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HomeMy WebLinkAbout2017-703-E Health - National Assn of State Mental Health Directors service agreement DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E [Departmental Use Only] TITLE NRI BHS Analysis FY 2017-2018 NORTH CAROLINA SERVICES AGREEMENT UNDER $90,000.00 RFP ORANGE COUNTY This Services Agreement (hereinafter"Agreement"), made and entered into this 15th day of November, 2017, ("Effective Date") by and between Orange County, North Carolina a political subdivision of the State of North Carolina (hereinafter, the "County") and National Association of State Mental Health Program Directors Research Institute, Inc., (hereinafter, the 'Provider"). WITNESSETH: That the County and Provider, for the consideration herein named, do hereby agree as follows: 1. Services a. Scope of Work. i) This Services Agreement ("Agreement") is for professional services to be rendered by Provider to County with respect to (insert type of project): Conduct behavioral health system of care analysis of Orange County,NC. ii) By executing this Agreement, the Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner. iii) Time is of the essence with respect to this Agreement. iv) The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof. Compensation to the Provider for Basic Services under this Agreement shall be as set forth herein. 2. Responsibilities of the Provider a. Services to be provided. The Provider shall provide the County with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b. Standard of Care. i) The Provider shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of Provider practice throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the Revised 2/17 1 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E performance of these services. Provider is solely responsible for the professional quality, accuracy and timely completion and/or submission of all work related to the Basic Services. ii) Provider shall be responsible for all errors or omissions of its agents, contractors, employees, and assigns in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes, or conflicts at no additional cost to the County. iii) The Provider shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of the County. No permission for subcontracting shall create, between the County and the subcontractor, any contract or any other relationship. iv) Provider is an independent contractor of County. Any and all employees of the Provider engaged by the Provider in the performance of any work or services required of the Provider under this Agreement, shall be considered employees or agents of the Provider only and not of the County, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Provider. v) If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Provider represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. 3. Basic Services a. Basic Services. i) The Provider shall perform as Basic Services the work and services described herein and as specified in the County's Request for Proposals or Request for Qualifications (the "RFP") "RFP Number 5240 for "Orange County Behavioral Health Systems Analysis Behavioral Health Consultant" issued September 1, 2017, and the Provider's proposal, which are fully incorporated and integrated herein by reference together with Attachments A)RFP and B)NRI Submitted Proposal (designate all attachments). In the event a term or condition in any document or attachment conflicts with a term or condition of this Agreement the term or condition in this Agreement shall control. Should such conflict arise the priority of documents shall be as follows: This Agreement, the County's RFP together with attachments, Provider's Proposal together with attachments. ii) The Basic Services will be performed by the Provider in accordance with the following schedule: (Insert task list and milestone dates) Revised 2/17 2 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Task Milestone Date 1. Deliverable 1: Inventory existing mental health June 30, 2018 resources in Orange County and create a registry of those resources in accordance with detail specified by Health Department staff 2. Deliverable 2: Create a systems map of the August 30, 2018 existing mental health resources in Orange County in accordance with detail specified by Health Department staff 3. Develop Behavioral Health Systems of Care November 30, 2018 assessments with both Orange County School systems and schedule the implementation of programming as deemed necessary by the assessments over a multi-year time frame in two pilot Family Success Alliance zones. The Systems of Care assessments should be completed in accordance with detail specified by Health Department and school system staff. 4. 5. 6. 7. 8. 9. 10. iii) Should County reasonably determine that Provider has not met the Milestone Dates established in Section 3(a)(ii), County shall notify Provider of the failure to meet the Milestone Date. The County, at its discretion may provide the Provider seven (7) days to cure the breach. County may withhold the accompanying payment without penalty until such time as Provider cures the breach. In the alternative, upon Provider's failure to meet any Milestone Date the County may modify the Milestone Date schedule. Should Provider or its representatives fail to cure the breach within seven(7) days, or fail to reasonably agree to such modified schedule, County may immediately terminate this Agreement in writing, without penalty or incurring further obligation to Provider. This section shall not be interpreted to limit the definition of breach to the failure to meet Milestone Dates. 4. Duration of Services a. Term. The term of this Agreement shall be from November 15, 2017 to November 30, 2018. b. Schedulin;;of Services Revised 2/17 3 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E i) The Provider shall schedule and perform its activities in a timely manner so as to meet the Milestone Dates listed in Section 3. ii) Should the County determine that the Provider is behind schedule, it may require the Provider to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform its services in accordance with the approved project schedule at no additional cost to the County. iii) The Commencement Date for the Provider's Basic Services shall be November 15, 2017. 5. Compensation a. Compensation for Basic Services. Compensation for Basic Services shall include all compensation due the Provider from the County for all services under this Agreement. The maximum amount payable for Basic Services is Seventy Eight Thousand Seven Hundred Sixty Nine Dollars ($78,769). In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. Payment for Basic Services shall become due and payable in direct proportion to satisfactory services performed and work accomplished. Payments will be made as percentages of the whole as Project milestones as set out in Section 3(a)(ii) are achieved. (For example, if there are 10 Project Tasks with Milestone Dates then Provider may invoice for the first 10% of the whole upon County's acknowledgement of the satisfactory completion of Task one. Upon the County's acknowledgement that the second Task has been satisfactorily completed Provider may invoice for the next 10%of the whole.) b. Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6. Responsibilities of the County a. Cooperation and Coordination. The County has designated (Rebecca Crawford) to act as the County's representative with respect to the Project and shall have the authority to render decisions within guidelines established by the County Manager and/or the County Board of Commissioners and shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. Insurance a. General Requirements. Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by County's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at http://www.orangecountVnc.gov/departments/purchasing division/contracts.php). If Revised 2/17 4 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E County's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of N/A (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the County's Risk Manager. 8. Indemnity a. Indemnity. The Provider agrees to defend, indemnify and hold harmless the County from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Project and arising from property damage or bodily injury including death to any person or persons caused in whole or in part by the negligence or misconduct of the Provider except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this provision to require the Provider to indemnify the County to the fullest extent permitted under North Carolina law. 9. Amendments to the Agreement a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written Amendment to this Agreement executed by the County and the Provider. The Provider shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from the County. 10. Termination a. Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days prior written notice to the Provider. b. Other Termination. The Provider may terminate this Agreement based upon the County's material breach of this Agreement; provided, the County has not taken all reasonable actions to remedy the breach. The Provider shall give the County seven (7) days' prior written notice of its intent to terminate this Agreement for cause. c. Compensation After Termination. i) In the event of termination, the Provider shall be paid that portion of the fees and expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. ii) Should this Agreement be terminated, the Provider shall deliver to the County within seven (7) days, at no additional cost, all deliverables including any electronic data or files relating to the Project. d. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a Revised 2/17 5 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. e. Suspension. County may suspend the Services at any time for County's convenience and without penalty to County upon three (3) days' notice to Provider. Upon any suspension by County, Provider shall discontinue the work and shall not resume the work until notified to proceed by County. 11. Additional Provisions a. Limitation and Assignment. The County and the Provider each bind themselves, their successors, assigns, and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement without the written consent of the other. b. Governing Law. This Agreement and the duties, responsibilities, obligations, and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147- 86.58. c. Non-Discrimination and Living Wage. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy(each policy is incorporated herein by reference and may be viewed at http://www.oran ec�ountync. ov�/departments/purchasing division/contracts.php.). Any violation of the Orange County Non-Discrimination Policy is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. e. Entire Agreement. This Agreement, together with the RFP and its attachments and the Proposal and its attachments, represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written Revised 2/17 6 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E instrument signed by both parties. Modifications may be evidenced by facsimile signatures. f. Severability. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. g. Ownership of Work Product. Should Provider's performance of this Agreement generate documents, items, or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. h. Non-Appropriation. Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County's obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. It is expressly agreed that County shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. In the event of a change in the County's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects County's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County's legal authority. i. Si natures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the consent of the Parties to utilize electronic signatures and the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. j. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail,return receipt requested to the following: Orange County Provider's Name &Address: Attention: Kimberlee Quatrone National Association of State Mental P.O. Box 8181 Health Program Directors Research Hillsborough,NC 27278 Institute Inc. 3141 Fairview Park Dr. Ste. 650 Fall Church, VA 22042 [SIGNATURE PAGE TO FOLLOW] Revised 2/17 7 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PROVIDER: DocuSigned by: 115DO97CEE851NED .OocuSigned.by: XV ByEE0637994B755E477... By. . County Manager Tim Knettler, Executive Director/CEO Printed name and title Revised 2/17 8 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Attachment A ORANGE COUNTY NORTH CAROLINA Behavioral Health Consultant RFP RFP#5240 September 1, 2017 Orange County Behavioral Health Systems Analysis Overview Orange County seeks proposals from organizations to partner with the County in conducting a county-wide Behavioral Health System of Care analysis, specifically focused on residents aged 0-25, including racial and ethnic subgroups, and their support networks. The consultant will also engage Cardinal Innovations to identify and address barriers to behavioral health prevention and treatment for this population in Orange County. The successful organization will work closely with the two Orange County K-12 school systems and community partners to analyze and make recommendations to improve the existing System of Care based on three deliverables described later. Background According to the U.S. Department of Health and Human Services, the majority of adolescents in North Carolina with mental health and substance use needs do not receive treatment services. Orange County is home to more than 141,000 residents, including up to 2,200 residents aged 3- 17 that are currently being treated for these conditions through the managed care organization Cardinal Innovations. In Orange County, hospitalization records from 2009-2015 demonstrate the percentage of visits due to mental health for youth 0-24 years is increasing as a proportion of all mental health visits (an increase from around 18% to 24% of all mental health visits). Data from the same period show that between 27% and 31% of all mental health visits for 0-24 year- olds are a result of mental and behavioral disorders due to psychoactive substance abuse. The Orange County Health Department (OCHD) sought a clearer understanding of the extent to which individuals in the 0-25 age group have access to resources for prevention and early intervention, as well as follow-up care and other support systems for recovery. Simultaneously, OCHD sought to identify the areas where these services could be improved by pinpointing significant barriers to treatment. OCHD interviewed ten prominent figures in the mental health community, surveyed more than 150 individuals based in the fields of healthcare, social 11Page DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E services, criminal justice, behavioral therapy, K-12 education, and others, analyzed UNC Chapel Hill Emergency Department records in the fall of 2016, and conducted focus groups in the winter of 2017 to list and prioritize those barriers to treatment. (See attached Needs Assessment.)The participants prioritized three main areas: • Restore funding for mental health services for birth to age 5 (not included in this RFP— will be examined in future reviews) • Provide greater (i.e. more, higher quality care) in-school mental health services in K-121h grade • Improve community's ability to access services (e.g., know: who to call, what number to call, when to call) The Orange County Board of County Commissioners echo the need to focus on these three priority areas and seek a consultant to assist the county in addressing these priorities while beginning the process to reduce the barriers to behavioral health treatment for Orange County residents. Scope of Work Analyze existing resources and propose fiscally sustainable behavioral health system improvement recommendations focusing on Orange County residents aged 0-25 and their support networks. • Deliverable 1: Inventory existing resources for mental health, substance abuse, and intellectual and developmental disabilities in Orange County serving ages 0-25, create a registry of resources, then distribute registry (to be updated annually) to community partners including Cardinal Innovations, area hospitals, local pediatricians, non-profits, school systems, etc. This registry would include resources readily accessible to residents throughout the county. A non-exclusive list of data to include on the inventory is listed below: o Contact information o Method(s) to access services (e.g. M.D. referral, walk-in, teacher referral) o Services provided o Capacity and utilization data for FY 16-17 o Number of providers by type o Geographic location o Funding sources (including external support and patient payor sources) o Hours of availability • Deliverable 2: Create a systems map of the existing mental health (including substance abuse, intellectual and development disabilities) resources for ages 0-25 identified in Deliverable 1 within Orange County that portrays how Orange County residents navigate and access resources within the current system. Analyze resulting systems map, identity areas of strength and weakness, and make recommendations for improvements to gaps in services, access to care, quality of care, ease of referral, etc. • Deliverable 3: Work with both the Chapel Hill Carrboro City Schools and Orange County Schools in developing Behavioral Health Systems of Care assessments and scheduled implementation of programming as deemed necessary by the assessments over a 2 Page DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E multi-year time frame. The implementation phase would be piloted in the Family Success Alliance zones 4 and 6 in Year 1 of the program. (see attached map) Proposals Review & Selection Proposals will be evaluated by a committee of representatives from Orange County Government, UNC Health Care, local K-12 school systems, and community stakeholders. Proposals will be reviewed and ranked first on proposal content, then reviewed by proposal cost, with a final proposal selected based on a combination of content and cost. Timeline Written Questions Due September 25, 2017 Proposals Due October 3, 2017 Oral Interviews October 16 — October 20, 2017 Project Selection October 23, 2017 Projected Start Date November 15, 2017 Projected Completion November 15, 2018 Required Proposal Content All proposals must contain the following information: 1. A complete description of approach to be taken by the individual or firm to the proposed project and discussion of any issues or concerns, which must be addressed in the plan. 2. Timeline for completion of each deliverable. 3. Name, address, and telephone number of the individual or firm submitting the proposal. 4. Names and qualifications of individuals employed by the individual or firm who will participate in the development of the plan and their individual responsibilities. 5. The name of one or more individuals authorized to represent the consultant in its dealings with Orange County. 6. Names, addresses, and qualifications of any professional firms other than the one submitting the proposal, or individuals other than those employed by the firm and not listed above who will be a part of the consulting team. 7. Detailed information on qualifications and past experience of the individual or firm as well as those who will be participating in the preparation of the plan, including experience and past performance on similar projects, professional staff, number of years in business, and proposed and current contract obligations. 8. A cost proposal based upon a maximum fee broken down separately for each of the deliverables listed under the Project Scope, indicating the individuals responsible for each, and the projected number of hours and the appropriate hourly rate of each. The cost proposal should include an estimate of any and all additional expenses anticipated. 3 Page DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E 9. Name and address of at least three references including contact names for which the individual or firm has performed the same or similar services within the last three to five years. Evaluation Criteria Proposals will be reviewed and evaluated on the ability of the individual or firm to meet or exceed the requirements set forth in the specifications. Determination of the respondents to perform accordingly shall be made by an evaluation team consisting of representatives from Orange County Government, UNC Health Care, local K-12 school systems, and community stakeholders. Proposals shall be evaluated on the following criteria: 1. The quality and clarity of the proposal as well as the presentation materials will be considered a reflection of the individual or firm's ability to communicate to the public, County officials, and staff. 2. Consultants approach to analysis and plan. 3. Experience, both general and with projects of this type. 4. Quality of past work. 5. Ability to complete the project within budget. 6. Ability to meet the desired time line for the project. Submittal Instructions Please submit three copies (one clearly marked "original") of your response (printed duplex on recycled paper). Attach cost proposal to the original in a separate, sealed envelope. Also include an electronic copy of the proposal and cost proposal in .pdf format on a thumb drive, or cd. Proposals must be submitted before 4:OOpm on Tuesday, October 3, 2017 to: David Cannell Purchasing Agent Orange County Financial & Administrative Services 200 S. Cameron Street P.O. Box 8181 Hillsborough, NC 27278 Questions regarding services should be directed to David Cannell, Purchasing Agent, (919)245- 2651, dcannellCcDorangecountync.gov (preferred). All questions must be received no later than 5:OOpm September 25, 2017. All respondents will receive copies of the questions and answers received during the response period. 4 1 P a g e DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E General Requirements 1. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies it funds to pursue the same goal. A copy of Orange County's Living Wage Contractor Policy is included. 2. HB786 imposes E-Verify requirements on contractors who enter into certain contracts with state agencies and local governments. The legislation specifically prohibits governmental units from entering into certain contracts "unless the contractor and the contractor's subcontractors comply with the requirements of Article 2 of Chapter 65 of the General Statues." (Article 2 of Chapter 65 establishes North Carolina's E-Verify requirements for private employers.) It is important to note that the verification requirement applies to subcontractors as well as contractors. The new laws specifically prohibit governmental units from entering into contracts with contractors who have not (or their subs have not) complied with E-Verify requirements. Complete the attached affidavit, and include it with your submittal. 5 Page DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E J% FAMILY SUCCESS ALLIANCE Strengthening the pipeline to success for families who struggle to make ends meet. Goal I. Goal 2. Goal 3. Goal 4. Children are healthy Children 1 youth are ri Youth graduate from Families&neighborhoods & prepared for school healthy&succeed in high school &college support the healthy school development of children Zone 4 We are working in two zones(Zone 4 &Zone 6)to strengthen the system of high quality,connected supports for children and families on the journey from cradle to career or college. Vt- Zone b �, r i L "w°". Orange County,NC * ,e III W Y "We dream big for our kids. ' P _We want them to have success in life,health,happiness and safety,plus the ability and opportunity to live up to their full potential:' f _ ° db Come Dream with us! 40, �i DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E STATE OF NORTH CAROLINA AFFIDAVIT ORANGE COUNTY ************************** I, (the individual attesting below), being duly authorized by and on behalf of (the entity bidding on project hereinafter"Employer") after first being duly sworn hereby swears or affirms as follows: 1. Employer understands that E-Verify is the federal E-Verify program operated by the United States Department of Homeland Security and other federal agencies, or any successor or equivalent program used to verify the work authorization of newly hired employees pursuant to federal law in accordance with NCGS §64-25(5). 2. Employer understands that Employers Must Use E-Verify. Each employer, after hiring an employee to work in the United States, shall verify the work authorization of the employee through E-Verify in accordance with NCGS§64-26(a). 3. Employer is a person, business entity, or other organization that transacts business in this State and that employs 25 or more employees in this State. (mark Yes or No) a. YES or b. NO 4. Employer's subcontractors comply with E-Verify, and if Employer is the winning bidder on this project Employer will ensure compliance with E-Verify by any subcontractors subsequently hired by Employer. This day of , 201_. Signature of Affiant Print or Type Name: State of North Carolina Orange County D -n Signed and sworn to (or affirmed) before me,this the o day of 2014. v' z My Commission Expires: M. v 01 Ln rD °'Notary Public DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Section I: General Governnnent and Adnnunistration Policy 10.0: Living Wage Contractor Policy. Reviewed by: Comity Attorney/County Manager Approved by: County Manager Original Effective Date: My 1,2017. Revisions: Policy Statement It is the policy of Orange County to ensure its employees,and all individuals who provide services for Orange County,are paid a living wage. Pti1,I7ose To encourage all vendors and contractors to pay a living wage to all employees who perform work pursuant to a contract with Orange County. Applicability Applies to all grange County contracts and purchases. Polies' 10.1 Living Wage 10.1.1 Orange County is coinnutted to providing its employees with a living wage and encourages all contractors and vendors doing business with Orange County to pursue the salve goal. Orange County's living wk2e is$13.75 per hour. To the extent possible,Orange County recommends that contractors and vendors seeking to do business with Orange County provide a living wage to their employees. 10.1.2 Prior to final execution of a contract with Orange Comity all contractors and i endors seeking to do business with Orange County shall submit to the C'ounty's representative a statement indicating whether those employees who will perform work on the Orange County contract are paid at least the living wage amount set out above. If such employees do not make at least the living wage amount set out above the contractor or vendor shall indicate in the statement the actital amount paid to Such employees. For bid projects this statement should be subnutted as part of the bid packet. This policy-may be reviewed annually and updated as needed by the Manager's Office DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E oc ASSESSMENT OF ORANGE COUNTY 4,k HD MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES AN ASSESSMENT OF COMMUNITY ASSETS AND NEEDS IN ORANGE COUNTY, NC BACKGROUND The North Carolina Institute of Medicine (NCIOM) stated in an October 2016 publication that"mental health and substance use are at the forefront of health policy issues today, both at the national and state levels, due to rising visibility of the costs of not addressing mental health and substance use treatment needs" (NCIOM, 2016). North Carolina's transition to a managed care system 15 years ago brought fresh challenges for local officials seeking to implement comprehensive, coordinated community-based prevention, treatment, and recovery services to meet the needs of their residents. Though progress is evident in some areas, NCIOM reported that this level of care "remains an elusive goal for many North Carolinians with mental health and substance use disorders." Like the rest of North Carolina, Orange County struggles to meet the need for mental health and substance abuse services for residents, especially those ages 0-25. This assessment was initiated by the Orange County Health Department (OCHD) to determine what barriers professionals face as they seek to refer county residents to mental health and substance abuse treatment services. The results of this assessment will be shared with the Board of County Commissioners prior to their strategic planning session in January 2017. According to the U.S. Department of Health and Human Services,the majority of adolescents in North Carolina with mental health and substance use needs do not receive treatment services. Orange County is home to more than 141,000 residents, including up to 2,200 residents aged 3-17 that are currently being treated for these conditions through the managed care organization Cardinal Innovations. In Orange County, hospitalization records from 2009-2015 demonstrate the percentage of visits due to mental health for youth 0-24 years is increasing as a proportion of all mental health visits (an increase from around 18% to 24% of all mental health visits). Data from the same period show that between 27% and 31% of all mental health visits for 0-24 year olds are a result of mental and behavioral disorders due to psychoactive substance abuse. OCHD sought a clearer understanding of the extent patients in the 0-25 age group have access to resources for prevention and early intervention, as well as follow-up care and other support systems for recovery. Simultaneously, we sought to identify the areas where these services could be improved by pinpointing significant barriers to treatment. UNC Master of Public Administration student Sabrina Willard conducted the assessment from August to November 2016. Ms.Willard interviewed ten prominent figures in the mental health community, surveyed more than 150 individuals based in the fields of healthcare, DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E social services, criminal justice,behavioral therapy, K-12 education, and others, and analyzed UNC Chapel Hill Emergency Department records. BARRIERS TO ACCESSING TREATMENT The primary findings of the assessment showed that existing levels of service do not adequately address the needs of this population although there are many examples of successful collaborations taking place across the county in an attempt to address the gaps. Responses from key opinion leaders around the barriers to accessing treatment for mental health and substance abuse helped to inform the findings included in the below table. These common themes were also incorporated into the survey questionnaire as a method for confirming their validity with a larger group. TREATMENT AND RESOURCES-e Affordability- #1 Gap The #1 gap in the OC mental health system is affordability. Many low-income residents either do not have insurance or find their coverage inadequately covers treatment services for MH and SA (e.g. must meet a high deductible before any coverage is provided, lack of reimbursement options, restricted to a low maximum number of appointments, etc.). This issue is exacerbated when adolescents age out of the Medicaid system at 18.There are very few sliding scale or pro bono options to fill this gap. Children and adolescents have difficulty with recovery if parents with mental health issues aren't treated as well,but parents run into these same issues with affordability. Transportation was ranked as the 2nd largest Location/Transportation -#2 Gap barrier to MH/SA services in Orange County. Services are especially scarce in the northern part of the county (i.e. Hillsborough and unincorporated areas). Public transportation helps somewhat with the older patients in the southern sector,but the younger ones still have unmet needs.This dilemma emphasizes the need for more accessible treatment centers and in/near-school care, especially when parents are unable to take their children to necessary appointments due to busy work schedules or other conflicts. Language/Cultural- #3 Gap For the most part,services for non-English speaking patients are either difficult to obtain or virtually inaccessible. 60% of respondents said it was difficult for non-English speaking DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E residents to access services for any of the listed disorders (Major Depressive,Generalized Anxiety,Bipolar,Personality,Eating,Substance Language/Cultural - #3 Gap (cont'd) Abuse,or Schizophrenia Spectrum),making this the#3 gap identified in the survey.There is need for more diversity in the languages MH and SA services are offered in (i.e.Spanish, Burmese/Karen...etc.),as well as cultural competency training to help providers better understand how to work with refugee/undocumented populations. Culturally-relevant practices that provide support for LGBTQ teens are also needed. Education to combat stigma (adolescent Awareness initiatives in the community are and family) - #4 helping combat the stigma associated with MH conditions.More could be done to continue the dialogue encouraging people to seek appropriate treatment. Parents also need to be educated about the importance of ensuring their child gets the help they need. Barriers exist where parents are either unaware of the importance of taking their child to appointments or have busy schedules that conflict with their ability to do so. Knowing how to navigate the Cardinal system and properly enroll their child in MH and SA services is a barrier to accessing treatment. Post-diagnosis maintenance of care - #5 Non-emergency treatment options are non- existent or scarce.Psychiatric care in particular is a critical need for adolescents yet this type of therapy is largely unavailable to this population,especially if uninsured.In general, there is a need for more varied types of therapy(i.e.cognitive behavioral therapy, other types of counseling),as well as therapists trained to do trauma work both in the school systems and in the community. Preventive/Early intervention care-#6 Preliminary efforts to incorporate MH services into the school system are showing success. More robust systems for identifying issues earlier within the primary care and school settings are still needed.There is also a need for more variety of screening tools. Citizenship status -barrier identified Cardinal Innovations does not provide through stakeholder interviews and survey behavioral health services to residents without responses proof of US citizenship.Undocumented immigrants have to rely on the scarce services provided by other community organizations. Inpatient Care Usage/Access-barrier 2009-2015 UNC Hospital data obtained shows identified through stakeholder interviews that after an initial decline in mental health- and survey responses related Emergency Department(ED)visits DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Inpatient Care Usage/Access-barrier between 2009 and 2012,we have begun to see identified through stakeholder interviews a large increase in visits for patients 0-24 and survey responses (cont'd) (51%).This increase supports reports of ED overcrowding we've received from UNC Hospitals.The percentage increase of youth mental health ED visits is also increasing at a faster rate than overall mental health ED visits (25% compared to 18%.) In the case of substance abuse, 29%of all mental health ED visits for 0-24 year olds are substance abuse related. Disorder/Diagnosis Type-barrier Survey data indicates that generalized anxiety identified through stakeholder interviews disorder and major depressive disorder are the and survey responses two mental illnesses that most frequently affect residents aged 0-25 in Orange County(93% and 89%respectively) and are also the easiest to refer for treatment. Drug and alcohol abuse were also frequent diagnoses (80% of respondents for both) however,only 39% of respondents found them easy to refer for treatment.Schizophrenia spectrum and other psychotic disorders were deemed the most difficult to refer for treatment(25%) and treatment for eating disorders was said to be the most inaccessible 11% . CONCLUSION The most common barriers for people in Orange County aged 0-25 who need mental health and/or substance abuse treatment services were affordability and accessibility. Affordability One of the biggest barriers to accessing services, even when they are available, is the lack of services that are provided based on a person's ability to pay.Any improvement to the mental health system in Orange County will need to address the affordability of these services. Accessibility We found that the ability to access services depends on a variety of factors (service type, location, eligibility and cultural/linguistic appropriateness) all of which have gaps. Certain types of services such as substance abuse treatment and psychiatric care are hard to find. The location of mental health services in the population centers makes them difficult for this age group to access. Restrictions on who can receive services (e.g., age, citizenship, diagnosis) results in decreased access. Finally,the inability to provide needed mental health services in a linguistically and culturally appropriate manner significantly limits access. DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Next Steps: The Health Department will convene a group of stakeholders to review the detailed results of this gap analysis (survey results attached). This group will prioritize which specific gaps to address first and identify potential programs and services to meet those prioritized needs by February 15, 2017. ACKNOWLEDGEMENTS Thank you to all of the participants who generously gave their time to this assessment. Special thanks to: Orange County Criminal Justice Resource Office (Caitlin Fenhagen) Orange County Health Department (Allison Young, Juliet Sheridan, Coby Austin,Jennifer Sharpe, and Karen Kyes) I Freedom House (Trish Hussey) I El Futuro (Luke Smith and Karla Siu) I Cardinal Innovations (Debra Farrington) I UNC Healthcare (Tammie Stanton) UNC Pediatric Psychiatry (Jack Naftel) I UNC School of Social Work (Josh Henson). DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E .9000, ORANGE COUNTY NORTH CAROLINA Orange County Financial Services Department ADDENDUM #1 September 14, 2017 RFP 5240 Orange County Behavioral Health Systems Analysis To all Vendors: Modifications to bid documents for the above-named Request for Proposal are made as follows and shall be included in the proposed amount. Questions received with County's responses are on page 2 & 3 Other requested items are also included All other terms and conditions shall remain the same By: David E. Cannell, Purchasing Agent; dcannell(ab-co.orange.nc.us / (919) 245-2651 Acknowledgement of receipt of this addendum shall be included with your submittal Company Name: By: Date Received: P.O. Box 8181 200 South Cameron Street Hillsborough, North Carolina 27278 Telephones: Area Code 919-245-2651 Fax: 919-636-4913 Orange County, 200 S. Cameron Street, Hillsborough, North Carolina 27278 Page 1 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E 1. In what format is the registry of resources to be presented, paper or electronic? a. Electronic 2. Is there a preferred method of presenting the information of the registry? a. Table format 3. Please clarify and define the term "resources". Is the registry a database of direct service providers of MH/IDD/SA services in orange County or any related type of resource? a. Resources can be defined as mental health providers (inpatient and outpatient), substance abuse treatment facilities, services, schools that provide mental health services, etc. (So yes, direct service provision of MH/IDD/SA in Orange County and any related type of resource.) 4. For deliverable#2, is the system map to show how citizens SHOULD access services or how they ACTUALLY access services? a. The systems map shows how residents (we have a subset population of non-citizens with MH needs) are currently(actually) accessing these services.This will help us identify how we can improve access for residents to these services. 5. Regarding the proposal content item #4 and #7, it seems these are the same information as related to individuals employed by the firm. Is this a correct interpretation and if so is this information required in both places? a. #4 and#7 are very similar, however,#4 focuses more on the roles of your staff on our project and#7 seeks further information regarding experience on similar projects,years of experience, and workload on other current projects. 6. Please clarify the data element"capacity and utilization data for FY 16-17" in deliverable#1. Is utilization specifically the number of people served or the number of units or hours of service delivered or some other metric? a. All of the above. Capacity will certainly be important regarding number of beds for inpatient facilities, however, many providers will define capacity as hours they are able to dedicate per provider. Utilization would be relevant to both of those as numbers and percentages of capacity. 7. Is the information required in deliverable#2 and 3 the same information as it relates to making recommendations for system improvements? If not please define the expectation related to a Behavioral Health System of care assessment. a. Deliverable#2 focuses on services county-wide (ages 0-25) while Deliverable#3 focuses on school-based systems of care within the 2 school districts in Orange County(generally ages 5-18).There may be overlap between the two regarding improvements (we anticipate there will be improvements identified from each deliverable separately at the very minimum). 8. Deliverable#3 requires an assessment;thus, it is not presently known the outcome of the assessment. How should a firm accurately present proposal costs for the program implementation phase? a. Our expectation is that the successful bidder will have performed similar systems of care assessments in the past and will be able to bid the project accordingly based on experience. 9. Is there a preferred proposal submission format? a. There is no preferred proposal submission format. 10. Regarding deliverable#3, how many years is the "multi-year time frame"? a. This will most likely depend on proposed costs for improvements in addition to the immediacy of the need. It could be anywhere between 0-5 years based on the recommend approach by the successful bidder. 11. Regarding the proposal submission, is the cost proposal only attached to the original document but not to the other two copies? a. That is correct. Please attach the cost proposal only to the original document; not the two copies. Orange County, 200 S. Cameron Street, Hillsborough, North Carolina 27278 Page 2 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E 12. 1. General: The proposal due date is listed as October 3, 2017. Would the County consider extending the due date of the proposal, given that questions are not due until September 25 (and we assume it will take several days to post final answers) which leaves very few days in between to finalize a response? No 13. 2. General: Has the County established an overall budget for this project and related tasks? If so, please share the figure. The county has budgeted $80,000. 14. 3. Deliverable#1: In regard to deliverable#1: 15. a. Orange County is bordered by five other counties. Is it the County's expectation that the inventory of existing resources include resources accessible to Orange County residents, but available through bordering counties? That would be great but certainly not expected. The focus is on existing resources located in Orange County. b.Will the inventory include resources available within the County, but provided by external State and Federal sources?Yes. Any mental health related resources in Orange County; regardless of the provider or funding source. c. Is it anticipated that the registry will be in print or electronic format? Electronic d.Will the registry be made available on a public website? The final product will be made available on a public website. 16. e.Will the contractor be directly responsible for marketing the registry? No f. Does the County anticipate that the cost of the yearly updates will be included in the initial budget? No 17. 4. Deliverable#3: In regard to deliverable#3: Please provide additional detail on the tasks related to the work with both the Chapel Hill Carrboro City Schools and Orange County Schools in developing Behavioral Health Systems of Care assessments and scheduled implementation of programming as deemed necessary by the assessments over a multi-year time frame. 18. a. Specifically, please clarify the meaning of"scheduled implementation of programming." Any recommended programming changes that result from the Systems of Care assessments may not be able to be implemented immediately based on cost. It may be necessary to phase them in over a scheduled, multi-year period. 19. b.Will the contractor be required to help establish an implementation schedule, or is the requirement to participate in the implementation of the assessments over time? The requirement of the contractor is to help establish an implementation schedule; not participate in the implementation. Orange County, 200 S. Cameron Street, Hillsborough, North Carolina 27278 Page 3 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E .9000, ORANGE COUNTY NORTH CAROLINA Orange County Financial Services Department ADDENDUM #2 September 21, 2017 RFP 5240 Orange County Behavioral Health Systems Analysis To all Vendors: Modifications to bid documents for the above-named Request for Proposal are made as follows and shall be included in the proposed amount. Questions received with County's responses are on page 2 All other terms and conditions shall remain the same By: David E. Cannell, Purchasing Agent; dcannell(ab-co.orange.nc.us / (919) 245-2651 Acknowledgement of receipt of this addendum shall be included with your submittal Company Name: By: Date Received: P.O. Box 8181 200 South Cameron Street Hillsborough, North Carolina 27278 Telephones: Area Code 919-245-2651 Fax: 919-636-4913 Orange County, 200 S. Cameron Street, Hillsborough, North Carolina 27278 Page 1 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E 1. Does the organization of the proposal response need to follow the order of the numbered items listed in the Required Proposal Content section of the RFP? Yes 2. Does the county have a specific format in mind for deliverable number one, e.g. paper-based vs. online resource? Electronic but not necessarily an online resource. 3. Can the county provide more detailed information about what the exact deliverable for#3 will include and what the role of the selected vendor will be in the process of developing this deliverable? No, we are relying upon the expertise of the selected vendor to help with this process.The successful vendor will have had experience in similar analyses. 4. Is there a maximum budget for this opportunity? $80,000 but we are interested in understanding what resources applicants believe it would take to accomplish the deliverables. 5. Is there additional information on the system of care initiatives and their stages of implementation? No additional information. 6. For the IDD population are you interested in behavioral health services, or all services for the IDD population? We are interested in all services for the IDD population, including behavioral health. 7. Will electronic proposal submissions be accepted? No, please submit according to the requirements in the RFP. "Please submit three copies (one clearly marked "original") of your response (printed duplex on recycled paper). Attach cost proposal to the original in a separate, sealed envelope.Also include an electronic copy of the proposal and cost proposal in .pdf format on a thumb drive, or cd. Proposals must be submitted before 4:00pm on Monday, October 2, 2017" 1. Orange County, 200 S. Cameron Street, Hillsborough, North Carolina 27278 Page 2 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Attachment B 430 years �1 A.1yl.Inq—ng Behavioral H.1U,sen October 2, 2017 Board of Directors: David Cannell Officers: Purchasing Agent President Orange County Financial &Administrative Services Lorrie Rickman Jones,Ph.D. 200 S. Cameron St. Vice President PO Box 8181 David Shern,Ph.D. Hillsborough, NC 27278 Mental Health America Treasurer Re: Response to RFP#5240 - Orange County Behavioral Health Systems Analysis Lynda Zeller Behavioral Health Consultant Michigan Dear Mr. Cannell: Secretary Stephen Baron,M.S.W. The National Association of State Mental Health Program Directors Research Members At-Large: Institute (NRI) is pleased to submit a proposal for Behavioral Health Consultant - Joyce Allen,M.S.W. Orange County Behavioral Health Systems Analysis. NRI has over 30 years of Wisconsin experience working with state and local behavioral health authorities in systems analysis,policy research, and program evaluations. We bring national expertise and Lisa Clements,Ph.D. evidence based solutions to the project. Beacon Health Options Miriam Delphin-Rittmon,Ph.D. The work will be a top priority for the staff identified in the proposal. We have the Connecticut adequate personnel time, expertise and facilities to perform the work and are prepared to begin on the start date. Melanie Harrison Alabama Dept.of Mental Health We look forward to working with Orange County to strengthen the Behavioral Ron Manderscheid,Ph.D. Health System of Care for young County residents. NACBHDD Joseph Parks,M.D. Sincerely, Missouri Medicaid Director Tanya Royster,M.D. District of Columbia / :: Matt Salo lf Nat'l Assoc.of Medicaid Directors Dena Stoner Tim Knettler, MBA, CAE Texas Department of State Health Services Executive Director/CEO Ann Sullivan,M.D. New York Executive Director/CEO Tim Knettler,M.B.A.,C.A.E. ial Association of State Mental Health Program Directors Research Institute, Inc. 3141 Fairview Park Dr.,Suite 650, Falls Church,VA 22042 ■ 703.738-8160■ Fax: 703.738-8185 ■ http://www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Response to RFP#5240 Orange County Behavioral Health Systems Analysis Behavioral Health Consultant ;i oyam . 3 Ana"es Improving Behavioral Health sw October 2, 2017 Submitted by: The National Association of State Mental Health Program Directors Research Institute, Inc. Contact: Tim Knettler, M.B.A., Executive Director& CEO 3141 Fairview Park Drive, Suite 650; p: 703-738-8160; e: tim.knettler@nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Table of Contents Organizational Overview................................................................................................................. 2 Introduction and Experience .......................................................................................................... 2 NRI Organizational History and Priorities................................................................................... 2 Previous corporate experience managing similar projects........................................................ 3 Evidence of prior experience...................................................................................................... 4 Approach to the Behavioral Health Systems Analysis.................................................................... 7 ProposedTimeline........................................................................................................................ 17 Expert Team Members and Roles................................................................................................. 18 Customer References.................................................................................................................... 21 AppendixA: Staff Resumes........................................................................................................... 22 Appendix B: Sample Integrated Care Quality Systems Review (QSR) Tool used in New Mexico 33 Page 1 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Organizational Overview Organization: National Association of State Mental Health Program Directors Research Institute, Inc. (NRI) Contact Name: Tim Knettler, MBA, CAE, Executive Director/CEO Address: 3141 Fairview Park Drive, Suite 650, Fall Church, VA 22042 Phone Number: 703-738-8160 Email Address: Tim.Knettler@nri-inc.org Introduction and Experience The National Association of State Mental Health Program Directors Research Institute (NRI) enthusiastically responds to the Orange County, NC RFP for a Behavioral Health Consultant to conduct a Behavioral Health Systems Analysis. NRI's expertise in behavioral health at the national, state, and local levels will help Orange County identify and address barriers to mental health, substance use, and intellectual and developmental disability services for individuals between the ages of 0-25. NRI Organizational History and Priorities NRI was formed in 1987 as the research ally of National Association of State Mental Health Program Directors (NASMHPD), the organization representing state mental health commissioners/directors and their agencies. NRI is a separate, strictly non-partisan, not-for- profit 501(c)(3) organization. Our goal is to ascertain, develop, and distribute information, data, statistics, performance measures, and knowledge about public and private behavioral health service delivery systems for administrators at state and local levels. NRI is committed to: • Improving the lives of consumers of public behavioral health services (i.e., mental health and substance use), and their families through professionally conducted and academically rigorous research and support services. • Developing effective and innovative working partnerships with mental health and substance abuse state agencies; local, county and regional authorities; service providers; consumers and their families; professional organizations; foundations; the academic community; and behavioral health advocates. • Pursuing science, objectivity, and integrity in behavioral health research. • High-quality, science-based, consumer-centered and continuously improving behavioral health services. • Cultural competence, sensitivity, and diversity in developing public policy related to the delivery of behavioral health services. Page 2 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E NRI has national and state-level information on over seven million consumers served by state behavioral health systems each year and collects data on the more than $40 billion expended financing these services. Through its State Profiles System, NRI maintains a state-by-state database on the organization, structure, services, and major policies of each state behavioral health system. NRI evaluates these data on national, state, and regional levels to help plan, budget, and evaluate the delivery of their services. Previous corporate experience managing similar projects NRI has 30 years of experience managing various types of contracts and grants both as a prime contractor and as a subcontractor in the federal, state, local and commercial environment. This experience solidly grounds NRI's staff in an ability to both manage and process varying contract needs. NRI has a targeted approach that allows it to effectively monitor timelines; remain in continuous communication with consultants to ensure their most effective use; and produce products and services that are useful, accessible, and meaningful. NRI has always adhered to the highest ethical and scientific standards when producing, utilizing, and analyzing national, community, and client-level datasets. Through NRI's extensive experience, it is proficient in applying current data analytics, policy analysis, product development and report-writing on a variety of topics such as: services and systems design and delivery; issues unique to children and older adults; workforce issues; quality improvement initiatives; financing of behavioral health; the needs of veterans and state-offered services; Olmstead compliance; current federal, state, and local policy implementation issues. Areas of demonstrated expertise and distinctive competence include: • Objective and incisive program assessment from development through outcomes for persons served; • Policy analysis based on broad knowledge of evidence-based research as well as current practice in the delivery and administration of public behavioral health services; • Network and team development to assist stakeholders to address emerging issues and trends; • Evaluation, implementation, and infrastructure requirements of evidence-based and promising practices and development and use of fidelity measures and implementation toolkits; • Technical assistance to promote the most up-to-date research, methods, expertise, and evidence-based practices; • Rigorous performance measurement of public mental health programs, services, and systems; • Effective research and evaluation design and methodology; Page 3 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E • Knowledge management, development and transfer to promote information sharing among all stakeholders to inform behavioral health policy and practice; • Standardized data collection, reporting, and analysis, enabling valid comparisons within and among behavioral health providers and systems to improve quality of care; and • Information systems development and implementation to support common data across systems and over time while providing data needed for local management. Communication It has been our experience that regular communication between assigned project directors is critical to the success of projects like this. NRI is proposing that bi-weekly phone calls be held between assigned project leads as soon as the project begins. NRI has local presence in the Triangle. Mark O'Donnell, a resident of Durham County, is available to meet with representatives from County Government, UNC Health Care, school systems, and other community stakeholders when needed. The additional experts that will work on the project are available via virtual communications— phone, email, or web meeting— as often as necessary. The County will benefit from gaining the expertise of national experts without incurring the cost of travel expenses. Utilizing virtual communications platforms such as GoToMeeting enables close collaboration through screen sharing and videoconferencing. NRI has successfully managed cross-state projects using these techniques for several years. Evidence of prior experience NRI has worked in all 50 states and has engaged in multiple contracts related to behavioral health systems evaluation, design and delivery. All our work is geared toward the implementation of effective, efficient recovery oriented systems of care that support people in the most integrated settings possible. The experience described below provides examples of our work and are relevant to the tasks identified in this RFP. Colorado Office of Behavioral Health State Needs Assessment: In 2014 and 2015, working for the Colorado Office of Behavioral Health, NRI, in partnership with Advocates for Human Potential (AHP) and the Western Interstate Commission for Higher Education (WICHE — Prime Contractor for the project), conducted a needs assessment of Colorado's behavioral health service delivery system as a whole and analyzed service utilization and unmet/under-met needs by population group, service category, and sub-state regions. Vera Hollen was the NRI lead on Page 4 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E the project. Using comparative research methods, we provided national and regional comparisons to assess capacity, service utilization, and to identify gaps and shortages. We identified opportunities for improvement, and made recommendations for optimal positioning for the future. NRI was specifically responsible for addressing the following tasks: • Assess the degree to which current system resources are serving special populations, including children, adults, older adults; and persons with traumatic brain injury, dementia, severe and persistent mental illness. To accomplish this task, a series of surveys and service inventories were completed. First, we designed and distributed a statewide stakeholder survey that was completed by nearly 1,500 individuals in every region of the state. The survey solicited important feedback on what is needed to improve the behavioral health system in Colorado. Second, a separate survey was administered to behavioral health providers to understand their perspectives on populations that are underserved and services needing improvement. Third, a Provider Inventory collected information about resources available for behavioral health consumers. The inventory represents a snapshot of the programs and services available across seven geographic regions. Lastly, several key informant interviews and focus groups were held to provide a forum for them to convey their experiences with the behavioral health system, and to offer solutions. • Analyze projected impact of court-ordered evaluation and competency restorations on civil bed availability. To complete this task, NRI staff analyzed state and national-level data to identify trends in inpatient bed use for evaluation and competency, conducted focus groups on court-ordered evaluation and competency, and prepared a summary of the projected impact these restorations would have on civil bed availability. • Identify the strengths and weaknesses in the public mental health delivery system related to community integration and the Olmstead mandate. To complete this task, NRI staff reviewed a docket of court cases related to the enforcement of the Americans with Disabilities Act Title II Integration Regulation to identify where Colorado might be at risk of violation based on past precedence. In addition to reviewing the docket of cases, NRI staff reviewed state and national-level data to see how Colorado compared regionally and nationally on a number of community integration measures. North Dakota State Disabilities Council Under contract to the ND State Disabilities Council, JoAnne Hoesel surveyed agencies with regulatory and legislative authority for IDD services and supports, and identified overlapping Page 5 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E goals. The project entailed gathering and analyzing information on services and supports related to: Health/healthcare, • Employment, Informal and formal services and supports, • Education/Early Intervention, • Housing, • Transportation, • Child Care, and • Recreation. Qualitative information was gathered through key informant interviews. The final report (written by Ms. Hoesel) was entitled, "Portrait of State Services: A Comprehensive Review of Services and Supports for Individuals with Intellectual Disabilities". Ms. Hoesel also reviewed state plans (ND Center for Persons with Disabilities, Developmental Disabilities Division, Vocational Rehabilitation, Department of Public Instruction, Protection & Advocacy, Money Follows the Person, Center for Independent Livings Services, Department of Health) and identified areas the plans might provide opportunity to collaborate with the council. The project included surveying agencies with regulatory and legislative authority for IDD services and supports; identifying overlapping goals and detailing a profile for each agency. Quality Service Reviews in Multiple Systems of Care: Mark O'Donnell, in addition to his experience working for the State of North Carolina Division of Mental Health/Developmental Disabilities/Substance Abuse Services as a Child and Adolescent Mental Health Project Director, has also worked on assessments of children and adolescents in New Jersey, Indiana, Iowa and North Carolina. Page 6 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Approach to the Behavioral Health Systems Analysis As discussed in the RFP, Orange County is seeking a partner organization to conduct a county- wide Behavioral Health System of Care analysis focused on ages 0 through 25, including racial and ethnic subgroups, and their support networks. The organization will engage Cardinal Innovations, the County's specialty health plan, to identify and address barriers to behavioral health service utilization for youth in Orange County. The organization will also work closely with Chapel Hill Carrboro City Schools, Orange County Schools, and other community partners to assess and recommend improvement to the existing System of Care. NRI is prepared to work in support of Orange County's goals consistent with the timeframe outlined in the RFP. According to the RFP, the project is anticipated to span November 15, 2017 to November 15, 2018. The County has outlined the following three Deliverables for the project: ■ Deliverable 1: Inventory, create and distribute a registry of resources for mental health, substance abuse, and intellectual and developmental disabilities in Orange County serving ages 0-25. ■ Deliverable 2: Create a systems map of the resources identified in Deliverable 1 to depict how County residents navigate and access resources within the current system. Identify strengths and recommendations for improvement. ■ Deliverable 3: Work with the two County School Systems to develop a Behavioral Health Systems of Care assessment. Based on the results of the assessment, develop an implementation timeline for programmatic improvements. Family Success Alliance Zones 4 and 6 will serve as pilot sites for programmatic implementation in Year 1. NRI has designed an approach that will help Orange County meet its goal of strengthening the behavioral health System of Care for its young residents. NRI has the expertise to identify system gaps, weaknesses, strengths and opportunities. NRI's national perspective will provide context regarding how other state/county systems are designing effective Systems of Care, including lessons learned. Since each county's system is unique, our approach is to provide context for best practices while providing Orange County with reasonable and practical solutions to reduce gaps in services, improve access to care, and increase the quality of care. Deliverable 1 is an inventory of existing mental health, substance use, as well as intellectual and developmental disability resources in Orange County serving ages 0 to 25. The purpose of the inventory is to better understand which organizations are providing what services and Page 7 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E resources. We will design the inventory to consist of provider information including, but not limited to: o Contact information ■ Primary Person to Contact with Follow-Up Questions ■ Phone Number ■ Email o Service Setting (Inpatient, Outpatient, Residential) o Types of Services provided (MH, SUD, IDD, Co-occurring diagnoses) ■ Evidence Based Programs provided o Special programs offered (e.g., homeless, LGBTQ, Veterans, immigrants, refugees, traumatic brain injury, criminal justice involved) o Languages (including deaf/hard of hearing) o Age group(s) served o Method(s) to access services ■ Referral source(s) (e.g. M.D. referral, walk-in, teacher referral) ■ Admission process (if there is a particular process required for admission) o Admission inclusion or restriction criteria (e.g., age, diagnosis, etc.) o Capacity for FY 16-17 o Utilization for FY 16-17 o Number of providers by type o Geographic location(s) o Funding sources ■ External funding support ■ Types of payment/insurance accepted ■ Can uninsured or indigent individuals/families access services? Through what means? o Hours of availability NRI will begin collecting this information by researching service providers online. Results of the online surveillance will yield a preliminary list of providers in the County that offer mental health, substance use, and/or intellectual and developmental disability services to individuals age 0-25. To fully populate the list of available providers, NRI will engage stakeholders through a focus group. The focus group will consist of representatives from Mental Health America of the Triangle, NAMI-Orange County, NC Families United, the school systems, providers and other youth-serving organizations. These stakeholders will likely be able to identify additional service providers that were not included in the on-line search. We will also allow focus group members to provide feedback on a Provider Survey tool. Once an exhaustive list of resources is created, we will distribute an electronic survey to each provider to solicit the types of information listed above. We propose using Google Forms to distribute the electronic Provider Survey. Google Forms provides a simple platform for survey Page 8 NRI ■ 3141 Fairview Park Drive ■ Suite 650• Falls Church, VA■ 22042 ■ 703-738-8160 ■www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E development and distribution, embeds skip logic among questions, and the form templates can handle responses from mobile or desktop platforms. After all information has been compiled, it will be displayed in table format in an Excel file that will be delivered to the County electronically. Providing the information to the County in Excel format will allow for sorting of providers based on criteria of interest. Excel is a flexible format which will also allow the County to create an on-line interface for public access. This could be achieved through allowing electronic downloads of the Excel file on the Orange County, NC website. As the registry is updated annually (which is a separate task and not part of the current RFP), the Excel spreadsheet could be easily updated and re-posted on the website for download. This update and re-post method would allow for immediate distribution of the most current provider information across the County. We acknowledge that an ideal online resource would be user-friendly and interactive for the general public. However, creating a database with these features could be cost prohibitive for the County. This is especially true if the online tool was to be developed to allow individuals to search for specific criteria (e.g. mental health services for individuals between the ages of 0 and 5 only). One potential way to circumvent this issue would be to update SAMHSA's Behavioral Health Treatment Locator (https://findtreatment.samhsa.gov/). The Treatment Locator is a free service provided by the federal government to allow persons seeking mental health and/or substance use treatment to locate appropriate services. Users can query the system based on specific search criteria to generate a map and list of local providers. NRI would take the necessary steps to update existing information in the Treatment Locator with the information uncovered by the Provider Survey. Orange County could provide a link on their website to the Treatment Locator which would make a powerful searchable database available to County residents at minimal cost. One caveat to this method is that the Treatment Locator does not include the intellectual and developmental disability population. A potential solution is that the County website could also provide a downloadable spreadsheet of intellectual and developmental disability services identified through the Survey. The final electronic registry will be distributed to community partners, including Cardinal Innovations, general hospitals, local pediatricians and family practitioners, schools, not-for- profit agencies that have contact with youth and families, and other agencies. Distribution will be in electronic format so that the registry can remain a living document. The end goal is for the registry to become widely known across the County. Deliverable 2 utilizes the information gained through the Provider Survey in Deliverable 1. The Provider Survey was intentionally designed to gain a thorough understanding of the types Page 9 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E of mental health, substance use and intellectual/developmental disability services that are available to young County residents. Specific information such as target client groups served, specialized programming, funding supports, payment considerations will be used to analyze the degree to which Orange County offers a complete and robust Behavioral Health System of Care. NRI will incorporate the use of well-researched models of care in our approach to identifying strengths and weaknesses in Orange County's current system. In 2011, SAMHSA created a description of a Good and Modern Addictions and Mental Health Service System'. The report lists the prevention, treatment and recovery services that should be incorporated in comprehensive system, along with the care coordination and support services that are necessary to help individuals navigate complex care structures. The Institute of Medicine (now called The National Academies of Sciences, Engineering, and Medicine) also released a report that provides multiple strategies for meeting the behavioral health needs of youth 2. These two national reports will serve as an objective measure of the completeness of Orange County's mental health, addictions, and IDDD services for ages 0-25. k�� C U A�`���` .. \. 41 CIO a,, 0 �rO�atoi�° Re'ha'�tl�t�ltonl a � Promotion Mental health intervention spectrum. From 1994 IOM report:Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. i Substance Abuse and Mental Health Services Administration, Financing Center for Excellence. (2011). Description of a Good and Modern Addictions and Mental Health Service System. Draft retrieved from https://www.sa mhsa.gov/sites/default/files/good_and_modern_4_18_2011_508.pdf Z Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington DC: National Academies Press Page 10 NRI • 3141 Fairview Park Drive • Suite 650 • Falls Church, VA • 22042 • 703-738-8160 • www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E An objective review of the strengths and weaknesses in the Behavioral Health System of Care only goes so far to make recommendations for improvements. The true test of effectiveness rests within the perceptions of clients, family members, and other stakeholders. To meet this goal, NRI will facilitate the focus group described in Deliverable 1 to gain their perspectives on gaps in services and resources, barriers to accessing care, and referral processes. Focus group members will also be asked how residents navigate and access resources within the current system. Hearing from service recipients themselves, as well as those that have helped someone obtain services, will provide valuable insights into how residents are actually accessing services. This qualitative information will be used to supplement the objective review of services based on national guidance on the optimal composition of local behavioral health systems. NRI will create two visual depictions of the system. The first will be a geographic map to display the physical location and distribution of services across the county. The map will be created using GIS software. In our experience, public transportation —either the lack of or limited routes - is often cited as a major barrier to accessing care. We noted that location of services and transportation was listed as a barrier to receiving treatment in the 2016 OCHD Assessment of Mental Health and Substance Abuse Services. For these reasons, we believe that a geographic map of provider locations overlaid with public transportation routes will yield an interesting perspective on service availability within the County. The second map is conceptualized to be a drawing which highlights how an individual or family actually navigates the system. NRI will employ the creative technique of live illustration during the focus group of stakeholders. Live illustration maximizes participant engagement and greatly increases mutual understanding of ideas. When people can literally see the conversation take shape and see their ideas captured in a visual way, they feel heard and understood at a very deep level that leads to a sense of trust and shared understanding unlike anything they've experienced before. The combined power of listening to the spoken word I Tw�MK r pLII U P_ �J to PJTLNS .E GOP FALIt+T��wc ,te�Wk:ll Page 11 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E with the magic of drawing will unlock a new understanding of obstacles that residents face when trying to access services and will highlight new opportunities for systems improvement. The result is a simple and engaging graphic aimed at synthesizing residents' experiencing seeking care. The "Visual Facilitator" (Mark Schlegel) is an expert group leader and will participate in designing and co-leading the focus group along with Mark O'Donnell, NRI's Subject Matter Expert. An example of the focus group "visual summary" that will be produced is provided below. The final graphic will be available in electronic format that can be printed on letter- sized paper. There may be specific parts of the illustration that warrant special focus, so parts of the final drawing can be isolated and saved separately. T44E 'FSERAVIORA[_ 44EALTH WELLNESS PATH-SUPPORTS 4 SERVICES (ADULT) IFOLLS hJG . � uw'S N6Ev5 'w^ '�/•ay.Ys- Impl.m..n SwM.a9 � � `\ i�ppedt.G esr.f .. r.•I INro IXpn WELL CkECP_ .ga•p..d..ti. •W!^ INf Aiadn •"/ 'CISK .qT eM Ef.emu S •£d.mnm [Xwf+ 1{F.,.y4 /1 N m[rtatlY .v11 .S TES a& S fC,�,q •'•_•- �.(, elmm.XiaX; �'I'm sevint Bmis �s� y•' M e sMN� .I'n nmly w � �yb S Ny-0s�1 •'` C�-`'O�P, 4L wPMN . y t sP p Emsgi s ew.m-m rwi.e u �ftC' s�� C6FiSUYIE ...... . ''s .. - .. nN.mnL:T.awy°.er 2PENYIGY � _ R ryie•.Nfwe �vr+> ti p l -I ToMi A'iwMv 5fwp \ ^;Tw.aTi.nfrcm Tmruiteml Aya Y.ufM1 f7AY1i ylf�fA$ TOYO�d° n�� - , + fl — W.RAP tia,�or v.M1., LIX..aIE DulvehmKe M1W Ner � Ta A FA Wi LY. PROP1P8R w.xM•.,CAcaHcs) c^Rrol V!14 FRXEta6s� ZlidYner- fF rGTCµ^ Gronvt,n,, �--, fiiuLLT,'ufec-t•ce ............. Sv qq f?RT A�.:P._�ou..,, re� ,e,r�sr�•cr E. •--� �_ M lFd5FLTAL MOBILE CRISIS TEA k 41 RFCove Y RUtlILT AJ:C' i 'lhlL #ALC:rre.L.nf:n QqE �MEGIcAL . NRI Experts will closely analyze the information from the Provider Survey collected for Deliverable 1; the gaps in the currently available service continuum as measured against national recommendations for a robust System of Care; the geographic map of physical location of services and available transportation; and the qualitative feedback received from stakeholders. Together, this information will be used to identify strengths and weaknesses and to provide recommendations on improvements that can be made to remove gaps in services, streamline access, and improve the quality of care. Page 12 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E For Deliverable 3, NRI will initially consult with both the Department of Public Instruction Office of Special Education and with the Chapel Hill Carrboro City Schools and Orange County Schools to identify the current tools, process and expectations used for behavioral assessments. Consultation with the School Systems will begin with a face-to-face meeting to review the background, timeline, and goals of the project. NRI will request data that these agencies have gathered over time to identify student needs and to determine the parameters of the Behavioral Health Systems of Care (SOC) assessments. Working within the federally established SOC framework, NRI will use this information to conduct a Behavioral Health SOC assessment that will identify areas that can be improved upon. We will request the active assistance of school personnel as we develop and implement the assessment process. A dynamic and effective System of Care has the following expected outcomes: improvement of results for children with special needs and their families; promotion of efficiency, effectiveness, accountability for results; • provision of service coordination and case management; • implementation of interagency financing strategies, • provision of interagency personnel training and staff development. These outcomes require baseline knowledge of the capacities and challenges in a child or adolescent's life, along with knowledge about the systems (integrated or otherwise) that serve those children. It is important to understand how and where these systems support each young person's strengths and challenges. Noting this, NRI believes that the most effective tool to measure these outcomes is the Integrated Care Quality Systems Review (QSR) (See attached sample from the QSR tool used in New Mexico). The QSR is based on a body of work conducted by Ray Foster, PhD, Ivor Groves, PhD, Paul Vincent, MSW, George Taylor, MA, and Kate Gibbons, MSW, LICSW. NRI has received approval from the Director of the Child Welfare Group (copyright holder) to use the QSR Tool for Orange County, NC. The Integrated Care QSR Protocol would be used to determine specific areas of improvement for Chapel Hill Carrboro City Schools and Orange County Schools. The QSR provides ground-level, real-time, rapid assessment and feedback used by local and state agencies to strengthen frontline case practice, improve training and supervision capacities, and adapt practices to complex, ever-changing conditions. The QSR provides an in- depth case review and practice appraisal process to examine how well persons are benefiting from the services received and whether these services have been coordinated with one another in an effective manner through the use of in-depth case reviews and practice appraisal processes. Each individual served is viewed as a unique test of the local service system or provider agency. Small spot-checking samples drawn from the local service sites are also reviewed to determine the person's status, recent progress and related system practice and Page 13 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E performance results. The QSR inquiry process is supported by a qualitative case-based review protocol that measures the performance of core SOC practice functions in actual cases selected for an in-depth review. The review protocol involves the use of two reviewers (one experienced and one local trainee reviewer). A variety of methods are used to collect the information for the case review. Information can be collected through the implementation of qualitative measures, the use of focus groups and the integration of information from other sources (discovery- oriented inquiry process). QSR places its focus on practice and results, rather than on compliance with funding requirements or agency policies. QSR was used as the primary behavioral/systems assessment tool in the three North Carolina CMHS grant projects (PENPAL, NC FACES and NCSOCNET). Orange County via its then operating Orange Person Chatham Area Program was a part of the NC FACES grant and so utilized the QSR (then known as Service Testing). QSR is based on a set of concepts, principles and strategies related to organizational learning and positive action taken to improve practice in human service agencies that serve children and adolescents. It focuses on the life domains in a child's life and on the practices applied by public and private agencies that affect that child's life. The QSR involves case reviews, observations and interviews with the child/adolescent and people important to that child/adolescent. Results provide a rich array of lessons for next step action and improvement. These include: Detailed stories of practice and results in real situations and recurrent patterns observed across persons reviewed; Deep understandings of contextual factors that affect daily frontline practice in a site or agency being reviewed; • Quantitative patterns of service participant status, recent progress, and practice performance results based on qualitative measures; • Noteworthy accomplishments and successes; • Emerging problems, issues and challenges in current practice situations explained in local context; • Critical learning and input for next step actions and for improving program design practice and working conditions; and • Repeated measures revealing the degree to which important service system transformation aspirations are being fulfilled in daily frontline practice for children/adolescents. NRI believes that the QSR approach would provide the most comprehensive assessment of the effectiveness of the SOC. The approach has successfully been used as an evaluation tool in Page 14 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Orange County in the past. NRI believes that implementing SOC programmatic changes should be accompanied by an evaluation component—and we feel that the QSR is the best mechanism to accomplish the County's goals. Rather than implementing one point-in time assessment, the QSR delivers a continuous quality improvement approach embedding constant evaluation of programmatic changes. To test the utility of the QSR, NRI proposes piloting the Integrated Care QSR in Alliance Zones 4 and 5. Establishing a pilot phase offers several benefits. First, the QSR approach used during the pilot in Zones 4 and 6 may uncover minor modifications that would be beneficially before County-wide rollout. Second, a County-wide QSR assessment would require several reviewer dyads. The pilot phase would provide ample opportunity to train future reviewers. These reviewers would be recruited as volunteers from stakeholder groups such as the School systems, the Departments of Social Service and Public Health, potentially Cardinal Innovations, family members, local JCPC representatives. By choosing reviewers from this group, a cadre of trained QSR reviewers will be established enabling the County to maintain their own SOC evaluations over time, which is far more cost-effective than hiring paid reviewers. A third benefit of a pilot phase is that the process may yield SOC recommendations that are generalizable across the County, which could be included in an initial plan of programmatic improvements. The Integrated Care QSR pilot would be conducted on six randomly selected cases in each of Zones 4 and 6 over a period of one month. A small number of cases (6) can ably illustrate how the system is functioning and how the children in that system are faring given that level of functioning. We would be able to uncover systemic strengths and weaknesses and in so doing be able to adjust the QSR and respond to the findings in our rollout plans for the other Zones. The pilot phase would also be used to train future QSR reviewers. Results of the data analysis, along with the findings from Deliverable 2 described above, would be used to provide recommended changes to the SOC. Finally, NRI would lay out an implementation schedule for recommended programmatic changes, incorporating a County-wide QSR plan for years 2-5. The result would be a robust, continuous quality improvement approach. It is proposed that QSR be used to establish a baseline in Alliance zones 4 and 5 and be used subsequently in years 2-5, expanding to other Alliance zones as desired, to determine the progress made year by year by the involved systems and their ability to utilize the feedback via the lessons suggested above to adjust and adapt those systems to the needs of the children and adolescents in their care. The approach described above is highly dependent on support from the school and related public systems. The QSR approach requires the schools to identify randomly selected youth cases to be reviewed and individuals that should be included in case interviews or focus groups. Page 15 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Due to HIPAA sensitivities, NRI will guide the school systems on making initial contact with the individuals that will be part of the case review and scheduling interviews. NRI will not breach confidentiality and reach out to any interviewees directly. Page 16 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Proposed Timeline L L L L L L L L L L L C C C C C C C C C C C O O O O O O O O O O O f f 2 Deliverable 1: _.........-......_......_......._....... _......__......__......_................_........-......_.......-........._........_......._......_......_......_........_......_......._......._........_... ......_......_......_......_...... _ . Conduct research on providers on-line . ...._......_........_......._......._........._........._......._......_................... ........._......_........_........._......._......._......._.........-......_......_......._....... ....__......_..............-........._.......-.......-........._........_........._......._......._......_........_......_......._......._........_... ......_......_......_......._........._ Hold focus group of stakeholders .... ... ....... ......... ....... ......_........ ......_...... ............ ........._......._........._........._ Design electronic Provider Survey Distribute Provider Survey Compile data in electronic format ........ ....... .... ... _.......... . .. ..._..... ......_...... ........._........_.... ........._......_........._........._ Update SAMHSA Treatment locator ....._. ......__ ......_ ..... ... ........... .. ........_......... ........._............ ................ ....... . Distribute Registry to community partners ....._. .............. ......._ - ..._....._ ..._ ......... ... ........_........._. - _.......... Deliverable 2: Create systems maps _ ._....... ...... ....._ Provide recommendations for improvements ........_...... . Deliverable 3: _. _ - _ -.... -.. _ - - ........_.......-.......-........._........_........_......_......._......_........_......_......._......._........_... ......._......._......_................... Kick-off meeting with School Systems ...._. . ................... ..._................._......... .................. _... ........._........._................._.................... ......_......_ - ........... ........._......... .......... Finalize QSR approach Identify volunteer Reviewers for training Select cases to review(6 cases in each of Zones 4&6) .......-. Schedule dates/times for interviews .. Conduct interviews/Train Reviewers ............................................. Data Analysis _........ Recommendations for programmatic changes _-.1- -......... .. ..-... - ...... . .. - ..... -. _ -......._ ...... . ....- . Develop County-wide implementation schedule Page 17 NRI•3141 Fairview Park Drive•Suite 650•Falls Church,VA•22042.703-738-8160•www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Expert Team Members and Roles Vera Hollen, M.A. will serve as the project manager and Team Lead. Ms. Hollen has over 20 years of experience working with behavioral health systems in multi-site projects, policy analysis, strategic planning, program evaluation, and quality improvement activities. Ms. Hollen brings experience working with several state behavioral health systems looking at needs assessments at state and sub-state levels. Ms. Hollen served at the NRI Team lead for the Colorado Needs Analysis: Current Status, Strategic Positioning, and Future Planning. She also led the Ohio Association of County Behavioral Health Boards in developing strategies to fund a recovery oriented system of care. For this project, Ms. Hollen will lead the development and implementation of the Provider Survey and recommendations for system improvement. Mark J. O'Donnell, M.P.H will serve as a subject matter expert for the project and lead for the Quality Systems Review (QSR) activities. Mr. O'Donnell is local to the area and will lead the focus group and participate in any in-person meetings with County Administration. Mr. O'Donnell worked as a Local Management Entity (LME) Liaison with the NC Division of Mental Health/Substance Abuse/Developmental Disabilities (DMHDDSAS) providing technical assistance to LMEs for all levels of populations, but with a particular focus on children and adolescents and on integrated managed care. He has twice been acting Director of Child and Family Mental Health for DMHDDSAS. Prior to this he served as Principal Investigator, Director, Assistant Director, Research Director for three SAMHSA/CMHS federal System of Care grants to the State of North Carolina (PENPAL, NC FACES and NCSOCNET) and served as an advisor on the most recent CMHS federal grant to DMHDDSAS. In addition, Mr. O'Donnell served as a consultant to Human Systems and Outcomes, Inc. on their Quality Systems Review child and adolescent behavioral assessment and systems analysis process working in Hawaii, Iowa and New Jersey. Prior to coming to North Carolina, he had been the State Director for the Mental Health Association in Hawaii. He is the stepfather to two adopted children, both of whom had behavioral health or substance abuse challenges. JoAnne Hoesel, M.A. will serve as a subject matter expert for the project and will contribute to the development of the Provider Survey, identify gaps in services and provide recommendations for improvements. Ms. Hoesel has a 24+year Human Services career which includes direct service work and regional and state level policy and program development, Page 18 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E implementation, and oversight. She led North Dakota through their implementation of its SAMHSA/CMHS System of Care Grant (Partnerships Project) which transformed children's mental health services. During Ms. Hoesel's 10 year tenure as the director of the ND Mental Health and Substance Abuse Division, the state-wide Behavioral Health System was strengthened by implementing evidence-based treatment training and service delivery, training clinicians on process improvement and trauma-informed care, supporting the implementation of peer support and transition to independence, strengthening the substance abuse treatment licensure, and expanding prevention efforts. Ms. Hoesel served as the Executive Management Team Lead providing oversight and supervision to ND's Aging Services, Developmental Disabilities, Children and Family Services (Child Welfare), and Autism Services Divisions. Ms. Hoesel cultivated broad-based, department-wide expertise, working in the Legislative process and initiating and monitoring programs. Ms. Hoesel is trained on the Federal child welfare child and family services review process and is a Certified Child & Family Services Reviewer- Children's Bureau, as of February 2016. She compiled and authored a portrait of state services which provided a comprehensive review of services and supports for individuals with intellectual and developmental disabilities for North Dakota's State Council on Developmental Disabilities in 2015. Mihran Kazandjian, M.A. will serve as a Research Associate on the project and will assume primary responsibility for creating the geographic maps. Mr. Kazandjian has several years of experience in research, data collection, grant reporting and program planning. His professional research has focused on populations with mental illness and/or substance use disorders as well as the criminal justice population. Recently, Mr. Kazandjian has helped implement data collection and analyses of the activities and client characteristics of state mental health agencies. Mr. Kazandjian is proficient performing spatial analysis and map making using ESRI ArcGIS. Before coming to work at NRI, Mr. Kazandjian was a Lead Research Specialist for Oriana House, Inc., a substance abuse provider in Ohio. Amanda Wik, M.A. will serve as a Research Associate on the project. Ms. Wik will be responsible for administering the provider Survey, following up with non-responders, compiling information in electronic format, updating the SAMHSA Treatment Locator, and distributing the registry to community stakeholders. Ms. Wik will handle all logical arrangements related to the focus group or QSR activities. Page 19 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Mike Schlegel is a certified Graphic Facilitator and Co-Founder of the Whiteboard Academy. He has a distinguished career in the water resources field and has won numerous awards for his facilitation in his former role as the Water Resources Program Manager at Triangle J Council of Governments (TJCOG). While at TJCOG, Mike lead the Falls Lake Stakeholder Project, which brought together over 300 diverse stakeholders to participate in the development of the Falls Lake Nutrient Management Strategy. In addition, Mike served as the Technical Lead for the Jordan Lake Partnership's Triangle Regional Water Supply Plan, which developed an historic consensus on a 50-year plan to meet the future water supply needs for the entire Triangle Region. Mr. Schlegel is on a mission to help others unlock awesome through visual thinking. From his home in Raleigh, he works with rising leaders and innovative teams from the health care, pharmaceutical, real estate, environmental and technology sectors. He is highly sought after for his unique blend of leadership, facilitation and real-time visual capture that takes engagement and impact to a whole new level. Page 20 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Customer References Flo Stein Phone: 919-518-2581 Email: fsteinbolton@nc.rr.com Former Deputy Director NC Division of Mental Health Developmental Disabilities and Substance Abuse Services Department of Health and Human Services Patrick Fox, M.D. Chief Medical Officer Colorado Department of Human Services, Office of Behavioral Health 3824 W. Princeton Circle, Denver CO 80236 Phone: (303) 866-2727 Email: patrick.fox@state.co.us Dr. Brent A. Askvig Executive Director ND Center for Persons with Disabilities Minot State University 500 University Avenue West Minot, ND 58707 Phone: 701-858-3580 Email: Brent.askvig@minotstateu.edu Page 21 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Appendix A: Staff Resumes Page 22 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Vera Hollen,M.A. NASMHPD Research Institute,Inc. Senior Director of Research and Consulting Experience Summary Over 20 years of experience working with mental health systems in multi-site projects,policy analysis,strategic planning,program evaluation,and quality improvement activities. Director of NRI's Mental Health—Criminal Justice Research Center. Plans and conducts analyses on the Behavioral Healthcare Performance Measurement System and other specialized databases to produce technical papers and published reports. Skills include project management,data analysis,performance measurement,and staff training. Education • M.A.,Health Behavior Research,George Mason University, 1996 • B.S.,Psychology and French Literature,University of Mary Washington, 1990 Recent Experience Behavioral Health System Gap&Needs Analysis • Assessed community-based service capacity,existing mix of available services,and identification of service gaps for Colorado Office of Behavioral Health utilizing both qualitative and quantitative methods. Provided national and regional contexts of the findings to strengthen budget and policy decisions • Identified innovative approaches to maximize alternative payer sources such as Medicaid and private health insurance • Identified opportunities for expanded use of new evidence-based practices for tele-healthcare and summarized the potential impact of implementing these new practices Program Planning&Evaluation • Designed outcome measures at the client and program level to assess program effectiveness for children's residential facilities and inpatient psychiatric facilities • Designed qualitative and quantitative program evaluation methodology for new project charters in Illinois 7 state hospitals • Conducts on and off--site technical assistance for state psychiatric hospitals on data reporting for hospital accreditation and quality improvement activities • Conducts site visits and medical record reviews to ensure data integrity Data Collection,Analysis&Dissemination • Design standardized performance measures for use in public behavioral healthcare agencies • Authored standardized implementation guides&data dictionaries for use across 200+psychiatric settings for the Behavioral Healthcare Performance Measurement System • Lead technical workgroup consisting of 20 experts in the development of tools&processes for data gathering, analysis,interpretation&dissemination • Conduct specialized analyses on longitudinal database consisting of over 1 million patient records to uncover trends • Create organizational data flow maps and analysis of data integrity for behavioral health programs • Conduct large(150 attendees)and small group training sessions on data interpretation&utilization for quality improvement of programs via live trainings&web-based e-learning for state-level behavioral health directors, program planners,administrators, clinicians and consumers • Authored and secured federal grants to fund research dissemination activities Grant Applications(Authored) • Agency for Healthcare Research and Quality Research Dissemination Grant,2012 not funded • SAMHSA Conference Grants,multiple grants 1993-2007 funded • NIMH Public-Academic Liaison Post-doctoral Fellowship Program, multiple grants 1995-2002 funded • Janssen Pharmaceuticals Conference Grants,multiple grants 1997-2003 funded Page 23 NRI • 3141 Fairview Park Drive • Suite 650 • Falls Church, VA • 22042 • 703-738-8160 • www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Employment History • NASMHPD Research Institute,Inc.,currently Senior Director of Research&Consulting(1991 —Present) • Georgetown University Dept. of Psychology, Summer Fellow(1991) • University of Connecticut Alcohol Research Center,Research Assistant(1990-1991) • University of Hartford,Teaching Assistant(1990-1991) • Rappahannock Area Community Services Board,Prevention/Public Information Intern(1990) • Northern Virginia Mental Health Institute,Psychiatric Technician(1987) Publications Hollen,V.,Ortiz,G. &Schacht,L. (2016)Innovative Uses of Technology to Address the Needs ofJustice-Involved Persons with Behavioral Health Issues(Technical Assistance Assessment#2). Alexandria,VA:National Association of State Mental Health Program Directors. Ortiz,G.,Hollen,V,&Schacht,L. (2016). Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals.Journal of Psychiatric Practice,22,283-297. Hollen,V. (2015) Impact of court-ordered competency evaluations on civil bed availability in the Colorado Mental Health Institutes. Report for Colorado Office of Behavioral Health Needs Analysis: Current Status,Strategic Positioning,and Future Planning. Hollen,V. (2015) Regional behavioral health service distribution among rural,frontier, tribal, and urban population centers. Report for Colorado Office of Behavioral Health Needs Analysis: Current Status, Strategic Positioning,and Future Planning. Hollen,V.,Ortiz,G. &Schacht,L. (2015)Behavioral Health and Criminal Justice Systems:Identifying New Opportunities for Information Exchange(Technical Assistance Assessment#10). Alexandria,VA:National Association of State Mental Health Program Directors. Hollen,V. &Ortiz,G. (2015). Co-Occurrence of Mental Health and Substance Abuse Disorders in Youth Served in State Psychiatric Hospitals.Journal of Child&Adolescent Substance Abuse,24(2), 102-112. Hollen,V. &Ortiz,G. (2013). Characteristics of State-Operated or Supported Psychiatric Hospital Inpatient Care. Falls Church,VA:National Association of State Mental Health Program Directors Research Institute,Inc. Hollen,V.,&Roberts,K.(2011).State licensing and certification standards of mental health facilities:2011. Washington,D.C.:U.S. Department of Health and Human Services. Hollen,V,Ortiz,G,Schacht,L,Mojarrad,M,Lane Jr,GM,Parks JJ(2010).Effects of adopting a smoke free policy in state psychiatric hospitals.Psychiatric Services, 61 (9), 899-904. Ortiz, G., Mojarrad, M. & Hollen, V. (2008) Co-occurrence of diabetes and schizophrenia among adults in state psychiatric hospitals. Poster presented at the 5th Annual Conference on Behavioral Healthcare. Hollen, V.(Ed.). (2008). Summary of results presented at the 2008 Conference on State Mental Health Agency Services Research. Using Data,Changing Practice. Alexandria,VA:NASMHPD Research Institute,Inc. Ortiz,G.,Mojarrad M.,Hollen,V.(2008). Co-occurrence of Diabetes Mellitus and Schizophrenia among Adults in State Psychiatric Hospitals.Poster presented at the Fifth National Conference on Behavioral Health Care. Hollen, V. & Mojarrad, M. (Eds.). (2007). Summary of results presented at the 2007 BHPMS User Group Conference. Using Data,Changing Practice. Alexandria,VA:NASMHPD Research Institute,Inc. Hollen, V. & Monihan, K. (Eds.). (2007). Summary of results presented at the 2006 BHPMS User Group Conference. Using Data,Changing Practice. Alexandria,VA:NASMHPD Research Institute,Inc. Hollen, V. & Shaw, R. (2005). State Profile Highlights: FY 2003 Revenue and Expenditure Study Results. Alexandria,VA:National Association of State Mental Health Program Directors Research Institute,Inc. Lutterman, T.,Hollen,V. & Shaw,R. (2004). Funding Sources and Expenditures of State Mental Health Agencies: Fiscal Year 2002. Alexandria,VA:National Association of State Mental Health Program Directors Research Institute,Inc. Lutterman, T.,Hollen,V. & Shaw,R. (2003). Funding Sources and Expenditures of State Mental Health Agencies: Fiscal Year 2001. Alexandria,VA:National Association of State Mental Health Program Directors Research Institute,Inc. Hollen,V. &Mazade,N. (1999). Selected emerging trends in the public mental health system and their implications for research. In H.A. Pincus (Ed.)., Research Capacities and Activities of State Mental Health Agencies. Washington,D.C.:American Psychiatric Association. Page 24 NRI • 3141 Fairview Park Drive • Suite 650 • Falls Church, VA • 22042 • 703-738-8160 • www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Lutterman, T.,Hollen,V.; &Mazade,N. (1995). Research capacities and activities of state mental health agencies. In H.A. Pincus (Ed.)., Research Funding and Resource Manual: Mental Health and Addictive Disorders (pp. 235-259).Washington,D.C.:American Psychiatric Association. Lutterman, T., Harris, B., O'Brien, M., Bozynski, M., & Hollen, V. (1995). Funding Sources and Expenditures of State Mental Health Agencies: Fiscal Year 1993. Alexandria, VA: National Association of State Mental Health Program Directors Research Institute,Inc. Hollen, V. (1995). Summary of Fiscal Year 1994 Annual PATH Reports. Alexandria, VA: National Association of State Mental Health Program Directors Research Institute,Inc. Hollen, V. (1994). Summary of Fiscal Year 1993 Annual PATH Reports. Alexandria, VA: National Association of State Mental Health Program Directors Research Institute,Inc. Lutterman, T. & Hollen, V. (1993). Funding Sources and Expenditures of State Mental Health Agencies: Fiscal Year 1990. Alexandria, VA: National Association of State Mental Health Program Directors Research Institute,Inc. Hollen, V. (1993). Summary of Fiscal Years 1991 and 1992 Annual PATH Reports. Alexandria, VA: National Association of State Mental Health Program Directors Research Institute,Inc. Lutterman, T. &Hollen,V. (1992) Change in state mental health agency revenues and expenditures between fiscal years 1981 and 1990. In R.W. Manderscheid & M.A. Sonnenschein ( Eds.), Mental Health United States, 1992.(pp. 163-207).Washington,D.C. : Supt. of Docs.,U.S. Govt Print.Office. Page 25 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E MARK JOSEPH O'DONNELL Senior Consultant Experience Summary Mr. O'Donnell worked as a Local Management Entity(LME)Liaison with the NC Division of Mental Health/Substance Abuse/Developmental Disabilities(DMHDDSAS)providing technical assistance to LMEs for all levels of populations,but with a particular focus on children and adolescents and on integrated managed care.He has twice been acting Director of Child and Family Mental Health for DMHDDSAS.Prior to this he served as Principal Investigator,Director,Assistant Director,Research Director for three SAMHSA/CMHS federal System of Care grants to the State of North Carolina(PENPAL,NC FACES and NCSOCNET)and served as an advisor on the most recent CMHS federal grant to DMHDDSAS. In addition,Mr. O'Donnell served as a consultant to Human Systems and Outcomes,Inc.on their Quality Systems Review child and adolescent behavioral assessment and systems analysis process working in Hawaii,Iowa and New Jersey. Prior to working in North Carolina,he had been the State Director for the Mental Health Association in Hawaii. He is the stepfather to two adopted children,both of whom had behavioral health or substance abuse challenges. Education 12/73 Bachelor Of Arts in Anthropology,University Of California at Los Angeles. 2/80 Master of Public Health Education,University of Hawaii.Specialization in planning, implementing and evaluating community health education programs. 8/85 Certificate,American Banker's Association,National Trust School,Northwestern University. 7/87 Certificate,Cannon Financial Institute Intermediate Trust School. 7/87 Certificate,Cannon Financial Institute Advanced Personal Trust Administration School. 1/90 Certificate, Cannon Financial Institute Corporate Trust I School. 1/92 Certificate,Hawaii Pacific University:Weinberg Foundation Fellow-NonProfit Management Program Employment History 9/17—present Senior Consultant,NRI 8/09-9/10 State System of Care Coordinator State of North Carolina Department of Health and Human Resources Mental Health/Developmental Disabilities/Substance Abuse Division Child and Family Services Section, Raleigh,North Carolina 3/03—1/17 Local Management Entity Technical Assistance Liaison, Special Projects Manager State of North Carolina Department of Health and Human Resources Mental Health/Developmental Disabilities/Substance Abuse Division Child and Family Services Section, Raleigh,North Carolina 6/99—2/03 Project Manager/Principal Investigator 2/95—6/99 Assistant Project Manager/Research Director, State of North Carolina Department of Health and Human Resources Mental Health/Developmental Disabilities/Substance Abuse Division Child and Family Services Section, Raleigh,North Carolina Page 26 NRI • 3141 Fairview Park Drive • Suite 650 • Falls Church, VA • 22042 • 703-738-8160 • www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E 7/00—9/00 Acting Section Chief,Child and Family Services North Carolina Department of Health and Human Resources Mental Health/Developmental Disabilities/Substance Abuse Division Child and Family Services Section, Raleigh,North Carolina 5/90-2/95 Executive Director, Mental Health Association in Hawaii,Honolulu,Hawaii 8/89-2/95 Foundation and Nonprofit Organization Consultant Hawaii Community Foundation and HELP For NonProfits, Honolulu,Hawaii 8/89-5/90 Assistant Vice President and Bond Administrator for Corporate Trusts Hawaiian Trust Company,Ltd., Honolulu,Hawaii 8/88 -8/89 Associate Director, Executive Service Corps of Southern California,Los Angeles,California 5/84-8/87 Assistant Vice President and Personal Trust Officer for Charitable Trusts and Foundations, Hawaiian Trust Company,Ltd./Bank of Hawaii, Honolulu,Hawaii 8/82-5/84 Executive Director/Administrator,Waianae Coast Day Care Centers,Inc., Waianae,Hawaii 1/82-4/82 Legislative Research Analyst and Committee Clerk, State of Hawaii House of Representatives, Representative Bertrand Kobayashi, Honolulu,Hawaii 1/81 - 12/81 Chair, Special Event/Fund-raiser/Administrator and Supervisor of Community Development Youth Employment Program,Kahaluu Coalition/Kualoa-He'eia Ecumenical Youth Project, Kaneohe,Hawaii 1/80- 12/80 Health Education/Community Development Fieldwork Student,Kualoa-He'eia Ecumenical Youth Project, Kaneohe,Hawaii 3/77-5/78 Peace Corps/VISTA Recruitment Officer,California 5/78-8/79 and Hawaii State Recruitment Officer,U.S.ACTION Agency,Los Angeles and Honolulu 7/74-8/76 Peace Corps Volunteer Secondary School Teacher,Republic of Niger,West Africa Presentations Felix V. Waihee:A Case Study in a Community's Use of the Legal System in Building a Child and Adolescent Mental Health System of Care. PEN-PAL:Family Involvement in the Development of A Community-Based System PEN-PAL:A Partnership Between Community Agencies,Families and a State University System to Develop a Collaborative System of Care for Seriously Emotionally Disturbed Children and Their Families. Parents Assess Service Systems(PASS): A Report Card Evaluating Systems Of Care By Parents Quality Improvement Applications and System of Care Development Public Academic Liaisons:Pre-Service and In-Service Curricula in a System of Care Developing Rural Mental Health Systems for Children and Adolescents Coordinated Practice Reviews: Evaluating Linkages Between Child,Family and Service System System of Care and Caregiver Strain Using Service Review and Testing to Improve a System of Care Integrating Community-based Services: The Collaborative Planning Process Innovations in Human Resource Development and Training for Systems of Care Sex and Ethnic Origin in Selected Outcomes:North Carolina FACES Page 27 NRI • 3141 Fairview Park Drive • Suite 650 • Falls Church, VA • 22042 • 703-738-8160 • www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Honors and Awards Recipient N.C. Grant Site Participants Leadership Award 2003 Recipient Resolution of Honor,The House Of Representatives, State of Hawaii, 1995 Recipient Outstanding Advocate of the Year, 1995 Recipient Outstanding Young Man of America, 1983 Recipient University of Hawaii Public Health Scholarship, 1980 Community Service Member- CMHS Communications Committee(2000-03) Reviewer- SAMHSA grant reviewer(2001) Big Brother (2000-01) Adjunct Clinical Faculty/Lecturer- University of Hawaii School of Public Health(1992-1995) Member- Board of Health,State of Hawaii(1992-1995) Past President/Member Society of Public Health Education-Hawaii Chapter(1979-88) Board Member- Hawaii Community Services Council(1986-88) Board Member- National Society of Fund Raising Executives,Aloha Chapter(1987-88) Mediator- Neighborhood Justice Center(1984-88) Charter Member- Waianae Coast Coalition for Human Services(1982-84); Charter President- Friends of He'eia State Park(1980-83) Member- State of Hawaii Legislature Ad Hoc Committee on Human Services/County-State Relations(1985) Member- City and County of Honolulu Makiki-Tantulus Neighborhood Board(1982) Publications Evaluation in the Implementation of System of Care in North Carolina Chapter for Child Mental Health:Interdisciplinary Practice System of Care (with Maria E.Fernandez and Terri Grant) Herrick,C.&Arbuckle,M(Ed). Sudbury,MA:Jones&Bartlett,2006 Mental Health Services in Hawaii: Time to Reform Chapter for The Unfinished Health Agenda: Lessons From Hawaii R.Grossman and J. Shon. (Eds.)Honolulu,HI:University of Hawaii Press, 1994 Mental Health Care in Hawaii: The Health State Focal Point,University of Portland Research and Training Center,Winter/Spring 1994. Page 28 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E JoAnne D.Hoesel NASMHPD Research Institute,Inc.,Senior Advisor Experience Summary Accomplished executive with demonstrated ability to deliver mission-critical results.Leadership in human service policy development,program implementation,system change initiatives,and program monitoring. Education Bachelor of Arts,Psychology Master of Arts,Organizational Management Licensed ND Addiction Counselor#1317 Core Accomplishments State Behavioral Health Authority: Partnered with child welfare and juvenile corrections to implement performance-based standards(Pbs),a data-driven improvement model that identifies,monitors and improves service provision in residential facilities and programs using national standards and performance outcome measures in all residential and psychiatric treatment centers. Facilitated the statewide implementation of evidence-based treatment services in both mental health and substance abuse areas. Expanded substance abuse prevention efforts.Led the introduction and successful legislation which paved the way for the state's first opioid treatment program. Executive Management Lead for Program and Policy: Provided administrative supervision to state aging services,child welfare,and developmental disabilities divisions for over ten years which lead to increased collaboration and identification of partnering opportunities.Experience with extensive contracting including a pay-point or performance-based contracting for adoption services.Ms.Hoesel oversaw the Department's decision support unit,responsible for data analysis and reporting for 6 years. Chaired the state Autism Task Force and was instrumental in implementing the Medicaid autism waiver and autism voucher programs. Professional Experience Senior Advisor,NRI(National Association of State Mental Health Program Directors Research Institute)-Current Project Manager,ND Department of Human Services,Medicaid Program Current Consultant,JDH solutions— Bismarck,ND Current Director,Division of Mental Health and Substance Abuse l 0/2004 to 4/2015 ND Department of Human Services— Bismarck,ND Program and Policy Lead-Executive Management Lead 4/2005 to 4/2015 ND Department of Human Services-Bismarck,ND Interim Director,Child Welfare Division,2 years Division Director,Developmental Disabilities Division, 1-1/2 years Decision Support Unit director—6 years State Children's Mental Health Administrator 3/1999 to 10/2004 ND Department of Human Services— Bismarck,ND Child and Family Services Director 4/1992 to 3/1999 West Central Human Service Center ND Department of Human Services— Bismarck,ND Page 29 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Addiction Counselor West Central Human Service Center 12/1990 to 4/1992 ND Department of Human Services— Bismarck,ND Police Youth Worker,Bismarck Police Department— Bismarck,ND 6/1988 to 12/1990 Affiliations Certified Child&Family Services Reviewer—Children's Bureau,as of February 2016. Approved SAMHSA Grant Peer Reviewer,as of November 2015 Past Secretary,National Association of State Alcohol and Drug Abuse Directors(NASADAD) Region VIII NASADAD Representative Past Board Member-National Research Institute,National Association of State Mental Health Program Directors (NASMHPD) Past Addiction Technology Transfer Center Board Member-Prairie Lands/Central Rockies Past Board member-ND State Family-Based Services Association Past Board member and Treasurer-Bismarck-Mandan Chemical Health Foundation Harold Schafer Leadership Center-Executive Operations Committee Member-University of Mary Publications Simonich,H.K.,Wonderlich, S.A.,Erickson,A.L.,Myers,T.C.,Hoesel,J,Wagner, S.,Engel,K. (2015).A Statewide Trauma-Focused Cognitive Behavioral Therapy Network: Creating an Integrated Community Response System.Journal of Contemporary Psychotherapy. Wonderlich, S.A., Simonich,H.K.,Myers,T.C.,LaMontagne,W.,Hoesel,J.,Erickson,A.L.,Korbel,M. &Crosby, R.D. (2011).Evidenced-based mental health interventions for traumatized youth: A state-wide dissemination program.Behavior Research and Therapy,49(10),579-587. "Achieving the Vision for a Comprehensive,Family-Focused System of Care in North Dakota" P.Ronningen,K.Mourn,J.Hoesel,North Dakota Journal of Human Services, 1996. "North Dakota Partnerships'Success Story:Increasing Access to Quality Services,Satisfying Families and Containing Costs"P.Ronningen,K.Mourn,J.Hoesel,Behavioral Healthcare Tomorrow,April 1998. Awards 2001 Green Ribbon Award-ND Federation of Families. 2015 Consumer and Family Network-Exceptional Promotion of Recovery and Peer Support Services Page 30 NRI • 3141 Fairview Park Drive • Suite 650 • Falls Church, VA • 22042 • 703-738-8160 • www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Mihran Kazandjian, M.A. NASMHPD Research Institute, Inc.,Research Associate Experience Summary Mr.Kazandjian is a researcher with several years of experience in research, data collection, grant reporting and program planning. His professional research has focused on populations with mental illness and/or substance use disorders as well as the criminal justice population.More recently he has developed a research focus on state initiatives toward treating first episode psychosis, especially in relation to the MHBG 10% set-aside. He has helped implement data collection systems in substance use treatment and correctional facilities in support of program evaluation activities. Mr.Kazandjian currently helps implement data collection and analysis of the activities and client characteristics of state mental health agencies (SMHAs), including through the SAMHSA URS and MH-CLD initiatives. He also writes customized reports for SMHAs seeking to understand their agency's strengths and weaknesses. He is proficient using SPSS,performing data queries using SQL and performing spatial analysis and map making using ESRI ArcGIS and open source GIS software. Recent Experience Contributed to data analysis of 2014 and 2015 URS and MH-CLD that profile the characteristics of state mental health agency clients. Primary author of case study of funding strategies for FEP treatment synthesized from 14 interviews with SMHAs and FEP treatment providers. Contributed to snapshot of state activities to meet Mental Health Block Grant set aside funds for first episode psychosis. Participated in design of questions for 2015 State Mental Health Agency Profiles(SPS) information update from all state mental health agencies. Employment History NASMHPD Research Institute,Inc.,Research Associate, (2015 -present) Oriana House, Inc.,Lead Research Specialist, (2013-2014) Oriana House, Inc., GIS and Research Intern, (2012-2013) Kent State University, Geography Department, Teaching Assistant, (2011 —2012) Education M.A., Geography,Kent State University, 2014 B.A.,History; Chinese minor,The College of Wooster,2010 Publications (selected list) Substance Abuse and Mental Health Services Administration. (In Press).Funding and Characteristics of Single State Agencies for Substance Abuse Services and State Mental Health Agencies, 2015. HHS Pub.No. (SMA)xx-xxxx.Rockville, MD: Substance Abuse and Mental Health Services Administration. Kazandjian,M.;Lutterman, T. (In Press). The Un/Coordinated Costs of Behavioral and Primary Health Care:An Analysis of State Studies. Alexandria,VA: National Association of State Mental Health Program Directors. Neylon,K.,Kazandjian,M.,Lutterman,T. (In Press). Snapshot of SMHA Plans for Using the Five Percent Set-Aside for Early Intervention Programs, Fiscal Years 2014&2015. HHS Pub.No. (SMA) xx-xxxx. Rockville,MD: Substance Abuse and Mental Health Services Administration. Page 31 NRI • 3141 Fairview Park Drive • Suite 650 • Falls Church, VA • 22042 • 703-738-8160 • www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Amanda Wik, M.A. NASMHPD Research Institute,Inc. Research Associate Experience Summary Began working at NRI in January of 2017 as part of the newly formed Mental Health-Criminal Justice Center. Before coming to NRI Ms. Wik was a graduate student at the University at Massachusetts Lowell. Ms. Wik graduated with her Bachelor's degree in both Criminal Justice and Psychology from UML in 2014 and completed her Master's degree in Criminal Justice in 2015. The research that Ms. Wik does focuses on forensic patients and their access to treatment. She is currently responsible for reviewing research for the studies that are underway in the Mental Health-Criminal Justice Center. Ms. Wik is also involved in NRI's Mortality Study. She is assisting the lead research by reviewing the literature on mortality rates among individuals with mental health disorders, and analyzing the data for the project. Recent Experience • Provides expertise on Mental Health-Criminal Justice topics • Reviews literature for the projects underway in the Mental Health-Criminal Justice Center • Assists in data analysis Employment History • National Association of State Mental Health Program Directors Research Institute,Inc. (NRI), Falls Church,VA-Research Associate(2017-Present) • Wellesley Centers for Women. Wellesley,MA-Research Assistant(2016 to 2017) • University of Massachusetts Lowell,Lowell,MA-Research Assistant(2015 to 2017) • University of Massachusetts Lowell,Lowell,MA-Teaching Assistant(2015 to 2016) • University of Massachusetts Lowell,Lowell,MA-Research II Grader(2014) • University of Massachusetts Lowell,Lowell,MA-Psychology Tutor(2013-2014) • Home Depot,Nashua,NH- Sales Associate(2012-2014) • Donnelly's School Apparel, Dracut,MA- Sales Associate(2011-2013) • Petsmart, Salem,NH-Sales Associate (2011-2012) Education • M.A., Psychology,University of Massachusetts Lowell,2015 • B.S., Criminal Justice and Psychology,University of Massachusetts Lowell, 2014 Publications Wik,A.,Hollen,V., &Fisher,W. (2017).Assessment#9:Forensic Patients in State Psychiatric Hospitals: 1999-2016. Alexandria,VA:National Association of State Mental Health Program Directors. Morabito,M., Socia,K.,Wik,A., &Fisher,W. (2017). The nature and extent of police use of force in encounters with people with behavioral health disorders.International Journal of Law and Psychiatry, 50: 31-37. Page 32 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E Appendix B: Sample Integrated Care Quality Systems Review (QSR) Tool used in New Mexico Page 33 NRI • 3141 Fairview Park Drive • Suite 650• Falls Church, VA• 22042 • 703-738-8160 •www.nri-inc.org DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E QSR STATUS & PRACTICES MEASURES AND THEIR USES Quick StudyQSR Person Status and health and wellness,live a self-directed life,and strive to reach their full potential. Interventions are developed in accordance with the guiding principles of • • ` • • Practice Measures & Their recovery:hope,person-driven,holistic,peer supported,relational,responsive to PractitionersUses in Practice Development culture and to trauma,focused on strengths and responsibility,and respectful. The QSR Personal Status Measures encompass wellness as well as other important The Quality Service Review life areas.The 10 QSR Practice Measures cover practice functions that embrace well- ness and recovery as well as the following best practice approaches for providing The Quality Service Review(QSR)provides a case-based appraisal of frontline practice high quality behavioral health care: used for organizational learning and development to improve results in agencies providing integrated primary care and behavioral health care services. A multi- • Person-centered care. • Strengths-based practice. method approach is used that includes in-depth case practice reviews applying quali- • Solution-focused practice. • Trauma-informed care. tative measures, focus group interviews, and integration of other sources of information into a discovery-oriented inquiry process. QSR provides ground-level, The QSR practice measures are derived from the Practice Wheel and Practice Tip real-time, rapid assessment, and feedback used by local and state agencies to Sheets used in practice promotion and training activities in New Mexico.An illustra- strengthen frontline case practice, improve training and supervision capacities, and tion of the Practice Wheel is provided below, adapt practice to complex,ever-changing conditions. Measures of a Person's Present Status Guiding Principles for QSR Measures Personal Status Measures are qualitative indicators for assessing the degree to which The QSR measures presented here are designed for use in integrated care settings a person is achieving 15 important life outcomes.The applicability of these outcomes where primary health care and behavioral health care are provided jointly to persons depend in part on a person's life stage, personal choices, and situation. Personal in need of those services. These QSR measures reflect a behavioral health care Status Measures look at the person's present status in each area as viewed over the perspective that promotes Wellness and Recovery as central purposes of care and are past 30 days for most indicators. The 15 status indicators are defined as follows: reflected in the QSR qualitative measures. These two elements are defined as follows: 1. SAFETY. Degree to which the person is free from external risks of harm, • Wellness is an active process in which a person becomes aware of and makes inclusive of such factors as abuse,neglect,intimidation,and/or exploitation choices toward a more healthy and successful existence.Wellness is a conscious, by others.This indicator applies to all persons. self-directed,and evolving process of achieving full potential which is multidimen- sional and holistic, encompassing lifestyle, physical, mental and spiritual well- 2 BEHAVIORAL RISK Degree to which the person is avoiding self- being,and the environment. endangering situations and refraining from using behaviors that may put him/ her or others at risk of harm.This indicator may not apply to persons under • Recovery is an active, ongoing process through which persons improve their 3 years of age. 'ractice Wheel: Functions in Integrated Care Practicem 1.Recognition, Connection, Rapport 9.Situation Tracking, 2.Engagement& Plan Adjustments, Commitment to Transitions/Discharges Change Process 3.Person- 8.Implementing Centered Care, 4.Screening, Interventions, H Care Coordination,H Detection,Prevention/ Supports&Services Teamwork Mitigation,Monitoring 7.Planning Person- 5.Physical Exam,Bio- Centered Interventions, Psy-Soc Assessment, Supports&Services Case Formulation 6.Person-Centered Wellness&Recovery Goals Practice Functions May Occur Interactively,Concurrently,and - .. QSR INSTITUTE, CWPPG, 2016 • PAGE 1 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E QSR STATUS & PRACTICES MEASURES AND THEIR USES 3. PHYSICAL HEALTH STATUS.Degree to which the person is: • Achieving peer support and community activities. • The person has opportunities to and maintaining favorable health status,given any disease diagnosis and prog- meet people outside of the service provider organization and to spend time nosis that the person may have; and • Receiving adequate and consistent with them. • The person's social network supports recovery efforts. This levels of health care appropriate for the person's age, personal needs, and indicator may not apply to persons under5 years of age. preferences.This indicator applies to all persons. 12a. EARLY LEARNING STATUS.Degree to which: •The child's developmental 4. EMOTIONAL/MENTAL HEALTH STATUS: Consistent with age and ability, status is commensurate with age and developmental capacities. •The child's degree to which the person is displaying an adequate pattern of: • Presenting developmental status in key domains is consistent with age- and ability- an affect regulation appropriate to person and situation; • Managing clinical appropriate expectations.This indicator applies to persons under5 years. symptoms of emotional/behavioral/thought disorders that interfere with daily activities; • Socializing and connecting with others; and, • Participating in 12b. ACADEMIC STATUS.Degree to which: • The child or youth[according to age major activities and decisions affecting the person's life.This indicator may and ability]is:(1)regularly attending school,(2)placed in a grade level consistent not apply to persons under 3 years of age. with age or developmental level,(3)actively engaged in instructional activities,(4) reading at grade level or IEP expectation level,and(5)meeting requirements for 5. SUBSTANCE USE STATUS. Degree to which the person is achieving and annual promotion and course completion leading to a high school diploma,a GED, maintaining a life free from substance use impairment.This indicator may not or preparation for employment.This indicator applies to a school age child or apply to persons under 8 years of age. youth who is 5 years of age or older. 6. SPIRITUAL WELL-BEING. Degree to which: • The person has a positive 12c. PREPARATION FOR ADULTHOOD.Degree to which the youth[according to guiding force for purpose and direction in life; •The person relies on positive age and ability]is: • Gaining life skills,developing relationships and connec- spiritual beliefs and supports to provide comfort and encouragement in times tions,and building capacities for living safely,becoming gainfully employed, of difficulty, despair, and challenge,while bringing hope and faith to seem- and functioning successfully upon becoming independent of child services- ingly hopelessness situations; • In times of stress and worry,the person has OR- • Becoming eligible for adult services and with the adult system being positive sources for spiritual strength and emotional protection that enable ready to provide(via a seamless transition)continuing care,treatment,and the person to cope with fear,guilt,shame,loss,and gain courage to meet life residential services that the youth will require upon discharge from services. challenges; • The person belongs to and participates in group activities that This indicator applies to a youth 15 years to 18 years of age. support spiritual growth and well-being of members.This indicator may not apply to persons under 12 years of age, 12d. EDUCATION/CAREER DEVELOPMENT. Degree to which the person (adult): • Is actively engaged in educational activities(e.g.,adult basic educa- 7. FUNCTIONAL STATUS. Degree to which the person, based on need and tion, GED course work, or post-secondary education), vocational training choice,is actively acquiring and/or using acquired functional life skills necessary programs,or transitional employment. • Is receiving information about work for successful daily living.This indicator applies to persons over age 3. benefits, access to work supports, rights,responsibilities,and advocacy. This indicator applies to adults. 8. VOICE & CHOICE / SELF-DIRECTED CARE. Degree to which: • The person is an active ongoing participant(e.g.,having a significant role;voice, 13. WORK STATUS.As appropriate to life stage,functional status,and personal and influence)in decisions made about wellness and recovery goals,interven- preference,the degree to which the person is: •Actively engaging in employ- tion strategies,services,and results; • For a willing and able adult,the person ment,competitive or supported(earning federal minimum wage or above,in an is actively directing some or all aspects of the care being provided.This indi- integrated community setting),or in an individual placement with supports in a cator may not apply to persons under 12 years of age, productive situation. • [If presently limited by labor market opportunities or a disabling condition] The person is exploring or engaged in productive volun- 9. ECONOMIC SECURITY&PERSONAL MANAGEMENT.Degree to which: teer opportunities in consumer-operated services, a community center, or a •The person's earned income and economic supports are sufficient to cover library.This indicator applies to adults. basic living requirements (i.e.,shelter,food, clothing, transportation, health care/medicine,leisure,childcare). • The person is accessing,receiving,and 14. PARENT&CAREGIVER FUNCTIONING.Degree to which: • The person managing the economic benefits for which he/she is eligible. • The person functions as an adequate parent for dependent children and/or a caregiver for has economic security sufficient for maintaining stability and for sustaining the a dependent adult for whom the person has caregiving responsibilities. •The ability to meet ongoing life needs.This indicator applies to adults. person is willing and able to provide the child or dependent adult with the care,assistance,protection,guidance,supervision,and support necessary for 10. LIVING SITUATION.Degree to which: •APPROPRIATENESS.The person daily living,child development,or necessary adult care.This indicator applies is living in the most appropriate and least restrictive living arrangement that is to persons who care for dependent children or adults in the person's home. consistent with his/her physical and emotional needs,language and culture, life stage, ability level, and support for recovery. • STABILITY. The living 15. RECOVERY ACTION STATUS. Degree to which the person: • Is actively arrangement is consistent with the person's preference, enduring and free engaged in activities necessary to achieve and maintain freedom from substance from disruption,and provides continuity in daily routines,normal rhythms of use impairment, reduce psychiatric symptoms, improve health, and increase life,and relationships supportive of recovery.This indicator may not apply to competencies, coping, self-management, social integration, and ongoing persons in secure confinement. recovery. • [if not engaged in wellness and recovery efforts,the degree to which the person] Has access to wellness, recovery, and relapse prevention 11. SOCIAL SUPPORTS. Degree to which: • The person is connected to a opportunities, subject to his/her needs, life ambitions, and personal prefer- meaningful and supportive network of family,friends, and peers, consistent ences.This indicator applies to persons who are working on recovery. with his/her choices and preferences. • The person has access to positive QSR INSTITUTE, CWPPG, 2016 0 PAGE 2 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E QSR STATUS & PRACTICES MEASURES AND THEIR USES Measures of Practice Performance 6. Wellness and Recovery Goals.This indicator focuses on the degree to which planned life-change goals for the person: •Are based on understandings devel- A behavioral health care agency's integrated practice model should define and oped from current assessments and a clinical case formulation. • Define agreed support the basic functions or interaction patterns used by frontline practitioners to upon life changes necessary for achieving and maintaining wellness, meeting join with a person receiving services to bring about a positive life change process that essential needs,improving daily functioning,gaining greater independence,and helps the person in achieving well-being and recovery outcomes,The diagram shown supporting ongoing recovery. • Are stated as the person's vision for wellness on page 1 defines a set of practice functions expected to be used by agencies and recovery in the person's treatment plan. • Are measurable for tracking providing integrated primary and behavioral health care services. Practice progress and determining attainment of outcomes.This indicator applies to all Performance Measures are qualitative indicators used for assessing the degree to persons.For persons under age 12,goals may reflect the interests of the child's which functions of practice are working effectively for a person receiving services at a observed needs and interests of the child's primary caregivers. point in time.Practice Measures look at the person's service situation in each area as viewed over the past 90 days. The 10 Practice Measures are defined as follows: �� Planning Interventions. This indicator focuses on the degree to which: • Meaningful, measurable, and achieveable wellness and recovery goals for the 1. Recognition,Connection,Rapport.This indicator focuses on the degree to person are supported with well-reasoned,agreed-upon intervention strategies, which: • The person's sense of identity,culture,values and preferences,social supports,and services planned for their attainment.Intervention areas that may network,and life experiences are recognized by practitioners involved with the be examined include: physical wellness, mental health recovery, addiction person. • Any barriers to personal connection and acceptance are recognized recovery,trauma recovery,safety from harm,income and basic necessities,func- and resolved. • Necessary conditions for building mutual respect and rapport tional life skill development, education or work, and community integration. are established as a basis for successful engagement. This indicator may not This indicator applies to all persons. apply to persons under 5 years of age and instead would apply to the child's primary caregivers. 8. Delivering Interventions.This indicator focuses on the degree to which: • Planned strategies,supports,and services are delivered in a manner sufficient to 2. Engagement and Commitment.This indicator examines the degree to which: help the person make adequate progress toward meeting planned goals. • The • Service providers are building and maintaining a trust-based working relation- combination of supports and services fits the person's situation so as to maximize ships with the person and the person's informal supporters to involve them in benefits and minimize any conflicting strategies or inconveniences.This indicator ongoing assessment,service planning,and wellness and recovery efforts. • Service applies to all persons. providers are using effective outreach and ongoing engagement strategies to increase and sustain the person's participation in the service process and commit- �� Medication Management.This indicator focuses on the degree to which: • inert to life changes that support wellness and recovery, consistent with the Use of any psychiatric/addiction control medications for this person are neces- person's needs and preferences. This indicator applies to all persons. sary,safe,and effective. • The person has a voice in medication decisions and management. • The person is routinely screened for medication side effects 3. Person-Centered Care Coordination and Teamwork.This indicator focuses and treated when side effects are detected. • New atypical/current generation on the degree to which: Using a person-centered decision making process,the drags have been tried,used,and/or appropriately ruled out. • Use of medica- person's service providers and supporters are building and sustaining: •Common Lion is being coordinated with other treatment modalities and with any purpose by planning wellness/recovery goals and strategies with and for the treatment for any co-occurring conditions (e.g., seizures, diabetes, asthma/ person. • Unity of effort in service delivery by coordinating actions of the service COPD,GERD,HM.This indicator applies to all persons. providers and integrating services across providers, settings, time, and funding sources. This indicator may not apply to persons under 5 years of age and 10. Situation Tracking, Plan Adjustment, and Transitions. This indicator instead would apply to the child's primary caregivers. focuses on the degree to which: •Situational awareness is sustained by tracking the person's life situation,changing circumstances,service process,progress,and 4. Screening, Detection, Prevention/Mitigation, Monitoring. This indicator goal attainment. •Plans are kept relevant and effective by identifying and resolving focuses on the degree to which: • Screening detects imminent threats to the service problems,overcoming barriers,and replacing failed strategies. • Seamless person's health, safety, supports, or behavioral well-being upon entry and and successful transitions are achieved by ensuring continuity of care across ongoing thereafter. • Responsive actions are provided in a timely and appro- settings and providers as well as supporting the person's successful post-change priate manner to prevent or mitigate any foreseeable harm to the person or fife adjustments in a new setting or situation. This indicator applies to all others around the person arising from the detected threats of harm, risks of persons` near-term life disruptions,or risks of poor well-being outcomes. • Follow-along monitoring tracks the person's situation to detect and respond to any future These indicators provide a comprehensive picture of how well the broad functions of threats to well-being.This indicator applies to all persons. practice are working for a person at a point in time. 5. Assessment and Case Formulation.This indicator focuses on the degree to An agency's practice model should encompass the core values of the agency(e.g., which: • Ongoing formal and informal fact finding methods are used to develop use of recovery-oriented, culturally competent, person-centered, strengths-based, and update a broad-based understanding of the person's bio-psycho-social situa- solution-focused practice principles) and define the fundamental expectations tion,clinical history,strengths and assets,unmet needs,life challenges,stressors, concerning working relationships, integration of efforts among the practitioners and aspirations for wellness and recovery. •An evolving clinical case formulation serving an adult in recovery,care coordination,and essential action patterns or func- describin the person's physical status and clinically significant distress and impair- tions associated with effective case practice.The practice model becomes a central ( g p y y g p inert in functioning)is used to guide development of treatment plans informed by organizer for training of frontline staff,supervision,performance measurement,and the person's life stage, culture, social context,and preferences. This indicator accountability. applies to all persons. QSR INSTITUTE, CWPPG, 2016 0 PAGE 3 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E QSR STATUS & PRACTICES MEASURES AND THEIR USES Uses of QSR Results Reviewing Practice Performance. A Quality Service Review(QSR)Protocol is a booklet containing two sets of qualitative The QSR Practice Measures can be applied to a single individual receiving measurement indicators designed for use by frontline practitioners, trainers,super- services to determine how well key practice functions are being performed at visors of frontline practice,program managers,quality managers,and agency leaders. various points in the life of a case.Results determined for the practice measures One set of measures focuses on the present status of a person receiving services rela- can be aggregated across a sample of service recipients at a point in time to tive to key outcomes valued by all citizens.A second set of measures focuses on basic examine performance patterns for particular groups. Such analyses can reveal functions of case practice associated with achievement of desired outcomes. QSR successful performance areas in actual case practice and can uncover problem measures and related uses have evolved over the past 25 years,having been applied areas for next step action. successfully to various purposes across the broad span of human services. • Identifying Areas for Affirmation of Excellence. QSR measures and case review results can be used for the following purposes: An essential but under-used reinforcement strategy by supervisors, managers, • Teaching Rapid Assessment Skills to Frontline Practitioners, and leaders is the identification and affirmation of excellence in frontline prac- tice.Frontline practitioners aspire to do good work and to get good results for The Status Measures contained in the QSR Protocol can be used by trainers and the people they serve.They seek to learn more and get even better at the work supervisors in teaching frontline practitioners how to quickly assess the situation they do. When their good work is recognized and affirmed by supervisors, of a person who is seeking services. Each Status Measure focuses on a unique managers, and agency leaders, frontline practitioners are rewarded for their and important area in a person's life revealing the degree to which the assessed accomplishments and are motivated to continue to expand their successes. life outcomes are being attained by the person. Discoveries made are used to uncover unmet needs and information about the person's life essential for plan- ning wellness/recovery goals along with services to achieve those goals. Quality managers can play an important role in applying QSR measures in peri- • Teaching Practitioners Fundamental Craft Knowledge and Skills For odic reviews of client outcomes and quality of case practice. Working in Performing Basic Practice Functions. collaboration with frontline supervisors and program managers, quality managers can plan small sets of targeted case reviews in which some or all of the The Practices Measures contained in the QSR can be used by trainers and super- QSR measures are applied to small samples of persons receiving services. visors in teaching frontline practitioners the fundamental craft knowledge and Results can be used by supervisors to provide feedback to practitioners whose practice skills required for achieving important outcomes for the persons they cases were reviewed.Good results can be affirmed and opportunities for doing serve.Each Practice Measure focuses on a unique and fundamental area of prac- even better in particular areas can be planned.Aggregated results across cases tice associated with good and effective work. The focus is placed on the can be used to spot patterns of excellence for affirmation and detect any areas of performance of essential practice functions in actual case practice -- not on concern for planning next step actions.Where appropriate,quality managers can showing compliance with agency policies and procedures.The Practice Measures use QSR results for launching exploratory analyses(e.g.,Root Cause Analysis)to follow the "Practice Wheel and Tip Sheets" described in separate documents trace and identify causes of recurrent problems so that remedies can by under- available to interested agencies. taken by program managers and agency leaders. • Supervising Frontline Staff on High Quality Practice. Applying Action Learning Strategies for Strengthening Practice and Results. Frontline supervisors play an essential role as"teachers of practice"to their staff. Modeling,mentoring, and coaching of case practice are essential strategies for Managers and agency leaders play a critical role in using results of QSR measures building craft knowledge and skills for staff members supervised.QSR Status and to learn about problems affecting frontline practice and then to lead next step Practice Measures can be used effectively for teaching when conducting case- actions to remedy the problems.Without their prompt attention and commit- based,group-oriented supervision activities.Staff members can present their self- ment to next step action,known problems discovered by QSR review process selected or assigned cases for group analysis and discussion.Staff members can will not only continue but will possibly worsen. apply selected Status and Practice Measures as a group to each case being discussed.The case presenter has the opportunity to gain fresh insights about These seven strategies have been used successfully by trainers,supervisors,quality possible solutions from their colleagues'analyses. In addition, frontline practi- managers,program managers,and agency leaders to transform the quality and effec- tioners learn about the Status and Practice Measures and how to apply them to from th of frontline practice and to improve outcomes for persons receiving services their own cases.This can be a powerful and positive teaching strategy especially from their agencies. when the supervisor guides the presentation and discuss process while modeling,mentoring,and coaching good practice. Integrated Care QSR Protocol Available • Reviewing the Effectiveness of Treatment. Please note that the New Mexico Integrated Care QSR Protocol is available for The QSR person Status Measures can be applied to a single individual receiving training,review activities,and technical support for implementation and use upon services to determine the extent to which important life outcomes are being request. Interested persons should contact Dr. Betty Downes at the New Mexico attained at various points in the life of a case.Person outcomes can also be meas- Human Services Department:Betty.Downes@state.nm.us. ured and aggregated across a sample of service recipients at a point in time to examine patterns of results for targeted groups. Such analyses can reveal successful outcomes and can uncover problem areas for next step action. QSR INSTITUTE, CWPPG, 2016 9 PAGE 4 DocuSign Envelope ID:CAABEAFA-9919-4207-B5CD-58E618EA747E AC[]R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) F,010/216/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 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