HCS | 2013 Annual Impact Report

improving lives, discovering possibilities

2013 Annual Impact Report

Annual Impact Report HCS Mission

Highlands Community Services exists to provide the highest quality continuum of behavioral healthcare services available in Washington County and Bristol, VA. We are a center of excellence for all individuals seeking mental health, substance abuse, or intellectual disability services.

HCS Vision

Highlands Community Services is dedicated to discovering, implementing, and sustaining valuable services that improve lives. HCS will continue to operate with efficiency, financial viability, and innovation.

July 2012 - June 2013

From the Executive Director............................................. 4 Community Impact........................................................... 5 Financials at a Glance....................................................... 8 Board of Directors.......................................................... 10 FY13 Photo Review......................................................... 11 Intellectual Disability Services........................................ 12 Psychiatric & Emergency Services.................................. 14 Outpatient Services........................................................ 16 Children & Family Services............................................. 18 Adult Recovery Services................................................. 20 Impact Stories................................................................ 22 HCS in Your Community.................................................. 34

HCS Values

Highlands Community Services’ core values are integrity, respect, teamwork, empowerment, and transparency. These values guide all that we do.

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FROM THE EXECUTIVE DIRECTOR from the executive director Without question, Fiscal Year 2013 was one of the most challenging years I have professionally been a part of during my thirty plus years in the field. Beginning with the onset of managed care’s involvement with the daily operations of HCS last July, an array of new protocols and practices had to be quickly implemented to help ensure that there would be no interruption in the flow of earned revenues. Keeping abreast of the continual changes required by the managed care organizations has created significant stress for all departments.

Jeff Fox, Executive Director

Once again, our staff rose to the occasion, and has done a stellar job in protecting potentially vulnerable revenues from being denied. Reimbursement issues continue to be a challenge, exacerbated by the effect of the government sequestration. Despite such external constraints, HCS continued to expand during 2013, and met its budgetary targets. Interchange II, the alternative school program for high school students, opened on schedule in August, 2012 with great support from the school systems of Bristol and Washington County.

Several clinical programs were re-aligned during the year with Mental Health Supports becoming part of Adult Recovery Services. Such a shift has increased the quality of HCS’s continuum of treatment services.

Emergency Services is developing its program to create a more comprehensive continuum of crisis services for the community. Administration has been engaged in formal contract discussions with Johnston Memorial Hospital to become partners in behavioral health services. When signed, HCS will be responsible for overseeing behavioral health needs of JMH’s patients throughout the hospital.

Highlands continues to enjoy a “provider of choice” status for nearly six percent (6%) of the population of Washington County and the city of Bristol, Va. The organization continues to operate from a clear sense of direction, as well as from a clearly defined mission and set of value statements that represents a vibrant and “living” organization. As of the end of Fiscal Year 2013, Highlands employs nearly three hundred fifty (350) full time and part time employees. Due in large part to the commitment of staff towards HCS over the years, HCS proudly operates from an extremely high level of efficiency and quality. Our ultimate goal continues to be to create a comprehensive treatment program that

promotes Highlands Community Services as a “center of excellence” for the population we are committed to serving.

During Fiscal Year 2014, emphasis will be on creating a “culture of philanthropy” at HCS as we continue to move forward with the extremely ambitious children’s campus initiative. Major foundational steps will be taken toward the successful completion of a facility on purchased land in Abingdon for the benefit of the nearly fifteen hundred (1,500) children currently enrolled in one or more of HCS’s services. All initiatives undertaken during Fiscal Year 2013 were designed to “enhance” the level of prominence and positive community reputation that the Board is committed to provide. These creative and innovative initiatives have served as the foundational piece to HCS’s significant growth and continued success, and will continue to do so during the upcoming fiscal year.

Going forward, Fiscal Year 2014 will be an exciting, yet very challenging year. New managed care organizations, coupled with external state budgetary constraints, will continue to create external pressures that impact our program. I, however, believe HCS is well positioned to handle any external pressures, and should continue to see sustainable growth in most departments.

Collectively, I believe we remain vigilant yet are poised to enter into the next fiscal year with a high degree of enthusiasm, optimism, a keen sense of purpose, and a sense of professional pride.

- Jeff Fox, Executive Director

Local Return on Investment

$38

worth of HCS services is returned to the community for each $1 contributed by Washington County or Bristol, Virginia

Employment Opportunities

374

individuals were employed in full time and part time positions during the year at HCS

Our Annual Economic Impact

$31,000,000+

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Out of 58,798 ADULTS

Out of 14,054 CHILDREN

HCS served 2,947 of them in FY13

HCS served 1,672 of them in FY13

in Washington County and Bristol, Virginia

in Washington County and Bristol, Virginia

1 20 out of every

adults in our catchment area

was served at HCS

3 25 out of every

children in our catchment area

were served at HCS

In FY13, HCS helped

4 619 individuals ,

improve their lives and discover new possibilities

3,486

children & adults

participated in HCS Prevention & Education Programs

Prevention & Eduction includes both school and parenting programs. Due to the community-based nature of these programs, some duplication may exist.

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Financials at a Glance The year ending June 30, 2013 was a fiscally challenging yet successful year for HCS with total revenues reaching nearly $20 million. The rate of revenue growth remained consistent with the previous fiscal year at a modest but healthy rate of 4.7%. Fees for services (Medicaid, Medicare, Commercial Insurance, self-pay, etc.) totaled 75% of the total HCS revenue and likewise, personnel costs amounted to 75% of the total expenditures.

With careful, conservative budgeting and close attention to financial reporting Kathy Simpson, CFO throughout the year, revenues reached 99.6% of budget and expenditures totaled 98.3% of budget. The resulting surplus was 1.3% of budget, or $260,040 (on the modified accrual basis of reporting) helping to maintain HCS’s financial stability.

- Kathy Simpson, Chief Financial Officer

Balance Sheet

as of June 30, 2013 ASSETS

Cash and Cash Equivalents.... $2,334,292 Accounts Receivable.............. $3,161,588 Property and Equipment..... $12,788,888 TOTAL.................................$18,284,768

LIABILITIES

Accounts Payable...................... $191,977 Accrued Wages......................... $602,699 Notes Payable...................... $11,825,785 Accrued Interest......................... $16,444 Accrued Leave.......................... $771,653 Deferred Revenue....................... $57,801 TOTAL.................................$13,466,359

NET POSITION

Ăź

HCS Received an unqualified (clean) audit opinion on its financial statements for the 2013 fiscal year.

Investment in Capital Assets.... $963,103 Unrestricted.......................... $3,534,516 Restricted................................. $320,790 TOTAL...................................$4,818,409

Revenue

Expenditures

4.0%

9.4%

14.6%

1.8%

0.3%

1.7% 2.6% 4.2%

10.1%

1.5%

74.6% 75.3%

State Funds

Fees for Services

Personnel

Consult/Contracts

Local Funds

Other Funds

Staff Development

Program Operations

Facilities/Vehicles

Other Expenses

Federal Funds

Equipment/Supplies

REVENUE

State Funds........................................ $2,896,324 Local Funds........................................... $512,468 Federal Funds....................................... $828,486 Fees for Services.............................. $14,787,095 Other Funds.......................................... $793,571 TOTAL............................................ $19,817,944

EXPENDITURES

Personnel.................................................$14,726,379 Staff Development........................................$292,921 Facilities/Vehicles......................................$1,965,666 Equipment/Supplies.....................................$331,257 Consult/Contracts.....................................$1,837,147 Program Operations.....................................$351,187 Other Expenses..............................................$53,347 TOTAL................................................... $19,557,904

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Board of Directors

Fiscal Year 2013 was a successful yet challenging year for Highlands Community Services. Many lives were impacted and improved by the valuable services provided. The board of directors continues to be impressed, not only by the quality of services, but also the quality of staff.

We look forward to many more years of valuable behavioral health care in Washington County and Bristol as a result of our innovative agency.

- Steve Rowland, Board Chair

Representing WASHINGTON COUNTY, VA William L. Bowman Angie Browning Jane Johnson, Secretary/Treasurer Kittye Owens

Odell Owens Rebecca Querio Steve Rowland, Chair Lillian Spicer

Representing the CITY OF BRISTOL, VA Sondra Alan Donald Ashley Fred T. Bowman, Vice Chair

Nancy J. Brown Carter Miles

fy2013 pHOTO rEVIEW Staff Picnic • Thrive Radio Show • Autism Awareness Month • Staff Holiday Party • American Advertising Award • Staff Retreats Media Coverage • Lowe’s Heroes Partnership • Opening of Interchange II • New Logo Reveal • Mental Health Awareness Event

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Intellectual Disability Services

210

people served during Fiscal Year 2013

*This total is unduplicated within this department. Due to the nature of our services, adults and/or children in this department may also receive services in other HCS departments.

“

I am very satisfied with the services that my son receives [at HCS]. I know that a lot of work, care, and effort go into providing for his needs. We appreciate all that ID staff does to help him succeed in the community.

- Consumer Parent

Intellectual Disability Services

”

HCS Intellectual Disability Services provide a detailed Person-Centered Plan to individuals with significant limitations both in intellectual functioning and in adaptive behavior, originating before the age of 18. Our organization believes that within every disability is ability, and that a good life is possible for all individuals served.

Programs

• Horizons Day Support • Support Coordination Services • Sponsor Home Residential Program To learn more about individual programs, visit www.highlandscsb.org.

Notable Department Highlights of the Year • Three of the consumers living in Sponsor Homes participated in the state-level Special Olympics.

• As a result of a review of services across the state, the Department of Justice has implemented rules and regulations that will challenge communities to expand community service options (residential, day program, etc.) for those who currently live in VA Training Centers. This shift will and is greatly impacting HCS. Individuals moving from institutional settings to community settings will result in the expansion of HCS ID programs at large.

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Psychiatric & Emergency Services

1,688

people served in Psychiatric Services during Fiscal Year 2013

1,395

evaluations (face-to-face + telephone)

in Emergency Services during Fiscal Year 2013

*This total is unduplicated within this department. Due to the nature of our services, adults and/or children in this department may also receive services in other HCS departments.

“

Anyone with psychiatric challenges needs to be here at HCS.

- Consumer

Psychiatric & Emergency Services

”

Psychiatric Clinic Services implement appropriate medication services for qualifying HCS consumers. HCS psychiatrists, psychiatric nurse practitioners, and licensed practical nurses work together as a team to serve both children and adults.

Emergency Services are available 24 hours a day, seven days a week. They provide attentive, emergent care to consumers and families who present as needing immediate assistance. More often than not, Emergency Services staff can be found at our local hospital providing services within the emergency room setting.

Programs • • • • •

Psychiatric Assessment Medication Management Discharge Planning Crisis Intervention Triage

To learn more about individual programs, visit www.highlandscsb.org.

Notable Department Highlights of the Year

• Emergency Services specialists completed 802 mental health evaluations at Johnston Memorial Hospital with 681 of those occurring in the Emergency Room. The remaining 121 were completed on various medical floors within the hospital.

• Ninety percent of consumers were stable after one year in Psychiatric Services.

• Of the 1,090 consumers who were seen face to face for evaluation, 667 were referred and admitted to an inpatient psychiatric or substance abuse detoxification facility for further treatment. The remaining 423 consumers were referred and treated successfully in the community.

• The first full-time adult psychiatrist was successfully hired.

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Outpatient Services

1,880

people served during Fiscal Year 2013

*This total is unduplicated within this department. Due to the nature of our services, adults and/or children in this department may also receive services in other HCS departments.

“

Our therapist is wonderful with both my daughter and me. Even my daughter’s teachers have noticed major positive changes.

- Consumer Parent

Outpatient Services

”

HCS Outpatient Services provide short-term interventions that have long-term impact. Services are designed to meet the needs of children, adolescents, and adults whose substance abuse and/or emotional challenges have become significant, but do not warrant hospitalization. With premier therapeutic counseling services, an array of support groups, and advanced treatment options; outpatient services are dedicated to the most modern and effective practices that help HCS consumers achieve and maintain a healthy lifestyle.

Programs

• Individual, Group, and Family Therapy • Comprehensive Assessments and Diagnostic Studies • Substance Abuse Intensive Outpatient Program • Medication Assisted Therapy and Care Coordination • Women’s Services (including those provided under contract with JMH) • Alcohol Safety Action Program • Restoration to Competency Services • Virginia Highlands Community College Student Assistance Services

• • • • • • •

Community Support Groups Drug Court Services Autism Services Veteran’s Services Consultation Services Project Jane Domestic Violence Services Specialized Clinical Supervision Services

To learn more about individual programs, visit www.highlandscsb.org.

Notable Department Highlights of the Year

• Launch of Trauma 101 in-service training, presented across most HCS service areas and Crisis Intervention Team regional training.

• Further development and expansion of creative therapy services and other youth group therapy services.

• Approval from the Supreme Court of Virginia to operate an Intensive Drug Treatment Court in Washington County under partnership with Washington County Circuit Court. Enrolled seven participants in the first year and graduated three.

• Launch of Visitation Solutions, a supervised visitation and monitored exchange program seeking to reduce unnecessary exposure to childhood trauma due to domestic violence. Program was developed in collaboration with the 28th District Juvenile and Circuit Court Judges and received four referrals during its inaugural year.

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Children & Family Services

1,444

people served during Fiscal Year 2013

*Due to duplication, this number does not reflect the absolute total. In addition to this number, 3,486 children and adults were reached through HCS Prevention & Education Programs this year.

“

The Student Assistance Program is a vital part of our school. The students greatly need this program and the SAP counselors do a great job meeting the needs of the students.

- Local Teacher

Children & Family Services

”

HCS Children’s Services serve families, children, and adolescents in multiple settings including local schools, homes, in the community, and at HCS clinical office locations. Services are specifically designed to meet the needs of at-risk children and their families.

Programs • • • •

Behavior Intervention Prevention and Education Care Coordination Early Intervention

• • • •

EMBRACE Sponsor Homes Interchange School and Summer Programs Intensive Case Management Intensive In-Home

• Student Assistance • Transition Coordination • Therapeutic Day Treatment

To learn more about individual programs, visit www.highlandscsb.org.

Notable Department Highlights of the Year • The Parent CORE Program was developed to bridge the gap between treatment for children and a need for change in the home environment. The program has been embraced by CSA, care providers, and community stakeholders.

• Probation and truancy violations decreased for children involved in Behavior Intervention Services • Care Coordination Increased number of clients served during fiscal year from 792 to 831 • 97% of children in Early Intervention were functioning within age expectations regarding social/emotional skills by the time they exited the program.

• The Interchange II Program was in its first year of existence serving students who were in grades 9-12. The program continues to be a vital resource for the school systems, providing students with the opportunity to remain in the community to be educated instead of being placed in homebound or residential alternatives.

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Adult Recovery Services

977

people served during Fiscal Year 2013

*This total is unduplicated within this department. Due to the nature of our services, adults and/or children in this department may also receive services in other HCS departments.

“

When I started coming to Stepping Stones, I didn’t know what to expect, but the more I come, the better I feel.

- Consumer

Adult Recovery Services

”

HCS Adult Recovery Services provide a comprehensive community support system for people in recovery who have a serious mental illness and are unable to function independently in the community. These individuals require guidance, training, and considerable support in preventing hospitalizations, in accessing needed resources, and in maintaining a natural support system through meaningful relationships.

Programs • • • • •

Recovery Care Coordination Adult Crisis Stabilization Psychosocial Rehabilitation at Stepping Stones Peer Support Services (WRAP) Mental Health Supports at Oasis

To learn more about individual programs, visit www.highlandscsb.org.

Notable Department Highlights of the Year • Oasis became licensed to provide a “mini” Psychosocial Rehabilitation Program known as Tree House in June 2013. Tree House provides an opportunity for consumers to build skills that will allow them to transition to the larger PSR program at Stepping Stones.

• Consumers provided education about recovery to the Neff Center Nursing Students and the psychology students at Virginia Highlands Community College by sharing their personal stories.

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The following pages contain

TRUE STORIES.

With the help and support of HCS services, the following individuals have improved their lives and discovered

new possibilities for their futures.

The Brooks Family’s Story John and Brandy have had their share of hard times. There was a time when they were homeless, uncertain of what tomorrow would bring. Times were tough.

They willingly asked for assistance with their children. As a result, their two oldest children spent some time in foster care while John and Brandy fought their way back to stability and recovery. This hard-working family has been restored and back together for over a year! John and Brandy proudly maintain employment and a stable home for their girls.

Shannon Kent, HCS In-Home Family Counselor has worked with the Brooks family throughout most of their time at HCS. Shannon states that, “They had not been a family for a long time and it was a challenge to learn how to be a unit again. We worked together to develop things like a daily family schedule, meal plans, and a budget. We also worked on things like rewards and appropriate consequences; rules and boundaries; as well as roles and expectations. The Brooks family has done amazingly well! They went from homelessness to being a functioning family that is willingly compliant with services, even after they aren’t required to be.”

Mom, Brandy Brooks, states, “When I was referred to HCS, I didn’t think it would work. We had worked with another agency in the past without success. But, services from HCS have helped us a lot. Dr. Camperlengo, our therapists, and Shannon have been really good for us.”

Without the full HCS wrap-around services that this family receives, I don’t think they would’ve been as successful. I can’t say enough about our Outpatient therapists and child psychiatrist, Dr. Camperlengo, and all the other programs involved.

Our whole HCS team pulls together regularly to work with this family.

Shannon Kent In-Home Family Counselor

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Jeff’s Story Jeff attends HCS Day Support three times a week and lives in Saltville, VA with his sponsor home family. He enjoys swimming and bowling, and he went to the beach for the first time this year! Jeff is very social, has a girlfriend, and recently obtained the role of the Wizard in the Day Support production of The Wizard of Oz. Jeff has meaning in his life and a sense of belonging.

But this hasn’t always been the case.

Heather Burke, ID Support Coordinator explains, “Jeff grew up with a family member, but his behavior and support needs became too intense for them to manage. Jeff has intellectual disability as well as mental health challenges. For several years, Jeff moved from one assisted living facility to another. His behaviors and challenges caused multiple evictions. Jeff also tried several other HCS programs, but these were also unable to meet his high intensity support needs. Jeff became lonely, confined, and ostracized by his peers. He withdrew and at times presented as non-verbal when he really wasn’t. It wasn’t until Jeff obtained a VA Medicaid ID Waiver slot and moved into a sponsor home that things began to turn around for him. Jeff now attends the ID Day Support Program and lives with his sponsor family full-time. He is happy, thriving, and social.

This has truly been the most meaningful case that I’ve ever been part of. It has been so rewarding to see Jeff improve. Being able to see what an impact HCS services can have on the quality of life of an individual has brought a sense of encouragement and hope to me!

Heather Burke ID Support Coordinator

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Adam’s Story Adam isn’t originally from Southwest Virginia. He’s from a large city, where he explains, “There’s nothing like HCS and Project Dads there.” When Adam moved here and found himself in need of parenting skills, he became involved with Highlands Community Services. Since then, he’s become the father of an infant son, and he’s maintained steady employment. Adam looks forward to one day teaching Project Dads classes himself!

He further explains, “I first started coming to Project Dads when my fiancé got pregnant. I needed to learn how to be a father. I had a couple of family members that took care of me growing up, but most were abusive. I sank into a deep depression when my fiancé miscarried. I stopped coming to class, but Allen encouraged me to return. My fiancé and I conceived right around the time that we lost the first baby. We were so excited. I learned a lot from Allen and the other guys in the program. You have to be patient and you have to keep going no matter what. One of the most important things I learned from Allen and Project Dads is the difference between punishment and discipline. That’s so important. I also learned that I need to do my part to help out. I love being a dad, and I don’t mind getting up and changing diapers and stuff like that even when I’m tired. Lots of people don’t grow up with their fathers and most role models teach you the wrong things. I’m thankful for men like Allen. I recommend these classes for any new dad. You don’t have to be court-ordered to join. I tell guys to not hesitate and to just sign up!”

Adam is definitely a success story. He’s turned his life around and it’s been great to watch. He wants to be a dad to his son and that makes all the difference. Project Dads is one of the greatest needs for both older and younger dads. I learn as much from these guys as they do from me.”

Allen Umbarger Project Dads Facilitator

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Andy’s Story Mike Mead is the Unit Manager for Mental Health Supports at HCS, known as Oasis. This service, along with other Adult Recovery Services, works with adults with chronic and serious mental illness. Mike has worked with a certain consumer, Andy, for almost 12 years.

“I’ve worked with Andy throughout most of my career at Highlands Community Services”, Mike states. “He has a very difficult story. He comes from a background filled with poverty, abuse, mental illness, and substance abuse. Years ago, Andy was discharged from the state psychiatric hospital, to the Abingdon area, after a lengthy court battle. He was then court-ordered to full wrap-around services here at HCS.” Upon coming to HCS, Andy had lots of anxiety, and it was difficult for him to follow through with standard tasks like going to the bank or the grocery store. He also originally lived at an assisted living facility. After working with Andy, Mike and many other staff members at HCS, have seen significant changes.

When asked about the services he receives from Highlands Community Services, Andy responds, “It keeps me healthy and out of trouble. I have a lot of friends. I get to eat with them and spend time with them. I’ve been living on my own for eleven years, and I’m clean and sober. All of the clients and employees of HCS have been very good to me.”

Andy now lives independently and functions in the community. He manages his own money after receiving budget training and assistance.

He is able to have a social life and attends Stepping Stones five days a week where he has friends and activities. He has successfully remained stable and out of the hospital for ten years. I’m very proud.

Mike Mead Unit Manager, Oasis

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Rhonda’s Story EMDR (Eye Movement Desensitization and Reprocessing) is a unique and effective form of trauma treatment. EMDR uses bi-lateral stimulation to help a person take control of how they react to, and feel about, situations. It helps the brain to “digest” all of the mixed up feelings and emotions so that they can get rid of what is making them feel and react poorly.

No one knows this better than Rhonda. Rhonda came to HCS after experiencing layers of trauma during childhood and adulthood, most recently the death of an infant and a difficult divorce. Rhonda suffered from major depression and significant health issues which were escalating every day.

She explains, “When you go through a traumatic experience, your mind kind of disconnects from your body. I had gone through therapy before, but had never done EMDR. I was uncertain and scared at first. But, now, even my medical records prove just how beneficial this therapy has been for me. I’m stronger and more confident. I had put up so many walls that I had trouble trusting anyone. It has taken awhile to process all of the trauma that I’ve been through. I still have a long way to go, but I’m now healthier and feel like a new person. I believe that the combination of God and services at Highlands Community Services saved my life. My medical treatment was necessary, but the difference, even in my body has been astonishing since starting the EMDR therapy.”

“This is a process. You have to be ready, and you have to have courage. My breathing has improved, so has my kidney function. Even my neuropathy is better. I believe therapy like EMDR, combined with traditional medical treatment, is what is needed for many people. Be ready and willing to work on yourself. It’s worth it.”

After only the third session, I could see the changes begin in Rhonda. She began to get motivated to improve and not give up. It has truly been amazing to see how far she has come since beginning EMDR.

Teresa Viers Outpatient Therapist

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HCS in Your Community

We have nine locations throughout our service area of Washington County and Bristol, VA situated conveniently near Interstate 81.

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1. Oakview Children’s Services 102 Oakview Avenue, Bristol, VA 2. Recovery Care Coordination - Bristol 1969 Lee Highway, Bristol, VA 3. Interchange I & School-Based Services 80 Terrace Drive, Bristol, VA

4. The Annex 608 Campus Drive, Abingdon, VA 5. The Campus - Admin & Various Services 610 Campus Drive, Abingdon, VA 6. Stepping Stones 414 Ivy Street, Abingdon, VA

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7. Interchange II 751 Radio Drive, Abingdon, VA 8. Crisis Recovery Center 802 Hillman Highway, Abingdon, VA 9. Oasis 27018 Lee Highway, Abingdon, VA

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Highlands Community Services | 610 Campus Drive | Abingdon, VA 24210 | highlandscsb.org | 276.525.1550