Performance Details

Department of Revenue - Mental Health Trust Operations

• Return to Departments
• Department of Revenue website

Mission

The mission of the Alaska Mental Health Trust Authority is to administer the Alaska Mental Health Trust as a perpetual trust and to ensure a comprehensive and integrated mental health program to improve the lives of beneficiaries.

Core Services

• Spend Trust income to improve the lives and circumstances of Trust beneficiaries.
• Provide leadership in advocacy and planning around beneficiary related issues.
• Manage Trust cash and non-cash assets.
• Ensure funding of a comprehensive integrated mental health program.

Mission Results	Core Services
A: Beneficiary Quality of Life: Increase quality of life for Trust beneficiaries through Trust funding and partnering.  Details >	A1: Spend Trust income to improve the lives and circumstances of Trust beneficiaries.  Details > TARGET #1: Report annually the total number of funded grants. TARGET #2: Report annually the total number of beneficiaries and family members served. TARGET #3: 60% of direct service projects will provide direct beneficiary improvement information.
Mission Results	Core Services
B: Systems Change: Create change in the beneficiary service system lasting beyond temporary Trust interventions and resources.  Details >	B1: Provide leadership in advocacy and planning around beneficiary related issues.  Details > TARGET #1: Report major system changes related to beneficiaries in each focus area that are likely to continue beyond Trust funding.
Mission Results	Core Services
C: Cash & AMP; Non-cash Asset Development: Maximize payout in perpetuity.  Details >	C1: Manage Trust cash and non-cash assets.  Details > TARGET #1: Report annual payout rate and maintain reserve balances @ 400% of payout to ensure beneficiary services despite market variations.
Mission Results	Core Services
D: Fulfill Mission: Ensure the Trust's mission is fulfilled via strong stakeholder relations and efficient use of funds.  Details >	D1: Ensure funding of a comprehensive integrated mental health program.  Details > TARGET #1: Report Trust administrative overhead as a % of total expended income. TARGET #2: Report the percentage of Trust grant agreements processed in less than 30 days.

Performance Detail

Target #1: Report annually the total number of funded grants. Total Number of Trust Funded Grants Fiscal Year # Funded Grants FY 2020 235 +11.37% FY 2019 211 +17.88% FY 2018 179 -9.6% FY 2017 198 +2.06% FY 2016 194 -5.37% Analysis of results and challenges: In FY2020 there were 235 Mental Health Trust Authority Authorized Receipt (MHTAAR) and Authority Grants awarded. For comparison, there were 211 awarded in FY19, 179 in FY18, 198 in FY17 and 194 in FY16. There was an increase in number of grants awarded from FY19 to FY20. The number of MHTAAR and Authority grants awarded overtime will vary depending upon initiatives and proposals received, or the numbers of projects transitioned from MHTAAR funding to GF/MH. The overall number is within expected ranges over time.

Target #3: 60% of direct service projects will provide direct beneficiary improvement information. % Direct Service Projects Reporting Outcomes Fiscal Year Authority Grants MHTAAR FY 2019 100 +2.35% 100 0% FY 2018 97.7 +14.94% 100 +9.89% FY 2017 85 -7.41% 91 -9% FY 2016 91.8 +4.32% 100 +30.04% FY 2015 88 +6.02% 76.9 +15.29% Analysis of results and challenges: Trust authority grant projects may be awarded in a fiscal year, however they may not end in that same fiscal year, or grant data may not be available until well after the reporting deadline. The analyses for this measure is based upon the best available data. This is typically from projects that ended in the fiscal year prior to the current OMB reporting period. Out of the 176 projects that ended in FY 2019, 46 were categorized as Direct Service projects. Of these 46 projects (37 Authority Grants + 9 MHTAAR projects), 37 (100%) Authority Grant projects and 9 (100%) MHTAAR projects reported direct beneficiary improvements in quality of life. The percentage reporting improvements to beneficiaries' quality of life for grants that ended in FY 2019 was slightly higher than the percentage reported for FY 2018 for Authority Grants and the same for MHTAAR projects. As part of the grant agreement, performance measures are developed to assess the impact and overall success of each project. For all direct service projects, performance measures are included that request the grantee demonstrate and report beneficiary impacts on quality of life that occurred because of their participation in the project. Though we have obtained 100% compliance from our grantees in the reporting of quality of life outcomes, we will continue to encourage the inclusion of both qualitative and quantitative data that demonstrate beneficiary improvements in quality of life through participation in Trust funded projects.

Target #1: Report major system changes related to beneficiaries in each focus area that are likely to continue beyond Trust funding. Number of systems changes likely to continue beyond Trust funding Fiscal Year # System Changes FY 2020 15 +15.38% FY 2019 13 -7.14% FY 2018 14 +27.27% FY 2017 11 -31.25% FY 2016 16 -5.88% Analysis of results and challenges: In FY20 the Trust, as an active participant, facilitator, or funder, engaged in or supported significant systems change related activities. In FY20, the COVID-19 pandemic has impacted a number of systems, and systems improvement activities, related to Trust beneficiaries. For many of our partners and collaborators, resources and priorities have changed or been targeted at responding to the emergency. Despite the challenges of the pandemic emergency, the Trust was successful at advocating for systems changes. FY2020 Systems changes reported: Non-Focus Area Related Systems Change - Comprehensive Integrated Mental Health Program Plan 1. The Trust, in collaboration with the Department of Health & Social Services (DHSS), Statutory Advisory boards, and key partners, developed and implemented the Comprehensive Integrated Mental Health Program plan. Systems changes include building a network of departmental and division based data indicator workgroups, formatting the Comp Plan scorecard using the Results Based Accountability framework. The revised Alaska Scorecard tracking the Comp Plan will be published in Spring FY21. 2. There was a position created within DHSS - Division of Public Health focused on project management and monitoring of the Comp Plan. Non-Focus Area Related Systems Change - Medicaid Reform 3. 1115 Behavioral Health Waiver: The Trust's financial investment in, and staff collaboration with, the DHSS' Medicaid reform efforts resulted in the Centers for Medicare and Medicaid Services (CMS) approval of the substance use disorder (SUD) and the behavioral health components of the Section 1115 Behavioral Health demonstration waiver. The Trust, working with partners, provided formal public comment on proposed regulations. The Department of Health and Social Services will implement the behavioral health 1115 related regulations in FY21. Non-Focus Area Related Systems Change - Behavioral Health 4. Alaska Suicide Prevention Council - The Trust worked with the Alaska Suicide Prevention Council, Senator Kawasaki and key stakeholders to introduce Senate Bill 10, which asked the legislature to extend the life of the Council through 2027. This is strategic for Trust beneficiaries as the Council is the only statewide advocacy and awareness group that can advise the Governor and Legislature on suicide prevention matters within the state. This bill was signed into law. 5. Licensed Marriage and Family Therapists and Licensed Professional Counselors - The Trust worked with stakeholders, advisory boards, and the legislature to increase access to care through the development and implementation of statutes and regulations related to Licensed Marriage & Family Therapists and Licensed Professional Counselors. Non-Focus Area Related Systems Change - Workforce Development 6. The Trust worked with the DHSS, the SHARP Council and Senator Wilson on introducing Senate bill 93 which expanded the current SHARP 1 student loan repayment program to include more service areas and healthcare positions around the state. One of the best recruitment and retention tools is offering student loan repayment contracts for health care professionals in organizations that serve at least 30% Trust beneficiaries. This bill was signed into law. Non-Focus Area Related Systems Change - Early Childhood Intervention and Prevention 7. Early Childhood Service System Governance - The Trust is a key participant in an early childhood governance workgroup was initiated in spring 2020, that is expected to continue on into future fiscal years. The work was initiated in response to broad stakeholder recognition that a governance structure with greater authority would be more effective for early intervention systems to positively impact lifelong health and wellbeing of Alaska children and families. The group is being guided by expert consultation from the National Center on Early Childhood Quality with public-private partners in lead roles, including the Trust, the DHSS, and the All Alaska Pediatric Partnership. Focus Area - Beneficiary Employment and Engagement 8. Peer Support Workforce - The Trust, the DHSS and statewide partners continued work from previous years to design and develop a sustainable system of professional development and credentialing for peer support workers. Peer support workers provide key recovery supports for people with behavioral health needs and offer the unique lens and skills developed through their own lived experience. The Alaska Commission on Behavioral Health Certification was identified as the contract agency to lead and implement peer support certification. Multiple options for training and professional development are being developed to ensure a high level of quality and access for peer support workers statewide. The Trust continues to be a primary funding and advocacy partner in this systems effort. 9. Empowerment Through Employment - The Trust and advisory board leadership facilitated and worked closely with DHSS, DOL, DEED, UAA and many other partners to foster a cross-departmental effort for systems change related to disability employment. A resource guide 2020 Empowerment Through Employment was developed and will be used to continuously promote competitive integrated employment as a key priority for the State of Alaska and partner agencies. Focus Area - Housing and Long Term Services and Support 10. The Trust continued to fund Housing and Homeless Service Coordinators for two communities in Alaska; Juneau and Fairbanks. The partnership with the municipalities and city boroughs is to coordinate local housing and homeless services that assist persons experiencing homelessness in these core communities that experience the highest rates of homelessness in our state by coordinating the communities housing resources and social service programs to end the problems related to homelessness. Funding analysis, reduction of impediments to fair housing, elimination of barriers, coordinated emergency services and housing and community project development are all strategies to for better coordination between services and prioritization of resources to the most vulnerable. 11. The Trust provided partner funding in collaboration with the DHSS to implement a state level Intellectual and Developmental Disability (IDD) program survey, the National Core Indicators. In FY20, the in-person survey was initiated with people receiving IDD services to evaluate quality and impact of those services from their perspective. The survey results will be used to adjust services and supports to meet the needs of persons experiencing an IDD. This is expected to continue into the future. Focus Area - Disability Justice 12. The Alaska Justice Information Center (AJiC) is a partnership between the Trust and the University of Alaska Anchorage. The mission of AJiC is to compile, analyze, and report on criminal justice topics to policy makers and practitioners in order to improve public safety, to increase criminal justice system accountability, and to reduce recidivism. AJiC continued to formalize new relationships with justice related organizations and stakeholders to further the development of its integrated data platform to provide timely criminal justice related information to policy makers and collaborate with criminal justice partners. These relationships allowed for data and reports on issues such as officer involved shootings in Alaska, use of force by Alaska police officers, and beneficiary focused dashboards for the Department of Corrections. 13. Trust staff worked with the Alaska Police Standards Council (APSC) to help them adopt a policy that endorses and certifies the Memphis Crisis Intervention Team (CIT) Model as the CIT model to be taught and practiced by law enforcement agencies in Alaska. The policy adopted included a certification process for Alaskan CIT instructors. This will ensure Alaska law enforcement agencies will utilize and adhere to an evidence based model, and will complement the efforts to improve the psychiatric crisis care continuum through the implementation of the Crisis Now model and a coordinated community crisis system of services. Focus Area - Substance Abuse Prevention and Treatment Focus Area - Behavioral Health 14. Behavioral health crisis stabilization - The Trust, in partnership with the DHSS, continued to explore opportunities to improve the crisis response system in Alaska. Early in FY20, the Trust contracted with RI International, a consulting and service provider of crisis stabilization programs in Arizona, to complete stakeholder engagement and community assessments of the crisis response systems in Anchorage, Mat-Su Valley and Fairbanks. This work culminated in the Crisis Now Consultation Report, RI International, December 2019. The report includes 13 broad system and policy recommendations necessary for implementation of the Crisis Now model in Alaska. In March, 2020, the Trust secured contractual support to provide project management oversight to assist with organization and facilitation of the work plan and the various workgroups working on the Crisis Now initiative continuing to work on implementation into FY21. 15. As part of the Behavioral Health crisis stabilization work, the Trust's collaboration with legislators, DHSS, and community partners assisted in the passing of Senate Bill 120, an act relating to the establishment of alternatives to arrest procedures for individuals experiencing acute behavioral health crisis, emergency detention for mental health evaluation, and the administration of psychotropic medications to a patient without their informed consent, and the licensure of crisis stabilization centers.

Target #1: Report annual payout rate and maintain reserve balances @ 400% of payout to ensure beneficiary services despite market variations. Budget Reserve Balance (as % total payout) at Year End Fiscal Year % of Payout FY 2020 651% FY 2019 698% FY 2018 933% FY 2017 922% FY 2016 648% Analysis of results and challenges: The Trust maintains a target distribution of 4.25% of the four-year average from fiscal year-end Trust Mental Health Trust Fund principal and reserve accounts' asset values. In FY20, the distribution was $23,056,600, calculated from the average of FY16 through FY19 fund assets. The Trust's budget reserves at the end of FY20 were 651% of the FY20 payout. Although lower than anticipated for FY20, it is above the 400% target. During the 4th quarter of FY20, uncertainty regarding the impact of COVID-19 on the global economy increased investment assets' price volatility, resulting in a decline and then partial recovery of the value of Trust reserves. The methodology for calculating was revised for historical consistency, and prior year reserves have been restated to be consistent with historical calculations. Based on future expectations for reserves, the Board of Trustees may authorize reserves above the 400% target to be used to inflation proof the Mental Health Trust Fund

Target #1: Report Trust administrative overhead as a % of total expended income. Trust Admin as % of Total Funding Available Fiscal Year % of Total Funding Trust Admin Expense Total Funds Available FY 2020 11.3% $3,615,300 $31,875,600 FY 2019 13.7% $4,135,000 $30,008,400 FY 2018 13.4% $3,899.000 $28,908,000 FY 2017 12.3% $3,473,000 $28,234,000 FY 2016 11.8% $3,468,200 $29,421,000 FY 2015 12.1% $3,456,700 $28,497,000 Analysis of results and challenges: The Trust Authority administrative overhead for FY20 was 11.3% of the total available funds for the fiscal year. FY20 administrative overhead was expected to remain stable relative to FY19. This 2.4 percentage point reduction compared to FY19 was primarily due to staff vacancies and the impact of COVID-19 travel restrictions that reduced in-person activities. Expectations are that activities and services that advance the Trust's programming, planning and grant goals will return to stable levels.

Target #2: Report the percentage of Trust grant agreements processed in less than 30 days. % Trust grant agreements processed in < 30 days Year % < 30 days 2020 100% 2019 99.5% 2018 98.3% 2017 94.3% 2016 91.2% Analysis of results and challenges: Approximately 235 Authority Grant agreements were completed and executed in FY20, of which 100% of the projects executed within the 30-day target. For FY20, the percentage of projects completed and executed in under 30 days after approval increased when compared to FY19, and previous years. Trust grants staff engage in on-going process improvement activities to streamline the grants administration process to reduce any barriers to timely execution. In exploring the root cause of the delay, the variation in percentage of grant agreements processed from year to year continues is attributed to the readiness of grantees to initiate their projects after Trustee approval.

Current as of October 12, 2020