July telecare annual report Anticipating and Mastering Change

Transcription

1 telecare annual report Anticipating and Mastering Change July 2012 telecare corporation we exist to help people with mental impairments realize their full potential

2 Letter from the President & CEO Anne Bakar Throughout its 47-year history, Telecare has demonstrated itself as a resilient and adaptive mental health care provider. Our deep commitment to the welfare of clients, customers, and communities we serve has enabled and inspired us to meet new challenges in an ever-changing healthcare landscape. We have done this with a spirit of collaboration and an enduring commitment to excellence. This report shares exciting stories that illustrate how we are seizing opportunities presented by changing times and health reform, rather than remaining set in our ways or relying on past successes. We continue to enhance our leadership, technology, clinical systems, and partnerships all aimed at strengthening our ability to support people in recovery. Key developments are highlighted in this report. Building internal capacity Our ability to continuously deliver excellent services to clients and systems is fully dependent on our internal capacity. With this in mind, we ve taken steps to increase our organizational effectiveness and enhance our bench strength with new leadership and technology. Strengthening service excellence We continued to develop and study the effectiveness of our Recovery-Centered Clinical System (RCCS), which passed a major milestone when we validated the effectiveness of a tool that measures a program s recovery culture. We also enriched our recovery environments with new service approaches that engage consumers in exciting ways, including: a decision-support tool called CommonGround; peer counseling and mentoring programs; and the integration of early intervention and trauma-sensitive care into our service delivery framework. Accreditation is an important measure of service excellence as well. In addition to CARF s accreditation of 56 Telecare programs, our Alameda County Willow Rock Center, an adolescent psychiatric health facility, received initial Joint Commission accreditation under Hospital Standards and CMS Certification. Willow Rock joined Heritage Psychiatric Health Facility whose accreditation was renewed. Transforming services for the forensic population With the passage of California s Public Safety Realignment legislation (AB109), we rapidly expanded our services to forensic clients, opening several new programs with county customers that were moving quickly to comply with the new law. We also expanded our programs for treating forensic patients in Oregon. These programs provide specialized support to help individuals successfully transition out of prisons, jails, or forensic state hospital settings. 2 Telecare Corporation july 2012

3 Anne Bakar and Pat Deegan, PH.D. telecare is partnering with dr. deegan to pilot commonground software at our programs. Implementing health reform Although the implications of health reform are still being mapped out, we are keeping pace with new demands on health providers and have implemented significant changes. Our focus is on providing better care coordination for those with complex conditions, reducing costs and improving efficiency, and population management that emphasizes prevention and the holistic needs of individuals. Specific initiatives to address these trends included an expansion of our substance abuse programming, greater integration with health care systems, and additional focus on electronic health information exchange. Advocating for the future of behavioral health Telecare recognizes the importance of working with policy makers at local, state, and federal levels to ensure the needs of people with serious mental illness do not get lost among other high priorities. This past year, our advocacy work was notable in several states, including California and Oregon, where Medicaid funds for mental health care may be re-integrated into physical health care plans. As prison reform has gotten underway in California, it has also been important to assure that offenders with serious mental illness leave prisons and jails with access to treatment and rehabilitative services. Looking forward together In today s dynamic environment, we see meaningful opportunities to enhance partnerships with our customers, clients, communities, and other supporters. While we continue to expand the range of populations we serve, and broaden our capacity to address their needs, our core philosophy remains the same: we seek to empower individuals with mental illness to envision more hopeful and courageous futures. We thank you for your ongoing trust and collaboration in this important endeavor. It is foundational work in a time of change that holds promise for the longer-term. july 2012 Telecare Corporation 3

4 Building internal capacity Building Internal Capacity Telecare views its role as much more than a provider of services. To fulfill our mission of making a difference in the lives of people with serious mental illness, we must also be strategic thinkers and collaborators. Here are just a few of the things we ve done recently to help us become a stronger, more flexible, efficient, and capable partner. Infrastructure New Executive Level Leadership We added three new executive leaders to help build our foundation, bring innovative approaches, and guide our future course. We welcomed Marcie Atchison, JD, MA, Senior Vice President of Human Resources; Faith Richie, MBA, Vice President of National Marketing and Development; and Chin Chao, Vice President of Information Systems. leadership development We began crafting a preliminary framework for a new leadership development program called Telecare University. It is being designed to foster the leadershipcapacity needed to guide our organization in alignment with core values, while supporting us in succession planning, hiring decisions, performance management, and other critical activities essential for the successful delivery of client support and customer service. Design work on Telecare U is underway and classes will tentatively begin during FY2014. Technology enhancing systems, building capacity We are strengthening our technology to enable our employees to better serve our clients and customers. We started by improving our end users experiences by upgrading our infrastructure, workstations, and mobile devices. Work is underway to implement tools that will improve collaboration and communication both internally and with our customers, using updated and messaging systems and a customer relationship management tool (Salesforce.com). Coming soon, a new HRIS system will streamline our HR, payroll, and benefits functions, making these services more effective and efficient for our employees. We will also build upon the momentum of our EMR (Avatar) implementation, adding more clinical and operational tools for us to improve our clients recovery outcomes. All initiatives will be tied together through our Business Intelligence platform (BI), allowing us to establish benchmarks, track our progress, and report results of our efforts. From left: marcie atchison, svp of human resources faith richie, vp of national marketing and development chin chao, vp of information systems 4 Telecare Corporation july 2012

5 Strengthening our service excellence Strengthening Our Service Excellence We have focused our attention on meeting and exceeding the highest standards of clinical excellence, while incorporating advancements from the field and launching new and innovative programs with several of our customers. CARF Accreditation In 2011, Telecare once again earned a threeyear accreditation from CARF (Commission on Accreditation of Rehabilitation Facilities), following an intensive review of 56 programs in five states, as well as a corporate review. The 17-member CARF survey team closely examined Telecare s adult and criminal justice programs, and conducted a review of Telecare compliance with more than 1,500 CARF standards ranging from quality of care and clinical documentation to organizational culture and employee and consumer satisfaction. In its report, CARF stated, Telecare demonstrates a dedicated commitment to developing, maintaining, and expanding quality behavioral health services as it pursues its mission. Surveyors listed 25 strengths that included: Dedicated staff and leadership Mission-driven organization Great culture Teamwork and great cooperation Central role of recovery in the organization High degree of employee satisfaction Diversity of expertise Persons served talked about staff bringing them hope CommonGround Significant peer supports Many clients spoke of ACT saving their lives CARF recognized Telecare as a truly vital community partner that places the needs of the consumers first and is vigilant in the creation of clinical programming to meet the ever-changing needs of the communities served. july 2012 Telecare Corporation 5

6 Strengthening our service excellence tao members honor achievements at zen awards employees with lived experience handbook Non-Violent Environments Since 1998, Telecare has worked to create safe environments through recovery-focused cultures. During that time, we have reduced seclusions by 92%, restraints by 87%, and assaults by 53%. However, we believe that more can be done. Up to 95% of those with serious mental illness have experienced trauma at some point in their lives, which greatly affects efforts to support recovery. Telecare strives to minimize interventions that can re-traumatize clients. In 2010, we created Non-Violent Environment work group, which included representation from across the organization. Its purpose was to help Telecare increase understanding and awareness of traumasensitive cultures; investigate best practices such as the sanctuary model ; make recommendations to the RCCS Steering Committee that foster integration of non-violent practices and the RCCS; and conduct program pilots in how to adopt/adapt these practices. We expect that incorporating best practices from the field as well as sharing Telecare program best practices will help us further our work in creating non-violent and healing environments. Employees with Lived Experience We believe that people can and do recover from mental illness. At Telecare, we also believe that people with lived experience can add extraordinary value to the recovery process as peer support specialists and mentors. At Pierce County Evaluation and Treatment Center, an acute inpatient program developed in partnership with Optum Health in Washington, peers form a key component of the recovery environment. At Multnomah CATC, a crisis program in Multnomah County (OR), the Peer Support Specialists provide support and guidance to individuals at every stage of their stay. At TAO, an FSP program in Orange County (CA), the Peer Mentor Group functions as a team of consumers helping consumers, which has translated into real world impact such as a soft line for members to call when they need a friendly voice. In , we created an Employees with Lived Experience Task Force to formalize and expand our support system for peer employees and their supervisors. The Task Force developed a handbook that will be distributed broadly throughout the organization. 6 Telecare Corporation july 2012

7 Strengthening our service excellence pat deegan, Ph.d., (third from left) participating with Telecare staff in commonground discussion panel CommonGround CommonGround is a simple but powerful webbased, decision-support tool that helps consumers be more empowered partners in their own recovery and treatment. Developed by Pat Deegan, PhD., in collaboration with consumers and staff from eight mental health agencies across the United States, CommonGround enables consumers to clearly and powerfully articulate what they want and need from their psychiatric treatment in a simple one-page report. It also optimizes collaboration between clients and staff by identifying treatment problems early and presenting a holistic view of the client s needs, preferences, and goals. In 2011, Telecare piloted CommonGround at several programs, including San Diego Gateway/ Pathway to Recovery (CA), the Recovery Gresham (OR), and Sacramento SOAR (CA). The service is being expanded to other Telecare programs. Though CommonGround is gaining momentum, it is not yet being widely used by the broader mental health provider community. Telecare is proud to be an early adopter of this ground-breaking software. july 2012 Telecare Corporation 7

8 Strengthening our service excellence Program Recovery Culture Research recovery-centered measures Over the last 10 years, Telecare s Recovery- Centered Clinical System (RCCS) has been implemented at the majority of our programs. Our experience has shown that a program s culture can function as a primary treatment intervention. By focusing attention on specific interactions with clients and other staff, we can create a culture that enhances recovery and resilience. We believe so strongly in the impact of program culture that Telecare completed its first major research study in We developed and researchvalidated the Recovery Centered Measures (RCM). This is a set of three tools that measure a program s culture across five key domains that are crucial in an individual s recovery. This tool enables us to reliably quantify culture, which is critical in the larger goal of improving a program s recovery culture. In early 2012, a second research study across eight Telecare programs was initiated to demonstrate that program culture can be improved and that this change can be measured. The four programs participating in the intervention group are: Villa Fairmont MHRC and Alameda STRIDES in Alameda County, TAO in Orange County, and Older Adults/ATLAS in Los Angeles County. The other four programs serve as the control group and will be the next to participate in an actual intervention project. Telecare RCM-2 Study Get Ready Guide page 1 Telecare has written a paper summarizing initial research findings. The paper has been submitted for consideration to the Community Mental Health Journal. 8 Telecare Corporation july 2012

9 Strengthening our service excellence gateway to recovery staff ihot staff Innovative Programs with San Diego County Gateway to Recovery In 2012, Telecare was honored to receive the San Diego Mental Health Director s Program of the Year Award. Given by the San Diego County Behavioral Health Services Department, the award recognized a Telecare program which includes four outreach services: Gateway to Recovery ACT, Transition Team, Project 25, and Pathway to Recovery ACT/In-Reach Services. In presenting the award, Director Alfredo Aguirre stated, Telecare s program has been a model for innovative approaches to empowering clients with complex needs and for outstanding collaboration with other community mental health providers. In 2011, this program served more than 1,000 adults and transitional-age youth (age 18-25) who have been diagnosed with a serious mental illness and who also experience other related psychosocial issues. Its outreach and supportive programs (e.g. Assertive Community Treatment, case management, and transitional care) are designed to coordinate closely with families, hospitals, providers, and other community mental health care organizations. In-home Outreach Team (IHOT) In early 2012, Telecare launched the In-Home Outreach Team (IHOT), a new service for Telecare. IHOT receives Mental Health Services Act Innovations funding from the San Diego Health and Human Services Agency Behavioral Health Department. IHOT is being piloted as an alternative to Laura s Law (involuntary assisted outpatient treatment), and will be evaluated by UCSD. IHOT takes a different approach by partnering with the client so that treatment is seen as something they desire in order to achieve their life goals. IHOT uses mobile teams to provide outreach wherever necessary. They engage people who are reluctant to receive treatment and connect them to outpatient treatment, while also providing support to their family. The program also facilitates linkages to mental health services, medical care, SSI, and other community resources. A family participant whose son struggled with schizophrenia and substance abuse issues wrote, [Telecare] was instrumental in helping me to start taking care of myself and setting boundaries. Debbie [staff] was there by my side dealing with the chaos and taking the necessary steps to get my son the help he needed. july 2012 Telecare Corporation 9

10 Strengthening our service excellence vips staff Orange County steps staff and members sanger place Innovative Programs with Ventura County Ventura early intervention and prevention program (VIPS) In partnership with Ventura County Behavioral Health, Telecare s new Ventura early Intervention and Prevention Services Program (VIPS) is becoming a national model for community-wide early detection and treatment for individuals age at risk of psychosis. VIPS started outreaching to the Ventura County community in March of 2011, and the VIPS team has made 197 community presentations to schools, doctors, agencies, providers, and other mental health stakeholders. The VIPS team has had more than 100 referrals and has treated 25 individuals and their families. The community steering council has been crucial to our success, says Barry Boatman, Psy.D. They advocate and provide access to people and organizations that VIPS serves. Innovative Programs with Orange County Orange County STEPS An essential component of recovery is the process of increasing self-determination, self-control, and self-reliance. In 2012, we opened a new program in partnership with Orange County called Telecare STEPS (Striving Towards Enhanced Partnerships). This program is a 105-member Full Service Partnership (FSP) that serves as a crucial link between residential or locked programs and lower levels of care in the community. The program also serves a small population referred by the Mental Health Court, and has provided a much-needed resource in the local community. Plans are underway to open Telecare Whatever It Takes, a new court collaborative FSP program, this summer; it will serve an additional 100 members. Innovative Programs with Regional Centers sanger Place Mental Health Rehabilitation Center Sanger Place is Telecare s second inpatient program designed for individuals dually diagnosed with mental illness and developmental disability. Developed in partnership with Central Valley, Kern, and Tri-Counties Regional Centers, this 15-bed facility (hosted by Fresno County) was designed and built from the ground up specifically to meet the physical and clinical needs of this population. The state-of-the-art center is a model for other counties. Using the Recovery-Centered Clinical System (RCCS), Sanger Place provides treatment services that include assessment, crisis intervention, behavioral rehabilitation, enrichment, self-help, and pre-vocational/discharge planning services. The recovery model encourages each individual s journey toward self-control, self-responsibility, self-determination, and the increased capacity to love and be loved. 10 Telecare Corporation july 2012

11 Strengthening our service excellence Telecare Recovery partnership staff alameda steps staff Innovative Programs with Alameda County Sausal creek outpatient crisis stabilization center Since opening in 2002, Sausal Creek Outpatient Crisis Stabilization Center has helped thousands of Alameda County (CA) residents manage their mental health crises without utilizing local psychiatric emergency services. During its first eight years, Sausal Creek was the only program of its kind in Alameda County. It was open 24/7 and was designed to function like a freestanding emergency room, accepting clients regardless of county of residence or insurance coverage. Due to budget constraints, the program now operates six days a week, and despite restructuring, serves a yearly population of more than 4,000 clients. In June 2011, Sausal Creek began enrolling clients in Alameda County s low-cost health insurance program, formerly known as Health Plan of Alameda County (HPAC), and is currently enrolling more people in the plan than any other provider in the county. Sausal Creek is an ideal destination for HPAC enrollment because of the number of uninsured clients served at this program. Orange county crisis residential open house Clark County E&T staff with anne bakar Heritage phf staff La Paz diversity days july 2012 Telecare Corporation 11

12 Transforming services for the forensic population Transforming Services for the Forensic Population Telecare partners with state and county customers to provide an evolving array of services and supports to help ex-offenders with mental illness avoid recidivism and lead productive independent lives in the community. Most recently, we have expanded our forensic services to address changing needs in California as a result of AB109. Collaborating with Counties on AB109 Programs In April 2011, California Assembly Bill 109 (i.e., Public Safety Realignment) was signed into law, enabling thousands who would have served prison time to remain in their local communities where they serve their terms in county jail or alternative local custody, and/or receive intensive and focused clinical and rehabilitative supports. Telecare has opened four AB109 programs providing recovery-centered mental health services in Los Angeles, Ventura, San Diego and San Mateo Counties. In partnership with Los Angeles County, Telecare created a Full Service Partnership (FSP) service for 24 new members under county postrelease supervision. Following the Critical Time Intervention model, Telecare provides immediate, focused outreach and wraparound supports to ease the transition from prison back to the community and prevent recidivism. Peer staffing increases cultural competence and helps to create a welcoming environment in the program. Because of the early success of the program, the County asked Telecare to serve additional individuals transitioning back to the community and to provide two levels of care. The current census of the program is 100 members. In partnership with Ventura County, Telecare provides tiered mental health services (lower to higher intensity) for up to 54 persons with serious mental illness who are under county supervision as part of Realignment (AB109). The program includes psychiatry services, wraparound support services, 24/7 crisis intervention, and structured groups and activities at our program site for up to one year per participant. In partnership with San Diego County, Telecare expanded its existing FSP program by 40 slots for AB109 referrals. Similarly, in San Mateo County, we expanded our existing FSP program by 22 dedicated slots for AB109 clients. Telecare older adults/atlas, Step down services, and ab Telecare Corporation july 2012

13 Transforming services for the forensic population core Los Angeles staff and clients Collaborating with CDCR to Provide Integrated Services for Mentally Ill Parolees (ISMIP) Recidivism contributes to prison overcrowding in California. Parolees with serious mental illness are especially vulnerable and re-offend at a rate of 75.9% to 90% within three years. In 2009, in an effort to address this problem, the California Department of Corrections and Rehabilitation (CDCR) sought community-based solutions for these parolees, who need intensive behavioral health services. Telecare was awarded four of the eight initial ISMIP programs. The CORE Programs (Corrections Outreach Recovery Enhancement) include two in Los Angeles, one in San Bernardino, and one in San Diego. The programs maintain a low staffto-client ratio, provide wraparound services, and are client-centered and recovery-oriented. Outcomes have been positive. During the first two years, only 20% of clients were returned to custody. The programs have helped reduce hospitalization days by 73%, resulting in a cost savings of $2.6 million over two years. They have also reduced homeless days by 63%. This is significant because housed parolees are more stable and less likely to re-offend or to be a public nuisance. Clients average length of time in the program is 179 days. core san bernardino staff Telecare s yearly video update with anne bakar, Telecare s president and CEO, features stories from telecare s forensic programs (available at july 2012 Telecare Corporation 13

14 Transforming services for the forensic population San Bernardino FACT Staff Recovery center at woodburn staff Collaborating with Alameda and San Bernardino Counties and the State of Oregon on Other Forensic Mental Health Services Telecare has provided a broad array of forensic services since the mid-1990s, when we operated inpatient services in the Alameda County jail and MIOCR in Alameda and Solano Counties (CA). In San Bernardino County (CA), the Forensic Assertive Community Treatment (FACT) program helps members maintain their independence in the community using a whatever it takes approach, including crisis response, case management, medication support, peer support, housing, and employment support. The program also includes a fully integrated probation officer on the multi-disciplinary team. As of February 2011, only 14 of 79 (18%) past and present FACT members had returned to jail or prison, and only three (4%) were held in jail for periods of time requiring disenrollment. San Bernardino County was recognized in 2011 by the National Association of Counties for its innovative approaches and the San Bernardino FACT program was recognized as a best practice for its role in improving public services. In the State of Oregon, the Recovery Center at Woodburn serves consumers under the jurisdiction of the state s Psychiatric Security Review Board (PSRB). These individuals have been found guilty of crimes except for insanity. The Woodburn program was Telecare s first Secure Residential Treatment Facility (SRTF) and assists people transitioning out of long-term stays at the Oregon State Hospital, providing recoverycentered supports that prepare them for more independent, lower levels of care. In Deschutes County (OR), Telecare again partnered with the State of Oregon in FY10-11 to open another SRTF: the Deschutes Recovery Center. This program serves eight PSRB clients and eight civilly committed clients stepping down from the state hospital and other acute care settings. This program offers a therapeutic, recovery-centered environment for residents while also ensuring community safety. The newly constructed facility provides a comfortable, home-like environment with private bedrooms and outdoor activity space. Residents receive psychiatric treatment and assistance building independent living skills in preparation for living in less restrictive community settings. 14 Telecare Corporation july 2012

15 implementing health reform Implementing Health Reform The Patient Protection and Affordable Care Act of 2010 has triggered many healthcare reforms, particularly around integrated care. Telecare is meeting the challenge by building new partnerships, improving education and coordination, expanding skills, and leveraging new resources. Physical/Mental Health Integration On average, persons with serious mental illness live 25 years less than persons without mental illness. To address this, healthcare reform promotes coordinated, patient-centered primary and behavioral health care delivered by a multidisciplinary team. Partnering with federally qualified health centers At LA HOP 7 in Los Angeles County and San Diego Gateway to Recovery in San Diego County (CA), Telecare has established partnerships with two Federally Qualified Health Centers (FQHCs): Los Angeles Christian Health Centers and Family Health Centers of San Diego. Medical providers from these FQHCs visit our programs weekly to provide primary care to our members, many of whom have not received such care in years. Educating Consumers about health At Transitions in San Mateo County, CA, the program has implemented a rigorous health education component for members, focusing specifically on diabetes. It includes medically-supervised training on nutrition and blood glucose monitoring. Partnering with Acute Care Hospitals and Medical Centers to Provide GeroPsychiatric Services As the nation s population ages, the demand for specialized geropsychiatric care is growing dramatically. Telecare has partnered with acute care hospitals and medical centers to develop and manage inpatient geropsychiatric services for their older patients. These services enable older adults to receive both medical and behavioral health services at a single location, improving access to care, while reducing the stigma that can be associated with mental health treatment. Telecare currently operates a 15-bed unit at Eisenhower Medical Center in Rancho Mirage, CA; a 21-bed unit with Ohio Valley General Hospital in Pittsburgh, PA; and most recently partnered with the University of New Mexico Sandoval Regional Medical Center in Albuquerque, NM, to open a 12-bed program this summer. july 2012 Telecare Corporation 15

16 implementing health reform telecare recovery partnership staff host a holiday drive benefitting local community Business intelligence (BI) allows telecare to track outcomes trends more efficiently Payment Reform & Population Management In 2011, the federal government announced a population health management initiative to develop better ways to coordinate care and prevent unnecessary hospitalization for people with Medicare and Medicaid coverage ( dual eligibles ) who have complex and costly health care needs. Partnering with Health Plans on Population Management Working with managed health care plans, we have successfully demonstrated our ability to manage specific populations and achieve pay for performance targets. Our Recovery Partnership program with Optum Healthcare in Washington State has converted a target number of initial involuntary detentions to voluntary stays for the residents. Working with Kaiser Permanente in San Diego, the Kaiser Program for Intensive Community Support has consistently demonstrated 60% decreases in psychiatric hospitalization rates, as well as extremely high client satisfaction and quality of life measures. Investing in technology to deliver Excellent Outcomes Telecare is investing in technology and infrastructure to ensure we deliver excellent outcomes for managed populations. Our Business Intelligence (BI) efforts include a broad array of applications and technologies that help us merge service utilization data, outcome data, level of care assessments, and other information to track outcomes, identify trends, and develop systems of care that best meet consumers needs. For example, with more than 30 different Assertive Community Treatment or Full Service Partnership programs in four different states, BI enables us to compare each program s performance and compare them against statewide benchmarks. 16 Telecare Corporation july 2012

17 implementing health reform la casa staff celbrate social workers month CHANGES provides a new level of service for people with higher substance abuse needs Substance Abuse Services Persons with SMI are disproportionately impacted by substance use the literature states that nearly 60% of individuals with bipolar disorder and 52% of persons with schizophrenia have a cooccurring substance use disorder. The incidence of co-occurring disorders is even higher among Telecare s clients. We estimate that 70% of our clients are living with these challenges. Healthcare reform addresses underfunding of substance abuse treatment by expanding Medicaid eligibility to nondisabled adults and by mandating parity, which assures that mental health and substance abuse services are part of the essential benefit package. In Alameda County, we have adapted our CHANGES Dual Recovery Program to create a new level of service for individuals with lower level mental health needs and higher level substance abuse needs. Based on an in-depth internal assessment, Telecare has begun strengthening its ability to provide formal co-occurring disorders (COD) treatment. This is being achieved through a variety of new initiatives, including: mandatory substance abuse training for clinical staff; adapting Telecare s Recovery-Centered Clinical System (RCCS) to address COD; and implementing COD screening and treatment capabilities. Skill Development & Training Telecare has teamed with strategic partners, including the Matrix Institute, a leading provider of substance use treatment and research. In Los Angeles County, Telecare s La Casa MHRC has partnered with Matrix to research how its model can be adapted to the needs of persons with serious mental illness in inpatient settings. Telecare s la casa mhrc has teamed with The matrix institute to adapt the matrix model july 2012 Telecare Corporation 17

18 Advocating for the future of behavioral health Advocating for the Future of Behavioral Health As a mission-driven company, Telecare advocates in the public policy realm for broad access to quality behavioral health services, and also for a behavioral health care system that is recovery-focused at all levels of care. The current period of dynamic change has presented opportunities for Telecare to work with advocates and policy makers at the local, state, and federal levels to ensure that the needs and interests of people with serious mental illness do not get lost among other important priorities. State Hospital and Institution Alternatives Telecare believes strongly that people with serious mental illness do best living and being provided services in the least restrictive, most integrated settings possible. For those who require longer-term secure settings, we advocate for the use of smaller, more home-like residential treatment programs closer to consumers home communities. Taking Action Acting on these beliefs in California, we have reached out to county mental health directors about the 16-bed Mental Health Rehabilitation Center model as an alternative to institutional environments. In Oregon, we worked under the auspices of the Oregon Residential Providers Association (ORPA) to oppose construction of a new State mental hospital, and support smaller, more cost-efficient community-based alternatives like our Secure Residential Treatment programs in Portland, Gresham, Woodburn and Bend. In partnership with ORPA, Telecare has met with the Governor and his staff and is part of a stakeholder group advising the State Department of Addictions and Mental Health (AMH) on a new continuum of care. Similarly, in Nebraska, Telecare has worked closely with Regional Behavioral Health Authorities to develop Medicaid reimbursable 16-bed secure residential programs in Omaha and Bellevue with plans for future programs in additional regions. Healthcare Access and Affordability We believe healthcare plans with carved in specialty behavioral health can promote better integration of physical and behavioral health services. However, people with SMI are often underserved and vulnerable when navigating the system of care. Adequate resources and specialized skills are essential. Taking Action Acting on our concerns, we are closely monitoring developments and advocating for integrated behavioral healthcare models that recognize the complex care coordination needs of people with SMI. We strongly advocate that the dollars available for mental health services should not be reduced when carve-in programs take effect, as mental health dollars have historically been reduced when the needs of the broader health care system have taken priority. 18 Telecare Corporation july 2012

19 Advocating for the future of behavioral health Recovery center at Woodburn, a secure residential treatment program in Oregon Region six recovery center, a 16-bed secure residential program in Omaha, Nebraska Telecare actively participates in stakeholder groups in Washington, Oregon and California that are consulting on the design of new dual eligible pilot programs to be sure that these new integrated approaches deliver affordable and effective healthcare without sacrificing access to quality behavioral healthcare. In California, the decision was made to eliminate the Department of Mental Health due to State budget challenges. Telecare worked with the ACCESS Coalition and other community stakeholders to ensure that the loss of this agency did not result in a diminished focus on the needs of persons with serious mental illness. Legislation and Public Policy We believe effective legislation has the power to shape systems and transform lives. Taking Action Criminal Justice We believe that the principles of recovery and rehabilitation can be applied to offenders with serious mental illness. Effective treatment and daily living supports can reduce recidivism and improve lives, while being cost-effective. Taking Action Acting on these principles, Telecare partnered with the California Department of Corrections and Rehabilitation (CDCR) to bring Assertive Community Treatment (ACT) services to parolees with serious mental illness, who previously had access only to clinic-based outpatient services. In the months leading up to AB109 implementation, Telecare also circulated a position paper arguing for adequate behavioral health resources for the population coming out of prison and into community supervision. Acting in partnership with ACCESS Coalition and Mental Health Irregulars, Telecare works with other California service providers, public entities, and mental health professional associations to review legislation and public policy relevant to people with SMI and eliminate barriers to care. july 2012 Telecare Corporation 19

20 Telecare Snapshot Services Since 1965, Telecare has evolved to address the changing needs of people with serious mental illness (SMI). Today, we provide and manage an array of services from inpatient and communitybased programs to crisis, residential, and care management. We also provide specialized services to individuals who face other challenges in addition to their mental illness. These individuals may be homeless, incarcerated, developmentally disabled, have medical issues associated with aging, or face addiction issues. Telecare serves adults, older adults, and adolescents particularly those who may require more intensive, recovery-centered mental health programs. Awards In FY10-11, Telecare was once again named one of the Top 100 Best Places to Work in the Greater Bay Area. We are deeply proud of our staff and the work they do to support individuals in recovery. In FY11-12, Telecare San Diego received the San Diego Mental Health Director s 2012 Program of the Year Award. Also in FY11-12, Telecare s San Bernardino FACT program received an Achievement Award from the National Association of Counties (NaCo). telecare corporation 1080 marina village pkwy, suite 100, alameda, ca 94501, ,