Annual Report

Fiscal Year 2002

July 1, 2001 to June 30, 2002

Stephen T. Baron, LCSW-C, President

Peter Beilenson, M.D., Board Chairman

TABLE OF CONTENTS

HIGHLIGHTS

GOALS & PROGRESS REPORTS

Adult Services Division

Child and Adolescent Services Division

Community Housing Associates

Finance Office

Quality Improvement and Operations Division

PREFACE

Over the past year, Baltimore Mental Health Systems, Inc. (BMHS) continued its efforts to maintain a high level of services for Baltimore City residents. BMHS continued its many interagency collaborations during the past fiscal year. Most notable has been the many initiatives being planned or underway with the criminal justice system. Unfortunately many individuals of all ages with mental illness are in contact with the criminal justice system. As we closed out FY'02, the Public Mental Health System (PMHS) was faced with an increasing deficit and a corrective financial plan for FY'03 that could reduce access for uninsured individuals.

The chart below depicts the utilization of the PMHS by Baltimore City residents. During fiscal year 2002 (July 1, 2001 to June 30, 2002) 27,473 Baltimore City residents received services through the Public Mental Health System (PMHS). The data comes from the Maryland Health Partners (MHP) data system through June 30, 2002 and the FY'02 numbers will increase, as providers have nine months from the date of service to submit FY'02 claims.

Adults (18 years and older) represented 57% (14,862) of those seen and those 17 and younger represented 43% (12,310) of those seen.

Of the 27,172 individuals receiving at least one service in FY'02, 96% (26,190) received the service from an outpatient mental health clinic. Approximately 10,300 individuals received more than one service from the PMHS.

Adults with serious mental illness represent 60% of adults seen and children and adolescents with serious emotional disturbances are 80% of those 17 and under seen. The percent of individuals with the most serious illnesses increased by 3% over the past year.

HIGHLIGHTS OF BMHS' FY'02 ACTIVITIES

ADULT SERVICES DIVISION

Increased Residential Opportunities

BMHS' Adult Services staff worked with Community Housing Associates (CHA) staff who completed two residential projects for occupancy during FY'02. Both projects were completed with funds from the Department of Health and Mental Hygiene (DHMH) and the U.S. Department of Housing and Urban Development (HUD) Section 811, Supportive Housing for People with Disabilities program. These homes were developed to serve individuals in state hospitals with special needs or difficult community placement issues.

Belair Manor houses six adults who require 24 hour awake supervision and intensive rehabilitative training. The program is operated by Harford-Belair's Haven's Psychiatric Rehabilitation Program (PRP).

Glenmore Housing opened during the last week in December, '01. The program, operated by Alliance Inc., serves eight individuals with mental illness and one or more medical co-morbidities and/or functional disabilities. The ages of these individuals ranges from 61 to 80 years, with the average age being 68.5 years. These residents not only require 24 hour awake supervision, but also some assistance with daily living activities.

York House

York House, located on the grounds of Govans Presbyterian Church, opened in June 2002. This residence is an 8-bed Shelter Plus Care Single Room Occupancy (SRO) targeted towards homeless single women with mental illness related to trauma and/or legal issues. Initiated by BMHS Adult Services, this is a collaborative effort between Prisoner's Aid, BMHS, and People Encouraging People (PEP). BMHS provides the referrals, PEP provides mental health services such as case management and PRP services and Prisoner's Aid is the landlord.

Community Referrals from State Hospitals

BMHS Adult Services staff in collaboration with the staff of Springfield State Hospital (SHC) developed the Transitional Service Partnership (TSP). The TSP project compensates case management programs for up to 3 months to engage and transition patients from Springfield to the community. The project design is for referrals to come from SHC to the City's various case management programs. This program started in the final quarter of FY '02 and there were eight referrals by the end of FY'02.

Crisis Services

Baltimore Crisis Response Inc. (BCRI) continued in its role as city's psychiatric crisis provider for adults. The chart below depicts the range and volume of services provided by BCRI. In addition, BCRI expanded its services in FY'02 to include contracts with Baltimore Substance Abuse Systems, Inc. (BSAS) for detox beds and the Office of Homeless Services to operate its Shelter line.

SERVICE	FY'01	FY'02	CHANGE
Hotline calls	12,981	15,163	2,182 (17%)
Mobile Crisis Responses	2,299	1776	-523 (-28%)
Community/In-home Supports	119	152	+33 (28%)
Referrals to Crisis Beds	754	933	+179 (24%)
Crisis Bed Utilization	73%	87%	0.19

Forensic Conference

BMHS' 8^th Annual Forensic Conference Mental Health: Surviving the Criminal Justice System with Partnerships was held on June 14, 2002. It was attended by 140 persons.

Domestic Preparedness

Domestic Preparedness has unfortunately come to the forefront of everyone's minds in this past year. On 9/11, the state contacted BMHS to ask who for the mental health professionals who were available to assist. Within 4 hours of the incidents, BMHS contracted thirty people who had been trained and twenty-four were willing to go to NY, PA, or DC/VA. It was clear that more volunteers needed to be trained to deepen the teams and the number of active mental health responders. BMHS staff completed Critical Incident Stress Management Advanced Training and also the National Disaster Management System Annual Conference.

Adult Homeless Services

In FY 2002, BMHS worked to expand homeless services and improve their delivery in Baltimore. BMHS actively collaborated with the Baltimore City Office of Homeless Services, Department of Social Services, mental health service providers, consumers, and other key stakeholders to provide and maintain high quality services for City residents. Among our many successes, most notable are:

• Began receiving HUD funds directly and began first annual HUD grant monitoring/technical assistance visits.
• Receipt of a HUD Supportive Housing Program (SHP) award to create a second Safe Haven.
• Actively worked to meet Congressional HIPAA and HUD HMIS requirements in the development of a homeless services Citywide data base.
• Leader in Mayor's Homeless Stat Task Force with subsequent implementation of recommendations
• Received HUD SHP renewal grant for HOPE Drop-in Center
• Submitted HUD SHP renewals for mental health services for homeless adults and families for Bon Secours, JHH, NBC, PEP, and University's programs: Safe Haven I, and SSI Presumptive Eligibility.

CHILD AND ADOLESCENT SERVICES DIVISION

Expansion of Services

C&A Division initiated it's Transition Aged Youth (TAY) program in FY02. TAY provides extended services to twenty youth who are aging out of the child mental health system, to support and promote their capacity to manage as young adults.

C&A Division fully implemented it's Head Start-based mental health programs which are designed to meet mental health needs of pre-school aged children. The programs are in collaboration with Head Start Centers and BMHS provided city-wide training for Headstart staff.

The need to address violence and mental health in children and youth continued to be a high priority for BMHS during FY'02. Specifically, three initiatives where established.

• In partnership with the Baltimore City Juvenile Courts, C&A Division established it's LINKS program to ensure that children and families involved with the court system are connected to appropriate mental health and support services that address their specific needs.
• C&A applied for and received federal funding from SAMHSA to develop and implement a pilot Alternative elementary Center for young children 1^st through 5^th grades who were expelled from school due to violent behavior. The grant award is 400,000 per year for three years.
• In partnership with MHA, BMHS initiated both facility based and Aftercare programs to serve youth involved in the Juvenile Justice System.

Training and Education

C&A staff presented at the 9^th annual Governor's Child Abuse Conference. The presentation addressed the mental health issues and needs of young children 0-6 who are exposed to violence. BMHS completed its first cultural competence survey of the Baltimore City public Mental Health System. C&A staff provided cross-training of substance abuse and school-based mental health providers to promote greater coordination of services. C&A division responded to over 400 discrete Child Help Calls in FY02.

COMMUNITY HOUSING ASSOCIATES

During FY'02 CHA completed the acquisition and renovation of Glenmore Housing, an eight-bed residence which houses adults who have a mental illness and are functionally disabled and/or frail/elderly. This is the first project of its kind in Baltimore City.

CHA continued to improve its operations to better reflect housing industry standard practices. This was accomplished by contracting with an experienced property management company, creating new positions and increasing the number of rental subsidies in CHA-owned units.

CHA began an aggressive maintenance and repair project on all Shelter Plus Care and CHA Limited Partnership I units. The project, which will take another year to complete and will provide tenants with improved housing conditions.

QUALITY IMPROVEMENT/OPERATIONS DIVISION

Significant progress was made in implementing a formal quality management (QM) program to monitor and evaluate BMHS activities. There was a greater emphasis throughout the organization on identifying measurable outcomes for evaluation of all BMHS sponsored projects. BMHS' Board of Directors established a committee structure to reflect the organizations priorities. The committees are integrated care, adult services, child and adolescent services, financial and quality management. With the exception integrated care, Board members served as chairpersons.

• FY 02 saw a record number (333) of site visits conducted to evaluate services funded or monitored by BMHS.
• BMHS complied with 100% of state required time frames for (a) processing new applications to provide mental health services in Baltimore City and (b) review of performance improvement plans.
• QI staff participated in 96% of site visits conducted by Office of Health Care Quality in Baltimore City.
• QI staff implemented procedures for monitoring providers granted deemed status by Mental Hygiene Administration.
• Exceeded by 20% the minimum interviewing requirement for residential housing consumers.
• Attended joint meetings between providers and their landlords to facilitate timely and accurate completion of cited deficiencies.
• Received approval from DHMH to issue continuing education credits to social workers, occupational therapists, psychologists, and licensed professional counselors attending BMHS sponsored training.
• Conducted training on documentation in medical records to Baltimore City providers.
• In FY'02 Increased the timely execution of DHMH contracts and this number was exceeded for FY'03. Established criteria for QI conducting site visits to evaluate performance in compliance with BMHS contracts.
• Established thresholds that trigger increased monitoring/additional site visits.
• Revised contract management policies and procedures.
• Developed a uniform rating system for use when reviewing provider progress reports.
• Provided training to all BMHS employees with responsibilities for contract monitoring.
• Provided training to Baltimore City providers on BMHS FY 03 contract procedures to improve accuracy of reporting.
• Established a uniform rating system for evaluating provider performance.
• Completed the development of contract management data base and reports.
• Issued timely and accurate reports using the contract management data base.

SPECIAL INITIATIVES

Mental Health Police Initiative

Recognizing the need to improve mental health/police collaborations, BMHS, the Baltimore City Police Department (BPD) and the National Alliance for the Mentally Ill, Metropolitan Baltimore (NAMI) convened a work group to develop a plan for Baltimore City. The leadership of the three organizations began meeting in the summer of 2001 to learn more about different models of mental health/police collaborations. Models developed in Montgomery County and Baltimore County were reviewed and in October, 2001 a visit was made to Memphis Tennessee to learn more about the Memphis Police Department's Crisis Intervention Teams (CIT). Memphis's CIT is a nationally widely replicated program which uses uniformed police officers, specially trained in mental health issues, to act as primary or secondary responders to every call involving a person with mental illness.

In December of 2001, BMHS, BPD and NAMI convened the committee to review the need for an initiative in Baltimore City, examined different outcomes and helped develop a model for the city. The composition of the committee consisted of family members, mental health consumers, police representatives and mental health providers and academic experts in the field of mental health and the police. A complete listing of the committee is Attachment I.

The overall objective for this initiative is to develop a pilot project that will have the following goals:

• Decrease police down time, Increase linkages to mental health services for individuals who would have previously been arrested,
• Decrease police and citizen injury,
• Decrease use of deadly force, and
• Decrease jail usage.

As one of its first tasks the committee identified the strengths and weaknesses of the current system from the perspective of the police, mental health providers and family members and consumers. Based upon its finding the group identified areas of concern that needed to be addressed in the plan.

There is a recognition that Baltimore City's model could not require additional funding from the Baltimore City Police Department. Therefore, the Baltimore County model as currently constructed was not an option for the city.

There was support for developing a model that targets 20-25% of the patrol officers eligible to participate. A specially designed training program would be developed and selected officers would be expected to complete the training before being designated as "Crisis Intervention Team Members"(CIT). The CIT borrows on the description developed by Memphis and many other jurisdictions across the country.

There was consensus that there was a need for a coordinator of the project who would be an employee of the Police Department. This individual will coordinate the recruitment and initial trainings, organize ongoing training, be available to problem solve within the police department and the mental health system and coordinate the project with the public mental health system.

The workgroup meets monthly and anticipates having a plan to formally present to the Mayor, Police Commissioner and funding sources by late Fall of 2002.

Outcomes

In FY'02 BMHS began collecting outcomes data on Adult Psychiatric Rehabilitation Programs (PRP), Mobile Treatment Programs and finalized a process for the collection of Child and Adolescent PRP outcomes. The focus of the Adult PRP Outcomes (Attachment II) has been to monitor the service utilization, employment status, housing status, and hospitalization on a quarterly basis. For FY'02 we collected data for the last three quarters. Over the course of the three quarters, there has been a consistent increase in total number of people receiving PRP services during each quarter Among those enrolled in services, 17-20% have been employed with at least minimum wage earnings. While there has been some variability between quarters, the relative numbers of people who rent, live with family and friends, live in an RRP, or live in other (including unlicenced board and care facilities) has been consistent. Finally, the number of psychiatric hospitalizations has been stable (6%) over the course of the past three quarters.

Mobile Treatment Teams (MTT) began reporting outcomes for the fourth quarter of FY2002. (Attachment III) The MTT Outcomes focused on service utilization, reasons for discharge, hospitalization, housing status, frequency of contacts, substance abuse, and somatic care. In the first quarter of reporting, there were 355 clients served through the PMHS with individual program size varying from 14 at the Johns Hopkins COSTAR to 152 at University of Maryland Medical Systems (UMMS).

The C&A Division convened a workgroup comprised of child Psychiatric Rehabilitation Program (PRP) providers in the third quarter of FY02 to develop clinical outcome measures for PRP programs serving Baltimore City children. The group completed it's work early in the 4^th quarter and the data collection process is scheduled to begin in FY03. Attachment IV is the data collection sheet.

Integrated Care

In FY'02, BMHS and Baltimore Substance Abuse Systems, Inc. (BSAS) began the implementation of its strategic alliance. As part of BMHS' committee structure, an integrated care committee was established. The presidents of BMHS and BSAS served as the co-chairs. The group met four times during the fiscal year and identified areas of concern for both systems. Specifically, the committee was able to identify the need for methadone treatment for individuals with serious mental illness and twenty slots were identified at Sinai Hospital's methadone program and conducted a survey to ascertain if integrated care was being provided in both the mental health and substance abuse systems. Many providers reported that they were providing integrated care but there were definition problems that need to be corrected in a future survey.

The senior staff of BMHS and BSAS began meeting every six weeks. These meetings have enhanced our ability to jointly guide services. BSAS has been included in a number of new mental health initiatives including but not limited to the mental health police planning, a new DSS initiative, work with the courts and homeless systems. In early, FY'03 BMHS and BSAS will hold a joint city-wide conference as well as a joint meeting of the respective board of directors.

BMHS continued its joint project with BSAS to establish integrated care, treatment for mental illness and substance abuse at six city sites. The level of true integration of services varies. At the substance abuse clinics, services for mentally ill substance abusers are mostly provided by a specialized team of mental health professionals. At the mental health clinics, counselors are also becoming more comfortable with dually diagnosed clients, but there is still a need for specialized substance abuse treatment, especially residential and inpatient rehab. Initial screening for substance abuse has been performed with 791 new clients at the mental health clinics; 1/3 were identified as dually diagnosed at one clinic, 11% were identified as dually diagnosed at the other larger mental health clinic, and 25% were identified as dually diagnosed at the small mental health clinic specializing in services to deaf and hard of hearing. Screening for symptoms of mental illness has been done at the substance abuse clinics: 512 new clients were screened, and a total of 157 were referred for dual diagnosis services, or about 31% of new clients.

One barrier to full implementation of the best practices recommended for dually diagnosed individuals has been the difficulty in assigning small caseloads for dual diagnosis counselors. As the grant is completed in October, strategies will be identified to allow for smaller caseloads in future initiatives. The Open Society Institute has expressed interest in funding further initiatives in integrated services, and proposals are being prepared.

Evidence-Based Practices

Over the past thirty-five years, there has been great progress in developing new medications, treatments and services for individuals with serious and persistent mental illness. The professional literature contains many articles and studies that demonstrate great improvement in the lives of the seriously mentally ill. However, according to a recent article in Psychiatric Services by Dr. Robert Drake, Dr. Howard Goldman et.al. , "that despite extensive evidence and agreement on effective mental health practices for persons with severe mental illness, research also shows that routine mental health programs do not provide evidence-based practices to the great majority of clients with these illnesses."

BMHS has been involved in a national project led by Dartmouth College to promote the use of evidence-based practices. A three-phase project to implement six evidence-based practices for individuals with serious and persistent mental illnesses has been developed. The six evidence-based practices for which there is sufficient research in the literature to support their efficacy are: Medication Management, Integrated Care for Dual Diagnosed, Supported Employment, Assertive Community Treatment (ACT), Psycho-Family Education and Symptom Management. Phase 1 of the project, which is the development of tool kits for each evidence-based practice has recently been completed. BMHS will join the state of Maryland and seven other states in a project to test the tool kits' ability to assist the practice field to implement the evidence-based interventions.

For Phase 2 of the project the Maryland Mental Hygiene Administration (MHA) will test the Supported Employment and Psycho-Family education tool kits and North Baltimore Center's Chesapeake Connections will be participating in the Supported Employment initiative.

In addition, BMHS developed a local initiative to implement the ACT tool kit. In conjunction with two sites of the Veterans Administration (VA), Bon Secours and PEP mobile treatment teams we will be implementing the tool kit on ACT. Financial support for the ACT tool kit has been through a grant from the Blaustein Foundation, funding from the VA and PEP.

Training Institute

In the early part of this year, BMHS convened a number of leaders in the academic community to address the issue of the dearth of training and post graduate experiences creating a crisis in workforce development in public psychiatry and a parallel gap between research and practice. We have been able to attract the participation of many of the leading academic institutions in the Baltimore area. A full listing of the participants is Attachment V. The group meets regularly and is committed to establishing the Institute for Mental Health Leadership and Policy.

The overall mission of the Institute is to establish an ongoing link with and between the academic centers, governing bodies, payers and providers for the purpose of initiating, facilitating and coordinating training and education at all levels. The Institute's goal is to promote new leadership in the field of community mental health to significantly improve the delivery and quality of public mental health services in the community.

The Institute is still in the initial stages of development. However, several projects are already underway. These include a new psychiatry residency elective at the University of Maryland and Johns Hopkins which places the residents at BMHS' two capitation programs. The residents' clinical experience are combined with monthly meetings where the residents will learn about broader public policy, financing and administrative issues that place the clinical experience within the larger public health system context. The plan is to broaden the experience to include graduate nursing students and social workers and perhaps a fourth year medical student. A second project conducted under the auspices of the developing Institute, initiated with the assistance of Dr. Steinwachs and Dr. Eaton from the Johns Hopkins School of Public Health, is the design of a proposed expanded curriculum for the Department of Mental Health in the School of Public Health. The goal of the curriculum project is to develop a comprehensive program that will educate students in a broad range of public policy issues relevant to developing comprehensive systems of community care. The planning for the Institute will continue in FY'03.

GOALS & PROGRESS REPORTS

ADULT SERVICES DIVISION

Goal #1: Collaborate with key stakeholders to ensure access to high quality comprehensive mental health services.

Objective 1: Adult Services and Child Adolescent Services will work with C/A Providers (DSS, DJJ, etc.) to ensure that Transition Age Youth (TAY) clients make a smooth transition to Adult Services.

Indicators: Will provide 2 trainings for non-mental health C&A providers. Adult Service staff will monitor all referrals to RRP for those clients identified as TAY.

Progress: Adult Services continues to monitor Residential Rehabilitation Program ( RRP) referrals for this age group. All referrals for clients under the age of 21 are assigned to one specific staff. During FY '02, 22 referrals were received for RRP services for persons under the age of 21. Of these, 13 were referred to RRPs in Baltimore City. Four of these clients were placed in RRPs (18%). Alternative services were discussed with referral sources of those who were not placed or found inappropriate for RRP services.

Objective 2: Geriatric Services will work with City and State agencies providing services to the elderly in order to improve access to mental health services.

Indicators: Will chair 12 Clinical Subcommittee meetings by 6/02. Will increase by 25% the number of educational and support groups in Senior Centers and senior sites.

Progress: The Director of Geriatric Services represents BMHS on the Baltimore City Interagency Aging Committee (IAC), chaired by the City's Health Department Commission on Aging. The IAC's primary activities have included participation on Triad Committee, to improve collaboration between the Baltimore City Police and the Sheriff's Office, AARP, and providers in the Aging service network. Through this committee BMHS has collaborated with the Department of Social Services' Adult Protective Services Division to offer specialized training for Emergency Medical Technicians (EMT's) and some fire department staff. All Baltimore City EMT's receive this training as part of their Department's annual continuing education curriculum. In September 2001, this project was canceled after the events of 9/11, but may be offered in September 2002.

The Clinical Subcommittee of the IAC chaired by BMHS, met eight times during the course of this fiscal year and reviewed eleven new case of individuals who presented with complex problems that involve multiple agencies. Recommendations were made for a unified intervention plan by the client's care provider team, with one agency assuming lead responsibility.

Objective 3: Adult Services will work with Department of Corrections (DOC) to improve timeliness of access to services.

Indicators: Will increase referrals to a minimum of 35 persons to the mental health system, through BMHS, at least 3 months prior to release from a DOC facility.

Progress: There were 31 referrals from Patuxent Institution to Intensive Case Management

Programs through the Patuxent Initiative (which is an increase of 41% over last year).

Referrals were made to programs as follows:

Bon Secours: 7 Harford-Belair: 3

Johns Hopkins: 6 Bayview 5

North Balto Center: 5 PEP: 5

Outcomes for the 31 referrals:

10 were still incarcerated as of June 30, 2002.

21 were released prior to June 30^th

3 were not successfully released to the community

1 was sent to a regional hospital directly from Patuxent

1 refused treatment and was unavailable for further service

1 refused services once released, was admitted to an inpatient unit, reconnected to case management and eventually admitted to a regional hospital.

Objective 4: Adult Services will continue to promote interagency collaboration to improve services to individuals with mental illness in the criminal justice system.

Indicator: Will chair 5 multi-agency meetings.

Progress: Two local multi-agency committees met during this Fiscal Year. They are the Women in Need Group (WING) and the Forensic Meeting. Each group met 5 times.

WING, which was initiated last year, has focused on coordination of services and removing system barriers in order to meet the needs of women in the criminal justice system. BMHS actively worked to help develop mediation services in the Women's Detention Center C-Dorm.

Forensic meetings were held bi-monthly with a focus to improve the interagency process for pre-trail offenders. This group also focused on developing of the beginning stages of a Mental Health Court. Through the efforts of Judge Charlotte Cooksey, a plan for a Competency Court was implemented. The Competency Court hears all cases of defendants who have been referred for competency screening. Their cases are transferred for trial to Southern District Court where Judge Cooksey is the primary sitting judge. Having all competency cases in one location increases the likelihood of improvement for continuity of care for the defendants with mental illness who require a competency hearing. It is from this initiative that Baltimore City will initiate its Mental Health Court.

The forensic meeting continues to look at access to medication for incarcerated individuals at Baltimore City Detention Center (BCDC) , increasing crisis intervention training for police beyond the cadet training, and tracking of emergency petitions.

Goal # 2: Ensure that a wide range of services is available to meet the diverse needs of Baltimore City.

Objective 1: Adult Services will increase the number of persons authorized to receive Supported Employment.

Indicator: Will increase the number of persons authorized to receive Supported Employment by 25%.

Progress: BMHS has traditionally overseen 8 Supported Employment Programs (SEPs) in Baltimore City. During FY'02 regulations for Mental Health Vocational Programs were promulgated. All eight of our current programs received provisional status and continued to operate while waiting for DHMH site visits to determine their ongoing status. Although the new regulations make it possible for new providers to come on board, by the end of FY'02, only one additional provider, Restoration Rehabilitation Services has applied and received provisional status.

Each of the past four years has seen growth in the number of authorizations given for vocational services and in the number of persons working and receiving extended support services from Baltimore City SEPs. The numbers have grown from 88 in FY'99 to 183 in FY'02. These numbers only reflect those individuals who obtain employment through Supported Employment reimbursement structure.

Objective 2: Adult Services will foster collaboration between homeless service providers to increase services to homeless mentally ill individuals.

Indicator: Will increase by 10% the number of referrals to mental health homeless outreach teams/Baltimore Crisis Response from DSS street outreach teams. Will increase calls to BCRI hotline by 20%.

Progress: Hands in Partnership (HIP) consists of mental health outreach workers funded by HUD through BMHS, outreach workers from the Department of Social Services Homeless Environmental Unit, Downtown Partnership safety guides, BMHS, and BCRI. During this year stemming from an increased concern from the Mayor's office about the numbers of visible homeless persons, further community collaboration was deemed necessary. The Baltimore City Police Department, Office of Homeless Services, Health Care for the Homeless and Baltimore Substance Abuse Systems began to meet with the group in order to participate in the HIP initiative. All of these agencies now attend HIP meetings. HIP met 18 times in the past year and attendance has grown from 8 to approximately 25 persons attending on a regular basis.

HIP provided training to two new Downtown Partnership safety guide classes, and gave a presentation at the monthly roundtable discussion at the Center for Poverty Solutions.

For the year, BCRI calls increased by 17%.

Objective 3: Geriatric Services will increase the capacity of the City's outreach services to the elderly.

Indicator: Will increase the number of elderly clients receiving mental health services in the individual's home by 25%.

Progress: Mobile Outreach Mental Health Programs to seniors continued to be much in demand. The Hopkins Psychogeriatric Assessment and Treatment in City Housing (PATCH) which provides in-home psychiatric assessment, treatment and medication management in all Baltimore City public housing sites for the elderly, continued to provide services. There was a 32% (78 clients) decrease in new referrals during this fiscal year, however there was a 44% (94 clients) increase in individuals remaining in active treatment. The decrease in new referrals may be attributable to a growing younger population in these buildings.

The other Baltimore City mobile outreach service for the elderly, Senior Outreach Services (SOS), is at University of Maryland Medical Systems. This service is available to any elderly Baltimore City resident living in the community, but not in public housing. Referrals for this program's services come from a variety of agencies, individuals in the community or families. There was a 13% increase (85) in new referrals, 18 of which were evaluations for competency for Department of Social Services' Adult Protective Services' guardianship unit. The number of individuals remaining in active treatment (66) is consistent with last year's figures.

Goal # 4: Improve continuity of care.

Objective 1: Adult Services will continue to monitor and support Baltimore City residents who have been discharged from State Hospitals to the community through special initiatives.

Indicator: 85% of clients will remain in community.

Progress: The latest projects being monitored are the Community Enhancement Initiatives (CEI) from late FY'99, FY'00, and FY'01. In the original plan BMHS assisted persons to move from general level Residential Rehabilitation Program (RRP) beds into supported housing where they hold their own leases. The vacated beds were converted to intensive level and occupied by persons discharged from State hospitals. There were 38 persons who moved out of RRP and 35 (92%) of them remained in the community throughout this year. Of the original 38 clients, 27 received a subsidy from BMHS that assisted them in paying market rates for rents in the community. During FY '02, 14 of those receiving a subsidy acquired Section 8 vouchers through BMHS and now have permanent rental assistance.

Of the patients who moved out of State hospital facilities, there was a targeted number of 70 from the first CEI '99/'00 project and 25 from the second CEI '01 project. Of this targeted 95 clients, 89 were actually discharged and monitored. 28 of the patients went to Baltimore's two Capitation Programs and 61 went to Residential Rehabilitation Programs. The referring hospital and receiving program is shown in the chart below.

As part of the monitoring effort, BMHS Adult Services developed a tracking tool to collect and describe important information about the clients over the past year. The information was supplied by the providers and the clients. The information included residence, services received from the program, if discharged where they were referred, employment, incarceration, and what types of income each individual received. The data indicated that 71 of the 89 individuals (80%) were living in the community and nearly 27% of the clients had some form of employment in FY '02 and that only 4% had been incarcerated.

Objective 2: Adult Services will continue to promote comprehensive community planning for individuals discharged from acute care psychiatric units.

Indicator: Create and maintain the data collection system to track referrals by 6/02.

Progress: Although a data collection system was not developed, the objective of promoting comprehensive community planning was addressed. A Coordination Meeting was held every other month which included representatives from State Hospitals and community programs. The meeting has been instrumental in beginning the Transitional Services Partnership with Springfield Hospital. Baltimore Substance Abuse Systems, Inc. (BSAS) is included in this meeting to continue to enhance the concept of integrated care.

A meeting for Case Management providers is held every other month. Case managers frequently are working with individuals leaving psychiatric hospitalization and who have very complex needs. Initiatives related to services for homeless persons and housing are usually on the agenda. Our yearly Case Management Training ("Supporting a Person with Mental Illness in the Community") was held in November and was attended by 59 case managers.

Objective 3: Adult Services will promote comprehensive services for forensic clients.

Indicator: Complete 5 meetings with Clifton T. Perkins staff by 6/02.

Progress: Bi-monthly meeting were held with the social work liaison from Clifton T. Perkins Hospital Center (CTP) to coordinate discharge. The discharges to Baltimore City CTP and referrals for Residential Rehabilitation services have decreased in the last year as CTP transferred more of their patients to regional state hospitals which may actually postpone discharge to community.

Objective 4: Adult Services will work with the Forensic Alternative Service Team (FAST) to increase the percent of appropriate referrals.

Indicator: Provide 2 trainings by 1/02. There will be a 25% increase in the number of referrals that are accepted for service.

Progress: Training was offered to the social work staff at Spring Grove Hospital Center, Springfield Hospital Center, and Walter P. Carter Center regarding Forensic Services in Baltimore City. This training was in conjunction with F.A.S.T. and the Public Defenders Office of Client Services. The training reviewed the services available in the city as well as an opportunity for networking. The goal of increasing the number of referrals accepted into treatment was not met. There were 1,097 referrals for review (a decrease of 93 referrals from FY '01). The referral sources were Judges (41%), Pre-trial Services (18%), and Public Defenders (13%-an increase from last year.) Eighty-two individuals agreed to a plan for mental health services in the community and were released with on-going monitoring by FAST regarding their compliance with the plan. The decline in numbers for FY'01 could be due to the turn over in FAST staffing.

Objective 5: Adult Services will improve the transition of RRP residents to a decreased level of care.

Indicator: Complete clinical review of all 8 programs by 6/02.

Progress: Clinical Reviews were completed for the 8 adult Residential Rehabilitation Programs (RRPs)- The purpose was to review the program's service planning, staffing, and collaboration with other programs. Emphasis was placed on the clinical review of treatment plans for residents who were identified as High Cost Users using data from Maryland Health Partners (MHP). The information was compiled and reported back to each program and when needed there was a request for a Program Improvement Plan (PIP). The reviews were well received as an opportunity to focus on the clinical aspects of their program. One program wrote: "It was a constructive process that challenged our program to look at the way we deliver services and our expectations of our residents...I think that outlooks have changed at the counselor level and that this is starting to be reflected in relationship to goals and client progress." A second clinical review is planned for FY'03.

GOALS & PROGRESS REPORTS

Goal # 1: Collaborate with key stakeholders to ensure access to high quality comprehensive mental health services.

Objective 1: Collaboration with the Family League of Baltimore (FLBC) in the development and implementation of a capitation program focused on high-cost and deep-end child/adolescent service users.

Indicator: Complete outline of proposal and begin the services by March, 2002

Progress: In FY'02, The Family League of Baltimore City (FLBC) initiated an project to serve 25 youth in the custody of the Department of Juvenile Justice (DJJ). This project is meant to serve as a pilot for the child capitation program once funding mechanisms and agreements are in place. BMHS collaborated with FLBC in the development of the RFP and the selection of the North American Family Institute (NAFI) as the provider for this service.

In addition, planning meetings continued for the development a child and adolescent capitation project. Representatives from Montgomery County were added to the planning with the intent to develop an initiative for both jurisdictions. However, due to many factors the project has not proceeded as quickly as we would have liked.

Objective 2 : Continued collaboration in the development of integrated services to the larger Baltimore City community, and increases in the knowledge of the needs of the community

Indicator: Attendance at 75% of FLBC board meetings and 80% of sub-committee meetings. Process for transfer of data between the FLBC and BMHS initiated and completed by December, 2001. BMHS Coordinator of School-Based Mental Health Services will serve on at least two (2) interagency standing committees; attending at least 80% of scheduled meetings.

Progress: BMHS C&A division staff participated in three of the four quarterly board meetings of the FLBC in FY02. The C&A Division Director served as the chair of the Fiscal Management committee for the FLBC board. C&A staff collaborated with FLBC to kick off a Baltimore City "Leadership Breakfast" focused on the mental health needs of children ages 0-6. Representatives from state and local organizations including health, education, child care, child welfare, Mental Hygiene Administration, and the University of Maryland have attended the series and helped to clarify the needs and existing resources for this age group. The second and third meetings will be held in FY03 and the results will be incorporated into the BMHS needs assessment for FY04.

To evaluate service utilization, Maryland Health Partners (MHP) provided data to BMHS on a regular basis. While ensuring consumer confidentiality, BMHS, through it's Management Information Systems (MIS) Division has shared mental health utilization data with FLBC's Human Services Data Collaborative. The Collaborative incorporated this data into it's geo-mapping system and gave BMHS community-level data on service utilization for children and youth (Attachment VI and VII). This data can now be combined with other data elements in the Collaborative's data base to identify resources, utilization patterns and risk factors that contribute to the mental health needs of children.

BMHS school-based coordinator participated in the Education Health Policy committee as well as Safe Schools speciality committee and met the attendance goals.

Objective 3: Continued collaborations with the Department of Juvenile Justice (DJJ) and Juvenile Court resulting in increased access to Mental Health service for DJJ/Court involved children.

Indicator: Cross-training completed by June, 2002. Contract with provider(s) completed by September, 2001. Renew contract of pilot services - completed by September, 2001. Successful tracking and service linkage to appropriate Mental Health services for a minimum of 20 children/adolescents

Progress: BMHS contracted with Universal Counseling and the East Baltimore Mental Health Partnership (EBMHP) to provide seven (7) mental health clinicians to work as Family Intervention Specialists (FIS) in teams with DJJ case managers. The FIS were cross trained and assigned to teams by the end of March, 2002. The program has faced several challenges including staff turnover, ambiguity of the overall mission, and role clarification and reporting issues. DJJ and BMHS met several times throughout the latter half of the year to address these issues. While the program will continue to evolve in FY03 it is expected to be much stronger than in this first year.

BMHS fully established it's LINKS program in collaboration with Baltimore City Juvenile Court. The program is designed to identify and work with children and families where there are apparent or suspected mental health needs. LINKS provides a BMHS staff member to the courts for two days each week, working with in conjunction with court staff and families to assess needs and promote interagency collaboration.

Objective 4: Collaborate with Baltimore Police Department (BPD) to reduce youth related violence in communities and ensure timely access to Mental Health services for victims

Indicator: Revise/develop a memorandum of agreement with the BPD for expansion of the Child Development/Community Policing (CDCP) project by August 2001.

Progress: BMHS continued its work with BPD and the Child Development Community Policing Program (CDCP) to provide training and trauma response to families and communities victimized by violence. CDCP began FY02 operating in the East Baltimore and Park Heights communities. In October, BMHS approved BPD's request that the program be allowed to move to City-wide response. This was due in part to changes in the patterns of violence and exposure.

An MOU was completed between JHU-CDCP, the Mayor's Office of Children Youth and Families, and the BPD in early FY02. This MOU reestablished the general orders for the BPD to collaborate with the mental health system on meeting the mental health needs of children who have been victimized by violence.

Objective 5: Continue to work with the Mental Hygiene Administration (MHA) on issues of early childhood service development, Psychiatric Rehabilitation Programs (PRP), and Cultural Competency.

Indicator: Attend 75% of scheduled committee meetings, and related work groups. Develop and implement an assessment protocol to determine the need for and level of culturally competent services in Baltimore City by April, 2002.

Progress: BMHS participated in ongoing MHA meetings on early childhood development and on Cultural Competency. The early childhood initiatives were coordinated with the BMHS and FLBC local initiatives described under Objective 1. BMHS C&A staff worked with the committee on the development of its satisfaction survey and on planning for the annual conference on cultural competency. In FY02 BMHS developed and issued a provider survey on Cultural Competency.

Objective 6: In collaboration with Friends of the Family (FOF) increase access to Mental Health services to parents of infants and toddlers.

Indicator: Identify training needs in Family Service Centers (FSC) by August 2001. Identify provider through RFI by October, 2001. Implement training in identified FSC's by January, 2002.

Progress: Initial efforts were made to identify providers and FSC sites where mental health clinicians could be assigned. Two providers were identified and three FSC sites were chosen. The FSC site managers raised concerns about bringing in "outside" providers. After some discussion with the FOF, it was decided to postpone further action until the issues could be resolved.

Objective 7: Maintain communication with representatives of Mental Health provider agencies on a regular basis to develop services targeted to address the specific needs of Baltimore City children and adolescents.

Indicator: C&A Providers, School-based program Directors / Supervisors will share information about best practices and about barriers to service delivery. FUTURES Mental Health Clinicians will participate in at least 80% of scheduled meetings. FUTURES Mental Health Clinicians will meet performance indicators included in the BMHS FUTURES contracts. Development of a document reflecting the role and function of each team member by January, 2002. Development of a written process for collaboration between the Mental Health clinician and the Safe and Drug-Free Schools staff by March, 2002.

Progress: Regular monthly meetings of School-Based program Directors / Supervisors (attended by representatives from the thirteen mental health agencies that provide mental health services in 84 Baltimore City schools) were held throughout the year. These meetings provided an important forum for information sharing.

During FY02, six FUTURES clinician meetings were held. FUTURES is a school-based program that attempts to address the needs of high risk high school students. Half of the clinicians maintained an 83% attendance rate. The other three clinicians will work to improve their attendance in FY03.

FUTURES semi-annual data indicates that performance indicators were met. See the FUTURES Year End Data Chart.

The Safe Schools/Healthy Students Specialty Services COSAP workgroup (which included representation form BMHS, the Baltimore City Public Schools (BCPS), BSAS, the BCHD, and mental health provider agencies) addressed the special needs of children of drug abusing parents. The development of a document reflecting the role and function of each team member and the development of a written process for collaboration between the Mental Health Clinician and the Safe and Drug-Free Schools staff were some of the steps in establishing a pilot in two schools to address the issues experienced by children of substance abusing parents. (SEE Objective 8, indicator b below)

Objective 8: Collaborate with other public and private agencies and programs serving the youth of Baltimore City.

Indicator: Development and implementation of an action plan to address at least four (4) issues significantly affecting learning. Further implementation of a strategic plan for the establishment and maintenance of a "Model" School Based Health Project. Development and implementation of 1-year training/workshop schedule.

Progress: In order to address issues significantly effecting learning/impacting on the ability

of students to participate optimally in school, the Safe Schools/Healthy Students Specialty Services committee established the following 4 workgroups: 1) Child Abuse; 2) Foster Care; 3) Children of Substance Abusing Parents; and 4) Juvenile Justice. The workgroups completed all agreed upon tasks. During the 4^th quarter the following additional issues were identified for on-going work: Children of Incarcerated Parents; Gangs; Truancy; and Cultural Competency related to the needs of Gay, Lesbian and Transgender Students. Through a collaboration involving BMHS, BCPS, BSAS, and BCHD, a model/pilot program was established in two schools to address the issues experienced by children of substance abusing parents. Funding was provided by the Governor's Office of Children, Families, and Youth (OCYF). A 1-year training/workshop schedule was developed. See Objective 9 below.

Objective 9: Provide training sessions for school-based mental health clinicians to ensure the delivery of high quality mental health services in schools.

Indicator: School-based clinicians will attend training sessions and provide feedback

Progress: The following school-based mental health trainings were provided during FY'02:

JULY '01: Skillstreaming Training for After School Program Staff (105 attended); training was provided by Mark Amendola and Dr. Bob Oliver, internationally known Skillstreaming coaches.

AUGUST '01: "Strategies for Re-Connecting with Angry, Disconnected Students and their Families" (72 attended) Trainer: Kenneth Hardy, PhD, Professor of Family Therapy, Syracuse University

OCTOBER '01: Skillstreaming Training for SS/HS and Expanded School MH & Violence Prevention Project schools and for staff representing group homes, DJJ, After School Programs (130 attended); training was provided by Mark Amendola and Dr. Bob Oliver, internationally known Skillstreaming coaches.

OCTOBER & NOVEMBER '01: Effective Group work Seminar (25 attended) Trainer: Dr. Paul Ephross, Professor University of Maryland School of Social Work.

DECEMBER '01: Skillstreaming Training "Booster Session" (25 attended) Trainer: Denise Wheatley Rowe, BMHS

MARCH '02: Skills for Providing School-Based Services: Community Conferencing in Schools and Understanding Common Psychotropic Medications for Children and Adolescents (38 attended) Trainers: Lauren Abramson, PhD, Director, Community Conferencing; Melanie Ogunmefun, MD, University of Maryland Department of Psychiatry

APRIL '02: Managing Resistant Students in Groups (35 attended) Trainer: Dr. Paul Ephross, Professor University of Maryland School of Social Work.

JUNE '02: Utilizing the Arts in Social Skills Instruction (35 attended)Trainer: Stephanie Johns, registered dance movement therapist, doctoral candidate, University of Pennsylvania.

In addition to the school-based clinician several of the trainings were also attended by family members, DJJ staff and other school personnel. Evaluations were completed on all sessions with positive feedback.

Objective 10: Collaborate with key administrators at BCPSS and Office of Economic Development (OED) to ensure access to high quality coordinated, integrated services in school-based and FUTURES programs.

Indicator: BMHS and BCPSS will continue to partner and work collaboratively on obtaining outcome and volume of service data. Continued refinement and use of the BCPSS / BMHS data collection forms to yield meaningful composite data. Develop and disseminate a comprehensive list of School-Based Mental Health services via the BMHS web site and upon request.

Progress: BMHS and BCPSS continued to jointly obtain outcome and volume of service data from all mental health providers partnering with schools, regardless of funding sources. During FY02, thirteen mental health provider agencies reported data on 84 schools served. During the 1^st Quarter, a Data Committee was convened by BMHS' School-Based Coordinator, to refine the Data Collection forms to include information on number of students who had received service in the prior school year and resumed services during FY02 as well as the number of new referrals. This information on unduplicated students served has been of interest to members of the BCPSS School Board. C)A comprehensive list of School-Based Mental Health services was compiled in FY02 and several updates were provided to interested agencies, individuals, and partners in the school system.

Objective 11: Collaborate with Head Start to develop Mental Health services for preschool children and their families

Indicator: Program services initiated in six Head Start programs. Mental Health providers identified, contracts executed, and clinicians hired. Training plan developed and implemented. Clinicians will complete 40 hours of training in Early childhood development by June 2002. Mental health clinicians will complete a 5 day Effective Black Parenting training and a 2 day F.A.S.T. training (Families and Schools Together). FAST is a ten week training session for families designed to empower parents while fostering family development and cohesion and to help young children succeed at home, in early childhood programs, in their transition to elementary school and in their community) by June 2002. Development of a process for identifying additional Mental Health needs for Head Start children, families, and staff.

Progress: Six Head Start programs were identified to participate in the Mental Health Project (Emily Price Jones, Herring Run, Metro Delta, Morgan State University, SECO, and Umoja).

Two mental health providers were selected through an RFP process to provide mental health services to the six Head Start programs. The project experienced difficulties and by years end, BMHS was negotiating with a new provider to replace of the original two selected. All six clinicians as well as two program supervisors completed the 40 hours of training in Early Childhood Development.

Three clinicians participated in the 5 day Effective Black Parenting Training. The remaining three clinicians had not been hired at the time the training was offered. Program supervisors from both agencies attended the trainings as well. During FY 02, the F.A.S.T. training did not occur at any program and as a result the programs was not implemented.

By the end of FY 02, a formal process for identifying additional mental health needs for Head Start children, families, and staff had not been developed, however the Early Childhood Liaison regularly attends the Head Start Mental Health Subcommittee and is a member of the Head Start Health Advisory Board.

Goal # 2: Ensure that a wide range of services is available to meet the diverse needs of Baltimore City.

Objective 1: Identify continuing Mental Health service needs, emerging needs and service gaps for Baltimore City children and families.

Indicator: Focus group reports will be completed by May, 2002. Needs assessment will be completed by November, 2001. Service utilization data for CY-2000 will be reviewed by November, 2001. In the 3^rd and fourth quarter of FY02 Families Involved Together (FIT) held two focus groups attended by parents and youth involved in child public mental health system in Baltimore City. These groups were intended to gather information about the experiences families have when attempting to access and utilize the mental health system for their children. Information gleaned from the focus groups will be used to develop a plan of action to address the issues identified by the groups in BMHS' FY04 annual plan.

Parents (n=19) described the system as being "moderately difficult" to access. 43% of the parents stated that they had not participated in the creation of their child's treatment plan. Parental wish lists included additional respite services, greater partnership versus "participation"; and greater recognition by the school system about the mental health needs and challenges of children and their families.

Youth participants (n=21) in the focus group ranged from 8 to 14 years of age. 50% of the children agreed that they needed treatment with problems including anger, sadness, and "anti-social" behavior (e.g. lying, stealing, fighting, wanting to hurt someone). Overall youth rated their service providers as fair, although only 42% felt that they were a part of the treatment planning process (four of whom did not know what a treatment plan was ). Their first impressions were based primarily on how they were greeted rather than the looks of the facility. Most youth felt the facilities were comfortable, and that staff made efforts to help them feel good. Descriptive comments included: "wasn't professional, made to sit on the floor, cold".

Objective 2: Develop and promote the use of community-based alternatives to high-cost residential and inpatient services.

Indicator: RFP issued - September, 2001. Project initiated by March, 2002.

Progress: This objective refers to the capitation project discussed in Goal #1. Lack of projected FY02 funding by the State resulted in BMHS being unable to achieve this objective.

Objective 3: Improve access to child OMHC services in Baltimore City.

Indicator: Complete data-base identifying existing OMHC resources.

Progress: The BMHS data base of existing child-serving OMHC providers was completed in October 2001. This database includes OMHC's Psychiatric Rehabilitation Providers (PRP) mobile treatment, and case management providers and allows C&A staff to search resources based on multiple criteria such as type of service, location and ages served. At the end of FY02 efforts were underway to make this database accessible to the public to assist in identify provider resources through the BMHS web-site.

Objective 4: Promote the development of Culturally Competent service delivery by providers in Baltimore City.

Indicator: Develop and implement an assessment protocol to determine the need for and existence of culturally competent services in Baltimore City by April, 2002. Complete assessment of the demographics of Baltimore City and the public Mental Health service population by December, 2001.

Progress: The assessment protocol for cultural competency was developed and a survey was conducted in September and October of 2001. Key findings of the survey revealed that while many providers subscribe to principles of cultural competency the degree to which it is implemented in practice is highly inconsistent. The assessment of the demographics was not attained.

Objective 5: In collaboration with BCPS, continue the development of the Safe Schools/Healthy Students Initiative in order to reduce violence and substance abuse in Baltimore City public schools.

Indicator: Ensure adequate staffing and fiscal supports through contracting and monitoring process. Documentation on the implementation of the Skill Streaming curriculum. Implementation and evaluation of the Mental Health Service Continuum.

Progress: BMHS developed and issued subcontracts for the mental health services component of the Safe Schools / Healthy Students (SS/HS) Initiative. All mental health staff positions were filled during FY02. Skill streaming is an evidence-based program focused on reducing aggressive behaviors and increasing appropriate social skills and was part of the services continuum provided at SS/HS schools. During the year, the Skill streaming curriculum was expanded to include the 23 schools participating in the Expanded School Mental Health & Violence Prevention Initiative.

Mental Health Services continuum was developed during the first quarter, however this continuum served as descriptive of the range of services supported by SS/HS funding and included the services of Neighborhood Liaisons (family and community outreach personnel). As FY02 proceeded, it became evident that some components of the continuum (e.g. Neighborhood Liaisons) could not be sustained once funding ended. As a result, some of the participating agencies did not fill the Neighborhood Liaison positions. Evaluation of the Mental Health Services continuum did not occur.

Objective 6: Ensure that a continuum of preventive services including staff consultation, as well as treatment services will be available on-site in selected schools in Baltimore City.

Indicator: Programs receiving DHMH funding will provide at least 4500 teacher / school staff consultations per year. 70% of licensed OMHC's that have school-based Mental Health services, will follow procedures necessary to access reimbursement for pre-approved Community Prevention and Support activities in schools.

Progress: From July 1, 2001 through June 30, 2001, school-based mental health programs that receive DHMH funding documented 6000 teacher / school staff consultations. Seventy-five percent (75%) of the school-based OMHC Providers submitted proposals for Community Prevention and Support activities which followed reimbursement procedures.

Objective 7: Support integrated, coordinated school-based Mental Health services throughout the State of Maryland

Indicator: Use MHA and other grant dollars in combination with fee for service reimbursement, when appropriate.

Progress: BMHS oversees mental health services in 84 of the city's 174 schools. The total budget for these services is $4,685,700. Fee for service dollars are approximately $1,450,000 of the revenues. The rest come from a variety of grants including $1,600,000 from the Baltimore City Public Schools. During this fiscal year, we received an additional $400,000 from MHA which is targeted to reducing violence.

Objective 8: Increase the capacity to provide mental health services to young children and their families by qualified clinicians.

Indicator: Utilization of the Early Childhood Development Curriculum by mental health clinicians working with young children. Establish a resource list which includes providers with expertise in working with young children.

Progress: Capacity of provision of mental health services to young children has been expanded through a series of training sessions delivered during FY'02. By the end of FY 02, a resources list has not been developed. It is hoped that as training continues in FY 03 a resource list of providers with expertise in Early Childhood Mental Health can begin to be developed.

Objective 9: Collaborate with key administrators at BCPSS to maintain the BCPSS financial support of School-Based Mental Health Services.

Indicator: BCPSS will continue to partner with BMHS and will provide at least the FY01 level of funding to support School-Based Mental Health Services. Train selected School-Based Mental Health clinicians/staff to keep time study; BCPSS will appropriately document the percent of time devoted to approved Administrative activities and will succeed in accessing funding though Administrative Claiming. Presentation of school-based mental health services to school system CEO and School-board.

Progress: The Baltimore City School Board has approved FY03 School-Based Mental Health contracts at the same level as in the past. When the FY02 goals were developed, the BCPSS Office of Third Party Billing was in the process of seeking approval to do Administrative Claiming, which is a method for public school systems to access federal Medicaid funds for indirect services / administrative activities. School systems in some states have begun to access this funding, however, the process of approval in Maryland has not proceeded as rapidly as had been anticipated, therefore, the BMHS School-Based Coordinator did not have any activity on this Indicator.

The MOU between BMHS and the BCPSS is renewed every two years and was not up for renewal in FY02. It was therefore decided to wait until FY03 to do the next presentation to the BCPSS School Board and CEO. The Baltimore City School-Based Mental Health services were featured in an article in the nationally distributed publication Teaching Tolerance. Copies of the article were sent to key Administrators at BCPSS.

Goal # 4: Improve continuity of care.

Objective 1: Promote adequate service capacity for Baltimore City child OMHC's.

Indicator: Completion of job fair by May, 2002.

Progress: A C&A committee was established in the first quarter of FY02 to explore options for recruitment. The workgroup consisted of BMHS staff, BSAS representation, and OMHC and PRP providers. The committee was established due to providers reporting difficulties in recruiting clinical staff. A variety of options were explored including recruitment via internet, and a job fair. At the end of the first quarter C&A providers reported that the recruitment strategies were unnecessary since recruitment had improved. The group elected to take no further action on this objective.

Objective 2: Improve processes of transitions between service components of the Baltimore City Mental Health provider community.

Indicators: Training completed to school-based, community-based, and inpatient providers by December, 2001. Written operational guidelines for Baltimore City - by October, 2001. Complete two documented site visits to all Baltimore City children in RTC's - with recommendations. Monthly C&A and School-based Provider meetings; Meetings with MHP/MHA as needed.

Progress: There are approximately 140 Baltimore City youths and youth adults currently residing in Residential Treatment Centers (RTC) in the state of Maryland. BMHS is responsible (COMAR) for monitoring all Baltimore City residents at "in state" Residential Treatment Centers. During FY02 BMHS staff conducted site-visits to each RTC serving a Baltimore City child. During each visit an assessment was completed for new admissions and updated for residents reviewed during a previous visit. The process included a record/progress review, an interview with the child (if appropriate) and a review of plans for impending discharges. BMHS assisted in difficult discharge or RTC transfer cases and works closely with other child serving agencies. Also, as a member of the Local Coordinating Council, BMHS was able to make the appropriate referrals for the various "Step Down" resources. This assisted the RTC's and the Lead Agencies with timely and successful discharges. Below is a list of RTC's and number of visits made during the year.

Goal # 5: Ensure efficient and accountable financial agreement

Objective 1: Improve the management of funding targeted to Child and Adolescent Services to ensure appropriate and effective usage

Indicators: Approved policy completed and disseminated by October, 2001. Quarterly summaries of contract program expenditures. Semi-annual reprogramming report submitted to President for approval.

Progress: For FY02 C&A developed and monitored projected and actual expenditures of flexible funding used for essential services not reimbursable through the fee-for- service system. These funds supported specialized or temporary residential placements for "stuck kids", respite services, individualized care, transportation, etc. Over the year, a total of 11 children were supported in specialized placements by C&A; due to limited BMHS funding had to refuse services to approximately 10 children and families.

Goal # 6: Maintain a quality management program to continuously study and improve BMHS' activities.

Objective 1: Improve responsiveness and consistency of BMHS C&A authorization override and appeals process.

Indicator: Guidelines written and approved by October, 2001. Training provided to C&A providers by October, 2001.

Progress: This objective was not met. A general guideline was established to address appeals but was not formalized due to the low volume of authorization appeals reviewed by C&A division.

Objective 2: Improve Child and Adolescent Help Calls management.

Target: Complete and disseminate C&A policy to BMHS staff by October, 2001. Fully implement data-base and document type and frequency of Child-help calls.

Progress: C&A established a protocol for C&A Help calls designed to ensure that calls are handled within C&A division by all available C&A staff. In FY02 C&A documented a total of 438 discrete help calls. The type and frequency of the calls were documented.

Baltimore City Expanded School Mental Health (ESMH)

PROGRAM OUTCOMES

	No suspensions after beginning mental health services	Not referred to Special Education after beginning mental health services	No suspensions after beginning mental health services	Not referred to Special Education after beginning mental health services
Academic Year	Mid year (through December)	Mid year (through December)	Entire school year	Entire school year
99-00	94%	95% (n=1277)	94%	91% (n=1785)
00-01	95%	95% (n=1411)	90%	95% (n=2274)
01-02	97%	97% (n=1335)	92%	95% (n=2133)

Sample size (n) reflects every student served four or more times.

School-Based Mental Health Services

VOLUME OF SERVICE SUMMARY

Service Type	TOTALS
# schools included in DATA	84
Full time positions/FTE's represented in stats	78.1
# students "carried-over" from prior year:	906
New referrals served:	3,569
students seen without formal referral:	1,123 TOTAL Unduplicated Students Served:
TOTAL UNDUPLICATED STUDENTS SERVED:	5,598
TOTAL # Individual Sessions	25,080
# Treatment Group Sessions	2,124
#of Prevention group sessions	3,456
TOTAL # GROUPS	5,580
Student contacts in therapy groups	7,520
Student contacts in prevention groups	17,772
Total # Student Contacts in Groups	25,292
# of Parent/ Family Contacts	13,736
# of Teacher/ School Staff Contacts	12,752

FUTURES MENTAL HEALTH SERVICES DATA

# High Schools with FUTURES Programs:	6
FTE Mental Health Clinicians serving FUTURES:	3.9
TOTAL unduplicated students served:	508
Individual sessions:	2220
Group sessions:	490
Group contacts:	2406
# Student workshops provided:	72
# Staff development trainings facilitated:	25

GOALS & PROGRESS REPORTS

COMMUNITY HOUSING ASSOCIATES

Goal # 3: Ensure that affordable, safe and comfortable housing is available.

Objective 1: Maintain a 93% occupancy rate.

Indicator: The number of units occupied. The number of evictions.

Progress: Community Housing Associates occupancy for the year was 85.17%. However, there was progress made on reducing vacancies. The last quarter was the strongest for the year and the last month had a 90% occupancy rate. This year, CHA focused its efforts on (a) consolidating and integrating operational systems developed during the prior two years of rapid growth, (b) strengthening its operations, and, (c) continuing the implementation of recommendations from the Technical Assistance Collaborative's Strategic Plan consultation developed in FY'00. At the end of FY02, CHA owned 88 units of housing, administered 171 certificates for the Shelter Plus Care (S+C) program, and managed applications for 400 Section 8 vouchers, bringing the total number of households assisted/housed to over six hundred (600) people. A total of 17 tenants were evicted or asked to leave the program due to non-compliance with Shelter Plus Care requirements.

Objective 2: Develop twenty new units as of June 30, 2002.

Indicator: Number of new units purchased or leased. Number and type of grant awards received.

Progress: During FY02, CHA completed its' second SRO/group residence for people who had been long-term residents of a State Hospital. The project, Glenmore Housing, Inc., was developed with funds from the Maryland Department of Health and Mental Hygiene's Capital Bond program, the Maryland Affordable Housing Trust and the U.S. Department of Housing and Urban Development's (HUD) Section 811 Supportive Housing for People with Disabilities program. Glenmore Housing houses eight tenants.

In addition, CHA successfully concluded four years of negotiations with the State and the Enterprise Social Investment Corporation (ESIC) in relationship to its first project, CHA Limited Partnership #1. The workout agreement that resulted in renovations of twenty-two (22) units.

To continue development, CHA applied for several grants from federal, state and local sources. These included:

In conjunction with the Housing Authority of Baltimore City, seventy-five (75) housing choice vouchers through the Mainstream Program. For the second year, the application was awarded but not funded.

Grant renewals to HUD for the S+C program were submitted.

A Community Bond application for matching funds for the Safe Haven II was submitted. $182,000 was reallocated in lieu of additional funds being awarded. The Maryland Affordable Housing Trust awarded $28,750 to remodel two buildings.

Other:

• CHA contracted with Hersch/Lauren LLC, a professional property management company, for six months to manage the properties and make recommendations for improving operations. Consequently, CHA began to operate more like other affordable housing projects, by holding tenants accountable for timely rent payments and damages and emphasizing the need to be good tenants and neighbors. The length of stay in a unit and maintenance of the unit were identified as key indicators of good property management, necessary to maintain a high occupancy rate.

• CHA hired additional inspectors and began an aggressive program to inspect units and bring them up to housing quality standards. A full-time maintenance coordinator was hired to develop and implement a plan for improving the overall quality of housing. In addition, a position for a housing placement associate, was created. This allowed for better coordination between tenant re-certifications, unit inspections and repairs, which in turn resulted in a decreasing vacancy rate.

• Increased emphasis was placed on improving communication between CHA and other BMHS divisions, and CHA and the Baltimore City Office of Homeless Services (OHS). There are now bi-weekly meetings between CHA and Adult Services staff, and monthly meetings between the Financial Division and CHA staff, between CHA and OHS, and between the President of BMHS, the Adult Services Director and the Executive Director of CHA.

• CHA continued to represent integrated, independent housing for people with mental illness as an acceptable housing model for people with disabilities. BMHS and CHA presented at the national NAMI convention, and CHA staff participated in an Abt Associate Study Advisory Group which had representatives throughout the East Coast and is studying housing initiatives for people with disabilities. CHA also consulted for TAC on the Olmstead report, had meetings with Metro-NAMI regarding development of housing for people who live with aging parents and provided technical assistance to Main Street Housing, a consumer-run housing agency, which resulted in their receiving a grant of $250,000 to develop housing.

GOALS & PROGRESS REPORTS

FINANCE DIVISION

Goal # 5: Ensure efficient and accountable financial management.

Objective 1: Improve the management of funding targeted to Child and Adolescent Services (C&A) to ensure appropriate and effective usage.

Indicator: Approved policy completed and disseminated by October, 2001. Quarterly summaries of contract program expenditures. Semi-annual reprogramming report submitted to President for approval.

Progress: The appropriate procedures to improve the management of Child and Adolescent funding are in place. There has been ongoing communication between fiscal staff and C&A staff to ensure prompt payment and accurate recording of all expenditures. The detailed expenditures have been reviewed by C/A staff - funds have been requested at time frames appropriate for funding source and we have assigned one accounting staff during the last quarter to reconcile expenditures at year end and prepare records for audit.

Objective 2: Establish appropriate accounting record keeping to meet external funding source requirements and internal monitoring.

Indicator: BMHS audit.

Progress: The BMHS Board Finance Committee began meeting in December, 2001 and met quarterly throughout the fiscal year. The Committee members were introduced to all aspects of BMHS's internal controls such as the Investment policy, the accounting manual, BMHS financial policies & procedures as well as reviewing budgets. The successful settlement of the 98/99 State audit was presented as well as the FY'00 BMHS audit which had an unqualified opinion. The BMHS Finance Committee Charter was finalized and approved by the full Board. In addition, BMHS staff has reviewed the required provider audits for FY'01.

There also were monthly meetings with the Housing subsidiary staff (CHA) reviewing monthly financial statements and monitoring current financial issues. Reports were prepared for presentation at the CHA Monthly Board meetings.

Objective 5: Create a payment system that reconciles with reporting requiremen

Indicator: Contract monitoring spreadsheet.

Progress: The cash disbursement spreadsheet continued to be monitored by contract and was used to supplement information derived from the General Ledger. The appropriate recording systems were operational. They were used to support the contract oversight.

GOALS & PROGRESS REPORTS

QUALITY IMPROVEMENT/OPERATIONS DIVISION

Goal 3: Ensure that safe, affordable, and comfortable housing is available.

Objective 1: Conduct annual inspections of housing units approved under COMAR to evaluate continued compliance with regulations.

Indicators: Number of inspections, timeliness of inspections, type of approvals, letters of non-compliance

Progress: This objective was met. Baltimore City has 161 housing units (Residential Rehabilitation Programs, Therapeutic Group Homes, Adult Group Homes and Residential Crisis Services) approved by COMAR. The residential specialist conducted annual inspections to all 147 existing units on or before the due dates. The majority of the units were in compliance with the requirements. General approvals were granted to 92 (63%) of the units, which means no deficiencies were found. The remaining 55 (37%) of the units received "provisional approval" because of deficiencies cited. The most common deficiencies cited reflect repairs and general maintenance needs. In most cases the repairs were minor & fixed within the 30 day required period. QI staff were required to conduct return visits within 30 days. Between the initial and follow-up visits a total of 250 inspections occurred.

Objective 2: 90% of COMAR approved residential housing units in Baltimore City will receive general approval at the time of BMHS' annual inspection.

Indicators: Number of housing units, Number of units inspected, Number granted general approval at the annual inspection, written policies.

Progress: This objective was partially met not on target. Sixty-three percent (63%) of residential housing units received a "general approval" during the annual inspections. QI division will be working with providers in FY03 to identify strategies to increase the timeliness of repairs to ensure that all consumers live in housing that complies with the regulations. Any identified problems are referred to the appropriate BMHS division director and if needed to the Office of Health Care Quality (OHCQ) for additional investigation.

ANNUAL INSPECTION RESULTS

Providers	Annual Inspection Results By Provider			Follow Up Inspections
	Units	Compliance (General approvals)	Violations (Provisional Approvals)
Alliance, Inc.	15	20% - 3 Units	80% - 12 Units	12
Baltimore Crisis Response, Inc.	5	100%
Children's Guild	2	100%
Devereux Foundation	2	50% - 1 Unit	50% - 1 Unit	1
Fellowship House	1	100%		1
Guide Program, Inc.	1		100%	1
Harbor City Unlimited	20	25% - 5 Units	75% - 15 Units	19
Harford Belair	15	73% - 11 Units	27% - 4 Units	10
Key Point	21	67% - 14 Units	33% - 7 Units	7
New Phases	10	90% - 9 Units	10% - 1 Unit	1
North Baltimore Center	17	82% - 14 Units	18% -3 Units	3
People Encouraging People	26	85% - 22 Units	15% - 4 Units	16
Progressive Horizons	1	100%		1
Volunteers of America	7	43% - 3 Units	76% - 4 Units	4
Woodbourne Center	4	25% - 1 Unit	75% - 3 Units	3
TOTALS	147*	92 (63%)	55 (37%)	79

* Conducted 14 initial inspections for new units not included above.

CORRECTIVE ACTION TIMELINESS

Timeliness of Residential Housing Programs Corrective Action
Number of Units	Days to Correction
46	30
2	60
5	90
2	120 or more

Objective 3: Interview 50% of mental health consumers living in housing approved under Code of Maryland Administrative Regulations(COMAR) in Baltimore City and evaluate consumers satisfaction.

Indicators: Number of consumers in housing; Number/Percent interviewed; Level of Satisfaction, written procedures developed.

Progress: This objective was met based on the number of residents living in the housing units at the time of inspections. Three hundred seventy-nine (379) consumers resided in adult residential rehabilitation programs (RRP), adolescent therapeutic group homes and child residential crisis programs. Enrollment fluctuates throughout the year. The residential specialist interviewed 202 (53%) consumers. This exceeds the one-third minimum number of interviews required. The majority of residents both adult and adolescents made positive comments about their housing. Highlights from the surveys are shown in the tables below. A full report including individual provider results is available upon request.

Objective 4: Consumers concerns are addressed in a fair and timely manner.

Indicator: Consumer satisfaction with action/outcome; timeliness of response; appropriateness of action.

Progress: This objective was met. The residential specialist met with consumers individually to identify problems or concerns. All problems identified were discussed with program staff at the conclusion of the annual site visit. Consumer concerns related to late or missed dosages of medication, unwanted attention from fire drills, and timeliness of housing repairs.

The residential specialist submitted a written report within 5 days to the provider that included results of the housing inspection and consumer surveys. If concerns were serious, providers were required to submit a Program Improvement Plan (PIP) within a specific time frame.

Consumer Satisfaction Results
	N	Extremely Helpful	Moderately Helpful	Not at all Helpful
Staff Assistance with medication	200	134 (67%)	50 (25%)	16 (8%)
Staff Assistance in talking about emotional problems	199	120 (60%)	57 (29%)	22 (11%)

Consumer Satisfaction	N=	Yes	No
Respectful treatment from staff, regardless of race	201	191 (95%)	10 (5%)
Respectful treatment from staff, regardless of gender	200	190 (95%)	10 (5%)
Consumers want to spend time family	189	166 (88%)	23 (12%)
Consumers felt supported by their family	186	149 (80%)	37 (20%)
Consumers currently employed	202	47 (23%)	155 (77%)
Consumers felt safe in their residence	202	187 (92%)	16 (8%)
Consumers have easy access to transportation	202	200 (99%)	2 (1%)
Consumers would refer a friend or family member to the program	199	171 (86%)	28 (14%)

GOAL # 6: Maintain a Quality Management Program to Continuously Study and Improve BMHS Activities.

Objective 1: Implement BMHS' Quality Management Plan by August 2001.

Indicators: Approval of a written plan, Quality improvement Activities documented.

Progress: This objective met. The Director of Quality Improvement and Operations received final approval on the revised QM plan in July 2001. The plan was distributed to employees during August 2001. Approval of the written plan followed by a formal presentation to all employees were important initial steps in demonstrating BMHS' commitment to quality management.

Objective 2: Conduct 4 workshops for COMAR providers to address improvements identified during OHCQ site visits, provider training requests.

Indicator: Number/type of workshops; evaluation results.

Progress: This objective was met. QI provided two workshops on documentation in the medical records documentation training. Other divisions provided additional workshops which exceeded requirements.

Objective 3: Participate with the Office of Health Care Quality (OHCQ) in conducting site visit to 90% of COMAR providers in Baltimore City.

Indicators: Number/percent of programs visited; type of approvals.

Progress: This objective was met . The OHCQ conducted site visits to 45 community mental health programs approved under COMAR and BMHS QI staff attended 43 (96%) of them. Site visits were conducted under the following conditions, 1) new applications, 2) evaluate continued compliance, 3) evaluate implementation of performance improvement plan. There are two types of approvals which may be granted for up to 3 years. Full approval (no deficiencies) or conditional approvals. Two providers received full approval, Harford Belair mobile treatment services and Shapiro Training Employment Program, psychiatric rehabilitation program. The remaining programs received conditional approvals. The most common deficiencies cited were related to documentation in the medical records.

A summary of QI staff participation in FY'02 OHCQ site visits is summarized in the tables section.

Summary of Baltimore Mental Health Programs
Programs/Services	#
Adult Group Homes (GH)	3
Children Therapeutic Group Homes (TGH)	3
Mobile Treatment Services (MTS)	7
Outpatient Mental Health Clinics (OMHC)	24
Psychiatric Rehabilitation Programs (PRP)	35
Residential Rehabilitation Programs (RRP)	8
Residential Crisis Services (RCS)	3
Respite Care Services (RC)	2
Mental Health Vocational Programs (MHVP)	10
Targeted Case Management (TCM)	7
Partial Hospitalization Program (PHP)	10
TOTAL	112

Objective 4: Baltimore City providers granted deemed status by Mental Hygiene Administration (MHA) continued to comply with COMAR .

Indicator: Number of providers complying with terms of deemed status agreement.

Progress: This objective was met. Six providers were granted deemed status by MHA. Deemed status means that MHA granted approval to a program based on the program's certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or Commission on Rehabilitation Facilities (CARF). QI staff developed procedures for evaluating continued compliance of deemed status providers.

Objective 5: BMHS will monitor and evaluate COMAR providers implementation of performance improvement plans required by OHCQ.

Indicator: Written procedures. Number of programs monitored. Number/percent of program improvement plans implemented.

Progress: This objective was met. Written procedures are available. Staff reviewed 43 (100%) of performance improvement plans submitted and provided technical assistance. Staff also participated in 16 site visits conducted by OHCQ to evaluate implementation of PIPs.

Objective 6: BMHS will be in compliance with time frames included in COMAR regulations 90% of the time.

Indicators: Number and percent of timely completion of applications and PIPs.

Progress: This objective was met. Q I staff received 39 applications to provide community mental health services. 100% of the reviews were completed within the required time frame.

A great deal of time was spend providing technical assistance to providers interested in opening new services. Staff worked with providers on preparing the documents, organizing the information and interpreting required regulations.

Objective 7: Monitor and report on sentinel events (deaths, complaints, unusual incidents).

Indicator: Number of deaths reported; number/type of complaints.

Progress: This objective was met. BMHS received 65 Report of Death Forms from COMAR providers. These reports reflect known deaths of consumers actively enrolled in the program. We suspect actual numbers may be higher than reported. In some instances, providers are notified by third parties months after the death occurred if at all.

Summary of Consumer Death Reports
Consumer Deaths	Total
Total Reported	65
Males	39
Females	26
Cause of Death Known	37
Cause of Death Unknown	28
Mean Age	50 years

A total of 15 complaints forms were submitted. Complaints were received regarding customer service, inadequate treatment, rights violations, poor housing conditions and personnel complaints. Complaints are handled by all divisions. Reminders and training are needed to improve reporting.

Objective 8: Design and implement policies and procedures to ensure the effective management of contracts.

Indicator: Policies implemented.

Progress: This objective was met. BMHS' vendor contract management committee (VCMC) developed a comprehensive contract management and procedures manual. This manual describes in detail the process for requesting, approving, monitoring, and evaluating contracts. A significant accomplishment was made in the area of clarifying roles and responsibilities of providers and BMHS. The team focused on improving BMHS' ability to evaluate agency and provider performance. This included identifying minimum reporting requirements, uniform reporting format, and report due dates. Efforts were made to develop consistent practices where applicable. For the first time, division directors and providers were asked to rate provider performance. Q I division developed a standard rating system and providing training on the use of the tools. These findings were incorporated in the annual and bi-annual site visits. Providers have given positive feedback on the improvements in the contract monitoring process. Further improvements are needed in the procedures relating to data entry in the contract data base on provider progress reporting.

Objective 9: Increase the timely execution of DHMH contracts.

Indicators: Number/percent of contracts executed by July1, 2001. Number/percent of contracts executed by September 30, 2001.

Progress: This objective was met. Forty-six percent of DHMH funded contracts were executed by July 1, 2002 and sixty percent were executed by September 3, 2002. This was an improvement from FY01. The majority of the delays in executing DHMH contracts were related to providers returning contracts after the target date and late submission of requests to fiscal office. The vendor contract committee took additional steps to improve timeliness in FY03 which has been proven to be successful. By the end of FY'02 93% of FY'03 contracts were executed to July 1.

Objective 10: Contracts will be signed and executed for 100% of vendors receiving payments for services.

Indicator: Payment of vendors with executed contracts.

Progress: This objective was met. The VCMC monitored provider payments throughout the year to ensure compliance. Fiscal office issued regular payment reports.

Objective 11: Ensure providers receiving funds are delivering services purchased and complying with contract.

Indicators: Submission of progress reports, performance ratings assigned by division directors, site visit reports, follow up on recommendations, minutes

Progress: This objective was partially met. All providers were required to submit a progress report either quarterly or bi-annual. Division directors reported that most provider submitted progress reports on time. In order to improve monitoring a computer consultant was hired to design reports in the contract data base, training and technical assistance was provided to staff, The VCMC discussed the issues.

Annual and bi-annual site visits were conducted to evaluate 41 FY 02 contracts to determine if they were delivering services per their contract. In some instances, program staff had not seen the actual contract and was unaware of specific deliverables. Only one provider was found to be out of compliance. BMHS required performance improvement plans for any significant problems. All providers (except one) submitted performance improvement plans as required. VCMC continued to have problems obtaining internal reports on provider progress. An audit conducted on a sample of progress reports found numerous errors. Steps were taken to standardize reporting and rating of performance. Attempts were made to track progress. This was BMHS first attempt to automate reporting and due to technical difficulties we were unsuccessful. Although automating reports was the short term goal, problems with the data base should not remove responsibility for issuing these important report. If necessary, reports should be generated manually.

Objective 12: Contract management database will be functional by July 2001.

Indicator: Division Directors have access and reports were generated.

Progress: This objective was partially met. The consultant completed the design of the database and created access for approved staff. The contract coordinator submitted regular reports on the status of contract approvals and executions. These reports were used to monitor BMHS' internal performance and develop improvement strategies. The "contract management" report has significantly improved the ability to monitor and report timely and accurate information. The VCMC used the report to track contracts from the date of the request to final approval. The report also provides up to date information on changes in funding, budget submission and approval. As staff have become for familiar with the application, additional reports have been generated. As with any new system, there were problems. Some reports designed did not prove to be as useful as expected due to changes in BMHS procedures. Due to the lack of on site technical support for the data base, even small problems took weeks to be corrected. Problems continued throughout the year with reports developed to track provider progress report submission and performance. Their were two main contributing factors.

Additional Information Tracked:

The numbers below are understated due to problems with internal agency reporting. Steps will be taken in FY 03 to improve reporting.

Number of Help Calls Received

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