2014 Management Summary - Tri

Tri-County Human
Services, Inc.
Management
Report
1/1/14 – 12/31/14
PROGRAM LOCATIONS
Administrative Offices
1815 Crystal Lake Dr
Lakeland, FL 33801
(863) 709-9392
JASA (In-Jail) Program
2390 Bob Phillips Road
Bartow, FL 33830
(863) 534-0014
AGAPE Halfway House
759 Carroll Avenue
Winter Haven, FL 33880
(863) 299-7003
Detoxification Unit
2725 Hwy 60 East
Bartow, FL 33830
(863) 533-4139
JASA (In-Jail) Frostproof
1103 Hwy 98 West
Frostproof, FL 33843
(863)635-6920 x 2730
Prevention Services
Winter Haven Outpatient Clinic
41 Third Street SW
Winter Haven, FL 33880
(863) 299-5286
DUI – (863) 299-9631
JASA (In-Jail) Highlands County
434 Fernleaf
Sebring, FL 33870
(863) 402-7200 x 5265
Lakeland Outpatient Clinic
5421 US Hwy 98 S
Highland City, FL 33846
(863) 701-7373
DUI - (863) 701-7373
Florida Center for Addictions
and Dual Disorders
100 West College Drive
Avon Park, FL 33825
(863) 452-3858
DUI/DATE/BDI/ADI
1811 Crystal Lake Dr.
Lakeland, FL 33801
(863) 701-1919
Highlands Co. Outpatient Clinic
100 West College Drive
Avon Park, FL 33825
(863) 452-0106
DUI – (863) 452-2685
Wauchula Outpatient Clinic
202 South 9th Avenue
Wauchula, FL 33873
(863) 773-2226
Transition Living
1638-1644 Crystal Park Circle
Lakeland, FL. 33801
(863) 299-7003
Food Services
301 Moose Lodge Rd
Bartow, FL 33630
(863) 533-1340
501 Lemon Ave.
Sebring, FL 33870
(863) 327-2834
RASUW Center for Women
2725 Hwy 60 East
Bartow, FL 33830
(863) 533-5860
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AFFILIATIONS
Department of Children and Families
United Way
Central Florida Behavioral Health Network
The Greater Lakeland Community Foundation
Polk County Sheriff
Grady Judd, Sheriff
Florida Alcohol Drug Abuse Association
Highlands County Sheriff
Susan Benton, Sheriff
Polk County
Highlands County
Board of County Commissioners Board of County Commissioners
Hardee County Sheriff
Arnold Lanier, Sheriff
Hardee County
Board of County Commissioners
Commission on Accreditation
of Rehabilitation Facilities
Page 3 of 47
TRI-COUNTY HUMAN SERVICES INC.
ANNUAL MANAGEMENT REPORT SUMMARY
Website: www.tchsonline.org
TCHS Mission Statement
“Tri-County Human Services shall endeavor to provide an array of high quality human services consistent with
the needs of the community. Services shall be provided in a cost-effective, professional, and ethical manner and
shall focus on improving the quality of life of persons served.”
TCHS Core Values Statement
In keeping with our integrated mission statement, TCHS hereby declares their essential core value that drives
all decisions regarding the direction, program development for our people served, and staffing of the agency.
These values have been identified as the basis for the agency through continual education, applied experience,
and recognizing where change further improves the quality of our agency. Our core values are:
To promote the right for all to be treated with dignity and respect.
To promote the right to exercise informed choice for all persons.
To allow expedient access to needed services that have been designed and provided in a manner to
achieve optimum outcomes.
To use outcomes to continually improve the quality, elevate professional management, and services of
all its programs.
To embrace the cultural diversity of the community and utilize its strengths to relevant services of the
agency.
To respect its governance, leadership, associates, and partnerships that allows the agency to
continually function.
To promote a “No Wrong Door”, welcoming service process to all who request and enter services.
To meet all persons at a level of their ability: regardless of their physical, mental, substance, or cooccurring challenge.
To support the people we serve and the community by developing affordable, stable housing
opportunities.
TCHS Slogan
“Positive Support for Positive Change”
Page 4 of 47
Through revenues generated by contracts with DCF/ADM, CFBHN, the Counties of Polk, Highland and
Hardee, and Federal grants, Tri-County Human Services is able to serve its clients with the best available
Behavioral Health programs including substance abuse, mental health and co-occurring disorders. Our
dedicated staff consistently strives to meet our Core Values and Mission Statement to achieve “Positive
Support for Positive Change” for each and every client we serve throughout the year.
This annual management report is designed to capture information relative to activities and achievements
during calendar year 2014. This review includes the agency operations and program plans, specific fiscal year
related goals and objectives, review of data obtained from the Agency Outcomes Measurement System, State
of Florida objectives and outcomes related to state/agency contracts, safety and health report and analysis and
review of a variety of inputs from agency, community and client stakeholders.
A variety of instruments were used in the gathering of this information; including a yearly Community Needs
Assessment Questionnaire, a Client Needs Assessment Questionnaire, State of Florida performance Audits,
Internal Utilization Audits, Annual CPA financial audit, Quality Assurance Indicators from the QAI
Committee Minutes, Safety Committee Minutes, Training Committee Minutes, Retention and Recruitment
Committee Minutes, Client Satisfaction Surveys, 90-Day Post Discharge Treatment Surveys, MIS Data
Reports, Management QAI meeting minutes, Administrative Directors meeting minutes and the Annual
Operational Program Plan.
Services reviewed include all agency programs to include Prevention, Detoxification, Residential, Outpatient
(including the mental health program in Highlands County) treatment services. Medical Services and
DUI/DATE program services located in Polk-Highlands-Hardee Counties.
Strategic and Annual Program Plan:
This Strategic Plan originated in 2013 and replaces the plan originated in 2007 fiscal year due to the many
changes anticipated for the agency in the future. The Board of Directors are provided quarterly updates
regarding its progress, changes and management requested changes due to changes in the business and clinical
environment. The Strategic Plan is approved each fiscal year by the Board of Directors.
The Board of Directors support the efforts contained within this report. The Strategic and Annual
Management Report provides the agency with the groundwork for the progression of the agency throughout
the upcoming year and planning into the foreseeable future. The Plan incorporates information from many
agency resources such as performance goals of individual employees, program goals based upon stakeholder’s
interest and accepted clinical treatment modalities, capital and operational plans, risk plans, cultural diversity
plans, and support services plans that need to be initially developed to provide for the foundation for the future
of the agency in terms of growth and development.
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STRATEGIC AND PROGRAM PLAN
3 YEAR PLAN, PUBLISHED 3/1/2012
Applies to FY 2012/2013, 2013/2014, 2014/2015
Reviewed and updated 7/1/12, 8/16/12, 9/13/12, 10/11/12, 9/12/13, 11/14/13,
12/31/14
This Strategic and Program Plan is developed to meet those Human Service needs
identified as part this Strategic and Program Plan and is based on the Program
Plan activities to be carried over from the prior Fiscal Year.
Strategic Long Term Goals include ongoing activities and goals for up to the next 5 years:
General Goal
Objectives
I. Funding issues for the
current fiscal year and into
the future
A. Florida legislature funding – Attempt to
maintain at least current funding sources for
the fiscal year 2012/13, 2013/2014
B. DCF funding – when confirmed by DCF,
identify adjustments in Administrative
overhead and a redirecting of residential
dollars of up to 30% to other services (FY 12/13)
B.1 Identify residential programs that will
maintain viability
B.2 Identify program expansion that receive
redirected funds
B.3 Identify staff issues (qualification,
location, other) that can be used to facilitate
effective usage.
C. Florida Medicaid funding – bring the
agency and staff into compliance with new
Handbook. Identify job educational
requirements, service requirements, provide
Updates/Reports
Florida legislature reduced DCF funding for FY
2012/13 resulting in an $186,000.00 reduction in
TCHS funds.
9/11/13 - Funding for 2013/14 was established,
but a new amendment may adjust funding due to
sequestration limits and legislative cuts/gains in
specific programs. Polk government funds
established match funds, but cuts to JASA appears
to be $75,000 for this year. 11/14/13 – TCHS has
been told that sequester issues appear to be
resolved with no financial impact, at this time.
After January 1, 2014, another sequester may be
implemented by DCF on Florida providers/1/14Funding for 2013/2014 has been increased for
TANF and PPW. CFBHN will be advising TCHS
on next yeas funding by 5/1/14. There appears no
increases in general funding for State of Florida
funds in next year’s Governors proposed budget.
To date 8/16/12, no confirmation form DCF
received to re-direct funds from residential to
outpatient services. 10/11/12 No information from
DCF received. 9/11/13 – Redirection of funds
from residential to outpatient sis not occur in FY
2012/13. 2013/14 funds have been established by
DCF with cuts in PATH, TANF, and Level II
Residential funding being discussed currently.
11/14/13 – DCF has notified TCHS that increase
in TANF and Pregnant/Postpartum funding will
be passed to TCHS this fiscal year. 2/1/14 TCHS
received funding for TANF and PPW programs
There is questions if the funds will be recurring
into next year’s budget.
Ongoing as of 8/16/12. To date all linkages for
licensed staff has been sent to Medicaid. We are
now applying all licensed staff to become type 07
providers to expand scope of services we
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staff linkage to Medicaid billing and find
new services that are not being fully utilized
to maximize billing opportunities (FY 12/13
and FY 13/14)
D. Other Grant/Funding opportunities –
Identify at least two (2) different grant
opportunities to add to the general revenue
funding of the agency (on going)
D.1 Identify appropriate staff person to
monitor grant opportunities as they become
available( FY 2012/13)
D.2 Identify appropriate staff person to write
grants to maximize award success. (FY
2012/13)
E. Identify ways to expand Mental Health
services in Polk County (FY 12/13)
E.1 Identify programs in outpatient (IOP and
Others) as well as Outpatient Detox to
maximize billing opportunities in Medicaid
(FY 12/13 and FY 13/14)
F. Identify expansion of the Medical Model
and its application to TCHS as a agency (FY
12/13)
F.1 Identify partnerships with medical
practices that may partner with the agency to
provide these services, or other alternatives.
(FY 12/13 and FY 13/14)
potentially can provide. 10/11/12 Medicaid
applications are being sent for TCHS licensed
staff. 9/11/13 New Medicaid Handbook still not
released. TCHS is applying for Medicaid site
numbers for the integrated health programs in
Dundee, Winter Haven and Lakeland. A recent
review by ACHA on the Targeted Case
management and Psychosocial Rehab programs
indicate TCHS personnel need additional training
on charting more aggressively and more clearly
define program elements in the chart. 11/14/13 –
New Medicaid handbook has been released for
public comment. Effective date for new
implementation appears to be July 1, 2014. 2/1/14
– As of this date the new Medicaid handbook has
not been released. Legislature is defining rules on
telemedicine and other bureaucratic issues. No
dates has been established when the book will be
released. Medicaid billing has decreased for
TCHS in 2013/14
As of 8/16/12 Additional grant for $62,850.00 for
integration of services with local FQHC has been
awarded. 9/11/13 – TCHS again awarded grant
monies for integrated healthcare by Polk County.
Amount awarded is the same as last year’s//14/14
– TCHS applied for a grant in conjunction with
Sheriff Susan Benton for mental health training of
deputies and transportation of mental health
patients to Bartow. The grant was awarded to
other agencies. 2014/15 HUD grants were
submitted to HUD in January. Expectation is that
TCHS should receive most of the requested
funding.
8/16/12 TCHS has identified TCM programs as
way to start MH services at LOP. Initial start date
still not established. 10/11/12 With the expansion
of services into the FQHC, Medicaid/Medicare
billing will be able to increase due to new client
base.9/11/13 – TCHS is currently discussing with
the FQHC, billing opportunities to further
substantiate the integrated services in Polk county.
This will allow expansion of licensed and case
management staff to serve more people in a more
effective manner. TCM program and expansion of
mental health in Polk County is currently
underway with the hiring of Dr. Moore. A contract
with TCHS and Bartow Regional is anticipated for
10/1/2013. 11/14/13 – New psychiatric services
kickoff will be 11/15/13. Bartow Regional
contract is in the hospital legal department. 2/1/14
– psychiatric practice has been initiated by TCHS.
Still waiting on Bartow Regional for credentialing
on Dr. Moore. TCHS is gathering data on patinas
served, billing and meeting revenues with
expenses. Directors are gathering information to
present to the Board in upcoming meetings.
No activity
10/11/12 New partnership with FQHC has now
resulted in more opportunities to bill
Medicaid/Medicare. New locations in Dundee
Lakeland and Winter Haven. .9/11/13 – TCHS is
currently discussing with the FQHC, billing
opportunities to further substantiate the integrated
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F.2 Identify possible grants to support this
effort (stimulus monies or other sources)
F.3 Identify possible locations to initiate this
type of model. (FY 13/14)
G. Identify Supportive Housing that will
support the additions of housing units,
services to tenants of these homes, and
expansion of supportive housing in the
agency. (On going)
H. Continue to expand business
opportunities for current support services of
food service, pharmacy and rental programs.
(On Going)
H.1 Continue to refine growth potential and
assign growth objectives for each of the next
3 fiscal years. (On Going)
I. Project potential funding requirements
over the next 5 years. Consider the effect of
Managing Entities, Affordable Health Care
Act, Medicaid/Medicare issues, staffing and
EHR requirements (FY 12/13 and FY 13/14)
services in Polk county. This will allow
expansion of licensed and case management staff
to serve more people in a more effective manner.
TCM program and expansion of mental health in
Polk County is currently underway with the hiring
of Dr. Moore. A contract with TCHS and Bartow
Regional is anticipated for 10/1/2013. 11/14/13 –
FQHC had given TCHS a preliminary contract
that we revised and sent back to the FQHC. We
still need to negotiate monies for services and
determine what billing codes that the FQHC
utilizes that we can use for billing of services.
2/1/14 – TCHS still partnering with FQHC for
integrated program. Looking to move into Polk
Health Department in Haines City in the coming
months. TCHS talking with Dr. Dane Parker to
partner with Rural Health Care and Pharmacy
programs. To date Dept. of Ag has no grants
available to assist TCHS on “seed” monies to
assist in these programs.
8/16/12 Still in process of Ridgewood purchase.
HUD issues may prove insurmountable. 9/11/13
– There has been no activity on Ridgewood. The
sellers have not agreed to HUD requirement with
regard to their profits realized due to a sale of the
property. This item will be dropped for future
consideration. 2/1/14 - It appears that this program
is not moving as consultant has moved on to
another position and will not participate in
completing this transaction. Will not report unless
further information is forthcoming.
On going at this time. 10/11/12 Catering has
expanded and had booked weddings, buffets and
other catering events. This business shows great
growth potential. 9/11/13 – Food Service
continues to improve with catering events and
price increases. With the assistance of Board
Chair Linda Cunniff, TCHS is negotiating a new
food contract for migrant workers in Highlands
and Polk this contract will feed legal migrants
from December through June each recurring year.
11/14/13 – TCHS has a signed food contract for
80 migrant workers in Sebring. Lake Wales
famers have not yet approved the contract
proposal for 225 migrants. TCHS also advised to
plan for an additional 225 workers in Avon Park
in late March – June 2014. 2/1/14 – Food program
has now secured the migrant food program in
Highlands’s county. 70 initial persons served
with expansion to 210 people by May 1 2014. It
is expected that the program will continue in
2014/15 per our contractor.
8/16/12 CFBHN is our ME designate from DCF.
Many issues remain to be resolved in residential
programs. EHR requirements are being identified
and we are consolidating forms to reduce cost of
implementation. 10/11/12 CFBHN is utilizing
utilization Review (Medical Model) for admission
into residential programs. This is having a
negative effect on serving the needs of the patient.
9/11/13 - Funding for 2013/14 was established,
but a new amendment may adjust funding due to
sequestration limits and legislative cuts/gains in
Page 8 of 47
J. Identify the effect of Faith Based
programs entering into the SA/MH service
areas as competition and partners. (On
Going)
K. Develop a comprehensive marketing plan
to further promote the agency to new
customers and persons served. Utilize the
third party insurance market and specialized
programs in anger management, parenting
and the like, (FY 2012/13)
II Partnerships
A. Continue to explore partnerships with
the faith based community that will allow
integration between the faiths based
initiative and licensed programs such as
TCHS programs.
A.1 Identify at least one faith based
program to initiate this process in FY
2012/13
A.2 Identify other facilities to be able to
expand programs within our catchment area.
B. Continue to expand the college
practicum/intern program with local colleges
and universities.
B.1 Explore other disciplines such as health
care, pharmaceutical, Assisted living to
expand our contact and potential
employment base as future regulations
dictate change in the agency. (FY2013/14)
C. Identify individuals outside the agency
that can serve on development/advisory
committees to improve BOD candidates as
well as gain insightful knowledge in other
business disciplines. (On Going)
D. Develop better assessment tools to link
specific programs. Polk government funds
established match funds, but cuts to JASA appears
to be $75,000 for this year. 2/1/14 - There was no
sequester issue for TCHS so far this year with no
anticipated cuts due to Federal budget agreement
in Congress.
8/16/12 Working with PEACE and Highlands
County faith based groups for JASA persons
served. 10/11/12 Polk County budget will be
approved 10/16/12. TCHS funding is included in
this budget plan for FY 2012/2013.
9/11/13 – TCHS is working with faith based
groups for JASA program in Highlands County.
TCHS is also partnering with faith based groups
for aftercare programs in Polk county. FY
2013/14 more affiliations with faith based
programs (like Hope Now) will be a priority.
10/11/12 – TCHS reviewing use of social media
(Facebook) to promote programs, businesses and
success stories of the person served. 9/11/13 –
TCHS place a new Facebook page for fundraising
on the web. In June 2013, TCHS contracted with
a local web based company to develop a new web
page with links to all TCHS programs. TCHS
also changed form a .com to an .org web address
to better reflect our not for profit agency.
11/14/13 – New website will launch 11/24/13 that
will have a better lineup of programs, services,
locations and staff information. 2/1/14 – Web site
Launched. Due to programming errors, the
website had to be corrected and refined. This
process will continue for the next few months
until all details are finalized and working.
8/16/12 Working with PEACE and Highlands
County faith based groups for JASA persons
served. 9/11/13 – TCHS is working with faith
based groups for JASA program in Highlands
County. TCHS is also partnering with faith based
groups for aftercare programs in Polk county. FY
2013/14 more affiliations with faith based
programs (like Hope Now) will be a priority.
8/16/12 Working with technical colleges for
internships in encoding, medical billing and other
vocational opportunities. Local universities are
requesting more openings for interns to be at
TCHS. Looking at ways to utilize interns for
billing services. 10/11/12 TCHS is working with
several technical colleges for interns in billing.
9/11/13 – TCHS has assigned Donn VanStee to an
advisory board of Fortis Institute for technical
interns in MA and Medical Coding. These student
will be placed in position to learn aspects of their
training in a real world environment. 2/1/14 –
Due to the demand of interns for technical (billing
encoders)
No activity as of 10/11/12
Ongoing. 9/11/13 – Bob Rihn proposed to the
Page 9 of 47
TCHS to the community as identified in past
management reports. (FY2012/13)
III. Board of Directors
IV.
Selectivity/Specialization
of Services
A. Continue to gain representation of the
community as a whole on the BOD.
(ongoing)
B. Continue to inform/educate BOD
members on 990 Compliance and BOD
oversight of salaries, conflict of interest, and
financial status of the agency. (On Going)
C Identify a means to form Advisory
Committees to the BOD as a means to
identify potential BOD members as the need
becomes apparent. (On Going)
C.1 Complete the Advisory Board process
and identify members. (Fy 2013/14)
C.2 Identify measures to grow the Advisory
Board as the business environment changes.
(FY 2014/15)
D. Adopt a new BOD job description (FY
2012/13)
A. Investigate other programs such as male
half way houses
B. Investigate private residential program
for adolescence. (FY 2013/14)
C. Investigate additional HUD programs and
supportive housing programs linkages with
other like agencies. (FY 2013/14)
D. Investigate privatization of special
clinical therapy programs in SA and MH.
(FY 2012/13)
V. Management Issues
A. As identified above, identify issues with
the following:
A.1 Compliance with HIPAA regulations
and the EHR
A.2 Employee qualifications for billing of
services to Medicaid/Medicare and Third
party insurers.
A.3 Incorporating the medical model to be
able to accept future patients for SA/MH
treatment.
B. Identify acceptable programs for Trauma
Informed Care
BOD a new assessment tool for Board selfassessment. I August 2013. BOD to review and
take appropriate action in the coming months.
Ongoing. 9/11/13 -The Board added Eric Snelling
from Highlands County and Art Fullmer from
Polk County to the Board in the fiscal year.
10/11/12 – Baylis and Co presenting audited
financials and no issues found. 990 compliance
covered. 9/11/13 - Baylis and Co just completed
FY 2012/13 audit and will present to the BOD in
October 2013. 11/14/13 – Bayliss and Co will
give FY 2012/13 audited financials to BOD at
11/14/13 meeting. 2/1/14- No other activity
ON Going 9/11/13 – No activity as of this time.
Looking at May 1`7, 2014 for BOD strategic
planning meeting.
On Going – Gracepoint BOD may take precedent
9/11/13 – No activity as of this time.
On Going 9/11/13 – No activity as of this time.
On Going 9/11/13 – No activity as of this time.
10/11/12 New HUD regulation forthcoming to
expand HUD services 9/11/13 – New HUD
regulations were to affect funding for at least one
TCHS HUD program. To date all three programs
are fully funded. 2/1/14 – completed 2014/15
HUD grant applications. We expect funding on
most projects, but Congress has not addressed
budget issues, all funding is not assured.
10/11/12 TCHS investigating using a PA format
to expand medical services in Polk and Indian
River Counties. 9/11/13 – TCHS continues to
implement private practice medical model.
Expansion into Polk county and rural health
practice are being investigated and will be
presented to the BOD for approval.
8/16/12 Based on audits form AHCA and DCF,
compliance issues identified have been addressed
and completed (2 issues) Initiated E-Verify for
verifying citizenship of all new hires. 10/11/12
CDFBHN follow-up site review showed 100%
compliance to corrective action plan submitted to
DCF. 9/11/13 – TCHS has now secured new
physician credential checking on line. New
HIPPA changes are now complete and electronic
HIPPA regulations are now complete. As new
HIPPA changes and introduced, TCHS will
incorporate these changes as appropriate. 2/14/14
– new HIPAA changes incorporated into TCHS
operations and now available to all persons served
and on the new website.
10/11/12 TIC is now being taught at TCHA and
therapist are using in assessments of persons
served at clinic facilities. 9/11/13 – TCHS is
heading a local TIC commits and leads the county
Page 10 of 47
C. Identify training for employees in Best
Practices Model.
D. Identify other issues with moving to a
Managing Entity for DCF funding.
E. Identify ways to meet new Medicaid
requirements for billing/services/and staff
qualifications (educations)
F. Complete a management succession plan
for all key positions within the agency.
(Initiate FY 2012/13 complete FY 2013/14).
G. As identified previously, complete a
critical needs assessment for educational and
licensure requirement based on
Medicaid/Medicare and Third party payers.
H. Identify partners in the medical and
behavior health arenas that may be long
term partners to streamline efficiencies and
meet the demands of future revenue streams
as they develop in FY 2014 and beyond.
H.1 Identify potential alliances with other
agencies in participating in an Accountable
Care Organization.
H.2 Identify other alliances that will further
integrate the medical home model and be
cost effective to the agency.
H.3 Identify furthering integrated services
with the local public health departments.
H.4 Identify staffing trends and issues for
retention (FY 2013/14)
H.5 Identify a potential merge plan (FY
2012/13)
H.6 Based on above – adopt a merge plan
date (FY 2013/14)
I. Identify trends in employee retention
packages that allow the agency to be
competitive with like
industries/governmental agencies and health
care providers.
I.1 Identify potential staff severance plan to
retain personnel (FY 2012/13)
I.2 Identify potential retention letter to lock
in key individuals for merger( FY 2012/13)
J. Identify what this agency will look like
with regard to services, programs,
partnerships and corporate structure.
K. Investigate current person served fees
and formulate a strategy as to
in training and including TI”C in its programs.
10/11/12 Best Practices model being developed
for early 2013. 9/11/13 – TCHS is training
employees in Best practice models. First training
was in May 2013, with other scheduled in FY
2013/14
8/16/12 Many issues identified. Admission
criteria for residential programs, medical necessity
and utilization management reporting are major
issues still being clarified. 9/11/13 – ME issues
remain because ADM in Tally are changing
requirements. A new governing Appendix “A” is
being developed that may help clarify important
program and utilization issues in 2013/14.
10/11/12 New Medicaid handbook scheduled for
release in early 2013. TCHS already
implementing educational requirements for newly
hired staff. 9/11/13 – Still waiting for new
Medicaid Behavioral health handbook to be
released.
No activity 9/11/13 – No activity as of this time.
10/11/12 Assessment is being discussed at QAI
meetings. Implementation date not determined as
of yet. 9/11/13 – Critical need assessment has
been reviewed by Dr. Moore and is incorporated
into our Credible electronic health record.
On Going. ACO structure still not complete by
Federal government. 9/11/13 – TCHS identified a
potential medical partner and explored a
partnership arrangement. Medical partner pulled
away from the project. Currently TCHS
recommending a rural health care model to initiate
a medical practice. TCHS also hired a
pediatrician for mental health children in Avon
Park and hired Dr. Moore as full time Associate
Medical Director to lead this effort. TCHS
investigating partnering with Dr. Dane Parker for
Pharmacy and Rural Healthcare. .to add more
revenue streams into the business. Further
activity will be reported to the Board
On Going. 9/11/13 – A renewed effort has been
place by Bob Rihn in Recruitment and Retention
of TCHS employees. TCHS is exploring an
incentive program for clinical staff as well as
reviewing hiring practices to attract new licensed
staff. Continued efforts on interns from local
colleges/universities is ongoing in the clinical
programs with good success. TCHS now has paid
interns in some programs.
8/16/12 Merger potential with 3 other agencies
now ongoing. 9/11/13 – Merger efforts were
broken off in November 2012. With Gracepoint
agencies.
8/16/12 A new fee scale was developed and now
being utilized at all facilities. This addresses
Page 11 of 47
appropriateness for the service provided,
compliance with state regulation and
responsibility of the person served
VI. Regulatory/Legislative
Issues
A. Maintain compliance with all current
regulations from all licensing and funding
entities to include the following:
A.1 Government funding requirements
(electronic, credentialing, billing and
oversight issues)
B. Continue to integrate services of all
persons served to maintain co-occurring
treatments that are applicable to the person
served.
C. Continue to take advantages to any
“Green Programs” offered by the State and
Federal Government for environmental
sensitivity.
D. Be responsive to all local governmental
questions to ensure local funding, as
appropriate.
E. Identify the avenue to become a
credentialed Medicare provider in our
catchment area.
VII. Other Issues
A. Maintain contacts with decision makers
at DCF to sustain the contract for the Florida
Center in future years.
B. Identify a strategy for building ownership
(leasing) for the agency to be better able to
respond to changes in the way this business
is functioning in the future.
C. Identify resources (expertise) in business
areas that will be forth coming in the
immediate future (real estate, management
ideology, BOD consultation, financial
trends, etc)
sliding scale fee, private co-payments, Medicaid
co-payments and Share of Cost issues. 9/11/13 –
New sliding scale program working effectively
and within regulatory guidelines. 2/1/14 – Another
new sliding fee scale developed per Credible
guidelines.
On going as of 8/16/12 10/11/12 On Going
9/11/13 – New license applications being prepared
for 9/30/13 deadline.
8/16/12 Polk County Health Plan is requesting
$200,000 of integrated services at PHP providers
for FY 2012/13. We are ready to do this at this
time.10/11/12 Polk Health Plan has approved
monies for FY 2012/2013. Partnering with FQHC
for this opportunity. .9/11/13 – TCHS is currently
discussing with the FQHC, billing opportunities to
further substantiate the integrated services in Polk
county. This will allow expansion of licensed and
case management staff to serve more people in a
more effective manner. TCM program and
expansion of mental health in Polk County is
currently underway with the hiring of Dr. Moore.
A contract with TCHS and Bartow Regional is
anticipated for 10/1/2013.
On going
Ongoing 8/16/12. 9/11/13 – TCHS received a
renewal of integrated health program form Polk
county in 2013 for 2013/2014.
10/11/12 – Initiated application for Medicare.
Still issues with Community Health Centers
requiring partial hospitalization. TCHS sending
Medicare applications of qualified TCHS staff for
credentialing. 9/11/13 – Through Rural
Healthcare, TCHS will get Medicare billing
privileges.
8/16/12 DCF Tallahassee is now managing this
contract. TCHS will meet with DCF
administrators to ensure full utilization of the F/C
with an aim to increase funding over the next 5
years. 9/11/13 –TCHS got state approval for
funding of the F/C through 2013/14 with CFBHN
being the managing entity for the program.
8/16/12 Talking with WHHBH to lease space in
Sweet Center 10/11/12 WHHBHD decided not to
share space with TCHS due to merger with
Baycare. Other sites are now being discussed as
to what is best for TCHS locations in Winter
Haven. 9/11/13 – Due to the takeover of WWH
by Baycare, shared site is not possible. TCHS
entered into a 2-year lease with our current
landlord, 610 Corporation.
On Going 9/11/13 – Added Art Fullmer to BOD
for legal expertise.
Page 12 of 47
2014 - Highlights and Accomplishments:

TCHS adds two new directors to staff. – Heather Kaufmann and Becky Razaire were added into
the administration department to be responsible for the electronic health record, expanded
outpatient responsibilities, and budgeting for the agency.

TCHS develops new insurance department – In order to take advantage of more opportunities to
bill health insurance companies, Tri-County expanded the insurance department to be able to add
new health insurance companies and bill Medicaid faster than in previous years.
Agape House undergoes a new facelift – Agape was awarded monies from Give Well to upgrade
interior space for furniture, curtains, paint, and bathroom upgrades for both the big and little house
on the Agape property. All persons served and Agape staff contributed to this improvement.


TCHS Board Adds New Members – In 2014, the TCHS Board of Directors added Keith Edwards
and Mike Hickman to the Board of Directors. The board also welcomed back Barbara Cook from a
prolonged sabbatical

Bob Rihn appointed to CFBHN Regional Council Chair – CEO Bob Rihn was elected by the
providers in C-10 to be the Chair of the Regional Council and board representative for the CFBHN
Board of Directors

Credible recognizes Tri-County efforts at Annual provider meeting – During the 2014 Credible
providers meeting in Baltimore, MD, Tri-County was recognized as the provider who had more
direct input with regard to compliance to State of Florida billing requirements and leading the way
to develop a delete function for reported data that the State of Florida required. Eric Velazquez and
Jennifer LeMay were identified as contributing to this effort.

Tri-County expands Credible software for clinical use – In 2014, TCHS purchased more forms,
increased storage capacity and other software upgrades needed to assist the clinical team in
documenting services within the E.H.R system.

New jail medical contract awarded for Hardee jail – TCHS was awarded the contract from
Hardee County Jail to provide medical health services to the jail’s inmates.

New jail medical contract initiated for Okeechobee jail and added paramedics to that staff –
TCHS was also awarded the contract for medical services for Okeechobee County jail. We also
now employ paramedics to assist the nursing staff in the jail with medical services.

Tri-County increases Credible software utilization in 2014 – Tri-County increased it utilization
of the Credible software in 2014 that has resulted in more efficient use of the electronic health
record as well as added new reporting capabilities for management review.

Tri-County adds two new Administrative Directors – Tri-County added two Administrative
Directors positions in 2014. Heather Kaufmann was promoted to Special projects to include
Credible electronic health record, MSS/FIS, coordination with primary health physicians as well as
Lakeland and Winter Haven outpatient clinics. Becky Razaire was promoted to Operational
Programs to include Highlands and Wauchula outpatient clinics, JASA and Prevention.
Page 13 of 47
Who we serve by funding sources
All Funding Adult - Residential/Outpatient/Intervention SA and MH Services
Key –
AMH –
ASA –
ATCM –
CSA –
CTCM –
FL –
HOP –
JAG –
JASA –
LOP –
MH –
MSS –
PPWDC –
PTP –
SA SCRAC –
TL –
WHOP –
WOP –
Adult Mental Health
Adult Substance Abuse
Adult Targeted Case Management
Child Substance Abuse
Child Targeted Case Management
Florida
Highlands Outpatient
Jail Alternative Grant
Jail Alternative to Substance Abuse
Lakeland Outpatient
Mental Health
Motivational Support Specialist
Pregnant/Post-partum Women with Dependent Children
Private Testing Program (HIV)
Substance Abuse
Suncoast Aftercare
Transitional Living
Winter Haven Outpatient
Wauchula Outpatient
All Funding Adult Residential/Outpatient/Intervention SA and MH
Services
Program - Residential
FL Center
FC 5 Bed
FL Center Drug Court
Fl Center Level III
FL Center Aftercare
FL Center SCR AC
FL Center PPWDC
RASUW
RASUW Aftercare
RASUW Drug Court
RASUW Level III
RASUW PPWDC
AGAPE
TL Adult
Total
Program – Medical detox
Detox
Detox Drug Court
Detox III
Total
Program - Outpatient
HOP Outpatient
Total
207
36
1
0
189
99
3
89
20
3
11
12
44
9
723
Total
781
0
115
896
Total
435
Male
%
113
36
0
0
125
55
0
0
0
0
0
0
0
0
329
Male
452
0
57
509
Male
259
Female
100%
0%
0%
66%
56%
0%
0%
0%
0%
0%
0%
0%
0%
46%
%
94
0
1
0
64
44
3
89
20
3
11
12
44
9
394
Female
58%
0%
50%
57.00%
%
329
0
58
387
Female
60%
%
176
0%
100%
0%
34%
44%
100%
100%
100%
100%
100%
100%
100%
100%
54%
%
42%
0%
50%
43.00%
%
40%
Page 14 of 47
LOP Outpatient
MSS Services
PTP ASA
WHOP Outpatient
WOP Outpatient
Total
Program - Outpatient
ATCM
HOP AMH
PATH MH Services
RASUW MH
Total
Program – In Jail
JASA Frostproof
1172
262
436
498
144
2947
Total
57
849
83
15
1004
432
57
216
241
88
1293
Male
37%
22%
50%
48%
61%
48.00%
%
22
313
62
0
397
740
205
220
257
56
1654
Female
39%
37%
75%
0%
40%
63%
78%
50%
52%
39%
52.00%
%
35
536
21
15
607
61%
63%
25%
100%
60%
Total
Male %
Female
%
37
0
37
100%
JASA HC
JASA HC MH
JASA JAG
JASA Male
JASA Female
Total
120
36
49
161
74
477
62
28
49
161
0
337
52%
78%
100%
100%
0%
71.00%
58
8
0
0
74
140
0%
48%
22%
0%
0%
100%
29.00%
Total Adult
6047
2865
47.00%
3182
53.00%
All Funding Adolescent Residential/Outpatient/Intervention SA and
MH Services
Program – Child Outpatient
TL Child
HOP Outpatient CSA
LOP Outpatient CSA
PTP CSA
WHOP Outpatient CSA
WOP Outpatient CSA
Total
Program – Child Outpatient
Total
10
64
170
0
196
35
475
Total
Male
%
4
39
124
0
145
32
344
Male
Female
40%
61%
73%
0%
74%
91%
72%
%
6
25
46
0
51
3
131
Female
%
60%
39%
27%
0%
26%
9%
25.00%
%
HOP CMH
CTCM
Total
138
17
155
78
8
86
57%
47%
55%
60
9
69
43%
53%
45%
Total Adolescent
630
430
68%
200
32%
6677
3295
49%
3382
51%
Total Served
Page 15 of 47
2014 - Detox Admission
900
800
700
600
500
400
300
452
200
100
0
57
0
Detox Drug Court
Detox
Male
Detox III
Female
2014 - Transitional Living Admission
10
9
9
8
7
6
6
5
4
4
3
2
1
0
Adult Female
Male Child
Female Child
2014 - RASUW Admission
100
90
89
80
70
60
50
40
30
20
20
10
11
12
15
RASUW Level III
RASUW PPWDC
RASUW MH
3
0
RASUW
RASUW Aftercare RASUW Drug Court
Page 16 of 47
2014 - AGAPE Admission
50
45
40
35
30
25
20
15
10
5
0
44
Adullt Female
AGAPE
44
2014 - Florida Center Admission
250
200
150
94
64
113
125
100
50
0
36
0
FL Center
FC 5 Bed
44
55
1
0
0
FL Center Drug Fl Center Level
Court
III
Male
Fl Center
Aftercare
Fl Center SCR AC
3
0
FL Center
PPWDC
female
Page 17 of 47
2014 - MSS/FIS Admissions
250
205
200
150
100
57
50
0
MSS Services
Male
Female
2014 - Wauchula Outpatient Admissions
100
80
60
40
20
0
Adolsecent Male
Adloescent Female
Adult Male
Adult Female
Page 18 of 47
2014 - Winter Haven Outpatient Admissions
300
250
200
150
100
50
0
Adult Male
Adult Female
Adloescent Male
Adolescent Female
2014 - HIV Testing/Education
221
220
220
219
218
217
216
216
215
214
Male
Female
Page 19 of 47
Distribution by Family Income
$0.00
$1 - $2,499
$2,500 - $4,999
$5,000 - $9,999
$10,000- $14,999
$15,000 - $19,999
$20,000- $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 and over
2261
72
94
161
399
249
205
82
28
38
Distribution by Income
$50,000 and over
38
$40,000 - $49,999
28
$30,000 - $39,999
82
Income
$20,000- $29,999
205
$15,000 - $19,999
249
$10,000- $14,999
399
$5,000 - $9,999
161
$2,500 - $4,999
94
$1 - $2,499
72
$0.00
2261
0
500
1000
1500
2000
2500
Person Served
Page 20 of 47
Distribution by Race/Ethnicity
American Indian
Asian
Black
Multi-Racial/Hispanic
Native Hawaiian
White
15
62
1042
656
16
4256
Page 21 of 47
Service Demographic Analysis:
Tri-County continues to document the increase in females now obtaining services within the catchment area of
Polk, Highlands, and Hardee County. All counties noted increases. Economic indicators are reporting that
employment in our catchment area is steady but not keeping pace with State of Florida unemployment rates
and overall growth. Income levels of the person served has not changed significantly since 2013. Only about
17% of all persons served report income levels above the federal poverty line.
The population that is serviced by Tri-County is proportional to the general population for our catchment area.
In 2014, Tri-County served fifteen (15%) African American and eleven (11%) Hispanic population as
compared to the population as a whole. Because of the diversity of our catchment area, Tri-County also served
American Indian and Native Hawaiian persons. Although not a significant population as compared to our
overall persons served numbers, these individuals are now seeking treatment that heretofore would not have
been served by the agency.
Tri-County’s program areas continue to document that our outpatient programs are our highest utilized
programs within the agency. Our Detox program, compared to last year’s numbers, has increased in the
number of persons served, however, utilization of the Detox program is not at levels we expected in 2014. The
QAI committee continues to review data from the person served (satisfaction surveys and from high end
utilizers) to determine if the program needs more linkage services into outpatient services or referrals from
other resources to reach potential persons in need of Detox services. In 2015, there will be an increased focus
to move persons served into detox that then will be placed in a more intensive rehabilitative service (such as
residential and IOP) to allow for better utilization of the Detox program.
Drugs of choice continue to be Alcohol, Marijuana, and Methamphetamines. Abuse of prescription drugs now
tops the list, after alcohol as the number one killer of people when they are abusing drugs. Prescription drugs
are being used by more people than ever before and the trend is not decreasing over time. In 2014 new
legislation action has placed some restraints on the amount of medication prescribed by a physician and the
amount of medication distributed. With the introduction of K-2 and other synthetic drugs on the open market,
Tri-County is having a difficult time identifying some drugs as we do marijuana, oxycodone, and
amphetamines. This is why the graph shown indicates “other” and a large section of a diagnosis with a person
served.
Page 22 of 47
Persons Served and Community Assessment Surveys of the Agency:
Outpatient Services: - Community Assessment and Client Assessment indicate the following:
As is the case within all programs at TCHS, Individual Therapy/Counseling continues to be the single most
treatment modality offered. Outpatient services continue to be the majority of services offered the person
served when compared to all services offered. The mental health contract at Highlands Outpatient (HOP),
adds to the outpatient services in Highlands County. Persons served are overall satisfied (see chart and
reported numbers further on in this report) with services they receive as indicated by the client satisfaction
survey report.
The community does not quickly identify TCHS as the number one agency to seek behavioral health services.
The TCHS board of Directors has identified in the strategic plan a committee to review our promotional
literature and marketing practices. The State of Florida limits advertisements to promote the agency as it limits
revenue designated for person served care. Unless the client has a behavioral health problem, the individual
may never know that TCHS, as an agency in the community, is providing these types of services.
Our programs are considered by referral sources and stakeholders as model programs for substance abuse and
mental health within our community. Polk County Sheriff Grady Judd continues his support of TCHS. Polk
County BoCC funded JASA at $375,000 in 2013 vs $425,000 in 2012. In 2014 the funding for JASA was
reduced to $255,000 as the BoCC decision to not fund “outside of the county budgeted programs” that do not
provide direct services to the county as a political sub-division, is being implemented. The end result will be
that JASA will not be funded by the Polk County BoCC over time.
State of Florida Department of Children and Families (DCF) and other Community resources have long
recognized the high level of credible professionalism of the TCHS staff and the agency. The TCHS “no wrong
door” entry philosophy clearly enhances service access to Tri County co-occurring programs.
In 2014, Tri-County continued with previously identified issues of the integration of mental health and
substance abuse with the medical community. Working with the Polk Health Care Plan and Central Florida
Health Care, the agency is attempting to utilize the strengths of all agencies for the overall well-being of its
persons served. The PATH program continues exceeding expectations and funding issues are a continual issue
that will be addressed each budget session. In 2014, continuing into 2015, funding from the State of Florida
will be a challenge as block grant funding is being replaced, in part, with the Affordable Healthcare Act.
Medicaid expansion was not approved by the legislature placing pressure on agencies to offer services within
the constraints of approved funding with no additional funding being forecasted on the horizon.
Detoxification Unit: - Community Assessment and Client Assessment indicate the following:
As previously stated, in 2014, there was an increase in utilization of the detox program. The agency notes that
more out-of-catchment area and out-of-state individuals are now being admitted into Detox and increased in
2014 vs. 2013. In 2014, Tri-County expanded the use of level 3 beds as a means to maintain the person served
in beds after the initial detox program was completed and before a level 2 bed was available. This decision
allowed the agency to continue to provide substance abuse services to many persons served that may have
been discharged prematurely from Detox and needed more treatment. This process allowed the person served
to maintain a quality of service and stay within the agency rather than being discharged early from Detox.
Page 23 of 47
Residential Services - Community Assessment and Client Assessments indicate the following:
RASUW Center for Women:
The RASUW program is a 15-bed program that gives priority to pregnant and postpartum individuals with
substance abuse issues. As in 2013, in 2014 the agency continued to experience a decrease of the Medicaid
eligible women in the RASUW program. This activity has placed a strain on Central Florida Behavioral
Health Network (CFBHN) dollars and the ability to admit appropriate women into treatment. The agency is
now admitting more Temporary Assistance to Needy Families (TANF) eligible persons served into the
program. In 2014, the agency continued to receive $45,000.00 in funds for mental health person served
admitted into the RASUW program. There will be a continuation of that money for 2015 funding. RASUW
Center for Women continues to receive high marks, from United Way of Central Florida and Client
Satisfaction Surveys, for the success of persons served graduating from the program. Staff recognition from
the person served is remarkable for this program.
AGAPE Half-way Program:
The Agape program, a Level 3 female only half-way house, has been recognized by the local United Way as a
remarkable program serving the community. The United Way recommended, in 2014, full funding for the
agency to be able to assist these individuals in the program as well as in medical issues they may have while in
treatment. Ten residents are in this program at any one time seeking to become active members of the
community and restore their parental right to again unite with their children. In 2014, Agape under took a
major revitalization program with upgrades to the interior and furnishings of each of the buildings in the
Agape program. The person served also participated in the planning of the improvement, decoration of the
buildings and final placement of all furniture and accoutrements.
Assessments/satisfaction surveys for this program have been high from the community (United Way) and the
person served.
THE REZ:
Located adjacent to Agape in Winter Haven is not a treatment program but rather is a resident run facility with
general oversight by TCHS staff. Single women, having completed treatment are the focus of this program.
Florida Center: Florida Center for Addictions and Dual Diagnosis:
The Florida Center, being a unique co-occurring program serving the entire State of Florida, continues to
remain a valuable asset to the local community and the state as a whole. Many counties now have integrated
programs which enhances the return of individuals served to their home from Florida Center. The Florida
Center not only serves primary substance abuse individuals, but serves severely and persistently Mentally Ill
(SPMI) individuals as well as the forensic individuals who have been determined to be incompetent to stand
trial. Florida Center is treating all of these individuals and is experiencing success within the program.
Coupled with an aggressive aftercare program that follows Florida Center graduates after discharge, TCHS can
provide data to funding sources on the graduate status, continuing treatment/half-way house living and
recidivism, if any.
Local utilization and impression of the Florida Center is positive. Out of area assessments from community
referral agencies and other resources suggest that a lack of understanding of what the Florida Center offers in
terms of treatment and aftercare suggests a lack of clear knowledge of the program. These counties now have
the ability to offer integrated treatment with local treatment providers, which in past years was not an option.
Assessment/satisfaction surveys from the person served is generally high. However, common expressions of
Page 24 of 47
interest include limitations on physically aggressive sports and some individuals, primarily those with “junk
food” preference request food taste and food of higher carbohydrates. These are issues that are noted on the
satisfaction surveys. The agency has addressed these issues with our dietician for the food issues to come as
close as possible to existing food preference but meeting dietary requirements of the program. Because of
insurance coverage concerns and safety issues with physical aggressive sports programs, we have not been
able to reinstate those programs. The agency is also continuing the food stamp program for all persons served
in residential settings to include Florida Center in 2013.
The Highlands County Sherriff is a strong advocate of Tri-County programs and is trying to assist with local
funding issues. The Sherriff and TCHS personnel continue to work together to find additional funding to offer
more specialized programs at the Florida Center and within the community.
On the whole persons served express satisfaction with the program as it is currently configured.
trends were noted in this area.
No other
Housing and Urban Development (HUD) Program
HUD supported housing is available in a voucher program for women and families in need of housing. This
staffed site approval facilitates individual’s use of outpatient services and/or aftercare services to maintain
stability.
Prevention Services:
In 2014, the prevention program continued in its pure science based approach. Tri-County continues to work
in all schools in Highlands and Hardee County’s and expanded selected schools in Polk County. Due to school
rankings from achievement testing of students and the low grades the schools received in 2014, the ability to
offer prevention services was severely handicapped. To combat this issue, Tri-County introduced a new
prevention outreach program in which the agency placed counselors at local flea markets to hand out flyers
and program information to adults, parents and children interested in Tri-county services. This program is
generating more interest in Polk County schools and may assist us in bringing the program into more Polk
schools.
Each year the prevention team must obtain pre and posttests. Based on over four (400) hundred test results, all
showed improvement in value, self-awareness of the influence of drugs, and self-worth in making decisions
about alcohol and drugs. The prevention program provides positive value and knowledge to the students they
are targeting.
KEY OUTCOMES:
TCHS programs are meeting all of the outcome levels established by contracting sources. Recognition by
funding sources like DCF, Polk and Highlands County’s, and CFBHN are indicative of the quality programs
being offered to persons served on a daily basis. During contract negotiations, outcomes are discussed and
modified due to funding, economy and State regulation. Tri-County continues to keep all funding sources
aware of problematic issues so that they can be addressed timely.
As in past years, adult clients who successfully completed treatment service was documented in our electronic
health record at 75%, exceeding the State of Florida target. Data available indicates the following information
regarding outcomes at the end of 90 days following treatment.
1. The person served employment is documented at 78%, employed. This number continues to be of
concern as Polk County is one of the highest unemployment counties in the state.
2. The agency had thirty (30) persons served that had a new legal charge pending at the time of the
follow-up. Four hundred ninety-three (493) individuals did not have new charges at the time of the
survey.
Page 25 of 47
3. About 88% of TCHS served clients remained free of new charges and are now contributing to the
community and not requiring additional resources because of any new arrest charges.
4. The agency is recording increases in the number of person served who are leaving the residential
treatment against medical advice. Follow-up with staff report that individuals in treatment are
under increased pressure from families to leave because of legal issues, child issues or other family
related issues.
One goal for 2014 was to try to assign staff to work with the person served families to minimize negative
influences regarding leaving treatment early and to examine aftercare interventions that will increase length of
involvement of the person served. The HUD and aftercare program assigned staff to monitor and assist the
person served to involve families and reduce individuals leaving treatment early. The 90 day follow-up survey
indicates that this strategy is working.
As noted above in Highlights, AHCA advanced TCHS monies to allow the agency to continue to serve persons
for which services were on hold because of billing and payment issues. These issues are now resolved.
Outcomes for 2014
FY 13-14 Ending June 30, 2014 Performance Measures Achieved
Central Florida Behavioral Health Network Contract
Target Population and Performance Measure Description
Adults Community Mental Health
a. Percent of adults with severe and persistent mental illnesses who live in stable housing
environment
b. Average annual days worked for pay for adults with severe and persistent mental illness
Target
TOTAL
93
98.52
30
185
c.
Percent of adults in mental health crisis who live in stable housing environment
90
97.01
d.
Percent of adults with serious mental illness who are competitively employed
15
36.38
e.
Percent of adults in forensic involvement who live in stable housing environment
70
100
95
100
65
100
86
95
64
87.08
100
86.47
50
59.71
Percentage change in clients who are employed from admission to discharge
Percent of adults with substance abuse who live in a stable housing environment at the time of
discharge
d. Percent change in the number of adults arrested 30 days prior to admission versus 30 days prior to
discharge
Children’s Substance Abuse
20
27.41
80
96.81
35
-43.4
Percent of children who successfully complete substance abuse treatment services
Percent change in the number of children arrested 30 days prior to admission versus 30 days prior
to discharge
Percent of children with substance abuse who live in a stable housing environment at the time of
discharge
55
48.08
20
-17.39
85
98.75
Children’s Mental Health
a.
b.
c.
Percent of children with serious emotional disturbance (SED) who live in a stable housing
environment
Percent of children with serious emotional disturbances (SED) who improve their level of
functioning
Percent of school days seriously emotionally disturbed (SED) children attended
d. Percent of children with emotional disturbance (ED) who live in a stable housing environment
e. Percent of children with emotional disturbances (ED) who improve their level of functioning
Adult Substance Abuse
a.
Percent of adults who successfully complete substance abuse treatment services
b.
c.
a.
b.
c.
These numbers indicated that Tri-County is meeting and exceeding performance measures in 2014.
Page 26 of 47
FY 13-14 Ending June 30, 2014 Targets and Numbers Served
Central Florida Behavioral Health Network Contract
Target Population and Numbers Served
Adults Community Mental Health
a. Number of Adults with Forensic Involvement Served
b. Number of Adults with Severe and Persistent Mental Illness Served
c.
Number of Adults with Mental Health Problems Served
Target
TOTAL
11
25
360
415
325
112
13
10
41
2,420
26
2,142
601
392
7,000
13,036
700
798
185
175
2,260
176
132
8,497
148
199
Children’s Mental Health
a.
Number of Children with Serious Emotional Disturbances (SED) Served
b. Number of Children with Emotional Disturbances (ED) Served
Adults with Substance Abuse Problems Served
Children with Substance Abuse Problems Served
Regular Prevention Services
a.
Number of Children Participating in Prevention Services
b.
c.
Number of Children Participating in Level 1 Prevention Programs
Number of Children Participating in Level 2 Prevention Programs
Prevention Partnership Grant Services
a.
b.
Number of Children Participating in Prevention Services
Number of Children Participating in Level 2 Prevention Programs
The Florida Center – Adults with Substance Abuse and Co-Occurring Problems Served
Analysis of the performance measures indicated in the above data indicated that Tri-County performed at
above standards in all but four (4) outcomes out of forty-four (44) indicators or achieved 91% of all contracted
indicators. Because some categories have low census, a difference of new negative outcome will greatly affect
the overall percentage and final score. This was the case in several outcomes not meeting established goals for
the year.
In 2015, Tri-County will be focusing on outcomes on a monthly basis and will hold supervision accountable
for all outcomes monthly through a matrix monitoring process. This matrix process will allow management to
utilize existing data tools to monitor in almost real time to make corrections/adjustments timely so as to limit
negative outcomes by the end of the year.
90-Day Follow-up Surveys
Each year TCHS surveys all available persons served for follow-up after they have been discharged for 90
days. This survey is part of the contract requirement of DCF, as an indicator of the success of the person
served after they leave the agency.
Historically, TCHS has had difficulty in contacting these individuals as they have left the area, moved to
another location; don’t want to correspond with us after discharge, or other reasons known only to them. As
discussed in the two sections above, TCHS has assigned an employee of the agency to contact of these
individuals to see if we could contact more than or at least 10% of the discharged person served. We
established a contact rate goal of 15% of all discharged persons served.
Page 27 of 47
Last year (2013) we attempted to contact at least 10% of all discharged persons served participating in the
survey. In 2014 TCHS made 659 attempted contacts with the person served who were at the 90-day follow up
benchmark. This number of attempts was an increase of 202 contacts vs. last year. This represents an attempt
to contact success rate of 13.73% of all discharged persons served in 2014 compared to 11.12% of all
discharged persons served in 2013. A total of 523 individuals responded for a completed percentage of
10.385% of contacted persons served in 2014 vs. 9.49% of contacted persons served in 2013.
Data expressed below in graphic form identifies the key questions asked in the 90-day follow up survey.
The graphs tell a story of individuals who are trying to succeed and some who need to come back for services
to continue the recovery process. For the most part negative responses are within the statistical margin of error
and not out of line with expected results. TCHS continues to strive to improve indicated negative scores where
the agency can have a direct impact on certain criteria. The charts below reflect post treatment inquiries as
related to person served responses.
During the past 30 - 90 days have you spent time in
jail?
600
523
500
400
300
200
34
100
0
NO
YES
Have you used alcohol in the past 30 days?
500
450
451
400
350
300
250
200
72
150
100
50
0
YES
NO
Page 28 of 47
Current Employment Status
200
173
162
150
105
100
35
50
33
15
0
FULL-TIME (35+
HRS./WK.)
NOT IN LABOR
FORCE
NOT SEEKING
EMPLOYMENT
UNEMPLOYED
PART TIME
UNKNOWN
(STUDENT,
HOMEMAKER,
ETC.)
Compared to alcohol/drug use prior to treatment,
describe your current use
50
44
40
30
18
20
10
10
0
ABOUT THE SAME
MORE FREQUENT OR MORE SEVERE
LESS FREQUENT OR LESS SEVERE
Current Educational Status
500
450
400
350
300
250
200
150
100
50
0
455
64
4
ENROLLED IN EDUCATION
COURSE(S)
ENROLLED IN VOCATIONAL
COURSE(S)
NOT APPLICABLE
Page 29 of 47
Substance used in last 30 days
45
43
40
35
29
30
25
20
15
10
5
0
ALCOHOL
DRUGS
Have you been arrested on any new charges since
leaving treatment?
600
493
500
400
Yes
300
No
200
100
30
0
1
Have you been suspended from school since leaving
treatment?
500
485
400
300
200
8
100
30
0
YES
NO
DOES NOT APPLY
Page 30 of 47
My life, at this time, is . . .
250
227
200
163
150
100
63
53
17
50
0
VERY GOOD
OK, NO PROBLEMS
OK, NORMAL LIVING
PROBLEMS
DIFFICULT, SOME
PROBLEMS
VERY DIFFICULT,
MAJOR PROBLEMS
My personal relationships, at this time, are . . .
450
423
400
350
300
250
200
150
85
100
15
50
0
GOOD
FAIR
POOR
Are you actively involved in support groups?
280
278
270
260
245
250
240
230
220
YES
NO
Page 31 of 47
If in support groups. How often?
120
101
100
80
61
60
43
40
40
20
0
1X PER WEEK
2X PER WEEK
3X PER WEEK
4X OR MORE PER WEEK
Birth Outcomes for RASUW Persons Served
25
25
20
15
15
10
5
0
0
0
0
0
0
LIVE BIRTH
(DRUG
PRESENCE IN
NEWBORN)
LIVE BIRTH (NO
DRUG
PRESENCE IN
NEWBORN)
STILL BIRTH
MISCARRIAGE
PREGNANCY
TERMINATED
NOT YET
DELIVERED
N/A – DID NOT
ATTEND
RASUW
While at Tri-County - I felt comfortable with my
counselor
250
236
197
200
150
73
100
17
50
0
OUTSTANDING
GOOD
FAIR
POOR
Page 32 of 47
I was treated by staff in a considerate manner.
300
264
250
195
200
150
100
53
11
50
0
OUTSTANDING
GOOD
FAIR
POOR
I gained insight to my condition and made positive
changes.
300
287
250
200
180
150
100
45
11
50
0
OUTSTANDING
GOOD
FAIR
POOR
I was offered referrals for assistance upon
discharge.
300
293
250
200
163
150
100
56
11
50
0
Outstanding
Good
Fair
Poor
Page 33 of 47
There was a positive change in my life.
350
313
300
250
200
155
150
100
46
9
50
0
OUTSTANDING
GOOD
FAIR
POOR
My housing situation is now . . .
200
180
160
140
120
100
80
60
40
20
0
195
123
83
65
57
RENTING
OWN MY OWN
HOME
LIVING WITH
RELATIVES
LIVING WITH
FRIENDS
OTHER
Quality Assessment and Improvement
The Quality Assessment and Improvement Committee (QAIC) is charged with monitoring the quality of both
service provision and clinical documentation. This committee meets monthly and selects/reviews critical
indicators of care. Indicators are noted for quality improvement to established policy/procedures, or to
improve clinical/health quality in particular areas of concern.
Detoxification Unit:
Although CFBHN put into place stiffer qualifications for admittance into residential programs, utilization
criteria (days allowed into the program before another authorization was required for continuation in the
program and reporting data on high utilizers of the Detox program, the overall 2014 quality indicators
remained constant from 2013. This means that despite tighter restraints on admission into residential
programs, TCHS was able to admit the person served into treatment, complete timely assessments for referral
into treatment (residential or outpatient), maintain appropriate education of the person served on the addiction
Page 34 of 47
process, referral into medication management (if appropriate), and assistance with any Marchment Act persons
served at the Detox facility among other indicators. A new policy on the processing of insurance that covered
the person served was finalized and incorporated in the admission of new patients in the Detox program.
Though limited in its affect, this did allow the Detox program a tool to add additional funding for the program.
CFBHN requirements for utilization review placed the program in the position of getting approvals for
admission before the person served presented at the program. The TCHS developed Level III program for
Detox helped gain admission for a significant portion of the daily census at Detox. In 2015 new “real time”
reporting to the managing entity will be instituted by CFBHN to be able to report admissions and discharges at
the facility.
Florida Center:
In 2014, the Florida Center was funded by substance abuse and county monies. A decision was made to try to
incorporate level 3 beds at the Florida Center. Due to high person served utilization in 2014 that continues into
2015, Level 3 beds were not proportionally utilized. Placement of Florida Center graduates into half-way
housing had become more difficult due to person served income requirements. As most Florida Center
graduates are either homeless or not employed, placement into the half-way house is limited because of paying
residents already at the half-way house.
Assessments for admission to treatment to the Florida Center are being conducted at the Detox facility, when
appropriate, to assist in wait list criteria.
RASUW Center for Women:
Changes in DCF requirements that required the person served to be face to face interviewed before being
placed on a wait list as assessment is now in effect. RASUW is working with Detox to assess potential persons
served for admission not only to RASUW but to the Florida Center as well. A decision (that if appropriate)
was made to utilize Detox Level III beds in order to protect potential admissions into RASUW from relapsing
before being admitted. This process is accomplishing several goals in referrals to appropriate treatment until a
vacancy opens at the facility and to better utilize all programs as space becomes available.
CFBHN requirements for utilization review placed the program in the position of getting approvals for
admission before the person served presented at the program. In 2015 utilization review at CFBHN will be
changed to “real time” reporting; however the time involved in documenting admission to CFBHN is not being
changed significantly. TCHS gained mental health monies late in 2013 that assisted other females, not
otherwise qualified to be admitted into RASUW, to receive treatment. These monies continue into 2014 and is
expected to continue into 2015.
Agape Halfway House:
This program continues to be recognized by the United Way of central Florida as an outstanding program of
choice to fund as outcomes are above contracted goals and persons served are becoming productive members
of society. TCHS continues to partner with several agencies to find suitable housing after discharge from the
program. The Agape wait list continues to increase because of funding issues. Quality Assurance meetings
continue to focus on interim services or referral to other half-way housing in the area. Satisfaction surveys
indicate overall acceptance with the program. Successful outcomes in initiating reunification with the person
served and their children is one goal that the program asks their persons served to initiate and complete with
the Department of Children and Families (DCF) before discharge form the program.
Outpatient:
Page 35 of 47
Issues identified and addressed in 2014 related to proper documentation of the person served file timely and
accurately reflecting all presenting issues. Other issues identified include proper verification of the treatment
by the physician, and initializing the computer use for progress notes and the treatment plan. Contracts with
DCF and Medicaid also require aftercare and discharge planning, which makes the file more comprehensive.
Peer review and appropriate follow through in files will be a goal in 2014 to maintain. External audits results
remained at exceptional ratings from outside auditing sources like DCF and CFBHN. Internal tweaking of
files will remain within the QAI agenda.
Agency Wide:
Tri-County continues to be negatively impacted by funding issues that limit serving all possible individuals.
Identifying internal controls to better utilize the resources available in the agency and reporting on progress
towards these goals will help in better utilizing the limited funds available. Integration of medical health
programs along with behavioral health programs will be a continuing emphasis, as well as exploring new
opportunities as they present themselves in the future.
CFBHN requirements for utilization review placed the program in the position of obtaining approval for
admissions before the person served presented at the program. This required extreme attention to detail that
took time in gaining approvals for admission. In 2015 utilization review at CFBHN will be monitored as close
to real time as possible. Expectations of the clinical staff will include being productive at least 65% of their
work time and reviewing the drawdown of billing units by month, per contract guidelines.
Overall the agency is being received in the community as a viable and positive force in the treatment of
behavioral health issues. Staffing is changing to reflect these demands as we see needs for licensed and
masters level counselors. The addition of medical staff also requires medical peer to peer review that will be
addressed in FY 2014/15. The ability to hire and better utilize interns will build a solid core of employees for
the future.
Driving Under the Influence (DUI) Program Demographics
Driving Under the Influence (DUI) Program Demographics
January 1 – December 31, 2014
DUI Enrollments Polk County
Program Male Female Total
Level 1
444
148
592
Level 2
228
51
279
All DUI’s 672
199
871
DUI Enrollments Hardee & Highlands
Program Male Female Total
Level 1
65
25
90
Level 2
37
7
44
All DUI’s 102
32
134
All DUI Enrollments
Program Male Female Total
Level 1
509
173
682
Level 2
265
58
323
All DUI’s 774
231
1,005
1. 66% of the male DUI offenders were Level 1 and 34% were Level 2 or repeat offenders.
2. 75% of the female DUI offenders were Level 1 and 25% were Level 2 or repeat offenders.
Page 36 of 47
3. 77% of all DUI offenders enrolled were Level 1 and 23% were Level 2 or repeat offenders.
4. Of all Level 1 DUI offenders enrolled 75% were male and 25% were female.
5. Of all Level 2 DUI offenders enrolled 82% were male and 18% were female.
2012 - 2014 Comparison of Special Supervision Services and Ignition Interlock Device
New Enrollments and Monitoring Appointments
Special Supervision Services (SSS) - A hardship license reinstatement program for DUI offenders.
Ignition Interlock Device (IID) - A monitoring program for IID violations by DUI offenders
Year SSS New SSS Updates IID New IID Updates
2012
67
958
92
198
2013
50
1127
102
282
2014
40
1,116
108
282
SSS enrollment numbers continue to decrease due to the cost of the program, which includes a Driver License
reinstatement fee, payment of all unpaid tickets, initial SSS enrollment fee, ongoing case monitoring fees, biannual fees for Florida Department of Law Enforcement (FDLE) and driving records, and random drug
screens. All SSS enrollees are also required by law to pay for their IID installment, calibration and
monitoring.
DUI Program Summary
In 2014 the DUI enrollment percentages for the agency were fairly consistent with 2013 percentages. It
appears from meetings with Polk, Hardee, and Highlands Community Traffic Safety Teams that the number of
arrests in our catchment area has continued to lessen over the past three (3) years. The courts are still
processing approximately the same amount of DUI cases and convictions. We can only assume from our
summaries of the number of people enrolled that the economy continues to affect our program numbers. Many
DUI offenders appear to continue to drive without a valid driver’s license until they go through our program.
Any DUI offenders with higher Blood Alcohol Content, a Refusal, or a Level 2 offender status at the time of
their arrest/conviction will have the added cost and driving restrictions of IID.
DUI providers throughout the state are experiencing the same issues as we are with respect to numbers
enrolling in their respective programs. The re-organization of the Department of Highway Safety and Motor
Vehicles (DHSMV) in 2013, and their continued efforts in 2014 have been very productive.
The TCHS DUI program received its written audit report from the Florida DHSMV for their Site Visit. We
had no noted deficiencies.
Accessibility
TCHS continues to be totally accessible in all facilities for persons with disability. Changes in the DCF
contract for 2014 now require all agencies to pay particular attention to deaf and hard of hearing persons
served. Tri-County is now reporting monthly any person served who is in need of a deaf interpreter or hearing
aids in order to comprehend the program and successfully complete the program along with language barriers
and other accommodations that assist the person served in accessing treatment.
TCHS was audited by the Civil Rights Division of the Department of Children and Families (Deaf Hard of
Hearing requirements). We were found to be in compliance with all standards of the regulations.
Page 37 of 47
Cultural Diversity
The Recruitment and Retention (R&R) Committee is responsible for addressing cultural diversity for the
agency. The committee has been identifying barriers (attitudinal, physical facility, and cultural) within the
agency that may affect our recruitment and retention of potential minority employees. One of the identified
issues are building accessibility at our Lakeland outpatient facility and a ramp located within the building that
hinders persons with certain disabilities to access from one floor to another. Costs in correcting this issue have
not been identified to date so disabled person served must access the first floor by an entrance at the rear of the
building and not the front. Another issues identified is one of new counselors who are new graduates of
academic programs lake a sensitivity for addictions and mental health issues. The committee recommended
that program supervision take time at staffing meetings to review with staff what the person served was
presenting, conduct appropriate assessments by utilizing evidence based assessment tools and diagnose based
upon those factors and not allow individual preferences infer with treatment of the person served.
Utilization Review
Throughout the year, TCHS reviews data that reflects utilization of all programs (contracting for beds in
residential, utilization of all available contract monies and compliance to all outcome and performance
standards outlined in the contracts. This information is reviewed annually by the QAI committee as well as
management to determine if the agency is progressing successfully through the contracts, identify any program
changes or modification to better serve the person served and report to the community through this report on
utilization efforts to make the program as viable as possible and to be as compliant as possible to the contract
language. Changes (through amendments) in the contracts are required regularly due to utilization and/or
outcome fluctuations caused by many variables. All records of amendments are kept with the contract for a
period of seven (7) years. TCHS services provided were within the Rules and Standards promulgated for care.
All services were appropriately invoiced and reported to oversight and contractual monitors, based on internal
and external utilization review activities. A sampling method and a statistical review of specific charts
comprise utilization review of client services. Because of our CARF accreditation, State of Florida licensure
monitoring is reviewed annually but closely monitored every three years. One utilization criteria that has been
identified in 2015 is a report on the person’s length of stay in residential versus early release, leaving against
medical advice and administrative discharge. CFBHN has placed utilization review requirements on the
agency for residential programs. These requirements are timely and detailed and depend upon a third party to
grant access of the person served into treatment. This has slowed some admissions at different program
locations. CFBHN modified the utilization requirements in 2014, however early information indicated that
residential admissions are under significant review due to the expense of monies in residential treatment vs.
outpatient treatment of the same person served. QAI has determined that the agency has the data available but
it is not easily obtained and therefore not reported as frequently as Quarterly in the QAI meetings.
Peer Reviews
Peer reviews are conducted monthly through our QAI committee. A critical analysis of our peer review
structure revealed that this process needs to be improved through the reporting and documentation through the
QAI minutes to ascertain that the process was lacking depth and consistency of the review. A critical analysis
of the process does indicate that the peer review is acceptable, but reporting is not definitive enough to
properly document the process. In FY 2014/15 we will initiate peer reviews to include medical peer review.
Due to the mental health program in Highlands County, it is now necessary.
Page 38 of 47
In 2014 it was anticipated that some changes to the peer review process will be required due to new
requirements from CFBHN to detail and document admissions in emergent, urgent and routine admissions.
Peer review will then require a review of emergent admission and comment on proper referrals, referral follow
up and proper document of the chart to reflect what was done in the best interest of the person served.
Ineligible for Services Logs
These logs were reviewed monthly at the QAI Committee. Because of changes in the DCF contract,
residential programs will no longer have ineligible for services. A proper referral will be made to
accommodate these individuals. TCHS will continue to review those individuals who are referred to make
sure that services provided at an alternative source are inclusive of the needs of the person served.
Client Satisfaction Surveys
Each year, every person served within the agency is requested to complete a survey that indicates his or her
attitude towards the agency, the counselor, treatment received, and overall satisfaction of the services of the
agency. These results are reviewed monthly in our Quality Assessment and Indication Committee.
Noteworthy employees who were identified in these surveys are identified and recognized by management for
their exemplary service to our persons served.
The agency goal is to average 3.5 on this 4.0 scale. Noted below are the overall agency averages for the FY
2013/2014
2013/2014 - Client Satisfaction Survey Monthly Results
3.90
3.85
3.80
3.75
3.70
3.65
3.60
3.55
3.50
July
September
November
January
March
May
Average
Page 39 of 47
Safety
The agency continued in improving the safety results with regard to injury (employee and persons served) and
in facility safety improvements. With recommendations from our fire inspections (outside fire marshal and
internal reports) as well as outside building inspections, Tri-County continues to place safety paramount in all
aspects of our facility programs. The agency was inspected by our Workers’ Compensation insurance
company again this year. Based on these recommendations; new sidewalks were installed at Florida Center
and Agape to eliminate trip/fall hazards, electrical cords were relocated in LOP and the pharmacy. Overall the
agency’s safety record is improving with training, observation/elimination of safety issues and critical analysis
of reported incidents.
Incident Reporting
In 2014, there were 215 incidents reported to the agency through the unusual incident reporting system. This
was a decrease over 2013 by one report. As a comparison, employee reported incidents decreased again in
2014. Because of the nature of injuries requiring medical attention, Tri-County is experiencing increases in
workers’ compensation expenses over the previous year because of increase in medical treatment costs per
employee, if injured.
This year, following a review of 2014 incidents and 2013 reported incidents, we added some more information
regarding incidents. We are looking at injuries and medical only reports as well as abuse, medical errors
(medications given or not given in error), and other incidents such as serving warrants on a residential campus,
elopement of a person served or other incidents not covered above. This will assist the agency in better
identifying incidents that have direct person served application and other incidents that only have indirect
effect on the person served.
Analysis of the reports indicate that the residential programs reported the highest number of incidents for both
the person served and the employee.
CFBHN data details the reported deaths for person served within 6-months of discharge. Deaths did not occur
on the premises of any TCHS facility. TCHS reported ten (10) person served deaths in 2014. These deaths
were either mental health persons served who either took their own life through suicide or overdosing on
prescribed medication. One person served died from complications infection that could not be treated
effectively with antibiotics.
Tri-County Incident Summary Report CFBHN
Category
Child Arrest
Child-on-Child
Sexual Abuse
Death
Elopement
Employee Arrest
Employee
Misconduct
Escape
Missing Child
Number of
Incidents
0
1
Percent of Total
10
0
0
0
83%
0%
0%
0%
0
0
0%
0%
0%
8%
Page 40 of 47
Other-Media
Other (Not
Media)
Security Incident
- Unintentional
Sexual
Abuse/Sexual
Battery
Significant Injury
to Clients
Significant Injury
to Staff
Suicide Attempt
Total
0
0
0%
0%
0
0%
0
0%
1
8%
0
0%
0
12
0%
Incidents As of - 12/31/14 - Administration
1.2
1
0.8
0.6
1
1
1
0.4
0.2
0
0
0
0
0
0
0
0
0
0
0
Incidents As of - 12/31/14 - LOP
12
10
8
4
6
4
6
2
6
1
4
2
0
3
1
2
Page 41 of 47
Incidents As of - 12/31/14 - WHOP
4.5
4
3.5
3
2.5
2
4
4
1.5
3
1
0.5
1
0
Incidents As of - 12/31/14 - RASUW
14
12
10
8
6
12
12
4
6
5
2
0
0
0
0
0
1
0
0
0
Incidents As of - 12/31/14 - Agape
14
1
12
10
8
6
12
1
12
4
6
2
0
4
1
1
Page 42 of 47
Incidents As of - 12/31/14 - F/C
70
60
10
50
40
30
52
52
7
20
10
20
10
1
0
2
3
23
0
0
Incidents As of -12/31/14 - JASA Polk County
2.5
2
1.5
1
2
2
2
0.5
0
Incidents -As of- 12/31/14 - PATH
3.5
3
2.5
2
1.5
3
3
1
0.5
2
1
0
Page 43 of 47
Incidents - As of - 12/31/14 - Integrated
6
5
4
3
5
5
5
2
1
0
Incidents - As of - 12/31/14 - MSS/FIS
2.5
2
1.5
1
2
2
2
0.5
0
Incidents - As of - 12/31/14 - HOP
8
7
1
6
5
1
4
3
6
2
6
4
1
1
1
1
0
Page 44 of 47
Based on the individual incident reports by program. The category classified as “Other” is the single largest
category reported. This is because they do not fall into a category identified in our policy and procedure.
Examples of “Other” incidents include reportable law enforcement activity on premises, theft, etc. Tri-County
initiated a new safety committee investigation of each program location for safety and health hazards. Based
on input from employees and the person served we are expanding these inspections/investigations to include
housekeeping and cleanliness issues in 2015.
2014 Fiscal Report
Service dollars for fiscal year 2013/2014, ending fiscal year June 30, 2014 Funding from DCF, Polk, Hardee, and
Highlands County’s, CFBHN, Greater Lakeland Community Foundation and HUD
Program
Detox
Adolescent MH
Adult MH
Adolescent SA
Adult SA
Prevention
Florida Center
HUD
DUI
Support &Med Svcs
Polk County
JASA/Match
Other
Total
Revenue
1128442
$260,662
$916,864
$715,044
$4,056,966
$588,093
$2,363,158
$238,125
$448,662
$1,396,738
$1,041,417
$320
$12,026,049
Page 45 of 47
Polk County
JASA/Match
9%
2014 REVENUE
Support &Med Svcs
11%
Other
0%
Adolescent MH
2%
Adult MH
7%
Adolescent SA
DUI
4%
HUD
2%
Adult SA
34%
Florida Center
20%
2014 Fiscal Report - Continued
Agency financial support continues to be primarily from the Department of Children and Families (Central
Florida Behavioral Health Network being the assigned Managing Entity) with additional support revenue made
available via the Counties of Polk/Highlands/Hardee, DUI DATE programs, United Way, and client fees.
Revenues from TCHS Food Service, In-jail Medical Services, Psychiatric Medical Services, HUD renewals
and Path grant also added to our revenue base. The Florida Legislature passed a bare bones budget in 2014.
Management will seek to maximize dollars in the most efficient way possible and continue to grow the food
service business as well as look at other opportunities to expand services, as they arise. These efficiencies are:
1. Better utilization of the Electronic Health Record,
2. Review and identification of all programs work flow to address areas of redundancy, duplication of
efforts by one or more staff people
3. Higher expatiation of production as compared to total work hours.
4. Utilization of better data to improve the QAI process
5. Reduction of turnover of clinic staff
Employee Relations
The inability to give employee increases annually in the past four years, Tri-County is now preparing to
address this issue in 2015. One glaring issue is the clinical staff pay. TCHS is having difficulty filling vacant
positions partly due to low starting wages and the rural nature of our facilities.
Our staff continues to complete over 20 hours of training for clinical employees and 16 hours of training for all
other staff, within the first 6 months of employment with TCHS. The staff is also required to complete
Corporate Orientation, a 26 hour program designed to provide formal information regarding the Policy and
Procedures of the agency as well as meeting the initial training requirements of DCF and CARF Standards and
other agency required education. With the advent of the Deaf/Hard of Hearing requirement by CFBHN, some
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trainings now have to be completed within 60 days of hire. We continue to monitor training requirements for
all positions.
Respectfully submitted,
Compiled and edited by,
Robert C. Rihn, LCSW
Chief Executive Officer
Donn VanStee
Director of Agency Operation/Compliance
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