Backup Documents 06/25/2013 Item #16D14 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 0 14
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Barbetta Hutchinson HHVS BH 2/16/13
2. Jennifer B. White, ACA Office located in HHVS I a�'13
County Attorney Office Department
3. BCC Office Board of County
Commissioners /-(J,/ ' 60(03
4. Minutes and Records Clerk of Court's Office 701 911 (2_: Prr1
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Lisa N.Carr, Grants Coor inator Phone Number 239-252-6141
Contact/ Department
Agenda Date Item was Agenda Item Number 16.D.14
Approved by the BCC 7—S \?)
Type of Document First Amendment to Agreement Number of Original 2
Attached 14) )j' ., Documents Attached
PO number or account N/A
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column, whichever is Yes N/A(Not
appropriate. (Initial)/Applicable)
1. Does the document require the chairman's original signature? yes ✓
2. Does the document need to be sent to another agency for additional signatures? If yes, no n/a
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed yes
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's n/a
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the yes
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's yes
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip yes 1r/^
should be provided to the County Attorney Office at the time he item is input into SIRE.
Some documents are time sensitive and require forwarding Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware your deadlines!
8. The document was approved by the BCC on 6/25/13 and all changes made during the yes ✓
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if applicable. °=,E
9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made, and the document is ready for the Dp.-.5t) � �
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16014
MEMORANDUM
Date: July 2, 2013
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Amendment #1 to the agreement with the David Lawrence
Mental Health Center (DLC) for substance abuse and mental
health services to revise goals in the performance outcome report
Attached is an original copy of the document referenced above, (Item #16D14)
approved by the Board of County Commissioners on June 25, 2013.
The second original copy will be held on file in the Minutes and Record's Department
for the Board's Official Record.
If you have any questions please call me at 252-8406.
Thank you
Attachment
1bNis a
FIRST AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
DAVID LAWRENCE MENTAL HEALTH CENTER, INC.
This Amendment, is entered into this j`fh day of ,J
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: COLLIER COUNTY:
By: ;� B : eor•'a A. Hiller Es•.
Name (print) N: • t)
.641/i/) C Sc.<Y,/yJ.flAlL
IF IF
(Signature of authorized officer) (Sib . uY of authorized officer)
Can 0.- Chairwoman, Board of County Commissioners
Title Title
e S fi
ATTEST
I. I8RO K o CLERK Approved as to form and legality
t,; •
Assistant County A ey
Attest asto . tman's
signature only..
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
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.
•
I END OF SECTION ONE
Item#
Agenda(„ 5—��
Date
1�—=-�
Date
Recd
Deputy
161314 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)
will 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.)? N/A
END OF SECTION TWO I
16014
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 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
^ /
16012
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?
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.
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 including# 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
16014 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.
16014
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
1613 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 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?
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 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.
16014
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
6 1 4,
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%: 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?
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.
1601 .
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 served 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
16014
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 and Adult Drug Court
1. Outcome Statement including# 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 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.
16014
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 (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
16014 1 4
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%: 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.)?
I 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.
161J14
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 # 8
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.
I END OF SECTION ONE I
16014
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 # 8:
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.)?
I 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.
16014
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. 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 I
16 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 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.)?
I 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.
16Dlit
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 including# 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.
I END OF SECTION ONE I
16014
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?
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.
160J4 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 Childrens Urgent Care Services.
2. List the Activities or Services provided by this program. 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.
I END OF SECTION ONE I
16 014
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 Childrens 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 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.