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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 Page 2 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 Page 4 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 Page 5 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 Page 6 (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 Page 7 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. Page 8 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. Page 9 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 P a g e 10 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 P a g e 11 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) P a g e 12 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 P a g e 13 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%). P a g e 14 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. P a g e 16 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%). P a g e 17 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. P a g e 50 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 P a g e 58 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 P a g e 61 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 P a g e 63 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. P a g e 64 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) P a g e 65 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: P a g e 66 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 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 P a g e 67 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 P a g e 68 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 P a g e 69 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, P a g e 70 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 P a g e 71 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 P a g e 72 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. P a g e 73 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 P a g e 74 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 P a g e 75 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 P a g e 76 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 P a g e 77 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. P a g e 78 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 P a g e 79 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. P a g e 80 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 P a g e 81 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 P a g e 82 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. P a g e 83