State plan ... : blueprint for change.

              State Plan 2001: Blueprint for Change i
November 30, 2001
State Plan 2001: Blueprint for Change
Table of Contents
Chapter 1. Strategic Plan 1
Introduction and Overview 1
Assumptions 1
Mission, Principles, Vision 2
Mission 2
Guiding Principles 2
Vision 2
Challenges of Change 3
Chapter 2. A Description of the Current System 5
Area Programs and Qualified Providers 5
State Psychiatric Hospitals and Special Care Center 6
Mental Retardation Centers 7
Residential Treatment Facilities for Children 7
Alcohol and Drug Abuse Treatment Centers 8
Summary of Needs 8
People Needing Services 8
Children with Emotional Disturbances 9
Children with Substance Abuse Problems 9
People with Substance Abuse and Other Drug Problems 9
State Facilities 9
Local Hospitals 10
Funding 10
Chapter 3. Designing a New System for MH/DD/SA 11
Core Functions 12
Uniform Portal 13
Statewide System Contractor 13
System Access 14
Target Populations 14
Adult Mental Health Services 15
Child Mental Health Services 16
Developmental Disabilities Services 19
Substance Abuse Services 19
People with Co-occurring Disorders 21
Array of Services for Target Populations 23
Housing/Residential 23
Transportation 23
Treatment, Symptom Management, Therapies 23
State Plan 2001: Blueprint for Change ii
November 30, 2001
Work, School, Activity, Leisure 24
Wrap-Around Services 25
Crisis/Emergency (Including core emergency service) 25
Addressing Disparities in the MH/DD/SA System 25
Local Management Entity 27
Transition Issues 28
Individual Transitions 28
Provider Network Transitions 28
LMEs' Evolving Role 28
Qualified Service Provider Networks 29
Department Coordination and Infrastructure 29
Coordination 30
Documentation 30
Licensure and Monitoring of Services 31
Qualified Service Provider Network/Direct Enrollment 31
Training 32
Infrastructure 32
Collection and Analysis of Data 32
Appeals, Grievances, Human Rights, Consumer Advocacy 32
Office of Consumer Affairs 32
State and Local Consumer and Family Advisory Committees 32
Rules Adoption and Statute Revisions 34
System Quality Management Plan 34
Staff Competencies, Education and Training 35
Financing 36
Chapter 4. Business Plan Timeline 39
References 49
State Plan 2001: Blueprint for Change iii
November 30, 2001
The Secretary’s State Plan Advisory Committee
Wilda Brown
Parent – Chair of MRA/DD
15956 US 221 N
Marion, NC 28752
Henry Johnson
Associate State
Superintendent
Office of Instructional &
Accountability Services
301 N. Wilmington St.
Raleigh, NC 27601
Tom Savidge
Pitt County MHDDSA Center
203 Government Circle
Greenville, NC 27834-7706
Sally Cameron
North Carolina
Psychological Association
Subcommittee Chair SPDMI
1004 Dresser Ct., Suite 106
Raleigh, NC 27609
Richard Johnson
Dare County Commissioner
100 Carolina Court West
Manteo, NC 27954
Dr. Marvin Swartz
Dept. of Psychiatry
Duke University Medical Center
Durham, NC 27710
Carol Duncan Clayton
Council of Community
Programs
1318 Dale Street Suite 120
Raleigh, NC 27605-1275
Jill Keel
Autism Society of NC
505 Oberlin Road, #230
Raleigh, NC 27605
Kathi Shaw
Parent
4211 Mangum Drive
Wilmington, NC 28409
Connie Cochran
Chair, Coalition 2001
P.O. Box 27707
Raleigh, NC 27611
Gerald Leach, parent
1703-A Brockett Ave.
High Point, NC 27260
Gordon Simmons
RHA Health Services
12 Ridgefield Blvd., Suite 270
Asheville, NC 28806
Bibba Dobyns
C&F Service Coordinator
Guilford Area Mental Health
201 N. Eugene St.
Greensboro, NC 27401
Tom Lundy
Catawba County Manager
P.O. Box 389
Newton, NC 28658-0389
Ed Smith
Civil Rights Division
1203 Front St.
Raleigh, NC 27609
Josie Douglas, parent
9228 Poole Rd.
Knightdale, NC 27545
Beth Melcher
NAMI of NC
309 W. Millbrook Rd.,
Suite 121
Raleigh, NC 27609
Jack St. Clair, Director
Duplin-Sampson Area
MHDDSAS
P.O. Box 599
Kenansville, NC 28349
Sherrye Fowler
Governors Institute
P.O. Box 13374
Durham, NC 27709
Douglas Michaels
VOICES for Addiction
Recovery
P.O. Box 2925
Asheville, NC 28802
Dr. Don Stedman, Department of
Education, UNC-CH
6605 Huntingridge Road
Chapel Hill, NC 27514
State Plan 2001: Blueprint for Change iv
November 30, 2001
The Secretary’s State Plan Advisory Committee
Dr. Bob Golden
Dept. of Psychiatry
CB 7160 UNC-Chapel Hill
Chapel Hill, NC 27599
Tony Mulvihill
Alcohol/Drug Council of
NC
3500 Westgate Drive,
Suite 204
Durham, NC 27707
John Tote
Mental Health Association
3820 Bland Rd.
Raleigh, NC 27609
Rich Greb, parent
6712 Perkins Dr.
Raleigh, NC 27612
Dorothy O’Neal
NC Mental Health
Consumer’s Organization
P.O. Box 27042
Raleigh, NC 27603
David Turpin
Southlight, Inc.
2500 Blue Ridge Rd. – Suite 400
Raleigh, NC 27607
Donn Hargrove
Office of Juvenile Justice
MSC 1801
Raleigh, NC 27699-1801
Ron Osborne
Residential Treatment
Services of Alamance
POB 427
Burlington, NC 27216-0427
Dr. John Wagnitz
NC Psychiatric Association
P.O. Drawer 9
West End, NC 27376
Jim van Hecke
Pavilion International
P.O. Box 189
Mill Spring, NC 28756
Dave Richard
Arc of North Carolina
PO Box 20545
Raleigh, NC 27609
Margaret Waller-Stargell
Coastal Horizons, Inc.
3333 Wrightsville Ave. Suite 102
Wilmington, NC 28403
Bob Hedrick
NC Providers Council
211 E. Six Forks Road, #105
Raleigh, NC 27609
Holly Riddle
DD Council
1001 Navaho Drive,
Suite 103
Raleigh, NC 27609
Claretta Witherspoon
Family Advocate
Mental Health Association of
Greensboro
1004 N. Elm Street
Greensboro, NC 27401
Chris Howel, consumer
1435 Old Lystra Road,
Lot 11
Chapel Hill, NC 27516
Joel Rosch
Governor’s Crime
Commission
MSC 4708
Raleigh, NC 27699-4708
Bert Wood
STEP ONE, Inc.
665 West Fourth St.
Winston-Salem, NC 27101-2701
William J. Hussey, Board
Chair
NC MH Planning Council
2521 Perkins Rd.
Durham, NC 27706
Janice Rossi
NCARF
3211 Bramer Drive
Raleigh, NC 27604
Carlene Wood
Blue Ridge Area MHDDSA
Program
356 Biltmore Ave.
Asheville, NC 28801-4594
State Plan 2001: Blueprint for Change v
November 30, 2001
State Plan Sub-Committees
Hospital Target Population
Jack Haggerty, NC Psychiatric Association
Sherry Harrison, DMH/DD/SAS
Tony Lindsey, UNC Dept. of Psychiatry
Barbara Matula, Medical Society of North Carolina
James Osberg, Adult Community Mental Health, DMH/DD/SAS
Marvin Swartz, UNC-CH Dept. of Psychiatry
Laura Thomas, NC Hospital Association
Mike Vicario, NC Hospital Association
Adult Mental Health
Don Willis, Adult Mental Health Services, DMH/DD/SAS
David Jones, Piedmont Behavioral Health
Bonnie Morell, Adult Mental Health Services, DMH/DD/SAS
Anna Scheyette, UNC-CH School of Social Work
Jennifer Sullivan, NASW-NC
Dr. John Wagnitz, NC Psychiatric Association
Melody Wood, NC Mental Health Consumer’s Organization
Consumer and Family Input
Becky Chapman, Developmental Disabilities, DMH/DD/SAS
Mary Eldridge, Advocacy, Client Rights & QI, DMH/DD/SAS
Joe Donovan, MH Consumer
Ann Eller, Developmental Disabilities, DMH/DD/SAS
Sherrye Fowler, SA Consumer
Chris Howell, DD Consumer
Charlotte Jordan, Advocacy, Client Rights & QI, DMH/DD/SAS
Gerald Leach, Parent
Betsy MacMichael, Families of Developmentally Disabled consumers
Susan Mills, Advocacy, Client Rights & QI, DMH/DD/SAS
Dorothy O’Neal, Mental Health Consumers Organization
Martha Olaya-Crowley, Wake Human Services
Julie Siebert, Child & Family Services Section, DMH/DD/SAS
Brad Trotter, Adult Mental Health Section, DMH/DD/SAS
Syd Wiford , Behavioral Health Resource Program, UNC-CH
DD Advisory Group
Peggy Balak, Developmental Disabilities, DMH/DD/SAS
Wilda Brown, Mental Retardation Association
Connie Cochran, United Cerebral Palsy
Lisa Haire, Developmental Disabilities, DMH/DD/SAS
Marian Hartman, Developmental Disabilities, DMH/DD/SAS
Bob Hedrick, NC Providers Council
Jill Keel, Autism Society of NC
Laura Nuss, Developmental Disabilities, DMH/DD/SAS
Pat Porter, Developmental Disabilities, DMH/DD/SAS
Dave Richard, The ARC of NC
Holly Riddle, Developmental Disabilities Council
State Plan 2001: Blueprint for Change vi
November 30, 2001
Janice Rossi, NC Association of Rehabilitation Facilities
Jack St. Clair, Duplin-Sampson MH/DD/SAS
Kathi Shaw, Parent
Gordon Simmons, RHA Health Services
Stan Slawinski, Developmental Disabilities, DMH/DD/SAS
Don Stedman, Department of Education, UNC-CH
MR/MI DD Advisory Group
Doug Baker, Substance Abuse Services Section, DMH/DD/SAS
Alicia Graham, Child and Family Services Section, DMH/DD/SAS
Pat Porter , Developmental Disabilities, DMH/DD/SAS
Lynda Richard , Developmental Disabilities, DMH/DD/SAS
Anna Scheyette, UNC-CH School of Social Work
Child and Family Mental Health
Stephanie Alexander, Child & Family Section, DMH/DD/SAS
Sally Cameron, NC Psychological Association
Carol Duncan Clayton, NC Council of Community Programs
Austin Connors, Children & Family Services Association-NC
Joan DeBruyn, Child & Family Services Section, DMH/DD/SAS
Lana Dial, NC Administrative Office of the Courts
Joann Haggerty, NC Child Advocacy Institute
Donn Hargrove, Department of Juvenile Justice & Delinquency Prevention
Chuck Harris, Division of Social Services
Connie Hawkins, Exceptional Children’s Assistance Center
Bill Hussey, NC Mental Health Planning & Advisory Council
Diann Irwin, Exceptional Children Division, Department of Public Instruction
Linda Gunn-Jones, Child & Family Services Section DMH/DD/SAS
Martha Kaufman, Child & Family Services Section, DMH/DD/SAS
JoAnn Lamm, Children Services Section
Tara Larson, DMH/DD/SAS
Lee Lewis, Adolescent Substance Abuse Services, DMH/DD/SAS
Beth Melcher, NAMI North Carolina
North Carolina Families United Coordinator
Mark O’Donnell, Child & Family Services Section, DMH/DD/SAS
Lynda Richard, Developmental Disabilities Section, DMH/DD/SAS
Carol Robertson, Division of Medical Assistance
Susan Robinson, Child & Family Services Section, DMH/DD/SAS
Joel Rosch, Governor’s Crime Commission
Steve Shore, NC Pediatric Society
Carol Tant, Women’s & Children’s Health Section, Division of Public Health
John Tote, Mental Health Association in NC
Brad Trotter, Adult Mental Health, DMH/DD/SAS
Local Business Plan Committee
Steve Carpenter, Person County
Carol Duncan Clayton, NC Council of Community Programs
Regina Dickens, Riverstone Counseling & Personal Development
Tom Hogan, Wake County Human Services
Ed Jones, Forsyth County
Chuck Kitchen, Durham County Attorney
Tara Larson, DMH/DD/SAS
State Plan 2001: Blueprint for Change vii
November 30, 2001
Tom Lundy, Catawba County
Tom Maynard, Orange-Person-Chatham MH/DD/SA Authority
Ron Morton, Centerpoint Human Services
Patrice Roesler, NC Association of County Commissioners
Ed Ruffin, Durham County
Flo Stein, Substance Abuse Services Section, DMH/DD/SAS
Mike Watson, Sandhills Center
Bobby White, Caldwell County
Substance Abuse Sub-Committee
Flo Stein, Substance Abuse Services Section, DMH/DD/SAS
Spencer Clark, Substance Abuse Services Section, Women and Children’s Services
Doug Baker, Substance Abuse Adult Services, Institutional Management
Starleen Scott-Robbins, Substance Abuse Services, Women and Children’s Services
Margaret Waller-Stargell, Coastal Horizons
Sherrye Fowler, Governor’s Institute
Tom Savidge, Pitt County MH/DD/SA Center
Doug Michaels, VOICES for Addiction
Tony Mulvihill, Alcohol/Drug Council of NC
Bert Wood, STEP ONE, Inc.
Ron Osborne, Residential Treatment Services of Alamance
Jim Van Hecke, Pavilion International
Syd Wiford, Behavioral Health Resource Program UNC-CH
Smith Worth, Behavioral Health Resource Program, UNC-CH
Administration Cost Workgroup
Jim Burke, Department of State Treasurer
Jack Chappell, Benefit Payment Section/DHHS Controller’s Office
Curtis Crouch, DHHS Controller’s Office
Rick DeBell, Budget Section, DMH/DD/SAS
Bob Duke, DHHS Controller’s Office
Kyle Fay, Division of Budget & Analysis
Gary Fuquay, DHHS
Phillip Hoffman, Budget Section, DMH/DD/SAS
Vance Holloman, Department of State Treasurer
Aydlett Hunike, DHHS Controller’s Office
Pat Jeter, DHHS Controller’s Office
Tara Larson, DMH/DD/SAS
J. Thomas Lundy, Catawba County
Tom McDevitt, Smoky Mountain Center
Jim Panton, Rate Setting and Reimbursement, Division of Medical Assistance
Jack Parsons, Blue Ridge Center
Ann Rodriguez, NC Council of Community Programs
Mike Ruffin, Durham County
Mike Watson, Sandhills Center
Ann Wilson, Piedmont Area MH/MR/SAS
Ken Windley, Davie County
Project Team
Tara Larson, DMH/DD/SAS
Jim Osberg, Adult Mental Health Section, DMH/DD/SAS
Art Eccleston, DMH/DD/SAS
State Plan 2001: Blueprint for Change viii
November 30, 2001
Sherry Harrison, DMH/DD/SAS
Smith Worth, Behavioral Health Resource Program-UNC-CH
Peggy Balak, Developmental Disabilities Services Section, DMH/DD/SAS
Mary Eldridge, Advocacy, Client Rights & QI, DMH/DD/SAS
Joan Kaye, Communications and Training Section, DMH/DD/SAS
Jason Reynolds,Substance Abuse Services Section, DMH/DD/SAS
Administrative Staff Competencies
Janice Rossi, NC Association of Rehabilitation Facilities
Val Carmine, Communications and Training Section, DMH/DD/SAS
Stephanie Alexander, Child and Family Services Section, DMH/DD/SAS
Sammy King, Life Incorporated
Michael Mayer, NC Provider Council
Lynn Graham, Women’s and Children’s Health Section, Division of Public Health
Ken Marsh, Adult Mental Health, DMH/DD/SAS
Judy Bright, Developmental Disabilities Services, DMH/DD/SAS
Jim Jarrard, Program Accountability Section, DMH/DD/SAS
Holly Cole, Rescare, Inc.
Duncan Munn, Women’s and Children’s Health Section, Division of Public Health
Doug Baker, Substance Abuse Services Section, DMH/DD/SAS
Don Herring, Developmental Disabilities Services, DMH/DD/SAS
Bob Hedrick, NC Providers Council
Bill Harris, Program Accountability Section, DMH/DD/SAS
Barbara Flood, Wayne County Mental Health Center
Ann Rodriguez, NC Council of Community Programs
Yvonne French, Caring Family Network of NC
Tom Vitaglione, NC Hospital Association
Tara Larson, DMH/DD/SAS
Starleen Scot-Robbins, Substance Abuse Women and Children’s Services
Lynda Richard, Developmental Disabilities Services Section, DMH/DD/SAS
Larry Nason, Caring Family Network of NC
Karen Sticklin, Developmental Disabilities Services Section, DMH/DD/SAS
John Wagnitz, Sandhills Center
Jim Gibson, Substance Abuse Services Section, Employee’s Assistance Program
Fred Waddle, NC Providers Council
Cindy Kornegay, Program Accountability Section, DMH/DD/SAS
Cheryl Kombo, Child and Family Services Section, DMH/DD/SAS
Carol Duncan Clayton, NC Council of Community Programs
Bart Grimes, Wake County Human Services
State Plan 2001: Blueprint for Change 1
November 30, 2001
Chapter 1. Strategic Plan
Introduction and Overview
North Carolina's mental health, developmental disabilities and substance abuse services system is at
a crossroads. The state’s ability to respond to rapidly changing national standards has been severely
compromised by reductions in funding, changes in leadership, a lack of consensus regarding how to
improve the system, and severe budget problems. Consumers, families, advocates, providers,
legislators and administrators recognize that sweeping changes are needed to move the system
forward into the 21st century.
The North Carolina General Assembly has taken an increasingly active leadership role in the public
system for mental health, developmental disabilities and substance abuse services. During the 2000
Legislative Session, the bipartisan Joint Legislative Oversight Committee on Mental Health,
Developmental Disabilities, and Substance Abuse Services was established to oversee system
reform. The LOC, chaired by Senator Steven Metcalf and Representative Verla Insko, created the
mental health reform bill. Governor Michael F. Easley signed the bill on October 15, 2001. The
mental health reform bill (House Bill 381: An Act to Phase in Implementation of Mental Health
System Reform at the State and Local Level) provides much of the basis for this state plan,
particularly as it relates to coordination of state and local collaboration. The full text of the reform
legislation is incorporated by reference as a separate document.
The State Plan 2001: Blueprint for Change is DHHS Secretary Carmen Hooker Buell’s plan to transform
the present system. It is a living document for a five-year period of time that will be refined as the
state plan is implemented. The State Plan will ensure on-going consumer and family involvement
and oversight. The State Plan prioritizes services for people with the most disabilities, employs
evidence-based best practices, and promotes efficiency. It realigns service priorities and reallocates
system resources. It accepts limited funding as a fact and recognizes that the current economic
downturn is expected to continue. North Carolina’s financial shortfall makes it essential that the
service system channel funding to direct services. The State Plan sets clear limits on indirect service
costs and opts for the most cost efficient service delivery available.
Assumptions
The Secretary’s charge included the following assumptions:
Nothing Sacrosanct – Any program, service, value, tradition or custom must work or it goes.
Political Concerns Not Primary – Turf protection will not be allowed.
Vastly Increased Funding Unlikely – The State's current financial struggles will continue.
System Must Be Simplified – Statutes, rules and the new system design elements must be clear and
concise.
State Plan 2001: Blueprint for Change 2
November 30, 2001
Mission, Principles, Vision
The plan rests on the mission statement of the Division of Mental Health, Developmental
Disabilities and Substance Abuse Services (Division) and emphasizes quality assurance and
continuous quality improvement principles.
Mission
North Carolina will provide people with, or at risk of, mental illness, developmental disabilities and
substance abuse problems and their families the necessary, prevention, intervention, treatment,
services and supports they need to live successfully in communities of their choice.
Guiding Principles
Treatment, services and supports to consumers and their families shall be appropriate to needs,
accessible and timely, consumer-driven, outcome oriented, culturally and age appropriate, built on
consumer's strengths, cost effective, and reflect best practices.
Research, education and prevention programs lower the prevalence of mental illness, developmental
disabilities, and substance abuse; reduce the impact or stigma; and lead to earlier intervention and
improved treatment.
Services should be provided in the most integrated community setting suitable to the needs and
preferences of the individual and planned in partnership with the consumer.
Individuals should receive the services needed, given consideration of any legal restrictions, varying
levels of disability, and fair and equitable distribution of system resources.
System professionals will work with consumers and their families to help them get the most from
services.
Services will meet measurable standards of safety and quality and demonstrate a dedication to
excellence through adoption of a program for continuous performance improvement.
All components of the system will be clinically effective and operated efficiently.
Vision
Public and social policy toward people with disabilities will be respectful, fair, and recognize the
obligation to assist all who need help.
The state’s service system for persons with mental illness, developmental disabilities and substance
abuse problems will have adequate, stable funding.
State Plan 2001: Blueprint for Change 3
November 30, 2001
System elements will be seamless: consumers, families, policymakers, advocates, and qualified
providers will unite in a common approach that emphasizes support, education/training,
rehabilitation and recovery.
All human services agencies that serve people with mental health, developmental disabilities and/or
substance abuse problems will work together to enable consumers to live successfully in their
communities.
Consumers will have:
• Meaningful input into the design and planning of the service system.
• Information about services, how to access them, and how to voice complaints.
• Opportunities for employment in the system.
• Easy, immediate access to appropriate services.
• Educational, employment or vocational experiences that encourage individual growth, personal
responsibility and enjoyment of life.
• Safe and humane living conditions in communities of their choice.
• Reduced involvement with the justice system.
• Services that prevent and resolve crises.
• Opportunities to participate in community life, to pursue relationships with others and to make
choices that enhance their productivity, well being and quality of life.
• Satisfaction with the quality and quantity of services.
• Access to an orderly, fair and timely system of arbitration and resolution.
Providers will have:
• Opportunity to participate in the development of a state system that clearly identifies target
groups, core functions, and essential service components.
• Access to an orderly, fair, and timely system of arbitration and resolution.
• Documentation and reimbursement systems that are clear, that accurately estimate costs
associated with services and outcomes provided, and that contain only those elements necessary
to substantiate specific outcomes required.
• Training in services that are proven.
Challenges of Change
The State Plan will be phased in. Many services currently provided through institutions will be
transitioned to communities. The state's business plan is contained in this document—a general
overview, the state plan timeline, and the state business implementation document. Local business
plans, adopted by the counties, will ensure that this transition is properly planned and goes
smoothly. Regional providers will be adjusted to account for a changing population and service mix.
Area/county programs will move quickly to an area-wide planning and managing approach.
Funding will be studied and realigned over time.
State Plan 2001: Blueprint for Change 4
November 30, 2001
Bringing substantive change is difficult for public systems that have existed for a long time and
where day-to-day practices have become traditions that are respected and valued as much for their
antiquity as they are for their effectiveness. Change is essential to keep up with new research about
what works.
This State Plan is:
• Proactive.
• Requires change in the most basic structures and processes of the system.
• Clearly defines the purpose, consumers, and services of the system.
• Requires every individual, qualified provider, and agency to keep faith with the new mission and
vision.
• Develops solutions from the perspective of what is needed and what methods are proven to
work.
• Requires that everyone work together to build a new and better system.
• Requires county government leaders to engage all of their citizens in discussion and decision-making
about governance and local business plans.
• Requires the number and governance of area agencies to change as the mental health reform
legislation is implemented.
State Plan 2001: Blueprint for Change 5
November 30, 2001
Chapter 2. A Description of the Current System
The North Carolina mental health, developmental disabilities, and substance abuse service delivery
system includes state employees, local government employees in area authorities, and an extensive
network of qualified providers operating under contracts with the state Medicaid agency or with the
area programs. The total system budget is nearly $1.7 billion dollars, almost one-tenth of the state’s
overall expenditure.
The Division is responsible for oversight of North Carolina’s public service system provided
through state facilities, 38 area programs, and a large number of contracted qualified providers. The
Division consists of central office staff and state facilities. The central office organization is
composed of the Director’s Office, Adult Community Mental Health Services, Child and Family
Services, Substance Abuse Services, and Developmental Disabilities Services. It also includes
administrative sections like budget and information technology to handle the division's support
services. The Division operates state hospitals, mental retardation centers and residential facilities for
children and youth.
Other divisions of the Department of Health and Human Services, such as the Division of Medical
Assistance, the Division of Social Services, and the Division of Facility Services play key roles in the
administration and funding of the system. These divisions should work together, but they often
work at cross-purposes with each other. There also is a need for improved collaboration with other
departments within state and county government.
Area Programs and Qualified Providers
Area programs are at the center of community-based service delivery of services and supports in
North Carolina. Area programs provide services directly or contract to provide services. The state
also recently began to contract directly with providers. The 38 area programs provide services to
specified geographical (catchment) areas covering all of North Carolina’s 100 counties. Funding for
these programs in FY 99 was $751,541,709.
PERSONS SERVED BY N.C. AREA PROGRAMS
& CONTRACT PROVIDERS
130,000
150,000
170,000
190,000
210,000
230,000
250,000
270,000
290,000
310,000
330,000
350,000
FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00
FISCAL YEARS
Number of Persons Served
State Plan 2001: Blueprint for Change 6
November 30, 2001
In FY 2000, programs served a total of 300,245 individuals; a 61 percent increase over the past ten
years.
An area authority---generally a local political subdivision of the state---currently governs each area
program, except Mecklenburg and Wake counties. County commissioners appoint area authorities'
board members.
Area programs' budgets, staffing patterns, operations and populations vary considerably. Area
programs treat relatively few persons with severe and persistent mental illness. Children and youth,
and developmental disabilities services also rank far below what would be expected statistically.
There is strong financial pressure to use state psychiatric hospital beds for people with severe needs
to shift the cost of care from the area program to the state. Mental retardation center and alcohol
and drug abuse treatment center (ADATC) admissions are also paid by the state.
Caseloads, productivity, and program components differ from area program to area program.
Budget cuts have reduced area program options. The state limit on administrative costs has also
caused some programs to channel amounts of their funding away from direct care services. It has
been estimated that up to $100 million dollars each year is spent on area program administrative and
general support costs. This does not include administrative or general support paid to contract or
independent or enrolled providers.
Area programs and their contract providers served a total of 300,245 people in FY 2000.
Increasingly, area programs have used contract providers in addition to direct Medicaid enrolled
providers. Private providers carry out almost 60 percent of the services. Area programs provide or
contract for a range of services. Not all services are available statewide. In areas with a fairly broad
range of services, the capacity is far less than the need.
State Psychiatric Hospitals and Special Care Center
The Division operates four regional psychiatric hospitals and one specialty long-term care facility,
providing inpatient services to people with disabilities within the state. They are:
• Broughton Hospital, Morganton, 521 beds
• Cherry Hospital, Goldsboro, 588 beds
• Dorothea Dix Hospital, Raleigh, 503 beds
• John Umstead Hospital, Butner, 513 beds
• NC Special Care Center, Wilson, 248 beds
These institutions are accredited by the Joint Commission for Accreditation of Healthcare
Organizations (JCAHO) and are certified by the Centers for Medicare and Medicaid (CMS) — the
federal agency that administers the Medicare and Medicaid programs.
These facilities employ over 5,700 staff that include 135 psychiatrists and other physicians, 58
psychologists, 824 registered nurses, 141 social workers, and over 2,000 health care technicians.
Support staff include 431 dietary, 358 maintenance, 25 police, and 415 clerical employees. Each year
the facilities perform 20,000 dental procedures, 52,000 radiology studies, 1.6 million laboratory tests,
and serve over three million meals. Annual expenditures total $300 million.
State Plan 2001: Blueprint for Change 7
November 30, 2001
Mental Retardation Centers
The Division operates five regional mental retardation centers. They are:
• Black Mountain Center, Black Mountain, 73 residents
• Western Carolina Center, Morganton, 346 residents
• O'Berry Center, Goldsboro, 336 residents
• Murdoch Center, Butner, 601 residents
• Caswell Center, Kinston, 548 residents
The centers are certified as Intermediate Care Facility/Mental Retardation (ICF/MR) level of care
by CMS.
The centers primarily serve adults with severe and profound mental retardation, many of whom
have significant physical disabilities and/or medical fragility. Services provided by the centers
include communication; recreational, occupational, and physical therapies; psychology; education;
pharmacy; dietary; medical and advocacy.
These centers employ over 5,600 staff that includes 25 physicians/psychiatrists, 63 psychologists,
390 RNs/LPNs, 30 social/clinical workers, 2,200 health care technicians, 150 therapists, 150
teachers, 10 pharmacists, 100 youth program assistants, and 420 developmental disability trainers.
Support staff include 280 dietary, 220 maintenance, 250 clerical, 270 housekeepers, and 20
information technology employees. Annual expenditures in FY 00-01 were approximately
$238,374,000.
Residential Treatment Facilities for Children
Wright School
Wright School serves 24 children ages 6-12, focusing on the treatment needs of school age children
from around the state. Wright School uses a Re-Education model that teaches children appropriate
ways of interacting in their environment. Because the child’s home environment is incorporated into
treatment, children must be able to go home or to alternative community placement on weekends.
Wright School provides a staff-secure setting for treatment and has staff on duty 24 hours a day to
ensure appropriate supervision.
Whitaker School
Whitaker School is a residential treatment center located on the grounds of John Umstead Hospital,
for 38 youth, ages 12-17. It serves adolescents statewide and also uses the Re-Education model.
Children are encouraged to go home or to an alternative community placement on weekends.
Whitaker School is a locked, physically secure treatment setting with staff on duty 24 hours a day to
meet the needs of children served.
Eastern Adolescent Treatment Program
The Eastern Area Treatment program serves eight youngsters, eight to 12 years old. The program is
located at the Special Care Center in Wilson. This program functions as a Psychiatric Residential
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Treatment Facility, which is a secured, non-medical behavioral and emotional treatment center for
children with mental illness or substance abuse problems.
The three youth facilities employ over 175 staff that include three psychologists, eight therapists,
two nurses, one advocate, 28 teachers, three social workers, 78 youth program assistants, 18
educational development aides, and seven clerical staff. Annual expenditures in FY 00-01 were
$8,413,219.
Alcohol and Drug Abuse Treatment Centers
Julian F. Keith ADATC, Black Mountain
Julian F. Keith ADATC is an 80-bed (70 rehabilitation/10 detoxification/crisis recovery) residential
treatment facility for residents of Western North Carolina.
Walter B. Jones ADATC, Greenville
Walter B. Jones ADATC is a 76-bed, short-term residential treatment center serving 33 counties in
the Eastern Region and five counties in the South Central Region of the state. People who are deaf
or hard of hearing may be admitted from any of North Carolina's 100 counties. The Jones Center
also provides treatment for pregnant and postpartum women and their infants.
Butner ADATC, Butner
Butner ADATC serves men and women from the 16 counties of the North Central Region, as well
as 10 counties of the South Central Region. The center has 30 male rehabilitation beds, 15 female
beds, and 15 male acute treatment beds.
The ADATCs employ over 350 staff, including 17 physicians/psychiatrists, four psychologists, 85
RNs/LPNs, eight social workers, 65 health care technicians, and 45 substance abuse counselors.
Support staff include 22 dietary, 12 maintenance, 38 clerical, 21 housekeepers, and three information
technology employees. Annual expenditures in FY 00-01 were approximately $12,337,000.
Summary of Needs
People Needing Services
• Almost 6 percent of North Carolina adults (322,000) have serious mental illness, and 99,000 of
those have severe and persistent mental illness: 141,068 adults are being served; 35,000 are
considered to have severe and persistent mental illness.
• 10 to 12 percent (between 173,069 and 207,683) of children will experience a serious emotional
disturbance. The system serves 76,485 children with or at-risk of serious emotional
disturbances.
• 10, 557 individuals need development disabilities services; 5,234 of them are not receiving any
services/supports.
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Children with Emotional Disturbances
• There was a 300 percent increase in the number of children at risk for being seriously
emotionally disturbed between 1994 and 2000.
• In 1998, more than 9,100 North Carolina children waited for as long as three months for
services from mental-health providers.
• It will cost $44.5 million to move all the children on the waiting list into community-based
services.
• There are 73 severely challenged children on waiting lists for services who suffer from multiple
disorders and require long-term specialized treatment. That community-based treatment would
cost another $5.3 million.
• Lack of community-based services and overcrowded psychiatric hospitals put too many children
at risk.
• Of the 191 children and teenagers in the state’s psychiatric hospitals, almost half are eligible
for community services.
• Though half the children admitted to mental health facilities are younger than 15, a lack of
youth bed space means that these younger peoples are often placed with older teens, putting
their safety in jeopardy.
Children with Substance Abuse Problems
Early treatment of children with alcohol and other drug problems can prevent more serious
addiction problems.
• 14,000 children use substance abuse services.
• Another 7,000 children are on waiting lists for community treatment services.
• There is a 30-40 days waiting period for admission to community residential care.
• At a cost of $1,786 per child per year, the state would need to spend $12.5 million to provide
adequate community-based services.
People with Substance Abuse and Other Drug Problems
An estimated 784,000 North Carolinians need additional substance abuse services; 24 percent of
them have no health insurance coverage.
• 40 percent of welfare recipients need substance abuse treatment services.
• It will cost $30.2 million per year ($1,157 per client per year) to begin the most basic substance
abuse treatments in communities.
• Untreated addiction results in increased health and public safety costs – last year 3,000 adults
with addictive disorders were inappropriately admitted to state psychiatric hospitals, making
these beds unavailable to persons with psychiatric disorders.
• The total cost to the state for housing untreated addicts in psychiatric hospitals is $13 million.
That $13 million could be used in community-based treatment, if it was available.
State Facilities
The state’s facilities are in desperate need of repair and renovation.
• Total repair and renovation costs for all existing state hospitals and mental health and mental
retardation facilities (except for those scheduled to be closed) over the next six years is $213
million.
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Local Hospitals
• Local hospitals have been forced to close 450 beds statewide, limiting options for alternative
placement.
• Adequately reimbursing local hospitals for this bed space will cost $11.2 million per year.
Funding
The public system spends $1.7 billion annually; approximately 65 percent is funded through
Medicaid. Funding is provided as follows:
• 22 percent to adult mental health.
• 6 percent to child mental health.
• 42 percent to developmental disabilities.
• 6 percent to substance abuse.
• 13 percent to combined mental retardation/mental illness and at-risk children.
• 11 percent to area program administration.
• less than 1 percent to state administration.
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Chapter 3. Designing a New System for MH/DD/SA
The new system will be community-based. State government and county government will work
collaboratively in the new system. The services will revolve around the strengths and desires of the
individual, be family friendly and assure that consumers can make informed choices about care and
supports. Providing services to targeted populations with the most severe disabilities is the primary
focus of the new system.
Important features of the system will include use of best practices including evidence-based
interventions, cultural competence, services for people who do not speak English and for people
who are deaf or hard of hearing and deaf-blind; consistency and uniformity across programs; and an
emphasis on quality management. Current Clinical Guidelines issued by the Division will be reviewed
as necessary and serve as standards of care. Practice guidelines and protocols will be gathered from
nationally recognized experts including, but not limited to, professional organizations, updated
Division of MH/DD/SAS clinical guidelines, the toolkits currently being developed by the Robert
Wood Johnson Foundation (RWJ) and the Substance Abuse and Mental Health Services
Administration (SAMHSA), and the national movement toward self-determination including person-centered
planning and supports for people with developmental disabilities.
Local service systems will be developed and managed by a Local Management Entity (LME). The
county commissioners will determine the LME and approve local business plans. LMEs will
collaborate with community partners to develop local business plans. LMEs will build a network of
programs and providers, ensure that providers and staff are well trained, and monitor quantity and
quality of services.
A system of participant-driven supports for persons with disabilities allows the individual with the
disability and his/her support network the ability to make decisions regarding services and supports
within budget ranges appropriate to needs. The public system must create ways to support people
with disabilities to make informed decisions about how much control they want to assume over the
planning and purchasing of services. In a participant-driven system the role of the professional
changes from one who directs or determines the service package to one who supports the individual
and family in selecting services and supports. As the transition to this new approach occurs, the
system must also guard against professionals abandoning families in the name of choice, leaving
them to navigate the system blindly. Families and individuals with disabilities need information,
assistance and education to assist them in becoming knowledgeable about the service delivery
system. Competent professional services will continue to be provided when there is a need for
specialized services and supports and planning and protection will be provided for those who are
unable to and have no one else to help make those decisions.
The new system must separate lifestyle decisions (i.e. where to live, where/whether to work, what to
eat, what to wear, etc.) from treatment needs. These every day life decisions are often turned over to
healthcare professionals who have developed healthcare service models to respond to them. People
with disabilities and their families are less willing to turn to professionals for resolution of day-to-day
personal decisions, but support services will continue to be available for things like housing,
employment and transportation.
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The main features of the redesigned system are presented in this chapter. Many elements of the new
system are mandated by the mental health reform legislation, House Bill 381: An Act to Phase in
Implementation of Mental Health System Reform at the State and Local Level, passed by the
General Assembly during the 2001 Legislative Session.
Core Functions
The mental health reform legislation requires that, within available resources, each LME is
responsible for core functions. There are two types of core functions: service capacity such as
screening, assessment and emergency triage; and indirect services such as prevention, education and
consultation. Core functions may be limited and may require authorization.
• Screening is a brief standardized appraisal of an individual who is not currently being served
within the system in order to determine the nature of the individual’s problem and need for
services and supports. This includes Early Periodic Screening, Diagnosis and Treatment
(EPSDT) screening and other federally mandated screening. Both financial and clinical
information shall be gathered to determine the next steps. The screening process shall not be
considered an evaluation or assessment. Rather, it is a brief, structured interview conducted
either face-to-face or by telephone to determine whether or not the individual should be referred
for further services and, if so, to where.
• Assessment is a follow-up step to screening. It may include an evaluation of the nature and
extent of the individual’s problem through a systematic appraisal of any combination of mental,
psychological, physical, behavioral, functional, social, economic, and intellectual resources. Its
purpose is diagnosis, determination of the person’s disability and eligibility to be included in a
targeted population and a determination of the urgency and intensity of need.
• Referral refers to offering information about available qualified providers, generic resources and
community capacity to best meet the needs of the individual. This information shall be used by
LME’s to help determine gaps in service and network development.
• Emergency Services include a spectrum of functions including crisis response activities such as
24-hour crisis hotline and urgent or emergent clinic/practitioner visits. Also included is other
crisis stabilization such as family/care giver respite, crisis shelters, detoxification services or
emergency psychiatric hospitalization. These functions may be shared, and unless noted, not be
available in every county.
• Service Coordination is a separate and distinct administrative function. It involves ensuring
that individuals know about and are linked with the services and supports available in their
communities and increasing the community’s capacity to provide services and supports. This is
not the same as case management. It is only person-specific when related to issues such as
hospital discharge and continuity of care.
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• Consultation is provided to other agencies, groups or organizations and to individual
practitioners to promote planning and development of mh/dd/sa services. The local business
plan will outline how the area/county program will provide this service to the community.
• Education is designed to inform and teach various groups including persons being served,
families, schools, businesses, churches, industries, civic and other community groups about the
nature of mh/dd/sa and services and supports in the state and community. The local business
plan shall outline how education will be provided.
• Prevention is designed to inform and teach individuals, various groups, or the population at
large about the insights and skills related to healthy living. The local business plan shall outline
how prevention shall be provided.
Uniform Portal
A uniform portal system is a set of standardized processes and procedures that ensures that people
throughout the state enter and leave publicly funded services in the same way. There will be many
access points, but standards must be consistent. Access points shall include:
• Any public agency in the county (such as DSS, Vocational Rehabilitation, schools, Public
Health).
• A statewide referral service.
• Qualified service providers in the local network.
• Local Management Entity.
A uniform access system:
• Ensures availability of information about services.
• Facilitates access to available, timely, and appropriate treatment, services.
• Provides standardized, consistently implemented, statewide procedures that comply with the
Olmstead decision, and are understandable to consumers.
• Provides mechanisms for receiving and responding to feedback from people with disabilities,
family members and other stakeholders.
• Provides consistent and coherent information.
Statewide System Contractor
DHHS will contract with a single agency to provide referral, a statewide crisis hotline and utilization
management service. The contractor will support each LME by taking crisis hotline calls 24-hours-perday,
seven-days-per-week through a single, statewide 800 number telephone system. People
entering the system through any of the agencies participating in the uniform portal system shall be
referred to the contractor’s statewide 800 number for referral and service authorization as outlined
in the local business plan. If the consumer accesses the system directly through the LME, the LME
will report that data to the contractor to assure the accuracy of data collection. The contractor will
screen, register and refer people seeking help to services available in their local area. The contractor
will also follow up to ensure that the person actually received services. The contractor shall provide
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LMEs with daily status reports and maintain a database of referrals. The contractor shall be
reimbursed on a cost-plus system, and there shall be NO financial incentive for denying care.
System Access
System access will be available 24-hours-a-day, seven-days-a-week through crisis phone lines or face-to-
face. People seeking services will receive a brief screening and assessment using a single
standardized process. Screening will determine the seriousness of a person's needs and the proper
actions to take. Everyone will have access to a reasonable and responsible level of care that meets
his or her needs.
If the individual is eligible/or could be eligible for services, a referral will be made. If the ideal
service is not available, interim services may be provided. If the assessment determines that the
individual is not in a target population for priority services, but needs services, brief services may be
provided. Referral shall be made to community-based agencies, self help groups, or faith-based
initiatives, if available.
The contractor will provide utilization management (UM) – a system to ensure the most efficient
and effective utilization of finite resources – statewide using standards and criteria set by the state.
The state shall establish trigger points for service authorization.
Emergency services include 24/7 hotline provided by centralized UM Contractor; walk-in
emergency/urgent care; crisis shelter/respite beds, and psychiatric inpatient beds. Limited service
coordination and follow-up will be provided to individuals discharged from an emergency service in
order to assure appropriate follow-up. Discharged individuals who are part of target populations,
will be referred to the appropriate system of care. If individuals are not in a target population,
referrals will be made to other services like an independently enrolled qualified provider, a
community-based agency, a self-help group or a faith-based initiative.
LMEs will develop innovative, creative ways to ensure access to services for target populations.
Options may include taking services to individuals in rural areas where there is little or no
transportation, and/or developing comprehensive full-service clinics in county public health settings
or in psychosocial rehabilitation programs, or school-based health clinics and other typically
occurring work or day activities. Suitable transition plans shall be a part of each LME's local
business plan.
Target Populations
Providing services to individuals with the most severe disabilities is the primary focus of the
redesigned system. Selecting appropriate criteria to identify individuals with various disabilities and
the greatest needs will include both diagnostic and functional elements as well as circumstances
unique to each consumer. The availability and access to appropriate services that meet the needs of
each person served shall also be considered. The Urgency and Intensity of Needs chart in this
chapter will be applied throughout the system to establish a structured process for prioritizing
services and/or managing waiting lists.
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The State Plan’s target populations for people with various disabilities are as follows.
Adult Mental Health Services
Recent advances in treatment for individuals with Serious Mental Illness (SMI) and Severe and
Persistent Mental Illness (SPMI) make it possible for individuals with these conditions to live far
more satisfying lives than ever before. The system for adults with SPMI and SMI shall adopt a
rehabilitation and recovery model focusing on providing or assisting individuals to obtain the skills
they need to live as normally as possible in communities of their choice.
As part of the assessment process, each adult mental health consumer is administered a Global
Assessment of Functioning (GAF) test to determine how well a person is functioning. These GAF
scores are one factor used to determine eligibility.
• People with severe and persistent mental illness: People 18 years or older who as a result of
a mental illness display functioning so impaired that it interferes substantially with their capacity
to remain in their communities. These people often require multiple services such as medication
management, housing and transportation supports, rehabilitation and recovery activities, case
management, job skills development and more. The following diagnoses are included under the
category of severe and persistent mental illness: schizophrenia, bipolar disorder, major
depression, schizoaffective disorder, schizophreniform disorders, psychotic disorder NOS (not
otherwise specified). GAF s scores for these persons will usually be 40 or lower. Also included
are individuals 18 years or older who in the past have met all criteria previously listed, as a result
of effective treatment do not currently meet criteria and without ongoing treatment and
supports would likely experience greater disability and again meet level of functioning criteria.
• People with serious mental illness: People 18 years or older who have a mental, behavioral, or
emotional disorder that can be diagnosed and which substantially interferes with one or more
major life activities. GAF for these people will usually be 50 or lower. Also included are
individuals 18 years or older who in the past have met all criteria previously stated, as a result of
effective treatment do not currently meet criteria and without ongoing treatment would likely
experience greater disability and again meet the level of functioning criteria.
Within these target populations, priority populations including racial/ethnic minorities are:
1. Persons with multiple diagnoses: People 18 or older with a severe and persistent mental
illness and a diagnosis of substance abuse and /or mental retardation or serious health
complication like HIV/AIDS.
2. Homeless mentally ill: People 18 or older with a serious long term mental illness or a
serious long term mental illness and a substance abuse diagnosis who lack fixed, regular,
adequate nighttime residence.
3. Mentally ill adults in the criminal justice system: People 18 or older with serious mental
illness who are released from the Division of Prisons, or are in local jails, or on probation.
4. Elderly persons: People age 65 and over with a serious mental illness, including dementia.
5. Deaf mentally ill persons: People 18 or older with a mental, behavioral, or emotional
disorder that can be diagnosed and who need specialized services provided by staff who
have American Sign Language skills and knowledge of deaf culture.
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• People needing care in state hospitals: Shall provide psychiatric inpatient care to adults or
children with severe mental illness or severe emotional disorders who cannot be appropriately
treated in local communities. Admission to state psychiatric hospitals will always be a last resort,
meaning when acute admission is determined to be needed and non-state operated hospitals are
unable to admit the individual. The hospital shall provide care for the shortest period of time
consistent with the reasonable safety of the individual and the public. Populations served are as
follows.
1. Adults and older adults with psychiatric illness including schizophrenia spectrum, bipolar
disorder, major depression, and personality disorder requiring acute inpatient treatment to
stabilize and return to community.
2. Adults with psychiatric illness including schizophrenia spectrum, bipolar disorder, major
depression, and personality disorder requiring long-term inpatient treatment to rehabilitate and
prevent rapid relapse and readmission.
3. Children with severe emotional disorders requiring acute inpatient treatment to stabilize and
return to lower level of care.
4. Adults and older adults with psychiatric illness and substance abuse disorders requiring acute
and/or longer-term inpatient treatment to stabilize and prevent rapid relapse and re-admission.
5. Forensic consumers, including House Bill 95 (incapable of proceeding to trial), NGRI (not
guilty by reason of insanity), and others detained for legal reasons.
6. Consumers who voluntarily agree to be part of a research program.
7. Deaf and hard of hearing people requiring acute or long-term inpatient psychiatric services.
• People needing care at the NC Special Care Center: Will provide intermediate and skilled
nursing care for consumers referred from state hospitals when beds are not available and
intensity of psychiatric services needed are unavailable in the community.
Specialty population to be served: People with disabilities with mid-stage Alzheimer’s disease
requiring nursing care.
Child Mental Health Services
All children and their families are unique, and have diverse strengths and needs that change over
time within a context of developmental, environmental and social risk and support factors. The
needs and circumstances of the child/youth and the related needs of the family are incorporated into
each target population category.
The system shall adopt a System of Care approach that offers a holistic and cost effective
opportunity to create a comprehensive, interrelated prevention and intervention service delivery
system.
Child mental health consumers are administered a standardized test called the Child and Adolescent
Functioning Scale (CAFAS), which determines how well a child is functioning in its daily living
environment. Children are also given an Assessment Outcome Inventory (AOI) to determine how
well the child handles stress factors and possesses the skills necessary to address the challenges.
CAFAS and AOI results are used to determine treatment for children.
State Plan 2001: Blueprint for Change 17
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• Children with severe emotional and behavioral problems, and their families
Characteristics include:
1. Functional impairment that seriously interferes with or limits his/her role or functioning in
family, school, or community activities:
• Children with severe functional difficulties in home, childcare, school or community
activities that lead to a CAFAS score of at least 90, or a CAFAS score 60 with at least
one domain having a score of 30.
• Presence of an extreme level of psychosocial risk as measured by the presence of 4 or
more psychosocial risk factors and 10 or fewer psychosocial protective factors on the
AOI Part I (Resilience Assessment).
• Children and youth who fall into this Target Population are those from whom supports
and interventions routinely provided through human service agencies are not working,
those who need the highest level of support and treatment in order to regain the ability
to function successfully.
AND
2. Have a serious diagnosable mental, behavioral, or emotional disturbance disorder that meets
diagnostic criteria specified with DSM-IV:
• Are identified as sexually aggressive and/or
• Deaf and/or
• Dually or multiply diagnosed.
AND
3. Placed out of home or at imminent risk of out of home placement as evidenced by one or
more of the following:
• Utilizing or having utilized acute mental health crisis intervention in the past year or
intensive wraparound services in order to maintain community placement.
• 3 or more state hospitalizations in the past year or at least 1 hospitalization of 60
continuous days.
• DSS substantiated abuse, neglect or dependency in the past year.
• Experienced school (or child care) failures, suspension or expulsion.
• Conviction of a felony or 2 or more serious misdemeanors in juvenile/adult court or being
currently placed in a youth advocacy program (training school), prison, juvenile
detention center, or jail – any within the past year:
AND
4. In need of and not receiving, or not evidencing improvement from services from more than
one child serving agency (e.g. MH/DD/SAS, DSS, DPI/Schools, DJJDP, Health Care, other
community organizations/providers). This could include children with significant/serious
chronic health conditions.
AND
5. Unable to access informal supports, as indicated by more than one of the following
circumstances:
• Support network is not accessible to the child and family.
• Support network is overwhelmed by current needs of the child and family.
• There are not enough supports resources to address current needs, e.g. safety.
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• Children with moderate mental health problems, and their families
Characteristics include:
1. Functional impairment that significantly interferes with or limits his/her role or functioning in
family, school, or community activities:
• Children with moderate functional difficulties in home, childcare, school or community
activities that lead to a CAFAS score of at least 60, or a CAFAS score 40 with at least
one domain having a score of 20.
• Presence of a moderate level of psychosocial risk as measured by the presence of two or
more psychosocial risk factors and 6 or fewer psychosocial protective factors on the
AOI Part I (Resilience Assessment).
AND
2. A diagnosable mental, behavioral, or emotional disturbance disorder that meets diagnostic
criteria specified with DSM-IV.
AND
3. At significant risk of developing problems that could escalate and require out of home
placement, and/or have a recent history (within the past 12 months) of at least one of the
following:
• Crisis intervention (an individual or family crisis), behaviors may include those that impact
the safety/well-being of self and/or of others, e.g. assaults, withdrawal/depression,
suicide threats/attempt.
• Wraparound services, behaviors may include those that impact the safety/well-being of
self and/or others, e.g. assaults, withdrawal/depression, suicide threats/attempt).
• Abuse, neglect, or dependency; foster care or adoption.
• School failure, suspension, expulsion, Special Education services.
• Adjudication in juvenile court; conviction of at least a significant misdemeanor; diversion
from court involvement; charged (but not necessarily adjudicated) with a criminal
activity; on probation.
AND
4. In need of and/or receiving services from more than one child serving agency (e.g.
MH/DD/SAS, DSS DPI/Schools, DJJDP, Health Care, other community
organizations/providers). This could include children with significant health conditions.
AND
5. Significant difficulty accessing informal supports, as indicated by at least one of the following
circumstances:
• Support network is not accessible to the child and family.
• Support network is overwhelmed by current needs of the child and family.
• Available supports are not sufficient to address current needs, e.g. safety.
• Children with mild mental health problems, and their families
Characteristics include:
1. Have functional impairment that interferes with or limits his/her role or functioning in family,
school, or community activities:
• Children with functional difficulties in home, childcare, school or community activities
that lead to a score of at least 30 on the CAFAS.
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• Children who have not proven resilient enough to combat their level of psychosocial risk,
as measured by the presence of 1 or more psychosocial risk factors and 4 or fewer
psychosocial protective factors on the AOI Part I (Resilience Assessment).
AND
2. Children evidencing symptoms of a DSM IV diagnosable emotional disturbance.
AND
3. Children in need of and/or receiving services from at least one child serving agency (e.g.
MH/DD/SAS, DSS, DPI Schools, DJJDP, Health Care, other community
organizations/providers). This could include children with significant health conditions.
AND
4. Children in need of and/or receiving enhanced informal supports.
Developmental Disabilities Services
Developmental disabilities services are provided across a broad and diverse population. The target
population is created by the application of a functional rather than diagnostic definition and is
applicable across the lifetime of most individuals who are eligible for services.
• People who meet the state definition of developmental disability AND meet criteria for
priority services and supports using the new Intensity and Urgency of Need Assessment
protocol. Developmental disability means a severe, long-term disability of a person that:
1. Is attributable to a mental or physical impairment or combination of mental and physical
impairments.
2. Is manifested before the person attains age 22, unless the disability is caused by a traumatic
head injury and is manifested after age 22.
3. Is likely to continue indefinitely.
4. Results in substantial functional limitations in three or more of the following areas of major
life activity – self care, receptive and expressive language, capacity for independent living,
learning, mobility, self direction and economic self-sufficiency, and
5. Reflects the person’s need for a combination and sequence of special interdisciplinary, or
generic care, treatment, or other services which are lifelong or extended duration and are
individually planned and coordinated, or
6. When applied to children from birth through four (4) years of age, may be evidenced as a
developmental delay.
Substance Abuse Services
People with substance abuse problems face numerous and sometimes overwhelming obstacles. Due
to economic status, lack of suitable housing options, and vocational/educational status, these
individuals may live in unstable or unsafe environments, including households where others use
alcohol or other drugs. Target populations include:
• Injecting drug users, those with communicable disease risk and/or those on opioid
maintenance therapy who are currently injecting non-prescribed drug for non-medical
reasons, assessed at Level of Eligibility 1 or 2 and meet DSM IV criteria for substance abuse
State Plan 2001: Blueprint for Change 20
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dependence; or infected with HIV, tuberculosis, or hepatitis B, C, or D; assessed at Level of
Eligibility 1 or 2 and meet DSM IV criteria for substance abuse or dependence; or meet DSM
IV criteria for dependence to an opioid drug, addicted at least one year before admission and 18
years or older.
• Substance abusing women with children: Adult women with DSM IV diagnosis of substance
abuse or dependence who are currently pregnant and have Level of Eligibility 1, 2, or 3, or have
dependent children and Level of Eligibility 1 or 2, or are seeking custody of child(ren) and have
Level of Eligibility 1 or 2.
• DSS involved parents who are substance abusers: DSS involved parents who are substance
abusers include those who have legal custody of a child or children under 18 and meet DSM IV
criteria for substance abuse or dependence and are under active investigation or supervision by
child protective services for suspected or substantiated child abuse or neglect or who are
authorized by DSS to receive Work First assistance and/or services.
• High management adult substance abusers: Persons with substance abuse or dependence
diagnosis and:
1. Involuntarily committed to substance abuse treatment (legally determined to be dangerous to
self or others and may have co-occurring mental illness), or
2. Have long-term substance abuse problems and Level of Eligibility 1, whose substance use
pattern is recurring episodes of habitual use requiring assisted detoxification, are advanced in
their disease, have no social or environmental supports, have few coping skills, may be
highly resistive to treatment, may have co-occurring disorders, and may have moderate
biomedical conditions.
• Persons being served who are involved in the criminal justice system: A criminal justice
client authorized by a TASC Program Care Manager as an individual involved in the adult
criminal justice system and voluntarily consents to participate and has a history of substance
abuse problems, mental illness problems or charged with drug-related offense.
• DWI Offenders: Persons with a substance abuse or dependence diagnosis and convicted of
driving while impaired, commercial DWI, driving under 21 after consuming alcohol or other
drugs and completed DWI assessment and identified with substance abuse handicap and client
pays for assessment and treatment and has income level 200 percent of poverty.
• Child with Substance Abuse Disorder: Child with substance abuse or dependence diagnosis
and Level of Eligibility 1, 2 or 3.
• Child Substance Abuse Indicated Prevention: Designed to prevent onset of substance abuse
in individuals at risk.
• Child Substance Abuse Selective Prevention: Prevention interventions for special subsets of
populations thought to be at increased risk, such as children of adult alcoholics, dropouts, failing
in school, etc.
State Plan 2001: Blueprint for Change 21
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Within target populations, prioritization will occur as follows:
• Adult and child pregnant injecting drug users.
• Adult and child pregnant substance abusers.
• Adult and child injecting drug users, and
• All others.
People with Co-occurring Disorders
Individuals with co-occurring mental illness and/or developmental disabilities, and/or substance
abuse frequently have great vulnerability to stress and significant interference with their ability to live
successfully in the community. While not all persons with co-occurring disorders will need the full
array of services and supports available to target populations, there are groups of individuals with
co-occurring disorders who should be prioritized for targeted services, including the following:
• People with serious mental illness, or severe and persistent mental illness, and minor substance
abuse problems and/or mild developmental disabilities.
• People with mild mental illness and co-occurring severe substance abuse problems.
• People with a significant developmental disability and a mild mental illness or mild substance
abuse problem.
• People with a serious mental illness, or severe and persistent mental illness, and/or
developmental disability, and/or substance abuse problems, and a significant and chronic
medical condition(s) that endangers the life or well-being of the consumer.
State Plan 2001: Blueprint for Change 22
November 30, 2001
Intensity of Need
1* 2 3* 4 5*
URGENT
Examples
Service/Support Need Immediate
Imminent Danger of:
􀂉􈤠 Homelessness
􀂉􈤠 Interface with Justice System
􀂉􈤠 Institutionalization
Medical/Psychiatric Emergency
Death of Primary Caregiver
Living in unsafe environment
CRITICAL
Examples:
Will need services/supports
within 12 months
􀂉􈤠 Aging Caregiver
􀂉􈤠 Facing major life transition
􀂉􈤠 On Waiting List X amount of time and
requires service
WAITING/PLANNING
Examples:
Not expected to need services/supports
within the next year
􀂉􈤠 May need more or different services
􀂉􈤠 Life transition being planned for
but not imminent
􀂉􈤠 On Waiting List
U R G E N C Y O F N E E D
State Plan 2001: Blueprint for Change
November 30, 2001
23
Array of Services for Target Populations
LMEs will build community capacity to provide adequate services to target populations,
including interpretation/translation services, housing options and employment
opportunities. Some services and supports such as housing and transportation may be shared
within various geographic areas or developed in cooperation with other agencies, qualified
providers or public services. A key element for approval of each local business plan will be
the creativity, innovation, breadth and inclusiveness of its proposed service array for targeted
populations, including those with co-occurring disorders. The service array must be
appropriate to the needs of people with disabilities in each target population, will be adjusted
to the unique needs of the individual, and must meet standards derived from evidence based
practices and/or nationally recognized models such as recovery or self-determination.
Housing/Residential
Housing will be designed to ensure that an individual lives with maximum independence in
the least restrictive setting, including independent single or shared living quarters in
communities, with or without onsite support. Options include:
• Living with family or friends with adequate support/respite services.
• Small, home-like facilities in local communities close to families and friends, with the
goal of moving to a less structured living arrangement when clinically appropriate.
Residential placements shall also include any equipment and supplies needed to assist in
successful, long-term housing stability. Admissions to state or private hospitals, mental
retardation centers, state schools, or ADATC’s are not permanent or long-term residential
options.
Transportation
In areas where public transportation is available, a voucher system will be created to help
clients reach services. Vouchers can also be used to pay neighbors to provide transportation.
In areas where no public transportation exists, LMEs will design ways to take services to the
clients or potential clients on a regular basis. The LME may need to collaborate with local
public or private agencies to assist in providing services in remote areas or borrow
community facilities to directly provide services on a regular basis.
Treatment, Symptom Management, Therapies
People who have psychiatric symptoms, substance abuse issues, developmental disabilities,
co-occurring disorders, or other conditions amenable to medication management; physical,
speech, or occupational therapy; or brief and intensive psychotherapy must have these
services locally available. In urban areas, services can be offered in a broad variety of settings
suitable to the needs of the individual. In rural areas, services may need to be brought to the
area on a regular basis. Other interventions may include detoxification services,
outpatient or inpatient substance abuse treatments with varying levels of intensity,
therapeutic communities and services to those with co-occurring disorders.
State Plan 2001: Blueprint for Change
November 30, 2001
24
Evidenced-based, best practices and emerging best practices services shall be made available
to target populations. These include but are not limited to:
• The evidence-based treatment for persons with a serious mental illness or severe and
persistent mental illness and co-occurring severe substance abuse problems (MISA) is
the integrated treatment model. The integrated treatment approach involves the
treatment of both mental illness and substance abuse problems by an individual trained
in treatment of both conditions. This integrated treatment model has proven effective in
greatly reducing the need for inpatient treatment of this population.
• Clinical Service Guidelines/Standards as published by the DMH/DD/SAS.
• The “toolkits” currently under development by the Robert Wood Johnson
Foundaton/SAMHSA.
• Self – determination models.
• Recovery models.
Work, School, Activity, Leisure
There are a broad spectrum of services that teach living skills that make the most of the
individual’s ability to adapt to his/her environment, engage in meaningful work, and develop
satisfying, lasting relationships. These include rehabilitation, before and after school
activities, prevocational and vocational training, employment, health and wellness education,
substance abuse prevention or treatment, adult day vocational programs that provide
transition to employment, and others.
All services will emphasize personal empowerment, providing constant opportunities to
learn, develop and exercise increasing levels of self-determination, recovery and control.
Program activities will flow with the natural rhythms of daily life (i.e. work/study in the day
time, recreation and play after work and on weekends). Programs will not be composed of
static, repetitive activities that do not teach, develop, empower or guide the individual
toward a more effective and independent lifestyle.
Over the past decade, mental health consumers and their families, supported by innovative
providers and researchers, have become active in defining and advocating for new models of
care. The result of these efforts has been the emergence of “recovery” as a foundation upon
which best practice interventions for adults with serious mental illness are designed.
Traditionally, mental health services have been designed based on the assumption that the
prognosis for adults with serious and persistent mental illness is limited, at best. As a result,
services have focused primarily on reducing or stabilizing symptoms. In contrast, a
“recovery-oriented” model presumes that the individual can learn to effectively manage
his/her symptoms, and can therefore hope for and attain a life of meaning, productivity, and
satisfaction. Consistent with this newly emerging best practice model, North Carolina’s
services for adults with severe and persistent mental illness shall explicitly address self care,
wellness, and effective coping. Further, each mental health consumer shall be provided with
the opportunities and supports necessary to identify and pursue his/her aspirations for a
fulfilling and personally meaningful quality of life.
State Plan 2001: Blueprint for Change
November 30, 2001
25
Wrap-Around Services
Wrap-around services include an extensive array of services dictated by the unique needs of
individuals and their families. Examples include substance abuse relapse prevention, family
respite supports, family education and training, various peer supports and activities, personal
support, live-in care giver, day supports, Assertive Community Treatment teams, case
management and care coordination. Also included are assertive outreach, interpreter
services, case consultation and any other participant-driven services/supports needed to
enable individuals to live successfully in their communities.
Crisis/Emergency (Including core emergency service)
These include a range of emergency management services including short term diversion
beds, crisis stabilization, after hours services, detoxification, facility-based crisis services,
crisis hotline, walk-in services and inpatient hospitalization. The emphasis in emergency
services must be on planning and early intervention and stabilization, avoiding the need for
intensive inpatient or acute residential services.
In addition to the more traditional notion of crisis/emergency services, the range of these
services will also include disaster response and recovery. Disaster response and recovery
activities include crisis counseling, debriefing and defusing, and grief counseling. Within
available resources such activities must be provided to anyone who is affected by a disaster.
Addressing Disparities in the MH/DD/SA System
Minority and ethnic groups are over-represented in the priority populations described in this
plan. African-Americans are over-represented in our state hospitals. African-Americans are
more than twice as likely to be inpatients in psychiatric facilities, and are much more
reluctant to access community treatment. The Division and LMEs shall examine data to
identify disparities in access to services and disparities in consumer outcomes for the
following areas: race/ethnicity, gender, sexual orientation, age, disability, geographical
location, income and education level. As disparities are identified, strategies shall be
developed to eliminate them through the state and local business plans. An annual progress
report will be issued.
State Plan 2001: Blueprint for Change
November 30, 2001
26
UNIFORM ACCESS TO MH/DD/SAS
SYSTEM ACCESS
􀀹􃤠 Face-to-face or telephone
􀀹􃤠 Uniform Access
􀀹􃤠 Standardized process/form
􀀹􃤠 Brief screening, referral and notification to Local Management Entity (LME) or by LME
􀀹􃤠 Financial and clinical
􀀹􃤠 Triage at designated points of access
NO services needed
within MH/DD/SAS
system. Referral may
be required
elsewhere (i.e., DSS,
Consumer Credit
Counseling)
YES services are needed within
MH/DD/SAS system
LME
Health Promotion
Universal Prevention
NO, this person is not in
target population. This
person may have issues
that can best be served by
a referral to:
􀀹􃤠 Provider Network
􀀹􃤠 Various community
agencies
􀀹􃤠 Faith-based initiatives
􀀹􃤠 Other
􀀹􃤠 Situation calls for
more information
􀀹􃤠 Standard
Assessment
Process/Form
􀀹􃤠 May differ by age
and disability
EMERGENCY
SERVICES
24/7 Hotline
Walk-in
Emergent/Urgent
Detoxification beds
Crisis shelter/beds
Psychiatric inpatient
beds, respite care,
All discharged
individuals receive
referral/follow-up
(limited service
coordination)
YES, meets criteria for a target
population. Referral made to:
NO, this person is not in target
population. This person may have
issues that can best be served by a
referral to:
􀀹􃤠 Provider Network
􀀹􃤠 Various community agencies
􀀹􃤠 Faith-based initiatives
􀀹􃤠 Other
Treatment services
not available due to
funding or provider
ADULT MENTAL HEALTH
CHILD MENTAL HEALTH
DEVELOPMENTAL DISABILITIES
SUBSTANCE ABUSE
State Plan 2001: Blueprint for Change
November 30, 2001
27
Local Management Entity
The Local Management Entity (LME) is the administrative body that develops, implements,
oversees, monitors, and evaluates system services in a specific region or area of the state.
Area programs or county governments can operate as LME’s. County commissioners will
decide which counties are covered by the LME and will approve local business plans.
The LME is responsible for core functions. The LME will direct the development,
maintenance and oversight of a network of qualified providers sufficient to address the
needs of the people in its geographic area. These functions shall be described in each local
business plan and shall be approved based on established state requirements. LME
adherence to these requirements will provide consistency for people with disabilities
accessing the system across the state.
LMEs may not provide services except as allowed by state-adopted criteria and with the
written approval of the DHHS Secretary. The primary duties and functions of the LME are:
• Develop, implement, and oversee services in a geographic area.
• Develop and implement a local business plan with its community partners.
• Continuously assess local needs for services throughout the geographic area.
• Incorporate unmet needs into the local business plan as resources become available.
• Develop and maintain a comprehensive qualified provider network for the service area.
• Assure that services are provided to individuals according to the approved local business
plan and state criteria and standards.
• Develop a continuum of services for the area.
• Develop creative approaches to engaging people in target populations.
• Provide technical assistance, coaching and/or mentoring to new qualified providers.
• Evaluate statistical and other program data from the utilization management contractor
to make corrections or decisions regarding clinical management and qualified provider
development.
• Develop and monitor program budgets.
• Link with other public and private agencies throughout region.
• Manage multiple points of access throughout an area.
• Provide or manage functions of face-to-face screening, assessment, and referral within
timeframes.
• Provide service coordination across network and assure case management for individuals
in target populations.
• Assess individual and qualified provider satisfaction continually.
• Troubleshoot problems or issues of access, treatment, services and/or supports.
• Participate in state level committees, workgroups, and taskforces.
• Provide links among qualified providers of different levels of care to assure that services
are provided in an integrated, seamless manner.
• Develop a disaster plan in coordination with other responsible community agencies. The
plan shall address planning and preparedness activities, alert and mobilization plans and
State Plan 2001: Blueprint for Change
November 30, 2001
28
activities, response plans and activities, recovery plans and activities. Disaster planning
must be conducted according to the requirements set forth in the Division’s Disaster
Preparedness, Response, and Recovery Plan.
• Conduct disaster response and recovery activities in response to disasters in coordination
with the other responsible community agencies and DHHS.
• Develop effective methods of communication among qualified providers and program
elements.
• Assure opportunities for consumers to become a part of their communities.
• Develop employment opportunity options for consumers including consumer owned
and operated businesses and competitive employment.
• Establish a Consumer and Family Advisory Committee to provide input, suggestions,
recommendations, and active participation in policy and program issues.
• Provide referrals for non-targeted populations and target populations.
• Provide or manage crisis services.
• Track data required by the state.
• Assure that people receiving services and their families receive meaningful and respectful
consideration of their suggestions and recommendations.
• Include people receiving services and their families in quality management and service
monitoring activities.
Transition Issues
Local business plans developed by area/county programs will be the basis for transition to
the new system. In order to assist the state in planning for statewide transition and to
develop operational components required to implement the state plan, DHHS shall identify
one or more geographic areas to pilot the plan.
Individual Transitions
Currently there are a number of individuals who are being served by the system who do not
meet eligibility criteria for a target population. These clients will be transitioned out of the
system over a clinically appropriate but reasonable period of time. Clients whose care,
services and/or supports substantially exceed those indicated for their level of disability must
be reevaluated and the level of supports realigned in order to free up resources for others
who are equally or more in need of services.
Provider Network Transitions
Area planners in every region may find that the qualified provider network currently in place
is not sufficient. The local business plan will address the development of a qualified provider
network that delivers the range of services needed in the amounts required and the
temporary measures planned to minimize the impact of gaps in the network.
LMEs' Evolving Role
All LMEs will build in transitional steps for the development of their role as leader, overseer,
and manager of services in a geographic area. This planning must not disrupt or cancel
existing services.
State Plan 2001: Blueprint for Change
November 30, 2001
29
Qualified Service Provider Networks
The LME will develop an extensive provider network to ensure that there are enough
qualified providers to meet the needs of people with disabilities throughout the area and that
each individual has a choice of qualified providers. This must include consideration of ways
to bring services to people in isolated areas. LMEs shall also consider developing full-service
one-stop settings where the vast majority of services can be accessed in one place for those
people who have multiple service needs not easily met by solo or small group practices. All
providers eligible for Medicaid or Medicare reimbursement shall be required to join the
network in order to receive Medicaid or Medicare reimbursement. LMEs will identify
qualified potential providers and facilitate their entry into the network. It may be necessary
to develop incentives that encourage practice in rural or under-served areas. The State Plan
calls for outcomes and performance standards of qualified providers to be recorded and
reported. Future funding will depend on meeting these outcomes.
There are many secular and faith-based programs and services across the state that volunteer
to provide human services and supports. The LME and DHHS shall encourage development
of additional services of this nature. These providers who give so much to their communities
will be important and respected partners in the statewide effort to provide services to the
people who need them.
Department Coordination and Infrastructure
The state business plan implementation document and the state business plan timeline,
which are included in this document, comprise the state's business plan. The State Plan
requires fundamental change at the department/division level. The rules will be simple and
straight forward. It is vitally important that DHHS divisions work closely together. DHHS
will create a mechanism to coordinate policies and planning with its divisions to address
administrative and business functions as well as programmatic and clinical guidelines,
outcomes and initiatives. Attention will be given to Medicaid, Carolina Access, Health
Choice, and public health policy coordination in order to promote coordinated care. The
Department will also prepare a coordinated strategy for integration of the Olmstead, Long-
Term Care and state MH/DD/SAS plans.
DHHS divisions will work together to develop and revise programmatic policy. Particular
attention will be paid to areas where multiple divisions and departments work on similar
issues such as employment, housing, transportation, workforce and long-term care issues.
Coordination shall occur among DHHS divisions, and with the Governor's Advocacy
Council for People with Disabilities, the departments of Commerce, Corrections and
Transportation and the Housing Finance Administration.
This State Plan requires changes in Division practices, leadership methods and business
functions. One of the first actions will be the selection of a division director who will
assume responsibility for moving the system forward. The director will lead reorganization
of the Division to accomplish the tasks outlined in the State Plan.
State Plan 2001: Blueprint for Change
November 30, 2001
30
Coordination
Coordination must occur in these areas:
• Documentation of services.
• Licensure and monitoring of services.
• Direct enrollment including memoranda of agreement and qualified provider
participation agreements, and collection and analysis of data to meet performance
indicators and quality improvement activities.
• Training efforts throughout DHHS, within the Division and at all levels of the system
so that all efforts complement each other and that content is appropriate, timely and
provided regularly.
Documentation
Consumers and their legal guardians usually have the right to read their records. Staff will
help consumers understand the content and their rights to privacy and the confidentiality of
the information. Accurate documentation by all agencies is essential for assessing and
monitoring the total service system and the person’s progress over time. Reducing
redundancy and extraneous elements is essential for a complete, accessible and accurate
record. Medical record elements will be consistent, no matter the funding source or type of
provider, and shall be shared only according to confidentiality laws and regulations. Record
documentation will include:
• Consumer-specific information.
• Assessment and relevant information to support a person centered plan that should align
all of the assistance the person is receiving, combining formal, informal and natural
supports.
• Type of services to be delivered.
• Personal outcomes to be achieved as a result of the services of supports.
• Potential risks and crisis plans.
• Status and efforts to strengthen/sustain the primary circle of supports and recovery for
the person.
• Proof of delivery of service or support including who provided the service, what service
was provided, date and duration of the service, what was achieved as a result of the
specific service.
Documentation requirements will be developed in coordination with other divisions within
DHHS and across departments as applicable and shall include families, consumers and
qualified providers as appropriate. Documentation requirements will be standard for a
variety of divisions when possible. Documentation standards and requirements shall be the
same for any qualified provider of services.
Qualified providers/agencies are accountable to the consumers served, to their communities
and to their funding source. Qualified providers shall assume liability for the quality of the
records. Local managing entities shall be responsible for ensuring qualified providers receive
accurate and timely information. The Division and/or Department shall distribute materials
directly to enrolled qualified providers.
State Plan 2001: Blueprint for Change
November 30, 2001
31
Documentation is also essential for billing services to third parties (insurance companies,
government agencies, other funding sources, etc). Third parties may arrange for periodic
audits to ensure they are getting what they pay for. Records and charts will be examined
during audits along with other relevant information and data. Public and private agencies
shall be audited using the same standards and criteria except as mandated by federal or state
law. The state shall establish audit criteria to be used. Results of audits, monitoring visits or
investigations shall be published within 45 days of review and will be used for quality
management activities and reports cards.
Licensure and Monitoring of Services
The Division of Facility Services (DFS) will serve as the regulatory agent for the state
oversight of licensed services. DFS will be responsible for conducting inspections. Results of
these inspections will be published and used as quality indicators for performance.
The LME will conduct local monitoring of qualified providers within the network. This local
monitoring will focus on the quality of clinical and programmatic delivery and will not be
considered a licensure inspection. Monitoring protocols and criteria will be standardized. All
LMEs shall use state-adopted criteria and participate in rater training to improve consistency.
The state, in collaboration with stakeholders, will develop the protocols and criteria.
Licensure for professional practitioners will be used as an indicator of qualification for
service. Direct enrollment will be evaluated for all licensed practitioners. In the future,
qualified providers of non-facility based services will be subject to licensure or compliance
with identified standards.
Qualified Service Provider Network/Direct Enrollment
As part of the DHHS initiative to make services for children seamless, the State Plan will
build upon existing practices of coordinating policies between Health Choice, Medicaid and
state DMH/DD/SAS funding for all individuals. Children and adults who are eligible for
Medicaid or Health Choice will continue to receive their benefits from qualified providers.
Direct enrollment requirements will be linked with licensure and performance of quality
indicators. The ability to meet outcomes will be used to measure effectiveness and eventually
payment of services. This shift has many implications and will be one of the final steps of
implementation. As an interim step, reports of qualified provider performance will be
published and will be an integral part of educating individuals and families about selection of
qualified providers. These reports will also be used as a factor in examination of qualified
provider rates.
Memoranda of Agreement (MOA) shall be required for direct enrolled qualified providers
who make services available to target populations. These MOA shall be standardized and
established by a participatory process including state staff, LME staff, qualified providers
and consumer/family representatives.
State Plan 2001: Blueprint for Change
November 30, 2001
32
Training
Training will be coordinated within the Division and DHHS. Training will:
• Reflect the latest research, best practices and state-adopted practices.
• Positively affect consumers.
• Be self-sustaining to the extent that individual training efforts are part of larger plans and
continue on a regular basis.
• Be accessible across the state.
• Increase local capacity to provide services and supports.
• Result in permanent work place change.
• Be sensitive to all cultures.
Infrastructure
Collection and Analysis of Data
A variety of data shall be collected and analyzed for purposes of planning, establishing
benchmarks, and informing decision-making. All area/county programs and other qualified
providers shall participate fully in the state’s efforts to study and evaluate system
components.
The Pioneer System, now used to report services for payment, is being replaced by the
Integrated Payment and Reporting System (IPRS). This is part of a major effort to upgrade
the Division’s management and information system, which includes a consolidated
movement of data into a decision support warehouse. These changes require extensive
revision of the statewide management information system capacity.
Appeals, Grievances, Human Rights, Consumer Advocacy
The mental health reform legislation requires a wide range of activities to ensure fairness,
consumer choice, client rights and protections, client advocacy, and quality of care. There are
also a number of existing avenues to address appeals, client/human rights and advocacy. The
DHHS Secretary will study consolidation of these activities, and shall make a report of the
findings and recommendations to the Joint Legislative Oversight Committee.
Office of Consumer Affairs
The Division of MH/DD/SAS will establish an Office of Consumer Affairs. The office will
be lead by a consumer who reports directly to the Division Director and is a member of the
Division’s management team. The office will include a designated position from each of the
service groups served through the Division and administrative support.
State and Local Consumer and Family Advisory Committees
The Division shall convene a state level consumer and family advisory committee and
require each LME to convene a consumer and family advisory committee. The composition,
staffing and recruitment of members, and the timing and links to other entities shall be as
follows:
State Plan 2001: Blueprint for Change
November 30, 2001
33
• Membership will be 100 percent consumers and family members.
• People representing all disability groups will be equally represented.
• Race and ethnicity of members will be representative of those who are served by the
system.
• Each committee will have, for each disability group, a man, a woman and a youth
member. Family members may represent children. A parent may represent the needs of
parents of adult consumers, but shall not represent adult consumers.
• The state advisory committee will be staffed by the Office of Consumer Affairs
coordinator, who will recruit the initial members of the state advisory committee in
collaboration with consumer and family advocacy organizations.
• Each local advisory committee will be staffed by an employee of the LME whose
responsibilities will be to obtain consumer and family input from the community, to
implement recommendations of the advisory committee, and to serve as liaison to the
state advisory committee and other local agencies, organizations and associations. This
staff person will recruit the initial members of the local advisory committee in
collaboration with local consumer and family advocacy organizations.
• The state committee and the local committees will be in place prior to the development
of local business plans.
• State and local advisory committees will have clearly specified relationships to one
another and to state and local consumer advocacy programs, human rights committees
and the Governor’s Advocacy Council for Persons with Disabilities.
• Local committees will have clearly specified relationships to county/area boards.
• Advisory committees will help educate elected officials and advocate for funding.
Local committees shall advise the LME regarding the local planning process and will review
and submit to the state their own reports on local business plans. The state committee will
review local plans and local committees’ reports on plans and will make recommendations
regarding state approval of local business plans.
State and local advisory committees will also:
• Review and advise regarding long term and annual state and LME plans.
• Provide recommendations regarding service eligibility and service array, including:
• Identifying gaps in services.
• Identifying under-served populations.
• Advising regarding development of additional services, and
• Monitoring service development and delivery.
• Review and monitor the state’s budget for services and LMEs’ budgets.
• Monitor the state and LMEs implementation of State Plan and local business plans.
• Educate state and local elected officials and advocate for funding.
• Review and advice regarding outcome date collection.
• Monitor tracking and reporting of outcomes.
• Monitor activities undertaken to improve quality.
• Ensure consumer and family participation in all quality improvement projects.
State Plan 2001: Blueprint for Change
November 30, 2001
34
The Division and LMEs will support state and local Consumer and Family Advisory
Committees with:
• Stipends as appropriate to ensure participation.
• Transportation or compensation for travel expenses.
• Childcare and eldercare if needed.
• Flexible scheduling of meeting times.
• Information and education regarding the service system:
• User-friendly primer regarding existing system and funding sources.
• List of the services that are available and how to access them.
• Materials regarding model systems and best practice services/supports.
Rules Adoption and Statute Revisions
There are many existing rules and statutes that do not support the implementation of the
State Plan and that are actual barriers to its mission and goals. The department will complete
a review of all rules for vagueness, duplication and ambiguity. This review shall be a
participatory process involving people with disabilities and their families, qualified providers
and advocates.
In addition to existing rules, the department will use the rule making process to establish
service standards, procedures for rate setting and for establishing qualified provider
standards. The Division of Medical Assistance (DMA) and the Division of MH/DD/SAS
will cooperatively plan any policy or rule making in order to meet the mission of a unified
system and to meet statutory requirements of both agencies for rules and policies.
This plan requires realignment of service definitions and standards in order to meet
management information system requirements and array of services for targeted population,
licensure rules, documentation requirements, clinical care guidelines, medical necessity
criteria, monitoring requirements, readiness reviews of LMEs, and competencies for staff.
System Quality Management Plan
A quality management program for North Carolina’s mental health, developmental
disabilities, and substance abuse services system will promote accountability, efficiency,
human rights, and continuous improvement in the quality of treatments, services, and
supports provided to consumers. Components of this system will include:
• Utilization review activities at state facilities, at LMEs and with qualified providers.
• Utilization management using standardized review criteria of services provided with
public funding.
• Quality assurance including licensure, credentialing, program monitoring, and financial
audits.
• Quality improvement activities conducted throughout the system.
System-wide quality management and improvement will be coordinated by a committee that
includes consumers, families and other stakeholders.
State Plan 2001: Blueprint for Change
November 30, 2001
35
Report Cards
To assess and broadcast performance results for the system, periodic report cards will be
issued. These report cards will consist of an easy to understand evaluation format for a
range of performance and consumer outcome measures. Report cards will be publicized
across the state in a variety of different ways.
Domains Sample Indicators for Report Cards
Access • Penetration rate (percent of eligible consumers who access services and
supports)
• Timeliness of receiving services and supports
• Adequacy of qualified provider network (capacity)
Quality of
Care
• Engagement/retention in treatment
• Continuity of care and care-givers
• Completion of consumer-driven, clinically appropriate and evidence-based
service plans
• Consumer/family education
Administrative
Processes
• Collaboration of consumers, families, and public and private agencies in
planning and monitoring
• Effectiveness of system quality improvement processes and activities
• Training competency, service standards, best practices including cultural
competence
Consumer
Outcomes
• Core Indicators Project
• Client Outcomes Inventory
Staff Competencies, Education and Training
A competency-based system for qualified providers services providers has been developed to
achieve measurable outcomes and raise the level of quality and consistency statewide for the
delivery of human services. This effort is consistent with the national move toward
competency-based requirements for billable services. Recognition is also given to those
licensing and certification boards already in place and serving well the people with
disabilities.
There are seven core competencies required to meet the minimal standards for a
competency-based system for staff services in North Carolina:
1. Technical knowledge
2. Cultural awareness
3. Analytical skills
4. Decision-making
5. Interpersonal skills
6. Communication skills
7. Clinical skills
State Plan 2001: Blueprint for Change
November 30, 2001
36
Several implementation phases are necessary to build a solid, cost effective, stable system
that will achieve measurable objectives. The rewards of a competency-based qualified
provider system will be:
• Better personal outcomes for people with disabilities through more stable support
systems.
• Less staff turnover and reduction of associated costs with replacing and training new
personnel.
• Reduction in administrative costs through standardizing qualifications and competencies
for professionals and paraprofessionals.
• Improved professional ethics and standards.
• Higher morale and more motivated employees.
• Streamlined, cost effective statewide standardization of qualification and documentation
processes for professionals and paraprofessionals.
• Improved quality outcome indicators that can be measured against national standards
(accident injury rate, staff turnover, etc.).
Financing
In North Carolina, a number of agencies serve people with mental health, developmental
disabilities and substance abuse service needs. Each has its own mandates, funding priorities
and procedures. Funding categories, which limit the ability to move funds to where they
may be most needed, further fragment service delivery. Funding fragmentation provides little
incentive to work with other systems and actually creates incentives to continue to operate
independently of other systems. There are few incentives that encourage shared or
coordinated funding. This plan requires shared planning among state and local partners.
While present funding does not match the level of need, better coordination among existing
funding sources will make better use of available resources. Funding must follow the
consumer.
During the 2001 legislative session, $47.5 million was appropriated to establish a trust fund
for mental health, developmental disabilities and substance abuse services. This fund
provides bridge dollars to expand community capacity, assist in the implementation of the
Olmstead plan and encourage joint agency ventures in innovative community options such
as housing, transportation and meaningful employment.
Funding must follow the person upon discharge from state facilities. This will require re-alignment
of funds and making use of funds available to transfer people from institutions to
community intermediate care facilities. Funding realignment and consumer discharges shall
be coordinated to allow for state facility downsizing and expanding community capacity.
This action meets the requirements as outlined in the Olmstead Plan. It helps people who
have lived together in state facilities continue to live together in community settings, thus
nurturing relationships in the community. Increasing community capacity to provide services
and providing ongoing funding sources will be needed.
State Plan 2001: Blueprint for Change
November 30, 2001
37
Funding links between LMEs and use of state facilities must exist. The state shall establish a
bed-day allocation system for use of state hospitals, and a similar plan shall be developed for
referral to the mental retardation centers and residential schools.
Funding LME functions must be separated from funding of service delivery. Currently,
administrative dollars are tied directly to the delivery of units of direct service. As the LME
moves from providing services to managing services, payment for these administrative/
management functions will be distinct from payments for services to people with disabilities
and their families. Federal dollars must be leveraged to fund administrative functions.
Funding for services to people with disabilities and their families must be based on realistic
costs and expectations. Services that do not meet national standards, or do not meet desired
outcomes will not be funded. Medicaid and state funding shall be re-aligned to implement
this plan. This includes adoption of new and revised service and support definitions, new
and revised Medicaid waivers and examination of blending funding with other agencies.
Analysis and cost modeling of all components must be coordinated with the Legislative
Oversight Committee’s review of financing the system. This analysis includes core functions,
LME activities, target populations and proposed benefit packages, training and monitoring
the quality management plan.
State Plan 2001: Blueprint for Change
November 30, 2001
39
Chapter 4. Business Plan Timeline
The State Plan implementation steps shown here were developed using a project
management software application. The elements and parameters of this implementation plan
will be steadily broadened and refined to include increasing levels of detail and timeframes as
they are identified. As they are approved, steps that must be led or performed by the
Department will be shown on the project list as well as all transition steps from the
Department, project teams, LME’s and community partners. In this way, everyone involved
can know about any changes, follow progress and review accomplishments.
ID TASK NAME TASK
COMPLETION
DATE
1. Initiate plan to coordinate policies and planning with other divisions to
address administrative and business functions, funding sources, as well as
programmatic & clinical guidelines, outcomes and initiatives
11/30/01
2. Provide initial report to Legislative Oversight Committee on state plan,
and quarterly thereafter on each required activity listed below.
11/30/01
3. • Submit the State MH/DD/SAS Plan to the Legislative Oversight
Committee
11/30/01
4. • Review of rules and statutes inside and outside DHHS 11/30/01
5. • Review oversight & monitoring functions implemented
• by DHHS
11/30/01
6. • Report on development of service standards, outcomes,
financing formula for core and targeted services, to
prepare for their admin, financing & delivery by area
authorities/county programs
11/30/01
7. • Develop format & required content for business plans
submitted by boards of county commissioners & for
contractual agreements between DHHS & area
authorities/county programs
11/30/01
8. • Assessment of DHHS readiness for reform
implementation
11/30/01
9. Expand service capacity for substance abusers to assist in diversion from
state psychiatric hospitals
11/30/01
10. • Division of Facility Services to give priority consideration to
construction on projects related to the development of service
capacity
11/30/01
11. • DHHS personnel to expedite additional staffing needs of Alcohol &
Drug Abuse Treatment Centers (ADATC)
11/30/01
12. New Director of MH/DD/SAS announced 01/01/02
13. DD to convene workgroup to build plan for integrating private
Intermediate Care Facilities/MR into unified community-based system
01/01/02
14. Prepare, with the County Commissioner’s Association, a technical 01/01/02
State Plan 2001: Blueprint for Change
November 30, 2001
40
ID TASK NAME TASK
COMPLETION
DATE
assistance/communication plan for decision regarding Letters of Intent.
15. Distribute revised service record manual to field staff for review 01/01/02
16. Submit a research waiver for consumer directed services for people with
developmental disabilities
01/01/02
17. Revise service definitions for July implementation of Integrated Payment
& Reporting System (IPRS) statewide rollout & establish plan for:
01/01/02
18. • Submit changes to Medicaid Plan & coordinate with Health Choice &
state funding as needed
01/01/02
19. • Promulgate rules & publication of activities as required by the rule-making
authority (G.S. 150B) & new Medicaid legislation
01/01/02
20. • Analyze financial impact 01/01/02
21. • Begin training of staff & field staff 01/01/02
22. • Set rates for new services 01/01/02
23. • Electronic Data Systems (EDS) & IPRS programming 01/01/02
24. Begin establishment of licensure rules through MH Commission on
MH/DD/SAS for prevention program
01/01/02
25. • Develop criteria for qualified prevention professional 01/01/02
26. Based on Olmstead assessments, analyze services needed to facilitate
discharge of patients from state hospitals and reduce admissions to such
hospitals.
01/31/02
27. Complete annual public review of plan 03/01/02
28. Present progress report to LOC on the status of state plan
implementation
03/01/02
29. Establish outpatient crisis teams from state facilities to develop re-integration
plans
03/01/02
30. Report to Appropriations Committee finding of Section 21.28A of Senate
Bill 1005, Traumatic Brain Injury Waiver
03/01/02
31. Implement plan to divert substance abuse admissions from state
psychiatric hospitals
03/01/02
32. • Complete renovation of 3 ADATCs for 90 additional beds 03/01/02
33. • Recruit & hire for 90 additional beds 03/01/02
34. Develop multilevel integrated quality management committee structure
including consumers, families and other stakeholders
03/01/02
35. Develop and/or strengthen collaborative agreements with community
college systems, DPI, colleges and universities, Area Health Education
Centers & associated training vendors to establish training for state plan,
best practices including cultural competence & staff competencies
03/01/02
36. • Develop & present funding needs for competency programs 03/01/02
37. • Complete content competencies for each curriculum & establish
inter-rater reliability
03/01/02
38. Complete 1 through 5 year financing plan to support mission core
services, target populations, LME functions, state functions, bed-day
allocations, mental retardation center downsizing, leveraging funds from
state facilities & Mental Health Trust Fund & evaluate sharing of funding
for functions that cross agencies
03/01/02
State Plan 2001: Blueprint for Change
November 30, 2001
41
ID TASK NAME TASK
COMPLETION
DATE
39. • Review current allocations of state funding to area authorities/county
programs & recommend changes in methods & formulae to ensure
equitable distribution of state funds & evaluate means of
increasing/realigning funding to stabilize & support MH/DD/SAS
03/01/02
40. • Develop accurate picture of current resource allocation in the
MH/DD/SAS System including current methods of funding &
disparities
03/01/02
41. • Develop a realignment plan of state facility resource 03/01/02
42. • Develop a dedicated source of ongoing of state & federal funding for
the system
03/01/02
43. • Examine ways to obtain additional funding through traditional/non-traditional
means
03/01/02
44. • Complete analysis and make recommendations for direct/indirect
cost of qualified public/private providers
03/01/01
45. Develop criteria & operational procedures for the Consumer Advocacy
Program
03/01/01
46. Develop the DHHS Appeals Panel for clients and family members, as
well as qualified providers
03/01/02
47. Evaluate consolidation of the Quality of Care Consumer Advocacy
Program w/other consumer advocacy/ombudsman programs in DHHS
and report to the LOC. Include Consumer Advocacy Programs, Office
of Consumer Affairs
03/01/02
48. Establish training & promotion strategies for state plan 03/01/02
49. Present integration of the Olmstead, Long-term Care & State
MH/DD/SAS plans
03/01/02
50. Review financing options for interpretation/translation services to
people being served and make specific recommendations
03/01/02
51. Initiate expansion of community support services for adults with mental
illness in order to facilitate closure of state hospital beds.
03/28/02
52. Provide financial and/or technical assistance to LME's to enhance service
development/provision to the adult mental health target population.
04/30/02
53. Complete analysis and make recommendations for direct/indirect cost of
qualified public/private providers
05/01/02
54. Open admissions at 3 ADATCs to involuntary substance abuse
admissions
05/01/02
55. Adopt a standardized assessment & treatment protocol and provide
regional training to area authority/county program and ADATC staff in
order to carry out diversion of substance abuse clients to state hospitals
05/01/02
56. Present recommendations regarding expansion of direct enrollment of
qualified providers & possibly agencies
05/01/02
57. Complete annual State Plan modification 06/01/02
58. Update all Memoranda of Agreement (MOA) for July implementation 06/01/02
59. Complete data gathering and analysis related to geographic (catchment)
area consolidation plan
07/01/02
60. Complete review of state plan for FY 02-03 implementation 07/01/02
61. Submit quarterly report for LOC on status of state plan implementation 07/01/02
State Plan 2001: Blueprint for Change
November 30, 2001
42
ID TASK NAME TASK
COMPLETION
DATE
62. Increase target populations of children w/severe impairment & their
families to be served through SOC
07/01/02
63. • FY 2002-6000 youth/families (doubling 3,000 baseline of youth
served in System Of Care (SOC) currently eligible for At Risk SOC in
100 counties)
07/01/02
64. Establish annual 5 year benchmarks to: 1) strengthen school counseling
programs, primary care linkage & qualified provider networks through
SOC approach for 253,407 with mild/moderate impairment; 2)
incorporate prevention through SOC targeting 1,851,191 youth pop.
07/01/02
65. Assess with Community Collaborative the current service array & gaps in
services to establish baseline
07/01/02
66. Develop local services to reduce the number of children in state hospitals,
DSS custody & Youth Development Centers
07/01/02
67. Increase capacity using 3% of Child Mental Health funds pool (approx.
1.5 million) for comprehensive treatment services special provision to
children with highly complex needs
07/01/02
68. SOC for children At Risk or already out-of home operational in 30
counties
07/01/02
69. Refine collaborative plan with other child-serving agencies/communities
to expand resources through integration of services
07/01/02
70. Increase/add resources for CMH at the community level at 25% 07/01/02
71. Recommend integrated SOC structure that includes JCPC through
legislation/executive order to reduce duplication
07/01/02
72. Establish flexible funds & voucher resources across all disabilities 07/01/02
73. Modify CAP/MR-DD waiver to expand community-based services 07/01/02
74. Initiate rule revisions on an ongoing basis as systems & policies are
implemented
07/01/02
75. Eliminate 72 state psychiatric hospital beds & transfer patients to
community
07/01/02
76. • Dix Hospital 39 beds-close Wright Building 07/01/02
77. • Broughton Hospital 18 beds-close nursing facility 07/01/02
78. • Umstead Hospital close 15 gero-psychiatry beds 07/01/02
79. Systematically and on ongoing basis, redirect funds from state hospitals to
community services for substance abuse, mental health, child mental
health to expand community services
07/01/02
80. Prepare Eastern Adult Treatment Program, Whitaker & Wright Schools
for Medicaid certification
07/01/02
81. Develop cross agency policy recommendations for statewide outcomes
based SOC best practices consistent with state plan
07/01/02
82. Implement comprehensive outcome measurement plan with elements
across agencies and develop framework for outcome report cards
07/01/02
83. Implement SA standardized risk assessment protocol and pilot use in 10
communities
07/01/02
84. Develop 2 pilot projects from ICF-MR homes to community support
using CAP-MR/DD funds
07/01/02
85. Mental retardation centers & private sector develop 5- bed homes in 07/01/02
State Plan 2001: Blueprint for Change
November 30, 2001
43
ID TASK NAME TASK
COMPLETION
DATE
community for those person previously unsuccessful in community
placements
86. HB 1395 Transfer-ICF-MR beds to transfer at least 40 people from
mental retardation centers to community ICF-MR beds
07/01/02
87. Develop & operate three 12-bed specialized MR/MI units one for
children, two for adults in each of the 3 MRCs to serve moderate to
severe MR & MI for crisis intervention, diagnosis & treatment
07/01/02
88. Convert Black Mountain Center ICF-MR beds to Skilled Nursing Facility
to serve aging persons with DD & medical care needs
07/01/02
89. Develop MH/DD/SA protocols based on evidence-based practices
and/or national standards of service delivery
07/01/02
90. • Develop service definitions consistent with evidence-based
services/expert consensus
07/01/02
91. • Update clinical guidelines for client assessment,
schizophrenia, mood disorders, substance related disorder
and psychiatric issues in persons with MR
07/01/02
92. • Making use of Robert Wood Johnson/SAMHSA and
other national tool kits as appropriate, review &
evaluate standards on person-centered planning, cultural
competence, Assertive Community Treatment,
psychiatric rehabilitation and case management for
adults with severe and persistent mental illness,
schizophrenia outcomes research, dual disorders,
dialectical behavioral treatment.
07/01/02
93. Develop specs for DHHS management information system including
decision support & build upon Medicaid MIS & IPRS for DHHS
coordination; manage coordination at department level
07/01/02
94. Develop Memoranda Of Agreement between state & local agencies
including qualified provider enrollment agreement and qualified
provider/LME agreements
07/01/02
95. Establish local monitoring protocols for use by LME & credential local
auditors; coordinate with Division of Facility Services licensure review
including relationship with national accreditation & deemed status
07/01/02
96. Establish Office of Consumer Affairs that is consistent with Division
reorganization
07/01/02
97. Develop readiness plan for conducting reviews & certifying area
authorities/county programs as LME’s.
07/01/02
98. Reduce child out-of-state placements by 25% 07/01/02
99. Promote increased flexibility of child-serving funds-develop mechanisms
in 100 counties to de-categorize 1-5% of child-serving agency funds
07/01/02
100. Establish regional learning center-engage university & community college
systems with team of specialists of trainers in each region for TA in best
practices and trouble-shooting. One center per year for 4 years
07/01/02
101. Identify all existing outcome tools and data collection efforts across
agencies that can contribute to one integrated data set to measure
indicators regarding specified outcome targets
07/01/02
State Plan 2001: Blueprint for Change
November 30, 2001
44
ID TASK NAME TASK
COMPLETION
DATE
102. Present quarterly report to the LOC on the status of State Plan
implementation
10/01/02
103. Receive and act on letters of intent from counties regarding LMEs 10/01/02
104. Develop criteria for performing Utilization Management including
centralized functions & LME functions
10/01/02
105. • Develop budget & fee structure for UM functions 10/01/02
106. • Develop criteria for measuring the performance of the
UM entity on an ongoing basis
10/01/02
107. • Begin process for the selection of a vendor 10/01/02
108. • Determine process & content of UM information to state
& LME
10/01/02
109. Present quarterly report to the LOC on the status of state plan
implementation
11/29/02
110. Develop and maintain a mh/dd/sa competency, education and training
system that is coordinated among system members & is based on best
practices including cultural competence, professional competencies, and
performance standards
11/29/02
111. Develop & maintain a workforce that is reasonably compensated 11/29/02
112. • Develop & periodically update career enhancement
procedures for the MH/DD/SA system
11/29/02
113. • Perform regular salary reviews to ensure a workforce that
is reasonably compensated at the local community level
(public & private)
11/29/02
114. Each area authority/county program submits their proposed business
plan to the DHHS Secretary
01/01/03
115. Establish licensure categories for agencies providing non-facility based
services & begin rule making
01/01/03
116. Create separate Home and Community Based (HCB) waiver for persons
leaving institutions
01/01/03
117. Reduce alcohol, tobacco & other drugs (ATOD) usage by children
between the ages of 12-17
01/01/03
118. • Work with Center for Substance Abuse Prevention to
identify a menu of approved prevention services
01/01/03
119. • Develop prevention service system, definitions, staff
competencies & outcome criteria
01/01/03
120. • Initiate negotiations with Medicaid & other payers to
establish rates & approve reimbursement for prevention
services in NC
01/01/03
121. Complete annual public review of plan 03/01/03
122. Establish a 24-bed substance abuse crisis triage unit and complementary
intensive outpatient program for Wake County
03/28/03
123. • Identify & renovate an appropriate facility 03/28/03
124. • Recruit & hire staff 03/28/03
125. • Evaluate progress in development and implementation of 03/03/03
State Plan 2001: Blueprint for Change
November 30, 2001
45
ID TASK NAME TASK
COMPLETION
DATE
seamless electronic communication systems across
agencies and qualified providers (MMIS/IPRS, etc.)
12