Local Services Plan For Mental Hygiene Services. Rensselaer Co. Dept of Mental Health October 31, 2017

Transcription

1 2018 Local Services Plan For Mental Hygiene Services Rensselaer Co. Dept of Mental Health October 31,

2 Table of Contents Planning Form LGU/Provider/PRU Status Rensselaer Co. Dept of Mental Health (LGU) Executive Summary Optional Certified Goals and Objectives Form Required Certified Office of Mental Health Agency Planning Survey Required Certified Community Services Board Roster Required Certified Alcoholism and Substance Abuse Subcommittee Roster Required Certified Mental Health Subcommittee Roster Required Certified Developmental Disabilities Subcommittee Roster Required Certified Mental Hygiene Local Planning Assurance Required Certified Rensselaer Co. Dept of Mental Health 70300/70300 (Provider) Rensselaer Co. Dept of MH PriPrev 70300/70300/90063 (Prevention Program) 2

3 Executive Summary 2018 Local Services Plan 2017 Mental Hygiene Executive Summary Rensselaer Co. Dept of Mental Health Certified: Katherine Alonge-Coons (5/26/17) The Rensselaer County LGU engages in planning efforts throughout the year, and each month actively tracks progress toward every objective. Via Community Service Board Meetings, Subcommittee Meetings, Data review, Town Hall meetings held throughout the county with consumers, and tracking of regional and statewide issues; the LGU updates and develops the Local Services Plan. All planning efforts are conducted within the context of the Medicaid Redesign initiatives i.e. transition to Managed Care; preparing for Value Based Payments; DSRIP projects and initiatives; Regional Planning Consortiums; and Regional Collaborations and planning initiatives. The overall direction of the plan is to increase the ability for persons experiencing Mental Illness/Severe Emotional Disturbance; Addiction Issues and/or IDD to thrive in the community. Rensselaer County has a four decade commitment to reduce reliance on inpatient and institutional levels of care; and build the continuum of care at the community level. Over the past several years, the LGU has had a consistent presence at the DSRIP table in the development and implementation phases of the Alliance for Better Health PPS. This involvement has included: County Commissioner serving on the Board of Managers; County Commissioner as Chair of the Audit and Compliance Committee; Fiscal Analyst as a member of the Finance Committee; Medical Director for RCDMH serving on the Clinical integration Committee; and County Commissioner chairing the Task Force implementing Project 4aiii. The county is benefiting from the DSRIP funding to develop Behavioral Health services in: increased integrated care opportunities; ambulatory detox; medical respite; increasing Primary Care staff knowledge of trauma informed care and the Fast Track initiative to improve outpatient engagement post inpatient discharge. The county has benefited from the DSRIP projects; and seeks to continue to build new models of care via the DSRIP opportunities for collaboration building and funding, especially in the implementation of integrated care opportunities. Rensselaer County has been working in its own operations as well as with providers in the network to prepare for Value Based Payments. To this end the county operated clinic has entered into a Level One VBP pilot project with a local MCO. In addition, the LGU is working with providers to track outcomes in an effort to build in metric tracking. Another effort toward VBP is the utilization of PSYCKES QI projects to focus on improved outcomes and metrics. The county seeks to participate in the leadership of a Capital Region Behavioral Health Care Coalition to move the region forward toward Value Based Payment structures. The LGU has also been active in the development and implementation of the Capital Region Health Connections Health Home serving adults in the county. In 2016, the LGU worked in collaboration with the three health Homes Serving Children designated to serve the county s eligible children and youth. These efforts continue through a recently launched county based effort to orient the care management workforce to the child serving network of the county. Via the RCDMH Commissioner s role in leading the Child and Family Committee for the NYS CLMHD, the Rensselaer County model will be offered as a replicable model to be launched by other counties in the state. Consistent with the county s motto; a great place to live, work and enjoy! ; the LGU is working in conjunction with the County s Health Department and the Healthy Capital District Initiative in improving population health. These efforts focus on orienting health care providers to a trauma informed care culture; Youth MH First Aid trainings; Suicide Prevention; and Addiction prevention via school based prevention and community coalition building. Improving the overall health of the county is paramount. As noted in the Goals and Objectives form, housing is a top priority for the county; and has consistently been so for the past five years. Each year, incremental progress has been in increasing housing opportunities for specialty populations; however, the need continues to grow. The AOT population continues to hold steady at a monthly average of 60 persons, State Prison Forensic Discharges and State PC discharges, often thwart efforts to obtain housing via community referrals. The LGU remains committed to engage in transformation initiatives with solution focused efforts to bring about necessary changes in the heath/behavioral health care delivery system, to meet the Triple Aim. Respectfully submitted, Katherine G. Alonge-Coons LCSWR Rensselaer County Commissioner of MH 3

4 1. Overall Needs Assessment by Population (Required) Mental Hygiene Goals and Objectives Form Rensselaer Co. Dept of Mental Health (70300) Certified: Katherine Alonge-Coons (5/26/17) Please explain why or how the overall needs have changed and the results from those changes. a) Indicate how the level of unmet mental health service needs, in general, has changed over the past year: Improved Stayed the Same Worsened Please Explain:. In 2016 and 2017 new MH treatment opportunities have emerged, thus improving access. This expansion includes: increased enrollment in the PROS programs serving the county; and increased satellite clinic sites for the county operated Children's Outpatient Clinic. In addition, there are integrated care opportunities emerging in the county, funded via the DSRIP project 3ai. There are three sites identified for Model One of 3ai i.e. embedding BH services into Primary Care sites. One of these sites is in the early phase of implementation and the remaining two remain in the planning stage. In addition, various primary care practices in the county have hired licensed BH practitioners to provide MH treatment within the practice. One such practice is the Upstate Physicians Group, which has included in the group private licensed BH practitioners to provide MH treatment to the patients of the practice. HCBS opportunities are emerging in the region/county to serve the high need HARP population. These services (though early in implementation) are beginning to provide supportive recovery oriented services for this high need population, contributing to the improved ability to support recovery and increase community tenure. These services need to have ongoing development to meet the needs of the population. MCOs report the HCBS most requested is crisis respite. One provider in the county has recently opened this service on a limited basis. Specialty housing remains the greatest service need for adults and seniors with mental illness. NYS specialty population and MRT funding for housing is focused on the development of supported housing opportunities. However, this level of housing does not provide any enhancement for staffing to assist in supporting medication compliance, and monitoring of chronic health conditions i.e. diabetes, hypertension, COPD or asthma. The local VNA does not serve persons with behavioral health conditions thus limiting the ability to support these individuals in supported housing sites. Housing providers are working in conjunction with the LGU and legacy HH Care Management Agencies via flex funds, to purchase medication dispensing machines (not covered by Medicaid), develop relationships with private pharmacies to blister pack medications to support persons in taking the correct dose of medication, reimbursing family members or friends of the recipient to monitor medications; and extra payments to housing programs for assistance in monitoring the recipient in loading medication dispensing machines. A continued need is funding to support these and other efforts to assure compliance with medications and adherence to care and monitoring of chronic medical conditions as a means of assuring health and preventing avoidable ED visits and inpatient admissions for persons residing in supported housing, shelters or on their own. Referrals to Housing SPOA from State Prisons for Forensic release have increased. Housing options in the county are challenged to meet the needs of this population. In addition housing opportunities for inmates released from the County Jail are also limited, reportedly resulting in extended time in jail. The county has no forensic housing program. Safe, affordable, independent housing is difficult to access for individuals with criminal histories, due to landlords conducting criminal background checks. Leveled sex offenders are especialy difficult to house. Data obtained from DSRIP analysis indicates the emergency departments located in the Troy Hospitals have the highest percentage of avoidable ED visits in the 6 county PPS catchment (see attached DSRIP dashboard data). Samaritan Hospital Troy is taking advantage of the DSRIP Max program in an effort to decrease avoidable ED visits and inpatient readmissions. The LGU is advocating for behavioral health evaluation services to be included in any urgent care service to be developed in the Troy area. DSRIP data also indicates a high rate of avoidable inpatient admissions. The hospital reports extended lengths of stay for geriatric patients with behavioral health conditions. Extended lengths of stay exist in both the gero-psych unit and the med/surg units. Barriers to discharge are noted most especially for those in need of nursing home placement. (In 2016 the social work staff accessed out of state nursing home placements for several patients.) A second barrier is for the homeless population, to have viable services to meet their needs consequently, via DSRIP funds a Medical Respite (regionalized) program has been established in Troy. This program is accepting referrals from gero psych and med/surg inpatient units. Individuals who are in need of further medical support but do not require inpatient level of care are referred to this program. Housing SPOA wait list as of May 1, 2017: 12 individuals referred for OMH Community Residence; 12 individuals refererd for OMH Treatment Apartment; 72 individuals referred for OMH Supported Apartments. There is a lack of affordable housing in the county, and individuals there are high percentages of individuals with behavioral health disorders among the homeless population (see attached Housing Data for LSP). There has been an increase in 730 competency eval orders from the local courts = 46; 2015 = 26; 2014 = 35; 2013 = 47; 2012 = 25. This increase is noted not only as a county trend but is also acknowledged as a regional issue. Samaritan Hospital reports an increase in crisis evaluations for children and youth in = 533 evaluations for C & Y; 2016 = 545 evaluations for C & Y. In 2015 = 114 and 2016 = 141 crisis evaluations resulting in transfer to inpatient facilities. This data denotes both an increase in evaluations and inpatient admissions as well as nearly 400 potentially avoidable crisis evaluations which could have been diverted from the ED. The hospital also reports extended holding of children and youth for inpatient admission. In the last 6 months of 2016, those children and youth awaiting inpatient admission were held an average of 31 hrs 36 mins for the inpatient transfer. This data in conjunction with the overall high utilization of ED data, indicates a need for increased mobile crisis and respite capacity for all age groups. b) Indicate how the level of unmet substance use disorder (SUD) needs, in general, has changed over the past year: Improved Stayed the Same Worsened Please Explain: SUD Needs: The number of individuals receiving treatment for Substance Abuse in Rensselaer County has increased since 2014 (see the attached Individuals with Medicaid receiving OASAS Services LSP) The Heroin/Opiate Epidemic continues to negatively impact the county (see the attached Opiate Overdoses LSP). In 2016 the County, under the leadership of the Sherriff and Health Dept director launched a county wide Heroin/Opiate Coalition including a cross section of stakeholder groups. Smaller municipal coalitions participate in this larger county wide coalition. The county Health Department reports an increase in deaths due to overdose from 2015 (26) to 2016 (32), confirmed by toxicology tests. The local Emergency Depts report an increase in overdose reversals, with a high level of recidivism. Providers of Medicaid Service Coordination serving the county are reporting struggles in obtaining addiction treatment for persons with intellectual/developmental disabilities, who also have addiction and mental health concerns. A specialty treatment oportunity needs to be developed for this population. The county seeks to work with residential providers in transitioning housing to the new 820 regs of OASAS. In 2017, RCDMH applied for and received from NYS OASAS funding to establish Peer Engagement Specialist services. This is scheduled for implementation in summer of In 2017 new Conifer Park Medication Assisted Treatment programming opened in the county. Seton Addictions has an application pending with NYS OASAS to 4

5 open an Ambulatory Detox program which is foundational to future development of an integrated care opportunity to serve high end MICA clients.. c) Indicate how the level of unmet needs of the developmentally disabled population, in general, has changed in the past year: Improved Stayed the Same Worsened Please Explain: Data is not readily available from OPWDD. Needs are identified by limited data available from the Capital District DDRO and based upon reports submiitted by the DDRO in July This data indicates 941 Rensselaer County residents receiving at least one OPWDD service. (This data doesn't allow the LGU to determine: 1. What service is being recived. 2. Whether or not the service received is adequate for the person's needs. 3. What services these person's are waiting for or 4. Ages of the persons receiving services.) This data doesn't allow for county comparison to region or statewide numbers - or to compare in a historical trend. The DDRO reports 16 persons have emergency need for residential services. This data doesn't allow for an understanding of how long each person has been waiting for the service; how this compares to: state wide or regional numbers; where these persons are currently housed; how this number compares to historical county data or the type of residential service being sought. The LGU has no county data re: the number of persons awaiting residential services who are not in Priority One. Anectodal reports from MSC providers serving county residents indicate long waits for Waiver services...in home respite, community habilitation, and residential. Extreme workforce challenges are present and twart the timely delivery of waiver services. Survey conducted of MSC providers: 9 MSC providers serving most of the Rensselaer County OPWDD population = 784 MSC recipients - responded to the survey. Results to be cited below. A small yet highly challenging popoulation has been identified via MSC providers, This is a subpopulation of 10 persons who are crosssing all three disabiity opulations (IDD, SUD and MH) - effective treatent services do not exist for this population. Region 3 START 2016 Data: Served 9 residents of Rensselaer County with a total of 51 residents from the Capital District. Of the 51 CD residents: child=10, adult = % of the children have MH conditions and 95% of adults have MH conditions. The primary referral source of the START referrals is Case Managers. Aggression is determined to be the most common reason for START enrollment. (There are no data domains re: Substance Use in the START report.) These numbers are low, as the START team was not fully staffed in 2016, and referrals were held back. In 2017, the LGU AOT Coordinator has been approached by the DDRO to consider AOT petitions for IDD and MH involved individuals. Mental Hygeine Legal Services has been consulted and expressed concern re: capacity of these persons to adequately particpate in their AOT hearings and ultimately be able to comprehend and benefit from the order. AOT petition has been filed to date on persons with co-occurring issues. 2. Goals Based On Local Needs Issue Category a) Housing b) Transportation c) Crisis Services d) Workforce Recruitment and Retention (service system) e) Employment/ Job Opportunities (clients) f) Prevention g) Inpatient Treatment Services h) Recovery and Support Services i) Reducing Stigma j) SUD Outpatient Services k) SUD Residential Treatment Services l) Heroin and Opioid Programs and Services m) Coordination/Integration with Other Systems for SUD clients n) Mental Health Clinic o) Other Mental Health Outpatient Services (non-clinic) p) Mental Health Care Coordination q) Developmental Disability Clinical Services r) Developmental Disability Children Services s) Developmental Disability Adult Services t) Developmental Disability Student/Transition Services u) Developmental Disability Respite Services v) Developmental Disability Family Supports w) Developmental Disability Self-Directed Services x) Autism Services y) Developmental Disability Person Centered Planning z) Developmental Disability Residential Services aa) Developmental Disability Front Door ab) Developmental Disability Service Coordination OASAS Applicable State Agenc(ies) OMH OPWDD 5

6 ac) Other Need (Specify in Background Information) 2a. Housing - Background Information Rensselaer County has been dedicated to reducing state PC census, and has successfully reduced census at the Capital District Psych Center to 9 patients. (See below for barriers to discharge for these 9 individuals). Per the OMH PCS data, the percentage of residents in institutional settings is low (see attached PMH PCS Housing LSP). Prioritization for housing opportunities are given to: AOT (average of 60 individuals per month); Forensic State Prison Realease; State PC discharge. These priority populations create wait lists for MH housing opportunities. Stats from the housing SPOA as follows: Discharge Barriers for 9 remaining Rensselaer County Patients at CDPC: 2 are needing OPWDD settings/supports (1 has Eligibility, 1 lost Eligibility and CDPC has been working with OPWDD to address) 2 need Assisted Living or Skilled Nursing Home level of care upon discharge 2 will need MH housing/supports (applications in progress) 3 are CPL/Forensic clients and therefore have more legal steps to accomplish before being discharge ready. Some of their legal histories (i.e. Sex offenses and leveled status) will present challenges to discharge planning/community resettlement Rensselaer County Housing SPOA data: The NYS Residential Indicators report indicates high occupancy rates for all OMH funded housing programs in Rensselaer County (range from 92.3% to 100%). The wait list for licensed Congregate Care II settings has remained steady over 2016, with an average of 12 people waiting for Community Residence level of housing and 12 people waiting for Treatment Apartment. In 2016, there were 68 applications made through SPOA to OMH licensed residential programs in Rensselaer County, which is an increase from last year (50 referrals in 2015). NYS OMH continues to promote priority access to housing for adults deemed in need through the legal AOT (Assisted Outpatient treatment) process and individuals being discharged from State Psychiatric Centers or Forensic settings. In 2016, there were 6 housing referrals to SPOA from State prison or jails and 2 referrals from CDPC. The number of AOT consumers continues to increase over time; currently 62 individuals are under an AOT order. There has been an increase in the number of AOT s generated from NYS Forensic settings (5 in 2016). Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Expand access to a continuum of housing for specialty populations which are affordable, culturally inclusive, and safe; in order to support persons returning to the community from inpatient psychiatric settings, state prisons, OPWDD forensic settings, local jails, and those from the community in need of housing. Objective Statement Objective 1: Increase the number of supported housing opportunities. Objective 2: Develop SUD housing meeting new redesign NYS OASAS Part 820 regulations. Objective 3: Develop housing opportunities to support those referred in priority 1 status for OPWDD. Objective 4: Continue to develop medication oversight and health condition monitoring for persons in supported housing. Objective 5: Develop housing dedicated to the forensic population. Change Over Past 12 Months (Optional) 2017 LSP Priority Outcome 1 - Expand access to housing options that are affordable, culturally inclusive, and safe. A continuum of housing options will be created to allow individuals to move through the appropriate levels of housing in a timely manner LSP Strategy Explore housing redesign for special populations and support proposals submitted by intra and inter county housing providers for the expansion of supported housing in Rensselaer County. Progress: NYS OMH funding provided for an increase of 4 supported housing beds, awarded to Unity House Inc. A new provider, ACCA, for OASAS residential funding has been identified, and is committed to developing 820 redesign beds - to be launched in fall This may result in an increase in OASAS licensed residential opportunities. OASAS Community Residence operated by Hudson Mohawk Recovery Ctr, Inc. increase capacity by two beds in LSP Strategy Improve collaboration to support the Re-Entry of individuals with serious mental illness being released from NYS prisons/jails so as to prevent recidivism and prevent avoidable hospitalization/er usage through service linkage prior to release. Progress: An increase in forensic referrals has yielded difficulty in housing placements for these persons due to status i.e. leveled sex offenders. The LGU continues to work in collboration with the local Health Home serving adults to complete match of the HH roster with the jail census to improve linkage upon release LSP Strategy 1.4 Develop hospital diversion/transitional housing models in Rensselaer County to prevent inpatient hospitalization and for step down back to the community. A Medical Respite Program via DSRIP funds opened in the county. This is a 30 day, 10 person capacity, respite, serving med/surg and gero psych patients in need of discharge from inpatient yet requiring medical interventions, with questionable home status (many are homeless) LSP Strategy Explore medication oversight options to support individuals in Supported Housing or independent housing in Rensselaer County. 6

7 Progress: Unity House Inc, has agreed to use nursing support to address medication compliance and health protocols in the Treatment Apt program, and has successfully engaged a pharmacy with 365 day coverage to deliver medications suitably packaged for medication dispensing machines. Hospital reports barriers in accessing nursing home placements for gero psych patients (creating extended lengths of stay with no insurance payment, and med/surg patients with behavioral health diagnoses. The hospital is frequently unsuccessful in acquiring nursing home placements within the state and reports accesing out of state nursing home opportunities for persons with behavioral health diagnoses. te: CDPC has launched a MIT service which is currently being integrated into the continuum of care and may improve community support for persons being discharged from the State PCs. The team has attended Housing SPOA meetings and have targeted two current inpatients being prepared for disharge. 2b. Transportation - Background Information A significant portion of Rensselaer County is rural and has limited public transportation. Medicaid transport is accessed for medical services, n-medical services support recovery and Medicaid does not transport to these services, i.e. gyms, recreation programs, self help groups etc. This transportation challenge is not unique to Rensselaer County and is known to be a regional issue. This problem negatively impacts ED utilization, as persons in both urban and rural areas find it convenient to obtain ambulance transport to the ED, and do not have adequate transport options for urgent care. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Rensselaer Co will expand transportation opportunities to support recovery activities. Objective Statement Change Over Past 12 Months (Optional) The Capital District Transit Authority has eliminated bus passes and tokens, which had been a purchasable commodity for county providers to assist persons in accessing necessary services. This will no longer be an option. The Capital Region Regional Planning Consortium has been established. Regional issues are being identified, one of which is transportation. 2c. Crisis Services - Background Information As noted above, the Emergency Departments in the county have an excessive number of avoidable visits (see attached DSRIP Dashboard). In particular data has been provided by the Samaritan Crisis Unit re: crisis evaluations of minors. In 2016 the Child and Adolescent Mobile Team responded to a total of 169 calls regarding a Rensselaer County youth 121 calls resulted in a mobile visit (72% mobility rate) 83% of the onsite visits resulted in a safety plan and diversion from higher levels of care In 2016 the Adult MobileTeam responded to a total of 101 calls regarding Rensselaer County adults 45 calls resulted in a mobile visit (45% mobility rate) 73.3% of the onsite visits resulted in a safety plan and diversion from higher levels of care Both teams are regionalized and have limited hours of operation due to funding challenges. The Adult Team also has limitations of population to serve: priority populations are: AOT and former AOT clients; State PC discharges, and Forensic Prison releases, and high utilizers of ED services. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Rensselaer County will decrease Emergency Department utilization for behavioral health crisis evaluations. Objective Statement Objective 1: Obtain additional funding resources for the Child and Adolescent Mobile Team to increase hours of operation. Objective 2: Increase hours of operation and broaden the population served by the Adult Mobile Crisis Team via new funding opportunities. Objective 3: Improve utilization of overnight respite services for children and youth to proactively decrease stressors yielding crises. Objective 4: Identify opportunities to expand the new HCBS crisis respite service to other populations. Objective 5: Orient new Care Management workforce to the Mobile Crisis services available for Rensselaer Co recipients. Change Over Past 12 Months (Optional) In 2016 the Regional (5 county) Adult Mobile Program, expanded target population to include former AOT clients and frequent utilizers of ED BH services. The program inaugurated services in 2015, and full implementation occurred in LSP Strategy Improve the reduction of avoidable ED visits and Inpatient admissions through the development of Crisis Respite beds or Crisis Diversion services for adults in Rensselaer County - 12/ in progress: In April 2017, Unity House Inc. launched HCBS short term crisis service designed to divert HARP persons from avoidable Emergency Dept based Crisis Evaluations. the need for this service goes well beyond the HARP population - expnded funding is needed. 2d. Workforce Recruitment and Retention (service system) - Background Information Rensselaer County ARC reports over 200 vacancies in their work force. Barriers to employment are low wages, and background checks. Samaritan Hospital is 7

8 now continually recruiting for Psychiatrists and Psychiatric Nurse Practitioners (even when all positions are full), given the extreme recruitment challenges. Providers serving the county identify staff shortages in all ranks: aides, care managers, therapists, and medical staff. Related to the DSRIP funded integrated care projects with RCDMH - the county has been searching for a Psychiatric Nurse Practitioner since January applicants to date. The local Community College has reported none of the 2016 Human Service graduates pursued employment in a Human Service venue. Limited workforce is identified as a barrier to providing OPWDD Waiver services. The LGU survey of MSC providers serving the majority of Rensselaer Co OPWDD population cites the number one barrier to obtaining waiver services, as the lack of workforce to provide the services. One provider summarized the issue; "There is a clear workforce shortage across the board everywhere for all individuals through OPWDD. There is not enough funding/resources for the agencies that do this work to attract/hire the staff to fulfill the need of the # of individuals who require services in the area." The MSC programs report over 100 elligible persons awaiting waiver services. The primary barrier identified to service acess is the shortage of workforce. Recent information received from the Capital Region Health Connections Health Home, is that nearly all of the Care Management Agencies have vacancies and have not been able to recruit staff, thus limiting the ability to enroll new HH members. Do you have a Goal related to addressing this need? Yes If "", Please discuss any challenges that have precluded the development of a goal (e.g. external barriers): This is a statewide issue which can be addressed on both a state and regional basis. This does not appear to be solved at the community/county level. Change Over Past 12 Months (Optional) Increased need for work force, and greater competition for staff. As Managed Care Organizations, PPSs, HCBS providers etc, seek to hire, it is increasingly difficult to hire experienced staff. 2e. Employment/ Job Opportunities (clients) - Background Information NYS OMH 2015 PCS data indicates the individual's in MH treatment/services in Rensselaer County have a lower rate of employment than the state average. While employment has been increasing state-wide, employment has not been increasing in Rensselaer County (see attached OMH PCS Employment LSP). There is also a lack of information (on the part of both clients and providers) re: retention of SSI benefits and employment. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Increase employment rate for Rensselaer County residents experiencing SUD, MI or IDD. Objective Statement Objective 1: Review with all MH treatment/service providers the need to assess for vocational readiness. -1/18 Objective 2: Provide orientation to all providers how pre-vocational and vocational services can be accessed. 1/18 Objective 3: Review with providers/ensure access to information regarding employment and benefits retention. 6/18 Objective 4: Increase education and employment opportunities and success for persons experiencing SUD, MI, and/or IDD. Change Over Past 12 Months (Optional) 2017 LSP Priority Outcome 2 - Embrace all initiatives thru MA redesign, DSRIP and MC HCBS waiver. Develop person centered, collbaorative and recovery oriented culture. County will develop regioanl and intra county recovery oriented services LSP Strategy Rensselaer County LGU will develop a community based continuum of care for adults, children/youth and families; offering comprehensive resources to support living in the least restrictve setting. Progress: New HCBS pre-vocational and educational support services have been designated. These services are limited to the HARP population and are not yet in full operation LSP Strategy In fall 2015, Unity House Inc. opened a non-clinical PROS program with an emphasis on vocational services. Enrollment in this PROS program has steadily increased each month of operation. Three PROS programs currently serve residents of Rensselaer County LSP Strategy Increase education and employment opportunities and success for persons experiencing SUD, MI, and/or IDD. - continue 2f. Prevention - Background Information (see attached Prevention LSP) PNA data- In many areas of the PNA the findings reflected the significant need for prevention services in the Rensselaer City School District. Reported alcohol use among the 8th grade showed to be double at 20.5% compared to that of the Monitoring the Future statistic at 9.0%. The PNA findings also reflected that Binge Drinking among the 8th and 10th grade is higher than both the Rensselaer County averages and Monitoring the Future. Participants reported that they have been drunk or high at school 14.6% of the time, higher than the Bach Harrison norm of 7.8%. The percentage of high risk youth students, defined as the percentage of students who have more than a specific number of risk factors in their lives, was 54.3% compared to the Bach Harrison average of 38.1%. PNA Data- reflected high risk factor in the community domain of Laws and rms Favor Drug Use, higher than the BH rm. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Expand the Substance Abuse Prevention services to all areas of Rensselaer County Objective Statement 8

9 Objective 1: Expand Student Assistance program by at least one full time staff person based on results of PNA. Objective 2: Offer Provide technical guidance to community organizations in developing coalitions across Rensselaer County. Objective 3: Increase informational awareness to community organizations, schools, and families to increase knowledge and awareness of prevention programs/services via the attendance at 10 health promotion events (presentations or resource sharing) Objective 4: Increase number of participants (parents/family members) attending Family Evidence Based programs by 15 throughout Rensselaer County in order to address substance abuse risk factors, protective factors, and increase knowledge base of the effects of substance abuse on individuals/families Objective 5: Expand early intervention services by providing EBP Teen Intervene programming to 25 students that exhibit symptoms and behaviors of substance use or gambling but do not meet criteria for a diagnosis, in order to reduce early levels of substance use. Change Over Past 12 Months (Optional) 2017 LSP Strategy 3.2 -Rensselaer County will establish a county wide Coalition to address the Opiate/heroin epidemic. The County Health Dept and Sherriff launched a County Wide Community Coaltion against Heroin/Opiate addiction, staff from multiple addiction prevention/treatment/service programs particpate. - achieved 2017 LSP Strategy In 2017, RCDMH Prevention program began to provide Prevention Counseling Services at the Rensselaer City Schools, negotiations are underway to add one FTE Student Assistance position to serve this district in 2017/2018 schools year. - The RCDMH Prevention Program has increased admissions to Prevention Counseling. The program is strong in providing Evidence Based Currciculums (see attached Prevention LSP) LSP Strategy 4.7 Develop a sustainable community coalition focused on youth prevention in the City of Rensselaer with increased engagement from all sectors of the community. - achieved 2g. Inpatient Treatment Services - Background Information 2015 NYS OMH PCS data indicates local hospital psychiatric inpatient utiization as less than 50% from Renssleaer County. (adults). Overall adults from the county do not have difficulty accessing psych inpatient services. Data provided from the Samaritan Hospital Crisis Unit notes for the last 6 months of 2016, minors evaluated to be in need of inpatient admission waited at the ED an average of 31 hrs 36 mins until transfer to inpatient could occur. This wait is significantly higher than the year's average of 13 hrs 18mins. The hospital, LGU and NYS OMH have discussed this concern. A shortage of psych inpatient beds is identified as the causative factor. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Rensselaer County LGU will work with other counties/regions to engage in strategies to decrease need for child and youth inpatient services. Objective Statement Objective 1: Establish a full array of proposed C & Y SPA services in the county/region. 6/18 Objective 2: Establish alternatives to psych inpatient services via propsed 115 waiver services. 9/18 Objective 3: Increase utilization of the Child and Adolescent Mobile Team and crisis respite opportunities toward hospital diversion. 1/18 Objective 4: Increase referrals to Helath Homes Serving Children to ensure linkages to community resources. 1/18 Change Over Past 12 Months (Optional) A statewide decrease in the number of children and youth psych inpatient beds. Launch of Health Homes Serving Children in 12/16, resulting in increased Care Management capacity. Delay in proposed SPA services and 1115 Waiver services to provide supports which may decrease inpatient need. Admissions to CDPC are more difficult with greater review of referrals, and efforts to decrease length of stay in State PCs. This is beginning to create longer LOS in Samaritan Hospital Psych inpatient and is creating a negative impact to access at this local hospital LSP Strategy Plan and implement the appropriate training for all staff to improve skill sets and increase efficiency and quality of care throughout Progress: The LGU has initiated in May 2017, Child and Youth care Manager orientation and networking to educate re: resources for children and youth in teh county, including overnight respite and Mobile Crisis services. 2h. Recovery and Support Services - Background Information Rensselaer County has limited recovery and support services. Via OMH State Aid funding, the Mental Health Empowerment Project - MHEP, a non-profit peer run service providing: advocacy; wellness activities; employment support; and peer support. Funding for this service has not increased, yet services remian strong and the program works to cover peers residing throughout the county. MHEP is a designated HCBS provider for peer support and it is hoped this will increase the program's ability to serve more persons. 9

10 HARP/HCBS - are early in devlopment and delivery. HCBS designated providers are receiving referrals from MCOs, most espcially from CDPHP. Providers are struggling with implementation, given the need to redeploy staff hours from existing programs, as there is no ability to hire new staff dedicated to the HCBS services. Rensselaer County's HCBS porviders are being encouraged to particpate in the Ad Hoc work group of the Regional Planning Consortium to problem solve together barriers to implementation. General lack of information re: HARP and HCBS for both the provider network and clients. The LGU contracts with the Commission on Economic Opportunity to provide family support services, via family advocates. This program is expanding read below. The county seeks to devleop the new SPA services and HCBS service array in the Children's redesign initiatives. Within the Addiction Treatment/service continuum of the county, there have been no peer support services. The LGU applied for and was granted funding from NYS OASAS to establish a Peer Engagement Specialist. This service is anticipated to be launched by the fall of 2017; and will need to be integrated into the health care delivery system, most especially the Emergency Departments in the county. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Rensselaer County will continue to establish a robust network of recovery and support services. Objective Statement Objective 1: Launch and establish a Peer Engagement service for persons with addiction. 3/18. Objective 2: Expand the Family Advocacy Service 12/17. Objective 3: Embed two certified youth advocates in the newly created High Fidelity Wraparound program. 12/17. Objective 4: Increase the number of persons recieving HCBS via the completion of the brief Community MH Assessment. 1/18 Objective 5: Integrate the new C & Y SPA services and HCBS array into the continuum of care. 6/18 Change Over Past 12 Months (Optional) 2017 LSP Strategy Develop a robust network of peers, youth specialists, and family advocates to serve persons experiencing IDD, MI, and/or SUD. partially achieved. Through the redistribution of NYS OMH State Aid, a third family advocate position will be created in In addition to this increase, the county was selected as one of three counties, by the state to participate in a SAMHSA System of Care grant to develop High Fidelity Wrap Around services in a Health Home environment. Two High Fidelity Wrap teams will be developed and embedded with the County operated Child and Youth Care Coordination program. Each of the two teams will have a Care Coordinator (facilitator), a family advocate and a youth advocate. CEO will be the subcontractor of the advocate staff. Within the Addiction Treatment/service continuum of the county, there have been no peer support services. The LGU applied for and was granted funding from NYS OASAS to establish a Peer Engagement Specialist. This service is anticipated to be launched by the fall of 2017; and will need to be integrated into the health care delivery system, most especially the Emergency Departments. Limited utilization of the Adult HCBS - need to bolster the use of these services. Despite the ellimination of the full CMHA, Care Management Agencies report difficulty in integrating the Brief CMHA into the work flow due to other competing priorities re: client basic needs and care. 2j. SUD Outpatient Services - Background Information Priority Outcome 3, of the 2017 Local Services Plan was dedicated to the establishment of an accessible continuum of care for addiction, due to the Opiate/Heroin epidemic treatment needs. Opiate and Heroin addiction remain high for the county as indicated by the overdose death rate, and OASAS certified chemical dependence treatment admission data. The Rensselaer County Department of Health has informed the LGU of confirmed deaths due to overdose in the county increased in Stakeholders throughout the community express continued concern re: the use of Heroin/Opiates, and recognize this as as a continued life threatening epidemic negatively impacting the county. Changes in the continuum of care for persons with addiction have occurred in the past 12 months. Read below. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Rensselaer County will establish an accessible continuum of care for addiction including comprehensive levels of prevention and treatment. Objective Statement Objective 1: Establish ambulatory detox program within the county 1/18. Objective 2: Establish an integrated care opportunity to serve high end MICA (and IDD) clients 6/19. Objective 3: Establish Peer Engagement Services focused on serving persons with or effected by addiction 1/18. Objective 4: Increase the availability of Vivitrol prescribing to other than approved sentenced inmate population at RCJ, to inlcude all appproved inmates with known release dates. 10

11 Change Over Past 12 Months (Optional) 2017 LSP Strategy to develop ambulatory detox. In Oct 2016, Seton Addictions closed the Inpatient Detox program, with a proposal to establish ambulatory detox via DSRIP funding. Application has been reviewed by NYS OASAS and policy edits are now unerway LSP Strategy 3.4 establish Medication Assisted Treatment program - achieved 2/17. In 2016, Upstate Physicians Group received an OASAS outpatient clinic license thus increasing outpatient treatment capacity within the county. In 2016, Hudson Mohawk Recovery Center expanded prescribing of Suboxone, and Vivitrol. In 2016, three inmates being released from Rensselaer County Jail received Vivitrol. In 2017, Rensselaer County will receive funding from NYS OASAS to provide Peer Engagement Services. 2k. SUD Residential Treatment Services - Background Information Effective June 2017, Rensselaer County will have a new OASAS certified residential treatment provider, ACCA of Abany, N.Y. This provider will be establishing OASAS Part 820 residential programming, and has agreed to make Rensselaer County residents in need of this service a top priority for admission. (This is a funding transfer and may result in increased capacity within the county.) Hudson Mohawk Recovery Center is making plans for Part 820 conversion for the residential programs in its operations; and is seekingto develop an opportunity for women and children. In 2017 HMRC increased Elizabeth House capacity by two beds. In Rensselaer County Joseph House Shelter Inc. operates an award winning "housing first" opportunity (funded by HUD and NYS OMH/Support Services), which houses many persons with addiction disorders who are not engaged in recovery. The community cites the need for further harm reduction housing opportunities. Via the county Wide Community Coalition - a need for sober living communities has been identified. See attached OASAS Residential Service Info Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Establish a continuum of housing for persons with addiction disorders. Objective Statement Objective 1: Establish OASAS Part 820 residential services in Rensselaer County. 3/18 Objective 2: Explore posssibilities for the expansion of Housing First oppoprtunities. 12/18 Objective 3: Explore opportunities for sober community living situations. 12/18 Change Over Past 12 Months (Optional) 2017 LSP Strategy Explore housing redesign for special populations and support proposals submitted by intra and inter county housing providers for the expansion of supported housing in Rensselaer County. Progress: New OASAS residential treatment provider in Rensselaer County - ACCA to open a new residence under Part 820 regs and supported living. Hudson Mohawk Recovery Ctr Inc. has expanded Elizabeth House Residence by two beds, and is converting residence to meet the Part 820 redesign LSP Strategy Develop "housing first" opportunities for persons not yet in recovery from addiction. - no progress, but need remains. 2l. Heroin and Opioid Programs and Services - Background Information Priority Outcome 3 of the 2017 Local Services Plan - "establish an accessible continuum of care for addiction, due to the Opiate/Heroin epidemic treatment needs." Opiate and Heroin addiction remains high for the county as indicated by the overdose death rate. Community stakeholder groups recognize this epidemic to be a public health issue for the county. The number of individuals receiving treatment for Substance Abuse in Rensselaer County has increased since 2014 (see the attached Individuals with Medicaid receiving OASAS Services LSP) The Heroin/Opiate Epidemic continues to negatively impact the county (see the attached Opiate Overdoses LSP). In 2016 the County, under the leadership of the Sherriff and Health Dept director launched a county wide Heroin/Opiate Coalition including a cross section of stakeholder groups. Smaller municipal coalitions participate in this larger county wide coalition. The county Health Department reports an increase in deaths due to overdose from 2015 (26) to 2016 (32), confirmed by toxicology tests. The local Emergency Depts report an increase in overdose reversals, with a high level of recidivism Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Rensselaer County will establish an accessible continuum of care for addiction including comprehensive levels of prevention and treatment. Objective Statement Objective 1: Establsih ambulatory detox program within the county 1/18. Objective 2: Establish an integrated care opportunity to serve high end MICA (and IDD) clients. 6/19 11

12 Objective 3: Establish Peer engagement Services focused on serving persons with or effected by addiction, especially those whohave had overdose reveral. 9/17 Objective 4: Increase the availability of Vivitrol prescribing to other than the sentenced inmate population at RCJ, to inlcude this as an option for all qualified and interested inmates with a known release date. 9/17. Objective 5: Increase opportunities for family education and involvement in SUD treatment. 12/18 Change Over Past 12 Months (Optional) 2017 LSP Strategy Working in collaboration with the County's Chemical Dependence/MICA subcommittee RCDMH will develop a "best Practice" plan to increase tratment options and access for persons who are opiate addicted. - in progress LSP Strategy Establish a county wide coalition to address the Opiate/Heroin epidemic - achieved Sept LSP Strategy To develop ambulatory detox. In Oct 2016 Seton Addictions via St Peter's Health Partners closed the inpatient detox program, with a proposal to establish an ambulatory detox program within 6-9 months. DSRIP funds have been awarded to support this development, and the application is under review by NYS OASAS LSP Strategy 3.4, establish Medication Assisted Treatment program. - achieved 2/ LSP Strategy Develop a robust network of peers, youth specialists, and family advocates to serve persons expereincing IDD, MI and/or SUD.- in progress. The county applied for and received from NYS OASAS funding for the creation of Peer Engagement Specialist services. To be implemented summer of The LGU also submitted an application for Family Navigator funding. In 2016, Upstate Physicians Group received an OASAS outpatient clinic license, thus increasing the outpatient treatment and Suboxone prescribing capacity in the county. In 2016, Hudson Mohawk Recovery Center Inc., initiated the prescribing of Suboxone. and Vivitrol. The LGU routinely responds to increasing calls from families/caregivers of persons with Opiate addiction to ptovide system navigation and education. 2m. Coordination/Integration with Other Systems for SUD clients - Background Information Providers in Rensselaer County continue to acknowledge difficulty in treating/serving the high end MICA population. The Samaritan Hospital MICA inpatient Psych Unit is struggling to link to discharge opportunities to serve these clients. In general the MICA clients with low - moderate treatment needs can have treatment needs met via a combination of OASAS and MH treatment. In the 2017 Local Services Plan Strategy 3.5 "Develop an integrated care opportunity to serve high end MICA clients." Target date 6/18 will be continued. The overarching plan is Phase 1 - Seton Addictions establish Ambulatory Detox. Phase 2 - establish integrated OMH and OASAS outopatient treatment. Phase 3 - Add in Primary Care. This is the ultimate program to serve the high end MICA clients. OPWDD MSC programs serving the county report difficulty in obtaining SUD and MH treatment services for at least 7 persons with IDD and co-occurring MH and addiction disorders. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Develop integrated care oportunities to serve/treat persons with MH and addiction disorders, and programing for IDD persons with both MH and addiction issues. Objective Statement Objective 1: Develop a tretament program to serve high end MICA clients - 6/19 Objective 2: Develop a treatment opportunity for persons with IDD also experiencing mental illness and chemical dependency. 6/19 Objective 3: Develop a means of delivering coordinated MH and SUD treatment with an ability to adjust one or the other based upon current client needs. 12/17 Change Over Past 12 Months (Optional) 2017 LSP Strategy develop an integrated care opportunity to serve huigh end MICA clients - Progress: Samaritan Hospital has a plan to phase in an integrated care treatment program for high end MICA clients. This will be phased in and developed from the ambulatory detox program over atwo year time period.. Within the first quarter of 2017, the LGU has received information from the MSC providers re: persons with IDD who also have Mental Illness and addiction issues. There is not a program in the county (or region) with the expertise to treat this population. The LGU has consulted with the NYS START Team Region 3 about any potential training resources. The LGU recently learned of a coordinated treatment arrangement for persons with MICA status, located in Schenectady County. The Samaritan PROS program will look into this and determine how it may be replicable in Rensselaer County. The RCDMH Child and Adolescent Outpatient Clinic has trained 90% of the therapists in Teen Intervene, as a participant in a NYS OASAS Pilot project, including this co-occurring tretament approach in MH licensed clinics. 2n. Mental Health Clinic - Background Information MH Outpatient clinic services are offered in Rensselaer County by both Samaritan Hospital and the county. Samaritan's outpatient clinic serves not only Rensselaer County residents but also residents from northern Albany and Southern Saratoga counties.those from Rensselaer County receiving care at the Samaritan 12

13 Hospital clinic live in the City of Troy and areas surrounding the city. The county operated clinics serve persons residing in the City of Rensselaer and rural areas of the county. The county is also the provider of outpatient MH services for children and youth. The MH treatment continuum in the county is very dependent upon outpatient treatment (as evident in the NYS OMH Utilization data). In addition the county operates the Forensic MH services in the Rensselaer County Correctional Facility. Number of Individuals served in 2016 via RCDMH clinic operations: Children's Clinic = 1543; Foensic = 357; Hoosick Falls = 267, and Rensselaer = 761. Given the vast rural nature of the county, the county operated clinic services seek to develop tele-psychiatry services. Integrated care opportunities have been developed by the county operated clinics, and have been proven to reach more persons in the rural areas. In 2015, the county had to close one such site; and in 2017 have closed another - due to space issues with the hosting primary care practices. The county is in the sixth year of operations with the longest standing co-located primary care site. Via DSRIP funding from the Alliance for Better Health, the county is receiving funding to establish additional co-location primary care sites. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes The Mental Health Care network in Rensselaer County will continue to create more accessible mental health outpatient care opportunities for persons of all ages experiencing emotional disturbance or mental illness, including quick access for persons diverted from ED/Inpatient settings. Objective Statement Objective 1: Outpatient clinics in the county will develop further expertise in Evidence Based Practices. - 12/18 Objective 2: Increase integrated care opportunities by 3 sites. - 12/18 Objective 3: Increase school based satellite clinics by 2 sites. - 12/18 Objective 4: Develop tele-psychiatry services in one clinic site. 12/18 Objective 5: Explore need to develop IOP in Rensselaer County. 12/17 Change Over Past 12 Months (Optional) In 2016 RCDMH Adult Outpatient services have implemented Open Access intake opportunities. In 2017, Samaritan Hospital Clinic operations implemented a Rapid Access process. Both interventions have elliminated Wait lists for adult Intake appointments. The Children's Outpatient clinic has developed same day and next day intake appointments. This has improved access and eliminated wait list. According to PSYCKES data, the RCDMH clinic operations exceed both the regional and statewide metrics re: access post inpatient discharge. RCDMH has closed one primary care satellite and one school satellite clinic site due to loss of office space. The county operated programs are currently working to increase these satellites. Two school districts have approached RCDMH to open satellite operations in the district for the 18/19 school year LSP Strategy Develop effective partnerships within and beyond the county borders through HH networks, managed care networks, Alliance for Better Health Care PPS and other interested entities to deliver integrated care. RCDMH as both LGU and provider will work to build collaboration to this end throughout in progress LSP - Strategy Develop tele-psychiatry services in the county to serve persons in a variety of settings i.e. primary care, OASAS licensed settings and rural clinics - in progress Funding received via DSRIP to develop the following shared space integration sites: Model One: St Peter's Health Partners/Samaritan Hospital Outpatient - 1 site at South Troy Primary Care; RCDMH - 3 sites a. Upper Hudson Planned Parenthood; two St Peter's Health Partners Primary Care Practices. Model two: Shared space Primary care into MH outpatient clinic at Samaritan BH Outpatient and RCDMH Rensselaer City Clinic. Included in the funding received by RCDMH, is funding to establish hub and spoke between the county main clinic sites and satellites in Primary Care LSP - Strategy Plan and implement the appropriate training for all staff to improve skill sets and increase efficiency and quality of care throughout in progress. RCDMH seeks to obtain training for outpatient clinic staff in evidence based practices suitable for the proposed children's CPST service LSP Strategy Improve integrated care opportunities in the rural regions of the county - in progress, the County is engaging in conversation with a local Primary Care network considering re-opening the Schodack site LSP Strategy Continue to offer PROS and a supported education program to adults with psychiatric disabilities. In 2016 the PROS programs serving the county advanced in deveopment and are serving more clients, thus creating additional ambulatory care opportunities and expanding the county's care options. 2o. Other Mental Health Outpatient Services (non-clinic) - Background Information C & Y respite: In 2017 he LGU worked with NYS OMH in repsonse to the OMH request to redistribute state aid under the program code 1650 Family Support Services. This funding had historically been used to fund both family advocay and respite services. OMH requested the funds be fully placed into family/peer advocacy. The LGU requested the ability to preserve respite service funding as much as possible; by increasing funds for family/peer advocacy and retain partial funds for respite, this was accomplished. While serving to improve Family/Peer advocacy; the result has been to significantly decrease planned respite services. When this change was made, the new SPA and HCBS aray for children and youth was anticipated for This delay has further accentuated the gap in respite services. The Planned Respite services for Children and Youth in Rensselaer County is delivered under contract by St Catherine's Center for Children. Number of nique recipients of planned respite services by year: 2015 = 50; 2016 = 65; 2017 Jan thru April = 34; the remianing funding for 2017 provides a capacity to serve only 8 children and youth. High Fideliety Wraparound - Rensselaer County was selected by the state to be one of three counties to pilot High Fidelity Wraparound services in a Health Home environment via the SAMHSA funded NYS Achieve Project. Adult Respite beds: Unity House of Troy has had one crisis respite opportunity attached to a current Community Residence, intended for those awaiting CR placement or as step down 13

14 from inpatient hospitalization. This resource is nearly 100% occupied given the bottlenecks in the Congregate Care II housing system. Although additional resources are needed, proposals for crisis respite beds have not been approved by State Agencies to date. RSS has developed a 3 bed Capital District Stabilization and Support program (CDSS) for hospital diversion, hospital step-down (when a permanent residence is in existence), and for stabilization of situational crises that do not meet criteria for inpatient psychiatric hospitalization. There have been numerous referrals from Rensselear County to this resource; however, many referrals have been generated in inpatient psychiatric settings for individuals without a permanent residence thus not meeting criteria. At least one individual from Rensselaer County successfully participated in this resource in There is a need for such a resource for undomiciled individuals so that discharge planning can occur in a timely manner. There has been discussion of a recipient run respite program in Rensselaer County, similar to the model implemented by People Inc. There is no crisis respite bed opportunity available for persons with IDD. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Increase opportunities for additional ambulatory services i.e. respite services for adults and children, and High Fidelity Wraparound services for SED children/youth of Rensselear County. Objective Statement Objective 1: Expand adult crisis bed opportunities (crisis diversion and hospital step down) for individuals with behavioral health diagnoses and homeless status, via HCBS and other avenues.12/18 Objective 2: Explore peer run respite programs for possible replication.- 12/18 Objective 3: Join with regional efforts to develop an urgent respite opportunity for persons with IDD to divert from inpatient admission -12/18 Objective 4: Establish two High Fidelity Wraparound teams in Rensselaer County. 1/18 Change Over Past 12 Months (Optional) LSP Strategy Rensselaer County LGU will develop a community based continuum of care for adults, children/youth & families offering comprehensive resources to support living in the least restrictive setting. Progress: Unity House began to offer short term crisis respite as an HCBS service, on a limited basis. State aid funding cut to support planned respite services for children and youth - noted above. Rensselaer County receiving funding via SAMHSA - NYS Achieve project to establish two High Fidelity Wraparound teams for high acuity SED children/youth. (ted above). 2p. Mental Health Care Coordination - Background Information n Medicaid Care Coordination RCDMH continues to operate non Medicaid Care Coordination programs serving children and adults. The goal of the program is to monitor behavioral/physical health, coordinate care among service systems, link/refer to community resources, decrease utilization of ED/inpatient settings, and overall increase community tenure. The Adult program served 56 clients in 2016; 71 in 2015, and 60 in (te: in 2016 one staff person serving this population was on medical leave whic suppressed capacity). There appear to be different challenges with this population, in terms of the network of private practitioners available and housing limitations (based on income or insurance). There have been non Medicaid AOT s served by the RC DMH program, a small number by history and two current AOT s. HH+ guidelines are adhered to for the AOT/HH+ population regardless of payor. Unity House Inc also receives state aid to provide non-medicaid Care Management services. the agency reports serving an average of 33 indiividuals each month in thsi program. In addition UH operates a Young Adult Case management program funded by state aid. As of May 2017, this program is serving 58 young adults. This is an increase from a monthly average of 39 in The main recurring issue for this program is the lack of housing and resources for this population makes it hard to secure/maintain stability. The County operated n-medicaid care management for Children and Youth is currently serving 19 individuals and to date in 2017 have served a total of 23 individuals.. the total unique recpients served by this program in 2016 was 31. The proposed advent of the High Fidelity Wrap Around services (SAMHSA pilot project in progress) will include a team working with non Medicaid youth/families (one Care Coordinator, Parent Advocate, and Youth Advocate). NYS DOH Health Homes continue to operate for Medicaid members and OMH TCM programs have converted to this new model of care. In Rensselear County, the Adult Health Home conversion began in July 2012 (Phase 3 conversion) and Health Homes Serving Children went live in December RC DMH is a subcontractor Care Management Agency under one adult Health Home and three Children s Health Homes. To date, the RC DMH CMA serves: 335 adults 78 youth/families Do you have a Goal related to addressing this need? Yes 14

15 Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Increase number of non Medicaid Care Coordination opportunities for children and adults Objective Statement Objective 1: Hire High Fidelity Wrap around team to support non Medicaid youth/families. 8/17 Objective 2: Expand non Medicaid adult Care Coordinator as demand for this service increases Change Over Past 12 Months (Optional) Rensselaer County selected as High Fidelity Wrap Around pilot county. (as noted above) Increased needs for Young Adult Case Management services. 2r. Developmental Disability Children Services - Background Information There is no data available from NYS OPWDD regarding the number of children and youth determined to be eligible for services residing in Rensselaer County. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Children and Youth with OPWDD eligibility will receive needed services in a timely manner. Objective Statement Objective 1: The LGU will work with local MSC to learn the number of children & youth receiving services. 12/17 Objective 2: The LGU will work with the Capital District DDSO to determine what services and how many children and youth are awaiting each service. 12/17 Objective 3: The LGU will identify barriers to timely service access for children and youth. Change Over Past 12 Months (Optional) A high level of workforce shortage is identified as the source of most lack or delay of services for all age groups. 2s. Developmental Disability Adult Services - Background Information Little data is available from NYS OPWDD regarding the number of adults residing in Rensselaer County eligible for services. The LGU survey of MSC providers indicates wait lists for in home respite, community hab and residential. How many and the ages of those waiting for each service is unknown. Region 3 NY START data is presented above. While understaffed in 2016, this team was unable to provide services to meet community needs, despite a demand for this service. There is no crisis respite bed service available to date for this program. Seven young adults with IDD have been identified by MSC providers to be in need of MH & addiction treatment services - no provider is equipped to fill this need. Housing resources are also limited for this subgroup of Young Adults with cross systems needs. This population also displays an increased criminal justice system interface. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes The LGU will work in conjunction with the Capital District DDSO and MSC providers to determine the service needs of the adults. Objective Statement Objective 1: The LGU will work with the DDSO to determine barriers for attainment of residential services. 12/17 Objective 2: The LGU will work in conjunction with MSC providers & DDSO to determine how many adults are awaiting each service 12/17 Objective 3: The LGU will work with the DDSO in navigating barriers to care. 12/18 Objective 4: The LGU will continue to encourage referrals to NYS START program. 12/17 Objective 5: The LGU will work to develop a cross system care conferencing mechanism to support persons with co-occurring challenges. 12/18 Change Over Past 12 Months (Optional) Insufficient in home respite, community hab and residential services to meet community needs. Limited service available from NYS START. Emergence in the community of a high need population in need of IDD services, Mental Health, and addiction treatment services. 15

16 Increasing need for integrated behavioral health treatment for persons with IDD and decrease criminal justice involvement. 2u. Developmental Disability Respite Services - Background Information In home respite service is the primary needed service identified by MSC providers. The LGU has no data re: how many persons are waiting; ages of those waiting; length of time waiting, impact of the lack of this service on those waiting; or barriers (other than lack of workforce) to service delivery. Do you have a Goal related to addressing this need? Yes If "", Please discuss any challenges that have precluded the development of a goal (e.g. external barriers): This is a statewide issue, not readily resolved at the local level. Change Over Past 12 Months (Optional) 2z. Developmental Disability Residential Services - Background Information As reported to the LGU by the DDRO, 16 persons designated as Priority 1 emergency, as awaiting OPWDD residential services. The LGU has no data regarding the total number of persons in need of residential services. The LGU has been aprised of at least 3 cross system (MH, SA, IDD) young adults in need of residential Services that challenge the traditional residential model. Do you have a Goal related to addressing this need? Yes If "", Please discuss any challenges that have precluded the development of a goal (e.g. external barriers): A statewide concern not able to be resolved at the local level. Change Over Past 12 Months (Optional) 2ab. Developmental Disability Service Coordination - Background Information The LGU has learned there are 16+ persons from Rensselaer County awaiting MSC services. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Maximum 5 Objectives per goal)? Yes Develop MSC services in Rensselaer County to meet the needs of the population. Objective Statement Objective 1: The LGU will work with providers to particpate in the establishment of the local Care Coordination Organization Objective 2: Expand the RCDMH/Unified Services MSC program to meet the current unmet need for MSC services. 12/17 Change Over Past 12 Months (Optional) OPWDD is preparing for the transition to Managed Care and is proposing the development of regional Care Coordination organizations. 3. Goals Based On State Initiatives State Initiative a) Medicaid Redesign b) Delivery System Reform Incentive Payment (DSRIP) Program c) Regional Planning Consortiums (RPCs) d) NYS Department of Health Prevention Agenda 3a. Medicaid Redesign - Background Information OASAS Applicable State Agenc(ies) OMH OPWDD 2017 LSP Priority Outcome 2 - Embrace all initiaves thru MA Redesign, DSRIP & Managed Care HCBS waiver. Develop person centered, collaborative & recovery oriented culture. County will develop regional and intra county recovery oriented & HCBS services - in progress. Integral to the MA redesign efforts in NYS for 2016 & 2017 is the launch of HARP and Adult HCBS. Community MH Assessments have been slow to proceed, and referrals to HCBS services have been slow. The LGU has representation on the Capital Region Health Connections Health Home Steering Committee. Obstacles noted by the Helath Home is that clients are declining the assessment, likely due to having more pressing needs, feeling they can access many of these services via phone call today, and the absence of treatment team support for the services. The Brief assessment is perceived as intrusive and lengthy for the population. The County operated Care Management program has continued to work to achieve the assessments, and referrals to HCBS services, and have encountered HCBS providers who are not yet ready to deliver the service. In addition, consumers have lost their Medicaid, and have recertified via the Exchange and lost HARP benefit. A locally based MCO is actively working in collaboration with HCBS providers to develop efficient work flow. OPWDD is now gearing up for the transition of services to managed care. The county is aware of a local effort to prepare for the development of a care management entity. MSC providers in the county have been approached to sign on for particpation in the forming of a Upstate Regional Care Coordination Organization (CCO) via the Center for Disability Services. (RCDMH MSC program has signed on.) However much confusion exists in teh system, with questions about current work force, whether or not the current programs will be subcontractors, or the entire work force may need to transition to the newly formed CCO. The latter alternative will disrupt care and increase migration of the MSC workforce; thus contribuing to workforce shortages. Do you have a Goal related to addressing this need? Yes 16

17 Goal Statement- Is this Goal a priority goal? Yes The LGU will continue and build upon al efforts to transition the behavioral health care and IDD systems to Managed Care. Objective Statement Objective 1: The LGU will work in conjunction with the Health Homes and Regional Planning Consortium to orient the community of providers to the HCBS service array in order to encourage consumer participation. Objective 2: The LGU will encourage deignated HCBS providers to work in conjunction with the Capital Region RPC in increasing Care Management awareness of services offered. Objective 3: RCDMH will particpate in the Care Coordination Organization to serve upstate. 12/18 Objective 4: The LGU will take a leadership role in the establishment of a Capital Region Behavioral Health Care Coalition. 12/18 Change Over Past 12 Months (Optional) The initiaion of the HARP benefit and adult HCBS services has occurred within the past 12 months. Providers have been designated to deliver a variety of HCBS services. Some have been in hiatus and are gradually ramping up to deliver care. Further HCBS development has happened, most espacially in creating a short term crisis respite opportunity delivered by Unity House Inc. Vacancies in the Care Management workforce has decreased the ability to complete the assessments. New workforce serving children and Youth in the county via the HHSC CMAs. The LGU has initiated in May 2017, a networking and training forum to educate the Care Managers about services in the county for children and youth and orienting all to the supportive role of CSPOA. The County Commissioner of MH is working in leadership with the NYS CLMHD to develop and implement solutions to implementation challenges. As of May 2017, the Rensselaer Co LGU in collaboration with the other Capital Region LGUs is putting forward to the state a tification of Interest in leading a Capital Region Behavioral Health Care Coalition. NYS is committed to moving forward with Value Based Payments by 2020; and the LGU will be embracing all opportunities to propel the system forward for this reimbursement. 3b. Delivery System Reform Incentive Payment (DSRIP) Program - Background Information Over the past several years, the LGU has had a consistent presence at the DSRIP table in the development and implementation phases of the Alliance for Better Health PPS. This involvement has included: County Commissioner serving on the Board of Managers, County Commissioner as Chair of the Audit and Compliance Committee; Fiscal Analyst as a member of the Finance Committee; Medical Director for RCDMH serving on the Clinical integration Committee; and County Commissioner chairing the Task Force implementing Project 4aiii. The county is benefiting from the DSRIP funding to develop Behavioral Health services in: increased integrated care opportunities; ambulatory detox; medical respite; increasing Primary care staff knowledge of trauma informed care and the Fast Track initiative to improve outpatient engagement post inpatient discharge; as well as the MAX initaive with Samaritan Hospital. In addition CBOs in the county have particpated in improving patient activation via the PAM initiave. The Alliance has worked with providers in each county to develop collaborations for project implementation and delivery of new models of care. RCDMH has worked in conjunction with St Peter's Health Partners in the planning and execution of integrated care sites, and ambulatory detox. RCDMH is also a collaborating partner in developing integrated care with Upper Hudson Planned Parenthood, and has included Hudson Mohawk Recovery Center, Inc., in this effort. Samaritan Hospital is also involved in an additional DSRIP effort; the MAX program. This is aimed at decreasing avoidable inpatient admisions and post discharge 30 day readmisisons; which includes both med/surg and behavioral health admissions. The LGU has also particpated in Ad Hoc committee efforts to engage mnore CBOs in the DSRIP initiaves of the Alliance for Better Health. The LGU has (and will continue to) invite Alliance staff to present at subcommittee meetings in an effort to maintain community engagement in the efforts. As noted in the plan above, the DSRIP projects are woven into the network development in the county. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal? Yes Rensselaer County will continue working with the Alliance for Better Health in improving the network of behvaioral health care to be less reliant on emergency room and inpatient services. Objective Statement Objective 1: The LGU will work with St. Peter's Health Partners in identifying any barriers to the implementation of DSRIP BH projects. 12/18 Objective 2: The LGU will encorage providers serving the county to become more involved in the Alliance efforts. 12/18 Objective 3: Launch the Trauma Informed Care pilot project in Capital Care - Troy Pediatrics. 12/18 Change Over Past 12 Months (Optional) DSRIP funds have entered the Behavioral Health care network in the county through St Peter's Health Partners, RCDMH and Upper Hudson Planned Parenthood collaboration. Development and implementation of a new medical respite program opened in March Efforts to orient Primary Care practices to the impact of adverse childhood experiences (ACEs) on overall health; and devloping trauma informed practices. The 17

18 LGU is supporting the funding of a pilot project to this end in the Capital Care - Pediatrics Troy practice. RCDMH will be a collaborator in this project. 3c. Regional Planning Consortiums (RPCs) - Background Information The County Commissioner of RCDMH Co-Chairs the Capital Region RPC, and has enocuraged the pilot of the RPC Child and Family subcommittee. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal? Yes The LGU will continue and expand all efforts to support the region in the implementation of Health Care redesign. Objective Statement Objective 1: Rensselaer County will step forward as a leader in the identification of challenges and development of solutions. 12/18 Objective 2: Rensselaer County will participate in efforts to initiate regional planning. 6/28 Objective 3: Rensselae County will step forward to represent teh LGUs in leading a Capital Region Behavioral Health Care Coalition. 6/17 Change Over Past 12 Months (Optional) The RPC was launched in June 2016, with the Rensselaer County Commissioner of MH as Co-Chair, and has initiaed the Child and Family Subcommittee. The RPC has hosted a networking event and Q&A session with OMH and BH providers in the region focused on the development of a regional BHCC. 3d. NYS Department of Health Prevention Agenda - Background Information RCDMH continues to work in collaboration with the County Health Dept in the devlopment and implementation of the Wellness Plan. The LGU continues work in Suicide Prevention, Addiction Prevention and now emerging in improving population health through Trauma Informed Care and Rescilency strategies. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal? Yes Renssleaer County will continue efforts to build protective factors in the community to improve population health. Objective Statement Objective 1: The Suicide Prevention task Force will coninue efforts in a county and regional approach for zero suicides. 12/18 Objective 2: Cultures of trauma informed care will be developed in Primary Care Practices in the county. 12/19. Objective 3: Existing Addiction prevention curriculums will be leveraged for populations beyond the school venues. Objective 4: A minimum of three Youth MH First Aid courses will be offered in Change Over Past 12 Months (Optional) 2017 LSP Strategy 4.1 reduce suicides and the stigma associated. Rensselaer County has demonstrated a decrease in suicide rate; and the task force holds fast to the goal of zero suicides. The Task Force post-vention team has been mobilized to respond, and coordinates these efforts with the Coroner's Office and providers LSP Strategy Implement a trauma informed care cultre throughout the health care system to improve MEB infrastructure in collaboration with the Alliance for Better Health - Progress: The LGU is working in conjunction with the Alliance for Better Health on Project 4aiii to build trauma informed cultures in primary care. To this end, a pilot project will be launched in a Rensselaer Co practice. The Rensselaer Co LGU has also facilitated a collbaoration between the local HARTS and MARC initiatives via SUNY Albany to work with the Alliance trauma informed care efforts LSP Strategy Expand opportunities for prevention/education for persons of all ages with high trauma exposure and low protective factors. Via this pilot,existing addiction prevention curriculums will be leveraged to build resiliency and protective factors for persons and communities LSP Strategy Particpate in Renss Co Health Dept Wellness Committee and HCDI to promote wellness/prevention. An additional Youth MH First Aid trainer became credentilaled in There are now 3 YMHFA trainers in the county. In 2016 four YMHFA trainings were conducted. the RCDMH supervisor of Prevention assited the Co Health Dept in providing Narcan trainings. 4. Other Goals (Optional) Other Goals - Background Information Rensselaer County has been committed to achieving diversion of incarceration for persons with mental illness. The LGU continues to fund a MH Probation Officer via NYS OMH State Aid. The county has also conducted several EDPRT trainings for law enforcement; and trainings for judges re: 730 evaluations and alternatives. Do you have a Goal related to addressing this need? Yes Goal Statement- Is this Goal a priority goal (Only 5 goals can be selected as priority goals)? Yes 18

19 Rensselaer County will expand diversion of incarceration efforts. Objective Statement Objective 1: Develop a Mental Health Specialty Court as a means of Jail Diversion for adults in Rensselaer County Objective 2: Improve outcomes of the MH Probation Officer superviison caseload. Objective 3: Continue education of the judiciary, prosecuters and defense counsel on alternatives to 730 evaluations. Objective 4: Change Over Past 12 Months (Optional) LSP 2017 Strategy 2.11 Develop a Mental Health Specialty Court as a means of Jail Diversion for adults in Rensselaer County. - progress due to no funding. The county does have a Task Force which has visited MH court in the state and can be mobilized for implementation. In 2016 the county hosted another EDPRT training. Attendees were from Rensselaer Co Law Enforcement agencies, as well as adjacent counties. Attachments DRSIP Dashboard Data for LSP.pptx - 1. Overall Needs Assessment DSRIP Dashboard Rensco Co Occuring.pptx - Co-Occurring Disorders Housing Data for LSP.pptx Opiate overdoses LSP.pptx Individuals with Medicaid receiving OASAS services LSP.pptx OMH PCS Housing LSP.pptx OMH PCS Employment LSP.pptx Prevention LSP.pptx OMH Inpatient Capacity Utilization LSP.pptx Residential_2015_OASAS_Admissions_Rensselaer_Updated_August_2016 (2).xlsx - OASAS Residential service Info 19

20 Consult the LSP Guidelines for additional guidance on completing this exercise. Office of Mental Health Agency Planning Survey Rensselaer Co. Dept of Mental Health (70300) Certified: Katherine Alonge-Coons (5/23/17) 1. For Criminal Procedure Law 730 Chargeback Budgeting: Please indicate the department within your county that is responsible for budgeting CPL 730 restoration chargebacks. Mental hygiene/community services Sheriff/county law enforcement Other If "other" please indicate how these charges are budgeted Questions regarding the above survey item should be directed to Hank Hren at or For Local Administration of the Assisted Outpatient Treatment Program: a) Please describe the system used in your locality to ensure that petitions are filed for individuals requiring Assisted Outpatient Treatment. The provider team will discuss AOT considering criteria, eligibility and ability to benefit from assisted outpatient treatment. Appropriate providers (including mental hygiene legal service) and the patient will be involved in meetings to discuss pursuit of AOT and ensure, to the best of our ability, patient comprehension. If the patient is outpatient, those providers will collaborate and prepare paperwork and once completed and signed by the physician, those will be forwarded to AOT Coordinator, for AOT investigation. If the patient is on inpatient unit and a current member of an outpatient program, outpatient and inpatient staff will collaborate and inpatient staff will prepare paperwork and follow procedure as indicated above. If patient is an inpatient and not linked with outpatient services, appropriate outpatient program will be contacted and consulted and inpatient staff will prepare paperwork and follow procedure as outlined summarized below. The provider team including psychiatrist, primary clinician, care coordination, housing providers, mental hygiene legal service, and director of community services (designated AOT Coordinator) will coordinate a provider meeting to discuss AOT appropriateness and forward doc to County DCS. Program Psychiatrist will meet with patient to assess mental status and disposition regarding AOT status. At minimum, MD evaluation will include program psy and MHLS. Patient will meet with provider team (with consent) to provide input and participate in development of a treatment plan. Intent to pursue assisted outpatient treatment will be discussed and explained to the client. Provider team, with patient input, will develop treatment plan. Appropriate staff person will complete the AOT Petition paperwork to justify that the criteria for AOT is met. Reinforce that AOT is the least restrictive alternative. If patient is inpatient, documentation will be signed by psychiatrist, forwarded to AOT coordinator, and will be forwarded to the County Attorney for filing in court within 10 days of evaluation. If the patient is outpatient, documentation will be signed by psychiatrist, forwarded to AOT coordinator, and will be forwarded to the Director of Community Services for signature. At that time, it will be forwarded to the county attorney who will pursue the scheduling of the hearing within 10 days of evaluation. Appropriate staff, will participate in the court hearing to present the case to the judge. Psychiatrist testimony is mandatory at this hearing if client contests the AOT Petition. MHLS can represent clients who consent to order. (taken from the Rensselaer County Policy and Procedure for AOT Petition Process) b) Please describe the system used in your locality to ensure that such individuals requiring Assisted Outpatient Treatment receive the services included in the AOT treatment plan. The AOT Coordinator - who is the Deputy Commissioner - Clinical, in the LGU, works in conjunction with the County Operated Care Management program (RCDMH Adult Care Coordination Program), the only Health Home Plus provider for AOT Case management serving Rensselaer County, to track all AOTs in the county. The AOT Coordinator obtains weekly reports from the Case Coordination program, attends Case Management staff meetings on a monthly basis (minimum frequency); and when barriers to service access are identified, the AOT Coordinator and Director of Community Services work to overcome the barriers. The AOT Coordinator also provides superviison for the Director of the RCDMH Adult Care Coordination Program. c) Please list the Care Management Programs your Single Point of Access (SPOA) uses to assign AOT referrals. Rensselaer County Dept of Mental Health Adult Care Coordination Program. Questions regarding this survey item should be directed to Rebecca Briney at Rebecca.Briney@omh.ny.gov or Thank you for participating in the 2018 Mental Hygiene Local Services Planning Process by completing this survey. Any technical questions regarding the online County Planning System, please contact the OASAS Planning Unit at or by at oasasplanning@oasas.ny.gov 20

21 Consult the LSP Guidelines for additional guidance on completing this exercise. Community Service Board Roster Rensselaer Co. Dept of Mental Health (70300) Certified: Katherine Alonge-Coons (4/26/17) te: There must be 15 board members (counties under 100,000 population may opt for a 9-member board). Indicate if member is a licensed physician or certified psychologist. Under item labeled "", enter the name of the member's organization or enter "Consumer", "Family", "Public Representitive", etc. to indicate the particular community interest being represented. s shall serve four-year staggered terms. Co-chairperson Robert Holtz Physician Psychologist CDPHP Behavioral Health Term Expires 12/31/2017 rholtz@cdphp.com Co-chairperson Thomas Bendon Physician Psychologist Hudson Mohawk Recovery Term Expires 12/31/2017 tomb@hmrecovery.net Scarlet Clement - Buffoline Physician Psychologist Samaritan Hospital BHS Term Expires 12/31/2018 scarlet.clement-buffoline@sphp.org Marianne Briggs Physician Psychologist MHEP Term Expires 12/31/2018 mariannemhep@live.com Hanns Meissner Physician Psychologist Renss Cty Chapter NYSARC Term Expires 12/31/2018 hmeissner@renarc.org Ruth Fennelly Physician Psychologist Consumer Term Expires 12/31/2018 rfennelly@ceo-cap.org Katherine Maciol Physician Psychologist Community Services Rep. Term Expires 12/31/2018 kmaciol@ceo-cap.org Thomas Hulihan Physician Psychologist Troy Housing Authority Term Expires 12/31/2017 hulihant@troyhousing.org Kiki Garg Physician Psychologist NE Career Planning Term Expires 12/31/2017 kgarg@northeastcareer.org Kevin O'Connor Physician Psychologist Joseph's House and Shelter Term Expires 12/31/2018 koconnor@josephshousetroy.org Karen Nash Physician Psychologist Educational Rep. Term Expires 12/31/2018 k.nash@hvcc.edu Linda Lewis Physician Psychologist Housing Rep. Term Expires 12/31/2017 llewis@unityhouseny.org Physician Patrick Abrams Physician Gladys Cruz 21

22 Psychologist Veteran Services Term Expires 12/31/2018 Psychologist Questar!! BOCES Term Expires 12/31/

23 Consult the LSP Guidelines for additional guidance on completing this exercise. Alcoholism and Substance Abuse Subcommittee Roster Rensselaer Co. Dept of Mental Health (70300) Certified: Katherine Alonge-Coons (4/26/17) te: The subcommittee shall have no more than nine members. Three subcommittee members must be members of the board; those members should be identified here. Under item labeled "", enter the name of the member's organization or enter "Consumer", "Family", "Public Representitive", etc. to indicate the perspective the member brings to the subcommittee. Chairperson Is CSB Tom Bendon Hudson Mohawk Recovery Center Yes Is CSB Tammi Williams Samaritan PROS Is CSB Kristin Hansen St. Mary's Addiction Is CSB Priscilla Reiff St. Mary's Addiction Yes Is CSB Joseph LaCoppola Coniferf Park Is CSB Elisa Schneider Renss Cty Department of Mental Health/DSS Is CSB Lou Desso Renss Cty Department of Mental Health/DSS Is CSB Dan Godfry Upstate Physicians Is CSB Bob Schaffer 820 River Street Is CSB Mary Delory Hudson Mohawk Recovery Center 23

24 Consult the LSP Guidelines for additional guidance on completing this exercise. Mental Health Subcommittee Roster Rensselaer Co. Dept of Mental Health (70300) Certified: Katherine Alonge-Coons (4/26/17) te: The subcommittee shall have no more than eleven members. Three subcommittee members must be members of the board; those members should be identified here. Under item labeled "", enter the name of the member's organization or enter "Consumer", "Family", "Public Representitive", etc. to indicate the perspective the member brings to the subcommittee. Co-chairperson Is CSB Davia Plusch RCDMH Children's SPOA Yes Co-chairperson Is CSB Linda Lewis Unity House Yes Is CSB Annamae Fingar Joseph's House & Shelter afingarjosephshousetroy.org Is CSB Cher Montayne OASAS Is CSB Mary Beth Musco Renss Cty Parson Adult Mobile Crisis Is CSB Michael Ballester Upstate Physicians Is CSB Tami Colwell St. Anne Institute Is CSB Sarah Trombley Unity House Is CSB DeborahSchoonmaker Empowerment Exchange Is CSB Ruth Fennelly CEO 24

25 Consult the LSP Guidelines for additional guidance on completing this exercise. Developmental Disabilities Subcommittee Roster Rensselaer Co. Dept of Mental Health (70300) Certified: Katherine Alonge-Coons (4/26/17) te: The subcommittee shall have no more than nine members. Three subcommittee members must be members of the board; those members should be identified here. Under item labeled "", enter the name of the member's organization or enter "Consumer", "Family", "Public Representitive", etc. to indicate the perspective the member brings to the subcommittee. Chairperson Is CSB Hanss Meissner Renss Cty Chapter NYSARC Yes Is CSB Paula Jubic Catholic Charities Disability Services Is CSB Susan Kittle Catholic Charities Disability Services Is CSB Crystal Waite ARC of Rensselaer County Is CSB Kirstein DonVito RCDMH Is CSB reen Gill NYSTART Is CSB Jennifer Calandra NYSTART Is CSB Laura Clark Vanderheyden Is CSB Cheryl Fiore RCDMH Is CSB Lyndsi Wickert Independent Living Center 25

26 Consult the LSP Guidelines for additional guidance on completing this exercise Mental Hygiene Local Planning Assurance Rensselaer Co. Dept of Mental Health (70300) Certified: Katherine Alonge-Coons (5/12/17) Pursuant to Article 41 of the Mental Hygiene Law, we assure and certify that: Representatives of facilities of the offices of the department; directors of district developmental services offices; directors of hospital-based mental health services; directors of community mental health centers, voluntary agencies; persons and families who receive services and advocates; other providers of services have been formally invited to participate in, and provide information for, the local planning process relative to the development of the Local Services Plan; The Community Services Board and the Subcommittees for Alcoholism and Substance Abuse, Mental Health, and Developmental Disabilities have provided advice to the Director of Community Services and have participated in the development of the Local Services Plan. The full Board and the Subcommittees have had an opportunity to review and comment on the contents of the plan and have received the completed document. Any disputes which may have arisen, as part of the local planning process regarding elements of the plan, have been or will be addressed in accordance with procedures outlined in Mental Hygiene Law Section 41.16(c); The Community Services Board and the Subcommittees for Alcoholism and Substance Abuse, Mental Health, and Developmental Disabilities meet regularly during the year, and the Board has established bylaws for its operation, has defined the number of officers and members that will comprise a quorum, and has membership which is broadly representative of the age, sex, race, and other ethnic characteristics of the area served. The Board has established procedures to ensure that all meetings are conducted in accordance with the Open Meetings Law, which requires that meetings of public bodies be open to the general public, that advance public notice of meetings be given, and that minutes be taken of all meetings and be available to the public. OASAS, OMH and OPWDD accept the certified 2018 Local Services Planning Assurance form in the Online County Planning System as the official LGU assurance that the above conditions have been met for the 2018 Local Services planning process. 26

27 Rensselaer County Examples of DSRIP Dashboard Data

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29 Trend in ER Usage/1000 Medicaid Enrollees Year Average of Rest of State Average of Capital District Average of Rensselaer

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33 Inpatient Admission Trend/1000 Medicaid Enrollees Year Average of Rest of State Average of Rensselaer Average of Capital District

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36 Rensselaer County OMH PCS Co-Ocurring Disorders by Program Category Program Category Total Clients* Co-Occuring Disorders Yes Unknown % Yes Total 1, , % Emergency % Crisis Intervention % Inpatient % Outpatient 1, % Residential % Support %

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38 What are the most common housing problems? The single largest housing problem in the City of Troy for both renters and owners is the housing cost burden. For renters, it is housing cost burden greater than 50% of AMI and for owners it is the housing cost burden greater than 30%. Thirty-seven percent of rental households experience having one or more of the four housing problems (lacks kitchen or complete plumbing; severe overcrowding; severe cost burden). Twenty-one percent of owner households experience having one or more of the four housing problems. Family households, with householders years of age, account for the largest number of owner occupied housing in the City of Troy. n-family, householders living alone ages 35-64, accounts for the largest number of renter-occupied housing in Troy. This is consistent with why small related households for renters and elderly households for owners are the household types more affected than others at both >30% and >50% cost burden. Thirty-five percent of small related rental households suffer from a cost burden at >30% AMI and 36% have a cost burden at >50% AMI. Forty-two percent of elderly households suffer from a cost burden at >30% AMI and 50% at >50% AMI.

39 Need for Housing Assistance The Troy Housing Authority utilizes the Housing Choice Voucher program at 100%. The Housing Authority recently re-opened its Section 8 Housing Choice Voucher waiting list for one week. The waiting list was closed again on March 6, The Troy/Rensselaer CoC Annual Report for 2013 identified that 29% of all persons served reported one or more disabling conditions; HIV/AIDS - 0.3% Physical Disability - 8% Chronic Health Condition - 11% Mental Health Problem - 28% Substance Abuse Alcohol Abuse - 5% Drug Abuse - 7% Both Alcohol and Drug Abuse - 11%

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54 Prevention Planning Served/100,000 Population Geography EBP Education number served n-ebp Education number served Positive Positive Alternatives - Alternatives - Recurring One-Time number served number served Information Awareness (indirect) number reached Information Awareness (direct) number served Community Capacity Building number reached EBP Environmental Strategies number reached Statewide 1, ,014 6,748 1, ,183 Region 1, ,642 1, ,915 Rensselaer 1,

55 Prevention Planning Served/100,000 Population Geography Prevention Counseling EBP Prevention Counseling number newly assessed number newly admitted number newly assessed number newly admitted EBP Early Intervention number served Statewide Region Rensselaer

56 Adult and Child Total Psychiatric Inpatient Bed Capacity by Provider County and Average Daily Census by Patient County of Residence

57 Adult and Child State Psychiatric Center Average Daily Census by Patient County of Residence - CY 2015 and Year ending September 2016

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