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ENGROSSED SENATE BILL 2012HOUSE APPROPRIATIONS
HUMAN RESOURCES DIVISIONREPRESENTATIVE JON NELSON, CHAIR
Combined Human Service CentersTom Eide, Director of Field/Interim CFORosalie Etherington, Chief Clinic Officer/NDSH SuperintendentJeff Stenseth, Field Services Operations Officer/SEHSC Regional Director
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Key approaches in Field Services
Build on culture and employee retention
Strategy of getting services to people sooner, at a lower level of care and in their own communities.
Evidenced based methods appropriate for our core group of constituents
Operational effectiveness and efficiencies
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Build on culture and employee retention
• Leverage state wide focus on values and cultural aspirations• Engage employees in joint work to improve work culture
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Sooner, earlier and in the community
• Invest in• 1915i• Funding of Targeted Case Management• Free Through Recovery Expansion • Expansion of SUD Voucher• Mobile Crisis Teams
• Divert funds from • HSC Growth• Reduce beds/stop growth at the North Dakota State Hospital
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Evidenced based changes
• Updating care models and practices• Restructuring teams to reflect new processes and approaches• Pursuit of accreditation
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Operational
• Improving access, reduced time to services• Implementation of a new electronic health record that meets
meaningful use criteria• Changes to allow for more client face time
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Field ServicesSystem of Care
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Administration, 135.9
Behavioral Health, 501.35
Children & Family, 28
Developmental Disabilities, 114.37
Aging, 18
Vocational Rehabilitation, 75
A BREAKDOWN OF STATEWIDE HSC 872.62 FTE
8
9
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NW HSC NC HSC LR HSC NE HSC SE HSC SC HSC WC HSC BL HSC NDSH
Field Services Turnover Rate
2016 2017 2018
Designing Behavioral Health Care to:
SERVE THOSE MOST FUNCTIONALLY
IMPACTED
SUPPORT/INCREASE INDEPENDENT FUNCTIONING
SUPPORT INDIVIDUALS ACHIEVING THEIR RECOVERY GOALS
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Clinical TransformationRehabilitation and Recovery Services
• Multidisciplinary Team Based Services• Treatment Focused on Restoring Health and Function• Client Outcomes and Satisfaction Measured• Service Quality and Accuracy Measured• Accreditation Readiness Measured• Crisis Service Gaps and Needs Identified
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•
12
0
1
2
3
4
5
6
7
8
NWHSC NCHSC LRHSC NEHSC SEHSC SCHSC WCHSC BLHSC
Full
Tim
e Eq
uiva
lent
Crisis Service Personnel Enhancement
Sub-Acute Crisis Unit Personnel Enhancement (Contracted)Sub-Acute Crisis Unit Personnel Enhancement (agency run)Crisis Response Team Personnel
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Criminal Justice Specific Services
Select Services to County JailsAdolescent and Adult Drug Court Services Treatment to Individuals in Free Through Recovery Tompkins Rehabilitation Center Re-Opened to Community Referrals SCHSC Cooperative Release Treatment Services
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Youth Specific Services
• Specialized Intensive Family Therapy-Multisystemic Therapy• Trauma-Focused Cognitive Behavioral Therapies• Statewide Review Team for Problem-Solving Difficult Cases• Region Specific Intensive In-Home Therapies• Safety Net Provider for Psychiatric Residential Treatment• Targeted Adolescent Residential Substance Use Disorders Treatment
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Key Statewide PositionsStatewide Alignment
• Field Services Medical Director• Statewide Child Psychiatrist• Statewide Rehabilitation Psychologist• Field Health Records/Coding Specialist• Field Accreditation Lead
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NOV2017
DEC2017
JAN2018
FEB2018
MAR2018
APR2018
MAY2018
JUN2018
JUL2018
AUG2018
SEP2018
OCT2018
Client Count ND 6,757 6,446 6,844 6,509 6,695 6,933 7,023 6,556 6,415 6,595 6,380 7,282Hours ND 17,307 15,354 17,904 16,188 16,689 16,915 17,665 15,856 16,364 17,694 14,452 16,731Services ND 45,779 44,364 49,691 43,626 46,615 45,783 48,186 42,451 42,190 47,109 40,278 46,356
0
10,000
20,000
30,000
40,000
50,000
60,000
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Coun
t of S
ervi
ces
and
Hou
rs
Uni
que
Coun
t of C
lient
sDuration (Hours) of Services, Count of Services, and Unique Count of Clients,
Statewide NOV 2017 - OCT 2018
17
546
469
428
468
493
358
462
390
462
499
452
531
302
323
292309
348
287
336
287 293
379
305
356
0
100
200
300
400
500
600
APR 2017 MAY 2017 JUN 2017 JUL 2017 AUG 2017 SEP 2017 OCT 2017 NOV 2017 DEC 2017 JAN 2018 FEB 2018 MAR 2018
Count of Emergency Services Face-to-Face and Phone Calls, Statewide APR 2017 - MAR 2018
ND Phone Call ND Face-to-face 18
Emergency Services Disposition StatewideApril 2017 – March 2018
19
Open AccessBehavioral Health Walk-In
20
21
JUL2017
AUG2017
SEP2017
OCT2017
NOV2017
DEC2017
JAN2018
FEB2018
MAR2018
APR2018
MAY2018
JUN2018
JUL2018
AUG2018
SEP2018
OCT2018
ND Triaged 622 855 724 738 791 642 841 738 782 799 783 621 650 740 638 754ND Assessed 419 561 428 460 505 367 483 464 464 484 459 367 421 491 411 496ND Referred Out 89 133 121 150 113 132 141 123 102 117 159 130 159 188 115 104
0
100
200
300
400
500
600
700
800
900Co
unt o
f Clie
nts
Open Access Statewide by Month, JUL 2017 – OCT 2018
12
11
910 10 10
8
7 7 76 6
0
2
4
6
8
10
12
14
Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Average Statewide # of days from assessment to first day of treatment
22
NOV2017
DEC2017
JAN2018
FEB2018
MAR2018
APR2018
MAY2018
JUN2018
JUL2018
AUG2018
SEP2018
OCT2018
Client Count 493 456 540 464 516 593 479 551 547 601 621 765Count of Sessions 538 491 600 507 570 649 550 617 618 718 702 893
0
100
200
300
400
500
600
700
800
900
1,000UNIQUE COUNT OF CLIENTS AND TOTAL SESSIONS FOR TELEHEALTH
SERVICES STATEWIDE NOV 2017 - OCT 2018
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Clients and Families Express Satisfaction2016 2017
• Satisfaction with response and wait time 90% 89%
• Satisfaction with wait time to first appointment 92% 92%
• Satisfied with service location and times 97% 95%
• People helping this child stuck with us no matter what 91% 96%
• “If I had other choices I would still get services here” 92% 92%24
Client Functions Improve2016 2017
• “I am better able to take care of my needs” 93% 94%
• “My housing situation has improved” 85% 89%
• “I am better able to deal with crisis” 84% 89%
• “The child gets along better with family” 86% 86%
• “The child gets along better with friends and others” 79% 84%25
BUDGET OVERVIEWCOMB I NE D H U MA N S E R V I C E C E NT E R S
OVERVIEW OF BUDGET CHANGES
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Description 2017-2019 Budget
Increase/ (Decrease)
2019-2021 Executive Budget
Senate Changes
2019-2021 Budget to
HouseSalary and Wages 143,518,093 13,662,245 157,180,338 (1,830,808) 155,349,530 Operating 18,586,900 (273,936) 18,312,964 - 18,312,964 Capital 40,449 39,551 80,000 - 80,000 Grants 27,564,955 1,341,962 28,906,917 864,710 29,771,627 Total 189,710,397 14,769,822 204,480,219 (966,098) 203,514,121
General Fund 115,572,020 11,873,018 127,445,038 (289,478) 127,155,560 Federal Funds 59,689,555 (2,581,008) 57,108,547 (521,444) 56,587,103 Other Funds 14,448,822 5,477,812 19,926,634 (155,176) 19,771,458 Total 189,710,397 14,769,822 204,480,219 (966,098) 203,514,121
Full Time Equivalent (FTE) 852.62 20.00 872.62 - 872.62
OVERVIEW OF BUDGET CHANGES
2015-17 BienniumExpenditures
2017-19 BienniumAppropriation
2019-21 ExecutiveBudget Request
2019-21 Budget tothe House
Grants 30,671,868 27,564,955 28,906,917 29,771,627Capital 10,699 40,449 80,000 80,000Operating Expenses 17,273,921 18,586,900 18,312,964 18,312,964Salaries and Wages 133,893,102 143,518,093 157,180,338 155,349,530FTE 861.4 852.62 872.62 872.62
0
200
400
600
800
1,000
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000Budget Analysis
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MAJOR SALARY AND WAGES DIFFERENCES
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MAJOR OPERATING DIFFERENCES
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MAJOR GRANTS DIFFERENCES
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OVERVIEW OF FUNDING
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2015-17 BienniumExpenditures
2017-19 BienniumAppropriation
2019-21 ExecutiveBudget Request
2019-21 Budget toHouse
Special Funds 10,974,623 14,448,822 19,926,634 19,771,458State General Fund 115,350,950 115,572,020 127,445,038 127,155,560Federal Funds 55,524,017 59,689,555 57,108,547 56,587,103
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
Funding Sources
