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Discovering

Possibilities

2010-2011 Annual Report for Centerstone Research Institute


150

Centerstone Research Institute has conducted more than 150 research studies since 2003.

Centerstone’s mission is to prevent and cure mental illness and addiction.

TABLE OF CONTENTS 2 From the CEO 3 From the Board Chair Centerstone Research Institute Board of Directors 4 About CRI 5 The Year in Review – 2010-2011 Highlights 7 Research 9 CRI Leadership 10 Major Funding Sources Major Donors Revenues and Expenses 11 Centerstone of America Leadership

1 / 2010-2011 ANNUAL REPORT CENTERSTONE RESEARCH INSTITUTE


We believe in the possibilities of lives changed forever through prevention, early intervention and research-driven treatments. FROM THE CEO

It has been an exciting year for Centerstone Research Institute (CRI). It’s also been a year of change. While change can sometimes be unsettling, it is important to remember that all change opens up countless possibilities for the future. Personally, I am quite excited at all the possibilities currently before us. In addition to securing $17.6 million in funding this past year to implement research-based practice at Centerstone, we have continued to grow the Knowledge Network consortium, launched the Human Performance Lab in collaboration with the Indiana University School of Informatics, and have been working steadily to build Clinical Decision Support (CDS) tools for our multiple Centerstone organizations and for our behavioral health industry. These efforts were made possible by the generous philanthropic support of The Ayers Foundation, the Cal Turner Family Foundation, and the Joe C. Davis Foundation. This year, CRI was featured by the IBM Smarter Planet series for our work in CDS and predictive modeling of behavioral healthcare services. In addition, Behavioral Pathway Systems, a company of CRI, is now described as the premier resource for behavioral health and human services benchmarking at national conferences and other public gatherings. Thanks to the leadership of Tennessee board chair Lee Ann Ingram, we have identified and facilitated a new partnership with Massachusetts General Hospital (MGH) and Harvard University. Our academic partners, Dr. Madhukar Trivedi (University of Texas Southwestern), Dr. Rick Shelton (University of Alabama - Birmingham), Dr. Herbert Meltzer (Northwestern University) and Dr. Kay Connelly (Indiana University) have been wonderfully supportive of our efforts. And our new partnership with MGH has introduced us to expert collaborators at the Harvard Medical School including Dr. Maurizio Fava, Dr. A. Eden Evins, Dr. Jordan Smoller and Dr. Isaac Kohane. We are incredibly excited about the potential of this partnership. And finally, we have officially launched our Knowledge Network Data Warehouse within the Knowledge Network and are planning a public launch in early 2012. Currently, the data warehouse contains de-identified secure data from over 200,000 behavioral healthcare clients across the country, including diagnoses, services and medication information, making it the richest and largest shared database in community mental healthcare history. This in turn allows us to turn complex data into meaningful information for the improvement of care. We are excited to share, on the following pages, a few of our highlights from our numerous accomplishments this past year. To all who have supported and partnered with CRI in these efforts, we extend our heartfelt gratitude.

Thomas W. Doub, Ph.D. Interim Chief Executive Officer Centerstone Research Institute 2 / 2010-2011 ANNUAL REPORT CENTERSTONE RESEARCH INSTITUTE


FROM THE BOARD CHAIR On behalf of the Board of Directors for Centerstone Research Institute (CRI), I want to thank the staff and leadership team at CRI and our supporters around the world who make this such a great organization. We are continually amazed at what we have accomplished and how much is left to do to improve healthcare delivery through the marriage of research and information technology. In 2011, CRI made significant advances towards its mission and goals throughout the year. We have made exciting progress in several areas of ground breaking research, we have been recognized as a thought leader throughout the world, and we have established ourselves as a key voice in the public policy arena for mental health and addiction issues. We have also improved internal operational processes to make the organization more efficient and fiscally sound. CRI is a tremendous asset for the mental health and addiction field and the communities in which we live and work. We have also experienced challenges along the way, which provide opportunities for the organization in 2012 and beyond, yet we see a bright future for the organization and the patients around the globe that benefit from the hard work of our team at CRI. We could not do it without the support of the Centerstone organization, our donors, partners, vendors and supporters worldwide. We look forward to a productive 2012! Sincerely, Steven E. Bryant Chair Centerstone Research Institute Board of Directors

CENTERSTONE RESEARCH INSTITUTE BOARD OF DIRECTORS Steve Bryant, Chair Joan Sivley, Vice-Chair Ken Shidler, Secretary Janet Ayers Don Buesching, PhD David E. Lawler, DDS

Trish Lindler Tom Mahler Gil Palmer Nedda Pollack Deborah Taylor Tate Thomas W. Doub, PhD Interim Chief Executive Officer 3 / 2010-2011 ANNUAL REPORT CENTERSTONE RESEARCH INSTITUTE


ABOUT CENTERSTONE RESEARCH INSTITUTE Centerstone Research Institute (CRI) is a unique not-for-profit organization dedicated to improving mental healthcare through research, information technology and clinical informatics. CRI conducts service and clinical studies and partners with leading research institutions to advance knowledge of mental health and addiction disorders and discover innovative treatments. CRI works to enhance patient care by reducing the number of years it takes innovative developments to become standard clinical practice. We do this by leveraging technology to help healthcare providers have faster access to the latest treatments and practices and leveraging our program evaluation and implementation expertise to transform programs. Two award-winning CRI services include:

CRI’s Analytics platform helps healthcare providers use the data they collect to reduce costs, improve their operations and enhance patient care. It helps behavioral health providers become more efficient and effective, improving clinical productivity, patient access to services, and clinical quality.

• CRI’s Program Evaluation team works to translate research into practice and policy in behavioral

health through innovative evaluation. Our evaluators are skilled at providing utilization focused information to direct care staff that helps strengthen implementation of research-based best practices, resulting in improved outcomes among our behavioral health clients and family members. Evaluation enrolled 2, 239 clients in program evaluations last year and measured outcomes among 4,365 clients, including the successful completion of one Department of Education Evaluation and three SAMHSA Program Evaluations.

The organization maintains an Institutional Review Board and manages the Knowledge Network, a national technology-based, partner-driven alliance to facilitate the translation of research to practice. CRI also offers Behavioral Pathway Systems, a best practices benchmarking service.

Centerstone Research Institute has received over $75 million in federal and private grants since 2003 and conducted more than 150 research studies. The Knowledge Network Data Warehouse is the largest mental health database of its kind in the country. This secure database contains information such as diagnoses and demographics for over 200,000 de-identified patients across the U.S. It includes over 11 million service records and almost 2 million prescriptions.

INSTITUTIONAL REVIEW BOARD David Ayer, PhD, Chair Jan van Eys, MD, PhD Sid Levy, PhD Sally Violin, MBA

April Bragg, PhD Frank Stevens, PhD Sarah Suiter, PhD Jon Wolfe

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THE YEAR IN REVIEW – 2010-2011 HIGHLIGHTS

Secured $17.62M in funding this year through federal and private grant awards to implement multiple research-based programs throughout Centerstone. Submitted $1.2M grant to Agency for Healthcare Research and Quality (AHRQ) to support implementation of clinical decision support. Secured a $1M grant from The Joe C. Davis Foundation to support the development of a national data repository and dashboard for behavioral healthcare. Launched the Human Performance/Factors Lab in collaboration with Indiana University School of Informatics. The New Human Factors Lab provided three rounds of usability testing and recommendations for improvement to Centerstone research studies which measured completion times, error rates and usability with 29 therapists completing a simulated intake across two states. Completed development and launch of multiple analytic tools to increase data analysis and improve financial and operational management. Continued behavioral healthcare advocacy with Members of Congress, as well as continued federal policy leadership in the Behavioral Health Information Technology Coalition. Hosted two site visits by Members of Congress staff. CRI Board Vice Chair Joan Sivley provided moving testimony to Congress about the tremendous need for expanded Health IT funding in behavioral healthcare. CRI staff co-authored over 20 different publications, scientific posters and presentations, ranging from outcomes research to suicide prevention, and presented at conferences such as the American Evaluation Association and the Institute of Electrical and Electronics Engineers. Hosted two national summits for the Knowledge Network. Presenting speakers included: Dr. David Meltzer, Health Economics researcher at University of Chicago; Kathryn Power, Director of CMHS; and Charles Curie, former SAMHSA administrator and member of the New Freedom Commission appointed by President G.W. Bush. Former FCC Commissioner and board member, Deborah Taylor Tate, and former CRI CEO, Dr. Dennis Morrison, presented at the annual national conference of the National Council of Community Behavioral Healthcare on cyber bullying. Behavioral Pathway Systems (BPS) implemented new mental health benchmarking initiative in collaboration with Association for Behavioral Health in Michigan. BPS established new mental health and substance abuse benchmarking initiatives in collaboration with the Florida Association for Alcohol and Drug Abuse, Florida Council for Community Mental Health, and the Florida Department of Children and Families. (continued) 5 / 2010-2011 ANNUAL REPORT CENTERSTONE RESEARCH INSTITUTE


THE YEAR IN REVIEW – 2010-2011 HIGHLIGHTS (continued)

BPS received a grant through W.K. Kellogg Foundation for a new national Benchmarking Initiative on Civic Engagement in cooperation with the Alliance for Children and Families. BPS developed a new National Benchmarking Survey on Recovery Practices. BPS implemented a new national survey on Health Care Reform Readiness. BPS established a collaborative relationship with Open Minds (Monica Oss). Developed our first smart phone and tablet application – an app that permits rapid entry of behavioral self-monitoring, which summarizes entries and displays trends. Completed the development of a mobile app for entering form data (e.g., National Outcomes Measurements System/NOMS) using iPad, which ties into a web-based reporting framework for near real-time program reporting to include progress on outcome achievement. Implemented an electronic data exchange with the Davidson County Jail in Nashville, Tennessee. This data exchange identifies Centerstone clients from a list of those incarcerated to ensure awareness for the treatment team and medication regimes and ensures treatment(s) are not compromised. Implemented ePrescribing in Tennessee for prescribers and integrated with Centerstone’s EHR. Implemented EMS records imaging system in Tennessee and migrated all images from the previous imaging system, seamlessly integrated EMS into the EHR for better presentation of archived records. Modified a clinical productivity management system in Indiana to drive a shift in activity mix by providers so that the organization would be more viable after recent MRO changes. This resulted in Centerstone of Indiana ranking 5th out of 25 mental health centers in successfully managing this transition to a new funding system.

To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science. – Albert Einstein 6 / 2010-2011 ANNUAL REPORT CENTERSTONE RESEARCH INSTITUTE


The Centerstone Research Institute is dedicated to improving behavioral healthcare through the integration of research and information technology. USING RESEARCH TO HELP CLIENTS Clinical Research R**** is a 49-year old woman who for the last ten years had endured constant auditory hallucinations of a derogatory nature, visual hallucinations of bodily decay, and paranoid delusions, such that she was unable to concentrate or function, despite treatment with virtually every antipsychotic drug available. Hospitalizations and suicide attempts occurred annually. She was referred by the Clarksville Centerstone clinic to Dr. Meltzer for participation in a controlled study to determine if a very high dose of risperidone, given for up to six months, would prove effective in this type of refractory patients. Her baseline severity of psychosis and cognitive impairment was the worst of all 150 patients in the study. Very minor improvement occurred during the first five months after being randomly selected to receive high dose risperidone. Then, quite suddenly, the voices, visual hallucinations, and delusions stopped – completely. Subsequent assessment of her cognitive function showed she had returned to a normal level of performance. Now, over 18 months later, she has been able to enjoy all the things she and her companion had enjoyed before schizophrenia took away her capacity for and enjoyment of normal activities. Her fear of the symptoms returning has diminished. Her companion works in the music industry and has been inspired to write a song celebrating the elimination of her psychosis. Brain imaging studies showed improvement in specific brain areas which may be the basis for her striking improvement. The results of the full study are currently being analyzed. A follow up study, using the most recently approved antipsychotic drug, lurasidone, is already underway at the Madison clinic of Centerstone.

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USING RESEARCH TO HELP CLIENTS (continued) Services Research BE Well (Building Exceptional Wellness) is a program in Indiana made possible by a federal grant secured by CRI. Launched in January 2011, BE Well provides primary healthcare, screening and assessments, care management, prevention and wellness support services, and infrastructure to adults in Monroe County, Indiana who have been diagnosed with a serious mental illness. Participants are assisted in tracking their progress in order to improve their health status. Currently, thanks to the hard work of Centerstone’s BE Well staff, CRI evaluators report that BE Well is resulting in positive outcomes for more than 50 patients, including positive health indicators such as reduced fasting blood sugar levels and average weight loss of 11.97 pounds per person. Project FREE (Project For Recovery, Encouragement and Empowerment) is a concluded grant in Tennessee that was made possible by funding secured by CRI. Project FREE has now transitioned to a new program, Team Recovery, thanks to an additional federal grant award. Project FREE served adults residing in seven rural Middle Tennessee counties who were substance-involved, substance-dependent, or had a substance abuse disorder or a co-occurring disorder of substance abuse and mental health, and were involved with community justice systems. The target area included counties designated as and/or bordering the “Appalachia High Intensity Drug Trafficking Area” as defined by the U.S. Office of National Drug Control Policy. In 2006 alone, 3,516 local arrests were specifically related to drug, narcotic, DUI, or “drunkenness” offenses. Thanks to the hard work of Centerstone staff, in 2011, CRI Evaluators reported that Project FREE served over 200 people and reduced substance use 70% at 6-month and discharge follow-up, reduced days incarcerated by 70% and reduced mental health symptomatology by 50% in clients with co-occurring substance abuse and mental health disorders.

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CENTERSTONE RESEARCH INSTITUTE LEADERSHIP Tom Doub, PhD, Interim Chief Executive Officer David Ayer, PhD, Director of Clinical Research Kathryn Bowen, PhD, Director of Program Evaluation April Bragg, PhD, Research Communications Manager Wayne Easterwood, Chief Information Officer Russell Galyon, Director of Analytics Jan Goodson, Director of Grant Writing Prasad Kodali, Director of Enterprise Applications Paul Lefkovitz, PhD, President, Behavioral Pathways Systems Howard McClung, Director of Technology Paul Robbins, Director of Clinical Applications Development Eric Stein, Director of IS Projects, Indiana Frank Stevens, PhD, Vice President for Clinical Informatics Scott Valentine, RHIA, Director of Health Information Management Christina VanRegenmorter, Communications and Policy Coordinator

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MAJOR FUNDING SOURCES Substance Abuse and Mental Health Services Administration (SAMHSA) National Institutes of Health (NIH) Agency for Healthcare Research and Quality (AHRQ) Vanderbilt University Northwestern University

MAJOR DONORS Joe C. Davis Foundation The Ayers Foundation Jim and Janet Ayers Cal Turner Family Foundation

REVENUES Government 27.5%

Philanthropy 12%

Non-Governmental 60.5% Total $2,646,124

EXPENSES Administrative 14%

BPS 12%

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Research and Evaluation 74% Total $2,604,650

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CENTERSTONE OF AMERICA LEADERSHIP Centerstone of America exists to provide oversight and support for all companies of Centerstone.

Executive Cabinet David Guth, Chief Executive Officer Debbie Cagle, Chief Executive Officer of Advantage Behavioral Health Tom Doub, PhD, Interim Chief Executive Officer of Centerstone Research Institute Linda Garceau, MBA, MA, Chief Executive Officer of Centerstone Foundation Barry Hale, Chief Administrative Officer Mike Jones, Executive Director of Not Alone Karen Keene, Security Officer, Tennessee Suzanne Koesel, LCSW, Chief Executive Officer of Centerstone of Indiana Bob Vero, EdD, Chief Executive Officer of Centerstone of Tennessee Gwen Watts, Administrative Chief of Staff Bob Williams, PhD, Chief Strategy Officer and CEO Emeritus

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Michael Butler, CPA, Corporate Controller and Treasury Officer Lynn Chappin, Director of Human Resources Sherry Harrison, MSSW, Corporate Compliance Officer Sarah Hirsch, MBA, Director of Contract Management and Managed Care Christy Hooper, PHR, Vice President for Human Resources Rona Krueger, MSW, Executive Vice President for Quality Improvement Joe Moore, Finance Officer for Affiliates Brad Nunn, PhD, Executive Vice President for Measurement and Performance Improvement Ramona Rhodes, Vice President for Marketing and Public Relations Natalie Stone, Director of Web Communications Mark Uebel, Director of Business Solutions for SolutionsEAP

The potential of the average person is like a huge ocean unsailed, a new continent unexplored, a world of possibilities waiting to be released and channeled toward some great good.

– Brian Tracy Author and Coach

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Learn more about Centerstone Research Institute www.centerstoneresearch.org facebook.com/ResearchAtCRI.org twitter: @ResearchAtCRI


Discovering Possibilities