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            Client Profile Process for MRO Planning
            of ACT and Community Support Services

1. Data Gathering Process
Choosing LOCUS Tool:
Workgroup: In the fall of 2005, the Connecticut MRO Client Profile Workgroup was
developed in conjunction with other activities ongoing at DMHAS aimed at implementing
two additional services within the Medicaid Rehabilitation Option (MRO): ACT (Assertive
Community Treatment) and Community Support. This workgroup was charged with
recommending a tool to be used to evaluate individuals who were:
   1. High risk and high utilizers as defined by criteria developed by the workgroup,
      and/or
   2. Currently enrolled in grant-funded ACTT1 and require that intensity of services,
      and/or
   3. Currently enrolled in the Young Adult Program (YAS).

The goals of this workgroup were to develop an estimate of the numbers of individuals
currently enrolled in DMHAS programs who would likely be eligible for MRO-ACT
services and to develop a profile of these individuals using data gathered from providers
and the DMHAS MIS systems. (Note that this process was not meant to assign
individual clients to a level of care, but to gather information that would assist planning
and system development.)

An earlier assessment completed by NCCBH consultants working on the
implementation of the MRO for DMHAS had found that many of the clients currently
enrolled in the grant-funded ACTT were receiving:

    •     minimal services defined as 2 or less services per month;
    •     primarily case management services rather than the services of a
          multidisciplinary team as usually required by and MRO ACT-fidelity model;
    •     VNA and other services in addition to ACTT. (ACT is usually considered to be
          an all inclusive bundle of services

The workgroup determined that because of these findings it would not be prudent to
assume that all clients currently enrolled in grant-funded ACTT would meet level of care
criteria for MRO-ACT if it were defined according to the federal definition. In addition,
the group noted that grant-funded ACTT services were not available throughout the
state and that there were likely some clients who would be eligible for MRO-ACT if the
service were available locally. Finally, because the YAS services did not necessarily

1
 Throughout this report, the acronym ACTT is used to refer to the current, DMHAS grant-funded
Assertive Community Action Team. ACT or MRO-ACT is used to refer to an ACT service that would meet
medical necessity and fidelity criteria for a Medicaid-reimbursed service.

                            Final Report: Client Profile Workgroup
                                                                                 Page 2 of 16



mirror the federal ACT model, it was determined to profile these clients separately so
that they and their programming could be separately evaluated for inclusion in the MRO.

LOCUS: The LOCUS is a tool designed by the American Association of Community
Psychiatrists for use by community-based providers to evaluate and assign clients to
levels of care. The tool is quite flexible and easy to use and evaluates client needs in six
dimensions:

       1.   Risk of Harm
       2.   Functional Status
       3.   Medical, Addictive, and Psychiatric Co-morbidity
       4.   Recovery Environment: Stressors and Supports
       5.   Treatment and Recovery History
       6.   Engagement

The scoring, although easy to learn, encourages the use of clinical judgment and
caution in scoring. In most cases a composite score from all 6 dimensions is used to
assign a client to a level of care. However, in three dimensions: risk of harm, functional
status, and co-morbidities, high scores in the one dimension only results in an
independent requirement to assign a client to a highly structured, 24 hour program,
regardless of how the client scores on other dimensions. These high scores of 4 or 5 in
dimensions 1, 2, and 3 would usually preclude an ACT level of care.

There are 7 levels of care used in the LOCUS. Six of these levels of care are service
levels and one is basic preventative and crisis services that are available to the entire
community regardless of mental health status.

ACT services are included in LOCUS Level 5, Medically Monitored Non-Residential
Services; require a LOCUS composite score of 20 to 22 and scores of 3 or less in the
areas of risk of harm, functional status and co-morbidities.

Data Gathering Rules:

This report reflects a data gathering process with the goal of determining the numbers,
location, and age of adults in ACTT or non-ACTT (including YAS participants) who
using a standardized tool, meet level of care criteria for MRO-ACT services.
Additionally, information about other services being delivered to these clients was
collected.

For the initial phase an Excel spreadsheet was created for providers to enter basic de-
identified client data, the dimensional and composite LOCUS scores, and information on
the client’s services other than ACTT. This spreadsheet was password protected for
additional security and was posted on the DMHAS website so that providers could
easily download and use it. In addition to collecting the LOCUS scores on the
spreadsheet provided profilers were asked to also provide information on other services
the clients were enrolled in and receiving



                            Final Report: Client Profile Workgroup
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The Profiled Sample
The Connecticut MRO Client Profile Workgroup met twice to develop the rules that
providers would use to determine which of their clients would be profiled. The goal was
to profile only those for whom there was a reasonable possibility that they might meet
the MRO-ACT level of care criteria. Therefore, those ACTT clients who were receiving
very few services per month and remaining stable were not included in the sample.
Individuals in group homes that were already providing Medicaid Rehabilitation Option
services and clients in identified Institutions for Mental Diseases (IMDs) were also
eliminated from the sample as they would not be eligible to receive the MRO-ACT
services.

The project also worked to capture the profiles of those for whom MRO-ACT services
might be appropriate but who were not currently in an ACTT program. Each provider
was asked to identify “high utilization” clients within their system and to profile these
individuals as well. Also included were individuals who might currently be hospitalized
but who could be discharged if ACT services were available. “High risk” clients -- those
for whom the current ACTT model was available but not being used because of wait
lists, low intensity models, etc. -- were also profiled.



                     Guidelines for Choosing Profiling Sample:
      Do not profile:
             Clients in Medicaid Rehabilitation Option Group Home
             Clients in a designated Young Adult Program
             Clients in an IMDI
             ACTT clients who have been seen less than 2 times per month for the last three months.
             (Providers were allowed to make exceptions for those clients for whom they thought ACT
             was appropriate but who were very hard to engage in services or were in the
             engagement process at the time of the profile.)
                 o Providers could not count as a visit any medication drops the client was receiving
                      from the VNA. In many cases, this is the only intensive service the client is
                      receiving but it is not being delivered by a DMHAS funded program.
                 o Providers could not count as a visit attendance at Social Clubs or other social
                      programs regardless of DMHAS funding.
                 o Medication management visits did not count unless they were provided by a
                      member of the ACT team, i.e. the ACT physician or nurse practitioner.

      Do profile:
             Clients in ACTT that have been seen more than 2 times per month for the last three
             months. They could include in this group adolescents or young adults who were in ACTT
             but not in a YAS program.
             High utilization clients. This group of clients had to meet one or more of the following
             criteria:
                  o The client is enrolled in an Intensive Case Management or other similar program
                       that provided a high intensity community-based service that was not ACTT.
                  o The client:
                               Needs or uses intensive amounts of services (the precise definition of
                               intensive was left up to the provider), and
                               Is difficult to engage, and
                               Has had multiple failures with regular outpatient clinic and/or case
                               management services, and

                          Final Report: Client Profile Workgroup
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                               Is at risk for hospitalization or other higher levels of care including
                               multiple crisis contacts.
                 o   In cases where the affiliate of an LMHA identifies a high risk client, the LMHA
                     needs to agree with the affiliate that the client meets the definition of “high
                     utilization”.




Scoring Instructions
Profilers were instructed to score the LOCUS based only on the client’s current status,
as the goal was to collect a snapshot of the numbers of clients eligible for ACT at a
particular point in time. Providers were told that while there were clients receiving small
numbers of services now who might be in need of more intensive services in the near
future, the client’s history should be taken into account only in the LOCUS dimension
that scores history and not into any of the other dimensions where current status only
should be scored.

Because the LOCUS relies on clinical judgment, there were also guidelines for who
should complete the profiles. Because the of the short turn around time for the scoring
and the limited training that would be given prior to the profiling, only experienced
master’s level clinicians were allowed to profile. Exceptions were made only in the
cases of ACTT Team leaders without a master’s level credential. Providers were told to
feel free to interview and work with ACTT case management staff to complete the
LOCUS profiles, but that a mental health professional had to be the primary scorer.

All providers were told to use their judgment as to what additional information they
needed other than their own knowledge of the client before profiling. The LOCUS can
be completed through an interview of the client, a review of the client’s medical record,
or an interview with the direct service providers about the client’s current status.
Profilers could use any and all of these sources to complete their scoring.

The tool requires that clients in an ACT level of care receive certain scores in
Dimension IV to represent the wraparound approach and strong supports provided by
ACT. This may understate somewhat the total numbers of clients eligible for ACT
services, as some ACTT clients are not receiving true team-based wraparound
services.


Training Providers to Use the LOCUS Tool
Training was provided for those individuals who would be the actual LOCUS profilers,
as well as for DMHAS regional managers and YAS staff so that they could provide
back-up and technical assistance to the providers.


2. Data and Analysis
The total number of adult clients profiled was 1824 clients. There were in addition 329
clients currently in YAS programs also profiled for a total of 2,153 clients. This

                          Final Report: Client Profile Workgroup
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represents an estimated 5% of 45,000 total enrolled DMHAS mental health population.
The chart below illustrates that roughly two-thirds of the adult profiled clients were
enrolled in an ACTT program at the time of profile, and roughly one-third were profiled
because they were identified as “high utilizers.”


                      Total Adult and YAS Clients Profiled

         2500                                                     2153
         2000          1824

         1500

         1000

          500                               329

            0
                      Adults               YAS                    Total




                 LOCUS Profiling Distribution pf Adult Clients
                     Between ACTT and High Utilizers

         2000                                                     1824

         1500
                       1151
         1000
                                            673

          500

            0
                   ACTT Clients         High Utilizers    Total Adult Clients




LOCUS Level of Care Results for Adults
   •     23% (421 clients) met level of care (LOC) placement criteria for ACT or other
         intensive community-based programming placement by their LOCUS scores.
         (These clients will be referred to as LOCUS ACT Clients to distinguish them
         from current clients who are in ACTT programs.)
   •     52% (946 clients) met placement criteria (based on composite scores only) for
         levels of care lower than ACT.
   •     25% (457 clients) met placement criteria for levels of care higher than ACT –
         either residential or inpatient placements.

                         Final Report: Client Profile Workgroup
                                                                                                               Page 6 of 16




                                                   Adult Clients in Each Level of Care



              Numbers of Clients
                                   500                               457
                                                                                421        394
                                   400                  334
                                   300
                                   200   149
                                                                                                      63
                                   100         8%           18%           25%        23%        22%        3%
                                     0
                                          10-13         14-16         17-19      20-22       23-27    28+

                                               1            2             3     4 (ACT)         5          6
                                                                Score Ranges/Level of Care




LOCUS Level of Care Results for YAS Clients
  •    18% (59 clients) met level of care (LOC) placement criteria for ACT or other
       intensive community-based programming placement based on their LOCUS
       scores. (These clients will be referred to as YAS LOCUS ACT Clients to
       distinguish them from current clients who are in ACTT programs.)
  •    57% (189 clients) met placement criteria (based on composite scores only) for
       levels of care lower than ACT.
  •    25% (81 clients) met placement criteria for levels of care higher than ACT –
       either residential or inpatient placements.

                                               YAS Clients in Each Level of Care

                                                                     75
             Numbers of Clients




                                   80                  73
                                                                                           65
                                                                                59
                                   60
                                         41
                                   40
                                                                                                      16
                                   20
                                           12%           22%           23%        18%         20%          5%
                                   0
                                         10-13         14-16         17-19      20-22      23-27      28+

                                           1             2                3     4 (ACT)       5            6
                                                                Score Ranges/Level of Care




                                         Final Report: Client Profile Workgroup
                                                                                                                           Page 7 of 16



LOCUS Level of Care Results for the Combined Populations

                             Client Assignments to Level of Care Using LOCUS
   Score/Level of Care



                         30%
                                                                    2 5% 2 5%
                         25%                                  22%            23%   22%
                                                                                      23%
                                                                                               2 1%2 2 %
                                                                                                        20%
                                                  19 % 18 %
                         20%                                                            18 %

                                                                                                                           Combined Client
                         15%               12 %
                                                                                                                           Assignments to LOC
                                 9%
                         10%          8%

                                                                                                                      5%
                                                                                                                           Adult LOC
                          5%                                                                                  4% 3%

                                                                                                                           Assignments
                          0%
                                                                                                                           YAS LOC
                                 10-13            14-16             17-19          20-22       23-27           28+         Assignments


                                      1                2                3          4 (ACT)         5             6
                                                               Percentage of Clients



Age Ranges

Adult Clients: The age range for the adult LOCUS ACT Clients was distributed as
follows:

                         13% or 53 clients were 19 to 29 years old. Of this number only 9 were between
                         the ages of 19 to 22 and possibly eligible for YAS services.
                         22% or 92 clients were 30 to 39 years old.
                         39% or 163 clients were 40 to 49 years old. This was the largest cohort and
                         which is somewhat logical given that many of these individuals have experienced
                         multiple failures prior to their assignment to ACT.
                         21% or 90 clients were 50 to 59 years old.
                         5% or 23 clients were 60+ years of age, with 3 clients 75 years +.




                                                  Final Report: Client Profile Workgroup
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                                                      All Adult Clients Age Groups

                               700                                        647
         Numbers/Percentages
                               600
                               500                                                       432
                                                           372
                               400
                               300        220
                               200                                                                   144
                                                 12%              20%           36%            24%          8%
                               100
                                 0
                                          19-29            30-39           40-49         50-59        60+
                                                                         Age Groups




                                          Adult LOCUS ACT Clients by Age Group

                                  200
         Numbers/Percentage




                                                                            163
                                  150
              Client




                                                             92                           90
                                  100
                                                53
                                     50                                                               23
                                                     13%            22%            39%         21%          5%
                                     0
                                                19-29            30-39       40-49         50-59       60+
                                                                          Age Groups




YAS Clients: The age range for the YAS LOCUS ACT Clients was distributed as
follows:

     •                         57% of the total YAS population is between the ages of 16 to 18 with only
                               one 16 year old and one 17 year old client. This is within the expected age
                               range for YAS clients.
     •                         In some cases clients over the age of 21 may be kept on for a transitional
                               period. However, this “transitional” population actually represented 42% of
                               the total YAS population. (There were a very few clients who were profiled
                               whose age information was missing.)
     •                         Even in the YAS LOCUS ACT population (those whose composite scores
                               put them in the ACT level of care) the population of >21 years represented
                               44% of the eligible population.



                                                     Final Report: Client Profile Workgroup
                                                                                                                               Page 9 of 16




                                                          All YAS Clients Age Groups


            Numbers/Percentages   200
                                                                   165
                                  150                                                 128

                                  100

                                   50          24
                                                     7%                  50%                 39%               9     3%
                                       0
                                                  16-18                19-21               22-25                   26+
                                                                              Age Groups



                                               YAS LOCUS ACT Clients Age Groups

                                                                   27
         Numbers/Percentages




                                  30
                                  25                                                  22
                                  20
                                  15
                                  10          6
                                                                                                               4
                                  5                 10%                   46%                37%                         7%
                                  0
                                               16-18               19-21               22-25                   26+
                                                                          Age Groups



Combined Clients: In the age ranges for the combined clients who met the LOCUS
ACT criteria, middle aged adults were the largest group, followed by the young adult
populations.


                                           Adult and YAS LOCUS ACT Clients Age Groups
         Numbers/Percentages




                                  200                                                168
                                  150
                                                           114                                     103
                                                                         94
                                  100

                                  50                                                                                30
                                              6 1%               22%           18%         33%           20%              6%
                                   0
                                              <19          19-29         30-39       40-49         50-59            60+
                                                                           Age Groups



                                                     Final Report: Client Profile Workgroup
                                                                                      Page 10 of 16




LOCUS Scores for Adult LOCUS ACT Clients

The scores in each dimension for adult LOCUS ACT Clients generally averaged around
3 (or moderate) in terms of need. The only exception to this is Dimension 4b:
Environment. Any clients already in ACT would be scored a 1 on this dimension and all
spreadsheets were checked and modified to ensure that this scoring was correct for
current ACTT clients. The average score for this dimension, therefore, was 1.72
reflecting the combination of both ACTT and non-ACTT clients in this sample.

The highest scores were in Functionality at 3.4 and History at 3.3. These scores reflect
both the significant impact of mental illness on these individuals’ ability to function and
the significant treatment histories and treatment failures that are typical of ACT clients .


                                  Average Scores for Adult LOCUS ACT
                                                Clients
                                    4         3.4                    3.3
                 Average Score




                                  3.5   3.1             3.2                3.2
                                                    3
                                    3
                                  2.5
                                    2                         1.72
                                                                                 Avg Scores
                                  1.5
                                    1
                                  0.5
                                    0
                                                          s


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LOCUS Scores for YAS LOCUS ACT Clients

The average scores in each dimension for the YAS clients were similar to adults except
for a lower average score on co-morbidity which may be solely a factor of age and
better health. All other scores (again with the exception of Environment) were moderate
(Scores of 3+) and were overall slightly lower than the adult scores. The environment
score was slightly higher reflecting the various levels of environmental supports YAS
clients get, (i.e. not all are being treated by an ACT-type team and so would score
higher than a 1 on this dimension.)




                                   Final Report: Client Profile Workgroup
                                                                                                                 Page 11 of 16




                             Average Scores for YAS LOCUS ACT Clients

                        4                        3.4                     3.3                     3.2           3.2
                      3.5          3.1
  Average Score




                        3                                 2.7
                      2.5                                                             2.1
                        2
                      1.5
                        1
                      0.5
                        0
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                                                                  Dimension



LOCUS Scores for the Combined Populations of LOCUS ACT Clients


                             Scores of LOCUS Assigned ACT Clients
                                   (Combined Adult and YAS)

                              4
                             3.5
                              3
                             2.5                                                                               Combined
  Score




                              2                                                                                Adult ACTT
                             1.5                                                                               YAS

                              1
                             0.5
                              0
                                                2:                           4b:                6:
                                    1: Risk            3: Co-     4a:                   5:
                                            Function                       Environ            Engage
                                    of Harm           Morbidity Stress                History
                                            al Status                       ment               ment
                       Combined          3        3.3    2.9       3.2         2.3     3.2       3.1
                       Adult ACTT        3.1      3.4     3        3.2         1.72    3.3       3.2
                       YAS               3.1      3.4    2.7       3.3         2.1     3.2       3.2

                                                               Dimension




                                               Final Report: Client Profile Workgroup
                                                                                                      Page 12 of 16



LOCUS ACT Clients with Independent Placement Criteria Scores

For placement purposes, LOCUS requires that individuals who score either a 4 or 5 on
Dimensions 1, 2, or 3 (Risk of Harm, Functional Status, or Co-morbidities) be
automatically placed in either residential or inpatient care because of their level of
current needs. These clients have significant risk and/or are very low functioning such
that it interferes with their safety, and/or have significant co-morbidities that must be
addressed in a medically monitored or managed facility. If a client in ACTT or YAS,
therefore, scored a 4 or 5 on one of these Dimensions, they would be likely placed in a
level of care above ACT.

      Adult Client Scores: 283 unique adult individuals met ACT level of care
      placement criteria based on their composite score and had a score of 4 on either
      dimension 1, 2 or 3. Thirty (30) unique individuals met ACT level of care
      placement criteria based on their composite score, and had a score of 5 on either
      dimension 1, 2 or 3. If the LOCUS scoring alone determined level of care, these
      individuals would therefore need to be in a higher level of care.

      The range of 4 and 5 scoring for adult clients whose composite LOCUS score
      placed them in ACT AND who scored a 4 or 5 on Dimensions 1, 2, or 3 is
      summarized in the table below: (Note that these are NOT unique individuals.)


                                     Dimension 1: Risk         Dimension 2:         Dimension 3: Co-
                                     of Harm                   Functional Status    morbidities
        Score
        4                            189 clients /45%          296 clients/70%      213 clients/51%
        5                            41 clients/10%            47 clients/11%       81 clients/19%




                                      Adult LOCUS ACT Clients with Scores of 4
                                             or 5 on Dimensions 1, 2. or 3

                                                             47
                 Numbers of Client




                                          41                                81

                                                                                       Score: 5
                                         189                296                        Score: 4
                                                                           213



                                       1: Risk of            2:          3: Co-
                                         Harm           Functionality   morbities
                                                        Dimensions


                                         Final Report: Client Profile Workgroup
                                                                                                     Page 13 of 16




These clients, with very few exceptions, are currently being maintained in the
community setting. In some cases they are in community residential settings (with the
exception of MRO group homes clients who were not profiled). Connecticut’s current
rules do allow for clients to be in both a residential placement and in ACTT.

Another possible reason for so many clients scoring 4 or 5 on Dimension 2:
Functionality is profiler error. The LOCUS directions include a statement requiring that a
client who has chronic functional deficits be scored no higher than a 3 on Dimension 2:
Functional Status. If this direction was not followed accurately it could explain the high
numbers of clients with this high score.

   YAS Client Scores: Very few clients in YAS scored a 5 in Dimensions 1, 2, or 3.
   However, there were clients (although many fewer than in the adult population) who
   did score at the level 4 in these 3 key dimensions. These clients are being
   maintained in the community as well and in some cases are likely in YAS residential
   programs.


                                      YAS LOCUS ACT Clients with Scores of 4 or 5 on
                                                  Dimensions 1,2,3
                 Numbers of Clients




                                      30
                                      25                            0
                                      20                                                          Score: 5
                                      15                           26
                                                 1                                                Score: 4
                                      10                                               0
                                       5         12                                   10
                                       0
                                           1: Risk of Harm   2: Functionality   3: Co-morbities
                                                              Dimensions



Finally, although all providers were assured that these initial profiles would not be used
to make either funding or placement decisions, there may have been some scoring
creep caused by these provider concerns. These results clearly point to the need for
more extensive training and rules on provider testing for inter-rater reliability before
beginning to use the LOCUS or another tool as part of a placement decisions.


Potential Unmet Need: Clients with ACT Level Scores but Not in an ACTT
Program
As outlined earlier in the report, providers were asked to identify “high utilization” clients
using a list of requirements (see above under Rules). A total of 673 persons who were
so identified were profiled using the LOCUS. Of this number, 414 or 62% met criteria for
ACT level of care (using the composite score only).
.

                                           Final Report: Client Profile Workgroup
                                                                                     Page 14 of 16



This suggests that there are significant numbers of clients who may qualify for an MRO-
ACT program who are currently being served in other DMHAS-funded programs.

The same is not true within the YAS population which did not include in its profiling any
clients not already in YAS programs.


Clients in ACTT or YAS Who Did Not Meet LOCUS ACT Scoring Criteria

Adult ACTT Clients:
There were 677 clients in an ACTT program at the time of profiling who scored below
ACT criteria on the composite scoring. This represents 59% of those ACTT clients who
were profiled. When added to the ACTT clients who were not profiled because they
received less than an average of two visits per month, this indicates a significant
number of clients will move from ACTT to Community Support under the MRO service
definitions.


         800
                                                                 677
         700
         600
         500                  414
         400
         300
         200
         100
           0
               Adult Clients not in ACTT but with   Adult Clients in ACTT but with
                    LOCUS ACT level score           score lower than LOCUS ACT


YAS Clients: There were 270 clients currently in a YAS program who did not meet
LOCUS criteria for ACT either because of low or high composite scores. There were 81
clients currently being served in ACTT who by composite scores alone appear to need a
higher level of care than ACT. Some of these clients are likely in YAS Residential
Services and are being maintained by a combination of residential and ACT-like
services. In addition, 189 clients or almost 60% of the YAS population did not meet
LOCUS ACT criteria because of low scores. This is likely reflective of the significant
differences between the programs which can range from recreational/case management
type programs to intensive team based interventions.




                          Final Report: Client Profile Workgroup
                                                                                                                                                          Page 15 of 16




                                            YAS Clients with LOCUS Scores Higher Than or
                                                Lower Than LOCUS ACT Level of Care

                                                                                                                             189
                    200
                    150
                    100                                    81

                          50
                          0
                                              Score Higher than ACT                                           Score Lower than ACT
                                                                             Client Numbers




     ACTT Clients in Other Services

     Data was collected to identify those clients in ACTT who were receiving
     additional services other than ACTT. Many of these additional services would be
     bundled into the MRO-ACT benefit and would not be separately reimbursed. The
     numbers of clients in other services than ACTT currently reflect the differences
     among the current ACTT programs and the staffing patterns.

                                                            Adult LOCUS ACT Clients in Other Services

       250                                                                                   193
       200    155              136                                                                                                                                          111
       150                                       54                     54
       100                                                                         24                                                47            46          41
                                                            14                                                      14
        50
         0
                                                                                                 Med Mngmnt
             Management




                                                          Homeless



                                                                     Intensive
                               Counseling




                                                                                                                                   Residential
                                                                                                                  Hospital




                                                                                                                                                 Supervised




                                                                                                                                                                Voc Rehab
                                                                                                                                                 Residential
                                               Services




                                                                                 Services




                                                                                                                                                                            VNA
                                                                                                                                   Supported
                                                                      Mngmnt


                                                                                  IOP/SA
                                                          Services




                                                                                                                   Partial
                                                Crisis




                                                                       Case
                Case




                                                                                      Services




     YAS Clients in Other Programs: There are a number of YAS clients who meet
     LOCUS ACT criteria who are also receiving additional services. However, the
     bundle of YAS services is not as clear as that for adults. Some clients are in YAS
     but are not receiving team services at all.

     The YAS team services were defined as Case Management, Medication
     Management, Therapy, Vocational Services, and Substance Abuse services.
     Services beyond those were also listed and reported by providers.

Locations of LOCUS ACT Clients
     The location of the current LMHA was used to approximate the location of
     LOCUS ACT eligible clients in this sample. Because some providers cover more

                                             Final Report: Client Profile Workgroup
                                                                      Page 16 of 16



than one catchment area, the actual location by town was not easily ascertained.
Future analysis can determine current addresses and allow for a more fine-tuned
mapping of ACT client locations.

The charts divide the sample ACT-eligible population into those catchment areas
with less than 20 and more than 20 clients in each area.


Catchment Areas and Clients:

Locations of LOCUS ACT Clients
                                     Catchment Total    Adult   YAS
Local Mental Health Authority          Areas   Clients Clients Clients
Bridges                                  6          18      14       4
CHR                                    15,17        28      27       1
Capitol Region                         18,23        66      48      18
Community Mental Health
Affiliates (CMHA)                        19                6      1          5
Connecticut Mental Health Center
(CMHC)                                    7            13        12          1
Harbor Healthcare                         8             5         5
Intercommunity Mental Health
Group                                    16            28        26          2
Northwest Mental Health Authority        22             1         1
River Valley Services                    10            52        52
Rushford                                  9             8         8
South East Mental Health
Authority                               11,12          89        78        11
South West Mental Health
Authority                              1,2,3,4         70        69          1
United Services                         13,14          20        19          1
Valley Mental Health Services             5             5         1          4
Western CT. Mental Health
Network                               20,21,22         70       59         11
(Note: 1 missing)                                     479      420         59




                  Final Report: Client Profile Workgroup

								
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