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Resolution 2017-076 RESOLUTION NO. 2017- 76 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, ADOPTING THE TRANSPORTATION PLAN FOR ACUTE CARE SERVICES FOR ADULTS AND CHILDREN IN COLLIER COUNTY FOR STATE FISCAL YEAR 2017-2010. WHEREAS, in 2016, the Florida Legislative passed Senate Bill 12, requiring communities to develop a coordinated transportation plan to serve those suffering with acute substance abuse and mental health issues. The intent of the legislation is for communities to I develop plans that provide safe and well-coordinated transportation to the nearest designated receiving facility; and WHEREAS, Collier County, as a member of the Department of Children and Families Suncoast Region, and through its participation in the Community Behavioral Health Advisory Committee, has a transportation plan in place to serve this vulnerable population; and WHEREAS, the Board of County Commissioners desires to adopt this transportation plan to meet the legislative requirement set forth in Senate Bill 12. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that the Collier County Transportation Plan 2017-2020, as attached hereto and made part hereof, is hereby adopted in accordance with Senate Bill 12. THIS RESOLUTION ADOPTED after motion, second and majority vote favoring same,thisaS*' day of ?i- , k , 2017. ATTEST: ` BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK,CLERK COLL i' !.l1U TY, FLORIDA __. //leb: ' ;.'" i 4 1 ' e • i . ii By. T•, F • ,�' AN it ty Clerk PENNY : OR, C • s signature only. Approved as to form and legality: ‘-----A ' ,--"k Jenni er A. Belpedio 09 Assistant County Atto t DEPARTMENT OF CHILDREN AND FAMILIES SUNCOAST REGION SUBSTANCE ABUSE AND MENTAL HEALTH COLLIER COUNTY TRANSPORTATION PLAN 2017-2020 Page °'6 r^ . Introduction 2 Purpose 2 Community Behavioral Health Advisory Committee 3 Goals/Objectives 3 System Capacity 3 Baker Act Transportation 4 Medical Treatment 4 Criminal Charges 5 Transportation between Facilities 5 System Oversight 5 Inter-organizational Collaboration 6 Index 7 Letters of Support 15 Collier County Transportation Plan 1 Introduction In accordance with Florida Statute Chapter 394,Part 1,Florida Mental Health Act or the"Baker Act", Florida Statute Chapter 397,I Ial S.Marchman Alcohol and Other Drug Services Act of 1993,and Senate Bill 12,a plan has been developed to organize a centralized approach for access to acute care services,and to describe how the community shall support and facilitate safe and well- coordinated transportation to the nearest receiving facility system. This plan has been developed by community stakeholders,as described herein,and referred to as the Collier County Community Behavioral Health Advisory Committee(CBHAC).This transportation plan requires approval by the Collier County Board of County Commissioners,Central Florida Behavioral Health Network and the Department of Children and Families. Upon approval,this document will serve as the transportation plan for Collier County per legislative intent,and be referred to as the Collier County Transportation Plan(CCTP). The intent of this plan is to: 1. Describe methods of transport to a facility within the designated receiving system for individuals subject to involuntary examination under s.394.463 or involuntary admission under s_397.6772,s. 397.679,s. 397.6798,or s. 397.6811. 2. Describe the commitment to ensuring a specialized transportation system that provides an efficient and humane method of transporting patients to receiving facilities, among receiving facilities,and to treatment facilities. 3. Describe arrangements by which a facility may provide, in addition to require psychiatric and addiction services,an environment and services which are uniquely tailored to the needs of an identified group of persons with special needs,such as persons with hearing impairments or visual impairments,or elderly persons with physical frailties; 4. Specify how persons shall be transported to,from,or between participating facilities when necessary and agreed to,including persons unable to pay the expense of transportation, pursuant to s. 394462(2). The plan, along with an accurate inventory of designated receiving facilities and related public resources to provide care for persons in need of behavioral health acute care services, shall be maintained and available to law enforcement and to first responders,per s. 394.4573(2)(b). Purpose In the continued best interest of persons in need of public behavioral healthcare in Collier County,it is agreed that this plan will continue the successful established Baker Act/Marchman Act transportation system,known as the Collier County Transportation Plan.The Plan will insure that individuals on an involuntary Baker Act/Marchman Act will obtain immediate access to acute care services and will reduce the need for inter-hospital transfers for psychiatric and addiction services.Coordination of services among providers in Collier County will meet the individualized needs of persons experiencing a behavioral health/substance abuse crisis,with timely access to care. The Plan calls for all law enforcement agencies in Collier County to transport: 1. Adults and youth on an involuntary Baker Act to the David Lawrence Center's Emergency Services Assessment Centel(ESAC). 2. Adults on an involuntary Marchman Act to Collier County Jail Center. 3. Youth under the age of 18 years on an involuntary Marchman Act to the nearest local hospital emergency room. 1 Community Behavioral Health Care Advisory Committee: The purpose of the Community Behavioral Health Care Advisory Committee is to discuss the operations of the Collier County 2 Transportation Plan and to establish ongoing communication for the implementation of best practices and quality behavioral health services via a community collaborative approach.The committee meets regularly to discuss grievances,public satisfaction,and assurance of patient rights as related to this plan. The Community Behavioral Health Care Advisory Committee is composed of,but not limited to, representatives of the following agencies: • Central Florida Behavioral Health Network • City of Naples Police Department • Collier County Emergency Medical Services. • Collier County Sheriff's Office • David Lawrence Center • Department of Children and Families Substance Abuse and Mental Health office • Florida Department of Corrections • Hazelden-Betty Ford Foundation-Naples • National Alliance on Mental Illness • Naples Community Hospital • Park Royal Hospital • Physicians Regional Healthcare System • Riverside Behavioral Health Center • The Will ough of Naples Goals and Objectives The following objectives are expected to be met by establishing this Transportation Plan for Collier County: • Implement an integrated and coordinated system of transportation and access to psychiatric services for children and adults under a Baker Act order and appropriate and available substance abuse services for adults or children under a Marchman Act order for Collier County • Provide specialized services to children and the elderly. • Assist law enforcement in the efficient transport of individuals in need of services to the most appropriate facility. • Enhance the ability to fully utilize the capacity of acute care services in the county and reduce the unnecessary delay of transfers between facilities. • Ensure timely access to care, continuity of care, and provide integrated and client-centered coordination of care among providers. System Capacity • David Lawrence Center(DLC), located at 6075 Bathey Lane,Naples,FL is a public receiving facility licensed by the Agency for Health Care Administration(ARCA)to operate 30 Crisis Stabilization Unit beds for adults and minors. DLC also operates a 12-bed adult substance abuse detox facility,and 18 adult substance abuse residential beds. At all times,DLC will maintain the current number of publicly funded beds serving the needs of Collier County residents. • Naples Community Hospital(NCH)and Physicians Regional Medical Center(PRMC)are not receiving facilities,but are responsible to evaluate, treat and transfer persons in need of mental health and addiction treatment as part of their emergency department.This is in accordance with federal(EMTALA) emergency care rules and the medical treatment aspect of the plan applies to NCH and PRMC • The receiving facilities within the County,and in near-by sister Counties will notify the 3 "j 9 Community Behavioral Health Care Advisory Committee of any changes in system capacity. • Overflow: The David Lawrence Center(DLC) CSU is licensed by the Agency for Health Care Administration for a specified number of beds for adults and children.At no time will the David Lawrence Center's census status prevent the acceptance of a law enforcement Baker Act. DLC and local community hospitals will follow Florida Statute and EMTALA regulations regarding the care of clients at the hospital who are under the Baker Act when a bed is not available at the CSU. Baker Act Transportation • Law enforcement agencies in Collier County will remain the responsible parties to transport those individuals in need of mental health services under the Baker Act to the nearest receiving facility. Transportation to,from,or between facilities may be required due to several factors, including medical necessity, inpatient acute care capacity,or individual choice. The receiving facility, and the facility that the person is being transported to or from shall coordinate these transportation arrangements. • if an individual has a medical issue that needs to be addressed or an intoxication level that is medically compromising,Emergency Medical Services are required to transport the individual being detained under a Baker Act order to the nearest emergency care center for medical stabilization.When the individual has been stabilized,and is accepted by the Baker Act receiving facility,the Baker Act receiving facility will notify law enforcement to transport the individual to the receiving facility, Medical Treatment Community Behavioral Health Care Advisory Committee will review medical exclusionary guidelines that will be used to assist in determining the most appropriate inpatient setting for psychiatric patients requiring hospitalization.These guidelines will be shared among all the community partners to ensure that individuals who are assessed to need medical care are treated in an emergency care center or medical facility. When medically necessary,persons are treated for high-risk physical health care conditions either at an emergency department or appropriate health care facility(either Naples Community Hospital or Physicians Regional Medical Center).In the event a person arrives at an emergency room,it is the expectation that the hospital will abide by federal Medicare Guidelines Section 1867,(COBRA) Examination and Treatment for Emergency Medical Conditions and Women in Labor(EMTALA)to screen,examine,stabilize,treat and transfer individuals appropriately.in turn,the designated receiving system shall work with the emergency room to coordinate the ongoing care of the individual, whether it is an outpatient discharge or referral or inpatient treatment. Once an individual has been medically cleared by the hospital and accepted by the receiving facility: • Fndividuals under the Baker Act will be transported to the David Lawrence Center by the Collier County Sheriff's Office,unless an active felony criminal charge is present, which requires transfer to the Collier County Jail. • Adults under the Baker Act who are medically stabilized and who have Medicare insurance will be offered transfer to the nearest Medicare-receiving facility (e.g.,Park Royal Hospital or riverside Behavioral Hospital.) 4 Criminal Charges: Law enforcement will be required to transport individuals in need of mental health services under the Baker Act directly to the Collier County Jail if charged with a felony or violent misdemeanor crime. If charged with a non-violent misdemeanor, the arresting law enforcement agency will transport the individual to the appropriate receiving facility with the"Jail Hold form." If the individual is charged with a felony or violent misdemeanor,the individual will be transported to the Collier County Tail.Once the individual has completed the booking procedure,the Jail medical personnel will be required to notify the receiving facility of the nature of the crime and to request prior approval before arranging a transfer.The receiving facility will review each felony Baker Act referral case by case to ensure that the facility can safely manage the needs of the individual.The Baker Act facility can determine that the felony Baker Act referral is not appropriate for transfer/admission to the receiving facility and will provide a letter of written refusal of the Baker Act felony referral in such cases where the referral is not appropriate for admission to the receiving facility.Other arrangements for servicing the Baker Act will be coordinated between the facilities. Upon completion of treatment for individuals who are designated"Jail Hold" as a result of being booked prior to treatment,the receiving facility will be required to contact the Collier County Sheriff's Office to arrange for transportation to the Collier County Jail. Transportation between Facilities-Post-Admission: Once an individual is in the care of the receiving facility,there will be occasions when that individual needs to be transferred from one facility to another. The Baker Act receiving facility will arrange for trained staff to provide transportation when indicated if a medical emergency is not present,to include arranging for transfer to the State Hospital facility. For individuals transferred out of county to a private facility based on choice,the receiving facility will coordinate transfer arrangements with contracted approved transportation providers and in coordination with the out of county private receiving facilities. When such arrangements are not available or suitable, trained staff from the receiving facility may provide transfer out of county to another receiving facility. In the case of medical emergencies,the local EMS system will provide transportation to the nearest and appropriate local hospital facility,post admission,and will be provided with a copy of the Baker Act. When a client is on a jail hold, the receiving facility must contact the local law enforcement agency to ensure an appropriate escort of the individual to the local hospital for safety. Law enforcement is not responsible to transport individuals from one facility to another unless the individual has criminal charges. System Oversieht/Accountability In an effort to resolve complaints, grievances, and disputes which may arise during implementation of the plan, personnel from above referenced agencies will meet.The Community Behavioral Health Care Advisory Committee will implement necessary actions in response to its ongoing review and any public or Central Florida Behavioral Health Network(CFBHN)or Department of Children and Families review. The Suncoast Region Department of Children and Families,Substance Abuse and Mental Health Program Office and CFBHN is responsible for providing oversight to the Transportation Plan.The Department of Children and Families and CFBHN have the authority to resolve issues concerning the Transportation Plan,approve interagency agreements, as well as coordinate other services needed for individuals beyond • acute care services.The Regional office also has a working relationship with the Agency for Health Care Administration if issues arise beyond the department's authority.The Suncoast Region Substance Abuse and Mental Health Program Office telephone number in Tampa is 813-337-5700. 5 r' Interorganizational Collaboration Implementing an effective Transportation Plan on behalf of persons in need of behavioral health services requires a significant amount of cooperation,commitment and collaboration from all parties involved. Besides having the strong support of law enforcement and the behavioral health providers,Collier County hospitals have engaged in a public planning process which has strengthened the relationships between all parties responsible for implementing the Transportation Plan in Collier County.The community support for this plan is evidenced by the attached letters. Index of Attachments to Collier County Transportation Plan A. Definitions B. Acute Care Services Overview C. Collier County Sheriff Office MOU/Transportation Plan(Pending final approval) D. Letters of Support(Pending) E. David Lawrence Mental Health Certificate of Liability Insurance(Note: Certificate will be attached with final PDF version. Includes minimum of$100,000 as specified in Checklist.) i 6 Attachment A DEFINITIONS Baker Act: The Florida Mental Health Act, Marchman Act: The Hal S.Marchman Alcohol and Other Drug Services Act Receiving Facility: Any public or private facility designated by the Department of Children and Families to receive and hold involuntary patients under emergency conditions or for psychiatric evaluation and to provide short-term treatment. Private Receiving Facility: Any hospital or facility operated by a for-profit or not-for-profit corporation or association that provides mental health services and is not a public facility. Public Receiving Facility: Any facility that has contracted with the Department of Children and Families to provide mental health services to all persons,regardless of their ability to pay, and is receiving state funds for such purpose. Law Enforcement: Means any person who is elected,appointed,or employed full time by any municipality or the state or any political subdivision thereof; who is vested with authority to bear arms and make arrests;and whose primary responsibility is the prevention and detection of crime or the enforcement of the penal,criminal,traffic, or highway laws of the state.This definition includes all certified supervisory and command personnel whose duties include, in whole or in part,the supervision,training, guidance,and management responsibilities of full-time law enforcement officers,part-time law enforcement officers,or auxiliary law enforcement officers but does not include support personnel employed by the.employing agency. Law Enforcement Agencies Serving Collier County: Collier County Sheriff's Office Naples Police Department Marco Island Police Department Florida Highway Patrol Seminole Police Department • 7 Attachment B Introduction: David Lawrence Center, Inc., d.b.a. David Lawrence Center, is a private, not-for-profit community mental health center whose primary mission is to provide a wide range of mental health, alcohol and substance abuse services to meet the needs of the citizens of Collier County. Furthermore, David Lawrence Center's Board of Directors and management staff are committed to a planning and performance improvement process consistent with the overall mission of the agency. This Written Plan for Clinical Services establishes a framework to identify the organization's values and the goals and objectives that rise from them; to assess the organizational environment as to its opportunities and challenges; to assess the resources and capabilities that are allocated; to identify and form the organizational components and determine the authority, responsibility and communication relationships they have with one another; and to develop the management and decision-making structure which allows the organization to allocate its resources in order to realize its values within the constraints of its environment, It is reflective of the efforts made, through formal and informal planning processes, to address the future growth and development of the David Lawrence Center. Core Values: The Center, its leaders and employees support and implement core values of service provision throughout the service delivery process,including but not limited to: • Accessibility and timeliness of services • Life Changing Wellness • Recovery and resilience based care • Provision of exceptional compassionate care utilizing healthcare practices • Caring and supportive environment • Client-centered care • Client empowerment and satisfaction with care • Continuity of care and services • Continuous improvement and learning • Cultural competency • Effectiveness of care through the use of Evidence Based Practices • Employee empowerment and satisfaction • Empowered Leadership who honor their word • Least restrictive care • Management of information and technology • Outcomes focused • Professional/clinical competence • Respect the dignity and expression of each individual • Safety • A spirit of teamwork where everyone matters 8 � ,r Acute Care Services A. INTRODUCTION Emergency Services Assessment Center(ESAC)is staffed with Emergency Service(ES)clinicians who are available to provide clinical triage services for emergency referrals. Services include Crisis Assessment, Risk Assessment, Crisis Intervention,Crisis Support referral for Urgent Care Services or other appropriate service(s) within or outside the agency, andlor referral for admission to an appropriate Acute Care Unit, The Emergency Services Assessment team works collaboratively with the Acute Care team,where ongoing clinical triage/assessment occurs off hours and on weekends. The ESAC serves as the Collier County Baker Act receiving facility. The Adult Crisis Stabilization Unit (CSU) is a 24-bed, locked, non-hospital inpatient mental health unit that provides brief voluntary and involuntary evaluation and stabilization treatment services for individuals experiencing a psychiatric crisis who meet the criteria defined under the Florida Mental Health Act. The Children's Crisis Stabilization Unit (CCSU) is a 4-bed, locked,.non-hospital inpatient mental health unit, which provides brief voluntary and involuntary evaluation and stabilization services for children who are in a psychiatric crisis. B. REFERRAL SERVICES Emergency Services Assessment Center, Adult&Children's Crisis Stabilization Unit: Referrals to the Emergency Services Assessment Center (ESAC) include self-referrals, professionals within or outside of the David Lawrence Center and/or law enforcement. Individuals may access walk-in crisis services 24 hours a day,seven days a week. ESAC provides telephone triage and crisis intervention outside the normal business hours and during regular business hours. Baker Act admissions and law enforcement cases are received 24/7. Involuntary admission to the CSU may be through appropriate professionals,law enforcement or ex-parte court orders, identified in the Florida Mental Health Act(Baker Act). The Crisis Stabilization Units serve any person who without care or treatment of a mental illness, may cause harm to his/herself or others as evidenced by recent behavior or who, without care or treatment, is likely to suffer from neglect,refuse to care for his/herself,or pose a real and present threat of substantial harm to personal well-being. Individuals admitted will be determined to meet the Baker Act criteria,as per the Florida Mental Health Act(Ch.394). Individuals may he admitted under voluntary or involuntary status. 9 Attachment D Collier County Sheriff Office MOU/Transportation Plan Between Collier County Sheriff Office (Law Enforcement Agency),and David Lawrence Mental Health Center Inc. (Baker Act receiving facility). In order to implement the provisions of 094.462 Florida Statute enacted by the 2009 Florida Legislature governing transportation of persons by law enforcement from a hospital to receiving facilities for involuntary examination,or from a receiving facility to the jail,the following is required: 1. Each law enforcement agency shall develop a memorandum of understanding with each receiving facility within the law enforcement agency's jurisdiction which reflects a single set of protocols for the safe and secure transportation of the person and transfer of custody of the person. These protocols must also address crisis-intervention measures. 2. Custody of a person who is transported pursuant to this part,along with related documentation, shall be relinquished to a responsible individual at the appropriate receiving or treatment facility. Therefore it is agreed that: 1, Law enforcement officer shall deliver each individual under involuntary examination status to the nearest receiving facility. This transportation plan requires approval by the Collier County Board of County Commissioners,Central Florida Behavioral Health Network and the Department of Children and Families. 2. The law enforcement officer will determine which receiving facility is the nearest by relying on knowledge of the geographic area or by requesting dispatch to use MapQuest. 3. When possible, either the officer or the Communications Center will give the facility a courtesy telephone call to alert the staff that the officer is en route. The facility agrees that such a courtesy call will not be used to instruct an officer to take the individual to any other facility. 4. Upon arrival with the individual,the officer will complete legally required paperwork and then may leave the individual at the receiving facility with Clinical staff at the Emergency Services Assessment Center at David Lawrence Center unless the individual is being violent or combative,or the person has serious criminal charges in addition to the involuntary examination under the Baker Act. If the individual becomes violent or combative after the deputy leaves the receiving facility and staff reports this to the law enforcement agency nearest to the receiving facility,a law enforcement officer will be dispatched as soon as possible. 5. The facility to which the individual is brought by law enforcement for involuntary examination will accept the person and conduct the examination. 6. If the facility has no available beds, or has determined that the person is in need of services from a different facility (including medical), arrangements for a safe and appropriate transfer of the individual to a different receiving faciliO/medical facility will be made by the facility that first received the individual (See #8 below). The facility will not ask an officer to transport such an individual. 7, Transport companies used for transfers between receiving facilities and/or medical facility and receiving facility include: Collier County EMS, Ambitrans, MediCab, David Lawrence Center- approved staff when indicated, or hospital-approved transportation. Safety provisions include: 10 14":,)1 / Appropriate Medical equipment to meet client needs,appropriate level of supervision to ensure safety and prevent elopement. 8. The receiving facility will ensure that the person's safety is protected and dignity is respected through application of all David Lawrence standards of care as written in clinical policies and procedures,the code of ethics,Quality Assurance and Improvement Plan, Safety Plan and the Client's Rights Handbook. 9. The receiving facility will ensure that the individual receives the Mandatory Initial Involuntary Examination prior to release, but if found to meet criteria for admission, will be admitted or transferred to another receiving facility. If not appropriate, the individual will be released with referral to community services as appropriate. 10. Regarding individuals with criminal or non-criminal charges in addition to the initiation of a Baker Act involuntary examination: a. A law enforcement officer who has custody of an individual based on a non-criminal violation or arrested for a misdemeanor shall transport the individual to the receiving facility for examination before booking in the jail; b. A law enforcement officer who has arrested an individual for a felony shall book the individual into the jail in the same manner as any other felony arrest. The jail will thereafter immediately notify a public receiving facility, which shall be responsible for promptly arranging for the examination of the individual,wherever the individual is held. 11.The law enforcement officer will inform facility personnel in each situation where an individual has violations or criminal charges and the facility will not release such persons except back to the law enforcement agency that brought the individual to the facility. 12.Other Issues: Collier County Sheriff's Office David Lawrence ental Health Centel Inc. Name of Law Enforcement Agency N o i ct Receiving Facility 4111 104.1 " Signature: �'f' :. Person for Agency Siu r. ofAutho Person for Facility Printed Name of Authorized Person Prod Name of Au prized Person Date MOU Signed by Authorized Person Date MOU Signed by Authorized 11 Parties of Agreement for COLLIER COUNTY TRANSPORTATION PLAN 2017-2020 Acknowledgment Form The b� � p V1,yt S kY;#c 61') 'ti does hereby confirm (Agency name) that we have received a written copy of the Collier County Transportation Plan 2017-2020 and have reviewed and understand the plan. COPY PROVIDED / COPY REFUSED C-0 \i,u1 Lvutir. 5 1 Agency Name Kw1 VI 17 7)-41. /\)0t1Sk \ 1--i Print Name Date moi' Signat r e Date :13) ;fY'