Agenda Item Name:
Title
Review and Approval of Behavioral Health Transportation Plan 2020-2023 Developed for Alachua County
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Presenter:
Stuart Wegener, 548-3708
Description:
Review of Comprehensive Plan to Respond to State Requirements of Senate Bill 12 for the Development of a Formal Transportation Plan for Behavioral Health Focused on Individuals Transported Under the Baker or Marchman Acts in Alachua County.
Recommended Action:
Recommended Action
Adopt the revised Behavioral Health Transportation Plan Proposed for Alachua County for the next three years.
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Prior Board Motions:
6/27/2017: Approval of the Alachua County Behavioral Health Transportation Plan for 2017-2020
Fiscal Consideration:
Fiscal Consideration
None
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Background:
Senate Bill 12 was signed into law on April 15, 2016, providing for significant reforms to the State’s behavioral health system’s intake and referral processes. Importantly, the legislation called for the establishment of receiving systems that will function as a “No Wrong Door” model which ensures access to services regardless of where a person may enter the system of care. SB 12 called for multiple behavioral health care system changes, including DCF’s role and responsibilities; revision of applicable statutes; requirements for annual assessments of services; and, much more. Transportation of those with behavioral health needs was a major element of SB 12, especially those needing acute care services following the involuntary commitment of an individual under a Baker Act (mental health) or under a Marchman Act (substance abuse.)
Specifically, Senate Bill 12 required the development and approval of a local acute care receiving system plan and a local acute care transportation plan to support that receiving system plan. Each of Florida’s 67 counties was required to develop and approve a formal behavioral health transportation plan, and the plan must also be approved by the applicable Managing Entity (ME) established by DCF having responsibility for that county. The Managing Entity for Alachua County is Lutheran Services Florida (LSF) Health Systems. The presentation of our County’s plan to DCF occurred on June 27, 2017 following BoCC approval.
The Plan describes a coordinated system of care, which requires collaboration among the County’s receiving facilities, law enforcement, EMS and other entities in order to assure those being transported under the Baker or Marchman Acts have dedicated access to the acute care they need. The Plan specifies the role of law enforcement agencies and emergency service providers to transport both adults and youth to specific receiving facilities. Alachua County’s behavioral health resources are explicitly outlined based upon the current receiving system. Services to help veterans under such circumstances are also identified. The Plan provides for flexibility in the transport of such individuals allowing for individual or family choice on the selection of a receiving facility for care.
Since the last Plan was approved by the County and subsequently accepted by DCF, over three years has passed. On June 23, 2020, the County Manager’s Office approved a request to allow the County a six-month period to prepare and submit a revised plan for the next three-year period. The deadline for this requirement for submission of a revised plan is now December 1, 2020.
Court Services is the County department charged to organize and coordinate the activities necessary to bring the Plan to fruition and present it to the BoCC. On October 6th, Court Services held a meeting among all the organizations who had participated in the development of the 2017-2020. During this meeting by Zoom, staff solicited input from key participants, stakeholders and virtually every organization concerned with behavioral health care-related transportation including providers, law enforcement, public and nonprofit agencies. During this meeting, feedback from representatives of participating organizations was positive, however there were identified specific needs for updated data to be added to the developing Plan for 2020-2023.
A list of the organizations and agencies - public and private - engaged in the Alachua County Plan’s development is included, as is a list of invitees to such meetings. Representatives of at least 25 organizations participated in this process, including law enforcement (City, County and municipalities), justice system agencies, County departments, social service agencies, hospitals, behavioral health providers, consumer and family members, and more. The Managing Entity Lutheran Services Florida was involved in every planning session and has provided technical assistance in this Plan’s development much as the organization was engaged in the 2017 Plan.
There remains a consensus among the organizations included in the present process that the current system of transportation in the 2017 Plan for these special populations does work well, with a demonstration of strong collaboration among the receiving facilities, law enforcement, emergency medical support agencies, and others. The proposed Plan re-formalizes the existing commitment of all agencies and organizations in the County now involved in transport of those under the auspices of the Baker or Marchman Act, in order to meet the requirements of SB 12 for transportation in the future.
Three changes have been recommended for this Plan, apart from updating data related to the community’s receiving facilities. First, included in the Plan is a recommendation that the participants providing behavioral health care work toward aligning local services for both the Baker and the Marchman Acts. This feature was included as a recommendation in the original SB 12 legislation, but not addressed in the 2017 Plan. There was no guidance particularly to counties about how to operationalize that goal, but it is more likely to be available now. Second, it was recommended that the new Plan include a goal for our community that if emergency medical care is needed before entry into a receiving facility, that access to such care is sought. It is our understanding that the need for emergency care is limited among this special population, when law enforcement is providing the transport.
Recent guidance from the DCF Office of Substance Abuse and Mental Health has indicated that County transportation plans should include the availability of Mobile Response Teams (MRT) being available as a front-end mechanism, for the behavioral health system prior to invoking the use of the Baker or Marchman Act. Therefore, the revised Plan does include significant language noting the County’s primary MRT tool is available to our local behavioral health and law enforcement partnership through the Alachua County Crisis Center, and also articulates the services obtainable through the Center. There was unanimous support for this addition to the proposed Plan.
The Behavioral Health Transportation Plan recommended entails a recognition that once it is in place, the implementation of the Plan must be carefully monitored. A Transportation Plan Advisory Committee is, as before, included in the Plan, however a renewed commitment exists for this entity to meet regularly to review operation of the Plan once it is in place. A roster of the proposed Advisory Committee is again incorporated in the Plan.
As the BoCC is aware, there are currently efforts to advance the concept of a central receiving facility for the County’s existing behavioral health system to coordinate entry and to improve and enhance access to care. A special Subcommittee on Oversight to the Alachua County Public Safety Coordinating Council has recently been established for this express purpose. The Plan before the BoCC, once approved, will need to be revisited to take into account changes in program development -like the addition of a central receiving facility would present for our community’s overall system.