{short description of image}
{short description of image}
CAMINO REAL COMMUNITY MHMR CENTER LOCAL SERVICE AREA PLAN

FY 2006 through FY 2007
September 1, 2005 to August 31, 2007

Comments or inquiries regarding this document may be addressed to the Executive Director at:
Camino Real Community MHMR Center
P.O. Box 725
Lytle, Texas 78052
Phone: (210) 357- 0310
FAX: (210) 357- 0456
Email: emmag@crcs.mhmr.state.tx.us

This Local Service Area Plan is the product and property of Camino Real Community MHMR Center


TABLE OF CONTENTS





I. EXECUTIVE SUMMARY

VISION, MISSION, AND PHILOSOPHY

Camino Real Community MHMR Center officially came under local governance on September 1, 2000. The transition process which commenced in 1996 to convert the state operated community services to a Community MHMR Center finally became a reality. A Board of Trustees was appointed by the local county judges of Atascosa, Dimmit, Frio, Karnes, La Salle, Maverick, McMullen, Wilson and Zavala counties. Camino Real is one of 41 Centers across the State of Texas that assure services are available in every community.

The services provided by Camino Real Community MHMR Center are predicated on the performance contracts with The Texas Department of State Health Services, The Texas Department of Assistive and Rehabilitative Services and The Texas Department of Aging and Disability Services. Persons with mental illness, mental retardation, severe emotional problems and developmental disabilities meeting eligibility criteria for services comprise the priority population. Funding for these services are made up of local, state and federal funds, with the majority of the funds being general revenue. The general revenue is allocated by the Texas legislature through the above state agencies.

Camino Real is the Mental Health Authority (MHA) and the Mental Retardation Authority (MRA) for the following counties: Atascosa, Dimmit, Frio, Karnes, LaSalle, Maverick, McMullen, Wilson and Zavala. Early Childhood Intervention (ECI) services are also provided in Atascosa, Dimmit, Frio, Gonzales, Guadalupe, LaSalle, McMullen, Wilson and Zavala counties.

It is the desire of Camino Real to provide the highest quality of services in the most efficient manner to eligible consumers while being good stewards of the public dollar. It is the intent of Camino Real to: assure accountability for, cost-effectiveness of and the relative value of service delivery options; to minimize the need for state hospital and community hospital care; to ensure a client with mental retardation is placed in the least restrictive environment appropriate to the person's care; to ensure that all potential and incoming consumers are aware of the availability of service of state schools; to divert consumers of services from the criminal justice system; to ensure that a child with mental illness remains with the child's parent or guardian as appropriate; and to look for opportunities for innovation in services and service delivery. The responsibility for Camino Real to work in partnership with consumers and the community to accomplish this intent is reflected in the vision, mission and philosophy of the Center. Developing the vision, mission and philosophy was a multifaceted effort that included input from consumers, community and staff.

VISION

As a thriving center, Camino Real, in partnership with consumers, families, communities, service providers, and policy makers envisions:

  • Quality customer driven services
  • Accessible, innovative and culturally sensitive services
  • Communities which embrace and support persons with mental illness, mental retardation, and developmental disabilities
  • Consumers achieving their individual dreams
  • A great place to work

Camino Real will accomplish this vision by:

  • Making sure the needs of consumers are identified
  • Being strong advocates for consumer and staff needs
  • Recognizing that the employees of Camino Real are the agency's most valuable asset
  • Delivering appropriate and relevant mental health and Intellectual and Developmental Disabilities services that meet consumer needs
  • Implementing an approved "plan of services", which includes an agency Quality Improvement Plan
  • Obtaining and maintaining certifications, and licensures
  • Maintaining a qualified workforce to provide these services
  • Executing the four "C's" of "Doing it Right" in our day to day operations:

    • 1. Communicating openly
    • 2. Coordinating our efforts
    • 3. Cooperating with all concerns
    • 4. Collaborating as needed

Camino Real shall serve each consumer of the Center with a comprehensive, individualized plan that enhances the consumer's ability to function successfully in the community, or other least restrictive environment. Camino Real shall provide the highest quality mental health and Intellectual and Developmental Disabilities services in a safe and humane environment with absolute respect of the consumers' rights.

MISSION

Abriendo Puertas…



opening doors through choice, dignity and respect.


PHILOSOPHY

Camino Real values:

  • INDIVIDUAL WORTH - We affirm that the individuals we serve share with us common human needs, rights, desires and strengths. We celebrate our cultural diversity and individual uniqueness and commit ourselves to support and enable each person's choices and preferences.
  • QUALITY - We commit ourselves to the pursuit of excellence in everything we do.
  • INTEGRITY - We believe that our personal and professional integrity is the basis of public trust.
  • DEDICATION - We take pride in our commitment to public service and to the support of the people we are privileged to serve.
  • INNOVATION - We are committed to developing an environment which inspires and promotes innovation, fosters dynamic leadership and rewards creativity among our staff, volunteers and the people we serve.
  • PARTNERSHIPS - We believe that our vision and values are best realized when individuals working in teams achieve positive outcomes.


II. LOCAL SERVICE AREA PLANNING PROCESS

The approach to planning at Camino Real Community MHMR Center is based on the gathering of information internally, as well as from stakeholder issues of concern, and identifying those outside forces which impact center operations. Factors impacting planning include the organizational mandates attached to the various funding streams used to finance services, waiting lists, as well as the changing demographics of the nine-county area served with MHMR services by the Center.

DATA GATHERING PROCESSES

Camino Real CMHMRC gathers data internally on the local center level from which regional and clinical managers plan day to day activities. The Anasazi database, from which productivity reports are generated, is used to make decisions about objectives to accomplish as well as how best to manage personnel to achieve those objectives. Information about these reports and objectives is then taken to program management meetings where it is refined and reviewed against Center objectives. All information is funneled through the Executive Council with feedback provided at program manager's meetings and Center administrative staff meetings. The Executive Director is the conduit for information getting to the Board of Trustees for approval on a policy level.

The Local Service Area Plan is devised to achieve the Center vision using both the data gathered from annual reviews and the ongoing, day to day Center processes. The Local Service Area Plan is considered to be a fluid document that must respond to the changing landscape of behavioral health care. This requires the ongoing review and updating of Center strategies at all levels of management.

Camino Real CMHMRC has many committees and councils that provide ongoing input concerning services. Some groups are composed solely of personnel, internal to Camino Real, but many include participation by stakeholders from outside the Center. These committees and councils include the following:

  • Local Advisory Councils: Local Mental Health Advisory Councils made up of local stakeholders meet monthly with the local mental health clinic director to discuss various community issues affecting the mentally ill population in their county and solutions.
  • Planning and Network Advisory Committee (PNAC): Membership of this committee includes consumers, family members, community members, and staff from other agencies from various counties served by Camino Real CMHMRC. Meetings are held bimonthly to identify local needs and priorities and strategies to address them. Many of the members are also members of their respective county's local Advisory Councils and bring local issues of concern for consideration as a possible Center-wide concern that may need to be addressed.
  • Utilization Management (UM) Committee: This group is composed of the executive management team and is tasked with making recommendations concerning management of services in light of available resources to ensure that best value is realized for dollars spent. This is done within the context of performance accountability measures and data from the cost accounting methodology.
  • Corporate Compliance Committee: This committee has the task of ensuring ethical business practices occur through ongoing performance improvement. This includes monitoring that will ensure the Center meets all legal and ethical responsibilities in its services offered and billing practices.
  • Risk Management Committee: Risk Management includes the review and assessment of all areas that put the consumers, employees, or Center at risk and taking preventative action. The Committee, that is composed of the Executive Council, provides an oversight function of several committees that fall under the purview of risk management (Safety Committee, Human Rights Committee, Infection Control Committee, and the Abuse Neglect Authority Review) and report their findings and recommendations for further review and action.


LOCAL SERVICE AREA PLAN REVIEW

Formal review of the Local Service Area Plan will be done annually at a minimum or more often if necessary. It is first reviewed by the Planning and Network Advisory Committee to ensure stakeholder input and review. The Executive Council is the body ultimately responsible for making changes based on recommendations, findings, etc. of various survey processes or Performance Contract and rule changes. The Executive Council will recommend changes to the Board of Trustees for final approval. Goals and objectives that are part of action plans generated by specific committees are routed to the Executive Council for final approval. All planning committees must be making recommendations in line with the Center vision, mission and values, and it is up to the Executive Council to review all plans for improvement against these criteria. This is not just a rubber- stamping process, but a concerted effort being made to assure we are "pointing all the arrows in the same direction". This is an ongoing, day-to-day process to ensure that Camino Real CMHMRC is responding to the needs of its consumers.


III. EXTERNAL / INTERNAL ASSESSMENT

Camino Real has a comprehensive methodology for gathering information to assess key factors that influence the Center's effort in meeting its stated vision, mission, and goals.

EXTERNAL ASSESSMENT

The following external methodologies are utilized to gather input regarding the many facets of service delivery:

Reviews of the Provision of Home and Community Based Waiver Services (HCS) and Texas Home Living Waiver Services (TxHmL) - The HCS Provider Review was conducted in April 2005 by staff from the Department of Aging and Disability Services. The TxHmL Initial Certification Review occurred in August 2005. Corrective action plans were put in place for any Identified citations.

Texas Home Living and Quality Assurance Authority Review - This review was conducted by the Department of Aging and Disability Services in September 2005. No items of non-compliance were found in this review.

ECI Review - The ECI Program is surveyed (monitored) on a varied schedule for program and financial compliance. In September 2004, a technical assistance visit was provided by the state level legacy agency which is now under the auspices of the Department of Assistive and Rehabilitative Services. All recommendations have been addressed. The program is now monitored through quarterly conference calls with the state office to review data. Camino Real continues to grow this program within its service area.

Mental Health Satisfaction Survey - The Health and Human Services Commission distributes a Mental Health Satisfaction Survey on an annual basis to a random sample of consumers across the state. Camino Real assists with providing information as needed to send out surveys. Results are tabulated on a statewide basis and are accessible on the website of the Department of State Health Services.

Mental Retardation and Behavioral Health Outpatient Data Warehouse (MBOW) - MBOW is an integrated database designed for analysis, decision support, and historical reporting. Data regarding service encounters is submitted by centers across the state and integrated with financial data. This data is used by both DADS and DSHS to monitor centers for compliance with the measures and outcomes required in by performance contracts in regard to the provision of services. This data is also useful for internal assessment by Camino Real, particularly in network decision making.

Annual Fiscal Audit - Fiscal audits of the Center are conducted annually by an auditor external to the center. The stated opinion of the auditor was that the general purpose financial statements, in all material respects, presented fairly the financial position of Camino Real Community MHMR Center. Furthermore, the operations of the Center and the associated fiscal reporting were done in conformity with accounting practices and principles generally accepted in the United States of America. In addition, the auditor issued a management letter that stated there were no negative findings or corrections needed. The results are reviewed and approved by the Center's Board of Trustees and shared with the state and local governance. Camino Real has exceeded its goals in financial viability for the past three years.

Collection and Analysis of Demographic Data - Information is gathered by Center staff and includes reports from the Texas DADS, DSHS and DARS, information from other State of Texas web sites and the United States Census Bureau. Reports are generated by the data collection system used by Camino Real. This information is then used in designing the Center's Local Service Area Plan.


INTERNAL ASSESSMENT

HCS Satisfaction Survey - An annual satisfaction survey is sent to all consumers and family members who participate in the HCS program. The results are reviewed at the quarterly HCS committee meeting and plans of improvement developed as needed. In the survey conducted in November 2005, 95% of consumers indicated they were pleased with their services and had been made aware of their rights.

Corporate Compliance/Quality Management Audit - The Center Corporate Compliance Plan requires an annual self-assessment of Camino Real's business and program practices to ensure proper business and clinical ethics are consistently adhered. The corporate compliance officer is responsible for investigating any allegations that are reported regarding inappropriate business or clinical practices. The Quality Management Department schedules reviews of records and focuses on compliance with billing requirements. The integrity of the record is also assessed to assure format and content meet standards. The annual audit conducted in March of 2006 shows the Center continues to be in compliance.

Community Needs Assessment Survey - Every 2 years, Camino Real distributes a survey to its consumers, family members, and community stakeholders for input regarding community needs. The Planning and Network Advisory Committee (PNAC) is responsible for revising the survey to assure it addresses pertinent issues and is user friendly. The results of the survey are tallied and reviewed by the PNAC. Goals and objectives are developed and incorporated into the Center's Local Service Area Plan. The Plan is then finalized and brought before the Board of Trustees for review and approval.

CARE Data Verification/Encounter Verification Reviews - The Quality Management Department of Camino Real CMHMRC coordinates the process for verifying data that is reported through CARE and encounter data, assuring accuracy and ensuring services were delivered during the specified time period. A 95% accuracy rating is required as per the performance contract. Camino Real CMHMRC is in the Self-Monitoring Pool for both Mental Health and Intellectual and Developmental Disabilities services.


IV. LOCAL AUTHORITY ASSESSMENT COMPONENTS

POPULATION

Priority Population Description for Mental Health Services: Camino Real Community MHMR Center provides mental health services to children, adolescents, and adults. The adults served are ages 18 and older and have severe and persistent mental illnesses such as schizophrenia, major depression, bipolar disorder, or other severely disabling mental disorders, which require crisis resolution or ongoing and long-term support and treatment. The Child & Adolescent Services Program serves the individual needs of children ages 3 through 17 with a diagnosis of mental illness who exhibit serious emotional, behavioral, or mental disorder. The Mental Health Program serves dually diagnosed consumers with mental illness and substance abuse disorders as well as consumers with mental illness and mental retardation. Individuals with mental health issues who are not in the DSHS target population may receive services via initial screenings/crisis assessments and referrals to local agencies.

Priority Population Description for Intellectual and Developmental Disabilities services: The priority population for Intellectual and Developmental Disabilities services consists of individuals who meet one or more of the following descriptions: mental retardation, as defined by Section 591.003; autism as defined in the current edition of the Diagnostic and Statistical Manual (DSM); Pervasive Developmental Disorder (PDD) as defined in the current edition of the DSM; children who are eligible for services from the Early Childhood Intervention Interagency Council; persons with related conditions who are eligible for services in Medicaid programs operated by the department, including ICF/MR, Waiver Programs; and nursing facility residents who are eligible for specialized services for mental retardation or a related condition pursuant to Section 1919(e)(7) of the Social Security Act.


SERVICES AND SUPPORTS

Mental Health

Mental Health Services are provided in clinics as well as the homes, schools and in the community. Services include:

  • Screening & Assessment
  • Supported Employment
  • Community Referrals
  • Supported Housing
  • Psychiatric Assessment
  • Assertive Community Treatment-Alternative
  • Family Support & Education
  • Intensive Case Management Services
  • Medication Related Services
  • Crisis Intervention & Stabilization
  • Skills Training
  • 24-Hour Crisis Hotline
Each month the program serves approximately 150 children and 1200 adults of various ethnic backgrounds. Counties served include Atascosa, Dimmit, McMullen, Frio, LaSalle, Karnes, Maverick, Zavala, and Wilson. Maverick County, the Center's largest county, borders Mexico and is also the home of the Kickapoo village, a Native American Tribal Community. Financially, consumers are in the lower Socio- Economic Status and Medicaid covers approximately 60% of the population served.

Mental Retardation

The Center provides the following services:

  • Eligibility Determination: An assessment or endorsement conducted in accordance with the Texas Health and Safety Code, 593.005 and 25 TAC Chapter 415, Subchapter D to determine if an individual has mental retardation or is a member of the TDMHMR mental retardation priority population.
  • Service Coordination: Assistance in accessing medical, social, educational and other appropriate services and supports to help an individual achieve quality of life and community participation acceptable to the individual.
  • Continuity of Services: Assistance in placement into or out of a state facility, enrollment or transfers into the HCS or ICF/MR program, or assistance in maintaining an individual's placement or developing another placement for the person.
  • Service Authorization and Monitoring: Case coordination provided to an individual who is assessed as having a single need.
  • Respite: Support Services provided to the consumer in or out of the home to give the family or primary care givers temporary relief.
  • Early Childhood Intervention: Services provided to children 0-3 who have been identified as having a disability or a developmental delay.
  • Employment Assistance: assistance in helping a participant locate paid employment in the community by assisting the participant to identify his or her employment preferences, his or her job skills, his or her requirements for work setting and work conditions, and prospective employers offering employment comparative with the participant's identified preferences, skills, and requirements.
  • Supported Employment: Supports provided to an individual to assist them in maintaining their job in the community.
  • Vocational Services: Services provided away from an individual's home to help the individual develop and refine skills necessary to live and work in the community.
  • Day Habilitation: assistance with acquiring, retaining, or improving self help, socialization, and adaptive skills necessary to live successfully in the community and participate in home and community life.
  • Community Supports: Services and supports provided to an individual in the individual's home or community that are necessary to achieve outcomes in the Person Directed Plan.
  • Foster Care Services: Services provided to individuals who are in need of a residential setting and are eligible for HCS.
  • Special Therapies: OT, PT, Speech, audiologists, and dietary services provided to individuals who have been identified with a need.
  • Behavioral Support: Provides specialized interventions that assist a participant to increase adaptive behaviors to replace or modify maladaptive behavior that prevent or interfere with the participant's inclusion in home and family life or community life.
  • Nursing: This service includes treatment and monitoring of health care procedures prescribed by a physician/medical practitioner and /or required by standards of professional practice or state law to be performed by licensed nursing personnel.
  • Permanency Planning: This service is for persons under age 22 enrolled in or in the process of being enrolled into an Intermediate Care Facility or HCS residential setting. Camino Real conducts permanency planning every 180 days to assist the person in moving toward residence with either their natural family or a family based alternative.


IN-HOME FAMILY SUPPORT (IHFS) GRANT PROGRAM

The IHFS Grant Program serves people who have either mental retardation or who are between the ages of birth-4 years with developmental delays. A person is not required to be receiving services through Camino Real CMHMRC to access this program. The program assists people to purchase those items or services that a person needs because of their disability that directly support the person to live in his/her natural home, rather than living in a more restrictive setting at a higher cost and are not available to them through another resource. It is the payer of last resort. Grants are available for the following services:

  • Medical, surgical, therapeutic, diagnostic, and other health services, including medication
  • Counseling or training programs that assist the person in an independent living situation or assist the family in providing proper care for the person, and that provide for the special needs of that person or family
  • Attendant care, home health aid services, homemaker services, and chore services that provide assistance with training, routine body functions, dressing, preparation and consumption of food, and ambulation
  • Transportation for the person
  • Transportation and room and board incurred by the person or family during the person's evaluation for services or treatment that has been pre-approved by the administering agency
  • Respite assistance for the family
  • Other services or items consistent with the intent of state statute and this subchapter and as negotiated between the person and the administering agency
  • Architectural modifications to the home and purchase or lease of special equipment that improve or facilitate the care, treatment, therapy, general living conditions as related specifically to the person's mental disability, or access of the person
  • Specialized child care costs in excess of the prevailing rate for routine child care.


COLLABORATION

Camino Real is firmly integrated into the community and collaborates with various agencies and local systems in order to provide comprehensive supports to consumers while avoiding duplication of effort. Examples of these collaborative efforts include but are not limited to:

State Mental Health Facilities: The Center maintains ongoing communication with the designated state mental health facilities. Staff is assigned to monitor admissions and discharges and arrange for appropriate follow up. Twice a year, a meeting is arranged between the state hospital and community centers to discuss needs and recommendations for improvement. The Center also co-sponsors training to local officials regarding commitments and admissions to State Mental Health Facilities.

State Mental Retardation Facilities: The Center works closely with the State School to facilitate placements in the community once consumers are identified as needing placement. Collaboration with the admissions department occurs when community based consumers are in need of facility placement.

Community Resource Coordination Groups (CRCG's): Camino Real assigns staff to participate in local CRCG's to assist in planning for consumers that are served by multiple providers.

Local School Districts: Collaboration occurs with transition into and out of the school system. Supports are provided to school aged children who meet priority population criteria.

Counties: Camino Real works closely with the local governance entities that are the sponsoring agencies for the Center. Routinely provide minutes from Board meetings and presentations made to Commissioners courts regarding Center business and needs. Several counties provide physical locations for the Center operations. Staff routinely works closely with county judges, sheriffs departments, police departments, constables, JP's, clerks and local hospitals to facilitate response to crisis and admissions to SMHF when necessary.

Community MHMR Centers: Camino Real is a member of the Texas Council of Community MHMR Centers, Inc. through which efforts for collaboration are facilitated. Visits to other centers, sharing of information, and identification of opportunities for efficiencies are just a few examples of the communication and cooperation between centers.

Area Law Enforcement and Judicial Officials: The Center collaborates with area judicial officials in developing and implementing strategies for the treatment and diversion of persons with mental disabilities who interface with law enforcement. This has included mental health officer training as well as ongoing task force meetings to address the issues that arise.

Camino Real employs staff that is reflective of the community they serve so that services are delivered in a culturally sensitive manner.

RESOURCE DEVELOPMENT AND ALLOCATION

It is the philosophy of Camino Real Community MHMR Center to maximize its resources through conservative and responsible expenditure of funds while maintaining a viable service delivery system. Simultaneously, the Center leadership maintains awareness of new and developing funding, both in public as well as private sources.

Resource development and allocation activities involve adding more support through the accrual of new resources and by increasing service efficiencies.

Resource allocation involves reviewing and analyzing current methods of service delivery as well as the organization's current overall strategies. The Center pursues increases in resources via fund-raising activities, increased volunteer activities, donations, maximization of Medicaid and Medicare revenues, retention of profitable sheltered workshop contracts, and finally, by assuring that all funding sources (including local, state and federal) to which the Center has rights, are sought after and obtained.

Methodologies

The resource goals of the Center are:

  • Ensure existing resources continue to be available
  • Create opportunities to maximize existing resources (e.g., making organizational or programmatic changes, applying for program or staff certification, training staff and/or providers, performing cost-benefit analysis of current and new resource-generating programs)
  • Identify (through research or business contact) additional sources of funds which may be available
  • Create opportunities to obtain additional resources (e.g., grant writing, contracting)
  • Identify federal, state or local programs (public and private) in which to participate.


Specific Sources

In general, funding for Camino Real Community MHMR Center comes from the following primary sources:

  1. Local Funds

    1. In-Kind Local Match Funds
    2. Work-Center Production Earnings
    3. Consumer Fees
    4. Third (3rd) Party Insurance

  2. State Funds

    1. General Revenue
    2. Block Grant Funds
    3. ECI Contract
    4. Waiver Funds

  3. Federal Funds

    1. Medicaid Rehabilitation Funds
    2. Medicaid Service Coordination Funds
    3. Medicaid Administrative Claiming (MAC)
    4. Medicaid Card Services
    5. Medicare


Very little, if any, funding is available for "discretionary" spending (i.e. providing new services for programs or enhancing the number of persons receiving services). Camino Real CMHMRC is also faced with fluctuating general revenue dollars and reduced Medicaid reimbursement rates. Given this state of funding, the Center will be engaging in activities to increase the number of resources and funding sources to maintain the current level of services being provided, and when possible, provide additional needed services and supports.

Maximize Existing Funding Sources

  • Implementation of strategies to increase the number of Medicaid eligible service recipients
  • Develop better understanding of rate-setting methodologies such as the TAFI which impacts rehab rates
  • Implement a more refined training and processing system that will ensure retainment of earned revenues and prevent and/or eliminate paybacks
  • Implement management system which maximizes medication revenues and minimizes costs. This system at a minimum would include maximization of Medicaid funds, use of the Prescription Assistance Program (PAP) and implementation of a formulary which structures prescription practices used by physicians. With the advent of Medicare Part D the Center is also assisting consumers to access these funds to best suit their individual needs.

Explore New Dollars and Resources

  • Explore grant opportunities to replace funds lost to budget reductions
  • Explore fund raising activities

Increase Administrative and Service Efficiencies

  • Collaboration with other MHMR centers to achieve administrative efficiencies
  • Continued monitoring of Performance Accountability Measures to increase service efficiencies
  • Identify and eliminate inefficiencies, clarify staff roles and activities
  • Utilization Management techniques will be continued to do an analysis of appropriate cost to service ratios as well acceptable levels of service delivery
  • Refine internal information systems and standardized reports that can be provided to managers and their staff related to performance as well as budgetary measures

As a means of refining administrative and service efficiencies throughout the organization, Camino Real holds quarterly Administrative Staff Meetings and an annual two-day Management Retreat in December. The Management Retreat is the venue for review and updating of the Center's Management Plan. This plan is a living document which evolves as new administrative and services efficiency needs are identified. At the retreat held in December 2005 management training was provided on special topics, a need identified through this planning process.

V. COMMUNITY NEEDS AND PRIORITIES

ONGOING REVIEW OF GOALS AND OBJECTIVES OF THE 2005-2007 LOCAL SERVICE AREA PLAN

In FY 2005, a Community Needs Assessment Survey was conducted which resulted in the development of goals and objectives to address the identified needs. The following is a review of progress on the goals and objectives in the Local Service Area Plan:

  1. Camino Real CMHMRC will increase public awareness of the services it provides through:

    1. Ongoing marketing efforts throughout the service area.
    2. The availability of staff, PNAC members and Board of Trustee members to speak to local civic groups or provide education on MHMR topics.

    Camino Real has continued its ongoing marketing efforts throughout the service area. This has been accomplished through the implementation of paid ongoing Public Service Announcements in all the major local area newspapers as well as individual articles regarding center services and accomplishments. Other public activities have included Open Houses in conjunction with the opening of new facilities in area counties and Public Awareness activities during Mental Health Awareness Month and Mental Retardation Awareness month. Mental Health Deputy Training and Mental Health Commitment training have also been offered at several sites across the nine county service area.

  2. Camino Real CMHMRC will ensure a solid network of providers for medication and counseling services by:

    1. Recruiting and maintaining qualified internal and external providers.
    2. Implementing and adhering to the RDM Model of Care.


    Camino Real has assisted consumers with accessing external providers as needed and assisted with signing up for the Medicare Part D plan that best suits their individual needs. This has included arranging for local pharmacy resources to be available at the various clinics. The Center has also added Prescription Assistance Program Clerks at all clinics to assist with accessing needed medications. In implementing the Resiliency and Disease Management model of care in the mental health program Camino Real has worked hard to become one of the leading centers in meeting the performance requirements.

  3. Camino Real CMHMRC will improve family support services through:

    1. Researching and implementing strategies that encourage and engage family participation in consumer recovery.
    2. Enhanced services that are responsive to family needs.
    3. Ensuring consumers are receiving services in the least restrictive environment appropriate to their care.


    Camino Real has assisted eligible person with accessing Medicare D funding, as mentioned above. Additionally, the respite program has been greatly expanded in Intellectual and Developmental Disabilities services in response to people's needs. Transportation services continue to be provided to both mental health and mental retardation consumers to assist them in accessing Camino Real services as well as other services within their communities. Also, the foster care provider program has expanded in Intellectual and Developmental Disabilities services to allow persons to live in alternative family settings as opposed to more institutional settings.

FY 2005 SURVEY DATA COLLECTION

In April 2005, the Community Needs Assessment Survey was distributed once again to a random selection of customers of Adult Mental Health Services, Child and Adolescent Mental Health Services, and Intellectual and Developmental Disabilities services. Surveys were also distributed to randomly selected community members within the Camino Real service area. The survey was provided to all participants in both English and Spanish. A total of 1,046 surveys were distributed. The return rates for each group are as follows:

Adult MH Services - 30.77% with a 3.85% return rate in Spanish
C&A MH Services - 16.67% with a 0.93% return rate in Spanish
MR Services - 20.00% with a 1.54% return rate in Spanish
Community Stakeholders - 7.55% with a 0.88% return rate in Spanish


A total of 115 surveys were completed and returned for an overall return rate of 11%.

The following four pages represent the results of the Community Needs Assessment Survey:


CONSUMER & FAMILY RESPONSES - OVERALL SCORES BY QUESTION

Question #1

Are you aware of the services Camino real provides for Mental Health and Mental Retardation?		 Yes No
Adult MH Services

MH C&A Services

MR Serves		 21

16

10		 3

1

3
Totals: 47 7
Score Response by Percentage: 85.5% 12.7%


Question #2

If you or someone you know had a need for MH or MR Services, how would you access these services?		 Go to CR Facility Telephone Directory Don't Know How Personal Contact
Adult MH Services

MH C&A Servcies

MR Services		 19

14

11		 2

2

2		 0

1

0		 2

5

4
Totals: 44 6 1 11
Score Response by Percentage: 80.0% 10.9% 1.8% 20.0%


Question #3

Previous survey results from '03 indicated Camino Real needed to focus on the following areas as service priorities in your community. Check the ones you think are still a priority:		 Counseling Transportation Family Support & Training Medication Services Increased Public Awareness Emergency/
Crisis Services
Adult MH Services

MH C&A Servcies

MR Services		 16

9

6		 10

3

5		 12

10

6		 15

12

4		 10

10

3		 10

6

5
Totals: 31 18 28 31 23 21
Score Response by Percentage: 56.4% 32.7% 50.9% 56.4% 41.8% 38.2%


Question #5

What is the benefit or advantage of having a non-profit MHMR Center in your local community?

From the list, mark those you feel apply:		 Local Access to Services Strong Community Partnerships Familiarity with Staff Local Responsiveness to Needs Services Help People be Productive Members of Community Healthier/
Safer Communities		 Ability
to give Local Public Input
Adult MH Services

MH C&A Servcies

MR Services		 17

10

10		 9

12

4		 14

10

5		 12

8

3		 18

16

10		 10

9

3		 8

5

5
Totals: 37 25 29 23 44 22 18
Score Response by Percentage: 67.3% 45.5% 52.7% 41.8% 80.0% 40.0% 32.7%



COMMUNITY STAKEHOLDER RESPONSES - OVERALL SCORES BY QUESTION

Question #1

Are you aware of the services Camino real provides for Mental Health and Mental Retardation?		 Yes No
Community Stake Holders 25 34
Totals: 25 34
Score Response by Percentage: 41.7% 56.7%


Question #2

If you or someone you know had a need for MH or MR Services, how would you access these services?		 Go to CR Facility Telephone Directory Don't Know How Personal Contact
Community Stake Holders 18 14 16 10
Totals: 18 14 16 10
Score Response by Percentage: 30.0% 23.3% 26.7% 16.7%


Question #3

Previous survey results from '03 indicated Camino Real needed to focus on the following areas as service priorities in your community. Check the ones you think are still a priority:		 Counseling Transportation Family Support & Training Medication Services Increased Public Awareness Emergency/
Crisis Services
Community Stake Holders 25 18 29 24 45 23
Totals: 25 18 29 24 45 23
Score Response by Percentage: 41.7% 30.0% 48.3% 40.0% 75.0% 38.3%


Question #5

What is the benefit or advantage of having a non-profit MHMR Center in your local community?

From the list, mark those you feel apply:		 Local Access to Services Strong Community Partnerships Familiarity with Staff Local Responsiveness to Needs Services Help People be Productive Members of Community Healthier/
Safer Communities		 Ability
to give Local Public Input
Community Stake Holders 39 16 19 25 33 27 20
Totals: 39 16 19 25 33 27 20
Score Response by Percentage: 65.0% 26.7% 31.7% 41.7% 55.0% 45.0% 33.3%



LOCAL SERVICE PRIORITIES

The following chart shows the priorities that have been identified through the various assessment processes in developing the Local Service Area Plan. The authority has identified those issues of importance to the different populations served by Camino Real as well as those issues of prime importance to the continuation of Camino Real CMHMRC and its endeavors to meet the needs of its service population.

SERVICE PRIORITIES
For Adults Needing Mental Health Services For Children and Adolescents Needing Mental Health Services
1. Counseling
2. Medication Services
3. Family Support & Training		 1. Medication Services
2. Family Support & Training
3. Increased Public Awareness
For Persons With Mental Retardation For Community Members
1. Counseling
2. Family Support & Training
3. Transportation Services
4. Emergency/Crisis Services		 1. Increased Public Awareness
2. Family Support & Training
3. Counseling


2005-2007 LOCAL SERVICE AREA PLAN (LSAP) GOALS AND OBJECTIVES

  1. Camino Real CMHMRC will increase public awareness of the services it provides through:

    1. On going marketing efforts throughout the service area.
    2. The availability of staff, PNAC members and Board of Trustee members to speak to local civic groups or provide education on MHMR topics.

  2. Camino Real CMHMRC will ensure a solid network of providers for medication and counseling services by:

    1. Recruiting and maintaining qualified internal and external providers.
    2. Implementing and adhering to the RDM Model of Care.

  3. Camino Real CMHMRC will improve family support services through:

    1. Researching and implementing strategies that encourage and engage family participation in consumer recovery.
    2. Enhanced services that are responsive to family needs.
    3. Ensuring consumers are receiving services in the least restrictive environment appropriate to their care.


IMPACT OF KEY FORCES

The strengths, weaknesses, opportunities, and threats to Camino Real are derived from the numerous surveys and assessments identified in section III.

Strengths

  • Committed staff with strong technical and clinical expertise
  • Experienced management team
  • Strong community involvement demonstrated by the local advisory councils, involvement of county judges, and PNAC
  • Active and committed Board of Trustees
  • Center has developed process to assess overall organizational functions
  • Good procedures in place to identify financial information and maximize all potential revenue streams
  • Access to "state of the art" technology (i.e. video conferencing)
  • Low turnover rate
  • Pursing grant opportunities to expand funding base
  • Good internal auditing process especially related to Medicaid compliance
  • Good Customer Services
  • Consumer Focused
  • Strong work center programs that provide local funds to the Center and real, meaningful work activity to the consumer
  • Bilingual services are provided (English/Spanish)
  • Marketing and educating the communities at large regarding all program services
  • Supervisory skills training has been expanded


Weakness

  • Not enough money to meet the demand for services
  • Problems in the use and management of information
  • Need to strengthen utilization management process to increase accountability and assure decisions are data driven
  • Procedures need to be updated in order to establish consistency and continuity
  • Need to increase the technical skills of service providers and support staff and standardize clinical approaches
  • Communication within the Center needs further improvement


Opportunities

  • Exploration of additional grant opportunities for expanding or enhancing services
  • Strengthen the relationship with TDCJ to provide transitional services to mentally ill persons released from prison into community based programs
  • Continue to enhance strong work center programs where consumers experience real, meaningful work activity while the Center benefits from generated revenues


Threats

  • Legislative directives toward privatization of services
  • Lack of sufficient General Revenue Funding to meet need for services and all the administrative requirements related to service delivery
  • Texas has poorly funded human services- one of the lowest in the nation
  • Poor economy in the areas served by Camino Real which directly impact services
  • Difficulty in recruiting and maintaining experienced and qualified staff in the rural areas
  • Increase in Health Care costs/fringe benefit package without corresponding funding to offset the increase
  • Continual changes within the MHMR system pertaining to funding streams, policies, etc. that prevent stability and development of expertise with requirements
  • Rapid outdating of technology and ongoing costs
  • Requirement to implement urban based models of care in rural areas which lack sufficient resources to accomplish the models as presented
  • Medicaid rate reductions
  • Rising costs of medication
  • As a small center, not having adequate size to gain the economy of scale to support the administrative support services
  • Execution of Medicare D funding has been challenging due to implementation problems at the federal level


VI. NETWORK DEVELOPMENT

It is the intention and goal of Camino Real Community MHMR Center to expand a network of service providers that allow consumers to have increased options for accessing a comprehensive array of service providers. These services would be monitored for the provision of quality services. The Network Plan, which depicts the configuration of the local service delivery system, is the culmination of understanding community priorities and assessment factors.

PLANNING GUIDELINES
Through the community needs survey process, interpretation of the results by the Planning and Network Advisory Committee (PNAC) as well as both formal and informal discussions, it has been determined that the services currently in place, provided primarily by internal providers, should continue as the basic model of services to be provided. An understanding of the services may be gained through review of descriptions of these services contained at the end of this document. These services are basic community-based services and include: Adult Mental Health, Mental Health service for Children and Adolescents, services to all ages of individuals having Mental Retardation and very young children qualifying for Early Childhood Intervention (ECI) services.

PROVIDER OF LAST RESORT PLAN
The FY 2005 Performance Contract between Camino Real Community MHMR Center (Camino Real), the Texas Department of State Health Services (DSHS) and the Texas Department of Aging and Disability Services (DADS) required Camino Real to submit a "Provider Of Last Resort Plan" that contained a summary of all responses to Camino Real's March 2004 RFI as well as a listing of all the services for which the Center planned to contract and timelines for implementation. Camino Real submitted its "Provider of Last Resort Plan" on November 24, 2004. This Plan stated that the Center anticipated submitting its Local Service Area Plan inclusive of the Baseline Provider Network Analysis and the procurement plans. In addition, it stated that the determination of which services will be procured for FY 2006 and the implementation timeline would be contingent upon a variety of factors including: (a) analysis of baseline level of current provider network; (b) incorporating the procurement plans with public input process, including the Local Service Area Plan; and (c) obtaining clarification and guidance for the concerns enumerated in the Plan.

The recent Opinion No. GA-0416 from the Attorney General's Office has clarified the uncertainty of the applicability of "Provider of Last Resort" laws to mental health services. The Center is now awaiting clear direction and guidance for implementation regarding "Provider of Last Resort" for mental health services from DSHS. Guidelines have been provided by DADS that identify the process for HCS enrollment when a center functions as both a provider and an authority. These guidelines address the requirements for Provider of Last Resort. As in the past, Camino Real will continue to respond to the requests of DSHS and DADS and will comply with all legislative, regulatory and contractual requirements- plans and timelines for procurement of client services for FY 2006 are no exception.

COMMUNITY FACTORS
The catchment area that Camino Real serves is very rural in nature. Basically, the area consists of nine counties stretching 190 miles from the eastern County of Karnes to the southwestern County of Maverick. There are about 12,000 square miles in this territory occupied by 178,596 residents or about 15 people for every square mile of land. There are no cities to speak of in the geographic area other than Eagle Pass, which is basically a large border town, population 22,413 with very limited socio-economic opportunities. The next largest towns are the Pleasanton/Jourdanton area with combined populations of 11,998. Most of the other towns in the area range in population from a few hundred to as many as 7,200 residents.

Two Year Growth Projections



Atascosa Dimmit Frio Karnes La Salle McMullen Maverick Wilson Zavala Totals
 Percent growth Between 2005 & 2007 5% 4% 4% 3% 5% -1% 5% 5% 4% 5%
 Growth Difference Between 2005 & 2007 2,205 457 626 456 316 (13) 2,768 1804 489 9,108
 Projected Population 2007 44,199 11,059 17,824 16,620 6,537 867 54,269 38,071 12,614 202,060
 Projected Population 2005 41,994 10,602 17,198 16,164 6,221 880 51,501 36,267 12,125 192,952
 2000 Census Population 38,628 10,248 16,252 15,446 5,866 851 47,297 32,408 11,600 178,596


There is some economic development in the territory as well as the establishment of local and regional hospital and health care services. Still, a significant number of residents go to San Antonio for their health services, shopping, entertainment and other services. Many residents simply do without if they do not have the financial wherewithal or the distances are too great to travel.

Agriculture (ranching and farming) is the primary industry in the area offering limited employment or economic opportunity to the vast majority of residents. The towns as described above have some opportunities available in various service industries and retail establishments.

The above provides the backdrop in which Camino Real has responsibility to provide services through internal and external providers. The challenges to provide services are significant. Whether from the public or private sector, obtaining qualified staff willing to reside in the area is most difficult. Even after qualified staff is located, a provider can lose significant productivity time when staff has to travel. If staff does not travel, transportation of the consumer to the service provision site is costly both in time, staff resources and equipment resources. This rural setting is not conducive to economies of scale when considering caseloads. In a large urban area, one might acquire one facility that would serve say 1,000 MH consumers per month. In the rural area, there would have to be multiple facilities (i.e. seven) to provide services to about the same caseload. This means 7 different buildings, 7different phone systems, 7 different clerical staff, and so on.

Given these challenges and the lack of numbers of funded consumers, there is minimal attraction to providers to come into the area. Profitability is very limited due to the logistics involved. It will be these challenges that the Network Plan needs to address in order to develop a viable service delivery system of both internal and external providers.

COMPONENTS OF PLAN
Major components of the Network Plan include:

  1. Identification of who the service providers are that can serve the local communities. Are there adequate numbers of providers to respond to the identified needs of the various communities?
  2. Does the pool of qualified providers reflect the local demography? Are these providers qualified, diverse, and accessible?
  3. What service configuration would provide the most good for the greatest number of consumers at the most reasonable cost?
  4. How will providers of services that are placed for competitive bidding be systematically reviewed and selected? Will this process minimize disruption of the treatment and services to individuals?
  5. What strategy will Camino Real use in developing relationships with other agencies/providers in its service area?


PROVIDER SURVEY

A Request for Information (RFI) was conducted in the spring of 2004 to identify the availability or interest of providers of services in the nine (9) county area. Providers will be evaluated on various factors including what they offer in terms of consumer choice, accessibility and quality services. Basically, a request for information packet was solicited from local providers or providers willing to provide services in the area. To accomplish this solicitation, lists of providers were used who were linked with the TDMHMR system such as HCS, ICF/MR and other comparable types of services. The outcome provided a comprehensive listing of providers of mental health and Intellectual and Developmental Disabilities services. Efforts to identify providers included local newspapers, metro newspapers, professional publications and individual notifications. Additional work will be done to refine information on these providers. This will include such elements as size, types of services, existing facilities and equipment, numbers of staff, types of staff, etc. In addition, information will be obtained on the quality of services as determined by existing certifying or approving entities. Information will be updated pursuant to guidelines from DADS and DSHS, particularly in implementation of Provider of Last Resort laws.

INTERNAL/EXTERNAL PROVIDER MIX

With the provider information complete, an analysis will be done of existing services to determine viability, efficiency and quality of these services. Initial consideration for outsourcing would be taken into consideration and focus would be placed on those programs that have been unable to stay within budgetary parameters and have difficulty maintaining reasonable quality standards. If there are external providers available that have the essential qualifications to provide the services in question, the decision most probably would be made to go through the complete process of review and request for proposals from both internal and external providers.

REQUEST FOR PROPOSALS/ OBJECTIVE REVIEW

The decision making process would require an objective approach. A complete, comprehensive set of program descriptions and specifications would be developed to assure that it was clearly understood what services were being considered. A request for proposals (RFP) would be issued. Proposals would be accepted from both internal and external providers. These would need to detail the capability and background of the provider as well as provide a full description of the methodology that would be utilized in the provision of services. Best value would be determined through use of an evaluation process both of information included by the provider as well as independent research on the part of the Authority. Following is a list of areas that would be taken into consideration in this review process:

  1. COST/BENEFIT: The proposed configuration providing the most good for the greatest number of consumers at the most reasonable cost .
  2. STAFFING PATTERNS including numbers of staff and intended staff to consumer ratios.
  3. QUALIFICATIONS AND EXPERIENCE of staff providing direct service. (QMHP, QMRP, LPHA, etc. and other requirements)
  4. PHYSICAL PLANT and EQUIPMENT that the provider intends to use in the provision of services.
  5. Demonstrated ability of the provider to handle necessary DOCUMENTATION and INFORMATION TECHNOLOGY necessary to support reporting and billing requirements.
  6. Demonstrated ability to provide QUALITY SERVICES as determined by surveys, accreditation, peer review and any other reviews related to professional practices.
  7. LICENSING and CERTIFICATION as required.
  8. Absence of major problems in relation to ABUSE AND NEGLECT findings or CONSUMER RIGHTS.
  9. STABILITY and LONGEVITY of provider in the service delivery system.
  10. PUBLIC RELATIONS in various communities including consumer, parents, etc.
  11. DIVERSITY, ACCESSIBIITY and reflection of local demography.
  12. SPECIAL SKILLS including bi-lingual (English/Spanish), sign language, etc.


VII. DESCRIPTION OF AUTHORITY SERVICES

Authority Administrative Services
Local Service Area Planning Camino Real Community MHMR Center
Quality Management
Credentialing
Managed Information Systems
Claims Adjudication and Payment
Contract Management
Utilization Management


Authority Essential Services
Access & Intake (MR/MH) Camino Real Community MHMR Center
Avail Inc.
Service Coordination (MR)
In Home and Family Support (MR)
Crisis Hotline
Authorizations (MH]
Continuity of Care


VIII. DESCRIPTION OF PROVIDER SERVICES

Intellectual and Developmental Disabilities services Providers
Habilitation and Vocational Training and Support in Work Center Settings Camino Real CMHMRC
Maverick County Association
Nutrition Therapy
Mark Steege
Hill Country MHMR
WoodCare Center, Inc.
Elizabeth Mitchell, M.D.
Multiple Foster Care providers
Chris Mayhew, Psychological Associate
Laurence P. Perotti, Ph.D. Licensed Psychologist
Supported Employment
Supported Home Living
Foster Care
Other Specialized HCS services
HCS Case Management
Special Therapies including psychology, nursing, psychiatry and occupational therapy


Adult Mental Health Services Providers
Medication related services including pharmacological management, medication administration, medication monitoring and medication training Camino Real CMHMRC
Timothy Bischoff, M.D.
Frio Regional Hospital
Wilson Memorial Hospital
Fort Duncan Hospital
The Wood Group, Inc.
LTC (Pharmacy Resource)
Rehabilitation Services including skills training and skills maintenance
Residential Treatment including skills training and respite care
Counseling and Psychotherapy
Family Training
Case Management


Mental Health Child & Adolescent Services Providers
Family Support Services Camino Real CMHMRC
Frio Regional Hospital
Wilson Memorial Hospital
Fort Duncan Hospital
Elizabeth Mitchell, M.D.
Southwest Mental Health Center
Medication related services including pharmacological management, medication administration, medication monitoring and medication training
Counseling and Psychotherapy
Family Training
Rehabilitation Services including skills training
Case Management


Early Childhood Intervention (ECI) Providers
Home based intervention services Camino Real CMHMRC
Kelly Olive, LPT
Therapeutic Intervention for Kids
Nutrition Therapy
Speech Specialist of San Antonio
Diane Herchek, PTA
Merry Livingston, Speech Pathologist
Special Therapies including occupational therapy, physical therapy, speech and medical services
Screening and Assessment
Service Coordination
Child Find





Home | Mental Health Services | Intellectual and Developmental Disabilities | Early Childhood Intervention Services | Administration | About Camino Real | Board of Trustees | Links | Planning & Network Advisory Committee | Local Plan | Contact & Service Locations | Application Information & Requirements | Job Postings | Center Privacy Practices | Contact Webmaster


© 2011 Camino Real Community Services
DHTML Web Menu by OpenCube