Annual Report – FY 2017

Burke’s mission is to provide the highest-quality and most compassionate and comprehensive mental health and developmental disability services. To meet this mission, Burke has established Strategic Initiatives to direct the work of Burke leadership and staff, review the FY 2017 Strategic Initiatives.

To inform clients, community members, elected officials of our performance, impact and financial management, we periodically provide snapshots of our various departments. The following information is current as of January 2018.

Burke provides award-winning services in twelve East Texas counties (Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity and Tyler).

Across our region, we operate 46 facilities that specialize in personal, professional, and compassionate care for each and every client. Part of the East Texas health care community for over 40 years, Burke is the only system that provides comprehensive behavioral health and developmental disability services. This annual report describes new services and programs introduced by Burke.  These new programs allow Burke to serve more people with even more services tailored to meet their needs.

Service Provision – All Programs

 

Burke served 13,037 East Texans in FY17, an increase in individuals served of 69% over the 7,700 who received services in FY12.

 

Mental Health Services

Capacity for mental health services has continued to increase since FY12 when 6,624 children were seen. In FY17, mental health services were provided to 11,039 adults and children, a 66.65% increase over FY12. This increase correlates with our constant and increasing efforts to provide quality customer care. Efforts include maintaining new clinic sites added in recent years, utilizing our comprehensive telemedicine network and additional staff at all locations through a variety of mental health programs.

Thanks to increased appropriations from the Texas Legislature and dollars from the Texas Medicaid Transformation Waiver, Burke has experienced an increase in funding for mental health treatment. With these new resources, Burke has added new clinic sites, enhanced our telemedicine network and expanded our capacity to serve more people.

Most individuals who present to Burke in psychiatric crisis can be served at the Mental Health Emergency Center. There are cases, however, when more intensive treatment is needed. In the past, these individuals were admitted to one of the State Mental Health Facilities (State Hospitals like Rusk). The capacity at these State Mental Health Facilities has steadily decreased over the past four years, and now they are no longer able to serve this population. Instead, Burke has been sending these individuals to private psychiatric hospitals, all of which are outside the Burke service area. Burke receives no funding to pay for these needed placements, yet the cost of these placements continue to grow. Burke has applied for funding appropriated during the recent legislative session to offset some of these costs.

New Mental Health Service Programs

Youth Empowerment Services, also know as the YES Waiver provides home and community-based services to individuals ages 3-19 who have a serious emotional disturbance putting them at risk of being placed outside of the home. Services include non-traditional therapies, respite, non-medical transportation, paraprofessional services, family supports, employment assistance, and community living skills. YES Waiver work is channeled through a team approach that includes community providers, families, and their informal supports with common goals of reducing time spent out of the home and community, preventing entry into the foster care system, and improving the lives of children and their families.

System of Care is a state-led initiative to introduce a philosophy of doing business that improves the way we interact with community, families, and other child-serving systems. System of Care builds meaningful partnerships with families and youth, addresses cultural and linguistic needs, and uses evidence-based practices to help children, youth and families function better at home, in school, in the community, and throughout life. The program works to improve behavioral health outcomes for children and youth (3-20) with serious emotional disturbances and with their families by expanding utilization of high-fidelity Wraparound to engage children and youth in the juvenile justice system, child welfare, and residential treatment center placement.

Specialized Treatment of Early Psychosis (STEP) is a recovery-oriented treatment program for individuals ages 15-30 who have experienced their first psychotic episode. They receive a team approach of case management, doctor services, psychosocial rehabilitation, peer services, therapy, and supportive employment and/or education for up to two years based on need and preferences. The primary goal of the program is to decrease the length of time between the onset of psychotic symptoms to the beginning of treatment to minimize brain damage as well as strain on the individuals and their families. Burke has partnered with Stephen F. Austin State University’s student counseling program to recruit program participants. In FY17,  the program served over 30 individuals.

Certified Community Behavioral Health Clinic (CCBHC) is a national model of program design that focuses on awareness and coordination designed to provide a comprehensive range of mental health and substance use disorder services, particularly to vulnerable individuals with the most complex needs. Clients are carefully followed and assisted for traditional mental health services as well as other needs such as medical care.

Although Texas was not chosen for the Certified Community Behavioral Health Clinic program, Burke still received its certification as a CCBHC program.  Burke, along with HHSC and seven other certified programs meet on a regular basis to prepare for CCBHC programming.  HHSC is currently in the process of securing funding and developing the CCBHC level of care.  Once these are complete Burke will implement the CCBHC service delivery system.

 

Developmental Disabilities

Burke developmental disabilities services are tailored for each client’s personal and unique needs. We work with each client and family member to develop the most appropriate course of care that will help achieve individual goals.

 

 

New Intellectual and Developmental Disabilities (IDD) Programs

Host Companion Care – In 2017, Burke began to shift residential care for individuals in the Home and Community-based Services Program from group home environments to host home care.Hosts are family or non-family members who desire to open their home up to individuals with IDD to provide a supportive and caring living environment. Hosts provide personal assistance with activities of daily living (ADLs) and functional living tasks. These services are provided in a private residence by a host provider who lives in and owns or leases the residence. Host providers are compensated for their time and reimbursed for rent. In FY 2017, Burke facilitated host home companion care for 55 individuals.

In 2016, Burke began providing Crisis Intervention Services to support individuals with intellectual and developmental disabilities (IDD) with significant behavioral and psychiatric challenges. Resources were expanded to address crisis situations with individuals who have IDD.  Crisis Intervention staff also work closely with Service Coordinators to identify people at risk of crisis and reviewing supports currently in place to see if they are effective. In 2017, 240 referrals were made in our service area for Crisis Intervention Services, over 200 community organizations, school professionals, and law enforcement officers were trained in detecting crisis among IDD individuals.

 

Early Childhood Intervention (ECI) Services

Burke Early Childhood Intervention Services help children from birth to age three overcome difficulties in early development. Together, parents and staff work to improve the child’s physical, cognitive, social and adaptive development to build a stronger foundation for the child’s future.


1115 Medicaid Transformation Waiver

Following are specific project areas / objectives for which Burke received funding via the 1115 Medicaid Transformation Waiver.

1. Expand Capacity:  Adding staff and resources to serve more people needing mental health services. Burke has doubled mental health capacity since 2001 and served over 11,000 individuals in FY17.

2. Expand Telemedicine:  Burke provided 9,635 services via telemedicine in FY17.

3. Primary Care Integration:  Partnering with the Angelina Cities/County Health District to create a primary care clinic in our Lufkin facility to provide essential medical treatment for those we serve. Burke provided integrated services to 1,031 individuals in FY 17.

4.  Specialized Teams:  Focusing services on persons with complex or re-occurring needs by creating a team of experts to provide and coordinate their care closely. This means home visits, frequent contacts and specialized programs to reduce repeated crises or criminal justice involvement. Specialized services have been provided to over 640 individuals each year. Service engagement for persons with substance use disorders increased.

5.  Peer Support:  Hiring individuals who are recovering from mental illness to provide services and supports in our programs. Research has shown that their experience and encouragement helps others on their recovery journey and can significantly improve outcomes for those they serve. Burke has served over 299 individuals with this initiative, with a focus of improving mental and physical health care needs.

6.  Detox and Treatment:  Adding a detoxification component to our Mental Health Emergency Center partners with the Alcohol and Drug Abuse Council (ADAC) to provide ongoing recovery support and treatment. Burke provides detoxification services to over 250 individuals each year.

7.  Mental Health Education, Outreach, and Engagement:  Implementing a public education and outreach program using a variety of media platforms to improve engagement in behavioral healthcare services and promote mental health. Burke engaged 1,942 clients in either Burke’s myStrength educational and support platform or Burke’s automated phone reminder system. Burke’s multimedia REAL campaign has served millions of impressions that have sent thousands of individuals to Burke’s website.

 

Burke Funding

 

Burke receives state and federal funds administered by the Texas Health and Human Services Commission to provide services in the East Texas area. Insurance payments including Medicare, Medicaid and commercial policies for client services are an additional source of funds. Burke staff and clients earn funds from Intellectual and Development Disability (IDD) enterprise activities and contracted services. Additional funds include contributions from county governments and hospitals for special projects, local donations, and other in-kind sources.

 

Insurance Payments

In FY17, Burke collected $5.6 million in insurance payments. For FY18, Burke has budgeted for an estimated $6.1 in insurance revenue.

Burke Employees

As of October 2017, Burke employed 647 individuals; 421 full-time and 226 part-time.

Over the past five years, staff turnover ranged from 16-22%; the FY17 turnover rate was 20.1%.  The average employee tenure was 5.19 years.

More than half of Burke employees reside in Angelina County, 19% live in Nacogdoches County, 7% live in Polk County, and 6% live in Jasper County. The remaining 14% live in other Burke region counties.