Table Of Contentv
UMASS/AMHERST
312066 0362 8865 9
The Commonwealth of Massachusetts
Executive Office ofHealth and Human Services
Department ofMental Health
DOCUMENTS
GOVERNMENT
COLLECTION
JAN 2 0 1998
Massachusetts
University of
C^y
Depository
FISCAL YEAR 1996
ADULT & CHILD/ADOLESCENT
IMPLEMENTATION REPORT
and
FISCAL YEAR 1997
STATE MENTAL HEALTH PLAN
December 1996
Digitized by the Internet Archive
2014
in
https://archive.org/details/fiscalyearadultc1996mass
Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Mental Health
Marylou Sudders, Commissioner
1997 Community Mental Health Services
Block Grant Application
(P.L. 102-321)
including:
1996 Adult and Child/Adolescent
Implementation and Expenditure Report
1997 State Mental Health Plan
December 1996
1997 BlockGrantApplication December 1996
MassachusettsDepartmentofMental Health
TABLE OF CONTENTS
EXECUTIVE SUMMARY 5
STATE MENTAL HEALTHPLANNING COUNCIL 7
THE MASSACHUSETTS DEPARTMENT OF MENTAL HEALTH 10
1996 IMPLEMENTATION REPORT 17
REQUIREMENT#1: ESTABLISHINGAN ORGANIZED SYSTEM OF CARE 18
RegulationsandStandards 20
Planning 25
ConsumerandCommunityInvolvement 27
REQUIREMENT#H: QUANTITATIVE IMPLEMENTATION TARGETS 30
PopulationtobeServed 31
Adults. 32
Children andAdolescents (under 19) 33
DeafandHardofHearing 33
Adultswith/a>K)Ccurringpsychoactive substanceusedisorder 34
Children/adolescentswith mental illnesswhoalsoabuse substances 35
ForensicaUy involvedadults 36
Forensically involvedchildrenandadolescents 36
Elders 38
ManagementInformationSystems 38
REQUIREMENT#IH: ACCESS TO SERVICES 41
IncreasedAccesstoServices 43
AccesstoServicesforSpecialandSub-Populations 47
ProtectionandAdvocacy 61
REQUIREMENT#TV: AVAILABILITY OFSERVICES 66
1996 AdultmentalhealthServices/annualCapacity 68
1996 ChildandAdolescentmentalhealthServices/annualCapacity 69
ExtentandAvajlabilityofServices 70
.
REQUIREMENT#V: FINANCIALAND HUMAN RESOURCES 76
FundsAvailableforCommunityPrograms 77
AvailabilttyofHumanResources 78
Training 81
EmergencyServicesTraining 87
REQUIREMENT#VI: REDUCINGHOSPITALIZATION 90
ProgrammaticInitiativestoReduceHospitalization 92
2
1997 BlockGrantApplication December1996
MassachusettsDepartmentofMentalHealth
REQUIREMENT#VH: CASE MANAGEMENT 94
CaseManagementModel 95
SizeofPopulationReceivingCaseManagementServices 97
REQUIREMENT#VTII: HOMELESS MENTALLY ILL. 97
Planning 99
REQUIREMENT#K: INTEGRATED SERVICES FORCHILDREN/ADOLESCENTS 102
InteragencyCoordination 103
REQUIREMENT#X: RURAL SERVICES 105
AccesstoServices 106
REQUIREMENT#XI: PREVALENCE ESTIMATES 106
REQUIREMENT#XH: BLOCKGRANTEXPENDITURE REPORT 108
TABLE I: SUMMARYOFBLOCKGRANTFUNDING 109
TABLE II: distributionofblockgrantfundsbyarea(SFY'95-'97) 109
TableHI: SFY'96 expendituresforffy'94/95grantaward 112
TableIV: FFY'94/95 blockgrantexpendituresbyarea 113
1997 STATE MENTALHEALTHPLAN 115
REQUIREMENT#1: ESTABLISHINGAN ORGANIZED SYSTEM OFCARE 116
RegulationsandStandards 118
Planning 120
ConsumerandCommunityInvolvement 121
Research 122
REQUIREMENT#H: QUANTITATIVE IMPLEMENTATION TARGETS 123
PopulationtobeServed 125
Adults. 126
Childrenand Adolescents (Under 19) 126
Deafand HardofHearing 127
AdultswithMental Illness/Co-OccurringPsychoactive Substance.UseDisorder 127
Children/Adolescents withMental Illness WhoAlso Abuse Substances 128
Forensically Involved Individuals 129
Elders 130
ManagementInformationSystems 131
REQUIREMENT#HI: ACCESS TO SERVICES 132
IncreasedAccesstoServices 134
3
1997BlockGrantApplication December1996
MassachusettsDepartmentofMental Health
AccesstoServicesforSpecialandSub-Populations 136
DeafandHardofHearing 136
MentalIllnessandSubstanceAbuse 137
RacialandCultural/LinguisticMinorities/PhysicallyChallenged. 138
Elders 139
Children andAdolescents 140
ForensicallyInvolvedIndividuals 140
ProtectionandAdvocacy 142
REQUIREMENT#IV: AVAILABILITY OFSERVICES 145
1997 AdultmentalhealthServicesannualCapacityChart 146
1997 Child/AdolescentmentalhealthServicesannualCapacityChart 147
ExtentandAvailabilityofServices 148
REQUIREMENT#V: FINANCIALAND HUMAN RESOURCES 150
FundsAvailableforCommunityPrograms 151
AvailabilityofHumanResources 152
Training 153
EmergencyServicesTraining 155
REQUIREMENT#VI: REDUCINGHOSPITALIZATION 156
ProgramInitiativestoReduceHospitalization 158
REQUIREMENT#VH: CASE MANAGEMENT 158
CaseManagement 159
SizeofPopulationReceivingCaseManagementServices 159
REQUIREMENT#VHI: HOMELESS MENTALLY ILL 160
Planning 161
REQUIREMENT#K: INTEGRATED SERVICES FORCHILDRENAND ADOLESCENTS....162
InteragencyCoordination 163
REQUIREMENT#X: RURALSERVICES 165
AccesstoServices 165
REQUIREMENT#XI: PREVALENCE ESTIMATES 166
REQUIREMENT#XH: BLOCKGRANTSPENDINGPLAN 168
TABLEONE: PROJECTEDSPENDINGPLANBYPROGRAMTYPE 169
TABLETWO: PROJECTEDSPENDINGPLANBYAREA 170
STATE MENTAL HEALTH PLANNING COUNCILLETTER 172
4
1997BlockGrantApplication December1996
MassachusettsDepartmentofMentalHealth
EXECUTIVE SUMMARY
The 1997 Community Mental Health Services Block Grant Application
includes the 1997 State Plan, a letter from the Mental Health Planning Council
and an Implementation Report on the goals, objectives and expenditures in the
1996 State Plan. Federal block grant funds are used by the Department of
Mental Health (DMH) to address service gaps identified through local planning.
DMH
During the past year, continued the restructuring of its service
delivery system to assure access, quality and cost-effectiveness of mental health
services in all 33 natural service areas ofthe state. Each natural service area
represents a mix of state and provider-operated services, grouped within six
DMH Areas, and provides a continuum offlexible mental health and
rehabilitation services that are responsive to the individual needs and
preferences of adult clients and of children, adolescents and their families.
Highlights of State Fiscal Year 1996 accomplishments are: the
establishment and monitoring of a single program code for residential contracts
aimed at increasing flexibility for clients by tying the amount and type of service
provided to their individual needs and preferences; further strengthening of the
quality and utilization management systems; completion of standards of care for
many more ofthe Department's programs and services; contracting with a
vendor to begin implementation ofthe Client Registration and Enrollment
System; continuation of training for adult and child providers, including training
focused exclusively on the needs of elders; completion of the final report by the
Children's Mental Health Task Force and implementation ofthe Task Force
recommendation to establish an interagency Children's Policy Steering
Committee; and signing an Interagency Service Agreement with the Division of
Medical Assistance/Medicaid (DMA) that will establish standards of care and
DMA DMH
pool funds for the purchase of all acute mental health services by for
DMH
clients, beginning July 1 , 1996. In addition, for the first time, achieved
national accreditation, by the Joint Commission on Healthcare Accreditation
(JCAHO), of all it's inpatient hospitals and community mental health centers. It
also continued its systematic review of all policies, wherever possible aligning
them with appropriate JCAHO or other nationally accepted standards. Clients,
family members and other interested stakeholders continued to be involved in
DMH planning and policy activities at all levels, and many participated actively
on a task force that led to enactment of an Informed Consent policy for DMH.
A major focus during SFY'97 will be implementation of the ISA signed last
year by DMH and DMA. Starting July 1 1996, DMA will purchase on DMH's
,
behalf, through a managed care organization (MCO), acute care and most
emergency services for DMH clients, as well as for Medicaid recipients. The
MCO, under contract to DMA, will be required to use DMH standards and clinical
criteria in all of its programs and will be held accountable, with DMA, for
DMH DMH
providing appropriate care to clients. will continue to provide an
extensive array of adult, child and adolescent continuing care services, and the
MCO
will use agreed upon protocols for effecting transfers between the systems.
5
1997BlockGrantApplication December 1996
MassachusettsDepartmentofMentalHealth
DMH
Expected savings resulting from this initiative will enable to invest in
additional continuing care services. A new MCO, the Massachusetts Behavioral
Health Partnership, was selected through a competitive bidding process to
manage this mental health and substance abuse program for DMA. Under the
terms of the contract, the MCO is required to establish advisory councils where
clients, family members and other interested parties will be able to provide input.
Two other initiatives will move from planning to implementation this year.
The Registration and Enrollment System will be site-tested for eventual
statewide installation, enabling DMH to track and account for all services directly
provided or funded by DMH to continuing care clients. An accompanying
Consumer Accounting and Billing System will track expenditures. Protecting the
privacy of clients enrolled in these systems has been a primary focus of
planning. Also, a process for determining clients' eligibility for continuing care
services was implemented July 1, 1996. This process was developed to meet
the terms of the ISA and as a complement to the Department's utilization
management program to ensure that resources are targeted appropriately.
In SFY'97, DMH will review and revise its entire code of regulations,
pursuant to an executive order of the governor. All executive agency regulations
will be sunset December 31 1996 unless the agency can provide justification for
,
their existence. The Department is using this opportunity to completely
restructure its regulations, carefully defining its mission and ensuring integration
with other executive agencies, particularly concerning licensing issues and
duplicative contracting requirements for vendored programs. Workgroups,
including outside interested parties in addition to DMH program, policy and legal
staff, have been established to review each section of the regulations.
Finally, DMH will continue to promote interagency cooperation and
systems integration for children and adolescents through various collaborative
efforts.
The Planning Council continues to monitor implementation of goals and
objectives and approved the 1997 workplan. It's subcommittee on the mental
health needs of elders is actively engaged in drafting a core curriculum targeted
to elders' needs, and the series of training conferences for professionals and
senior advocates to address some of the unmet mental health needs of elders
continues. The Multicultural Advisory Committee sponsored a second
symposium on multicultural research issues for professionals, clients and family
members of color, held in October 1995, and is working to establish a research
entity in collaboration with the Department's Research Centers of Excellence.
With the arrival of a new Commissioner of Mental Health in February
1996, and subsequent staffing changes, some of the original goals and
objectives in the 1996 State Plan were re-evaluated and in some cases,
refocused. Thus, although the Department did not fully accomplish every
objective articulated in the 1996 Plan by the end of the fiscal year, there is ample
evidence to demonstrate that the state made substantial progress in moving
toward a comprehensive community-based system of care that serves the state's
adults and children with serious mental illness or serious emotional disturbance.
6
1997BlockGrantApplication December1996
Massachusetts(DepartmentofMentalHealth
STATE MENTAL HEALTH PLANNING COUNCIL
The State Mental Health Planning Council is a standing committee of the
Statewide Advisory Council (SAC) to the Massachusetts Department of Mental
Health. The SAC, established by statute (MGL c.19, §1 1) and regulation (104
CMR
2.16 [5]), consists of 15 individuals appointed by the Secretary of the
Executive Office of Health and Human Services to "advise the commissioner on
policy, program development and the priorities of need in the Commonwealth for
comprehensive programs in mental health." The Council does not have its own
set of by-laws. All members ofthe Planning Council are nominated and
appointed by SAC and represent clients, family members, legal advocates,
providers, other state agencies, mental health professionals and professional
organizations, legislators and state employee unions. Membership includes
family members of adults and children and members of racial, cultural and
linguistic minority groups. The Department provides staff to the Council.
Many members of the Planning Council have also been actively involved
in the Department's locally based participatory planning process. There are
currently three groups that function as subcommittees of the Council, with
membership that includes individuals on the Planning Council as well as other
interested persons. These subcommittees address issues concerning the
mental health needs of: elders, children and adolescents, and racial and
cultural/linguistic minority groups. They maintain their own schedules and
agendas.
The Elder Mental Health subcommittee has actively responded to
concerns about the unmet mental health needs of this segment of DMH's target
population. The subcommittee produced a set of recommendations that were
reviewed and approved by the commissioner and largely implemented during
SFY'95. In addition, the Massachusetts Association for Older Americans (under
contract to DMH) has been running a training program aimed at improving and
increasing mental health services for this population. It held a series oftraining
conferences for professionals and senior advocates, funded through the federal
block grant, in SFT95 and SFY'96 and will do so again in SFY'97.
Child/Adolescent interests are overseen by the Professional Advisory
Committee (PAC), which serves as an advisory group to the DMH Child/
Adolescent division. The PAC monitors planning for children and adolescents
and advocates with the administration and legislature on a broad range of issues
related to children's mental health.
Accomplishments ofthe Multicultural Advisory Committee during
SFY'96 included a symposium for mental health professionals, consumers and
family members of color and regularly scheduled multicultural grand rounds.
Recently reorganized, the committee will continue to work with representatives
of constituent agencies and academic institutions to help define mental health
research needs applicable to people of color.
7
