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Moving Forward: Comprehensive Integrated Mental Health Plan, 2006-2011 

IV. Examples of Current Initiatives, Projects, and Activities That Fill Service Gaps

DHSS Priority Area: Vulnerable Alaskans

Affordable Appropriate Housing: A Trust Focus Area

The Affordable Appropriate Housing Focus Area is working to reduce the rates of homelessness and displacement of Trust beneficiaries. The Trust and state agencies, non-profit service organizations and housing advocates worked together to simplify and coordinate the state’s housing and social support programs and increase the assistance available for housing providers serving individuals with a disability, chronic addiction or mental illness. Retooling these programs allows for adequate supportive services and rental subsidies so Trust beneficiaries and other vulnerable Alaskans can afford housing.. With integration of these strategies into the core housing programs at Alaska Housing Finance Corporation (AHFC) and the Department of Health and Social Services, it is anticipated that more assistance will be provided to the growing number of families and adults with disabling conditions who are homeless.

Recent Accomplishments

  • Homeless Assistance Increased. The Trust, AHFC, the Alaska Council on the Homeless, housing providers and advocates gained legislative support in 2009 for an additional $2.5 million to retool AHFC’s ongoing Homeless Assistance Program to better serve the state’s most challenging populations. The Trust committed $1 million to the program and, with federal and state funding pooled, the overall funds available for homeless assistance in FY2009 totaled more than $8 million and assisted more than 13,000 Alaskans. 
  • Special Needs Housing Improved. The Special Needs Housing Grant program, administered by AHFC, assisted approximately 250 Trust beneficiaries with intensive needs in FY2009.  During the year, the program offered the following components necessary for sustainability:
    • A three-year renewal cycle to allow housing providers more planning time and the ability to create infrastructure for future supported housing projects. 
    • Financial assistance in the construction or remodeling of 53 units
    • Operations assistance to 50 units to help with recurring expenses (rent, utilities and building operation), bringing the rent for each unit to an affordable level while maintaining the safety of the residents
    • Social services assistancefor 230 units to ensure there are social services available to assist residents with financial issues, social-skill building, problem solving and crisis management, thereby preventing evictions and promoting stability and safety for residents.
  • Bridge Home Continued Successes. The Bridge Home program creates a safe, affordable housing environment with support services to help stabilize Trust beneficiaries who have been cycling through the Department of Corrections, Alaska Psychiatric Institute, emergency facilities and other higher cost services.Resources The program includes a behavioral health center to provide additional case management, consumer resources and any “extra” that can assist the person in remaining successfully housed.  In a two-year analysis of program participants, admissions and lengths of stay in the Department of Corrections were reduced.  (See the chart below for details on Department of Corrections admissions and stays).
  • Technical Assistance for supported housing providers: Trust beneficiaries with intensive mental health or multiple disabling conditions require additional assistance to remain successfully housed, and these needs can strain social service agencies’ ability to maintain or afford ownership of housing units. For the past three years, the Trust and the State Department of Health and Social Services’ Office of Supported Housing have collaborated to provide grant resources and technical assistance to behavioral health providers struggling to maintain housing units or placements.  This work has assisted our technical assistance team in better understanding the needs of social service providers who are sponsoring housing projects and to translate the areas of concern into improvements in the housing funding programs through Alaska Housing Finance Corporation. 

Recent Challenges

  • In the recent economy, housing is becoming more difficult to provide at a reasonable rate, especially if renters require additional assistance to remain successfully housed. Trust beneficiaries with the highest needs are frequently represented in the lowest income bracket due to challenges with mental illness, addiction and multiple diagnoses.
  • The economy has also impacted the amount of capital funding that is available for housing project in the state. 
  • State resources for non-Medicaid eligible activities such as social support and skill development in the home have dwindled over the past 10 years. This void leaves landlords and housing providers with a larger share of the costs to house people in low income brackets. 

Outcomes

For Bridge Home program participants, admissions and lengths of stay in the Department of Corrections decreased between 2005 and 2009. See Figure 17A and 17b.

Alaska Works Initiative

The Alaska Works Initiative (AWI) is a statewide, federally-funded initiative comprised of a variety of stakeholders who are implementing the following vision: Alaskans who experience disabilities are employed at a rate as close as possible to that of the general population.  Initiative partners through the leadership of the Governor’s Council on Disabilities & Special Education are working together to implement the following three goals:

  • Goal 1:  Transform disability support programs to emphasize employment and meet the needs of working Alaskans with disabilities.
  • Goal 2:  Ensure access to resources needed by Alaskans with disabilities to secure and maintain employment.
  • Goal 3:  Collaborate with business and industry to assist youth and adults with disabilities to secure and obtain employment in Alaska’s labor market.

The Governor’s Council on Disabilities & Special Education (Council) received a new grant from the Centers for Medicare & Medicaid Services (CMS) to continue AWI activities, build on prior accomplishments and address identified challenges in calendar year 2010.

Recent Accomplishments

Governor Palin co-sponsored the Disability Employment Policy Summit February 6, 2008. The purpose of the summit was to discuss and prioritize recommendations associated with three major issues impacting the employment of Alaskans with disabilities: 1) state government as a model employer, 2) assets building, and 3) integrated services and resources.  As a result of these recommendations, workgroups were formed for each area and are addressing the specific recommendations in each area.

  • A workgroup developed a strategic plan to develop stronger relationships and policies that support employment as an expectation within the State divisions of vocational rehabilitation and behavioral health.  A Memorandum of Understanding was developed and signed by directors of both agencies in May 2009.  Pilot sites in Juneau and Kenai that are using collaborative strategies to enhance employment outcomes and supports for individuals with behavioral health disabilities. 
  • A website has been developed to support asset building activities including utilization of Individual Development Accounts and the Earned Income Tax Credit; and to assist providers with accessing financial literacy curricula designed to meet the needs of individuals with disabilities.
  • The Supported Employment Task Force developed a set of recommendations for improving supported employment services provided to individuals with developmental disabilities.  Staff charged with overseeing the implementation of these recommendations is in the process of being hired. 

Recent Challenges

  • Expanding the number and availability of Individual Development Account programs for low-income individuals within the State of Alaska to access education, purchase a home or start a small business.
  • Integrating work as an expectation across service delivery systems.
  • Collecting outcome data across service delivery systems.

Outcome Data

In calendar 2008, 1,947 individuals were supported by Alaska Works Initiative activities; approximately 640 secured full or part time employment. In the previous year, 1,200 individuals were supported by Alaska Works Initiative activities and approximately 514 secured full or part time employment.

Division of Behavioral Health Performance Management System Project

The DHSS Division of Behavioral Health maintains an ongoing commitment to the development of a “Performance Management System” to function as a continuous quality improvement process to guide policy and decision-making for improving the behavioral health of Alaskans. The Performance Management System Impacts at several levels:

  • The public service delivery system – The performance measures address the following:  how much did we do; how well did we do it; it anybody better off as a result.
  • Population planning – the performance management system addresses the following questions:  are Alaskans who need services getting them, and able to get them conveniently;   do Alaskans with behavioral health disorders live with a high quality of life; and   are efforts taking place to prevent or lessen problems that result in consumers needing services.

Recent Accomplishments

  •  A key component of the Performance Management System, is the method of distributing treatment funding based on provider performance and outcomes, i.e., Performance-Based Funding (PBF).  For FY09, the PBF effort successfully developed the performance measures of grants management scoring; substance abuse utilization; the consumer service evaluation survey; data / record completeness; and client outcomes. The results were used in the determination of FY’10 treatment and services grant awards.
  • In partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), Research Technology Inc. (RTI), the Division of Behavioral Health completed a one-year plan for the Alaska Automated Information Management System (AKAIMS).  This new version update enhances the division’s ability to fulfill Federal reporting requirements.  It provides significant enhancements to the functionality of the AKAIMS, including group note functionality, electronic signature, profile set up for multiple users, State Outcomes Measurement and Management System (SOMMS) reporting, and a Contracts Management module.  This upgrade also established the groundwork for future billing capability.
  • The DBH implemented a new feature of the Alaska Automated Information Management System (AKAIMS) that is worth highlighting.  Specifically, the “SQL Server Reporting Services” (SSRS) module, also known as the “ad hoc reporting”, has been made available to grantee agencies. The functionality of the AKAIMS SSRS reporting capability is an important contribution to the division’s goal of a data driven Performance Management System.  Some of the many benefits to this system include the ability to:
  • Access a sophisticated suite of pre-developed reports, which includes client level detail information for aggregate counts.
  • Create agency specific reports and data dumps for analysis in third party software packages.

Recent Challenges

The ongoing planning and implementation of the Performance Management System involves multiple challenges that include:

  • Performance Management System:
    A performance oriented system requires a correlate data infrastructure system. Related challenges involve the budgeting for appropriately skilled research staff in order to maximize the necessary data collection, analysis, reporting, and application to business and service delivery practices.  In addition, this system realignment absorbs a significant amount of leadership time and energy that, in effect, limits our resources for new program development and we will need to address this shortfall in upcoming budget cycles.
  • Information Management System Enhancement &  Maintenance:
    The Alaska Automated Information Management System (AKAIMS) is the data collection and reporting system for the division's Performance Management System.  The AKAIMS has been successfully implemented with 100% of grantee provider agencies now submitting data to the division. The grantee provider user network includes 70 agencies, with a combined individual user group membership of 1,965.  System development, enhancements and maintenance of a management information system is standard and expected business practice. Challenges involve budgeting for this standard life cycle of the MIS system with adequately skilled technical and training staff.   
  • Performance Based Funding: 
    A key component of the Performance Management System is the method of distributing prevention and treatment funding, based on provider performance and outcomes(i.e. performance based funding).  Mandated by the 2007 legislature, PBF was successfully implemented by the DBH with significant positive outcomes in the management of the behavioral health system of care.  However, as the sophistication of the PBF effort continues, the workload implications for current and future development is better understood.  Challenges involve budgeting for adequately skilled personnel for ongoing development, maintenance and application.  

Outcome Data

  • Performance Based Funding
    The performance of 58 behavioral health providers was measured with the following results in the allocation of FY 10 grant funds:
    • The SFY10 process was based on both agency performance and agency scores on the grant application.
    •  20 of 58 (34%) of grantees had an increase in their grant funding, totaling $16,136.
    •  38 of 58 (66%) of grantees had a decrease in their grant funding, totaling $16,136.
  • The Alaska Screening Tool (AST)
    In FY 09, 12,966 screenings using the AST were conducted. This resulted in:
    • 8,295 (64.4%) cases identified with Substance Abuse (SA) needs;
    • 10,392 (80.1%) cases identified with mental health needs;
    • 4,184 (34.5%) cases indicated suspected Traumatic Brain Injury;
    • 1,155 (8.9%) cases indicated suspected Fetal Alcohol Spectrum Disorder; and
    • 6,949 (53.6%) cases indicated suspected dual diagnosis.
    • 66% of grantees had a decrease in their grant funding, totaling $16,136.
  • Program Enrollments
    During FY09, the behavioral health system of care provided 4,096 enrollments in Severely Emotionally Disturbed (SED) programs, 8,443 enrollments in Severely Mentally Ill (SMI) programs, and 6,605 enrollments in substance use disorders (SUD) programs, for a total of 19,144 program enrollments. Program enrollments are not an unduplicated count of individuals served, as one person may be enrolled in several programs.
    Improvements in data collection have resulted in greater measurement of program enrollments.
    From FY08 to FY09:
    • The reported number of SED program enrollments increased 53.0% from 2677 in FY08 to 4096 in FY09.
    • The reported number of SMI program enrollments increased 23.3% from 6848 in FY08 to 8443 in FY09.
    •  The reported number of SUD program enrollments increased 27.5% from 5180 in FY08 to 6605 in FY09.
  • The Behavioral Health Consumer Survey
    The FY2008 survey represents the third Behavioral Health Consumer Survey (BHCS) for the state. The percent of respondents evaluating services positively over all was:
    • Seventy-eight percent (77%) of adults evaluated services positively;
    • Seventy-seven percent (79%) of teens/young adults ages 13-17; and
    • Seventy-four percent (77%) of parents and caregivers of children ages 0-17.
  • The Client Status Review of Life Domains
    For FY 2009, the CSR outcomes indicate the following findings:
    • For each of three life domains (housing situation, physical health, and thoughts of self harm), more than 75% of individuals who received services through the comprehensive, integrated Behavioral Health Service System reported improvement or maintaining condition.
    • For each of the remaining three life domains (financial/basic needs, meaningful activities/employment, and mental/emotional health), less than 75% of individuals reported improvement or maintaining condition.

Families First! / Family Centered Services

Families First! is the name of a new departmental initiative based on the promising outcomes of the family centered services pilot project conducted in Wasilla and Fairbanks. Adults that participated in the pilot were long-term recipients of the Alaska Temporary Assistance Program who were having difficulty meeting the program’s work requirements. At the end of the pilot project, participating families showed marked improvements in key indicators such as hours of participation in work activities, employment and wages.

Families First! focuses on helping families address challenges to employment and self-reliance by using a proven, national “customized employment” model. The model relies on close collaboration with other agencies and service providers working as a multi-disciplinary team with the family to develop comprehensive and integrated service plans designed to mitigate barriers and engage family members in activities that help move families towards employment, self-sufficiency, and an improved quality of life. 

This reflects the Department’s goals to coordinate and integrate services among agencies serving common clients to reduce redundancy, share information, identify barriers, and improve client outcomes.

Recent Accomplishments

  • Six project assistants have been hired to be Families First Facilitators. The facilitators stationed in Fairbanks, Nome, Kenai, Mat-Su, Anchorage, and Sitka are organizing local implementation teams, community meetings, and partner training sessions. Training sessions held in each community provide partners with the fundamental principles of the “customized employment” model central to the service delivery model.

Recent Challenges

  • None to report

Public Health Nurses Addressing Domestic and Family Violence

Alaska’s public health nurses provide a wide variety of health promotion and disease and injury prevention services to Alaskans in their communities. Over the past three years this has included a concentrated focus on addressing domestic and family violence issues. Activities include: screening all clients for domestic/interpersonal violence, date rape prevention education, enhancing community awareness and education related to the effects of interpersonal violence, and mobilizing community efforts to address domestic and family violence.

Recent Accomplishments

  • Public health nurses completed approximately 18,000 screenings for domestic violence in FY 2009. This is an increase from the previous year when they completed approximately 14,000 screenings.
  • Routine universal screening for domestic/interpersonal violence for public health clients was implemented in 2007.
  • All public health nurses have received in-service education to increase their knowledge and strengthen their skills in addressing interpersonal violence.

Recent Challenges

  • Lack of resources to support violence victims, particularly in small, rural communities.
  • In some cases interpersonal violence is viewed as a social norm
  • Need for ongoing education and support for health care providers to further implementation of routine DV screening and counseling.

Outcome data

Public health nurses completed approximately 18,000 screenings for domestic violence in FY 2009. This is an increase from the previous year when they completed approximately 14,000 screenings.

Due to the nature of domestic violence, outcomes often are not seen for several years. In the meantime work continues toward the goals of developing zero community tolerance for interpersonal violence, providing education about healthy relationships, and mobilizing additional community partnerships to advocate for safe shelters and services for victims of DV, and for support services for children exposed to DV.

Start Up Alaska Project

In October 2006, the Governor’s Council on Disabilities and Special Education received a three-year research and demonstration grant from the federal Office of Disability Employment Policy to increase the number of Alaskans with disabilities who are self-employed. A part of the overall Alaska Works Initiative, the Start Up Alaska Project has the following goals:

  1. Update and expand resource mapping and needs assessments to identify strengths and limitations of existing resources and ascertain training, technical assistance and policy needs.
  2. Develop, test, evaluate and disseminate a customized self-employment model at the one-stop job centers in Anchorage, Fairbanks and Southeast Alaska.
  3. Establish a business incubator program
  4. Modify and/or develop policy that facilitates permanent, systemic change that results in increased numbers of Alaskans with disabilities becoming self-employed.

It is anticipated that the following outcomes will be achieved:

  • System wide assessment and identification of self-employment improvement opportunities via resource mapping (see Goal 1 above)
  • Piloting and demonstration of two self-employment models (customized self-employment partnerships and business incubator) for 30 self-employed persons with disabilities (see Goal 2 and 3 above)
  • Utilizing lessons learned from the pilots, development and implementation of longer term policy and training strategies to enhance Alaska’s workforce system’s capacity to successfully serve people with and without disabilities so they can become successfully self-employed (see Goal 4).

Recent Accomplishments

  • The customized self employment and virtual business incubator model has been operating in full for nearly two years and these services are now being purchased by Vocational Rehabilitation agencies for clients seeking self employment.
  • A distance based delivery system of business supports (virtual business advisor) was established for entrepreneurs and microenterprise site facilitators across the state.
  • A self employment policy summit involving the Divisions of Vocational Rehabilitation, Employment Security, Behavioral Health and Public Assistance along with the U.A.A. Centers for Human Development and Economic Development and the Small Business Development Center took place in February of 2010.  A plan for sustainability of Customized Self Employment services and supports is being developed based on partner input from the summit.

Recent Challenges

  • Working with state agencies to develop policy that promotes self-employment.
  • Changing attitudes about the potential for self-employment by people with disabilities.
  • Sustaining the program when federal funds end.

Policy discussions were held individually with partners prior to the summit which facilitated productive cross-systems discussions about how to align programs better in a sustainable self-employment delivery system.

Outcome Data

  • To date, 73 individuals have been served and 33 businesses have been launched.
  • From October of 2008 to October of 2009, 20 entrepreneurs completed business plans (150% increase over the previous year), 15 completed a business feasibility study (50% increase), 19 received startup financing (138% increase), 13 new businesses were created (63% increase) and 16 new businesses made their first sale or contract (23% increase).

Trust Beneficiary Projects Initiative

In FY09, the Trust authorized $3.8 million for the Beneficiary Projects Initiative (BPI) Focus area, which supports and funds grassroots, beneficiary-driven, peer-to-peer programs.  It also includes a grants program that improves the lives of Trust beneficiaries with support for individual services, one-time projects and adult dental care.  The initiative is founded on the belief that people who participate in the decisions that affect their lives are much more likely to act in their own best interest. 

The initiative is structured around three broad goals designed to make progress toward self-directed programs which result in an improved quality of life for beneficiaries.  When achieved, beneficiaries will participate in projects that are sustainable, demonstrate positive outcomes and cost efficiencies, and eventually transition to other stable funding sources.  These goals are:

  1. Provide a source of funding and technical assistance to beneficiary group initiated and managed projects and activities;
  2. Ensure that Trust beneficiary group initiated and managed activities are safe, sustainable and effective; and
  3. Provide a viable avenue for Trust beneficiary group initiated advocacy that is rooted in community needs and addresses existing service gaps

Trust funded BPI programs provide a range of peer support services.  A few examples of such programs include the Juneau Polaris Club House for persons with mental illness, the Alaska Mental Health Consumer Web in Anchorage, which operates a drop-in center for people experiencing mental illness, substance abuse and homelessness and the Alaska Women’s Recovery Project which provides peer support for women in recovery from alcoholism and drug addiction.

Recent Accomplishments

  • Since inception of the BPI Focus area in 2005, the Trust has supported development and stabilization of more than 20 consumer-operated programs that allow beneficiaries to actively engage in their recovery and long-term wellbeing.
  • In 2009 the Trust funded 12 consumer organizations.  With technical assistance from the Trust, 66 percent of the grantees diversified their funding, receiving additional support through competitive state grants, federal funding and donor contributions.
  • The Trust completed a 3-year commitment of $4.2 million in matching funds for the Adult Dental Medicaid Program for preventative and restorative dental service.  Reauthorized as a permanent program by the 2009 legislature, the total cost was transitioned from Trust funding to the Department of Health and Social Services general fund/mental health budget for FY2010.

Recent Challenges

  • Establishing a stable reoccurring funding base for peer support programs in GF/MH budget
  • Continuing need for technical assistance targeting organizational capacity building of peer-support programs
  • Limited funds are available, other than Trust grants, for peer programs.

Outcome Data

  • Since inception of the BPI Focus area in 2005, the Trust has supported development and stabilization of more than 20 consumer-operated programs that allow beneficiaries to actively engage in their recovery and long-term wellbeing.
  • In 2009 the Trust funded 12 consumer organizations.  With technical assistance from the Trust, 66 percent of the grantees diversified their funding, receiving additional support through competitive state grants, federal funding and donor contributions.

More information about the BPI Focus area can be found on The Trust website under Focus Areas.

Trust Coordinated Communications Committee

Stereotypes about mental illness, addictive diseases, developmental disabilities and dementia make it harder for people with these conditions to find work, housing and meaningful social contacts. Additionally, stigma often dissuades people from seeking the care they need. Moving Forward’s goal is to reduce the stigma associated with mental illness, alcohol abuse, developmental disabilities and age-related dementia. The Coordinated Communications and Advocacy Committee is an initiative funded by the Alaska Mental Health Trust Authority in partnership with beneficiary advisory boards (Alaska Mental Health Board, Advisory Board on Alcoholism and Drug Abuse, Governor’s Council on Disabilities and Special Education, Alaska Commission on Aging, Alaska Brain Injury Network and Statewide Suicide Prevention Council). The goals of the committee are to reduce the stigma associated with mental disabilities, to promote the concept that treatment and services work, and to gain public support, especially among policymakers, for funding necessary to provide services for Trust beneficiaries.

Each year the committee collaborates on a multi-media campaign to address the goals, including developing brochures, DVDs, posters, and newspaper, TV, radio and movie theater ads. The overall theme of the campaign is “You Know Me,” which points out that the issues addressed by The Trust touch nearly every Alaskan, whether it is a family member, a neighbor or a coworker.

Recent Accomplishments:

  • During FY2009, a new You Know Me TV spot was produced that focused on passage of federal mental health parity legislation. The TV ad and a companion print ad ran in media outlets across the state, including on Gavel to Gavel Alaska, a cable television service that provides coverage of state government activities.
  • The advisory boards each ran individual anti-stigma and awareness campaigns during the year to supplement You Know Me.  These included:
    • a print ad during Mental Illness Week highlighting the loss of productivity employers experience related to absenteeism due to depression;
    • a series of print ads promoting community events planned during Alcohol Awareness Month;
    • a series of print and radio ads providing a detection checklist for depression and alcoholism among seniors as part of Older Americans Mental Health Week;
    • a series of movie theater ads highlighting treatment and services related to traumatic brain injury, alcoholism and suicide.
    • a public education video entitled “Treatment works. Recovery happens.” for use by members of the Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse when making presentations about mental illness and alcohol/substance to civic organizations and other outreach efforts.
    • a public information video regarding brain injuries produced by the Alaska Brain Injury Network to educate brain injury survivors and their families and policymakers.  It features the personal stories of two young people, including a former Miss Alaska contestant, who all have experienced a traumatic brain injury. 
  • Issues related to suicide and suicide prevention were highlighted in a breakout session presentation produced for the annual Elders and Youth Conference, which is sponsored by the First Alaskans Institute. The event was attended by approximately 1,000 youth and elders from communities throughout Alaska.  This is the third year The Trust and its partner boards have been invited to participate. The presentation included the premiere of a 12-minute DVD on suicide prevention entitled “Building Resilience,” which was funded by The Trust and co-produced with the Statewide Suicide Prevention Council.

Recent Challenges and Outcomes:

Public opinion surveys conducted by The Trust 2006 and 2008 showed that more than 50 percent of respondents knew that Trust beneficiaries are people with mental illness, developmental disabilities, brain injury, Alzheimer’s disease and alcoholism.

Compared to the 2006 poll, the 2008 poll showed a slight decline in awareness about each of The Trust beneficiary groups except for the beneficiary group with mental illness.  Of the 612 Alaskans randomly surveyed in 2006, 74.5% were aware that people with mental illness are beneficiaries of The Trust, as compared to 78.7% of the 252 randomly surveyed in 2008.  The largest decline in awareness in the two-year period was about people with alcoholism.  In 2006, 55.5% of those surveyed identified this group as Trust beneficiaries compared to 50.7% in 2008. 

The Trust is committed to continuing the ongoing You Know Me campaign and other awareness measures to increase knowledge and understanding of The Trust and to raise awareness of who Trust beneficiaries are and what issues impact their lives.

Other Examples of Current Initiatives, Projects, and Activities That Fill Service Gaps

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