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									PUBLIC COMMENT ON THE STATE PLAN

The draft State Plan was published on the Department of Mental Health and Mental
Retardation, Alabama Family Ties, and National Alliance for the Mentally Ill – Alabama
websites. The final plan will be published on these websites after submission September
1, 2005. At the time that the application was completed for submission, no comments
had been received on the draft.

SET-ASIDE FOR CHILDREN'S MENTAL HEALTH SERVICES

The children and adolescent set-aside maintenance of effort (MOE) target was calculated
in FY 1994 as required. The state has maintained block grant children and adolescent
expenditures at or above the required level. The table below contains a comparison of the
FY 1994 MOE target, and the estimated (budgeted) expenditure of CMHS block grant
funds in FY 2004 and FY 2005 for mental health services to children and adolescents.
The total projected expenditures for children and adolescent services in FY 2006 equal
the required maintenance of effort level for child and adolescent services.


DATA REPORTED BY:           X State FY      X     Federal FY         Other

                        Block Grant Expenditures for Children
                        and Adolescent Mental Health Services

FY 1994               FY 2004                      FY 2005              FY 2006
Calculated            Actual                       Actual               Projected
Maintenance of Effort
Target
$2,372,554            $2,372,554                   $2,372,554           $2,372,554

There is no Maintenance of Effort waiver requested.


MAINTENANCE OF EFFORT (MOE) REPORT

Section 1919 (b)(3)(B) requires that States submit information sufficient to enable the
Secretary to make a determination of compliance with the statutory MOE requirements.
Data are required that document that the State has maintained expenditures for
community mental health services at a level that is not less than the average level of such
expenditures maintained by the state for the previous 2-year period. The table below
titled “State Expenditures for Mental Health Services” gives the amounts of state funds
expended for community mental health services in FY2004 and FY2005 and estimated
for FY2006.

Alabama defines the “2 year period preceding FY2006 for which the state is applying to
receive block grant funding” as the twenty-four month period between October 1, 2003
     and September 30, 2005 Alabama‟s fiscal year is the twelve-month period between
     October 1 of one year through September 30 of the following year. FY2006 for which
     funds are being applied, is thus October 1, 2005 through September 30, 2006.

     DATA REPORTED BY:            X      STATE FY         X_    FEDERAL FY ____ OTHER

                         State Expenditures for Mental Health Services

       ACTUAL            ACTUAL        PROJECTED          PROJECTED
        FY 2003            FY 2004        FY 2005            FY2005
                                          Projected
            $                 $               $            $75,000,000

     The Maintenance of Effort target is $. get Shawn to update

     There is no Maintenance of Effort waiver requested at this time.



     STATE MENTAL HEALTH PLANNING COUNCIL

     See the following list of members and Bylaws of the Alabama Mental Illness
     Planning Council.

                  ALABAMA MENTAL ILLNESS PLANNING COUNCIL

                            Family Members – Children and Adolescents
1.    AL Family Ties                 Jacquelyn Scales          Birmingham      Designated
2.    AL Family Ties                 Linda Champion            Montgomery      Designated
3.    AL Family Ties                 Sarah Ellen Thompson      Montgomery      Designated
4.    Family Member                  Beth McGuire              Montgomery      12/31/06
                                    Family Members - Adults
1.    Family Member                  Rogene Parris             Birmingham      12/31/05
2.    Family Member                  Tom McVay                 Gulf Shores     12/31/05
3.    Family Member                  Mary Elizabeth Perry      Mobile          12/31/06
4.    Family Member                  Joyce Cahela              Opelika         12/31/05
5.    Family Member                  Jack Crosswell            Talladega       12/31/05
6.    Family Member                  Greg Carlson              Birmingham      12/31/05
7.    NAMI Ex. Director              Shannon Weston            Birmingham      Designated
8.    NAMI President                 Jolene James              Birmingham      Designated
                                          Consumers
1.    Wings Ex. Director             Steve Puckett             Birmingham      Designated
2.    Wings President                Roy Willingham            Emelle          Designated
3.    Primary Consumer               Nancy Jester              Cullman         12/31/06
4.     Primary Consumer                 Mike Herring              Mt. Vernon    12/31/06
5.     Primary Consumer                 Alvin Callier             Grove Hill    12/31/06
6.     Primary Consumer                 Sylvia Richey             Roanoke       12/31/05
7.     Primary Consumer                 Wade McGee                Killen        12/31/05
8.     Primary Consumer                 Bob Brown                 Troy          12/31/05
9.     Primary Consumer                 Titus Battle              Birmingham    12/31/06
10.    Dir. Consumer Relations          Mike Autrey               Montgomery    Designated
11.    AL Minority Consumer Council Fannie Hicks                  Midway        Designated
12.    Adolescent                       Ashley Thompson           Birmingham    12/31/06
                              State Employees/University Representatives
1.     Commissioner                     John Houston              Montgomery    Designated
2.     Associate Commissioner           Otha Dillihay             Montgomery    Designated
3.     Dept of Educ. Spec. Ed           Abbie Felder              Montgomery    Designated
4.     Dir. of Comm. Services           Molly Brooms              Montgomery    Designated
5.     House Fin. Authority             H. R. Theriot             Montgomery    Designated
6.     Human Resources                  Kay Pilgreen              Montgomery    Designated
7.     Public Health                    Kathy Vincent             Montgomery    Designated
8.     Rehabilitation Services          To be named               Montgomery    Designated
9.     Youth Services/Correctional      Alesia Allen              Mount Meigs   Designated
       Agency
10.    University Affiliated            Dr. Richard Powers        Birmingham    12/31/05
11.    Medicaid Agency                  Lynn Sharp                Montgomery    Designated
12.    University Affiliated            James Thompson, Ph.D..    Tuscaloosa    12/31/06
13.    State Coordinator of Deaf Svs.   Steve Hamerdinger         Montgomery    12/31/05
14.    Department of Corrections        Ron Cavanaugh             Montgomery    12/31/06
                                              Providers
1.     Community Provider               Richard Craig, Ph.D.      Birmingham    12/31/05
2.     Council President                James Dill, Ed.D.         Birmingham    Designated
3.     Private Provider                 Emmett Poundstone         Montgomery    12/31/06
4.     Private Provider                 Gerald Faircloth          Tuscaloosa    12/31/06
                                                Others
1.     AL House                         Oliver Robinson           Birmingham    Designated
2.     AL House                         Steve McMillan            Bay Minette   12/31/06
3.     AL Senate                        E. B. McClain             Brighton      12/31/06
4.     AL Senate                        Charles Steele            Tuscaloosa    Designated
5.     Law Enforcement                  Judge Tracey McCooey      Montgomery    12/31/06
6.     MHA Exec. Dir.                   Darold Dunlavy            Montgomery    Designated
7.     MHA President                    Jeff Baxter               Gadsden       Designated
8.     Probate Judge                    Judge Reese McKinney      Montgomery    12/31/06

      NAMI Alabama – National Alliance for the Mentally Ill of Alabama
      MHCA-Mental Health Consumers of Alabama
      MHA-Mental Health Association of Alabama
      UAB-University of Alabama in Birmingham
  CMHC Council-Council of Community Mental Health Boards


           Type of Membership                Total Members      % of Total
TOTAL MEMBERSHIP                                         50
Consumers/Survivors/Ex-patients (C/S/X)                  12
Family Members of children with SED                        4
Family Members of adults with SMI                          8
Vacancies (C/S/X and family members)                        0
Others (not state employees or providers)                   8
TotalC/S/X, Family Members, and Others                     32            64%
State Employees                                            14
Providers                                                   4
Vacancies                                                   0
Total State Employees and Providers                        18            36%
                              BY LAWS OF
       ALABAMA MENTAL ILLNESS PLANNING COUNCIL


                          ARTICLE I. NAME

Section 1.01:

The name of the organization shall be the Alabama Mental Illness Planning
Council.

                        ARTICLE II. PURPOSE

Section 2.01:

Public Law 99-660, as amended by Public Law 100-639, provided for the
establishment of the Alabama Mental Illness Planning Council as the
advisory body to the Alabama Department of Mental Health and Mental
Retardation to assist in the development and implementation of the state‟s
Mental Health plan.

The purpose of the Alabama Mental Illness Planning Council is to review,
monitor and evaluate the implementation of a comprehensive community
based system of care for adults with serious mental illness and children and
adolescents with severe emotional disturbances.

The Council shall:

1.    Advise and assist in the development and implementation of plans and
      reports required under Public Law 99-660.

2.    Prepare and submit a separate annual report of progress to the
      Governor.

3.    Promote and advocate for improved and innovative services for
      individuals in Alabama with serious mental illness.

                     ARTICLE III. MEMBERSHIP
Section 3.01: Composition

As provided for in Public Law 99-660 legislation, the Alabama Mental
Illness Planning Council shall consist of members with the following
designated composition of which at least 50% must be non-service
providers.

The Commissioner of the Alabama Department of Mental Health and
Mental Retardation shall emphasize geographical representation as well as
representation for children and adolescents, geriatrics, and other special
populations.

I.     PRIMARY CONSUMERS – Seven (7) members

       Seven (7) at-large members to be nominated by Planning Council, at
       least one of which will be a minority of color.

II.    FAMILY MEMBERS – Seven (7) members

       Seven (7) at-large members to be nominated by Planning Council, at
       least one of which will be a minority of color.

III.   ADVOCATES – Six (6) members

       Contact: Wings across Alabama President or designee
       Contact: Wings across Alabama Executive Director or designee
       National Alliance for the Mentally Ill of Alabama President or
       designee
       National Alliance for the Mentally Ill of Alabama Executive Director
       or designee
       Mental Health Association President or designee
       Mental Health Association Executive Director or designee
       Alabama Family Ties – three members
       Alabama Minority Consumer Council – 1 member

IV.    OTHER STATE AGENCIES – Six (6) members

       Department of Education (Special Education)
       Department of Human Resources
       Department of Public Health
      Division of Rehabilitation Services
      Department of Youth Services
      Medicaid Agency
      Department of Corrections

      Appointments shall be made by the respective commissioners of the
      above state agencies.

V.    UNIVERSITIES – Two (2) members

      To be nominated by Planning Council

VI.   PRIVATE PROVIDERS – Two (2) members

      To be nominated by Planning Council

VII. DEPARTMENTAL – Four (4) members

      Commissioner or designee
      Associate Commissioner for Mental Illness or designee
      Director, Office of Consumer and Ex-Patient Relations
      Director, Community Services

VIII. COMMUNITY MENTAL HEALTH – Two (2) members

      Alabama Council of Community Mental Health Boards designee
      Executive Director of the Alabama Council of Community Mental
      Health Boards

IX.   LEGISLATURE

      One member from the Alabama Senate to be nominated by the
      Planning Council.

      One member from the Alabama House of Representatives to be
      nominated by the Planning Council.

      And any number of legislators to serve in an ex-officio capacity as
      deemed necessary and to be nominated by the Planning Council.
X.    OTHERS – As determined by the Planning Council

      To be nominated by Planning Council


XI. ADOLESCENT CONSUMER

      To be nominated by the Planning Council

Beginning January 1, 1992, appointments which are not predetermined by
position (predetermined positions include presidents, executive directors,
etc.), shall be established by the Commissioner for terms of no less than one
year nor greater than three years. After the initial appointments, all new
appointments will be a period of three (3) years. Appointments may be
extended for additional terms, if appropriate. Appointments to replace
members who vacate positions will be made for the unexpired term of that
position. Members whose appointments expire shall continue to serve until
their replacements are appointed by the Commissioner.

Section 3.02: Definitions

PRIMARY CONSUMERS – Those persons who are or have been in
treatment as a result of having been diagnosed as having a serious mental
illness, as defined by the Alabama Department of Mental Health and Mental
Retardation.

FAMILY MEMBERS – Immediate family members and/or legal guardians.

Section 3.03: Appointments

It will be the responsibility of the Commissioners of the Alabama
Department of Mental Health and Mental Retardation to make appointments
to fill non-designated Council vacancies.

The Mental Illness Planning Council will submit nominations to the
Commissioner regarding appointments to non-designated positions. The
chairperson of the Council shall appoint a nominating committee on which
at least on primary consumer and one family member will serve. This
committee will solicit nominations from the Planning Council membership
and will present their recommendation for each vacated slot. The
Nominating Committee will send these recommendations to the Planning
Council membership at least two weeks prior to the next Council meeting
along with a full listing of nominations as well ass the qualifications of those
recommended for membership. Additional nominations can be made from
the floor during the Council meeting. If need be, a vote will be taken during
the meeting to finalize the Council‟s recommendation for each vacant slot to
the Commissioner.

Section 3.04: Voting

Members may designate in writing an official representative; however, each
representative can only serve for on member of the Council.

Members or others officially designated by members will vote in the election
of officers, the selection of nominations for membership to be submitted to
the Commissioner, and other issues which require an official vote. Members
unable to attend and unable to officially designate a representative, may vote
by writing proxy on those issues to be discussed at the next Council meeting.
Such proxy votes shall be delivered (facsimile acceptable) to the chairperson
prior to the beginning of the Council meeting.

Section 3.05: Attendance

Members shall make every effort to attend all Mental Illness Planning
Council meetings. The Council shall meet a minimum of four (4) times
during a calendar year. When a member fails to attend two (2) meetings
during a 12 month period, the Mental Illness Planning Council shall make
recommendation to the Commissioner regarding continued service or
replacement of such members. The Commissioner shall then make a
determination regarding continued service or replacement of such members.

                         ARTICLE IV. OFFICERS

Section 4.01: Mental Illness Planning Council Chairperson

The Chairperson of the Mental Illness Planning Council shall be elected at
the first meeting of each calendar year by the Council. The Chairperson
shall preside over Council meetings and serve as liaison to the Office of
Planning/Alabama Department of Mental Health and Mental Retardation.
Section 4.02: Mental Illness Planning Council Vice Chairperson

The Mental Illness Planning Council shall elect a Vice Chairperson from its
membership to serve in the absence of the Chairperson.

Section 4.03: Secretary

In lieu of an elected secretary, the Alabama Department of Mental Health
and Mental Retardation will provide secretarial support to the Alabama
Mental Illness Planning Council, to include keeping summaries of
proceedings and the dissemination of proceedings and other information to
Planning Council members and others as appropriate.

                          ARTICLE V: MEETINGS

Section 5.01: Quorum

One-third (1/3) of the Council membership, either present or represented by
official proxy designee, shall constitute a quorum sufficient to conduct its
business and take action, as long as a majority of primary consumer
members and a majority of family members are represented.

        ARTICLE VI: FINANCIAL AND OTHER SUPPORT

Section 6.01:

The Alabama Department of Mental Health and Mental Retardation will
provide the necessary financial support through its Mental Health block
grant or other funds to support the activities of the Council. Staff support
will be provided as deemed appropriate by the Commissioner of the
Alabama Department of Mental Health and Mental Retardation.

                ARTICLE VII: AMENDMENT OF BYLAWS

Section 7.01: Changes in Bylaws
Amendments to bylaws will be addressed as needed. Following a discussion
of proposed changes, members will be given advance notice of the proposed
changes to the Council bylaws for consideration and/or adoption at the next
meeting. Changes to the bylaws require a two-thirds (2/3) vote of those
members voting and present.

                  ARTICLE VIII: EFFECTIVE DATE

Section 8.01:

These bylaws will go into effect on January 1, 1992.


Amended: April 22, 1994

Amended: November 28, 2001

Amended: October 15, 2004
STATE MENTAL HEALTH PLANNING COUNCIL COMMENTS AND
RECOMMENDATIONS

See letter beginning on next page from Planning Council Chair
Part C. Specific Guidance for State Applications and Plans

Section I. Description of State Service System
    A. An overview of the State’s mental health system; a brief description of how the
public mental health system is currently organized at the State and local levels, including
the State Mental Health Agency’s authority in relation to other state agencies.

The Alabama Department of Mental Health/Mental Retardation (DMH/MR) was created
under Act 881 of the 1965 legislature. The Department is responsible for mental illness,
mental retardation, and substance abuse services. The Department is responsible for
operating state psychiatric facilities, establishing standards for community services, and
is empowered to contract for services.


The Commissioner of the DMH/MR is a cabinet member appointed by the Governor.
John Houston, the Commissioner, and other Departmental staff coordinate services with
other state agencies such as the Department of Human Resources (adult and child
protective agency), Department of Youth Services (juvenile corrections), Department of
Corrections, Department of Public Health, and Medicaid.


There are six state-run mental illness inpatient treatment facilities serving adults and
children in Alabama. Acute services are provided in four geographic regions by (1)
Bryce Hospital in Tuscaloosa, (2) North Alabama Regional Hospital in Decatur, (3) Greil
Hospital in Montgomery and the (4) Searcy Hospital in Mt. Vernon. Long-term care is
provided by Bryce Hospital, serving the northern portion of the state, and Searcy
Hospital, including the Thomasville Hope Unit in Mount Vernon (near Mobile), serving
the southern portion. In addition, Bryce Hospital also operates an intermediate care
nursing home (ICF/MD), the Alice Kidd Nursing Home. Bryce Hospital also operates a
20-bed adolescent inpatient unit. The Mary Starke Harper Hospital provides specialty
services to the geriatric population and serves as a teaching facility to train caregivers in
the community serving persons with dementia. The Taylor Hardin Secure Medical
Facility in Tuscaloosa provides services for Alabama‟s male forensic population.


Alabama has developed a comprehensive system of care for the mentally ill that extends
across the State. There are 24 community mental health centers (CMHCs) serving the 22
mental illness regional areas in the state (see map next page). These centers are non-
profit corporations operated by local governing bodies, referred to as “310 Boards” (so
named after Act 310 of the Alabama Legislature) or, in the case of three centers, under
contract arrangements with a 310 Board. In addition to the main centers, services are
available, or at least accessible, to each county through satellite programs of the CMHC.
As non-profit organizations, these centers provide services for adults with serious mental
illness as well as children and adolescents with severe emotional disturbances through
contractual arrangements with the Alabama Department of Mental Health and Mental
Retardation (DMH/MR), as Medicaid and Medicare provider organizations, through
contracts with other entities, and through support from local governments.
   B. A brief summary of areas identified by the State in the previous State plan as
needing particular attention, including the significant achievements in its previous fiscal
year.

The FY05 Block Grant Plan identified the following system weaknesses:
    Increasing census in the state hospital admission units
    Inadequately developed system of care for people with co-occurring mental
      illness and substance abuse diagnoses
    Employment opportunities and peer support services not well-developed
    Poor fiscal health for the state as a whole

These areas remain problematic, particularly the increased census in the state hospital
admission units.

In February, 2005, Commissioner Kathy Sawyer retired John Houston was the Acting
Commissioner from February until August when he was appointed on a permanent basis
by Governor Riley. Mr. Houston was previously the Commissioner‟s Executive Assistant
and is familiar with Departmental operations. The Associate Commissioner for Mental
Illness, Kim Ingram, left State service in Septermber, 2004. Her Executive Assistant was
appointed the Acting Associate Commissioner until he left the Central Office to take over
leadership of the Adolescent Unit at Bryce Hospital. Dr. Paul Bisbee, the Director of
Mental Illness Facilities, assumed the responsibilities of Acting Associate Commissioner
for Mental Illness until July 13, 2005. Mr. Otha Dillihay, the Associate Commissioner for
Administration, assumed the duties of the Associate Commissioner for Mental Illness.
The Executive Assistant to the Associate Commissioner position remains vacant. In
addition, the Assistant Director of the Office of Performance Improvement position was
vacant from March to August, 2005. The Coordinator of Child and Adolescent Services
within the Office of Community Programs left in July, 2005. This position is currently
vacant.

A number of activities are worthy of note:
    Third Criminal Justice and Mental Health Conference scheduled in September
    Child and Adolescent and Adult Psychiatric Institutes scheduled in July and
     September, respectively
    Preparations underway for implementation of Medicare Part D
    Filled Housing Advocacy position to provide advocacy for individuals
     experiencing difficulties in maintaining permanent housing
    Issued RFP for Housing Development consultant to prepare housing plan and
     assist in developing funding to support the plan
    Training for law enforcement and court personnel in Montgomery by Officer
     Frank Webb from the Houston Police Department and by Henry Stough, a local
     trainer
    Statewide anti-stigma campaign conducted in cooperation with NAMI and
     consumers to send message of hope and recovery
    Held Consumer Conference with approximately 850 in attendance
      Supported development and submission of HUD grants which will total
       approximately $3Million if funded
      Through an Acute Care Crisis Committee, developed a plan for the following
       services:
           o 12 new local inpatient beds (6 in Mobile and 6 in Birmingham) to divert
              admissions from state hospitals
           o 42 new residential beds to permit increased discharges from state hospitals
           o 25 crisis residential beds in Montgomery to divert admissions from state
              hospitals and/or to reduce length of stay
           o 3 sixteen bed Intermediate Care units to provide a new level of residential
              care
      Had a successful PATH site visit
      Coordinated the development of and training for Crisis Counseling services after
       Hurricane Ivan and had a successful federal site visit
      Continued to provide training for clinicians to improve skills for serving
       individuals with co-occurring mental illness and substance abuse disorders
      Funded 4 regional Utilization Review positions to monitor residential utilization
       and provide input into systems development

    C. New developments and issues that affect mental health service delivery in the
State, including structural changes such as Medicaid waivers, managed care, State
Children’s Health Insurance Program (SCHIP) and other contracting arrangements.

As noted in B. above, there have been significant changes in leadership positions in the
Department, particularly in the Mental Illness Division. The excess census in state
hospitals remains a challenge despite efforts to reduce both admissions and census. The
decreased number of private psychiatric beds continues to add pressure on the public
hospital system.

The implementation of Medicare Part D coverage for medication remains a concern,
particularly relative to consumers who have dual Medicare and Medicaid coverage. The
Department has a committee to provide education to providers, families, and consumers
across the three service divisions. Part D implementation is featured prominently on the
agenda for the Adult Psychiatric Institute in September. At the suggestion of the Chair of
the Mental Illness Planning Council, a statewide conference on implementation of
Medicare Part D is scheduled for October 20, 2005 in Birmingham. This session is
scheduled after the different plans‟ formulary and pharmacy benefit management
techniques are released.

   D. Legislative initiatives and changes, if any

The State continues to struggle with inadequate revenue to support state functions,
including the Department of Mental Health and Mental Retardation. The Legislature was
unable to pass a General Fund budget during its Regular Session. The budget passed
during the July Special Session provides $189,059,549 in state funds, an increase of
approximately $15,000,000.
   E. A brief description of regional-sub-State programs, community mental health
centers, and resources of counties and cities, as applicable, to the provision of mental
health services within the State.

     The public community mental health services system is based upon 22 service
regions (see map in Part A.). There are twenty-two public, non-profit regional mental
health boards (called 310 Boards based on Act 310 of the 1967 Regular Session of the
Alabama Legislature). The 310 Board is also a mental health service provider board. In
Birmingham, the 310 Board provides adult residential and case management services and
is the recipient of a federal Partnership Grant to develop and coordinate child and
adolescent services within the region. There are twenty-five community mental health
centers serving the 22 regions. There are three mental health centers plus the regional
mental health authority in Birmingham. In addition to these multi service centers there
are two specialty service providers: 1) Brewer-Porch in Tuscaloosa provides residential
and out patient services for children and adolescents and 2) Glenwood Mental Health
Services provides child and adolescent residential services and outpatient services for
children, adolescents, and adults.


    These local providers use a variety of revenue to support their operations including
city and county funds, United Way, AllKids, commercial insurance, Medicare, and
Medicaid. The level of city and county support for these providers varies significantly
across the state. In addition to contracting with the DMH/MR, providers may also enter
local arrangements with the Department of Human Resources, the Department of Youth
Services, and local education agencies.


   F. A description of how the State mental health agency provides leadership in
coordinating mental health services within the broader system.

    The Department has entered into agreements with the Alabama Housing Finance
Authority and the Medicaid Agency to produce increased services and revenue. The
Commissioner is a member of the Governor‟s Cabinet. As such, he participates in
Cabinet meetings and has the opportunity to coordinate services at the highest level.
Services are coordinated with other state agencies through the Planning Council, issue
specific work groups, and case coordination on an individual basis. Staff at all levels of
the Department have daily contact with staff from other agencies and the general public
for purposes of providing, coordinating, or developing services or information.


       The Commissioner attends the annual meeting of Probate Judges to address
concerns of these individuals who are statutorily responsible for making decisions on
involuntary commitment. The Commissioner will attend the 2005 meeting to address
concerns of the judges relative to delays in admissions to acute units. A statewide
conference on the topic of decriminalizing mental illness, one of the special projects
supported by the Planning Council, will be held in September, 2005. Based on prior year
conferences, there will be excellent attendance with follow-up action in several
communities.


        Staff of the Mental Illness Division also participate in law enforcement training,
are members of the state Suicide Prevention Task Force, and present at various meetings
and conferences including the Annual Conference of Community Mental Health Boards.
The MI Planning Council has representatives from the six state agencies with which
mental health services are coordinated. A member of the Planning Council representing
NAMI chairs the Medicaid Medical Advisory Committee. As discussed in the Child and
Adolescent section, the DMH/MR coordinated closely with all state agencies involved in
the implementation of the Children‟s Health Initiative program. The Planning Council
and DMH/MR are well-represented in state level Olmstead planning which involves all
social service and health provider agencies. A past statewide anti-stigma campaign was
implemented in part through distribution of material to middle and high school students
with the strong support of the Superintendent of Education.



Section II. Identification and Analysis of the Service System’s Strengths,
Needs and Priorities
   A. A discussion of the strengths and weaknesses of the service system

Strengths:
        The Department has a long standing inclusionary planning process. The
           Management Steering Committee, the Mental Illness Coordinating
           Subcommittee, and the Planning Council all include family and consumer
           representatives. The Planning Council has broad state agency representation
           as well.
        The public mental illness service system is mature with long term community
           providers, stable leadership, and nationally accredited state hospitals.
        There is a combined Performance Improvement process for hospitals and
           communities that also involves families, consumers, providers, and advocates.
        There is an Advocacy system for both hospitals and communities which not
           only protects consumer rights, but contributes to development of certification
           standards and departmental policies.

Weaknesses:
      There is increasing census in admission units which is related to the decline in
         private hospital psychiatric beds and increased numbers of previously
         hospitalized people in the community. While this increase is consistent with
         national trends, it is of major concern.
      The system of care for people with co-occurring mental illness and substance
         abuse disorders is in the early development stage and is currently inadequate.
      Employment opportunities for consumers and consumer peer support are not
         well-developed.
        The poor fiscal health of state has slowed mental illness system development
         and has placed constraints on other state agencies such as Medicaid. Caps on
         brand-name prescriptions under Medicaid are a result of insufficient state
         funding.
        Vacancies and acting appointments in key leadership positions have continued
         for up to a year.


   B. An analysis of the unmet service needs and critical gaps within the current
      system, and identification of the source of data which was used to identify them.

The focus during FY05 was on developing services to help reduce the census at the state
hospitals. Plans were developed through the Acute Care Crisis Committee and approved
by the MI Coordinating Subcommittee. Data on state hospital admissions and census
show that the census in acute care units remains a problem.

Adequate funding for the public system of care remains a challenge. The state psychiatric
hospitals were underfunded at the beginning of FY05 in anticipation that the new
community services would result in a decrease in census and the ability to live within the
allocated budget. While recent data suggests that the new services are beginning to have a
positive impact on the census, it is too late in the fiscal year to mitigate the deficit in the
state hospital budget through the reduction in census alone. Revenue enhancements and
expenditure decreases as well as transfers from other areas of the Department will be
needed to finish the year within budget. Adequate funding remains a challenge.

There is no integrated system of care for people with co-occurring disorders.

The availability of safe and affordable housing remains a challenge for people with
mental illness and limited incomes. Information developed as part of the application for
HUD funds shows the need for more housing. The Department‟s Housing Advocate stays
busy assisting people who are having difficulties with their current living situation. For
people with mental illness and a criminal background, even greater barriers to obtaining
subsidized housing exist due to the exclusion of people with a criminal record from
certain housing. In addition to the housing itself, supports in the form of intensive case
management and treatment services are also needed to assist consumers in achieving a
greater degree of self-sufficiency.

Peer support services in the community do not exist.

There has not been a systematic effort to improve employment opportunities for people
with serious mental illness.

   C. A statement of the State’s priorities and plans to address unmet needs.

The following goals have been established by the Mental Illness Coordinating
Subcommittee for FY06:
To provide a quality continuum of community services for persons with mental illness
regardless of origin, ethnicity, gender, culture, and language of preference.

To reduce admissions to and census at state psychiatric hospitals.

To improve availability of and access to treatment and support services.

Plans to address the unmet needs will focus on the hospital census and remaining within
budget as the first priorities. Commissioner Houston has appointed an Acute Care Work
Group to develop recommended strategies to address both the immediate issue of hospital
overcrowding as well as longer term strategies for future service development. The
membership of the committee includes representatives of community providers, state
hospitals, Departmental administrators, NAMI, consumers, Probate Judges, Alabama
Hospital Association, the Alabama Disabilities Advocacy Program, and the Office of
Avocacy Services. The Work Group is scheduled to meet from September to November
with recommendations due in December. Plans are underway to seek consultation both
from the Bazelon Center and the National Association of State Mental Health Program
Directors.

In addition to funding of services, incorporation of evidence-based practices (EBP) into
the administrative and service delivery infrastructure will be undertaken as a way to
improve the current system delivery system. A EBP Committee is under development to
assess how to incorporate the SAMHSA toolkits for Family Psychoeducation, Illness
Management and Recovery, Medication Algorithms, and Supported Employment into the
community system of care through training and revisions to the Department‟s
certification standards and service contracts. There will also be a committee taking a look
specifically at how to best provide services to the homeless population.

   D. A brief summary of recent significant achievements that reflect progress towards
       the development of a comprehensive community-based mental health system of
       care.
See Section I.B. for a description of significant achievements in FY05.

   E. A brief description of the comprehensive community-based public mental health
      system that the State envisions for the future

     The Alabama Department of Mental Health and Mental Retardation strategic plan,
A New Day Begins: Beyond the Wyatt Years Strategic Plan FY03-05, contains the
following mission and vision statements:
Mission:
The mission of the Alabama mental health and mental retardation service delivery system
is to ensure that the mental illness, mental retardation and substance abuse needs of the
state’s citizens are addressed in a manner that is maximally effective and efficient, while
promoting the individual’s quality of life, human worth, and dignity.
Vision:
        All aspects in the provision of mental illness, mental retardation and substance
abuse services by and through the DMH/MR shall be consumer and family drive – based
upon the identified needs and expressed desires of consumers and their families.
        The continuum of care in each Service Division will be flexible to meet the needs
of consumers and targeted toward improving the quality of their lives and shall be
designed in concert with consumers and families. Outcomes shall be based upon and
measured by consumer and family satisfaction.
        Quality is defined as meeting customer requirements. Therefore, the
administrative component of services at all levels of the system shall redefine its
customers as the care and treatment components of the service system. Administrative
services shall be redesigned to meet its customers' requirements, so that care and
treatment staff can provide services to clients in the most effective and efficient manner
possible. Quality outcomes for administrative services shall be based on customer
requirements and assessed by customer satisfaction.
        The entire system of DMH/MR services shall also recognize as its customers, not
only the clients and families it serves directly, but also the citizens of Alabama who are
represented by a multitude of individuals, agencies, and organizations. The outcomes of
the DMH/MR system shall also be monitored and evaluated by the satisfaction level
expressed by its customers.

         If adequate resources are available, a system of care that emphasizes a rich array
of community services to complement the state hospital system care will result. The state
hospital beds will be the minimum necessary to meet the needs of people who are
seriously mentally ill and meet the involuntary commitment criteria. The community
system of care will provide a flexible array of services that are focused on meeting as a
first priority the needs of people with a serious and persistent mental illness, particularly
those who have been in a state psychiatric hospital. All services will be provided from a
person-centered treatment planning perspective driven by family and consumer needs.
Consumers will receive not only high quality treatment services, but will receive the
necessary supports to achieve the highest degree possible of independent living in safe
and decent housing, employment, and social interaction with friends and family.
Section III Performance Goals and Action Plans

The following chart compares the goals of the President‟s New Freedom Commission,
the National Outcome Measures, the Block Grant Mandatory Criteria, and the Proposed
Goals in this application. There are a number of initiatives underway with the focus of
transforming the public mental health system. Kathryn Power, the Director of the Center
for Mental Health Services, was the keynote speaker at the annual meeting of the
Alabama Council of Community Mental Health Boards. She was enthusiastically
received by the 800+ people representing community providers, state hospitals, state
agencies, advocates, family members, and consumers in attendance.

President’s New                  National Outcome          Block Grant           Proposed Goals
Freedom                          Measures (NOM)            Mandatory
Commission Report                  *Mandatory                Criteria
Goals
Goal 1 - Americans
Understand that Mental
Health is Essential to
Overall Health
1.1 Advance and                                         Criterion 1.2            Provide anti-
implement a national                                    Criterion 3.1           stigma public
campaign to reduce the                                                          information
stigma of seeking care and                                                       Collaborate with
a national strategy for                                                         the Suicide
suicide prevention                                                              Prevention Task
                                                                                Force to implement
                                                                                the Suicide
                                                                                Prevention Plan
1.2 Address mental health                               Criterion 5.1
with the same urgency as
physical health
Goal 2 - Mental Health
Care is Consumer and
Family Driven
2.1 Develop an                  Improved Level of       Criterion 1.1            Revise
individualized plan of care     Functioning –           Criterion 3.1           certification
for every adult with serious    measurement to be       Criterion 4.1 and 4.2   standards to
mental illness and child with   determined                                      incorporate principles
a serious emotional
                                                                                of person-centered
disturbance
                                                                                treatment planning
                                                                                (with the addendum
                                                                                that incorporates
                                                                                principles of
                                                                                child/family centered
                                                                                treatment planning)
                                                                              Reduce census at
                                                                             state hospital acute
                                                                             units
                                                                              Maintain the
                                                                             number of youth
                                                                             served at the state
                                                                             adolescent
                                                                             psychiatric unit at or
                                                                             below the number
                                                                             served in FY2003
President’s New                National Outcome                Block Grant    Proposed Goals
Freedom                        Measures (NOM)                  Mandatory
Commission Report                *Mandatory                      Criteria
Goals
2.2 Involve consumers and     * Client Perception of        Criterion 1.2     Maintain 70% or
families fully in orienting   Care – measured by            Criterion 3.1    better of
the mental health system      Clients Reporting                              consumers/families
toward recovery               Positively about Outcomes                      reporting positive
                              Increased/Retained                             general satisfaction
                              Employment or Return to                        scores
                              /Stay in School – measured
                                                                             (Child/Adolescent)
                              by Profile of Adult Clients
                              by Employment Status and                        Maintain 85% or
                              by Increased School                            better of consumers
                              Attendance                                     reporting positive
                              Increased Social                               general satisfaction
                              Supports/Social                                scores (Adults)
                              Connectedness –                                 Hold annual
                              measurement to be                              Consumer Recovery
                              determined                                     Conference
                                                                              Continue to
                                                                             support Alabama
                                                                             Family Ties Annual
                                                                             Conference
                                                                              Maintain the six
                                                                             existing drop-in
                                                                             centers
2.3 Align relevant Federal    Increased Stability in        Criterion 1.2     Maintain the
programs to improve           Housing – measured by         Criterion 3.1    number of homeless
access and accountability     profile of client‟s change    Criterion 4.1    individuals with mental
for mental health services    in living situation                            illness served within
                              (including homeless           Criterion 1.2    95% of the FY05 level.
                              status)                       Criterion 3.1     Maintain
                                                                             expenditures for shared
                              Decreased Criminal
                                                                             funding of services for
                              Justice Involvement –                          Multiple Needs
                              measured by Profile of                         children
                            Client Involvement in                      Maintain the
                            Criminal and Juvenile                     number of children
                            Justice Systems                           served with Allkids
                                                                      Basic or Plus insurance
                                                                      at the FY05 level
                                                                       Continue
                                                                      implementing the
                                                                      Emergency Response
                                                                      Capacity Plan
President’s New              National Outcome           Block Grant    Proposed Goals
Freedom                      Measures (NOM)             Mandatory
Commission Report              *Mandatory                 Criteria
Goals
2.4 Create a                                         Criterion 1.2
Comprehensive State                                  Criterion 3.1
Mental Health Plan
2.5 Protect and enhance                              Criterion 1.2    Maintain expanded
the rights of people with                            Criterion 3.1    Advocacy Services
mental illness
Goal 3 - Disparities in
Mental Health Services
are Eliminated
3.1 Improve access to       *Increased access to     Criterion 2.2     Maintain state
quality care that is        services – measured by   Criterion 5.1    policy that persons with
culturally competent        Number of Persons                         serious mental illness
                                                                      are served as a top
                            Served by Age, Gender,
                                                                      priority
                            and Race/Ethnicity
                                                                       Maintain the current
                                                                      access to care as
                                                                      measured by the total
                                                                      number served in the
                                                                      community by age,
                                                                      gender, and
                                                                      race/ethnicity
                                                                       Maintain
                                                                      accessibility to
                                                                      treatment for children
                                                                      and adolescents with a
                                                                      severe emotional
                                                                      disturbance
                                                                       Continue
                                                                      implementing the use
                                                                      of teleconferencing
                                                                      technology to support
                                                                      services for consumers
                                                                      who are deaf/hard of
                                                                      hearing in areas where
                                                                      interpreters are difficult
                                                                      to obtain
                                                                       Maintain case
                                                                      management services
                                                                      as measured by the
                                                                      number of recipients

President’s New              National Outcome           Block Grant    Proposed Goals
Freedom                      Measures (NOM)             Mandatory
Commission Report              *Mandatory                 Criteria
Goals
3.2 Improve access to       *Increased access to     Criterion 4.2     Maintain access to
quality care in rural and   services – measured by                    care in the 11
geographically remote       Number of Persons                         predominantly rural
areas                       Served by Age, Gender,                    catchment areas at
                            and Race/Ethnicity                        least at 20.0 persons
                                                                      served per 1000
                                                                      population
                                                                       Continue
                                                                      implementing the use
                                                                      of teleconferencing
                                                                      technology to support
                                                                      services for
                                                                      consumers who are
                                                                      deaf/hard of hearing
                                                                      in areas where
                                                                      interpreters are
                                                                      difficult to obtain
                                                                       Maintain the
                                                                      number of homeless
                                                                      individuals with
                                                                      mental illness served
                                                                      within 5% of the
                                                                      FY05 level.
                                                                       Participate in the
                                                                      evaluation of the
                                                                      telemedicine project
                                                                      and determine how to
                                                                      expand to other areas
                                                                      of the state
                                                                       Maintain
                                                                      accessibility of
                                                                      children and
                                                                      adolescent services in
                                                                      the rural areas of the
                                                                      state at the FY03
                                                                      level
President’s New               National Outcome      Block Grant    Proposed Goals
Freedom                       Measures (NOM)        Mandatory
Commission Report               *Mandatory            Criteria
Goals
Goal 4 – Early Mental
Health Screening,
Assessment, and
Referral are Common
Practice
4.1 Promote the mental                           Criterion 3.1     Identify and
health of young children                                          develop an
                                                                  implementation plan
                                                                  for at least one
                                                                  nationally recognized
                                                                  best or recommended
                                                                  practice
                                                                   Work
                                                                  collaboratively with
                                                                  other agencies to
                                                                  serve children who
                                                                  are involved with
                                                                  multiple agencies
                                                                   Maintain
                                                                  expenditures for
                                                                  shared funding of
                                                                  services for Multiple
                                                                  Needs children
                                                                   Maintain the
                                                                  number of children
                                                                  served with Allkids
                                                                  Basic or Plus
                                                                  insurance at the FY04
                                                                  level
                                                                   Provide public
                                                                  information to reduce
                                                                  stigma
4.2 Improve and expand                           Criterion 3.1
school mental health
programs
4.3 Screen for co-occurring                      Criterion 3.1     Hire Co-Occurring
mental and substance use                                          Disorders Coordinator
disorders and link with                                            Continue training
integrated treatment                                              to improve clinicians‟
strategies                                                        skills treating
                                                                  specialty populations
                                                                               Provide technical
                                                                              assistance and peer
                                                                              consultation
                                                                              opportunities for
                                                                              ACT Teams, PATH
                                                                              grantees,
                                                                              psychiatrists, and
                                                                              clinicians providing
                                                                              services to consumers
                                                                              with co-occurring
                                                                              disorders
President’s New                 National Outcome                Block Grant    Proposed Goals
Freedom                         Measures (NOM)                  Mandatory
Commission Report                 *Mandatory                      Criteria
Goals
4.4 Screen for mental                                        Criterion 3.1    Implement pilot test on
disorders in primary health,                                                  use of DISC IV as a
across the life span, and                                                     screening instrument in
connect to treatment and                                                      five areas of state.
supports
Goal 5 – Excellent
Mental Health Care is
Delivered and Research
is Accelerated
5.1 Accelerate research to     Improved Level of             Criterion 5.1
promote recovery and           Functioning –
resilience, and ultimately     measurement to be
to cure and prevent mental     determined
illnesses
5.2 Advance evidence-          *Reduce Utilization of        Criterion 1.2     Identify and develop
based practices using          Psychiatric Inpatient         Criterion 3.1    an implementation plan
dissemination and              Beds – measured by                             for at least one
demonstration projects         Decreased Rate of                              nationally recognized
and create a public-private    Readmission to State                           best or recommended
                               Psychiatric Hospitals within Criterion 5.1     practice
partnership to guide their
                               30 and 180 days *Use of                         Complete an
implementation
                               Evidence Based                                 assessment of what
                               Practices - measured by                        changes in
                               Number of Evidence-based                       administrative
                               Practices Provided by State                    infrastructure are
                               and by Number of Persons                       needed to implement
                               Receiving Evidence-based                       the SAMHSA toolkits
                               Practice Services                              for Supported
                                                                              Employment,
                                                                              Medication Algorithms,
                                                                              Family
                                                                              Psychoeducational
                                          Services, and Illness
                                          Self-Management
                                           Continue the 11
                                          ACT Teams and 2
                                          PACT Teams
                                           Maintain the rate of
                                          readmission to state
                                          psychiatric hospital
                                          within 30 days and 180
                                          days at or below the
                                          national rate
                                           Implement the
                                          Performance
                                          Improvement Plan for
                                          the MI Division
                                           Maintain the
                                          number of youth served
                                          at the state adolescent
                                          psychiatric unit at or
                                          below the number
                                          served in FY2003
5.3 Improve and expand    Criterion 5.1    Provide technical
the workforce providing   Criterion 5.2   assistance and peer
evidence-based mental                     consultation to ACT
health services and                       teams, PATH
supports                                  grantees,
                                          psychiatrists, and
                                          clinicians treating
                                          persons with co-
                                          occurring disorders
                                           Provide one
                                          Psychiatric Institute
                                          per year
                                           Provide training
                                          for In-home
                                          Intervention Teams
                                          and child and
                                          adolescent case
                                          managers
                                           Provide one
                                          statewide technical
                                          assistance/peer
                                          consultation event for
                                          community providers
                                          of child and
                                          adolescent mental
                                          health services
                                                                      Develop and
                                                                     assure provision of a
                                                                     child and adolescent
                                                                     service track at the
                                                                     Annual Council of
                                                                     Community Mental
                                                                     Health Boards
                                                                     Meeting

President’s New                  National Outcome      Block Grant    Proposed Goals
Freedom                          Measures (NOM)        Mandatory
Commission Report                  *Mandatory            Criteria
Goals
5.4 Develop the knowledge                           Criterion 5.1
base in four understudied
areas: mental health
disparities, long-term effects
of medications, trauma, and
acute care
Goal 6 – Technology is
Used to Access Mental
Health Care and
Information
6.1 Use health technology                           Criterion 5.1     Participate in the
and telehealth to improve                                            evaluation of the
access and coordination of                                           telemedicine project
mental health care,                                                  and determine how to
specially for Americans in                                           expand to other areas of
                                                                     the state
remote areas and in
                                                                      Continue
underserved populations
                                                                     implementing the use
                                                                     of teleconferencing
                                                                     technology to support
                                                                     services for consumers
                                                                     who are deaf/hard of
                                                                     hearing in areas where
                                                                     interpreters are difficult
                                                                     to obtain
6.2 Develop and implement                           Criterion 5.1
integrated electronic health
record and personal health
information systems
Criterion 1: Comprehensive Community-Based Mental Health Service
System
1.1 Provides for the establishment and implementation of an organized
community-based system of care for individuals with mental illness.

        The DMH/MR Division of Mental Illness, under the direction of the Associate
Commissioner for Mental Illness, has responsibility for the development and
coordination of the system of community treatment services for mental illness. This
responsibility includes contracting for services with local providers and monitoring those
service contracts, evaluation and certification of service programs in accordance with
statutory standards, and the development of needed services. Alabama continues to
develop a comprehensive system of care for the mentally ill that extends across the state.
The foundation of the public community mental illness service system is the network of
public, non-profit regional mental health boards authorized under Act 310 of the 1967
Legislature. There are 22 service regions with 25 community mental health centers
(CMHCs). In the Birmingham area, there are three mental health centers in addition to
the regional 310 Board. In addition to the main centers, services are available to each of
the state‟s 67 counties through the satellite programs of the CMHCs. In addition to the
public mental health centers, there are two specialized child and adolescent service
providers also under contract with the Department.

        The Division of Mental Illness is the primary administrative unit of the
Department of Mental Health and Mental Retardation that addresses community mental
illness services. This office coordinates planning and program development, certification,
contract development and monitoring, performance improvement, and consumer affairs.
In addition, the Department has an Office of Advocacy Services that has staff interacting
with community providers to protect the rights of person with mental illness.

        Services are planned and implemented through a participatory planning process
that includes the MI Planning Council, the Mental Illness Coordinating Subcommittee of
the Management Steering Committee. Family members, consumers, advocacy
organizations, other state agencies, and providers are represented on these planning
bodies.

1.2 Describes available services and resources in a comprehensive system of care,
including services for individuals with both mental illness and substance abuse. The
description of the services in the comprehensive system of care to be provided with
Federal, State, and other public and private resources to enable such individuals to
function outside of inpatient or residential institutions to the maximum extent of their
capabilities shall include:
health, mental health and rehabilitation services
employment services
housing services
educational services
substance abuse services
medical and dental services
support services
services provided by local systems under the Individuals with Disabilities Education Act
case management services
services for persons with co-occurring (substance abuse/mental health) disorders
other activities leading to reduction of hospitalization


The Department contracts with the community mental health centers (CMHC) to provide
an array of community services including basic outpatient services, day treatment,
Assertive Community Treatment teams, case management, and a variety of residential
programs. The contract eligibility criteria specify that funds should be used to serve
individuals who cannot afford to pay, are not otherwise insured, and who meet the criteria
for Serious Mental Illness and Severe Emotional Disturbance as well as those individuals
presenting in an emergency situation.

Consumer run drop-in centers and support groups are seen as essential elements of the
continuum of care, but these services are not covered in the Department‟s contract with
community mental health centers. The Block Grant has been used to support the
development of consumer-operated services as well as the annual consumer conference.

Local providers have developed referral arrangements to available inpatient units.
Whenever possible, local providers work with hospitals to secure local inpatient services
for indigent consumers. Probate judges can also make involuntary commitments to local
inpatient units or residential program that request and receive „designated mental health
facility‟ status per the 1991-commitment law.

The preceding services are funded through a mix of resources including federal MHS
Block Grant funds, state funds, Medicaid, Medicare, other third party (insurance), local
government, donations, and client fees generated under a sliding fee scale. In FY 2005,
block grant funds will account for approximately 4.6% of DMH/MR contracts for
Community Mental Health services while state sources such as the General Fund, Special
Mental Health Fund and other state sources accounted for 54.2% of total resources.
Medicaid reimbursements and other federal funding account for an additional 41.2% of
the DMH/MR Community Mental Health budget. This does not include support that is
provided by local sources, the proportion of which varies greatly from center to center.

The mental health centers work with a variety of public and private resources to obtain
services and supports needed by mentally ill people in the community. Case Management
services are essential to successful maintenance of persons who have serious mental
illness in the community. Alabama began case management with a federal Community
Support Project in the early 1980‟s. Medicaid started coverage in 1988 through the
Optional Targeted Case Management Program. As recommended by the MICS, funding
was increased to maintain the existing outpatient and case management infrastructure.
The MICS at its June, 2002, planning meeting recommended the following caseloads for
case managers: 20 for intensive case management and 50 for regular case management.

Case mangers provide the necessary linkages to medical and dental care, housing,
education, and income supports. Most of the adults with serious mental illness have
Medicaid coverage for medical and dental services. However, it is a challenge to find
providers who will accept Medicaid. Case managers provide a vital service by linking
consumers to individual practitioners who will accept Medicaid or who will agree to see
consumers on a sliding scale or no fee basis. Additionally, case managers are familiar
with public health department services and other federally qualified health centers where
they exist. Many times case managers are instrumental in persuading a practitioner to
take one or more consumers as an exception to the general refusal to take Medicaid
clients. The Medicaid State Agency raised its rates for medical services which has made
it somewhat easier to find clinicians who will accept Medicaid.

General health services can also be provided directly by community mental health
providers or by referral to other resources. Consumers in day treatment and residential
programs receive health education on general nutrition, personal hygiene, exercise, and
health lifestyle. They also routinely receive training in universal precautions. Individuals
in residential frequently receive health monitoring and general health advice from staff
nurses. Individuals in outpatient, day treatment, and residential services who are also
receiving medication services routinely have vital signs monitored with referrals for
necessary medical care. Recommendations for routine health screenings are incorporated
in all services. Community resources such as health fairs, free blood pressure checks, flue
vaccines, etc. are utilized when available. Additionally, people are referred to public
health clinics and federal community health centers, as appropriate and when available.

Consumers who are in state hospitals are provided medical care as part of their
involuntary confinement where there is no insurance or other source of coverage for
medical expenses. Likewise, consumers who have no health insurance and who reside in
DMH/MR community residential programs have minor medical services paid by the
provider. There is a statewide fund for residents of foster homes to pay for incidental
medical expenses when there is not other source of revenue. The fund is limited and
expenses must be prior approved.

The University of Alabama School of Dentistry also provides free clinics around the
state. The waiting list for these clinics is very long. Case managers assist consumers in
getting on the waiting list for any available free clinics. In some areas of the state, local
dentists volunteer time for free clinics. Again, the amount of time and the range of
services are limited.

Case managers and clinicians from the mental health centers work with local educational
institutions and Rehabilitation Services offices to refer consumers for education and
employment services. Consumers are provided basic educational services and pre-
employment services in day treatment and residential programs. Outpatient consumers
are referred to local GED classes and/or institutions of higher learning such as
community colleges and universities based on the consumers‟ interests and abilities..
Providers work with the Rehabilitation Services office to refer people for regular
rehabilitation services as well supported employment. Employment is a key aspect of
Recovery for many consumers.

The effort to define a Medicaid Rehab Option service to replace Optional Targeted Case
Management was unsuccessful. This effort was directed to eliminating the Medicaid
requirement for a case manager to have a Bachelor‟s Degree which would allow
consumers and family members to serve as case managers (peer specialist). However,
the definition of the Assertive Community Treatment Team includes a peer specialist
position that does not require a Bachelor‟s Degree. Providers are encouraged to consider
consumers and family members for the position.

The DMH/MR has been successful in getting the Alabama Housing Finance Authority
(AHFA) to focus attention on the housing needs of persons with mental illness, mental
retardation, or substance abuse. A total of 451 units are scheduled to be built. These
units are not exclusively available for individuals with mental illness, but are also
available for individuals with mental retardation or substance abuse. The need to provide
case management and clinical support to persons residing in these units was recognized
in the Wyatt FY 02 funding recommendations from the MICS. A total of $250,000 was
set aside to assist consumers in gaining access to more independent housing. This
statewide pool of funds is renewed every fiscal year. Of the 451 units, 401 units have
been completed occupied by DMH./MR consumers.

The Alabama Rural Coalition for the Homeless (ARCH) was created in FY04 to provide
a mechanism to access HUD funds that had been underutilized in the past. There were 47
counties in the state that did not have a local Continuum of Care organization, a
prerequisite for applying for certain HUD funds. Through the interest of the Planning
Council in developing more housing for people with serious mental illness, the Council
Chair and other Council members participated in developing ARCH. x HUD applications
were submitted in FY05 totaling almost $3 Million and providing x new units. Although
the applications submitted in the FY2004 funding cycle were not funded, they were
highly rated for first year applications, providing hope that the second year cycle will get
funded.

The area of housing for persons who are homeless and have a serious mental illness is a
promising one as the Planning Council membership learns about the allocation process
throughout the state. The Planning Council will in FY 05 team up with the Department
and the community providers to educate on how these dollars can acquired for permanent
housing. HUD has established permanent supportive housing in its plan to end
homelessness, coupled with the fact that the mental health system is willing and able to
establish such housing, will result in significant progress toward securing more resources
for the SMI who are considered chronically homeless. The collaboration of ACT teams
in this effort is also seen as a potential to the success of the team‟s work. Safe, affordable
and decent housing is in very short supply for this population especially with the
restrictions of credit checks and criminal background checks. We must team up with the
private sector too in the struggle to end homelessness.

Evidence-based practices are under development in Alabama through a variety of
mechanisms. Alabama is in the third year of developing ACT services. The model used
is based upon the principles of Program for Assertive Community Treatment (PACT) as
articulated in the NAMI manual and in the Dartmouth Fidelity Scale. However, when the
model was developed, the work group modified the national model to focus on mental
health services only with a team of 3 with a part-time psychiatrist. The staff to consumer
ratio is 1:12. The size of the team was based on the minimum necessary to meet the
treatment and support needs of consumers while maintaining conformance to the core
principles. Given the predominantly rural nature of the State, there are few areas that
could support a full fidelity PACT team costing approximately $1 Million per year. There
are two PACT teams in the Birmingham area.

A review of the teams was conducted last summer to assess fidelity to the measures
contained in the Dartmouth Fidelity Scale. As noted above, there are some areas where
compliance with the fidelity measures would not be possible because of the way the
teams are structured. On the other measures, the teams achieved a high degree of fidelity
to the core principles of Assertive Community Treatment A technical assistance and peer
consultation session was held August 8, 2005. The purpose of this meeting was to review
service data related to the functioning of the teams and to discuss issues of
interest/concern to the teams.

The State continues to work on developing a system of care for people who have both
mental illness and substance abuse diagnoses. Alabama was a successful applicant for
participation in the National Co-occurring Policy Academy. Through this mechanism a
plan for development of an integrated system of care was developed. An application for
the Co-SIG grant was developed based on this plan. The grant submission did not meet
the deadline, so it was not considered. Implementation of the plan has been delayed
because the Coordinator of Co-occurring Disorders has not been hired.

Teaming up with the Southern Coast Addiction Technology Transfer Center (SCATTC)
in the provision of statewide training for 900 mental health and substance abuse
professionals has been very beneficial to the effort to transform two separate systems into
one that collaborates and expects a significant number of persons who have both
disorders. As the Adult Academy Team finalizes its plan and the Child and Adolescent
Academy Team finishes it plan of action, if the state were to receive one or both of the
COSIG Grants, there will be significant movement in this area. During FY05, SCATTC
continued training for clinicians treating adults and initiated a process of training the
trainers for clinicians treating adolescents.

Two workgroups are under development to address incorporation of the SAMSHA
Toolkits into community service provision. The first will be a small group of providers,
family members, and consumers to learn the toolkits and to develop strategies to
incorporate the practices into existing community services. The second group will
address issues of homelessness and housing needs, particularly promising practices for
the PATH grantees as well as other mental health centers.

As noted in Sections I and II, the increase in state hospital acute unit census was and is of
major concern and focus of planning. During FY05 a number of new programs were
funded in the community and a regional residential utilization monitoring process was
initiated. All new services in FY05 were designed to reduce admissions and reduce
census. While recent numbers indicate the beginnings of a positive impact, it has only
been late in the fiscal year that such evidence is emerging. The census has on the average
been above capacity by x. As of xxxx, the census was x over the capacity. The highest
that the census has been in FY0 is x. Thus, the amount of overage has decreased. The
chart below shows the trend in increasing admissions over the last few years. Despite, the
increase in admissions, the number served has somewhat stabilized. See the chart below
for total number served in state hospitals. The census at the end of the fiscal year through
FY04 and year to date in FY05 shows the dramatic decrease in census over time and the
recent
                                                                     ADMISSIONS & READMISSIONS TO MI FACILITIES

                                  3200



                                  3000
                                                                                                                                                 3022
                                                                      2858
                                                    2805
                                  2800      2820
                                                                                                                                 2793
  TOTAL ADMISSIONS/READMISSIONS




                                                                                                                                         2782
                                                             2788                                                                                               2707

                                                                                                                                                           2628
                                  2600
                                                                                                                          2514
                                                                               2502
                                  2400


                                                                                         2253
                                  2200
                                                                                                                 2171
                                                                                                 2148


                                  2000                                                                   2009



                                  1800



                                  1600
                                         88/89   89/90     90/91    91/92    92/93    93/94   94/95   95/96   96/97   97/98   98/99   99/00   00/01     01/02     02/03
                                                                                                  FISCAL YEAR
                                                                      PATIENTS SERVED IN MI FACILITIES
                     5500

                                         5320
                                                               5262
                            5282                  5281


         5000
        NUMBER OF PATIENTS SERVED
                                                                                                                                                              4804
                                                                         4741
                                                                                                                                                      4705


                     4500                                                                                                                  4467
                                                                                   4411


                                                                                                                               4220
                                                                                                                                                                           4186 4099
                                                                                               4070
                     4000
                                                                                                                     3940

                                                                                                         3789



                     3500




                     3000
                            88/89   89/90       90/91     91/92       92/93     93/94     94/95       95/96     96/97       97/98     98/99       99/00      00/01       01/02     02/03
                                                                          FISCAL YEAR                                          Methodology changed 99/00 forward




                                                                   ALL MI INPATIENTS AT END OF FISCAL YEAR

                     2800


                     2600
                                                        2493
                                          2515
                     2400       2462                              2404

                                                                          2239
                     2200
PATIENTS ON-CAMPUS




                                                                                        2158


                     2000
                                                                                                  1922

                     1800                                                                                     1780
                                                                                                                     1769                     1674
                                                                                                                                    1706
                                                                                                                                                          1683
                     1600
                                                                                                                                                                     1558

                                                                                                                                                                                 1426
                     1400


                     1200                                                                                                                                                            1268

                                                                                                                                                                                                1090
                     1000
                            87/88      88/89    89/90      90/91       91/92     92/93     93/94       94/95     95/96        96/97     97/98        98/99       99/00     00/01     01/02   02/03
                                                                                                       FISCAL YEAR
In FY04, the total number served in the public mental health system was 103,145+ served
in hospitals. Of this total, x were served in state hospitals and 103,145 were served by
community providers. One of the key services in the community that supports discharge
from state hospitals is residential. The table below shows the current availability of
residential services by community service area by type of program. Residential slots have
increased from 1,253 in FY1991 to over 2,500 units including community nursing home
slots.
                              Community Residential Beds by Type
                                        August, 2005
MHC             THOME   RCH   RCSPEC   CRISIS   SEMINT   SPHOUS   FOSTER   NURSING   3 Bed   TOTAL
                                                                                     Home
     Baldwin       14    14      13                 20                                          61
      Cahaba       14            24                          33        8       25              104
    Cal-Cleb             11                                  12                 1               24
        CED                      24                                   79       22              125
      Cheaha       16                                        39        5        5               65
  Chil-Shelby                    31                                                             31
     Cullman                                                  9                                  9
     East Ala                    30        9                 12       3        19               73
 East Central      12    14      10                                  15        41               92
   Huntsville            32                                  67      32         1       3      135
Indian Rivers            10       7        9        28       23      66        34              177
         JBS       30    40      30                 57       68     101        84       6      416
 Mar-Jackson             10                2                  8      56                         76
       Mobile      48    33      51                          60     115        82       6      395
 Montgomery        19            20       10        12       50      45        10       3      169
  No. Central                    34                           8      12                         54
   Northwest             14     110                 10       57      29        15              235
   Riverbend                     16                 20       21      13                 3       73
  So. Central      16             8                                                             24
   Southwest                     17                 25                                          42
  Spectracare                    61                          30      31                        103
    West Ala                     10                          12       5        20               47
     TOTAL       169    186     488       30       172      509     615       359      21     2549


This list represents the number of housing units for seriously mentally ill adults that are
provided by community mental health centers (CMHC) or are under contract with CMHCs.
There are also numerous consumers who reside in housing supported with Section 8 Rental
Assistance that are not tracked since they are not operated by the CMHC or under contract.

THOME = Therapeutic Group Home
RCH = Residential Care Home
RCSPEC = Residential Care Home with Specialized Services
CRISIS = Crisis Residential
SEMINT= Semi-independent living with intensive supervision
SPHOUS = Supported Housing
FOSTER = Foster Care Facility
        In FY 05, the MI Performance Improvement (PI) Committee met 7 times to
review PI data and to conduct PI business. The Committee also held training sessions for
committee members. To date, the MI PI Committee has reviewed 15 quarters of inpatient
and community data. The MI PI Risk Reduction Work Group met three times to review
incident related data and made recommendations to reduce client injuries and enhance
safety.

       The Inpatient PI Subcommittee met twice and had two conference calls. The
following items were discussed/actions taken:
 Revised forms to be more comprehensive and to capture requested data
 Upcoming NRI changes
 JCAHO tracer methodology
 2005 National Patient Safety Goals
 MHSIP Survey
 Mortality Review Process
 PPR Process

       The Community PI Subcommittee met March 16, 2005. Presentations on the
following topics were made to the committee:
 24 Hour and Special Incident Reporting
 New standards
 Clinical investigations
 Technical assistance visits


        The Return from Temporary Visit (TV) PI Workgroup met in January to review
Return from Temporary Visit annual summary data for 2003 and made revisions to the
data collection tool for the indicator.

        The MI PI Committee also provided oversight to the Community MHSIP Survey
process which was conducted for the third time in May, 2005. The Community MHSIP
Adult, Youth, and Youth Family Satisfaction, Adult Life Satisfaction and Family
Satisfaction Surveys were administered from May 9th to May 20th. Over 8500 surveys
were returned:
      3606 MHSIP Adult
      863 Family Satisfaction (NAMI Tool),
      3062 Life Satisfaction
      461 MHSIP Youth
      550 MHSIP Youth Family

       The MI PI Committee will review the results of findings at the November, 2005,
meeting. Data from the results of the MHSIP Adult and MHSIP Youth Family will be
submitted as part of the Block Grant Reporting requirements (URS Table 11). The Youth
and Youth Family survey results are being reviewed by the Child and Adolescent Task
Force, and any recommendations for improvement will be reported to the MI PI
Committee.

       The PI Office will coordinate the process for two “Independent Peer Reviews”
inJune and August, 2005. This year‟s peer review process focuses on review of Adult In-
home Intervention and Adolescent Adaptive Skills Training Program. Six different
community providers participated in the peer review process. The Community PI
Subcommittee will discuss methods to share findings from the peer review process with
other community programs throughout the state. Community Providers who have not yet
had an opportunity to participate in the peer review process have been identified and will
be contacted regarding participation in the process for the next fiscal year.

        The PI Committee reviews certification deficiencies each quarter to identify
trends/opportunities for improvement. The PI Office conducted five PI technical
assistance site visits to certified community providers between October, 2004, and June,
2005.

       The DMH/MR Office of Consumer and Ex-Patient Relations (OCER) brings the
mental illness experience and its related treatment experiences into the planning, policy
making, and operations of the Division of Mental Illness Services. The Office has three
major functions:

(1) To advocate and provide insight to the senior management teams of the Division of
    Mental Illness Services and other agencies;

(2) To provide technical assistance and consultation in the establishment and funding of
    consumer self-help networks, peer support/self help groups and consumer run drop-
    in centers;

(3) To promote the concept of recovery from mental illness.

        The Alabama Directions Council serves as the advisory board of the Office of
Consumer Relations. Its composition includes the presidents of local support groups and
drop-in centers around the state, as well as the Visionary Guild (for mentally ill artists),
CONTACT - Wings across Alabama (Wings), and the Alabama Minority Consumer
Council. The Council meets regularly to discuss important issues and to make collective
decisions about the direction of the consumer movement. The Directions Council also
plays a major role in planning the annual Alabama Recovery Conference and the funding
of local consumer run support groups.

        The Office of Consumer Relations coordinates the Annual Alabama Recovery
Conference. This year‟s conference was the 13th Anniversary with over 800 in
attendance, most of whom were consumers. In FY 05, the Acting Associate
Commissioner for Mental Illness, Division of Mental Illness Staff, and all facility
directors participated in the conference to assist consumers and make their stay as
pleasant as possible. In addition to visiting with consumers, these individuals served
meals, cleared tables, and removed trash. The Director of Nursing and doctors from each
state facility volunteered to be part of the Crisis Response Team.

       Through the leadership of the OCER and local consumer groups there are now 8
consumer run drop-in centers in various stage of development. Originally 10 groups
received developmental funding. Six programs are now in operation, with two more in
the development stage. The ninth program is currently inactive, and one program closed.

       The Alabama Minority Consumer Council (AMCC) is a statewide organization
formed to address the unique issues specific to the ethnic and cultural background of
minority consumers. It held the 5th Annual Retreat with approximately 80 in attendance.
Membership is open to all consumers. The Planning Council approved funding in the
amount of $8,000 to support the Alabama Minority Consumer Council activities
including the annual retreat. A representative from the Alabama Minority Consumer
Council serves on the Planning Council. The AMCC has provided outreach to the Asian
and Hispanic populations during the past year.

       CONTACT – Wings Across Alabama (Wings) was funded in FY04 as a result of
a statewide Request for Proposals. This organization provides consumer advocacy, an
external voice, and education on recovery, self-help, peer support, and consumer rights.
The organization is holding a series of town meetings around the state to obtain input
from local consumers on local issues and the planned future activities of the organization.
Meetings with excellent participation have already been held in Cullman, Opelika, Jasper,
and Birmingham. Meetings are scheduled in Mobile and Baldwin County during
September. Additionally, a representative of Wings made a presentation at the monthly
meeting of the Alabama Council of Community Mental Health Boards and at a NAMI
meeting.

        The Visionary Guild is a group of artists who have a mental illness. The
Visionary Guild promotes participation by consumers in creation of art and also supports
public display of consumer art. In the past the Visionary Guild, the Department, and the
Montgomery Museum of Art have collaborated to highlight consumer art by having a
special display at the Museum. This year the display is in the historic State Capitol and
has been advertised statewide. Each piece of art selected for display also has a brief
biographical description of the artist. Such displays contribute to addressing the stigma
associated with mental illness.

        Wings, the statewide consumer organization, and the National Alliance for the
Mentally Ill of Alabama (NAMI Alabama) continue as strong advocates at the local and
state levels. Both organizations are primary stakeholders, and are intimately involved in
the planning of mental illness services in this state. NAMI Alabama and Wings have
representation on DMH/MR‟s Management Steering Committee, the Mental Illness
Coordinating Committee, and the Child and Adolescent Services Taskforce. Consumers
and family members hold majority membership on the Alabama Mental Illness Planning
Council. In the past, a consumer and a family member have chaired the Management
Steering Committee.
       The Governing Body of the MI facilities and the MI Facilities Directors
Committee also have consumer and family member representation. Each group formed
by the Department to tackle specific problems and issues has consumer and family
member representation, including Wyatt Implementation Workgroups. Additionally,
consumer and family involvement is guaranteed through inclusion in the Alabama
Administrative Code, which has the force and effect of law. Consumers and family
members are also involved in resource allocation and service evaluation at the local
community mental health center level.

       The Rights Protection and Advocacy Program was expanded to the community in
FY1997 and continues to provide services to all clients served in community programs
operated by or under contract with the DMH/MR. Services provided include: information
and referral services; complaint intake, investigation and resolution services; participation
in certification reviews of community programs to ensure standard compliance;
unannounced monitoring of community residential and program areas; and rights
education and training.

        There are 26 FTE advocates who specialize primarily in either community or
facility responsibilities. A number of the advocates are family members or consumers.
Community advocates are no longer scheduled for routine certification visits, but conduct
random or for cause unannounced visits to community residential and day program
providers, now including foster care facilities. The Office of Advocacy Services has an
after-hours telephone response capability to address emergency rights-related issues and
also is notified of all community Serious Special Incidents within 24 hours of occurrence.

      The Office of Advocacy Services meets at least quarterly with the Advocacy
Advisory Board. It is represented on the Mental Illness Coordinating Subcommittee, the
MI Community Standards Committee, and other MI committees as needed. The
community and facility advocacy services are integral to the quality of services and the
Department‟s commitments.

Goal: Provide essential state hospital and community services for adults
with serious mental illness at the highest level permitted by the state
budget


Objective:     Reduce the capacity in state hospital acute care units

Population:    Individuals committed to or at risk of commitment to state acute care
               hospitals

Brief Name:    Census Reduction
Indicator:      The average daily census in the acute care units in FY06 compared to
                FY05

Measure:

                     FY03 Actual        FY04 Actual      FY05 Projected      FY06 Goal
Average Daily
Census in
Acute Care
Units

Source of Information:          State hospital data system

Significance: The state hospital acute care units have had census exceed capacity for
more than a year. A number of interventions have been developed and are beginning to
have a positive impact. The ultimate goal is to have the census be at or below the physical
capacity. An Acute Care Work Group was appointed by the Commissioner in July. The
charge of the subcommittee is to make recommendations for immediate actions as well as
to develop longer-term goals and strategies to achieve the desired system configuration.

                            National Outcome Measure
Objective:      85% of consumers will report positive general satisfaction scores

Population:     Individuals served by a community mental health center who complete a
                consumer or family member satisfaction survey

Brief Name:     Consumer Satisfaction

Indicator:      The percentage of consumers and family members completing a survey
                who report positive general satisfaction scores – numerator is the number
                who report positive general satisfaction scores; denominator is the number
                of consumers and family members who complete the survey

Measure:

                     FY03 Actual        FY04 Actual             FY05        FY06 Actual
                                                             Revised Goal
% Reporting              87.8               85.2                 80.0           85.0
Positive
General
Satisfaction


Source of Information:          MHSIP Survey Results – data based maintained by the
                                University of Alabama in Tuscaloosa
Significance: This measure is both a National Outcome Measure and an indicator
              tracked by the Department‟s Performance Improvement Committee. There
              is no more important measure than the satisfaction of consumers and
              families with the services received. The results of the survey are carefully
              assessed by the Performance Improvement Committee every year relative
              to developing improvement strategies. The goal was revised downward in
              FY05. However, it is anticipated that scores will be at least at 85%, so that
              remains the goal for FY06. Results are currently being compiled.

Objective:     Hold annual Consumer Recovery Conference

Population:    Primary consumers receiving community mental illness services

Brief Name:    Consumer Conference

Indicator:     Number in attendance

Measure:

                  FY03 Actual        FY04 Actual        FY05 Actual       FY06 Goal
# Attending       810                865                870               870
Consumer
Conference

Source of Information:        Registration for the conference

Significance: The Consumer Recovery Conference is an annual event drawing about
              850 consumers, presenters, and staff each year. It has grown to reach the
              maximum capacity at Shocco Springs Conference Center. The conference
              provides an opportunity to educate consumers as well as for them to
              socialize in a beautiful setting. The staff at Shocco Springs work very
              cooperatively with the Office of Consumer and Ex-patient Relations to
              provide good food, good fun, and excellent educational facilities. Each
              year the conference theme and keynote speakers are selected by an
              advisory group of consumers.


                              National Outcome Measure
Objective:     Maintain the rate of readmission to state psychiatric hospitals within
               30 days at or below the national rate and readmissions at 180 days at
               or below the xxxxxxxx

Population:    Individuals who discharged from a state psychiatric hospital

Brief Name:    Short-term Readmission Rate
Indicator:     The number of people who return within 30 days or 180 days from the
               date of discharge expressed as a percentage of the total number discharged
               from state hospitals

Measure:
                FY04         FY05            FY05            FY06            FY06
                Actual       National        Alabama         National        Alabama
                State Rate   Rate            Rate            Rate            Rate
% Readmitted    1.56%        8.0%            YTD xx                          <national
within 30                                                                    rate
Days
% Readmitted
within 180
Days

Source of Information:        National Research Institute provides the national public
                              rate for readmissions within 30 days. The
                              state hospital data system provides the Alabama rate based
                              on total number of discharges and those readmitted within
                              30 days and 180 days.

Significance: The readmission rate is both a National Outcome Measure and a state
              Performance Indicator. The short-term readmission rate is an important
              measure of how effective discharge planning is as well as how effective
              the re-integration into the community is.


Objective:            Maintain six operational consumer-operated drop-in centers.

Population:    Consumers who attend drop-in centers

Brief Name:    Drop-in centers

Indicator:     Number of drop-in centers and number of people served


Measure:

                             FY 03       FY04         FY 05             FY 06
                             Actual      Actual       Projected         Goal
Existing Drop-in Centers     10          10           8             6
Number Served                250         325          350           350

Source of Information:                Reports from drop-in centers contract files
Significance:                 Drop-in centers are a high priority to achieve the goal of
                              Recovery for consumers. At one time, 10 centers were
                              funded. One has closed, and three are still under
                              development. The goal reflects maintenance of currently
                              operational centers.

Objective:             Implement the Performance Improvement Plan for the MI
                       Division.

Population:            Hospital and community providers of mental health services,
                       consumers and families.

Brief name:            Performance Improvement.

Indicators:            Performance Improvement Committee meetings. Improvement
                       strategies identified and recommendations made to the Governing
                       Body. Implementation of the MHSIP Consumer Satisfaction
                       Survey.

Measures:              Dates of MI PI Committee and work group meetings. Smmary of
                       PI Committee recommendations including recommendations
                       resulting from the Community MHSIP findings. Meeting dates for
                       Community PI Subcommittee and agenda of educational and
                       informational topics. Reports on development/findings from joint
                       inpatient/community indicators.

Source of Information:        Records of Office of Performance Improvement.

Significance:          An active, consolidated PI Committee is integral to assuring the
                       highest quality in community and hospital services.


                            National Outcome Measure
Objective:      Maintain the 11 ACT Teams and 2 PACT teams currently in
                operation.

Population:     Individuals served by ACT and PACT teams

Brief Name:     ACT Teams

Indicator:      Number of ACT and PACT teams certified and in operation.
Measures:
                              FY03 Actual   FY04 Actual       FY05 Projected FY06 Goal
 # ACT Teams Certified
 and in Operation                 13               11               11               11
 # PACT Teams certified                             2                2                2
 and in operation

Source of Information:          Certification and contract files

Significance:                   The ACT and PACT teams represent a significant
                                investment in providing evidence-based services. The State
                                will increasingly rely upon evidence-based services to meet
                                the needs of consumers and family members.


Objective:      Provide anti-stigma public information

Population:     The general public

Brief Name:     Anti-stigma

Indicator:      The number of public education events and the estimated number of
                people impacted

Measure:        Quantification of the anti-stigma efforts as it may be represented in
                billboards, radio/television spots, printed material, or other forms of
                communication.

Source of Information:          Office of Public Information records relative to the number
                                of educational activities and the estimated number of
                                recipients

Significance: Stigma is cited by the President‟s New Freedom Commission as a
              continuing national problem and potential barrier to people seeking
              treatment. The Office of Public Information has implemented a billboard
              campaign and a series of public service announcements on television. The
              television ads were created in cooperation with the National Alliance for
              the Mentally Ill and NBC Channel 13 in Birmingham. The form and
              manner of the public education effort in FY06 has not been determined as
              yet.



Objective:      Collaborate with the Suicide Prevention Task Force to implement the
                Suicide Prevention Plan
Population:   Residents of Alabama

Brief Name:   Suicide Prevention

Indicator:    Implementation of activities recommended by the Suicide Prevention Task
              Force

Measure:      Participation in quarterly Suicide Prevention Task Force meetings, reports
              of activities implemented as recommended in the Suicide Prevention Plan

Source of Information:       Minutes of meetings, reports of activities sponsored by the
                             Task Force

Significance: Suicide prevention is one of the national goals cited in the President‟s
              New Freedom Commission Report. The Department has had a
              representative participating on the State‟s Suicide Prevention Task Force
              since 2003. She helped develop the Suicide Prevention Plan which is
              available through links on the Department‟s website. Each mental health
              center has designated a Suicide Prevention Coordinator. The
              Commissioner, the head of the Department of Public Health, and the
              Governor held a joint press conference to launch implementation of the
              Plan.


Objective:    Hire the Co-occurring Disorders Coordinator

Population:   Persons with co-occurring mental illness and substance abuse diagnoses

Brief Name:   Co-occurring Services

Indicator:    Joint funding between the Mental Illness and Substance Abuse Divisions
              to hire a Coordinator for Co-occurring Disorders

Measure:      Position announced and filled

Source of Information:       Departmental personnel records

Significance: The Co-occurring Disorders Task Force recommended hiring a
              Coordinator so that proper attention and administrative support would be
              available to implement the plan to develop an integrated service system
              for co-occurring disorders.

Goal: Revise certification standards to incorporate principles of person-centered
      treatment planning

Population:   Consumers served by certified providers
Brief Name:     Person-centered Planning

Indicator:      Standards Revised

Measure:        Revised standards are submitted to Administrative Procedures Office for
                incorporation into the Administrative Code

Source of Information:        Revised Standards Manual and Administrative Code

Significance: Treatment planning has been identified in past consumer surveys as an
              area of lower satisfaction scores. Significant effort has been expended to
              train staff on principles of person-centered treatment planning.
              Incorporation of the principles into the certification standards will
              complete the process.

Goal: Maintain expanded Advocacy Services

Population:            Consumers of DMH/MR operated/certified program.

Brief name:            Expanded Advocacy Services.

Indicator:             Staff positions funded and filled during the year

Measures:

Measure                       FY 2003         FY 2004        FY2005        FY 2006
                              Actual          Actual         Actual        Goal
# Staff positions             26              26             26            26

Source of Information:        Personnel records of the Office of Advocacy Services.

Significance:          Protection of consumer rights is a key element of the Wyatt
                       Settlement and of the Department‟s commitment to quality
                       services.
Criterion 2: Mental Health System Data Epidemiology

2.1 Contains an estimate of the incidence and prevalence in the State of
serious mental illness among adults and serious emotional disturbance
among children

2.2 Presents quantitative targets to be achieved in the implementation of the
system of care described under Criterion 1

  In FY 2005, the community mental health system is expected to serve at least 100,000
individuals with a mental illness diagnosis, of which 76,000 + state hospital will be
contract eligible adults and children and adolescents. This number represents the next
point in a continuing trend of increasing total number and contract eligible number served
in community programs. The chart below shows the steady growth in number of contract
eligible people served.
Double check data for chart
                                              SMI/SED Served


                   84000



                   82000



                   80000



                   78000
  SMI/SED Served




                   76000                                                       SMI/SED Served



                   74000



                   72000



                   70000



                   68000
                           98/99   99/00     00/01             01/02   02/03
                                           Fiscal Year
The following is a description of those individuals who are contract eligible:

Serious Mental Illness

A: Persons who meet the diagnosis and disability criteria for serious mental illness listed
below in Section 1 or who meet the criteria for high risk listed below in Section 2.

   Section 1: Persons who are Seriously Mentally Ill:
   Diagnosis: Any diagnosis listed below in combination with at least two criteria from
    the disability category:


   Schizophrenia and Other Psychotic Disorders

 295.xx    Schizophrenia.
.30        Paranoid Type
.10        Disorganized Type
.20        Catatonic Type
.90        Undifferentiated Type
.50        Residual Type
295.40     Schizophreniform Disorder
295.70     Schizoaffective Disorder
297.1      Delusional Disorder
298.8      Brief Psychotic Disorder
297.3      Shared Psychotic Disorder
298.9      Psychotic Disorder NOS


Mood Disorders (Major)

296.xx     Major Depressive Disorder
.2x        Single Episode
.3x        Recurrent
296.xx     Bipolar I Disorder
.0x        Single Manic Episode
.40        Most Recent Episode Hypomanic
.4x        Most Recent Episode Manic
.6x        Most Recent Episode Mixed
.5x        Most Recent Episode Depressed
.7         Most Recent Episode Unspecified
296.89     Bipolar II Disorder
296.80     Bipolar Disorder NOS

Anxiety Disorders (Severe)
300.01     Panic Disorder Without Agoraphobia
300.21     Panic Disorder With Agoraphobia
300.22     Agoraphobia Without History of Panic Disorder
300.3      Obsessive-Compulsive Disorder

    Disability: (must meet at least two criteria listed below as a result of one of the
    above diagnoses)

    1. Is unemployed, is employed in a sheltered setting, or has markedly
        limited skills and a poor work history.
    2. Shows severe inability to establish or maintain personal social support
        systems.
    3. Shows deficits in basic living skills.
    4. Exhibits inappropriate social behavior.

    Section 2: High Risk (must meet one of the criteria listed below):

    l. A person who has a history of DMH/MR supported inpatient or public residential
    treatment as a result of an Axis I mental illness diagnosis (excludes mental
    retardation and substance abuse)

    2, A person who without outpatient intervention would become at imminent risk of
    needing inpatient hospitalization.

B. An individual regardless of diagnosis shall be eligible for one intake per year and pre-
   hospital screening and crisis intervention as needed.



Prevalence Data

        The 2003 Center for Mental Health Services estimate of adults with serious
mental illness (SMI) is 182,488 with a range from 125,038 to 239,937 people. The
DMH/MR definition of Serious Mental Illness is more restrictive than the federal
definition in that the diagnostic categories are limited. The types of functional disability
are similar between the state and federal definitions. The Alabama public sector‟s priority
population is the SMI population that requires treatment and care outside the private
sector. This priority population is estimated at approximately 58,000 adults based on
annual rates-under-treatment. Assuming that all the people served by the hospital and
community system fall within the federal definition of serious mental illness, Alabama is
close to serving the number of people at the lower end of the estimated number. A total of
xxxx people with a mental illness diagnosis were served in the public sector.
Goal:           Maintain state policy that persons with serious mental illness are
                served as a top priority.

Population:     Adults with serious mental illness served in the public mental health system

Brief Name:     SMI Served

Indicator:      The number of adult persons with serious mental illness served in the
                community will be maintained within 95% of the FY05 actual level.

Measure:

                              FY 2000      FY2003      FY 2004     FY 2005      FY2006
                              Actual       Actual      Actual      Projected    Goal
        SMI Served            53,784       58,469      57,129                   xxxx

Source of Information:           The DMH/MR Central Data Repository

Significance:                    This goal measures the extent to which public funds are
                                 expended on persons most in need.




Goal:           Maintain the current access to care with respect to total number
                served in the community

Population:     People receiving public community mental health services

Brief Name:     Access to care

Indicator:      The total number of people served in the community will be maintained
                within 95% of the FY05 actual number served.

Measure:

    Measure             FY 2000      FY03           FY04          FY 05         FY06
                        Actual       Actual         Actual        Projected     Goal
    SMI Served          92,630       101,788        103,145       92,630        95,000

Source of Information:           The DMH/MR Central Data Repository

Significance:                    This goal measures the extent to which services remain
                                 accessible to residents of Alabama
Criterion 4: Targeted Services to Rural and Homeless Populations
4.1 Describes State’s outreach to and services for individuals who are
homeless

       Since February 1988, the Alabama Department of Mental Health /Mental
Retardation has used Mental Health Services for the Homeless (MHSH) Block Grant
funds available under the Stewart B. McKinney for services to people who are homeless
and seriously mentally ill. Programs for Assistance in Transition from Homelessness
(PATH) Formula Grant Program (P.L. 101-645) replaced the MHSH Block Grant
program. PATH funds allocated to Alabama increased to $437,000. This increase will
permit the State PATH contact and local provider staff to receive national training.
During FY05, Montgomery Area Mental Health Authority received an additional $25,000
in PATH funds to assist individuals in obtaining or maintaining housing. The Jefferson-
Blount-St. Clair Mental Health/Mental Retardation Authority also received an additional
$25,000 to add psychiatric nursing to its PATH program. The Indian Rivers Mental
Health Center also received an additional $25,000 to assist consumers in obtaining
housing in coordination with a Shelter Plus Care grant that provided additional HUD
vouchers.

        The target population for the grant funds is defined as “Individuals who suffer
from severe mental illness, or who suffer from co-occurring severe mental illness and
substance abuse disorders, and who are homeless or at imminent risk of becoming
homeless.” Homeless includes individuals who lack housing (without regard to whether
the individual is a member of a family), including an individual whose primary residence
during the night is a supervised public or private facility that provides temporary living
accommodations and an individual who is a resident in transitional housing. Imminent
risk includes individuals living in a doubled up living arrangement where the individual‟s
name is not on the lease, individuals living in a condemned building without a place to
move, individuals with arrears in rent/utility payments, individuals having received an
eviction notice with a place to move, individuals living in temporary or transitional
housing that carries time limits, individuals being discharged from a health care or
criminal justice institution without a place to live. Jails are excluded as an eligible setting
for provision of services supported by PATH funds.

         In regard to services for the homeless in rural areas, the original five PATH
programs were selected on the basis of population density on the assumption that
homelessness was a primarily urban phenomenon. Given limited PATH resources, the
greatest number of homeless mentally ill could be found and engaged in services in the
state‟s five largest urban areas. As the amount of the grant increased, the additional funds
have been awarded based on responses to a Request for Proposals. The other less
populous regions in the state, who do not receive PATH funds, would be hard pressed to
identify, locate, and engage in case management services sufficient numbers of homeless
persons who are mentally ill to fill a case load. What is available to the homeless
mentally ill in all mental health regions in the state are regular case managers for the
seriously mentally ill, who also serve the homeless who are mentally ill.
        ACT Teams assist consumers to locate and maintain stable living environments as
do In-home Teams. Ninety new residential slots were created in FY05. Additionally,
$250,000 in Housing Support funding is available in a statewide fund that all providers
can access to assist consumers with initial expenses associated with moving into stable
housing. Over the past three years, new HOME and Low Income Tax Credit units were
set aside at reduced rental rates for individuals with mental illness and mental retardation
through the Alabama Housing Finance Authority. To date, 451 units designated for
occupancy by consumers with mental illness or mental retardation have been constructed
with 401 occuppied. Additionally, housing is available at reduced rental rates through
underutilized USDA Farmers Home developments for individuals with mental illness,
mental retardation, or substance abuse.

In January, 2004, the Alabama Housing and Urban Development (HUD) Office through a
grant with the Alabama Department of Economic and Consumer Affairs (ADECA) and
Collaborative Solutions consulting firm initiated the formal development of a Balance of
State Continuum. Alabama Rural Coalition for the Homeless (ARCH) was established to
set priorities and seek opportunities to end homelessness in 47 counties of the state
without a local continuum of care organization. Persons with mental illness, substance
abuse, and co-occurring disorders were ranked as the top three priorities. This year
ARCH ranked two community mental health centers to receive priority funding.
East Alabama MHC was ranked first to receive $873,386 to provide supported
scattered site apartments. The primarily rural county of Autauga within the
Montgomery Area Mental Health Authority’s catchment area was ranked second to
receive $442,489 to also establish scattered site supported housing.

Goal:                  Maintain the number of homeless individuals with mental
                       illness served within 95% of the FY05 level.

Population:     People who are homeless or at risk of homelessness and have a mental
                illness

Brief Name:     Homeless Services

Indicator:      The number of homeless consumers with serious mental illness served
                during FY 2006.

Measure:

                                      FY 03     FY 04      FY05          FY06
                                      Actual    Actual     Revised       Goal
                                                           Goal
             # Homeless
             Receiving MI Services    2,633     2,965      1,700         2,500

                                                           Goal

                                                           GoalGoal
             Receiving
             Mental Illness
             ServicesRecReceiving
Source of Information:        Central Data Repository

Significance:                 PATH funds provide a small, but significant source of
                              revenue to provide special services in the most populous
                              areas of the State. Additionally, access to safe and
                              affordable housing for people with mental illness remains a
                              priority, particularly for those who would otherwise be
                              homeless. During FY05, the goal was revised substantially
                              downward based on data available at the time. Significant
                              effort has been expended to determine how to improve
                              accuracy in reporting. It is expected that the actual number
                              in FY05 will be higher than the revised goal.


4.2 Describes how community-based services will be provided to individuals
in rural areas
        The Alabama Department of Mental Health and Mental Retardation (DMH/MR)
has worked with local communities to develop a comprehensive system of twenty-four
community mental health centers (CMHC's) which provide an array of mental health
services to citizens in all 67 counties in the state. In all counties except two, full-time
offices have been established which provide court screening, diagnostic/evaluation and
therapy to residents as well as referral to the main office for more extensive services.

       In one of the counties, Coosa, which does not have a full-time satellite office,
there is an office available for a part-time staff person to provide court and jail
screenings, consultation with families and referrals on as needed basis. This staff person
also participates in probate court hearings concerning county residents. The major
population center of the other county (Colbert) is located in close enough proximity to the
large outpatient office of a neighboring county to make referrals. Thus, there is a
statewide infrastructure of community mental health services for rural as well as urban
residents in the state. These services are available and give priority to adults with serious
mental illness, as well as children and adolescents with serious emotional disorders.

      Medicaid coverage of the centers as providers of Non-Emergency Transportation
assists community mental health centers to maintain/expand transportation services,
particularly those in rural areas. The chart below shows the number of consumers for
whom transportation services have been billed to Medicaid in FY04 and FY05 YTD.
                     Medicaid Transportation Units (0ne/Consumer/Day)
                               Billed in FY04 and FY05YTD

            Center                           FY04                           FY05 YTD
Baldwin                                                   5223                             4053
CED                                                       2029                              769
Cahaba                                                   12519                             9559
Calhoun-Cleburne                                         20602                             9831
Cheaha                                                    3465                               30
Chilton-Shelby                                            4933                             3611
Cullman                                                   2841                             2736
East Alabama                                             30358                            21632
East Central                                              5197                             3944
Huntsville                                                9504                             6827
Indian Rivers                                             2470                             1360
JBS                                                       8056                             5696
North Central                                            22338                            15943
Mobile                                                   10751                            11336
Montgomery                                                9190                            12549
Northwest                                                27600                            24712
Riverbend                                                31809                            21146
South Central                                             6228                             5201
Southwest                                                17489                            12743
Spectracare                                              25048                            17001
West Alabama                                              6613                             4996
Total                                                   264263                           195675


        In order to determine if residents of the 11 most rural mental health centers are
being provided adequate community mental health services, an analysis of CMHC
services was completed which compared numbers of persons served from the 11 most
rural centers in the state to all persons served by CMHCs. In FY 99, the state number
served per 1000 population was 19.7 and the rural rate was 20.8. In FY 04, the state rate
was 22.6, and the rural rate was 24.7. Clearly, rural residents have at least equal access to
community mental health services.

       The Office of Deaf Services has partnered with Sprint to provide teleconferencing
equipment in each mental health catchment area. There are currently 25 units in place.
Due to the lack of qualified interpreters and the difficulty in quickly responding to the
need for interpreters, particularly in rural areas, these units will prove valuable in
enhancing access to services for all deaf/hard of hearing consumers. There is a
demonstration project involving access to psychiatric services via teleconferencing. It is
described in more detail in the Child and Adolescent Section. A long term goal is to use
the equipment provided by the Office of Deaf Services to enhance access to psychiatric
services and for staff training.


Goal:           Maintain access to care in the 11 predominantly rural catchment
                areas at or above the state average rate.

Population:     Persons in need of mental health services who reside in rural areas of the
                State

Brief Name:     Rural access to services

Indicator:      Rates of Persons Served per 1,000 population in 11 rural
                mental health centers

Measures:       CMHC Persons Served/1,000 Population


                   FY 2003           FY2004            FY2005              FY 2006
                   Actual            Actual            Revised Goal        Goal
11                 24.99             24.7              19.3                19.0
Rural Centers

State              21.96             22.6              16.9                16.0

Source of Information:                2000 Population Estimates, U.S. Bureau of Census
                                      and Central Data Repository

Significance:                         Because Alabama is a predominantly a rural state, it
                                      is important to provide equal access in service areas
                                      that are primarily rural. The target numbers were
                                      revised in FY05 based on rates at one point in the
                                      year. It is possible that data reporting problems
                                      account for the lower rates in service. The important
                                      factor is that rates/1000 in service in rural areas be
                                      at or above the average rate statewide.


Goal: Continue implementing the use of teleconferencing technology to support
      services for consumers who are deaf/hard of hearing in areas where
      interpreters are difficult to obtain
Population:      Consumers who are deaf/hard of hearing in areas where interpreters are
                 difficult to obtain

Brief Name:      Teleconferencing

Indicator:       Number of centers where teleconferencing equipment is installed

Measure:

                        FY03             FY04           FY05           FY06
                        Actual           Actual         Actual         Projected
# Centers with          0                7              25             35
Equipment

Source of Information:           Office of Deaf Services and CMHCs

Significance:                    The use of technology to enhance access to services will be
                                 critically important as a way to cost effectively deliver
                                 services in rural areas.
Criterion 5: Management Systems

5.1 Describes financial resources, staffing, and training for mental health
service providers necessary for the plan

        The proportion of the mental health budget allocated for community programs has
shifted dramatically since FY 1990 from 28.75% to an estimated 53.6% in FY 2004.
This fact is particularly significant since the overall budget has seen infusion of new
dollars from both state sources and the Medicaid program. The community budget grew
from $46.9 million in FY 1990 to an estimated $145.5 Million in FY04. The projected
figures for FY04 indicate that the respective percentages for facilities and community
programs will be 46.4% to 53.6%. The projection for FY06 is unknown at this time.
While more resources are always needed to do all that is desired, the Department has
been fortunate to not receive cuts in state appropriations at a time when the State is facing
severe funding problems. Many agencies have been eliminated from the state budget or
severely reduced. The FY06 budget includes an increase in state funds.

        Person-centered Treatment training was provided through a contract with the
Boston Center for Psychiatric Rehabilitation Services. A workgroup with representatives
from community mental health centers, Medicaid, the Office of MI Community
Programs, and the Office of Consumer and Ex-Patient Relations worked with the
consultant to develop a training manual and protocol to train all community mental health
clinicians in recovery-oriented person-centered treatment planning. The training was
completed in FY05. The next step is to incorporate the principles embodied in the
training into the certification standards.

        Block grant funds were used to support the 3nd Criminal Justice and Mental
Health Conference. The Conference brings national experts to the state to discuss best
practices relative to decriminalizing mental illness. In support of this goal, block grant
funds were also used to provide training to law enforcement personnel in Montgomery
where Judge Tracy McCooey initiated a Mental Health Court Advisory Committee
subsequent to the first Criminal Justice conference. She also operates a Mental Health
Court. Funds were also provided to the training center at Auburn University at
Montgomery to expand their crisis intervention training to other areas of the state so that
more law enforcement officers can participate.

       The Alabama Department of Mental Health/Mental Retardation contracts with
independent community providers for services. The providers must meet certification
standards for credential and staffing requirements in order to be paid under contract. The
credential requirements involve education and training requirements for key positions
such as Executive Director, Medical Director, Clinical Director, and program
coordinators as well as direct care clinical and case management staff. The Department
uses a standard rate setting methodology for residential services based on minimum
required staffing for each type of residential service. These staffing requirements are also
reflected in the certification standards. All state hospitals are accredited by the Joint
Commission on accreditation of healthcare Organizations as well as Medicaid and/or
Medicare, and thus meet national staffing and credential standards. Recruitment and
retention remain challenges for the publicly supported system, particularly in rural areas.
However, the providers have been able to do so in a manner that permits compliance with
regulatory requirements for the Department, Medicaid, and other national accrediting
bodies. CMHCs also maintain cooperative relationships with universities whereby
students complete the internship/practicum portion of their degrees within mental health
disciplines. When possible, these students are hired as employees.

        Psychiatrists remain in short supply in the state. The Department has guaranteed
employment for all psychiatric residents graduating from UAB in either a state hospital
or through the community mental health centers. In addition, the Department works
closely with the Department of Public Health in the Manpower Shortage Designation
process. Using a revised methodology, most areas of the state are designated as shortage
areas for psychiatric services to indigent consumers. The designated areas are eligible for
recruitment of J-1 psychiatrist and Public Health Service Corps staff.

        Block grant funds along with other funds continue to support the statewide
conferences for psychiatrists working in state hospitals and in community mental health
centers. These conferences provide a forum for communication between hospital and
community psychiatrists and for providing information on topics of mutual interest.

       The Planning Council has approved numerous training events by providing
funding for the event or by paying for attendance at the event as follows:

          Consumer conference
          Alabama Minority Consumer Council Retreat
          ACT and In-home Intervention Team training
          Family Ties Conference
          Psychiatric Institute
          Child Mental Health Institute. and NASMHPD Child/Family Annual
           Conference

        The DMH/MR Cultural Diversity Task Force identifies and addresses cultural
barriers to treatment in order to improve client care throughout the service delivery
system. The Task Force originated within the Division of Mental Illness, however it has
expanded to include representation from all DMH/MR divisions. Cultural Diversity and
Beyond training was implemented by the Cultural Diversity Task Force. This training
addresses treatment issues, skill building, and education and relationship issues. The
training is provided to new employees during orientation, and it is a part of the core
curriculum training at all DMH/MR facilities. It was expanded to include training of
community mental health centers and other social service agencies through a train-the-
trainer process. Additionally, the Minority Consumer Council identifies and addresses
issues specific to the ethnicity/culture of minority consumers. Membership is open to all
consumers
        DMH/MR has developed specific standards of care of people with hearing loss
that includes, among other things, requirements for identifying the hearing status of all
consumers. This has resulted in an increased demand for training from the Office of Deaf
Services. The staff, including the director and the regional coordinators, have provided
more than a dozen in-service workshops to community providers the past year on topics
covered by the standards, such as screening for hearing loss, Deaf Culture, modifying
services for people with minimal language skills, and treatment planning for people who
are deaf and hard of hearing. They have also provided consumer oriented training for
various consumer groups such as local associations of the deaf and at the annual
consumer conference. In addition, for the second straight year, they have conducted a
40-hour training for interpreters who work with mentally ill deaf consumers. This effort
has resulted in 50 interpreters having taken the training and 10 interpreters who have
completed a rigorous practicum and comprehensive examination to earn certification as
Qualified Mental Health Interpreters.

                              National Outcome Measure
Goal:           Complete an assessment of what changes in administrative
                infrastructure are needed to implement the SAMSHA Toolkits for
                Supported     Employment,     Medication      Algorithms, Family
                Psychoeducational Services, and Illness Self-Management

Population:           Community contract providers

Brief Name:           Evidence-based Practices

Indicator:            Creation of a committee to develop strategies for incorporation of
                      the SAMHSA Toolkits into practice via training, standards, and
                      contract provisions

Measures:             Recommended training, revisions to certification standards, and
                      contracts

Sources of Information:      Committee meetings, revised documents

Significance:         Adoption of evidence-based practices is a National Outcome
                      Measure as well as a goal in the Department‟s Strategic Plan.

Goal:                 Provide technical assistance and peer consultation
                      opportunities for ACT teams, PATH grantees, Psychiatrists,
                      and Clinicians Providing Services to Consumers with Co-
                      occurring Disorders

Population:           CMHC staff

Brief Name:           Training
Indicator:             Provision of at least one technical assistance/peer consultation for
                       ACT Teams and PATH grantees, Holding at least one Adult
               Psychiatric Institute, and Provision of co-occurring disorders
               familiarization training for community clinicians

Measures:      Schedule of training, sign-in sheets

Source of Information:        Division of Mental Illness staff records, SCATTC records

Significance: Having trained staff is an essential ingredient necessary for incorporation
              of evidence-based practices and provision of quality services.


5.2 Provides for training of providers of emergency health services
regarding mental health
        Law enforcement officials and other emergency health service providers receive
periodic training at both the state and local levels concerning how to relate to individuals
with serious mental illness. Community mental health centers consult with local jail
personnel on individual cases when requested or when it is known that an enrolled
consumer is in jail. NAMI Alabama has also provided ongoing training in local areas for
these types of service providers.

        The Department is the recipient of an All Hazards Planning Grant. A multi-
agency advisory group has been meeting over the last couple of years to develop an
integrated plan for mental health and substance abuse response to disasters. A draft plan
has been developed, and the Advisory Council was scheduled to meet August 23, 2005
for review and final approval. The meeting had to be re-scheduled due to the Coordinator
having a health emergency. The All Hazards grant lays the foundation for cooperatively
planning crisis response in conjunction with first responders from all areas of state
government. April Naturale, the Project Coordinator for New York City‟s Project Liberty
presented at the Council of Community Mental Health Boards annual meeting. She had
been scheduled to consult with the Advisory Council at the meeting that had to be
cancelled. The Department of Public Health has also brought this trainer in to provide
regional training sessions for Public Health social workers, local volunteers, and mental
health center personnel. These sessions were held during August, 2005. Additionally, the
Department of Public Health gave the Department a $50,000 grant to assist with
collaboration and training activities.

        During FY2005, the Coordinator of Adult Services within the Division of Mental
Illness spent a significant portion of her time during the first two quarters working with
the four mental health centers serving the areas declared as disaster areas by President
Bush after Hurricane Ivan hit. Training for the local teams was coordinated by a staff
member in the Substance Abuse Services Division in coordination with the Mental Illness
Division. Due to the widespread and extensive destruction, both Immediate Services and
Regular Services grants were submitted and approved. A federal site visit was conducted
with a positive response from the reviewer to presentations by each of the crisis outreach
teams. The Coordinator of Adult Services has participated in both general and specialized
crisis counseling response training.


Goal: Continue Implementing the Emergency Response Capacity State Plan

Population:    Citizens who experience a natural or man-made disaster

Brief Name:    Emergency Response

Indicator:     The Advisory Committee will approve the Plan, and work will
               begin/continue on achieving the Plan objectives.

Measures:      Meeting minutes re approval of Plan, reports of activities completed

Source of Information:        Minutes, reports from the Advisory Committee

Significance: It is imperative that state agencies and local providers be as prepared as
              possible to meet the needs of survivors when disaster strikes. Coordination
              of training and response activities in advance will reduce the likelihood of
              chaos when disaster strikes.


5.3 Describes the manner in which the State intends to expend the grant
under Section 1911 for the fiscal years involved
                                                                             Alabama 2005
                                                              Child and Adolescent Services
                                                                      Section 3: Criterion 5


                  CHILD AND ADOLESCENT SERVICES



A.     An overview of the State’s mental health system: a brief description of how the
       public mental health system is currently organized at the State and local levels,
       including the State Mental Health Agency’s authority in relation to other State
       agencies.
The Alabama Department of Mental Health/Mental Retardation (DMH/MR) was created
under Act 881 of the 1965 legislature. The Department is responsible for mental illness,
mental retardation, and substance abuse services. The Department is responsible for
operating state psychiatric facilities, establishing standards for community services, and
is empowered to contract for services.
There is one 20 bed state run impatient facility serving children and adolescents in
Alabama. The remaining services provided for children and families are community-
based services provided through contracts with private non-profit organizations or
through the Multiple Needs Child Office. Alabama has developed a comprehensive
system of care for the mentally ill that extends across the State. There are 24 community
mental health centers (CMHCs) serving the 22 mental illness regional areas in the state.
These centers are non-profit corporations operated by local governing bodies, referred to
as “310 Boards” (so named after Act 310 of the Alabama Legislature) or, in the case of
three centers, under contract arrangements with a 310 Board. In addition to the main
centers, services are available, or at least accessible, to each county through satellite
programs of the CMHC. As non-profit organizations, these centers provide services for
children and adolescents with severe emotional disturbances through contractual
arrangements with the Alabama Department of Mental Health and Mental Retardation
(DMH/MR), as Medicaid and Medicare provider organizations, through contracts with
other entities, and through support from local governments.

B.     A brief summary of areas identified by the State in the previous state plan as
       needing particular attention, including the significant achievements of the past
       year.

Critical gaps in services, as identified by the Child and Adolescent Task Force and
through a survey of parents of children with a severe emotional disturbance, that are
projected for the plan being submitted are: 1) Community/School-Based Day Treatment
Programs; 2) Work Force Development; 3) Transitional Services; 4) Co-occurring
Services; 5) Respite Care Services; 6) Collaboration with Pediatricians and Community
Mental Health Psychiatrists around appropriate Child and Adolescent Psychiatric Care; 7)
Telemedicine Mental Health Psychiatric Services.

In February, 2005, Commissioner Kathy Sawyer retired John Houston was the Acting
Commissioner from February until August when he was appointed on a permanent basis
                                                                               Alabama 2005
                                                                Child and Adolescent Services
                                                                        Section 3: Criterion 5
   by Governor Riley. Mr. Houston was previously the Commissioner‟s Executive Assistant
   and is familiar with Departmental operations. The Associate Commissioner for Mental
   Illness, Kim Ingram, left State service in Septermber, 2004. Her Executive Assistant was
   appointed the Acting Associate Commissioner until he left the Central Office to take over
   leadership of the Adolescent Unit at Bryce Hospital. Dr. Paul Bisbee, the Director of
   Mental Illness Facilities, assumed the responsibilities of Acting Associate Commissioner
   for Mental Illness until July 13, 2005. Mr. Otha Dillihay, the Associate Commissioner for
   Administration, assumed the duties of the Associate Commissioner for Mental Illness.
   The Executive Assistant to the Associate Commissioner position remains vacant. In
   addition, the Assistant Director of the Office of Performance Improvement position was
   vacant from March to August, 2005. The Coordinator of Child and Adolescent Services
   within the Office of Community Programs left in July, 2005. This position is currently
   vacant.

           Progress continues to be made in several areas:
          Census at Bryce Adolescent Unit stayed at or below capacity despite reduction in
           capacity.
          Held the second Child and Adolescent Psychiatric Institute.
          Implemented special projects approved by the Mental Illness Planning Council
           including numerous training and educational events.
          Held the largest ever statewide Alabama Family Ties Conference.
          Provided training to child and adolescent mental health professionals in the
           treatment of co-occurring disorders at a conference attended by more than 300
           professionals from all child-serving agencies.
          Continued work on Respite Care Grant.
          Continued work on telemedicine project.
          Continued Transitional Work Group.
          Started implementation of the DISC IV assessment pilot study.
          Added additional case management positions.

   C.      New developments and issues that affect mental health service delivery in the
   state, including structural changes such as Medicaid waivers, managed care, State
   Children’s Health Insurance (SCHIP) and other contracting arrangements.

   Will be expanded in final draft
      Children’s First Initiative through the Children’s First Foundation and
   Alabama Family Ties
       Change in fiscal intermediary for AllKids (SCHIP)
       Telemedicine project


D. Legislation initiatives and changes, if any
   The State continues to struggle with inadequate revenue to support state functions,
   including the Department of Mental Health and Mental Retardation. The Legislature was
                                                                                Alabama 2005
                                                                 Child and Adolescent Services
                                                                         Section 3: Criterion 5
   unable to pass a General Fund budget during its Regular Session. The budget passed
   during the July Special Session provides $189,059,549 in state funds, an increase of
   approximately $15,000,000.



E. A brief description of regional/sub-State programs, community mental health centers,
   and resources of cities and counties, as applicable to the provision of mental health
   services within the state.


   The Child and Adolescent Services section is staffed by two professionals, the
   Coordinator of Child and Adolescent Services and the Resource Specialist. The
   Coordinator of Child and Adolescent Services reports to the Director of Community
   Programs. The Resource Specialist is directly supervised by the Coordinator of Child
   and Adolescent Services.

   The public community mental health services system is based upon 22 service regions.
   There are twenty-two public, non-profit regional mental health boards (called 310 Boards
   based on the number of the Act that authorized their creation). The 310 Board is also a
   mental health service provider board. In Birmingham, the 310 Board provides adult
   residential and case management services and is the recipient of a federal Partnership
   Grant to develop and coordinate child and adolescent services within the region. There
   are twenty-four community mental health centers serving the 22 regions. There are three
   mental health centers, plus the regional mental health authority in Birmingham. In
   addition to these multi service centers, there are two specialty service providers: 1)
   Brewer-Porch in Tuscaloosa provides residential and out patient services for children and
   adolescents and 2) Glenwood Mental Health Services provides child and adolescent
   residential services and outpatient services for children, adolescents, and adults.


   These local providers use a variety of revenue to support their operations including city
   and county funds, United Way, AllKids, commercial insurance, Medicare, and Medicaid.
   The level of city and county support for these providers varies significantly across the
   state. In addition to contracting with the DMH/MR, providers may also enter local
   arrangements with the Department of Human Resources, the Department of Youth
   Services, and local education agencies.


   F. A description of how the State Mental Health agency provides leadership in
      coordinating mental health services within the broader system.


   As noted in other sections, the Department has entered into agreements with the Alabama
   Housing Finance Authority and the Medicaid Agency to produce increased services and
   revenue. The Commissioner is a Cabinet member. As such, he participates in Cabinet
                                                                             Alabama 2005
                                                              Child and Adolescent Services
                                                                      Section 3: Criterion 5
meetings and has the opportunity to coordinate services at the highest level. Services are
coordinated with other state agencies through the Planning Council, issue specific work
groups, and case coordination on an individual basis. Staffs at all levels of the
Department have daily contact with staff from other agencies and the general public for
purposes of providing, coordinating, or developing services or information.


The Commissioner attends the annual meetings of Probate and Juvenile Court Judges to
address concerns of these individuals who are statutorily responsible for making
decisions on involuntary commitment. A statewide conference on the topic of
decriminalizing mental illness, one of the special projects supported by the Planning
Council, is schedule for September, 2005.
 Staff of the Mental Illness Division also participate in law enforcement training, are
members of the state Suicide Prevention Task Force, and present at various meetings and
conferences including the Annual Conference of Community Mental Health Boards. The
MI Planning Council has representatives from the six state agencies with which mental
health services are coordinated. A member of the Planning Council representing NAMI
chairs the Medicaid Medical Advisory Committee. The Department coordinated closely
with all state agencies involved in the implementation of the Children‟s Health Initiative
program. As noted in Section D, the Planning Council and DMH/MR are well-
represented in state level Olmstead planning which involves all social service and health
provider agencies. The statewide anti-stigma campaign was implemented in part through
distribution of material to middle and high school students with the strong support of the
Superintendent of Education. The Mental Illness Division has actively pursued grants
which are directed to achieving gains in priority areas including use of evidence-based
practices.
A. Discuss the strengths and weaknesses of the service system.

The Department of Mental Health and Mental Retardation continues its efforts in
developing an integrated continuum of community-based, family driven mental health
system for families and children, yet the progress made is not uniform. As a result the
following strengths and weaknesses exist in the current children‟s mental health service
system.

Strengths:

   The Department has a close working relationship with other child-serving agencies, to
    include Medicaid, and has an active representative from each of these agencies
    serving on all of the planning bodies for child and adolescent services. These
    collaborative relationships have resulted in increases in the Medicaid reimbursement
    rates for providers and the development and joint funding of premier programs such
    as Daniel House at Glenwood and the STTEP Program at Brewer Porch.
   The Department has also been able to utilize a SAMHSA Child Initiative Grant site in
    Jefferson County as a “laboratory of learning” and expand the successes of this
    county throughout the state improving child and adolescent services and increasing
    the integrations of the service systems.
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    The growth and support of the Alabama Family Ties Network is the strength of the
    Alabama mental health system that has promoted the “family voice” at all levels of
    service development and implementation, as well as in the training of mental health
    professionals.
   The state of Alabama, like most states, continues to face fiscal challenges.
    Fortunately, for the children of Alabama, a portion of the state‟s Tobacco Settlement
    funds was earmarked for the development of child and adolescent services. These
    funds have allowed the Department to continue a small amount of growth in the
    children‟s mental health service system. These funds have been generally directed
    towards expanding the services available in rural Alabama.
   In December of 2002, the Department expanded the State Children‟s Insurance
    program to mirror the array of services available through the Medicaid Rehab Option.
    This expansion, called AllKids Plus, has resulted in insurance coverage for a wide
    range of community-based and non-traditional services for children up to 200% of
    poverty.

Weaknesses:

   Services targeting the unique needs of youth transitioning to the adult system are not
    well-developed in the state. Currently services provided to these individuals are
    pieced together from the two existing service systems, leaving emerging issues such
    as early employment training and housing issues inadequately addressed.
   Like the rest of the nation, Alabama is contending with work force development
    issues, specifically the high rate of turn over with child serving mental health
    professionals and the need for skill development in child and adolescent related
    treatment issues.
   The lack of sufficient mental health support service in the educational systems.
   The need to develop a system of care for adolescents with co-occurring disorders.

B.     Describe the unmet needs and critical gaps within the current system and
identification of the source of data, which was used to identify them.

The following map graphically depicts the services offered by the public mental health
system. As true in most states, some geographic areas are richer in service array than
others. Some of the gaps in the service continuum have been addressed with the
development of services funded through the Children‟s First Funds. Further development
of the continuum of care will be an ongoing challenge. Critical gaps in services, as
identified by the Child and Adolescent Task Force and through a survey of parents of
children with a severe emotional disturbance, that are projected for the plan being
submitted are: 1) Community/School-Based Day Treatment Programs; 2) Work Force
Development; 3) Transitional Services; 4) Co-occurring Services; 5) Respite Care
Services; 6)      Collaboration with Pediatricians and Community Mental Health
Psychiatrists around appropriate Child and Adolescent Psychiatric Care; 7) Telemedicine
Mental Health Psychiatric Services.
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                                                               Child and Adolescent Services
                                                                       Section 3: Criterion 5
A combination of sources was used to identify critical service gaps. For years, DMH/MR
has monitored the utilization of public mental health services through analyzing service
data reported to the Department. This data, in conjunction with periodic survey of the
providers, allowed the Department to identify trends in service utilization by the
consumers. Traditionally, the stakeholder representatives on the Child and Adolescent
Task Force provided to the Department ongoing feedback from the state as a whole.
Alabama Family Ties and the parents of children with SED who serve on the Child and
Adolescent Task Force are an integral part of this feedback process.

Another very valuable measure the Department has for identification of gaps in the
service delivery continuum is through its participation in the Case Review Committee of
the Multiple Need Child Office. This staffing occurs monthly with legislatively
mandated child-serving agencies charged with developing plans for children who have
multiple needs and who are at risk of placement in a more restrictive setting.


C. Discuss Alabama’s priorities and plans to address the unmet needs.

The Child and Adolescent Task Force and the Mental Illness Planning Council have
identified the following as priority unmet needs to be addressed in the coming year.
Work groups with state experts from a variety of child serving entities, to include family
members and youth, have been developed and will be making recommendations to the
MI Associate Commissioner for system improvements in the coming year. Specific
priorities to be addressed are the following:
 Workforce development and training.
 Service development for youth transitioning into the adult service system.
 Co-occurring disorders and statewide implementation of a comprehensive assessment
    tool.
 Collaborate with an existing ADAP work group to address school-based mental
    health service needs of children in Alabama.
 Collaborate with pediatricians and community mental health psychiatrists around
    appropriate child and adolescent psychiatric care.
 Collaborate with an existing public health/mental health work group to address
    telemedicine mental health psychiatric services.
 Service development of respite care services for children, adolescents and their
    families.
 EBT/Best Practices.

The following map depicts the child and adolescent services available in each county.

D. A brief summary of recent significant achievements that reflect progress towards the
   development of a comprehensive community-based mental health system of care.

See Section I. B. for discussion of recent significant achievements
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The net effect of these initiatives has been the expansion of the continuum of care. These
services are expected to facilitate access to and the navigation through the DMH/MR‟s
system, as well as the various state systems that children and adolescents with SED often
come in contact. By providing better coordination at entry and transitional points in the
system, it is anticipated that the service system will be more appropriate, effective, and
ultimately successful for the youth and their family.

E. Briefly describe the State public mental health service system as it is envisioned for
the future.

The Department of Mental Health and Mental Retardation (DMH/MR) continues to make
strides in developing a comprehensive system of care for children and families who
struggle with Serious Emotional Disturbances (SED). Beginning in the mid-eighties,
with the awarding of a federal initiative CASSP grant that facilitated the development of
a system of care for children and adolescents, DMH/MR has gradually moved toward
strategic growth of child and adolescent services through planning and resource
development. In an effort to develop a continuum of care that offers an array of services
at various levels of care, an emphasis has been placed on non-traditional service delivery
that truly meets the needs of the consumer, family and community. Services for children
and youth are complicated by developmental variables, legal status, educational
requirements, health factors, cultural factors, and living situations. The presence of a
serious emotional disturbance further complicates the need for and delivery of services.
Ethnicity may make a significant difference in use of mental health services, as well.

Children with serious emotional disturbance and their families frequently require, not
only mental health services, but services from special education, child welfare, public
health and/or juvenile justice. This need for multiple services from multiple agencies
necessitates the integration and coordination of programs and services, not only in the
service delivery arena, but also during the system planning process. As a result, the
mental health system must approach service delivery from a systems perspective.
Additionally, the mental health system needs to be a component of a tightly meshed
overall system of care that incorporates all child caring agencies and programs.

Much has been learned over the past 18 years of service development for children and
adolescents. The following core values have been recognized as essential for a public
mental health system of care for children and adolescents and are present in all planning,
designing, and implementation of child and adolescent service development activities
within the Mental Illness Division of the DMH/MR.

           The system of care must be child-centered and family driven. The needs of
            the child and family should dictate the types and mix of services available.
           The system of care must be community-based as much as possible. The
            system of care should embrace a philosophy of a community-based network
            of services and the provision of care in the least restrictive setting.
           Individuals with mental illness are first and foremost persons with basic
            human needs, aspirations, and desires; they are, at the same time, citizens of
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                                                                 Child and Adolescent Services
                                                                         Section 3: Criterion 5
            a community with all the rights, privileges, opportunities, and responsibilities
            accorded other citizens; and finally, they are individuals with a serious,
            disabling condition. Thus, these individuals should have access to supports
            and opportunities needed by all persons, as well as specialized mental health
            treatment and services dictated by their needs. They should also be
            integrated, to the extent possible, into normalized work, housing, learning,
            and leisure time activities in the community.
           The seriously mentally ill population is recognized as a diverse one with
            respect to needs, concerns, strengths, motivations, and disabilities.
            Therefore, an effective service system must be highly flexible with services
            provided in an individualized manner.
           Families are not viewed as the cause of mental illness. Rather they are
            recognized for their adaptive capacities and are provided assistance,
            information, and supports that respond to their concerns and needs.
           Consumer and family rights, wishes, and needs are paramount in planning
            and operating the mental health system. They are, therefore, involved
            individually at the treatment level and collectively at the system level in the
            decision-making processes, and the system is accountable to them.
           The service system is sensitive to members of minority, ethnic and racial
            groups, who have special needs, so that services are provided in a manner
            that respects and attends to those needs.
           For the majority of individuals, the community is the best place for long-term
            care. Inpatient care is a part of the array of needed community-based
            services, but should be used only as a last resort for short-term evaluation and
            stabilization and for the small number of individuals who may require long-
            term inpatient care.
           Local communities are the most knowledgeable regarding their particular
            environments, issues, gaps, strengths, and opportunities and, therefore,
            should be responsible for planning for local needs and for operating service
            systems within the framework of the comprehensive system determined by
            the state.
            Staff is highly regarded and valued who have the professional training,
            expertise, motivation, community organization skills, patience, assertiveness,
            and flexibility, needed to work effectively with individuals with a severe
            emotional disturbance.

The Child and Adolescent Programs, as well as the entire system of DMH/MR services,
shall also recognize as its customers, not only the clients and families it serves directly,
but also the citizens of Alabama who are represented by a multitude of individuals,
agencies, and organizations. The outcomes of the DMH/MR system shall also be
monitored and evaluated by the levels of satisfaction expressed by its customers.

The needs and responses of children and adolescents are different from those of adults
and will change over a relatively brief period of time due to developmental processes and
environmental influences. For children with a need for mental health services and their
families, immediate and future successes in life may be significantly influenced by those
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                                                               Child and Adolescent Services
                                                                       Section 3: Criterion 5
differences being recognized and addressed by qualified mental health professionals,
specially trained to assist children, adolescents and their families. A comprehensive
system of care must include community programs whose staff is knowledgeable in child
development, cultural issues, available mental health services, and traditional approaches
to treatment and current innovations in care. Through the development and
implementation of a plan for mental health services for children and adolescents with
serious emotional disturbance and their families, the Child and Adolescent Section of the
Strategic Plan proposes the following:

         1. Examine the information and research data acquired in the past several years
            and improve mental health service delivery to children and their families
            accordingly.
   .
         2. Develop a system of care that is family driven and child centered, with the
            needs and best interests of the child and family always of primary
            importance.

         3. Develop a system of care which results in more appropriate referrals to
            service providers, allowing them to more frequently serve the clients for
            whom the program was designed and with which they are most successful.

         4. Ensure that a system of care is in place so that all of the multi-agency
            services utilized by the client will be more efficient and more effective.

         5. Develop a system of child mental health services which is integrated into a
            comprehensive continuum of services that responds to a child‟s physical,
            emotional, social and educational needs including those served by
            education, juvenile justice, child welfare, and health agencies.

         6. Develop a system responsive to the social, economic, cultural, relocation
            and ethnic forces that effect child and adolescent development.

         7. Develop a system with flexibility in funding, decision-making, service
            delivery and structure to ensure responsiveness to child and adolescents and
            their families as their needs change.

With all of the focus on “systems”, it is critical not to lose perspective. The plan for
services must be a plan for “individualized services”. No matter the quality or quantity of
services, success is unlikely if the services are not appropriate and timely for the
individual child and family. The challenge for the community is to constitute a system
that focuses on the individual while allowing smooth movement and continuity of care
through and among providers.

                    Organized Community-Based System of Care
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                                                               Child and Adolescent Services
                                                                       Section 3: Criterion 5
The community mental health care system in Alabama is composed of a network of 24
community mental health centers serving Alabama‟s 67 counties or 22 regions. There are
22 non-profit regional area boards charged by Alabama statute with the responsibility of
determining the needs and services of their assigned geographic areas. Services funded
through the DMH/MR are provided by or through these regional mental health boards
through a contracting mechanism. A more detailed description of this structure can be
found in the Section 1 of this application.

Planning for children and adolescent services is performed as a part of the overall
Management Steering Committee process described in the Adult section of the
application via a Child and Adolescent Services Task Force. The Task Force is
constituted from a representative group of stakeholders, including advocates and family
members. This body assesses the needs of the state, designs the conceptual framework,
and prioritizes strategic growth of child and adolescent services for the DMH/MR Mental
Illness Division. This work is expressed in the Child and Adolescent Task Force Three
Year Strategic Plan 2005 - 2007.


                             Minimum Continuum of Care

The Levels approach to a minimum continuum of care for mental health services
delineated in 1985 by the Alabama CASSP Definition Committee and revised in 1998
and 2004 by the Strategic Plan Workgroup provides a sound framework for prioritizing
service development and expansion. The structure (by delineating statewide, regional,
and local levels) intends to strike a realistic balance between a minimal service set,
economy of scale, and fiscal reality. It is assumed that DMH/MR, in conjunction with
the community mental health centers, will not necessarily create and/or operate the total
system, but will exhibit the leadership necessary to assure development, effective
operation, and coordination. The continuum as envisioned is as follows:
Level I: (Community/County-Based)
               Diagnosis and Evaluation (screening)
               Outpatient (Individual, Group, Family)
               Family Support (Consultation, education, training, networking to
               build a support system)
        Level II: (Community/Catchment Area-Based)
               Diagnosis and Evaluation (comprehensive)
               Case Management
               Day Treatment
               Respite Care
               In-Home Intervention
               Behavioral Aide
               Child and Adolescent Psychiatric Services
        Level III: (Regional/Shared)
               Respite Care Beds
               Crisis Residential
               Residential Treatment
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                                                             Child and Adolescent Services
                                                                     Section 3: Criterion 5
              Acute Hospitalization
       Level IV: (Statewide)
              Short Term Treatment and Evaluation Program (STTEP)
              Bryce Hospital Adolescent Unit

                      Mental Health and Rehabilitation Services

Alabama continues to develop a comprehensive system of care for children and
adolescents with serious emotional disturbances that extend across the state. In addition
to the main offices in the 24 community mental health centers, services are available in
most of the state‟s 67 counties through the satellite programs of the CMHCs. The
services available vary across the catchment areas (See table below).

              Children and Adolescent Services by County Survey
                            (Conducted by DMH/MR)

                             SERVICE TYPE
       PROVIDER
                               OPT    LIAISON   CASE     INHOME       DAY     RESID.   CRISIS
                                                MGMT     INTERV.     TXMT
(1) Baldwin County MHC         X        X         X         X        C/A                 X

(2) Calhoun-Cleburne
Calhoun                        X        X         X                  P/C                 X
Cleburne                       X        X         X                                      X
(3) Cahaba MHC
Dallas                         X        X         X         X                            X
Perry                          X        X         X         X                            X
Wilcox                         X        X         X         X                            X
(4) CED MHC
Cherokee                       X        X         X                                      X
Dekalb                         X        X         X                                      X
Etowah                         X        X         X         X         C                  X
(5) Cheaha MHC
Clay                           X        X         X                                      X
Coosa                          X        X         X                                      X
Randolph                       X        X         X                                      X
Talladega                      X        X         X                                      X
(6) Chilton-Shelby MHC
Chilton                        X     X            X                                      X
Shelby                         X     X            X         X         C                  X
                             SERVICE TYPE
PROVIDER
                               OPT    LIAISON   CASE     INHOME       DAY     RESID.   CRISIS
                                                MGMT     INTERV.     TXMT
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                                      Child and Adolescent Services
                                              Section 3: Criterion 5
(7) Cullman MHC           X   X   X   X                           X

(8) East Alabama MHC
Chambers                  X   X   X   X       C/A                 X
Lee                       X   X   X   X       C/A                 X
Russell                   X   X   X   X       C/A                 X
Tallapoosa                X   X   X   X       C/A                 X
(9) East Central MHC
Bullock                   X   X   X                               X
Macon                     X   X   X                               X
Pike                      X   X   X                               X
(10) Huntsville-Madison   X   X   X   X       C/A                 X

(11) Indian Rivers MHC
Bibb                      X   X   X   X                           X
Pickens                   X   X   X   X                           X
Tuscaloosa                X   X   X   X                           X
                                               C         X        X
(12) Brewer-Porch
(13) J-B-S MHA            X   X   X   X                           X
                          X
(14) Eastside MHC
                          X
(15) Western MHC
                          X                    A
(16) UAB MHC
(17) Gateway              X                   X          X
                          X                 P/C/A        X        X
(18) Glenwood MH
(19) Marshall-Jackson
Jackson                   X   X   X   X                           X
Marshall                  X   X   X   X                           X
(20) Montgomery MHA
Autauga                   X   X   X   X                           X
Elmore                    X   X   X   X                           X
Lowndes                   X   X   X   X                           X
Montgomery                X   X   X   X                           X
(21) Mobile MHC
Mobile                    X   X   X   X       C/A        X        X
Washington                X       X                               X
(22) North Central MHC
Lawrence                  X   X   X            P                  X
Limestone                 X   X   X                               X
Morgan                    X   X   X   X        C                  X
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                                                       Child and Adolescent Services
                                                               Section 3: Criterion 5

PROVIDER                 SERVICE TYPE
                          OPT     LIAISON   CASE   INHOME      DAY      RESID.   CRISIS
                                            MGMT   INTERV.    TXMT
(23) Northwest MHC
Fayette                   X         X        X       X         C/A                 X
Lamar                     X         X        X       X                             X
Marion                    X         X        X       X                             X
Walker                    X         X        X       X         P/C                 X
Winston                   X         X        X       X                             X
(24) Riverbend MHC
Colbert                   X         X        X       X          P                  X
Franklin                  X         X        X       X          P                  X
Lauderdale                X         X        X       X          P                  X
(25) South Central MHC
Butler                    X                  X                                     X
Coffee                    X                  X                                     X
Covington                 X         X        X       X                             X
Crenshaw                  X                  X                                     X
(26) Southwest MHC
Clarke                    X                  X                                     X
Connecuh                  X         X        X                                     X
Escambia                  X         X        X                                     X
Monroe                    X         X        X                                     X
(27) West Alabama MHC
Choctaw                   X         X        X       X                             X
Green                     X         X        X       X                             X
Hale                      X         X        X       X                             X
Marengo                   X         X        X       X                             X
Sumter                    X         X        X       X                             X
(28) Wiregrass MHC
Barbour                   X         X                                              X
Dale                      X         X        X                                     X
Geneva                    X         X                                              X
Henry                     X         X        X                                     X
Houston                   X         X        X       X                             X

                                Abbreviations
Opt – Outpatient                Mgmt – Management
Interv – Intervention           Txmt – Treatment
Resid – Residential             C – Child
A – Adolescent                  P – Preschool
FC – Family Court

                                Current Services
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                                                                       Child and Adolescent Services
                                                                               Section 3: Criterion 5
The overall number of children and adolescents served by the mental health system has
grown dramatically over the past 14 years. In 1987, a total of 10,246 children and
adolescents were served in the community programs under contract with DMH/MR
throughout the state. In FY04, this number has steadily increased to 23,744.

The number of units of service provided to this population has also grown dramatically
and in fact at a faster rate than the increase in the number served. Service units increased
in FY04 by over 20,000 units. Below is a chart reflecting the growth in service units.
UPDATE CHART




              Total Community Service Units to Children and Adolescents



           450,000


           400,000


           350,000


           300,000


           250,000


           200,000


           150,000


           100,000


            50,000


                 0
                     91   92   93   94   95   96   97   98   99   00   01   02   03
                                              Fiscal Year


Services included in the service units calculation include: individual, group, family,
intake, testing, court screening, doctor, medication monitoring, medication
administration, emergency, basic living skills, family support, treatment plan review,
consultation, case management, day treatment, in-home intervention, residential, respite.




                                Community Based Services
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                                                             Child and Adolescent Services
                                                                     Section 3: Criterion 5
The services eligible for reimbursement for the children and adolescents who are severely
emotionally disturbed throughout the state, via contractual relationships between the
Department and the 310 Boards, are shown below. Many of these service categories
apply to adult and child populations.



              Mental Illness Ambulatory Services

       1. Intake/Evaluation
       2. Diagnostic Testing
       3. Individual Counseling or Psychotherapy
       4. Group Counseling or Psychotherapy
       5. Family Counseling or Psychotherapy
       6. Crisis Intervention and Resolution
       7. Pre-Hospitalization Screening/Court Screening
       8. Physician/Medical Assessment and Treatment
       9. Medication Administration
       10. Medication Monitoring (Non-Physician)
       11. Child and Adolescent Mental Illness Day Treatment
       12. In-Home Intervention
       13. Mental Illness Basic Living Skills
       14. Family Support Education
       15. Treatment Plan Review
       16. Mental Health Consultation



                      Case Management Services

       17. Case Management



                             Residential

       18. Child/ Adolescent Residential Care
       19. Child/ Adolescent Residential Care – Severe
       20. Child/ Adolescent Diagnostic and Evaluation Residential Care

As noted in the Context section to the Children and Adolescent Plan, in 1985 components
of a minimal continuum of care were delineated. As funds become available, services
have been developed and funded in a manner consistent with the approach and
philosophy first identified in 1985. Child and adolescent service expansions in FY95,
FY97, FY99, FY01, FY02, FY03, FY04, and FY05 are the most recent examples.
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                                                              Child and Adolescent Services
                                                                      Section 3: Criterion 5
In FY01 the following services were funded: 1) a Transition and Support Service for
adolescents being stepped-down from the state hospital to the community; 2) re-
establishment of crisis residential services in the southern part of the state, 3) an In-
Home Intervention team pilot project that serves dually diagnosed (MI/MR) children, and
4) eleven (11) Court Liaison positions that will assist the juvenile courts with
coordinating services for children and adolescents for which DMH/MR has
responsibility.

In FY02 and FY03, eleven (11) more Court Liaison positions were funded, as well as
three more In-Home teams for dually diagnosed children and adolescents. In a
collaborative project with the state‟s Juvenile Court and Child Welfare system, DMH/MR
pooled funding with the other two agencies and issued an RFP for children‟s services and
programs aimed at the needs of the local communities. The proposals submitted under
this initiative, referred to as OUR KIDS, total more than six million dollars and were
reviewed by a statewide representative body, which included all child serving state
agencies, as well as members of a statewide family advocacy group. Seventeen programs
covering 31 counties were funded and the types of services funded include In-Home and
community based services for the dually diagnosed, transitional services for youth
leaving the juvenile justice system, a short–term assessment home, a mentoring program,
and an after school day program. Two additional child and adolescent case managers
were also funded in FY03 in rural MHC catchment areas where these services previously
did not exist.

In FY04, consultation and training for CMHC general psychiatrist‟s and local community
pediatricians and primary care physicians around child and adolescent mental health
“best practices” was funded. This effort was aimed at making CHMC psychiatrists,
pediatricians, and primary care physicians more comfortable with serving this unique
population and provide a consultation resource for those providers with complex child
and adolescent cases. The first Child and Adolescent Psychiatric Institute was held in
February 2004, targeting community mental health center psychiatrists. The Children‟s
First dollars received in FY04 also allowed for two more FIND teams and two case
managers to be added to rural areas previously without access to these services.

In FY05, the second Child and Adolescent Psychiatric Institute was held in July 2005,
focusing on training and consultation offered to community mental health psychiatrists
around “best practices” information regarding the treatment of children and adolescents
with severe emotional disturbances. A partnership occurred with Department of Public
Health which allowed for expansion of this training institute to include pediatricians. In
FY05, it was determined that the implementation of a standardized assessment process
was needed to be a foundation building step in the development of a child and adolescent
mental health system of care. Dr. Gail Wasserman from Columbia University was
identified as a national expert with whom to consult on this project and to assist in the
planning of the pilot project and statewide implementation. Columbia University
provided consultation and training on the VOICE DISC IV for five pilot projects which
will begin implementation in FY06. The MI Division applied for and received a
Medicaid Real Choices Planning and Feasibility Grant in October of FY04 that allowed
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                                                              Child and Adolescent Services
                                                                      Section 3: Criterion 5
for the development of a Task Force and the hiring of a Project Director through
Alabama Family Ties to perform the oversight of this service development. It is
anticipated that, in FY06, four pilot projects through community mental health centers
will be implemented. The Children‟s First dollars received in FY05 also allowed for five
case managers to be added to rural areas previously without access to these services.

                                  Case Management

Through the implementation and evaluation of two federal Community Support Program
(CSP) grants which provided brokerage type case management services to adults who
were seriously mentally ill (1983), and adults who were homeless and seriously mentally
ill (1987), and an Office of Substance Abuse Program (OSAP) local demonstration grant
which focused on case management to children and adolescents with serious emotional
disturbances (1987), the Alabama DMH/MR was ready in FY88 to begin statewide
implementation of case management services. The demonstration grants provided
expertise and techniques to organize and deliver effective case management services, as
well as staff with the training skills to disseminate the service statewide.

Two events converged to give impetus to the development of case management services
in FY88. One was the funding of a CSP systems development grant which provided
funding support for training 100 new case managers in the state. The other critical event
was the addition of the Targeted Case Management Option to the Alabama Medicaid
Plan beginning on October l, 1988. Optional Targeted Case Management provided a new
funding source specifically for services to adults who are seriously mentally ill (SMI),
and children and adolescents who have serious emotional disorder (SED).

Children and adolescents with serious emotional disturbances are provided case
management services in several ways in the state. First, there are Family Integration
Network Development (FIND) projects currently operating in ten of the state‟s twenty-
two mental health regions, which include dedicated case managers and two-person in-
home intervention teams. The in-home teams also provide case management services as
part of their 12-week intervention. A number of other mental health regions have a total
of thirty two designated children's case managers. Children and adolescents may also
receive case management from qualified CMHC staff who has been cross-trained in the
delivery of case management to both adults and youth. In FY04, 3,534 children and
adolescents received case management services from DMH/MR case managers, a number
that increases each year.



Hospitalization

The inpatient beds operated by the Mental Health system in Alabama for adolescents are
located at Bryce State Hospital Adolescent Unit serving the state‟s child and adolescent
population, which totals approximately 1.1 million. In March of 2004, the original 40
bed unit for adolescents at Bryce Hospital was reduced to a 20 bed unit. While this
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reduction was in part a cost saving measure, it was possible because of the significant
census reduction experienced by the unit over the past 14 months. A total of 62
adolescents were served at the Adolescent Unit at Bryce Hospital during FY04. This
number represents a significant decrease over the past few years attributable to the
expansion of community services and the development of a new service referred to as a
Juvenile Court Liaison. Juvenile Court Liaisons work closely with the state child and
adolescent services staff, with the sole mission of appropriately diverting mental health
and juvenile court commitments in lieu of more appropriate community based services.
Children or adolescents are not placed in out-of-state programs by DMH/MR, Division of
Mental Illness Services.

In order to support the emphasis on community services in lieu of placement in state
inpatient facilities, efforts will be made to (1) maintain the comprehensive diagnostic and
evaluation services at Brewer-Porch and residential services at Daniel House (an
intensive residential service program for children with severe emotional disturbance), (2)
develop adolescent crisis residential/ evaluation centers in the southern part of the state,
and (3) maintain at a minimum the current level of services present in the continuum of
care. UPDATE CHART


                              Bryce Adolescent Unit - Admissions & Number Served




   140


   120


    100


     80


     60
                                                                                                 Admissions
                                                                                                 Number Served
     40


      20


          0
              1996                                                          Number Served
                     1997
                            1998
                                   1999                                   Admissions
                                          2000
                                                 2001
                                                         2002
                                                                 2003
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                              RESIDENTIAL CARE:

While residential services do not exist in all catchment areas, there is access statewide to
the following components:

Short Term Treatment and Evaluation Program (STTEP):
A 10 bed short-term treatment and evaluation program fills gaps in the service system for
comprehensive evaluation outside of inpatient psychiatric hospitals. STTEP offers
comprehensive diagnostic and evaluation services and short-term (7-90 days) residential
treatment to the statewide population of children and adolescents, ages 5-12 years, with a
serious emotional disturbance. This program is jointly funded by the Department of
Mental Health and Mental Retardation and the Department of Human Resources.

Children’s Residential Treatment:
One intensive residential program, located in Birmingham, serves children with serious
emotional disturbances from across the state, ages six through twelve. A program located
in Mobile has 12 contract DMH/MR beds and serves the southern portion of the state.
This program serves children as well as adolescents and has been able to resume crisis
stabilization and evaluation services to the southern portion of the state. In addition, the
program for adolescents, in Dothan, which served a total of 8 adolescents, closed in
FY05.


                                 SUPPORT SERVICES

As described earlier, a comprehensive system of community mental health services is
being developed for seriously mentally ill adults and children and adolescents with
serious emotional disorders. The primary mental health service that ties clients to other
needed services is case management. Case managers through their assessment of client
needs, development of comprehensive service plans, and linkage of clients to needed
services through referral, active assistance and advocacy, and monitoring of service
utilization are responsible for assuring access to the broad range of needed community
services.

Consumer outcome research conducted as part of the program evaluations of
demonstration case management programs for adult SMI, homeless SMI, and SED
children and adolescents in the state have all found case managers to be successful in
significantly increasing the use of the broad range of services needed by clients.
Research results also suggest that the level of functioning of clients increased with the
increased use of services. These outcomes suggest that increased participation in a
variety of needed services not only improve the quality of life of clients, but can also
increase the adaptive functioning of clients in areas of everyday life that are critical to
their community tenure. The following are the types of health, rehabilitation, education,
housing, medical and support services that, in addition to mental health services
described earlier, are needed in order for clients to function in their home communities.
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              MEDICAL AND DENTAL HEALTH CARE SERVICES

For consumers who are Medicaid or Medicare eligible, almost every type of medical care
is provided. Very often the only barrier to service is finding providers who serve
Medicaid clients. Other, non-Medicaid eligible clients have typically exhausted health
care resources such as insurance, and must rely on health care available in their
community on an indigent basis. Typically, local Public Health clinics and community
health centers are the main referral resources used by case managers to meet the primary
health care needs of their clients. Local hospitals provide a very limited amount of
inpatient care to indigent clients. Because of historical practices among indigent clients,
many emergency rooms provide the only primary health care some clients get.
Individuals with mental illness have wrestled with the health care issue for years and in
general this is one of the few areas where children and adolescents fare better than the
adults. For example, Medicaid benefits for persons under 21 can exceed usual limits
when indicated by the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Program. Children and adolescents in the care of DHR and DYS receive medical care
from these agencies, as well as through school nurses where available. In addition to
coverage by Medicaid, dental services are covered by AllKids, Alabama‟s SCHIP
program.

In FY01, DMH/MR participated in a task force convened by the Medicaid State Agency
in an effort to address dental care needs of Alabama‟s children. The focus was on an
expansion of dental care services and an increase in the reimbursement rates for dental
services. This task force also developed a marketing plan which included attending
professional dental association meetings and meeting with local dentists as a group and
individually to encourage them to see children and adolescents or increase the number of
children receiving dental care at their facilities.

Typically case managers access dental care though local dentists, public health clinics
and community health centers. In FY 02, the Governor, in conjunction with Public
health, held a medical and dental care forum for service providers in a further effort to
ensure dental services are available throughout the state though Medicaid, or on a sliding
scale fee basis.

Additionally, child and adolescent case managers are trained to identify and monitor the
medical and dental care needs of the consumer and access care as needed. They are
frequently successful in tapping into local community resources to pay for medical and
dental services as well as persuading a local practitioner to take on a “pro bono” client.



                        Children’s Health Insurance Program

Alabama was the first state to receive approval of their plan to implement the CHIP
program under the new federal legislation. This plan has been implemented in phases:
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(1) Medicaid Expansion of the SOBRA coverage for youth ages 14-19, effective
February 1, 1998, (2) Benchmark Health Insurance for children, ages 0-19, in families
between 100% and 200% of poverty, effective September 1, 1998, and (3) a self insured
“special needs” package of services.

The third phase was implemented by a coalition of agencies – Public Health, Mental
Health, Children‟s Rehabilitation Services, and BC/BS. The mental health component of
the Children‟s Health Insurance Program, referred to as ALL Kids, was expanded in
December 2002 and now mirrors the services available through the Rehab Option for
those eligible for Medicaid.

                            OTHER SUPPORT SERVICES

While the linkage of clients to the broad range of needed support service is primarily the
function of brokerage-type case managers in the state, other mental health providers,
including day program, residential, and clinical staff also routinely perform the functions.
Below are listed some of the resources generally available to a person with serious mental
illness and children and adolescents with serious emotional disturbances.


Income: SSI and/or SSDI checks provided by the Social Security Administration are the
main source of income for a large number of adults and youth in our system of care.
With SSI eligibility comes Medicaid eligibility which opens the broad range of mental
health rehabilitation and case management services as well as medications. Similarly,
SSDI eligibility, after a waiting period of two years, results in Medicare eligibility, which
covers some mental health and most medical care (no medication). SSI/Medicaid
eligibility in Alabama also qualifies eligible clients for the Food Stamp Program. Youth
with serious emotional disturbances (SED) often qualify for Temporary Assistance for
Needy Families (TANF) administered by the Alabama Department of Human Resources
(DHR).

Education: The State Department of Education is responsible for educational services
for children and there are over one hundred school systems in the state. Case managers
and in-home intervention teams employed by the CMHCs have frequent contact with the
educational system on behalf of the children with a serious emotional disturbance and
families that they are serving. In FY99, the educational system identified a portion of At-
Risk funding to develop school day treatment programs in conjunction with community
mental health centers. This initiative enabled 10 additional community-based child and
adolescent day treatment programs to be established statewide.

Case managers and CMHC clinical staff assess their client‟s educational strengths and
deficits and link clients to training and other services necessary to enhance their
educational status. A variety of services are available to meet the individual educational
needs of adolescents transitioning into adulthood including adult education, literacy
training, and specialized vocational and training services provided by the Department of
Vocational Rehabilitation Services (VRS). For children and adolescents with a serious
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emotional disturbance, case managers and clinical staff have available the array of special
education services provided within the educational system, as well as day-treatment
programs which also contain a school component, or alternative school programs
provided in other settings by mental health centers, the Department of Youth Services
and some private, non-profit agencies.


Substance Abuse: A major gap in the current system of care for children and
adolescents is coordinated care for individuals with co-occurring mental illness and
substance abuse problems. Often programs and services are not available due to
eligibility rule-outs in their admission criteria, or complex funding requirements may
hinder access to coordinated substance abuse and mental health services.

One of the major responsibilities of the newly developed Office of Children’s Services
is the planning and development of programs and services across the Department’s
three divisions: Mental Illness (MI), Mental Retardation (MR), and Substance
Abuse (SA). The funding, in FY01 and FY02, of a Juvenile Court Liaison for each
community mental health center catchment area is an example of an initial effort to
improve the service capacity and flexibility in addressing co-occurring disorders. Since
the juvenile court is frequently where children and adolescent with co-occurring disorders
first enter the system, the Juvenile Court Liaison will assist the court in assessing the
individual and make appropriate treatment recommendations. They will also be
responsible for linking the youth and their family members to needed services, to include
substance abuse services. Significant further efforts are needed and will be undertaken in
coordination with the Office of Children‟s Services.

The Mental Illness Division also recently collaborated with the Substance Abuse
Division and a local community in an effort to begin planning for an integrated service
system. A group of representative members from these groups, as well as Department of
Youth Services, submitted an application and was selected as an attendee of National
Policy Academy on Improving Services for Youth with Mental Health and Co-occurring
Substance Abuse involved in the Juvenile Justice System, sponsored by the National
Center for Mental Health and Juvenile Justice. As a result of this effort, a state task
force is being developed to begin state wide planning and development and a SAMSHA
Child and Adolescent Co-Occurring Infrastructure Grant application was submitted. At
the local level, the child serving agencies in Jefferson County is in collaboration with the
state agencies and the Southern Coast ATTC in an effort to begin co-occurring awareness
training for case managers, probation officers and line staff from Family Court. This
training will begin in October of 04 and will continue throughout the fiscal year.
The outcomes from the trainings in Jefferson County will be used in developing the
training plan for the other 66 counties in Alabama.

Transportation: A new limited transportation voucher system was implemented by the
Alabama Medicaid Program for all recipients for non-emergency transportation to assist
recipients in attending their respective programs. In FY01, the Alabama Medicaid
Program and DMH/MR entered into an agreement to reimburse transportation of
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consumers to rehab option services in further effort to eliminate barriers to mental health
treatment.

Housing/ Employment Transitional Services:
As part of the overall Housing initiative outline in the adult section, it is anticipated that a
small number of housing units may be identified and developed to assist with transition
services from child and adolescent services to adult services (18-21 years of age). Due to
the unique developmental, social, and educational/vocational needs of the 18–21 year old
consumer population, it makes sense to offer residential services that are designed to
address these needs programmatically. Strategic planning of this resource will be part of
the overall Wyatt settlement planning efforts.

The DMH/MR service delivery system recognizes adults at 18 years of age. A consumer
is eligible for all adult services if they also meet the SMI criteria. At present, there is a
gap in the service delivery system around residential and day treatment needs. This
appears to be not one of eligibility on the part of the young consumer, but rather a
perceived inappropriateness based on the developmental issues of each consumer
population. This transitional population (18 – 21) presents with additional challenges in
regards to legal status. Often these consumers may be under the jurisdiction of a juvenile
court until they are 21, or in the legal custody of the Department of Human Resources.
System wide accommodation will take some time. Until then, consumers who have needs
greater than outpatient and case management are handled on a individual basis.

An emerging issue for child and adolescent mental health services is the unique unmet
needs of those adolescents transitioning from the child mental health system and entering
the very different adult mental health system. In an effort to better address these needs, a
work group has been developed by the Child and Adolescent Task Force, which includes
adult advocates and mental health professional and planners from adult services. The
recommendations resulting from this group‟s effort will be submitted to the Associate
Commissioner for consideration and it is anticipated the housing and employment will be
a central issue to be addressed by this work group.

                             Community Advocacy Services:

Beginning in FY97, a network of community advocates were hired system-wide to
respond to alleged rights violations for persons with serious mental illness receiving state
supported services. These advocates have also been responsive to the children and
families with SED who receive state-supported services, but the need for and advocacy
group devoted to the efforts of promoting children‟s mental health issues was evident. In
2000, the Alabama Family Ties organization was funded with a federal grant. The
Department has embraced this advocacy and support group for families and has
incorporated them into all planning and development efforts. DMH/MR has also
supported Alabama Family Ties financially by providing funds annually for each of the
annual family advocacy conference and to support attendance by family members at state
and national conferences. This year, the MI Division and community mental health
center staff organized and supervised a youth activities track which ran concurrent with
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                                                                Child and Adolescent Services
                                                                        Section 3: Criterion 5
the sessions for parents and family members at this event.     It was a well-received, and
plans are already being made for next years youth track.

                  Parent and Family Networking Grant Application

As indicated previously, the state of Alabama has recently begun to accelerate its focus
on the needs of children and youth including those with a serious emotional disturbance.
This is evidenced by: (a) the Multiple Needs Child Legislation, (b) Children First
Legislation, (c) Child Health Insurance Program (CHIP), (d) strategic planning efforts by
the Mental Illness Division‟s Child and Adolescent Task Force and (e) advocacy efforts
by multiple groups targeting different aspects of services for and needs of children.

For many years, no unified statewide presence existed to represent and advocate
specifically for children and adolescents with a serious emotional disturbance and their
families. While many of the existing groups were active participants on mental health
related statewide planning committees, a need was very evident to foster the development
of a collective representation that could participate on behalf of children with a serious
emotional disturbance and their families across all agencies (e.g. juvenile justice, child
welfare, education, health care). A need existed, therefore, for a coalition of families and
various advocacy groups to facilitate collaboration among families, advocates, and other
child-centered coalitions and organizations.

Funded in October 1998, a grant from CMHS for a Statewide Family Network resulted in
the creation of Alabama Family Ties (AFT), a coalition of parents, family members, and
existing groups and organizations. In addition to the planning involvement, the grant will
also foster skill development of the groups in the areas of leadership and advocacy, as
well as business principles and practices. The coalition has designed a Strategic Plan
based upon the needs of the children and their families with the outcome of improved
visibility and enhanced awareness of issues affecting children with a serious emotional
disturbance and their families.

A board was created as per Articles of Incorporation and is composed primarily of family
members. Alabama Family Ties is located in Montgomery, the capitol of the state, due to
its proximity to the legislature, state agencies, and other statewide organizations.

Alabama Family Ties is beginning to fill a distinct weakness in the system development
structure: the absence of an organized independent family voice that is consistently
present and involved. It is critical that families have a voice when discussions are held
and decisions are made that individually and collectively impact their children and their
families. Alabama Family Ties will be that voice and the catalyst for a chorus of voices.
Alabama Family Ties is present on the MI Planning Council, the Child and Adolescent
Task Force, the Mental Illness Coordinating Subcommittee, and the Children‟s Advisory
Committee. Do we put other committees? If so, the Department of Human
Resources Quality Assurance Committee and the Department of Public Health
Allkids Advisory Committee.
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                                                             Child and Adolescent Services
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Goal: Provide essential community services for children and adolescents at the
highest level permitted by the state budget.

Performance Indicator:      Maintain case management services as measured by
                            number of recipients.

Population:                 Children and Adolescents with SED who receive case
                            management.

Criterion:

  Fiscal Year                    FY 03         FY 04         FY 05            FY06
                                 Actual        Actual       Projected         Goal
  # Case Man. Recipients         3,503         3,534          3,600           3,600



Goal:    To develop a mental health services system that is community-based,
individualized and family driven.

Performance Indicator(s):   Continue to Support Alabama Family Ties Annual
                            Conference.

Population:                 Children with SED and their family members.

Measure:                    Funding allocated for conference, attendance at
                            conference, conference evaluations,


Goal: To serve children and adolescents in the least restrictive yet clinically
appropriate setting.

Performance Indicators:     Maintain the number of youth served at the state adolescent
                            psychiatric unit at or below the number served in FY 2003.

                            Maintain the rate of readmission at the state psychiatric
                            hospital within 30 days and 180 days at or below the
                            national rate.

Population: Children with SED.

Criterion:

Fiscal Year                 FY 2003          FY 2004         FY 2005           FY2006
                             Actual           Actual         Projected          Goal
                                                                               Alabama 2005
                                                                Child and Adolescent Services
                                                                        Section 3: Criterion 5
 # Admitted to Bryce               69              42              42               <69



                                  FY05          FY05          FY06             FY06 State
                                  National      Alabama       National         Rate (Goal)
                                  Rate          State Rate    Rate
 30 day readmissions rate
 180day readmission rate

 ________________________________________________________________________
 Goal: To maintain 70% or better youth and family satisfaction report on the
 MHSIP Survey.

 Performance Indicator:        % of general overall satisfaction reported in MHSIP
                               survey.

 Population:                   Children with SED and their family members completing
                               the MHSIP Satisfaction Survey.

 Criterion:

 Fiscal Year                    FY 03            FY 04           FY 05             FY06
                              ReReResults
                                Actual           Actual         Projected          Goal
 Performance Indicator          70.2%             84%             80%              80%

                               PROGRESS/PERSPECTIVE

The following definition was revised and approved in August 1996, by the DMH/MR
Children and Adolescent Taskforce. The revised definition became effective October 1,
1996.

               DEFINITION OF SERIOUS EMOTIONAL DISTURBANCE/
                 DESCRIPTION OF CONTRACT ELIGIBLE CLIENTS
                        (CHILDREN AND ADOLESCENTS)

 For the purposes of this agreement/definition a child or adolescent is an individual, age
 17 years or less, and a legal resident of the state of Alabama. To be eligible for contract
 services he/she must meet the following criteria for (I & II) or (I & III):

 I.     Diagnosis

        Must have a DSM-IV Axis I diagnosis. A primary diagnosis of a “V” code,
        substance use, or mental retardation does not meet criteria.
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       However, for the purposes of Medicaid Rehabilitation and Optional Targeted
       Case Management match payments, individuals do not have to meet the criteria
       listed above, but must, of course, meet Medicaid requirements.

       By policy, responsibilities for persons who are diagnosed with Autism and who
       have dual mental illness and mental retardation diagnoses fall under the
       jurisdiction of the Division of Mental Retardation within the DMH/MR.

II.    Separated from Family (Out-of-Home Placement)

       Separated from family due to a child or an adolescent‟s admission to, residing in,
       or returning from an out-of-home placement in a psychiatric hospital, a residential
       treatment program, therapeutic foster care home, or group treatment program as
       the result of a serious emotional disturbance.


III.   Functional Impairments/Symptoms/Risk of Separation

       Functional impairment is defined as a behavior or condition that substantially
       interferes with or limits a child or adolescent from achieving or maintaining one
       or more developmentally appropriate social, behavioral, cognitive,
       communicative, or adaptive skills. Functional impairments of episodic, recurrent
       or continuous duration are included unless they are temporary and expected
       responses to stressful events in the environment.

       Must have A or B or C as the result of a serious emotional disturbance:

       A.     Functional Impairment

              Must be of one-year duration or substantial risk of over one year duration.
              Must have substantial impairment in two of the following capacities to
              function (corresponding to expected developmental level):

              1. Autonomous Functioning: Performance of the age appropriate activities
              of daily living, e.g., personal hygiene, grooming, mobility;
              2. Functioning in the Community - e.g., relationships with neighbors,
              involvement in recreational activities;
              3. Functioning in the Family or Family Equivalent - e.g., relationships
              with parents/parent surrogates, siblings, relatives;
              4. Functioning in School/Work - e.g., relationships with peers/teachers/co-
              workers, adequate completion of school work.

       B.     Symptoms
              Must have one of the following:
              1. Features Associated with Psychotic Disorders
              2. Suicidal or Homicidal Gesture or Ideation
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         C.                  Risk of Separation
                             Without treatment there is imminent risk of separation from the
                             family/family equivalent or placement in a more restrictive treatment
                             setting.

                                            Community Programs
                                                 FY04

                                      Overall Total Served (MI) – 103,145

 SMI Adult (Contract Eligible) –57,129
                                        SED (Contract Eligible) – 19,466




The number of children and adolescents served over the past few years has steadily
increased as shown in the figure below. While we are unsure as to the factors contributing
to this phenomenon, it is important to note that total community units of service have
continued to increase for the SED population in the state, as well.


                          Unduplicated Count of Children and Adolescents Served by
                                           Community Programs

                          28,000

                          26,000

                          24,000

                          22,000

                          20,000

                          18,000
          Number Served




                          16,000

                          14,000

                          12,000

                          10,000

                           8,000

                           6,000

                           4,000

                           2,000

                               0

                                                         Fiscal Year
                                                                             Alabama 2005
                                                              Child and Adolescent Services
                                                                      Section 3: Criterion 5

UPDATE CHART



                                     PREVALENCE

 UPDATE THIS SECTION if new federal received

 The URS Table 1 of the number of children and adolescents with serious emotional
 disturbance shows Alabama ranked in a High state tier for percentage of children age 5-
 17 in poverty at 17.5%. The estimated number between 9 and 17 with a Level of
 Functioning score of 50 ranges from 39,994 to 51,421. At a score of 60, the estimated
 range increases from 62,848 to 74,275. In FY03, the total number of children and
 adolescents under the age of 17 served by public community mental health providers was
 27,004. Many children with serious emotional disturbance are served in the private
 sector, by the Department of Human Resources, by the Department of Youth Services,
 and by educational agencies. There is no way to access complete data on all children with
 serious emotional disturbance served in the state.

 In the past prevalence rates of serious and persistent emotional problems in children and
 adolescents were estimated to be five to nine percent. There are newer estimates ranging
 from 9 percent to a high of 25 percent. This increase can most likely be attributed to
 national improvements in assessment and identification. Applying the most conservative
 of the revised prevalence rates to Alabama‟s 2000 census data for populations‟ ages 0-17
 would project 101,107 children and adolescents in need of mental health services. Of this
 group, Robert M. Friedman of the University of South Florida suggests that the public
 mental health sector should anticipate a need to provide services for 1.2% of this
 population. Applying the 1.2% estimate to the 2000 Alabama population ages 0-17
 would project a target penetration rate of 12,133.


 Goal: To maintain accessibility to treatment for children and adolescents with a
 severe emotional disturbance.

 Performance Indicator:       Increase access to services by increasing the number of
                              children and adolescents served each year.

 Population:                  Children with SED.

 Criterion:

    Fiscal year                    FY 03         FY 04         FY 05       FY06
                                   Actual        Actual       Projected    Goal
    Total Served                   24,279        23,744        24,000      24,000
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                               Interagency Collaboration

A variety of avenues have been utilized in the ongoing attempts to provide a system of
integrated services. In 1986 an interagency agreement creating the Interagency Council
on Youth (ICOY) was signed by all five state child-serving agencies to cooperate on
improving services to children. In 1987, an interagency agreement was negotiated and
signed with DYS, which governed the referral and assessment of problematic cases,
which in the past had frequently resulted in protracted legal battles. In 1988, DMH/MR
entered into an agreement with DHR to jointly fund three Family Integration Network
Demonstration Projects (FIND). These projects consisted of in home intervention and
case management operated through a CMHC. The FIND programs serve children with
serious emotional disturbances and their families who are generally involved with
multiple agencies. Currently, there are twenty-five such jointly funded teams across the
state.    Since this first cooperative funding venture with DHR, the two agencies
(DMH/MR and DHR) have jointly funded the Short Term Treatment and Evaluation
Program (STTEP) and Daniel House. STTEP is designed to provide evaluation and
short-term treatment for children who had previously been hospitalized or were at risk of
hospitalization. Daniel House provides residential treatment for children who in the past
would frequently have been placed in an inpatient unit or in a residential program that
would not encourage family involvement. Admissions to these programs are jointly
screened by the agencies involved.

A Joint Task Force of DHR and DMH/MR was established in 1991 to address
problematic interagency issues. The Task Force established subcommittees to work on
conflict resolution procedures, cross-agency training, promotion of coordination at the
local level, and planning for future needs. In 1993, the Alabama Legislature passed the
amendments to the Juvenile Justice Act, otherwise known as the Multi-need Child
Legislation. Patterned after the “clusters” in Ohio, the Act requires the establishment of a
State Facilitation Team, and facilitation teams in each of Alabama‟s 67 counties. At a
minimum, the agencies mandated to participate include Education, Human Resources
(welfare), Public Health, Mental Health, and Youth Services (juvenile corrections).
Currently, the local teams and the state team meet monthly to discuss programmatic and
funding issues in an effort to effectively serve the neediest children in the state. The
Mental Illness Division continues to support maintenance of effort of $544,000 each year.

The Mental Illness Division was extensively involved in the design and implementation
of the plan for the Children‟s Health Insurance Program (CHIP). A special needs
package was developed in 2000 which expands the mental health services available.
Under the revised plan a package of services equivalent to the Medicaid Rehab Option,
mental health services is now available to CHIP/ALL Kids eligible children and
adolescents.

The Department collaborated with the state Department of Education in the development
of an RFP and review of proposals for collaborative day treatment programs. Local
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education associations applied for funding in cooperation with local community mental
health centers. Ten systems received grants of $50,000 each to develop the day treatment
programs. These programs are completing their fourth year of operation. A number of
school systems, in conjunction with local CMHCs, applied for federal funding under the
Safe-School grant initiative.

In a collaborative project with the states Juvenile Court and Child Welfare system,
DMH/MR pooled funding with the other two agencies and issued an RFP for children‟s
services and programs aimed at the needs of the local communities. The proposals
submitted under this initiative, referred to as OUR Kids, total more than six million
dollars and were reviewed by a statewide representative body which included all child
serving state agencies, as well members of a statewide family advocacy group.
Seventeen programs covering 31 counties for a total of almost three million dollars were
funded. Types of services funded include In-Home and community based services for the
dually diagnosed, transitional services for youth leaving the juvenile justice system, a
short–term assessment home, a mentoring program and an after school day program.

A key component of the integrated services system is the child and adolescent case
management services provided in each community mental health catchment area that is
multi-agency in scope and function. The case management services not only increased
the access of children, family members, and caregivers to the array of needed services,
but also facilitated movement among and through services based on the child‟s needs.
Linkages to needed services and programs beyond the mental health related service
system has also been developed through a state mandated child serving agency cross-
training for all child and adolescent case managers. This training includes a presentation
from Alabama Family Ties, the state parent network, on their organization and the parent
perspective of service delivery.

In an effort to assist the Department of Education in addressing the educational needs of
the children of Alabama the Department also collaborates with the Special Education
Action Committee to provide a one-day training to all child and adolescent mental health
professionals on services provided to individuals and families under the Individuals with
Disabilities in Education Act (IDEA). Further, the Coordinator of Child and Adolescent
Mental Health Service is serving on a statewide committee which is developing a state
plan which will focus on the need for the mental health support services in educational
settings.

In FY04, in a collaborative effort between the Mental Illness Division and the Substance
Abuse Division and the Department of Youth Services, the Department also began to
develop a state plan to address the needs of children and adolescents with co-occurring
disorders including participation in a National Policy Academy sponsored by the
National Center for Mental Health and Juvenile Justice. To further these collaborative
efforts, the Mental Illness and Substance Abuse Division jointly submitted SAMHSA
Child and Adolescent Co-Occurring Infrastructure Grant. The funding of the submitted
grant will permit the Department to aggressively implement the state plan, which
resulted from attending the National Policy Academy.
                                                                            Alabama 2005
                                                             Child and Adolescent Services
                                                                     Section 3: Criterion 5



While the Department recognizes the need for an integrated service system with a wide
array of options available to families, the uses of block grant funds for mental health
services in FY 06 are based on the Department‟s 2005-2007 Strategic Plan and will not
be expended to provide any services other than comprehensive community mental health
services. The one-year planning goals were developed and targeted to the mission of the
mental health system, which is to provide an appropriate continuum of treatment services,
in the least restrictive environment, to the following priority populations: Children and
adolescents (aged 17 years or less) who are Seriously Emotionally Disturbed with
impaired role functioning resulting from mental illness.

Specifically, funds will be allocated to continue the support of outpatient services and
eleven Family Integrity Network Demonstration (FIND) programs for SED youth. These
programs are located in Birmingham, Montgomery, Selma, Gadsden, Decatur, Jasper and
Mobile. The FIND program encompasses two basic service elements as follows: (1) two
person in-home intervention teams; and (2) case management services. FY 06 block
grant funds will also be used to sustain outpatient services available to children and
adolescents through the system of community mental health centers across the state.

Goal: To provide improved mental health screening for children and adolescents.

Performance Indicator:       Implement pilot test on use of DISC IV as a screening
                             instrument in five areas of state.

Population:                  Children with SED and their family members.

Measures:                    Training of staff, number of instruments administered,
                             results of assessments.

Goal: To identify and develop an implementation plan for at least one nationally
recognized best or recommend practice.

Performance Indicator:       One best practice identified by C and A Task Force with
                             written recommendations for implementation.

Population:                  Children with SED and their family members.

Measures or Criterion:



Goal: To maintain or increase the number of FIND or Intensive In-Home
Intervention teams currently in operation as this service has been identified as an
emerging best practice in child and adolescent mental health treatment.
                                                                        Alabama 2005
                                                         Child and Adolescent Services
                                                                 Section 3: Criterion 5
Performance Indicator:    Number of Intensive In-Home teams currently trained
                          and providing services.

Population:               Children with SED and their family members.

Criterion:

 Fiscal Year                FY 03         FY 04         FY 05             FY06
                          ReReResults
                            Actual        Actual       Projected          Goal
  In-Home Intervention        20           28             28               28
  Teams
  teams
Goal: To insure well-integrated service delivery for SED youth with multi-agency
involvement.

Performance Indicator:    Maintain expenditures for shared funding of services for
                          Multiple Need Children.

Population:               Children with SED and their family members.

Criterion:

 Measure                  FY 03         FY 04       FY 05            FY06
                          Actual        Actual      Projected        Goal

 Expenditures             544,503       544,503     544,503          544,503


Goal: To eliminate funding barriers for SED youth and increase access to mental
health services.

Performance Indicator:    Maintain the number of children served with AllKids Basic
                          or Plus at the FY04 level.

Population:               Children with SED and their family members.



Measure                   FY 03         FY 04       FY 05            FY06
                          Actual        Actual      Projected        Goal

Number Served             1,211         1,509        1,600           1600
                                                                                Alabama 2005
                                                                 Child and Adolescent Services
                                                                         Section 3: Criterion 5
SERVICES TO HOMELESS INDIVIDUALS

It should be noted that children and adolescents are served, when part of a homeless
family, by PATH case managers and by specialized children's case managers in the
mental health regions, which have dedicated children's case management. The major
provider of homeless services for children and adolescents is the Department of Human
Resources (DHR), the child welfare agency. Runaway youth are also identified and
referred for other mental health services, including case management by runaway shelters
located across the state. The DMH/MR staff also participates in the training of the state‟s
law enforcement personnel. Since the police are frequently the first to encounter
runaway youth, a considerable amount of time is allocated for discussion of identification
and referral for mental health services.


SERVICES TO INDIVIDUALS RESIDING IN RURAL AREAS

Services available to children and adolescents in rural areas will be maintained, and
efforts will be made during the year to increase services by equal inclusion of rural areas
in the implementation of legislation for the "Multi-Need Child”. In May of 2001, each
county facilitation team received funds under the Children‟s First legislation to assist
with wrap-around services for children in their county. The amount of these varied as a
function of their 2000 census for children and adolescents under 18 years of age. In
regard to “mini grants” awarded to county facilitation teams under the previously funded
CASSP Infrastructure Grant, all counties had equal access to grant funds.

In order to assess the delivery of services to children and adolescents with a serious
emotional disorder in rural regions, the twenty-two mental health regions in the state
were divided into eleven urban and eleven rural regions based on population density of
the regions from the 2000 census. Rural mental health regions are defined as those in
which more than 50% of the catchment area population resides in places having 2,500
people or less. The table below lists the eleven rural mental health regions and the
number of children and adolescents in the region who were SED and who were served by
the local mental health center during FY 04. A total of 19,466 children and adolescents
who were SED were served by the local mental health centers during FY 04, and 6,405 or
32.90% were served in the eleven rural regions. This relationship indicates that children
and adolescents with serious emotional disorders in rural regions continue to have the
same access as in previous years. The two most frequently identified areas of need in
rural areas are transportation to needed services and child and adolescent psychiatric
services. Medicaid coverage of transportation services should assist in maintaining
treatment access in rural areas.


In FY 05, the Department submitted a SAMSHA Child Initiative Grant for three counties
in the western portion of the state. If awarded, the grant will increase services available to
this largely rural population. Currently, services in rural area are being expanded with the
                                                                                Alabama 2005
                                                                 Child and Adolescent Services
                                                                         Section 3: Criterion 5
use of Children‟s First dollars with rural areas targeted for most of the continuum
development efforts.


UPDATE CHART



                         Rural Regions       # of SED
                                           Served FY 04
               North Central Alabama                  926
               North West Alabama                     841
               Cheaha                                 390
               West Alabama                           496
               Cahaba                                 614
               East Central Alabama                   614
               Southwest Alabama                      539
               South Central Alabama                  135
               Marshall - Jackson                     544
               Baldwin County                         914
               Cullman County                         392
                                     Total          6,405
                    Total SED Served               19,466
                 % Rural of Total SED             32.90%
                    Served Statewide


Goal: Maintain accessibility of children and adolescent services in the rural areas
of the state at the FY03 level.

Performance Indicator:        The percentage and the number of children and adolescents
                              with serious emotional disturbances served in the rural
                              community will be maintained at the FY 04 level.

Population:                   Children with SED.

Criterion:

UPDATE CHART

  Measure      FY 2003           FY 2004             FY 2005                  FY06
                Actual            Actual             Projected                 Goal
  Total         24,279            19,466              19,466                  19,466
  SED
  % SED        37.04%            32.90%               >32%                    >32%
  Served
                                                                             Alabama 2005
                                                              Child and Adolescent Services
                                                                      Section 3: Criterion 5
 Rural           8,994            6,405              >6,000                >6,000
 SED
 Served

Goal: Participate in the evaluation of the telemedicine project and determine how
to expand to other areas of the state.


Performance Indicator:               Attendance at meetings, dissemination of evaluation
                                     results, development of implementation strategy.

Population:                          Children with SED and their families.

Measures/criterion:

                              Financial and Staffing Data

As indicated in the Adult section, the overall proportion of the mental health budget
allocated for community programs has shifted dramatically since FY 86 from 19% to
over 53.6% in FY 05. This fact is particularly significant since the overall budget
has seen an infusion of new dollars from both state sources and Medicaid. The
community budget grew from just $20 million in 1985 to over $145.5 million in 2005,
including the reallocation of institutional funding which has been occurring as a function
of the census reduction at State Hospitals and the Wyatt implementation.

As the Child and Adolescent mental health delivery system moves progressively toward a
comprehensive, community-based, family focused system, the recruitment, selection, and
training of state and community personnel becomes vital to its success. The staff at the
state and community level needs to work closely toward the same goals and objectives.
Specifically, activities identified to be planned and developed during FY 06 include:

1. Continued expansion of recruitment activities between state and community programs
   to include the Department's supporting personnel from Community Mental Health
   Centers to attend national conferences. The attendance of both state and community
   program representatives will enhance the recruitment of psychiatrists to the state and
   open alternate employment options which should be attractive to prospective
   applicants.

2. Continued participation in the ongoing planning and development of the continuum
   of care for the state mental health delivery system. The staff will continue to foster
   interagency collaboration through the work with the Multiple Need Child Office and
   through the representation of DMH/MR on various state committees.

3. Continued participation in training experiences for child and adolescent case
   managers, public health case managers, County Children‟s Facilitation Teams, and
   DMH/MR standards.
                                                                               Alabama 2005
                                                                Child and Adolescent Services
                                                                        Section 3: Criterion 5

4. Continue to serve as a resource for families and professionals who need assistance in
   accessing services for children and adolescents with SED. Staff will also assist in the
   coordination of services between state agencies.

5. Continue to provide technical assistance to CMHC on programming issues for child
   and adolescent services. The staff will also provide monitoring of child and
   adolescent programs through their participation on the certification site visits and the
   development of DMH/MR services.

Law enforcement officials and other emergency health service providers receive periodic
training at both the state and local levels concerning the proper handling of children and
adolescents with a severe emotional disturbance. The Mental Illness Division staff
participates in four such trainings each year through a local University in Montgomery.
This intense three-day training is directed at police, juvenile probation officers, juvenile
detention staff, hospital staff, private mental health practitioners and the general public.
Local mental health centers are also responsible for consultation and education of the
local community with emphasis on emergency care personnel such as clergy, judges, law
enforcement and medical personnel. Also, the Alliance for the Mentally Ill has in
numerous local areas provided ongoing training for these types of service providers. At
the state level, an individual has been specifically appointed to handle natural disasters
such as hurricanes, tornadoes, etc. and is a member of the Emergency Management
Team, which is deployed when such disasters occur. This is a more efficient means of
providing consultation onsite as needed.

                                         Staffing

Surveys have been conducted to ascertain the number of staff in the community programs
that provide services for the population with a Serious Emotional Disturbance. Below are
the results from those surveys, which reflect a significant expansion of the number of
FTE positions serving children and adolescents.
                                  UPDATE CHART

   Provider       C/A Staff C/A Staff C/A Staff           Percent             Percent
                                                          Change              Change

               Aug 03           Jul 04   Aug 05 Aug 03-Jul 04 Jul 04-Aug 05
Baldwin County   20.20            25.50    24.25          26%          -05%
Brewer-Porch     80.00            80.00    87.75          00%           10%
Calhoun-Cleb.    20.60            20.80    21.80          01%           05%
Cahaba           11.20            16.00    13.25          43%          -17%
CED              10.40            10.25    10.75         -01%           05%
Cheaha            6.30              8.30   13.50          32%           63%
Chilton-Shelby   12.75              9.80   11.45         -23%           17%
Cullman           9.42              9.50    9.50          01%           00%
                                                                                 Alabama 2005
                                                                  Child and Adolescent Services
                                                                          Section 3: Criterion 5
East Alabama            28.88        36.80       32.25                27%               -12%
East Central            10.30        10.30       10.30                00%                00%
Eastside                 6.85         6.50        4.75               -05%               -27%
Glenwood                62.00        68.00       94.00                10%                38%
H’ville-Madison         22.83        27.75       41.00                22%                48%
Indian Rivers           19.00        20.00       23.50                05%                18%
J-B-S                   62.00        63.25       66.00                02%                04%
Marshall-                5.05         8.00        8.00                58%                00%
Jackson
Montgomery             29.00        29.00       28.00                 00%               -03%
Mobile                110.00       118.00      148.00                 07%                25%
North Central          29.00        34.00       32.50                 17%               -04%
Northwest              30.00        31.00       33.00                 03%                06%
Riverbend              22.00        24.00       28.50                 09%                19%
South Central           4.00         5.00        8.00                 25%                60%
Southwest               4.00         5.00        6.00                 25%                20%
UAB                    22.00        22.00       22.00                 00%                00%
West Alabama            8.50        13.50       11.25                 59%               -17%
Western                 4.20         4.20        3.50                 00%               -17%
Wiregrass              13.00        18.00       11.30                 38%               -37%
        TOTALS                     724.45      804.10                  9%                11%
                   665.44

DESCRIPTION OF INTENDED USE
OF BLOCK GRANT FUNDS IN FY 2006

The use of FY 06 block grant funds will contribute to attaining FY 06 goals stated earlier
in Section 2 which are also related to the Department‟s 2005-2007 Strategic Plan. The
realization of tobacco revenues along with at least stable state funding will greatly assist
DMH/MR with implementing a more complete system of care for children and
adolescents in this state.


Activities to be Supported Chart goes here

FY 06 mental health block grant funds will be used in accordance with the authorizing
legislation to further the goals identified earlier in Section 2, as well as to meet legislative
requirements for use of block grant funds. All contract funds including the Block Grant
are allocated exclusively to support services for people with serious and persistent mental
illness.

In order to meet the requirement to maintain the block grant award funding for the system
of integrated services for children and adolescents, block grant funds in FY 06 will be
allocated to continue the support of outpatient and residential services. A total of
                                                                           Alabama 2005
                                                            Child and Adolescent Services
                                                                    Section 3: Criterion 5
$2,372,554 FY 06 block grant award funds are estimated for expenditure on mental
health services for children and adolescents.


Goal: Provide one Psychiatric Institute per year.

Performance Indicator:      One Psychiatric Institute held – Registration, Agenda, and
                            Evaluations.

Population:                 Children and Adolescents accessing the community mental
                            health service system.

Criterion/Measure:




Goal: Develop and assure provision of a child and adolescent service track at the
Annual Council of Community Mental Health Boards Meeting.

Performance Indicator:      Conference agenda with clearly identified child and
                            adolescent track on the program.

Population:                 Children and Adolescents accessing the community mental
                            health service system.

Criterion/Measure:



Goal: Revise certification standards with the addendum attached that incorporate
principles of Child/Family Centered treatment planning (see narrative and goal in
the Adult Section).

Performance Indicator:

Population:

Criterion/Measure:



Goal: Provide training for In-home Intervention Teams, child and adolescent case
managers, child and adolescent supervisors, juvenile court liaisons, and crisis
intervention training.
                                                                             Alabama 2005
                                                              Child and Adolescent Services
                                                                      Section 3: Criterion 5

Performance Indicator:      Training sessions scheduled, attendance lists, training
                            agenda.

Population:                 Staff providing child and adolescent mental health services.

Criterion/Measure:



Goal: Provide one statewide technical assistance/peer consultation event for
community providers of child and adolescent mental health services.

Performance Indicator:      At least one technical assistance event conducted as
                            measured by agenda, attendance roster, and minutes.

Population:                 Children and Adolescents accessing the community mental
                            health service system.

Criterion/Measure:


Goal: Continue training to improve clinicians’ skills around specialty populations.

Performance Indicator:      Identify special populations for which training will be
                            sought, select trainers, schedule training, attendance roster,
                            and agenda

Population:                 Staff serving specialty populations.

Criterion/Measure:

								
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