HomeMy WebLinkAboutAgenda - 03-21-2006-9bORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRAC'i
Meeting Date: March 21, 2006
Action Agenda
Item No. ~___~
SUBJECT: Authorization to Release One -Time Supplemental Funding to OPC/LME to
Facilitate Divestiture/Transition of Cross Disability Services
DEPARTMENT: County Manager's Office
PUBLIC HEARING: (Y!N) No
ATTACHMENT(S):
1. OPG Area Program -Program
Transition Worksheet
2, OPC/LME Request/Report
INFORMATION CONTACT
Gwen Harvey, Asst Co. Mgr, 245 -2307
Judy Truitt, OPC/LME Director,
913-4037
PURPOSE:
To authorize the release of a one-time County supplemental appropriation in the amount of
$41,012 to OPC/LME to facilitate the divestiture (transfer) of Gross Disability Services to Cross
Disability Services, Inc, (XDS, Inc,), anon-profit organization established by existing OPC
operations staff, with a projected start-update of May 1, 2006,
BACKGROUND:
In its budget work session on June 16, 2005, the BOCC received an update from County and
OPC/LME staff on the projected need on a program fay program basis for one-time
supplemental "bridge" funding (in the approximate amount of one-month's operating expense)
to help facilitate the divestiture of OPC programs serving Orange County residents as provided
under the approved business plan for mental health reform. This effort was intended to assure
a smooth transition for area staff and consumers in Orange County, In the fall of 2005, the
BOCC authorized the release of one-time supplemental funding to effect the transition of
KidsCope/Early Childhood Intervention of Orange County to the Chapel HiII Training Outreach
Project (CHTOP), Inc..
Attachment 1 is a copy of the Program Transition Worksheet that accompanied this item on the
June budget works session agenda. Based on OPC/LME calculations and overall request far
supplemental assistance, the County anticipated the need to provide up to $67,000 (one
month's operating expense) for the planned divestiture of the Cross Disability Services function
during FY2005-06.
OPC/LME management, after a competitive review process and extensive analysis involving
program staff and community stakeholders, has advised the OPC/LME Board of its intent to
recommend that the Board authorize the award of a contract to Cross Disabilities Services, Inc.
(XDS, Inc.) as a "spin-off' organization. At its April meeting the OPC/LME Board will be asked to
formally authorize management to enter into final contact negotiations with XDS, Inc. to assume
operational responsibilities, utilizing all of the current program staff, effective May 1, 2006.
XDS, Inc. is a North Carolina non-profit corporation dedicated to serving individuals ages 17
and older who have multiple behavioral disabilities (mental illnesses, developmental disabilities,
and substance use disorders) and in the greatest need for service and support in a community-
based framework. XDS, Inc. will provide the. following services (as presently conducted under
the area program, OPC/LME):
Assertive Community Treatment Team (ACTT) -accountable, mobile, mental health services
delivery staff for crisis intervention, supportive household skills, psychopharmacologic treatment
and the like
Community Support Team (CST) -direct intervention, coordination, and monitoring on behalf of
individual clients (step-down from ACTT.)
Mental Retardation/Mental Illness Services -case management services coordinated with
clinical services
Adolescent Transition Team -comprehensive case management to arrange, link, and integrate
multiple clinical, rehabilitative, and support services for old youth and young adults
Psychiatric Services Psychology Services and Recreational Therapy -therapeutic
interventions especially tailored to meet individual client needs
In order to facilitate a smooth organizational start-up and transfer of responsibilities, OPC/LME
management requests release of the one-time County funding in the amount of $41,012 as
described in Attachment 2, the memo from the Area Director. OPG/LME as the contracting
authority will be the transfer agent to provide the one-time, additional BOCC funding as required
to XDS, Inc.
FINANCIAL IMPACT:
One-time supplemental "bridge" funding, to be transferred at the time of divestiture, for the
Cross Disability Services program was included in the FY2005-06 budget adopted by the
BOCC. OPC/LME "bridge" funds were specifically set aside by budget ordinance within the
Critical Needs Reserve.
RECOMMENDATION(S): The Manager recommends that the Board authorize the release of
$41,012 from the Critical Needs Reserve to facilitate the divestiture and transfer of Cross
Disability Services from the OPC/LME to Cross Disability Services, Inc. (XDS, Inc.)
L
RS O
~ ~ ~n
O O o
Q ~ N
CS
N
~ C c
H ~
O~
a'1
O
L
Q..
~ ~ ~ ~
c cD
C
O C C
..
E N C
m
E N C
m .~
E N
N ~ ~ ~
6'~
T p. ~ ~
11p p.
D"~ ~ ~ O
6p
p Q LL~ ~ ~
~'N
p D_ ~ ~ ~
O'p
p O.
R C ~~y NN NN ~Ny ,Ny
rn °
~ ~ E 3sa o E °~ o E °~ E ~~
O O E °`~
~
c ° ~U HU F-U _
NU HU
F °
T ° °
O °
O a,
O
p O
C N
N O U
0. C C ~ c2f
~
~ ~ oa~°'
c
a~
N .~ ~ ? ~~
I C .n
~
~ C W N
-> ~ 61
~
~
E -
j
. -
'j
.
Y L
O
~
N
d ~ ~ ti a'
i ~
~•C N QU ~ ~
~/ ~
~ c
~' ~
m
~ EcaEa~i> E E ° E
O C9 O O p p~
f- a D U Q -o O
f- O
I-
U
U
p L
~ U
~ t6 N ~ fn N N fp
+~+ G Q~ Q L7. Q Q
;~ d
y E °°
~ ~Q 0
~ 0
n. 0
~ 0
d
L c to
o
L
0
V
0
0
0° o °U
~ N Q U N N N O
O N ~ N
N
G>
~UQ N
~ ~ ~ ~
T
~ N
`m m
N
~ E
° w O N
~
~ ~ ~
a .a _,
d > ~ ° °
a g Z
~ a
i
V
~ O C C
~ U ~ ~ H'm¢
¢ N ~ ~ N
~° T >,
O .
C N O C .
° m Y E .a
d o ~ TLS
r
~ ' ~
p F--~m
U
F °~'~
U
°~ ~
O
~
o ~ ~~
Z a.
¢mv c
~ (.~
m
~Zu
UU
.a
~~ v
~ ~
_
~
L C
O v~-cV m O
U .N
n- m m
cn~a m
W OL
U
3
E `o ~
L ~ '4d
0 ; L ~
Q O .+O~ O O
U
cd~Q°
O C ~()~
o ~O-
~~oo,~
O > >, O
O +'
~ ~ ~ O d
O
G , y d' N ~
O yM~'S
~ +~+ C ~
~ O ~ ~ ~
~ c ~ ~ C
~.+
r-+ `fir M Q +=~
C O CD fU ~
~ ,C CD ~ _
O tS) ~p y, N
y ~ EFt ~ v,..
O
+'O+ OS ~ V L
~ 'a V
O
++ G O ~
~ ;~, d O O
w- d ~ a.+ ~
c~~ its
~~~~~
C O ~ ^ N
4- a.+ O O C
G~Q~ ~O
:a y y~U
O
.Q w C ~
~ O O ~ ~
C y Occ'pu'i
J o
a~i~>aa~N
QQ.NZ~:i+ A
to .Q ~ +'C+ y ~
~~U.QOo
~ ~ d C ~ i
O Q- ~ R O
0 ~ K Q> ~ ~
Z .Q o> '6 ~. tp
Memo
_ =;;
1~1;~A - ~ ~ccs '~ ,'
ii c !:.'J
To: Orange County Board of County Commissioners L~~
Attention: Barry Jacobs, Chair
From: Judy R. Truitt, Area Director
CC: John Link Gwen Harvey
Date: 03/03/06
Re: Request to Release One-Time Supplemental Funding to OPC-LME to
Facilitate Divestiture of Cross Disability Services
OPC Area Program/LME has entered negotiations with XDS, Inc. to assume
operational management for Cross Disability Services. XDS, Ina.. is anon-profit
organization established by the existing staff of the OPC service program, which
provides assertive community treatment services to individuals with multiple
diagnoses. The actual transfer of management responsibility is expected to occur on
May 1, 2006, but XDS has requested early transfer of transition funding to facilitate
their organization's start up of human resources, IT, insurance, legal fees, and quality
improvement activities. OPG Area Program would support the request in an effort to
assure a smooth transition for staff and consumers, Please find attached a brief
history of XDS, Inc., as well as their transition plan, and a spreadsheet identifying a
portion of their early pre-divestiture expenses.
In ah effort to assure successful transition of OPC's service programs in Orange
County, the BOCC and OPC Area/LME Beards agreed to provide bridge funding for
programs in Orange County equal to one month operating expenses. Cross
Disability Services covers all three counties in the OPC catchment area, so the
proportionate one-month operating expense in Orange County would be $67,000.
As part of the budget planning process for FY06-07, OPC Area/LME Boards
approved the use of continuation of effort monies already provided to OPC from the
counties and staff set aside $25,988 for this program. The remaining $41,012 was
fequested and approved as one-time supplemental funding from the BOCC,
• Page 1
5
Based on the above information, 1 would request that the Board of County
Commissioners release $41,012 to OPC/LME for subsequent distribution to XDS,
Inc.
Continuation of effort monies
One-time supplemental funding
Total Qrange County funding forXDS, Inc
$25,988 No action required 6y BOCC
41 012
$67,000
Thank you very much for your continued support and please do not hesitate to call
should you need any further information.
• Page 2
XDS Inc.
History, Program design & service
implementation
Introduction
Cross Disability Services, Inc. (XDS Inc.) is a North Carolina non-profit
corporation dedicated to serving individuals ages 17 and older who have multiple
behavioral disabilities (mental illnesses, developmental disabilities, substance
use disorders) and who are the responsibility of the Orange-Person-Chatham
Local Management Entity (OPC LME), XDS serves clients in greatest need of
comprehensive, integrated services in order to ensure maximum safety, s{ability,
and health within acommunity-based framework of rehabilitative treatment,
services and supports. The target population is also considered "clients in
greatest need" because individuals with multiple, co-existing disorders (mental,
developmental, substance abuse and physical) often experience a number of
negative consequences. These negative consequences include persistent
symptomotology, functional impairments, and quality of life due to multiple
hospitalizations, multiple evictions, and involvement in the criminal justice
system.
The mission of XDS, lnc. is to empower and assist people with multiple
disabilities to live in the community of their choice, achieve personal
responsibility, and gain an enhanced quality of life by providing an array of
clinically appropriate, person-centered, and flexible treatment,
rehabilitative, and support services.
Through the following values and goals, XDS Inc. will:
• Support individuals to make meaningfial choices and to achieve their personal
and family goals.
• Respect the dignity and diversity of those we serve.
• Ensure human and civil rights.
• Serve individuals most in need.
• Make services readily available and as timely as possible.
• Assist individuals to secure and keep a home and a job.
Recognize the importance and complex interaction of families.
• Use natural supports, such as family, friends, neighbors, and community
organizations,
• Use appropriate resources wisely by providing na more and no less than what
is needed.
XDS Inc.
Cross Disability Services, Page 16
XDS Inc. embraces the following overall concepts that comprise ifs clinical
service theory and philosophy:
First and foremost, XDS services strive to help individuals develop high-
quality, satisfying lives. Certainly this includes helping to stabilize symptoms
and reduce hospitalizations. Mare importantly, XDS Inc helps individuals
pursue their own personal recovery process that allows them to manage their
illnesses arid move ahead with their lives. Emphasis is on personal
empowerment as it relates to their psychiatric illnesses and their physical
health.
Mirroring national standards regarding evidence practice, XDS embraces the
five core principles of recovery in all aspects of its service delivery: hope,
personal responsibility, education, self-advocacy, and support. For example,
when the ACT Team helps an individual avert hospitalization during a
psychiatric crisis, the Team also helps the individual recognize crisis "triggers"
so the individual can build one's own crisis-prevention strategies.
These two broad principles regarding high-quality, satisfying lives and personal,
ongoing recovery guide all aspects of service design, staff management, service
delivery, and quality improvement. The specific service Components described
throughout this .proposal add detail to these overall philosophical tenets.
XDS Inc. Service Arrav
XDS is highly skilled at serving individuals with multiple disorders (mental illness,
substance use, developmental disabilities} who have the greatest need far
comprehensive, coordinated, integrated treatment. XDS currently provides the
following services and will continue to do so if awarded this contract,
Assertive Community Treatment Team: (ACT Team )
Founded in 1999, XDS' ACT Team model of clinical service delivery is a
multidisciplinary mental health staff organized as an accountable, mobile mental
health agency who fiinction interchangeably to provide the treatment,
rehabilitation, and support services that individuals with severe mental illnesses
need to live successfully in the community. The ACT Team is not a "linkage" or
"brokerage" case management program that connects individuals to services
provided by other mental health, housing, or rehabilitation agencies or programs
in the community. The ACT multidisciplinary staff work as a "team" to deliver the
majority of treatment, rehabilitation, and support services individuals need to
achieve goals regarding recovery, life quality, and community-based living.
XDS Inc.
Crass Disability Services. Page 17
XDS has established criteria for admission into its ACT Team services, stressing
individuals with the greatest treatment need, The following describes individuals
appropriate for the ACT Team:
Individuals with severe and persistent mental illness. Priority given to people
with schizophrenia, other psychotic disorders, or bipolar disorder due to long-
term psychiatric disability usually associated with these disorders
Individuals with significant functional impairments in personal care,
employment, maintaining a safe living situation
individuals with one or more of the following problems (i.e. indicators of
continuous high service need):
^ Frequent use of psychiatric hospital
^ Intractable, severe major symptoms
^ Coexisting substance use disorder of significant duration
^ High risk or recent history of criminal justice involvement
^ Inability to meet basic survival need, including substandard housing or
homelessness
^ Inability to participate in traditional office-based services
^ Residing in an inpatient bed or in a supervised community residence,
but clinically assessed to be able to live in a more independent living
situation if intensive clinical services are provided, or requiring a
residential ar institutional placement if more intensive clinical services
are not available.\
XDS' ACT Team specifically offers the fallowing:
• Serves adults with serious & persistent mental illness(es), developmental
disabilities, substance abuse disorders.
• Multidisciplinary, mobile staff able to deliver a full array of treatment,
rehabilitative, and support services, 24 hours per day, 365 days per year.
• Meets all national fidelity standards and is based on 30-years national,
scientific research regarding effectiveness.
• Current capacity is 75 adults.
• Individual services may include:
^ Psychopharmacologictrectment
^ Individual and group cognitive/behavioral and supportive therapy
^ Crisis intervention
^ Hospitalization
^ Substance abuse treatment
^ Supportive housing that includes independent living, therapeutic family
living, and supervised living in licensed facilities.
• Entitlement/benefits management including role of payee for some
clients
^ Individualized recreational activities
XDS Inc.
Crass Disability Services. Page 18
^ Supportive employment services
Community Support Team;
XDS's Community Support Team (CST) serves individuals with serious mental
illness(es), developmental disabilities and substance use disorders who, while
significantly disabled, do not need the more intensely coordinated clinical,
rehabilitative, and support interventions of the ACT Team to remain stabilized in
the community.
The CST provides direct intervention and also arranges, coordinates, and
monitors other services on behaff of an individual. Within XDS, the CST may be
used as a "step-down" level of service for individuals who have stabilized and no
longer need the intensively coordinated services of the ACT Team. Once
"stepped down" individuals maintain contact with treatingprofessionalstrom the
ACT Team. Should individuals not be able to maintain treatment gains within the
CST, they can easily transfer back to the ACT Team in order to maintain
psychiatric stability.
The Community Support Team offers the following:
• Serves adults with serious & persistent mental illness(es), developmental
disabilities, substance abuse disorders.
• Less intensive than ACT Team services, brut multi-trained staff provide direct
intervention and the arrangement, coordination and monitoring of services to
an individual.
• Current capacity is 25 adults.
• Individual services may include:
^ Assistance and support for clients in crisis situations
^ Service coordination
^ Psycho-education and support for clients and their families
^ Individual restorative interventions for the development of
interpersonal, community coping, and independent living skills
^ Development of symptom monitoring and management skills
^ Monitoring medication and self-medication
Menfal Retardation /Mental Illness Services:
XDS Mental Retardation /Mental Illness case management services are
available to individuals with developmental disabilities and mental illness(es) who
typically require coordinated clinical services and comprehensive supports from a
24/7/365 residential provider.
The MR/MI case manager consults with identified providers, includes their input
into service planning, informs all stakeholders, coordinates services and monitors
XDS Ina.
Cross Disability Services. Page 19
(C~
service results in relation to an individual's treatment goals. Within XDS, the
MR/MI Team may be used as a "step-down" level of service far individuals who
are psychiatrically stable and no longer need the intensively coordinated services
of the ACT Team or the Community Support Team. Qnce "stepped down"
individuals maintain contact with treating professionals from the ACT Team or
Community Support Team. If individuals are not able to maintain treatment gains
within the MI/MR Team, they can easily transfer back to the more intensive
service components of ACT or Community Support Team in order to ensure
psychiatric stability.
XDS current service capacity is 30 adults.
Individual MR/MI case management services may include:
• Case management to arrange, link or integrate multiple services.
• Assessment and reassessment of the client's need for services.
• Arrangement for the recipient to receive benefits and services.
• Monitoring of service provision and success in relation to an individuals
treatment goals.
Adolescent Transition Team:
The ATT will serve approximately 15 clients, ages 17-21, who have serious
mental illness(es), developmental disabilities and substance use disorders. The
Team will provide comprehensive case management to arrange, link, and
integrate multiple clinical, rehabilitative, and support services to these older youth
and young adults who have typically experienced extended time in foster care
and are at increased risk of negative consequences once they become adults
and are no longer eligible for the array of intensive clinical, social, and residential
services provided to individuals under eighteen years of age. The ATT goal is to
prevent negative consequences that may include dropping out of school,
unplanned parenthood, homelessness, criminal activity, and untreated
psychiatric illness that may lead to psychiatric hospitalizations. These poor
outcomes can be minimized by successfully transitioning these individuals into
the appropriate level of adult services that will continue to provide the level of
clinical, rehabilitative, and support services necessary to maintain psychiatric
stability. Upon reaching 18, clients will already be connected to either the
Assertive Community Treatment Team, the Community Support Team, or the
Mental Retardation/Mental Illness Case Management Team so there is continuity
of services to maintain psychiatric stability during the stressful transition to
adulthood.
• Serves adolescents ages 16-18 who have serious mental illness(es),
developmental disabilities and substance abuse disorders.
• Provides comprehensive case management services to arrange, link, and
integrate multiple clinical, rehabilitative, and support services.
XDS Inc,
Cross Disability Services. Page 20
• Particularly emphasis is placed on securing a smooth, seamless transition
from the child / adolescent to adult service delivery systems.
• Current capacity is 15 adolescents.
Description of Additional Services Available as Needed;
The pillars of the XDS service array are the four core services described above.
Ultimately their success depends on successful implementation of individual
services tailored to meet unique needs. XDS meets these individual needs in
two ways. Each core service staff member contributes his or her own specific
expertise within and across teams. in addition, XDS contracts with external
providers in order to fully meet all unique access, availability, treatment, support,
and cultural competency needs.
Three types of specialized services available within and beyond the four core
service programs deserve special mention due to state-wide concerns about
availability:
Psychiatric Services: one full-time Psychiatrist i$ available to the ACT Team
and apart-time contract psychiatrist is available to clients within the MR/MI,
Community Support, and Adolescent Transition Programs. Responsibilities
include:
Identify symptoms, develop a individual profile, discuss significance of these
symptoms, and frame them as manifestations of aspecific psychiatric illness
far an individual, in accessible language, to help him or her recognize
symptoms. Identify, prescribe, explain, and discuss medications (medication,
potential side effects, administration) recommended to reduce symptoms.
Does so in language most accessible to individuals, family members and/or
natural supports ident~ed by the individual.
Ongoing assessment, management, and collaboration with the individual
regarding medication effectiveness, side effects, regimen modifications.
Suppcirtive therapy to help the individual in self-empowered disease
management and recovery.
Support follow through with medical examinations and treatment by other
physicians, performing limited medical assessment and treatment and
recommending specialized medical treatment.
Psvcholoay Services: one full-time Ph.D. Psychologist is available to provide to
the ACT Team and to assist with clinical supervision and quality improvement
activities. Part-time contract psychologists are available to clients in the MR/MI,
Community Support and Adolescent Transition Programs. Psychological services
include:
Psychometric testing to clearly define needs for clinical intervention.
• Specialized services of a neuropsychologist to assess organic impairment,
XDS Inc.
Cross Disability Services. Page 21
i~
• Individual and getup cognitive-behavioral therapy for alcohol and drug use
disorders, bipolar disorders, depression, anxiety disorders, and
schizophrenia.
• Specialized system of treatment (D137) for individuals with borderline
personality disorder.
Recreational Therapy: 1 FTE medical case manager with degree in
recreational therapy. The discipline of recreational therapy embraces a definition
of "health" which includes not only "the absence of illness", but extends to include
enhancement of physical, cognitive, social, and affective development, such that
persons may participate fully and independently in chosen life pursuits.
Correspondingly, recreational therapists conceptualize the scope of "health care"
as extending beyond acute care, to encompass a continuum of services,
including rehabilitation, ongoing health maintenance, and preventive education
and intervention.
Therapeutic interventions address the individual as well as the quality
of his/her environment and support systems, in order to maximize both physical
health and psychosocialtyell-being. Interventions take place in inpatient,
transitional, and home-or-community-based settings, and include structured
activities which target reduction of speck symptoms or enhancement of specific
functional skills; education which proactively addresses personal health
maintenance skills, prevention, health promotion, and reduction of health risk
factors; and guided participatory experiences which address psychosocial health
and quality of life.
In addition to psychiatric, psychological, and recreational therapy services, XDS
delivers the fallowing wide array of necessary, specific services through a
combination of staff and contracted professionals and paraprofessionals:
• Supported independent housing.
• Entitlement /benefits management (payeeship).
• Supported employment.
• Contract and clinical collaboration to provide Alternative family living,
supervised group housing, and individual day supports.
Each of these services meets nationally recognized definitions or standards that
guide successful service delivery and outcomes.
XDS Inc.
Cross Disability Services. Page 22
13
XDS Guarantee of Evidence Based Best Practice Approach
Crass Disability Services has demonstrated a commitment to outcome focused
services since XDS was created in 1996 when Thava Mahadevan became the
Director of what was then called the Thomas S. Program. Because the Thomas
S. Program was created in response to a Federal Class Action Law Suit against
the State for not providing adequate treatment to individuals with mental
retardation and mental illness(es) there was a wealth of evidence based, best
practice training required for Cross Disability Staff.
XDS Staff have received the following training:
• Psychopharmacology. -
• Circle of Friends Supports.
• Social role valorization.
• Value based caregiving.
• Legal and ethical issues in working with individuals with DD.
• Person centered planning with on-site fallow-up by national consultant
Michael Smull (this included individual-speck person centered planning for
CDS clients and clients preparing to leave John Umstead Hospital.
• Person centered plan monitoring by Thomas S. Program consultants within
the NC Division of MH/DD/SAS.
National Accreditation:
It is within this culture of person-centered treatment and support interventions
that XDS pursued national accreditation from The Council on Quality and
Leadership in Supports to People with Disabilities. CQL Accreditation is a
long, "developmental process that is designed to ensure a service organization
maintains a person centered focus by requiring a quality management process
that systematically collects and analyzes data toward improving quality of
services," The centerpiece of CQL accreditation is evaluating the strength of the
person centered planning process and services and ensuring positive outcomes.
CQL reviews programs in a highly detailed fashion through a series of interviews
with service recipients and providers to determine if certain outcomes are
present. If outcomes are not present, it is determined whether processes are in
place to ensure their presence in the future.
XDS Inc.
Cross Disability Services. Page 23
i~_
The personal outcome measures used by the CQL to assess for accreditation
include the fallowing:
• Identity.
• Autonomy.
• Affiliation.
• Attainment.
• Safeguards.
• Rights.
• Health and Wellness.
XDS received cone-year accreditation from the Council on Quality in Leadership
in Supports for People with Disabilities in 1995, atwo-year accreditation in 1996,
and athree-year accreditation on December 17, 1998. Accreditation was not
renewed in 2002 due to budgetary reasons. If CQL is approved by the NC
Division of MH/DD/SAS and the OPC-LME, CDS plans to seek re-accreditation
by CQL in 2006.
Other XDS Services:
XDS remains committed to providing the highest quality services based on
national or state best practice standards. Each of the XDS services currently
meet criteria and standards set in the North Carolina proposed service definitions
that reflect national evidence based best practices. CDS will review and improve
its services in compliance with new Local Management Entity (LME) /Division of
Medical Assistance (DMA) provider endorsement tools as they are finalized in
order to secure athree-year LME endorsement and direct enrollment with the
DMA,
Continuity of Care
Continuity of Care Within XDS:
Because XDS is specifically designed to serve individuals with muitiple-
disabilities in amulti-disciplinary manner; we can offer extensive continuity of
care within our own service array.
Our four core services -ACT Team, Community Support Team, MR / MI
Services, Adolescent Transition Team -work in concert to ensure that an
individual receives the right intensity of services at the right time for the most
beneficial cutcames. Individuals with the most intensive needs receive ACT
Team services. Upon achieving positive outcomes and goal attainment, an
individual can be "stepped-down" to the Community Support Team or MR / MI
Services. Individuals receiving Community Support Team or MR / MI Services
who need more intensive services can "step-up" to ACT Team services, The
Adolescent Transition Team is specifically designed to assure smooth transition
XDS Inc,
Cross Disability Services. Page 24
is
and care continuity to youth as they "age out" of the child /adolescent service
system and enter the adult service system.
Staff for all services routinely communicate and share appropriate information so
an individual's transition is timely, efficient, and smooth.
Continuify of Care wifh Ofher Services:
The pillars of the XDS service array are the four core services (AC'T Team,
Community Support Team, MR / MI Services, Adolescent Transition Team).
Ultimately their success depends on successful implementation of individual
services tailored to meet unique needs. XDS meets these individual needs in
two ways, Each core service staff member contributes his or her own speck
expertise within and across teams, In addition, XDS contracts with external
providers in order to fully meet all unique access, availability, treatment, support,
and cultural competency needs.
Staff and contracted providers deliver the following wide array of these
necessary, specific services:
• Supported independent housing,
• Alternative familyaiving,
• Supervised group housing.
• Entitlement /benefits management.
• Supported employment.
• Psychiatric services.
• Recreational therapy.
• Psychological services (individual, group, DBT, behavior plans).
• Targeted case management.
• Developmental therapy.
Continuity of care is critical when XDS individuals receive additional services
from other providers, XDS staff ensure care is appropriately coordinated through
a variety of means, including:
• Participation from other providers in person centered plan development,
implementation, and review.
• Appropriate, consent-approved sharing of information, particularly crisis
plans, person centered plan goals, and all issues related to service
collaboration and transitions.
• Continuous collaboration in care delivery and progress toward goals.
• Special attention when an individual's life circumstances change, when levels
of care change, or when services change or end to ensure seamless
continuity of care and successful transitions.
XDS Inc.
Cross Disability Services. Page 25
i~
Community Coordination & Collaboration
Collaborative Relationships with Other Providers:
In addition to directly provided services, XDS has excellent, well-established
relationships with providers of complementary services and other service
partners. These agencies include:
• Duke Department of Psychiatry (Resident Program).
• North Catalina Central University Psychology Department (Intern Program).
• UNC Department of Therapeutic Recreation (Intern Program).
• Community Resources Court.
• Departments of Social Services for Orange, Person, Chatham, Durham and
Alamance Counties.
• Vocational Rehabilitation.
• Disability Determination Units,
• t_ocal Banks.
• Guardians.
• Attorneys. -
• Families.
• Local Emergency Rooms and Psychiatric hospitals (e.g. UNC Neumsciences,
Duke, Durham Regional, Alamance Community Hospital, Alamance Crisis
Facility, Jahn Umstead Hospital and Cherry Hospital.
• Providers of medical services (e.g. UNC Hospital and outpatient clinics, Duke
Hospital and outpatient clinics, numerous independent providers of medical
and dental services.
• Homeless shelters.
• landlords.
• Local Magistrates.
• Police and Sheriffs Departments.
• Freedom House.
• City and County Departments of Recreation.
• NC Special Olympics Program.
• Private Employers, Arb~s, Blue Cross Blue Shield, Whole Foods, OE.
• OPC Children's Services.
• OPC Staff.
• ARC of NC.
• TEEACH.
• Chrysalis Foundation.
XDS Inc.
Cross Disability Services. Page 26
i'
Collaborations with Education Community:
XDS enjoys close professional relationships with a broad array of educational
institutions, both clinical and non-clinical. They include:
• Duke Department of Community Psychiatry; XDS staff Spencer Lyerly is
Adjunct Professor in the Department of Psychiatry.
• North Carolina Evidence Based Practices Center/Duke AHEC; CDS
Executive Director Thava Mahadevan and Spencer Lyerly are trainers for the
NCEBP Center.
• ACT Center of Indiana/Indiana University and Perdue University; XDS
Executive Director Thava Mahadevan and Spencer Lyerly are certified ACT
Team trainers by the ACT Center of Indiana.
• NH-Dartmouth Psychiatric Research Center,
• Duke University Fuquay School of Business.
• University of North Carolina (UNC) Law School.
• UNG School of Nursing.
• UNC School of Social Work.
• UNC Department of Therapeutic Recreation.
• UNC School of Rehabilitation Counseling:
XDS Staff Serving as National Experts:
In addition to numerous professional affiliations designed to benefit XDS services
and our consumers, XDS staff are also recognized as national experts in the field
of serving individuals with cross-disability needs. These trainings include:
• Duke Department of Community Psychiatry; XDS staff Spencer Lyerly is
Adjunct Professor in the Department of Psychiatry.
• North Carolina Evidence Based Practices Center/Duke AHEC; CDS
Executive Director Thava Mahadevan and Spencer Lyerly are trainers for the
NCEBP Center,
• North Carolina NAMI (Raleigh): December, 2001 and April, 2002
• NAMI of Orange County (Chapel Hili): June, 2001
• North Carolina Council for Community Programs (Southern Pines):
December, 2000
• National Association of Dual Diagnoses (San Francisco): November 2000
XDS Inc,
Cross Disability Services. Page 27
I~,
XDS Emeraencv /Crisis Services
XDS believes a high quality crisis system is paramount to successful services for
individuals with multiple disorders and complex treatment needs. This kind of
successful crisis system has to have two distinct strengths.
1. Identifying potential crisis situations and provide timely interventions
and supports to avert those crises.
XDS relies on numerous mechanisms to avert crises whenever passible.
During the initial assessment, person centered planning, and plan review
processes special attention is dedicated to building an individualized crisis
plan. This plan identifies specific triggers and,waming signs that can alert the
individual, family members, and treatment staff of impending crises. it also
describes specific safety and supportive actions that can quickly be
implemented in response to waming signs.
• With consent, the crisis plan is shared with appropriate family members,
supports and other providers in order to encircle an individual with help when
waming signs emerge.
• The crisis plan also includes preferences for treatment if, in fact, a crisis
response arises.
2. Providing immediate, 24 hour, 365 day per year crisis response when
crisis situations do emerge,
XDS has 24/7/365 responsibility for clients being served by the ACT Team
and for other XDS Clients on an as needed basis. In addition to the 24/7/365
crisis response, crisis interventions and services are available Monday
through Friday 8:00 am to 5:00 pm, evenings, and weekends on a routine and
as needed basis.
Individuals, family members, and support staff are given a crisis pager
number and a cell phone number to be used in emergency situations. XDS
does not use the Protocol crisis number published by the OPC LME for
individuals it serves, If a XDS client does call the Protocol crisis number,
Protocol is instructed to refer the crisis caller to the XDS on-call staff for
assessment and intervention.
XDS Inc.
Cross Disability Services, Page 28
iq
Strategies & Timelines for Implementation and
Transition of Consumers
XDS inc and OPC -LME staff are jointly planning far a spin off date in early May
of this year. Many details are being thoughtfully discussed and planned for a
smooth transition of consumers and staff. Under this arrangement there would be
minimal stress to clients, families and staff during the transition of providers. This
proposal tnaly describes a seamless, "tram-key" operation.
Specifically, all transition issues relate to administrative services rather than
clinical services. This seamless, "tum-key" transition is predicated upon finalized
agreements regarding the following assumptions:
1, XD5 will receive start up funds for the transition of service administration
( $100,000 allocated by the NC general assembly, $67,000 Orange co, )
2. XDS will Purchase the three Thomas S. properties back from Chrysalis
Foundation far $100 each to establish a line of credit as needed.
3. XDS will purchase for $1.00 all equipment, furniture, computers and cars
currently used by OPC Cross Disability Services and paid for by MR / MI
dollars.
4. XDS has already identified and working with a Human resources &
information systems vendor and will transition HR and IS services from OPC
LME to XDS.
CDS Commitment to Cultural Competence
CDS is surrounded by a rich and diverse community, serving both urban and
rural communities. CDS takes amufti-faceted approach in benefiting from this
mixture of people and cultures. Staff recruitment efforts assure advertisement of
vacancies in a variety of communities. Personnel policies of the OPC Area
Program ensure a legal and balanced approach in the hiring of qualified staff,
CAS's current staff is comprised of persons of varied racial and ethnic
backgrounds, socioeconomic backgrounds, as well as various disabilities.
XDS currently employs 2 clinical staff fluent in Spanish.
XDS Inc.
Crass Disability Services. Page 29
ao
Q~
V
,~
~'
i~
,.o !~.
U~ y o
.y
H
Q~ ~
~CUE~-~
a
d
a
o
0
0
0
~
0
0
0
V b N N N can Vim' N N N
O ~'
~ N
~ N y
p,
d
~
9
`°
~
`'4
q
aai
y
~
;~
A
`j'
°
F+
~i N
'~
a
O.
>>
wq> ~
Y
~
> ~
'
>> ~
> ~
>>
P
ai
H ~
t-~
H
H
~
F-~ ~
y
H
'd
G
^ .'~ ~ b bA
C7 U y
N ~
~ ~CyU
^ .O
°~ aai
~
~
gi' ~
H
O
y
~
q
~ ti
v ti-i
~
~ [d h tyy
{ ~py
~
~ U ~ H
a1- r~ ~ ~y~
V •~~'1 ~
'O 4y~r ~ y ^~
t
O 6
J '~ 'ICON ? ~
~
+ ~ U
N a
~ ~ ~ ey
,
a]
O O ~
.. b ~
•:~1
FI
V
'O~ ~
~ •~.i !f~
b o
~
.d E'~ N
'd a~i
y
;~ ~'' ~ 1
r
1
" ~ ~
'
~
,~ ~ ti aaoi
aoi
~ .:
~ ~
y x
~7
~
a vai °';~ 6D U " o .~ v
:a a'o ~
° v3 ~ 3 "
F w'~a°~ o.
O ~ ~ ~ a
~ ~ ~ a qq
a
aw
i ,
o°n~ ~ ~ m y
' c
y
o .~
~ 3~°
~^
°°~ o
w ° m o >,
N a.o °~
~ a " o
q ~i ~
a ~ p
v ~
q
~
~~~ ~ '
~ ~ o
~ T
~ ~~~ a
$ va
~ a ~~
U
` g ~ ~ ~ ~
~
3~ ~~
... o a,o ~
w ~q
~ Ca w A,.n >,
a p ' ~
; ~
a o y
~ m o
~ a
a ~b
~
o
y a a ~ a. •.. .
~ ~
~~`-'.ov fzi~ U U o ABC ~ k7 ~ ~
3 GA~ CJ N
o
N
0
~ ~r4
~/y
~
o W
A o
° O
~ O U
a
~ o
U N ^
p
~ ~ a
i
~"i m
~
O h
m
~ y-
~T a
d o a ~
°
,
,
o
~
H ~ ,
,5
C
a p
ti p]~A V b
~
~~
q ~ ~5 ~
~^
j ,y W Ar F~ v
~ N
F'~'1
~
H
N
CI y N o
~.~N
~i
•.Vi
Q~
~a
~-
D A.
~~ ~1
~r q_r~+
q~ y
~C U H
A
'~+
O
00
0
w ~o
do ~0
o 0 o
~ ~ b
0 b
0 b~~~~~
000000
~~ ~
'mo ~
o
U ~
Qd' ~
m ~ ~
N N v
N ~
N ~ ~. ~ ~ ~ ~
NNNNNN ~ ~
mN ~ ~
mm ~
m
~ + i
'~
w
a
~
~ a
~
~' ~
~ a
o
~~~~> .5
O •5
O
. ~ id
y ~ o ~
o ~ ~ ~ ~ m a
~~qq gg ~g ~ ~ o
~
a a ka ~ ~° v x ~AAAUw w mO aa
~ b ~
(~.y! ^
1 'V "+ U
0 R
p O i '~
0
ti ~ll v .. O
o ~ v N
~ U ~,
O
b
b
~ O
O u
'b ~ U
"~
~
H u
v [[
N O
U g %~ bT V V
Y ~~ H '~ Y
d Oa '3U ~ ~ Y
b ~
~ m~ ~ 3'~ ~'N coa
e~n ~ y
~ ,.,
::v.°.~ a °
~ "C m y
'~ ~'
~ ~ eno ~
~ ~'5
n a o
~ °n,w°a,~gg~ ~
~ ~ ~
~ ~
'
~
E ~ ~~ o
o T y a
aad °~ U '
a ~
.~~, y~~ Aa U y ~ ° ~ ~ ^
~ to ~ N m m W Ri .
a
i
~
m P U O
q = ~ w itlO o o ° N`" coi ~'L~`L~.'~ ~ v vqq~0 ~~ ~ .,~
a
'~ ~' h o
~ ~ ~.~ .~.~ o~ a
0 ~ ~
oq
~ ~ ..
•• ~ Q o
aai
A U~ u: U ¢ UUUHAU U~" ogP
U v~6
.oFclb v~ W +
o o
U ~
w
O ~
w° O
'~ ctl '~ q
"a ~
0 PC
~~
N
° ~
~ ..
,
U U
O
P. N
•(j
b 7
.
~
~ ~
.
~ ~ U ~
0 q ~ ~ A
O
~ ~i
N V . N °
~ y ^ N V
'" ~5~ ~~ ~
m 0 o v
U
~ o a
U a o
U
p..
~,~
y
N
..Vi
N
C/]
.~ a
a
Q ~
(~ y ~
~C U H
q
'~~+
.~.
a ~O
o ~O
o
~o
~o ~O b ~D
~o ~0 0 0 0 ~O
0 ~D ~O
~0 0 0
a~ ~ ~ ~ ~ ~ ~ a a a
o a
UA ..
,~
m ..
~.
N
~
m
,~
m
~ ~. c\n M m
m m v mot' v
~
N
~
m m m
~ `~
0 o
~
~ ~ ~
~ ~ > > >
~
~ ~ y yy+
~ O
0+ y a
> ,-~
y 0
- a
> a
> ~ a ~ ~ ~
> > U U U td
>
U U U
~ i,,,
E4 v a
~q ~~
U
x a
~ a
~ m a .~, y y
~ ~ w
C
a a
~ .~, y y
w a a
i a
.
O H
.U.
.~ U
~ ''~ ~"'
:~ 1
R H CJ ~ b
N
w ,~ V
~e ~ b
~ U
y U
N -
~cy [y ~
o V] o
~ q UN o 0
U
O b ~ ~
~ U ~ ~
qo"A w o a ~ ~ o o ~~y, ~ .3 ~ a
p O U .
~ ' V .d
a ~ ~ ~~j
-
~ ~ . d ~
'~
.a V ~ '~ cd
a v
y 0 .q
U ~ F„
~
G ppq
L7 .
te
y U O A o
a~ :~ U ~ .,U., 'b
~ ~ a+ ~
WD
0
0 y
~ ~ o ~ o "~ ~ ~ ~ U ~ 3 ~ ~ ^^^yyy
~~j:::
~
.
ay p '~ ~ U , ~
~ Z a~ o y a°~i cOi c°~
°
E' ~ ~i a ~ ~ ~°y' ~ ~ a a 'a ~ ~
a
w R ~ O U U
g
q .b y '~ ~ .y. a b ~ ,.r b O ~ > y
W .r~'v m ;~ A U w °~ o ~ o ~ ~
0 0 `~
~ v w w `~
~
w
o a o `°a'
o. oo~
~ ~~ :
~
a o U a , ab
,
j
w a.9 ~ ~ m q > ~ v
U m n
C7 C7 d ~o U ~ Qa ~ H F Z ~ Q fA d
.
v
~
~
O
~ H
~
~ .
Ui
q.
V
N q
~
y
U
W
y
V q q
l7 ~
N 1yy
H
~ 0
U
O~ U U
~ O
U
O
A ~
O ~
U
w ~ ~
O ~
..,
• ~ '~
C y ,~ N ~ ~ ~ ~ tti
Q! ~ O
P ~ m ro >~ ~
'-' y
h U U
q ~ n
O~ c o o~ A ~ V y a,
. U a q
, q ~ ,,, •-~ no
4 o ~,
~ '~ U
: O U
~~~ ^'E
a d y
~~ ~ ._Oi d .-~i
.~ ~ q
w
~
~
O ~
~
W~ U°~ : p~ ~ ~
Cj ~U d d
d vi
L~
V
.~
f~1
Qi
^ti ~
IY •~
(~~~
~C U
b
0
d
~
au, 0 0
~., vt 0
vi 00
~ v~ 0 00
~, ~n ~n 0~ o
~
p
U b ..
N M .~
N
.-~
N N
ti ti .-~
M M M q
.-i
O M
Ri ~ U U O ~ ~
~
V]
N
a
N ~
a~
~ q
~ N
~
h o
°~ ~
a w a H €- ~ ~fA a
o
~
b U ~ ~ '~
O ~ U q~q ~ a
.~ o
~ P, ~g
O q
`'you
,
~o u ~ $'i ~ ,fl ~
iT ~ ~y
~7 ~~Uyy .~ ~ •iy ~ 'O o~ _
V N O ~ ~ +~ ~ p ~ ~ .a
,~
;~ ~ a r
"
~> ~ a ~
.u ~ o ~
v o
~
~ c ~ '~ .~ y
o ~
e~'n'ti 'd ~ ~
.° b v ~ ~
~, o0
n°
.
.
«t
1~
'~
~
Q,'
~ ~
~ • y
V] y
~
q
~
b
I
. .
~'~
b ~
A ~
~~o ~
~ a ~ o .
y
b
J
~ ~~~
~
N H V
o ~
V1 r~ ,b ~ N V
w ~ ~-!
C
0
n~
a~ o c°a
~ i.a.~ o a
o 6
,y~
~
~o ~~1q~(~
v ~
~ a
v~3 ~q~
UU >~~>
AvwA .b>~
~ ~
r'
a
Vr
G °? U
r
G
w ,fl
o
u
~ ~
:~ ~ ~ ~
~
o W
0.i ,n? $ O
N
~ '
"
"
O ~ O H ~
3 {
J
Fl
~
^J u
~ y o
~ ~
,
~ ~
r c
d
O ~ .
~ ~ b
(~~,'
°~
c u o Q ~
~ u
~ W
o
~G .
. ~ u: U U c a
~4
Pre Divestiture expenses XDS Inc.
Discription cost
Human resources start u
Asmara HR
initial fee for
Policy and Procedure manual , perfonnanace $3,975.00
review system, benefits Employee records
set up on site orientation ,payroll etc
One time set up fee $250.00
First month full service payroll processing, consultation $600.00
on employee issues, on site training, drug tests
Total
_
IT (IMPICA Inc
One time set up (config software, a mails etc) $6,400.00
Server $3,100.00
Liabili insurance
( Waiting to hear back from Citizens ins)
Le al
Set up review contracts on behalf of XDS Inc. $4,000.00
Loan applications
QI
Endorsement, enrollment $2,000.00
initial set of medical records
520,325.00