2017 Community Mental Health, Substance Use and Developmental Disabilities Services Needs and Gaps Analysis

Transcription

1 2017 Community Mental Health, Substance Use and Developmental Disabilities Services Needs and Gaps Analysis This study assesses the Cardinal Innovations Healthcare community to determine needs and capacity of providers to deliver services. This evaluation will aid in the development of organizational strategic plans, such as local business plans, network development plans and strategic initiatives, as needed to incorporate results from the service needs assessment and gaps analysis.

2 Table of Contents Cardinal Innovations Healthcare Section One... 4 Executive Summary... 4 Progress and Achievements... 7 Increase the quality and availability of psychological testing in the Cardinal Innovations Provider Network... 7 Increase training of providers and clinicians with a trauma focused specialty to enhance cultural competency with lesbian, gay, bisexual, transgender, questioning (LGBTQ) youth for appropriate placement and referral... 7 Increase availability and access to the Peer Bridger Program... 7 Increase availability of facility-based crisis beds and services... 7 Explore and identify options to pilot a Psychiatric Rehabilitation Treatment Facility (PRTF) program to serve dually diagnosed members... 7 Demographic Data... 8 Cardinal Innovations General Population Demographics... 8 Member Served Population... 9 Members Served by Diagnosis and Benefit Plan Medicaid Served Racial Demographics Special Populations Needs Assessment Members and Families Stakeholders Section Two: Access and Choice Standards Data Outpatient Services Location-Based Services Community / Mobile Services Crisis Services Inpatient Services Specialized Services C-Waiver Services Service-Related Items Section Three: Service Needs and Gaps Identified by Members, Family Members and Other Stakeholders Mental Health, Developmental Disabilities and Substance Use Disorder Service Gaps Identified by Members and Family Members Mental Health, Developmental Disabilities and Substance Use Disorder Service Gaps Identified by Stakeholders.. 28 Mental Health, Developmental Disabilities and Substance Use Disorder Service Gaps Identified by Geographic, Cultural or Demographic Groups Section Four: Strategies for Addressing Service Gaps Section Five: Geo Maps P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

3 Section Six: Departmental Priorities Prevention and Education Intervention and Treatment Housing and Employment Children and Families Quality Monitoring and Management Integrated Care Appendix A Geo Maps Location-based Services Psychosocial Rehabilitation Child & Adolescent Day Treatment Substance Abuse Comprehensive Outpatient Therapy (SACOT) Substance Abuse Intensive Outpatient Treatment Program (SAIOP) Opioid Treatment Community / Mobile Services Assertive Community Treatment Team (ACTT) Community Support Team (CST) Intensive In-Home Service (IIHS) Mobile Crisis Multi-Systemic Therapy (MST) (b)(3) MH Supported Employment Service (b)(3) IDD Supported Employment Service (b)(3) Wavier Community Guide (b)(3) Waiver Individual Support (Personal Care) (b)(3) Waiver Peer Support (b)(3) Waiver Respite Crisis Services Facility-based Crisis (Adults) Facility-based Respite Crisis Detox (Non-Hospital) Inpatient Services Inpatient / Hospital (Adult) Inpatient / Hospital (Child) Specialized Services Partial Hospital Psychiatric Residential Treatment Facility (PRTF) P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

4 Residential Treatment Level Residential Treatment Level Residential Treatment Level 2 (Therapeutic Foster Care) Residential Treatment Level Residential Treatment Level SA Medically Monitored Community Residential Treatment (b)(3) Out of Home Respite (b)(3) IDD Facility-based Respite (b)(3) IDD Residential Supports Intermediate Care Facility (IDD) C-Waiver services Day Supports Residential Supports Residential Supports Residential Supports Residential Supports Appendix B Needs Assessment Survey English Version Spanish Version P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

5 Section One Cardinal Innovations Healthcare Executive Summary As a national leader in special needs plans and managing care for individuals with complex needs, Cardinal Innovations Healthcare is committed to ensuring quality outcomes for our members and their families. The 2017 Community Mental Health, Substance Use and Developmental Disabilities Services Needs and Gaps Analysis is one tool that Cardinal Innovations utilizes to provide benefits and provider choices to meet the specific needs of its members. The Cardinal Innovations Healthcare describes identified behavioral needs within its service area which includes Mecklenburg, Union, Cabarrus, Davidson, Alamance, Orange, Rowan, Chatham, Franklin, Stanly, Granville, Halifax, Vance, Person, Caswell, and Warren counties for the fiscal year of July 2015 June On July 1, 2016, Cardinal Innovations and CenterPoint Human Services consolidated, adding 4 more counties (Forsyth, Stokes, Davies, and Rockingham) to the Cardinal Innovations service area. Because the 2017 Community Needs and Gaps Analysis requires an analysis of the demographics, access and choice data, and mapping from the period July 2015 June 2016, the data in these sections will not include the CenterPoint data. The CenterPoint data for this period will be available in a separate needs and gaps analysis report. The Needs Assessment Survey, however, includes information from all 20 counties (Cardinal Innovations & CenterPoint). The 2017 Community Needs and Gaps Analysis incorporates data, reports, and input from the following sources: Cardinal Innovations Healthcare s internal data bases North Carolina State Budget Office Medicaid Global Eligibility File (GEF) United States Census Bureau Substance Abuse and Mental Health Services Administration (SAMHSA) NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) NC Division of Medical Assistance (DMA) Department of Health Service Regulation (DHSR) Licensed Facilities Survey data from members, family members, providers and stakeholders (Needs Assessment Survey) The 2017 Needs and Gaps are identified based on Geo access analysis to determine if choice and access standards as set by NC Department of Health and Human Services are met Analysis of data gathered from the Needs Assessment Survey GeoNetworks GeoAccess GIS application was used to analyze the proximity or distance of contracted Network providers to member locations. This data was used to determine if choice and access standards were met. Based on the Geo Access data, the following services did not meet the access and choice standards (for Medicaid funded services, 100% of eligible individuals must have a choice of two different provider agencies for each location-based service within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. For non-medicaid funded services, 100% of eligible individuals must have access to at least one provider agency for each location-based service within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences: Child and Adolescent Day Treatment (Medicaid and non-medicaid funded) Substance Abuse Comprehensive Outpatient Treatment Program (SACOT) (Medicaid and non-medicaid funded) Opioid Treatment (Medicaid and non-medicaid funded) Day Supports (non-medicaid funded) 4 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

6 The Cardinal Innovations Consumer & Family Advisory Committees (CFACs) were asked by Cardinal Innovations to participate in the electronic (online) Needs Assessment Survey and assist with distribution of the online survey link to members and their families. The survey was available from October 1, 2016 through November 11, 2016 in English and Spanish. To reach provider and stakeholder input, the needs assessment survey link was promoted through the Community Relations and Community Engagement Departments. Based on the Needs Assessment Survey, the following perceived needs and gaps were identified: Members and family members Additional psychiatrists are needed in all service areas, especially in rural counties. Need additional capacity at walk-in clinics and provider offices to reduce wait times. Additional SUD classes including more convenient start times was suggested. Reduced wait time for medication administration of methadone in Forsyth County. Need medications to be more affordable. Stakeholders Additional psychologists needed to increase psychological testing capacity and decrease the wait time for evaluations. Need increased case management to assist members in the community. (e.g. therapists provide case management as much as possible, but they are not paid for the function of going into the community to assist in linkage and follow through). Need to decrease mobile crisis response times in Mecklenburg, Warren, Halifax, Union, and Davison counties. Additional SUD services are needed in all rural counties. Need more Child/Adolescent SUD services across all service areas. More clinicians are needed across all service areas who specialize in treatment of dual diagnosis (IDD/MH), domestic violence/anger management, sex offender, eating disorders (adolescents), gender identity, and PTSD/trauma related issues. In addition, there is a need for additional clinicians who serve children who are under 5 years old and for adolescents. Need additional capacity at walk-in clinic in Mecklenburg to reduce long wait time. Additional detox beds are needed in Mecklenburg to meet demand; funding is needed for people without insurance to access detox; Rockingham County needs a detox facility to handle the large SUD population in that county. For Level II, III, and PRTF, need decreased wait times for authorizations and placements; need additional Level II & III beds in Warren County; additional TFC beds in Stanly; more Level II, III, and PRTF beds to meet demand in Rowan County. For the juvenile population, need to reduce authorization approval time and placements for Level II, III, PRTF and TFC services. In addition, respondents recommended a wraparound service for moderate to high level juveniles and better case management. Increased independent living skills training needed. Additional services needed for individuals with a dual diagnosis, specifically MH/IDD. Recommended additional services to support individuals with Autism such as ABA therapy. Increased stability among (b)(3) providers needed. Need ability to locate services in a searchable directory to locate services at the local level. Need to be educated on services available. Need greater access and funding to naloxone and needle exchange due to high use of opiates. Additional peer services are needed to bridge gaps in care. Need more emergency respite for children. Medications need to be more affordable. Need more convenient CIT training times. Need more inpatient beds. 5 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

7 Geographic & Cultural Groups Increased out-patient therapy is needed for elderly who are 65 and above. This population is growing rapidly with limited behavioral services available. In addition, in-home services are a need for those who have physical disabilities making it difficult for them to go into the community. Additional professionals, clinicians, and other staff are needed who speak Spanish to meet the linguistic and cultural needs for treatment and engagement of those who do not speak English. In addition, there is a need for Spanish speaking IDD providers as well as IDD educational materials in Spanish. Additional support groups and community resources are needed for individuals who speak Spanish. Need additional financial capacity to serve individuals who are undocumented. For children 5 and under, need more focused services for this age group. Need community based services for individuals who are being released from prison or jail. Need to increase awareness and knowledge on how to access assistive technology/devices and home modifications. Additional services for visually impaired. Increased services for deaf and hard of hearing. Additional services needed for individuals with traumatic brain injury (TBI). Cardinal Innovations will conduct a more detailed analysis of the needs and gaps identified in this report, and will develop appropriate strategies. 6 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

8 Progress and Achievements From last year s capacity and gaps analysis, several goals were developed to address Cardinal Innovations member needs. Below is a summary of the progress and achievements of each goal. Increase the quality and availability of psychological testing in the Cardinal Innovations Provider Network Cardinal Innovations developed an incentivized payment structure for providers who obtain a satisfactory score on a utilization review measuring quality of testing. In order to identify psychologists willing to go through the review process, 151 psychologists in the network were invited to participate. Of the 151 psychologists invited, 15 chose to participate in the review process; 6 had a passing score greater than 80%; 7 were provided a summary of actions for improvement; 1 was placed on a plan of correction; and 1 did not complete the process. Of the 6 with a passing score, 3 have entered into a contract to increase acceptance of referrals from Cardinal Innovations. Increase training of providers and clinicians with a trauma focused specialty to enhance cultural competency with lesbian, gay, bisexual, transgender, questioning (LGBTQ) youth for appropriate placement and referral Providers were invited to attest to being LGBTQ affirmative. Twelve providers responded favorably. Since July 2016, six internal planning meetings have occurred; a competency audit tool has been piloted; and training is in the planning stages. In addition, the workgroup and Medical Department are reviewing practice parameters and the nine principles of care from the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment guide. Increase availability and access to the Peer Bridger Program The Peer Bridger Program places a Peer Support Specialist in the Behavioral Unit and Emergency Departments of local hospitals to provide support immediately at time of discharge for those who have been treated for psychiatric crises. The Peer Bridger is responsible for assisting people in getting to their first appointments and helping to address any barriers to beginning treatment. In addition, the specialist builds a relationship with the person by sharing his/her past experiences/successes, and instills hope during the recovery process. Cardinal Innovations developed several partnerships between local providers and hospitals to increase availability and access to the Peer Bridger Program. Partnerships have been developed in Mecklenburg, Five County, and Alamance- Caswell. Talks are underway in other regions to develop the same program. In addition, evaluation of outcomes and best practices continue to be monitored. Increase availability of facility-based crisis beds and services A child facility-based crisis center is scheduled to open in Mecklenburg in Fall Construction of the facility is underway by Monarch the provider. Monthly planning meetings are occurring between Monarch, Cardinal, and other stakeholders. In Forsyth, the Highland Avenue Center, behavioral health urgent care center and outpatient clinic, is scheduled to open in late Summer 2017, complimented by the opening of a facility based crisis facility in nearby Lexington in Summer Planning for clinical focus, outcomes, reporting, and stakeholder training are currently underway with the provider Daymark. Explore and identify options to pilot a Psychiatric Rehabilitation Treatment Facility (PRTF) program to serve dually diagnosed members Cardinal Innovations requested proposals for expansion of PRTF in Mecklenburg; however, none have been approved due to a lack of clinical acumen for the identified population and not meeting the specific population needs. Efforts will continue to expand PRTF in the service area. In Union County, great success has occurred with Anderson Health Services PRTF who will be opening in quarter 4 of P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

9 Demographic Data Below is a description of the demographic make-up of the Cardinal Innovations Healthcare service area including Mecklenburg, Union, Cabarrus, Davidson, Alamance, Orange, Rowan, Chatham, Franklin, Stanly, Granville, Halifax, Vance, Person, Caswell, and Warren counties for the fiscal year of July 2015 June On July 1, 2016, Cardinal Innovations and CenterPoint Human Services consolidated adding 4 more counties (Forsyth, Stokes, Davies, and Rockingham) to the Cardinal Innovations service area. Because the 2017 Community Needs and Gaps Analysis requires an analysis of the demographics, access and choice data, and mapping from the period July 2016 June 2016, the data in these sections will not include the CenterPoint data. The CenterPoint data for this period will be available in a separate capacity study. Cardinal Innovations General Population Demographics According to the 2015 North Carolina Office and State Budget estimates (most current), there are approximately 2,486,636 people living in the Cardinal Innovations service area. Fifty-one percent (51%) are female and forty-nine percent (49%) are male with the average median age per county of The counties in the Cardinal Innovations service area are organized into 5 geographic regions. Mecklenburg Piedmont Alamance-Caswell OPC Five County Mecklenburg Cabarrus Union Stanly Rowan Davidson Alamance Caswell Orange Person Chatham Vance Granville Franklin Warren Halifax 8 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

10 The Mecklenburg County area is the largest by population, followed by Piedmont, OPC, Five County, and Alamance -Caswell. Geographic Area Female Male Total Piedmont 398,190 51% 383,247 49% 781,437 Alamance-Caswell 94,891 52% 86,376 48% 181,267 Five County 120,366 50% 120,174 50% 240,540 OPC 130,526 52% 120,246 48% 250,772 Mecklenburg 529,079 51% 503,541 49% 1,032,620 Cardinal Innovations 1,273,052 51% 1,213,584 49% 2,486,636 Member Served Population For Fiscal Year 2016 (FY16), the service area consisted of 463,601 Medicaid eligible individuals. Of this population, 60,710 received at least one Medicaid service. In addition to the Medicaid eligible population, Cardinal Innovations provided at least one State-funded service to 19,731 individuals or members. The largest percentage of the Medicaid served population was in Mecklenburg at 37.4% followed by Piedmont, Five County, and OPC. Note: Members may be counted in more than one county due to relocation For State-funded services, the highest percentage of members served was in Mecklenburg at 36.6% followed by Piedmont, Five County, OPC, and Alamance. Note: Members may be counted in more than one county due to relocation For all service areas, the total number of members with Medicaid receiving at least one service per the total number of the Medicaid eligible population for the fiscal year is 13.1%. 9 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

11 Members Served by Diagnosis and Benefit Plan Cardinal Innovations Healthcare Child/Adolescent members (Ages 3-17) with a Mental Health (MH) diagnosis comprised the highest number of members served for Medicaid and/or State-funding compared to Intellectual and Developmental Disabilities (I/DD) and Substance Use Disorder (SUD) members. Geographic Area Medicaid State I/DD MH SUD Other Total I/DD MH SUD Other Total Grand Total Piedmont/Southern 657 7, , ,551 Alamance-Caswell 157 1, , ,094 Five County 249 2, , ,124 OPC 185 2, , ,250 Mecklenburg 803 9, , ,521 Other Cardinal Innovations , , ,397 Adult members (18+) with a MH diagnosis comprised the highest number of members served for Medicaid and/or State funding compared to I/DD and SUD members. Geographic Area Medicaid State I/DD MH SUD Other Total I/DD MH SUD Other Total Piedmont/ Southern 1,317 8,435 2, , ,791 2, ,210 16,507 Alamance-Caswell 358 2, , , ,897 4,862 Five County 533 4,725 1, , , ,447 7,757 OPC 559 2, , , ,086 5,129 Mecklenburg 1,856 10,136 2, , ,576 3, ,491 18,237 Cardinal Innovations Grand Total 4,606 28,376 7, ,569 1,008 11,901 7, ,386 52, P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

12 Medicaid Served Racial Demographics Cardinal Innovations Healthcare The racial demographics for Cardinal Innovations service area by county are described below. Racial demographics vary greatly between counties and aggregated community areas. County White Black or African American American Indian and Alaskan Native Asian Other Race Other Total Alamance 59.7% 31.6% 0.4% 0.2% 7.4% 0.7% 100% Cabarrus 66.4% 26.5% 0.3% 0.5% 5.6% 0.6% 100% Caswell 62.1% 35.0% 0.3% 0.1% 2.2% 0.3% 100% Chatham 58.8% 26.0% 0.1% 0.3% 13.0% 1.8% 100% Davidson 80.2% 13.6% 0.2% 0.6% 4.7% 0.6% 100% Franklin 56.2% 37.3% 0.4% 0.4% 5.1% 0.7% 100% Granville 55.4% 38.1% 0.3% 0.3% 5.1% 0.9% 100% Halifax 31.3% 60.3% 5.2% 0.1% 2.8% 0.3% 100% Mecklenburg 33.8% 56.9% 0.3% 0.9% 3.5% 4.6% 100% Orange 59.5% 26.9% 0.4% 2.7% 8.5% 2.0% 100% Person 62.6% 33.6% 0.5% 0.1% 2.6% 0.7% 100% Rowan 71.6% 22.0% 0.5% 0.4% 5.1% 0.5% 100% Stanly 74.5% 19.9% 0.3% 0.4% 3.1% 0.8% 100% Union 64.5% 26.1% 0.5% 0.2% 7.8% 0.9% 100% Vance 33.1% 61.3% 0.2% 0.0% 4.5% 0.9% 100% Warren 28.6% 62.5% 5.7% 0.1% 2.8% 0.4% 100% Cardinal Innovations 51.2% 40.6% 0.6% 0.6% 4.8% 2.2% 100% 11 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

13 Special Populations Cardinal Innovations Healthcare Ethnic Groups Communities in America are becoming more culturally diverse. Current projections suggest that by 2025, racial and ethnic minorities will account for more than 40 percent of all Americans. Lack of awareness of cultural differences can affect the prevention, identification, and treatment of many mental health problems. 1 The five most recognized racial and ethnic minority groups according to United States Federal classifications are African-American, American Indian/Alaska Natives, Asian-Americans/Pacific Islanders, White American and Hispanic-American. Latino is tracked in our data as an ethnicity designation, and may apply to a person of any race. 2 The graph below represents the number of members in the given ethnic group with Medicaid receiving at least one MH/SUD/IDD service per the total number of members receiving at least one service in the Cardinal Innovations service area. Traumatic Brain Injury (TBI) Population Each year Cardinal Innovations requests funds from the State of North Carolina to help support members with TBI. Currently, Cardinal Innovations is able to provide additional support to approximately 35 members and 5 provider agencies who specialize in treating people with TBI. Other members with TBI may receive services but the current prevalence of TBI cannot be accurately assessed because a provider may bill under other diagnosis codes (e.g. depression). In addition to providing funding for services, Cardinal Innovations also has set up easy access to the Ohio State University TBI Identification Method (OSU TBI-ID), a standardized, structured interview designed to elicit lifetime TBI history. Providers serving members with TBI in the network have been trained and encouraged to screen the members they serve. The OSU TBI-ID data is reported to DHHS and used to determine if additional funding and programs are needed in North Carolina, for example a TBI Waiver Program. 1 New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA Rockville, MD: U.S. Office of Management and Budget, OMB, P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

14 Service Members, Veterans and their Families (SMVF) Cardinal Innovations is committed to providing information and services for SMVF, as well as providing support to our partners who provide services to these members. Based on new enrollments, the increase in SMVF enrolled to receive services may be attributed to coordinated referral efforts statewide for supporting returning SMVF, linking to supports across all life domains. Pregnant Women Cardinal Innovations participates in the Managing Substance Use in Pregnancy Collaborative that is a partnership with providers, stakeholders, physicians and Northwest Community Care Center (NWCCC) to address the needs of this priority population. NWCCC serves Davidson, Davie, Forsyth, Stokes, Surry, Wilkes and Yadkin Counties. Working with NWCC, in November 2016, addiction specialist psychiatrists, Wake Forest Baptist Medical Center, Novant Health Forsyth Medical Center, and Insight Human Services committed to staff a consultation access line as part of Project ECHO (Extension for Community Healthcare Outcomes). Project ECHO links expert specialist teams at an academic hub with primary care clinicians in local communities. Primary care clinicians, the spokes in the ECHO model, become part of a learning community, where they receive mentoring and feedback from specialists. Together, they manage patient cases so that patients get the care they need. Although the ECHO model makes use of telecommunications technology, it is different from telemedicine. Currently, the partnership is exploring funding options to fund the project. Cardinal Innovations also participates in the Managing Substance Use in Pregnancy Collaborative with Community Care of Southern Piedmont serving Rowan, Cabarrus, and Stanly counties. Stakeholder meetings have been underway and have identified a list of needs for this special population. Discussions on how to meet these needs are in the planning stages now. Sexually Aggressive Population Cardinal Innovations collaborates with Children s Hope Alliance for treatment of sexually aggressive youth in a program called Treatment Alternatives for Sexualized Kids (TASK). TASK is an array of services that provides evidence-informed treatment for youth who have committed offenses and require sexual harm specific treatment. The average length of stay is 12 months with treatment occurring primarily through an in-home outpatient model that provides structured family, individual and group therapy, as well as safety planning. Timber Ridge is another provider that works in collaboration with Cardinal Innovations delivering services to sexually aggressive youth. Their treatment components include Trauma Focused Cognitive Behavioral Therapy, quantitative EEG brain mapping, risk assessments, safety plans, individual, family and group therapy. 13 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

15 Individuals in Jail and Prisons Cardinal Innovations Healthcare New enrollments of individuals being discharged from prisons and jails needing behavioral healthcare is on the rise. Cardinal Innovations is reaching out to community partners to educate and increase public awareness about mental illnesses in jails and prisons, as well as inform them of the services available. Working with communities in its service area, Cardinal Innovations is assisting counties implementation of the National Stepping Up Initiative to reduce the number of people with mental illnesses in jails. An estimated 2 million people with serious mental illness are incarcerated across the United States and almost three-quarters of them have substance use disorders. The number of people with serious mental illness in jails is three to six times higher than for the general population. 3 The initiative engages law enforcement, court and jail officials, treatment providers, individuals with mental illnesses and their families, program directors and others. Youth and Juvenile Justice Cardinal Innovations supports and collaborates with the Juvenile Justice Substance Abuse Mental Health Partnerships (JJSAMHP) across the service area. JJSAMHP are local teams across NC that work together to deliver effective, familycentered services and supports for juveniles who are involved with the criminal justice system. The partnerships require an organized person-centered system that operates under the System of Care principles. Cardinal Innovations supports each local JJSAMHP within the service area with funding to support sustainability. This funding allows JJSAMHP to better serve juveniles with mental health or substance use disorders who are involved with the Division of Adult Correction and Juvenile Justice Needs Assessment In addition to utilizing access and choice data to identify service needs, gaps, and strategies, Cardinal Innovations conducted a Needs Assessment Survey among people who need and use services, their families, providers and other stakeholders. The survey was comprised of closed-ended and open-ended questions (see Appendix B for the Needs Assessment Survey). Offered in English and Spanish, the survey was made available on the Cardinal Innovations website from October 1, 2016 to November 11, The needs assessment included the Triad Region this year since the merger of Cardinal Innovations and CenterPoint Human Services took place on July 1, Based on responses, Cardinal Innovations had a record number of participants in the study this year. A total of 3,317 started the English version of the survey and 2,681 completed it giving us an 80.83% completion rate. On the Spanish version of the survey, 54 started and 11 completed the survey giving Cardinal Innovations a 20.37% completion rate. The survey conducted was not a random sample of all members, family members, providers, or stakeholders, but rather was offered via multiple outlets. Distribution of the survey was led by the Community Operations Department who is responsible for engaging with community advisory boards, county leaders, elected officials and other key stakeholders. The department is also responsible for educating members and their families on the resources available through Cardinal Innovations and within their service areas, and assist in the navigation of those systems and supports. Responsibilities of the department are 3 The Problem. (2017, April 28). Retrieved from 14 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

16 divided among three distinct units: Community Relations, Community Engagement, and Member Engagement. The method of distribution to members, their families, and other stakeholders is described below. Members and Families The Cardinal Innovations Consumer & Family Advisory Committees (CFACs) were asked by the Member Engagement unit to participate in the online survey and assist with distribution of the online survey link to members and their families. Member Engagement assist Cardinal Innovations' members and their families in navigating Medicaid benefits, Cardinal Innovations and community resources and supports, and provides education and programming designed to promote selfadvocacy, health awareness and wellness among members and their families. CFACs provide a means for members and/or family members to have a voice and be included in their local behavioral health system. While Cardinal Innovations is required to have only one CFAC, seven are sponsored, one for each community (Mecklenburg, Piedmont, Triad, Alamance-Caswell (AC), Orange-Person-Chatham (OPC), Five County) and one as the Executive CFAC. The Executive CFAC is composed of 3 representatives from each of Cardinal Innovations community CFACs. Each CFAC is comprised of adult members and family members ages 18 and older who equally represent the disabilities of mental health, intellectual and/or developmental disabilities and substance use disorder. In addition, the membership reflects as closely as possible the racial and ethnic composition of the service area. In addition to promotion of the online survey by the CFACs, hard copies were distributed throughout the service area to local provider offices. The local provider offices placed the hard copies in their waiting areas and encourage members, family members, and those seeking services to complete. Distribution through CFAC and the local provider offices provided a broad outreach to all disability groups. Stakeholders To reach stakeholder input, the needs assessment survey link was promoted through the Community Relations and Community Engagement Departments. Community Relations, through Cardinal Innovations Senior Community Executives, provides an executive-level link between Cardinal Innovations and local leaders, elected officials and other key stakeholders who represent the interests of the communities served. Community Engagement engages key community partners, such as law enforcement agencies, school systems and non-profit organizations, through outreach, education and training to promote awareness of Cardinal Innovations, the special populations served and their unique needs. Senior Community Executives sent the survey link to all VIP stakeholders (e.g. elected officials, county managers) in each of their regions covering all 20 counties in the Cardinal Innovations service area. The survey link was also promoted at Community Partner meetings attendees (e.g. DSS, Public Health, hospital representatives, Law Enforcement Officers, EMS, school system officials, judicial staff), public meetings, Mental Health First Aid, and Crisis Intervention Team trainings as well as distributed by to attendees. Last, the survey link was promoted in InfoSource, Cardinal Innovation s news source for providers. 15 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

17 Section Two: Access and Choice Standards Data Outpatient Services Medicaid-funded services standard 100% of eligible individuals must have a choice of two different outpatient services provider agencies within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. Non-Medicaid-funded services standard 100% of eligible individuals have a choice of two different outpatient services provider agencies within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. Categories # of enrollees with choice of two providers within 30/45 miles/ minutes* Medicaid # of Medicaid Enrollees % Non-Medicaid Funded # of consumers with choice of two providers within 30/45 miles/minutes* # of Consumers % Reside in urban counties 365, ,047 15,987 15,987 Reside in rural counties 58,710 58,710 2,975 2,975 Total (standard = 100%) 423, , % 18,962 18, % Adults (age 18+) 185, , ,207 Children (age 17 and younger) 238, , Total (standard = 100%) , % 18,962 18, % * 30/45 miles/minutes is the abbreviated term used in this document for individuals having choice and/or access within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. Medicaid-funded services exceptions Is an exception for Medicaid-funded outpatient services in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes No If the access and choice data is not at 100%, is an exception request included with the 2017 gaps report? Yes No If no, please explain. Non-Medicaid-funded services exceptions Is an exception for non-medicaid-funded outpatient services in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes No If the access and choice data is not at 100%, is an exception request included with the 2017 gaps report? Yes No If no, please explain. Location-Based Services Medicaid-funded services standard 100% of eligible individuals must have a choice of two different provider agencies for each location-based service within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. Non-Medicaid-funded services standard 100% of eligible individuals have access to at least one provider agency for each location-based service within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. 16 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

18 Medicaid Non-Medicaid Funded Location-based Services # and % of enrollees with choice of two providers within 30/45 miles/minutes of their residences Total # of Medicaid Enrollees # and % of consumers with at least one provider within 30/45 miles/minutes of their residences Total # of Consumers # Urban/rural % Urban/rural (30/45 miles) # Urban/rural % Urban/rural Psychosocial Rehabilitation 185, % 185,628 12, % 12,585 Child and Adolescent Day Treatment 194, % 238, % 662 SA Comprehensive Outpatient Treatment Program (SACOT) 333, % 423,757 6, % 7,516 SA Intensive Outpatient Program 422, % 423,757 7, % 7,516 Opioid Treatment 136, % 185,628 5, % 7,439 Day Supports % 984 Medicaid-funded services exceptions Are exceptions for any Medicaid-funded location-based service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No o Child and Adolescent Day Treatment o SACOT o Opioid If the access and choice data is not at 100% for any Medicaid-funded location-based service, are exception requests included with the 2017 gaps report? Yes, please list. No, please explain. o Child and Adolescent Day Treatment o SACOT o Opioid Non-Medicaid-funded services exceptions Are exceptions for any non-medicaid-funded location-based service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No o Child and Adolescent Day Treatment o SACOT o Opioid If the access and choice data is not at 100% for any non-medicaid-funded location-based service, are exception requests included with the 2017 gaps report? Yes, please list. No, please explain. o o o Psychosocial Rehabilitation Child and Adolescent Day Treatment SACOT 17 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

19 o o Opioid Day Supports Cardinal Innovations Healthcare Community / Mobile Services Medicaid-funded standard 100% of eligible individuals must have a choice of two provider agencies within the LME/MCO service area for each community/ mobile service. Non-Medicaid-funded services standard 100% of eligible individuals have access within the LME/MCO service area to at least one provider agency for each community/ mobile service. Community/Mobile Service Assertive Community Treatment Team Medicaid # and % of enrollees with choice of two provider agencies within the LME-MCO catchment area Total # of Medicaid Non-Medicaid-Funded # and % of consumers with access to at least one provider agency within the LME-MCO catchment area # % Enrollees # % Total # of Consumers 185, % 185,649 12, % 12,008 Community Support Team 185, % 185,649 17, % 17,531 Intensive In-Home 238, % 238, % 662 Mobile Crisis 423, % 423,820 18, % 18,963 Multi-systemic Therapy 238, % 238, % 662 (b)(3) MH Supported Employment Services (b)(3) I/DD Supported Employment Services (b)(3) Waiver Community Guide (b)(3) Waiver Individual Support (Personal Care) 423, % 423, , % 423, , % 423, , % 423,820 (b)(3) Waiver Peer Support 423, % 423,820 (b)(3) Waiver Respite 423, % 423,820 I/DD Supported Employment Services (non- Medicaid-funded) Long-term Vocational Supports (non-medicaidfunded) MH/SA Supported Employment Services (IPS- 1, % 1, % , % 17, P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

20 SE) (non-medicaid-funded) I/DD Non-Medicaid-funded Personal Care Services I/DD Non-Medicaid-funded Respite Community Services I/DD Non-Medicaid-funded Respite Hourly Services not in a licensed facility Developmental Therapies (non-medicaid-funded) Cardinal Innovations Healthcare 1, % 1,084 1, % 1,084 1, % 1,084 1, % 1,084 Medicaid-funded services exceptions Are exceptions for any Medicaid-funded community/mobile service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If the access and choice data is not at 100% for any Medicaid-funded community/mobile service, are exception requests included with the 2017 gaps report? Yes, please list. No, please explain. Non-Medicaid-funded services exceptions Are exceptions for any non-medicaid-funded community/mobile service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If the access and choice data is not at 100% for any non-medicaid-funded community/mobile service, are exception requests included with the 2017 gaps report? Yes, please list. No, please explain. Crisis Services Medicaid-funded services standard 100% of eligible individuals must have access within the LME/MCO service area to at least one provider agency for each crisis service. Non-Medicaid-funded services standard 100% of eligible individuals must have access within the LME/MCO service area to at least one provider agency for each crisis service. Crisis Service Facility-Based Crisis - adults Medicaid # and % of enrollees with access within the LME-MCO catchment area to at least one provider agency Total # of Medicaid Non-Medicaid Funded # and % of consumers with access within the LME-MCO catchment area to at least one provider agency # % Enrollees # % Total # of Consumers 185, % 185,649 18, % 18,208 Facility-Based Respite 423, % 423,820 18, % 18,963 Detoxification (nonhospital) 423, % 423,820 7, % 7,776 FOR INFORMATION 0 0% 238, % P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

21 Crisis Service PURPOSES ONLY: Facility-Based Crisis - children Cardinal Innovations Healthcare Medicaid # and % of enrollees with access within the LME-MCO catchment area to at least one provider agency Total # of Medicaid Non-Medicaid Funded # and % of consumers with access within the LME-MCO catchment area to at least one provider agency # % Enrollees # % Total # of Consumers Medicaid-funded services exceptions Are exceptions for any Medicaid-funded crisis service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If the access and choice data is not at 100% for any Medicaid-funded crisis service, are exception requests included with the 2017 gaps report? Yes, please list. No, please explain. Non-Medicaid-funded services exceptions Are exceptions for any non-medicaid-funded crisis services in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If the access and choice data is not at 100% for any non-medicaid-funded crisis service, are exception requests included with the 2017 gaps report? Yes, please list. Inpatient Services Medicaid-funded services standard No, please explain. 100% of eligible individuals must have access within the LME/MCO service area to at least one provider agency for each inpatient service. Non-Medicaid-funded services standard 100% of eligible individuals must have access within the LME/MCO service area to at least one provider agency for each inpatient service. Service Inpatient Hospital Adult Inpatient Hospital Adolescent/Child Medicaid Non-Medicaid-Funded # and % of enrollees with access # and % of consumers with access within the LME-MCO catchment area Total # of within the LME-MCO catchment area to at least one provider agency Medicaid to at least one provider agency Total # of # % Enrollees # % Consumers 185, % 185,649 17, % 17, , % 238, % 662 Medicaid-funded services exceptions Are exceptions for any Medicaid-funded inpatient service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If the access and choice data is not at 100% for any Medicaid-funded inpatient service, are exception requests 20 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

22 included with the 2017 gaps report? Yes, please list. Cardinal Innovations Healthcare No, please explain. Non-Medicaid-funded services exceptions Are exceptions for any non-medicaid-funded inpatient service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If the access and choice data is not at 100% for any non-medicaid-funded inpatient service, are exception requests included with the 2017 gaps report? Yes, please list. Specialized Services Medicaid-funded services standard No, please explain. 100% of eligible individuals must have access to at least one provider agency for each specialized service. Non-Medicaid-funded services standard 100% of eligible individuals must have access to at least one provider agency for each specialized service. Number Parent Agencies with Number Parent Agencies with Current Contract for Service Current Medicaid Contract Non-Medicaid Funded Services Partial Hospitalization 7 1 MH Group Homes 47 Psychiatric Residential Treatment Facility 18 2 Residential Treatment Level 1 20 Residential Treatment Level 2: 21 Therapeutic Foster Care Residential Treatment Level 2: other 12 than Therapeutic Foster Care Residential Treatment Level 3 39 Residential Treatment Level 4 2 Child MH Out-of-home respite 3 SA Non-Medical Community Residential 0 3* Treatment SA Medically Monitored Community 1 1 Residential Treatment SA Halfway Houses 7 I/DD Out-of-home respite (non- 7 Medicaid-funded) I/DD Facility-based respite (non- 7 Medicaid-funded) I/DD Supported Living (non-medicaidfunded) 7 (b)(3) I/DD Out-of-home respite 89 (b)(3) I/DD Facility-based respite 5 (b)(3) I/DD Residential supports 91 Intermediate Care Facility/IDD 35 *The number of providers for non-medicaid SA non-medicaid Community Residential Treatment is based on codes YP760, YP770, and YP780 in place of H0012HB. Medicaid-funded services exceptions Are exceptions for any Medicaid-funded specialized services in place as of the date of the 2017 gaps report 21 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

23 submission, 5/1/2017? Yes, please list. Cardinal Innovations Healthcare No If there is a Medicaid-funded specialized service without a current (5/1/2017) contract with the LME/MCO, is an exception request included with the 2017 gaps report? Yes, please list. No, please explain. o SA Non-Medical Community Residential Treatment Non-Medicaid-funded services exceptions Are exceptions for any non-medicaid-funded specialized services in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If there is a non-medicaid-funded specialized service without a current (5/1/2017) contract with the LME/MCO, is an exception request included with the 2017 gaps report? Yes, please list. C-Waiver Services No, please explain. A. C-Waiver Services Requiring Choice of At Least Two Providers within the Service Area. Standard: 100% of eligible individuals must have a choice of two provider agencies within the LME/MCO service area for each service. C-Waiver Services-Choice of two providers Services Adult Child # and % of enrollees with choice of two provider agencies within the LME/MCO catchment area # % Total # of C- Waiver Enrollees Community Living and Supports 2, % 2,671 Community Navigator 2, % 2,671 Community Navigator Training for 2, % 2,671 Employer of Record Community Networking 2, % 2,671 Crisis Behavioral Consultation 2, % 2,671 In Home Intensive 2, % 2,671 In Home Skill Building 2, % 2,671 Personal Care 2, % 2,671 Crisis Consultation 2, % 2,671 Crisis Intervention & Stabilization 2, % 2,671 Supports Residential Supports 1 2, % 2,671 Residential Supports 2 2, % 2,671 Residential Supports 3 2, % 2,671 Residential Supports 4 2, % 2,671 Respite Care - Community 2, % 2,671 Respite Care Nursing LPN & RN 2, % 2,671 Supported Employment 16 & older 2, % 2,671 Supported Employment Long Term 16 & older 2, % 2,671 Follow-up Supported Living 18 & older 2, % 2, P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

24 B. C-Waiver Services Requiring Access within the Service Area to At Least One Provider Standard: 100% of eligible individuals must have access within the LME/MCO service area to at least one provider agency for each service. C-Waiver Services Access to at least one provider Services Adult Child # and % of enrollees with access within the LME-MCO catchment area to at least one provider agency # % Total # of C- Waiver Enrollees Day Supports 2, % 2,671 Out of Home Crisis 2, % 2,671 Respite Care - Community 2, % 2,671 Facility Financial Supports 2, % 2,671 2, % 2,671 Specialized Consultative Services (at least one provider of one of multiple services) Medicaid-funded C-Waiver services exceptions Are exceptions for any Medicaid-funded C-Waiver service in place as of the date of the 2017 gaps report submission, 5/1/2017? Yes, please list. No If the access and choice data is not at 100% for any Medicaid-funded C-Waiver service, are exception requests included with the 2017 gaps report? Yes, please list. No, please explain. Service-Related Items A. Medicaid-funded In Lieu of Services The following section is a description of Medicaid-funded In Lieu of services for Cardinal Innovations. In-Home Therapy (H2022 HE US) Geographic area covered o Available in all service area regions (added to Triad in December 2016) Service capacity o Between July 2016 and April 2017, the number of youth served ranged from 120 in March 2017 to 177 in November How service filled the gap it was intended to address o Engages families in intensive treatment to minimize need for higher levels of care when in home therapy and coordination are needed but the child does not meet medical necessity requiring Intensive In-Home (IIH) or Multi-Systemic Therapy (MST) services. o Increases the service continuum for children and adolescents with complex clinical needs that traditional outpatient therapy cannot adequately address, particularly in an office based setting. Barriers encountered and aha moments experienced during implementation o Locating and hiring fully licensed therapists is difficult because most fully licensed therapists want to be office based. o Providers struggle to market the service 23 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

25 o Cardinal Innovations Healthcare In-Home Therapy providers are viewed as competitors by providers who offer other child services Family Centered Treatment (FCT) (H2036 HK US) Geographic area covered o Available in all service area regions (added to Triad in December 2016) Service capacity o Between July 2016 and April 2017 FCT has grown from 28 to 38 individuals served with the strongest presence in Piedmont and Mecklenburg service areas. How service filled the gap it was intended to address o Prevents the use of Residential Treatment Level III services or shortens a placement in Level III to 90 days or less. o National research suggests community based intensive services lead to longer term positive outcomes for child and adolescents and ensures the family is engaged in the treatment process. Family engagement is often minimal in many cases in Level III services and the short term gains are lost when the child or adolescent returns home. o Cardinal Innovations is working with the Family Centered Treatment Foundation and Duke Endowment to conduct a formal randomized control measurement of FCT to have data to demonstrate these outcomes. Barriers encountered and aha moments experienced during implementation o Staffing the service in more rural areas is difficult due to lack of referrals. o FCT Foundation requires certification before the provider can deliver the service, as opposed to on the job training/certification. Assertive Community Treatment Team Step Down (ACTT-SD) (H0040 TS US) Geographic area covered o Service available in Piedmont, OPC, and Mecklenburg service areas. Service capacity o Large ACTT providers are permitted to serve no more than 20 individuals through their ACTT-SD program at any given time. Mid-size teams may be approved by DMA as needed to provide ACTT-SD to 10 to 15 individuals. How service filled the gap it was intended to address o Supports members who no longer need the full array of ACTT services but are not prepared to move to office based care. o Members continue to have access to the same nurse and psychiatrist that provided care while receiving the full version of ACTT. This creates a seamless transition for members as they move into the less intensive service ACTT-SD. Barriers encountered and aha moments experienced during implementation o Staffing patterns is a challenge for some providers because the number of members appropriate to step down to this service has not resulted in a full caseload initially. o Rural areas have not been able to implement due to having a small number of ACT Teams. o Some providers find it difficult to obtain the fidelity score required before service can be offered. Complex Needs (H0018 HA; H0018 HB) Geographic area covered o Available in all service area regions Service capacity o 4 children (ages 10 or older) served; referrals managed by Cardinal Innovations Healthcare. Capacity is at maximum level until another home can be added. However, due to stringent licensure and expense of starting a new group home this will take time. 24 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

26 Cardinal Innovations Healthcare How service filled the gap it was intended to address o Utilizes a multi-disciplinary treatment team who have expertise in providing services to members with co-occurring IDD and Mental Health diagnoses. This is an area that existing services were not able to meet as most focus solely on Mental Health or IDD rather than co-occurring diagnosis. Barriers encountered and aha moments experienced during implementation o Licensure process to approve the property chosen by the provider is more extensive than anticipated (somewhat due to specific requirements by the city). o Startup cost are high. B. Non-Medicaid-funded (State-funded) Services The next two items apply to services referenced in: State-Funded Enhanced Mental Health and Substance Use Disorder Services 2016 effective 10/1/16 State-Funded ACTT Policy State-Funded DMHDDSAS Service Definitions effective 9/1/16 Individual Supported Employment with Long-Term Vocational Supports YP630/YM For non-medicaid-funded services, the following is a description of any geographic discrepancies in services included in the LME/MCO s local benefit plan. That is, are residents of some counties excluded from coverage under the LME/MCO benefit plan, or have stricter eligibility requirements? All services are available to all members across the service area. Some services are reviewed on a case by case basis with the Medical team due to historical benefit plans in place prior to expansion. ADVP, SACOT, and Day Activity are examples of services reviewed on a case by case basis because there may be alternative (b)(3) Medicaid programs that are able to meet member needs and are more integrated for members. Site based programs such as SACOT are not sustainable in every area due to the census required to support the full program requirements, but these members still have access to programs in other areas. IPS-SE teams are expected to prioritize TCLI clients, not to the exclusion of non-medicaidfunded members. 2. For non-medicaid-funded services, describe any services that were closed to new admissions or not offered during the year. Include which services, why this occurred, the period of time, and how the LME/MCO ensured priority populations continued to access appropriate levels of care. No services were closed for non-medicaid-funded members. 3. For the following are approved non-medicaid-funded alternative service definitions for the LME/MCO Peer Support (YA308) Geographic area covered o Available in all service area regions Service capacity o 9 providers have served 376 distinct members since July 1, 2016 How service filled the gap it was intended to address o Allows Certified Peer Support Professionals to provide services to members with SMI or SUD in communities lived. o Available to members receiving SAIOP, PSR and basic outpatient services whereas in the past was available only to members receiving CST or ACTT. 25 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

27 o Cardinal Innovations Healthcare Recovery-focused empowering members to manage their own recovery through natural supports, coping and self-management skills, community engagement, selfadvocacy and navigating the healthcare system. o Used as a bridging service to connect with members discharging from acute settings supporting their transition back to the community Barriers encountered and aha moments experienced during implementation o Providers hesitant to employ community based positions with individuals who have Mental Health or SUD diagnoses. o Implementing and utilizing appropriate interventions as intended with a focus on recovery support. Peer Support Group (b)(3) (YA309) Geographic area covered o Available in all service area regions Service capacity o 4 providers have served 60 distinct members since July 1, 2016 How service filled the gap it was intended to address o Provides a means for Peer Support Professionals to provide psychoeducation, groups such as Wellness Recovery Action Planning, and illness management to individuals receiving Peer Support Services. Barriers encountered and aha moments experienced during implementation o Some members receiving Peer Support cite being uncomfortable in a group setting. o Some Peer Support Specialists cite being uncomfortable leading group sessions. Residential Supports SF 002 Community Assistance Series At the end of FY15, this service was ended. Members receiving this service were transitioned to Family Living, Group Living, or YM850 Residential Supports. Residential Supports SF 003 Community Assistance Series (YA312) At the end of FY15, this service was ended. Members receiving this service were transitioned to Family Living, Group Living, or YM850 Residential Supports. Assertive Engagement (YA323) Service was phased out in 2015 after Cardinal Innovations created Mobile Engagement services which are billed using enhanced outpatient CPT codes and provided by licensed clinicians. Peer Support Hospital Discharge & Diversion Individual (YA343) Cardinal Innovations does not have this service in provider contracts. The service was in CenterPoint contracts prior to the consolidation with Cardinal Innovations. CenterPoint providers transitioned to Cardinal Innovations had Peer Support (YA308) added to their contract. Peer Support Hospital Discharge & Diversion Group (YA375) Cardinal Innovations does not have this service in provider contracts. The service was in CenterPoint contracts prior to the consolidation with Cardinal Innovations. CenterPoint providers transitioned to Cardinal Innovations had Peer Support (YA309) added to their contract. Assertive Engagement (YA356) Service was phased out in 2015 after Cardinal Innovations created Mobile Engagement 26 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

28 services which are billed using enhanced outpatient CPT codes and provided by licensed clinicians. Hourly Safety Supervision (YA385) Geographic area covered o Available in all service area regions Service capacity o 6 members since 10/16; managed via the Client Specific Agreement process (Projected at members/100,000) How service filled the gap it was intended to address: o Service is provided in a residential setting providing additional staffing resources for supervision and monitoring of a member. Additional staffing ensures that the individualized safety plan to minimize harm to self or others and individualized behavior plan are followed. Referrals for this service are provided by Cardinal Innovations. o Allows for increased oversight to ensure behavioral interventions such as behavior plans, modification of treatment interventions, etc. are being implemented with a planned approach rather than adding more staff. o Allows for additional supports to be in place at of transition from inpatient services to give time for assessment of member s needs in a less restrictive setting. Barriers encountered and aha moments experienced during implementation: o Providers have struggled to develop sufficient behavior plans to meet the needs and ensure that treatment for high intensity members is individualized. o Oversight by QP has been cited by some providers as a barrier. Afterschool Summer Enrichment Program (YA392) Geographic area covered o Available in Triad service area only Service capacity o 12 members have received the service since the CenterPoint consolidation How service filled the gap it was intended to address: o Service exposes children to a variety of recreational events that are socially inclusive for the child in the community lived. Barriers encountered and aha moments experienced during implementation: o No known barriers. Youth Enrichment Supports (YA395) Geographic area covered: o Available in Triad service area only Service capacity: o 8 members received service during the summer of 2016 How service filled the gap it was intended to address: o Provides extra support and opportunity for children and youth to experience summer activities in an integrated setting. Barriers encountered and aha moments experienced during implementation: o No known barriers. 27 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

29 Section Three: Service Needs and Gaps Identified by Members, Family Members and Other Stakeholders Mental Health, Developmental Disabilities and Substance Use Disorder Service Gaps Identified by Members and Family Members In the Cardinal Innovations Needs Assessment Survey, members and family members were asked to identify barriers to accessing services from a list and then describe what they would change about services being received. The most selected barriers were medical issues, lack of employment, transportation, homeless/housing issues, unable to pay for services, no insurance, fear or embarrassment, lack of support from family/friends, physical disability, and legal issues. When respondents were asked what they would change about services being received, the most frequently perceived gaps/needs were identified: Additional psychiatrists are needed in all service areas, especially in rural counties. Need additional capacity at walk-in clinics and provider offices to reduce wait times. Additional SUD classes including more convenient start times was suggested. Reduced wait time for medication administration of methadone in Forsyth County. Need medications to be more affordable. Mental Health, Developmental Disabilities and Substance Use Disorder Service Gaps Identified by Stakeholders In the Cardinal Innovations Needs Assessment Survey, providers and other stakeholders such as Department of Social Services, Child Protective Services, Department of Justice, Division of Juvenile Justice, school systems, police & sheriff departments, Public Health Departments, primary care practices, hospitals and others were asked to identify barriers to accessing services from a list, and were asked to describe what other needs are not being met for members being served. The most frequently selected barriers were lack of transportation, no insurance, homeless/housing issues, cannot pay for services/medications, lack of employment, lack of support from family/friends, don t receive services as often as needed, provider not close to home (proximity), on a waiting list, language. When respondents were asked to describe what other needs are not being met for members served, the most frequently perceived gaps/needs were identified: For medication management, need additional psychiatrists in all service areas to reduce long wait periods accessing services, especially for children, adolescents, and those in rural counties. Additional psychologists needed to increase psychological testing capacity and decrease the wait time for evaluations. Need increased case management to assist members in the community. (e.g. therapist provide case management as much as possible, but they are not paid for the function of going into the community to assist in linkage and follow through). Need to decrease mobile crisis response times in Mecklenburg, Warren, Halifax, Union, and Davison counties. Additional SUD services are needed in all rural counties. Need more Child/Adolescent SUD services across all service areas. More clinicians are needed across all service areas who specialize in treatment of dual diagnosis (IDD/MH), domestic violence/anger management, sex offender, eating disorders (adolescents), gender identity, and PTSD/trauma related issues. In addition, there is a need for additional clinicians who serve children who are under 5 years old and adolescents. Need additional capacity at walk-in clinic in Mecklenburg to reduce long wait time. Additional detox beds are needed in Mecklenburg to meet demand; funding is needed for people without insurance to access detox; Rockingham County needs a detox facility to handle the large SUD population in that county. For Level II, III, and PRTF, need decreased wait times for authorizations and placements; need additional Level II & III beds in Warren County; additional TFC beds in Stanly; more Level II, III, and PRTF beds to meet demand in Rowan County. 28 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

30 Cardinal Innovations Healthcare For the juvenile population, need to reduce authorization approval time and placements for Level II, III, PRTF and TFC services. In addition, respondents recommended a wraparound service for moderate to high level juveniles and better case management. Increased independent living skills training needed. Additional services needed for individuals with a dual diagnosis, specifically MH/IDD. Recommended additional services to support individuals with Autism such as ABA therapy. Increased stability among (b)(3) providers needed. Need ability to locate services in a searchable directory to locate services at the local level. Need to be educated on services available. Need greater access and funding to naloxone and needle exchange due to high use of opiates. Additional peer services are needed to bridge gaps in care. Need more emergency respite for children. Medications need to be more affordable. Need more convenient CIT training times. Need more inpatient beds. Mental Health, Developmental Disabilities and Substance Use Disorder Service Gaps Identified by Geographic, Cultural or Demographic Groups In addition to the gaps/needs described earlier, respondents to the Cardinal Innovations Needs Assessment indicated the following needs/gaps in relation to geographic location, culture or demographic groups: Increased out-patient therapy is needed for elderly who are 65 and above. This population is growing rapidly with limited behavioral services available. In addition, in-home services are a need for those who have physical disabilities making it difficult for them to go into the community. Additional professionals, clinicians, and other staff are needed who speak Spanish to meet the linguistic and cultural needs for treatment and engagement of those who do not speak English. In addition, there is a need for Spanish speaking IDD providers as well as IDD educational materials in Spanish. Additional support groups and community resources are needed for individuals who speak Spanish. Need additional financial capacity to serve individuals who are undocumented. For children 5 and under, need more focused services for this age group. Need community based services for individuals who are being released from prison or jail. Need to increase awareness and knowledge on how to access assistive technology/devices and home modifications. Additional services for visually impaired Increased services for deaf and hard of hearing. Additional services needed for individuals with traumatic brain injury (TBI). Section Four: Strategies for Addressing Service Gaps This is a separate document due Friday, June 30, Strategies for addressing service gaps identified by access and choice data as well as by members, family members and other stakeholders are to be included in the 2017 Network Development Plan, due Friday, June 30, Section Five: Geo Maps Separate geo maps for all Medicaid-funded services listed in this document, except for outpatient services can be found in Appendix A. The geo maps show only provider agencies with current (as of 1/1/2017) LME/MCO contracts to provide Medicaid services. Section Six: Departmental Priorities The following section is a brief description of recent activities and projects that Cardinal Innovations is engaged to address Departmental (DMH/DD/SAS and DMA) priorities. 29 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

31 Prevention and Education Cardinal Innovations Healthcare One of the key roles Cardinal Innovations plays in the communities throughout its service area is to provide education and training opportunities for members and families, providers, and local stakeholders. Supporting and hosting various training events and programs is an important way to educate people and communities and build collaboration. Most of the training programs are free and open to the public, while some are specifically for providers or local partners. In the Community Operations department, the Community and Member Engagement representatives assist in the development and implementation of preventative, educational and outreach programs. They help establish and facilitate community collaboration and coordination with local stakeholders and community partners. Community and Member Engagement representatives provide general education to the community and outreach activities to unserved and underserved populations. Member Engagement provides non-clinical support and referrals for members and their families. The team strives to empower members through education, advocacy, systems navigation, support, and health promotion, preventive training, and other initiatives. Trainings include Prime for Life Tobacco Cessation, Wellness Recovery Action Plan and Whole Health Action Management. In addition, Member Engagement maintains Wellness Centers where members and others in the community can access trainings and resources that include integration of medical and behavioral health topics. Member engagement is also involved other projects such as completing the Community Needs Assessment to determine needs and gaps and setting measurable programming goals; and, providing referrals and information for behavioral health and medical health via the referral line. In relation to events for this fiscal year so far: 391 events offered with 134 hosted by Cardinal Innovations 4,166 participants in total with 2,428 being new participants 970 participants at Cardinal Innovations hosted events 224 prevention strategies presented Community Engagement engages key community partners (e.g. law enforcement agencies, school systems and non-profit organizations) through outreach, education and training to promote awareness of Cardinal Innovations and the services they provide to special populations. Examples of trainings offered by Community Engagement are Mental Health First Aid, Crisis Intervention Team, Suicide Prevention Training: QPR (Question, Persuade, and Refer), Stigma, Trauma Informed Care, and Alcohol Impairment Simulation. For this fiscal year, Community Engagement has reached several accomplishments so far: 4,072 People trained in 204 trainings Provided training on the IVC process with Mark Botts to Rockingham and Davie justice systems Partnered with NC Strive to host Higher Education Conference for college administrators so they may better support military veterans in their programs In partnership with several departments, facilitated a tailored Cardinal overview for DSS agencies in Triad area With Network Management, assisted the NC Governors Institute with conducting a smoking cessation survey to our Providers Intervention and Treatment Cardinal Innovations is committed to delivering effective strategies for crisis care as envisioned by the North Carolina Crisis Solutions Initiative. The North Carolina Crisis Solutions Initiative focuses on identifying and implementing the best known strategies for crisis care while reducing avoidable visits to emergency departments and involvement with the criminal justice system for individuals in behavioral health crises. There are a variety of crisis services available at Cardinal Innovations such as facility-based crisis, mobile crisis, and behavioral health urgent care. Facility-based Crisis units are open 24/7/365 providing an alternative to hospitalization for individuals in crisis who have a mental illness, substance use disorder or intellectual and developmental disability. Treatment includes assessment; evaluation; group and individual therapy; skills training to assist individuals in preventing or managing future crises; 30 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

32 medication management; case management; and medical substance detoxification for those who need it. In addition, the facility-based crisis units accepts involuntarily committed individuals. The goal of the program is to de-escalate and stabilize the individual so that he or she can safely return to a lower level of care. Behavioral Health Urgent Care units provide immediate care to adults, adolescents or families in crisis. Treatment includes assessment and diagnosis for mental illness, substance use disorder and intellectual and developmental disability issues; planning and referral for future treatment; medication management; and outpatient treatment. In addition to the crisis services already available at Cardinal Innovations, additional services will be added: A behavioral health urgent care unit operated by Daymark will open in late Summer 2017 in Forsyth County. A primary care clinic will be co-located. A child and adolescent facility-based crisis unit operated by Monarch will open in Mecklenburg County in Fall A facility based crisis facility will open in Davidson County in Summer Cardinal Innovations is also engaged in other activities to promote and reduce avoidable visits to the emergency departments and involvement with the criminal justice system for individuals in crises such as providing Crisis Intervention Team (CIT) training, Mental Health First Aid (MHFA) training, and promoting a pilot EMS Diversion Program. CIT training provides law enforcement officers with 40 or more hours of training to prepare them to assist individuals experiencing a mental health, substance use or developmental disability crisis. Training topics include Overview of Mental Health, Geriatrics, Substance Abuse/Co-Occurring Disorders, Special Concerns with Adolescents, Mental Health Commitment Process, Personality Disorders, Developmental Disabilities, Autism, Suicide, Trauma and its aftermath, Homelessness Crisis Intervention and De-escalation. For FY17 a total of 293 people have been trained across the service area. MHFA is an 8-hour course that teaches individuals how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training provides skills to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis. The training is designed for professionals, teachers, first responders, veterans, parents, friends, faith based leaders, etc. For FY17 a total of 1,618 people have been trained across the service area. The EMS Diversion Pilot Program is designed to use EMS staff who have been trained in CIT to assist patients experiencing behavioral health crises. Funding for the pilot program come from the state through the North Carolina 2015 Appropriations Act, Session Law , Section 12F.8(a). The pilot funding provides a reimbursement mechanism for the participating EMS to either treat on-scene or take individuals not needing medical treatment to lower cost alternatives to hospital emergency departments such as facility-based crisis units. Davie, Franklin, Orange, Halifax, Forsyth, Stokes, and Rockingham Counties were awarded funds to be used for the pilot diversion program. Housing and Employment Transitions to Community Living Initiative (TCLI) TCL is an initiative that began after the State of North Carolina entered into a settlement agreement with the U.S. Department of Justice in The purpose of the agreement was to ensure that individuals with mental illness are able to live in their communities in the least restrictive settings of their choice. TCL helps people with mental illness who are living in adult care homes find and choose housing in their communities. The NC Department of Health and Human Services (DHHS) is implementing the agreement through the TCLI. Cardinal Innovations TCL unit is part of the Care Coordination Department. Cardinal Innovations Healthcare offers TCL training for providers throughout its service regions. This TCL training highlights the TCL process, roles and expectations of Cardinal Innovations and provider staff within the direction of DHHS and the U.S. Department of Justice. For FY17, Cardinal has achieved the following with the TCL program: 31 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

33 Cardinal Innovations Healthcare Helped over 350 individual find homes to date Ahead of pace for achieving FY17 goals set by DHHS Fifty-eight staff operating throughout the service area creating success stories for individuals Enhanced processes through partnerships with Network Management, Finance, and Utilization Management In addition, Cardinal Innovations has developed a new Community Engagement Housing Specialist position to support the TCLI in the Triad Region. The Specialist is supporting the program by educating property managers, landlords, investors, and real estate agents about the Cardinal Innovations TCL program. So far, the Specialist has presented and received verbal interest to provide housing to members in the TCL program from the following: 24 property managers 4 private investors 4 private owners 2 realtor organizations Following up on the verbal interest, the Specialist has secured 61 housing opportunities in Forsyth County and 3 in Rockingham. The Specialist will begin building housing capacity in Stokes and Davie beginning in April. Cardinal Innovations will be expanding the Community Engagement Housing Specialist into other regions in the months ahead. Last, Cardinal Innovations has launched a TCL-related pilot with CCNC local network Community Care Partners of Greater Mecklenburg. Members shared by Cardinal Innovations and Community Care Partners of Greater Mecklenburg are identified for integrated care. Information is exchanged increasing the chances of success for members. Cardinal Innovations has also hired a TCL RN to support members medical and behavioral health needs with transitioning to community. Individual Placement and Support Supported Employment (IPS-SE) IPS-SE is an evidence-based service focused on supporting individuals with serious to severe and persistent mental illness (SPMI) and co-occurring disorders in their efforts to achieve stable employment. The service emphasizes assistance in choosing, acquiring, and maintaining competitive paid employment in the community for individuals 18 years old and older. A fidelity scale is a tool to measure the level of implementation of an evidence-based practice. The IPS-SE Fidelity Scale defines the critical elements of IPS-SE in order to differentiate between programs that have fully (high fidelity) implemented the model and those that have not (low fidelity). As demonstrated through research, high-fidelity programs are expected to have greater effectiveness than low-fidelity programs. Once a fidelity review is completed by fidelity reviewers, feedback is provided to the agency by sending a completed IPS-SE Fidelity Scale and a written report that includes observations, assessments, and recommendations for program improvement. Cardinal Innovations has established a Learning Collaborative for contracted IPS-SE providers to provide additional support and technical assistance toward maintaining and enhancing fidelity. Significant focus has been placed on assuring that providers are well versed in the TCL processes and improving collaboration between TCL Care Coordination and IPS-SE providers. Two new teams had their initial fidelity review and met fidelity during this past year. A total of 551 members have been served (Medicaid and non-medicaid), of which 174 were referred by TCL, and 293 served by a fidelity provider. IPS-SE teams prioritize admission of TCL members. Children and Families System of Care is a comprehensive network of community-based services and supports organized to meet the needs of families who are involved with multiple child service agencies such as child welfare, mental health, schools, juvenile 32 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

34 justice, and health care. Families and youth work in partnership with public and private organizations, ensuring supports are effective and built on the individual's strengths and needs. System of Care at Cardinal Innovations has been involved with the Partnering for Excellence (PFE) effort in Rowan County. PFE is an effort to improve services and outcomes for children and families affected by trauma. PFE began in 2012 when The Duke Endowment provided funding to Benchmarks, an alliance of nationally-accredited human service agencies in North Carolina, to redesign the way the child welfare and mental health systems interact to: Provide trauma-informed services to support improved child and family outcomes; Reduce costs by helping both systems avoid unnecessary use of high-end services; and Reduce the need for future CPS involvement in families currently receiving child welfare services. The pilot of PFE began in July 2013 in Rowan County, where Cardinal Innovations, the department of social services, and private mental health providers have been collaborating to increase their focus on trauma and the use of evidence-based practices. The PFE model pro-actively screens children for trauma and links the child with appropriate treatment. As a result of the collaboration efforts, the number of Trauma-Focused Cognitive Behavior Therapists have increased in Rowan County. In addition, Cardinal Innovations through the Community Operations Department has conducted several trainings for community partners such as law enforcement agencies, school systems and non-profit organizations, educating trainees on what trauma is, the types of trauma, and identifying signs of trauma. Last, the PFE model is being expanded into Davidson County. In preliminary evaluation results by the Center for Child and Family Policy at Duke University who is evaluating the PFE pilot, results comparing children before and after PFE came to Rowan County seem promising. As indicated, the data is preliminary, but since the start of PFE there has been a decrease in the percentage of young people diagnosed with ADHD and conduct disorder, while the number diagnosed with PTSD has increased, thus influencing subsequent treatment approach and modalities. One explanation for this shift in diagnoses is that Trauma-Focused Behavior Therapists are more informed about trauma and provide more appropriate diagnoses, leading to young people receiving appropriate services. In addition to PFE, System of Care has also partnered with UNC Charlotte School of Social Work and North Carolina Families United (NCFU), to collaborate for the best interests of children and families. The partnership is focused on training social work students on system of care and child and family teams from the family perspective. The classroom environment turns into a simulated child and family team meeting as students assume roles and apply content learned from the training. For FY17, 29 social work students from UNC Charlotte have been trained. Quality Monitoring and Management The Quality Management Department at Cardinal Innovations works closely with network providers to improve services delivered to members and their families, offering guidance and training. Quality Management is responsible for overall monitoring of internal and external service quality to meet federal and state standards and the development of the organization s Quality Improvement Work-plan. The Quality Improvement work plan is a cross departmental and provider collaborative activity which aids in planning, developing, prioritizing and supporting quality improvement initiatives and activities. The Quality Improvement program incorporates, implements and supplements system goals and objectives as part of its overall Quality Improvement Work Plan. Once opportunities are identified through internal data, member and provider surveys, Regional Global Continuous Quality Improvement (GCQI) committees, state and federal reports, grievances, and performance metrics, etc., they are discussed and prioritized at the Continuous Quality Improvement (CQI) Committee. 33 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

35 The Quality Improvement program is structurally designed to continuously solicit feedback of outcomes and performance, make informed decisions, prioritize resources, set goals, identify greatest opportunities for improvement and provide the infrastructure to achieve improved outcomes. FY16 quality improvement project achievements included: Improved utilization of long acting injectable antipsychotic mediations in adult schizophrenia from 9.19% to 10.83%. Increased schizophrenia/schizoaffective member compliance in filling prescriptions for smoking cessation medications from 0.36% to 3.05%. Improved post hospitalization follow-up visits with outpatient providers scheduled for behavior health hospitalizations within 7 days of discharge from 34.58% to 38.67%. Reduced number of MH/SA individuals needing 3 or more crisis services in a 12 month period from July 2015 to June The work-plan goals are reviewed throughout the year and are continued, revised, retired and/or additional goals are added based on set outcomes and areas of improvement identified to improve quality of care. FY17 quality improvement projects includes: Improving timely emergent access to care. Increasing compliance follow-up with outpatient provider 7 and 30 days after hospitalization. Decreasing the number of members who experience 3 or more crisis service utilizations in a 12 month period. Implementation of a centralized grievance resolution process with a goal of increasing the timeliness of grievance resolutions. Intervention by Cardinal Innovations pharmacist for members on antipsychotics who are at risk of crisis to support medication compliance to decrease risk of crisis events. Integrated Care Integrated Care is a blending of medical services and behavioral health in the patient care setting. According to Katzelnick, et al in 2000, Integrated Care provides more effective medication management; reduces severity of depression; improves health status; decreases disability; provides better occupational function; improves patient satisfaction; and is cost effective. Cardinal Innovations is committed to individuals receiving Integrated Care. At their March 2017 meeting, the Care Management Team at Cardinal Innovations approved the creation of an Integrated Care Strategy Development subgroup. This subgroup includes representation from various departments such as Care Coordination, Medical, Member Engagement, and Utilization Management. The subgroup will be identifying an operational Integrated Care strategy for supporting existing Integrated Care initiatives internally and externally in the network and for vetting incoming Integrated Care requests. In addition to the Integrated Care Strategy Development subgroup, a Grants and Special Projects subgroup has been formed to review special project requests, including Integrated Care special projects. The Integrated Care Strategy Development subgroup will develop a priority grid for the evaluation of special projects and will report this information to the Grants and Special Projects subgroup. Cardinal Innovations supports three full-time Integrated Care positions: Integrated Care Strategist (Medical Department) - provides project management for internal integrated care projects and support/development of external Integrated Care projects Integrated Health Registered Nurse (RN) (Care Coordination Department) - a nurse manager for internal Integrated Care and care coordination projects in the community. Transition to Community Living RN (Care Coordination Department) - a nurse who supports members medical and behavioral health needs with transitioning to community living. 34 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

36 Additionally, the Integrated Health RN partners with the Clinical Director of Care Coordination, a doctoral-level psychologist, to provide clinical support staffing for individuals with intellectual and developmental disabilities. Staffing will support the holistic health and medical needs as well as the intellectual and developmental disability needs of the individual. Current internal Integrated Care projects include Antipsychotic Adherence calls, Acute Transitional Care Coordination (ATCC) Intervention, and ATCC trigger for pregnant members. Antipsychotic Adherence calls: Members who are late to refill their prescribed antipsychotic medications receive a call from Cardinal Innovations pharmacist or pharmacist assistant; alternatively, outreach may be to the member s pharmacy and/or caregiver. Information regarding this exchange is then faxed to both the member s pharmacy and primary care physician. The ATCC Intervention project is facilitated by the Integrated Health RN. Members who are in the first 30 days following discharge from a behavioral health hospitalization are assigned a care coordinator. The care coordinator is available to conduct home visits, do medication reconciliation, and accompany member to medical and behavioral health office visits. In addition, they ensure linkage to services and engagement. The ATCC trigger for members who are pregnant ensures that members receiving ATCC who are pregnant or become pregnant get a care coordination trigger for a Medication Review from the Cardinal Innovations pharmacist. Additionally, Cardinal Innovations has an ongoing partnership with Community Care of North Carolina (CCNC). Through this partnership, Cardinal Innovations is able to promote greater Integrated Care for Cardinal members. In addition the partnership provides behavioral health collaboration and support for CCNC staff. Cardinal Innovations also has a Transition to Community Living (TCL) pilot with a CCNC local network Community Care Partners of Greater Mecklenburg. Through this pilot, shared members are identified for Integrated Care and information is exchanged to increase the chances of success for members in the community. Cardinal Innovations has also hired a Transition to Community Living RN to support members medical and behavioral health needs with transitioning to community. The Highland Avenue Center is an Integrated Care project funded by Cardinal Innovations that will soon offer Integrated Care to the service area. The Center will consist of a behavioral health urgent care unit, outpatient behavioral health clinic, wellness center, and primary care medical clinic. Cardinal Innovations also supports external Integrated Care initiatives in the network. These include partnerships with primary care clinics and academic medical centers pursuing Integrated Care approaches. These external programs are summarized below: Embedded Psychiatrist at Downtown Health Plaza Cardinal Innovations funds a part-time embedded psychiatrist for a local medical center serving indigent and Medicaid patients in Winston-Salem. The psychiatrist splits time between the pediatrics department and the adult internal medicine department. Duke Integrated Care Project Duke Psychiatrics is applying for a Kate B. Reynold Charitable Trust grant to implement a child psychiatry telephone consultation program supporting the Person, Granville, Warren, Vance, and Franklin. Cardinal Innovations has been brought the table as a collaborator on this project. Cabarrus Health Alliance Cardinal Innovations adapted its credentialing and contracting process to assist Cabarrus Health Alliance in partnering with Monarch to provide women with post-partum tele-therapy and medication management. Cabarrus Free Clinic Cardinal Innovations has assisted in facilitating a partnership between the Cabarrus Free Clinic and SIMS Consulting and Clinical Services allowing SIMS to provide behavioral health services to individuals. 35 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

37 Appendix A Geo Maps Cardinal Innovations Healthcare Location-based Services One geo map for each Medicaid location-based service. Maps show provider locations with a radius of 30 miles for providers located in urban counties and 45 miles for providers located in rural counties for the Cardinal Innovations service area. Psychosocial Rehabilitation 36 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

38 Child & Adolescent Day Treatment Cardinal Innovations Healthcare 37 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

39 Substance Abuse Comprehensive Outpatient Therapy (SACOT) 38 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

40 Substance Abuse Intensive Outpatient Treatment Program (SAIOP) 39 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

41 Opioid Treatment Cardinal Innovations Healthcare 40 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

42 Community / Mobile Services One geo map for each Medicaid community/mobile service. Blue shaded area indicates provider coverage in the Cardinal Innovations service area. Assertive Community Treatment Team (ACTT) Community Support Team (CST) 41 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

43 Intensive In-Home Service (IIHS) Cardinal Innovations Healthcare Mobile Crisis 42 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

44 Multi-Systemic Therapy (MST) Cardinal Innovations Healthcare (b)(3) MH Supported Employment Service 43 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

45 (b)(3) IDD Supported Employment Service Cardinal Innovations Healthcare (b)(3) Wavier Community Guide 44 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

46 (b)(3) Waiver Individual Support (Personal Care) Cardinal Innovations Healthcare (b)(3) Waiver Peer Support 45 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

47 (b)(3) Waiver Respite Cardinal Innovations Healthcare 46 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

48 Crisis Services One geo map for each Medicaid crisis service that shows provider locations within the Cardinal Innovations service area. Facility-based Crisis (Adults) Facility-based Respite 47 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

49 Crisis Detox (Non-Hospital) Cardinal Innovations Healthcare Inpatient Services One geo map for each Medicaid inpatient service that shows provider locations within Cardinal Innovations Service area. Inpatient / Hospital (Adult) 48 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

50 Inpatient / Hospital (Child) Cardinal Innovations Healthcare Specialized Services One geo map for each Medicaid specialized service that shows Cardinal Innovations contracted provider locations within North Carolina. Partial Hospital 49 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

51 Psychiatric Residential Treatment Facility (PRTF) Residential Treatment Level 1 50 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

52 Residential Treatment Level 2 Cardinal Innovations Healthcare 51 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

53 Residential Treatment Level 2 (Therapeutic Foster Care) Residential Treatment Level 3 52 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

54 Residential Treatment Level 4 Cardinal Innovations Healthcare SA Medically Monitored Community Residential Treatment 53 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

55 (b)(3) Out of Home Respite Cardinal Innovations Healthcare (b)(3) IDD Facility-based Respite 54 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

56 (b)(3) IDD Residential Supports Cardinal Innovations Healthcare Intermediate Care Facility (IDD) 55 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

57 C-Waiver services One geo map for each C-Waiver residential and day supports service contracted with Cardinal Innovations. Day Supports Residential Supports 1 56 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

58 Residential Supports 2 Cardinal Innovations Healthcare Residential Supports 3 57 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

59 Residential Supports 4 Cardinal Innovations Healthcare 58 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

60 Appendix B Needs Assessment Survey English Version 59 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

61 60 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

62 61 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

63 62 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

64 63 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

65 64 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

66 65 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

67 66 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

68 67 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

69 68 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

70 69 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

71 70 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

72 71 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

73 72 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

74 73 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

75 74 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

76 75 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

77 Spanish Version Cardinal Innovations Healthcare 76 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

78 77 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

79 78 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

80 79 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

81 80 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

82 81 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

83 82 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e

84 83 P a g e C a r d i n a l I n n o v a t i o n s H e a l t h c a r e