Community Strategies: New Hampshire Comprehensive Program Review December 21, 2012

Successfully transitioned through the changes with Community Strategies. Reorganized Keene and separated Day Program and Residential Services. Promoted Tia Tallman to Sr. Program Coordinator. Hired Charles Richwine in the newly created position – Day Program Events Coordinator. Charles developed a new Day Program in Keene – Active Life – MDS and the community are very impressed with the new program and activities being offered. We now have a solid day program staff. Hired Tom Grinley in the newly created position – Assistant Clinician. Through this changed how clinical services are being provided. Bonnie Addario, Office Coordinator, hours were increased to 24 hours per week.

Moved the Manchester Office from 1490 Elm Street to 1480 Elm Street. All three beds at Unity House are full – AC moved in on 10/10/12 but we received full contract for FY 13 and LV moved in on 8/23/12. Additionally, we were awarded a new day program in July, a Residential/ Day program in October, as well as two more starting in December. For the first time in approximately 10 years of various residential placements, JT (Newmarket) has been free of any self-harming behaviors that require ER treatment and/or hospital admission. Julie G’s colon cancer is now 1 year in remission. Both PT and PM (who live in the apartments at 1490 Elm Street) have been stable and incident free for the last 6 months and living successfully semi-independent.

GM appears to be drinking less. He spent 3 successful overnights with his ex-wife. This was the first time in 5 months she allowed him to visit because she would not tolerate his drinking. CD went on a cruise in the Caribbean with a national group that supports people with disabilities. An article was written by MDS about WM’s life changes since he has been with us. Dina going to Florida for 4 months. This also took place last winter and was very successful including the ability to continue to bill. PB had serious medical issues in the past and through months of hard work and dedication from her team and her physician she has the ability to laugh and enjoy life again. RC continues to thrive in a family setting. This is a high profile case and his success is well known within the state.

Challenges in CS-NH : Obtain increased funding for Newmarket. Continue to resolve the financial cost of fee for service agencies – MCS and MDS. Increased clinical presence for staff/client support by utilizing Tom Grinley Providing services for individuals with substance abuse issues. Being 100% compliant with all CS-NH inspections due to the changes in state regulations. Preparing for Managed Care and the changes put forth by the state and our funding agencies. Ensure that all performance reviews are up-to-date. Utilizing our resources within CRJ/CS-NH to accomplish what needs to be done. Utilizing vacation time in a timely fashion with the ability to continue to accrue vacation time. Bring up the hourly rate for DSPS to market value and equal hourly rates based on education and experience.

STAFFING Staff Turnover Rates Performance Evaluations Staff Training

STAFF TURNOVER RATES May 2012 – October 2012  The current CSNH turnover rate is 23.4% compared to the last CPR of 17.9%  Last CPR: Keene = 10%; Manchester and Unity = 0%; Individual Sites = 22% (August 2011 – January 2012) Data obtained from HR Reports

OVERDUE PERFORMANCE EVALUATIONS May October 2012  Total of 66 FT and 30 PT overdue performance evaluations between May 2012 – October  Last CPR, a total of 72 FT and 55 PT overdue performance evaluations from August January Data obtained from HR Department & HR Personnel Summary MayJuneJulyAug.Sept.Oct. FTPTFTPTFTPTFTPTFTPTFTPT Keene Manchester Unity Individual Sites Totals Overdue Evaluations 2 or more months FTPT Keene56 Manchester00 Unity4 0 Individual Sites62 Totals158

 Total 261 training hours were completed May 2012 – October 2012  Average of 7.6 training hours per staff/six months E Training Hours MMR Training Hours Total Keene910 Unity House580 Newmarket Program8.250 Manchester Totals MMR Training Hours = combined and not sorted by individual programs Data obtained from MMRs and HR Reports

CLIENT RELATED Clinical Hours Walk-Aways Restraints New Clients Medication

EVOLVING MODEL OF CLINICAL SUPPORT  Recognition we are serving more individuals with co-occurring disorders  The milieu is an essential component of any treatment plan  Clinical support of program and staff  Greater use of standardized, objective scales and assessments  More of a Clinical Case Management approach  Person centered, recovery oriented, trauma focused treatment*  Continuity in planning across service providers *When applicable  Please refer to CSNH Clinical Presentation Handout

Community Strategies Day Program ACTIVELife  The ACTIVELife name was chosen because it is the core mission of the day program. We work to insure that all our individuals are active within their lives. ACTIVELife is NOT an adult daycare…we are not a place where individuals are dropped off for the day to only stay within the walls of the facilities. ACTIVELife is about being out and involved within the community.  Please refer to the CSNH Day Program Handout

 Average of 0.79 clinical hours per client/month  Total Clinical Hours = 39; last CPR, total Clinical Hours = 188 (August 2011 – January 2012)  Last CPR, the average of. 7 clinical hours per client/month Data obtained from MMRs

Client Walk-Aways May 2012 – August 2012 August 2011 – January 2012 CSNH00 Client Restraints May 2012 – August 2012 August 2011 – January 2012 CSNH10 Data obtained from MMRs New Clients - CSNH

 Total of 0 medication incidents and occurrences (May 2012 – October 2012)  Last CPR, a total of 7 medications incidents and occurrences, over six months. Data obtained from MMRs

There was one restraint for May – October 2012; last CPR, there was one restraint (August 2011 – January 2012 There were zero elopements for May – October 2012; last CPR, there were zero elopements There were two incidents involving contraband for May – October 2012; last CPR, there were zero incidents involving contraband There were zero medication incidents for May – October 2012; last CPR, there was one medication incident There are ten clients competitively employed; twenty-seven clients partaking solely in day activity programs There were six site visits by outside regulators/funders from May 2012 – October 2012 CSNH received 3 written commendations from site visits by outside regulators/funders and 7 deficiencies (over 6 months). However, at the time of the last CPR there were 27 deficiencies so this is an improvement.

See Handout