Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families, and Advance Personal and Family Recovery and Resiliency. Charlie Crist, Governor George H. Sheldon, Secretary Presentation to Florida Alcohol and Drug Abuse Association Board David Fairbanks, Assistant Secretary for Programs David Sofferin, Assistant Secretary for Substance Abuse and Mental Health November 18, 2010

Why Services Integration? Needs of families are more complex and require multiple system responses Achieve better outcomes with families that have multiple needs Broaden the base of community support for children and families 2

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Integration of Services Leadership Team Key Partners -Florida Alcohol and Drug Abuse Association -Florida Council for Community Mental Health -Community Based Care Agencies & the Magellan Partnership -Florida Coalition for Children -Department of Children and Families Assistant Secretaries for Administration, Operations, Programs and Substance Abuse and Mental Health Purpose: To promote an integrated service delivery approach across child welfare, mental health and substance abuse systems 4

Integration of Services Leadership Team Three Committees: Financing: to identify opportunities for maximizing available funding mechanisms Organizational & Policy: To identify systemic issues and opportunities to promote integration (e.g., – contracting, performance measures & policies) Practice: to develop core shared practice expectations and advance a team-based planning and decision- making model 5

Integration of Services Resource Page: Center for the Advancement of Child Welfare Practice Purpose: Purpose: To provide a single web-based access point for various resources related to Integration of Services Initiative. Content includes: Meeting agendas and minutes, practice framework and other related leadership team documents Evidenced-based best practices and job aides National resources, presentations, peer-reviewed empirical literature and research Serv/Forms/AllItems.aspx 6

Integration of Services Training Series An intensive classroom and activities based in-services training curriculum for child welfare and related professionals Developed by the Department’s Family Safety Program through a contract with Florida State University Center for Prevention and Early Intervention Policy in Spring 2010 A panel of state and national level subject matter experts, including provider representation (e.g., – National Center for Substance Abuse and Child Welfare and Operation PAR) were used for curriculum content and guidance Builds on concepts from the statewide Family Centered Practice training and has a specific focus on practice issues related to engaging and teaming with families and providers Includes four content specific modules: substance abuse; mental health, domestic violence and health / developmental issues, as well as, multi-disciplinary teaming Implemented statewide via “train-the-trainers” in Summer 2010, with a second wave of statewide implementation planned for

Integration of Services Capacity Instrument A survey of local stakeholders to assess values and perspective as to level of collaboration occurring across the service delivery system –Modeled after an Instrument developed by the National Center for Substance Abuse and Child Welfare. Florida’s Capacity Instrument was developed in partnership with the NCSACW and with feedback from the Leadership Team –Respondents will include child welfare, substance abuse, court / legal & other providers from the frontline and administrative / managerial perspective –Intended to provide feedback for understanding of context, readiness for change and for strategic planning purposes –Format will be electronic; circulated via and web-based data collection (e.g., – Survey Monkey) 8

Integration of Services Capacity Instrument Major Domains of the Survey: 1.Understanding values and principles of collaborative relationships 2.Practice components 3.Organizational Issues 4.Budgeting and program sustainability 5.Strengths and barriers to integration of services 9

Integration of Services Capacity Instrument After the Survey… Present results to team and discuss findings Prioritize opportunities for improvement Develop Action Plan Re-administer survey in 18 months to measure progress 10

CM & Family working to Coordinate and lead services while Advocating for those not available Begin assessment & understanding of child and family Assemble team to continue assessment Use a family teaming process to develop individual plan Implementation of plan with strategies for behavioral change Monitor progress and evaluate results in terms of outcomes Adapt services through ongoing engagement assessment and planning Engage a Child & Family in Need => ENTRY EXIT THROUGH CASE CLOSURE =>when safety, stability, permanency, well- being needs met A Practice Model Framework & Core Practice Functions 11

Update on Co-Occurring Initiative Year 3 New Contract Requirement - Use of COMPASS and CODCAT Department hosted 8 regional meetings – 600+ participated Co-occurring Steering Committee – venue for feedback Ziapartners, Inc. – one more year – training, technical assistance Created an OPS position to lead co-occurring initiative 12

Substance Abuse and Mental Health Advisory Council Charge: To provide a consumer/family/community viewpoint on policies, programs and services for individuals served by SAMH. Advisory Council will recommend strategies for service reinvestment to avoid: –Costly and inefficient deep-end services; and –Long-term adverse economic and social consequences. 13

Advisory Council will advise Secretary/Assistant Secretary on community-based behavioral health care services that address: –federal healthcare reform legislation –integration of behavioral and primary healthcare –best practices –involvement with juvenile/adult justice system –supportive employment and supportive housing –integration of SAMH with other DCF programs 14 Substance Abuse and Mental Health Advisory Council

Advisory Council Membership includes Substance Abuse representatives Upcoming Advisory Council Meeting –February 18 th 15 Substance Abuse and Mental Health Advisory Council

Results of State Mental Health Facilities Workgroup Charge: To conduct a review of state mental health treatment facilities. The workgroup was directed to address: –Leadership –Problem-solving –The current management and admission process for forensic and civil consumers –The integration of state-operated and private hospital systems –The financial and human resource management systems –Emergency preparedness –Length of stay 16

Results of State Mental Health Facilities Workgroup Membership: Broad-based, facility and community representation, including providers and other non-DCF Six (6) Meetings Held: August – October 2010 Final Report Major Recommendations: –The creation of a Director of State Hospital Operations to manage the operations of all of the hospitals from a system of care perspective. –Development of a resident classification system for evaluating resident needs. 17

Results of State Mental Health Facilities Workgroup Final Report Major Recommendations (con’t.): –Development of a plan and budget that gradually and systematically increases community placements and reduces hospital capacity. –Evaluation of the potential utility of common internal systems and procedures in human resources, purchasing, pharmacy, materials management, and maintenance. –Development of a strategic plan that moves the state to an integrated system of care. –Identification of short and long term solutions to integrate hospital data management systems, including electronic health records. –Ensuring the Substance Abuse Program is included in prevention, treatment, and recovery of residents in the hospitals. 18

Results of State Mental Health Facilities Workgroup Final Report Major Recommendations (con’t.): –Identification of a common organizational structure, with common job classifications, for use at each state operated hospital. –Identification of a data-driven, industry based, and defensible staffing model and normal staffing ratios to ensure staff and patient safety and required care levels to meet the hospital’s statutory mission. Next Steps: Action plan under development Final Report and all materials available at: 19

Feedback from Fingerprinting / Screening Provider Requests Assisted providers from Florida Council/FADAA with delays in screening results Variability in response times (few days to 2 months) Concern about lack of responsiveness from Background Screening Units Of the 18 individuals referred by Florida Council/FADAA:  8 were cleared  8 were provider omissions/errors  2 were in process of being disqualified (extended review times) 20

Feedback from Fingerprinting / Screening Provider Requests Response generally within 1-2 days of request Lessons Learned: –If more than 30 days, submit data or status of applicant’s screening and ask for assistance –Verify accuracy of employee information; include OCA# –Ensure provider contact information – , address, phone contacts up-to-date 21

Good News – Expansion of Community SAMH Capacity New Cycle of Criminal Justice, Substance Abuse and Mental Health Reinvestment Grants (SA/MH) with emphasis on diversion from justice systems $2.8 million per year $8.6 million 3 years $17.2 million total funds including county match over 3 years 14 Total Grants  Expansion grants – 5 counties  Implementation grants – 9 counties 22

Community Behavioral Health Integration Team Legislative Budget Request PURPOSE: Reduce impact of substance use and/or mental health disorders on Florida’s families involved with the Child Welfare System Protect Florida’s children from abuse, neglect, violence, or exploitation This issue is aligned with Department’s priority of integrating behavioral health services with the Child Welfare System. 23

Community Behavioral Health Integration Team Legislative Budget Request (cont’d.) To assist parents in becoming drug free and stable in order to provide appropriate and safe care for their children To identify mental health needs of children early, and whenever possible, avoid referrals to deep end, more costly treatment services 24

Community Behavioral Health Integration Team Legislative Budget Request (cont’d.) The Substance Abuse Family Intervention Specialists (FIS) workers will: –Coordinate services across the CBC lead agencies and the Community Behavioral Health Integration Teams 25

Community Behavioral Health Integration Team Legislative Budget Request (cont’d.) IMPLEMENTATION OR UTILIZATION STRATEGIES - The Behavioral Health Integration Teams will: –Collaborate with CBC lead agency to provide specialized services as an adjunct to the CBC Family Safety Case Plan. –Expand the existing capacity of the Family Intervention Specialists (FIS) under contract throughout the State. –Be contracted with licensed or certified, private, not-for-profit Substance Abuse and Mental Health (SAMH) agencies throughout the State. 26

Community Behavioral Health Integration Team Legislative Budget Request (cont’d.) Eight (8) Community Behavioral Health Integration Teams will: –Offer Intensive In-Home Behavioral Health Services to engage parents in seeking services –Conduct Evidence-Based Clinical Assessments –Increase Access to Clinical Treatment and Recovery Support Services 27

Community Behavioral Health Integration Team Legislative Budget Request (cont’d.) $4,454,601 – 8 Teams at $556,825 direct services funds per team Includes one Substance Abuse Headquarter position to coordinate/integrate team services across Substance Abuse, Family Safety, Mental Health and Domestic Violence with non-recurring expenses of $3,898 Total Cost of Issue $4,458,499 Joint funding from SA/MH Program Offices No cost share is projected from Family Safety or the CBC Agencies 28

Community Behavioral Health Integration Team Legislative Budget Request (cont’d.) PROPOSED OUTCOMES FAMILY REUNIFICATION –50% families removed due to substance use/mental disorders will be reunited upon case closure ACCESS TO BEHAVIORAL HEALTH TREATMENT –60% of individuals needing substance abuse and/or mental health services in the FS Case Plans will receive services SUCCESSFUL COMPLETION OF TREATMENT –68% of the individuals receiving SA/MH services will successfully complete treatment 29