Joint Finance Committee Hearing Fiscal Year 2016 Gerard Gallucci, M.D. MHS Acting Division Director February 26, 2015 Department of Health and Social Services Division of Substance Abuse and Mental Health

Delaware Health and Social Services DSAMH 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/Administration, the Delaware Psychiatric Center (DPC), and a variety of community mental health, substance use disorder, and gambling services

Delaware Health and Social Services Accomplishments FY 14 USDOJ Settlement Agreement DE has met substantial compliance in all but three of the of the Settlement Agreement Targets. There are three targets that have met partial compliance: 30% Reduction of Bed Days, Risk Management and Fidelity of ACT Teams. 356 Mental Health Screeners, including Emergency Department Physicians and other behavioral health professionals have been trained/certified & are in a variety of settings. They provide first level assessment services regarding an individual’s need for involuntary hospitalization or referral to other services.

Delaware Health and Social Services Accomplishments FY 14 USDOJ Settlement Agreement The Mobile Crisis Teams (NCC & Kent/Sussex) continue to exceed their response time target (1 hour) & average 45 minutes per call. There are a variety of housing options for clients with Serious and Persistent Mental Illness:  State Rental Assistance Voucher(SRAP) and 811 Project Demonstration Program both are partnerships with Delaware State Housing Authority  Supervised Apartment Program  Group Homes  Transitional Housing  Crisis Beds (3 to 5 days)  Resource/Respite beds The Peer Programs throughout the state continue to expand. Peer supports are now provided as part of a new Problem Solving Court in New Castle County.

Delaware Health and Social Services Accomplishments A Medicaid & DSAMH partnership facilitated revisions in the Delaware Medicaid State Plan to expand federal funding for behavioral health services.

Delaware Health and Social Services Accomplishments Substance Abuse System Re-Design is underway. The American Society of Addiction Management (ASAM) guidelines have been adopted to guide services, level of care determinations, and expected outcomes. Contracts for the re-designed Comprehensive Behavioral Health Outpatient Treatment Programs have been finalized. This model will provide a better coordination of care throughout an individual’s journey to recovery. Contracts for the re-designed Withdrawal Management Programs are being finalized.

Delaware Health and Social Services Residential SUD Services Currently DSAMH contracts for 78 beds on the Governor Bacon Campus (Gateway). The program must be relocated as the campus will be used for other purposes. This has allowed for us to re-think and re- design our residential treatment programs.

Delaware Health and Social Services Residential SUD Services The re-design and additional funding in the FY ‘16 GRB will result in: 47 beds (for men) will be moved to a renovated facility on the Delaware Hospital for the Chronically Ill campus bed treatment facilities across the state. These programs will serve a total of 63 males and 32 women. Increase of 17 beds.

Delaware Health and Social Services Sober Living Residential Beds Formerly known as half-way houses. These programs offer recovery supports in addition to housing. Currently we have 60 beds and have requested funding for 60 more in FY ‘16. We continue to explore another intermediate treatment level (Recovery Residence Level 3) of treatment homes to add to the treatment continuum.

Delaware Health and Social Services Young Adult Residential Opiate Treatment Program Currently one program in operation providing 15 beds. Expansion in FY ‘15 to 16 beds. With the funding proposed in the GRB, we would add a second program for 16 beds.

Delaware Health and Social Services Accomplishments Another Medicaid & DSAMH partnership resulted in CMS approval of the new PROMISE program, to leverage additional federal funding to provide an array of services to individuals residing in the community, who have Serious and Persistent Mental Illness and/or other diagnostic criteria.

Delaware Health and Social Services PROMISE Promoting Optimal Mental Health for Individuals through Supports and Employment

Delaware Health and Social Services PROMISE - Its Goals To provide an array of community based services. To meet the USDOJ requirement that individuals be provided mental health services in the most appropriate setting. To ensure that the services provided to individuals through PROMISE meet the individual’s needs. To ensure that the health and safety of PROMISE participants are maintained. To both leverage federal funding and to assure that the services provided are value based and cost effective in meeting the individuals needs.

Delaware Health and Social Services PROMISE — Services and Supports PROMISE will offer individually-tailored, community-based, and recovery-oriented mental health services to help individuals live independently in the community: Care Management Individual Employment Supports Short-Term Small Group Supported Employment Financial Coaching Benefits Counselling Peer Support Non-Medical Transportation Community- Based Residential Supports, Excluding Assisted Living Nursing Community Psychiatric Support and Treatment Psychosocial Rehabilitation Respite Independent Activities of Daily Living/Chore Personal Care Community Transition Services

Delaware Health and Social Services Community Treatment Teams

Delaware Health and Social Services Crisis Walk-In Center

Delaware Health and Social Services Crisis Calls

Delaware Health and Social Services US DOJ Settlement Agreement Housing Vouchers Generated By Year

Delaware Health and Social Services FY ‘14 Peer Support Services – Contacts Note: Numbers include phone and in-person contacts (including walk ins). Contacts are duplicative across clients

Delaware Health and Social Services Supported Employment

DPC Annual Average Daily Census FY 2008 – FY 2014 Delaware Health and Social Services

Reallocation of Resources from Facility-Based to Community: Efficiencies DSAMH FY ‘15 Expenditures DSAMH FY ‘10 Expenditures

Delaware Health and Social Services FY ‘16 Governor’s Recommended Budget Substance Use Disorder Withdrawal Management*$ Sober Living Residential Programs$ Young Adult Residential Treatment/Opiate$1,150.0 Residential Treatment$ Subtotal$3,635.0 One-Time Funds$ Total$4,450.0 *Additional $950.0 structurally transferred to DSAMH for Withdrawal Management from the Office of Management & Budget

Delaware Health and Social Services FY ‘16 Governor’s Recommended Budget USDOJ Requirements Assertive Community Treatment (ACT)$ Crisis Services$ Targeted Case Management$ Supported Employment$ Housing Vouchers$1,125.0 Peer Supports$ Total$3,214.0

Delaware Health and Social Services Thank you very much for your continued support Behavioral Health (MH/SA) is essential to overall health Prevention Works Treatment is Effective People do Recover