Broward Regional Health Planning Council, Inc. Inc. 200 200 Oakwood Lane, Suite 100 100 Hollywood, Florida 33020 T: T: (954) 561-9681 F: F: (954) 561-9685 MENTAL HEALTH / SUBSTANCE ABUSE QI NETWORK April 19, 2013 at 2:00 p.m. Ryan White Part A Program Office 115 S. Andrews Ave., Ft. Lauderdale, FL 33301 I. Call to Order AGENDA II. III. IV. Welcome/Introductions Review April 19, 2013 Meeting Agenda and February 15, 2013 Meeting Minutes NQC In + Care Campaign Measures Report ACTION ITEM: Review summary of retention rates and discuss role of Mental Health/Substance Abuse in retention V. Annual Mental Health/Substance Abuse Work Plan ACTION ITEM: Review Mental Health/Substance Abuse annual work plan and discuss FY 13-14 activities VI. Review Presentation on Assessing Depression ACTION ITEM: Discuss and finalize Assessing Depression Presentation for Case Manager Training VII. Old/New Business VIII. Resource Sharing IX. Review Agenda Items for Next Meeting X. Adjournment Next Meeting Date: June 21, 2013
COMMUNITY PARTNERSHIPS DIVISION Health Care Services Section 115 S Andrews Avenue, Room A300 Fort Lauderdale, Florida 33301 954-357-5390 FAX 954-357-5897 MENTAL HEALTH/ SUBSTANCE ABUSE QI NETWORK Friday, February 15, 2013 at 2:30 P.M. Ryan White Part A Program Office 115 S. Andrews Ave., Ft. Lauderdale 33301 MEMBERS PRESENT Elizabeth Johnson, SBHD Gary Sullivan, Broward House Tom Pietrogallo, Care Resource MEMBERS ABSENT Edith Garcia, MDEI GUESTS Abe Feingold, BCHD PROACT Program I. Call to Order The meeting was called to order at 2:40 PM. Minutes PART A GRANTEE Shaundelyn Degraffenreidt Mary Elizabeth Swanson Leonard Jones CLINICAL QUALITY MANAGEMENT (CQM) SUPPORT STAFF Ariela Eshel Rachele Solomon II. III. Welcome and Introductions Introductions were made and affiliations were stated. Review and Approve February 15, 2013 Agenda and January 11, 2013 Meeting Minutes The Network reviewed the agenda and minutes. The agenda was approved. PROACT requested that the minutes reflecting an introduction to PROACT on 1/11/13 be changed to include the following changes: Eliana Amar from PROACT facilitated a discussion with the Network about PROACT. Ms. Amar explained that PROACT was launched to support the provision of HIV/AIDS care in Broward County. The focus of the program is assistance with retention for clients who have been struggling to stay in care. Ms. Amar wanted to ensure that the Network is aware of the program as well as the referral process to and from Part A. She noted that the PROACT program will be making referrals to Part A mental health/substance abuse providers as the PROACT program does not provide MH/SA care that is already available in the community. It was announced that the PROACT program is hiring an experienced licensed behavioral health professional and asked the Network to share the job opportunity with anyone interested. IV. NQC In+Care Campaign Measures Report The Network was given a copy of the annual summary of the In+Care Campaign. The Network will review the summary at the next meeting (copy on file). Broward County Board of County Commissioners Sue Gunzburger Dale V.C. Holness Kristin Jacobs Chip LaMarca Ilene Lieberman Stacy Ritter John E. Rodstrom, Jr. Barbara Sharief Lois Wexler www.broward.org
2 V. Mental Health and Substance Abuse Service Delivery Models The Network agreed on the following revisions to the SDMs. Outcomes, Outcome Indicators, Inputs, Strategies, Data Sources (Mental Health) Client Outcome Outcome Indicators Inputs Strategies Data Source 1-Improvement in client s symptoms associated with primary mental health diagnosis. 1.1-85% of clients achieve Plan of Care goals by designated target date. 2-Increase and/or maintain retention in Outpatient/Ambul atory Medical Care. NOTE: Retention in care reflects an OAMC visit with a provider in the first 6 months and the last 6 months of a 12 month measurement period. 2.1-85% of clients are retained in Outpatient/Ambulatory Medical Care. Staff Funding Clients Clinical Scales Facilities Supplies Staff Funding Clients Facilities Supplies 1.1.1 Initial intake completed 1.1.2 Complete Biopsychosocial Evaluation 1.1.3 Administer appropriate Clinical Scale as needed 1.1.4 Develop Treatment Plan 1.1.5 Treatment Plan Review 1.1.6 Re-administer Clinical Scale at Time of Treatment Plan Review (Quarterly) 1.1.7 Discharge 2.1.1. Determine if client is currently enrolled in Outpatient/Ambulatory Medical care 2.1.2. Assess for barriers to care 2.1.3. Address any identified barriers in treatment plan 2.1.4. If indicated, complete referral to Outpatient/Ambulatory Medical care 2.1.5 Documentation of medical appointment kept on file Standards for Service Delivery (Mental Health) Standard Indicator Data Source 2. Client is oriented to Ryan White Mental Health Services. 2.1. 100% of clients will be informed of expected participation in and development of individualized treatment plan. 2.2. 100% of clients will be informed as to availability of various treatment modalities (internal and external to the individual provider). 2.3. 100% of clients will be informed of availability of psychiatric evaluation as part of individualized treatment plan. 2.4. 100% of clients will be informed of availability of access to psychotropic medications as part of their individualized treatment plan. 1.1.1 Intake Form 1.1.2.1 Biopsychosocial Evaluation 1.1.3.1 Clinical Scale 1.1.4.1 Agency Treatment Plan 1.1.5.1 Agency Treatment Plan Review Form 1.1.6.1 Clinical Scale 1.1.7.1 Transfer/Discharge Summary 2.1.1.1. Biopsychosocial Evaluation 2.1.2.1. Biopsychosocial Evaluation 2.1.3.1. Treatment Plan 2.1.4.1 MIS service request 2.1.4.2 Paper certified referral 2.1.4.3. Progress Notes Log 2.1.5.1. Lab documentation 2.1.5.2. Doctor Letter 2.1.5.3. Medical slip (appointment reminder note) PE appointment record 2.1.5.4 Documented phone conversation with medical clinic 2.1.1. Consent Acknowledgment Form 2.2.1. Combined Consent and Acknowledgment Form 2.3.1 Combined Consent and Acknowledgement Form 2.4.1 Combined Consent and Acknowledgement Form
3 3. Client is orientated to other Ryan White services. 8. Client participates in decision making related to treatment. 10. Client Treatment Plan is followed up quarterly. 11. Re-assessment is ongoing and driven by client need. 12. Client receives intervention to access Outpatient/Ambulatory Medical care. 13. Client in Outpatient/Ambulatory Medical care is assessed for retention in Outpatient/Ambulatory Medical care. 14. Client is assessed for adherence to prescribed HIV and/or psychotropic medications. 15. Client completes mental health treatment plan. 3.1. 100% of client charts show orientation was provided. 3.2. 100% of client charts have a copy of Client Rights and Responsibilities in the Combined Consent and Acknowledgment Form, signed by the client. 3.3. 100% of client charts show discussion of client confidentiality. 3.4. 100% of client charts show discussion of grievance process. 3.5 100% of clients are provided education, orientation to programs and services. 8.1 100% of client charts show documentation of client participation through their signature on Treatment Plan. 10.1 100% of client charts show Treatment Plan reassessed quarterly. 10.2 100% of client charts show at least, quarterly follow-up of referrals given. 11.1 100% of clients will be re-assessed annually, at a minimum. 12.1. 100% of clients consenting to receive Outpatient/Ambulatory Medical care receive a referral to medical care. 12.2. 100% of clients consenting to receive Outpatient/Ambulatory Medical care receive a list of Ryan White Outpatient/Ambulatory Medical care Providers. 13.1 100% of clients are assessed for retention in care on a quarterly basis 13.2. 100% of client charts show assessment of barriers to remain in Outpatient/Ambulatory Medical care. 13.3. 100% of charts of clients disclosing barriers to retention in Outpatient/Ambulatory Medical care show referral to Medical Case Manager. 14.1. 100% client charts minimally show assessment of client adherence to prescribed HIV and/or psychotropic medications at treatment plan review. 15.1. 65% of clients complete the Treatment Plan. 3.1.1. Combined Consent and Acknowledgment Form 3.2.1 Combined Consent and Acknowledgement Form 3.3.1 Combined Consent and Acknowledgement Form 3.4.1. Agency grievance process 3.4.2. Combined Consent and Acknowledgment Form 3.5.1 Client signature in chart. 8.1.1. Treatment Plan 8.1.2. Progress Notes Log 10.1.1. Treatment Plan 10.1.1. Progress Notes Log 10.2.2. Progress Notes 11.1.1. Assessment 11.1.2 Treatment plan 11.1.3 Progress Notes Log 12.1.1. Progress Notes Log 12.1.2. Certification/ Referral/Recertification Form 12.2.1. List of Ryan White Outpatient/Ambulatory Medical care Providers 13.1.1 Treatment Notes Plan 13.2.1. Progress Notes Log 13.3.1. Certification/ Referral/Recertification Form 14.1.1. Progress Notes Log 15.1.1. Treatment Plan 15.1.2. Progress Notes Log Outcome/Indicator Definitions (Mental Health) Indicator 1.1 This indicator is applicable to new clients only for a maximum of one year. Scales are to be administered quarterly in conjunction with treatment plan updates. Indicator 2.2 Discharge definition is a planned and/or anticipated termination of service by the client and registered clinical intern or licensed practitioner. Enrolled in Outpatient/Ambulatory Medical Care is defined as a client who has attended a Medical clinical (doctor s visit or lab) appointment in the last 6 months or presents an appointment card or faxed confirmation from physician s office of future appointment.
4 Credentials (Mental Health) Graduate level student currently enrolled in an accredited university of Mental Health Counseling, Marriage and Family Therapy, Social Work or Psychology Supervisor (Mental Health) Licensed practitioner and State of Florida Qualified Supervisor Outcomes, Outcome Indicators, Strategies and Data Sources (Substance Abuse) Client Outcomes Outcome Indictors Inputs Strategies Data Source 1-Improvement in client s 1.1-85% of clients Funding 1.1.1.1 Intake Form symptoms and/or behaviors associated with primary substance abuse diagnosis achieve Plan of Care goals by designated target date.) Clients 2-Increase and/or maintain retention in Outpatient/Ambulatory Medical Care. Retention in care reflects an OAMC visit with a provider in the first 6 months and the last 6 months of a 12 month measurement period. 2.1-85% of clients are retained in Outpatient/ Ambulatory Medical Care. Staff 1.1.1 Initial Intake Completed 1.1.2 Complete Biopsychosocial 1.1.3 Administer Appropriate Clinical Scale as needed 1.1.4 Develop Treatment Plan 1.1.5 Treatment Plan Review 1.1.6 Re-administer Clinical Scale at Time of Treatment Plan Review (Quarterly) 1.1.7 Discharge 2.1.1. Determine if client is currently enrolled in primary medical care 2.1.2. Assess for barriers to care. 2.1.3. Address any identified barriers in treatment plan. 2.1.4. If indicated, complete referral to primary medical care. 2.1.5. Documentation of medical appointment kept on file. Standards for Service Delivery (Substance Abuse) Standard Indicator Data Source 3. Client is orientated to Ryan White service system. 3.1. 100% of client charts show orientation was provided 3.2. 100% of client charts have a copy of Client Rights and Responsibilities in the Combined Consent and Acknowledgment, signed by the client. 3.3. 100% of client charts show discussion of client confidentiality. 3.4. 100% of client charts show 1.1.2.1 Biopsychosocial Evaluation 1.1.3.1 Clinical Scale 1.1.4.1 Agency Treatment Plan 1.1.5.1 Agency Treatment Plan Review Form 1.1.6.1 Clinical Scale 1.1.7.1Transfer/Discharge Summary 2.1.1.1. Biopsychosocial Evaluation 2.1.2.1. Biopsychosocial Evaluation 2.1.3.1. Treatment Plan 2.1.4.1 MIS service reguest 2.1.4.2 Paper certified referral 2.1.4.3. Progress Notes Log 2.1.5.1. Lab documentation 2.1.5.2 Doctor Letter 2.1.5.3. MIS CD4/viral load documentation 2.1.5.4. Medical slip PE appointment record 2.1.5.5. Documented phone conversation with medical clinic 3.1.1. Combined Consent and Acknowledgment form (Exhibit 2) 3.2.1 Combined Consent and Acknowledgeable form 3.3.1 Combined Consent and Acknowledgeable form 3.4.1. Agency grievance process 3.4.2. Combined Consent and Acknowledgment Form 3.5.1 Client signature in chart
5 7. Client participates in decision making related to treatment. 9. Client Treatment Plan is followed up quarterly. 11. Client in primary medical care is assessed for retention in primary medical care. 12. Client is assessed for adherence to prescribed HIV and/or psychotropic medications. discussion of grievance process. 3.5 100% of clients are provided education, orientation to programs and services. 7.1. 100% of client charts show documentation of client participation through their signature on Comprehensive Treatment Plan. 9.1. 100% of client charts show Treatment Plan reassessed quarterly. 9.2. 100% of client charts show at least, quarterly follow-up of referrals given. 11.1 100% of clients are assessed for retention in care on a quarterly basis 11.2. 100% of client charts show assessment of barriers to remain in primary medical care. 11.3. 100% of charts of clients disclosing barriers to retention in primary medical care show referral to case manager. 12.1.100% client charts minimally show assessment of client adherence to prescribed HIV and/or psychotropic medications at treatment plan review. 7.1.1. Treatment Plan 7.1.2. Progress Notes Log 9.1.1. Treatment Plan 9.1.2. Progress Notes Log 9.2.1 Progress Notes 11.1.1 Treatment Plan 11.2.1. Progress Notes Log 11.3.1.Certification/ Referral/Re-certification Form 12.1.1. Progress Notes Log 12.1.2. Tracking system Outcome/Indicator Definitions (Substance Abuse) Indicator 2.2 Discharge definition is a planned and/or anticipated termination of service by the client and licensed or certified practitioner. Enrolled in Outpatient/Ambulatory Medical Care is defined as a client who has attended a Medical clinical (doctor s visit or lab) appointment in the last 6 months or presents an appointment card or faxed confirmation from physician s office of future appointment. Credentials (Substance Abuse) Graduate level student currently enrolled in an accredited university of Mental Health Counseling, Marriage and Family Therapy, Social Work or Psychology Supervisor (Substance Abuse) Licensed practitioner and State of Florida Qualified Supervisor VI. Provider Training for Depression Warning Signs The Network discussed developing or using an existing screening tool to assist with the identification of clients suffering from mental health conditions and/or substance abuse. Dr. Feingold (PROACT) brought the Substance Abuse and Mental Illness Symptom Screener (SAMISS) which was developed by Duke University Medical Center, specifically for HIV/AIDS clients. The SAMISS is a broad screener with questions focusing on alcohol and substance use, various mental health conditions and is designed for a variety of settings and for persons with varying levels of functionality. The Network was provided with the SAMISS tool and key (copy on file). The Network discussed common symptoms of depression and possible ways to use a list as a tool to assist clients with symptom communication. It was suggested that Medical Case Managers (MCMs) use the SAMISS interview tool during Needs Assessment. The Network discussed educating MCMs as they have the greatest opportunity to screen clients and are responsible for MH/SA referral services. The Grantee suggested that the Network provide a separate training for the MCMs on the identification of mental illness, emphasizing the importance of making the correct connection. The Network agreed to communicate electronically to plan for the upcoming MCM training. The Network discussed the importance of drug interactions for MH medications and agreed to educate the physicians. It was suggested that PE be programmed to include this screening tool. The Network also agreed to educate the system less the physicians on the importance of adherence at the next All Networks meeting.
6 VII. VIII. IX. Old/New Business There was no additional old or new business. Resource Sharing There was no resource sharing. Review Agenda Items for Next Meeting Standing Agenda Items X. Adjournment The meeting was adjourned at 4:19 PM. Next Meeting Date: April 19, 2013
Clients Gender Race Ethnicity FPL Mental Health FY12-13 Demographics - Total Total New Ongoing 508 157 356 Male Female Trans FTM Trans MTF Other 418 84 0 6 0 Am Ind/Alas Hawaiian/Pac More Asian Black Native Islander than White Other 0 3 186 0 2 317 0 Haitian Hispanic Non- Hispanic Unknown 35 124 384 0 0-100 101-200 201-300 Over 300 338 121 46 3
FY12-13 Mental Health - Females Race/Ethnicity Household Size FPL Average FPL Range 1 Black Hisp 1 0% 0% 53 Non-Hisp Black 1 (n=36) 2 (n=11) 3 (n=4) 59% 0%-230% 1 11 4 (n=2) More than one race Hisp 1 0% 0% 1 (n=7) White Hisp 2 (=3) 38% 0%-146% 5 (n=1) 18 1 (n=16) Non-Hisp White 2 (n=2) 38% 0%-219% Total 84 FY12-13 Mental Health - Males Race/Ethnicity Household Size FPL Average FPL Range 1 More than one race non-hisp 1 0% 0% 5 125 105 179 Black Hisp Non-Hisp Black White Hisp Non-Hisp White 1 (n=4) 4 (n=1) 1 (n=109) 2 (n=13) 3 (n=2) 5 (n=1) 1 (n=102) 2 (n=2) 5 (n=1) 1 (n=168) 2 (n=10) 4 (n=1) 148% 60% 71% 93% 43%-261% 0%-298% 0%-404% 0%-427% Total 418 FY12-13 Mental Health - Transgender Race/Ethnicity Household Size FPL Average FPL Range 2 Non-Hisp Black 1 92% 55%-128% 2 White Hisp 1 2% 2% 2 Non-Hisp White 1 133% 0%-267% Total 6
Clients Gender Race Ethnicity FPL Substance Abuse FY12-13 Demographics - Total Total New Ongoing 126 44 82 Male Female Trans FTM Trans MTF Other 95 31 0 0 0 Am Ind/Alas Asian Black Hawaiian/Pac Islander More than One White Other Native 0 1 67 0 0 57 1 Haitian Hispanic Non-Hispanic 2 14 111 0-100 101-200 201-300 109 16 1 Unknown 0 Over 300 0 Substance Abuse FY12-13 - Females Race/Ethnicity Household Siz FPL Average FPL Range 19 Non-Hisp Black 1 (n=19) 41% 0%-230% 1 Unknown 2 0% 0% 11 Non-Hisp White 1 (n=11) 2% 0%-21% Total 31 Substance Abuse FY12-13 - Males Race/Ethnicity Household Siz FPL Average FPL Range 48 Non-Hisp Black 1 (n=43) 2 (n=4) 3 (n=1) 43% 0%-167% 1 Asian non-hispan 1 95% 95% 14 White Hisp 1 (n=13) 20% 0%-175% 3 (n=1) 32 Non-Hisp White 1 (n=32) 38% 0%-167% Total 95
In+Care Campaign Retention Measures Gap Measure Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who did not have a medical visit with a provider with prescribing privileges in the last 6 months of the measurement year. Medical Visit Frequency Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who had at least one medical visit with a provider with prescribing privileges in each 6-month period of the 24-month measurement period with a minimum of 60 days between medical visits. Patients Newly Enrolled in Medical Care Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who were newly enrolled with a medical provider with prescribing privileges who had a medical visit in each of the 4-month periods in the measurement year. Viral Load Suppression Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with a viral load less than 200 copies/ml at last viral load test during the measurement year. Data Submission Dates Submission Due Date Measurement Year* 24 Month Measurement Period** 12/01/2011 10/01/2010-09/30/2011 10/01/2009-09/30/2011 02/01/2012 12/01/2010-11/30/2011 12/01/2009-11/30/2011 04/02/2012 02/01/2011-01/31/2012 02/01/2010-01/31/2012 06/01/2012 04/01/2011-03/31/2012 04/01/2010-03/31/2012 08/01/2012 06/01/2011-05/31/2012 06/01/2010-05/31/2012 10/01/2012 08/01/2011-07/31/2012 08/01/2010-07/31/2012 12/03/2012 10/01/2011-09/30/2012 10/01/2010-09/30/2012 02/01/2013 12/01/2011-11/30/2012 12/01/2010 11/30/2012 04/01/2013 02/01/2012 01/31/2013 02/01/2011 01/31/2013 06/03/2013 04/01/2012 03/31/2013 04/01/2011 03/31/2013 08/01/2013 06/01/2012 05/31/2013 06/01/2011 05/31/2013 10/01/2013 08/01/2012 07/31/2013 08/01/2011 07/31/2013 12/02/2013 10/01/2012 09/30/2013 10/01/2011 09/30/2013 *applies to the following measures: Gap Measure, Patients Newly Enrolled in Medical Care, and Viral Load Suppression ** applies to the Medical Visit Frequency measure 1 NQC In+Care Retention Rates
Broward County Rates 2 NQC In+Care Retention Rates
National Part A Data Group Rates 3 NQC In+Care Retention Rates
Part A Benchmark Report GAP MEASURE 4 NQC In+Care Retention Rates
Part A Benchmark Report MEDICAL VISIT FREQUENCY 5 NQC In+Care Retention Rates
Part A Benchmark Report PATIENTS NEWLY ENROLLED IN MEDICAL CARE 6 NQC In+Care Retention Rates
Part A Benchmark Report VIRAL LOAD SUPPRESSION 7 NQC In+Care Retention Rates
Medical MCM MH/SA OHC Combined All MCM Training March X X April X X X X X May X X June X X X July X X X X August X X X X September X X October X X X X X November X X December X X X January X X X X February X X X X X
FY 13-14 Mental Health/Substance Abuse Network Work Plan March April May No Meeting In+Care Data Review No Meeting Review presentation on assessing depression Review Annual WP June July August No Meeting In+Care Data Review Review Annual WP Review baseline HHS Data Review baseline Broward Client-Level Outcomes and Indicators Review Findings from Client Survey Review MH/SA Gap Measure and VL Suppression Date Develop retention QIP In+Care Data Review Review HHS Data Review Broward Client-Level Outcomes and Indicators Prepare Do stage of PDSA September October November No Meeting In+Care Data Review No Meeting Review QIP Progress December January February No Meeting In+Care Data Review Review baseline HHS Data Review Broward Client-Level Outcomes and Indicators Review AETC Record Review findings In+Care Data Review Review baseline HHS Data Annual SDM Review Annual evaluation of Accomplishments and Challenges Update WP