ACCESS MHMR

Local Service Area Plan

FY 2011-2012

 

 

 

 Approved by:

 

        Cathy Newman, ACCESS Board Chairperson

Allyn Lang, ACCESS Executive Director

 

 

Table of Contents

 

I.                   Vision, Mission, and Core Values

 

II.                Organizational History

 

III.             Service Area & Demographics

·        Populations Served

IV.            Array of Services and Supports

 

V.      Resource Development and Allocation

 

VI.            Local Planning Process

 

VII.         Local Service Area Plan Goals & Objectives

 

VIII.      Planning Considerations

 

IX.            Identified Service Delivery Needs, Priorities, Gaps in Services

 

X.               Long Term Planning for Network Development

 

XI.           Changes Over Next Biennium

 

Attachments:

            Crisis Services Plan

            Jail Diversion Plan

            Local Network Development Plan

 

 

 

 

 

 

 

 

Vision

ACCESS will be the number one choice in Anderson and Cherokee Counties for people with brain and behavioral disorders.

Mission

People can count on ACCESS:

·         To work hand in hand with those around us to assure a choice of effective, efficient programs and caregivers, and

·         To offer excellent services that enhance quality of life.

Core Values

·         Service to the customer.

·         Respect for the individual.

·         Respect for the Dignity of risk.

·         Pursuit of Excellence in all that we say and do.

·         Commitment to personal Integrity in every facet of every relationship.

 

 

 

 

 

 

 

 

 

 

 

 

 

ORGANIZATIONAL HISTORY

 

Anderson/Cherokee Community Enrichment ServiceS, d.b.a. ACCESS, was established by  Anderson County, Cherokee County, and the City of Jacksonville via an Interlocal Agreement dated January 11, 1993  pursuant to Texas Health & Safety Code, Chapter 534, Subchapter A.  Having previously served as the local community services for Rusk State Hospital, the development of ACCESS as a local community mental health and mental retardation center was prompted by TDMHMR’s determination to separate community services from host state hospitals and state schools.  After a three-year planning and transition period, ACCESS was formed as a Community Mental Health and Mental Retardation Center under the auspices of a local Board of Trustees on September 1, 1995.

 

ACCESS currently operates under Performance Contracts with the Texas Department of State Health Services, the Texas Department of Aging and Disability Services, and the Texas Department of Family and Protective Services.  In addition to adherence to the requirements of those Contracts, other state regulations governing the Center’s business include State Laws and the Texas Administrative Code. County and local regulations apply to buildings, health, and other issues.  ACCESS is a qualified Medicaid/Medicare provider, and all related federal regulations apply.  Other key federal regulations include the Code of Federal Regulations, in particular CFR42; the Occupational Health and Safety Act; the Americans with Disabilities Act; the Fair Labor Standards Act; the U.S. Department of Health and Human Service OMB Circular A-87; HIPAA, and OMB Circular A-133.

 

The ACCESS Board of Trustees has eight members, appointed by the sponsoring entities.  Four trustees are appointed by the Anderson County Commissioners.  Two are appointed by the Cherokee County Commissioners, and two are appointed by the City of Jacksonville.  Members serve two-year, renewable, staggered terms.

 

The first year of operations focused on the demands of start-up. The Board of Trustees took essential steps required for a new center.  Staff kept services running smoothly while implementing operational changes.  A significant challenge was implementation of an Information System, which involved installation of hardware and software for client data, human resources, and fiscal systems.  After an executive search by the Board of Trustees, a permanent Executive Director came on board in 1996.  The formal budgeting process began shortly thereafter.  The Executive Director and the Board set an early goal of establishing sound fiscal practices and building financial reserves. 

 

A formalized planning process for ACCESS began in spring 1997.  The Planning Advisory Committees were organized in 1997.  Regional and/or local committees have met continuously since that time. As a young center with a short track record, ACCESS senior management and trustees utilized "strategic initiatives" to provide planning goals for its immediate needs. ACCESS developed initiatives to assist the Board and staff to focus on those issues of greatest importance.  One-year plans were developed for FY1997, 1998, and 1999.

 

The Center added Services to At-Risk Youth (the STAR Program) to its array of services starting in 1997, after securing grant funding from the Texas Department of Protective and Regulatory Services.

 

A two-year Strategic Plan for 2000-2001 was developed in the spring of 1999 for the Center with input from the Board of Trustees, ACCESS staff, consumers, and the Planning Advisory Committees.  The Strategic Plan addressed five areas: regulatory compliance and accreditation, customer satisfaction, increased efficiencies, managed care readiness, and community participation and awareness. The Local Plan has been revised each year, to comply with State guidelines and to reflect changing community priorities. 

 

ACCESS serves people of all ages who have problems caused by mental illness, developmental disability, or substance abuse, as well as at-risk youth.  The Center serves youth ages 0-17 who are truant, runaway, or in family conflict, through the "STAR" program funded by The Texas Department of Protective and Regulatory Services.  Since FY2004, the STAR program also offers universal prevention services to the two counties to prevent child abuse and neglect.                  

                                                                                               

 

    Service Area Demographics                         

 Cherokee and Anderson Counties are largely rural, with the largest cities of any size, Jacksonville and Palestine, each having populations under 20,000, with total population of the two Counties combined reaching 104,872.  The county seat of Anderson County is Palestine, and the county seat of Cherokee County is Rusk.  Rusk is the site of a state mental hospital.  The Texas Department of Corrections has several facilities in both Cherokee and Anderson Counties. Neither County has public transportation, and each County faces similar issues in terms of poverty and unemployment relative to State of Texas averages, placing significant stressors upon families. Median household incomes are well below the State average, and unemployment rates for each County exceed the State average of 6%.   The number of youths, ages 0-17 years, living below the poverty level are also higher than the State average of 22.7% (25.3% in Cherokee County and 24.5% in Anderson County).  Of school-age students, 67.23% of Cherokee County students and 52.89% of Anderson County students are considered economically disadvantaged. (2006 Data from Texas Education Agency and Department of State Health Services). Truancy and gang related activity are increasingly problematic in both Counties and there is a growing population of undocumented Hispanic families, particularly in Cherokee County, necessitating the hiring of bi-lingual staff and increased availability of program materials in Spanish.  Both Counties have undesirable child abuse and delinquency rates. Anderson and Cherokee Counties both fall in the 25% of Texas counties having the most victims of child abuse. Anderson County also falls in the 25% of Texas counties having the highest levels of juvenile delinquency, while Cherokee County, with a ranking of 128, falls near the halfway point for rates of delinquency.

 

As is true of many rural areas, existing community resources are limited.  Because the two-county area covers over 2,000 square miles and because there is no public transportation in the two counties, ACCESS maintains a fleet of vehicles and provides transportation for consumers to and from services at the Center.  Also, many services are provided in the community in natural settings, and staff use Center vehicles to visit consumers in those settings.  U.S. Census 2000 statistics indicate the number of persons in the two Counties who are “disabled but non-institutionalized” totals over 19,000 persons, about 19% of the total population.

 

Populations Served: 

 

For adults, the priority population served by ACCESS is defined by the Department of State Health Services as persons who have severe and persistent mental illnesses such as schizophrenia, major depression, bipolar disorder, or other severely disabling mental disorders (excluding a single diagnosis of substance abuse, mental retardation, autism, or pervasive developmental disorder) which require crisis resolution or long-term support and treatment.  The MH Target Population is further defined as persons with a diagnosis of schizophrenia, bipolar disorder, and severe major depression.

 

For children, the priority population served by ACCESS is defined by the Department of State Health Services as persons ages 3 through 17 with a diagnosis of mental illness (excluding a single diagnosis of substance abuse, mental retardation, autism, or pervasive developmental disorder) who exhibit serious emotional, behavioral or mental disorders who:  a) have a serious functional impairment; or b) are at risk of disruption of a preferred living or child care environment due to psychiatric symptoms; or c) are enrolled in a school system’s special education program because of a serious emotional disturbance.

 

The priority population for developmental disability services includes those persons who request and need services and possess one or more of the following conditions: developmental disability, as defined by Section 591.003 (13), Title 7, Health and Safety Code; autism as defined in the current edition of the Diagnostic and Statistical Manual  (DSM); Pervasive Developmental Disorder (PDD) as defined in the current edition of the DSM; eligibility for Early Childhood Intervention Services; eligibility for OBRA mandated services for developmental disability or a related condition as defined in 42 Code of Federal Regulations 453.1009.

 

In targeting services to the priority populations, the choice of and admission to services is determined jointly by the person seeking service and the Center. Criteria used to make these determinations are the level of functioning of the individual, the need of the individual, and the availability of resources.

 

The Center provides services to persons with substance abuse problems through a Memorandum of Agreement with the East Texas Council on Alcohol and Drug Abuse (ETCADA, the regional OSAR), which organization provides counseling in each County by a Licensed Chemical Dependency Counselor (LCDC) with office space and administrative support provided by ACCESS.

 

The Center serves youth ages 0-17 who are truant, runaway, or in family conflict, through the "STAR" program funded by The Texas Department of Protective and Regulatory Services.  Since FY2004, the STAR program also offers universal prevention services to the two counties to prevent child abuse and neglect.

 

ARRAY OF SERVICES AND SUPPORTS

 

      The present service array facilitates a system of care that is readily accessible to all individuals of any age requiring mental health services and/or developmental disabilities services.

 

 

 

 

 

·         Crisis Services - Crisis services are available 24 hours a day, 7 days a week. Calls to the 800 number are triaged by an AAS accredited crisis hotline.   As needed, face-to-face assessment or intervention is provided at ACCESS locations, jails, emergency rooms, or other community sites. Staff consult with consumers to meet emergent needs, including medication and housing, in order to prevent more restrictive treatment or incarceration. Crisis Respite services are provided through a contract with The Wood Group.

           

 

 

 

 

 

·         Skills Training - Staff train consumers in skills needed for independent living and functioning in home and community.

 

 

 

 

 

 

ACCESS contracts for services in psychiatric services and supports of various types.  ACCESS plans to continue to contract for various services.

 

ACCESS Board of Trustees supports the services offered under State contracts to the two county area.  The board also supports additional substance abuse services. 

 

RESOURCE DEVELOPMENT AND ALLOCATION

 

 In general, funding for ACCESS comes from the following sources: General Revenue and block grant funds from State agencies (DADS, DSHS, TDFPS) and from earned revenue from Medicaid and other third party sources.

 

 Steps taken by the center to maximize utilization of existing funds include the following:

 

·         Reduction of positions at the Center through attrition

·         Reduction of purchases (such as, vehicles not replaced)

·         Reduction of rent and utilities by closing office sites and restructuring programs

·         Renewed emphasis on establishing Medicaid benefits for consumers who might be eligible

·         Increase in direct service time by service providers to maximize earned revenue

·         Reduction of pharmacy costs through a contract with the ETBHN pharmacy

·         Expansion of patient assistance program that helps consumers apply for pharmaceutical assistance or to receive sample medications

 

 

ACCESS Executive and Management staff engage in an ongoing process to evaluate existing direct service practices for all Center client services in order to identify and eliminate inefficiencies, clarify staff roles and redesign activities for maximum impact.

 

Current trends that affect budgeting include the following:

 

·         increased medication costs;

·         decreased revenue from Medicaid;

·         development of reserves at a level set by the Board of Trustees;

·         debt burden for buildings;

·         increasing cost of insurance and other benefits for employees;

·         reduced funding from State Contracts.

 

ACCESS focuses efforts on meeting all performance targets each year.  The Center hopes that services can be provided to the communities without waiting lists or reductions in services.

Local Planning Process

Overview

The central premises of the ACCESS planning process are as follows:

·         Involvement of key stakeholders: consumers, family members, advocates, service providers, executive and management staff, trustees, and citizens

·         Integration of planning and budgetary processes

·         Monitoring and reporting of plan implementation

 

Members of the Board of Trustees and the Executive Council of ACCESS are committed to regular discussion of the changes in the marketplace and in the health care arena, in order for the Center to respond in a timely manner to these realities. Consumers, staff, contractors, and trustees participate in ongoing evaluation of the key concerns of customers and the community, so that the Center can continue to meet its commitment to quality services.

 

Internal Processes

Planning and problem-solving issues are brought to the Executive Council, which meets twice a month.  The Executive Council and the Management Team hold joint meetings twice a year (more often if needed) as part of the planning and budgeting process. At these meetings, decisions are made about the allocation of resources and about the priorities for operations.  The meetings also address how the planning process works between the two groups, how information is communicated, and how decisions are made.

 

A representative from Executive Council meets regularly with the Management Team to improve communication flow and to identify needs, recommendations, or items needing decisions. The Management Team meets quarterly (more often if needed) to plan implementation of policies and procedures and to share information across organizational lines. The Management Team also develops ideas to present to the Executive Council. Planning issues may originate in either group.

 

At monthly meetings of the Board of Trustees, the members receive reports on issues of concern to the Center, as well as recommendations about services, use of resources, or other programs.  All meetings of the Board of Trustees are public, and citizen comment is encouraged at each meeting.

 

An on-line planning survey was developed, requesting feedback regarding crisis and jail diversion services and level of satisfaction with ACCESS services.  The survey also requested input about what services, if any, ACCESS should consider expanding or developing. A link to the survey was posted on the ACCESS website in June 2010 and emails were sent to 164 local stakeholders inviting them to complete the on-line survey.  ACCESS staff also met with local consumers, family members, and advocacy group members to elicit their responses to the survey questions.  Survey responses and input from consumer focus groups indicated a strong interest in expanding counseling and medication services to adults and children.  Respondents indicated considerations most important to them in expanding the provider network were: having services provided in a location close to their home, availability of transportation assistance, and cost of services.

 

Consumers also expressed their general satisfaction with services provided by the Center. Although several respondents expressed their dissatisfaction with wait times to see physicians and the lack of available counseling services, others made numerous written comments expressing gratitude for the services they have received.

 

Not surprisingly, stakeholders generally mirrored consumer responses when identifying services they feel would be important to the service area and identified the same kinds of factors as important considerations when contracting out services.

 

Other significant issues and concerns identified by stakeholders concerned the lack of substance abuse treatment and treatment providers in the local service area, as well as the need for affordable housing and half-way house type of facilities for those individuals with a persistent and severe mental illness. A number of respondents and attendees at meetings expressed concern that they might lose access to services if contracted providers decided to leave the area.  ACCESS staff assured those having such concerns that the Center will ensure the continued provision of services by maintaining necessary redundancy and critical infrastructures to preserve the mental health safety net.

 

The following graphs reflect responses to questions regarding satisfaction with ACCESS services and the relative importance of ACCESS services to the local communities.

 

 

Members of the Center’s staff participate in local community groups, including:  Community Resource Coordination Groups (Anderson and Cherokee Counties), Jail Diversion Task Forces (Anderson and Cherokee Counties), and the Cherokee County Care Collaboration (an interagency group that includes representatives from schools, hospitals, home health organizations, churches, state and local agencies, and charitable organizations).

 

Through personal contact members of the staff consult and collaborate with Anderson County Juvenile Probation, Cherokee County Juvenile Probation, law enforcement agencies in the two county area, the Department of Assistive and Rehabilitative Services, the Department of Family and Protective Services, the Crisis Center of Anderson and Cherokee Counties, the fourteen school districts in the two county area, the Jacksonville United Fund and the Palestine Area United Way, and the health departments in Anderson and Cherokee Counties.

 

ACCESS provides support to the Cherokee County Peer Support Group, which group also hosts a recently formed local NAMI Chapter.

 

The Executive Director or designee makes a presentation to sponsoring entities at least once a year:  Jacksonville City Council, Palestine City Council, Anderson County Commissioners Court, and Cherokee County Commissioners Court.

 

 

Planning and Network Advisory Committees

The Regional Planning and Network Advisory Committee (RPNAC), with representatives from all centers who are members of the East Texas Behavioral Healthcare Network, meets quarterly.  The regional committee provides “arms length” for reviews of programs and deliberations about contracting out services.  The RPNAC also provides feedback to the local Boards about the needs of consumers and communities. A local Developmental Disabilities Planning Advisory Committee meets quarterly to provide feedback about services provided to consumers of ACCESS’ Developmental Disabilities services, as well as input about satisfaction with ACCESS and contracted providers’ services. The recently formed NAMI group has agreed to also serve as a Mental Health Planning Advisory Committee to provide local input about the needs of consumers in the ACCESS service area.

 

 

Planning Sources

ACCESS makes use of the reports available from the local database and from the statewide database in order to guide decisions about service delivery, staffing, and use of resources. The time and effort devoted to planning and budgeting result in guidelines for the center and its staff to follow in service delivery, development of programs and supports, use of resources, and incentive targets.  In addition, the involvement of consumers and citizens ensures that the Center's plans address priority issues and increase the public awareness of services offered to the community.

 

Research from a variety of professional publications is distributed to the Executive Council on a regular basis by the Executive Director.  Examples of sources of data used in planning are as follows:

 

Consumers:

Advocacy Groups; Surveys;

Suggestions; Complaints

Community:

Planning Advisory Committees; Surveys; Board Meetings; Public Forums; Interagency meetings

Staff  & Contractors:

Service Delivery Data; Program Management;

Administration

Experts:

Consultants; Professional organizations; Literature reviews; Models for Planning and Programming; Prevalence data

State databases (CARE & MBOW):

DVC reviews; CARE reports; MBOW reports; data on use of state facilities

Risk Management:

Legal data; Financial data; Demographic data; Performance data

Other MHMR Centers:

Lists and reports; ETBHN  and MBOW data; Consults

Funding Sources:

Local Sponsors; DADS; DSHS;  TDFPS; Medicaid; Medicare; Insurance; Donors

Fiscal:

Budget reports; Revenue reports; Financial audits

Environmental:

Demographic predictions; Economic predictions

 

 

At least once a year the Center holds Public Forums on Mental Health and Developmental Disabilities in each of the two counties served.  Clients, volunteers, consumer advocates, and citizens are invited to discuss their concerns.  Input is welcomed regarding the quality of Center services, operational issues within particular programs, access to services, use of resources, means of communication, complaints about perceived issues, and ways to be more involved with staff and the Board of Trustees in developing services for consumers.  During the Forums, input from the public is solicited on the use of federally-funded Block Grants.

 

The Center has a designated staff person for Consumer Relations and has a "helpline" number that is a local call anywhere in the two-county area in order to reach the Consumer Relations Officer.

 

These formal measures support the ongoing informal needs assessment that occurs in all service areas.  Program staff and management receive input from consumers regarding their particular program area, dealing with concerns such as times of service planning, consumer schedules, activity planning, and individual consumer preferences.  Each program site has a "Suggestion Box" available for consumer comments.

 

The Center summarizes these formal and informal inputs into annual objectives for implementation into Center operations.  This occurs during annual budgetary planning, service planning cycles, staffing schedules, and when the relevant input results in capital expenditures for improvements in buildings, facilities, or equipment.

 

 

LOCAL SERVICE AREA PLAN GOALS AND OBJECTIVES

 

I. Regulatory Compliance

To comply with regulations of relevant oversight and funding bodies.

 

Objective

 

Outcome Measure

1

Meet or exceed requirements of pay sources.

 

 

 

 

a

The Center will meet or exceed requirements of contracts with state agencies or others providing funding.

 

 

b

The Center will meet or exceed requirements of Medicaid, Medicare, or other third-party payors.

2

Meet or exceed requirements in applicable laws and rules.

 

 

 

 

a

The Center’s Corporate Compliance activities will be implemented and documented.

 

 

b

The Center will comply with applicable federal and state laws as well as agency rules about confidentiality and protected health information.

 

II.  Quality Services

To provide quality services to consumers, family members, and the community.

 

Objective

 

Outcome Measure

1

Provide prompt and easy access to services.

 

 

 

 

a

Crisis response will be available within minutes, or at most, hours.

 

           

b

Intake and screening services will be available within ten working days by appointment or sooner by allotted walk-in times.

 

 

c

Staff with bilingual skills will be available as needed by Spanish-speaking consumers.

 

 

d

Signing translation will be available for hearing-impaired consumers.

 

 

e

Center sites will provide physical access for persons with handicapping conditions.

2

Provide satisfactory services within cost guidelines set by pay sources.

 

 

 

 

a

Cost analysis will indicate that services are provided within guidelines set by pay sources.

 

 

b

Satisfaction measures by pay sources will indicate consumer satisfaction with services.

3

Provide education to the public about mental illness and developmental disabilities in order to reduce stigma.

 

 

 

 

a

At least one Public Forum will be held in each county each year.

 

 

b

Planning Committees or Focus Groups will gather information about community needs and priorities.

 

 

c

The Center will place articles or announcements in print media regarding ACCESS and/or its targeted populations.

 

 

d

The Center will provide at least one presentation per year to each sponsoring agent or to other interested governmental entities.

4

Support advocacy groups and advocacy education for populations served.

 

 

 

 

a

The Center will provide support to Texas Mental Health Consumers, NAMI, or The ARC groups for consumers, families, and citizens in the two-county area.

 

 

b

The Center will provide training on advocacy to community groups, upon request.

 

III. Increased Efficiencies

To work within declining resources, to stretch resources through collaboration with others, and to seek out new sources of revenues, using strategies for increased efficiency.

 

Objective

 

Outcome Measure

1

Decrease costs of administrative overhead.

 

 

 

 

a

Administrative overhead costs will be at 10% or less.

2

Achieve reduction of medication costs.

 

 

 

 

a

Achieve savings through the use of pharmaceutical companies' indigent medication programs, bulk purchasing, pharmacy benefit management, regional pharmacy services, or other methodologies.

 

 

b

Ensure that the annual budgeted amount for medication is not exceeded.

 

 

c

When needed, utilize a waiting list for new clients to receive medications and report quarterly the number of consumers on the waiting list and the average waiting time for consumers to obtain medications.

 

 

d

Track the savings to the center from the use of sample medications for eligible clients.

3

Increase the percentage of Medicaid clients.

 

 

 

 

a

Provide information on benefits eligibility criteria to all clinical and support staff at least once a year (to assure proper screening and referral).

 

 

b

Assist any potentially eligible consumers to complete application for Medicaid benefits.

4

Increase "billable hours per month" for every billable employee.

 

 

 

 

a

Servers will meet goals for service time or events or billable hours.

 

 

b

Supervisors will determine effective caseload size for each position.

 

 

c

Credentialing process for providers will be current and accurate.

 

 

d

Billing software will accurately reflect current information about credentials of providers.

 

IV. Effective Infrastructure

To maintain and enhance an effective infrastructure and to develop resources that support the Center in fulfillment of its mission.

           

Objective

 

Outcome Measure

1

Improve internal communications.

 

 

 

 

a

E-mail communication will be available to employees.

 

 

b

Web-page will maintain current information.

 

 

c

Inter-office mail will be delivered promptly.

2

Assure the safety and health of staff and guests.

 

 

 

 

a

The Center will comply with local fire and safety codes in all facilities.

 

 

b

The Center will maintain reasonable standards of operational safety for all vehicles.

 

 

c

The Center will provide not less than annual training regarding safety issues to designated staff.

 

 

d

Any incident of accident or other health or safety issue with a consumer, guest, or employee will be investigated, and recommendations will be made if needed to improve conditions.

3

Participate in collaborations, such as the East Texas Behavioral HealthCare Network.

 

 

 

 

a

The Center will participate in collaborations with ETBHN as appropriate to the Center's needs.

 

 

b

The Center will participate in other collaborations, based on proximity or common interests, as appropriate to the Center's needs.

 

 

V. Accurate, Reliable Data

To implement and maintain data resources that prove accurate and reliable, for use in decision-making and monitoring.

 

Objective

 

Outcome Measure

1

Achieve accuracy and reliability in data.

           

 

 

 

 

 

a

Data entry accuracy will be maintained at a high level, reflected in reliability of data-based reports.

 

 

b

Data will be analyzed regularly to identify trends or issues.

2

Utilize data in decision-making.

 

 

 

 

a

Minutes of meetings at executive level will reflect consideration of data reports.

 

 

b

Managers will have data about services provided, server hours, revenues, and expenses.

3

Utilize data in monitoring and tracking clinical and business practices.

 

 

 

 

a

Fiscal audits will report acceptable business practices.

 

 

b

Clinical audits will report acceptable clinical practices.

 

 

c

Identified significant outcomes will be measured, including, but not limited to, the following:

·         CAM Data

·         Encounter Data

·         Direct Service Time Data

 

 

d

Caseloads and due dates will be tracked and reported to service delivery staff.

4

Utilize data in collaboration with other Centers or entities.

 

 

 

 

a

The Center will cooperate with other centers, agencies, or entities to establish common data in order to measure efficiency and effectiveness of delivery of services.

 

 

b

The Center will cooperate with other centers, agencies, or entities to develop or revise plans for service delivery, based on data collected.

 

 

 

 

 

Planning Considerations

An essential component of any planning initiative is monitoring and evaluation. The process for review and monitoring of the Center's plan includes the following steps:

 

·         The ACCESS Local Plan is subject to ongoing review.  The Executive Director has the responsibility for review and delegates related activities to members of the Executive Council. 

·         The process for reviewing the plan incorporates the involvement of staff, consumers, and community stakeholders.

·         All service areas are responsible for implementing specified goals within their program areas.

·         The goals outlined in the plan are incorporated into the budgeting process.

·         Questions, comments or concerns raised by the Center's administration, Board of Trustees, and Planning Advisory Committees are documented with actions taken within a specified time frame, with follow-up submitted to the Executive Director, who routes this information as appropriate to the Center's administration, Board of Trustees, and Planning Advisory Committees.

  

The Executive Council members assess plan compliance annually.  In addition, they assess the external regulatory, administrative, and fiscal factors impacting the plan and its implementation. The review results in adjustments to the plan as required and assignment of action teams to work on specific strategies with projected completion dates and outcomes expected.

 

Through the various information-gathering tools, stakeholders (staff members, trustees, consumers, contractors, Planning Advisory Committees, and community citizens) have means of providing input to the Local Plan review process. Through their input, an ongoing process of evaluation of delivery of services occurs, and the Center also identifies emerging needs and changing priorities.

 

Planning provides educational opportunities for stakeholders.  As groups review the previous plan and evaluate the Center's progress, they learn which objectives were realistic and doable, and which objectives were vague, broad, or had some other flaw that made them less achievable. Also, they see which objectives should be continued into the future and which ones should be discontinued or revised.  Planning provides a valuable learning process for stakeholders. People involved often identify skills that they need in order to do a better job, and this provides the opportunity to train people, to develop new "tools" for planning, or to develop better procedures.    

 

Cost Effectiveness and Relative Value of Service Delivery Options

The ACCESS Board of Trustees and Executive Council members review financial reports monthly to track revenues and expenses and to look for ways to reduce spending.  Examples include the following: 

·         Every position that is vacated is reviewed to see if those job functions could be redistributed so that the position could be deleted. 

·         The Center utilizes the ETBHN pharmacy for bulk purchasing, and also maximizes the use of Patient Assistance Programs (PAP) from pharmaceutical companies, in order to reduce the Center’s expenditures on medications.

·         The replacement schedule for vehicles and other equipment has been stretched over a longer time period, to get more use out of present vehicles and equipment. 

 

Leadership at the Center use the Data Warehouse reports and local database (Anasazi) reports to track service delivery, especially the implementation of R&DM, and to analyze staff productivity.

 

Minimizing the Need for State Hospital and Community Hospital Care

ACCESS views inpatient treatment as the treatment of last resort.  Adult consumers who have a history of repeated inpatient stays are evaluated for Assertive Community Treatment, which provides more intensive outpatient treatment.  Although inpatient treatment is available through contracts with area hospitals and through admission to state hospitals, ACCESS clinical staff focus on finding family and community solutions to emerging situations, and avoid inpatient treatment if other, less restrictive alternatives are available and are clinically sound for the person in treatment.

 

The Executive Director of ACCESS stays in touch frequently with the Superintendent of Rusk State Hospital to resolve any difficulties related to use of state hospital beds. At least once a year representatives from ACCESS meet with representatives from Rusk State Hospital and/or other state facilities for planning.  They review the eligibility criteria for admissions, the role of utilization management, the process for authorizing admissions, and the continued stay and discharge criteria.  ACCESS has a MOU with Rusk State Hospital agreeing to work cooperatively on mutual issues.  A Continuity of Care worker from ACCESS is on site at the state hospital frequently to assure that persons being discharged are followed by the Center on a timely basis.

 

The Center contracts for psychiatric beds with two area inpatient providers, and persons in crisis are placed in these beds rather than state hospital beds whenever possible. ACCESS has also entered into a collaborative arrangement with Andrews Center and Community Healthcore to contract for a Crisis Respite facility, managed by The Wood Group, and opened in April, 2010.

 

Diversion from Criminal Justice System 

ACCESS has a Jail Diversion Plan, as required by Department of State Health Services. Implementation of this plan is ongoing and is appended to this document as an attachment.  A Jail Diversion Taskforce meets in each county (Anderson and Cherokee). 

Funding is available through TCOOMI for the Chapter 46b medication reimbursement program.  Also, additional TCOOMI funding was provided, which may be used to assist with custody and transportation in order to increase the use of appropriate screening prior to incarceration.  Through a Commitment Reduction Program Grant funded through TCOOMMI, ACCESS and the Cherokee County Juvenile Probation Department have partnered to develop a program reducing residential placements and, ultimately, to divert youth from placement at TYC. 

 

 

 

 

Ensuring Children with Mental Illness Remain with Parents/Guardians

Keeping a family intact is a goal of services to children at ACCESS.  With the implementation of the R&DM model for service delivery, ACCESS has increased family education and family involvement in treatment.  The person hired by ACCESS as the Family Partner is an experienced parent of a person with a serious mental disorder and is dedicated to helping other parents cope with the challenge of a child with mental illness. 

 

The Community Resource Coordination Group meets as needed to address the needs of families who require interventions or assistance from more than one agency or community organization.  One of the goals of this group is to preserve family unity, whenever possible.

 

The STAR program at ACCESS is funded by the Texas Department of Family and Protective Services.  One of the goals of the STAR program is family preservation.  Referrals flow both ways between the STAR program and the Children’s Mental Health program.

 

Planning for Continuity of Care

Access to and appropriateness of care and services delivered, as well as outcomes for individuals, will be monitored through evaluation of waiting lists, missed appointments, service utilization and accompanying costs, referrals outside of the provider network, consumer/provider complaints, utilization of joint case conferences, continuity of care planning, efficacy of discharge and transfer planning, and results of consumer, provider, and family satisfaction surveys.  Results of profiling activities will be disseminated to providers and other stakeholders to ensure continuous and sustained improvement in the care provided to consumers.  To further continuity of care and seamless service delivery, the ACCESS Continuity of Care staff will participate in admission and discharge planning activities at state hospitals, state supported living centers, and at local community in-patient facilities to serve as a conduit for the relay of clinical and planning information between Center staff and those facilities.

 

Consumer Choice and Access

Local planning efforts have been directed towards identifying opportunities to increase access to services and a wider choice of providers.  However, there is a realistic expectation of a shortage of willing and qualified providers interested in providing services in this largely rural service area. Consumers and families will be educated about provider options and processes for choosing and/or changing providers. This will occur in a manner that preserves a “level playing field”, giving no advantage to one provider over another. ACCESS will provide a telephone and space for consumers to contact providers and will not assist in the provider selection process unless specifically requested to do so. In situations where no external provider of a service is available, whenever possible, consumers will be offered a choice of internal providers and also have the right to refuse services for which they are otherwise eligible.  Consumers also can choose to receive services in either County and special provider requests arising from cultural or ethnic beliefs or other concerns, such as requesting a provider of a specific gender, are granted whenever possible.

 

Access to services is all about removing barriers – physical, scheduling, wait times, language, financial, social prejudices, etc. Office-based services will be provided in settings that are ADA compliant and centrally located.   Due to the rural nature of the two Counties, the wide geographic distribution of consumers, and complete lack of public transportation, providers must demonstrate their willingness to provide services in non-traditional settings. ACCESS makes every effort to provide services and written materials in the primary language of the consumer and respecting issues of diversity. Consumers are assisted in obtaining any financial benefits to which the consumer may be entitled. ACCESS Quality Management staff monitor wait times, cancellation rates, no-shows, provider change requests, and consumer complaints to ensure unimpeded consumer access to the service delivery system.

 

Cultural and Linguistic Diversity

The two-county area has African-American population above the state average and the White (non-Hispanic) population is also above the state average. The most significant change in population in the last ten years has been the growth of the Hispanic population in the area.  The Hispanic population in Cherokee County went from 6.6% in 1990 to 13.2% in 2000.  In Anderson County the Hispanic population increased from 8.2% to 12.2%.  Although the percentage of Hispanic population is less than in other areas of the state, the increase over the last decade has been significant in its impact on the area, which historically has less experience than other areas of the state in accommodating Spanish language and Hispanic cultural differences. Other ethnic groups in the 2 Counties combined amount to less than 4 % of the total population.

 

It is the position of Anderson-Cherokee Community Enrichment ServiceS (ACCESS) that all persons receiving services have the opportunity to communicate effectively with providers, regardless of the cultural background from which the individual comes or the language which the person may speak. We allow and encourage full participation for all consumers and their families.  Cultural competence occurs in the service delivery system when cultural issues are acknowledged and addressed at all levels of an organization:  administration, service delivery, and planning and oversight.

 

All ACCESS staff are required to complete cultural diversity/competency training as part of their new employee orientation and are also required to complete annual refresher classes thereafter.  Training includes information on protecting and respecting the rights of all individuals as to race, ethnicity, gender, sexual orientation, and age. Staff interactions are monitored to ensure services are delivered in a manner that respects the diversity of the individuals they serve. Written information is available in English and Spanish.

 

Spanish and American Sign Language translation services are available and the Center contracts for other translation services when needed.  Bi-lingual staff are tested for fluency and are paid a salary incentive for providing Spanish translation services. However, even with the incentive, the Center experiences considerable difficulty in recruiting and retaining bi-lingual staff and has tried recruiting bi-lingual volunteers to assist with translation needs.

 

Other Recent Planning Initiatives

With the funding of crisis redesign, the Center has been able to meet the following objectives of a rapid response mobile crisis outreach team:  provide for expedited local stabilization; aid in diversion from incarceration; and, reduce the burden on law enforcement and emergency health care resources.  This was accomplished by improved crisis response team infrastructure, training, and response processes. New crisis funding has been used to improve ACCESS’ crisis hotline service.  ACCESS previously contracted with an AAS accredited hotline service during evenings, weekends, and holidays.  ACCESS expanded the utilization of the contractor to include the provision of crisis hotline services during business hours to ensure the provision of accredited crisis hotline services 24/7.

 

Other new crisis dollars led to the creation of an improved crisis response team infrastructure through the creation of a Mobile Crisis Outreach Team which has improved the consistency and timeliness of rapid crisis responses in the community  and enhanced provision of crisis services, particularly crisis follow-up and crisis intervention.  It is anticipated that the outcome will be a reduction in jail incarceration, ER visits, and inpatient hospitalizations.

 

Redesign funding also allowed the MHA to offset transportation costs incurred by law enforcement, as well as costs incurred by their lengthy detainments at ERs, by underwriting a Mental Health Peace Officer (MHPO) in each County.  The inclusion of a MHPO as part of the Mobile Crisis Outreach Team has already resulted in a reduced burden on the ER’s maintenance of consumers in need of transportation and rapid stabilization.  It has had the added benefit of improving relationships with local law enforcement and hospital emergency room staff who appreciate the improved timeliness of services and increased safety provided by the presence of the MHPOs. New funding was also used to purchase additional local inpatient hospitalization capacity to assist in efforts to divert individuals from the State Hospitals and provide greater flexibility to the MHA in coordinating local intervention and support services.    

 

Psychiatric service capacity has also been expanded through initiation of a telemedicine contract, developed in conjunction with the Burke Center, to enlist the services of a Board certified child psychiatrist, as well as through free psychiatric medication management services provided by UTMB through a grant.  Other opportunities for expansion of telemedicine services are being explored to assist in improving crisis response availability to local jails and detention facilities.

 

Services to veterans are being expanded through implementation of peer-to-peer facilitated support groups, training of licensed counseling staff in Cognitive Processing Therapy  for individuals suffering from Post Traumatic Stress Disorder, and coordination and expansion of existing community resources.

 

Administrative Cost Efficiency

Access makes efforts to maximize service dollars and reduce overhead costs through its continued sponsorship with the East Texas Behavioral Health Network (ETBHN), established under provisions of the Interlocal Cooperation Act to provide a means for the sponsoring entities to act jointly and be mutually accountable for those functions they agree can be performed with more economy, effectiveness and objectivity at the regional level.  ACCESS is one of eleven members of this network.  The mission of ETBHN is to improve the quality of service, enhance the operating efficiency, and expand the capacity of behavioral health in the communities of East Texas through greater integration of center clinical and administrative activities while also pursuing additional revenue resources.  The following is a summary of cost-savings and/or efficiency providing projects:

 

Regionalization of Authorization Process – ETBHN now completes authorization of services of 7 of the 11 Centers that comprise ETBHN.  We have reduced 7 FTE’s region-wide to 3 FTE’s on the regional level.  Authorization staff are located at various locations around the region.  They each log in to each Center’s system and provide same day authorizations.

 

Regional Planning and Network Advisory Committee – Each Center in ETBHN has representatives on the RPNAC, which takes the place of each Center having their own PAC and NAC.  This gives a broader perspective on community impact and allows consumers and their families to learn about services of other Community Centers.

 

Regional Utilization Management Committee – Each Center has a representative on the ETBHN UM Committee.  This replaces the need to have a Center UM Committee and allows for more comparison between Centers.  Some Centers continue to have a local Committee, as well, but find the regional one to be invaluable with benchmarking.

 

Pharmacy – The ETBHN Closed Door Pharmacy has saved Centers hundreds of thousands of dollars.  Plans are in progress to expand to other Centers and non-profits at this time.

 

Sharepoint – Recently, ETBHN has implemented a Sharepoint Website.  This is a working Website that allows Committees and Workgroups to each have their own Site with calendars, document sharing, message boards, etc.  Video Conferencing will soon be available, as well.  Each ETBHN Center will be implementing their own Sharepoint Site to replace current Websites.  This will  connect all members to the ETBHN Site for quick interfacing.

 

Wide Area Network – This has connected participating Centers for “real time” data retrieval and Video Conferencing.  This is a cornerstone for future consolidation efforts.

 

Service Code Matching – ETBHN is in the process of matching the service codes of all ETBHN Anasazi Centers.  This is a step in the direction of standardization and will make the data comparable.

 

Planning and Quality – ETBHN continues to coordinate meetings and sharing of information for planning of state-wide initiatives including Local Planning Network Development, Crisis (MCOT) planning, etc. These projects being coordinated by the region allows for more standardization between the Centers and pools the knowledge base of key staff.

 

Board of Trustee Retreats – Every 6 months, ETBHN plans and sponsors a Board Retreat for all Member Centers.  Any Board training that is needed is completed during this time and the Boards of each Center are kept aware and involved in all ETBHN projects.

 

ETBHN, also, explores opportunities for cost savings and quality improvement in all areas.  All senior staff at each Center are involved in meeting and planning for their area.  As an example, HR Directors recently reviewed new software for staff development and training that could possibly be regionalized.  Developmental Disabilities Directors and staff meet quarterly to review implementation of current and proposed State initiatives.  CFO staff recently met to review areas for growth and improvement, Information Technology Directors meet monthly and are working on several projects at the current time to improve efficiencies, etc.

 

Business Opportunities Committee – This committee is reviewing how ETBHN Centers can think outside the box and create opportunities in other non-GR related businesses.  Areas such as housing, Autism services, and private clinics are just a few of the areas being explored currently.

 

ACCESS will continue exploring additional opportunities for collaborations over the next biennium that reduce inefficiencies and that serve to streamline administrative and other support functions.

 

ACCESS plans to continue to use public forums, the existing network of collaboration committees in each County, the ETBHN RPNAC, as well as other approaches and formats to increase feedback to expand upon and continue this stakeholder base.  In addition to contacting stakeholders by phone, ACCESS staff will continue distributing consumer and stakeholder surveys throughout the initial planning cycle and will incorporate those responses into future planning enhancements.  ACCESS believes continuance of these processes will strengthen the Center’s ability to meet changing consumer, community and stakeholders’ needs. It is anticipated that this process will continue to evolve as additional stakeholder input is received through reviews of the ACCESS Draft Local Plan and from information gathered from other upcoming meetings with County Commissioners’ Courts, City Councils, and Jail Diversion Meetings. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Participating Agencies, Organizations, and Other Stakeholders in the Planning Process:

Many groups, organizations, and individuals participated in planning activities.  The last planning cycle ended in 2009 and since that time planning efforts have revolved around the development and expansion of crisis and jail diversion services, as well as ensuring the continued successful transition of ICF/MR Group Homes subsequent to their sale to a private provider and transition of HCS case management services.  Other planning initiatives have been directed towards improving Center efficiencies and through collaboration with other LMHA members in the East Texas Behavioral Health Network (ETBHN).

 

Anderson County Sheriff’s Department

Cherokee County Sheriff’s Department

Anderson County Judiciary

Cherokee County Judiciary

ETBHN Regional Planning and Network Advisory Committee

 

OSAR/ETCADA

Cherokee County Peer Support Group

Anderson County Juvenile Probation

Cherokee County Juvenile Probation

East Texas Crisis Center of Anderson and Cherokee Counties

Jacksonville Police Department

Rusk Police Department

Palestine Police Department

East Texas Medical Center

Palestine Regional Medical Center

Trinity Mother Francis Hospital

Cherokee County Health Department

Cherokee Care Collaboration

Partners in Health Advisory Board

Mental Health Providers, ACCESS

Developmental Disabilities Planning Advisory Committee

Developmental Disabilities Providers, ACCESS

Clients and Family Members

Rusk State Hospital

 

 

In 2010, the Center continued in its community planning efforts by initiating this FY 2011-2012 Local Service Area Planning and Network Development process with the intent of encouraging even more community involvement as a means of meeting the

needs and priorities of Anderson and Cherokee Counties.  The stakeholders and organizations targeted to participate in this planning effort included all entities included in the table above.

 

The chart below depicts the scheduled information-gathering meetings for this most recent planning cycle as well as those who actively participated in each of the meetings.

 

Description, Location/Format,  and Date or Timeframe

Participating Organizations

Summary of Input

 

 

 

Number of Individuals

Consumers

Family

Other

Stakeholder Survey (Internet & Consumer Focus Groups)

June 15, 2010 – July 9, 2010

ACCESS consumers, family members, NAMI, local government officials, interested citizens, members of law enforcement, medical and mental health service providers,

Responses reflected the communities’ desire (66.7%) to see increased services for children, including counseling and skills training, and expanded access to medication services for children and adults (40%).  Factors considered most important for ACCESS to consider when expanding the external provider network included experience in providing mental health services (43%), availability of transportation (68%), cost of services (68%), and proximity of service locations (68%). Responses indicated a high degree of satisfaction (95%) with services currently delivered by ACCESS.  Although there were no interested providers, there was a general consensus that ACCESS should consider procuring additional counselors to provide CBT services and also to attempt to add more psychiatrists to its network.  Other feedback addressed the need for public transportation, low-cost housing, and employment opportunities as this area has been hit particularly hard by the recent economic downturn.

21

3

22

Meeting of Jacksonville Kiwanis

February 10, 2010

Community Stakeholders: business people, civic officials, ACCESS staff

Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. Feedback elicited from group involved concerns about costs of services and lack of sufficient local behavioral health providers.

 

 

22

Meeting of Palestine Leadership

February 10, 2010

Community Stakeholders: business people, civic officials, ACCESS staff

Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. There were no specific recommendations regarding network expansion.

 

 

10

 

Partners in Health Advisory Board

February 24, 2010

Stakeholders from Public Health Department; community non-profits; colleges; medical providers; ACCESS staff

Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. Discussed need for more providers of low-cost medical services for large indigent population and concerns about reductions in Prescription Assistance Programs. Also discussed there is no “back door” out of services ACCESS offers due to lack of providers and pay sources. Recommended ACCESS and other stakeholders continue attempts to bring a Federally Qualified Healthcare Center (FQHC) to the local area.

 

 

11

IDD Public Planning Forum in Palestine, TX

March 30, 2010

ACCESS staff

Although heavily advertised (local newspapers, invitations mailed to 164 local stakeholders, notices posted in ACCESS Clinic and local assisted living facility), there were no attendees other than ACCESS staff.

 

 

 

IDD Public Planning Forum in Jacksonville, TX

March 31, 2010

ACCESS staff

Although heavily advertised (local newspapers, invitations mailed to 164 local stakeholders, notices posted in ACCESS Clinic and local assisted living facility), there were no attendees other than ACCESS staff.

 

 

 

ACCESS Board of Trustees Meeting

Jacksonville, TX

April 27, 2010

ACCESS Board members; ACCESS staff; family member

Provided overview of local planning activities and requirements.  Advised Board that no willing providers had been identified but that ACCESS should possibly consider attempting to increase the pool of counselors and psychiatric medication management providers. 

 

4

11

ACCESS Staff Training Day

Jacksonville, TX

April 30, 2010

ACCESS staff

Provided update to ACCESS staff on local planning and probable efforts to recruit additional providers of counseling and psychiatric medication management services as directed by consumers and community stakeholders.

 

 

72

Public Planning Forum in Palestine, TX

May 25, 2010

ACCESS staff

Although heavily advertised (local newspapers, invitations mailed to 164 local stakeholders, notices posted in ACCESS Clinic and local assisted living facility), there were no attendees.

 

 

 

 

Public Planning Forum in Jacksonville, TX

May 26, 2010

ACCESS staff

Although heavily advertised (local newspapers, invitations mailed to 164 local stakeholders, notices posted in ACCESS Clinic and local assisted living facility), there were no attendees.

 

 

 

Meeting with Cherokee County Juvenile Probation

Jacksonville, TX

May 26, 2010

Cherokee JPD staff and ACCESS staff

Acknowledged there were no willing providers identified during this procurement cycle but agreed that ACCESS should attempt to procure additional counseling and psychiatric medication management services to expand the pool of local providers.

 

 

7

Meeting of Palestine Rotary

Palestine, TX

June 9, 2010

Community Stakeholders: business people, civic officials, ACCESS staff

Reviewed the programs currently offered by ACCESS and local planning and network expansion requirements. Feedback elicited from group involved concerns about access to needed community services and lack of services for indigent individuals. No specific recommendations regarding network expansion were elicited as there are no interested providers.

 

3

72

Local Festival (Tomato Fest)

Jacksonville, TX

June 12, 2010

 

Community stakeholders, ACCESS staff and consumers

Handed out information about ACCESS services and discussed network expansion requirements to festival attendees who expressed an interest. No recommendations specific to network expansion were elicited.

 

 

53

Meeting of NAMI & Cherokee County Peer Support Group

Jacksonville, TX

June 15, 2010

Consumers, family members, ACCESS staff

Reviewed draft Local Network Development Plan with group and advised them that no willing and qualified providers had expressed interest in contracting at this time.  Discussed barriers to recruiting providers to the area and NAMI members expressed their concerns about lack of public transportation and the possibility that services might not be offered in the same location or close proximity to where they live. Although no providers indicated their interest, the group still recommended that ACCESS should attempt to procure the discrete services of counseling and psychiatric medication management in an attempt to increase choice through the availability of additional providers.

12

2

1

Crisis/Jail Diversion Meeting

Rusk, TX

7/9/2010

ACCESS staff, law enforcement, hospital providers, local judicial representatives

Discussed existing crisis services and shortage of qualified behavioral health providers, as well as extreme difficulties experienced in accessing state hospital beds.   Stakeholders reported satisfaction with crisis hotline services provided by AVAIL and responsiveness of ACCESS crisis staff. 

 

 

13

Disaster Relief Council

July 15, 2010

Jacksonville Mayor, local hospital providers, representatives from local non-profit agencies, law enforcement, city officials, concerned citizens, ACCESS staff

Planning forum for provision of disaster relief and preparedness.  Requested feedback about ACCESS current planning initiatives.  Again, concerns raised about lack of public transportation and growing numbers of individuals in crisis straining all local resources.

 

 

20

                                                         

PNAC Involvement

 

Date

PNAC Activity and Recommendations

ETBHN RPNAC

March 11, 2010

Reviewed and approved member Centers’ draft Local Network Development Implementation Timelines

5/11/2010

Identified local service priorities, including strengths of the current system, gaps in service delivery, and potential barriers to external provider recruitment.

7/7/2010

Approved draft LPND procurement plan for FY 2011-2012 procurement cycle, with no recommendations for changes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identified Service Delivery Needs and Priorities, including gaps in service:

 

The ETBHN Regional Planning and Network Advisory Committee (RPNAC) conducted a “SWOT” Analysis during its May, 2010 meeting and subsequently identified the following strengths, weaknesses, opportunities, and threats, as well as gaps in services:

 

Strengths:

            Desire to involve families and consumers

            Extensive experience in providing service

            Implementing business approaches to be more competitive

            Proven to be adaptable and flexible

            Adapting to scarce resources

            Continues to provide services with limited financial resources

            Strong board of trustees that advocate for centers at the state level

 

 

Weaknesses:

            Under funded

            Forced to implement waiting lists

            Large geographical service areas

            State mandates put centers at a disadvantage when competing

            Population is defined for us – we cannot choose who we serve

 

Opportunities:

            Diversify to other services to broaden base

            Educate general public to needs

            Develop the mail order pharmacy

 

Threats:

            Legislation restricts what we can do

            Provider of last resort

            Manner in which equity is determined

            Funding cuts

            Staff retention

            Not an equal player with private providers

            Difficult to plan for the unknown

            Complying with regulations

            Not a popular cause with the legislature

            CAM data is not consistent and not reflective of true comparisons

 

Gaps in Services:

Adults

Too many in the MH low service packages

Resource limitations

Not able to provide needed services due to RDM

No funding for outreach, education

Jail diversion is under-funded and so not as effective

Housing options (few licensed boarding homes in the area)

Community resources, particularly psychiatrists to refer people to

Transportation

State hospital bed availability

Dual diagnosis (Chemical dependency/mental health)

Few resources for detox

Counseling and Therapy services for GR funded consumers

            Few resources for individuals having autism

 

Children

Limited availability of Child Psychiatrists

State hospital bed availability

Residential care

Transportation

Counseling services

Willing foster care providers for RDM foster care

Dual diagnosis (Chemical dependency/mental health)

Few resources for detox

Limited integration with public schools

 

Due to the lack of regional services and resources, the Local Authorities have developed strong collaborative efforts to fill those gaps, through partnerships with each other and also through participation in the East Texas Behavioral Health Network. As the smallest of those Local Authorities, ACCESS has benefited from expanded opportunities for access to a larger pool of administrative and clinical expertise, as well as regional efforts to attract service providers to the area.  Local collaborative efforts in the two Counties are also strong, with area agencies and charitable organizations pooling resources to focus limited resources where they will provide the most benefits.

 

There is a lack of licensed and degreed staff in the local area and competition for qualified staff is intense between ACCESS, the local State Hospital, State prison system, and bordering Local Authorities. This poses a threat as smaller Local Authorities also have less capacity for staffing redundancy and any loss of well-qualified staff poses a significant problem for maintenance of critical infrastructures. As a corollary weakness, and as a gap in services, there is only one external provider of psychiatric services in the two Counties and that individual has limited caseload capacity as he also serves as the Medical Director of the local in-patient psychiatric facility.

 

Results of planning initiatives also identified the following strategic issues, priorities and potential consequences:

 

#

Description of strategic issue or need

Reasons the issue has priority

Consequences of failing to address the issue

1

Compliance with applicable laws and rules and with requirements of pay sources.

Funding is necessary in order to provide services in the area, and funding depends on compliance.

Sanctions, penalties, or loss of contracts or funding

2

Competent staff with diversified backgrounds that reflect the communities ACCESS serves.