Department of Health and Social Services Division of

Department of Health and Social Services Division of Substance Abuse and Mental Health Joint Finance Committee Hearing Fiscal Year 2016 Gerard Gallucci, M. D. MHS Acting Division Director February 26, 2015

DSAMH • The Single State Agency for prevention and treatment services for substance use, mental health and gambling conditions • Provides services regardless of ability to pay • Organizational structure consists of the Central Office/Administration, the Delaware Psychiatric Center (DPC), and a variety of community mental health, substance use disorder, and gambling services Delaware Health and Social Services

Accomplishments FY 14 USDOJ Settlement Agreement • DE has met substantial compliance in all but three of the Settlement Agreement Targets. There are three targets that have met partial compliance: 30% Reduction of Bed Days, Risk Management and Fidelity of ACT Teams. • 356 Mental Health Screeners, including Emergency Department Physicians and other behavioral health professionals have been trained/certified & are in a variety of settings. They provide first level assessment services regarding an individual’s need for involuntary hospitalization or referral to other services. Delaware Health and Social Services

Accomplishments FY 14 USDOJ Settlement Agreement • The Mobile Crisis Teams (NCC & Kent/Sussex) continue to exceed their response time target (1 hour) & average 45 minutes per call. • There a variety of housing options for clients with Serious and Persistent Mental Illness: Ø State Rental Assistance Voucher(SRAP) and 811 Project Demonstration Program both are partnerships with Delaware State Housing Authority Ø Supervised Apartment Program Ø Group Homes Ø Transitional Housing Ø Crisis Beds (3 to 5 days) Ø Resource/Respite beds • The Peer Programs throughout the state continue to expand. Peer supports are now provided as part of a new Problem Solving Court in New Castle County. Delaware Health and Social Services

Accomplishments • A Medicaid & DSAMH partnership facilitated revisions in the Delaware Medicaid State Plan to expand federal funding for behavioral health services. Delaware Health and Social Services

Accomplishments • Substance Abuse System Re-Design is underway. • The American Society of Addiction Management (ASAM) guidelines have been adopted to guide services, level of care determinations, and expected outcomes. • Contracts for the re-designed Comprehensive Behavioral Health Outpatient Treatment Programs have been finalized. This model will provide a better coordination of care throughout an individual’s journey to recovery. • Contracts for the re-designed Withdrawal Management Programs are being finalized. Delaware Health and Social Services

Residential SUD Services • Currently DSAMH contracts for 78 beds on the Governor Bacon Campus (Gateway). • The program must be relocated as the campus will be used for other purposes. • This has allowed for us to re-think and redesign our residential treatment programs. Delaware Health and Social Services

Residential SUD Services The re-design and additional funding in the FY ‘ 16 GRB will result in: • 47 beds (for men) will be moved to a renovated facility on the Delaware Hospital for the Chronically Ill campus. • 3 -16 bed treatment facilities across the state. • These programs will serve a total of 63 males and 32 women. • Increase of 17 beds. Delaware Health and Social Services

Sober Living Residential Beds • Formerly known as half-way houses. • These programs offer recovery supports in addition to housing. • Currently we have 60 beds and have requested funding for 60 more in FY ‘ 16. • We continue to explore another intermediate treatment level (Recovery Residence Level 3) of treatment homes to add to the treatment continuum. Delaware Health and Social Services

Young Adult Residential Opiate Treatment Program • Currently one program in operation providing 15 beds. • Expansion in FY ‘ 15 to 16 beds. • With the funding proposed in the GRB, we would add a second program for 16 beds. Delaware Health and Social Services

Accomplishments • Another Medicaid & DSAMH partnership resulted in CMS approval of the new PROMISE program, to leverage additional federal funding to provide an array of services to individuals residing in the community, who have Serious and Persistent Mental Illness and/or other diagnostic criteria. Delaware Health and Social Services

PROMISE Promoting Optimal Mental Health for Individuals through Supports and Employment Delaware Health and Social Services

PROMISE - Its Goals • To provide an array of community based services. • To meet the USDOJ requirement that individuals be provided mental health services in the most appropriate setting. • To ensure that the services provided to individuals through PROMISE meet the individual’s needs. • To ensure that the health and safety of PROMISE participants are maintained. • To both leverage federal funding and to assure that the services provided are value based and cost effective in meeting the individuals needs. Delaware Health and Social Services

PROMISE — Services and Supports PROMISE will offer individually-tailored, community-based, and recovery-oriented mental health services to help individuals live independently in the community: Care Management Peer Support Psychosocial Rehabilitation Individual Employment Supports Short-Term Small Group Supported Employment Non-Medical Transportation Community. Based Residential Supports, Excluding Assisted Living Respite Independent Activities of Daily Living/Chore Financial Coaching Benefits Counselling Nursing Community Psychiatric Support and Treatment Personal Care Delaware Health and Social Services Community Transition Services

Community Treatment Teams 1600 1403 1200 1093 FY 2012 800 FY 2013 864 806 FY 2014 600 618 701 400 470 200 199 251 41 34 0 TCM ACT ICM Delaware Health and Social Services Wait List 153

Crisis Walk-In Center Hospital Diversion Rates FY 14 and 1 st Quarter FY 15 84 Number of Clients 83 82 81. 8 82. 4 81 RRC Diversion Rate 80 79 78. 7 Linear(RRC Diversion Rate) 78 77 76 FY 14 Jul-14 Aug-14 Sep-14 Delaware Health and Social Services

Crisis Calls 3000 2500 2000 SUD Calls 1500 Crisis Calls 1000 500 0 Jul-14 Aug-14 Sep-14 Oct-14 Delaware Health and Social Services Nov-14

US DOJ Settlement Agreement Housing Vouchers Generated By Year Delaware Health and Social Services

FY ‘ 14 Peer Support Services – Contacts Mental Health Court DPC Peers, 1276 Peers, 224 Trauma Peers, 1687 Community Peers, 7307 Note: Numbers include phone and in-person contacts (including walk ins). Contacts are duplicative across clients Delaware Health and Social Services

Supported Employment Number of Clients 1200 1100 1000 800 663 569 600 400 Clients Receiving Supported Employment Services FY 12 to FY 15 (Target) Linear(Clients Receiving Supported Employment Services FY 12 to FY 15 (Target)) 238 200 0 FY 12 FY 13 FY 14 FY 15 (Target) Delaware Health and Social Services

DPC Annual Average Daily Census FY 2008 – FY 2014 250 232 204 200 Number of Clients 200 162 146 150 136 113 100 50 0 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 Delaware Health and Social Services FY 2013 FY 2014

Reallocation of Resources from Facility-Based to Community: Efficiencies DSAMH FY ‘ 10 Expenditures DSAMH FY ‘ 15 Expenditures 3% 2% 27% 40% 57% Delaware Psychiatric Center 71% Delaware Psychiatric Center Community Services Community Mental Health Inpatient Delaware Health and Social Services

FY ‘ 16 Governor’s Recommended Budget Substance Use Disorder Withdrawal Management* Sober Living Residential Programs Young Adult Residential Treatment/Opiate Residential Treatment Subtotal One-Time Funds Total $ 750. 0 $ 935. 0 $1, 150. 0 $ 800. 0 $3, 635. 0 $ 815. 0 $4, 450. 0 *Additional $950. 0 structurally transferred to DSAMH for Withdrawal Management from the Office of Management & Budget Delaware Health and Social Services

FY ‘ 16 Governor’s Recommended Budget USDOJ Requirements • Assertive Community Treatment (ACT) • Crisis Services • Targeted Case Management • Supported Employment • Housing Vouchers • Peer Supports Total Delaware Health and Social Services $ 954. 0 $ 760. 0 $ 100. 0 $1, 125. 0 $ 175. 0 $3, 214. 0

Thank you very much for your continued support ü Behavioral Health (MH/SA) is essential to overall health ü Prevention Works ü Treatment is Effective ü People do Recover Delaware Health and Social Services