I: State Information. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 1 of 98. State Information

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1 I: State Information State Information I. State Agency for the Block Grant Agency Name Department of Children and Families Organizational Unit Substance Abuse and Mental Health Program Office Mailing Address 1317 Winewood Blvd., Building 6, Room 275 City Tallahassee, Florida Zip Code II. Contact Person for the Block Grant First Name Hayden Last Name Agency Name Mathieson Department of Children and Families Mailing Address 1317 Winewood Blvd., Building 6, Room 275 City Tallahassee, Florida Zip Code Telephone Fax Address III. Expenditure Period State Expenditure Period From 7/1/2012 To 6/30/2013 Block Grant Expenditure Period From 10/1/2010 To 9/30/2012 IV. Date Submitted Submission Date 12/2/2013 5:37:26 PM Revision Date V. Contact Person Responsible for Report Submission First Name Annette Last Name Culp Telephone Fax Address VI. Contact Person Responsible for Substance Abuse Data First Name Adam Last Name Wasserman Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 1 of 98

2 Telephone Address footnote: Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 2 of 98

3 II: Annual Report Table 2 - State Priorities Number Title Description Florida identified this as its first and most critical priority. Enhancing its good and modern system of care to improve accountability, quality of care and coordination with local, state and federal partners is essential today and to prepare for the future. In addition, to maintain current programs that address block grant priority populations (i.e., individuals with SED and SMI, women who are pregnant and in need of SA and MH services, persons with communicable disease (tuberculosis and HIV/AIDS), intravenous drug users and services for those at risk of substance abuse or mental disorders) the system must continue to strengthen its abilities to maximize resources and effectiveness in ways that are culturally appropriate and relevant. Florida's SAMH 1 "Good and Modern" System of Care When establishing this priority the State considered its needs assessment, realizing that in order to meet block grant requirements, and the emerging issues such as the prescription drug crisis, without new funding it is necessary to gain system. This led to the development of our first priority, its goal and objectives. Priority 1 goals are designed to increase system capacity by managing substance abuse and mental health resources collaboratively, measuring performance and quality and conducting ongoing quality improvement processes in the State s Regional Systems of Care (RSOC), their managing entities, community coalitions and provider networks. This will provide Florida with the tools it needs to monitor its system as it is described in the Substance Abuse and Mental Health Services (SAMHSA) Good and Modern System Brief. The strategies outlined within each of P1 s goals strengthen our State s ability to address needs of individuals with co-occurring disorders. Strategies outline plans to enhance communication and data sharing among partners to improve access to substance abuse and mental health services regardless of payer source. It continues to build on the State s work with child welfare and primary care. In addition, P1, Obj. 6 describes the state s plans to expand access to supportive housing, using scattered housing and community based services and supports in communities of high need. The objective includes action steps for developing a three year plan to increase community access for individuals seeking placement following care in State Mental Health Treatment Facilities (SMHTF). Goal: Increase use of Evidence Based Practices (EBP) in the delivery of SA and MH services for children and adults. As a major component of a Good and Modern System the State identified as its second priority the increased use and quality implementation of evidence based practices. P2 focuses on building the capacity of the RSOCs (including managing entities, community coalitions and provider networks) to improve practice in substance abuse and mental health prevention, treatment and recovery services and supports. Increasingly there are new techonologies available to enhance service delivery, respond more effectively to diverse populations and move research to practice more quickly. As Florida reponds to its unmet needs, including a growing Hispanic population, the use of prevention, treatment and recovery technologies is critical. 2 Evidence Based Practices Initiative P2 uses the good and modern system of P1 to bring quality healthcare to SAMHSA s priority populations and address the needs identified in the State s assessment. The priority is to establish and then support standards of care across state systems, including direct services provided to prioritized populations through the Florida Agency for Healthcare Administration (Medicaid) Florida Department of Corrections, Department of Health, Florida Department of Juvenile Justice, Florida Department of Children and Families, Florida Department of Education and the Board of Governors (state university system). SAMH will extend EBP training and technical assistance to other agencies who serve or come in contact with individuals within our priority areas, including Florida s Department of Highway Safety and Motor Vehicles, Department of Transportation, Department of Elder Affairs, Agency for Workforce Innovation, Agency for Persons with Disabilities and all of their community based counterparts. P2 s goal that Florida s substance abuse and mental health system of care funds culturally relevant evidence-based practices in the delivery of prevention, treatment and recovery services and supports extends beyond block grant funding and is meant to further establish the DCF SAMH as the single state authority for substance abuse and mental health. It further enhances existing services, including those using block grants funds, moving practice from a delivery of a unit of service to performance of quality care. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 3 of 98

4 Florida s growing multi-cultural population gives use of evidence based practices great significance. Implicit in the use of evidence based strategies is cultural appropriateness, relevance and best fit of services and supports for individuals being served. P2 objectives support the State s mental health and substance abuse activities outlined in our current level of service for our priority populations and concerns (i.e., co-occurring conditions, services for homeless individuals, and care for Veterans). The objectives create client feedback loops to provide support decision making and assure that services are culturally relevant and appropriate. Strategies are designed to improve practice by monitoring fidelity of implementation. They provide for self assessment of fidelity of implementation and quality improvement initiatives across the spectrum of mental health and substance abuse services, including prevention, treatment and recovery. The P2 objectives create a system of checks and balances that help the State manage with fewer staff managing while assuring that successful outcomes for individuals remains central to our mission. The routine reporting of performance and quality embedded in the strategies of P2 objectives will, at the end of this planning period, provide the State with realistic measures to use as indicators of system health. 3 Prevention and Recovery Priority 3: Reduce Onset and Prevalence of SAMH Disorders; Promote Recovery. The goals in this priority will specifically address identified needs, including prescription drug abuse; underage drinking; deaths by suicide; serious psychological distress among adults; disease progression among children and youth; adult heavy drinking and binge drinking. P3 objectives begin to address health promotion and enhance prevention services for children at risk of mental and substance use disorders. The objectives mobilize communities, increasing their awareness and organization to use local resources to impact negative behaviors. Changes in behavior will reduce the need for services among many in our priority populations. This priority's goals will also address the state's committment to recovery support and services for those with substance use disorders, mental illneess or co-occurring disorders Services to women with dependent children and women who are pregnant Services to veterans and active military personnel Services to persons with HIV AIDS Florida will give priority for substance abuse services to women with dependent children and women who are pregnant. Florida veterans and active military personnel have access to quality substance abuse and mental health services Florida will provide early intervention testing to persons with HIV AIDS, other blood borne illness and highly contagious disease. Services to 7 intravenous drug users. Florida will provide early intervention testing to intravenous drug users. footnote: Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 4 of 98

5 II: Annual Report Table 3 - Objectives, Strategies and Performance Indicators Priority: Goal of the priority area: Florida's SAMH "Good and Modern" System of Care Goal 1.1 Florida s SAMH system of care, including its six regional systems of care, is responsive to community needs, establishes standards of care, and routinely monitors progress using data and information to inform decision making. * Strategies to attain the goal: Strategy (2012) Establish performance and quality benchmarks at provider, regional and state levels using key indicators of a good and modern system. Strategy (2012) Establish routine data collection processes within Regional Systems of Care (RSOCs). Strategy (2012) Establish reporting mechanisms at each level to support data-driven continuous improvement of performance and quality indicators. Strategy (2012) Develop training and technical assistance plans to support systems development at provider, regional and state levels. Strategy (2013) Conduct regular analysis of performance and quality indicators to monitor progress of system development. Strategy (2013) Provide routine feedback to RSOCs regarding progress and continuous quality improvement. Strategy (2013) Implement training and technical assistance plans for individual providers and RSOCs Performance and Quality Improvement (PQI). * This plan describes the mechanisms for implementing and sustaining the outcomes of numerous grants, including SAMHSA Children s Mental Health System of Care planning grant; SAMHSA s Access to Recovery grant; SAMHSA s Partnership for Success and Strategic Prevention Enhancement grants; Office of Juvenile Justice and Delinquency Prevention s Enforcing Underage Drinking Laws grant; SAMHSA s Projects for Assistance in Transition from Homelessness (PATH) grant program and SAMHSA s Jail Diversion & Trauma Recovery with Priority to Veterans. It also describes mechanisms Florida will use to improve, and measure, success with specialty populations required by the SAPT and Mental Health block grants. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 5 of 98

6 Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.1 By July 1, 2013, 100% of RSOCs will be reporting quarterly on PQI measures. Description of Collecting and Measuring Changes in Performance Indicator: Annual System of Care report including needs assessment, performance improvements, outcomes and updated strategic plan National Outcome Measures State quality and performance measures including: Average number of days between client assessment and the date of first treatment service; Percent of adults who are discharged from crisis stabilization services (detoxification/crisis Stabilization Units) who receive subsequent treatment services; The average number of days between client screening and first treatment service. Achieved: No Proposed Changes: The Department has created a Behavioral Health Programmatic Allocation Plan that has been shared with the administrators of the Managing Entities. The Plan will provide the program with an outline of the system of care, expenditure plans, subcontracted providers, performance targets for subcontracted providers and strategies to achieve these targets, a point of reference for the performance of the managing entities and an outline of the managing entity s strategy for upcoming fiscal year. Managing Entities will also have to complete a Cost Allocation Plan. Reason Not Achieved: The performance measure could not be attained due to delays in establishing contractual expectations for the Managing Entities. Priority: Florida's SAMH "Good and Modern" System of Care Goal of the priority area: Goal 1.2 Enhance resource utilization among substance abuse and mental health funding agencies. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 6 of 98

7 Strategies to attain the goal: Strategy ( ) Conduct quarterly funder workgroup meetings to enhance understanding and communication. Strategy ( ) Identify data and other information needed to conduct analysis and identify measures to improve utilization, contain costs and improve access to care. Strategy ( ) Develop training and technical assistance tools to help communities use data to support effective decision-making. Florida s plan builds upon existing initiatives to help communities achieve goals and objectives. ** Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.2 By July 1, 2013 Florida SAMH will begin producing annual reports on RSOC resource utilization. Description of Collecting and Measuring Changes in Performance Indicator: Annual System of Care report including: Needs assessment; Performance improvements; Outcomes; and, Updated strategic plan. RSOCs will review data monthly and provide SAMH with regular updates on progress toward quality improvement goals, including increased utilization of multiple funding streams and partnership development. Achieved: No Proposed Changes: The Department has created a Behavioral Health Programmatic Allocation Plan that has been shared with the administrators of the Managing Entities. The Plan will provide the program with an outline of the system of care, expenditure plans, subcontracted providers, performance targets for subcontracted providers and strategies to achieve these targets, a point of reference for the performance of the managing entities and an outline of the managing entity s strategy for upcoming fiscal year. Managing Entities are also required to complete a Cost Allocation Plan. Reason Not Achieved: The performance measure could not attained due to delays in establishing contractual expectations for the Managing Entities, who are now responsible for completing the reports. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 7 of 98

8 Priority: Florida's SAMH "Good and Modern" System of Care Goal of the priority area: Goal 1.3 Develop bidirectional integration of behavioral health and primary care services. Strategies to attain the goal: Strategy ( ) Continue to establish effective linkages with Federally Qualified Health Centers (FQHCs). Strategy ( ) Continue to establish linkages with Medicaid managed care providers within RSOCs to prepare for providing Medicaid services through managed care organizations. Strategy ( ) Establish indicators to demonstrate effectiveness of relationships at each level. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.3 By December 30, 2015, increase the number of primary care providers who routinely screen for substance abuse and mental health disorders. Description of Collecting and Measuring Changes in Performance Indicator: Florida s annual SAMH provider survey question regarding partnerships with primary care, including FQHCs. SAMH contracts require Memoranda of Understanding with FQHCs. Achieved: No Proposed Changes: The Advisory Teams for both the System of Care and Launch Grants now have representation from the primary health care field. This is a move forward in efforts to move to integrated services. Florida also has seven recipients of the Primary and Behavioral Healthcare Care Integration (PBHCI) Grants. These sites are supported by the Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 8 of 98

9 Department. Reason Not Achieved: MOUs have been required in contract, however, the survey was not developed for FY Priority: Florida's SAMH "Good and Modern" System of Care Goal of the priority area: Goal 1.4 Enhance integration with Child Welfare Strategies to attain the goal: Strategy ( ) Identify and prioritize points of contact at community, regional and state levels. Strategy ( ) Establish indicators to demonstrate effectiveness of relationships at each level and track progress indicators to demonstrate effectiveness of relationships. Strategy ( ) Conduct training and technical assistance within the two systems to assure use of screening and assessment tools for children and their families. Through Building Integrated Approaches, SAMH continues to work with primary care, the justice system, education (K-12 and higher education) to support increased integration and identify needs early, increase access to care and support early interventions that reduce prevalence. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.4 By Dec. 31, 2015 increase the number of family safety cases with identified SA or MH needs who receive services. Description of Collecting and Measuring Changes in Performance Indicator: Continuum of SAMH module in state Children's IT system. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 9 of 98

10 Achieved: Yes Proposed Changes: Reason Not Achieved: Priority: Goal of the priority area: Florida's SAMH "Good and Modern" System of Care Goal 1.5 Enhance use of information technology (i.e., Electronic Health Records (EHR), Financial and Accountability Management) to support system development. Strategies to attain the goal: Strategy (2012) Require all SAMH providers to adopt EHR technology. (2012) Strategy (2012) Establish standards for data systems improvements that consider federal and other state initiatives. Strategy (2012) Work collaboratively with the state Agency for Health Care Administration (AHCA) to develop the Florida Medicaid Management Information Systems (FMMIS), a modernized technology plan that supports specialty care and provides tools to enhance data sharing, resource utilization and improve quality. Strategy (2012) Establish training and technical assistance to individual providers and RSOCs. Strategy (2013) Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 10 of 98

11 Develop new opportunities to use interactive communication technologies in SAMH service provision, health promotion and other communications. Strategy (2013) Continue to collaborate with the state Agency for Health Care Administration (AHCA) to develop the Florida Medicaid Management Information System (FMMIS) planning and technology development that supports specialty care and provides tools to enhance data sharing, resource utilization and improve quality. Strategy (2013) Conduct training and technical assistance to individual providers and RSOCs These changes will enhance Florida s work with its specialty populations required by the SAPT and Mental Health block grants. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.5 By July 1, 2013, 85% of all providers using block grants funds will be using electronic health records to conduct their reporting. Description of Collecting and Measuring Changes in Performance Indicator: Annual System of Care report including: Needs assessment; Performance improvements; Outcomes; and, Updated strategic plan. National Outcome Measures. State quality and performance measures. Achieved: No Proposed Changes: The Department will continue to monitor the progress of contracted providers to expand the use of EHR technology. Reason Not Achieved: Since FY , the Department has delegated this responsibility via contract to providers. This allows a more realistic strategy to implement Interactive Communication Technology (ICT). It should be noted that in the State Fiscal Year 12-13, which overlaps with the end of this reporting period, and the beginning of the next, Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 11 of 98

12 the state implemented managing entities to administer and manage behavioral health services in Florida. As with any implementation, there have been structural issues that were not anticipated, and one of those issues has been related to Information Technology (IT). In the transition, the managing entities have established new IT systems, which have experienced technical difficulty in connecting and transmitting to the state system. There have also been issues with providers, and these have resulted in data issues which will manifest themselves throughout the remainder of SFY For SFY the state has implemented a number of solutions to overcome the issues, including monthly report (via Excel) of expenditures and the number of people served. A number of more also made to the allocation methodology for the IT system. These enhancements are expected to produce more realistic outcomes. Also, it should be noted that the Department stopped the sporadic input of non-department funded clients into the Department s IT system in an effort to generate more reliable outcome and utilization data. Priority: Goal of the priority area: Florida's SAMH "Good and Modern" System of Care Goal 1.6 Increase capacity of community mental health system of care to provide alternatives for persons discharged from state mental health treatment facilities. Redirect state mental hospital funding for community services. Strategies to attain the goal: Strategy ( ) Develop three-year plan to redirect state mental health facility funds for community services. *** Strategy ( ) Conduct clinical review of existing hospital patients to determine community needs. Strategy ( ) Ensure community capacity is available, allowing for choice. Strategy a ( ) Community-Based Services to Individuals in Rural Areas: SAMH work in rural communities includes strengthening the individual s natural support system, establishing satellite clinics in rural areas for a limited number of days each month, and building relationships with primary health care providers such as local public health units to ensure individuals have access to medication and medication management. Strategy b ( ) Community Alternatives for Individuals in Long Term Care: SAMH has identified that if community services are enhanced more individuals in civil state mental health facilities can successfully reintegrate with their communities. SAMH is asking permission to redirect state general revenue funds in 2012 to assist with transition of an estimated 150 individuals that are ready for community placement if appropriate services are in place. Funding will be used to develop the needed treatment and supports in communities for one year. Strategy c ( ) Supportive Housing: SAMH will increase its use of supportive housing in substance abuse and mental health. Activities include developing Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 12 of 98

13 scattered housing options for communities where needs assessments indicate that enhanced services and supports will improve outcomes for special populations such as veterans and persons in recovery. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.6 Increase the number of supportive services and supports for persons needing long term care. Description of Collecting and Measuring Changes in Performance Indicator: Data collected by the state's mental health treatment facilities on monthly discharges and placements. Achieved: No Proposed Changes: While the Department was unable to secure the requested funding through a legislative budget request, efforts will continue to increase the capacity of the community mental health system. Reason Not Achieved: An appropriation was not made to address this issue. Priority: Goal of the priority area: Florida's SAMH "Good and Modern" System of Care Goal 1.7 Increase access to behavioral health services so that adults, children and families are active, self-sufficient participants in their communities. Strategies to attain the goal: Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 13 of 98

14 Strategy ( ) Strengthen integration of substance abuse and mental health services with delivery of primary care. Strategy ( ) Reduce barriers to access to substance abuse and mental health services that impact the ability of children and adults to live and participate fully in their communities. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.7 By 12/31/15: Increase # of primary care provider screening & referrals; 5% increase in persons with SAMH coverage; Maintain independent living rate; 24% adult competitive employment; & 85% school attendance by children with SED. Description of Collecting and Measuring Changes in Performance Indicator: DCF provider survey of partnerships with primary care providers, including FQHCs; DCF provider survey question: source of referrals; BRFSS core question, state questionnaire for treatment; State quality and performance measures. Achieved: No Proposed Changes: Since FY , the Department has delegated this responsibility via contract to contracted providers. Reason Not Achieved: The Department recently funded a peer run organization to provide 24 hour, 7 day access line for consumers. The organization will also report any issues related to access to care to the managing entity. Priority: Florida's SAMH "Good and Modern" System of Care Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 14 of 98

15 Goal of the priority area: Goal 1.8 Individuals served in the Florida system of care will be assessed for co-occurring disorders and have access to trauma informed care. Strategies to attain the goal: Strategy ( ) RSOCs and their managing entities will review existing contracts to assure that assessment tools are standardized and are inclusive of co-occurring disorders. Strategy ( ) RSOCs and their managing entities will review existing contracts to ensure that assessment tools assess exposure to trauma. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 1.8 By September 30, 2013, 85% of treatment plans will indicate that the individual was assessed for trauma exposure and co-occurring disorders. Description of Collecting and Measuring Changes in Performance Indicator: Florida will monitor its provider treatment planning to assure that persons are being assessed for trauma exposure and co-occurring disorders. Achieved: No Proposed Changes: The Department has hired a Cultural Competence Coordinator through the Launch Grant to assure that policies and practices reflect cultural appropriateness. Reason Not Achieved: This performance measure was unrealistic, given the limitations of the Department's IT architecture. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 15 of 98

16 Priority: Goal of the priority area: Evidence Based Practices Initiative Goal 2.1 The SAMH SOCs fund culturally relevant EPBs in prevention, treatment and recovery services and supports. Florida will expand the SAMH Program s list of culturally and linguistically relevant and appropriate EBPs based on its needs assessments. Strategies to attain the goal: Strategy Establish review process to support selection using existing client and professional feedback. Strategy Use Florida Learning System to review EBP selection. Strategy Monitor emerging science to identify opportunities to expand EBPs available in the state. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 2.1 Increased educational participation by children; Increased diversion from criminal justice system; Improved functioning; improvement on state quality measures. Description of Collecting and Measuring Changes in Performance Indicator: Number of EBPs funded by SAMH and Medicaid; Number of people receiving services that are evidence-based; Functional Assessment Rating Scales (FARS); National Outcome Measures (NOMS); Customer Satisfaction Survey; State quality and performance measures. Achieved: No Proposed Changes: The Department has hired a Cultural Competence Coordinator through the Launch Grant to assure that policies and practices reflect cultural appropriateness. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 16 of 98

17 Reason Not Achieved: This performance measure was not realistic. Priority: Evidence Based Practices Initiative Goal of the priority area: Goal 2.2 Florida will develop written Standards of Care for identified and funded SAMH and Medicaid EBPs assuring cultural appropriateness. **** Strategies to attain the goal: Strategy ( ) SAMH Services sections identify and draft written protocols for use by providers using state-managed funding (i.e., block grants, Medicaid, state general revenue). These will include Florida initiatives: Screening, Brief Intervention, Referral and Treatment (SBIRT) In light of the findings from the just completed SBIRT grant, the Department will continue to explore options with the VA system to fill services gaps for collaborative, universal screening in primary care settings and provision of brief therapies for this population. Access to Recovery (ATR) Using an array of 36 clinical treatment and recovery support services, the SAMH program will promote early engagement of veterans and their families in the behavioral health system by coordinating outreach, marketing, and referral efforts in cooperation with federal VA hospitals, outpatient clinics, and re-entry coordinators. Treatment of Co-occurring Disorders Integrated treatments for MH and SA problems have been hampered by systemic and economic barriers such as differing funding streams, regulatory environments, and treatment philosophies, and by a lack of financing incentives. Medication Assisted Treatment Use medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. With the documented success of Vivitrol among individuals with alcohol related disorders, the Department will continue to support use of this type of treatments in substance abuse treatment. In addition the Department will continue its Indigent Drug Program to provide assistance to individuals in care who are in need of assistance. Annual Performance Indicators to measure goal success Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 17 of 98

18 Indicator: Performance Indicator 2.2 Five written standards of care will be adopted for substance abuse prevention and treatment evidence based strategies; five written standards of care will be adopted for evidence based treatment of mental illness. Description of Collecting and Measuring Changes in Performance Indicator: Number of written standards of care; Number of trainings; Number trained; Number of EBPs funded by SAMH and Medicaid; Higher rates of fidelity to EBP; Number of people receiving services that are evidence-based. Achieved: Yes Proposed Changes: Reason Not Achieved: Priority: Evidence Based Practices Initiative Goal of the priority area: Goal 2.3 Florida providers will be trained and receive technical assistance using written EBP Standards of Care. Strategies to attain the goal: Strategy (2012) Develop training and technical assistance plan. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 18 of 98

19 Strategy (2012) Revise peer-coaching sections to support rapid change and EBP adoption. Strategy (2012) Develop training evaluation tools to measure learning and delivery adoption. Strategy (2013) Conduct training and technical assistance to support culturally and linguistics appropriate implementation of SAMH selected EBPs. Annual Performance Indicators to measure goal success Indicator: Performance Indicator % of providers contracted to provide one of the adopted EBP standards of care will receive training or technical assistance. Description of Collecting and Measuring Changes in Performance Indicator: Number of trainings per EBP SOC; Number trained per EBP SOC; Number of hours of technical assistance provided per EBP SOC. Achieved: Yes Proposed Changes: Reason Not Achieved: Priority: Evidence Based Practices Initiative Goal of the priority area: Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 19 of 98

20 Goal 2.4 Florida will monitor quality standards for delivery of evidence-based practices. **** Strategies to attain the goal: Strategy (2013) Monitor all SAMH Program contracted services to assure compliance with EBP funding mandates. All substance abuse prevention funds by July 2012 must be spent on EBPs and all other SAMH funds must purchase EBPs by July Annual Performance Indicators to measure goal success Indicator: Performance Indicator % of services undergoing EBP fidelity self assessment will measure progress on fidelity improvement. Description of Collecting and Measuring Changes in Performance Indicator: Annual reports from managing entities will be combined into an annual performance report for review by regional and state staff. Achieved: No Proposed Changes: The Department is in the process of delegating this responsibility via contract to providers. The process is currently being reviewed. Reason Not Achieved: The current method of monitoring EBPs uses a sample to impute the whole, which was not made clear in the initial outline of this goal. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 20 of 98

21 Priority: Prevention and Recovery Goal of the priority area: Goal 3.1 Florida s SAMH system of care funds culturally relevant evidence-based practices in the delivery of prevention, treatment and recovery services and supports. **** Strategies to attain the goal: Strategy ( ) Revise substance abuse fidelity monitoring tool to be inclusive of mental health EBPs. Strategy ( ) Train providers on use of the tool. Strategy ( ) Include use of the tool and continuous improvements as a service requirement. Strategy (2013) Monitor progress toward improved fidelity of substance abuse and mental health EBPs. Annual Performance Indicators to measure goal success Indicator: Performance Indicator % of providers will report improvement on fidelity to BPs. Description of Collecting and Measuring Changes in Performance Indicator: State annual report. Achieved: No Proposed Changes: The Department is in the process of delegating this responsibility via contract to providers. The process is currently being reviewed. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 21 of 98

22 Reason Not Achieved: The current method of monitoring EBPs uses a sample to impute the whole, which was not made clear in the initial outline of this goal. Priority: Goal of the priority area: Prevention and Recovery Goal 3.2 Florida s system of care will develop community capacity to impact prevalence of mental/emotional disorders and substance misuse/abuse by postponing onset and/or changing behaviors related prescription drug abuse and underage drinking. ***** Strategies to attain the goal: Strategy ( ) Support community SAMH development of relationships with Primary Care providers. Strategy ( ) Support community SAMH development of relationships with Child Welfare Providers. Strategy ( ) Support community SAMH development of relationships with K-12 and higher education providers to facilitate conditions for learning. Strategy ( ) Support community SAMH development of relationships with local law enforcement, justice and social services organizations. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 3.2 By July 1, 2013, 85% of counties will have active anti drug coalitions with MOUs with primary care, child welfare providers, treatment providers, education and justice. Children s MH SOCs will increase by 30%. (Current = 8) Description of Collecting and Measuring Changes in Performance Indicator: 2013 State annual report. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 22 of 98

23 Achieved: No Proposed Changes: The Department has implemented five (5) SOC sites as of November Reason Not Achieved: This performance measure was unrealistic. Priority: Goal of the priority area: Prevention and Recovery Goal 3.3 Florida s system of care impacts prevalence of mental/emotional disorders and substance misuse/abuse by postponing onset and/or changing behaviors related to development of disorders. Strategies to attain the goal: Strategy ( ) Develop community based health promotion initiatives to support local activities with evidence of effectiveness at reducing prevalence and promoting recovery of substance use and mental health disorders. Strategy ( ) Continue to strengthen the capacity of Florida s Peer to Peer Network to connect individuals to services and supports. Strategy ( ) Promote consumer self direction in substance abuse and mental health treatment and recovery supports. Strategy ( ) Integrate goals and objectives of required plans such as the Florida Children s Mental Health SOC strategic plan, Substance Abuse Prevention enhancement plan and Florida Suicide Prevention strategic plans to achieve comprehensive and effective single plan. Annual Performance Indicators to measure goal success Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 23 of 98

24 Indicator: Performance Indicator 3.3 By 7/1/13, 85% county coalitions & children s MH SOCs have SA or MH promotion campaigns; 25% increase persons served by Peer to Peer Network; Long range plan includes SA prevention, children SOC expansion & regional SOC plans. Description of Collecting and Measuring Changes in Performance Indicator: 2013 State annual report State SAMH Long Range Plan. Achieved: No Proposed Changes: The Department has implemented five (5) SOC sites as of November Reason Not Achieved: This performance measure was unrealistic. Priority: Prevention and Recovery Goal of the priority area: Goal 3.4 Florida s system of care enhances the use of EBP screening and assessment tools and brief interventions Strategies to attain the goal: Strategy ( ) Standardized screening tools will be used in SAMH treatment planning. Strategy ( ) Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 24 of 98

25 Conduct awareness activities for primary care providers on use of SBRIT. Strategy ( ) Conduct training and technical assistance to enhance use of screening and brief interventions (i.e., Screening, Brief Intervention and Referral to Treatment (SBIRT) and Global Appraisal of Individual Need (GAIN), and Addiction Severity Index). Strategy ( ) Mandate use of SAMH screening tools by child welfare providers. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 3.4 By 7/1/13, identify standardized screening tools for SA and MH; 85% of Florida FQHCs know where to refer persons in need of SA and MH care; 50% increase in adults with children in safety investigations who receive SA screening. Description of Collecting and Measuring Changes in Performance Indicator: 2013 State annual report. Achieved: No Proposed Changes: The Department is still in the process of establishing expectations for a partnership between providers and FQHCs. Reason Not Achieved: Florida has seven recipients of the Primary and Behavioral Healthcare Care Integration (PBHCI) Grants. These sites are supported by the Department. The Launch Grant has partnered with a local FQHC (Community Health Centers of Pinellas, Inc.) to pay the cost of screenings. Priority: Prevention and Recovery Goal of the priority area: Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 25 of 98

26 Goal 3.5 Florida s system of care is data driven & community focused. Florida will conduct surveillance & monitor changes to consequences, underlying conditions & rates of use by children & adults related to the state s priority substance abuse issues. Strategies to attain the goal: Strategy ( ) Conduct annual Florida Youth Substance Abuse Survey. Strategy ( ) Seek funding for an adult epidemiological survey. Strategy ( ) Provide regular epidemiologic reports from these and other valid and reliable sources to key stakeholders at all levels (Florida SEOW). Strategy ( ) Provide regular analysis of state conditions impacting prevalence. Strategy ( ) Enhance use of regional health and safety surveillance networks. Strategy ( ) Implement prevention dashboard. Annual Performance Indicators to measure goal success Indicator: Performance Indicator 3.5 Annual report on state trends and patterns related to prevalence and negative consequences of substance misuse and abuse and mental health disorder will be distributed. Description of Collecting and Measuring Changes in Performance Indicator: Florida Youth Substance Abuse Survey (FYSAS) Behavioral Risk Factor Surveillance System (BRFSS) Florida Medical Examiner s annual report National Outcome Measures (NOMs) State quality and performance measures Achieved: No Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 26 of 98

27 Proposed Changes: Remove epidemiological study for adults. Reason Not Achieved: Appropriation was not made. Priority: Services to women with dependent children and women who are pregnant Goal of the priority area: Goal 4.1 Florida will give priority for substance abuse services to women with dependent children and women who are pregnant. Strategies to attain the goal: Strategy ( ) Substance abuse providers will manage wait lists so that women with dependent children and women who are pregnant receive priority access to services. Annual Performance Indicators to measure goal success Indicator: Performance Indicator % of women with dependent children or who are pregnant will enter treatment within 48 hours of assessment. Description of Collecting and Measuring Changes in Performance Indicator: The state will maintain data that captures wait list management of providers. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 27 of 98

28 Achieved: No Proposed Changes: The Department is in the process of recreating the methodology for the Block Grant Application. This will provide a more realistic assessment of the state's capability in relation to pregnant women. Reason Not Achieved: The performance measure was not constructed in a way that reflected the capability of the state. Priority: Services to veterans and active military personnel Goal of the priority area: Goal 5.1 Florida veterans and active military personnel have access to quality substance abuse and mental health services. Strategies to attain the goal: Strategy ( ) Staff will participate in planning activities in collaboration with other state agencies working with this population. Strategy ( ) Florida will provide training and technical assistance to providers to increase use of trauma informed care. Annual Performance Indicators to measure goal success Indicator: Performance Indicator percent of veterans and active military personnel, and their families, will begin treatment within 48 hours of assessment. Description of Collecting and Measuring Changes in Performance Indicator: Florida will monitor its provider wait lists to assure veteran and military personnel access to care. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 28 of 98

29 Achieved: No Proposed Changes: The council has been addressing issues related to substance abuse, homelessness and the need for peer specialists for veterans. However, the state statutory priority populations do not include veterans specifically, and is outside the scope of the Department's statutory mission. The efforts of the local veteran s advisory council in Hillsborough county has resulted in the creation of a Misdemeanor Veteran s Treatment Court. The court is located in a county with one of the highest concentration of veterans. The Access to Recovery Grant has consistently met target population service goals for veterans, active military personnel, and their families. This accomplishment is the result of active recruitment and partnerships with community agencies. Reason Not Achieved: This performance measure was not realistic. Priority: Services to persons with HIV AIDS Goal of the priority area: Goal 6.1 Florida will provide early intervention testing to persons with HIV AIDS, other blood borne illnesses and highly contagious disease. Strategies to attain the goal: Strategy ( ) Florida will provide resources to areas with high concentrations of persons living with HIV/AIDS, tuberculosis and other highly contagious disease to assure access to treatment and recovery supports. Annual Performance Indicators to measure goal success Indicator: Performance Indicator % of individuals with HIV/AIDS and other highly contagious illnesses who seek treatment Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 29 of 98

30 will begin service within 48 hours of assessment. Description of Collecting and Measuring Changes in Performance Indicator: Florida will monitor its provider wait lists to assure access to care for persons seeking treatment and recovery support. Achieved: No Proposed Changes: The Department is in the process of recreating the methodology for the Block Grant Application. This will provide a more realistic assessment of the state's capability in relation to persons with HIV/Aids. Reason Not Achieved: The performance measure was not constructed in a way that reflected the capability of the state. Priority: Services to intravenous drug users. Goal of the priority area: Goal 7.1 Florida will provide early intervention testing to intravenous drug users. Strategies to attain the goal: trategy ( ) Florida will provide resources to areas with high concentrations of intravenous drug users. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 30 of 98

31 Annual Performance Indicators to measure goal success Indicator: Performance Indicator % of referred intravenous drug users will begin service within 48 hours of assessment. Description of Collecting and Measuring Changes in Performance Indicator: Florida will monitor its provider wait lists to assure access to care for persons seeking treatment and recovery support. Achieved: No Proposed Changes: The Department is in the process of recreating the methodology for the Block Grant Application. This will provide a more realistic assessment of the state's capability in relation to intravenous drug users. Reason Not Achieved: The performance measure was not constructed in a way that reflected the capability of the state. Footnotes: Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 31 of 98

32 III: Expenditure Reports Table 4a - State Agency Expenditure Report Expenditure Period Start Date: 7/1/2012 Expenditure Period End Date: 6/30/2013 Activity A. SA Block Grant B. MH Block Grant C. Medicaid (Federal, State, and Local) D. Other Federal Funds (e.g., ACF (TANF), CDC, CMS (Medicare) SAMHSA, etc.) E. State Funds F. Local Funds (excluding local Medicaid) G. Other 1. Substance Abuse Prevention and Treatment 66,385,976 13,701,602 81,347, Primary Prevention 25,081,365 2,709,924 2,072, Tuberculosis Services 4. HIV Early Intervention Services 4,548, State Hospital 6. Other 24 Hour Care 7. Ambulatory/Community Non-24 Hour Care 8. Administration (Excluding Program and Provider Level) 2,396, ,544 2,388, Subtotal (Rows 1, 2, 3, 4, and 8) 10. Subtotal (Rows 5, 6, 7, and 8) 98,412,317 16,723,070 85,808,543 2,396, ,544 2,388, Total 98,412,317 16,723,070 85,808,543 Please indicate the expenditures are actual or estimated. nmlkji Actual nmlkj Estimated Footnotes: Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 32 of 98

33 III: Expenditure Reports Table 4b - State Agency SABG Expenditure Compliance Report Expenditure Period Start Date: 10/1/2010 Expenditure Period End Date: 9/30/2012 Category FY 2011 SAPT Block Grant Award 1. Substance Abuse Prevention* and Treatment 61,428, Primary Prevention 30,832, Tuberculosis Services 4. HIV Early Invervention Services** 3,941, Administration (excluding program/provider level) 3,593, Total 99,796,302 *Prevention other than Primary Prevention **HIV Designated States footnote: For this and future reporting periods, the Department is working to develop a new methodology for the collection of TB service data. This has not been done well in the past, and the Department is attempting to rectify this. In the past, the Department has reported TB services provided by the Florida Department of Health (DOH). For the future reporting periods, the Department will instead project on expenditures based on the estimate of the regulatory cost of a provider complying with the testing and counseling requirement for a consumer entering residential treatment. Florida OMB No Approved: 05/21/2013 Expires: 05/31/2016 Page 33 of 98