TABLE OF CONTENTS:

Preface

Mission, Vision and Values Statements

Description

Goal #1: Establish and Maintain Collaboration with Key Stakeholders

Goal #2: Establish and Implement a Planning Process that Sets Forth the Vision, Goals, and Objectives for Baltimore City

Goal #3: Expand and Maintain the Range of Services

Goal #4: Improve Continuity of Care

Goal #5: Develop and Maintain Affordable Housing

Goal #6: Establish and Maintain Sound Financial Management Practices

Goal #7: Develop and Implement a Comprehensive Quality Improvement Program

Goal #8: Develop and Provide Training

Goal #9: Other Accomplishments

Appendices

PREFACE

During fiscal year 2000 (July 1, 1999 to June 30, 2000) BMHS focused on expanding the range of services, improving access to care for Baltimore City residents and strengthening our collaborative relationships with providers, government agencies and foundations. Some of the highlights of this year's activities include the implementation of a crisis system for children, adolescents, and their families; increased utilization of the services available through Baltimore Crisis Response Inc. (BCRI); processing over 100 new Section 8 housing certificates; continued expansion of school-based mental heath services; implementing joint training and planning with Baltimore Substance Abuse Systems, Inc. (BSAS); and, initiatives with the Department of Public Safety and Correctional Services and the Department of Juvenile Justice.

In FY'00 there were 22,215 Baltimore City residents who received services through the Public Mental Health System (PMHS), as reflected in the Maryland Health Partners (MHP) data system as of July 31, 2000. A breakdown of the utilization of the public mental health system is included in Appendix 1.

iii

Baltimore Mental Health Systems, Inc. (BMHS) Annual Report - Fiscal Year 2000 (July 1, 1999 to June 30, 2000)

Goal #1: Establish and maintain collaboration with key stakeholders.

A. Objective: Meet with mental health providers to assess problems, concerns, and progress with the public mental health system.

Strategies:

1. Continue quarterly provider meetings with providers in the public mental health system.

2. Continue regular meetings with child and adolescent providers, case management, residential rehabilitation providers, and designated providers to homeless individuals.

BMHS continued its quarterly meeting with Baltimore City providers. The meetings presented the providers with an overview of current issues facing the PMHS. In addition to updates by BMHS staff, the meetings included presentations by the Family League of Baltimore City, the International Association of Psychosocial Services on the new federal Work Incentive Improvement Act for the disabled, the Mental Health Association on depression education, Baltimore Child and Adolescent Response System (B-CARS), the National Alliance for the Mentally Ill (NAMI) and the Mental Hygiene Administration (MHA)on home ownership opportunities for individuals with psychiatric disabilities.

Throughout the year the Adult Services Division continued to meet regularly with Case Management Unit Directors, Residential Services Providers, programs that provide services to homeless persons with mental illness and with programs that are working together to improve services to those individuals with mental illness who have entered the criminal justice system. The meetings focused on improving continuity of care by identifying gaps in services, problems of access to care and new services or providers available in the community.

The Child and Adolescent Services Division (C&A) conducted monthly meetings with the community providers, school-based mental health program directors and supervisors. In addition to standing meetings, the C&A staff met with providers to address issues related to the start-up of new Outpatient Mental Health Clinics (OMHC'S) and helping existing OMHC providers to address fiscal and staffing difficulties. BMHS' Coordinator of School-Based services met three times with all school-based clinicians. The purpose of these meetings was to address clinical, administrative and financial concerns.

B. Objective: Ensure that issues which affect providers of the public health system are addressed with the Mental Hygiene Administration (MHA) and/or Maryland Health Partners (MHP).

Strategy: Regularly meet with MHA and MHP for the purpose of addressing and resolving issues, and influencing policies that affect Baltimore City citizens and providers.

BMHS met regularly with MHA and MHP to resolve provider billing and claims issues. A great deal of time was spent helping Urban Behavioral Associates (UBA) attempt to resolve its financial situation; working with Project STEP to become financially solvent; resolving income documentation issues with Awele; and, at the end of the fiscal year working with Woodbourne to help them resolve a serious financial situation.

The Adult Services Division continued to explore with both MHP and MHA a change in the process of referral for individuals needing residential rehabilitation programs (RRP). As of June 2000, all referrals for RRP's for Baltimore City residents are being sent directly to BMHS for authorization. This process required some internal reorganization, but will improve the process for both clients, providers and staff.

Regular meetings with case management units who serve adults were reconvened. The purpose of these meetings was to assist the case management units to comply with regulations primarily in their roles within their parent agencies. Each unit must be able to document that linkage to mental health services are offered to the client from a variety of providers.

Ongoing discussions on the provision of services to the elderly were held. BMHS' Adult Services Director served on a MHA task force and the Director of Geriatric Services met with MHA on issues of financing and designing services to geriatric population in need of psychiatric services.

Throughout the year BMHS worked with MHP to develop and implement the service authorization bundle for the Baltimore Child and Adolescent Response System (B-CARS), the new psychiatric crisis program for children, adolescents and their families. This bundling allowed multiple services to be authorized by a single phone call. The C&A division also worked with MHP, MHA and the Baltimore City Department of Social Services to address the placement needs of children who were abandoned by their parents and/or there were foster placement issues.

C. Objective: Continue to work with local, state, and federal agencies e.g. Family League of Baltimore (FLBC), Department of Social Services, Department of Juvenile Services (DJJ), Baltimore City Police Department (BCPD), Baltimore City Public Schools (BCPS), Office of Homeless Services (OHS), Baltimore Substance Abuse Systems, Inc. (BSAS) and the Department of Public Safety and Correctional Services to develop and maintain collaborative projects.

Strategies: 1. Work with the FLBC to implement and provide oversight of the child and adolescent crisis system.

C&A staff worked with the FLBC to develop, implement and provide oversight to the B-CARS child crisis system throughout the year. FLBC staff participated in both the Oversight and Implementation Committees of BCARS. The BCARS program, after completing a brief pilot phase, initiated city-wide services on November 1, 1999. The FLBC disseminated information about the availability of service both through its Board and programs.

2. Continue working with the FLB, Baltimore City DSS, DJJ, and Department of Education to plan for the implementation of a demonstration project for "high end" individuals.

C&A staff continued to work with FLBC, DJJ, and DSS on the development of a demonstration project to work with "high end" children. While a single concerted demonstration project was not initiated, the collaborations contributed to FLBC's initiative to begin return-diversion activities for children in in-state Residential Treatment Centers (RTC), and in the development of community-based resources to address the needs of high-end children in the community. The collaborative discussions set the stage for a collaborative proposal for a capitation pilot project for children and adolescents to be submitted to MHA in early FY01.

3. Continue to work with OHS on developing services for homeless individuals who have a serious mental illness.

During this year BMHS continued its collaborative working relationship with OHS to develop mobile comprehensive services to individuals with a serious mental illness. The teams at Sinai and PEP, Bon Secours and North Baltimore Center (NBC) provided services to 250 individuals; the Safe Haven while maintaining close to 100% occupancy served 77 individuals; and, SSI Presumptive Eligibility Project at UMMS assisted 90 individuals in receiving their entitlements. Five mental health program renewals were submitted as part of the Baltimore City's application to HUD's Super Notice of Funding Availability (NOFA)2000 for fiscal years '02,'03 and '04. They included the two programs presently provided through the University of Maryland Medical Systems: the Safe Haven and the SSI Presumptive Eligibility. Continued funding for the three outreach/treatment teams operating from Bon Secours, People Encouraging People and Johns Hopkins Hospital were included in the request. BMHS received one new award for FY'01 for a newly established consumer operated drop-in center. The provider will be Project HOPE. Community Housing Associates Inc. (CHA), BMHS' housing development subsidiary is renovating the building for the drop-in-center.

CHA continued its management of the Shelter Plus Care program which provides rental assistance for homeless individuals with a mental illness. As of June 30, 2000, 165 of the 171 (96%) vouchers were in use.

In August 1999 a Task Force on Homelessness was established. BMHS' president served on the task force in one of the five at-large member seats. The task force developed a plan with recommendations to the Mayor for improvements in the organization, services and resources for individuals who are homeless.

During the fiscal year, Sinai Hospital discontinued its mobile treatment team to homeless individuals. BMHS took the leadership to ensure there was no disruption for clients and worked with Sinai and People Encouraging People (PEP) to transition the services to PEP. This was done with little disruption to clients and staff.

4. Continue to work with the Baltimore City Public schools to ensure that mental health services are adequately funded and maximized.

BMHS continued its collaborative relationship with the Baltimore City Public Schools (BCPS) which has resulted in 80 of the Baltimore City 183 schools having mental health providers on-site in the school. Appendix 2 includes a listing of the schools and a description of outcomes of the school-based services.

During the 2^nd Quarter, BMHS and BSAS distributed a Needs Assessment Survey to the school based mental health clinicians to determine to what extent substance abuse issues were being identified by the school-based mental health providers and the need for additional services. The survey revealed a limited collaboration between the substance abuse and mental health school-based staff. As a follow-up, BMHS and BSAS held a joint training session for substance abuse counselors and mental health clinicians in middle and high schools.

The BMHS Coordinator of School-Based Mental Health Services advocated at the state level for support and expansion of school-based mental health services. The coordinator participated in the Safe Schools Interagency Steering Committee, and served on the Executive Committee of Safe Schools Interagency Steering Committee to discuss Systems Change at the State Level. She also participated in an interagency committee to plan the state-wide conference on "Enhancing and Sustaining School Mental Health Partnerships."and, was elected President of the Maryland Assembly on School-Based Health Care.

A Safe Schools / Healthy Students (SS/HS) federally funded violence prevention grant was awarded to the Baltimore City Public School System, in partnership with BMHS, the Johns Hopkins School of Public Health, Baltimore City Police Department, Mayor's Office, Baltimore Departments of Health and Social Services, Baltimore Substance Abuse Systems, Inc., Family League of Baltimore City, Maryland Department of Juvenile Justice, Safe and Sound Campaign, and the Archdiocese of Baltimore for new school-based mental health clinician positions at 3 public schools and at two parochial schools. The BMHS Mental Health Liaison for Safe Schools/Healthy Start was hired and moved implementation forward while strengthening the BMHS connection to the school system and to the participating schools.

While not specifically school based services, BMHS joined in a collaboration with the Baltimore City Headstart, and the Johns Hopkins University, School of Public Health, to explore to the need for and feasibility of developing mental health services in Headstart centers. These discussions were initiated as part of BMHS' effort to increase access and capacity to services for the birth to age 6 population. These discussions led to an approved request to MHA for an increase in state funding to develop mental health services in 6 to 7 Headstart programs in FY'01. The goal is to improve school readiness for a high risk pre-school population.

5. Develop an informational tool on psychiatric crisis services that is easily accessible to all members of the Baltimore City Police Department.

BMHS staff developed a template for an information tool that included BCRI's phone number that would be placed in all Baltimore City police cars. The idea was presented to the Police Department but no response was received. Changes in the police leadership prevented the issue from being pursued further in FY'00. Strengthening the relationship with the Baltimore City Police Department (BCPD) continues to be a BMHS priority.

6. Continue to chair the Interagency Aging Committee Clinical subcommittee and ensure that the needs of individuals needing interventions from multiple agencies are addressed.

The Interagency Clinical Subcommittee of the Baltimore City Commission on Aging is chaired by BMHS and includes representation from the Commission on Aging, Department of Social Services, the Health Department, the Housing Authority, Family & Children's Services, Jewish Family Services and Catholic Charities. The subcommittee met monthly to review clients with complex clinical and social service needs which crossed agency boundaries and to ensure continuity of care by making recommendations to each client's care provider team. During FY 2000, 10 new cases were presented. In addition to the case conferences the agencies represented on the Subcommittee identified problems and ongoing difficulties with the implementation of the Assisted Living regulations. To date only 32 of 2,000 homes have been fully licensed. There are on-going problems related to the complaint process and responses from the Office of Health Care Quality (OHCQ). The clinical subcommittee and the individual agencies are making efforts to meet with OHCQ to clarify roles and responsibilities and to explore options for a more timely licensure process.

7. Meet with the staff of the Department of Public Safety and Correctional Services (DPSCS) to improve discharge planning from incarceration to community care for persons with serious mental illness.

DPSCS with leadership from its Mental Health Director developed the Mental Health Transitional Unit (MHTU) which is housed at Patuxent Institution. This unit has been designed to accept transferred inmates from other prisons within the Department of Corrections, who are 6-8 months from their mandatory date of release. The MHTU is designed to offer extensive evaluation, psycho-education, counseling services to assist with the inmates reintegration to the community. BMHS obtained funding for a demonstration project that would allow for the provision of Intensive Case Management services three months prior to discharge for those inmates who would be expected to need mental health services in the community.

The program began during the second half of the fiscal year and initially, the MHTU had difficulty getting appropriate referrals which slowed the startup. However, as the program continued to define itself and the needs of the inmates, referrals have increased. The MHTU released eight persons into the Community with assistance from the case management units.

BMHS staff met with the Maryland Correctional Institution for Women (MCIW) to plan an extension of the program to this facility in FY'01. A research component was developed in collaboration with the MHTU, BMHS, and University of Maryland Department of Psychiatry's Center for Behavioral Health, Justice and Public Policy to evaluate the effectiveness of coordinating discharge planning.

8. Continue to work with BSAS to plan for services to meet the needs of individuals with mental illness and substance abuse.

BMHS and Baltimore Substance Abuse Systems, Inc. (BSAS) developed a training on integrated care for individuals with co-existing mental health and substance abuse needs. The trainings were held in March and April with over 250 individuals representing over 50 agencies attending.

In the later part of the fiscal year, BMHS and BSAS developed and submitted a proposal to the Open Society Institute Foundation (OSI) for a demonstration project for integrated mental health and substance treatment in Baltimore City. The concept was reviewed favorably by OSI and the proposal is being revised. In addition, as noted above, BMHS and BSAS worked together to better serve students in the Baltimore City Public Schools.

D. Objective: Ensure that family members, consumers and advocacy groups are given opportunities to participate in assessing, planning, and monitoring the mental health system.

Strategies: 1. Include family members on the oversight committee for the child and adolescent crisis system.

BMHS actively involved families as key partners in the development of its Child and Adolescent crisis service system. This included representation on the Implementation and Oversight Committees of B-CARS, and in the development of the BMHS respite care proposal submitted to MHA in the spring. FIT was funded by BMHS to develop and conduct family focus groups, training, and to develop a report-card system to review service providers. A final report on their activities is pending and will be shared with the Board of Directors in FY'01.

2. Develop a plan for utilizing the expertise of family members and consumers in the oversight of the public mental health delivery system.

BMHS began working with family members, advocates and consumers to develop a Consumer Satisfaction Team (CST) for Baltimore City. A CST establishes an active role for consumers and family members in the oversight of the service system. CSTs conduct site visits and interview users of the system and report findings back to the mental health authority. The Baltimore planning group for a CST consisted of BMHS staff, the Maryland Chapter of NAMI, the Mental Health Association, Families Involved Together (FIT), Black Mental Health Alliance and On Our Own. The group visited a CST program in Philadelphia and hopefully will begin the program development work in FY'01.

3. Continue support for mental health advocacy groups.

BMHS continued to fund the Mental Health Association, National Alliance for the Mentally Ill (NAMI), Black Mental Health Alliance for Consultation and Education, Inc. (BMHA) and Families Involved Together (FIT), as well as the following consumer drop-in centers: On Our Own (OOO) and Hearts and Ears. BMHS assisted Project HOPE to become established.

Goal #2: Establish and implement a planning process that sets forth the vision, goals, and objectives for Baltimore City.

A. Objective: Develop strategies that respond to the needs identified in the FY'99 provider survey.

Strategy: Analyze the responses that indicated dissatisfaction and when appropriate develop a corrective action plan.

This goal was partially met. Policies and procedures were developed and revised in an effort to improve services based on comments from providers. Unfortunately, we did not develop a monitoring tool as planned to track continued performance. This will be addressed by QI during upcoming fiscal year.

B. Objective: Develop a planning initiative for the design of a continuum of care for transitional age youth.

Strategy: 1. Increase residential rehabilitation resources for transitional age youth.

There was no increase in residential rehabilitation programs for transitional age youth.

2. Increase day programming opportunities for transitional age youth.

The Office of Employment Development (OED) awarded funds to BMHS to target teen mothers (in school and out of school) and youngsters in Kinship Care through DSS. BMHS worked with OED on developing a Request for Proposal for the services and Sheppard-Pratt Health Systems was awarded the contract. In addition, OED was funded for by the Department of Labor for 3 years for a youth opportunity grant. OED sub-contracted to BMHS who awarded the contract to the North Baltimore Center (NBC).

3. Continue to work closely with DSS to implement initiatives for transitional age youth.

The Adult Services Division submitted an application to DSS for a 3 year grant providing $500,000 per year to provide a specialized program for 20 youth between the ages of 18 and 21, who would be leaving DSS child care services. Each youth would have a diagnosed mental illness and be expected to need ongoing services from the PMHS in order to live successfully in the community. The program would have a research component to measure the value of this programmatic approach to transition.

Adult Services staff were invited by DSS Foster Care Teen Unit to train DSS staff in public mental health system resources. The full spectrum of services were described in detail as well as procedures for accessing them. This was part of the on-going efforts of BMHS to work collaboratively with DSS and offer technical assistance as a children's system attempts to access adult services. Other collaborative efforts were made by BMHS and another CSA who had a mutual transition age adult client who wished to continue living on the Eastern Shore.

C. Objective: Complete the planning with the Family League of Baltimore City for a demonstration program for "high end" children and adolescents.

Strategy: Develop a proposal by December 31, 1999.

See Goal 1 C 2.

D. Objective: Develop a plan to assess the need for targeted case management (TCM) for children and adolescents.

Strategy: Identify the providers to deliver targeted case management for children and adolescents by November 1, 1999.

C&A providers were surveyed to identify existing city-wide capacity/need for TCM services. Three TCM providers are operating in Baltimore City. The patterns of referral suggest the current capacity is sufficient to meet the needs. BMHS remains concerned that TCM is an underutilized service and that the actual need is substantially higher. We will continue to address this issue in FY'01.

E. Objective: Assess the utilization of mental health services to ensure that members of various cultural and ethnic group have access to the system.

Strategy: Review the demographics of individuals using the public mental health system to determine if they reflect the demographics of Baltimore City.

The MHP data based on paid claims indicated that 71% of the population served by the Public Mental Health System in Baltimore is African-American. The population of Baltimore City is 63% African-American. The following table shows the age distribution for those receiving services in FY'00.

Age Group	Percent
0-5	5%
6-12	24%
13-17	12%
18-21	3%
22-64	50%

65 and over

6%

It appeared the 18-21 (transitional age youth) and the over 65 were underserved. BMHS is in the process of securing additional funding for the transitional age youth population. The over 65 group which is about 13% of Baltimore City's population is more difficult to obtain accurate data on. A large number of the population have Medicare as their primary insurance, and Medicare data is not collected.

F. Objective: Complete the housing needs assessment.

Strategy: Work with the consultant through the Maryland Association of Non-Profit Agencies (MANO) to complete the housing needs assessment by December 31, 1999.

This goal was completed and is addressed in Goal 5 A. 4.

Goal #3: Expand and maintain the range of services.

A. Objective: Increase the number of forensic clients placed in the community.

Strategy: Provide in-service training to state hospital forensic staff about community providers.

The Adult Services Coordinators have continued to meet regularly with the staff of the State Hospitals to assist them with the development of community living plans for their patients who require a conditional release plan. In FY00 a total of 158 persons were placed on conditional release via Baltimore City Courts. Of those 158 persons, 16 violated (thus, hospital warrants were issued and they returned to the hospitals); 7 conditional releases were revoked; 14 completed their conditional release program. Thus, 121 persons with conditional release are successfully living in the community at this time.

The Forensic Alternative Services Team (FAST) of the Medical Services of the Circuit Court continued to operate and expand during this year. The program continued to focus on diversion of individuals from incarceration at Central Booking and the District Court level. The team also provided diversion and after discharge planning services to individuals incarcerated in the Baltimore City Detention Center (BCDC).

During this year a total of 1,286 persons were referred to the program. These referrals were from three primary sources: PreTrial Services (65%), Public Defenders (12%) and District Court Judges (7%). The referrals were screened for appropriateness for and willingness to participate in the program. Most of those referred were not accepted into the program as they either did not have a mental illness (many had substance abuse problems and/or the charges were too severe) or they refused to participate with the program. At the present time, the FAST staff of four mental health professionals and a director are monitoring over 200 persons who have been diverted from incarceration and are living in the community.

FAST hired a fourth worker in February 2000 to focus on women who are awaiting trial in the Baltimore City Detention Center. The focus of the worker will be to identify women who have histories of mental illness, trauma and abuse who have not been linked to services. These women will be assessed for referral to the new psychiatric rehabilitation program (PRP) being developed by the North Baltimore Center (NBC). FAST and NBC are working with the outreach teams, Prisoner's Aid, You Are Not Alone (YANA), and the House of Ruth to improve the availability of appropriate services and continuity of care for this population.

B. Objective: Ensure that the goals of the CRI'99 initiative are met.

Strategies: 1. Implement and monitor the Census Reduction Program (CRI'99).

The Mental Hygiene Administration (MHA) changed the name of the Census Reduction Initiative (CRI) to the Community Enhancement Initiative (CEI) halfway into the project. Monitoring of the CEI'99 and CEI'00 was done in conjunction with MHA as this was a State wide initiative. BMHS configured Baltimore City's plan to assist moving persons out of general level Residential Rehabilitation Program (RRP) beds into the community and then converting the beds to intensive level to make them appropriate for patients from State hospitals. For those 38 individuals who were assisted in moving from RRP to the community, a monthly review of their status was performed by an Adult Services Coordinator. BMHS used monies from this project to assist 27 of these individuals with apartment start-up and rental subsidy which made the move possible. As of June 30, 2000 all of these individual were still living in the community receiving off-site PRP services and enhanced support services as needed.

2. Establish a regular procedure to monitor the CRI'99 initiative.

The goal of the CEI project, established between BMHS and MHA, was to assist a total of 70 patients to move out of Spring Grove, Springfield and Clifton T. Perkins Hospital Centers by the end of FY'00. The table below shows the outcomes of the initiative, both the projected goal and actual number are given. At the end of the fiscal year 64 patients were as a result of the initiative to a combination of RRP and Capitation Programs. There were six persons who were re-hospitalized during the course of the project. Although the final numbers were of the original goal, the initiative is continuing into FY'01. Due to variables such as patient resistance and lengthy transitions needed in response to long term institutionalization or forensic protocols, it was learned that to be successful, a project such as this needs a much larger pool of potential candidates than the number of patients targeted. This impacted the Capitation Programs' outcomes as they had fewer referrals than did the RRPs. A secondary goal achieved was the increase of intensive level RRP beds to the system. Furthermore, the initiative helped "kick start" the supported housing model whereby consumers are lease holders and services are brought to them. MHA continues to support BMHS' efforts in supplying ongoing subsidies to these consumers.

FY 2000 CEI OUTCOMES

	Spring Grove	Springfield	Perkins	TOTAL
Discharged to Residential Rehabilitation Programs	Goal - 18 Actual - 24	Goal - 15 Actual -17	Goal - 12 Actual - 6	Goal - 45 Actual - 47
Discharge to Capitation	Goal - 1 Actual - 2	Goal - 24 Actual - 15	Goal - 0 Actual - 0	Goal - 25 Actual - 17
Total Discharges per Hospital	Goal - 19 Actual - 26	Goal-39 Actual-32	Goal - 12 Actual - 6	Goal-70 Actual- 64

C. Objective: Continue to expand and monitor Baltimore Crisis Response, Inc. (BCRI) to ensure that at least 75% of referrals receive an assessment by BCRI staff.

Strategy: Identify the necessary funding for BCRI to expand its services so it can respond within one hour to 75% of referrals for mobile crisis services.

BMHS was able to increase BCRI's FY'00 funding by $345,000. This enabled BCRI to establish additional mobile crisis team coverage. BCRI met its goal of responding to 75% of the appropriate mobile crisis team referrals in one hour or less. In FY'00, BCRI received 2,367 referrals to mobile crisis services and had the capacity to respond to 1,969 of the requests. Therefore, only 398 (17%) could not be responded to because the arrival time was greater than one hour. The additional funding enabled BCRI to increase the mental health teams responses by 91%. The length of stay in the residential crisis beds continued to average four days.

At the present time BCRI is operating 12 crisis beds and has received authorization to increase to 15 beds. Finding a location for the residential component of the program has been a top priority for BCRI and CHA has been able to offer assistance. However, a suitable location has not been located.

The following is a summary of BCRI activities comparing '99 to '00:

Service	FY'99	FY'00	Increase
Hotline calls	8,390	8,637	3%
Mobile Crisis Responses	1,242	2,367	91%
Crisis Bed Utilization	742	704	5%

D. Objective: Implement the child and adolescent crisis system through the Baltimore Child and Adolescent Response System (B-CARS).

Strategies:

1. Ensure that B-CARS is providing services city-wide by November 1, 1999.

2. Implement the oversight committee consisting of BMHS, FLB, DSS, and family members to monitor the project.

The B-CARS program was implemented city-wide in November, 1999. The program received a total of 796 calls through June 30^th. Of those calls 416 children were deemed appropriate for BCARS services and were seen by the Mobile Treatment team. This number was below the projection. In addition the B-CARS consortium experienced problems in its administrative operations and in coordination between the several member agencies. As a result the consortium decided to consider forming B-CARS into a non-profit corporation to operate the crisis system. A plan is due to BMHS during the first quarter of FY'01. Several interesting patterns emerged over the year for both referral sources and peak referral times. These patterns are highlighted in the following tables.

The B-CARS Oversight Committee met in the 4^th quarter to review the programs progress and to identify strategies for increasing the referrals, particularly from DSS. A more detailed analysis of the year and proposed changes in the operations of BCARS will be presented to the Board in FY01.

E. Objective: Ensure that Project Hope has adequate funding to operate its consumer drop-in center.

Strategy: Obtain funding to enable Project Hope to operate by December 1, 1999.

BMHS was able to secure $50,000 to initiate Project HOPE and to purchase furnishings and infrastructure for this new consumer run drop-in center. In addition approval was received from OHS and HUD for a two year award of $497,587 beginning in July, 2000.

F. Objective: Work closely with transition clinics and the providers who have expressed concerns about their ability to continue to provide services

Strategy: Ensure that the outpatient clinic providers are operational in FY'00.

In FY'00, all Baltimore City Outpatient mental health clinics continued operations. However, the outpatient clinics had the greatest financial difficulty of any service in the public mental health system. In Baltimore City, the greatest financial difficulty was in the free-standing clinics such as North Baltimore Center and Harford-Belair. In March 2000, the Mental Hygiene Administration increased the rates for outpatient clinics by about 20%. This was helpful but many of the providers are still experiencing problems. Due to several factors including costs, complications of clinical presentations, a lack of available clinicians especially child psychiatrists, and the demand for child and adolescent services exceeding the system's current capacity. BMHS will be addressing these issues in FY'01.

G. Objective: Work with MHA's outpatient commitment to determine the feasibility of a pilot outpatient commitment project for Baltimore City.

Strategy: Actively participate in MHA's outpatient commitment committee.

BMHS was represented on MHA's outpatient commitment committee which was comprised of consumers, family members, providers and lawyers. The group's focused shifted from outpatient commitment to an effort to implement a system to encourage, through training and education, the use of advanced directives. In addition, the group advocated for increased funding for community-based services. A report was developed and submitted to the Maryland General Assembly.

Goal #4: Improve continuity of care.

A. Objective: Ensure that the Hands in Partnership (HIP) program developed in collaboration with the Downtown Partnership, is able to refer homeless individuals who have a mental illness to community based services.

Strategy: Increase the number of homeless individuals with a mental illness seen by a mental health provider as a result of the BMHS/Downtown Partnership's HIP initiative.

The Hands In Partnership initiative had a difficult year due to a change in leadership at the Downtown Partnership and at the DSS Homeless Unit. However, monthly meetings continued to occur with the programs present continuing to collaborate in their efforts to engage homeless persons and to assure that BCRI was notified in the event of a perceived crisis.

B. Objective: Implement a mental health initiative with Woodbourne and the Department of Juvenile Justice (DJJ).

Strategy: Monitor the pilot program with Woodbourne and Cheltenham to ensure that the appropriate services are being delivered.

The Woodbourne project experienced delays and set backs throughout the year. As a result, while services were provided in both Waxter and Cheltenham detention facilities, the level of service provision did not reach expected levels. The delays were due to a combination of a leadership change at Woodbourne, difficulties in recruiting staff and serious financial problems at Woodbourne. While the program began to address these difficulties Woodbourne's financial problems continued to hamper the program. In the fourth quarter, BMHS decided not to renew the contract with Woodbourne, and identify a new provider. The following chart summarizes the activities at Cheltenham Youth Facility and Waxter Children's Center.

Cheltenham Youth Facility

	Screened	Reduced Detention Stay	Individual Therapy Based on Screening	Individual Therapy By Request	Group Therapy Sessions
Totals	27	0	16	8	0

Waxter Childrens' Center

	Screened	Reduced Detention Stay	Individual Therapy Based on Screening	Individual Therapy By Request	Individual Therapy By Request
Totals	49	0	37	70	17

C. Objective: Expand residential services for individuals who are homeless and have a mental illness.

Strategy: Implement a feasibility study for the development of another Safe Haven.

During this year the Safe Haven was in high demand for individuals who have not been willing to accept housing or mental health services in any sustained manner. The census in Baltimore City's sole facility approached 100% each month and provided services to 77 homeless individuals with mental illness. Case management staff continuously listed the development of an additional safe haven as a priority. Identification of a location and funding remains major impediments.

Goal #5: Develop and maintain affordable housing.

A. Objective: Expand affordable housing opportunities.

Strategies: 1. Implement the HUD 811 project, Belair Manor, for six adults.

All documents needed by HUD to proceed to closing on the Belair Manor project were submitted by year's end. Several delays were encountered, including: difficulty in obtaining a building permit, receiving a commitment from DHMH for the use of Community Bond funds, loss of HUD's attorney working on the project and finding an appropriately zoned building to relocate On Our Own, a consumer-run drop-in center which had been housed at the Belair Manor site. By year's end CHA had identified a building for On Our Own, located at 6301 Harford Road.

2. Ensure that new 100 Section 8 Certificates are used appropriately.

BMHS Adult Services Division and CHA implemented a system for notifying and processing applicants for the 100 vouchers awarded through the Mainstream Program. By June 30, 2000 BMHS and CHA had interviewed, processed and referred 180 applicants to the Baltimore City Section 8 office.

3. Complete the development of the group home for eight adults with mental illness and functional disabilities who need 24 hour awake supervision services.

CHA was notified that its application to HUD under the Section 811 program for developing an 8-bed group home at the Glenmore Avenue property was approved. To expedite renovations, HUD agreed to allow CHA to purchase and renovate the property and then "sell" it to Glenmore Housing Associates, Inc. using Section 811 money. Finalized architectural plans are prepared and the bidding process will begin during FY'01.

4. Develop an additional 6-8 units in West Baltimore in collaboration with the Housing Authority (HAC).

CHA decided that the proposed project in partnership with the Housing Assistance Council (HAC) was not feasible. However, CHA began working with Historic East Baltimore Community Action (HEBCAC) to develop transitional and permanent housing which will include units for people with substance abuse problems and mental illness.

B. Objective: Identify additional funding sources for housing development.

Strategies: 1. Apply for additional projects through HUD 811.

CHA chose not to apply for the HUD Section 811 program this year due to continuance of two prior 811 projects currently in development.

2. Apply to HUD for 75 additional Section 8 Certificates.

CHA, in coordination with the Housing Authority of Baltimore City (HABC), applied for and was awarded an additional 75 Section 8 vouchers through the Mainstream Program for People with Disabilities, bringing the total number of certificates/vouchers to 400. CHA also applied for two additional grants, one in coordination with the HABC, and one in coordination with BMHS, BSAS and AIRS. Each application was for seventy five vouchers.

3. Apply to the Department of Health and Mental Hygiene's Community Bond program.

CHA did not apply for funds from the Community Bond program since it is currently developing five projects.

CHA met with staff from the Office of Planning regarding the housing needs of people in the Baltimore public mental health system. A report from BMHS and CHA was written for inclusion in the Baltimore City Consolidated Plan.

Other CHA Activities:

By the end of the year, CHA has made available over 630 affordable housing units for individuals with mental illness. The Maryland Affordable Housing Trust (MAHT) awarded $85,000 for renovations at the Glenmore Avenue property. MAHT also honored CHA as a model agency at its Annual Awards Ceremony.

In response to the Housing Needs Assessment conducted by TAC, CHA began focusing on strengthening its operating capacity. Specific actions taken during FY'00 include:

* Requesting and receiving an annual increase of $80,000 in grant from BMHS to hire an Operations Director and provide funds to offset the loss created by the Shelter Plus Care (S+C) project.

* Hiring a Master's level person, part-time, to manage day-to-day operations of CHA including the oversight of the 171 S +C units for which CHA is the sponsor as well as the 76 units owned by CHA.

* Identifying a new site to move CHA offices, which will provide a more visible separation of housing from services (BMHS).

* Hiring a consultant with financial and housing expertise to pursue a work-out plan between the Enterprise Social Investment Corporation (ESIC) and the Maryland Department of Housing and Community Development with regards to CHA Limited Partnership I.

* Purchasing a property management computer program to improve tracking of the maintenance of CHA units, tenants and rental payments.

Goal #6: Establish and maintain sound financial management practices.

A. Objective: Establish the appropriate accounting records to meet external funding source requirements.

Strategy: Ensure that BMHS is meeting all financial requirements required in the Memorandum of Understanding (MOU) with MHA.

BMHS operates with an accounting system that meets the generally accepted accounting principles. An annual single audit was performed according to the state compliance requirements and the A-133 requirements for federal funds. All funds awarded under the state contracts were subject to the provisions of the Department of Health and Mental Hygiene (DHMH) Human Services Agreements Manual. The latest auditor's report for FY'99 expressed an unqualified opinion on the consolidated financial statements of BMHS and subsidiaries. The accounting software was upgraded for greater efficiency and flexibility.

In accordance with the terms of the Memorandum of Understanding (MOU) with MHA, all funds awarded under the state block grant were subject to the provisions of the DHMH Human Services Agreements manual. BMHS adhered to the provisions of the manual, as well as to the additional conditions which were written specifically for each vendor contract. The vendor contract special conditions were integrated as requirements in our vendor contracts, as well as performance reports.

B. Objective: Monitor the expenditures through the fee for service system.

Strategy: Utilize the electronic monitoring program to monitor the fee for service payments.

In FY 2000, the Mental Hygiene Administration made a policy decision to remove the Fee for Services (FFS) funds from the Core Service Agencies budgets and therefore, Baltimore Mental Health Systems, Inc. had no fiscal responsibility for handling the cash payments for FFS claims in FY'00. A reconciliation report was required of BMHS for the FFS funds handled in FY'99. The FY'99 funds received and disbursed were reconciled and a final report closing BMHS' special bank account for FFS activities was issued to MHA (with a zero balance) on September 9, 1999.

BMHS developed a plan to oversee the payment data by Maryland Health Partners (MHP) to the vendors for appropriateness of payment, e.g., overpayments and duplicate payments, etc., even though MHA has the primary oversight responsibility. However, there were problems in procuring data from MHP and therefore BMHS could not monitor the data. We are aware that MHP has undergone its own internal audit of this data. It is expected that up-to-date data will be available to BMHS to review and monitor in the Fall of 2000. A report will be issued on the findings.

Other Financial:

In FY'00 BMHS managed 228 contracts totaling $20,765,585 (see Appendix 3).

Goal #7: Develop and implement a comprehensive quality improvement (QI) program

A. Objective: Ensure that the Program Improvement Plan (PIP) for the adult capitation program is implemented.

Strategy: BMHS' Medical Director to meet quarterly with the programs to monitor the PIP.

BMHS implemented the PIP during fiscal year 1999, and its medical director met with each program on a monthly basis, and with both programs together on a quarterly basis. During these meetings, issues such as housing, high risk members, and programmatic themes were discussed. In addition, the Medical Director monitored the programs with weekly reports on members considered to be at high risk for medical or psychiatric complications. Monthly reports were also monitored, and yearly site visits were completed in conjunction with the quality assurance team. An education program was presented on substance abuse issues in mentally ill adults, and a quality assurance plan was implemented with special attention focused on documentation of interventions on substance abuse, violence to self and others, housing, and education of staff and assisted living providers. By June 30, 2000 the programs had a total enrollment of 261, an increase of 43 from enrollment of 218 on June 30, 1999. MHA has approved the expansion of the program beyond the 300 client capacity which has been in place since the program's inception.

The quality improvement plan was revised and implemented. Improvements were noted in submission of monthly data reports. Program Directors submitted detailed information to BMHS on a regular basis on high risk clients. The Medical Director followed up with program staff as needed and kept BMHS up to date on issues. Site visits were planned and conducted at Creative Alternatives. We found that medical records supported that care and services were provided consistent with the high risk reports received weekly. A site visit will was rescheduled at the request of Chesapeake Connections due to some administrative changes occurring at the time BMHS planned the visit.

B. Objective: Develop the structure to monitor the child and adolescent crisis system. (B-CARS).

Strategies: 1. Implement the oversight committee and ensure that it meets on a regular basis.

2. Monitor quarterly reports on program utilization.

The B-CARS Oversight Committee was established and convened in August. The Oversight Committee met during the fourth quarter to review the program progress and to address the concerns of low referrals and administrative organizational issues. The Committee recommended to that the B-CARS administrative team hire a facilitator to assist in the process of forming a corporation between multiple agencies.

B-CARS submitted monthly reports to BMHS' Director of Child and Adolescent Services. The reports were reviewed and used in our monitoring of the project. A summary of B-CARS activities are contained in Goal #3 D.

C. Objective: Provide orientation about the public mental health system and BMHS to all newly licensed providers under COMAR.

Strategies: 1. Develop a manual on the BMHS' role in the public mental health system.

The Director of Q I and Operations developed an orientation for new providers and used this information when meeting with new applicants.

2. Monitor the number of newly licensed providers under COMAR and ensure that all receive information on the system from BMHS.

This objective was met. Q I staff provided all new applicants with information about BMHS and public mental health system. The division plans to provide a formal group presentation in the Fall (see Appendices 4-5).

D. Objective: Develop the structure to monitor the FY'99 Census Reduction Program. (CRI'99).

Strategy: Establish a regular process that includes BMHS staff and providers to ensure that the goals of the initiative are met.

This has been covered in 3B.

E. Objective: Continue to monitor all contracts including site visits.

Strategies: 1. Maintain a regular BMHS meeting that oversees the contract process.

This goal was met. Staff with responsibilities for managing contracts met on a regular basis throughout the fiscal year.

2. Ensure that all contracts are mailed out and returned in a timely fashion.

This goal was partially met. All of the contracts were completed by the end of the fiscal year but only 16 contracts had been completed by the end of December 1999. The delays were caused by late notification to BMHS by MHA of the FY'00 conditions. The Director of QI met with division directors on a regular basis and reported the status of contract completion. This process will be closely monitored in FY'01(see Appendix 6). By June 30, 2000, BMHS staff had mailed out the majority of its FY'01 contracts.

3. Monitor all contracts to ensure that conditions and reporting requirements are met

This objective was partially met. Vendor contract committee met on a regular basis to monitor performance of vendors. Specific concerns with individual vendors were discussed either at committee or management team and the BMHS division directors were responsible for taking corrective action. There is the need for improvement of the contract monitoring database. This will occur in FY'01.

4. Conduct site visits for specified providers not operating under the auspices of Licensing and Certification.

This goal was partially met. Quality Improvement staff conducted site visits to only four programs. This was the first time BMHS conducted visits to evaluate compliance with the conditions of the contract in three out of the four vendors seen during the year. Other visits are scheduled. Steps will be taken to increase the sample of vendors site visited (see Appendix 7).

5. Participate in the Licensing and Certification site visits of providers licensed under COMAR.

This goal was partially met. BMHs participated in 94% of site visits(see Appendices 8-9 ).

See Appendices 10-12 for additional QI activities.

Goal #8: Develop and provide training.

A. Objective: Continue to provide training to mental health providers, family members, and consumers.

Strategies: 1. Offer training to new providers on the public mental health system.

BMHS QI staff met all providers who made application to deliver services through the PMHS in Baltimore City.

2. Provide at least two city-wide trainings on mental health issues.

This goal was met (see Appendix 13) and the following describes selected training highlights.

During the 2^nd Quarter, BMHS sponsored a bi-yearly training meeting for all school-based mental health clinicians, which was attended by approximately 60 clinicians. The agenda included information on developing Community Prevention and Support activities in schools and the process of applying to BMHS for pre-approval, as well as a presentation about B-CARS (Baltimore Child and Adolescent Response Service).

During FY 2000, BMHS conducted three training session for all school-based mental health clinicians. Topics included Prevention Activities in Schools-Community Prevention & Support and Documentation of Other Non-reimbursable Prevention Activities; B-CARS presentation; Community Mediation and Conflict Resolution; Coping With Reimbursement & Documentation Requirements-Front Line Perspective on Making It Work; Network Against Domestic Violence presentation on Dating Violence and The Impact of Domestic Violence on Children.

BMHS and BSAS co-sponsored a training on integrated mental health and substance abuse treatment. The trainings were in two three-day segments and were attended by over 200 individuals representing 50 agencies.

During the year the C&A staff presented and trained Baltimore City state and national audiences on the Baltimore public mental health system and on children's mental health issues. Presentations topics included: Community Prevention and Support activities in schools; Prevention and early intervention; B-CARS (Baltimore Child and Adolescent Response Service); accessing the public mental health system; the impacts of violence on children; cultural competency; collaboration and systems of care.

The QI division conducted a medical records documentation training which was attended by 90 individuals.

3. Provide training to room and board providers and mental health providers on the new assisted living regulations.

The plan to provide training to Assisted Living providers proved to be an unrealistic expectation. At year end only 32 of 2000 former board and care/domicillary homes had been licensed by the Office of Health Care Quality. Efforts with the mental health network have been limited to assisting and supporting providers through the complaint process when they are working with clients who are living in substandard homes. BMHS has worked with two individual assisted living providers who are providing care for Community Enhancement Initiative clients. Behavior management and improved communication with the mental health team were the focus of our interventions on behalf of the clients.

4. Work with the Training Division of the Baltimore City Police Department (BCPD) to provide mental health training at all levels.

BMHS through its collaboration with the BCPD arranged for the Child Development Community Policing Program (CDCP) to provide training to cadets at the BPD Police academy. Training will begin in early FY01 and will continue throughout the year. Training focused on the traumatic impact of violence on children and families.

BMHS collaborated with the Baltimore City Police Academy to assure that for each new class of recruits receives training on mental illness, services available in Baltimore City and the utilization of the emergency evaluation procedure. The training is provided in one four (4) hour class by staff from the Medical Office of the Circuit Court and its FAST (Forensic Alternative Services Team) program and Baltimore Crisis Response, Inc.

Goal #9: Other Accomplishments

1. Welcome House:

In the the spring of FY'99, BMHS working closely with Baltimore City Health Department, with the Department of Housing and Community Development and the local Department of Social Services was able to relocate 26 individuals many of whom had lived at the facility for more than five years, with serious psychiatric disabilities who were living in a substandard board and care home. Six months after the closing of the home, a follow-up review was conducted. A summary of the Welcome House follow-up is attached as Appendix 14.

2. Geriatric Mobile Outreach and Psychiatric Treatment:

Baltimore City has two Geriatric Mobile Outreach mental health programs, Psychogeriatric Assessment and Treatment in City Housing (PATCH) at Johns Hopkins and Johns Hopkins Bayview and Senior Outreach Services (SOS) at University of Maryland.

PATCH is a program that has been in operation since September 1987 and currently provides in-home psychiatric assessment and treatment in all 17 Baltimore City public housing sites for the elderly. There are two teams, each consisting of a nurse and a part time geropsychiatrist. One team is based out of Johns Hopkins Hospital, the other is based out of Johns Hopkins Bayview. In addition to providing mental health treatment PATCH offers in-service training for housing authority staff and mental health educational programs for tenants.

During FY '00 there were:

99 new referrals, 33 of whom refused treatment

1548 follow-up visits

4 persons were successfully transitioned to traditional outpatient clinic services

48 clients remain in active treatment at year-end

Referrals made to 19 other community based services for the elderly

5 in-service trainings were held

Sixty two percent of PATCH clients were diagnosed with dementia, with a concurrent diagnosis of a mental illness. 14% of clients had a long history of serious and persistent mental illness. 19% of clients were first diagnosed after age 60.

The other Baltimore City mobile outreach service for the elderly is SOS ( Senior Outreach Services--a Mental Health Service), which operates out of University of Maryland Medical System. The team consists of a full time nurse, psychologist, and a part time nurse and a geropsychiatrist. They are currently available to provide assessment and in-home psychiatric treatment to any elderly Baltimore City resident living in the community, but not in public housing. Referrals to SOS came primarily from other Baltimore City agencies serving the elderly: Commission on Aging, Adult Protective Services, Geriatric Evaluation Services and Baltimore Mental Health Systems) and from within the UMMS hospital system. They have been in operation since 3/96. During FY '00 there were:

Evaluations completed on 213 elderly clients, a 69% increase over FY'99

86 remained in active treatment at year-end, a 68% increase

65% of those assessed were greater than 70 years of age

20% were unable to perform at least one Activity of Daily Living

34% needed assistance with cooking, cleaning or other Instrumental Activity of Daily Living

25% were completely dependent for assistance with IADL's

Most prevalent diagnoses were depression (31%), dementia, with concurrent mental

health diagnosis (34%), schizophrenia and delusional disorders (18%), depression with dementia (8%) and bipolar (5%). Of these clients, 77% had not been diagnosed previously.

At the end of FY'99 the program was operating at capacity with a short waiting list. This continued throughout FY'00. There was a 3-4 week period before any of these individuals could been seen in the home.

The literature indicates that elderly clients are reluctant to accept services in traditional outpatient mental health clinic settings. As a condition of their grant, SOS agreed to make serious efforts to transition clients into more cost effective clinic services. Clients who did transition into clinic services were seen by the same therapy team that served them in the community--a bridge that appears to have been successful. 38% of clients were transitioned into traditional out-patient clinic services. Of the 62% who continued to receive services in their homes: 32% could come to clinic if reliable transportation were available; 3% were too newly engaged in services to transfer and 65% are not expected to transition to clinic services (54% due to somatic problems/ 46% due to psychiatric problems).

3. Ageless Learning - an Educational Series for Seniors:

Based on a FY'99 Senior Center survey, BMHS funded a six month start-up project with one time only funds in FY2000 to offer outreach and a series of educational presentations in Baltimore City's Senior Centers and other senior service sites. The Mental Health Association of Metropolitan Baltimore (MHAM-MB), through its PEERS project was selected to provide this service in Baltimore City. Funding for the project was not available until February 25, 2000 so the project was only operational for four months. A mental health educator was hired part time to give the presentations.

The presentations subject matter addressed issues such as depression, anxiety, substance abuse and the stigma attached to having a mental health problem. Topic titles included: Cool Down, How to Cope with and Deal with Anger; Senior Power, How to Get along Better in Community Settings; Laughter Is Good Medicine; When the World Is Asleep and You're Awake; Successful Aging and How to Handle Everyday Stress.

Brochures were developed and distributed to potential program sites. In addition BMHS and the educators attended a senior center directors' meeting to explain the project

The Ageless Learning project exceeded the goals established for FY2000. There were 20 presentations in 12 of Baltimore City's 14 Senior Centers and in several senior apartment buildings. They exceeded the goal of reaching 250 seniors by 200 individuals as 400 individuals attended the training. There were requests for many more presentations than they could offer and the senior center directors have requested the continuation of the program.

BMHS plans to link the Ageless Learning project with an Outpatient Mental Health Clinic in FY 2001. This will enable the project to be funded through Community Support and Education funds as one of the MHP funded services. The current mental health educator will continue with the project on a part time basis.

4. Elderly and Depression:

Dr. Annelle Primm and the Mental Health Association of Metropolitan Baltimore worked collaboratively on a project to develop a film for consumers about depression and the elderly. The plan included demonstrations in several senior apartment buildings, showing the film to management and residents and completing a depression screening for those individuals participating. This phase of the project may not be feasible without the mobile outreach capacity to serve those individuals found to be at risk.

5. Supported Employment Programs:

In the three years since the inception of the Fee For Service (FFS) system, Psychiatric Rehabilitation Programs with vocational services have been serving an increasing number of consumers in Supported Employment Programs (SEP).

BMHS worked with the eight SEPs in Baltimore City. The total number of persons working with job coaching from SEP programs in FY'00 is 103. The number of authorizations given and persons working has increased in each of the last three years.

6. Residential Treatment Center Placements:

BMHS' C&A Resource Coordinator continued to chair the Local Coordinating Committee (LCC). The LCC is the multi-agency committee that reviews and approves all requests for Residential Treatment Center (RTC) placements. Site visits and reviews of all Baltimore City children who are in RTC placements throughout the state were completed. The site visits revealed that approximately 30% of the children currently residing in RTC's could be returned to the community if adequate resources existed, and discharge planning was initiated.

The following chart lists the RTC's that have admitted Baltimore City youngsters and the responsible agency.

RTC	Total	BMHS	DSS	DJJ	LEA
Villa (12 and under)	34	4	29	0	1
RICA	12	5	6	0	1
Fairbridge	17	5	8	4	0
Good Shepard	4		1	3
New Dimensions (TAMAR) DJJ only	9	0	0	9	0
Taylor Manor (Lisa L. only)	5	0	5	0	0
Focus Point	5	1	4	0	0
Woodbourne	15	0	10	4	1
Edgemeade	10	0	4	5	1
Chesapeake	5	0	4	1	0
Jefferson	1	0	1	0	0
Mann	11	0	10	1	0
TOTAL	128	15	82	27	4

7. Employee Satisfaction Survey:

Quality Improvement staff conducted BMHS' first employee satisfaction survey. The survey focused on the level of satisfaction of employees in various areas of the work environment. Highlights of the results of the survey are in included in Appendix 15. The findings of the survey were distributed and discussed with staff and the Board of Directors. A project improvement team was established with membership from all of BMHS' divisions.