Department of Health and Social Services Division of

Department of Health and Social Services Division of Substance Abuse and Mental Health Joint Finance Committee Hearing Fiscal Year 2013 Kevin A. Huckshorn, RN, MSN, CADC Division Director Thursday, February 23, 2012 Delaware Health and Social Services

MISSION STATEMENT To provide services that promote health and well-being, foster self sufficiency, and protect vulnerable populations who have substance use, mental health conditions, and/or gambling disorders in natural community settings. Delaware Health and Social Services

Vision DSAMH’s Vision is the development of a public system of mental health and addiction services and supports that is based on a Prevention Approach, where Treatment Works, and the people we serve “are the evidence” of what Recovery is all about. Delaware Health and Social Services

Overview • The Single State Agency for prevention and treatment services for substance use, mental health and gambling conditions. • Provides services regardless of ability to pay. • Organizational structure consists of the Central Office, the Delaware Psychiatric Center (DPC), community mental health and substance abuse services and gambling services. • Leadership function in utilization review and performance monitoring. Delaware Health and Social Services

Strategic Goals 1. Transitioning to becoming a state division that serves primarily as a leader, monitor and funder. 2. Ensuring that all services and supports DSAMH provides are: recovery-oriented and trauma informed; provided in safe environments for clients and staff; and monitored against performance-based outcomes that consider both staff productivity and client recovery benchmarks. Delaware Health and Social Services

Strategic Goals 3. Ensuring success and accountability of state and provider staff by providing ongoing training, supervision, and timely communication to state and provider staff and stakeholders on our mission, vision, goals, expected outcomes, and care standards so that, collectively, we are all involved with, and accountable for these outcomes and care standards. 4. Meeting or exceeding the USDOJ Settlement Agreement expectations. Delaware Health and Social Services

Community Services Overview • 24/7 Crisis Services • 24/7 inpatient psychiatric hospitals • Community mental health and addiction programs ranging from outpatient to intensive wrap-around services • Range of care management models from Assertive Community Treatment to Targeted Care Management • Range of peer-run programs and supports from inpatient to outpatient settings and a number of drop-in centers • Statewide gambling prevention and treatment services Delaware Health and Social Services

Community Services Overview • Statewide Treatment Access Centers (TASC) supporting individuals in the courts and community corrections • 19 Group Homes; 174 supported housing units • 37 Oxford Houses providing supportive housing • Detox services statewide, including ambulatory • 56 SA halfway houses and transitional housing • 4 specialty SA residential programs Delaware Health and Social Services

DSAMH Services 2010 – 2012 Break-out FY 12 Expenditures (estimated) FY 10 Expenditures 21% 3% 23% 41% 36% 3% 35% 38% Delaware Psychiatric Center Community Mental Health Inpatient Substance Abuse Treatment Delaware Health and Social Services

Quality Assurance/Performance Improvement • DSAMH’s QA/PI Unit oversees program accountability, authors and enforces standards for DSAMH-licensed programs. Program expansion is in process. • Includes the following Units: – Licensing and Medicaid Certification – Contract and Grant Monitoring – Eligibility and Enrollment Unit – Risk Management – Utilization Review for state clients in inpatient beds (IMDs) Delaware Health and Social Services

Accomplishments • Developed and posted 6 RFP’s to implement systemwide changes (in process) • Increased number of individuals served (1, 481 as of Dec. 1) in transformed Newark state-run mental health clinic • Over 1, 400 peer support contacts this year • Opening of the Drop Zone and Creative Vision Factory; 2 new peer run programs • DPC reduced operating capacity from 189 to 168 Delaware Health and Social Services

Accomplishments • Maintained full Joint Commission Accreditation • Maintained full CMS certification • Restructured the DPC Units to provide an increased number of crisis/ acute beds and fewer long-term beds • Implemented evidence-based risk assessment scales for violence and suicide • Implementing the Pyxis Medication Delivery System: Go Live Target Date April 2012 Delaware Health and Social Services

Individuals Receiving Behavioral Health Services (Primary Mental Health) Fiscal Years 2009 through 2011 (duplicated across categories) Point of Service FY 09 FY 10 FY 11 Community Mental Health Clinics 3, 349 2, 985 2, 638 CCCP 1, 569 1, 543 1, 610 Mobile Crisis 1, 150 1, 400 1, 600 Total 6, 068 5, 928 7, 190 Delaware Health and Social Services

Individuals Receiving Addiction Services Fiscal Years 2009 through 2011 (duplicated across categories) FY 09 Intensive Outpatient and Case Management Treatment Total FY 11 6, 687 6, 347 6, 362 360 413 460 7, 047 Outpatient (incl. Medication Assisted Treatment) FY 10 6, 760 6, 822 Delaware Health and Social Services

FY 09 through FY 11 Inpatient Detoxification Admissions by County 2000 1800 1600 1400 1200 1000 800 600 400 2009 2010 2011 New Castle 1811 1443 1246 Kent 290 172 161 Delaware Health and Social Services Sussex 464 238

DSAMH Funded Contract Psychiatric Inpatient FY 09 - FY 12 5, 500 $ 3, 500, 000 $ 3, 000 5, 000 $ 2, 500, 000 EXPENDITURES NUMBER OF BED DAYS $ 2, 000 4, 500 $ 1, 500, 000 $ 1, 000 FY 09 Expenditures $ 3, 111, 780 Bed Days 5, 019 FY 10 FY 11 $ 2, 845, 800 4, 590 $ 2, 873, 125 4, 597 FY 12 Estimated $ 2, 592, 857 4, 149 Delaware Health and Social Services 4, 000

Supported Employment 100 90 80 70 60 10 day employment benchmark 50 90 day employment benchmark 40 30 20 10 0 FY 09 FY 10 FY 11 Delaware Health and Social Services

DPC Trends/Projection in Staff FTE’s compared with total Staff Costs Delaware Health and Social Services

Delaware Psychiatric Center Adverse Events 2008 -2011 *The number of Sexual Encounters listed does not include one outlier, who was represented in 12 of 25 reported cases. Delaware Health and Social Services

US DOJ Findings (2008 -present) • DE was found out of compliance with the 1999 Supreme Court’s Olmstead decision that upholds the ADA mandate of the integration of people with disabilities—that they be served in their communities, not in institutions. • Six month interim report released; overall positive. • First-year targets well underway. Delaware Health and Social Services

US DOJ – Year 1 Status Report • Crisis Diversion – 24/7 Mental Health Crisis Hotline live – 24/7 Mobile Crisis Services. Needs to be in compliance by June 30, 2012 – New Crisis Walk-In Center (on target re renovation and will be done by August 1, 2012) – Crisis Apartments (in place currently but need to grow) • Crisis Stabilization Services – Working on plan to manage LOS at all IMDs for state funded clients – Increased acute care services at DPC Delaware Health and Social Services

US DOJ – Year 1 Status Report • Community Services RFP’s went out, first as of December 2011 – Community Reintegration Project (CRISP) – Assertive Community Treatment (ACT) – Intensive Case Management (ICM) – Targeted Case Management (TCM) • We expect a number of RFP responses from current and new providers Delaware Health and Social Services

US DOJ – Year 1 Status Report • Integrated Housing – 150 units approved – 100 more by July 1, 2012 (on target) • Supported Employment – 100 persons will be served by July 1, 2012 (on target) • Family and Peer Supports – 250 individuals served with family and peer supports (on target) Delaware Health and Social Services

Governor’s Recommended Budget US DOJ Specifics US DOJ Target FY 13 GRB Crisis Walk-in (CAPAC) $3, 217. 0 ACT Expansion $1, 302. 0 Intensive Case Management $1, 469. 8 Targeted Care Management $ 371. 3 Community Placements-DPC $3, 500. 0 Housing Supports $ 800. 0 US DOJ Total Delaware Health and Social Services $10, 660. 1

Opportunities • A committed community and hospital provider network already mobilizing to meet state needs • Strong support from federal partners through grants and technical assistance • Growing base of talented Peer Support Specialists (20+ now) who have proven of great value in improving services in DPC and in the community clinics • Strong support from the Governor’s Office, the Deputy Attorney General and DHHS for our goals • New funding allowing DSAMH to develop integrated community homes, supports and services, statewide, for Delaware citizens Delaware Health and Social Services

Challenges • Statewide training on importance and scope of ADA • Need to identify how DSAMH can continue to take advantage of federal dollars to support current projects • Build in incentive-based performance outcomes in all contracts • Need to prepare for national Health Care Reform • Need to improve/maintain morale and retention of talented staff in all settings • Need to implement electronic (EMR) record keeping and maximize use of technology for providing services in community and at DPC Delaware Health and Social Services

QUESTIONS? 302 -255 -9398 • Kevin Huckshorn, RN, MSN, CADC (Div Dir) Kevin. huckshorn@state. de. us • Melissa A. Smith, MA (Dep Div Dir) Melissa. a. smith@state. de. us • Greg Valentine, MSW (DPC Director) greg. valentine@state. de. us Delaware Health and Social Services

Thank you very much! Delaware Health and Social Services