fy 2017 annual report - nwiacareconnections.org€¦ · mgt assessment evaluation regional contract...

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FY 2017 Annual Report

Geographic Area: Clay, Dickinson, Lyon, O’Brien, Osceola, and Palo Alto Counties

Approved by Northwest Iowa Care Connections Governing Board:

November 28, 2017

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Table of contents

A. Introduction.................................................................................................................................................... 3 B. Services provided in Fiscal Year 2017............................................................................................................. 3 C. Individuals Served in Fiscal Year 2017............................................................................................................ 6

1. Persons Served by Age Group and by Primary Diagnostic................................................................ 6 2. Unduplicated Count of Adults and Children by Diagnosis……………………………………………………………. 7

D. Moneys Expended......................................................................................................................................... 7

1. Total Expenditures by Chart of Accounts Number and Disability Type............................................ 7 2. Revenues.......................................................................................................................................... 12 3. County Levies.................................................................................................................................... 12

E. Outcomes..................................................................................................................................................... 13

1. Service Progress by Core, Additional Core, and EBPs...................................................................... 13 2. Region Program Outcomes ……………………………………………………………………………………………………….. 23 Service Coordination…………………………………………………………………............................. 25 3. Other Community Living Support Services………………………………………………………………………………….. 26 4. Statewide Outcomes (Quality Service Development & Assessment, QSDA)................................... 27

F. Collaboration………………………………………………………………………………………………………………………………………….. 30

1. Regional collaboration with Department and medical assistance program

2. Regional collaboration with Managed Care Organizations, community organizations

3. Regional collaboration with Providers, stakeholders, and Regions

Appendix A. Regional Access Points…………………………………………………………………………………………………………. 31

Appendix B. Regional Provider Network..……………………………………………………………………………………………….. 32

Appendix C. Regional Satisfaction Surveys..……………………………………………………………………………………………... 34

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Introduction

Northwest Iowa Care Connections Mental Health and Disability Region was formed under Iowa Code Chapter 28E to create a Mental Health and Disability Service Region in compliance with Iowa Code 331.390.

In compliance with IAC 441-25 the Northwest Iowa Care Connections Mental Health and Disability Services Regional Management Plan includes three parts: Annual Service and Budget Plan, Annual Report and Policies and Procedures Manual.

Services provided in Fiscal Year 2017: The Northwest Iowa Care Connections Mental Health and Disability Services Region provided the following services included in this section of the report:

Access Standards for Core Services and what we are doing to meet access standards

Additional Core Services, availability and plans for expansion

Provider Practices and Competencies o Multi-occurring Capable o Trauma Informed Care o Evidence Based Practices

Core Service/Access Standards: Iowa Administrative Code 441-25.3 Northwest Iowa Care Connections is responsible for funding only those services and supports that are authorized in accordance with the process described in the MH/DS Plan, within the constraints of budgeted dollars. Northwest Iowa Care Connections is the service funder of last resort and regional funds cannot replace other funding that is available. The table below lists core services, describes if the region is meeting the access standards for each service, how the access is measured and plans to improve or meet access standards.

Code

Reference

Standard Results:

Met Yes/No

By which providers

Comments:

How measured

If not what is plan to meet access standard and how will it be measured

25.3(1)a A community mental health center or federally qualified health center that provides psychiatric and outpatient mental health services in the region.

Yes Seasons Center for Behavioral Health

Psychiatric Inpatient Services- Outpatient MH Services

All offices serving regional counties do not exceed access standards.

25.3(1)b A hospital with an inpatient psychiatric unit or state mental health institute located in or within reasonably close proximity that has the capacity to provide inpatient services to the applicant.

Yes Spencer Hospital Cherokee MHI

Inpatient Services

Spencer Hospital is located within the region and CMHI is adjacent and are within access standards.

Outpatient: (Mental Health Outpatient Therapy, Medication Prescribing & Management, and Assessment & Evaluation)

25.3(3)a(1) Timeliness: The region shall provide outpatient treatment services. Emergency: During an emergency, outpatient services shall be initiated to an individual within 15 minutes of telephone contact.

Yes Seasons Center Yes Hope Haven during regular business hours

Outpatient Therapy Medication Prescribing and Mgt Assessment Evaluation

Regional Contract requests and analyzes information for compliance regarding crisis screening and assessment. Currently options are available in person within 24 hours

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Code

Reference

Standard Results:

Met Yes/No

By which providers

Comments:

How measured


25.3(3)a(2) Urgent: Outpatient services shall be provided to an individual within one hour of presentation or 24 hours of telephone contact.

Yes Seasons Center Hope Haven Spencer Psychiatric and Counseling

Outpatient Therapy Medication Prescribing and Mgt. Assessment Evaluation

Regional Service Coordinator (s) and Contract requests and analyzes information for compliance regarding assessment and treatment access.

25.3(3)a(3) Routine: Outpatient services shall be provided to an individual within four weeks of request for appointment.

Yes Seasons Center Hope Haven Spencer Psychiatric and Counseling New Horizons Plains Area MHC



25.3(3)a(4) Proximity: Outpatient services shall be offered within 30 miles for an individual residing in an urban community and 45 miles for an individual residing in a rural community.

Yes Seasons Center Hope Haven Spencer Psychiatric and Counseling



Inpatient: (Mental Health Inpatient Therapy) 25.3(3)b(1) Timeliness: The region shall provide inpatient

treatment services. An individual in need of emergency inpatient services shall receive treatment within 24 hours.

Yes Spencer Hospital

Inpatient Treatment As a contracted provider, Spencer Hospital provides statistics on access for regional analysis for compliance.

25.3(3)b(2) Proximity: Inpatient services shall be available within reasonably close proximity to the region. (100 miles)


Inpatient Treatment As a contracted provider, Spencer Hospital provides statistics on access for regional analysis for compliance

25.3(3)c Timeliness: Assessment and evaluation. An individual who has received inpatient services shall be assessed and evaluated within four weeks.


Inpatient Treatment As a contracted provider, Spencer Hospital provides statistics on access for regional analysis for compliance.

Basic Crisis Response: (24-Hour Access to Crisis Service, Crisis Evaluation, Personal Emergency Response System)

25.3(2) & 25.3(4)a

Timeliness: Twenty-four-hour access to crisis response, 24 hours per day, seven days per week, 365 days per year.

Yes Seasons Center

Basic Crisis Services Crisis Evaluation Personal Emergency Response System

Regional Contract requests I and analyzes information for compliance regarding types of calls, level of intensity, and disposition.

25.3(4)b Timeliness: Crisis evaluation within 24 hours. Yes Seasons Center

Regional Contract requests statistical info regarding access and analyzes for compliance.

Support for Community Living: (Home Health Aide, Home and Vehicle Modification, Respite, Supported Community Living) 25.3(5) Timeliness: The first appointment shall occur

within four weeks of the individual’s request of support for community living.

Yes Available by contract with local County Public Health Services SCL- Horizons, Hope Haven, Village NW

Home Health Aide Respite Home and Vehicle Modification Supported Community Living

Regional contracts requests and analyzes information for compliance regarding Timeliness for regionally funded service access.

Support for Employment: (Day Habilitation, Job Development, Supported Employment, Prevocational Services) 25.3(6) Timeliness: The initial referral shall take place

within 60 days of the individual’s request of support for employment.

Yes Available by contract with Horizons, Hope Haven, Village NW

Day Habilitation Job Development Supported Employment Prevocational Services

Regional contracts requests and analyzes information regarding timeliness for access to regionally funded employment

Recovery Services: (Family Support, Peer Support) 25.3(7) Proximity: An individual receiving recovery

services shall not have to travel more than 30 miles if residing in an urban area or 45 miles if residing in a rural area to receive services.

Yes Seasons Center

Family Support Peer Support

Regional contract requests and analyzes information regarding timelines for access to regionally funded Family and Peer Support.

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Code

Reference

Standard Results:

Met Yes/No

By which providers

Comments:

How measured


Service Coordination: (Case Management, Health Homes) 25.3(8)a Proximity: An individual receiving service

coordination shall not have to travel more than 30 miles if residing in an urban area or 45 miles if residing in a rural area to receive services.

Yes- DHS & County TCM Yes

Case Management Integrated Health Home per Seasons Center

DHS and County TCM agencies contract states these parameters and reporting are available as requested for statistics.

25.3(8)b Timeliness: An individual shall receive service coordination within 10 days of the initial request for such service or being discharged from an inpatient facility.

Yes-DHS & County TCM Yes

Case Management Seasons Integrated health Home

DHS and County TCM through contracts. Oversight with IHH has noted some delays in receiving services.

Additional Core Services Available in Region: Iowa Code 331.397(6)

The Chart below includes additional core services currently provided or being developed.

Service Domain/Service Available:

Yes/No

By which providers

Comments:

Is it in a planning stage? If so describe.

Comprehensive Facility and Community-Based Crisis Services: 331.397~ 6.a. 24-Hour Crisis Hotline

Yes Contract negotiated with Seasons Center providing interregional comprehensive service which will be associated with mobile response dispatching.

Mobile Response

No

RFP was issued and proposal accepted for July 1, 2017.

23-Hour crisis observation & holding

No

NWIACC is exploring options to address this need to have these services available within 50 miles of our region

Crisis Stabilization Community Based Services

No NWIACC will consider plans to address this need in coordination in conjunction with mobile crisis services.

Crisis Stabilization Residential Services Yes- Plains Area MHC/Turning Point

Signed contract with Plains Area MHC, Sac City Turning Point and Sioux Rivers’ Crisis Residential Services in Sioux City.

Other

Yes NWIACC contract with Avera McKennon, an out-of-state hospital, provides psychiatric inpatient services. This same hospital has partnerships with two local hospitals that provide support services, including emergency room tele-health access to specialists, including psychiatrists for real-time care. NWIACC offers Project Alert in all 6 counties as a preventative measure to assist individuals in need of 1st responder care to enroll voluntarily in Comm Center data base for shared crisis information.

Crisis Residential Services: 331.397~ 6.b. Sub-acute Services 1-5 beds No There is no planning for less than 5 sub-acute beds in our region.

Sub-acute Services 6+ beds

No There is some planning for sub-acute bed availability for our region in cooperation with neighboring regions.

Justice System-Involved Services: 331.397~ 6.c. Jail Diversion

Yes Stepping Up initiative is combining approaches from a Sheriff’s probation project and Integrated Service Pathways 2nd Gen. pilot project in Palo Alto County to form a regional jail diversion and care coordination service.

Crisis Prevention Training

Yes Mental Health Adult First Aid and Mental Health First Aid for Public Safety are both offered in NWIACC region.

Civil Commitment Prescreening

No Strength based service coordination and a collaborative service model with our Mental Health Advocate help to focus efforts among crisis service providers to address this need as situations arise.

Other

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Individuals Served in Fiscal Year 2017: Persons Served by Age Group and by Primary Diagnosis

This chart lists the number of individuals funded for each service by diagnosis.

FY 2017 Actual GAAP

Northwest Iowa Care Connection MHDS Region

MI (40) ID(42) DD (43)

BI (47)

Other Total

A C A C A C A C A C

Core

Treatment

42305 Psychotherapeutic Treatment - Outpatient 5 5

71319 State MHI Inpatient - Per diem charges 8 8

Basic Crisis Response

44301 Crisis Evaluation 26 26

Support for Community Living

32325 Support Services - Respite Services 2 2

32329 Support Services - Supported Community Living 4 12 1 17

Support For Employment

50367 Day Habilitation 2 1 3

50368 Voc/Day - Individual Supported Employment 28 1 7 36

50362 Voc/Day - Prevocational Services 2 21 23

Recovery Services

Service Coordination

Core Evidence Based Treatment

Core Subtotals: 73 1 44 2 120

Mandated

74XXX Commitment Related (except 301) 279 282

75XXX Mental health advocate 764 764

Mandated Subtotals: 1043 3 1046

Core Plus

Comprehensive Facility and Community Based Treatment

44313 Crisis Stabilization Residential Service (CSRS) 5 5

Sub-Acute Services

Justice System Involved Services

46305 Mental Health Services in Jails 34 1 35

Additional Core Evidence Based Treatment

42397 Psychotherapeutic Treatment - Psychiatric Rehabilitation 1 1

Core Plus Subtotals: 40 1 41

Other Informational Services

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Community Living Support Services



33340 Basic Needs - Rent Payments 1 1

22XXX Services management 364 53 429

31XXX Transportation 2 2

50399 Voc/Day - Day Habilitation 5 1 6

Community Living Support Services Subtotals: 372 10 54 2 438

Congregate Services

64XXX RCF-6 and over beds 38 1 39

Congregate Services Subtotals: 38 1 39

Administration

Uncategorized

Regional Totals: 1566 14 100 4 1684

Unduplicated Count of Adults and Children by Diagnosis The chart below shows the unduplicated count of individuals funded by age group and diagnosis

Moneys Expended

Total Expenditures by Chart of Accounts Number and Disability Type The annual budget and planning process is utilized to identify and implement core disability service improvements. The Northwest Iowa Care Connections Region collaborates with stakeholders to assess need and to advocate adequate funding for services and supports in the initial core and additional core service domains. Northwest Iowa Care Connections is the funder of last resort. This section includes:

Funds expended for each service

Revenues

County Levies The chart below show the regional funds expended by service and by diagnosis.

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FY 2017 Actual GAAP

NW IA Care Connections MHDS Region

MI (40) ID(42) DD (43)

BI (47) Admin (44) Total

Core Domains

COA Treatment

43301 Assessment & evaluation $ 66,000 $ 66,000

42305 Mental health outpatient therapy $ 3,419 $ 3,419

42306 Medication prescribing & management $ 171,615 $ 171,615

71319 Mental health inpatient therapy-MHI $ 72,494 $ 72,494

73319 Mental health inpatient therapy $ -

Basic Crisis Response

32322 Personal emergency response system $ -

44301 Crisis evaluation $ 93,054 $ 93,054

44305 24 hour access to crisis response $ -


32320 Home health aide $ -

32325 Respite $ 3,357 $ 3,357

32328 Home & vehicle modifications $ -

32329 Supported community living $ 11,078 $ 55,399 $ 66,477

Support for Employment

50362 Prevocational services $ 402 $ 93,810 $ 94,212

50367 Day habilitation $ 17,188 $ 17,188

50364 Job development $

50368 Supported employment $ 23,518 $ 22,734 $ 46,252

50369 Group Supported employment-enclave $ -

Recovery Services

45323 Family support $ -

45366 Peer support $ -


21375 Case management $ -

24376 Health homes $ -

Core Evidenced Based Treatment

04422 Education & Training Services - provider competency $ 10,797 $ 10,797

32396 Supported housing $ -

42398 Assertive community treatment (ACT) $ 33,522 $ 33,522

45373 Family psycho-education $ -

Core Domains Total $ 485,899 $ 192,488 $ - $ - $ 678,387

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FY 2017 Actual GAAP

NWIACC MHDS Region MI (40) ID(42) DD (43)


46319 Oakdale $ -

72319 State resource centers $ -

74XXX Commitment related (except 301) $ 46,184 $ 46,184

75XXX Mental health advocate $ 49,933 $ 49,933

Mandated Services Total $ 96,117 $ - $ - $ - $ 96,117

Additional Core Domains

Comprehensive Facility & Community Based Crisis Services

44346 24 hour crisis line $ 36,000 $ 36,000

44366 Warm line $ -

44307 Mobile response $ -

44302 23 hour crisis observation & holding $ -

44312 Crisis Stabilization community-based services $ -

44313 Crisis Stabilization residential services $ 13,200 $ 13,200

Sub-Acute Services

63309 Sub acute services-1-5 beds $ -

64309 Sub acute services-6 and over beds $ -

Justice system-involved services

46305 Mental health services in jails $ 14,259 $ 14,259

25xxx Coordination services $ -

46422 Crisis prevention training $ -

46425 Mental health court related costs $ -

74301 Civil commitment prescreening evaluation

$ -

46399 Justice system-involved services-other

$ -

Additional Core Evidenced based treatment

42397 Psychiatric rehabilitation (IPR) $ 1,552 $ 1,552

42366 Peer self-help drop-in centers $ -

Additional Core Domains Total

$ 65,011 $ - $ - $ - $ 65,011


03371 Information & referral $ -

04372 Planning and/or Consultation (client related)

$ -

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FY 2017 Actual GAAP



04377 Provider Incentive Payment $ -

04429 Planning and Management Consultants (non-client related)

$ -

04399 Consultation Other $ -

05373 Public education $ -


Total $ - $ - $ - $ -

$ - Other Community Living Support Services

06399 Academic services $ -

22XXX

Services management $ 85,198 $ 85,198

23399 Crisis care coordination other $ -

24399 Health home other $ -

31XXX Transportation $ 381 $ 381

32321 Chore services $ -

32326 Guardian/conservator $ -

32327 Representative payee $ -

32399 Other support $ -

32335 CDAC $ -

33330 Mobile meals $ -

33340

Rent payments (time limited) $ 29 $ 29

33345 Ongoing rent subsidy $ -

33399 Other basic needs $ -

41305

Physiological outpatient treatment

$ -

41306 Prescription meds $ -

41307 In-home nursing $ -

41308 Health supplies $ -

41399 Other physiological treatment $ -

42309 Partial hospitalization $ -

42310 Transitional living program $ -

42363 Day treatment $ -

42396 Community support programs $ -

42399 Other psychotherapeutic treatment $ -

43399 Other non-crisis evaluation $ -

44304 Emergency care $ -

44399 Other crisis services $ -

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FY 2017 Actual GAAP



45399 Other family & peer support $ -

50361 Vocational skills training $ -

50365 Supported education $ -

50399 Other vocational & day services $ 210 $ 42 $ 252

63XXX RCF 1-5 beds $ -

63XXX ICF 1-5 beds $ -

63329 SCL 1-5 beds $ -

63399 Other 1-5 beds $ -

Other Comm Living Support

Services Total $ 97,818 $ 42 $ - $ -

$ 97,860

Other Congregate Services

50360 Work services (work activity/sheltered work)

$ -

64XXX

RCF 6 and over beds $ 612,375 $ 20,429 $ 632,804

64XXX ICF 6 and over beds $ -

64329 SCL 6 and over beds $ -

64399 Other 6 and over beds $ -

Other Congregate Services Total $ 612,375 $ 20,429 $ - $ - $ 632,804

Administration

11XXX Direct Administration $ 230,053 $ 230,053

12XXX Purchased Administration $ 26,960 $ 26,960

Administration Total $ 257,013 $ 257,013

Regional Totals $ 1,357,220 $ 212,959 $ - $ - $257,013 $ 1,827,192 (45XX-XXX) County Provided Case Management $ -

(46XX-XXX) County Provided Services $ -

Regional Grand Total $1,827,191.85

Transfer Numbers *Do Not Include in Total Expenditures

13951 Distribution to MHDS regional fiscal agent from member county $ 1,723,501

14951 MHDS fiscal agent reimbursement to MHDS regional member county $ -

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Revenue FY 2017 Actuals

Northwest Iowa Care Connections Region

Revenues

Audited Accrual FY16 Ending Balance $ 4,304,580

Local/Regional Funds $ 1,939,440

10XX Property Tax Levied 1,876,257

12XX Other County Taxes 2,715

16XX Utility Tax Replacement Excise Taxes 31,176

4XXX-5XXX Charges for Services 18,949

6XXX Use of Money & Property 6,233

8XXX Miscellaneous 4,110

State Funds $ 155,073.00

21XX State Tax Credits 114,944

22XX Other State Replacement Credits 40,086

2910 State Payment in Lieu of taxes 43

Federal Funds $ 9.00

2900 Payment in Lieu of taxes 9

Total Revenues $ 2,094,522.00

Total Funds Available for FY17 $ 6,399,102

FY17 Actual Regional Expenditures $ 1,827,192

Region's Accrual Fund Balance as of 6/30/17 $ 4,571,910

County Levies

Northwest IA Care Connections

MHDS Region

2014 Est. Pop.

47.28 Per Capita Levy

Base Year Expenditure Levy

FY17 Max Levy

FY17 Actual Levy

Actual Levy Per Capita

Clay 16,515 780,829 402,866 402,866 402,866 24.39

Dickinson 16,935 800,687 412,509 412,509 412,509 24.36

Lyon 11,683 552,372 248,113 248,113 248,113 21.24

O'Brien 14,056 664,568 570,532 570,532 570,532 40.59

Osceola 6,218 293,987 195,225 195,225 195,225 31.40

Palo Alto 9,099 430,201 688,176 430,201 193,263 21.24

Region 74,506 3,522,644 2,517,421 2,259,446 2,022,508 27.15

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As its mission, Northwest Iowa Care Connections exists to enhance the lives of the people it serves through an

array of services to meet the needs of the citizens of Northwest Iowa using evidence based practices wherever

possible to provide unparalleled services that achieve life altering outcomes for the people we serve.

In our region’s initial organizational phase, we collectively identified four key areas for collaboration in

development and implementation that addresses the six domains; Crisis Services, Integrated Community Based

Employment Initiatives, Housing, Justice-Related Services, and Service Coordination. Subsequently, we have

incorporated Justice-Related Services into the national model of the Stepping Up Initiative, and we have

increased our focus on Integrated Care through our Crisis Prevention Services and Family Supports.

ACCESS POINTS and SERVICE PROVIDER NETWORK

Our region’s local access points (see attachment A) and our network of providers (see Attachment B) assisted

our region to use its contracting capacity to implement a series of strategies to move toward these teams’ goals.

Our region’s designated Targeted Case Management Providers assisted person centered planning to clients

provided that service.

Because Northwest Iowa Care Connections uses a mix of fee-for-service and capitated rates for most of its

service, there are opportunities for negotiation and performance measuring for services provided. NWIACC

provides block grants only for specific population based activities where billing by individuals served is

impossible or impractical. Non-traditional provider contracts are used in instances when services are provided

by individuals and families to assure a robust array of services available to meet access standards.

Northwest Iowa Care Connections service contracts require that all providers meet all applicable licensure,

accreditation, or certification standards. However, Northwest Iowa Care Connections makes serious efforts to

stimulate access to more natural supports in its service provider network. Successful attainment of positive

outcomes, consumer and family satisfaction, and cost effectiveness measures are in the most important factors

in continued network participation.

Service Progress by Core, Additional Core, and EBPs

Crisis Emergency Slots: As in FY 2016, there has been a total of 10 emergency time slots available each week in each of the county based Seasons Center offices. This translates to a total of 40 slots available each month, and 480 slots available in a 12 month period of time. The slots allocated in Sioux Center have been included in this data as they were open to be used by any county in the region if necessary and we have no information that would support the not including in the regional data. The slots are allocated as follows:

Spencer Spirit Lake Sheldon Rock Rapids Sioux Center

4 1 3 1 1

OUTCOMES-PROGRESS ON GOALS

UTILIZING THE SIX DOMAINS Access to Service

Life in the Community

Person Centeredness

Health and Wellness

Quality of Life and Safety

Family Natural Supports

14

Utilization of Emergency Slots by County:

Clay Dickinson Lyon O’Brien Osceola Palo Alto

34 18 2 6 2 11

32 24 1 9 4 9

As we see by these results, we have more work to do to increase awareness of Crisis Service options in some our Region’s more rural counties. We have County Teams meeting through various coalitions in most of our counties. This is, and will continue to be, a forum we will expand to increase crisis services access within our communities.

0 5 10 15 20 25 30 35 40

Total # of Contacts:

Total #of Unduplicated Contacts:

Face to Face or Crisis AssessmentScreening Contact Numbers

FY 2016 & 2017

FY 17 FY 16

0

10

20

30

40

Clay Dickinson Lyon O'Brien Osceola Palo Alto

Utilization of Emergency Slots FY 16 & FY 17

FY 16 FY 17

0 5 10 15 20 25 30

# of High Risk Emergency Care

# Moderate Risk-Crisis Intervention:

# Lower Risk-Listen, Protect, Connect:

Face to Face or Crisis Assessment and Intensity of Crisis ServicesFY 2016 & 2017

FY 17 FY 16

15

Finally, the following is a table that compares the Face to Face Crisis Assessments, Level of Risk, and category of Contacts reported through the contract with Seasons Center. We can see the level of usage has decreased which has resulted in an increase in costs. Our intention to increase awareness will help us gain efficiencies in providing these services region-wide.

Service FY 16 FY 17

Cost Per Contact: $ 970.32 $ 453.03

Average Time Spent Per Contact 1:08 .22

Average Time Spent per Unduplicated Contact: 1:15 .23

Total # of Contact 17 34

Total # of unduplicated Contacts 16 33

# of High Risk Emergency Care 4 3

# of Moderate Risk Crisis Intervention 2 8

# of Lower Risk- Listen, Protect, Connect 11 24

#of Clients or Potential Clients 11 28

# of Caregivers, Family, Friends, Acquaintances: 4 5

Other Service Providers (i.e. ED Staff) 1 0

Average Cost per Service Unit $ 846.98 $ 1,982.76

Within our region’s crisis response is contracted beds with neighboring Regions, Rolling Hills and Sioux Rivers. Usage at

their facilities in Sac City and Sioux City respectively continue to increase as awareness of the service is being increased

through marketing and promotional visits to our Region on a regular basis.

In addition, continued regional contracting with Avera McKennon Behavioral Health Services in Sioux Falls, South

Dakota, provides a valuable connection to inpatient psychiatric services to our local hospital Emergency Rooms for

court-ordered and/or voluntary hospitalization. Through this partnership, NWIACC attempts to complement the

affiliations of many of our local hospitals and clinics with Avera to support an integrated care model whenever possible.

NWIACC especially sees the benefit of this arrangement in our western counties, whose proximity to Sioux Falls makes

Avera’s services a client and family friendly option to individuals requiring that level of care. Service coordination efforts

between NWIACC staff and Avera affiliated centers continue to increase as “Familiar Faces” are being identified and

person-centered plans are being developed to address the individual’s needs.

JUSTICE-RELATED SERVICES For the second fiscal year, Northwest Iowa Care Connections held a contract with Hope

Haven to provide psychiatric services to those regional residents that were incarcerated within our regional jails. Jail

staff in communication with Regional enrollment staff in Dickinson County determine whether those in law enforcement

0 5 10 15 20 25 30

# of Consumer or Potential Consumers:

# of Caregivers, Family, Friends, Acquaintances:

Other Service Providers (i.e. ED Staff):

Face to Face or Crisis Assessment and Crisis Referral SourceFY 2016 & 2017

FY 17 FY 16

16

custody would benefit from a referral to Hope Haven, who then would provide Psychological Evaluations, Individual

Therapy, and Medication Management to those deemed to benefit from this service.

The following information is taken from monthly reports submitted to the region by Hope Haven. The first table below

indicates the total number of times Hope Haven staff provided services to an inmate. There were 149 instances that

Hope Haven provided services to our Regional jails. This number is a duplicated total, meaning there were several units

of services to a single individual. It does give an overall picture of the services provided in that setting.

The next table shows that same service provision, only tied to single individuals. Hope Haven staff saw and provided

services to individuals, specific to each type of service (i.e. Individual Therapy). For example, in Clay County the table

below shows a count of 9 who received individual therapy, 5 receiving Medication Management and 17 that received

Psychological Evaluations, each of those counts is unduplicated and the unit of service is tied to a single individual.

However, there were some of the same individuals that received services from two or all three types of service

categories. So while the 9, 5, and 17 within each service category are separate individuals and unduplicated for Clay

County, the total of those individual service types together (31) would be duplicated. In comparison of the two tables for

Clay County, in the previous table, it shows a total of 26 units of Individual Therapy provided to those 9 individuals

below, 12 units of Medication Management provided to 5 individuals and 28 units of Psychological evaluation provided

for 17 individuals. In many instances it will be noted that the evaluation sessions were provided by both a Master Level

therapist and referral to a Psychiatrist for medication options, so it is easy to have multiple units of service to individual

people served.

This chart shows a count of individuals receiving service by county, if an inmate received any type of service from Hope

Haven, they were counted only once for the purpose of the pie chart for a total of 78 individuals served.

0

10

20

30


Hope Haven Jail ServicesDuplicated Number of Visits with Inmates by Service Type and County

Individual Therapy Medication Management Psychological Evaluation

0

10

20


Hope Haven Jail ServicesNumber of Visits by Service Type and County

Individual Therapy Medication Management Psychological Evaluation

17

This chart is one that reflects the cost of the total number of units of service (Table #1) for each regional county, as well

as the table below that separates and compares the two years of contracted service by average cost per individual seen

and average cost per visit to the jail.

Number of Individual Served: 86

Total Paid to Hope Haven, Inc. for Crisis Evaluations $18,648.00

Average Cost Per Individuals Served $ 216.84

Number of Visits to Jail: 110

Total Paid to Hope Haven, Inc. for Crisis Evaluations $18,648.00

Average Cost Per Visit to Jail $ 169.53

78 In a separate database, Hope Haven provided the following information to the Region, the data shared additional information regarding the number of contacts that Hope Haven staff had with local jail staff and follow up with individuals served after release from incarceration and whether individuals followed through with the recommendation to continue mental health services, first from FYE 6/30/2017 and then from FYE 6/30/2016.

Clay, 31

Dickinson, 21

Lyon, 2

O'Brien, 1

Osceola, 8

Palo Alto, 15

Hope Haven Jail ServicesUnduplicated count of inmates seen by County


$0.00$1,000.00$2,000.00$3,000.00$4,000.00$5,000.00$6,000.00$7,000.00$8,000.00$9,000.00

$10,000.00$11,000.00

1

Hope Haven Jail Services Cost of Program by County


18

0 10 20 30 40 50 60 70

# of Individuals Served

# of Visits to Jail

# of Individuals Treated with Therapy only

# of Individuals treated with Meds and Therapy

# of Consultations with Jail Staff

# of Individuals treated with Co-Occurring MH & Substance Abuse

# of Individuals Released from Jail this month

# of Referrals to outpatient behavioral health services

# of Individuals Following up with services in the community within30 days.

Hope Haven Jail Services by County for FYE 6/30/17

Osceola O'Brien Clay Palo Alto Lyon Dickinson

0 5 10 15 20 25 30 35 40 45 50 55

# of Individuals Served

# of Visits to Jail

# of Individuals Treated with Therapy only

# of Individuals treated with Meds and Therapy

# of Consultations with Jail Staff

# of Individuals treated with Co-Occurring MH & Substance Abuse

# of Individuals Released from Jail this month

3 of Referrals to outpatient behavioral health services

# of Individuals Following up with services in the communitywithin 30 days.

Hope Haven Jail Services by County for FYE 6/30/16

Osceola O'Brien Clay Palo Alto Lyon Dickinson

19

This pie chart displays the same information as the line graph from FYE 6/30/2017 above, it does add individual numbers

and percentages to the information presented.

Finally, this graph shows a comparison for Regional Jail services from FY 16 and FY 17.

# of Individuals Served, 78, 14%

# of Visits to Jail, 149, 27%

# of Individuals Treated with Therapy only, 68, 13%

# of Individuals treated with Meds and Therapy,

10, 2%

# of Consultations with Jail Staff, 123, 23%

# of Individuals treated with Co-Occurring MH &

Substance Abuse, 67, 12%

# of Individuals Released from Jail this month, 24,

4%

3 of Referrals to outpatient behavioral health services,

6, 1%

# of Individuals Following up with services in the community within 30 days., 23, 4%

Hope Haven Jail Services for FYE 6/30/2017

0 20 40 60 80 100 120 140 160

# of Individuals Served# of Visits to Jail

# of Individuals Treated with Therapy only# of Individuals treated with Meds and Therapy

# of Consultations with Jail Staff# of Individuals treated with Co-Occurring MH & Substance Abuse

# of Individuals Released from Jail this month3 of Referrals to outpatient behavioral health services

# of Individuals Following up with services in the community…

Hope Haven Jail Services for FY 16 & FY 17 for the Region

FY 6/30/2017 Totals NWICC FY 6/30/2016 Totals NWICC

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This is the first year the Region has received information from our provider in regards to the follow-up appointments

that were staffed following initial contact in the jail with individuals incarcerated within the Region. The following are

two tables that provide information regarding that information by Hope Haven, the first indicates the amount of

appointment slots used by each of the counties within the Region, and the second shows information in regards to the

type of appointment or service provided by appointment.

NWIACC continues to work closely with regional law enforcement and jails to identify concerns and address gaps in

service. At the request of our one of our counties, NWIACC developed a successful law enforcement training, vetted by

the Iowa Law Enforcement Academy to provide an opportunity for mental health and substance use disorder personnel

serving the county, court personnel, including the local magistrate, county attorney, and County Clerk of Court, along

with the local hospital Emergency Room, and regional service coordination to provide information about various

components of mental health and/or substance abuse civil commitments, emergency holds, and transfers to inpatient

facilities.

In addition, all six counties in NWIACC have adopted resolutions to participate in the state and national Stepping Up

Together Initiative. This has the potential to integrate practices and procedures into a more comprehensive approach to

jail diversion. Our region has supported two models as pilot projects with hopes of blending elements of both to more

effectively serve offenders upon release. The Region’s work with Clay County to provide a Sheriff Probation Oversight

service for individuals with mental health and/or co-occurring disorders referred to an enhanced service coordination

model has yielded information about the role of court-ordered accountability for participation. The Integrated Services

Pathways (ISP) 2nd Generation Pilot Project in Palo Alto County has developed voluntary options for jail release follow-up

that has the potential to utilize incentives and other positive supports to assure compliance to reduce recidivism. Both

of these models provided pilot project participants and the Region with valuable information to move Jail Diversion into

a more cohesive, intentional, and collaborative process moving forward.

Clay, 4, 34%

Dickinson, 3, 25%Lyon, 1, 8%

Palo Alto, 4, 33%

Hope Haven Followup Appointments by County FY 2017

Clay Dickinson Lyon Palo Alto

0 1 2 3 4 5 6

Psychological Evaluation

Individual Therapy

Did not Show for Appt.

Enrollment Session

Hope Haven Followup Appointments by Type of Service, FY 2017

21

Rural Access to Inpatient Psychiatric Care: Inpatient Services and rural access to psychiatric care continue to be a challenging service to provide locally. Due to limited staff, Spencer Hospital and Seasons Center have developed a partnership for after-hours coverage for the Spencer Hospital Mental Health Unit through mid-level practitioners. NWIACC provides a block grant to Seasons Center to support this work. The following table provides totals for the FYE 6/30/16 and FYE 6/30/17 per county of Inpatient Encounters.

Consumer Inpatient Encounters:

Clay Dickinson Lyon O’Brien Osceola Palo Alto Total:

FYE 6/30/2016 100 74 0 31 4 33 240

FYE 6/30/2017 51 50 0 21 7 15 144

Financially, the Region paid $72,600 in the fiscal year 6/30/16 to Seasons for Access to Psychiatric Inpatient Services. This amount divided by the total number of individuals that accessed this service through Seasons Center averaged $302.50 per Individual Contact. For the FYE 6/30/2017 the region had invested $66,000 which then averaged $458.34 per individual Contact. The below table shows the total number of individuals seen by county and the percentage for each county.

Medication Encounters: Because access to affordable and effective medications is a key component for successful

intervention and recovery strategies for many individuals in our region who require medication, NWIACC provides a

block grant to Seasons Center to assure individuals have proper supervision and coordination for their medication

management. Medication encounters tabulated below help to reflect the volume of contacts provided by Seasons

Center to support psychiatric access to those who are indigent or have other factors which challenge their access to the

medication they need.

A total of $343,299.76 in the fiscal year ending 6/30/2016 and 6/30/2017 has been invested for the Medication

Encounters for its residents ($171,614.88 for each fiscal year respectively). This information has been split into the two

categories of 0-17 years of age and 18+ years of age. The following two charts provides a picture to the number of

individuals served by county for each age group:

Clay, 51, 35%

Dickinson, 50, 35%

Lyon, 0, 0%

O'Brien, 21, 15%

Osceola, 7, 5%

Palo Alto, 15, 10%

FY 17 Inpatient Encounters by County


0 20 40 60 80 100 120

FY 17

FY 16

NWICC Consumer Inpatient Encounters byCounty and Fiscal Year

Palo Alto Osceola O'Brien Lyon Dickinson Clay

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This table gives a summary of the information collected:

NWIACC Consumer Medication Encounters for FYE 6/30/16

Clay Dickinson Lyon O’Brien Osceola Palo Alto Total Seen Total Time Spent

Age 0-17 763 374 22 228 74 152 1613 309.08 Hours

Age 18+ 1798 1306 100 627 132 464 4427 904.88 Hours

NWIACC Consumer Medication Encounters for FYE 6/30/17

Clay Dickinson Lyon O’Brien Osceola Palo Alto Total Seen Total Time Spent

Age 0-17 185 62 7 45 32 37 365 93.89 Hours

Age 18+ 712 394 93 126 40 100 1465 330.39 Hours

From the information in the above table combined with total dollar amounts paid in each of the fiscal years, the

following information can be calculated:

FY 16 FY 17 FY 16 & FY17

Average Time Per individual Client Seen (0-17 Years) 11.49 min 15.43 min 12.23 min

Average Time Per Individual Seen (18+years) 12.26 min 13.53 min 12.58 min

Average Dollar Amount Spent on medication Encounters Combined

$28.42 per Individual Seen



Average Dollar Amount spent per Hour as a unit of service $141.37 $404.49 $209.56

This next table compares the two fiscal years to one another by county totals and split by age category. One can see the comparison of the age groups of 0-17 years in light green (FY 17) to blue (FY 16), and the age 18+ group in yellow (FY 17) to dark green (FY 16).

0

1000

2000


NWIACC Consumer Medication Encounters FYE 6/30/16

FYE 6/30/16 - Child Age 0-17 Years Old FYE 6/30/16 - Adult Age 18 + Years Old

0

200

400

600

800


NWIACC Consumer Medication Encounters FYE 6/30/17

FYE 6/30/17 - Child Age 0-17 Years Old FYE 6/30/17 - Adult Age 18 + Years Old

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Regional Program Outcomes

Employment: NWIACC continues to work with clients, their families and service providers to provide more integrated,

community based employment in NWIACC’s Region. NWIACC provides funding in cooperation with the Sioux Rivers

Region for training to certify employment specialists in APSE and Customized employment practices for both MHDS

Regions to assure a qualified workforce when implementing this service for persons with disabilities. Both Regions have

participated in presentations with Hope Haven regarding the Individualized Placement Services (IPS) model which has

been successfully provided in the SW Minnesota area with Hope Haven, Vocational Rehabilitation, and the SW

Minnesota Mental Health Center based in Worthington. We see the value of developing this evidence-based integrated

employment option for persons with mental illness as its implications nation-wide show positive outcomes.

NWIACC offered incentives to Service Providers for Outcomes for Supported Employment. To date, Hope Haven claimed

$19,700 in incentives as they reported 28 consumers achieving integrated employment in the community. Of those 28

clients, eight were placed in customized employment while the balance was served with supported employment.

Nineteen different employers were represented in this report. Hourly client wages ranged from $7.25 to $10 per hour.

Job types include but are not limited to information center attendant, packaging and assembly, cleaning, dishwashing,

laundry, dietary aide, kennel attendant, Parts Department, greenhouse attendant, dye press operator, and

groundskeepers. Over 70% of this group were employed in the Lakes Region.

We applaud the efforts of our Employment Specialists, who serve as job coaches as well as job developers to provide

these opportunities to our regional workforce. Through our Regional Lunch and Learns, employers were encouraged by

testimonials of their fellow employers to seek out individuals who can and will be a productive addition to a shrinking

workforce.

As regional providers enter in their data to ISAC’s CSN (County Services Network) database, FY 17 NWIACC employment

ratings are reported at 46% compared with a state-wide average of 45% for integrated community employment

opportunities, hourly wage, and hours worked by persons with disabilities.

Housing: NWIACC continues to provide support to individuals in need of housing options, from residential care

facilities to supported community living sites. With the closure of a large residential care facilities and subsequent

moves of many regionally funded individuals to other settings, regional service coordinators along with our regional

Mental Health Advocate worked tirelessly to assess needs, to match the preferences with available housing settings in a

very short timeframe to resettle individuals as quickly and with as much comfort as possible. There have been initial

conversations with two community based entities regarding transitional housing options for homeless individuals with

mental illness and/or substance use disorder needs.

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The Regional Housing Team has identified workforce shortages and retention as major challenge in providing services to

persons with disabilities. In spite of these issues, QSDA compiles Service provider reports which reflect a 65% rate of

safe, affordable and accessible housing being available to their clients based on a 70 % average state-wide. NWIACC will

continue to work with service providers, landlords, community partners and other interested individuals to encourage

least restrictive, safe, affordable community based housing options for persons with disabilities.

QSDA 5 Star Quality Somatic Care measure- NWIACC service providers reported an average of 87% somatic care compliance compared with the state-wide average of 88%. This includes an individual’s participation in an annual physical to address medical needs. QSDA Community Integration- NWIACC service providers reported an average of 76% on community

integration based on an 80% statewide average for opportunities to be in and of their home communities

Education and Training: NWIACC has invested in training on Motivational Interviewing to assist local care teams in

developing and sustaining techniques to learn the basic clinical style of Motivational Interviewing (MI). The two days of

training taught 30 employees from a variety of service provider agencies the finer points of empathic listening skills,

recognizing and responding to fundamental client language cues of change and to deconstruct resistance in the Sustain

Talk and Discord Model. It was suggested that we have follow-up course work in this upcoming year to build off the

introductory training with support for higher level skill building.

-Zero Suicide Project As part of our training outreach, NWIACC began this Pilot Project in Palo Alto County as a

response to the request and interest of local providers who identified the need for suicide prevention opportunities.

Research was compiled on the Zero Suicide Project and shared with representatives from law enforcement, the court

system, local medical providers, the faith community, school personnel, mental health and substance use disorder

providers, domestic violence, and regional staff. At monthly meetings, we familiarized ourselves with this model and

prioritize opportunities to begin the increase of awareness, education, and advocacy opportunities for suicide

prevention. As our efforts took shape, resource directories were compiled for use by law enforcement and Emergency

Rooms to use with individuals and families who want contact information. Plans were made to provide an A.S.I.S.T

(Applied Suicide Intervention Skills Training) to nursing staff from the local hospital who are psychiatrically boarding

patients for periods of time as well as other interested participants. Plans are being discussed to pursue other suicide

prevention awareness activities as we partner with the American Foundation of Suicide Prevention to determine next

steps in development of a local model that fits our needs.

-Powerful Tools for Care Givers: In coordination with the Iowa State Extension, Sioux Rivers Region and NWIACC, we

embarked on a partnership to provide the Powerful Tools for Care Givers evidence-based family education program to

assist families of children with disabilities to gain knowledge of parenting tools and resources. Over 43.5 million family

caregivers in America provide a vast array of emotional, financial, nursing, social, homemaking and other services to

children with special health and behavioral needs on a daily or intermittent basis. Due to increased waiting lists for HCBS

Waiver Services, these partners believed this 6 week educational series could provide caregivers with the tools they

needs to better take care of themselves and be better equipped to take care of a loved one. This curriculum teaches

how to reduce stress, improve self-confidence, better communicate their feelings, balance their life, increase their

ability to make tough decisions, and locate helpful resources. Interactive lessons, discussions and brainstorming will help

participants take the tools they learn and put them into action in their life. Seven families participated from our

Regions. Participants reported a positive experience as this class also provided a caring network of peers for support.

Assertive Community Treatment (ACT): NWIACC’s local Community Mental Health Center began their development

of a rural Assertive Community Treatment (ACT) program as a component of their application for the CCBHC grant. In

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spite of Iowa not being awarded the grant, Seasons Center and NWIACC continued their plans to implement this service

to high need individuals who struggle with frequent hospitalizations, possible incarcerations and other barriers to their

independent functioning due to their mental illness. NWIACC contracted with Seasons Center for start-up costs in

January 2017 to secure staff, equipment, and other needs for tentative implementation in October 2017 for this

evidence-based practice. By June 2017, recruitment of staff was taking place with hopes to meet the timeline for

operation by the fall of 2017.

Mobile Crisis- NWIACC has been researching the viability of mobile crisis in our rural region. Attempting to bring crisis intervention to residents of our regional communities where and when they need it through this 24 hour service compelled the Governance Board to discuss options with Seasons Center to contract this service which was achieved in July 2017.

Project Alert: NWIACC has reached out to first responders throughout the Region to develop this database for individuals with disabilities who may require emergency service visits to their home. Partners in this process include Representatives from each county:

Clay Dickinson Lyon O’Brien Osceola Palo Alto

Regional Staff Regional Staff Regional Staff EMA Osceola County Ambulance

ILCC/EMS

Outreach in each county continues to identify individuals to voluntarily participate in this opportunity to provide information in advance to first responders when they require emergency service.

Crisis Prevention Services-Mental Health First Aid: NWIACC’s Adult Community Mental Health First Aid instructor

had the following training record for the 91 participants this year as this service became more familiar to entities in the

Region.

County City Agency Number of Participants

Clay Spencer Compass Pointe Dream Center Hope Haven

20 14 8

O’Brien Sheldon NW IA Community College 22

Dickinson Spirit Lake Presbyterian Church 17

Lyon Rock Rapids Disciples of Christ Church 10

Palo Alto * Emmetsburg Iowa Lakes Community College 9

*this course was the first of the FY 17 fiscal year offered by Mental Health First Aid Public Safety instructors, who work in

partnership with our Region and Iowa Lakes Community College to support a continuing education option for law

enforcement and first responders. Plans are to credential this program through Iowa Technical College in Sheldon for

use in all our western counties in the upcoming fiscal year.

Intake and Referral and Service Coordination: In addition to the active role Regional Service Coordination takes with the aforementioned housing needs and justice related services, the 429 individuals served in this capacity can be found in work done through inpatient hospitalization discharge planning, school outreach activities to identify students in need of various services and access to funding streams (i.e. applying for HCBS Waiver services etc.) as well as regional initiatives (Zero Suicide Project, Project Alert, etc.) that improve access to services. In many cases, regional service coordination is the only resource to the individual and/or their families until referrals can be made. Combined with extensive collaboration with fellow community partners, this linkage service provides a valuable service to individuals and their families to navigate a complex system.

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Other Community Living Support Services

Transportation-NWIACC partnered with the Spencer A.D.A. (Americans with Disabilities Act) Council to sponsor a well-

attended Forum on Transportation (approximately 80 people attended) on October 18, 2016 in Spencer. In the planning on this Forum, there were surveys sent to local service providers to determine the unmet transportation needs and their effect on access to services. Regional service providers (10 respondents or 41% surveyed) reported to the team that transportation affected their clients’ access to services. Sixty percent (60%) of these providers serve over 200 clients in our region. Of these providers surveyed, 40% of them reported access issues between 26% -50%/ Twenty per cent (20%) of them said access difficulties were experienced by over 20% of their clients. In addition, 25% of these service providers reported that their clients struggled particularly with access to transportation 26% to 50% of the time and over 51% of the time for clients of 37.5% of the providers The goal of the session was for persons with disabilities, along with their Support System Partners will develop Awareness, address Access, and encourage Advocacy to meet their transportation needs. The Service Delivery System connected providers, resources, and management to integrate transportation into a seamless, responsive service to promote better health outcomes in our rural region. We invited participants from the various area of the NWIACC Region (Clay, Dickinson, Lyon, O’Brien, Osceola and Palo Alto Counties) impacted by Transportation Access:

Consumers and Disability Service Providers In 4 county area (Clay,

Dickinson, O’Brien, & Palo Alto)

Consumers from Other Community Providers

Other interested community members

Hope Haven (MI & ID) Independent in Community Family/Natural Supports

Seasons From All Service Providers Legislators

Village NW Schools/AEA Elected officials

Horizons IVRS ADA Council

Pride Group SCL PHN NAMI

Lake Life Skills SCL Elder Bridge DBSA

Spencer Hospital Assisted Living Employers

Case Managers Nursing Homes RSVP-Volunteer Network

Care Coordinators (MCOs, IHH) Hospital/EDs Faith Community

MCOs Amerigroup Primary Care IDOT

AmeriHealth Caritas

United HealthCare

We began the session with an Advocacy activity with Rik Shannon of the IA DD Council and ID Action. We then served

supper which was followed by the Public Forum in which our local newspaper Editor moderated. We have

representatives for all the MCOs, from our local hospital, from private and public transportation providers, as well as

service providers, explain the complexities of transportation services, access and funding. By having consumers, their

families, funders, including local and state elected officials, as well as service providers, in the same room talking about

gaps in service, funding, logistics, and brainstorming to improve access and awareness, our local regional Transportation

Team went to work compiling information for a collaborative DOT Grant with our local transportation authority. After

much work, we plan to launch the service as a pilot project in the Clay Dickinson Counties Corridors due to the

availability of drivers, vehicles, and a critical mass of individuals who will utilize these services for supported/customized

employment and essential needs (grocery shopping, laundry, and pharmacy) after hours and on weekends. Stay tuned

for usage and plans to incorporate this model throughout the region.

27

SOAR –NWIACC has a trained staff to address SOAR Referrals. During FY 2017, there was one referral to that program.

The Regional Website-nwiacareconnections.org continues to be a source of information for regional constituents and other interested parties. We have seen a 25% increase in session and 28% increase in users since the last fiscal year.

Website Activity FY16 Totals FY17 Totals

Sessions 854 1,110

Users 726 1,002

Page Views 2,670 3.43

Pages/Sessions 3.35 3.43

Avg. Session Duration 1.72 2.41

Bounce Rate 53.28 45.5

% of New Sessions 83.9 75.14

Percent of Sessions Viewed from US 81.57 90

Statewide Outcomes (Quality Service Development & Assessment, QSDA)

To gauge performance and progress in the measurement domains identified in 2014 Code of Iowa 225C.6A: access to service, life in the community, person centeredness, health and wellness, quality of life and safety, and family natural supports. The Regions have charged QSDA with the following responsibilities:

Facilitate the implementation of service delivery models- Learning Communities, multi-occurring, culturally capable, evidence based practices, research based practices and trauma informed care.

Work to ensure that Providers are utilizing Evidence Based Practices, Research Based Practices and Promising Practices.

Identify and collect Social Determinant Outcome data. Work to create a Value Based Service Delivery System utilizing performance/value based contracts.

QSDA Mission and Values/Guiding Principles

QSDA Mission Statement: QSDA is a group of stakeholders facilitating a statewide standardized approach to the development and delivery of quality MH/DS services measured through the utilization of outcome standards. QSDA Values/Guiding Principles: All services should be the best possible.

- Service Philosophy is based on the 5 Star Quality Model- will always strive to achieve the highest degree of community integration as possible.

- We have identified the need and value in providing disability support services in the person’s home community. We believe individuals with disabilities have the same basic human needs, aspirations, rights, privileges, and responsibilities as other citizens. They should have access to the supports and opportunities available to all persons, as well as to specialized services. Opportunities for growth, improvement, and movement toward independence should be provided in a manner that maintains the dignity and respects the individual needs of each person. Services must be provided in a manner that balances the needs and desires of the consumers against the legal responsibilities and fiscal resources of the Region.

- We want to support the individual as a citizen, receiving support in the person’s home, local businesses, and community of choice, where the array of disability services are defined by the person’s unique needs, skills and talents where decisions are made through personal circles of support, with the desired outcome a high quality of life achieved by self-determined relationships.

28

- We envision a wide array of community living services designed to move individuals beyond their clinically diagnosed disability. Individuals supported by community living services should have community presence (characterized by blending community integration, community participation, and community relationships). Through the use of Evidence Based Practices, (EBP) and Research Based Practices, (RBP), Regions will continually strive to improve service quality.

Activities must be meaningful. - Any task or work completed must be meaningful. That is that it contributes to delivering quality services. - Will ensure the use of standardized/efficient practices. - Work to establish a single data entry process. - Will work to ensure that outcome measures align. - Coordinated training process. - QSDA structure, projects and processes shall be based on a philosophy of accommodation and flexibility. - Utilize website to organize resource information, data, activities, training and process tracks.

Strategic Action Plan

The following projects define the FY 18 Strategic Action Plan. The FY 18 Plan in addition to identifying new tasks is also is a continuation and expansion of a number of FY 17 projects. Projects are grouped within four Strategic

Areas: Service Development, Service Delivery, Service Assessment and System Infrastructure.

Service Development o Urban Rural Learning Community Development

Facilitate development of Learning Communities for legislated EBPs, including TI/COD/CC with service delivery team.

Coordinate with ISCA Training Committee on state-wide trainings involving QSDA initiatives. Support collaboration among CEOs and Regions to address mutual interests where possible. Work on collaboration with the statewide QSDA Service Assessment team for mutually beneficial

services. o Develop a Statewide Trauma Informed Care trainer network.

Develop a TI Training Network with the Lincoln NE model to support a unified, consistent and sustainable TI training model statewide.

Identify costs and funders for this model. Work collaboratively with CEOs and Providers to support this model in Regions.

o Develop an Integrated Co-Occurring Practice Model Coordinate efforts with CEOs, ITAIC, DHS and IDPH. Develop a state-wide training in cooperation with the Service Delivery Team Populate the QSDA website with Integrated Co-Occurring Care resources.

o Continue QSDA Website development of Service Environment information. Continue to develop tool kit/resource directory for Trauma Informed Care. Develop tool kit/resource directory for Integrated Co-Occurring Disorders. Develop tool kit/resource directory for Cultural Competency.

Service Delivery Work Group o Support utilization of Evidence Based Practices, Research Based Practices, Best Practices and Promising

Practices. Coordinate training and supports, including in house expertise for Supported Employment,

Permanent Supportive Housing and Co-Occurring Disorders. Provide C3 De-escalation training for direct support staff and Providers.

29

o Measure effectiveness of Evidence Based Practices, Research Based Practices, Best Practices and Promising Practices, including but not limited to: Supported Employment, Permanent Supportive Housing and Co-Occurring.

Emphasis through training and supports on Outcomes-positive results with individuals. Assist Agencies in determination of fidelity.

o Develop a statewide EBP Provider list and populate QSDA website.

Service Assessment Work Group o Provide Outcomes training.

Provide Outcome Project Overview training Train Regional Staff to perform data reviews Train Regional Staff and Providers to utilize data to set goals.

o Generate Outcome reports from CSN and validate accuracy. Survey Providers and CEOs to establish report content Develop Provider report procedure manual Generate Regional report Generate a statewide report

o Implement Phase II, Data Review Train Regional staff Review 12 months of Provider Outcome data.

o Implement Phase III, Setting Annual goals and Develop Incentives Create Agency summary from 12 month data review. Establish Outcome targets and goals for next 12 months. Create Provider supports to maintain and improve performance.

System Infrastructure o Website – Populate Work Group data and resource information

Expand Functionality Create training listing Populate Work Group info.

o Initiate and Coordinate training Work with the Community Services Training Committee, IACP, MCOs, and DHS to develop training

tracks. Coordinate train the trainer functions.

o Participate in planning and developing Value Based Service Delivery system.

FY 17 Accomplishments

Maintained member participation. o QSDA has membership participation from the Regions, Providers, MCOs and DHS.

Implemented and increased participation in the Outcomes Project o Currently outcomes are being entered by 181 Providers. o Have moved to Phase II, Data Review, Goal Setting and Incentives, of the Outcomes Project. o Provided training on the Outcomes Project

Maintained and enhanced the CSN Provider Portal. Training Process – Worked with the Iowa Community Services Affiliate, Regions and the Iowa Association of

Community Providers to establish a process to coordinate and fund training within the QSDA scope. Began working with a multi-regional consortium looking at EBPs for supported housing and employment.

30

Training o Trainings were conducted on Evidence Based Practices, 5 star quality, value based contracting and Trauma

Informed Care. A second EBP Survey was sent to Providers and results summarized

o Determined which EBPs were being utilized. o Measured EBP knowledge. o Looked at the level of fidelity.

Met regularly with Regional CEOs providing updates and recommendations. MCOs – had meetings with AmeriHealth and Amerigroup. Are looking at how outcome data may fit in with their

reporting and evaluation needs and how data may be managed.

Collaboration with DHS regarding Medicaid Assistance NWIACC partners with stakeholders to ensure the authorized services and supports are responsive to individuals’ needs consistent with system principles and are cost effective as follows: Through the current IA Health Link Plan (fka Iowa Plan) Northwest Iowa Care Connections monitors the utilization of programs that constitute supported community living (i.e. Habilitation services, integrated health homes) and those that are part of special initiatives to ensure proper coordination with region-financed services. Since NWIACC does not supplement rates nor does it pay for services provided to individuals who have been decertified based on the state contractor’s medical necessity criteria, NWIACC works with Iowa’s Medicaid funded contractor (s) to seek alternatives to assist clients in the region to access services and funding as their needs require. NWIACC does not approve admissions to Mental Health Institutes (MHIs) for persons who are enrolled in the Iowa Plan and/or Health Link so works with local providers and consumers to access alternative options that can be funded through the Iowa Plan and/or Health Link when available. Prior to authorizing regionally -financed services, NWIACC Disability Services Coordinators determine if treatment providers and coordinators of services requested the Medicaid managed care company pay for Iowa Plan-covered services for eligible consumers and that all available levels of appeal were accessed and followed through on in the event of denials by the Medicaid managed care company. Third-party Payers NWIACC Disability Service Coordinators work with treatment providers to seek approval from Medicaid, Medicare, or any other third-party payer for any service that is similar to the region-financed services being considered. If a provider licensed or certified by the state loses that license or certification and, as a result, may no longer participate in the Medicaid or Medicare program or be eligible for reimbursement from third party payers, NWIACC works with the client to find alternative service providers who are properly licenses and certified by third party payers. NWIACC Disability Service Coordinators works with affected clients and their service provider (s) to address the provider’s responsibility for filing reports necessary to maintain Medicaid eligibility for an individual consumer since NWIACC Region will not assume financial responsibility for the share of service costs which could have been billed to Medicaid. Chemical Dependency Services Northwest Iowa Care Connections coordinates training and technical assistance to encourage all network providers to be capable of serving individuals with multi-occurring disorders, including chemical dependency. Northwest Iowa Care Connections provides payment for mental health and intellectual/developmental disability services that fully integrate chemical dependency treatment and recovery supports as defined by mental illness diagnostic criteria.

31

Attachment A. Regional Access Points

Access Point Address Phone

Cherokee MHI 1200 W. Cedar Loop Cherokee IA 712-225-2594

Department of Human Services

Targeted Case Mgt.

2105 Main St Room 103

Emmetsburg, IA 50536

21 W. 6th St. Suite 306

Spencer IA. 51301

2400 Park Street, Suite 2

Sheldon, IA 51201-8506

Pam Moldovan: Work Cell:

712-830-1509

Jamie Holmes: Work Cell:

712-540-5873

NWIACC Regional Offices 1802 Hill Ave.

Spirit Lake IA 51360

215 W. 4th St. Ste. 6

Spencer, IA 51301

315 1st Ave. Suite 200

Rock Rapids, IA 51246

712-336-0775

712-262-9438

712-471-8240

Seasons Center 201 E. 11th St. Spencer, IA 51301 712-262-2922

800-242-5101

Spencer Hospital

1200 1st Ave. E. Spencer IA 712-264-6228

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Attachment B. Provider Network

NWIACC Regional Network of Providers Funded Programs in the NWIACC Region

Broadlawns Regional Medical Center 1801 Hickman Road Des Moines, IA 50309 515-282-2200

Adult Inpatient Psychiatric Services

Cherokee Mental Health Institute 1200 W. Cedar Cherokee, Iowa 51012 712-225-2594

Adult Inpatient Psychiatric Services

Admission and Discharge Coordination Services

Community and Client Services of Iowa 518 9th Ave. N. Sibley, Iowa 51249 712-754-3608

Supported Community Living

Compass Pointe 1900 Grand Ave. N. Suite A. Spencer, IA 51301 712-262-2952

Multi-Occurring Disorders Crisis Care

Jail Multi-Occurring Disorders Screening Services

Creative Living Center 1905 10t h St. Rock Valley, IA 51247 712-476-5245

Adult Outpatient MH Services

Department of Human Services 20 W. 6th St. Spencer, Iowa 51301 712-264-3540

Targeted Case Management

Hope Haven-Headquarters 1800 19th St Rock Valley, Iowa 51247 712-476-2737

--Hope Haven-Clay County

Box 225

Spencer, IA 51301

712-262-7805

--Hope Haven-Dickinson County

1808 Jackson

Spirit Lake IA 51360

712-336-4052

--Osceola County Work Services (OES)

1206 11th Ave

Sibley, IA 51249

712-754-2635

--Hope Haven-O’Brien County

212 10th St.

Sheldon, IA 51201

712-324-3286

--Hope Haven- Palo Alto County

968 Broadway Suite #2 Emmetsburg, IA 50536 Phone: 712-852-3101

Supported Community Living Respite

Employment and Day Services MI Day Habilitation

Crisis Services Adult Outpatient Therapy

Peer Support Jail Multi-Occurring Disorders

IPR Screening & Therapy Services

33

Horizons Unlimited 3826 460th Ave. Box 567 Emmetsburg, IA 712-852-2211


Employment and Day Services

Kathleen’s RCF 1505 E. 5th St. Emmetsburg, Iowa 50536 712-852-2267

Residential Services


Life Skills 1510 Industrial Rd. SW LeMars, IA 51031 712-546-4785


Mercy Medical Center North IA 1000 4th St. SW Mason City, Iowa 50401 641-428-7000

Inpatient Psychiatric Services

Mercy Medical Center 1111 6th Ave. Des Moines, IA 50314 515-247-3121

Inpatient Psychiatric Services

New Horizons Psychiatric Care 1004 21st St. Milford, IA 51351 712-338-6911

Mental Health Evaluation

Prairie View 18569 Lane Road Fayette, IA 52142 563-425-3291


Pride Group 214 Plymouth St SE LeMars, IA 51031 712-546-6500 6059 390th St. Primghar, IA 51245 712-757-6375



Habilitation Services

Seasons Center for Behavioral Health 201 E. 11th St. Spencer, IA 51301 712-262-9438 1-800-242-5101

Inpatient Psychiatric Hospitalization-Evaluation and Treatment Outpatient MH Services – Psychiatric Evaluation & Medication Management Outpatient Therapy Services Community Based Services (CBS) Crisis Services Family and/or Peer Support Services Multi-Occurring Disorders Care

Spencer Hospital 1200 1st Ave. E. Spencer IA 51301 712-264-6228

Inpatient Psychiatric Hospitalization

Unity Point (Iowa Lutheran & Iowa Methodist) 700 E University Ave Des Moines, IA 50316 515-2635-5612

Inpatient Psychiatric Hospitalization

Village Northwest 330 Village Circle Sheldon, IA 51201 712-324-4873



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Willow Heights 60191 Willow St. Atlantic, IA 712-243-3411



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Attachment C. Regional Satisfaction Surveys Fiscal Year 6/30/17 and Comparable Information Northwest Iowa Care Connections completed the satisfaction survey process with input that was sought from both consumers and Parents/Family Members/Guardians at the close of the 6/30/2017 Fiscal Year. While the Parent/Family Member/Guardian survey remained the same as it was in past years, the consumer survey was changed slightly to include questions that it was hoped would provide additional information that was more useful in nature, these surveys were returned with mixed results, as many of the additional questions weren’t answered. Below you will see in the table the additional information asked of our regional clients, and you will also note that we received 21 of 53 surveys sent for a return percentage of 40%, this is compared to a return percentage of 31% in FY 15, and 61% in FY 16.

Question: Yes No

Are you Working? 14 8

Question: Community Facility-Based

If yes, what type of Employment? 7 9

Question: No Answer 1-5 hours/week 15-30 hours/ week More than 30/week

Hours per week you are working

2 1 2 3

Question: Independently Staffed Home with Roommates

Residential Care Facility

Home with Relatives

Where do you live now?

10 4 6 1

Question: No Amount Specified

Paid by Piece Rate

Rate at $4.10/hr Rate at $7.25/h4 Rate at $11.00

Wages 3 2 1 3 1

Of the 2 individuals responding that they were unhappy with their work, they indicated they would like a different work place if they could change.

The additional comments included:

Would like more workshop hours if I could get them. Really like doing newspapers, assembly work or pop line.

Who is regional staff? Hours of work varies with the job.

36

The first table below indicated the results of the standardized questions asked for the FY 17 year and then compared those same results with the FY 15 and FY 16 years. Table 1.

Table 2.

0 5 10 15 20 25

Were you able to get services when you needed them?

Were you given options for services?

Were the regional staff helpful in getting the services you…

Are you happy with your services?

Are you included in the planning of your services?

Do you like your job?

Do you like where you live?

Consumer Satisfaction Survey FY 17 (21 of 53 Responding = 40%)

Agree: Agree Most of the Time Neither Agree or Disagree Disagree Most of the Time Disagree

0

5

10

15

20

25

30

Consumer Satisfaction Survey Comparing FY 15, FY 16 and FY 17


37

The survey distributed to the Parents/Guardians or Family Members had the following listed as additional comments:

As a retired Psychiatric nurse, I am frustrated with the inability to hospitalize my son when needed. The medications have caused him diabetes insipidus (lithium) and fluid around the heart (Clozaril). I would like a review of his medications. He was hospitalized for 8 days in Sioux Falls after the Spencer inpatient unit refused his admission – why?? I would like to see him evaluated before other physical problems occur.

Family member’s rent is too high.

Would like if she had more hours to work.

Upon receiving this survey, I was not familiar with Northwest Iowa Care Connections and their role in my sister’s services. I called the Lyon County office and appreciated the call back from Lisa explaining the role of the region with Village Northwest.

I get reports, not questions.

Thank you very much!

We are very satisfied with all the programs that our family member is able to participate in and all the services and staff that work for and with them.

Family member gets excellent care, could not be more pleased!

Family member appears to be happy with his working and living style when I see him.

Because we live in Florida, we have very little opportunity to be involved with the planning of services and contact with staff. We are satisfied with our family member’s situation. She seems happy and when we receive reports, she presents few issues/problems.

The following table #3 represent the responses received from the family members for the FY 17 year with 19 of 29 responding for a 66% return rate. We have included a final table #4 that shows FY 15, 16 & 17 compared. Table 3.

0

2

4

6

8

10

12

14

16

18

20

Were you ableto access theservices you

wanted for yourfamily

member?

Were you ableto access theservices when

your familymember

needed them?

Did the regionalstaff provider

you withservice optionsfor your family

member?

Are yousatisfied withthe regionalservices your

family memberreceives?

Do you believeyou are

included in theplanning of

their services?

Are yousatisfied withyour familymember's

current job?

Are yousatisfied with

the hours yourfamily member

is working?

Are yousatisfied withwhere your

family memberis living?

Parent/Guardian/Family Member Survey FY 17 (19 of 29 Responding = 66%)


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Table 4.

0

5

10

15

20

25

Parent/Guardian/Family Member Survey Results FY 15, 16 & 17 Compared


fy 2017 annual report - nwiacareconnections.org€¦ · mgt assessment evaluation regional contract...

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