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Agenda 06/25/2013 Item #16D14n 6/25/2013 16.D.14. EXECUTIVE SUMMARY Recommendation to approve the First Amendment to Agreement with David Lawrence Mental Health Center, Inc. (DLC) for substance abuse and mental health services, which will revise the performance measurable goals contained in the Performance Outcome Report OBJECTIVE: To provide behavior and substance abuse services to the Collier County community. CONSIDERATION: On December 11, 2012, item 16.1). 18 the Board approved a contract with DLC for it to provide substance abuse and mental health services. As mandated by Sections 394.76 (9)(a) and (b), Florida Statutes, a commitment has been made to provide funding in the amount of $1,154,200 to the DLC, a provider of behavioral health and substance abuse programs. The contact is for a (1) year period, commencing on October 1, 2012 and terminating on September 30, 2013, with three (3) additional (1) year renewal options. Pursuant to the contract, DLC is required to submit quarterly Performance Outcome Report with specific performance measures for each program. The purpose of this amendment is to revise the contract specific performance measures relating to the each program in the Performance Outcome Report for FY12 /13, Exhibit 3 of the contract. Currently, DLC provides the Performance Outcome Reports, as required in the contract. However, the Performance Outcome Report includes all clients that are served by DLC. The department has revised the performance measures to reflect only those clients and services needing finance assistance. FISCAL IMPACT: There is no fiscal impact associated with this Executive Summary. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated with this Executive Summary. LEGAL CONSIDERATIONS: Section 394.76, Florida Statutes requires the County to participate in the funding of alcohol and mental health services. The amount of the participation shall be at least that amount which, when added to other available local matching funds, is necessary to match state funds. This item is approved as to form and legality and requires a majority vote for approval. - JAB RECOMMENDATION: That the Board of County Commissioners approves the First Amendment to Agreement with David Lawrence Mental Health Center, Inc., which will modify the performance measurable goals contained in the Performance Outcome Report, Exhibit 3. Prepared by: Lisa N. Carr, Grants Coordinator, Housing, Human and Veteran Services Packet Page -987- i'*N 6/25/2013 16.D.14. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.D.16.D.14. Item Summary: Recommendation to approve the First Amendment to Agreement with David Lawrence Mental Health Center, Inc. (DLC) for substance abuse and mental health services, which will revise the performance measurable goals contained in the Performance Outcome Report. Meeting Date: 6/25/2013 Prepared By Name: CarrLisa Title: SHIP Program Coordinator 6/7/2013 4:41:37 PM Approved By Name: GrantKimberley Title: Interim Director, HHVS Date: 6/11/2013 11:35:17 PM Name: SonntagKristi Date: 6/12/2013 10:33:36 AM Name: AlonsoHailey Title: Operations Analyst, Public Service Division Date: 6/12/2013 11:43:05 AM Name: Joshua Thomas Title: Grants Support Specialist, Date: 6/12/2013 12:11:26 PM Name: CarnellSteve Title: Director - Purchasing /General Services,Purchasing Date: 6/12/2013 1:15:57 PM Name: BelpedioJennifer Title: Assistant County Attomey,County Attorney Date: 6/13/2013 4:57:55 PM Packet Page -988- Name: KlatzkowJeff Title: County Attorney Date: 6/14/2013 8:54:37 AM Name: FinnEd Title: Senior Budget Analyst, OMB Date: 6/14/2013 12:07:02 PM Name: StanleyTherese Title: Management/Budget Analyst, Senior,Office of Manage Date: 6/14/2013 4:22:18 PM Name: OchsLeo Title: County Manager Date: 6/15/2013 1:04:30 PM Packet Page -989- 6/25/2013 16.D.14. 6/25/2013 16.D.14. FIRST AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND DAVID LAWRENCE MENTAL HEALTH CENTER, INC. This Amendment, is entered into this day of 2013, by and between David Lawrence Mental Health Center a private not - for - profit corporation existing under the laws of the State of Florida, herein after referred to as "David Lawrence Center" and Collier County, Florida, herein after to be referred to as "COUNTY," collectively stated as the "Parties." WHEREAS, on December 11, 2012, the County entered into an agreement with David Lawrence Center for it to provide substance abuse and mental health services to Collier County residents (hereinafter referred to as the "Agreement "); and WHEREAS, the Parties desire to amend the Agreement by modifying the original Exhibit 3, Performance Outcome Report. NOW, THEREFORE, in consideration of foregoing Recitals, and other good and valuable consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree to amend the Agreement as follows: 1. Exhibit 3, Performance Outcome Report, is replaced with the attached Exhibit 3, Performance Outcome Report. 2. All other terms and conditions of the Agreement remain in full force and effect. This Amendment merges any prior written and oral understanding and agreements, if any, between the parties with respect to the matters set forth herein. IN WITNESS WHEREOF, the Parties have executed this Amendment, on the date and year first above written. DAVID LAWRENCE CENTER: By: Name (print) (Signature of authorized officer) COLLIER COUNTY: By: Georgia A. Hiller, Esg. Name (print) (Signature of authorized officer) Chairwoman Board of County Commissioners Title Packet Page -990- Approved as to form and legality 6/25/2013 16.D.14. EXHIBIT 3 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract r OUTCOME # 1: Crisis Stabilization Unit 1. Outcome Statement including # or %: 468 admissions (10% increase from previous year) will be processed to the Crisis Stabilization Unit during contract year. 2. List the Activities or Services provided by this program. The Crisis Stabilization Unit provides short term, inpatient crisis stabilization and support for individuals or adults who are either at risk of harming themselves or others due to a mental health crisis. David Lawrence Center manages the only Baker Act receiving facility for Collier County which includes emergency services and the Crisis Stabilization Unit. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers of CSU admissions. END OF SECTION ONE Packet Page -991- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services SECTION TWO .Reporting Period:. Contract year — October:a, 2012 September 30,`2013 Due::,OUARTERLY Can be submitted by mail, email or fax OUTCOME # 1: Crisis Stabilization Unit 1. Outcome Statement including_# or %: 468 admissions (10% increase from previous year) N)ill be processed to the Crisis Stabilization Unit during contract year. 2. From data collected during the term of the contract, provide the following information: A. How many admissions were processed into this program during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? NIA END OF SECTION TWO Packet Page -992- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06/01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract OUTCOME # 2: Emergency Services Assessment Center 1. Outcome Statement including # or %: 992 assessments will be completed in the Emergency Services Assessment Center during contract year. 2. List the Activities or Services provided by program. The Emergency Services Assessment Center provides Psychiatric Evaluations and Clinical Assessments for individuals or adults who in crisis. These assessments are completed within the scope of the Baker Act. David Lawrence Center manages the only Baker Act receiving facility for Collier County which includes emergency services and the Crisis Stabilization Unit. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers of assessments completed in the Emergency Services Assessment Center. END OF SECTION ONE LLA Packet Page -993- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services SECTION TWO Reporting Period: Contract year — October.1, 2012 September 30, 2013 Due :.QUARTERLY Can be submitted by mail, email or fax OUTCOME # 2: Emergency Services Assessment Center 1. Outcome Statement including # or %; 992 assessments will be completed in the Emergency Services Assessment Center during contract year. 2. From data collected during the term of the contract provide the following information: A. How many assessments were completed in this program during the specified time period? n B. How many unduplicated clients were measured for this outcome during the time period? C. if answers A and B are different, explain why (sampling, outcome population definition, etc.)? Same individuals are sometimes assessed more than one time during the reporting period. END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -994- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract OUTCOME # 3: Emergency Services Assessment Center 1. Outcome Statement includin #g or %: 305 individuals will be released from Baker Act placement and diverted from inpatient Crisis Stabilization Unit admission during contract period. 2. List the Activities or Services provided by this program. The Emergency Services Assessment Center diverts provides Psychiatric Evaluations and Clinical Assessments for individuals or adults who in crisis. These assessments are completed within the scope of the Baker Act. Individuals may be held in an emergency services screening area according to the regulations of the Baker Act and may be released following professional evaluation that determines Baker Act criteria is no longer met. David Lawrence Center manages the only Baker Act receiving facility for Collier County which includes emergency services and the Crisis Stabilization Unit. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing Baker Act evaluation and release data. END OF SECTION ONE Packet Page -995- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services ' :SECTION TWO Reporting Period: Contract year —October 1, 2012 - September.30. 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 3: Emergency Services Assessment Center 1. Outcome Statement including # or %: 305 individuals will be released from Baker Act placement and diverted from inpatient Crisis Stabilization Unit admission during contract period. 2. From data collected during the term of the contract provide the following information: A. How many individuals were released and diverted from Crisis Stabilization Unit admission during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO _ Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -996- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1. ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06/01/13= 9/30/13 (revised) :SECTION ONE To Be Completed and returned with contract OUTCOME # 4: Crisis Stabilization Unit 1. Outcome Statement including %: 85% or more of individuals discharged from the Crisis Stabilization Unit (CSU) will not be readmitted during the 30 days following discharge. 2. List the Activities or Services provided by this program. The Adult Crisis Stabilization Unit provides short term, inpatient crisis stabilization and support for persons who are either at risk of harming themselves or others due to a mental health crisis. The CSU is the only Baker Act receiving facility for Collier County. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record database and presented quarterly via internal reports capturing numbers and percentages of people re- admitted within 30 days. END OF SECTION ONE Packet Page -997- 6/25/2013 16.D.14. n PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services SECTION TWO Reporting Period:. Contract year October, 1, 2012 - September 30, 2013 Due QUARTERLY Can be submitted by mail, email or fax OUTCOME #4: Crisis Stabilization Unit 1. Outcome Statement including %: 85% or more of individuals discharged from the Crisis Stabilization Unit (CSU) will not be readmitted during the 30 days following discharge. 2. From data collected during the term of the contract provide the following information: A. How many unduplicated clients did the CSU admit during the specified time period? n B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? D. How many of the unduplicated clients from B achieved the outcome during the time period? E. Outcome percentage (D divided by B): END OF SECTION TWO Agencies are welcome to submit a' /2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -998- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract OUTCOME # 5: Adult Medical Services 1. Outcome Statement including # or %: 708 individuals who do not have Medicaid or Medicare coverage will be served in Adult Medical Services. 2. List the Activities or Services provided by this program. Medical Services include Psychiatric Evaluations and Medication Management for persons who are experiencing mental health problems that are serious and acute or related to a services and persistent mental illness. Services also include nursing services in addition to coordination with primary care physician. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -999- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Medical Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 5: Adult Medical Services 1. Outcome Statement includin # or %: 708 individuals who do not have Medicaid or Medicare coverage will be served in Adult Medical Services 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? n B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a' /z page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1000- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Outpatient and Adult Drug Court Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract OUTCOME # 6: Adult Substance Abuse Outpatient and Adult Drug, Court 1. Outcome Statement including # or %: 262 individuals who do not have Medicaid or Medicare coverage will be sewed in Adult Substance Abuse Outpatient Services and Adult Drug Court. 2. List the Activities or Services provided by this program. Substance Abuse Outpatient Services include group and individual therapy and may also include family therapy. Different levels of group therapy are available based on the intensity of the substance abuse or dependency. Treatment focuses on helping the individual accept his /her addiction and support the individual in establishing a recovery lifestyle. 3. List the Activities or Services provided by this program. The Adult Drug Court Program diverts offenders with substance abuse and drug related criminal activity from the criminal justice system by offering them an opportunity to proactively deal with their dependence rather than face punitive alternatives. 4. How are outcomes measured for Adult Substance Abuse Outpatient services and Adult Drug court? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1001- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Outpatient Services SECTION TWO Reporting Period: Contract year — October l,, 2012 - September 30, 2013 Due .:,QUARTERLY. Can be submitted by mail, email or fax OUTCOME # 6: Adult Substance Abuse Outpatient Services and Adult Drue Court 1. Outcome Statement includin #g or %: 262 individuals who do not have Medicaid or Medicare coverage will be served in Adult Substance Abuse Outpatient Services and Adult Drug Court. 2. From data collected during the term of the contract provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a '/z page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1002- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Detox Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) 'SECTION ONE To Be Completed and returned with contract OUTCOME # 7: Detox Services 1. Outcome Statement including # or %: 359 admissions will be served in Detox Program. 2. List the Activities or Services provided by this program. The Detox program is a voluntary, medically- managed program for individuals who are in need of detoxification services utilizing American Society (oj) Addiction Medicine level III. 7d admission criteria. � 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1003- '*—N, 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Detox Services SECTION TWO Reporting Period; Contract year - October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 7: Detox Services 1. Outcome Statement includiny, # or %: 359 admissions will be served in Detox Program. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1004- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06/01/13- 9/30/13 (revised) SECTION ONE To Be Completed and returned with contract OUTCOME # S Immokalee Medical Services 1. Outcome Statement including # or %: 43 individuals who do not have Medicaid or Medicare coverage will be served in Immokalee Medical Services. 2. List the Activities or Services provided by this program. Medical Services provided in the Immokalee Community that include Psychiatric Evaluations and Medication Management for persons who are experiencing mental health problems that are serious and acute or related to a services and persistent mental illness. Services also include nursing services in addition to coordination with primary care physician. 3. How is outcome measured? List the tools /approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1005- n 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Medical Services SECTION TWO Reporting Period: Contract year - October. J1 20,12. September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # S: Immokalee Medical Services 1. Outcome Statement including # or %: 43 individuals who do not have Medicaid or Medicare coverage will be served in Immokalee Medical Services 2. From data collected during the term of the contract provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO I Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1006- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Outpatient Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract OUTCOME # 9: Immokalee Outpatient Services 1. Outcome Statement including # or %: 54 individuals who do not have Medicaid or Medicare coverage will be served in Immokalee Outpatient Services. 2. List the Activities or Services provided by this program, hnmokalee Outpatient services include substance abuse and mental health services designed to promote emotional health and well - being. Mental Health Services include assessment, individual and group treatment services and case management services for persons who are experiencing mental health problems that are serious and acute or related to a severe and persistent mental illness. Substance Abuse Outpatient Services include group and individual therapy and may also include family therapy. Different levels of group therapy are available based on the intensity of the substance abuse or dependency. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1007- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Outpatient Services SECTION TWO Reporting Period: Contract,year. — October 1, 2012 — September 30, 2013 . Due QUARTERLY Can be submitted by mail, email or fax OUTCOME # 9: Immokalee Outpatient Services 1. Outcome Statement including # or %: 54 individuals who do not have Medicaid or Medicare coverage will be served in Immokalee Outpatient Services 2. From data collected during the term of the contract provide the followingyinformation: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1008- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract OUTCOME # 10: Childrens Medical Services 1. Outcome Statement includipZ # or %: 80 children who do not have Medicaid or Medicare coverage will be served in Childrens Medical Services. 2. List the Activities or Services provided by this program. Medical Services include Psychiatric Evaluations and Medication Management for persons who are experiencing mental health problems that are serious and acute or related to a services and persistent mental illness. Services also include nursing services in addition to coordination with primary care physician. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE 1 Packet Page -1009- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Medical Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 . Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 10: Childrens Medical Services 1. Outcome Statement including# or %: 80 children who do not have Medicaid or Medicare coverage will be served in Childrens Medical Services. 2. From data collected during the term of the contract provide the following information: A. How many unduplicated clients did this program serve during the specified time period? /0—*N B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1010- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Urgent Care Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 06 /01 /13- 9 /30 /13(revised) SECTION ONE To Be Completed and returned with contract OUTCOME # 11: Childrens Urgent Care Services 1. Outcome Statement including # or %; 103 children who do not have Medicaid or Medicare coverage will be served in Children Urgent Care Services. 2. List the Activities or Services provided by this prouam. Childrens Urgent Care Services consist of activities aimed at providing centrally accessed quality clinical assessments as well as diverse and brief treatment to the children of Collier County. Treatment services include crisis intervention, individual treatment, group treatment and family treatment in the areas of mental health and substance abuse /dependency. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1011- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Urgent Care Services SECTION TWO Reporting Period: Contract year — October; 1, 2012 — September. 30, 2013 Due :QUARTERLY Can be submitted by mail, email or fax OUTCOME # 11: Childrens Urgent Care Services 1. Outcome Statement including # or %: 103 children who do not have Medicaid or Medicare coverage will be served in Children Urgent Care Services. 2. From data collected during the term of the contract provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1012- 6/25/2013 16.D.14. EXHIBIT 3 Formatted: centered PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2013 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 1: Crisis Stabilization Unit 1. Outcome Statement including # or %: 4(t �8 admissions (10% increase from previous _ Deleted: f zoo yea) will be processed to the Crisis Stabilization Unit during contract year. 2. List the Activities or Services provided by this program. The Crisis Stabilization Unit provides short term, inpatient crisis stabilization and support for individuals or adults who are either at risk of harming themselves or others due to a mental health crisis. David Lawrence Center manages the only Baker Act receiving facility for Collier County which includes emergency services and the Crisis Stabilization Unit. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers of CSU admissions. END OF SECTION ONE Packet Page -1013- /0-• 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 1: Crisis Stabilization Unit 1. Outcome Statement including # or %: 468 admissions (10% increase from previous year) ,, - -{ oeieted:1200 will be processed to the Crisis Stabilization Unit during contract year. 2. From data collected during the tern of the contract, provide the following information: A. How many admissions were processed into this program during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. if answers A and B are different, explain why (sampling, outcome population definition, etc.)? N/A END OF SECTION TWO Agencies are welcome to submit a'' /z page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1014- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 2: Emergency Services Assessment Center 1. Outcome Statement including # or %: 222 assessments will be completed in the Deleted: r.asr J Emergency Services Assessment Center during contract year. 2. List the Activities or Services provided by this program. The Emergency Services Assessment Center provides Psychiatric Evaluations and Clinical Assessments for individuals or adults who in crisis. These assessments are completed within the scope of the Baker Act. David Lawrence Center manages the only Baker Act receiving facility for Collier County which includes emergency services and the Crisis Stabilization Unit. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers of assessments completed in the Emergency Services Assessment Center. END OF SECTION ONE Packet Page -1015- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services SECTION TWO Reporting Period: Contract year— October 1, 2012 —September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 2: Emergency Services Assessment Center 1. Outcome Statement including # or %: 992 assessments will be completed in the Deleted: LILI Emergency Services Assessment Center during contract year. 2. From data collected during the term of the contract, provide the following information: A. How many assessments were completed in this program during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? Same individuals are sometimes assessed more than one time during the reporting period. END OF SECTION TWO Agencies are welcome to submit a'' /x page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1016- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 3: Emergency Services Assessment Center 1. Outcome Statement including # or %: �Qj individuals will be released from Baker Act —{ Deleted: placement and diverted from inpatient Crisis Stabilization Unit admission during contract period. 2. List the Activities or Services provided by this pro The Emergency Services Assessment Center diverts provides Psychiatric Evaluations and Clinical Assessments for r� individuals or adults who in crisis. These assessments are completed within the scope of the Baker Act. Individuals may be held in an emergency services screening area according to the regulations of the Baker Act and may be released following professional evaluation that determines Baker Act criteria is no longer met. David Lawrence Center manages the only Baker Act receiving facility for Collier County which includes emergency services and the Crisis Stabilization Unit. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing Baker Act evaluation and release data. END OF SECTION ONE Packet Page -1017- /-1- 10\ 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due QUARTERLY Can be submitted by mail, email or fax OUTCOME # 3: Emergency Services Assessment Center 1. Outcome Statement including # or %: 3� 0_S individuals will be released from Baker Act Deleted; 3 0 placement and diverted fom inpatient Crisis Stabilization Unit admission during contract period. 2. From data collected during the term of the contract, provide the following information: A. How many individuals were released and diverted from Crisis Stabilization Unit admission during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 Packet Page -1018- 6/25/2013 16.D.14. for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 4: Crisis Stabilization Unit 1. Outcome Statement including %: 85% or more of individuals discharged from the Crisis Stabilization Unit (CSU) will not be readmitted during the 30 days following discharge. 2. List the Activities or Services provided by this program. The Adult Crisis Stabilization Unit provides short term, inpatient crisis stabilization and support for persons who are either at risk of harming themselves or others due to a mental health crisis. The CSU is the only Baker Act receivingfacilitvfor Collier County. 3. How is outcome measured? List the tools /annroaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record database and presented quarterly via internal reports capturing numbers and percentages of people re- admitted within 30 days. END OF SECTION ONE Packet Page -1019- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Emergency Services SECTION TWO Reporting Period: Contract year — October 1, 2012— September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME #4: Crisis Stabilization Unit 1. Outcome Statement including %: 85% or more of individuals discharged f om the Crisis Stabilization Unit (CSU) will not be readmitted during the 30 days following discharge. 2. From data collected during the term of the contract. provide the following information: A. How many unduplicated clients did the CSU admit during the specified time period? 10"N B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? D. How many of the unduplicated clients from B achieved the outcome during the time period? E. Outcome percentage (D divided by B): END OF SECTION TWO Agencies are welcome to submit a'' /2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1020- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 5: Adult Medical Services 1. Outcome Statement including # or %: 1(l8 individuals who do_not_have Medicaid or , - Deleted: L44 Medicare coverage will be served in Adult Medical Services. 2. List the Activities or Services provided by this program. Medical Services include Psychiatric Evaluations and Medication Management for persons who are experiencing mental health problems that are serious and acute or related to a services and persistent mental illness. Services also include nursing services in addition to coordination with primmy care physician. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1021- Al-N, 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Medical Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 5: Adult Medical Services 1. Outcome Statement including # or %: 708individuals who do not have Medicaid or - Deleted: txaa ) Medicare coverage will be served in Adult Medical Services 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a' /z page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1022- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Outpatient Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 6: Adult Substance Abuse Outpatient and Adult Drug Court 1. Outcome Statement including # or %: ,262 individuals who do not have Medicaid or Deleted: yi Medicare coverage will be served in Adult Substance Abuse Outpatient Services. 2. List the Activities or Services Provided by this program. Substance Abuse Outpatient Formatted: Font: Times New Roman Services include group and individual therapy and may also include family therapy. Different levels ofgroup therapy are available based on the intensity of the substance abuse or dependency. Treatment focuses on helping the individual accept his/her addiction and support the individual in establishing a recovery lifestyle diverts of/endery with substance abuse and drug related criminal activity born the criminal justice system bi, offering them an opportunity to proactiveiv, deal with their dependence rather than face punitive alternatives. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1023- Formatted: Font: (Default) Times New Roman Formatted: Normal, Indent: Left: 0.38 ", No bullets or numbering Deleted: < # >How is outcome measured? List the tools/approaches /methods used to track or measure this outcome .¶ 1.0-N �*N 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Outpatient Services SECTION TWO Reporting Period: Contract year— October 1, 2012 —September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 6: Adult Substance Abuse Outpatient Services 1. Outcome Statement including # or %: �A2 individuals who do not have Medicaid o_r - Deleted: Medicare coverage will be served in Adult Substance Abuse Outpatient Services. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a `h page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1024- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Detox Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 7: Detox Services 1. Outcome Statement including # or %: 35.9 admissions will be served in Detox Program. , j Deleted: 2. List the Activities or Services provided by this program. The Detox program is a voluntary, medically- managed program for individuals who are in need of detoxification services utilizing American Society (of) Addiction Medicine level III, 7d admission criteria. .� 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1025- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Detox Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 7: Detox Services 1. Outcome Statement including # or %: 59 admissions will be served in Detox Program_; . Deleted: ago 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? _ B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1026- PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: !Adult Drug Court Program Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract END OF SECTION ONE Packet Page -1027- 6/25/2013 16.D.14. Comment[ic1]: Adult Drug Court Program is combined withAdult Substance Abuse Outpatient - Outcome #6 Comment [lc2]t Adult Drug Court Program was combined with Adult Substance Abuse Outpatient-Outcome #6. Deleted: OoTCOME # &I Adult Drug Court Program ¶ a# ,Outcome Statement including # or %: 63 individuals who do not have Medicaid or Medicare coverage will be served in Adult Drug Court program. I < #>List the Activities or Services provided by this orocram. The Adult Drug Court Program diverts offenders with substance abuse and drug related criminal activity from the criminal justice system by offering them an opportunity to proactively deal with their dependence rather than face punitive alternatives. ¶ < # >How is outcome measured? List the tools /anoroacheslmethods used to track or measure this outcome.¶ Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Drug Court SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 8: Adult Drug Court Program 1. Outcome Statement including # or %: 63 individuals who do not have Medicaid or Medicare coverage will be served in Adult Drug Court program. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? AO—IN B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a %2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1028- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # $: ; — Deleted: v- Immokalee Medical Services 1. Outcome Statement including # or %: 43 individuals who do not have Medicaid or ,— Deieted: Y J Medicare coverage will be served in Immokalee Medical Services. 2. List the Activities or Services provided by this program. Medical Services provided in the Immokalee Community that include Psychiatric Evaluations and Medication Management for persons who are experiencing mental health problems that are serious and acute or related to a services and persistent mental illness. Services also include nursing services in addition to coordination with primary care physician. 3. How is outcome measured? List the tools /annroaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1029- /1-1N 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Medical Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # $ _ _ ,. - -� Deleted: 9 Immokalee Medical Services 1. Outcome Statement including # or %: ,93 individuals who do not have Medicaid or - Deleted: L3 Medicare coverage will be served in Immokalee Medical Services 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1030- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Outpatient Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 9• Meted: LO Immokalee Outpatient Services 1. Outcome Statement including # or %: ,54 individuals who do not have Medicaid or —{ Deleted: 147 Medicare coverage will be served in Immokalee Outpatient Services. 2. List the Activities or Services provided by this program. Immokalee Outpatient services include substance abuse and mental health services designed to promote emotional health and well - being. Mental Health Services include assessment, individual and group treatment services and case management services .for persons who are experiencing mental health problems that are serious and acute or related to a severe and persistent mental illness. Substance Abuse Outpatient Services include group and individual therapy and may also include family therapy. Different levels of group therapy are available based on the intensity of the substance abuse or dependency. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1031- 11�, 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Immokalee Outpatient Services SECTION TWO Reporting Period: Contract year— October 1, 2012 —September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 9; —{ Deleted: to Immokalee Outpatient Services 1. Outcome Statement including # or %: L4 individuals who do not have Medicaid or Deleted: L47 ) Medicare coverage will be served in Immokalee Outpatient Services 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. if answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a'' /2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1032- 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # 10, Childrens Medical Services 1. Outcome Statement including # or %: 524 children who do not have Medicaid or Medicare coverage will be sewed in Childrens Medical Services. 2. List the Activities or Services provided by this program. Medical Services include Psychiatric Evaluations and Medication Management for persons who are experiencing mental health problems that are serious and acute or related to a services and persistent mental illness. Services also include nursing services in addition to coordination with primary care physician. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE Packet Page -1033- PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Medical Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 10. _ _ ,; { Deleted: 1 Childrens Medical Services 1. Outcome Statement including # or %: 524 children who do not have Medicaid or Medicare coverage will be sewed in Children Medical Services. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a'' /2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1034- 6/25/2013 16.D.14. 6/25/2013 16.D.14. PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Urgent Care Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2012 for time period 10/01/12- 9/30/13 SECTION ONE To Be Completed and returned with contract OUTCOME # U: — = Deleted: ? Childrens Ureent Care Services 1. Outcome Statement includinjz # or %: 422 children who do not have Medicaid or Medicare coverage will be served in Children Urgent Care Services. 2. List the Activities or Services provided by this program. Children Urgent Care Services consist of activities aimed at providing centrally accessed qualitv clinical assessments as well as diverse and brief treatment to the children of Collier County. Treatment services include crisis intervention, individual treatment, group treatment and family treatment in the areas of mental health and substance abuse /dependency. 3. How is outcome measured? List the tools /approaches /methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers served. END OF SECTION ONE �—s' Packet Page -1035- PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Urgent Care Services SECTION TWO Reporting Period: Contract year — October 1, 2012 — September 30, 2013 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 11; { Deleted: 2 Childrens Urgent Care Services 1. Outcome Statement including # or %: 422 children who do not have Medicaid or Medicare coverage will be served in Children Urgent Care Services. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did this program serve during the specified time period? /O�\ B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why (sampling, outcome population definition, etc.)? END OF SECTION TWO Agencies are welcome to submit a/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Packet Page -1036- 6/25/2013 16.D.14.