Program Description:

Outpatient Mental Health Services:

ARC Broward's Outpatient Mental Health Program offers a continuum of specialized outpatient services that address the specific needs of children, adolescents, and adults with or without disabilities and their family members. Specialized Outpatient Mental Health Services are conducted onsite and offer psychotherapy, psychological testing, psychiatric evaluations and medication management, for Broward, Miami-Dade and West Palm Beach county residents who require help in managing their mental health issues. Individual, group and family therapy sessions are available days or evenings, Monday through Saturdays by appointment.

ARC Broward's Outpatient Mental Health Program can assist people with varying mental health issues. General indicators for making referrals are as follows:

	Acceptance Difficulties - Family demonstrates difficulty accepting the fact that their child has special needs/is developmentally delayed.
	Adjustment Difficulties - Experience of discomfort, which interferes with normal daily routine at time of adjustment to new circumstance (job, school, etc.).
	Anger Outbursts - Exhibition of inappropriate bursts of anger (overreaction to situations, criticism, etc.).
	Anxiety - Inability to concentrate, a high degree of stress/nervousness/agitation, feeling undue pressure.
	Behavior Problems - As a supplemental service to behavior programming, an individual or family member may benefit from further insight and open expression regarding identified behavior problems.
	Complicated Grief - Due to situations of experiencing death, dying or significant loss, individuals may be going through the process of grieving, which may impact on other aspects of daily functioning.
	Control Issues - Parent expresses frustration regarding overwhelming stresses related to raising a child with special needs/developmental disabilities.
	Crisis Situation - An urgent need for mental health intervention due to an unexpected crisis.
	Depression - Symptoms of lack of energy, loss of appetite, sleep problems, withdrawal, tearfulness, isolation, that notably interfere with daily routines.
	Disorientation - A significant change in being able to relate to present circumstances.
	Emotional Support - Parent/siblings lack emotional support system and express feelings of isolation.
	Family Problems - Demonstrated feelings of anger, confusion, rejection, or communication difficulties with family members.
	Fears - Demonstration of unusual fears that interfere with ability to perform daily tasks, such as height, open space, darkness.
	Forgetfulness - A sudden demonstration of forgetting things, which normally are not expected to be forgotten.
	Hallucinations - Audio or visual hallucinations being reported by individual.
	Mood Swings - Demonstration of severe ups and downs.
	Marital Difficulties - Due to the difficulties raising a child with special needs, excessive stressors have been placed on the marital relationship.
	Sexual Issues - Demonstration of confusion regarding sexual identity; may demonstrate sexual inappropriateness or sexual aggression.
	Obsessive Compulsiveness - Recurrent and persistent ideas, thoughts, impulses, behaviors that interfere with an individual's daily routine, job performance, etc.
	Suicidal Expression - Verbally or non-verbally indicates thoughts of suicide with or without a plan.

Outpatient Mental Health Services for the Deaf and Hard of Hearing:

Mental health and psychiatric services are provided for individuals who are Deaf, Hard of Hearing or non-verbal. A Sign skilled Licensed Psychologist and Psychiatrist conversant in American Sign Language are available to provide psychotherapy services and psychological testing to children and adults with or without special needs. Individual, group and family therapies are available. Case Managers are specifically trained to help identify goals and community supports that will assist in achieving optimum health. ARC Broward uses Nationally Certified and Registered Interpreters for the Deaf (RID). ARC Broward follows strict confidentiality guidelines that comply with state laws and professional ethical guidelines. Interpreters follow the RID Code of Ethics.

ARC Broward's Outpatient Mental Health Services can assist the Deaf and Hard of Hearing community with the following issues:

	Depression
	Self-Esteem
	Discrimination
	Parenting Skills
	Suicidal Thoughts
	Abuse and Neglect
	Anger Management
	Alcohol and Drug Use
	Relationship Problems
	Cultural Identity Issues
	Sexual and Health Issues
	Child Behavior Problems
	Independent Living Skills
	Family Relationship Issues
	Gay, Lesbian and Bisexual Issues

Outcome Management System:

Effectiveness Indicators:

	a) Maximize the average post admission annual number of days spent in the community.
	Target: 340 days per year Measurement Tool: DCF Mental Health Performance Measures Form Reporting Period: Quarterly (October, January, April, July)

Data will be calculated by obtaining the total number of days spent in the community per person receiving services and dividing by the total number of persons served. Additionally, target will be adjusted to reflect the portion of the year that has elapsed (i.e. Quarter 1 Target: 85; Quarter 2 Target: 170; Quarter 3 Target: 255; Quarter 4 Target: 340).

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining steps for improved performance, where indicated. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	b) Maximize the average post admission number of days worked for pay, community participation activities, volunteer activities, and/or educational/vocational training.
	Target: Average 24 days per year Measurement Tool: DCF Mental Health Performance Measures Form Reporting Period: Quarterly (October, January, April, July)

Data will be calculated by obtaining the total number of days worked for pay per individual by the total number of persons served. Target will be adjusted to reflect the portion of the year that has elapsed (i.e. Quarter 1 Target: 7.5 Quarter 2 Target: 15;Quarter 3 Target: 22.5;Quarter 4 Target: 30).

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining steps for improved performance, where indicated. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	c) Maximize the average post admission monthly income. (including SSI/SSDI)
	Target: $530 Measurement Tool: DCF Mental Health Performance Measures Form Reporting Period: Quarterly (October, January, April, July)

Data will be calculated by obtaining the average monthly income per individual and dividing by the number of individuals served.

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining steps for improved performance, where indicated. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Efficiency Indicator:

	a) Maximize the average post admission GAF scores.
	Target: Average score will be at least 49 Measurement Tool: DCF Mental Health Performance Measures Form Reporting Period: Quarterly (October, January, April, July)

Data will be calculated by adding the individual's GAF scores and dividing by the total number of individuals.

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining steps for improved performance, where indicated. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	b) Minimize the average post admission number of days from referral date to completion of a psychiatric assessment for medication.
	Target: Average of 7 calendar days Measurement Tool: Referral forms and Initial Face to Face Assessments Reporting Period: Annually (October)

Data will be calculated by adding the total number of days from initial referral date to completion of initial face-to-face assessment for all individuals served during the reporting period and dividing by the number of individuals served.

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining steps for improved performance, where indicated. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	c) Minimize the average post admission number of days from initial referral date to completion of an initial face-to-face interview by a qualified psychotherapist / psychologist for individuals with hearing impairments or communication disorders.
	Target: Average of 7 calendar days Measurement Tool: Referral forms and Initial Face to Face Assessments Reporting Period: Annually (October)

Data will be calculated by adding the total number of days from initial referral date to completion of initial face-to-face assessment for all individuals served during the reporting period and dividing by the number of individuals served.

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining steps for improved performance, where indicated. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Satisfaction Indicator:

	a) Maximize average post admission consumer satisfaction scores.
	Target: Average BHRS scores will be at least 130 Measurement Tool: Behavioral Health Care Rating of Satisfaction Reporting Period: Annually (October)

Data will be calculated by adding the total scores and dividing by the number of BHRS surveys completed.

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and an examination of the specific responses with action prescribed according to the feedback based upon twenty-six (26) question survey. A follow up plan outlining steps for improved performance, where indicated, will be included in the analysis. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

	b) Maximize stakeholder satisfaction
	Target: 90% of referring sources will indicate overall satisfaction Measurement Tool: Stakeholder Satisfaction Survey Reporting Period: Annually (October)

Surveys will be disseminated to referral source upon discharge for each individual served and will be compiled throughout the year. All surveys completed from October 1st through September 30th will be analyzed each October. Data will be calculated by totaling the number of respondents who indicated overall satisfaction by the total number of respondents and multiplying by 100 to obtain the percentage of referring sources who indicate overall satisfaction.

The analysis will include a statement of performance in relation to the target outcome and past performance; significant variables, if any, which may correlate with performance; and a follow up plan outlining steps for improved performance, where indicated. The report will be submitted to the Director of Program Services annually by the November 1 and will be shared with individuals served, staff members, the Board of Directors and stakeholders.

Outcomes Management Results:

Program: Outpatient Mental Health

Analysis of Findings:

Quarter 1:

Results of performance for all indicators exceeded targeted outcomes. The measurements of "days living in the community," "days worked for pay," and "GAF rating scores" were reported for one hundred percent of consumers seen for services. Information regarding "average monthly income" was reported for 73 % of consumers seen (information was unknown for 7 clients). Many new ADM clients seen during this period were non-dually diagnosed ARC clients, and therefore, the days worked for pay, monthly income averaged and GAF scores were slightly increased since last period.

BHRS completion will start as of this month for clients who have now been in the program for six months. Training regarding data collection on the Mental Health Performance Measures Form and data entry to MHSA computer software program continues. Additional training with ADM is ongoing as needed with all program therapists regarding Performance Measures form completion.

Quarter 2:

Results of performance for all indicators met or exceeded targeted outcomes. The measurement of "days living in the community" was reported for 99% of clients served, "days worked for pay " was reported for 95% of clients served, "GAF rating scores" were reported for 100% of clients served and information regarding "average monthly income" was reported for 90 % of clients served.

Due to the additional ADM funding as January 1, 2000 for outpatient services for a minimum of six individuals with severe and persistent mental illness who also have a hearing or communication disorder and for six medication evaluations, two efficiency indicators were added to the Outcome Measurement System for Outpatient Mental Health Services. During this quarter two hearing-impaired clients were seen for a total of twelve sessions. Medical evaluations will begin as of April 13, 2000. Due to the extensive time period it took from award of additional funds until a qualified psychiatrist was interviewed, background screened, and hired, no psychiatric evaluations were performed during the months of January, February, or March.

BHRS completion started as of January for the 4 clients who had been in the program for six months. The BHRS has been found to be a difficult measurement tool to use with the dually diagnosed population of mentally retarded individuals and its continued use will be evaluated during the next reporting period.

Quarter 3:

Performance on all effectiveness and satisfaction indicators and the efficiency measure to maximize the average post admission GAF scores met or exceeded targeted outcomes. The efficiency outcome to minimize the average post admission number of days from referral date to completion of a psychiatric assessment for medication was not met. One client was not initially seen for 28 days due to scheduling constraints; the Psychiatrist sees clients every other Thursday and a Sign Language Interpreter assists the Psychiatrist once per month - this client waited for an appointment when the interpreter would be available. At the other extreme, three clients received initial Psychiatric Evaluations in three days or less. The efficiency outcome to minimize the average post admission number of days from initial referral date to completion of an initial face-to-face interview by a qualified psychotherapist/ psychologist for individuals who are Deaf and/or with communication disorders was also not met. One client was not initially seen for 28 days due to difficulties with verifying insurance. If he is not included in the sample, the average length of time from initial referral to completion of the face-to-face interview is 8 days. Although 100% of clients are contacted within 48hours of the initial referral, there are extenuating circumstances (i.e. scheduling constraints of client/ therapist/ interpreter/ Psychiatrist and insurance verification difficulties) that result in clients not being seen within seven days.

The measurement of "days living in the community" was reported for 92% of clients served, "days worked for pay " was reported for 92% of clients served, "GAF rating scores" were reported for 100% of clients served, information regarding "average monthly income" was reported for 91 % of clients served, "days from referral to date of Psychiatric assessment" and "days from referral to completion of face-to-face interview for Deaf individuals" were both reported for 100% of clients served. During this last quarter, psychiatric services were provided to 9 clients and psychotherapy services were provided to 15 Deaf or Hard of Hearing clients. The feasibility of the target outcomes of 7 days from referral date for completion of Psychiatric evaluation and initial face-to-face interviews will be evaluated with a possible increase in the target outcomes.

Completion of BHRS was initiated in January 2000. The BHRS has been found to be a difficult measurement tool to use with individuals with mental retardation and, consequently, the Coordinator of Mental Health Services is researching alternative tools. Stakeholder Satisfaction Surveys were initiated during this quarter.

Quarter 4:

Performance on all effectiveness and satisfaction indicators and the efficiency measure to maximize the average post admission GAF scores met or exceeded targeted outcomes. The efficiency outcome to minimize the average post admission number of days from referral date to completion of a psychiatric assessment for medication was not met. Variables contributing to the outcome including scheduling constraints and insurance verification are not controllable. Therefore, the target outcome will be increased to 21 days beginning the next reporting period. The efficiency outcome to minimize the average post admission number of days from initial referral date to completion of an initial face-to-face interview by a qualified psychotherapist/ psychologist for individuals who are Deaf and/or with communication disorders was also not met. Variables contributing to the outcome including scheduling constraints and insurance verification are not controllable. Therefore, the target outcome will be increased to 10 days beginning the next reporting period.

The measurement of "days living in the community" was reported for 99% of clients served, "days worked for pay " was reported for 100% of clients served, "GAF rating scores" were reported for 100% of clients served, information regarding "average monthly income" was reported for 100 % of clients served, "days from referral to date of Psychiatric assessment" and "days from referral to completion of face-to-face interview for Deaf individuals" were both reported at 100% of clients served.

The BHRS completion requirement was discontinued during this quarter. The Department of Children and Families Client Satisfaction Survey will be begin to be implemented during the next reporting period.