APPENDIX 1

Information for three charts is based on Maryland Health Partners (MHP) claims paid as of 7/31/00. Claims may be submitted up to 9 months from the date of service. Therefore, the FY'00 data will increase as additional claims are processed.

Service Utilization Data:

1. Unduplicated Baltimore City Consumers comparison of FY'98-FY'00

Category	FY'98 Number and Percent	FY'99 Number and Percent	FY'00 Number and Percent
Medicaid recipients in the waiver	19,992 (83%)	18,884 (80%)	17,743 (80%)
Gray zone (uninsured) individuals	2,475 (10%)	3,101 (13%)	3,305 (15%)
Medicaid individuals not waiver eligible	1,695 (7%)	1,598 (7%)	1,167 (5%)
Total	24,162	23,583	22,215

2. Unduplicated Baltimore City Consumers comparison by age group from FY'98-FY'00

AGE GROUP	FY'98	FY'99	FY'00
0-5	1,740	1,124	965
6-12	5,641	5,588	5,609
13-17	2,884	2,867	2,863
18-21	717	752	741
22-64	11,491	11,869	11,077
65 AND OVER	1,689	1,383	960
TOTAL	24,162	23,583	22,215

3. Service Utilization of Baltimore City Consumers for FY'98-FY'00. A consumer may use more than one service type.

Service Category	FY'98	FY'99	FY'00
Case Management	1,094	1,104	1,106
Crisis	291	409	184
Inpatient	2,994	3,182	2,294
Mobile Treatment	413	524	493
Outpatient	23,895	22,977	20,483
Partial Hospitalization	187	242	371
Psychiatric Rehabilitation	2,598	2,921	3,435
Residential Rehabilitation	442	438	477
Respite Care	6	19	3
Residential Treatment	563	380	252
Supportive Employment	204	231	272
Total	32,687	32,427	29,370

APPENDIX 14

At the time of the Welcome House closing there were 26 residents and one to two staff persons who resided at the house. As BMHS staff and persons from other Baltimore City agencies began to visit the houses there was a great deal of anxiety among the residents about their future. Many of the residents had lived at Welcome House for as long as 5 to 10 years. The house mascot, a cat who generously expressed affection was said to have resided at Welcome House for 20 years. Despite the disgraceful surroundings, sporadic electricity and plumbing, lack of heat in the winter, and no relief from summer temperatures, this was home to the people who lived there. Many were disenfranchised, and had little or no contact with their families. They had developed a community, and had come to regard their fellow house mates as family. They now faced losing this connection. Equally distressing, they faced homelessness.

Given the magnitude of the problem, it was obvious that it would take the efforts of multiple agencies to successfully navigate a solution. Through the leadership and coordination efforts of Baltimore Mental Health Systems in partnership with Adult Protective Services (APS) and the Housing Authority, a plan of action was developed. The effort required the quick response, of mental health providers and service agencies, including (but not limited to); Alliance, Chesapeake Connections, Johns Hopkins Case Management, Liberty Medical Center, the Mayor's Station, North Baltimore Center Case Management and Residential Programs, Sinai Case Management, the Veteran's Administration, and UMMS Case Management.

At the outset of the relocation effort an idea of who the residents were, what supports were currently in place for them, their financial, physical, and emotional well-being had to be considered. This was accomplished through the use of a multi-agency team which conducted interviews with all of the residents. Initially it was noted that about 27% of the residents had active cases with one of the traditional public mental health programs in Baltimore. Another 27% were working with other mental health providers in Baltimore City (e.g., Transitional Living Council, Union Memorial out-patient, Urban Behavioral Associates, and the Veteran's Administration). The fact that slightly more than half of the residents had an established relationship with a mental health service provider was an immense asset to the endeavor, as it provided a resource known to the resident to assist in the relocation. That is, some clients already had a professional connection that they trusted and were willing to work with. In addition, all residents had a source of income. As a whole they were psychiatrically stable, motivated, and capable of working on a new housing arrangement.

In addition to re-housing all of the residents, another goal was to keep the stress level of the residents as low as possible. This was primarily achieved by having BMHS staff available. For example, primarily BMHS staff visited the facility frequently to answer questions and encourage residents to work with the case managers and/or APS workers, so that no one would face homelessness. Early on in an effort to reduce tensions and gain the trust of the residents, BMHS staff hosted a question and answer social at Welcome House supplying desserts and fresh fruits. BMHS staff were also available by phone to those in the household.

As mentioned earlier, 7 of the residents were working with a traditional mental health program prior to the house closing. During the relocation process an additional 11 of the residents who were either working with other mental health programs that did not offer case management services or who were not working with any outside agency, agreed to work with traditional mental health case management providers in order to locate new housing. Fifteen percent (4) were able to obtain case management through their current mental health providers which was sufficient to the task of relocating the residents. So, by the time of the actual relocation a total of 22 of the residents were working with a mental health program. Six months after the closing of Welcome House, all but one of the 22 have continued with services, and many have developed full service treatment plans including a range of mental health and rehabilitative programming.

Of the 4 who never entered the mental health system, half did not qualify for services. All did successfully find housing at the time of the facility closing. All but one continues in stable housing six months later.

The type of housing obtained by the residents when they relocated varied. It can be summarized as follows; 10 went to room and board homes, 6 moved to independent living, 2 moved to a Residential Rehabilitation Program (RRP), 2 moved to a DSS Project Home site, 2 moved to a transitional housing program, 2 moved in with family, 1 was involuntarily hospitalized, and 1 had unknown housing arrangements. Some arranged to move to board and care homes together. This appeared to help ease the stress. One of the pleasant surprises was the move of 6 individuals to independent living. Within this group some arranged to share a home; again helping them to maintain their sense of connectedness. Others either rented a room, apartment, or choose to reside in a motel. Additionally 2 moved to a transitional housing program together, and 2 moved to a Residential Rehabilitation Program (RRP) together. As a group, those who moved to an independent housing arrangement, as well as those moving to transitional housing or a RRP would seem to indicate a positive relocation. That is, they are now in settings requiring a more growth oriented community involvement, and self-reliant community integrated life-style than Welcome House encouraged.

In conducting the follow-up survey, it can be said that on the whole the residents' housing arrangements have remained stable, or improved. Sixty-five percent (17) remain in the housing they obtained immediately following the closing of the Welcome House. Thirty-five percent (35%) of the former Welcome House residents have moved a second time since the house closing.

The second relocation may be described as follows:

1 person has moved from an independent arrangement to transitional housing,

1 was discharged from the hospital to a board and care,

1 moved out of his family's home to an independent shared housing arrangement,

1 moved from his family's home to Project Home,

2 went from a transitional arrangement (long-term shelter) to a room and board home,

1 moved from a room and board setting to an independent living arrangement,

1 moved from an independent arrangement to a room and board, and

1 person went from an independent living arrangement to a mission.

(Note: This person was not a mental health consumer, but abuses alcohol. While intoxicated he become physically aggressive toward his housemate which necessitated police involvement.)

Overall, the Welcome House relocation was a success. In conducting the follow-up survey encouraging stories were told about new opportunities utilized by the residents. For instance, at least one person has begun an employment training program, and several have begun attending psychiatric rehabilitation programs. Everyone has been afforded decent stable housing with an adequate availability of food, heat, operational toilets, and running water. Several people who are now house sharing said they were going to get a Christmas tree for the first time this year; and that they just didn't realize when they moved that things were going to be better than ever!

Success was achieved through the willingness of multiple Baltimore City agencies and health and mental health providers to work cooperatively with individuals to achieve what turned out to be shared goals.