NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
A. Executive Summary
1. Enhancement of existing, proactive, pilot OCR collaboration between Dallas County Criminal Justice
stakeholders and NorthSTAR behavioral health treatment providers, and establishment of similar
programs throughout the NorthSTAR region. The existing Dallas County based program was
established in September 2007 (without any outside funding) to proactively address OCR, and will
serve as a basis for programs throughout our region.
2. Consumers are members of the NorthSTAR open access system, and will have access as appropriate to
the highest level of care possible: package 3 or 4 services, with the addition of ACT and ICM services
when needed. As a result, they will have access to treatment during established clinic hours, as well as
after hour’s crisis and ACT team access as appropriate.
3. The direct cost applied to this funding is estimated to be $39.00 to 49.00 per day based on current
costs from pilot OCR program ($1,200 - $1,500 per month with enhanced service packages that include
housing and transportation to facilitate appropriate restoration and supervision).
4. The target population is limited to persons throughout our region deemed incompetent to stand trial
by local courts, but judged appropriate for OCR services. As our plan benefits from NorthSTAR’s open
access format, we will be able to assure treatment throughout the region. Data suggests that Dallas
County will provide the vast majority of participants in both FY08 and FY09.
5. Current partners active since summer 2007 in the aforementioned proactive pilot project include:
Dallas County Criminal Justice Department, Judge Wade, Judge Hawk, Judge Crowder, Judge Hoffman,
Judge Fuller, Judge Rosenfeld, Judge Skemp, Dallas County District Attorney, Dallas County Public
Defender, ValueOptions, Adapt of Texas, Centro de Mi Salud, ABC Behavioral Services, LifeNet
Community Behavioral Health Care, and Dallas MetroCare Services. Dallas County is currently
consolidating all Misdmeanor competency cases under Judge Skemp top streamline this process.
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
We anticipate a number of additional stakeholders and treatment providers to join this collaboration
during FY2008/FY2009, as we enhance and expand the OCR pilot program throughout the region. As
NorthSTAR maintains an open access system, there are twenty-three (23) total clinic sites available
through ten (10) speciality network providers potentially capable of providing this programming to
consumers. Our system also maintains four (4) chemical dependency residential settings, and the level
of services potentially authorized for the target consumers includes integrated mental health and
chemical dependency care. Our rural counties have indicated they have not experienced the IST
prevalence rates seen in Dallas County, but are examining outpatient competency more closely in the
next year. We will work with them to assess and provide for their respective need levels.
6. Our region was proactive in establishing an OCR pilot project in September 2007. However, a legal
skills training component based on approved DSHS models will be an addition to the current model.
North Texas Behavioral Health Authority (NTBHA) will facilitate the collaborative development of a
unified curriculum with partners from both criminal justice and behavioral health systems. As this is
already in process, we expect to have this piece implemented within 45 days of funding.
7. Estimates based on historical figures are extremely difficult, as there has been little State-wide or
Region-wide comprehensive examination of past inpatient restoration commitments for outpatient
level appropriateness. However, we do have the advantage of experience through our pilot project
that has been active since September 2007. As a result, our estimates are based on (1) past inpatient
competency restoration data from all seven [7] counties in our region and (2) estimates from partners
in the OCR pilot program established in Dallas County (which have the added advantage of coming
from experience specifically with an OCR program that meets State guidelines for participant
selection). We anticipate approximately 60 new participants during the remaining months of FY2008
(based on estimates from Dallas County of 20 per month to be screened for OCR, historical rate of
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
approval for OCR by Value Options of approximately 40%, and possible additional flow from the all
NorthSTAR counties). We expect to see increased participation to a minimum of 150 new participants
in FY2009 (based on historical inpatient competency restoration rates, historical rate of approval for
OCR by Value Options, and additional flow due to program enhancements and establishment in all
NorthSTAR counties). In addition to new participants, it is important to keep overall program
population in mind as well. Each participant may stay in the program for up to 6 months (initial
restoration period of 120 days followed by extension of 60 days). Current experience from the pilot
program indicates that many participants do not experience consistent progress toward competency,
perhaps due to the many uncontrolled variables in an outpatient setting. As a result, we expect that
overall program participation will steadily grow as new additions outpace attrition. At an average of 10
new participants per month, with a 30% attrition rate (the rate of the current pilot project, which we
expect to improve through program enhancements), we will expect to build to a consistent monthly
program population of 30 by the end of FY2008. This overall population would be expected to
continue to increase over FY2009.
B. Demonstrated Need
1. We estimate 150 new participants in FY2009. This estimate is based on historical numbers from 2007,
experience through the existing NorthSTAR OCR project and input from the Dallas County Criminal
Justice Department. See Table 1 for historical data.
2. Existing gaps and service needs include: (a) Inpatient beds available in a timely fashion, (b) Appropriate
treatment in local jail settings while awaiting inpatient beds, (c) Timely transfer from inpatient beds
back to local jurisdiction, (d) Timely, effective and appropriate disposition by court system, (e) Post-
disposition continuity of care, (f) Access to outpatient competency programs that fully meet the
standards set forth in Ch 46b of the Code of Criminal Procedure as amended by Senate Bill 867, (g)
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Appropriate community housing, (h) Convenient access to community transportation, (i) Coordinated
and appropriate treatment and supervision in most counties. Through the Dallas County/ NorthSTAR
collaborative pilot OCR project, coordinated and appropriate treatment and supervision is currently
available through multiple providers.
3. Funding provided through the PCA will fill the following gaps: (a) Reducing reliance on inpatient beds in
State Mental Health Hospitals will result in more timely availability of those beds for other consumers,
(b) Timely availability of inpatient beds will reduce the amount of time consumers wait in local jail
settings – potentially reducing local costs/decreasing stabilization time, (c) Timely, effective and
appropriate dispositions within the court system through effective cross system collaboration, (d) Post-
disposition continuity of care is enhanced - potentially resulting in increased, consistent stabilization, (e)
Program that meets the standards set forth in Ch 46b of the Code of Criminal Procedure/Senate Bill
867, (f) Provision of housing and transportation supports toward effective competency programming,
(g) Coordinated and appropriate treatment and supervision in the NorthSTAR Region.
4. This program will “reduce the number of individuals determined to be IST... on the State Mental Health
Hospital clearinghouse waiting list” by diverting appropriate consumers to a collaborative outpatient
competency restoration program with proven effectiveness. Table 1 shows over 325 inpatient
restoration commitments from our region. A spot check for the period of June to November 2007
revealed an average wait time of 75 days, with a high wait period of over 160 days. As there is
currently no alternative to using State Hospital beds, the impact of a functional OCR program is
expected to be significant. Although we have kept our estimates in line with past commitment
numbers, Dallas County alone indicates new referrals to OCR could top twenty (20) per month with a
robust program in place. NorthSTAR’s pilot OCR program currently meets the goal of “prompt access
to clinically appropriate outpatient competency restoration services”, through access to the highest
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
level of care with included housing and transportation supports. In addition, this care can be accessed
through multiple providers, allowing flexibility for consumers with co-occurring chemical dependency
issues and those in need of multi-lingual/multi-cultural services. As noted above, NTBHA will facilitate
the collaborative development of a unified legal skills training curricula.
C. Collaboration
1. Key collaborators: See Table 2; 2. Resources: See Table 3; 3. Letters of support/agreements: See
Appendix A; Collaborator Participation: See Table 4
D. Program Design
1. Any person found to be incompetent to stand trial may be considered for the OCR program. The focus
of this program will be individuals with mental illness or co-occurring psychiatric and substance
disorders that may be impacting competency. Further eligibility criteria include the nature of the
offense (misdemeanor vs. felony), the ability to maintain safety to self and others in an outpatient
setting, and consent and agreement by the individual to participate in an outpatient competency
restoration program. The final approval for participation rests with the presiding Judge, as the
consumer remains under the court’s jurisdiction while participating.
2. NorthSTAR will provide the opportunity for this program throughout our region, which includes Collin,
Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall counties. Dallas County will be a primary focus for
programming in 2008 due to the volume and identified need in this county, coupled with the existence
of the collaborative NorthSTAR OCR pilot project. We will focus on establishing collaborative programs
in the other six counties during FY2008, with the availability of programming as needed through
NorthSTAR’s open access system. As a number of the providers currently involved in the pilot project
have clinics throughout our region, subsequent program implementation will benefit. The overall
NorthSTAR regional program will be a collaborative effort among numerous entities throughout the
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Criminal Justice, Behavioral Health and community advocate systems working from various locations
throughout the NorthSTAR service delivery area.
3. The OCR program design builds on existing service structures within the NorthSTAR service delivery
area and provides a solid base for qualified staff. Five (5) Specialty Provider Networks (SPN)
participated in collaborative planning and implementation efforts with the Dallas County Criminal
Justice Department, Judges, District Attorney and Public Defender. This collaborative effort has
focused a great deal on cross-system education toward effective implementation of the pilot program.
The three (3) SPNs that currently have participating consumers in the OCR pilot project are Dallas
Metrocare Services, Adapt of Texas and Centro de Mi Salud. All of these programs have well
established experience in coordinating with the Dallas County jail system and/or Divert Courts in the
existing Jail Diversion Program. A comprehensive training program has already been conducted across
the multi-disciplinary systems to educate and train court personnel, treatment providers, Dallas County
social work staff, and others. This type of system wide multi-disciplinary training will be part of the
ongoing program. At the treatment provider level, a competency based training program is in place
regarding the evidence based practices of Resiliency and Disease Management. The specialty staff
assigned to OCR will have an augmented training program that provides comprehensive training of all
aspects of psychosocial rehabilitation, treatment and recovery in Co-Occurring Psychiatric and
Substance Disorders, competency restoration curriculum, and interface with judicial systems.
4. Program staff listing: See Table 5
5. The use of an electronic same time interface allows immediate communication between the parties
among the various systems. Incoming referrals are processed the date of receipt. The initial
assessment at the jail is scheduled as soon as possible, and no later than 48-72 hours following the
referral. As NorthSTAR has an existing program coordinator in place, prompt access is centrally
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
facilitated and monitored. We will continue to explore ways to enhance this piece through appropriate
use of both CJ and NorthSTAR data systems.
6. This process is based on the existing Dallas County pilot program, and will be altered as necessary to
meet other counties’ needs. When the question of competency arises, the court will stay any hearings
and order an evaluation that is conducted by qualified practitioners either in the local jail or courtroom
holdover setting. An individual found to be incompetent to stand trial is referred to ValueOptions in
order to meet legal requirements related to consideration for outpatient competency. ValueOptions
has assigned a LPHA who reviews all requests to determine if the person meets basic eligibility criteria
as referenced above. ValueOptions’ LPHA coordinates all activities, contacts the assigned behavioural
health provider on the same day to provide the initial referral information, and works in concert with
Criminal Justice Department coordinators to assure connection. All qualifying provider groups will
have the opportunity to provide these services in order to maintain open access. ValueOptions and
the Criminal Justice Department coordinator provide all available information to the provider,
including that noted in relevant Criminal Codes under Ch46. The provider then conducts an on site
face to face assessment with the individual at the jail and completes the psychosocial assessment and
initial treatment plan. The initial treatment plan is submitted to the court prior to the individual being
released from jail to the service provider with approval to enter the OCR program.
7. A complete psychosocial assessment is conducted by a QMHP-CS under supervision of an LPHA during
the intake process in order to identify areas of need, and to ensure that supports and services are in
place to promote successful participation in outpatient competency restoration. All available sources
of information are utilized in order to ensure a comprehensive assessment is conducted. Through this
process, the treatment team can identify unmet medical needs or substance abuse issues that may be
impacting the individual’s health status as well as competency. They also identify needs/supports
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
related to housing and transportation during this process. This process helps to assess the severity of
needs, and to determine if they can be safely addressed in an outpatient setting. Based on the clinical
information gathered through this process and the required psychiatric evaluation, the TRAG and a
treatment plan are completed that also take into account various needs such as co-occurring substance
abuse disorders, cultural competency needs, family and physical health issues. The high level of care
authorized for appropriate participants in this program allows the provider to target these needs, and
identify the most appropriate resources available.
8. The NorthSTAR service delivery area has an open access model to community based services inclusive
of SP3 and SP4 services. These services are readily available with no waiting lists. Outpatient
Competency Restoration participants are also authorized for Assertive Community Treatment (ACT)
and Intensive Case Management (ICM) when appropriate, as detailed below. In addition, the
established pilot OCR program successfully makes use of the collaborative relationship between Dallas
County, ValueOptions, and treatment providers to assure prompt and coordinated transfer between
the court setting and appropriate outpatient treatment.
9. Individuals entering the OCR program will be authorized for the most intensive services through ACT.
This model allows for the service intensity to be adjusted based on the level of need. It is a team based
approach that provides the structure for enhanced psychosocial rehabilitation and pharmacological
management services. It also encourages the wrap around of collateral and community based
resources as well as a recovery orientation. The individual will also receive an ICM authorization in
order to promote the case management activities related to OCR e.g. facilitating attendance at physical
health/mental health appointments, obtaining social services, participating in the judicial process.
10. NorthSTAR’s blended mental health and substance abuse system of care provides an advantage in
continuity of care for OCR individuals in need of substance abuse treatment. All individuals entering
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
the OCR program are currently screened for substance abuse, and providers will begin using the DSHS
Substance Use Screening Tool offered through this RFPCA. The outpatient providers currently have an
integrated care model with substance abuse treatment specialists on each ACT team. If the individual
requires a higher level of care for substance abuse treatment, that will be requested by the OCR
treatment team and coordinated through the ValueOptions LPHA Program Coordinator. The
ValueOptions LPHA will oversee that treatment and ensure continuity throughout the transitions in
levels of care.
11. Outpatient competency restoration is a curriculum based didactic approach. It can be implemented as
soon as the individual demonstrates enough stability to participate in didactic sessions. This is
assessed case by case for each individual, and will often be possible following some level of psychiatric
stabilization. The curriculum provided by DSHS as best practices will provide the basis for a unified
curriculum developed collaboratively by treatment providers, criminal justice system stakeholders and
NTBHA. The ACT teams will use this curriculum in delivering legal education and training to the
consumer in both individual and group sessions. Part of this curriculum will include a central “mock
court” setting that will be utilized for role playing as one method of reinforcing and generalizing the
skills and knowledge related to competency. We anticipate that the collaborative development of this
curriculum will include a cooperative arrangement among service providers related to the “mock
court” component. Perhaps with the cooperation of the criminal justice system in providing an actual
courtroom to enhance this curriculum component. NTBHA will facilitate the collaborative
development of this curriculum.
12. Housing needs are supported through this proposal in FY 2008, with plans to target additional
resources for FY2009. Needs will be assessed for every individual entering the OCR program. Through
the case management process, individuals will be assisted in applying for housing programs through
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
existing service providers, other community resources, and re-instating any lost benefits or applying for
new benefits e.g. SSDI. Case managers will also help individuals explore natural resources and
reconnect with supportive family or friends when appropriate to help with housing. Individuals will be
assessed for the need for temporary rental assistance when resources are not available, and
appropriate options are being considered. Truly appropriate housing for this population is extremely
scarce, as they labor under both behavioral health and criminal justice barriers. Limited housing is
available through NorthSTAR service providers, and will be the first option considered when a
supportive natural environment does not exist. However, other potential possibilities such as
approved boarding homes and transitional facilities that will be available through the Dallas Homeless
Assistance Center in spring 2008 will be considered. Although current targeted housing is
concentrated in the county that accounts for the majority of competency restoration cases, housing
opportunity development is a point of focus throughout our region in both FY2008 & FY 2009.
13. Please see flowchart for program progression in Appendix B.
14. Individuals entering the OCR program will be enrolled in the NorthSTAR program and will have services
tracked under the fee for service model with the BHO. ValueOptions will compile electronic service
code data based on admissions authorizations to ACT with a JD client type. Providers will be required
to submit encounter data to support the billable services under the OCR program which will be
compiled and analyzed by ValueOptions. NorthSTAR is open to additional reporting requested by
DSHS.
E. Work Plan
Please see Table 6.
F. Program Budget:
Please see Appendix C
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Attachments and Tables
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Appendix A: Letters of support
Please see email attachments
Dallas County Commissioners’ Court
Dallas County Criminal Justice Department
Adapt of Texas
Metrocare Services
ABC Behavioral Health
Centro de Mi Salud
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Appendix B: Coordination/ Program process flowchart
Please see chart attached in email
Note: Although the law provides for an initial 120 day period, with one extension of 60 days, the
projected average length of stay is extremely variable. Without the constant of a secure inpatient
environment, many variables will affect a consumer’s ability to achieve and maintain competency. The
OCR pilot project is currently seeing consumers ordered to 120 day programs, with some 60 day
extensions. We anticipate the courts will continue to order an initial 120 day period, with an additional
extension as needed in cases where the consumer has made positive progress toward competency and
has maintained compliance with court mandates. Discharge and continuity of care are enhanced
through NorthSTAR’s open access system and the intensive level of care present in this program.
Consumers may either continue in services with the current provider, or may transfer to another
provider if that is preferred or more appropriate. In addition, the ValueOptions OCR Program
Coordinator will also assure continuity of care.
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Appendix C: Budget
Please see spreadsheets attached in email
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Table 1
II.B.1. Estimated eligible population (calendar year 2007)
1a: Inpatient Competency Restoration Commitments by County for 2007:
County # committed for inpatient
competency restoration (2007)
Collin 2
Dallas 308
Ellis 3
Hunt 3
Kaufman 8
Navarro 0
Rockwall 2
TOTAL REGION: 326
Source: North Texas Behavioral Health Authority (January 2008)
1.b: Average Wait Period:
An analysis of consumers waiting for beds between June 2007 through November 2007 (n=70) revealed an average wait
time of 75 days, with a high wait period of over 160 days. Source:
North Texas Behavioral Health Authority (January 2008)
1.c: NorthSTAR OCR Pilot Project (September 2007 through December 2007):
Referred for OCR consideration: 31 Recommended for OCR participation: 12
Source: ValueOptions and Dallas County Criminal Justice Department (January 2008)
The NorthSTAR OCR pilot project focused on establishing a program with high levels of cross-system coordination and
appropriate levels of treatment. In addition, it was an unfunded initiative. As a result, historical numbers for
participants referred to and recommended for OCR are lower than we anticipate seeing in the enhanced program
proposed.
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Table 2
II. C.1. Key Collaborators:
As mentioned in the narrative, we expect to expand on this collaboration over the FY 2008 and FY2009 period to include
additional representation from all counties within the NorthSTAR region. In addition, collaborations to enhance support
services such as transportation and housing will also be targeted for FY2008/FY2009.
Name of Agency Lead Contact Title/Role within Agency
Dallas County Criminal Justice Patricia Scali Mental Health Coordinator
Department
Dallas County Criminal Justice Courtney Young Competency Program
Department Coordinator
Dallas County District Attorney Kristina Geiser Competency DA
Dallas County District Attorney Vanita Budhrani White Mental Health DA
Dallas County Public Defender Patricia Sessa Competency PD
Judge Douglas Skemp (CCC 3) Mikah Mitchell County Court Manager
(NOTE: Dallas County in process of
consolidating all competency
matters under this judge)
Judge Kristin Wade (CCCAppeals Tania Robinson Court Coordinator – Note this
1) Judge was very involved in
planning/implementing pilot, but
cases are now being
consolidated in Judge Skemp’s
Court
Judge Susan Hawk (291st DC) Sandra Burns Court Coordinator - Note this
Judge was very involved in
planning/implementing pilot, but
cases are now being
consolidated in Judge Skemp’s
Court
ADAPT of Texas Beth Epps Executive Director
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Name of Agency Lead Contact Title/Role within Agency
ADAPT of Texas Malissa McEntire Forensic Team Leader
Centro de Mi Salud Diana R. Brown Executive Director
Dallas Metrocare Services Sherry Lockhart Clinical Manager
Dallas Metrocare Services Tipphany Divine Clinical Manager
ABC Behavioral Health Services Carolyn Lennox Clinical Director
Value Options (BHO) Thomas Vanduzer LPHA Program Coordinator
Value Options (BHO) Holly Brock Director of Program Support
North Texas Behavioral Health Vivian Lawrence Jail State Hospital/Criminal
Authority Justice Liaison
North Texas Behavioral Health Patricia Wooldridge Clinical Systems Analyst
Authority
North Texas Behavioral Health Pat Lawson Board Chair & Collin County
Authority representative
North Texas Behavioral Health Laurie Ann Base Treasurer & Collin County
Authority Representative
North Texas Behavioral Health Mackie Owens Vice-Chair & Ellis County
Authority Representative
North Texas Behavioral Health Jerome Byers M.D. Secretary & Dallas County
Authority Representative
North Texas Behavioral Health Judge Michael Chitty Kaufman County Representative
Authority
North Texas Behavioral Health Steve Shipp, Atty Hunt County Representative
Authority
North Texas Behavioral Health Andy Dillard, M.D. Rockwall County Representative
Authority
North Texas Behavioral Health Commissioner Kit Herrington Navarro County Representative
Authority
North Texas Behavioral Health Ron Stretcher Dallas County Representative
Authority
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Name of Agency Lead Contact Title/Role within Agency
North Texas Behavioral Health Ryan Brown Dallas County Representative
Authority
North Texas Behavioral Health Zachary Thompson Dallas County Representative
Authority
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Table 3
II.C.2. Resources:
Collaborator Resource Est Value (if in- Contribution toward DSHS
kind match) goals
Dallas County Criminal Match resource is $221,048 Proactive response to OCR has
Justice Department staff/expertise proven effective in contributing
(inclusive of Judges, District (Competency focused to both goals as 12 participants
Attorney, Public defender Coordinator, Public have already entered the OCR
and Department staff) Defender and Asst. District program – therefore reducing
Attorney). waitlist numbers. Collaborative
work with NorthSTAR BHO and
multiple treatment providers
has assured cross-system
coordination contributing to
prompt access to clinically
appropriate services.
Value Options Staff (LPHA and Program $13,750 Unfunded proactive and
Support Director) – collaborative response to OCR
Includes overall OCR resulted in coordinated
program coordinator program with 12 participants
required by DSHS; data thus far. This has already
reporting; operations reduced the waitlist numbers,
management . and establishment of
enhancements to the program
will increase that effect. Close
collaboration with the CJ
system and treatment providers
to implement prompt access to
appropriately intensive levels of
care meets the goal of prompt
access to clinically appropriate
care. Oversight of care has
ensured care standards as well.
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
North Texas Behavioral Staff – (Criminal Justice $19,500 Facilitation of efforts towards
Health Authority Liaison & Clinical Systems effective cross system
Analyst) development of collaboration. Our facilitation
curricula, individualized of a collaborative and unified
planning with each of seven NorthSTAR curricula, continued
counties, collaborative development of the current
coordination, and Dallas County based OCR
operations oversight. program, and expansion of
individualized programs for
each of the other 6 counties
contributes to both reducing
the waitlist numbers and
assuring prompt and clinically
appropriate care. Our status as
a neutral authority that is
completely separate from
treatment provision allows us
to assure clinically appropriate
treatment through oversight, as
well as facilitate improved cross
system relations toward better
coordination that affects this
goal as well.
Adapt of Texas Forensic ACT team with Experience with forensic
past experience in jail consumers, as well as in
diversion and established treating current OCR pilot
relationships with criminal project participants contributes
justice stakeholders in five to prompt and clinically
(5) of the seven (7) appropriate treatment for this
NorthSTAR Counties, population. Presence in five (5)
transportation and aid in of the seven (7) NorthSTAR
attending court counties will enhance our
appearances, participation region’s ability to individualize
in collaborative programs for each county and
development of legal accelerate implementation.
training skills curricula, This contributes not only to
consultation and appropriate care but adds to
development of OCR the positive effect on the
programs throughout waitlist.
multiple counties in
NorthSTAR region.
Metrocare Services Housing assistance through Existing Special Needs Offender
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Metrocare Housing Program/ Outpatient
programs, access to Competency Program currently
forensic psychiatrist, provide prompt, clinically
collaborative relationship appropriate outpatient
with University of Texas SW competency restoration
Forensic Fellowship training services. Access to forensic
program – providing physician services enhances this
additional access to treatment. Providing these
forensically trained services and having an
physicians, weekly established ongoing
substance abuse training, relationship with the criminal
transportation services justice system reduces the
inclusive of accompanying waitlist numbers. Access to
participants to court, peer multiple providers with special
support drop-in center, areas of focus enhances ability
rehab skills training, after to positively affect the waitlist.
hours clinics, ongoing In addition, providers bring
existing coordination with valuable expertise that will
court systems enhance implementation
throughout the region.
ABC Behavioral Health Care Housing assistance through Special emphasis on housing
program resources with resources and co-occurring
HUD and Housing disorders enhances ability to
Authority, agency focus on provide clinically appropriate
co-occurring disorders, treatment for this population.
peer led dual diagnosis Access to multiple providers
support group meeting five with special areas of focus
days per week, enhances ability to positively
participation in affect the waitlist. In addition,
development of providers bring valuable
competency curricula expertise that will enhance
implementation throughout the
region.
Centro de MI Salud Focus on culturally Special emphasis on culturally
congruent services for congruent, family centered
Latinos, family centered treatment and co-occurring
approach, co-occurring disorders enhances ability to
disorders and physical provide clinically appropriate
health focus, existing jail treatment for this population.
diversion program and Access to multiple providers
Outpatient Competency with special areas of focus
Restoration program, enhances ability to positively
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
participation in affect the waitlist and
development of continued enhancement of
competency curricula current programming. In
addition, providers bring
valuable expertise that will
enhance implementation
throughout the region.
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Table 4
II.C.4. Collaborative Partners’ Participation:
Partner Participation
ValueOptions (local BHO) Weekly Dallas County Mental Health Steering
Committee since summer 2007; LPHA level
program coordinator since September 2007;
Clinical Director involved in conceptualization,
planning, development and implementation of
both existing OCR pilot project and overall regional
program development plan
Dallas County Criminal Justice Department Weekly Dallas County Mental Health Steering
Committee since summer 2007; involved in all
aspects of conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County; will participate
in collaborative development of unified legal skills
training curricula; will provide consultation on
cross-system collaboration as relates to program
expansion throughout region; will participate in
ongoing development meetings as noted ion work
plan
Dallas County Judges (Past development = Wade, Weekly Dallas County Mental Health Steering
Hawk, Skemp, Crowder, Hoffman, Fuller, Committee since summer 2007; involved in all
Rosenfeld. Future development = focus will likely aspects of conceptualization, planning,
be on Judge Skemp as he is consolidating all development and implementation of OCR pilot
competency hearings under his court) project focused on Dallas County; will participate
in collaborative development of unified legal skills
training curricula; will provide consultation on
cross-system collaboration as relates to program
expansion throughout region
Dallas County District Attorney Weekly Dallas County Mental Health Steering
Committee since summer 2007; involved in all
aspects of conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County; will participate
in collaborative development of unified legal skills
training curricula; will provide consultation on
cross-system collaboration as relates to program
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
expansion throughout region; will participate in
ongoing development meetings as noted in work
plan
Dallas County Public Defender Weekly Dallas County Mental Health Steering
Committee since summer 2007; involved in all
aspects of conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County; will participate
in collaborative development of unified legal skills
training curricula; will provide consultation on
cross-system collaboration as relates to program
expansion throughout region; will participate in
ongoing development meetings as noted in work
plan
Adapt of Texas (tx provider) Involved in conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County; actively serving
OCR participants; will participate in collaborative
development of unified legal skills training
curricula; will participate in ongoing development
meetings as noted in work plan; specialized
experience and knowledge through Forensic
Program
Dallas Metrocare Services (tx provider) Involved in conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County; actively serving
OCR participants; will participate in collaborative
development of unified legal skills training
curricula; will participate in ongoing development
meetings as noted in work plan; specialized
experience and knowledge through Special Needs
Offender Program providing mental health and
substance abuse treatment
Centro de Mi Salud (tx provider) Involved in conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County; actively serving
OCR participants; will participate in collaborative
development of unified legal skills training
curricula; will participate in ongoing development
meetings as noted in work plan; specialized
experience and knowledge regarding culturally
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
congruent practices for Latinos and past
experience with jail diversion programs
ABC Behavioral Health Services Involved in conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County; will participate
in collaborative development of unified legal skills
training curricula; will participate in ongoing
development meetings as noted in work plan;
specialized experience and knowledge regarding
culturally congruent practices for Latinos and past
experience with jail diversion programs
LifeNet Community Behavioral Healthcare Involved in conceptualization, planning,
development and implementation of OCR pilot
project focused on Dallas County
North Texas Behavioral Health Authority Coordinated conceptualization, development of
proposed OCR plan; will oversee implementation
of OCR regional plan; will facilitate collaborative
development of unified legal skills training
curricula; will facilitate cross-systems collaboration
(focus of Board representatives from each county)
and program development as relates to regional
expansion of OCR; will participate in ongoing
monthly development meetings as noted in work
plan; staff involved have experience in cross system
development involving criminal justice and
behavioural heal programs
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Table 5
II.D.4. Program Staff:
Provider Position Qualifications/Licensure Role/Responsibility Availability
ValueOptions LPHA Program LPC Program Coordinator 8-5 M-F (office)
Coordinator
ValueOptions Director of LPC, Med, LCC Senior Management Clinical 8-5 M-F (office)
Program Support Lead
North Texas State BA Program facilitation and 8-5 M-F (office)
Behavioral Hospital/Criminal oversight
Health Justice Liaison
Authority
North Texas Clinical Systems MSCJA, Forensic Psychology Program facilitation and 8-5 M-F (office)
Behavioral Analyst concentration oversight
Health
Authority
Metrocare Medical Director Board Certified by the Responsible for oversight of 8-5 M-F
Services (Judith Hunter, American Board of the restoration process, (office); after
MD) Psychiatry and Neurology in medication management, hours by
Adult and Forensic clinical documentation, and mobile phone
Psychiatry supervision of forensic fellows
and physician assistants.
Metrocare Clinical Manager V Licensed by the Texas State Responsible for providing 8-5 M-F (office);
Services (Tipphany Divine, Board of Examiners of clinical oversight of the after hours by
LPC) Licensed Professional restoration process and mobile phone
Counselors documentation as well as
clinical supervision to the
Qualified Mental Health
Professional.
Metrocare Clinical Manager III Masters degree in Social Responsible for providing 8-5 M-F (office);
Services (Sherri Lockhart, Work clinical oversight of restoration after hours by
MSW) process and documentation as mobile phone
well as clinical supervision to
the Qualified Mental Health
Professional.
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Provider Position Qualifications/Licensure Role/Responsibility Availability
Metrocare Qualified Mental Bachelor’s degree in Responsible for providing 8-5 M-F
Services Health Professional Sociology direct clinical services to (field/office);
(Michael Degrate, clients, inclusive of a minimum after hours by
BA) of three visits per week as well mobile phone
as clinical documentation.
Metrocare RN (Rebecca Licensed by the Texas Board Responsible for providing 8-5 M-F
Services Vickers, RN) of Nursing as a Registered medication education,
Nurse nutrition training, health and
wellness training, and clinical
documentation.
Metrocare LCDC Intern Licensed by the Texas State Responsible for providing 8-5 M-F
Services (Adolph Miller, BA) Board of Examiners of direct clinical services to (field/office);
Licensed Chemical clients, with an emphasis in after hours by
Dependency Counselors chemical mobile phone
dependency/substance abuse
rehab skills training as well as
clinical documentation.
Metrocare M.D. (Sarah Rasco, Board Eligible by the Responsible for oversight of 8-5 M-F
Services MD) American Board of restoration process,
Psychiatry and Neurology in medication management, and
Adult Psychiatry with clinical documentation.
Enhanced Forensic Training
Metrocare Physician Assistant Board Certified by the Texas Responsible for assisting 1-5 T/Th
Services (Catherine Judd, Physician Assistant Board physicians with medication
PA) management as well as clinical
documentation.
Metrocare Bilingual Qualified Bilingual clinician with a Bilingual clinician responsible 8-5 M-F
Services Mental Health Master’s degree for providing direct clinical (field/office);
Professional services to clients, inclusive of after hours by
(Sandra Medina) a minimum of three visits per mobile phone
week as well as clinical
documentation.
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Provider Position Qualifications/Licensure Role/Responsibility Availability
Metrocare M.D. or D.O. Board Certified/Eligible by Responsible for oversight of 8-5 Th
Services the ABPN in Adult Psychiatry; restoration process, possible
currently in Adult Forensic use as experts for competency
Training reassessment, medical
management, and clinical
documentation.
Centro de Mi Counselor LPHA, LPC Supervisor Mon – Sat
Salud 9:00a.m.- 8p.m.
Multi - lingual/Spanish,
English, Portuguese, French
Centro de Mi Counselor QMHP, LPCi, LCDCi Counselor, CD Counselor Tues- Sat
Salud
Bi-lingual 11:00a.m. –
8p.m.
Spanish/English
Centro de Mi Counselor QMHP, LPCi Counselor Tues – Fri
Salud 5:00p.m. –
8:00p.m.
Sat: 10:00a.m.
– 8:00p.m.
Centro de Mi Counselor LCDC CD Counselor Mon-Fri
Salud
Bi-lingual 4:00p.m.- 8:00
p.m.
Spanish/English
Centro de Mi Caseworker QMHP Rehabilitation Services Tue-Sat
Salud
Bi-lingual 11:00a.m. –
8:00 p.m.
Spanish/English
Centro de Mi Caseworker QMHP Rehabilitation Tue-Sat
Salud
Bi-lingual Services 11:00a.m. –
8:00 p.m.
Spanish/English
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Provider Position Qualifications/Licensure Role/Responsibility Availability
Centro de Mi Nurse/LVN QMHP, LVN Rehabilitation Services Mon – Fri
Salud
Multi-lingual 9:00a.m. –
7:00p.m.
Spanish, English, Portuguese
Centro de Mi Psychiatrist MD, Specializes in pediatric Evaluations/Medication 2 days per
Salud psychiatry Management week
Centro de Mi PA PA – Psychiatry speciality Evaluations/Medication 2 days per
Salud Management week
Centro de Mi Psychiatrist MD – Psychiatry Evaluations/Medication 60 hours per
Salud Management month
Bi-lingual
Spanish/English
ABC Clinical Director LCSW- this is an LPHA Provides clinical supervision to Available as
Behavioral (Carolyn Lennox) credential all programs and staff at ABC needed for
Health Behavioural Health. supervision.
Services Sees everyone
at least twice a
month
ABC Engagement QMHP Provides individual rehab Could handle
Behavioral Specialist (Crystal services for new clients both in up to 2 OTR
Health Trammel) the field and in the office. clients a month
Services Also teaches Schizophrenia
class.
ABC Forensic Specialist QMHP Provides individual rehab Could handle
Behavioral (Joshuq Strange) services for clients with up to 3 OTR
Health forensic issues. Also teaches clients a month
Services Anger Management class
ADAPT of Team Leader MA, QMHP Supervise Forensic ACT Team M-F 8-5pm
Texas (Malissa McEntire)
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Provider Position Qualifications/Licensure Role/Responsibility Availability
ADAPT of Community MEd, QMHP Caseworker on Forensic ACT M-F 8-5pm
Texas Support Specialist Team
(Tim Hauley)
ADAPT of Community MA, QMHP Caseworker on Forensic ACT Hired pending
Texas Support Specialist Team background
(Deliah Hogan) check
(M-F 8-5pm)
ADAPT of Clinic Director, QMHP Manage the Dallas Clinic M-F 8-5pm +
Texas Dallas County after hours
(Heather Ramey) access
ADAPT of Clinic Director, Ellis LPC, LPHA Manage the Waxahachie Clinic M-F 8-5pm +
Texas County (Shara after hours
Lattimer) access
ADAPT of Clinic Director, LPC, LPHA Manage the Corsicana and M-F 8-5pm +
Texas Navarro & Kaufman Clinics after hours
Kaufman Counties access
(Dee Dromgoole)
ADAPT of Assistant Executive LPC, LPHA Supervise all clinical services M-F 8-5pm
Texas Director (Todd
Wright)
ADAPT of Executive Director Med, QMHP Director of all Adapt services M-F 8-5pm
Texas (Beth Epps)
NorthSTAR Proposal for Contract Amendment
Outpatient Competency Restoration (OCR) Programs RFI # PCA 256.1 – Due Date January 31, 2008
Table 6
II. E. 1-3: Work Plan
The NorthSTAR region currently has a successful collaborative pilot project in place in Dallas County. As a result, much of
the planning and implementation phases are complete for this area of our region. NorthSTAR’s work plan focuses on
enhancing the current pilot program, coordinating with all other counties to identify and address their needs, consistent
evaluation of progress, and planning/implementing strategies for FY2009 based on experiences in FY2008.
Target dates for completion
Tasks and activities Individuals responsible
(assuming funded 3/7/2008)
Identify strategies to develop NTBHA lead: Court systems, March 21,2008 and ongoing at
enhancements for current treatment providers, VO regular stakeholder meetings
system (to include housing, involved
transportation, training)
Develop targeted enhancements Court systems, treatment Ongoing
providers, NTBHA, VO
Identify strategies to incorporate NTBHA lead: Court systems, Ongoing
enhancements for current treatment providers, VO
system involved
Incorporate above strategies Court systems, treatment April 15,2008 and ongoing
into process providers, NTBHA, VO
Identify needs of remaining six NTBHA lead: Treatment March 21, 2008 and ongoing
counties without established providers, County governments
OCR program
Create collaborative/unified NTBHA lead: Court systems, April 15,2008
legal skills training program treatment providers, VO
involved
Regular meetings of Court systems, treatment Quarterly - ongoing
stakeholders for providers, NTBHA, VO
evaluation/improvement of
system