Joint Finance Committee HearingFiscal Year 2016

Gerard Gallucci, M.D. MHSActing 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 14USDOJ 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 14USDOJ 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.

• 3-16 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 SupportsPROMISE 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 TransitionServices

Delaware Health and Social Services

Community Treatment Teams

TCM ACT ICM Wait List0

200

400

600

800

1000

1200

1400

1600

251

864

470

41

701

806

618

34

1093

1403

199153

FY 2012

FY 2013

FY 2014

Delaware Health and Social Services

Crisis Walk-In Center

FY14 Jul-14 Aug-14 Sep-1476

77

78

79

80

81

82

83

78.7

81.281.8

82.4

Hospital Diversion RatesFY 14 and 1st Quarter FY 15

RRC Diversion RateLinear (RRC Diversion Rate)

Nu

mb

er o

f C

lien

ts

Delaware Health and Social Services

Crisis Calls

Jul-14 Aug-14 Sep-14 Oct-14 Nov-140

500

1000

1500

2000

2500

3000

SUD Calls

Crisis Calls

Delaware Health and Social Services

US DOJ Settlement Agreement Housing Vouchers Generated By Year

0

50

100

150

200

250

FY11 FY12 FY13 FY14 FY15

Num

ber o

f Clie

nts

HUD Housing ChoiceVouchers

CRISP

SRAP Vouchers

Grandfathered

Delaware Health and Social Services

FY ‘14 Peer Support Services – Contacts

Trauma Peers, 1687

Community Peers, 7307

DPC Peers, 1276

Mental Health Court Peers, 224

Note: Numbers include phone and in-person contacts (including walk ins). Contacts are duplicative across clients

Delaware Health and Social Services

Supported Employment

FY 12 FY 13 FY 14 FY 15 (Target)

0

200

400

600

800

1000

1200

238

569663

1100

Clients Receiving Supported Em-ployment Services FY 12 to FY 15 (Tar-get)Linear (Clients Receiv-ing Supported Em-ployment Services FY 12 to FY 15 (Target))N

um

ber

of

Cli

ents

DPC Annual Average Daily CensusFY 2008 – FY 2014

Delaware Health and Social Services

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 20140

50

100

150

200

250232

204 200

162

146136

112.6775

Nu

mb

er

of

Clie

nts

Delaware Health and Social Services

Reallocation of Resources from Facility-Based to Community: Efficiencies

DSAMH FY ‘15 ExpendituresDSAMH FY ‘10 Expenditures

41%

57%

3%

Delaware Psychiatric Center

Community Services

Community Mental Health Inpatient

27%

71%

2%

Delaware Psychiatric Center

Community Services

Community Mental Health Inpatient

Delaware Health and Social Services

FY ‘16 Governor’s Recommended Budget

Substance Use DisorderWithdrawal Management* $ 750.0

Sober Living Residential Programs $ 935.0

Young Adult Residential Treatment/Opiate$1,150.0

Residential Treatment $ 800.0

Subtotal $3,635.0

One-Time Funds $ 815.0

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) $ 954.0• Crisis Services $ 760.0• Targeted Case Management $

100.0• Supported Employment $

100.0• Housing Vouchers

$1,125.0• Peer Supports $ 175.0

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 WorksTreatment is EffectivePeople do Recover