Baltimore Mental Health Systems, Inc. (BMHS) http://www.bmhsi.org

Annual Report

Fiscal Year 2001

July 1, 2000 to June 30, 2001

TABLE OF CONTENTS

PREFACE

GOAL #1: Maintain and improve collaboration with key stakeholders

GOAL #2: Continue efforts to improve the planning process to ensure it is consistent with the vision, mission and values of Baltimore Mental Health Systems

GOAL #3: Expand and maintain the range of services

GOAL #4: Develop and maintain affordable housing

GOAL #5: Establish and maintain sound financial management policies 24

GOAL #6: Develop and implement a comprehensive quality improvement program

GOAL #7: Develop and provide training 31

GOAL #8: Other accomplishments and issues 34

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. The Baltimore City provider community has done a tremendous job in serving its population while dealing with complex administrative requirements, inadequate rates for some services, and, difficulties in attracting and retaining staff . BMHS recognizes the challenges that providers have met and is appreciative and grateful for their contributions. BMHS also values its relationship with the Mental Hygiene Administration (MHA) whose support and funding has made it possible for BMHS to carry out its mission.

These combined efforts have produced many successes during the year:

Established a dual diagnosis initiative in six settings for individuals with cooccurring mental health and substance abuse disorders. This initiative was developed in partnership with Baltimore Substance Abuse Systems, Inc. (BSAS) and is primarily funded by the Open Society Institute (OSI).

Relocated the Safe Haven to a much improved setting. The Safe Haven serves twenty homeless individuals who have a mental illness and is operated by the University of Maryland's Department of Psychiatry.

Reconfigured the Baltimore Child and Adolescent Response System (B-CARS) to ensure greater access to crisis services for children, adolescents and their families.

Established mental health services in six Head Start centers.

Developed a new service for Age Youth (TAY).

Expanded affordable housing opportunities created by Community Housing Associates, Inc. (CHA).

Expanded efforts in serving youth and adults in the Department of Juvenile Justice (DJJ) and the Department of Corrections (DOC).

Continued successful transition into the community of individuals leaving state hospitals through the Census Enhancement Initiative (CEI), Capitation project and a new initiative to transition individuals being released from Patuxent.

Improved BMHS' internal contract monitoring.

Developed and submitted a proposal for a child and adolescent partial capitation program.

Received national recognition for the Adult Capitation Program which was selected for an honorable mention from the Thomas M. Wernert Award for Innovation in Community Behavioral Healthcare.

During fiscal year 2001 (July 1, 2000 to June 30, 2001) 24,912 Baltimore City residents received services through the Public Mental Health System (PMHS), as reflected in the Maryland Health Partners (MHP) data system through June 30, 2001. The utilization of the Public Mental Health System for Baltimore City residents has been consistent over the past three years. The chart below depicts the utilization of the PMHS by Baltimore City residents. We expect the FY'01 numbers to increase, as providers have nine months from the date of service to submit FY'01 claims.

Category	FY'99 Number and Percent (Based on claims through 6/30/01)	FY'00 Number and Percent (Based on claims through 6/30/01)	FY'01 Number and Percent (Based on claims through 6/30/01)
Medicaid recipients in the waiver	19,213 (80%)	19,868 (79%)	19,675 (79%)
Gray zone (uninsured) individuals	3,185 (13%)	3,576 (14%)	3,434(14%)
Medicaid individuals not waiver eligible	1,659 ( 7%)	1,834 ( 7%)	1,803(7%)
TOTAL	24,057	25,396	24,912

Of the 24,912 individuals receiving at least one service in FY'01, 23,361 (94%) received the service from an outpatient mental health clinic. Approximately 9,800 individuals received more than one service from the PMHS and almost 50% of the additional services were rendered by a Psychiatric Rehabilitation Program (PRP). This is expected as PRPs provides a range of important community support services to individuals with serious mental illness (SMI).

The next section of this report describes the extent to which BMHS achieved the goals set for FY'01.

GOAL #1: Maintain and improve collaborations with key stakeholders.

A. Objective: Ensure that providers, consumers, and family members have an opportunity to have necessary information and input into the public mental system.

Maintaining and improving our collaborative relationships was a priority for BMHS. During this past fiscal year we continued our quarterly meetings with providers, and staff have been very active in working with other agencies, family and consumer groups and providers. BMHS surveyed its provider network to assess the value of the quarterly provider meeting. Most respondents agreed that they are valuable and a few procedural recommendations were made. Their recommendations were incorporated into the meeting structure.

ADULT SERVICES

Intensive Case Management Providers

Meetings were held bimonthly with the seven Intensive Case Management programs providing services in Baltimore City. The lack of adequate reimbursement rates have led to (1) an increase in caseload size (2) a lack of transportation for case managers and clients, and (3) significant difficulty in hiring and retaining credentialed staff. The availability of BMHS's Housing and Urban Development (HUD) supportive services grants to four of the programs has allowed them to offset the problem caused by the inadequate reimbursement rate.

Residential Rehabilitation Program (RRP) Providers

Meetings were held bimonthly throughout the year. A new referral process was developed to improve the ability of the Core Service Agencies (CSA) to manage referrals. This new process established the role and responsibility of BMHS to review all applications for RRP services by Baltimore City residents. The active review of referrals by BMHS staff has improved the acceptance rate by providers of the applicants referred to them and the providers have maintained a 90% or higher occupancy rate overall.

A request to increase the number of intensive level beds was approved by MHA. The beds were designated for persons identified by Springfield Hospital Center as ready for community placement. This new RRP initiative, known as Community Enhancement Initiative 01 was awarded through an RFP to three providers. The allocation of RRP beds to providers is shown in the following table.

PROGRAMS	6/30/00 BEDS	6/30/01 BEDS	CEI Intensive	SRO	TOTAL
HCU	21 Intensive 26 General	21 Intensive 26 General			47
Young Adult	6 Intensive	6 Intensive			6
New Phases	23 Intensive	23 Intensive			23
PEP	6 Intensive 33 General	6 Intensive 33 General			39
Deaf	6 Intensive 2 General	6 Intensive 2 General			8
Forensic	4 Intensive	4 Intensive			4
Ascension Home	20 Intensive	20 Intensive			20
NBC	34 General	34 General			34
Alliance	8 Intensive 34 General	16 Intensive 22 General			38
HB	14 Intensive 20 General	14 Intensive 19 General	6	6	45
Forensic	6 Intensive	6 Intensive			6
KP	14 Intensive 32 General	14 Intensive 32 General	3		49
VOA	16 Intensive 6 General	16 Intensive 6 General	6		28
TOTAL # BEDS	144 Intensive 187 General	152 Intensive 174 General	15	6	347

There was an increase of 16 State funded beds operated by RRP providers in FY'01.

Forensic Services

A significant change occurred in BMHS's design for collaboration for services and coordination in Forensic Services. In August , 2000 a combined meeting of a number of specialized groups was created and moved to Civil District Court to facilitate attendance of court officials including Judges, States' Attorneys and Public Defenders. Other interested groups in attendance included jail personnel, representatives of State Hospital Centers, BSAS, the Forensic Alternative Services Team (FAST) and community service providers. An ongoing agenda to share information and to problem solve was established. The meetings maintained their focus on the pre-trial processes.

The Adult Services Division worked with consumers and providers to identify the need to improve services for women, especially those who have experienced trauma. This gap led to the establishment of the Women in Need Group which met monthly to review services and care for women in the criminal justice and community mental health system.

Chemical Weapons Improvement Response Plan

A staff member of the Adult Services Division continued to chair the Mental Health Sub-committee of the Baltimore City Health Department's Chemical Weapons Improvement Response Plan Committee known as the Domestic Preparedness Team. This consisted of attending 10 chemical planning meetings organizing and implementing a training for those who had previously completed a two-day training held in April. The training exercise was reviewed and a new mental health response process was added to the Weapons of Mass Destruction Mass Casualty Plan.

Focus Groups

The Adult Services staff of BMHS conducted a series of focus group meetings in the first part of FY'01. The purpose was to identify the community's thoughts and ideas regarding needs, gaps and possible solutions to their identified concerns. Areas in which the community believes the public mental health system works well in Baltimore City were also discussed. There were four meetings held. A total of 332 participated in the four focus groups. All meetings followed the same format. The results showed that there is a similarity between the suggestions made by the provider group and those from the consumer groups. For example, consumers were concerned about staff salaries, retention and training. There was agreement that the PMHS was working well, especially the continuum of housing options, the range of service options, and the level of care.

Among the items identified as having changed over the past three years was, that the providers listen more, the consumers agreed that they have an increased opportunity to develop goals and to have the clinicians hear them around treatment issues. All groups agreed foremost that housing stock and location were of primary concern. Specifically that housing needs to be quickly available to meet demand, and it needs to be located in safe, decent neighborhoods. Additionally, participants stated that financial stability, good mental health and somatic care provided by well trained committed staff were very important. In addition to increased funding, participants want a system clearly collaborative and standardized in its operation across agencies. Ideally it would also be a system that provides immediate access to services, housing, and entitlements.

CHILD AND ADOLESCENT SERVICES

The Child and Adolescent (C&A) Division staff continued its meetings with child and adolescent mental health providers. There were monthly meetings open to all providers delivering services to children and adolescents. Regular meetings with the community and school-based mental health providers to share information, highlight key issues, and maximize the utilization of the fee-for-service system were held.

As part of the Safe Schools/Healthy Students Initiative (SS/HS) a committee of School-Based Mental Health providers was convened to develop SS/HS Mental Health Services Continuum document describing the range of services from prevention to treatment provided in a school-based setting.

Additionally, there were regular meetings with representatives from Office of Employment Development and the Mental Health Clinicians participating in the FUTURES programs.

Head Start

Based on the need to develop additional early childhood activities, BMHS received new funding from MHA in FY'01 to provide start up funds for Mental Health Clinicians in six Head Start Programs in Baltimore City. A portion of the grant was utilized for the development and implementation of a training curriculum in Early Childhood Development and Mental Health. The following Head Start programs were identified to participate in the project: Emily Price Jones, Herring Run, Metro Delta, Morgan State University, SECO, and Umoja Head Start Programs. Each Director was asked to select one site where the clinician would be placed.

A Request for Proposals (RFP) for the project was distributed to mental health providers Three providers responded A selection committee, with representatives from BMHS and Head Start, met in January 2001 and selected Villa Maria and Johns Hopkins Bayview Medical Center as the two providers for the project.

Finally, a committee of local experts in Early Childhood Development and Mental Health was convened to develop the Early Childhood curriculum for the mental health clinicians working in Head Start. This group met several times between April and June 2001. An outline of the planned curriculum was developed, training dates were established, and trainers were selected.

Juvenile Justice

C&A staff met throughout the year with Judges and staff from the Baltimore City Juvenile Court to develop a court-based services system to link identified children with mental health services. Final plans were developed and funding strategies agreed upon. The program is scheduled to begin operation in FY'02.

RTC Site Visits

All twelve instate Residential Treatment Centers (RTC) sites were visited quarterly by BMHS' Resource Coordinator. The purpose of the site visits was to assess the progress and discharge plans of their Baltimore City clients. During FY'01 there were 119 Baltimore City youngsters residing in this high level of care. Each site visit involved an interview of the child's therapist and review of the treatment plan. The BMHS Resource Coordinator identified mental health aftercare services, residential resources, and critical linkages to other child serving agencies. Clients that were ready for discharge or had remained at one program for more than two years were referred to the Local Coordinating Council (LCC) for review of care and consultation with the lead (placing) agency. Based on the BMHS' staff review, it was felt that approximately 30% of the youngsters did not need an RTC level of care if the right education and flexible community services plan was in place. The proposed child and adolescent partial capitation program will hopefully provide the needed flexible community services.

QUALITY IMPROVEMENT/OPERATIONS

The Quality Improvement/Operations division assumed responsibility for inspecting the residential rehabilitation programs and therapeutic group homes in Baltimore City at the beginning the fiscal year. Written policies and procedures were established. The consumer satisfaction survey was revised to include questions related to cultural needs.

For the first time, we began tracking the number of residential units that are wheelchair accessible. Unfortunately, we found only one unit in the City. This is a residence managed by People Encouraging People. Quality Improvement staff inspected 100% (161) of the residential units approved under COMAR 10.21. 22. Staff interview 100 (1/3 of consumers) of consumers living in the housing unit. Overall, the physical condition of the units was good. There were minor deficiencies found. A summary of the inspection results is shown in the following table.

B. Objective: Meet with the Mental Hygiene Administration (MHA) and Maryland Health Partners (MHP) to address issues of concern to the public mental health system.

BMHS staff regularly attended the monthly MACSA, MHA clinical committee meetings. BMHS staff served on over 25 committees that were involved with coordinating the local mental health system as well as the PMHS. BMHS continually met with providers, MHP and MHA to attempt to resolve administrative and billing issues of the PMHS.

C. Objective: Collaborate with local, state, and federal agencies on joint initiatives, programs and policies impacting on the mental health needs of Baltimore City.

ADULT SERVICES

This fiscal year BMHS, in cooperation with BSAS, received a grant from OSI to improve services for adults who are dually diagnosed with co-occurring mental illness and substance abuse or dependence. BMHS and BSAS contributed $40,000 each per year per agency for a two year grant for three mental health agencies and three substance abuse agencies, and OSI will contribute a total of $310,000 over the two year period. Requests for proposals were disseminated in November 2000, and a pre-bidders meeting was held in December 2000. Proposals were received from four mental health agencies and six substance abuse agencies. One proposal from a substance abuse agency was disqualified for being submitted after the deadline date, and a committee was convened to review the remaining proposals.

Five agencies were chosen: a joint award was given to Johns Hopkins Medical Center for their Community Psychiatry Program (CPP) and their Persons With Alcohol and Other Drug Dependencies (PAODD) program; Family Service Foundation received an award for their mental health program; Johns Hopkins Bayview Medical Center received an award for their Community Psychiatry program; Man Alive Research received an award for their Methadone Maintenance program; and University of Maryland received an award for their Drug Treatment program. Each program will receive a total of $35,000 over two years as incentive and start-up funds to be used for staff time and/or administrative costs of setting up billing in order to sustain the programs past the grant period. The joint award to Johns Hopkins will be for a total of $70,000 over two years since there are two clinical programs involved.

Homeless Services

The Adult Services Division responded to a request of its providers and the Office of Homeless Services to submit a proposal to HUD for a second Safe Haven to be developed.

During this year BMHS assumed responsibility for the administration of seven HUD- funded initiatives for services for homeless persons with mental illness. In prior years the City's Office of Homeless Services had awarded the grants to BMHS but retained the administrative responsibilities.

BMHS and Community Housing Associates (CHA) continued to operate the Shelter Plus Care program which provides rental assistance for 171 units. Services grants which include outreach and mobile services are provided by Bon Secours, Johns Hopkins, People Encouraging People and the North Baltimore Center. One additional outreach worker is funded at North Baltimore Center. These providers collaborate with other outreach workers and assist homeless individuals and families to obtain treatment and housing.

Project Hope, a consumer operated drop in center, was opened in East Baltimore.

The Safe Haven provides shelter and assistance in linking homeless people with psychiatric disabilities to mainstream resources. This is currently the only Safe Haven in the City and maintains close to 100% occupancy. The project was moved to a much improved facility in a church in Northeast Baltimore.

A grant submission by BMHS through the Baltimore City Health Department to the federal government was completed for the establishment of a mobile treatment team for forensic clients. If funded, the program, to be known as Forensic Alternative Services Treatment Team (FACTT) will be operated by People Encouraging People (PEP) in collaboration with FAST and the Department of Parole and Probation. The funding awards will be announced in the fall, 2001.

Homeless Persons Served During FY'01 Agency As of June 30,2000 # Entered Total Served People Encouraging People 47 23 70 SSI/UMMS 35 102 137 Safe Haven 20 41 61 Bon Secours 89 20 109 John Hopkins Hospital 78 23 101

GERIATRIC SERVICES

The Director of Geriatric Services represented the PMHS on the Baltimore City Interagency Aging Committee (IAC), chaired by the Commission on Aging. This is a unique activity for a CSA as in all other jurisdictions, the Health Department represents mental health concerns on the local IAC. In Baltimore City the Committee's primary activities have included:

Participation on Triad Committee, to improve collaboration between police and sheriff's departments, AARP, and providers in the Aging service network. This committee has collaborated with Adult Protective Services to offer specialized training for Emergency Medical services (EMT's) and some fire department staff. All Baltimore City EMT's will receive this training, as part of the Department's annual continuing education curriculum, in Sept. 2001.

The Clinical Subcommittee continued to review and plan for individuals who presented with complex problems that involve multiple agencies. Recommendations were made to the client's care provider team with one agency assuming lead responsibility. The committee met monthly.

Ten consultations were provided to the Guardianship and Case Management units at the Commission on Aging.

Our Director of Geriatric Services was appointed as a member of the steering committee of the National Association of Social Workers' Section on Aging.

Mobile Outreach Mental Health Programs to seniors continued to be much in demand. Psycho geriatric Assessment and Treatment in City Housing provided in-home psychiatric assessment, treatment and medication management in all Baltimore City public housing sites for the elderly. During this fiscal year there were 114 new referrals. The other Baltimore City mobile outreach service for the elderly Senior Outreach Services is at University of Maryland. 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 other agencies, individuals in the community or families. Less than 1% of clients have self-referred. During this fiscal year there were 74 new referrals with a waiting list of 3 weeks or more.

Both of these programs are supported through BMHS with state grant funding. BMHS identified the need to expand this service through our monitoring of the waiting list for services. The programs submitted a joint proposal for expansion and BMHS was successful in obtaining some additional funding for mobile outreach in FY'02. BMHS was in ongoing discussions with policy makers, advocates and providers to explore effective ways in which to provide geriatric mobile mental health services for this Medicare population through the fee for service structure or as part of a new or revised Medicaid waiver.

Following a model developed by MHA using psycho geriatric nurse consultants to assist in the placement of elderly individuals in need of skilled nursing care from State Hospitals into nursing homes, a Psycho geriatric nurse consultant was retained by BMHS. In this role the nurse provided case consultation and training for staff of community programs, assisted living settings and nursing homes. Service in Baltimore City had expanded to include consultations to three acute care hospitals with geriatric in-patient units, and 3 Adult Medical Day Care settings. Adult Services continued to use special consultations to assist in planning for difficult to place elderly individuals who might otherwise be admitted to a State Hospital.

CHILD AND ADOLESCENT SERVICES

The C&A staff continued to meet with and serve on the Family League of Baltimore City board and subcommittees throughout the year. BMHS also participated as a member of the City Team in negotiations with the Governor's's Office of Children Youth and Families to develop a "Community Partnership" agreement that will provide state dollars in FY02 to strengthen and expand the array of services and opportunities for city children.

In the third quarter, C&A staff began meeting with the Mayor's Office of Children Youth and Families to offer support and collaboration in the development of the Mayor's Baltimore Rising initiative.

C&A staff continued to serve on the Lieutenant Governor's sub-committee on Juvenile Justice Aftercare.

Throughout FY2001, BMHS continued to collaborate with the Baltimore City Public School System and other agencies in the implementation of school-based services. Through the partnership between BCPSS, BMHS and twelve community-based mental health agencies, school mental health services are available to students in regular education in eighty-one Baltimore City Public Schools. These services address underlying emotional and behavioral concerns, thereby enabling students to participate in academic instruction. A full description of the school-based services are included as Attachment #1.

In FY'01, billing for Public Mental Health System (PMHS) services became the responsibility of the individual provider. This replaced a cumbersome centralized billing system which had been the responsibility of BCPSS. As a result of a year long collaborative process with the FLBC and BCPSS the city will be one of 6 regions awarded additional funding for school-based mental health. Provider's will be selected in the first quarter of FY02. In addition BMHS will serve on the Technical Assistance Oversight Committee, established by MHA to provide Statewide technical assistance to the newly selected sites.

In FY'01 C&A suspended meetings of the oversight committee for Baltimore Child and Adolescent Response System, Inc. (B-CARS). This was due to the decision for B-CARS to reorganize its corporate structure. This process took most of the fiscal year and the revision has Villa Maria as the sole contractor. Villa sub-contracted the Medical Director responsibility to Johns Hopkins Department of Psychiatry, crisis residential beds to Woodbourne and BCRI continued to operate the 24-hour hotline.

Beginning in the fourth quarter the BMHS Board of Directors created a Child and Adolescent Subcommittee. The Committee will become active in FY'02 and will serve to provide oversight for Children's crisis and other services.

GOAL #2: Continue efforts to improve the planning process to ensure that it consistent with the vision, mission, and values of Baltimore Mental Health System.

A. Objective: BMHS' plan will meet all requirements and includes input from key stakeholders.

BMHS' Quality Improvement plan describes this process.

B. Objective: Develop a plan to better serve individuals who are either high cost users or not assessing consistent community based services.

ADULT SERVICES

During this year, the Adult Services Division initiated a plan to meet with each of its residential rehabilitation program providers to review the rehabilitation plans being developed for the residents. Adult high cost users are invariably residents of these programs. Therefore, during these reviews special attention was paid to the services that the high cost users were receiving. Four of the eight programs were reviewed. In most reviews the plan and service utilization of the consumer was found to be appropriate. At one program, a review of the level of care being requested by the program for its residents was requested. Two residents were found to no longer require Intensive Services. Their service authorization was reduced to General Level. We will continue this process for all providers.

CHILD AND ADOLESCENT SERVICES

BMHS and FLBC have developed a partial capitation proposal to serve 200 youngsters. The proposal was submitted to MHA. It has received a favorable response. BMHS will be continuing work on this in FY'02.

C. Objective: Based upon the housing needs assessment, develop a five-year plan to develop housing for people with mental illness in Baltimore City.

CHA staff had input and reviewed the Baltimore City Consolidated plan.

D. Objective: Develop a plan for improving the continuum of care for transition-age youth.

ADULT SERVICES

BMHS had submitted a proposal to DSS for TAY which was approved for funding through federal dollars. However funding was rescinded when the Federal dollars did not become available to DSS.

CHILD AND ADOLESCENT SERVICES

During FY01, BMHS continued to work cooperatively with the Office of Employment Development (OED) to provide mental health and substance abuse prevention and treatment services to participants in their Youth Opportunity Project, which provides job training and job placement services to in-school and out-of-school youth ages 14 - 21. In spite of difficulties with staff recruitment and retention, the North Baltimore Center continued to provide these services at the Westside Youth Opportunity Center, on a limited basis.

During the second quarter, BMHS developed an RFP for the provision of mental health and substance abuse services at an additional Youth Opportunity Eastside site. During the 3rd Quarter, through an RFP process, Johns Hopkins Bayview was selected to provide services at the Eastside site; both mental health and substance abuse services began at the Youth Opportunity East-Side Center during the third quarter.

BMHS applied for and received a TAY grant from MHA to provide services for 20 identified Baltimore City youth and young adults ages 14-23 currently being served by the PMHS. This initiative is intended to address the multiple needs of the target population, promote increased self-sufficiency, bridge service needs in the adult system, and address gaps in service as they age out of child and adolescence and into adulthood. BMHS developed a "Request for Proposal" (RFP) which was sent to various agencies currently serving the targeted population. A proposal review committee was formed with representation from FLBC, Baltimore City Department of Social Services, Baltimore City Department of Juvenile Justice, Court Appointed Special Advocates, and the BMHS C&A/Adult Services Divisions. People Encouraging People (PEP) was chosen by the committee to provide TAY services. A contract has been drafted and services are scheduled to begin in the First Quarter of FY02.

E. Objective: Complete assessment of need for Targeted Case Management services for children and adolescents. Increase capacity as needed.

CHILD AND ADOLESCENT SERVICES

This effort was subsumed under the development of the Partial Capitation proposal. Our work with the Family League of Baltimore City suggests that there are between 150 and 200 children who could benefit from Targeted Case Management. However, many of these children are either at risk of placement or in residential treatment centers throughout the state, and are not readily served by TCM as currently structured. BMHS's proposal calls for an intensive case management and services delivery model using a partial capitation model to fund the service. MHA and OCYF continued to explore the feasibility of funding a demonstration.

F. Objective: Assess the Cultural Competency of the provider network to ensure that services provided are accessible, appropriate and responsive to members of the various cultural and ethnic groups in Baltimore City.

CHILD AND ADOLESCENT SERVICES

C&A staff joined the MHA State-wide Cultural Competency Committee, and worked with the group to develop a statewide Cultural competency satisfaction survey. C&A staff continued to work to develop a provider survey for use in Baltimore City in FY02.

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

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

ADULT SERVICES

The FAST Program received 1190 referrals for review. Approximately one half (47%) of these came from Pre-trial Services, 20% from Public Defenders and 9% directly from Judges. Nearly 25% of those referred were housed in the Women's Detention Center. Ninety three (23%) individuals agreed to a plan for mental health services in the community and were released with ongoing monitoring by FAST of their compliance with the plan.

FAST continued to participate in the Forensic Meeting and the adult service coordination meetings chaired by BMHS. Other efforts to reduce incarceration for persons with mental illness have included the training of all new police cadets for the Baltimore City Police Department. The use of the Petition for Emergency Evaluation is emphasized in this training.

BMHS and Clifton T. Perkins Hospital Center (state forensic hospital) entered into an agreement to clarify the referral process for individuals who would be accepted by BMHS for referral to Residential Housing Providers and who would be leaving the hospital on conditional release status. Following approval, the policy was initiated at Perkins to assure that the individual being referred had attained a status within the hospital which would make release by the Court to the community a reasonable expectation. It is hoped that this policy will be accepted by each of our referring hospitals who serve court ordered individuals.

A database of all the persons who are on Conditional Release and who are receiving services with Baltimore City Mental Health Providers was created. During this year 12 persons successfully completed their community trial and were granted release from conditions imposed by the court. One individual had his release revoked and was returned to the hospital. Release conditions were extended for 2 persons. The numbers at year end were: 97 persons in Baltimore City on Conditional Release (an increase of 7 persons) and 27 out-of-county persons received services in Baltimore City.

The potential establishment of a mental health court was refocused to begin an exploration of early notification to BMHS of persons arrested who are consumers in the Public Mental Health System. With the support of the group, a small grant was provided to University of Maryland's Center for Behavioral Health, Justice & Public Policy to explore the establishment of a Data Link between Detention Centers, MHP and the CSA. The report will be available shortly.

BMHS established a relationship with the Patuxent Institute of the Department of Corrections. There have been 22 referrals to Baltimore City Targeted Intensive Case Management programs under the Patuxent Initiative, including three from the Maryland Correctional Institute for Women.

Patuxent Initiative Referrals JHH-BV: 3 NBC: 6 UMMS: 2 PEP: 4 JHH: 4 Harford/Belair 2 Bon Secours 2 TOTAL 23* *Actual client number is 22. One client referred to 2 programs as preferred by the client and programs involved.

B. Objective: Ensure that the goals of the Client Enhancement Initiative are met.

ADULT SERVICES

The CEI initiative for this year was funded to provide residential placements for 15 individuals to return to the community from State Hospitals. The goal was to discharge 15 Springfield Hospital Center patients by 6/30/01. Following the award of funding, BMHS issued a request for proposals from Residential Rehabilitation Providers.

CEI Initiative Award Recipients Harford/Belair's Haven 6 beds Volunteers of America 6 beds Key Point Health Services 3 beds

As of July, 2001, 12 of the projected 15 patients have been housed in the community. Three patients actively transitioning but cannot be officially discharged until their Conditional Release has been approved by the court. It is expected that this will be forthcoming in early FY'02.

C. Objective: Continue to expand and monitor Baltimore Crisis Response, Inc. (BCRI) to ensure that at least 80% of referrals receive an assessment by BCRI staff.

ADULT SERVICES

Referrals to the crisis teams resulted in 754 (33%) persons being admitted to the program's residential crisis beds. The average length of stay in the unit remained at an average of 4 days. The occupancy rate for the beds was 73%. In home supports were provided to 119 persons. This is a 32% increase over the previous year.

PRINCIPAL SOURCES OF CRISIS REFERRALS
Family, Friend, Self	229
Bon Secours ER	212
University ER & Urgent Care Center	208
Johns Hopkins ER	111
Sinai ER	94
Hopkins - Bayview ER	67
Maryland Health Partners	25

Service	FY'00	FY'01	Change
Hotline calls	8,637	12,981	4344 ( 50%)
Mobile Crisis Responses	2,367	2,299	- 68 ( -3%)
Community/In-home Supports	87	119	+ 32 ( 36%)
Crisis Bed Utilization	69%	73%	4%

BCRI was awarded a grant by BSAS to develop and service 10 new detox beds. Referrals to these beds are limited to BCRI and the Division of Parole and Probation. The new program has been approved by the State. The average length of stay is expected to be 10 days.

D. Objective: Expand the number of consumer drop-in centers in Baltimore City.

ADULT SERVICES

Project HOPE was jointly funded with State and HUD funds to establish a drop-in center. In addition, with the funding from HUD the program was able to open its doors for homeless persons with mental illness who are not connected to services or housing. The program opened in East Baltimore in December 2000. Through the support provided by Project HOPE, staff linkage to housing and services of all types will be initiated. After just six months of activity, approximately 15 persons were visiting the Center each day with a quarter agreeing to talk to one of BMHS's funded homeless outreach teams. The center was open seven days a week to provide referral to mental health outreach teams, housing and support and encouragement from staff who are themselves consumers. Project Hope has provided services to a total of 157 persons during the period of December 2000-June 30, 2001.

E. Objective: Ensure that there is appropriate outreach and services for individuals who are homeless and have a mental illness.

ADULT SERVICES

Although BMHS continued to hold the Hands in Partnership (HIP) meetings monthly to bring together the outreach programs, the overall achievements of this initiative have been disappointing. This program is operated with the Downtown Partnership. With each change in leadership at one of the participating programs, there was a reduction in the level of cooperation among the programs. This resulted in reduced attendance at meetings and failure to be able to use the referral process effectively. As we enter FY02 the project appears to be attaining more stability and plans to work more closely with the Office of Homeless Services and the Baltimore City Police are being explored.

A needs assessment to determine if another Safe Haven is needed was conducted by a simple request to providers of services to the homeless. They were unanimous in their response. In addition, the waiting list for bed space at Safe Haven continued indicating an ongoing need for this service. As a result, an application to HUD for a second Safe Haven was submitted in the spring as a component of Baltimore City's Homeless Services Plan.

F. Objective: Continued development and evaluation of the child and adolescent crisis system through the Baltimore Child and Adolescent Response System (B-CARS).

CHILD AND ADOLESCENT SERVICES

C&A continued to work monitor BCARS progress through monthly reports and periodic meetings. During this time, BCARS continued to provide services to the community, albeit at a reduced level. In the third quarter, Catholic Charities' Villa Maria proposed to become the sole primary provider of BCARS and to contract with Hopkins and Woodbourne to provide crisis beds and Johns Hopkins for the medical director. The negotiations on this agreement and process continued throughout the third quarter.

One of the major reasons for the restructuring of B-CARS was the need to improve B-CARS ability to respond to calls. As demonstrated by the data there is a significant gap between the numbers of calls received by BCRI and the number of children served by B-CARS.

REFERRALS

Calls Received by BCRI	Clients Served by B-CARS Team	Service Rate	Month
27	26	96.30	August
45	20	44.44	September
58	26	44.83	October
60	29	48.33	November
62	18	29.03	December
64	18	28.13	January
34	10	29.41	February
			March
89	30	33.71	April
46	10	21.74	May
			June

Several contributing factors have led to this "gap" in service delivery:

BCRI errors in assessing the appropriateness of a child for referral to B-CARS

Overly stringent criteria for the definition of a "psychiatric" crisis

A significant number of referrals of children who were not eligible for Medicaid or grey zone services (children covered by private insurance)

The use of a consortium proved to be inefficient and inconsistent and inefficient in service delivery.

These concerns and issues led to the restructuring of B-CARS for FY02. The revised model for B-CARS, completed and approved in late FY'01, broadened the eligibility criteria for referral to B-CARS, and consolidated the organization under one agency, creating clear lines of authority and accountability.

G. Objective: Work with DJJ and MHA to identify and expand the range of mental health services available to the Juvenile Justice Population.

CHILD AND ADOLESCENT SERVICES

BMHS contracted with Universal Counseling to provide mental health screening on all Baltimore City youth detained in the Cheltenham facility. Universal assigned two FTE staff to conduct assessments using the MAYSI-2. The MAYSI-2 is a standardized, reliable, 52-item, true-false, paper-and-pencil method for screening every youth of ages 12-17 entering the juvenile justice system, in order to identify potential mental health problems in need of immediate attention. The MAYSI-2 provided information that alerted staff to issues related to: Alcohol/Drug Use, Angry-Irritable Experiences, Depressed-Anxious Experiences, Somatic Complaints, Suicide Ideation, Thought Disturbance, and Traumatic Experiences. A positive screening does not necessarily mean that a mental health problem exists but that there are risk factors or behavioral factors that suggest the presence of emotional/behavioral concerns.

Annual Data on Children Seen and Rates of Positive Indicators

Number Screened	Number of Positives	Percentage
852	695	81.57

Ethnicity	Number Screened	Number of Positives	Percentage of Positives
African-American	807	678	84.01
White	42	14	33.33
Hispanic	3	3	100
Total	852	695	81.57

There are several significant concerns raised by this. Aside from the disproportionate representation of African American males in the Baltimore City population, a disproportionate number of African American males and Hispanics were also screening positive for emotional behavioral problems. There are multiple possible explanations for this finding including but not limited to:

Cultural bias in the instrument may produce higher scores for persons of color

A disproportionate number of children of color entering the system may have unaddressed emotional/behavioral needs

Decisions at various levels in the legal process may be biased towards detaining persons of color rather than referral to alternative (mental health) services.

In reviewing this data, there was some concerns with the high incidence of positive screens in the population. National estimates on the incidence of emotional/behavioral problems in DJJ populations ranges from 50 to 75%.

A review of the procedures used by Universal Counseling found no significant errors in administering or scoring the MAYSI. Discussion with other professionals familiar with the MAYSI suggested that the instrument occasionally yields false positives. In reviewing the case files with Universal staff, there was some agreement that although the tool was overly sensitive, the population did, in fact, have a high number of children with emotional/behavioral problems. One possible explanation for the higher number might be the focus of the screening on DJJ children whose behaviors have resulted in detention. This may be a more severely disturbed population than is included in the national prevalence estimates.

Because the MAYSI is not a diagnostic tool, it is not possible to assess the nature or range of the diagnostic problems in the population. For FY'O2, BMHS will continue to work with Universal, Johns Hopkins, and DJJ to develop a more refined screening and evaluation process, which will hopefully yield clearer results.

BMHS was approved to develop a Kids - Forensics Alternative Services program (FAST) program in collaboration with the Juvenile Court. In the third quarter, we began planning the process to implement this program beginning in FY02.

GOAL #4: Develop and maintain affordable housing.

A. Objective: Continue to expand affordable housing opportunities.

COMMUNITY HOUSING ASSOCIATES

During FY01, CHA continued to expand its housing development and property management capacity. At year end, CHA had housing capacity for six hundred and forty four (644) people.

As of June 30, 2001

	Shelter Plus Care	CHA-owned units	Mainstream / Section 8 (vouchers)
Total Available Units	171	71**	400***
Occupied Units	158 (92%)	64 (90%)
Vacant Units	13*	7

* The number of vacant units fluctuates on a regular basis due to factors such as people moving in and out, landlords wanting the units returned, increased rent, and people getting Section 8 certificates and staying in that unit.

** CHA owns seventy four units of housing, but three are not available due to the need for extensive renovations. Vacancies occurred in CHA units in June due to unit turnovers taking a long time to complete, the death of a tenant, a slow lease-up process, and not acquiring prospective tenants from BMHS in a timely manner. Plans of correction are in place.

*** CHA processed 248 applications for the 175 slots available through the Mainstream program. The remaining Section 8 vouchers were received several years ago and there is not an adequate means of tracking their use through the Section 8 office. CHA is therefore continuing to refer individuals for Section 8 certificates through the City's Section 8 office.

CHA completed one of two projects in FY'01. Belair Manor houses six adults who require twenty-four hour awake supervision if they are to live in the community. This is CHA's first group home/Single Room Occupancy (SRO) project and has enabled some people to leave their housing in a State Hospital. The project was developed with funds from the U.S. Department of Housing and Urban Development (HUD) Section 811, Supportive Housing for People with Disabilities program. The project was completed in late June 2001, and will be occupied during July.

CHA's other SRO/Group home, Glenmore Housing, Inc., needed to extend its occupancy date past June 30,2001 end due to several circumstances including delays in the initial Contractor solicitation and award process, and fire. electrical and sprinkler code issues which unexpectedly required the retention of an Engineer. Completion is anticipated to be in mid-September, 2001. When completed, the project will house eight (8) adults also who need awake supervision.

Two hundred and forty eight (248) applicants were referred for housing assistance through the Section 8 Mainstream Housing Choice Voucher program. CHA and BMHS' Adult Services Division met with applicants on a weekly basis and provided technical assistance in completing initial intake forms and referring clients to the Housing Authority of Baltimore City's Section 8 program.

On Our Own, Inc., a consumer-run drop-in center, was successfully relocated to a larger, more accessible site, located on Harford Road. The new site consists of a two unit house and an attached store-front building. Acquisition of the site and relocation from Belair Road were completed during the second quarter; upgrades and renovations will be completed during the early part of FY'02.

The second consumer-run drop-in center, Project H.O.P.E., moved into 1426 E. Fairmount Avenue, near Johns Hopkins Outpatient Center, in a building owned by a third party. CHA leases the property from the owner and subleases the space to BMHS on behalf of Project H.O.P.E. Renovations were completed prior to occupancy.

CHA had submitted two applications, each for 75 additional housing choice vouchers through the Mainstream Program. One was submitted on behalf of the Housing Authority of Baltimore City (HABC) in partnership with BMHS; the other was submitted with CHA as the lead applicant with BHMS, BSAS, and AIRS (AIDs provider) as partners for service delivery. Both project were approved but not funded. CHA intends to submit two applications in the next fiscal year.

Rental Assistance for twenty (20) units of housing through the Shelter Plus Care program was renewed for one year. CHA decided not to apply for a new Section 811 project this year since we wanted to focus on the projects already in development. The completion of Belair Manor brought the number of units owned by CHA up to seventy-nine.

CHA staff participated in meetings regarding the needs of disabled individuals and family and reviewed the City's draft document of the Consolidated Plan.

B. Objective: Continue to provide/improve property management.

COMMUNITY HOUSING ASSOCIATES

A property management software program, Yardi, was purchased and installed prior to June 30^th.. Staff were trained on its use and began inputting financial and programmatic data. Once fully operational, the software will be capable of producing reports designed to provide the data needed by supervisory staff to effectively manage housing operations. It will track and report tenant data including applicant data, household composition, income amounts and sources, move-ins/move outs, annual recertifications, interim rent changes, inspection, generating work orders, owner data, property data and demographics.

Yardi also maintains and generates reports on a general ledger account, checkbook maintenance, accounts receivable/payable, and tenant charges/receipts. Although the system was not operational for most of the year, the Operations Manager successfully submitted all reports required by our funding sources.

CHA expanded its capacity to operate new and existing units by creating four new positions. An experienced Operations Manager was hired to oversee daily operations, including oversight and coordination of maintenance, housing placements, and collectibles. A Maintenance Coordinator was hired to develop and implement cost containment strategies including directly responding to maintenance calls, determining the scope of a project, identifying contractors, and soliciting bids.

This year was the first time that CHA contracted with the Schapiro Training and Employment Program (STEP) to become a training site providing hands-on work experience to people receiving services through the PMHS. Both trainees participated in support services for up to twenty hours a week. One trainee worked with the Administrative Assistant and the other trainee worked with the Fiscal Associate.

CHA began to target key indicators which would provide the data needed to move from a grant-based administration to an outcome based, fixed fee on a unit basis.

Residents received a Satisfaction Survey, developed between CHA and BMHS' Division of Quality Improvement/Operations. Variables included responding to calls for maintenance services, housing conditions and services provided. Twenty nine (29) out of 171 residents responded. Highlights of the survey included:

98% agreed that they feel safe and secure in their environment

90% agree that there is enough lighting inside and outside of the home.

98% said know who to call for help with rent payment.

56% agree that items in the home are properly repaired.

53% agree that items in the home are repaired within a reasonable amount of time.

100% know who to call if something needs to be repaired and 100% know who to call for emergencies.

100% know how to reach CHA when the office is closed.

88% agree that CHA responds quickly to emergency calls.

During the fiscal year, there were 57 new households admitted to CHA and S+C units. These included 40 single individuals and 34 children. There were 117 units inspected during the year.

GOAL #5: Establish and maintain sound financial management practices.

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

FINANCE OFFICE

The following activities are some of the checks and balances in effect at the year end. All Department of Health and Mental Hygiene funds were deposited in an interest bearing account. Instruments were guaranteed per the terms of the Investment Policy which has been signed and approved by the President and Chairperson of the Board of Directors of BMHS.

The accounting system was maintained such that it separated the funding and expenditures for the various sources. It adhered to the requirements of generally accepted accounting principles.

BMHS and subsidiaries are audited annually and have been given an unqualified opinion for fiscal year 2000. The annual audit for FY'01 is currently underway.

The funding allocated through vendor contracts was monitored monthly by a BMHS internal committee. The committee reviewed all facets of the timely processing, payment and reporting of the contracts.

Vendors whose contract required an audit were monitored for findings that would affect the delivery of mental health services and prevent the vendors from fulfilling the terms and conditions of their contract.

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

BMHS has developed a process in which MHP data is downloaded and electronically reviewed. The purpose is to determine if there are any duplicate or incorrect payments made for services. This information is shared with MHP for their review.

GOAL #6: Develop and implement a comprehensive quality improvement program.

A. Objective: Monitor performance of 100% of vendors who contract directly with BMHS.

QUALITY IMPROVEMENT/OPERATIONS

Quality Improvement staff conducted 36 site visits to contracted vendors this year. This was a record number for the agency. Providers overall were complying with performance expectations. Reports were issued for each site visit. The visits were helpful to providers and BMHS because it provided an opportunity to observe service delivery directly, provide technical assistance, and provide feedback to program directors from providers. A process was created that allowed for direct communication with the BMHS contract manager and the BMHS staff conducting the site visit. If a performance improvement plan was required, QI director and Director of Adult Services or Child and Adolescent Services reviewed and approved the plan.

VENDOR CONTRACT

SITE VISIT SUMMARY FY 01

	1st Quarter	2nd Quarter	3rd Quarter	4th Quarter	FY00 Total	FY 01 Total
Number of Site Visits	5	6	9	16	4	36
Met/Partial Met On Target	5	6	8	16	4	21
Not Meeting	0		1	0	N/A	1

The vendor contract committee met monthly. Minutes are available of all meetings. The committee's major focus was on the contract execution process. The major accomplishments of the committee included the completion of an Access data base that includes pre-defined reports. The data base was used to track fiscal and program deliverables. Policies and procedures were developed and revised throughout the year. Quarterly reports have been submitted. A true test of the system will be during FY 02 when we have a full year experience. A contract manual was developed that explains the development and monitoring process. The procedures were reviewed with key staff and appropriate training provided. Mental Hygiene Administration recognized BMHS's contract process as a "best practice" for other Core Service Agencies.

B. Objective: Monitor BMHS performance and identify opportunities for improvement of its core administrative functions such as contracting, planning, procurement, service development and training.

QUALITY IMPROVEMENT/OPERATIONS

BMHS made significant progress this year compared to previous years in the timely initiation and execution of vendor contracts. Forty-One (41) state block grants, one (1) federal block grant contract, and one (1) Capitation Project contract were initiated prior to July 1, 2000. This was the result of the division directors and fiscal contract coordinator working more collaboratively to meet internal deadlines. Contract execution was also improved. For FY'01, there was an increase over the prior year in the number of fully executed contracts early in the year. In fact, a number of FY'02 contracts were fully executed in FY'01. This information will be reported in the first quarter of the FY'02 report.

Ninety-five percent (95%) of the contracts were executed by June 30, 2001. For those not executed there were a variety of reasons including that a number were short-term wrap-around services for children for which signatures in large systems were late in coming. Other improvements included the development of internal process to ensure compliance with issues raised by Mental Hygiene Administration during the quarterly site visits.

The table below provide a summary of vendor contract management. The first table highlights the improvements in the timely execution of contracts. The second table provides the details of contracts executed by funding source.

VENDOR CONTRACT - DETAIL REPORT

FUNDERS	1st Quarter		2nd Quarter		3rd Quarter		4th Quarter		FY01 Total
	Int.	Exc	Int	Exc	Int	Exc	Int	Exc	Int	Exc.
State	65	48	9	15	15	13	19	25	108	101
Rollover	1	1	1	1	10	4	6	11	18	17
Brian Injury	0	0	1	1	0	0	0	0	1	1
Federal Block	8	7	0	1	2	0	1	3	11	11
BCPSS	0	0	4	2	0	2	0	0	4	4
Capitation	2	2	1	1	0	0	0	0	3	3
Federal HUD	0	0	0	0	0	0	1	1	1	1
PATH	0	0	1	0	0	1	1	1	2	2
OED-Y.O.	0	0	0	0	0	0	1	1	1	1
O.S.I.	0	0	0	0	0	0	5	4	5	4
SS/HS	1	1	4	3	1	1	4	5	10	10
Administration	3	2	4	3	0	2	1	1	8	8
Total	80	61	25	27	28	23	39	52	172	163 (95%)

C. Objective: Support the Office of Health Care Quality's effort to monitor providers compliance with COMAR regulations.

QUALITY IMPROVEMENT/OPERATIONS

QI staff participated in 89% of scheduled OHCQ site visits in Baltimore City. Staff reviewed and provided technical assistance to 100% of providers submitting new applications to provide public mental health services. This included providing orientation to new applicants using the manual BMHS had created. 100% of performance improvement plans were reviewed and technical assistance to provided. BMHS was in 100%compliance with COMAR established time lines for the CSA. BMHS has an excellent relationship with the OHCQ team. Communication is frequent. The team often expresses appreciation for the support and assistance provided by BMHS. The following slides summarize the major findings from site visit to COMAR providers in Baltimore City graphs.

BMHS PARTICIPATION IN OHCQ SITE VISITS

Deemed Status Providers

Quality Improvement staff developed a process to monitor continued compliance with COMAR regulations for Baltimore City providers granted deemed status by MHA. This included onsite visits to evaluate implementation of the performance improvement plans required by OHCQ. This was the first attempt to implement a formal procedure to monitor these providers.

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

QUALITY IMPROVEMENT/OPERATIONS

Staff provided orientation and technical assistance to new applicants as requested. The following table summarizes the total number of COMAR providers in Baltimore City as of June 30, 2001.

BALTIMORE CITY COMAR PROVIDERS As of June 30, 2001
Adult Group Homes	3
Therapeutic Group Homes (Chid & Adolescent)	2
Mobile Treatment Services	8
Outpatient Mental Health Clinics	29
Partial Hospitalization Programs	16
Psychiatric Rehabilitation Programs	40
Residential Crisis Programs	9
Respite Care Programs	1
Targeted Case Management Programs	8
TOTAL	120

E. Objective: Meet or exceed the expections of providers.

A provider survey was not conducted in FY'01.

F. Objective: Explore the possibility of establishing a Consumer Satisfaction Team (CST) in Baltimore City by the end of FY'01.

QUALITY IMPROVEMENT/OPERATIONS

As reported earlier, Quality Improvement staff conducted eight focus groups with mental health consumers and providers in Baltimore City. The purpose of the focus groups was to assess the level of interest in establishing a CST. The CST would involve primary or secondary mental health consumers who would interview other consumers in Baltimore's public mental health programs. While the focus groups and provider surveys showed overwhelming support; no funding has been found at this time. This is a project BMHS supports and funding opportunities will be pursued.

CONSUMER SATISFACTION TEAM

FOCUS GROUPS AND PROVIDER SURVEY

Provider Surveys	75 Surveys were delivered 22 (29%) responded	21 (95%) Providers Supported CST
Consumer Focus Groups	8 Focus Groups	91 Participants	100% Supported CST

GOAL #7: Develop and provide training.

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

QUALITY IMPROVEMENT/OPERATIONS

BMHS sponsored several workshops within the community. A record was set (2,381) for the number of participants since BMHS began tracking this data. Staff targeted adult and child/adolescent mental health providers, Head Start providers, advocates, Juvenile Justice Department, District Courts, families, churches, Department of Social Services, Examples of training included, Second Step Pre-K Curriculum, Effective Parenting, School-Based mental health services, Domestic Preparedness, Meeting the Needs of Older Adults with Mental Illness, Focus Groups, Housing Options, Prevention of Youth Violence, National Depression Screening Day, Medical Records documentation, Incarcerated Women and Trauma, etc. Reporting improved this year, although, there may have been training not reported. Steps have been taken to remind staff the importance of timely reporting. A summary of BMHS' community education activities is shown below.

ADULT SERVICES

The forensic group is exploring the training needs of our mental health service providers in the areas of identification and treatment and furthering collaboration between the broad array of agencies providing services to this population. This theme was highlighted by our annual forensic conference, "Women and Trauma: From Incarceration to Recovery" which was held on June 15^th with a total of 225 people in attendance. The conference evaluations were overwhelmingly positive.

Training was provided throughout the year to improve services for individuals who are eligible for conditional release from one of our state hospitals following a finding by the court of 'Not Criminally Responsible'. The training was offered by Adult Services and the Office of Forensic Aftercare (OFA) which provides the monitoring of this population. Programs were provided with OFA for mental health providers at Bon Secours, Alliance and Harford Belair. The process of conditional release and the supports available to the therapists through the OFA. were reviewed.

CHILD AND ADOLESCENT SERVICES

Between April and June 2001, various training opportunities were provided to the clinicians that had been hired. In addition, other clinicians working in Head Start through other funding sources as well as Head Start staff were included in these trainings.

Training Opportunities Provided Second Step Pre/K Violence Prevention Curriculum April 9 - 12, 2001 A Family Guide to Second Step May 9 - 11, 2001 Families and Schools Together (FAST) Overview May 30, 2001 Effective Black Parenting June 25 - 29, 2001

B. Objective: Provide training to the senior centers to increase awareness of mental health problems and decrease stigma.

QUALITY IMPROVEMENT/OPERATIONS

Support Groups In Senior Centers

Based on the FY'99 Senior Center survey which identified both educational presentations and support groups as unmet needs, and on the success of the Ageless Learning project, BMHS again met with the Senior Center directors. Each center has specific needs, but common themes for support groups emerged, including adjustment to multiple losses and change, parenting as grandparents and coping with family dynamics and substance abuse. Support groups can be provided by an Outpatient Mental Health Center (OMHC) and funded through Community Support and Prevention dollars as another MHP funded service.

Four OMHC's expressed an interest in providing this service. BMHS met with those clinics to identify a provider for each of the Baltimore City Senior Centers. Fourteen of the fifteen centers have been linked to a program and a contact person has been identified. BMHS continues to look for a Korean speaking therapist to provide these services in the Korean Senior Center. These linkages and guidelines for implementing the support group project were presented at the spring Senior Center Directors' meeting. In addition, our Ageless Learning - an Educational Series for Senior Centers was funded using Community Support and Prevention funds through Harford-Belair Outpatient Mental Health Clinic. The project has met its goal of 7-8 presentations per month.

GOAL #8: Other accomplishments and issues

ADULT CAPITATION PROJECT

The adult capitation project has been in existence since early 1994. During fiscal year 2001, the two programs increased their census from 125 at Chesapeake Connections (The North Baltimore Center) and 131 at Creative Alternatives (Johns Hopkins Bayview) to 137 at Chesapeake Connections and 143 at Creative Alternatives. This does not include 20 disenrollments from Chesapeake Connections during the year, and 17 from Creative Alternatives, for a total of 157 clients served by Chesapeake Connections and 160 served by Creative Alternatives during the year. Of the new enrollments, 15 enrollees were from state hospitals, with 9 from Spring Grove, 5 from Springfield, and one from Walter P. Carter. However, of these 15, 4 were unsuccessful and returned to the state hospital (3 to Spring Grove, 1 to Springfield). Of the other disenrollments, there were a variety of reasons which included moving, violation of conditional release, 5 deaths, and some clients who chose to get treatment in another model of care.

Outcomes measurements indicate some increase in acuity of capitation clients: hospitalizations are up from 3.8 days per client per year to 8.3 days at Chesapeake Connections. Hospital days at Creative Alternatives remained static at 2.4 days per client per year. Employment rates were also down from about 60% to 43% at Chesapeake Connections, but remained at about 60% at Creative Alternatives.

The capitation program received national recognition as an honorable mention from the Thomas M. Wernert Award for Innovation in Community Behavioral Healthcare and submitted the program for consideration for the American Psychiatric Association's Gold Award.

PROPOSED MERGER OF BMHS/BSAS

Shortly after taking office, Baltimore's newly elected Mayor Martin O' Malley, requested that the Greater Baltimore Committee (GBC) examine five of the city's largest departments and make recommendations for improvements. In their review of the Baltimore City Health Department (BCHD), the GBC recommended that a merger between BMHS and BSAS, the city's mental health and substance abuse authorities be considered. The over-riding premise for this recommendation was that there could be significant financial savings. While there was a consensus of the BMHS and BSAS leadership that the premise was not correct, there still was an interest in exploring a possible merger. This inquiry would be focused on the question of improving clinical services through integrated care.

During FY'01, BCHD in collaboration with BMHS and BSAS contracted with the Lewin Group to determine the feasibility, strengths and weaknesses of the proposed merger and to determine if there might be other options short of a merger which could produce the same desired outcomes. The Lewin Group worked with both BMHS and BSAS leadership and boards. They interviewed key stakeholders and interested parties before issuing a report that did not recommend a merger. The reasons provided that discouraged a merger included:

No compelling reason for a merger that could be identified.

No potential cost savings could be identified due to the restricted funding for both BMHS and BSAS.

The key stakeholders (providers and administrators) did not see a benefit and many were quite resistant to a merger for a variety of reasons.

Cost increases to implement a merger could be anticipated.

Improved clinical (integrated) care for individuals with coexisting mental health and substance abuse disorders could be accomplished using other strategies.

In order to promote improved clinical care for individuals with coexisting mental health and substance abuse disorders, BMHS and BSAS developed a proposed strategic alliance that would be addressed in FY'02.

EVIDENCE-BASED PRACTICE DEMONSTRATION PROJECT

BMHS has been involved in a project to implement evidence-based mental health interventions for individuals with serious mental illness. Dr. Robert Drake of Dartmouth initially received funding from the Robert Wood Johnson Foundation (RWJ) to develop a three-phase project to implement 6 evidence-based practices. The six interventions are: Medication Management, Integrated care for dual diagnosed, supported employment, assertive community treatment, psycho-family education and symptom management. There is sufficient research in the literature to support the efficacy of the six areas.

Phase 1 is the development of tool kits for each area; Phase 2 is a demonstration project in New Hampshire, Maryland and Ohio to test the ability of the tool kits to assist the practice field to implement evidence-based interventions and Phase 3 will be a national demonstration project. Besides RWJ, the Department of Health and Human Services through CMHS, MacArthur, National Association of State Mental Health Directors are supporting the project. Maryland has decided to test supported employment and psycho-family education and we are hopeful that Baltimore will be a site.

In addition to the state's initiative , BMHS is planning to promote Assertive Community Treatment (ACT) in the City. ACT is a proven intervention for individuals who have histories of non-compliance with traditional outpatient mental health settings.

QUALITY MANAGEMENT PLAN

BMHS quality management plan was approved by management. It established a BMHS performance improvement team that reviewed findings from the employee satisfaction survey and received approval from management to implement staff recommendations.

COMMUNITY EDUCATION AND STAFF DEVELOPMENT

Applied for and received approval from Maryland Board of Examiners to provide continuing education units to social workers, licensed professional counselors, occupational therapists, and psychologists attending workshops sponsored by BMHS.

Sponsored the first state-wide conference at Sheppard Pratt for Child and Adolescent Psychiatric Rehabilitation Providers in Maryland.

Provided Medical Records Documentation training to Baltimore City COMAR providers.

Initiated "brown bag lunch" education sessions for BMHS staff development.

Participated in National Mental Health Association's Depression Screening Day (October 2000) and screened over 237 Baltimore City residents.

Coordinated BMHS' second annual Employee Wellness Program.

Established a consumer satisfaction committee with membership from major consumer and family organizations in Baltimore City to evaluate the feasibility of establish a CST.

Provided consumers with training on conducting focus groups.

ADDITIONAL DATA COLLECTED