Mental Health and Addiction Ad Hoc Agenda 01/18/2019Mental Health and Addiction Ad Hoc Committee Meeting
January 18, 2019 – 2:00 pm
County Manager’s Front Conference Room
3299 Tamiami Trail East, Bldg. F, 2nd Floor
Naples, FL 34112
1. Call to Order
2. Pledge of Allegiance
3. Roll Call
4. Adoption of the Agenda
5. Public Comment
6. Adoption of Minutes from Previous Meeting
7. Staff Reports
8. New Business
8.1. Past BCC Mental Health Workshop Priorities (Scott Burgess)
8.2. Review of Substance Abuse and Mental Health Services Strategic Plan (Pam Baker)
8.3. Veterans Liaison Information (Dale Mullin)
8.4. Future Meeting Schedule
8.5. Application Process Update (Staff)
9. Old Business
10. Announcements
11. Committee Member Discussion
12. Next Meeting Time, Date and Location
13. Adjournment
MINUTES OF THE REGULAR MEETING OF THE COLLIER COUNTY
Mental Health and Addiction Ad Hoc Committee Meeting
January 4, 2019
Naples, Florida
LET IT BE REMEMBERED that the Collier County Mental Health and Addiction Ad Hoc Committee
met on this date at 10:00 A.M. at 3299 Tamiami Trail East, Building F, 2nd Floor CMO Front
Conference Room, Naples, Florida with the following Members Present:
Mental Health Committee
Present: Dale Mullin
Lt. Leslie Weidenhammer
Dr. Thomas Lansen
Scott Burgess
Pam Baker
Honorable Janeice Martin
Not Present: Dr. Emily Ptaszek
Susan Kimper
Also Present: Andy Solis – County Commissioner and Board Liaison
Sean Callahan – Executive Director County Manager’s Office
Geoff Willig – Sr. Operations Analyst County Manager’s Office
Heather Cartwright-Yilmaz – Sr. Operations Analyst County Manager’s
Office
Colleen Greene – Assistant County Attorney
1. Call to Order & Pledge of Allegiance
Sean Callahan, Staff Liaison, called the meeting to order at 10:00 and led the pledge of allegiance.
3. Roll Call – Committee Members
Six members of the Mental Health and Addiction Ad Hoc Committee were present representing a
quorum.
4. Adoption of Agenda
The agenda was distributed to all present and approved.
5. Public Comment
No public comment was received.
6. Adoption of minutes from Previous Meeting (None)
7. Staff Report
Sean Callahan introduced the members of the committee and provided the details about the election
of a Chair and Vice-Chair and adoption of the Committee Rules of Procedure.
8. New Business
8.1: Election of Committee Chair and Vice Chair
Committee Chair: Scott Burgess
Vice Chair: Pam Baker
Motions were made and unanimously accepted for Scott Burgess as Chair and Pam Baker as Vice
Chair of the Committee.
8.2: Adoption of Rules of Procedure
Committee members reviewed the proposed rules of procedure. Mr. Lansen asked where the
information about committee meetings. Staff explained this information is sent publicly through the
Communication Division and posted in public spaces.
Staff explained the rules regarding attendance and quorum, and made two updates to the document
in Section A(2) removing the option to call in to meetings, and clarifying the establishment of a
quorum. Mr. Burgess inquired why members could not call into the meeting, it was explained by the
County Attorney’s Office that this practice was curtailed, and live attendance was required to
conduct Committee business. Staff offered to provide meeting minutes and recordings of the
proceedings to absent Committee members.
Following this discussion, a motion was made, and the rules of procedure were adopted
unanimously.
8.3: Board of County Commissioners Liaison
The Committee Members expressed interest in having a Member of the Board of County
Commissioners serve as a liaison to the ad hoc committee. Commissioner Solis expressed his
willingness to continue attending and will ask the Board to approve this at the Tuesday, January 8th,
2019 meeting.
8.4: Review of Vacant Positions
Staff reviewed vacancies that exist on the Committee and advised that four applications had been
received to date. Discussion ensued around existing vacancies, and staff explained that not all
positions needed to be filled to conduct Committee business, as the initial appointments were made
by the Board of County Commissioners.
8.5: Application Process for New Members
Staff asked the Committee to advise on how they would like to consider applications for Committee
vacancies and whether a cutoff date should be implemented for applications. Discussion ensued.
Mr. Burgess suggested that a cutoff date be made of January 30, 2019 to receive applications. Mr.
Lansen asked if extraordinary candidates could be considered after the deadline. Ms. Baker inquired
about how qualifications would be reviewed and if a CV and/or resume could be included with the
application and whether or not conflicts of interest are outlined during the application process.
Staff explained that these were considerations in the application and asked whether the Committee
preferred to that staff review applications and make recommendations to the Committee, or the
Committee would individually review each application. Discussion ensued, in which the Committee
expressed the desire to vet applications individually.
Staff explained that a public notice could go out advising of the January 30 deadline and that any
applications received could be included in the February 8 agenda packet, so the Committee could
review them and make a decision at that meeting,
Mr. Burgess made a motion to set an application cutoff deadline of January 30, after which only
special consideration for vacancies would be given, and to have staff provide all applications to the
committee for future vetting at the February 8, 2019 committee meeting. The motion was adopted
unanimously.
8.6: Sunshine Law Procedures
Colleen Green from the County Attorney’s Office provided a presentation and reviewing Sunshine
Law procedures and requirements for advisory committee members.
The Honorable Janeice Martin asked a question regarding informational trips for two or more
members of the advisory committee. Ms. Greene explained that this trip would be subject to
Sunshine Law requirements.
Discussion ensued throughout the presentation regarding committee communications and
participation in public meetings by members of the advisory committee, as well as the keeping of
public records.
8.7: Future Meeting Schedule
During the presentation of Sunshine Law regulations, the committee asked to decide on the next
meeting dates so that a committee member could be excused. The Committee decided that the next
two meeting dates would be January 18, 2019 at 2 pm and February 8, 2019 at 8:30 am.
Mr. Burgess made a motion for this meeting schedule that was accepted unanimously.
9. Old Business (None)
10. Announcements (None)
11. Committee Member Discussion
Committee discussion ensued about what items should be on the next agenda. Ms. Baker suggested
that the committee review the Federal and State Mental Health Strategic Plans. Mr. Burgess offered
to make a bullet point outline of previously discussed priorities in the Collier County mental health
workshop.
Mr. Mullin inquired whether he should be the veteran liaison on the committee and provide
information from the Department of Veterans Affairs. Staff confirmed these items would be placed
on the next agenda and asked that the Committee members provide the material to the staff liaison
prior to the meeting.
12. Adjournment
The meeting was adjourned at 11:07 with nothing further to discuss.
13. Next Meeting
The next meeting of the Mental Health and Addiction Committee will be on January 18, 2019
at 2 PM in the County Manager’s Front Conference Room at 3299 Tamiami Trl E, Naples FL
34112 on the second floor.
Collier County Mental Health and Addiction Ad Hoc Advisory Committee
_______________________
Scott Burgess – Chairman
The foregoing Minutes were approved by Committee Chair on January 10, 2019, “as submitted” [ ]
or “as amended” [ ]
COLLIER COUNTY
Board of County Commissioners
MENTAL HEALTH WORKSHOP AGENDA
Board of County Commission Chambers
Collier County Government Center
3299 Tamiami Trail East, 3rd Floor
Naples, FL 34112
June 05, 2018
9:00 AM
Commissioner Andy Solis, District 2 - BCC Chair
Commissioner William L. McDaniel, Jr., District 5 - BCC Vice-Chair; CRAB Co-Chair
Commissioner Donna Fiala, District 1; CRAB Co-Chair
Commissioner Burt Saunders, District 3
Commissioner Penny Taylor, District 4
Notice: All persons wishing to speak must turn in a speaker slip. Each speaker will receive no more than three (3) minutes.
Collier County Ordinance No. 2003-53 as amended by Ordinance 2004-05 and 2007-24, requires that all lobbyists shall,
before engaging in any lobbying activities (including but not limited to, addressing the Board of County Commissioners),
register with the Clerk to the Board at the Board Minutes and Records Department.
1. PLEDGE OF ALLEGIANCE
2. WORKSHOP TOPICS
2.A. Agenda and Strategic Plan
3. PUBLIC COMMENTS
4. ADJOURN
Inquiries concerning changes to the Board’s Agenda should be made to the County Manager’s Office at
252-8383.
06/05/2018
COLLIER COUNTY
Board of County Commissioners
Item Number: 2.A
Item Summary: Agenda and Strategic Plan
Meeting Date: 06/05/2018
Prepared by:
Title: Operations Analyst – County Manager's Office
Name: Geoffrey Willig
05/29/2018 4:32 PM
Submitted by:
Title: County Manager – County Manager's Office
Name: Leo E. Ochs
05/29/2018 4:32 PM
Approved By:
Review:
Operations & Veteran Services Sean Callahan Additional Reviewer Completed 05/29/2018 4:57 PM
County Manager's Office Geoffrey Willig County Manager Review Completed 05/29/2018 5:00 PM
Board of County Commissioners MaryJo Brock Meeting Pending 06/05/2018 9:00 AM
2.A
Packet Pg. 3
2018 Mental Health and Addiction Workshop
June 5, 2018
Agenda
Board of County Commission Chambers
Collier County Government Center
3299 Tamiami Trail East, 3rd floor
Naples, FL 34112
9:00 am Welcome and Pledge of Allegiance – Chairman Andy Solis
9:05 am How We Got Here and Why – Chairman Andy Solis
9:10 am Brief Update and Review of the Last Year
Treatment Courts – Judge Janeice Martin
David Lawrence Center – Scott Burgess, CEO
National Association for the Mentally Ill – Pam Baker, CEO
Collier County Sheriff’s Office – Sgt. Leslie Weidenhammer & Cptn. Chris Roberts,
Mental Health Intervention Team; Katina Bouza, Inmate Service Bureau Manager
Collier County Public Schools – Karen Stelmacki, Executive Director, Exceptional
Education & Student Support Services
9:40 am Criminal Justice, Mental Health & Substance Abuse Planning Council
Strategic Planning Sessions – Review and Identified Priorities with their Champions:
Centralized Receiving System / Addiction Receiving and Baker Act Receiving Facility – Scott
Burgess, CEO David Lawrence Center; Allan Weiss, CEO Naples Community Hospital
Permanent Supportive Housing (Scattered Sites & Supportive Services) – Pam Baker, CEO
NAMI, and Beverly Belli, DLC
Behavioral Health Data Collaborative – Chairman Andy Solis
Increase Use of Evidence-based Practices – Nancy Dauphinais, COO David Lawrence Center
Increase Effectiveness and Capacity of Treatment Courts – Judge Janeice Martin and Beverly
Belli, DLC
Baker Act / Marchman Act Transportation – Sgt. Leslie Weidenhammer, CCSO
Build Sustainability for Criminal Justice, Mental Health & Substance Reinvestment Grant –
CJMHSA Planning Council
10:30 am Break
10:45 am Public Comment & Commissioner Discussion
11:30 am Next Steps Moving Forward – Chairman Andy Solis
2.A.1
Packet Pg. 4 Attachment: June 5 2018 Workshop Agenda (5797 : Agenda and Strategic Plan)
1
Mental Health and Substance Abuse
Strategic Plan
2018-2021
Mission: To collaboratively plan for and coordinate a full array of effective services and
supports to improve the lives of individuals with mental health and substance use conditions
and overall quality of life in the Collier County community.
Overview and Purpose
In June of 2017, Collier County Commissioners held a workshop to elicit community
wide input regarding the urgent and growing need for expanded mental health and
substance use (behavioral health) services in our community. Workshop
stakeholders, including behavioral health providers, law enforcement, judiciary, and
family members, presented the current description, status, successes, challenges,
gaps, and opportunities within the local system of care. While all acknowledge that
current collaboration among local stakeholders is impressive, the issue is becoming
more urgent as the overall local population is rapidly expanding with no plan, or
dedicated resources in place, to expand essential mental health and substance use
treatment services.
Since 2010, the Criminal Justice, Mental Health and Substance Abuse (CJMHSA)
Planning Council has maintained strategic plans specifically outlining coordinated
local approaches for the population of persons with serious mental illness who are
in the criminal justice system. However, there is no such coordinating plan for the
much larger population of people with mental health and substance use problems
who do not fall into that category—though all are at risk. The conclusion of the
June workshop was that a community-wide, integrated strategic plan was needed
to coordinate local responses and maximize scarce resources.
To facilitate the plan, in November 2017 and again in May 2018, Mark Engelhardt,
MSW, Director of the CHMHSA Technical Assistance Center at University of South
Florida’s Florida Mental Health Institute, facilitated community-wide strategic
planning sessions. Between and following those meetings, informal groups have
been meeting monthly to provide additional input.
The current strategic plan was completed using information from these meetings
along with several other sources, including CJMHSA Planning Council input, best
practices in the behavioral health field, and relevant aspects of partners’ agency-
specific strategic plans to ensure cohesion among plans and coordinated community
2.A.2
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2
planning efforts. This plan focuses on the adult (18 years of age and older)
population with behavioral health care needs. A current local process for children’s
behavioral health is in place through the Naples Children & Education Foundation.
The Richard M. Schulze Family Foundation conducted a Collier County Needs and
Assets Assessment in 2017 which included significant input from community-wide
surveys and focus groups. Key points cited in the report include:
“A lack of affordable assisted living, residential options for elderly, and for
those with mental health issues and disabilities continues to be a problem in
the area”.
“Residents are worried about the lack of mental health care and addiction
treatment availability. Though the number of providers has increased in
recent years, gaps in services remain”.
General Considerations
Mental health and substance use conditions require a wide array of services and
supports to fully address their complex biopsychosocial nature. Optimally,
comprehensive community services help to ensure that people with mental illnesses
do not enter either the criminal justice system or institutional settings such as state
mental hospitals. Incarceration, and deep-end, acute care programs are expensive
but are needed when community-based treatment and recovery-oriented supports
do not work. We know that evidence-based treatment and recovery practices, when
used, are effective in helping people recover to lead full and productive lives in the
community.
Some behavioral health services are paid for through Medicaid and sometimes
Medicare for people on disability due to serious mental illnesses. For those without
a means to pay (i.e., indigent), state and federal behavioral health funds are
contracted to local community mental health centers, such as the David Lawrence
Center, which is then required to provide people with treatment regardless of their
ability to pay. However, these state funds are not at all adequate to pay for all in
need. Depending upon the source, Florida reportedly ranks 49th or 50th among
states with regards to per capita state funding appropriated for mental health care.
In addition, Florida opted out of the recent Medicaid expansion program which
would have expanded the Medicaid-eligible population and infused additional federal
Medicaid dollars to pay for behavioral health care.
Under Florida statute, local jurisdictions are required to provide funding as match to
the state mental health and substance use contracts. Collier County currently meets
and exceeds these requirements. Without adequate funding for community-based
services, counties must often foot the bill for citizens in need of care beyond the
2.A.2
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3
required local share of cost—often in jails— not because people with mental
illnesses and addictions tend to be criminals, but because their criminal offenses are
often committed as a function of their untreated, or inadequately treated, mental
illness or addiction.
Population Growth. Collier County alone is projected to grow by roughly 40,000
people over the next five years. With a current population estimate of 372,880, by
2030, the county will be home to roughly a half million people when adding the
roughly 90,000 seasonal residents who stay through the winter months. Any
increase in population will negatively affect the local behavioral health system to
meet the needs of citizens, especially since the system is at or over capacity at
present.
Behavioral Health System Map. The University of South Florida assisted the
State of Florida in the creation of a Community Behavioral Health System Access
and Process Mapping document which gives a visual depiction of service types,
access points and relationships to services within any given mental health system in
the state. It highlights the complexities of such systems, and includes potential
services that are not in place locally, such as an addiction receiving facility or peer-
run crisis center. The map provides a visual tool for the overall local strategic
planning.
2.A.2
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Figure 1. Behavioral Health System 1 Brown, R; McLean, C., Engelhardt, M., & Armstrong,
M. (2015). Behavioral Health Systems Design Recommendations. University of South
Florida, September 2015
Current Resources and Challenges
Law Enforcement: Mental Health Unit
The CCSO’s Mental Health Unit recently implemented a new strategy, called the
Mental Health Intervention Team (MHIT). The MHIT includes CCSO deputies along
with a licensed clinician contracted through the David Lawrence Center. The team
focuses on responses to persons considered ‘high risk, high utilizers’ of services,
often conducting wellness checks in the community to ensure the person has the
resources and supports they need so they do not re-enter jail or hospitals
Civil Court
Involuntary
Order
Professional
Certificate
Minor
Alternative
Assessment
Protective
Custody
Voluntary
Application
Screening,
Assessment
and/or
Intake
Crisis
Stabilization
Unit -secure
Addictions
Receiving
Facility -
secure
Residential
Detoxification
(nonsecure)
Hospital
Outpatient
Services
Residential/
Supportive Housing
Medication
Assisted Therapy
Outpatient
Detoxification
Room and
Board Facility
Social Setting
Detoxification
Inpatient
Inpatient
Residential/
Supportive Housing
Residential/
Supportive Housing
Outpatient
Outpatient
Involuntary
Inpatient
State Hospital or SRT
Involuntary
Residential
Involuntary
Outpatient
Initial
Petitions
Renewal &
Termination
Petition
Community Behavioral Health System Access and Process Mapping
Consumer Choice
Diversion
Involuntary Placement
Non-Secure
Involuntary Placement
Secure
Petition (Initial,
Renewal)
Initiating Involuntary
Process
EXIT
EXIT
EXIT
EXIT
EXIT
EXIT
Home
Mobile
Crisis Teams
Peer-Run
Crisis Centers
CIT-Trained Law
Enforcement
Hospital/ER
In-Reach
SAMH Primary
Care
A B C D E F
Community Routes of Access Triage Functions/Acute Care Court Rulings Involuntary
Interventions to Care Receiving
Facilities
Placements
2.A.2
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unnecessarily. The inclusion of a DLC clinical staff person allows the team to access
historical data and expand the continuity of care for individuals in crisis. (Appendix
II)
Crisis Intervention Team (CIT) training is a best practice that helps to train first
responders in effective ways to de-escalate crises with people with behavioral
health problems, diverting them from the criminal justice system and into the
mental health system. Importantly, CIT saves lives and averts cost to the local
criminal justice system. Coordinated by the Collier County Sheriff’s Mental Health
Unit, Collier County has a robust Crisis Intervention Team (CIT) training program,
with a goal of training 100% of all law enforcement, including state and county
probation, and most recently added fire and EMS staff as trainees. The 40-hour
classes are led by the Collier County Sheriff’s Office (CCSO) and Naples Police
Department and are held at National Alliance on Mental Illness (NAMI) of Collier
County five times per year. Collier County is the only Gold Standard CIT program in
the state, as designated by the Florida CIT Coalition.
In 2018, CCSO began a method of collecting valuable CIT data on numbers of
persons diverted and disposition using a new signal and code. This will allow
tracking of law-enforcement assisted jail/criminal justice diversions.
Law Enforcement Assisted Diversion (LEAD) is an innovative diversion program
developed through a partnership between the Collier County Sheriff’s Office and
David Lawrence Center. The LEAD program allows law enforcement officers
discretionary authority to redirect certain drug-related activity to community-based
treatment services, instead of jail and prosecution. By diverting eligible individuals
to services, LEAD is committed to saving lives, and improving public safety and
public order. (Appendix III)
Law Enforcement: Corrections Department
The Collier County Sheriff contracts for its medical services for inmates, including
limited mental health and addictions care, with Armor Correctional Health Services
(Armor), a for-profit entity which specializes in institutional care. As Armor is not a
community-based provider, this sometimes creates communication issues among
parties responsible for discharge planning and continuity of care, for example with
medications. Notably, since the 1990’s Collier County’s jail, through Armor and its
predecessors, has provided in-jail substance use treatment services, called the
Project Recovery Program (PRP), to those in need. PRP can help facilitate early
release of successful program graduates, who, as a result are less likely to return to
jail in the future.
Each of these strategies employed by local law enforcement are relatively low cost,
but high-impact resources for the mental health and substance use population.
2.A.2
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Acute Care
David Lawrence Center (DLC) operates Collier County’s only public Baker Act
receiving facility. It is licensed and designated under Chapter 394, F.S. as a Crisis
Stabilization Unit (CSU). Crisis Stabilization Units, which may be no larger than 30
beds per license, provide brief (72 hour) psychiatric evaluation primarily for low-
income individuals with acute/emergent psychiatric conditions. The DLC CSU adult
CSU has a 22-bed capacity, and 8 designated beds for children. However, the 30
beds may be used in a flexible manner, serving additional or fewer adults or
children as needed due to demand.
The generally recognized ‘rule of thumb’ for adequate mental health care, where
the needs of a community are considered met, is 30 adult acute care beds per
100,000 of population. That means Collier County, at 372,880 population and only
22 beds, falls far short of the benchmark. There should currently be over 100 of
these beds. By 2020, with the projected population growth, Collier should have
over 120 crisis beds.
Acute care services are paid for by insurance when available, and with public dollars
when an individual lacks insurance. Public support is provided through the State of
Florida and partly through county matching funds.
Utilization of David Lawrence Center’s Crisis Stabilization Unit nearly quadrupled
over the past 10 years. Last year, at least 38% of people in need of mental health
crisis care under the Baker Act were sent to facilities in other counties due to lack of
local capacity-- particularly for individuals with Medicare or who are medically
compromised and need a hospital environment. The overall payor mix for the CSU
is 50% indigent, 25% insurance, and 25% Medicaid. The reimbursement from
Medicaid does not adequately cover the cost of care.
A mobile crisis team or mobile crisis response service is a nonresidential crisis
service attached to a public receiving facility and available 24 hours a day, 7 days a
week, through which immediate intensive assessments and interventions are
provided, including screening for admission into a receiving facility. David Lawrence
Center as the county’s only public receiving facility does not currently offer this
service--which can be quite costly due to the need for 24/7 clinical staff availability
for off-site screenings. The Mental Health Intervention Team operated by CCSO is
not a mobile crisis team.
For substance use acute care, David Lawrence Center operates a 12-bed, voluntary
detox unit. Additionally, Naples Community Hospital also has 12 voluntary beds for
people with co-occurring mental health and substance use problems. No other local
hospital has services available for the population. Collier County does not have a
designated Addiction Receiving Facility (ARF), a locked unit for persons in custody
under the Marchman Act for substance use disorders.
2.A.2
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Centralized Receiving Systems (CRS). A central receiving system consists of a
state-designated central receiving facility for both Baker Act and Marchman Act that
serve as a single point or a coordinated system of entry for individuals needing
evaluation or stabilization for mental health or substance use disorders. The model
is currently in use in several Florida communities, and has been shown to:
Reduce the inappropriate utilization of emergency rooms;
Increase the quality and quantity of services through coordination of care
and recovery support services; and
Improve access and reduce processing time for law enforcement officials
transporting individuals needing behavioral health services.
New building and/or renovation of current space would be needed locally to
accommodate both an increase in Baker Act and Marchman Act capacity and space
for a functional CRS. (Appendix IV).
Collier County does not have a private Baker Act receiving facility. Private Baker Act
receiving facilities are licensed under Florida Statutes Chapter 395 as either free-
standing or connected to general medical hospitals. Funding is largely provided by
billing to Medicare and private insurances. In some instances, private receiving
facilities also contract with the State for public mental health funds to serve
uninsured persons. Private receiving facilities are available in both Lee (Park Royal
Hospital) and Charlotte Counties (Riverside Behavioral Health). In fact, most Florida
counties the size of Collier have at least one private receiving facility. The absence
of such a facility in Collier County requires older adults on Medicare, or
who have private insurance, and are in need of acute care to go to the
facilities in nearby Lee and Charlotte Counties, away from their family and
support system.
Baker Act Transportation
The duty for primary transport to a receiving facility for persons on involuntary
status lies with law enforcement. Law enforcement has the authority and
responsibility to provide the transport and can decline only under limited
circumstances specified in the law. However, if the county has a contract with a
medical transporter to provide this transport on behalf of law enforcement, it can
seek reimbursement from the patient or an insurer. Several models may be
considered for this purpose.
To ensure care is available to the indigent/publicly funded population at David
Lawrence Center’s CSU, Collier has a county- and state- approved transportation
exception plan which allows persons under the Baker Act to be transported to
facilities, as ‘exceptions’ to the ‘nearest receiving facility’ as required by the Baker
2.A.2
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Act statute. These are generally people with Medicare or private insurance, or who
have complex medical needs beyond the scope of a CSU. Often, the hospital / NCH
is responsible for transporting people from its facility to DLC or to out of county
facilities. In addition, many Baker Act transports from NCH and Physician’s Reginal
Medical Center are completed by CCSO under an MOU between the Sheriff and DLC.
The hospital pays for its costs via contract with medical transportation company.
Within county transports completed by medical transport are $550 per trip. Out of
county costs are considerably higher. There may be opportunities for cost savings
and improved coordination for these types of transportation needs.
Outpatient Services
David Lawrence Center’s community Access Center can provide assessments on a
walk-in basis, 24 hours a day, 7 days a week. This often helps to avert unnecessary
Crisis Unit admissions as people may be able to get their urgent needs taken care
of in an outpatient setting before they turn into emergencies.
Capacity for publicly funded, office-based outpatient therapy and psychiatric care is
currently adequate, with minimal wait lists. That having been stated, DLC
consistently provides more of these services than is supported by public resources
and is challenged to continue to financially sustain such. Additionally, waiting lists
do exist for specialized treatment such as Dialectical Behavior Therapy (DBT) or
Traumatic Incident Reduction (TIR).
NCH recently opened a small outpatient mental health office, staffed with a
psychiatric Advanced Registered Nurse Practitioner (ARNP). This new service should
help provide additional choice of provider and, to some extent, reduce pressure on
DLC’s outpatient department.
One recent occurrence that will negatively impact outpatient care capacity for
addictions is a reduction of $250,000 in state adult substance abuse outpatient
funding in the David Lawrence Center’s contract.
Integrated Health Care
A significant strength locally is the on-site DLC location of the local Federally
Qualified Health Center (FQHC), Healthcare Network of Southwest Florida
(HCNSWF). This model of integrated health care ensures that people with serious
mental illnesses receiving psychiatric care at DLC, who are at high risk for certain
medical conditions, can receive their care in a coordinated manner in one place.
In addition, another form of integrated health and behavioral health care is on site
at the Health Care Network. Behavioral health services are available organization-
wide, resulting in 18,000 visits annually. Approximately 40% of those are adult
visits. Nationally, as many as 70% of primary care visits are related to behavioral
health needs and over 80% of all psychotropic medications in the U.S. are
2.A.2
Packet Pg. 12 Attachment: Strategic Plan Draft 5 29 (5797 : Agenda and Strategic Plan)
9
prescribed by primary care physicians. Primary care is often the default entry point
for many in need of mental health care, but generally does not provide the specialty
care (e.g. case management, supported employment) needed for persons with
serious mental illnesses.
Health centers across the nation are being encouraged to provide more behavioral
health services for reasons cited above. This also is going to apply to substance
abuse services.
In 2017, DLC opened a pharmacy on its main campus, operated by Genoa
Healthcare. As such, DLC clients can conclude their mental health appointments
and walk immediately over to the on-site pharmacy to receive their prescribed
medications. This helps to reduce potential barriers to use of psychotropic and other
prescription medications.
Opioid Crisis
In response to the nationwide opioid crisis, local efforts include significantly
expanded access at David Lawrence Center to effective interventions including:
Narcan (opioid overdose reversal kits)
Medication Assisted Treatments (MAT) including Vivitrol and Suboxone
Case management services for individuals receiving MAT
Expanded MAT education and support in problem solving courts
Problem-Solving Courts
Collier County currently offers three Problem-Solving Courts for legally and clinically
appropriate adults facing criminal charges. They are Drug Court, Mental Health
Court and Veterans Treatment Court, each of which operates in a similar
fashion. These courts are run by a unified multidisciplinary team, which includes a
dedicated judge, dedicated prosecutor, dedicated public defender, dedicated
probation officers, as well as the Sgt. from the CCSO Mental Health Unit, and
clinicians and case managers from the David Lawrence Center. Beyond these,
partnerships with the Jail and its medical provider, St. Matthew’s House, NAMI, The
Shelter, the FACT Team, Gulf Coast Runners, the Neighborhood Health Clinic, and
many others are crucial to the success of these courts.
Participants in each court are afforded an individualized treatment plan aimed at
addressing the full behavioral health picture for that individual. This may include
any combination of group and individual therapy, medication, trauma treatment
and collateral support. Participants are held to high standards of intensive
supervision, rigorous honesty, and personal accountability. They are connected
with long-term peer supports, they make restitution to their victims, and are
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supported in securing the housing, education, healthcare and employment needed
to maintain their recovery.
In 2017, Collier County provided resources to add staff to the team in order to (1)
expedite identification and connection of appropriate defendants to these programs,
and (2) track data that may be used to measure outcomes and secure sustainable
funding. National data suggests these courts are highly effective at improving
outcomes for recovery, thereby reducing recidivism, improving public safety, saving
tax dollars and restoring individuals to productive lives with their families,
businesses and communities.
Criminal Justice Reintegration
The Forensic Intensive Reintegration Support Team (FIRST) is a jail reentry
program providing an intensive, multidisciplinary, case management team from
Collier County jail reintegration specialists, David Lawrence Center case managers,
and a NAMI peer specialist to assist individuals with community reentry after a
period of incarceration. Many participants had multiple arrests prior to admission
into the program. The program’s ultimate goal is to improve the person’s
probability of success in the community and reduce their chances of re-
arrest/recidivism. The FIRST team has demonstrated success at lowering the rate of
recidivism among participants to just 22%. For the grant period 2014-2017, the
FIRST served 313 people. Of those only 69, or 22% we re-arrested.
Reintegration Grant. Implemented in 2010, the Collier County Criminal Justice,
Mental Health and Substance Abuse Reintegration grant is in the first year of its
third, three-year grant cycle. Supporting the FIRST program, the grant is provided
through the Florida Department of Children & Families’ Substance Abuse & Mental
Health state headquarters office through Memorandum of Agreement with Collier
County. The current grant funding (July 2017 through June 2020) is $1,042,506
with county/partner agency match of $1,052,300 for a total of $2,094,806. The
state also pays for significant assistance from the USF Technical Assistance Center
throughout the grant cycle. This project demonstrates significant state funding and
support for a local project, and stakeholders want to ensure continuation of the
FIRST program.
Housing
Strategic planning participants agreed that housing is perhaps the most daunting
issue to address regarding people with behavioral health needs in Collier County.
Many residents have a hard time finding affordable housing. Affordable housing is
considered housing that consumes 30 percent or less of a household’s income. It
includes income target levels starting at “very low,” those making less than 30
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percent of the $75,000 Collier County median income, up to “moderate income”
and “gap income.”
Table 1. Fair Market Rent Naples Marco Island, 2018
The average single-family home value in Collier County is estimated at $573,519,
which is much higher than the state average
of $219,681. About 40% of Collier residents
are considered ‘cost burdened’, meaning they
spend at least 30% or more of their income
on housing, and 20% pay more than 50% of
their income for housing. Individuals with
mental illnesses are even further priced out
of the housing market, many of whom rely on
Supplemental Security Income (SSI) due to
disability. SSI is currently $750 per month or
just $9,000 per year, that is 14.5% of the
median income. For individuals with
disabilities living solely on SSI, renting even an efficiency at the fair market rent
would require more than 100% of their monthly income. Rental units at or below
fair market rent in Collier County are extremely scarce. The problem was
compounded by Hurricane Irma in September of 2017, which devastated the stock
of affordable housing throughout the county, often mobile homes, which will take
time to replace.
Also, there are higher costs of applying for rentals and high deposits for rent and
utilities which complicate renting properties for lower income households. Securing
affordable housing for people with convictions and substance abuse issues is even
more difficult due to increased use of background checks.
The lack of safe and affordable housing is one of the most powerful barriers to
recovery. When this basic need isn’t met, people cycle in and out of homelessness,
jails, shelters, and hospitals. Supportive housing provides an essential platform for
the delivery of services that lead to improved health and stability. At the most basic
level, housing provides physical safety, protection, and access to basic needs.
HUD FY 2018 Fair Market Rents by Unit Bedrooms
Year Efficiency
One-
Bedroom
Two-
Bedroom
Three-
Bedroom
Four-
Bedroom
FY 2018
FMR $778 $996 $1,220 $1,630 $1,978
MYTH: “Housing is a Privilege”
Everyone has a right to a standard of
living adequate for the health of them and
their family including food, clothing,
housing, medical care, and necessary
social services.
--Article 25 of the Universal Declaration of
Human Rights
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Supportive housing improves access to quality health care by providing a physical
space for service delivery staff (e.g., case management, FACT) that directly provide
or link tenants to community-based social, mental health, substance abuse and
primary/specialty medical care services.
Local supportive housing options operated by non-profit agencies include David
Lawrence Center and Community Assisted Supported Living (CASL). There are
generally wait lists for these. NAMI has a HUD grant administered through the
county for a small amount of rental assistance for people who are homeless.
However, securing willing and benevolent landlords along with affordable units has
proven virtually impossible. Some supportive housing models may be helpful in
addressing barriers to housing for the target population. These include sites for
which behavioral health providers hold a ‘Master Lease’; Florida Assertive
Community Treatment teams; Housing First; and the Dave’s House or Jerry’s House
model. (Appendix V).
Peer Run Services
Peer-run services provide a safe and supportive environment for self-help, mutual
support, and employment opportunities for people with disabilities. A peer is a
person who has experienced mental illness personally, and who has received special
training in how to use that experience to support others facing similar challenges
from mental illnesses. Along with medication and therapy, peer supports are proven
to be effective in helping individuals recover from mental illnesses and addictions.
NAMI Collier’s Sarah Ann Drop in Center (SAC) is a peer-operated program for
adults with serious mental illnesses. The Sarah Ann Center is open Monday through
Saturday and offers socialization and support groups for persons who may
otherwise be isolated. Many wellness supports are available for participants via
volunteers including yoga, nutrition education, mindfulness practice, and therapist-
facilitated improvisational comedy exercises. Drop-in centers often appeal to people
who have been disenfranchised or who wish avoid the traditional mental health
system. The centers are accessible; provide safe, nonjudgmental, and informal
environments; and put few demands on clients.
In addition to the Sarah Ann Center, NAMI’s COPE, Community Outreach Peer
Education, provides a variety of individual and group peer supports through
Certified Recovery Peer Specialists (CRPS). NAMI also operates a state-wide, peer-
run Warm Line to provide telephone support when people are isolated and need an
experienced, empathic ear.
Some communities operate peer-run respite homes. Non-emergent peer respites
are voluntary, short-term, overnight programs that provide community-based, non-
clinical crisis support to help people find new understanding and ways to move
forward. They operate 24 hours per day in a homelike environment, and act as a
diversion from high end psychiatric care when possible.
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Evidence Based Practices
Evidence-based practices (EBPs) are defined as treatments that have been
researched academically or scientifically, been proven effective, and replicated by
more than one investigation or study. Evidence-based treatment practices are
meant to make treatment more effective for more people by using scientifically
proven methods and research. Ultimately, because they are proven to be effective,
the use of evidence-based practices saves money and lives. Whenever possible,
local agencies will implement programs using evidence based practices. There are
several evidence based practices recognized by the Substance Abuse and Mental
Health Services Administration (SAMHSA) including but not limited to:
Early Intervention for First Episode Psychosis
Medication- Assisted Treatment (MAT) for Opioid Use Disorder
Peer Support Services in a Recovery-Oriented System of Care (ROSC)
Trauma- Informed Care
Dialectical Behavior Therapy
Supported Housing and Supported Employment
Data: Collection, Compilation, Analysis and Sharing
For each of the areas discussed above, there is a need for improvement of local
data-driven decision making. In Collier County, there is a well-established tradition
of health and behavioral health care organizations, county, law enforcement,
judiciary, community partners, and concerned individuals collaboratively working
toward local behavioral health solutions.
Multiple sources collect internal data, and share with other entities in limited ways,
but there is not a process for comprehensively collecting and using relevant data,
both at the systems and clinical levels, to enhance and inform the planning and
delivery of behavioral health care among all related community organizations.
Figure 2 depicts the primary local mental health and substance use service array
and relationships.
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Figure 2. Collier County FL Behavioral Health Local Collaborative Relationships (June
2017).20
18services
A centralized data collaborative could collect information from entities including
DLC, hospitals, and courts, law enforcement, and homeless providers such as:
Number of days acute care units are at or over capacity
Disposition and impact of acute care overflow
What agencies are providing uncompensated care and to what extent?
Numbers and demographics of persons served in each type of service
Demonstration of cost avoidance in criminal justice through diversion
activities
Individuals needing multiple types and levels of services
The data may be aggregated in many ways to use for planning, quality
improvement, program evaluation, and grant applications. A single person or
repository would be needed to collect and disseminate multiple data points from
multiple entities. Such data can then help better coordinate and target care among
entities for people with high needs, and who frequently use multiple services
throughout the county.
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Local Priorities and Committee Leads
Participants in the planning sessions agreed upon several priorities and identified a
lead person (or persons) to oversee continued planning and execution of objectives
and action steps for each priority. An Ad Hoc committee will be needed to oversee
the process.
# Priority Lead(s)
1
Centralized Receiving System/Addiction
Receiving & Baker Act Receiving Facility
Scott Burgess, DLC CEO
2
Permanent Supported Housing (Scattered
Sites and Supportive Services)
Pamela Baker, NAMI CEO;
Beverly Belli, DLC
3
Behavioral Health Data Collaborative
Commissioner Andy Solis;
Sean Callahan, County
Administration
4
Increase use of evidence-based practices, e.g.
Early intervention for 1st time psychosis.
Nancy Dauphinais, DLC COO
5
Increase effectiveness and capacity of
Problem-Solving Courts
Judge Janeice Martin;
Beverly Belli, DLC
6
Baker Act / Marchman Act transportation
Sgt. Leslie Weidenhammer,
CCSO
7 Build sustainability for Criminal Justice, Mental
Health & Substance Abuse Reinvestment
grant.
CJMHSA Planning Council
Table 2. Strategic plan local priorities and lead person(s).
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APPENDIX I
State and National Resources
Florida Criminal Justice Mental Health and
Substance Abuse Technical Assistance
Center
www.floridatac.org
Louis de la Parte Florida Mental Health
Institute Department of Mental Health Law
and Policy
http://mhlp.fmhi.usf.edu
Justice Center www.justicecenter.csg.org
Policy Research Associates www.prainc.com
National GAINS Center/ TAPA Center for Jail
Diversion www.gainscenter.samhsa.gov
National Law Center on Homelessness and
Poverty
https://www.nlchp.org/Simply_Unacce
ptable
Center for Mental Health Services http://beta.samhsa.gov/about-
us/who-we- are/offices-centers/cmhs
Center for Substance Abuse Prevention http://beta.samhsa.gov/about-
us/who-we- are/offices-centers/csap
Center for Substance Abuse Treatment http://beta.samhsa.gov/about-
us/who-we- are/offices-centers/csat
Council of State Governments Consensus
Project www.consensusproject.org
Florida Alcohol and Drug Abuse Association www.fadaa.org
National Association of Drug Court
Professionals www.nadcp.org
National Alliance on Mental Illness www.nami.org
National Center on Cultural Competence www11.georgetown.edu/research/gucc
hd/nccc/
National Clearinghouse for Alcohol and Drug
Information www.health.org
National Criminal Justice Reference Service www.ncjrs.org
National Institute of Corrections www.nicic.org
National Institute on Drug Abuse www.nida.nih.gov
Office of Justice Programs www.ojp.usdoj.gov
Partners for Recovery www.partnersforrecovery.samhsa.gov
Substance Abuse and Mental Health
Services Administration www.samhsa.gov
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APPENDIX II
The M ent al Healt h Int ervent ion Team (M HIT)
is a p art nership b et ween David Lawrence
Cent er and t he Collier Count y Sheriff’s O ff ce
(CCSO ). M HIT provides out reach and assist s
wit h coordinat ion of ment al healt h services
t o ind ivid uals in Collier Count y t hrough t he
work of a licensed clinical social worker, who
is co-located with CCSO.
The MHIT pr ogram seeks to:
•Divert individuals wit h ment al illness from t he
criminal justice system
•Red uce st igmatizat ion of persons wit h ment al
illness
•Link individuals with ment al illness t o app ropriat e
treatment and resources in the community
•Promot e safet y of t he communit y, including
individuals in crisis, family members, and law
enforcement off cers
•Red uce concerns among family and friends
of those with mental illness by pr oviding them
with the knowledge that ther e are specially
trained of f cers and clinicians who can de-escalate
the situation
CO MMUNITY MENTAL HEALTH SERVICES
Mental Health Intervention Team (MHIT)
MHIT IS COMPRISED OF:
Certified Crisis Intervention Team
(CIT) law enforcement deputies,
support staff, a licensed clinical social
worker, and liaisons from the local Fire
Departments and Collier County EMS.
5/2018
MHIT also conducts follow-up and wellness
check-ups for individuals who ar e at high-risk,
or who are high-need or high-utilizer s of
services.
Additionally, the program provides assistance
to individuals who may be in need of
treatment, such as those frequently calling
law enforcement fo r assistance with behavioral
challenges.
David Lawrence Center is a not-for-profit behavioral
health provider dedicated to inspiring and creating
li e-changing wellness for every individual through
revention, intervention, and treatment services.
CALL 239-455-8500
D avid LawrenceCent er.o rg
6075 Bathey Lane
Naples, FL 34116
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APPENDIX III
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APPENDIX IV
Receiving Facilities
Baker Act, Marchman Act and Centralized Receiving Facilities
The Baker Act (Florida Mental Health Act; F.S. Chapter 394 Part I), includes
provisions for involuntary commitment if the person “exhibits substantial likelihood
that without care or treatment the person will cause serious bodily harm to self or
others in the near future, as evidenced by recent behavior”.
Crisis Stabilization Unit (CSU): Also known in Florida as a Baker Act receiving
facility, a CSU provides brief (72-hour hold) voluntary and involuntary psychiatric
stabilization services in a secure, locked unit, for persons who are in a psychiatric
crisis.
The Marchman Act (F.S. Chapter 397.6744) essentially provides a means to care for
an individual who has lost the power of self-control with regard to substance abuse
and there exists the likelihood that the individual has the potential to inflict harm
upon themselves or others unless they get help. Furthermore, it must also be
demonstrated that the impaired individual is without the capacity to make rational
decisions with regard to appreciating the need for treatment.
Detoxification Program (Detox): A voluntary (non-secure), medically-managed
program for adults who are in need of alcohol and/or drug detoxification services.
Addiction Receiving Facility (ARF): Also known as a Marchman Act receiving
facility, an ARF is similar to a detox program, but the ARF is secure/locked, and
individuals can be legally held at the facility. The ARF provides higher levels of
staffing and professional treatment than a detox facility.
Centralized Receiving Facility: A Centralized Receiving Facility (CRF) is a single
point of access for persons exhibiting challenges related to mental health or
addiction-related issues. The CRF provides rapid assessment and linkage to the
most appropriate level of care, every day, at any time of day, whether the person’s
situation is emergent, urgent, or routine/non-emergent, and whether the issue is
mental health or addictions-related.
The gold standard for community behavioral health care is to have a Centralized
Receiving Facility or System (CRF) to which ALL behavioral health needs can be
directed. The CRF can be accessed 24/7 by citizens, their families, law
enforcement, or any community member seeking help for a behavioral health
need. Once accessed, the CRF diverts people to the appropriate care
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inside. Typical components of a CRF include a Crisis Stabilization Unit (CSU) and an
Addictions Receiving Facility (ARF).
The CRF is referred to as a “No Wrong Door” approach in which families or law
enforcement officers can bring an individual to one place, without having to
predetermine whether the person meets criteria for mental health or substance
abuse intervention. The triage and placement decisions are made at the CRF by
mental health professionals.
For emergent, (i.e. acute) levels of care, whether on a voluntary or involuntary
basis, the CRF facilitates direct admission to a Crisis Stabilization Unit (CSU), or
Baker Act Receiving Facility. For persons needing clinical intervention related to
acute substance use disorders, the CRF facilitates admission to an Addiction
Receiving Facility (ARF) or “Marchman Act” receiving facility.”
For non-emergent situations, the CRF offers education and linkage to services as
needed by the individual. This may include such services as outpatient psychiatric
evaluation and medication management, residential substance use treatment,
intensive outpatient therapy, case management, supported employment, or a
variety of peer led recovery supports.
NOTE: Centralized Receiving Systems (CRS) are a relatively new concept in
Florida, and do not yet exist in most communities. Where they do exist, they are
currently mostly in larger metropolitan areas. Some include a Centralized Receiving
Facility. Centralized Receiving Systems are collaborative efforts of receiving
facilities of several different provider organizations. In Collier County, aside from
the David Lawrence Center, there are currently no other receiving facilities for
mental health, and Collier County has never had an Addictions Receiving Facility.
CRS’s can also employ additional interventions and responses to meet community
mental health and addictions needs, such as Mobile Crisis Teams.
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APPENDIX V
HOUSING MODELS (Examples)
Permanent Supportive Housing
Permanent Supportive Housing (PSH) is a nationally recognized, proven, and cost-
effective solution to the needs of vulnerable people with disabilities who are
homeless, institutionalized, or at greatest risk of these conditions. The PSH
approach integrates permanent, affordable rental housing with the best practice
community-based supportive services needed to help people who are homeless
and/or have serious and long-term disabilities - such as mental illnesses,
developmental disabilities, physical disabilities, substance use disorders, and
chronic health conditions - access and maintain stable housing in the community.
Key components of PSH that facilitate successful housing tenure include:
Individually tailored and flexible supportive services that are voluntary, can be
accessed 24 hours / day, 7 days / week, and are not a condition of ongoing
tenancy
Leases that are held by the tenants without limits on length of stay
Ongoing collaboration between service providers, property managers, and
tenants to preserve tenancy and resolve crisis situations that may arise.
The evidence on PSH demonstrates that the housing preferences of homeless
people and people with disabilities are consistent with the PSH model which
provides independent housing that is integrated in the community; offering greater
satisfaction and perceived choice to the individuals it serves. The expansion of PSH
using innovative systems-level approaches such as those authorized in HUD's
reformed Section 811 Program holds great promise for systematically expanding
new integrated supportive housing opportunities in states and localities across the
country.
Integrated supportive housing approaches are responsive to the community
integration mandates within the 1999 U.S. Supreme Court's Olmstead decision, a
landmark disability rights case which affirms the right of people with disabilities
under the Americans with Disabilities Act (ADA) to live in the most integrated
setting appropriate to their needs.
Reference: http://www.tacinc.org/knowledge-resources/topics/permanent-supportive-
housing/
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An example of privately-funded supported housing program for people with mental
illnesses is Dave’s House.
The Traditional Home Model. Dave’s House has two different housing models.
The Traditional Home Model, which began operating in 2008, serves to keep
individuals from becoming homeless by placing four to five people in a single-family
home with supportive services. Residents function as a modern family, supporting
each other, sharing housekeeping duties and socializing. By living with others who
struggle with the same illness, some residents are able to form meaningful
friendships, often for the first time.
The Housing First Model. In early 2016, Dave’s House launched a second
program called Dave’s Housing First to take chronically homeless people with
serious mental illnesses (SMI) off the streets and provide permanent housing in
one-bedroom apartments scattered throughout Orlando.
In both models, residents are given ongoing mental health services; 24-hour, 365-
day-a-year crisis intervention; access to medical care; help applying for benefits;
guidance in finding supportive employment for those who are able to work; and
assistance in learning general life skills such as how to shop for groceries and use
public transportation. Dave’s House partners with Pathway Homes, Aspire Health
Partners, Henderson Behavioral Health and Hope South Florida to provide this level
of encompassing support, which has proven to be the most successful way to allow
individuals with SMI to live independent, fulfilling lives.
Residents break the cycle of homelessness, incarceration and hospitalization, so
that they may focus on improving themselves, contributing to their communities
and realizing their dreams.
Providing individuals with permanent supportive housing changes lives. Each
individual has a story, hopes and the potential for positive contributions to society.
The personal costs to the individual suffering from SMI when we allow them to
become and remain homeless are immeasurable – unachieved individual goals as
well as loss of familial connections and societal contribution. The costs to the
community, however, are very measurable – and staggering and avoidable.
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Initiated in 2017 by the Vanderhorst
Family Foundation in collaboration with
NAMI of Collier County, Jerry & Janet's
House was inspired by and partially
modeled on the Dave’s House concept.
Jerry and Janet’s House is a privately-
funded permanent supportive housing
program for adults disabled by mental
illnesses in SW Florida.
Disability income falls short of providing
even substandard housing in Collier
County. While there are a few publicly-funded HUD units that can serve the
population, wait lists of over two years prohibit people in need from ever
participating. Without decent, safe, affordable housing, recovery from mental
illness is not likely. Jerry and Janet’s House was created to help address this
problem.
Located in Bonita Springs, Jerry and Janet’s House is a large five-bedroom, 3 and
1/2 bath home that houses up to five individuals with serious mental illnesses. The
residents receive supportive services from agencies such as Florida Assertive
Community Treatment (FACT) team, and NAMI of Collier County’s Self-Directed
Care and Community Outreach Peer Education (COPE) programs.
A non-residential ‘property manager’, a master’s level counseling student, visits the
home on a frequent basis, several times a week, working with residents on meal
planning, budgeting, shopping, home maintenance, and mutually agreed upon
social activities. Residents each sign their own lease and pay roughly one third of
their income for rent and utilities. The ultimate goal is to improve their chances for
a productive and meaningful life in a safe and supportive environment.
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APPENDIX VI STRATEGIC PLANNING PARTICIPANTS
Name Organization
Commissioner Andy Solis Collier County Board of County Commissioners
Judge Janeice Martin 20th Judicial Circuit
Scott Burgess CEO, David Lawrence Center
Dr. Emily Ptaszek COO, Healthcare Network of SW Florida
Susan Kimper Naples Community Hospital
Robert Tabor Central Florida Behavioral Healthcare Network
Nicole Mirra State Attorney's Office
Susan Vivonetto Collier County Sheriff's Office, CIT
Sgt. Leslie Weidenhammer Collier County Sheriff's Office, CIT, MHIT
Beverly Belli David Lawrence Center
Tamara Glynn David Lawrence Center
Sheila Forrester Collier County Sheriff's Office
Kristen Metz Physicians Regional Medical Center
Katina Bouza Collier County Sheriff's Office
Nancy Dauphinas COO, David Lawrence Center
Dr. Pamela Baker CEO, NAMI of Collier County
Lisa Dean Park Royal Hospital
Brenda Iliff CEO, Hazelden
Bill Gonsalves Collier County Sheriff's Office, CIT
Marlee Hartnett, RN Isle of Palms Recovery Center
Dawn Whelan Collier County Community and Human Services
Kristi Sonntag Collier County Community and Human Services
Leanne Morrison Park Royal Hospital
Katie Burrows David Lawrence Center
Amanda Krause State Attorney's Office
Dena Landry Collier County Public Schools
Jim Ignelsi The Willough at Naples
Doug Williams Collier County Sheriff's Office
Monique Nagy Collier County Sheriff's Office
Michael Lisboa Colllier County Sheriff's Office
Angela Goodner Collier County Commission
Zachary Ward Public Defenders Office
Jeff Nichols Circuit 20 Court Administration
Vann Ellison St. Matthews House
Keri Miller David Lawrence Center/CCSO MHIT
Tabitha Butcher Collier County Government
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STRATEGIC PLANNING PARTICIPANTS (CONTINUED)
Name Organization
Brigette DaBiere Armor Correctional
Marien Ruiz Collier County Sheriff's Office
Shelley Forrester Collier County Sheriff's Office
Dr. Lois Bolin Southwest Florida Veterans Alliance
Mark Engelhardt USF FMHI CJMHSA Technical Assistance Center
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Substance Abuse and Mental
Health Services Administration
Strategic Plan
FY2019 – FY2023
SAMHSA Strategic Plan – FY2019-FY2023
Table of Contents
Introduction ................................................................................................................ 1
Vision and mission of the Substance Abuse and Mental Health Services
Administration ........................................................................................................... 2
Core principles ......................................................................................................... 2
Priorities, Goals, and Measurable Objectives ......................................................... 4
Priority 1: Combating the Opioid Crisis through the Expansion of Prevention,
Treatment, and Recovery Support Services ............................................................ 4
Priority 2: Addressing Serious Mental Illness and Serious Emotional Disturbances
............................................................................................................................... 10
Priority 3: Advancing Prevention, Treatment, and Recovery Support Services for
Substance Use ....................................................................................................... 16
Priority 4: Improving Data Collection, Analysis, Dissemination, and Program and
Policy Evaluation .................................................................................................... 20
Priority 5: Strengthening Health Practitioner Training and Education ..................... 24
Key Performance and Outcome Measures ............................................................ 28
Priority 1: Combating the Opioid Crisis through the Expansion of Prevention,
Treatment, and Recovery Support Services .......................................................... 28
Priority 2: Addressing Serious Mental Illness and Serious Emotional Disturbances
............................................................................................................................... 30
Priority 3: Advancing Prevention, Treatment, and Recovery Support Services for
Substance Use ....................................................................................................... 32
Priority 4: Improving Data Collection, Analysis, Dissemination, and Program and
Policy Evaluation .................................................................................................... 34
Priority 5: Strengthening Health Practitioner Training and Education ..................... 35
SAMHSA Strategic Plan – FY2019-FY2023
Page 1 of 36
Introduction
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the
agency within the U.S. Department of Health and Human Services (HHS) that leads
public health efforts to advance the behavioral health of the nation and to improve the
lives of individuals living with mental and substance use disorders, and their families.
The SAMHSA Strategic Plan FY2019-FY2023 outlines five priority areas with goals and
measurable objectives that provide a roadmap to carry out the vision and mission of
SAMHSA over the next four years. The five priority areas are:
1. Combating the Opioid Crisis through the Expansion of Prevention, Treatment,
and Recovery Support Services
2. Addressing Serious Mental Illness and Serious Emotional Disturbances
3. Advancing Prevention, Treatment, and Recovery Support Services for Substance
Use
4. Improving Data Collection, Analysis, Dissemination, and Program and Policy
Evaluation
5. Strengthening Health Practitioner Training and Education
For each priority area, an overarching goal and series of measurable objectives are
described in the Strategic Plan. Following the discussion of SAMHSA’s priority areas
are examples of key performance and outcome measures SAMHSA will use to track
progress. Given the broad range of issues and populations that SAMHSA addresses,
this Strategic Plan is not intended to be an inventory of all objectives or activities
SAMHSA will pursue. Rather, the Strategic Plan presents priority goals and objectives
reflecting important changes and outcomes that SAMHSA aims to achieve over the next
four years.
The SAMHSA Strategic Plan FY2019-FY2023 aligns with the U.S. Department of Health
and Human Services Strategic Plan FY2018-FY2022. Specifically, the Priorities, Goals,
Measureable Objectives of the SAMHSA Strategic Plan FY2018-2023 will serve to
advance HHS Strategic Goal 1, Objective 1.4 to Strengthen and Expand the Healthcare
Workforce to Meet America’s Diverse Needs; HHS Strategic Goal 2, Objective 2.3 to
Reduce the Impact of Mental and Substance Use Disorders through Prevention, Early
Intervention, Treatment and Recovery Support; and HHS Strategic Goal 4, Objective
4.1 to Improve Surveillance, Epidemiology, and Laboratory Services.
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Vision and mission of the Substance Abuse and Mental
Health Services Administration
Vision: To provide leadership and resources – programs, policies, information
and data, funding, and personnel – advance mental and substance use disorder
prevention, treatment, and recovery services in order to improve individual,
community, and public health.
Mission: To reduce the impact of substance misuse and mental illness on
America's communities.
Core principles
SAMHSA’s work is guided by five core principles identified by the Assistant Secretary
for Mental Health and Substance Use that are being infused throughout the Agency’s
activities. The five core principles are:
Supporting the adoption of evidence-based practices.
SAMHSA is committed to advancing the use of science – in the forms of data; research
and evaluation; and evidence-based policies, programs and practices – to improve the
lives of Americans living with substance use disorders and mental illness, as well as
their families.
Increasing access to the full continuum of services for mental and substance use
disorders.
Through grant funding, a new approach to national, regional, and local training and
technical assistance, the dissemination and adoption of evidence-based practices, and
outreach and engagement, SAMHSA will work to ensure all Americans understand and
access to a comprehensive continuum of mental and substance use disorder services,
including high-quality, evidence-based prevention, treatment, and recovery support
services.
Engaging in outreach to clinicians, grantees, patients, and the American public.
SAMHSA is dedicated to engaging clinicians, grantees, states, people who have mental
and substance use disorders, their family members, and other stakeholders to improve
access and quality of mental and substance use disorder care in every community
across the nation and to combat the stigma that continues to be a barrier to many
Americans seeking and receiving help.
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Collecting, analyzing, and disseminating data to inform policies, programs, and
practices.
SAMHSA will enhance its data collection, outcomes, evaluation, and quality support
efforts to enhance health care and health systems integration; to identify and to address
mental and substance use disorder-related disparities; to identify what works;, and to
strengthen and to expand the provision of evidence-based behavioral health services
for Americans. Such performance-based efforts will be conducted by SAMHSA along
with federal, state, territorial, tribal, and community partners, will directly improve the
delivery of services, promote awareness, and will inform the development of policy and
programmatic initiatives.
Recognizing that the availability of mental and substance use disorder services is
integral to everyone’s health.
SAMHSA will lead efforts to advance the recognition of mental health and freedom from
addiction as being essential to overall health. Such recognition and focus will help to
improve access to and integration of services, support the development of financing
mechanisms to support and sustain positive outcomes, and address gaps and
disparities in service delivery.
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Priorities, Goals, and Measurable Objectives
Priority 1: Combating the Opioid Crisis through the Expansion of
Prevention, Treatment, and Recovery Support Services
Goal
Reduce opioid misuse, use disorder, overdose, and related health consequences,
through the implementation of high quality, evidence-based prevention, treatment, and
recovery support services.
Overview
The opioid crisis continues to have devastating effects on individuals, families, and
communities across the United States. In 2017, 11.1 million Americans 12 years or
older reported misuse of prescription opioids, nearly 900,000 reported heroin use, and
2.1 million had an opioid use disorder in the past year; and more than 42,000
Americans died from an opioid overdose in 2016.1,2 In addition, opioid misuse and
opioid use disorder are contributing to rising rates of hospital emergency department
visits,3 neonatal abstinence syndrome,4 and viral hepatitis associated with opioid
injection,5 among others. Since 2013, the proliferation of such highly potent synthetic
opioids such as fentanyl and carfentanil has further fueled a dramatic increase in
overdose deaths and underscores the urgent need for action.2 SAMHSA is leading
efforts to support the implementation of the full range of prevention, treatment, and
recovery support services that can bring an end to the opioid crisis.
1 Substance Abuse and Mental Health Services Administration. Results from the 2017 National Survey on
Drug Use and Health. 2018.
2 Jones CM, Einstein EB, Compton WM. Changes in synthetic opioid involvement in drug overdose
deaths in the United States, 2010-2016. JAMA. 2018;319(17):1819-1821.
3 Kantor-Vivolo, Seth P, Gladden RM, Mattson CL, et al. Vital Signs: trends in emergency department
visits for suspected opioid overdoses – United States, July 2016-September 2017. MMWR Morb Mortal
Wkly Rep. 2018;67(9):279-285.
4 Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and costs of neonatal
abstinence syndrome among infants with Medicaid: 2004-2014. Pediatrics. 2018;141(4). Pii:e20173520.
5 Zibbell JE, Asher AK, Patel RC, Kupronis B, et al. Increases in acute hepatitis C virus infection related to
a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public
Health. 2018;108(2):175-181.
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Measurable Objectives
Objective 1.1: Strengthen public health surveillance
How we will accomplish our objective:
• Revise SAMHSA’s surveys to collect additional information related to opioid
misuse, opioid use disorder, and overdose, as well as receipt of services,
such as medication-assisted treatment (MAT) for opioid use disorder, training
first responders and community members on overdose prevention and use of
naloxone, and the availability of recovery support services among people with
opioid use disorder.
• Implement a new Drug Abuse Warning Network (DAWN) survey to provide
hospital emergency department data to communities about the evolving
opioid crisis.
• Collaborate with SAMHSA grantees to improve the collection of grantee data,
including through the implementation of a new innovative client-based data
collection system that can be used to identify and disseminate information on
effective opioid-related prevention, treatment, and recovery support
programs, practices, and policies.
• Partner with federal, state, tribal, territorial, and local partners on surveillance
initiatives that improve the timeliness and specificity of opioid-related data.
• Collaborate with federal, including the Centers for Disease Control and
Prevention (CDC), state, tribal, territorial, and local partners on surveillance of
comorbidities associated with opioid misuse and opioid use disorder,
including co-occurring substance use disorders.
Objective 1.2: Advance the practice of pain management
How we will accomplish our objective:
• Promote technical assistance, training, and effective educational strategies to
clinicians, policy makers, and the public on the risks of opioid pain
medications.
• Support the dissemination and adoption of evidence-based guidelines for
acute and chronic pain management in both general and high-risk populations
to mitigate the risk of opioid misuse, use disorders, and overdose, and to
improve the care of individuals living with chronic pain.6
6 e.g., Centers for Disease Control and Prevention (CDC) Guidelines for Prescribing Opioids for Chronic
Pain https://www.cdc.gov/drugoverdose/prescribing/guideline.html
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• Increase understanding and support of multi-disciplinary, multi-modal pain
management approaches among clinicians, patients, the public, and
policymakers to ensure that non-pharmacologic (including psychologic
interventions, procedures, and complementary and alternative approaches)
and non-opioid pharmacologic options are readily accessible for patients and
clinicians.
• Develop and disseminate clinical practice guidelines to healthcare
professionals on evidence-based treatment of co-occurring substance use
and mental disorders and pain disorders.
• Collaborate with the National Institutes of Health (NIH), CDC, Health
Resources and Services Administration (HRSA), and education accreditation
bodies to advance pain management and substance use education to be core
training elements in colleges, universities, and health professional schools,
including through work in SAMHSA’s Regional Offices.
Objective 1.3: Improve access to, utilization of, and engagement and retention in
prevention, treatment, and recovery support services
How we will accomplish our objective:
• Develop and disseminate educational materials and science-based
messaging to educate the public about not sharing medications, safe storage
of medications, and safe disposal of medications.
• Develop and disseminate communication materials and other resources to
increase understanding of families and caregivers on facts around privacy of
information and access to records.7
• Leverage SAMHSA’s Provider’s Clinical Support System – Universities to
expand access to MAT services for persons with an opioid use disorder
seeking or receiving MAT through ensuring the education and training of
students in the medical, physician assistant and nurse practitioner fields.
• Support, through SAMHSA funding, training, and technical assistance, the
adoption of evidence-based policies, programs, and practices to prevent
opioid misuse, and to diagnose and treat opioid use disorders and co-
occurring substance use and mental disorders.
• Utilize SAMHSA’s new approach to technical assistance for opioids that
engages localized expert teams of clinicians, preventionists, and recovery
specialists to provide technical assistance to states, communities, and
healthcare providers on addressing the opioid crisis.
7 e.g., the Health Insurance Portability and Accountability Act (HIPAA).
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• Utilize SAMHSA’s Regional Prevention Technology Transfer Centers in
collaboration with SAMHSA’s Regional Addiction Technology Transfer
Centers to educate providers and other stakeholders on opioid use disorder
prevention, treatment, and recovery.
• Leverage SAMHSA funding to expand access to MAT and recovery support
services 8 for individuals with opioid use disorder, including through efforts to
increase the number of MAT providers and programs, the advancement of
telehealth approaches and use of mobile technologies, and through the
implementation of comprehensive service delivery models.
• Facilitate collaboration between primary care and specialty care providers
and the recovery community to support the development and implementation
of comprehensive and integrated systems of care that provide the full
spectrum of treatment and recovery support services for people with opioid
use disorder.
• Partner with the Agency for Healthcare Research and Quality (AHRQ),
HRSA, and the United States Department of Agriculture (USDA) to expand
use of telehealth and e-prescribing protocols for opioid-related crisis response
and treatment and to expand access to MAT in rural and remote areas.
• Collaborate with CDC and other stakeholders to advance efforts to screen,
prevent, and address the infectious disease complications of opioid use
disorder,9 particularly among people who inject drugs.
• Leverage SAMHSA funding, training, and technical assistance to increase
access to MAT and behavioral therapies and ongoing recovery support
services for individuals with opioid use disorder involved in the criminal justice
system.
• Disseminate patient education information to clinicians regarding the dangers
of opioid use by girls and women of childbearing age, and those who are
considering pregnancy or are pregnant.
• Support efforts, in collaboration with other federal and nonfederal partners, to
ensure that substance-exposed infants and their mothers are identified,
treated, and receive long-term follow up to monitor/prevent long-term
consequences.
• Collaborate with the Centers for Medicare & Medicaid Services (CMS) and
other public and private payers to support the implementation of payment
8 e.g., MAT, recovery coaches, vocational training and employment services, legal services, and safe and
supportive housing
9 e.g., HIV, HCV, infectious endocarditis
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policies that can sustain evidence-based opioid prevention, treatment, and
recovery support services.
Objective 1.4: Target the availability and distribution of overdose-reversing drugs
How we will accomplish our objective:
• Develop and disseminate educational and training materials to first
responders and the public on how to respond to an opioid overdose with
naloxone.
• Leverage SAMHSA funding, training, and technical assistance to support
states and communities in the design and implementation of prevention
systems to support first responders and lay audiences in overdose prevention
and naloxone administration.
• Support community and peer intervention models that encourage overdose
survivors to seek evidence-based treatment and recovery support services.
• Provide guidance to federal grantees on how program resources can be used
to support state and local efforts to prevent opioid overdoses and encourage
at-risk populations to seek treatment.
• Promote opioid overdose prevention planning for those working with criminal
justice populations pre- and post-release from jail, prison, or detention
centers.
• Increase availability of naloxone for emergency medical technicians,
hospitals, jails/prisons, and primary care through work in SAMHSA’s Regional
Offices.
• Collaborate with first responders and community crisis lines to provide
telehealth services related to naloxone use and overdose response.
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Objective 1.5: Support cutting-edge research on pain and addiction
How we will accomplish our objective:
• Conduct service delivery research and evaluations to identify effective opioid-
related prevention, treatment, and recovery programs, practices, and policies.
• Utilize SAMHSA’s National Mental Health and Substance Use Policy
Laboratory in collaboration with external partners, including states, tribes,
local jurisdictions, and non-government entities, to identify and evaluate
promising approaches to address opioid misuse, opioid use disorder, and
overdose and to support the replication and scaling of opioid-related
evidence-based programs, practices, and policies.
• Engage with federal partners such as ASPE, NIH, CDC, CMS, and AHRQ to
identify research needs and to advance priority research on pain, addiction,
and overdose.
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Priority 2: Addressing Serious Mental Illness and Serious Emotional
Disturbances
Goal
Reduce the impact of serious mental illness (SMI) and serious emotional disturbance
(SED) and improve treatment and recovery support services through implementation of
the comprehensive set of recommendations put forward by the Interdepartmental
Serious Mental Illness Coordinating Committee (ISMICC).
Overview
In 2017, 4.5 percent (11.2 million) of Americans 18 years or older had an SMI,10 and it is
estimated that 6.8 to 11.5 percent of children and youth have an SED.11 Individuals with
SMI often have multiple mental disorders,10 co-occurring substance use disorders,10
have a substantially elevated risk for suicide,12 and are at increased risk for
homelessness and involvement with the criminal justice system.13,14 Yet, despite the
well-documented health and social impacts of SMI and SED on individuals, families,
and communities, only a fraction of individuals with these disorders receive the
evidence-based care they need.9,10 To address this priority area, SAMHSA is focusing
its efforts on the guidance and recommendations provided by the ISMICC – a new
federal advisory council authorized by the 21st Century Cures Act to improve the lives
of people living with SMI or SED.
10 Substance Abuse and Mental Health Services Administration. Results from the 2017 National Survey
on Drug Use and Health. 2018.
11 Interdepartmental Serious Mental Illness Coordinating Committee. The Way Forward. Federal Action
for a System That Works for All People Living with SMI and SED and Their Families and Caregivers.
2017. Available at: https://store.samhsa.gov/shin/content/PEP17-ISMICC-RTC/PEP17-ISMICC-RTC.pdf
12 Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. Journal of
Psychopharmacology. 2010;24(4_Suppl):81-90.
13 U.S. Department of Housing and Urban Development (HUD). HUD 2016 continuum of care homeless
assistance programs homeless populations and subpopulations. Available at:
https://www.hudexchange.info/resource/reportmanagement/published/CoC_PopSub_NatlTerrDC_2016.pdf
14 Steadman HJ, Osher FC, Robbins PC, Case B, Samuels S. Prevalence of serious mental illness
among jail inmates. Psychiatric Services. 2009;60(6):761-765.
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Measurable Objectives
Objective 2.1: Strengthen federal coordination to improve care
How we will accomplish our objective:
• Collaborate and align efforts with federal partners through inter and intra-
departmental initiatives 15 to:
o Improve care across the lifespan for people with SMI or SED by
developing a comprehensive continuum of care, including a list of core
services that encompass evidence-based prevention, treatment, and
recovery supports to address such issues as crisis services, early
mental illness including first-episode psychosis (FEP), suicide, trauma,
homelessness, criminalization and outreach and engagement.
o Convene expert panel meetings on various topics, such as co-
occurring disorders, school mental health, older adult issues, inpatient
care, and psychotropic medications, to gather input on actions to
improve care and policy development.
o Leverage SAMHSA resources, including funding, training, and
technical assistance, such as the Promoting Integration of Primary and
Behavioral Health Care grants and the Center for Integrated Health
Solutions, to improve the integration of primary healthcare with
services for mental illness and substance use disorders.
o Work with partners to improve data collection and use of quality
measures, including program evaluations to improve service delivery,
quality of care, and outcomes and identify, expand, and maximize the
use of evidence-based practices by evaluating promising approaches
and achieving wide-scale adoption of evidence-based practices for
SMI and SED.
15 e.g., ISMICC and the HHS Behavioral Health Coordinating Council
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Objective 2.2: Facilitate access to quality care through services expansion, outreach,
and engagement
How we will accomplish our objective:
• Define, implement, and disseminate guidance for a national standard for crisis
care, including increasing awareness and use of Psychiatric Advanced
Directives, and reassessment of involuntary civil commitment standards and
processes.
• Review and assess treatment-planning practices to develop and disseminate
guidelines to practitioners in order to improve quality of care.
• Increase professional development by expanding the quantity and quality of
the mental health workforce through outreach and partnerships with federal
agencies such as HRSA and CMS; professional organizations and graduate
schools; provider training and technical assistance; the use of trained peer
professionals in diverse settings; and outreach to underserved populations.
• Increase the mental health literacy of the public by training school personnel,
first responders, law enforcement, faith communities, and primary care
providers to understand and be able to detect the signs and symptoms of
mental illness and engage and connect individuals to care.
• Utilize SAMHSA funding, training, and technical assistance to develop and
support innovative approaches to providing behavioral healthcare in specialty
and primary care settings, including expanding efforts for screening, effective
treatment planning, and on-going care engagement.
• Develop and disseminate communication materials and other resources to
increase understanding among families and caregivers on facts around
privacy of information and access to records.16
• Leverage SAMHSA funding to engage individuals living with SMI or SED who
may be experiencing homelessness in treatment, housing, and other recovery
support services.
• Work with federal and nonfederal partners to expand the use of telehealth,
electronic health records, and other health information technology
approaches to facilitate the provision of evidence-based and coordinated
care.
• Expand, through collaborations with the Department of Education and state
and local education stakeholders, student access to and engagement in the
continuum of mental health services and supports in primary and higher
education settings.
16 e.g., the Health Insurance Portability and Accountability Act (HIPAA).
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• Utilize SAMHSA Regional Administrators to advance efforts related to SMI
and SED - including the promotion of televideo/telehealth crisis response
services and Assertive Community Treatment (ACT) - in partnership with first
responders, and deflection/diversion community crisis lines.
• Develop and disseminate training standards for disaster workers who deliver
disaster-related mental and substance use disorder services and
referral/linkage services to the public, including individuals who have SMI or
SED.
Objective 2.3: Improve treatment and recovery by closing the gap between what works
and what is offered
How we will accomplish our objective:
• Use SAMHSA funding, training, and technical assistance and collaborations
with federal and nonfederal partners to adopt a comprehensive continuum of
care throughout the nation for individuals with SMI or SED that includes
making available high-quality acute care, such as the National Suicide
Prevention Lifeline, Disaster Distress Helpline, crisis centers, respites, mobile
crisis teams, alternatives to emergency rooms, inpatient services, assisted
outpatient treatment, assertive community treatment, certified community
behavioral health clinics, partial hospitalization programs, intensive outpatient
programs, supported housing, including group homes and apartments in
communities.
• Prioritize the early identification and intervention for children, youth, and
young adults by promoting best practices for mental health and substance
use screening in schools and supporting mental health consultation and
training of the youth-serving workforce.
• Develop a national network of regionally based training and technical
assistance centers to better equip behavioral health professionals and others
to meet the needs of individuals living with or at risk for developing SMI or
SED.
• Leverage SAMHSA resources through funding, training, and technical
assistance, including through the new Clinical Support System for Serious
Mental Illness (CSS-SMI), to increase the quality of clinical care by improving
medication management – including the use of clozapine, other
antipsychotics, and long-acting injectable antipsychotic medications – as well
as recovery services, including supported housing, supported employment,
family psychoeducation, FEP programs that have high fidelity to the
Coordinated Specialty Care model, ACT, and peer-delivered services.
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• Use SAMHSA’s National Mental Health and Substance Use Policy Laboratory
and Evidence-Based Practices Resource Center to consolidate and improve
the dissemination and translation of research findings and the adoption of
evidence-based practices among the behavioral health workforce, clinicians,
policymakers, peers, and family members.
• Foster the agency’s Zero Suicide efforts by promoting comprehensive suicide
prevention efforts in health and mental health and substance use disorder
systems.
• Expand – through SAMHSA funding, training, and technical assistance, and
collaborations with federal and nonfederal partners – the supply of mental
health providers and the delivery of high-quality treatment and recovery
support services across the United States, particularly in underserved and
rural areas, especially those found in culturally diverse communities and in
tribal nations.
• Increase the delivery of systems of care for children, youth, and families
affected by SMI or SED by expanding transition-age youth services, child
trauma services, school-based care, early childhood services, and efforts for
young people who are at clinically high risk for developing psychosis.
• Expand, through SAMHSA funding, collaborations, training, and technical
assistance, efforts to address the needs of individuals living with SMI or SED
who have co-occurring addictions, intellectual and developmental disabilities,
hepatitis C virus, and/or HIV/AIDS, including making integrated services
readily available, incorporating tobacco dependence treatment into mental
health services, and increasing the number of providers trained in and
offering MAT for opioid use disorders for people who have SMI.
• Expand the availability of high-quality, integrated, and comprehensive care by
expanding and evaluating Certified Community Behavioral Health Clinics
(CCBHCs).
• Expand use of community recovery support systems such as clubhouses and
other peer-to-peer focused support services.
Objective 2.4: Increase opportunities for diversion and improve care for people with SMI
or SED involved in the criminal and juvenile justice systems
How we will accomplish our objective:
• Support, through SAMHSA funding, training, and technical assistance, state
and local efforts to divert if appropriate, individuals living with SMI or SED
from the juvenile or criminal justice systems to community-based care for
mental and substance use disorders and through other developmental
support services.
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• Identify and promote evidence-based practices with the goal of reducing the
incidence and duration of psychiatric hospitalization, homelessness,
incarcerations, and criminal justice system interactions.
• Provide training and technical assistance to stakeholders to help address
issues of competency restoration in states to assure delivery of timely and
appropriate care.
• Strengthen collaboration with adult and juvenile justice-based organizations to
provide education and training to first responders, courts, jails, prisons, and
parole officers on how to work with individuals who have SMI or SED.
• Collaborate with federal and nonfederal partners to promote therapeutic
justice dockets in federal, state, and local courts for individuals living with SMI
or SED.
• Improve information sharing among justice, mental health, and others who
interact with individuals at risk for or living with SMI or SED, to promote
coordinated service delivery.
Objective 2.5: Develop finance strategies to increase availability and affordability of care
How we will accomplish our objective:
• Collaborate with CMS to provide guidance to states on financing evidence-
based treatment and recovery services for SMI or SED.
• Promote full enforcement of the Mental Health Parity and Addiction Equity Act
and other parity laws.
• Collaborate with commercial health insurers on supporting comprehensive
and innovative coverage and payment policies for those with SMI or SED,
including for FEP.
• Collaborate with CMS and the HHS Office of the Assistant Secretary for
Planning and Evaluation to evaluate the effectiveness of the CCBHC value-
based payment approach, identifying innovative best practices and promoting
opportunities for expansion.
• Conduct evaluations, including economic assessments, of innovative service
delivery models for SMI or SED treatment and recovery supports that can
improve care and outcomes.
• Partner with other federal agencies and nonfederal partners to implement
innovative service delivery models that improve care and outcomes for
individuals with SMI or SED.
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Priority 3: Advancing Prevention, Treatment, and Recovery Support
Services for Substance Use
Goal
Reduce the use of tobacco (encompassing the full range of tobacco products and
reduce the misuse of alcohol, the use of illicit drugs, and the misuse of over-the-
counter and prescription medications and their effects on the health and well-
being of Americans.
Overview
In 2017 more than 140 million Americans 12 years or older reported alcohol use
in the past month, 48.7 million reported cigarette use in the past month, 30.5
million reported illicit drug use in the past month, and 19.7 million had a
substance use disorder in the past year.17 The implementation of evidence-
based programs, practices, and policies to address substance use across the
continuum of care and across the lifespan are essential to preventing substance
use, to reducing the burden of substance use, and to creating healthy
communities. SAMHSA’s efforts in this area are grounded in the knowledge that
all levels of prevention – universal, selective, and indicated – are important; that
people with substance use disorders do recover when they receive appropriate,
evidence-based treatment and recovery support services; and that celebrating
those in recovery can help reverse the myths and negative beliefs that persist
about substance use and substance use disorders.
Measurable Objectives
Objective 3.1: Increase public awareness and subsequent behavior change regarding
the risks of substance use with a focus on alcohol, marijuana, and stimulants
How we will accomplish our objective:
• Apply science-based prevention research to develop accurate and timely
prevention messages and strategies that strengthen community, state, and
federal actions to prevent substance abuse and misuse.
• Develop, evaluate, and promote effective education strategies (e.g., health
observances, public education campaigns, social media campaigns) to
increase public awareness and to prevent substance use and misuse at all
stages of life.
17 Substance Abuse and Mental Health Services Administration. Results from the 2017 National Survey
on Drug Use and Health. 2018
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• Develop and disseminate products and resources to inform parents, children,
youth and young adults, schools, workplaces, and communities about the
facts and consequences of substance use and misuse.
• Strengthen community, state, and national partnerships in order to expand
the reach of substance use and misuse related health messages and to
facilitate the implementation of effective prevention, treatment, and recovery
strategies.
• Increase public and provider risk communication about the contamination of
the illicit drug supply with highly potent synthetic opioids and new
psychoactive substances and the dangers this contamination poses to people
who use substances.
Objective 3.2: Expand community engagement around substance use prevention,
treatment, and recovery
How we will accomplish our objective:
• Promote the Strategic Prevention Framework, SAMHSA’s planning process
model, to help communities assess needs, build capacity, plan, implement,
and evaluate.
• Identify, evaluate, and promote community successes and innovations
through new and existing avenues, such as social media, list serves,
newsletters, conferences, communication collaboratives, publications, and
SAMHSA’s Evidence-Based Practices Resource Center.
• Leverage SAMHSA’s regional Prevention and Addiction Technology Transfer
Centers to facilitate the provision of technical assistance and training on
prevention, treatment, and recovery support services to a diverse group of
communities.
Objective 3.3: Reduce youth substance use initiation through strengthening protective
factors and reducing risk factors
How we will accomplish our objective:
• Develop and disseminate products and resources to assist communities and
states to conduct strategic planning to increase protective factors and reduce
risk factors related to substance use and misuse, including risk and protective
factors related to homelessness, education/employment, recovery, and
overall well-being.
• Identify and promote best practices and evidence-based programs through
technical assistance programs, educational programs, campaigns,
SAMHSA’s Evidence-Based Practices Resource Center, and collaborations
with other federal agencies.
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• Utilize SAMHSA-supported training and technical assistance to increase
community and state capacity to conduct needs assessments, and plan,
implement, and sustain effective strategies and programs to address risk and
protective factors for substance use and misuse.
• Leverage SAMHSA funding to provide support for communities and states to
prevent substance use and misuse by implementing effective, science-based
prevention programming and strategies to address risk and protective factors.
Objective 3.4: Support the identification and adoption of evidence-based practices,
programs, and policies that prevent substance use, increase provision of substance use
disorder treatment, and enable individuals to achieve long-term recovery
How we will accomplish our objective:
• Increase, through training, technical assistance, and educational efforts,
understanding and support for the science of prevention, including the
benefits and appropriateness of universal, selective, and indicated prevention.
• Facilitate, promote, and sustain the collaboration of the prevention, treatment,
and recovery fields through aligned messages, strategies, and programs that
address the full continuum of individualized care.
• Promote the adoption of evidence-based programs, practices, and policies
through SAMHSA’s Evidence Based Practices Resource Center.
• Utilize SAMHSA funding, training, and technical assistance to expand
integration of substance use and misuse prevention, treatment, and
community-based recovery support services into primary and specialty care
settings to improve access, utilization, and quality of care for individuals with
or at risk for substance use disorders and co-occurring substance use and
mental disorders.
• Identify and promote effective strategies to prevent and reduce homelessness
through coordinated federal, state, and local planning and service delivery
that integrates stable housing as an essential component of mental health
and substance use services provided to individuals with substance use
disorders as well as co-occurring disorders.
• Collaborate with CMS and other public and private payers to identify,
evaluate, and implement payment policies that will support service delivery
models that provide the full continuum of treatment and recovery support
services for those with substance use disorders, as well as those with co-
occurring substance use and mental disorders.
• Through the scale and spread of evidence-based cessation strategies,
coordinate with CDC’s Office on Smoking and Health and Million Hearts®,
and other federal and nonfederal partners, to improve tobacco use cessation
SAMHSA Strategic Plan – FY2019-FY2023
Page 19 of 36
among people with mental and substance use disorders, among whom
combustible tobacco use is higher and who suffer a higher burden of
cardiovascular events.
• Leverage SAMHSA funding, training, and technical assistance to expand and
explore new and emerging evidence-based recovery approaches.18
• Promote coordination and partnership between mental and substance use
disorder and criminal justice systems through use of the Sequential Intercept
Model (SIM) to identify and address challenges to implementing evidence-
based interventions with individuals involved in the criminal justice system.
Objective 3.5: Strengthen federal coordination to improve substance use prevention,
treatment, and recovery support services
How we will accomplish our objective:
• Increase cooperation, coordination, and collaboration with federal partners
through inter and intra-departmental initiatives 19 to:
o Convene expert panel meetings on various topics to gather input on
actions to improve the delivery of services for individuals with or at risk
for substance use disorders and for co-occurring substance use and
mental disorders.
o Improve prevention, treatment, and recovery services across the
lifespan for people with substance use disorders by aligning federal
efforts to increase access to prevention, treatment, and recovery
support services.
o Leverage SAMHSA resources, including funding, training, and
technical assistance, to improve the integration of primary care and
services related to the care and treatment of substance use and
mental disorders.
o Work with states and community partners to improve data collection
and the use of quality measures, including program evaluations, to
improve service delivery, quality of care, and outcomes and identify,
expand, and maximize the use of evidence-based practices by
evaluating promising approaches and by promoting wide-scale
adoption of evidence-based practices in preventing and treating
substance use disorders.
18 e.g., recovery coaches, reimbursement policies, peer-to-peer programs, and recovery housing
19 ee.g. Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), HHS
Behavioral Health and Criminal Justice Coordinating Committee, and other Interagency Workgroups
SAMHSA Strategic Plan – FY2019-FY2023
Page 20 of 36
Priority 4: Improving Data Collection, Analysis, Dissemination, and Program
and Policy Evaluation
Goal
Expand and improve the data collection, analysis, evaluation, and dissemination of
information related to mental and substance use disorders and receipt of services for
these conditions to inform policy and programmatic efforts, to assess the effectiveness
and quality of services, and to determine the impacts of policies, programs, and
practices.
Overview
Timely, high-quality, ongoing, and specific data help public health officials, policy-
makers, community practitioners, and the public to understand mental health and
substance use trends and how they are evolving; to inform the development of targeted
interventions, focus resources where they are needed most; and to evaluate the
success of response efforts. This priority area supports: strengthening SAMHSA data
collection activities to reflect the real-time needs of the mental and substance use
disorders field and policymakers; prioritizing the use of grant performance data and
evaluation reports to enhance oversight, monitoring, and impact of SAMHSA grant
programs and federal efforts; leveraging data analysis and dissemination to better
identify needs and target resources in communities across the United States; evaluating
innovations in the field to identify promising practices; and replicating bringing to scale
evidence-based programs, practices, and policies.
Measurable Objectives
Objective 4.1: Develop consistent data collection strategies to identify and track mental
health and substance use needs across the nation
How we will accomplish our objective:
• Implement a new Drug Abuse Warning Network (DAWN) survey as a
nationwide public health surveillance system that will provide early warning
information on substance use-involved hospital emergency department (ED)
visits with a focus on the nation's opioid crisis.20
20 Through DAWN, SAMHSA will leverage data on substance-use involved ED visits from a network of
hospitals across the U.S. that can be used to target prevention, treatment, and recovery efforts.
SAMHSA Strategic Plan – FY2019-FY2023
Page 21 of 36
• Update the National Survey on Drug Use and Health (NSDUH).21 Key
planned activities include:
o Collecting and analyzing survey data on MAT for opioid use disorder
and alcohol use disorder to inform national estimates of prevalence, of
MAT access, and of individual correlates of MAT receipt.
o Revising the NSDUH to update clinical diagnostic information for
substance use disorders.
o Redesigning the NSDUH to collect emerging mental health and
substance use related behaviors, including, where feasible, data on the
use of emerging substances and products (e.g., tobacco products) to
provide national estimates.
• Update the National Survey of Substance Abuse Treatment Services
(NSSATS) and National Mental Health Services Survey (N-MHSS).22 Key
planned activities include:
o Updating the NSSATS to include information on MAT in order to
provide information on the availability of MAT services for both opioid
use disorder and alcohol use disorder.
o Updating the NSSATS to include information on treatments for HIV,
viral hepatitis, mental disorders, medication-managed withdrawal,
naloxone and overdose education, and recovery support services
provided in substance use disorder treatment facilities in the United
States.
o Revising the N-MHSS to provide information on the availability of
treatment services to address data gaps identified by the 2017 ISMICC
Report to Congress.
o Ensuring the online Behavioral Health Treatment Services Locator is
regularly updated and is populated with substance use disorder and
mental health facility survey data to help policymakers, providers,
patients, and the public identify relevant treatment services information
and availability.
21 The NSDUH is the primary source of statistical information on the prevalence of substance use and
mental illness in the U.S. The NSDUH generates statistical estimates at the national, state, and sub-state
levels.
22 These national surveys collect data on the location and characteristics of substance abuse and mental
health facilities and are used to update the SAMHSA online Behavioral Health Treatment Services
Locator.
SAMHSA Strategic Plan – FY2019-FY2023
Page 22 of 36
• Reassess the Treatment Episode Data Set (TEDS) and the Mental Health
Client Level Data (MH-CLD) data collections.23 Key planned activities include:
o Working with states to address what data can be collected when
considering changing service delivery and financing systems, including
the continuum of care, while facilitating high-quality and timely
collection of TEDS and MH-CLD data as required by the Substance
Abuse Prevention and Treatment and Community Mental Health
Services Block Grants.
o Convening and supporting partnerships with states and other
stakeholders to develop options to revise or replace TEDS and MH-
CLD data collections.
• Pursue new data collections that provide updated national estimates on the
incidence and prevalence of specific mental and substance use disorders and
receipt of services for those conditions.
Objective 4.2: Ensure that all SAMHSA programs are evaluated in a robust, timely, and
high-quality manner
How we will accomplish our objective:
• Modernize SAMHSA’s Performance Accountability and Reporting System
(SPARS). SPARS captures real-time data for SAMHSA discretionary grant
programs in order to monitor the progress, impact, and effectiveness of
SAMHSA programs. Key planned activities include:
o Collecting and analyzing clinical diagnostic data for clients served in
SAMHSA-funded programs to more effectively target program
resources.
o Developing and collecting web-based client self-report data platforms
for all SAMHSA discretionary grant programs to ensure high quality
and reliable mental health and substance use program performance
data.
o Implementing the collection of clinically validated client-level data for all
SAMHSA discretionary grant programs to track programmatic and
client progress and impact of SAMHSA programs, including on
treatment and related health outcomes.
23 TEDS collects demographic and substance use characteristics of treatment admissions and discharges
from publicly funded substance abuse treatment facilities. MH-CLD collects administrative data on mental
health clients in state funded mental health treatment facilities.
SAMHSA Strategic Plan – FY2019-FY2023
Page 23 of 36
o Developing benchmarks and disseminating annual Performance
Evaluation Reports for all SAMHSA discretionary grant programs.
Objective 4.3: Promote access to and use of the nation's substance use and mental
health data and conduct program and policy evaluations and use the results to advance
the adoption of evidence-based policies, programs, and practices
How we will accomplish our objective:
• Expand access to substance use and mental health data.24 Key planned
activities include:
o Releasing annual reports and updated public-use files in a timely and
efficient manner.
o Ensuring continuous and seamless public access to Substance Abuse
and Mental Health Data Archive (SAMHDA) data in the cloud.
o Enabling the availability of access to SAMHSA restricted-use, micro-
level data at CDC’s National Center for Health Statistics (NCHS)
Research Data Centers to promote broader researcher integration and
use of public health data.
• Strengthen partnerships with communities, states, stakeholders, and other
federal agencies to increase understanding of the prevalence, patterns,
trends, and program data, including risk and protective factors, on substance
use and mental illness.
• Develop and disseminate effective data-driven products, resources, and tools
to assist clinicians, policymakers, community practitioners, patients, and the
public in efforts to advance substance use and mental health prevention,
treatment, and recovery.
• Conduct epidemiological studies and other data analyses and disseminate
findings in order to inform policy and program development and resource
allocation.
• Advance the use of evidence-based, data-driven programs, practices, and
policies to prevent and to treat substance use and mental disorders and to
support recovery through rigorous evaluations of innovative and promising
approaches and the replication and scaling of evidence-based interventions.
24 SAMHSA disseminates key national annual reports and evaluation summaries throughout the year. In
addition, SAMHSA provides access to the Substance Abuse and Mental Health Data Archive (SAMHDA),
SAMHSA’s platform for disseminating public-use and restricted-data collected from our national mental
health and substance use data collections.
SAMHSA Strategic Plan – FY2019-FY2023
Page 24 of 36
Priority 5: Strengthening Health Practitioner Training and Education
Goal
Improve the supply of trained and culturally competent professionals and para-
professionals to address the nation’s mental and substance use disorder
healthcare needs across the lifespan.
Overview
Given the insufficient supply and unbalanced geographical distribution of mental
and substance use disorder professionals, and other healthcare professionals
with expertise in the diagnosis, evaluation, or treatment of people with serious
mental illness and substance use disorders, SAMHSA is committed to supporting
a strategy to improve training and education of a diverse and robust workforce
with skills in addressing prevention, screening, evaluation, diagnosis, treatment,
and recovery support services. Using a multi-pronged approach, SAMHSA will
engage in enhanced collaboration with federal, state, and local governments,
communities, and tribes and tribal organizations. This approach will involve
attracting new professionals to the field, as well as retaining existing
professionals and expanding their reach through such multiplier-effect strategies
as Project Extension for Community Healthcare Outcomes (ECHO), the Hub-
and-Spoke model, broader use of peers, and other innovations. This approach
will also involve improving the clinical skills of all health practitioners with training
on evidence-based practices, including prescriber training for those who are
eligible.
Measurable Objectives
Objective 5.1: Develop and disseminate workforce training and education tools, and
core competencies to prevent and address mental and substance use disorders
How we will accomplish our objective:
• Build and promote the SAMHSA Evidence-Based Practices Resource
Center’s collection of scientifically based resources, so that all stakeholders
have access to tools for improving prevention, treatment, and recovery
support services regardless of their geographic locations.
• Raise the awareness and utility of:
o The Providers’ Clinical Support System (PCSS) as a source of
education and clinical coaching on the treatment of opioid use
disorders, treating chronic pain and preventing opioid use disorder,
and Drug Addiction Treatment Act of 2000(DATA) waiver training for
physicians, nurse practitioners, and physician assistants.
SAMHSA Strategic Plan – FY2019-FY2023
Page 25 of 36
o The Clinical Support System for Serious Mental Illness as a source of
education and clinical coaching on the treatment of and recovery from
SMI or SED.
• Continue to advance SAMHSA’s new approach to training and technical
assistance through the implementation of a national network of regional
centers that provide expertise and training on addiction, substance abuse
prevention, and mental health. This new system is available to all
practitioners and providers and replaces the previous system that focused
primarily on technical assistance delivery only to SAMHSA grantees.
• Develop timely, strategic, and high-value products and publications to support
delivery of evidence-based practices by providers of services for mental and
substance use disorders.
• Support Drug Addiction Treatment Act (DATA) waiver coursework – the
training required for qualified practitioners to obtain a waiver to prescribe
buprenorphine for the treatment of opioid use disorder - delivered prior to
graduation in medicine, physician assistant, and nurse practitioner academic
programs so that new practitioners have completed the required DATA waiver
training by the time of graduation. In addition, expand this approach to other
healthcare professionals who may become eligible to qualify for a DATA
waiver.
Objective 5.2: Collaborate with HRSA, CMS, and other partners to improve mental and
substance use disorder workforce opportunities, including recruitment, training, and
retention
How we will accomplish our objective:
• Collaborate on the Behavioral Health Workforce Education and Training
program administered by HRSA to optimize the resources contributed by
each agency.
• Collaborate on the SAMHSA-HRSA Behavioral Health Workforce Research
Center to provide analysis of workforce issues and gaps, and the data
needed to inform policy and program planning.
• Increase the utilization of the training and technical assistance resources of
the SAMHSA-HRSA Center for Integrated Health Solutions to better address
the whole health needs of individuals with mental and substance use
disorders, whether seen in specialty or primary care settings.
• Expand the relationships and partnerships between the HRSA Area Health
Education Centers and the SAMHSA Regional Technology Transfer Centers.
• Support National Health Service Corps (NHSC) expansion to include
licensed, masters-level addiction counselors to demonstrate the utility of
SAMHSA Strategic Plan – FY2019-FY2023
Page 26 of 36
continuing to expand the NHSC to new mental and substance use disorder
professions and sites.
• Promote cross-state license and credentialing portability by working with state
regulatory agencies and other professional associations and accrediting
bodies, including for peer professionals, to facilitate practice flexibility.
• Explore with CMS and other public and private payers innovative payment
policies and service delivery models that incentivize the provision of mental
and substance use disorder prevention, treatment, and recovery support
services across the health system.
• Promote development of standards for mental and substance use disorder
professionals to conduct tele-mental health/addiction services and leverage
the SAMHSA Regional Administrators to help establish these standards in the
states.
Objective 5.3: Support use of credentialed peer providers and other paraprofessionals
as an integrated component of the comprehensive care provided by the primary and
specialty care systems to prevent substance use disorder and to address the needs of
individuals living with mental and substance use disorders and their families
How we will accomplish our objective:
• Disseminate the SAMHSA “Core Competencies for Peer Workers in
Behavioral Health Services” publication and provide training and technical
assistance to support application and attainment of these competencies.
• Explore with CMS and other public and private payers options to support the
use of programs by states to collect existing information on the impact of the
use of peers, and study service model enhancements and payment policies
that use peer workers as part of a comprehensive health and community care
system.
• Work with local, regional, state, tribal, and national groups to develop a
strategy for increasing the quality of the peer workforce – including
credentialing, licensing and certification – and explore complementary uses of
community health workers.
• Support an in-depth analysis of the variation in peer roles and distribute the
results to organizations that have an interest in using peers to support the
service delivery continuum.
• Work with stakeholders and researchers to further build the evidence base for
different peer roles.
• Develop model job descriptions for peer workers and disseminate these
descriptions to stakeholders.
SAMHSA Strategic Plan – FY2019-FY2023
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• Develop and disseminate information about the essential skills needed in
substance use treatment settings for peer recovery support services through
the publication of a Technical Improvement Protocol or other resources with
accompanying, ancillary materials.
• Collaborate with CMS to support analysis of CMS and managed care
organization case rates and billing codes for services provided by peer
workers, to assess status, growth, and sustainability of the peer workforce
and how best to integrate community-based peer support services into the
continuum of care.
• Collaborate with The Department of Labor's Bureau of Labor Statistics to
develop labor codes for the peer workforce, in order to have better
information about the national peer provider workforce in behavioral health.
• Encourage, through technical assistance and training, a better understanding
by healthcare professionals about community recovery supports and
increased understanding of and collaboration with peer professionals with
mental health and substance use healthcare providers.
SAMHSA Strategic Plan – FY2019-FY2023
Page 28 of 36
Key Performance and Outcome Measures
To track performance and progress in realizing the goals and objectives described in
the Strategic Plan, SAMHSA has identified a series of key performance and outcome
measures. The example measures, presented below, were selected from among the
many measures used by SAMHSA to track performance, progress, and impact of the
Agency’s work, and do not provide a complete enumeration of all measures and metrics
SAMHSA will use to track progress. Priorities 1 through 3 include both key performance
and outcome measures; Priority 4 includes key milestones, and Priority 5 includes only
key performance measures.
Priority 1: Combating the Opioid Crisis through the Expansion of
Prevention, Treatment, and Recovery Support Services
Key Performance Measures
• Number of opioid prescriptions dispensed, and the average number of morphine
milligram equivalents dispensed per prescription in the outpatient setting.
• Percentage of opioid prescriptions with a daily morphine equivalent dose greater
than 50 morphine milligram equivalents.
• Percentage of opioid prescriptions with an overlapping benzodiazepine
prescription.
• Number of naloxone kits distributed, and number of naloxone prescriptions
dispensed.
• Number of practitioners (physicians, nurse practitioners and physician assistants)
with a DATA 2000 waiver to prescribe buprenorphine to individuals with opioid
use disorder.
• Percentage of practitioners with a DATA 2000 waiver who have a patient limit of
275.
• Number of individuals receiving buprenorphine (sublingual/buccal, injectable, and
implantable) in the office-based setting.
• Number of individuals receiving extended-release naltrexone in the office-based
setting.
• Number of opioid treatment programs.
• Number of individuals receiving methadone, buprenorphine, and extended-
release naltrexone in opioid treatment programs.
• Percentage of individuals with opioid use disorder receiving any form of MAT in
the past year.
• Percentage of individuals who had opioid use disorder receiving any form of MAT
in the past year and who were engaged in treatment for at least six months.
• Number of communities with a recovery community organization.
SAMHSA Strategic Plan – FY2019-FY2023
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Key Outcome Measures
• Prevalence of past-year initiation of prescription opioid misuse.
• Prevalence of past-year initiation of heroin use.
• Prevalence of past-year opioid initiation.
• Prevalence of past-30-day prescription opioid misuse.
• Prevalence of past-30-day heroin use.
• Prevalence of past-30-day opioid misuse.
• Prevalence of past-year prescription opioid use disorder.
• Prevalence of past-year heroin use disorder.
• Prevalence of past-year opioid use disorder.
• Rates of opioid-related hospital emergency department visits.
• Rates of opioid-related hospitalizations.
• Rates of opioid-related overdose deaths.
SAMHSA Strategic Plan – FY2019-FY2023
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Priority 2: Addressing Serious Mental Illness and Serious Emotional
Disturbances
Key Performance Measures
• Number of individuals trained to recognize mental health distress and to connect
individuals to needed services.
• Number of programs serving individuals experiencing FEP.
• Number of communities with a crisis response system for SMI and SED.
• Number of communities with a comprehensive continuum of care for SMI and
SED.
• Number of communities with an ACT program.
• Number of communities with an Assisted Outpatient Treatment program.
• Number of adults with SMI who experience homelessness.
• Number of adults with SMI who are unemployed.
• Number of children with SED who are in out-of-home placements.
• Number of children with SED who continue in school.
• Percentage of adults with any mental illness receiving mental health services in
the past year.
• Percentage of adults with SMI receiving mental health services in the past year.
• Percentage of adults with co-occurring any mental illness and substance use
disorders receiving both mental health and substance use services in the past
year
• Percentage of adults with co-occurring SMI and substance use disorders
receiving both mental health and substance use services in the past year.
• Proportion of mental health treatment facilities that screen patients for tobacco
use, offer tobacco cessation counseling, offer nicotine replacement therapy, offer
non-nicotine tobacco cessation medications, and have smoke-free policies.
• Percentage of youth with major depressive episodes receiving mental health
services in the past year.
• Percentage of adults with SMI retained in treatment for at least six months.
SAMHSA Strategic Plan – FY2019-FY2023
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Key Outcome Measures
• Prevalence of past-year any mental illness in adults.
• Prevalence of past-year SMI in adults.
• Prevalence of past-year major depressive episode in adults.
• Prevalence of past-year major depressive episode in among youth.
• Prevalence of past-year suicidal ideation.
• Prevalence of past-year suicide attempt.
• Rates of mental health-related hospital emergency department visits.
• Rates of mental health-related hospitalizations.
• Rates of suicide deaths.
SAMHSA Strategic Plan – FY2019-FY2023
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Priority 3: Advancing Prevention, Treatment, and Recovery Support
Services for Substance Use
Key Performance Measures
• Prevalence of perceptions of harm/risk for parents and youth related to
substance use and for specific substances, including alcohol, tobacco products,
marijuana, cocaine, prescription drugs, methamphetamine, and heroin.
• Number of Synar non-compliance reports, which are state-level reports that track
retailers’ compliance with laws governing tobacco product sales to minors.
• Percentage of individuals with nicotine dependence receiving cessation
pharmacotherapy in the past year.
• Percentage of individuals with nicotine dependence receiving cessation
pharmacotherapy in the past year and were engaged in treatment for at least six
months.
• Proportion of substance abuse treatment facilities that screen patients for
tobacco use, offer tobacco cessation counseling, offer nicotine replacement
therapy, offer non-nicotine tobacco cessation medications, and have smoke-free
policies.
• Percentage of individuals with alcohol use disorder receiving any form of MAT in
the past year.
• Percentage of individuals with alcohol use disorder who received any form of
MAT in the past year and who were engaged in treatment for at least six months.
• Percentage of individuals with substance use disorders who received any form of
substance use disorder treatment in the past year.
• Number of communities with a recovery community organization.
• Number of communities utilizing peer recovery coaches in hospital emergency
departments.
SAMHSA Strategic Plan – FY2019-FY2023
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Key Outcome Measures
• Prevalence of past-year initiation of substance use for specific substances
(tobacco, including the full range of tobacco products, alcohol, marijuana,
cocaine, methamphetamine, prescription stimulants, sedatives, and
tranquilizers).
• Prevalence of past-30-day substance use for specific substances (tobacco,
including the full range of tobacco products, alcohol, marijuana, cocaine,
methamphetamine, prescription stimulants, sedatives, and tranquilizers).
• Prevalence of past-30-day binge drinking and past-30-day heavy drinking.
• Prevalence of past-month nicotine dependence.
• Prevalence of past-year substance use disorders for specific substances
(alcohol, cannabis, cocaine, methamphetamine, prescription stimulants,
sedatives, and tranquilizers).
• Rates of alcohol and substance-related hospital emergency department visits.
• Rates of alcohol and substance-related hospitalizations.
• Rates of alcohol-attributable deaths.
• Rates of drug overdose deaths.
SAMHSA Strategic Plan – FY2019-FY2023
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Priority 4: Improving Data Collection, Analysis, Dissemination, and Program
and Policy Evaluation
Key Milestones
• Begin data collection in DAWN in April 2019. Release first DAWN data in June
2019.
• Incorporate new questions on MAT for opioid use disorder and alcohol use
disorder in the 2019 NSDUH. First release of these new data in September 2020.
• Update NSDUH to include new Diagnostic and Statistical Manual of Mental
Disorders (DSM-5)-based substance use craving and withdrawal items in the
2020 NSDUH. First release of these new data September 2021.
• Revise N-SSATS to include additional questions and response options, including
those related to MAT for opioid use disorder and alcohol use disorder in the
2019, 2020, and 2021 N-SSATS. First release of the new data from the 2019 N-
SSATS in summer 2020.
• Revise NMHSS to include additional questions and response options, including
those related to data gaps identified by the ISMICC in the 2019, 2020, and 2021
NMHSS. First release of the new data from the 2019 NMHSS in summer 2020.
• Revise SPARS data collection with ICD-10 diagnostic codes and program-
specific outcomes questions by fall 2018. First performance evaluation reports
based on these new data will be generated for the 2019 grant cycle.
• Implement updated SPARS data collection system with new web-based self-
report interface by fall 2019.
• Implement revised SPARS data collection to include such validated assessment
instruments as the Addiction Severity Index and the Colorado Symptom Index by
fall 2019. First performance evaluation reports based on these new data will be
generated for the 2020 grant cycle.
SAMHSA Strategic Plan – FY2019-FY2023
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Priority 5: Strengthening Health Practitioner Training and Education
Key Performance Measures25
• Number of practitioners participating in webinars or other training opportunities
funded by SAMHSA.
• Number of practitioners participating in training offered by the PCSS-MAT.
• Number of practitioners participating in training offered by the Clinical Support
System for Serious Mental Illness.
• Number of high-value products and publications to support delivery of evidence-
based practices by the mental and substance use disorders workforce.
• Number of new resources added to Evidence-Based Practices Resource Center.
• Number of consultations and trainings provided, and products developed and
disseminated by SAMHSA’s Technology Transfer Centers.
• Number of individuals and programs meeting SAMHSA’s “Core Competencies
for Peer Workers in Behavioral Health Services.”
• Number of practitioners who indicate that the training they received will change
their current practice.
25 Key Performance measures related to healthcare provider practice change in Priorities 1-3 also apply to
Priority 5.
SAMHSA Strategic Plan – FY2019-FY2023
Page 36 of 36
SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on
America’s communities.
1-877-SAMHSA-7 (1-877-726-4727) • 1-800-486-4889 (TDD) • www.samhsa.gov
Mental Health & Addiction
Ad Hoc Committee Meeting
1/18/19
1/14/20191
Veterans -Collier County
Prelimary Assessment
Dale A. Mullin
Overview
1/14/20192
•Data Collection –Prelimary Summary
•Comments & Observations –Collier County
•Next Steps
•Attachments # 1 -3
Data Collection –Prelimary Summary
1/14/20193
▪Florida has the 3rd Largest Veteran Population in the US –1.5 million (See VA Attachment #1)
▪Collier County –Florida –* 28, 515
▪WWII -2,844
▪Korean 4,896
▪Vietnam 10,404
▪Gulf War 1990 -2001 2,298
▪Gulf War > 2001 1,375
▪SWF Veterans receive treatment in 3 VA Facilities
▪Clinic –Naples, FL
▪Healthcare Center –Cape Coral, FL
▪Hospital –Bay Pines, FL
▪Total Expenditures for Services -$104.6 million
▪Medical Care -$34.8 million
▪Regional Staff Support Services
▪Healthcare Center –Cape Coral, FL
▪Veteran Services Office –Collier County
▪2017 –Clients Served –3,168
▪2018 -Clients Served -3,413
▪David Lawrence Center 2017 Treated
▪194 Veterans –50% Repeat
* US Census Data 2017 (Attachment #2)
Comments & Observations –Collier County
1/14/20194
•Need to coordinate collaboration between Veteran Support Services in our County
•VA, David Lawrence, Veteran Services, NCH, Homeless & Hungry Collation, CCSO & NAMI
•Lack of awareness within the general public & some health and service organizations
•Understanding Combat Related PTSD & TBI –“ Invisible Wounds of War”
•A tendency for these Veterans to spiral downward after 3 –5 years after discharge
•There are a number of government and public events throughout the year recognizing
Veterans for their Service i.e., Memorial Day, 4th July, & Fishing Trips, Veterans Day, Honor Flight
•There are Post 9/11 Veterans, who were born in Collier County, and now have returned from today’s
wars and to live in our community as well as those who have moved here from out of State.
•There are Veteran Charity Organizations and Veteran fund raising efforts in our community that focus
on helping Veterans and their families with transitional needs i.e., Health/Wellness, Education, housing
& mental health
•Wounded Warriors of Collier County
•Veteran’s Mentors (VTC) of Collier County
•Home Base SWFL –Red Sox Foundation (Mass General Hospital)
•Wounded Warrior Project –Jacksonville, FL
•Celebrity Martini Glass Auction –Naples, FL
Next Steps
1/14/20195
•Analyze Requested Data to be provided by Veteran Administration (Attachment #3)
•To Conduct a Veterans Focus Group in mid February
•Mix of Veterans 10 –15 –Gulf War & Vietnam
•Solicit any Questions from Committee Members for use by the facilitator
•In the process of setting up a Round Table Discussion with VA Representatives –within 30 days
•David Soldano –Veteran Center, Collier County
•Jenee Garcia –Homeless Veteran Outreach Liaison, Cape Coral
•Lue Richardson –Coordinated Entry, Cape Coral
•Heather Davis –Veteran Justice Outreach Coordinator
•Representative from Veteran Services of Collier County
Veteran Statistics Collier County Florida
Population 18>* 28,515
CATEGORY 2016 2017 + (-)
WWII 3,309 2,844 -465
Korean 5,248 4,896 -352
Vietnam 10,357 10,404 47
Gulf War 1990 - 2001 1,783 2,298 515
Gulf War 2001 >1,420 1,375 -45
* TOTAL 22,117 21817 -300
Male 27,222 27,228 6
Female 1,349 1,287 (62)
AGE
18 to 34 958 781 (177)
35 to 54 2,854 3,280 426
55 to 64 2,682 2,420 (262)
65 to 74 8,356 7,909 (447)
75 >13,721 14,125 404
Race & Hispanic or Latino Origin
White 27,900 27,792 -108
Black 336 337 1
American Indian 44 28 -16
Asian 84 110 26
Other 207 248 41
Hispanic or Latino 1,290 1,322 32
White Alone 26,684 26,536 (148)
Poverty Status in Past 12 Months
Income Below 1406 1,297 -109
Income Above 26,903 26,938 35
Disability Status
With any disability 7,635 8,022 387
With out a disbility 20,674 20,213 -461
* Margin Error 2.8%Source: factfinder.census.gov/faces/tableservices/jsf/pages/productview
1/14/2019 VetStatsfactfinder.cenus.gov#2
January 8, 2019
In Reply Refer To:
Mr. Dale Mullin
411 Saddlebrook Lane
Naples, FL 34110
dale@woundedwarriorsofcolliercounty.com
516/001PV
FOIA 19-03120-F
Dear Mr. Mullin:
Thank you for your inquiry to the Bay Pines VA Healthcare System (BPVAHCS).
This letter acknowledges receipt of your January 5, 2019 request under the Freedom of
Information Act (FOIA), 5 U.S.C. § 552, for the following:
1. Total number of Veterans living in Collier County last census count.
2. Breakdown of the total number of Veterans served in overseas wars living in
Collier County: WWII, Korea, Vietnam, Post 9-11.
3. Breakdown by gender for item #2.
4. Number of Veterans diagnosed with PTSD or TBI living Collier County (2015-
2018).
5. Number of homeless Veterans reported in Collier County by year (2015-2018).
6. Number of Veterans receiving housing payments from VA/HUD in Collier County
(2015-2018).
7. Number of Veterans receiving treatment for PTSD and TBI by VA living in Collier
County (2015-2018).
8. Number of Veterans arrested in Collier County (2015-2018).
9. Veteran suicides reported in Collier County (2015-2018).
10. Number of Veterans treated for substance abuse living Collier County (2015-
2018).
Your request was received in my office on January 7, 2019. Your FOIA request
was assigned the tracking number at the top of this letter. Please include this tracking
number in all future communications concerning this FOIA request. In addition, we
have placed your request in the simple processing category.
We will search for records responsive to your FOIA request that were gathered or
created by the BPVAHCS on or before January 5, 2019. When we have completed our
search for records responsive to your FOIA request, we will send you another letter
telling you the results of that search and our next step in processing your request.
DEPARTMENT OF VETERANS AFFAIRS
Bay Pines VA Healthcare System
Post Office Box 5005
Bay Pines, Florida 33744
Page 2.
Mr. Dale Mullin
In your request letter, you asked for expedited processing of your FOIA
request. Please be advised, the FOIA provides that an agency shall process a FOIA
request on an expedited basis if the individual making the FOIA request demonstrates a
compelling need for the information requested or the agency otherwise determines that
the expedited processing request should be granted, 5 U.S.C. § 552(a)(6)(E)(i).
The FOIA states that a “compelling need” may exist in either of two
situations. First, a compelling need exists when a FOIA requester’s failure to obtain
records on an expedited basis “could reasonably be expected to pose an imminent
threat to the life or physical safety of an individual”, 5 U.S.C. § 552(a)(6)(E)(v)(I). Under
this test, the FOIA requester must demonstrate how failure to receive the requested
records on an expedited basis places an identified individual at immediate risk of death
or physical harm. Second, a compelling need may exist where, “with respect to a
request made by a person primarily engaged in disseminating information, [there is]
urgency to inform the public concerning actual or alleged Federal Government activity”,
5 U.S.C. § 552(a)(6)(E)(v)(II).
Your expedited processing request fails to demonstrate how failure to obtain the
requested record on an expedited basis poses an imminent threat to the life or physical
safety of an individual. Nor did your FOIA request qualify for expedited processing
under the second test as you have failed to demonstrate why there is an urgency to
inform the public concerning actual or alleged Federal Government activity. For these
reasons, I have denied your request for expedited processing of your FOIA request.
Please be advised you may appeal the denial for expedited processing made in
this letter to:
Office of the General Counsel (024)
Department of Veterans Affairs
810 Vermont Avenue, N.W.
Washington, D.C. 20420
Email: ogcfoiaappeals@va.gov
If you should choose to file an appeal, your appeal must be postmarked or
electronically transmitted no later than ninety (90) calendar days from the date of this
letter. Please include a copy of this letter with your written appeal and clearly state why
you disagree with the determinations set forth in this response.
You may also seek assistance and/or dispute resolution services for any other
aspect of your FOIA request from VHA’s FOIA Public Liaison and/or Office of
Government Information Services (OGIS) as provided below:
VHA FOIA Public Liaison:
Email Address: vhafoia2@va.gov
Phone Number: (877) 461-5038
Page 3.
Mr. Dale Mullin
Office of Government Information Services (OGIS)
Email: ogis@nara.gov
Fax: (202) 741-5769
Mailing address: Office of Government Information Services
National Archives and Records Administration
8601 Adelphi Road
College Park, MD 20740-6001
Thank you for your interest in VA. If you have any further questions, please feel
free to contact me at (727) 398-6661, extension 14626 or via email at
VHABAYFOIAOffice@va.gov.
Sincerely,
Mental Health and Addiction Ad Hoc Committee Meeting
January 18, 2019
Item 8.5 – Application Process
Vacancies have been advertised and are posted on line.
Residents interested in applying for positions on the Mental Illness and Addiction Ad Hoc
Committee may obtain an application by calling (239) 252-8400, or by downloading an
application from the county’s website at Online Advisory Board Application | Collier County,
FL
Per Resolution No. 2018-232: “Following the first meeting, additional members can be added by
majority vote of the Committee then present.”
As of January 14, thirteen applications have been received for the Committee.