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					                        ANNE ARUNDEL COUNTY
                        CORE SERVICE AGENCY
                           ANNUAL REPORT

                              FISCAL YEAR 2006



I.     EXECUTIVE SUMMARY

       The Anne Arundel County Mental Health Agency, Inc. is the Core Service Agency
(hereinafter referred to as the “CSA”) for the County. The CSA is a not for profit organization
enabled by state law and created by County Ordinance to plan, finance, coordinate, and monitor a
system of mental health services funded with public funds. Although funded primarily by the
State Department of Health and Mental Hygiene (DHMH), through the Mental Hygiene
Administration (MHA), it is legally an “agent of County Government”.

       Fiscal Year 2006 was the year of program restructuring. The CSA began a long term
process of realignment of the service system to comport with the Goals set forth in the
President’s New Freedom Commission Report on Mental Health. The Crisis Response System
moved to a new location, expansion to six Mobile Crisis Teams was funded by the county, and
The In-Home Crisis Service was reconfigured into a Community Outreach Team for Anne
Arundel (COTAA). The CSA implemented The FIVE COUNTY PROJECT that became
operational in January 2005 with Crisis Beds, In-home Intervention for youth and adults, and
Assertive Community Treatment (ACT) as component services. The CSA’s partnership with the
Mental Hygiene Administration and the Arundel Community Development Service (ACDS), the
county housing development agency, doubled the number of consumers receiving Shelter Plus
Housing. The county funded an expanded Mental Health Jail Project and Mental Health Unit
for FY2007, and partnered with the CSA and MHA for an expansion of Trauma, Mental
Health, Addictions and Recovery (TAMAR), all being re-bid with a new provider. A Co-
occurring Charter Document was signed by all Human Service Departments of County
Government and major providers, and a mental health Network of Care website was launched.
Medicare D changes were implemented with minimal service disruptions, and Arundel Lodge
moved into a new building and transformed the Geriatric group home to a grant methodology.
Three Supported Employment Programs were funded by MHA as Evidence-Based Practices.

         Despite all of these achievements, the use of restrictive and expensive hospital and
institutional care grew and Out Patient Mental Health Clinics (OMHC) capacity continues to
shrink. (See Appendix I.)

II.    AGENCY ACTIVITIES

1. Management and Coordination Activities:

       A. The Executive Director continues to be a leader in Behavioral Health Care. As of
          July 1, 2006 he was reappointed as representative from Maryland to the Board of
          Directors of the National Association of Behavioral Health & Developmental
          Disabilities (NACBHDD), an affiliate of National Association of Counties (NACO).
   The Director also participated in state and national leadership endeavors by attending
   conferences with SAMHSA. The Executive Director was named to the Board of
   Directors of the International Critical Incident Stress Foundation (ICISF)
   beginning in August 2002. In June 2005 he was appointed to the State NAMI Board
   of Directors and continues to serve on this Board. He also serves on the Anne
   Arundel Community College Human Services Department Advisory Committee,
   and the Allied Health Division Advisory Committee.

B. STATE PUBLIC MENTAL HEALTH SYSTEM-CSA staff served in leadership roles
   on several committees, including the MHA Finance Committee, and Step Down and
   Diversion work group. Adrienne Mickler is chair of the MACSA CFO Committee
   and chair of the CSA Budget Committee. She is a member of the MHA Data
   Committee. It has finally been reconvened this year, the first time since APS assumed
   the Managed Care Contract. Frank Pecukonis, Ph.D., C & A Coordinator, is co-chair
   of MACSA’s C & A Coordinators Group. Cathy Weaver was an active participant
   with MHA’s Case Management, Supported Employment, and Shelter Plus Care
   meetings. Robert Durner represents the CSA at the Supported Employment and
   Housing meetings as well as being the AACMHA’s Ticket to Work contact person.
   He also is a member of the SUPPORTED HOUSING DEVELOPERS (SHD),
   INC. Board of Directors. The CSA has five licensed clinical staff, and two
   consultants with licenses. All are participating in Maps-MD monitoring activities.

C. COMMUNITY INVOLVEMENT- Adrienne Mickler, the CFO, remains a member of
   the Maryland Association of Certified Public Accountants (MACPA)’s
   Government and Not for Profit Committee. The MACPA members in Government
   and NFP Committee are actively involved with compliance and auditing standards as
   they affect government entities. The focus of this group this year is accountability
   and the new ethics requirement for CPA’s. This continues to affect the costs of audits
   and the compliance required by management and accountants. The CSA Director
   serves on the Local Management Board (LMB), the Local Mental Health
   Advisory      Committee      (MHAC),      and    the    CRIMINAL           JUSTICE
   COORDINATING COUNCIL (CJCC). The CSA Director serves on the county
   government Human Services Core Group (a monthly meeting of County Service
   Directors). The CSA is involved with the County Disaster and Terrorism Planning
   Process. Various staff conducted presentations regarding the PMHS, including the
   Division of Parole & Probation, the Human Services Coordinating Committee,
   Department of Aging, On Our Own, NAMI, Health Department, District and Circuit
   Court Staff, Criminal Justice Coordinating Council, Public School Guidance
   Counselors, Department of Social Services, County DDA Managers, Hospital
   Emergency Personnel, and County Government Department Heads.

D. WEB SITE-The CSA has a web site. This provides information, resources, a provider
   list, referral information, procedures, and complaints can be filed on line or the form
   downloaded. There are numerous links to other mental health resources and web
   sites, including MHA’s. As a major undertaking, the CSA purchased the
   NETWORKOFCARE software to improve service coordination and information
   access by the public. County Government and its media center were most helpful in
   ongoing public awareness of this resource. The Director and the County Executive
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          explained the system in great detail on the County’s Public Television Network. Staff
          has conducted numerous trainings and the site is experiencing over 45 visitors per
          day, averaging 17 minutes.

2. Quality management activities

      A. AUDIT RESULTS-The CPA Firm of Toal, Griffith and Ayers conducted an external
         Financial Audit. Our records were again found to be in excellent order. The CSA
         staff continues to require independent audits for all major contracts and implemented
         a system for documentation review and service verification.

      B. NON-MEDICAL ASSISTANCE-The CSA’s now authorize and monitor “Non-
         Medical Assistance consumers for PRP. The CSA developed a procedure for tracking
         and verifying service delivery to this population. However, no encounter data has
         been made available. So, the CSA cannot determine if adequate number and type of
         services are being delivered. We do know that the number of PRP uninsured
         consumers continues to drop and OMHC Uninsured Consumers has shown little
         change. (See Appendix II).

      C. PSYCHIATRIST FOR APPEALS-The CSA contracted with the Health Department
         to review appeals. The CSA has offered to handle other counties’ appeals. There
         were 13 appeals for Anne Arundel cases, two for Garrett County.

      D. As a component of the FIVE COUNTY PROJECT, “Credible Wireless” electronic
         system was purchased for providers to use to record notes, treatment plans,
         scheduling, etc., and “realtime” electronic records The CSAs, provider managers, and
         staff may monitor and review records in real time for on going Quality Improvement.
         Additionally the system automatically reports Fidelity Compliance to Evidence Based
         Practice (EBP) standards, allowing for completely objective grading with
         instantaneous backup documentation. This has become a vital tool to monitor
         quantity and quality of provided services.

      E. The CSA and the HEALTH DEPARTMENT continued to assume leadership for the
         implementation of COMPREHENSIVE CONTINUOUS INTEGRATED SYSTEM
         OF CARE (CCISC) for dual diagnosis treatment. The implementation began in FY06
         after three years of planning and research.

3. Internal data mechanisms & service utilization/systems monitoring

      A. All grantees have regular monitoring visits and file monthly service reports. This
         oversight activity is a major source of information concerning the functioning of
         system, identification of problems, and consumer reaction. The staff conducts annual
         program activity audits, matching documentation to productivity reports that are
         submitted to the CSA. These reports in turn are compared to the budget deliverables
         to track the provider’s attainment of stated objectives as to quantity. Within the CSA
         staff, individuals are assigned as grant managers. The CSA grant managers receive
         the monthly reports and review them to determine if the program is on track to
         accomplish their goals as stated in the Conditions of Award from the CSA’s contract
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          with MHA. The manager, with input from the Executive Director, can also add
          additional indicators that would improve the oversight process. Once a year, the
          manager, with the assistance of another CSA staff member, will randomly select a
          monthly report and make a site visit to verify the information contained therein. The
          result of the site visit will be provided to the Executive Director and follow-up action
          is taken and documented as appropriate. Each grant manager will determine the two
          or three most critical indicators and provide monthly data to the CSA Board of
          Directors to insure that they are kept up to date. The CSA staff maintains active
          involvement in the grants assigned to them.

      B. The BHRS satisfaction scale is utilized with consumers in RRP. The overall results
         in FY06 was 4.53 verses FY 05 4.77 that fall into the agree category. A score of 6 is
         “strongly agree.” The response to two questions are consistently well below 5, which
         is the threshold of a positive response utilized for this survey. The questions are “This
         program is too controlling” (low scores system wide at 2.97), and “the services focus
         on what I want from treatment” at 4.11.These lower scores are viewed as significant
         and not in line with system goals.

      C. An active grievance and complaint procedure is in place and has been used effectively
         by consumers and providers. Before the change to the PMHS, complaints concerning
         access predominated. Four years ago, quality of service was the predominant
         complaint. Three years ago, the focus appeared to be on communication issues
         between consumer/family and the providers. In FY06 the complaints were
         predominately communication and access. Informal complaints center on the system
         not responding to a need, whereas formal complaints relate to access or lack of
         communication. The complaint report can be found in the Appendix III.

      D. For the past 6 years, the CSA has been reviewing the nature of RRP discharges within
         Anne Arundel County. Discharges are categorized in 3 groups: positive, neutral, and
         negative discharges. In FY 04, neutral and positive discharges were low and negative
         discharges high. In FY05, there was an increase in positive discharges, but these
         centered on PTS, which had a major downsizing. In FY06 there were 57 discharges,
         which is the same number as in FY04. In Fy05 60% of all discharges were under
         “positive circumstances”, compared to 51% in FY06. The full report can be found in
         Appendix IV.

4. Services

   The following is a summary of the types, activity level, and comparison to FY05 activities:

   A. FEDERAL HOUSING GRANTS – The federal housing grants are made up of 2 programs
      – Shelter Plus and SHOP. 1) SHELTER PLUS - These are placements for persons
      coming out of detention. The number of placements increased to 24 from 13. Eight (8)
      more were placed due to funding through the efforts of the of Arundel Community
      Development Service (ACDS, Inc.) (See #2 below). Recidivism for this program is
      minimal. Although the number of slots available doubled from FY05 to FY06 the CSA
      was unable to fill all of them due to the very severe restrictions of the expanded grant
      award. The CSA is limited to one-person units and many of the people on the waiting list
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   have children and do not meet the new criteria. The CSA is still working to fill the
   additional slots. The CSA is also an active partner with ACDS. ACDS, Inc., is the
   county’s housing development agency. 2) Supported Housing Opportunities Program
   ( SHOP) -The CSA applied through ACDS for and received a homeless grant to provide
   housing to homeless mentally ill, focusing on consumers with children, and to those with
   criminal background and substance abuse histories. These are two major barriers to
   consumers in need of housing. This project provides outreach services to assure
   successful transition to competitive housing. 8 individuals with a total of 10 children
   were placed in the program filling the 18 total slots. There is virtually no turnover in this
   program. The Omni House case manager has done an excellent job assisting people in
   the program in locating apartment units and maintaining people in the program.

B. SUPPORTED HOUSING DEVELOPERS (SHD), INC. is a housing agency originally
   created by Omni House. SHD has received state grants over the years from the
   COMMUNITY DEVELOPMENT ADMINISTRATION (CDA) to purchase and renovate
   34 housing units for 66 consumers. Most of these units used to be HUD Section 8. 53
   consumers have housing as of June 30. The CSA gives SHD a small grant for staff
   support and Board Liability Insurance. This year the CSA worked with MHA to pay rents
   totaling $60,814. All funded subsidies follow Section 8 guidelines and units are
   inspected by the Anne Arundel Housing Authority.

C. FLEXIBLE FUNDS-The CSA considers these funds vital in meeting the needs of
   consumers. Most persons need furnishings, rental or utility deposits or assistance, help
   with utilities (one time only situations), movers, and other various one time only items. A
   number of persons utilized these funds for these items when moving into SHD
   apartments. Numerous persons needed birth certificates for entitlements applications.
   Interpreters are needed for foreign languages. Medication co-pays, dental, toiletries,
   maternity clothes were expenses for adults. For Children and Adolescents, the major
   needs were therapeutic camp assistance, and vocational training. The total amount spent
   for flexible funds in FY 06 was $22,096 for youth and adults.

D. PRESCRIPTIONS AND LAB-This area changed significantly due to increased cost of
   drugs, less stigma, and national policy, mostly in the Medicare arena. The SECOND
   GENESIS DUAL DIAGNOSIS PROGRAM also is a major cost driver. This is an
   arrangement between Second Genesis and the CSA. Persons are committed by the court
   to the program, usually coming from pre-trial detention. As such they have no benefits.
   The CSA fills in the gap until Primary Access to Care (PAC) or Medicaid (MA) kicks
   in. Unfortunately, most of the consumers in this program will not be eligible for MA or
   PAC, so the CSA obtained a grant. For all consumers, in FY 06 the expenses were
   $116,760, in FY 05, the costs were $119,830 for prescriptions, FY06 $4,460 for labs from
   FY 05-$3,428 and FY06 $1,057 for transportation (up from FY 05-$454). In FY 06,
   there were 1,137 prescriptions and 331 lab tests completed for 656 consumers.
   Transportation continues to be a small part of the total service. Expenditures have
   decreased with Medicare Part D implementation but not significantly. Medbank is a
   program that coordinates and assists persons in accessing free medication programs
   offered by the pharmaceutical companies.


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E. YOUTH SCREENERS-The Health Department and LMB co-funded two mental health
   screeners who are placed in the Department of Juvenile Services (DJS) Intake Center
   by the Health Department. This year the Health Department co-funded the screeners
   instead of the CSA. The workers saw 643 youths for screenings, down from 666,
   conducted 642 assessments, down from 658, referred 466 for mental health treatment,
   down from 580. The CSA continues to monitor this effort.

F. COMMUNITY ENHANCEMENT INITIATIVE (CEI) & PILOT PROJECT-In FY99 the
   Mental Hygiene Administration (MHA) solicited proposals from CSAs to place
   consumers from State Hospitals into community placements. Six persons were placed at
   the time and the number of available slots was therefore increased to 27 in total. Each
   individual under the project required special services, usually increased or enhanced
   supervision or transportation. The CEI and Pilot Programs were combined to provide a
   smoother funding mechanism of the CEI process in FY01. This arrangement has worked
   satisfactorily. But with the change in “enhanced consumer support” billing through APS,
   this program ended on June 30, 2006.

G. JAIL PROJECT- A continuing problem for this program is the entry being through the
   medical service unit at the Jail. This results in under diagnosis or substance abuse only
   being identified. In FY06, only 91 inmates were served with 658 visits. This decrease
   was related to staff turnover and penalties were applied. Discussions were held in FY06
   concerning a revamping of mental health services in the detention centers that resulted in
   a mental health unit opening July 1, 2006. This necessitated a rethinking of the current
   service configuration and resulted in an RFP, additional County funding, and ultimately a
   new provider who upgraded all therapeutic staff to licensed mental health professionals.
   The Case Management component was expanded to two persons, and a new provider was
   selected. This was a suggestion from MHA that will be implemented in FY07.

H. JAIL TRAUMA PROJECT-In FY06 the program reached 590 people by using groups. In
    FY05 the number of inmates receiving treatment was 136 and the number of sessions was
    747. The CSA received a request from Detention Center Management that an additional
    position be allocated due to an almost doubling in the percent of women who are
    incarcerated, and the increase of the number of inmates. At the end of February, 2006,
    the existing worker resigned. The position remained vacant, and penalties were applied.
    A new provider was selected via RFP for FY07 and an additional 0.5 FTE was added as
    well as upgrading both positions to licensed mental health providers.

I. ON OUR OWN (OOO) - The CSA gives an annual grant to the local On Our Own
   chapter. The drop in center is on 134 Holiday Court in Annapolis. This new location
   provides more space for needed activities and is accessible via public transportation.
   The center provides support, information, transportation, and recreational activities. They
   provide out reach presentations to potential consumers in hospitals and out patient
   centers. A new group of leaders has developed to advance the needs of consumers. This
   year they produced a newsletter, disseminated information, and had 67 persons receive
   information and support services.




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             J. FEE FOR SERVICE-The following is based on data sets that are incomplete for the total
                year See Appendix V for the raw data. Overall, the total number of consumers served
                was 4,532 in FY05 and in FY 06 was 4,309. The FY 05 claims was $24,669,863. The
                FY06 claims were $22,050,122. Concerning categories, uninsured consumer costs was
                $1,695,416 in FY 06, up from $1,303,317, but down for Medicaid and State Only
                Medicaid. Looking at age groups, those consumers aged 65 and older increased from FY
                05 to FY 06 34 to 41). This is still a huge under representation. In FY 98, the total
                elderly served was 243. For the age group of up to 21 years old decreased. Adults
                experienced a decreased number of consumers. PRP use was down slightly for all age
                groups combined, but significantly for adults.

                  By type of service, acute inpatient admissions were 272 (down 93)1, State Hospital
                  admissions were 410 duplicated, State Hospital bed days used were 32,277 (up 808),
                  State Hospital length of stay was 73 days (down 22 days), and RTC unduplicated count
                  was 43 down from 59). The county partnership strategy of early intervention, and the
                  impact of TAY, IHIP-C, and the BEST programs appear to be working.

             K. TRANSITION AGE YOUTH (TAY) INITIATIVE – The program continues to be
                structured along the lines of the CEI Program, using purchase of service to enhance each
                individual’s treatment needs. – PSSM, Inc remained the vendor of the TAY program.
                There were a total of 27 youth served in the TAY program in fiscal year 2006, the target
                being 11 youth. There were 7 discharges and 9 new admissions. All of the youth remained
                in mental health treatment. One youth did have an emergency room visit for psychiatric
                reasons but did not require admission to a psychiatric unit. In FY 2006, 44% of youth
                gained employment. This fiscal year has been the largest number of youth transitioning
                into the workforce. All of the youth were enrolled in an educational setting. 82%
                remained in high school, 15% are in college and 3% in GED classes. There were 2 youth
                who successfully graduated from high school. The additional youth were served via
                rollover funding and more youth could benefit if the increased funding could be
                sustained.

             L. COMPREHENSIVE CRISIS SERVICES GRANT-Anne Arundel County was selected in
                1999 as the demonstration site for a design, implementation and assessment of providing
                an array of support and outreach services to more effectively handle mentally ill persons
                in crisis The program, operated by ASG, features an Operations Center open 24 hours a
                day, which opened 10/11/99; a walk-in center open until 10:00 P.M. seven days per week;
                urgent care appointments with two days per week psychiatrist coverage; Community
                Outreach Team of Anne Arundel (COTAA); three police based Mobile Crisis Teams
                (MCT). The Mobile Crisis Team, responding with the police, operates seven days per
                week, 365 days per year, and phased in between 11/1/99 and was countywide by 4/24/00.
                COTTA Team, operating with a part time psychiatrist and part time therapist, works with
                homeless and non-compliant SPMI persons. The operations center uses the Network of
                Care community service listings to coordinate services and referrals. In FY 06 the
                system provided 690 (up from 531 in FY 05) urgent care appointments for evaluations,

1
 In-patient data has a lag of 3-4 months due to billing patterns and may be distorted. Extrapolation would increase the
number to 363, or almost the same as FY05.
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     handled 26,120 calls (up from 21,217 in FY 05), transported 211 people to services (up
     from 182 in FY 04), purchased 32 days of housing (down from 50 in FY 05), provided
     1,282 COTAA services (down from 1,441 in FY 05); also 1,473 Mobile Crisis Team
     dispatches (down from 1575), and 90 in-home stabilizations to 112 families (down/up
     from 120/48 in FY 05). The need for therapy services continues to strain urgent care slots
     The CRS has become the focus of the Disaster Mental Health Response Plan
     coordinated between the Health Department and the CSA.

M. CHILD & ADOLESCENT MENTORING PROGRAM-The CSA provided funding to the
   Anne Arundel County YWCA for a mentoring program serving males and females in
   the Public Mental Health System throughout the county. The services are all located on
   site at the YWCA Building in Arnold, three nights a week throughout the year. During
   FY 06, an average of 25 mentors a month working in the program that has served an
   average of 40 children ages 6 to 18. A scheduled program of both group activities and
   individual mentoring time occur each night of the program. The CSA obtained a $5,000
   grant from the United Way that funded 5 weeks of therapeutic camp and transportation.
   Currently there are 15 children/adolescents on the waiting list for this program. This has
   proven to be one of our most successful and popular services. Anne Arundel County
   Mentoring Roundtable honored the program as the first “Mentoring Program of the
   Year 2005.”

N. FAMILY INTERVENTION SPECIALIST-The CSA received a grant from MHA to
   establish a Family Intervention Specialist position for the DJS In home Intervention
   Program. The contract began in March 2003 and a worker was hired. In FY06 47 youth
   were enrolled, 461 therapy sessions were provided, 17 crisis response calls, and 24 new
   admissions and 23 discharges.

O. WORKSHOPS/TRAINING- The CSA sponsored 20 NETWORK OF CARE trainings
   and four major trainings on the topics of treating co-occurring disorders. The CSA co-
   sponsored two additional training with the Local Management Board and the Anne
   Arundel County Crisis Response System.

P.   TERRORISM - The local Crisis Management Center will be the communication point for
     use of mental health assets, activated in cooperation with the County Crisis Manager and
     the Health Officer. A MOU is now in place. The team has preordained meeting points if
     communications go out. These mental health resources are listed on the anthrax website
     and in the county crisis and disaster brochure. A comprehensive ALL HAZARDS PLAN
     was prepared and submitted to MHA. All CSA staff received NIMS training with the
     help of MHA in June 2006.

Q. SECOND GENESIS DUAL DIAGNOSIS PROGRAM-This program was changed to a
   grant for Medicaid ineligibles last year. The grant funds a psychiatrist for this program.
   He provided 258 visits (up from 228 in FY 05) for 52 unduplicated consumers, up from
   35.




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R. OUTREACH- The CSA obtained funding for a Spanish-speaking psychiatrist in FY03 and
   was able to continue this service in FY06. The CSA has contracted for a Spanish speaking
   MSW to do a weekly immigrant’s issues group in FY07. Additional Spanish-Speaking
   therapy remains on-going, unmet need for Anne Arundel County.

S. TRAUMATIC BRAIN INJURY GRANT-This CSA and the Frederick CSA were selected
   to pilot this program.         The CSA subcontracted for training through SKY
   REHABILITATION for screening and assessment training to three providers. This
   program satisfactorily closed out its activities in October 2006.
T. FIVE COUNTY CROWNSVILLE ALTERNATIVES PROJECT- Due to unexpected
   patterns of service use among the five counties, it was agreed to revise slot allocations for
   several programs. This became effective in 11/05 by consensus at the 10/19/05 Oversight
   Committee meeting. (See Appendix VI.)
   Specific program updates are below:
    Technology: Credible Wireless continues to provide technology services for the Five
      County project, including use of handheld devices and internet program for medical
      record documentation. This system allows for increased accountability and ease of
      access to clinical information. Electronic generation of Fidelity Scales is scheduled to
      become available in 7/06.
    Crisis Beds: In June 2006, the location of the Crisis Beds moved to 1350 Walnut Road
      in Port Republic, in order to better maximize space for services.
    In-Home Intervention Program for Children (IHIP-C): North Carolina Family
      Assessment Scale (NCFAS) scores for families that received IHIP-C services show
      improvement in all domains. The most notable improvements were in family
      interactions (32% improved), family safety (36% improved), and child well-being
      (27% improved). A contract was obtained with the University of Maryland, School of
      Social Work to conduct an impact study of IHIP-C services.
    Assertive Community Treatment (ACT): To date, 75 ACT consumers (43% of
      caseload) have obtained and/or maintained housing through assistance from the ACT
      Teams. Twenty-three of these individuals were referred from a state psychiatric
      hospital. To date, 31 state hospital patients have transitioned into the community with
      the support of ACT services. Fourteen ACT consumers engaged in competitive
      employment during FY 06.
    In-Home Intervention Program for Adults (IHIP-A): The Illness Management and
      Recovery (IMR) curriculum continues to be used successfully with consumers
      receiving IHIP-A services.
    Jail Mental Health Services: The Jail Mental Health contracts continue to provide
      augmented Social Work and Psychiatrist hours in county detention facilities in Charles
      and St. Mary’s counties.




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      Census for 2006: Service usage in 2006 is described below:

  Program       Provider        County           FY 06       Census as of     % of
                                               Allocation      6/30/06       Target
             Villa Maria    Anne Arundel           12              8          67%
                            Prince George’s        12              9          75%
 IHIP-C      SMCN           Calvert                12             11          92%
             IFCS           Charles                 8              7          88%
             SM MHA         St. Mary’s              8              9         113%
                            Calvert                 4              4         100%
 IHIP-A      Pathways       Charles                 0              2          N/A
                            St. Mary’s             16             12          75%
 Program     Provider       Deliverable          FY 06       Status as of     % of
                                              Expectation      6/30/06       Target
                            Assessments           250            183          73%
 ACT         PEP            Admits                190            190         100%
                            Slots                 175            173          99%
                            # Auth. for MTS       140            122          87%

                             ADULT CRISIS BEDS - SMCN
       County             FY 06     FY 06 Target   Bed Day Use               % of
                        Allocation     (80%)       as of 6/30/06            Target
 Anne Arundel              170           136            121                  89%
 Calvert                   607           486            497                 102%
 Charles                   340           272            247                  91%
 Prince George’s            47            38             25                  66%
 St. Mary’s                296           237            178                  75%


U. MEDICAL SERVICES AT ARUNDEL LODGE GROUP HOMES-As a part of the close
   out of the CEI Program, MHA and the CSA recognized the importance of medical
   supports to medically frail individuals who had been placed in “Geriatric Group Homes”.
   Funding was provided for a 0.5 FTE Registered Nurse and other supports. The RN
   worked a total of 981 hours.

V. EVIDENCE BASED PRACTICE GRANTS FOR SUPPORTIVE EMPLOYMENT-
    Arundel Lodge received a MHA grant to receive training for EBP Supportive
    Employment. PDG Rehabilitation and Omni House also received the same designations
    in the Fiscal Year.




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III.   FY 2006 PLAN IMPLEMENTATION-This section reviews the FY06
       Comprehensive Plan Goals and the progress towards meeting those goals and
       objectives.

GOALS/OBJECTIVES/STRATEGIES

 OVERALL SYSTEM GOALS

 1.    Comprehensive approach to crisis and outreach

       GOAL: Assure that Anne Arundel County has a comprehensive approach to crisis and
       outreach for all citizens.

       OBJECTIVE 1: Measure outcomes of components within the program.

       STRATEGY: Utilize the following desired outcomes to determine effectiveness:
       From baseline projections:
        Maintain the average length of hospital stay from FY 05 (84.54 days) to FY 06. MET
          – FY 05 = 95 DAYS (MHA DATA). FY06 = 73
        Maintain the number of persons admitted to State Hospitals from Anne Arundel
          County from FY05 (295 persons) to FY 06. UNMET – 379 PERSONS (MHA
          DATA)
        Maintain the number of State Hospital bed days used by Anne Arundel County
          residents from FY 05 (31,469 bed days) to FY 06. UNMET – 32,277 BED DAYS
          (MHA DATA) SUBSTANTIAL REDUCTION
        Maintain the number of Residential Treatment Center (RTC) bed days used from FY
          05 (9,913 bed days) to FY 05. MET – FY 06 = 8,083 BED DAYS (MHA DATA)
          SUBSTANTIAL REDUCTION
        Maintain the number of persons with major psychiatric illness in treatment in the
          community system as a percentage from FY 05 (69.25%) to FY 06. (72.21%) (See
          Appendix VII)
        Consumer satisfaction with the Public Mental Health System services will exceed an
          average of 4.5 on the Behavioral Health Care Rating of Satisfaction. MET – FY 05 =
          4.78 (CSA INTERNAL DATA) FY06=4.54
        Maintain police officer satisfaction with PMHS at current levels MET – FY 05 =
          4.56 RATING OUT OF 5 (VERY GOOD/USEFUL) (POLICE DEPARTMENT
          DATA) FY06 = 4.75 (See Appendix VIII)
        Maintain the number of psychiatric Emergency Room assessments from FY 05 (North
          Arundel Hospital = 2,513, Anne Arundel Medical Center = 1,535) to FY 06.
          (BWMC (FORMALLY NAH) FY 06 = 2,591. ASSESSMENTS (INCREASE)
          SUBSTANTIALLY MET. AAMC FY 05 = 1,808 ASSESSMENTS AAMC FY06
          = 1850 (PROVIDER DATA) (GOAL MET: adjusted for population growth.)

       OBJECTIVE 2: Assure that police continue to use petitioning procedures appropriately.

       STRATEGY: Educate police on the use of petitions. MET 46 TRAININGS
       PROVIDED. (See Appendix IX.)

                                                                                          11
     OBJECTIVE 3: Establish an operations center that would manage all components of the
     system.

     STRATEGY: Submit as grant request. NOT MET – CHANGE IN MANAGED
     CARE PROCEDURES NEGATED THE STRATEGY. ALTERNATIVE
     STRATEGY IS PURCHASE OF NETWORK OF CARE information website.

2.   Housing

     GOAL: Insure that housing options are available to consumers that need them.

     OBJECTIVE 1: Maintain 90% occupancy of the SHD housing slots (66). NOT MET –
     79% OCCUPANCY. CSA WILL NOT ENDORSE NEW BOND REQUESTS
     UNLESS CAPACITY IS AT 90%.

     STRATEGY: Monthly telephone contact with SHD concerning housing occupancy
     status.

     OBJECTIVE 2: Maintain 90% occupancy of the RRP housing slots (266). MET –
     96.0% OCCUPANCY

     STRATEGY: Weekly telephone contact with all RRP providers concerning housing
     occupancy status. Encourage rapid filling of empty beds from the waiting list.

     OBJECTIVE 3: Expand Shelter Plus opportunities

     STRATEGY: Applied for bonus money through SUPERNOFA funds to expand Shelter
     Plus. Award should be announced by end of year. MET – AWARDED FY 06 FIVE
     YEAR SHELTER PLUS CARE GRANT FOR 15 UNITS TOTALING $684,840

     OBJECTIVE 4: Maintain 18 people, including their children, who are mentally ill and
     also may suffer from co-occurring disorders and/or criminal history.

     STRATEGY: Monitor the grant. MET – ALL UNITS ARE FILLED

3.   Client Support System – Prescriptions, laboratory, transportation, etc.

     GOAL: Insure that those support services such as prescriptions, lab tests, transportation
     and other specific needs critical to maintaining good mental health are available.

     OBJECTIVE: process the requests within 1 working day of receipt.

     STRATEGY: Monitor to insure criteria met as the funds of last resort. MET




                                                                                           12
4.   Consumer Drop In Center/Peer Support

     GOAL: Insure that social resources and information services are available to individuals
     with SMI to facilitate recovery.

     OBJECTIVE 1: Maintain a consumer drop in center through On Our Own of Anne
     Arundel County. MET

     STRATEGY: Provide ongoing funding to On Our Own to operate the center since it is
     not in the FFS rate.

     OBJECTIVE 2: CSA to insure that targets are met. PARTIALLY MET

     STRATEGY: Monitor progress towards meeting targets.

5.   Hispanic Outreach

     GOAL: Insure that the Hispanic Community has knowledge and opportunity to utilize
     the PMHS.

     OBJECTIVE: Insure that culturally competent services are available. MET

     STRATEGY: Provide funding for a culturally competent psychiatrist.

6.   Community Alternatives to Institutional Care

     GOAL: Insure that there are community alternatives to institutional care following the
     closing of Crownsville Hospital Center.

     OBJECTIVE #1:
     Establish an Operation Center – This 24-hour, seven day per week operation would
     manage all components of the system. Physically, it can be located anywhere, but ideally
     with the Urgent Care and/or OMHC. The center is responsible to:

     STRATEGY:
     1. Operate a 24/7 “Warm Line” for information, referral, authorization, and arranging
        for services on a priority protocol approved by the CSA.
     2. Maintain a complete PMHS and private resource database (this already exists in AA
        & PG Counties).
     3. For each CSA, maintain a register of consumers and assure authorizations are
        obtained from MHP. For non-MA persons with insurance, be a resource for how to
        obtain services and authorizations (this function may be provided by OASIS in AA
        County), and for those without insurance, arrange for authorization from the CSA
        based upon a priority protocol supervised and approved by the CSA.
     4. Serve as a contact point for the PACT, IHIT, and MCT with the authority to dispatch
        these teams based on priorities set by the CSA.
     5. Authorize and arrange for urgent care, in-patient alternative services, and support
        services.
                                                                                          13
      6. Arrange for transportation between components of the PMHS.
      7. Coordinate State Hospital admissions with MHA’s central admissions.

      NOT MET – DROPPED AS A STRATEGY BY THE 5 COUNTIES INVOLVED
      AND MHA

      OBJECTIVE #2:

      Establish a comprehensive clinical assessments and services – This is an extended hours
      (8 a.m. to 12:00 noon – weekdays; 12:00 midnight to 2:00 a.m. Saturday; and 1:00 p.m.
      to 9:00 p.m. Sunday), with the ability to conduct comprehensive assessments, triage, and
      observation to non-medically complex cases.

      STRATEGY:
      1.  On-site psychiatry is needed for the afternoon and early evening/weekend hours,
          and on-call response for the other hours. MET – EXPANDED ON-CALL
      2.  Access to sub-acute substance abuse beds, substance abuse services, mental health
          and mental health support services is vital. DROPPED – INSUFFICENT
          FUNDING
      3.  Funds to maintain existing crisis beds in Calvert County and PG County are
          needed. MET AND FUNDED
      4.  Laboratory work up capability must be present. DROPPED – INSUFFICIENT
          FUNDING
      5.  Outreach Services – These services are essential to meeting people’s needs and
          removing barriers to service. MET – ADULT IHIP. Restructing of CRS
          COTAA.
      6.  Access to partial hospital programs in AA and PG Counties would be
          regionalized. DROPPED – INSUFFICIENT FUNDING
      7.  PACT would be expanded in AA County and made available to the three
          Southern Maryland Counties. (PG County could also develop a team.)
          MODIFIED AND MET – PRINCE GEORGES COUNTY, ANNE
          ARUNDEL COUNTY CO-ESTABLISHED, & SoMD DEVELOPED IN-
          HOME ADULT SERVICES (IHIP-A)


                        CHILDREN AND ADOLESCENTS

1. Mentoring for Behavioral Issues

   GOAL: Insure that a quality-mentoring program is available to SED individuals.

   OBJECTIVE: Insure that 30 children receive mentoring services at the YWCA. MET – 40
   Average

   STRATEGY: Provide oversight to insure a quality program. MET – Award won.



                                                                                           14
2. Screening

     GOAL: Screen children and adolescents who present at DJS intake. Monitor and intervene
     through Intensive Aftercare Team.

     OBJECTIVE 1: Provide 600 screenings annually. MET – PROVIDED 643 SCREENING
     DURING FY 06

     STRATEGY: Insure that screeners provided to DJS by the Health Department meet the
     Established quality indicators.

     OBJECTIVE 2: Monitor and evaluate effectiveness of the Family Intervention Specialist
     position on the DJS Intensive Aftercare Team to determine future needs.

     STRATEGY: Monitor Program. MET – DJS & CSA satisfied with performance.

3.   Transition Age Youth

     GOAL: Provide a bridge for youth aged 16-22 who are in the mental health system to
     effectively transition to appropriate adult life patterns and independence.

     OBJECTIVE: Provide an individualized service, on a case-by-case basis utilizing Case
     Management techniques.

     STRATEGY: Referrals and monitoring through the CSA. Maintain 12 consumers served
     in the community. MET – MAINTAINED AN AVERAGE OF 17.8 CONSUMERS IN
     THE COMMUNITY DURING FY 06 WITH NO HOSPITALIZATIONS.

4.   In home intervention/On Call Availability

        GOAL: Maintain an on-call system responsive to home intervention.

     OBJECTIVE: Provide an on-call service for children and adolescents that, if clinically
     appropriate, diverts them from admission to RTCs.

     STRATEGY: Integrate existing program into new In Home Intervention program. MET –
     BUT PROGRAM CUT BY MHA FOR FY 06.

5.   Aftercare Service Worker

     GOAL: Insure that C&A are maintained effectively in the community.

     OBJECTIVE: Re-establish grant for C&A Aftercare Worker.

     STRATEGY: Submit request for over the allocation of funds. MET – GRANT RE-
     ESTABLISHED IN FY 05

                                                                                         15
     6.     Psychologist Services at Waxter Center

            GOAL: Insure testing for consumers and supervision of unlicensed staff.

            OBJECTIVE: Provide a Clinical Psychologist to meet the need. MET

            STRATEGY: Monitor services provided


                                               ADULT

1.        Comprehensive approach to crisis and outreach
          See Overall System Goals

2.        Housing
          See overall System Goals

3.        Traumatic Brain Injury Project

          GOAL: Provide resource coordination to individuals with brain injuries who live in Anne
          Arundel County who are presently not receiving coordination through any other service
          system.

          OBJECTIVE: 1) Focus on identifying individuals with Traumatic Brain Injury (TBI) within
          mental health settings; 2) Train mental health providers to use intervention strategies that
          will meet the unique needs of individuals with brain injuries; and 3) Link individuals with
          brain injury to appropriate resources.

           STRATEGY: Hire .5 FTE Brain Injury Resource Coordinator who will: 1) be responsible
           for case managing individuals with brain injury in the county and identifying service gaps
           for individuals with brain injury and their families and 2) be expected to maintain a caseload
           of 15 individuals and to service a minimum of 20 individuals with brain injury a year. MET


                                                ELDERLY

All prior efforts to engage the elderly population to participate in the Public Mental Health System
have been unsuccessful. The inability of the system to eliminate the Medicare copy has made the
services unattractive to the elderly. In Anne Arundel County, there are very few elderly consumers
in the PMHS.

                                                   DEAF

     Continue programming adequate to meet demand. MET




                                                                                                      16
                                             HOMELESS

     1.   Outreach

          GOAL: Have accessible services for homeless who are SMI. See “Housing/Adult.”

          OBJECTIVE: Expand programs to meet the goal such as PACT.

          STRATEGY: Work with state and local agencies to develop payment mechanisms to fund
          the outreach. Establish a second PACT. In PACT, add “Housing First” model. MET –
          EXPANDED UNDER FIVE COUNTY ONLY. CRS PACT reorganized into
          Community Outreach Team for Anne Arundel County (COTAA).


2.        Housing

          GOAL: Insure that housing opportunities are made available to the seriously mentally ill
          and their families who are homeless.

          OBJECTIVE: Utilize the “Supportive Housing Opportunity Program” (SHOP)

          STRATEGY: Maintain 17 individuals who are seriously mentally ill and homeless. MET
          – MAINTAINED 18 PEOPLE (CSA INTERNAL DATA)

                                         JAIL POPULATION

1.        Case Management

          GOAL: Insure linkage with the mental health community after release from detention
          facilities.

          OBJECTIVE 1: Continue to provide 1 Case Manager for linkage between recently
          released consumers from jail with the community mental health providers. POSITION
          WAS VACANT, NOW FILLED

          STRATEGY: Maintain person in position with services to 300.
          Not met – 83 served. New provider chosen.

2.        Treatment for trauma

          GOAL: Serve inmates who have a history of trauma.

          OBJECTIVE: CSA will monitor to insure that 200 inmates will be served. MET – 590
          INMATES SERVED

          STRATEGY: One full time on-site specialty trained clinician assigned.
                                                                                                     17
                 MENTALLY ILL/SUBSTANCE ABUSING CONSUMERS

GOAL: Existence of a charter document to guide the development and delivery of services to this
population in Anne Arundel County.

OBJECTIVE 1: Explore opportunities to establish an integrated comprehensive approach for
treating consumers with Mental Illness/Substance Abuse (MISA) in Anne Arundel County.

STRATEGY: Form Mental Health/Substance Abusers leadership group - MET
Develop draft charter document. MET
Sign document. MET – Signed by all members 12/05.
Integrate the effort with Anne Arundel County Government . MET

OBJECTIVE 2: Increase effectiveness of mental health providers to treat individuals who are
MISA.

STRATEGY: Provide classes or seminars to mental health providers relating to treating
individuals with SMI who also abuse substances. MET – TRAININGS HELD




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APPENDICES




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