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Agenda 03/23/2021 Item #16D10 (After-the-Fact Medication Assisted Treatment Grant Application03/23/2021 EXECUTIVE SUMMARY Recommendation to approve an "After -the -Fact" grant application for a 3-year Florida Department of Children and Families Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant in the amount of $1,200,000. OBJECTIVE: To engage inmates exiting the jail system in medication -assisted treatment (MAT) to reduce re -incarceration. CONSIDERATIONS: The Collier County Community and Human Services (CHS) Division, in conjunction with the Collier County Sherriff s Office (CCSO) and the David Lawrence Center (DLC), is requesting "after -the -fact" approval for the submission of a Criminal Justice Mental Health and Substance Abuse grant application to the Florida Department of Children and Families (DCF). This grant application is to expand and enhance substance abuse treatment services for inmates who are currently participating in Medication Assisted Treatment (MAT) at the time of arrest and provide community treatment and integration services at the time of release. Collier County is one of sixteen (16) counties nationwide participating in the implementation of MAT in correctional facilities. In addition, Collier County has been selected as one of four (4) demonstration sites to be evaluated further by the Friends Research Institute for our promising approach to addressing the Opioid epidemic in correctional settings and our countywide strategic planning efforts to comprehensively addressing substance abuse and mental health. The grant will also fund a data collaborative and a mental health/substance abuse care coordinator to provide oversight and implement the County's Mental Health -Substance Abuse strategic plan. The application is requesting $1,200,000 in grant funding with a one-to-one required match of $1,200,000 for a total of $2,400,000 over a three-year period. The majority of the match will be met through the participating partner agencies, DLC, and CCSO. Any remaining match by the County will be met through the CHS annual General Fund support. The grant application was due to the Department of Children and Families on March 9, 2021. Due to the unique nature of the grant and its collaborative application process between the partnering agencies, time was needed to assemble the application. Collier County CMA #5330 authorizes the County Manager to approve the submittal of grant applications with subsequent Board of County Commissioners (Board) action at the next available Board meeting to ratify the approval as an "after -the -fact" application. The County Manager approved the grant application on March 8, 2021. If the grant is awarded, the grant agreement and associated subrecipient award(s) will be brought to the Board at a later date for final approval and execution. As the fiscal agent of the grant, Collier County will be responsible for ensuring compliance with the programmatic and financial reporting requirements of the grant. FISCAL IMPACT: If the grant is awarded, state funds from DCF in the amount of $1,200,000 over three (3) years will be appropriated into CHS Grant Fund (707). The CHS match portion in the amount of $10,863, will be appropriated into CHS Match Fund (708) via Budget Amendment at the time of Board acceptance of the grant. The County match portion is available from a General Fund (001) transfer from Client Assistance. The following table reflects the annual budget over the three-year period and cash and in -kind match as proposed in the grant application: Grant Year Grant Amount Cash Match Total 1 $387,608.15 $402,184.59 $789,792.74 2 $405,265.36 $396,696.34 $801,961.70 Packet Pg. 1187 03/23/2021 3 $407,126.49 $401,119.07 $808,245.56 Totals $1,200,000 $1,200,000 $2,400,000 The grant requires a match on an overall one-to-one basis. The match is proposed to be provided by DLC, CCSO, and CHS in a combined total of $1,200,000 for a total impact of $2,400,000. The Collier County match portion will be an amount of $93,253, with $82,390 provided by CCSO through in -kind and Collier County is responsible for the remaining $10,863. The table below reflects the match totals contributed to the grant from each participating agency. Agency Cash Match Total Collier County $10,863 $10,863 David Lawrence Center $259,738 $259,738 Sheriff's Office $929,399 $929,399 Totals $1,200,000 $1,200,000 GROWTH MANAGEMENT IMPACT: There is no Growth Management impact due to this request. LEGAL CONSIDERATIONS: The Board will have the opportunity to accept or reject the funds if the grant is approved. Accordingly, this Office has no issue with respect to the legality of this request, which is appropriate for Board action and requires a majority vote for Board action. - JAB RECOMMENDATION: To approve an "After -the -Fact" grant application for a three-year Florida Department of Children and Families Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant in the amount of $1,200,000. Prepared By: Joshua Thomas, Operations Analyst, Community & Human Services Division ATTACHMENT(S) 1. [linked] APP DCF CJMHSA (PDF) 2. CM MEMO DCF CJMHSA (PDF) Packet Pg. 1188 16.D.10 03/23/2021 COLLIER COUNTY Board of County Commissioners Item Number: 16.13.10 Doe ID: 15234 Item Summary: Recommendation to approve an "After -the -Fact" grant application for a 3-year Florida Department of Children and Families Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant in the amount of S1,200,000. Meeting Date: 03/23/2021 Prepared by: Title: Operations Analyst — Community & Human Services Name: Joshua Thomas 03/08/2021 4:38 PM Submitted by: Title: Manager - Federal/State Grants Operation — Community & Human Services Name: Kristi Sonntag 03/08/2021 4:38 PM Approved By: Review: Community & Human Services Kristi Sonntag CHS Review Community & Human Services Tami Bailey Additional Reviewer Community & Human Services Maggie Lopez Additional Reviewer Operations & Veteran Services Kimberley Grant Additional Reviewer Public Services Department Todd Henry Public Services Deapartment Public Services Department James C French PSD Dept Head Review Grants Erica Robinson Level 2 Grants Review County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Budget and Management Office Ed Finn Additional Reviewer Grants MaryJo Brock Additional Reviewer County Manager's Office Dan Rodriguez Level 4 County Manager Review Board of County Commissioners MaryJo Brock Meeting Pending Completed 03/08/2021 6:10 PM Completed 03/09/2021 7:39 AM Completed 03/09/2021 8:08 AM Completed 03/09/2021 9:09 AM Completed 03/09/2021 11:08 AM Completed 03/09/2021 11:23 AM Completed 03/09/2021 3:56 PM Completed 03/11/2021 3:48 PM Completed 03/12/2021 8:24 AM Completed 03/12/2021 10:00 AM Completed 03/12/2021 10:42 AM Skipped 03/12/2021 2:41 PM Completed 03/15/2021 7:41 AM 03/23/2021 9:00 AM Packet Pg. 1189 PROPOSAL INFORMATION Project Title: Collier Criminal Justice Medication - Assisted Treatment Program (CMAT TEAM County(ies): Collier Preferred Project Start Date July 1, 2021 APPLICANT INFORMATION Type of Applicant: County Government Applicant Organization Name: Collier County Board of County Commissioners_ Contact Name and Title: Kristi Sonntag, Community and Human Division Director Services Address Line 1: 3339 Tamiami Trail East City, State and Zip Code Naples, FL 34112 Email: Kristi.Sonntag@colliercountyfl.gov Phone: 239-252-2486 ADDITIONAL CONTACT Participating Organization Name: Collier County Government Contact Name & Title: Tami Bailey Street Address: 3339 Tamiami Trail East City, State and Zip Code: Naples, FL 34112 Email: Tami.Baile colliercountyfl.gov Phone: 39-252-5218 FUNDING REQUEST AND MATCHING FUNDS Total Amount of Grant Funds Requested Total Matching Funds Program Year 1 $ 387,608.15 $ 402,184.59 Program Year 2 $ 405,265,36 $ 396,696.34 Program Year 3 $ 407,126,49 $ 401,119,07 otal Project Cost $13200,000 $1,200,000 CERTIFYING OFFICIAL Certifying Official's Signature: Certifying Official's Name (printed) L o E. Ochs Jr. Title: County manpger Date: M=N1V1 a- TAB 2 COLLIER COUNTY Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant TABLE of CONTENTS Tab 1 ec ion 3.7.1 i we Cover Page rage Number 1 Tab 2 3.7.2 Table of Contents 2 Tab 3 3.7.3 Statement of Mandatory Assurances 3 Tab 4 3.7A Match Commitment and Summary Forms 4 Tab 5 3.7.5 Statement of the Problem 10 Tab 6 3.7.6 Project Design and Implementation 19 3.7.6.1 Description of Planning Council 19 3.7.6.1.1 Composition of Planning Council 19 3.7.6.1.2 Planning Council Activities 20 3.7.6.3 Implementation 22 3.7.6.3.1 Strategic Plan 22 3.7.6.3.2 Project Design and Implementation 24 3.7.6.3.3 Strategies 35 3.7.6.4 Performance Measures 37 3.7.6.4.1 Data Collection 37 3.7.6.4.2 Proposed Targets and Methodologies 40 3.7.6.4.3 Additional Proposed Performance Measure 41 3.7.6.5 Capability and Experience 41 3.7.6.5.1 Capability and Experience of Applicant and Other Participating Organizations 41 3.7.6.5.2 Availability of Resources 43 3.7.6.5.3 Role of Advocates, Peer Specialists, Family Members, Partners 43 3.7.6.5.4 Proposed Staff 44 3.7.6.6 Evaluation and Sustainability 45 3.7.6.6.1 Evaluation 45 3.7.6.6.2 Additional Evaluation Requirements 46 3.7.6.6.3 Sustainability 48 Tab 7 3.7.7 Project Timeline 50 Tab 8 3.7.8 Letters of Commitment 51 Tab 9 3.7.9 Budget and Budget Narrative 59 Tab 10 Exhibits 75 Tab 3 APPENDIX D— STATEMENT f)P MANDATORY ASSURANCES Initial A. Infrastructure: The Appricant shall pmssess equipment and Internet access rosary to participate fully in this solicitation. B Site Visits: The Applicant will cooperate fully with the Department in coordinating site visits, I desired by the Department NonAscriminafiow The Applicant agrees that no person will, an the basis of race, color, national origin, creed or religion be excluded from participation in, be refused the benefits of, or be otherwise subjected to discrimination pursuant to the Act governing these funds or any project, program, activity or su"rant supported by the requirements of, (a) Tale VI of the Curl Rights Act of 1964 which prohibits discrimination on the basis q1 race, color C. or national origin; (b) Title IX of the Education Amendments of 1972, as amanded which prohibits discrimination the basis of sex; (cl Section 504 of the Rehabilitation Act of 1973, as amended which prohibits discrimination in employment or any program or activ y that receives or benefits from federal financial assistance on the basis of handicaps; (d) Age Dscriminadon Act 1975, as amended which prohibits discrininatron on the basis of age, (e) Equal Employment Oppodunly Program (ESOP) must meets the requirements of 28 CFR 42:301. Lobbying: The Applicant is prohibited by Tide 31, USC, Section 1352, entitled 'Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions,' from using Federal funds for lobbying the D Executive or Legislative Branches of the federal government in connection with a specific grant orcooperative agreement Section 1352 also requires that each person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with non -Federal funds if grants and,`or cooperative agreements exceed 3100,000 in total costs (45 CFR Part 93). E Drum -Free Workplace Requirements: The Applicant agrees that a will, or will continue to, provide a drug4ree workplace in accordance with 45 CFR Part 76. Smoke -Free Workplace Requirements: Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the ProCNIcIren Act of 1994 (Act), requires that smoking not be pernitted in any portion of any indoor facility owned or leased or contracted for by an enfity and used routinely or regularly for the provision of health, day taro, education, or library projects to children under the age of 16, if the projects are funded by Federal programs either F. directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law does not apply to children's projects provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for Inpatient drug or alcohol treatment. Failure to comply with the provisions of the lax may result in the imposition of a civil monetary penalty of up to $1,000 per day andar the imposition of an acirrinisirative compliance order on the responsible entity. Compliance and Performance: The Applicant understands that grant funds in Years 2 and 3 are contingent upon G. compliance wide the requirements of this grant program and demonstration of performance towards completing the grant key activities and meeting the grant objectives, as well as availakilityof funds. H. Certification of Non -supplanting: The Applicant certifies that funds awarded under this solicitation will real be used for programs currently being paid for by other funds orprograms where the funding has been committed. Submission of Data: The Applicant agrees to provide data and other informatimn requested by the Criminal Justice, I. Mental Health, and Substance Abuse Technical Assistance Center at the Florida Mental Health Institute to enable the Center to perform the statutory duties established in the authorizing legislation. J. Subnssion of Reports: The Applicant agrees to submit quarterly progress reports and quarterly fiscal reports, signed by the County Administrator, to the Department. DCF RFA 2021 001 APPENDIX H - COMMITMENT OF MATCH DONATION FORMS (FOR THE ENTIRE GRANT PERIOD) T0: (name of county) Collier County FROM: (donor name) N/A ADDRESS: 3339 E Tamiamf Trail Bldg H Room 211 Naples, FI 34112 The following _ space, _ equipment, _ goods or supplies, and X services, are donated to the County permanently (title passes to the County) _ temporarily (title is retained by the donor), for the period 07/01/2021 to06/30/2024. Description and Basis for Valuation (See next page) Description ii Salaries Value $10,863,11 TOTAL VALUE $10)863.11 The above donation is not currently included as a cost (either director matching) of any state or federal contract or grant, nor has it been previously purchased from or used as match for any state or federal contract, (DP (County Designee Signature) 37 (Date) OCF RFA 2621 001 , APPENDIX H COMMITMENT, OF MATCH DONATION FORMS (FOR THE ENTIRE GRANT PERIOD) TO: (name of•county) Colller County FROM: (donor name) '_Collier. Courity Sheriffs:Office ADDRESS: 3319 Tamiami Trail [-�E. Bldg J •Na les .•FL 34112 The following'_ space, _ equipment, goods or. supplies, and ...X_ services; are donated to fhe County. Collier . . tjtly.(tltle the County) —temporarily (iit(e' is retained by the donor); for -the period to Description and 8asis'for Valuation (See 'next page) Desdriatibn : Value (.q�Salaries' t327,_61.8.25 (2�Benefits , $1 Q 1-,780.64 (4) g TOTAL VALUE $'929,398.89 The abbve'donatlon Is not currently Included as a cost (eltherdirect or matching) of -any state* or'federal,contract or Oran t i r,as fieen previously purchased.from or used•as 'inatch for any stafe.or federal contract. ono Si afore (gate) (COL �y Designee Slgnatufej ho 37 • r DCF RFA 2021001 APPENDIX H - COMMITMENT OF MATCH DONATION FORMS (FOR THE ENTIRE GRANT PERIOD) TO: (name of county) Collier County FROM: (donor name) David Lawrence Mental Health Center, Inc. ADDRESS: 6075 Bathey Lane Naples, FL 34116-7536 The following — space, _ equipment, _ goods or supplies, and . X services, are donated to the County permanently (title ppasses to the County) X temporarily (title is retained by the donor), for the period 07/01/2021 to 06/30/2024 Description and Basis for Valuation (See next page) Description Value (1) Personnel salaries and fringe 25$ 9,738 (2)— $ (3) $ (4)— $ TOTAL VALUE $_259,738 The above donation is not currently included as a cost (either direct or matching) of any state or federal contract or grant, nor has it been previously purchased from or used as match for any state or federal contract. Ic r 1 f7 •.... 03/0312021 f. ( onor Signature) (Date) !(County Designee Signature) (Date) I1 DCF RFA 2021 001 Date - 3/2/2021 County - Collier Appendix I - MATCH SUMMARY (for the entire grant period) Type of Grant - Reinvestment/Criminal Justice Match Requirement Percentage- 100% Total Match Required for the Grant $ _$93,253.40_ Match Committed: Cash $ 00,863.11 In -Kind $ Total $ 10186$11_ Comments: The additional match ($82,390.29) needed to meet the 100% requirement will be provided by the Collier County's Sheriff Office CCSO . Please see CCSO Appendix I. Pre pared g Jose Alvarado - Accoehtant 3/2/2021 p Y 39 DCF RFA 2021 001 Appendix I - MATCH SUMMARY (for the'entire grant period) 2/17/2021 Date -. County. - _Collier County Type of Grant - CJMHSA Match Requirement Percentage : 100% Total Match' Required for the Grant $929,398.8.9_ Match Committed: Cash $_929,398.89 In -Kind $ Total $ 39 DCF RFA 2021 001 Date - 03/02/2021 County - Collier Type of Grant - Appendix I - MATCH SUMMARY (for the entire grant period) Reinvestment/Criminal Justice Match Requirement Percentage - 100% Total Match Required for the Grant $ 2 11,466.60 Match Committed: Cash $ 259,738 In -Kind $ -0- Total $ 259,738 Comments: CCSO will assist with making up the difference ($1,728.60) needed on the match. Prepared By Krista Patrick, CFO 03/02/2021 Approved By 39 Tab 5 3.7.5 Project Narrative 3.7.5.1 Statement of the Problem Located in Southwest Florida, Collier County is geographically the second largest county in the state, with 2,305 square miles. Collier also ranks as the 16t" most populous in Florida. In 2020, the population estimate for Collier County was 391,603, with the highest concentration along the Gulf Coast. In the span of 10 years, Collier County has grown from 322,581 permanent residents in 2010 to an estimate of more than 391,000 in 2020 (https://worldpol)ulationreview.com/us-counties/fl/collier-county- population). During Collier County's peak season, the countywide population is estimated at 465,754 (Census Bureau and Bureau of Economic and Business Research (BEBR)) Collier County includes the incorporated cities of Naples and Marco Island as well as the agricultural and fishing communities of Immokalee and Everglades City. A sharp contrast in population characteristics exists between the city of Naples, on the Gulf Coast, and Immokalee, a largely migrant farm worker community located inland. Overall, Collier County's poverty rate is 12.3%. In Immokalee, 43% of residents are below the poverty level, while in Naples the poverty level is 9%. Collier County has a high number of uninsured adults, 16% as compared to the state population of 13%. The Collier County Sheriff's Office (CCSO) operates two jail facilities that serve the county. The Immokalee Jail Center, located in Immokalee Florida, strictly houses minimal -risk inmates. The Immokalee Jail Center has a capacity of 192 inmates. The Naples Jail Center, located in Naples, Florida, has a capacity of 1,112 inmates. The combined capacity of the two jail centers is 1,304. An analysis of the current population of the Collier County indicates that the jail population demographics do not mirror those of the general population in the County. Table 1 includes demographics of both Collier County and Collier County Jail. Collier County 2020 Collier County Jail All Races White 62.4% Unknown White (Non -Hispanic) Unknown 56% White (Hispanic) Unknown 27% Black 6.72% Unknown Black (non -Hispanic) Unknown 16% Black (Hispanic) Unknown .03% Hispanic/Latino (any race 27.74% Unknown American Indian 0.18% Unknown American Indian (Non- Hispanic) Unknown .2% 10 American Indian (Hispanic) Unknown 0.002% Asian 1.42% Unknown Asian (Non -Hispanic) Unknown 0.2% Asian Hispanic Unknown 0.001 % Other 1.54% N/A Gender Male 49.25% 80% Female 50.75% 20% Table 1. Collier County Population U.S. Census Estimates and Collier County Jail census 2020. Between 2010 and 2020, Collier County experienced a 21.2% increase in the overall population, while the jail population decreased by 19%. The decrease in the jail population is directly correlated to COVID19. During the peak of COVID19, only those that committed a felony, a violent misdemeanor, or a DUI, were booked into the Collier County Jail. Other law violators were given notices to appear in court instead of being arrested. This was done throughout 2020 in order to reduce the possibility of a COVID19 outbreak within the jail. Despite this decrease in jail population, the percentage of inmates with mental health and substance use disorders has significantly increased. In February 2021, the Collier County Jail amended its contract with Armor Correctional Health Services, the jail's medical provider, to add an additional six hours to the psychiatrist's schedule, as the number of inmates requiring psychiatric care was drastically increasing. Currently, 45% of the Collier County jail population has been identified as suffering from a mental health and/or a substance use disorder. Approximately 31 % of the Collier County Jail inmate population have self -identified as having a substance use disorder at intake. Furthermore, it is estimated that the number of inmates suffering from a substance use disorder is even higher than reported, as inmates may tend to under -report substance use due to fear of additional criminal charges. The National Council for Behavioral Health reports that persons who are incarcerated are approximately 100 times more likely to die by overdose in the first two weeks after their release compared to the general public. Multiple studies consistently show that two-thirds of patients in abstinence -based programs relapse. The National Treatment Outcome Research Data on Opioid Addiction Patients reports that of 242 patients in residential treatment programs, 34% relapse within 3 days, 45% relapse within 7 days, 50% relapse within 14 days and 60% relapse within 90 days. (httr)s://www.rehabcenter.net) According to drugabuse.gov, more than 70,000 Americans died from drug -involved overdose in 2019, including illicit drugs and prescription opioids. Drug -involved overdoses have increased by 28% during 1999 and 2019. Each day, approximately 130 people in the U.S. die from opioid overdose; however, despite the availability of evidence -based medications to treat OUD, it is estimated that fewer than 1 percent of jails and prisons in the U.S. provide access to medications. Opioid use disorder is highly prevalent among justice -involved individuals, leading to increased risk of early death, 11 hepatitis C and HIV, yet more than 80% of individuals who are incarcerated and have a history of opioid use do not receive treatment. To treat those with opioid use disorder, it is crucial to expand access to evidence -based treatments, including medication - assisted therapy (MAT). MAT is a comprehensive way to address the needs of individuals that combines the use of medication (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies. The Collier County Sheriff's Office has collaborated with the High Intensity Drug Trafficking Areas (HIDTA) program to collect accurate overdose information for Collier County. In 2020, there were a total of 448 overdoses in Collier County. Of those 448, 27 were fatal. Of those 448, NARCANO was deployed a total of 282 times; 179 were single NARCANO deployments and 103 multiple deployments. From January 1, 2020 through March 2, 2020, Collier County has reported 85 overdoses, 9 of which were fatal. Of those 85, NARCANO was deployed a total of 44 times; 25 were single NARCANO deployments and 19 were multiple deployments. The current statics are showing an increase from FY 2019 of 1.2 overdoses per day to 1.4 overdoses per day for FY 2020 to date, while fatalities from overdoses are showing an upward trend from .06% to .10%. In addition to concerns for individual and public health and safety, the increased spending that accompanies growing populations of individuals with mental health and/or substance use disorders presents further challenges to the community. The Average Daily Population (ADP) and costs are shown in Table 2. As shown, the Average Cost Per Inmate Per Day is inverse to the ADP of the Jail: as the ADP of the Jail increase the Average Cost Per Inmate Per Day decreases. However, the Average Cost Per Mentally III/Co-Occurring Inmate Per Day does not follow this trend. As the Jail Population increases — so does the cost relating to Mentally III/Co-Occurring Inmates. According to CCSO, local costs to house persons with mental illnesses and/or substance use disorders in the jail tend to average more than 2 '/2 to 3 times more than those for a non - mentally ill inmate. This is generally due to longer stays, heightened supervision requirements, medical/psychiatric costs, and one-to-one staffing needs (LPN, RN, OT) to maintain safety (https://www.usf.edu/cbcs/mhlp/tac/documents/florida-main/cjmhsa- reinvestment-grantee-applications/2017-grantees/collier-tabs-4-5.pdf). The overall average length of stay for local inmates in 2020 was 42 days. While those suffering with substance abuse disorders length of stay is 152 days or 3.5 times longer. Year Collier County Total Population ADP of the Jail Average Cost Per Inmate Per Day Average Cost Per Mentally III/Co- Occurring Inmate per day 2010 321,520 893 $117 $351 2011 327,712 875 $111 $333 2012 332,528 988 $94 $282 2013 1 339,642 910 1 $98 1 $294 2014 1 348,777 872 $107 $321 12 2015 357,305 797 $132 $396 2016 365,136 783 $139 $350 2017 372,880 757 $149 $373 2018 376,544 842 $143 $358 2019 378,488 765 $159 $398 2020 391,000 616 $210 $465 Table 2. Collier County population and average daily costs 2010 2020. Due to concern for increasing jail population and overdose rates, on December 11, 2018, the Collier County Board of County Commissioners approved a resolution establishing a Mental Illness and Addiction Ad Hoc Advisory Committee. The committee identified six priorities, ranked in order of their relative importance by the Committee, which are: 1. Build and operate a Central Receiving Facility/System to serve persons experiencing an acute mental health or substance use crisis. 2. Increase housing and supportive services for persons with serious mental illness and/or substance use disorders. 3. Establish a Mental Health and Substance Use Disorder Data Collaborative for data Sharing, collection and outcomes reporting. 4. Increase the capacity and effectiveness of justice system response for persons experiencing serious mental illness and/or substance use disorders. 5. Revise and implement Non -Emergency Baker Act and Marchman Act Transportation Plans, and; 6. Improve community prevention, advocacy, and education related to mental health and substance use disorders. Since the establishment of the committee, the greater Collier County community has shown increased support for access to treatment for mental health and substance use disorders as evidenced by voter approval of the Collier County Infrastructure Sales Surtax, which included $25 million for building a Central Receiving Facility. This facility will include crisis stabilization, detox and addiction receiving facility (ARF) units, including a centralized access, "no wrong door" approach. Collier County's partners began researching the implementation of medication -assisted treatment (MAT) in the county jail setting in order to improve transition of inmates into the community in 2019. Members from Collier County Government, Armor Correctional Health, David Lawrence Centers for Behavioral Health and the Collier County Jail participated in the Bureau of Justice Assistance's Comprehensive Opioid, Stimulant and Substance Abuse Program's (COSSAP) Planning Initiative to Build Bridges Between Jail and Community -Based Treatment for Opioid Use Disorder in August 2019 and January 2020 in Arlington, Virginia. Collier County was one of 13 municipalities nationwide selected to participate in this innovative initiative. Collier County chose to apply for the planning initiative after jail data showed the number of inmates requiring a detox protocol, and the need for MAT to be implemented to prevent post -release overdoses. In 2019, one thousand three hundred thirty (1,330) or 15% of new intakes were placed on detox protocol. In 2020, four hundred eighty 13 (480) or 8.4% of new intakes were placed on detox protocol. It is important to note that the average daily population decreased by 19% during 2020 due to the COVID19 pandemic. Extensive research demonstrates that individuals with opioid addiction who follow detoxification with complete abstinence (i.e., no treatment medication) are at higher likelihood for relapse (e.g., Bart, 2012, Mattick, et al., 2008 & 2009, Volkow et al., 2014). Though relapse is a common and expected step on the path to recovery, it can also be life -threatening, raising the risk for a fatal overdose. Thus, an important way to reduce mortality and support recovery from heroin or prescription opioid addiction is to maintain abstinence from illicit drug use, supported by the use of FDA -approved medications that reduce the negative effects of withdrawal and craving. Understanding substance use disorder as a brain disease has become widely accepted in recent years. It is considered a disease that has "cognitive, behavioral, and physiological characteristics that contribute to continued use of drugs despite the harmful consequences." (NIDA, 2012). As a result, national and international professional organizations consider medical treatment for OUD to be an evidence - based best practice for treating OUD. These include the National Association of State Alcohol and Drug Abuse Directors (NASADAD), the American Academy of Addiction Psychiatry (AAAP), the American Society of Addiction Medicine (ASAM), the World Health Organization (WHO), and the Substance Abuse and Mental Health Services Administration (SAMHSA). The most effective treatment for opioid use disorder is the use of FDA -approved medications (methadone, buprenorphine, and extended -release injectable naltrexone), a treatment commonly known as medication -assisted treatment or medication -in -addiction -treatment (MAT), or medication for opioid use disorder (MOUSD). Current Services within Collier County Jail: In July 2020, through a grant provided by the Department of Children and Families, the Collier County Jail began receiving free naloxone kits for qualifying inmates, to be given to them at the time of their release. The Collier County Jail shows a seven -minute video to all inmates daily on the proper use of Narcan. Qualifying at -risk inmates are those being released from jail who: 1. Use illicit opioids or engage in non -medical opioid use 3. Have a history of opioid intoxication or overdose 4. Have an active opioid prescription 5. Have enrolled in or graduated from the Collier County Jail's Project Recovery Residential Treatment Program. 6. Are on medication -assisted treatment programs for opioid use disorder. A naloxone kit includes: 1. Two devices of Narcan Nasal Spray 2. A flyer with community resources for treatment of substance addiction 14 3. Printed materials regarding overdose prevention and treatment, including information regarding recognizing and responding to suspected opioid overdose and the importance of summoning emergency responders. Since July of 2020, the Collier County Jail has handed out 38 Narcan kits to inmates prior to their release from custody. Of all subjects arrested in 2020 (5, 375), 239 inmates admitted having experienced an overdose, an average of 3 times. As an awardee of the BJA Building Bridges grant, in March 2020 the MAT team created a video on the benefits of MAT that is currently shown in the jail to those interested upon release. In May 2020, the Collier Jail began referring inmates who A) self - reported being treated with MAT at the time of their arrest, B) reported having been in a MAT program during the previous twelve months, or C) who were interested in enrolling in a MAT P\program post -release, to the David Lawrence Centers' MAT Care Coordinator. The MAT Care Coordinator comes into the jail regularly and works with the identified inmates on a discharge plan to get them linked with a MAT program upon release. Collier County has further identified the need to establish MAT services within the jail, together with a comprehensive support system that extends into a long-term community -based network. Through the proposed MAT Program, Collier County intends to provide a comprehensive jail -to -community network of resources and treatment, to create more successful outcomes for individuals with substance use and co-occurring disorders within our criminal justice system. Currently, the Collier County jails do not have the resources to provide the support and treatment that these individuals require. Many inmates who are booked into the jail who have been receiving MAT in the community must then be initiated with a detox protocol while in the jail and are unable to continue receiving MAT due to the lack of resources in the jail setting. In 2020, the Collier County jail established a memorandum of understanding with the local methadone clinic. The MOU includes the delivery of methadone in the jail for those pregnant females currently enrolled should they be incarcerated. However, those not pregnant but on methadone are currently not offered MAT services. Collier County intends to use the grant funds to implement a comprehensive MAT program for inmates who require MAT services and who would otherwise undergo a detox protocol in jail that may increase their risk of overdose after release. Upon the implementation of this program, Collier County will also begin to initiate services to inmates who were not receiving MAT at intake, but who present with an opioid use disorder and are candidates for these supportive resources upon release. These individuals will be able to participate in the other associated services, through our community partners, which can assist them in preparing for a safer and more successful transition into the community after release. 3.7.5.2.1. Screening and assessment process used to identify the target population The Collier County Sheriff's Office contracts with Armor Correctional Health for inmate health care. At the time of booking, each inmate is assessed using an Armor Correctional Health Patient Intake Health Screening Form (PT-051). In 2017, nursing 15 staff began to identify inmates during the intake process who reported receiving medication -assisted treatment (MAT) at time of arrest or who reported receiving MAT in the previous 12 months. The comprehensive assessment is used for future treatment planning. This comprehensive review includes as assessment of social and environmental factors to identify facilitators and barriers to treatment and long-term recovery. For those with substance use disorders who were on MAT at the time of their arrest, information is collected regarding the type of medication and the name of the provider dispensing their medication. In addition, information regarding prior treatment of overdose with naloxone is collected, along with the number of overdoses the inmate has experienced. This implementation and data collection led to the implementation of an improved screening process in 2018 whereby each new intake is screened by a nurse within eight (8) hours of arrest. New inmates are asked about mental health and substance use diagnoses at intake. Armor Correctional Health staff members screen each inmate for mental health disorders by using a mental health intake screening form, a behavioral health assessment, and a review of prior medical records. Each inmate is also asked if they are using any substances, and if so, which ones. Those who state that they are using opioids are asked if they would be interested in enrolling in a MAT program if one were offered in the jail. All of this information is entered into the CCSOjail management system, where review data, statistics as needed, and make appropriate referrals. In late 2019, the County and its partners, through BJA Building Bridges grant award, developed a program to provide referral to and MAT care coordination for inmates. The MAT Care Coordinator meets with referred inmates to discuss treatment options. Participation in MAT care coordination and referral to a MAT program is completely voluntary. To address inmates' mental health needs, Armor Correctional Health employs a psychiatrist 20 hours per week, recently increased, and two full-time mental health counselors, who meet with inmates and respond to inmates' mental health needs. Collier County Jail Reentry Program Staff interview every new intake within 72 hours of arrest. The interview consists of self -reporting for substance use, mental health diagnoses and essential needs. The Reentry Program Staff will then make appropriate referrals to one of the County's three problem -solving treatment courts: Mental Health, Drug Court, or Veterans Court. Reentry Program staff will also refer appropriate inmates to the MAT Care Coordinator. 3.7.5.2.2 Percentage of persons admitted to the jail that represents people who have a mental illness, substance use disorder, or co-occurring disorders During the 2020 calendar year, the average percentage of new inmates booked into the Collier County jail who self -admitted to substance use was 68%. Data during this timeframe also indicates that at the time of booking, 81 individuals reported receiving methadone; 87 reported receiving Suboxone and 4 reported receiving Vivitrol. Thirty- nine (39) additional inmates reported a prior history of MAT in the previous 12 months, and 130 inmates indicated that they would be interested in enrolling in a MAT program. During the last quarter of 2020, 73 new jail inmates were placed on a detox protocol (4%). 16 Data analyzed from the 2020 calendar year indicates that 783 persons who were incarcerated were identified as having co-occurring behavioral health disorders. During the last quarter of 2020, 31 % of those incarcerated were identified as having co- occurring disorders, while in the last quarter of 2019, only 26% of those incarcerated were identified as having co-occurring disorders. This indicates an upward trend in co- occurring disorders among those arrested in Collier County. 3.7.5.2.3. and 3.7.5.2.4 Contributing factors/why the target population is at -risk of re-entering the criminal justice system Inmates with mental health and co-occurring substance use disorders have complex and challenging needs that many other inmates may not face upon release. Inadequate transition planning can contribute to individuals with substance use and co-occurring disorders who enter jail in a state of crisis to be released back into the community while still in crisis. Those with serious mental illnesses, many of whom have a history of trauma, poor community support systems, and experience chronic unemployment, have specific needs that, if unaddressed, lead to re -arrest and multiple community -wide problems. Many will soon end up in emergency rooms, back in jail, or in psychiatric inpatient or detox units — outcomes with major financial costs for the community. In Collier County, a significant factor that puts the target population at risk of entering and reentering the criminal justice system is the extremely high cost of living. As shown in Table 4, the cost of housing in Collier County exceeds the Florida average by 40 points. This high housing cost is a primary cause of homelessness, which also contributes to arrests such as loitering or trespassing. Item Collier Florida US Overall 113 103 100 Grocery 108 103 100 Health 101 98 100 Housing 143 103 100 Utilities 99 101 100 Transportation 89 113 100 Table 4. Best Places. https://www.bestplaces.net/cost of living/county/florida/collier Access to stable housing is an extremely important contributing factor when considering recidivism. Individuals released from jails or prisons are four times more likely to be homeless. Individuals without stable housing reported the highest levels of drug use after release from a correctional facility. Inmates with mental illness were 2.5 times more likely to have experienced homelessness in the year prior to arrest, when compared to inmates who are not diagnosed with mental health illness. Additionally, nearly half of inmates with a mental health illness in jail were incarcerated for committing a nonviolent crime, further increasing probability for recidivism for inmates 17 with co-occurring disorders. (https://www.huduser.gov/portal/periodicals/em/summerl 6/highlightl .html) 3.7.5.3.1 The projected number of the broader category of persons served in any capacity Collier County has identified the Target Population of this program to be individuals within the local jails who face substance use and co-occurring disorders. Data collected as of the last quarter of 2020 indicates that 45% of the inmate population were seen by an Armor psychiatrist. During this time, there were 38 inmates in custody who during intake expressed an interest in initiating participation in a MAT program upon their release from incarceration. All participants who express an interest in participating in MAT during their incarceration as well as after release, will be served in some capacity. These services include: referral to the in -jail substance use treatment program, Project Recovery; meetings with the MAT coordinator; appointments with mental health professionals; peer support; and discharge planning specific to the inmate needs. The Collier County MAT Program will be comprised of a MAT Team that provides both in -jail MAT and associated services, as well as community -based MAT services. Based on historical data, our current projection indicates up to 15 incarcerated inmates monthly will receive in -jail MAT and associated support services, with a subset of 5-15 persons who will be released monthly and will transition to the community MAT Team. Over the lifetime of the grant, Collier County plans to serve a minimum of 300 persons within the jail, with 80 of these individuals annually transitioning from jail -based to community -based MAT resources. 3.7.5.3.2. A projected number of any subset of persons served during their involvement in applicant's program Although the Collier County MAT Program will be made available to all inmates who have been identified as having a substance use or co-occurring disorder, the program will offer the most intensive treatment services to individuals who are already receiving MAT at the time of arrest. The inmates will be prioritized in order to continue receiving their medication while incarcerated. This ensures that individuals booked into the jail while receiving MAT will not have to be placed on a detox protocol and can continue to maintain their MAT medication during incarceration through release back into the community. During the 2020 calendar year, 20% of new inmates indicated that they were on MAT at the time of their arrest and 15% of new inmates were placed on detox protocol in 2019 and 8.4% in 2020 (COVID impact). During the same time, the average daily population for the Collier County Jail was 616 inmates. Based on this data, we anticipate that 20% of the inmate population will be receiving MAT at the time of their incarceration. Therefore, the expected number of inmates who will receive MAT while in custody is projected to be 300 inmates during the grant period. IV M.ZI 3.7.6 Project Design and Implementation 2.2.4.2.1 and 3.7.6.1 Planning Council The Collier County Public Safety Coordinating Council (PSCC) was formed in 2005. PSCC was guided by Resolution No. 2005-92 authorized by Section 951-26, Florida Statutes, which provides that a Board of County Commissioners shall establish, within its county, a county public safety coordinating council. The purpose of the PSCC is to assess the population status of all detention or correctional facilities, formulate recommendations to ensure that the capacities of such facilities are not exceeded, assess the availability of pretrial intervention or probation programs, work -release programs, substance use programs, gain -time schedules, applicable bail bond schedules, and the confinement status of the inmates housed within each facility. For the purposes of this grant, the PSCC will be responsible for reviewing data and making informed program recommendations or corrections as needed. When this grant is implemented, at each subsequent PSCC meeting there will be a presentation of the MAT program by member(s) of the MAT Team or designees. The PSCC will be provided statistics regarding MAT, including both those being treated in custody, as well as those transitioned to community services and referred from the jail to a community provider. Statistics may include, but are not limited to: a comparison of community overdoses prior to in -jail MAT; recidivism rates for those inmates with substance use disorders on MAT at the time of release and those not receiving MAT; a review of community overdose fatalities and Narcan deployments. The MAT Team will provide any additional information requested by the PSCC and will modify and refine data collection at their request as it relates to the MAT program and OUD in the community. The MAT Team will also work to implement any project recommendations made by the PSCC. On an annual basis, the PSCC will receive the annual progress report prepared by the contracted evaluator. The PSCC partners will also be included as participants in the three-year Strategic Plan. 3.7.6.1.1. Composition of the Planning Council Current members of the Collier County Public Safety Coordinating Council (PSCC) Name Title/Agency Role Amira Fox State Attorney, 20th Judicial Circuit Statutory Member Kathy A. Smith Public Defender, 20th Judicial Circuit Statutory Member Chief Judge Michael T. McHugh Chief Circuit Judge Statutory Member Judge Rob Crown County Court Judge Statutory Member Sheriff Kevin Rambosk ( Vice Chair) Sheriff, Collier County Sheriff's Office Statutory Member 19 Brad Rouskey State Probation Circuit Administrator Statutory Member Commissioner Rick Commissioner, Board of County Statutory Member LoCastro Chair Commissioners Jeff Nichols Director of County Probation Statutory Member Scott Burgess Chief Executive Officer, David Statutory Member Lawrence Centers Nancy Dauphinais Chief Operating Officer, David DLC Executive Director's Lawrence Centers designee if unable to attend Joe Paterno Executive Director, Southwest Statutory Member Florida Workforce Development Crystal K. Kinzel Collier County Clerk of the Circuit Non -voting Participant Court Katina Bouza Director Corrections Support Non -voting Participant Division, Collier County Sheriff's Office Judge Janeice Martin County Court Jude Non -voting Participant Lee Willer -Spector Staff Liaison Non -voting Participant Kristi Sonntag Collier County Human Services Non -voting Participant Director 3.7.6.1.2. Planning Council Activities and Meetings During the last five years, the PSCC has been involved in: • Reviewing arrest statistics to examine the use of pre -arrest diversion in Collier County. • Updating the Collier County policy on extra -gain time for inmate workers in the jail. • Reviewing data for Collier County petit theft arrests, in anticipation of a Legislative amendment changing the petit theft statute. It was anticipated that an increased number of individuals arrested for petit theft would have higher bonds and would remain incarcerated. • Discussion on Community Corrections, to reduce jail population for those who do not pose a risk to the community. • Discussion on re -introducing a work -release program in the jail. • Discussion on introduction of MAT for new inmates that are on MAT at the time of their arrest. All members unanimously voted for the jail to begin to look for grant funding to move forward with MAT in the jail. The Collier County PSCC will develop a subcommittee to review and provide oversight to the MAT program. The MAT Team will report all statistics, challenges, and successes to the Collier PSCC for guidance and support. In previous years, Collier County has utilized a Criminal Justice, Mental Health and Substance Abuse (CJMHSA) Planning Council. This council was formed in 2010 and now it will be part of the Collier PSCC as a subcommittee responsible for the 20 implementation and performance review of this project. It was determined that the need for a separate council was not necessary since the same members served on both and it was more efficient for all to utilize a subcommittee approach. Utilizing both councils in a joint effort will allow for a more comprehensive review of the program. Due to the COVID19 pandemic, there were no PSCC meetings held in the last 12 months. The next meeting of the PSCC is scheduled to take place on March 26, 2021, at which point the PSCC anticipates resuming their regular meeting schedule. 2.2.4.2 Collaboration and Collaborative Partners The key project partners have a proven history of collaboratively developing and managing criminal justice diversion programs in Collier County. These include: 1) Adult Mental Health Court in operation since 2007; 2) Adult felony Drug Court, active since 2000; 3) Veteran's Treatment Court, active since 2015; 4) Forensic Intensive Reintegration Support Team (FIRST) program, utilizing CJMHSA funds from 2010 to 2019; 5) Crisis Intervention Team (CIT) training since 2008; 6) Mental Health Intervention Team (mobile, community -based co -responder team); as well as other rapid response and law -enforcement -assisted diversion (LEAD) initiatives. All members of the PSCC will be considered primary grantee partners. The group has collaborated on criminal justice -focused behavioral health strategic plans together since 2010. The PSCC will have a and subcommittee that will facilitate improved coordination of all current diversion programs and provide direction for future development and sustainability. Each of the partner agencies has demonstrated its long-term commitment to the project. This commitment has been demonstrated through completion of an interagency Memorandum of Understanding (MOU), participation in the CJMHSA subcommittee planning council and strategic planning, and through its ongoing operations of several local centralized coordination projects as described above. Council member input is essential to ensure the programs are meeting the needs and expectations at both the policymaking and service delivery levels. 2.2.4.2.2 and 2.2.4.2.5. Project progress, adjustments, and review of goals An objective, third -party university evaluator through Florida Gulf Coast University (FGCU) will be engaged to complete an evaluation of the project performance and generate a progress report annually. This progress report will identify critical points in the program's performance, as well as identify areas for concern or reinforcement. The evaluator will be tasked with presenting outcomes and measures to the PSCC annually for their review. The Planning Council will review the grant implementation and associated data at regularly scheduled meetings. In the event adjustments to the implementation are necessary, the subcommittee may be directed by PSCC to focus on the priorities and 21 corrections needed to comply with the terms of the grant or to improve the outcomes or progress of the project. 3.7.6.3. Implementation 3.7.6.3.1 Collier County Criminal Justice, Mental Health & Substance Abuse (CJMHSA) Strategic Plan 2020-2024 Vision: Collier County citizens with substance use disorders and co-occurring disorders receive effective, community -based treatment and supports to increase quality of life through a reduction in recidivism. Mission: The mission of the Collier County Public Safety Coordinating Council is to implement effective treatment and resources for individuals with substance use disorders and co-occurring disorders who have contact with the criminal justice system. 3.7.6.3.1 Collier County Strategic Plan 2020-2024 (Exhibit A) Starting in 2017, an informal group of community stakeholders began to meet with the goal of improving the continuum of care around mental health and addiction services in Collier County. Throughout this process, the group identified many strengths in the community, including agencies and stakeholders exceptionally dedicated to supporting each other in collaborative efforts and ideas. Communication thrived as issues were discussed, and the group worked to eliminate silos and better coordinate services. Several collaborative working groups are in place that align well with this Mental Health and Addiction Services Strategic Plan and should be complementary in its advancement such as: Blue Zones; Collier County Public Safety Coordinating Council; Criminal Justice, Mental Health, and Substance Abuse Planning Council; Community Behavioral Health Advisory Committee, and community groups such as the Community Foundation of Collier County and Richard M. Schulze Family Foundation. Providers of treatment for substance use disorders and mental illness work collaboratively to refer individuals to the appropriate treatment modality based on diagnosis. They identify high service utilizers for enhanced services. They are committed to utilizing evidence -based practices that have emerged in recent years to improve care. These practices include medication -assisted treatment, assisted outpatient treatment, problem -solving courts, Housing First, and the use of both mental health professionals and trained peers. Sequential Intercept Map (2.1.3) (Exhibit B) The Planning Council uses the Sequential Intercept Model (SIM) (Munetz & Griffin, 2006) as a `cross -system map' and conceptual tool for planning purposes. The model (Figure 1) depicts the six primary points or intercepts where an individual would typically progress through the criminal justice system. At each of these points are opportunities to intervene and "intercept" the person, moving or diverting them from the justice system to treatment system. The following discussion considers each intercept with respect to 22 related local resources and gaps in the system. The SIM was developed by a group of 15 participants representing cross -systems stakeholders including mental health and substance use treatment providers, human services, corrections, advocates, peer specialists, law enforcement, county courts, county commission, and the judiciary. Mark Engelhardt, from the University of South Florida (USF) Criminal Justice, Mental Health, and Substance Abuse Technical Assistance Center (CJMHSA TAC) facilitated the mapping on two separate occasions for the County over the last 9 years. Since inception in 2010, the sequential intercept map is reviewed annually and updated as needed. Intercept 0: Community Services Intercept 1: Law Enforcement Intercept 2: Initial Detention/Initial Court Hearings Intercept 3: Jails and Courts Intercept 4: Reentry Intercept 5: Community Corrections 1111 Y':Y111 1111Y':Y111 l ""'C'kp! 2 1-6ricYPr a I-'f lrY 3 L"'El"•Ir:klb-w� L.;,- Erfo{ti+vti+u. L. 141 pnM+lW , •Iti A— I r C LNC) C-i1 i�tii �X15 41 het, 5 ;ucu 4y L'vull 1 __F— 917 Pnrvn 0 & ire^ P�rala r3 �y s L�rM �oli _ J11 U xpmIm NJ .3i 7F fEei Li,*= ti.,,ema �V6 —'WR .58 y. rLldn Figure 1: Sequential Intercept Model, Policy Research Associates 2020-2024 Strategic Plan Priorities The following are Collier County priorities for 2020-2024: ➢ Increase use of evidence -based practices for treatment of addictions in order to eliminate/reduce overdoses (fatal and non -fatal) after release from incarceration. ➢ Increase law enforcement -related opportunities for early intervention, diversion, and improved care for high -risk, high -needs persons who are incarcerated or at risk of arrest or Baker Act. ➢ Implement, enhance, and sustain coordinated reentry/reintegration services and processes between the criminal justice system and community resources. ➢ Expand, improve and sustain the justice system response to persons with substance use and co-occurring disorders who are involved with the criminal justice system. 23 3.7.6.3.2 Project Design, Implementation and Objectives 3.7.6.3.2.1 Project Goals, Strategies, Milestones, and Key Activities For this grant, Collier County has chosen to focus on Intercept 3 and Intercept 4 of the Sequential Intercept Map and in doing so, will be contributing to the accomplishment of the Strategic Plan Priorities outlined above. The proposed Collier County MAT Program coincides with Priorities 1 and 4: to "Increase use of evidence -based practices for treatment of addictions in order to eliminate/reduce overdoses" and "Increase the capacity and effectiveness of justice system response for person experiencing serious mental illness and/or substance use disorders". Collier County plans to develop a dedicated MAT Team that consists of staff members based within the local jail as well as community -based team members to assist those being released back to the community. Collier County will use the CJMHSA grant funds, through subrecipient agreements, to fund the local law enforcement agency and jail administrator (Collier County Sheriff's Office) and the community mental health/substance use treatment provider (David Lawrence Centers). The Collier County jail currently has a contractual agreement with Armor, the jail medical/mental health and substance abuse vendor. In addition, funds will be used to support the cost of in -jail MAT through New Season and Armor through subaward agreements issued by CCSO as well as the cost of support services in the community (i.e., incidentals) through the identified subrecipient agreement. It is the intent of the Collier County MAT program to begin and work with inmates who are on MAT at the time of their arrest, before considering if there are enough funds to expand to treat inmates interested in beginning MAT while in -custody. Collier County will be using a "Medication First" model. Often individuals with OUD present in the early stages of withdrawal, which is an opportune time to engage them with the medical professional at the jail, who can provide medical stabilization and then engage in care planning. Medication stabilization should occur first because the inmate may be suffering from withdrawal symptoms. In the current situation at the Collier County jail, those inmates may experience these withdrawal symptoms without supportive services. The implementation of this evidence -based model will allow jail medical staff to ease inmate suffering by managing withdrawal symptoms and assist to reduce drug craving. This model prioritizes providing access to evidence -based medications for opioid use disorders while honoring the clients' choice related to treatment. Our approach will focus on four main principles: (a) Clients will receive pharmacotherapy as quickly as possible, prior to lengthy assessments or treatment planning. (b) Maintenance pharmacotherapy is delivered without arbitrary tapering or time limits. (c) Individualized psychosocial services are offered but are not required as a condition of pharmacotherapy. (d) Pharmacotherapy is discontinued only if it appears to be worsening the client's condition or should the client request to do so. 24 Project Design Phase #1: Engagement. The following steps represent the "engagement" of the inmate with OUD in services: (a) The individual is booked into the jail. (b) A brief screening occurs at the time of booking with the Armor nursing staff. (c) Those inmates who report current MAT use are immediately engaged with the MAT nursing personnel (d) I Inmates who do not report MAT at the time of screening but do report OUD will be identified to engage with support services and receive MAT referrals upon release. (e) The inmate completes a medical screening, urine drug testing, and the Texas Christian University Drug Screen 5 (TCUDS-5) screening. (f) MAT Team meets with the inmate and develops a plan for medication administration and services while in the jail. Inmate is engaged with Armor medical staff to administer medication treatment. If the inmate is receiving methadone, then Armor medical staff will coordinate with New Season to have the inmate assessed, set up appointments with New Season and have methadone delivered to the jail for Armor medical staff to administer. 3.7.6.3.2.5 Screening Process The model of care is based on best practice principles which incorporate the client/family/referral source involvement, initial assessment of needs, and immediate determination of medical necessity criteria with the appropriate response and plan of action. At the time of booking, a medical screening is completed by a jail medical staff coordinator to determine presenting concerns (Exhibit C). If an inmate is screened in the jail who has been receiving MAT and he/she consents to participate in the program, Armor medical staff will have release of protected health information documents signed. This will allow Armor medical staff to request the inmate's MAT treatment information from the community MAT provider. A medical profile is completed during this screening process to identify need for further education, referral and testing in various areas. The following information is collected during the screening: a. Date of birth b. Vital signs c. Results of a urine drug screen d. Report of substances used in the past 30 days, frequency of use, date/amount of last use, and route of administration e. Report of prior overdose events f. Release of information documents signed g. Need for immediate detox protocol 25 h. For those admitted who are currently receiving MAT: 1. Current medications 2. MAT community provider information to determine type of MAT, dosage, etc. 3. Inmate will then meet with APRN for assessment and prescribing MAT medication. An individual is designated as an emergent client for immediate treatment access when they report that they are currently receiving MAT at the time of booking. At this time an Armor LPN would assess the need for further medical consultation. The clinical triage and service access delivery systems are provided under the supervision of Armor Licensed Independent Practitioners with the skills, experience, and credentials to meet the needs of the individuals served, as indicated and appropriate. Specialty assessments/evaluations may be completed by Armor staff specially trained and certified in specific areas, such as psychiatry, general medicine board certified doctors, substance use disorder counselors, mental health clinicians and nurses. These services will be provided as recommended by the Armor medical and MAT Team. The information regarding inmates who were on MAT at the time of their arrest will be provided to the MAT Team. The MAT Team nursing staff will meet individually with MAT -involved inmates, within 24 hours of intake, to have releases of information completed for their MAT treatment providers, and these inmates will be assessed using the Texas Christian University Drug Screen 5 (TCUDS-5) along with the Opioid Supplement. Exhibit D Screening Tool Purpose Description/Validity for Target Population TCUDS-51 Substance Use Disorders Based on the DSM-5. The TCUDS 5 screens for mild to severe substance use disorder, and is particularly useful when determining placement and level of care in treatment. Valid for use in 'ails. I Institute of Behavioral Research. (2014). TCU Drug Screen 5 (TCUDS 5). Fort Worth: Texas Christian University, Institute of Behavioral Research. Available at ibr.tcu.edu. Inmates who report OUD at the time of booking, but do not report that they are currently receiving MAT, will receive the medical screening to collect the pertinent information referenced above, however, they may not receive the TCUDS-5 screening. This population of inmates will have access to non -medication -related services but may not be eligible to receive in -jail MAT through this grant funding, due to limitation of resources. They will have the opportunity to participate in all of the associated services that focus on elements such as planning and preparing for release from the jail. 26 Phase #2: Treatment and Services within the Jail After initial engagement with the participant, MAT Team staff will obtain documentation from the MAT provider in the community and verification of the inmate's medication and dosage to be continued by the in -jail MAT providers. The MAT Team APRN will then meet with the inmate to access and prescribe the appropriate MAT. Armor staff will administer buprenorphine/vivitrol and will coordinate with New Season for inmates who are receiving methadone. Procedures will require that the inmate is to receive MAT within 48 hours of intake. Inmates on Vivitrol will continue to receive Vivitrol from their community provider, due to the fact that the average length of stay for inmates receiving Vivitrol is one day. Therefore, inmates on Vivitrol may not need the MAT Team to be involved in their treatment, except to work with them on their continuum of care for associated services and discharge planning. In the event that an inmate on Vivitrol is in custody for a longer time period, which would require another dose of Vivitrol, the MAT Team will make contact with the inmate's MAT provider to continue treatment while in custody. Inmates who are receiving methadone or Suboxone/buprenorphine will meet with MAT Team staff at least weekly to monitor their condition and determine if the medication dosage is still appropriate or needs to be changed. Dosage will be determined by the Armor Medical Director or the New Season Medical Director, depending on the medication the inmate is being provided. Medication levels are closely monitored on a continuous basis by means of urine drug testing. If agreed to by the participant, the dosage may be adjusted to decrease with time as the client progresses through the different phases of treatment. During this phase, MAT Team staff will also provide the participant with opportunities to participate in the associated services. Motivational interviewing will be offered to assist participants to commit to their recovery, even if the initial motivation for treatment may stem from wanting to avoid conviction, wanting to avoid a jail or prison sentence, or being ordered to seek treatment as a condition of probation or parole. These services are available to inmates at their request, by speaking to Armor staff while they make their rounds, by requesting to speak to a MAT Team member, or by participating in the jail's Project Recovery Program, which is provided by DLC via contract with CCSO (described below). The Collier County Jail currently offers several resources that are available to all inmates, including any future participants of this program. First, the jail provides video - based training twice per day to all inmates. This video includes training on the use of naloxone (i.e. Narcan and Evzio) to reverse overdose, as well as information on accessing varied community -based resources for needs such as substance use treatment and recovery. Additionally, CCSO currently facilitates a voluntary treatment program for inmates, Project Recovery, which is sub -contracted to the local not -for -profit behavioral health facility, David Lawrence Centers. Inmates participate in a 90-day treatment program, which, if completed, helps inmates with their early release from custody. This program offers reentry planning for participants and assists participants with linking with aftercare programs in the community. As this grant program is based in 27 the "Medication First" model, these services will be available to, but not required of, MAT participants. Phase #3: Pre -Release Planning. Reintegration and Discharge Planning Specialists, funded through the CJMHSA grant, will meet with all participating inmates prior to their release to develop a discharge plan, including community -based MAT planning for all participants. Armor will notify the MAT Team Supervisor 30 days prior to an inmate's anticipated release date, so that MAT Team case managers can be assigned to complete their pre-release triage in the jail. These release -planning sessions will take place twice per week during the 30 days leading up to release. In the event that an inmate will be released in 30 days or less from the date of booking, a MAT Team case manager will be assigned to begin their twice -weekly meetings during the inmate's first week in the jail. The reintegration team will include trained staff who will conduct Overdose and Naloxone Distribution training with the individual and the natural supports prior to discharge. The MAT Team will review overdose prevention, recognition and response strategies including how to use naloxone. The inmate will be provided with two naloxone kits at release. Research has shown that recovery support case managers bridge the gap between institutions and communities. The MAT Care Coordinator will meet with individuals before release and remain available for support and assistance for up to three months following release from the jail. By maintaining collaboration and regular communication with the jail, inmate, and community -based resources, the MAT Team works together to optimize success and enhance the prospects of long-term recovery for each shared client. It is the intent of the Collier MAT Team, through a "warm handoff," that each participating inmate being discharged will have a referral to the Community MAT Team members and community -based MAT resources. The inmate will work closely with the Community MAT Care Coordinator and Peer Specialists (PS) who are employed by the local community behavioral health service provider, DLC. This team will ensure comprehensive and holistic assessment of post -discharge needs and referrals to various community providers for services such as continued MAT and treatment, options for housing and supportive employment services. The MAT Team and PS will assist the inmates in identifying barriers to continued care and assist with identifying resources available in the community such as linkage to community -based mental health/addiction treatment services. Phase #4: Release Individuals returning to the community after incarceration face a myriad of challenges including: securing stable housing; obtaining employment and a stable source of income; complying with community supervision requirements; accessing transportation; and rebuilding social connections. When these needs go unmet, the likelihood of accessing and remaining on MAT in the community diminishes. Studies demonstrate 28 that the elevated risk of opioid-related overdose death among people released from jails and prisons is increased through disrupted social networks, poverty, disruptions in health care access, stigma and an exacerbation of underlying mental illness and SUD. The MAT Care Coordinator will work with community treatment providers to establish the inmates' follow-up appointment with treatment providers. Procedures will outline that the first follow-up appointment will take place within 5 business days of discharge. The MAT Team will work closely with treatment providers to develop a comprehensive plan and identify those clinically appropriate supports. In one Rhode Island Study, lack of transportation was cited as the top reason that incarcerated individuals did not connect to MAT services post -release. The MAT Team will work with transitioning inmates to develop transportation plans to support access to needed treatment services. As part of the community care coordination, additional assessments may be determined by care setting, the client's needs and desire for care (particularly if significant changes occur in client's condition or diagnosis), as well as the individual's response to previous care and treatment. The clinical assessment is a biopsychosocial tool conducted through semi -structured interview and is updated annually for clients who remain active in a treatment program. However, the assessment of an individual is also an ongoing process throughout treatment, for the purpose of continually identifying and prioritizing client needs. As part of this assessment process, the MAT Team will coordinate with David Lawrence Centers as well as other community resources to ensure that a full range of services can be made reasonably available to all participants, including, but not limited to: a. Substance use counseling as clinically necessary. The American Society for Addiction Medicine's (ASAM) multidimensional level of care assessment tool will be used to assist with appropriate referral to substance use treatment. This counseling shall be provided by a program counselor, qualified by education, training, or experience to assess the psychological and sociological background of clients; to contribute to the appropriate treatment plan for clients; and to monitor client progress. b. Counseling on the prevention of exposure to, and the transmission of, HIV disease for each client admitted or readmitted to maintenance or medically managed withdrawal treatment. c. The MAT Team will provide directly, or through referral to adequate and reasonably accessible community resources, vocational rehabilitation, education, and employment services for clients who either request such services or who have been determined by the program staff to need such services. d. Community Supports: those with needs related to entitlements, housing, employment, social supports, legal problems, physical health and wellness. Community Partners include St. Matthew's House, Collier County Housing Authority, Southwest Florida Workforce Development, Collier County Department of Health, Legal Aid, DLC and the Neighborhood Health Clinic. e. Individual Counseling: this will be highly individualized, using varying therapies. Motivational interviewing will be used. Cognitive -behavioral therapies and interventions have been shown to have the best outcomes, particularly focusing 29 on craving management and behavior modification. For those individuals with specialized needs (e.g., co-occurring disorders and trauma histories), referral to specific individual counseling or other interventions will be provided. Community Partners include DLC. f. Medical Services for low-income inmates, for routine medical and dental services— community partners include: Healthcare Network of SWFL (local federally qualified healthcare center), the Neighborhood Health Clinic and the Collier County Department of Health. g. Health Insurance/Benefit Coverage such as Medicare and Medicaid for those eligible through the Collier County Department Community and Human Services. h. Peer Support through the David Lawrence Centers. i. Recovery Housing — St. Matthew's House and the David Lawrence Centers. j. Transportation — Collier Area Transit. k. Client -specific outreach: a method used to maintain client engagement. This may involve recovery management check-ups, which involve reviewing the individual's recovery and progress in the areas of substance use, housing, employment, criminal justice and social connectedness. The MAT Care Coordinator will establish connection with the local community behavioral health pharmacy, Genoa Healthcare, who partners with the local community behavioral health center (David Lawrence Centers) to provide access to MAT medications via state or federal grants. Those discharged on methadone will return to a community methadone provider, New Seasons, or other community provider, and will continue to be followed by the MAT Care Coordinator and/or Peer Specialist to ensure continuation of treatment services. The MAT Team will seek to implement same -day access to treatment with a medication -first model for those on methadone and within 5 business days for all other participants. Each participant will have an individualized treatment plan with goals that will added or changed as they are identified and achieved and will address all life domains affected by the OUD. As each participant progresses through the program, sustainability for continued care and a transition plan will be developed and modified with the support of the MAT Team. Each participant will receive weekly visits with the prescriber to assist with stabilization or maintenance of medication dosage. Between follow-up appointments, the client may be assessed by the nursing support staff. During office visits, urine drug screens or salivary drug screens to test for other substances and for the presence of buprenorphine or its metabolites will be administered. Other lab testing may be recommended such as liver function test or pregnancy testing for female clients. In the event a client tests positive for illicit opioids, the client may receive adjusted buprenorphine dose, increased medical visit frequency as well as the opportunity for increased motivational interviewing/counseling/peer support. Peer recovery specialists play an important role on the MAT Team. Peer recovery specialists are individuals with lived experience of recovery from a substance use disorder and who are trained to assist others with their recovery. Peer specialists offer knowledge that treatment staff often lack based on life experiences. An increasing 30 number of MAT programs in correctional settings have integrated peer supports within MAT Team. Peer specialists employed by David Lawrence Centers are certified by the Florida Certification Board or are working towards certification within one year of employment. The MAT Team Peer Specialist will facilitate re-entry into the community alongside the MAT Team Care Coordinator. It is the intent of the MAT Team to provide up to three to six months of support and linkage with outpatient treatment services, however this is based on individual need and may continue beyond this timeframe. MAT will be prescribed by the community facility and will be consistent with its purpose of being a risk -reduction and craving -reducing component of the program. It is important to note that medication will not depend upon the individual receiving or participating in behavior therapies or other services. Phase #5: Maintenance The Maintenance phase is reached when the participant is functioning well on a steady dosage, with few or no cravings, while abstaining from illicit use of opioids. This phase will continue indefinitely for many clients, as long-term maintenance of medication treatment is recommended due to a high risk for relapse. If the client is medically, socially, and environmentally stable, and expresses wishes to taper off medication or transition to Vivitrol/long-acting naltrexone, the MAT Team will assist with this gradual reduction of medication alongside highly collaborative supports from appropriate resources. The community -based MAT Care Coordinator will monitor and provide support to the participants for three consecutive months following their release from jail. Once the participants reach this three-month marker, they will be considered fully integrated into their community resources and will be successfully discharged from the Collier County MAT Program to continue treatment within the community. Participants who request to continue coordination with the MAT program may be retained in the program on an as - needed basis. Alternatively, a client may request discharge from the program prior to this three-month marker and will also be considered a successful completion if the client is actively participating in community resources and determined by MAT Team staff to have reached the maintenance phase of their treatment. 3.7.6.3.2.2 Organization and key stakeholders responsible for each task or key activity necessary to accomplish the objectives It is the responsibility of the PSCC subcomittee team to have access to and be able to assess data and information as they strive to assess the allocation and adequacy of services specifically: Service needs of individuals with mental health and substance use disorders, issues, and concerns. 2. Services delivered to those individuals at the program, service, and client level. 3. Service gaps that must be filled to meet the needs of those who need substance use and/or behavioral health care; and 31 4.The effectiveness and efficiency of all services, especially those funded by the CJMHSA MAT program. The subcomittee team of DLC, CCSO and Collier County will focus on administration treatment, transition and implementation of the MAT program. 3.7.6.3.2.3 PSCC participation in expansion project ongoing The Public Safety Coordinating Council is to oversee planning and grant activities, as required by Florida's Reinvestment Act legislation. Members must include the judiciary, State's Attorney and Public Defender's Offices, mental health and substance abuse treatment providers, advocacy organizations, family members, and behavioral health consumers. The key task or activities include: • Building relationships and increase collaboration with the MHSA behavioral health community. • Increase legislative activities. • Expand public advocacy and education. • Enhance council involvement in planning, implementing, and monitoring grant services. • Integrate local planning council efforts more effectively. • Increase council involvement in developing and monitoring accountability measures. 3.7.6.3.2.4 Agencies and Organization Communication and Collaboration To monitor and guide program performance, Collier County Community and Human Services (CHS) division will provide an Administrative Grant Coordinator — who will provide project management and oversight of the grant program. The CHS Grant Coordinator will attend quarterly scheduled meetings to ensure regular communication and coordination with the MAT care providers, as well as to discuss data collection for program evaluation and reporting. The quarterly meeting participants will consist of: Project Director from Collier County Sheriff's Office — tasked with overseeing all in -jail services. o CCSO Nursing Staff — responsible for verifying community MAT treatment, prescribe in -jail MAT and provide suboxone treatment with oversight from the Armor Medical Director. o CCSO Discharge and Reintegration Staff — responsible for collecting data on inmates receiving in -jail MAT, coordinate continuum of care at the time of the inmate's release from custody and meet with inmates to assist in reentering the community. New Season — responsible for providing all in -jail Methadone to the inmates. Clinical Supervisor from David Lawrence Centers — tasked with overseeing community -based services after release. o DLC MAT Care Coordinator — responsible for working with inmates prior to release and after release to the community to ensure access to resources 32 needed to attend follow-up care and support continued engagement in treatment. o DLC MAT Peer Specialist -- responsible for working with inmates prior to release and after release to the community to provide recovery coaching and support to enhance client motivation and engagement in recommended services and participation in active recovery. The Grant Coordinator will assist the multiple agencies and care providers to coordinate with one another, while providing feedback on regular program updates provided by the MAT Team. The CHS Grant Coordinator oversight will focus primarily on ensuring that the program is showing timely progress toward grant goals and objectives, and that the program services remain within the established measures. 3.7.6.3.2.6. Care Coordination Navigating access to MAT services in the community after release can be a challenging experience. Collier County has established procedures to coordinate care with our community providers that will help to increase clients' likelihood of engaging in treatment and long-term recovery during re-entry. These procedures include obtaining the necessary HIPAA releases for community providers and notifying the community provider via the Care Coordinator that an inmate is in the jail and the estimated date of release. The Care Coordinator meets with inmates to discuss recommended continuing care services and to establish follow-up appointments as soon as possible within seven days of release. The Care Coordinator and Peer Specialist work with the inmate to ensure reliable transportation to follow-up appointments, as well as ensuring resources are available to obtain necessary prescription medications. The Discharge Planner and the MAT Team will work together to make contact with the inmate's community MAT provider to notify them of the inmate's up -coming release date. They will make appointments for the inmate prior to their release and give the inmate their continuum of care packet, which will provide appointments and resources in the community for their continued care. Through the outlined measures for creating and implementing a Jail -to -Community MAT program, Collier County plans to meet the following objectives: Objective 1: Establish programs and Initiatives • Initiate and implement MAT jail to community program to serve individuals with substance use and co-occurring disorders over the course of the three-year project. • Maintain a MAT staff -to -participant ratio of 1:20 or lower for the Community MAT Care Coordinator and Peer Specialist • Maintain a Jail MAT staff -to -participant ratio of 1:17 Objective 2: Collaboration • Participate in PSCC planning council meetings, strategic planning process, and Grantee Oversight Committee meetings. 33 • Facilitate a warm handoff from incarceration to community providers through maintenance of MAT and inmate connection to community resources. Objective 3: Improved Quality of Life • Obtain disability benefits for 10% of the eligible program participants within one year of application. • Retain clients in treatment and reduce drug -related recidivism. • Utilize enhancement funds for individualized recovery supports to address barriers to treatment and community integration. • Expand local initiatives to increase public safety, avert increased spending on criminal justice systems, and improve the accessibility and effectiveness of treatment services for adults with mental illnesses and co-occurring mental health and substance abuse disorders, who are in, or at risk of entering, the criminal justice system. 3.7.6.3.2.7 Law Enforcement Assessment The CCSO has a Law Enforcement Assisted Diversion (LEAD) program that allows our deputies to interface with an individual in the community who might be having difficulty in locating resources to assist him/her with Substance Use issues. The deputies are trained via roll call and at CIT training on the program that is managed by the CCSO Mental Health Bureau (MHB) and partnered with DLC. The MHB deputy will respond to the scene of a call when requested by a deputy to assist in getting the individual to treatment at DLC or the hospital. CIT training started training deputies on the LEAD program approximately 3 years ago. The CCSO MHB has also collaborated with Collier County EMS on the Follow-up program. This program involves the phone call to a person who OD a few days prior and refused transport to the hospital after a Narcan use. EMS makes the cold call to the individual and explains various different programs available in the county and if the individual requests further assistance then we will meet with the individual as a team and get him or her to treatment via LEAD or other programs. Deputies and Corrections Officers are trained in CIT on how to recommend an individual to Collier County Problem Solving Courts and often make referrals to the CCSO MHB for individuals that might be in need of assistance once released from jail. 3.7.6.3.2.8 Recovery Support Specialist and Peer Support The Peer Recovery Specialist's role is to support others in recovery from a substance use disorder. The Peer Recovery Specialist will serve as a role model, mentor, advocate and motivator to recovering individuals in order to help prevent relapse and promote long-term recovery. The Peer Specialist must demonstrate an ability to share personal recovery experiences and to develop authentic peer -to -peer relationships. Peer support is a best practice and an essential component of recovery programs for 34 adults with behavioral health disorders. The MAT Team will employ a dedicated, part- time Peer Specialist (either currently Florida -certified, or certified within one-year of hire). This peer specialist will assist with connecting participants to local peer supports, recovery community organizations (RCO's) and the recovery -oriented system of care (ROSC). David Lawrence Centers for Behavioral Health currently employs five peer specialists who are in long-term recovery from a substance use disorder and who are active participants in DLC"s ROSC committee and statewide ROSC initiatives. DLC has established Hospital Bridge partnership programs with peers embedded in local emergency departments and has also successfully established a peer relationship with the jail through the current COSSAP grant. 3.7.6.3.3 Strategies and Target Population The local Planning Council chose to focus on the adult population for the CJMHSA Reinvestment grant for several reasons. The first reason was the overrepresentation in numbers of and cost related to adults with behavioral health disorders in the local jail. The council recognizes the cycle of arrest, incarceration and release associated with substance use disorders, as individuals with SUD often return to the community without connections to treatment, resulting in frequent re -arrest. Secondly, partnerships necessary to implement programs for adults were already forged through the implementation and operation of adult mental health and drug courts. Thirdly, there has been emerging nationwide adoption of MAT into correctional settings as a best practice, and the research for the National Commission on Correctional Health Care identified potential cost -saving and life-saving benefits. Finally, Collier County recently adopted a Mental Health and Addictions Strategic plan with an initial focus on the adult system of care, and this grant will further priorities identified for adults in that plan. 3.7.6.3.3.1 Specialized responses by law enforcement Each year since 2010, the CJMHSA Planning Council, including the Collier County Sheriff's Office (CCSO), reviewed its Criminal Justice Mental Health/Substance Abuse strategic plan along with the sequential intercept map and adjusts objectives and targets accordingly. CCSO maintains its own strategic plan which includes several goals for implementation and expansion of diversion initiatives (see Strategic Plan). CCSO has fully endorsed Crisis Intervention Teams (CIT) to facilitate interagency collaboration and increased access to mental health treatment. CIT helps to ensure improved early intervention for multi -system involved individuals, promotes cross -training for justice and treatment professionals. Continuation of CIT training is the central foundation of the overall local CIT program and will continue outside of this project. CCSO is currently working on a 10-year strategic plan with groups of sub -committees to address issues as they relate to law enforcement, corrections and the community. One of the sub -committee groups is led by the Corrections Support Division Director, which is seeking ways to address substance -use disorders and mental health crises in the jail and community. CCSO is committed to increasing its Mental Health Bureau by adding 35 liaisons in each district, in the schools, and in the jail. Additionally, CCSO is committed to treating and/or referring inmates who suffer from behavioral health disorders. 3.7.6.3.3.2 Centralized Receiving Facility As part of the County's recently adopted Mental Health and Addictions Strategic Plan, the County will be building a new, $25 million Central Receiving Facility (CRF) to be located near the local community behavioral health provider (David Lawrence Centers). The facility is estimated to be completed prior to the end of this CJMHSA grant cycle and will most likely double the County's current Baker Act and Marchman Act receiving capacity. The CRF will expand access at SIM Intercept points 0 and 1, providing increased opportunities for diversion and deflection of individuals with behavioral health disorders from the criminal justice system. 3.7.6.3.3.6 and 3.7.6.3.3.9 Intensifies transition services to facilitate transition to the community and linkages to community based, evidenced based treatment programs for target populations Establishing procedures to coordinate care with community providers will help to increase clients' likelihood of engaging in treatment and long-term recovery during re- entry. The MAT Care Coordinator and Peer Specialist will establish relationships with community providers, especially given their employment with community providers, in order to assist with scheduling appointments and ensuring transitioning inmates have access to continue MAT medication and obtain necessary prescriptions. MAT Care Coordination. The MAT Care Coordination team will utilize a care coordination model. Care coordination is the deliberate organization of client care activities between two or more participants (including the client) involved in a client's care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required client care activities and is often managed by the exchange of information among participants responsible for different aspects of care. (Agency for Healthcare Research and Quality). Supported Housing. SAMHSA's Supported Housing Toolkit will direct the MAT Team efforts to provide supported housing services for program participants. Principles include: flexible, individualized recovery support services; community integration through affordable, scattered site housing; choice of housing based on individual needs and preferences; and peer supports. All MAT Care Coordination team members will be educated about this model. Supported Employment. The MAT Care Coordination team will utilize the SAMHSA evidence -based Supported Employment Toolkit to guide efforts to help participants choose, obtain, and keep competitive employment. Disability Benefits. SOAR (SSI/SSDI Outreach, Assessment and Recovery) is a best 36 practice model aimed at facilitating attainment of disability benefits for people with serious mental illnesses. MAT Care Coordination staff will be trained and receive ongoing supervision in the practice and will employ SOAR practices for all eligible participants, with the goal of assisting a minimum of 70% of participant in determining eligibility for and applying for eligible benefits. Peer Support. Peer support is a best practice and an essential component of recovery programs for adults with behavioral health disorders. A Florida Certified Peer Specialist will provide recovery support throughout clients' participation in the MAT program, including linkage to support groups. Motivational interviewing (MI). All MAT Coordination team members will be trained in motivational interviewing techniques. MI techniques help to engage and retain participants in treatment, supports self -efficacy, and uses shared decision -making to identify goals. MI is an evidence -based, client -centered style of counseling. Based on the assumption that an ambivalent attitude is an obstacle to behavior change, motivational interviewing helps clients explore and resolve ambivalence to improve their motivation to change their behavior. Key features of motivational interviewing include nonjudgmental reflective listening on the part of the counselor, with the client doing much of the work him- or herself. A concrete action plan for behavior change with measurable goals is developed, and sources of support are identified. 3.7.6.4 Performance Measures The Collier County MAT team will review progress indicators related to goals and action steps to evaluate our progress and take appropriate action. The team will develop a data monitoring and implementation plan and the data collected will be used by the Evaluator on an annual basis to review the progress associated with the project and provide an annual performance review. Some key actions steps of the team include: a. An annual evaluation will be conducted by an evaluator engaged from a local university (FGCU). b. Collier County Grant Staff will perform and compile the ongoing data for the grant metrics. c. PSCC subcommittee will review the metrics and monitor the progress and evaluate the impacts on a semiannual basis, or more often if needed. Standards. The Jail and the Community MAT Team will keep ongoing documentation of program data on a participant roster. The team will gather data and document progress for each of the performance measures listed below. 3.7.6.4.1. Process for collecting performance measure data. The Collier MAT program includes elements and interventions specifically designed to target each of the required performance measures. Both process and outcome data, in addition to the performance measures cited in the data table, will be collected and reviewed/analyzed quarterly by the grantee partners' subcommittee and at each PSCC meeting. Process and output data include but are not limited to: 37 a. Number of screenings completed. b. Referrals made to MAT Team, including source, timeframe, level of need/risk, barriers. c. Attendance at and results of meetings conducted, including grantee quarterly team meetings, PSCC meetings, and FMHI technical assistance trainings. Responsible staff. The MAT Team will collect the raw data for the performance measures for enrollees. The Collier County Grant Coordinator will be responsible for contacting discharged participants for the long-term performance measure data. CCSO jail personnel will collect and track data regarding total number of persons with mental illnesses or co-occurring substance use disorders in the jail, as well as the number of screenings and referrals made to MAT. The DLC Care Coordinator will maintain a participant roster, within which detailed data will be kept regarding each person referred and admitted to the program. This includes number of previous arrests, dates of referral(s), admission and discharge, as well as demographic information. DLC utilizes an electronic medical record for each enrolled participant which includes individual progress notes including case management, psychiatric or counseling encounters, treatment plan, and information related to any residential or acute care admissions. The Grantee Partner Committee, comprised of supervisors of direct care staff, will collectively and cross -agency review and revise each data element for accuracy and quality assurance purposes. In addition, each partner agency's own Quality Improvement (or equivalent) committee will review its own internal data for accuracy and quality. Results of the data analysis will be compiled by the Collier County Grant Coordinator and distributed to the PSCC and its subcommittee at each scheduled meeting. Upon review, Council members may suggest additions or changes to the program activities to improve performance. Data Sharing Relevant data will be readily available for monitoring and evaluation purposes. Collier County is currently collecting data and sharing data as part of the COSSAP Building Bridges Planning Initiative. Currently the data being collected and shared include metrics such as: the number of inmates seen by a psychiatrist while in custody; the number of inmates diagnosed with psychotic, mood, and anxiety disorders; the number of inmates with PTSD; and the number of inmates whose mental health disorders are co-occurring with a substance use disorder. Substance use -related data collected and shared includes new inmates who self -admit to substance use (alcohol, marijuana, cocaine, opioids, benzodiazepines, and/or stimulants/hallucinogenics). Additional data collected includes those who injected drugs within the last 14 days, those who are on methadone or buprenorphine treatment, and prior history of overdoses. 38 Medical data is currently collected and stored in electronic health records or paper charts. Data related to the person's incarceration is stored in the corrections department's records. Sharing data across corrections and health systems is often difficult, however the Collier County jail maintains a standing agreement with Armor Correctional Health Services (the jail's healthcare administrator) so data sharing processes are already in place. Data sharing for this program will include all of the MAT Team, consisting of staff members from the jail, Armor, New Season (the in -jail methadone provider), as well as the local community behavioral health service provider, David Lawrence Center. Each individual enrolled in MAT will sign a release of information for each agency to allow appropriate data sharing. Collier County is currently pursuing a data system ("data lake" or clearinghouse) to allow all data for this project and other CJMHSA projects to be shared. Collier County has also recently adopted an MHSA Strategic Plan for the County, which establishes data sharing as a key priority. This system will contain intake and discharge forms, mental health/substance use assessments, and treatment records. Additionally, the system will have the capacity to generate export raw data as well as generate progress reports for review. Collier County will select a vendor who offers a secure, HIPAA- compliant system that will allow shared access across service providers and court systems. Once purchased and implemented by Collier County, this system will be fully accessible to the MAT Team and will assist in the quantitative evaluation of the program through cohesive record --keeping and participant tracking across systems and providers. The data system will track all clients served in the jail, including those not on MAT but who are part of the larger target population and will also track data following release. The warehouse also includes a treatment court component for long-term outcome tracking. It is the intent for all stakeholders to work together to determine what types of additional data and measures are relevant. All stakeholders will be involved in the initial planning endeavors to ensure that a clear request is presented to them, detailing exactly what data is needed and toward what purposes. It may be necessary for some datasets to be extracted and analyzed by the individual stakeholders in order to maintain compliance with privacy laws. Aggregate, blinded data can often be shared about groups rather than individuals. Where identifiers are used to track individuals across systems, agreements will be essential to enabling the sharing and integration of data. The types of agreements will vary depending on the data sources, the intended use of the data, and the roles of the agencies using the data. Findings from these analyses will be shared in a collaborative manner, so that all agencies involved may benefit from the information shared and collectively strategize to make systemic improvements. All results will be shared on a regular basis with the PSCC, no less than once per year. Collier County will collect a set of data elements for every incarcerated individual who participates in the MAT program, using the Jail Management System (WINGS). Reports for each participant are created, using WINGS, to include type of medication, length of 39 stay, history of overdoses and community referrals/appointments made. Collier County will utilize this existing jail database to track individuals served by the grant. Collier County will collect the participant data on a monthly basis from the subrecipients to evaluate performance related to participants served during the project and one-year post discharge. The County currently utilizes data searching system, LexisNexis, to assist with locating persons. 3.7.6.4.2 Proposed targets and methodologies to address the measures specified in Section 2.4.2 Section Performance Measure Data Source Outcome 2.4.2.1.1 Arrests or re -arrests while Collier County Arrest 40% receiving services Database 2.4.2.1.2 Assisted in applying for social Initial participant intake 60% security or other benefits for screening which they may be eligible but were not receiving benefits at their pro ram start date 2.4.2.1.3 Diverted from a State Mental Initial participant intake 50% Health Treatment Facility screening 2.4.2.1.4 Successfully complete program Community Based Services 55% services Records 2.4.2.2.1 Arrested or rearrested within six Collier County Arrest 30% months following their ending Database date for program services Tab/e 5. List of performance measures and methodology The program performance measures will be collected and evaluated using various data sources and methodologies. Data sources will include: the initial screening for program eligibility which occurs when participants are booked into the jail, CCSO staff access to arrest records through the Collier County Arrest Database, and community -based service records monitored by David Lawrence Centers MAT Care Coordinator. The initial intake screening is necessary to gather information related to eligibility for benefits as well to identify participants who qualify for a State Mental Health Treatment Facility and can be diverted from those facilities. Arrest records and community -based service records will be utilized to capture measures relating to recidivism and successful completion of and discharge from the program. The following methodologies will be utilized to quantify these measures: • 2.4.2.1.1: The total number of arrests among released participants while enrolled in the program, divided by the total number of arrests among participants one year prior to program admission shall be less than or equal to 40%. • 2.4.2.1.2: The total number of program participants who were eligible for, but not receiving, social security or other benefits at program admission who are 40 assisted with being screened for and/or applying for benefits within 180 days of admission, divided by the total number of program participants who were eligible for, but not receiving benefits at program admission shall be greater than or equal to 60%. • 2.4.2.1.3: The total number of individuals enrolled in the program who are diverted from a State Mental Health Treatment Facility divided by the total number of individuals screened for program eligibility who meet the criteria for a State Mental Health Treatment Facility shall be greater than or equal to 50%. • 2.4.2.1.4: The total number of individuals enrolled in the program who are successfully discharged divided by the total number of individuals who are enrolled in the program shall be greater than or equal to 55%. • 2.4.2.2.1: The total number of arrests among participants within six months after their program end date divided by the total number of arrests among participants one year prior to program admission shall be greater than or equal to 30%. 3.7.6.4.3 Additional proposed performance measure Percent of participants receiving in -jail MAT Participant Report 65% who attend community MAT appointment within 5 business days of release Proposed Methodology: The total number of participants receiving in -jail MAT who attend a community -based MAT appointment within 5 business days of release divided by the total number of participants receiving in -jail MAT who are released with a referral for community -based MAT appointment shall be greater than or equal to 50%. The proposed performance measure will concisely assess program performance in an area that is not comprehensively addressed by the performance measures listed under section 3.7.6.4.2. While the measures listed in Section 3.7.6.4.2 are necessary for gaining an overall assessment for the program, these measures do not address the core method of our proposed programming. The proposed measure will quantify the percent of MAT participants who choose to participate in community -based MAT upon release. This measure is essential in order to identify the percent of the target population who are linking with MAT during their reintegration into the community. The measurement of MAT services continued after release is crucial to gain comprehensive empirical basis for the success of the program. 3.7.6.5 Capability and Experience 3.7.6.5.1 Capability and Experience of Applicant and Other Participating Organizations Collier County Community and Human Services (CHS) The Collier County Board of County Commissioners (BoCC) will act as the applicant, primary grantee, and fiscal agent for the collaborative project. CHS, a department of the BoCC, is an experienced grantee for the criminal justice and behavioral health programs. The CCHS is a past 41 recipient of the Bureau of Justice Assistance Drug Court Enhancement grant 2017-2020 and current recipient of the same grant for 2020-2023. CCHS has been a grantee for the Florida Department of Children & Families' Criminal Justice Mental Health & Substance Abuse Reintegration grant since 2010. The County Community and Human Services (CHS) office will: 1) Provide continued oversight of the CJMHSA Grant Program of the CJMHSA Grant Program; 2) continue to convene the partners for regular collaboration meetings; 3) collect and compile data from partner agencies as required by the grant; 4) submit required programmatic and financial reports to DCF. The coordinator will ensure compliance with the statutory and mandatory requirements of the grant program requirements and serve as the primary point of contact with DCF. CHS will also establish the agreements with all participating entities outlining their scope of work, program parameters and initiatives. CHS will also be responsible for data collection and reporting post close-out for one year. The CHS coordinator will coordinate with the area managing entity; Central Florida Behavioral Health Network, as needed. Collier County Sheriff's Office (CCSO) The Collier County Sheriff's Office has been providing Crisis Intervention Team training for the past twelve years, offering a minimum of four trainings per year. This is offered not only for CCSO staff, but also includes other local jurisdictions including Naples and Marco Island Police Departments; Hendry and Highlands County Sheriff's Offices; and non-LEO participants such as mental health and criminal justice staff such as Public Defenders, Judges and State Attorney's office representatives. The Collier County Jail contracts its medical services, to include general health and behavioral health services, with Armor Correctional Health. David Lawrence Centers for Behavioral Health (DLC) DLC provides comprehensive mental health and substance use treatment services for all of Collier County, including inpatient, outpatient, residential and community based -prevention and treatment services. Evidence -based programs include (but are not limited to): trauma specific - services, supported housing, Collier's Florida Assertive Community Treatment Team, MAT and other addiction treatment services. DLC's organization follows trauma - informed care principles. Forensic services department includes Drug Court, Mental Health Court, Veterans Court, case management, community -based competency restoration and the jail -based Project Recovery substance use treatment program. David Lawrence Centers also helps staff the CIT training courses. The MAT Team Care Coordinator will assist with SOAR application processes when indicated and will ensure linkage to primary care and medical follow-up for each participant. All of the DLC programs are available to participants who, in case of any wait lists, will have priority. DLC will bill Medicaid, Medicare, and the state contract for community -based treatment costs for individuals when possible. The intensive case management model includes "enhancement funds" which help pay for items that are necessary to facilitate community integration, including housing, transportation and medications. Founded in 1968, David Lawrence Centers for Behavioral Health is accredited by The Joint Commission (TJC) and has decades of experience administering millions of dollars in annual federal, state, and local government grants and contracts. The Centers 42 maintain an exemplary record of meeting or exceeding expectations of each of its grantor and contractor organizations. David Lawrence Centers' centralized Access Center provides assessments and crisis support on a walk-in basis, 24 hours a day 7 days a week. DLC is the sole Baker Act receiving facility in Collier County. Evaluator: The project evaluator, through partnership Florida Gulf Coast University (FGCU), will conduct a yearly evaluation of the project and provide a summary report of the success, failure and areas for project refinement each year. The Evaluator will also assist the team to update the strategic plan and intercept map as needed, and work collaboratively with the team members, the PSCC, and other local resources who serve the population. 3.7.6.5.2 Availability of Resources Local Resources for the Target Population. There are several features of the current systems for adults in Collier County that are particularly noteworthy. These include but are not limited to: ➢ Mental Health Court, Veteran's Treatment Court and Adult Drug Court ➢ Judicial leadership ➢ Integrated, co-occurring capable and specific provider (David Lawrence Centers) ➢ Collaborative interagency pursuit of multiple grants: BJA, DCF, SAMHSA ➢ In -jail substance use treatment services: Project Recovery ➢ SOAR (SSI/SSD Outreach, Advocacy, and Recovery) ➢ Supported Employment and Supported Housing via DLC, FACT, St. Matthew's House ➢ Support from broad community — Homeless services/shelters ➢ Florida Assertive Community Treatment (FACT) Team ➢ The Willough of Naples -- treatment for co-occurring disorders ➢ PATH (Projects for Assistance in Transition to Homelessness) program at CASL ➢ HUD Housing operated by David Lawrence Center, CASL, St. Matthew's House and NAMI Reintegration and Discharge Planning staff within the jail will serve as the primary source of referral for inmates being released into the community. The Collier County jails and David Lawrence Centers both have an established working relationship with community -based agencies and programs. The participants of this program will be connected and referred to various other agencies and programs as listed above, on a case -by -case basis. 3.7.6.5.3 Role of advocates, peer specialists, family members, and responsible partners MAT staff members will participate in community awareness meetings, including the Collier County Drug Response Team, to provide opportunities for education, outreach and support related to opioid overdose prevention and access to evidence -based 43 treatment services. Because naloxone cannot be self-administered, initiatives will include training family members and friends of individuals who are incarcerated and have OUD. As best practices provide a foundational model of client/family/referral transition, it is imperative that families are incorporated into this safety training for release. MAT will assist advocates, family members and community members in obtaining access to naloxone and safety information. The MAT Team formally includes a peer specialist. This peer specialist is part of the community -based portion of the grant and will be accessible to the participants during the crucial stage of transitioning back into the community. Trained peer specialists will provide additional support and guidance to inmates, from the perspective of shared experience, during the particularly challenging phase of community reintegration. The lived experience of individuals in recovery, as well as that of their families, is an essential element of successful programs for individuals with substance use disorders. 3.7.6.5.4 Proposed staff Agency Position (Level Effort) Activities Collier County Grant Coordinator (0.20) Grant Oversight and Government/C Accountant (.15) Project Director ommunity and Operations Analyst (.10) Grant Accounting Human Yearly Project Services Evaluation Collier County Discharge Planner (1.0) Jail -Based Sheriff's Office/ Advanced Registered Nurse Practitioner (.5) screening ARMOR Registered Nurse (.5) Grant Coordination (Subcontractor) Director of Nursing (.25) Health Services Administrator (.25) Senior Grants Coordinator (.15) Grants Fiscal Clerk (.15) Reintegration Manager (.35) Reintegration Program Supervisor (.5) Corrections Support Division Director (.5) Jail Administration Clerk (.25) Jail Crime Analyst (.25) New Season Personnel- Methadone Clinic provider ( MOU) David Care Coordinator (1.0) Provides linkage Lawrence Peer Specialist (.50) and referral, case Centers Program Director(. 10) management, and (Subcontractor) Case Manager Supervisor (.25) other supportive Program Support Specialist (.20) services Practice Manager (.15) 44 Nursing Coordinator (.25) Peer support and QI/Compliance/Data Manager (.10) recovery coaching Accounting Specialist (.25) Accounting Supervisor (.10) Clinical oversight 3.7.6.6 Evaluation and Sustainability 3.7.6.6.1 Evaluation The Collier County evaluation will determine if a program is achieving its intended goals by assessing the program's key outcomes and impact over time. Our evaluator will assess whether the program activities led to the intended improvements. The County grant team will also provide monitoring regularly, and program evaluations will be conducted quarterly through reporting. At designated times after program implementation, a complete program evaluation report will be prepared annually. Collier County recognizes that it is important to collect baseline data at the beginning of the program so the impact of the program can be observed over time. The internal collaborative evaluation will include a process evaluation to examine the extent to which the project was implemented according to the proposed elements including implementation timeframes, agency involvement, and staffing/qualifications. The outcome evaluation will examine the extent to which the goals and objectives and performance measures were met, including the extent to which recovery -oriented behavioral health services, such as supported housing and peer supports, have increased through the MAT Team. The process and outcome evaluations will each use qualitative data such as participant and partner feedback, along with the qualitative objective and performance measure data. In addition to measuring performance, evaluation of the partners' collaboration is a key prerequisite for the sustainability of interagency programs, particularly those programs initially created with the support of time -limited grant -funding sources. However, assessing collaboration among grant partners is often difficult. It is also challenging to present collaboration data to stakeholders in a way that is meaningful. It is the intent of the project to utilize the Levels of Collaboration Scale. Ongoing progress reports and annual fiscal reports will be completed by the contracted agencies and submitted to DCF by the CCHS Grant Coordinator. Our annual program evaluation will be a comprehensive document that identifies the program's goals, objectives and activities; the key metrics that will be assessed; the sources of data to be collected; the types of analyses that will be conducted; and the timing of data collection and analyses. Identifying key metrics include: 1. Screening incarcerated individuals for OUD and assessing those who report a history of use 2. Offering MAT treatment to incarcerated individuals with OUD currently on MAT 45 3. Retaining incarcerated individuals in MAT treatment 4. Referring individuals to a community MAT provider upon release. The FGCU evaluation team will evaluate and review the needs of both clients and providers in order to focus and refine development, and implementation opportunities. This requires an understanding of the complexities of the context of client and care coordination, potential barriers and facilitators to participation, and the feasibility and practicality of providing and attending programs. The implementation -focused analysis will be conducted to identify any gaps between the implementation plan and the execution of that understanding the nature and implications of barriers, identifying barriers, identifying new components or refining the original strategy to optimize the potential for success. Data sources will include semi - structured feedback, structured surveys, focus groups, direct observations, document reviews, and management information systems. A progress -focused analysis will be used to monitor progress of program goals and objectives on an ongoing basis. Interpretive data will be collected before and during new strategies implementation, and will be used to generate hypotheses about why the strategies did or did not work and utility and value, barriers to and facilitators of implementation success, and any recommendations for refinements to the implementation strategy, regardless of the strategy's ultimate success. Confirmative evaluation, a new paradigm for continuous improvement, will be implemented as a logical next step to formative and summative evaluation of new training. FGCU performance evaluators will employ methods to provide continuous quality control over the life cycle of the training, building on the findings and recommendations generated during formative and summative evaluation, in an effort to confirm the continuing worth of training and facilitating continuous performance improvement efforts. 3.7.6.6.2 Additional Evaluation Requirements Cost Savings/Averted Costs According to the Jail -Based MAT: Promising Practices, Guidelines and Resources from the National Commission on Correctional Health Care "comprehensive drug treatment programs in jails are associated with reduced system costs." The Collier County MAT Program will be able to reduce the number of inmates in withdrawal protocol, as well as the number of sick calls (medical visits) due to withdrawal symptoms. The program is expected to reduce recidivism for inmates on MAT at their release and will increase connections for inmates interested in starting MAT once released. Research has shown that a medically managed withdrawal program is easing the strain on deputies by more quickly transitioning inmates into the general population, with more positive outcomes. Jail health administrators in Snohomish County, Washington, reported to local media, "They started their medication yesterday and within a couple hours were night and day difference. They went from 46 vomiting, nausea, diarrhea, body aches to feeling well, eating, drinking, and wanting to shower." 3.7.6.6.2.1 Reduced Expenditures with incarceration of Target Population Given the average daily cost of $159 per inmate (not with a serious mental illness) (See Table 3) per day and using a conservative average length of stay of 32 days, the cost is $5,088 per inmate/per day. More than two thirds (68%) of persons released from prison will be rearrested within the first three years of release (https://nin.omp.gov/topics/articles/measuring-recidivism). Comprehensive drug treatment programs in jails are associated with reduced system costs. Research has begun to show that adding MAT to the treatment of those involved in the criminal justice system reduces recidivism by as much as 35% in certain settings. According to the 2018 Substance Abuse and Mental Health Services Administration (SAMHSA) Medications for Opioid Use Disorders, data indicate that medications for OUD are cost effective and cost beneficial." (https://www.sheriffs.org/publications/Jail- Based-MAT-PPG.pdf). Data collected by the Collier County Jail during the last seven (7) months, indicates that there will be approximately twenty-four (24) inmates on MAT per month. The cost of maintaining them in jail, minus the cost of MAT medication, for 32 days at $159/day comes to $122,112. Using a conservative recidivism rate of 20%, there would be a cost reduction of $76,320 per month or $915,840 per year or $2,747,520 for a 3-year period. It's important to note that the true benefits of MAT in jails is not measured in dollars saved, but in lives saved. Defendants who are arrested while on MAT in the community, are currently forced into detox. The majority of inmates detox without any medication. Many inmates, once released, will return to illicit drug use. Unfortunately, this often leads to potentially fatal overdoses. MAT in jails can help reduce overdoses in Collier County. Every $500 invested in medication treatments is likely to save 1 year of life https://www.recoverVanswers.org/research-post/medications-work-for- criminal-justice-populations-but-at-what-cost/ . 3.7.6.6.2.2. The proposed methodology to measure the defined outcomes and corresponding savings or averted costs In order to comprehensively measure the effectiveness of the Collier County MAT Program in averting costs, overall recidivism rates must be measured and compared between two groups: inmates with substance use and co-occurring disorders who receive MAT services through the program, and inmates who are identified as having substance use and co-occurring disorders but who do not participate in the MAT program. This data will be collected annually, culminating in one final evaluation of the cost-effectiveness covering the lifetime of the grant. After measuring the reduction in 47 recidivism among MAT participants, as compared to non -MAT participants, a cost analysis will be conducted, providing the final number of costs averted. Proposed Methodology: The average rate of recidivism among program participants divided by the average rate of recidivism among inmates identified as having substance use disorders who do not participate in the program. This methodology will produce the average percentage by which recidivism is reduced by the MAT program. The average rate of recidivism reduced multiplied by the average cost per day of incarceration will result in the costs averted. 3.7.6.6.2.3 Reduced use of State treatment facilities Crisis Intervention Team (CIT) training reduces arrests. According to the CCSO CIT Coordinator, CIT training has contributed to an increase in CCSO-initiated Baker Acts (involuntary mental health commitments) from 2008 to 2015 (n=502 - 1226). This represents a significant improvement diverting individuals from law enforcement to the mental health system. In addition, individuals are less likely to have legal charges that may have led to forensic commitments. Many previous forensic hospital admissions were for those persons found Incompetent to Proceed with legal processes after a felony arrest. The state forensic institution was the only place for them to receive competency restoration, which is now available in the community. As a result, the persons admitted to the forensic institution recently were those few who were deemed not capable of being safely housed in the community. 3.7.6.6.3 Sustainability The Collier County PSCC will continue to use the Sequential Intercept Model as a conceptual framework to organize targeted strategies for justice -involved individuals with serious mental illness and substance use disorders. If grant funding runs out, the MAT Team may go before the PSCC to request further funding from the County to continue to provide MAT in the jail for those that were arrested while on MAT. The Collier County Jail is also willing to go before the BCC to request additional budget funds for this medical treatment. The PSCC CJMHSA subcommittee will facilitate improved coordination of the current criminal justice, mental health and substance abuse programs and provide direction for future development and sustainability. The Collier County PSCC Strategic Plan will be revised to include an in-depth three-year funding and sustainability plan for all current and proposed local diversion programs by the end of year two of the grant. The use of evidence -based practices and an evaluation demonstrating evidence of effectiveness will each impart marketability of the program to future funders and secure support from stakeholders. Currently the project has a diversity of funding streams including support through a Centers for Disease Control and Bureau of Justice COSSAP award. The Collier County team will continue to pursue other grant opportunities, such as: DOJ Justice and Mental Health Collaborative, DOJ Improving Re-entry for Adults with Co- 48 occurring Substance Abuse and Mental Illness, Residential Substance Abuse Treatment, BJA COSSAP, to name a few. The project evaluation will include an analysis of the progress toward sustainability, including effectiveness of strategies to enhance or expand the local behavioral health service system. The current Collier County MHSA strategic plan adopted by the Board of County Commissioners in 2019 will also provide direction and guidance in the plan for sustainability. The investment in the project as a diversion and cost -saving measure for jail costs will ultimately impact future sustainability. 49 Tab 7 7.7 Project Timeline YEAR 1 YEAR 2 YEAR 3 KEY TASKS, RESPONSIBILITIES Q Q Q Q Q Q Q Q Q Q MILESTONES 1 2 3 4 1 2 Q3 4 1 2 3 Q4 Project Person (s) Milestones/Tasks Responsible Hire and Orient CHS/DLC/CCS New Staff O/ARMOR X DLC/CCSO/ MAT services ARMOR X X X IX IX X X X X X X Weekly MAT MAT Team meetings Members X ix X X X X X ix X X X X Consultation and MAT Team Training Members X X X X X X Data Collection Collier County Plan Completed CHS X Data Collier County Collection/Analyzed CHS X X X X X X X X X X X X Review/Revise CHS/DLC/CCS Strategic Plan O/ARMOR X X X In jail Screening ARMOR X X X X X X X X X X X X Meet target # DLC/ARMOR/ individuals served CCSO X x x Quarterly Program Collier County Status Report CHS X X X X Quarterly Financial Collier Report County CHS X X X X Final Program Collier Status Report County CHS X Final Financial Collier Report County CHS X Project Evaluation FGCU Completed Evaluator X X X 50 3.7.8 Tab 8 Letters of Commitment List of Organizations Collier County Government Collier County Sheriff's Office David Lawrence Centers for Behavioral Health Armor Correctional Health HIDTA Florida Gulf Coast University 51 Board of Collier County Commissioners Rick LoCastro Andy Solis, Esq. Burt L. Saunders Penny Taylor William L. McDaniel, Jr. District 1 District 2 District 3 District 4 District 5 February 17, 2021 Ms. Michele Staffieri Procurement Manager Department of Children & Families 1317 Winewood Blvd., Building 6, Room 231 Tallahassee, FL 32399-0700 Dear Ms. Staffieri: Collier County is applying for a three-year expansion for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant. The Collier County Sheriff's Office is committed to continuing medication assisted treatment (MAT) for inmates who suffer from a substance -use disorder and are admitted into the Collier County Jail. When provided as part of a rehabilitation, treatment and reentry process, MAT has been shown to contribute to long-term recovery and the reduction of recidivism. Treatment, recovery and reintegration is a collaborative effort with Armor Health Services for two contracted Discharge Planners, an Advanced Registered Nurse Practitioner and a Licensed Practical Nurse, jail staff, and community partners. Inmates admitted into the Collier County Jail, who are already on MAT, will be screened for continuation of treatment. They will have access to medicated treatment and a short-term substance abuse treatment program, Project Recovery. Discharge planning includes assisting inmates with an array of individualized community services and supports to provide optimal reintegration into the community. 3299 Tamiami Trail East, Suite 303 • Naples, Florida 34112-5746.239-252-8097 • FAX 239-252-3602 The Collier County Sheriff's Office will participate in the CJMHSA Public Safety Coordinating Council meetings, strategic planning, and grant evaluation activities, and provide any required data collection, and grant reporting. The Collier County Commission supports the Collier County Sheriff's Office efforts for the opportunity to continue to provide these necessary treatment, recovery and reintegration services to inmates, while incarcerated and as they transition back into the community. A three-year expansion of the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant will greatly assist with these efforts. Yours very truly, Penny Taylor Board of Collier County Commissioners, Chair District 4 Commissioner February 23, 2021 Ms. Michelle Staffieri Procurement Manager Department of Children & Families 1317 Winewood Blvd., Building 6, Room 231 Tallahassee, FI 32399-0700 Dear Ms. Staffieri: Collier County is applying for a three-year expansion for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant. The Collier County Sheriff's Office is committed to continuing medication -assisted treatment (MAT) for inmates who suffer from a substance -use disorder and are admitted into the Collier County Jail. When provided as part of a rehabilitation, treatment and reentry process, MAT has been shown to contribute to long-term recovery and the reduction of recidivism. Treatment, recovery and reintegration is a collaborative effort with ARMOR Health Services for contracted Discharge Planners, an Advanced Registered Nurse Practitioner and a Licensed Practical Nurse, jail staff, and community partners. Inmates admitted into the Collier County Jail, who are already on MAT, will be screened for continuation of treatment. They will have access to medicated treatment and a short-term substance abuse treatment program, Project Recovery. Discharge planning includes assisting inmates with an array of individualized community services and supports to provide optimal reintegration into the community. The Collier County Sheriff's Office will participate in the CJMHSA Public Safety Coordinating Council meetings, strategic planning, and grant evaluation activities, and provide any required data collection, and grant reporting. The Collier County Sheriff's Office hopes to have the opportunity to continue to provide these necessary treatment, recovery and reintegration services to inmates, while incarcerated and as they transition back into the community. A three-year expansion of the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant will greatly assist with these efforts. Sincerely, K J. ambosk S eriff, Collier County DUM2'4&CENTERS FOR BEHAVIORAL HEALTH'" February 16, 2021 Ms. Michelle Staffieri Procurement Manger Department of Children & Families 1317 Winewood Blvd., Building 6, Room 231 Tallahassee, FL 32399-0700 Dear Ms. Staffieri, As you know, Collier County is applying for a three-year expansion for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant. As a strong community partner, the David Lawrence Centers (DLC) is committed to continuing to work in cooperation with the County and the Sheriff's Department in ensuring that medication -assisted treatment (MAT) is provided for inmates who suffer from substance use disorders and are admitted into the Collier County Jail. When provided as part of a rehabilitation, treatment and re-entry process, MAT has been shown to contribute to long-term recovery and the reduction of recidivism. Indeed, treatment, recovery and reintegration are collaborative efforts involving numerous professional and community partners. Inmates admitted into the Collier County Jail who are already on MAT will be screened for continuation of treatment. They will have access to FDA -approved medications for treatment of substance use disorders. Discharge planning includes assisting inmates with an array of individualized community services and supports to provide optimal reintegration into the community. This includes the delivery of medication -assisted treatment through DLC's Outpatient Medical Services. DLC has and will continue to participate in the CJMHSA Public Safety Coordinating Council meetings, strategic planning, and grant evaluation activities, and provide any required data collection, and grant reporting. It is important that the Collier County Sheriffs Office continues to have the opportunity to provide the necessary treatment, recovery and reintegration services to inmates while incarcerated as they transition back into the community. A three-year expansion of the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant will greatly assist with these efforts. As the leading provider of behavioral health solutions in Collier County, DLC looks forward to our continued partnership with Collier County to ensure the delivery of these important services. Sincerely,, Scott Burgessr President/CEO �f DAVID LAWRENCE CENTERS FOR BEHAVIORAL HEALTH MAIN CAMPUS 1 (239) 455-8500 1 6075 BATHEY LANE I NAPLES, FL 34116 . WWW.DLCENTERS.ORG T Armor February 17, 2021 Sheriff Kevin Rambosk Collier County Sheriff's Office 3319 E. Tamiami Trail Naples, FL 34112 Subject: Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant Program Dear Sheriff Rambosk, Armor Correctional Health Services is committed to providing evidence based care for our patients. The population we serve includes many who have limited access to medical and mental health services in the community, and one that also suffers with significant co -morbidities, including drug and alcohol addiction. We have seen firsthand the impact of the opioid crisis on the incarcerated population and have been advised of your interest in obtaining grant funding through the Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant Program. Collier County has been one of the most highly affected counties in Florida, a state that is one of the most severely impacted by the opioid epidemic. The work of bringing together key stakeholders to address the need to implement medication -assisted treatment in the Jail and to bridge those services is critical. With the support from the Collier County Sheriff, the State of Florida and the Department of Justice, the Collier County Jail working together with the treatment community, are in a pivotal position to create a well -designed plan. Armor will fully engage in this effort to support our citizens while incarcerated and when they return to the community from incarceration in receiving the services and support they require to re-engage as productive members of our community. We look forward to working with the designated training and technical assistance providers to develop a comprehensive continuum of care model that both targets the Collier County Jail population and builds bridges between in -custody and community -based treatment. Sincerely, Steve, EPP-L& Regional Vice President Florida Armor Correctional Health Services, Inc. s JOCTH FLOR�4� EXECUTIVE OFFICE OF THE DIRECTOR SOUTH FLORIDA HIGH INTENSITY DRUG TRAFFICKING AREA Weston, FL 33331 February 17, 2021 Collier County Sheriffs Office 3319 Tamiami Trail E. Naples, FL 34112 Attention: Sheriff Kevin Rambosk Dear Sheriff Rambosk, I am writing this letter in support of the Collier County Sheriffs Office application applying for a three- year grant extension titled Criminal Justice Mental Health and Substance Abuse Reinvestment Grant (CJMHSA). The South Florida HIDTA is committed to support the Collier County Sheriff s Office if they receive the grant funding extension or anything that may be needed by the Collier County Sheriffs Office. The Collier Sheriffs Office have been involved with the South Florida HIDTA for several years, assisting when called upon to do so. They have been a recognized HIDTA County for the past four years. They were the first county in the State of Florida to implement the ODMAP Program and have been utilizing the program for the past several years. They also have been instrumental in working with other public safety entities in expanding the utilization of the ODMAP Program and enrolling them into the Program. The CJMHSA grant extension affords the Collier County Sheriffs Office the opportunity to continue its tradition of providing quality Medical Assisted Treatment (MAT) to the inmates of the Collier County Jail. I applaud you and the Sheriffs Office aggressive involvement in the community and your participation in several community based programs to address the opioid addiction issues in Collier County. In closing, I want thank you and the members of the Collier County Sheriffs Office for all you do in combatting opioid abuse and protecting the community in Collier County and our nation. '-T � r�� Hugo Barrera Executive Director South Florida HIDTA 0ftdRIDA GULF COAST UNIVERSITY THE WATER SCHOOL Ms. Michelle Staffieri Procurement Manger Department of Children & Families 1317 Winewood Blvd., Building 6, Room 231 Tallahassee, FL 32399-0700 Dear Ms. Staffieri, College of Arts and Sciences March 1, 2021 As you know, Collier County is applying for a three-year expansion for the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant. As a strong community partner, Florida Gulf Coast University (FGCU) is committed to work in cooperation with the County and the Sheriff's Department as the evaluator for the program which will ensure that medication assisted treatment (MAT) is provided for inmates who suffer from a substance use disorder and are admitted into the Collier County Jail. When provided as part of a rehabilitation, treatment and re-entry process, MAT has been shown to contribute to long-term recovery and the reduction of recidivism. FGCU has long partnered in many educational and training initiatives with Collier County's premier behavioral health provider, David Lawrence Centers, and FGCU has educated many of the current professionals employed in the Southwest Florida behavioral health industry. FGCU currently acts as the evaluator for Collier County's current three-year federal grant awarded by the Department of Justice to the County's Drug Court Program. FGCU leadership looks forward to participating in the CJMHSA strategic planning process and completing grant evaluation requirements and protocols. In the midst of the current "twindemic" of COVID-19 and opioid use disorder, it is important than ever that the Collier County Sheriff's Office continues to have the opportunity to provide the necessary life-saving treatment, recovery and reintegration services to inmates while incarcerated as they transition back into the community. A three-year expansion of the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant will greatly assist with these efforts and we whole-heartedly support this effort. Sincerely, S. Gregory Tolley, Ph.D. Professor of Marine Science Executive Director, The Water School Florida Gulf Coast University (239) 590-1878 * (800) 590-FGCU (3428) 10501 FGCU BOULEVARD SOUTH * FORT MYERS, FLORIDA 33965.6565 AN AFFIRMATIVE ACTION EQUAL OPPORTUNITY EMPLOYER * A MEMBER OF THE STATE UNIVERSITY SYSTEM OF FLORIDA 3.7.9 Tab 9 Budget and Budget Narrative 59 3 Year Totals Per Organization CCSO excess Total Project Match Over / Grant Cash Match Match Adjustment (Short) CHS $ 93,253.40 $ 10,863.11 $ 82,390.29 $ 186,506.80 $ (82,390.29) DLC: $ 261,466.60 $ 259,738.00 $ 1,728.60 $ 522,933.20 $ (1,728.60) CCSO: $ 845,280.00 $ 929,398.89 $ (84,118.89) $ 1,690,560.00 $ 84,118.89 $ 1,200,000.00 $ 1,200,000.00 $ - $ 2,400,000.00 $ - Total Grant Funded: $ 1,200,000.00 Total Match (Cash + In -Kind): $ 1,200,000.00 Match Over/(Short): $ CCSO excess match $ 84,119.00 To CHS $ 82,390.00 To DLC $ 1,729.00 Collier County Criminal Justice, Mental Health Substance Abuse Reinvestment Act Grant Budget Narrative Year One CHS Grant Cash Match In Kind Match Total Salaries: FTE Annual Salary Salary 1 Grants Coordinator (20% FTE @$54,733 annual salary) 20.0% 54,733 10,946.60 $ 5,473.78 $ 4,105.34 $ $ 9,579.12 2 Lead Accountant ( 15% FTE @ $49,692 annual salary) 15.0% 49,692 7,453.80 $ 3,727.30 $ 2,795.48 $ $ 6,522.78 3 Operations Analyst (10% FTE @ 52,124 annual salary) 10.0% 52,124 5,212.40 $ 2,606.20 $ 2,345.58 $ $ 4,951.78 Year One Salaries Subtotal: $ 11,807.28 $ 9,246.40 $ $ 21,053.68 FICA Retirement Fringe Benefits: 7.65% 10.50% Fringe 1 Grants Coordinator (FICA @ 7.65%, Retirement @ 10.5%) 837.41 1,149.39 1,986.80 $ 993.40 $ 745.05 $ $ 1,738.45 2 Lead Accountant (FICA @ 7.65%, Retirement @ 10.5%) 570.22 782.65 1,352.87 $ 676.44 $ 507.33 $ $ 1,183.77 3 Operations Analyst(FICA @ 7.65%, Retirement @ 10.5%) 398.75 547.30 946.05 $ 473.03 $ 364.33 $ $ 837.36 Year One Fringe Subtotal: $ 2,142.87 $ 1,616.71 $ $ 3,759.58 Equipment: Equipment: 1 1 Laptop computer $ 1,400.00 $ 700.00 $ $ 700.00 2 1 Docking station $ 150.00 $ 75.00 $ $ 75.00 3 2 monitors $ 400.00 $ 200.00 $ $ 200.00 Year One Equipment Subtotal: $ 975.00 $ $ $ 975.00 Other Expenses Other Expenses 1 Offices Supplies $ 100.00 $ 50.00 $ $ 50.00 2 Postage $ 100.00 $ 50.00 $ $ 50.00 3 Training and Travel $ - $ - $ $ $ - 4 Contractual Key Staffing $ 33,000.00 $ 16,500.00 $ $ 16,500.00 Year One Other Expenses Subtotal: $ 16,600.00 $ $ $ 16,600.00 Year One Subtotal CHS: $ 31,525.15 $ 10,863.11 $ $ 42,388.26 vid Lawrence Center Salaries FTE Annual Salary 1 Care Coordinator (100% FTE @ $39,000 Annual Salary) 100% 39,000.00 $ 29,250.00 $ - $ $ 29,250.00 2 Peer Specialist (50% FTE @ $33,000 Annual Salary) 50% 32,000.00 $ 11,997.00 $ - $ $ 11,997.00 3 Program Director (10% FTE @ $75,000 Annual Salary) 10% 75,000.00 $ - $ 7,500.00 $ $ 7,500.00 4 Case Manager Supervisor (25% FTE @ $47,000 Annual Salary) 25% 47,000.00 $ $ 11,750.00 $ $ 11,750.00 5 Program Support Specialist (20% FTE @ $35,000 Annual Salary 631.125 20°/u 35,000.00 $ $ 7,000.00 $ $ 7,000.00 6 Practice Manager (15% FTE @ $50,000 Annual Salary) 15% 50,000.00 $ $ 7,500.00 $ $ 7,500.00 7 Nursing Coordinator (25% FTE @ $60,000 Annual Salary) 25% 60,000.00 $ $ 15,000.00 $ $ 15,000.00 8 QI/Compliance/Data Manager (10% FTE @ $70,000 Annual Salary) 10% 70,000.00 $ 7,000.00 $ 7,000.00 9 Accounting Specialist (25% FTE @ $45,000 Annual Salary) 25% 52,000.00 $ $ 13,000.00 $ $ 13,000.00 10 Accounting Supervisor (10% FTE @$60,000 Annual Salary) 10% 65,000.00 $ $ 6,500.00 $ $ 6,500.00 Year One Salaries Subtotal: $ 41,247.00 $ 75,250.00 $ $ 116,497.00 FICA Fringe: 7.65% FTE Annual Salary 1 Care Coordinator (FICA @ 7.65%) 994.50 2,237.63 1009/6 39,000.00 $ - $ 2,235.53 $ $ 2,235.53 2 Peer Specialist (FICA @ 7.65%) 408.00 917.77 50% 32,000.00 $ $ 917.77 $ $ 917.77 3 Program Director (FICA @ 7.65%) 573.75 573.75 100/. 75,000.00 $ $ 573.75 $ $ 573.75 4 Case Manager Supervisor (FICA @ 7.65%) 898.88 898.88 25% 47,000.00 $ $ 898.88 $ $ 898.88 5 Program Support Specialist (FICA @ 7.65%) 535.50 535.50 20% 35,000.00 $ $ 535.50 $ $ 535.50 6 Practice Manager (FICA @ 7.65%) 573.75 573.75 15% 50,000.00 $ $ 573.75 $ $ 573.75 7 Nursing Coordinator (FICA @ 7.65%) 1,147.50 1,147.50 25% 60,000.00 $ $ 1,147.50 $ $ 1,147.50 8 QI/Compliance/Data Manager (FICA @ 7.65%; 535.50 535.50 100/. 70,000.00 $ $ 535.50 $ 535.50 9 Accounting Specialist (FICA @ 7.65%) 994.50 994.50 25% 52,000.00 $ $ 994.50 $ $ 994.50 10 Accounting Supervisor (FICA @ 7.65%) 499.16 499.16 10% 65,000.00 $ $ 499.16 $ $ 499.16 Year One Fringe Subtotal: $ $ 8,911.84 $ $ 8,911.84 Collier County Criminal Justice, Mental Health Substance Abuse Reinvestment Act Grant Budget Narrative Travel/Mileage: 1 Gasoline for Team vehicles - $200/month 2,400.00 $ 2,400.00 $ $ $ 2,400.00 Year One Travel/Mileage Subtotal: $ 2,400.00 $ $ $ 2,400.00 Equipment 1 2 Laptop computers $ 1,000.00 $ 1,000.00 Year One Equipment Subtotal: $ 1,000.00 $ $ $ 1,000.00 Other Expenses: 1 Medication for inmates released to community ($150 suboxone/month for 10-12 inmates) $ 18,000.00 $ $ $ 18,000.00 2 EMIR System ($11000/mo for 20 programs. $550/mo for 1 program x 12 months) $ - $ $ - 3 Transitioning Housing for Inmates - $675/month for 1 resident $ 8,676.00 $ 8,676.00 4 Bus passes ($20 tickettmonth for 20 inmates) 4,800.00 $ - $ $ $ 5 Computer for staff $ - $ - 6 Program Evaluation $ 3,000.00 $ 3,000.00 Year One Other Expenses Subtotal: $ 29,676.00 $ $ $ 29,676.00 Year One Other Expenses Subtotal: $ 33,076.00 $ $ $ 33,076.00 Year One Subtotal DLC: $ 74,323.00 $ 84,161.84 $ $ 158,484.84 Contract 2. Collier County Sheriff's Office (CCSO)M Salaries: FTE Annual Salary Grant Cash Match In Kind Match Total 1 Discharge Planner 1 (100 % FTE @ $56,264.00 Annual Salary) 100 % $ 56,264.00 $ - $ 56,264.00 $ $ 56,264.00 3 Advanced Registered Nurse Practitioner (50% FTE @ $136,806 Annual Salary) 50% $ 136,806.00 $ 68,403.00 $ - $ $ 68,403.00 4 Registered Nurse (50% FTE @ $103,626 Annual Salary) 50% $ 103,626.00 $ 51,813.00 $ - $ $ 51,813.00 5 Director of Nursing (25% FTE @ $85,000 Annual Salary) 25% $ 85,000.00 $ - $ 21,250.00 $ $ 21,250.00 6 Health Services Administrator (25% FTE @ $100,817.00 Annual Salary) 25% $ 100,817.00 $ $ 25,204.25 $ $ 25,204.25 7 Senior Grants Coordinator (15% FTE @ $76,086 Annual Salary)for meetings, and coordination with county and required grant reporting 15% $ 76,086.00 $ $ 11,412.90 $ $ 11,412.90 8 Grants Fiscal Clerk (15% FTE @ $33,412 Annual Salary) for processing invoices 15% $ 33,412.00 $ $ 5,011.80 $ $ 5,011.80 9 Reintegration Manager (35% FTE @ $77,771 Annual Salary) 35% $ 77,771.00 $ $ 27,219.85 $ $ 27,219.85 10 Reintegration Program Supervisor (50% FTE @ $52,811 annual salary) 50% $ 52,811.00 $ $ 26,405.50 $ $ 26,405.50 11 Corrections Support Division director (50% FTE @ $150,925 annual salary) 50% $ 150,925.00 $ $ 75,462.50 $ $ 75,462.50 12 Jail Administration Clerk (25% FTE @ $49,233 Annual Salary) 25% $ 49,233.00 $ $ 12,308.25 $ $ 12,308.25 13 Jail Crime Analyst (25% FTE @ $51,729 Annual Salary) 25% $ 51,729.00 $ $ 12,932.25 $ $ 12,932.25 Year One Salaries Subtotal: $ 120,216.00 $ 273,471.30 $ $ 393,687.30 Benefits FICA Retirement 1 Reintegration Manager & Reintegration Program Supervisor and Corrections Supporl Division Director (FICA @ 7.65%) 7.65% $ 129,087.85 $ - $ 9,875.22 $ $ 9,875.22 2 Reintegration Manager (retirement 10% @ $27,219) 10.00% $ 27,219.85 $ $ 2,721.99 $ $ 2,721.99 3 Reintegration Program Supervisor (retirement 10% @ $26,405) 10.00% $ 26,405.50 $ $ 2,640.55 $ $ 2,640.55 4 Corrections Support Division Director (retirement .50FTE @ $75,463 x 24.45%) 24.45% $ 75,462.50 $ $ 18,450.58 $ $ 18,450.58 Year One Benefits Subtotal: $ $ 33,688.34 $ $ 33,688.34 Medication 1 Suboxone strips ($120/mo x 144 inmates/yr) $ 30,600.00 $ - $ $ 30,600.00 2 Methadone via Methadone Clinic ($496/month x 204 inmates/yr) $ 130,944.00 $ $ $ 130,944.00 Year One Medication Subtotal: $ 161,544.00 $ $ $ 161,544.00 Year One Subtotal CCSO $ 281,760.00 $ 307,159.64 $ $ 588,919.64 YEAR ONE TOTAL ALL AGENCIES $ 387,608.15 $ 402,184.59 $ - $ 789,792.74 Collier County Criminal Justice, Mental Health Substance Abuse Reinvestment Act Grant Budget Narrative Line Item Year Two CHS Grant Cash Match In Kind Match Salaries: FTE Annual Salary Salary 1 Grants Coordinator (20% FTE @$56,375 annual salary) 20% 56,375 11,275.00 $ 5,637.50 $ $ 5,637.50 2 Lead Accountant ( 15% FTE @ $51,183 annual salary) 15% 51,183 7,677.45 $ 3,838.73 $ $ 3,838.73 3 Operations Analyst (10% FTE @ 53,688 annual salary) 10% 53,688 5,368.80 $ 2,684.40 $ $ 2,684.40 Year Two Salaries Subtotal: $ 12,160.63 $ $ $ 12,160.63 FICA Retirement Fringe Benefits: 7.650% 10.500% Fringe Benefits 1 Grants Coordinator (FICA @.0765, Retirement @.105) 862.54 591.94 1,454.48 $ 727.24 $ $ 727.24 2 Lead Accountant (FICA @.0765, Retirement @.105) 587.32 403.07 990.39 $ 495.20 $ $ 495.20 3 Operations Coordinator(FICA @.0765, Retirement @.105) 410.71 281.86 692.57 $ 346.29 $ $ 346.29 Year Two Fringe Subtotal: $ 1,568.73 $ $ $ 1,568.73 Equipment: Equipment 1 1 Laptop computer $ $ - $ $ $ 2 1 Docking station $ $ $ $ $ - 3 2 monitors $ $ $ $ $ Year Two Equipment Subtotal: $ $ $ $ Other Expe Other Expenses Other Expenses 1 Offices Supplies $ 100.00 $ 50.00 $ 50.00 2 Postage $ 100.00 $ 50.00 $ 50.00 3 Training and Travel reduce from $ - $ - $ - 4 Contractual Key Staffing $ 33,000.00 $ 16,500.00 $ 16,500.00 Year Two Other Expenses Subtotal: $ 16,600.00 $ $ $ 16,600.00 Year Two Subtotal CHS: $ 30,329.36 $ $ $ 30,329.36 David Lawrence Center Grant Cash Match In Kind Match Contract 1. Salaries FTE Annual Salary 1 Care Coordinator (100% FTE @ $39,7800 Annual Salary) 100% 39,780.00 $ 39,780.00 $ $ $ 39,780.00 2 Peer Specialist (50% FTE @ $32,640Annual Salary) 50% 32,640.00 $ 16,320.00 $ $ $ 16,320.00 3 Program Director (10% FTE @ $75,000 Annual Salary) 10% 76,500.00 $ - $ 7,650.00 $ $ 7,650.00 4 Case Manager Supervisor (25% FTE @ $47,000 Annual Salary) 25% 47,940.00 $ $ 11,985.00 $ $ 11,985.00 5 Program Support Specialist (20% FTE @ $35,000 Annual Salary) 20% 35,700.00 $ $ 7,140.00 $ $ 7,140.00 6 Practice Manager (15% FTE @ $50,000 Annual Salary) 15% 51,000.00 $ $ 7,650.00 $ $ 7,650.00 7 Nursing Coordinator (25% FTE @ $60,000 Annual Salary) 25% 61,200.00 $ $ 15,300.00 $ $ 15,300.00 8 QI/Compliance/Data Manager (10% FTE @ $70,000 Annual Salary) 10% 71,400.00 $ $ 7,140.00 $ $ 7,140.00 9 Accounting Specialist (25% FTE @ $45,000 Annual Salary) 25% 53,040.00 $ $ 13,260.00 $ $ 13,260.00 10 Accounting Supervisor (10% FTE @$60,000 Annual Salary) 10% 66,300.00 $ $ 6,630.00 $ $ 6,630.00 Year Two Salaries Subtotal: $ 56,100.00 $ 76,755.00 $ $ 132,855.00 FICA Fringe Benefits: 7.65% FTE Annual Salary 1 Care Coordinator (FICA @ 7.65%) 3,043.17 3,043.17 100% 39,780.00 $ - $ 3,043.17 $ $ 3,043.17 2 Peer Specialist (FICA @7.65%) 1,248.48 1,248.48 50% 32,640.00 $ $ 1,248.48 $ $ 1,248.48 3 Program Director (FICA @ 7.65%) 585.23 585.23 10% 76,500.00 $ $ 585.23 $ $ 585.23 4 Case Manager Supervisor (FICA @ 7.65%) 916.85 916.85 25% 47,940.00 $ $ 916.85 $ $ 916.85 5 Program Support Specialist (FICA @ 7.65%) 546.21 546.21 20% 35,700.00 $ $ 546.21 $ $ 546.21 6 Practice Manager (FICA @ 7.65%) 585.23 585.23 15% 51,000.00 $ $ 585.23 $ $ 585.23 7 Nursing Supervisor (FICA @ 7.65%) 1,170.45 1,170.45 25% 61,200.00 $ $ 1,170.45 $ $ 1,170.45 8 QI/Compliance/Data Manager (FICA @ 7.65%) 546.21 546.21 10% 71,400.00 $ $ 546.21 $ $ 546.21 9 Accounting Supervisor (FICA @ 7.65%) 1,014.39 1,014.39 25% 53,040.00 $ $ 1,014.39 $ $ 1,014.39 10 Accounting Supervisor ((FICA @ 7.65%) 507.20 507.20 10% 66,300.00 $ $ 507.20 $ $ 507.20 Year Two Fringe Benefits Subtotal: $ $ 10,163.42 $ $ 10,163.42 $ $ 2,400.00 Travel/Mileage: 1 Gasoline for Team vehicles - $200/month 2,400.00 $ 2,400.00 $ - Year Two Travel/Mileage Subtotal: $ 2,400.00 $ $ $ 2,400.00 Collier County Criminal Justice, Mental Health Substance Abuse Reinvestment Act Grant Budget Narrative Equipment 1 2 Laptop computers $ $ Year Two Equipment Subtotal: $ $ $ $ Other Expenses: 1 Medication for inmates released to community ($150 suboxone/month for 15 inmates) $ 22,000.00 $ $ $ 22,000.00 2 EMIR System ($11000/mo for 20 programs. $550/mo for 1 program x 12 months) $ - $ $ 3 Transitioning Housing for Inmates - $675/month for 1 residenl $ 8,676.00 $ 8,676.00 4 Bus passes ($20 ticket/month for 20 inmates) 4,800.00 $ - $ $ $ 5 Computer for staff $ - $ - 6 Program Evaluation $ 4,000.00 $ 4,000.00 Year Two Other Expenses Subtotal: $ 34,676.00 $ $ $ 34,676.00 Year Two Travel/Mileage, Equipment and Other Expenses Subtotal: $ 37,076.00 $ $ $ 37,076.00 Year Two Subtotal DLC: $ 93,176.00 $ 86,918.42 $ $ 180,094.42 Contract 2. Collier County Sheriffs Office CCSO Grant Cash Match In Kind Match Total Salaries: FTE Annual Salary 1 Discharge Planner 1 (100% FTE @ $56,264.00 Annual Salary) 100% $ 56,264.00 $ - $ 56,264.00 $ $ 56,264.00 3 Advanced Registered Nurse Practitioner (50% FTE @ $136,806 Annual Salary) 50% $ 136,806.00 $ 68,403.00 $ - $ $ 68,403.00 4 Registered Nurse (50% FTE @ $103,626 Annual Salary) 50% $ 103,626.00 $ 51,813.00 $ - $ $ 51,813.00 5 Director of Nursing (25% FTE @ $85,000 Annual Salary) 25% $ 85,000.00 $ - $ 21,250.00 $ $ 21,250.00 6 Health Services Administrator (25% FTE @ $100,817.00 Annual Salary) 25% $ 100,817.00 $ $ 25,204.25 $ $ 25,204.25 7 Senior Grants Coordinator (15% FTE @ $77,988 Annual Salary)for meetings, and coordination with county and required grant reporting 15% $ 77,988.00 $ $ 11,698.20 $ $ 11,698.20 8 Grants Fiscal Clerk (15% FTE @ $34,247 Annual Salary) for processing invoices 15% $ 34,247.00 $ $ 5,137.05 $ 5,137.05 9 Reintegration Manager (35% FTE @ $79,715 Annual Salary) 35% $ 79,715.00 $ $ 27,900.25 $ 27,900.25 10 Reintegration Program Supervisor (50% FTE @ $54,131 Annual Salary) 50% $ 54,131.00 $ $ 27,065.50 $ 27,065.50 11 Corrections Support Division director (50% FTE @ $150,925 Annual Salary) 50% $ 150,925.00 $ $ 75,462.50 $ 75,462.50 12 Jail Administration Clerk (25% FTE @ $50,463 Annual Salary) 25% $ 50,463.00 $ $ 12,615.75 $ 12,615.75 13 Jail Crime Analyst (25% FTE @ $53,022 Annual Salary) 25% $ 53,022.00 $ $ 13,255.50 $ 13,255.50 Year Two Salaries Subtotal: $ 120,216.00 $ 275,853.00 $ $ 396,069.00 Benefits FICA Retirement 1 Reintegration Manager & Reintegration Program Supervisor and Corrections Support Division Director (FICA @ 7.65%) 7.65% $ 130,428.25 $ 9,977.76 $ 9,977.76 2 Reintegration Manager (retirement 8.47% @ $27,900.25) 10.00% $ 27,900.25 $ 2,790.03 $ 2,790.03 3 Reintegration Program Supervisor (retirement 50% @ $26,405) 10.00% $ 27,065.50 $ 2,706.55 $ 2,706.55 4 Corrections Support Division Director (retirement .50FTE @ $75,463 x 24.45%) 24.45% $ 75,462.50 $ 18,450.58 $ 18,450.58 Year Two Fringe Subtotal: $ - $ 33,924.92 $ $ 33,924.92 Medication 1 Suboxone strips ($120/mo x 144 inmates/yr) $ 30,600.00 $ - $ $ 30,600.00 2 Methadone via Methadone Clinic ($496/month x 204 inmates/yr) $ 130,944.00 $ $ 130,944.00 Year Two Medication Subtotal: $ 161,544.00 $ - $ $ 161,544.00 Year Two Subtotal CCSO $ 281,760.00 $ 309,777.92 $ $ 591,537.92 YEAR TWO TOTAL ALL AGENCIES $ 405,265.36 $ 396,696.34 $ - $ 8019961.70 Collier County Criminal J-b.., Mental Health Substance Abuse Reinvestment Ad Gant Budget Nanative Salaries: FTE Annual Salary Salary 1 Grants Coordinator (20% FTE @$58,067 annual salary) 20% 58,067 11,613.40 $ 5,806.70 $ $ 5,806.70 2 Lead Accountant ( 15% FTE @ $52,718 annual salary) 15% 52,718 7,907.70 $ 3,953.85 $ $ 3,953.85 3 Operations Analyst (10% FTE @ 53,688 annual salary) 10% 55,299 5,529.90 $ 2,764.95 $ $ 2,764.95 Year Three Salaries Subtotal: $ 12,525.50 $ $ $ 12,525.50 FICA Retirement Fringe Benefits: 7.650% 10.500% Fringe 1 Grants Coordinator (FICA @.0765, Retirement @.105) 888.43 1,219.41 2,107.64 $ 1,053.92 $ $ 1,053.92 2 Lead Accountant (FICA @.0765, Retirement @.105) 604.94 830.31 1,435.25 $ 717.63 $ $ 717.63 3 Operations Coordinator(FICA @.0765, Retirement @.105) 423.04 580.64 1,003.68 $ 501.84 $ $ 501.84 Year Three Fringe Subtotal: $ 2,273.39 f f $ 2,273.39 Equipment: Equipment: 1 1 Laptop computer $ $ f f $ 2 1 Docking station $ $ S f $ 3 2 monitors $ $ S f $ Year Three Equipment Subtotal: $ f f $ Other Expenses Other Expenses 1 Offices Supplies $ 100.00 $ 50.00 $ 50.00 2 Postage $ 100.00 $ 50.00 $ 50.00 3 Training and Travel f $ $ 4 Contractual Key Staffing $ 33,000.00 $ 16,500.00 $ 16,500.00 Year Three Other Expenses Subtotal: $ 16,600.00 1 $ f $ 16,600.00 Year Three Subtotal CHS: $ 31,398.891 $ S $ 31,398.89 Contract 1. David Lawrence Center ash Match I In Kind Match Salaries FTE Annual Salary 1 Care Coordinator (100 % FTE @ $39,535 Annual Salary) 100 % 40,575.60 $ 40,575.60 $ $ $ 40,575.60 2 Peer Specialist (50% FTE @ $33,292 Annual Salary) 50% 33,292.00 $ 16,646.00 $ $ $ 16,646.00 3 Program Director (10% FTE @ $78,030 Annual Salary) 10% 78,030.00 $ $ 7,803.00 $ $ 7,803.00 4 Case Manager Supervisor (25% FTE @ $48,899 Annual Salary) 25% 48,898.80 $ $ 12,224.70 $ $ 12,224.70 5 Program Support Specialist (20% FTE @ $36,414 Annual Salary 20% 36,414.00 $ $ 7,282.80 $ $ 7.282.80 6 Practice Manager (15% FTE @ $52,020 Annual Salary) 15% 52,020.00 $ $ 7,803.00 $ $ 7.803.00 7 Nursing Supervisor (25% FTE @ $67,626 Annual Salary) 25% 62,424.00 $ $ 15,606.00 $ $ 15,606.00 8 QI/Compliance/Data Manager (10% FTE @ $70,000 Annual Salary) 10% 72,828.00 $ $ 7,282.80 $ $ 7.282.80 9 Accounting Specialist (25% FTE @ $46,818 Annual Salary) 25% 54,100.80 $ $ 13,525.20 $ $ 13,525.20 10 Accounting Supervisor (100% FTE @$62,424 Annual Salary) 10% 67,626.00 $ $ 6,763.60 $ $ 6,763.60 Year Three Salaries Subtotal: $ 57,221.60 $ 78,291.10 $ $ 135,512.70 FICA Fringe: 7.65% FTE Annual Salary 1 Care Coordinator (FICA @ 7.65%) 3,104.03 3,104.03 100% 40,575.60 $ $ 3,104.03 $ $ 3.104.03 2 Peer Specialist (FICA @ 7.65%) 1,273.42 1,273.42 50% 33,292.00 $ $ 1,273.42 $ $ 1,273.42 3 Program Director (FICA @ 7.65%) 596.93 596.93 10% 78,030.00 $ $ 596.93 $ $ 596.93 4 Case Manager Supervisor (FICA @ 7.65%) 935.19 935.19 2594. 48,898.80 $ $ 935.19 $ $ 935.19 5 Program Support Specialist (FICA @ 7.65%) 557.13 557.13 20% 36,414.00 $ $ 557.13 $ $ 557.13 6 Practice Manager (FICA @ 7.65%) 596.93 596.93 15% 52,020.00 $ $ 596.93 $ $ 596.93 7 Nursing Supervisor (FICA @ 7.65%) 1,193.86 1,193.86 25% 62,424.00 $ $ 1,193.86 $ $ 1.193.86 8 QI/Compliance/Data Manager (FICA @ 7.65%) 557.13 557.13 10% 72,828.00 $ $ 557.13 $ $ 557.13 9 Accounting Specialist (FICA @ 7.65%) 1,034.68 1,034.68 25% 54,100.80 $ $ 1,034.68 $ $ 1.034.68 10 Accounting Supervisor (FICA @ 7.65%) 517.34 517.42 10% 67,626.00 $ $ 517.34 $ $ 517.34 Year Three Fringe Subtotal: $ $ 10,366.64 $ $ 10,366.64 Travel/Mlles e: 1 Gasoline for Team vehicles - $200/month 2,400.00 1 $ 2,400.00 $ $ $ 2,400.00 Year Three Travel/Mileage Subtotal: $ 2,400.00 $ $ $ 2,400.00 Equipment 1 2 Laptop computers $ $ Year Three Equipment Subtotal: $ $ $ $ Other Expenses: 1 Medication for inmates released to community ($150 suboxone/month for 10-12 inmates) $ 20,170.00 $ $ $ 20,170.00 2 EMR System ($11000/mo for 20 programs. $550/mo for 1 program x 12 months) $ $ $ 3 Transitioning Housing for Inmates - $675/month for 1 resident $ 8,676.00 $ 8.676.00 4 Bus passes ($20 ticket/month for 20 inmates) 4,800.00 $ $ $ $ 5 Computer for staff $ $ $ $ 6 Program Evaluation $ 5,500.00 $ $ $ 5,500.00 Year Three Other Expenses Subtotal: $ 34,346.00 $ $ $ 34,346.00 Year Three Travel/Mileage, Equipment and Other Expenses Subtotal: $ 36,746.00 $ $ S 36,746.00 Year Three Subtotal DLC: $ 93,967.60 $ 88,657.74 $ $ 182,625.34 Collier County Criminal Jusfice, Mental Health Substance Abuse Reinvestment Ad Gant Budget Na—W. Contract 2. Collier County Sheriffs Office CCSO Grant Cash Match In Kind Match Salaries: FTE Annual Salary 1 Discharge Planner 1 (1 FTE @ $56,264.00 annual salary) 100% $ 56,264.00 $ $ 56,264.00 $ $ 56,264.00 3 Advanced Registered Nurse Practitioners (0.5 FTE @ $136,806 annual salary) 50% $ 136,806.00 $ 68,403.00 $ $ $ 68,403.00 4 Registered Nurse (0.5 FTE @ $103,626 annual salary) 50% $ 103,626.00 $ 51,813.00 $ $ $ 51,813.00 5 Director of Nursing (.25 FTE @ $85,000 annual salary) 25% $ 85,000.00 $ $ 21,250.00 $ $ 21,250.00 6 Health Services Administrator (.25 FTE @ $100,817.00 annual salary) 250% $ 100,817.00 $ 25,204.25 $ 25,204.25 7 Senior Grants Coordinator (.15 FTE @ $79,937 annual salary)for meetings, and coordination with county and required grant reporting 15% $ 79,937.00 $ $ 11,990.55 $ $ 11,990.55 8 Grants Fiscal Clerk (.15 FTE @ $35,103 annual salary) for processing invoices 15% $ 35,103.00 $ $ 5,265.45 $ $ 5,265.45 9 Reintegration Manager (.35 FTE @ $81,707 annual salary) 35% $ 81,707.00 $ $ 28,597.45 $ 28,597.45 10 Reintegration Program Supervisor (.50 FTE @ $55,484 annual salary) 50% $ 55,484.00 $ $ 27,742.00 $ 27,742.00 11 Corrections Support Division director (.50 FTE @ $150,925 annual salary) 50% $ 150,925.00 $ $ 75,462.50 $ 75,462.50 12 Jail Administration Clerk (.25 FTE @ $51,724 annual salary) 25% $ 51,724.00 $ $ 12,931.00 $ 12,931.00 13 Jail Crime Analyst (.25 FTE @ $54,347 annual salary) 25% $ 54,347.00 $ $ 13,586.75 $ 13,586.75 Year Three Salaries Subtotal $ 120,216.00 $ 278,293.95 $ $ 398,509.95 Benefits FICA Retirement 1 Reintegration Manager & Reintegration Program Supervisor and Corrections Support Division Director (FICA @ 7.65%) 7.65% $ 131,801.95 $ $ 10,082.85 $ 10,082.85 2 Reintegration Manager (retirement .35FTE @ $28,597.45 x 8.47%) 10.00% $ 28,597.45 $ $ 2,859.75 $ 2.859.75 3 Reintegration Program Supervisor (retirement .50FTE @ $27,742 x 8.47%) 10.00% $ 27,742.00 $ $ 2,774.20 $ 2.774.20 4 Corrections Support Division Director (retirement .50FTE @ $75,463 x 24.45%) 24.45% $ 75,462.50 $ $ 18,450.58 $ 18,450.58 Year Three Payroll Taxes and Fringe Subtotal $ $ 34,167.38 $ $ 34,167.38 Medication 1 Suboxone strips ($120/mo x 144 inmates/ yr) $ 30,600.00 $ $ $ 30,600.00 2 Methadone via Methadone Clinic ($496/month x 204 inmates/yr) $ 130,944.00 $ $ 130,944.00 Year Three Medication Subtotal: $ 161,544.00 $ $ $ 161,544.00 Year Three Subtotal CCSO $ 281,760.00 $ 312,461.33 $ $ 594,221.33 YEAR THREE TOTAL ALL AGENCIES $ 407,126.49 $ 401-119.07 $ Line Ite G Cash Match In Kind Match Total CHS Salaries: 1 Grants Coordinator $ 16,917.98 $ 4,105.34 $ 21,023.32 2 Lead Accountant $ 11,519.88 $ 2,795.48 $ 14,315.36 3 Operations Analyst $ 8,055.55 $ 2,345.58 $ 10,401.13 Three Year Total for Salaries: $ 36,493.41 $ 9,246.40 $ $ 45,739.81 Fringe Benefits: 1 Grants Coordinator $ 2,774.56 $ 745.05 $ 3,519.61 2 Lead Accountant $ 1,889.27 $ 507.33 $ 2,396.60 3 Operations Analyst $ 1,321.16 $ 364.33 $ 1,685.49 Three Yeat Total for Fringe: $ 5,984.99 $ 1,616.71 $ $ 7,601.70 Equipment: 1 1 Laptop computer $ 700.00 $ - $ - $ 700.00 2 1 Docking station $ 75.00 $ - $ - $ 75.00 3 2 monitors $ 200.00 $ $ $ 200.00 Three Year Total for Equipment: $ 975.00 $ $ $ 975.00 Other Expenses 1 Offices Supplies $ 150.00 $ - $ 150.00 2 Postage $ 150.00 $ - $ 150.00 3 Training and Travel $ - $ - $ - 4 Contractual Key Staffing $ 49,500.00 $ $ 49,500.00 ' Lawrence Center Three Year Total for Other Expenses: $ 49,800.00 $ $ $ 49,800.00 TOTAL CHS FOR THREE YEARS: $ 93,253.40 $ 10,863.11 $ - $ 104,116.51 Contract Cash Match In Kind Match Total Salaries (FIRST Team): $ - 1 Care Coordinator $ 109,605.60 $ 109,605.60 2 Peer Specialist $ 44,963.00 $ - $ 44,963.00 3 Program Director $ - $ 22,953.00 $ 22,953.00 4 Case Manager Supervisor $ - $ 35,959.70 $ 35,959.70 5 Program Support Specialist $ - $ 21,422.80 $ 21,422.80 6 Practice Manager $ - $ 22,953.00 $ 22,953.00 7 Nursing Supervisor $ - $ 45,906.00 $ 45,906.00 8 QI/Compliance/Data Manager $ - $ 21,422.80 $ 21,422.80 9 Accounting Specialist $ - $ 39,785.20 $ 39,785.20 10 Accounting Supervisor $ $ 19,893.60 $ 19,893.60 Three Year Total for Salaries: $ 154,568.60 $ 230,296.10 $ $ 384,864.70 Fringe: 1 Care Coordinator (FICA @ 7.65%) $ - $ 8,382.73 $ 8,382.73 2 Peer Specialist (FICA @ 7.65%) $ - $ 3,439.67 $ 3,439.67 3 Program Director (FICA @ 7.65%) $ - $ 1,755.91 $ 1,755.91 4 Case Manager Supervisor (FICA @ 7.65%) $ - $ 2,750.92 $ 2,750.92 5 Program Support Specialist (FICA @ 7.65%) $ - $ 1,638.84 $ 1,638.84 6 Practice Manager (FICA @ 7.65%) $ - $ 1,755.91 $ 1,755.91 7 Nursing Supervisor (FICA @ 7.65%) $ - $ 3,511.81 $ 3,511.81 8 QI/Compliance/Data Manager (FICA @ 7.65%) $ - $ 1,638.84 $ 1,638.84 9 Accounting Specialist (FICA @ 7.65%) $ - $ 3,043.57 $ 3,043.57 10 Accounting Supervisor (FICA @ 7.65%) $ $ 1,523.70 $ 1,523.70 Three Yeat Total for Fringe, $ $ 29,441.90 $ $ 29,441.90 Travel/Mileage: 1 Gasoline for Team vehicles - $200/month $ 7,200.00 $ $ $ 7,200.00 Three Year Total for Travel/Mileage: $ 7,200.00 $ $ $ 7:200.00 Equipment 1 12 Laptop computer $ 1,000.00 $ $ $ 1,000.00 Three Year Total for Equipment: $ 1,000.00 $ $ $ 1,000.00 Other Expenses: $ - 1 Medication for inmates released to community ($150 suboxone/month for 10- 12 inmates) $ 60,170.00 $ - $ - $ 60,170.00 2 EMIR System $ - $ - $ - $ - 3 Other Incidentals (housing) - $675/month for 1 resident $ 26,028.00 $ - $ - $ 26,028.00 4 Bus passes ($20 ticket/month for 20 inmates) $ - $ - $ - $ - 5 Computer for staff $ - $ - $ - $ - 6 Program Evaluation $ 12,500.00 $ $ $ 12,500.00 Three Year Total for Other Expenses: $ 98,698.00 $ $ $ 98,698.00 Three Year Total for Expenses: $ 106,898.00 $ $ $ 106,898.00 TOTAL DLC FOR THREE YEARS: $ 261,466.60 $ 259,738.00 $ - $ 521,204.60 Will 2 Salaries: Wlier County Sheriffs Office CCSO rant ash Matc Kind I 1 Discharge Planned $ - $ 168,792.00 $ - $ 168,792.00 3 Advanced Registered Nurse Practitioner $ 205,209.00 $ - $ - $ 205,209.00 4 Registered Nurse $ 155,439.00 $ - $ - $ 155,439.00 5 Director of Nursing $ - $ 63,750.00 $ - $ 63,750.00 6 Health Services Administrator $ - $ 75,612.75 $ - $ 75,612.75 7 Senior Grants Coordinator $ - $ 35,101.65 $ - $ 35,101.65 8 Grants Fiscal Clerk $ - $ 15,414.30 $ - $ 15,414.30 9 Reintegration Manager $ - $ 83,717.55 $ - $ 83,717.55 10 Reintegration Program Supervisor $ - $ 81,213.00 $ - $ 81,213.00 11 Corrections Support Division director $ - $ 226,387.50 $ - $ 226,387.50 12 Jail Administration Clerk $ - $ 37,855.00 $ - $ 37,855.00 13 Jail Crime Analyst $ $ 39,774.50 $ $ 39,774.50 Three Year Total for Salaries: $ 360,648.00 $ 827,618.25 $ $ 1,188,266.25 Benefits 1 Reintegration Manager & Reintegration Program Supervisor and Corrections Support Division Director (FICA @ 7.65%) $ - $ 29,935.83 $ 29,935.83 2 Reintegration Manager (retirement @ 8.47%) $ - $ 8,371.77 $ 8,371.77 3 Reintegration Program Supervisor (retirement @ 8.47%) $ - $ 8,121.30 $ 8,121.30 4 Corrections Support Division Director (retirement @ 25.41 %) $ $ 55,351.74 $ 55,351.74 Three YeatTotal for Benefits: $ $ 101,780.64 $ $ 101,780.64 Medication 1 Suboxone strips ($120/mo x 144 inmates/yr) $ 91,800.00 $ - $ - $ 91,800.00 2 Methadone via Methadone Clinic ($496/month x 204 inmates/yr) $ 392,832.00 $ $ $ 392,832.00 Three Year Total for Medication: $ 484,632.00 $ $ $ 484,632.00 TOTAL CCSO FOR THREE YEARS $ 845,280.00 $ 929,398.89 $ $ 1,774,678.89 TOTAL CJMHSA ALL AGENCIES $ 1,200,000.00 $ 1,200,000.00 $ $ 2,400,000.00 YEAR 1 Table A: Line Item Budget Applicant Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 11,807.28 9,246.40 General Fund Fringe Benefits: 2,142.87 1,616.71 General Fund Equipment 975.00 Staff Travel: Supplies: 50.00 Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: (Total ALL subcontract services) 356,083.00 391,321.48 Operating Account and Local Funds Other (Postage & Contractual Staff ): 16,550.00 Administrative Cost: Total: 387,608.15 402,184.59 Total Project Cost: 789,792.74 = Grants Funds Requested + Matching Share Match Percentage: 51% = Match I Total Project Cost Table B: Line Item Budget Subcontracted Services - David Lawrence Center Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 41,247.00 75,250.00 Operating Account Fringe Benefits: 8,911.84 Operating Account Equipment 1,000.00 Staff Travel: 2,400.00 Supplies: Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: Other (Medication, Housing, Program Evaluation): 29,676.00 Administrative Cost: Total: 74,323.00 84,161.84 Total Project Cost: 158,484.84 = Grants Funds Requested + Matching Share Match Percentage: 53% = Match 1 Total Project Cost Table B: Line Item Budget Subcontracted Services - Collier County Sheriffs Office Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 120,216.00 273,471.30 Local Funds Fringe Benefits: 33,688.34 Local Funds Equipment Staff Travel: Supplies: Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: Other (Medication): 161,544.00 Administrative Cost: Total: 281,760.00 307,159.64 Total Project Cost:1 588,919.64 = Grants Funds Requested + Matching Share Match Percentage: 52% = Match 1 Total Project Cost u *Provide a separate line item budget for EACH proposed subcontracted service provider. YEAR 2 Table A: Line Item Budget Applicant Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 12,160.63 Fringe Benefits: 1,568.73 Equipment Staff Travel: Supplies: 50.00 Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: (Total ALL subcontract services) 374,936.00 396,696.34 Operating Account and Local Funds Other (Postage & Contractual Staff ): 16,550.00 Administrative Cost: Total: 405,265.36 396,696.34 Total Project Cost: 801,961.70 = Grants Funds Requested + Matching Share Match Percentage: 49% = Match I Total Project Cost Table B: Line Item Budget Subcontracted Services - David Lawrence Center Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 56,100.00 76,755.00 Operating Account Fringe Benefits: 10,163.42 Operating Account Equipment Staff Travel: 2,400.00 Supplies: Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: Other (Medication, Housing,Program Evaluation): 34,676.00 Administrative Cost: Total: 93,176.00 86,918.42 Total Project Cost: 180,094.42 J= Grants Funds Requested + Matching Share Match Percentage: 48% = Match 1 Total Project Cost Table B: Line Item Budget Subcontracted Services - Collier County Sheriffs Office Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 120,216.00 275,853.00 Local Funds Fringe Benefits: 33,924.92 Local Funds Equipment Staff Travel: Supplies: Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: Other (Medication): 161,544.00 Administrative Cost: Total: 281,760.00 309,777.92 Total Project Cost: 591,537.92 = Grants Funds Requested + Matching Share Match Percentage: 52% J= Match 1 Total Project Cost ❑ *Provide a separate line item budget for EACH proposed subcontracted service provider. YEAR 3 Table A: Line Item Budget Applicant Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 12,525.50 Fringe Benefits: 2,273.39 Equipment Staff Travel: Supplies: 50.00 Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: (Total ALL subcontract services) 375,727.60 401,119.07 Operating Account and Local Funds Other (Postage & Contractual Staff ): 16,550.00 Administrative Cost: Total: 407,126.49 401,119.07 Total Project Cost: 808,245.56 = Grants Funds Requested + Matching Share Match Percentage: 50% = Match I Total Project Cost Table B: Line Item Budget Subcontracted Services - David Lawrence Center Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 57,221.60 78,291.10 Operating Account Fringe Benefits: 10,366.64 Operating Account Equipment Staff Travel: 2,400.00 Supplies: Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: Other (Medication, Housing,Program Evaluation): 34,346.00 Administrative Cost: Total: 93,967.60 88,657.74 Total Project Cost: 182,625.34 = Grants Funds Requested + Matching Share Match Percentage: 49% = Match 1 Total Project Cost Table B: Line Item Budget Subcontracted Services - Collier County Sheriffs Office Grant Funds Requested Matching Funds and Other In -Kind Contributions Funding Source of Funds Salaries: 120,216.00 278,293.95 Local Funds Fringe Benefits: 34,167.38 Local Funds Equipment Staff Travel: Supplies: Building Occupancy: Consultant Services: Consultant Travel: Consultant Supplies: Subcontracted Services: Other (Medication): 161,544.00 Administrative Cost: Total: 281,760.00 312,461.33 Total Project Cost: 594,221.33 = Grants Funds Requested + Matching Share Match Percentage: 53% J= Match 1 Total Project Cost ❑ *Provide a separate line item budget for EACH proposed subcontracted service provider. Exhibit A Mental Health and Addiction Services Five Year Strategic Plan 2020-2024 Collier County Meni and Addiction Ad H Advisory Committee October 29, 2019 Introduction Starting in 2017, an informal group of community stakeholders began to meet with the goal of improving the continuum of care around mental health and addiction services in Collier County. Throughout this process, the group identified many strengths in the community, including agencies and stakeholders exceptionally dedicated to supporting each other in collaborative efforts and ideas. Communication thrived as issues were discussed, and the group worked to eliminate silos and better coordinate services. Programs were identified, created, and enhanced through partnership efforts. The Collier County Sheriff's Office has invested considerable resources in its Mental Health Bureau, and the County's three problem -solving courts continue to see improved results in recidivism and cost -avoidance. Law enforcement, corrections, local government and the courts take an active role in providing substance use and mental health intervention and treatment, including crisis response, diversion, treatment services in the county jail. The David Lawrence Center and other community providers have enhanced the services being provided in the County, but demand continues to grow as the population and mental health awareness expands. Collier County Government has continually increased the resources provided to law enforcement, the courts, and community health care providers during this same time period. Several collaborative working groups are in place that align well with this Mental Health and Addiction Services Strategic Plan and should be complementary in its advancement such as: Blue Zones, Collier County Public Safety Coordinating Council, Criminal Justice, Mental Health, and Substance Abuse Planning Council, Community Behavioral Health Advisory Committee, and community groups such as the Community Foundation of Collier County and Richard M. Schulze Family Foundation. Providers of treatment for substance use disorders and mental illness work collaboratively to refer individuals to the appropriate treatment modality based on diagnosis. They identify high service utilizers for enhanced services. They are committed to utilizing evidence -based practices that have emerged in recent years to improve care. These practices include medication assisted treatment, assisted outpatient treatment, problem -solving courts, housing first and the use of both mental health professionals and trained peers. PAGE 2 The greater Collier County community supports increased access to treatment for substance use disorders and mental illness as evidenced by voter approval of the Collier County Infrastructure Sales Surtax, which included $25 million for the Central Receiving Facility/ System. A strong sense of community is also reflected throughout the philanthropic efforts of Collier County. The Committee would like to acknowledge the financial support of the Community Foundation of Collier County, as well as the countless hours that our residents donate to improving outcomes and service within, Collier County. All these aforementioned strengths have come together in the creation of the Collier County Mental Illness and Addiction Ad Hoc Advisory Committee and are reflected throughout the five-year strategic plan. PAGE 3 Committee Origin, Membership, and Charge On December 11, 2018 the Collier County Board of County Commissioners approved Resolution 2018-2321 establishing the Mental Illness and Addiction Ad Hoc Advisory Committee. The Advisory Committee was charged with making recommendations regarding the County's role in providing assistance and treatment of adults with mental health and substance use disorders. The Resolution required that Committee membership not exceed 19 individuals appointed by the Board with consideration given to ensure geographic and background diversity. Special qualifications for membership included: • representative designated by a Veteran services organization; • representative designated by the Collier County Sheriff's Office; • representative designated by a Collier County grantor entity which provides funding to providers of services for mental illness and substance use disorders for adults; • psychiatrist, licensed to practice in Florida; • behavioral health professional, licensed to practice in Florida; • medical health professional; • representative from a homelessness advocacy organization; • representative of the David Lawrence Center, Inc.; • representative from the National Alliance on Mental Illness; • a certified peer specialist; • representative from the recovery community; • representatives from the local business community; and, • representatives at -large with experience or demonstrated interest in mental illness and substance use disorders. The Resolution defined the purpose of the Committee to include "providing input from all entities involved in providing assistance to, and the treatment of, persons with mental health or addiction issues, both public and private, as well as members of the public, to identify existing mental and behavioral health services issues in the community to ensure the inclusion of all possible services, treatment, and public and private assistance for county residents struggling with mental illness and/or substance use disorders." The Committee was charged with development of a five-year strategic plan for mental health and addiction services. Following review and adoption of this strategic plan by the Board of County Commissioners, the Collier County Mental Illness and Addiction Ad Hoc Advisory Committee will sunset, per Resolution 2018-232. In order to ensure follow through on this plans priorities, the Committee recommends exploring an 1 Appendix B PAGE 4 arrangement with community non -profits and private sector partners to drive, monitor, and evaluate implementation of the recommendations in the plan. This group, meeting quarterly, should be coordinated through existing channels and established committees, such as the Collier County Public Safety Coordinating Council and/or Criminal Justice, Mental Health, and Substance Abuse Planning Council. Members of the Ad Hoc Advisory Committee would be invited to attend along with interest members of these and other groups that touch no topics related to mental health and substance use disorders. The Community Foundation of Collier County is seen as a potential convener/host of these quarterly meetings. The Committee also recommends that an external evaluation of progress toward plan and priority implementation be completed and reviewed by the Board of County Commissioners during the fourth quarter of 2021. Mission Statement The Committee adopted the following mission statement: "The Committee will collaboratively plan for and support a coordinated effort for a full array of evidence informed services to improve the lives of adults with mental health and substance use disorders and overall quality of life in the Collier County community." Collier County Committee Work and Report Development The Mental Illness and Addiction Ad Hoc Advisory Committee was organized and convened for the first time on January 4, 2019. Ultimately the Committee met 21 times over the course of the year, including 18 regular meetings and 3 half day workshops to organize the information included in this report. The Committee utilized its meeting time to gather information and develop strategies to implement the priorities established in the Mental Illness and Substance Use Strategic Plan submitted to the Board of County Commissioners in June 2018 and included as Appendix D to this report. External subject matter experts made presentations to the Committee on issues related to Housing, Veteran Services and the design of a Data Collaborative. The knowledge gained from study of those priorities was applied in 4- hour planning workshops held on August 10, September 12 and October 8. During these workshops the Committee restated those priorities and established the goals, objectives and an action plan for the implementation of each priority that follows in this report. In preparing this report the Committee used the format employed by the Substance Abuse and Mental Health Services Administration (SAMHSA) in its most recent Strategic Plan. SAMHSA is the federal agency that promotes a vision for the United States behavioral health care system, establishes national policy directives along with other Federal partners and allocates Mental Health and Substance Abuse funding to states and PAGE 5 local communities through block and discretionary grant programs. In the spirit of recovery, the Committee recognizes SAMHSA's working definition of recovery from mental disorders and/or substance us disorders that was developed by dozens of stakeholders as: "A process of change through which individuals improve their health and wellness, live a self -directed life, and strive to reach their full potential". There are four major dimensions that support a life in recovery: Health, Home, Purpose and Community. With those four pillars, there are 10 Guiding Principles of Recovery: 1. Recovery emerges from hope 2. Recovery is person -driven 3. Recovery occurs via many pathways 4. Recovery is holistic 5. Recovery is supported by peers and allies 6. Recovery is supported through relationship and social networks 7. Recovery is culturally -based and influenced 8. Recovery is supported by addressing trauma 9. Recovery involves individual, family and community strengths and responsibility 10. Recovery is based on respect This report attempts to replicates SAMHSA's approach, then summarizes our recommendations for each priority through action plans. Selected SAMHSA evidenced - based practices tool kits and best practices guidelines that align with the plan are included in Appendix C of this report. This report identifies six (6) priorities that we recommend receive ongoing attention and support by the Board of County Commissioners over the next five years. Some priorities will require substantial financial support, while others will require little funding, but will require the involvement of County staff working in collaboration with community partners. Financial considerations are discussed in Appendix A of this report. The priorities, ranked in order of their relative importance by the Committee, are: 1. Build and Operate a Central Receiving Facility/System to Serve Persons Experiencing an Acute Mental Health or Substance Use Crisis; 2. Increase Housing and Supportive Services for Persons with Serious Mental Illness and/or Substance Dependence; 3. Establish a Mental Health and Substance Use Disorder Data Collaborative for Data Sharing, Collection and Outcomes Reporting; 4. Increase the Capacity and Effectiveness of Justice System Response for Persons Experiencing Serious Mental Illness and/or Substance Use Disorders; 5. Revise and Implement Non -Emergency Baker Act and Marchman Act Transportation Plans, and; 6. Improve Community Prevention, Advocacy, and Education Related to Mental Health and Substance Use Disorders. PAGE 6 Special Considerations The Committee identified Veterans as a population that we recommend receive special consideration. Specific attention must be paid to the unique needs of Veterans in all activities related to these priorities, ensuring that there is easy access to treatment and specialized programs to assist Veterans experiencing Post Traumatic Stress Disorder and Traumatic Brain Injury both in community programs and from the Veterans Administration. The Committee also received input from the public regarding the special needs of Senior Adults, particularly those in cognitive decline who experience profound changes in their behavior and emotional stability as a result of their illness. These individuals require specialized care very different from that provided in Baker Act Receiving Facilities that primarily treat individuals in crisis from a mood or thought disorder. In addition, all services, programs and activities related to the identified Priorities and special populations must be grounded in the best available Evidence Based or Evidence Informed Practices in order to ensure maximum quality and cost effectiveness in services provided to the community. See Appendix C for a more detailed discussion of the importance of utilizing evidence based or evidence informed practices. Limitations It should be noted that this planning process was limited in scope to issues related to mental health and substance abuse disorders exclusively among adults age 18 and older, except for the Committee's prevention priority. The provision of mental health and substance use disorder treatment to children and adolescents younger than age 18 involves a substantially different set of issues, diagnoses, and community providers in domains that include schools, child welfare agencies, juvenile justice programs, and treatment providers. In recent years, there has been substantial expansion in both preventative and interventional programs offered to children and adolescents in response to multiple issues including the increasing number of children requiring protective services, human trafficking, and mass casualty events in schools that have occurred across the country, including nearby Parkland, Florida. The Committee anticipates that the Prevention activities proposed in this plan will be both supportive of and integrated with these new services and programs for children and adolescents. Further we would encourage a similar community wide planning effort in support of even more comprehensive mental health and substance use disorder services for Collier's children and adolescents. Acknowledgements The Committee would like to thank and acknowledge the numerous county and agency staff, presenters, guests, volunteers, and members of the public who provided input and PAGE 7 participated in the planning process, as well as the generous financial support of the Community Foundation of Collier County. On the following pages find the Committee's recommendations regarding the six plan priorities that emerged from its deliberations, including goals, objectives and outcomes anticipated for each. Action plans for each priority are also provided in Appendix F, offering an "at a glance" overview of the inputs required, activities to be conducted and outcomes anticipated for each priority. PAGE 8 Priority #1 Build and Operate a Central Receiving Facility/System to Serve Persons Experiencing an Acute Mental Health or Substance Use Crisis Overview: A Central Receiving System consists of a designated central receiving facility with 24 hour assessment, inpatient and related services that serve as a single point or a coordinated system of entry and treatment for individuals needing evaluation or stabilization under section 394.463 (Baker Act) or section 397.675, (Marchman Act) Florida Statutes, or crisis services as defined in subsections 394.67(17)-(18), Florida Statutes. The Collier County Community Needs and Assets Assessment (2017) noted the need for additional inpatient beds and more than 80% of its health focus group participants identified mental health and substance use issues as major public health problems. It should be noted that currently there is no local provision for involuntary inpatient evaluation or stabilization under the Marchman Act. Due to this service deficiency all persons requiring such services are treated at the Collier County Jail, a facility neither designed nor appropriate for that purpose. The Central Receiving System will include a secure inpatient Addictions Receiving Facility to address this major deficiency in our local system of substance use disorder treatment. CCSO Baker Acts (2001- 2018) 1750 1500 1250 1000 750 500 250 I 0 r-� N rn Ln k.0 � 00 O O O O O O O O O O O O O O O O N N N N N N N N M O rl N M'ZT Ln lD I� W O O O O O O O O O O N N N N N N N N N N Behavioral Health providers like the David Lawrence Center continue to see dramatically increased demand for services, as evidenced by CCSO data that shows Baker Act cases PAGE 9 increased from 1,182 in 2013 to 1,570 in 20182, or an increase of approximately 33%. Total services from DLC provided to adults and children also increased from 165,062 in FY 13 to 276,989 in FY 19, or approximately 68 %3. The Collier County Infrastructure Sales Surtax will provide $25 million to build a new facility that will house these services and increase capacity. While the Surtax will provide the infrastructure necessary to expand facility capacity, additional funds will be required to provide the human resources and other ongoing operational costs associated with the central receiving system. Funding to support operations, estimated at $2 Million - $3 Million annually, will require federal, state, and local funding. In 2016-2017 the Florida Legislature authorized the Department of Children and Families to support central receiving systems and awarded funding to 3 Florida communities. A Legislative Budget Request closely aligned with the requirements of the FY 16-17 appropriation and supported with matching dollars from Collier County appears to be a logical approach for obtaining the needed operational funds. The County will study multiple options on where to locate the facility, including the current site of the David Lawrence Center. Another potential option is to co -locate the facility with other existing government services, such as the Collier County Government Center. The location of the facility is an important decision that must take into account the comprehensive system of services outlined in this plan, existing demand, and future growth. Goal: Ensure that there is a coordinated system and adequate capacity to assure that citizens in crisis will be able to access emergency mental health and substance use disorder services over the next 20 years. Objectives: • Design, build, staff, and operate Central Receiving Facility/System including an access center and follow-up recovery -oriented treatment services in the community by 2022 • Assure sustainable funding to ensure ongoing Central Receiving operations over the next 20 years • Provide both co-occurring Baker Act (Crisis Stabilization) and Marchman Act (Detoxification) services as part of Central Receiving Facility/System • Explore the feasibility of providing primary integrated healthcare at the new facility Outcome/Impacts: 2 Information provides by the Collier County Sheriff's Office 3 Presentation to MHAAHC, September 2019 PAGE 10 • Increased access to mental health and substance use disorder crisis care • Improved crisis care by offering a full range of mental health and substance use crisis services and by providing direct linkage and a warm hand off to community - based services following crisis care • Reduced law enforcement processing time for an immediate drop-off • Provide appropriate jail diversion options and services • Reduced transfer time from local hospitals • Improved patient satisfaction with access to and quality of care in crisis services Data elements required to assess outcome and impact: • Episode of care data • Baker Act and Marchman Act Data - Both public and private facility data from residents and non-residents of Collier County • Law enforcement time in drop off data • Hospital transfer referral data • Crisis Intervention Team (CIT) data • Jail Diversions as a result of the Central Receiving System • Client satisfaction questionnaire at discharge Workgroup: Scott Burgess, Susan Kimper PAGE 11 Priority #2 Increase Housing and Supportive Services for Persons with Serious Mental Illness and/or Substance Use Disorders Overview: For people with mental health and substance use disorders, housing is considered a 'golden thread', providing the foundation through which all aspects of treatment and recovery are possible. When this basic need isn't met, people cycle tragically in and out of homelessness, jails, shelters, and hospitals at a high cost to individuals and society. The Urban Land Institute's 2017 report on housing, land use, and real estate issues in Collier County noted that an area of concern was the lack of residential mental health care and support services. Further, the recent Collier County Needs Assessment Survey identified housing as the number one community need. While this need extends beyond those with severe mental illness or substance use disorders, the housing shortage exacerbates the problem for these especially vulnerable individuals. Due to low incomes (typically less than $800 per month), discrimination, and difficulties in daily functioning, persons with serious mental illnesses and substance use disorders generally cannot compete for market rental housing. Additionally, affordable housing units and supported housing programs have long wait lists and few in need can access them. To be successful, housing supports should follow evidence -based and evidence -informed practices, including the use of the SAMHSA Permanent Supportive Housing Tool Kit; a 'Housing First' philosophy and model in which housing is a right, not a privilege; eligibility is not dependent on psychiatric treatment compliance and sobriety; and housing units are integrated within the community. An array of options should include rental assistance vouchers, rapid re -housing, recovery housing, transitional housing, peer run respite, and permanent supportive housing, each bundled with appropriate levels and choices of services and supports. Goal 1: Increase availability and accessibility of a variety of housing options and supportive services for persons with mental health and substance use disorders. Objectives: • All Collier County -approved affordable housing should include a required set - aside for persons with a mental health and/or substance use disorder, which may require Board of County Commissioners action • Increase number of private landlords accepting rental assistance vouchers • Increase number of supportive housing and supported employment providers or agencies • Increase individual incomes beyond disability amounts to ensure long term stability • Ensure supportive housing rents are limited to 30% of the individual's income PAGE 12 • Implementation of a high fidelity Permanent Supportive Housing Evidenced - based program Goal 2: Homelessness among persons with mental health and substance use disorders is rare, brief and one-time. Objectives: • 100% of people who are chronically homeless who are diagnosed with a severe mental health disorder will be housed within 7 days of enrollment in coordinated entry • 100% individuals who are homeless will have immediate access to low -barrier emergency shelter • 100 % of persons with a serious mental health disorders identified annually during the Point in Time count will not meet the definition of chronically homeless • Increase number of SOAR (SSI/SSDI Outreach, Access and Recovery) -trained staff and number of dedicated staff hours to facilitate attainment of Social Security benefits for eligible individuals Outcomes/Impact: • Increased number of affordable housing units available to persons with a mental health and/or substance use disorder • Increased number of persons receiving rental assistance/low income housing/housing voucher • Increased number of persons attaining SSI/SSD and accompanying Medicaid or Medicare benefits • Increased number of peer specialists employed in variety of roles in mental health and substance use programs • Increased number of days that residents are in stable housing in the community • Increased number of days that housing residents worked for pay Data elements required to assess outcome and impact: • Number of agencies/providers • Increased capacity/number of available housing units • Number of hours of supportive services provided • Number of persons or months on housing wait lists • Number of persons who are chronically homeless identified during annual Point in Time count • County annual housing report • State SAMH and Medicaid data systems • Drug Court Case management system PAGE 13 • Number of people accessing supportive housing upon reentry from county jail and mental health or Veterans treatment court • Local data collaborative reports • Cost effectives report on permanent supportive housing after implementation; and • Qualitative analysis from the residents served in supportive housing services; using individual and focus group methods Workgroup: Dr. Pam Baker, Cormac Giblin, Dr. Jerry Godshaw, Michael Overway PAGE 14 Priority #3 Establish a Mental Health and Substance Use Disorder Data Collaborative for Data Sharing, Collection and Outcomes Reporting Overview: Chapter 163.62 F.S. authorizes governmental and certain private agencies to share information. The mission of a mental health and substance use disorder data collaborative would be enhancing the delivery of mental health programs to Collier County residents by encouraging communication and collaboration among all related community providers, organizations, interested government agencies, and educational institutions. Potential partners would include, among others, the Collier County Board of County Commissioners; Clerk of Circuit Court; Collier County Sheriffs Office; the 20th Judicial Circuit; Central Florida Behavioral Health Network; David Lawrence Center; NAMI; Collier County Public Schools; Florida Department of Juvenile Justice; and the University of South Florida (USF) Department of Mental Health, Law and Policy (Louis de la Parte Florida Mental Health Institute); although not exclusive, those agencies would be the primary members of the collaborative. Goal: Create a data collaborative that will collect and analyze data from all stakeholders that provide services to persons experiencing a mental health and/or substance use disorder and use that information to continuously improve program quality and patient outcomes. Objectives: • To inform the planning and delivery of mental health and substance use prevention and treatment among all related community organizations. Multiple sources will collect internal data and share with other entities, providing a process for comprehensively using relevant data, both at the system and clinical levels. • Collect aggregate data for use in planning, quality improvement, program evaluation, and grant applications. A repository, along with staff, is required to maintain, aggregate, and disseminate reporting on the data collected. Data elements required to assess outcome and impact: A centralized data collaborative could collect information from entities including the David Lawrence Center, National Alliance on Mental Illness, hospitals, courts, law enforcement, community providers, including but not limited to: • Numbers and demographics of persons served by each cross -system and provider • Calculation of the cost or persons served by each payer system, DCF, Medicaid, County Jail, Medicare/Medicaid, Department of Corrections, housing etc. PAGE 15 • Demonstration of cost avoidance in criminal justice involvement through jail diversion and reentry 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 the community health system Action Items: • Start with a list of data points to report on - including frequency, length of treatment, outcomes, granularity, and sophistication of data efforts can be leveraged from those employed in other communities • Consult with the USF Department of Mental Health, Law and Policy about existing data collaboratives and permissions necessary to access public data • Draft MOUs for each participating entity surround collection and distribution of data • Establish a steering committee to guide the project development • Design a project plan to establish the database to house collaborative data • Begin to collect data and report on a routine basis Workgroup: Sean Callahan, Dr. Jerry Godshaw, Michael Overway PAGE 16 Priority #4 Increase the Capacity and Effectiveness of Justice System Response for Persons Experiencing Serious Mental Illness and/or Substance Use Disorders Overview: Persons with mental health disorders and/or substance use disorders are at disproportionate risk to experience involvement with the criminal justice system. Predictably, traditional justice responses such as jail or prison have done little to address what is ultimately a treatable medical problem. Communities have been frustrated by poor outcomes among this population in traditional justice settings, as persons with these disorders have cycled in and out of jails at great expense, with no discernible benefit to the individual or the community. Enter the Problem -Solving Court movement, now an international effort, which began when Miami -Dade County created the first drug court in 1989. The Problem -Solving Court model has evolved to recognize certain key components, and corresponding standards have been developed to ensure that all courts incorporate those components. Simply stated, the model involves a multi -disciplinary team, led by a judge, serving a targeted population within the criminal justice system which has an identifiable and serious need for treatment intervention. The team aims to identify, as early in the process as is possible, those persons in the justice system for whom a program of intensive treatment, supervision and accountability can reasonably be expected to end the justice involvement successfully, restore the individual to wellness and self-sufficiency, and facilitate a lasting recovery from the disorder(s) that contributed to the criminal conduct in the first place. The Supreme Court of Florida has promulgated standards for drug courts and is preparing to promulgate standards for mental health courts and Veteran treatment courts. Additionally, the Supreme Court is working on a certification process for these courts, which will ensure fidelity to the promulgated standards and maximize chances for the best possible outcomes across a variety of populations in the state. Further, the Legislature has created a dedicated and recurring funding source for these courts, with funding expected to be tied into the upcoming certification process. Now is the time for significant advancement of these powerful courts, and communities are wise to commit themselves to positioning their courts to take advantage of these developments for the best possible service of their populations needs. Collier County has long been a leader among counties in this regard, and has had a drug court since 1999, a mental health court since 2007, and a Veteran treatment court since 2012. Significant steps need to be taken in order to ensure the sustainability of these courts, as well as to continue to grow and improve them. Recidivism rates are notably lower for graduates of problem -solving courts, nationally 12-40 %, compared to recidivism rates from the Florida Department of Corrections of around 65 %. For 2018, and through September 2019, graduation rates for Collier County's three problem -solving courts were: PAGE 17 • Drug Court - 60% successfully graduated • Mental Health Court - 63 % successfully graduated • Veterans Treatment Court - 75% successfully graduated Immediately following the June 2018 Board of County Commissioners' workshop on mental health and addiction, a Rapid Response Team was formed in the 20t" Judicial Circuit to address profoundly mentally ill persons in jail facing misdemeanor charges. Since then, fourteen individuals have been served, of which three are currently active. For the other eleven, only one has had a negative outcome, having failed to remain connected to services and being re -arrested. All others have been considered successful outcomes. In addition to problem -solving courts, there are a variety of related and complimentary opportunities for increasing the capacity and effectiveness of the justice system's response to this population. Persons with mental health and substance use disorders are not only disproportionately represented in the criminal divisions of the justice system, but also in the family, domestic violence and dependency divisions. Expanding behavioral health training for judges and practitioners within each of these divisions will ensure that persons in need of treatment will be assisted in accessing it, and outcomes overall will benefit from this holistic approach. Goal 1: Expedite deflection and diversion of persons with mental health and/or substance use disorders prior to arrest and from jail to treatment, thereby reducing recidivism, improving community safety and directing resources to optimize outcomes. Goal 2: Expand trauma -informed and trauma -responsive practices to all divisions of the justice system and incorporate the use of court -supervised clinical assessments and treatment plans as appropriate in each division. Objectives: • Ensure the sustained commitment of dedicated resources from each of the disciplines represented on the multi -disciplinary teams for each problem -solving court • Ensure the achievement and maintenance of certification status for each problem - solving court, so that stable funding can be obtained, and the overall sustainability of these courts can be secured • Ensure the collection and analysis of robust data in connection with the operation of the problem -solving courts so that proper periodic evaluation and adjustment PAGE 18 of the courts can be made to optimize efficacy, and so stable funding can be obtained and maintained • Expand capacity of existing problem -solving courts, including the case management services to support persons served by the court in the community. • Increase the accuracy and speed with which all incarcerated persons are screened for mental health and substance use disorders • Ensure that incarcerated persons who have been identified as having mental health and substance use disorders are referred to appropriate jail -based or community -based treatment services, as appropriate, and that they are referred promptly to an appropriate jail diversion program or problem -solving court. • Expand capacity of jail diversion programs for persons with the most severe and persistent mental health disorders, including the case management services to support persons served by the court in the community • Implement medication assisted treatment in Collier County Jail and ensure continued access to same in the community upon re-entry, regardless of whether an individual is involved with a problem -solving court or diversionary program. • Increase training for judges, attorneys, probation officers, investigators, case managers, law enforcement officers and all other justice personnel in the causes and treatment of both mental health and substance use disorders, and in topics related to trauma, adverse childhood experiences, and trauma -informed and trauma -responsive practices • Encourage judges across all divisions to employ trauma -informed practices in addressing parties who come before them, and to ensure that courts are set up to be trauma -responsive whenever possible Data elements required to assess outcome and impact: • Reduced number of arrests and re -arrests • Increase number of incarcerated persons who are screened for mental health and substance use disorders • Identify the number of people with co-occurring mental health and substance use disorders, also in need of primary health care • Conduct an analysis of the number and percentage of people served by the court who have any type of health insurance • Improved symptoms • Improved child and family reunifications with supports • Reduce time between removal of at -risk or dependent children from parents and reunification of the family unit • Increase number employed • Increase number receiving additional education and training • Increased independence and self-reliance • Maintenance of sobriety - number of days sober • Reduce relapse rates • Increase medication adherence rates PAGE 19 • Reduce time between arrest and screening for mental health and substance use disorders • Reduce time between arrest and referral to an appropriate problem -solving court or diversionary treatment program • Increased stable housing • Increased number of treatment services • Increased number of appropriate referrals into diversion • Increased capacity of each diversionary court program • Increased graduation rates • Increased pathways to treatment (new programs) • Reduce the number of adverse childhood experiences for children of adults involved in the justice system, and increase opportunities to build resilience for them Workgroup: Judge Janeice Martin, Trista Meister, Janice Rosen. PAGE 20 Priority #5 Revise and Implement Non -Emergency Baker Act and Marchman Act Transportation Plans Overview: In the continued best interest of persons in need of behavioral healthcare in Collier County, there is a need to establish a non -emergency transportation plan for individuals receiving involuntary evaluation and/or treatment under either Chapter 394 or 397 F.S. (Baker Act/Marchman Act) who are transferred between local receiving facilities and local hospitals. The plan will ensure the coordination of services among providers in Collier County and provide timely access to care for persons experiencing a mental health/ substance use crisis. Emergency transports of individuals having a mental health/substance use crisis will still be completed by law enforcement. The impact of law -enforcement non -emergency transport of individuals in severe mental health or substance use crisis adds to the criminalization of mental illness/substance use. It can also project a perception of adverse consequence(s) for the individual(s) seeking help and delays access to timely treatment. Law enforcement involved in non -emergency transportation can also cause further trauma to an individual. The benefit of a coordinated system of care is less fragmentation of services and a more human, efficient and cost-effective method of providing transport. The Collier County Sheriff's Office has spent a considerable amount of time and money providing non - emergency transport of individuals with mental illness and/or substance use issues from facility to facility. The amount of time law enforcement has spent in non -emergency transports of people in crisis between facilities sums up to over 2,150 hours since 2017 at a cost of approximately $250,000. A non -emergency transportation plan will free up law enforcement to provide service and safety to our community. The plan will largely eliminate non -emergency transport by law enforcement, providing a more dignified, humane, and timely method of transportation to and from acute care facilities. Hillsborough and Sarasota County have implemented non -emergency contractual transportation plans with external transportation companies that pays for indigent care to reduce the demand on law enforcement transportation. The transportation providers may bill individual's private insurance or Medicaid/Medicare. Collier County can utilize the design and experience of these non -emergency plans in design of our non -emergency transport plan. Goal: Whenever possible, the transportation of an individual under the Baker Act or the Marchman Act from a medical facility to a receiving facility will be completed by a non - emergency transportation provider. Objectives: • Implement a transportation plan that utilizes non -emergency transportation companies (Ambitrans, MediCab, David Lawrence Center approved staff, or PAGE 21 hospital -approved transportation) to transfer individuals being evaluated to treated under the Baker Act or Marchman Act from a medical facility to a receiving facility • Establish safety provisions that include appropriate medical equipment or safety equipment to meet client needs • Establish appropriate level of supervision to ensure safety and prevent elopement Outcome/Impacts: • Provide a dignified, humane, and streamlined method of transportation to and from acute care facilities • Patient satisfaction with quality of care between receiving facilities • Enhance the ability to fully utilize the capacity of acute care services in the county and reduces the unnecessary delay of transfers between facilities • Reduce the time that law enforcement is diverted from its primary duties to transport a person being evaluated or treated under the Baker Act or Marchman Act between receiving facilities and local hospitals • Law enforcement and Collier County EMS will continue to transport Emergency Baker Act or Marchman Act individuals to the appropriate receiving facility; and • Enhanced continuity and care coordination among providers Data elements required to assess outcome and impact: • Collier County Sheriff's Office non -emergency Baker Act and Marchman Act transport calls for service to David Lawrence Center • Collier County Transportation Plan 2017-2020/Suncoast Region Substance Abuse and Mental Health MOU Workgroup: Lt. Leslie Weidenhammer, Susan Kimper PAGE 22 Priority #6 Improve Community Prevention, Advocacy, and Education Related to Mental Health and Substance Use Disorders Overview: Preventing mental health and/or substance use disorders and related problems is critical to our community's behavioral and physical health. Prevention and early intervention strategies can reduce the extent and impact of mental health and substance use disorders in Collier County. Prevention approaches focus on helping people develop the knowledge, attitudes, and skills they need to make good choices or change harmful behaviors. Substance use and mental disorders can make daily activities difficult and impair a persons ability to work, interact with family, and fulfill other major life functions. Mental illness and substance use disorders are among the top conditions that cause disability in the United States. In addition, drug and alcohol use can lead to other chronic diseases including diabetes and heart disease. In 2017, 11.2 million Americans 18 years or older had a serious mental illness and 19.7 million people reported having a substance use disorder in the past year. Many individuals experiencing a diagnosable mental health or substance use disorder do not know they have one and do not seek help. For almost all mental health disorders, people delay getting help, the median delay is 10 years, and of those who have been diagnosed with a mental illness, only 41 percent of persons access mental health services in a given year. Collaborative and coordinated community efforts to provide awareness, education, prevention and advocacy are critical to reducing the stigma associated with and the myths surrounding mental illness and substance use disorders. A greater understanding of mental illness and substance use interventions can offer the community invaluable information on access to resources and better methods to support those who may be experiencing these challenges. Implementation and supportive delivery of evidence - based educational opportunities will allow individuals, community and family members and businesses to better identify when someone may be experiencing mental health and substance use issues and seek help sooner. Targeted public service information and resources around mental illness and substance use will further contribute to stigma reduction and expand awareness of educational opportunities offered in the community. Goal: Provide evidence -based education and training on mental health and substance use disorders to the community at large. Objectives: • Create an ongoing mental health and substance use disorder educational program for community businesses and organizations to increase knowledge and public awareness PAGE 23 • Make available ongoing education to 100% of the Collier population to increase access to services and reduce stigma related to mental health and substance use disorders • Develop prevention and education activities in collaboration with SW Florida Blue Zones Project and other health focused community organizations • Expand the delivery of Mental Health First Aid Training in the community Outcomes/Impact: • Increase knowledge and awareness of mental illness and substance use disorders to increase access to services • Increased awareness and education can also increase availability of funding for programs (private donor, grants, etc) • Reduced loss of life and overdose due to substance use and suicide in Collier County • Decreased percentage of those experiencing symptoms of mental illness and/or substance use enrolling in healthcare services Data elements required to assess outcome and impact: • Number of participating businesses and organizations in Collier County • Number of educational programs provided • Number of attendees • Assess how the training was implemented • Survey assessment of increased knowledge Action Items: • Establish or identify the evidence -based programs to utilize for trainings and certification processes (ex. Adult and Youth Mental Health First Aid, Trauma Informed Care, Suicide Awareness and Prevention, Substance Use Prevention and Treatment) • Identify collaborative organizations/agencies and staff to provide education and awareness programs and materials • Identify businesses, organizations, professionals and communities for roll out (stages, communities, workplaces) • Identify Public Service Announcement opportunities and methods of delivery (TV, social media, brochures, town halls, ads) • Develop and disseminate materials (how, where, to whom) • Evaluate effectiveness of programs/materials utilizing pre/posts/surveys and data from Community Health Needs Assessments Workgroup: Caroline Brennan, Council Member Michelle McLeod, Pat Barton, Dr. Michael D'Amico PAGE 24 Special Consideration #1 Improve Services to Veterans Experiencing Mental Health and/or Substance Use Disorders Overview: Veterans make up approximately 10% (26,094) of the adult population in Collier County, and an estimated 3,200 are post -Gulf War Veterans. As a country, and community, we have a responsibility to help these Veterans and their families, who from time to time are in need of an array of programs and services that cannot be solely provided by the Department of Veterans Affairs (VA). Veterans receive the best care when local communities work collaboratively with the VA to provide a variety of supportive services. Within this population the most significant issues are Post Traumatic Stress Disorder (PTSD), traumatic depression, Traumatic Brain Injury (TBI), military sexual trauma, and Veteran suicide. Nationally twenty (20) Veterans a day die by suicide, which is twice the rate of the non -Veteran population. In addition, it is estimated that over 40% of Veterans are returning home with PTSD and/or TBI. The primary reason is due to multiple tours of duty which are unique to this generation of warriors, and the exposure to "Blast" trauma to the body. These invisible wounds of war present create unique health and transitional issues for Veterans that result in mental health and substance use issues. The impact can be devastating for the Veterans and their families. There is a need in our community to design and implement services and programs to meet the unique needs of our Veteran population. Goal: Make the public and the Veteran community aware of the transitional, mental health, substance use, housing, and employment needs of post -combat Veterans and mobilize resources to address these issues for Veterans and their families. Objectives: • Reduce Veteran suicides - ensure that trackable data exists for Collier County • Reduce Veteran substance use - 274 Collier County Veterans were treated by the VA in 2018 • Reduce the number of Veterans arrested in Collier County, currently approximately 100 per year • Continue to keep accurate data on Veterans who are homeless and have mental health and substance use issues to advocate for various grant programs, to include VA's Homeless Providers Grant and Per Diem Program, the VA's Supportive Housing (HUD-VASH), Low Demand Safe Havens, Substance Abuse Treatment Programs and Community Resource Centers for Veterans PAGE 25 • Increase the participation rate of Veterans in the diversion program provided by the Veteran Treatment Court • Reduce the number of homeless Veterans. A count conducted in July 2019 identified 40 plus homeless Veterans living in Collier County • Include a part-time social worker in the staffing of the Central Receiving System to interact with and ensure that Veterans are linked with specialized services to meet their unique needs • Employ a full-time social worker or other liaison as part of the Collier County Veterans' Service Office responsible for coordination of mental health public education, outreach to Veterans and families, coordination with services at Bay Pines, VA, Hunger and Homeless Coalition, Home Base and other service providers • Increase access to combat related unique treatments • Educate and advocate on behalf of Veterans regarding size and demographics of this group in our region • Make Veterans and their families aware of and engaged in the programs and services Data elements required to assess outcome and impact: • Number of homeless Veterans; number offered housing • Number of Veterans arrested annually • Number of Veterans enrolled in treatment • Veteran treatment outcomes Workgroup: Dr. Thomas Lansen, Dale Mullin PAGE 26 COLLIER COUNTY MENTAL ILLNESS AND ADDICTION AD HOC COMMITTEE MEMBERSHIP Mr. Scott Burgess (chair), David Lawrence Center Dr. Pamela Baker (vice -chair), NAMI Collier County Lt. Leslie Weidenhammer, Collier County Sheriff's Office Council Member Michelle McLeod, Naples City Council The Honorable Janeice Martin, County Judge, 201h Judicial Circuit Ms. Caroline Brennan, Collier County Public Schools Mr. Michael Overway, Hunger & Homeless Coalition Ms. Susan Kimper, NCH Healthcare System Mr. Dale Mullin, Wounded Warriors of Collier County Dr. Paul Simeone, Lee Health Ms. Trista Meister, Mindful Marketing Ms. Pat Barton Ms. Janice Rosen Dr. Jerry Godshaw Dr. Michael D'Amico Dr. Thomas Lansen Mr. Russell Budd Mr. Reed Saunders Staff Liaison: Mr. Sean Callahan, Collier County Consultant: Mr. Chet Bell Technical Review: Mr. Mark Engelhardt, University of South Florida, Department of Mental Health, Law and Policy, Louis de La Parte Florida Mental Health Institute PAGE 27 APPENDIX A: FINANCIAL CONSIDERATIONS One of the items that will need to be considered is the cost of the services outlined in this five-year strategic plan. With the increased demand for mental health and substance abuse services in Collier County, the Board of County Commissioners has continued to increase the amount of funding available and is planning to appropriate over $2.3 million for David Lawrence Center in FY 19-20. This would represent an increase of roughly $950,000 in County funding to DLC compared with FY 15-16. Over this same time period DLC operating expenses, associated with growing programs and services to meet the increased demand in Collier County, have also significantly increased and are projected to grow in FY 19-20 by almost $3.9 million compared to FY 15-16. While the County has increased funding, the State of Florida continues to be one of the worst funders in the nation for mental health and substance use funding4 , has higher uninsured rates than the national average (approx. 13% vs. 9%) and Collier County has one of the highest uninsured rates in our region (16.8%). With the passage of the Collier County Infrastructure Sales Surtax in 2018, $25 million in funding is now available for the construction of a Central Receiving Facility. This funding is limited in scope to be used only for infrastructure improvements and construction, which leaves the funding of operations of the facility to be determined, estimated at $2 million - $3 million per year. Should the Board of County Commissioners adopt this strategic plan as presented in this report, the remaining items will also need to have funding identified for implementation. This plan cannot solely rely on increased funding from the County and will need a comprehensive strategy to leverage federal and state funding, along with private funding to be raised from the community. However, in addition to the hard costs associated with the plans implementation, a successful continuum of care for mental health and substance use issues will drastically reduce costs to the County. For example, cost avoidance analysis has revealed that nationally $3.33 in "hard" justice (e.g. incarceration) costs are saved for every $1 invested in Drug Courts, and number goes up to $27 when "soft" (e.g. reduced child welfare, reduced ER visits, increased employee productivity, increased tax revenue, etc.) costs are mixed in. In 2015, the Pinellas County Board of County Commissioners committed funding to address the needs of residents with serious behavioral health concerns who are frequently hospitalized or incarcerated. The Pinellas County Empowerment Team (PCET) pilot program was developed to respond to these issues and began delivering services in June 2016 to a select group of individuals who represent some of the highest service users in Pinellas County. In the "Year Two Cost Analysis,5" it was found by the a https://www.news-press.com/in-depth/news/local/2019/05/05/crisis-without-end-florida-ranks-last 5 PCET Empowerment Team High-Utillizer Behavioral Pilot, Year Two Cost Analysis, 2019, USF PAGE 28 USF Department of Mental Health, Law and Policy, (PSRDC - Policy and Services Research Data Center) that total costs for these systems decreased by 58.8% ($610,682) in the first year and 56% ($580,321) in the second year for a total savings of $1,190,603. Similar results in cost reductions can be expected in Collier County if this strategic plan is implemented and will be tracked through the implementation of the data collaborative outlined in the plan. This will lead to a better system of care for Collier County residents, as well as recoup some of the initial investments made in the plan. PAGE 29 APPENDIX B: RESOLUTION 2018-232 AND EXECUTIVE SUMMARY ] V11I701 S U\I'{'I I'LVY1%,I %I%IIItl' R-et,uni tenndaliuie lu adupi ai resu€utiun Oslahlishihk E11V {'+,Ilit-r ( uunty 1iaalal IIc-a1lb and Asldictiou-lal IfoeAdviwr4 Comnillteu. OFITYCTIVE, To esiabliab the Calker Caunh• dental Hcalih and addiction Ad Hoc Adtiiaco-v i'ONS DERATIONS= On Jame 6- 20M the Guard held a xsorls wp to elicil community wide input reie rdivg the Wv Unt and wo-wingnnA far e.�pancl;jd rnrntal health and rubiclam% Use (heb3viural heAlfh) aeit'iM in sour cummunily- Wodship eu",holders, including l+eli,Miorat ht:altli pixr`, &I-4_ !aw enrarv=unt- judiciary- and family mrmbm- pmwnted the aarrsnt descripLicm- status- suec es- cha€€"tg FL ryaps. and LVpuourd ics wkhua the €oml systeynofcare, Since'2010- thr< (71riminai JWietl, MLmtal Il%:alth and Substanve Abusc I.C=AJiISA) Planning Cuawil has mainlained atratepis plimmi M ciftcal €V uul] ining 6:00rc iuW Iocal appi nacho s far llie population of pc"om with to kvs mensal i €tn+ais� u'ho arc in the criminai jusit oo %ystom. However. tb= is no such coordinating pion For the much larger pnputatirm of pmplrs wkh mental klW11i and sub�tanec use prohler nawhn do not fall vats that caingaryahough a] I arcat risk- Tho c0nc]ai9id3n of die hose wnrkshop was that a camm mity-wide- integrated strategic plan was needed to conrdinalt` local responses and ma -Linde scar6V resnm ues. To facilitalt the plan, in November 2017 and again in May 2018, lark GnKelhardE -'113V4`- director of the { 3- E4$A Technical AusLarice C'enterat Uriii'i;raity of South FIf ida's Florida dental Health Enstiwtr,, facaliloted cammuaiLy-wide strategic: planning wseicw- Rdween and fulluuing thas.e meetings_ infurmal pvuFn have 5tvn msxiing monthly to pnrvide, add6u-nal input. On Junc 5_ 241S, the Board conducLed a "x-ond rmmwl hwallh veorkshop whUv reprtnsrntati,,-t* from t1w CIFYmnly'x se%-e-al ratFLW health tTqnnnii, and rest=La rat -.mac 1&i edhely to discuss Lhc L'unrunt Altus 19b mental illness and subsUn" kLw disorders in Collier Courtly and potential solutions to w:isl.ing problemu- ,V the %vorbhup- the Ykwd dim isaged the cfeaiion of an ad hoc advisory wmmilwe consisting of tvsp,r+ssti [atives of tttmul and heliavitmtl Iwattli organixaticrm anal programx with 11io }wrlxn3e i}f campiiuig attd ixpolling to the Hoard of Counly C'oisimissioam a 'anegic plan w itriproLx scrviucs far mental illness and Nulbstarioe rise disonkm provided in the County, frallavwing whidi die ad lion oc nmmitlee would lea dissolved Participants in dw plarming s.oaaicros agrued upon waveral prioritioe sect i&ntiti-vl a iuul petsun (or peons) m the Junc 201tt worbhop t0 owscc cwnliriucd pinning and ccul'Eon ol"ohjcxiitiva said action .4ugw fbr "ph pxoarity- Thwdtl o, tt is 1hr, rcuomu ndadon +xf staff khan 1hc fcr€€nwing individak are appointed to the Collier County llk nial Health and Addiction Ad Hac AdMsnry Commitice: ■ OMa 40 ee-preserflcr(rm cdes{&mawd Fv r+ Ecle'rnns servIL-€s aWcenr.utiow Chile Mullin- Pmai&A Wounded Warriuss of Collier County • One ff1 repm.mutatove desrgmereal tw the C'oifk-jL Comm)- Sher "a t7ft& LI. Leslie Vi wAeuharoroer, Collier County Sherfir-4 Cdrwc • one! r7o pychfrrrrfsr cw psyCAVIOVA dreclrseJ ?0 pt'ar fiC4c rM Mcwoda: Dr. Erred} FYaszdlx. Hesltlsauc tictaworl:ofSouthwca Fkri&, PAGE 30 11111 201R • One f1) &harioral heulrh profrsa'k, fjcenh' lu pnecrlc'e to 17cvkio: Susan Kimps7_ Nfopl6s Cnrf .ity Hnapi#nl • Ode 11) mlFdieal hanilhproftssiculat. Dr- Thtrrnae I.anscrL N4ples_ FL • One (1) represenrafm from the Dowd Lowmme C6wrer, Mo. Seott Surgeas. CEO- Dwiz tawfl.fice Center • Une T l) an Nm baker, (SO. Natiolml Alliw= on Menial I[lncss • Represemlomias el -large worh rie ar o dm+ gmtra+red interest pn pwntol i wss and substance use duordms: Judge Janeiue T. L%Amlhi. Collier Camay 201 Judicial Cimuit Folloa►mg tines initial appoirdmmts- the rcmaaiusg vacancisz on the Qmrrnittee will be Gl'led as presctibud in the resolution- FI;SCAL BrIPACT: 'I1r m arc no fiscal kgpacts assncial�d uiLh thi41 [ccuii��e S+uiunat�, OROWnI NIANAGENIFN'T INEP-WT; Tharc imec mi Gro►,th hfana rnrnt Impacts ahmm aw with thffi Execartive 4umm y. LEGAL ('0"!5IDOUTIONS. This item baa betm reviewed by tho Gomm- AmMey- is appFMFp] as to 1{11m al Itg;rlity- and mIkki es a wajOritYvote f v appteval. -J;1F: RT-'.C()Wdl.N:1)Aj TON: 'tb adapt a mmol0ion e81ab16hing tlrc ('0111a. Cauaty L%kntal H01111 and AckliCtiOiL .mil Ilo4 f1 VLv (Wy COMMiq-M, Prcprared by: Scan Ca 11ahan, E,roculivr DircL. w. t.orpirratc Fkmin ss Opiwatiam ATTACHNfE TOO I. Resolution dental Illnrss and AAdiotim Ad Hop Adtisark Committoc � PDF) PAGE 31 RESOLUTIONS No. ;(lW A RESOLUTION OF THE 130ARD OF COI;h'IY COMmLSSIONE€ts or COLLIER COUNTY, FL.ORMA, ES'rARL1%"i t(; THE COLLIER COUNTY ]RENTAL ILLNESS AND ADDICTION AD 110C ADVISORY CONE alf'[TEE, WHIZ REAS, OH 3une 5, 241 k cJ c F1Ck" of C'otlnt}'COnmtissionerx of Collier-'aLmty cnndusted a mental health "rkshop where reprc5etttativcs fFm the county's several mental health pmgrams Rnd teltlttroes came tngetherto diacussthe cun-nl staius onmental i.ilness andsuhstance use disorders in Collier County and p n;ial Solutions io existing probiem; and WHEREAS, aL the workshop, the Commissioners discussed the creation of an ad hoc advisory committee cvmsisting of representatives of menial and beheviomi health orgaiiixations and pnpgrAms with the purpose of compilim�,tnd rcpcni,tg to the Board of County Commissianers a UTme& plan to impnwe services for mental illnmis and substance uw di;;orders provided in thcCounty, following which the ad hoc rurnminre umuld be dissoh-cd; and WHEREAS. it is the desire of the Board that the ad boc committee provide input Crum all mdtiCs inwoived is pros idiq ns9istanre tv, and the treatment or, persums with trwrdAi health and add ict" issues, hoih puhl ie and private, as wetl as meinbers of the public, to iderttifycxisling mental and behavioral health scrvim issues in Ilse community meld to ensure the kmlusiom of all possible services. treatment, and pulrli¢ and privt+te t<sslstfime for County rnsidenls skugglingwith mcrtmal illrtesa anVorsubatance rise disorders. NON41, THEREVORE, 13t IT ]RESOLVED BY TITE oc)ARlp OF COUNTY CGMVIISSJION1ERS O>H COLLfFR COUNTY, FWRFDA, thei: SECTION ONE, Cmiion and hu rposc. of the Collier Coo oty KewNi likes& itnd Addietiun Ad Hoc Advlaory Committee, Pursuant to the provisions of Collar County Ordinance No, 2001-55, as amondeo, the Dowd of County Commimioners hemby cstablishcs the Collier County Meeiml illness and Addiction Ad floc Advisory C'ommimm to prepare and presem to the Raard of County Commissiatets a Ikl pwrt and Rommmrndatipn as to what actiottx the Bound of Caanry Commissioners Should tale to nwximiu the accessibility, 4fic, c cy, and eMcl Lvenms of services for mental i 1 mess and substanac use disorders for the citizens of collier County - Page ] of 3 PAGE 32 SECTION rWO- Appoinimeoi of N emhcm Mv0mhip itltuUricCommitlee $ball not exceedriWeen (19) individuals, who shalt initially be aappeimed by the fiogrd, Crntsidora6a for membership wits Ise given tocnsurc gcograpbic acid bacicgrorrnd divcmky. Special qualMeations fur mtrmbership include, One (1) repmemtutive dpsignarccl by a Veteran services organilaaioer, One (1) represertta4tiwe designated by the C-1I ier County Sheriff's Office; One ( I) represemetive designaied by as Collier Coumy gvwwr entity which prow ides funding nr providers of aervicc5 for mental ilhim and substamr use diwrdcm for adults; One (1) psychiaarist or psychologii% licensed to prociice in Florida; One (1) bebAvioraJ health professional, iioenwd iu prattice in Florida; Om (1) me+dieml hea h prtrfessimal; One (1) representativrc from a hotrtelcssncw advocacy organi2se=-, One (1) representative from thr David I-awrencc CSC' Lqw, Inc. (DLC): One (1) representative From Ehc Nauipoat Uiuke on Mental IJtdem (NAM 1); Ono (?) wiii5cd peer specialist; D11e { t ) reprcwnUrLiYc from the recnvt ry community; Representatim fibm the local business comm4nity, and Repremutetives at -lame with experknee of o demonstrated interesE in mental itlmess and smhstencE; use disorders- GeoRmphical preference will be given to (1) applivarw from m1i Coietnissionet 13istrict, SECTION THREE: Dllicere, Quaram, and Compnsilion. At the Commitlee's first muMingthe meinb--rship shall eleai a Chair imd Vice -Chair, The peke of nt bast half of the m cmbarp shall emstitule a quorum_ Following the fires meeting. atdditiorim] numbers can be added by malodty vote of the C xhmittce then present 'l'h,c Commitwe may foam sub�oommittcm a-5 k deenis tit. All meeting of the Comm in= sere} any sub-commfnee shall bt upcn tD the public, with tvasUoahle notice nfsuch meetings given; shall be head within Collier Czortty; and shaill follow Robert's Page 2 of 3 PAGE 33 RuIG& of Order for the trm mmian of husinesS, wish mimkWs oftite meet inp taken and pmimpdy recorded w[Lh the Clerk. The County Mukagershp3l appgint a staffliaisan la thtCpmmittcc, tvlio SINAI br MSlxtttaible For the adm injsvati&n of the Committee_ The members of the C u Minee -Sh ul t senVe u ithout Mnpensatiun, hot may bo reimbtrrsed Ahr vmvel, ntileegv, andlar Pqr diem cxpeasrs if approvc+d in advance by ihL Board, SEC7745N FOUR: Ftt meliuns, Prmwers, and DO Ica ai I he -Cam mittw. T11e primmy respnttsihillty or this ad hex Cmnmimc shall be gathering inronnatian regarding existing and future mental illness and addicrion sen•iq¢s 1301icies, issues, pr{rgrams, and plims thni will support the purpose us set forth 1 CFOR: Wr ing as a public forum for a discussion of chase matters; and premrkd% to the ti-,arc{ of County Comm i ssia mrs a final IZE' m; arHd Rccommendatko. SECTION FIVE: Dlmlttlildn orenmmwee, U-Mess exrended by kewltnion of dw Bt%ard, this Cnmmittee shill tulttummticaily sunset Y011mij fumber aL6m upon making Its finial Rcrport and k ecmnmcndation so the Hoard of c7aun%- CcDmmisaianers, PA45FI) AND I)(IC,Y ADOPTED by the SaMd' of C'otmty C-mom ssiorims of Collier County, Flori, a, iltis duy LA' , 2018, ATTEST: BOARD OF COUNTY COMM ISS IDMERS CF)stml K. Kinael, Clerk COLLIER COUNTY. FLORIDA Bv: fly_ I3oputy Clsrk ANI)Y tif7Li5, UTAIRMAN im: Jrffrcy 44 F 14-o +', County AttmTtgv Pagt: 3 of 3 PAGE 34 APPENDIX C: EVIDENCE -BASED PRACTICE AND SAMHSA TOOLKITS Evidence -based practice (EBP) began as a movement when the concept was formally introduced in medicine in 1992. This represents an attempt to systematically address the research -to -practice gap that exists in areas of clinical practice, operations and policy - setting, leading to the adoption of more rigorous, proven, and effective methods. Since then, the methodology underlying EBP has been applied to various allied health disciplines, along with spreading to other fields such as management, education and law. When this occurs, the evidenced-base/informed approaches implemented are often referred to as "best practices" in any given application or field. At its most basic level, EBP bases systematic decision -making - in operations and clinical practice - on existing science to reduce variation, improve outcomes and reduce cost. Moreover, wherever possible, it also takes into consideration critical population parameters, extant values, preferences, and available resources, along with environmental and organizational contexts relevant to EBP implementation. A distinction is often drawn between "evidenced- based" practices, where the benefits of a process or treatment are delivered under highly controlled conditions, versus "evidenced -informed", which describes the modification of EBP to be used under less ideal circumstances. The latter represents the modal use of EBP practices and is regarded as a sensible place to start when such ideal circumstances do not exist. The Transdisciplinary EBP model (Satterfield et al., 2009) depicted below illustrates an optimal process where decision -making (and clinical practice) takes all of these variables in to account, against the backdrop of the best available research evidence, to deliver context -relevant, "best practices." Transdisclplinary ESP Model 694k O �a - - � � co►K� `ti smog"% � r f I .f prahr�nn � � $iltyrri4lrF. �xrr�, $rGwrMaL 1�'bn. T�ritqura, � Yrhwuc� I�O4h T�.+HW � fiwRd�w4ey� rtsdM ei aurd�.daa� pia buam�rry, �T(7J 3M6 S9a PAGE 35 The use of evidence -based or informed practices and services in the implementation of this strategic plans Priorities will enhance quality and cost effectiveness for the targeted mental health and/or substance use disorders programs and services proposed. Therefore, the Committee recognizes the importance of using SAMHSA's Evidenced - based Program (EBP) Tool Kits, Best Practices and Guidelines. A full list of SAMHSA's EBP's can be found at the SAMHSA EBP Resource Center: https: / /www.samhsa.gov/ebp-resource-center In alignment with the Priorities in this strategic plan, use of the following EBP Tool Kits in program implementation are recommended: • Permanent Supportive Housing; • Supported Employment; • Integrated Treatment for Co-occurring Disorders; and • Assertive Community Treatment The following Guidelines are useful best practices for the implementation of this Strategic Plan and are also recommended: • Principles of Community based Behavioral Health Services for Justice Involved Individuals: A research -Based Guide; • Medicated Assisted Treatment in the Criminal Justice System: Brief Guidance to States; • Recovery Housing: Best Practices and Guidelines (Substance Abuse); and • Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice. Outcomes/impacts of utilizing EBPs: Patient -centered metrics • Decreased symptoms per targeted disorder (e.g., anxiety, SUD, trauma) leading to improved global functioning; • Increased # of days of work for pay; • Lower arrest/incarceration rates; • Decreased number and severity of medical co -morbidities (Congestive Heart Failure, Diabetes); • Decreased number and severity of negative social determinants of health (housing, income, safety, education, access to health services); and • Increased patient satisfaction. Outcomes/impacts: Operational Metrics • Increased training opportunities negotiated and initiated; • Increased number of staff trained in evidence -based treatment/practices; PAGE 36 • Increased number and percentage of patients referred to evidence -based treatment as opposed to treatment as usual; • Higher treatment adherence and completion rates of patients in evidence -based treatment as opposed to treatment as usual; • Lower "no show' rates in evidence -based treatment as opposed to treatment as usual; • Increased number of patients screened for various mental health/substance use disorder problems; • Decreased admission/readmission rates pre/post implementation of evidence - based practices; • Reduced number of ED visits pre/post; length of stay in outpatient treatment; medication compliance; and • Increased number of case management contacts with peer specialists and care managers. PAGE 37 APPENDIX D: 2018 DRAFT STRATEGIC PLAN CULLICRCUUNTY Beard ofCuunfyC5MIMisxinnen MENTAL HEALTH WORKSHOP AGENDA Board of County CommissionChmubrrs CoidierCuuntyGavernmenl C,enler 32"'Pwikkarpli Thi I I Fn%t, 3rd 111nor Nap4es,1 1 :0112 ILIIlP. 0-�.:,U18 9;00 AM Comml;sioner Andy Solis, District 2 - 130C Chair CommissionerW Hlam L. McDanfel, jru District 5 - 6CC Vice -Chair; CRAB Co -Chair Commissioner Donna Fiala, Disidd 1, CRAB Co -Chair CommI sslone r Burt Salua& rs, District 3 Commissioner Penny Taylor, District 4 ' o1kc, All paRan+wiakarlp In Vcnk rn13A nun pn a 5pe11ker %1%p fxh-1Kalkcr 011 m=. rK, mare Ikwn I UQ f3] mmwr CoflSst 2003.53 n ainelld2[I ♦}jrad{ iu pc2 Z004-05 and121*7.34- fegp1m detail d41 35iEts &a11, h�, c.alg*ng in any lr:#,byh%iict %+ Uca dr dudir@ irul nntiinuWtD, ducssil ihrl3anrd of-CzaWg{bomaaL3rn ). TeM3S .h wl Ih qw 0i;rk ID iim'{icuni al Lh1 licigrd MiTwleg O&L Rfl4rR1% Dgeagbfwo PAGE 38 21318 Jfii#ontal Heakh and Atldkilan Workshop June 5, 2019 Agenda Board of C.OUnty Corrlrni5Si4n QNarHben Callief Courtly Fm,owemment Center 3299 Tamiami Trail East, T' flaar Naples, FL 34112 5;00 am Welcome and Pledge of Allegianre-Chairman Andy Solis 9-05 am Haw We Got Here a rtd Why - Chairman Andy Solis 5;10 am grief Update and Review of the Last Year TreatrnentCoufts-kelgeJaneke Martin IMWid Lawrcnte Center -Stott Burgess, CEO NaOonaI Assadation for the Mentally 41 - Pam Baker, CEO Collier County Sheriff's Offrae -5gt. tulle Weldenhe mmer & Cptn, Chris Roberts, MentiLL Health Intervention Team; Katina Boma, Inmate. 5en,i a Bureau Manager Collier County Public Schools - Karen Stefmacki, Ewecvtive Difwtar, Exceptional' Education & Student Support Serwi:ces 9:40 a m Crim inal Just'€rr ?Anntal Health & Substa n€e Abuse Manning Cou ncil 5trategi€ Piannirq Sessions- Review and Identified Priorities with their Champians; Centralf.zcsk ffeceiring 5ystern 1 AMIction Receiving and Baker Act Recelviog Faclllty -Stott Burgess, CEO David Lawrence Center; A1Earr Weiss, CEO Naples Community Haspl to I Permanent 5wpportive Howling (scattered Sites & Supportive SmimQ - Pam Baker, CEO NAMIr and l3evedy flellir DiC BelrawiaraI Health DataCoiliqbaratlwe- Chairman Andy SDI is Increase Use of Evidence-ba sed Practices - Nancy Dauphinaisr Mo David Lawrence Canter Inorease Efiecti�-,eness and Capacity of Treatment Courts -Judge Janice Martin and 9evedy Brill, DLC Baker Art { Mlarchman Act Transportation - Sgt Leslie Weidenhammer, CCSO Build Sustainablllty for CrIminal Justice, Mental Health & Substance Reinvestment 6rant- CJfMH5A Planning Council 10,30 am Weak Vk45am Pubdic.Cnntrnent&Comm issianerDisrusMon 11.30 am Next Steps Mowing Forward -Chairman Andy $olio Packet P.q. d PAGE 39 I 2.A.2 I CO e-r CAMY Mental Health and Substance Abuse Strategic Plan 2G18-2G21 Missxan: To co+laborab'vely plan for and coordinate a full array ofeffecb've services and sup parts ba impfuve ne lives of individuals wib'a men tat heaIn and-uobstance use caodibyans and Overall quality Of life in the Collier COun ty Comm amity, 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, presentedthe current d escri pti on, status, successes, challenges, gaps, and opportunities within the local system of care. Mile 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 Pacw p % 5 PAGE 40 I 2.A.2 I �� -r CAMY 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 chiIdren'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 warriedabout the lack of mental health care and addictran 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 cam munity -ha sed treatment and recovery -oriented supports do not work. We k no w that ev i d ence -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 Medi care for people on disabi Iity 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 treatm ent regardless of their abi Iity to pay. However, these state funds are not at all adequ�yate to pay for all in need. Depending upon the source, Florida reportedly ranks 4911 or 5011 among states with regards to per capita state funding appropriated for m ental 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 requirem ents. Without adequate funding for cam munity-based services, counties must often foot the bill for citizens in need of care beyond the Pacw p % 6 PAGE 41 I 2.A.2 I CO -r CAMY 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 estim ate of 372,880, by 2 030 , the county WII 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 c meetthe needs of citizens, especially since the system is at or over capacity at a present. Behavioral health System leap. 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 i n place locally, such as an addiction receiving facility or peer- a run crisis center. The map provides a visual tool far the overall local strategic rz planning. - S P iCW P% 7 PAGE 42 CM: Cb J It I_J nt-y 4U¢r h aRa:lo +ral Ci¢rt�F-3t¢ F MI -I Arts,gn M¢ AsnQa —t I 2.A.2 I Community Behavioral Health System Access and Process Mapping A 6 C ❑ E F Comm uri tp Ro utes of A—s Trio ge Furtotlo MI A—te Corc Court RrdI n9� Invd urrte rp Irrte rrtlom t Cerc R.—MA� Pleae me rrts I - J Fuah�es; 4�661G C UkT. rr¢ Fa R­ Cost Caner CIFra Vad laN E Muao-rcrtn ­UVERO I+rRai[n PratQCtIW C-i dy arlrcuW RQfkk4ftav SAMH Caa figure 1. Sehavioral Heath .System 1 Brown, R; McLean, C., Engelhardt, M., & Armstrong, M. (2015). 6ehaviaral health Systems Design RecommendaUaos, University of South Florida, September 2015 Current Resources and Challenges Lew EnMicement., Mental Health Unit The CCSO's Mental Health Unit recently implemented a new strategy, called the Mental Health Intervention Team WHIT) . The MHIT includes CCSO deputies alonq with a licensed clinician co ntracted throu gh 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 4 Pa-ew P% 8 PAGE 43 I 2.A.2 I �8-r CAMY 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 fi re 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 (NAM I) 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 jailfcriminal 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) Lew 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 i n 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, Pacw p % 9 PAGE 44 I 2.A.2 I CO8-r CAMY 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 CS adult CS 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 pay or mix far the CS is 50% indigent, 25% insurance, and 25% Medicaid. The rei m bur sem ent f rom 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 2 4/ 7 clinical staff availability for off -site screenings. The Mental Health Intervention Team operated by CCS0 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. Packat P% 10 PAGE 45 I 2.A.2 I C M Y CeneralizedReceiving Systems (CRS). A central receiving system consists of a state -designated central receiving faci Iity for both Baker Act and March man 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 b me 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 Conn ty requires older adults on Medicare, or who have private insurance. end ere 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 m edi cal transporter to provide thi s transport on behalf of law enforcem ent, 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, a s 'ex cepti o ns' to the'nearest receiving facility' as required by the Baker Packat P% 77 PAGE 46 I 2.A.2 I �� -r CAMY 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 f NCH is responsible for transporting people from its facility to DLC or to out of county faci Iities. In addition, many Baker Act transports from NCH and Physician's Reg inaI 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 cast savings and improved coordination for these types of transportation needs. ou wa trerr t 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 m ay 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 outpati ent the rapy 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 ldeald'r Care A si gnificant strength locally i s 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, an other 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 Packat P% 12 PAGE 47 I 2.A.2 I C M 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 m ore 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 m edications. 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 VivitroI 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 CCS0 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, NAM I, 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 Packat P% 13 PAGE 48 I 2.A.2 I CO -r CAMY 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 appropri ate defendants to these programs, and (2) track data that m ay 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. CrrmrnaI Justice Rear tegre Iron 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 NAM 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- arrestfrecidivism, The FIRST team has demonstrated success at I ower i ng th e rate of recidivism among participants to just 2201a. For the grant period 2014-2017, the FIRST served 313 people. Of those only 69, or 22% we re -arrested. Rein tegratron 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 Mem orandum of Agreement with Collier County. The current grant funding (July 2017 through June 2020) is $1,042,506 with countyfpartner agency match of $130523300 for a total of $230943806. The state also pays for significant assistance from the US F 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 ti m e f i n di n g affordable housing. Affordable housing is considered housing that consumes 30 percent or less of a househoId's incom e. It includes income target levels starting at "very low," those making less than 30 10 Paclaet P 9 14 PAGE 49 I 2.A.2 I �� -r CAMY percent of the $75,000 Collier County median income, up to "moderate income" and "gap income." HUD FY 2018 Fair Ma rket Relents by Unit Bedrooms Year Efficiency One Tvuo- Three- Four - Bed room Bedroom Bedroom Bedroom FY 2018 $778 $996 $1,220 $1,630 $1,978 FMR Table 2, FairPlarket Rent Naples Marco Island, 2028 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 MYTH ,.Hausfuug is a PrMAE!ge— are considered `cost burdened', m eaning they spend at least 30% or more of their income Everyone has right to a standard of on housing, and 20% pay more than 50% of living adequate for nE heain of therm and their income for housing. Individuals with Merrfamilymdudingfacd, doMmg, mental illnesses are even further priced out hausxng,medicalcare, and necessary of the housing market, many of whom rely on sooalse- vices, Supplemental Security Income (SSI) due to disability, SSI is currently $750 per month or --Prude 25 of bye Lkifversal Dedarabyor: of just $9,000 per year, that is 14.5% of the human Rights 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 th roug hout the county, often mobile homes, which WII take time to replace, Also, there are higher costs of applying for rentals and high deposits for rent and utilities which complicate renting proper ties 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 m ost powerful barriers to recovery, 1fien 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. 11 Parke# P% 15 PAGE 50 I 2.A.2 I CM 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 primaryfspecialty medical care services. Local supportive housing options operated by non-profit agencies include David Lawrence Center and Community Assisted Supported Living (CASE), There are generally wait lists far these. NAM 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 impassible. 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 Treatm ent 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. NAM 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, Comm unity 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 tD provi de 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 hom elike environment, and act as a diversion from high end psychiatric care when possible. 12 Paclaet P % 16 PAGE 51 I 2.A.2 I CO8T CAMY Evidence Based Practices Evidence -based practices (EBPs) are defined as treatments that have been researched academically or scientifically, been proven effective, and replicated by m ore than one investigation or study, Evidence -based treatment practices are meant tD 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 Nrst 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 i mpro vement 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 wth 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. 13 Paclaet P 9 17 PAGE 52 I 2.A.2 I CO8-r CAMY trxra.rwr: David hePancnc{Purtx F#pirxr [b.x: •= ilrvarrsn,ti,L d urnry u•yrrr � Irf.Jnrr.nw. {y,�r� nw...moi.r awrence r nn rr�rr G c.m•y r.�r .v 6,rr .,.per 4au AC4. Center 20W%c-dicr.7rrminnr&-nd ,. •.-y.�,.r..�"1'r•7'�•' �rLJ-�yy rems.eu WUIL ��n—c-3,J acsorrn�r LC} are reterre: - Ul . Maples tonflmwfity Hnrpital - Plre R EMS Nh 5iddns Coliler County Fro�µ-�nal P u bk 5cha-cAa Hiispi7� it r ,'H. *I �M arpnlz7Vensan � s moP WorrFh I rum adr�al ar riiihar riw ao-i Lrw• Iw ri�uir .,r rm.rrnrr.--, nr la.��La HWaLi. �..: s.r.« am..... F•army, L'aum,L Figure Z. Collier County FL Behavioral health Local Collaborative ReJabyonships (3une 2017). 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 • Mat 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 acti vities • 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. 14 PackUt p% 18 PAGE 53 ��-r C-Ant 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 Scott Burgess, DLC CEO Receiving & Baker Act Receiving Facility 2 Permanent Supported Housing (Scattered Pamela Baker, NAMI CEO; Sites and Supportive Services) Beverly Belli, DLC Commissioner Andy Solis; 3 Behavioral Health data Collaborative Sean Callahan, County Administration 4 Increase use of evidence -based practices, e.g. Nancy Dauphinais, DLC COO Early intervention for 13` time psychosis. Increase effectiveness and capacity of Judge Janeice Martin; 5 Problem -Salving Courts Beverly Belli, DLC 6 Baker Act f Marchman Act transportation Sgt. Leslie Weidenhammer, CCSO 7 Build su stai nab i I ity for Criminal Justice, Mental Health & Substance Abuse Reinvestment CJMHSA Planning Council grant. Table 2. Strategic plan local priorities and feed person(s). I 2.A.2 I 15 Paclaet P% 79 PAGE 54 APPENDIX E: CCSO MENTAL HEALTH BUREAU DATA Collier County heriff's Office Mental Health Bureau Mental Health Intervention Team - Interventions S9 Maker Act 1%Arrest % l 4% Baker Art I Oetahee 10. M!) 2019 Type of Irnervention Number Unked to Service3 142 Wellness Check 288 Balser Ask 23 Arrest 4 TOTAL 457 2019 ]AN -SAP TWe of Intervention Number Llnkedto ScryIces 195 Wellness Check 429 Baker Ask 23 Arrest 1 TOTAL $ 47 PAGE 55 Collier County Sheriff's Office Mental Health Bureau Baker Act Transportation from Hospital to David Lawrence Center 2017 2019 2019 3 Soo 4M 3co 2co idn 7 5 ■ NCH-N r NCH-QT it PAC$ ■ PRPR ■ NCH -Alf Transports from 2027 1 2018 2019 SRN - SEP N0j - North 17S 147 114 N04 Downtown 177 145 82 Physibans Regional - Coliier Blvd 46 42 20 Physi�clans:Regional Pine Ndge 215 177 115 NCH , Northeast 3 5 8 TOTAL 616 511 339 Ga0ber 10, M19 PAGE 56 Collier County Sherif l s Office Mental Health Bureau CCSO BAKER ACTS 01/01/2009 — 12/ 1/2019 (projected) ;*ki j€ i 14 QO 11 DO 1DW &4 m 4-m I DO a 117S 2Z3 812 3,74 313 !SL YEAR: 2008 2m 2011 2U12 2023 2DIA 2mS 2016 21117 2019 2479 TOTAL: 717 7% 892 1052 1192 1727 Lm5 1337 1494 1597 IfiO4 jPAOJECTMJ I Yearly Totals § Total Adults octalser ia. 2m!) Total AlVEnik'S PAGE 57 Collier County Sheriff's Office Mental Health Bureau Current CCSO Members C.I.T. Trained 2% 4% DEPARTMENT CIS! CERT TOTAL OPERATIONS 23 348 371 CORRECTIONS 15 176 191 INVESTIGATIONS 2 90 92 ADMINISTRATION 8 I 19 27 COMM ENGAGE LEGAL 5 22 27 0 18 18 TOTALS 5'3 a7'3 776 Crisis Intervention Team Total Trained 2009-2018 AGENCIES' � I 7017 2018 COLDER COUNTY SHERIFF'S OFFICE I 739 939 Includes LEO, CO, civilian. and former vwmbers FIRE 10 ) Includes North Colkier I -fa & 6feater Na Ies Fire ovrSIDE L5i ENFORCEMENTAGENCI€S Iodudes $tatp wabation. tounty probation, National Par# 303 342 Service, PAIPD. NPD. and Hendry County SO CIVILIAN 50 137 includes DLC. LOS, DCf, NAW and others j ' TOTAL TRAINED I 111>t 1274 octalser Ia. M!) PAGE 58 APPENDIX F: ACTION PLANS Priority: Central Receiving Services ACTION PLAN Goal: Ensure that there is a coordinated system and adequate capacity to assure that citizens in crisis will be able to access emergency mental health and substance use disorder services over the next 20 years. Inputs Required (Kesources) $25 Million for construction and related capital purchases for Central Receiving Services structure(s) $2-3 Million annual state and local government appropriation for Central Receiving Services operations Outputs Activities Participation Determine site. Define terms Collier County BOCC and processes regarding and David Lawrence ownership, design, Center construction and funding of Central Receiving Services structure(s) and Furnishings, Fixtures and Equipment. Multiple activities related to David Lawrence Center design and construction of Central Receiving Services structure(s) and identification and procurement of FFE. Develop an operational Collier BOCC, Collier budget and plan for Legislative delegation, sustainable funding for David Lawrence operations. Center. Outcomes -- Impact Short- 1 year Long 2-5 year Completion of all pre- Completion of Construction. construction activities and initiation of construction. Increased inpatient capacity over baseline. Central Receiving Services utilized as single point of access for persons in crisis as a result of a Mental Health and/or Substance Use Disorder Submit a Legislative Budget Secure state funding and Request to partially fund matching county funds to operations. sustain Central Receiving Services operations in Secure funding from Collier perpetuity. County to use as match to support Legislative Budget Request. Priority: Housing and Supports Goal: ACTION PLAN Increase availability and accessibility of a variety of housing options for persons with mental health and substance use disorders. essness among person$ with mental health and substance use disorders is rare, brief and one-time. Provide Incentives to Landlords, builders, developers Increase available Affordable Housing units Existing Rental Vouchers Assure a source of income/healthcare for chronically homeless with severe mental illness Funding from local, state and federal grant opportunities Funding from private charitable foundations that support housing initiatives Outputs Activities Participation Legislative Advocacy Homeless COC, Community Education State SAMH, Housing, State Legislators Identify and amend any County Housing and prejudicial local zoning Community Services, language Board of County Commissioners Recruit at least one non- County Housing and profit developer, determine Community Services, site Board of County Commissioners Ensure Vouchers are County Housing and provided to eligible persons Community Services who are chronically homeless and severely mentally ill T SOAR applications Employment agencies: T# Supported Employment Goodwill, Voc Rehab providers and # hours Respond to grant Collier County, local opportunities and submit homeless service and proposals to private mental charitable foundations health/substance abuse provider agencies Outcomes -- Impact Short- 1 year Long 2-5 year County approves % set aside L# days to enroll in specific to Chronically programs homeless w/ Severe Mental Illness . # days to obtain Transitional housing from .Discrimination / prejudicial jail, hospital or language in local zoning docs homelessness. Identify new non-profit �# days to obtain developer permanent housing T # SOAR applications # employed T# SMI on SSI/SSDI; homeless SMI Medicaid/Medicare 0 Wait lists for housing # Community education and services sessions, op eds, news articles 0 New homeless in CoC PIT count T # Providers and volunteers trained in Supported T Days in Community/ Employment, Supportive Housed (not hospital, jail, Housing and SOAR. shelter) # of grant and foundation T Days worked for pay proposals submitted and # awarded T # on SSI/SSDI Priority: Data Collaborative ACTION PLAN Goal: Create a data collaborative that will collect and analyze data from all stakeholders that provide services to persons experiencing a mental health and/or substance use disorder and use that information to continuous improve program quality and patient outcomes. Assignment of county staff to provide leadership and direction to development of the data collaborative. Identify and secure participation of essential governmental, non- profit and for profit organizations to participate in and share data with the collaborative Outputs Activities — participation What we will do Identify and recruit data Active participation by collaborative members 75% or more of recruited members. Define data elements to be 100% of data elements collected and shared by and collected and collaborative members shared by collaborative members. Define standard reports, 100% of Standard reporting frequency, and reports are prepared mechanism of report and distributed on time. distribution. Data collaborative members Analysis of data to utilize shared data to identify identify trends and and report on emerging emerging issues is issues related to program reviewed and reported quality and patient outcomes. by data collaborative members at least annually. Data collaborative members Data collected and utilize shared data to provide reported by data data for grant opportunities collaborative is used 4 and new programming or more times annually in materials prepared in response to funding opportunities or to justify new or revised programming. Outcomes -- Impact Short- 1 year Long 2-5 year Data Collaborative is organized, Data Collaborative releases meeting, collecting data and data according to a issues a baseline report on data schedule agreed upon by all collected. members. Data Collaborative identifies at least one emerging issue annually. Data Collaborative provides data that assists in obtaining new funding or reinvestment of existing funding to address emerging community needs in mental health and substance use disorder treatment. PAGE 61 Priority: Justice System Response ACTION PLAN Goal: Expedite deflection and diversion of persons with mental health and/or substance use disorders prior to arrest and from jail to treatment, thereby reducing recidivism, improving community safety and directing resources to optimize outcomes. Inputs Required (Kesources) Pre -Arrest Diversion Educate Law Enforcement Expand Mental Health Unit Increase capacity of treatment providers Jail Diversion Implement Medication Assisted Treatment at Collier County Jail. Expand Project Recovery Increased number of community based and in jail mental health and substance use counselors Develop alternative in -jail treatment program for inmates already receiving Medication Assisted Treatment prior to incarceration. Expand court ordered assisted outpatient treatment to circuit court. Outputs Activities Participation Utilize Mental Health Unit to Mental Health Unit, train road deputies in Collier Sheriff's deflection processes. Deputies, David Lawrence Center staff Seek CJMHSA Reinvestment Criminal Justice Grant funding to implement Planning Council Medication Assisted Treatment in the County Jail. Seek County, State and Collier Legislative Federal funding to support delegation, Collier additional judicial and County government, treatment team positions for U.S. Department of court based diversionary Justice, U.S. programs including drug Department of Health court, veteran's court and and Human Services, assisted outpatient private foundations. treatment. Outcomes -- Impact Short- 1 year Long 2-5 year # of law enforcement trainings Continued decrease in provided. possession arrests and continued increase in Decrease in arrests for drug number of referrals to possession. treatment year over year. Increase in number of referrals to treatment directly from law enforcement. Increase in the number of Quicker response team in treatment referrals either in diverting from jail or custody or through transfer to enrolling in jail based community based programs. programs. Decrease in jail days for inmates Year over year decreases in whose crimes are directly recidivism among inmates related to their mental health who participate in jail and substance use disorders. diversion programs. Decrease in recidivism among Year over year Increases in inmates who participate in jail the number of treatment diversion programs. referrals either in custody or through transfer to community based programs. Priority: Non -Emergency Baker Act/Marchman Act Transportation ACTION PLAN Goal: Whenever possible, the transportation of an individual under the Baker Act or the Marchman Act from a medical facility to receiving facility will be completed by a non -emergency transportation provider. Inputs Required Resources tablish Transportation Workgroup consisting of involved partners — CCSO, Collier County Government, David Lawrence Center, NCH, and other interested parties Funding to support transportation plan and costs of transport vehicles and drivers. Outputs Activities Participation Develop answers to who, Transportation what, when and where Workgroup questions that will drive the structure of the transportation agreement. Prepare a cost analysis that includes current costs for all partners, the annual number of transports provided, the annual number of patients transported and a projection of future need. Develop a share cost agreement among partners Transportation to be either included in the Workgroup Transportation Plan or included by reference in the plan. Outcomes -- Impact Short- 1 year Long 2-5 year Transportation Plan written and Law enforcement agencies signed off by all partners. no longer providing non - emergency transport except Identification of Transportation in cases of unstable Provider or Providers individuals at high risk to harm self or others. Increased patient satisfaction regarding quality of care in transportation. Law enforcement agencies re -allocate time previously spent in transportation to other public safety activities. Cost sharing agreement Transportation Contract (s) developed and signed off by all in force and functioning. partners. Transportation Workgroup continues to meet to review data and address any inter- agency issues that may develop. PAGE 63 Priority: Prevention ACTION PLAN Goal: Provide evidence based education and training on mental health and substance use disorders to the community at large. Inputs Required Resources Identify collaborative agencies and personnel that provide evidence based prevention programs. Including, but not limited to, Drug Free Collier, NAMI, Mental Health providers, Blue Zones, Chambers of Commerce, local religious groups, and any other local organization with an interest in drug abuse prevention and education regarding substance use and mental illness Outputs Activities Participation Develop Collaborative Drug Free Collier Partners in Prevention NAM I Identify evidence based programs available. Mental health providers Develop speaker's bureau Chambers of to present evidence based Commerce prevention programs Religious groups Develop or adopt an App SW Florida Blue Zones Project that can be marketed in the community to support local substance abuse prevention and awareness of mental health disorders Create public service announcements for print, electronic and social media Develop resource center that can provide materials and programs to the community. Outcomes -- Impact Short- 1 year Long 2-5 year Collaborative group of providers Funding and staffing to organized and meeting regularly support education and prevention Collaborative Partners in Relationship to 211. Prevention provides training for agencies and community App implementation responders resulting increased access to recovery services Identify funding Annual Awareness/ Linkage with print and electronic Prevention/Education media campaigns PAGE 64 Exhibit B Collier County Criminal Justice, Mental Health & Substance Abuse (CJMHSA) Sequential Intercept Mapping - Strategic Plan 2020-2024 The Collier County Criminal Justice, Mental Health & Substance Abuse Planning Council convened members and other stakeholders for two strategic planning meetings on August 16, 2019 and September 20, 2019. The group was initiated in 2010 and has been actively overseeing the Collier Criminal Justice, Mental Health and Substance Abuse Reinvestment grants since that time. Over the previous two years, Collier County's Mental Health and Addictions' Ad Hoc Committee worked to create a comprehensive, county -wide strategic plan for the general population of persons with mental health and addiction issues. The plan was approved by the Board of County Commissioners in December of 2019. The current CJMHSA plan is intended to focus on the subset of the population of persons who are in, or have significant risk of involvement in, the criminal justice system. The two planning groups, including several people with dual memberships', intentionally chose priorities and strategies for their concurrent plans to ensure their functions are complementary and not duplicative. Where there are priorities identified by both groups, the issue will be included in the county -wide plan. During the two CJMHSA planning meetings, participants: 1) reviewed the most recent local 3-year CJMHSA strategic plan; 2) reviewed the County -wide Ad Hoc Committee draft strategic priorities; 3) reviewed the Sequential Intercept Mode12 and the process of system mapping; 4) discussed best practices, resources, and gaps by intercept; and 5) collectively decided upon priorities, champions, and strategies. The Sequential Intercept Model (Figure 1) was developed in the early 2000's as a conceptual model to inform community -based responses to the involvement of people with mental and substance use disorders in the criminal justice system. The goal is to use the model to determine a local jurisdiction's current practices at each intercept and where gaps exist where individuals might be diverted from the criminal justice system to mental health or substance use disorders services and treatment. Figure 1: Sequential Intercept Model, Policy Research Associates The following section is a discussion of resources and gaps by intercept as identified by the CJMHSA Planning Council: ' Planning body members are shown in Appendix 1 with 2 Policy Research Associates Page 1 of 9 Intercept 0 Community Services Current Resources • Mental Health Intervention Team (MHIT): Collier County Sheriff's Office (CCSO) • Peer -Run Warm Line: NAMI • Drop -In Center: NAMI • Community Outreach Peer Education (COPE): NAMI • Detox Unit, Crisis Stabilization Unit (CSU): DLC • St. Matthew's House Transitional Housing and Justin's Place • Housing & Urban Development (HUD) Veteran's Affairs Supportive Housing (VASH) vouchers --limited • Goodwill Pathways to Work • Supportive Housing and Supported Employment --limited: NAMI and DLC • Florida Assertive Community Treatment (FACT) Identified Gaps • Centralized Receiving System/Facility • 911 vs. MHIT: Increase Capacity • Mobile Crisis Unit (serves 5 counties) --need local team/should be county -specific • Need more Supportive Housing --Landlords, Homes, Vouchers • Need more Mental Health Case Management (currently there is a waitlist) • Need more Peer Support/Peer-Run Respite (more than outpatient but less than crisis) • Need a true homeless shelter (short-term) Intercept 1: Law Enforcement and Emergency Services Current Resources • CIT-97 % Trained • MHIT—Pre/Post 911 calls • DLC CSU • NCH Healthcare System's Mental Health Unit Identified Gaps • Misdemeanor diversion • CIT refresher and add EMS • Centralized Receiving System/Facility Intercept 2: Initial Detention & Court Hearings Current Resources • Brief Jail Mental Health Screen (medical) • Pre-trial risk assessment (jail) • Identification of substance abuse and mental health • Assisted Outpatient Treatment (AOT)--Rapid Response • Jail Arrestee Commitment Page 2 of 9 • LEO panel • Re-entry screen (PCL-5, TCUDS, ORAS, MHSF-III) Identified Gaps • Expansion of Rapid Response (LEO training, Jail intake form) • Clinical Assessment • Centralized Receiving System/Facility Intercept 3: Jails and Courts Current Resources • Project Recovery • Capacity Mental Health Court 40-45 • Capacity Drug Court 65 • Capacity Veterans Court 24 • Beyond Trauma, 7 Habits, Thinking 4 Change • Mental Health First Aid (inmates) • Cell Dogs • Limited Medication Assisted Treatment (MAT) Identified Gaps • MAT for all • Peer Support Jail & Court • Housing for court participants • Treatment Court Funding (Treatment has some funding, Justice has limited funding) • In -Jail Mental Health Unit • Psychiatry/Counseling • Misdemeanor Conditional Release • Funding for Forensic Intensive Case Management Intercept 4: Re -Entry Current Resources • Re-entry Planning • Limited Warm Hand -Off • 3-day supply of medications • Same day walk-in Clinical Assessment • Tele-Clinical Assessment • VA appointments • DMV ID replacements, replacement Social Security Cards & replacement Birth Certificates • Career Source-4 times per week • Forensic Intensive Reintegration Support Team(FIRST)/Forensic Intensive Case Management (FICM) Page 3 of 9 Identified Gaps • Warm Hand-offs SA/MH clients • DLC HCN on site/near facility (Medication & Services) • Bus/Van to transport for appointments vs. Uber/Lyft • Peers • Increase # of days for medication supply • Discharge Planners • Transitional Housing • Provide Narcan at release Intercept 5: Community Corrections Current Resources • Designated Probation Officer/Problem-Solving Specialty Courts • MH Bureau-Monitoring/Supervision • Pre-trial Supervision • CIT Trained Probation Officers • FIRST • MAT (Vivitrol, Etc.) Community/Voluntary Identified Gaps • Warm Hand-offs SA/MH clients • Fentanyl Test Strips at discharge • Supportive Probation/Parole/Pre-trial • Housing • Employment • Transport • Peer Support/Respite • MAT Sustainability/increase capacity • Enhancement/Emergency Fund (co -pays, meds) 2020/2024 Strategic Priorities: 1. Increase use of evidence -based practices for treatment of addictions to in order eliminate/reduce overdoses (fatal and non -fatal). 2. Increase law enforcement -related opportunities for early intervention, diversion, and improved care for high -risk, high -needs persons who are incarcerated or at risk of arrest or Baker Act. 3. Implement, enhance, and sustain coordinated reentry/reintegration services and processes. 4. Expand, improve and sustain the justice system response to persons with mental health and substance use disorders in or at risk of involvement in the criminal justice system. The following pages provide details of the Collier County CJMHSA 2020/2024 Action Plan. Page 4 of 9 Priority Area 1: Increase use of Evidence Based Practices for Addictions to Eliminate/Reduce Overdoses (Fatal and Non -fatal) Objectives Action Steps Who When/Status 1.1 Identify all potential a) In -jail clinical Armor February 2020 inmates in need of assessment TCUDS and Medication Assisted Medical for those not on treatment (MAT) access for but potentially needing opioid addictions. MAT b) CCSO/Armor in -person CCSO February 2020 or tele-assessment for persons on MAT upon arrest c) Provide clinically CCSO, Armor April 2020 and appropriate MAT for ongoing identified individuals during incarceration. 1.2 Reduce potential for a) MAT used whenever CCSO, Armor April 2020 and overdose after release possible in jail as best ongoing from jail. option to prevent overdose upon release. b) Provide Narcan and CCSO February 2020 education on use at and ongoing release for all inmates, family members. c) Continuation of jail- DLC April 2020 and initiated MAT for CCSO ongoing individuals via DLC outpatient services or residential as needed. 1.3 Improve community -wide a) Expand capacity to DLC April 2020 and recovery outcomes and provide best practices in CCSO ongoing eliminate/reduce fatal and MAT, and ensure MAT is non -fatal overdoses. available and accessible for all persons in need. b) Promote and obtain DLC DLC clinical staff training to ensure use of evidence based practices across addiction programs and services. c. Implement an After OD CCSO Response Team to include EMS Drug Court Graduate Peer DLC Page 5 of 9 Priority Area 2: Increase law enforcement related opportunities for early intervention, diversion, and improved care for high risk, high needs persons who are incarcerated or at risk of arrest or Baker Act. Objectives: Action Step(s) Who When/Status 2.1 Expand CCSO Mental a) Increase staffing by CCSO By December Health Bureau and adding: DLC 2021 Mental Health • 1-2 deputies NAMI Intervention Team . 1 clinician (MHIT) . 1 Data Analysis • 1 Mental Health Certified Peer Specialist 2.2 Expand CCSO Mental a) Identify and train Liaisons CCSO By December Health Bureau to 2021 include Law Enfacement CCSO By December and Corrections Liaisons b) Expand Law Enforcement DLC 2020 and Ongoing in the field to improve Assisted Diversion (LEAD) care of those individuals Program w/ more subjects incarcerated with entering treatment mental illness and to divert individuals from jail. 2.3 Expand Mobile Crisis a) Advocate for DLC By December responses through local reinvestment of current NAMI 2021 agencies/providers to state mobile crisis funding improve for Collier County to local communication, agency(ies) coordinated responses, and continuity of care for persons in mental health crisis. 2.4 Implement and expand a) Continue to train Law CCSO By December continuing education of Enforcement and Correction 2020 and Ongoing Deputies on Crisis Deputies in Crisis Intervention Team (CIT) Intervention Team (CIT) Training training b) Implement CIT continuing education for Law Enforcement and Correction Deputies Page 6 of 9 Priority Area 3: Implement, Enhance and Sustain Coordinated Reentry/Reintegration Services and Processes Objectives: Action Step(s) Who When/Status 3.1 Maintain FIRST a) Realign priorities among DLC By July 2020 staffing for funding sources. NAMI b) Agencies to fund FIRST DLC July 2020 and community reintegration services positions to ensure ongoing successful, coordinated NAMI reintegration: 1-2 DLC Case Managers 1-2 NAMI Certified Recovery Peer Specialists 3.2 Implement/expand a) Add two (2) Pretrial CCSO By July 2020 pretrial release Supervision Officers in order supervision (PTS) and to add to the number of supportive probation defendants that can partake i n PTS b) Work with County and CCSO July 2020 and State Probation to provide County Probation ongoing supportive probation State Probation through a partnership with Reentry, prior to an inmate's release from incarceration. c) Increase CCSO Mental By December Health Bureau Liaisons to 2020 assist with accountability of individuals released from incarceration. 3.3 Create and operate a a) Designate and convene a CCSO; County By June 2020 co -located mental steering committee to Community & County health, substance use, research opportunities for Human Services, primary care, Rx and location, operations, BoCC; DLC; Genoa; social services hub at funding. Healthcare Network or near the (HCN) and/or Collier government center to Health Department; ensure smooth NAMI transition for post- b) Committee report Steering Committee December arrest and jail recommendations/ 2020 reintegration. workplan(s) re options for location, operations, funding presented to the BoCC. c) Complete steps in TBD January 2021- workplan. December 2021 c) Commence operations of DLC, HCN, Genoa, January 2022 Hub CCHS, NAMI Page 7 of 9 Priority Area 4: Expand, improve and sustain the justice system response to persons with mental health and substance use disorders in or at risk of involvement in the criminal justice system. Objectives: Action Step(s) Who When/Status 4.1 Ensure the achievement a) Adjust practices, Each stakeholder By end of 2020 and maintenance of procedures and on team, led by certification status for documentation to County -funded 3 each problem -solving conform to FTEs. court, so that stable promulgated standards funding can be obtained that underlie and the overall certification process. sustainability of these courts can be secured. 4.2 Increase accuracy and a) Streamline Each stakeholder By end of 2020 speed with which all procedures and on team, led by arrested persons are communication among County -funded 3 screened for MHSA stakeholders to reduce FTEs. disorders for referral time between arrest problem -solving courts and referral, ideally or diversionary down to 30 days or programs. less. b) Obtain funding for 1 Judge Martin By end of 2020 FTE inside jail to conduct all screenings and assessments connected with referrals to problems solving courts and jail diversion programs. 4.3 Expand capacity of jail a) Obtain CJMHSA Planning By end of 2020 diversion programs for Reinvestment Grant to Council persons with the most fund resources needed severe and persistent for these programs mental health disorders, within both the Jail and including: 1) Case treatment provider management services to agencies. support persons served by the court in the community; 2) Assisted Outpatient Treatment; 3) Rapid Response Team; and 4) other programs and processes to expedite connection to treatment for justice - involved individuals. Page 8 of 9 4.4 Expand training for all a) May require funding All stakeholders in Ongoing justice professionals on from federal, state problem -solving signs and symptoms of and/or local (including courts and jail mental health disorders; private) sources. diversion best practices for programs. treatment of mental health and substance use disorders; trauma - informed and trauma - responsive court practices; adverse childhood experiences and resiliency; and any other behavioral health advances relevant to treating disorders and facilitating long-term recovery. Page 9 of 9 Collier County Criminal Justice Mental Health Substance Abuse Planning Council Name Agency Amanda Krause State Attorney's Office Barbaro Baez -Alvarez NAMI Beverly Belli David Lawrence Center/Director Bianca Borges David Lawrence Center Chief Chris Roberts Collier County Sheriffs Office Cindy Highsmith NAMI Connie Kelley Public Defender's Office/Mental Health Court Dareece Canady Collier County Sheriffs Office Darrow Rexford Public Defender's Office/Mental Health Court Dawn Whelan CHS Grant Coordinator Eric Townsend Public Defender's Office/Mental Health Court Heather Davis Veteran Justice Outreach Program Coordinator Honorable Janeice Martin Mental Health Court and Drug Court Judge Jeff Nichols County Probation/Court Administration Jennifer Campo Collier County Sheriffs Office Juan Ramos County Probation/Court Administration Julie Franklin Shelter for Abused Women and Children Katie Burrows David Lawrence Center/Forensics Supervisor Katina Bouza Collier County Sheriffs Office Keri Miller David Lawrence Center Kristi Sonntag CHS- Director Kylie Sumner CPE Laura Farrell State Attorney Representative Leslie Weidenhammer Collier County Sheriffs Office Lois Bolin SWFL Vets Alliance Marien Ruiz Collier County Sheriff/Grants Michael Lisboa Collier County Sheriffs Office Michael Overway Collier Hunger & Homeless Coalition Michelle Rubbo Community and Human Services Monique Nagy Collier County Sheriffs Office Nancy Dauphinais David Lawrence Center Nicole Mira State Attorney's Office/Mental Health Court Pam Baker NAMI Executive Director Peter Arvin State Probation Rachel Brandhorst CHS Grants Coordinator Robin Eckenroth Collier County Sheriffs Office Scott Burgess David Lawrence Center Sheriff Kevin Rambosk Collier County Sheriffs Office Susan Vivonetto Collier County Sheriff s Office Tami Bailey CHS Federal/State Grant Manager Traci Foss Department of Juvenile Justice Tyrone Davis Naples Police Department Exhibit C (T Medication -Assisted Treatment (MAT) Armor Medical screening Correctional Health Services, Inc, Inmate Name A# DOB: Weight Blood Pressure &Pulse signsVital Temperature Respiratory rate Oximeter rate Substance• Urine Drug Screen ❑ Negative ❑ Positive for Results Substance used in the past 30 days Frequency of use Date of last use Amount of last use Route of administration of last use History of overdose? ❑ No ❑Yes; how many? Date of last overdose: History of Narcan use? ❑ No ❑ Yes; date of last Narcan use: MAT Screening Current medications MAT Community Provider ❑ Release of Information documents signed ❑ Immediate detox protocol needed ::7i117f1oil I II II II II I II II IIII I II IIIII I II II I III Client ID# Today's Date Facility ID# Zip Code Administration TCU DRUG SCREEN 5 During the last 12 months (before being locked up, if applicable) - Yes No 1. Did you use larger amounts of drugs or use them for a longer time thanyou planned or intended?........................................................................................ O O 2. Did you try to control or cut down on your drug use but were unable to do it? ............. O O 3. Did you spend a lot of time getting drugs, using them, or recovering fromtheir use?................................................................................................................ O O 4. Did you have a strong desire or urge to use drugs?........................................................ O O 5. Did you get so high or sick from using drugs that it kept you from working, going to school, or caring for children?.......................................................... O O 6. Did you continue using drugs even when it led to social or interpersonal problems? ... O O 7. Did you spend less time at work, school, or with friends because of your drug use? .... O O 8. Did you use drugs that put you or others in physical danger? ........................................ O O 9. Did you continue using drugs even when it was causing you physical or psychological problems?.............................................................................. O O 10a. Did you need to increase the amount of a drug you were taking so that you could get the same effects as before?............................................................................. O O 10b. Did using the same amount of a drug lead to it having less of an effect asit did before?.............................................................................................................. O O 1 la. Did you get sick or have withdrawal symptoms when you quit or missed takinga drug?................................................................................................................. O O 1 lb. Did you ever keep taking a drug to relieve or avoid getting sick or having withdrawalsymptoms?................................................................................................... O O 12. Which drug caused the most serious problem during the last 12 months? [CHOOSE ONE] O None O Stimulants - Methamphetamine (meth) O Alcohol O Synthetic Cathinones (Bath Salts) O Cannaboids - Marijuana (weed) O Club Drugs - MDMA/GHB/Rohypnol (Ecstasy) O Cannaboids - Hashish (hash) O Dissociative Drugs - Ketamine/PCP (Special K) O Synthetic Marijuana (K2/6pice) O Hallucinogens - LSD/Mushrooms (acid) O Natural Opioids - Heroin (smack) O Inhalants - Solvents (paint thinner) O Synthetic Opioids - Fentanyl/Iso O Prescription Medications - Depressants O Stimulants - Powder Cocaine (coke) O Prescription Medications - Stimulants O Stimulants - Crack Cocaine (rock) O Prescription Medications - Opioid Pain Relievers O Stimulants - Amphetamines (speed) O Other (specify) TCU Drug Screen 5 (v.Sept202O) 1 of 2 © Copyright 2020 TCU Institute of Behavioral Research, Fort Worth, Texas. All rights reserved. Client ID# Today's Date Facility ID# Zip Code Administration 13. How often did you use each type of drug during the last 12 months? Never Only a few times 1-3 times per month 1-5 times per week Dail a. Alcohol.......................................................................... O O O O O b. Cannaboids — Marijuana (weed) .................................... O O O O O c. Cannaboids — Hashish (hash) ........................................ O O O O O d. Synthetic Marijuana (K2/Spice)..................................... O O O O O e. Natural Opioids — Heroin (smack) ................................. O O O O O £ Synthetic Opioids — Fentanyl/Iso................................... O O O O O g. Stimulants — Powder cocaine (coke) .............................. O O O O O h. Stimulants — Crack Cocaine (rock) ................................ O O O O O i. Stimulants — Amphetamines (speed) ............................. O O O O O j. Stimulants — Methamphetamine (meth) ......................... O O O O O k. Synthetic Cathinones (Bath Salts) ................................. O O O O O 1. Club Drugs — MDMA/GHB/Rohypnol (Ecstasy) .......... O O O O O m. Dissociative Drugs — Ketamine/PCP (Special K) .......... O O O O O n. Hallucinogens — LSD/Mushrooms (acid) ...................... O O O O O o. Inhalants — Solvents (paint thinner) .............................. O O O O O p. Prescription Medications — Depressants ........................ O O O O O q. Prescription Medications — Stimulants .......................... O O O O O r. Prescription Medications — Opioid Pain Relievers ........ O O O O O s. Other (specify) .... O O O O O 14. How many times before now have you ever been in a drug treatment program? [DO NOT INCLUDE AA/NA/CA MEETINGS] O Never O 1 time 0 2 times 0 3 times 0 4 or more times 15. How serious do you think your drug problems are? O Not at all O Slightly O Moderately O Considerably O Extremely 16. During the last 12 months, how often did you inject drugs with a needle? O Never O Only a few times O 1-3 times/month O 1-5 times per week O Daily 17. How important is it for you to get drug treatment now? O Not at all O Slightly O Moderately O Considerably O Extremely TCU Drug Screen 5 (v.Sept202O) 2 of 2 © Copyright 2020 TCU Institute of Behavioral Research, Fort Worth, Texas. All rights reserved. 16.D.10.b Co per c01.nty Office of Management & Budget TO: Leo E. Ochs, Jr., County Manager CC: Tami Bailey Grant Manager — Community and Human Svcs Kristi Sonntag Director — Community and Human Services FROM: Therese Stanley Manager — OMB Grants Compliance DATE: March 8, 2021 Grant Application Reviewed and Approved by C tnty Manager, or des' r► County Ma er *(date) After -the -Fact Approval by the BCC is required at the March 23, 2021 BCC meeting RE: County Manager review and approval to submit an application to the Department of Children and Families in the amount of $1,200,000 (ATF 21-003) The Community and Human Services Division is applying for funding to the Department of Children and Families under the Criminal Justice, Mental Health, and Substance Abuse Grant Program. Funding will be used to expand and enhance substance abuse treatment services for inmates who are currently participating in Medication Assisted Treatment at the time of arrest and provide community treatment and integration services at the time of release. This grant will also fund a data collaborative and a mental health/substance abuse care coordinator to provide oversight and implement the County's Mental Health -Substance Abuse strategic plan. The total project cost and grant application request is in the amount of $1,200,000 to be obtained over a three-year period. The grant requires a one-to-one local match of $1,200,000 (100%). The match portion is split between Collier County, David Lawrence and the Collier County Sheriff's Office. Collier County's local match portion is $93,253 of which the Collier County Sheriff's Office is providing $82,390 leaving $10,863 for Collier County's portion to be funded within the CHS Annual General Fund Transfer for operations (Cost Center 155930). The Collier County Sheriff's Office is also providing $1,729 towards David Lawrence's match share. The Department of Children and Families issued a Notification of Funding Availability on January 20, 2021 with applications due no later than March 9, 2021. Due to the unique nature of the grant and the time needed for its collaborative application process between agencies, we are asking for your approval to submit the application followed by an After -the -Fact approval by the Board of County Commissioners at the March 23, 2021 BCC meeting. Once you have reviewed the application, please sign in the box above and in the areas marked throughout the application and call me for pickup at 239-252-2959. Thank you, and please let me know if you have any questions regarding this request. 3299 Tamiami Trail East, Suite 201 • Naples, Florida 34112-5746.239-252-8973 - FAX 239-252-8828 Packet Pg. 1190