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Backup Documents 01/13/2015 Item #16D14 1 Z. ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#I through#2,complete the checklist,and forward to the County Attomey Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Peggy Hager Community and Human �� Services '!% 12.AS- 2. County Attorney Office County Attorney Office 3. BCC Office Board of County Commissioners 1zto.\S 4. Minutes and Records Clerk of Court's Office t( )((S PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Leslie Hayes,Grant Coordinator, Phone Number 239-252-2903 Contact/ Department Community and Human Ser s Agenda Date Item was January 13,2015 Agenda Item Number Approved by the BCC /(p f Type of Document Fourth Amendment DLC 3 Attached PO number or account `c‘dSao �'�X' `. number if document is - - . •' ••• Account# to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column, whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original .ignature? LMH 2. Does the document need to be sent to anoth- .gency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be LMH signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the LMH document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's LMH signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 01/13/15 and all changes made during LMH the meeting have been incorporated in the attached document. The County No Attorney's Office has reviewed the changes,if applicable. _`s 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made,and the document is ready for the 46, Chairman's signature. I I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 16 ® 14 MEMORANDUM Date: January 27, 2015 To: Leslie Hayes, Grant Coordinator Community and Human Services From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Fourth Amendment to Agreement with David Lawrence Mental Health Center, Inc. Attached are two originals of the contract referenced above, (Item #16D14) approved by the Board of County Commissioners on Tuesday, January 13, 2015. The third original contract will be held in the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252-8411. Thank you. Attachment 16j4 FOURTH AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND DAVID LAWRENCE MENTAL HEALTH CENTER, INC. 3 2014, by and This Amendment, is entered into this day of = "� - �-� -_ between David Lawrence Mental Health Center, Inc. a private MI for-profit V,rporation existing under the laws of the State of Florida, herein after referred to as David Lawrence Center and Collier County, Florida, herein after to be referred to as "COUNTY," collectively stated as the "Parties." WHEREAS, on December 11, 2012, the County entered into an agreement with David Lawrence Center to provide substance abuse and mental health services to Collier County residents (hereinafter referred to as the"Agreement"); and WHEREAS, the Parties desire to amend the Agreement by modifying the language in Article III, Compensation and Reports, Article IV Audits, Monitoring and Records, and Exhibits 1, 1A, 3A and 5A. WHEREAS, this Agreement is funded by local funds matched with Federal funds as provided in the October 23, 2012 Letter of Agreement between COUNTY and Agency for Healthcare Care Administration that allows County participation in an intergovernmental transfer program. NOW, THEREFORE, in consideration of foregoing Recitals, and other good and valuable consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree to amend the Agreement as follows: 1. All references to Housing, Human and Veteran Services (HHVS) shall be replaced by Community and Human Services (CHS) throughout the agreement. 2. Amend Article III Compensation and Reports, A. Contract Payment, B. Deferred Payments and C. Contract Deliverables: ARTICLE III COMPENSATION AND REPORTS A. Contract Payment Once invoiced by the DAVID LAWRENCE CENTER and validated, the COUNTY will submit payments one payment on a quarterly reimbursement basis in the first quarter of each county fiscal year to on a quarterly reimbursement basis to the County's community health partner Naples Community Hospital for $149,566.00 for Mental Health and Substance Abuse servic-es units delivered in accordance with Exhibit 5 and 5A. The DAVID LAWRENCE CENTER agrees to accept as full compensation the total annual amount not to exceed $171-547-20£6941 $149,566.00 from Naples Community Hospital as . - -- . . -- . •-a . . a'" :— - a•a" -- Page 1 16014 matching program of $1,355,040.00. payments will be authorized only for work completed and/or services for units delivered during the term of the contract as stated in ARTICLE II: TERM OF CONTRACT and prior to the payment request date. Documentation of eligible ex-peftses units will be provided as stated in Article III C. Contract Deliverables. Payment is subject to the provisions of Article III B Deferred Payment/Return of Funds and Article IX, Suspension/Termination. All requests for payment shall be submitted in accordance with Exhibit 1 and be accompanied by the required supporting documentation as outlined in the payment/deliverable performance table below. Funding is contingent upon the availability of funds. SALES TAX. The DAVID LAWRENCE CENTER shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the work. All payments are contingent upon the payment/deliverable performance table below: Quarter 1 $149,566.00 Performance data Due Date: October 1- Exhibit 1 Exhibit 3A and Unit January 30,2015 December 31 Data Exhibit 1A Quarter 2 N/A Performance data Due Date: January 1- March Exhibit 3A and April 30,2015 30 Unit Data Exhibit 1A Quarter 3 April N/A Performance data Due Date: 1 - June 30 Exhibit 3A and July 30,2015 Unit Data Exhibit 1A Quarter 4 July N/A Performance data Due Date: 1 -- September Exhibit 3A and October 30,2015 30 Unit Data Exhibit 1A The County has agreed to purchase the units service(s) listed in Article I. For unit rate contracts, this contract is for the payment of a fixed numbcr of units of _-.... Page 2 _. _ _...._.... .._.. (0) 6 .E 4 Approved Minimum Unit By Botiget Unit —County Program Area Program Area Category and AHCA fond-ing Allocation Adult Mental (a) Emergency $563,000 $1,039,000 Health Services 2,803 units (b)Medical Services $363,000 (c)Immokalee Medical $25,000 (d)Immokalee $8880 Outpatient Adult Substance (a) Detox $100,000 $230,090 Abuse 921 units (b) Outpatient $697900 (c)Drug Court $70,000 Children's Mental (a) Medical $58,040 $116,010 Health 314 units (b) Urgent Care $ 0 Modifications to Article I may only be made if approved in advance by the Grant Coordinator. Unit shifts among program areas shall not be more than 10% and does not signify a change in scope. Fund shifts that exceed 10% of a program area shall only be made with board approval. B. Deferred Payment/Return of Funds The COUNTY may defer payment to the Naples Community Hospital and Physician's Regional Hospital paid on behalf of DAVID LAWRENCE CENTER for noncompliance with contract deliverables or program requirements. If, as a result of monitoring or audit, units of service provided are not properly documented, a payment may be deferred. If units are found to be unallowable, no future payments will be made until the full amount of overpayment is remitted to the COUNTY or a repayment agreement Page3 ------.-......--- --------- _._. _._.._...... _._. _._..__ ©vp s 1F$' Ca is accepted by the COUNTY. If the monitoring or audit occurs after the term of this contract, the DAVID LAWRENCE CENTER will be required to remit funds to the COUNTY in accordance with the repayment conditions below. The DAVID LAWRENCE CENTER agrees to return to the COUNTY any overpayments due to funds disallowed pursuant to the terms of this Contract and/or COUNTY, State or Federal requirements. The DAVID LAWRENCE CENTER will be required to reimburse the COUNTY for any acts of non-compliance resulting in disallowed costs or fines. * * * C. Contract Deliverables 1. Required Reports (checked boxes are applicable) 0 EXHIBIT 1- Payment Request - Due: t4 The first quarter of the County Fiscal year by the 30th of the following month. The first quarter Al4 payments will be reimbursement for expenses/services units and quarter two-four shall be $0 invoices accompanied by performance and unit report for units rendered during the contract term. • = ;•'_ : ; • • •• ' • in the Contract Clescout Section (Article III 2 D). Copies of supporting unit documentation is are required as part of the Quarterly Payment Request for review before payment will be freele authorized by Heusing, Human and Veteran Service Community and Human Services. Reimbursement for eligible units .cxpcnscs Authorization will be made after review and authorization of a correct and complete Exhibit 1 and all required performance and unit data documentation . Eligible units cxpcnscs are defined as uncompensated _xisence3/3"r-vices units delivered during the term of the contract and paid prior to final payment request due date as indicated in the Contract Closeout Section (Article III 2 D). invoices, authorized purchase orders, attendance/service logs, other funder invoices, expenditure spreadsheets or other original check issued with authorized signature. Two sided copies of back up documentation arc preferred. * * * ARTICLE IV AUDITS, MONITORING, AND RECORDS A. Monitoring The DAVID LAWRENCE CENTER agrees to permit persons duly authorized by the COUNTY to inspect all records, papers, documents, facility's goods and services of the DAVID LAWRENCE CENTER and/or interview any clients and employees of the DAVID LAWRENCE CENTER to be assured of service delivery and performance of the terms and conditions of this contract to the Page 4 16 14 extent permitted by the law after giving the DAVID LAWRENCE CENTER reasonable notice. The monitoring is a limited scope review of the contract and agency management and does not relieve the DAVID LAWRENCE CENTER of its obligation to manage in accordance with applicable rules and sound management practices. Following such monitoring the COUNTY will deliver to the DAVID LAWRENCE CENTER a written report regarding the manner in which services are being provided. The DAVID LAWRENCE CENTER will be requested to respond and rectify all noted deficiencies within the specified period of time indicated in the monitoring report or provide the COUNTY with a reasonable and acceptable justification for not correcting the noted shortcomings. The DAVID LAWRENCE CENTER'S failure to correct or justify the deficiencies within the time specified by the COUNTY may result in the withholding of payments, being deemed in breach or default, or termination of this Contract. The County will conduct an annual financial and programmatic review. The Provider agrees that Community and Human Services Department will carry out no less than one (1) annual on-site monitoring visit and evaluation activities as determined necessary. At the County's discretion, a desk top review of the activities may be conducted in lieu of an on-site visit; The continuation of this Agreement is dependent upon satisfactory evaluations. The Provider shall, upon the request of Community and Human Services Department, submit information and status reports required by Community and Human Services Department to enable Community and Human Services Department to evaluate said progress and to allow for completion of reports required. The Provider shall allow Community and Human Services Department to monitor the Provider on site. Such site visits may be scheduled or unscheduled as determined by Community and Human Services Department. The County will monitor the performance of the Provider based on performance standards as stated with all other applicable federal, state and local laws, regulations, and policies governing the funds provided under this contract. Substandard performance as determined by the County will constitute noncompliance with this Agreement. If corrective action is not taken by the Provider within a reasonable period of time after being notified by the County, contract suspension or termination procedures will be initiated. Provider agrees to provide the County's internal auditor(s) access to all records related to performance measures under this agreement. * * * 3. Amend Exhibit 1, Payment request, Attached. 4. Add Exhibit 1A, Unit Report, Attached 5. Add Exhibit 3A, Performance Outcome Report, Attached. 6. Add Exhibit 5A, Program Area Unit Cost for Fiscal Year 2014-2015, Attached. Page 5 1 D 1 4 7. All other terms and conditions of the Agreement remain in full force and effect. This Amendment merges any prior written and oral understanding and agreements, if any, between the parties with respect to the matters set forth herein. DAVID LAWRENCE CENTER: BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA By: Scott Burgess Name (pr.nt) 41111" 4=1. By: 7.../( ( .gna ure o au- orized officer) TIM NANCE, CHAIRMAN Chief Executive Officer Title t 1,--511 5 Date December 17,2014 Date Approved for form and legality: C Jennifer A. BelplI Al I ESTAssistant County orney DW IGHT E. ROCK, CLERK L>3) \r,L7 e • • bA/1-1' . • CLERK Most 4sAt3 uldti s , gnature only. Item# 16.1)14 Agenda 15 Date Date Rec'd 1. 1 • Deputy Clerk Page 6 16014 EXHIBIT 1 PAYMENT REQUEST Line item Contract Contract* Agenmi.Caved Lattrerot Certhr c„„, Lng airing Address: Mail to:Commumilyand Human Se yams Expenditures for period: Flora: ATTN:Leslie Hayes • FAX: Cliedr appropriate lira: E-mail: FAX Regular Raimbursenem - E-Mail:Leslie fia),esd coMergovnet Final Re int ar*nent Fnal Payment Recorth are d ire by the twentieth calendar day.21zr Ina e rd of the reporting period. ji:APPFfilfgq#*.i51.4:1 la' .0"a"4°"4-- D.Total Paid F. Ehd ci 4404,-Ewg,d4 Expenditures for RopodIN Pe ad(Cm r cit Reporting Period 4 • - - • PROVIDER Bysigning telott, re rafythist the:cork arwhor aervices provided and FOR COLLI R COUNTY USE ONLY reported in Exhibit t are for uncompensated mmensesisnit,and have been By signing below,I certify that to the best of my completed andior debvatel 0 the be al of my knowiz,Ve. I hAiher atMst tut knowledge and abilities,the work andior cervices payment has been made hr accordance with at applicable=rules,regulators provided have been inspected,monitored or reviewed and approved CauntyDantrad. taximsthmi that knowirglyproviding Term and appearto be in compliance with all applicable informatort mild result in trweEt4alior,and prowtion. Sismaare of Authorized Official: L.FTHO1f2EDBY: •PPROVEDA MOUNT. 5 - Dire appicvird: DATE APPADVED: Page 7 .... _..... _ 47". . E 1601 DAVID LAWRENCE CENTER Reporting Period: October 1,2013-September 30,2014 DEMOGRAPHICS OF CLIENTS SERVED Exhibit 1A UNDUPLICATED CLIENT Adult Mental Adult/Substance Child/Mental Child/Adolese. CHARACTERISTICS Health Abuse Health Substance Abuse Total 5328 1816 2191 324 AGE'GROUP' 5 and Under A7 0 6.12 years 881 7 13-17 years 1223 317 18-30 years 1487 886 31-50 years 2017 676 51-61 years 1060 181 62 and over 757 73 Not Collected 7 0 0 0 TOTAL 5328 1816 2191 324 GENDER..: Male 2411 1078 1300 239 Female 2889 736 886 85 Not Collected 28 2 5 0 TOTAL 5328 1816 2191 324 RACE. American Indian or Alaska Native 21 12 11 0 Asian 28 5 I I 1 Black or African American _ 349 88 190 45 Native Hawaiian or Pacific Islander 20 3 9 2 White 4156 1527 1442 206 Multi-Racial 670 176 513 69 Other 0 0 0 0 Not Collected 84 5 15 1 TOTAL 5328 1816 2191 324 ETHNIICITY Hispanic or Latino 1277 373 948 131 Not Hispanic or Latino 3967 1438 1228 192 Not Collected 84 5 15 1 TOTAL 5328 1816 2191 324 I FGAL.RESIDENCE AT REFERRAL ,, ` .. Goodland 34140,34145,34146* 102 37 44 17 Immokalee 34142,34143 262 80 261 27 Lely 34113 * 233 93 87 24 Marco Island 34140,34145(*included Goodland) Naples 34102,34103,34104,34105,34112 1245 383 404 72 Naples Manor 34113(*included Lely) Naples Park 34108* 162 45 53 14 Orangetree 34120 342 115 196 33 Pelican Bay 34108(*included Naples Park) Pelican Ridge 34108(*included Naples Park) Plantation Island 34139,34141 4 5 3 0 Vineyards 34116,34119 835 285 434 59 Out of County 526 214 259 8 Other County Not Incuded Above 1136 359 429 70 Not Collected 58 7 12 0 Homeless 423 193 9 0 TOTAL 5328 1816 2191 324 _.... - - _ _.-.__._._.. _;r Page 8 -- y.. 1611j4 4 Exhibit 3A PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Crisis Sunport/Emergencv Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31,2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 1:, Adult Mental Health Crisis Support/Emereency Services 1. Outcome Statement including#or%: 350 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Health Crisis Support/Emergency Services programs. 2. List the Activities or Services provided by this program. Adult Mental Health Crisis Support and Emergency Services provides triage and admission services that includes Clinical Assessments, Psychiatric Evaluations and crisis intervention for individuals or adults who in crisis. Many assessments are completed within the scope of the Baker Act. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. 1 END OF SECTION ONE Page9 _......___.............___._.........__-_._.____.._._.... 16flj4 Exhibit 3A PERFORMANCE OUTCOME REPORT Program: Adult Mental Health Crisis Support/Emerg_encv Services SECTION TWO Reporting Period: Contract year—October 1,2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 1: Adult Mental Health Crisis Supnort/Emergencv Services 1. Outcome Statement including #or%: 350 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Health Crisis Support/Emergency services programs. 2. From data collected during the term of the contract,provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a ''/z page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page 16D14 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Mental Health Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME#2: Adult Mental Health Medical Services 1. Outcome Statement including# or%: 500 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Health Medical Services program. 2. List the Activities or Services provided by this program.Adult Mental Health Medical Services include Psychiatric Evaluations and Medication Management for persons who are experiencing mental health problems ranging from acute to more long term treatment for a persistent mental illness. Services also include nursing services in addition to coordination with primary care physician. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page _........ - _ _..... _._._._....... 1 6 0 1 °T Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Mental Health Medical Services, SECTION TWO Reporting Period: Contract year—October 1,2014—September 30,2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME #2: Adult Mental Health Medical Services 1. Outcome Statement including# or%: 500 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Health programs. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a '/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page 16014 6 0 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Mental Health Comprehensive Community Service Team Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME#3: Adult Community I'roerams 1, Outcome Statement including#or%: L distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Comprehensive Community Service Team programs. 2. List the Activities or Services provided by this program. Adult Community Service are community based mental health programs that include Case Management (care coordination, linking and advocating for clients experiencing serious mental health disorders), Supported employment, and Forensic Services for individuals within the legal system who have been found incompetent to proceed or not guilty by insanity to proceed due to their mental condition. Adult community services promote a recovery lifestyle that maximizes individual's ability for independent functioning in the least restrictive setting based on their ability and individualized need. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page __..._-..... .._..__... ..._.._._... 16fl1 � Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Mental Hejth Comprehensive Community Service Team SECTION TWO Reporting Period: Contract year—October 1,2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME #3: Adult Community Programs 1. Outcome Statement including# or%: 150 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Community programs. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page _........._._..-.---__._...____.---__._......_..._..__._._.____...._.._....-._.._.__.._-_._ 16014 6 0 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Mental Health Outpatient Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 4: Adult Mental Health Outpatient 1. Outcome Statement including # or%: 200 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Health Outpatient program. 2. List the Activities or Services provided by this program. Adult Mental Health Mental Health Outpatient Services include individual, group and family therapy according to clinical recommendations based on the Assessment and Treatment Planning Process. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page 16014 ' Exhibit 3A PERFORMANCE OUTCOME REPORT Program;Adult Mental Health Outpatient SECTION TWO Reporting Period: Contract year—October 1, 2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 4: Adult Mental Health Outpatient 1. Outcome Statement including# or%: 200 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Health Outpatient program. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a V2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page 161314 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Mental Health Crisis Stabilization Unit I CSU Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31,2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME#5: Adult Mental Health Crisis Stabilization Unit/CSU 1. Outcome Statement including# or%: Lj{Ldistinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in the Adult Mental Health Crisis Stabilization Unit/CSU program. 2. List the Activities or Services provided by this program. Adult Mental Health Programs include the Crisis Stabilization Unit that provides short term, inpatient crisis stabilization and support for individuals or adults who are either at risk of harming themselves or others due to a mental health crisis. David Lawrence Center manages the only Baker Act receiving facility for Collier County. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page 161314 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Mental Health Crisis Stabilization Unit 1 CSU SECTION TWO Reporting Period: Contract year—October 1, 2014—September 30,2015 Due : QUARTERLY Can be submitted by mail,email or fax OUTCOME# 5: Adult Mental Health Crisis Stabilization Unit/CSU. 1. Outcome Statement including# or%: 150 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in the Adult Mental Health Crisis Stabilization Unit/ CSU program. 2. From data collected during the term of the contract,provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO 1 Agencies are welcome to submit a '/ page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. __.__..__...._...----._.___........_._.__....__---._._._._...___..------..._.__....__......... Page 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health 1 Crisis Stabilization Unit 1 CSU, Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31,2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 6:, Crisis Stabilization Unit 1. Outcome Statement including%: 85% or more of individuals discharged from the Crisis Stabilization Unit (CSU) will not be readmitted during the 30 days following discharge. 2. List the Activities or Services provided by this program. The Adult Crisis Stabilization Unit provides short term, inpatient crisis stabilization and support for persons who are either at risk of harming themselves or others due to a mental health crisis. The CSU is the only Baker Act receiving facility for Collier County. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record database and presented quarterly via internal reports capturing numbers and percentages of people re-admitted within 30 days. END OF SECTION ONE Page 16fl14 Exhibit 3A PERFORMANCE OUTCOME REPORT Program: Adult Mental Health /Crisis Stabilization Unit/CSU. SECTION TWO Reporting Period: Contract year—October 1,2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME#6: Crisis Stabilization Unit I. Outcome Statement including%: 85% or more of individuals discharged from the Crisis Stabilization Unit (CSU) will not be readmitted during the 30 days following discharge. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients did the CSU admit during the specified time period? B. How many unduplicated clients were measured for this outcome during the time period? C. If answers A and B are different, explain why(sampling, outcome population definition, etc.)? D. How many of the unduplicated clients from B achieved the outcome during the time period? E. Outcome percentage (D divided by B): END OF SECTION TWO Agencies are welcome to submit a V2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Outpatient Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31,2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 7:. Adult Substance Abuse Outpatient 1. Outcome Statement including# or%: 124 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Substance Abuse Outpatient programs. 2. List the Activities or Services provided by this program.Adult Substance Abuse Outpatient Services include individual, group and family therapy according to clinical recommendations based on the Assessment and Treatment Planning Process. Outpatient Services also include the Drug Court program and Intensive Outpatient Service program. Different levels of group therapy are available based on the intensity of the substance abuse or dependency. Treatment focuses on helping the individual accept his/her addiction and support the individual in establishing a recovery lifestyle. The Drug Court program diverts offenders with substance abuse and drug related criminal activity from the criminal justice system by offering them an opportunity to proactively deal with their dependence rather than face punitive alternatives. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served I END OF SECTION ONE Page 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Outpatient SECTION TWO Reporting Period: Contract year—October 1, 2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail,email or fax OUTCOME# 7: Adult Substance Abuse Outpatient 1. Outcome Statement including#or%: 120 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Substance Abuse programs. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a '/s page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page __........._... _ ___ ._.._.._ 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Detox Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME#8: Adult Substance Abuse Detox 1. Outcome Statement including#or%: 80 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in the Adult Substance Abuse Detox program. 2. List the Activities or Services provided by this program. Adult Substance Abuse Programs include the Detox program which is a voluntary, medically- managed program for individuals who are in need of detoxification services. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page �,......: 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Detox SECTION TWO Reporting Period: Contract year—October 1,2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 8: Adult Substance Abuse Detox 1. Outcome Statement including# or%: 80 distinct individuals that do not have Medicaid, Medicare or other,funding sources will be served each quarter in the Adult Substance Abuse Detox program. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a '/page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page 4 161314 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Residential Level Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed quarterly for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME#9: Adult Substance Abuse Residential Level I 1. Outcome Statement including#or%; jS distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in the Adult Substance Abuse residential program. 2. , . ; • • •. • . 11 • . , $ • II ,• , , 'r: 11. Adult Substance Abuse Programs include the Residential Program, Crossroads, which is a licensed Level I residential facility. Services are structured and individualized with focus on therapeutic rehabilitation provided to those suffering from alcohol or chemical dependency that need residential level of care. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page 1. 6D14 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Residential Level SECTION TWO Reporting Period: Contract year—October 1,2014—September 30,2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME#9: Adult Substance Abuse Residential Level I 1. Outcome Statement including#or %: 25 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in the Adult Substance Abuse residential program. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. y'1 Page — _._...... -- ._.._...........__.... 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Crisis Su000rt I Emergency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31,2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 10: Adult Substance Abuse Crisis Support/Emeraency Services 1. Outcome Statement including#or%: Ladistinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Substance Abuse Crisis Support/ Emergency Service programs. 2. List the Activities or Services provided by this program. Adult Substance Abuse Programs include Crisis Support and Emergency Services that provide triage and admission services. These services include Clinical Assessments and crisis intervention for adults who present initially for substance abuse services or are in crisis relating to substance use. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page __.......__..._. ___......... 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Crisis Support I Emergency Services SECTION TWO Reporting Period: Contract year—October 1,2014—September 30,2015 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME# 10: Ad It Substance Abuse Crisis Support/Emergency Services 1. Outcome Statement including# or%: J9J_distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Substance Abuse Crisis Support/ Emergency Services programs. 2. From data collected during the term of the contract, provide the following information: 1. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page 16D14 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Case Management Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME # 11: Adult Substance Abuse Case Management 1. Outcome Statement including# or%: 50 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Substance Abuse Case Management Services. 2. List the Activities or Services provided by this program. Adult Substance Abuse Programs include Case Management Services which are outreach, screening, referral, linking and monitoring services provides to those families and children that are at risk due to substance us. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page . . 16D14 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Adult Substance Abuse Case Management SECTION TWO Reporting Period: Contract year—October 1,2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 11: Adult Substance Abuse Case Management 1. Outcome Statement including# or%: 50 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Substance Abuse Case Management Services. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a % page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Provider Name: ?avid Lawrence Center Program: Childrens Mental Health Medical Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31,2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 12: Childrens Mental Medical Health Medical Services 1. Outcome Statement including#or%: a distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Medical Services, 2. List the Activities or Services provided by this program. Childrens Mental Health Programs include Children's Medical Services that include Psychiatric Evaluations and Medication Management for children who are experiencing mental health problems ranging from acute to more long term treatment for a persistent mental illness. Services also include nursing services in addition to coordination with primary care physician. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served END OF SECTION ONE .......... Page 1 6 0 1 4 Exhibit 3A PERFORMANCE OUTCOME REPORT Provider Name: pavid Lawrence Center Program: Childrens Mental Health Medical Services SECTION TWO Reporting Period: Contract year—October 1,2014—September 30,2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 12: Childrens Mental Health Medical Services 1. Outcome Statement including#or%: 25 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Medical Services. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a '/Z page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Children's Mental Health Crisis Support/Emeraency Services Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31,2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 13: Children's Mental Crisis Support/Emergency Service 1. Outcome Statement including# or%: 35 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Crisis Support/Emergency Services programs. 2. List the Activities or Services provided by this program. Children's Mental Health Programs include Children's Crisis Support and Emergency Services that provide triage and admission services including Clinical Assessments, Psychiatric Evaluations and crisis intervention for children who in crisis. Many assessments are completed within the scope of the Baker Act. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page -........_._......._-......... _..__......._.__..._..._.. _..._.._....._. 16fl12 Exhibit 3A PERFORMANCE OUTCOME REPORT Program: Children's Mental Health Crisis Support/Emergency Services, SECTION TWO Reporting Period: Contract year—October 1,2014-September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 13; Children's Mental Health Crisis Support 1 Emergency Services 1. Outcome Statement including#or%: ,indistinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Crisis Support/ Emergency Services programs. 2. From data collected during the term of the contract,provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a '//page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. --._..._...__..____..__..._________._._-___...-...._..._..___..__._..--------._...._........_...._._._.......------ Page 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program: Children's Community Programs Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2015 for time period 10101/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 14: Children's Community ProErams 1. Outcome Statement including#or%: 2jdistinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Community programs. 2. List the Activities or Services provided by this program. Children's Community Programs are mental health services consisting of Case Management (care coordination, linking and advocating for clients experiencing serious mental health disorders), and community based services provided in the home, at school and other locations in the community. Children's Community Services promote family involvement in the Child's treatment and recovery. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. I END OF SECTION ONE Page _._.._..-_.—____.._..._----_._.._..__---_.....__......-----__..__......---....---....__....__.. 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program: Children's Community Programs SECTION TWO Reporting Period: Contract year—October 1,2014—September 30,2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 14: Children's Community Programs 1. Outcome Statement including#or%: 25 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Community Programs. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a 'A page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page _ _ —._.._._....... __._._._-._..._.. 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Children's Mental Health Outpatient Section 1 ONLY to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 I SECTION ONE To Be Completed and returned with contract OUTCOME# 15:, Children's Mental Health Outpatient 1. Outcome Statement including# or%: ,_distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Outpatient program. 2. List the Activities or Services tmovided by this program. Children's Mental Health Programs include Children's Mental Health Outpatient Services that provide individual, group and family therapy according to clinical recommendations based on the Assessment and Treatment Planning Process. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served, END OF SECTION ONE Page __._..._......_..._._._... _...._.._....._. 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Outpatient SECTION TWO Reporting Period: Contract year--October 1,2014—September 30, 2015 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 15: Children's Mental Health Outpatient 1. Outcome Statement including#or%:IQdistinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Outpatient program. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a ''Y2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. Page _....... _... _.__ 16014 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Children's Mental Health Crisis Stabilization/CSU Section 1 ON I'to be completed at time of contract execution. Section 2 to be completed for full term of the contract due October 31, 2015 for time period 10/01/14-9/30/15 SECTION ONE To Be Completed and returned with contract OUTCOME# 16:. Children's Mental Health Crisis Stabilization /CSU 1. Outcome Statement including#or%: Ldistinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Crisis Stabilization /CSU program. 2. List the Activities or Services provided by this program. Children's Mental Health Programs include the Crisis Stabilization Unit that provides short term, inpatient crisis stabilization and support for children who are either at risk of harming themselves or others due to a mental health crisis. David Lawrence Center manages the only Baker Act receiving facility for Collier County. 3. How is outcome measured? List the tools/approaches/methods used to track or measure this outcome. Outcome information is tracked via electronic medical record and presented quarterly via internal reports capturing numbers and characteristics of persons served. END OF SECTION ONE Page _.__....._..._._.._...-_---._....__.._.......----._.__.__....._._.._.__._____.......----._._.___._-_..._.._ 1 6 EI 14 Exhibit 3A PERFORMANCE OUTCOME REPORT Program:Children's Mental Health Crisis Stabilization 1 CSU SECTION TWO Reporting Period: Contract year—October 1,2014—September 30, 2015 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME# 16: Children's Mental Health Crisis Stabilization /CSU 1, Outcome Statement including# or%: Ldistinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Crisis Stabilization / CSU program. 2. From data collected during the term of the contract, provide the following information: A. How many unduplicated clients were served and were measured for this outcome during the time period? END OF SECTION TWO Agencies are welcome to submit a V2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. 40 161314 Exhibit 5A update for 2014-2015 DAVID LAWRENCE MENTAL HEALTH CENTER, INC. For all programs Collier County purchases services and assists with the costs that are in addition to funding by Central Florida Behavioral Health Network (CFBHN), the managing entity for substance abuse and mental health funding for the Florida Department of Children and Families. • ADULT MENTAL HEALTH Program Area : #1- Crisis Support/Emergenty► Services . 1) DLC Projected Cost to provide a unit of service = $42.71 2) DLC county Unit Rate = $42.71 3) State Maximum Rate = $42.71 4) CFBHN Contract Rate = $42.71 5) Hours, days, location of operation: 24 hours a day / 7 days a week 6075 Bathey Lane Naples, Florida 6) Activities/Services provided Services include Crisis Assessment, Risk Assessment, Crisis Intervention, Crisis Support referral for Urgent Care Services or other appropriate service(s) within or outside the agency, and/or referral for Admission to an appropriate Acute Care Unit. The Emergency Services Assessment team works collaboratively with the Acute Care team, where ongoing clinical triage/assessment occurs off hours and on weekends. 7) Target population: Adults experiencing acute and serious mental health or substance abuse problems. #2—Ad u it Medical Serv'ces...' 1) DLC Projected Cost to provide a unit of service = $370.69 2) DLC county Unit Rate = $370.69 3) State Maximum Rate = $369.55 4) CFBHN Contract Rate = $369.55 5) Hours, days, location of operation: 8:00-5:00 Monday thru Thursday; 8:00-3:00 Friday 6075 Bathey Lane Naples, Florida 6) Activities/Services provided: Psychiatric evaluation, medication management and nursing services. 7) Target Population: Adults experiencing mental health problems or severe and persistent mental illness. 41 F6, 161314 #3- Adult Targeted Case Management; 1) DLC Projected Cost to provide a unit of service = $76.64 2) DLC county Unit Rate = $76.64 3) State Maximum Rate = $63.21 4) CFBHN Contract Rate = $63.21 5) Hours, days, location of operation: 8:00-5:00 Monday thru Friday 2806 S. Horseshoe Dr. Naples, Florida 6) Activities/Services provided: Provides an array of services to individuals in their natural environment, which range from assessing one's living arrangements and mental status to accompanying an individual to psychiatric, social service, and other appointments. Additionally, an Adult Case Manager will plan and coordinate an individual's discharge from all inpatient treatment facilities by linking the individual with recommended services and basic needs to ensure successful transition into the community at large. The Case Managers will ensure continuity of care via regular and ongoing communication with other service providers, family members, and other natural supports with regard to the served individual's needs and progress. Case Managers make comprehensive efforts to facilitate clients in achieving an optimal level of independence by linking them to internal and community resources. Case Managers assist the individual to identify their needs on a holistic basis and seek to link them to all potentially beneficial resources. 7) Target population: Adults experiencing mental health problems. #4 Fo.ensics 1) DLC Projected Cost to provide a unit of service = $76.64 2) DLC county Unit Rate = $76.64 3) State Maximum Rate = $63.21 4) CFBHN Contract Rate = $63.21 5) Hours, days, location of operation: 8:00-5:00 Monday thru Friday 2806 S. Horseshoe Dr. Naples, Florida 6) Activities/Services provided: Forensics is a service provided to consumers within the legal system who have been found incompetent to proceed or not guilty by reason of insanity due to their mental condition but who have been charged with a felony. They receive advocacy, support, monitoring, technical assistance and facilitation of movement through the criminal justice system. 7) Target population: Adults experiencing mental health problems. 42 16 [1 14 #5- Mental Health.Court 1) DLC Projected Cost to provide a unit of service = $76.64 2) DLC county Unit Rate = $76.64 3) State Maximum Rate = $63.21 4) CFBHN Contract Rate = $63.21 5) Hours, days, location of operation: 8:00-5:00 Monday thru Friday 2806 S. Horseshoe Dr. Naples, Florida 6) Activities/Services provided: Mental Health Court Program represents an effort to increase cooperation between the criminal justice system and the mental health treatment system. The intent of the program is to assist select defendants struggling with a mental illness who have committed a non-violent crime with numerous services in order for the person to become stable. Referrals may originate from legal services, family members, or community providers that have concerns regarding the individual mental health status. 7) Target population: Adults experiencing mental health problems. #�,- Siupporte�I Employment 1) DLC Projected Cost to provide a unit of service = $71.14 2) DLC county Unit Rate = $71.14 3) State Maximum Rate = $51.99 4) CFBHN Contract Rate = $51.99 5) Hours, days, location of operation: 8:00-5:00 Monday thru Friday 2806 S. Horseshoe Dr. Naples, Florida 6) Activities/Services provided: These services, offered to adults 18 years or older, provide resources to assist clients with entering the workforce and maintaining strong employment relationships. On the job assistance is included in these services along with unlimited ongoing support. 7) Target population: Adults experiencing mental health problems. #? Pfioject for:Assistanceln Trar tiion Barn Homelessness..{PATH) 1) DLC Projected Cost to provide a unit of service = $76.64 2) DLC county Unit Rate = $76.64 3) State Maximum Rate = $63.21 4) CFBHN Contract Rate = $63.21 5) Hours, days, location of operation: 8:00-5:00 Monday thru Friday 2806 S. Horseshoe Dr. Naples, Florida 43 16 ® 1 4 6) Activities/Services provided: Project for Assistance in Transition from Homelessness (PATH) is a Homeless Outreach program designed to identify homeless individuals in the community and link them to appropriate services such as housing, medical, substance abuse and mental health services. Case management, supported living, housing and vocational services are provided as needed. 7) Target population: Adults experiencing mental health problems. #8-Adult Mentai Heafth;Outpatien 1) DLC Projected Cost to provide a unit of service = $93.82 2) DLC county Unit Rate = $93.82 3) State Maximum Rate = $91.09 4) CFBHN Contract Rate = $91.09 5) Hours, days, location of operation: 8:00-6:00 Monday-Thursday; 8:00-3:00 Friday 6075 Bathey Lane Naples, Florida 6) Activities/services provided: Outpatient Services include integrated mental health and co-occurring services following a brief treatment model of intervention. Services include individual, marital, family, and group counseling services; educational components within the provision of treatment services; treatment planning; linking and referral services; and clinical care management. Counseling groups are created based on assessed client needs and demand. 7) Target population: Adult individuals experiencing primary mental health problems. . #9:- Adult Mentai Health Cr�s�s::Staaiiizati�n.(CSU)... , ` 1) DLC Projected Cost to provide a unit of service = $380.56 2) DLC county Unit Rate = $380.56 3) State Maximum Rate = $291.24 4) CFBHN Contract Rate = $380.72 5) Hours, days, location of operation: 24 hours day/ 7 days a week 6075 Bathey Lane Naples 6) Activities/services provided: Short term crisis stabilization and support for individuals who are either at risk of harming themselves or others due to a mental health crisis. Individuals may receive voluntary or involuntary services within the scope of the Florida Baker Act. David Lawrence Center is the only Baker Act receiving facility in Collier County. 7) Target population: Adults experiencing acute and serious mental health problems. 44 16014 #10-Crisis Stabilization Percentage There isn't a irate.for this "service No Rates • ADULT SUBSTANCE ABUSE Program Areas: #11 .Adult Sulbatanee Abuse.Outpatient 1) DLC Projected Cost to provide a unit of service = $93.82 2) DLC county Unit Rate = $93.82 3) State Maximum Rate = $91.09 4) CFBHN Contract Rate = $91.09 5) Hours, days, location of operation: 8:00-6:00 Monday-Thursday; 8:00-3:00 Friday 6075 Bathey Lane Naples, Florida 6) Activities/services provided: Outpatient Services include integrated substance abuse and co-occurring services following a brief treatment model of intervention. Services include individual, marital, family, and group counseling services; educational components within the provision of treatment services; treatment planning; linking and referral services; and clinical care management. Counseling groups are created based on assessed client needs and demand. Each client's length of stay is determined by individual need and the appropriateness of the intervention 7) Target population: Adult individuals experiencing primary substance abuse or dependency problems 1) DLC Projected Cost to provide a unit of service = $249.79 2) DLC county Unit Rate = $249.79 3) State Maximum Rate = $204.94 4) CFBHN Contract Rate = $204.94 5) Hours, days, location of operation: 24 hours a day/ 7 days a week 6075 Bathey Lane Naples, Florida 6) Activities/services provided: Medically managed detoxification program. 7) Target population: Adults presenting with symptoms of alcohol or substance withdrawal or signs that withdrawal syndrome is imminent. 413-Residential Level I . 1) DLC Projected Cost to provide a unit of service = $229.69 2) DLC county Unit Rate = $229.69 45 6 1 4 3) State maximum Rate = $241.10 4) CFHBN Contract Rate = $229.69 5) Hours, days, location of operation: 24 hours a day/ 7 days a week 6075 Bathey Lane Naples, Florida 6) Activities/Services provided: Services are structured and individualized with focus on therapeutic rehabilitation provided to those suffering from alcohol or chemical dependency that need residential level of care. 7) Target population: Adult individuals experiencing substance abuse or dependency problems that need residential care. #14 Cr�s�S-Suppor �'E�rnergency,Serv�ides 1) DLC Projected Cost to provide a unit of service = $42,71 2) DLC county Unit Rate = $42.71 3) State Maximum Rate = $42.71 4) CFBHN Contract Rate = $42.71 5) Hours, days, location of operation: 24 hours a day / 7 days a week 6075 Bathey Lane Naples, Florida 6) Activities/Services: Evaluations, assessments or crisis intervention counseling for individuals in crisis. Individuals may receive voluntary or involuntary services within the scope of the Florida Baker Act. David Lawrence Center is the only Baker Act receiving facility in Collier County. 7) Target Population: Adults experiencing acute and serious mental health or substance abuse problems. #15-Case Manageiment: .. 1) DLC Projected Cost to provide a unit of service = $76.64 2) DLC county Unit Rate = $76.64 3) State maximum Rate = $63.21 4) CFBHN Contract Rate = $63.21 5) Hours, days, location of operation: 8:00-5:00 Monday thru Thursday; 8:00-3:00 Friday All locations 6) Activities/Services provided: Services which are outreach, screening, referral, linking and monitoring services provided to those families and children that are at risk due to substance abuse. 7) Target Population: Adult individuals experiencing substance abuse or dependency problems. 46 16014 • CHILDREN'S MENTAL HEALTH Program Areas: 016;Chiildrens Setlfcal Servjces 1) DLC Projected Cost to provide a unit of service = $370.69 2) DLC county Unit Rate = $370.69 3) State Maximum Rate = $369.55 4) CFBHN Contract Rate = $369.55 5) Hours, days, location of operation: 8:00-5:00 Monday thru Thursday; 8:00-3:00 Friday 6075 Bathey Lane Naples, Florida 6) Activities/Services provided: Community based programs that include Case Management (care coordination, linking and advocating for clients experiencing serious mental health disorders), and community based services provided in the home, at school and other locations in the community. Children's Community Services promote family involvement in the Child's treatment and recovery. 7) Target population: Children experiencing mental health problems. #�.7 Crisis Support/finer�ency,Sierviccs . . : , .: : 1) DLC Projected Cost to provide a unit of service = $42.71 2) DLC county Unit Rate = $42.71 3) State Maximum Rate = $42.71 4) CFBHN Contract Rate = $42.71 5) Hours, days, location of operation: 24 hours a day / 7 days a week 6075 Bathey Lane Naples, Florida 6) Activities/Services provided: Services include Crisis Assessment, Risk Assessment, Crisis Intervention, Crisis Support referral for Urgent Care Services or other appropriate service(s) within or outside the agency, and/or referral for Admission to an appropriate Acute Care Unit. The Emergency Services Assessment team works collaboratively with the Acute Care team, where ongoing clinical triage/assessment occurs off hours and on weekends. 7) Target population: Children experiencing acute and serious mental health or substance abuse problems. #1.8 Therapeutic av . Beh ioral On Site Services (TBOSS) 1) DLC Projected Cost to provide a unit of service = $102.75 2) DLC county Unit Rate = $102.75 3) State Maximum Rate = $70.20 47 ();"-) • 16D14 4) CFBHN Contract Rate = $70.20 5) Hours, days, location of operation: 8:00-5:00 Monday thru Thursday; 8:00-3:00 Friday 2806 S. Horseshoe Dr. Naples, Florida 6) Activities/Services provided: Provides individualized therapeutic services to children and adolescents in community settings including: home, daycare, school, and work with the goal of strengthening family systems and increasing protective factors resulting in youth living at home and living successfully in their community. The child must meet specific criteria based on the Community Behavioral On-site Coverage and Limitations Handbook and/or as specified in the Center's Utilization Management Program. Youth may be at risk for residential placement or in the process of being stepped down from a residential program. 7) Target population: Children experiencing mental health problems. #19-Chi dr reS Targeted.Case Management 1) DLC Projected Cost to provide a unit of service = $76.64 2) DLC county Unit Rate = $76.64 3) State Maximum Rate = $63.21 4) CFBHN Contract Rate = $63.21 5) Hours, days, location of operation: 8:00-5:00 Monday thru Thursday; 8:00-3:00 Friday 2806 S. Horseshoe Dr, Naples, Florida 6) Activities/Services provided: Services consist of an assessment aimed at identifying an individual's complex needs, advocating and coordinating access to various service systems; monitoring and evaluating service delivery to ensure the unique needs of the individual are met; and coordinating the various service and system components to optimize individual functioning. 7) Target population: Children experiencing mental health problems. X20-Childr+ens iNntal Health`Qutpatie i 1) DLC Projected Cost to provide a unit of service = $93.82 2) DLC county Unit Rate = $93.82 3) State Maximum Rate = $91.09 4) CFBHN Contract Rate = $91.09 5) Hours, days, location of operation: 8:00-5:00 Monday & Thursday; 8:00-7:00 Tuesday & Wednesday; 8:00-3:00 Friday 6075 Bathey Lane Naples, Florida 6) Activities/services provided: Outpatient Services include integrated mental health and co-occurring following a brief treatment model of intervention. Services include individual, family, and group counseling services; educational components within the provision of treatment services; treatment planning; linking and referral services; and clinical care management. 48 16014 6 0 7) Target population: Individuals experiencing primary mental health problems and/or a combination of mental health and substance abuse or dependency problems. #2 -Crisis Stabiilization/CSU 1) DLC Projected Cost to provide a unit of service = $380.56 2) DLC county Unit Rate = $380.56 3) State Maximum Rate = $291.24 4) CFBHN Contract Rate = $380.72 5) Hours, days, location of operation: 24 hours day/ 7 days a week 6075 Bathey Lane Naples 6) Activities/Services provided: Short term crisis stabilization and support for individuals who are either at risk of harming themselves or others due to a mental health crisis. Individuals may receive voluntary or involuntary services within the scope of the Florida Baker Act. David Lawrence Center is the only Baker Act receiving facility in Collier County. 7) Target population: Children experiencing acute and serious mental health problems. 49