ADAMH BOARD OF FRANKLIN COUNTY TREATMENT SERVICES 2014 SYSTEM INVESTMENTS REQUEST FOR RESULTS APPLICATION

Transcription

1 ADAMH BOARD OF FRANKLIN COUNTY TREATMENT SERVICES 2014 SYSTEM INVESTMENTS REQUEST FOR RESULTS APPLICATION AGENCY NAME AGENCY CONTACT TELEPHONE STREET ADDRESS CITY, STATE, ZIP PROGRAM TITLE SYSTEM INVESTMENT CATEGORY ALLOCATION REQUEST Checklist for Additional Material Yes/No Budget worksheet Proof of accreditation Proof of certification by ODMH or ODADAS Audited financial statements * Logic Model** * For applicants who are not currently providers of ADAMH services ** See Appendix 1 ADAMH System Investments Treatment RFR Application Page 1

2 A. COMMUNITY NEED Describe the need, condition, or opportunity that the program addresses. For example: The program addresses the needs of older adults who need mobile behavioral healthcare crisis intervention. Following the first sentence, provide additional documentation including local data about the needs of the specific population. Please provide data sources. B. TARGET POPULATION Provide a description of your target population. Clearly describe the program s customers (who will benefit) in s of all of the following elements: a) the behavior or conditions they experience; b) environmental situations that exist (e.g. family structure, school atmosphere, level and type of substance abuse, health status, culture, language and gender issues, violence issues, involvement with corrections and human service agencies that serve lowincome and uninsured people, etc.); c) geographic location of the population; d) barriers that need to be overcome; and e) customer s unmet needs. The description can portray all customers as one group or illustrate distinct customer groups. Again, focus on those behaviors, conditions and experiences that are relevant to the program and the results the program is intending to achieve. If the identified target population has a higher level of need than other groups in the community, please explain and supply data to verify this assumption. C. PROGRAM DESCRIPTION 1. Describe the program and its major elements, including the evidence-based model. 2. Describe how the proposed services will alleviate or address the needs of the target population. In your description, please identify unmet needs in Franklin County that the proposed services will alleviate and how the proposed services will alleviate the unmet needs (what are the best practices being utilized to meet those needs). 3. Describe your agency s historical or current experience providing services to the target population. 4. Describe what the consumer will experience as a program participant. Include in your description the following: a) outreach and engagement strategy; b) estimate of the amount of time needed to engage a consumer; c) strategies utilized to reach and engage the uninsured, please include referral sources; d) a timeline of the admission and intake process that estimates the anticipated time between program inquiry or referral and first day receiving services (the timeline should include the duration for each step of the process); e) how prospective consumers are prioritized to assure that uninsured consumers receive priority access; f) how this program will be structured to allow timely access and intensive response to new and ongoing consumers with urgent and emergent needs; g) menu of services provided include Medicaid and non-medicaid taxonomy of services; ADAMH System Investments Treatment RFR Application Page 2

3 h) estimates of the Medicaid and uninsured penetration rates; i) length of stay; j) referral sources; and k) discharge process. 5. Describe how the clinical interventions, strength-based strategies, best practices, and evidence-based modalities used in this program will work in practice. 6. Please identify the evidence models you re using and why your approach will be the best to address this issue. Identify the resource that has deemed it an evidence based model or a best practice. Please cite the research, research body, outcomes analysis, or literature upon which practices are based and why you chose this model. If the practice has not been tested, please provide your research that supports adoption and use of the practice. Describe how evidence-based practices are being utilized to shorten the length of stay in this program. 7. Outside of the annual ADAMH Consumer Satisfaction survey, describe how consumers and families will be allowed opportunities to provide input to improve these services. 8. Based upon your proposed target population, please describe the strategies that will be used to address the cultural needs of consumers. Explain how the chosen model lends itself to adaptation to cultural differences. 9. List your community partners in this project. Describe how they will be involved in the program. 10. Describe how care coordination in this program will interface with the continuum of care currently provided by your agency. Include other organizations such as housing services and other providers. Include in your description the anticipated impact of Health Care reform on the program and in particular the impact of Medicaid expansion. 11. Describe how the program will be staffed. List the number of FTEs, job classifications, and credentials assigned to this program and whether they will be new hires or existing agency staff. 12. Cite the non-adamh funding sources leveraged to assist in funding the program and explain how you plan to sustain the program. 13. Describe how you will bulid and maintain collaboration with the host agency and the OSU Medtapp Program. D. IMPLEMENTATION PLAN 1. Describe your implementation plan, quarter by quarter for the first 12 months. Include a timeline that identifies planning and development phase and the implementation phase, service delivery start date, end date, and step-by-step completion dates for first year activities. Include target numbers of consumers who will be reached in each quarter of the implementation period. 2. Identify any potential barriers to program development and implementation and how you will overcome them. ADAMH System Investments Treatment RFR Application Page 3

4 E. PROGRAM PERFORMANCE MEASURES 1. List the annual number of unduplicated consumers served by this project. This is the number of consumers expected to be served by this proposal alone. If this is an expansion of an existing program, list only those consumers added by this proposal. If consumers are expected to leave the program and return, include them only once. 2. In addition to completing this information as part of Part III of the budget template, provide a result statement for this program and complete the supporting data in the table. Follow this example for your result statement: 70% of clients completing the AOD vocational program will be placed in a job and maintain employment for at least 60 days. Program Budget Demand Number of clients Output Number of clients Result % % of participants Output Efficiency $... Result Efficiency $ Describe the source of your data and explain how you will capture data to support this result and how you will provide that information to the ADAMH Board. 4. Explain how consumer outcomes will be measured and demonstrated. Define what you consider programmatic effectiveness. Include clear examples of your experience achieving positive outcomes for consumers and using data and measurable results for informing and influencing consumer care or treatment and relapse prevention planning. 5. Describe what customer service indicators will be used to measure consumer satisfaction for this particular program. For example, what are your customer service timeframes for returning consumer phone calls or for informing consumers when an appointment has been cancelled? Is there a mechanism in place to communicate these standards and expectations to consumers in this program? F. PERFORMANCE REQUIREMENTS 1. Provide proof that your agency is in good standing with an accrediting body, or outline a plan to meet accreditation including a timeline. 2. Provide proof of certification by OHMHAS, or outline a plan to meet needed certification for the service you will be providing with this program. In addition, applicants who are not currently providers of ADAMH services must: 3. Provide audited financial statements. 4. Explain how you will meet the same reporting requirements as current ADAMH providers: Submission of service information electronically through MACSIS or MITS, as appropriate. Submission of consumer outcomes data through the ADAMH Extranet. ADAMH System Investments Treatment RFR Application Page 4

5 Particpation in a formal evaluation of Integrated Health Care programs within the ADAMH system. Other preformace metrics as identified. APPENDIX 1 ADAMH may ask for logic models to be included in our requests for results responses in Here are some resources that may be useful in developing a logic model: Develop a Logic Model (handout 5-5) from SAMHSA s technical assistance manual W. K. Kellogg Foundation Logic Model Development Guide. Using the result statement from Section E question 2 for this program, please complete the logic model below: Inputs Outputs Outcomes Impact Activities Participants Short Medium Long ADAMH System Investments Treatment RFR Application Page 5