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Backup Documents 01/14/2014 Item #16D13 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI,p TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO IUDI 3_ 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: Itorney. Office at the time the item is placed on the agenda. 4,11 completed routing slips and original documents must be received in the County %llorne.Office no later than Slonday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Lisa Carr HHVS It 2. Jennifer B. White, ACA Office located in HHVS County Attorney Office Department I I"\\14 3. BCC Office Board of County Commissioners \r 7 l\V--\\\� 4. Minutes and Records Clerk of Court's Office PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Lisa Carr 1 \ate � Phone Number 252-2339 Contact/ Department Agenda Date Item was 1/14/14 Agenda Item Number 16D13 Approved by the BCC Type of Document Standard Contract Amendment for DLC ✓Number of Original 3 Attached 3 ret A,,,1 c n-I n-Nerr Documents Attached PO number or account number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? Yes 2. Does the document need to be sent to another agency for additional signatures? If yes, No provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman,with the exception of most letters,must be reviewed and signed Yes by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's Yes— N\A Office and all other parties except the BCC Chairman and the Clerk to the Board f 5. The Chairman's signature line date has been entered as the date of BCC approval of the Yes document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's Yes V signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip Yes V 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 1/14/14 and all changes made during the Yes NIA*tot meeting have been incorporated in the attached document. The County Attorney's f for Office has reviewed the changes,if applicable. ar 9. Initials of attorney verifying that the attached document is the version approved by the Yes , . t BCC,all changes directed by the BCC have been made,and the document is ready for the flit Chairman's signature. ��1w a. 16D13 MEMORANDUM Date: January 21, 2014 To: Lisa Carr, Grants Coordinator Housing, Human & Veteran Services From: Martha Vergara, Deputy Clerk Minutes & Records Department Re: 3rd Amendment to Agreement Contractor: David Lawrence Center Attached are two (2) originals of the document referenced above, (Agenda Item #16D13) approved by the Board of County Commissioners on Tuesday, January 14, 2014. The Minutes and Record's Department has kept an original for the Board's Official Record. If you have any questions please call me at 252-7240. Thank you Attachment 16013 THIRD AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND DAVID LAWRENCE MENTAL HEALTH CENTER, INC. This Amendment, is entered into this day of aw orp, 2014, by and between David Lawrence Mental Health Center, Inc. a private not- or-profit oration existing under the laws of the State of Florida, herein after referred to as David Lawrence Center and Collier County, Florida, herein after to be referred to as "COUNTY," collectively stated as the "Parties." WHEREAS, on December 11, 2012, the County entered into an agreement with David Lawrence Center for it to provide substance abuse and mental health services to Collier County residents (hereinafter referred to as the"Agreement"); and WHEREAS, the Parties desire to modify the Agreement by replacing Article III, Compensation and Reports of the Agreement, and adding Exhibit 2A, Exhibit 3A, and Exhibit 5A to the Agreement. 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 modify the Agreement as follows: 1. Replace chart in Article III to include Program Area, Sub-Category cost centers of services without a detailed allocated budget for sub-categories costs centers and the annual County and AHCA funding allocation budget for each Program Area, attached hereto. 2. Amend the first sentence in Article III to state: Once invoiced by the DAVID LAWRENCE CENTER and validated, the COUNTY will submit payments on a quarterly reimbursement basis to COUNTY's community health partner for services delivered in accordance with Exhibit 5A. 3. Add Exhibit 2A, Demographics of Clients Served, attached. 4. Add Exhibit 3A, Performance Outcome Report, attached. 5. Add Exhibit 5A, Statement of Work, attached. 6. 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. 1 161113 3 IN WITNESS WHEREOF, the Parties have executed this Amendment, on the date and year first above written. DAVID LAWRENCE CENTER: COLLIER COUNTY: By: S c U 2 A. Gt1 -77,41At By: Tom Henning Name (prl,nt) Nam Chairman (Signature of authorized officer) (Signature of authori d officer) C/-- Chairwoman, Board of County Commissioners Title Title / X/43 1\\L-k\ ILk Date Date ATTEST: DWIGHT E.;BROCK, CLERK By: V`! , .1...:M Attest as to ChairmaI °.PU ERK signature only. Approved for form and legality: Jennife "� . Belpedio Assistant County Attor- 2 0 16013 Article III of the Agreement-FY 13/14 Replace Chart with the following : Total Annual Program Area Approved Budget Sub-Category Cost County and Center AHCA Funding Allocation For Program Area Adult Mental Health (a) Crisis Support/Emergency Services $1,039,000 (b) Adult Medical Services (c) Comprehensive Community Service Teams (d) Adult Mental Health Outpatient (e) Crisis Stabilization/CSU (f) Crisis Stabilization/CSU-None Re- admitted percentage Adult Substance Abuse (a) Adult Substance Abuse Outpatient $230,000 (b) Detox (c) Residential Level 1 (d) Crisis Support/Emergency Services (e) Case Management Children's Mental Health (a) Children's Medical Services $116,040 (b) Crisis Support/Emergency Services (c) Comprehensive Community Service Team (d) Children's Mental Health Outpatient (e) Crisis Stabilization/CSU Total $1,385,040.00 c\C$ EXHIBIT 2A-DUE SEPTEMBER 30TH 16 013 DAVID LAWRENCE CENTER DEMOGRAPHICS OF CLIENTS SERVED Reporting Period: October 1,2013-Se,tember 30,2014 Adult Children's Child/Adolesc. UNDUPLICATED CLIENT Adult Mental Substance Mental Substance CHARACTERISTICS Health Abuse Health Abuse Total Number Served: AGE GROUP i . 5 and Under 6- 12 years 13 - 17 years . 18-30 years #704;T/""-:4-;,,N-1 31 -50 years 51 -61 years ' 62 and over Not Collected TOTAL GENDER Male Female Not Collected TOTAL American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White Multi-Racial Other Not Collected TOTAL ETHNItvITY ,; , Hispanic or Latino Not Hispanic or Latino Not Collected TOTAL I LEGAL RESIDENCE AT REFERRAL Goodland 34140,34145 * Immokalee 34142 Lely 34113 * Marco Island 34140,34145(* included Goodland) Naples 34102,34103,34104,34105,34112,34113 Naples Manor 34113 (* included Lely) Naples Park 34108 * Orangetree 34120 Pelican Bay 34108 (*included Naples Park) Pelican Ridge 34108(* included Naples Park) Plantation Island 34139,34141 Vineyards 34116,34119 Out of County Not Collected Homeless TOTAL d� EXHIBIT 3 A , 6 D 1 3 FY 13-14 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Crisis Support/Emergency 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 31,2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME# 1: Adult Mental Health Crisis Support/Emergency 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. END OF SECTION ONE 16 01 3 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Crisis Support/Emergency Services SECTION TWO Reporting Period: Contract year—October 1, 2013—September 30, 2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 1: Adult Mental Health Crisis Support/Emergency 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 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. 0 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center 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, 2014 for time period 10/01/13-9/30/14 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 0 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Medical Services SECTION TWO Reporting Period: Contract year—October 1, 2013—September 30, 2014 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? I END OF SECTION TWO Agencies are welcome to submit a 1/2 page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. 9 16D13 I PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center 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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME #3: Adult Mental Health Comprehensive Community Service Team 1. Outcome Statement including # or%: 60 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 Mental Health Comprehensive Community Service Team Programs are community based 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 0 161313 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Comprehensive Community Service Team SECTION TWO Reporting Period: Contract year—October 1,2013—September 30, 2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME #3: Adult Mental Health Comprehensive Community Service Team 1. Outcome Statement including # or%: 60 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Adult Mental Health Community Service Team 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? I 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. 9 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center 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, 2014 for time period 10/01/13-9/30/14 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 0 161113 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Outpatient SECTION TWO Reporting Period: Contract year—October 1,2013—September 30, 2014 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 ''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. 0 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Crisis Stabilization Unit/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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract 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. 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 ® 161 :131 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health Crisis Stabilization Unit/CSU SECTION TWO Reporting Period: Contract year—October 1,2013—September 30, 2014 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? I 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. 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health /Crisis Stabilization Unit/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, 2014 for time period 10/01/13-9/30/14 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 160131 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Mental Health / Crisis Stabilization Unit/CSU SECTION TWO Reporting Period: Contract year October 1,2013—September 30,2014 Due : QUARTERLY Can be submitted by mail, email or fax 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. 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 'h page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. 16013 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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 7: Adult Substance Abuse Outpatient 1. Outcome Statement including # or%: 60 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. END OF SECTION ONE 16013 6 Di 3 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Outpatient SECTION TWO Reporting Period: Contract year—October 1, 2013 —September 30, 2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 7: Adult Substance Abuse Outpatient 1. Outcome Statement including # or%: 60 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 '/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. 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center 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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 8: Adult Substance Abuse Detox 1. Outcome Statement including # or%: 75 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 (77.) 16013 3 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Detox SECTION TWO Reporting Period: Contract year-October 1,2013—September 30,2014 Due: QUARTERLY Can be submitted by mail, email or fax OUTCOME # 8: Adult Substance Abuse Detox 1. Outcome Statement including# or%: 75 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? I 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. 7„ 1613 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Residential Level I 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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME #9: Adult Substance Abuse Residential Level I 1. Outcome Statement including # or%: 20 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. List the Activities or Services provided by this program. 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 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Residential Level I SECTION TWO Reporting Period: Contract year—October 1, 2013—September 30, 2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 9: Adult Substance Abuse Residential Level I 1. Outcome Statement including# or%: 20 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 'h page narrative explanation. This could include explanation regarding your actual versus target percentage and any comments about the outcome results or the outcome process. 161) 13 ' PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Crisis Support/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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 10: Adult Substance Abuse Crisis Support/Emergency Services 1. Outcome Statement including # or%: SO distinct 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 X .) 169131 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Crisis Support/Emergency Services SECTION TWO Reporting Period: Contract year—October 1, 2013-September 30, 2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 10: Adult Substance Abuse Crisis Support/Emergency Services 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 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 ''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. cio 16013 .1 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center 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 31,2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 11: Adult Substance Abuse Case Management 1. Outcome Statement including # or%: 40 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 provided to adult family members whose substance use place the family at risk. 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 1 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Adult Substance Abuse Case Management SECTION TWO Reporting Period: Contract year-October 1,2013—September 30,2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 11: Adult Substance Abuse Case Management 1. Outcome Statement including # or%: 40 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 ''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. C'1O 16D13 PERFORMANCE OUTCOME REPORT Provider Name: David 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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME# 12: Childrens Mental Medical Health Medical Services 1. Outcome Statement including # or%: 10 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 I I CAA0 160131 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Childrens Mental Health Medical Services SECTION TWO Reporting Period: Contract year-October 1, 2013-September 30,2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 12: Childrens Mental Health Medical Services 1. Outcome Statement including # or%: 10 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? I 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. 160131 0 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Crisis Support/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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 13: Children's Mental Crisis Support/Emergency Services 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 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Crisis Support/Emergency Services SECTION TWO Reporting Period: Contract year—October 1,2013—September 30,2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 13: Children's Mental Health Crisis Support/Emergency Services 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. 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. 16013 3 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Comprehensive Community Service Team 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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 14: Children's Mental Health Comprehensive Community Service Team 1. Outcome Statement including # or%: 15 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Comprehensive Community Service Team programs. 2. List the Activities or Services provided by this program. Children's Mental Health Programs include Children's Community 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. END OF SECTION ONE 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Comprehensive Community Service Team SECTION TWO Reporting Period: Contract year-October 1,2013-September 30,2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME# 14: Children's Mental Health Comprehensive Community Service Team 1. Outcome Statement including# or%: 15 distinct individuals that do not have Medicaid, Medicare or other funding sources will be served each quarter in Children's Mental Health Comprehensive Community Service Team 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. (llrj 16O13 3 ki PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center 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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 15: Children's Mental Health Outpatient 1. Outcome Statement including # or%: 30 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 provided 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 t' �1 \ i' 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Out ap t SECTION TWO Reporting Period: Contract year—October 1, 2013-September 30,2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 15: Children's Mental Health Outpatient 1. Outcome Statement including# or%: 30 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. 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. 16013 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Crisis Stabilization /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, 2014 for time period 10/01/13-9/30/14 SECTION ONE To Be Completed and returned with contract OUTCOME # 16: Children's Mental Health Crisis Stabilization /CSU 1. Outcome Statement including # or%: 8 distinct 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 1 .1,x) 16 311 PERFORMANCE OUTCOME REPORT Provider Name: David Lawrence Center Program: Children's Mental Health Crisis Stabilization /CSU SECTION TWO Reporting Period: Contract year—October 1, 2013-September 30, 2014 Due : QUARTERLY Can be submitted by mail, email or fax OUTCOME # 16: Children's Mental Health Crisis Stabilization /CSU 1. Outcome Statement including# or%: 8 distinct 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 '/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. \. 16O13 ! Exhibit 5A STATEMENT OF WORK FY 13/14 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 Areas: #1.Crisis Support/Emergency services, 1) DLC Projected Cost to provide a unit of service =$51.28 2) DLC county Unit Rate=$51.28 3) State Maximum Rate=$42.53 4) CFBHN Contract Rate=$42.53 5) Hours, days, location of operation: 24 hours a day/7 days a week 6075 Bathey Lane Naples, Florida 6) Activities/Services provided: 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. #2-Adult Medical Services 1) DLC Projected Cost to provide a unit of service=$451.17 2) DLC county Unit Rate=$451.17 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. #3-Comprehensive Community Service Teams 1) DLC Projected Cost to provide a unit of service=$54.16 2) DLC county Unit Rate=$54.16 160131 3) State Maximum Rate=$37.86 4) CFBHN Contract Rate=$37.86 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),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. 7) Target population:Adults experiencing mental health problems. #4-Adult Mental Health Outpatient 1) DLC Projected Cost to provide a unit of service =$107.14 2) DLC county Unit Rate=$107.14 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: Group and individual therapy primarily but may also include family therapy. Different levels of group therapy are available based on the intensity of the substance abuse or dependency. 7) Target population: Adult individuals experiencing substance abuse or dependency problems. #5.Adult Mental Health Crisis Stabilization(CSU) rk`4''; 1) DLC Projected Cost to provide a unit of service=$411.28 2) DLC county Unit Rate=$411.28 3) State Maximum Rate=$291.24 4) CFBHN Contract Rate=$391.24 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. #6-Crisis Stabilization Percentage—There isn't a rate for this service No Rates if,l 160131 • ADULT SUBSTANCE ABUSE Program Areas: #7-Adult Substance Abuse`Outpatient *kG n 4 1) DLC Projected Cost to provide a unit of service=$107.14 2) DLC county Unit Rate=$107.14 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: Group and individual therapy primarily but may also include family therapy. Different levels of group therapy are available based on the intensity of the substance abuse or dependency. 7) Target population: Adult individuals experiencing substance abuse or dependency problems. #8-Detox ` 1) DLC Projected Cost to provide a unit of service=$265.63 2) DLC county Unit Rate=$265.63 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. #9-Residential Level 1) DLC Projected Cost to provide a unit of service =$245.05 2) DLC county Unit Rate=$245.05 3) State maximum Rate=$207.25 4) CFHBN Contract Rate=$207.25 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. 1, � 16013 4 7) Target population:Adult individuals experiencing substance abuse or dependency problems that need residential care. #10-Crisis Support/Emergency Services 1) DLC Projected Cost to provide a unit of service=$51.28 2) DLC county Unit Rate=$51.28 3) State Maximum Rate=$42.53 4) CFBHN Contract Rate=$42.53 5) Hours, days, location of operation: 24 hours a day/7daysaweek 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. #11-Case Management 1) DLC Projected Cost to provide a unit of service =$65.41 2) DLC county Unit Rate=$65.41 3) State maximum Rate=$61.12 4) CFBHN Contract Rate=$61.12 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. • CHILDREN'S MENTAL HEALTH Program Areas: #12-Childrens Medical Services 1) DLC Projected Cost to provide a unit of service=$451.17 2) DLC county Unit Rate=$451.17 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 16fl13 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. #13-Crisis Support/Emergency;'Services e 1) DLC Projected Cost to provide a unit of service=$51.28 2) DLC county Unit Rate=$51.28 3) State Maximum Rate=$42.53 4) CFBHN Contract Rate=$42.53 5) Hours,days, location of operation: 24 hours a day/7 daysaweek 6075 Bathey Lane Naples, Florida 6) Activities/Services provided: 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:Children experiencing acute and serious mental health or substance abuse problems. #14-Comprehensive Community Service Teams 1) DLC Projected Cost to provide a unit of service=$54.16 2) DLC county Unit Rate=$54.16 3) State Maximum Rate=$37.86 4) CFBHN Contract Rate=$37.86 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),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. 7) Target population: Children experiencing mental health problems. I #15-Childrens Mental Health C utpatient E' ry, 1) DLC Projected Cost to provide a unit of service=$107.14 2) DLC county Unit Rate=$107.14 3) State Maximum Rate=$91.09 16013 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: Group and individual therapy primarily but may also include family therapy. Different levels of group therapy are available based on the intensity of the substance abuse or dependency. 7) Target population: Individuals experiencing substance abuse or dependency problems. I #16-Crisis Stabilization/CSU a. 1) DLC Projected Cost to provide a unit of service=$411.28 2) DLC county Unit Rate=$411.28 3) State Maximum Rate=$291.24 4) CFBHN Contract Rate=$391.24 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.