Centerstone Research Institute Creating the Future of Behavioral Healthcare
Annual Report 2013
Centerstone Research Institute Annual Report 2013 Letter from the CEO The Why, How and What of CRI Science to Service Research and Evaluation Analytics Research Advancement Center for Clinical Excellence Information Technology Grant Writing Leadership Financials Funding Sources and Donors
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From the CEO This has been an outstanding year at CRI, a year of significantly impacting the behavioral health industry and the lives of individuals and families facing behavioral health disorders. We have had the honor and privilege of forging new partnerships and sparking exceptional advancements in research, technology, and treatment. As is evidenced in this report, we have worked with clinicians, researchers, technology and healthcare industry leaders, and behavioral health consumers to continue bridging the science to service gap and to bring consumers ever closer to having the best possible care available, accessible, and at their fingertips. On the pages of this report, you will find details of diverse and expanding accomplishments. All are the result of the unwavering efforts of our skilled, committed, and motivated staff coupled with the efforts of our talented and visionary board of directors. I am always amazed by what can be accomplished through the hard work and dedication of these individuals who share a commitment to eradicating mental illness and addiction. As we move into the coming year, we are already building on our body of work and are looking forward to embracing new opportunities to advance behavioral healthcare and individual recovery. Sincerely,
Tom Doub, PhD Chief Executive Officer Centerstone Research Institute
Our vision is to create a future where all individuals and families facing behavioral health disorders receive exceptional care grounded in mental and physical whole-person wellness. We pursue this through the acceleration of research, technology, and clinical innovation, balancing technology with humanity to enhance the quality of care while enriching the patient experience.
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does CRI exist? To improve the quality and effectiveness of care for individuals and families facing behavioral health disorders.
does CRI accomplish this? By bridging the gap between science and service.
services does CRI provide to do this? Research, analytics and evaluation services, which are all fueled by the Center for Clinical Excellence, Information Technology, Grant Writing and Philanthropy.
is CRI? Centerstone Research Institute (CRI) is a nonprofit organization, which exists to improve the quality and effectiveness of care for individuals and families facing behavioral health disorders. Research shows an alarming 13–17 year delay between significant treatment breakthroughs and the standard use of those treatments in clinical settings. This means that a young person diagnosed with depression may have to suffer for 15 years before receiving a life-saving treatment already known today. CRI aims to bridge this gap between science and service, so the 33 million Americans seeking help for behavioral health and addiction disorders receive the most effective care without delay. Partnering with clinicians and other research professionals in academia and industry, CRI provides research, analytics and evaluation services. CRI’s efforts – including the development of Enlighten Analytics™, an advanced business intelligence tool – are funded through contracts, grants, foundations and individual donors who share our commitment to bridging the gap between science and service. Together with partners, donors, clients and their families, CRI is advancing behavioral healthcare and recovery.
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Research and Evaluation This year, we expanded services to include Centerstone’s non-grant-supported general and specialty service areas. The outcomes information gathered will be published to establish Centerstone as the preferred provider for mental health and substance abuse treatment services in Tennessee and Indiana. In addition to providing cutting-edge evaluation services, R & E worked collaboratively with CRI’s Analytics Department to launch two visually-oriented, user-friendly dashboard systems that allow program administrators and clinical staff to support patient-centered outcomes and quality improvement efforts. These dashboards enable clinicians to monitor key performance indicators within two current projects and, using this data, make better, faster decisions about intervention strategies, supports and services that will have the most positive impact on overall outcomes for patients. With new technology, clinicians are making well-informed, data-driven decisions concerning treatment, vastly improving the service experience of patients and helping them manage their behavioral health. Chris’s story below exemplifies this. Sincerely,
CRI’s Research and Evaluation (R & E) area provides a systematic exploration and judgment of processes, documentation of experiences, and primary and behavioral health outcomes measurement in a wide variety of programs that have been primarily grant-related.
FY 2013 Accomplishments • The evaluation team provided services for 22 grant projects, enrolled 13,982 patients into program evaluation, and conducted 1,136 discharge and follow-up interviews. • The clinical research office conducted 48 ongoing and 18 new studies that enrolled 3,032 participants and 30 investigators from 14 institutions, including Vanderbilt, Northwestern, and Harvard. • The Institutional Review Board (IRB) conducted over 100 human subject protections reviews of studies taking place at Centerstone facilities or by Centerstone/CRI staff. • Research and Evaluation partnered with Genomind to give clinicians providing services to those diagnosed with major depressive disorder a personalized medicine tool that helps them decide which antidepressant is appropriate for each of their symptoms. • The Shield of Care, a curriculum for Juvenile Justice workers authored by Research and Evaluation’s Jennifer Lockman, was accepted into SAMHSA’s Best Practice Registry. • The K-Town Youth Empowerment Network evaluation team won two of SAMHSA’s highest honors: the 2013 Excellence in Communication and Community Outreach (ECCO) award and the Overall People’s Choice Award and Silver Award in Partnership Development. • Research and Evaluation conducted a comprehensive literature review for the State of Tennessee on the risks and benefits of diagnosing and labeling during early childhood. This review will help determine statewide policies for early screening, assessment, diagnosing, intervention, and re-assessment. • The CRI R & E Division diversified funding sources by adding contracts from Tennessee Department of Health, Mental Health Association of Middle Tennessee, Indiana University, and National Council.
Goals for the Coming Year Kathryn Mathes, BSN, MS, PhD VP for Research & Evaluation
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Conceptualize and implement an Outcome Measurement Project across Centerstone’s clinic and specialty services areas. Develop a Data Warehouse to include all R & E projects. Create a consulting arm and/or obtain evaluation contracts to enhance opportunities for growth and funding diversification.
Chris, age 15, suffers with Serious Emotional Disturbance (SED) and has a history of receiving a traditional, one-size-fits-all treatment approach. For Chris, that approach was ineffective, and he was often non-compliant. His school work and relationships continued to deteriorate. He enrolled in one of the projects using the visually-oriented dashboard, and clinicians quickly determined a personalized course of treatment for Chris based on his age, gender, location, disorder, and other subsets. Now, Chris is making great strides toward recovery, and, with the ability to continually adapt his treatment to changing conditions through the dashboard’s monitoring system, both Chris and his clinician can better understand what he needs to overcome his SED.
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ANALYTICS Effectively capturing, interpreting, and applying data is the key to quality patient care. In order to help organizations transform the raw data that they collect every day into useful information, CRI developed Enlighten Analytics™, a leading business intelligence platform. Through Enlighten Analytics™ and other services – including operations metrics, statistical analysis and reporting, predictive modeling, and leading indicators detection – CRI helps improve efficiency and enhance patient care.
FY 2013 Accomplishments • Marketed Enlighten Analytics™, an affordable, intuitive, interactive business intelligence platform, that helps behavioral health providers harness the power of their own data to reduce costs, improve operations and enhance patient care. • Maintained a partnership with Netsmart to expand the user base of Enlighten Analytics™ products to community mental health. • Increased number of Enlighten users. • Secured non-grant revenue.
Goals for the Coming Year • Provide monitoring and success metrics to clinicians and management related to clinical initiatives. • Roll out Enlighten Analytics™ across Centerstone to standardize metrics and enable conversion to the Netsmart electronic health record system. • Streamline Centerstone of Indiana reporting, yielding significant cost savings to the bottom line. • Extend Analytics to further support integrated care projects. • Continue to play a critical role in reporting on the quality and effectiveness of patient care at Centerstone.
Centerstone clinicians and administrators have been collecting client data for decades. Analyzed, this information paints a picture of the populations accessing mental health and substance abuse prevention and treatment services. It gives insight into operations, effectiveness, and efficiencies. Since Centerstone first started electronically compiling clinical, financial, and other data more than a decade ago, this information has been poised to promote improvements in care delivery and administration. Recognizing the untapped potential of that data, CRI began providing analytics services across the enterprise to enhance revenue generation through billing improvements, reporting, productivity measures, “what-if” scenario planning, and financial analysis, all while increasing the quality of care for patients through patient engagement initiatives, compliance, and outcomes reporting. CRI analytics services are changing lives for Centerstone patients and, through Enlighten Analytics, for individuals and families across the nation. Partnerships with 10 behavioral health providers in eight states and with Netsmart, America’s largest behavioral health electronic health records vendor, enable CRI analytics services to empower clinicians and inform care nationally. Sincerely,
Russ Galyon Director of Analytics
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RESEARCH ADVANCEMENT At the Knowledge Network’s 2012 Fall Summit, CRI hosted leading speakers such as David Aylward, former Executive Director of the mHealth Alliance, and Becca Stevens, founder of the nationally acclaimed Nashville-based social enterprise, Thistle Farms & Magdalene House. In spring 2013, Summit attendees heard about the latest work from behavioral health genetics pioneer Genomind, whose easy-to-use genetics screen is providing critical biological insights to inform the care of Centerstone patients. These Summits regularly provide key opportunities for dialogue between behavioral health providers and researchers and have led to implementation of new treatment practices at community-based mental health centers collectively serving over 350,000 patients annually across the US. This year, we also coordinated private sector grant writing for the Centerstone enterprise, securing approximately $850,000 in funding that now supports critical services across Indiana and Tennessee and impacts patients’ lives every day. Such services include addiction intervention, a comprehensive program for veterans and their families, and employment services in struggling rural areas. In the coming year, we will continue to pursue resources to further CRI’s efforts to bridge the gap between science and service and ensure that all Americans have access to cutting-edge treatments for mental health and addiction disorders. Sincerely,
April Bragg, PhD VP for Research Advancement
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CRI’s Research Advancement area cultivates innovative, strategic partnerships that position CRI to improve behavioral health care nationally and locally. As part of this work, Research Advancement includes the Knowledge Network initiative, a CRI-led national consortium with the mission to translate research into practice in community-based behavioral health settings by leveraging policy, advocacy, technology, and academic research collaborations.
FY 2013 Accomplishments • CRI hosted The Two M’s of Health: Mental Health and Mobile Health, a panel held at the largest mobile health event in the world, the mHealth Summit, in Washington D.C. • Knowledge Network members using Enlighten Analytics grew to encompass over 350,000 patients, 15 million service records, and three million prescriptions. • Knowledge Network Summits held in fall 2012 and spring 2013 highlighted wellness, technology, and integrated care. • An educational video to increase patient and provider awareness of clozapine filmed at Centerstone in FY12 was released and distributed by TEVA Pharmaceuticals. The video, featuring interviews of Centerstone medical staff and patients, is being disseminated and used in clinical settings across the country. • Raised $848,983 in private sector funding for services at Centerstone in Tennessee and Indiana, as well as Not Alone. • New Knowledge Network members included ViewPoint Health and Central Community Health Board. • Developed the CRI Philanthropic Strategic Plan.
Goals for the Coming Year • • • •
Implement comprehensive sustainability measures for Knowledge Network. Secure national foundation funding for CRI. Double attendance at Knowledge Network Summits. Publish findings from the Knowledge Network Data Warehouse.
INFRASTRUCTURE services CCE provides a systematic framework to identify, prioritize, implement and scale strategic initiatives that improve quality of care and patient outcomes. These efforts aim to accelerate the adoption of the most effective practices within Centerstone and beyond, bridging the gap between science and service.
FY 2013 Accomplishments • Ensured that all large clinical excellence projects were managed with transparency and improved their related metrics by 90%. • Implemented an enterprise-wide campaign focused on three broad outcome goals: – Reducing hospitalizations – Improving patient engagement – Preventing suicide • Engaged direct services staff to participate in clinical excellence activities through the online Idea Hub and recognized their innovations and achievements through “Excellence Heroes” and “Innovator of the Month” distinctions. • Implemented three IT improvements into the electronic health record (Diagnosis Module, MHCD Measures, and NOMS Facesheet) in order to improve diagnoses, outcomes tracking, and recovery outcomes for patients. • Piloted three clinical pathways with embedded clinical decision support, including the Zero Suicide Project, Depression Pathway, and Recovery Culture. • Led an initiative to ensure that direct services staff have knowledge of their team’s outcome achievements, with 82% of those randomly surveyed reporting at least two key outcomes.
Goals for the Coming Year • Improve lower level manager satisfaction with transparent project management in both states by at least 20%. • Continue to ensure that all high priority service and clinical excellence projects have transparent portfolio and project management. • Integrate Analytics related tasks into a transparent CCE project management system. • Implement at least six ideas coming from direct staff through the Idea Hub. • Feature six staff as Innovator Heroes and six staff as Excellence Heroes. • Pilot Centerstone Service “Always Events” project. • Expand Zero Suicide Protocol throughout the Centerstone enterprise and transparent analytics and reporting tools. • Improve client engagement by 10%. • Pilot the revised depression protocol. • Continue to transparently track clinical excellence outcomes throughout the enterprise. • Communicate to all staff and key external stakeholders key outcomes results. • Provide resources to help managers, directors, and COOs improve clinical and service excellence outcomes.
At CRI, I am privileged to work with creative, passionate staff across Centerstone who are committed to high quality care, and I hear and share patient stories that are testaments to the quality of care being delivered. We piloted three clinical decision support projects this year, and one, the Zero Suicide project, is already saving lives. In this project, we emphasize that all lives are valuable and that we don’t want to lose even one of the 75,000 precious men, women, and children served. Centerstone’s newly trained staff now track suicide risk, empower patients to openly combat suicidal thoughts, and consistently go the extra mile for those at highest risk. One such patient, Anthony, wrote to his Congressional representative: “I was homeless, under a bridge, drinking myself to death, off all my medications, majorly depressed, unable to be employable, and had a number of suicidal thoughts… I am learning how to cope with life, back on my meds, employed, looking forward to each day. I owe it all to Centerstone. I would not have made it without their help.” In implementing this pilot project, CRI met and exceeded its deadlines to provide the required technology resources and we continue to support transparent communication for outcomes related to preventing suicide. I am very excited that we plan to implement this project across Centerstone by January 2014. Sincerely,
Christina VanRegenmorter, MSW Director of Center for Clinical Excellence
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INFORMATION TECHNOLOGY Technology is sweeping through our lives with increasing velocity, weaving itself into our daily activities and promising to redefine healthcare delivery. Today’s patients need and are demanding technology-enabled care (TEC), which is driving providers to focus on improving both access and quality of care through technology. Technology-enabled access is becoming as essential as electricity, but identifying the patients as both the operator of technology and the direct beneficiary of it is still rare within the healthcare sector. One of the most powerful technology-enabled tools is the ability to bring behavioral health specialists to a patient in the midst of crisis. Through video and data sharing technology, a provider can instantly connect to a patient in a rural clinic, assist a crisis intervention team in the emergency room, or virtually convene a dispersed multi-disciplinary team. TEC prevents duplication of work, eases the exchange of information among healthcare providers, alerts clinicians to patients’ crisis events, and enables patients to provide interim progress reports using web tools. Rather than being the central focus of care, the clinic setting becomes one of several essential ingredients in the protocol of evidence-based care.
Wayne Easterwood Chief Information Officer
Technology is heavily embedded in many aspects of modern life and is an essential enabler of optimal clinical practice in the new era of healthcare. CRI views technological innovation as central to improving quality and individual outcomes while increasing the efficiency of care. From help desk support and training to sophisticated product development, CRI is passionate about using technology to advance care. CRI rigorously operates and protects the systems our providers and patients rely on daily, and we embrace innovations. We work to have real-time information at all points of care and inquiry through our electronic health record, customer care, crisis support, and analytics systems. In the way only technology can deliver, CRI’s systems combine these multiple data points and organize the data into meaningful, real-time visualizations. CRI is helping forge a technology-enabled healthcare culture by implementing a model of care that fuses technology and humanity.
FY 2013 Accomplishments • Completed the first year of implementation of our largest and most critical project, the enterprise transition to MyAvatar as a new Electronic Health Record (EHR). • During the transition, supported clinical excellence initiatives in the current EHR while planning for their accommodation in the future EHR. • Improved business systems connectedness by automating information and data exchange. • Built and implemented Centerstone’s first pilot mobile app for use on tablets in the field. • Infrastructure upgrades, consolidation, cost savings, and efficiencies implemented, including the areas of telephone networking; tele-health system improvements; and software upgrades. • Deployed new services leveraging FCC rural health subsidies, which will represent an 80% cost savings directly to Centerstone on qualifying locations for five years. • Deployed a new enterprise network and systems monitoring solution for proactive alerting, reporting and capacity planning. • Supported Enlighten Analytics refactoring for newest generation, expansion, and testing.
Goals for the Coming Year • Complete the MyAvatar EHR implementation throughout Indiana and initiate in Tennessee. • Expand Centerstone tele-health locations, including connectivity to Unity Health clinic sites. • Launch a new innovation pilot that uses tele-health as a key service delivery component. • Introduce patient engagement tools for the new Centerstone.org website including request/change appointment, self-assessment tools, chat, etc. • Enhance business systems, including new time/attendance and eProcurement system. • Enhance security, HIPAA compliance and readiness, including conducting a security awareness campaign and policy and procedure review/update. • Move Centerstone’s main data center to a purpose-built facility.
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grant writing As a nonprofit organization, CRI relies on government and foundation grants and the generous support of individuals. CRI refers to its supporters as Bridge Builders because they play a critical role in bridging the gap between science and service. The Grant Writing and Research Advancement teams at CRI have raised over $100 million in funding to advance behavioral healthcare and individual recovery. This money has funded service implementation and research studies in areas like addiction, depression, psychosis and suicide prevention…yielding results that have literally saved lives.
FY 2013 Accomplishments Secured $17,390,000 in federal, state, and local government grants for the Centerstone enterprise. Funding awarded and programs initiated during FY13 include: • $1 million US Department of Veterans Affairs Supportive Services for Veteran Families grant to provide housing and other supportive services for Middle Tennessee veteran families at risk for homelessness. • $1.2 million US Department of Labor grant to provide mentoring, reintegration, and employment services for ex-offenders returning to Bloomington, Indiana. • $4.7 million contract to work with the Tennessee Department of Mental Health and Substance Abuse Services to provide program and evaluation services to stabilize, strengthen, and preserve families with children at risk of entering foster care due to parental substance abuse. • $1 million to extend the Building Strong Families program for at-risk children in eight rural Tennessee counties. • $2 million contract with Metro Nashville Government to provide housing, employment, behavioral health, and other supportive services for chronically homeless individuals. • $1.6 million grant to establish integrated primary care and health home services for seriously mentally ill patients within the behavioral health clinic in Davidson County, Tennessee (Nashville). • $1.2 million project with the Tennessee Department of Health to provide home visiting and support services to prevent child abuse/neglect in at-risk families.
CRI’s grant writing team plays a key role in reaching individuals and families battling mental illness and addiction disorders, and in helping them find recovery. Every team member brings a unique, unparalleled passion and commitment to the mission of preventing and curing mental illness and addiction, a commitment that since 2004 has resulted in the implementation of more than 40 federally funded programs, the award of over $100 million in private and government grants and contracts, and more than 40,000 individuals and families accessing services – people who would likely have otherwise gone unreached and untreated. The CRI grant writing staff partners with all levels of the enterprise – from direct program, administrative, and evaluation staff to chief executives – in order to develop, initiate, and support implementation and evaluation of research-based and innovative prevention and treatment services. We also maintain relationships with local and state government representatives to promote partnerships that secure funding to implement these services, often across multiple counties or even statewide. Sincerely,
Jan Goodson VP Grant Writing and Research Communications
Goals for the Coming Year • Secure at least $6 to $10 million in federal, state, and local funding to expand and enhance consistently improved behavioral health services. • Support integrated care implementation strategies across the enterprise to improve patient access to comprehensive healthcare. • Ensure that grant-funded programs contribute to the behavioral health knowledge base via comprehensive evaluation and dissemination efforts.
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leadership Board of Directors Joan Sivley (Chair) – Retired, former healthcare executive Janet Ayers (Vice Chair) – President, The Ayers Foundation Ken Shidler (Secretary) – Career Counselor, Indiana University Kelley School of Business Career Services Tom Doub – CEO, Centerstone Research Institute Steve Bryant – Immediate Past Chair, Executive Director, Gayle and Bill Cook Center for Entrepreneurship, Ivy Tech Community College–Bloomington Trish Lindler – Retired, former Senior Vice President of Government Programs for HCA, Inc. Tom Mahler – Colonel, USAF (Retired) Gil Palmer – Agent, State Farm Insurance Nedda Pollack – Retired, former executive of AmSouth Bank Deborah Taylor Tate – Special Envoy for Child Online Protection, International Telecommunications Union; Former Commissioner, FCC
Institutional Review Board Operated by CRI, the Institutional Review Board is an independent committee that approves, monitors, and performs ethical reviews of proposed research involving Centerstone consumers or staff in Indiana and Tennessee. Centerstone is the only community mental health center in the country to meet and maintain federal requirements to operate an IRB. IRB members are listed below, and CRI would like to extend a special thank you to each one for his or her service. David W. Ayer, PhD (Chair) Frances Crater, MBA Jan van Eys, MD, PhD Jason Luellen, PhD Heather Nelms, MPH John Putz, MA (alternate) Frank Stevens, PhD Sarah Suiter, PhD
Russ Galyon, Director of Analytics, was the 2013 recipient of the Howard McClung Award for Excellence in Leadership. This award is given to a CRI employee, or group of employees, who showcases exceptional leadership principles.
Tom Doub, PhD, Chief Executive Officer Crystal Hurst, Executive Assistant Wayne Easterwood, Chief Information Officer Kathryn Mathes, PhD, Vice President of Evaluation and Research April Bragg, PhD, Vice President for Research Advancement Jan Goodson, Vice President of Grant Writing and Research Communications Marlene Alvarez, Finance Manager Russ Galyon, Director of Analytics Prasad Kodali, Director of Enterprise Applications Christina VanRegenmorter, MSW, Director of Center for Clinical Excellence
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• CRI is a 501(c)(3) nonprofit organization. • CRI ended the fiscal year on June 30, 2013 with a net surplus of $1,090,979. •
Shared Services 50.0%
CRI sold Behavioral Pathway Systems, a behavioral health benchmarking tool, to Netsmart in August of 2012. The sale of Behavioral Pathway Systems and PsychRemix resulted in an abnormally high net surplus for FY13.
CRI Financial Report Revenues Government $1,079,596 Non-Government and Philanthropy $4,693,788 Shared Services $5,777,957 Total Revenue
Total = $11,551,341
Direct Expenses Salaries $5,113,952 Fringe Benefits $1,031,583 Facilities $658,718 Telephones $517,349 Travel & Vehicles $342,272 Supplies $93,307 Subcontracted Services $5,031 Other Professional Services $423,689 Computer $716,092 Liability Insurance $57,328 Professional Development $83,553 Depreciation $822,959 Other $226,859 Total Direct Expenses Net Surplus Total Indirect Allocations
expenses Research, Evaluation and Shared Services 90.3%
$10,092,692 $1,458,649 $367,670
Total Direct Expenses
Total Net Surplus
Total = $10,460,362
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Our Mission To prevent and cure mental illness and addiction.
to the individuals and foundations whose generosity has helped bridge the gap between science and service, so that the 33 million Americans seeking assistance for behavioral health disorders can receive the most effective care without delay.
Major Funding Sources Administration for Children and Families National Institute of Mental Health Office of Adolescent Health Substance Abuse and Mental Health Services Administration (SAMHSA) Tennessee Department of Mental Health and Substance Abuse Services
Major Donors The Ayers Foundation Jim and Janet Ayers Joe C. Davis Foundation Cal Turner Foundation
Centerstone Research Institute Creating the Future of Behavioral Healthcare
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Centerstone Research Institute (CRI) is a not-for-profit organization dedicated to improving the quality and effectiveness of care for those with behavioral health disorders. CRI provides research, analytics and evaluation services that help bridge the gap between the scientific discovery of effective treatments and the implementation of these treatments into standard clinical practice. CRI is funded through contracts, grants, foundations and individual donors who share the organizationâ€™s commitment to bridging the gap between science and service. Learn more about CRI at www.centerstoneresearch.org.