HFS Transformation Grant Application

Executive Summary

The project we are submitting for a Healthcare Transformation Collaboratives grant is the integration of the entire continuum of psychiatric care across the partner organizations and their cooperating to provide inpatient, partial hospital, intensive outpatient treatment, outpatient psychotherapy and medication management. The close relatedness and agreement between these organizations will improve care by having strong management and seamless linkage for a patient through the levels of care they may need and effective communication between the professionals to enhance the quality and outcomes for the patient.

In addition to enhancing the clinical behavioral healthcare individuals will receive, we have integrated two levels of housing services with the treatment system noted above. We have included an organization as partner, who will develop permanent housing solutions by constructing housing on the campus of Lake Behavioral Hospital. The integration of clinical services while bringing in high quality and equitable housing, one of the most serious psychosocial stressors those subject to social inequities experiences, should act to improve outcomes over care alone.

Participating Entities:

Lake Behavioral Hospital is a 146-bed psychiatric hospital, located at 2615 Washington Street in Waukegan, that offers a full continuum of inpatient and outpatient behavioral programs. As the sole standalone behavioral hospital in Lake County, Lake Behavioral Hospital treats the unmet need for behavioral healthcare with specialized, evidence-based programs for adolescents, adults and older adults. Lake Behavioral Hospital is open 24/7 and offers free confidential assessments as a community service. Our compassionate and experienced team of psychiatrists, licensed therapists, nurses and support staff are here to create an atmosphere of health, hope and healing.

Formerly known as Vista Medical Center West and prior to that St. Therese Hospital, Lake Behavioral expanded to 146 beds in June 2020 with the development of a new 88,000 square foot state-of-the-art hospital. Contained within four floors, the hospital is designed to provide a therapeutic environment for treatment. The latest in patient safety features, brightly lit hallways, open corridors and comfortable patient accommodations are part of the overall design. Additional features include recreational and activity therapy areas, outdoor courtyards and a dining room. This expansion hospital revitalized Waukegan with the creation of over 200 high quality jobs and increased access to urgently needed behavioral services.

Lake County Health Department (LCHD) is one of the largest, high quality, state-certified public health departments in the country, ranking among the top 6 percent of 2,864 local health departments nationwide. LCHD, with approximately 1,000 employed professionals and 52 separately funded programs, is a leader in promoting the health and well-being of those who live in Lake County. LCHD has a large behavioral health division and will provide outpatient services to this collaborative. This partner in the proposal brings a myriad of behavioral health services beyond traditional outpatient to the collaborative. These include assertive community treatment, a crisis program, mental health group home, women’s residential services, medication assisted treatment, harm reduction program, community support services, addiction treatment/ detox, child and adolescent behavioral health, family care services, Williams consent decree services and professional and community training.

Lake County United is a not-for-profit organization whose mission it is to improve the quality of life for residents in Lake County Illinois through advocacy and education, providing equitable housing, mental health and supportive housing, education and leadership development as well as advocacy on a host of issues such as gun violence and funding for and creation of mental health treatment.

NICASA, NIRCO and Live4Lali are outpatient mental health treatment organizations provide a variety of services including outpatient psychotherapy, outpatient group therapy, medication management, outreach and case management, and they will function as the more traditional outpatient component of this collaborative partnership.

PADS Shelter is one of the longstanding highest quality housing organizations in Lake County.

The DeBruler Company is a real estate firm based in Libertyville North that acquires, develops, builds and manages residential properties that has a long-standing 30 year respected reputation based on integrity, innovation and social consciousness.

Grant – Part I

Behavioral health disorders have been exacerbated by the pandemic and affect one in five Americans. People of color are at a higher risk of being undiagnosed and untreated. Addressing mental health and substance abuse disorders is an urgent matter and expanded access to treatment is critical.

A core part of Lake Behavioral Hospital’s mission is to treat all patients, regardless of ability to pay. Over 60% of our patient population is Medicaid beneficiaries. Another part of our grant request is to enable us to increase access to care for unfunded patients and improve quality outcomes for all patients including people of color. Unfunded individuals face formidable barriers and access to care and behavioral health organizations. The partners aligned together in this proposal intend to develop a system to provide care on a complete continuum from inpatient through outpatient and sheltering/ residential to those are unfunded that most often has virtually no options for treatment.

In this model, Lake Behavioral Hospital will provide an inpatient treatment environment for those with psychiatric disorders who are unfunded and would often be referred to the state system where beds are difficult to secure. Lake will work with community partners in constructing a system where levels of care will have smooth transitions and extremely effective linkage to lower levels of care will be of the utmost importance. Lake County Health Department and Lake Behavioral Hospital already have a longstanding collaborative relationship that has improved care through our respective services, working relationship and effective linkage. Lake County Health Department, Lake County United, NICASA, NIRCO, PADS and Live4Lali will be the partner organizations responsible for receiving patients into aftercare or shelter after inpatient treatment, making a linkage before the conclusion of inpatient care and providing an outpatient appointment within only a few days of discharge. On-site face-to-face linkage by an outpatient provider with a patient prior to being discharged from an acute care environment has been proven by research to reduce recidivism very dramatically.

The staffing costs of Lake Behavioral Hospital and the community partners will center on hiring and retention of healthcare employees, mainly nurses, social workers and other licensed therapists as well as some bachelors level professionals may provide services such as case management and linkage. There has been one management position submitted to lead the collaborative effort, and there will also be psychiatrists and medical physicians who will be subcontracted with to provide their areas of expertise.

One our community providers, PADS shelter, will address another inequity which is often a complication in the Medicaid and unfunded population in distressed communities, that being the lack of stable living arrangements which has a severe detrimental impact on mental health stability. Another important part in the continuum where a patient is discharged from the hospital into outpatient care would be to have the availability of a supportive housing situation available. Housing instability has been seen for some time is one of the more serious contributors to mental health problems.

All of the partners coming together under this proposal treat very high percentages of Medicaid clients and considerable numbers of unfunded clients as well. The large proportion of the patients served in all of the organizations coming together under this proposal are African-American, Hispanic or other minorities.

Grant – Part II

Lake Behavioral and Lake County United have worked together over the past several years to increase access to behavioral health services through community participation. This strong collaboration led to discussions about how to best utilize the campus of Lake Behavioral. After an extensive analysis of alternatives, both parties concluded that the development of equitable housing on campus would be the highest and best use of the extra land not being used by the hospital. Providing access to equitable and affordable housing promotes residential stability and is one of the most critical social determinants of health.

Lake Behavioral will donate a large tract of land on its campus near the hospital to Lake County United to redevelop the former St. Therese Hospital site into a new community in Waukegan – providing affordable homes for working families, affordable housing with services for the formerly homeless or households with disabilities, and access to health care and other amenities.

Lake Behavioral and Lake County United will work with The DeBruler Company to redevelop, re-purpose and transform mostly vacant buildings into a new neighborhood – with essential housing for essential workers, supportive housing for the most vulnerable, access to health care, and new jobs, tax base, and economic activity in Waukegan. To be clear, Lake Behavioral Hospital would remain on the site and continue to own and operate the hospital. Though not finalized and still subject to City of Waukegan approvals, Lake Behavioral and Lake County United envision a new community consisting of about 200 affordable homes and apartments. This is not just about an increase of affordable housing and transforming communities; this is an investment in broad-base community organizing.

The proposed housing development would include the following: one 40 - unit supportive housing unit for people with special needs (mental, physical, addiction, veterans) with room next to the complex for a second 40 - unit building in the future and 75+ single family detached homes and 50+ town homes. The development would lease the existing parking structure from Lake Behavioral for apartments next to parking garage.

Lake Behavioral and Lake County United are requesting capital funding to be used for demolition, site preparation, architectural drawings and other predevelopment costs as part of the above-described Development. Lake County United will use this funding commitment to leverage other financing sources for pre development and construction of affordable housing

We are requesting $6 million in funding for the pre-development costs. We anticipate total development costs of $40 million to create 200 affordable homes and apartments. The requested funds ($6 million) will catalyze this $40 million investment in Waukegan to create approximately 200 affordable homes and apartments.

Community Input

According to the City of Waukegan’s 2021 Housing and Community Development Annual Action Plan, housing was the top priority area to meet the greatest needs of its residents. Lake Behavioral and Lake County United have had preliminary conversations with elected officials regarding concept plans and structure. It is clear there is a community need for equitable housing in Lake County, especially in Waukegan.

Lake County United and its affiliates have a proven track record of building political will and political support and getting affordable housing built – including in places where people said it was not possible and where opposition was strong. Lake County United and its affiliates have turned the political tide and overwhelmed NIMBY opposition in places as diverse as Grayslake, Mundelein, Elgin, Oak Park and Lincoln Park (to name just a few) for diverse kinds of affordable housing (e.g. housing for individuals suffering from mental illness, victims of domestic violence, low-income working families, households with physical disabilities, and the formerly homeless). In addition they have succeeded in obtaining zoning approval for a hospital and mosque where there was significant opposition. Lake County United will build off this success to press for even more housing on the land donated by Lake Behavioral.

And The DeBruler Co. has a proven track record in developing and owning and operating affordable housing in places as varied as Libertyville, Grayslake, North Chicago, Zion, Antioch, Freeport, and Macomb (just to name a few). In addition, they have a sterling reputation in Waukegan because of housing they developed and have owned and operated there since 1970.

This joint venture approach minimizes the risk and maximizes the opportunity for this fund to invest in a proven team for a transformative project that will not only produce high-quality affordable housing next to health care and other amenities, but also create a new community and help to jump-start a rebirth of this area of Waukegan.

Lake Behavioral Hospital routinely holds meetings with many community organizations in the service area to discuss the needs of organizations and the populations they serve in an continuing effort to improve care in the area through the relationship between organizations. Lake Behavioral has developed strong working relationships with numerous community-based organizations to identify and expand programs that reduce stigma and combat barriers to care. We have used these ongoing meetings with the intent to gain information from community organizations to form strategies to provide better care and specific programs for an impoverished population that suffers significant healthcare disparities. One of our most active partners, Lake County Health Department, whom we communicate with on a daily basis, has been invaluable in gaining information about the needs of the area. Our regular clinical and administrative interchanges with them has given us the benefit of their understanding of mental health needs and inequities in Lake County. Lake County Health Department regularly tracks data on mental health populations and service needs that will help guide this collaboration. We have had discussions of disparities in behavioral healthcare with local chapters of national organizations to gain their perspectives on barriers to access to appropriate behavioral

treatment. We have arranged visits to our organization and hosted discussions with local mayors, state representatives and senators, State of Illinois departments, county officials and a US Congressman to exchange ideas, inform them of our perspectives and gain their views and input on what is needed in behavioral health treatment in our area. The service area of focus for this proposal is northern Lake County in lower SES areas with a concentration of minority populations who suffer healthcare inequities. The primary zip codes of this area are 60083, eastern portion of 60002, 60046, 60099, 60087, 60031, 60085, 60064, 60064, 60030, 60073 and 60041.

Data

Information from our own systems, as well as from other community providers, was reviewed in forming our proposal. The methodology included extracting data from our own information systems as well as being provided data from other healthcare organizations in our area. First, in our immediate geographic area there is an average need for unfunded hospitalizations equivalent to approximately 10 per week or 42 per month. These patients often wait in emergency rooms for days to be hospitalized in the state system. This project will secure care more quickly in the private system. Lake hospital accommodates unfunded patients as much as possible. Funding under this proposal would ease the financial strain of doing so. Our community partners also have significant incidence of unfunded or underfunded presentations and since these often make up the majority of who they serve as well, their financial resources are also extremely strained. If we go beyond our service area these numbers will increase and if all zip codes were included, there would be significantly more unfunded or underfunded presentations. With awareness of the resource if granted under this proposal, Lake Behavioral and its community partners would see an influx of those seeking care.

Lake currently has total admissions of 2,065 per year but is on track in our newly constructed and moved-into building to grow to over 5,000 admissions annually. Our unfunded percentage of inpatients at Lake Behavioral is as high as 10%. Our patient population is 40% Hispanic, 25% African American and 3% Asian / Pacific Islander, which equates to 70% racial/ ethnic minorities.

Health Equity and Outcomes

Individuals from racial and ethnic minority groups who have been diagnosed with a behavioral health disorder often face problems accessing psychiatric care and often, limited health literacy, geographic inaccessibility and lack of medical insurance are common among minority populations and individuals of low socioeconomic status. The extant literature cites African-American and Hispanic as groups who suffer the most inequity in mental health care.

Integrated care models hold promise for reducing mental healthcare disparities in racial and ethnic minority groups as they do for medical healthcare. Current research suggests that patients treated in an integrated behavioral health care model experience an improvement in their symptoms and functioning across many behavioral health diagnoses. Additionally, patients in integrated behavioral healthcare settings report greater satisfaction with care and a stronger therapeutic alliance with their behavioral health care takers. Our partner in this proposal, Lake County Health Department, has been a leader in northern Illinois in developing integrated care within their own treatment system. Lake Behavioral Hospital in joining efforts with them and our other partners will be able to maximize this integration as well as access to care. Our proposal aims to integrate care between partners in this project, not only on a multidisciplinary level, but integration for fluid and effective transitions among different levels of care.

Most of the failures in mental health outcomes are related to access and availability, which are also driven by financial resources, adequacy of insurance and affordability and availability of treatment. Racial and ethnic minorities suffer more failures in outcome due to linkage problems and less access and availability according to their poor funding or lack thereof.

There has also been the mistaken assumption that evidence-based interventions are readily available for diverse populations. It appears that this may not be the case for African-American and Hispanic minority populations. We will ensure that the theoretical treatment will include all relevant evidence-based treatment frameworks across all partners to address what appears to be yet another significant inequity in the actual model of care delivery.

The partners in this proposal will introduce focused education in preparation of staff in the commonly demonstrated mental health disparities of minority populations. Low compliance with medication, poor doctor-patient communication, persistent stigma, general mistrust providers and perceived mistreatment in healthcare settings due to race or ethnic background are some of the problem that these populations face. We will also include staff education on cultural and linguistic competence which will contribute to more effective assessment and interactional care provided by the various partners. Cultural and linguistic competence in the delivery of mental health services racial and ethnic minority populations has a profound effect on access to care and quality of care. We also strive to create a diverse workforce that delivers care and reflects the population served. We attempt to increase the effectiveness by providing care in a culturally and linguistically competent, patient centered framework that adequately addresses the concerns and barriers that affect minority populations who are at great risk for marginal health.

Quality Metrics

In review the HFS Quality Improvement Pillars, we would like to focus on the Pillar of Adult and Child Behavioral Health, providing a linkage coordinator with the expectation to finding appropriate resources for the underserved to impact recidivism and compliance to after care. This will be monitored using our Performance Improvement Plan and Committee

The Lake Behavioral Hospital Performance Improvement Program is established to ensure objective and systematic monitoring and evaluation of the appropriateness and quality of patient care. In addition, the program provides a formal mechanism for performance improvement activities to resolve identified problems and continuously enhance the care and service which are consistent with the mission, vision, and values of the hospital. The core values of the performance improvement program are to provide a robust clinical experience, enhance outcomes, and bolster all hospital procedures to foster safe practice. The collaborators have taken a multi-disciplinary approach to the measurement, and is providing a linkage coordinator with the expectation to finding appropriate resources for the underserved to impact recidivism and compliance with after care. When processes are examined to determine opportunities for improvement, the activities of all disciplines are considered in a collaborative manner. The hospital leaders prioritize resources and staff energy on projects that have the greatest impact on patient outcomes. The funding and addition of a linkage coordinator will have true impact in an extremely underserved community by providing ongoing support from our community partners. Senior leadership has been assigned the responsibility of setting priorities for resource intensive improvements. The decisions made are based on objective criteria established by senior leadership.

Each criterion considered, to respect the desired objectivity, must be scored based on data. Departments requesting assistance with improvement efforts must accompany such requests with data so that senior leadership can carry out an effective priority-setting function. The hospital has adopted the FOCUS-PDCA method as its platform for the interpretation of collected data. Assessment activities carried out in the program include:

• Comparison of outcome and process data to ensure that the same level of care is provided regardless of geographic location in the hospital where the care is provided.

• Data assessment designed to produce actionable information, which serves to identify opportunities for improvement and to facilitate setting of priorities.

As stated, earlier Lake Behavioral Hospital has adopted a performance improvement model for carrying out this plan. Statistical monitoring and evaluation of key indicators that lead to discovering opportunities for improvement are conducted using the scientific methodology FOCUS –PDCA. Lake Behavioral Hospital has adopted a performance improvement model for carrying out this plan. FOCUS - PDCA is an extension of the Plan, Do, Check, Act (PCSA) cycle sometimes called the Deming or Shewhart cycle. It is a process improvement methodology to achieve Continuous Quality Improvement results. This model was adopted from similar models used in Six Sigma, The W. Edwards Deming Institute, and in Lean systems. The model is used by collecting data regarding the process using data collection tools such as a run chart or Pareto chart, or brainstorm and complete a flow diagram of what is the current procedure and determine where the defects are. We then focus on understanding the cause of process variation, using a cause and effect diagram to know why the process isn’t working effectively. If a new process is established, determine requirements. The team then selects the most appropriate solution keeping in mind the cost and difficulty of implementation. How the model is used: FOCUS-PDCA is an acronym that describes the basic components of the performance improvement process. It includes the following steps: FOCUS Find an opportunity to improve This could be determined by variation in data collection on key indicators and measures, or systematic identification of opportunities for improvement (OFIs). Organize a team who understands the process The team should consist of people directly involved in the process being improved. Clarify the current knowledge of the process Collect data regarding the process using data collection tools such as a run chart or Pareto chart, or brainstorm and complete a flow diagram of what is the current procedure, and determine where the defects are. Understand the cause of process variation Use a cause and effect diagram to know why the process isn’t working effectively. If a new process, determine requirements. Select the process improvement The team selects the most appropriate solution keeping in mind the cost and difficulty of

implementation. PDCA Plan the improvement Develop an action plan for how the process will be improved. Also data collection for monitoring the improvement and change is planned at this stage. Do the improvement Implement the improvement and change, first as a pilot on small scale. Check the results Evaluate the effect of the improvement and change through data collection and comparison with baseline data or data collected prior to the improvement. Act to hold the gain

Lake Behavioral Hospital supports an integrated approach and group effort for the provision of care and performance enhancement. Most performance improvement activities, therefore, are accomplished with a multi-disciplinary focus. The Medical Staff is integrated into these activities and takes an active role in the success of this program and assumes the position of oversight of all initiatives. While performance or process improvements are affected collaboratively, when practitioner related problems

are identified, the appropriate clinical or professional group is consulted for resolution, and/or peer reviews are to be performed.

The effectiveness of the provisions of this plan is monitored as part of the performance improvement activities surrounding the performance improvement function. The program is evaluated annually, and revisions made as necessary to ensure the ongoing and progressive improvement of care at Lake Behavioral Hospital and its community partner. This plan, its evaluation and any subsequent revisions must be approved by the Board of Directors.

Care Integration and Coordination

Our care integration and coordination will improve and guide the process of helping a person with mental illness to access range of services that may be necessary in a way that is effective and seamless, such that there will be improvement in outcomes. The relationship between the partners will create improved communication between the respective mental health professionals and thereby improve care coordination. The partners will initiate highly efficient referral mechanisms between them that will improve access, expedience of care, communication of clinical information and agreement to give preference to individuals managed within the system who would otherwise experience inequity and disparity. The development of his collaborative will benefit from the fact that Lake Behavioral Hospital and Lake County Health Department have had a close, effective working relationship, coordination and integration of services for over three years now. The services of the providers will also readily offer all levels of behavioral healthcare. These characteristics will combine the separate partners together into a more synchronous or coordinated unit and eliminate the more typical fragmented system of care that the behavioral health minority patient often faces. Simply put, the partners will collaboratively mange and coordinate the behavioral health services that each provide so that the people get the care they need, at the time they need it.

Access to Care

Access to care in our community will be improved by our well-coordinated, similarly prepared and educated group of partner organizations who will all provide easier, more responsive access points to an organized behavioral health treatment system that offers all levels of care. Prevention of recidivism will naturally occur with this more efficient transition through levels of care on the system. Treatment failures often occur during these transitions, as separate behavioral health organizations typically do not respond as well as an integrated system will.

Social Determinants of Health

As referenced above, providing access to equitable and affordable housing promotes residential stability and is one of the most critical social determinants of health. Housing is fundamental to physical, mental and social well-being and quality of life. Poor living conditions lead to increased stress, social isolation, an unhealthy and unsafe environment and increased risk of disease or injury. In donating the land and building the proposed multi-access housing adjacent to the facility, Lake Behavioral and its collaborators will be serving a critical community need. This social determinant (supportive and affordable housing), paired with access to nearby mental health services, will reduce homelessness and make a measurable impact on the quality of life and well being for all people and especially people of color.

Social determinants of health are the conditions , places and life circumstances under which people are born, grow up and physically and psychologically develop, play, socialize, learn and are educated in, and where they work; all of which will have an effect on a wide range of health risks and outcomes. The core of the numerous social determinants of behavioral health center around issues of racial discrimination and social exclusion, adverse early life experiences, poor education, unemployment or job insecurity, poverty, inadequate nutrition, neighborhood deprivation and poor housing quality. The etiologies of mental illness and substance abuse disorders are at least partially driven by social risk factors and subsequently, inequity of care is largely caused by some of the same factors.

Our proposal will address a relatively narrow, but critically important sector of these many social determinants that create the barriers. History cannot literally be changed, but the cultural preparation and education of our partnership will create a philosophy and organizational culture that will not exhibit racism and will consistently offer inclusion. The behavioral health treatment will be culturally sensitive to understanding and helping address some of the negative psychological consequences of many of these social determinants. If there is homelessness or housing instability our shelter partner will be available to resolve this. We will be able remediate the social determinants of poverty and lack of financial and other resources such as insurance by being able to offer services under this collaboration grant, regardless of funding. We will measure and evaluate our proposal’s impact upon these social determinants by tracking admission to care of unfunded patients, successful movement/ linkage through levels of care, treatment engagement in terms of continuity and length of treatment episode across levels of care, and length of stability in psychiatric illness at outpatient levels of care.

Budget

Grant Part I – Clinical Development and Operations

We are requesting the following funding for development, clinical operations and capital items:

** FULL BUDGET ATTACHED

Grant Part II – Equitable Housing (Pre-Development Funds Request)

For the equitable housing development, we are requesting capital funds to demolish the vacant buildings on campus. Without the funds from this grant, the housing development cannot move forward. The anticipated cost of the demolition is $6 million so we are submitting this cost as a capital request in addition to the clinical funding requests and EMR capital request in the budget.

Year 1 Year 2 Year 3Source Activity Funded Amount Amount Amount

Transformation Funds START UP AND OPERATIONS 10,054,377 11,880,378 12,471,999 State Capital Funds EMR 209,996 99,996 99,996 State Capital Funds OLD BUILDING DEMOLITION 6,000,000 PhilanthropyOther

Total Revenue 16,264,373 11,980,374 12,571,995

Milestones

The following graph indicates the implementation plan and timeframe:

Racial equity

Staffing

FTE

Leader

5/1

6/1 7/1

Project FTE needs CEO

start complete

Nursing Supervisors - ONGOING 4.2 start complete

RNs - 8.2 start complete

Clinical Staff - therapist 3 start complete

- case manager 3 start complete

- activity therapist 3 start complete

- group leader 2 start complete

- community linkage coordinator

6 start complete

Finance Review Pro Forma and Prepare Budget

CFO

start complete

Marketing/Business Dev

Update Detailed Competition Analysis & Summary

Dir BD start complete ongoing

Payor contracts - review Dir BO start complete ongoing

Marketing strategy Dir BD start complete ongoing

Develop News Release Ad Dir BD start complete ongoing

Update collateral materials Dir BD start complete ongoing

Website / Social Media start complete ongoing

Update with new partnership announcement

Dir BD

start complete ongoing

Operations

Determine opening services (will be2 existing units)

CEO start complete

Policies and Procedures - Updated for linkage program

SVP Clin / CEO / PIRI

start complete

Partner meetings to establish data metrics

CEO / PIRI start complete

The proposed equitable housing development addresses racial equity as a sustainable solution to residential stabilization. The housing development will offer housing to all groups of need, especially people of color.

Racial equity can be defined as both an outcome and a process. Very important to this project, we intend to achieve racial equity as an outcome by ensuring that race and socioeconomic status no longer determines limited access to effective care, by providing care as readily as to any other population. Funding through this project will remove one of the most significant racial equity barriers; the ability to pay. Purposefully increasing access specifically to groups of minorities also directly remedies this barrier. As a process we can increase racial equity by meaningfully involving those most impacted by structural racial inequity in the process of creating and implementing the policies and services that we deliver. Our community partners having minority management will contribute to the development of this process and Lake Behavioral will employ an executive director for this project who is African-American or Hispanic, as these racial groups comprise the majority of the patients we serve.

To address the fact that beyond access, racial and ethnic minorities tend to receive poorer quality care, we will implement additional staff training and development and a rigorous quality metric monitoring system along with assertive and continuous performance improvement change. The training we will design will help staff recognize and acknowledge that race and racism factor into healthcare, an acceptance that is a critical step in beginning to improve inequity. We will mount an effort to identify any implicit bias and structural racism in our own integrated system between the partners so that we may develop approaches that ameliorate their effects. We will address quality both in terms of the skill levels of the staff and training in the cultural challenges we must overcome in those groups served under this project. As briefly alluded to previously we will deliver treatment through evidence-based therapies. This in itself is corrective of the demonstrated inequity that compared to the white population, racial/ ethnic minority populations are often treated in poorly funded healthcare setting that are less likely to implement new treatments. Our standard will be the use of only evidence based treatments.

Generally speaking, equity simply means giving patients the care they need when they need it and that does not vary in quality based on any personal characteristics, whether gender, ethnicity, geography or socioeconomic status. Our project and partnerships will deliver this equity.

Minority Participation

The list of partner entities attached that will take part in the collaboration are nonprofit organizations. Lake itself, strives for diversity in its workforce and its current employee demographics include 29% African-American employees, 13% Hispanic employees, 9% Asian employees and .5% Native American/Pacific Islander employees. The partner organizations include African-Americans and Hispanics in their executive, director or managerial levels. Additionally, the collaborating partner organizations serve largely minority patients. Lake Behavioral also commits that this collaborative will subcontract with Business Enterprise (BEP) organizations to provide services to patients receiving care in this integrated system.

NIRCO, run by Dr. Mary Roberson, who is an African American Executive Director, will provide outpatient behavioral health services, either post-acute levels of care or as an entry point to care. NICASA, a longstanding behavioral health organization will also post-acute aftercare or may also be an

entry point for outpatient therapies, and they also have director level minority employees. Lake County Health Department is a county governmental organization that does include minority leadership in its metal health division. Live4Lali will also provide outpatient care under this collaboration but will also provide community education and prevention services. PADS will add the option of temporary shelter to patients being cared for in the collaborative effort who have no housing. Lake County United, an organization which is also inclusive of minorities in their leadership ranks, will provide the management of the demolition and housing construction project that will result in the availability of permanent housing to populations cared for under this collaboration. They will subsequently perform ongoing management of the housing component. Finally, although not a partnering organization, we have obtained the commitment of Dr. Nicholas Papanos and his medical group to subcontract and provide and integrate medical care into this collaboration.

Jobs

The Lake Behavioral / Lake County United equitable housing project will create hundreds of jobs that will be involved in the planning, development, construction, maintenance and operation of the housing development. Lake Behavioral Hospital current employees reside in a variety of communities, mainly local. The chart below identifies staff by position and home zip code:

14

7 52 1 2 1 1 1 3 1 1 1 1 1

910

1 1 1 1 1 1

12

3 1 2 2 16 5

16

1

12

3 3 1 25 5

24

8

16

19

1 1 1 1 1 1 2 2 2 2 2 2 1 105

1015202530

5310

5

5314

2

5314

4

5315

8

5320

8

6000

2

6001

3

6001

8

6003

0

6003

3

6004

0

6004

2

6004

6

6005

0

6005

3

6006

0

6006

2

6007

1

6007

4

6007

7

6008

3

6008

5

6008

9

6009

9

6011

5

6013

1

6061

3

6062

0

6063

0

6065

6

6110

3

Staff By Zip Code

213

3 4 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 4 2 1 1

53

81 1 1 1 2

16

2

50

1 5 71 4

0102030405060

Staff By Position

Total

Within the proposed program, we anticipate the hiring of: 1 executive director 8 full time registered nurses 3 per diem registered nurses 14 full time mental health technicians 4 per diem mental health technicians 3 clinicians 2 recreational therapists 5 linkage case managers The linkage case managers are a key element in accomplishing the tight integration of services in this collaborative through their connecting, navigating and monitoring the patients’ engagement in care. This role reflects one of the critical driving factors in the grant, and will help us attain true integration of this system of behavioral healthcare.

The retraining and development of current staff and new staff will include a collaborative orientation and training program with partnering agencies. A training series with topics including ethics, cultural diversity, social justice and racial equality will be offered to all staff, new and current. Community partners will be encouraged to attend the training series in order to develop tools for their own organizations that promote equality in service accessibility and delivery to members within our community.

Sustainability

The equitable housing development will be sustainable and a permanent resource for the community. Once the demolition is complete, the equitable housing development project will be funded through a combination of other sources of capital, including tax credits and grants from other areas/organizations.

Regarding the clinical behavioral healthcare sustainability, our management team has over 30 years of experience in the development of hospitals and programs. Through the development of resources for the clients served in this program, such as gaining funding for the central group of unfunded, the services delivered in the collaborative care organizations should subsequently be reimbursed by insurances they will be assisted in securing (e.g. Medicaid). Organizations in this collaboration will additionally continue to search for further funding sources and grants to sustain the programs and services. As the system matures over the course of the grant, we will strive to create efficiencies such that we may deliver the same quality care at less cost.

Governance Structure

Lake Behavioral will be the main organization responsible for the funds associated with the grant. We will coordinate with all partners for participation in our collective mission and goals.