TIMBERLANDS REGIONAL SUPPORT NETWORK P. O. Box 217, Cathlamet, WA / timberlandsrsn@trsn.org

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1 TIMBERLANDS REGIONAL SUPPORT NETWORK P. O. Box 217, Cathlamet, WA / timberlandsrsn@trsn.org ANNUAL REPORT 214 Regional Support Networks (RSN), as Prepaid Inpatient Health Plans (PIHP), provide mental health services through contracted providers for children and adults who are eligible Medicaid-covered enrollees. Mental health services are also provided, as funds allow, to non-medicaid enrollees. Any person regardless of funding source is eligible for crisis services. The RSN staff themselves do not provide any direct client services. The RSN provides funding for, and oversight of, direct services delivered by its contracted providers. Timberlands Regional Support Network (TRSN) is located in rural Southwest Washington and is comprised of Lewis, Pacific and Wahkiakum Counties. TRSN stretches from the Pacific Ocean to east of Mt. Rainier in the Cascade mountain range encompassing 3,947 square miles and approximately 11, people. TRSN contracts with Cascade Mental Health Care, Willapa Behavioral Health, and Wahkiakum County Mental Health Services who in turn provide mental health services for each of TRSN s three Counties. The mission of Timberlands Regional Support Network (TRSN) is to ensure that people of all ages experiencing mental illness can better manage their illness; achieve their personal goals; and live, work and participate in their community. ELIGIBILITY WHO IS TIMBERLANDS REGIONAL SUPPORT NETWORK? WHO RECEIVED MENTAL HEALTH SERVICES FROM TRSN? A total of 29,14 individuals were eligible for Medicaid mental health services in TRSN s three counties in 214. The number of individuals eligible for Medicaid in the TRSN reflects a 13% increase in 214. This significant increase follows Washington's implementation of Medicaid Expansion on 1/1/214. The Affordable Care Act increased Medicaid eligibility limits, bringing health care coverage to hundreds of thousands of adults in Washington State (ages 19 to 65) who earn up to 138% of the federal poverty level. With Medicaid expansion in effect in 214 the Medicaid eligible population in Washington is projected to continue to increase between 25.2 and 33.6% by 219 (Kaiser Commission on Medicaid and the Uninsured) TRSN Unduplicated Count of Medicaid Eligibles In 214, TRSN coordinated mental health services for 4,32 Medicaid enrollees and other county residents who meet eligibility requirements for State-funded or grant-funded services. Of those served through TRSN contractors during 214, 3297 (77%) were unique Medicaid enrollees, This indicates a penetration rate of 11%. TRSN shows a 1% increase in its penetration rate from 213 (1%). TRSN contractors provided additional mental health services for 15 (23%) unique individuals through allocation of State mental health funds. The majority of these services reflect special project funds being utilized to serve non-medicaid individuals TRSN Unduplicated Count of Members Served Medicaid Non-Medicaid

2 POPULATION SERVED CHILDREN & ADOLESCENTS A total of 116 children and adolescents (17 years or younger) were served in 214. Children and adolescents represent 28% of TRSN clients served. OLDER ADULTS A total of 36 older adults (6 years and older) were served in 214. Older adults represent 11% of TRSN clients served Unduplicated Count of Children Served Unduplicated Count of Geriatric Served Caucasian 83% Ethnicity per TRSN 21 Census Native American 1% Hispanic 8% Other 7% African- American % Asian/ Pacific Islander 1% OUTPATIENT SERVICES The full array of outpatient community support services includes: Assessment to determine eligibility/ medical necessity and for additional services; Individual, family and group counseling; Case management; Residential services and housing support; Vocational and Educational services; Psychiatric evaluation; and Medication management 21% of services were provided to children and adolescents. 11% of services were provided to older adults. 68% of services were provided to adults. These proportions have remained steady over the last 4 years (+/-5%) Count of Services by Age Group Age 6+ Age Age -17 Total

3 INPATIENT SERVICES COMMUNITY HOSPITALS People needing inpatient mental health treatment voluntarily request the service and are certified as needing that level of care by a TRSN Designated Mental Health Professional (DMHP). Some people, because of their mental illness, are not able to recognize their acute need of inpatient services and are involuntarily detained to a hospital by a DMHP. An emphasis is placed on serving people in their home community with outpatient services whenever possible. Outpatient staff work closely with hospitals to coordinate discharge plans and provide timely follow up care. Historically, Timberlands RSN has used inpatient services at a lower rate than most other regions. TRSN reduced the number of community hospital admissions by 23% in Community Hospital Admissions CRISIS SERVICES Crisis response services are available throughout the region, twenty-four hours a day, seven days a week. Crisis services include: crisis counseling by telephone or face-to-face, mobile outreach, crisis stabilization, crisis respite, jail and hospital diversion, certification for psychiatric hospitalization, and investigation and detention for involuntary treatment. TRSN Crisis Services are provided by Designated Mental Health Professionals (DMHP). Additional nonface to face crisis services after hours are provided by a contractor, ProtoCall Services Inc. TRSN observed a 43% increase in crisis contacts in 214. This is likely due to the increase in new Eligibles attempting to navigate an unfamiliar RSN system and the high demand for initial services. TRSN anticipates that hiring additional staff to meet demand and outreach to help engage clients in the outpatient system will help decrease these contact in Voluntary Involuntary 88 3 STATE HOSPITALS Western State Hospital (WSH) is one of two stateowned psychiatric hospitals for adults 18 or older that provides evaluation and inpatient treatment for individuals with serious or long-term mental illness. Within the hospital there are two systems of care: civil and forensic. Patients enter the civil wards of the hospital through a referral from Designated Mental Health Profession (DMHP) for an involuntary commitment that was authorized by the Regional Support Network (RSN) system and approved by a court order. Admissions to the forensic (legal) units of Western State Hospital are through the criminal justice system. Timberlands RSN cooperates with the seven other RSNs to manage the daily census at Western State Hospital. Of the 556 WSH beds available to RSNs, Timberlands RSN is allocated 1. TRSN maintained its census below 1 throughout Western State Hospital Average Daily Census Total Number of Face to Face Crisis Contacts

4 Timberlands RSN Administrative Functions ADMINISTRATION Timberlands Regional Support Network (TRSN) Administrator is responsible for the overall operations and administration of Timberlands RSN. The Administrator develops plans, policies, procedures, standards, and budget and oversees fiscal operations, personnel, and information system functions for TRSN, as approved by the TRSN Governing Board. The Administrator develops provider contracts, oversees funding, monitors providers for contract compliance, quality, capacity and manages the appropriate allocation of resources in accord with contract expectations and Governing Board direction. TRSN maintains an Executive Coordinator to perform complex secretarial, executive administrative assistance, and office coordination duties for TRSN. The Executive Coordinator uses knowledge and interpretation of policies and procedures to assists with the administrative details of a regional, multiple county office. QUALITY AND CLINICAL MANAGEMENT Timberlands Regional Support Network (TRSN) maintains a Quality Manager to monitor and improve clinical care and service delivery to Medicaid enrollees and State-funded recipients of mental health services in Pacific, Lewis, and Wahkiakum Counties. The quality management process includes: Quality and Utilization data collected through multiple sources including reports and surveys which is presented in summary reports to TRSN and the Quality Management Committee (QMC). Clinical Directors from each provider analyze and validate the data contained in the reports to determine if further study or action is needed. If action is needed Quality Improvement Initiative (QI) recommendations are presented to the QMC. The QMC reviews the recommendations and prioritizes the areas determined to need QIs. The QMC makes recommendations for QIs to be implemented in the coming year to the Governing Board. Upon approval by the Governing Board, the TRSN Administrator applies corrective action sanctions as needed and/or turns the QIs over to the Clinical Directors to plan QIs. The Clinical Directors plan QIs and determine quality indicators that will be monitored to measure improvement in the area selected. The TRSN Administrator works with TRSN staff to translate the QIs into policy and procedure changes. The Agency Directors implement the QIs. The Quality Manager and Clinical Directors monitor the quality indicators and report on the success of the QIs at the QMC. FISCAL ACCOUNTING TRSN contracts with an Accountant who is responsible for accurate accounting and reporting of TRSN funds. The Accountant works with the TRSN Administrator to monitor and implement the TRSN Budget. The TRSN Budget describes how funds are paid through the State and Federal contracts and distributed in order to meet contract requirements and provide quality services to TRSN clients. In the current budget period to date, December 214, TRSN expenditures were comprised of 81.4% Direct Service, Direct Service Supports and Special Project Funds. The use of funds for Direct Service increased from 78% in 213. TRSN share of Hospital Expenses decreased by 3.4% from 213 as the TRSN Network targeted hospital diversion and hospital transition. TRSN s share of expenses for Administration, Quality Management and Information Services remained about the same from 213. TRSN current financial strength and reserve fund planning has positioned us well for 215. INFORMATION SYSTEMS ADMINISTRATION Timberlands Regional Support Network (TRSN) Information System (IS) Administrator is responsible for TRSN management information systems. The IS Administrator maintains TRSN databases, assists, provides recommendations and maintains policies and procedures to comply with RSN, State and Federal requirements, produces and facilitates necessary reports for management and contract compliance, coordinates and provides support, training, and instruction to provider agency MIS managers, coordinates with the Washington State Rural Consortium (WSRC) and Netsmart Technology and evaluates, analyzes, and recommends MIS technology needs to TRSN Administrator / Fiscal Manger. 4

5 Timberlands RSN Provider Network LEWIS COUNTY Cascade Mental Health Care - Children / Adult 2428 Reynolds Road Centralia, WA / / PACIFIC COUNTY Willapa Behavioral Health 224 North Pacific Highway Long Beach, WA WAHKIAKUM COUNTY Willapa Behavioral Health 3 Ocean Avenue Raymond, WA Wahkiakum County Mental Health Services 42 Elochoman Valley Road Cathlamet, WA / SPECIALIZED CONTRACT SERVICES ProtoCall Services, Inc. After-hours telephone crisis intervention and answering services 621 SW Alder, Suite 4 Portland,OR 9725 Behavioral Healthcare Options, Inc. Authorizes TRSN Client Services PO Box Las Vegas, NV GLENN LIPPMAN, M.D. D.F.A.P.A. Medical Director QUALITY REVIEW TEAM (QRT) LLC per WAC OMBUDS SERVICES per WAC Justin Blackwell, TRSN ADVISORY BOARD An Advisory Board was established as outlined in the TRSN Governing Board Bylaws that represents Lewis, Pacific and Wahkiakum County residents made up of clients, family members and other interested community members serves in an advisory role to the Governing Board. Suzanne Holmes, Chair, Wahkiakum County Susan Dingethal, Wahkiakum County Steve Clark, Vice Chair, Lewis County Coralee McDonald, Lewis County Joplin Harper, Lewis County Doug Levitt, Pacific County Sigrine Vally, Pacific County Joannie Bjorge, Law Enforcement, Wahkiakum Tribal Representative - Vacant TRSN GOVERNING BOARD The Timberlands Regional Support Network (TRSN) policy to establish a Governing Board that shall be the single point of authority and responsibility for the administration and provision of mental health services for Lewis, Pacific and Wahkiakum Counties which make up the TRSN. The Governing Board consists of three (3) members, one member from each of the three (3) Counties appointed by the Board of County Commissioners of the member Counties. Board members serve at the pleasure of the appointing authority. Ron Averill, Chair, Lewis County Commissioner Edna Fund Lewis County Alternate Commissioner Frank Wolfe, Vice Chair, Pacific County Commissioner Steve Rogers, Pacific County Alternate Commissioner Mike Backman, Treasurer, Wahkiakum County Fred Johnson, Attorney / Wahkiakum County Alternate Timberlands RSN Volunteers Volunteers are important for Timberlands RSN s success. Volunteers are clients, family members, system partners and community leaders who together donate hundreds of hours to ensure that services are effective, efficient and meet clients needs. Our sincere thanks to the following volunteers in addition to those serving on the Governing and Advisory Boards: QUALITY REVIEW TEAM QUALITY MANAGEMENT COMMITTEE LaRonna Lorber County Advocates Tracy McDougall Quality Review Team Representatives Provider Agency Representatives Ombuds Services TRSN Administrator TRSN Quality Manager TRSN IS Administrator