Department of Health and Social Services Division of Substance Abuse and Mental Health

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

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

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

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

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

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

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

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

9. DSAMH Services 2010 – 2012 Break-out

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

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

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

13. Individuals Receiving Behavioral Health Services (Primary Mental Health)Fiscal Years 2009 through 2011 (duplicated across categories)

14. Individuals Receiving Addiction Services Fiscal Years 2009 through 2011 (duplicated across categories)

15. FY 09 through FY 11 InpatientDetoxification Admissions by County

16. DSAMH Funded Contract Psychiatric InpatientFY 09 - FY 12

17. Supported Employment

18. DPC Trends/Projection in Staff FTE’s compared with total Staff Costs

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

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

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

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

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

24. Governor’s Recommended Budget US DOJ Specifics

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

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

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

28. Thank you very much!