Local Plan Template

October, 2012 Consolidated Local Service Plan (CLSP) Template

Component: 140 LMHA: Spindletop Center

Mental Health Services and Sites  In the table below, list sites operated by the LMHA (or a subcontractor organization) that provide mental health services using DSHS and Medicaid funds. Include clinics and other publicly listed service sites; do not include addresses of individual practitioners, peers, or individuals that provide respite services in their homes.  To add additional bullet points, press “Enter” on your keyboard after completing the first bullet point.  List the specific mental health services and programs provided at each site, including whether the services are for adults, children, or both (if applicable): o Screening, assessment, and intake o Crisis Residential o Full levels of care (FLOC): adults, children, or o Contracted Inpatient both o Respite o Selected levels of care (specify the levels): adults, o Crisis Stabilization Unit. children, or both o Other (please specify) o Extended Observation

Operator (LMHA or Street Address City Zip Services & Populations Contractor Name) LMHA 2750 South 8th Street Beaumont 77701  Screening, Assessment, & Intake - Adults & Children FLOC - Adults & Children LMHA 3407 57th Street Port Arthur 77640  FLOC - Adults & Children LMHA 4305 North Tejas Parkway Orange 77630  FLOC - Adults & Children LMHA 837 North Main, Suite 104 Lumberton 77657  FLOC - Adults & Children Beaumont Baptist 3080 College Beaumont 77701  Contracted Inpatient - Hospital of Southeast Adults & Children Texas Medical Center of 2555 Jimmy Johnson Blvd. Port Arthur 77640  Contracted Inpatient - Southeast Texas Adults & Children The Wood Group 2750 South 8th Street Beaumont 77701  Crisis Residential Contract - Adults Only

1 October, 2012

Operator (LMHA or Street Address City Zip Services & Populations Contractor Name) Harris County 7011 Southwest Freeway Houston 77074  Crisis Hotline MHMRA      

Community Participation LMHAs have been engaged in multiple planning activities over the past year, including those relating to jail diversion efforts, plans to reduce utilization of state hospitals, and implementation of the Medicaid 1115 Transformation Waiver. The results of these planning efforts are summarized in this Local Service Plan.

Identify community stakeholders who participated in your local service planning activities over the past year.

Stakeholder Type Stakeholder Type

Consumers Family members Advocates (children and adult) Concerned citizens/others Local psychiatric hospital staff State hospital staff Mental health service providers Substance abuse treatment providers Prevention services providers Outreach, Screening, and Referral (OSAR) County officials City officials FQHCs/other primary care providers Local health departments Hospital emergency room personnel Emergency responders Faith-based organizations Community health & human service providers 2 October, 2012

Stakeholder Type Stakeholder Type

Probation department representatives Parole department representatives Court representatives from each county (judges, DAs, Law enforcement public defenders, etc.) Education representatives Employers/business leaders Planning and Network Advisory Committee Local consumer-led organizations

List the key issues and concerns identified by stakeholders. Only include items that were raised by multiple stakeholders and/or had broad support. When you finish listing one issue, press “Enter” on your keyboard to create a new bullet point.  Improve psychiatrist access Transportation for consumers Increase community awareness of available services, with emphasis on toll-free telephone number Medical community information and awareness of Center services Continue to assist consumers with applying for Medicaid and disability benefits Dually diagnosed services – IDD / MH for adults & children Dually diagnosed services – IDD / Substance Abuse for adults & children Integration of primary physical health with behavioral health Funding support from the state and area local county commissioner courts Expand medication support services for those with mental illness Address needs of adults caring for their adult children with mental illness Expand availability of alcohol and substance abuse services in the community Mental health consumers with medical conditions needing emergency mental health services Emergency inpatient and crisis respite MH services for children and adolescents, especially those with no fund source Education and support for families Detoxification facilities, especially for children and adolescents Increase community awareness of consumers with mental illness or IDD Consistent lack of available state psychiatric hospital beds for civil admissions Extremely high rate of uninsured consumers in Southeast Texas

System-Wide Priorities: Jail Diversion Strategies Indicate which of the following strategies you use to divert individuals from the criminal justice system.

3 October, 2012

Intercept Point Components 1: Law enforcement and emergency Co-mobilization with Crisis Intervention Team (CIT) or MH Deputies services Co-location with CIT or MH Deputies Training law enforcement staff Documenting police contacts with persons with mental illness Training law enforcement staff Police-friendly drop-off point Service linkage and follow-up for individuals who are not hospitalized Other: MCOT available 24 hours to assist law enforcement on psychiatric calls

2: Post-arrest: initial detention and Staff at court to review cases for post-booking diversion initial hearings Routine screening for mental illness and diversion eligibility Staff assigned to help defendants comply with conditions of diversion Staff at court who can authorize alternative services to incarceration Link to comprehensive services Other:

3. Post-initial hearing: jail, courts, Routine screening for mental illness and diversion eligibility forensic evaluations, and forensic Mental Health Court commitments Veterans’ Court Drug Court Community Court Re-entry Court Outpatient Competency Restoration Services for persons Not Guilty by Reason of Insanity Services for persons with other Forensic Outpatient Commitments Providing services in jail for persons Incompetent to Stand Trial Compelled medication in jail for persons Incompetent to Stand Trial Providing services in jail (for persons without outpatient commitment) Staff assigned to serve as liaison between specialty courts and services providers Link to comprehensive services

4 October, 2012

Intercept Point Components Other:

4: Re-entry from Jails, prisons, and Providing transitional services in jails forensic hospitalization Staff designated to assess needs, develop plan for services, and coordinate transition to ensure continuity of care at release Structured process to coordinate discharge/transition plans and procedures Specialized case management teams to coordinate post-release services Other:

5: Community corrections and Routine screening for mental illness and substance use disorders community support programs Training for probation or parole staff TCOOMMI program Forensic ACT Staff assigned to facilitate access to comprehensive services; specialized caseloads Staff assigned to serve as liaison with community corrections Working with community corrections to ensure a range of options to reinforce positive behavior and effectively address noncompliance Other:

System-Wide Priorities: Management of Hospital Utilization Complete the check boxes to indicate which strategies you use to minimize utilization of state and community hospitals, including emergency departments. A single strategy may be applicable to multiple populations. For each strategy that you use, identify the target population(s):  Freq. State Hosp: Population with frequent state hospital admissions (ten or more psychiatric hospitalizations in the past five years with at least one admission in the past one year)  LT State Hosp: Population with long-term state hospital stays (one year or longer)  Local Hosp/ER: Population with high utilization of community hospital and emergency services for psychiatric issues (as defined by LMHA/local stakeholders)  Population on forensic commitments (Forensic)

5 October, 2012

Freq. LT Local State State Hosp/ Hosp. Hosp. ER Forensic Strategies Regular multi-agency review of data relating to admission and length of stay to identify clients with repeat admission and/or extended LOS Regular multi-agency reviews of cases with high utilization to identify contributing systemic issues and develop system improvements MCOT support for local emergency departments. Regular multi-agency review of cases with high utilization to identify and address individual client needs Multi-agency, multi-disciplinary discharge planning Outpatient case manager meetings with client during hospitalization and facilitating transition to community services Court liaisons to assist in identifying appropriate alternatives to long-term forensic commitment. Regular review of clients on forensic commitment to identify those who may be recommended for transfer to an alternative setting. Assigned liaison to facilitate discharge planning and transition to community services Identifying and transitioning clients to long term care facilities Frequent follow-up appointments during immediate post-discharge/crisis period Home visits during post-discharge/crisis period Regular telephone follow-up, especially during post discharge/crisis period Regular team staffings focused on clients with history of high utilization Regular multi-disciplinary treatment planning with community partners involved in client’s treatment and support Evaluation and intervention related to identify and address substance use issues Specialized caseload (team or individual) for clients with history of high utilization

6 October, 2012

Freq. LT Local State State Hosp/ Hosp. Hosp. ER Forensic Strategies Multi-agency action to develop and/or improve COPSD services (availability, access, level of coordination/integration, quality, etc.) Telephone or home visit (e.g., MCOT) follow-up for no-shows Home-based treatment services 24/7 access to support (warmline, on-line chat, peer sponsor, etc.) Peer specialist participation in team staffings and/or ACT team Peer support services Use of long-term injectable medication when appropriate Community Resource Coordination Groups Wellness Recovery Action Planning or other person-centered, strength-based and recovery-based approaches Housing assistance (Supported Housing, PATH outreach, housing vouchers, etc.) Transportation assistance to ensure access to services Use of token economies or other incentives Focused effort to develop and/or engage natural community supports “Hotspot” evaluation of catchment area zip codes and use of data to plan resource allocation, outreach to community partners, etc. Other:

Other System-Wide Strategic Priorities List current activities in the following areas and any plans for the next two years. When you finish entering one bullet point, press “Enter” on your keyboard to create a new bullet and form field in the same cell. For those areas not required in the DSHS Performance Contract, enter NA if the LMHA has no current or planned activities. Space is provided to note activities related to other local priorities, if applicable.

7 October, 2012

Area of Focus Current Activities Plans Implementing and  Fidelity reviews now being implemented in  Continue to implement fidelity review maintaining fidelity with all psychosocial rehabilitation and cognitive updates based on new DSHS requirements evidence-based practices behavioral therapy Transition to a recovery-  Center now has peer specialists  Piloting new intake process to more oriented system of care, incorporated into psychosocial accurately assess the global assessment of including development of rehabilitation programs functioning (GAF) peer support services and Piloting new recovery plans in supported Continue to incorporate peer specialists other consumer employment into other programs involvement in Center Peer specialists and staff attend leadership Continue to participate in peer specialist activities and operations academy training training academies (e.g., planning, evaluation) Leadership Team and Change Team Form a new leadership coalition to involved in Peer Specialist Initiative facilitate consumer involvement in Center through the Recovery Institute operations Implement recovery plan into all Center programs Community support services program will be pilot site for the Peer Specialist Initiative that is focused on integrating peer specialists in service provision on a more widespread basis - to later become a model for other units in the Center Incorporating trauma-  The Trauma-Informed Care (TIC) Core  Work with a national trauma-informed informed principles into Implementation team receives trauma- training specialist / consultant to advance care informed training principles into Center operations and into staff training Addressing the needs of  Screen all consumers for dual diagnosis of  Enter into an agreement with local consumers with co- mental illness and substance abuse behavioral health hospital to begin a new occurring substance use Refer consumers to appropriate substance detoxification program disorders abuse treatment providers Incorporate illness management and Center has staff designated as COPSD staff recovery principles into COPSD programs Integrating behavioral  Received grant from Community Health  Implement new Community Health Choice 8 October, 2012

Area of Focus Current Activities Plans health and primary care Program to begin new primary health clinic grant services and meeting Refer consumers to local county indigent Onsite internal health provider (MD), physical healthcare needs of care clinics, local FQHC, and primary care nursing support staff, laboratory services consumers. providers If approved, implement Medicaid 1115 Currently perform minimal on-site lab and transformation program included in RHP 2 EKG exams for an integrated physical health clinic Contract with outside laboratories to perform minimal lab tests Formal Agreement with primary care provider? Yes No Formal Agreement with primary care provider? Yes No Identifying and addressing  Identify veterans in need of mental health  Continue to support the veteran peer to needs of veterans services peer support group Support peer to peer veteran support group Continue to implement DSHS-funded Support monthly veteran advocacy Veteran Program network support group Utilize DSHS Veteran Program grantfor veterans Addressing diversity and  Assess cultural issues in the bio-  Continue to attempt to recruit and hire bi- cultural needs of consumers psychosocial assessment lingual staff Provide cultural diversity training for all Center staff Provide interpreters when necessary to assist consumers from diverse cultures Local Priorities (Specify): H  Based on identified lack of housing for  HUD Section 811 funding awarded for 14 ousing consuemrs with disabilities, Center has additional housing units developed and opened 26 housing units for Medicaid 1115 DSRIP program for consumers with disabilities renovation of 19 additional housing units in Jefferson and Orange counties Local Priorities (Specify): Ja  Screen all MH patients leaving local county  Provide additional training for jail staff il Diversion / Forensic jails to make appropriate referrals Investigate possibility of implementing Services Provide pre / post booking for jail diversion new mental health court 9 October, 2012

Area of Focus Current Activities Plans Staff are dedicated to provide continuity of Attempt to use more mental health care for forensic patients in state hospitals deputies Outpatient competency restoration program

Local Unmet Needs In each of the following area, list unmet service needs. When you finish entering one bullet point, press “Enter” on your keyboard to create a new bullet in the same cell.

Service Unmet Service Needs Adult Services  Detoxification Long term residential Day programs Recruit additional peer support providers Continued lack of housing Continued lack of state hospital beds Child & Adolescent  Detoxification Services Long term residential Day programs Recruit additional peer support providers Crisis Services  Psychiatric inpatient beds for violent consumers and consumers with extreme medical problems or needs Other  Lack of transportation for adults and children Lack of primary physical medical care for MH consumers Lack of private providers to serve Medicaid consumers - adults and children

Local Priorities and Plans  Based on indicators of unmet needs, stakeholder inputs, and your internal assessment, identify your local priorities for the next two years. These might include changes in the array of services, allocation of resources, implementation of new strategies or initiatives, service enhancements, quality improvements, etc. Examples of possible priorities:  Implementing WRAP  Reducing state hospital admissions 10 October, 2012

 Integrating trauma-informed principles into services  Expanding consumer/peer involvement in planning, service delivery, and evaluation  Addressing primary healthcare needs or management of chronic physical disorders  Improving access to services  Jail diversion  For each priority, identify at least one key objective and strategies/actions you will implement to achieve the objective(s).  List at least one but no more than five priorities. These may relate to projects you are implementing under the Medicaid Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver.  When you finish entering one bullet point, press “Enter” on your keyboard to create a new bullet in the same cell.

 Priority (Specify): Improve Physical Health for Consumers Receiving Behavioral Health Services Objectives Strategies/Actions  Implement a primary health care clinic on campus  Create / renovate space for clinic, hire MD, RNs, & support staff  Implement evidence-based In-Shape program on  Create / renovate space for program, develop contracts campus with local health / fitness centers, acquire equipment Hire / train program staff health mentors

 Priority (Specify): Improving Access to Service Objectives Strategies/Actions  Improve access for non-target population  Implement new structured interview process Implement improved GAF process accuracy Streamline records request process  Improve access for target population  Implement rapid cycle change plan as developed during the consultation with MTM services

 Priority (Specify): Implementing Behavioral Health Training Objectives Strategies/Actions  Implement cognitive enhancement therapy training  Hire / train program staff, create / renovate space, acquire equipment for computer lab, acquire program curriculum material, train program staff on implementing material  Implement cognitive adaptive therapy training  Hire / train program staff 11 October, 2012

 Priority (Specify): Housing for Consumers with Disabilities Objectives Strategies/Actions  Create additional affordable housing for consumers  Finalize HUD plans and agreement for Section 811 funds with disabilities Use Medicaid 1115 waiver funds to renovate additional 12 units in Orange and 7 in Beaumont  

 Priority (Specify): Improve Access to Inpatient Services for Consumers in Crisis Objectives Strategies/Actions  Implement new detoxification unit  Create partnership agreement with local behavioral health hospital  Provide inpatient crisis stabilization services for up to  Create partnership agreement with local behavioral health 30 days hospital

Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver  List the titles of all projects you proposed for implementation under the Regional Health Partnership (RHP) plan.  Identify the RHP Region(s) associated with each project.  In each of the three status columns, check Yes or No. If approval status is unknown, leave blank.

1115 Waiver Projects RHP Project Title Accepted Approved Approved Region(s) in RHP by HHSC by CMS Plan 2 NOTE: The following 9 projects have been accepted in Yes Yes Yes the RHP 2 plan (University of Texas Medical Branch at No No No Galveston). As of the submission to DSHS of this plan, Spindletop Center does not know if any of the following 9 proposed projects have been Approved by HHSC, or Approved by CMS.

12 October, 2012

1115 Waiver Projects RHP Project Title Accepted Approved Approved Region(s) in RHP by HHSC by CMS Plan 1. Behavioral Health Training (BHT) – to implement evidence based Cognitive Enhancement Therapy (CET) and Cognitive Adaptive Therapy (CAT) with target population clients. 2 2. Community Behavioral Crisis (CBC) – enhance Yes Yes Yes behavioral health services to better meet the needs of No No No people with intellectual and developmental disorders who are in crisis in a non hospital environment. 2 3. Detoxification Unit – Collaborative project with Yes Yes Yes Baptist Hospital Behavioral Health to create 10 detox No No No inpatient beds. 2 4. Extended Crisis Stabilization Unit – Collaborative Yes Yes Yes project with Baptist Hospital Behavioral Health to create No No No additional beds to keep people in crisis for up to 30 days to create increased compliance with treatment and reduce recidivism. 2 5. In Shape Program - to implement Individualized Self Yes Yes Yes Health Action Plan for Empowerment (“In SHAPE”), a No No No wellness program for individuals with mental illness. Health mentors will be hired and trained to work one-on- one with BH clients for education, planning, coaching, and measuring progress. 2 6. Housing - Create 19 affordable studio apartments for Yes Yes Yes people with serious mental illness who are homeless or No No No at risk of being homeless due to their mental illness. Existing buildings currently owned by Spindletop Center will be remodeled and refurbished to create 7 new apartments in Beaumont and 12 new studio apartments in Orange

13 October, 2012

1115 Waiver Projects RHP Project Title Accepted Approved Approved Region(s) in RHP by HHSC by CMS Plan 2 7. Primary Healthcare Integration - We will establish Yes Yes Yes additional primary care clinics by co-locating a primary No No No care physician in our behavioral health (“BH”) facilities. We will also implement a mobile clinic for integrated primary and behavioral healthcare. 2 8. Specialty Psychiatric Clinic - To increase the Yes Yes Yes availability of affordable treatment for non-target No No No population psychiatric diagnoses such as Anxiety, Depressive, Adjustment, Obsessive Compulsive and Post Traumatic Stress Disorders 2 9. Youth Respite Facility - A 16-bed term Yes Yes Yes respite/residential treatment facility for adolescents will No No No be equipped within an existing Spindletop facility Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes No No No Yes Yes Yes 14 October, 2012

1115 Waiver Projects RHP Project Title Accepted Approved Approved Region(s) in RHP by HHSC by CMS Plan No No No Yes Yes Yes No No No

15 October, 2012

Mental Health Block Grant Inventory of Services The following table identifies the components of the “Good and Modern Addictions and Mental Health Service System” defined by SAMHSA. It reflects the full range of behavioral health services, including substance abuse services and excluding IDD services. These inventories are for information only and do not define DSHS requirements. SAMHSA has posted a description of the Good and Modern system on its website: http://www.samhsa.gov/healthreform/docs/good_and_modern_4_18_2011_508.pdf.

The survey is for behavioral health services available to individuals eligible for DSHS-funded services. For each service listed:  Identify which age groups (if any) currently receive or have access to the service in your local service area, either through the LMHA (regardless of funding source) or elsewhere in the community.  Identify the approximate percent of service area in which the service is available. It is acceptable to enter the percent of counties in which the service is available.  Indicate whether the service is provided through the LMHA, through another community provider, and/or through collaboration between the LMHA and one or more community partners. Check as many columns as applicable.

Category Pop Service % of Source Area . t r l n A l e o o u H i h d t d t M A a A O L r / o d l b i a h l l C o C

Healthcare Generalized and specialized outpatient medical services 100 Home/ Physical Acute primary care 75 Health General health screens, tests, and immunization 100 Comprehensive case management 75 Care coordination and health promotion 100 Comprehensive transitional care 100 Individual and family support 50 Referral to community services 100 Prevention Screening, Brief Intervention, and Referral to Treatment (SBIRT) 100 (including Brief motivational interviews 100 Promotion) Screening, Brief Intervention, and Referral for Tobacco Cessation 100 16 October, 2012

Parent training 100 Facilitated referral 100 Relapse prevention/Wellness recovery support 25 Warm line 100 Engagement Assessment 50 Services Specialized evaluations (psychological, neurological) 25 Service planning (including crisis planning) 100 Consumer/family education 100 Outreach 100 Outpatient Individual evidenced-based therapies 100 Group therapy 50 Family therapy 50 Multi-family therapy 50 Consultation with staff/caregivers 100 Medication Medication management 100 Services Pharmacotherapy (including MAT) 100 Laboratory services 100 Community Parent/Family/Caregiver Support 100 Support Skill building (social, daily living, cognitive) 100 (Rehabilitative) Case management 100 Behavioral management 100 Supported employment 100 Permanent supportive housing 100 Recovery housing 25 Therapeutic mentoring 100

17 October, 2012

Traditional healing services Other Supports Personal care (Habilitative) Homemaker Respite Supported education services Transportation Assisted living services Recreational services Interactive communication technology devices (Technological support services) Trained behavioral health interpreters Intensive Substance abuse intensive outpatient services 100 Support Partial hospital 25 Services Assertive community treatment 100 Intensive home based treatment 100 Multi-systemic therapy Intensive case management 100 Out-of-Home Crisis residential/stabilization 100 Residential Clinically managed 24-hour care 100 Services Clinically managed medium intensity care 100 Adult mental health residential 100 Children’s mental health residential Youth substance abuse residential 25 Therapeutic foster care 100 Acute Intensive Mobile crisis services 100

18 October, 2012

Services Medically monitored intensive inpatient 100 Peer-based crisis services Urgent care services 100 23-hour crisis stabilization service 100 24/7 crisis hotline services 100 Recovery Peer support 100 Supports Peer recovery support coaching 100 Peer-operated recovery community center 100 Supports for self-directed care 100 Continuing care for substance abuse disorders 100 Relapse Prevention/Wellness Recovery Support 100 Behavioral health peer navigator