August 2007

       Volume 3: Issue 11
Welcome to Texas Health Institute
 
 

We are pleased to provide you with the August issue of the Texas Health Institute Newsletter.

Texas Health Institute (THI) is a 501(c) (3) nonprofit, independent organization serving as an honest broker of information to promote dialogue among all healthcare stakeholders and to enable policymakers to more thoroughly explore health policy issues and make informed decisions.

Our August issue of our newsletter is dedicated to the work being done in Texas to transform Mental Health in our state.  In this issue you will find a summary of activities that are being supported through the Texas Mental Health Transformation State Incentive Grant funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), sponsored by Governor Rick Perry, and administered through the Texas Department of State Health Services.  We have summarized statewide activities as well as grassroots efforts in mental health transformation. 

 

As stated in the 2003 President's New Freedom Commission on Mental Health Final Report, "mental health transformation must ensure that mental health services and supports actively facilitate recovery, and build resilience to face life's challenges."  At THI, we are excited and honored to be a part of this incredible team of mental health stakeholders working to make a difference in the mental health system of care for Texas and ultimately our nation.

 

In our next issue of the Texas Health Institute Newsletter, we will be reporting on the 13-state Southern Obesity Summit hosted by THI in collaboration with the Southern Regional Health Consortium, the Arkansas Center for Health Improvement, the Directors of Health Promotion and Education, the National Society of Physical Activity Practitioners in Public Health, and the National Association of Chronic Disease Directors.

Sincerely,

Camille's signature

Camille D. Miller

IN THIS ISSUE

  • A Meeting of the Minds - A Texas Mental Health Transformation Symposium

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  • Health Policy Focused Forum on Mental Health

  • Mental Health Transformation: Communities in Action

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    • Tarrant County Transformation Project

  • THI Announces Memorial and Honor Giving Program

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  • About The Texas Health Institute

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    A Meeting of the Minds - A Mental Health Transformation Symposium

     

    In its continued work under the Texas Mental Health Transformation Initiative under the Mental Health Transformation State Incentive Grant (MHTSIG), the Texas Health Institute organized and provided support for A Meeting of the Minds, A Texas Mental Health Transformation Symposium.  This dynamic five-day event was held Wednesday, August 15th through Sunday, August 19th, 2007 in Austin, Texas. 

     

    The 2007 Symposium featured national keynote speakers on mental health transformation.  Kathryn Power, MEd, Director of the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) addressed the role of the consumer and community collaboratives in Texas mental health transformation.  Ron Manderscheid, PhD, Director of Mental Health and Substance Use Programs for Constella Group and former Chief of Survey Analysis for the Center for Mental Health Services, shared his perspective on national transformation efforts and the 2005 Institute of Medicine (IOM) mental health report.  Both Power and Manderscheid are recognized as architects of change, revolutionizing the federal mental health agenda.

     

    The symposium's theme, A Meeting of the Minds, underscored the important role collaboration plays in mental health transformation.  The invitational symposium brought together transformation partners representing community collaboratives working on local transformation initiatives, consumer and family leaders in the area of consumer-directed services, state and national mental health transformation experts, and state policy decision-makers.

     

    The first two days of the Symposium (August 15 and 16) focused on MHTSIG-funded community collaboratives' plans for transforming mental health systems and services at the community-level.  Presentations included question and answer periods and feedback from a national advisory panel which included: 

     
     

    On the evening of August 16th, the consumer and family member portion of the conference kicked-off with a reception to welcome participants.  August 17 through 19 focused on consumer and family member topics on the following topics: peer-to-peer learning, peer support certification, and the consumer role in Texas mental health transformation at the state and local levels.  With the success of bringing MHT consumers together to dialogue on Mental Health Transformation, Texas organizers are currently researching the possibility of hosting regional and local Mental Health education programs.

     

     

    Funding for this conference was made possible (in part) by 5 U79 SM57485-02 from SAMHSA.  The views expressed in written conference materials or publications and by speakers and moderator do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices or organizations imply endorsement by the US Government.

     

    Health Policy Focused Forum For Mental Health
     

    On Thursday, August 30, 2007, the Texas Health Institute presented Taking the Case for Mental Health Transformation to the Communities.  The health policy focused forum presenters provided policymakers and other mental health stakeholders with an update on the Texas Mental Health Transformation Project.

     

    Moderated by Camille D. Miller, Texas Health Institute President and CEO, presentations included:

    Funding for the August 30, 2007 focused forum was made possible in part by 5 U79 SM57485-02 from the United States Department of Substance Abuse and Mental Health Services Administration (SAMHSA).  The views expressed in written forum materials or publications and by speakers and moderator do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices or organizations imply endorsement by the US Government.

     

    Mental Health Transformation: Communities in Action

     

    During the Meeting of the Mind Symposium seven communities presented their plans for transforming mental health systems and services at the community-level.  Each of the seven community collaboratives are at varying stages of transformation.  The eight community collaboratives funded reflect the diversity of the state and include urban, rural, frontier and border areas.  This selection recognizes that mental health system improvement is needed across all Texas communities.

     

    These collaboratives are willing to own mental health as a community problem.  As part of their work collaboratives are addressing issues such as the integration of health with mental health, early intervention, implementing quality initiatives and using new technologies such as the Internet and teletechnology to improve mental health care. 

     

    The Texas Mental Health Transformation State Initiative Grant funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and sponsored by Governor Rick Perry, recognizes that behavioral health issues permeate all aspects of community life, and is working to address these issues at both the state and local levels. This initiative is based on the premise that mental health services must be less fragmented and better integrated with services provided by health, criminal justice, education and social service agencies.

     

    The following materials summarize the collaborative presentations highlighting:

     

    • Past collaboration successes and community strengths.
    • Challenges to providing mental health services in the community.
    • Community plans for transformation.
    • Proposed evaluation and measurements tools.

     

    • Williamson County Community Collaborative
     

    Transformation Team

    John Bradley, District Attorney

    Anne Burwell, Project Director and Mobile Outreach 

    Director

    James Wilson, Williamson County Sheriff

    Betty Cobb, Consumer

    Dale Rye, Assistant County Prosecutor

    Kathy Grimes, Executive Assistant Commissioner

    Precinct 2

    Fred Uppright, Consumer

    Lt. Mike Gleason, Williamson County Sheriff's Office

    Capt. Shawn Newson, Williamson County Sheriff's Office

     

    Community

    Williamson County is a geographically diverse county with both rural and suburban areas.  This conservative community located north of Austin, Texas has a strong law and order focus.

     

    Background

    The Williamson County Commissioners Court recognized the county was not providing adequate mental health services: complaints were on the rise, jail and emergency rooms were overcrowded, and the courts were overwhelmed. 

     

    In response, the Commissioners Court convened a task force, which included: the county district attorney, county prosecutor, county administrators, county sheriff, and area service providers.  The commissioners charged the task force with developing a plan to provide mental health services in a cost-effective manner.  Based on the task force's recommendations, the commissioners made service improvements resulting in a $1.8 million savings in 2006.   This task force serves as the community collaborative.

     

    Past Successes/Strengths

    Community collaborative members indicated the task force was successful because participation was by invitation-only and task force members, not designees, attended meetings.  They also suggested the panel members' commitment to confidentiality and agreements not to run to the media when there was a conflict also contributed to the group's success.  The task force met on a monthly basis, in closed sessions.  All system improvements were discussed within a cost-benefit framework.

    Selected service improvements include:

    ·         Mobile Outreach Team Funding.  Commissioners earmarked $50,000 in flexible funds for "problem solving."  Mobile Outreach caseworkers used these funds to fix a consumer's immediate crisis before finding long-term solutions.

    ·         Police Officer Crisis Intervention Team.  The commissioners charged the county sheriff with establishing a pre-booking jail diversion program.  The county sheriff admitted he initially was reluctant to implement the program, but came to realize that jail diversion is a more compassionate approach for those individuals with mental illness.  Jail diversions have increased 40% since 2005 (570 diversions in 2006, and 240 diversions in the first six months of 2007). Crisis Intervention Counselor.  The commissioners established a counselor to coordinate County Jail mental health services.

    ·         Federally Qualified Health Clinic (FQHC).  The commissioners increased funding for FQHC to expand services.

     

    Challenge(s)

    Collaborative members expressed a concern that the current system does not provide law enforcement, providers and emergency room workers with real time access to consumer information, making it more difficult to identify and assist mental health consumers.

     

    Transformation Plan

    To improve communication, Williamson County plans to:

    ·  Implement an Electronic Mental Health Records  System.

    ·  Establish a County Mental Health Website.

    ·  Expand peer-to-peer networks.

    ·  Establish a 24-48 hour hold/respite care program.

    ·  Organize regional mental health conferences.

     

    Evaluation and Measurement

    Williamson County will measure success based on:

    ·  Reduction in suicide rate.  

    ·  Decrease in number of involuntary commitments.

    ·  Increase in jail diversions.

    ·  Return on investment/money saved.

     

    Conclusions

    The Williamson County Collaborative members believe local control gets results and contend that the key to success is confidential collaboration and trust among stakeholders.

     

     

     
    •   Llano Estacado Alliance for Families (LEAF)

    Transformation Team

    Ron Trussler, CEO Central Plains Center, LEAF Chair

    DeAnn Lechtenberger, PhD, Texas Tech University; 

    LEAF Vice-Chair

    Jere Newton, Lead Parent Liaison/Family Partner

    Kay Brotherton, Executive Director, STAND Prevention

    Olga Ybarra, Parent Case Manager, Uniting Parents;

    Consumer/Family Partner

    Fred Barra, Consumer/Family Partner

     

    Community

    Llano Estacado Alliance for Families (LEAF) encompasses a rural community in west Texas.  The collaborative includes Hale, Floyd, Lamb, Briscoe, Motley and Bailey Counties.  Dollar General serves as a primary provider of durable goods.  The community is approximately 60 miles from Texas Tech University.

     

    Background

    The collaborative has been in existence for many years.  Eleven years ago, the collaborative formed an Executive Council, which now comprises the LEAF steering committee.  LEAF includes six (6) of the 11 counties in the regional mental health service area.  They welcome the opportunity to develop a transformation plan and to be held accountable to their actions. 

     

    Past Successes/Strengths

    The community:

    • Uses flex-funds for non-traditional services.  Flex-funds have been used to meet consumers' basic needs, such as paying a family's electricity bill.  LEAF also uses flex-funds for creative solutions such as tutoring, horseback riding, vocational instruction program for young offenders, art and exercise programs.
    • Provides Wraparound Service Programs.  The community has established consumer-centered programs in which providers, consumers and family members come together to establish a treatment plan.  Professional participation is limited to 50% of team membership, so once the professionals step aside there is a strong network of support.
    • Addresses cultural competency.  The community has established outreach programs to address needs of the rural community as well as ethnic/cultural needs.

     

    Challenge(s)

    The collaborative expressed concern that access to mental health services is a major issue in rural west Texas.  They contend programs are under-funded and service providers are limited.  According to LEAF members, rural west Texas families are often close knit and members circle around those with mental health needs and prevent them from receiving the care they need.

     

    Transformation Plan

    The collaborative believes mental health transformation in their community will mean they provide the right care, at the right time in the right setting.  They are committed to promoting a shift in public opinion and a holistic approach to mental health care. 

     

    To achieve this vision, the community intends to:

    ·         Establish a climate for change.

    ·         Engage people of power.

    ·         Educate public officials about New Freedom Commission reports.

    ·         Commit to a long-term view.

    ·         Establish a realistic timetable for change.

     

    LEAF will use information technology to increase communication and distribute information.  Content will focus on general service information, evidence-based practices, mental health awareness, education and training.  IT services include: 

    ·         Website with blog and resource postings.

    ·         Informational DVDs.

    ·         Public service announcements (PSAs) on mental health awareness.

    ·         Webinars and rural web portal distance learning.

    ·         Video conferencing and electronic records sharing for increased inter-agency communication.

     

    LEAF will also increase consumer involvement by making consumers and family members full partners in all aspects of planning, practice, evaluation, quality improvement, social marketing, advocacy, and cultural competency.

     

    Evaluation and Measurement

    The collaborative is in the early stages of development and has not devised specific evaluation measures.

     

    Conclusions

    The collaborative has not budgeted additional funds for transformation activities but will leverage existing services and supports.  Their current mental health services budget for the 11-county area is $650,000 annually.  The collaborative is committed to achieving their vision of transformation and have adopted the motto "collaborate or die." 

     

    • Dallas County Initiative: NorthSTAR
     

    Transformation Team

    Maurine Dickey, Dallas County Commissioner

    Norma Melo Westurn, Executive Director, Centro de Mi  Salud

    Donald Spies, Director of Health Initiatives, Office of Maurine Dickey

    Ron Stretcher, Dallas County Director of Criminal Justice

    Janie Metzinger, Public Policy Director, Mental Health America of Greater Dallas

    Kathryn Candarelli, PhD, Urban Health Research Center, J. McDonald Williams Research Institute

    David Dillard, Consumer

    Jacqueline Stephens, PhD, Director of Behavioral Health and Social Services, Parkland Health and Hospital System

    Jack Szcepanowski, CEO ValueOptions NorthSTAR

    Ed Miles, PhD, Exec. Director, Centro de mi Salud

    Joe Powell, Executive Director, Association of Person Affected by Addiction

    Robert P. Stewart, LCSW, Project Director, President, Community Service Builder

     

    Community

    The Dallas County Initiative includes the Dallas metropolitan area.  In 2004, the U.S. Census estimated Dallas County population to be 38% Hispanic as compared to 49% of the Texas population.

     

    Background

    Currently, the community lacks the capacity to meet consumer mental health needs.  NorthSTAR, a health maintenance organization (HMO), provides mental health and substance abuse services for area medically indigent.  The HMO has limited capacity, but is prohibited by state contract to place consumers on a waiting list.  According to collaborative members, the community also has inadequate jail diversion programs and limited consumer and family-directed services.  ValueOptions Dallas County, a consumer advocacy group, provides the only county peer-to-peer services.

     

    Past Successes/Strengths

    The community strengths include:

    • NorthSTAR services system is an open access system.
    • NorthSTAR has integrated and collaborated with community-based providers.
    • Community has an established framework for effective consumer, provider, and leader dialogue.

     

    Challenge(s)

    The current county system is a mixture of federal, state, local and faith-based services.  The community needs grossly exceed capacity.  Collaborative members expressed concern that service supports such as law enforcement, schools, housing support, and social service agencies are under-funded.

     

    Transformation Plan

    The collaborative proposes using evidence-based practices to develop consumer-driven, culturally congruent, recovery-focused programs which will bridge gaps between county and NorthSTAR services and will eliminate funding silos.  Information technology systems will permit those responding to needs of children, adolescents and adults with mental illness and emotional disorders to communicate in real time with access to complete information. 

     

    Workgroups will be established to address issues surrounding:

    • Service Delivery Culture. Workgroup efforts will focus on inclusion of consumer voice in transformation process through the expansion of wraparound services and peer-to-peer counseling programs.  Workgroup will also present strategies to include consumers and family members in all task force activities.
    • Service Delivery.  Workgroup will focus on issues surrounding housing, judiciary, law enforcement, returning veterans and access to primary care.
    • Community Interface.  Workgroup will develop strategies for culturally congruent and age- and gender-specific services, with an emphasis on Hispanic needs.  The workgroup will reach out to pubic schools to develop early intervention and prevention strategies.
    • Workforce Development.  Workgroup will develop workforce development and training initiatives to expand mental heath service workforce. 
    • Information Technology.  Workgroup will develop strategies for communication and information sharing among administrators, clinicians, law enforcement, mental illness courts and behavioral health providers.  Possible strategies include registries to provide remote access to data, increased capacity for real-time data sharing and communication, and a central server.  IT consultants and business leaders will be consulted.

     

    Evaluation and Measurement

    The Williams Institute will conduct all evaluations including a needs assessment, feedback session with consumers/family members, and a final formal evaluation.  Evaluation components will be funded through a $120,000 grant from Meadows Foundation and in-kind contributions. 

     

    Conclusions

    The community collaborative has budgeted $300,000 for transformation activities.  They believe the grant provides a unique opportunity to build on their efforts to improve community public mental health services.  The community is cognizant that transformation triggers both high expectations and deep fears, and is committed to proceeding with caution.

    • Nacogdoches County Mental Health Collaborative
     

    Transformation Team

    Tim Hayward, Administrator, Nacogdoches Memorial Hospital

    Susan Rushing, CEO, Burke Center

    Joe English, Nacogdoches County Judge

    Thomas Kerss, Nacogdoches County Sheriff

    Robin Moore, CEO, East Texas Community Health Clinic

    Linda Morales, Chair, School of Social Work, Stephen F. Austin State University

    Jim Sevey, Nacogdoches Chief of Police

    Sue Kennedy, Director of Community and Guest Relations, Nacogdoches Medical Center Hospital

    David Cozad, Director of Operations, Burke Center

    Kenneth Placke, Director of Mental Health Services, Burke Center

    June Clifton, Administrator, Nacogdoches County Court-at-Law

    Anne Bondesen, Program Director, Rural East Texas Hospital Network

    Lyle Moel, National Alliance for Mental Illness, Consumer and Family Member

    Les Moel, Consumer and Family Member

     

    Community

    Nacogdoches is a small east Texas town with a population of 32,000 and a county population of 65,000.  The Stephen F. Austin State University is located in Nacogdoches, adding an additional 11,000 students to the community, as well as culture and events.

     

    Background

    The administrator of the Nacogdoches Memorial Hospital indicated Nacogdoches does not have adequate mental health facilities. Individuals in crisis often become "hot potatoes" - with facilities passing off individuals to other centers during the day so they do not have to find a bed for the individual at night.   

     

    Collaborative members also contend that the community lacks sufficient services to treat consumers early, before an incident becomes a full-blown crisis.  They suggest that the community mental health center, the Burke Center, does not have the beds and services to meet community demand.

     

    Past Successes/Strengths

    Nacogdoches' mental health community has a rich history of collaboration.  During Hurricane Katrina and Rita and the Columbia Shuttle Disaster, the mental health community learned how to come together to address immediate needs and formulate plans for long-term solutions.

     

    Challenge(s)

    Collaborative members argue the community does not have adequate mental health services to meet the demand.  Law enforcement, jails and hospital emergency rooms shoulder a disproportionate share of the mental health service burden.

     

    Transformation Plan

    The collaborative plans to improve and expand mental health services by establishing a mental health crisis service center.  The collaborative will seek outside expertise to determine best practices and funding strategies.  Plan includes:

    • Triage Crisis Center.  The triage center will serve as a main point of entry for consumers.  The crisis center would provide a non-threatening environment where consumers could be evaluated to determine if their mental health crisis warrants hospitalization.  The clinic would also function as a "cooling-off place" where consumers could stay 24-48 hours without needing to be hospitalized.  The crisis center could also deal seamlessly with other issues such as medication prescription refills.
    • Information Technology.  A data warehouse and instant messaging will be used to enable providers, law enforcement and courts to share information and data in real time.  Increased use of telemedicine will provide better access to and quality of health services in rural areas.
    • Consumer Involvement.  Consumers and family members will be invited to participate in the redesign of the system and develop strategies to increase involvement and engagement.

    Additional Goals:

    • Establishing programs to combat stigma.
    • Integrating of mental healthcare with primary care.
    • Working with Stephen F. Austin State University to recruit student to health professions.
    • Expanding ancillary services such as peer support, housing and youth services (e.g. Recreational Center Boys and Girls Center).

     

    Evaluation and Measurement

    The collaborative is in the early stages of development and has not devised specific evaluation measures.

     

    Conclusions

    The Nacogdoches Community Collaborative members researched other means to triage mental health cases and determined that this crisis center model is the most cost-effective program for their community.  The projected Crisis Center budget is approximately $1 million annually.

     
    • Bexar County Safety Net
    Presenters

    Leo Evans, Executive Director, Center for Health Care Services (CHCS)

    Gilbert Gonzales, Director, Jail Diversion Initiatives, Center for Health Care Services

     

    Transformation Team

    County Judge

    San Antonio Police Department

    County Sheriff

    The Center for Health Care Services

    Metro Health

    University Hospital System

    Criminal Justice

    Magistrate

    Pre Trail Services

    Emergency Medical Services

    National Alliance on Mental Illness

     

    Court System

    Mental Health District Attorney

    Mental Health County Clerk

    Juvenile Justice

    Adult Probation

    San Antonio State Hospital

    Private Hospitals

    Consumers/Family Members

    Texas Department of State Health

    Services

    University of Texas

     

     

    Community

    San Antonio, Texas, an urban community with a large Hispanic population.

     

    Background

    The collaborative members explained that the San Antonio Community Collaborative dates back to 2000 when the City of San Antonio's mental health system struggled to meet consumer demands.  For example, the average waiting time for a hospital emergency room psychological evaluation was 12 hours.  In response, County Judge John Specia, Jr. convened a broad group of stakeholders to address these issues.  Together, the stakeholders developed short- and long-term strategies for crisis intervention training, jail diversion programs and a crisis service "triage" center.

     

    Past Successes/Strengths

    Today, San Antonio has a crisis intervention facility located within a hospital in downtown San Antonio.  The facility is within walking distance of the County Court and operates 24 hours a day, 7 days a week.  The center has 23 observation beds and treats 500-600 consumers each month.  Today, the wait at the crisis facility for a medical evaluation is 60 minutes and a psychological evaluation is 20 minutes.  The facility also has pharmacy services available on-site.

     

    Other programs developed in conjunction with the Bexar County Collaborative include:

    • Bexar County Children's Diversion Initiative.  This program educates and trains school police officers and principals on how to identify students with mental illness.
    • Integration of Health and Behavioral Health.  This initiative is developing and implementing strategies to integrate health and behavioral health care and better serve those in need.
    • Substance and Detoxification Services.  This initiative will add an additional 60 detoxification beds and intensive outpatient substance abuse services in the community; center is located within close proximity to the court.
    • Haven for Hope. This new center is a 600-bed homeless facility in downtown San Antonio.

     

    Challenge(s)

    Though the community has numerous service programs to serve community mental health needs, community collaborative members expressed concern that the community lacks a centralized repository for mental health consumer data.

     

    Transformation Plan

    The community collaborative will warehouse data from the Center for Health Care Services, the University Hospital System, the University of Texas Health Science Center at San Antonio, County Jail, Texas Department of State Health Services, and other community-based organizations.  The data will be stored in a secure, web-accessible warehouse which may be accessed by multiple sources.  CHCS will use the data to improve performance and treatment through 1) cost-benefit analyses and 2) clinical outcome assessments.

     

    Consumers will act in an advisory role during the development phase of the data warehouse system consulting on issues such as consumer needs and privacy issues.

     

    Evaluation and Measurement

    The program will complement the findings of a six-year research study which presents a cost-benefit analysis/best practices of jail diversion programs.  The report traces costs per event, start-up costs for best practices and successful practices and includes data gathered from this initiative.

     

    Conclusions

    Collaborative is committed to providing comprehensive services for those in need - by reducing barriers to access, employing best practices; tracking consumer treatment to continually improve results.  The total budget for Crisis Center services is $9 million annually.

     
    • Coastal Bend Rural Health Partnership 

    Transformation Team

    Charles Sportsman, Executive Director, Coastal Planes Mental Health and Mental Retardation

    Barbara Giovannone, Director of Essential Mental health services, Costal Plaines Mental Health and Mental Retardation

    Diana Franco Bill, PhD, Health Programs Director, Community Action Corporation of South Texas

    Martin Ornelas, Kingsville Community Health Center Director, Coordinator for Community Health Workers, Community Action Corporation of South Texas

    Joann Mancias, Community Health Worker, Community Action Corporation of South Texas / Costal Plaines Mental Health and Mental Retardation

    Sylvia Molina, Consumer, Costal Plaines Mental Health and Mental Retardation

    Zelda Turcotte, Consumer, Community Action Corporation of South Texas

     

    Community

    Coastal Bend Rural Health Partnership represents a rural community which encompasses three counties.  The largest area employers are Texas A&M, the local independent school districts and the local community colleges.

     

    The community population is two-thirds (63%) Hispanic and ranks 10th in the state for lowest median age.  One-third (31%) of adults have not completed high school and the median family income is between $10,000 to $13,000 as compared to the median Texas income, which is $20,000.   The community also has a high rate of uninsured (60%), incidents of child abuse, single parent families, and children on SSI (attributed to poor birth outcomes).

     

    Background

    The group came together to identify overlaps and gaps in services.  The hospital administrator in Kingsville recognized the need for a Federally Qualified Heath Clinic (FQHC) in the community.  The collaborative applied for an incubator grant and opened an FQHC in 2003.  This early success helped them realize the power of the partnership.

     

    Past Successes/Strengths

    The community collaborative seeks to build on the existing structure of the partnership, which includes a broad array of stakeholders such as law enforcement, county commissioners, providers and consumers.  They have expanded their advisory board to include pediatricians and consumers in their efforts.

     

    Challenge(s)

    Collaborative members explained that the community mental health consumers routinely enter the "wrong door."  For example, the Coastal Plains MHMR only serves clients with schizophrenia, bipolar, reoccurring depression and those in extreme crisis and must refer non-qualifying consumers to other providers for appropriate care.  Unfortunately, because the center providers are overburdened with cases, they often are not able to follow-up on these referrals and consumers fail to obtain the care they need.

     

    Transformation Plan

    The community collaborative seeks to 1) increase access to holistic and comprehensive healthcare for all income levels and across life spans, 2) integrate mental health and healthcare including dental and gynecological services, and 3) reduce stigma surrounding mental health services by focusing on mental illness as a brain disorder.

    • Screening Program Proposal.  The collaborative will implement a screening program for clients who "enter the wrong door."  Initially one full-time employee (FTE) will manage the program and make sure the clients are "walked through" the system.  The coordinator will have an office at all clinics in the area to facilitate coordination of services.  After the program is established, additional FTE's may be added.
    • Technology.  The community collaborative will use technology to permit the MHMR and FQHC to access each other's databases, follow referrals, establish continuity of care and track outcomes. Telemedicine will be used for real time communication with clinics and jails.  The County has equipment for telemedicine but has not used it due to lack of training and funding issues.
    • Culturally Congruent Care. The community already provides culturally congruent care.  Approximately 90% of the mental health staff speaks both English and Spanish.  The staff routinely conducts family and consumer meetings in both languages.

     

    Evaluation and Measurement

    The collaborative is in the early stages of development and has not devised specific evaluation measures.

     

    Conclusions

    The program budget is limited to the funding available through the community collaborative grant funding.  The collaborative will limit the number of clients participating in the program so as to "set themselves up for success."  Only after the program is established will the collaborative seek the funding for additional staff to expand the services. 

    • Tarrant County Transformation Project

    Transformation Team

    B. Glen Whitley, County Judge, Tarrant County

    Susan Garnett, Deputy CEO, Mental Health and Mental Retardation Tarrant County

    Patsy Thomas, Pr