Mental Health and Addiction Ad Hoc Agenda 04/16/2019Mental Health and Addiction Ad Hoc Committee Meeting
April 16, 2019 – 8:30 am
5th Floor Training Room
3299 Tamiami Trail East, Bldg. F
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
7.1. Review of Committee Ordinance and Attendance Requirements
7.2. Upcoming Workshop Schedule – CHANGE OF DATE
8. New Business
8.1. Priority 2 – Permanent Supportive Housing (continued)
8.1.1. Introduction of CHS Housing Staff
8.2. Priority 3 – Data Collaborative
8.2.1. Review of Data Collaborative Proposal (staff)
8.3. Tentative Presentation by Central Florida Behavioral Health Staff
9. Old Business
9.1. Future Meeting Schedule
9.1.1. Possible amendments to meeting schedule
10. Announcements
11. Committee Member Discussion
12. Next Meeting Time, Date and Location
12.1. April 30, 2019 – 8:30 am – same location
13. Adjournment
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MINUTES OF THE REGULAR MEETING OF THE COLLIER COUNTY
Mental Health and Addiction Ad Hoc Committee Meeting
April 02, 2019
Naples, Florida
LET IT BE REMEMBERED that the Collier County Mental Health and Addiction Ad Hoc
Committee met on this date at 8:30 A.M. at 3299 Tamiami Trail East, Building F, 5th Floor
Training Room, Naples, Florida with the following Members Present:
Mental Health Committee
Present: Dale Mullin
Lt. Leslie Weidenhammer
Dr. Emily Ptaszek
Dr. Thomas Lansen
Scott Burgess
Dr. Pam Baker
The Honorable Janeice Martin
Reed Saunders
Janice Rosen
Dr. Jerry Godshaw
Dr. Paul Simeone
Council Member Michelle McLeod
Russell Budd
Dr. Michael D’Amico
Not Present: Pat Barton
Christine Welton
Susan Kimper
Also Present: Heather Cartwright-Yilmaz – Sr. Operations Analyst
1. Call to Order & Pledge of Allegiance
Chairman Scott Burgess called the meeting to order at 8:33 A.M. and let the Pledge of
Allegiance.
3. Roll Call – Committee Members
Fourteen (14) members of the Mental Health and Addiction Ad Hoc Committee were present,
representing a quarum.
4. Adoption of the Agenda
A motion ot approve the agenda was made and was unanimously adopted.
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5. Public Comment
There was no public comment.
6. Adoption of Minutes from Previous Meeting
Following discussion with changes, a motion was made and Minutes from precius meeting
were approved as amended.
7. Staff Reports
There was no Staff Report.
8. New Business
8.1. Priority 2 – Permanent Supportive Housing (continued)
This item was left on the agenda for further discussion. Christine Welton did not attend th is
meeting or the previous meeting.
8.2. Review of Calgary Housing Solutions - Guest Speaker: Tim Hearn
Mr. Hearn presented information about the Calgary homelessness plan. Calgary is a wealthy
city that had around 3500-4000 homeless in 2006 with around 30-35% with mental illness. In
2007 the Community Development plan was to eliminate homeless in 10 years.
The first recommendation from Mr. Hearn was to not wait for perfection to start an initiative.
He also commented that shelters are not a long term solution. Knowing this he said that
homeless people spend all their waking days thinking of where they are going to stay the night
safely and sleep. Another finding was that homeless ere working; however, th ere was not
affordable housing in the area.
Mr. Hearn informed the committee that in 2008, Calgary set up the homeless foundation 10-
year plan. Calgary started with the serving agency, churches and other advocacy agencies for
the homeless. The organization lobbied community and business leaders to get involved,
engage others, find solutions, and implement a plan. After the first 12-15 months, State and
Federal agencices provided funding to the intiative.
Mr Hearn shared that the takeaway from this experience is to hire the best financial planner
that will oversee all transactions to make everything transparent and be able to keep business
and administrative costs lean. The other initiative is to show that community funding as a
whole is reduced. Calgary was able to reduce community funding system costs by
approximately 62%
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Mr. Hearn suggested that building shelters was not the answer to fixing the homeless problem,
it was creating affordable perment housing. Calgary was able to reduce homeless by 35% in
about 3-4 years.
Calgary and the intiiative did not build a management system the first year, it took about 3-4
years before the Management Data system was built.
First, Calgary put 10,000 people into Supportive Housing according to their ability to pay.
Permanent supportive housing that offered care for patients was offered with rent subsidies.
Mr. Hearn then shared lessons learned: Use best practices from other communities and
agencies. This will help reduce time to do what Collier County wants to do. Be pragmatic and
work in differences. Start small as you learn and do not try to bild a plan all at once. Get all
key stakeholders invested. Give clear mandate and put someone in charge. Please note:
financial and business control is essential. Put in Business Control system, so that foundation
stakeholders feel comfortable with efforts.
Mr. Hearn finished his presentation and opened up the floor to Committee member questions.
The following questions were asked by members of the Committee, and Mr. Hearn gave the
below summarized answers:
How do you get around that homeless are lazy and the not in my backyard mentality and how
do you overcome these issues?
1. Shock: They are working
2. No more halfway houses
3. Educate the community
4. Show that plan is successful-Do this early
5. Put in 70 cent dollars
6. Community involvement
What do you know about Naples? How do we get a stakeholders group together? How do we
get the rest of the community envolved?
1. Get a couple of Business Community Leaders together (1-2).
2. Touch their hearts.
3. Get a Pastor from ont of the Churches (1-2).
4. Get frontline people envolved to share experiences and give guidance.
What can we do to make fundraising more exciting for this initive? Other initiatives seem to
get more excitement and interest. They think the homeless problem is a government issue.
1. Helping the community is an advanctage. Calgary takes great care of it’s
community and cares about it’s citizens.
2. Will have a case for positioning this initiative. Put a case together that compels
people to get envolved.
With an operating budget of 46M, what is the breakdown per person for permanent housing,
supportive housing, etc.
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1. All funds gathered up
2. Get State Government
3. Get Builders to donate funding, human resources and building
4. Get Private Business to Help
5. Talk to CEO’s – Attract them and show them we can do better!
What can we do to get Community Leaders envolved?
1. Show cost of EMS, Emergency Room, Law Enforcement, etc.
2. Get some surplus property, get them to donate land
3. Rent out part of home or room, defray cost – Must charge something – Dignity
4. Code Enforcement adjustments
5. Proxies
6. Permitting issues must be resolved with HOA
7. Financial Subsidies: Pay as you can – Everyone must pay a certain amount of rent
8. Paying rent gives people a sense of rsponsibloity and accountability
9. Dignity work: Ability to pay is a positive outcome
10. Bring doctors and advocates in to help navigate system
11. Prevent Homeless: Get more proactive with families that are on the edge.
12. Get started and start small
Discussion ensued around the Healthcare system being different in Canada versus Florida.
Florida is one of the worse funded for Mental Health with a high percentage that are uninsured.
1. Get providers to try to streamline – Less cost or no cost
2. Show Clients: Providers want to do the right thing
3. Create a funding model for Service Providers
4. Offer rate plan
5. Provide a solution for certain kind of services that are very affordable
6. Make arrangements
7. Create wrap-around services to make plan successful
Mr. Hearn offered to fund a member of the Calgary homelessness iniaitive to come speak with
the Committee.
8.3. Review of Committee Vacancies
The Committee discussed the two (2) at-large vacancies on the committee. The committee
then discussed concerns over absences of Committee members. Committee members
suggested that Staff reach out to member to find out if still interested in being member and
next steps to select another member.
Committee members suggested that someone from the Collier County Community and Human
Services Department with a focus on housing attend meetings. Staff contacted Mr. Cormac
Giblin and he will be attending upcoming meeting Dr. Lansen also suggested bringing in a
religious organization.
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8.4. Reconsideration of Previous Applications
A motion was made for Caroline Brennan to fill one of the vacancies and was approved
unanimously.
9. Old Business
9.1. Future Meeting Schedule
Mr. Burgess reviewed future meeting schedule. Upcoming meeting on April 16th at 8:30.
9.2. Discussion of Bed Supply per capita
There was a question related to the bed supply per capita and Pam Baker sent information
contained in this packet.
9.3. Collier County Vital Signs Report (Christine Welton – absent)
Christine Welton was absent from this meeting and previous meeting and unable to cover the
Vital Signs report.
9.4. Priority 1 – Central Receiving System
There was no follow up on this item.
10. Announcements
There were no announcements.
11. Committee Member Discussion
Dr. Baker mentioned the Continuum of Care meeting run by the Collier Hunger & Homeless
Coalition at the Untied Way building. Heather Yilmaz sent out information to Committee
members.
Mr. Burgess discussed draft plan with the committee.
12. Next Meeting Time, Date and Location
April 16, 2019 – 8:30 am – same location.
13. Adjournment
The meeting adjourned at 10:02 am with nothing further left to discuss.
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Collier County Mental Health and Addictions Ad Hoc Advisory Committee
Scott Burgess – Chairman
The foregoing Minutes were approved by Committee Chair on March 19, 2019, “as submitted” [
] or “as amended” [ ]
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1
CallahanSean
From:BrockMaryJo
Sent:Tuesday, April 9, 2019 4:22 PM
To:KlatzkowJeff; CasalanguidaNick; RodriguezDan; CarnellSteve; YilmazGeorge; CohenThaddeus;
PriceLen; IsacksonMark; SheffieldMichael; MillerTroy; CallahanSean; WilligGeoffrey; CarballoMiguel;
MarcellaJeanne; YilmazHeather; BrethauerPaula; HenryTodd; HamiltonSarah; FlemingValerie;
HancockJoy; minutesandrecords@collierclerk.com; BrownleeMichael; FilsonSue; GoodnerAngela;
GrecoSherry; LykinsDave; TrochessettAimee
Subject:Future Workshop Topics.docx
Attachments:Future Workshop Topics.docx
Good afternoon,
Please be aware, the June 4 BCC Workshop subject has changed. Per the attached schedule it is now the BCC/County
Facilities Masterplan Workshop.
Thank you, MJ
Mary‐Jo Brock ‐ Executive Assistant to Leo E. Ochs, Jr.
maryjo.brock@colliercountyfl.gov
County Manager’s Office
3299 East Tamiami Trail Naples FL 34112
239.252.8364
Under Florida Law, e-mail addresses are public records. If you do not want your e-mail address released in response to a
public records request, do not send electronic mail to this entity. Instead, contact this office by telephone or in writing.
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Mental Health and Addiction Ad Hoc Committee Meeting
April 16, 2019
Item 8.2 – Continuum of Care Mapping
Hi Sean,
At the recommendation of Dr. Baker, I attended the COC meeting last week. At that meeting, Michael
Overway with the Hunger and Homeless Colition shared the attached flowchart of available resources as
they related to homelessness in our community.
Can you please share this information with the other members of our committee for their reference.
Thanks so much!
Michelle
Michelle McLeod, M.B.A.
City Council Member
From: Michelle McLeod
Sent: Wednesday, April 10, 2019 10:18:10 AM
To: Michael Overway
Subject: Re: Collier Continuum of Care Mapping
Michael,
Thank you so much for this information. I am going to forward this information on to the members of
the Mental Health Ad Hoc committee. I am sure they will find this extremely interesting.
Again, thank you for this very informative flowchart.
All the best,
Michelle
Michelle McLeod, M.B.A.
City Council Member
From: Michael Overway <hmis@collierhomelesscoalition.org>
Sent: Tuesday, April 9, 2019 11:37:14 AM
To: Michelle McLeod
Subject: Collier Continuum of Care Mapping
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CAUTION: This email originated from outside of the City of Naples e-mail system. Do not click links or open
attachments unless you recognize the sender and know the content is safe.
Councilwoman McLeod,
First let me apologize for not getting the requested CoC Mapping to you sooner, my wife is ill and was
hospitalized for the last 5 days.
Attached is the CoC Mapping that tells the story of who is actively participating in homeless prevention
and rapidly rehousing of those experiencing homelessness.
Should you have any questions please do not hesitate to contact me at (941) 615-7094 or this email
address.
Thank you,
Michael Overway
CRN Administrator
239-263-9363 (Office) 941-615-7094 (Cell)
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May 11, 2018
TO: Leo Ochs, Collier County Manager
CC: Steve Carnell, Public Services Department Head
FR: Sean Callahan, Director, PSD Operations and Veteran Services
RE: Mental Health Data Collaborative
Overview
The need for a data collaborative has been raised for improvement of data-driven decision making in the
area of mental health. In Collier County, there is a well-established tradition of health and behavioral
healthcare organizations, county, law enforcement, judiciary, and community partners working together
towards behavioral health solutions.
Multiple sources collect internal data and share with other entities in limited ways, but there is not a
process for comprehensively using relevant data, both at the system and clinical levels, to infor m the
planning and delivery of behavioral health care among all related community organizations.
A centralized data collaborative could collect information from entities including the David Lawrence
Center, hospitals, courts, law enforcement, community providers, including but not limited to:
• Numbers and demographics of persons served by each provider
• Demonstration of cost avoidance in criminal justice through diversion activities
• Justification for efficient distribution of public funding
• Number of days acute care units are at or over capacity
• Other metrics used to gauge effectiveness and efficiencies of community health system
The data could be aggregated for use in planning, quality improvement, program evaluation, and grant
applications. A repository, along with staff, would be needed to maintain, aggregate, and disseminate
reporting on the data collected.
Florida Statute – Data Sharing
In 1997, a statute1 was enacted for collaborative client information systems. The statute authorizes local,
county-level data collaborative – and was used to set up the Pinellas County Collaborative. Relevant
provisions of the law are in sections 163.61-163.65 of the Florida Statutes, which can be found here2. The
statute prescribes the collecting agency “means any state, county, district, authority, or municipal officer,
department, division, board, bureau, commission, or other separate unit of government created or
1 FSS Title XI – Chapter 163 - Intergovernmental Programs – Part VI – Collaborative Client Information Systems
2 http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0100-
0199/0163/0163PartVIContentsIndex.html&StatuteYear=2017&Title=-%3E2017-%3EChapter%20163-%3EPart%20VI
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established by law” and gives a broad definition of data that can be included, such as “criminal justice,
juvenile justice, education, employment training, health, and human services.”
The counties involved in the creation and administration of a collaborative client information system shall
form a steering committee, consisting of representatives of all agencies and organizations participating in
the system, to govern the organization and administration of the collaborative system.
In addition, memorandums of understanding (MOU) need to be put together with all agencies and entities
participating in the collaborative that outline what types of information will be shared and who it will be
shared with. This type of information will likely require compliance with several data security laws,
including the Health Insurance Portability and Accountability Act (HIPAA) and the Florida Information
Protection Act (FIPA).
Appendix A shows the different agencies and entities that provide data to the Pinellas County
Collaborative. There are a variety of sources interested in participating in Collier County were a
collaborative to be launched.
Other Examples
Though Pinellas County offers a model closest to what could be implemented here in Collier County, a
number of other collaboratives exist around the country; some examples are below:
• UPenn – Actionable Intelligence for Social Policy
• NYC – Center for Innovation through Data Intelligence
These projects provide support and information to help local data hubs or collaborative to set up data
sharing systems. The following model demonstrates an integrated data system:
Project Approach
Were a data collaborative to be initiated in Collier County, the suggested approach would be to:
1) Start with a list of data points we would like to report on – including frequency, granularity, and
sophistication of data;
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2)Work backward to outline who was needed to participate in the collaborative and what specific
data was necessary;
3)Draft MOUs for each participating entity surround collection and distribution of data;
4)Establish a steering committee (potentially ad hoc committee out of Friday group?) to guide the
project development;
5)Design a project plan to establish the database to house collaborative data;
6)Begin to collect data and report on a routine basis.
Stakeholders around the county are already collecting most of the data needed to form a collaborative, but
there is no coordination among them or central repository to store the data. While commercial solutions
exist on a low-cost basis to provide the architecture necessary to store the data, the biggest resource
necessary would be an employee to collect, maintain, and manipulate the data for reporting.
This collaborative would be a new and emerging mission for County staff, and if accepted and
implemented successfully, could provide future opportunities for data collection and analysis on a larger
scale for both the Public Services Department and County as a whole.
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Data System Description Period
Geographic
Area
Pinellas County Criminal Justice (CJIS Adults)
Pinellas County Criminal Court and Law Enforcement related activity from the initial
arrest, including jail movement, court appearances, docket information, sentencing
information and disposition of court cases of individuals and Demographics in
Pinellas County 1997-2017 Pinellas
CJIS (Under 18) Arrests, statutes, some demographics in Pinellas County 2003-2005 Pinellas
Department of Human and Health Service (Pinellas County)
Information on Services received by individuals within the county of Pinellas
including general assistance, case management, medical services, and many other
services and demographics (Some Homeless) 1998-2017 Pinellas
EMS (Emergency Medical Services (Pinellas County)
Information on 911, EMS calls where EMS did and did not transport, cost
information for individuals in Pinellas County 1998-2017 Pinellas
JWB (Juvenile Welfare Board (Pinellas County)
Information on social programs and their participants funding through JWB in
Pinellas County 1998-2012 Pinellas
Substance Abuse Mental Health Information System (DCF)
Information such as mental health and substance abuse services, diagnosis,
admissions, discharge for individuals in Florida (Some Homeless) 1998-2017 Statewide
Medicaid Services and Claims Data (AHCA)
Information on Medicaid physical, mental health claims, services, and pharmacy
provided through Medicaid eligibility and demographic information 1998-2017 Statewide
Baker Act (FL. Involuntary Civil Commitment Evaluation)
Information on Baker Act Initiations for 72 hour involuntary psychiatric evaluations
in Florida 1998-2016 Statewide
Child Welfare Florida Safe Families Network (FSFN)
Information on investigations, findings and actions for reports of child abuse in
Florida 1998-2017 Statewide
Other Systems (requiring special requests)
Florida Department of Juvenile Justice
Information on youths detained and/or incarcerated with the State Juvenile Justice
system on statutes, sentencing, length of stay, release information
Upon
Request Statewide
Florida Department of Corrections
Information on adults incarcerated with the State Department of Corrections on
statutes, sentencing, length of stay, release information
Upon
Request Statewide
Florida Department of Law Enforcement
Arrests across the state of Florida, statutes, sentencing, length of stay, release
information
Upon
Request Statewide
Appendix A - Pinellas County Data Sources
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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
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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
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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.
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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
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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.
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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.
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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
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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
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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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PART VI
COLLABORATIVE CLIENT
INFORMATION SYSTEMS
163.61 “Agency” defined.
163.62 Collaborative client information system; establishment.
163.63 Steering committee; security policy information sharing agreements.
163.64 Sharing of client information.
163.65 Agencies receiving government funding encouraged to participate.
163.61 “Agency” defined.—For the purposes of ss. 163.61-163.65, the word “agency” has the
meaning ascribed in s. 119.011.
History.—s. 43, ch. 97-286.
163.62 Collaborative client information system; establishment.—Notwithstanding any general or
special law to the contrary, the agencies of one or more local governments may establish a
collaborative client information system. State agencies and private agencies may participate in the
collaborative information system. Data related to the following areas may be included in the
collaborative information system, although the system is not limited to only these types of information:
criminal justice, juvenile justice, education, employment training, health, and human services.
History.—s. 44, ch. 97-286.
163.63 Steering committee; security policy information sharing agreements.—
(1) The counties involved in the creation and administration of a collaborative client information
system shall form a steering committee, consisting of representatives of all agencies and organizations
participating in the system, to govern the organization a nd administration of the collaborative system.
Each steering committee shall determine its procedures for governance of the organization,
participation in the collaborative information system, and administration of the data in the system.
Each steering committee also must develop a security policy to be followed by all agencies
participating in the collaborative system to ensure the integrity of the data in the collaborative
information system and to guarantee the privacy, to the extent possible, of all cli ents served by an
agency that participates in the collaborative system.
(2) Before sharing confidential information with other members of the information collaborative,
each member of the steering committee shall sign an agreement specifying, at a minimum, the
following information:
(a) What information each agency will share with the collaborative;
(b) How the information will be shared;
(c) How clients will be notified that an agency participates in the collaborative;
(d) Who in each agency will have access to the information;
(e) The purposes to be served by sharing the information;
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(f) Assurances from each agency that it will maintain the confidentiality of the information as
required by law; and
(g) Other information decided upon by members of the information cooperative.
History.—s. 45, ch. 97-286.
163.64 Sharing of client information.—Notwithstanding any law to the contrary, an agency that
participates in the creation or administration of a collaborative client information system may share
client information, including confidential client information, with other members of the collabora tive
system as long as the restrictions governing the confidential information are observed by any other
agency granted access to the confidential information. An agency that participates in a collaborative
information system is not required to have a release signed by its affected clients before sharing
confidential information with other members of the collaborative system.
History.—s. 46, ch. 97-286.
163.65 Agencies receiving government funding encouraged to participate.—An agency that
receives moneys from a federal, state, or local agency is encouraged to participate in any collaborative
client information system that is available within the service area of the agency.
History.—s. 47, ch. 97-286.
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