Questions from 10/10/2014 Question 1: Response: From reading the case it appears as if all of the services provided within the organization are very de-centralized so patients can go from one to another without the individual arms realizing. Is this an accurate assumption? If so, is the current system of record integrated amongst all divisions? Peace River Center operates 30 different programs out of 23 locations across Polk, Hardee and Highlands counties as you have seen. Ease of access to services is important but we do use a centralized registration process and our information system is also used across all of our programs. Centralized registration ensures that regardless of the program of entry or location a client can be seen and participate in other programs and each program is aware of their participation. Your assumption was incorrect. I refer to PRC as being integrated to indicate that all of our services and programs talk to and can relate to each other. Clients in our group homes can and do also receive outpatient mental health counseling services and they may also receive our psychosocial rehabilitation services and medical services through our Wellness Clinic (as an example) and, all data is entered into our information system and all programs have access to information to support open communications. Question 2: Response: Question 3: Response: Where are all of these offices/facilities located? One central location? Peace River Center operates 30 programs out of 23 locations in Polk, Hardee and Highlands counties. See Attachment A for the program directory with locations. Campaign strategies include organizational structure/human resources. Are we going to be given any information about the existing organizational structure/human resources? Fund raising campaigns and sales programs do not necessarily always include ALL employees of an organization because the goal is to reach out to community members that are asked to Fund the Vision of the organization. Peace River Center employs approximately 390 dedicated and enthusiastic employees. Attachment B is the high level organization chart that shows the general operating structure. The Executive Team is made up of: The Chief Financial Officer (CFO) that leads all accounting and financial operations, Plant Operations and Transportation, Information Technology, Purchasing, and Billing and Centralized Registration. 1
The Chief Operations Officer (COO) leads all direct client services, including the Medical Staff, Victim Services, Crisis and Inpatient Services, outpatient Services, rehabilitation Services, Substance Abuse Services, the Wellness Clinic, and our various outpatient mobile services (CAT, FACT, Resiliency, FITT). The Chief human Resources Officer (CHRO) oversees human resources, benefits, employee training, talent recruiting and retention, medical records, professional staff credentialing, and quality improvement. The Chief Development Officer (CDO) oversees fund raising, development and grant writing, public relations, marketing, web site development and management, Thrift Shoppe Operations. The CEO oversees all financial, strategic planning and strategy development, Board relations and recruitment, external relations and everything else. I achieve my goals by working in collaboration and partnership with the executive and leadership teams. The Leadership Team includes all of the managers and supervisors that report directly to the Executive Team. The Leadership Team is made up of about 22 people. Question 4: Response: Question 5: How does PRC breakdown/distribute the funding for all the different groups/categories they need to fund? You will see the budget and monthly operating report breakdown by program when provided in the next data release. All services and programs are included in a program budget some generate a surplus (profit), some operate at a loss, others operate at a loss and do contribute to our G&A expenses (overhead). Overhead is distributed across all programs based on each programs share of agency total revenue. It seems like PRC is more on the mental side of healthcare rather than the injury/disease healthcare, so how are they drawing the line with the baby boomers as they get older and more of their mental health problems are a result or affect their physical health? Response: Your statement about increasing problems due to age is correct this is one reason why we started to provide medical care services to our clients. 2
If the primary diagnosis for a patient is a medical problem and those needs are greater than our licensed ability, we will refer the client to a medical provider in the community for services. Once the medical issues are resolved, we can address the behavioral health issues. Peace River Center is a community mental health center or, as I refer to it, an integrated behavioral health system. We also do provide primary care (medical) services to some of our clients. Behavioral health is the phrase of art that means we provide both mental health and substance abuse services. There is much research and literature available related to the need to provide integrated medical and mental health care to people, regardless of age. But it is certainly VERY important to people as they age. The Triple Aim, discussed on our call today, cannot be achieved without the provision of medical and behavioral health services together. Many people suffer from more than one mental disorder at a given time. In particular, depressive illnesses tend to co-occur with substance abuse and anxiety disorders. Attachment C shows the cost impact of having comorbid chronic physical and behavioral disorders it can increase the cost of care by a factor of 7 or greater. Also important is that people with mental illness have a much shorter life expectancy than people who do not 25 years shorter so not recognizing, treating and responding to this as we provide care is NOT really a good option. Question 6: Response: Does PRC have any specific competitors? We have competitors, partners and collaborators. We compete with but also refer to other providers in the community as well as collaborate to provide care to a common client. For example: Lakeland Regional Medical Center is the large medical center here in Polk County. They have an emergency department, medical/surgical services and inpatient psychiatric and substance abuse services. They are a Baker Act Receiving Facility. Peace River Center is also a Baker Act Receiving Facility. Both of our inpatient programs run at or above 75% occupancy and many times are full. We provide outpatient mental health services when their patients are discharged from their inpatient program. We transfer patients to them and they transfer inpatients to us to make sure we can both meet the needs of our clients. 3
We have a therapist that works daily in their outpatient medical family practice clinic to help divert people form the emergency department. Another example: Tri County Services is a provider in our community that provides similar services to Peace River Center, well, sort of, as can be seen in the table below: % Mental Health % Substance Abuse PRC 97.8% 2.2% Tri County 19.7% 80.3% PRC is a mental health provider that also provides substance abuse services. Tri County is a substance abuse provider that also provides mental health services. We compete, but like Lakeland Regional Medical Center we collaborate together and refer to each other, depending on client needs to emphasize our strengths and to meet client needs. 4
Attachment A DIRECTORY OF SERVICES WITH LOCATION 5
CRISIS SERVICES CRISIS RESPONSE TEAM On Site Service Address: 1255 Golfview Avenue, Bartow 24-hour crisis line: (863) 519-3744 Toll-free: (800) 627-5906 Hours of Operation: 24 hours a day, 365 days a year Mobile Service Polk and Hardee County Residents On-Site Description: This mobile outreach service is designed to provide immediate crisis assessment, crisis intervention and counseling, linkage and referral, and crisis follow-up contact to promote resolution for individuals (adults and children) experiencing any type of emotional crisis which can include: suicidal intentions, self-destructive behaviors, or acute, severe, and intense emotional distress. Services also include suicide prevention awareness, critical incident stress debriefing, and stress management CRISIS STABILIZATION UNIT Physical Address: 1255 Golfview Avenue, Bartow 24-hour crisis line: (863) 519-3744 Business line: (863) 519-3747 Hours of Operation: 24 hours a day, 365 days a year Description: A secured thirty bed public receiving facility for Florida s Baker Act. The Crisis Stabilization Unit provides psychiatric stabilization services including group counseling, medication management, recovery education, discharge planning and referrals, and family education. 6
OUTPATIENT SERVICES PHYSICIAN/PSYCHIATRIST SERVICES Physical Address and Lakeland Office: 1835 N. Gilmore Avenue, Lakeland, FL (863) 248-3311 8:00am - 5:30pm Mon-Thurs; 8:00am - 12:00pm Fri Bartow Office: 1255 Golfview Avenue, Bartow, FL (863) 248-3311 8:00am - 5:30pm Mon-Thurs; 8:00am 12:00pm Fri Wauchula Office: 213 E. Orange Street, Wauchula, FL (863) 248-3311 8:00am - 6:00pm Mon-Thurs; 8:00am - 12:00pm Fri Gateway Office: 715 N. Lake Avenue, Lakeland, FL (863) 248-3311 Gateway Office (Adults only): 8:00am - 12:00pm Tues & Thurs Champion for Children Office *: 1000 S. Highlands Avenue, Sebring, FL (863) 773-3228 8:00am 5:00pm Tues Polk, Hardee and Highlands County Residents (*) Children and Adolescents only Description: Psychiatric evaluations, on-call consultation, inpatient consultation, medication evaluations, medication administration and nursing assessments. COUNSELING/THERAPY SERVICES -1559 Physical Address and Lakeland Offices: 1835 N. Gilmore Avenue, Lakeland, FL (863) 248-3311 7:30am - 6:00pm Mon-Thurs; 7:30am - 1pm Fri Polk County Health Department (863) 413-2620 3241 Lakeland Hills Boulevard, Lakeland, FL 8:00 4:00pm Mon-Thurs; 9:00 12:00pm Fri Bartow Office: 1255 Golfview Avenue, Bartow, FL (863) 248-3311 7:30am-5:30pm Mon-Thurs; 7:30am 1pm Fri Wauchula Office: 213 E. Orange Street, Wauchula, FL (863) 248-3311 8:00am-6:00pm Mon-Thurs; 8:00am 12pm Fri 7
Sebring Office: Highlands County Health Department 7205 S. George Boulevard, Sebring, FL Champion for Children Office *: 1000 S. Highlands Avenue, Sebring, FL (863) 773-3228 8:00am 5:00pm Tues Lake Placid Office: Highlands County Health Department 106 N. Main Avenue, Lake Placid, FL Western (*) Children and Adolescents only Description: Outpatient services include individual, family and group therapy for both children and adults. We treat a wide variety of mental disorders that affect an individual s ability to function at an optimal level. Some of the common disorders that we treat are major depression, bipolar illness, anxiety, schizophrenia, ADHD and child behavioral disorders. We also treat co-ocurring mental health and addiction disorders. SUBSTANCE ABUSE AND CO-OCCURRING COUNSELING SERVICES (863) 248-3311 Mailing Address: P.O. Box 1559, Bartow, FL 33831-1559 Physical Address: 1825 N. Gilmore Ave., Lakeland, FL 33805 Hours of Operation: 10:00am 8:00pm Mon; 12:00am 9:00pm Tues-Thurs Description: The Substance Abuse Treatment program at Peace River Center is a short-term and intensive outpatient program (IOP) that is an alternative to residential care. The typical course of IOP is a 100+ hour program, participants commit to 3 day a week for 3 months. A variety of treatment methods are incorporated including individual and group counseling. We also incorporate a family component to treatment. Traditional Substance Abuse Outpatient services for both Adults and Adolescents are also available as determined by individual needs. Each individual/family will receive a comprehensive evaluation and treatment plan to get on the way to recovery. Treatment is provided by experienced Licensed and Master s level clinicians. 8
INTEGRATED PRIMARY AND BEHAVIORAL HEALTHCARE WELLNESS CLINIC (863) 519-0930 Physical Address: 1831 N. Gilmore Avenue, Lakeland, FL 33805 Hours of Operation: 8:00am 5:00pm, Mon-Fri Polk County Residents Description: The Wellness Clinic offers integrated primary and behavioral healthcare and addresses a broad range of physical health needs including management of high blood pressure and diabetes. Educational groups on topics such as smoking cessation, diabetes management, and fitness and health, provide wellness support. An onsite therapist is also available. The Wellness Clinic serves the general adult population, as well as individuals with mental illness, ages 18-64, who do not have insurance, or are insured by Medicaid or the Polk Health Care Plan. 9
RECOVERY SERVICES ADULT CASE MANAGEMENT SERVICES (863) 519-0575 Physical Addresses: 715 N. Lake Avenue, Lakeland, FL (863) 248-3311 213 E. Orange St., Wauchula, FL ext: 4108 1835 N. Gilmore Avenue, Lakeland, FL Western Polk and Hardee County Residents Description: Assesses people with mental illnesses for service needs and links them to the needed community resources such as social security, Medicaid/ Medicare & food stamps. Assists people in planning short and long- term goals for recovery while monitoring progress on reaching the recovery goals. Also, case management serves as an advocate in people s recovery. FLORIDA ASSERTIVE COMMUNITY TREATMENT (863) 248-3314 (FACT TEAM) Mailing Address: 1825 N. Gilmore Ave., Lakeland, FL 33805 Physical Address: 1825 N. Gilmore Ave., Lakeland, FL Hours of Operation: 24 hours a day, 365 days a year Western Polk and Hardee County Residents Description: The Florida Assertive Community Treatment Team is a comprehensive and intensive multidisciplinary service model designed to serve 100 adults with severe and persistent mental illness to help them improve their quality of life and avoid long-term hospitalization. RESIDENTIAL PROGRAM (863) 519-0575, EXT. 4104 Facilities: Stepping Stones (Group Home I) Success House (Group Home II) Hours of Operation: 24 hours a day, 365 days a year * Out-of-area referrals accepted based on bed availability. Description: Assists severely and persistently mentally ill residents in the development and refining of daily living skills so they may attain the goal of living in the least restrictive environment possible. Treatment plans are developed which pair the resident s strengths with their personal goals. Residents may also receive medication management, case management, vocational, forensic, and psychosocial rehabilitation services. PEACE RIVER APARTMENTS (863) 519-0575, EXT. 2157 HUD SUBSIDIZED HOUSING PROGRAM 8:00am 5:00pm Mon-Fri Polk, Hardee and Highlands County Residents 10
Description: Provide income based, permanent housing opportunities to individuals with mental disabilities. PSYCHOSOCIAL REHABILITATION SERVICES (863) 519-0575, EXT. 4103 Physical Addresses: 715 N. Lake Avenue, Lakeland, FL 213 E. Orange St., Wauchula, FL 8:00am - 5:00pm Mon-Fri Client Participation Hours: 9:00am - 2:00pm Mon-Fri Description: Provides opportunities to develop essential communication skills, coping skills, daily living skills and a deeper understanding of emotional well-being using two tracks: Track 1 - Independent Living/Community Tenure helps clients achieve independent living in the least restrictive environment possible and avoid hospitalization. Track 2 - Vocational Track helps clients develop workplace and employment skills. VOCATIONAL AND SUPPORTED EMPLOYMENT SERVICES (863) 519-0575, EXT. 4108 Physical Addresses: 715 N. Lake Avenue, Lakeland, FL 1835 N. Gilmore Ave., Lakeland, FL 1255 Golfview Ave., Bartow, FL 213 E. Orange St., Wauchula, FL 8:00am - 5:00pm Mon-Fri Description: Develops emotional, social and employment skills necessary to secure job placement. Provides opportunities to try various jobs to assess interest and skill level, and provides opportunities to work in the community for a competitive wage with a job coach working to maximize the client s opportunity for success. SUPPORTED HOUSING PROGRAM (863) 519-0575, EXT. 4108 Physical Addresses: 715 N. Lake Ave., Lakeland, FL 1835 N. Gilmore Ave., Lakeland, FL 8:00am - 5:00pm Mon-Fri Polk, Hardee and Highlands County Residents Description: Assists homeless individuals with mental disabilities, in seeking, securing and retaining permanent scattered-site housing. SHORT-TERM ADULT RESIDENTIAL (SRT) (863) 519-3741 -1559 11
Physical Address: Hours of Operation: 1255 Golfview Avenue, Bartow, FL 24 hours a day, 365 days a year Description: A secured 30-bed treatment unit providing psychiatric rehabilitation services to prepare for community reintegration using comprehensive assessments, group treatment, medication management and education, discharge planning and referrals, family education and psychosocial rehabilitation. CLUB SUCCESS (863) 413-3267 -1559 Physical Address: 600 El Paseo, Lakeland, FL 33805 Hours of Operation: 9:00am - 5:00pm Mon- Fri Description: A rehabilitation club for people with mental illness where real-life job skills are taught and used to achieve meaningful work as a contributing member of society. Club members learn responsibility, develop self-esteem and learn to interact professionally. Provides transitional employment with local community partners, guidance to secure housing and/or advance their education and promotes on-going psychiatric care, while maintaining government benefits. FORENSIC SERVICES (863) 519-0575, EXT. 1124 8:30am - 4:30pm Mon-Fri (flexible) Polk, Hardee and Highlands County Residents Description: Provides the necessary evaluations and resource brokering for adult individuals involved with the local criminal justice system, committed to the state forensics hospital, or on conditional release. Competency Restoration Services operate in cooperation with the justice system to avoid state hospital admissions. 12
CHILDREN & ADOLESCENT SPECIAL SERVICES RESILIENCY TEAM (863) 519-0575, EXT. 1150 8:00am - 5:00pm Mon-Fri Western Polk and Hardee County Residents. Description: Provides needs assessments, develops service plans, links and refers to community resources to meet identified needs; monitors progress for the treatment team and advocates on behalf of the client and family/foster family to keep emotionally disturbed children in the home. HOME TO STAY (863) 519-0575, EXT. 1156 Physical Address: 1239 East Main Street, Bartow, FL Flexible hours, 7 days a week Description: An in-home crisis intervention/stabilization program for high risk families. Designed to provide the family with the necessary skills and case management services to keep the child in the home. Assists in reunifying families with children in out-of-home placements. Teaches various skills: problem solving, behavioral modification, parenting, conceptual change, communication. CHILDREN ACTION TEAM (CAT) (863) 519-0575, EXT. 1105 Mailing Address: PO Box 1559 Bartow, FL 33831 Physical Address: 1831 N. Crystal Lake Dr., Lakeland, FL 33801 8:00am - 5:00pm Mon-Fri Description: The Children s Services Community Action Team (CAT) is a self-contained multidisciplinary clinical team that provides comprehensive, intensive community-based treatment to families with youth and young adults, ages 11-21, who are at risk of out-of-home placement due to a mental health or co-occurring disorder and related complex issues for whom traditional services are not/have not been adequate. SOBRIETY TREATMENT AND RECOVERY TEAM (START) (863) 519-0575, EXT. Mailing Address: PO Box 1559 Bartow, FL 33831 Physical Address: Gulf Coast 5925 Imperial Parkway, Suite 130, Mulberry, FL 8:00am - 5:00pm Mon-Fri Description: The Sobriety Treatment and Recovery Team (START) is a family treatment approach that fully integrates substance abuse and mental health treatment. The START model supports and treats families in the child welfare system with children five years of age and under with co-occurring child maltreatment and substance abuse. 13
SPECIAL SERVICES DOMESTIC VIOLENCE SHELTER SERVICE -1559 Physical addresses in Lakeland and Sebring are confidential. Lakeland 24-hour crisis line: (863) 413-2700 Sebring 24-hour crisis line: (863) 386-1167 * Collect calls are accepted. Hours of Operation: 24 hours a day, 365 days a year. Polk, Hardee and Highlands County Residents (Primarily but not exclusively) Description: Provides a free and confidential assessment, shelter and related services to domestic violence survivors and their dependents including crisis intervention, problem solving skills, self-help groups, safety planning, information and referrals, and outreach services including external support group. DOMESTIC VIOLENCE OUTREACH SERVICE (863) 534-4350 -1559 Physical Address: Polk County Courthouse, 255 N. Broadway Ave., Bartow 8:00am - 5:00pm Mon-Thurs and by appointment Polk and Hardee County Residents Description: Provides safety planning, information and referral, supportive counseling, and court accompaniment for domestic violence survivors upon request. SEBRING DOMESTIC VIOLENCE OUTREACH SERVICE (863) 386-1167 -1559 Outreach services by appointment Polk, Hardee and Highlands County Residents (Primarily but not exclusively) Description: Provides a free and confidential assessment, shelter and related services to domestic violence survivors and their dependents including crisis intervention, problem solving skills, self-help groups, safety planning, information and referrals, and outreach services including external support group. 14
RAPE RECOVERY & RESOURCE CENTER (863) 413-2708 -1559 Physical Address: 1860 S. Crystal Lake Drive, Lakeland, FL 24-hour Crisis Line: (863) 413-2707 Toll-free: (877) 688-5077 Highlands Co. 24-hr Crisis Line: (863) 386-1169 8:00am - 5:00pm Mon-Fri Description: Provides free and confidential crisis intervention services to sexual assault survivors and their significant others including 24-hour crisis intervention, advocacy, problem-solving, therapy (at the Rape Recovery Resources Center in Lakeland only), supportive counseling and weekly support groups. The Polk County Health Department also provides on-site forensic exams. RETAIL PEACE RIVER CENTER THRIFT SHOPPE (863) 647-4224 -1559 Physical Address: Courtyard Center, 4419 S. Florida Ave. Suite 5, Lakeland Hours of Operation: 10:00am - 6pm Mon-Fri; 10:00am - 4:00pm Sat Description: The Thrift Shoppe is open to the public. The community donates items which are sold in the store. Additionally, it is a drop-off point for donations to PRC and open to clients to receive donations through a voucher system. If you are interested in shopping at the store, donating items to PRC or volunteering your time at the Thrift Shoppe, please call the Community Relations office at (863) 519-0575 ext. 1131. 15
Attachment B Peace River Center Organization Chart 16
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Attachment C Comorbid Chronic Physical and Behavioral Disorders - Impact on Cost of Care Example 18
Attachment C 19
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