenced-based practices and other training for local PATH funded staff. PATH workers are required to have 20 hours of practice-based training annually. This training may include evidenced-based trainings in areas such as cultural competence, trauma informed care, co-occurring disorders, supported employment, and motivational interviewing. PMHC provides funding for these trainings. This year the PATH Program will be consulting with staff of Bucks County Behavioral Health System and the Bucks County Drug and Alcohol Commission to assist the PATH Program to identify training related to the enhancement of practice based skills and the identification of additional resources to address co-occurring mental illness and substance abuse disorders. H. Indicate whether the provider provides, pays for, or otherwise supports HMIS training and activities to migrate PATH data into HMIS. HMIS training is provided to PMHC as the PATH provider at no cost by the Pennsylvania DCED and the OCBD. I. Community organizations that provide key services (e.g., primary health, mental health, substance abuse, housing, employment) to PATH eligible clients and describe the coordination activities and policies with those organizations. The community organizations that provide key services to eligible PATH clients are as follows: Mental Health Services PMHC housing, residential, outpatient, partial hospitalization, psychiatric rehabilitation, case management, crisis intervention. Northwestern Human Services of Bucks County housing, residential, case management services. Lenape Valley Foundation housing, residential, outpatient, partial hospitalization, psychiatric rehabilitation, case management, crisis intervention, Acute Respite Care Program. Penn Foundation Village of Hope MH/D&A residential program. Family Services Association mental health treatment, case management, housing for consumers who have HIV. Brooke Glen Hospital inpatient psychiatric services. Horsham Clinic inpatient psychiatric services. Aria Hospital inpatient psychiatric services. Lower Bucks Hospital inpatient psychiatric services. St. Luke s Hospital inpatient psychiatric services Montgomery County Emergency Services inpatient psychiatric services Attachment C Page 55

58 Housing and Shelter Bucks County Emergency Shelter shelter services. Trenton Rescue Mission shelter services Missionaries of Charity homeless Shelter A Woman s Place shelter for battered or abused women Days Inn Motel emergency housing YWCA shared housing program Bucks County Housing Group shared living program Penndel Mental Health Center PATH Shelter Plus Care Program (2010) Framar Boarding House Bucks County Housing Authority subsidized housing. Lenape Valley Foundation FOR Program The Bucks County Housing Group shared living program Lenape Valley Foundation Acute Respite Care Program Comans, Inc. housing and residential services. Cedar House drug and alcohol recovery house. The Next Step drug and alcohol recovery house New Path Recovery, Inc. Sunday Breakfast Mission Interfaith Housing Development Corp. Advocates for the Homeless and Those in Need Substance Abuse Treatment Bucks County Drug and Alcohol Commission Aldie counseling and treatment Livengrin counseling and treatment Penn Foundation Village of Hope co-occurring mental health and substance abuse disorders residential program The Southern Bucks County Recovery Center (A Pro-Act Recovery Community Center education, information, support, and socialization Other Community Agencies and Programs Bucks County Area Agency on Aging case management Bucks County Assistance Office (Bristol) cash assistance, medical insurance, food stamps. Bucks County Opportunity Council heating and utility assistance, housing/rental assistance Bucks County Children and Youth child protection and advocacy Salvation Army community action agency Catholic Social Services community action agency Center for Independent Living Reach Out Foundation self help group for those suffering from mental illness Attachment C Page 56

59 Social Security Administration Veteran s Assistance Program Bucks County Correctional Facility correctional mental health services Bucks County Adult Probation and Parole The PATH program works in collaboration with the above providers to ensure continuity and coordination of care and services for individuals who are homeless. PATH has forged strong relationships with the above providers and communicates with them regularly when working with an individual. The PATH outreach workers not only provide direct services to the individual but also provide technical assistance and consultation to the provider agencies. J. Gaps in the current service system. The lack of affordable housing in the County is a major issue for individuals we serve. Even when they have a decent income, they are often priced out of the current housing market, and the availability of subsidized housing is not nearly enough to meet the needs of individuals we serve. In terms of housing for individuals with co-occurring mental health and substance abuse disorders, we continue to utilize recovery houses. Although they have been a great resource, they often cannot accommodate individuals who present with more severe psychiatric challenges. Additionally, the Penn Foundation Village of Hope Program also provides housing and residential supports to those with cooccurring mental health and substance abuse disorders, but it is located in the Northern part of Bucks County. The most difficult challenge we encounter is providing services to individual who are released from the criminal justice system with sex offence crimes. There is limited treatment or housing resources available for individuals who have been charged with these crimes. K. Integrated services available for clients who have both a serious mental illness and substance abuse disorder. PATH refers individuals who may be in need of drug and alcohol rehabilitation to Aldie or Livengrin for assessment. Aldie and Livengrin also have outpatient programs that are available to individuals served through PATH. PATH will also refer individuals in need of supported housing to the Village of Hope program, which provides housing and residential support services to individuals who are homeless and who are diagnosed with co-occurring mental health and substance abuse disorders. The PATH Program will continue to explore the availability of additional housing and rehabilitative resources for this population. L. Describe strategies for making suitable housing available to PATH clients (e.g., indicate the type of housing usually provided and the name of the agency that provides such housing). Attachment C Page 57

60 PATH begins with an assessment of an individual s strengths and needs. We try to get a feel for where they would do well in addition to trying to meet their stated preferences. In an emergent housing situation, the PATH worker will try to place the consumer in an emergency shelter or provide funding to prevent an eviction from occurring. Sometimes a motel may be utilized for a few days as a bridge from one housing situation to another. Once an individual is established in stable housing, the PATH worker will help the individual organize required paperwork and verifications, such as a birth certificate, social security card, and photo identification and assist him/her to apply for health insurance, food stamps, cash assistance, etc. The PATH worker will also identify housing resources that may be available and assist him/her to apply to these programs. At this juncture, PATH will begin looking at more permanent housing options with the individual. The individual s personal preferences as well as their financial resources, ability to live independently, substance abuse issues, etc. play a role in the type of housing that is available. If the individual needs a more supportive housing option, PATH will make referrals to Community Residential Rehabilitation Services (CRRs) or Supported Living Programs (SLPs). If the individual is able to live more independently, an option such as Bucks County Housing Group s Shared Housing Program, in which an individual will share an apartment with another in order to cover the rental costs, may be an appropriate resource. PATH also makes referrals to the extensive network of recovery houses in the area for those individuals who are diagnosed with mental health and co-occurring substance abuse disorders. Agencies and providers that are primary sources of housing for PATH are: The Bucks County Emergency Shelter The Lenape Valley Foundation Acute Respite Care Program The Penn Foundation Village of Hope MH/DA Supported Living Program Cedar House (Recovery House) Penndel Mental Health Center s HUD II Program COMANS Residential Program (Community Residential Rehabilitation Services (CRRS) and Supported living program (SLP) Northwestern Human Services Residential Program (CRRS and SLP) Days Inn Motel Emergency Placement Village Lodge Motel Emergency Placement Bucks County Housing Group Shared Living Program Woodview Terrace Personal Care Boarding Home Sunday Breakfast Rescue Mission 4. Describe the participation of PATH local providers in the HUD Continuum of Care program and any other local planning, coordinating or assessment activities. PATH is a participant in the Homelessness Continuum of Care Committee for Bucks County (HCOCBC) and is represented on the Local Housing Option Team Attachment C Page 58

61 (LHOT) that is a subcommittee of the HCOCBC. The HCOCBC is comprised of providers such as the Bucks County Emergency Shelter, government agencies, consumers, and representatives from other agencies that touch the lives of the homeless in Bucks County. Through the HCOCBC and the LHOT, the PATH program contributes to the formulation of the Mental Health Housing Plan and has also provided input on the use of reinvestment dollars to fund new housing initiatives. The LHOT also reviews the PATH Intended Use Plan and provides feedback relative to any pertinent revisions. PATH case managers also attend the bimonthly the Bucks County Direct Services Coalition (DSC) meetings. The DSC is comprised of direct care workers from a variety of human service agencies that work with the homeless who meet to discuss issues surrounding housing and homelessness in Bucks County. 5. Describe: (a) the demographics of the client population; (b) the demographics of the staff serving the clients; (c) how staff providing services to the target population will be sensitive to age; gender and racial/ethnics differences of clients; and (d) the extent to which staff receive periodic training in cultural competence. The PATH Annual Report Survey for FY 2011 indicates that 79% of the Bucks County individuals who were served are Caucasian, 14% of the individuals served are Black or African-American, 3% of those served are Hispanic or Latino. In terms of the types of mental illnesses PATH clients experienced: 74% have an affective disorders, 15% have schizophrenia related disorders, and 8% have other psychotic disorders or other serious mental illness. 57% of PATH clients have a co-occurring mental illness and substance abuse disorder. In terms of age, 70% of individuals are between the ages of 18 and 49; 29% are The staffing of the PATH program is consistent with the above demographics, and is comprised of a 75 year old Caucasian male, a 53 year old African American male, and a 28 year old Caucasian male. In keeping with the policies of PMHC, all individuals are treated with dignity and respect. Staff regularly attends trainings that focus issues related to evidenced-based practices including trainings emphasizing cultural competence. 6. Describe how persons who are homeless and have serious mental illnesses and family members will be involved at the organizational level in the planning, implementation, and evaluation of PATH-funded services. For example, indicate whether persons who are PATH-eligible are employed as staff or as volunteers or serve on governing or formal advisory boards. PMHC has a Board of Directors that has mental health consumers and family members of consumers serving. The board is regularly apprised of the activities Attachment C Page 59

62 of the PATH program. Although the PATH program does not currently employ any individuals who are formerly homeless on the team, PMHC does employ a number of Certified Peer Specialists who are available to work with individuals connected with PATH. Several individuals who formerly received services through PATH have assisted with the Unsheltered Homeless Point in Time Count, and it is hoped that these individuals could serve as part of an alumni group that would mentor and support individuals who are referred. PATH also continues to work with self-help groups, such as the Reach Out Foundation and Voice and Vision, that have completed surveys relating to housing options and homelessness. 7. Provide a budget narrative that provides details regarding PATH Federal and match (i.e., State and local) funds. *See separately attached documents: Penndel Mental Health Center-PATH Program (Bucks County)- Program Budget Penndel Mental Health Center Budget Narrative-PATH Budget-(Bucks County) Attachment C Page 60

63 PENNDEL MENTAL HEALTH CENTER-BUDGET NARRATIVE PATH BUDGET Personnel: This component of the budget remains the same at the 2011/2012 budget amount of $36, The personnel costs that are supported by PATH dollars represent 37.73% of the Director s salary, 44.65% of one of the case manager s salary, and % of the other case manager s salary. Given the availability of state and county funds, which augment the PATH Program Budget, it is anticipated that there are adequate funds available to support the program s personnel costs. Fringe Benefits: The fringe benefit cost of $8, represents 23.5% of the total personnel costs. Travel: The costs for travel have remained the same as in 2010/2011 at $5, Given the availability of state and county funds, which augment the PATH Program s budget, it is anticipated that there are adequate funds available to support the program s requirement for travel costs. Supplies: The total budget for supplies for 2011/2012 is $3, $ of office supplies were moved to staff training in an effort to enhance program staff knowledge regarding best practice based skills and resources related to serving individuals with co-occurring mental health and substance abuse disorders. Given the availability of state and county funds, which augment the PATH Program s budget, it is anticipated that there are adequate funds available to support the program s requirement for supplies. Other: The total budget figure for one-time housing rental assistance, security deposits, assistance in obtaining housing, and staff training for 2011/2012 is $13, This figure represents an increase in funding by $ for 2011/2012. Additional costs for staff training would be applied to offset staff training costs related to enhancing best practice based skills and staff s knowledge of resources for serving those with cooccurring mental health and substance abuse disorders. Although there is significant demand for these funds, it is anticipated that the state and county funds, which augment the PATH Program budget, will adequately address this portion of the budget. Indirect Administrative Costs: Administrative costs calculated to be $2, Total Federal PATH Allocation $70,835.00* Attachment C Page 61

64 PENNDEL MENTAL HEALTH CENTER-PATH PROGRAM (BUCKS COUNTY) PROGRAM BUDGET PERSONNEL Position Annual Salary PATH Funded FTE PATH Funded Salary Director 35, % 12,277 Casemanager 29, % 12,277 Casemanager 27, % 12,277 $36, Fringe Benefits $8, Travel Staff Travel $ Motor Vehicle $2, Motor Vehicle Repairs/maintenance $1, $5, Supplies Office Supplies $1, Client Related Supplies $2, $3, Other One-Time housing rental assistance $ Security Deposits $1, Assistance in obtaining housing-client travel expenses $7, Staff Training $1, $13, Indirect Cost Administrative 4% $2, State Match ($24,379) + Federal PATH Allocation ($46,456) = $70, * *Based upon Budget figure for Attachment C Page 62

65 Attachment D County Program FY County Plan COMMUNITY SUPPORT PROGRAM (CSP) COUNTY PLAN DEVELOPMENT PROCESS Instructions: The following checklist should be completed by County CSP Committees to guide and document their input into the development of the County Annual Mental Health Plan. Check the appropriate Yes or No column to indicate sources of information or completion of each task. Use the Comments section to qualify your answers. YES NO 1. Representatives of what group (s) below provided reports/information to help the Mental Health (MH) Plan Committee develop its recommendations for the County Mental Health Plan? [x] [ ] Consumer Satisfaction Team [x] [ ] County Office of Mental Health [x] [ ] Consumer groups [x] [ ] Family groups [x] [ ] Provider organizations [ ] [ ] Mental Health Association [x] [ ] Other (C/FST) Comments: There is broad stakeholder involvement including mental health and drug and alcohol representatives. Membership is also representative of the various serving systems transitional age youth, adults and older adults. 2. The MH Plan Committee prioritized at least one or more CSP service components and exemplary practices they would like the county to develop. [x] [ ] Comments: The MH Plan committee provided significant input in the development of the values and priorities that are identified in the MH Plan. 3. The MH Plan Committee held meetings with county Office of Mental Health representatives to discuss recommendations for the mental health plan prior to public hearing sessions. [x] [ ] Comments: 4. The MH Plan Committee received written notification of when and where the public hearings on the mental health plan will be held. [x] [ ] Comments: Attachment D Page 63

66 YES NO 5. The MH Plan Committee endorses the County s Annual Mental Health Plan. [x] [ ] Comments: 6. The MH Plan Committee sees evidence that the CSP Recovery Model Wheel and/or Call for Change is used by the County Management Office to guide planning activities. [x] [ ] Comments: 7. The MH Plan Committee members are invited to attend the OMHSAS review of the County s Annual Mental Health Plan if the review occurs. [x] [ ] Comments: The MH Plan committee will be invited to an OMHSAS plan review. 8. The county office of Mental Health responded to the County CSP Committee outlining how it intends to implement the Committee s recommendations. [x] [ ] Comments: The development of the MH Plan has been a collaborative process with all stakeholders. 9. The County CSP Committee and the County Office of Mental Health have jointly developed a process to report on progress in implementing the current year s Plan. [x] [ ] Comments: The MH Plan Committee will reconvene in the fall. Updates will be provided as to the transformation priorities outlined in the Plan and will determine next steps. Attachment D Page 64

67 Name of CSP Committee CSP Committee Chair Address City, State, Zip Phone Fax Date SIGNATURES: (Your signature designates that you have participated in this process and does not necessarily imply endorsement of the County Plan itself) Member(s) Representing Consumers: Member(s) Representing Consumers: Member(s) Representing Consumers: Member(s) Representing Families: Member(s) Representing Families: Member(s) Representing Families: Member(s) Representing Professionals: Member(s) Representing Professionals: Member(s) Representing Professionals: Member(s) Representing Professionals: Member(s) Representing Professionals: Member(s) Representing Professionals: Names of other participants: Attachment D Page 65

68 The Bucks County CSP Committee has been struggling. Membership has dwindled and now consists of three (3) officers. County staff met with CSP members in order to brainstorm ways to increase membership and encourage consumer participation. In order to address the CSP County Plan Development Process, we received input from the MH Plan Committee, which has broad stakeholder involvement. We are unsure of the future of the CSP Committee, but we are committed to supporting the reorganization and re-establishment of the Bucks County CSP Committee. During the Annual Advancing In Recovery (AIR) Event, a survey was distributed in order to gather information regarding the Community Support Program (CSP) in Bucks County. On March 15, 2012, Bucks County held a CSP forum in order to reenergize CSP in Bucks County. Broad stakeholder participation was solicited. The results of the survey were distributed, and the group was able to brainstorm ideas of how to re-establish CSP in Bucks County. The meeting was well attended and an energized group of participants brainstormed for potential ideas for CSP along with some challenges past committees have faced. Attachment D Page 66

69 Attachment E County Program FY County Plan Existing County Mental Health Services SERVICE CATEGORY Enrichment Treatment Case Management CONSUMER DESCRIPTION Engaging consumers in fulfilling and satisfying activities Alleviating symptoms and distress Obtaining the services consumer needs and wants CONSUMER OUTCOME Self Development Symptom Relief Services Accessed SERVICE DESCRIPTION AACES COFFEE HOUSE PROGRAM: A specialized social program designed to support successful transition outcomes for individuals, ages years-old, with a diagnosis of Asperger s Syndrome or PDD NOS. The model includes social skills training and career exploration. ACUTE PARTIAL HOSPITALIZATION: An intensive day treatment program designed to provide mental health treatment as an alternative to inpatient. ADMINISTRATIVE CASE MANAGEMENT: General case management that provides referral, monitoring and service coordination. Acts as hospital liaison for community hospitals, the State Hospital and correctional facilities and monitors, involuntary, outpatient commitments. FUNDING SOURCE Reinvestment County HealthChoices MA Fee-for- Service Other POPULATION SERVED Transition Age Youth Adults 1 and 2 Children/ Adolescents 1 and 2 County Adults 1 and 2 Children/ Adolescents 1 and 2 Attachment E Page 67

70 SERVICE CATEGORY Case Management Case Management/ Treatment Treatment CONSUMER DESCRIPTION Obtaining the services consumer needs and wants Obtaining the services consumer needs and wants/ Alleviating symptoms and distress Alleviating symptoms and distress CONSUMER OUTCOME Services Accessed Service Access/ Symptom Relief Symptom Relief SERVICE DESCRIPTION ADMINISTRATIVE CASE MANAGEMENT (McKinney/PATH): This case management service provides support exclusively with persons who are homeless or are at risk of homelessness. Through this service, consumers are supported through outreach, rental assistance, and access to other resources, to prevent homelessness. ASSERTIVE COMMUNITY TREATMENT (ACT): Intensive, teamdelivered clinical and case management service available 24/7 to individuals wherever they are willing to be engaged. Follows the national ACT model. ACT Team in Upper Bucks County has a forensic specialty. BEHAVIORAL HEALTH REHABILITATION SERVICES (BHRS) FOR CHILDREN AND ADOLESCENTS: Are individualized strengthbased behavioral health services delivered in the home, community, school, or in combination as medically necessary. Services are designed to keep a child in the community. These services include but are not limited to mobile therapy, behavioral specialist, and therapeutic staff support. FUNDING POPULATION SOURCE SERVED County Adults 1 and 2 County HealthChoices MA Fee-for- Service HealthChoices MA Fee-for- Service Adults 1 and 2 Children/ Adolescents 1 and 2 Attachment E Page 68

71 SERVICE CATEGORY Case Management Crisis Intervention CONSUMER DESCRIPTION Obtaining the services consumer needs and wants Controlling and resolving critical or dangerous problems CONSUMER OUTCOME Services Accessed Personal Safety Assured SERVICE DESCRIPTION BLENDED CASE MANAGEMENT (formerly Intensive Case Management and Resource Coordination): Eligibility-based case management service with 24/7 capacity to provide individualized, face-to-face contact with person on an ongoing basis to assist the person in gaining access to needed supports, services and to assist in the coordination of care. BUCKS COUNTY CHILDREN S CRISIS SUPPORT: Available 24/7 to all Bucks County individuals and their family members. Crisis support offers telephone and mobile crisis support and includes follow-up if needed in order to assist in the development of a crisis support plan and referral to appropriate services and supports. FUNDING SOURCE County HealthChoices MA Fee-for- Service County Reinvestment POPULATION SERVED Adults 1 and 2 Children/ Adolescents 1 and 2 Children/ Adolescents 1 and 2 Attachment E Page 69

72 SERVICE CATEGORY Enrichment Basic Support CONSUMER DESCRIPTION Engaging consumers in fulfilling and satisfying activities Providing the people, places and things consumers need to survive (e.g., shelter, meals, healthcare) CONSUMER OUTCOME Self Development Personal Survival Assured/ Symptom Relief SERVICE DESCRIPTION CERTIFIED PEER SPECIALISTS (CPS): A specialized peer position which requires state approved certification. The CPS provides peer support and serves as a model of recovery in action through their interaction not only with peers but also with staff. CPS s are powerful agents in moving the transformation to a recovery oriented system forward by their individual presence in a person s life, by their work in helping the person identify their hopes/dreams/aspiratio ns, by helping the person enter the community in new ways and by their working as peers with staff demonstrating that recovery is possible. COMMUNITY RESIDENTIAL REHABILITATION FOR ADULTS: Licensed community based residential programs, which are designed to assist individuals with the development of Independent living skills, which are necessary for living in the community. There are three levels of support, which are designed to address a range of requirements, which are presented by those pursuing this service. FUNDING SOURCE County, HealthChoices Reinvestment POPULATION SERVED Adults 1 and 2 Transition Age Youth County Adults 1 and 2 Attachment E Page 70

73 SERVICE CATEGORY Basic Support/ Treatment Basic Support Case Management/ Treatment Rehabilitation CONSUMER DESCRIPTION Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare)/ Alleviating symptoms and distress Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare) Obtaining the services consumer needs and wants/ Alleviating symptoms and distress Developing skills and supports related to consumer s goals CONSUMER OUTCOME Personal Survival Assured/ Symptom Relief Personal Survival Assured Services Accessed/ Symptom Relief Role Functioning SERVICE DESCRIPTION COMMUNITY RESIDENTIAL REHABILITATION FOR CHILDREN AND ADOLESCENTS (RTF): Licensed, communitybased program designed to assist in the development of daily living skills for individuals to prepare for a more independent living arrangement. Children s CRR/RTF s provides an inclusive treatment approach to help children and adolescents move to a less restrictive setting. COMMUNITY RESIDENTIAL REHABILITATION FOR TRANSITION AGE YOUNG ADULTS (CRR): Licensed, community-based, transitional housing program designed to assist in the development of daily living skills for individuals to prepare for a more independent living arrangement. COMMUNITY TREATMENT TEAM: An intensive, teamdelivered clinical and case management service available 24/7 to individuals wherever they are willing to be engaged to promote holistic health. CONSUMER DROP-IN CENTER: Afford individuals opportunities for socialization, peer support/education, skill development and in some instances, competitive employment in a non-clinical setting. FUNDING SOURCE HealthChoices MA Fee-for- Service County Reinvestment County HealthChoices MA Fee-for- Service County/ Reinvestment POPULATION SERVED Children/ Adolescents 1 and 2 Adults 1 and 2 Adults 1 and 2 Adults 1 and 2 Attachment E Page 71

74 SERVICE CATEGORY Rights Protection Crisis Intervention Treatment/Case Management/ Basic Support Crisis Intervention CONSUMER DESCRIPTION Advocating to uphold one s rights Controlling and resolving critical or dangerous problems Alleviating symptoms and distress/ Obtaining the services consumer needs and wants/ Providing the people, places, and things consumers need to survive (e.g., shelter, meals, healthcare) Controlling and resolving critical or dangerous problems CONSUMER OUTCOME Equal Opportunity Personal Safety Assured Symptom Relief/ Services Accessed/ Personal Survival Assured Personal Safety Assured SERVICE DESCRIPTION CONSUMER SATISFACTION SERVICES: County contracts for the provision of consumer and family satisfaction services. Through a survey process, information is compiled and opportunities for change are identified for the providers, consumers, family members to address in a collaborative fashion. CRISIS INTERVENTION TEAM (CIT): Crisis Intervention Team (CIT) training provides police officers with knowledge and skills to improve their responses to individuals with mental illnesses. DEAF SERVICES CENTER: Provides outpatient, partial hospitalization, intensive case management, and housing for persons who are deaf or hard of hearing. EMERGENCY/CRISIS SERVICES: Available 24/7 currently at three locations within the county. Designed to assist people who are having a crisis or persons seeking help for someone in crisis. Includes evaluation, crisis telephone, walkin, and assistance with the involuntary commitment process. FUNDING SOURCE County BCBHS County, HealthChoices MA Fee-for- Service POPULATION SERVED Adults 1 and 2 Children/ Adolescents 1 and 2 Adults 1 and 2 HealthChoices Adults 1 and 2 County HealthChoices MA Fee-for- Service Other All Attachment E Page 72

75 SERVICE CATEGORY Treatment Basic Support Case Management Basic Support Treatment CONSUMER DESCRIPTION Alleviating symptoms and distress Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare) Obtaining the services consumer needs and wants Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare) Alleviating symptoms and distress CONSUMER OUTCOME Symptom Relief Personal Survival Assured Services Accessed Personal Survival Assured Symptom Relief SERVICE DESCRIPTION FAMILY BASED MENTAL HEALTH SERVICES: Intensive, team delivered family therapy and case management delivered in the child s home, school, and community. The service is utilized when there is defined risk of out of home placement and includes crisis response and prevention available 24 hours a day/7 days a week for a maximum of 32 weeks. FAMILY SUPPORT: Group and individual assistance through support, information and referral and linkages. The focus is to help individuals and/or families to be able to live successfully in the community. FORENSIC SERVICES: Specialized case management services available to assist persons involved in the criminal justice system. Service is a specialized tract through the CTT. HOUSING SUPPORTS: A wide range of activities that include housing and staff supports, and financial assistance to individuals living in a variety of settings. INPATIENT: Intensive 24/7 hospital services in a licensed facility with a secure environment and treatment through a multidisciplinary team. FUNDING SOURCE County HealthChoices MA Fee-for- Service POPULATION SERVED Children/ Adolescents 1 and 2 County Adults 1 and 2 Children/ Adolescents 1 and 2 County Adults 1 and 2 County Adults 1 and 2 County HealthChoices MA Fee-for- Service Other Adults 1 and 2 Children/ Adolescents 1 and 2 Attachment E Page 73

76 SERVICE CATEGORY Rehabilitation/ Enrichment Case Management/ Basic Support Basic Support/ Treatment Case Management CONSUMER DESCRIPTION Developing skills and supports related to consumer s goals/engaging consumers in fulfilling and satisfying activities Obtaining the services consumer needs and wants/ Providing the people, places and things consumers need to survive (e.g., shelter, meals, healthcare) Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare)/ Alleviating symptoms and distress Obtaining the services consumer needs and wants CONSUMER OUTCOME Role Functioning/ Self Development Services Accessed/ Personal Survival Assured Personal Survival Assured/ Symptom Relief Services Accessed SERVICE DESCRIPTION INTENSIVE PSYCHIATRIC REHABILITATION (IPR): Assists individuals with serious mental illness and/or co-occurring disorders in setting and achieving personal goals in their living, learning, working, and social environments. This program is licensed and utilizes the Boston University Model. L.I.F.E.: Works on a multi-system level, providing family support and education for parents and families with children who have behavioral health needs. Provides technical assistance to the county child serving systems and develops and delivers an annual training series. The program also provides short-term case management for children with intense mental health needs. LONG TERM STRUCTURED RESIDENCE (LTSR): Secure/locked residential facility in the community, which provides intensive treatment. Staffing includes psychiatric, nursing, social worker, and mental health professionals. MENTAL HEALTH TECHNICIANS: This service is available to assist case management in less intensive instances. Consumers are recruited to deliver this service. FUNDING POPULATION SOURCE SERVED HealthChoices Adults 1 and 2 County Children/ Adolescents 1 and 2 County Adults 1 and 2 County Adults 1 and 2 Attachment E Page 74

77 SERVICE CATEGORY Case Management/ Basic Support Treatment Rehabilitation Treatment CONSUMER DESCRIPTION Obtaining the services consumer needs and wants/ Providing the people, places and things consumers need to survive (e.g. shelter, meals, healthcare) Alleviating symptoms and distress Developing skills and supports related to consumer s goals Alleviating symptoms and distress CONSUMER OUTCOME Services Accessed/ Personal Survival Assured Symptom Relief Role Functioning Symptom Relief SERVICE DESCRIPTION OLDER ADULT OUTREACH: Provides outreach and assessment to older adults in their homes. Contracted through the Area Agency on Aging. OUTPATIENT SERVICES: Mental Health treatment services provided by qualified mental health professionals that include individual, group and family therapy, medication management, diagnostic evaluation and assessment that focuses on managing symptoms and maintaining stability. PSYCHOSOCIAL/ PSYCHIATRIC REHABILITATION SERVICES: Goal directed activities that assist individuals to enhance, retain, or develop skills in areas of living, learning, working, and socialization. This service is designed to increase a person s independence and satisfaction in the environment of their choice. Bucks County has one licensed ICCD certified Clubhouse. RESIDENTIAL TREATMENT FACILITY: Twenty-four hour mental health treatment available to children and adolescents for active, non-acute mental health treatment that is provided at a licensed facility by a multidisciplinary team. Services must be recommended by a psychiatrist or licensed psychologist. FUNDING SOURCE County Area Agency on Aging County HealthChoices MA Fee-for- Service Other County/ HealthChoices HealthChoices MA Fee-for- Service POPULATION SERVED Older Adults Adults 1 and 2 Children/ Adolescents 1 and 2 Adults 1 and 2 Children/ Adolescents 1 and 2 Attachment E Page 75

78 SERVICE CATEGORY Treatment CONSUMER DESCRIPTION Alleviating symptoms and distress CONSUMER OUTCOME Symptom Relief SERVICE DESCRIPTION RESIDENTIAL TREATMENT FACILITY FOR ADULTS (RTFA): Twenty-four hour mental health treatment available to adults for active, non-acute mental health treatment that is provided at a licensed facility by a multidisciplinary team. FUNDING SOURCE HealthChoices MA Fee-for- Service, private insurance POPULATION SERVED Adults 1 and 2 Basic Support Basic Support Rehabilitation Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare) Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare) Developing skills and supports related to consumer s goals Personal Survival Assured Personal Survival Assured Role Functioning RESPITE CARE: Provides a short-term alternative living situation for those residing in the community. Also provides programming, which prevents hospitalization and/or support services for those reentering the community from a hospitalization. RESPITE CARE FOR CHILDREN AND ADOLESCENTS: Provides short-term temporary care to families in caring for a child with behavioral health needs. This service may be provided in the child s home or in a host home, and all providers are screened and trained. The service provides a structured break for the child and family. SOCIAL REHABILITATION SERVICES: Leisure and enrichment activities that are social and/or recreational in nature. County County Reinvestment County Reinvestment Adults 1 and 2 Children/ Adolescents 1 and 2 Adults 1 and 2 Attachment E Page 76

79 SERVICE CATEGORY Case Management/ Wellness/ Prevention Rehabilitation/ Enrichment Basic Support Rehabilitation CONSUMER DESCRIPTION Obtaining the services consumer needs and wants/ Promoting healthy life styles Developing skills and supports related to consumer s goals/engaging consumers in fulfilling and satisfying activities Providing the people, places and things consumers need to survive. (e.g., shelter, meals, healthcare) Developing skills and supports related to consumer s goals CONSUMER OUTCOME Services Accessed/Health Status Improved Role Functioning/ Self Development Personal Survival Assured Role Functioning SERVICE DESCRIPTION STUDENT ASSISTANCE PROGRAM: Preassessment, assessment, referral, and consultation services available to all school districts for the identification and support for children and adolescents at risk for emotional and behavioral health concerns. MH SAP Liaisons have written service agreements with all school districts and adhere to the State s best practice guidelines. SUPPORTED EDUCATION: Provides peer support and assists individuals to identify and achieve post-secondary education goals. SUPPORTED LIVING PROGRAM: Provides housing support services within a community based residential program. Supports vary in accordance to the needs of the residents. CHIPPs, MH/D&A, HUD Section 8ll, Shelter Plus Care, and Respite housing are included in this category. VOCATIONAL/ SUPPORTED EMPLOYMENT SERVICES: Vocational Services are provided in a workshop setting and provide training in work skills in preparation for community employment. Supported Employment services provide assistance with job development, job coaching, and ongoing support for individuals seeking competitive employment within their community. FUNDING SOURCE County County Reinvestment POPULATION SERVED Children/ Adolescents 1 and 2 Adults 1 and 2 County Adults 1 and 2 County Adults 1 and 2 Attachment E Page 77

80 Attachment F County Program FY County Plan EVIDENCE-BASED PRACTICES SURVEY Provider Name and Master Provider Index (MPI) Number (List all providers offering EBP) Lenape Valley Foundation Penn Foundation Sellersville FACT Employment Technology, Inc. Goodwill Employment Services Penn Foundation Sellersville FACT Penn Foundation Sellersville FACT Penn Foundation Sellersville FACT Penn Foundation COMANS Lenape Valley Foundation Penndel MH Center List the Evidence-Based Practices provided (please see the list below) Assertive Community Treatment Assertive Community Treatment Supported Employment Supported Employment Supported Employment Illness Management and Recovery Integrated Treatment for Co-Occurring Disorder Supported Housing Supported Housing Supported Housing Supported Housing Supported Housing Supported Approximate # of consumers served Name the Fidelity Measure Used 77 DACTS/ ACT Bulletin Who measures Fidelity MH/DP; BHS; MBH/ ACT Program Director 40 TMACT Hired consultant through ACHI and Director of ACT SVCS 61 SE Fidelity Scale 55 SE Fidelity Scale MH/DP staff and Program Director MH/DP staff and Program Director TMACT Hired Consultant ACHI and Director of ACT SVCS TMACT Consultant ACHI and Director of ACT 25+ TMACT ACHI and Director of ACT SVCS How Often is fidelity measured Is the SAMHSA EBP toolkit used to guide EBP implementation Annually Yes Yes 1x/year Yes Yes Annually No Yes Annually No Yes 1x/year Yes Yes 1x/year Yes Yes 1x/year Yes Yes 33 N/A N/A N/A No No 38 N/A N/A N/A No No 21 N/A N/A N/A No No 35 N/A N/A N/A No No NHS of Bucks County 19 N/A N/A N/A No No Salisbury Behavioral 14 N/A N/A N/A No No Health Housing * NAMI - Bucks Family Psycho- 70 N/A N/A N/A No No County Family to Education Family *This is a NAMI Family to Family program and not the Family Psycho-Education EBP Have staff been specifically trained to implement the EBP Attachment F Page 78

81 Attachment G County Program FY County Plan COUNTY DEVELOPMENT OF RECOVERY-ORIENTED/PROMISING PRACTICES** Services Exist (Check all appropriate) Services Planned (Check all appropriate) #'s Served $$ Existing $$ Planned Consumer Satisfaction Team X 2,449 $202,865 Family Satisfaction Team Compeer Self Help / Advocacy (Specify) X Reach Out, NAMI Included above Included above 2058 $227,000 Outreach for Older Adults SELF 30 $135,000 Warm Line PACT X 65 $4,100 Mobile Services/In Home Meds PACT, CTT, FACT, SELF 134 $531,000 Fairweather Lodge X $300,000 PACT, CTT, FACT, Crisis County base MHASP, Penn Fd funds and Family Svs X $375,000 Medicaid Funded Peer Specialist Program Dialectical Behavioral Therapy PACT, LVF group and Project Transition 15 $51,560 Other **This form is an effort to identify the existence of or plans for some of the services that traditionally have been underdeveloped and that adults, older adults, and transition-age youth with serious mental illness and family members would like to see expanded. Current cost centers do not capture this level of detail. Please report on both County and HealthChoices funding. Attachment G Page 79

82 Attachment H County Program SERVICE AREA PLAN CHART The five counties in the Southeast Region have a long history of working individually and together to enhance the community mental health/behavioral health system. Beginning with the closing of Philadelphia State Hospital in 1990, the closing of Haverford State Hospital in 1998 and continuing through several downsizing initiatives, the Region has reallocated resources that originally supported almost 1200 State Mental Hospital beds to community supports. Counties in the Southeast Region make minimal use of large institutions, specifically Norristown State Hospital (NSH), to support individuals with serious mental illness. Recently DPW released the 2010 Report on State Mental Hospitals. It is of interest to see the variation in utilization of the State Hospital by the counties in each service area. Among its information was the number of individuals in each State Hospital by County of residence on December 31, We were also able to have the 2010 census by County. Measured by the number of people in each State Hospital on December 31, 2010, it appears that the NSH service area has the lowest number of beds per 100,000 adults. This is not to say that every county in the SE region had the lowest utilization, only that taken as a service area, it had the fewest beds. Fiscal year (FY) was the first time in many years that the counties in the Southeast Region did not reduce the capacity at NSH. In FY 10-11, we anticipate closing 28 beds, reducing the civil capacity at NSH to 176. Additionally, with the release of the Olmstead Plan, Pennsylvania has embarked on an initiative to reduce unnecessary institutionalization significantly. The counties in the Southeast Region welcome this effort. The counties have consistently demonstrated their willingness to engage with the Office of Mental Health and Substance Abuse (OMHSAS) in similar initiatives. Over the course of the next five years, the Southeast Region counties envision the following: A significant reallocation of resources from NSH to the community. We can no longer CHIPP away at NSH capacity. The amount of funding provided in the past few years has not been sufficient to impact demand for the level of care provided at NSH, in extended acute inpatient and in Long Term Structured Residential programs. A significant expansion in the types of services available through HealthChoices funding. There are not enough resources between outpatient and inpatient to support people in the community. We need an increase in the amount and the variety of these services and supports. Attachment H Page 80

83 An increase in the number of specialty services that respond to specific needs, such as Dialectic Behavioral Therapy, Trauma Informed Services, supports for people with dissociative disorders. A restructuring of County Mental Health (MH) funded community residential services so that every person with serious and persistent mental illness has a home and mental health residential services are organized to achieve specific outcomes for their residents. Improved access to other supports such as housing supplements, aging services, higher education and other community opportunities A significant decrease in the number of individuals involved with the criminal justice system. A significant enhancement of the system s infrastructure through training, improved compensation and other strategies. The transfer of people from the NSH forensic unit into the civil unit continued to decline from the FY 2008 high of 29 (43% of total admissions). In FY 2009, there were 25 transfers (52% of total admissions). In FY 2010, there were 17 transfers (28% of total admissions). While Philadelphia continues to be the main source of forensic transfers, their totals have declined from 22 in FY 2008, to 20 in FY 2009, to eight (8) in FY Overall the percentage of admissions that have some criminal justice involvement is also declining. In FY 08-09, there were 20 County approved admissions to NSH and 35 forensic related admissions In FY 09-10, there were 39 County approved admissions and 22 forensic-related admissions. In FY 08-09, forensic related admissions comprised 65% of total admissions. In FY 09-10, 36% of admissions were forensic related. The 2010 Report on State Mental Hospitals shows the percentage and number of people with any criminal history in each State Hospital Civil Unit on December 31, The statewide average was 33%. Norristown s average was 61%. The statewide average for all the hospitals except Norristown was 27%. Through February 1, 2011 admissions to the civil units at NSH have been as follows: County County Approved Forensic Related Total Admissions Bucks Chester Delaware Montgomery Philadelphia Total Percentage 69% 31% Attachment H Page 81

84 Overall, Philadelphia remains above its target capacity at NSH, as does Chester County. Even though the other counties are often below their target capacity, the overall census is beds over the combined bed cap of 204. The Civil Census at NSH on February 1, 2011 was as follows: County Civil Census as of 2/1/11 Bed CAP FY 10/11 Over/under cap Bucks Chester Delaware Montgomery Philadelphia Total NSH also provides a forensic unit that serves the eastern half of Pennsylvania. The Southeast Region accounts for the majority of admissions, discharges, and individuals served in that unit. Data for December 31, 2010 from the above referenced State Hospital Report show the following numbers in the Forensic Unit on December 31, 2010: County Forensic % of Total Unit Census Bucks 5 4% Chester 6 5% Delaware 26 19% Montgomery 15 12% Philadelphia 55 42% Other Counties 24 18% Total % During the course of this FY, the waiting list for the Forensic Unit has fluctuated from a low of 44 to a high of 75. The most recent information indicates a waiting list of 65, from the following counties: County Men Women Total Bucks Chester Delaware Montgomery Philadelphia Others Total Attachment H Page 82

85 On July 1, 2009, NSH took over responsibility for the Community Support Plan (CSP) Process. Since the inception of the CSP process in 2007 there have been 254 CSPs completed. A total of 169 persons have been discharged with a CSP since July Each of the five Southeast County MH Programs has a staff person who acts as a liaison with NSH. County staff are responsible for working with NSH staff and community providers around the community support needs of individuals currently hospitalized at NSH. Continuity of Care meetings are held between NSH and each County MH Program routinely throughout the year. The County MH Directors and CHIPP Coordinators continue to meet at least monthly to review issues related to services and supports for people assessed in the Service Area Plan. County staff are active in assessing all referrals to NSH and in developing diversion plans for people who can be served in the community. Additionally, the counties support the Southeast Region Mental Health Services Coordination Office which focuses on regional planning and data collection, oversight and monitoring of the specialty regional services, as well as forensic monitoring for the suburban counties. Goal #2: Involuntary Commitment Data The Counties have been collecting involuntary commitment data via the Regional Involuntary Commitment Data Extract Project since 2007, coordinated by the Regional M.H. Services Office. The annual commitment data by the Region and County is collected and analyzed by each County to measure the commits per 100k population as well as focus on reductions in the commitment numbers. This information is further analyzed by each county to review specific outliers and data sets which focus on best practices in services, crisis outreach, services for individuals, and ultimately reduction of overall involuntary commitments. The table below reflects the data collection over a four year period. This last calendar year shows an 8.2 % decrease overall in involuntary commitments. Number of Commitments per County 1/07-12/07 Commit s per 100k 1/08-12/08 Annual Involuntary Commitments % Commit 1/09 - chang s per 12/09 e 100k % chang e Commit s per 100k 1/10-12/10 % chang e Commit s per 100k Bucks Chester Delaware 1, , , , Montgomery 1, , , , Philadelphia 9, , , , Total 13, , , The Above section contains the total number of individual commitments for each 12 month period * County Population is based on the most current actual or estimated U.S. Census Data. 10, Attachment H Page 83

86 Goal #3 Incarceration Rates The data for each County Jails and information on individuals in the County jails and maxouts is unavailable as of this writing. The Southeast Counties continue to track and monitor all individuals who are returning to the SE Counties who are listed on the DOC MH/MR roster. Philadelphia and the suburban Counties via a Regional Forensic Liaison have dedicated staff position(s) to monitor and assist in the development of aftercare plans for consumers upon reentry to the community. The table below reflects the numbers of persons who are on the roster as of January 31, 2011 and of those individuals on the roster, the number of persons with serious and persistent mental illness (PRT) who are to be released upon serving their maximum sentences during this current FY 10/11. TOTAL MH/MR ROSTER (as of 1/31/11) County "C" roster "D" (PRT only) Bucks Chester Delaware Montgomery Philadelphia TOTAL Max outs during FY 10/11 County "C" roster "D" (PRT only) Bucks 25 1 Chester 21 3 Delaware 29 5 Montgomery 44 6 Philadelphia Total Source data - PA Dept. of Corrections, MH/MR/PRT Roster This last year, the Southeast Regional MH Services Coordination Office in collaboration with the Pennsylvania Mental Health and Justice Center of Excellence, completed Sequential Intercept Mappings with Bucks, Chester, and Delaware counties. Now all counties in the SE region have been successfully mapped. Since this effort, the Regional MH Services Coordination office has continued to assist and work with the Counties to focus on action plans to address the intercept points which will help to improve and develop the services and divert persons from the criminal justice system. Presently, all counties have active task forces and are implementing recommendations from the Sequential Intercept mappings. Finally, the Regional Continuous Quality Improvement Committee (CQI) continues to bring together representatives from the five county Quality Improvement staff as well as community stakeholders to meet and review the outcomes of the regional programs. In FY 09-10, the UPENN (now Temple University) Collaborative on Community Integration, recognized the Regional Recovery Organizational Review Model and Tool as an Exemplary Community Innovative Initiative. The committee has developed an Annual Regional Quality Improvement plan which focuses on various CMS Domains. Attachment H Page 84

87 The development of the Regional Incident Management Data Project is an ongoing information and data collection project which is useful to the Counties as well as programs to identify trends and patterns of incidents that occur in regional programs and to focus on quality improvement objectives within the programs. Service Area Plan Goals Goal 1: Within five years no person will be hospitalized at a State Mental Hospital for more than two years. Goal 2: Within five years no person will be committed to a community hospital more than twice in one year. Update for County Plan- Request for County specific information Please review attached data regarding length of stay prior to answering the following questions Abuse/StateHospitals/. How many of the individuals with length of stay greater than 2 years have gone through Community Support Plan (CSP) process with a peer-to-peer assessment*, clinical assessment, and family assessment* and have had CSP meetings? 23 How many of those individuals have a targeted discharged date during the current fiscal year? 7 Next fiscal year? 15 * If applicable. For Goal 2 different counties have different data points that are being followed. Please be consistent if the county has selected to report on involuntary admissions- report involuntary admissions, if the county has selected voluntary- report on voluntary. If the data are not available please check no data. Previous Calendar Year 09 Current Calendar Year 10 Involuntary Admissions- 73 Involuntary Admissions- 67 Voluntary Admissions- Voluntary Admissions- All Admissions- All Admissions- No Data- No Data- Goal 3: Within five years the incarceration rate of the target population will be reduced. How many individuals are currently incarcerated in the county jail in the target population- please select a point in time and report data that is available after working with county jails? Point in time previous Fiscal Point in time current Fiscal Year Year # individuals- 33 # individuals- 30 No data No data How many individuals are going to max-out from the county jail in the target population during this fiscal year? 15 How many individuals is the county planning for the possibility of parole from the county jail in the target population during this fiscal year? 5 How many individuals are currently incarcerated in the State Correction Institution from your county in the target population? Attachment H Page 85

88 Update for FY 2014: Point in time previous Fiscal Year Point in time current Fiscal Year # individuals # individuals No data X No data X How many individuals are going to max-out from a SCI in the target population during the current Fiscal Year? 20 How many individuals is the county planning for the possibility of parole from a SCI in the target population during current fiscal year? 0 The above information is estimated. This is one of the areas for improvement that we will be working with jail staff to provide more accurate information. Measured by the number of people in each State Hospital on December 31, 2011, the NSH service area continues to have the lowest number of beds per 100,000 adults. The Torrance State Hospital Service area runs a close second. This is not to say that every county in the SE region had the lowest utilization, only that taken as a service area, it had the fewest beds at 4.30 per 100,000 adults. The average admission rate for the NSH service area is.35 persons per 100,000 adults. In FY 10-11, the Southeast Region implemented a 28-person CHIPP project intending to reduce the civil capacity at NSH to 176. In the last year, OMHSAS has agreed to implement the final year of the Fred L. Plan. The proposed Commonwealth budget for Fiscal Year contains funding to provide community placements for 90 people from NSH. In response to the Fred L. Plan, the Counties in the Southeast Region have proposed the following discharges: Proposed CHIPP 90 County Discharges Bucks 20 Chester 4 Delaware 15 Montgomery 30 Philadelphia 21 Total 90 Current and enhanced resources will be used and new services will also be developed during this phase of continued downsizing. Regional Extended Acute Care resources are being proposed to help to divert persons from State Hospital level of care. The Counties continue to be committed to comprehensive services to address the support needs of the consumers at NSH. However, Attachment H Page 86

89 considering the multiple challenges within the current NSH population, it is evident that more secure and clinically supportive programs are necessary. Admission to NSH civil units continues at rate equivalent to FY 10/11. However, the source of admissions has drastically changed. Through March 31, 2012, there have been 19 criminal justice related transfers/admissions, 70% of total admissions to the civil unit, and 8 non criminal justice/county approved admissions (30%). The transfer of people from the NSH forensic unit into the civil unit has increased from same time last year by 105%. Philadelphia continues to be the main source of forensic transfers. Through March 1, 2012, admissions to the civil units at NSH have been as follows: County County Approved Forensic Related Total Bucks Chester Delaware Montgomery Philadelphia Total Percent 30% 70% These percentages are completely opposite those for the same period last year when County Approved admissions were 69% and Forensic Related were 31%. There has also been a 32.5% decline in total admissions, compared to same time last year (3/1/11) from 40 last year to 27 this year. Overall, Philadelphia remains consistently above its target capacity at NSH, as does Chester County. Even though the other counties are often below their target capacity, the overall census is about 30 beds over the combined bed cap of 176 The Civil Census at NSH on March 1, 2012 was as follows: County Census Bed Cap Over/Under Bucks County Chester Delaware Montgomery Philadelphia Total NSH continues to have a larger percentage of individuals with criminal justice history. According to the 2011 PA State Hospital Demographic Report, the statewide average for the number of residents with a criminal justice history was 13%, while Norristown s average was 39% and the average for all hospitals except Norristown was 7%. Attachment H Page 87

90 1/07-12/07 Commits per 100k 1/08-12/08 % change Commits per 100k 1/09-12/09 % change Commits per 100k 1/10-12/10 % change Commits per 100k NSH also provides a forensic unit that serves the eastern half of Pennsylvania. The Southeast Region accounts for the majority of admissions, discharges, and individuals served in that unit. As of March 1, 2012, the census in the Forensic Unit was as follows: County Forensic Unit Census % of Total Bucks 7 6% Chester 6 5% Delaware 21 17% Montgomery 10 8% Philadelphia 66 52% Other Counties 16 12% Total % During the course of this fiscal year, the waiting list for the Forensic Unit has fluctuated from a low of 44 to a high of 75. The most recent figures for the forensic waiting list over the last 3 months have averaged 42 persons on the wait list. The Counties and NSH continue to implement the Community Support Plan process for all consumers at NSH. As of February 1, 2012, of the total civil population at NSH, 130 (60%) of consumers have had completed CSPs. Goal #2: Involuntary Commitment Data The table below reflects the data collection over a four-year period. This last calendar year shows an 8.2 % decrease overall in involuntary commitments. Annual Involuntary Commitments Number of Commitments per County Bucks Chester Delaware 1, , , , Montgomery 1, , , , Philadelphia 9, , , , Total 13,622 11, , , The Above section contains the total number of individual commitments for each 12 month period. * County Population is based on the most current actual or estimated U.S. Census Data. Attachment H Page 88

91 Goal #3 Incarceration Rates The data for each County Jails was collected in June As of that time, the following figures were provided regarding SMI population in the jails: Number of persons with SMI diagnoses in County Jail Approximate number of persons in jail receiving psychotropic medications # referrals to NSH forensic unit per month ( on average) County Total Capacity Bucks (4%) Chester (7%) Delaware (5%) ~ Montgomery (8%) ~ Philadelphia (14%) TOTAL (11%) 1991 Department of Correction MH/MR Rosters The Department of Corrections classifies individual according to the level of their need for mental health intervention. The C list is composed of people who are relatively stable, while the D list is composed of people who are actively followed by the Psychiatric Review Team. The table below reflects the numbers of persons who are on the roster as of January 31, 2012 who are to be released upon serving their maximum sentences through December 2012:. Total max out County C D before 12/12 Bucks Chester Delaware Montgomery Philadelphia Total Of these individuals, approximately 70% will require some mental health treatment and likely case management support in accessing services. Based on data collected from the last 2 years of reentry activity, approximately 10-15% will require some form of specialized housing and supports upon reentry into the community. This number has been growing over the last 5 years of tracking reentry from the Department of Corrections. Attachment H Page 89

92 Attachment I County Program OLDER ADULTS PROGRAM DIRECTIVE The Memorandum of Understanding (MOU)/Letter of Agreement is a collaboration between the County Office of Mental Health/Developmental Programs (MH/DP) and the County Office of Aging (AAA). The MOU should be revised (and signed) annually and included with County Mental Health Plan. Is a dated and signed MOU in place affirming this collaborative relationship between the county office of MH/DP and AAA? Yes X NO Last Updated (date): April 2012 Is a copy of the MOU attached (Y/N)? Yes Attachment I Page 90

93 County of Bucks Aging / Mental Health/Developmental Programs / Drug and Alcohol Commission Memorandum of Understanding Background In accordance with the original Interdepartmental Cooperative Agreement between the Office of Mental Health (OMH), Department of Public Welfare (DPW), and the Pennsylvania Department of Aging (PDA) signed on May 21, 1984 and the Mental Health and Substance Abuse Services (OMHSAS) Bulletin Number OMHSAS dated February 1, 2006, this Letter of Agreement is to serve as a statement of understanding among the Bucks County Department of Mental Health/Developmental Programs (MH/DP) and the Bucks County Area Agency on Aging (AAA) and Bucks County Drug and Alcohol Commission, Inc. (BCDAC) relative to Values/Philosophy associated with Care, Access to Services, Referral Processes, Continuity of Care, Exchange/Release of Information, Conflict Resolution and Grievance and Appeals. I. General Provisions A. Legal Base The legal base for this agreement includes this Memorandum of Understanding between the Bucks County Area Agency on Aging (BCAAA), Bucks County Department of Mental Health/Developmental Programs (MH/DP), and Bucks County Drug and Alcohol Commission, Inc. (BCDAC); the Pennsylvania Public Welfare Code of 1967 and its revisions; the Pennsylvania Mental Health/Mental Retardation Act of 1966 as amended; the Mental Health Procedures Act of 1976 as amended; the Federal Public Law of 1992 and federal Mental Health and Substance Abuse Block Grant Legislation; the Federal Older Americans Act (42 USC); the Commonwealth legislation creating the Department of Aging (71 PS);and the Pennsylvania Drug and Alcohol Abuse Control Act of B. Non-Discrimination Services will be delivered in accordance with Title VI, Section 504 of the Civil Rights Act of 1969, Pennsylvania Human Relations Act, and DPW Executive Order as it relates to the provision of services. All agencies and their subcontractors are expected to make every effort to deliver services in a culturally competent manner which reflects the diversity of Bucks County. Lastly, no client is ever denied services because of gender, race, creed, color, religion, age, sexual preference, disability, or national origin. II Purpose A. Agency Descriptions and Mission Statements and B. Description of the service area and population to be served: Bucks County Department of Mental Health/Developmental Programs (MH/DP): Mental Health: It is the mission of the MH/DP Mental Health Unit that all individuals in Bucks County including, older adults, adults with serious mental illness, youth in transition and every child and Attachment I Page 91

94 adolescent with serious emotional disturbance and those with addictive disease will have an opportunity for Recovery, Wellness and Resiliency. Likewise, our vision is that Bucks County will be a community of hope, acceptance and understanding and will become a State leader in accessing and delivering quality services that are peer and family driven and are evidence based &/or based upon best practice. Values: Services are based on Community Support Program and Children and Adolescent Service System Program principles. People will treat each other with dignity and respect. Everyone will have the opportunity for: Personal development Inclusion in the community Easy access to services and supports of his/her choice so as to realize an improved quality of life Contact information for Mental Health: Title: Deputy Director, Mental Health Services Address: 600 Louis Drive, Suite 101, Warminster, PA Phone: Fax: Crisis Line: Developmental Programs: The MH/DP Developmental Programs Unit supports the mission of the Office of Developmental Programs which is to provide individuals with intellectual disabilities, and their families the services and supports they need and the opportunity to make real choices about living, working and options for social activities to enable them to live in and participate fully in the life of their communities. Description/Goal: The Developmental Programs Unit is responsible for the administration of services to Bucks County residents with intellectual disabilities, and their families. The purpose of the services is to support individuals to live and work in the community and to assist them in actively participating in community life. This unit is an administrative unit which provides direction and oversight to community agencies providing supports and services to individuals with intellectual disabilities. The Developmental Programs Unit identifies needs, coordinates, locates and monitors service delivery and oversees the development of new and innovative supports and services for individuals with intellectual disabilities and children eligible for the Early Intervention. The Developmental Programs Unit provides Information and Referral. Information is maintained on community resources. Service/Supports Coordinators operate as liaisons between the Department, individuals, families, and service providers. The primary functions of Service/Supports Coordinators are assessment, coordination, monitoring and assistance in locating services and supports in the community. The unit also oversees services that are funded through the Federal Medicaid Waiver that are provided to individuals who need assistance in acquisition, retention or improvement of skills related to living and working in the community and to prevent institutionalization. Attachment I Page 92

95 Contact information for Developmental Programs: Title: Deputy Administrator, Developmental Programs Address: 600 Louis Drive, Suite 101, Warminster, PA Phone: Fax: Bucks County Area Agency on Aging: Description/Goal: The Bucks County Area Agency on Aging (BCAAA) is the a public agency designated as the Area Agency on Aging for the Planning and Service Area (PSA) of Bucks County under the 1973 Amendments to the Older Americans Act of 1965 and by the Bucks County Commissioners. BCAAA is responsible for the planning and implementation of a variety of services and programs to assist older persons in Bucks County. An appointed Senior Citizens Advisory Council approves the annual plan. Aging services are financed by federal, state and county funds, and contributions. The broad goal of the agency is to develop comprehensive services to assist persons age 60+ to remain independent in the community and prevent premature institutionalization. Our priority consumers are those with the greatest needs and fewest resources. The Area Agency on Aging offers more than twenty programs to help older adults and their families and is an advocate for all older persons in Bucks County. We also directly provide information and referral, outreach, assessment, care planning and management, as well as a county-wide volunteer program. BCAAA services also include protection from abuse, neglect, exploitation and abandonment under the Older Adults Protective Services Act 79 of 1987, with amendments. Additional services and projects are by agreement or contract with other community agencies. Contact Person for Area Agency on Aging: Title: Deputy Administrator II for Long-Term Care Address: 30 East Oakland Avenue, Doylestown, PA Phone: Fax: Toll Free: Elder Abuse Hotline: Bucks County Drug and Alcohol Commission, Inc. The mission of the Bucks County Drug and Alcohol Commission, Inc. (BCDAC) is to promote healthy individuals, families and communities, eliminate the misuse, abuse and/or addiction to alcohol, tobacco and other drugs and support those in recovery from addiction. As the state and locally designated Single County Authority (SCA) for alcohol, tobacco and other drugs, the agency will ensure the provision of a comprehensive and balanced continuum of quality prevention, intervention, treatment and recovery services for the county. In carrying out its mission, the Bucks County Drug and Alcohol Commission, Inc. will always: Support education for all in the county on issues of alcohol, tobacco and other drug (ATOD) use, abuse and addiction Support initiatives that aim to create cultures of responsibility for healthy communities. Attachment I Page 93

96 Commit to research/evidence based programming as well as best and promising practices as identified by the field Advocate for and support programming that meets the individual needs of clients and their families and empowers them in the recovery process Commit to the highest standard of excellence and quality care within our service provider community Support a quality workforce in our field Collaborate with our partners to further our mission including: other county departments and affiliates, courts and criminal justice system, federal and state entities, client/consumer and family organizations and recovery community centers, community coalitions, service provider agencies, physical health and behavioral health entities, educational institutions and other systems Addressing behavioral health issues of older adults through educational initiatives, intervention services and the development of appropriate treatment and recovery resources is a priority for this agency. Contact Person for Bucks County Drug and Alcohol Commission Inc.: Title: Executive Director Address: 600 Louis Drive, Suite 102-A, Warminster, PA Phone: Fax: C. Purpose for this MOU: It is clear that neither the AAA, MH/DP, nor BCDAC is independently capable of meeting the full array of service needs presented by older adults with intellectual disabilities or at risk of developing mental illness, or an addictive disease. Collaboration among the agencies will potentially better meet these needs, while maximizing available resources. This MOU describes the protocol for these activities. III. Scope A. Description of population to be jointly served: All older adults with behavioral health needs and/or intellectual disabilities residing in the County may request services by contacting the above numbers, the Base Service Units, or the BCDAC assessment sites. B. Listing of all services that are provided by each agency is included as Attachments 1, 2, and Process for cross-systems referral: Both direct and subcontracted staff of MH/DP and BCDAC make referrals to AAA by calling AAA Information and Referral. AAA and BCDAC staff refer for MH/DP services by calling the MH/DP office for intellectual disability services, or the Base Service Unit in the person s geographic area for mental health services. AAA and MH/DP staff refer to BCDAC by calling one of the assessment sites in the county. Attachment I Page 94

97 2. Process for cross-systems collaboration/case review/planning/service delivery: When a complex case arises, or one that would benefit from cross-systems collaboration in care planning, the Supervisor from the agency dealing with that case contacts a Supervisor from the other agency (agencies) to identify collaborators and schedule a meeting. Subcontractors and other agencies are involved as appropriate. 3. Process for resolving funding issues: Since the services of MH/DP, AAA, and BCDAC are generally mutually exclusive, funding issues are not anticipated. If they would occur, the Deputies for MH/DP and AAA and the Director for BCDAC will be in contact with each other or their designees to work toward resolution. 4. Privacy and confidentiality: AAA, MH/DP, and BCDAC agree to exchange information regarding the individual on an as-needed basis, in accordance with all applicable Federal and Commonwealth of Pennsylvania regulations. MH/DP and the AAA co-developed a generic release of information form that can be used with and between the AAA, MH/DP, the Base Service Units, Northwestern Human Services, and Family Service Association of Bucks County to facilitate the sharing of information. As necessary, a release that meets the state and federal requirements of the drug and alcohol system will be obtained in order to better meet the service needs of individuals with a substance use disorder. 5. Incorporation of community and natural supports in service delivery: AAA, MH/DP, and BCDAC agree to work together with older adults and families toward the least restrictive alternative of the informed individual s choice. AAA, MH/DP, and BCDAC agree to be supportive of involved families and other informal supports and operate in accordance with Recovery Principles, the Community Support Program (CSP) values and within the framework of community based substance abuse recovery support systems. Consumers and families are encouraged to make optimum use of community and natural supports. 6. Collaborative outreach efforts for persons needing services: Recognizing an unmet need in this area, the AAA and MH/DP continue to collaborate and co-fund a demonstration program called SELF (Senior Empowerment for Life Fulfillment), which connects older adults who have unmet behavioral health needs, to services to meet those needs. SELF includes outreach to older adults who are homebound and experiencing unmet behavioral health needs. Other areas of concern that are addressed include access to treatment and payment for services, and linkage to traditional treatment when the older adult is ready. AAA and BCDAC jointly developed and continue to support Project MEDS, Medication Education Designed for Seniors, a peer-led prevention education program. This program is being expanded to address prevention of gambling issues of older adults. Additionally, all three agencies (AAA, BCDAC, & MH/DP) serve/participate in the highly successful Bucks County Medication Give Back Program, a program that enhances substance abuse prevention by removing unused, unwanted and expired medications, many of which include medication with addicting substances. AAA, MH/DP, and BCDAC also invite each other to participate in their annual planning processes. Attachment I Page 95

98 As trends emerge and unmet needs are identified AAA, MH/DP, and BCDAC are committed to collaboratively working together to address these needs. In addition, planning workgroups have been developed, that include representatives from MH/DP, AAA, and BCDAC, that are looking at the system as a whole in an attempt to address issues in a proactive manner. C. Cross-systems training: Orientation for new staff at MH/DP, AAA, and BCDAC includes information about the respective agencies as well as other community resources. In addition updated information and changes in any of the above mentioned agencies is shared during ongoing inservices. Information is always available on an as-needed basis through cross systems referral, collaboration, case review, planning, or service delivery as mentioned above in section III B, 1 and 2. Bucks County MH/DP, BCDAC and AAA will continue to assess the need and plan for ongoing cross-systems training, to include both subcontracted and agency staff members. The agencies have held cross-systems trainings for MH/DP, AAA & BCDAC staff at multiple levels and plan to continue this endeavor. AAA, MH/DP & BCDAC training activities have been and will continue to be held regarding older adults and substance use, misuse, abuse and dependence. All partners share information and resources on available trainings. IV. Assignment of Staff A. How staff will be designated: The Deputy Directors at each agency and the Director of BCDAC bear lead responsibility for designating staff assignments for specific activities. B. Staff responsibilities/authority: The Deputy at the AAA bears responsibility for Long Term Care client services from both in-house and contracted providers. The Deputy at MH has the responsibility for emergency/court services and County contracted MH services. The Deputy for Developmental Programs is responsible for the oversight and supervision of all intellectual disability and early intervention services of the Department. Each Deputy Administrator reports to their respective agency director, who provides oversight and supervision of their activities. The Executive Director of BCDAC bears responsibility for all BCDAC activities and reports to the Board of Directors, The Director for Bucks County Behavioral Health System (BCBHS) and the Bucks County Division of Health and Human Services. It should be noted that the BCBHS is the umbrella organization which oversees services for people enrolled in HealthChoices. Whenever possible, BCBHS will coordinate efforts with the Area Agency on Aging, Department of Mental Health/Developmental Programs, and Bucks County Drug & Alcohol Commission, Inc. The older adult population is considered to be a high priority, at-risk population for each of the agencies in this MOU. V. Conflict Resolution When a conflict arises, the involved parties should make every effort to come to terms that are acceptable to the parties. When an agreement cannot be reached, the named contact person from each entity should be notified and arrangements will be made for a resolution meeting. If an agreement still cannot be reached, the matter will be referred to the signatories of this agreement. If an agreement still cannot be reached, the matter will be referred to the Bucks County Health and Human Services Director for final resolution. Attachment I Page 96

99 Grievance and Appeals: Any individual receiving publicly funded services or a person acting on behalf of an individual has the right to file a complaint or grievance against the provider of service and/or the AAA, MH/DP, and BCDAC. The Long Term Care Ombudsman as well as individual case managers/supports coordinators may be accessed to provide assistance in the process. Similarly, a provider of service may choose to appeal a decision or action taken by the signatory agencies to this agreement, to the Director of Health and Human Services. VI. Continuity of Care AAA, MH/DP, and BCDAC agree to provide services in a manner that ensures continuity of care and minimizes any disruptions in service to individuals. VII. Amendments and VIII. Effective date and term of agreement This Agreement will be reviewed and signed on an annual basis. Amendments will be completed as needed by mutual consent of the parties and become formal attachments to this Agreement. Attachment I Page 97

100 Signed and Agreed By: AAA Director (Acting): Najja R. Orr Date MH/ID Administrator: Mary Beth Mahoney, MS Date BCDAC Inc. Executive Director (Acting): Bern McBride Date Attachment I Page 98

101 SERVICES PROVIDED BY THE AAA Attachment 1 Organizationally, the Agency is divided into Long Term Care, Public Affairs and Administrative and Financial Affairs. LONG TERM CARE Protective Services Ombudsman Services Assessment Home/Community Based Services Facility-based Services Care Management Care Planning Care Plan Implementation/Follow-up Ongoing Care Management Reassessment/Recertification Home/Community Based Services Personal Care Personal Assistance Service Home Health Aide Home Support Home Delivered Meals Adult Day Services Personal Emergency Response System Therapeutic Counseling SELF Programs for Caregivers Caregiver Education / Support Financial Assistance Family Counseling Other Services Telephone Reassurance Student Internships Charity Funds Utilization Money Mgt.-Selected Clients PUBLIC AFFAIRS Information and Referral Senior Centers Nutrition Congregate Meals Home Delivered Meals Health Promotion Apprise Project MEDS Transportation Employment Senior Games/Expo ADMINISTRATIVE AND FINANCIAL AFFAIRS Fiscal/Administrative Management Legal Services Retired & Senior Volunteer Program Attachment I Page 99

102 MENTAL HEALTH SERVICES: SERVICES PROVIDED BY MH/DP Attachment 2 CASE MANAGEMENT Administrative Case Management PATH Case Management (Homeless) Blended Case Management Supportive Case Management Outreach Team (SCOT) Mental Health Technicians Treatment Services Community Treatment Team (CTT) Forensic Services Program (FSP) Program for Assertive Community Treatment (PACT) Forensic Assertive Community Treatment (FACT) Acute Partial Hospitalization Outpatient Treatment Services Psychiatric Inpatient CONSUMER SERVICES Peer Support DAY SERVICES Intensive Psychiatric Rehabilitation (IPR) Psychosocial Rehabilitation Services Consumer Drop-in Centers Employment Services Pre-Vocational Services (Vocational Facilities) Transitional Employment Services (Clubhouse) Educational Supports HOUSING SERVICES Long Term Structured Residential (LTSR) Community Residential Rehabilitation (CRR) Housing Supports Respite Care (short term) Supported Living SPECIALTY SERVICES Crisis and Emergency Services Older Adult Outreach Services (S.E.L.F.) Attachment I Page 100

103 DEVELOPMENTAL PROGRAMS SERVICES: HOME AND COMMUNITY BASED SERVICES Supports Coordination Companion Respite Vehicle Accessibility Adaptations Education Support Special Diet Preparation Support (Medical Environment) Assistive Technology Behavior Support Specialized Supplies Supports Broker Service Behavior Therapy Occupational Therapy Physical Therapy Speech and Language Therapy Visual/Mobility Therapy Nursing Services Family Aide Family Support Recreation/Leisure Time Activities Homemaker Chore Service Home Accessibility Adaptations Home Rehabilitation Home Finding Habilitation Services DAY SERVICES Day Habilitation (Adult Training Facilities) Prevocational Service Supported Employment Transitional Work Older Adult Living Centers ADMINISTRATIVE SERVICES Agency With Choice/Financial Management Services Vendor/Fiscal Employer Agent Financial Management Information & Referral Training, Education, & Technical Assistance TRANSPORTATION Trip Public Mile Per Diem HOUSING SERVICES Residential Habilitation Community Living Arrangement Family Living/Lifesharing Home Accessibility Adaptations Home Rehabilitation Supplemental Habilitation NOTE: Services are dependent on available funding and eligibility requirements. Attachment I Page 101

104 SERVICES PROVIDED BY BCDAC, Inc. Attachment 3 ADMINISTRATIVE SERVICES CLIENT SERVICES Screening, Assessment, and Case Management Services Approval of Care Services Intervention Services Treatment Services Intensive Case Management Services Community Education and Outreach Services Prevention and Training Services Prevention and Cessation Tobacco Efforts Attachment I Page 102

105 Attachment J County Program TOP FIVE TRANSFORMATION PRIORITIES TRANSFORMATION PRIORITY 1 Outpatient Treatment This initiative will be a multiyear project. Initial work will focus on the core, foundation issues that will support a system that provides access, quality, and efficiency. While many of the specific initiative goals relate to access, quality, and efficiency, the goals are as follows: Meeting Access Standards: For this goal, the focus will be on ensuring that participating agencies meet access standards for initial routine appointments and first clinical follow-up. The first clinical follow-up appointment should be individualized based on need, but must occur within 30 days of the initial face-to-face assessment. Ensuring quality and efficiency: For this goal, the focus will be building on gains made toward consistently meeting access standards and will broaden in focus to improve quality and efficiency. Core Competencies: An integral element of the initiative will be the expectation of and support for the outpatient professionals achieving and maintaining competence in responding effectively to individuals. 2 Peer Support The expansion of Certified Peer Specialist (CPS) services has been a priority for Bucks County for the past several years. It is our intention to infuse peer support into all programs, both existing and newly developed. By December 2011, Bucks County anticipates its first free-standing CPS program to be operational. The Mental Health Association of Southeastern PA has been instrumental in making this goal a reality. The new program will be named PeerNet and will support Bucks County in its goal to increase peer support activities. Attachment J Page 103

106 TRANSFORMATION PRIORITY 3 Crisis We will be taking a multi-pronged approach to examining the current delivery of crisis services in Bucks County. In keeping with OMHSAS goal of improving crisis intervention services, Bucks County has created a crisis workgroup that includes varied stakeholder representation - Mental Health and Drug and Alcohol staff, consumer and family membership, police and providers of crisis services. We will be gathering information from various stakeholders (people who have utilized crisis services, family members, treatment providers, law enforcement, and crisis service providers). The goal is to identify gaps, the effectiveness of the service and opportunities for improvement. We will be utilizing a survey process through Voice and Vision s Consumer and Family Satisfaction Team (CFST) as well as public forums. We will also be looking at ways to maximize our current county allocation as well as utilizing HealthChoices funds. 4 Behavioral Health and Physical Health (BH/PH) Coordination The HealthChoices/Health Connections initiative provides a unique opportunity to achieve better outcomes for individuals with a Serious Mental Illness (SMI) by testing new approaches to improving access to healthcare, integrating physical and behavioral healthcare, and promoting more healthy lifestyles, while at the same time reducing costs associated with the use of emergency, inpatient, and other acute services. Members who participate in this initiative are assigned staff (navigators) who are responsible to encourage members to complete PH/BH evaluations, coordinate care across BH/PH systems, advocate for individual perspective/preference, provide clinical guidance, and establish a wellness plan with members based on members health interests and needs. Smoking cessation and outcomes related to reducing risk factors associated with metabolic syndrome (i.e. weight reduction through improved nutrition and increased exercise) have been major areas of wellness focus. 5 Transitional Age Youth There is a severe lack of resources for this group of young people. They do not Attachment J Page 104

107 TRANSFORMATION PRIORITY fit into the traditional services that are currently offered to adults. There is also a significant difference in the intensity of services available in the children s system as opposed to the adult system. In many instances, if provided the appropriate supports, these young adults could make temporary use of services and move out of the behavioral health system. The goal of this transformation priority is to enhance the supports and resources available for transition age youth so that their goals are more attainable. We must bridge the gap between the adolescent and adult serving systems in order to develop a broad array of support services that promote wellness and recovery for youth and young adults. Attachment J Page 105

108 Attachment K County Program EXPENDITURE TABLES AND CHARTS NEW FUNDING REQUESTS Identify the Request Target Population* Cost Center** 6 Month Cost Annualized Cost 1 2 Outpatient (OP) As noted in the Transformation Priority s section, Bucks County is undertaking an OP initiative that focuses on access and quality issues. Although the majority of funding for this service comes through HealthChoices (HC), there are still a significant number of individuals who receive services who are not HC, and in many cases, never will be eligible for Medical Assistance. Over the last several years, providers have ended the fiscal year (FY) with huge deficits in OP services. The county has not been in a position to be able to cover these costs. As part of the OP initiative, there will be an expectation related to training and supervision that will be difficult to achieve without additional resources. We are requesting funds to cover the full cost associated with OP services as well as funds to increase rates to support the increased expectations that will be required to enhance the quality of this service as outlined in our current initiative. Transition Age Youth (TAY) In 2005 Bucks County developed a residential program to support 6 young adult males that had transitioned from the children s system into the adult system. It began as a reinvestment program. The supports offered in the program Adults 1 and 2 Outpatient $67,500 $135,000 Adults 1 and 2 Attachment K Page 106 Community Residential Services $72,500 $145,000

109 3 4 do not lend themselves to be brought in-plan. Currently the program is a moderate Community Residential Rehabilitation (CRR) program and we have found that the young adults have significant mental health and cooccurring needs that require a higher level of support. We are requesting the funds that are currently allocated thru reinvestment monies along with funds to increase the level of staffing that will provide the young adults with a greater ability to support their recovery goals and connect with them with their local community for both educational and vocational pursuits. Blended Case Management (BCM) BCM is one of the most important services that support individuals with a mental illness and co-occurring substance use disorder. Bucks County s support of BCM is shown through the Case Management Transformation Initiative (CMTI) in which a significant amount of resources have been expended in order to provide a level of competency and support for CM who are supporting individuals with many more complex presentations. Because of the limited county funding that is available for individuals, who are not eligible for Medical Assistance, provider agencies are not able to meet the demand for this service. In essence, a two-tiered system has been created that entitles some individuals to service, whereas others must wait until a county-funded slot becomes available. We are requesting funds to serve the individuals who are currently on the agencies waiting lists as well as cover the full annual cost incurred for this service. Housing - The mental health residential system is severely underfunded. Programs that were once considered highly supportive are now barely able to meet every-day demands. Over the years, staffing has been eroded in order to adjust to no cost of living adjustment. We are Adults 1 and 2 Adults 1 and 2 Intensive Case Management Community Residential Services $64,000 $128,000 $166,400 $652,800 Attachment K Page 107

110 5 also seeing individuals present with much higher needs the most pressing being the multiple and complex medical conditions. We are requesting funds to add an additional staff person for each residential program. This amounts to 13 additional staff at 6 agencies. As part of the Bucks County Housing Plan, we are also requesting funds to develop a Fair Weather Lodge, which is an evidence-based housing model where individuals live and work together collectively supporting each other. We have made this request as part of the last three Mental Health Plan submissions and believe this would provide another service option unlike current support services. Crisis - Another transformation priority that Bucks County is pursuing is looking at the current delivery of crisis services and providing recommendations to improve upon it. Different areas of consideration include: mobile v. site-based, hospital v. non-hospital based, utilizing models such as the Living Room and the infusion peers supports. Although we will be looking at ways to maximize our current county allocation in conjunction with HC funds, we anticipate the need for additional county finding. Our request is based on the increase of individuals, that crisis centers are serving, who have recently lost employment and/or will not be eligible for MA. As crisis is a mandated service, it is available for all Bucks County residents who are in need of the service and no one is turned away due to their insurance status. We are also requesting funds based on our recent experience with expanding the Lower Bucks Crisis Center which was necessary when we developed the Crisis Intervention Team (CIT). As CIT expands into the Central and Upper Bucks areas, we anticipate the need to enhance our crisis services in those areas as well. All Target Groups Emergency Services $250,000 $500,000 Attachment K Page 108

111 Chart 1a Service Category/Service Description Table for County Funds FY Service Description/Cost Center (Bulletin OMH-94-10) 1. Outpatient (3.6) 2. Psych Inpatient Hospitalization (3.7) Service Category Expenditure (in 1000's of $) Treatment $1, Partial Hospitalization (3.8) 4. Family-Based MH Services (3.17) 5. Community Treatment Teams (3.23) 1. MH Crisis Intervention Services (3.10) Crisis Intervention $1, Emergency Services (3.21) 1. Intensive Case Management (3.4) Case Management $2, Resource Coordination (3.19) 3. Administrative Management (3.20) 1. Community Empl & Empl Related Svs (3.12) Rehabilitation $8, Community Residential Services (3.16) 3. Psych Rehab (3.24) 4. Children's Psychosocial Rehab (3.25) 5. Other Services (3.98) 1. Adult Development Training (3.11) Enrichment $1, Facility Based Vocational Rehab Svs (3.13) 3. Social Rehab Services (3.14) * 1. Administrator's Office (3.1) Rights Protection $0 1. Housing Support Services (3.22) Basic Support $ Family Support Services (3.15) Specify if used Self Help $0 1. Community Services (3.2) Wellness/Prevention $140 Any Services not identified above Other $0 * Peer Support included Attachment K Page 109

112 Chart 1b County Expenditure Chart FY $9,000 $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 Treatment Crisis Intervention Case Management Rehabilitation Enrichment Rights Protection Basic Support Self Help Wellness/Prevention Other $1,000 $0 Chart 1c County Percentage Chart FY % 0% 0% Treatment 6% 0% 5% 10% 12% Crisis Intervention Case Management Rehabilitation 15% Enrichment 51% Rights Protection Basic Support Self Help Wellness/Prevention Other Attachment K Page 110

113 Chart 2a Service Category/Service Description Table for County Funds FY Service Description/Cost Center (Bulletin OMH-94-10) 1. Outpatient (3.6) 2. Psych Inpatient Hospitalization (3.7) Service Category Expenditure (in 1000's of $) Treatment $1, Partial Hospitalization (3.8) 4. Family-Based MH Services (3.17) 5. Community Treatment Teams (3.23) 1. MH Crisis Intervention Services (3.10) Crisis Intervention $1, Emergency Services (3.21) 1. Intensive Case Management (3.4) Case Management $1, Resource Coordination (3.19) 3. Administrative Management (3.20) 1. Community Empl & Empl Related Svs (3.12) Rehabilitation $8, Community Residential Services (3.16) 3. Psych Rehab (3.24) 4. Children's Psychosocial Rehab (3.25) 5. Other Services (3.98) 1. Adult Development Training (3.11) Enrichment $ Facility Based Vocational Rehab Svs (3.13) 3. Social Rehab Services (3.14) * 1. Administrator's Office (3.1) Rights Protection $0 1. Housing Support Services (3.22) Basic Support $ Family Support Services (3.15) Specify if used Self Help $0 1. Community Services (3.2) Wellness/Prevention $82 Any Services not identified above Other $0 * Peer Support included Attachment K Page 111

114 Chart 2b County Expenditure Chart FY $9,000 $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 Treatment Crisis Intervention Case Management Rehabilitation Enrichment Rights Protection Basic Support Self Help Wellness/Prevention Other Chart 2c County Percentage Chart FY % 1% Treatment 5% 0% 4% 0% 9% 12% Crisis Intervention Case Management Rehabilitation 11% Enrichment Rights Protection 58% Basic Support Self Help Wellness/Prevention Other Attachment K Page 112

115 Chart 3a Service Category/Service Description Table for HealthChoices Funds FY Service Description/HealthChoices Rate Code Service Grouping Service Category Expenditure (in 1000's of $) 1. Inpatient Psychiatric (provider type 01 - specialties 010, 011, 022, 018) Treatment $12, Outpatient Psychiatric (provider type 08 - specialties 110, 074, 080; provider type 11 - specialties 113, 114; provider type 10 - specialty 190) 3. RTF - Accredited (provider type 01 - specialties 013, 027) 4. RTF - Non-accredited (provider type 56 - specialty 560; provider type 52 - specialty 520) 5. Family Based Services for Children and Adolescents (provider type 11 - specialty 115) 1. Crisis Intervention Services (provider type 11 - specialty 118) Crisis Intervention $1, Targeted CM, ICM (provider type 21 - specialty 222) Case Management $7, Targeted CM, blended (provider type 21 - specialty 222) 3. Targeted CM, RC (provider type 21 - specialty 221) 4. Targeted CM, ICM-CTT (provider type 21 - specialty 222) 1. BHRS for Children & Adolescents (all BHRS provider types and specialties under HC Behavioral Health Services Reporting Classification Chart) Rehabilitation $ Rehabilitative Services (provider type 11 - specialty 123) Specify if used Enrichment $0 Specify if used Rights Protection $0 1. Residential and Housing Support Services (provider type 11 - specialty 110) Basic Support $0 2. Family Support Services (provider type 11 - specialty 110) 1. Peer Support Services (provider types 08, 11, 21 - specialty 076) Self Help $ Mental Health General (provider type 11 - specialty 111) Wellness/Prevention $0 Any Services not identified above Other $441 Attachment K Page 113

116 Chart 3b HealthChoices Expenditure Chart FY $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 Treatment Crisis Intervention Case Management Rehabilitation Enrichment Rights Protection Basic Support Self Help Wellness/Prevention Other $0 Chart 3c 33% HealthChoices Percetage Chart FY % 0% 4% 7% 0% 0% 2% 0% 54% Treatment Crisis Intervention Case Management Rehabilitation Enrichment Rights Protection Basic Support Self Help Wellness/Prevention Other Attachment K Page 114

117 Chart 4a Service Category/Service Description Table for HealthChoices Funds FY Service Description/HealthChoices Rate Code Service Grouping Service Category Expenditure (in 1000's of $) 1. Inpatient Psychiatric (provider type 01 - specialties 010, 011, 022, 018) Treatment $14, Outpatient Psychiatric (provider type 08 - specialties 110, 074, 080; provider type 11 - specialties 113, 114; provider type 10 - specialty 190) 3. RTF - Accredited (provider type 01 - specialties 013, 027) 4. RTF - Non-accredited (provider type 56 - specialty 560; provider type 52 - specialty 520) 5. Family Based Services for Children and Adolescents (provider type 11 - specialty 115) 1. Crisis Intervention Services (provider type 11 - specialty 118) Crisis Intervention $1, Targeted CM, ICM (provider type 21 - specialty 222) Case Management $9, Targeted CM, blended (provider type 21 - specialty 222) 3. Targeted CM, RC (provider type 21 - specialty 221) 4. Targeted CM, ICM-CTT (provider type 21 - specialty 222) 1. BHRS for Children & Adolescents (all BHRS provider types and specialties under HC Behavioral Health Services Reporting Classification Chart) Rehabilitation $ Rehabilitative Services (provider type 11 - specialty 123) Specify if used Enrichment $0 Specify if used Rights Protection $0 1. Residential and Housing Support Services (provider type 11 - specialty 110) Basic Support $0 2. Family Support Services (provider type 11 - specialty 110) 1. Peer Support Services (provider types 08, 11, 21 - specialty 076) Self Help $ Mental Health General (provider type 11 - specialty 111) Wellness/Prevention $0 Any Services not identified above Other $574 Attachment K Page 115

118 Chart 4b HealthChoices Expenditure Chart FY $16,000 $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 Treatment Crisis Intervention Case Management Rehabilitation Enrichment Rights Protection Basic Support Self Help Wellness/Prevention Other $2,000 $0 Chart 4b HealthChoices Percentage Chart FY % 0% 3% 0% 1% 2% 0% Treatment Crisis Intervention Case Management 33% 54% Rehabilitation Enrichment 7% Rights Protection Basic Support Self Help Wellness/Prevention Other Attachment K Page 116

119 Chart 5a Services Funded with Reinvestment Funds CY 2012 Service Category Expenditure (in 1000's of $) Consumer Drop In: Reach Out $ - Consumer Drop In: NAMI $ - Consumer Drop In: LVF $ - Respite: Child and Family Focus $ 200 COMPEER: MHA $ - Transitional Housing: COMANS $ - Summer Camp: Penn Foundation $ - School Based Services $ 148 Autism Community Srvcs $ - Forensic Behavioral Health Coordination $ 33 Tobacco Training Cessation $ - Consumer Run Alternatives $ 35 Housing Specialist $ 54 Transition Age Youth/Young Adult Housing $ - Kids in Care $ - AACES $ 125 X-SITE $ - Bucks Landing Family Center $ 37 Options $ 60 Family Connections $ 130 SMI Innovation Project $ 97 Crisis for Children $ 66 High Fidelity Wraparound $ 36 Total: $ 1,020 Attachment K Page 117

120 Chart 5b Reinvestment Expenditure Chart 2012 $250 $200 $150 $100 $50 Treatment Crisis Intervention Case Management Rehabilitation Enrichment Rights Protection Basic Support Self Help Wellness/Prevention Other $0 Attachment K Page 118