Performance Details

Department of Revenue - Mental Health Trust Operations

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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 & 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 agency expenditures as a % of total approved funding. 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 2021 197 -16.17% FY 2020 235 +11.37% FY 2019 211 +17.88% FY 2018 179 -9.6% FY 2017 198 +2.06% Analysis of results and challenges: In FY21 there were 197 Mental Health Trust Authority Authorized Receipt (MHTAAR) and Authority Grants awarded. There was a decrease in number of grants awarded from FY20 to FY21. The number of MHTAAR and Authority grants awarded overtime will vary depending upon initiatives and proposals received, the funded amounts of individual grants, or the number of funded projects that transitioned to other funding sources. The overall number in FY21 is within expected ranges over time.

Target #2: Report annually the total number of beneficiaries and family members served. Funded Trust Projects with Services to Beneficiaries Fiscal Year # Total Served # Beneficiaries # Outreach/Educ # Professionals Trained FY 2020 147,105 +18.04% 51,159 -5.88% 79,774 +40.49% 16,172 +19.92% FY 2019 124,625 +57.49% 54,357 +107.75% 56,782 +46.47% 13,486 -5.03% FY 2018 79,132 +19.56% 26,164 -13.01% 38,767 +62.55% 14,201 +15.85% FY 2017 66,185 -58.18% 30,078 -14.67% 23,849 -77.45% 12,258 -28.87% FY 2016 158,253 35,247 105,772 17,234 Analysis of results and challenges: Data for FY20 is presented in this table, because at the time of this report FY21 data had not been fully collected and analyzed. FY21 data will be presented next year. For Trust projects that ended during FY20, 51,159 beneficiaries and family members were served or impacted through MHTAAR and Authority Grant projects. This is an 5.89% decrease from FY19, when 54,357 beneficiaries and family members were served or impacted through Trust projects. Additionally, there was a 40.49% increase in the number of individuals impacted through outreach and/or education projects; from 56,782 individuals during FY19 to 79,774 impacted during FY20. For the most part, two projects can be attributed to the large increase in outreach and/or education numbers, all of which have components of both. Sultana’s Recover Alaska works to reduce the stigma associated with alcohol misuse through positive messaging and outreach programs. Over the course of FY20, approximately 30,000 individuals across Alaska were impacted through the program’s outreach efforts via radio ads, brochures, and a well-designed interactive website. Trust funds for the Anchorage School District’s Suicide Awareness and Prevention project helped to procure promotional, educational, and training materials on suicide prevention to distribute to schools around the district. Approximately 11,000 school children were targeted for outreach with this project. Also noteworthy was the moderate increase (19.92%) in the number of individuals trained; from 13,486 individuals in FY19 to 16,172 during FY20. Although there were several projects that contributed to the increase, the most significant was The Anchorage School District’s Suicide Awareness and Prevention project. This project trained 1,345 school counselors and staff in the Question, Prevent, Response (QPR) suicide awareness and prevention model. When comparing these numbers, it is important to note that the number of grants and types of projects that are funded vary from year to year, thus contributing to the variance in the number of individuals served. In total, 147,105 individuals received some type of training, service, and/or were impacted as a result of the Trust’s efforts through projects that ended in FY20: an overall increase of 18.04% from FY19. These figures may also include duplicated counts.

Target #3: 60% of direct service projects will provide direct beneficiary improvement information. % Direct Service Projects Reporting Outcomes Fiscal Year Authority Grants MHTAAR FY 2020 100 0% 100 0% 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% Analysis of results and challenges: Data for FY20 is presented in this table, because at the time of this report FY21 data had not been fully collected and analyzed. FY21 data will be presented next year. Out of the 169 projects that ended in FY20, 49 were categorized as Direct Service projects. Of these 49 projects (40 Authority Grants + 9 MHTAAR projects), 49 (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 FY20 was the same as the percentage reported for FY19 for both Authority Grants and 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 2021 11 -26.67% FY 2020 15 +15.38% FY 2019 13 -7.14% FY 2018 14 +27.27% FY 2017 11 -31.25% Analysis of results and challenges: In FY2021 the Trust, as an active participant, facilitator, or funder, engaged in or supported significant systems change related activities. In FY21, the COVID-19 pandemic continued to impact 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, Alaska Scorecard 1. The Trust and Department of Health & Social Services (DHSS) worked together with partners across Alaska to develop new partnerships and significantly overhaul the Alaska Scorecard which was published in May of 2021. The new scorecard includes both new indicators and new narratives that are consistent with goals set forth in Comprehensive Integrated Mental Health Program Plan: Strengthening the System that define a health care system that provides a full continuum of prevention, treatment, and support services to Trust beneficiaries in Alaska. Non-Focus Area Related Systems Change - Workforce Development 2. The Alaska Department of Health and Social Services, in conjunction with the support and advocacy leadership of the Trust, opened the SHARP-3 option on 01-04-21. The intent of the SHARP-3 is to increase the availability of health care services throughout the state, and especially to individuals, who are underserved, or in health care professional shortage areas or in rural locales. The SHARP Council began a sub-committee of five members who will review new SHARP 3 contracts monthly, which provides the program with more expediency in getting practitioners on boarded with agencies around the state. There were 60 contracts approved for service between January to June of 2021. Non-Focus Area Related Systems Change – Early Childhood Intervention and Prevention 3. A new partnership between The Trust and the Alaska Association for Infant Mental health (AK-AIMH), and the University of Alaska Anchorage - Alaska Training Cooperative has resulted in new systems to improve access to high quality infant and early childhood mental health training for Alaska professionals. “Project Compass” builds Alaska's capacity to deliver Infant and Early Childhood Mental Health (IECMH) services by increasing workforce capacity to serve beneficiaries ages birth to five years old who experience mental health challenges and mitigate impact of trauma and adverse childhood experiences. Going forward, Project Compass will continue to provide statewide access to trauma-informed, competency-based training specific to Alaska's needs; build and maintain a Collaborative Team to design a Comprehensive Workforce Development Plan and mobilize resources to implement the Plan. Focus Area - Beneficiary Employment and Engagement 4. The Beneficiary Employment Policy Initiative implemented the Work Matters Task force. Led by the Trust, Department of Labor, Division of Vocational Rehabilitation, statutory advisory boards, and a diverse stakeholder group, the task force will focus on improving statewide systems to better support employment outcomes for people with disabilities. A report will be developed going forward that will help the State of Alaska improve employment outcomes for Alaskans with disabilities. 5. The Peer Support Specialist certification project led by the Trust and the Department of Health & Social Services - Division of Behavioral Health and the Alaska Commission for Behavioral Health Certification launched their enrollment and certification process in January of 2021. Informational webinars have been held to inform community members and agency staff around the state on how to become certified. This project will help meet Alaska’s behavioral health workforce demands by supporting individuals with lived experience become a valuable part of the behavioral health workforce. Focus Area – Housing and Home & Community Based Services 6. The Trust continued to fund Housing and Homeless Service Coordinators for two communities in Alaska; Juneau and Fairbanks and added a third in Kotzebue through funding to AHFC. The partnership with the municipalities, tribal organizations, and city boroughs coordinates local housing and homeless services to assist persons experiencing homelessness in these core communities which experience the highest rates of homelessness in Alaska. 7. The Trust provided partner funding in collaboration with DHSS to implement a state level Intellectual and Developmental Disability (IDD) program survey, the National Core Indicators. The work on the in-person survey continued 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. 8. The Trust funded the strategic plan “A Call for Action: Alaska’s 10-Year Map to Address Alzheimer’s Disease and Related Dementia”. The core planning team included state, tribal, non-profit and community members representing areas across the State of Alaska. Six goals were established to frame the next ten years of work to improve the system of care for people with Alzheimer’s Disease and Related Dementia. After this plan was issued, a Dementia Action Collaborative formed to begin planning the work needed to achieve these goals. The collaborative has a steering committee established and is in the process of identifying committees, a regular meeting schedule, and the workplan for the first year. Focus Area – Mental Health and Addiction Intervention 9. The Trust, DHSS, and additional community partners have moved into the implementation phase of a behavioral health crisis response continuum of care in Fairbanks, Mat-Su Valley, Anchorage, and Juneau. This first phase of the process has involved funding from the Trust for operational support with Careline (statewide call center), mobile crisis team launch in Fairbanks, crisis stabilization staffing coordination (Fairbanks, Mat-Su, and Anchorage), and 23-hour stabilization centers (Anchorage). 10. As part of the behavioral health crisis response work, the Trust has collaborated with DHSS on legislation that will enhance access to care through crisis stabilization centers. The legislation is SB 124/HB 172, titled Mental Health Facilities and Meds. 11. The Trust made significant investments for the development of adult residential mental health treatment, and substance abuse treatment services in the Anchorage and Fairbanks regions. This addresses significant gaps in the continuum of care for adult beneficiaries by adding up to 16 treatment beds for adults experiencing mental illness or co-occurring disorders in Fairbanks, and up to 20-36 substance use related treatment beds in Anchorage.

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 2021 403% FY 2020 484% FY 2019 478% FY 2018 747% FY 2017 731% Analysis of results and challenges: Trust reserves are restated from prior years’ reports. Earnings reported in Reserves now exclude unrealized gains(losses) attributed to principal. Per AS 37.13.140, this aligns with APFC’s method used to calculate net income. To support spending for beneficiary services, the Trust draws its revenue from its Mental Health Trust earnings reserve accounts. The amount to withdraw is based on a four-year average of the year-end asset value of the Mental Health Trust principal and earnings accounts. 4.25% of that average is withdrawn. The FY21 percent of market value (POMV) distribution was $24,157,100, calculated from the average of FY17 through FY20 year-end fund assets. To ensure sufficient funds are available to help support beneficiary needs should financial markets suffer a significant and prolonged decline, the Trust targets an earnings reserve balance of four times its current fiscal year’s POMV distribution. At the end of FY21, the Trust’s available reserves met that 400% target. Strong earnings in Trust funds managed by Alaska Permanent Fund Corporation and the Department of Revenue enabled Trustees to commit funds to inflation proofing the Trust’s principal. $50 million was transferred from reserves to principal during the fiscal year, with a commitment to transfer additional reserves, yet still maintain the 400% target balance. That obligated amount to further inflation proof was $26.3MM, leaving a balance of $96.6MM in available reserves.

Target #1: Report Trust agency expenditures as a % of total approved funding. Trust Admin as % of Total Funding Available Fiscal Year % of Total Funding Trust Agency Expense Total Approved Funding FY 2021 11.34% $3,703,896 $32,668,100 FY 2020 10.67% $3,495,872 $32,771,500 FY 2019 12.00% $3,532,732 $29,437,600 FY 2018 11.28% $3,262,108 $28,908,000 FY 2017 11.55% $3,286,076 $28,458,800 Analysis of results and challenges: The Trust Authority monitors its direct deployment of resources for beneficiary support and its agency work on mental health policy, planning and administration of the Trust. This metric has been revised to measure total agency expenditures occurring over the fiscal year relative to the total approved Trust Authority budget. The Trust Authority’s FY21 agency expenses were 11.34% of the total FY21 budget authorized to support Trust activities. Due to the impact of COVID-19 restrictions that significantly reduced in-person activities, and the agency expenditure was 12% below projections. It is expected that when the impacts of the COVID-19 pandemic lessen, activities and services that advance the Trust’s programming, planning and grant goals will return to a stable level.

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 2021 98.9% 2020 100% 2019 99.5% 2018 98.3% 2017 94.3% Analysis of results and challenges: Approximately 197 Authority Grant agreements were completed and executed in FY21, of which 98.9% (195) of the projects executed within the 30-day target. For FY21, the percentage of projects completed and executed in under 30 days after approval decreased slightly when compared to FY20, and previous years. This slight decrease is within expected range of variation. 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 11, 2021