BALTIMORE MENTAL HEALTH SYSTEMS, INC.
ANNUAL REPORT FISCAL YEAR 2012
ONE-YEAR PLAN FISCAL YEAR 2014
Jane D. Plapinger, MPH John A. Gray, JD
President & CEO Board Chair
Baltimore Mental Health Systems, Inc.
Annual Report and Mental Health Plan
Table of Contents
Executive Summary .............................................................................................................5
Annual Report, Fiscal Year 2012
Introduction ......................................................................................................................9
Highlights of Accomplishments ......................................................................................9
Report of Activities ..........................................................................................................20
Goal I: Americans Understand that Mental Health is Essential to
Overall Health ..................................................................................20
Goal II: Mental Health Care is Consumer and Family Driven ...........................24
Goal III: Disparities in Mental Health are Eliminated .........................................29
Goal IV: Early Mental Health Screening, Assessment, and Referral
to Services Are Common Practice ....................................................49
Goal V: Excellent Mental Health Care is Delivered and Research is
Accelerated While Maintaining Efficient Service System
Accountability ..................................................................................57
Goal VI: Technology is Used to Access Mental Health Care Information .........79
One-Year Plan, Fiscal Year 2014
Introduction ......................................................................................................................82
Data on Service Utilization and Outcomes ......................................................................84
State Priority Areas .........................................................................................................143
Mission, Vision and Values .............................................................................................149
Goals, Objectives and Strategies......................................................................................150
Appendices
Appendix A: Glossary and Acronym Descriptions .........................................................167
Appendix B: FY 12 Quality Management Report ...........................................................175
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Executive Summary
Baltimore Mental Health Systems, Inc. (BMHS) is a non-profit agency established by Baltimore
City to perform the governmental function of managing the City’s public mental health system
(PMHS). As such, BMHS serves as the local mental health authority, or core service agency
(CSA), for Baltimore City. BMHS’ primary activities focus on: improving access to care and
expanding and improving the range of services available to Baltimore City residents with mental
illness. This is accomplished through active collaborations with City and State agencies, and
other system-level partners.
BMHS oversees a network of predominantly private, non-profit providers that deliver services to
over 43,000 Baltimore City residents who are Medicaid and/or Medicare recipients or uninsured.
The majority of public mental health system services are reimbursed through a statewide fee-for-
service system. In addition to overseeing the provision of these services, BMHS directly awards
public and private funds to support the development of innovative programs and the ongoing
operations of mental health services not reimbursable by the fee-for-service system.
During FY 12, BMHS was affiliated with two non-profit entities, Community Housing
Associates, Inc. (CHA) and the Behavioral Health Leadership Institute, Inc. (BHLI). CHA is
dedicated to developing and managing affordable housing for low-income individuals and
families in Baltimore City who are affected by mental illness. CHA owns or manages 217
housing units. BHLI (formerly Mental Health Policy Institute for Leadership and Training, or
MHPILT), the second affiliate, was established to address issues related to workforce
development in community behavioral health across disciplines, and the gap between research
findings, policy and practice. BMHS and BHLI disaffiliated as of June 30, 2012.
BMHS and the State’s 18 other CSAs are required to submit an annual report to Maryland’s
Mental Hygiene Administration (MHA) in which progress on goals delineated in the agency’s
immediately previous Mental Health Plan is described, and to develop an updated Plan based
both on progress made to-date and new opportunities. This document is BMHS’ Annual Report
for Fiscal Year 2012 (July 1, 2011 through June 30, 2012)1 and the agency’s One-Year Plan for
FY 14. The Annual Report addresses the activities and accomplishments of BMHS during FY
12, while the Mental Health Plan describes public mental health system utilization during FY 12,
strategies on eight of the State Priority Areas, and updated goals, objectives and strategies for FY
14.
The first part of the annual report is the Highlights of Accomplishments section, which presents
significant accomplishments, organized under the following headings: Expanding Prevention
1 Henceforth throughout this document, fiscal years; e.g., 2012, will be abbreviated FY 12.
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and Early Intervention, Increasing Access to Mental Health and Related Services, Improving the
Quality of Mental Health Service Delivery, Managing Public Funds, and Federal Healthcare
Reform. Some of the accomplishments noted in this section fall outside of the purview of the
plan previously created for this time period due to unforeseen opportunities and challenges, in
particular the passage of federal health care reform. Therefore, the work BMHS has begun
relative to federal health care reform is described in this section.
BMHS exercises significant authority over funds allocated to public mental health through its
coordination and oversight of the fee-for-service Public Mental Health System and its
management of a grants portfolio. In FY 12, BMHS awarded $19.6 million in grants, with 106
contracts issued to 57 provider agencies. The Report of Activities section of the annual report
provides a detailed description of programmatic activities related to these grant funds and the
related administrative activities of the agency. It identifies BMHS’ goals and associated
strategies and objectives for FY 12 and describes the extent to which the strategies were
accomplished. BMHS’ overarching goals were those put forth in New Freedom Commission on
Mental Health, Achieving the Promise: Transforming Mental Health Care in America:2
GOAL I: Americans Understand that Mental Health is Essential to Overall Health
GOAL II: Mental Health Care is Consumer and Family Driven
GOAL III: Disparities in Mental Health are Eliminated
GOAL IV: Early Mental Health Screening, Assessment and Referral to Services are
Common Practice
GOAL V: Excellent Mental Health Care is Delivered and Research is Accelerated
While Maintaining Efficient Service System Accountability
GOAL VI: Technology is Used to Access Mental Health Care Information
The one-year Mental Health Plan describes new developments in the local PMHS, utilization of
public mental health services, initiatives that promote eight of the State priority areas, and the
goals and objectives BMHS plans to focus on in the upcoming year. The Introduction provides
an update on planning relating to behavioral health integration and an overview of the Mental
Health Plan section. The Data on Service Utilization section presents summary service
utilization data for the 43,821 individuals served by the fee-for-service Public Mental Health
system and the associated $228,184,888 in expenditures. It includes a comparison of FY 12 and
previous years’ data and notes trends in individuals served, services rendered and expenditures.
Significant trends noted in the FY 12 data include:
Number of consumers served increased by 5%, while the cost per consumer decreased by 6%
Inpatient hospitalization decreased by 11%, while outpatient services increased by 5%
2 New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in
America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.
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The State Priority Areas section describes BMHS activities that advance the State’s behavioral
health priorities. The System Mission, Vision and Values for BMHS are then presented.
Finally, the Goals, Objectives and Strategies that BMHS intends to pursue in FY 14 are
presented.
There are two appendices:
Appendix A: Glossary and Acronym Description
Appendix B: FY 12 Quality Management Report
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ANNUAL REPORT
Introduction
This section of the Annual Report describes progress made during the past fiscal year. The
Highlights of Accomplishments section describes the significant and innovative achievements
that expanded prevention and early intervention, increased access to care, and improved the
quality of care, while effectively managing public funds and planning for health care reform. The
Report on Activities describes the progress made toward the goals, strategies and objectives
previously presented to MHA for FY 12.
Highlights of Accomplishments
Expanding Prevention and Early Intervention
Prevention and early intervention services aim to minimize the progression of mental disorders
and the associated personal and societal costs.
Provide Early Childhood Mental Health Services
Three thousand four hundred nine (3,409) children were enrolled in Head Start in FY 12.
Sixty-three percent (2,137) accessed mental health prevention, early identification, and/or
treatment services. Clinicians provided 339 classroom observations and 712 mental
health consultations. These Early Childhood Mental Health (ECMH) services were
provided in 11 out of 12 Baltimore City Head Start Centers. In addition, in FY 12,
clinicians implemented multiple evidenced-based practices that improved the quality of
services the children received.
One hundred two (102) out of 196 (52%) of Baltimore City public schools had clinicians
who provided Expanded School Mental Health (ESMH) services to students. Four
thousand six hundred sixty six (4,666) students received mental health prevention
services in FY 12. In FY 12, clinicians implemented multiple evidenced-based practices
that improved the quality of care the students received. Another major focus of FY 12
was BMHS’ implementation of web-based reporting, which will facilitate more accurate
data collection on the impact of services on local school children while also lowering the
burden of the reporting process on clinicians.
Train City Patrol Officers to Respond to Individuals Experiencing a Behavioral Health
Crisis - Behavioral Emergency Services Team (BEST)
One hundred sixty-two (162) patrol officers received BEST crisis intervention training in
the past year, a significant increase from last year (115 trained). BEST-trained officers
are trained to de-escalate mental health crises, minimize arrests, and decrease officer
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injury. The BEST project was successfully integrated into the training program of the
Police Department, so that all new police recruits now receive this training. Additionally,
the five agency partners signed an action plan which delineates responsibilities and
commits partners to a quarterly meeting to monitor and further develop the BEST project.
Increasing Access to Mental Health and Related Services
Increasing access to community-based alternatives to expensive, restrictive and often-
traumatizing mental health services improves outcomes for consumers and is cost-effective for
the public mental health system.
Divert Felony Defendants with Serious Mental Illness into Treatment
Defendants with serious mental illness started pleading into the Mental Health Case
Management Docket on June 1, 2011. This three-year pilot project in the Circuit Court of
Baltimore City provides mental health assessments, plans of care, monitoring and linkage
to services. Johns Hopkins Bloomberg School of Public Health was brought in to conduct
an evaluation to determine its impact in lowering arrest rates and promoting positive
mental health outcomes. As of the end of FY 12, the project had enrolled ten individuals,
with five additional individuals identified to enroll, following their completion of a six-
month residential substance abuse treatment program. The program goals are to increase
enrollment to 20 individuals and to then maintain that number at all times thereafter.
Reconnect Arrested Individuals with Mental Illness To Services
BMHS collaborated with the Department of Corrections (DOC) to restore a data-feed,
called DataLink, which identifies individuals known to the PMHS who have entered the
City jail. As of May 10, 2012, the data-feed became fully operational. On behalf of
identified individuals, BMHS contacts their most recent mental health provider to notify
them of the arrest and inform them of resources, such as the Forensic Alternative
Services Team, to reconnect the individual to community services. As of June 30, 2012,
101 notifications via email, telephone and facsimile were made to providers on behalf of
arrested individuals identified through DataLink.
Ensure Mental Health Services for Children in the Child Welfare System
Eight hundred fifty-three (853) youth who entered the Baltimore City Department of
Social Services (BCDSS) foster care system received evidence-based mental health
assessments through the Making All The Children Healthy (MATCH) program. These
assessments are part of an integrated care management unit within BCDSS, intended to
provide coordinated somatic and mental health care to children in the foster care system.
There was a 144% increase in the number of youth served (350 in FY 11); this was
attributable to: 1) FY 12 being the first full year of operation of the program; and 2) the
program expanding to include a larger age range of children.
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Expand Community-Based Services for Children and Reduce Institutionalization
BMHS worked closely with Wraparound Maryland (the care management entity for
Baltimore City), and ValueOptions® to enroll 82 youth in the Psychiatric Residential
Treatment Facility Waiver. This is more than double the 41 youth enrolled in FY 11, as
FY 12 was the first full year of implementation for this program. Through the waiver
program, these children received a higher level of care in a community-based setting and
avoided placement in a more restrictive residential treatment environment.
In an effort to expand the continuum of community-based services available to youth in
the foster care system, BMHS coordinated efforts with Baltimore City's Department of
Social Services (BCDSS) to blend family-driven, evidence-based practices within mental
health and child welfare for 81 children and adolescents with complex behavioral health
needs. Services provided focused on improving each child’s individual social,
emotional and behavioral health outcomes. This initiative was funded by a Substance
Abuse Mental Health Services Administration (SAMHSA) grant, titled Maryland Crisis
and At Risk for Escalation diversion Services for children (MD-CARES).
Expand the Continuum of Crisis Services for Individuals Experiencing a Behavioral Health
Crisis
BMHS developed and began to implement a plan to reduce City expenditures on
psychiatric hospitalization by $6 million, or about 15%, in response to the cost
containment item in the FY 13 State budget. BMHS’ plan is comprised of four
components: 1) communication and collaboration with emergency departments; 2) divert
to community-based services in lieu of inpatient admission; 3) reduction in 30-day
hospital readmissions; and 4) reallocation of funds to a provider that can coordinate care
for consumers visiting the emergency rooms and those who are identified as high cost
users. More specifically:
BMHS worked closely with Baltimore Crisis Response, Inc. (BCRI), the City’s crisis
provider for adults, to increase public access to mobile crisis services by expanding
the evening hours of its crisis response teams by two hours, now operating from 7 am
- midnight. In addition, grant funding was identified at the end of the year to hire
more staff at BCRI to strengthen the coordination of crisis response services with
emergency departments with the aim of reducing avoidable hospitalizations.
BMHS worked closely with Baltimore Child and Adolescent Response System
(BCARS), the City’s crisis provider for children and adolescents, to provide
accessible urgent care to children and adolescents in lieu of avoidable and costly
hospital emergency department visits. This new initiative places BCARS clinicians in
two local hospitals where they are providing mental health assessments, stabilization
services, and immediate linkage to other services. Since this initiative began on April
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16, 2012, 32 children have been diverted from emergency departments and linked to
community-based crisis services.
Engage High-Utilizers of Mental Health Services
In the spring of 2011, BMHS participated in a state-wide symposium, Balancing Public
Health and Individual Liberties: Exploring New Options in Outpatient Treatment,
sponsored by the University of Maryland Schools of Law, Medicine, and Social Work. It
focused on the challenge of better engaging individuals with serious mental illness who
have high rates of utilization of psychiatric inpatient care. The outcome was the creation
of a committee, chaired by BMHS, to design a program that would address the shortfalls
of existing programs geared to this population. A program that would provide intensive
engagement and flexible services was designed and a grant proposal to fund it was
submitted to the Centers for Medicaid and Medicare Services (CMS). The grant request
was not funded (only 8% of submitted proposals were funded via this very competitive
grant opportunity), and efforts to secure funding will continue.
Twenty (20) consumers with recent histories of inpatient psychiatric care were linked to
an Assertive Community Treatment (ACT) team with enhanced peer staffing as part of
the Peer Support Engagement Project (PSEP), a pilot project funded by the Maryland
Mental Health Transformation State Incentive Grant. The aim of the pilot project was to
determine whether enhanced peer support would enable consumers who are at high risk
for repeated hospitalization to be served and supported in the community and thus avoid
inpatient care. An analysis of the consumers served by the PSEP showed that the
initiative reduced: 1) visits to the emergency department (24%); 2) inpatient
hospitalizations (53%); 3) days of inpatient hospitalizations (42%); and 4) PMHS costs
associated with these consumers (18%).
Reduce Homelessness Among Individuals with Mental Illness
BMHS continued to work with the Mayor’s Office of Homeless Services to implement
the City’s ten-year plan to end homelessness. BMHS is involved in ongoing planning and
collaboration with system partners and continues to provide technical assistance to
mental health outreach providers. Additionally, BMHS co-facilitates Hands in
Partnership (HIP), a coalition of City homeless outreach teams. HIP teams engaged in
1,249 visits with individuals identified as vulnerable and in need of intensive, coordinated
outreach services. These services resulted in 11 individuals being placed into housing.
Six hundred seventeen (617) homeless individuals received street outreach services and
linkage to care from BMHS’ HUD-funded outreach teams. These teams made 3,119
contacts with homeless individuals. Forty-eight (48) of these individuals were placed into
permanent housing as a direct result of this outreach.
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Promote Housing Development
In order to more efficiently address the limited housing opportunities for individuals with
serious mental illness in Baltimore City, the Boards of Directors of BMHS and
Community Housing Associates, Inc. (CHA) approved a resolution for CHA to cease its
affiliation with BMHS. The disaffiliation will enable CHA to migrate its assets into a
larger organization that can further CHA’s mission to develop and operate housing for
persons with serious mental illness and histories of homelessness in Baltimore City. The
Request for Qualifications and Interest: To Merge Community Housing Associates with a
Larger Organization was issued in February for the purpose of identifying an interested
and qualified large organization, and this process concluded in June with the selection of
People Encouraging People (PEP). The planning process continues to move forward with
CHA, BMHS and PEP.
Improving the Quality of Mental Health Service Delivery
High quality of care is associated with beneficial outcomes and a better life for individuals with
mental illness. Evidence-based practices (EBPs) are service protocols or program models whose
beneficial impacts on consumers have been validated through research. Maryland certifies
programs that demonstrate fidelity to EBPs.
Expand Access to Evidence-Based Practices
Common Elements: To better ensure that children receiving mental health services in
Baltimore City schools receive quality care, BMHS funded a year-long professional
development training for 72 Expanded School Mental Health (ESMH) clinicians to learn
and practice Common Elements of Evidence-Based School Mental Health Practices.
Common Elements takes components of interventions that have been shown in clinical
trials to be effective in treating specific disorders of childhood and adolescence, and re-
bundles those elements to allow clinicians to more effectively provide behavioral health
interventions. It is expected that children at the schools where trained clinicians are
located will receive higher quality care, because the clinicians will utilize and adapt the
new strategies and techniques learned.
Integrated Dual Disorders Treatment (IDDT): As of April 10, 2012, individuals with a
co-occurring mental illness and substance abuse disorder who were court-ordered to
receive substance abuse treatment could access integrated treatment for both disorders.
IDDT is an evidence-based practice model for treating individuals with both mental
health and substance abuse disorders. The opening of enrollment in April followed a two-
year planning process by BMHS and bSAS to develop and implement these specialized
services. Three individuals have been enrolled to date.
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Promoting Trauma-Informed Care
In FY 12, BMHS realized an opportunity to better enhance the quality of care to
consumers by using grant funds to train nine outpatient mental health clinics to develop a
trauma-informed culture within their agency. This initiative will be achieved through a
training collaborative led by the National Council for Behavioral Healthcare. Trauma-
informed care is beneficial to the majority of individuals in the public mental health
system. It is estimated that 90% of pubic mental health system consumers have been
exposed to trauma on multiple occasions.3
Use Consumer Perceptions of Care Data to Improve Care in Grant-Funded Programs*
Starting in FY 12, BMHS required grant-funded direct service programs to collect and
use consumer feedback to inform their quality improvement efforts. (Consumers’
perception of care is a nationally recognized quality measure.) These providers are
required to use their FY 12 survey results to identify an aspect of care for focused quality
improvement activity in FY 13.
Implement Quality Improvement Framework for the Capitation Project
In FY 12, to continue BMHS’ efforts in improving the quality of care for consumers
enrolled in the Capitation Project, BMHS and the two Capitation Project providers
implemented the continuous quality improvement (CQI) framework that was created in
FY 11. CQI activities focused on increasing employment opportunities for Capitation
consumers – an area that was identified as a priority by consumers in the two Capitation
programs.
Managing Public Funds
BMHS exercises significant authority over public mental health funds through its coordination
and oversight of the fee-for-service public mental health system in the City with expenditures of
approximately $228 million in FY 124 and its management of a grants portfolio of $19.5 million.
This year, BMHS implemented a number of administrative infrastructure and operational
improvements focused on enhancing its management of public funds.
Fee-For-Service Public Mental Health System Funds
Manage the Public Mental Health System to Ensure Efficient Service Delivery
BMHS continued to collaborate with MHA and ValueOptions® to manage the resources
of the PMHS and its ever increasing population of individuals served in Baltimore City –
3 Muesar et al., in press; Muesar et al., 1998.
4 These data are incomplete and will likely be higher as claims may be submitted up to twelve months after the date
of service delivery.
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a projected 42,800 in FY 12. BMHS worked to authorize services for consumers with
public insurance, ensure access to care for uninsured individuals, and authorize and
manage access to the Capitation project and Residential Rehabilitation Program services.
Improve Risk Management of Capitation Project Funds
In FY 12, BMHS realigned its relationship with the City’s two Capitation programs, with
the transfer of financial risk from BMHS to the two providers. These modifications were
agreed upon and planned for in FY 11.
Grant Funds
Fund Critical Client Needs
BMHS granted over $3,600 in need-based client support funds on a case-by-case basis to
135 individuals to provide assistance with medications.
Repurpose Unspent Grant Funds
BMHS repurposed under-spent funds before the end of the contract year, distributing
$61,444 as supplemental grant awards to 13 providers in good standing to fund a variety
of one-time requests focused on improving care to clients. Knowing that the opportunity
to repurpose FY 12 unspent funds through “rollover” would be unlikely due to the tight
State budget, repurposing funds during the fiscal year became a priority for BMHS.
Greater provider compliance with fiscal reporting requirements and improved oversight
by BMHS facilitated this process.
Oversee Provider Contracting
Ninety seven percent (97%) of BMHS provider contracts (96 contracts with 56 different
providers) were renewed “on-time”, i.e., prior to the start of the 2013 fiscal year.
Renewing contracts on time is an important performance goal for BMHS, because it
ensures programs will receive timely payments from BMHS, enabling consumers to
receive uninterrupted services.
Improve Organizational Processes
As a result of continuing improvement efforts in contract monitoring and reporting, the
contractual compliance rate5 for FY 12 was 93%. Contractual compliance allows BMHS
to make more informed decisions about funding, including the repurposing of unspent
funds and strategic decisions about budget reductions that minimize the impact on service
delivery.
5 These rates measure compliance by grant-funded providers with programmatic deliverables, fiscal reports, and
submission of professional licenses, insurance and fidelity bonds.
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BMHS completed the planning of the implementation of an electronic contract
management system that is designed to replace what is currently a paper-intensive,
manual system. The contract management system aims to increase process efficiency;
create automated, customized reports; and allow users access to real-time and point-in-
time data. The system will benefit providers by enabling online submission of invoices
and reports and record-keeping capacity for provider documents.
BMHS brought on an organizational consultant, Stanton Executive Group, to strengthen
organizational operations in preparation for the growing workload relating to behavioral
health care integration and the planning of the merger of BMHS and bSAS. This
consultation has focused on internal processes, procedures and standards; workflow;
output and quality control. The consultation has enabled BMHS to reduce administrative
staffing and is laying a foundation for the merger-related planning in the areas of
operations, staffing and finance.
Contract-Funded Services
The table below, which lists just a portion of BMHS’ grant-funded contract portfolio,
indicates the range of services funded. These services are discussed in greater detail in
the Report on Activities section.
Contract-Funded Services, FY 12
Type of Service Services Provided # Served/ # Services
Provided
Consumer-Run:
Wellness and Recovery Centers Peer support 626 individuals
Family-Driven:
High Fidelity Wraparound
Mental health treatment and
supportive services 261 families
Forensic (adults):
Forensic Alternative Services Team
(FAST), Forensic Assertive
Community Treatment Team
(FACTT), Case Management,
Chrysalis House
Mental health treatment and
diversion
1,507 individuals; 40
discharged from State
Hospital
Forensic (youth):
Court Medical Evaluation Team Mental health assessments 289 individuals
Homeless:
Hands In Partnership
Outreach and Coordination
of care 284 individuals
Homeless:
Transitional Housing Housing services 265 individuals
Homeless:
HUD-funded projects Housing services 1,001 individuals
Trauma: Trauma-focused 88 calls
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Child Development Community
Policing
interventions
Early Childhood Prevention and treatment
services
339 classroom
observations and 712
mental health
consultations
School-Based Prevention and treatment
services
4,666 students in 102
schools
Crisis (adults):
Baltimore Crisis Response Inc.
(BCRI)
Crisis intervention and
follow-through
28,444 calls
1,665 crisis team visits
Crisis (youth):
Baltimore Child and Adolescent
Response Systems (BCARS)
Crisis intervention and
follow-through
1,829 calls;
384 families receiving
crisis stabilization
services
Hospital Diversion Project Hospital diversion 317 individuals
Veterans:
Pro Bono Counseling Project Mental health counseling 104 veterans
Develop and Implement Agency Quality Management Plan
BMHS’ Quality Management Plan was launched in FY 12. Quality management efforts
focused on three measures of the performance of BMHS-funded programs – consumer
perceptions of care, provider compliance with contractual requirements, and program
quality – and three measures of BMHS performance – consumer complaint resolution,
timely contract renewals, and help call satisfaction. A Quality Management Committee
was established and met throughout the year to review data related to these measures (and
other quality-related activities such as site visits and provider applications), and identify
and plan opportunities for improvement.
Behavioral Health Integration/Federal Healthcare Reform
Federal healthcare reform offers opportunities to improve care, particularly for individuals with
multiple health issues – mental, somatic and substance use disorders – who will benefit from its
focus on greater integration of care, improved experience of care and better outcomes. With the
continued progress in planning for both federal healthcare reform implementation and
behavioral health integration in Maryland this year, BMHS increased its focus on related
planning activities.
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Planning for Behavioral Health Integration
BMHS actively participated in the nine-month State planning process aimed at the
selection of an integrated financing model for state-funded mental health and substance
abuse services. BMHS management advocated at the workgroups and larger DHMH
planning meetings, through its leadership in the Maryland Association of Core Service
Agencies (MACSA) and its representation of MACSA at Maryland Mental Health
Coalition meetings. The focus of the advocacy was the continuation of the strengths of
the current financial model and the continuation and expansion of the role of local mental
health authorities (which will evolve into local behavioral health authorities).
BMHS executive management established a weekly internal behavioral health integration
planning meeting to begin to develop a common vision of programmatic opportunities
that could be pursued through behavioral health integration.
The focus of FY 12 quarterly BMHS all-staff meetings was behavioral health integration
– its relevance to the work of BMHS and the need for all staff to “own” the opportunities
to promote integration in their specific areas of work.
The focus of the three FY 12 provider meetings was likewise integration. BMHS invited
subject matter experts to present at these meetings. The speakers included: Chuck
Ingoglia, Vice President for Public Policy, National Council for Community Behavioral
Health and Brian Hepburn, Executive Director for the Mental Hygiene Administration
(MHA).
BMHS continued weekly meetings with bSAS to collaborate on promoting integrated
behavioral health care through the IDDT project (see page 13), and expanded those
discussions to lay the foundation for broader programmatic collaboration aimed at
promoting a more integrated approach at the systems level to behavioral health care
access and service delivery in the City.
In the spring, both BMHS and bSAS Boards of Directors agreed to commence planning
for the creation of a local behavioral health authority that will replace BMHS and bSAS.
An Integration Steering Committee, comprised of the President & CEO of BMHS and of
bSAS, chair of each board, and five representatives of each agency, was established.
Develop and Strengthen Key Partnerships
In the fall of 2011, BMHS conducted a needs assessment as part of the development of its
three-year plan. A consultant was hired to conduct interviews and focus groups with
stakeholders to determine gaps in mental health services for Baltimore City residents as
well as to determine barriers to quality mental health care. Twenty-two (22) individual
interviews and two focus groups were conducted in October 2011. A total of 46
stakeholders participated, which included representatives from local hospitals and
Federally Qualified Health Centers (FQHCs).
The Partnership Advisory Council was established and launched in accordance with a
resolution approved at the June 2011 BMHS Board meeting. The Partnership Advisory
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Council meetings serve as a high-level forum for leaders in partner organizations to
identify shared priorities and opportunities to collaborate – to expand access to mental
health services, including prevention, to specific populations and within specific locales
(schools, child welfare, criminal justice system, etc.).
BMHS recognizes that FQHCs are key healthcare reform partners. Therefore, throughout
FY 12, executive management began to meet individually with local FQHCs.
Additionally, school-based clinicians funded thorough the Expanded School Mental
Health initiative are now required to partner with FQHCs located in the school’s
community to connect somatic care and behavioral health services and to increase access
to care.
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Report on Activities, Fiscal Year 2012
Unless otherwise indicated, all strategies were accomplished.
GOAL I: Americans Understand that Mental Health
is Essential to Overall Health.
Objective 1.1: Baltimore Mental Health Systems (BMHS) will increase public awareness of
mental health disorders, prevention mechanisms, treatment services, and supports.
STRATEGY 1: Provide direction, funding and ongoing consultation to organizations that
implement public education and training activities.
Action Step: Support organizations that provide public educational workshops,
distribute educational literature, and offer information and referrals:
■ Mental Health Association of Maryland (MHAMD);
■ National Alliance on Mental Illness (NAMI);
■ Maryland Coalition of Families for Children’s Mental Health;
■ On Our Own of Maryland.
BMHS continued to support the agencies listed above, which provide outreach and
education to a wide variety of audiences on a range of topics. In FY 12, over 30,000
individuals received training, participated in educational programs, or attended
workshops sponsored by these agencies.
Indicator: Report on progress to date.
MHAMD held 367 performances of the “Kids on the Block,” with 22,757 attendees and
distributed 69,997 publications, general children’s mental health information and
campaign materials for Children’s Mental Health Matters. MHAMD also participated in
30 health fairs for adults, conducted 33 Older Adult Mental Health issues trainings and
10 advanced directive trainings, participated in 39 health fairs and also distributed 35,786
educational materials.
NAMI served 233 family members through 7 Family-to-Family courses, and conducted
90 workshops about mental health topics, with 1,275 individuals attending. One
consumer was trained by NAMI National in a workshop facilitator refresher course. Two
consumers were trained by NAMI National as peer-to-peer mentors. Twenty-seven (27)
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were trained as mentors to teach the peer-to-peer education course, which 97 consumers
completed. Twenty-four (24) support group facilitators were trained. An additional 24
family members completed the train-the-trainer course. NAMI also held their annual
NAMI Walk, a public education event that promotes awareness of mental illness, at two
locations this year. Over 1,000 individuals participated, including a BMHS team.
Maryland Coalition of Families for Children’s Mental Health held 10 webinars, with 200
participants; 14 family trainings, with 122 participants; and 10 Family Leadership
Institutes, with 74 participants. They also responded to 308 calls for information, referral
or support, and continued to be the lead coordinator for a statewide Children’s Mental
Health Awareness Week campaign.
On Our Own of Maryland provided assistance and referrals by phone or in person to
5,024 individuals. They completed 51 educational presentations which focused on the
stigma of mental illness, with 927 participants, and worked with 24 local consumer-run
organizations through their participation in various educational events.
STRATEGY 2: Participate in community events that promote awareness of mental health.
Action Step: Provide education and outreach regarding depression and available
mental health services through the Behavioral Health Leadership Institute.
The education of paraprofessionals, clients and community stakeholders continues to be
an ongoing effort of the Poverty and Depression Project Connections (hereafter “Project
Connections”). Project Connections provides training to paraprofessionals on mental
health issues at five community sites, and provided informal educational groups to clients
about symptoms of depression, parenting skills and issues, and other relevant topics. The
educational activities continue to focus on reducing stigma about mental health treatment
among both outreach workers and clients.
Baltimore City’s Youth MOVE (Motivating Others Through Voice of Experience) is the
local chapter of a national youth-led organization, which works to improve services and
systems that support positive youth and family growth and development. BMHS
established the local chapter in March 2010 to provide public education and outreach
regarding mental health and mental health services to City youth. It is dedicated to
eliminating the stigma of mental health illness and educating young people with mental
health illnesses to become advocates for themselves and peers. Members of this group
participate in health fairs across Baltimore City and coordinate fundraising activities to
support local homeless youth shelters.
Indicators: Number of community events.
22
Number of Individuals Attending Educational Events
Community Event Individuals
9 Health Fairs 2,000
Client Education Groups at 5 Project Connections Sites 70
Project Connections Staff Training Series 15
STRATEGY 3: Collaborate with the Baltimore City Health Department (BCHD) and
Federally Qualified Health Centers to identify opportunities to provide educational
information about mental health issues and access to care.
Action Step: Reach out to staff at BCHD, with priority to those working with
populations at high risk for mental health disorders.
In FY 12, BMHS collaborated with BCHD’s Office of Youth Violence on a presentation
for the Inter-American Development Bank (IDB), the largest source of social and
economic development financing for Latin America and the Caribbean. One of the main
topics of the presentation was the correlation between mental health and community
violence. Recommendations and best-practices on establishing violence prevention
initiatives were also discussed.
Indicator: Report on progress to date.
See above for progress to date.
In FY 12, BMHS began to reach out and meet individually with local FQHCs.
Additionally, school-based clinicians funded through the Expanded School Mental Health
initiative are now required to partner with FQHCs located in the school’s community to
promote access to somatic care and coordination between behavioral health services and
somatic care.
Objective 1.2: BMHS will educate public safety personnel regarding current information
about mental illness, managing mental health emergencies and available services.
Strategy I was partially accomplished.
STRATEGY 1: Improve the capacity of the City’s police officers, Downtown Partnership
Safety Guides and other public safety personnel (e.g., parole and probation officers, 911
operators and correctional officers) to respond to psychiatric emergencies.
23
Action Step: In collaboration with the Baltimore Police Department, provide
leadership to the Behavioral Emergency Services Team (BEST) to train police
officers.
Significant progress was made this past year with the BEST project, an ongoing initiative
that trains police officers in crisis intervention to de-escalate mental health crises,
minimize arrests, and decrease officer injury. The focus of activities in FY 12 continued
to be training all new police recruits, who start out as patrol officers. Five training classes
were held, with 156 new patrol officers and six experienced officers successfully
completing the course. More than double the number of officers participated in FY 12
compared to FY 11. The Police Department predicts that if the project maintains the same
pace of training, most patrol officers will be BEST-trained within the next three years.
Progress was also made toward obtaining certification of the course by the Maryland
Police and Correctional Training Commissions (PCTC) by completing lesson plans for
all modules included in the training. It is anticipated that additional required materials
will be submitted to PCTC for review during the next fiscal year and certification will be
granted. Certification by PCTC will grant in-service credit to officers who successfully
complete the course.
Additionally, progress was made toward the creation of a video to be shown at daily roll-
calls for patrol officers. The video will provide a brief summary of de-escalation
strategies and resources officers can utilize in mental health crisis situations. BMHS will
continue to coordinate with the BPD Video Unit to complete the video with an
anticipated completion date within the next year. This will substantially increase the
dissemination and reinforcement of the BEST concepts throughout the Department.
Action Step: Collaborate with public safety organizations to identify opportunities
to provide educational information about mental health issues.
Efforts to improve the capacity of public safety personnel to respond to psychiatric
emergencies again focused predominantly on the Police Department this past year. The
training of additional public safety personnel, such as Downtown Partnership Safety
guides, 911 operators, and Parole and Probation staff will continue to be explored next
year.
Indicators: Number of personnel trained; Report on progress to date.
162 Baltimore City police officers (156 new recruits and 6 experienced officers) were
trained in FY 12. See above for progress to date.
24
GOAL II: Mental Health Care is Consumer and Family Driven
Objective 2.1: Promote efforts that facilitate recovery and build resiliency.
STRATEGY 1: Promote and support consumer-operated programs.
Action Step: Provide direction, funding, and consultation to the City’s three (3)
Wellness & Recovery Centers: Helping Other People through Empowerment
(HOPE), On Our Own, Inc. and Hearts and Ears.
Wellness and Recovery Centers continue to be a vital component of the City’s public
mental health system. Two of these Wellness and Recovery Centers are unique in the
state: Helping Other People through Empowerment (HOPE) serves homeless individuals,
and Hearts and Ears serves lesbian, gay, bi-sexual, transgender (LGBT) individuals. On
Our Own, Inc. operated their transitional age youth (TAY) center for its second year,
again serving a population for whom more targeted programs are needed. While a total of
626 consumers were served, between FY 11 and FY 12, there was an 8% decrease in the
number of consumers served by the Wellness and Recovery Centers, with an increase at
HOPE and a decrease at Hearts and Ears and at On Our Own. Although the numbers of
individuals served at On Our Own decreased, the Center surpassed the target set by the
state of 300 persons served for the second year in a row. On Our Own also met or
surpassed the target for the number of support services, especially the number of WRAP
classes and WRAP support groups. Hearts & Ears relocated in FY10 to the west side of
Baltimore and experienced a decrease in persons using the Center as a direct result of this
move. In June of 2012, Hearts & Ears again relocated back to the Mount Vernon district
as this area of the city is more easily accessed by LGBT consumers. There was
significant staff and board turnover in FY 12, and BMHS has taken an active role in
assisting the program to enhance leadership and strengthen board functioning.
Baltimore’s three Wellness and Recovery Centers continue to provide consumer-centered
peer support services and have been serving a vital role in promoting the use of Wellness
Recovery Action Plan (WRAP) among the City’s consumers. The Centers have continued
efforts to sustain On Our Own’s WRAP project by recruiting and training consumers as
peer WRAP facilitators.
The chart below details the peer support and educational services provided by the
Centers. It should be noted that in recent years, MHA’s Office of Consumer Affairs has
clarified the definition of services and refined data collection so that Wellness and
25
Recovery Centers across the state are collecting data in the same way. Therefore, some of
the changes in the numbers of services provided may be due to the way data are now
being collected.
Peer Support/Educational Services Provided
Wellness and Recovery Center Outreach
Sessions Peer Support
Sessions Educational
Forums
On Our Own 17 113 6
Helping Other People Through
Empowerment 12 40 10
Hearts and Ears 4 40 9
TOTAL 33 193 25
Indicator: Number of consumers served.
Number of Consumers Served by Wellness and Recovery Centers
Center Consumers
On Our Own 329
Helping Other People Through Empowerment 241
Hearts and Ears 56
TOTAL 626
STRATEGY 2: Increase implementation of consumer-centered practices such as Wellness
and Recovery Action Planning (WRAP), use of peer staff and consumer-directed recovery
planning.
Action Step: Provide direction, funding and ongoing consultation to the Human
Services Training program at Goodwill, Inc. that trains consumers for employment
in the human services field.
The Human Services Training program at Goodwill, the only service of this kind in the
State, enrolled 48 consumers in the training program for careers in public mental health.
Although the number of consumers enrolled represents a 4% decrease from FY 11, the
program still exceeded its goal of serving 40 consumers for the year. Of those enrolled,
27 (56%) graduated from the training compared to 34 (68%) in FY 11. All consumers
graduating from the program are offered referrals to supported employment programs at
Goodwill and other SEP providers to further assist in gaining employment or to receive
assistance in maintaining employment.
26
Action Step: Provide education and technical assistance to providers in
implementing practices targeted at assisting consumers to move to their defined
next level of recovery.
BMHS continued to provide technical assistance to the two Capitation programs to
implement a Continuous Quality Improvement process, the goal of which is to identify
and implement change projects aimed at improving targeted aspects of care. The area of
focus for FY 12 was supported employment. Both providers achieved their FY 12 goals
of enhancing supported employment program services. The baseline percentage of
members participating in the supported employment program who were working at
Mosaic/Chesapeake Connections was 11%. The target goal was 15%, and within 12
months, 20% were employed. The baseline percentage of members participating in the
supported employment program who were working at Bayview/Creative Alternatives was
16%.The target goal was 25%, and within 12 months, 43% were employed.
Implementing the CQI plan had a positive impact on overall employment for members of
both Capitation Projects.
In FY 12, based on BMHS’ nomination, the University of Maryland Medical Center
(UMMC) received technical assistance and consultation on person-centered planning for
individuals with mental illness. The goal of this project, which is coordinated and funded
by MHA, is for treatment planning to become more consumer-oriented.
In FY 12, BMHS collaborated with bSAS to host a joint meeting between the Wellness
and Recovery Centers (mental health funded programs) and the Threshold to Recovery
Centers (substance abuse funded programs). This meeting created a dialogue between
consumers and consumer advocates with the goal of identifying opportunities to integrate
efforts among the consumer-run behavioral health programs in the city.
Indicators: Number of consumers served; Report on progress to date.
See above for numbers served and progress to date.
Objective 2.2: Help families be active advocates for their children on the system, program
and individual level.
STRATEGY 1: Increase family input in planning and evaluation of mental health services.
Action Step: Elicit feedback from family support and advocacy organizations
concerning mental health needs of children and families in the community.
27
Maryland Coalition of Families for Children’s Mental Health, along with Wraparound
Maryland, The MATCH Program, the University of Maryland School of Social Work,
and BMHS, hosted seven focus groups for an information exchange on the cultural and
linguistic needs of families and youth with mental health needs who are in or at-risk of
entering the foster care system. The focus groups centered around three themes: the
emotional impact on youth in foster care, foster families and natural or biological families
(including parents, grandparents, adoptive families and other relatives).
Action Step: Provide funding, oversight, and evaluation of services to meet the
mental health needs of families in Baltimore City.
In FY 12, Villa Maria served a total of 53 youth in the Planned Respite program, 14 of
whom were served in facility-based respite care and 39 of whom were served in home-
based care. The total number of youth served represents a 25% increase over the number
of youth served in FY 10. More children were served in home-based care for FY 12 (FY
11- 48%; FY 12 - 74%). The number of children receiving respite services in the fee-for-
service system also increased. This correlates with the increased number of youth
receiving services under the Medicaid waiver, which broadens the services available to
youth through the Public Mental Health System.
Indicators: Annual feedback on mental health service needs; composite summary of
family satisfaction with continuum of mental health services available in the City.
Villa Maria collected surveys from 115 participants (this included families and the youth)
who received Planned Respite services in FY 12. An overwhelmingly number (98%), of
those surveyed indicated being satisfied with the services they received.
STRATEGY 2: Promote leadership development and advocacy skills among families.
Action Step: Provide funding and support to the Maryland Coalition of Families for
Children’s Mental Health for their sponsorship of family leadership trainings.
The Coalition provided family leadership trainings to support families. Evaluations for
the family leadership trainings showed a 100% satisfaction rate among participants who
submitted evaluations. In addition, the Coalition provided peer-to-peer training and
family-to-family support and also conducted workshops on infrastructure development
for family-serving organizations.
Indicator: Number of family members who attended leadership training.
74 family members attended 10 family leadership trainings.
28
Objective 2.3: Promote family-driven and family-centered initiatives.
STRATEGY 1: Provide support and consultation to family-centered initiatives implemented
in Baltimore City.
Action Step: Participate in statewide and local planning for the implementation of
home and community-based wraparound services for youth who would otherwise
require residential treatment level of care.
BMHS staff continued to participate in state and local planning in an effort to reduce the
number of Baltimore City youth entering more restrictive institutional placements. Staff
worked closely with the Care Management Entity for Baltimore City, Wraparound
Maryland, and other stakeholders to remove barriers for youth in need of community-
based services via the wraparound process. Eighty-seven (87) youth received
comprehensive community-based services in lieu of being placed in residential treatment
centers. These youth were enrolled in the Psychiatric Residential Treatment Center
(RTC) Medicaid Waiver through Wraparound Maryland in partnership with BMHS.
There were 67% more youth served in FY 12 than FY 11.
Changes were projected for the availability of slots through the RTC Waiver for the end
of FY 12 and beginning of FY 13. Maryland was making preparations in FY 12 to close
out the federally-funded RTC Demonstration Waiver (1915c). Locally, BMHS and
partners at The Institute for Innovation and Implementation coordinated with families on
the waiting list to ensure their enrollment into services prior to the September 30th
deadline. At the end of FY 12 the RTC Waiver waiting list closed as the State made plans
to move forward with a Medicaid State Plan Amendment to add the 1915i as a
replacement.
Wraparound Maryland also provided care coordination and connected 62 DSS-involved
youth to behavioral health services this past year. Wraparound Maryland continued to
provide services to DJS-involved youth during this fiscal year, and a total of 31 DJS
youth participated in FY 12. In addition, MD-CARES, the federal system of care
cooperative agreement, made it possible for 81 youth and their families involved with
Baltimore City’s Department of Social Services to receive care coordination and clinical
services.
In the spring of FY 12, the Governor’s Office for Children (GOC) issued a Request for
Proposals to procure services for a statewide Care Management Entity that would serve
all 26 of Maryland’s independent jurisdictions. The contract was awarded to Maryland
Choices at the end of FY 12. As a result, BMHS collaborated with city stakeholders to
29
ensure a smooth transition for children and families, as well as providers involved in their
care. Under the new agreement, DSS and DJS slots for wraparound services are now
statewide, with each lead agency funding 75 slots. MD-CARES was reduced by one slot
to a new total of 40 in the City for FY 13.
Indicator: Report on progress to date.
There was a 59% increase in the total number of youth served by the care management
entity. In March 2011, a reinterpretation of the Code of Maryland Regulations (COMAR)
was authorized by Medicaid, allowing each jurisdiction, including Baltimore City, to
immediately fill open slots with youth on the waiting list for the RTC Waiver. As a result,
the number of youth enrolled in the RTC Waiver nearly doubled from FY 11 to FY 12.
In addition, there have been ongoing efforts to inform families and community agencies
about the eligibility requirements along with the availability of this home- and
community-based service. A new partnership was created with Johns Hopkins Hospital
Child & Adolescent Psychiatric Inpatient Unit through the MD-CARES grant so that
youth with severe emotional disturbances at-risk for DSS involvement could be referred
to wraparound services in the community. Of the 81 youth served through MD-CARES,
13 youth were referred by JHH in FY 12.
Care Management Entity
Population/Funding Stream # Served
RTC Waiver 87
MD-CARES 81
Group Home Diversion - DJS 31
Group Home Diversion - DSS-Place Matters 62
TOTAL 261
GOAL III: Disparities in Mental Health are Eliminated.
Objective 3.1: Improve access to culturally and linguistically competent public mental
health services for racial and ethnic minority individuals.
STRATEGY 1: Recruit and retain racial and ethnic minorities and multi-lingual
professionals in the mental health services workforce.
Strategy 4 was not accomplished.
30
Action Step: Provide direction, funding and ongoing consultation to the Maxie
Collier scholarship program at Coppin State University, which encourages minority
students to pursue careers in mental health.
In FY 12, 10 Maxie Collier scholars enrolled in classes. Internship sites included Johns
Hopkins University Department of Child and Adolescent Community Psychiatry,
University of Maryland’s Department of Child Psychiatry Clinical Research Program,
Project PLASE and Life Renewal Services Dual Diagnosis Clinic.
The Maxie Collier scholarship program has had 52 graduates since the program first
accepted students in 1996.
In collaboration with the Maxie Collier scholarship program, Coppin State offers a course
entitled “Emerging Issues in Mental Health,” which is open to all students and intended
to increase the number of students who are exposed to the mental health field.
Representatives from the provider community, the Mental Hygiene Administration, core
services agencies, and the mental health advocacy community regularly present on
mental health topics as part of the curriculum. An estimated 706 students have attended
the class since the program’s inception, and 31 students completed this class in FY 12.
Indicators: Number of students enrolled by discipline.
Maxie Collier Scholars (n=10)
Discipline # Students
Nursing 3
Psychology 5
Natural Sciences 1
Social Work 1
Action Step: Provide direction, funding and ongoing consultation to the Johns
Hopkins Hospital Hispanic Clinic, which provides mental health treatment to
Spanish-speaking individuals and families through the use of bilingual staff.
In FY 12, the Johns Hopkins Hispanic Clinic served 31 individuals and provided 325
therapeutic sessions to Spanish-speaking individuals and families, using models of care
such as Motivational Interviewing, Trauma Focused Cognitive Behavioral Therapy,
Abuse Focused Cognitive Behavioral Therapy, Psychodynamic Therapy and Gradual
Exposure Therapy.
31
STRATEGY 2: Develop collaborations with community-based organizations working to
increase understanding of mental health issues and to improve access for services among
racial, ethnic and linguistic minorities.
Action Step: Provide direction, funding and ongoing consultation to the Black
Mental Health Alliance for Education and Consultation in promoting awareness of
the needs of African Americans with mental illness and offering information,
support and referrals to individuals and families.
The Black Mental Health Alliance (BMHA) continued to advocate for mental health
issues, providing consultation to 139 community-based providers regarding issues of
culture and mental illness. Through collaborations with other advocacy organizations,
BMHA organized National Minority Mental Health Month awareness activities and
sponsored five educational programs and five depression screening events.
Indicator: Report on progress to date.
Through support groups, information, referrals, educational programs and individual
support services, BMHA served 268 families and provided consultation to 139 providers.
STRATEGY 3: Develop collaborations with health care providers, mental health care
providers, community-based Latino organizations and other willing partners to identify
opportunities to improve access to mental health care for Baltimore City’s growing Latino
population.
Action Step: Implement at least one recommendation identified either in the Latino
Needs Assessment Report or through dialogue with key partners.
As reported in FY 11, BMHS hired a Spanish-speaking staff member with extensive
history working with the Latino community throughout Maryland. This staff member
continues to attend the Latino Providers Network for updates on community initiatives
and Latino community needs. In FY 12, she developed a resource guide of Spanish-
speaking mental health programs. In addition, BMHS partnered with City School’s
International Student Center to provide a list of resources for psychoeducational materials
translated in multiple languages for families. Lastly, as recommended by the Latino
Needs Assessment Report, NAMI Baltimore provided a Spanish language version of their
Family-to-Family program.
Indicator: Report on progress to date.
See above for progress to date.
32
STRATEGY 4: Collaborate with faith-based organizations to reduce barriers resulting from
religious beliefs about mental illness and treatment.
Action Step: Provide direction, funding and ongoing consultation to the Center for
the Integration of Spirituality and Mental Health in sponsoring educational
programs that target racial and ethnic minorities.
Funding for the Center for the Integration of Spirituality and Mental Health (CISMH)
was eliminated at the end of FY 11 due to budget reductions. There is no FY 12 activity
to report.
Indicator: Report on progress to date.
None.
Objective 3.2: Improve access to mental health services for special populations that are
underserved by the public mental health system.
Strategies 8 and 10 were not accomplished.
STRATEGY 1: Provide direction, funding and ongoing consultation to agencies that serve
transitional age youth.
Action Step: Contract with a vendor(s) to provide residential rehabilitation and case
management services for youth who have complex mental health and social needs.
BMHS funded two vendors to provide residential rehabilitation and case management
services for transitional age youth (TAY), those who are 18-25 years old. People
Encouraging People (PEP) and the University of Maryland Medical Center (UMMC)
Harbor City Unlimited were funded to provide enhanced support, which includes
overnight supervision, community living skills development, vocational and educational
services and social/recreational activities to better address the complex presenting needs
of transitional age youth. It should be noted that the requests for assistance to provide
enhanced residential and case management services far outnumber the slots available.
Action Step: Provide technical assistance to child and adolescent mental health
providers and other child serving systems regarding accessing the adult mental
health system and strategies to assist youth in developing skills needed for success in
the adult system.
In FY 12, there was a legislative change redefining the mission of the Local Care Teams
throughout the state. The Local Care Teams (LCT) are now charged with reviewing all
33
requests for Voluntary Placement through the Department of Social Services. In addition,
referrals also come from Department of Juvenile Services and Department of Social
Services, case managers, and families looking for resources to meet a child’s needs. All
referred TAY individuals who meet Medicaid eligibility criteria were encouraged to
complete and submit applications to the appropriate CSA in order to ensure a smooth and
timely transition to adult services.
Indicators: Number of youth who receive services; report on technical assistance
provided.
In FY 12, one third, or four, of the youth referred to the LCT were TAY consumers, and
30 of the Certificates of Need (CON) reviewed by BMHS were for TAY consumers.
BMHS staff provided technical assistance in all cases, which resulted in 100% of TAY
consumers being encouraged to apply for adult services within the PMHS.
TAY Contracts
Vendor # Individuals Served
PEP Case Management 15
PEP Enhanced RRP 8
UMMC Enhanced RRP 7
TOTAL 29
STRATEGY 2: Facilitate access to treatment for war returnees, especially those from Iraq
and Afghanistan.
Action Step: Make available free mental health treatment by contracting with a vendor
to recruit and provide specialized training for volunteer mental health professionals.
The Pro Bono Counseling Project continued to provide free mental health treatment services
to veterans and war returnees by utilizing a network of volunteer clinicians. In FY 12, 104
individuals and families received information and referrals, and 47 were linked with a
clinician for free mental health care. A total of 393 hours of clinical services were provided
statewide.
While 19 more individuals and families were served this year compared to FY 11, there were
only 19 more clinical hours reported. Of all services provided, 13% were provided to
Baltimore City residents, which was a decrease from FY 11. In addition, the Pro Bono
Counseling Project recruited 66 new clinicians to the program, and sponsored a one-day
34
training for therapists who will be working with veterans and other war returnees throughout
the State.
In FY 12, depression and couples issues were the top reasons care was requested, the same as
in FY 11. In FY 12 though, grief and loss became the third highest reason care was requested
(16), whereas in FY 11, grief and loss was the least provided reason (4). Also, in FY 12, the
Project expanded its list of reasons care was requested to include suicide, brain injury,
legal/accounting, life transition and family dysfunction.
Air Force 9% Air National Guard
8%
Army 41%
Army National Guard 15%
Marines 6%
Navy 9%
Army Reserves 6%
Unknown 6%
Individuals Served by Pro Bono Counseling Project (n=104)
35
Indicator: Number of individuals served.
See above for number of individuals served.
STRATEGY 3: Provide direction, funding and/or ongoing consultation to agencies that
interact with individuals involved with the criminal justice system.
Action Step: Divert individuals from incarceration by providing support and
technical assistance to the Baltimore City Mental Health Court, Forensic Assertive
Community Treatment Team (FACTT) and Forensic Alternative Services Team
(FAST).
BMHS provided support to the Baltimore City Mental Health Court, Circuit Court Case
Management Docket project (further described on page 37), FACTT, CHHS, and FAST
throughout the year. BMHS staff regularly attended meetings with Mental Health Court,
Circuit Court Case Management Docket project and CHHS personnel. Access to services
within the Public Mental Health System and the role of the service providers in serving
court-involved clients were recurring topics. BMHS continues to use the reference
document Mental Health Services for Adults in Baltimore City to create more alignment
between the Court’s requests for services and those services available in the community.
To further align the Court’s expectations of community-based services, BMHS continued
to organize regular educational meetings between Mental Health Court and Circuit Court
30 25
16 12
8 7 7
6 6 6
5 3
1 1
Depressed Couples
Grief and Loss Family dysfunction
Anxiety Life transition
Anger History of Mental Illness
PTSD Stress
Legal/Accounting Medication Only
Brain injury Suicidal
0 5 10 15 20 25 30 35
Pro Bono Counseling Project: Reason Care was Requested (n=104)
36
Case Management Docket personnel and community providers. The meetings focused on
educating providers on the Court’s role and educating the Court on the provider’s role in
serving clients with court involvement. Several providers presented overviews of their
services to orient Court personnel to the range and scope of available community-based
services.
FAST continued to provide jail diversion activities and actively participate in Mental
Health Court. FAST screened 1,370 individuals for diversion services, an increase of
40% from FY 11. Of the 1,370 screenings, FAST conducted 431 face-to-face assessments
to determine eligibility for appropriate services and possible return to the community.
This represented a 16% reduction in face-to-face assessments from FY11. In addition,
FAST monitored 38 individuals in the community as part of court-ordered plans. The
FAST program continues to rely on the judicial system for the majority of its referrals,
which determines the number of individuals who are screened.
FACTT, a specialized ACT team, continued to provide intensive services to individuals
with either court involvement or forensic histories. FACTT outcomes data show that in
FY 12, FACTT served a total of 116 individuals with 30 new referrals. Of the new
referrals, 67% (20) were referred from State hospital facilities, an increase from FY11
(52%, 12 referrals). There were four referrals (13%) from jails and the six other referrals
(20%) were community referrals to FACTT. BMHS has worked with FACTT to target
high users of psychiatric services in the community who met the legal requirements for
FACTT services.
Jail Personnel 14%
Judge 16%
Family/Self 8% Drug Court
8% Defense 14%
State's Attorney 10%
Other 19%
Community Provider
11%
Source of FAST Referrals (n=1,370)
37
Action Step: Collaborate with the Baltimore City Circuit Court to develop
alternatives to incarceration for sentenced individuals.
In FY 11, BMHS leveraged a small amount of BMHS and DHMH funds to secure private
foundation funds (The Leonard and Helen R. Stulman Foundation, The Charles Crane
Family Foundation, The Aaron and Lillie Straus Foundation and the Baltimore
Community Foundation) to implement a 3-year pilot project in the Circuit Court of
Baltimore City for felony defendants called the Circuit Case Management Docket project.
This three-year project funds a clinician to provide behavioral health assessments and
link eligible defendants to behavioral health services in the community. The goals of this
project are to decrease recidivism, increase mental health service utilization among
defendants with mental illness and increase public safety.
In FY 12, this project enrolled 14 participants, who received an intensive behavioral
health assessment, linkage to community-based behavioral health services, and continued
case management and coordination with providers. The target is to serve an ongoing
caseload of 20 individuals each year. At this point, this project has been fully integrated
into the operation of the consolidated mental health docket in the Circuit Court of
Baltimore City.
Action Step: Provide support and technical assistance to the Chrysalis House
Healthy Start Program, which serves pregnant and post-partum women and their
babies as an alternative to incarceration.
Chrysalis House has continued to focus on enhancing its service array and building
collaborations with referral sources to increase the number of individuals utilizing
services. In FY 12, Chrysalis House served a total of 21 women from different statewide
referral sources. Of the 21 women served in FY 12, 11 were new admissions. In addition,
seven babies were born to mothers in the CHHS program in FY 12. BMHS provided
financial assistance to Chrysalis House to enable the program to purchase furniture to
accommodate and enhance the overall living environment. Furthermore, BMHS provided
housing assistance to all of the women who successfully graduated from the program in
FY 12 (a total of four).
In FY 12, LEVELheaded, Inc. conducted interviews with 22 past and current residents of
the Chrysalis House Healthy Start program to obtain baseline, post-delivery and
discharge information as part of an updated evaluation of the Chrysalis House program.
The findings from the FY 12 updated evaluation are generally very consistent with the
key findings identified in the original 2010 evaluation conducted by LEVELheaded.
38
Key findings from the interviews indicated that 26% of the women admitted into the
program were from the Baltimore City Detention Center and 17% from the Baltimore
City Women’s Detention Center. The mean number of arrests for the women prior to
admission was five. Of the 22 interviewed, 76% reported receiving a diagnosis of mental
illness, and 87% reported a history of trauma. Other key findings from the evaluation
include:
● Significant improvements reported in mental health, cognitive functioning,
and day-to-day functioning while enrolled in the program.
● Significant reductions reported in criminal behavior, including the use of
illegal drugs and receiving money from illegal sources.
● Increases in the amount of money received from benefits such as TANF
(Temporary Assistance for Needy Families) and SNAP (Supplemental
Nutritional Assistance Program), formerly known as Food Stamps.
● Increases in enrollment in trainings and/or school programs.
● High level of satisfaction with the services received from the Chrysalis
House Healthy Start program.
Indicators: Number of individuals served; report on progress to date.
In FY 12, there was an overall 34% increase in the number of individuals with forensic
histories served by FAST, FACTT and the Chrysalis House Healthy Start program.
Number of Individuals with Forensic Histories Served, FY 12
Program # of Individuals
FAST 1370
FACTT 116
Chrysalis House Healthy Start 21
TOTAL 1,507
Individuals with Forensic Histories Discharged from State Hospitals, FY 12
Program # of Individuals
RRP 17
FACTT 20
Capitation Project 1
Geriatric Community Placements* 2
TOTAL 40
*Coordinated by the Geropsychiatric Nurse Specialist
39
STRATEGY 4: Fund mental health services targeted to individuals who are deaf and hard of
hearing.
Action Step: Contract with a vendor to provide residential rehabilitation,
psychiatric rehabilitation, and outpatient mental health treatment services to this
population.
BMHS continued to fund People Encouraging People, Inc. to provide signing services for
individuals who are deaf and hard of hearing. The services were provided in the
following programs: residential rehabilitation, psychiatric rehabilitation, outpatient
mental health treatment and supported employment.
Indicators: Number of individuals served and level of care received.
18 unduplicated individuals who are deaf or hard of hearing received signing services in
the following levels of care:
PMHS Services Received by Deaf or Hard of
Hearing Individuals
Level of Service # Individuals
Psychiatric Rehabilitation 17
Residential Rehabilitation 8
Outpatient Mental Health Treatment 5
Supported Employment 4
STRATEGY 5: Fund mental health services targeted to individuals with traumatic brain
injury (TBI).
Action Step: Contract with a vendor to provide individualized therapeutic activities
in a residential setting, including life skill services and family supports.
BMHS funded Mary T. Maryland to provide residential services for three individuals
with traumatic brain injury discharged from a state hospital facility. Services provided by
Mary T. Maryland are individualized to each client and based upon a thorough
assessment of the individual’s needs. Because the three individuals enrolled in the
program were ineligible for the Medicaid waiver, which would otherwise cover their cost
of care, there was no turnover in the program in FY 12.
Indicator: Number of individuals served.
40
3 individuals with TBI received residential support services.
STRATEGY 6: Provide funding and/or consultation to programs that offer outreach or
mental health services to individuals and families who are homeless.
Action Step: Provide leadership to the multi-agency coalition of homeless outreach
advocates and providers known as the Hands in Partnership (HIP) initiative to
identify, engage and coordinate outreach services to individuals experiencing
homelessness.
In collaboration with the Mayor’s Office of Human Services (formerly Baltimore
Homeless Services) and HealthCare Access Maryland, BMHS continued to co-facilitate
HIP. The goal of HIP is to provide coordinated, goal-directed outreach to vulnerable
homeless individuals and families on the street or in emergency shelters. Using HUD and
PATH funding, BMHS oversees four outreach teams that participate in HIP. In FY 12,
service providers met weekly to coordinate services to homeless individuals and families.
Data are tracked and analyzed to ensure accountability and to document the movement of
clients from homelessness to permanent housing. Training of outreach workers and
resource sharing is a regular aspect of HIP, with presentations from outside entities
occurring at least monthly.
In FY 12, outreach teams engaged in 1,249 visits with approximately 284 homeless
individuals and families identified as vulnerable and in need of intensive, coordinated
outreach.6 These services resulted in 11 individuals placed into housing. The number of
individuals housed is expected to significantly increase in FY 13, as the Mayor’s Office
of Human Services was recently notified that they would have access to approximately
150 Housing Choice Vouchers by the Housing Authority of Baltimore City, and these
vouchers will be designated for individuals being served by HIP.
In addition to the above HIP activities, Baltimore City was an active participant in the
SSI/SSDI Outreach Assistance and Recovery (SOAR) initiative through the work of
Health Care for the Homeless and LEVELheaded, Inc. SOAR, which teaches providers
how to expedite entitlement applications, continues to experience tremendous growth in
both the number of providers trained in SOAR methodology and the number of SSI/SSDI
claims submitted. SOAR allows individuals to receive the benefit of expedited access to
income, health insurance and treatment services as well as support through the SSI/SSDI
application process, which helps alleviate the associated anxiety experienced by many
consumers. Providers report that SOAR has been a successful tool in engaging
6 There was a change in data collection methodology from FY 11 to FY 12.
41
individuals in services and has assisted in the therapeutic process by helping to identify
diagnoses and treatment needs during the application process.
In FY 12, Health Care for the Homeless (HCH) collaborated with LEVELheaded, Inc. to
provide five 2-day Stepping Stone to Recovery SOAR trainings to providers in Baltimore
City and other jurisdictions. LEVELheaded, Inc. also coordinated and delivered one
additional statewide 2-day SOAR training and one refresher training in Maryland. In all,
184 case managers benefited from the six 2-days SOAR trainings. An additional 16 case
managers also benefited from the one refresher training.
In FY 12, the two BMHS-funded SOAR case managers at HCH provided technical
assistance to HCH staff and other Baltimore City providers to submit a total of 358
SSI/SSDI applications using the SOAR methodology on behalf of Baltimore City
consumers. The Social Security Administration made benefit decisions on a total of 135
SOAR applications statewide in FY 12. Eighty-three percent (83%) of the benefit
decisions were approved, leaving the statewide approval rate unchanged at over 80%. Of
the total statewide SOAR claims approved in FY 12, 44% were from Baltimore City,
whose SOAR approval rate remained at over 90% (93%).
Additionally, LEVELheaded, in collaboration with other Baltimore City SOAR-
Workgroup partners (BMHS, HCH, State Disability Determination Administration),
instituted a pilot SOAR-Certification program in Baltimore City and Montgomery
County. In all, eight SOAR trained case managers received certification, including four
full-certifications and four-provisional certifications.
In FY 12, five counties were assisted to develop SOAR implementation workgroups, and
nine other counties and Baltimore City received technical assistance from LEVELheaded.
Additionally, LEVELheaded co-presented on the SOAR initiative at three conferences
including: MHA Office of Special Needs Populations, MHA-Case Management and the
Brain Injury Association of Maryland annual conferences. LEVELheaded also presented
an “Introduction to SOAR” at the Continuous Learning Center of Montgomery County
and the Anne Arundel NAMI Chapter.
Action Step: Provide direction, funding and ongoing consultation to HUD-funded
projects: three (3) mental health outreach teams; two (2) Safe Havens; one (1) SSI
Presumptive Eligibility Outreach program; and one (1) Wellness and Recovery
Center for homeless individuals.
BMHS was again awarded $1,991,410 from HUD to fund projects as described above.
Funding from HUD has remained level since the inception of each project. As a result,
42
programs have been forced to manage rising operational costs by increasing their match
beyond the level required by HUD and have consequently struggled to balance budgets.
Both safe havens have had particular difficulty meeting increased operational costs this
year.
Representatives from every City HUD-funded project are active in HIP. It is through
regular meetings of HIP and site visits to the providers that BMHS provides guidance and
support to the HUD-funded projects. In FY 12, these projects served 1,001 unduplicated
individuals, a slight decrease from FY 11 (1,161). Despite the overall number served
remaining relatively stable, there was a 33% increase in the number of families served,
and a 10% decrease in the number children served from FY 11.
Action Step: Collaborate with the Mayor’s Office of Human Services to implement
the City’s 10-year plan to end homelessness.
In FY 12, the Mayor’s Office began to take steps toward review and revision of the Plan
and the restructuring of the governance practices of the Continuum of Care. BMHS
actively participated in this process by serving on the planning committee with other
homeless service providers and taking part in several surveys and focus groups to provide
feedback on the current performance of the Continuum. BMHS continues to assist with
the coordination of services between the city’s homeless service providers and mental
health providers to ensure that the immediate and ongoing mental health needs of
homeless individuals are met.
Additionally, BMHS played an active role during FY 12 in the planning process for the
City’s first ever Project Homeless Connect, a city-wide event that provided
comprehensive services to individuals who are at risk of or experiencing homelessness.
This event was based on a national model that has been replicated in over 620 cities
across the U.S. and focused on going beyond the traditional resource fair by providing an
array of on-site services directly to participants. The event took place in August 2012 and
attracted over 1,000 participants.
BMHS also partnered with the Mayor’s Office, the Housing Authority of Baltimore City,
and the Veteran’s Administration to take part in a national training in the implementation
of a Registry Week, a new, innovative method for carrying out the Point-in-Time census.
This method is modeled after the 100K Homes campaign and incorporates a more
thorough approach to identifying and targeting services to the City’s most vulnerable
homeless individuals and families. BMHS has taken a leadership role in the initial
planning activities in anticipation of implementing the Registry Week in January 2013.
43
Action Step: Provide funding and consultation to programs serving homeless
children and families.
BMHS continued to fund a therapeutic nursery program, PACT, which offers specialized
childcare, including mental health and educational services for children under the age of
three. Services are provided to families that either currently live in homeless shelters or
that have recently experienced homelessness. The primary focus of services is to provide
mental health interventions that promote parent-child attachment and improve stability in
the family. Services are community-based and include those delivered in a family shelter,
providing ease of access for families in Baltimore City. In FY 12, there was a 34% (44)
decrease in referrals to PACT and a 35% (102) decrease in the number of children and
parents served. The decreases in FY 12 are attributed to a lower rate of turnover in the
shelter compared to FY 11. The average length of stay for families in FY 11 was eight to
nine weeks. In FY 12, the length of stay per family was 11 to 12 weeks. The high
turnover rate in FY 11 resulted in more families being served and more referrals being
made.
Indicators: Report on progress to date; number of individuals served.
See above for progress to date.
Services Provided by HUD-funded Providers to Homeless Individuals and Families in Baltimore City
Provider # Individuals not
in Families # Adults in Families
# Children
Total # of Individuals
# Families
Bon Secours Outreach
158 32 43 233 32
HOPE Drop-In Center
167 9 20 196 9
HOPE Safe Haven 62 0 0 62 0
Johns Hopkins Hospital Outreach
43 17 32 94 17
People Encouraging People Outreach
109 16 26 151 16
UMMS Safe Haven 78 0 0 78 0
UMMS SSI Project 140 18 29 187 18
TOTAL 757 92 150 1,001 92
44
STRATEGY 7: Fund transitional housing opportunities.
Action Step: Contract with a vendor(s) to provide transitional housing services.
BMHS funded five agencies to provide transitional housing for individuals experiencing
homelessness in Baltimore City with funding from MHA and HUD. Housing continues to
be a priority need for Baltimore City residents. Almost all transitional housing programs
experienced turnover in the BMHS funded beds. Due to inconsistencies in data reporting,
it is difficult to determine an accurate understanding of the reasons why individuals
vacated transitional housing beds when movement into permanent housing continued to
be a major problem. BMHS will continue to collaborate with the providers and the City
to collect more meaningful data in order to better understand the outcome of transitional
housing services.
In FY 12, Project PLASE served a total of 14 individuals experiencing homelessness in
Baltimore City. Six (43%) individuals had co-occurring mental illness and substance
abuse diagnoses and 12 (85%) were referred or linked to mental health care. Of the 14
individuals served, 10 (71%) exited the program; of those, nine (90%) obtained housing
and one (10%) individual was hospitalized. Of those who obtained housing, two moved
into Shelter-Plus Care permanent housing, three obtained Section-8 permanent housing
vouchers, one obtained a non-subsidized rental unit, two reunited permanently with
family members, and one moved in with friends for temporary housing. In all, 89% of
individuals housed were placed in permanent housing placements.
In FY 12, Ethel Elan Safe Haven served a total of 62 individuals experiencing
homelessness in Baltimore City. Of the 43 individuals who exited the program in FY 12,
16 (37%) moved into permanent housing. Safe Haven I served a total of 78 individuals
experiencing homelessness in Baltimore City. Of the 60 individuals who exited the
program in FY 12, 36 (60%) moved into permanent housing. Jacobs Well served a total
of 60 individuals experiencing homelessness in Baltimore City, 23 in transitional housing
and 37 in permanent housing. Of the 3 individuals who exited the transitional housing
program in FY 12, 2 (67%) moved into permanent housing. Lastly, My Sister’s Place
Lodge, a program of Associated Catholic Charities, served a total of 51 individuals
experiencing homelessness in Baltimore City. Of the 28 individuals who exited the
program in FY 12, 23 (82%) moved into permanent housing.
45
Indicators: Number of beds funded; number of individuals served.
Transitional Housing Opportunities
Provider # of Beds # of Individual
Served
At Jacob’s Well 42 60
Safe Haven I 20 78
Ethel Elan Safe Haven II 19 62
My Sister’s Place Lodge 27 51
Project PLASE 3 14
TOTAL 91 265
STRATEGY 8: Identify opportunities for BHLI to increase attention to and action regarding
Baltimore City’s homeless youth population.
Action Step: Collaborate with organizations serving homeless youth to identify
opportunities to develop outreach to youth ages 12 to 17 years.
BHLI no longer works with homeless youth. This strategy and action step will not be
included in future reports.
Action Step: Participate in the Baltimore Homeless Youth Initiative and other
forums addressing this problem.
Same as above.
Action Step: Convene meeting of local foundations around this topic.
Same as above.
Action Step: Advocate for increased resources to address the problem of homeless
youth and support efforts to address consent-to-treatment barriers through
legislation.
Same as above.
Indicator: Progress to date.
There is no progress to report.
46
STRATEGY 9: Provide mental health screening, intervention, and referral for children
exposed to violence.
Action Step: Provide funding and oversight to the Child Development Community
Policing (CDCP) program, which provides mental health outreach, assessment, and
referral for children who are witnesses or victims of a violent crime, and trains
volunteers about the needs of this population.
CDCP works collaboratively with families, police officers, mental health clinicians and
community members to break the cycle of violence by providing early intervention,
mental health services, training and community outreach. The intervention occurs shortly
after a child has witnessed or been impacted by violence and/or a traumatic event. The
CDCP team consists of community coordinators (e.g., a retired police officer) and a
mental health clinician. Funding for the CDCP was reduced for FY 11, which led to
reduced staffing and a more restricted geographic region (eastern Baltimore) being
served. Consequently, the numbers served by this project decreased by 79% between FY
10 - 12.
Indicators: Number of requests to CDCP; number of children and adolescents served.
Of the 88 calls, 50 families required face-to-face services by the CDCP response team:
● 12 (14%) were in response to children witnessing a traumatic event in the
community.
● 36 (41%) were in response to children being victims of assault.
● 29 (33 %) were in response to children being victims of other traumas, i.e.
car/bike accidents, falls, and dog bites.
CDCP Calls Received
Fiscal Year # Calls
FY 06 129
FY 07 323
FY 08 384
FY 09 496
FY 10 400
FY 11 84
FY 12 88
47
CDCP Calls Received by Age of Child
Age Groups # Calls
0-5 years 16 (18%)
7-12 years 22 (25%)
13 years & up 50 (57%)
As part of the training and community outreach, 155 individuals, including police
officers, youth and other community members were trained as specified below.
● 34 police officers received Trauma-Informed Training;
● 69 fellows received 640 hours of Fellows Training; and
● 41 youth from local churches and city elementary schools participated in
CDCP-facilitated violence prevention activities.
STRATEGY 10: Provide mental health services to individuals suffering from depression and
trauma and living in highly vulnerable communities.
Action Step: Through BHLI’s Connections Project, in partnership with Johns
Hopkins Bayview Medical Center, provide mental health services on-site in non-
traditional community-based settings.
Project Connections (PC) has successfully engaged and retained clients in this program, a
major goal of the project. Among the 164 clients discharged in FY 11, 68% who received
an initial evaluation returned for treatment services. With respect to program retention,
the average length of enrollment was 11 months. In addition to client engagement and
retention, PC has played a role in improving the overall mental health status of the clients
served, as exhibited by increases in Global Assessment of Functioning (GAF) scores,
which measure overall mental health and functioning over the course of treatment.
Furthermore, on average, participation in PC has been associated with an increased
likelihood of participating in entitlement programs, obtaining a primary care doctor and
receiving appropriate medication to treat mental health problems.
Indicators: Number of sites; number of individuals served.
In FY 12, Project Connections (PC) served 240 individuals at 4 sites.
STRATEGY 11: Fund mobile psychiatric assessment and treatment for elderly individuals.
48
Action Step: Contract with vendor(s) to identify, assess, treat, and link elderly
clients to services.
BMHS funded two vendors to provide mobile assessment and treatment for elderly
individuals: Johns Hopkins Hospital for the Psycho-Geriatric Assessment and Treatment
in City Housing (PATCH) program and the University of Maryland for the Senior
Outreach Services (SOS) program. Over the last 15 years, the funding for these programs
has not kept pace with increasing operating costs, and both providers have had difficulty
maintaining balanced operational budgets. To address the funding challenges, PATCH
downsized from two teams to one at the end of FY 10. Despite the downsizing from FY
11 to FY 12, there was a 28% increase in the number of individuals in active treatment as
well as a 53% increase in the number of individuals assessed.
Indicator: Number of individuals served.
Elderly Individuals Served by PATCH and SOS
Program
# Individuals
Assessed
# Individuals
in Active
Treatment*
Senior Outreach Services (SOS) 77 72
PATCH 53 19
TOTAL 130 91
*At end of fiscal year
STRATEGY 12: Provide technical assistance and consultation to coordinate access to
community-based services for elderly individuals.
Action Step: Assist State hospital facilities to transition elderly residents to
community placements.
BMHS continued to employ a Geropsychiatric Nurse Specialist to collaborate with State
hospital facilities to assist with discharge planning and to track clients’ progress when
discharged to the community. As a part of this effort, the Nurse Specialist meets regularly
with staff at State hospital facilities to review clinical information and progress toward
discharge for all elderly or medically fragile residents in the facility, which includes
clients who are 65 years of age or older and clients who are younger and medically
compromised. In addition, the Geropsychiatric Nurse Specialist works with assisted
living facilities and nursing homes in the community to provide education, technical
assistance and case consultation with the goal of assisting the client to remain in his/her
community placement after discharge from a State hospital facility.
49
In FY 12, the Geropsychiatric Nurse Specialist served 103 individuals statewide, 52% of
whom were Baltimore City residents, in 25 nursing homes and 30 community assisted
living facilities. Of the 20 new referrals, 55% were Baltimore City residents, 55% were
discharged to a community assisted living facility, and none were rehospitalized at a state
hospital facility within one year of placement. Following consultation with MHA and
significant outreach from the Geropsychiatric Nurse Specialist, collaboration between
community facilities and state hospital staff increased as did the timeliness of referrals to
the Geropsychiatric Nurse Specialist, which resulted in a 54% increase in referrals from
FY 11 to FY 12.
In addition to the work of the Geropsychiatric Nurse Specialist, BMHS provides funding
to Glenmore Manor, a residential rehabilitation program that provides enhanced staffing
for elderly and medically complicated individuals who have been discharged from State
hospital facilities. BMHS staff has worked closely with State hospital facilities and
Glenmore Manor to identify and transition individuals to this community setting.
Indicators: Number of individuals served.
See above for number of individuals served and progress to date.
GOAL IV: Early Mental Health Screening, Assessment, and Referral to
Services are Common Practice.
Objective 4.1: Promote healthy social and emotional development by making mental health
services available within settings where children grow and learn.
STRATEGY 1: Promote the provision of mental health promotion, prevention, and
intervention services in early childhood settings.
Action Step: Partner with Baltimore City Head Start to make mental health services
available on-site.
In FY 12, a total of 11 out of 12 (92%) Head Start Centers participated in the Early
Childhood Initiative, a collaborative effort between BMHS and BCHS to provide a
continuum of on-site mental health services, including mental health prevention, early
identification and intervention and/or treatment. Four organizations (Hope Health
Systems, Inc., University of Maryland, Change Health Systems, Inc. and Catholic
50
Charities/Villa Maria) provided 13 licensed mental health professionals who worked on a
multidisciplinary team to plan and implement mental health services within those 11
Head Start Centers throughout the City.
Indicators: Number of Head Start sites offering mental health services on-site; number of
mental health consultations provided.
Clinicians conducted 339 classroom observations and 712 mental health consultations.
The decrease in the number of classroom observations (61%) and mental health
consultations (35%) compared to FY 11 is attributed to clinicians implementing better
practices. In FY 11, clinicians were trained on four evidenced-based practices. In FY 12,
these practices were implemented, which resulted in children receiving higher quality
prevention activities and longer consultations. A higher quality of care was the emphasis
rather than the quantity of care.
STRATEGY 2: Promote the provision of mental health prevention, screening, assessment and
treatment services in public schools.
Action Step: Partner with the City Schools and Family League of Baltimore City to
fund school-based mental health services through the Expanded Mental Health
(ESMH) project.
BMHS continued to work with key stakeholders to provide expanded School Mental
Health (ESMH) services in 102 out of 196 (52%) of Baltimore City Public Schools in FY
12, a 5% increase from FY 11. The Sixth Grade - Expanded School Behavioral Health
Initiative (Sixth Grade Initiative) continued in 35 Baltimore City schools during the
2011-2012. This initiative is an innovative approach targeting sixth graders exhibiting the
following risk factors: attendance issues; behavioral issues; and low math and English
proficiency. The goal of this initiative is to support students during a critical transitional
period and to decrease the likelihood of school disengagement and drop-out. Funding for
this initiative is provided by Baltimore Substance Abuse Systems, Inc. and represents a
collaborative effort to promote resiliency and prevent substance use and other negative
outcomes for these at-risk sixth-graders.
Action Step: Track outcomes to demonstrate impact of school-based mental health
services.
In FY 12, a web-based database for the collection of ESMH data was launched to replace
the previous manual data collection and reporting process. The electronic database
enables ESMH clinicians to enter data in real-time and increases efficiency and accuracy.
The database also enables BMHS to create customized reports.
51
Action Step: Work with partners to explore possibilities for the expansion of ESMH
services.
An open and competitive procurement process was initiated in FY 11 that solicited high-
quality mental health providers to offer a full range of services in select City Schools for
academic year 2011-2012. The adjustment of funding levels that resulted from the
procurement process allowed 13 more schools to receive ESMH services in FY 12 as
compared to FY 11.
Action Step: Provide oversight and support to specialized school-based mental
health initiatives that serve targeted populations.
In FY 12, BMHS funded a year-long professional development training for ESMH
clinicians, known as The Common Elements. The Common Elements takes components
of interventions shown to be effective in treating specific disorders of childhood and
adolescents, and rebundles those elements, which provides more effective behavioral
health treatment. Seventy-two ESMH clinicians completed this training.
Indicators: Number of children and adolescents served; report on selected outcomes.
Expanded School Mental Health Services
FY 08 FY 09 FY 10 FY 11 FY 12
# of Schools Participating 96 106 102 89 102
# of Providers 13 12 12 9 4
Unduplicated Students Receiving Prevention Services
8,820 6,543 7,942 6,934 4,666
Total Funding Amount $3,009,950 $3,118,950 $2,964,500 $2,664,435 $2,304,000
During FY 2011-2012, 46,779 students in the 102 schools with ESMH services had
access to school-wide prevention activities, such as school assemblies and education
campaigns. This represents approximately 52% of the entire City Schools’ student
population. Four thousand six hundred sixty-six (4,666) students received mental health
prevention services7 in FY 12. As noted above, FY 12 was the implementation year of the
web-based database for the collection of ESMH data, which may be a reason as to the
decrease in the number of students served compared to previous years. In addition,
7 These prevention services differ from the school-wide prevention activities in that they specifically target at-risk
children rather than the general school population. In addition, these services are provided individually or in a small
group setting of 6 to 10 children.
52
similar to Head Start, which was discussed on page 49, in FY 12, ESMH clinicians
implemented better practices due to evidenced-based practice trainings provided in FY
11. These trainings resulted in the clinicians providing students higher quality prevention
services and longer consultations, but resulted in fewer students served.
Objective 4.2: Identify and seek to address the mental health needs of children and
adolescents in other child-serving systems.
STRATEGY 1: Work cooperatively with the Juvenile Justice System to identify and address
the mental health needs of involved youth.
Action Step: Provide consultation and technical assistance regarding mental health
services and resources on-site at Juvenile Court.
BMHS staff provided ongoing technical assistance and advocacy support services to
ensure that mental health services were delivered in a comprehensive family-friendly,
culturally competent manner. Meetings were held regularly with the service provider,
Hope Health Systems, in a continued effort to maximize service delivery within the
Juvenile Justice Center. Department of Juvenile Services (DJS) Administration continued
to express satisfaction with the quality of mental health services provided by Hope Health
Systems.
Action Step: Provide funding and oversight for the delivery of court-ordered mental
health assessments for post-adjudicated youth.
Despite additional budget reductions during FY 12, 289 youth received mental health
assessments. DJS outlined a plan in 2010 to gradually transition from a high volume of
in-house, grant-funded psychological evaluations to Medicaid-funded, fee-for-service
outpatient services, including assessment and treatment, through community mental
health clinics. As a result, DJS has developed plans for Reception/Assessment Centers at
various sites including Baltimore City Juvenile Justice Center, which are launching mid-
year FY 13. BMHS will continue to partner with DJS in order to support the transition of
this project to its new structure.
Action Step: In collaboration with Department of Juvenile Services (DJS), provide
funding and oversight for mental health and substance abuse screening and
treatment services for youth supervised by DJS at the Baltimore City Juvenile
Justice Center and in the community.
53
BMHS staff conducted site visits at the Baltimore City Juvenile Justice Center (BCJJC)
to provide technical assistance to ensure that mental health services are being delivered in
a comprehensive family-friendly, culturally competent manner. Youth in detention at
BCJJC continued to receive an array of mental health services, including screenings for
mental health and substance abuse issues, mental health treatment, and access to psycho
educational groups. In FY 12, 2,129 youth in detention were screened for mental health
and substance abuse issues, and 1,434 youth received mental health treatment during their
stay at BCJJC. (Note: some of the 1,434 youth were screened and began treatment in FY
11.) There was a 69% increase in the number of youth screened in FY 11 compared to FY
12, which is directly proportional to the number of youth cycling in and out of detention
during FY 12.
Indicator: Number of DJS-involved or court-involved youth served.
The data sets below outline the number of youth receiving court-ordered mental health
assessments at Baltimore Juvenile Justice Center (BCJCC). The program was
restructured in January 2012 to create a more streamlined referral process supported by
BMHS and Department of Juvenile Services (DJS) Resource Office. During this re-
organization process, DJS also began utilizing community-based resources to secure
mental health assessments, which diverted some referrals from this project; those
numbers are not captured in the below data. In addition, a reduction in funding also
contributed to the decrease in the number of youth who received mental health
assessments in FY 12 through this program.
Juvenile Mental Health Assessments Program (JMHAP) Court-Ordered Mental Health Assessments
Fiscal Year # of Assessments % Change FY 06 461 - FY 07 513 11% FY 08 662 29% FY 09 584 -12% FY 10 445 -24% FY 11 405 -9% FY 12 289 -28%
STRATEGY 2: Participate in statewide and local efforts to more adequately meet the mental
health needs of children and adolescents in foster care.
Action Step: Provide funding and oversight, in conjunction with MHA and
Department of Human Resources (DHR), of mental health assessments for children
at risk of entering or entering the foster care system.
54
BMHS staff continues to be involved in incorporating evidence-based mental health
assessments into the Making All the Children Healthy (MATCH) program, the integrated
care unit of Baltimore City’s Department of Social Services (BCDSS). Utilizing an
evidence-based assessment tool increases the likelihood that children entering the City’s
foster care system receive thorough health assessments that include a mental health
component. Those children who have identified treatment needs are linked to care.
In FY 12, Catholic Charities provided these mental health assessments. Through a
contract with the University of Maryland, up to 80 hours per month of
psychopharmacological chart review and medication management has been provided for
children involved in the foster care system. BMHS led quarterly implementation
meetings to ensure coordination among all involved partners. Eight hundred fifty-three
(853) youth who entered the BCDSS foster care system received evidence-based mental
health assessments and recommendations for appropriate mental health services through
this project, a 144% increase from FY 11 (350).
Action Step: Provide funding and oversight, in conjunction with MHA and DHR, of
mental health mobile crisis and stabilization services for children and families in the
foster care system.
In FY 12, BMHS continued to foster collaborative efforts with BCDSS and Catholic
Charities in implementing the BCDSS/BCARS Mobile Crisis Stabilization Program.
Steering committee meetings were held quarterly to provide updates on the work plan, to
review quarterly reports and otherwise act to strengthen collaboration around stabilizing
children and families in the foster care system.
Indicators: Number of children assessed; number of children able to maintain foster
care placement; number of mobile crisis responses.
BCARS/DSS Crisis Stabilization
FY 10 FY 11 FY 12
# of referrals/calls 177 385 135
# of youth eligible for services 130 352 123
# face-to-face assessments 67 95 88
% of children who maintained current DSS placement 90% 99% 95%
In FY 12, all 135 calls were responded to as per the policy of the program. Of the 123
youth and families eligible for services, 35 did not receive services for a variety of
reasons, including: families refused services, the youth’s foster care placement was
disrupted before BCARS could make contact, families could not be reached after the
referral was made or families canceled assessment appointments. Of the remaining 88
55
families who were eligible and willing to receive services, 52 families were admitted into
the program and received an assessment and treatment plan, and 36 families received
assessments only, with referrals to other community providers. Sixteen (16) families
required an immediate response and received face-to-face services in less than 2 hours as
per protocol. In FY 12, the average length of treatment associated with BCARS/DSS
stabilization services was 31 days, more than doubling the average length in FY11 (12
days). This trend is positive in that longer lengths of stay provide BCARS with a longer
period of time to implement a successful stabilization plan.
Of note, there was a 65% decrease in the number of referrals/calls compared to FY 11.
This is a direct result of a DSS policy change. In FY11, DSS made referrals to BCARS
without consulting with foster care workers, foster families or the youth. In FY 11,
referred services were declined 150 times (92%). In FY 12, DSS only referred individuals
and families that requested services. This, in turn, significantly decreased the rate of
declines for referred services; services were only declined 12 times out of 135 referrals in
FY 12 (9%).
Objective 4.3: Promote screening for mental health disorders, including co-occurring
disorders, and linkage to appropriate treatment and supports across the lifespan.
STRATEGY 1: Expand screening, assessment and coordinated treatment for individuals with
co-occurring mental health and substance use disorders.
Action Step: Continue planning activities with Baltimore Substance Abuse Services
(bSAS) and other Baltimore City stakeholders including the Expanded School
Mental Health Sixth Grade Initiative, and Integrated Dual Disorders Team (IDDT).
Continued intensive collaboration between bSAS and BMHS resulted in the
implementation of an Integrated Dual Disorders Treatment (IDDT) Initiative in February
of 2012 to serve individuals with co-occurring disorders who are court-ordered to
substance abuse treatment (8-507 designation). IDDT is an evidence-based practice
model that provides integrated mental health and substance abuse treatment to support
consumers in the recovery process. The first client was enrolled in April of 2012. There is
a projected enrollment of 55 clients for each of the three providers for a total of 165
clients served within the first year of operation.
BMHS also coordinated a joint mental health and substance abuse provider meeting with
bSAS in FY 12. Approximately 200 people attended. The guest presenter and speaker
was Chuck Ingoglia, Vice President of Public Policy for the National Council for
56
Community Behavioral Healthcare. He discussed behavioral health integration from a
national perspective.
Lastly, BMHS continued to collaborate with bSAS to implement the Sixth Grade
Initiative as part of the Expanded School Mental Health program, as described on page
50. This initiative provides prevention and early intervention services for youth who are
at risk of dropping out of school, which in turn is a risk factor for substance use.
Action Step: Continue efforts to increase knowledge among BMHS and BSAS staff
of treatment issues relating to individuals with co-occurring disorders and promote
closer collaboration between the two agencies.
BMHS and bSAS continue ongoing dialogue to generate ideas and identify opportunities
to improve the coordination of care for individuals with co-occurring disorders. The two
agencies hold regular management-to-management meetings that: increase shared
knowledge of both service systems; strengthen relationships between the agencies, their
staff and boards; and identify opportunities to strengthen their system-level collaboration.
In addition, BMHS held trainings with bSAS-funded providers and staff on the levels of
care available in the Public Mental Health System and how to access services.
Indicator: Progress to date.
BMHS participated in ongoing meetings with bSAS and various key partners to improve
integrated services for individuals with co-occurring disorders. See above for description
of activities.
STRATEGY 2: Make buprenorphine treatment available to individuals with mental illness
and opioid addiction.
Action Step: Through BHLI’s Project Connections, continue offering
buprenorphine treatment in coordination with mental health treatment at one site.
During FY 12, BHLI continued operations at Dee's Place, a 24-hour substance abuse
program, and opened a second site in December 2012, Recovery in Community.
.Indicators: Report on progress to date and number served.
In FY 12, there were 130 clients served between Dee’s Place and Recovery in
Community.
57
GOAL V: Excellent mental health care is delivered and research is
accelerated while maintaining efficient service system accountability.
Objective 5.1: Promote workforce development and training through educational activities
and technical assistance to mental health service providers and other service sectors.
STRATEGY 1: Sponsor continuing education and training opportunities in evidence-based
and emerging best practices.
Action Step: Sponsor community trainings for community-based mental health
clinicians.
During FY 12, BMHS contracted with the National Council for Behavioral Healthcare to
facilitate a Trauma-Informed Care Learning Community consisting of eight agencies
within the Baltimore City Public Mental Health System. Agencies participated in an
organizational self-assessment during two face-to-face learning community meetings and
two training webinars. The goals of the trainings were to create safe and secure
environments; address staff self-care; provide trauma-sensitive services; and to avoid
retraumatization of consumers. The agencies will become more trauma-informed through
critical policy and practice changes, implementing evidenced-based practices, expanding
consumer and peer support roles and partnering with human and social services agencies.
Action Step: Sponsor professional development sessions for school-based mental
health clinicians.
There were 3 professional development sessions for school-based mental health
clinicians, with 125 clinicians attending. The training topics for clinicians were as
follows:
● Back to School- Effective Collaborative Partnerships in Head Start Centers &
City Schools
● Informed by Common Elements (Basic)
● Informed by Common Elements (Plus)
Indicators: Number of training activities; number of participants.
See above for number of training activities and participants.
58
STRATEGY 2: Provide support and technical assistance to community service providers in
how the public mental health system works.
Action Step: Provide presentations to community service organizations about the
resources available for clients in need of mental health services.
BMHS staff received multiple requests to educate community service providers on how
the Public Mental Health System works. Presentations were made to Clifton T. Perkins
State Hospital social work staff, Union Memorial Hospital’s inpatient social work team,
providers receiving Ryan White funding, agencies participating in the Baltimore
Homeless Youth Initiative, Department of Public Safety and Correctional Services case
managers, Baltimore City Detention Center staff, Hands In Partnership (HIP) providers,
bSAS Care Coordinators, participants in the Department of Education Transition Age
Youth Resource Expo and various other caregivers.
BMHS continued to distribute its reference document, Mental Health Services for Adults
in Baltimore City, to guide presentations on community services available to adults in the
fee-for-service Public Mental Health System. This document was used for the majority of
the presentations listed above and was distributed at provider meetings and to the BMHS
board.
BMHS’ Geropsychiatric Nurse Specialist conducted 31 trainings to nursing home and
assisted living staff on a variety of topics related to aging and mental health resources.
Indicators: Types of community service organizations that received presentations;
number of presentations.
BMHS provided 44 trainings for community service organizations. Over 230 Mental
Health Services for Adults in Baltimore City documents have been distributed. See above
for types of organizations.
Objective 5.2: Provide access to services in the least restrictive setting.
Strategies 5 and 6 were partially accomplished.
STRATEGY 1: Strengthen crisis response services.
Action Step: Provide funding and oversight to Baltimore Crisis Response, Inc.
(BCRI) and to Baltimore Child and Adolescent Response System (BCARS).
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Baltimore Crisis Response, Inc. (BCRI)
BMHS continued to fund BCRI for mobile crisis services and for a 24-hours-per-day, 7-
days-per-week crisis hotline. In addition to licensure as a residential crisis facility, BCRI
has licensure as a targeted case management program and an outpatient mental health
clinic and receives reimbursement through the State’s fee-for-service Public Mental
Health System for these services. This fee-for-service revenue was permitted by the state
and promoted by BMHS to compensate for the reduction in funding that occurred in FY
10, when funding for the diversion project was eliminated. In FY 12, BCRI was able to
increase the fee-for-service revenue which enabled the expansion of the mobile crisis
team hours, which had been reduced when the diversion project was eliminated. The
mobile crisis teams are now available from 7am to midnight. BCRI’s services continue to
be vital to the City’s mental health services continuum, and BCRI continues to provide
ER diversion services. BMHS continues to provide technical support both to assist BCRI
in their efforts to maximize the community’s utilization of BCRI services and in the
collection of fee-for-service revenue to support increased capacity.
BCRI’s call volume was 28,444 calls in FY 12, approximately 4% less than the number
of calls in FY 11. The distribution of types of calls in FY 12 was very similar to the
distribution in FY 11.
26,833 24,695
27,248
30,314 29,719 29,711 28,444
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# C
alls
Fiscal Year
BCRI Hotline Calls, FY 06-FY 12
60
BCRI also experienced a slight (4%) decrease in the number of mobile crisis team face-
to-face visits.
BCRI Services
FY 09 FY 10 FY 11 FY 12 Mobile Crisis Team Referrals 2,534 2,556 1,991 1,969 Mobile Crisis Team Visits 2,285 2,325 1,736 1,665 % of referrals resulting in Mobile Crisis Team visit 90% 91% 87% 85%
In FY 12, there was an increase in the occupancy rate to 85% from 80% in FY 11, and a
slight increase in the length of stay in residential crisis beds. The increased occupancy
rate was in part due to BCRI’s participation in the coordination of services for high
inpatient users8 of psychiatric inpatient services. BCRI partnered with BMHS, Value
Options and MHA to coordinate services for these high inpatient users.
FY
10 %
Change FY
11 %
Change FY
12 %
Change
Individuals receiving Residential
Crisis Services 826 5% 710 -14% 732 3%
Residential Crisis Bed Days 5,351 0% 6,133 15% 6,537 7%
Residential Crisis Average Length of
Stay (Days) 6.5 -11% 8.8 35% 9 1%
8 A high inpatient user is a consumer who has been hospitalized for more than 30 days or has had five
hospitalizations within the last 6 months.
Information 63%
Crisis 6%
Suicide 4%
Supportive Counseling
2%
Referred to Other 1%
Detox 3%
BCARS 6%
Shelter Hotline 14%
Homeless 1%
BCRI Type of Call (n=28,444)
61
Baltimore Child and Adolescent Response Services (BCARS)
In the last quarter of FY 12, BCARS expanded their services and implemented a Pediatric
Emergency Room Department Diversion program with the University of Maryland
Medical Center and Johns Hopkins Hospital. BCARS also established a free-standing
BCARS Urgent Care Clinic. For the University of Maryland, BCARS provided a full-
time (8-hours a day, Monday through Friday) crisis clinician liaison who assisted referred
families to access services via telephone. At Johns Hopkins Hospital, a full-time BCARS
crisis clinician was present in the emergency department to also assist in accessing
services. The Urgent Care Clinic provided crisis response services in a clinic setting to
those youth and families who could access the clinic and were not in need of a mobile
response. The BCARS Emergency Room Diversion clinicians assisted with crisis
assessments and stabilization services. In addition to linking families to community based
services, the diversion program included crisis respite beds and up to eight weeks of care
coordination, in addition to the traditional two-week BCARS response. As one of the
crisis stabilization providers under the 1915c waiver, BCARS continued to provide crisis
services to a small number of families.
Indicator: Number of individuals served by each provider; progress to date.
Baltimore City Crisis Services
BCRI Services
Crisis Calls 28,444
Mobile Crisis Team Visits 1,665
Individuals receiving Residential Crisis Services 732
Individuals Receiving In-Home Interventions 361
BCARS Services
Crisis Calls 1,829
Families Receiving Crisis Stabilization Services 384
Emergency Room Diversion Program (last quarter FY 12) referrals 65
STRATEGY 2: Facilitate coordination of care for individuals using emergency rooms as their
point of access to psychiatric services.
Action Step: Facilitate access to community-based services for uninsured
individuals through the diversion project.
The Hospital Diversion Project, a pilot program that targeted uninsured consumers
visiting emergency rooms for psychiatric care, was eliminated in FY 11 due to greater
62
ease of inpatient admission for uninsured individuals presenting at local emergency
rooms. This was due to changes in the way the Emergency Medical Treatment and Active
Labor Act (EMTALA) was being implemented in Maryland. As a result, clients are more
frequently admitted from City emergency rooms to acute psychiatric inpatient care units,
and there are fewer requests for diversion. BCRI, the provider that previously operated
the Hospital Diversion Project, continues to serve clients, insured and uninsured, in
hospital emergency rooms. In FY 12, BCRI served 317 individuals in emergency rooms,
a 21% decrease from the number served in FY 11. Of all the referrals received by the
mobile crisis teams, 44% were from emergency rooms compared to 49% for FY 11.
Mobile Crisis Team Referrals from Emergency Rooms
FY 11 FY 12
Total # Referred 969 866
% Referred from Emergency Rooms 49% 44%
Action Step: Facilitate access to community-based services for clients identified by
MHA and the Administrative Services Organizations (ASO) as high inpatient
utilizers.
BMHS continued to coordinate services for individuals identified as high utilizers of
inpatient psychiatric services, i.e., those consumers who have either been hospitalized for
more than 30 days or who have had five or more hospitalizations in the last six months.
In FY 12, BMHS coordinated services for a total of 49 high inpatient user (HIU) project
consumers from various inpatient hospitals in and around Baltimore City. Of the 49
individuals, 28 (57%) were referred and successfully linked to community providers for
outpatient care. Individuals were referred to services such as case management, assertive
community treatment, outpatient mental health clinics, and RRP. BMHS staff continues
to collaborate with the ASO, local inpatient hospitals and community providers to
identify strategies to engage HIU project consumers not yet connected to care.
BMHS continued to receive funding through September of 2011 from the State’s Mental
Health Transformation Project to enhance a Baltimore City assertive community
treatment (ACT) team with two peer support specialists to provide enhanced assertive
engagement and support to HIU project consumers. The goal of the project, called the
Peer Support Engagement Project (PSEP) and operated by People Encouraging People,
Inc. (PEP), is to improve consumer outcomes and reduce avoidable use of hospital
emergency and inpatient care, along with associated costs. A majority of consumers
served in the HIU project during FY 12 were referred to PSEP and enrolled in care by the
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team. Following the end of grant funding, this ACT team continued to serve HIU project
consumers through reimbursement through the State’s fee-for-service Public Mental
Health System (PMHS). The enhanced peer support, however, is no longer in place.
In FY 12, an analysis of 20 consumers served by the PSEP was done. These individuals
are adults ranging in age from 24 to 59, with 80% male, 20% female, 75% African-
American, and 25% Caucasian. Eighty-two percent (82%) of these individuals were
diagnosed with co-occurring mental health and substance use disorders. For 17 of the 20
consumers served, service utilization and claims data was available through the PMHS.
During the first nine months of enrollment in the PSEP, as compared to the nine months
prior, data for these 17 individuals shows that there was:
A reduction per consumer in visits to emergency departments (ED) (24.2%),
admissions to inpatient psychiatric hospitals (53%), and days of inpatient
psychiatric hospitalization (42.3%).
A reduction in the percentage of ED visits that resulted in an inpatient psychiatric
hospitalization from 71% to 44%.
An aggregate reduction in PMHS costs associated with these individuals of
17.6%, which includes a 39.3% reduction in inpatient psychiatric costs, a 24.4%
reduction in ED costs, and an 88.4% increase in community-based outpatient
costs.
The PSEP staff identified housing as a primary need for the majority of the 20 consumers
served, and that assisting these individuals in accessing permanent housing was an
essential component in reducing their use of ED and inpatient services. BMHS, through
its experience in funding the PSEP as well as the Capitation Project and FACTT,
continues to support the notion that the combination of comprehensive community-based
services with flexible consumer support funds and housing subsidies improves outcomes
and reduces overall system costs for individuals with multiple complex needs who are at
high risk for negative outcomes and are using a disproportionately high volume of the
most expensive services.
Indicator: Number of individuals served.
In FY 12, a total of 49 high inpatient utilization (HIU) project clients were served.
BCRI served 317 individuals in hospital emergency rooms.
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STRATEGY 3: Whenever possible, divert children and adolescents from admission to
Residential Treatment Centers (RTCs) through offering alternative community-based
interventions and supports.
Action Step: Participate in the approval process for home- and community-based
wraparound services for children and adolescents.
In an effort to expand the continuum of community-based services available to youth, the
State of Maryland received a federal System of Care grant in 2007 to be implemented in
Baltimore City. This grant, titled Maryland Crisis and At Risk for Escalation diversion
Services for children (MD-CARES), strengthens cross-agency partnerships that blend
family-driven, evidence-based practices within mental health and child welfare to better
serve this high-risk population. In previous years, the 1915c waiver also expanded the
pool of children eligible to receive wraparound services. In FY 12, the 1915c waiver
enrollment, which had a sunset provision, ended. In FY 12, 81 children and adolescent
with complex behavioral health needs were served by Wraparound Maryland.
Action Step: Review Certificate of Need (CON) documents to ensure that all
referred youth meet eligibility requirements and community-based services have
been exhausted prior to determining whether an RTC level of care is needed.
BMHS staff reviewed 149 Certificates of Need, 39 for the 1915c Waiver and 109 for
traditional “brick and mortar” residential treatment centers, to ensure that children were
referred to the least restrictive, most appropriate treatment environment.
Indicators: Number of children and adolescents referred for RTC placement; number of
children and adolescents diverted from RTC services via the Care Management Entity
(CME).
Certificate of Need Packets Reviewed
FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# of packets reviewed 107 99 104 106 82 143 149
# Approved 106 95 103 93 77 141 140
# Rejected 1 4 1 13 5 2 9
261 children were diverted from RTC admission; 81 children were served under the
1915c Medicaid Waiver within the Care Management Entity (CME); and 174 children
were served through other programs (e.g., MD-CARES, group home diversion) offered
65
within the CME. The increased number of CON packets reviewed is likely due to the
increased awareness of the above-mentioned services. It is also important to note that not
all children diverted from RTC required a CON.
STRATEGY 4: Provide support to programs that work with children and adults
transitioning out of inpatient/institutional facilities.
Action Step: Facilitate opportunities for communication between BCARS and
Wraparound Maryland, and child and adolescent psychiatric inpatient programs in
Baltimore City to increase utilization of BCARS or Wraparound Maryland to assist
youth in returning to the community following an inpatient admission.
BCARS continued to provide brief and intensive community-based services for children
in psychiatric crisis to divert or shorten inpatient hospitalization. BCARS also linked
clients to community providers for ongoing treatment once discharged from inpatient
settings. BMHS and BCARS staff communicated regularly to ensure that children and
their families were able to access the continuum of services across the public mental
health system, including services that facilitate a successful return to the community
following inpatient admissions.
Action Step: Collaborate with State hospital and acute care facilities in identifying
community resources to assist in discharge planning.
BMHS staff met monthly with the staff of Spring Grove Hospital, the State hospital
facility with the largest number of Baltimore City residents, to share resources and
collaborate on discharge planning. As part of this collaboration, a case review process
was utilized whereby individual client cases are reviewed and specific resources are
recommended to assist hospital staff in transitioning clients to the community. BMHS
facilitated collaboration among stakeholders to support the successful closure of the
Assisted Living Units (ALU) at Spring Grove and Springfield Hospitals, meeting the
target closure date established by MHA. This included facilitating the inclusion of court
personnel to enhance communication and collaboration between the state hospitals,
courts and the community-based services system, maximizing successful discharge
planning.
BMHS staff presented a workshop to the hospital’s social work department on the system
of services in Baltimore City in order to increase their knowledge of services available
and improve discharge planning. BMHS staff also provided training to hospital social
workers on effective discharge planning for individuals needing nursing home or assisted
living level of care in the community. This has resulted in a significant increase in
requests for BMHS’ Geropsychiatric Nurse Specialist to provide consultation.
66
BMHS facilitated one community provider presentation for staff and current clients at
Spring Grove Hospital Center (SGHC). Five (5) Baltimore City providers and five
consumers formerly hospitalized at SGHC provided education and encouragement to
individuals currently hospitalized to consider leaving the hospital and seeking community
placement. The presentation targeted hospital clients who have been reluctant to
transition to the community.
BMHS staff participated in monthly conference calls with Springfield Hospital social
work staff to share resources and collaborate on discharge planning for Baltimore City
residents. The BMHS Geropsychiatric Nurse Specialist also participated in monthly
interdisciplinary committee meetings to facilitate the successful discharge of individuals
needing nursing home or assisted living level of care to community providers throughout
the state.
BMHS staff collaborated more closely with social work staff at Clifton T. Perkins
Hospital in FY 12 to increase their knowledge of the array of community-based services
available in Baltimore and assist in developing discharge plans for those ready to return
to the community.
BMHS employs a Referrals Coordinator to manage the referral process for RRP, FACTT
and Capitation. Communication occurred almost daily with State hospital facilities to
ensure that individuals being discharged from these facilities were given priority for
vacancies in the above programs. RRP was the most frequent placement, with 26
individuals admitted from State hospital facilities. Of those individuals placed into RRP
beds, the average length of stay in a State hospital facility prior to discharge was 2.65
years, with a range of 18 days to 11 years. For Capitation, the average length of stay in a
State hospital facility prior to discharge was around 1 year, with a range of 10 months to
4 years.
On Our Own of Maryland, using funding from a grant from BMHS, provided peer
counseling services to 143 individuals hospitalized in state psychiatric hospitals. The goal
of this service is to assist clients in transitioning from the hospital to the community, and
improve tenure in the community following discharge. Seventy-three (73) individuals
served were discharged from the hospital to the community.
Indicators: Report on progress to date; number of individuals who transitioned from
inpatient/institutional facilities.
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FY 12 Number of Individuals Discharged from State Hospitals
Forensic Non-Forensic Total Capitation Project 1 4 5
FACTT 20 0 20
Geriatric Community Placements* 2 18 20
RRP 17 9 26
TOTAL 40 31 71 *Coordinated by the Geropsychiatric Nurse Coordinator
Overall, there was a 5% increase in the number of individuals discharged from State
hospitals to public mental health services in FY 12 (total of 71) compared to FY 11 (total
of 68), with only the Capitation Project experiencing a decrease. These discharges are
largely dependent on State hospitals identifying consumers in need of public mental
health services. BMHS staff continue to work collaboratively with state hospital staff
toward more effective and rapid identification of consumers in state hospitals ready for
discharge and planning for their return to the community.
STRATEGY 5: Provide access to affordable housing for individuals and families with mental
illness.
Action Step: BMHS’ housing affiliate, Community Housing Associates (CHA), will
provide 266 units of safe and affordable housing throughout Baltimore City.
CHA provided housing to 217 households (159 individuals and 58 families). CHA
completed 10 additional units in FY 11, and 7 units in FY 12. CHA has a contract on a
property which will yield 9 units in FY 13. Ninety-seven percent (97%) of tenants
remained housed with CHA for over a year, 55% over 5 years and 5% over 10 years.
Indicators: Number of individuals and families housed; retention in housing greater than
6 months.
See above for progress to date.
Strategy 6: Increase the number of affordable housing units available to individuals and
families with mental illness.
Action Step: CHA will apply for funding to develop housing for adults and families
with mental illness.
CHA applied for funding through the Department of Health and Mental Hygiene Capital
Bond Program and received $3.5, $2.9 and $2.5 million for FY 10, FY 11 and FY 12
68
respectively. CHA is matching the awarded funds with funds committed from the
Department of Housing and Community Development and the Housing Authority of
Baltimore City to develop 17 new units of affordable housing for individuals with
disabilities. CHA has a third property under contract which will be similarly funded by
DHM, DHCD and HABC.
Action Step: CHA will acquire and rehabilitate 20 units of affordable housing.
CHA has acquired 17 units of affordable housing. Ten (10) units were acquired in
December 2009, and seven additional units were acquired in June 2010. Construction is
now complete on 10 units of housing with occupancy planned for early FY
13. Construction of an additional seven units was completed in FY 12. CHA has a
contract pending on an additional 9 units to be completed in FY13.
Action Step: CHA will secure funding to acquire and rehabilitate an additional 20
units of housing to serve adults and families with mental illness.
Same as above.
Action Step: CHA will secure rental subsidies for all new units, ensuring tenants
pay no more than 30% of income for rent.
All new units will have Project-Based Section 8 rental subsidies, and tenants will pay no
more than 30% of their income towards rent.
Action Step: CHA will secure funds to make support services available to residents
of CHA housing.
Support for social services is incorporated in each of the budgets that fund the 17 units.
The social service funds were approved and will support a Resource Coordinator to
support the tenants.
Indicators: Number of applications submitted; number of individuals housed; number of
units developed; number of units with rental subsidy.
CHA submitted 2 applications to the Department of Housing and Community
Development and the Baltimore City Housing Authority, 1 application to the United Way
of Central Maryland, 1 renewal application for the Service Linked Housing program, 1
renewal application to Maryland’s Community Development Block Grant Program, and 2
renewal applications for the Shelter Plus Care Program. See above for progress to date.
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Objective 5.3: Identify and promote the implementation of evidence-based, effective,
promising and best practices for mental health services.
Strategy 3 was not accomplished.
STRATEGY 1: Explore opportunities to increase access to evidence-based practices (EBP)
for children and adolescents.
Action Step: Collaborate with stakeholders throughout the City to establish a
continuum of EBP’s in Baltimore City.
In FY 12, BMHS collaborated with the National Council to establish evidenced-based
practice and emerging best practices in trauma-informed care for adults and children. In
addition, BMHS participated in monthly planning meetings facilitated by the Mental
Hygiene Administration’s Early Childhood Mental Health Committee to create four
demonstration sites, one in Baltimore City, that conduct evidenced-based practices in pre-
school settings. Lastly, BMHS partnered with Baltimore City Public Schools to fund The
Common Elements training for 72 ESMH clinicians.
Action Step: Provide oversight of and explore increased funding for the Center on
the Social and Emotional Foundations for Early Learning (CSEFEL) Positive
Behavior and Supports (an evidence-based practice) in at least one Head Start
Center.
In FY 12, five Head Start sites in Baltimore City were trained on SEFEL and began using
the evidence-based practice. Additionally, 18 of the 24 local school systems in the state
of Maryland have implemented or are making plans to implement SEFEL. BMHS
continues its participation in the statewide Steering Committee for Early Childhood’s
planning and monitoring of SEFEL. To date, there are over 350 individuals trained
throughout the State as trainers of this evidence-based practice model.
Indicators: Number of clinicians trained; progress report on implementation and
associated outcomes.
See above for progress to date.
STRATEGY 2: Facilitate implementation of MHA’s evidence-based practice guidelines for
supported employment and assertive community treatment (ACT).
70
Action Step: Provide information, support and encouragement to programs
expressing interest in adopting evidence-based practices.
BMHS continued to promote the adoption of evidence-based practices in Baltimore City
for services to adults. Supported Employment Programs (SEPs) and Assertive
Community Treatment (ACT) teams are the two evidence-based practice models most
utilized for adults in the City.
BMHS continued to utilize mobile treatment provider meetings to promote the adoption
of evidence-based practices. This has given programs already certified by the State as
ACT teams the opportunity to offer guidance and support to programs interested in
becoming certified. Currently, six of the nine mobile treatment programs in Baltimore
City are certified as ACT teams. One additional mobile treatment team submitted a plan
for ACT certification after receiving technical assistance from BMHS, and is currently
receiving intensive training by the State. The remaining two mobile treatment programs
have expressed interest in further exploring the benefits of ACT certification.
BMHS staff provided technical assistance and support for five Supported Employment
Programs working toward evidence-based practice fidelity. In addition, BMHS staff
served on the leadership team for one of the programs that is considered a leader in
supported employment services for the state. Leadership teams are a recommended action
for programs interested in adopting SEP, and they provide support and guidance for the
program in implementing the EBP.
Finally, BMHS, in collaboration with bSAS, implemented an Integrated Dual Disorders
Treatment (IDDT) team, an evidence-based program model similar to ACT, for
individuals with co-occurring mental health and substance abuse disorders. See page 55
for a description of this initiative.
Indicators: Number and type of programs maintaining fidelity to the models.
There were 2 Supported Employment Programs (SEP) and 6 Assertive Community
Treatment (ACT) teams that maintained fidelity throughout the year.
STRATEGY 3: Identify opportunities to improve coordination in the provision of mental
health treatment and somatic care.
Action Step: Collaborate with MHA, Community Behavioral Health and other
interested partners in implementing practices that address somatic risk factors,
such as tobacco cessation, in mental health treatment settings.
71
The BMHS Geropsychiatric Nurse Specialist is an active participant in the Maryland Quit
Advisory Board and participates in two state-level groups formed to address smoking
cessation: the Department of Health and Mental Hygiene (DHMH) Maryland Leadership
Academy on Smoking Cessation and Wellness and the Mental Hygiene Administration
(MHA) Smoking Dependence Task Force. In addition, this staff person co-chairs a
workgroup with the Director of the Office of Chronic Disease Prevention for the DHMH
Leadership Academy as well as spearheads the efforts of MHA to address wellness and
smoking cessation. This staff person regularly provides updates n smoking cessation-
related activity and shares smoking cessation resources with BMHS staff.
Indicator: Report on progress to date.
See above for progress to date.
Objective 5.4: Improve public mental health programs’ compliance with quality standards
established by Mental Hygiene Administration (MHA) and State and Federal regulations.
STRATEGY 1: Conduct quality assurance site visits to mental health programs.
Action Step: In collaboration with MHA and the Administrative Services Organization,
conduct audits of mental health programs to evaluate quality of services, billing practices
and compliance with State and Federal regulations.
BMHS staff collaborated with MHA, Office of Healthcare Quality (OHCQ) and Value Options
to conduct quality assurance site visits of mental health programs. Site visits were conducted
with 84 programs during FY 12. 30 programs failed to meet at least one quality standard and
were required to submit a Performance Improvement Plan (PIP). When requested, BMHS
provided technical assistance to providers in support of provider PIP submissions.
Action Step: Using data from compliance audits, identify areas where system-wide
improvements in services are needed and educate providers regarding deficiencies.
BMHS staff identified the following seven deficiencies that were most frequently cited by
compliance auditors for PMHS fee-for-service programs. These seven areas represent
opportunities for providers to improve care:
1. Transition and discharge planning are not done early or adequately.
72
2. Comprehensive strength and need assessments are not done, particularly for adults.
Many child-serving programs use Child and Adolescent Needs Assessments (CANs)
to address this issue.
3. Discharge follow-up is not done or not done adequately.
4. Collaboration with medical (somatic) providers is limited.
5. Individualized and differentiated treatment is lacking.
6. Treatment plan goals are not consumer-driven.
7. Case management providers frequently miss deadlines for assessment, re-assessment,
and service planning. Also, documentation of the condition of the home and of the
related presence or absence of safety issues is lacking.
BMHS staff noted that the technical assistance given to grant-funded providers has resulted in
these providers performing adequately in these seven areas. Therefore, it is likely that
providing similar technical assistance to the non-grant funded providers would result in fewer
deficiencies. Additionally, BMHS found that PRP providers are most frequently cited for not
adequately following specific COMAR treatment plan requirements, and that Case
Management providers are most frequently cited for missing deadlines for assessment, re-
assessment, and service planning (as in #7 above). These are additional areas where training
could lead to system-wide improvements in service delivery.
BMHS has implemented the following to address these concerns:
Increased technical assistance to case management providers through more frequent
site visits.
Identified training for PRP providers in compliance with the COMAR PRP treatment
plan requirements.
Indicators: Number of programs whose services meet quality standards; reduction in number
of programs found to be non-compliant.
84 programs received quality assurance site visits; 30 (36%) failed at least one standard and
were required to submit PIPs due to deficiencies. No programs received sanctions due to non-
compliance because their program improvement plans adequately addressed the issues of
concern.
There were 56 grant-funded providers; 2 (4%) were issued corrective action plans (CAPs) for
failing to meet one or more programmatic deliverables. 96% were compliant with contractual
obligations.
STRATEGY 2: Provide training and technical assistance to mental health programs.
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Action Step: Offer education and technical assistance to new programs that submit
applications to deliver public mental health services.
Seven (7) new programs submitted applications to provide mental health services in Baltimore
City, and all of them received technical assistance. Some applicants were new providers to the
PMHS and others were current providers interested in establishing new programs. Providers
were asked to submit a business plan and a break-even cost analysis as part of their application
submission. These documents are reviewed by BMHS staff to ensure that system needs are
being addressed during the application process. Providers were given feedback on application
materials submitted and were given suggestions on how to attain compliance with COMAR.
Once an application adequately addressed the regulations, BMHS provided a letter of support.
Providers were then instructed to submit the revised application to the Office of Health Care
Quality to initiate the approval process.
Action Step: Offer technical assistance to existing providers in developing performance
improvement plans in response to quality assurance site visits.
BMHS staff provided technical assistance to 19 providers who received PIPs resulting from
failed OHCQ site visits. BMHS staff provided technical assistance to providers in developing
their performance improvement plans, which were then submitted to OHCQ for approval.
Indicators: Number of programs receiving technical assistance; reduction in the number of
non-compliant programs.
7 programs received technical assistance to start new programs. 19 programs received technical
assistance with PIPs.
STRATEGY 3: Monitor public mental health programs using a quality management
framework.
Action Step: Review and monitor quality management metrics in a newly established
quality management committee.
The Quality Management Committee was created at the beginning of FY 12 and met eight
times throughout the year. The Committee developed six measureable quality indicators, which
are as follows:
Measures of Quality within the City’s Publicly-Funded Mental Health Programs
1. Consumer Perceptions of Care
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2. Provider Compliance with Contractual Requirements
3. Provider Program Quality
Measures of Quality Relating to BMHS Performance
4. Consumer Complaint Resolution
5. Timely Annual Contract Renewals
6. Help Call Satisfaction Rates
At each meeting, the Committee reviewed and analyzed data collected on the indicators,
identified improvement opportunities, and developed interventions to promote improvement.
In addition, quality assurance site visit results and provider applications to establish, expand
or close services/service lines were reviewed to assist in identifying PMHS service gaps and
provider trends.
Objective 5.5: Ensure that residential rehabilitation programs provide safe, affordable, and
quality housing.
STRATEGY 1: Inspect 100% of residential rehabilitation program (RRP) housing to
evaluate compliance with Code of Maryland Regulations.
Action Step: Conduct initial and annual housing inspections.
Every core service agency is required to conduct annual inspections of all residential
rehabilitation program (RRP) housing. BMHS also inspects the crisis residential beds in the
City. BMHS staff inspected 100% of the City’s 137 housing units, which have the capacity to
house a total of 381 residents. Units are defined as individual dwellings with leases or
ownership (i.e. apartment, house, group home, residential unit for crisis). Overall, the housing
was found to be in good repair, with all 137 inspections resulting in recertification after repairs
were completed.
Action Step: Conduct follow up inspections to determine if deficiencies identified during
inspections were corrected.
BMHS staff conducted 94 follow-up inspections of RRP and group home units that had
deficiencies during their annual inspection. An RRP receives either general approval when no
deficiencies are found or provisional approval for one or more deficiencies. Providers have 30
days to make repairs once they have received a provisional approval. Failure to make repairs
can lead to a program’s license being revoked by MHA. The most common deficiencies cited
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in FY 12 were general maintenance that had not been performed. All deficiencies were
corrected, resulting in recertification.
Action Step: Assist the RRP’s by identifying and documenting the deficiencies so that
they can successfully complete the changes needed depending on their specific
circumstances.
BMHS staff works closely with providers during inspections to identify needed repairs, such as
safety issues, including working smoke alarms, proper food storage, etc. BMHS staff follows
up by sending written reports to providers listing all findings and requiring corrections to be
completed within the 30-day required timeframe. If the needed repairs are extensive, a provider
may submit a request for more time to complete repairs.
Action Step: Re-visit all RRP’s found to have had deficiencies.
Follow up inspections are conducted as described above.
Indicators: Number of RRPs inspected; reduction in the number of RRPs found to have
deficiencies.
FY 12 Residential Housing Inspections Conducted by QM staff
Provider Type of Housing # Housing
Units Beds
Inspected
Type of Approval Year End
General Provisional
Alliance Inc. RRP 14 46 14 0
Harford/ Belair RRP 15 46 15 0
Harbor City Unlimited RRP 19 51 19 0
Key Point RRP 21 49 21 0
Bon Secours-New Phases RRP 10 23 10 0
Mosaic/North Baltimore Center RRP 16 32 16 0
People Encouraging People RRP 34 80 34 0
Volunteers of America RRP 6 28 6 0
Mosaic Adult Group Home 1 5 1 0
BCRI Residential Crisis 1 21 1 0
Total 137 381 137 0
Objective 5.6: Provide an adequate network of mental health service providers to meet
community needs.
STRATEGY 1: Improve BMHS vendor contract management process.
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Action Step: Assess vendor performance through submission of fiscal and
programmatic reports, and request corrective action plans from providers identified
as not meeting fiscal audit standards or programmatic deliverables.
There were 106 contracts issued in FY 12, totaling $19,550,168 in awards. Eighty-one
(81) contracts were funded by DHMH, and 25 were funded by various non-DHMH
funding sources. The provider contract compliance rate is measured by the percentage of
providers that receive payment on-time. Payments are held when the submission of
contractual documents, including quarterly program reports, invoices, quarterly fiscal
reports, insurance, audits and fidelity bonds are not timely, complete or accurate.
There was a 23% decrease in the number of contracts from FY 11 (137) to FY 12. This is
mainly attributed to the reduction in contracts for ESMH. In FY 11, there were 27
contracts for the ESMH initiative. In FY 12, the number of contracts was reduced to four
due to re-organization of ESMH into four regions. Regionalizing ESMH contracts allows
for better oversight and an increased efficiency of resources.
The average provider contract compliance rate improved from 59% in FY 10 to 92%, in
FY 11, and this improvement was sustained in FY 12 with 90% compliance. During the
contract renewal meetings, BMHS reviewed with providers contract reporting
requirements as well as the consequences of non-compliance, including payment
withholds, ineligibility for one-time supplemental funding, and nonrenewal of contracts
or delay in renewal. BMHS also increased communication with providers throughout the
year in an effort to promote greater compliance.
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*Provider compliance rate is measured by the percentage of providers that receive payment on time.
Payments are held when the submission of contractual documents, including quarterly program reports, invoices, quarterly fiscal reports, insurance and fidelity bonds are not timely, complete or accurate.
The table below compares timeliness of contract execution over the past three years.
Efforts to improve the contract renewal process began in FY 10 and continued in FY 12,
resulting in 89% timeliness of contract executions. Delays in contract renewals were
caused by two issues this year. One provider required several new contracts, rather than
renewals, because of its contract process requirements, and a significant change in how
Expanded School and Early Childhood contracts were regionalized under four lead
agencies resulted in a delay in renewing them.
Timeliness of
Contract Execution
FY 10 59%
FY 11 92%
FY 12 89%
Action Step: Conduct random and targeted site visits to monitor vendor
performance, compliance with conditions in their contract, and regulatory
compliance; request performance improvement plans from providers identified as
non-compliant.
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00% P
erc
en
tage
of
pro
vid
er
com
plia
nt
BMHS Provider Contract Compliance Rates FY09 - FY12*
FY09 % Compliant
FY10 % Compliant
FY11 % Compliant
FY12 % Compliant
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BMHS conducts site visits to verify that services purchased by the contract are being
delivered as reported and that the quality of those services is acceptable. Contracts funded
for more than $200,000 require an annual site visit. Contracts funded for less than
$200,000 are visited once every two years. During the site visit, BMHS interviews
program staff and consumers and then issues a written report to the program. The report
is provided to the program and is available to Mental Hygiene Administration (MHA) on
request. In FY 12, 84 site visits were conducted, compared to 90 in FY 11. These 84
visits constituted all required site visits. The number of required site visits fluctuates from
year to year based on the number of programs that require a regularly scheduled visit and
the number of programs that require a visit due to a previous finding or complaint. All
site visits were conducted either in accordance with mandated schedules or as required by
previous findings or complaints.
Additionally, at the request of MHA, BMHS began conducting site visits in FY 10 for
certification of the fee-for-service case management programs. Nine (9) case
management programs were reviewed and certified for an annual period. These programs
are now reviewed for re-certification annually.
Action Step: Provide technical assistance to non-compliant vendors; assess areas in
need of improvement, educate providers and schedule follow-up site visits to
evaluate progress.
As previously described on page 71, BMHS identified seven deficiencies related to
clinical service delivery that were cited most frequently during site visits. Additional
trends were noted for specific service types. Follow-up site visits were conducted to
provide technical assistance and training to providers and to assess whether deficiencies
were adequately addressed.
Indicators: Number of contracts in compliance; timeliness of contract execution;
program compliance ratings; reduction in the number of programs non-compliant;
percentage of providers who receive corrective action plans or performance
improvement plans, percentage of providers that, upon performance improvement plan or
corrective action plan follow-up, successfully improved performance.
See above for progress.
STRATEGY 2: Increase vendor understanding of BMHS contracts and policies through
education and technical assistance.
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Action Step: Provide education and training to vendors and staff through
contractual cycle, as needed.
All grant-funded vendors were given information about their contracts and a report
schedule to increase their understanding of their contractual obligations in reporting:
contractual documents, including progress reports; financial information, such as budgets,
invoices and quarterly fiscal documents; and insurance certificates and audits.
Indicator: Type and numbers of trainings provided.
All grant-funded providers attended a face-to-face contract renewal meeting.
GOAL VI: Technology is used to access mental health care information.
Objective 6.1: Explore the application of technology to improve service delivery, including
promoting the use of web-based technology as a tool to improve information sharing, data
collection, and evaluation.
STRATEGY 1: Use the BMHS integrated database to facilitate coordination of care.
Action Step: Train staff on utilizing database to extract and analyze client-level,
program-level and contract-level data to support improved agency operations and
performance.
Since BMHS’ integrated database was launched in FY 10, tutorials have been created to
provide guidance on how to use the database. All staff members have been trained on the
database, and all new staff members are trained as part of their orientation.
A quality improvement committee was established to determine why help call data were
not being adequately captured. The committee examined the drop-down menus and fields
for the help calls section of the database and presented their recommendations to improve
the menu structure to facilitate easier data entry. In addition, a comprehensive analysis of
the integrated databases functionality was conducted by the software vendor, which
resulted in a series of recommendations to effectively optimize the software and thereby
improve its functionality. All of these changes to the database are scheduled to be made
by the software vendor in FY 13.
Indicator: Progress to date.
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See above for progress to date.
STRATEGY 2: Maintain and publicize Baltimore City’s site for Network of Care, a web-
based application that includes a service directory and other mental health-related
resources.
Action Step: Collaborate with City providers to update and add new resources as
identified.
BMHS continues to review and approve new resources to be added to the Network of
Care website. All new resources are reviewed by BMHS’ quality management staff to
ensure that new vendors added to Network of Care are in good standing with the Office
of Health Care Quality and MHA.
Action Step: Provide training to City providers and other organizations on how to
use Network of Care to improve their delivery of services.
BMHS continues to encourage Baltimore City mental health providers to participate in
Network of Care with reminders during all meetings and conferences. In addition, BMHS
encouraged staff to include an introduction to Network of Care in trainings for
community stakeholders. A template Network of Care PowerPoint presentation was
created for staff to use in these trainings. Lastly, BMHS’ redesigned website increased
access to Network of Care by creating multiple links to it throughout the site.
Indicator: Report on progress to date.
The Network of Care website received 280,793 hits, or views, in FY 12 for Baltimore
City, compared to 137,061 in FY 11, a 105% increase, most likely caused by the
additional exposure from BMHS’ website and ongoing outreach activities as noted above.
STRATEGY 3: Develop redesigned agency website into an effective resource for the City’s
public mental health system, key partners and the general public.
Action Step: Update the website with important announcements, events and forms
that are pertinent to the Baltimore City provider community.
BMHS’ redesigned website was launched in March 2011. BMHS continually updates and
maintains the site to ensure current and relevant information is accessible.
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Action Step: Keep resources and information on services up-to-date and easily
accessible to the general public.
BMHS staff review and update the website weekly to ensure it remains up-to-date and
easily accessible.
Indicator: Report on progress to date.
See above for progress to date.
STRATEGY 4: Use Datalink to identify individuals in the City’s jails who have mental health
needs in order to increase access to mental health services.
Action Step: Develop a plan in collaboration with the Department of Public Safety
and Correctional Services to utilize the data available through Datalink to improve
release plans for incarcerated individuals with mental illness.
BMHS started receiving data from the Datalink in mid-May of 2012. The data are sent to
BMHS each day in a report, with a list of individuals who have been arrested in
Baltimore City and have had one or more authorizations for public mental health services
within the last two years. BMHS staff uses this data to notify service providers that
consumers with active authorizations have been arrested, with the goal of improving
continuity of care.
BMHS staff also uses the Datalink reports to identify individuals who would benefit from
a face-to-face assessment and release planning by staff in the jail. In FY 13, BMHS will
begin making these referrals to the provider in the jail that will be doing this enhanced
release planning for individuals with serious mental illness.
Indicator: Report on progress to date.
In the last month and a half of FY 12, the Datalink identified 329 individuals who were
arrested in Baltimore City and had active authorizations for public mental health care.
BMHS notified providers on behalf of 101 (31%) of those individuals. BMHS initially
prioritized notifications to providers of higher levels of care (e.g., Residential
Rehabilitation Programs, Psychiatric Rehabilitation Programs, Mobile Treatment, and
Case Management). As the project has progressed, BMHS has also started to notify
providers of lower levels of care (e.g., outpatient clinics) as well. The goal established for
FY 13 is to notify providers on behalf of at least 65% of arrested individuals with active
authorizations for public mental health services.
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MENTAL HEALTH PLAN, FISCAL YEAR 2014
Introduction
BMHS oversees approximately a quarter of a billion dollars of publicly funded mental health
services in Baltimore City. The majority of these services are funded through the statewide fee-
for-service Public Mental Health System; a broad range of additional services and programs not
reimbursable by Medicaid are directly funded by BMHS through grants. Through these and other
activities, BMHS seeks to expand the reach and quality of the public mental health system,
promote the development of new and innovative services and address specific population and
system-level needs.
While BMHS and other core service agencies are tasked by the State to manage public mental
health services within the specialty system of care, mental health is increasingly being
recognized as a leading public health issue. The World Health Organization recently identified
mental health problems as the leading cause of disability in youth between the ages of 10 and 24.
Forty-five percent (45%) of disability among this age group is related to some type of behavioral
health issue.9 Additionally, depression is the leading cause of disability in the United States for
individuals ages 15 to 44,10
and mental illness is one of the top five reasons individuals apply for
Social Security disability.11
There is a significant opportunity for prevention and early
intervention services, which BMHS seeks to expand for at-risk populations – both children and
adults – in Baltimore City. In addition, BMHS is committed to expanding treatment and support
services to all in need.
BMHS already works to serve many at-risk populations and sees opportunities to strengthen
prevention and early intervention in the future through collaborative partnerships. BMHS
maintains strong relationships with key partners in City and State agencies, with a focus on those
systems where at-risk populations can be identified, such as the Department of Juvenile Services,
Department of Social Services, Baltimore City Public Schools, Baltimore Police Department, the
District and Circuit Courts of Baltimore City and the Mayor’s Office of Human Services. It is
through these partnerships that BMHS will continue to expand over the next several years.
FY 12 marked the beginning of planning for historic changes for BMHS. Movement toward an
integrated behavioral health service delivery system began to be contemplated, with the initiation
of planning at both the state and local level. In December 2011, the State of Maryland announced
its intention to merge its substance abuse and mental health treatment systems to create an
integrated behavioral health system and commenced a public planning process. Recognizing that
9 Source: http://thechart.blogs.cnn.com/2011/06/06/mental-illness-leading-cause-of-disability-in-youth/
10 World Health Organization, 2004.
11 Council for Disability Awareness, 2011.
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an integrated system can provide the highest-quality care to people with substance abuse and
mental health disorders, and recognizing the value to the City of moving into alignment with the
State’s future approach to managing and financing this care, the boards of directors of BMHS
and bSAS voted in the spring of 2012 to develop recommendations for merging the two
organizations into a single behavioral health authority for the City.
Under the leadership of Baltimore City’s Health Commissioner, BMHS and bSAS have
embarked on a year-long planning and implementation process. The goal is to create a strong and
forward-looking organization that will leverage the opportunities afforded through state-level
and federal-level health care reform to better serve the people of Baltimore City. The
overarching goal will be the creation of a “no wrong door” system where individuals will be
welcomed into treatment wherever they enter and receive a comprehensive assessment that
addresses both substance and mental health issues.
Furthermore, with the assistance and guidance of expert consultants, BMHS and bSAS are
working towards creating a new Baltimore City behavioral health authority that will be well-
organized and highly functional. We anticipate that the new organization will be able to (1)
expand access to behavioral health care, (2) improve the quality of behavioral health care, (3)
manage the public behavioral health care system to provide services more efficiently, (4)
emphasize behavioral health promotion, prevention, screening, and early intervention, and (5)
increase coordination with somatic care.
BMHS’ one-year (FY 14) plan describes the major activities BMHS will embark on over the
next year. BMHS recognizes that its work will likely undergo significant change with the
implementation of federal healthcare reform. The design of the mental health service delivery
system platform and its financing and regulatory structures will be different in ways that have yet
to be determined. With this in mind, BMHS plans to keep abreast of information on the
implementation of changes at the state and national levels in order to continue to play a proactive
role in promoting the behavioral health status of the City’s residents.
BMHS’ Mental Health Plan is divided into five sections: Data on Service Utilization and
Outcomes; State Priority Areas, Mission, Vision and Values; and Goals, Objectives, and
Strategies. BMHS has elected to again present its work using the framework of the goals put
forth in the New Freedom Commission on Mental Health’s Achieving the Promise:
Transforming Mental Health Care in America.
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Data on Service Utilization and Outcomes
DATA ON SERVICE UTILIZATION - SUMMARY
Baltimore City Population12
620,961 individuals, 0.1% increase
11% of the State’s population, no change
62% Non-Hispanic Black (1% decrease), 26% Non-Hispanic White (2% decrease), 5%
Hispanic, any race (1% increase), 3% Asian (1% increase), and 2% other races (1%
increase)
Prevalence of Mental Illness and Substance Use Disorders in Adults (18 years and older)
161,449 individuals (26%) have a mental disorder13
55,887 individuals (9%) have a substance use disorder14
13,114 – 23,469 individuals need both mental health and substance abuse treatment15
Utilization of the Public Mental Health System (PMHS)16
43,821 individuals served, a 5% increase
95% of individuals have Medicaid, 6% uninsured and 11% Medicaid State-funded17
41,600 individuals with Medicaid served in the PMHS, a 6% increase over the last year
27,601 adults 18 years and older served, a 5% increase
16,220 children/adolescents served, a 5% increase
16% decrease in the number of adults with inpatient hospitalizations, and 2% increase in
the number of children/adolescents with inpatient hospitalizations
6% and 5% increase, respectively, in adults and children/adolescents utilizing outpatient
services
Expenditures for Services
City consumers represent 30% of those served in the State, and 35% of State expenditures
Total PMHS expenditures in Baltimore City decreased by 1%
Average expenditure per adult consumer was $4,920, a 6% decrease
Average expenditure per child/adolescent consumer was $5,696, a 2% decrease
12
Unless otherwise noted, US Census Bureau Data from 2009 and 2010 are compared. 13
Estimates based on national prevalence data. Source: Kessler, R., Berglunc, P., Demler, O., Jin, R., Merikangas, K.,
Walters, (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity
Survey Replication. Archives of General Psychiatry, 62, 593-602. 14
Based on estimates from the National Survey of Drug Use and Health. 15
Based on estimates from the U.S. Department of Health and Human Services. 16
Unless otherwise noted, comparisons are to FY 10 data. 17
Many people use services in more than one service type and/ coverage type. As a result, the sum of the percentage of
people served across service types and across coverage types exceeds 100%.
85
Trends
More consumers served (5%) at a lower cost per consumer (6%)
Less inpatient hospitalization (11%) while more outpatient services (5%)
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SOURCE OF DATA
Unless otherwise specified, the data presented in this section of the report are service utilization
and Outcome Measurement System (OMS) data collected by the Administrative Services
Organization (ASO) for Maryland’s fee-for-service Public Mental Health System (PMHS),
which is currently ValueOptions (VO). The utilization data describe the use of services and
associated expenditures for children and adults in FY 12, and the OMS data describe point-in-
time outcome measures of various dimensions of wellness, from July 1, 2011 through June 30,
2012. Data reports were run through October 9, 2012 (just over three months after the end of FY
12).
As in previous years, the most recent utilization data reported (FY 12) are incomplete, as claims
may be submitted up to 12 months after the date of service delivery. Therefore, the data for FY
12 do not reflect all of the claims for services rendered to Baltimore City individuals, while the
data for previous years, to which it is being compared, represent 100% of claims for those years.
This needs to be kept in mind when comparing FY 12 data to FY 11 and FY 10 data for trends.
When comparisons with previous years show increases in FY 12, it is likely that the actual
increase is somewhat greater. Conversely, decreases in FY 12 compared to previous years will be
somewhat offset by the missing claims data. This artifact of the PMHS is more pronounced for
expenditures and service data and less for numbers of consumers served, since the majority of
consumers served have a severe mental illness or emotional disorder and receive services for a
significant duration. The review of data throughout this section takes this information into
account. Therefore, the comments are focused on changes from previous years that appear to be
significant in magnitude.
This is the second year that OMS data are included in this document. FY 12, however, is the first
year that MHA is requiring specific OMS indicators to be reported. Consumers treated in other
settings are not included. The OMS data are gathered through interviews with individuals, ages
6-64, who are receiving outpatient mental health treatment services. Interviews are conducted at
the commencement of treatment and then every six months in licensed outpatient mental health
clinics, federally qualified health centers, and hospital-based clinics. Consumers who are dually
eligible for Medicaid and Medicare are not included.
Furthermore, the tables and charts that follow are required by Maryland’s Mental Hygiene
Administration (MHA) for inclusion in this report. They present summary data from the past
three fiscal years for Baltimore City and the past fiscal year for Maryland. It should be noted that
previously reported data for the three fiscal years prior to FY 12 have been updated to include
claims that were paid after September 30th
following the respective fiscal year and, therefore,
may differ from data reported in previous BMHS annual reports. The OMS data compare
outcomes for Baltimore City and the State for FY 12 only.
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Finally, it should be noted that the data presented here do not provide a complete picture of the
utilization of publicly funded mental health services, since services funded by Medicare are not
included, nor are services funded through grant-funded contracts. Throughout this report, “those
served by the Public Mental Health System” refers only to individuals utilizing services funded
through Maryland’s fee-for-service PMHS.
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OVERVIEW OF UTILIZATION DATA
Comments on the data that follow in this section will be limited to overall trends. Many of the
trends of interest are specific to particular age groups and program types and will be discussed
later in this section under the headings titled Service Utilization by Adults and Service
Utilization by Children and Adolescents, beginning on page 107.
Overall, there are four striking observations from the FY 12 data on service utilization in the
PMHS:
The PMHS in Baltimore City continues to expand, both in terms of the number of
individuals served (13% over the last three years to 43,821) and the total amount of
expenditures (3% over the past three years to $228 million)
The expansion in the number served in FY 12 was significantly greater than the increase
in expenditures, continuing the trend of an overall decrease in the cost per person of 6%
from FY 11 to FY 12.
There has been a continued increase in Medicaid consumers, 6% from FY 11 to FY 12,
and a continued decrease in uninsured, 2% from FY 11 to FY 12.
The number of consumers utilizing inpatient treatment has significantly decreased by
11% compared to FY 11, and the amount in expenditures for this service type has also
decreased by over $9 million (15%).
Consumers Served
While Baltimore City represents 11% of the State’s population, it represents 30% of those who
utilized the PMHS in FY 12. During the past three fiscal years, the number of City residents
served has increased by 13%, and the number of Maryland residents served has increased by
17%. The overall increase in the City is due to services being provided to more individuals in
nearly all age groups, but can be largely attributed to an increase of 1,431 or 6% in the number of
adults (22-64 years) who utilized services, followed by: children (6-12 years) which increased by
609 or 8%; young children (0-5 years) which increased by 116 or 5%; elderly (65 and over)
which increased by 47 or 13%; and adolescents (13-17 years) which increased by 42 or 1%.
There was 2% decrease, or 44 fewer, in transitional (18-21 years) youth served.
Expenditures
Total expenditures of $228,184,888 for Baltimore City account for 35% of the State’s total
expenditures on public mental health services in FY 12. During the past three years, City
expenditures increased at a slower rate than the State’s, 3% and 15% respectively, and in FY 12,
City expenditures decreased by 1% versus a 3% increase statewide.
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While the total number of individuals served increased by 5%, expenditures have decreased by
1%. The average cost per person decreased for all age groups, except for early child, adolescent,
and elderly. The decrease of approximately $2 million in PMHS expenditures in Baltimore City
is largely due to decreases associated with two service types: inpatient ($9 million) and partial
hospitalization ($2 million), which were offset by an increase in outpatient treatment ($5 million)
and psychiatric rehabilitation ($3 million). This is significant because it suggests that care is
shifting from hospitals to less intensive community settings.
For inpatient treatment, the number of consumers served decreased by 11%, and expenditures
decreased by 15%. The cost per consumer for inpatient treatment decreased 4% this fiscal year
and remained steady for outpatient treatment and psychiatric rehabilitation. However, the cost
per consumer decreased by 25% for partial hospitalization, which experienced decreases in both
the numbers served and total expenditures. This is most likely due to some combination of longer
lengths of stay and more episodes of care for those served.
Insurance Coverage
The main source of health insurance coverage for public mental health services is Medicaid,
including Medicaid State-funded.18
Most noteworthy is the continued expansion of service to
individuals with Medicaid, which has increased by 15% (since FY 10) over the last three years
and 6% in the last year alone. The total number of uninsured consumers continued to decrease
over the past three years, mostly due to increased enrollment in Primary Adult Care (PAC), a
State program that covers outpatient mental health services and prescription drugs for adults who
meet income and assets eligibility and are not covered by Medicare. However, there was also a
decline in uninsured expenditures in FY 12, most likely due to the limited benefits package for
uninsured individuals.
Between FY 11 and FY 12, Medicaid expenditures for public mental health services decreased
by 1%, while the number of consumers in the PMHS receiving Medicaid increased at a higher
rate of 5.9%. Medicaid State-funded expenditures for public mental health services increased by
3%, and the number of individuals served in this category increased comparatively by 2%.
The following tables present overall data for Baltimore City and the State of Maryland. It should
be noted that statewide data include data from Baltimore City, which, as previously stated,
comprise about a third of all consumers served in Maryland and more than a third of State
expenditures.
18
Medicaid State-funded expenditures are state-only funds (versus those with a federal match) for State programs
such as Primary Adult Care (PAC) for individuals who are eligible based on certain income and assets criteria.
90
BALTIMORE CITY PUBLIC MENTAL HEALTH SYSTEM UTILIZATION
Baltimore City Total Consumers Served
FY2010 FY 2011 % Change FY 2012 % Change
Early Child (0-5) 2,013 2,169 7.7% 2,285 5.3%
Child (6-12) 7,229 7,743 7.1% 8,352 7.9%
Adolescent (13-17) 5,498 5,541 0.8% 5,583 0.8%
Transitional (18-21) 2,323 2,667 14.8% 2,623 -1.6%
Adult (22 to 64) 21,337 23,137 8.4% 24,568 6.2%
Elderly (65 and over) 373 363 -2.7% 410 12.9%
TOTAL 38,773 41,620 7.3% 43,821 5.3%
Baltimore City Consumers Served by Service Type
FY2010 FY 2011 % Change FY 2012 % Change
Case Management 927 1,059 14.2% 1,086 2.5%
Crisis 660 582 -11.8% 560 -3.8%
Inpatient 3,319 3,241 -2.4% 2,877 -11.2%
Mobile Treatment 816 892 9.3% 959 7.5%
Outpatient 36,411 39,373 8.1% 41,437 5.2%
Partial Hospitalization 1,438 860 -40.2% 738 -14.2%
Psychiatric Rehabilitation 6,368 6,850 7.6% 7,641 11.5%
Residential Rehabilitation 1,077 965 -10.4% 966 0.1%
Residential Treatment 133 165 24.1% 193 17.0%
Respite Care 80 75 -6.3% 87 16.0%
Supported Employment 389 440 13.1% 444 0.9%
BMHS Capitation 302 303 0.3% 303 0.0%
Emergency Petition 13 15 15.4% 36 140.0%
Purchase of Care 134 92 -31.3% 89 -3.3%
PRTF Waiver 11 36 227.3% 41 13.9%
**TOTAL 38,773 41,620 7.3% 43,821 5.3%
Baltimore City Consumers Served by Coverage Type
FY2010 FY 2011 % Change FY 2012 % Change
Medicaid 36,317 39,295 8.2% 41,600 5.9%
Medicaid State Funded 3,602 4,608 27.9% 4,676 1.5%
Uninsured 3,145 2,576 -18.1% 2,538 -1.5%
**TOTAL 38,773 41,620 7.3% 43,821 5.3%
91
Baltimore City Expenditures By Age
FY2010 FY 2011 % Change FY 2012
% Change
Early Child (0-5) $6,127,637 $6,640,360 8.4% $7,064,888 6.4%
Child (6-12) $45,132,263 $47,837,646 6.0% $46,543,275 -2.7%
Adolescent (13-17) $35,136,166 $35,328,393 0.5% $38,779,291 9.8%
Transitional (18-21) $11,156,257 $11,431,623 2.5% $10,408,565 -8.9%
Adult (22 to 64) $121,642,018 $125,636,434 3.3% $121,590,649 -3.2%
Elderly (65 and over) $3,219,504 $3,322,983 3.2% $3,798,220 14.3%
TOTAL $222,413,845 $230,197,439 1.7% $228,184,888 -0.9%
Baltimore City Expenditures by Service Type
FY2010 FY 2011 % Change FY 2012
% Change
Case Management 1,565,546 1,931,613 23.4% 1,875,542 -2.9%
Crisis 1,582,881 1,546,693 -2.3% 1,774,924 14.8%
Inpatient 62,342,879 62,792,000 0.7% 53,593,724 -14.6%
Mobile Treatment 7,128,441 7,608,588 6.7% 8,396,630 10.4%
Outpatient 85,170,184 90,957,047 6.8% 95,678,789 5.2%
Partial Hospitalization 7,467,995 5,274,948 -29.4% 3,383,972 -35.8%
Psychiatric Rehabilitation 33,300,683 35,987,907 8.1% 38,990,400 8.3%
Residential Rehabilitation 1,576,830 1,563,942 -0.8% 1,645,348 5.2%
Residential Treatment 12,278,290 12,698,735 3.4% 13,075,104 3.0%
Respite Care 164,273 125,218 -23.8% 165,284 32.0%
Supported Employment 799,607 875,612 9.5% 757,023 -13.5%
BMHS Capitation 7,868,650 8,025,300 2.0% 7,986,690 -0.5%
Emergency Petition 12,086 10,347 -14.4% 28,242 172.9%
Purchase of Care 1,150,009 756,212 -34.2% 769,472 1.8%
PRTF Waiver 5,489 43,275 688.4% 63,745 47.3%
**TOTAL $222,413,843 $230,197,437 3.5% $228,184,889 -0.9%
Baltimore City Expenditures by Coverage Type FY2010 FY 2011 % Change FY 2012 % Change
Medicaid 204,371,750 215,172,306 5.3% 213,002,300 -1.0%
Medicaid State Funded 11,575,080 10,506,077 -9.2% 10,827,683 3.1%
Uninsured 6,467,014 4,519,055 -30.1% 4,354,905 -3.6%
**TOTAL $222,413,844 $230,197,438 3.5% $228,184,888 -0.9%
92
Baltimore City Expenditures: Child / Adolescent (Age 0 – 17 Years)
FY2010 FY 2011 % Change FY 2012 % Change
Case Management 252,754 188,784 -25.3% 150,885 -20.1%
Crisis 7,074 5,367 -24.1% 3,415 -36.4%
Inpatient 19,312,936 18,939,193 -1.9% 17,535,851 -7.4%
Mobile Treatment 392,144 698,702 78.2% 672,118 -3.8%
Outpatient 43,633,571 45,824,391 5.0% 48,971,763 6.9%
Partial Hospitalization 2,998,231 3,010,232 0.4% 2,131,383 -29.2%
Psychiatric Rehabilitation 7,492,324 8,937,376 19.3% 10,054,015 12.5%
Residential Rehabilitation 4,624 268 -94.2% 402 50.0%
Residential Treatment 11,688,921 11,978,287 2.5% 12,633,860 5.5%
Respite Care 163,046 125,218 -23.2% 164,260 31.2%
Supported Employment 624 1,769 183.5% 1,248 -29.5%
BMHS Capitation 0 0 0.0% 0 0.0%
Emergency Petition 1,174 1,498 27.6% 0 0.0%
Purchase of Care 48,151 55,518 15.3% 16,527 -70.2%
**TOTAL $86,396,066 $89,806,399 3.0% $92,387,454 2.9%
Baltimore City Persons Served: Child / Adolescent (Age 0 – 17 Years)
FY2010 FY 2011 % Change FY 2012 % Change
Case Management 137 122 -10.9% 80 -34.4%
Crisis 1 3 200.0% 1 -66.7%
Inpatient 804 846 5.2% 859 1.5%
Mobile Treatment 108 103 -4.6% 103 0.0%
Outpatient 14,48
6
15,18
5 4.8%
15,88
9 4.6%
Partial Hospitalization 436 427 -2.1% 435 1.9%
Psychiatric Rehabilitation
2,733 3,124 14.3%
3,558 13.9%
Residential Rehabilitation
3 3 0.0%
1 -66.7%
Residential Treatment 125 150 20.0% 180 20.0%
Respite Care 77 75 -2.6% 86 14.7%
Supported Employment 2 2 0.0% 3 50.0%
BMHS Capitation 0 0 0.0% 0 0.0%
Emergency Petition 0 1 0.0% 0 0.0%
Purchase of Care 7 9 28.6% 6 -33.3%
**TOTAL 14,740 15,453 4.8% 16,220 5.0%
93
Baltimore City Persons Served: Adult (Age 18+ Years)
FY2010 FY 2011 % Change FY 2012 % Change
Case Management 790 937 18.6% 1,006 7.4%
Crisis 659 579 -12.1% 559 -3.5%
Inpatient 2,515 2,395 -4.8% 2,018 -15.7%
Mobile Treatment 708 789 11.4% 856 8.5%
Outpatient 21,925 24,188 10.3% 25,548 5.6%
Partial Hospitalization 1,002 433 -56.8% 303 -30.0%
Psychiatric Rehabilitation 3,635 3,726 2.5% 4,083 9.6%
Residential Rehabilitation 1,074 962 -10.4% 965 0.3%
Residential Treatment 8 15 87.5% 13 -13.3%
Respite Care 3 0 0.0% 1 0.0%
Supported Employment 387 438 13.2% 441 0.7%
BMHS Capitation 302 303 0.3% 303 0.0%
Emergency Petition 13 14 7.7% 36 157.1%
Purchase of Care 127 83 -34.6% 83 0.0%
**TOTAL 24,033 26,167 8.9% 27,601 5.5%
Baltimore City Expenditures: Adult (Age 18+ Years)
FY2010 FY 2011 % Change FY 2012 % Change
Case Management $1,312,792 $1,742,829 32.8% $1,724,657 -1.0%
Crisis $1,575,807 $1,541,326 -2.2% $1,771,508 14.9%
Inpatient $43,029,943 $43,852,807 1.9% $36,057,873 -17.8%
Mobile Treatment $6,341,296 $6,909,885 9.0% $7,724,513 11.8%
Outpatient $41,536,612 $45,132,657 8.7% $46,707,027 3.5%
Partial Hospitalization $4,469,764 $2,264,716 -49.3% $1,252,589 -44.7%
Psychiatric Rehabilitation
$25,808,359 $27,050,531 4.8%
$28,936,385 7.0%
Residential Rehabilitation
$1,572,206 $1,563,674 -0.5%
$1,644,946 5.2%
Residential Treatment $589,368 $720,449 22.2% $441,243 -38.8%
Respite Care $1,228 $0 -100.0% $1,023 0.0%
Supported Employment $798,984 $873,843 9.4% $755,774 -13.5%
BMHS Capitation $7,868,650 $8,025,300 2.0% $7,986,690 -0.5%
Emergency Petition $10,913 $8,849 -18.9% $28,242 219.2%
Purchase of Care $1,101,858 $700,695 -36.4% $752,945 7.5%
**TOTAL $136,017,779 $140,391,040 0.8% $135,797,434 -3.3%
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
94
Persons Served Expenditures
STATE* COUNTY STATE* COUNTY
AGE Number Per
Cent Number Per
Cent Number Per
Cent Number Per
Cent
Early Child 6,972 4.8% 2,285 5.2% $16,324,794 2% $7,064,888 3.1%
Child 28,221 19.5% 8,352 19.1% $120,736,993 18% $46,543,275 20.4%
Adolescent 20,599 14.3% 5,583 12.7% $118,066,675 18% $38,779,291 17.0%
Transitional 9,378 6.5% 2,623 6.0% $35,150,227 5% $10,408,565 4.6%
Adult 77,967 54.0% 24,568 56.1% $357,147,321 54% $121,590,649 53.3%
Elderly 1,284 0.9% 410 0.9% $11,657,127 2% $3,798,220 1.7%
TOTAL 144,421
43,821 $659,083,135 100% $228,184,888
SERVICE TYPE 0.303
Case Management 3,812 2.6% 1,086 2.5% $5,996,629 0.9% $1,875,542 0.8%
Crisis 1,680 1.2% 560 1.3% $5,579,823 0.8% $1,774,924 0.8%
Inpatient 9,537 6.6% 2,877 6.6% $138,956,568 21.1% $53,593,724 23.5%
Mobile Treatment 2,984 2.1% 959 2.2% $22,576,403 3.4% $8,396,630 3.7%
Outpatient 136,472 94.5% 41,437 94.6% $245,798,307 37.3% $95,678,789 41.9%
Partial Hospitalization 2,033 1.4% 738 1.7% $7,014,090 1.1% $3,383,972 1.5%
Psychiatric Rehabilitation 20,011 13.9% 7,641 17.4% $147,325,022 22.4% $38,990,400 17.1%
Residential Rehabilitation 4,356 3.0% 966 2.2% $10,515,406 1.6% $1,645,348 0.7%
Residential Treatment 711 0.5% 193 0.4% $51,639,705 7.8% $13,075,104 5.7%
Respite Care 447 0.3% 87 0.2% $1,277,691 0.2% $165,284 0.1%
Supported Employment 3,034 2.1% 444 1.0% $6,661,591 1.0% $757,023 0.3%
BMHS Capitation 368 0.3% 303 0.7% $9,529,979 1.4% $7,986,690 3.5%
Emergency Petition 950 0.7% 36 0.1% $442,346 0.1% $28,242 0.0%
Purchase of Care 704 0.5% 89 0.2% $5,454,495 0.8% $769,472 0.3%
PRTF Waiver 134 0.1% 41 0.1% $315,081 0.0% $63,745 0.0%
TOTAL 144,421
43,821 $659,083,135 $228,184,889
COVERAGE TYPE
Medicaid 134,133 92.9% 41,600 94.9% $593,327,277 90.0% $213,002,300 93.3%
Medicaid State Funded 19,964 13.8% 4,676 10.7% $47,037,187 7.1% $10,827,683 4.7%
Uninsured 11,259 7.8% 2,538 5.8% $18,718,671 2.8% $4,354,905 1.9%
TOTAL 144,421 43,821 $659,083,135 $228,184,888
95
State of Maryland and Baltimore City Cost per Person Served
State County Difference Per Cent
AGE
Early Child $2,341 $3,092 $750 24.3%
Child $4,278 $5,573 $1,294 23.2%
Adolescent $5,732 $6,946 $1,214 17.5%
Transitional $3,748 $3,968 $220 5.5%
Adult $4,581 $4,949 $368 7.4%
Elderly $9,079 $9,264 $185 2.0%
TOTAL $4,564 $5,207 $644 12.4%
SERVICE TYPE
Case Management $1,573 $1,727 $154 8.9%
Crisis $3,321 $3,170 -$152 -4.8%
Inpatient $14,570 $18,628 $4,058 21.8%
Mobile Treatment $7,566 $8,756 $1,190 13.6%
Outpatient $1,801 $2,309 $508 22.0%
Partial Hospitalization $3,450 $4,585 $1,135 24.8%
Psychiatric Rehabilitation $7,362 $5,103 -$2,259 -44.3%
Residential Rehabilitation $2,414 $1,703 -$711 -41.7%
Residential Treatment $72,630 $67,747 -$4,883 -7.2%
Respite Care $2,858 $1,900 -$959 -50.5%
Supported Employment $2,196 $1,705 -$491 -28.8%
BMHS Capitation $25,897 $26,359 $462 1.8%
Emergency Petition $466 $785 $319 40.6%
Purchase of Care $7,748 $8,646 $898 10.4%
$2,351
TOTAL $4,564 $5,207 $644 12.4%
COVERAGE TYPE
Medicaid $4,423 $5,120 $697 13.6%
Medicaid State Funded $2,356 $2,316 -$41 -1.7%
Uninsured $1,663 $1,716 $53 3.1%
TOTAL $4,564 $5,207 $644 12.4%
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
96
OVERVIEW
Baltimore City residents continue to comprise approximately one-third of all consumers served
in the State and one-third of total expenditures on PMHS services.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Compared to the State, Baltimore City residents have a higher rate of utilization of PMHS
services: 7% of the City population compared to the State’s 3%.
0
50,000
100,000
150,000
200,000
FY 10 FY 11 FY 12
Number of Consumers Served in Baltimore City and Maryland
Baltimore City State
$-
$100,000,000
$200,000,000
$300,000,000
$400,000,000
$500,000,000
$600,000,000
$700,000,000
FY 10 FY 11 FY 12
Baltimore City and Statewide PMHS Expenditures
Baltimore City State
97
Between FY 10 and FY 12, Baltimore City consistently had a higher overall cost per consumer
than the State. In FY 12, the cost per consumer was 12% higher in Baltimore City than in
Maryland. This cost difference appears to be the result of the higher costs per consumer for a few
services, such as inpatient, outpatient, and partial hospitalization. For the third year in a row, the
overall cost per consumer for both Baltimore City and the State decreased; however, the gap
between City and State costs per consumer persists. This is likely related to the broader range of
higher intensity services such as ACT and Capitation available in Baltimore City.
The difference in expenditures and per-consumer costs reflect characteristics specific to
Baltimore City’s population and its PMHS. The Baltimore City population is among the poorest
in the State, as measured by median income, and likely experiences a higher rate of serious
mental illness/severe emotional disturbance, which requires more intensive services. The City’s
PMHS is the largest and most diversified in the State. There are more hospitals and, therefore,
proportionately more hospital-based services (i.e., inpatient and partial hospitalization) available.
Additionally, Baltimore City has services that many other jurisdictions do not currently have. For
example, Baltimore City is the sole jurisdiction with the Capitation Project, which serves
frequent users of inpatient and emergency services.
FY 10 FY 11 FY 12
Baltimore City 6% 7% 7%
State 2% 2% 3%
0%
1%
2%
3%
4%
5%
6%
7%
8%
Percentage of Baltimore City and Maryland residents who Utilize the PMHS, FY 10-12
Baltimore City
State
98
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
The chart below indicates that the cost per consumer is higher in Baltimore City for every age
group. The highest discrepancies in the average cost per consumer are for early child (0-5 years),
32%; child (6-12 years), 30%; and adolescent (13-17 years), 21%.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
The gap between the proportion of adult and youth consumers served by the PMHS has
continued to grow over the last several years, from roughly equal numbers of
children/adolescents and adults served in FY 06 to two out of three PMHS consumers being
adults and one out of three being children/adolescents in FY 12. Adults represent 78% of the
total population in Baltimore City compared to 63% of consumers served in the PMHS, while
FY 10 FY 11 FY 12
Baltimore City $5,736 $5,531 $5,207
State $5,017 $4,798 $4,564
$-
$2,000
$4,000
$6,000
$8,000
Baltimore City and Statewide PMHS Average Cost Per Consumer
Early Child (0-5)
Child (6-12)
Adolescent (13-17)
Transitional (18-21)
Adult (22 to 64)
Elderly (65 and over)
TOTAL
Baltimore City $3,092 $5,573 $6,946 $3,968 $4,949 $9,264 $5,207
State $2,341 $4,278 $5,732 $3,748 $4,581 $9,079 $4,564
$-
$2,000
$4,000
$6,000
$8,000
$10,000
Baltimore City and Statewide PMHS Average Cost Per Consumer by Age Group
99
children/adolescents represent 22% of the total population compared to 37% of consumers
served.
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
The charts below show that the distribution of expenditures and cost per consumer by service
type in Baltimore City differs in several respects from that of the State. Overall expenditures are
higher in Baltimore City than for the State for four service types: outpatient, inpatient, partial
hospitalization, and Capitation. Overall expenditures are comparatively lower in Baltimore City
for three service types: psychiatric rehabilitation, residential rehabilitation and residential
treatment. Of note, despite being a Baltimore City program, the Capitation Project serves
residents of other jurisdictions, and the payment claims are submitted in the county of residence.
In regard to average cost per consumer, the three service types that are higher for Baltimore City
than the State are partial hospitalization (25%), inpatient (22%), and outpatient (22%). The
service types that have a relatively lower average cost per consumer for Baltimore City are
respite care (-51%), psychiatric rehabilitation (-44%), residential rehabilitation (-42%).
FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Child and Adolecent 48% 45% 43% 41% 38% 37% 37%
Adult 52% 55% 57% 59% 62% 63% 63%
0%
10%
20%
30%
40%
50%
60%
70%
% o
f C
on
sum
ers
Baltimore City Percent of Adult and Child and Adolescent Consumers
100
Baltimore City and Statewide Expenditures by Service Type FY 12
Other 8%
Inpatient 23%
Mobile Treatment
4%
Outpatient 42%
Psychiatric Rehab 17%
Residential Treatment
6%
Baltimore City
Other 8%
Inpatient 21%
Mobile Treatment
4% Outpatient
37%
Psychiatric Rehab 22%
Residential Treatment
8%
Statewide
101
Changes in expenditures and the number of consumers served by different program categories
over the past three years are highlighted and discussed in the separate adult and child and
adolescent sections beginning on page 128.
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
Case Management
Crisis
Inpatient
Mobile Treatment
Outpatient
Partial Hospitalization
Psychiatric Rehabilitation
Residential Rehabilitation
Residential Treatment
Respite Care
Supported Employment
BMHS Capitation
Emergency Petition
Purchase of Care
PRTF Waiver
Baltimore City and Statewide Percentage of Expenditures, FY 12 State
Baltimore City
102
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Although inpatient cost per child and adolescent consumer has continually declined, it remains
significantly higher than adult inpatient cost per adult consumer.
$- $20,000 $40,000 $60,000 $80,000
Case Management
Crisis
Inpatient
Mobile Treatment
Outpatient
Partial Hospitalization
Psychiatric Rehabilitation
Residential Rehabilitation
Residential Treatment
Respite Care
Supported Employment
BMHS Capitation
Emergency Petition
Purchase of Care
PRTF Waiver
Baltimore City and Statewide Cost Per Consumer FY 12
State Baltimore City
$24,021
$17,109
$22,387
$18,310 $20,414
$17,868
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
Child and Adolescent Adult
Inpatient Cost per Consumer Children and Adolescents vs. Adults
FY10
FY 11
FY 12
103
INSURANCE COVERAGE
Most (95%) of the individuals being served by the public mental health system were covered by
Medicaid (including Medicaid State-funded), while 6% or 2,538 individuals were uninsured.19
Compared to the State’s 8% uninsured rate, Baltimore City has proportionately fewer individuals
served who were uninsured (6%), and the proportion of total expenditures for uninsured
individuals was slightly lower for the City, 2% versus 3%.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
The total number of uninsured consumers served in Baltimore City decreased by 2% in FY 12
and by 19% over the last two years. Although there was a 17% decrease in the number of
uninsured adults served in FY 12, there was an 8% increase in uninsured children and
adolescents served. The increase in uninsured children and adolescents may be due to the
increase in the number of undocumented children deemed ineligible for Medicaid.
Medicaid has the highest cost per consumer of the three coverage types in the PMHS. This is
likely due to previously mentioned restrictions in access to care for uninsured individuals and a
more limited benefits package for the Primary Adult Care (PAC) program20
.
19
Many people use services in more than one category. As a result, the sum of the percentage of people served
across service categories and across insurance statuses will exceed 100%. 20
PAC accounts for a substantial portion of Medicaid State-funded. There are few other services that are State-only funded.
Medicaid 93%
Medicaid State
Funded 14%
Uninsured 8%
Statewide Consumers Served by Coverage Type, FY 12
Medicaid 95%
Medicaid State
Funded 11%
Uninsured 6%
Baltimore City Consumers Served by Coverage Type, FY 12
104
Baltimore City Cost Per Consumer by Coverage Type
Medicaid
Medicaid State-funded
Uninsured
FY 10 $5,627 $3,214 $2,056
FY 11 $5,476 $2,280 $1,754
FY 12 $5,120 $2,316 $1,716
FY 10-FY 12 % Change -9% -28% -17%
Between FY 10 and FY 12, the Medicaid State-funded population increased by 94% as a result
of the expansion of the Primary Adult Care (PAC) program, which began in 2006. The eligibility
criteria for PAC were expanded further at the end of FY 09. Between FY 09 and FY 10,
statewide PAC enrollment increased by 66%,21
and between FY 11 and FY 12, increased by
17%.
Source: Maryland Medicaid Program
Over the last five years, the number of Medicaid consumers receiving services in the PMHS has
increased both in the City and State, 47% and 65% respectively. Perhaps the increase was not as
21
Maryland Medicaid program, Overview of the Maryland Primary Adult Care (PAC) program presentation,
November 17, 2010.
24,093 27,351
29,087
36,020
41,008
17,264 20,243
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
Jul-
06
Oct
-06
Jan
-07
Ap
r-0
7
Jul-
07
Oct
-07
Jan
-08
Ap
r-0
8
Jul-
08
Oct
-08
Jan
-09
Ap
r-0
9
Jul-
09
Oct
-09
Jan
-10
Ap
r-1
0
Jul-
10
Oct
-10
Jan
-11
Ap
r-1
1
Jul-
11
Oct
-11
Jan
-12
Ap
r-1
2
Jul-
12
# C
on
sum
ers
Total Statewide PAC Enrollment July 2006- July 2012
105
high in Baltimore City because proportionally more Baltimore City residents had already been
accessing PMHS services compared to other jurisdictions.
Source: DHMH Membership Data
The City’s Medicaid penetration rate, or the percentage of Medicaid enrollees accessing the
PMHS, increased by 13%. Since 2007, the City’s Medicaid penetration rate increased by 46% to
20.3%, which is the highest rate among the State’s four largest jurisdictions.
28,320 32,381 36,317 39,295
41,600
81,182
97,828
121,723 130,879
134,133
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
FY 2008 FY 2009 FY 2010 FY 2011 FY 2012
Baltimore City and Statewide Medicaid Consumers Receiving PMHS Services, 2008 - 2012
Baltimore City
Statewide
106
Source: DHMH Membership Data
13.9% 13.5%
16.0%
18.1% 18.0%
20.3%
11.7% 10.9%
13.6%
15.0% 14.3%
16.5%
6.8% 6.2%
7.8% 8.8% 8.4%
9.8%
5.8% 5.1%
6.8% 7.4% 7.2%
8.5%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Medicaid Penetration Rate, 2007 - 2012
Baltimore City Baltimore County Montgomery County Prince George's County
107
SERVICE UTILIZATION BY ADULTS
This section presents PMHS utilization data and trends specific to individuals 18 years and older.
Populations Served
In FY 12, 27,601 adults were served by the PMHS, an increase of 5% from FY 11. In contrast,
expenditures decreased by 3% for a total of $135,797,434 for all adult consumers, representing
60% of all City expenditures. In addition, there was a 6% decrease in the overall cost per
consumer. The decrease in expenditures and cost per consumer may be attributed to the
significant reduction in the number of adults utilizing inpatient services (16%) and partial
hospitalization services (30%).
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
In FY 12, there was a 3% decrease in the number of uninsured adult consumers utilizing the
PMHS. This corresponds with a 4% decrease in the overall number of uninsured adults in
Baltimore City22
and is likely attributable to the migration of uninsured individuals to PAC.
Conversely, there has been a 3% increase in the number of adults in the PMHS with Medicaid
State-funded coverage, which is also likely to be a reflection of the expansion of PAC.
There was a 1% decrease in uninsured expenditures between FY 11 and FY 12. This decrease is
due to the lower number of uninsured individuals served as well as a reduction in the benefits
package for uninsured individuals. Additionally, in FY 11, a change in the way the Emergency
22
US Census Bureau American Fact Finder (2008 & 2009). Health Insurance Coverage Status Retrieved November
16, 2010 from http://www.factfinder.census.gov.
FY 08 FY 09 FY 10 FY 11 FY 12
Cost Per Consumer $5,749 $5,963 $5,639 $5,247 $4,920
$-
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
Cost Per Consumer, Adults (18-65+)
108
Medical Treatment and Active Labor Act (EMTALA) is being implemented in Maryland has
made inpatient hospital admissions much more likely for uninsured clients. This contributed to
the decreased expenses for uninsured clients, because acute care hospitals are not paid by the
public mental health system for these consumers. Instead, hospitals receive a rate adjustment that
factors in uncompensated care for uninsured patients.
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
The proportion of adult consumers served by the PMHS with a diagnosis of a serious mental
illness (SMI) has remained relatively steady since FY 07 at about two out of three consumers
served.23
23
An individual qualifies as having a serious mental illness in the PMHS if he/she is 18 or older and is diagnosed
with one of the following: Schizophrenia, Schizoaffective disorder, Bipolar disorder, Major Depressive disorder,
other psychotic disorders, Schizotypal Personality disorder, or Borderline Personality disorder.
4,001
4,551
3,015 3,158 3,272
2,727
2,124 2,103
1,145 915
1,525 1,618 1,784
2,779
3,498 3,619
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# C
on
sum
ers
Baltimore City Uninsured and Medicaid State-Funded Adult Consumers
Uninsured
Medicaid State-Funded
109
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
Most adults with SMI receive care in service types that provide community-based supports, such
as Capitation, mobile treatment, PRP, SEP and RRP.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
The number of individuals with serious mental illness and co-occurring substance abuse has
remained relatively steady since FY 07, based on the most recent available data from FY 12. It
63.1%
66.0% 66.3%
67.1%
67.7%
66.4% 67.4%
68.1%
67.2%
60.0%
61.0%
62.0%
63.0%
64.0%
65.0%
66.0%
67.0%
68.0%
69.0%
FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Percent of Adults with Serious Mental Illness (SMI) Served in the PMHS
96% 96% 95% 92% 86% 85% 83% 83% 77% 75% 73%
64%
38%
0%
20%
40%
60%
80%
100%
120%
Percent of Adults with SMI Served in the PMHS by Service Type, FY 12
110
should be noted that co-occurring substance abuse is most likely under-reported due to
inconsistencies in reporting this information in claims data.
In FY 12, a disproportionate number of individuals with co-occurring disorders continued to
utilize high-cost services. These individuals represented 52% of all adults served and 49% of the
total expenditures for adult services.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
3,304
4,330 4,771
5,343 5,564 5,488 5,737 5,397 5,291
0
1000
2000
3000
4000
5000
6000
7000
FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY12
# o
f C
on
sum
ers
Fiscal Year
Number of Adult Consumers with Serious Mental Illness and Co-Occurring Substance Abuse Disorders
111
The majority (89%) of the adult population served by the PMHS is between the ages of 22 and
64. Transitional age youth (TAY) are between the ages of 18 and 21 and represent 10% of adults
served. Elderly consumers 65 and over represent only 1% of adults served. As displayed in the
charts below, the elderly population is underrepresented in the PMHS as compared to the total
Baltimore City adult population. This is most likely due to Medicare covering a significant
portion of the elderly population’s health care costs.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Although the percentage of TAY served in the PMHS remained steady at 6%, the number of
TAY served in the PMHS decreased by 2% in FY 12.
Transitional (18-21) Adult (22 to 64) Elderly (65 and over)
Baltimore City PMHS 6% 56% 1%
Baltimore City Population 7% 60% 12%
0%
10%
20%
30%
40%
50%
60%
70%
Baltimore City Population and Baltimore City PMHS Age Distribution
112
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
The only growth in service types utilized by TAY consumers in FY 12 were Residential
Rehabilitation and Crisis. The overall cost per TAY consumer decreased by 7% from FY 11 to
FY 12 ($4,286 in FY 11 to $3,968 in FY 12).
3.7% 3.1% 3.4%
4.2%
6.0% 6.4%
6.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f To
tal P
op
ula
tio
n
Fiscal Year
Percentage of Transitional Age Youth Who Utilize the PMHS, FY 06 - FY 12
113
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
As previously mentioned, it is difficult to assess trends in the utilization of the fee-for-service
PMHS by elderly consumers because these data do not include Medicare-funded mental health
services, which is the primary payer for inpatient and outpatient mental health treatment services
for individuals 65 and over. The data in this report only describe utilization by elderly consumers
who utilize those service types not funded by Medicare or those services in which the fee-for-
service PMHS is the secondary payer.
Between FY 11 and FY 12, there was a 13% increase in the number of elderly consumers
receiving services. Adults 65 and over represent only 1% of the adult population served by the
PMHS, yet they represent 15% of the total Baltimore City population. Services for the elderly
continue to be disproportionately expensive. There was an overall 14% increase in expenditures
for the elderly and a 1% increase in the cost per elderly consumer. This contributed to elderly
consumers continuing as the age group with the highest average cost per consumer, $9,264
versus $5,169 for adults younger than 65 in Baltimore City. This is to be expected because
Medicare is covering lower-cost services such as outpatient treatment, for which it is the primary
payer. This is supported by the fact that only 58% of elderly consumers in the PMHS utilize
outpatient services, compared to 95% of PMHS consumers overall.
Residential Rehabilitation
Crisis Mobile
Treatment Supported
Employment Inpatient PRP
Case Management
Partial Hospitalizatio
n
Service 13% 2% -8% -13% -14% -17% -33% -50%
-60%
-50%
-40%
-30%
-20%
-10%
0%
10%
20%
% C
han
ge in
Co
nsu
me
rs
Service Type
TAY Consumer Percent Change in Service Utilization, FY 12
114
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Utilization by Service Type
The following data describe trends in utilization of specific types of services.
Psychiatric inpatient care is of great interest because it is the most intensive and expensive
service type. It is also of interest because of an expanded effort to minimize preventable
hospitalizations in FY 12 by focusing on community-based care. Use of inpatient services
decreased by 5% in FY 11 and 16% in FY 12, after a 17% increase in FY 10 and a 9% increase
in FY 09.
$7,533 $7,637
$9,576 $8,806
$10,201
$8,631 $9,154 $9,264
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Co
st P
er
Co
nsu
me
r
Fiscal Year
Average Cost per Consumer Age 65+ FY 05 - FY 12
115
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
Over the past ten years, the percentage of Baltimore City adults in the PMHS receiving inpatient
services has steadily decreased from 15% in FY 03 to 6% in FY 12.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
In addition, the percentage of Baltimore City adults diagnosed with SMI accessing inpatient
services has decreased from 19% in FY 05 to 9% in FY 12.
2,179 2,022 2,012 2,057 2,027 1,978 2,156
2,515 2,395 2,018
0
500
1000
1500
2000
2500
3000
FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Number of Adult Consumers in Baltimore City Utilizing Inpatient Mental Health Services, FY 05-FY 12
15% 13% 13% 13% 12% 11% 11% 8% 7% 6%
0%
5%
10%
15%
20%
FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f C
on
sum
ers
Fiscal Year
Percentage of All Adult Consumers in Baltimore City PMHS Utilizing Inpatient Mental Health Services
FY 03-FY 12
116
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Between FY 11 and FY 12, the cost per adult consumer utilizing inpatient services decreased by
4% from $19,374 to $18,628. Additionally, there was a 2% decrease in the number of adults with
SMI utilizing inpatient services between FY 11 and FY 12. The decrease since FY 05 indicates
that as more individuals with SMI are being treated successfully in the community, those who
need hospitalization and high levels of care often have longer lengths of stay.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Since FY 08, there has been a significant decline in the number of individuals utilizing partial
hospitalization services. In FY 10, partial hospitalization services were eliminated from the
19% 18% 16% 16% 16%
14% 14% 13% 11%
9%
0%
5%
10%
15%
20%
FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f C
on
sum
ers
Fiscal Year
Percentage of Adults with SMI Served in Baltimore City PMHS Utilizing Inpatient Mental Health Services
FY 03-FY 12
$10,228 $10,846 $12,642 $13,491
$15,786 $18,784 $19,374 $18,628
$0
$5,000
$10,000
$15,000
$20,000
$25,000
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Co
st p
er
Co
nsu
me
rs
Fiscal Year
Inpatient Mental Health Services Cost Per Consumer FY 05-FY 12
117
benefits package for uninsured individuals, resulting in a 70% decrease in the number of adults
receiving this service from FY 10 to FY 12.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Outpatient mental health services continue to be the most widely accessed type of service,
utilized by 93% of adult PMHS consumers. There has been a steady increase in the number of
adults receiving outpatient mental health care, with a 6% increase between FY 11 and FY 12.
1,854 1,856
1,585 1,701
1,345
1,002
422 303
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Number of Adult Consumers in Baltimore City Utilizing Partial Hospitalization Services
FY 05-FY 12
13,179 13,670 14,235 15,688
18,448 21,925
24,188 25,548
0
5,000
10,000
15,000
20,000
25,000
30,000
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Number of Adult Consumers in Baltimore City Utilizing Outpatient Mental Health Services, FY 05-FY 12
118
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
The percentage of adults in the PMHS accessing outpatient services increased slightly in FY
12, continuing the steady increase observed since FY 08. The percentage of adults with SMI
utilizing outpatient services remained steady in FY 12, which indicates that most PMHS
consumers utilize outpatient services.
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
85% 86% 86% 87%
90% 91%
92% 93%
80%
85%
90%
95%
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f C
on
sum
ers
Fiscal Year
Percentage of Adult Consumers in Baltimore City PMHS Utilizing Outpatient Mental Health Services
FY 05-FY 12
78% 78% 79%
81%
85% 87%
89% 89%
70%
75%
80%
85%
90%
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f C
on
sum
ers
Fiscal Year
Percentage of Adults with SMI in Baltimore City PMHS Utilizing Outpatient Mental Health Services
FY 05-FY 12
119
While the number of consumers utilizing outpatient services has increased by 14% since FY
10, the cost per consumer has remained relatively steady during that time frame.
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
Inpatient care is such a high-cost service that it continues to account for a disproportionate share
of total public mental health expenditures, relative to the number of consumers served. In FY 12,
inpatient care for 7% of adult PMHS consumers accounted for 27% of total PMHS expenditures.
The 93% of adult PMHS consumers who utilized outpatient services accounted for 34% of total
PMHS expenditures, increasing from 33% of total expenditures in FY 11.
$1,624 $1,831
$2,102 $2,116 $2,059
$2,335 $2,302 $2,309
$0
$500
$1,000
$1,500
$2,000
$2,500
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Co
st p
er
Co
nsu
me
r
Fiscal Year
Outpatient Mental Health Services Cost Per Consumer FY 05-FY 12
Inpatient Treatment Outpatient treatment
Expenditures 27% 34%
Person Served 7% 93%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
% C
on
sum
ers
Inpatient vs. Outpatient Treatment Spending for Adults, FY12
120
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
In FY 12, there were decreases in the utilization of several services, most notably residential
crisis and RRP. The number of adult consumers who received crisis services decreased by 4%,
most likely due to the increased access to inpatient care as a result of changes in the
implementation of the Emergency Medical Treatment and Active Labor Act (EMTALA) in
Maryland, which has increased access to inpatient hospital care for uninsured individuals.
In FY 12, BCRI, the only provider of residential crisis services in the City, received 44% of their
referrals from emergency rooms, compared to 49% in FY 11. In addition, in FY 12, BCRI saw a
7% increase in the number of crisis bed days used and a 1% increase in the length of stay,
resulting in an increase in the overall occupancy rate. This most likely contributed to the 19%
increase in cost per consumer for residential crisis services.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
The percentage of adult consumers in the PMHS using residential crisis services has declined
from 4% to 2% since FY 05.
604
559 550 565
598
659
581 559
450
500
550
600
650
700
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Number of Adult Consumers in Baltimore City Utilizing Residential Crisis Services, FY 05-FY 12
121
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
There was a 2% increase in the number of consumers utilizing RRP services from FY 11 to FY
12. The number of RRP beds remained steady until an increase in capacity at the end of FY 12
from 357 to 361. Because of this, the increase in the number served most likely represents an
increase in turnover of beds. This is a reversal of the trend from FY 10 to FY 11 in which the
number of individuals using RRP services decreased 12%, likely due to less turnover in beds.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
4.0%
3.0% 3.0% 3.0% 3.0% 2.7%
2.2% 2.0%
0%
1%
2%
3%
4%
5%
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f C
on
sum
ers
Fiscal Year
Percentage of Adult Consumers in Baltimore City Utilizing Residential Crisis Services, FY 05-FY 12
991
949 946 952
1,016
1,076
944 966
850
900
950
1,000
1,050
1,100
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Number of Adult Consumers in Baltimore City Utilizing Residential Rehabilitation Programs
FY 05-12
122
The percentage of individuals in the PMHS using residential rehabilitation services remains low
and has decreased by 33% since FY 05. This is because the number of individuals served by the
PMHS has continued to grow, while the number of available beds has increased slightly.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Psychiatric rehabilitation program (PRP) services continue as one of the faster growing service
lines in the PMHS. In FY 12 there was an increase of 10% in the utilization of PRP services.
There has been an 88% increase in the number of individuals utilizing PRP services since FY 05.
6.0% 6.0% 6.0%
5.0% 5.0%
4.5%
3.7% 3.5%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f C
on
sum
ers
Fiscal Year
Percent of Adult Consumers in Baltimore City Utilizing RRP Services, FY 05-FY 12
123
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Although the number of individuals utilizing PRP has increased significantly since FY 05, the
percentage of individuals in the PMHS using this service has remained relatively steady, at about
15%.
2,170 2,298 2,601
2,880 3,244
3,637 3,709 4,083
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Number of Adult Consumers in Baltimore City Utilizing PRP Services, FY 05-FY 12
14% 14% 16% 16% 16% 15% 14% 15%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Percentage of Adult Consumers in Baltimore City Utilizing PRP Services, FY 05-FY 12
124
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
In FY 10, case management services moved from being grant-funded to fee-for-service. Since
then, there has been a 20% increase in the number of adults utilizing this service.
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
BMHS has been particularly focused on adult consumers who utilize a disproportionate number
of high-end mental health services (e.g., inpatient treatment, partial hospitalization) and generate
disproportionately high expenditures, often without experiencing positive service outcomes. The
Capitation Project, in its 19th year, provides a community-based alternative to consumers with
histories of long and/or recurring inpatient admissions. Fifty percent (50%) of the admissions are
from State psychiatric hospitals. The Capitation Project has 354 slots, and the average cost per
year per consumer is $25,973. By comparison, the average cost per year in FY 10 for Baltimore
City residents treated at Spring Grove Hospital was $100,504.24
FY 12 data on the City’s 50 “high-cost” consumers, those whose public mental health service
costs were highest among all consumers served in Baltimore City, indicate they accounted for
4% of total adult expenditures. The costs for these individuals include inpatient treatment and
other service types within the PMHS.
24
Mental Hygiene Administration, November 9, 2011.
790
937 1,006
0
200
400
600
800
1,000
1,200
FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Number of Adult Consumers in Baltimore City Utilizing Case Management Services, FY 10 - FY 12
125
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
High-cost consumers incur a disproportionate amount of the expenses for inpatient care. In FY
12, high-cost consumers (0.18% of all adult consumers) accounted for 14% of total inpatient
expenditures.
Utilization of Evidence-Based Practices
The implementation of the Substance Abuse and Mental Health Services Administration’s
(SAMHSA’s) evidence-based practices (EBPs) is a priority for Maryland’s PMHS. BMHS has
been actively promoting two EBP models for adults: Assertive Community Treatment (ACT)
and Supported Employment Programs (SEPs). ACT is an evidence-based model used by six of
the City’s nine mobile treatment teams. Outcomes data collected from mobile treatment and
ACT providers documented that 545 individuals (64%) were served by the nine ACT teams in
FY 12.
There has been a steady increase in the number of individuals served in mobile treatment/ACT
since FY 05. The 8% growth from FY 11 to FY 12 is most likely attributed to changes begun in
FY 11 and further implemented throughout FY 12. In FY 11 one ACT provider expanded
services to address the specific needs of homeless individuals, and an additional ACT team
actively worked to increase their census. The census of both teams continued to grow in FY 12.
$5,020
$141,503
$0
$50,000
$100,000
$150,000
All Adult Consumers (n=27,601)
High Cost Consumers (n=50)
Average Cost per Consumer for High-Cost Consumers Compared to All Adult
Consumers, FY 12
$17,868
$100,134
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
All Adult Consumers (n=2,018)
High Cost Consumers (n=50)
Average Inpatient Cost per Consumer for High-Cost Consumers Compared to all
Adult Consumers, FY 12
126
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
There has been a 40% increase in the number of consumers receiving supported employment
services through both EBP-certified and non-certified programs since FY 05. This increase may
be due to the State’s promotion of EBPs as well as promotion of the federal government’s
Employment for Individuals with a Disability (EID) Program, which provides a financial
incentive for Supplemental Security Income (SSI) recipients to work. While 441 individuals
were served according to the claims paid data, providers also report service data directly to
BMHS. According to these data, the number of individuals served actually totaled 559.25
SEP is
one of the least expensive service types, with a cost per consumer of $1,705, which is a 13%
decrease from FY 11. The percentage of individuals in the PMHS that utilized SEP services has
slightly increased in the last fiscal year by 1%.
25
There is often a discrepancy between the outcomes data that mobile treatment (including ACT) and supported
employment providers submit to BMHS and the claims data provided by ValueOptions. This could be due to the lag
time between service provision and claims payment, City-based mobile treatment teams providing services to
individuals who reside outside of Baltimore City and/or some claims being denied.
541 590
626 685 683 707
792 856
0
100
200
300
400
500
600
700
800
900
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Number of Adult Consumers Utilizing Mobile Treatment Services
127
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Two out of 13 supported employment programs were certified as evidence-based practice
programs in FY 12. Five additional providers are pursuing certification and have received
technical assistance from BMHS. According to outcomes data submitted to BMHS by SEP
providers, 45 individuals (9%) participating in SEP programs were served by evidence-based
SEP providers.
314 288 300
378 367 387
438 441
0
50
100
150
200
250
300
350
400
450
500
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Number of Adult Consumers Utilizing Mental Health Supported Employment Services
128
SERVICE UTILIZATION BY CHILDREN AND ADOLESCENTS
This section presents PMHS utilization data and trends specific to children and adolescents, from
birth to 17 years of age.
Population Served
In FY 12, 16,220 children and adolescents were served by the PMHS, an increase of 5% from
FY 11. Expenditures increased by 3% for a total of $92,387,454 for all child and adolescent
consumers, representing 40% of all PMHS expenditures in Baltimore City. In addition, there was
a 2% decrease in the overall cost per consumer.
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Due in part to the State receiving a Psychiatric Residential Treatment Facility (PRTF) 1915c
Medicaid waiver,26
which added additional services to the PMHS in FY 10, there was an increase
in the number of youth receiving public mental health services over the last two years. The
waiver added respite services (both in-home and out-of-home placements), crisis stabilization,
family-to-family and peer-to-peer support, expressive therapies and family training. Youth
enrolled in the PRTF waiver much faster than expected, which led to a waiting list once the 210
slots (statewide) were filled. The delay in additional youth being able to access home- and
community-based PRTF waiver services resulted in an increased number of Baltimore City
youth being placed in traditional residential treatment centers (RTCs) in FY 12 since more
people were aware of and, therefore, making referrals to these new services.
26
The PRTF 1915c Medicaid waiver is a Medicaid Psychiatric Residential Treatment Facility demonstration waiver
that provides families with the option of receiving comprehensive community-based services through a wraparound
process that provides a variety of services for youth with serious mental health needs.
15,085 14,576
13,600 13,643 13,925
14,740
15,453
16,220
12,000
13,000
14,000
15,000
16,000
17,000
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Number of Baltimore City Children and Adolescents (0-17 years) Served in the PMHS, FY 05-12
129
While the cost per child and adolescent served steadily increased between FY 05 and FY 10, it
decreased slightly over the last two years. In FY 12, the number of children and adolescents
served increased by 5%. The decreased cost per child can be attributed in part to a decrease in
purchase of care (-70%), partial hospitalization (-29%), and case management (-20%).
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
The percentage of children and adolescents served by the PMHS who are diagnosed with a
severe emotional disturbance (SED) or as emotionally impaired27
(EI) gradually increased from
FY 05 to FY 10. In the last few years, however, the percentage has leveled off and slightly
decreased. Between FY 11 and FY 12, 723 additional youth were served, which is a 10%
increase. Full implementation of the Care Management Entity (CME) and PRTF waiver in FY 10
is a major contributing factor to the 10% increase of children and adolescents with SEDs who
were served by the PMHS from FY 10 to FY 12.
27
Emotionally impaired is the preferred terminology in Maryland, but severe emotional disturbance is more
commonly used nationwide.
$4,270
$4,836 $5,122 $5,311 $5,669 $5,861 $5,812
$5,696
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Child and Adolescent Cost per Consumer FY05-FY12
130
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
While the number of uninsured children and adolescents has increased, the percentage of
uninsured children and adolescents among those served by the PMHS has remained very small.
72% 72%
73%
74%
76% 76%
78% 78%
77%
68%
70%
72%
74%
76%
78%
80%
FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
% o
f C
on
sum
ers
Fiscal Year
Percent of Child and Adolescents with SED Served in the PMHS
268 280
348 329
359
419 454
435
0
50
100
150
200
250
300
350
400
450
500
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Baltimore City Uninsured Child and Adolescent Consumers
131
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
There was a 6% increase in service utilization among the early childhood population (ages 0-5)
in Baltimore City, from 2,169 children served in FY 11 to 2,285 in FY 12.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
1.8% 1.9%
2.6% 2.4%
2.6% 2.8% 2.9%
2.7%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Baltimore City Percentage of Uninsured Child and Adolescent Consumers
1,827 1,868 2,013
2,169 2,285
0
500
1,000
1,500
2,000
2,500
FY 08 FY 09 FY 10 FY 11 FY 12
# o
f C
on
sum
ers
Fiscal Year
Numbers of Young Children (Ages 0-5) Utilizing the PMHS
132
The percentage of young children in Baltimore City utilizing public mental health services has
remained relatively steady.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Utilization by Service Type
The chart below delineates the number of children and adolescents who received psychiatric
rehabilitation (PRP) services, partial hospitalization, inpatient hospitalization, and residential
treatment center (RTC) services. The most notable changes were the significant increases in the
utilization of PRP services (14%) and RTC services (20%).
Between FY 05 and FY 10, there was an overall declining trend in youth being placed in RTCs.
In FY 11 and FY 12, however, there was a 20% increase in youth served by RTCs. As stated
previously, the increased use of RTCs was correlated with the delay in youth receiving home-
and community-based PRTF waiver services. Because the number of youth eligible to receive
community-based services had exceeded the openings available to serve them, children and
youth were placed in traditional RTCs instead. In addition, youth placed on a waiting list waited
an average of four months to gain access to the PRTF waiver services during FY 12.
Consequently, those children and youth who otherwise would have received home- and
community-based services were served in residential treatment centers.
The number of youth who utilized inpatient treatment increased by 2%, while outpatient
utilization increased by 5%, which is equal to the overall increase in youths served. Psychiatric
rehabilitation increased at a significantly faster rate at 14% and residential treatment increased
15%.
5.5%
5.4%
5.2% 5.2% 5.2%
5.0%
5.1%
5.2%
5.3%
5.4%
5.5%
5.6%
FY 08 FY 09 FY 10 FY 11 FY 12
Percentage of Young Children (Ages 0-5) Utilizing the PMHS
133
Child and Adolescent Consumers Served by
PRP Partial Hospitalization Inpatient RTC
FY 05 1,420 455 806 201
FY 06 2,287 455 788 204
FY 07 2,434 403 730 155
FY 08 2,177 406 695 163
FY 09 2,247 446 756 138
FY 10 2,733 436 804 125
FY 11 3,124 427 846 150
FY 12 3,558 435 859 180
Source: ValueOptions
Based on claims paid through September 30, 2012 Run Date: October 9, 2012
-300
200
700
1,200
1,700
2,200
2,700
3,200
3,700
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Child and Adolescent Consumers Served by Select Service Types
PRP
Partial Hospitalization
Inpatient
RTC
134
Source: ValueOptions
Based on claims paid through September 30, 2012
Run Date: October 9, 2012
Services provided through the PRTF waiver cost significantly less per consumer than traditional
residential treatment: $1,555 compared to $67,747, respectively.
9%
16%
18%
16% 16%
19%
20%
22%
3% 3% 3% 3% 3% 3% 3% 3%
5% 5% 5% 5% 5% 5% 5% 5%
1% 1% 1% 1% 1% 1% 1% 1%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Percentage of Child and Adolescent PMHS Consumers Served by Select Service Types
PRP Partial Hospitalization Inpatient RTC
135
As with the adult population, inpatient care accounts for a disproportionate share of total public
mental health expenditures relative to the number of consumers served. Inpatient services
accounted for 19% of total child and adolescent expenditures and were utilized by 5% of the
corresponding PMHS consumer population. Outpatient services accounted for 53% of total child
and adolescent expenditures and were utilized by 98% of the corresponding consumer
population. The inpatient cost per consumer in FY 12 decreased by 9% compared to FY 11. This
may be a result of shorter lengths of stay and an expansion of home and community-based
service options.
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: October 9, 2012
$1,555
$67,747
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
Residential Treatment Waiver (n= 41) Traditional Residential Treatment (n= 193)
Residential Treatment Waiver vs. Residential Treatment Cost per Consumer, FY 12
Inpatient Outpatient
Expenditures 19% 53%
Persons Served 5% 98%
0%
20%
40%
60%
80%
100%
120%
Inpatient vs. Outpatient Spending for Child and Adolescents FY 12
136
The number of children and adolescents receiving respite services has steadily increased from
FY 05 to FY 12, with a slight decrease (3%) (from 77 in FY 10 to 75 in FY11) in FY 11. While
expenditures for respite services have fluctuated over this period, there was a significant decrease
of 23% in FY 11 and a significant increase of 31% in FY 12. This is most likely a result of the
efforts of the CME to provide wraparound services, with the aim of reducing residential
treatment utilization.
Based on the most recent data from FY 12, high-cost users were identified as consumers whose
PMHS costs were highest among all children and adolescents served in Baltimore City. A
comparison of FY 09 and FY 12 expenditures for child and adolescent high-cost users28
shows a
decrease of 80%. More specifically, the data show:
A 96% ($2,165,343) decrease in expenditures for RTC services, largely resulting from the
development of the CME, which provides community-based comprehensive mental health
treatment as an alternative to RTC services.
A 7% decrease in inpatient hospital expenditures, also largely resulting from the
development of the CME, which provides community-based comprehensive mental health
treatment. The CME was utilized as a step-down from inpatient hospitalization, resulting in
decreased length of hospital stays, which in turn lowered the total expenditures for high-cost
users.
28
High-cost users refer to consumers whose public mental health service costs were highest among all child and
adolescent consumers. Because data was not available for FY 10 and FY11 data, due to the transition to the new
ASO, ValueOptions, only the 22 individuals who were also high-cost users in FY 09 are included in this
comparison.
137
Source: ValueOptions Based on claims paid through September 30, 2012
Run Date: December 11, 2012
$490,193
$2,165,343
$2,706,453
$122,792 $95,583 $228,395
$-
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
Inpatient RTC Total
C&A High-Cost Users Expenditures FY 09 and FY 12 (n= 22 individuals)
FY 09 FY 12
138
Outcome Measurement System*^ Child and Adolescent Adults
STATE COUNTY STATE COUNTY
Aggregate Score
Aggregate Score
Aggregate Score
Aggregate Score
Adult BASIS 24® Subscales
Depression Initial
2.07 2.08
Depression Most Recent
1.73 1.76
Depression Change
-0.34 -0.32
Self Harm Initial
0.49 0.54
Self Harm Most Recent
0.33 0.37
Self Harm Change
-0.16 -0.17
CHILD KIDNET EMOTIONAL SUBSCALE
Emotional Initial 0.92 0.83 Emotional Most Recent 0.68 0.62 Emotional Change -0.24 -0.21
Outcome Measurement System*^ Child and Adolescent Adults
STATE COUNTY STATE COUNTY
Percent Percent Percent Percent
POINT IN TIME DATA
Employed now or last 6 months
28.8% 20.6%
Actively looking for a job
30.0% 24.3%
Smoking cigarettes** 11.1% 7.4% 51.1% 53.5%
CHANGE OVER TIME DATA
Employed now or last 6 months
Gained Employment
9.7% 8.0%
Employed both interviews
15.5% 9.4%
Unemployed both interviews
63.5% 73.5%
Lost employment
11.3% 9.2%
Smoking cigarettes**
Stopped smoking 2.8% 1.8% 8.2% 8.4%
Not smoking either interview 88.7% 93.5% 43.3% 39.8%
Smoking both interviews 3.5% 1.8% 41.4% 44.7%
Started smoking 5.0% 2.8% 7.0% 7.1%
139
Outcome Measurement System*
Child and Adolescent Adults
STATE COUNTY STATE COUNTY
Per Cent Per Cent Per Cent Per Cent
POINT IN TIME DATA
Homelessness in past six months 2.4% 2.3% 15.0% 19.9%
In jail or prison in the past six months
7.1% 7.3%
Have you been arrested in past six months 3.8% 3.8% 7.7% 7.9%
CHANGE OVER TIME DATA
Arrested in past six months
Decreased 2.3% 1.8% 6.7% 6.8%
Not arrested either interview 95.3% 95.9% 89.1% 88.8%
Arrested both interviews 0.5% 0.7% 1.3% 1.2%
Increased 1.9% 1.6% 2.9% 3.3%
Been to jail or prison in past six months
Decreased
5.5% 5.7%
No jail/prison either interview
91.3% 90.8%
Jail/prison both interviews
1.0% 1.0%
Increased
2.2% 2.6%
* Shaded boxes denote that data is “n/a”
** Most recent observation for each consumer in FY 12; provision data which may change slightly as Datamart refinement continues
^ Indicators MHA requires each CSA to report on
Data Source: http://maryland.valueoptions.com/services/OMS_Welcome.html
Most Recent Interview Only, FY 2012
140
OVERVIEW OF SERVICE OUTCOMES:
This section discusses the Outcome Measurement System (OMS) data. The data were collected
via survey from 25,636 Baltimore City residents and 81,185 individuals statewide, ages 6-64,
who received outpatient mental health treatment (hereinafter referred to as “respondents”).
Baltimore City respondents represent 32% of all respondents, the same proportion as the
numbers served in the PMHS. As previously stated, because Baltimore City data represent such a
large proportion of the State data, many of the outcomes do not differ significantly, as actual
differences between the City and the rest of Maryland are under-stated.
Wherever possible, the data collected through OMS have been compared to data describing the
general population. These comparisons, however, are only being used to make general
statements about differences in the populations. Limitations in comparisons are noted below.
For example, there are OMS data for both the adult and child populations; however, some of the
comparison data on the general population refer to all ages.
Employment
The data suggest that respondents both in Baltimore City and statewide continue to have
significantly lower rates of employment than the general population. At the time of interview,
21% of adults respondents in Baltimore City were employed, compared to 90% of all adults in
Baltimore City. The statewide comparisons were 29% versus 93%, respectively.29
Of further
concern for Baltimore City, the unemployment rate reported by respondents increased
significantly by 8% compared to FY 11 (13%), whereas the unemployment rate for the
respondents statewide only increased by 1% (FY 11 29%).
Smoking
Participating in outpatient mental health treatment is a stronger predictor of smoking than is
residence. Respondents report a significantly higher rate of smoking than the general population:
54% versus 27% for Baltimore City, and 51% versus 17% statewide,30
whereas adult
respondents had comparable rates of smoking in Baltimore City and statewide, 54% and 51%
respectively. This is consistent with FY 11 data, although there was a 3% decrease in the
smoking rate for respondents in both Baltimore City and statewide.
Child and adolescent respondents in Baltimore City had somewhat lower rates of smoking than
their counterparts statewide, 7% versus 11%. Comparison data for children and adolescents in
the general population could not be found.
29
Department of Labor, Licensing and Regulation, Division of Workforce Development and Adult Learning, 2012.
141
Homelessness
Compared to FY 11, the data continues to suggest a significantly higher rate of homelessness in
the last six months among adult respondents than the general population. While this is true for
both the State and Baltimore City within the OMS population, Baltimore City’s percentage rate
is higher, with 20% of adults homeless in the last six months (FY 11 20%) versus 15% for the
State (FY 11 16%). Children and adolescents reported very low rates of homelessness: 2% for
both Baltimore City and statewide.
Incarceration and Arrest
The data suggest a significantly higher rate of incarceration in the last six months among adult
respondents than the general population. Adults in the OMS population reported a 9%
incarceration rate during the past six months, whereas both the City and State have a general
population incarceration rate of 1%.31
32
Interestingly, adult respondents in Baltimore City
reported a lower rate of arrest than the general Baltimore City population, 9% compared to 12%.
Adult respondents statewide, however, had a higher rate of arrest than the general population,
8% compared to 4%. It is possible that Baltimore City has a lower arrest rate compared to the
general population due in part to multiple Baltimore City PMHS initiatives. Behavioral
Emergency Services Team (BEST) trains every new Baltimore City police officer in crisis
intervention to de-escalate mental health crises, minimize arrests, and decrease officer injury.
Forensic Alternative Service Team (FAST) provides jail diversion activities and participates in
Mental Health Court. Lastly, the Circuit Court Case Management Project provides behavioral
health assessments and linkage to behavioral health services to a small number of eligible
defendants, with the aim of reducing recidivism.
The child and adolescent respondents in both Baltimore City and statewide reported 4% arrest
rates in the past six months, which is the same rate as FY 11. No comparison data could be found
for this population.
Adult BASIS 24® Subscales
The BASIS 24 is a 24-item patient self-reporting questionnaire designed to assess treatment
outcomes by measuring symptoms and functional difficulties experienced by consumers seeking
mental health services. Questions are answered on a five-point scale. Scores range from 0 to 4,
with lower scores indicating lower levels of symptomatology; a score of 0 indicates no
31
Justice Policy Institute, Baltimore Behind Bars, June 2010. 32
Department of Public Safety and Correctional Services Fiscal 2012 Budget Overview, Department of Legislative
Services, January 2011.
142
symptoms and a score of 4 indicates maximum symptoms. This is the first year that this national
test is included in the OMS data.
The data show that adult respondents had a similar aggregate score for depression during the
initial survey, 2.07 statewide and 2.08 for Baltimore City. Over time, this data point reflects
incremental positive change: the difference between the initial and most recent surveys was -0.32
for Baltimore City and -0.34 statewide.
As with depression, the aggregate, initial self harm score was similar for Baltimore City (0.54)
and the State (0.49), and the difference between the initial and most recent surveys reflects
incremental positive change (-0.17 for Baltimore City and -0.16 for the State).
Child KIDNET Emotional Subscale
The KIDNET emotional subscale is similar to BASIS-24 in that questions are answered on a
five-point scale. Scores range from 0 to 4, with lower scores indicating lower levels of
symptomatology; a score of 0 indicates no symptoms and a score of 4 indicates maximum
symptoms. This is also the first year that this subscale is included in the OMS data.
The data show that child and adolescent respondents in Baltimore City and the State had similar
aggregate scores for feeling emotional during the initial survey, 0.79 for Baltimore City and 0.92
statewide. The change in aggregate score between the initial and most recent surveys was also
similar, -0.19 Baltimore City and -0.24 statewide.
143
State Priority Areas
FY 12 is the first year MHA is requiring CSAs to select and report on eight areas that: a)
improve communication; and b) support the implementation of health reform and coordination of
care in the delivery of services to individuals across the lifespan with mental illness and co-
occurring disorders for their respective jurisdictions.
BMHS has selected the below eight areas as priorities for Baltimore City:
1. Recovery Supports
2. Public Awareness and Education
3. Suicide Prevention
4. Efforts to Address Co-occurring Disorders/Promotion of Dual Diagnosis Capability Training
5. Access to Services
6. Evidence Based Practices
7. Diversion Efforts
8. Outcomes/Quality
The following sections will highlight current and future efforts in addressing these areas. Many
of the initiatives listed below are described in detail in the Annual Report section of this
document.
1. Recovery Supports
Supported Employment Programs - These programs provide supportive services for
individuals with serious mental illness who are not employed competitively33
, and for
who employment is a goal. The service includes five components: 1) pre-placement; 2)
placement in a competitive job; 3) intensive job coaching; 4) extended support services;
and 5) psychiatric rehabilitation program services.
Wellness and Recovery Centers - Baltimore’s three Wellness and Recovery Centers
continue to provide consumer-centered peer support services and have been serving a
vital role in promoting the use of Wellness Recovery Action Plan (WRAP) among the
City’s consumers. Two of these Wellness and Recovery Centers are unique in the State:
Helping Other People through Empowerment (HOPE) serves homeless individuals, and
Hearts and Ears serves lesbian, gay, bi-sexual, transgender (LGBT) individuals. On Our
Own, Inc. operated their transitional age youth (TAY) center for its second year, again
serving a population for whom more targeted programs are needed.
Co-occurring Disorder Supportive Housing Project - BMHS, in collaboration with
Mosaic Community Services, Inc., the State Hospital system and community providers,
33
Competitive employment refers to employment that 1) pays at least minimum wage; 2) takes place in an
integrated community setting; 3) is held by the individual worker (not by the program in which he or she
participates); and 4) is available to anyone qualified for the job (i.e. not set aside for people with disabilities).
144
will facilitate the transition of 25 or more consumers who have co-occurring mental
health and substance use disorders and forensic involvement from their current residence
in State Hospitals to community placements in Baltimore City. These consumers will be
provided with housing subsidies, peer support, and person-centered services, including
community-based, dual-diagnosis recovery supports that will meet their mental health,
substance use disorder and other needs.
Second-Chance Grant - Through the Second Chance Grant, People Encouraging People
(PEP) will provide case management and peer support services to 75 men with co-
occurring behavioral health disorders who are transitioning from prison (the Patuxent
Institution) to Baltimore City. PEP will begin engaging individuals several months prior
to their release in order to develop and then implement a comprehensive release plan that
addresses the individuals’ behavioral health and community living needs.
Continuous Quality Improvement with the Capitation Project - BMHS continues to
provide technical assistance to the two Capitation programs to implement a continuous
quality improvement process, the goals of which are to identify and implement change
projects aimed at improving targeted aspects of care. The area of focus for FY 12 was
supported employment. Both providers achieved their FY12 goals of enhancing
supported employment program services. For FY 13, the Capitation Project providers
will focus on improving the volunteer opportunities available to consumers. In addition,
both providers are hiring peer support specialists in FY 13.
2. Public Awareness and Education
BMHS continues to support the Mental Health Association of Maryland (MHAMD),
National Alliance on Mental Illness (NAMI), Black Mental Health Alliance for
Education and Consultation, Maryland Coalition of Families for Children’s Mental
Health; and On Our Own of Maryland.
MHAMD: provides children’s mental health information and campaign materials for
Children’s Mental Health Matters, participates in health fairs, conducts Older Adult
Mental Health issues trainings and advanced directive trainings and collaborates with
BMHS to disseminate Mental Health First Aid throughout the City.
NAMI: provides family support trainings and workshops on mental health topics and
coordinates its annual NAMI Walk, a public education event that promotes awareness
of mental illness.
Black Mental Health Alliance for Education and Consultation: provides culturally
competent trainings on mental health topics, promotes the growth of mental health
programs in schools and provides assistance and referrals to consumers via telephone
and in person.
145
Maryland Coalition of Families for Children’s Mental Health: provides webinars and
family trainings on mental health topics and coordinates the Family Leadership
Institute, which provides education and resources to parents, caregivers and family
members of children with mental health/behavioral challenges.
On Our Own of Maryland: provides presentations on the stigma of mental illness,
partners with local consumer-run organizations in various educational events and
provides assistance and referrals to consumers via telephone and in person.
3. Suicide Prevention
BMHS currently promotes suicide prevention by making crisis services available to at-risk
populations and more generally facilitating access to mental health treatment services for those
in need. By making crisis and urgent care services more readily available, more people could
receive the help they need when they need it, preventing and de-escalating crises that might end
in suicide. To this end, Baltimore Child and Adolescent Response System (BCARS) was
recently expanded. In addition, Baltimore Crisis and Response, Inc. (BCRI), maintains a 24/7
crisis hotline and provides Lifeline services (a national suicide prevention network). The Lifeline
services are funded by SAMHSA and the American Association of Suicidology. Additionally,
Network of Care – a Baltimore City website - and BMHS’ website provide information about
available treatment and crisis services.
4. Efforts to Address Co-occurring Disorders/Promotion of Dual Diagnosis Capability
Training
Integrated Dual Disorders Treatment (IDDT) - BMHS, in collaboration with bSAS,
developed a new IDDT initiative for Baltimore City in FY 12 to serve individuals with
co-occurring disorders who are court-ordered to substance abuse treatment. Enrolled
individuals have access to integrated services in two outpatient clinics and one Assertive
Community Treatment team. BMHS and bSAS meet regularly to develop strategies to
better coordinate services for this target population.
Trauma-Informed Training - BMHS formed a training collaborative to develop more
trauma-informed treatment in Baltimore City with funding from MHA that was allocated
for co-occurring disorders. (Present or past trauma is common in the lives of people with
co-occurring substance use and mental health disorders.) BMHS contracted with the
National Council for Behavioral Health Care to facilitate no-cost trainings for providers
to become more trauma-informed through critical policy and practice changes, and to
provide Trauma-Informed Cognitive Behavioral Therapy training to clinicians.
Co-occurring Disorder Supportive Housing Project - This project’s (previously
mentioned in #1 above) aim is to transition 25 consumers with co-occurring mental
health and substance use disorders from the State Hospitals into the community.
146
5. Access to Services
Maryland Crisis and At-Risk for Escalation Diversion Services (MD CARES) - This
federal System of Care grant seeks to strengthen cross-agency partnerships that blend
family-driven, evidence-based practices within mental health and child welfare systems
so that the high-risk youth population obtains greater access to quality services.
Early Childhood Mental Health and Expanded School Mental Health - These two
programs provide a continuity of care through the transition between Head Start and
elementary school. Both initiatives have a strong prevention and early intervention
emphasis and reach a significant number of children.
Temporary Assistance for Needy Families (TANF) Wellness Education Program -
This program identifies individuals in local DSS offices with mental health needs. These
individuals are assessed, provided brief interventions, and, if needed, connected to other
PMHS services.
6. Evidence-Based Practices
Integrated Dual Disorders Treatment (IDDT) – This initiative (previously mentioned
in #4 above) is an evidence-based practice model that provides integrated mental health
and substance abuse treatment to support consumers in the recovery process.
Assertive Community Treatment (ACT) – BMHS supports and funds ACT teams.
ACT is an evidenced-based practice model that requires mobile treatment providers to
receive specialized training and evaluation by the State of Maryland using the Dartmouth
Assertive Community Treatment Scale. Six of the nine mobile treatment programs in the
City are ACT certified. A seventh mobile treatment program is in the process of
converting to ACT.
Common Elements - BMHS funded a year-long professional development training for
72 Expanded School Mental Health (ESMH) clinicians to learn and practice Common
Elements. Common Elements is an evidence-based practice that takes components of
interventions that have been shown in clinical trials to be effective in treating specific
disorders of childhood and adolescence and re-bundles those elements to allow clinicians
to more effectively provide behavioral health interventions.
7. Diversion Efforts
Reducing Avoidable Emergency Department Visits and Inpatient Episodes
Adult Emergency Room Department Diversion - Baltimore Crisis and
Response, Inc. (BCRI) coordinates with emergency departments to maximize use
147
of community-based alternatives to inpatient admission. Point persons from BCRI
and BMHS provide technical assistance and consultation as needed for discharge
planning and to address other challenges.
Pediatric Emergency Room Department Diversion - Baltimore Child and
Adolescent Response System (BCARs) places clinicians in Johns Hopkins
Hospital and the University of Maryland Medical System where they provide
mental health assessments, stabilization services and immediate linkage to other
services.
High Inpatient Utilizer Project - This project identifies individuals who utilize
high levels of psychiatric inpatient care, i.e. those consumers who have either
been hospitalized for more than 30 days or who have had five or more
hospitalizations in the last six months, in order to facilitate appropriate
community-based treatment and support services. The goals are to enhance
assertive engagement and support services, while decreasing the high inpatient
utilizer’s cycle of reliance on preventable emergency room visits and acute
psychiatric inpatient admissions.
Diverting Mentally Ill Defendants from Incarceration
Forensic Alternative Service Team (FAST) - BMHS supports FAST, which
provides jail diversion activities and actively participates in Mental Health Court.
FAST screens individuals for diversion services and conducts face-to-face
assessments to determine eligibility for appropriate services and possible return to
the community.
Circuit Court Case Management Project - This three-year project funds a
clinician to provide behavioral health assessments and link eligible defendants to
behavioral health services in the community. The goals of this project are to
decrease recidivism, increase mental health service utilization among defendants
with mental illness and to increase public safety. The project has been fully
integrated into the operation of the consolidated mental health docket in the
Circuit Court of Baltimore City.
8. Outcomes/Quality
As previously discussed on page 73, in FY 12, BMHS implemented a formal Quality
Management Plan (QM Plan), focusing attention agency-wide on the quality of both the
City’s publicly-funded mental health programs and BMHS’ performance in key areas.
Indicators of quality performance for both BMHS and the PMHS were established, and
baselines were determined. Performance is monitored and analyzed on a monthly basis
to ensure that consumers are receiving quality services and that the City’s PMHS is
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operating effectively and efficiently. The Quality Management Report for FY 12 is
attached as Appendix B.
As previously mentioned in #1 above, the Capitation project’s continuous quality
improvement process is an initiative with the goal of improving targeted aspects of care.
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Mission, Vision and Values
Mission
The mission of BMHS is to develop and manage a system of care in which Baltimore City
residents have access to high quality public mental health services.
Vision
Baltimore City seeks to be a national leader in the development of high quality, innovative, and
effective public mental health services. Services are developed to meet the needs of the
community based on input received during ongoing planning processes. BMHS will be a model
for other local mental health authorities throughout the country because of effective leadership,
collaboration with the community, efficient management of costs, and a comprehensive data-
driven quality management program.
Values
BMHS strives to:
Design a continuum of services that meets the mental health needs of the residents of
Baltimore City;
Include the perspectives of consumers, families, mental health providers, and other key
stakeholders in developing and improving systems of care;
Recognize the rights of consumers and families to participate in care decisions and to be
treated with dignity and respect;
Support individuals in their efforts to maximize their full potential;
Offer high quality mental health services;
Ensure cost-effective delivery of services;
Ensure delivery of services in the least restrictive environment appropriate to the needs of
consumers;
Promote culturally competent services that respect differences among individuals;
Educate, train, and promote research; and
Offer safe, attractive, and affordable housing for persons with mental illness.
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Goals, Objectives and Strategies
GOAL I: Americans Understand that Mental Health
is Essential to Overall Health.
Objective 1.1: Baltimore Mental Health Systems (BMHS) will increase public awareness of
mental health disorders, prevention mechanisms, treatment services, and supports.
STRATEGY 1: Provide direction, funding and ongoing consultation to organizations that
implement public education and training activities.
Action Step: Support organizations that provide public educational workshops, distribute
educational literature, and offer information and referrals:
Mental Health Association of Maryland (MHAMD);
National Alliance on Mental Illness (NAMI);
Maryland Coalition of Families for Children’s Mental Health;
On Our Own of Maryland.
Indicator: Report on progress to date.
STRATEGY 2: Participate in community events that promote awareness of mental health.
Action Step: Provide education and outreach regarding depression and available mental
health services through the Behavioral Health Leadership Institute.
Indicator: Number of community events.
STRATEGY 3: Collaborate with the Baltimore City Health Department (BCHD) and
hospitals and other healthcare providers and Federally Qualified Health Centers (FQHCs)
to identify opportunities to provide educational information about mental health issues and
access to care.
Action Step: Reach out to staff at BCHD and healthcare providersFQHCs, with priority to
those working with populations at high risk for mental health disorders.
Indicator: Report on progress to date.
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Objective 1.2: BMHS will educate public safety personnel regarding current information
about mental illness, managing mental health emergencies and available services.
STRATEGY 1: Improve the capacity of the City’s police officers, Downtown Partnership
Safety Guides and other public safety personnel like parole and probation officers, 911
operators and correctional officers, to respond to psychiatric emergencies.
Action Step: In collaboration with the Baltimore Police Department provide leadership to
the Behavioral Emergency Services Team (BEST) to train police officers.
Action Step: Collaborate with public safety organizations to identify opportunities to
provide educational information about mental health issues.
Indicators: Number of personnel trained; report on progress to date.
GOAL II: Mental Health Care is Consumer and Family Driven.
Objective 2.1: Promote efforts that facilitate recovery and build resiliency.
STRATEGY 1: Promote and support consumer-operated programs.
Action Step: Provide direction, funding, and consultation to the City’s three (3) Wellness &
Recovery Centers: Helping Other People through Empowerment (HOPE), On Our Own, Inc.
and Hearts and Ears.
Indicator: Number of consumers served.
STRATEGY 2: Increase implementation of consumer-centered practices such as Wellness
and Recovery Action Planning (WRAP), use of peer staff and consumer-directed recovery
planning.
Action Step: Provide direction, funding and ongoing consultation to the Human Services
Training program at Goodwill, Inc. that trains consumers for employment in the human
services field.
Action Step: Provide education and technical assistance to providers in implementing
practices targeted at assisting consumers to move to their defined next level of recovery.
Indicators: Number of consumers served; Rreport on progress to date.
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Objective 2.2: Help families be active advocates for their children on the system, program
and individual level.
STRATEGY 1: Increase family input in planning and evaluation of mental health services.
Action Step: Elicit feedback from family support and advocacy organizations concerning
the mental health needs of children and families in the community.
Action Step: Provide funding, oversight, and evaluation of services to meet the mental
health needs of families in Baltimore City.
Indicator: Composite summary of family satisfaction with continuum of mental health
services available in the City.
STRATEGY 2: Promote leadership development and advocacy skills among families.
Action Step: Provide funding and support to the Maryland Coalition of Families for
Children’s Mental Health for their sponsorship of family leadership trainings.
Indicator: Number of family members who attended leadership training.
Objective 2.3: Promote family-driven and family-centered initiatives.
STRATEGY 1: Provide support and consultation to family-centered initiatives implemented
in Baltimore City.
Action Step: Participate in statewide and local planning for the implementation of home and
community-based wraparound services for youth who would otherwise require residential
treatment level of care.
Indicator: Report on progress to date.
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GOAL III: Disparities in Mental Health are Eliminated.
Objective 3.1: Improve access to culturally and linguistically competent public mental
health services for racial and ethnic minority individuals.
STRATEGY 1: Recruit and retain racial and ethnic minorities and multi-lingual
professionals in the mental health services workforce.
Action Step: Provide direction, funding and ongoing consultation to the Maxie Collier
scholarship program at Coppin State University, which encourages minority students to
pursue careers in mental health.
Action Step: Provide direction, funding and ongoing consultation to the Johns Hopkins
Hospital Hispanic Clinic, which provides mental health treatment to Spanish-speaking
individuals and families through the use of bilingual staff.
Indicator: Number of students enrolled by discipline.
STRATEGY 2: Develop collaborations with community-based organizations working to
increase understanding of mental health issues and to improve access for services among
racial, ethnic and linguistic minorities.
Action Step: Provide direction, funding and ongoing consultation to the Black Mental
Health Alliance for Education and Consultation in promoting awareness of the needs of
African Americans with mental illness and offering information, support and referrals to
individuals and families.
Indicator: Report on progress to date.
STRATEGY 3: Develop collaborations with health care providers, mental health care
providers, community-based Latino organizations and other willing partners to identify
opportunities to improve access to mental health care for Baltimore City’s growing Latino
population.
Action Step: Implement at least one recommendation identified either in the Latino Needs
Assessment Report or through dialogue with key partners.
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Indicator: Report on progress to date.
STRATEGY 4: Collaborate with colleges and universities to improve cultural competence
among newly trained healthcare workers and professionals regarding the unique needs of
Baltimore City consumers.
Action Step: Reach out to the University of Maryland School of Social Work to provide
educational opportunities to improve cultural competence of graduating social work
professionals.
Indicators: Report on progress to date.
Objective 3.2: Improve access to mental health services for special populations that are
underserved by the public mental health system.
STRATEGY 1: Provide direction, funding and ongoing consultation to agencies that serve
transitional age youth.
Action Step: Contract with a vendor(s) to provide residential rehabilitation and case
management services for youth who have complex mental health and social needs.
Action Step: Provide technical assistance to child and adolescent mental health providers
and other child serving systems regarding accessing the adult mental health system and
strategies to assist youth in developing skills needed for success in the adult system.
Indicators: Number of youth who receive services; report on technical assistance provided.
STRATEGY 2: Facilitate access to treatment for war returnees, especially those from Iraq
and Afghanistan.
Action Step: Make available free mental health treatment by contracting with a vendor to
recruit and provide specialized training for volunteer mental health professionals.
Indicator: Number of individuals served.
STRATEGY 3: Provide direction, funding and/or ongoing consultation to agencies that
interact with individuals involved with the criminal justice system.
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Action Step: Divert individuals from incarceration by providing support and technical
assistance to the Baltimore City Mental Health Court, Forensic Assertive Community
Treatment Team (FACTT) and Forensic Alternative Services Team (FAST).
Action Step: Collaborate with the Baltimore City Circuit Court to develop alternatives to
incarceration for sentenced individuals.
Action Step: Provide support and technical assistance to the Chrysalis House Healthy Start
Program, which serves pregnant, and post-partum women and their babies as an alternative to
incarceration.
Indicators: Number of individuals served; report on progress to date.
STRATEGY 4: Fund mental health services targeted to individuals who are deaf and hard of
hearing.
Action Step: Contract with a vendor to provide residential rehabilitation, psychiatric
rehabilitation and outpatient mental health treatment services to this population.
Indicators: Number of individuals served; level of care received.
STRATEGY 5: Fund mental health services targeted to individuals with traumatic brain
injury (TBI).
Action Step: Contract with a vendor to provide individualized therapeutic activities in a
residential setting, including life skill services and family supports.
Indicator: Number of individuals served.
STRATEGY 6: Provide funding and/or consultation to programs that offer outreach or
mental health services to individuals and families who are homeless.
Action Step: Provide leadership to the multi-agency coalition of homeless outreach
advocates and providers known as the Hands in Partnership (HIP) initiative to identify,
engage and coordinate outreach services to individuals experiencing homelessness.
Action Step: Provide direction, funding and ongoing consultation to HUD-funded projects:
three (3) mental health outreach teams; one (1) SSI Presumptive Eligibility Outreach
program; and one (1) Wellness and Recovery Center for homeless individuals.
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Action Step: Provide funding and consultation to programs serving homeless children and
families.
Indicators: Report on progress to date; number of individuals served.
STRATEGY 7: Fund transitional housing opportunities.
Action Step: Contract with a vendor(s) to provide transitional housing services.
Indicators: Number of beds funded; number of individuals served.
STRATEGY 9: Provide mental health screening, intervention, and referral for children
exposed to violence.
Action Step: Provide funding and oversight to the Child Development Community Policing
(CDCP) program, which provides mental health outreach, assessment, referrals for children
who are witnesses or victims of a violent crime and trains volunteers about the needs of this
population.
Indicators: Number of requests to CDCP; number of children and adolescents served.
STRATEGY 10: Provide mental health services to individuals suffering from depression and
trauma and living in highly vulnerable communities.
Action Step: Through Baltimore Health Leadership Institute’s (BHLI) Connections Project,
in partnership with Johns Hopkins Bayview Medical Center, provide mental health services
on-site in non-traditional community-based settings.
Indicators: Number of sites; number of individuals served; number of services provided.
STRATEGY 11: Fund mobile psychiatric assessment and treatment for elderly individuals.
Action Step: Contract with vendor(s) to identify, assess, treat and link elderly clients to
services.
Indicator: Number of individuals served.
STRATEGY 12: Provide technical assistance and consultation to coordinate access to
community-based services for elderly individuals.
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Action Step: Assist State hospital facilities to transition elderly residents to community
placements.
Indicator: Number of individuals served.
GOAL IV: Early Mental Health Screening, Assessment and Referral to
Services are Common Practice.
Objective 4.1: Promote healthy social and emotional development by making mental
health services available within settings where children grow and learn.
STRATEGY 1: Promote the provision of mental health promotion, prevention and
intervention services in early childhood settings.
Action Step: Partner with Baltimore City Head Start to make mental health services
available on-site.
Indicators: Number of Head Start sites offering mental health services on-site; Number of
mental health consultations provided.
STRATEGY 2: Promote the provision of mental health prevention, screening, assessment
and treatment services in public schools.
Action Step: Partner with the City Schools, Baltimore City Health Department and any
other interested partners to fund school-based mental health services through the Expanded
School Mental Health (ESMH) project.
Action Step: Track outcomes to demonstrate impact of school-based mental health services.
Action Step: Work with partners to explore possibilities for the expansion of ESMH
services.
Action Step: Provide oversight and support to specialized school-based mental health
initiatives that serve targeted populations.
Indicators: Number of children and adolescents served; report on selected outcomes.
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Objective 4.2: Identify and seek to address the mental health needs of children and
adolescents in other child-serving systems.
STRATEGY 1: Work cooperatively with the Juvenile Justice System to identify and address
the mental health needs of involved youth.
Action Step: Provide consultation and technical assistance regarding mental health services
and resources on-site at Juvenile Court.
Action Step: Provide funding and oversight for the delivery of court-ordered mental health
assessments for post-adjudicated youth.
Action Step: In collaboration with Department of Juvenile Services (DJS), provide funding
and oversight for mental health and substance abuse screening and treatment services for
youth supervised by DJS at the Baltimore City Juvenile Justice Center and in the community.
Indicator: Number of DJS-involved or court-involved youth served.
STRATEGY 2: Participate in statewide and local efforts to more adequately meet the mental
health needs of children and adolescents in foster care.
Action Step: Provide funding and oversight, in conjunction with MHA and Department of
Human Resources (DHR), of mental health assessments for children at risk of entering or
entering the foster care system.
Action Step: Provide funding and oversight, in conjunction with MHA and DHR, of mental
health mobile crisis and stabilization services for children and families in the foster care
system.
Indicators: Total number of calls; number of children assessed; number of children able to
maintain foster care placement; number of mobile crisis responses.
Objective 4.3: Promote screening for mental health disorders, including co-occurring
disorders and linkage to appropriate treatment and supports across the lifespan.
STRATEGY 1: Expand screening, assessment and coordinated treatment for individuals
with co-occurring mental health and substance use disorders.
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Action Step: Continue planning activities with Baltimore Substance Abuse Services (bSAS)
and other Baltimore City stakeholders including the Expanded School Mental Health Sixth
Grade Initiative, and Integrated Dual Disorders Team (IDDT).
Action Step: Continue efforts to increase knowledge among BMHS and bSAS staff of
treatment issues relating to individuals with co-occurring disorders and promote closer
collaboration between the two agencies.
Indicator: Report on progress to date.
STRATEGY2: Make buprenorphine treatment available to individuals with mental illness
and opioid addiction.
Action Step: Through BHLI’s Project Connections, continue offering buprenorphine
treatment in coordination with mental health treatment at one site.
Indicators: Report on progress to date; number served.
GOAL V: Excellent mental health care is delivered and research is accelerated while
maintaining efficient service system accountability.
Objective 5.1: Promote workforce development and training through educational activities
and technical assistance to mental health service providers and other service sectors.
STRATEGY 1: Facilitate opportunities to educate and provide technical assistance in
emerging best practices. Sponsor continuing education and training opportunities in
evidence-based and emerging best practices.
Action Step: Support providers in identifying professional development
opportunities.Sponsor community trainings for community-based mental health clinicians.
Action Step: Sponsor professional development sessions for school-based mental health
clinicians.
Indicators: Number of training activities; number of participantsReport on progress to date.
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STRATEGY 2: Provide support and technical assistance to service providers in how the
public mental health system works.
Action Step: Provide presentations to community service organizations, hospitals and
FQHCs about the resources available for clients in need of mental health services.
Indicators: Types of community service organizations that received presentations; number
of presentations.
Objective 5.2: Provide access to services in the least restrictive setting.
STRATEGY 1: Strengthen crisis response services.
Action Step: Provide funding and oversight to Baltimore Crisis Response, Inc. (BCRI) and
to Baltimore Child and Adolescent Response System (B-CARS).
Indicator: Number of individuals served by each provider; report on progress to date.
STRATEGY 2: Facilitate coordination of care for individuals using emergency rooms as
their point of access to psychiatric services.
Action Step: Facilitate access to community-based services for clients identified by MHA
and the Administrative Services Organizations (ASO) as high inpatient utilizers.
Indicator: Number of individuals served.
STRATEGY 3: Whenever possible, divert children and adolescents from admission to
Residential Treatment Centers (RTCs) by offering alternative community-based
interventions and supports.
Action Step: Participate in the approval process for home- and community-based
wraparound services for children and adolescents.
Action Step: Review Certificate of Need (CON) documents to assure that all referred youth
meet eligibility requirements and community-based services have been exhausted prior to
accessing whether an RTC level of care is needed.
Indicators: Number of children and adolescents referred for RTC placement; number of
children and adolescents diverted from RTC services via the 1915c Waivervia the State plan.
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STRATEGY 4: Provide support to programs that work with children and adults
transitioning out of inpatient/institutional facilities.
Action Step: Facilitate communication between Baltimore Child and Adolescent Response
System (B-CARS) and the Care Management Entity (CME), Wraparound Maryland, and the
child and adolescent psychiatric inpatient programs in Baltimore City, to increase utilization
of B-CARS or Wraparound MarylandCME and thereby better assist youth to return to the
community following inpatient admission.
Action Step: Collaborate with State hospital facilities in identifying community resources to
assist in discharge planning.
Indicators: Report on progress to date; number of individuals who transitioned from
inpatient/institutional facilities.
STRATEGY 5: Provide access to affordable housing for individuals and families with mental
illness.
Action Step: BMHS’ housing affiliate, Community Housing Associates (CHA), will
provide 266 units of safe and affordable housing throughout Baltimore City.
Indicators: Number of individuals and families housed; retention in housing greater than 6
months.
Strategy 6: Increase the number of affordable housing units available to individuals and
families with mental illness.
Action Step: CHA will apply for funding to develop housing for adults and families with
mental illness.
Action Step: CHA will acquire and rehabilitate 20 units of affordable housing.
Action Step: CHA will secure funding to acquire and rehabilitate an additional 20 units of
housing to serve adults and families with mental illness.
Action Step: CHA will secure rental subsidies for all new units ensuring tenants pay no
more than 30% of income for rent.
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Action Step: CHA will secure funds to make support services available to residents of CHA
housing.
Indicators: Number of applications submitted; number of individuals housed; number of
units developed; number of units with rental subsidy.
Objective 5.3: Identify and promote the implementation of evidence-based, effective,
promising and best practices for mental health services.
STRATEGY 1: Explore opportunities to increase access to evidence-based practices (EBP)
for children and adolescents.
Action Step: Collaborate with stakeholders throughout the City to establish a continuum of
EBPs’ in Baltimore City.
Action Step: Provide oversight of and explore increased funding for the Center on the
Social and Emotional Foundations for Early Learning (CSEFEL) Positive Behavior and
Supports (an evidence-based practice) in at least one Head Start Center.
Indicators: Number of clinicians trained; Rreport on progress implementation and
associated outcomes.to date.
STRATEGY 2: Facilitate implementation of MHA’s evidence-based practice guidelines for
supported employment and assertive community treatment (ACT).
Action Step: Provide information, support and encouragement to programs expressing
interest in adopting evidence-based practices.
Indicators: Number and type of programs maintaining fidelity to the models.
STRATEGY 3: Identify opportunities to improve coordination in the provision of mental
health treatment and somatic care.
Action Step: Collaborate with MHA, Community Behavioral Health and other interested
partners in implementing practices that address somatic risk factors, such as tobacco
cessation, in mental health treatment settings.
Indicator: Report on progress to date.
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Objective 5.4: Improve public mental health programs’ compliance with quality standards
established by Mental Hygiene Administration (MHA) and State and Federal regulations.
STRATEGY 1: Conduct quality assurance site visits to mental health programs.
Action Step: In collaboration with MHA and the Administrative Services Organization,
conduct audits of mental health programs to evaluate quality of services, billing practices and
compliance with State and Federal regulations.
Action Step: Using data from compliance audits identify areas where system-wide
improvements in services are needed and educate providers regarding deficiencies.
Indicators: Number of programs whose services meet quality standards; reduction in
number of programs found to be non-compliant.
STRATEGY 2: Provide training and technical assistance to mental health programs.
Action Step: Offer education and technical assistance to new programs that submit
applications to deliver public mental health services.
Action Step: Offer technical assistance to existing providers in developing performance
improvement plans in response to quality assurance site visits.
Indicators: Number of programs receiving technical assistance; reduction in the number of
programs non-compliant.
STRATEGY 3: Monitor public mental health programs using a quality management
framework.
Action Step: Review and monitor quality management metrics indicators in an newly
established quality management committee.
Indicators: Report on progress of establishing metricsindicators, quality improvement
interventions, and the results of quality improvement interventions.
Objective 5.5: Ensure that residential rehabilitation programs provide safe, affordable,
and quality housing.
STRATEGY 1: Inspect 100% of residential rehabilitation program (RRP) housing to
evaluate compliance with Code of Maryland Regulations.
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Action Step: Conduct initial and annual housing inspections.
Action Step: Conduct follow up inspections to determine if deficiencies identified during
inspections were corrected.
Action Step: Assist the RRP’s by identifying and documenting the deficiencies so that they
can successfully make the changes needed depending on their specific circumstances.
Action Step: Re-visit all RRP’s found to have had deficiencies.
Indicators: Number of RRPs inspected; reduction in the number of RRPs found to have
deficiencies.
Objective 5.6: Provide an adequate network of mental health service providers to meet
community needs.
STRATEGY 1: Improve BMHS vendor contract management process to strengthen
monitoring of grant-funded programs.
Action Step: Assess vendor performance through submission of fiscal and programmatic
reports, and request corrective action plans from providers identified as not meeting fiscal
audit standards or programmatic deliverables.
Action Step: Utilize contract management software.
Action Step: Conduct random and targeted site visits to monitor vendor performance,
compliance with conditions in their contract, and regulatory compliance; request
performance improvement plans from providers identified as non-compliant.
Action Step: Provide technical assistance to non-compliant vendors; assess areas in need of
improvement, educate providers and schedule follow-up site visits to evaluate progress.
Indicators: Number of contracts in compliance; timeliness of contract execution; program
compliance ratings; reduction in the number of programs non-compliant; percentage of
providers who receive corrective action plans or performance improvement plans,
percentage of providers that, upon performance improvement plan or corrective action plan
follow-up, successfully improved performance.
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STRATEGY 2: Increase vendor understanding of BMHS contracts and policies through
education and technical assistance.
Action Step: Provide education and training to vendors and staff throughout contractual
cycle, as needed.
Indicator: Type and number of trainings provided.
GOAL VI: Technology is used to access mental health care information.
Objective 6.1: Explore the application of technology to improve service delivery including
promoting the use of web-based technology as a tool to improve information sharing, data
collection, and evaluation.
STRATEGY 1: Use the BMHS integrated database to facilitate coordination of care.
Action Step: Train staff on utilizing database to extract and analyze client-level, program-
level and contract-level data to support improved agency operations and performance.
Indicator: Report on progress to date.
STRATEGY 2: Maintain and publicize Baltimore City’s site for Network of Care, a web-
based application that includes a service directory and other mental health-related
resources.
Action Step: Collaborate with City providers to update and add new resources as identified.
Action Step: Provide training to City providers and other organizations on how to use
Network of Care to improve their delivery of services.
Indicator: Report on progress to date.
STRATEGY 3: Develop redesignedMaintain updated agency website asinto an effective
resource for the City’s public mental health system, key partners and the general public.
Action Step: Update the website with important announcements, events and forms that are
pertinent to the Baltimore City provider community.
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Action Step: Keep resources and information on services up-to-date and easily accessible to
the general public.
Indicator: Report on progress to date.
STRATEGY 4: Use Datalink to identify individuals in the City’s jails who have mental health
needs in order to increase access to mental health services.
Action Step: Develop a plan in collaborationWork collaboratively with the Department of
Corrections to utilize the data available through Datalink to improve release plans for
incarcerated individuals with mental illness.
Indicator: Report on progress to date.
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Appendices
Appendix A: Glossary and Acronym Description
A
ACT – Assertive Community Treatment – An evidence-based practice of mobile, community-
based treatment provided by a multidisciplinary team to persons requiring higher level of care
than traditional outpatient programs.
ADAA – Alcohol and Drug Abuse Administration
ASO – Administrative Service Organization – An organization that assists MHA in the
operations of the PMHS. It switched from MAPS-MD to ValueOptions in August 2009.
B
BCARS – Baltimore Child & Adolescent Crisis Response System – A program that provides
mobile psychiatric crisis stabilization services to children and adolescents.
BCDSS – Baltimore City Department of Social Services
BCHD – Baltimore City Health Department
BCHS – Baltimore City Head Start
BCJJC – Baltimore City Juvenile Justice Center
BCPS – Baltimore City Public Schools
BCRI – Baltimore Crisis Response, Inc. – A program that provides 24/7 crisis intervention
services such as a crisis hotline, mobile crisis teams, and residential crisis beds.
BEST – Behavioral Emergency Services Team – A project that trains police officers and other
public safety personnel about mental illness and how to respond to psychiatric emergencies.
BHLI – Baltimore Health Leadership Institute (formerly Mental Health Policy Institute for
Leadership and Training or MHPILT) addresses the issues related to workforce development in
community behavioral health across disciplines and the gap between research findings, policy,
and practice.
BMHA – Black Mental Health Alliance
BMHS – Baltimore Mental Health Systems, Inc.
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BMWPS – Bi-Annual Mental Wellness Promotion Service – An event coordinated by the Center
for the Integration of Spirituality and Mental Health that focuses on mental health topics and
provides mental health screenings.
BPD – Baltimore City Police Department
bSAS – Baltimore Substance Abuse Systems, Inc.
C
Capitation Project – Intensive community-based treatment service that removes categorical
funding barriers to facilitate high quality comprehensive care to clients in the community with
individualized, flexible and innovative treatment plans.
CANS – Child and Adolescent Needs Assessment
CBH – Community Behavioral Health
CDCP – Child Development Community Policing – Trauma response services provided to
children/adolescents who have witnessed or been a victim of violence.
CHA – Community Housing Associates, Inc
CHHS – Chrysalis House Healthy Start
CISMH – Center for Integration of Spirituality and Mental Health
CME – Care Management Entity
CMET – Court Medical Evaluation Team
COMAR – Code of Maryland Regulations
CON – Certificate of Need – Evaluation documents (i.e., psychiatric, psychological, psycho-
social assessment, and physical) required to validate a clinical recommendation for placing a
youth in a residential treatment center.
CQT – Consumer Quality Team – A consumer team that visits mental health programs and
interviews consumers with the goal of improving the quality of services within the PMHS.
Crisis Services – Short-term crisis interventions, including crisis beds, designed to address
psychiatric emergencies and reduce unnecessary hospitalizations.
CSA – Core Service Agency – Local mental health authority
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CSEFEL – Center on the Social and Emotional Foundations for Early Learning – A national
resource center funded by the Office of Head Start and Child Care Bureau focused on promoting
the social emotional development and school readiness of young children, birth to age 5, and
responsible for disseminating research and evidence-based practices to early childhood programs
across the country.
D
DHMH – Department of Health and Mental Hygiene
DJS – Department of Juvenile Services
DOC – Department of Corrections
DPP – Division of Parole and Probation
DPSCS – Department of Public Safety and Correctional Services
E
EBP – Evidence-Based Practice – A service or service model that has been demonstrated
through research to be effective.
ECMH – Early Childhood Mental Health
EMTALA – Emergency Medical Treatment and Active Labor Act
ESMH – Expanded School Mental Health – Mental health prevention and treatment services
provided in identified Baltimore City public schools.
F
FACTT – Forensic Assertive Community Treatment Team
FAST – Forensic Alternative Services Team
FFT – Functional Family Therapy – A family-based prevention and intervention program
designed to improve long-term outcomes for youth who are in the care and custody of
Maryland’s Department of Juvenile Services.
FLBC – Family League of Baltimore City – Local management board for Baltimore City
designed to focus attention and resources on improving the well-being of children and families
by engaging communities and encouraging public and private partnerships.
FQHC – Federally Qualified Health Center
G
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GAF – Global Assessment of Functioning
H
HCH – Healthcare for the Homeless
HEBCAC – Historic East Baltimore Community Action Center
High Fidelity Wraparound Services – A family-driven team process to develop, implement
and monitor a plan of care that is culturally competent, strength-based, and individualized to
achieve positive outcomes for the family of children with severe emotional disturbance.
HIP – Hands In Partnership – A coalition of outreach advocates jointly led by BMHS, Baltimore
Homeless Services, and Baltimore Health Care Access.
HIU – High inpatient utilizers
HOPE – Helping Other People through Empowerment – One of three of the City’s Wellness and
Recovery Centers; it focuses on serving homeless individuals.
Hospital Diversion – Coordination of services and linkage to the appropriate level of
community-based care for uninsured individuals using emergency departments as their primary
source of psychiatric care.
I
IDDT – Integrated Dual Disorders Treatment – An evidence-based practice model that fully
supports individuals with mental illness who are court-ordered to receive substance abuse
treatment.
J
N/A
K
N/A
L
LCT – Local Care Team – A collaborative body of child-serving agencies that meets regularly to
address the needs of youth with special or intensive needs requiring residential or community-
based placement due to behavioral, educational, developmental or mental health disabilities.
M
MACSA – Maryland Association of Core Service Agencies
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MATCH – Making All The Children Healthy program – A program that provides evidence-
based mental health assessment to children in the child welfare system.
MBRFSS – Maryland Behavioral Risk Factor Surveillance Survey
MD-CARES – Maryland Crisis and At-Risk for Escalation diversion Services for children - The
State’s System of Care grant.
MHA – Maryland Mental Hygiene Administration
MHAMD – Mental Health Association of Maryland
MHPILT – Mental Health Policy Institute for Leadership and Training, now Behavioral Health
Leadership Initiative (BHLI). See BHLI for description.
N
NAMI – National Alliance on Mental Illness
O
OHCQ – Office of Health Care Quality – The agency within DHMH charged with monitoring
the quality of care in Maryland’s 8,000 health care and community residential programs.
OMHC – Outpatient Mental Health Clinic – Multidisciplinary community-based services such
as individual, group, and family therapies as well as medication management.
P
PAC – Primary Adult Care Program – A program in Maryland that provides health coverage for
a limited set of health services for income-eligible adults.
PATCH – Psycho-Geriatric Assessment and Treatment – A Johns Hopkins Hospital’s program
that provides mobile assessment and treatment for elderly individuals
PC – Project Connections
PEP – People Encouraging People, Inc.
PMHS – Public Mental Health System
PRP – Psychiatric Rehabilitation Program – A range of rehabilitation services designed to
maximize the ability of the mental health consumer to function successfully in the community.
PSEP – Peer Support Engagement Project – A project with goals to improve client outcomes and
reduce avoidable use of hospital emergency and inpatient care, along with associated costs.
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Q
N/A
R
RRP – Residential Rehabilitation Program – Community-based residential services for adults
enrolled in psychiatric rehabilitation programs (may include adult group homes).
RTC – Residential Treatment Center – Intensive residential programs for children and
adolescents with serious emotional disturbance whose needs cannot be met in the community.
S
SAMHSA – Substance Abuse and Mental Health Services Administration
SEP – Supported Employment Program – Employment training and support to prepare persons
for employment and link to jobs.
SNAP – Supplemental Nutritional Assistance Program
SOAR – SSI/SSDI Outreach Assistance and Recovery – A Health Care for the Homeless
program that coordinates Social Security benefits for homeless individuals.
SOCTI – System of Care Training Institute
SOS – Senior Outreach Services – A University of Maryland program that provides mobile
assessment and treatment for elderly individuals.
SGHC – Spring Grove Hospital Center
T
TAC – Technical Assistance Collaborative
TANF – Temporary Assistance for Needy Families
TAY – Transitional Age Youth – Young people, between age 16 and 24, who are transitioning
from the child to the adult mental health system.
TF-CBT – Trauma-Focused Cognitive Behavioral Therapy – A type of psychotherapy that is
applicable to children and adolescents who are experiencing significant emotional and behavioral
difficulties related to traumatic life events.
U
UMMC – University of Maryland Medical Center
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V
W
WRAP – Wellness Recovery Action Plan – A consumer-centered peer support service practice
X
Y
YO! Center – Youth Opportunity Center – Centers that serve youth who are working towards
receiving their GED
Youth MOVE (YM) – Youth Motivating Others through Voices of Experience – A youth-led
organization devoted to improving services and systems that support positive growth and
development.
Z
174
175
Quality Management Report
for
Fiscal Year 2012 (July 1, 2011 – June 30, 2012)
Presented to the Board of Directors
September 12, 2012
by
Jane Plapinger, President & CEO
Appendix B
176
Introduction
Baltimore Mental Health Systems’ Quality Management Plan serves as the foundation of BMHS’
commitment to continuously improve the quality of Baltimore City’s Public Mental Health System
(PMHS). Quality management is a strategy that uses data to monitor quality, identifies opportunities for
quality improvement and implements targeted interventions to improve processes associated with
meaningful outcomes.
All core service agencies, including Baltimore Mental Health Systems, Inc. (BMHS), are contractually
obligated to engage in quality management activities in their jurisdictions, and BMHS has three
dedicated quality management coordinators who conduct mandated quality assurance audits of the
City’s public mental health programs – both those funded through the State’s fee-for-service carve-out
and those grant-funded by BMHS. Until this year, the scope of these activities was limited to what the
state required, conducting site visits to programs and reviewing provider applications to establish,
expand or close programs. In FY11, BMHS decided to expand and formalize its quality improvement and
quality assurance activities, and developed its Quality Management (QM) Plan as a framework.
FY 12 was the first year of implementation of the QM Plan. The Plan requires that BMHS report to the
Board on an annual basis on its QM activities. This first report to the Board will summarize the goals of
the QM Plan for FY 12, and describe what was achieved. In addition, this report will describe the
indicators and targets that have been identified for FY 13.
The first step in implementing the QM Plan was establishing the Quality Management Committee34. The
Committee was created at the beginning of FY 12 and met eight times throughout the year. (The Plan
specified that the Committee meet no fewer than ten times, but the restructuring of the Administrative
Division and change in staff impacted the agency’s capacity to meet this goal.) The Committee
developed six measureable quality indicators, which are as follows:
Measures of Quality within the City’s Publicly-Funded Mental Health Programs
1. Consumer Perceptions of Care
2. Provider Compliance with Contractual Requirements
3. Provider Program Quality
Measures of Quality Relating to BMHS Performance
4. Consumer Complaint Resolution
5. Timely Annual Contract Renewals
6. Help Call Satisfaction Rates
34
Per the QM Plan, Committee membership includes: President & CEO, Director of Operations, CFO, Director of Adult Services, VP/Director of Child and Family Services, one Adult Services Manager, one Child and Family Services Manager and two Quality Management Coordinators.
177
At each meeting, the Committee reviewed and analyzed data collected on the indicators, identified
improvement opportunities, and developed interventions to promote improvement. In addition, quality
assurance site visit35 results and provider applications to establish, expand or close services/service lines
were reviewed to assist in identifying PMHS service gaps and provider trends. Specific details on each of
the quality management indicators follow below.
Measures of Quality within the City’s Publicly-Funded Mental Health Programs
1. Consumer Perceptions of Care
Total # of providers required to conduct a survey 58
Total # of providers that met the requirement 58
% of providers compliant 100%
A key quality measure in the Public Mental Health System is the consumer’s perception of the services
she or he received. This measure is a nationally recognized quality measure that many Baltimore City
providers routinely collect data on. BMHS’ aim is for all grant-funded direct service programs to elicit
and use consumer feedback to inform their quality improvement efforts.
To this end, in FY 12, BMHS added a requirement that BMHS-funded programs conduct an annual survey
of consumers to identify improvement opportunities. By including this requirement in our contracts,
BMHS is attempting to ensure that all providers are conducting surveys and utilizing the feedback to
focus improvement efforts.
In FY 12, the total number of providers that were required to conduct a survey was 58 and there was
100% compliance. In FY 13, these programs will be required to identify an area of improvement based
on the consumer feedback collected, and implement a quality improvement project which will be
described to BMHS as part of their FY 13 report of programmatic deliverables. This indicator will be
retained for FY 13 with a target of 100%.
2. BMHS Grant-Funded Provider Compliance with Contractual Requirements
Total # of grant-funded providers 56
Total # providers compliant with contractual obligations 52
% of providers in compliance 93%
35
A site visit is when BMHS’ Quality Improvement (QI) staff visit a mental health program to conduct a compliance audit. For fee-for-service providers, QI staff review the program for compliance with the Code of Maryland Regulations. For grant-funded providers, QI staff review the program for compliance with their BMHS contract. The frequency of site visits is determined by 1) the amount of funding for grant-funded programs, and 2) the requirements of the Mental Hygiene Administration for fee-for-service programs.
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Contractual compliance is the accurate and timely submission of required fiscal, programmatic and
other contractual documents by grant-funded programs. It is important because the timely submission
of contractual documents enables BMHS to pay providers on schedule, since payment is withheld when
contractual documents are outstanding. Interrupted payments put programs at operational risk, which
could impact services to consumers. Also, the receipt by BMHS of timely and accurate information from
grant-funded providers enables it to better track City grant funds, identify opportunities to repurpose
funds unlikely to be spent, and make the best possible decisions about budget reductions. This indicator
is intended to assess provider contractual compliance rates.
Over the last fiscal year, BMHS has been working with the City’s grant-funded providers to improve
performance in this area. In FY 12, the total number of BMHS grant-funded providers was 56, while the
average number of providers compliant with contractual obligations was 5236, for an average
compliance rate of 93%.
This indicator will be retained for FY 13 with a target of 100%. BMHS is implementing a grant/contract
software management system which will go live in FY 13, and will support providers in achieving
contractual compliance with greater efficiency. This web-based system will enable providers to submit
contractual documents electronically instead of manually, as is currently done, and will provide real-
time and point-in-time information and data. This will facilitate timely and accurate reporting, and will
allow BMHS to more quickly identify non-compliance.
3. Quality per Site Visits and Compliance with Programmatic Deliverables
Fee-for-Service & Grant-Funded Programs
# of site visits 68
# of Performance Improvement Plans (PIPs) issued 30
% of programs that failed to meet one or more COMAR standards 44%
BMHS is responsible for quality oversight of two categories of publicly funded mental health programs:
grant-funded program funded through contracts with BMHS, and services that are funded on a fee-for-
service basis by ValueOptions®37 through the PMHS Medicaid carve-out. Program Improvement Plans
(PIPs) are generated when a site visit is conducted and the provider (grant-funded or fee-for-service) is
found to be non-compliant with one or more Code of Maryland Regulations (COMAR). Corrective Action
36
This indicator is a conservative measure of provider contractual compliance because multi-program providers are deemed noncompliant if one or more of their programs are noncompliant. 37
ValueOptions® is the current administrative service organization of the PMHS in Maryland.
Grant-Funded Programs
# of providers 56
# of Corrective Action Plans (CAPs) issued 2
% of providers failed to meet one or more programmatic deliverables 4%
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Plans (CAPs) are generated when a provider fails to meet one or more programmatic deliverables38
delineated in its contract with BMHS.
In FY 12, 68 site visits were conducted by BMHS staff to City mental health programs39, and 30, or 44%,
had findings which required a Performance Improvement Plan. Based on the submission of data on
deliverables by BMHS’ grant-funded providers, 2 out of 56, or 4%, were found to be deficient and were
required to develop and implement a Corrective Action Plan.
For FY 13, the Quality Management Committee decided not to set a target for the percent of audited
programs with PIPs, because BMHS has very limited control over quality in these programs, which are
governed by state regulations (COMAR) and funded through ValueOptions® . However, data on this
indicator will continue to be collected, since it will be useful in determining trends in quality of care.
Two additional related indicators were added for FY 13: 1) percent of programs that submitted a timely
and satisfactory PIP, and 2) percent of programs that fully implemented their PIP within the required
timeframe. On the other hand, since BMHS does have significant control over BMHS grant-funded
programs, the Committee set the FY 13 target at 100% for providers that are compliant with contractual
deliverables; i.e., no providers would be required to submit a Corrective Action Plan.
Technical assistance to the City’s publicly-funded mental health programs by BMHS staff has been, and
will continue to be, individualized for all programs that have either a PIP and/or a CAP in place. BMHS
staff have worked together with these providers to assist them to become compliant. One area of focus
for improvement within BMHS is the coordination of technical assistance between BMHS’ Quality
Management and Adult and Child & Family Services Divisions.
Measures of Quality Relating to BMHS Performance
4. Consumer Complaint Resolution
# of complaints received 63
# of complaints resolved 52
% of complaints resolved 81%
Addressing complaints relating to the quality and accessibility of publicly-funded mental health services
is an important core service agency function. BMHS aims to resolve all complaints to the satisfaction of
the complainant, and do so within a 30-day timeframe. The intention of these two indicators is to track
consumer complaints about both fee-for-service and grant-funded providers, and to determine the
extent to which they are resolved in a timely manner.
38
Programmatic deliverables are specific to each contract and often include: number of consumers served; number and type of services rendered, e.g., number of outreach contacts, number of consultation; number of trainings provided; number of clinical sessions administered; etc. 39
References both BMHS grant-funded programs and fee-for-service programs.
# of complaints received 63
# of complaints resolved within 30 days 41
% of complaints resolved timely 65%
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In FY 12, the Quality Management Committee defined a “resolved” complaint as one in which the
consumer was satisfied or, when consumer satisfaction was not possible to ascertain, one in which
BMHS had done everything possible to ensure satisfaction, including referring to the appropriate state
authorities. The total number of complaints received was 63, while the number of resolved complaints
was 52, for a resolution rate of 81%. The number of those complaints that were resolved within the
required timeframe (30 days) was 41 (65%).
In examining the above data, the Quality Management Committee determined that the frequent lack of
responsiveness by complainants to BMHS’ efforts to investigate complaints sometimes prevented full
resolution or the timely resolution of complaints. Therefore, the Committee set a FY 13 target of 85%
for the number of resolved complaints, a modest increase from the baseline number (81%). However,
the Committee decided not to set a target for the percent of complaints resolved within 30 days,
because it was determined that BMHS lacks the ability to reliably control complaint resolution within a
30-day timeframe. Instead, an additional sub-indicator, tracking the number of complaints “responded
to within the required timeframe,” was added, to measure BMHS’ responsiveness. Both sub-indicators
(“response” timeframe and “resolved” timeframe) will be useful indicators in determining how
effectively BMHS acts to resolve consumer complaints.
5. Timely Annual Contract Renewals
Total # of contracts being renewed 96
# of contracts renewed by the start of new contract period 93
% of contracts renewed timely 97%
Target 85%
The timeliness of contract renewals is important to the uninterrupted provision of service of BMHS’s
grant-funded programs, and is an aspect of the effective management of public funds. BMHS’ goal is for
all contracts to be renewed by the start of the new contractual period.
In FY 12, in an effort to continue improving BMHS’ on-time contract renewal rate, the agency shifted the
direct responsibility for coordination of the contract renewal meetings to the Adult and Child & Family
Services Divisions, while the Administrative Division provided both support to and oversight of the
contract renewal process. This joint effort proved to be an effective approach, and 93 out of 96, or 97%
of contracts were renewed on time.
The Quality Management Committee has set a FY 13 target of 100% of contracts renewed on time.
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6. Help Caller Satisfaction
# of help calls received 1,173
# of callers indicating satisfaction with result of their call 1,067
% of callers satisfied 91%
One of BMHS’ core functions is to provide information about the PMHS and assist individuals, families
and other interested stakeholders to access public mental health services. The intent of this indicator is
to monitor the number of individuals who are satisfied with the outcome of their help call.
In FY 12, the total number of help calls received was 1,173 while the number of callers who expressed
initial satisfaction40 with their call’s result was 1,067, or 91%. Discussions about this indicator by the
Quality Management Committee revealed a low level of confidence that BMHS was collecting valid
“satisfaction” data from the available information. A better measure would be to conduct follow-up
calls to ask callers whether they were satisfied with the information provided; however, it was agreed
that BMHS does not, at this time, have resources to obtain this information. Therefore, the Committee
decided not to set a target for this indicator in FY 13, but will continue to collect the data for this
indicator. The Committee plans to examine the help call process further to determine how we might
increase our ability to confirm caller satisfaction.
Conclusion
Summary of Recommendations for the FY 13 Quality Management Plan
The first year of implementation of BMHS’ Quality Management Plan created an agency-wide focus on
quality – both of the City’s publicly-funded mental health programs and of BMHS’ performance in
several key areas. The newly formed Quality Management Committee brought together diverse staff at
all levels of the agency to review quality-related data to understand trends, identify improvement
opportunities, and begin to act on those opportunities. FY 12 data indicates many areas of high
performance relating to both the City’s mental health programs and BMHS as a funder, overseer of
quality and public resource for assistance with access to care. The FY 12 data and ensuing discussions of
the Quality Management Committee also indicated opportunities to target for improvement.
The goals of the Quality Management Plan for FY 12 were largely met. The plan was implemented and
the Committee established. Baseline data were collected for each indicator. Improvements in
processes related to the indicators were initiated. The indicators and associated targets for FY 13 are
detailed in the table below.
40
We currently attempt to collect this information at the close of each phone call by asking the caller, “Are you satisfied with the results of this call?”
182
FY 13 Quality Indicators and Targets
Provider Quality Measures
1. Consumer Perceptions of Care (BMHS Grant-Funded Providers)
Indicator # of providers that conducted a survey # of providers required to conduct a survey
Target 100%
Assessment
Frequency Annually
2. BMHS Grant-Funded Provider Compliance with Contractual Requirements
Indicator # of providers compliant with contractual obligations total # of providers
Target 100%
Assessment
Frequency Monthly
3. PMHS and BMHS Grant-Funded Provider Program Quality
Indicator A # of providers meeting contractual deliverables (no Corrective Action Plan) total # of BMHS grant-funded providers
Target 100%
Indicator B # of providers with a Performance Improvement Plan total # of PMHS providers with site visits
Target No target/monitoring only
Indicator C* # of programs that submit a satisfactory and timely Performance Improvement Plan
total # of programs that received a Performance Improvement Plan
Target Establish baseline in FY 13
Indicator D* # of programs that fulfilled all Performance Improvement Plan requirements total # of programs that received a Performance Improvement Plan
Target Establish baseline in FY 13
Assessment
Frequency Monthly
Agency Quality Measures
1. Consumer Complaint Resolution
Indicator A # of resolved complaints total # of complaints
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*Denotes new indicators for FY 13.
Target 85%
Indicator B* # of complaints resolved within required timeframe total # of complaints
Target No target
Indicator C # of complaints responded to within required timeframe total # of complaints
Target Establish baseline in FY 13
Assessment
Frequency Monthly
2. Timely Annual Contract Renewals
Indicator # of contracts renewed prior to the new contractual period total # of contracts being renewed
Target 100%
Assessment
Frequency Annually
3. Help Caller Satisfaction
Indicator # of callers satisfied with result of their call total # of calls
Target No target/monitoring only
Assessment
Frequency Monthly