Table of Contents

Executive Directors Report ............................................................. 1

Board Listing, Message from Chair ................................................. 2

Financial Report ............................................................................ 3

Community Relations ................................................................ 4

Psychiatric Services.................................................................... 5-6

Emergency Services ................................................................... 7-8

Children’s Services ..................................................................9-19

Mental Health/Substance Abuse Outpatient Services ......... 20-23

Recovery Care Coordination ............................................... 24-26

Community Support Services .................................................27-28

Access ..................................................................................... 29

MISSION STATEMENT

Highlands Community Services,Center for Behavioral Health

is committed to providing the highestquality continuum of behavioral health care,

promoting a “center of excellence” for allindividuals seeking mental health, substance

abuse, or intellectual disability services.

Dedicated to empowering each individual“consumer” to lead a healthy, independent

lifestyle, Highlands shall advance a professionalenvironment that has dignity, respect, hope,and genuine empathy as basic cornerstones.

Highlands will continue to provide servicesin an efficient and financially viable mannerto ensure the continuation of developing new

programs based on community need.

From the Executive DirectorIt is hard to believe that Fiscal Year 2011 has come to an end. This year was certainly one that exhibited sustained growth and presented unique challenges. I continue to be extremely proud of the quality and “spirit” of our staff. There remains a continued determination of staff to achieve lofty ideals while protecting a high degree of integrity within each program. I could not be more proud of such accomplishments. Highlands Community Services continues to be a “Center of Excellence” with a sincere commitment to meet the behavioral health needs of our community. HCS remains committed to both quality and customer service. By the middle of Fiscal 2012, Highlands will employ over 300 staff making it one of the largest employers in Washington County or the City of Bristol. I am pleased to say we remain the organization of choice for an increasing number of professionals seeking employment. We will continually strive to make sure this achievement is never taken for granted, doing all we can to insure the organization reflects the highest quality for our staff and customers.

Fiscal Year 2012 will be an exciting, yet challenging, year with new Managed Care initiatives and the current state of the economy. Despite such challenges, I believe Highlands is well positioned to handle any external constraints; and should continue to see sustainable growth in all departments. As HCS’s Executive Director, it has been extremely rewarding to witness staff “roll out” new initiatives which in turn has created a sense of vibrancy within their programs. In each department an atmosphere of creativity and forward thinking exists. As an example, the development of the Children’s Campus Foundation and initiative should be an exciting process for everyone involved.

Finally, it is my hope that each individual will enter into the next year with a high degree of enthusiasm, optimism, a sense of purpose, and a sense of personal pride. Without such attributes at the core of what we represent as an agency, we collectively run the risk of being like too many other organizations that operate without a “living mission”.

It is my hope that HCS will continue to represent the ideal that mental health is an integral part of any communities well-being, and that we remain committed to serve the community in a way that all parties involved in the process can take pride and maintain a genuine sense of dignity.

Thank you for all you do for “Highlands Center for Behavioral Health”. It is greatly appreciated.

- Jeff

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Board of DirectorsRepresenting the City of Bristol, VA:

Sondra Alan, Vice-ChairDonald AshleyFred Bowman

Danny JohnsonDeb Read

Representing Washington County, VA:

Leslie BirchClaudia DuffyCarolyn HaleKathy Melvin

Kittye Owens, Vice-ChairOdell Owens

Darlene Rowland, Chair Lillian Spicer, Secretary/Treasurer

From the Chair...Fiscal Year 2011 has been another great year here at Highlands Center for Behavioral Health. I am consistently amazed at the amount of dedication from staff here at HCS.

More changes have occurred this year with the move of Mental Health Supports to the former Stepping Stones location on Lee Highway. New paint, new decorations have brought new hopes & dreams to the consumers who participate in that program.

HCS continues to forge into the future by providing services for Domestic Violence, Autism and even Geriatrics. HCS is also a

part of the SWAAG (Southwest Virginia Autism Action Group), the Washington County Sub-stance Abuse Prevention Coalition and has developed a domestic violence task force knows as Project Jane. Participating in groups like this ensures we are always in the forefront of what is going on in our community.

Without the dedication of the community and the staff of HCS, these changes within the agency would not be possible. The organization remains financially sound with solid growth potential going forward. On behalf of the Board of Directors for Highlands Center for Behavioral Health, we want to say “thank you”.

Darlene Rowland, Board Chair, 20112

Financial Report

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During the fiscal year ending June 30, 2011 Highlands Community Services Center for Behavioral Health continued the growth pattern of the past several years, expanding services to meet increasing community needs. This continued growth resulted in an increase in revenues of more than 6% over the prior fiscal year, with operating income (received from providing consumer services) increasing nearly 7%. Highlands Community Services’ collaborative budget development process as well as ongoing budget monitoring resulted in actual revenues for the year totaling 101.79% of budget and expenditures totaling 99.62% of budget. The resulting excess of revenue over expenditures (cash basis) totaling $386,374 for the year represented 2.2% of budget.

Highlands Community Services continues to maintain a strong financial position and once again received an unqualified audit opinion. As of June 30, 2011 the Statement of Net Assets reported that Highlands Community Services had 5.61 times more current assets than current liabilities and more than $5.4 million in total net assets. The largest addition to Highlands Community Services’ assets during FY11 was the 13,000 square foot Stepping Stones psychosocial rehabilitation “clubhouse”, located at 414 Ivy Street in Abingdon.

Fiscal Year 2011 has been a year of change for the Community Relations Department. The department name was changed to Communications and Development; focusing more on branding, communication, media and developing relationships in the community.

Along with this change came a completely transformed website. The site is now very user friendly, contains more information, maps to each site, news and events section, history section and much more. Please check us out at www.highlandscsb.org.

In FY11, HCS held their 1st Annual Autism Conference titled “Understanding, Treating and Living with Autism Disorders”. The tracts were geared toward families, educators & clinicians. The conference was very well received with over 300 in attendance. We are already in the planning stages for the 2nd Annual Autism Conference

New for FY11 was the development of the very first logo for a service; Project Jane. This service under the Outpatient Department, deals with educating the community on Domestic Violence. With grant money provided we were able to work with a local design company and develop a logo specific for the service.

The department also participated in the Mental Health Walk and Family Fun Day as yet another way to let the community know that we are here for them and what services are available to those with mental illness.

Community Relations

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CMYKCoated Paper

Psychiatric Services Service Highlights

The Manufacturer’s Medication Assistance Programs are being fully utilized for consumers who cannot afford to pay for their medications or can only afford a small co-pay. Ecumenical Faith in Action, in Washington County and Twin City Medical Services, in Bristol, Virginia are the contact points for consumers to apply to get their medications at no cost. The Psychiatric Front Office also works directly with Pharmaceutical Companies for samples and for coupons. The annual cost savings over the last year for the cost of medication is approximately $150,000.

Utilization Review

The following data represents Psychiatric Support activity from July 1, 2010 through June 30, 2011.

6,007 assessment and medication management services were provided. 1,787 unduplicated consumers received 5,447 medication management services.

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The following tables reflect specific demographics:

Psychiatric Services (continued)

IV. OUTCOME MEASURES

• Greater than 90% of medications ordered from Patient Assistance Program were available to our consumers.

• 99% of consumers were sent written notice of their medical appointments.

• 100% of consumers were counseled concerning side effects.

• 90% of consumers were stable after one (1) year.

• Greater than 80% of consumers who participate in the Consumer Satisfaction Surveys reflect agreement that Highlands does a good job providing services.

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Emergency Services

Service Highlights

• HCS remains 100% in compliance in the attendance of required civil commitment hearings in the Commonwealth either via direct attendance or indirectly through agreements with other CSBs.

• Emergency Services saw an increase of 9% more consumers than is the last fiscal years.

• Emergency Services saw 97% of the 1090 consumers within 1 hour and 98% within 2 hours. There were 7 consumers of which the wait time exceeded 2 hours due to overlapping ECOs or multiple consumers at the same time.

• Emergency Services has expanded its department to include 3 PRN staff to help cover shortages to the on-call schedule in time of FT staff vacation, sickness or leave.

II. Utilization Review

The following data represents Emergency Services face to face and telephone contacts for FY2011 (July 1, 2010 to June 30, 2011):

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Emergency Services (continued)

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• Number of inmates served: 30.

• Of the 1,090 consumers who were served, 417 were hospitalized in the following facilities:

• Other UR demographics are as follows:

• A total of twenty (20) children/adolescents were admitted during this fiscal year, a decrease of six (13) over FY10

• The average time of prescreening evaluations: 2 hours and 07 minutes

Children’s ServicesPrevention & Education

During 2011 Prevention & Education logged 9,034 hrs of services. Prevention & Education provides programs related to prevention and early intervention to increase development of positive life skills in order to prevent/reduce youth substance abuse and negative behavior. 3,637 students (K-8) participated in the Life Skills, Second Step, and Too Good for Drugs programs. Thirty-seven attended the Strengthening Families Classes, 87 parents received education services in the early childhood, and twenty-nine teenagers completed the Life Skills SA/Violence Prevention Program.

Prevention Program Highlights• 95% completion rate in the Strengthening Families Program • 94% of parents in the Strengthening Families Program reported seeing positive changes in their child during the SFP classes. • 96% of parents in early childhood classes reported having more confidence in being able to meet their child’s needs. • Teens completing 12 sessions of TND increase their ATOD knowledge by 25%, and reported a 36% reduction of cigarette use, 42% reduction of alcohol use, and 42% reduction of marijuana use.• Students participating in Too Good for Drugs and Life Skills programs performed at an 85% rate on all four core measures of Intentions to Not Smoke, Knowledge about the Harmful Effects of Tobacco, the Perceived Benefits of Remaining Tobacco Free, and Self-Efficacy, exceeding the state’s 75% objective

Grants awarded to Prevention & Education for 2011• Virginia Healthy Youth Foundation (VHYF) $74,340 • Governor’s Office on Substance Abuse Prevention (GOSAP) $10,457. • Governor’s Office on Substance Abuse Prevention (GOSAP) $22,670 • Strengthening Families Initiative $92,669 (Virginia Department of Behavioral Health and Developmental Services).• Virginia Department of Social Services $36,094

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Children’s Services (continued)Therapeutic Family Care/Support Homes

Service Highlights

• Switched from foster care to sponsor homes in January• Arranged three social events for sponsor home providers o Foster Parent Appreciation Dinner o Christmas Dinner o Back to School trip to Splash Country• Opened 4 new homes• Collaborated specific trainings with BDSS and WCDSS• 2 trained with Bryan Post Institute

Utilization Review

• Served a total of 62 consumers during the FY 11, 27 female and 35 male• 20 consumers age 2-12, 26 consumers 13-17, 16 consumers 18-22• 57 consumers were Caucasian/White, 3 consumers were Black/African American, and 2 other• 18 Bristol City, 43 Washington County, and 2 Other

Effectiveness of TFC

We are in business to provide housing, and treatment to consumers, ranging in age from 3 to 18 with serious emotional or mental health disturbances. (Younger children may be accepted on a case-by-case basis.) We effectively manage problem behaviors through the provision of the following services: extensively-trained professional parents & frontline staff; 24 / 7 crisis intervention service; well-established network of partner-agencies within the community; on-site Psychiatric services. Our business primarily serves the MH population, but has in the past and will continue to provide services to ID and SA consumers as deemed appropriate. TFC staff envision seeing the program stepping to the forefront in the training & preparation of consumers as they approach independent living status. We are uniquely positioned to accomplish our goals due to our positive standing / reputation within the community and our close partnerships with referral sources.

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Children’s Services (continued)Intensive Case Management

The mission of Intensive Case Management (ICM) is to provide and coordinate quality treatment services in the home and community setting to children and adolescents who are seriously emotionally disturbed (SED) or at risk of being SED. In the continuum of services, ICM bridges the gap between regular care coordination services and In-Home Family Therapy by providing a moderate intensity and frequency of services that provides both support and accountability for parents who wish to receive effective community services for their at-risk or SED child. This service continues to provide a critical link between the high intensity of intensive in-home services and the lower intensity of care coordination. It has effectively been used both to aid in the “step down” process from in-home and also provides an alternative to intensive in-home for families who may not align easily to more intensive services.Service Highlights

• Hired Behavioral Family Resource Specialist• We now have male and female ICMs as well as a bi-lingual staff • ICM met with OP staff in order to “staff” co-cases• Transferred less intensive cases to care coordination• ICMs doing well with PA Continued Stays

Utilization Review

• 129 consumers served during FY 11• 42 female, 87 male• 0 ages 0-2, 55 ages 3-12, 54 ages 13-17, and 20 ages 18-22• 29 school referrals, 51 family/friend referrals• 111 White/Caucasian, 6 Black/African American, 12 other • 54 Bristol City, 71 Washington County, 4 Other

Outcome Measures

• Preventing most adolescents from being removed from the home was successful• Families who have had services previously are requesting it again• High recommendations from within the community

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Children’s Services (continued)Student Assistance Services

Service Highlights

• Washington County schools had 660 referrals; 533 high school referrals, 127 middle school referrals• Elementary schools referred 14 students for crisis or supportive services• Virginia High had 170 referrals• Counselors at AHS, JSB, and PHHS carried small caseload of care coordination for students receiving day treatment services (generating $12,779 in revenue) • Two counselors, including unit manager, are certified pre-screeners, which is crucial to providing crisis intervention services and screening for a population high-risk for suicidal ideation/gestures• The SAP counselors were readily available to provide critical incident stress debriefing and grief counseling to students after the tornado that impacted Abingdon, Glade and Damascus areas• There were 37 (4%) referrals from Area Wide Discipline Committee for serious policy infractions• Typical or Troubled program (grant through the American Psychiatric Foundation) was presented to all 5 high schools, promoting awareness of mental health issues among adolescents, how to identify troubled students and referral process. • A Truancy Prevention Education program was piloted at AHS for those students missing more than 8 unexcused days of school• SAP Counselors facilitated after school substance use/abuse education groups for students in violation of school’s substance use policy referred by Area Wide Discipline Committee; groups discussed substance use, impact and consequences of substance use and decision making• Program received one-time funding appropriation of $54,000 to provide crisis and supportive services to students (432 children/adolescents, 3048 units (762 hours) approximating $54,864)

Utilization Review

• 830 consumers served during FY10; • 53% females, 47% males• 660 referrals from Washington County Schools o 170 from Virginia High o Abingdon High School/EB Middle 255 o Holston High School/Damascus Middle 97 o John Battle High School/Wallace Middle 175 o Patrick Henry High School/Glade Spring Middle 133 o Virginia High School 170 WCPS Elementary Schools: o Abingdon: 4 o High Point: 1 o Watauga: 4 o Valley: 2 o Rhea Valley: 2 o Stonewall Jackson: 1

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Children’s Services (continued)• 99 (12%) were current HCS consumers• Referrals came from a variety of sources, as follows: o 25% from school administrators o 22% from faculty o 10% from guidance counselors o 4% from area wide discipline committee from School Board office o 4% from parents/family o 12% were self referrals o 3% from peers o 9% from other community (other HCS programs, DSS, other private practitioner or community agency)• Counselors made 572 referrals (69%) to other services (school based, community, or HCS), demonstrating the goal to link students to services to effectively meet their needs

Outcome Measures

Teacher/student evaluations of the SAP were conducted during the month of May 2011. The evaluations received indicate overall satisfaction with SAP, with positive feedback regarding involvement and intervention with students. The majority of students surveyed indicated that their involvement with staff was both a positive and helpful experience for them. The primary concern stated by a majority is the significant number of students needing support in relation to the number of available counselors, reflective of the continually increasing need for the services at all the schools

Intensive In- Home Services

Service Highlights

• Met projected billable hours• Hired Behavioral Family Resource Specialist• Juvenile Competency Restoration Services was provided for 4 new consumers• Juvenile Competency: 3 consumers were restored• Appropriate utilization of CSA and Mental Health Int. Funds• VICAP process has been initiated• Fiscal Services was able to get Medicaid to back pay nearly $100k• IIH met with OP staff in order to “staff” co-cases• IIH relocated to the Campus from Oakview office• Now have 2 male IIH staff as well as bi-lingual staff

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Children’s Services (continued)Utilization Review

• 104 served during FY 11• 40 age 3-12, 53 age 13-17, 11 age 18-22• 72 male, 32 female• 29 referrals from school, 33 from family/friend, others evenly spread among other sources such as self referrals, DSS, etc.• 49 Bristol City, 53 Washington County, 2 Other• 8,766 direct and related hours provided

Outcome Measures

• DMHMRSAS Performance Contract targets were met. • Majority of children remained in the home.• Community agencies continue to exhibit high levels of cooperation and satisfaction with program services as demonstrated through continued program referrals. • Families who have had services previously are requesting it again• High recommendations from within the community as well as HCS staff

Therapeutic Day Treatment ProgramsInterchange, Summer Day Treatment, School Based

and High School

Service Highlights

Summer Day Treatment Program

• The Interchange Summer Day Treatment and Education Program ran from June 20th to July 28th. There were 100 + children that signed up with an average of 60-65 children in attendance daily. • Interchange billed Medicaid and New Initiative money through CSA for the summer program participants this year. • Consumers were able to participate this summer in numerous field trips which included the Coomes Recreation Center, the movies, a greenhouse, Sugar Hollow Park, the BIS center, Steele’s Creek Park, Pizza Plus, and Bristol Motor Speedway. Also, a trip to Fun Expedition was taken for the consumers that had earned it throughout the camp.• Summer Program this year was also held at Highpoint Elementary School. The students had access to the gym, cafeteria, outside playground equipment, library, and classrooms, which is where groups and therapeutic activities were held.• Managers and staff from other HCS departments also attended a day at camp to help provide support to the annual summer program

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Children’s Services (continued)Interchange Program

• The Interchange Day Treatment school program had a productive year both clinically and financially. The implementation of new groups and activities such as Healthy Days and the continuation of Art classes enhanced the consumer’s treatment along with the therapeutic treatment modules and groups that have made Interchange so successful in years past. • The Interchange school program averaged 14 students for the entire school year.• All consumers were funded this past school year either by Medicaid or CSA funds.• Trips and activities that took place included a Halloween trip, Christmas Santa and a trip to Fun Expedition. Also smaller trips were held at the Hands-on Museum and the Washington County Fair.

School Based Day Treatment

• Two new unit managers were hired, one overseeing Washington County TDT and the other supervising Bristol TDT • 22 counselors on staff (9 in Washington County; 13 in Bristol)• An additional counselor was hired at Highland View Elementary, only one counselor requested at Valley Institute, only 2 counselors requested at Van Pelt

• School Based Day Treatment served 157 children in their regular school environment.• Budget expectations for the program were met (and exceeded) for the school year• Christmas Decorating Contest implemented for all sites; participation involved consumer participation• Counselors provided with resources to provide therapeutic groups and activities

High School Day Treatment

• TDT services provided to 4 high schools (JSB, PHHS, AHS, VHS)• 7 counselors on staff (3 in the County, 4 in Bristol City)• VHS added two additional counselors to meet need, one of which for support in Alternative School• High School program served 46 students

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Children’s Services (continued)Utilization Review

Interchange

Referrals from Washington County and Bristol City school systems were higher than normal. The school year began with 14 children on the roster and ended the year with 15. The Interchange Program continues to be a vital resource for the schools systems. It also provides the student with the opportunity to remain in the community to be educated instead of other placements that may include homebound or residential.

The Interchange Program served both elementary and middle school students last year with and average of 7 students in each classroom per day. The numbers remained consistent for the entire year continuing to show the need for the alternative school placement and the Day Treatment Program. Interchange continued to bill Medicaid and CSA for funding without any major issue with Prior Authorizations.

Summer Day Treatment

For the Summer Day Treatment Program there were 100+ total children who signed up. 90 of these children were funded through Medicaid while the remaining received funding from New Initiative money from CSA or were served free and clear. The average daily attendance for the program ran between 62-65 children, which is the highest average attendance thus far. Washington County Schools ran transportation for the county this year with their school buses while Bristol City kids continued to be transported by HCS. Highpoint Elementary again allowed us to use their facility to house the summer program and continues to show that support for the program and students who participate.

School Based

The school based program was provided at 8 elementary schools and 1 middle school, serving 157 children, 25 female and 128 male. The program was able to bill Medicaid for the children enrolled in the program. Per the MOA between the schools and HCS, day treatment did serve a few children who were non-billable. 11 students were provided the service free. There were 60 Washington County students and 97 Bristol students that received TDT FY10. Breakdown is as follows:

Greendale 13: 12 male; 1 female (12 Medicaid, 1 nonbillable)High Point 26: 26 male; 2 female (23 Medicaid, 3 nonbillable)Highland View 15: 11 male; 4 female (15 Medicaid)Stonewall Jackson 15: 10 male; 5 female (13 Medicaid, 2 nonbillable)Valley Institute 7: 5 male; 2 female (6 Medicaid, 1 nonbillable)Van Pelt 14: 11 male; 3 female (13 Medicaid, 1 nonbillable)Washington & Lee 15: 13 male; 2 female (14 Medicaid, 1 nonbillable) Watauga 14: 13 male; 2 female (12 Medicaid, 2 nonbillable)Virginia Middle 38: 32 male; 6 female (38 Medicaid)

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Children’s Services (continued)

High School

The High School Day Treatment program was provided in 4 high schools and served 46 students, 33 males and 8 females. 45 of these students were billed for Medicaid for services rendered, the remaining was a nonbillable case. Breakdown is as follows:

AHS 8: 7 males; 1 female (all Medicaid)JSB 6: 5 males; 1 female (5 Medicaid, 1 nonbillable)PHHS 6: 4 males; 2 females (all Medicaid)VHS 26: 18 males; 8 females (all Medicaid)

Children’s Care Coordination

Service Highlights

• Increased number of clients served during fiscal year from 671 to 717• Expanded to 14 total care coordinators due to growth• Continued limited self pay cases to no more than 10% on any given caseload • Ongoing partnership maintained with Holston Family Services, Lifeline Services• Exceeded budget predictions for the year (greater than $1,500,000)

Utilization Review

• 717 consumers served during FY 11 • 256 females, 461 males • 627 Caucasian, 47 African American, 43 other races• 440 Washington County, 251 Bristol• Most frequently reported referral sources included self (45), family/friend (234), school system (237), other community referral (63), and private physicians (63)

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Behavior Intervention Service

Service Highlights

• Three clients graduated high school, one achieved Magna Cum Laude status. One client graduated middle school. Throughout program, 95% academic success was achieved.

• One client was successful in completing her training, passing her state boards and achieving her license in Cosmetology. She secured employment immediately.

• One client successfully entered Virginia Highlands Community College.

• BIS Team pursued volunteer work at People Inc. day care and was accepted. We now work there twice a month or more.

• One Autistic client was awarded Volunteer of the Week at Faith In Action.

• One client who had formerly lived in a residential facility has now secured permanent placement in a foster home. He also was awarded the Citizenship Award from his middle school and earned a place on the football team.

• We continue our strong community relations & volunteer spirit. We are continually sought out to participate.

• One Asperger’s client was accepted into Woodrow Wilson Rehabilitation Center for the Independent Living Program.

• One client accomplished self-control and behavioral management and was able to leave foster care and return home.

• BIS secured a grant through Virginia Department of Juvenile Justice. The new program component, “Defy the Odd’s, will serve 15 youth ages 13-17, for 1 year. Upon success, the grant can be renewed for the next 2 years.

Children’s Services (continued)

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Children’s Services (continued)Utilization Review

This year, the majority of referrals came from Family/Friends. School System referrals maintained strong. Although case numbers decreased, referrals remained consistent with community agencies, organizations and practitioners/hospitals.

Utilization Break Down – Out of the 59 children and families served, the referrals had the following distribution:

16-Family/Friend;14-School System;

6-Self;4-Private Physician;

6-DSS;3-Health Department;

3-Mental Health;4-Other Community Agencies;

1-Other VA CSB;2-Unknown

The most frequent consumers served were middle school aged, but the total population ranges from 3 years to 18 years of age.

• Average work hours : 4 per week minimum • Average Service Length: 3 months to 6 months Average Week for Educational Support Client: 30 hours per week

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Recovery ServicesService Highlights

In the Recovery Services program, each individual is viewed as “the director” of their plan of services and is regarded positively as a person who can learn, grow, and change. Close ongoing assistance is provided to help people in recovery choose the roles he/she may wish to occupy and learn the skills to integrate that role into a confident and positive self-concept.

Due to the stability of the management of the Recovery programs, the program development to empower consumers, staff development, sound fiscal responsibility, the management positions were retained.

• Stepping Stones Psychosocial Rehabilitation Program moved to Ivy Street in the town of Abingdon in November 2010. It offers group education, community integration and leadership opportunities to consumers• Mental Health Supports opened the Oasis Training Center at the former Clubhouse location on Lee Highway in Abingdon. It serves as a one of a kind program to individually train consumers in skills needed to live healthy, safe, more independently and in interpersonal skills to have a better quality of life.

Utilization Review

Of 153 persons served in the Psychosocial Rehabilitation Programs, 93% were Caucasian, with the next highest race represented at 4.6 % African American. 76 % are between the ages of 23-59, with 11% between the ages of 60-64 and 13% between the ages of 61-74. 59% are male, and 81 % reside in Washington County.

Of 184 persons served in the Mental Health Supports Program, 93% were Caucasian, with 6.5% African American. 75% are between the ages of 23-59, with 12% between the ages of 60-64 and 13% between the ages of 61-74, 48 % are male. 74% reside in Washington County.

Hospitalization data for FY2011 is as follows

Stepping Stones had 11 consumers hospitalized and a total of 16 psychiatric hospitalizations. 6 consumers or 3.75 % hospitalized at SWVMHI and 5 consumers or 3.1 % hospitalized at area inpatient units. 5 of the 11consumers had more than 1 hospitalization.

Mental Health Supports had 16 consumers hospitalized and a total of 21 psychiatric hospitalizations. 4 consumers or 2.17% were hospitalized at SWMHI and 15 consumers or 8.15% hospitalized at area in-patient units. 5 consumers had more than 1 hospitalization.

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Recovery Services (continued)Employment statistics for FY2011 are as follows

Stepping Stones had 8 consumers or 5.2 % employed. Mental Health Supports had 7 consumers or 3.8 % employed.

Referrals

Stepping Stones had 99 referrals, opened 54 cases and discharged 47 consumers.

Mental Health Supports had 88 referrals, opened 79 cases and discharged 72 consumers.

Persons Served

Program performance in the PSR & Mental Health Supports Program is reflected in the following hours recorded:

Program Persons Served YTD Actual Annual Target % Stepping Stones 153 150 102%Residential 184 150 122.6%

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Mental Health/Substance Abuse Outpatient Services

Service Highlights

• HCS has continued to be a role model for other CSB’s and private providers across the state for service provision to individuals who are diagnosed along the Autism Spectrum. This has included HCS staff hosting and planning a regional conference on Autism for parents, teachers and clinicians which featured HCS Outpatient staff as presenters for a break-out session on play therapy. These same staff have provided additional Autism trainings to various groups, both internally and externally.• Launch of Project Jane Task Force to address domestic violence issues in the same methodology in which we have approached Autism services. HCS hosted one day training on Seeking Safety, an evidence based practice that simultaneously addresses both substance abuse and domestic violence issues. This was done in conjunction with Project Jane activities and sponsored by a grant obtained from the Virginia Department of Health.• Submitted application to have a team of community partners attend training sponsored by the National Drug Court Institute for development of policies and procedures to launch a drug court in Washington County. Application was accepted and the team of 8 attended the training in Nashville, Tennessee in March of this year.• Submission of application to the Supreme Court of Virginia to operate an Intensive Drug Treatment Court in Washington County.• Collaborated with grant writer to submit federal grant application for implementation funds for Washington County Drug Court.• Completed our first year of involvement with Federal Drug Re-Entry Court as assessor and treatment provider.• Developed implementation plan for launch of VICAP Assessment process and hired license-eligible clinician to lead the process.• Provided disaster relief and continued support services in the Glade Spring area following the tornado disaster. Worked as part of County and Red Cross efforts in initial disaster relief

Consumer Demographics

o 349 total consumers served within Substance Abuse services: - 134 females - 215 males - 338 adults - 11 juveniles o 62 of the overall Substance Abuse adult consumers served were served within the Medication Assisted Treatment division of the program: - 43 females - 19 males o 1,452 consumers served within Mental Health services which include: - 694 females - 758 males - 814 adults - 638 juveniles 22

Mental Health/Substance Abuse Outpatient Services (con’t)

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Persons Served FY’10(FY’11)

MH Outpatient 1452(1155) (25% increase)SA Outpatient 349(284) (7% increase)Medication Asst. Tr. 62(55) (7% increase)

• Admissions in FY’09 for those under age 18 in Outpatient Services with HCS o Mental Health – 232 o Substance Abuse – 14 o Autism-Related Admissions (agency wide, all ages)-62 (agency-wide total up from 49 in FY’18) • Admissions in FY’10 for those under age 18 in Outpatient Services with HCS o Mental Health – 355 (53% increase from one year prior) o Substance Abuse – 22 (57% increase from one year prior) o Autism-Related Admissions (agency wide, all ages) – 128 (106% increase agency-wide from one year prior• Admissions in FY’11 for those under age 18 in Outpatient Services with HCS o Mental Health – 638 (80% increase from one year prior) o Substance Abuse 11 (50% decrease from one year prior) o Autism-Related Consumers Served (agency wide, all ages) – 200 (56% increase agency-wide from one year prior)--includes 71 new admissions of individuals diagnosed on the Autism Spectrum with only 37 individuals being discharged from care.

ReferralsMental Healtho 43% of mental health consumers were self-referred or were referred by a friend/family member o 7% of mental health consumers were individuals being discharged from inpatient hospital facilities, with an additional 2% coming from private outpatient providers.o 22% of mental health consumers were referred by school systems, employers or other community resourceso 6% of mental health consumers were referred by legal entities or DSS services.

Substance Abuseo 32% of substance abuse consumers were VASAP referralso 27% of substance abuse consumers were self/family referredo 12% of substance abuse consumers were referred legal entities or DSSo 18% of substance abuse consumers were referred by other miscellaneous sources such as inpatient facilities, community referrals, school systems and private physicians

Recovery Care Coordination Services

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Program Highlights

In the past year, Care Coordinators have been able to grow their programs by 12.88%, reflecting growth in business for the 4th year in a row. We are proud of the recovery orientation that welcomes people to HCS with a hopeful approach that promises sufficient support and education to control stressors and increase supports. Our goal is to avoid hospitalizations and to facilitate productive community roles. We do that by focusing on strengths, assets and abilities, recognizing that each individual is more than just a “diagnosis.” We also work closely with Peer Support Specialists who reinforce these interventions by helping our consumers build Wellness Recovery Action Plans. And for those who experience crises, a referral to the Home Recovery program offers an immediate solution in focusing on what’s strong, not on what’s wrong.

Quarterly meetings with Recovery Services (PSR and MHSS) have focused on coordinating services, exchanging information, confirming referral criteria, and preparing for changes in Medicaid regulations requiring Licensed Mental Health Professional assessments for their services and provider monthly reports to Care Coordinators regarding consumer progress in meeting goals and objectives on the treatment plan. Care Coordinators are helping consumers to celebrate recovery by visiting them at Stepping Stones.

Care Coordinator Unit Managers have also met with Out-Patient staff to coordinate referrals from Access for men and women who meet the criteria for Serious Mental Illness and have developed a plan for all people with Medicaid and all hospital discharges to be referred directly to Care Coordination Unit Managers for assessment. This has improved continuity of care tremendously.

Coordination with Psychiatric Support Services has resulted in a formal plan for Care Coordinators to share psychiatrists’ records with Primary Care Physicians to assist them in treating medical conditions possibly related to psychiatric medications.

WRAP facilitators have provided an important service in reaching out to patients at Southwest Virginia Mental Health Institute to remind them that we have not forgotten them, that we want them back home and to focus on strengths that may overcome symptoms that are preventing discharge. WRAP facilitators are also offering assistance to Care Coordinators with brief services that fulfill their consumers’ treatment plans, but are time consuming. Examples include transporting consumers to the Veterans Administration Hospital in Johnson City, to Social Security, to home visits from SwVMHI, and to Assisted Living Facilities and the clubhouse. These visits have an added benefit of focusing on wellness activities from a consumer’s perspective.

Care Coordination staff have also participated in a new domestic violence task force dedicating to improving the training of all HCS staff in recognizing, assessing and treating individuals with symptoms of abuse, as well as reaching out to the medical community to share our concerns and improve coordination of interventions, both medical and psychiatric, to victims of domestic violence. The endeavor was named the “Project Jane” Task Force in recognition of a consumer of care coordination and out-patient services who died recently.

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Recovery Care Coordination Services (continued)

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Finally, the Director of Recovery Care Coordination Services continues to chair the Family & Consumer Support Services Committee of the Southwest Virginia Mental Health Board, with oversight into an emerging consumer and family presence in the planning, delivery and evaluation of mental health services. Specific benefits to HCS have included financial support for the meetings with PCP’s (now focused on communication around domestic violence issues), training consumers in leadership skills through the Leadership, Empowerment and Advocacy Program (LEAP) and teaching consumers how to tell their own recovery stories through the NAMI “In Our Own Voice” program as well as the Mental Health Awareness Day at Emory & Henry.

Program Demographics

There were a total of 1,151 individuals served in all of the programs of Recovery Care Coordination. The majority of consumers were between the ages of 21 and 64 and the majority were Caucasian. 49 or 4% were African American. 494 or 43% were male, with more males served in Bridge, Home Recovery, WRAP, and SwVMHI than any of the other programs. 763, or 66% of the persons served were residents of Washington County.

Utilization Review

Program performance in the Care Coordination Units is reflected in the following number of persons served:

State Hospitalizations Private Hospitalizations BCSS 1 BCSS 15 (3 twice) WCSS 21 (3 private before; 2 twice) WCCSS 20 ( 1 3 times) Bridge 20 (1 twice; 3 private before) Bridge 18 (two twice) TOTAL 42 TOTAL 53

Recovery Care Coordination Services (continued)

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State and private hospital utilization remained level from FY 2010 (41 state and 51 private). Re-hospitalizations included 8 people attending clubhouse (2 to the Institute and 6 to a private facility), but this is a huge decrease from 24 clubhouse members in FY 2009. Re-hospitalizations also included 9 people receiving mental health supports (2 to the Institute and 7 to private facilities), also a significant decrease from 19 persons in FY 2009. Clubhouse and mental health supports re-hospitalizations remained level from FY 2010. No individuals were hospitalized following Home Recovery or WRAP. It is evident that our extensive array of rehabilitation services are a major factor in reducing hospitalizations and not surprising as they all focus on personal strengths, wellness activities, and recovery!

Outcome Measures

Efficiency: Targeted units of service were met. Effectiveness: 4 % of the 1,051 persons served with mental illness were re-hospitalized at SwVMH. 5% of the 1,051 persons served with mental illness were re-hospitalized in private hospitals. The goal for 80% of people in recovery not to be re-hospitalized due to relapse of symptoms of mental illness has been met with 91% not re-hospitalized, the same as FY 2010.

Persons with dual diagnosis are served in all programs and are included in the data reported above. It is important to note that the percentage of hospitalized persons from clubhouse and mental health supports remained low. Again, we believe that the focus on strengths in these programs as well as in Home Recovery and WRAP services is evidence that the quality of service is constantly improving. And that there is considerable congruence between the philosophical frameworks of the Care Coordination and Recovery Departments.

Satisfaction: Satisfaction Surveys were conducted by Peer Support Specialists using the Recovery Oriented System Indicators (ROSI) and submitted to the Department for 70 adults with serious mental illness. The results were extremely positive in describing staff who “believe in me,” “respect me as a whole person,” “see me as an equal partner in my treatment program,” “treat me with respect regarding my cultural background,” “listen carefully to what I say,” and “use my own words in my treatment plan goals.” There were mixed responses regarding having enough income, family involvement, and reliable transportation, all understandable given the number of consumers who live in Adult Care Residences away from their families and communities of origin as well as the absence of a comprehensive public transportation system.

Community Support Services

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Service Highlights

• Developmental services are provided to yearly average of 72 children in Washington County and Bristol City. Care Coordination services have been provided for 55 children.• New program relationships within the HCS agency have emerged with Outpatient therapy, In- home therapy, Prevention and Children’s’ Services during this year which has created an increase in referrals for all programs. • The staff continues their involvement with public awareness and local child find activities by participating in community events that center around young children and their families.• Staff continues to keep abreast of new program developments and best practices by attending training offered at local, state and national level. State level trainings have been provided via teleconferences and at local regional trainings. Specific trainings included: Autism, Eligibility Determination, and Medicaid Billing for Providers, Infant Mental health and on-going training for IFSP development. • The collaboration between the local Early Head Start program and Highlands Infant & Toddler program continues to conduct developmental screenings for birth to age 3, twice a year.• Our program continues to grow as a resource for providing training opportunities to groups in the community who are involved with young children. Presentations for our programs have included King College nursing students, Care Connection for Children and Highlands Pediatrics.• Transition activities between our program and the local school divisions have been conducted in timely manner while following Virginia’s mandated policies and procedures.• We continue to work with local DSS agencies with mandated CAPTA (Child Abuse Prevention and Treatment Act) referrals and non-CAPTA referrals which have increased due to number of children exposed to meth labs in the home and neglect as a result of parent/caregiver substance abuse.• The need for services for young children with ASD is met through participation with HCS Autism Task Force and services offered through Outpatient therapy.• The EI staff continues to work diligently to meet and maintain standards as set by OSEP and the Part C office for this 2010-11 year. Results indicate that our local system has maintained the “Meet Requirements” category. Additional information can be found at www.infantva.org website.

Support Coordination

• Due to downsizing and possible closing of the Southwestern VA Training Center, ID SC have been working to coordinate appropriate supports for those being discharged back into the community. Developed services via Money Follows the Person (MFP) funding.• Internal record reviews were conducted for all ID services and got excellent ratings with no citations. In addition to internal record reviews, the department required quarterly record reviews to be completed and results entered on the “Survey Monkey” that was a direct link to the department.• Expansion of work area due to Early Childhood Services vacating the space, allowing for more privacy.

Community Support Services (continued)

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Residential Services

• The number of Sponsor Homes increased from three (3) to eight (8) with nine (9) individuals receiving supports.• Consulted with and continuing to consult with a private provider to evaluate for the need of establishing a small, 4 person, home.• Unit Manager continuing the process to obtain Positive Behavioral Support Trainer Certification;• Two of the consumers living in Sponsor Home Placements participated in the State Special Olympics.• Worked with children’s services in establishing and maintaining the Sponsor Home for children program.

Horizons

Family Support• The Family Support services continued to provide funding to families to assist with respite, home modifications, long distance travel to obtain specialized medical care, adaptive equipment/assistive technology for child and more. Providing the family with funding for a child to attend a week long camp, thus allowing family respite.• Family support funding will not be restricted as of July 1, 2011 and thus the funds will go into the IDSC budget and used to assist individuals as usual.

Utilization ReviewDemographics• Of those who received services within the ID Programs, 94% were Caucasian. There were 74% in the 23 to 59 age range. • There were 83 females and 111 males who received services. Family Support and Horizons have about 53% female and 47% male within the programs.• The number consumers served in Washington County (130) was over twice as many as in the Bristol City (64) area.• As far as referral sources, the majority came from family/friend, MR Non-State provider and other community referrals. There was 52% that came from family/friend, 8% MR Non State provider, 10% from schools and 15% other community referral.

In reviewing residential type, there were 87% from private residence/household, 7% from Licensed Home for Adults and 6% from community residence.

OUTCOMES

• Program performance is reflected in data for the following two reports:

HCS Program Performance FY’11: Persons Served YTD Annual % of Annual Target TargetID Support Coordination 189 175 106%Horizons 56 51 110%Sponsor Home 10 6 166% In summary:• All programs met and exceeded the projected units of services.

The mission of the Center for Behavior Health, Highlands Community Services (HCS) Access Services is to provide a single point of entry for all residents of Washington County, Virginia, and the City of Bristol, Virginia, who are seeking mental health, mental retardation and substance abuse services offered by HCS. Access/Emergency Services will provide attentive, emergent care to consumers and families who present as needing immediate assistance. All services will be provided in the least restrictive environment. Staff are trained to provide an environment that promotes dignity, respect, hope and genuine empathy to those that seek services. It is important that this concept is at the cornerstone of our services to ensure the return of potential consumers and future referrals.

Total Referrals

All Referrals New, Previous and Existing for July 1, 2010 – June 30, 2011

Under 18 429 Over 18 1177

Total 1616

ACCESS

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