TABLE OF CONTENTS

ANNUAL REPORT

Fiscal Year 2013

We Care, We Listen, We Respond… 24 hours a day

TABLE OF CONTENTS

Contents

History ____________________________________________________________________________________________________ 1

A Year In Review – Fiscal Year 2013 ____________________________________________________________________ 2

ACI Crisis Services – DMH Eastern Region of Missouri 2

St. Louis County – Youth Connection Services 2

St. Charles County – Youth Connection Services 2

Follow-up Program 3

National Suicide Prevention Lifeline (NSPL) 3

National Safe Place 3

Mental Health First Aid and ASIST Training 3

Other Services 3

Who We Are _______________________________________________________________________________________________ 4

Governance – BHR Board of Directors 4

Leadership 4

Clinical Team 4

Links with the Community 4

Community Impact _______________________________________________________________________________________ 6

Call Volume 6

Our Clients 6

Mobile Outreaches 7

How We Perform _________________________________________________________________________________________ 8

Accreditation 8

Continuous Quality Improvement 8

Satisfaction 8

Strategic Goals 10

FY 2013 Strategic Goals Evaluation 10

FY 2014 Strategic Goals 10

Contact Information _____________________________________________________________________________________ 11

HISTORY

Page 1

History Behavioral Health Response (BHR) is a nonprofit organization developed in 1994 by the Eastern Region

Community Mental Health Centers designated as the Administrative Agents (AAs) for the Missouri Department

of Mental Health (DMH). BHR was developed to plan, coordinate, and deliver access and crisis intervention

services. The crisis system serves all residents of DMH’s Eastern Region of Missouri and the counties of Iron,

Washington and St. Francois; some 2.2 million individuals reside in the ten-county region. Find out more

about BHR at www.BHRstl.org.

A for-profit subsidiary, BHR Worldwide (BHRW) was incorporated in 2006. With innovative approaches to

assessment, intake, crisis intervention and call handling, we provide clients many value added services. BHRW

helps increase access to client facilities, decrease expenses and improve processes. BHRW provides services to

clients as varied as community and state mental health centers, Managed Care organizations, in-patient and

out-patient substance abuse facilities, hospitals, regional and national employee assistance programs. Find out

more about BHR Worldwide at www.BHRworldwide.com.

BHR systems are designed and our staff is selected and trained to provide professional, culturally sensitive and

immediate clinical assistance. BHR provide professional clinical services twenty-four hours a day, 365 days a

year. BHR staff consists almost entirely of master’s level and above clinicians with degrees in psychology,

counseling, social work and other behavioral health disciplines.

Eastern Region Population Distribution

(Population estimates as of July 1, 2012, per US Census –www.census.gov)

County Population PCT Community Mental Health Center

St. Louis 1,000,438 45.55% BJC Behavioral Health

St. Charles 368,666 16.79% Crider Mental Health Center

City of St. Louis 318,172 14.49% Hopewell Center/BJC Behavioral Health

Jefferson 220,209 10.03% COMTREA

Franklin 101,412 4.62% Crider Mental Health Center

St. Francois 65,917 3.00% BJC Behavioral Health

Lincoln 53,354 2.43% Crider Mental Health Center

Warren 32,753 1.49% Crider Mental Health Center

Washington 25,095 1.14% BJC Behavioral Health

Iron 10,374 0.47% BJC Behavioral Health

2,196,390 TOTAL

A YEAR IN REVIEW – FISCAL YEAR 2013

Page 2

A Year In Review – Fiscal Year 2013 ACI CRISIS SERVICES – DMH EASTERN REGION OF MISSOURI

BHR handled 47,125 inbound and outbound calls providing crisis services in the eastern region. The

components of the access/crisis intervention (ACI) system coordinated by BHR include: a professionally

staffed 24/7 telephone crisis hotline; 24/7 face-to-face evaluations in the community (Mobile Outreach

Services); follow-up and care coordination services for all individuals who receive Mobile Outreach Services;

next-day urgent appointments at the community mental health centers; a crisis-stabilization bed; and

information about and assistance with the civil involuntary detention process.

ST. LOUIS COUNTY – YOUTH CONNECTION SERVICES

BHR’s funding through the St. Louis County Children’s Service Fund to provide a dedicated Youth Connection

Helpline was significantly increased on January 1, 2013. Between July 1, 2012 and June 30, 2013 BHR handled

23,651 inbound and outbound calls on the Helpline - a 77% increase over call volume from the prior fiscal

year. BHR provided assistance to over 1,700 St. Louis County youth, which is an increase of 128% when

compared to the number of youth served prior to the Helpline in 2010. The Helpline provides assistance to

youth experiencing mental, emotional and/or behavioral symptoms and substance abuse symptoms. Services

provided included crisis intervention, referrals/linkage to community resources and face-to-face evaluations in

the community. BHR also provided texting services so that St. Louis County Youth could contact the helpline

24/7 via texting. BHR will start providing online chat crisis assistance in the 2014 Fiscal Year.

ST. CHARLES COUNTY – YOUTH CONNECTION SERVICES

BHR received continued funding through the St. Charles County Community and Children’s Resource Board

(CCRB). Between July 1, 2012 and June 30, 2013 BHR handled 5,042 inbound and outbound calls on the St.

Charles County Youth Connection Helpline which is over a 600% increase from BHR’s first year of funding. The

Helpline provided assistance to youth experiencing mental, emotional and/or behavioral symptoms and

substance abuse symptoms. Services provided included crisis intervention, referrals/linkage to community

resources and face-to-face evaluations in the community. BHR also provided texting services so that St.

Charles County Youth could contact the helpline 24/7 via texting.

A YEAR IN REVIEW – FISCAL YEAR 2013

Page 3

FOLLOW-UP PROGRAM

BHR Follow-Up Program was established in Fall 2010, with the creation of the St. Louis County Youth

Connection Helpline funded through the Children’s Service Fund and the Suicide Lifeline Crisis Helpline funded

through SAMHSA. In January 2011, BHR added another follow-up program, St. Charles County Youth

Connection helpline funded through The Community Resource Board of St. Charles County. In March 2013,

BHR crisis line began to offer follow-up calls to all callers who utilized our mobile outreach services in our 10

county regions. In Fiscal Year 2013, over 2300 cases received follow-up services. Follow-up coordinators

made nearly 14,000 outbound calls for those cases.

NATIONAL SUICIDE PREVENTION LIFELINE (NSPL)

BHR is a networked crisis center for the National Suicide Prevention Lifeline (NSPL). BHR was awarded funds

through Substance Abuse and Mental Health Services (SAMHSA) to provide follow up services for a cohort of

callers who have experienced recent suicidal ideation and agreed to participate in follow up services. BHR

handled 8,617 inbound and outbound calls though our Suicide Lifeline and SAMHSA follow-up services.

NATIONAL SAFE PLACE

BHR provides live clinician access via the National Safe Place Text for Help Program. Youth who text the

National Safe Place program are given the option to reach a live clinician via an SMS texting system. BHR

responded to requests from youth across the United States, engaging in over 360 text exchanges on via the

National Safe Place Text for Help system.

MENTAL HEALTH FIRST AID AND ASIST TRAINING

BHR provided 30 Mental Health First Aid training to agencies and organizations. Mental Health First Aid

teaches a 5-step action plan encompassing awareness, recognition, skills, resources and compassion to assist

an individual in crisis connect with appropriate professional, social, peer, and self-help care. Mental Health

First Aid training programs were primarily funded by the St. Louis County Children’s Services Fund.

BHR continued to offer Applied Suicide Intervention Skills Training (ASIST) to internal staff, mental health

center colleagues and a broad community of mental health providers, law enforcement personnel and

educators. ASIST is a comprehensive suicide intervention training program. BHR provided 3 ASIST trainings

this fiscal year and some in partnership with the Gateway Youth Suicide Prevention Resources Partnership

(GYSPRP).

OTHER SERVICES

BHR’s sophisticated technology as a 24/7 call center is continually enhanced with the expansion of and

improvements to an intranet which provides rapid access to key contract information, on-call schedules,

resource information and company policies and procedures. In addition to Eastern Region ACI services, BHR

provides crisis hotline services for the Missouri Crisis Access Response System (MOCARS) , a consortium of

Missouri DMH AAs outside of the Eastern Region. BHR provides crisis and after-hours call-center services for

two Community Mental Health Systems in Michigan and for SEARHC a non-profit tribal health consortium of

18 Native communities which serves the health interests of the Tlingit, Haida, Tsimshian, and other Native

people of Southeast Alaska.

WHO WE ARE

Page 4

Who We Are GOVERNANCE

BHR is governed by a Board of Directors consisting of the CEOs of the founding Administrative Agents and

other key behavioral health providers. Board members are: Kim Gladstone, BJC Behavioral Health; Laura

Heebner, Crider Health Center; Mike Keller, Independence Center; Mike Morrison, Bridgeway Behavioral

Health; Wendy Orson, Amanda L. Murphy Hopewell Center; Lara Pennington, Queen of Peace; Margo Pigg,

Community Treatment, Inc (COMTREA); and Joe Yancey, Places for People. Wendy Orson served as Board Chair

during FY ’13.

BHR financial records are audited annually by an independent auditing firm for compliance with standard

accounting practices. For the ’13 audit (completed during the 2nd quarter of FY ’14) auditors approved

accounting practices and found BHR to be financially sound at year-end.

LEADERSHIP

BHR’s Executive Team is Patricia Coleman, President and CEO, Dr. Bart Andrews, Vice President of Clinical

Operations and Carisa Hill, Chief Financial Officer. Angela Tate oversees the call center and mobile outreach

services as Director of Clinical Services.

CLINICAL TEAM

BHR’s clinical team includes five clinical managers and 85 full-time and part-time employees who provide

access and crisis services telephonically and through mobile outreach evaluations. All clinicians have mental-

health-related master’s degrees, and many are licensed to practice independently as professional counselors,

social workers, or psychologists.

LINKS WITH THE COMMUNITY

Our community involvement

BHR employs a full-time Community and Organizational Development Manager who ensures BHR is connected

and represented in the community throughout the eastern region of Missouri. BHR also has a Community

Advisory Board comprised of community members that collaborate with BHR to aid in the continued

development of the relationship with the community. BHR continues to market and promote the Youth

Connection Helpline in St. Louis County.

Crisis Intervention Team (CIT) trainings

In partnership with dozens of law enforcement agencies, National Alliance on Mental Illness (NAMI), Mental

Health America (MHA), and the mental health provider community, BHR aides in the development and

expansion of Crisis Intervention Team (CIT) in the Eastern Region and statewide. BHR has membership on the

CIT Coordinating Council, CIT Missouri Council, CIT Training Committee, and other committees devoted to CIT

and success. To date, over 3500 police officers have received CIT training to provide competent, safe,

compassionate intervention for mental health consumers and those at risk of suicide. BHR was instrumental in

the development of CIT training for officers that work with youth and in the expansion of CIT program in the

St. Louis area and surrounding regions.

WHO WE ARE

Page 5

Gateway Youth Suicide Prevention Resources Partnership (GYSPRP)

BHR is a founding member of GYSPRP. GYSPRP has been awarded Department of Mental Health funding for six

consecutive years to continue expansion of community suicide prevention and education services. The

partnership provides age-appropriate suicide prevention awareness education in schools, ASIST workshops

and Question Persuade and Refer (QPR) Training for providers, teachers, school counselors, clergy, police

officers and other gatekeepers, general and specialized crisis hotlines. An advisory committee consisting of

educators, providers, advocates and community leaders provides leadership and direction for GYSPRP.

Other community involvement

In close collaboration with the Regional Health Commission, BHR Board Members and senior executives played

key roles on workgroups and advisory boards for the Eastern Region Behavioral Healthcare Initiative (ERBHI).

BHR leadership is well-represented on the Board and working committees of the Behavioral Health Network

(BHN).

BHR’s management team serves the community in many capacities, participating in: the St. Louis County

Health Improvement Plan, The St. Louis Integrated Health Network’s Transitions of Care Task Force, the St.

Charles County Children’s Coalition, Paraquad’s Board of Directors. the Great Circle’s Regional Council,

TouchPoint Autism Service’s (now Life Skills / TouchPoint) Human Rights Board, Mental Health America of

Eastern Missouri, Missouri Coalition of Community Mental Health Centers, Workforce Investment Board – City

of St. Louis, and the St. Louis Regional Chamber.

COMMUNITY IMPACT

Page 6

Community Impact CALL VOLUME

Call Center Goal FY11 FY12 FY13

Total Calls Answered 175,814 188,480 196,199

Call Abandonment Rate 5% 4.10% 5.7% 3.5%

Average Speed to Answer 15 sec 12 14 11

% of Calls Answered < 30 sec 95% 94.30% 93% 95.4%

OUR CLIENTS

Age/Gender Breakdown Who Calls

Presenting Problem Lethality Screening

COMMUNITY IMPACT

Page 7

MOBILE OUTREACHES

Outcomes

Outreach Totals

Outreach Age/Gender Breakdown

Outreach Outcomes

HOW WE PERFORM

Page 8

How We Perform ACCREDITATION

BHR is accountable to a Quality and Standards Committee comprised of the Clinical Directors of its partners in

the Eastern Region ACI System, and meets the Missouri Department of Mental Health standards and regulations

for staffing, training, safety, service delivery, and, utilization reporting.

BHR invites CARF and the American Association of Suicidology (AAS), two external credentialing organizations,

to review its leadership, management and service delivery systems. CARF conducted a site examination in

August 2011 and determined that BHR was in compliance with all of its standards for Crisis and Information

Call Centers. The examiners’ report found BHR’s information technology and IT Plan to be exemplary and cited

27 organizational strengths. BHR was awarded a three year certification with no recommendations for

improvement. (Fewer than 3% of organizations reviewed by CARF receive certification without

recommendations.) BHR’s most recent AAS recertification site examination in November 2008 resulted in a

highly favorable evaluation report and full five-year accreditation. BHR’s next AAS site examination is

scheduled for October 2012.

CONTINUOUS QUALITY IMPROVEMENT

BHR executives demonstrated commitment to continuous quality improvement and support for accrediting

organizations by serving as CARF surveyors and AAS site-examiners. BHR’s CEO served as the Crisis Center

Director on the Board of Directors.

Data from virtually every aspect of service delivery, financial performance, training, employee performance and

productivity, and, internal and external customer satisfaction is monitored, measured against benchmarks and

objectives, analyzed and utilized for continuous quality improvement. Program evaluation data is reported

continuously through BHR’s monthly performance reports, monthly utilization reports, and monthly, quarterly

and annual quality summary reports.

SATISFACTION

Employees

The Employee Satisfaction survey for FY’13 was revamped from the previous surveys. The anonymous survey

focused on work satisfaction and consists of eight questions in 4 point-Likert format. It provides the

opportunity to offer general comments and comments related to each question.

Fifty-four of our employees responded. Overall aggregate Likert scores were in the “somewhat satisfied-very

satisfied” range, Employees reported a score of 3.06 I often leave work with feeling of satisfaction. Employee’s

recommendations were reviewed prioritized and an action plan was created to address concerns.

Consumers

BHR offers a telephonic consumer satisfaction surveys at the end of every call from individuals who have called

the crisis line and for whom an intake was conducted. Likert scores average in the “Very Satisfied” (8.0) range

for a series of items that tap satisfaction with promptness of response, courteousness, understanding and

compassion of counselors, referrals and respect. BHR achieved an average score of 8.56 out of 9 on an item

that assesses the likelihood that the consumer will call the crisis line again if needed.

HOW WE PERFORM

Page 9

DMH E. Region – Satisfaction

St. Louis County Youth Connection Helpline –

Satisfaction

St. Charles County Youth Connection Helpline –

Satisfaction

HOW WE PERFORM

Page 10

STRATEGIC GOALS

BHR’s companywide goals for FY ’13 were established as part of the Board of Directors’ annual strategic

planning meeting convened in April 2012. The management team reviewed the five-year strategic plan and,

with that plan in mind, set ’12 goals for three major areas of the organization. The table below presents the

goals, highlights key objectives associated with each goal, and summarizes outcomes achieved by year-end.

FY 2013 STRATEGIC GOALS EVALUATION

1. BHR will increase its revenue by 10%. BHR met this goal

2. BHR will increase its profit by 1%. BHR did not meet this goal

3. BHR will adapt and thrive in a changing healthcare environment. BHR continues to succeed and adapt in a rapidly-changing healthcare environment.

FY 2014 STRATEGIC GOALS

1. BHR will increase its revenue by 10%. 2. BHR will increase its profit by 2%. 3. BHR will adapt and thrive in a changing healthcare environment.

CONTACT INFORMATION

Page 11

Contact Information

In Crisis? For an emergency dial 911;

Otherwise, check www.BHRstl.org for crisis services and

phone numbers to call

Employment: www.bhrstl.org/employment.htm

Admin Line: 1.314.469.4908

1.866.469.4908 (toll free)

Sales: 1.314.628.6235

1.866.366.5885 (toll free)

Find out more at http://ww.BHRstl.org

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