Download Local Service Area Plan - North Texas Behavioral Health Authority

NORTH TEXAS BEHAVIORAL HEALTH AUTHORITY
think populations...see individuals
Local Service
Area Plan
SFY 2016 & 2017
Page 1
Table of Contents
Mission ..................................................................................................................................................................... 3
Executive Summary.......................................................................................................................................... 4
Review of 2014/2015 Goals ..................................................................................................................5
The Planning Process ............................................................................................................................8
Regional Needs Assessment ................................................................................................................................ 11
NAMI Dallas Public Policy Platform Development Survey ............................................................................. 25
NorthSTAR Member Satisfaction Survey........................................................................................................... 26
Local Authority Goals and Service Priorities ...................................................................................................... 44
Service Area Population ....................................................................................................................................... 50
NorthSTAR Provider Network and Array of Services
Cornerstones of NorthSTAR's Distinctive Approach............................................................................. 50
Array of Services......................................................................................................................................... 51
Provider Network ........................................................................................................................................ 53
Principles to Consider in Service Delivery .............................................................................................. 55
County Match Contributions ..................................................................................................................... 56
Crisis Services Plan ............................................................................................................................................... 58
Diversion Action Plan and Continuity of Care Services................................................................................... 61
Performance Measures ......................................................................................................................................... 70
BHO Oversight Plan ..............................................................................................................................................72
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Mission
To Create a Well Managed, Integrated and High Quality Delivery System of Behavioral Health Services
Available to Qualified Consumers in the NorthSTAR Region.
Page 3
North Texas Behavioral Health Authority
Local Service Area Plan
SFY 2016 & 2017
Executive Summary
The North Texas Behavioral Health Authority (NTBHA) is the Local Behavioral Health Authority
(LBHA) as defined in Texas Law (Chapter 531, Section 3) for the “NorthSTAR” area which serves
Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall Counties. The NorthSTAR Program is a
unique public mental health/substance abuse treatment program serving indigent and Medicaid clients
residing in the seven-county North Texas service area.
The NorthSTAR model separates the oversight, control, and financial management from the contracted
providers of service. The Department of State Health Services contracts directly with ValueOptions
(VO), the Behavioral Health Organization (BHO), to financially manage the services provided to
NorthSTAR consumers. ValueOptions, in turn, contracts with a wide array of Providers who
directly provide services to NorthSTAR consumers. Lastly, the Department of State Health
Services also contracts with NTBHA to provide the oversight of the NorthSTAR system and
ensure community interests are being met and consumers are receiving needed mental health and
substance abuse services.
NTBHA is a governmental entity whose Board of Directors is appointed by the Commissioners’ Courts
of each respective county. The distribution of Board members is based on population: Collin County has
two appointments, Dallas County has four appointments, and the remaining five counties have one
appointment each. In compliance with Texas State Statutes, the Local Behavioral Health Authority
(NTBHA) shall, in conjunction with the Texas Department of State Health Services, develop a local service
area plan for public behavioral health services.
This local service area plan for SFY 2016-2017 is designed to address the priorities and needs of the
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existing NorthSTAR system while also dedicating significant attention to the mandated transition of
NorthSTAR from the current service model to an updated model of indigent only behavioral healthcare.
Pursuant to the recommendations of the Sunset Advisory Commission Report on the Health and Human
Services Commission (HHSC), the NorthSTAR Program will be discontinued as currently structured,
separating the funding and administration of behavioral health services for Medicaid and indigent
populations in the Dallas region. This recommendation will result in the transition of behavioral health
services for Medicaid clients to the managed care organizations (MCO) responsible for their primary
health care, as is currently occurring in the rest of the state. NTBHA has reached an agreement with
HHSC and DSHS to serve as the LBHA and lead the system redesign and transition process for a six
County service area that includes Dallas County, Ellis County, Navarro County, Kaufman County, Hunt
County, and Rockwall County. The implementation date for this updated system of indigent behavioral
health services is January 1, 2017. As the LBHA, NTBHA will be responsible for system design,
oversight, local planning, policy development and management, coordination, resource development
and management, resource allocation and management, and ensuring access to required mental health
and substance use disorder services. LifePath Systems will serve as the LBHA for Collin County.
Review of 2014/2015 Strategic Plans and Goals
1. Increase awareness of NTBHA’s role in the NorthSTAR system. Increase the authority’s
presence within the community to foster greater collaboration and familiarity with the authority’s
role and functions.
a. NTBHA staff purposefully increased engagement in community outreach/education events
hosted by community stakeholders and partners. Outreach efforts in SFY 2014-2015
included collaboration with VO’s SOS (Stamp Out Stigma) campaign; staffing booths at
various health fairs, mental health expos, and conferences; facilitating table discussions
and presenting at the State funded mental health “surge” focus group; speaking at ADRC
(Aging and Disability Resource Centers) monthly meetings in various counties; speaking
at training events for licensed boarding home owners; attending trainings and Brown Bag
events; and via CFAC outreach to the community with DARS and other speakers
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presenting at various SPN locations. CFAC also hosted subject matter expert presentations
that attracted members of the community and provided opportunities to discuss
NorthSTAR services and benefits.
b. In SFY 2015, NTBHA hosted town hall meetings in Dallas County, Ellis County,
Kaufman County, Navarro, County, Hunt County, and Rockwall County which were
widely publicized and offered opportunities to answer questions and educate consumers
and community stakeholders regarding NorthSTAR services and the role of NTBHA.
NTBHA will continue to make staff available to reach out to the community through these
and other means as opportunities arise.
c. NTBHA maintains membership in the Dallas County Behavioral Health Leadership Team
(BHLT) and its subcommittees and the Ellis County Behavioral Health Alliance
(ECBHA). NTBHA provides updates at each of these monthly meetings which consist of
a wide variety of community stakeholders and providers.
2. Maintain adequate funding to ensure continued high quality delivery of services to all qualified
consumers in the NorthSTAR region
a. The NorthSTAR community including the NTBHA Board of Directors, VO, community advocacy
groups, providers and stakeholders made significant efforts to educate state legislators on the
importance of maintaining adequate funding for NorthSTAR to ensure continued access to quality
behavioral health services.
b. NTBHA continues to participate in the Regional Legislative Steering Committee hosted by Mental
Health America of Greater Dallas.
c. NorthSTAR providers and stakeholders provided responses and testimony related to the Sunset
Advisory Commission Staff Report recommendation (Issue 9) to transition the provision of
behavioral health services in the Dallas area from NorthSTAR to an updated model. Although
staff recommendations in Issue 9 were ultimately adopted by the Sunset Commission, bridge
funding was allocated to both NTBHA and Collin County in order to help preserve funding and
facilitate continuity of care during the first year of the updated models. NTBHA was allocated
$7,087,817 for one-time transition needs.
3. Increase focus on implementation of Recovery-Oriented Systems of Care focused on both mental
health and substance abuse recovery.
a. NTBHA maintained active participation in the Dallas Recovery Oriented Systems of Care
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(ROSC) group which is a partnership of Dallas recovery communities that promotes a
recovery movement that initiates, stabilizes, maintains and celebrates recovery that enhances
long term quality of life.
b. NTBHA facilitated ROSC presentations at various community stakeholder forums including
the NorthSTAR Consumer and Family Advisory Council (CFAC) and MHA hosted training
for boarding home owners.
c. NTBHA regularly participates in provider audits conducted by VO which include a review of
treatment records to ensure treatment plans are individualized and recovery oriented.
d. Providers received information, resources, and updates related to Person Centered Recovery
Plans (PCRP) through NorthSTAR Quality meetings and VO communications.
4. North Texas Behavioral Health Authority will work in collaboration with VO to improve current
Community and State Hospital discharge processes and coordination of continuity of care.
a. VO initiated an ongoing quarterly coordination meeting with SPN providers and community
hospitals in order to discuss issues, barriers and best practices related to discharge planning
and continuity of care. VO organized a similar meeting to facilitate improved
communication and coordination between community hospitals and SUD providers.
b. VO compiled and distributed a SPN and Hospital contact list for discharge coordination.
VO has also worked with Southern Area Behavioral Healthcare to develop a process for
coordination of care with providers when one of their members has received services at the
after-hours clinic.
c. VO, in coordination with NTBHA, developed a brochure to be provided to consumers upon
discharge from community hospitals and Terrell State Hospital that encourages engagement
in outpatient aftercare services and includes information related to outpatient care. This
Hospital Discharge Brochure was designed to be a resource to discharging patients including
addressing transportation needs and what to bring/expect at the first clinic appointment.
d. NTBHA allocated SFY 2014 Penalties and Incentives Funds (PIF) to implement a
Transportation Pilot that allowed for SPNs to receive a set reimbursement rate for
transporting individuals from a community hospital or Terrell State Hospital to a same day
aftercare appointment at the outpatient clinic. The goal of this pilot was to allow for a
“warm handoff” between levels of care while also ensuring that individuals have timely
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access to aftercare appointments.
5. North Texas Behavioral Health Authority will work in collaboration with ValueOptions to
enhance housing options to NorthSTAR consumers.
a. VO implemented a NTBHA approved process for allocating funds available for rental and
utility assistance along with existing supportive housing services using funds earmarked
for 83rd Legislative Expanded Service Requirements.
b. NTBHA allocated $315,000 in available SFY 2015 PIF funds to increase SFY15 housing
funds available through pre-funded rental and utility assistance. NTBHA was also able to
reallocate a portion of SFY 2014 PIF funds that were not projected to be expended
through the Transportation Pilot.
c. Processes were put in place to prioritize placement in licensed boarding homes including
members discharging from State Hospital and individuals receiving rental assistance and
supportive housing services.
d. NTBHA has provided support to the City of Dallas and MHA in efforts to provide
relevant trainings to boarding home owners in order to help establish safer, more
recovery-oriented housing options. NTBHA facilitated presentations to boarding home
owners at MHA hosted training events.
The Planning Process
NTBHA is unique in the State of Texas as a local authority in that it represents both mental health and
substance abuse treatment services. Ongoing planning is multidimensional with broad stakeholder
participation. This process is continually being improved upon, as the agency adapts to changes in
the regional system and legislative changes. NTBHA has a solid base from which to build. This base
includes the following vehicles for stakeholder input:

Provider Advisory Council (PAC)-An advisory group that represents the NorthSTAR service
providers and provides information and recommendations to the NTBHA Board.

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Consumer Family Advisory Council (CFAC) - An advisory group that represents NorthSTAR
consumers and their families/guardians that provides information and recommendations to the
NTBHA Board.

Psychiatrist Leadership and Advocacy Group (PLAG) - An advisory group that represents
NorthSTAR physicians as well as physicians outside the NorthSTAR system that provides
information and recommendations to the NTBHA Board.

Dallas County Behavioral Health Leadership Team (BHLT) – A team of Dallas County
stakeholders empowered by the Dallas County Commissioners Courts and Dallas County
Hospital District Board of Managers to function as a single point of accountability, planning,
oversight, and funding coordination for all Dallas County behavioral health services and
funding streams as well as the numerous BHLT sub-committees and workgroups.

Dallas County Behavioral Health Steering Committee - a team of dedicated community
stakeholders that have a vested interest in criminal justice related issues, jail diversion, and
behavioral health services in Dallas County.

Ellis County Behavioral Health Alliance (ECBHA) – a team of dedicated community
stakeholders that have a vested interest in the mental health and substance abuse services their
community receives.

Collin County Social Services Committee – a team of involved community stakeholders that
have an interest in behavioral health and other community services and resources available to
Collin County residents.

North Texas Behavioral Health Authority Board of Directors – NTBHA Board – “Board”

Mental Health America of Greater Dallas (MHA) and National Alliance on Mental Illness
(NAMI) – Advocacy groups that are active both within NorthSTAR and beyond.

Coalition on Mental Illness – collaborative, interagency forum to discuss local behavioral
health needs and programming.

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NorthSTAR Regional Legislative Steering Committee – coordinated and hosted by MHA of
Greater Dallas to address regional legislative needs, advocacy efforts, and priorities.

NorthSTAR Satisfaction Survey conducted by VO with collaboration from NTBHA has occurred
annually beginning in 2010.

Town Hall Meetings were held in six counties (Dallas, Ellis, Hunt, Kaufman, Navarro and
Rockwall Counties). Town Hall Meetings had a significant focus on the transition of
NorthSTAR to an updated model of indigent behavioral healthcare on January 1, 2017. As
Collin County is separating from the NorthSTAR service delivery area and developing a
separate single-county service delivery model effective January 1, 2017, NTBHA did not hold
a Town Hall Meeting in Collin County. Collin County has formed and is engaged in a separate
transitional planning process. An additional focus group was conducted with licensed boarding
home owners and managers to collect their feedback.

NorthSTAR Needs Assessment Surveys developed by NTBHA and completed in odd-numbered
years was conducted in July, August, and September 2015 targeting all seven NorthSTAR
Counties.

Analyzing complaint and call data.

Analyzing NorthSTAR data – NorthSTAR Data warehouse, DSHS Databook, VO data and
reports

Participating in ValueOptions’ Quality Improvement Program.

NTBHA Local Plan for Indigent Behavioral Health Services
Data and information for this plan was collected via a number of methodologies designed to maximize
community input regarding priority services, unmet needs/service gaps, priority populations and the
role of the LBHA.
The NTBHA Board fulfills a stakeholder input function as noted above, but is also the governing
body for NorthSTAR and NTBHA. As such, the Board is an active force in local planning. The plan
will be reviewed by the above groups, and published for general community review. Input
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concerning the plan will be solicited during regular community meetings, through direct contact with
stakeholders, and through the NTBHA website.
Regional Needs Assessment
NTBHA conducted a regional needs assessment in the months of July, August, and September 2015
to assist in the identification of service needs and gaps in services. Adult consumers and
parents/guardians of children and adolescent consumers participated in paper surveys at the various
SPN clinics and several SUD facilities. An online survey was developed and made available for
providers to submit input. Additionally, an online survey was provided for all others in the
community including family members, law enforcement, schools, courts, jails, and any other
stakeholders who wished to participate.
Also, during the months of August and September 2015, NTBHA conducted town hall meetings in
each county of the six counties that have chosen to continue to partner under the updated model of
indigent behavioral healthcare with NTBHA serving as LBHA. The purpose of these meetings was
to collect stakeholder input related to transition planning and to identify needs that are regarded as
barriers to recovery. In addition to NTBHA, representatives from MHA of Greater Dallas, NAMI
Dallas, and NAMI Kaufman helped facilitate the collection of responses at these local meetings to
identify the needs and desires of the community for current and future behavioral health services that
promote recovery and reduce recidivism. All town hall meetings were open to the public and widely
promoted to consumers, local NorthSTAR providers, community stakeholders, and press releases
were submitted to local newspapers.

Dallas County: NAMI Dallas General Meeting hosted a town hall meeting on August 6,
2015. In addition to the open town hall meeting for Dallas, a focus group was also held on
September 16, 2015 with owners and managers of licensed boarding homes in the city of
Dallas.

Ellis County: Ellis County Behavioral Health Alliance hosted a town hall meeting during
their August 28, 2015 meeting at the juvenile court in Waxahachie.

Kaufman County: Two (2) meetings were held, one at the Kaufman NAMI General Meeting
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on August 20, 2015 hosted at the Lakes Regional Community Center in Terrell and another
was held at Our Merciful Savior Episcopal Church on September 3, 2015 in the city of
Kaufman.

Rockwall County: Lakes Regional Community Center in the city of Rockwall hosted the
town hall meeting the afternoon of September 28, 2015.

Navarro County: The town hall meeting was held at the Corsicana Public Library the evening
of September 28, 2015.

Hunt County: Texas A&M University at Commerce hosted the town hall meeting the evening
of September 30, 2015.
Since this is a year focused on transitional planning for NorthSTAR, the most voiced concerns at
each meeting were:

No wait lists – NorthSTAR has enjoyed a system without wait lists since inception in 1999.
Consumers fear what may happen if wait lists must be activated for the indigent consumers
under the new plan in 2017. Early intervention without waits provides the best care and
outcomes for the consumer.

Choice of provider – Regardless whether the NorthSTAR consumers have Medicaid or are
indigent members, they want to maintain choice of provider.

Peer navigators could be instrumental in obtaining training necessary to assist qualified
indigent consumers in filing paperwork for SSI/SSDI benefits so they may get enrolled in
Medicaid coverage.

Traditional NorthSTAR services that participants identified most commonly as services that
must continue and/or increase:
o SUD Treatment (residential and IOP/SOP for all age groups)
o Urgent Afterhours Walk-in Crisis Clinic (more in the region)
o Case Management
o Medication Management with a Prescriber
o Prescriptions covered
o Crisis Hotline for both telephonic and mobile crisis support
o Hospitalization – greater access to needed inpatient crisis treatment (community beds,
state hospital beds, all types needed)
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o Therapy
o Peer Support Services
o Jail diversion to treatment
o Integration and coordinated care with physical healthcare
o Less restriction in communicating with family, boarding home owners, other
providers and caregivers on behalf of the consumer
o Value-added services that provide wraparound such as PATS or ICM

Other services not necessarily funded directly by NorthSTAR service dollars that were
mentioned at town hall meetings include:
o Transportation
o Housing
o Job assistance programs
o Legislative advocacy for more funding
o Jail diversion to treatment
o Life skills training (anger management, parenting, budgeting, etc.)
o Court Ordered Assisted Outpatient Treatment
o Close coordination and oversight of MCOs as NorthSTAR consumers with Medicaid
transition to them
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Adult Consumer Needs Assessment Results
430 adult consumers completed paper needs assessment surveys that were conducted by NTBHA
staff onsite at each SPN location as well as SUD treatment facilities in July, August, and September
2015.
In the past 6 months, what services have you received
25.0% 23.5%
20.0%
15.0%
10.0%
5.0%
16.6%
13.5%
7.8%
5.0% 3.7% 3.7% 3.6%
3.5% 3.2% 3.1% 3.0% 2.6%
1.7% 1.7% 1.2% 0.9% 0.8% 0.8%
0.0%
The top services utilized over the past six months by adults were reported as:

Medication management (23.5%);

Case management (16.6%);

Individual counseling (13.5%);

Group counseling (7.8%).
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In the past 6 months, what services have you needed but could not get?
16.0% 14.2%
14.0%
11.9%11.4%
12.0%
8.3% 7.5%
10.0%
7.3% 7.3%
8.0%
5.7%
4.7%
6.0%
3.6% 2.8%
2.6% 2.6% 2.3% 2.3% 1.8% 1.8%
4.0%
1.0% 0.8%
2.0%
0.0%
The top services reported as needed by adult consumers in the past six months that could not be
obtained were:

Housing (14.2%);

Individual counseling (11.9%);

Medication management (11.4%);

Transportation (8.3%).
Please indicate what problems you have experienced which resulted in your inability to get services?
32.8%
35.0%
30.0%
25.0%
20.0%
17.0%
14.9%
15.0%
14.1%
12.0%
9.1%
10.0%
5.0%
0.0%
No transportation Appointment not
available at time
of need
Service not
available
Service available,
but required too
much time and
effort
Other (please
describe):
Service denied
In regards to why adult consumers failed to receive services needed, the reasons given were:
P a g e 15

No transportation (32.8%);

Could not get an appointment at the time needed (17.0%);

The service was not available (14.9%);

Service was available, but required too much time and effort (14.1%);

Denied services (9.1%);

Other (12.0%).
Longer approvals…
Special mental…
Peer Services
Clubhouse / drop-…
IOP/SOP…
Mobile crisis face-…
Jail diversion
Intensive case…
Recovery-…
Care coordination
Coordination of…
23-hour…
Other (please…
Jail release…
Wraparound…
Detoxification
Inpatient…
ACT services
Respite care
Group support
Transportation…
Crisis hotline by…
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Housing services
Transportation to…
Choice of…
Integration of…
Work assistance…
Life skills training…
Longer doctor visits
Urgent afterhours…
Co-occurring…
In home support
Intensive case…
Case management
Diagnosis and…
Longer hospital…
What other services do you think are missing or need to be expanded to serve your needs?
The top services adult consumers believe are missing and should be expanded include:

Housing services (6.4%);

Transportation to appointments (6.3%);

Choice of medication (6.0%);

Integration with physical healthcare (5.8%);

Work assistance and support (5.4%);

Life skills training (4.7%);

Longer doctor visits (4.5%);

More urgent afterhours crisis walk-in clinics (4.0%).
Historically, housing and transportation have shown up in the top three (3) identified needs in
surveys conducted in 2007, 2009, 2011, 2013 and again now 2015.
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Parent or Guardian of Child and Adolescent Consumer Needs Assessment Results
183 parents and/or guardians of children and adolescents receiving NorthSTAR treatment were
surveyed via paper needs assessments conducted by NTBHA staff onsite at each SPN location that
serves the C&A popultion.
In the past 6 months, what services has your child received?
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Parents were asked what services their children received in the past six (6) months. Top responses
included:

Medication management (33.5%);

Individual counseling (24.6%);

Case management (10.9%);

Life skills training (6.1%);

Inpatient Psychiatric Hospitalization (5.6%).
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In the past 6 months, what services has your child needed but could NOT get?
30.0%
25.0%
24.4%
20.0%
15.0%
12.2% 12.2%
10.0%
10.0%
7.8%
7.8%
5.0%
7.8%
5.6%
5.6%
3.3%
1.1%
1.1%
1.1%
0.0%
0.0%
Parents were asked what services their children needed but could not get in the six (6) months prior
to the survey and gave highest responses to these:

Individual counseling (24.4%);

Medication management (12.2%);

Life skills training (12.2%);

Family Counseling (10.0%);

Home visits (7.8%);

Transportation (7.8%).
P a g e 18
Please indicate what problems you have experienced which resulted in your inability to get
services for your child.
27.9%
19.7%
19.7%
14.8%
9.8%
Appointment Service not
not available at available
time of need
8.2%
Other (please
No
Service
Service denied
describe): transportation available, but
required too
much time and
effort
When asked what problems they experienced which resulted in the inability to get these services for
their children, they cited:

Appointment not available at time of need (27.9%);

Service not available (19.7%);

Other (19.7%)

No transportation (14.8%)

Service available but required too much time and effort (9.8%)

Service denied (8.2%)
P a g e 19
20.0%
18.0%
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
School based programs
Life skills training (parenting,…
Group support for child
Group support for family…
Local mental health…
Family counseling without…
Housing services
Diagnosis and treatment…
Urgent afterhours crisis walk-…
Transportation to appointments
Choice of medication
Clubhouse / drop-in center
Peer Services
In home support
Early Childhood Intervention…
Other (please describe):
Case management
Integration of services with…
Longer doctor visits
Intensive case management…
Therapeutic foster care
Respite care
Care coordination
Mobile crisis face to face…
Coordination of care for…
Wraparound services
Crisis hotline by phone
Co-occurring mental health…
Recovery-oriented systems of…
Longer hospital stays
Intensive case management…
Local substance use disorder…
Jail /detention diversion
Transportation for other
Longer approvals for…
Jail/detention discharge…
What other services do you think are missing or need to be expanded to serve your child?
When parents were asked what services they think are missing or need to be expanded to serve their
children, the top services listed were:

School based programs (17.2%)

Life skills training for parents and children (9.5%)

Group support for child (8.8%)

Group support for family members (7.7%)
Provider Needs Assessment Results
The provider needs assessment was posted as an online survey and communicated widely and in
multiple ways to solicit feedback from any and all levels of staff in provider clinics. There were 30
surveys completed within the NorthSTAR network with varying roles of those surveyed. 10.0% of
respondents were caseworkers and 30.0% were administrative/managerial staff. Licensed therapists
accounted for 13.3%. 6.7% respondents were prescribers (APNs, but no physicians). Non-prescribing
nurses (6.7%), Social workers (3.3%), LCDCs (6.7%), and other staff (23.3%) also participated.
P a g e 20
2015 Provider Needs Assessment - Satisfaction
Your ability
NorthSTAR
The
to be a
range of
Medication participatin
NorthSTAR
services to
Emergency
system of
choices g provider
meet
response
(formulary) in the
care
consumer
(overall)
NorthSTAR
needs
system
Customer
service at
ValueOptio
ValueOptio
North
ns
Claims,
ns
Texas
providing
Enrollment
regarding
authorizati Behavioral
services to
process
ons, billing Health
filing
NorthSTAR
complaints,
Authority
consumers
obtaining
info, rate…
Very Satisfied
13%
10%
6%
23%
10%
10%
10%
10%
13%
16%
Satisfied
36%
23%
33%
30%
23%
33%
36%
23%
23%
30%
Somewhat Satisfied
36%
40%
33%
26%
23%
23%
13%
23%
20%
13%
Not Satisfied
10%
23%
16%
10%
23%
26%
26%
26%
20%
13%
No opinion/Unknown
3%
3%
10%
10%
20%
6%
13%
16%
23%
26%
85% of providers surveyed are very satisfied, satisfied or somewhat satisfied with the overall NorthSTAR
system of care. 10% are not satisfied and 3% had no opinion.
73% of providers were very satisfied, satisfied or somewhat satisfied with the range of services to meet
consumer needs. 23% were not satisfied and 3% had no opinion.
69% of providers were satisfied with medication choices in the formulary, but 16% were not satisfied and
10% had no opinion.
79% were very satisfied, satisfied, or somewhat satisfied with their ability to participate as a provider in the
NorthSTAR System. 10% were not satisfied and 10% had no opinion.
56% were somewhat satisfied, satisfied, or very satisfied with the emergency response in NorthSTAR. 23%
were not, and 20% had no opinion.
66% of providers were satisfied with ValueOptions providing services to NorthSTAR consumers. 26%
were not satisfied and 6% had no opinion.
59% were somewhat satisfied, satisfied or very satisfied with customer services at ValueOptions regarding
complaints, obtaining info, rate of response, etc. 26% were not satisfied and 13% had no opinion.
56% were somewhat satisfied, satisfied or very satisfied with the enrollment process. 26% were not
satisfied and 16% had no opinion.
56% were somewhat satisfied, satisfied or very satisfied with claims, authorizations, and billing. 20% were
not and 23% had no opinion.
59% were somewhat satisfied, satisfied or very satisfied with NTBHA. 13% were not satisfied, and 26%
had no opinion.
P a g e 21
20.00%
18.75%
18.00%
15.63%
16.00%
14.00%
12.00%
10.42%
10.42%
9.38%
10.00%
8.00%
6.00%
8.33%
7.29%
7.29%
7.29%
5.21%
4.00%
2.00%
0.00%
Providers were asked what barriers they have experienced causing an inability to provider services. While
7.29% believe they are able to provide all services they feel are necessary, the top barriers reported were:

Service not covered under NorthSTAR (18.75%)

Consumer can’t get to appointments due to transportation (15.63%)

Service not authorized by ValueOptions (10.42%)

Financial constraints for training (10.42%)

Consumers outweigh the number of daily appointment slots (9.38%)

Service not covered under consumer’s assigned TRR package (8.33%)

Time constraints for training (7.29%)
P a g e 22

Other (7.29%)

Provider staff not trained to offer certain services (5.21%)
Top provider responses regarding what other services they think are missing and/or need to be expanded in
NorthSTAR include:

Transportation to appointments

Longer stays in psychiatric hospitals

Integration of services with physical healthcare

Life skills training

Longer approvals for SUD treatment

Mobile crisis face-to-face services

Housing services

Urgent afterhours crisis walk-in clinic for youth
P a g e 23
Community Stakeholder Needs Assessment Results
18 respondents completed the community stakeholder needs assessment and identified themselves as staff
from school systems, judicial systems, social services agencies, advocacy groups, as well as friends and
family members of consumers.
2015 Community Stakeholder Needs Assessment - Satisfaction
Customer
service at
NorthSTAR
ValueOptio ValueOptio
North Texas
range of
The
Medication
ns providing ns regarding
services to
Emergency
Enrollment Behavioral
services to
filing
NorthSTAR
choices
Health
meet
response
process
system
(formulary)
NorthSTAR complaints,
consumer
Authority
consumers obtaining
needs
info, rate of
response,…
Very Satisfied
11%
11%
11%
16%
33%
22%
22%
33%
Satisfied
27%
33%
22%
22%
11%
22%
44%
11%
Somewhat Satisfied
33%
16%
16%
16%
11%
5%
5%
16%
Not Satisfied
5%
16%
16%
22%
16%
16%
11%
11%
No opinion/Unknown
22%
22%
33%
22%
27%
33%
16%
27%
When community stakeholders were asked what services are missing or need to be expanded in the
NorthSTAR service area, these were the most commonly identified:

Clubhouse or drop-in center

Housing services

Life skills training

Transportation to appointments

Family counseling without patient present

Longer stays at psychiatric hospitals
P a g e 24
NAMI Dallas Public Policy Platform Development Survey
NAMI Dallas conducted an online survey in September 2015 which asked their members to rank order a
list of 12 public policy platform issues related to behavioral health. The top priorities identified by 40
survey respondents (in order of preference) include:

Open Access to Care: People should receive the care they reach out for at the time they need it – no
wait lists are formed.

Funding: Medicaid Expansion, a Texas Solution to increase access to care and to increase evidence
based practices in mental health care in Texas.

Supportive Housing.

Provider Choice: People have a choice in providers and selection is not reduced to just one
organization or individual.

Emergency Room holds on people with mental illness deemed to be a danger to self or others by the
physician: Right now, in order for a med/surg hospital to hold someone against their will, law
enforcement must be called in to make that determination.

Jail Diversion: Pre-booking as in CIT and post booking as in Mental Health, Drug, and Veterans
Courts.

Peer Supports: People in recovery who have received training to provide support and assistance to
people striving for recovery are utilized in the recovery process.

Other issues of concern: Supported employment, integrated care, continuation of benefits (e.g.,
Medicaid) during incarceration to prevent a gap in services upon release from a criminal justice
facility, increased funding for public education about mental illness and substance use disorders in
order to decrease stigma, and an increase in clubhouses and other recovery based initiatives.
P a g e 25
NorthSTAR Member Satisfaction Survey
ValueOptions has conducted a Member Satisfaction Survey each year since 2010.
Year
Number of
Respondents
2010
470
2011
384
2012
525
2013
632
2014
522
2015
758
Several primary questions were used for comparison between the years with some additional
questions asked in 2011 and 2012. Former wait time survey questions were included in the Member
Satisfaction Survey beginning in 2012. There have been no modifications made since the 2013
survey.
Although there was a slight decline in satisfaction in most areas from 2010 to 2012, this could be
contributed to the increased education efforts of NTBHA, MHA, and NAMI to educate consumers
and raise their awareness of the quality of services they receive. However, overall satisfaction
increased each year since 2013. Each year, the greatest opportunity for improvement is in the clinics’
ability to help consumers seek out supports from the community. Each year providers look at this
element and try to look at opportunities to improve ratings. It is evident that changes are being made
to enhance this service to the consumer, because 2015 saw a significant 12.7% increase over the
2014 number with an all-time high at 65.5%. It still leaves room for improvement, but the trend is
positive. Some potential strategies for increasing satisfaction in this area include increasing the
availability of peer support services and working with providers to ensure that case workers and other
staff are knowledgeable of available community resources through system-wide information sharing
and training opportunities. This is the executive summary from ValueOptions:
P a g e 26
NorthSTAR 2015 Member Satisfaction Survey
The 2015 NorthSTAR Member Satisfaction Survey was conducted during the months of May-July 2015 in
collaboration with the North Texas Behavioral Health Authority (NTBHA) and Mental Health America
(MHA). Surveys were conducted at 28 Specialty Provider Network (SPN) locations by MHA advocates.
The number of surveys collected was 758, which represents a larger sample than 522 surveys collected in
2014 and the largest sample since the survey began in 2010. Results were compiled by NTBHA staff. The
survey was available in English and Spanish. There were no changes to the survey in 2015.
The survey questions were categorized into the following domains:

Overall Satisfaction

Clinic Experience and Ratings

Access to Care

Outcome of Services
DEMOGRAPHICS: Respondents’ self-report of race / ethnicity appears to represent a range of diversity
among members surveyed. Surveys included children, adolescents and adult members. In 2015 a greater
percentage of all surveys were completed on behalf of adults 61.7% than previous year 56.8% in 2014.
Also in 2015 there were slightly more African-American respondents 26.4% than Hispanic respondents
22.9% than in 2014 which were 22.4% and 25.9% respectively.
P a g e 27
GENERAL QUESTIONS
Gender:
Survey completed for child or self?
Race/Ethnicity:
P a g e 28
Age:
How long have you received services at your clinic?
OVERALL SATISFACTION
Overall, how satisfied are you with the mental health services of your clinic?
Overall Satisfaction with clinic services from 2011 to 2015 with the following results:
 2010 result: 85.0% of members surveyed were very satisfied or satisfied
 2011 result: 82.9% of members surveyed were very satisfied or satisfied
 2012 result: 80.2% of members surveyed were very satisfied or satisfied
 2013 result: 84.7% of members surveyed were very satisfied or satisfied
 2014 result 87.7% of member surveyed were very satisfied or satisfied
 2015 result 89.5% of member surveyed were very satisfied or satisfied
P a g e 29
Overall Satisfaction has continued to trend up since 2012, with the highest score since the beginning of the
survey in 2010.
HISTORICAL COMPARISON OF OVERALL SATISFACTION
CLINIC EXPERIENCE AND RATINGS
How do you feel about how your clinic has shown respect for your ethnic, cultural or religious background
(including race, language and sexual orientation)?
65.0%
60.0%
55.0%
50.0%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
57.5%
VerySatisfied
Satisfied
36.2%
Dissatisfied
VeryDissatisfied
NoOpinion/ Don’t
Know
3.7%
1.9% 0.7%
Satisfaction with cultural aspects of service from 2012 to 2015:
 2012 result: 90.1% of members surveyed were very satisfied or satisfied
 2013 result: 91.3% of members surveyed were very satisfied or satisfied
 2014 result: 92.7% of members surveyed were very satisfied or satisfied
 2015 result: 93.7% of members surveyed were very satisfied or satisfied
Satisfaction with cultural respect went up slightly and has been consistent with positive ratings over the years.
P a g e 30
How satisfied are you with the progress you’ve made toward reaching your goals?
55.0%
51.3%
50.0%
45.0%
40.0%
35.0%
VerySatisfied
32.0%
Satisfied
30.0%
Dissatisfied
25.0%
20.0%
VeryDissatisfied
15.0%
NoOpinion/ Don’t
Know
10.0%
5.0%
7.9%
7.4%
1.5%
0.0%
Satisfaction with progress toward reaching goals from 2012 to 2015:
 2012 result: 76.6% of members surveyed were very satisfied or satisfied
 2013 result: 77.9% of members surveyed were very satisfied or satisfied
 2014 result: 82.5% of members surveyed were very satisfied or satisfied
 2015 result: 83.3% of members surveyed were very satisfied or satisfied
Member satisfaction in the amount of help from staff when making decisions 91.9% improved in 2015 and
satisfaction with reaching their goals 83.3% went up slightly. Satisfaction with amount of staff involvement with
family 82.9% stayed consistent after trending up significantly last year. All three of these measures are focused on
member-directed, recovery-oriented treatment model and continue to be a focus in NorthSTAR.
P a g e 31
How satisfied are you in the amount of help you are getting from staff when you are making decisions?
50.0%
46.7%
45.2%
45.0%
40.0%
35.0%
VerySatisfied
30.0%
Satisfied
25.0%
Dissatisfied
20.0%
VeryDissatisfied
15.0%
NoOpinion/ Don’t
Know
10.0%
3.5%
5.0%
1.3%
3.3%
0.0%
Satisfaction with help from staff when making decisions from 2012 to 2015:
 2012 result: 85.0% of members surveyed were very satisfied or satisfied
 2013 result: 87.6% of members surveyed were very satisfied or satisfied
 2014 result: 89.7% of members surveyed were very satisfied or satisfied
 2015 result: 91.9% of members surveyed were very satisfied or satisfied
How satisfied are you about how the staff involves your family or support system when you want them
involved?
50.0%
43.2%
45.0%
40.0%
39.7%
35.0%
VerySatisfied
30.0%
Satisfied
25.0%
Dissatisfied
20.0%
VeryDissatisfied
15.0%
10.7%
10.0%
5.0%
NoOpinion/ Don’t
Know
4.9%
1.5%
0.0%
Satisfaction with staff involvement of members’ family or support system from 2012 to 2015:
 2012 result: 74.1% of members surveyed were very satisfied or satisfied
 2013 result: 77.8% of members surveyed were very satisfied or satisfied
 2014 result: 83.0% of members surveyed were very satisfied or satisfied
 2015 result: 82.9% of members surveyed were very satisfied or satisfied
P a g e 32
ACCESS TO CARE
During the past year, how long, on average, was your
wait time between your appointment time and the
time you were seen by clinical staff?
Access to Care Trends:
Below shows appointment access times for office wait time
Trends show that scores for office wait time over 90 minutes
dropped significantly 2014 to 2015. The wait timeframe 3060 minutes increased with 0-30 and 60-90 times relatively
unchanged
Office wait
0 to 30 minutes
30 to 60 minutes
60 to 90 minutes
over 90 minutes
No Opinion /
Don’t Know
P a g e 33
2015
46.9%
32.0%
10.3%
5.4%
2014
50.5%
23.1%
11.0%
10.0%
2013
51.1%
23.8%
10.5%
8.7%
2012
48.6%
24.3%
11.0%
11.2%
5.4%
5.5%
5.9%
4.8%
If you began services during the past year, how long
was the wait between the day you first requested
services and the day you were offered your first
appointment with a doctor?
Access to Care Trends:
Scores for the wait time between the first day an
appointment was requested and the date the consumer was
offered their first appointment with a doctor in 2015 were
fairly consistent with 2014. Respondents that were seen
within 24 hours increased slightly whereas all other
appointment access scores decreased slightly. Overall,
52.9% received an appointment within the 14 day standard,
12.4% were outside of timeframes with 21.5% already in
services and 13.2% had no opinion.
Appointment
Access
Within 24 hours
Within 7 days
Within 14 days
Within 30 days
Over 30 days
I started services
over a year ago
No Opinion /
Don't Know
P a g e 34
2015
2014
2013
2012
17.2%
23.1%
12.6%
9.2%
15.7%
24.5%
14.4%
10.5%
20.0%
23.7%
12.3%
21.7%
21.1%
8.5%
3.2%
4.1%
10.2%
4.3%
8.3%
6.1%
21.5%
21.4%
18.8%
21.1%
13.2%
9.3%
10.7%
13.0%
Member satisfaction with being seen as often as they would like to be seen 89.6% continued to trend
upwards as in previous years for 2015. Member responses related to receiving all of the services the
member thinks are needed from the clinic 88.9% were significantly higher than 80.9% in 2014 and was
highest score in previous years. See the graphs below for the 2015 results and comparison with previous
years.
How satisfied are you with being seen as often as you need to be seen by your clinic?
55.0%
49.9%
50.0%
45.0%
40.0%
39.7%
VerySatisfied
35.0%
Satisfied
30.0%
Dissatisfied
25.0%
20.0%
VeryDissatisfied
15.0%
NoOpinion/ Don’t
Know
10.0%
3.8%
5.0%
4.9%
1.7%
0.0%




2012 - 82.5% of members surveyed were very satisfied or satisfied
2013- 85.4% of members surveyed were very satisfied or satisfied
2014 – 88.6% of members surveyed were very satisfied or satisfied
2015 – 89.6% of members surveyed were very satisfied or satisfied
P a g e 35
Are you receiving all the services you think are needed from this clinic?




2012 – 81.3 % of members surveyed responded always or most of the time
2013- 82% of members surveyed responded always or most of the time
2014- 80.9% of members surveyed responded always or most of the time
2015- 88.9% of members surveyed responded always or most of the time
Phone calls returned within 24 hours has trended up slightly over the past several years. The question about
ease in speaking with a live person that was new in 2014 trended down in 2015 to 82.1%. Phone
availability and accessibility have been a focus for NorthSTAR and providers with many SPNs reporting
new phone systems, processes and staff training.
P a g e 36
How often are your phone calls returned from this clinic within 24 hours?
Satisfaction with clinic returning phone calls within 24 hours from 2012 to 2015:
 2012 result: 66.3% of members surveyed always or most of the time
 2013 result: 67.5% of members surveyed always or most of the time
 2014 result: 69.5% of members surveyed always or most of the time
 2015 result: 71.1% of members surveyed always or most of the time
P a g e 37
How easy is it to speak to a live person when you make a phone call to the clinic?
Satisfaction with ease in speaking with a live person from 2014 to 2015 with the following result:
 2014 result: 83.5% of members surveyed always or most of the time
 2015 result: 82.1% of members surveyed always or most of the time
NOTE: This question was added in 2014 at the request of DHS in response to their Mystery Call monitoring process.
P a g e 38
OUTCOME OF SERVICES
Since beginning services, how would you rate your symptoms and problems now?
Satisfaction with ratings for symptoms and problems for 2015 with the following result
 2012 result: 74.6% of members surveyed rated their symptoms and problems as much better or somewhat
better
 2013 result: 77.9% of members surveyed rated their symptoms and problems as much better or somewhat
better
 2014 result: 79.3% of members surveyed rated their symptoms and problems as much better or somewhat
better
 2015 result: 83.2% of members surveyed rated their symptoms and problems as much better or
somewhat better
Overall scores for rating symptoms and problems trended up for 2015 with a significant increase in feeling
much better. Respondent ratings for “not much better and worse than before” decreased (favorable).
I am feeling much better
I am feeling somewhat better
I don’t feel much better
I’m worse now than before
No Opinion / Don’t Know
P a g e 39
2015
49.3%
33.9%
6.7%
1.4%
8.8%
2014
43.9%
35.4%
8.3%
4.3%
8.1%
2013
40.9%
37.0%
10.4%
2.7%
9.0%
2012
40.6%
34.0%
9.5%
3.6%
12.3%
Member satisfaction with the ability to improve their own lives 83.1% improved in 2015 and continues to
trend up from previous years. Respondents surveyed about staff help in seeking community supports
significantly improved to 65.5% from 52.8% in 2014, however this remains an opportunity in the focus on
recovery oriented care.
How satisfied are you about your ability to improve your own life?
Satisfaction with member ability to improve their lives from 2012 to 2015:
 2012 result: 74.2% of members surveyed responded very satisfied or satisfied
 2013 result: 74.8% of members surveyed responded very satisfied or satisfied
 2014 result: 80.3% of members surveyed responded very satisfied or satisfied
 2015 result: 83.1% of members surveyed responded very satisfied or satisfied
P a g e 40
How often do staff at this clinic help you to seek out people and supports from your community, outside of this
clinic?
40.0%
35.0%
33.9%
31.6%
30.0%
Always
25.0%
Mostofthetime
20.0%
Rarely
15.0%
10.0%
14.2%
12.5%
7.7%
Never
NoOpinion/ Don't
Know
5.0%
0.0%
Satisfaction with seeking out people and community supports from 2012 to 2015:
 2012 result: 59.4 % of members surveyed responded always or most of the time
 2013 result: 57.9% of members surveyed responded always or most of the time
 2014 result: 52.8% of members surveyed responded always or most of the time
 2015 result: 65.5% of members surveyed responded always or most of the time
P a g e 41
How satisfied are you with being treated with respect by staff at this clinic?
Satisfaction with being treated with respect with the following result from 2014 to 2015:
 2014 result: 92.4% of members surveyed were very satisfied or satisfied
 2015 result: 94.9% of members surveyed were very satisfied or satisfied
NOTE: This question was added in 2014. Results trended up slightly in 2015 and remain positive.
P a g e 42
VO’s Actions/Recommendations from the Member 2015 Satisfaction Survey:

Results were reviewed in the August 6, 2015 SPN Meeting and August 20, 2015 SPN Quality
meeting and August 25, 2015 Quality Management Committee. Individual SPN results by clinic
with member comments were distributed to SPNs July 10, 2015 with a recommendation to review
and provide results to clinic staff.

Overall satisfaction trended up in 2015 as well as several measures intended to support a recoverybased service orientation trended up, including satisfaction in reaching their goals and ability of
members to improve their own lives. There was also significant improvement in respondents rating
feeling much better and receiving all of the services they need.

Several measures were identified to target with the SPN clinics for improvement including
satisfaction with seeking people and community supports, a key element of recovery as well as
phone accessibility. The Texas service delivery systems implementation of Texas Resilience and
Recovery (TRR) includes more thorough clinical assessments and evidence based practices with
emphasis on Person Centered Recovery Planning. This recovery-based approach will continue to be
the focus of best practices and collaboration with providers.
P a g e 43
Local Authority Goals and Service Priorities
GOAL 1:

North Texas Behavioral Health Authority will continue, in collaboration with VO, to focus on
efforts to improve Community and State Hospital discharge processes and continuity of care.
Process

NTBHA and VO will solicit ongoing feedback from providers and community stakeholders
regarding discharge processes and coordination of aftercare. Currently this is done via quarterly
SPN Quality Committee meetings where clinical outcome measures are reviewed by SPN and for
NorthSTAR overall. Barriers to discharge planning with hospitals and aftercare appointments are
discussed. Quarterly Hospital/SPN meetings are conducted to discuss discharge care coordination,
quality of hospital discharge plans, availability of SPN prescriber appointments and follow-up
appointments with a mental health provider. Finally, on alternate months, VO meets with each
SPN individually to review their QIP results, clinical outcome measures, discharge planning and
appointment availability, and other outcome measures such as hospital readmissions and ACT
acute admissions.

VO will continue to facilitate, with active participation and input by NTBHA, a quarterly
coordination meeting with SPN providers and community hospitals in order to identify and
discuss issues, barriers and best practices related to discharge planning and continuity of care.

NTBHA will support efforts by VO, TSH, and DSHS to ensure appropriate discharge planning
and continuity of care for individuals who have been in the State Hospital for an extended period
of time in order to ensure appropriate levels of care and an efficient use of currently limited State
Hospital bed capacity.

NTBHA and VO will explore options for making the Hospital Discharge Brochure available in
Spanish.

NTBHA will provide support and collaborate with VO and DSHS to address the needs of
individuals on forensic commitments to ensure that these individuals are receiving care in the
most appropriate environment.

NTBHA will solicit feedback from the Provider Advisory Council and Physicians Leadership and
Advocacy Group on strategies for improving current processes and ensuring efficient processes
P a g e 44
are in place under the updated system of indigent behavioral health services.
Outcome Measures

Improvement in outcome measures related to community service follow-up, prescriber follow-up,
and readmissions after discharge from inpatient hospitalization.

Participation by all SPN and community hospital providers in quarterly coordination meetings.
GOAL 2:

North Texas Behavioral Health Authority will work in collaboration with VO to enhance
housing options to NorthSTAR consumers.
Process:

NTBHA will work in Collaboration with VO to ensure processes for allocating available
funds for rental and utility assistance are efficient and result in the greatest possible impact on
consumer outcomes and recovery.

NTBHA will work to identify funding opportunities to assist in expanding current housing
options as well as to develop new housing projects and provide support to appropriate
providers and community partners in their efforts to secure funding.

NTBHA will work with MDHA as needed to support housing initiatives and monitor progress
in NorthSTAR towards tracking and responding to housing instability and minimizing the
prevalence of new homelessness.

NTBHA will continue to support local initiatives to implement boarding home licensure
requirements and monitoring.

NTBHA will provide support to local municipalities and MHA in efforts to increase the
number of licensed boarding homes and provide relevant trainings to boarding home owners
in order to help establish safer, more recovery-oriented housing options.

NTBHA will participate in the Dallas Continuum of Care Committee and monitor
opportunities offered through the Texas Health Institute’s Housing Policy Academy.
Outcome Measures:

A decrease in number of NorthSTAR consumers reporting housing instability or
homelessness.
P a g e 45

Detailed tracking of utilization of rental and utility assistance initiated as part of the 83rd
Legislative Expanded Service Requirements.

Number of boarding homes that complete the licensure process and participate in
recommended trainings.

Decrease in number of consumers housed in unlicensed boarding homes versus licensed
boarding homes.
GOAL 3:

NTBHA will promote suicide prevention in the community through training events and other
opportunities such as health fairs, speaking engagements, etc., collaborating with NAMI, MHA, and
the Suicide and Crisis Center who also provide trainings and events in the community.
Process:

NTBHA staff has participated in the following events:
o 2013 Texas Suicide Prevention Symposium
o ASK About Suicide to Save a Life Training Of Trainers Certification class (September
2015). ASK is designed to teach adults a suicide prevention gatekeeper model.
o 2015 National LOSS (Local Outreach to Suicide Survivors) Team Conference in Fort Worth
(October 2015).

A NAMI Dallas member also became certified to teach the ASK About Suicide to Save a Life
TOT class and attended the National LOSS Team Conference.
Outcome Measure:

The NTBHA will designate a Suicide Prevention Coordinator by January 1, 2017. The
Suicide Prevention Coordinator will work collaboratively with local staff, LMHA suicide
prevention staff statewide, and DSHS’s Suicide Prevention Office to reduce suicide deaths and
attempts.

NTBHA staff will conduct a minimum of three (3) ASK About Suicide to Save a Life training
events in the NorthSTAR region annually in FY16 and FY17. Possible venues include PLAN,
CFAC, NAMI, MHA, local colleges (18 or older or parental permission required to attend)
P a g e 46
and the faith-based communities. NTBHA will finalize the training materials and work with
community stakeholders to propose the first training event by March 2016 with future classes
to be determined.
GOAL 4:

Complete identified transitional planning activities and make necessary changes to the NTBHA
infrastructure to ensure a smooth transition to the updated model of indigent behavioral health
services by the January 1, 2017 implementation date.
Process:

Continued analysis of the infrastructure restructuring and expansion necessary for NTBHA to
meet all requirements outlined in the DSHS performance contract.

Conduct open enrollment for providers. Transitional planning is focused on creating a
competitive provider market and securing a robust network of providers capable of providing
broad access to services. The NTBHA will make significant efforts to retain providers
currently contracted under NorthSTAR through VO in order to facilitate successful transitions
for consumers from NorthSTAR to the new indigent behavioral health model.

Develop a contingency plan detailing how the transition of currently authorized services and
levels of care will be coordinated in the event that available funding is not sufficient to serve the
current six-county caseload.
Outcome Measure:

Operational readiness for transition to new indigent behavioral health system effective January
1, 2017.

Transition of members from NorthSTAR services to services under the new system with a
focus on continuity of care and minimal interruption to service delivery.

Coordinate with LifePath Systems and develop necessary processes for collaboration and
coordination with the Collin County indigent behavioral health system.
GOAL 5: Ensure transitional planning activities are communicated effectively to NorthSTAR
P a g e 47
consumers, family members, providers, and community stakeholders and ensure these groups are
provided opportunities to offer feedback and input related to system design.
Process:

Identify strategies for providing updates on transitional planning to reach a broad audience.

Coordinate with local groups such as Mental Health America and NAMI.

Conduct informational forums and Town Hall meetings as needed to provide information and solicit
community input.

Conduct targeted outreach to consumers, family members, providers, and community stakeholders as
needed through various strategies such as website postings, mailings, email communications, public
announcements, etc. Conduct outreach at clinics using specifically selected peers during the last three
months of 2016 and first three months of 2017.
Outcome Measure:

Updates provided on transitional planning activities through regularly scheduled NTBHA
Board of Directors meetings, NTBHA Advisory Groups, and other community meetings.

Town Hall meeting held in each of the six partnering counties in advance of the January 1,
2017 implementation date for the updated indigent behavioral health system. NTBHA will
coordinate with LifePath Systems to ensure appropriate processes are in place to provide
information to Collin County residents.
GOAL 6: Increase number of NorthSTAR members enrolled in other benefits such as Medicaid and
Supplemental Security Income.
Process:
P a g e 48

Provide outreach to consumers through various communications and workshops to provide information
on Medicaid, Medicare, SSI, other benefits resources.

Partner with community stakeholders, such as MHA and NAMI, and support initiatives to increase
access to and enrollment for benefit resources,

Collaborate with providers and VO to identify opportunities and best practices for screening for benefits
eligibility and assisting with application processes.
Outcome Measure:

Increased number of NorthSTAR members enrolled in other benefits.

Development of Client Benefits Plan for implementation and maintenance under the updated
system of indigent behavioral health services.
GOAL 7: Increase coordination with area MCOs in preparation for implementation of updated system
of behavioral health services.
Process:

Continue coordination with the HHSC Health Plan Management team in order to strengthen relationship
and stay up to date on HHSC transitional planning activities.

Assist in coordination of engagement between Medicaid MCOs and NorthSTAR traditional and valueadded providers.

Work with HHSC and area MCOs to ensure continuity of care as Medicaid members transition
behavioral health coverage from NorthSTAR to the MCOs responsible for their primary health care.

Ensure that providers under the updated indigent behavioral health services system are also Medicaid
providers to assure quality of care for individuals who gain and/or lose Medicaid coverage over a given
period of time.

Secure NTBHA’s Medicaid provider status in order to prepare for this transition and work towards
execution of contracts with the four area Medicaid MCOs.
Outcome Measure:

HHSC Health Plan management representatives attend NTBHA Board of Directors and Dallas
County BHLT meetings as needed to provide updates and coordination.
P a g e 49

MCO representatives attend at least one Provider Advisory Council Meeting to engage with
NTBHA and providers.

Network providers under the updated indigent behavioral health system also hold contracts
with the area Medicaid MCOs.

Development of plan for coordination and continuity of care between area indigent behavioral
health system and Medicaid managed care system.
Service Area Population
The NorthSTAR Service Delivery Area is comprised of Collin, Dallas, Ellis, Hunt, Kaufman,
Navarro, and Rockwall Counties. The region encompasses approximately 5406 square miles, with a
population of 3,767,286 or 14.46% of Texas based on 2012 estimates (U.S. Census Bureau). Of the
total population in NorthSTAR, 36.8% are individuals that are living at 200% of the federal poverty
level (1,320,948) according to U.S. Census Bureau, 2011 American Community Survey estimates.
The NorthSTAR region’s population experienced a 23.29% increase in population between 2000
and 2012, 3,055,645 and 3,767,286 respectively. In several counties there were significant
population increases. Collin County experienced a 69.89% increase in population, Ellis experienced a
38.19% increase in population, Kaufman experienced a 49.41% increase, and Rockwall saw its
population increase 92.97%. The State of Texas has experienced a 24.97% growth in the same period
of time (U.S. Census Bureau).
NorthSTAR Provider Network and Array of Services
Cornerstones of NorthSTAR’s Distinctive Approach

Open Access-NorthSTAR participants have access to services virtually anytime.
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
Braided funding – Federal, state, and local sources contribute funds to purchase behavioral
health insurance coverage for eligible consumers.

Integrated services - Mental health and substance abuse treatment are coordinated under the
umbrella of behavioral health, allowing integrated treatment in a single system of care.

Behavioral Health Organization - Services are provided through a contract with a licensed
behavioral health organization (BHO) that contracts and manages the provider network.
Array of Services effective through December 31, 2016
NorthSTAR offers a wide array of mental health and substance use disorder services provided by a diverse
provider community which offers a variety of choices to the NorthSTAR consumers in which we serve.
Mental Health Services
1. Outpatient Services –
a. Adult Texas Resilience and Recovery (TRR) Service Package Services contained therein
b. Child and Adolescent TRR Service Package Services contained therein
c. Crisis Intervention Services
d. Psychosocial Rehabilitation Services
e. Skills Training and Development Services
f. Medication Training and Support Services
g. Counseling and Psychotherapy
h. Assertive Community Treatment (ACT)
i. Case Management Services
j. Home-based Behavioral Health Treatment
k. Intensive Case Management - Youth
l. Supported Employment- Add-On Service
m. Early Intervention
P a g e 51
2. Inpatient Services –
a. Acute (Mental Health) Inpatient Hospitalization
Substance Use Disorder Services
1. Inpatient Detoxification Services (Hospital and 24-Hour Residential)
2. Outpatient Detoxification Treatment Services
3. Residential Rehabilitation
4. Partial Hospitalization
5. Intensive Outpatient Rehabilitation Services
6. Outpatient Treatment Program
7. Outpatient Services
8. Medication Assisted Treatment (Methadone/Suboxone)
Crisis Services
1. Mobile Crisis
2. Crisis Hotline
3. 23 Hour Observation/Treatment (Hospital-based)
4. Emergency Room Services
5. Intensive Crisis Residential (1 - 14 days)
6. After Hours Crisis Clinic (1 location)
Specialty Children’s Programs
1. Specialty Program - Early Childhood Pre-School Day Treatment (Ages 3-5)
2. Specialty Program - Children and Youth Wrap – around Services
3. Specialty Program - Mental Health Services-Birth to Age Six
4. Specialty Program - Treatment Foster Care
Day Services
P a g e 52
1. Partial Hospitalization
2. Intensive Outpatient Programs
Additional Value-Added Services
1. Minority and Specialty Populations Outreach and Advocacy
2. Family Support Groups
3. Peer Education, Support, and Counseling
4. School-Based Prevention
5. Dual Diagnosis Support Groups
6. Targeted Case Management
7. Jail Diversion
8. Outpatient Competency Restoration
9. Transportation is available to Medicaid consumers
The depth and breadth of services offered within NorthSTAR requires a robust provider network in which
to provide consumers with adequate choice of service provider and location. The following outlines the
NorthSTAR providers contracted with ValueOptions to deliver the above mentioned NorthSTAR services.
Provider Network


Specialty Provider Network (SPN) Providers
o Collin -
4 clinic locations
o Dallas -
21 clinic locations
o Ellis -
2 clinic locations
o Hunt -
2 clinic locations
o Kaufman -
3 clinic locations
o Navarro -
2 clinic location
o Rockwall -
1 clinic location
Outpatient Clinics (non-SPN Providers) – Mental Health
P a g e 53



o Collin -
1 clinic locations
o Dallas -
5 clinic locations
o Ellis -
3 clinic locations
Substance Use Disorder Clinic Providers
o Collin -
8 clinic locations
o Dallas -
19 clinic locations
o Ellis -
2 clinic locations
o Hunt -
1 clinic location
o Kaufman -
1 clinic location
o Navarro -
1 clinic location
o Rockwall -
2 clinic location
Community Hospitals
o Collin -
1 hospital location
o Dallas -
3 hospital locations
o Hunt -
1 hospital location
State Hospitals
o Terrell State Hospital in Kaufman County (other SH’s across Texas are utilized as needed)

Individual Providers (both mental health and substance use providers)
o Collin -
23 individuals
o Dallas -
138 individuals
o Ellis -
19 individuals
o Hunt -
14 individuals
o Kaufman -
7 individuals
o Navarro -
10 individuals
o Rockwall -
8 individuals
o Other -
8 individuals
P a g e 54

Crisis Services Providers
o Adapt Community Solutions offers 24/7 hotline and mobile crisis services
o Southern Area Behavioral Health After-Hours Crisis Clinic
o Green Oaks Hospital 23-hour Psychiatric Observation Room
o Homeward Bound Crisis Residential Program
o Serenity Crisis Residential Program
o NorthSTAR SPN’s also provide walk-in crisis services
Principles Considered in Service Delivery and Service Design
1. All delivered services as well as service design must take into consideration the needs of the
individual client and the needs of the communities.
2. All resources should be maximized. The efficient use of funds and the prudent distribution of
care will ensure eligible citizens receive the needed services from competent providers at a
reasonable cost.
3. Delivered services and program design must take into consideration how they directly and indirectly
affect associated social service systems.
4. The cost or expense of operating existing and planned behavioral health programs must take
into consideration all or total cost including those incurred by other or associated public service
systems.
5. The local authority will be accountable to the public it serves.
6. The local authority will be an integrated service system that maximizes the use of all available
funds, including maximizing county match contributions.
P a g e 55
7. The system will match the levels of care to the levels of need, regardless of the individual’s ability
to pay.
8. The system will utilize evidence based best practices to identify disease management principles
when providing care.
9. The system will offer a seamless continuity of care encompassing prevention, treatment, after-care,
crisis and support services.
10. The system will offer access to recovery-based services that are responsive to the needs of the
consumer.
11. The local authority will promote community education and anti-stigma programs
designed to encourage the community to value people regardless of presenting illnesses
or disabilities.
12. The local authority will provide an independent and impartial avenue (ombudsman) for consumers,
family members, advocates, providers and stakeholders to seek resolution of complaints.
13. Services for all residents will include a safety net that provides emergency and crisis services.
Maximizing County Match Contributions
As of SFY 2016, only two NorthSTAR Counties contribute direct county match to NorthSTAR –
Rockwall, and Navarro Counties. Although Dallas County has traditionally contributed a County match,
effective SFY 2014 Dallas County chose to redirect funds previously used as NorthSTAR matching funds
in order to provide matching funds to participate in the 1115 Healthcare Transformation Waiver DSRIP
Program. The Dallas County DSRIP project funds existing NorthSTAR providers, targets NorthSTAR
consumers in the Dallas County criminal justice system, and coordinates closely with VO and the
NorthSTAR system.
It is imperative that each NorthSTAR County be actively involved in the mental health and substance use
disorder treatment of the residents of their respective counties to ensure all needs are being met. This is
P a g e 56
especially important as NTBHA prepares for the transition from NorthSTAR to an updated model of
indigent behavioral health services. NTBHA has worked closely with county judges of the six counties
partnering with NTBHA under the updated indigent behavioral service system to ensure that local match
requirements are met.
NTBHA has provided each County Judge with section 534.066 of the Health & Safety Code as well as
correspondence outlining expectations related to local match. NTBHA provided additional information
to the Judges that allowed for in kind considerations and a transition period, during which they could
work toward their determined county match total. The NTBHA Executive Director has held face to face
meetings with each County Judge and various County Commissioners from January 2015 to date to
provide updates on transition planning and specifically discuss local match obligations, working with
individual counties to determine how and when counties will begin providing match.
NTBHA has convened multiple meetings with County Judges or their designated representatives from
each of the six partnering counties to review the status of NTBHA’s transitional plan and discuss county
match fund contributions during SFY16 and continuing into SFY17 when the new system is in place.
NTBHA is working with each county to conduct a detailed analysis of activities currently being funded
that may qualify as in kind match to ensure a full and accurate accounting of eligible matching funds.
Each county has pledged to designate their full portion of local match during their FY 2017 budget
allocations.
NTBHA is committed to continued discussions with County Judges and County Commissioners Courts
to provide updates on transitional planning and educate them on the value of investment into the system.
NTBHA acknowledges the importance of identifying and addressing county level strategies while
determining how county specific needs fit in to the regional needs of the service delivery area. NTBHA
encourages and supports the development of local planning committees/task forces in each NorthSTAR
County to provide county-level organization and advocacy. NTBHA will continue to partner with each
County as they establish their own behavioral health leadership/advocacy groups. Currently, Dallas
County and Ellis County have strong behavioral health leadership/advocacy groups meeting regularly.
NTBHA will continue conducting semiannual collaborative reporting presentations to the NorthSTAR
P a g e 57
community and its stakeholders to provide data and discussion on the status of NorthSTAR, highlighting
the strengths, while identifying areas of improvement as we move forward as a community.
Crisis Services Plan
The 80th and 81st Legislatures appropriated funding for community mental health crisis redesign. The intent
of the Crisis Redesign funding across Texas was to implement crisis services (ie, 23/hr observation rooms
and MCOT services). NorthSTAR already had an established crisis services array and was therefore
offered the flexibility to enhance existing crisis services as well as expand to include some new crisis
services.
Description: NorthSTAR Crisis Response System
Mobile Crisis Response/Crisis Hotline
Adapt Community Solutions (ACS) provides mobile crisis response through their Mobile Crisis Outreach
Teams (MCOT) and telephonic crisis services are available 24/7/365 to the seven county NorthSTAR
region. MCOT and crisis hotline services are available to all residents in the service delivery area
regardless of whether or not they are enrolled in NorthSTAR. ACS provides a combination of services
including telephonic services, face-to-face crisis assessment, crisis intervention services, crisis follow-up,
and relapse prevention to children, adolescents, and adults. Services are provided to individuals in their
place of residence, school and or other community-based locations deemed as safe. In many cases the
MCOT can resolve crises and divert individuals from higher levels of care.
For emergent crisis situations, the MCOT is deployed within one hour. For urgent crisis situations the team
is deployed within 8 hours. Initial crisis follow-up and relapse prevention services are conducted within 24
hours of the first call or contact.
Walk-In Crisis Services
Southern Area Behavioral Healthcare (SABH), located in South Dallas, serves as the Urgent Care Walk-in
Clinic for NorthSTAR. This after hours clinic was developed to provide a place for persons experiencing
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urgent behavioral health issues, but who do not need emergency room care, to access services after usual
business hours and on weekends. SABH offers office-based crisis services including prompt screening and
assessment, crisis stabilization, crisis resolution, and linkage to appropriate community services while
preventing admissions to higher levels of care.
Adult Front Door Crisis System
NorthSTAR offers a single location, Green Oaks Hospital, to provide emergency psychiatric services, a 23hour observation unit, and inpatient services in order to evaluate, stabilize, and treat behavioral health crises
that require a higher level of intervention than can be provided in the community. Green Oaks serves as the
front door facility exclusively for adults. With the removal of Timberlawn Hospital from the NorthSTAR
network, there is currently no designated front door facility for children and adolescents.
Extended Observation Unit
NorthSTAR features a 23-hour observation unit through Green Oaks Hospital. The 23-hour observation
unit provides emergency stabilization in an environment that is secure and protected. This unit provides an
appropriate environment for short-term stabilization of behavioral health issues. Individuals in need of
longer term care to ensure stabilization are linked to the appropriate level of care such as inpatient
hospitalization.
Inpatient Hospital Services
NorthSTAR contracts with five community hospitals located across three NorthSTAR counties to provide
inpatient hospitalization services. Non-network hospitals are utilized as needed to ensure sufficient bed
capacity. Hospital services are provided by qualified medical and nursing staff ensuring 24-hour
monitoring, supervision, and assistance in a safe, secure setting. Intensive services are designed to reduce
acuity and restore the individual’s ability to function at a lower level of care.
Crisis Residential
NorthSTAR has a Crisis Residential Unit through Homeward Bound for individuals whose needs are
greater than can be addressed through community services, but do not require an inpatient level of care.
This program provides 24-hour residential services that are short-term, community-based crisis treatment in
a safe, fully staffed environment. The length of stay typically ranges from 1 to 14 days.
P a g e 59
NorthSTAR added a second Crisis Residential Unit in SFY 2015 through the Serenity Crisis Residential
Program.
Other Services Integral to the NorthSTAR Crisis Service Delivery System

Post Acute Transitional Services (PATS) program – designed to target individuals who need
additional wrap around services, engagement, and creative recovery planning to increase and
maintain engagement in community services. Transicare currently provides this level of services.
Individualized treatment planning and service delivery is targeted at increasing community linkages
and reducing recidivism to acute levels of care and the criminal justice system.

Intensive Case Management (ICM) program – developed by VO utilizing a predictive model to
identify individuals who utilize acute levels of care at a high rate but do not successfully engage in
ongoing community services following discharge. VO Care Managers provide intensive case
management and facilitate engagement in ongoing community based services.

Peer Navigators program – developed in collaboration with the Association of Persons Affected by
Addictions (APAA) to provide peers to offer support and engagement to individuals presenting at
the “front door” acute setting to encourage linkages to community supports and engagement in
aftercare services. APAA reports that peer navigators see approximately 1500 peers/consumers per
month with resulting outcomes such as decreased ER visits and increased behavioral health and
medical appointment follow-ups.
Although NorthSTAR currently offers a wide variety of crisis services, this is an area that requires
significant focus and analysis as transitional planning for the updated indigent behavioral health system
progresses and the crisis service array and model is solidified.
NTBHA will implement crisis services in
compliance with the standards outlined by DSHS. NTBHA will work with community partners to develop
a continuum of crisis services designed to meet the needs of the service area while achieving cost
efficiencies. The crisis services plan for the new system must include a focus on strategies to assure rapid
response to persons in crisis and stabilization at the least restrictive level of care. Planning must also
include strategies to divert individuals in behavioral health crisis from the criminal justice system, reduce
unplanned use of local emergency rooms to manage behavioral health crises, minimize law enforcement
P a g e 60
wait times, and divert individuals in behavioral health crisis from psychiatric inpatient beds when
appropriate.
Diversion Action Plan and Continuity of Care Services
Criminal Justice and Juvenile Justice are two areas in which collaboration is imperative between the local
behavioral health authority and community for increased continuity of care, appropriate services being
provided at the appropriate level of care, and the ability to realize real cost savings within criminal and
juvenile justice when mental health and substance use disorders are properly funded and services provided
for. Parkland Correctional Services provides high quality behavioral healthcare services for inmates at the
Dallas County Jail Lew Sterrett Justice Center and remains the second largest provider of mental health
services in Dallas County. The Dallas County Jail population is around 6000 inmates on any given day,
with almost 50 % of have physical and mental health issues. The behavioral health population in the jail
continues to increase. As in past NorthSTAR strategic planning, addressing this critical issue remains a
top priority in this 2015-2016 LSAP.
Jail Diversion and Outpatient Competency Restoration
Jail Diversion within NorthSTAR is accessible in three counties – Dallas County, Collin County, and
Kaufman County. Dallas County has Jail Diversion for misdemeanor and felony cases. Grant money
from TCOOMMI (Texas Correctional Office on Offenders with Medical or Mental Impairments) is used
to operate Dallas County misdemeanor and felony mental health jail diversion programs. Collin County
has an Outpatient Competency Case Management Program for coordinating mental health and substance
abuse treatment for inmates once released from custody. Grant money from Texas Indigent Defense is
used to operate Kaufman County and Collin County Programs.
Dallas County:
The Dallas County Jail Diversion Program has been successfully diverting mentally ill offenders from jail
to treatment programs in the community. The implementation of these programs has aided Dallas County
in keeping the jail population to a manageable level. Jail Diversion is a collaborative approach between
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law enforcement and mental health professionals that focuses on creating alternatives to arrest and jail
detention for individuals who come in contact with law enforcement and could benefit from mental health
and substance abuse services or other social services. The goal of the program is to provide intensive case
management, sanctions and judicial monitoring. The Dallas County Misdemeanor Jail Diversion Program is
run by Judge Kristin Wade who meets with the clients several times a month. The program is individualized
and focuses on goals such as education, employment, medication compliance and drug and alcohol treatment.
The program is about 6 months long and a successful completion of the program means the client’s criminal
case is dismissed.
The Dallas County Felony Jail Diversion Program is called Achieving True Liberty and Success
(ATLAS). ATLAS is a last chance program for persons with major mental illness who are on probation.
The program goal is not to revoke probation on these clients, but to offer a one year period to help clients
comply with probation by providing intensive case management, education, medication compliance,
sanctions and judicial monitoring. The requirement for this program is a current felony case. The Divert
Court Program is called Diversion and Expedited Rehabilitation and Treatment. This program is designed
for first time felony arrests, 3rd degree felony or a state jail Felony. There also must be a substance abuse
diagnose. Treatment may include inpatient or outpatient services. The program is 12-18 months in length.
Two years after a client successfully completes this program, if there have been no new arrests, the charge
may be expunged.
Judge Doug Skemp oversees the Outpatient Competency Restoration (OCR) Court. The program allows a
person with mental illness to seek treatment in the community, thus reducing the burden on the State Hospital.
The person has been found incompetent and restores their competency in the community by receiving intensive
case management, medication compliance and judicial monitoring. Misdemeanor and felony cases are
considered for OCR since all candidates are carefully screened and evaluated by the court before sending
recommendations to Value Options for approval. Once a candidate has been approved to start OCR, a service
provider in the community is identified to provide case management and treatment toward helping the
individual to regain competency and stabilization. The treatment is individualized and ongoing court hearings
are scheduled for judicial monitoring. The program is typically granted for a 90 -120 day period. If OCR
conditions are violated the Judge determines the nature of the penalty. The penalty could warrant a return
to jail to be reassessed for appropriateness in continuing in the program. Once OCR is successfully
P a g e 62
completed and the defendant is deemed competent to stand trial a court hearing is scheduled. The
successful candidate can enter a plea bargain or often have their cases dismissed. On average, about 50
individuals are participating in OCR every month.
Caruth Smart Justice Planning Grant - The W.W. Caruth, Jr. Foundation (Caruth) has awarded a grant to the
Meadows Mental Health Policy Institute (MMHPI) to coordinate a focused planning process with Dallas
County and Parkland. The goal of the smart justice planning grant is to engage local partners in developing
plans to transform the Dallas justice system to better identify, assess, and divert persons with mental illness from
the justice system. Justice system costs attributable to unmet mental health needs exceed $47 million annually in
Dallas County. The MMHPI will partner with the Dallas County Criminal Justice Director’s Office, Parkland
Hospital, the Caruth Police Institute, the Parkland Center for Clinical Innovation (PCCI), and the Justice Center
of the Council of State Governments to develop recommendations for transforming the Dallas justice system to
meet this goal.
The work of the planning grant will involve engaging local justice system and health partners in a two- phase
process. Phase one involves a rapid six-month assessment to review available data, develop consensus on
needed improvements, prioritize implementation steps, and develop a timeline for implementation. Phase two
will focus on development of business and sustainability plans over a three year period for each of the five main
points of intercept where the criminal justice system interacts with people with severe mental illness: Intercept 1
(Law Enforcement); Intercept 2 (Initial Detention/Initial Court Hearings); Intercept 3 (Jails/Courts); Intercept 4
(Re-Entry); Intercept 5 (Community Corrections).
Kaufman County:
The Kaufman County Substance Abuse and Mental Health Diversion Program is run by Judge B. Michael
Chitty and has been operating for several years. The program has seen success and resulted in reduced
recidivism. The program is small yet intensive. The referrals come from probation officers, public defenders,
district attorneys and judges. The goal of the program is to provide treatment for substance abuse and mental
health services to individuals who have a felony and/or misdemeanor charge. Kaufman County collaborates
with Lakes Regional MHMR to provide the services. Lakes Regional serves an integral role in the Kaufman
County program providing comprehensive assessments to determine if the individuals meet criteria for
outpatient services in the community. If the individual meets criteria for the program, Lakes Regional requests
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approval through NorthSTAR. The individuals often qualify for a higher level of services which includes case
management, medication monitoring and substance use disorder services. The individuals also receive judicial
monitoring. The length of stay in the program is typically 18 months depending on the progress and recovery
treatment plan. The program has helped to lower the recidivism rate in Kaufman County and connect
consumers with substance abuse and mental health issues with treatment providers in the community.
Collin County:
The Collin County Mental Health Management Council Program seeks systemic solutions to divert
mentally ill defendants out of the criminal justice system and reduce recidivism. The individuals that are
identified with having a mental illness in jail are immediately assessed and referred to receive an array of
treatment if program criteria are met. They are promptly assigned counsel with specialized knowledge in
mental health defense, streamlined coordination of competency restoration or stabilization, and provided
case management to assist attorneys through mental health case management, mitigation strategy
assistance, and defendant advocacy. The local mental health service provider in Collin County is LifePath
Systems. LifePath is an essential part of the Collin County Mental Health Management Program. The length of
stay in the program is typically dependent on the progress of the recovery treatment plan and the deposition of
the case. The program has been successful in helping to lower the recidivism rate and helping consumers with
substance abuse and mental health issues connect with treatment providers in the community.
Rockwall County:
In SFY 2015, NTBHA worked with VO, Lakes Regional MHMR, Rockwall County Jail, and the
Rockwall County DA’s Office to develop a process for improving coordination of aftercare for individuals
releasing from the jail who have been identified as being in need of ongoing behavioral health services.
This transitional case management project includes targeted referrals, assistance with NorthSTAR
enrollment, and outpatient behavioral health services including enhanced case management as needed.
This project targets a gap in services that has been identified by Rockwall County stakeholders through
forums such as focus groups and community leadership meetings. This project is being funded through
Rockwall County matching funds. Although utilization for the project has been low to date, funding will
continue through SFY 2016. There are continued efforts by the Jail and Lakes Regional MHMR staff to
work with local judges and reduce identified barriers.
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A successful Jail Diversion Program will improve efforts to provide effective treatment services to
individuals in the legal system with mental illness and substance use disorders, with the goal of
reducing recidivism rates with most cases resulting in dispositions such as reduced sentences,
probation, and regular and conditional dismissals which helps to reduce the numbers in the criminal
justice system.
Outpatient Competency Restoration is vitally important to the NorthSTAR community. OCR takes
individuals from the judicial system who have been found incompetent and restores their competency in
the community, thus reducing the burden on the State Hospital and making the hospital accessible for
the most chronically ill. In September 2015 the average wait for a State Hospital bed for NorthSTAR
Dallas County was approximately 69 days on a felony charge and approximately 37 days on a
misdemeanor.
NTBHA supports education and outreach as a critical component of Jail Diversion and Outpatient
Restoration Programs. Other programs of note that relate to diversion and continuity of care include the
following:

Assisted Outpatient Treatment (AOT) Court

Mental Health Courts

Provision of Mental Health Assessment Services in Rural Counties

TCOOMMI services
NTBHA shall oversee strategies and procedures (as outlined in the DSHS contract) to divert individuals
with mental illness from the criminal justice system to appropriate community services. NTBHA
actively participates in local criminal justice task forces including the Dallas County Behavioral Health
Steering Committee and the Ellis County Behavioral Health Alliance which meet monthly with a
primary focus on jail diversion and issues related to criminal justice involvement. The NTBHA Jail and
State Hospital Liaison engages in monthly meetings with criminal justice staff in the other NorthSTAR
counties in order to provide support, education, and ensure counties are aware of the services available
through NorthSTAR and processes for accessing these services.
Crisis Intervention Training (CIT)
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Crisis Intervention Training (CIT) is another important component of diversion. The state of Texas
requires that all law enforcement officers receive a minimum of 16 hours of Crisis Intervention Team (CIT)
training. The Dallas Police Department saw a need for better preparation when dealing with consumers
exhibiting signs of mental illness. They implemented a 40-hour CIT training that includes extensive
classroom training to identify mental illness symptoms and cognitive impairment disabilities, provide
effective communication skills involving active listening skills and de-escalation techniques. Two full days
are set aside for scenario training, a simulated environment to practice what has been learned in the
classroom. The last day is spent hearing from local advocacy groups, consumers who have been confronted
by police during mental health crises, and ACS Mobile Crisis. Through support of the DPD, these classes
have been made available to every law enforcement officer in the NorthSTAR region at no charge to their
departments. Upon completion of the exam at the end of the week, the officer receives 40 TCLEOSE hours
and is recognized as a Certified Mental Health Officer in the State of Texas.
a. The 2015 CIT Training Calendar includes events at the following locations:

Dallas County – 8 in Dallas

Collin County – 1 in Frisco, 2 in Plano

Kaufman County – 1 in Forney

Rockwall County – 1 in Rockwall

Ellis County – 1 in Red Oak
b. Participating law enforcement agencies have included:

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Allen PD
Brookhaven College PD
Collin County SO
Corsicana PD
Dallas City Marshal
Dallas County SO
Dallas Independent School District PD
Dallas PD
DeSoto PD
Ellis County SO
Forney PD
Frisco PD
Garland PD
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




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
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
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a.
Garrett PD
Glenn Heights PD
Hunt County SO
Irving PD
Kaufman County SO
Kaufman Independent School District PD
Kaufman PD
Lancaster PD
Mansfield PD
McKinney PD
Montague County SO
Murphy PD
Plano PD
Red Oak PD
Rockwall County SO
Sachse PD
University Texas South West Health System PD
Waxahachie PD
Wylie PD
Whitney PD
c. Fire department and EMT staff is not required by law to receive CIT classroom training, but take
several online courses regarding mental health. To supplement online trainings, DPD provides a 16hour CIT training for Dallas Fire Rescue that includes recognition of mental illnesses and
communication skills with some scenario training.
d. DPD also provides an 8-hour CIT training class for probation officers in Dallas and Collin Counties.
e. Additionally, a 4-hour class is given each semester at the UNT Dallas campus for a criminal justice
class.
Mental Health First Aid Training
The 83rd Texas Legislature appropriated funds to the Department of State Health Services (DSHS) to
procure Mental Health First Aid (MHFA) trainers utilizing Local Mental Health Authorities
(LMHA)/Local Behavioral Health Authorities (LBHA) employees and/or contractors. NTBHA was
awarded funding for SFY 2014 and SFY 2015 and formed a collaborative through subcontracts with
three providers, MHA of Greater Dallas, Dallas Metrocare, and Life Path Systems to conduct these
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trainings in the NorthSTAR service area.
NorthSTAR trained 148 educators and secured training for one Mental Health First Aid Instructor under
this grant for SFY 2014. During SFY 2015, NorthSTAR trained 204 educators, 373 non-educators, and
3 MHFA instructors under this contract.
NTBHA submitted a MHFA training plan to DSHS in order to secure training funds for SFY 2016.
NTBHA has again been awarded MHFA training funds. MHA of Greater Dallas, Dallas Metrocare, and
Life Path Systems will continue to serve as sub-contractors to train individuals, specifically school
employees and school resource officers, in MHFA throughout the NorthSTAR service area to maximize
the number of children who have direct contact with an individual who has successfully completed
MHFA training.
Primary Care Integration – Primary care integration is a significant need for the individuals served
through the NorthSTAR program. It is important for a variety of different community partners and service
providers to come together to develop strategies to address the need for integration of primary care and
behavioral health services for our consumers. Throughout the nation “people living with serious mental
illness are dying 25 years earlier than the rest of the population, in large part due to unmanaged physical
health conditions” (National Council for Community Behavioral Healthcare, 2009). There is significant
cost to individuals and to the system of care if this need is not addressed. In the NorthSTAR system of
care, integration of care is emerging with more targeted focus.
NTBHA will explore strategies to integrate primary care and behavioral health services to the greatest
extent possible given available funding. Although NTBHA and the local community recognize the
importance of primary care and behavioral health integration, there are existing barriers in place that will
require thoughtful innovation coupled with adequate funding to overcome.
The region is rich with pioneering 1115 Waiver Delivery System Incentive Reform Projects (DSRIP)
that focus on the integration of primary care and behavioral health services. Medical City Dallas, a
586-bed acute care hospital in Dallas, has a project that includes an integrated primary and behavioral
health clinic that provides primary care for patients receiving outpatient psychiatric care at Green Oaks
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Hospital. Metrocare Services has multiple DSRIP projects including two projects focused on primary
and behavioral healthcare integration. These Metrocare Services projects create an integrated model of
easy, open access to primary care services for persons who are receiving behavioral health services in
their community based behavioral health clinics. This effectively establishes a “one stop shop” for
patients to receive both behavioral and primary care services on the same day. Lakes Regional MHMR
has integrated primary healthcare services into three existing rural behavioral health centers (Paris, Mt.
Pleasant and Sulphur Springs). The project provides currently served individuals with serious mental
illness and without PCP access to integrated physical healthcare through a mobile medical unit.
Although the focus of this project falls outside the NorthSTAR service delivery area, it offers a potential
model for integration. Children’s Medical Center, Parkland Hospital and the Baylor health system also
have projects designed to support integration of physical and behavioral health care.
NTBHA has closely monitored the development, implementation, and progress of local DSRIP projects
in an effort to learn from the successes and positive outcomes being realized in our community.
NTBHA is prepared to build on the strong foundation of our local behavioral health system, provider
network, and stakeholders to maximize any additional opportunities available through DSRIP.
There are a number of current NorthSTAR providers making strides to integrate primary and behavioral
healthcare through strategies unrelated to DSRIP funding. One NorthSTAR SPN, Child and Family
Guidance Center, added a pediatrician in August 2015. Parkland Hospital coordinates a mobile unit that
services a local substance use disorder provider, Homeward Bound. NTBHA will conduct a detailed
analysis of existing projects targeting integration in order to build an inventory and identify programs
that lend themselves to expansion. NTBHA will work closely with NorthSTAR members, family
members, providers, advocates, and other stakeholders to identify gaps in integration, greatest primary
healthcare needs, and existing capacity.
NTBHA will work to strengthen relationships with local Federally Qualified Health Centers (FQHC),
Parkland Health & Hospital System (Dallas County’s public health system) and other providers of
primary and behavioral healthcare in order to identify opportunities for collaboration and coordination.
NTBHA will explore pathways for agreements with local FQHCs (four in Dallas County, one in Ellis
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County and one in Hunt County) and other low cost primary care clinics to facilitate reciprocal referrals
with NorthSTAR service providers.
VO is currently participating in data sharing initiatives with MCOs that are expected to increase
NorthSTAR coordination between behavioral health and medical services. One initiative uses data
elements from the Child and Adolescent Needs and Strengths assessment (CANS) that identify and rate
the severity of health needs. Members who are scored as having significant health issues trigger the data
for those members to be sent to the respective MCOs. These efforts currently underway highlight
opportunities for collaboration as members fluctuate between indigent and Medicaid coverage. This
also highlights the importance of well-established relationships between NTBHA, contracted providers,
and MCOs under the updated indigent behavioral service system.
Performance Measures and BHO Oversight Plan
Performance Measures
NTBHA has identified the following BHO performance measures based on needs assessment data,
community input, current NorthSTAR priorities, and transitional planning activities. NTBHA will
expand and build upon these measures throughout the contract period as additional needs emerge and
system priorities shift. NTBHA will monitor these identified performance measures and report on the
BHO’s performance.
1. Goal: Improved discharge planning and coordination of aftercare.
Performance Measures:

Maintenance of clear, consistent, uniform guidelines for NorthSTAR discharge processes and
continuity of care coordination.

Improvement in outcome measures related to community service follow-up, prescriber followup, and readmissions after discharge from inpatient hospitalization. NTBHA will continue to
work collaboratively with VO to monitor the Clinical Outcome Measures reports and attend
meetings with providers to review discharge planning, outpatient provider engagement,
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hospital readmission rates, etc.

SPN and Inpatient provider audits include evaluation of discharge coordination and referrals.

Shared responsibility for effective discharge planning by creating a system by which the
discharging facility and accepting provider would share an incentive payment for meeting above
expected, and share in penalty if below expected follow-up and readmission rates. Shared
accountability would encourage increased collaboration and acknowledge important roles of
both discharging facilities and outpatient providers in coordination of aftercare.

Targets would be determined for each facility/provider based on past utilization patterns of
assigned patients assigned to that provider.

Reduction in number of members who have been in State Hospital for longer than 180 days.
2. Goal: Designation of separate Front Door facilities for Adults and Adolescents.
Performance Measures:

BHO, in coordination with NTBHA, will evaluate current adult front door designation as needed
and make any necessary improvements to processes to facilitate smooth transition through the
continuum of crisis services and facilitate engagement with outpatient providers.

BHO will work with local community hospitals to identify a facility willing to serve as the Front
Door facility for children and adolescents. BHO will ensure that the selected facility has the
staffing, infrastructure, and processes in place to serve in as the Child and Adolescent Front
Door.

BHO will make a recommendation to NTBHA for approval of the designation of the Child and
Adolescent Front Door facility.
3. Goal: Identify additional opportunities and strategies for Jail Diversion.
Performance Measures:

BHO will continue engagement with the Dallas County 1115 Waiver Crisis Services Project.

BHO will coordinate with law enforcement agencies as needed to identify high utilizers, identify
barriers and gaps in service, and develop plans for engagement.

BHO will coordinate with the DART Police Department to develop and implement strategies for
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appropriate crisis intervention and jail diversion.
4. Goal: Develop and expand programming targeting high utilizers.
Performance Measures:

Continue to monitor and analyze outcome data related to PATS and ICM programs to inform
decisions regarding expansion of these programs.

Continue collaboration with Dallas County BHLT Adult Clinical Operation Team which focuses
on service gaps and barriers for individuals with a high rate of APOWWs and acute services and
low rate of engagement in aftercare services. Identify specific barriers to engagement and design
programming responsive to these needs.
5. Goals: Collaborate with NTBHA and DSHS to develop a strategic plan for the transition from the
current NorthSTAR model to an updated system of indigent behavioral healthcare.
Performance Measure:

Participate in strategic planning meetings with DSHS and NTBHA as needed to develop
transition plan for discontinuing the NorthSTAR program and transitioning behavioral health
services to the two new indigent behavioral health services and Medicaid MCOs.

VO’s transition plan ensures that Enrollees are transitioned appropriately to the other entities
without interruption of enrollees’ services. The transition plan outlines timeframes for critical
activities related to transition and outlines duties performed by key personnel.

VO will provide all relevant data and documentation as directed by DSHS.
BHO Oversight Plan –
NTBHA will monitor and track several aspects of the BHO over the remainder of the NorthSTAR
program, which will assist in identifying areas of strengths to capitalize on and areas of weakness to
improve. NTBHA will take a systematic approach to oversight of BHO’s activities in several key areas.
1. Utilization Management – There are several UM activities that NTBHA will target in FY16 and
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FY17, which will be accomplished through a variety of strategies and monitoring activities.
a. Mental Health Outpatient - NTBHA will continue to track and monitor the units of
service provided to consumers within each service package and the documentation of
individualized, person centered, and strength based services. This will allow NTBHA to
transition into the new indigent only behavioral health system with a recovery oriented
service delivery focus and an accurate assessment of system wide recovery oriented
training needs. NTBHA will continue to participate in SPN Quality Audits to ensure
quality provision and documentation of services.
b. Physical Health Care Coordination – NTBHA will track and monitor the rate of
consumers with identified physical healthcare needs being connected to appropriate
healthcare providers in the community. NTBHA will work with VO and service providers
to develop a comprehensive list of healthcare providers for consumers to be referred to and
provide education to service providers about the most significant healthcare issues faced by
consumers.
c. Substance Use Disorder – NTBHA will continue to track and monitor the rate of
consumers identified as co-occurring and that those receiving a SUD service are engaging
in treatment for at least 90 days. NTBHA will monitor adverse determinations levied by
VO and the appropriateness of those determinations.
d. Discharge Process – NTBHA will continue to monitor the community inpatient and State
Hospital discharge planning processes in order to ensure that there is effective
communication and coordination between hospital facilities, outpatient providers, and VO
to facilitate appropriate continuity of care and continued engagement. NTBHA will
monitor outcome measures related to 7 and 30 day follow-ups and hospital readmissions.
NTBHA will continue to collaborate with VO and providers to explore options for
improving discharge planning in order to increase follow-up rates and decrease
readmissions to higher levels of care.
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2. Quality Management - NTBHA will target several QM activities in FY16 and FY17, which will
be accomplished through multiple approaches. Since FY11 NTBHA and VO have convened a
QM meeting that is held every other month to discuss quality management issues that are being
worked on independently as well as collaboratively. Complaint trends are monitored and discussed
at the meeting as well to identify the need for further investigation and/or action.
a. ValueOptions Quality Improvement Projects – NTBHA will continue to participate and
collaborate with ValueOptions on their identified QIP’s. NTBHA reviews data provided by
VO regarding their QIPs and PIPs. Currently, NTBHA/VO are working on the following
QIP’s:
NorthSTAR Quality Improvement Projects and Clinical Outcomes
Texas NorthSTAR URAC Quality Improvement Projects (QIP): There are two current QI Projects
(QIP) that include all NorthSTAR Enrollees (Medicaid and Non-Medicaid).
1. Increasing Prescriber Engagement in NorthSTAR Mental Health consumers that are assigned
to a Mental Health Provider (SPN-Specialty Provider Network).
a. Summary: Based on a NorthSTAR contractual requirement for an appointment with a
prescriber within 7-days or 14-days after hospital discharge.
b. Annual measure that is the same quarter annually to control for seasonality issues and occurs
the first quarter of the State Fiscal Year (SFY) which is September 1 to November 30.
c. This measure is based on prescriber claims after hospitalization.
d. The focus is to improve SPN performance in providing member access to timely
prescriber appointments after hospital discharge. Ongoing interventions have included
providing daily admission reports to each SPN to inform them of their members admitted to
the hospital as well as weekly discharge reports. Clinical Outcome reports are provided
quarterly to SPN providers and they receive an incentive if they meet the performance
standard. They are also provided measure detail in order to review opportunities related to
members not seen by a prescriber within 7 or 14 days.
e. New Interventions: In late 2014, we added a Hospital Discharge Brochure designed to be a
resource to discharging patients including addressing transportation needs and what to
bring/expect at the first clinic appointment. In 2014, we implemented QM staff attending
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monthly Individual SPN Provider Operations/Clinical Meetings to review performance on
clinical outcome measures and other quality initiatives. We also added a quarterly
Hospital/SPN meeting in late 2014 to address hospital and SPN discharge coordination
barriers and to identify best practices. Some of these have included an actual appointment
time versus a walk-in appointment. Most SPNs now have dedicated Hospital Liaison staff
for discharge planning and coordination. Most SPNs are also doing reminder calls to the
individual prior to the appointment.
Outcomes:
Most Recent Remeasure: Discharges from 9/1/2014-11/30/2014 represent the population assessed. Due
to the claims lag, members are assigned by provider authorizations within 7 days of discharge.
7-Day Prescriber Engagement
Numerator:
426
Denominator: 1606
consumers seen by prescribers
hospital discharges during this quarter
14-Day Prescriber Engagement
Numerator:
536
Denominator: 1521
27%
35%
consumers seen by prescribers
hospital discharges during this quarter
There was an improvement from the previous measure of 20% for 7 day and 30% for 14 day
prescriber appointment. Below are the trended outcomes since the baseline measure:
Prescriber Follow Up
9/1/2009 - 11/30/2009
9/1/2010 - 11/30/2010
9/1/2011 - 11/30/2011
9/1/2012 - 11/30/2012
9/1/2013 - 11/30/2013
9/1/2014 - 11/30/2014
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7-Day Follow Up
31%
33%
24%
25%
20%
27%
14-Day Follow Up
42%
45%
33%
34%
30%
35%
Prescriber Follow Up After Hospitalization
50%
9/1/2009 - 11/30/2009
40%
9/1/2010 - 11/30/2010
30%
9/1/2011 - 11/30/2011
20%
9/1/2012 - 11/30/2012
10%
9/1/2013 - 11/30/2013
9/1/2014 - 11/30/2014
0%
7-Day Follow Up
14-Day Follow Up
2. QIP: Initiation and Engagement of Alcohol and Other Drug Dependence (AOD) Treatment in
NorthSTAR Medicaid and Non-Medicaid Members (IET)
a. Summary: Based on HEDIS® methodology that was implemented due to the State
recognizing this was an area of opportunity. NorthSTAR demographic data for 2013
showed that one third of membership had an AOD diagnosis.
b. Population for this measure includes youth (ages 13-17) and adults (ages 18+).
c. Initiation measure is the percentage of members who initiate treatment through an inpatient
AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization
within 14 days of the diagnosis.
d. Engagement measure is the percentage of members who initiated treatment and who had two
or more additional services with a diagnosis of AOD within 30 days of the initiation visit.
e. The focus has been to educate providers on this measure and to explore how SPN and
Substance Use Disorder (SUD) providers can impact this measure. This is a relatively
new QIP with a baseline annual measure and a recent 1st annual remeasure. The most recent
remeasurement shows a decline in both Initiation and Engagement measures for the full
population of adults and youth. There was an improvement of the Youth (age 13-17)
population. There was a 3 percentage point improvement in the Youth Initiation from the
baseline to the first remeasurement. There was a 2.3 percentage point improvement in the
Youth Engagement.
f. New Interventions: Updated the Hospital Discharge Brochure in late 2014 with Substance
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Use Disorder (SUD) Referral Phone number with the following, “If you think you may need
to cut down or stop using alcohol or other substances, call ValueOptions at 1-888-800-6799
for referrals or ask your clinic for more information on where to get help.”
g. New Provider Interventions: Added discussion to SUD Provider Meeting and SPN
Provider Meetings as well as held a Hospital/SUD Provider Meeting to address care
coordination and referrals to SUD services. A key barrier identified was that the SUD
Intensive Outpatient Service (IOP) code was not included in the measure and since this is as
National HEDIS® measure, no additions to the methodology are allowed. We were able to
run the data with the IOP code when we gave providers their member detail information.
Hospital Treatment Record reviews were performed with feedback to several hospitals on
the need for more specific SUD discharge referrals. A SUD Provider Program Description
was created to assist hospitals in understanding what services and which populations an
SUD provider serves.
Outcomes: The outcomes below are for the combined Youth and Adult population:
Total number initiated in treatment = 1854 of the 7,267 episodes.
Total number engaged in treatment = 936 of the 7,267 episodes
Overall Total Number of Index Episodes: 7,267
Percent Initiated:
25.5 %
Percent Engaged:
12.9 %
Initiation
Baseline
First Remeasure
Total
7856
7267
# Initiated
2217
1854
% Initiated
28.2%
25.5%
Goal >=
36.0%
36.0%
Total
7856
7267
# Engaged
1089
936
% Engaged
13.9%
12.9%
Goal >=
16.2%
16.2%
Engagement
Baseline
First Remeasure
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Texas Engagement Center Medicaid Performance Improvement Projects (PIP): NorthSTAR has two
current Medicaid Performance Improvement Projects (PIP). Both of these projects include only the
NorthSTAR Medicaid population.
These include the following:
1. Improving Follow-Up After Hospitalization for Mental Illness in NorthSTAR Medicaid
Enrollees within 7 and 30 Days (FUH)
a. Based on HEDIS® methodology that was a topic selected by HHSC to begin interventions
on 2/1/2014. The initial baseline was on Calendar Year 2012 with HHSC providing the
data. The State requested we replace this data with 2013 as the true baseline data. 2013 data
was received in November 2014. ValueOptions 2013 data was used to conduct the barrier
analysis and develop interventions.
b. This will be an ongoing PIP topic selected by HHSC for 2015 and 2016. Calendar Year
2014 data was received from HHSC in October 2015. This is based on claims data provided
by HHSC.
Outcomes:
7 and 30 Day Follow-Up (FUH )
7 and 30-Day FollowUp
2013 CY Baseline
2014 CY 1st
Remeasurement
7-Day Follow Up
32.50 %
30-Day Follow Up
58.44%
32.26%
56.33%
Note that Calendar Year 2012 data was initially provided by the State and identified this measure as an
opportunity for NorthSTAR. There was strong improvement from 2012 to 2013. There was a 10
percentage point improvement from 2012 to 2013 in the 30-Day Follow-Up Appointment measure and an 8
percentage point improvement in the 7-Day Follow-Up Appointment measure. The 2014 data was very
similar to the 2013 data with a slight decline.
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2. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) in
NorthSTAR Medicaid Enrollees
a. Based on HEDIS® methodology and was a topic selected by HHSC to begin interventions
on 2/1/2014. The initial baseline was on Calendar Year 2012 with HHSC providing the
data. The State requested we replace this data with 2013 as the true baseline data. 2013 data
was received in November 2014. ValueOptions 2013 data was ran to conduct the barrier
analysis and develop interventions.
b. This will be an ongoing PIP topic selected by HHSC for 2015 with the 2014 Calendar Year
data received from HHSC in October 2015.
Outcomes:
Initiation and
Engagement of Alcohol
and Other Drug
Dependence Treatment
2013 CY Baseline
2014 CY 1st
Remeasurement
Initiation
20.05%
Engagement
5.28%
18.86%
5.24%
There was slight decline between the baseline in 2013 and the remeasurement in 2014. One key barrier as
discussed under the IET QIP section above is the omission of the IOP service code in the methodology for
this measure. We have continued to work on improving this measure by providing results with member
detail to our SPN providers as well as presenting results and discussions with our Substance Use Disorder
Providers.
Prepared: 10/28/15 by ValueOptions if Texas, Inc., Quality Management Department
b. NTBHA’s Quality Improvement Projects – NTBHA has several areas being looked at
for quality improvement.
i. Several QIP’s currently being discussed in regards to admitting to acute care
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services and discharging from acute care services all while paying close attention to
decreasing the number of acute care services being utilized.
1. Admissions – NTBHA will continue to partner with CIT trainings to
provide law enforcement officers robust crisis training, education, and
resources to ensure consumers are brought to the most appropriate level of
care, which is oftentimes not jail. NTBHA will also continue to collaborate
with police officers to ensure that the most appropriate level of care within
the community is being utilized, which is not always 23/hour observation.
NTBHA, MCOT services, and community stakeholders will continue to
identify ways to divert individuals in behavioral health crisis from the
criminal justice system and from acute care setting when appropriate.
2. Discharge – NTBHA will continue to collaborate with community
stakeholders on implementing wraparound services from acute care settings
to community settings; whether mental health and/or substance use disorder
services. This will allow for a warm hand off integrating the consumer back
into community services or sometimes even engaging in community
services for the first time. Some of our higher need consumers have been
served under ValueOptions’ Intensive Case Management Program, which to
date has shown great success in engaging consumers who were previously
nearly impossible to engage. Additionally, NTBHA collaborated with
ValueOptions to establish an informative brochure that Green Oaks and
other hospitals are using at discharge to explain what to expect at their first
SPN appointment. It offers wellness and recovery tips, transportation
contacts, and resource info. NTBHA also oversaw the use of Penalty and
Incentive Funds (PIF) for transportation services in which consumers who
met certain criteria were assigned a SPN staff member who picked them up
upon discharge from the hospital and transported them to their initial SPN
appointments to encourage engagement.
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ii. Community Education and Outreach - In addition to participating in CIT
training events, NTBHA continues to look for opportunities to participate in
community outreach and education. Previous endeavors have included
collaboration with VO’s SOS (Stamp Out Stigma) campaign; staffing booths at
health fairs, mental health expos, and conferences; facilitating table discussions and
presenting at the State funded mental health “surge” focus group; speaking at
ADRC (Aging and Disability Resource Centers) monthly meetings in various
counties; and via CFAC outreach to the community with DARS and other speakers
presenting at various SPN locations. CFAC also hosts meetings on an as-needed
basis to gather feedback for the transitional plan to the new NorthSTAR system.
CFAC also hosts subject matter expert presentations that attract many people from
the community which provides opportunities to discuss NorthSTAR services and
benefits. Additionally, town hall meetings in each county have been widely
publicized and offer opportunities to answer questions and education consumers
and community stakeholders regarding NorthSTAR services. NTBHA will
continue to make staff available to reach out to the community in these and other
means as opportunities arise.
iii. MCOT/hotline services are another area NTBHA will continue to focus on.
NTBHA participates in monthly calls with ACS and VO aimed at monitoring
performance measures, addressing pertinent issues, and staffing difficult cases.
NTBHA will continue to monitor trends related to call volume and face to face
encounter capacity. NTBHA will conduct biennial audits of MCOT/hotline
services to ensure hotline calls are being coded correctly as emergent or urgent and
being responded to within the required timeframes. NTBHA will continue to
review hotline calls for appropriate handling and disposition.
3. Provider Network – NTBHA monitors appointment access for mental health SPN services. This
is largely to ensure provider network adequacy based on the availability of timely appointment
access and determine whether new providers should be added to the network to keep up with
demand of an open access system. NTBHA reviews appointment access monitoring data with VO
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to identify and address deficits and ensure that routine appointment access is available within 14
days. Action to address deficits typically includes informal follow-up by NTBHA or a formal
request by VO for a Corrective Action Plan depending on the nature of identified deficits.
NTBHA participates in ValueOptions Provider Review Committee meetings to review applicants
seeking to join the NorthSTAR network to ensure new providers are appropriately afforded access
to the network. The PRC committee takes into consideration factors such as geographical location,
provider saturation, language and multi-cultural competency, and specialized skill sets when
considering applicants for nomination to the provider network.
4. Customer Service – NTBHA attends quarterly Quality Management Committee meetings
convened by ValueOptions to review several dashboard measures. This report along with the
DSHS monthly complaints summary allows NTBHA to monitor VO costumer service activities,
such as abandonment rates and speed of answer. NTBHA continuously monitors complaints for
areas of concern identified in regards to VO’s customer service activities. NTBHA will begin
calling VO in their monthly rotation of contacting SPN’s to measure appropriate handling of a
variety of scenarios and presenting problems.
5. Financial Performance – NTBHA will continue to monitor, as it always has, VO’s medical loss
ratio to ensure 88% of funding received is in fact being spent on services. NTBHA will continue
identifying areas for improvement to utilize the funds NorthSTAR is allocated in the most fiscally
responsible manner that still allows for performance improvement.
6. Court-Ordered Behavioral Health Services – NTBHA will continue to reach out to all
NorthSTAR counties to collaborate between the criminal justice system and ValueOptions to offer
court-ordered behavioral health services such as Assisted Outpatient Treatment, Jail Diversion,
and Outpatient Competency Restoration. NTBHA will initiate quarterly meetings with
ValueOptions to discuss court-ordered behavioral health services work and monitor progress.
7. BHO Incentives – NTBHA will track and monitor Performance Incentives and Performance
Sanctions and Penalties included in the 2016/2017 DSHS/VO contract. NTBHA will monitor these
measures and report on any significant performance outcomes at monthly NTBHA Board of Directors
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Meetings and in summary of activities reports due to DSHS quarterly.
DSHS will determine the balance of penalties and unearned incentives for the BHO contract with DSHS
at the end of each state fiscal year. NTBHA will create a Penalties and Incentives Funds Plan (PIF) for
the possible use of these funds within the NorthSTAR service system.
8. Primary Care Integration – It is also imperative that NorthSTAR coordinate and collaborate with
many non-NorthSTAR Providers to offer seamless care to the consumers in which we all serve.
There are many ways in which NorthSTAR does this while there are many areas of improvement to
be made as well. Although such integration cannot be guaranteed due to primary care’s level of
willingness to collaborate, NTBHA can ensure VO’s responsiveness and willingness to such
collaboration.

NorthSTAR holds quarterly care coordination meetings with the MCO that manage
Medicaid, CHIP, and the STAR+Plus programs that offer physical and behavioral healthcare
to our consumers.

NorthSTAR Providers are audited to ensure they are exhibiting proper care coordination;
especially with physical health plans.

Monitor data sharing initiatives underway between VO and area Medicaid MCO’s aimed at
increasing coordination between behavioral health and medical services.

Monitor VO’s participation in DSHS Behavioral Health and Primary Health Integration
Initiative project between NorthSTAR program and the Primary Health Care Program
(PHC).

NTBHA will continue to monitor regional 1115 Waiver DSRIP projects targeting primary
care integration in order to look at how these initiatives might fit within the NorthSTAR
model.
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