Table Of Content4
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Commonwealth of Massachusetts
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Live Office ofHealth and Human Services
Department ofMental Health
Eileen Elias, Commissioner
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DOCUMENTS
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FISCAL YEAR
1994
ADULT & CHILD/ADOLESCENT
IMPLEMENTATION REPORT
and
FISCAL YEAR
1995
STATE MENTAL HEALTH PLAN
December 1994
The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Mental Health
Eileen Elias, Commissioner
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995 Community Mental Health Services
1
Block Grant Application
(P.L 102-321)
including:
* 1994 Adult and Child/Adolescent
Implementation and Expenditure Report
1995 State Mental Health Plan
December 31, 1994
Digitized by the Internet Archive
2014
in
https://archive.org/details/1995communitymen00mass
1995 BlockGrantApplication December. 1994
Massachusetts DepartmentofMental Health
TABLE OF CONTENTS
EXECUTIVE SUMMARY 5
STATE MENTAL HEALTH PLANNING COUNCIL 7
THE MASSACHUSETTS DEPARTMENT OF MENTAL HEALTH: A
DESCRIPTION 10
1994 IMPLEMENTATION REPORT 20
REQUIREMENT #l: Establishing an organized system ofcare 21
RegulationsandStandards 21
Planning 26
Consumerand CommunityInvolvement 28
REQUIREMENT #11: Quantitative implementation targets 31
TargetedPopulation to be Served 31
Adult consumers 32
Child/adolescent consumers (under 19 ) 33
Deafand hard of hearing consumers 33
Adultswith mental illness/co-occurring psychoactive substance use disorder 34
Children/adolescentswith mental illnesswho also abuse substances 34
Elderly consumers 35
Forensically involved adult consumers 35
Children and adolescents involved with the criminaljustice system 36
ManagementInformation Systems 44
REQUIREMENT #lll:.Access to services 46
IncreasedAccessto Services 46
Access to Services forSpecialandSub-Populations 51
Protection andAdvocacy 62
REQUIREMENT #IV: Availability ofservices 67
ExtentandAvailabilityofServices 68
NewService Programs 73
REQUIREMENT #V: Financial and human resources 78
FundsAvailable forCommunityPrograms 78
AvailabilityofHuman Resources 79
Training 83
EmergencyServices Training 88
REQUIREMENT #VI: Reducing hospitalization 89
Consumersin Hospitals 89
ProgrammaticInitiativesto Reduce Hospitalization 90
REQUIREMENT #VII: Case management 93
Case ManagementModel 94
Size ofPopulation Receiving Case Management Services 95
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1995BlockGrantApplication December. 1994
Massachusetts DepartmentofMental Health
REQUIREMENT#VIII: Homeless mentally ill 96
Planning 101
REQUIREMENT #IX: Integrated services forchildren/adolescents 105
Interagency Coordination 105
REQUIREMENT #X: Rural services 107
Access to Services 107
REQUIREMENT #XI: Prevalence estimates 109
Quantitative Estimates ofSize ofTargetPopulation 109
REQUIREMENT #XII: Block Grant Expenditure Report 11
TABLE I: Summary of Programs and Funding 112
TABLE II: Distribution OfBlock Grant Funds ByArea 11
TABLE III: SFY'94 Expenditures for FFY'93 GrantAward 11
TABLE IV: FFY'93 Block Grant Expenditures byArea 116
1995 STATE PLAN 118
REQUIREMENT #l: Establishing an organized system ofcare 119
Regulations andStandards 121
Planning 123
ConsumerandCommunityInvolvement 124
REQUIREMENT #ll: Quantitative implementation targets 126
TargetedPopulation to be Served- 127
Adult consumers 128
Children under 19 128
Deaf and hard of hearing consumers 129
Adultswith mental illness/co-occurring psychoactive substance use disorder 129
Children/Adolescentswith mental illnesswho also abuse substances 130
Forensically involved adult and child/adolescent consumers 131
Elderly consumers 132
ManagementInformation Systems 133
REQUIREMENT #lll: Access to services 134
IncreasedAccess to Services 135
Access to Services forSpecialandSub-Populations 137
Protection andAdvocacy 145
REQUIREMENT #IV: Availability ofservices 148
Adult Mental Health Services/Annual Capacity 149
Child/Adolescent Mental Health Services/Annual Capacity 150
ExtentandAvailabilityofServices 151
New Service Programs 153
REQUIREMENT #V: Financial and human resources 154
FundsAvailable forCommunityPrograms 155
AvailabilityofHuman Resources 156
Training 158
Emergency Services Training 160
REQUIREMENT #VI: Reducing hospitalization 161
1995 BlockGrantApplication December. 1994
Massachusetts DepartmentofMental Health
Consumersin Hospitals 163
Programmatic Initiatives to Reduce Hospitalization 163
REQUIREMENT #VII: Case management 165
Case ManagementModel 165
Size ofPopulation Receiving Case ManagementServices 167
REQUIREMENT #VIII: Homeless mentally ill 167
Planning 169
REQUIREMENT #IX: Integrated services forchildren/adolescents 172
Interagency Coordination 173
REQUIREMENT #X: Rural services 174
Accessto Services 174
REQUIREMENT#XI: Prevalence estimates 175
REQUIREMENT #XII: Block Grant Spending Plan 176
TABLE 178
I
TABLE 179
II
STATE MENTAL HEALTH PLANNING COUNCIL LETTER 181
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1995 BlockGrantApplication December, 1994
Massachusetts DepartmentofMental Health
EXECUTIVE SUMMARY
The 1995 Block Grant Application includes the 1995 State Plan, a report
from the Mental Health Planning Council and an Implementation Report on the
goals, objectives and expenditures in the 1994 State Plan. During the past year,
the Department of Mental Health continued the redesign of its service delivery
system to create a system of Public Managed Care, based on the establishment
of Comprehensive Community Support Systems (CCSSs) that assure access,
quality and cost-effectiveness of mental health services. Each CCSS represents
a consumer-centered mix of state and private provider-operated services located
DMH
in one of the Department's 33 natural service areas, grouped within seven
Areas. As the basis for Public Managed Care, a CCSS provides a continuum of
mental health and rehabilitation services that are flexible and responsive to the
individual needs and preferences of adult consumers and of children,
adolescents and their families. Each DMH Area is continuing to develop an
array of mental health services linked to a network of generic and informal
community supports to enable adults and children to live in their home
communities despite severe disabilities.
The goals and objectives in the 1994 State Plan formed the basis of
CCSS multi-year plans for each of the Department's natural service areas.
Highlights of Fiscal Year 1994 accomplishments are: savings derived from the
closing of the Gaebler Children's Center were used to fund one continuing care
inpatient unit and two Clinical Intensive Residential Treatment programs for
young children; policies regarding Smoking, AIDS/HIV+, Standards of Care,
Mandatory Forensic Reviews and Review of Criminal Records for DMH and
Vendor Employees were developed; Utilization Management standards as well
as standards for crisis, day, evening, and other programs were developed and
approved; and a task force met intensively to develop a new way of contracting
for adult and child/adolescent residential services in an effort to provide as much
flexibility as possible in meeting consumers' individual needs and preferences.
In addition, the Department's citizen advisory boards were reorganized, and new
members appointed. Consumers and other interested stakeholders continued to
be involved in DMH planning activities at all levels and advocates met regularly
to discuss and take action on national issues pertaining to health care reform.
In SFY'95, DMH expects to implement the single residential code for
contracts awarded in SFY96 and continue its review of the DMH enabling
statute to ensure that it appropriately reflects DMH's role in a reconfigured
health care system. The infrastructure for the quality and utilization
management systems will be strengthened, standards of care and performance
indicators for the rest of the Department's programs completed, the Client
Registration and Enrollment System further developed and the core curriculum
will continue to be taught to adult and child providers. Finally, there will be
continued focus on service and fiscal integration with Medicaid's mental health
and substance abuse managed care program and on developing an interagency
seamless system of care for children and adolescents.
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1995 Block GrantApplication December, 1994
Massachusetts DepartmentofMental Health
The Mental Health Planning Council continues to monitor implementation
of goals and objectives and approved the workplan for 1995. The Council's
subcommittee on the mental health needs of elders produced recommendations
that will be acted on by DMH in SFV95. A pilot project was initiated in SFY'94,
to continue in SFY95, that addresses some of the unmet mental health needs of
elders through a series of training conferences for professionals and senior
advocates. The Multi-Cultural Advisory Committee held a conference on
multicultural treatment and systems integration issues for professionals,
consumers and family members of color.
The 1995 Plan documents maintenance of effort in spending for
community services, including children's services, and provides a spending plan
for FFY'95, even though the final amount of the federal allocation is uncertain
(as of the time of its submission to the Center for Mental Health Services on
October 1 1994). The Department will use block grant funds to address service
,
gaps identified through the CCSS planning process, furthering the Department's
ability to ensure a public managed care system based on an organized system
of care.
6
1995 BlockGrantApplication December. 1994
Massachusetts DepartmentofMental Health
STATE MENTAL HEALTH PLANNING COUNCIL
The State Mental Health Planning Council was established under P.L.99-
660 as a standing committee of the Statewide Advisory Council (SAC) to the
Massachusetts Department of Mental Health. The SAC is established by statute
(MGL c.19, section 11) and regulation (104 CMR2.16 [5]) and consists of 15
individuals appointed by the Secretary of the Executive Office of Health and
Human Services to "advise the commissioner on policy, program development
and the priorities of need in the Commonwealth for comprehensive programs in
mental health." All members of the Planning Council are nominated and
appointed by SAC and represent consumers, family members, legal advocates,
providers, other state agencies, mental health professionals and professional
organizations, legislators and state employee unions. Membership includes
family members of adults and children and members of cultural and linguistic
minority groups. The Department provides staff to the Council.
Initially the Council appointed six subcommittees from among its own
members and other interested individuals to address what were identified as the
main issues in writing a comprehensive state mental health plan under P.L.99-
660. The subcommittees were: Adult Services, Child/Adolescent Services,
Legal/Human Rights, Human Resources, Finance and Minority Access.
Their work was instrumental in producing the Comprehensive Mental Health
Service Plan issued in May 1991 and revised in September 1991. For the most
part, the subcommittees were dissolved when the Plan was completed. The
Council was reorganized in 1992 and new members were nominated and
appointed by SAC. (It should be noted that many members of the Planning
Council also have been actively involved in the Department's Comprehensive
Community Support System participatory planning process, initiated in 1991 and
described in much detail in the 1993 Implementation Report.) There are
currently three subcommittees, with membership that includes individuals on the
Planning Council as well as other interested persons. These subcommittees
address issues concerning the mental health needs of: elders, children and
adolescents and racial and linguistic minority groups and maintain their own
schedules and agendas.
The Elder Mental Health subcommittee, for example, has been
particularly active in response to concerns about the unmet needs of this
segment of DMH's target population. Last year, the subcommittee proposed a
set of recommendations regarding the mental health needs of the elderly, to
assure their needs are incorporated into the planning and operations of DMH.
Also last year, a Request for Proposals was issued for a training program aimed
at improving and increasing mental health services for this population, and the
Massachusetts Association for Older Americans was subsequently selected to
present four training conferences, funded through the federal block grant, for
professionals and senior advocates. One conference was held in SFV94 and
the remaining three are scheduled for SFV95. The subcommittee's
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