I. SB 07-097 Community Mental Health Criminal Justice Initiative by wqs99947


									       Letter of Intent

                                            Exhibit O
I. SB 07-097 Community Mental Health Criminal Justice Initiative Program
1. Reduction in Recidivism: MHCD’s mission “Enriching Lives and Minds by Focusing on
Strengths and Recovery” is the guiding force behind our strengths-based, recovery oriented
treatment philosophy. Consumers are involved with shaping their own recovery which gives
them a real chance to regain control over their lives. A large segment of the offender population
has experienced homelessness, which has its own unique culture and values. Another important
consideration is the large percentage of participants who have a history of trauma or exposure to
violence. It is challenging to identify the belief systems of an entire group of individuals, each
with distinct life experiences, cultures and belief systems. Through development of an
individualized service plan at program entry, an individual’s own cultural considerations will be
honored and incorporated into treatment planning thus increasing the likelihood of successful
In September 2007, MHCD implemented a mental health service program for juvenile and adult
offenders with mental health problems who are involved in the criminal justice system, the
Denver Criminal Justice Initiative (DCJI), with funding from Senate Bill 07-097 provided
through the Colorado Division of Mental Health. The DCJI program increased community
capacity to outreach and engage adult offenders into evidence based practices such as Assertive
Community Treatment (ACT), Integrated Dual Diagnosis Treatment (IDDT), Dialectical
Behavioral Therapy (DBT) and the Trauma Recovery and Empowerment Program (TREM).
These evidence-based treatment services have been demonstrated to reduce recidivism, mental
health symptoms and substance abuse issues over the course of treatment.

The funding also allowed MHCD to increase capacity for juvenile offenders in the Intensive In-
home Family Therapy program which employed family-focused interventions supported by
community-based wraparound child/family support plans. The treatment interventions include
structural strategies designed to change patterns and practices in family subsystems that may
contribute to delinquent behavior.

The mental health status and recovery service needs of offenders referred to MHCD for
admission to the DCJI program are assessed through a Contact and Triage form completed at the
time of the initial referral, and a Multidisciplinary Assessment Tool and the Colorado Client
Assessment Record completed through a clinical interview at the time of admission. In addition,
the mental health and recovery status of adult offenders are assessed at admission and at six (6)
month intervals using MHCD’s proprietary Recovery Needs Level Rating instrument.

2. Start-up Timeline: Not applicable.

3A.Target Population of Adults:
   Adults, 18 years and older;
   Who are diagnosed by a mental health professional as having a Serious Mental Illness (SMI);
   Who are involved in the criminal justice system (defined as charged with or adjudicated for
   an offense); and
   Who reside in or are homeless within the City and County of Denver.

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In Denver, 6,326 individuals are actively under supervision in Denver Adult Probation
Department; 406 are currently under supervision with the mental health probation unit. 335 of
the probationers (83%) also have a substance abuse diagnosis (Frenette, 2007).1 The most
common mental health diagnosis is bipolar disorder (35%), followed by 27% with Major
Depressive Disorder, and 25% with Schizophrenia or other Psychotic Disorder. A small portion
of offenders have an anxiety diagnosis. The breakdown according to sex is 59% males (N=229)
and 41% females (n=142). This finding is particularly noteworthy; in 2004, 74% of offenders (at
intake) under supervision in the Denver Adult Probation Department were males. This change
requires attention to gender-based needs for services. Almost half of the probationers are non-
Hispanic whites (49%), 32% are African American, 18% Hispanic, and 1% American Indian.

Cultural norms and values relevant to this target population include the social stigma
surrounding both mental illness and substance abuse, which may limit willingness to engage in
program activities. Some participants may also have an anti-social component to their
personality, making them even less interested in moving forward to recovery.

3B. Target Population of Juveniles:
    Youth between the ages of 10-17;
    Who are diagnosed by a mental health professional as having a Serious Emotional Disorder
    Who are involved with the juvenile justice system; and/or
    Youth with co-occurring disorders of mental illness and substance abuse.

MHCD was a partner in the Colorado Multisystemic Therapy Outcomes Tracking Project (OTP)
which included seven (7) providers throughout the State of Colorado for fiscal year 2006-07 and
the results from this project indicated the following about the justice involved youth whom we
    MHCD youth were more likely to be male, younger, non-white and living at home at
    admission compared to other OTP youth.
    MHCD youth had more difficulty in school than other OTP youth. MHCD youth had higher
    rates of drop out, expulsion and multi-disciplinary issues, and lower rates of youth attending
    classes regularly and passing most of their classes.
    MHCD youth had more involvement with the legal system in the year prior to admission
    than other OTP youth. Legal involvement included a wide range of issues such as court
    supervision and corrections, as well as diversion, community service, deferred adjudication
    and appearances in drug and truancy courts.

4. Program Goals and Objectives:
       Increase community capacity to serve 36 juveniles with SED and their families in fiscal
       year 2008-09.
       Increase community capacity to serve 48 adults with SMI in fiscal year 2008-09.
       Provide outcome and recovery oriented services that increase the target population’s
       ability to function independently in the community in areas such as housing, school, and
       employment as measured by the MHCD Recovery Markers instrument.

    Frenette, C (2007). Data from the Denver Adult Probation client database.

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             Promote collaborative community work by continuing the timely and regular meetings
             and on-going dialogue that has already been successfully established with existing
             criminal justice partners and develop additional relationships with juvenile justice
             Reduce jail and prison recidivism by 25% as measured by the MHCD Recovery Markers
             instrument and inter-agency reporting.
             Provide for long term, local sustainability by demonstrating successful outcomes as
             measured by the MHCD Recovery Marker instrument and inter-agency data reports that
             can be used to support on-going funding.
             Provide services that are demonstrated to be cost effective by reducing the need for more
             expensive community resources such as incarceration, hospitalization, and residential
             treatment as measured by the MHCD Recovery Marker instrument and inter-agency data

       Please refer to section 11. Anticipated Outcomes for outcome and measurement detail.

5A. Services to Be Provided to Adults: MHCD has a strong history of implementing evidence-
based interventions which build on consumer strengths and develop skills that allow consumers
to recover, reduce dependence on the service system, and move into permanent supportive
housing outside of the criminal justice system. The DCJI program builds on a very successful
high intensity treatment approach that MHCD has employed for more than 12 years—Assertive
Community Treatment. The program has created more capacity to meet the growing need for
access to appropriate community treatment services as well as creating a seamless system of
services for adults with serious mental illness who are seen frequently in the criminal justice

Assertive Community Treatment (ACT) – Mental health policy experts call ACT the most
well-defined, evaluated and influential treatment in the field of community mental health care.2
ACT is for those who experience the most severe symptoms of mental illness and have problems
taking care of even their most basic needs, and who typically experience homelessness,
substance abuse and legal system involvement. ACT offers services to manage psychiatric
symptoms, housing, finances, employment, medical care, substance abuse, family life and
activities of daily living. A multi-disciplinary ACT team includes: clinical case managers,
psychiatrists, nurses, a clinical supervisor and therapists. In ACT, the staff to client ratio is 1:12.
This intensive intervention includes: outreach and engagement through strengths-based case
management, medication evaluation, medication monitoring, benefits acquisition and
management, group therapy, supportive housing services, and referral to primary care. One of
the most important services is assistance in locating and maintaining stable, safe, affordable
housing to support the consumer’s recovery goals. For the target population, mental illness is
almost always the root cause of legal system involvement and the ACT approach has been
effective in reducing recidivism.
To further facilitate recovery for persons with serious mental illness and co-occurring substance
use disorders, MHCD also offers Integrated Dual Disorders Treatment (IDDT)3 & 4 within
    Drake, R. E., & Burns, B. J. (1995). Special section on assertive community treatment. An introduction. Psychiatric Services, 46(7), 667-668.
    Minkoff, K. (1989). An integrated treatment model for dual diagnosis of psychosis and addiction. Hospital and Community Psychiatry, 40,

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           Letter of Intent

ACT services. IDDT helps people recover by offering mental health and substance abuse
services together, in one setting, at the same time. A wide variety of services are offered in a
step-wise fashion because some services are important early in treatment while others are
important later on. Individualized treatments are offered depending on the stage of recovery.
IDDT helps people manage both their mental illness and substance use problems so they can
pursue their own meaningful life goals.
Trauma Recovery and Empowerment Model (TREM)5 & 6 was designed to address issues of
physical, sexual, and/or emotional abuse in a population of women with histories of trauma, and
for whom trauma-informed treatment and recovery services have been unavailable or ineffective.
TREM has significantly better outcomes on several trauma-related measures, including mental
health symptoms, dissociation, sense of personal safety, and ability to cope with trauma.7 M-
TREM is a trauma model derived from TREM for male victims of trauma and will be used by
the CJI.
Dialectical Behavioral Therapy (DBT) is a treatment modality of individual and group therapy
for people recovering from personality disorders. DBT provides skills training that helps reduce
therapy interfering behaviors such as suicidal ideation and self-harm and increases coping skills.
DBT is provided by trained master’s level therapists.
Adult services are delivered in both a clinic setting as well as in the Denver community in
keeping with the ACT model. These community settings include consumers’ homes, residential
facilities, homeless shelters, criminal justice settings and a variety of other locations as dictated
by consumer need. Clinical services are primarily delivered by MHCD’s ACT located at 1733
Vine Street, Denver, Colorado 80206. While actual length of stay in the ACT program will vary
based on the individual recovery of the consumer, the initial goal is to move the consumer to a
lower level of care after 18 months of active enrollment.
5B. Juveniles: MHCD’s Child and Family Service Program is one of Denver’s leading resources
for comprehensive treatment for a range of emotional and behavioral disorders in children ages
0-18. DCJI treatment services are provided by the Intensive In-Home Family Services team
which consists of clinicians from a variety of cultural and educational backgrounds, interests,
and areas of professional expertise. They have extensive experience with Latino, African-
American, and Anglo families, particularly those with children with serious emotional and
behavioral problems, with multi-system involvement, and at risk of or history of out-of-home
placements. They have been trained in Multisystemic Therapy (MST) and Trauma Focused
Cognitive Behavioral Therapy models and some have training in Fetal Alcohol Spectrum
Disorders and Self-Injury. The clinicians have gained experience in treating substance abuse
issues through specific educational opportunities and in-vivo experience. In addition, through the
implementation of the MST model of treatment, the therapists have been able to address

  Minkoff, K. (1991). Program components of a comprehensive integrated care system for serious mentally ill patients with substance disorders.
   New Directions for Mental Health Services., 50, 13-27.
  Fallot, R.D., McHugo, G.J., & Harris, M. (2005). Preliminary studies of the Trauma Recovery and Empowerment Model. Unpublished
manuscript. Community Connections: Washington, D.C.
  Fallot, R.D., & Harris, M. (2006). Pilot Studies of the Trauma Recovery and EmpowermentModel (In Press)
  Toussaint, D., VanDeMark, N., Bornemann, A., & Graeber, C. (In press). Modifications to the Trauma Recovery and Empowerment Model
(TREM) for substance-abusing women with histories of violence: Outcomes and lessons learned at a Colorado substance abuse treatment center.
Journal of Community Psychology.

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substance abuse issues in a systemic manner. Furthermore, one of the therapists has a CAC-III
Last year through the DCJI funds, this team was trained in evidence-based family focused
interventions, which are flexible enough to be tailored to the specific needs of each family, that
have allowed them to serve greater numbers of families while maintaining quality of service
provision and increasing efficiency. The in-home therapeutic work is also supported by High
Fidelity Wraparound services that are provided in the neighborhoods in which the families live.
Recent research on High Fidelity Wraparound has demonstrated that the process can produce
significantly better outcomes than traditional approaches for children and families with intense
service needs. Essentially, Wraparound is a facilitated team-based service and support planning
process. The team is typically composed of four to eight people in the lives of the youth and
family who know them well and who care.
Intensive in-home services are delivered in the family’s home, community settings such as
schools, parks, and juvenile justice settings as well as either of MHCD’s two neighborhood
outpatient clinics located at 1405 N. Federal Blvd, Denver, CO 80204 and 4141 E. Dickenson
Place, Denver, CO 80222. The team has a low client to staff ratio which facilitates services being
provided in the home. The team has bilingual capacity and has incorporated intensive case
management into the continuum of care.
The intensive in-home family therapist assigned to each youth and his/her family average three
to four contact hours of service per week. Caseloads for each therapist range from seven to eight
families at any given time, based on the acuity level of the family (as compared to an MST
therapist whose caseload includes four to five families on average). Therapists have the
flexibility to schedule appointments at anytime throughout the day, Monday through Friday.
Some appointments are also scheduled on Saturdays depending on family and therapist schedule.
In addition, there is a 24-hours-a-day, seven-days-a-week, on-call system to provide emergency
consultations and interventions for youth and their families. Length of stay for DCJI enrollees is
between three to six months per family.

Youth and families who complete intensive in-home services are assessed to determine whether
step-down or transitional services are necessary. Due to the complexity of psychiatric/mental
health issues presented by youth in the juvenile justice population, clients also have access to
individual therapy, day treatment, school-based services, medication management, case
management and wraparound services through MHCD. MHCD also provides medication
evaluations and psychological testing as needed to facilitate treatment planning and to assist in
the mental health treatment of clients and their families.

6A. Service Relationship to Overall Community Services and Resources for Adults: The Denver
City Council formed the Crime Prevention and Control Commission (CPCC), Council Bill 152,
2005, to create a unified vision for criminal justice activities, with specific attention to mental
health needs (CPCC Final Report to the Mayor, 2005). The Mental Health Subcommittee
completed a comprehensive strategic plan, The Denver Action Plan, developed with technical
assistance from the National GAINS TAPA Center utilizing their sequential intercept model.
The action plan identified distinct priorities to be addressed. The number one identified priority
area is “Resources”. The plan called for expanding “resources available for treatment and
supportive services for individuals with mental illness and co-occurring disorders who are

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diverted from or become involved with the criminal justice system”. MHCD’s DCJI program
directly addressed this resource issue by utilizing an array of best practices in coordination with
the criminal justice system.
6B. Juveniles: Quality mental health services for youth involved in the juvenile justice system
are in high demand, especially with the recent changes regarding eligibility for Residential Child
Care Facilities and Residential Psychiatric Treatment Facilities for Children throughout the State
of Colorado. MHCD’s Child and Family Services division has noted an increase in the acuity
level of the population served as well as the need to maintain a waiting-list for intensive services
at various times throughout this past fiscal year. MHCD’s focus on best-practice family-focused
interventions (through this current funding opportunity) will allow our intensive in-home family
services team the flexibility to tailor interventions to the specific needs of the juvenile justice
population with significant mental health issues and their families and increase service capacity
at the same time. MHCD will continue its collaborative efforts with community partners to best
meet the needs of the juvenile justice population.

7A. Collaboration, Coordination with Systems Partners Serving Adults: MHCD has existing
collaborations and coordinates with local and /or State, criminal justice agencies and venues
including: Denver Adult Probation, the Denver County Jail Transition Unit for Mentally Ill
Offenders, the Denver Court to Community Treatment Program through the City and County of
Denver, the Denver Police CIT (Crisis Intervention Team) program, and parole officers working
with offenders in Denver. DCJI funding provided MHCD the opportunity to build upon these
well established relationships to enhance access to services for a greater number of offenders
with mental illness whom the referral sources above identified have wanted to refer but for
whom MHCD has lacked the capacity to serve in the past. We will continue to coordinate with
each of these entities as SB-97 funds allow us to expand access to services.

7A. Juveniles: MHCD’s Intensive In-home Family Services Team seeks to involve all systems
that impact the youth’s life and circumstances. As a result, we have collaborative relationships
with Denver Juvenile Probation, Treatment Alternatives to Street Crime (TASC), Denver
Department of Human Services, Emerson Street School, Denver System of Care, Paramount
Youth Services, and the Denver Collaborative Partnership (DCP). The DCP consists of all the
major child-serving agencies for Denver County and the member partners include: MHCD,
Denver Department of Human Services, Denver Youth Corrections, Denver Juvenile Probation,
Denver Public Schools, Denver Health, Access Behavioral Health, Denver Juvenile Court and
the Family Agency Collaboration. This partnership group is structured through a formal MOU
process and is partially funded through HB1451. This group supports an integrated staffing
process that is highly recommended for all youth facing commitment. This staffing process
invites the youth, his/her family and all involved service providers to discuss the history,
challenges and supports of any given family to determine the best course of subsequent action
for a particular youth/family. These integrated staffing meetings are held on a weekly basis and
provide a forum for MHCD to provide information regarding our treatment programs, capacity,
referral processes, eligibility requirements, etc. The DCP monthly meetings also keep MHCD
directly connected with our juvenile justice partners and provide an excellent forum for sharing
information and discussing current challenges as well as successes within the youth serving
system of care.

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8A. Coordination of Referral Process with the Adult Criminal Justice System: DCJI funding has
enabled MHCD to accept referrals for Department of Corrections offenders with mental illness
who are discharged into the community on parole and who would otherwise be unable to access
treatment due to capacity issues. MHCD has responded to a Request for Proposal from the
Department of Corrections, Division of Adult Parole, Community Corrections &
Youthful Offender System to become an Approved Treatment Provider. MHCD also accepts
referrals directly from Denver Adult Probation and the 2nd Judicial District. Jay Flynn, Deputy
Director of Adult Recovery Services, is responsible for individual case assignment, follow-up
and supervision of all cases funded by the DCJI program.

8B. With the Juvenile Criminal Justice System: Referrals are received by a number of resources,
including the DCP, the Department of Youth Corrections, Paramount Youth Services, Denver
Juvenile Probation, and TASC and are made to the Intensive In-Home Family Services team by
contacting the Program Manager, Dawn Wilson, Ph.D. Dr. Wilson is responsible for individual
case assignment, follow-up and supervision of all cases assigned to the intensive in-home family
services team through this funding opportunity. Referrals include pre-adjudicated Senate Bill 94
juveniles, juveniles on parole, and juveniles transitioning form parole. In order to increase the
number of referrals to the program, there has been increased communication with representatives
from 191J court, and Safe City Schools. Also, the MHCD staff located at Gilliam Youth Services
Center will now be directly supervised by Dr. Wilson which will facilitate the referral process of
DYC youth.

9. Documents related to SB97 Collaborations: Memorandum of Understanding (MOU) with
Denver County Jail, Denver County Court, Denver Pre-Arraignment Center, and Denver Adult
Probation. Template is attached and executed copies will be forwarded when complete.

10. Decreasing the Rate of Incarceration and Re-incarceration: MHCD’s DCJI program has
created additional capacity within the community to outreach and engage adult offenders with
serious mental illness and/or co-occurring disorders into evidence-based practices such as ACT,
IDDT, TREM, and DBT services. The DCJI program is closely linked with the Denver County
Court, the on-site psychiatric nursing services at the Denver County Jail and the Denver Pre-
Arraignment Detention Facility. The program is specifically designed to reduce the “revolving
door effect” by achieving a seamless transition from court and jail into intensive mental health
treatment and essential services that support a successful life in the community.

The program also increased the capacity to engage justice involved juveniles and their families
into intensive in-home services and high fidelity wraparound services that address the underlying
cause of youth crime and attempt to enlist family members, positive peers, and community
members in order to facilitate the treatment process and sustain treatment goals. MHCD
collaborates with juvenile justice system agencies to provide transition and on-going services for
incarcerated youths as they re-enter the community, and services for youth on probation and pre-
adjudicated youth to reduce and prevent further involvement with the juvenile justice system.

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           Letter of Intent

11A. Anticipated Outcomes for Adults:

Goal                       Activity                  Outcome                                             Indicator
Improve psychiatric        •   ACT Services          •   Increased involvement in activities of          • Change in Recovery Marker (Active
well-being among           •   Medication mgt.           interest-hobbies, entertainment, recreation       Growth/Orientation
target population          •   TREM                  •   Reduction in level of symptom interference,     • Change in Recovery Marker (Level of
                           •   DBT                       e.g. mild impact on the ability to engage in      Symptom Interference)
                                                         work or social relations etc.                   • Change in Recovery Marker
                                                     •   Improved role in directing their own               (Engagement with service providers)
                                                         services leading to recovery
Reduce psychiatric         •   ACT Services          •   Reduction of the number of days in a            Change in residential status (reduction of
ER & hospital use          •   IDDT Services             semester spent in hospital due to psychiatric   days in hospital due to psychiatric reasons)
                           •   TREM                      reasons
                           •   DBT
Reduce substance           •   ACT Services          •  Reduction in the level of alcohol and other      • Change in Recovery Marker (Substance
abuse in target            •   IDDT Services            substance use                                      Abuse-level of use)
population                 •   TREM                  • Reduction in number of days per semester          • Change in residential status (reduction of
                           •   DBT                      spent in Detox                                     Detox incidents and/or days in Detox
                                                     • Improved recognition that substance abuse         • Change in Recovery Marker
                                                        may be a problem                                 (Substance Abuse (stages of change)
Reduce involvement         •   ACT Services           • Reduction of number of days in jail based         • Data transfer containing number of
in the criminal justice    •   IDDT Services            on initial baseline established through the          arrests, jail days and court appearances
system by providing        •   Medication mgt.          data transfer                                     • Changes in residential status (reduced jail
effective community        •   TREM                   • Reduction of arrests                                 and court days
mental health              •   DBT                                                                        • Data transfer containing number of
treatment.                                                                                                   arrests, jail days and court appearances
Enhance cross system       •   ACT coordination       • Reduction of number of days in jail               • Data transfer containing number of
coordination.                  of services.           • Reduction of arrests                                 arrests, jail days and court appearances
                           •   Participation on                                                           • Changes in residential status (reduced jail
                               Mental Health                                                                 and court days
                               Sub-Committee                                                              • Data transfer containing number of
                                                                                                             arrests, jail days and court appearances

11B.Anticipated Outcomes for Juveniles:

                                                 Intensive In-Home Family Services Model of Care
                  Strategies and Activities                                    Outcomes                                 Indicators/Measures
• Family therapy interventions based on structural and             •   Increased family cohesiveness,            • Family Empowerment
  solution focused strategies utilized to increase resiliency          improved family dynamics and
                                                                                                                   Scale (systems advocacy,
• Assessment and client consultation to determine                      communication
  appropriate level of home based intervention or possible         •   Parent experiences reduction in stress      knowledge, competence
  referral to other services                                           and feels empowered to access               and self-efficacy)
• Engage families fully, meeting them in their context, in             services and supports                     • Caregiver Stress
  their home and neighborhood, listening carefully and             •   List of community/natural supports          Questionnaire (effects of
  respectfully to the families’ priorities. Staff work to              has been established and family is
  connect families meaningfully with schools and other                 linked to community supports to             caregiver responsibilities)
  resources in the community                                           promote stabilization and prevent need    • Ohio Youth Problem,
• Design services to address the needs of the entire family            for higher levels of care                   Functioning, and
  and based on the family’s strengths and the family’s             •   Family has safety/crisis plan and
                                                                                                                   Satisfaction Scales (youth,
  criteria for success. Staff demonstrate genuine caring and           demonstrates an ability to implement it
  are persistent and creative in meeting families’ needs               successfully when necessary                 parent, and agency worker
• Staff provides opportunities for family empowerment,             •   Child is on stable medications as           version)
  learning, and skill building, giving families the chance to          appropriate                               • Mental Health Recovery
  solve their own problems. This includes helping families to      •   Caregivers demonstrate increased            Measure
  develop coping and crisis management skills                          ability to monitor and manager
• Staff work with families to identify and increase stabilizing        medication                                • Colorado Client
  influences and to identify and decrease destabilizing forces     •   Improvement in school performance           Assessment Record
• Consultation with the psychiatrist                               •   Less legal involvement                      (CCAR)
• Appropriate linkage/transfer to the next level of care.          •   Reduction in mental health symptoms
  Bridge between people and programs                                   and substance abuse issues
• Developing sustainability plans to maintain treatment            •   Solid discharge/sustainability plan
  progress                                                             addressing barriers and identifying
                                                                       ways to overcome barriers

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12A. Program Evaluation for Adults: Beginning in 2005, MHCD has implemented an internal
outcomes system based on the notion that consumers of mental health services can and do
recover. Through an extensive literature review and consultation with clinical staff, directors,
consumers and experts in the field, MHCD developed the “Recovery Markers Inventory” which
measures objective criteria associated with outcomes in mental health recovery, such as visits to
hospital/emergency rooms, imprisonment, and orientation/growth. Clinicians score The
Recovery Markers Inventory on a regular schedule and the information is then sent to the ACT
team to use during clinical supervision and practice. It is used in addition to data transfer from
the Denver Jail and the Denver County Court to track program outcomes as identified in the
logic model shown above.

12B. Juveniles: MHCD’s outcomes department will track pre and post CCARs for all clients
served through this initiative. MHCD will continue its ongoing collection of data that captures
the following domains: socio demographics, out of home placements, school, legal, mental
health and substance abuse problems and services, instrumental/family domains and ultimate
domains (i.e. arrests, youth living at home and in school at admission and discharge).

13. Data system infrastructure: MHCD’s Evaluation and Research Department has a multitude
of experiences collecting and reporting performance measures for many contract and grant-
funded evaluations. MHCD has a ‘state of the art’ management information system (MIS)
designed to maintain electronic charts that contain comprehensive clinical data. Finally, MHCD
has experience with Microsoft Access databases, which can be used for data storage and

14. Number of Consumers Served: The DCJI adult program will serve 48 consumers at any
given time and will serve approximately 51 total consumers annually as some graduate from the
program and some leave for other reasons. All program participants will receive Assertive
Community Treatment services. Approximately 25 consumers will need and receive Integrated
Dual Diagnosis Treatment in the first year. Approximately 15 consumers will participate in
Trauma Recovery and Empowerment model services in the first year. Approximately four
consumers will participate in Dialectical Behavioral Treatment services in the first year. The
DCJI juvenile program will serve 36 juveniles and their families who will receive best practice
intensive in-home and wraparound services through this initiative.

15. Program Budget: Please see attached budget and refer to answer below.

16. Extent to which program will dovetail with DMH and Medicaid funding: When MHCD
developed its DCJI program, it utilized the additional funding provided by DMH to increase
capacity and enhance services of existing programs. These programs were, and still are, financed
by blended funding that consists of DMH, Medicaid, Medicare, grants, and other payers. In order
to develop a DCJI case rate for this contract, MHCD’s market case rate for each program was
multiplied by the number of consumers projected to be served and compared on a percentage
basis. The total contract funding was then allocated to each program based on this percentage.
The calculated percentage of the total funding is 70% for the adult program and 30% for the
juvenile program.

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MHCD’s average case rate for ACT services for adults with serious mental illness or persons
with co-occurring substance abuse disorders is $12,000 per year. In addition to the cost for the
ACT team, this includes costs for emergency services, residential treatment, supported
employment services and supportive housing services. The total percentage amount allocated for
the adult DCJI program to provide 48 annual treatment slots is $368,857. This translates into a
case rate of approximately $7,685. The difference between the actual cost of the adult program
and the proposed amount reflects an MHCD program match of approximately $207,120 provided
by existing funding.

MHCD’s average case rate for intensive in-home family therapy and wraparound services is
$10,400. This includes costs for individual therapy, day treatment, school-based services,
medication management and case management provided outside of the intensive in-home based
team. The total percentage amount allocated for the juvenile DCJI program to serve 36 juveniles
is $164,825. This translates into a case rate of approximately $4,578. The difference between the
actual cost of the juvenile program and the proposed amount reflects an MHCD program match
of approximately $209,592 provided by existing funding.

II. Statement of Assurances
The Mental Health Center of Denver agrees to satisfy the following requirements of the
Colorado Behavioral Health Services’ Community Mental Health Criminal Justice Initiative:
   Adhere to the BHS-DMH contract language relating to the administration and collection of
   Colorado Client Assessment Record (CCAR) data for all clients served in this program. This
   program will require at a minimum, admission and discharge Outcome version CCARs for
   each client served through this program including client identification number, date of birth,
   start date of SB 97 funding services.
   “SB 97” will be assigned in the first Special Studies Code field for all individuals that were
   provided services with SB97 funding.
   Submit Quarterly Status Reports Client Rosters, Demographic Reports, and billing
   statements using the required formats. Client Rosters at a minimum will contain: program
   name (if more than one program is funded by SB 97), client identification number, last name,
   first name, admission date, discharge date. The schedule of reporting is as follows:
           1. First Quarter ending September 30, 2008 report is due October 15, 2008.
           2. Second Quarter ending December 31, 2008 report is due January 15, 2009.
           3. Third quarter ending March 31, 2009 report is due April 15, 2009.
           4. Fourth quarter ending June 30, 2009 report is due July 15, 2009.
   Submit and update (as necessary) the name and contact information, including email address
   and phone number for the primary and secondary contact persons for the program.

     Administrative                Adult Program                     Juvenile Program
Beth Coleman, MS            Jay Flynn, JD                    Dawn Wilson, PhD
Director of Managed         Deputy Director Adult            Intensive In-Home Services
Care                        Recovery Services                Program Manager
4141 E. Dickenson Place     1733 Vine Street                 1405 N. Federal Blvd.
Denver, CO 80222            Denver, CO 80206                 Denver, Co 80204
Beth.Coleman@mhcd.org       Jay.Flynn@mhcd.org               Dawn.Wilson@mhcd.org
303-504-6630                303-504-1035                     303-504-1513

                                         Page 10 of 12
   Letter of Intent

All invoices shall include client rosters that at a minimum contain: program name, client
identification number, last name, first name, admission date, discharge date

                                      Page 11 of 12

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