• Report in PDF format
• Executive Summary
• Preface
• Introduction
• Background
• Promoting Independence Advisory Committee
• 2010 Promoting Independence Plan Recommendations
• Promoting Independence and Relocation Snapshot Data
• Interest List Funding
• Community Services 2012-2013 Funds and 2012-2013 Requested Funds and Average Monthly Caseloads
• Legislative Appropriations Request Exceptional Items
• 2008 Promoting Independence Plan Status Update
• Children's Issues
• Housing Issues
• Workforce
• Grants/Innovations Supporting Promoting Independence
• Conclusion
• Appendix A
• Appendix B
• Appendix C
• Appendix D
• Appendix E
• Appendix F
• Appendix G
• Appendix H
• Appendix I
• Appendix J
• 2010 Revised PI Plan home

• Doing business with DADS home

Other DADS resources

• Help for Texans
• Learn about DADS
• Doing business with DADS
• Rules and statutes
• DADS home

Appendix H

Promoting Independence Advisory Committee
Department Activity Report
FY 2010 Summary Report

Department Name: Department of State Health Services
Date: August 18, 2010
Legislation/Rider Update: HHSC Special Provisions for all Agencies, Sec. 52. of the 81st Legislative Session (Waiting List for Children’s Community Mental Health Services)
Rider 65 of the 81st Legislative Session (Transitional and On-Going Community Mental Health Services)

2010-2011 Promoting Independence Plan Directives:

1. Requires legislative direction and/or appropriations.
If directed and/or funded by the Legislature, HHSC will work with the Department of Aging and Disability Services (DADS), the Department of State Health Services (DSHS), and the Department of Assistive and Rehabilitative Services (DARS) to reduce community-based interest/waiting lists

This will be added as an addendum when received.

2. Requires legislative direction and/or appropriations.
If directed and/or funded by the Legislature, HHSC will work with DSHS to implement a fully funded Assertive Community Treatment (ACT) service package as part of the Resiliency and Disease Management (RDM) program.

• As of May, 2010, there were 3,620 adults readmitted three or more times in 180 days since the fiscal year 2001 (over the ten year period), with 1,480 receiving RDM services.
• 85.8% of these 1,480 received the same service package as that recommended by the uniform assessment.
• Also, as of May 31, 2010, there were 283 children or adolescents readmitted three or more times in 180 days since fiscal year 2001, with 64 receiving RDM services.
•  87.5% of those 283 received the same service package as recommended by the uniform assessment.

3. Requires legislative direction and/or appropriations
If directed and/or funded by the Legislature, HHSC will work with DSHS to provide services and supports for individuals leaving the state mental health facility (state hospital) system.

• Year to date, (Q3 of FY 2010) 49,502 individuals have been served in Crisis Outpatient services. This is a 190% increase over the Q3 target measure.
• As of May 31, 2010, 14,824 persons have been served in Crisis Residential Services, which is 106% of the projected Q3 target.

Topics of Interest (ongoing issues/projects):

The Department of State Health Services conducted the following monitoring activities:

• Monitored the number of individuals in State Mental Health Hospitals (SMHHs), with an average daily census of 2,358 as of May 31, 2010 and 14,912 projected total admissions during fiscal year 2010.                       
• Monitored the number of individuals hospitalized in SMHHs for more than one year, with 625 patients as of May 31, 2010. Of these, 538 need continued hospitalization, 19 have been accepted for placement, 42 have a barrier to placement, and 26 have court involvement. There were no persons under the age of 18 that have been hospitalized more than a year. There continue to be increases in the number of forensic patients hospitalized for more than one year from 311 (May 31, 2009) to 375 (May 31, 2010). There also continues to be increases in the number of civil patients hospitalized for more than one year from 235 (May 31, 2009) to 250 (May 31, 2010).
• Monitored individuals in SMHHs who are deaf and hard-of-hearing. There have been no more than three patients who are deaf or hard-of-hearing in an SMHH over one year as of May 31, 2010. This data is not reported as part of the PIAC quarterly report but is maintained and is sent to Advocacy Inc. biannually.
• Monitored the number of individuals admitted to psychiatric hospitals (both SMHHs and community hospitals) three or more times in 180 days. As of May 31, 2009 there were 160 individuals admitted three or more times (State funded community hospitals are included in the data). As of May 31, 2010 there were 163 individuals admitted three or more times. This is attributable to crisis redesign and resiliency and disease management.

YES (Youth Empowerment Services) Waiver

The 78th and 79th Texas Legislatures directed HHSC to “develop and implement a plan to prevent custody relinquishment of youth with serious emotional disturbances (SED),” and authorized the request of any necessary waivers from the federal government.

CMS approval of the waiver project occurred in February, 2009

• Staff were hired to operate the program (April, 2009)
• Staff developed a website to provide information and outline program specifics (July, 2009)
• MCAC and DSHS Council approved program rules (Aug, 2009)
• Rates approved by MCAC and DSHS Council (Aug, 2009)
• Developed an open enrollment application for potential YES providers (May, 2009)
• Developed credentialing criteria for YES providers (May, 2009)
• Held stakeholder educational forums (May, 2009 – Present)
• Developed policy and procedure manual for program operations (May, 2009 – Present)
• Developed plan of care, billing, and encounter data collection systems for providers (Sept, 2009)
• Developed, negotiated, and entered in to MOUs with LMHAs to perform local administrative functions associated with the waiver program (Aug, 2009)
• Developed, negotiated, and entered into waiver provider agreements with community centers for waiver service provision (Feb, 2010)
• Developed, negotiated, and entered into contract with Children’s Partnership for wraparound training contract with waiver provider staff (April, 2010)
• Initiated program operations on April 1, 2010
• Developed a participant handbook for distribution to YES participants and families (June, 2010)
• Developed a performance reporting template to be shared with stakeholders to inform them of program performance (June, 2010)
• Working with TMHP on IT automation changes that will include YES participant plans of care authorization and claims processing (March, 2010 – Present)
• 60 individuals registered on the Travis County interest list
• 48 individuals registered on the Bexar County interest list
• Thirteen participants currently are enrolled

Money Follows the Person Behavioral Health Pilot (MFP BH)

The Money Follows the Person Behavioral Health Pilot (Pilot) in Bexar County (San Antonio) helps individuals with co-occurring physical and mental health/substance abuse conditions leave nursing facilities to live independently in the community. Two pilot services, Cognitive Adaptation Training (CAT) and substance abuse counseling, are currently provided by the local mental health authority. CAT is an evidence-based service designed to empower participants who have been dependent and institutionalized to improve or regain skills in managing daily activities. Examples of Pilot participants’ increasing independence include obtaining paid employment; volunteering at the nursing facility where the participant formerly resided; obtaining a GED; attending exercise or computer classes; and working towards a college degree. Lack of affordable, appropriate housing continues to be the major barrier in deinstitutionalizing pilot candidates. Significant accomplishments for FY 2010 include:

• Relocated over 60 adults to the community from nursing facilities in Bexar County
• Demonstrated positive outcomes including –
• 88% of individuals successfully have maintained independence in the community
• Individuals served demonstrated improvement as assessed by the Multinomah, which is a clinically validated tool that assesses how people with psychiatric disabilities function in the community.
• Examples of success include operating a vehicle to commute independently, obtaining paid employment, volunteering at the nursing facility where the participant formerly resided, obtaining a GED, attending exercise or computer classes, and attending classes to obtain a college degree
• Developed plans to expand Bexar MFP Behavioral Health project to Guadalupe, Wilson, and Atascosa Counties
• Developed plans to expand to Travis County—developing contracts with UTHSC-SA and Austin/Travis Integral Care to provide interventions
• Developed plans to include state psychiatric facility residents in Bexar Pilot, utilizing General Revenue funds to provide Pilot services, and leveraging relationships/resources to coordinate Medicaid STAR+PLUS services.
• Developed proposal to expand behavioral health administrative and evaluative activities related to MFP beginning in FY 2011, and obtained CMS approval for 100% federal funding

Independent Living Contract

• Provided relocation services through the following programs: Section 8 vouchers, Project Access Voucher, tenant-based rental assistance program vouchers, and STAR+PLUS HMO services
• Partnered with community stakeholders in Aransas, Bee, Calhoun, Jim Wells, Kleberg, Nueces, Refugio, San Patricio, and Victoria Counties
• Training, outreach, and coordination took place with HMO relocation staff, behavioral health and housing agency personnel, local community transition teams, and community resource coordination groups

Mental Health Transformation Grant

A full description of the Comprehensive Mental Health Plan and progress toward its goals is available at www.mhtransformation.org the following summarizes progress made in the third quarter of FY 2010.

• Competed for and won an award for a jail diversion grant that focuses upon identifying and treating trauma experienced by veterans. Developed a draft strategic plan for implementation of the Jail Diversion and Trauma Recovery grant that focuses on identifying and treating the trauma experienced by veterans
• Conducted training of peer specialists under contract with Via Hope, utilizing services from Appalachian Consulting. The training was the first in the country to devote a full day to “Whole Health” and to set a health goal
• Initiated a “Learning Community” in January, 2010, for organizations interested in initiating or enhancing the use of peer specialists
• Initiated a Supported Employment Learning Community with state and local partners
• Implemented a project to train clinicians to serve children and adolescents utilizing Trauma-Focused Cognitive Behavioral Therapy
• Implemented MHT online to improve networking and community development opportunities for consumers, youth, and family members
• Implemented a program to fund communities across Texas to support returning veterans and their families. Trained 94 therapists to provide Cognitive Processing Therapy for PTSD. Trained 75 veterans to conduct veterans’ peer-to-peer groups. Trained 20 facilitators to conduct Operation Resilient Families groups, which is a family-to-family peer support model for those who are experiencing deployment.

Supported integrated mental health and primary healthcare through consultation and training of LMHAs and FQHCs.

Follow-Up From Previous PIAC Request:

Relevant Meeting Notices:

Note: Please note that due to grace periods in the submission of encounter data by funded community mental health centers to DSHS, the values listed in this report do not freeze until 37 days after the last day of FY 2010 Quarter 3 (May 31, 2010), namely on/after July 7, 2010.

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Updated: May 24, 2011