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

121 Attachment L County Program HOUSING PLAN A part of an OMHSAS requirement, Bucks County submitted its first Housing Plan in The plan follows this summary. We continue to use the plan to guide our efforts in addressing housing issues in Bucks County. As part of the plan, we identified five areas of focus: 1. Individuals currently inpatient at NSH or who are at risk of being admitted to NSH 2. Individuals with a mental illness in the community who need housing options 3. Individuals who are homeless who have a mental illness 4. Individuals who have a mental illness who are involved in the criminal justice system 5. Transition age youth who have a mental illness An important project which had been identified in the housing plan is the Penn Villa Project. Groundbreaking for Penn Villa occurred on May 19, Penn Villa came about after eighteen years of planning by the Penn Foundation Housing Task Force, which was comprised of professionals, family members, and consumers. This project is an integrated community of one group home, which will be licensed as a Maximum Community Residential Rehabilitation Services (CRRS) Program, serving 8 individuals, and 5 townhomes, which will provide housing for 15 people in Supported Living. Penn Villa was made possible through years of engendering support for the project from a variety of sources, including the Pennsylvania Housing Finance Administration (PHFA) Exchange funds provided by the American Recovery and Reinvestment Act, Bucks County HOME funds, the Pittsburgh Federal Home Loan Bank Affordable Housing Program, 12 Project Based Section 8 Vouchers through the Bucks County Housing Authority, Bucks County HealthChoices Reinvestment funds through Bucks County Behavioral Health System, and Mental Health/Developmental Program funds through Bucks and Montgomery Counties, which are designated for support services. This project is slated for implementation June or July of We have made significant progress in addressing the needs of individuals who are homeless who have a mental illness. In January 2011, Bucks County conducted its Homeless Point In Time Survey as part of the County s Housing and Urban Development (HUD) Continuum of Care Plan. Of the 32 individuals who were identified as homeless, 8 have a mental illness. The majority of individuals were residing in an encampment in the Lower Bucks area. We were recently informed Attachment L Page 119

122 that the owner of the land has requested assistance with helping individuals find alternate living arrangements for possible sale of the land. The Bucks County MH Housing Specialist along with staff through the Programs for Assistance in Transitioning from Homelessness PATH program have been participating in the identification of supports needed in order to assist individuals in obtaining housing options as well as accessing treatment and case management services. Another agency that has been involved in this process is the AHTN who the county collaborated with as part of its Code Blue initiative. During this past winter, PATH staff worked collaboratively with the AHTN and Reach Out, a county consumer drop-in center, in order to ensure that individuals received shelter and food during a Code Blue declaration. As part of Code Blue, PATH staff have formed relationships with several individuals at the encampment, which will soon be closed and will be of assistance in identifying alternative support services. Another area in which PATH has been instrumental has been in regard to individuals who have served their maximum sentence at state and local correctional facilities. Addressing the needs of individuals in the state system is much more difficult as those individuals typically have not been involved with the system or any support system for extended periods of time. PATH staff, treatment team staff, and county office staff are currently developing a process to ensure that individuals returning to Bucks County from a state correctional facility are able to get re-established with needed supports including housing options. In fiscal year 2011/2012, we anticipate discharging approximately 20 individuals from NSH through CHIPPs. We are planning on developing services to support individuals that have more intensive medical concerns. We expect this will include residential options. In July 2009, The Bucks County Behavioral Health System (BCBHS) utilized reinvestment funds to hire a BCBHS Housing Specialist whose main focus was housing development. Several resources were developed including an Apartment Locator website which provides a user friendly approach to detailing local housing options. In addition, the BCBHS Housing Specialist developed a Shared Living Program which provides low income housing. Through a matching process, consumers were able to be connected with others who were also in need of housing. Service linkages and supports are provided by case management, certified peer specialists, supports coordinators, etc., within the existent service system to increase the likelihood of success. Although the majority of individuals that have been referred to the program are adults, there have also been a number of transitional age youth. Another initiative, which was introduced by the BCBHS Housing Specialist to Bucks County, was the creation of a Centralized Waiting List for MH Housing and Residential Services. We anticipate that this will assist us in providing a more coordinated approach to service utilization. The centralized waiting is under development, and its implementation is anticipated on July 1, Attachment L Page 120

123 Bucks County s Local Housing Options Team (LHOT) is currently in the process of re-establishing itself in order to incorporate a broader approach to housing development. It has been re-established as an Ad Hoc committee of the Bucks County Housing Coalition. The LHOT will be focusing on the following goals for 2011: 1. Review the housing options for individuals who have a mental illness who are transitioning out of nursing homes. Members of the LHOT are partnering with staff from the local JEVS agency and staff from Bucks County Area Agency on Aging. 2. Develop a revised Housing Plan that addresses development opportunities. 3. Provide a housing/residential clearinghouse of information. Below is the Housing Plan that has been in effect since This year the LHOT will be developing a new Plan that helps to focus Bucks County s efforts around developing housing opportunities. The following Housing Plan Updates/Changes are additions to the Bucks County Housing Plan: - A proposal for the development of a medically enhanced supported housing program through the utilization of Community Hospital Integration Projects Program (CHIPP) Funds that would serve ten adults who have both psychiatric and medical needs. - A proposal for the development of a Long Term Structured Residence (LTSR), through the utilization of CHIPP funds, that would serve eight to twelve adults who could benefit from a secure, highly structured therapeutic residential mental health treatment facility. - The development of two HUD Shelter Plus Care Grants (for FY 2010 and FY 2011) that provide sponsor based rental subsidies and an array of mental health services and service linkages to four individuals who are homeless and have a mental illness. These projects are to be provided in conjunction with the Penndel Mental Health Center (PMHC) PATH Program. The PATH Program has collaborated with the Bucks County Housing Group as the landlord for these projects. - A proposal for the development of a Transition Age Youth Supported Housing/Host Home(s) Program, through the utilization of HealthChoices reinvestment funds, with a mobile psychiatric rehabilitation component that would serve six transition age youth (ages 18-22). - A proposal for the development of a Forensic Housing/Peer Support Program through the utilization of HealthChoices reinvestment funding. This pilot project, which is proposed by Penn Foundation, would provide Tenant Based Rental Assistance (TBRA) to 8 to 10 individuals and peer support services to 23 to 25 individuals annually. Attachment L Page 121

124 Summary of Housing Plan Updates Housing Plan Updates/Changes Medically Enhanced Program Target Population: Bucks County proposes to develop a medically enhanced supported housing program through the utilization of CHIPP funds. The program would provide limited clinical and rehabilitative supports necessary for ten adults who have both psychiatric and medical needs and are currently inpatient. Brief Description Of Program Or Services: This service would provide supportive housing to individuals, who have psychiatric and medical needs, within handicapped accessible housing. The supports would alter as an individual s needs change, allowing him/her to maintain his/her housing. The intent of this program would be to provide necessary staff support, when required, and to allow for a level of independence within community integrated housing. Individuals would be provided supports including the facilitation of a Wellness Recovery Action Plan (WRAP), peer support, community integrated activities, and the Implementation of Illness Management, and Recovery and Integrated Treatment for Co-occurring Disorders. Other services include the provision of recovery-oriented clinical services, including psychiatric consultation, nursing, medication management, monitoring of physical well-being, and the coordination of medical services. Summarize The Changes Being Made Through This Update: The impetus for this program was as a result of Bucks County s response to the number of individuals who remain at NSH who present with physical health concerns. As part of this year s CHIPP, Bucks County is discharging twenty individuals from Norristown State Hospital (NSH) and has been provided a CHIPP allocation to fund this transition. Additionally, there are a number of individuals who are residents within existing community-based programs who will also benefit from this type of program. Description Of Fund Expenditures: The following are the anticipated costs related to this program: Startup and capital expenses: $342,798 (Start up, capital, and other occupancy costs are $99,536) Operating Expenses Year 1: $814,481 (Capital and other occupancy costs are $116,608) Operating Expenses Year 2: $831,276 (Capital and other occupancy costs are $115,105) Other funding sources such as waiver programs will be evaluated as possible resources to augment the CHIPP allocation for support services that will be provided within this program. Attachment L Page 122

125 Expected Outcomes: The primary goals of the program are to: 1. Advance mental health and co-occurring substance abuse recovery. 2. Strengthen communication and interpersonal skills. 3. Facilitate community integration and participation. 4. Develop and support independent living skills. 5. Improve the quality of life for each person. In order to assess the program s effectiveness, the provider will utilize the following processes: 1. Annual consumer satisfaction surveys. 2. Utilization review to evaluate the timeliness and appropriateness of an individual s services based on the program s efficacy and the thoroughness of coordination among all parties. 3. Documentation compliance and quality through peer review. 4. Program responsiveness to incidents or concerns raised by individuals directly or through the agency s grievance procedure. 5. Development of performance indicators to establish acceptable outcomes. Information gleaned from QI activities will be used to improve services for each person and to identify patterns that may require system modification, staff development, and/or the development of additional resources. 6. The utilization of the Mental Health Recovery Star tool to track individual recovery outcomes and program outcomes. Stakeholder Involvement In Decision Making: The Local Housing Options Team (LHOT) and the Mental Health Planning Committee have endorsed the concept of this program. Both groups have broad stakeholder involvement including, peer specialists, representatives from the Bucks County Area Agency on Aging, provider agencies, representatives from Bucks County Drug and Alcohol system, and representatives from other local government agencies. Housing Plan Updates/Changes Long-Term Structured Residence Target Population: Bucks County proposes to develop a Long-Term Structured Residence (LTSR) through the utilization of CHIPP funds. The program will support both males and females over the age of 18 who are currently inpatient at NSH. Individuals may present with forensic backgrounds, co-occurring mental health and substance abuse disorders, and other challenging behaviors. Additionally, individuals may present medical needs including but not limited to diabetes, polydipsia, dysphasia, and Fragile X Syndrome. Attachment L Page 123

126 Brief Description Of Program Or Services: The LTSR will be a secure, highly structured therapeutic residential mental health treatment facility designed to serve eight to twelve persons who are eighteen (18) years of age and older. A LTSR is intended for those who do not require inpatient hospital care or skilled nursing care but do require treatment and rehabilitation in a secure therapeutic setting. It is expected that the LTSR will strive to promote the acquisition of skills in order to support the individual to exercise self-determination and independence and prevent or decelerate the loss of current skills. The program will be designed to support individuals living in this residence in a culture of safety and recovery. Staffing will include a master s level director, a psychiatrist, 24 hour per day nursing, a licensed psychologist, a recovery coordinator/case manager, a recreation coordinator, direct service staff, a shift manager, a certified peer specialist, and a vocational specialist. Summarize The Changes Being Made Through This Update: The impetus for the development of this program is a result of the number of individuals who remain at NSH who require this level of care. As part of this year s CHIPP, Bucks County is discharging twenty individuals from NSH and has been provided a CHIPP allocation to fund this transition. Although this program is proposed to be developed in fiscal year , the development of this program is contingent upon the availability of adequate funding through CHIPP. Description Of Fund Expenditures: 3/1/12-6/30/12: (As proposed by identified provider) Personnel Expenses: $201,888 Operating expenses: $75,436 Equipment/fixed assets: $315,859 Administrative costs: $94,909 Total expenditures: $688,092 7/1/12-6/30/13: (As proposed by identified provider) Personnel Expenses: $920,453 Operating Expenses: $293,980 Equipment/fixed assets: $46,420 Revenue (room and board): $72,000 Total Expenditures: $1,390,590 As mentioned previously this program will be developed contingent upon the availability of CHIPPS funds. Expected Outcomes: The LTSR will be grounded in three general principles that are applied to all aspects of the program: recovery, trauma-focused care, and community linkage. The program will be designed to support individuals to progress to more independent settings. Attachment L Page 124

127 The following tools will be utilized to measure program outcomes: 1. Recovery Assessment Scale (self-report): The purpose of this scale is to capture evidence of program efficacy in support of the recovery model and facilitating individual empowerment and self-determination. 2. Quality of Life Assessment: The Brief Quality of Life Scale (self-report) will be utilized quarterly to determine each individual s perception of well-being and will guide the development of individualized treatment goals. 3. Satisfaction Survey: Data will be collected quarterly via survey in order to analyze the overall satisfaction of individuals with services provided. These outcome measures will be assessed on a semi-annual basis with certified peer specialists conducting the reviews with residents. On an individual level, this information will become part of the overall assessment process that precedes updating each resident s recovery plan. On a program level, this information will be aggregated and reviewed by program staff to ascertain whether the results indicate a need to develop action plans to improve program performance. Stakeholder Involvement In Decision Making: There were a number of stakeholders who were involved with the proposal review committee. Committee members included peers specialists, (one with a co-occurring mental health/drug and alcohol background), a representative from Bucks County Behavioral Health System, a representative from Magellan Health Services, and representatives from BC MH/DP. Additionally, the concept of this program has been endorsed by the Bucks County LHOT. Housing Plan Updates/Changes HUD Shelter Plus Care Grant Target Population: The Bucks County Department of MH/DP, in concert with Penndel Mental Health Center (PMHC), was awarded a second HUD Shelter Plus Care Sponsor Based Rental Assistance grant in March of 2012 that the county made application for in This project will provide rental subsidies and support services to two adults who are homeless and have a mental illness. Individuals will be identified and served in conjunction with the PMHC PATH Program. Brief Description Of Program: Individuals served by this program will receive rental subsidies and mental health services (e.g. case management, psychosocial rehabilitation, outpatient services, partial hospitalization services, respite Services, CTT) and substance abuse services. Individuals will also have access to Attachment L Page 125

128 employment and educational services, medical services, and other services through case management. Summarize The Changes Being Made Through This Update: This project was identified in the Bucks County Mental Health Housing Plan 2011 Update, however, the application had not yet been operationalized. It is anticipated to begin by the end of CY Description Of Fund Expenditures: The following is an accounting of the costs: The total grant was for $107, units x $900 per unit per month (fair market rate) x 60 months (5 years) = $108,000.The services for this project are the in-kind match of $107,800 for the grant. Expected Outcomes: 1. Two individuals will remain in permanent housing by the end of the operating year or will access alternate permanent housing options. 2. Two individuals, age 18 and older, will maintain or increase their total income (from all sources) at the end of the operating year or by the time they leave the program. 3. Two individuals who are chronically homeless will be provided with case management services to assist them to reside in permanent housing for over six months. Stakeholder Involvement In Decision Making: This project was endorsed by the Bucks County LHOT and the Bucks County Homeless Continuum of Care Committee. These committees are made up of local governmental agencies, provider agencies, consumers, and family members. Housing Plan Updates/Changes HUD Shelter Plus Care Grant Target Population: The Bucks County Department of MH/DP, in concert with PMHC (a 501 C-3 non-profit organization), received funding in January 2012 for a 2010 HUD Shelter Plus Care Grant. The grant was developed as a Sponsor Based Rental Assistance Program that will provide rental subsidies and support services to two adults who are homeless and have a mental illness. Individuals will be identified and served in conjunction with the PMHC PATH Program. Brief Description Of Program: Individuals served by this program will receive rental subsidies, mental health services, (e.g. case management, psychosocial rehabilitation, outpatient services, partial hospitalization services, respite services, CTT) Attachment L Page 126

129 and substance abuse services. Individuals will also have access to employment and education services, medical services, and other services through case management. Summarize The Changes Being Made Through This Update: This project was outlined in the 2011 Bucks County MH Housing Plan update; however, the grant had not been awarded until August This grant has been executed by HUD and the project is currently being implemented. Description Of Fund Expenditures: The following delineates the costs: The total grant award was $108,000. The HUD grant is applied to the rental subsidies. The support services that are being provided are applied as the in-kind match for the grant. 2 units x $ per unit per month (fair market rate) x 60 months (five years) = $109,000. Expected Outcomes: 1. Two individuals who are chronically homeless will be served by this program and will transition to alternate permanent housing. 2. Two individuals who are chronically homeless will reside in permanent housing for over six months. 3. Two individuals who are chronically homeless will obtain employment. Stakeholder Involvement In Decision Making: This project was endorsed by the Bucks County LHOT and the Bucks County Homeless Continuum of Care Committee. These committees are comprised of representatives of local government agencies, provider agencies, consumers, and family members. Housing Plan Updates/Changes Supported Housing for Transition Age Youth Target Population: Through the utilization of HealthChoices reinvestment funds, Bucks County proposes to develop, a Transition Age Youth Supported Housing Program/Host Home(s) Program. This program will serve transition age (18-22) youth that are in need of a structured living environment designed to meet their specialized needs including but not limited to transition from adolescence to adulthood, mental health, co-occurring mental health/drug and alcohol, and other disabilities. Many of the youth will be transitioning from out-of-home placements, such as Psychiatric Residential Treatment Facilities (PRTF) and foster care, or have high utilization of behavioral health Attachment L Page 127

130 services in the child serving systems. The program will be designed to support both males and females. Brief Description Of Program: This specialized transitional living model will provide a well structured therapeutic environment where age appropriate, individualized service plans will be developed to address the needs of the targeted population and, if appropriate, the individual s family. The program will focus on enabling the individual to engage in regular activities inside and outside the program with support and encouragement to pursue the use of age appropriate community based activities when possible. There are two distinct components to this initiative: a three-bed primary residence and a mobile psychiatric rehabilitation service. Additionally, we are developing an interim living arrangement with the Host Home 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. Description Of Fund Expenditures: The funding for this proposal is as follows: Year 1 Personnel: $289,082 Operating Expenses: $120,812 Administrative Costs: $42,629 Total Expenditures: $452,523 Revenue (Room and Board): $18,648 Total Reinvestment Request: $433,875 Year 2 Total Personnel: $294,629 Operating Expenses: $124,473 Administrative costs: $43,587 Total Expenditures: $ Revenue (Room and Board): $18,828 Total Reinvestment Request: $443,861 The provider selected for this initiative will need to identify a site that will be the location for the three-bed primary residence and the three-bed host home(s). A Peer Specialist position will be built into the staffing roster for this initiative. Consideration will be given to billing for the Peer Specialist through HealthChoices. Additionally, funding for the mobile psychiatric rehabilitation will be billed through HealthChoices. Expected Outcomes: 1. Shorter lengths of stay in PRTF for transition age youth. 2. Effective discharge planning from PRTF and long term foster care. Attachment L Page 128

131 3. Improve successful re-integration of youth into their communities. 4. Improve independent living skills. 5. Find and maintain employment or post-secondary education. 6. Increase youth s natural supports and link them to more resources in the community. 7. Transition services from the children serving systems to the adult system to meet the mental health needs of each individual. 8. Person-Centered planning and adherence to the TIP Model for all individuals. Stakeholder Involvement In Decision Making: The need for supported housing for transition age youth was identified by the Bucks County Transition Age Youth and Young Adult workgroup, the Bucks County Children s Coordination Steering Committee, and the Bucks County Integrated Children s Planning Committee. These committees include representatives from the Bucks County Behavioral Health System, MH/DP, Bucks County Drug and Alcohol System, Bucks County Juvenile Probation, Bucks County Children and Youth, and Magellan Health Services. Housing Plan Updates/Changes Forensic Housing/Peer Support Target Population: Bucks County and Penn Foundation, a non-profit behavioral health agency, propose to develop a pilot program through the use of HealthChoices reinvestment funds. The goal will be to establish transitional housing and forensically-trained certified peer support services to address the needs of individuals who have had contact with local police and/or are involved with the county/state correctional system and have a severe and persistent mental illness and/or a co-occurring mental health/substance use disorder. Based on current agency statistics, 15% of this target population reflects transitional age youth aged 18 to 25 years old. Priority will be given to working with individuals within this age group. It is anticipated that 30 to 35 individuals will be served annually through this pilot. It is further anticipated that at least 85% or 26 to 30 individuals will be or will become MA-eligible. Brief Description Of Program Or Services: The proposed pilot will provide transitional Tenant Based Rental Assistance (TBRA) housing in the general community to eight to ten individuals. Peer Support Services will be provided to 23 to 25 individuals annually. The total unduplicated number of individuals served annually is estimated to be 30 to 35. This pilot is expected to provide both the financial and supportive resources to more effectively and efficiently promote and sustain the permanent housing of a very vulnerable target population that is currently disproportionately represented in the prison population and the criminal justice system. We anticipate this program will provide a more timely Attachment L Page 129

132 release from the Bucks County Correctional Facility (BCCF), as well as, a diversionary opportunity. Summarize The Changes Being Made Through This Update: Housing that would support individuals who have a mental illness and are forensically involved has been an identified need for an extensive period of time. Given the lack of resources, the number of individuals with mental illness who are involved with the correctional system has increased. Penn Foundation, which operates the FACT Team and the Village of Hope supported living program along with MH/DP, developed this proposal as a Reinvestment proposal. Description Of Fund Expenditures: The total annual budget for this pilot is $124,652. The above cost includes $43,152 for funding community-based transitional housing arrangements. This figure was established by applying the monthly 2012 HUD Bucks County Fair Market Rate of $899 for a 1-bedroom unit x 12 months x 4 units. This cost also includes $81,500 for salary and benefits which includes 1.5 FTE forensically trained Certified Peer Specialist positions and start-up operating expenses. Efforts will be taken to ultimately support the housing units through a HUD Shelter Plus Care Grant that will be applied for in 2012 by the MH/DP through the Bucks County Continuum of Care Application as part of the Bucks County s Supported Housing Program Application. Any funds awarded through the 2012 HUD application process will be made available in 2012/2013 to subsidize the pilot program. Ongoing funding for Certified Peer Specialist positions will be supported as an in-plan service through HealthChoices. Expected Outcomes: 1. 25% reduction in the number of participants who are released to the Upper Bucks County area from Bucks County Correctional Facility (BCCF) % of participants will remain out of prison during the first year. 3. The 6-month average readmission rate of participants, stepping down from inpatient co-occurring mental health/substance use care, will be 25% or less. 4. Once transitioned into subsequent permanent housing, 75%-80% of participants will sustain their housing for 6 months % of the Village of Hope participants will be competitively employed at the time of discharge. Attachment L Page 130

133 Stakeholder Involvement In Decision Making: Stakeholders include representation from Penn Foundation, BCCF, local Criminal Justice Enforcement departments, Bucks County Adult Probation and Parole Department, the Bucks County LHOT, Bucks County MH/DP, consumers and family members, NAMI, the Bucks County Drug and Alcohol Commission, and Bucks County BHS. Additional updates to Bucks County s efforts to expand and enhance housing options are as follows: - Penn Villa was implemented on June 20, This project, as outlined in last year s housing plan update, is an integrated community consisting of a licensed Maximum Community Residential Rehabilitation Program serving eight individuals and five townhomes that provide housing for fifteen adults. This project was funded through a variety of sources including the Pennsylvania Housing Finance Agency, Bucks County HOME funding, the Pittsburgh Federal Home Loan Bank Affordable Housing Program, twelve Project Based Section eight Vouchers through the Bucks County Housing Authority, Bucks County HealthChoices reinvestment funds, and MH/DP funds through Bucks and Montgomery Counties. - An Unsheltered Homeless Point in Time survey was again conducted in Bucks County in January of 2012 under the auspices of the Bucks County Homeless Continuum of Care Committee. Of the fifty individuals who were identified this year, six have a mental illness and six were identified with a chronic substance abuse disorder. - A centralized waiting list for the mental health residential and housing service system is operating as a pilot focusing on transitional age youth referrals. It is our intention to expand this process to all Bucks County MH residential services in order to ensure that individuals receive the most appropriate services and that programs maintain optimum occupancy. - The Bucks County LHOT, which functions as a sub-committee to the Bucks County Homeless Continuum of Care, has provided its membership with an education regarding the various housing resources and options that are available in the county to individuals with behavioral health challenges. In addition, members of the LHOT have provided input into the Bucks County Mental Health Housing Plan, various reinvestment proposals, the Program for Assistance for Transitioning from Homelessness (PATH) Intended Use Plan, and other housing activities. LHOT membership has been expanded to include a broader cross section of stakeholders who participated in the identification of unmet behavioral health housing needs and advocating for program development that would address those unmet needs Attachment L Page 131

134 - The Bucks County Affordable Apartment Locator website was developed and funded through HealthChoices reinvestment funds. This website, through the Bucks County Housing Group, is maintained by a rental specialist who actively seeks out and posts listings of affordable rentals throughout Bucks County. This popular website is updated weekly and is a resource used by consumers and service providers to find affordable rentals in a very competitive market. The website logs over 750 hits per month and has had approximately 14,000 visits since its inception. Attachment L Page 132

135 COMMONWEALTH OF PENNSYLVANIA OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES DEPARTMENT OF PUBLIC WELFARE DRAFT COUNTY MENTAL HEALTH/ SUBSTANCE ABUSE HOUSING PLAN COUNTY PROGRAM: Bucks CONTACT: Name: Deborah Perry-Neidhardt Title: Mental Health Program Specialist Address: Bucks County Dept. of Mental Health/Developmental Programs 600 Louis Drive, Suite 101, Warminster, PA Phone: SUMMARY OF COUNTY HOUSING PLAN: (UPDATED IN 2011) Please identify the estimated number of housing units/subsidies to be developed (a planned range is allowed), what financing strategies you are employing including, how you will meet OMHSAS guidelines for affordability (no more than 50% of income for housing). The original Housing Plan for Bucks County was submitted in In that plan, the Bucks County Department of Mental Health/Developmental Programs (MH/DP) pledged to take into consideration that the cost for housing to an individual would be no more than 50% of the individual s income. The original plan included a Project Based Operating Subsidy, also known as Penn Villa, which is now slated for implementation early in fiscal year (FY) It will be newly developed permanent housing, and will provide housing to twenty three (23) individuals, in an integrated community setting. The project also includes ten (10) town homes, which will be marketed to the private sector. Funds from the Bucks and Montgomery County Mental Health Departments will be utilized to furnish the support services for this project. Additional funds, which have been utilized to support this project are Pennsylvania Housing Finance Administration (PHFA) Tax Credit exchange funds provided by the American Recovery and Reinvestment Act, Bucks County HOME Program Funds, through the Bucks County Office of Community and Business Development, Affordable Housing Program Funds, through the Federal Home Loan Bank, twelve (12) Project Based Section 8 Vouchers, through the Bucks County Housing Authority, and Bucks County HealthChoices Reinvestment funds. Attachment L Page 133

136 The original plan of 2008 included three Master Leasing (Rental Subsidy) programs. One would be funded through Housing and Urban Development (HUD) Shelter plus Care (SPC) Program, and would serve a maximum of nine (9) individuals who are homeless, if funds were granted over a three year period. Another Master Leasing program would serve six (6) transitional age youth (TAY), and would be funded through HealthChoices. (Please note that the description of the SPC Project was completed in a separate template document, in the appropriate section). The Bucks County Mental Health (MH) Department has submitted proposals over the past three years to HUD for SPC Grants, as part of Exhibit II, of the Bucks County Continuum of Care plan; however, to date funding has not been received. A number of transitional age youth have received housing through a Shared Living Program, which has been developed by the Bucks County Behavioral Health Housing Specialist, in concert with other support service agencies. This program was implemented on May 1, 2010 and partners 2-4 people in apartment settings. The Shared Living Program is funded on a limited basis through HealthChoices reinvestment funds. The Bucks County MH Housing Specialist also collaborated with the Bucks County Housing Authority and the Bucks County Grants Program Coordinator, in writing to a HUD Notice Of Funding Available (NOFA) for 125 additional Non-Elderly Section 8 Vouchers. Unfortunately, Bucks County along, with most other counties in the Commonwealth of Pennsylvania, was unsuccessful in obtaining new vouchers. Bucks County is currently working on its Community Hospital Integration Projects Program (CHIPP) Plan for FY 11/12. The requirement for the development of a Project Based Medically Enhanced Program for several individuals had been identified in the original 2008 housing plan. We have received several proposals, regarding the development of a medically enhanced program. This program will serve four individuals, who have been identified from Norristown State Hospital (NSH), and will be implemented in FY The original plan also included a Transitional Age Housing Specialist Position, which would provide a housing Clearinghouse function, primarily for Transitional Age Youth. A Behavioral Health Housing Specialist was hired in June of 2009, and the role of this position was to find transitional and long term housing for young adults transitioning into adulthood who have Mental Illness and/or co-occurring MH and Substance Use Disorders. In addition to resource identification and placements, this individual also, developed training relative to housing and working with landlords, consumers as tenants, MH and Substance Abuse agency staff, and community residents and officials. The Behavioral Health Housing Specialist has designed and maintained a web-based affordable housing locator ( which assists all low-income residents of Bucks County. Another initiative which was introduced was the creation of a Centralized Waiting List for MH Residential and Housing Services. We anticipate that this will assist us to provide a more coordinated approach to service utilization, and expect the implementation of the Centralized Waiting List to occur on July 1, The original 2008 housing plan also included a proposal for the development of a Bridge Subsidy Program for tenant based rental assistance, funded through the CHIPP plan. This program would serve a maximum of forty (40) individuals annually, or one hundred and twenty (120) over a three year period. The program would work in concert with the existing Attachment L Page 134

137 Section 8 Program in Bucks County. This proposal has not been implemented due to no available CHIPPs funding. Individuals continue to be assisted on a case by case basis, through several resources, including PATH funds and funds through the Bucks County Opportunity Council. Also included in the original 2008 housing plan, was a proposal for housing contingency funds, through the CHIPPs plan that would address the requirements of ten to fifteen (10 to 15) individuals annually, or seventy five (75) individuals over the three year term of the plan. This proposal also has not been implemented, due to no available CHIPPs funding. Individuals continue to be assisted on a case by case basis, through other resources. The original 2008 housing plan also included Housing Support/Support Services, which would provide housing for five to twenty-five (5 to 25) individuals over a five year (5) period. Housing would be supported through the CHIPPs plan. Support services will be funded through County base dollars, Medical Assistance, and HealthChoices funds. Although, the CHIPP funds have not been in place to the degree necessary to support this plan, housing support services have been furnished to consumers, through the sources listed above, as well as, through the PATH Program, which has been a common thread countywide for service linkages, for those who are homeless and mentally ill. In addition, a recently convened Nursing Home Transition sub-committee of the Bucks County Local Housing Options Team (LHOT) is reviewing options for those who are interested in transitioning out of nursing homes in Bucks County. Members of this committee include a representative of Bucks County Area Agency on Aging (AAA), a representative from JEVS, the Bucks County Housing Authority Director, a representative from the Center for Independent Living (CIL), the Bucks County MH Housing Specialist, a MH residential housing provider director, the Deputy Director for the Bucks County Office of Community and Business Development, the regional housing coordinator for Bucks County, and representatives from Diana T. Myers and Associates a consultant contracted with the Commonwealth of Pennsylvania, to facilitate nursing home transitions. Several Pennsylvania waiver programs will be evaluated as, possible resources for supporting individuals who are interested in transitioning from nursing homes. It is also anticipated that much collaboration will occur, given the individuals who are participating on this committee. Bucks County has had numerous discussions with Kim Stucke and others regarding the development of a Fairweather Lodge. This was not requested in the 2008 Housing Plan, because at that time there was a requirement by OMHSAS that counties have a fund source commitment to support the program. Bucks County feels that this program model is valuable and will continue to evaluate the feasibility of developing a Fairweather Lodge. * Please also see attached documents to this plan including a Table of Organization for the Bucks County Department of Mental Health and the Bucks County Mental Health Residential Survey. Attachment L Page 135

138 Note: All references to MH Funding Streams in this Housing Plan document refer to one or a combination of HealthChoices Reinvestment funds, Community Hospital Integration Program Project (CHIPPs) funds, and Base Funds. I. FUNDING REQUEST: X 1. Capital Funding Amount: $135,000 Source*: Reinvestment Included in Penn Villa as part of # 2 below. X 2. PHFA Project Based Operating Subsidy Amount: $442,144 (Bucks and Montgomery Counties Office of MH Source: Base, CHIPPS) Other Funding For Penn Villa: $3,380,824 PHFA tax credit exchange funds American Recovery/Investment Act $780,000 Bucks County HOMES funds $390,000 Pittsburgh Federal Home Loan Bank Affordable Housing Program. $135,000 Bucks County HealthChoices Reinvestment Funds X 3A. Master Leasing (Rental Subsidy) Total Subsidy Request: $153,000 total requested. (Over three years) TAY Program, BCBHS Housing Specialist/Shared Living Program Source: HealthChoices Reinvestment 3B. Master Leasing (Rental Subsidy) Total Subsidy Request :( $200,940-average cost over 3 years) Source: (HUD-SPC-$200,940) 3C. Master Leasing (Rental Subsidy and supports) Total Subsidy Request: $2,475,000 ($275,000 (Start up) $440,000 to $450,000(annually)/over five years) Medically Enhanced Program: Source: CHIPPs Funds X 4. Bridge Subsidy Program (Tenant-Based Rental Subsidy) (*Proposed In 2008 Not implemented) X 5. Program Management/Clearinghouse (* Proposed in Not Implemented) X 6. Housing Contingency Fund (*Proposed in Not Implemented) X 7. Housing Support/ Support Services Attachment L Page 136

139 Amount: $405,000 over three years Source: HealthChoices Reinvestment Funds 8. Fairweather Lodge and/or Evidenced-Based Supportive Housing (New Initiative) Amount: $300,000 (start up), $70,000 (annually) Source: To be identified Total Funding Request from all sources: 1. $ 135,000 (duplicate only added once) 2. $4, (excluding the above reinvestment funds-total Project Cost) a. $ 153,000 b. $ 200,940 c. $ 2,525,000 ( Start up and five year funding) 3. NA (Not included in current housing plan) 4. NA (Not included in current housing plan) 5. NA(Not included in current housing plan) 6. $ 135, $ 440,000 Total $8,699,644 * Sources: If more than one source add additional lines HealthChoices Reinvestment CHIPPs Funds Base Funds Other (specify in responses above)*see Penn Villa fund sources. Attachment L Page 137

140 II. ANALYSIS OF EXISTING AND POTENTIAL RESOURCES AND LOCAL CAPACITY: In order to develop a strategic use of MH Funding Streams for supportive housing, it is important to identify the availability or lack of availability of resources in your county. In your responses to this section of the Plan, please highlight any unique opportunities (funding or real estate market) that you would like to take advantage of as part of this plan. Please complete Attachment A to identify current available housing resources for people with mental illness or attach your current resource inventory if one exists that includes all of the information requested on Attachment A. 1. Capital Funds, Rental Subsidies, Loans: Identify city/county/state/federal housing development resources, such as local housing trust funds, HOME or CDBG; State HOME or other DCED funds; PHFA PennHOMES or Low Income Housing Tax Credits; Federal Home Loan Bank Affordable Housing Program or, HUD McKinney-Vento Homeless Assistance Program or Section 811 Program. Also include sources of rental assistance such as Housing Choice Vouchers (Section 8) or other rental subsidy programs. Include resources that have been used to develop both existing housing and sources for housing now under development. The information in Column H of Attachment A should be used in completing this section of the plan. In reviewing the Bucks County MH Residential Survey, there is an array of housing and residential services that have been developed since There are a total of 86 Community Residential Rehabilitation Services (CRRS) residential slots remaining in Bucks County funded through OMHSAS base funding. There are a total of 77 Supported Living slots, also funded through OMHSAS Base funding and CHIPP funds. In addition, there is an Alumni Program operated by Penn Foundation, which provides housing support to 35 to 50 individuals annually, who have graduated from the residential program and are living in the community. The Bucks County Section 8 Local Preference Program for those with Behavioral Health challenges closed in March of 2009 because the Bucks County Housing Authority s as funding had been revised by HUD, making it impossible for the Housing Authority to financially support the local preference program. However, it is estimated by the Bucks County Housing Authority that approximately four to five hundred ( ) individuals with Mental Illness, currently have Section 8 Vouchers. Individuals may still access Section 8 Vouchers, through applications to the Housing Authority through the Non-elderly Disabled waiting List. Bucks County was successful in receiving a significant SPC Grant from HUD, which was implemented in This program serves 23 individuals, within various housing options throughout Bucks County. This program required HUD, Community Development Block Grant (CDBG), Bucks County Housing Trust Funds, and Home Program funds for site acquisition and development. One of the sites for this program was acquired through the Federal Base Closure process for a Naval Air Warfare Center. There are four housing/residential providers that participate in this program. Support service funds are mostly CHIPPs for this program. The Bucks County Housing Authority acted as the Attachment L Page 138

141 sponsor for this program and currently administers the program s fiscal and reporting requirements. This project continues to operate on extension of the SPC funds through HUD. One of the county s freestanding residential providers has been successful in obtaining 2 Section 811 HUD grants, which serve a total of 13 individuals. OMHSAS Base funding supports the services for these programs. There are several HUD Supported Housing Programs (SHP) within the county. One of these is the Village Of Hope, operated by Penn Foundation, which serves eight men and eight women and provides residential services for those with mental health and cooccurring substance use disorders. The service funds for this program are CHIPPs and County base funding. Another Penn Foundation Program is Penn Gardens, which is a HUD Section 202/8 Program, which is supported through case management services and the Penn Foundation Alumni Program. Penndel Mental Health Center (PMHC) received a HUD SHP grant, which serves 12 individuals, who have been homeless prior to placement. The support funds for this program are CHIPPs and County base funding. Lenape Valley Foundation operates a Respite Program, for four individuals. This program furnishes respite, step-down and inpatient diversion services to those in the community. The site for this program was acquired through CHIPPs and the services are supported by CHIPPs and County base funding. The county is currently supplementing 20 people annually in community settings. These funds are also utilized as rental subsidies and housing contingency funds. Over the past several years, we have begun supporting more people in their own apartments. There is a Regional Long Term Structured Residence (LTSR) in Bucks County, serving 16 individuals who have a mental illness. This program is supported CHIPPs and base funding. Additionally, on May 1, 2010, the Behavioral Health Housing Specialist and the Bucks County Housing Group, in concert with other stakeholders, implemented the Shared Living Program that partners 2-4 people in housing to create an economy of scale. Nine individuals have been placed to date county-wide. The Behavioral Health Housing Specialist also designed and maintains a web based affordable housing locator ( which assists all low income residents of Bucks county. 2. Housing Development Capacity: Availability of local organizations who can develop affordable rental housing in a competitive environment and assessment of the need for capacity building for expanded affordable housing development. The Bucks County Department of MH has had some dialogue with the Interfaith Housing Development Corporation (IHDC), a private non-profit housing development agency, around the development of rental housing. There has been recent collaboration with Attachment L Page 139

142 IHDC and other interested Behavioral Health and other homeless serving agencies around the closure of a homeless encampment in lower Bucks County. We anticipate that additional housing options will come out of this process. This Department will continue to explore the feasibility of pursuing rental housing availability through this agency, and others, as appropriate. 3. Housing-Related Administration and Management: Potential organizations who can act as administrator of rental resources, manage contingency funds, housing clearinghouse, selection and waiting list management and tenancy facilitation. To avoid conflict of interest, this organization should be separate from housing development organization(s) if housing development funds are to be managed at local level. As the Bucks County MH Department has not dealt with any significant amount of contingency funds and rental resources in the past, the Department has not identified an outside management resource to oversee the expenditure of these funds. We also believe that it is important to use our current housing dollars for housing. If contingency funds expand beyond our ability to administer the funds in-house, we will pursue administrative assistance through other agencies. 4. Services Capacity: Potential mainstream or specialty providers who can provide housing support as a stand alone or integrated service. Describe any CTTs, ACT or other comparable services that are available in the county and can also be identified as services that provide a clinical home ; describe progress on Peer Services implementation. There is currently an Assertive Community Treatment (ACT) team through Lenape Valley Foundation (LVF) that serves individuals within the central and upper Bucks County areas. There is a Community Treatment Team (CTT) through PMHC that serves individuals within southern Bucks County. In addition, there is an ACT that was developed at Penn Foundation (PF) which serves individuals who have become involved with the criminal justice system and reside in the Northern part Bucks County. Bucks County values the Certified Peer Specialist (CPS) concept. Several programs have CPS embedded within them. These include but are not limited to: ACT, CTT, Forsythia Gate, LTSR, Wellspring Clubhouse, and the Acute Partial Programs. The three Base Service Units and the Family Service Association of Bucks County (a private counseling agency) have all been certified to operate a CPS Program. A CPS training was conducted by Recovery Innovations in July 2008, and we will be holding another training through the Mental Health Association of Southeastern Pennsylvania in October Bucks County employs a CPS to work with the Bucks County Behavioral Health System, the Bucks County MH/DP and the Bucks County Drug and Alcohol Commission, Inc. This CPS works with providers to provide technical assistance for CPS program start-up, providing WRAP classes with CPS from provider agencies as well as being an active member of the team in all aspects of planning and program development. Attachment L Page 140

143 III. LOCAL PLANNING/COUNTY MH/DP PROGRAM STAFFING 1. Please describe your Local Housing Options Team (LHOT) or other local housing planning effort that serves a similar purpose. Identify what role the LHOT (or other group) will play in the implementation of this Plan. Please briefly describe the membership of the team/group by title or representation. Bucks County had established a LHOT in April of 2004 as a subcommittee of the Bucks County Housing Coalition (which is also the Continuum of Care Planning Committee). In addition, the Bucks County MH Housing Planning Committee was established in the fall of 2007 in an effort to involve individuals who had not participated in the LHOT. The two groups have been consolidated into one committee. The committee at that time consisted of five peers, a representative from NAMI, two representatives from Bucks County Behavioral Health, the Director of the Bucks County Housing Authority, four representatives from MH housing/residential provider agencies, and seven representatives from Bucks County MH/DP. Additionally, other members of the Bucks County Housing Coalition participated on this committee. It is anticipated that several of the members of the MH Housing Planning /LHOT committee, including peers, will remain involved with the actual implementation of the Bucks County MH Housing Plan. Although, the LHOT committee has once again been re-structured, and a number of consumers continue to actively participate. 2. Please identify other local or state housing planning processes (i.e. Continuum of Care planning process) in which either County MH/DP staff or other local stakeholders have actively participated. Describe the entities that have participated and the extent of involvement. The Bucks County MH Housing Specialist has actively participated on the Bucks County s Continuum of Care Planning Committee (Bucks County Housing Coalition) since its inception. In addition, several staff from Bucks County MH housing/residential agencies also participate. The Bucks County LHOT is a subcommittee of the parent committee. The Bucks County MH Housing Specialist has taken the lead in organizing the annual Unsheltered Homeless Point in Time survey since the first count in OMHSAS expects that the planning process used to develop the County Housing Plan be peer driven. Please describe how your County involved MH/DP peers in developing the proposed Housing Plan and how peers will be involved in the ongoing implementation and evaluation of the program approach(es). If the County has not already conducted a housing choice or preference survey to better assess what types of housing opportunities peers prefer; please make arrangements to complete such a survey as part of the implementation of your housing plan. Describe results and/or plans. Please indicate if you need technical assistance to complete this survey/needs assessment. Attachment L Page 141

144 The Bucks County MH Department established a MH Housing Planning Committee, which was combined with the LHOT in 2008, in order to develop the Housing Plan. There were five peers on the committee, and many also participated on the various target population subcommittees. Consumers, particularly through the development of the Penn Villa Project, have continued to actively participate through input in an advisory capacity. As mentioned previously, a number of consumers continue to actively participate on the LHOT, which is the forum within the county MH system for stimulating ideas for improving the MH residential and housing service system. NAMI of Bucks County conducted a housing needs assessment survey in The Bucks County MH Housing Specialist acted in an advisory capacity to that process. The results of that survey were included within this document. 4. Please identify your lead staff person to implement this plan and identify where this individual is located within the organization. Attach an organizational chart if available. The MH Housing Specialist has taken the primary lead in the development of the Bucks County MH Housing Plan. The Deputy Administrator for MH also participated in this process. In addition, other Bucks County MH Departmental staff have participated in both the MH Housing Planning Committee and in the sub-committee meetings. The MH Housing Specialist collaborates on an on-going basis with the CHIPPs Director and CHIPPs Coordinator, the Bucks County Behavioral Health Services (BCBHS) Housing Specialist, case managers from all MH service providers, the PATH Program, the MH Residential Directors, as well as staff from other housing related agencies within Bucks County. The MH Housing Specialist is classified as a MH Program Specialist II and works directly under the Deputy Administrator for MH. *See Attached Table of Organization IV. IDENTIFICATION OF PRIORITY CONSUMER GROUP: Identify up to four priority groups (if using HealthChoices persons targeted must be MA eligible) for these targeted housing resources. You have a choice of listing them all as high priority or may be listed in descending priority order; please indicate which method you are using. Counties can choose to identify the priority group by age, type of disability/need or other designation. In the rationale for priority, please discuss why the priority group is most in need of permanent housing to be created by this initiative. Provide local or state data and statistics to support your priority consumer targeting plan. In the rationale for priority, please describe any strategic, systems considerations for identifying a priority consumer group. Keep in mind that Reinvestment funds must be targeted to address the unmet need for permanent supportive housing among MA eligible persons in your County. Attachment L Page 142

145 Priority Group 1: Transition Age Youth Rationale for Priority: Several years ago, Bucks County had identified Transitional Age Youth as a priority population (youth who are ages 18-26). Subsequently the Transition Age Youth (TAY) Subcommittee was created to make recommendations for improved services and supports for Transition Age Youth. The subcommittee was charged with planning services for transition age youth with Serious Emotional Disturbance, Severe Mental Illness, and those with co-occurring MH/Substance Use Disorders. The TAY sub-committee and the Bucks County Consumer Satisfaction Team (BCCST) {now known as Voice and Vision, Inc.} conducted interviews and focus groups with over 80 transition age youth. Both the TAY/BCCST interview/focus group process and the Housing Needs Assessment Survey, which was conducted by the Bucks County NAMI, identified safe, affordable housing as a significant requirement for this population. A study which was conducted by the Center for Impact Research (Chicago, 2005), which included 400 surveys of homeless youth ages 14-21, evaluated the length, frequency and causes of homelessness. Of those surveyed, 52% indicated that the length of the homeless episode was greater than two months. Three-quarters of the youth had been homeless multiple times and had been without safe and stable housing for over a year, and one-quarter had been homeless for over three years. Factors contributing to homelessness included bad relationship to family, domestic violence, family economics, and drug and alcohol use by family. In another study conducted by the Northwest Foster Care Alumni/Casey Family Programs, 659 alumni were surveyed and evaluated income levels, in correlation to housing and health insurance. For those surveyed who were between the ages 18-24, one-third had incomes at or below the federal poverty level, one-third was without health insurance and nearly a quarter had experienced homelessness. In a Housing Needs Assessment, which was conducted by Bucks County NAMI ( ), 470 individuals were surveyed. Of the 79 transitional youth ages surveyed, 9% indicated that they were homeless at the time of the survey. Also, it is significant to note that decent, affordable, and permanent housing is widely recognized as a major component in recovery of those with mental illness and/or substance use disorders. This requirement is particularly acute among the transition age youth and in geographic areas such as Bucks County where housing and rental costs are higher than the state and national averages. Stable housing linked to services is critical to assisting homeless youth to transition successfully to adulthood. Regarding unmet and under-met needs: within Bucks County, there are notable insufficient support services and resources for transition age youth with Serious Emotional Disturbances, Serious Mental Illness, and Co-occurring Mental Illness and Substance Abuse Disorders. In addition, there are significant system barriers, which include separate funding stream and criteria for adolescent and adult services, lack of coordination, planning, and understanding between the adolescent and adult systems, lack of co-occurring mental health and substance abuse services, and a lack of affordable housing within Bucks County. Attachment L Page 143

146 Priority Group 2: Norristown State Hospital. Severely Mentally Ill and Co-occurring (Mental Health and Substance Abuse Disorder) Population Rationale for Priority: According to a Bucks County Housing Needs Assessment Survey, which was conducted by NAMI of Bucks County in 2007, 100% (or 446) of the respondents in that survey had a significant MH diagnosis. Further, according to the survey, 77% of these individuals indicated that they could benefit from housing that would better address their needs. In Bucks County there are currently 200 individuals on the waiting list for housing and/or residential services. In addition to this, there are currently 40 Bucks County residents who are receiving treatment at NSH with varying lengths of stay (LOS). Of those 40, 80% (or 32 individuals) have LOS that is two years or more. The state has charged the county with developing services/programs that would enable this priority population to be able to be discharged and supported in the community. The lack of affordable, accessible housing in Bucks County is one of the major barriers in accomplishing this goal. Please note that there is minimal overlap on the waiting list for residential services across this target population. While reviewing the needs of the 40 individuals at NSH, it became readily apparent that development of community programs that address medical needs is essential. There are currently 19 individuals (39%) who have significant medical issues and would require a program which would provide medical supports for individuals with mental illness within a community based setting. Of those 19 individuals, 16 (84%) fall within the priority population of two year LOS or longer and 11 (58%) are over 60 years of age. There are multiple medical concerns that impact this group s ability to successfully transition back into the community including Dysphasia (47%), Diabetes (47%), Cardiac issues (42%), Vision impairment (47%), Osteoporosis (42%), Gait disturbance (37%), Obesity (32%), Blood Pressure issues (26%), and COPD (21%). There are also two individuals diagnosed with Huntington s chorea. It is estimated that at least 60-65% of those served in the MH System countywide have cooccurring MH and Substance Abuse Disorders. Regarding the 40 individuals currently at NSH, 29 have been identified with co-occurring needs and would also require supports which can address these issues. Priority Group 3: Forensic Mentally Ill Population Rationale for Priority: According to the Bucks County Forensic MH Panel Final Report (August 2003), at any given time, of the 1,100 inmates in the custody of the Bucks County Department of Corrections, or about 25%, are actively involved with Correctional Mental Health Services, 2-3% are considered to be severely and persistently mentally ill. Exacerbating this problem is the high incidence of co-occurring disorders of mental illness and substance use. Also according to this report, after release, the behavioral health issues make it particularly challenging for sustained self-sufficiency and reintegration into the community. Family members have often reached the limits of their ability to provide care and support. All too Attachment L Page 144

147 often, lack of suitable housing adds to the problem. The Bucks County Forensic MH Project was launched in June 2002 after the Pennsylvania Commission on Crime and Delinquency awarded funding. Ultimately, the goal of this project is to divert from the criminal justice system more offenders whose crime may be the result of, or associated with, untreated mental illness and/or substance abuse dependency. The report proceeded to state that the need for housing is critical. All levels of housing are needed: transition, permanent, respite, bridge housing, and contingency funds as well as service which bolster family supports. Priority Group 4: The Homeless and Mentally Ill Population Rationale for Priority: Bucks County has received PATH funds since The most recent PATH Annual Report for FY 2010, which reported on services provided over a period of six months, revealed that 79 individuals received support services through the PATH Program. Of the 79 individuals served through the PATH Program, 58 received some form of housing service including housing identification, coordination of housing, security deposits, and one time, rental funds to prevent eviction. Those who received these services came from a variety of settings prior to their involvement with the PATH Program. These settings included, living outdoors, in shelters, their own home/apartment, someone else s home/apartment, hotels, boarding homes, halfway houses, institutions, correctional facilities, and other unidentified places. In addition, the Bucks County, Bristol-Bensalem HUD Continuum of Care point in time survey on 1/25-1/26/11 revealed that there were 32 individuals who are homeless, mentally ill, and in need of housing. The NAMI of Bucks County Housing Needs Assessment Survey, which was conducted in 2007, indicated that 37% (or 170) of the 446 individuals surveyed had experienced homelessness, and 24 % (or 69) of the 290, who responded to that portion of the survey, had been homeless within the last two years. V. PERMANENT SUPPORTIVE HOUSING (PSH) APPROACH Please complete the templates provided below to describe your PSH Program approach. If you do not plan to incorporate one or more of the objectives below in your PSH Approach, please indicate that by simply writing in Not Applicable in the first block of the objectives table. The County should consider each of these objectives in developing their local housing plan. These objectives are also described in the OMHSAS Paper on Utilizing HealthChoices Reinvestment Funds to Develop Permanent Supportive Housing that was distributed in November 2006 and summarized in a handout provided at the Mental Health Housing training. Remember to think strategically in your planning of MH Funding Streams across the program strategies. Select the program strategies that take full advantage of opportunities in your local area as well as effectively leverage both Federal and State affordable housing resources. In particular, since some type of rental subsidy is Attachment L Page 145

148 necessary for people living on very low fixed incomes, it is expected that each county will have an objective to offer some type of rental subsidies. While you are not required to dedicate MH Funding Streams to support all program objectives, there is an expectation that a County will need a structured program management function as well as dedicated housing support services in order to manage and support the PSH opportunities (i.e. either targeted units or tenant-based rental subsidies) developed by the Plan. In designing your program approach to develop permanent supportive housing in your community, the County must ensure that the housing created by the following approaches is consistent with the OMHSAS permanent supportive housing definition: Supportive housing is a successful, cost-effective combination of affordable housing with services that helps people live more stable, productive lives. Supportive housing works well for people who face the most complex challenges individuals and families who have very low incomes and serious, persistent issues that may include substance use, mental illness, and HIV/AIDS; and may also be homeless, or at risk of homelessness. A supportive housing unit is: Available to, and intended for a person or family whose head of household is experiencing mental illness, other chronic health conditions including substance use issues, and/or multiple barriers to employment and housing stability; and may also be homeless or at risk of homelessness; Where the tenant pays no more than 30%-50% of household income towards rent, and ideally no more than 30%; Associated with a flexible array of comprehensive services, including medical and wellness, mental health, substance use management and recovery, vocational and employment, money management, coordinated support (case management), life skills, household establishment, and tenant advocacy; Where use of services or programs is not a condition of ongoing tenancy; Where the tenant has a lease or similar form of occupancy agreement and there are no limits on a person s length of tenancy as long as they abide by the conditions of the lease or agreement; and Where there is a working partnership that includes ongoing communication between supportive services providers, property owners or managers, and/or housing subsidy programs. Supportive Housing is: 1. Safe and Secure 2. Affordable to individuals 3. Permanent, as long as the individual pays the rent and honors the conditions of the lease. Attachment L Page 146

149 Supportive Housing is linked to support services that are: 1. Optional. People are not required to participate in services to keep their housing, although they are encouraged to use services 2. Flexible. Individualized services are available when the peer needs them, and where the individual lives. 1. Objective for Capital Investment (i.e. Housing Development Fund) Describe the need and opportunity for using MH Funding Streams for Housing Capital financing to create targeted permanent supportive housing units: See Project Based information #2 below. Describe the strategy(ies) for using MH Funding Streams to support a Housing Development Fund: See Project Based information #2 below. Reinvestment funds of $135,000 for capital financing. The request was approved in October Range of housing units to be created: See Project Based information #2 below. Amount of MH Funding required: Planned Avg. Capital Investment per unit: Amount and source of leveraged funds: Describe the Source(s) of Rental or Operating Subsidy (i.e. Section 8 Project Based Rental Assistance) commitments, Section 811, McKinney-Vento subsidies) to ensure that PSH units are affordable to priority consumers. This is required for any capital development initiative: Describe the plan to select/identify a Fund Administrator including the selection process, qualifications and experience that you will be looking for and any possible candidates: Sustainability Plan: Please discuss how the County plans to provide housing coordination, tenant referral and housing support services to sustain these units over the long-term: Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) Develop Reinvestment Plan for $135,000 of capital financing as part of a larger Project Based Proposed Completion Date 1 Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) 9/2008 Bucks County Behavioral Health System, Bucks County Department of MH/DP and the Bucks County Adult Committee Attachment L Page 147

150 Program for Penn Villa at Penn Foundation Reinvestment Plan Approved 10/2008 OMHSAS Committee Ongoing work as described in #2 below, Project Based Program for Penn Villa 10/2008-7/ Objective for Project-Based Operating Subsidies (PHFA Administrated Program) Describe the need and opportunity for using MH Funding Streams for Project-Based Operating Subsidies: There is a vast lack of affordable housing in Bucks County. The Fair Market Rental value established by HUD for Bucks County for a one-bedroom apartment unit (for 2011) is $ per month. Consequently, many people with Mental Illness who qualify for the low or very low levels of poverty have little to no success in identifying safe, affordable housing within the county. In response to this identified shortage of housing, PF proposed to develop a housing project, known as Penn Villa, which would provide housing to 23 individuals in 23 bedrooms. Fifteen people will reside in single room occupancy units in five, three-bedroom townhouses and eight others will reside in an eight bedroom recovery house. This integrated community will also include private sector housing within ten town homes. The existing allocation to PF from the Bucks and Montgomery County Offices of Mental Health for Supported Living and the Alumni Program of $442,144 will be utilized in concert with Home Funds, Federal Home Loan Bank of Pittsburgh funds, PHFA Funds, PENN Home, and HealthChoices reinvestment Funds to support the development, operations, and sustainability of the project. Individuals who are currently residing with the PF Supported Living Program (SLP) would have the first preference, as to whether or not they wish to reside at Penn Villa. As implementation got closer and the logistics of identifying consumers became more established, PF s application procedure became governed by PHFA housing application process. Those who were first to make application, would be the ones who would most likely be housed. Because CHIPPs Funds never became available for this project, a contingency fund never became available for those existing residents of the Penn Foundation residential program not choosing to move to Penn Villa. Only one individual has chosen not to move to Penn Villa and he was not eligible to move there because his income exceeded the income eligibility level. He will be living independently in the community with supports. Describe the strategy for using MH Funding Streams for Operating Subsidies including a discussion of which PHFA-sponsored properties (if able) may be attractive (i.e. livability, reputation of the management company, accessibility to community amenities) As mentioned previously, the total existent residential and housing allocation of $442,144 for PF s program, from Bucks and Montgomery County Offices of Mental Health, will be utilized Attachment L Page 148

151 along with a variety of other funding sources for the development, operations, and sustainability of the Penn Villa Project. In an effort to secure financial support for Penn Villa, PF has received commitments from Bucks County for $780,000 in HOME Funds, and from the Federal Home Loan Bank of Pittsburgh for $390,000, through the Affordable Housing Program. Penn Foundation had secured $3,380,824 in tax credit exchange funds through the American Recovery Investment Act. A commitment of $135,000 in HealthChoices reinvestment funds had been utilized through The Bucks County Behavioral Health System. PF is completing the building of new facilities known as Penn Villa, which will provide more private, less crowded housing for tenants. The funding sources, to which the agency is applying for development / building funds, document that Penn Villa will provide permanent housing. If building plans are successful, 23 individuals will have their own rooms, located within a fully integrated community setting. Each individual living at Penn Villa would also have housing support services available. It is important to note that this project is budgeted for rents to be calculated at 30% of net income, with a maximum charge at $507 per unit, per month. As mentioned previously, the (HUD) Fair Market Rental value for a one bedroom unit in Bucks County is currently $ per month. Penn Villa will be located on a 9-acre parcel of land. There will be 10 additional privately owned mixed income town homes on the site. Penn Villa will be fully integrated into the residential community and will be an integral part of the larger Sellersville community. The Penn Villa community is located within.6 miles of stores (pharmacy, pizza shop, convenience store, etc.) within the borough limits. It is also located within one to two miles of various shopping, healthcare, and recreational facilities. Access to transportation will be available, as necessary. Individuals residing in Penn Villa will be encouraged to become part of the community. Penn Foundation will use program funds to pay for memberships in the YMCA or local gyms if residents desire to join. Individuals will be encouraged to take classes at the local school district, the Upper Bucks County Community College, etc. Residents of Penn Villa will be working with organizations that may provide scholarships for tuition, books, etc. There will also be assistance to apply for student loans to encourage individuals to further their education. Residents will be encouraged to seek employment, according to their interests, by accessing the Office of Vocational Rehabilitation, Career Link, CIL, etc. PF has an extensive history of residential and housing development. The agency initially opened a Minimum Supervision CRRS Program in In 1992, the agency developed Penn Gardens, which is a 20-unit HUD (Section 202/8) subsidized apartment complex. The development of this project was sponsored by PF, though Penn Gardens is a separate corporation, which utilizes PF staff to manage the apartment complex. In addition, PF developed two 8-person homes, (a house for men in 1996 and a house for women in 2002) known as the Village of Hope, which serves individuals with co-occurring mental health and substance use disorders. These sites were developed through the HUD SHP program, under Attachment L Page 149

152 the HUD Continuum Of Care application process. Range of PSH units to be supported: 23 Total Amount of MH Funding required: There are no additional mental health funds needed at this time. The total residential and housing allocation of $442,144 through the Bucks and Montgomery County MH Departments will continue. Planned Term of the Operating Subsidy Contracts (minimum of 5 year term): Ongoing Sustainability Plan: Discuss the County s plans to sustain the target units after the initial term of the operating subsidy contract: It is anticipated that Penn Villa will be supported on an ongoing basis through a combination of resources, consisting of Bucks County MH funds, PHFA Tax Credit Exchange Funds, and Bucks County HOMES funds. Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) PHFA announced recipients of Tax credit exchange funds Federal Home Loan Bank funding approved Funding approval For HC Reinvestment by OMHSAS Proposed Completion Date Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) 1/2010 Penn Foundation/PHFA 2008 Federal Home Loan Bank/ Penn Foundation 10/2008 OMHSAS Closing on all Fund sources 1 5/2010 PHFA/Penn Foundation Federal Home Loan Bank Bucks County (HOME) Construction of Project 5/2010-5/2011 Penn Foundation/ Bucks Co. Gen. Contractor Hilltown and W. Rockhill Twps 100 % leased up and operational 6-7/2011 Penn Foundation Staff tenants 3 A. Objective for Master Leasing Program Describe the need and the opportunity (i.e. existence of benevolent landlords, conducive rental market, quality existing rental housing stock) for using MH Funding Streams to establish Master Lease Agreements with private property owners of multi-family rental housing: Opportunities for rental contracts do exist within quality multi-family rental housing at the $ fair market rental values that have been established by HUD for Bucks County. It was anticipated that the location for this program would be located within the Central area of the County through the LVF s TAY ACT program. However, for a variety of reasons, the agency was unable to establish consistent housing for the Attachment L Page 150

153 individuals whom they were serving. Therefore in 2009, the project was transferred to the Bucks County Housing Group with the understanding that the agency would hire a Housing Specialist who would establish resources for those with Behavioral Health needs with a focus on TAY. The Apartment Locator Website and the Shared Living Program was ultimately developed out of this process, and a number of TAY individuals have benefited from those housing opportunities. Describe the strategy(ies) for using MH Funding Streams for a Master Leasing Program: $51,000 of Reinvestment funds were designated for the Shared Living Program. This figure also includes funds for start up costs for acquisition of household goods, such as linens, furnishings, kitchen ware, etc. Funds were also applied to allow for some flexibility in individual choice should an individual choose to transition to an alternative housing situation. It is anticipated that individuals will have the option to pursue an application for Section 8 Vouchers and/or the opportunity to apply to other housing or residential options. As individuals who have tenure within the program acquire Section 8 vouchers and/or move on to other programs, additional individuals will be served by the program. Program for Assertive Community Treatment (PACT) services will be supported primarily through Medical Assistance; however there are funds built into the program for non-ma eligible individuals. The leases for the Shared Living Program are held by the Bucks County Housing Group, which is a private non-profit housing organization. Range of PSH units to be supported: Six individuals will be served within an array of housing configurations, from one or two bedroom units to single homes with one to four bedrooms. Amount of MH Funding required: $51,000 in HealthChoices Reinvestment Funds have been spent since the program s inception. MA funds have provided case management and ACT services as supports for some of those in the Shared Living Program. For individuals who are interested and eligible for Section 8 vouchers, this resource will be made available. Individual access to Section 8 vouchers will reduce overall rental costs within this program, thereby providing more flexibility within the program. Planned Term of the Master Lease Agreements (minimum of 5 year term): Describe the plan to select/identify a Program Administrator discussing the selection process, qualifications and experience that you will be looking for and any possible candidates: This housing initiative proved to be more effectively managed through a housing agency, which already had positive relationships established with landlords. It has been difficult, in some instances, to match the participating consumers with appropriate support services which enable them to remain in Shared Living at an affordable rate. However, we continue to refine our efforts. Attachment L Page 151

154 Sustainability Plan: Discuss the County s plans to sustain the master lease units after the term(s) of the agreement:: The Shared Living Program, although small, has demonstrated to Bucks County, thus far, that the model is viable in terms of supporting people in housing affordably. The Project allocation includes a small amount of funds which may be applied to rent; however, most of the rental costs are supported through resident income. The challenge of establishing appropriate support services for these individuals has remained an issue. As mentioned in the 2008 Plan, these individuals will be encouraged, if eligible, to apply for Section 8 vouchers to assist with their housing costs. It may be possible in some instances, for some program participants to remain in their current housing with Section 8 vouchers. Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) 1. Approval by OMHSAS of the TAY Master leasing Program Proposal 2. Provider agency Identified 3. Site selection and control (Leased confirmation, etc.) 4. Individual referrals and selection by PACT and housing program 5. Site preparation Proposed Completion Date FY 2009/2010 Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) OMHSAS Reinvestment committee, et al. 4/2009 Bucks County Behavioral Health Administration 2-5/2010 Provider agency, Behavioral Health Housing Specialist 1/2010 Behavioral Health Housing Specialist, Shared Living Selection Review Committee 2-5/2010 Behavioral Health Housing Specialist (Furnishings, etc) 6. Begin peer move in 5/2010 Behavioral Health Housing Specialist, consumers and other support personnel 3B. Objective for Master Leasing Program Describe the need and the opportunity (i.e. existence of benevolent landlords, conducive rental market, quality existing rental housing stock) for using MH Funding Streams to establish Master Lease Agreements with private property owners of multi-family rental housing: Application has been made as part of the HUD Supported Housing Application, Exhibit 2 of the HUD Continuum of Care application for 3 SPC slots for individuals who are both homeless and have a mental illness. If funded by HUD, PMHC, as the sponsor for a SPC Program, will implement a long-term master leasing program within a high-quality apartment complex which would be located within the Southern Bucks County geographical area. Attachment L Page 152

155 Describe the strategy(ies) for using MH Funding Streams for a Master Leasing Program: The PATH Program will be the service component for the SPC (sponsor based rental assistance program). MH Base funding is currently utilized to partially fund the PATH Program. These funds would also be utilized as required leverage dollars for the HUD SPC Grant should this program receive HUD funding. It is anticipated that the program would be expanded annually, to serve three additional individuals, thereby, serving six individuals by the end of this three-year plan. Range of PSH units to be supported: 3-6 units Amount of MH Funding required: $200,940 average annual request over 3 years (in kind match for leverage of HUD grant) Planned Term of the Master Lease Agreements (minimum of 5 year term): Describe the plan to select/identify a Program Administrator discussing the selection process, qualifications and experience that you will be looking for and any possible candidates: PMHC has appropriately managed the PATH Program for a number of years and would serve as the support component for the SPC Program. Additionally, because PMHC is considered the Program sponsor for the purposes of the HUD grant, this agency has been identified to administer the program. Sustainability Plan: Discuss the County s plans to sustain the master lease units after the term(s) of the agreement: If funding is received from HUD for this program, it is anticipated that the housing costs will be supported by HUD SPC funds. The support service and matching funds are already contained within the existing PATH Budget. Service costs associated with this program would continue to be sustained through existent MH base funding. In addition, as individuals become more independent in their community living skills, they will be referred for local preference Section 8 vouchers so that the housing that they are residing in may be sustained permanently. Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) Fulfill application requirement for SPC grant Proposed Completion Date Applications have occurred in- 10/08,10/09, 10/10 Notice of award of SPC 1/2009-1/11 HUD Website Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) County MH Housing Specialist Attachment L Page 153

156 Grant Grant award Identify, acquire, and furnish 3 1-bedroom apartment units. Identify peers Program implementation No Award NA-not funded NA-not funded PATH Director/PMHC *The Bucks County Department of MH will continue to make application to HUD for a SPC Project, as the Department feels that this would be a valuable resource for those Homeless Mentally Ill People who are engaged with the PATH Program. 3C. Objective for Master Leasing Program Describe the need and the opportunity (i.e. existence of benevolent landlords, conducive rental market, quality existing rental housing stock) for using MH Funding Streams to establish Master Lease Agreements with private property owners of multi-family rental housing: The Bucks County Department of MH, in collaboration with the identified program provider, will identify rental housing which will appropriately meet the requirements of those who would be served within a medically enhanced program. Handicapped accessibility and a willingness on the part of the property owner to make accessibility renovations, if necessary, would be considered as part of the site identification process. Describe the strategy(ies) for using MH Funding Streams for a Master Leasing Program: In an effort to support people in the community who are currently receiving treatment at NSH, we are proposing to develop a program which will support individuals who have both mental health and co-occurring medical issues, utilizing a combination of CHIPPs funds, Medical Assistance, and HealthChoices Reinvestment funds. We are also in discussion with AAA to allow for home and community based living services such as personal care and adult day care which may be provided through various programs of the AAA through Options or Pennsylvania Department Aging (PDA) waivers. Range of PSH units to be supported: 4 individuals Amount of MH Funding required: $ 2,525,000 of CHIPPS (over 5 years) Planned Term of the Master Lease Agreements (minimum of 5 year term): 5 years Describe the plan to select/identify a Program Administrator discussing the selection process, qualifications and experience that you will be looking for and any possible candidates: A Request for Information (RFI) has been disseminated to residential provider agencies which have an expertise and an interest in developing a program to serve individuals who require medically enhanced residential supports. Responses to the RFIs are being reviewed by MH staff. Attachment L Page 154

157 Sustainability Plan: Discuss the County s plans to sustain the master lease units after the term(s) of the agreement: It is anticipated that the occupancy costs for units developed within this program will initially be supported through CHIPPs funding. Ultimately, the feasibility of supporting these units through Section 8 will be explored with the Bucks County Housing Authority. Ongoing support services will be funded through CHIPPs, Medical Assistance, generic resources, such as those offered through the Bucks County AAA, and/or Reinvestment funding. Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) RFI for the medically enhanced housing support program to experienced and interested provider agencies Receipt of completed RFI from interested provider agencies Review of responses from provider agencies/ Selection of provider agency Receipt of funds/ selection of site/selection of individuals/ development of site/ hiring of staff/program implementation of the program Proposed Completion Date 12/2010-3/2011 Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) CHIPPS Director, Housing Specialist, MH Deputy Director 1-3/2011 Completion by provider agencies. Receipt of proposal by County Departmental Staff. 1-5/2011 The Bucks County MH Departmental staff 2-8/2011 Bucks County Departmental Staff/Identified Program Provider 4. Objective for Tenant Based Rental Subsidies (i.e. Bridge Subsidy Program) Describe the opportunity for using MH Funding Streams for Tenant Based Rental Subsidies: Please discuss your current relationship with your local PHA(s) and any commitments from the PHA(s) to systematically link your Bridge Subsidy Program with their Section 8 Housing Choice Voucher Program. The Bucks County Department of MH and The Bucks County Housing Authority have developed a Behavioral Health Section 8 Local Preference Program which closed in March 2009 due to funding constraints within the Housing Authority. The opportunity for individuals with mental health challenges to obtain Section 8 Vouchers still exists through application to the Non-Elderly Disabled Waiting List. Attachment L Page 155

158 The Bucks County MH Housing Specialist collaborated with the Bucks County Housing Authority and the Bucks County Grants Program Coordinator to make application to a HUD NOFA in 2010 to expand Non-Elderly Section 8 Vouchers by an additional 125 vouchers; however, this application was not funded. Individual CRRS residents have been and continue to be interviewed to determine whether they would be interested in pursuing a Section 8 voucher, with appropriate housing support services. In addition to those within the CRRS Program, some of the individuals referred for Tenant based rentals may be involved with the criminal justice system. These individuals may also receive support services through the Bucks County Forensic Services Program, PMHC, or the Forensic ACT Team through PF. Describe the strategy (ies) for using MH Funding Streams for Tenant Subsidies: (*Proposed in the 2008 Housing Plan. CHIPPS Funds were not received; therefore this initiative was not pursued.) In the 2008 Housing Plan, Bucks County had proposed to develop tenant based rental subsidies initially through CHIPPs funding. CHIPPs Funding was not received to support this initiative; however, CRRS residents have been interviewed to determine whether they would be interested in pursuing Section 8 Vouchers, with appropriate support services. It is anticipated that this process will expand CRRS availability as individuals receive Section 8 vouchers and move on to other housing options. Range of PSH units to be supported: *(Proposed in the 2008 Housing Plan and CHIPPS Funds were not received. This initiative will not be pursued at this time) Planned Length of the Tenant Based Subsidy in order to connect to the local Section 8 program (should correspond to the current wait time for people on your local Section 8 waiting list): NA Describe the plan to select/identify a Program Administrator, including a discussion of the selection process, qualifications and experience that you will be looking for and any possible candidates: NA Sustainability Plan: Discuss your sustainability plan, including how you will provide housing supports to people who transition to the Section 8 program over the long-term; discuss strategies to possibly diversify funding (i.e. HOME TBRA) for the program in order to increase the number of priority consumers supported): NA Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) Proposed Completion Date NA-Funds not received Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) Attachment L Page 156

159 5. Objective for Program Management/ Clearinghouse (Required Component) Describe the need for coordinating and managing the PSH opportunities through a Housing Clearinghouse: MA eligible adults, as well as young adults transitioning into adulthood, who have a mental health challenge and/or mental health and substance use disorder, and who are at risk of homelessness, will be served by this initiative. Describe the functions and activities of the Housing Clearinghouse including selection of priority consumers, management of the waiting list, tenant referral process to housing opportunities; coordination of housing support services; housing-related training; and coordination with various stakeholders The Behavioral Health Housing Specialist has located long term housing options for individuals who may be involved with a variety of child and adult serving systems including but not limited to Children and Youth, Juvenile Justice, Adult Probation, AAA, Behavioral Health, MH, and Drug and Alcohol. In addition to resource identification and placement, this position also advocated for the expansion of Section 8 housing opportunities, developed training relative to working with landlords, tenant challenges, working collaboratively with existing MH/Substance Use and Children and Youth case management, and housing resources. Amount of MH Funding required: HealthChoices Reinvestment- $135,000. Annual Budget of MH Funding for Program Management activities: Planned Length of Support from MH Funding Streams Funds (recommend a minimum of 3 years): What agency will be responsible for providing necessary program management coordinating all housing-related activities discussed above? Do you plan on doing this internally or contracting for these activities? If you plan on contracting for management services, describe your plan to select/identify a Program Management entity discussing the selection process, qualifications and experience that you will be looking for and any possible candidates: The Bucks County Housing Group, a non-profit housing agency, has hired the Behavioral Health Housing Specialist who was responsible for developing housing resources and coordinating support services for the identified individuals. In addition, the housing agency has managed the housing identified through the Shared Living Program. Sustainability Plan Discuss your plan to sustain the waiting list, tenant referral and overall coordination of housing activities over the long-term after MH Funding is exhausted: It is anticipated that training materials and a model for attaining and sustaining housing will be developed by the transitional Housing Specialist so that this information can be shared with case managers and other service brokers. The feasibility of identifying other funding to support this function is being evaluated. Attachment L Page 157

160 Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) 1. The Behavioral Health Housing Specialist position was originally approved as part of a HC reinvestment TAY Housing Program 2. BHS identified a Nonprofit housing agency to develop a job description and to hire individual 3. Housing agency to identify and hire individual to fill the BHS Housing Specialist Position 4. Development of Training Materials and resources will occur 5. Identification of housing resources and development of shared living Program 6. Initial housing of individuals in shared housing Proposed Completion Date Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) 1-5/2009 Bucks County Behavioral Health Systems Agency 1-3/2009 Bucks County Behavioral Health Systems Agency 6/2009 Bucks County Housing Group 6/2009-5/2010 6/2009-5/2010 Bucks County Behavioral Health Housing Specialist Bucks County Behavioral Health Housing Specialist, Representatives of Bucks County MH, Shared Living Selection and Review Committee 5/2010 Bucks County Behavioral Health Specialist and Shared living Selection and Review Committee 6. Objective for Housing Contingency Fund Describe the need for using MH Funding Streams to support a Housing Contingency Fund: Although there is some funding available through the Bucks County PATH grant for contingencies related to housing, the demand for these funds by far exceeds the availability. According to documentation by PATH staff, requests for security deposits and rental assistance (one-time rental funds) have tripled over the past year. Describe the strategy(ies) for using MH Funding for a Contingency Fund: *( Proposed in the 2008 Housing Plan and CHIPPS Funds were not received to support this initiative. Therefore, this initiative has not been pursued further.) CHIPPS funds were not received to support this initiative so that Bucks County will not be Attachment L Page 158

161 pursuing this initiative at this time. Please note that utilization of all other resources (e.g. through PATH Program, the Bucks County Opportunity Council, Salvation Army, Goodwill, etc.) are utilized on a case by case basis to address individual need. Other resources within Bucks County that may be potential partners would be the Salvation Army and Goodwill for furnishings, and the Bucks County Opportunity Council for assistance with utility costs. Amount of MH Funding required: NA Estimated Range (or number) of Priority Consumers that the Housing Contingency Fund will support: NA Describe the plan to select/identify a Program Administrator, including discussing the selection process, qualifications and experience that you will be looking for and any possible candidates: NA Sustainability Plan: Discuss your strategies to diversify funding for the program in order to continue the fund after MH Funding is exhausted: NA Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) Proposed Completion Date NA NA NA Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) 7. Objective for Housing Support Services (Required Component) Describe the need for using MH Funding for Housing Support Services. If you plan to use existing resources, please describe these resources and how they will be used: Individuals within the existing CRRS programs will be interviewed to ensure that they are receiving appropriate levels of service. Those who desire to move on to more independent settings will be supported to do so, either through other MH residential programs or utilizing a Section 8 Voucher with housing supports. Those individuals who are not ready to move for various reasons will receive the assistance that they need to become more prepared for a more independent setting. As individuals move forward towards more independent settings within the community, existing programs will then be available to serve those who require higher levels of service. It is also conceivable that some programs may choose to de-license some CRRS spaces, and convert this part of the program to Housing Support services, as this model fosters Recovery. In addition to those within the CRRS, individuals with mental illness who are involved with the criminal justice system have been appropriately served with housing support services with specialized forensic support services. There is also a large population of individuals who are residing in nursing homes who wish to Attachment L Page 159

162 transition to the community. The LHOT has recently convened a Nursing Home Transition Subcommittee in an effort to collaborate with agencies such as the Bucks County AAA, JEVS, CIL, the Bucks County Housing Authority, and the Bucks County Office of Community and Business Development. It is anticipated that through this subcommittee that additional resources for this population may be developed. Describe the strategy(ies) for using MH Funding Streams including existing resources for Housing Support Services and whether you will use the housing support team approach or the housing support capacity building approach: (CHIPP Funds were not received for this initiative, however there has been some activity around this initiative.) Although CHIPPs Funds were not received, HealthChoices Reinvestment funds were approved by OMHSAS to be applied to Housing Support Services. These funds were initially applied to the LVF PACT/TAY Program. The program experienced difficulty in identifying landlords who would agree to rent to this population, so that the program was transferred to the Bucks County Housing Group, which is a non-profit Housing agency. Because of its positive relationship with existing landlords, this agency has had some success in supporting young adult individuals in the Shared Living Program. Other housing supports have been provided to individuals from other populations identified within the housing plan, through the Shared Living Program. Other housing supports are provided through the PACT and CTT teams and are primarily funded through HealthChoices. As mentioned previously, for those who wish to transition from nursing homes, there is a need for in-home health care and nursing supports. It is anticipated that some of the costs related to this may be offset by the Pennsylvania Department of Aging Waiver. For others who may benefit from additional supports and skill development, the Bucks County CIL may be a resource. Services will be developed for those involved with the forensic system through the utilization of CTT which has a forensic component and serves the Southern Bucks area and through the PF ACT Program, which serves the Northern Bucks area. Both of these programs are funded through HealthChoices and County base dollars. Amount of MH Funding planned: $295,000 was dedicated through reinvestment for housing supports, which had been applied as resource development and for the development of housing supports, primarily for young adults. Estimated number of Priority Consumers that the Housing Support Services will serve: Initially 5 to 10 individuals. Planned Length of Housing Support Services from MH Funding Streams Funds (recommend a minimum of 3 years) 3 years Describe the plan to select/identify a service provider(s) to offer these housing support services, including the selection process, qualifications and experience that you will be looking for and any possible providers: Attachment L Page 160

163 The Bucks County Office of MH and the Bucks County Behavioral Health System staff have been collaborating through committees, such as the LHOT, to combine resources to support the needs of the various populations which we are responsible to serve. Sustainability Plan: Discuss your plan to provide housing supports to priority consumers residing in PSH over the long-term after the initial funding from MH Funding has been exhausted: The PACT and CTT services are currently reimbursed through HealthChoices, for most individuals. It is anticipated that that funding will continue; however, there is a need for additional county base funds, which would support non-healthchoices individuals. Some of the services that are required may be addressed through more generic resources, such as the PDA waiver or by the CIL. As mentioned previously, a Nursing home subcommittee to the LHOT has recently met in an effort to coordinate supports and maximize resources. Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) 1. Behavioral Health Housing specialist (BCBHS housing specialist) was hired by BCHG housing non-profit) for the development of housing support services 2. Development of training materials and resource identification and the Shared living Program by the BCBHS Housing Specialist 3-LHOT Nursing Home Transition (NHT) subcommittee met 4/2011 regarding resources required for NHT Population Proposed Completion Date Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) 6/2009 Bucks County Behavioral health Systems Agency, Bucks County Housing Group 6/2009-2/2010. (ongoing) BC BHS Housing Specialist, Bucks County Housing Group, BC MH/DP representatives, other Bucks County agency representatives 4/2011- Representatives from BC AAA, BC MH/DP, Penn Foundation, JEVS, BC Housing Authority, Diana T. Myers and Associates, BC CIL, BCBHS, BC Office of Community and Business Development 8. Objective for Fairweather Lodge or Other Evidenced-Based Supportive Housing Strategy (NOT APPLICABLE at the present time but we are exploring and will submit later as appropriate) Describe the Fairweather Lodge or Other Evidence-based Supportive Housing Strategy, not referenced in Objectives #1-7, and basis for using this strategy: Given the premise that Fairweather Lodges are living arrangements designed to accommodate those individuals who are mentally ill, active members of society, and wish to live independently, this program would be a valuable new housing option which would greatly serve some members of the Bucks County community. Therefore, the Bucks County MH/DP Attachment L Page 161

164 Department and the Bucks County Behavioral Health System is proposing to explore the feasibility of developing a Fairweather Lodge. Resources would have to be identified to support start up costs and the minimal costs, which Fairweather Lodges require on an ongoing basis. Development of this program would be contingent upon the identification of the availability of funds to support the model. Describe the specific use for MH Funding and other funds to support development of this housing. (attach a completed expenses and income spreadsheet; identify amount and source for each separate income entry): Bucks County has not identified funding at this time; however, the county Behavioral Health Agencies will continue to explore the feasibility of developing a Fairweather Lodge. Amount of MH Funding required: Estimated: $300,000 (Start UP), ($70,000 annually) Amount of other funds committed to this project: To be determined Describe the source for other funds and attach documentation of commitment: *See Above Please provide information regarding the proposed operating agency/ administrator for this program including their experience with this evidenced-based approach. If this request includes establishing a Fairweather Lodge, please describe plans to meet fidelity to this model. An agency has yet to be identified as the provider for this program, as Bucks County is exploring the feasibility of developing a Fairweather Lodge. Upon the identification of adequate funding, agencies which have had the experience of successfully developing Fairweather Lodges would be encouraged to submit proposals to this Department for review. Sustainability Plan: Discuss how the County plans to fund this program after this one-time commitment of MH Funding: As mentioned above the development would be contingent upon the identification of a fund source, which would support the model. Action Steps: (Describe each action steps to be accomplished over18 months to achieve the objective) 1. Further education regarding this model would be obtained 2. Exploration regarding the availability of fund sources Proposed Completion Date 2 Resources needed: (include partnerships, technical support, involvement of consumers, changes in use of existing resources, etc.) 1/2011 MH Housing Specialist, MH Housing Coordinator MH Deputy Director, and Magellan Health Services, had discussion with Kim Stucke (OMHSAS TA advisor for Fairweather Lodges) 1/2011- MH Departmental Staff 12/2011 Attachment L Page 162

165 would commence 3. If it is determined that there would be funds available then application would be made 4. Once funds are obtained a provider would be identified through a RFI. 5. Provider would identify, obtain and renovate the site, if necessary 6. Individuals would be identified, and site would be furnished with their assistance 6/2012 to funding opportunity application date Date of receipt of awards notification to 2 months later 3 months from date that provider is awarded program Concurrent with site identification and renovations 7. Move in Within one month of site readiness MH Departmental Staff MH Departmental Staff and Provider agencies Identified Provider agency Provider agency and consumers Provider agency, consumers and other support services personnel Attachment L Page 163

166 BUCKS COUNTY MENTAL HEALTH RESIDENTIAL SURVEY Residential Type Community Residential Rehabilitation (CRRS) Maximum, Moderate, Intensive HUD Section 8, Section 8 vouchers Housing Name Max CRR Mod/Max Mod. CRR Mod/Max. Intensive CRR Community Integrated apartments Owner/Manager of Property Leased Provider owned Provider owned Leased Provider owned Leased Various Service Provider Name Target Group Penn Foundation/ Adults Lenape Valley Foundation/Adults Comans, Inc Adults/YAT. Northwestern Hum. Services/Adult PMHC/Severely Mentally Ill Adults Case management supports for individuals across the county through Penn Foundation, PMHC and LVF Capacity: Units/Slots MH Currently utilizing vouchers Services Funding Base Base Base/Reinvestment Base Funding Base Funding (Case management services through HealthChoices/ Base) Housing Funding Base/peer Base/peer Base/peer Base/peer Base/peer HUD-(through Bucks County Housing Authority)/peer Supported Living (non HUD) SLP APHP/SLP SLP, Washington Ave, Franklin St.Grp.Home Sparrow LN/Parker Penn Foundation Lenape Valley Foundation owned PMHC Comans, Inc Leased Penn Foundation/Adults Lenape Valley Foundation/Adults Penndel MH Center/Adults Comans, Inc./Adults Northwestern Human Base /CHIPPS Base/CHIPPS Base Base Base CHIPPS Base/peer Base/peer Base/CHIPPS/peer Base/CHIPPS/peer Base/peer CHIPPS/peers Attachment L Page 164

167 Residential Type Housing Name ST. Group Homes Owner/Manager of Property Milestones Service Provider Name Target Group Services/Adults Milestones/ Adult Females Capacity: Units/Slots Services Funding Housing Funding Housing Supports-Penn Foundation Alumni Program Hillbrook Place Apts Street Road SLP/group home Kindle Lane Forsythia Gate Northwestern Hum. Services Lenape Valley Foundation Penn Foundation for Penn Gardensothers are leased apartments in Community Northwestern Human Services-/Adult Lenape Valley Foundation/Adult Penn Foundation/Adults graduates of residential program (annually) CHIPPS CHIPPS CHIPPS/Base CHIPPS/peers CHIPPS/peers HUD/peers Shelter Plus Care Various Housing settings within the community Easton Rd/Grp. Home Quarters B Grp. Home Leeward Milestones Lenape Valley Fd Comans, Inc. Penndel MH Cent Milestones/Sen.-women County of Bucks/men Comans, Inc/ men PMHC/women CHIPPS/BASE HUD/peers Attachment L Page 165

168 Residential Type Housing Name Grp. Home Goldengate Grp. Home Owner/Manager of Property Service Provider Name Target Group Capacity: Units/Slots Services Funding Housing Funding Section 811 Leeward an Comans Comans, Inc./ 5 men and 8 women HUD Supported Village of Penn Foundation Penn Housing Hope Foundation/MH/D&A(8,m en,8women) HUD/SLP Leased PMHC Penndel MH Center Homeless/ MI 13 Base HUD/peers 16 Base/CHIPPS HUD/peers 12 Base/CHIPPS HUD/peers Penn Gardens Section 202/8 Penn Foundation Penn Foundation- Independent Housing 20 Case management supports (Base, HealthChoices) HUD/peers Respite Long Term Structured (LTSR) Senator Hampton Rice House Durham House Lenape Valley Foundation Milestones Community Health Care Lenape Valley Foundation Adults Milestones Community Health Care 4 Base/CHIPPS Base/CHIPPS/ peers 16 (6 Bucks County slots) HealthChoices (Reverting back to Base/CHIPPS 08-09) CHIPPS CHIPP/ (Various Attachment L Page 166

169 Residential Type RESIDENTIAL SUPPLEMENT Housing Name residential community residential options, mostly within Bucks County Owner/Manager of Property Mixed options, some rental assistance, some PCH, etc Service Provider Name Target Group Various- Park Avenue Manor, Willow Crest, Southampton Estates, etc (Supplemental funding for Adults) Capacity: Units/Slots 45 to 50 individuals Services Funding CHIPPS Housing Funding CHIPPS/peers Attachment L Page 167

170 ORGANIZATION CHART Bucks County Department of MH/DP Mental Health Program County of Bucks Commissioners Joseph Funk Director of Human Services Margaret Hanna Executive Director D&A Lynne D. Rainey Director of C&Y Mary Beth Mahoney Administrator of MH/DP Director of AAA Vacant Bern McBride Director of BHS Deputy Administrator Developmental Programs Vacant Dawn Seader Deputy Administrator Mental Health Ginger Hoyt Fiscal Director Jennifer Brozenske Secretary Barbara Miller Director of Children's Services Vacant Director of Clinical Services & Quality Management Deborah Neidhardt Housing Specialist Carol Bamford Director of Emergency & Court Services Tina Mamonne Director of CHIPPs Services Lisa Haraburda Children's Services Coordinator Joyce Schug Rehabilitation Coordinator Wanda Swift Housing Coordinator Sharon Preston Emergency and Court Coordinator Meredith Pickens CHIPPs Coordinator Wendy Flanigan Emergency and Court Coordinator Attachment L Page 168

171 Attachment M County Program BUCKS COUNTY FORENSIC PLAN FOR FY Bucks County has a long history of collaboration between the Criminal Justice System and the Behavioral Health System. In 2002, the Bucks County Association for Corrections and Rehabilitation, Inc. (BACR) sponsored a forensic Mental Health (MH) project. The project utilized the sequential intercept model as the framework to identify strategies that would affect the increasing numbers of individuals with a mental health and co-occurring substance use disorder that interface with the Criminal Justice System. Significant strides were made in increasing cross agency communication and programmatic collaborations. Accomplishments of this project included: Identification of a Forensic Services Program (FSP) with a housing component at Penndel Mental Health Center (PMHC). Expansion of substance abuse treatment services. Design and implementation of a training program for police and corrections staff. Designation of a lead attorney in the District Attorney s office to review all cases where a mental illness or co-occurring substance use disorder was identified. Development of a Strategic Plan reflecting the guiding principles and recommendations as identified in the Bucks County Forensic MH Panel Final Report. These collaborations and accomplishments set the tone for service development that has addressed the various intercepts, including: Crisis Intervention Team (CIT) A CIT taskforce was convened in 2008 to determine the feasibility of developing a team(s) in Bucks County. It was quickly determined that a Bucks County CIT initiative would provide valuable education and expertise. The training has brought expertise to police forces and other stakeholders such as Emergency Medical Technicians (EMTs), adult probation, etc., within Bucks County, for individuals who come in contact with individuals who have a mental illness, a substance use disorder, and other vulnerable populations. In conjunction with the creation of the CIT, the Lower Bucks Crisis Center was enhanced in order to facilitate a smoother and quicker transition from an Attachment M Page 169

172 interaction with the Criminal Justice System to receiving supports through the Behavioral Health System. Enhancements included increased staffing hours as well as some limited mobile capacity. The mobile component has had positive results in supporting consumers, family members, and police in connecting individuals to services and directly addresses issues around Intercept 1. Forensic Assertive Community Treatment (FACT) and Forensic Services Program (FSP) Another strong collaboration occurs with several provider agencies, Bucks County Probation and Parole, and the Bucks County Correctional Facility (BCCF). The Community Treatment Team (CTT) in the Lower Bucks and the FACT team in the Upper Bucks areas are two programs that have a forensic tract. These programs were specifically designed to address re-entry issues of individuals who are incarcerated at the county jail and need more intensive support services in order to be released. The programs have a strong relationship with Probation and Parole and work together to enhance the individual s chances of successfully completing Probation or Parole and reduce recidivism. These programs address issues around Intercept 4. Bucks County Correctional Facility (BCCF) A significant collaboration that has been formed is the monthly jail meeting that involves stakeholders from both the Criminal Justice System and the Behavioral Health System. The meeting includes identifying individuals who have a serious mental illness (SMI) or co-occurring substance use disorder and are preparing for discharge or present unique challenges. The most pressing need for individuals being discharged from the BCCF is often housing. The group not only explores various housing options, but it also addresses the treatment needs and identifies the array of behavioral health services that are necessary in order to maximize an individual s chance of success in the community, which addresses issues around Intercept 3. At times, this process can appear endless as there are limited resources, but the group continues to creatively collaborate, share resources, and develop successful discharge plans. Cross-Systems Mapping On September 29 & 30, 2010, Bucks County had the opportunity to participate in the Cross-Systems Intercept Mapping process. Participants represented multiple stakeholder systems including mental health, drug and alcohol, human services, corrections, advocates, family members, consumers, law enforcement, and the court system. As noted previously, we had engaged in a similar process back in 2002, which established the foundation for developing relationships that continue and played a large part in the success of this process. A report was developed highlighting the various gaps and opportunities that will now be used as the basis for identifying future areas for collaboration, opportunities to improve communication, and development of support services. Attachment M Page 170

173 Criminal Justice Advisory Board (CJAB) The mission of the CJAB is to assist all Agencies and existing Boards, both county and municipal, in exploring and developing short term and long term plans in order to facilitate the efficient delivery of public safety services to the citizens of Bucks County. The Director of the County s Behavioral Health System, as a member of the CJAB, ensures the connection of and integration of critical coordination committees to and with the CJAB s mission for both the children s and adult serving systems. In the fall of 2011, the CJAB will be engaging in a strategic planning process in order to determine its priorities for the upcoming year. As an extension of the mapping process, the Bucks County CJAB approved the establishment of the CJAB Behavioral Health Subcommittee that is charged with developing long and short-term priorities for activities designed to improve the behavioral health system in order to effect change at each intercept. The subcommittee will use the mapping report as a basis for its work. The subcommittee also anticipates that the CJAB, as an outcome of its strategic planning, will be identifying various initiatives for the subcommittee to implement. Probation and Parole The Bucks County Adult Probation and Parole Department has been an integral partner in the collaboration related to the efforts of the criminal justice and behavioral health systems. One such effort is the Effective Communications training that is sponsored by Probation and Parole. This training focuses on Social Learning Theory, Criminal Logic and Basic and Advanced Communication Techniques. MH and Drug and Alcohol staff have also participated in the trainings, which has provided a much needed perspective for staff who traditionally has not had the experience working with individuals in the criminal justice system. Other initiatives that, although not specifically designated for working with individuals with a mental illness or co-occurring substance use disorder in the criminal justice system, that could support diversion: Crisis Initiative As one of Bucks County s Transformation Priorities, we are looking to improve crisis intervention services to create service options that will support individuals in crisis in order to minimize the need for inpatient hospitalization. Crisis services in the Lower Bucks area have already had a significant impact on diverting individuals from the criminal justice system with the inception of CIT and other noted enhancements. As we examine the current delivery of crisis services, we expect there will be other areas warranting improving the coordination of the criminal justice and behavioral health systems. Outpatient (OP) Treatment Another Transformation Priority that we anticipate having an effect with our work with the criminal justice system is the focus on outpatient services. The focus for this initiative will relate to access, quality, and Attachment M Page 171

174 efficiency. By also increasing the level of competency and treatment modalities within the behavioral health system, we expect that clinicians will have a better understanding of the presenting challenges in the provision of treatment to individuals in the forensic system. Peer Support (PS) As identified in the Peer Priority, it is our intention to infuse peer support throughout all services. We have seen positive results in peers working with individuals in the criminal justice system. The fiscal challenges in providing peer support in the jail related to not being able to bill for a medical assistance service in an institutional setting must be addressed. We have seen peers connect with other peers on a level that cannot be replicated with provider staff personnel. We will continue to be creative in our application of peer services in order to provide this highly valued support for all individuals in need. Housing As mentioned previously, housing is the most pressing need for both individuals coming out of jail and individuals currently receiving services in the community. This is not just a Bucks County but a state-wide and country-wide issue however further compounded by the cost of housing and the shortage of rental units. Affordable housing is necessary for individuals to feel safe and continue on their recovery journey. Below you will find excerpts from the Cross-Systems Intercept Mapping Report. This section of the report outlines the various areas throughout the five (5) intercepts where Bucks County has services. The report also identifies gaps and opportunities that were noted during the 1 ½ days mapping process. The full report can be found on the Bucks County s Network of Care website ( As mentioned previously, there has been extensive collaboration between the Behavioral Health System and the Criminal Justice System. We have been able to utilize this collaborative partnership in order to expand services and coordinate services for individuals who present challenges to the system. Below are several accomplishments that have occurred subsequent to the writing of the plan: 1. The Penn Foundation Forensic Assertive Community Treatment Team (FACT) has been in operation since August 1, The team quickly reached its full capacity of twenty participants. In July 2011, there was agreement to expand the team to forty participants. Since July 2011, the team has added three additional positions: a Vocational Specialist, a Mental Health Therapist, and a Co-occurring Disorders Specialist. Psychiatric hours were also increased to 32 hours per week. The Vocational Specialists have participated in an intensive Supported Employment Training series and have started job development with local businesses. We expect that this will significantly impact the team s ability to engage participants in vocational opportunities. The FACT Team Leader has joined the Bucks County CIT Task Force and continues to Attachment M Page 172

175 increase collaboration with local police departments in efforts to divert participants from incarceration. The FACT team continues to build upon community relationships with local landlords to access housing for individuals upon release from the Bucks County Correctional Facility. A lack of safe and affordable housing is the most significant impediment to release from incarceration. The team utilizes a variety of evidence-based practices to provide cutting-edge treatment to participants (e.g. Illness Management and Recovery and Supported Employment). During the next year, the team will incorporate the evidence-based practices of Integrated Dual Disorders groups and Family Psycho-Education groups. 2. The main stakeholders continue to meet on a monthly basis to discuss inmates that have a serious mental health diagnosis or co-occurring MH/D&A diagnosis. Discussions include discharge planning and referrals to community providers for outpatient treatment, case management, and housing options. As a result of these meetings, cooperation and collaboration has grown between Bucks County MH/DP, BCCF s mental health provider, and the Public Defender s Office including clarifying legal status, probation and parole options, and possibilities for early release when resources are in place. In January 2012, MH/DP and administrative personnel at BCCF began meeting regularly to discuss issues of mutual importance. Topics have included creating additional treatment options at the jail, streamlining access to mental health services, and overlapping training needs. 3. In December 2011, the Pennsylvania Commission on Crime and Delinquency announced a grant proposal for availability of grants funds up to $250,000. Bucks County submitted three concept papers. One was initiated by the District Attorney s office under the objective for innovation in technology and information sharing. BCCF also submitted a concept paper for evidence based program, practices in innovation. The concept paper addressed expanding the existing Pre-Trial Diversion Program. Currently, the program has identified offenders who have a severe substance abuse issue. A small percentage of those offenders treated through this program have been offenders with a co-occurring severe mental illness. However, the team has recognized that they could enhance their expertise to better identify treatment needs. A third proposal was submitted by Lenape Valley Foundation (LVF) with the objective of breaking the cycles of mental illness, substance abuse, and crime. They have proposed a two-prong approach, first to provide funding for training to the police departments involved in the CIT Task Force. Additionally, LVF through their crisis department will develop an Assertive Community Engagement (ACE) program. This will provide the opportunity for police officers, in cooperation with crisis workers, to intervene with Attachment M Page 173

176 individuals exhibiting significant behavioral health needs in the community. This will allow interventions to occur in order to support individuals who might otherwise face incarceration. 4. In early 2012, the Bucks CJAB released its strategic plan. One of the common threads that emerged was the facilitation of information sharing to facilitate appropriate disposition of offenders, their successful re-entry into society, and where possible their diversion from incarceration utilizing evidence based practices. This becomes much more challenging when addressing the behavioral health needs for individuals in the criminal justice system. The Behavioral Health CJAB Sub-committee continues to address the issue of communication. The sub-committee has spent the last year bringing together the various stakeholders in order to more appropriately plan for individuals who have behavioral health needs. 5. In 2011, two 40-hour CIT Certification classes were conducted in Bucks County. Law enforcement officers from many municipalities and from all geographic regions of the County, as well as officers interested in the CIT program from Northeastern Pennsylvania, participated. Fifty-four individuals were certified last year; and to date, 161 participants are certified since the program s inception in Another 40-hour certification class is scheduled for April A reunion get-together for graduates is also planned for later in calendar year In 2011, there were also two six-hour CIT Introductory Courses. Thirty-nine individuals participated including peers, probation and parole officers, and corrections staff. To date, a total of 429 people have participated in the Bucks County CIT Introductory Course. Another introductory class was conducted on February 28, 2012, training an additional twenty individuals. Efforts continue to bring trauma, substance abuse, and other relevant topics into even greater focus in all trainings. The collection and analysis of data has begun in earnest and will continue. Specific outcomes include the analysis of the average time to process a case with CIT involvement versus a case in which CIT is not involved. A class participant s knowledge level pre and post training is also an area of focus as an outcome measure. The CIT Taskforce has been collaborating with the National Center for Mental Health and Juvenile Justice to bring a Youth Crisis Intervention Team curriculum (CIT-Y) to Bucks County. This one-day class is an adjunct to the 40-hour training and will be offered to interested graduates. As the Transition Age Youth initiative is a transformational priority, we consider this next training step to be critical in supporting young adults that interface with the criminal justice system. Attachment M Page 174

177 COMMUNITY Law Enforcement 911 Intercept I: Law Enforcement/Emergency Services 911 Bucks County has one centralized call center, Bucks County 911 Center, which serves the entire County. Bucks County 911 Center currently has 38 individuals on staff, with an average of 1 to 3 call takers on the phones at any given time. 911 staff training includes; call taking, dispatch, radio, Emergency Medical dispatch, and a module on behavioral health issues. Intercept 1 Law enforcement The center receives approximately 1,000,000 calls each year, and each call is categorized by type of emergency (domestic, medical, etc.). At present, there is no category for mental health related emergencies. There is currently no link between 911 and other crisis lines (see below), but callers are occasionally referred to other hotlines. Law Enforcement Bucks County has 46 law enforcement jurisdictions and two State Police Barracks. The county police departments vary considerably in size --- some stations only employ part-time officers, while other larger stations are multi-officer 24/7 operations. All county police officers receive basic Municipal Police Officer and Education Center training provided by the Pennsylvania Municipal Police Officer's Education and Training Commission. Bucks County CIT The Crisis Intervention Team (CIT) program is a community partnership consisting of law enforcement officers, Behavioral Health providers (Lenape Valley Foundation and a representative from substance abuse treatment), and mental health consumers and family members through advocacy groups (NAMI). All community partners work together to understand mental illness, invest time and effort to avert crisis, work to deescalate crisis, and direct the consumer to appropriate care. The program is implemented through Bucks County law enforcement agencies. The objective is to stabilize the crisis and get the consumer to the appropriate resources for appropriate care. The Bucks County Crisis Intervention Team training is offered in several versions. The full program consists of a 40-hour training curriculum including exercises such as Attachment M Page 175

178 Hearing Distressing Voices, a consumer perspectives module, role-playing scenarios, and a recently added veteran s round table consumer component. The first of these trainings was held in September of 2009, with three completed trainings thus far, and a fourth scheduled for November In the county, 79 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, and a consumer component. Over the past year and a half, Bucks County has provided the 1-day Introduction to CIT to 350 individuals representing law enforcement, corrections, crisis workers, security personnel, and ambulance crews. In addition, thirty 911 call-takers completed the 4- hour training. In the future, Bucks County CIT plans to expand trainings from the lower portion of the county to Central and Upper Bucks, with a goal of training 20% of all Bucks County law enforcement officers in crisis intervention practices. Other Mental Health & Substance Abuse Training for Police Bucks County Police Officers have several behavioral health training opportunities. The county has several Special Response Teams, including police negotiators. The training for these teams includes a 40-hour training course, followed by a second 40- hour crisis response training and an optional advanced course. The Penn Foundation offers training to police as requested regarding 302 (involuntary commitment) and 201 (voluntary commitment) procedures. In addition, Penn Foundation recently participated in a collaborative training on domestic violence for local police departments (in conjunction with A Woman s Place and Ravenhill Psychological Services). Crisis Services Bucks County has three crisis centers: Penn Foundation at Grandview Hospital, and Lenape Valley Foundation at both Doylestown Hospital and Lower Bucks Hospital. A 24/7 Crisis Line ( ) is available and connects to trained staff at each of the centers. In addition, each crisis center has an individual crisis line (See below for numbers). There is continuity of care as the same person on the phone is there to interview the individual in person. Crisis services are accessible by phone and through three area hospital Emergency Rooms to individuals, families, and law enforcement. Psychiatric and treatment planning is available, providing for evaluation and disposition and the immediate start of medication and treatment. Substance abuse crisis issues are also addressed. These Attachment M Page 176

179 services are available 24/7 at Lenape Valley Foundation at Doylestown Hospital (Route 202 and 611 Bypass Doylestown, PA 18901; ) and Penn Foundation at Grand View Hospital (700 Lawn Avenue, Sellersville, PA 18960; The most active crisis unit is Lenape Valley Foundation at Lower Bucks Hospital (501 Bath Road Bristol, PA 19007; ). Access to psychiatric consultation is limited to a few hours each weekday. Other Crisis services are available through NOVA (Network of Victim Assistance) and A Woman's Place (for victims of sexual assault and other crimes and domestic violence, respectively). Crisis workers are familiar with these programs and also with Protection From Abuse (PFA) orders. When dealing with a mental health crisis situation involving domestic violence or serious danger in which law enforcement is not already involved, crisis workers inform the victim that there are other options instead of, or in addition to, a 302 involuntary commitment. Bucks County has access to Mobile Crisis services for adults Monday Friday during regular business hours. Typically, Mobile Crisis visits are scheduled in advance by a police officer, although they will occasionally be called to the site of a crisis if police officers need assistance. In addition, the county has recently implemented a Children s Mobile Crisis program that is meant to be a 24/7 resource to support and transform crisis services systems for juveniles. Other Crisis Lines Contact runs a Suicide Prevention Hotline which receives referrals from 911. Bucks County also has access to a NAMI Helpline hours a day, 7 days a week which is operated by a single person and provides referrals to individuals calling for assistance. The Council of Southeast Pennsylvania has a Drug and Alcohol Information and Intervention line , and the Networks of Victims Assistance operates a 24/7 hotline Additionally, the National Suicide Hotline number is TALK (8255), and the National VA Suicide Hotline number is Drug and Alcohol While Bucks County contracts with a number of detoxification facilities in Bucks and surrounding counties, it does not currently have a designated police drop off center for detoxification. There is a shortage of beds across the state for this level of care. As a result, individuals in need of detox services who come to the attention of law enforcement often end up in the Bucks County Correctional Facility until they are sober. The correctional facility estimates that nearly a third of the individuals admitted to the jail are under the influence of drugs or alcohol. Attachment M Page 177

180 Hospitals Bucks County has four Inpatient Psychiatric hospitals: Foundations Behavioral Health (Child/Adolescent only; ), Lower Bucks Hospital (Adults; ), Aria Hospital (Older Adults only; ), and St. Luke s Quakertown (Adults; ). Identified Gaps Crisis 800 number is not well known, and is not directly linked to 911 High cost of psychiatry limits the possibility of psychiatric expansion to 24/7 in the foreseeable future. Not all crisis center staff members are trained to diagnose and refer individuals with a co-occurring substance or dependency issue Understaffing in the Emergency Rooms results in overworked personnel Limited number of 911 call takers and limited time to assess MH specific calls No specific 911 category for MH Limited mental health training for call takers No frequent caller strategy Small PD cannot send officers to get CIT trained due to travel and schedule CIT training is not being fully utilized by 911 call takers No connection between 911 and Mental Health Crisis services Barriers with sharing information between Mental Health and CJ No MOU for legal framework Detox will often happen in jail, which is not medically equipped for detox Identified Opportunities Police departments have their own special units available across the county for major incidents. Very active CIT program in Lower Bucks County 4-hour CIT training has been offered to call takers Goal of 20% of all police departments CIT trained Expanding CIT to Upper and Middle Bucks Use of 6-hour CIT orientation training used by other first responders Promotion of CIT training to all first responders and non law-enforcement Use of Specialized Response Teams (70/80 officers with this training) Potential to identify frequent users of 911 services to connect to MH crisis with a 24/7 line Mobile crisis is available to children and is being considered for adults CIT trained officers can be available to do outreach with mobile crisis services Grant opportunities with the Networks for Victims Assistance for trainings with CJ and disabilities Attachment M Page 178

181 CIT officers have been provided a release of information from the Lenape Valley Foundation to share with consumers The Penn Foundation FACT team has created a release of information form for FACT consumers that allows staff to talk with the Forensic Diversion Committee a group of representative from local police departments Potential to encourage consumer groups using WRAP (wellness, recovery, and action planning) to include sharing of information Utilize the Veteran s Suicide Hotline Forensic ACT Team has developed relationships with local police departments and participates in a quarterly Forensic Diversion Committee Meeting to discuss FACT participants and create diversion plans when necessary Attachment M Page 179

182 Intercept II: Initial Detention/Initial Court Hearing Arrest and Initial Detention When an individual is arrested in Bucks County, he/she is taken to one of seven regional booking centers. The booking centers are run by either local police departments or the jail and serve as central locations for fingerprints, photos, and video arraignments, if possible. The individual will then either be sent back to a police station for additional reporting, or taken directly to the jail for admission. Access to Magisterial District Justices for arraignment in Bucks County is accomplished within four hours; thus, the length of detainment at a police facility is no longer than four hours. Some police contacts with persons who have a mental illness now result in direct transportation to a hospital-based crisis center. There is 24/7 access to District Attorney staff for consultation. Holding facilities at the more than 46 police departments vary greatly according to the size of the department. Supervision of the detainee depends upon each department s policies and practices and the staffing at the time of detainment. Policies, practices, and staffing vary across the different law enforcement jurisdictions. Each police department handles offenders with a mental illness or a co-occurring substance disorder differently. Preliminary Arraignment The Bucks County District Court system consists of 20 Magisterial District Judges and 113 clerks. All misdemeanor and felony violations are filed in the District Courts. In these cases, the defendants are arraigned, bail is set, defendants are advised of their rights, and a preliminary hearing is scheduled within two weeks. At the preliminary hearing, these court cases are either waived to the Court of Common Pleas by the defendant; or, after the hearing, they will be dismissed or bound over to court if a prima facia case is found. The Court of Common Pleas of Bucks County, a class 2A county, is the 7th Judicial District of Pennsylvania. First established in 1683, it hears all Criminal, Civil, Family, and Orphan's (Probate) matters. The Court consists of thirteen judges, and is located in Doylestown, Bucks County Pennsylvania. It supervises all Adult Probation, Juvenile Probation (including the Bucks County Youth Center), and Domestic Relations services, the Law Library, and provides administrative services for a twenty court system of Attachment M Page 180

183 limited jurisdiction courts (special courts) - issuing authority in all felony and misdemeanor cases, and hears all traffic and summary cases. It has concurrent jurisdiction in civil cases where the amount in controversy is less than $8,000. Deputy District Attorney Marc Furber supervises the prosecution of criminal cases in connection with other supervisors in the District Attorney s Office to address the disposition of defendants with mental illness. Each case involving a mentally ill offender is reviewed by DDA Furber and/or another supervisor in communication with DDA Furber to determine the District Attorney s Office position on the appropriate disposition to be approved and/or recommended to the Court. However, the District Attorney s Office, which ultimately decides and/or recommends the disposition of each criminal case involving an offender with mental illness, cannot recommend or agree to divert an offender from incarceration without a viable alternative placement or established and approved plan that is provided by the defense in advance of the trial date. The District Attorney s Office, Public Defender s Office, police officers, judges, and other agencies are in constant communication regarding disposition, treatment, and diversion. There is individualized treatment on a case-by-case basis. Assistant district attorneys have 24-hour access to chief deputies of the District Attorney, and they report to the District Attorney. Police officers have 24-hour access to District Attorney s office. There are no secure/supervised mental health facilities available at short notice for those not meeting the standard for a 302 involuntary commitment. A district justice is not in a position to commit an offender who has a mental illness to an appropriate level of care, due to the lack of facilities, and due to the short period of time that covers Intercept #2 and the length of time required to secure a bed in an appropriate inpatient facility. When an offender with a mental illness receives nominal bail and is released from custody pending trial, the district justice may impose various conditions, including that the offender continue with prescribed medication and treatment. Enforcing the conditions of bail, however, is problematic because the release is pre-adjudicatory and therefore unsupervised. Civilians not connected to the Court system must volunteer any information about violations of bail. Additionally, an offender failing to take medications and/or to continue with treatment may deteriorate and incur more criminal charges. A violation of a condition of bail, whether technical or as a result of new charges, results in a decision to revoke bail and commit the offender to the correctional facility. Usually, this type of hearing is done at the request of the District Attorney s office before a Court of Common Pleas judge. Pre-trial Diversion Programs Once an individual is detained, he/she is classified by what services may be necessary. If the person does not make bail, he/she will receive a pre-trial services assessment for Mental Health and Substance Use [the Level of Service Index- Screening Version (LSI- S)] with additional follow up assessment for Substance Use Disorders [the Texas Christian University Drug Screen-II (TCU-II)]. Attachment M Page 181

184 The Bucks County Pre-trial Diversion Program, initially funded by Byrne JAG and now funded by the county, is a collaborative effort among criminal justice, TASC, and treatment partners. Of the 223 pre-trial offenders served, 89% of cases submitted for bail were approved and 78% of cases were closed successfully (National Criminal Justice Association 2009 Report). The project functions under the Bucks County Department of Corrections Community Corrections Division. Treatment Alternatives for Safer Communities (TASC) is a key part of this Pre-trial Diversion Program and serves as a boundary spanner between the jail and mental health and substance abuse treatment programs in the community. Accepted individuals are monitored and tracked and also provided with two group options with a cognitive behavioral health curriculum that also addresses criminal thinking disorder. Pre-Trial participants are carefully monitored for up to three years following initial detention. Participation is on a voluntary basis. Identified Gaps Lack of safe, well-supervised holding facilities in all police departments for all detainees Delay in receiving assessments for those in crisis Emergency Rooms do not separate the general population from the detained Lack of formal processes for cases involving a person with a mental illness or a co-occurring substance disorder - causes inconsistent handling of detained Too much travel time because there are only 7 Regional Booking Centers in the County Not all Booking Centers have video arraignment Only 2 DJs on duty for arraignments, not all use video arraignments Loss of psychiatric inpatient beds due to hospital closures No hospitals to divert 302s to versus arrest and jail No formal data sharing process to notify County BH of arrests Identified Opportunities CJAB working on a more fluid centralized booking plan Video arraignments could be available in all booking centers TASC program for pre-trial for D&A and mental health in the jail Use of 302 commitments allowing a person to be HELD in treatment before charges are set Detailed assessments occur at pre-trial 302s can be referred to services such as FACT (if the person is already set up on the ACT Team) as needed to divert from further CJ involvement Attachment M Page 182

185 Jail Specialty Court Dispositional Court Intercept III: Jails/Courts Bucks County Department of Corrections The Bucks County DOC is a county operated and funded criminal justice agency. It is the largest department in county government. The department serves municipal, state, and federal law enforcement authorities through the Court of Common Pleas, 20 local District Courts, Probation and Parole agencies, neighboring county corrections, the Pa Department of Corrections, Federal Bureau of Prisons, Immigration and Naturalization Services (INS), and the United States Marshals Service. Public safety and service are the cornerstones of this operation. Intercept 3 Jails / Courts The department operates 3 facilities the Correctional Facility, or jail, and the Men s and Women s Community Corrections Centers in addition to alternative confinement, such as house arrest, day reporting, and weekend detention. Each facility is under the immediate direction of a warden, superintendent, or manager and is assisted by corrections and support staff. The Director of Corrections is responsible for the entire department. The Bucks County DOC 2009 Annual Report reported the ethnic representation in all Bucks DOC facilities as 66% Caucasian, 27% African American, 6% Latino, and 1% other. The offender gender breakdown was reported as 87% male and 13% female. Bucks County Correctional Facility The Bucks County Correctional Facility (BCCF), opened in 1985, serves as the countywide central receiving location for all persons committed to the system as either pre-trial detainees or convicted prisoners. Medium and maximum-security classified inmates are housed at this facility. Annually, the facility processes about 8,500 admissions. The current census is 768 inmates at BCCF with an additional 46 Bucks County individuals housed in other jurisdictions. The facility reports that the census fluctuates in the general range of prisoners at any given time. Space is an issue, as the facility was originally intended to house approximately 410 inmates. BCCF reports a high volume of monthly admissions and discharges, with an estimated individuals admitted and discharged each month. Attachment M Page 183

186 Bucks County Correctional facility has ten 10 modular living units utilizing a direct supervision philosophy while providing programs for the treatment and education of the inmate population. Community Corrections Centers The Bucks County Department of Corrections also operates both a men s and women s Community Corrections Center. These two centers are community-based, minimum security, work release facilities. The philosophy for minimum custody and work release emphasizes personal accountability and treatment while offering residents an opportunity to help themselves and their families. The Men s Community Corrections Center opened July 28, The building houses 270 male residents and provides shared treatment programming for both males and females. Shared services offered to male and female residents include: intensive drug and alcohol treatment, adult basic education, case management, community service, and work release. The Women s Community Corrections Center opened July 28, This building offers 48 beds for female residents. The opening of the Women s facility offered the same levels of custody services and opportunities as the male population. The Bucks County Community Corrections Centers are currently at capacity with 315 individuals utilizing services. Mental Health and Substance Use Screening All inmates are screened using the Level of Service Inventory Revised (LSI-R); it provides a comprehensive risk/needs assessment by looking at major and minor risk factors, including mental health and drug and alcohol issues. The Texas Christian University Drug Screen-II (TCU-II) is additionally used for drug and alcohol assessments. The prison s medical department also screens new inmates for mental illness and drug and alcohol problems. An intake counselor notifies Correctional Mental Health Services (CMHS) that there is a new inmate with a mental illness. CMHS will see the inmate within 24 to 48 hours after referral. Referrals to CMHS can be made by internal and external sources as well. Facility staff report that the number of inmates with a mental illness is increasing while the number of staff to do evaluations and provide services is not increasing. The ratio of inmates to staff has increased. Every individual entering the correctional facility is also questioned about suicidal thoughts and behaviors. If there are suicidal concerns, the monitoring of the inmate begins immediately. Monitoring is done by both correctional officers and other inmates. Male inmates have a separate secure area to be housed in during crisis. Female Attachment M Page 184

187 inmates do not have a separate secure area; a separate area is in process. The male mental health unit is frequently full causing inmates in need of the unit to remain on regular cellblocks. If the evaluation by CMHS warrants, a commitment to the Norristown Hospital Forensic Unit is initiated immediately. The typical time it takes to transfer an inmate to the Forensic Unit is four to six weeks. Inmates returning from Norristown Hospital sometimes decompensate while awaiting trial and end up back on the waiting list to return to the hospital for treatment. The Norristown Forensic Unit does not prioritize cases according to seriousness; and because other counties use the unit as well, Bucks County has no control over the availability of beds. Drug and Alcohol Treatment Services The Bucks County Department of Corrections operates a Drug and Alcohol Treatment Services program with a full-time supervisor, 4 Drug and Alcohol Program Specialists, 5 fee-for-service therapists, and 2 support staff employees. The program uses a risk/need model to match interventions with client need and implements Hazelden s A New Direction short-term cognitive behavioral model for treatment. According to the County of Bucks Department of Corrections annual report, a total of 1,398 persons were interviewed and assessed for Drug and Alcohol treatment needs in Including recovery houses, 475 offenders were referred to community agencies. The Drug and Alcohol Unit is able to place individuals directly into residential treatment services from within the jail as a result of long-standing relationships with the SCA and treatment facilities. An average of 31% of the offender population received Drug and Alcohol services in Mental Health Treatment Services A mental health consumer who is incarcerated may continue to receive services. When an individual makes the prison staff aware that he/she had mental health treatment in the community, steps are taken to ensure that the individual has that treatment set up upon release. The Bucks County Correctional Facility houses a small unit for Mental Health treatment. This unit is operated as an outpatient service because there are very few beds available for use. There are 8 beds that serve as temporary care for both mental health and medical services. Through the Mental Health Unit s outpatient services, inmates have access to a psychiatrist for 16 hours each week. The Inmate Services Department also provides community, social, and referral services to the inmate population. With responsibilities for both classification and case management, Inmate Services case managers are required to have bachelor s degrees Attachment M Page 185

188 in criminal justice, psychology, or related human service fields. Classification staff is responsible for classifying and housing every inmate in custody, while case management staff design and implement structured case plans specific to individual offender risks and needs. Personnel in this department also serve as a liaison between families, intergovernmental offices, and outside social service agencies. Every inmate is assigned a case manager. Programs referred to and coordinated by Inmate Services include: Adult Basic Education (ABE) Basic education services for the inmate population. Decision Making Sponsored by Vita Education Services, the decisions program encourages inmates to evaluate critical situations relative to their lives and to develop techniques for personal problem solving. Anger Management Classes are offered throughout the year for groups of approximately 20 inmates. A trained facilitator, who contracts with the DOC, meets with the group once per week. Topics include recognizing the origins of anger, degrees of behavioral manifestations or damaging results of angry behavior, and triggers and techniques for recognizing and managing anger. Graduates of this program included 162 males and 14 females. Victim s Empathy Training Mandated by the Pennsylvania Board of Probation and Parole, this program attempts to emphasize and show inmates how their criminal actions can have a negative impact on victims, both emotionally and psychologically. Job Readiness program 6-week program to promote necessary skills and promote employability. Literacy Tutoring Sex Offender Treatment This program is offered to offenders twice per year covering a 16-week format. The aim of the program is to raise the awareness of offenders engaged in maladaptive sexual conduct. Post Traumatic Stress Disorder This group was made available to our female population in This program, staffed by providers from the Network of Victim Assistance (NOVA), is an 8-week, closed, psycho-educational group available to women who have been victims of domestic violence and/or abuse. Potential applicants are prescreened to determine appropriateness by one of the group facilitators. 7 women were enrolled in this group in Seminar in Self (SOS) Based on the teachings of William Glasser s Reality Therapy and Choice Theory, the focus of this program emphasizes evaluating one s self, self-perceptions, and environmental and behavioral choices. This group is facilitated by a certified reality therapist for female inmates. In 2009, 71 women participated. Choice Theory An 8-week course on William Glasser s Choice Theory/Reality Therapy was offered to the male inmates at the main correctional facility. The course is facilitated by a certified instructor. Attachment M Page 186

189 Reach Out (Domestic Relations) - In September 2008, a representative from Bucks County Domestic Relations began individual meetings with inmates having open domestic cases. The goal of these meetings is to promote compliance with existing court orders and to provide communication opportunities regarding payments, updating information, and requesting petitions. Individuals with open cases are contacted by letter and can request a meeting with the representative who is available twice a month. There were 226 meetings in Inmate Work Programs Bucks County Department of Corrections Training Academy Correctional officers currently receive behavioral health training and act as an additional check in identifying inmates with mental illness and referring them to Correctional Mental Health Services (CMHS). There are no specialized mental health officers. Currently, the Bucks County DOC requires correctional officers to complete the following courses: Inmates with Mental Illness Discussion on the types of mental illness corrections staff may encounter including schizophrenia, bi-polar disorder, and anti-social personalities. Do s and Don ts on working with handling inmates with mental illness and the mental health referral system are also reviewed. Suicide Prevention Department policy and procedure on proper responses to an inmate suicide attempt is the focus of this training. Additionally, staff are reminded of the red flags to watch for in inmates with potential suicidal behavior. CMHS provides services to the inmates through a contract with Lenape Valley Foundation. Well-trained staff psychologists and psychiatrists are available for inmates mental health needs. (There are no state standards related to behavioral health stipulated for county jails.) Monthly SPMI Meeting The Bucks County Correctional Facility hosts a monthly meeting to discuss inmates who have been diagnosed with a severe and persistent mental illness (SPMI) and/or have substance use issues. The meeting is attended by multiple stakeholders including representatives from the Bucks County Behavioral Health System, the Bucks County Department of Mental Health/Developmental Programs, the Bucks County Drug and Alcohol Commission, community mental health providers, probation and parole staff, pre-trial services, the public defender s office, jail administration, jail case management staff, and housing specialists. Inmates at all levels of criminal justice involvement (pretrial through post-conviction) are identified and discussed with regards to services needed and discharge planning. Attachment M Page 187

190 Courts Bucks County recently received a 3-year grant ($349,000) that will be used to develop and operate a specialty Drug Court. The court will began service in October 2010 and will focus on parole and probation violators. The current goal is to serve 25 individuals in year 1, 35 during year 2, and 45 in year 3. One probation officer from each of the five Probation and Parole supervision units has been assigned to work with the drug court. Other Diversion Programs First time non-violent offenders (DUI, retail theft, other misdemeanor) may be eligible for the Accelerated Rehabilitation Program (ARD) in which a treatment program is recommended in lieu of jail time. Offenders who successfully complete this program may have their criminal record expunged. Bucks County also operates a Restrictive Intermediate Punishment (RIP) program with day reporting for individuals with substance use disorders. The program is the result of a partnership with Alcohol Drug Addiction Parole Probation Treatment (ADAPPT), and consists of a yearlong series of treatment modules. RIP participants complete a community corrections stay and then move to house arrest. To be eligible for this program, individuals must be level 3 or 4 offenders who would have otherwise received state sentences. This program serves a small number of high-risk individuals and has had excellent success, with very few program violations (individuals in violation of program requirements are sent to state correctional institutions). Identified Gaps Case management services do not have the financial capacity to continue to work with incarcerated consumers; and, while mental health county dollars are available, they are limited and can last for 30 to 60 days Lack of an integrated system of case management for those with cooccurring substance dependency Very little training available for behavioral health personnel in other systems working with corrections on aspects of the criminal justice process and system or on issues of criminality and its relationship to mental illness and/or substance abuse Issues with transportation for Drug Court consumers Limited access to MH long term treatment (NSH-Bldg 51) Long length of stay at the jail for MH consumers waiting for NSH beds No access to MCES for 304s Limited space in jail and funding to accommodate expanded drug and alcohol treatment services Competency issues --- people go back and forth from NSH to jail Jail is overcapacity and is housing individuals in other jurisdictions Community Corrections and House Arrest over capacity Women s jail waiting list for MH treatment 6-9 months Attachment M Page 188

191 Differences in processes for involuntarily medicating someone at pre-trial vs. sentenced Not a designated MH treatment unit in the jail Long waits for individuals who have achieved competency for trial No formal process for sharing jail admissions information with behavioral health Jail cannot identify individuals with MH issues due to confidentiality and no information sharing with MH Providers do not know when someone has been incarcerated Mental Health Court is only 2 days per week with significant travel time and long hours Identified Opportunities TCU screen is done in the jail for person with D&A, as well as other screens including criminal thinking TASC has a collaboration with pre-trial services Assessors with co-occurring certification Drug Court to start on 10/14 D&A unit in the jail since 1972 Persons may be referred directly out for D&A residential placement Outpatient MH treatment available in the Jail 8 beds available on the medical unit Creative use of 304s for longer term LOS for SMI DA s office has designated ADA for Mental Health ADAPPT substance abuse treatment program SPMI Meetings at the jail bring stakeholders together to discuss treatment and reentry Faith based groups are available as a resource in the jail Assigned BH forensic specialist to Drug Court Public Defender s office has formal MH training for staff Recent ROR and subsequent 304 after release Criminal cases are screened through DA Attachment M Page 189

192 Jail Re-entry Prison/ Reentry Intercept IV: Re-Entry Release and Re-Entry Planning Program The Bucks County DOC began this program in It is a 3-day, 6-hour program and is held for both men and women. The program focuses on release preparation, using a cognitive-behavioral treatment curriculum and is facilitated by Drug and Alcohol, case management, and Adult Parole and Probation staff. 439 individuals completed this program (DOC Annual Report). Intercept 4 Reentry Post-Release Medication Upon release, inmates may request a three-day supply of medication and a prescription for one week of medication. While the county prescription program assists with this request, there are many areas for this process to break down without case management assistance. The current case management system does not have the capacity to address the needs of all released inmates. Also, inmates can be released without notice directly from a court appearance without aftercare planning. Community case management is not usually in place at this point. Forensic Re-Entry Enhancement Program (FREE) This is a PCCD funded program that began providing direct forensic treatment, case management, peer support, and other supportive services in April 2010 focusing on offenders with significant substance abuse histories. The program is a collaboration between the Department of Corrections, Adult Parole and Probation, Aldie Counseling Center, and the Recovery Community Centers. The program is run out of the Aldie Counseling Center in Doylestown with staff located in the jail and accepts referrals from the County Correctional Facility. Aldie has a psychiatrist on staff which facilitates prompt psychiatric care following release. There are currently five individuals participating in the FREE program. Case Management Services There are several case management services and programs available to assist offenders who have behavioral health diagnoses with reintegration into the community. The various levels of case management and the available programs have different requirements, including financial and clinical criteria. There is variable clinical ability Attachment M Page 190

193 specific to forensics among the different levels of case management and the different programs. Case Management Service programs include: Administrative Case Management (ACM) Staff is located at each Base Service Unit (BSU) Lenape Valley Foundation, Penn Foundation, and Penndel Mental Health Center. The forensic population is a mandatory priority population. Staff can go into the jail to work with inmates. They help coordinate county-funded medication once released and public assistance benefits, and they coordinate intake into mental health and/or substance abuse services. ACM refers cases to Intensive Blended Case Management, Community Treatment Team, Assertive Community Treatment teams as well as other outpatient services. Blended Case Management (BCM) Staff is located at each BSU and at Northwest Human Services. The staff continues to work with incarcerated clients on the caseload, but not if the incarceration is an extended period of time. Inmates can be referred back to BCM through ACM once released, and the frequency of contact depends on level of care. Community Treatment Team (CTT) A Penndel Mental Health Center program provides an intensive level of care for people with severe mental illness. The program emphasizes a team approach and includes a psychiatrist, a nurse, case managers, therapists and peer support and as much community involvement as possible. The program is an alternative to traditional outpatient services; the CTT client can also be enrolled in traditional treatment services. Forensic Services Program (FSP) A Penndel Mental Health Center program designed for people with a severe and persistent mental illness involved in the criminal justice system. The team is made up of Master s level clinicians who provide individual therapy and needed case management services, including psychiatry, and close collaboration with the criminal justice system. The clients must have six months remaining on their sentence, a severe and persistent Axis I diagnosis, and undergo a thorough assessment prior to acceptance. Staff attends the SPMI meeting and receives referrals from the Bucks County Correctional Facility regarding incarcerated offenders, as well as from Adult Probation/Parole regarding individuals already in the community. Mobile Engagement Services (MES) Program at Penn Foundation and Aldie Counseling Center, based in the drug and alcohol system, and some staff are trained to work with people with a mental illness, substance use, or a co-occurring disorder as well. The staff can engage Attachment M Page 191

194 the client directly or be contacted for family intervention. Staff can go into the jail to work with the client. After engaging the client, staff works to connect the person to appropriate treatment services. Program for Assertive Community Treatment (PACT) A Lenape Valley Foundation program, which is an evidence-based program that is designed for people with severe mental illness in Central and Upper Bucks who have not responded to traditional treatment. It is an intensive team approach, including psychiatry and as much community involvement as possible. Staff can go into the jail prior to inmate s release. Services are provided 24/7/365. Forensic Assertive Community Treatment (FACT) A Penn Foundation evidence-based program that provides services to individuals with severe and persistent mental illness who have forensic involvement (recent incarceration, probation/parole supervision, pending charges related to mental health symptoms) who live in the Upper Bucks County area. Services include a team approach to community-based psychiatric and clinical services, addiction counseling, case management, vocational support, forensic support, and peer support. Services are provided 24/7/365. Intensive Case Management Services (ICM) A drug and alcohol services delivery system, administered through the Bucks County Drug and Alcohol Commission, Inc., which concentrates on the assessment and referral of clients to treatment and ancillary services. It coordinates the delivery of health, substance abuse, mental health and social services, linking clients with appropriate services to address specific needs and achieve stated goals. ICM is available to all clients who meet the eligibility criteria and reside in Bucks County. Recovery Centers The Pennsylvania Recovery Organization - Achieving Community Together (PROACT) operates three recovery community centers in New Britain, Central Bucks County, and Lower Bucks County. These centers provide programs and services to support the needs of individuals and families recovering from addiction. They promote recovery through advocacy, support, education, and service by offering support to the recovering person, coordinating and linking individuals to services, providing technological services, and reaching out to the community to promote recovery. Services are primarily peer delivered. Peer Support The National Alliance on Mental Illness (NAMI) has a free education program designed for people with a mental illness or co-occurring disorder to learn how to manage their mental illness and is taught by peers. Peer-to-peer support services are also available Attachment M Page 192

195 through the PROACT Recovery Community Centers (for substance use disorders), the FREE project (2 Drug and Alcohol peer recovery specialists), and the Penn Foundation Forensic Assertive Community Treatment (FACT) team. The FACT team currently has 2 peer specialists with a combined case-load of individuals. This FACT program is a shared program with Montgomery County. Penndel Mental Health Center also has peer support that work closely with CTT and the FSP programs. Re-Entry from State Correctional Facilities Currently, Bucks County individuals returning from State Correctional Institutions (SCIs) have limited local re-entry resources. They often have no contacts in the community and few housing options, a problem that is particularly salient for returning sex offenders. Treatment Alternatives for Safer Communities (TASC) accepts referrals directly from state parole and has separate case loads for state and local parolees. In addition, inmates with severe mental illness returning to the community from SCIs are served by the Regional Mental Health Services Coordination Office. This office coordinates referrals for community services at the time of reentry. This process begins six to twelve months in advance of the maximum sentence date and is coordinated with the SCI and the county in order to access the necessary supports that the individual needs. The SCIs provide the psychological reports and the DC 551 and then the Regional Forensic Liaison coordinates with the county s Base Service Units and other community resources as necessary. Identified Gaps No system of integrated and coordinated case management for those with a co-occurring mental illness and substance dependency Limited affordable housing stock Limited contacts and information shared from DOC for community services No services for sex offenders when they max out from DOC Very little community contacts and housing options for max outs No formal method of information transmission for max outs who need MH service Issues on who to give information or assessments to if the person has no identified case management upon release Only 3 days worth of medication given upon release One week worth of scripts are given if the consumer asks No medication reentry services No formal reentry process with Medical Assistance MA approval can be delayed because of lack of access to psychiatrist and delayed ability to get forms processed MH consumer may not have MH appointment set up upon release OP MH appointments can take weeks Issues with getting psychiatric evaluations and discharge summary Jail does not always know when a person is to be released Attachment M Page 193

196 No formal discharge form and process or information shared with community MH provider Only 1 recovery house in Upper Bucks County Most in lower Bucks Lack of formalized system for communication between MH and CJ Lack of documentation on how the system works Identified Opportunities Regional Forensic Liaison for DOC maxouts TASC program takes referrals directly from state parole 2 year + sentences now being sent to DOC, freeing up jail space and resources This allows partnership between the state and County for better reentry TASC gets some direct referrals from the DOC Resource list provided to consumers SPMI meeting for the reentry for MH population Forensic ACT program Modified use of the GAINS form and Reentry toolkit FACT and PACT team has immediate psychiatric access MA applications can be done before release Partnership with jail, ADAPT and Day Reporting Center With SPMI meeting person gets linkages to community MH services Linkages to recovery centers and recovery houses available for D&A 3 PROACT recovery centers Forensic Reentry Enhancement (FREE) program have an office in the jail Probation and Parole have a sex offender unit Use of MH/DP/PRT roster for person who have D&A issues Reentry Center idea for County jail for the DOC population Faith based resources for reentry Attachment M Page 194

197 Probation Parole COMMUNITY Intercept V: Community Corrections/Community Support Bucks County Adult Probation and Parole Bucks County Probation and Parole is organized geographically with five supervision units (Upper Bucks, Central Bucks, and three in Lower Bucks County). Each unit has specific officers designated to specialize in sex offending individuals, mental health issues (these officers have been through CIT training), and drug court participants. Intercept 5 Community corrections Violation In March of 2009, the Bucks County Adult Probation and Parole Department adopted the Level of Service Inventory-Revised (LSI-R) for risk/need classification. The LSI-R is an integrated risk/needs assessment tool designed for this population. The LSI-R has been widely used for over 25 years and consists of 54 questions divided into 10 categories that measure both static and dynamic risk factors. Violation All individuals entering the Parole System are screened using a modified National GAINS Center APIC (Assess, Plan, Identify, Coordinate) Model reentry planning tool. The measure provides a comprehensive picture of the individual including medical and mental health history, substance use issues, and history of homelessness (See Appendix C). In 2005, Bucks County Probation and Parole began an initiative to train staff in evidence-based practices and motivational interviewing. With annual refreshers, all staff have been trained, along with other correctional staff, as well as many mental health and drug and alcohol therapists and case managers. The emphasis of this initiative is reduction of criminal recidivism for offenders under supervision. Bucks County also has a Behavioral Health funded full-time Forensic Behavior Specialist position who acts as a liaison between probation and the courts. The Forensic Behavior Specialist takes referrals from probation officers regarding individuals who are at risk of violation of parole. She is then able to make home visits and provide motivational interviewing and connection to services such as Medical Assistance, Social Security, food stamps, and transportation. The Forensic Behavior Specialist has a current caseload of 35 parolees. Bucks County Adult Probation and Parole Department has two EARN-IT probation diversion programs. The Drug Intervention Earn it Program was implemented in Attachment M Page 195

198 August of 2010 and is designed to divert non-addicted, low risk offenders convicted of minor drug related charges from probation supervision. Under this program, offenders are sentenced to a term of one year probation with the condition they be screened for the program. Screening consists of administering the LSI-R short version and the TCU Drug Screen II instruments. Offenders that meet the criteria are referred to a 7-week cognitive behavioral therapy group. Upon successful completion of the group and submission of 2 negative drug tests, the participants appear before a Magistrate at which point their case is closed. During participation in this program, the offender is on non-reporting status and has no contact with the department. Program requirements can be completed in 75 to 90 days. The Earn-It Program is a Re-Entry initiative targeting low risk, misdemeanor offenders who are challenged by the Court to comply with conditions imposed at sentencing. Offenders sentenced to the Earn-It Program will appear for a hearing in no more than 90 days to have their progress assessed, with non-compliance addressed in a much quicker time frame than traditional probation caseloads allow. As with the Drug Intervention Earn it Program, the offenders are on non-reporting status while participating in the program. Forensic Assertive Community Treatment (FACT) This evidence-based program provides community-based psychiatric treatment, outreach, rehabilitation, and support to individuals with severe mental illnesses (including individuals with co-occurring substance use disorders)who are involved with the legal system through recent incarcerations, probation/parole supervision, and/or pending charges related to crimes committed as a result of mental health symptoms. The FACT team serves individuals in the Upper Bucks County area. The program is currently funded for 21 participants. There is currently a waiting list. The team consists of a team leader, half-time psychiatrist (20-hours per week), three registered nurses, master s level mental health therapist, master s level addiction counselor, two peer specialists, case manager, forensic specialist, and vocational specialist. Support is available 24 hours a day, 7 days a week. A crisis line is also available. Housing and Homelessness The Bucks County Housing Coalition (BCHC) is a coalition of public and private/nonprofit agencies working together to address the housing and social service needs of Bucks County s homeless population. The BCHC strives to assure the availability and sustainability of housing for homeless persons and/or persons facing homelessness. Recent efforts include a focus on persons leaving the criminal justice system. The Bucks County Housing Coalition has a large number of participating members including but not limited to: PA Department of Public Welfare, Bucks County Career Link, Bucks County Office of Human Services, Bucks County Behavioral Health, Bucks Attachment M Page 196

199 County Department of Children and Youth, Bucks County Dept. of MH/DP, Bucks County Drug & Alcohol Commission, Bucks County Dept. of Community & Business Development, Department of Military Affairs, American Red Cross, Tabor Children's Services, Bucks Interfaith Housing Development Corporation, Habitat for Humanity, Blessed Margaret, National Alliance on Mental Illness, Coalition for Women's Economic Justice, and United Way of Bucks Way. Bucks County also has a full-time Behavioral Health Housing Specialist, associated with Behavioral Health and with the Bucks County Housing Group, who is an active participant and contributor to the efforts of the Bucks County Housing Coalition. The Local Housing Options Team (LHOT) recently formed a Forensic Housing Subcommittee for Bucks County to improve housing options for those with mental health or substance use disorder issues and involvement in the criminal justice system. Bucks County is also utilizing Homelessness Prevention and Rapid Re-Housing Program (HPRP) funds to provide financial assistance and services to either prevent individuals and families from becoming homeless or help those who are experiencing homelessness to be quickly re-housed and stabilized. Homelessness prevention emergency housing assistance, including rental assistance, utility assistance, necessary legal services, and comprehensive case management is being provided to households, including the prisoner/reentry population, who would be homeless but for this assistance. Rapid Re-Housing services including rental assistance, utility assistance, housing placement, credit repair, necessary legal services, and comprehensive case management is being provided to assist households to be placed into permanent housing as quickly as possible in order to eliminate or decrease time in emergency shelter and/or transitional housing. In addition, Bucks County has approximately 75 privately owned Recovery Houses for individuals with substance use disorders. These facilities usually will not accept persons on psychiatric medication or methadone treatment. There are also a small number of Personal Care Homes for individuals with mental health issues. Vocational Services Bucks County is currently working to improve vocational services for individuals returning from correctional settings. The FACT team is utilizing the SAMHSA Supported Employment Implementation Resource Kit to provide increased support to participants who have identified work/educational pursuits as one of their recovery goals. Drug and Alcohol also provides a series of courses designed to increase employability. Adult Probation and Parole has an established connection with Careerlink which often provides them job postings. Attachment M Page 197

200 Community Behavioral Health Services There are a number of behavioral health agencies that support Bucks County individuals in the community. Examples include: Recovery Community Centers (Substance Use Disorders), Community Wellness Centers (Mental Health Issues), and the Women s Recovery Community Center. Advocacy Bucks County has a highly active branch of the National Alliance on Mental Illness (NAMI), with over 250 members. This branch is heavily involved in education, advocacy, and support and provides several services including a 12-week course for family members, a 6-week course for parents and/or caregivers of mentally ill children and, a 10-week course for consumers, peer-to-peer support services, and assistance in CIT trainings. Further information can be found at Identified Gaps Limited and competing funding for MH services Few County resources for persons without MA There are few vocational support services Public transportation is not throughout the County and limited on the lower end Issues with getting transportation for drug screening Lost hospital beds in the County Assessments are not provided from the jail unless requested by a provider Limited affordable housing Not enough outpatient services Low reimbursement rates for outpatient Competing issues and thoughts on how resources should be used When key staff change agreements/partnerships fall through the cracks Limited number of attorneys to handle all the cases for MH court Issues with competing national housing funds Folks coming from jail cannot meet landlords Cannot share housing when you have a voucher Lack of dedicated funding for reentry and community services for CJ/MH population Identified Opportunities Develop a behavioral health subcommittee under the CJAB P&P has specialized BH positions BH Forensic Specialist - attached to probation funded through reinvestment-bhs-d&a Probation officers have been through CIT training Designated sex offender probation officers NAMI trainings (Family to Family, Peer to Peer) Attachment M Page 198

201 WARM Line Recovery Specialist for D&A Routine for community agencies to assess for both MH and D&A Brief assessment from accompanies the person to probation or parole Forensic Peer Specialist Services provide in-reach Forensic ACT team PACT team deals with forensic issues New County Assistance Office director 2 Community Corrections settings FACT team has a vocational component Career Link services ex-offenders FACT and PACT teams have developed connections with landlords to address housing Person can get MA benefits while on work release Interest in development of local 2nd Chance employer list Expansion of HUD definition of homelessness Attachment M Page 199

202 Attachment N County Program County Program: Bucks County FY County Plan Contact Person: Joyce Schug Background THE SUPPLEMENTAL PLAN TO PROMOTE COMPETITIVE EMPLOYMENT In the Spring of 2009, the Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS) formed a representative Workgroup to develop state strategies to expand the availability of evidence-based practices (EBPs), particularly supported employment, that assist individuals with psychiatric disabilities to engage in competitive employment in community settings. The creation of the Workgroup reflected the goals of OMHSAS March 2008 Call for Change: Employment - A Key to Recovery ( and its goal of significantly increasing the number of persons served by the behavioral health system who are competitively employed. This is in response to the continuing high rate of unemployment among those with psychiatric disabilities and the slow development of evidence-based practices to address the employment aspirations of individuals. The Workgroup recommended that OMHSAS require each of the County Mental Health (MH) Programs to submit, as part of each year s MH Plan or Update, an annual Supplemental Plan to Promote Competitive Employment. The County Supplemental Employment Plan should: a) reflect an inclusive planning process at the county level; b) provide an overview of the current status of employment services in the county; and c) address the county s strategies to increase competitive employment through orientation of the county mental health system toward employment outcomes, staff training, new data collection protocols, and shifting current dollars and/or accessing new funding for supported employment. In developing the County Supplemental Employment Plan, counties should utilize the Substance Abuse and Mental Health Services Administration (SAMHSA) Supported Employment Toolkit, ( The Supported Employment Toolkit was developed by modifying the knowledge base and specific interventions about Supported Employment from the intellectual/developmental disability field and adapting them to the specific needs of the psychiatric field. Supported Employment programs: attach primary importance to consumer preferences; identify competitive employment as the goal; work toward mainstream jobs in community settings; Attachment N Page 200

203 seek jobs that pay at least minimum wage; find work settings that include people who are not disabled; focus on persons with the most severe disabilities; provide follow-along supports that are continuous; base eligibility on consumer choice; integrate employment services with clinical treatment; and begin job search activity as soon as a consumer expresses interest in employment. 1. Inclusiveness of the Planning Process. a. Please briefly describe the planning process for this Supplemental Plan: including stakeholder involvement, leadership roles, meeting schedules, the establishment or expansion of a local Employment Transformation Committee, data and information sources, etc. The Employment Workgroup of Bucks County began meeting in March 2011 and has a recurring monthly meeting date. This group is led by Bucks County Mental Health/Development Program s (MH/DP) Coordinator of Rehabilitation Services. Data has been gathered from a variety of sources including Community and Facility- Based Employment Providers, MH providers with embedded vocational specialists, and the Bucks County MH/DP Fiscal Department. The diverse stakeholder workgroup members gave full input into the development and finalization of this plan. b. Please involve a diverse stakeholder group in the planning process, including, but not limited to the entities/groups listed below. Please indicate the number of individuals or group representatives who were involved in this planning process in each category below: (#) (#) 3 Consumers 0 The District Office of Vocational 1 Family members Rehabilitation 10 Provider agencies 0 Local Workforce Investment Boards 1 Managed Care Organizations 0 Educational organizations 2 Community Support Program 0 Local business groups representatives 0 Individual employers 0 Criminal justice organizations 0 Advocacy organizations 0 Drug & alcohol / mental illness dual diagnosis groups 3 Others (please describe) Voice and Vision (CST)-1, SE Consultant 1, 0 Transition-Age Youth BCBHS 1. Many participants cover more than one role. Total active membership is Current Service Delivery Data. Please review the attached tables compiled from the County Income and Expenditure Reports and CCR POMS data for FY , which identify the numbers served and dollars spent within the two existing vocational cost centers for your county and answer the questions below. Attachment N Page 201

204 DEFINITIONS: Facility-Based Employment: Programs designed to provide remunerative development and vocational training within a community-based, specialized facility (sheltered workshop) using work as the primary modality. Sheltered workshop programs include vocational evaluation, personal work adjustment training, work activity training, and regular work training and are provided in facilities licensed under the Chapter 2390 regulations (Vocational Facilities). Community Employment: Employment in a community setting or employmentrelated programs which may combine vocational evaluation, vocational training, and employment in a non-specialized setting such as a business or industry or other work sites within the community. Included are competitive employment, supported/supportive employment, and industry-integrated vocational programs such as work stations in industry, transitional training, mobile work forces, enclaves, affirmative industries/business, and placement and follow-up services. a) Confirm the accuracy of the data provided. Please adjust any data and explain any corrections made. Check here if the data is accurate. Check here if the data should be adjusted, as follows: Community Employment fund amount did not match and has been adjusted below. Facility based funding was accurate. Community Employment and Employment Related Services 136 Number of individuals served $340, Funds expended Facility Based Vocational Rehabilitation Services 13 Number of individuals served $78, Funds expended b) Additional Expenditures for Employment Services. If there are additional mental health funds expended by the county for employment services that are captured in other cost centers, please indicate below the cost centers used, the expenditures made, and the number of individuals served: Cost center in which expenditures appear: Wellspring Clubhouse, Assertive Community Treatment (ACT) through Lenape Valley Foundation, Forensic Assertive Community Treatment (FACT) through Penn Foundation, and Community Treatment Team (CTT) through Penndel Mental Health Center Total additional Expenditures for employment services $64,794 for Wellspring Clubhouse only Numbers of additional individuals served: 170 c) Indicate the percentage of current county funding for employment as a percentage of overall current county funding. $17,885, Overall county funding $504, County funding for employment services Attachment N Page 202

205 3% Percentage of overall county funding for employment services d) Indicate the percentage of overall employment funding expended on facility based versus community services, based upon the cost center definitions above. $504, Total employment funding 21% Percentage of total employment funding for facility based services 79% Percentage of total funding expended on community services Please include a brief description of the numbers of consumers served in facility based services and their employment goals. (Interviews with consumers and cost-to-outcome analysis are encouraged. Presently there are 9 individuals who are participating in facility based employment services. The majority of these individuals have worked at this program for over 10 years and do not currently express a desire to work in the community. It is believed, however, that many of these individuals would be successful in achieving community employment, but fear change. Bucks County MH staff and this provider recognize that in order to encourage change, efforts must be made to provide ongoing education about community employment, share peer success stories, and provide benefits counseling with employees, their families, and providers of behavioral health services. e) Describe any changes you plan to make in total employment expenditures or percentages allocated to facility vs. community based services. Also, please report on other funds (e.g., HealthChoices, OVR, Criminal Justice, etc.) currently spent on employment. [Note: OMHSAS expects each county to establish a target goal for increasing funding for supported employment including, but not limited to a shift in funds from facility based to Supported Employment programs over the course of the 5-year Plan.] The idea of moving facility based funds to community employment was discussed with the Employment Workgroup. The group feels that this program provides a choice for individuals and at this time would not want to see funds moved. The workgroup would like to see the education described above provided to the facility based employees, their family members, and staff. Reinvestment monies are not currently being utilized for employment services. The Office of Vocational Rehabilitation (OVR) reports that approximately $900, is spent on Bucks County residents who have a disability. The percentage of individuals with a mental health diagnosis was not available at the time of this report. The Department has struggled with collecting data on the dollars spent on employment for individuals involved in the criminal justice system. Bucks County s Forensic Assertive Community Treatment team has provided employment and vocational supports to 15 of the 26 individuals they serve. $35, dollars has been allocated for the FACT vocational services. 3. Funding for Supported Employment. Please indicate the amount of vocational funding that the County anticipates will be spent in the next year specifically for Supported Employment programming, and whether those Attachment N Page 203

206 funds are currently in the Community Employment Services or Facility Based Services cost centers, or represent new dollars for Supported Employment. Supported Employment is defined above (Background). Total dollars to be expended on SE services $ a) % of those dollars within the cost centers of: Community Employment and Employment Related Services 100% Facility Based Vocational Rehabilitation Services 0% b) % of new dollars to be expended on SE services % Bucks County anticipates adding an additional provider of supported employment services. We will also be exploring ways to add Work Incentive Planning and Assistance (WIPA) Counselors to our continuum of supports for supported employment. Bucks County MH/DP has also engaged Dr. Kate Donegan as a consultant for Bucks County and is in the process of determining how best to utilize her skills. We have begun consulting with Networks, Inc. to support the development of an employment kick-off followed by a series of skill building trainings. This is a joint effort for individuals receiving supports through the MH and Intellectual Disabilities systems. Given that much more detail needs to be considered and plans developed, no dollar figures can be assigned at this time. 4. Prior County Activities to Promote Supported Employment. Please indicate the activities undertaken by the County in the past two or three years that have been designed to promote Supported Employment programming. Please note that prior activities can fall into one or all three stages of development. Early-Stage Development Activities. The County has: Developed consensus around both the importance of employment and the use of evidence-based employment interventions Provided basic training and technical assistance to provider agencies on the delivery of evidence-based practices Established a funding framework for the development of new evidence-based employment services Provided supportive information to consumers and families on the effectiveness of evidence-based employment practices Familiarized county and local program staff with the elements of supported employment fidelity measures Other activities: please describe It is the (SE) Employment Workgroups belief that many of the above early stage and middle stage activities below will take root following our upcoming SE EBP trainings, SE technical assistance with providers and the county and trainings through Networks, Inc. Attachment N Page 204

207 Middle-Stage Development Activities. The County has: Established new evidence-based employment services in one or more service sites in the county Provided information to consumers/families and providers on work incentives Developed evidence-based employment practices to focus on the types of employment in the local job market Provided detailed training and technical assistance to providers on the delivery of evidence-based employment services Developed evaluation mechanisms to insure a focus on appropriate consumer outcomes in competitive employment Assisted programs in using the supported employment fidelity measures to shape and assess service delivery approaches Other activities: please describe Later-Stage Development Activities. The County has: Further expanded the availability of evidence- based practices to all consumers in the County Developed resources to provide benefits counseling to consumers who are returning to work Supported providers who can serve as a model of evidence-based employment practices in other sections of the Commonwealth Improved the quality of jobs (re: income, benefits, tenure, promotion) obtained by graduates of evidence-based programs Integrated supported education opportunities into the delivery of evidencebased employment practices Used the supported employment fidelity measures to assess and improve program delivery Other strategies: please describe 5. Proposed County Activities to Expand Evidence-Based Employment Services. In the table on page 72, please list each of the specific, measurable strategies the county plans to use to promote and expand the use of evidence-based employment practices over the next 5 years, using the following eight categories ( A through H below). Each strategy should indicate who, what, when, where, & how, in order that the county and state can track attainment of the goals. The examples provided in each section are offered only as a starting point for your consideration of those approaches best suited to your county. For each strategy, indicate the anticipated outcome or outcomes and target date over the next Planning year. All eight goals and strategies do not need to be filled-in, only those that your county anticipates focusing on during the next 5 years. A. System Orientation To Employment Outcomes Indicate the county s strategies to ensure that employment is recognized throughout the county s mental health delivery system in both treatment and rehabilitation settings as a core aspect of the recovery process. Examples: Attachment N Page 205

208 Sponsor system-wide training on supported employment approaches and the value of work to recovery; target county-sponsored training on employment for therapists/doctors, provider board members, consumers and family members, and/or residential program staff; and establish county policies/procedures regarding the involvement of all provider agencies in supporting consumer employment outcomes. B. Staff Training and Technical Assistance Indicate the county s strategies to provide training and technical assistance to provider staff directly implementing evidence-based employment practices. Examples: Fund provider-staff participation in both on-site and web-based supported employment training; encourage all providers to include employment strategies and services as part of regular client assessments; require providers to meet SE Fidelity standards and conduct SE Fidelity Scale Reviews with providers; monitor SE providers in the county with regard to their consistent use of the six principles of supported employment; and implement regular Employment Network (EN) Meetings for local employment service providers. C. Funding for Employment Services Indicate the county s strategies for increasing funding for evidence-based employment practices for people with psychiatric disabilities. Examples: Slowly shift funds from sheltered workshops and day programs to more evidence-based employment practices; use reinvestment funds, and/or Medicaid Infrastructure Grant dollars to initiate training; help agencies explore the use of SSA Ticket-to-Work and Work Incentives programs for service delivery dollars by becoming an EN; work with OVR to shift contract dollars to EBPs; and collaborate with providers in seeking national, state, and local foundation funding for start-ups. D. Responding to Local Workforce Needs Indicate the county s strategies for helping providers to access and respond to information about local workforce needs and employer requirements for new workers. Examples: Work collaboratively with the Pennsylvania Business Leadership Network (PA-BLN) and both local Workforce Investment Boards (WIBs) and CareerLink offices; establish working relationships with local Chambers of Commerce; encourage providers to establish their own business advisory groups; and develop county-wide Business Advisory Councils to help providers better understand the workforce needs of local employers. E. Educational Linkages/Joint Projects Indicate the county s strategies to involve local educational organizations in the preparation, training, and certification of consumers with psychiatric disabilities seeking self-sustaining careers in the competitive labor market. Examples: Attachment N Page 206

209 Work with local schools to ensure access to ABE/GED programs for consumers; establish more formal Supported Education programs; ensure provider presence/focus on employment at individual education plan (IEP) meetings; develop collaborative relationships with community colleges offering a variety of career training programs; and develop a resource guide to existing academic training programs in both non-profit and for-profit career training settings. F. Utilizing Peer Specialists Indicate the county s strategies to utilize the experience of both currently certified peer specialists and other consumers in providing evidence-based employment practices. Utilizing peers will support other consumers, and may encourage the consumers to seek their own employment or educational opportunities. Examples: Train peer specialists on Supported Employment; fund employment peer specialist positions with employment provider agencies to work with individual consumers returning to the competitive labor market; rely upon peers to develop and operate employment support groups for working consumers; fund Consumer-Directed Services to develop evidencebased employment practices within their operations; and ask providers to develop employment-focused WRAP plans for interested consumers. G. Data Collection Indicate the county s strategies for improving the collection of data with regard to the employment status, progress, and success of consumers in evidencebased employment practices. Examples: Request that local Consumer/Family Satisfaction Teams specifically survey Supported Employment participants; ask employment providers to report on program outcomes using the Employment Reporting Grid in the Evidence-Based Practices Toolkit (from SAMHSA); and seek information on the differential use of treatment and rehabilitation services for those who are involved in EBPs and those who are not. H. Work Incentive Counseling Indicate the county s strategies for grappling with consumers fears of losing financial and/or medical benefits as a result of the income earned from competitive employment. Examples: Social Security Administration (SSA) sponsors Work Incentive Planning Assistance delivered through Community Work Incentive Coordinators who have been trained and certified by SSA; some county agencies and provider groups make good use of these resources to maximize resources for beneficiaries who are working or are planning to work in the future; and some counties are planning to devote their own funding to an expansion of these types of work incentive counseling programs. Attachment N Page 207

210 5. Supplemental Plan to Promote Competitive Employment: Proposed County Strategies & Outcomes County: Bucks FY Area Strategies Outcomes Target Dates Updates on Goal Implementation A. System Orientation to Employment Outcomes B. Staff Training and Technical Assistance Strategy 1 Strategy 2 Strategy 1 Sponsor training for Employment Workgroup on Supported Employment (SE) Evidence- Based Practice (EBP). Sponsor system wide training on SE and the value of work. Develop a strategic plan to deliver SE and EBP Training and Technical Assistance. Outcome 1 Outcome 2 Outcome 1 Attachment N Page 208 Create a foundation for leaders supporting the Supported Employment initiative throughout Bucks County. Foster philosophical shift towards the belief that employment has and can successfully be utilized as a tool in recovery. Provide an increased opportunity for individuals to choose employment. Increase skills and competencies of staff in their ability to effectively support employment choices. 4/21/11 A half-day training was provided on April 21, 2011 by Dr. Kate Donegan. Fall 2011 Bucks County MH/DP, with the support of the Competitive Employment Workgroup, offered an Orientation to SE EBP at two Bucks County locations. This training included stories from individuals who have a lived experience of a mental health challenge and the role employment played in their recovery. A presentation was also provided by CareLink s Career Services program that meets fidelity for SE EBP. For 2012, MH/DP has contracted with Networks for Training and Development to provide a monthly training series that will promote employment. 6/30/11 Bucks County recognizes the need to continue our focus and available training on SE EBP. Financial resources are not currently available to utilize consultants for this, however, we

211 Strategy 2 Develop a timeline for the delivery of a county wide employment kick-off and training series on employment best practices. C. Funding for Employment Services Strategy 1 Utilize CHIPPs dollars to support the addition of one SE provider and/or increasing access to WIPA Outcome 2 Outcome 1 Attachment N Page 209 Increase skills and competencies of staff in their ability to effectively support employment choices. Provide choice and access to SE services while addressing one of the core principles for SE EBP, which is personalized and increases benefits counseling. continue to explore alternate options. Bucks County is fortunate to have been selected to participate in OMHSAS s Employment Transformation Project. Our choice for collaboration was Beaver County and we have focused on the areas of SE EBP and WRAP for Employment. We have also collaborated in the areas of county leadership, integrating SE into psychiatric rehabilitation services, increasing employment outcomes for individuals with forensic histories, and developing community partnerships that suport the development of funding for SE. 8/31/11 Bucks County MH/DP held a countywide employment kickoff on November 15, Over 200 stakeholders were in attendance for a full day conference with Denise Bissonnette, an international motivational speaker and trainer on supported employment. The training was very well received and successfully set the stage for promoting competitive employment in Bucks County. 12/31/11 The MH Department began contracting with AHEDD, a supported employment provider in November While we do not have dedicated positions for WIPA Counselors

212 D. Responding to Local Workforce Needs Strategy 2 counselors throughout Bucks county Continue application for Medicaid Infrastructure Grants(MIG), Reinvestmen t dollars, and other grants that will support SE and increase transportatio n for individuals seeking employment. Outcome 2 Strategy 1 Outcome 1 Increase the number of people working competitively in our community. An increase in SE services and supports that promote competitive employment. Ongoing through this funding, we do have access to WIPA counselors through AHEDD for young adults (16-30yrs). Workgroup members report that limited access to WIPA counseling continues to create resistance towards employment for potential job seekers and their family members. Bucks County MH/DP and the Competitive Employment Workgroup are pleased to report that in August 2011 we received a MIG grant. These funds were utilized to support the training mentioned under section A, Strategy 2. Additionally this training included an employer recognition event and Resource Expo. There currently are no grant or Reinvestment applications in process. Strategy 2 Outcome 2 E. Educational Linkages/Joint Project Strategy 1 Provide ongoing information and education regarding the available funding for SE Programs available in Bucks County for individuals in recovery and other stakeholders involved with the mental health system. Outcome 1 Attachment N Page 210 Provide opportunities for skill development and enhancement for people working to increase their self-sufficiency and move forward with career goals. Ongoing Bucks County MH staff have participated in various trainings, transition fairs, and resource expos for educators, providers, transition age youth, family members and professional partners. The Competitive Employment Workgroup members recognize the value and need to continue activities within their own agencies in order to promote employment and further impact the belief that Work is Everybody s

213 Strategy 2 Bucks County will sponsor, in collaboration with OVR, a training for Certified Peer Specialist.(C PS) F. Utilizing peer Specialists Strategy 1 Utilize people in recovery who are employed including Peer Specialists in trainings as "the evidence" for success. Outcome 2 Outcome 1 Strategy 2 Outcome 2 G. Data Collection Strategy 1 Identify current employment outcomes Outcome 1 Attachment N Page 211 An increase in the number of individuals who can receive and benefit from Certified Peer Specialist services. An increase in the belief that employment is an attainable goal and that employment can and does support recovery. Unified data collection on measures that will allow the Business. Sharing both educational and employment resources will be a cornerstone in promoting career development. The MH Coordinator of Rehabilitation Services will continue to collaborate with contracted agencies to develop an agency specific plan to promote competitive employment in FY /30/11 In November 2011, Bucks County and OVR collaborated in funding a 21 person CPS class. OVR funded 11 of these students and reimbursed the training institute directly. The County provided the resources for the remaining students. An April 2012 class is currently being seated. We are looking to collaborate with OVR again, but understand that there may be budgetary Employme nt kick-off Fall 2011 constraints. Individuals with a lived mental health or co-occurring experience presented at both the Employment Kick-off and the SE EBP trainings. The Competitive Employment Workgroup recognizes the need to continue this focus at the local level in order to promote employment and further impact the belief that Work is Everybody s Business. 12/31/12 Bucks County participated in a recent Community of Practice call with

214 relative to SE Fidelity measures. Strategy 2 Outcome 2 County to identify what is working and what areas need to be strengthened. OMHSAS. The MH Department and the Competitive Employment Workgroup will take the next several months to further investigate what we may need in place in order to develop monitoring teams in order to schedule visits with programs. Bucks County will continue a self assessment process for this plan submission. Over the next year, we will determine how to include additional programs that have employment components. This includes the PACT, FACT, and ICCD Clubhouse programs that may measure employment outcomes with tools specific to their program model. Our new SE provider, AHEDD, will be educated further on SE EBP and directed to use the SE EBP Toolkit in the development of their program. It is our goal to complete full fidelity monitoring within CY 2012 for SE programs and use the data to improve programming outcomes. H. Work Incentive Counseling Strategy 1 Promote the use of WIPA counselors available in Bucks County Outcome 1 Attachment N Page 212 People will experience a decrease in fear as accurate information is provided promoting individualized SE goals. 8/31/11 and quarterly thereafter. Bucks County MH/DP has continued to share information with stakeholders regarding benefit counseling through the Disability Rights (DRN) Network of PA and AHEDD. In April 2012, our employment series training is on Dispelling the Myths Regarding SS and Work

215 Strategy 2 Provide and promote training resources for Work Incentive Counseling. Outcome 2 Through education and understanding. Bucks County stakeholders will become more competent when discussing work and benefits with people in recovery and their family members. A distribution list has been developed for receipt of this informatio n and will continue to occur. Incentives. AHEDD and DRN of PA will have counselors available. Over the past year, training opportunities have been shared with our on-line distribution list, such as the Works for Me Training - An Introduction to Work Incentives and Ticket to Work that occurred in the Fall These trainings have targeted individuals with disabilities and their families. We will continue to coordinate with the DRN of PA. Attachment N Page 213

216 Attachment O County Program FY County Plan COUNTY PLAN FEEDBACK FORM (OPTIONAL) Attachment O Page 214

217 Attachment P County Program FY County Plan FY COUNTY MENTAL HEALTH PLAN REVIEW FORM (To be completed by OMHSAS Staff) Bucks County County Program BPPD Reviewer Jennifer Parker Field Office Reviewer Frank Molina Directions: Please refer to the FY Plan Guidelines TOPIC Note: In each area briefly explain and describe areas of strength and areas where improvement is needed SUBMISSION The plan is submitted on time (Y/N). Yes The plan has been distributed electronically as well as in hard copy to the Field Office and the Bureau of Policy and Program Development, and electronically to the State Hospital CEOs. Yes EXECUTIVE SUMMARY Attachment P Page 215

218 TOPIC Does the Executive Summary summarize the plan as a stand-alone document? (for update years, please see the specific instructions in the guidelines) Note: In each area briefly explain and describe areas of strength and areas where improvement is needed Yes. The distinct plans listed are MH/plan, PATH, housing, forensic plan, and employment plan. The priorities are OP, PS, Crisis, BH/PH coordination, and transitional age youth. A summary of all other areas of the plan is absent. VISION & MISSION STATEMENT Does the Vision & Mission Statement clearly indicate the goal of recovery for adults, older adults, and transition-age youth with mental illness and co-occurring substance use disorders within the county mental health program? (for update years, please see the specific instructions in the guidelines) Yes. The vision statement outlines the direction Bucks County mental health programs are heading in the future. The mission statement and values state how the county mental health programs will achieve the vision encompassing recovery and resiliency principles. Reviewers recommend inclusion of substance abuse services. Attachment P Page 216

219 TOPIC Note: In each area briefly explain and describe areas of strength and areas where improvement is needed PROCESS USED FOR COMPLETING THE PLAN The process for completing the plan is described. The process for completing the plan was very briefly described with little supporting details. The description in FY Plan was much more thorough. There is evidence of inclusive, open, accessible meetings. Bucks County meets with various MH service systems in order to develop the MH/Plan. Meetings are briefly referenced, but little details provided. Identifies how OMHSAS feedback was addressed. No mention of OMHSAS feedback. Please note impressions of the process. The process seems to be a collaboration of the various MH providers, family members, and consumers. Attachment P Page 217

220 TOPIC Note: In each area briefly explain and describe areas of strength and areas where improvement is needed Required signature page is attached (Attachment A). Yes. With required signatures. Public Hearing notice is attached (Attachment B). Does the public hearing notice include contact information for requesting special accommodations? Attached with contact information but no information provided regarding special accommodations. If the County receives the Projects for Assistance in Transition from Homelessness (PATH) funding, PATH Intended Use Plan and Budget are attached (Attachment C). Yes. Both the Intended Use Plan and Budget are completed and attached. Path funding very clear. CSP Plan Development Process Review checklist (Attachment D) was received and signed as required. Plan checklist complete. The MH/Plan was a collaborative process with all stakeholders. Signatures are blank. Please note overall impression from checklist. CSP Committee endorses County Plan. (Question #5 in Attachment D) [If no to #5, indicate reason] Yes. Attachment P Page 218

221 TOPIC Note: In each area briefly explain and describe areas of strength and areas where improvement is needed List corresponding # s of No responses from the CSP Plan Development checklist. None. OVERVIEW OF EXISTING COUNTY MENTAL HEALTH SERVICE SYSTEM Existing mental health services are described using the Attachment E as per the guidelines provided in the Attachment. Please note any comments. Yes. The attachment list all service categories, service descriptions, outcomes, funding sources, and population served. (for update years, please see the specific instructions in the guidelines) Evidence-based Practices Survey (Attachment F) is included. Please note any comments. (for update years, please see the specific instructions in the guidelines) Yes- County has: ACT, Supported Employment, Supportive Housing, Illness Management/Recovery, and Integrated Treatment. Reviewers recommend greater utilization of SAMHSA s toolkit to measure fidelity for EBPs. Recovery-oriented/Promising Practices Chart has (Attachment G) been completed. Please note any comments. (for update years, please see the specific instructions in the guidelines) Yes. Provides facility names, services provided, number served, and expenditures in recovery oriented programs. All have funding except Fairweather Lodge and Medicaid Funded Peer Specialist Program. The county has included a brief narrative explaining Attachments E, F, and G. None provided. Attachment P Page 219

222 TOPIC (for update years, please see the specific instructions in the guidelines) Note: In each area briefly explain and describe areas of strength and areas where improvement is needed IDENTIFICATION AND ANALYSIS OF SERVICE SYSTEM NEEDS Describes the resources and strengths in the current system that the county can use/build upon. (for update years, please see the specific instructions in the guidelines) Yes- County identifies S.E.L.F program, partnership with AAA, peer services, forensic services, crosssystems mapping, and quality improvement process. Includes an analysis of the unmet needs and service gaps for adults, older adults, and transition age youth with serious mental illness/co-occurring substance use disorders, with each age group addressed separately and distinctly. (for update years, please see the specific instructions in the guidelines) Yes- Adults: housing; funding for services; lack of resources for forensic initiatives Older Adults: alcohol-related problems; stigma; mobility issues TAY: Access to services and resources; housing Reviewers recommend including cooccurring population. Provides a description of the data and stakeholder input that was used to identify what is working and what is not. (for update years, please see the specific instructions in the guidelines) Brief summary- vague description mentioning data but not outlining specifics of what was used. MH Plan committee reviewed data to determine what was working and what was not. The Service Area Plan Chart (Attachment H) is completed and reflects the progress towards meeting the Service Area Yes. Improving incarceration rate and reducing the length of stay in NSH goals identified. Incomplete Attachment P Page 220

223 Planning goals. TOPIC Note: In each area briefly explain and describe areas of strength and areas where improvement is needed data for goal 3. (for update years, please see the specific instructions in the guidelines) Addresses target groups that are underserved including special populations and cultural groups describes how these groups have been identified and why their service needs are not being met. (for update years, please see the specific instructions in the guidelines) Yes. Increase in outpatient and inpatient resources and specialty services such as Dialectic Behavioral Therapy, Trauma informed services, supports for people with dissociative disorders, housing, and aging. Does not address the co-occurring population. Older Adults Program Directive (Attachment I) is included. The narrative section addresses how the MOU supports service provision to older adults and also identifies all efforts to support service provision to older adults (for update years, please see the specific instructions in the guidelines) Yes. Attachment in file updated and signed April 18, MOU identifies that AAA, Area Agency on Aging, is divided into Long-Term Care, Public Affairs, Administrative and Financial Affairs, and specifies services rendered. Attachment P Page 221

224 TOPIC Note: In each area briefly explain and describe areas of strength and areas where improvement is needed The Plan includes (optional) description of systemic or other barriers, which the county has identified (which stakeholders may not have identified), which may be beyond the control of the planning process. Unclear which barriers are identified as systemic by the county and which barriers are identified by the committee. (for update years, please see the specific instructions in the guidelines) IDENTIFICATION OF RECOVERY-ORIENTED SYSTEMS TRANSFORMATION PRIORITIES Attachment J is completed and identifies three to five recovery-oriented systems transformation priorities required to accomplish the county s vision and mission. Yes. Complete and identifies Outpatient Tx, CPS, Crisis, BH/PH coordination, and Transitional Age Youth as the five recovery oriented systems transformation priorities. (for update years, please see the specific instructions in the guidelines) Includes an explanation of how these transformation priorities and related activities will address the service system needs identified in the previous section (Identification and Analysis of Service System Needs section). Yes it includes an explanation that links these services to the system needs identified in the prior section. (for update years, please see the specific instructions in the guidelines) Includes a time line to accomplish the No, it does not specify the time line Attachment P Page 222

225 TOPIC transformation priorities and related activities. Note: In each area briefly explain and describe areas of strength and areas where improvement is needed to accomplish changes. (for update years, please see the specific instructions in the guidelines) Addresses fiscal and other resources needed. Addresses the need for resources, but does not identify the resources. (for update years, please see the specific instructions in the guidelines) Includes Quality Management Plan for tracking implementation/outcomes. (for update years, please see the specific instructions in the guidelines) No, it does not include QMP tracking, implementation, nor outcomes. FISCAL INFORMATION Includes charts and tables (as per the instructions for Attachment K) that depict how county-based and HealthChoices funds are used to support the services in the county. The narrative sections. Attachment K also includes a table depicting requests for new state funding as per the instructions. Yes. New Funding Request includes: outpatient, transition age youth, blended case management, housing, and crisis. Includes charts and tables depicting expenditures for services rendered. No narratives provided. Includes a narrative explaining the charts in Attachment K and how funding is making a difference or how funding needs to be redirected to address the needs and priorities No narratives provided. Attachment P Page 223

226 TOPIC identified in the Identification and Analysis of Service System Needs section, and the Identification of Recovery-Oriented Systems Transformation Priorities section. Note: In each area briefly explain and describe areas of strength and areas where improvement is needed Includes a brief narrative explaining requests for new state funding included on Attachment K. SUPPLEMENTAL GUIDELINES Housing Plan (Attachment L) included (Y/N). Please note your impressions of the Housing Plan. Forensics Plan (Attachment M) is included (Y/N). Please note your impressions of the Forensics Plan. Employment Plan (Attachment N) is included (Y/N). Please note your impressions of the Employment Plan. Yes, housing plan present, very thorough, includes plan in effect since Identifies housing resources, housing development capacity, local planning, priority consumer groups, and organizational chart. Yes- County has crisis services, trainings for police, cross-systems mapping, and services at all five intercepts. County also identified gaps and opportunities in the forensic system. No data included for service area plan. Yes- County spent large % of employment funding on community based employment. Workgroup membership did not include any representation from OVR, Workforce Investment Boards, local businesses, and employers. COUNTY PLAN FEEDBACK FORM (OPTIONAL) If the County has completed The County Plan Feedback Form (Attachment O), please summarize the feedback here. Not Completed. Reviewers recommend that you provide feedback in the future in order to verify outcomes and ensure quality implementation of changes. Attachment P Page 224

227 TOPIC Note: In each area briefly explain and describe areas of strength and areas where improvement is needed OVERALL IMPRESSIONS/REMARKS ON THE PLAN. Bucks County is committed to recovery principles and demonstrated through their plan an integration of housing, employment, and forensic services in their behavioral health system. The plan clearly delineated services targeted to adults, older adults, and transition-age youth. County provided a long-term 5 year outlook, as well as a short-term, near-future timeline for goals/objectives. Reviewers recommend the following: inclusion of specific information for people requesting special accommodations in Attachment B; CSP form must be signed/dated; utilization of SAMHSA s toolkit to measure fidelity for EBPs for those programs not currently using it; providing narratives where requested in the guidance; documenting services/programs for co-occurring population. Attachment P Page 225