Dallas County Behavioral Health Leadership Team Thursday ...

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Dallas County Behavioral Health Leadership Team
Thursday, August 9, 2012
Henry Wade Juvenile Justice Center
2600 Lone Star Drive, Dallas, TX
Room 203‐A at 9:30 ‐11:30 a.m.
I. Welcome and Call to Order
II. Review/ Approval of Minutes from last meeting
III. BHLT Leadership, Membership and Staff Support
IV. 1115 Waiver, DSRIP Proposals, and Sources for IGT Match
V. MOU for Dallas County NorthSTAR Matching Funds
VI. Update on Parkland’s Performance Improvement and Impact on Service
Delivery
VII. Recommendations for BHLT Action
� Designating BHLT Representative to The Behavioral Health Committee
(12‐Cities Project)
VIII. Reports from and Charges to BHLT Committees
IX. NTBHA Update
X. Update on Pending Issues
� The Bridge’s protocol for accessing shared guests
� VO Report on ICM Program Outcomes
� City of Dallas Boarding Home Regulations
XI. Public Comments
XII. Adjournment

Dallas County Behavioral Health Leadership Team
Meeting Notes
Thursday, June 14, 2012
Welcome and Call to Order, Commissioner Price:
The meeting was called to order by Commissioner John Wiley Price at 9:31 AM.
Review/Approval of Minutes:
The minutes from the BHLT meeting held on May 17, 2012 were made a part of the
packet. There was a motion made to accept the minutes as printed. The motion was
seconded and approved.
Performance Improvement Process Report:
Dr. Balfour began her performance improvement report by introducing an ICM case of a
39 year old woman who has made enormous progress since forming a strong
relationship with her outpatient therapist. Her main goal is to learn how to deal with the
severe trauma she experienced as a child and move on with her life. Her father was in
the military, which resulted in the family having to frequently relocate. This young lady’s
mother also struggled with her own mental illness. Her mother suffered with
Munchausen by Proxy, and would force her to consume all sorts of horrible substances
in order to make her sick. As a result of this treatment she is to this day very cautious
and suspicious about her medications, often resisted medication changes for fear of
being “a guinea pig.” Like many trauma survivors, she struggles with being able to
control her intense emotions and frequently ends up in the ER after cutting or stabbing
herself. She has had a near fatal suicide attempt, she experiences episodes of mania
with psychosis, and has gone days without eating or sleeping. Along with experiencing
flashbacks, she has episodes where she speaks incoherently; talking about satanic
rituals, dead bodies, and delusional beliefs that she is a mass murderer expressing
homicidal ideations towards her parents.
Despite all of this, she has been making progress. She has successfully overcome her
addiction to cocaine and has been clean for 3 years. She lives with a friend who is her
major source of support. Her current goal is to overcome her past trauma. She was
referred to ACT and connected to a therapist there. She has been going to groups three
times a week, and individual DBT weekly. She has made significant progress and
formed a strong therapeutic relationship with her therapist. This year she has been able
to stay out of the hospital 3 months at a time, a great improvement from her previous
pattern of monthly admissions. The biggest challenge now is helping her to cope with the
loss of her current therapist who has left the clinic, and smoothly transition to a new
therapist. Needless to say this has been a significant loss for her, but the team is
encouraged by her progress that she will successfully overcome this obstacle.
Ron Stretcher asked if after focusing on this Top 200 have there been any lessons
learned. Dr. Balfour stated that forming of relationships with the clients has been very
helpful, but trauma is an area that is not covered by ValueOptions (VO) but is a very
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Behavioral Health Leadership Team
Minutes from June 14, 2012
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popular area of concern. Commissioner Price inquired as to how many of the top 200
have been surveyed. Dr. Balfour stated that although she cannot give an exact number,
the ICM team is working with about 60 clients at any given time. Eric Hunter with VO
stated that they are working on preparing a report.
Dr. Balfour continued her report with an announcement from Parkland Hospital. She
reported that remodeling has commenced to expand the ER area. The plan is to utilize
the inpatient unit to relocate some of the ER patients during the construction. There will
be a notification going out to the various hospitals in regard to this construction.
Update on the 1115 Waiver and Endorsement of DSRIP Proposals:
Dr. Balfour reported that the proposal discussed last meeting is in the packet for today’s
meeting. She reported that ACOT prioritized them, and the DSRIP list has also been
circulated. She stated that there have been concerns that this report looks Parkland
centric. Commissioner Price asked if that is the consensus of the committee. Tom
Collins stated that his concern is, how it is being viewed and can NTBHA be the entity
that receives the funds to represent the entire behavioral health community.
Dr. Balfour continued by explaining that the State has a template in to which the
proposals and projects this group has identified will need to be transferred. She
suggested that ACOT be charged with preforming this task. Ron asked that VO be
included in all meetings and discussions around this subject. Alex Smith added that
there are still concerns about what entity will hold the money. He stated that any agency
could choose to be a part of the DSRIP process independently, but the desire is that this
be a collective collaboration. The consensus was that ACOT and FACT would meet to
put the proposals and projects into the State template. They will try to schedule the
meeting for June 20, 2012. The date of implementation is September 1, 2012.
City of Dallas Attorneys working on the Boarding Home Regulations:
City attorneys Adam McGough and Maureen Milligan updated the committee on the
efforts being made to develop regulations for local boarding homes. Adam McGough
reported that the main concern is establishing regulations to impact the treatment of
individuals who reside within these facilities. He stated that over the past two (2) years
HB 216 has allowed municipalities to license boarding home facilities. A boarding home
is defined as a facility with three or more unrelated individuals living together in one or
more buildings that require some degree of service beyond room and board. Mr.
McGough stated that by establishing regulations there could be an impact on residents
with disabilities and restrictions on where these facilities are located. The city wants to
tailor the regulations to the specific disability so as not to create a negative impact. The
briefing to the City Council is scheduled for June 20, 2012, and the vote is scheduled for
June 27 th .
The goal is to implement some ordinances in and above those in HB 216. Sec. 215.075
of the Texas Local Government Code will be used as enabling authority which gives
municipal authority to regulate occupation. This effort is not designed to license,
regulate, or permit State Licensed facilities such as assisted living nor will this be
regulated through zoning. Commissioner Price asked how many facilities are currently
being reviewed. Mr. McGough responded that there are about 300 homes and the worst
are usually transient. Although unable to give an exact number of residents, Mr.
McGough stated eight (8) could be used as a count per home.
There was significant discussion in regard to the homes that are deemed to be “bad”,
that offer substandard and/or poor care and engage in human exploitation. Judge Kristin
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Minutes from June 14, 2012
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Wade expressed some concerns about what type of restrictions or consequences will be
in place for violators and will there be a licensing fee. The response was that there will
be a licensing fee, but they are still in the preliminary phase so no formal assessment
has been done on these facilities. There will be some additional posting and other
actions that are within the model standards. Many other concerns and comments were
expressed and shared. Mr. McGough and Ms. Milligan also reported that part of the
request is to hire at least three additional code enforcement officers and case workers to
monitor these regulations and that this ordinance will be a work in progress. Everyone
was encouraged to direct all questions and input to the City Attorney’s Office.
Update on the Serial Inebriate Program (SIP) Pilot:
Dr. Melanie Lippmann introduced herself and referenced the handout included in the
packet on page 24. The handout outlined the pathway that would provide a course of
action to assist the serial inebriates that frequently utilize the City of Dallas’s City
Detention Center. Dr. Lippmann went through the pathway highlighting the opportunities
available to those who decide to participate in this pilot program such as detox services
through Homeward Bound, counseling, and transitional living. Ron added that the focus
population of the 20 participant pilot program would more than likely fit into NorthStar
criteria for detox services and intensive outpatient counseling (IOP). Dr. Lippmann stated
that unlike the program in San Diego the Dallas pilot would be more “carrot” than “stick”.
The carrot would be helping to provide permanent supportive housing for those who
successfully complete the pathway. Due to the local laws regarding public intoxication
cases there is not much legal “stick”. Ron stated that the funding for the detox and core
services should come from Northstar, but there may be some challenges with funding
the transitional living. There are still some factors to be worked out, but meetings of the
key stakeholders have been taking place and the pilot should be ready to begin soon.
Recommendations for BHLT Action: Current Status of the BHLT
Commissioner Price presented the background of the recommendation and asked the
committee as a whole if it believes there is still value in the BHLT, and is there still
investment in the BHLT continuing to meet. He stated that as the BHLT approaches the
two year mark, the time has come to assess the group’s impact on behavioral health
services and determine if changes in the process are merited. He added that over the
past several months’ interest and attendance in the workgroup meetings have appeared
to wane. Ron Stretcher added that this may be a good time to reevaluate the current
leadership. Commissioner Price agreed that there may need to be a new Parkland
Hospital representative in the absence of Josh Floren, but believes Dallas County’s
representative should remain. Discussion ensued in regard to the relevance of the BHLT
in regard to legislation representation, and having a voice at the table. There was also
much discussion concerning changing the focus of the charges to the workgroups so
that old issues are not being revisited repeatedly. Summer Frederick suggested having a
more task specific workgroup structure that focuses on issues like the 1115 Waiver,
health reform, legislative agenda items, and other relevant and pertinent issues that are
current priorities. There was also discussion about developing a staff resource for the
BHLT. After much discussion about how to restructure the workgroups to be more
effective, review of the BHLT Charter, and the relationship between the BHLT and
NTBHA, the consensus was to maintain the committee, restructure the workgroups, and
refine the agenda.
There was a motion to cancel the meeting in July. The motion was seconded and
approved.
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Behavioral Health Leadership Team
Minutes from June 14, 2012
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Reports from and Charges to BHLT Committees:
Committee Reports:
All committee reports were made a part of the packet for this meeting.
Update on Pending Issues:
Ron asked if Jay Dunn would provide the group with an update on the Bridge visitation
protocol in the August meeting.
Public Comments:
There were no additional comments from the public.
Adjournment:
A motion was made, seconded and approved to adjourn the meeting at 11:36 AM.
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Minutes from June 14, 2012
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Co-chairs � Josh Floren � Josh.Floren@phhs.org � Ron Stretcher �
Ron.Stretcher@dallascounty.org● Summer Frederick ● sfrederick@childrenandfamilies.org
To: Dallas County BHLT
From: Ron Stretcher and Summer Frederick
Date: August 7, 2012
Subject: BHLT Leadership and Membership
BHLT Leadership
Josh Floren has notified the BHLT via the memo included below that he is changing roles at
Parkland and will no longer serve on the BHLT.
From: Josh Floren [mailto:JOSH.FLOREN@phhs.org]
Sent: Wednesday, August 01, 2012 11:29 AM
To: Ron Stretcher; Margaret Balfour; Summer Frederick (summerfrederick@hotmail.com)
Cc: Sharon Phillips
Subject: New Parkland Appointee to the BHLT
As you have probably heard, I am moving into a new position at Parkland and Sharon Phillips will now have
responsibility for behavioral health at Parkland. Parkland would like to appoint Sharon as my replacement on
the BHLT. I have thoroughly enjoyed working with you and will continue to support the efforts of the BHLT in
my new role. Thanks
Dr. Adam Brenner, Vice-Chair of Education and Director of Residency Training for the
Department of Psychiatry at UT Southwestern, has indicated a willingness to serve as a cochair
for the BHLT. Dr. Brenner has been a member of the BHLT since its inception and brings
a wealth of knowledge and experience to the BHLT. A copy of his current curriculum vitae is
attached.
BHLT Membership
Most of us have worked with Sharon Phillips in her leadership role for community care and jail
health care for Parkland. Ms. Phillips has stepped into an increased role for behavioral health
for Parkland and is willing to replace Josh Floren on the BHLT.
Recommendation
It is recommended that the Dallas County BHLT approve Dr. Adam Brenner as Co-Chair and
Sharon Phillips as a BHLT member.
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www.DallasBHLT.org

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Adam M. Brenner, M.D.
Vice Chair for Education,
Director of Residency Training
Dept. of Psychiatry, The University of Texas Southwestern Medical Center
DATE PREPARED: August 1, 2012
1. Office Address: Dept of Psychiatry, 5323 Harry Hines Blvd, Dallas, TX 75390-9070
Email: adam.brenner@utsouthwestern.edu Phone: 214-648-7054
2. Place of Birth: New York City, NY
3. Citizenship: USA
4. Education:
1985 B.A., Magna Cum Laude Emory University
1990 Doctor of Medicine Harvard Medical School
5. Postgraduate Training:
1990-1991 PGY1 Rotating internship McLean Hospital/Mt.
Auburn Hospital/
Massachusetts General
Hospital
1991-1994 PGY2-4 Adult Psychiatry McLean Hospital
2000-2008 Candidate Adult Psychoanalysis Boston Psychoanalytic
Society and Institute
6. Academic Appointments:
1994-2006 Instructor in Psychiatry Harvard Medical School
(Application for promotion to Assistant Professor in process at time of departure)
2006-2009 Assistant Professor The University of Texas Southwestern Medical School
2009- Associate Professor The University of Texas Southwestern Medical School
7. Licensure and Certification:
1986 Massachusetts Medical License
1996 Board Certification in Adult Psychiatry, American Board of Psychiatry and Neurology;
Recertified in July 2006

2006 Texas Medical License
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2006 Recertification in Adult Psychiatry, American Board of Psychiatry and Neurology
2008 Certificate of Graduation as Psychoanalyst Boston Psychoanalytic Society and
Institute
8. Hospital and Clinic Appointments:
1993-1995 Psychopharmacologist Center for Mental Health and Retardation Services,
(Mental Retardation Clinic; Group Homes for
Mentally Ill)
1994-2000 Consulting Psychiatrist Andover-Newton School of Theology
1994-1999 Attending Psychiatrist Faulkner Hospital
1996-1998 Day Hospital Psychiatrist Faulkner Hospital
1998-2000 Consulting Psychiatrist Brandeis University Counseling Center
2000-2004 Chief Psychiatrist Brandeis University Counseling Center
2004-2006 Dir. of Training and Education Brigham and Women’s/Faulkner Hospitals
Dept. of Psychiatry
2006-2009 Associate Residency Training Director, The University of Texas Southwestern Medical
School, Dallas, TX
2006- Director of Medical Student Education in Psychiatry, The University of Texas
Southwestern Medical School, Dallas TX
2009- Director of Residency Training in Psychiatry,
2011- Vice Chair for Education, Department of Psychiatry, The University of Texas
Southwestern Medical Center, Dallas, Texas
9. Hospital Privileges:
1996-2006 Faulkner Hospital, 1153 Centre Street, Boston, MA 02130
2004-2006 Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115
2006- Parkland Memorial Hospital, Dallas, TX
10. Awards and Honors:
1996 Melvin Kayce Award for Excellence in Psychotherapy, McLean Hospital Residency

2005 Selected as participant - Harvard Medical School Leadership Development for Physicians
and Scientists. Nominated by Dept. Chair to apply for admission to program.
2008 Outstanding PGY3 Teacher of the Year, U T Southwestern Adult Psychiatry Residency
2008 Outstanding PGY4 Teacher of the Year, U T Southwestern Adult Psychiatry Residency
2009 Outstanding Teacher Award, presented by the MS1 class of U T Southwestern Medical
School
2009 Outstanding PGY3 Teacher of the Year, U T Southwestern Adult Psychiatry Residency
2011 The Friend of PsychSIGN Award (Psychiatry Student Interest Group Network),
presented at American Psychiatric Association meeting, May 2011
11. Memberships in Professional Societies:
1996-2006 Massachusetts Psychiatric Society
1996- American Psychiatric Association
2000- Boston Psychoanalytic Society and Institute
2004- American Association of Directors of Psychiatry Residency Training
2005- Association for Academic Psychiatry
2006- Dallas Psychoanalytic Center
2007- North Texas Society of Psychiatric Physicians
12. Local Appointed Leadership and Committee Positions:
Boston Psychoanalytic Society and Institute:
2002-2004 Candidates Council Chairperson
2004 Financial Planning Committee, Member
2005-2006 Ethics Committee, Candidate Representative
Dallas Psychoanalytic Center:
2006-2007 Program Committee, Member
2007-2009 Selection Committee, Member
2009- Board of Directors, Member
North Texas Society of Psychiatric Physicians
2008- Executive Council, Member
2009- Co-Chair, Legislative Affairs Committee
2010-2011 Chair, Constitution and By-Laws Committee
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Texas Society of Psychiatric Physicians
2011- Consultant to Members-In-Training Committee
Dallas County
2009-2010 Dallas County Commissioners Behavioral Health Redesign Task Force, Member
2010- Dallas County Behavioral Health Leadership Team (BHLT), Member representing U T
Southwestern Psychiatry Residency Training
Dallas NAMI
2010 Nominating Committee for the NAMI Dallas Board of Directors, Member
Mental Health America of Greater Dallas
2011- Board of Directors, Member
Center for Education and Research at Metrocare
2011- Advisory Committee
13. National Appointed Leadership and Committee Positions:
Association of Directors of Medical Student Education in Psychiatry (ADMSEP)
2008-2010 Membership/Communications Committee
American Association Directors of Psychiatry Residency Training (AADPRT)
2005-2006 Psychotherapy Task Force, Member
2007-2008 Assistant and Associate Training Director Guidelines Workgroup, Chair
2008-2009 Assistant/Associate Training Directors Caucus, Co-Leader
2010 -2011 RRC and Program Requirements Task Force, Member
2009 Nominating Committee, Member
2011- Co-Chair, Psychotherapy Committee
2011- Executive Committee, Member
American Psychoanalytic Association
2007- Committee on Medical Student Education, Member
2009-2011 American Psychoanalytic Association Fellowship Committee, Member
2011- Assistant Head, Education Department
American Board of Psychiatry and Neurology
2005-2007 Adult Psychiatry Boards Examiner
14. Presentations:
2005 Faculty Forum, BWH Dept of Psychiatry “The Place of Personal Psychotherapy in
Becoming a Psychiatrist”, September 19, 2005
2005 Case Presentation for Workshop: “Clinical Applications of the Work of Andre Green”,
Discussant: Gail Reed, PhD, Boston Psychoanalytic Society and Institute, September 24,
2005
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2007 Workshop Chair, AADPRT Annual Meeting, March 10 2007: “Is Personal
Psychotherapy Still Relevant to the Culture of Psychiatric Training in the 21st Century?”
2007 “Interdisciplinary and Longitudinal Integration During Clinical Training” at the
American Psychiatric Association Annual Meeting, as part of a symposium on
"Challenges and New Developments in the Psychiatric Education of Medical Students”.
2007 “Teaching Bipolar Disorder to Medical Students”, UTSouthwestern Department of
Psychiatry, Faculty Retreat, September 28, 2007
2007 Case Presentation for Workshop: “We are Driven”. Discussant: Cordelia Schmidt-
Hellerau, PhD, Dallas Society of Psychoanalytic Psychology, November 4, 2007.
2008 Workshop at AADPRT Annual Meeting: “Guiding Principles for Successful
Assistant/Associate Training Director Positions”, March 14, 2008
2008 Workshop at AADPRT Annual Meeting: “Can We Predict Resident Performance?”,
March 14, 2008
2008 Poster presentation at AADPRT Annual Meeting, March 14, 2008. Byerly, M and
Brenner, A. “Using APA Practice Guidelines in Resident Education”.
2008 Case Presentation for Harlan Crank Symposium. Discussant: Abbott Bronstein, PhD.
Dallas Psychoanalytic Center, April 26, 2008.
2008 Grand Rounds, Department of Psychiatry, U T Southwestern Medical Center: Brenner,
A; Sadler, J; Wolff, T. “The Ethics of Supervision”. April 30, 2008
2008 Effective Teacher Series, U T Southwestern Medical Center. Lecture: “Can We Teach
Empathy”. May 6, 2008
2008 Plenary session presentation at ADMSEP Annual Meeting (with T.Wolff, M.D.) : “Core
Required Didactics vs. Elective Discussion Groups: Evolving Ideas in Clerkship
Education and Their Evaluation”, June 14, 2008.
2009 Case Presentation for Discussion Group on “Clinical Applications of Contemporary
Kleinian Theory”. Meeting of the American Psychoanalytic Association, January 15,
2009.
2009 Workshop at AADPRT Annual Meeting: “The Training Director at His/Her Best:
Passions, Priorities, and Commitments” March 15, 2009
2009 Workshop at AADPRT Annual Meeting: “Residents Treating Medical Students in
Psychotherapy: Challenges and Opportunities”, March 15, 2009
2009 Grand Rounds, Department of Psychiatry, UT Southwestern Medical Center: “What
Medical Students Want to Tell Us About Psychiatry (And What We Should Do About
It)”. May 13, 2009
2010 Grand Rounds, Department of Surgery, UT Southwestern Medical Center: “Can We
Teach Empathy?” February 10, 2010
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2010 Workshop at AADPRT Annual Meeting: “Assistant/Associate Residency Training
Directors (ATD) in Psychiatry: Guiding Principles for Successful ATD Positions”, March
12, 2010
2010 Lecture, Law Enforcement and Mental Health Conference Dallas TX: “When They’re
Not Ill: Creativity and Accomplishment in the Lives of Bipolar People”. March 26,
2010
2010 “Supportive Psychotherapy”, presented at Panel on Psychotherapy, May 22, 2010,
Psychiatry Student Interest Group Network Annual Conference, American Psychiatric
Association meeting in New Orleans.
2011 “What is the Evidence Base for Psychodynamic Theory?”, seminar for medical students
attending American Psychoanalytic Association Meeting, New York, January 15, 2011.
2011 Lecture, Law Enforcement and Mental Health Conference Dallas TX: “Borderline
Personality Disorder and Attachment: Making Sense of Senseless Behaviors”, February
11, 2011
2011 Grand Rounds, Department of Psychiatry, Texas Tech University Health Science Center,
Lubbock, TX: “Teaching the Evidence for the Unconscious: Links between Clinical
Psychodynamics, Cognitive Neuroscience, and Social Psychology” February 22, 2011
2011 Grand Rounds, Department of Psychiatry, John Peter Smith Hospital, Fort Worth, TX:
“Teaching the Evidence for the Unconscious: Links between Clinical Psychodynamics,
Cognitive Neuroscience, and Social Psychology” February 22, 2011
2011 Workshop at AADPRT Annual Meeting: “Moving from Inspiration to Action: Practical
Skills for Early Career Educators”, March 4, 2011
2011 Workshop at AADPRT Annual Meeting: “Inspiring Residents with Early Exposure to
Community Psychiatry in Jails and Homeless Shelters”, March 4, 2011
2011 Workshop at AADPRT Annual Meeting: “Problem Residents and Resident Problems”,
March 5, 2011
2011 Grand Rounds, Terrell State Psychiatric Hospital, Terrell TX: “Revisiting Supportive
Psychotherapy: Review, Refreshers, and Updates”, June 7, 2011
2011 Invited Speaker, Physician Assistants Day Ceremony, Parkland Memorial Hospital,
Dallas TX: “Listening, Healing, and the Patient-Clinician Relationship”, October 4, 2011
2011 Lecture, Combined Program of North Texas Society of Psychiatric Physicians and
Dallas Psychoanalytic Center: “Evidence-Based Psychodynamic Theory”, October 27,
2011
2011 Workshop, Faculty Retreat of UTSW Dept of Psychiatry: “Maintaining Board
Certification”, October 28, 2011
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2011 Discussion Group, Psychiatry Student Interest Group, UTSW: “Why Psychiatry?”,
November 3, 2011
2011 Chaired panel presentation, Texas Society of Psychiatric Physicians, Case Presentation
and Evidence Based Psychodynamic Theory and Practice”, with Dr. Marisa Toups and
Dr.Alyson Nakamura, November 12, 2011
2011 Discussion Group Leader, “What is Psychoanalysis?” at Student and Residents Day
Program, American Psychoanalytic Association Annual Meeting, January 14, 2011
2012 Workshop, at Southern Regional Meeting of Society for General Internal Medicine,
“Working with Difficult Patients: Tips from Outside the Medical Model”, Co-presenter
with Robert Goldsteen, D.O. New Orleans, February 10, 2012
2012 Poster presentation, AADPRT annual meeting: “Job Satisfaction Among Associate
Training Directors in Psychiatry: A Bimodal Distribution”. Melissa Arbuckle, MD,
PhD, Sallie DeGolia, MPH, MD, Karin Esposito, MD, PhD, Michael Weinberg, EdD,
Adam Brenner, MD. March 9, 2012
2012 Workshop, AADPRT annual meeting: “Program for Early Career Training Directors:
Negotiation as a Learnable Skill”. March 8, 2012.
2012 Workshop, AADPRT annual meeting: “Honey, I’m Off to AADPRT; Don’t Forget to
feed the Kids: Balancing Work and Home Lives”. March 9, 2012
2012 Faculty Development Workshop, Seton Hospital, UTSouthwestern – Austin: “Academic
Promotion and Personal Fulfillment”, April 24, 2012.
2012 Workshop, North Texas Psychiatric Society: “Maintaining Board Certification”, April
26, 2012
2012 Effective Teacher Series, U T Southwestern Medical Center. Lecture: “Empathy in
Health Sciences Education”, with James Wagner MD. May 15, 2012.
2012 Lecture, “Conflict Resolution on Medical Teams”, Presented at Chief Resident
Immersion Training, UT Southwestern Medical Center, June 2, 2012
15. Publications:
a. Peer reviewed articles:
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1. Brenner A: The Role of Personal Psychodynamic Psychotherapy in Becoming a Competent
Psychiatrist. Harvard Review of Psychiatry. 2006; 14: 268 - 272
2. Brenner A: Uses and Limitations of Simulated Patients in Psychiatric Education. Academic
Psychiatry 2009: 33: 112 – 119.

3. Wolff T, Jenkins C, Brenner A, Mohl P: Medical Student Moonlighting in a Psychiatry
Emergency Service. Academic Psychiatry 2009: 33:343 – 344.
4. Brenner A, Jain S, Mathai S, Mohl P: Can We Predict "Problem Residents"? Academic
Medicine, 2010; 85: 1147-1151
5. Brenner A: Narratives of Shame, Tormenting Ghosts, and the Job of the Therapist. Philosophy,
Psychiatry, and Psychology, 2010; 17: 259- 261.
6. Brenner A: What Medical Students Say About Psychiatry: Results of a Reflection Exercise
Academic Psychiatry 2011, 35: 196-198
7. Arbuckle MR, DeGolia S, Esposito K, Miller D, Brenner A: Associate Residency Training
Directors in Psychiatry: Demographics, Professional Activities and Job-Satisfaction. Academic
Psychiatry 2012; 36:1–4
8. Brenner A: Teaching Supportive Psychotherapy in the Twenty First Century. Accepted by
Harvard Review of Psychiatry, publication date pending.
9. Fuehrlein BS, Jha MK, Brenner A, and North C: Can We Address the Shortage of
Psychiatrists in the Correctional Setting with Exposure During Residency Training? Accepted
by Community Mental Health Journal, publication date pending.
10. Brenner A: Internalization, Internal Conflict, and I-Thou Relationships. Accepted by
Philosophy, Psychiatry, and Psychology, publication date pending.
11. Arbuckle MR, DeGolia S, Esposito K, Weinberg M, Brenner A: Job Satisfaction Among
Associate Training Directors in Psychiatry: A Bimodal Distribution. Accepted by Academic
Psychiatry, publication date pending.
12. Fuehrlein BS, Jha MK, Brenner A, and North C: The Attitudes of Psychiatry Residency
Training Directors Towards Resident Training in Correctional Facilities. Submitted for review
to Journal of Behavioral Health Services.
b. Popular press articles:
Brenner A: The Tools We’re Born With: Are We Hardwired to be Civil? Op – Ed Essay in Dallas
Morning News, July 25, 2010.
Brenner A: Why Not in Your Backyard? Attitudes Towards Homelessness. Op – Ed Essay in Dallas
Morning News, September 12, 2010.
c. Textbook chapters:
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Altshuler K, Brenner A: Other Methods of Psychotherapy, in Comprehensive Textbook of Psychiatry ,
Ninth Edition. Edited by Sadock B, Sadock V, Ruiz P, 2009.
Mohl P, Brenner A: Other Psychodynamic Schools, in Comprehensive Textbook of Psychiatry, Ninth
Edition. Edited by Sadock B, Sadock V, Ruiz P, 2009.
16. Editorial positions:
2007- Reviewer, Harvard Review of Psychiatry
2007- Reviewer, Academic Psychiatry
2009- Editorial Board Member, Academic Psychiatry
2010- Reviewer, Philosophy, Psychiatry, and Psychology
20. Major Institutional Committee Assignments:
a. Brigham and Women’s/Faulkner Hospitals
2004-2006 Brigham and Women’s Hospital Education Committee
2004-2006 Steering Committee BWH Dept. of Psychiatry
2004-2006 Leadership Committee Faulkner Dept. of Psychiatry
2004-2006 Kravitz Award for Outstanding Teaching Selection Committee
BWH Dept. of Psychiatry
2005-2006 BWH Principal Clinical Year Planning Group,
b. Harvard Longwood Psychiatry Residency Training
2004-2006 Training Directors Committee
2004-2006 Selection Committee
2004-2005 Program Review Committee
2005-2006 Program Implementation Task Force
2005-2006 Psychotherapy Curriculum Task Force Chairperson
c. Harvard Medical School
2004-2006 Core Clerkship in Psychiatry Task Force (curriculum reform project)
2004 Psychiatry 700 Task Force(curriculum reform project)
2005-2006 Harvard Medical School Assessment Committee, Program Evaluation Sub-Committee
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d. The University of Texas Southwestern Medical Center
2006-2009 MS1 Curriculum Committee, U T Southwestern Medical School
2006-2009 MS2 Curriculum Committee, U T Southwestern Medical School
2006- 2009 MS3/4 Curriculum Committee, U T Southwestern Medical School
2006- 2009 Medical Student Promotion Committee, U T Southwestern Medical School
2006- Department of Psychiatry Executive Committee
2006- Psychiatry Residency Education Committee, Dept of Psychiatry
2007-2009 Residency Education Task Force on Clinical Skills Credentialing
2006- Psychiatry Clerkship Committee, Dept of Psychiatry
2008 - Admissions Committee, Member, U T Southwestern Medical School
2009-2011 Graduate Medical Education Committee, Member, U T Southwestern Medical School
2009-2010 Search Committee for Director of Student Mental Health, U T Southwestern Medical
School
2010 Search Committee for Director of Academic Assistance, U T Southwestern Medical
School
2011 Search Committee for Director of Family Studies Center, U T Southwestern Medical
School
2011- Graduate Medical Education Executive Committee, U T Southwestern medical School
2012- Department of Psychiatry Appointment and Promotion Committee, U T Southwestern
Medical Center
17. Institutional Teaching Activities:
a. Medical Student teaching:
1993 “Structuring Psychiatry Treatment”, Adult Psychiatry Residency, McLean
Hospital
Course Coordinator
1994-2004 Psychiatry 700MJ Harvard Medical School
Site Director, Preceptor, and Lecturer (Mental Status Exam; Suicide and
Homicide; Personality Disorders) for required psychopathology
course for second year Harvard Medical students
Page 16

1995-2000 Inpatient Dynamic Psychiatry, Advanced Elective, Tufts University School of Medicine
for senior Tufts Medical students:
Course Director and Preceptor
1996 Core Clerkship in Psychiatry, Harvard Medical, Didactic Curriculum/ Longwood
Clerkship: Lecturer, Psychodynamic Psychiatry
2003-2004 Core Clerkship in Psychiatry, at Faulkner Hospital for third and fourth year Harvard
Medical students: Site Coordinator, Preceptor
2004-2006 Tutorial in “Interviewing and Formulation”, Harvard Longwood Psychiatry
Clerkship
2004-2006 Patient-Doctor Relationship Curriculum, Co-Director, Principal Clinical
Experience, Brigham and Women’s Hospital Pilot, Harvard Medical School
2006- Core Clerkship in Psychiatry: Co-Director, U T Southwestern Medical Center
2007- Co-teacher, core clerkship didactics: “Neuroscience and Clinical Psychiatry”, one two
hour session each clerkship rotation
2007- Small group leader, MS1 course ‘Human Behavior and Psychopathology’
2007-2011 Lecturer, “Psychotherapy” in MS1 course ‘Human Behavior and Psychopathology’
2012 Lecturer, “Attachment in Human Development and Medical Practice” in MS1 course
‘Human Behavior’
b. Resident and Post-Doctoral Teaching
1997-2006 Literature Conference for Faulkner Hospital Inpatient Staff and
Residents, Harvard Longwood Psychiatry Residency Training
Program (HLPRT)
Seminar Leader
2000-2004 “Advanced Topics in Formulation and Treatment”, Brandeis University
Counseling Center
Seminar Instructor for 5 psychology interns and psychology post-docs
2004-2006 Psychotherapy Supervisor, Harvard Longwood Psychiatry Residency
Training Program
Supervision PGY2-4 residents
2006 Seminar Co-Leader - “Reading Freud in the 21st Century”, monthly seminar for
residents, fellows, and faculty in the BW/F Outpatient Psychiatry Division.
2006- Psychotherapy Supervisor, U T Southwestern Psychiatry Residency Training Program
Supervision PGY2-4 residents (5 hours/week)
2006-2009 “Self Disclosure in Psychotherapy” 1 session in PGY4 Advanced Topics Seminar
Page 17

2007 Seminar presentation: “Self Disclosure in Psychotherapy” University of Texas at Dallas
Counseling Center Seminar Series, May 7, 2007
2007-2009 “Clinical Aspects of Kleinian Theory” 2 sessions in PGY4 Advanced Topics Seminar
2007-2010 Seminar co-leader (with Alyson Nakamura, M.D.) Continuous Case Conference for
PGY2 Residents
2007 Invited Lecturer at Residents’ Retreat, September 11, 2007: “The Inevitability of Group
Tensions and How to Ease Them: A view from Freud and Evolutionary Psychology”
2007 Lecturer, “Residents as Teachers” 1 session in PGY2 Psychosocial Basis of Psychiatry
Seminar, November 2007
2007 Co-leader and Co-organizer, Symposium on “Coping with Bad Outcomes in Psychiatric
Practice”, November 13, 2007
2007-2009 Seminar leader – elective for PGY3 and PGY4 residents: “Reading the Psychoanalytic
Literature and Psychoanalytic Readings of Literature”
2008-2010 Co-Teacher – “The Technique of Psychoanalytic Psychotherapy”, 8 week seminar,
Program for Psychoanalytic Therapy at the Dallas Psychoanalytic Center
2008 Invited Lecturer at Residents’ Retreat, September 16, 2008: “Shame, Secrets, and
Grandiosity: Reflections on the Psychodynamics of Learning and Teaching”
2009- Advanced Topics in Psychotherapy, PGY3 Residents, Co-Teacher (with Larry Thornton,
M.D.)
2009- Lecturer, two sessions in PGY2 series Psychosocial Basis of Psychiatry “Introduction to
the Psychotherapies” and “Attachment Theory and Practice”.
2010-2011 Co-leader, Elective Seminar for PGY3 and PGY4 residents: “Evidence Based Poetry:
Stretching the Boundaries of the Psychiatric Literature”
2011- Conference Leader, Monthly Psychoanalytic Case conference at Dallas County Jail
Mental Health Services, as part of PGY2 Rotation in Community Psychiatry: Jail Site
18. Community Service Related to Professional Work:
1998- Asylum Network, Physicians for Human Rights (Psychiatric consultation to asylum
seekers)
2009- Psychiatrist supervisor for Mental Health Screening program at the ‘Monday Clinic’,
UTSW free care medical student-run clinic
Page 18

COMBINED List of Behavioral Health DSRIP Projects
Intervention
Category I: Infrastructre
Program Originated by Possible IGT source Interested in funding
Project Area 1: Expand Behavioral Health Access
A. Implement technology‐
assisted services
(telemedicine, telephonic
guidance) to support or
deliver behavioral health.
B. Provide an early
intervention for a targeted
behavioral health population
to prevent unnecessary use
of services in a specified
setting (i.e., the criminal
justice system, ER, urgent
care etc.).
C. Enhance service
availability (i.e., hours, clinic
locations, transportation,
mobile clinics) to appropriate
levels of care.
Telepsych in ED’s Main RHP9 document
Telepsych in ED’s and urgent
care
BHLT/NTBHA group
Referral network for BH
patients leaving jail
Main RHP9 document
Providers for adolescents and
high risk youth in primary
care clinics
Main RHP 9 document
Programs for frequent users Overlap between:
of multiple systems: serial Main RHP 9 document
inebriates
BHLT/NTBHA group
Programs for frequent users Overlap between:
of multiple systems: Main RHP 9 document
behavioral health services BHLT/NTBHA group
Programs for frequent users Overlap between:
of multiple systems: jail Main RHP 9 document
recidivists
BHLT/NTBHA group
Supportive services for newly
housed people with BH
needs to help them retain
housing and prevent ER and
criminal justice system use
BHLT/NTBHA group
Fund NorthSTAR Main RHP9 doc
Expand Parkland BH services Main RHP9 doc
Build capacity in outpatient
BH system
BHLT/NTBHA group
Increase inpatient beds Overlap between:
Main RHP 9 document
BHLT/NTBHA group
Increase partial hospital beds Overlap between:
Page 1 of 7 6/25/12
Page 19

Intervention Program Originated by
Main RHP 9 document
BHLT/NTBHA group
Possible IGT source Interested in funding
Increase med/psych beds Overlap between:
Main RHP 9 document
BHLT/NTBHA group
Increase residential
substance use treatment
beds
BHLT/NTBHA group
Create access to Cognitive
Enhancement Therapy in
order to improve cognitive,
social, and occupational
functioning
BHLT/NTBHA group
D. Collaborate with
community partners to
explore and develop a long‐
term Crisis
Intervention/Stabilization
unit.
RHP9 doc: Collaboration
between CMC, Parkland
COPC/school clinics and BH
providers for a continuum of
care for children
BH doc: Capacity for crisis
intervention in school clinics
Expand transportation
services
Expand service availability by
Spanish‐speaking clinicians
In collaboration with BHLT
and North Star, develop
psych crisis stabilization
infrastructure
Expand alternatives to higher
levels of care: Develop a
recovery room “Living Room”
model for consumers in crisis
Expand alternatives to higher
levels of care: increased
capacity for mobile crisis
outreach team interventions
Overlap between:
Main RHP 9 document
BHLT/NTBHA group
BHLT/NTBHA group
BHLT/NTBHA group
Main RHP 9 document
BHLT/NTBHA group
Overlap between:
Main RHP 9 document
BHLT/NTBHA group
Page 2 of 7 6/25/12
Page 20

Intervention Program Originated by Possible IGT source Interested in funding
Expand alternatives to higher
levels of care: increase step‐
down crisis res beds
BHLT/NTBHA group
Expand alternatives to higher
levels of care: peer
supported respite options via
boarding homes (crisis house
model)
BHLT/NTBHA group
F. Expand residency training Expand training in
Metrocare/Dallas Co
slots for psychiatrists, child
psychiatrists, psychologists
and mid‐level behavioral
health practitioners (LMSW,
LPC, LMFT).
community BH setting Community Center
Project Area 2: Expand Primary Care Access
A. Enhance service
Infrastructure/equipment to BHLT/NTBHA group
availability (hours, clinic support primary care delivery
locations, urgent care,
transportation, mobile
clinics) to appropriate levels
of care.
in community MH settings
B. Develop a system for Expand number of primary Metrocare/Dallas Co
primary care provider care professionals providing Community Center
recruitment and retention. services in community MH
clinics in Dallas Co
Project Area 3: Expand Specialty Care Access
A. Enhance service
Develop services for people Metrocare/Dallas Co
availability (hours, clinic with developmental
Community Center
locations, urgent care, disabilities at high risk for use
transportation, mobile of ER, acute care due to
clinics) to appropriate levels disruptive behaviors:
of care.
intensive community based
treatment program
Develop services for people Metrocare/Dallas Co
with developmental
disabilities at high risk for use
Community Center
Page 3 of 7 6/25/12
Page 21

Intervention Program Originated by Possible IGT source Interested in funding
of ER, acute care due to
disruptive behaviors: day
program
Develop an intensive applied
behavioral analysis program
for children with
developmental disabilities to
prevent future use of acute
services due to disruptive
Metrocare/Dallas Co
Community Center
behaviors
Project Area 4: Enhance Health Information Exchange and Health Information Technology for Performance Improvement and Reporting Capacity
C. Recruit and/or train staff Fund staff position at NTBHA BHLT/NTBHA group
to lead analyses (including or other county entity to lead
data analytics, performance
benchmarking, and
implementation science) of
population management and
performance improvement
methodologies.
PI analyses
D. Facilitate coordination of Develop data exchange with Overlap between:
care by leveraging health community providers Main RHP 9 document
information exchange.
BHLT/NTBHA group
Page 4 of 7 6/25/12
Page 22

Intervention Program Originated by Possible IGT source Interested in funding
Category II: Innovative Programs
Project Area 2: Test Financing Mechanisms for Providers
A. Create patient‐directed
wellness pilot that includes
incentives, such as health
navigation with flexible
wellness accounts.
Develop Self‐Directed Care
(SDC) program for behavioral
health consumers
BHLT/NTBHA group
Project Area 3: Develop Innovations in Health Promotion/ Disease Prevention
A. Establish self‐management Develop a peer‐supported BHLT/NTBHA group
education programs in wellness program for BH
community settings including consumers based on the
self‐enrollment in the Wellness, Recovery, Action
program and appropriate Plan model. Incorporate
follow‐up with a health care nutrition, exercise, and
professional.
physical health promotion in
addition to behavioral health
Engage in wellness at non‐
medical locations using
CHWs.
self‐management.
Project Area 4: Develop Innovation for Provider Training and Capacity
A. Implement an integrated RHP9: Develop multi‐ Overlap between:
multi‐disciplinary care system disciplinary care programs for RHP9
to promote team‐based care. chronic diseases and train Parkland
providers in in all levels of BHLT/NTBHA
team‐based care
BH: Interdisciplinary Teams in
Area 5 below for BH
Metrocare: Interdisciplinary
teams for DD consumers
Metrocare
B. Develop chronic care
multi‐disciplinary training
programs for nurses,
pharmacists, social workers,
registered dietitians and
physicians.
Similar overlap as above Similar overlap as above
Project Area 5: Enhance Behavioral Health Access
Page 5 of 7 6/25/12
Page 23

Intervention Program Originated by Possible IGT source Interested in funding
A. Develop care management Develop care management BHLT/NTBHA group
function that integrates the program that coordinates
primary and behavioral care for consumers of both
health needs of individuals. behavioral health and
primary care services
Develop an interdisciplinary
team based program for
patients with complex
physical and behavioral
health needs based on the
Assertive Community
Treatment or Integrated Dual
Diagnosis Treatment Model.
BHLT/NTBHA group
Registries and care
management program for
depressed diabetics
RHP9/Parkland
B. Co‐locate primary and Integrate stable psych Main RHP9 document
behavioral health care patients into medical homes
services.
Multiple co‐location projects
outlined in Category I – not
sure where they fit best?
Develop a post‐partum BHLT/NTBHA list, added at
depression program
delivered in the community
women’s clinic setting
Parkland’s request
C. Provide telephonic Telemed projects outlined in
psychiatric and clinical Category I – not sure where
guidance to all participating
primary care providers
delivering services to
behavioral patients
regionally.
they fit best?
D. Establish post‐discharge Develop post‐discharge BHLT/NTBHA group
support for behavioral wrap‐around services to
health/ substance abuse. promote continuity of care
and a “warm handoff”
Page 6 of 7 6/25/12
Page 24

Intervention Program
transition from acute
care/crisis to stable
outpatient care
Originated by Possible IGT source Interested in funding
E. Recruit, train and support
consumers of mental health
services to be providers of
behavioral health services as
volunteers, paraprofessionals
or professionals within the
system.
Project Area 8: Reduce inappropriate ED use
A. Reduce ED visits by
identifying frequent users'
needs.
BH: Develop peer navigator
program to help consumers
with mental health and/or
substance use needs connect
to community based
programs (both clinic‐based
and peer‐based).
RHP9: Volunteer counselors
for behavioral health
Programs for frequent users
of multiple systems: serial
inebriates
Programs for frequent users
of multiple systems:
behavioral health services
Overlap between:
Main RHP 9 document
BHLT/NTBHA group
Overlap between:
Main RHP 9 document
BHLT/NTBHA group
Overlap between:
Main RHP 9 document
BHLT/NTBHA group
Page 7 of 7 6/25/12
Page 25

MEMORANDUM OF UNDERSTANDING
BETWEEN
DALLAS COUNTY
AND
VARIOUS PARTICIPANTS IN THE
DELIVERY OF BEHAVIORAL HEALTH SERVICES
UNDER THE NORTHSTAR
MANAGED CARE PROGRAM
FOR
ENHANCEMENT OF BEHAVIORAL HEALTH SERVICES
IN DALLAS COUNTY
1.0 Purpose: The purpose of this Memorandum of Understanding is to describe Dallas County’s
specific expectations relative to the delivery of mental health and substance abuse services, and to
describe County’s payment for enhanced behavioral health services.
2.0 Parties: The participants in this Memorandum of Understanding are the corporations chosen to
manage behavioral health services: ValueOptions, Inc. (hereinafter called “Behavioral Health
Organization” or “BHO”), the North Texas Behavioral Health Authority (hereinafter called
“NTBHA”), the Texas Department of State Health Services (hereinafter called “TDSHS”), and
Dallas County (hereinafter called “County”).
3.0 Services to be Provided by BHO: The BHO agrees that the following services are to be
included within the overall scope of treatment options available for residents of Dallas County:
Stabilization Beds - persons placed under Order of Protective Custody in Dallas County, pursuant to
Section 574.001 of the Texas Health and Safety Code, will be stabilized and diagnosed at a location
or locations selected to maximize the cost effectiveness of the plan.
Jail Diversion Services – BHO will ensure that jail diversion services will be provided that are,
at a minimum, consistent in numbers served and intensity of services with jail diversion services
currently available to Dallas County. The BHO will continue to provide a specialized Jail
Diversion Unit that is available to provide intensive services to twenty-one (21) individuals, who
are the most frequent recidivists in the Dallas County jail who are in need of behavioral health
services.
Transportation Services - provide transportation services for mental illness patients traveling from
Terrell State Hospital, located at 1200 E. Brin, Terrell, Texas 75160 in Kaufman County to the
Mental Illness Court, located at Green Oaks Hospital, 7920 Clodus Field Drive, Dallas, Texas 75251
in Dallas County and upon approval by County, provide return transportation services for mental
illness patients.
FY 2011-2012 MOU FOR NORTHSTAR PROGRAM 1
Page 26

Staff Services - the County will be provided the following staff resources:
� one (1) full-time equivalent behavioral health liaison whose primary work location is the Dallas
County Mental Illness Court; and
� two (2) full-time equivalent behavioral health liaisons whose primary work location is the Dallas
County Jail.
3.1 BHO’s Responsibilities as a Partner in Quality Improvement Activities
In addition to the specific services that BHO will provide as detailed in Section 3.0, the BHO agrees
to participate as an effective quality improvement partner with Dallas County and its constituencies
in designing, implementing, and overseeing NorthSTAR related behavioral services and recoveryoriented
systems of care. The BHO agrees to participate as an active member of the Dallas County
Behavioral Leadership Team (BHLT) and its quality improvement activities.
The BHO will develop mechanisms for service delivery and outcome reporting and evaluation in
support of the following quality improvement goals approved by the Dallas County BHLT. In FY
2012, the BHO will identify and report to NTBHA and Dallas County those outcome measures that
will indicate progress towards meeting the below identified goals. This outcome data will be used
by the BHO, in partnership with Dallas County and NTBHA, to develop and implement improved
service delivery strategies. While no performance incentives or penalties will result from BHO’s
activities in support of quality improvement in FY 2012, future agreements for transfer of Dallas
County funds to the NorthSTAR system are expected to include specific outcomes and related
incentives and/or penalties.
1. Improve patient outcomes and costly repeated hospital admissions and criminal
justice involvement.
2. Improved communication/collaboration between and less fragmentation of the
diverse array of service providers in our system.
3. Target resources towards those at high risk for poor outcomes.
4. Increase the impact of behavioral health services on homeless recovery.
5. Begin a framework upon which to develop improved integration between
behavioral health and primary care.
6. Develop and implement services and core competencies outside the service
packages for which there is an unmet need, including but not limited to peer
recovery services.
7. Increase co-occurring disease competency throughout the mental health system.
4.0 Services to be Provided by North Texas Behavioral Health Authority NTBHA: NTBHA
agrees that it will provide the following services for the residents of Dallas County:
FY 2011-2012 MOU FOR NORTHSTAR PROGRAM 2
Page 27

Performance Reporting - NTBHA will provide a year-end performance report to the Dallas County
Commissioners Court (hereinafter called “Commissioners Court”) related to each of the items
contained in section 3.0. NTBHA will work with the County in determining the form and format of
the performance report. This report will assess the degree to which the BHO has complied with this
agreement and provide suggestions for improvement and/or effectiveness.
Mediation Services - NTBHA will facilitate continued discussions between the County and the BHO
to provide an early resolution and/or mediation of disagreements that may arise between the parties.
5.0 Services to be Provided by TDSHS: TDSHS will provide the following services to Dallas
County:
Output Reporting - TDSHS will make available to the County a data book and an updated quarterly
regarding the overall performance of the managed care pilot. TDSHS will also make available to the
County a monthly Data Management Report. This data set will be received before any payment is
made by the County. A copy of such report is provided in Attachment A, which is incorporated
herein for all purposes.
Future Planning - At the time in which TDSHS plans to incorporate additional services currently
being provided by the County into the NorthSTAR program (e.g., jail health services, etc.), it will
notify the County of its intentions and will seek approval by the Commissioners Court.
6.0 Payment by County: County has agreed to make twelve (12) monthly payments of two
hundred seventy-eight thousand six hundred thirty-one dollars and thirty-three cents ($278,631.33)
to TDSHS for distribution and payment to the BHO, beginning October 1, 2011. Each such payment
will be initiated by the Dallas County Office of Budget and Evaluation after receipt of all
management data due to the County pursuant to the “Management Data Plan.”
6.1 Adequacy of Service Delivery: County’s continued payment will be contingent upon the
adequacy of the service delivery, as solely determined by the Commissioners Court with the
assistance of NTBHA. This determination will be made according to performance and outcome
measures and quality assurance reports required by the State of Texas’s contract with the BHO in
Article X, and Appendices 10 and 4, which are all incorporated herein by reference for all purposes.
Quality improvement activities, as detailed in Section 3.1, will also be evaluated by Dallas County,
primarily through its BHLT, and NTBHA to determine the adequacy of service delivery.
6.2 Voluntary Payment: BHO, NTBHA, and TDSHS understands and agrees that all County
payments are discretionary and are made as a result of a Commissioners Court decision to augment
services to persons in Dallas County and the County has final determination as to the manner in
which such payments are expended. Notwithstanding any provisions contained herein, the
obligations of the County under this Contract are expressly contingent upon the availability of
funding for each item and obligation contained herein for the term of the Contract and any
FY 2011-2012 MOU FOR NORTHSTAR PROGRAM 3
Page 28

extensions thereto. Contractor shall have no right of action against the County in the event the
County is unable to fulfill its obligation under this Contract as a result of lack of sufficient funding
for any item or obligation from any source utilized to fund this Contract or failure to budget or
authorize funding for this Contract during the current or future fiscal years. In the event that the
County is unable to fulfill its obligations under this Contract as a result of lack of sufficient funding,
or if funds become unavailable, the County, at its sole discretion, may provide funds from a separate
source or may terminate this Contract by written notice to Contractor at the earliest possible time
prior to the end of its fiscal year.
7.0 Payments to Providers: The BHO may offer subcontracted providers any method of payment it
determines appropriate, including but not limited to fixed payment, subcapitation, case rate, or fee
for service. However, payment arrangements other than fee for service must be reviewed and preapproved
by NTHBA, TDSHS and Dallas County. If contractor proposes any provider rate changes,
contractor shall allow NTBHA, TDSHS and Dallas County forty-five (45) days prior to the proposed
effective date, to review the proposed revisions and to assess and/or evaluate the impact such
revisions will have on the program.
NTBHA, TDSHS, and/or Dallas County may prohibit or instruct Contractor to terminate provider
payment methodologies that involve subcapitation, case rate, or fixed payment if either NTBHA,
TDSHS or Dallas County determines that the subcontractor’s encounter data or other required data
submission requirements are not being fulfilled
8.0 Term: The term of this Memorandum of Understanding begins on the effective date and
continues for twelve (12) months unless terminated earlier by either party upon sixty (60) days prior
written notification by any party to all other parties. Each party to this Contract shall designate a
person to receive notices hereunder within ten (10) days of execution of this Contract. Such notice
shall be deemed to have been given if reduced to writing and delivered by a nationally recognized
personal service delivery or courier service or mailed by certified or registered mail return receipt
requested, postage pre-paid and shall be deemed to be given five (5) days subsequent to the date it
was so delivered or mailed.
9.0 Attest: The parties to this Memorandum of Understanding herewith agree to the provisions
contained herein.
FY 2011-2012 MOU FOR NORTHSTAR PROGRAM 4
Page 29

EXECUTED THIS _______ DAY OF ______________________________, 2011.
DALLAS COUNTY: NORTH TEXAS BEHAVIORAL HEALTH AUTHORITY:
_________________________ _________________________
BY: Clay Lewis Jenkins BY: Alex Smith
Dallas County Judge Executive Director
TEXAS DEPARTMENT OF VALUE OPTIONS, INC:
STATE HEALTH SERVICES:
_________________________ _________________________
BY: Mike Maples BY: Eric Hunter
Asst. Commissioner Executive Director
RECOMMENDED:
______________________________
BY: Darryl Martin
Dallas County Court Administrator
APPROVED AS TO FORM*:
______________________________
BY: Gordon Hikel
Chief, Civil Division,
Dallas County District Attorney’s Office
*By law, the Dallas County District Attorneys’ Office may only advise or approve contracts or legal
documents on behalf of its clients. It may not advise or approve a contract or legal document on behalf of
other parties. Our review of this document was conducted solely from the legal perspective of our client. Our
approval of this document was offered solely for the benefit of our client. Other parties should not rely on
this approval, and should seek review and approval by their own respective attorney(s).
FY 2011-2012 MOU FOR NORTHSTAR PROGRAM 5
Page 30

12-Cities Project
Federal agencies responded to the release of the National HIV/AIDS Strategy with the
12-Cities Project. The project aims to demonstrate how the broad range of federally
supported HIV prevention, care and treatment activities can work together more
effectively across organizational and program boundaries in the 12 Metropolitan
Statistical Areas and Metropolitan Divisions most impacted by HIV/AIDS. The
Substance Abuse and Mental Health Services Administration contributed to the 12 Cities
Project with the release of the funding opportunity described below.
Minority AIDS Initiative - Targeted Capacity Expansion Project
Purpose
To facilitate the development and expansion of culturally competent and effective
integrated behavioral health and primary care networks, which include HIV services and
medical treatment, within racial and ethnic minority communities
Outcomes
Reduce the impact of:
� Behavioral health problems
� HIV risk and incidence
� HIV-related health disparities
Ensure that individuals who are at high risk for or have a mental and/or substance use
disorder and who are most at risk for or are living with HIV/AIDS have access to and
receive appropriate behavioral health services and HIV care in integrated behavioral
health and primary care settings.
Dallas Response
The Texas Department of State Health Services was awarded funds to partner with local
stakeholders in Dallas to achieve the following:
Purpose
To establish a permanent link between HIV, mental health, and substance use disorder
treatment and prevention to ensure that people who are HIV positive and who have a
mental health and/or substance use disorder are linked to and maintained in HIV medical
care.
Goals
� To enhance effectiveness and availability of HIV, mental health, and substance
use disorder services through the implementation of coordinated prevention
efforts
Page 31

� To improve the behavioral health and HIV treatment infrastructure in Dallas to
better serve HIV-infected persons with a dual diagnosis of mental health and/or
substance use disorders
Objectives
� Increase the number of mental health and substance use disorder treatment
providers trained to address the needs of populations most at risk for HIV in
Dallas
� Increase the number of HIV treatment providers trained to recognize and treat the
mental health and substance use disorder needs of HIV positive patients
� Enhance the integration of mental health and substance use disorder services and
HIV prevention and treatment through colocation of services.
� Increase the integration of HIV screening into mental health and substance use
disorder services
� Increase the integration of mental health and substance use disorder screening into
HIV prevention and treatment
Dallas Partners
Contracts have been established with the following Dallas-based agencies to work
towards the goals and objectives mentioned above.
AIDS Arms
AIDS Arms, Inc. is the largest nonprofit HIV/AIDS service organization in North Texas
and provides HIV outpatient medical care, case management, prison outreach, support
groups, and HIV prevention and risk reduction services. As a part of this project, AIDS
Arms will contract with a psychiatric nurse practitioner that will treat and manage HIV
positive individuals with mental health and/or substance abuse (MH/SA) disorders at
AIDS Arms’ Trinity Health and Wellness Clinic. A MH/SA case manager will also be
hired to ensure patients adhere to their HIV treatment regime and keep medical
appointments. Services will focus primarily on HIV positive black gay men and other
men who have sex with men.
Dallas Council on Alcohol and Drug Abuse
The Council serves as one of the foremost community-based organizations in North
Texas offering substance abuse prevention and intervention services. Under this
initiative, The Council will hire two part time Licensed Professional Counselors who will
travel to other agencies through out the County to provide on-site MH/SA assessments
and counseling services to HIV-positive clients. Emphasis will be placed on reducing
symptoms related to depression, anxiety, and posttraumatic stress disorders.
Dallas County Health and Human Services
Dallas County’s HIV Prevention Program will hire a SAMHSA MAI-TCE Coordinator
to oversee the implementation of this project and will be responsible for providing
technical assistance to local agencies, identifying training needs and convening the
Page 32

Behavioral Health Committee. Dallas County will also be responsible for developing a
unique resource directory for MH/SA services targeted towards HIV positive individuals.
Homeward Bound, Inc.
Homeward Bound provides drug and alcohol detoxification treatment plus
comprehensive residential and outpatient programs with counseling, social service
support and education about addiction and life skills needed for recovery. Under this
project, Homeward Bound will establish a peer-supported, 60 to 90 day Recovery
Support Residential program for HIV positive gay men who complete the inpatient
substance abuse treatment program at Homeward Bound. Additionally, Homeward
Bound will implement routine, opt-out HIV testing for all clients entering substance
abuse Detox and/or Residential treatment.
The Texas HIV Connection
The Texas HIV Connection provides training, information and resources about the
relationship between substance use, HIV/AIDS and related diseases. They will develop
unique HIV and MH/SA related curricula to address identified needs in Dallas. These
trainings will be delivered to Dallas area mental health, substance abuse and HIV
treatment and care professionals.
Page 33

12 Cities Project
Overview
The 12 Cities Project will serve as a proving ground to
demonstrate how the broad range of Federallysupported
HIV prevention, care, and treatment activities
can work together more effectively across organizational
and program boundaries. This effort will result in better
identification of and response to service gaps and unmet
needs, scaled-up activities that will have a greater
“payoff” in terms of achieving the goals of the National
HIV/AIDS Strategy (NHAS), enhanced integration of local
service delivery, and – where appropriate – realigned
resources from lower priority to higher priority
activities. This U.S. Department of Health and Human
Services (HHS) project supports and accelerates
comprehensive HIV/AIDS planning
and cross-agency response in the
12 U.S. jurisdictions that bear the
highest AIDS burden in the country.
This demonstration project is a
significant component of the HHS
National HIV/AIDS Strategy
Operational Plan and embodies
many of the key principles of the
NHAS:
� Concentrate resources where
the epidemic is most severe,
� Coordinate Federal resources
and actions across categorical
program lines,
� Scale-up effective HIV
prevention, care and treatment
strategies, and
� Innovate.
Acting on the Strategy’s imperative
for a more coordinated response to the epidemic across
all levels of government, the project is actively engaging
agencies from across HHS in collaborative efforts with
one another and with the State and local health
departments and other local agencies and organizations
in the 12 participating jurisdictions.
Page 34
The 12 Cities
Est. AIDS Cases
Metropolitan Area (Dec. 2007)
New York City, NY 66,426
Los Angeles, CA 24,727
Washington, DC 15,696
Chicago, IL 14,175
Atlanta, GA 13,105
Miami, FL 12,732
Philadelphia, PA 12,469
Houston, TX 11,277
San Francisco, CA 11,026
Baltimore, MD 10,301
Dallas, TX 7,993
San Juan, PR 7,858
44%
of U.S. total
Benefits
Actively coordinating Federally funded programs at the
local level in the 12 jurisdictions that represent 44% of
the nation’s AIDS cases can have huge payoffs and propel
progress toward the Strategy’s goals of reducing HIV
incidence, increasing access to care and improving
outcomes for people diagnosed with HIV, and reducing
HIV-related health disparities. But the impact of this
project is not limited to these communities. Lessons
from this project will be shared widely to benefit all
communities across the nation by informing future
Federal policies, funding opportunities, technical
assistance activities, and operational research agendas.
Foundation
The 12 Cities Project purposely builds
upon a strong platform created by the
Centers for Disease Control and
Prevention’s (CDC) grants for Enhanced
Comprehensive HIV Prevention Plans
(ECHPP) awarded in September 2010 to
each of these jurisdictions. With funds
made available through the Affordable
Care Act’s Prevention and Public Health
Fund, the CDC supports these
communities in undertaking intensive
and enhanced HIV prevention planning so
as to reduce HIV risk and incidence in
those areas. Each jurisdiction is working
with CDC to determine what mix of HIV
prevention approaches can have the
greatest impact in the local area – at the
individual, population, and community
level – based on the local profile of the
epidemic and by assessing and identifying
current gaps in HIV prevention portfolios.
While the exact combination of approaches will vary by
area, reflecting differences in local epidemiology and
circumstance, efforts funded under this program will
follow a basic approach of:
� Intensifying prevention for individuals at greatest
risk – especially gay and bisexual men, transgender
persons, Black Americans, Latino Americans, and
substance users – along with testing those
individuals to reduce undiagnosed HIV infection;

� Prioritizing prevention and linkage to care for people
living with HIV; and
� Directing these intensified efforts to communities
with the highest burden of HIV.
Expanding HHS Participation
The 12 Cities Project – with broader goals, scope and
collaborative oversight – substantially expands the
foundation established by CDC and ECHHP to include
other Federal partners who are essential to the success
of NHAS, moving beyond prevention to include the
continuum of HIV treatment and care. The project, under
the direction of the Office of the Assistant Secretary for
Health (OASH), actively engages HHS agencies whose
work addresses different dimensions of HIV/AIDS in
collective efforts to leverage departmental resources and
assets to support public health and other partners in the
12 cities. In addition to the Centers for Disease Control
and Prevention (CDC), participating HHS agencies
include the Centers for Medicare and Medicaid Services
(CMS), Health Resources and Services Administration
(HRSA) – both the HIV/AIDS Bureau and the Bureau of
Primary Health Care, Indian Health Service (IHS),
National Institutes of Health (NIH), and Substance Abuse
and Mental Health Services Administration (SAMHSA).
By challenging HHS agencies and offices to better
coordinate their planning, implementation, delivery and
evaluation of HIV/AIDS services in each of these 12
jurisdictions, HHS seeks to reduce new HIV infections,
promptly diagnose those who are infected with HIV and
ensure that persons with HIV/AIDS have access to
continuous, quality care, so as to reduce current
disparities. Other specific actions to be undertaken in
this demonstration project, as outlined in the HHS
Operational Plan, include:
� Provide a complete mapping of Federally funded
HIV/AIDS resources in each jurisdiction including
Ryan White Care Act-supported services; Community
Health Centers; IHS and tribal health care facilities;
CDC-supported HIV prevention activities; SAMHSA
mental health, substance abuse prevention, and
substance abuse treatment grantees; and Centers for
AIDS Research activities.
� Provide demographic data on Medicare and
Medicaid clients who are receiving HIV/AIDS
services in each of the 12 jurisdictions.
� Share data and information from across the range of
HHS HIV/AIDS grantees in each jurisdiction to
inform better locally coordinated planning for HIV
prevention, care and treatment.
� Identify opportunities to harmonize and streamline
Federal reporting and other grants requirements.
� Identify and address local barriers to coordination
across HHS grantees.
� Develop cross-agency strategies for addressing gaps
in coverage and scale of necessary HIV prevention,
care, and treatment services.
� Coordinate the implementation of and develop the
capacity to deliver strategies and interventions
addressing HIV prevention, care and treatment.
� Develop common measures and evaluation
strategies to assess processes and outcomes as they
relate to the goals of the NHAS.
� Actively promote opportunities to blend services
and, where appropriate, funding streams across
Federal programs.
� Develop and apply lessons learned in these 12
jurisdictions to Federally funded activities in other
jurisdictions, including creating technical guidance
on the development of statewide HIV/AIDS plans, as
called for in the Strategy.
The participating HHS agencies are mobilizing their
respective program officers, grantees and other
stakeholders in these 12 jurisdictions. Program officers
are also pursuing ways to coordinate Federal technical
assistance to these jurisdictions in ways that help to
diminish program “silos” and, instead, encourage the
local integration of HIV/AIDS prevention, care, and
treatment efforts.
Partnerships
Although this overview focuses on critical activities
taking place at the HHS level, the success of the 12 Cities
Project – like the success of the Strategy itself – will
depend upon on the active participation and support of
many different voices and sectors, including other
Federal departments, state and local government,
community advocates, faith and business leaders, and
persons living with HIV/AIDS. Each must share in the
responsibility of working with their respective
communities to achieve the vision of the National
HIV/AIDS Strategy.
Timeline
Phase I of this project (October 2010–April 2011)
focuses on data collection and planning, with an explicit
focus on identifying gaps in coverage in terms of
populations, interventions, and services. The second
phase of this project (May 2011–September 2011 and
beyond) will focus on responding to the results of the
enhanced planning process, including making
recommendations about redirecting resources in order
to optimize outcomes.
The contributions of each HHS agency planned for 2010
and 2011 are detailed in the HHS NHAS Operational Plan.
To learn more about and follow the progress of the 12
Cities Project, visit the AIDS.gov blog and click on the “12
Cities Project” topic tag to see all the related posts.
Vision for the National HIV/AIDS Strategy
The United States will become a place where new HIV infections are rare and when they do occur, every person,
regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will
have Page unfettered 35
access to high quality, life-extending care, free from stigma and discrimination.

On July 13, 2010, the White House released the National
HIV/AIDS Strategy (NHAS). This ambitious plan is the
nation’s first-ever comprehensive coordinated HIV/AIDS
roadmap with clear and measurable targets to be achieved
by 2015.
Vision for the National HIV/AIDS Strategy
The United States will become a place where new HIV
infections are rare and when they do occur, every person,
regardless of age, gender, race/ethnicity, sexual
orientation, gender identity or socio-economic
circumstance, will have unfettered access to high quality,
life-extending care, free from stigma and discrimination.
The development of the NHAS is important because it is an
effort to reflect on what is and is not working in order to
increase the outcomes that we receive for our public and
private investments. The Strategy is intended to refocus
our existing efforts and deliver better results to the
American people within current funding levels, as well as
make the case for new investments. It is also a new
attempt to set clear priorities and provide leadership for
all public and private stake-holders to align their efforts
toward a common purpose.
Thirty years ago, the first cases of human
immunodeficiency virus (HIV) garnered the world’s
attention. Since then, over 575,000 Americans have lost
their lives to AIDS and more than 56,000 people in the
United States become infected with HIV each year. i
Currently, there are more than 1.1 million Americans
living with HIV. ii Moreover, almost half of all Americans
know someone living with HIV.
Our country is at a crossroads. Right now, we are
experiencing a domestic epidemic that demands a
renewed commitment, increased public attention, and
leadership. We have the knowledge and tools needed to
slow the spread of HIV infection and improve the health of
people living with HIV. Despite this potential, however, the
public’s sense of urgency associated with combating the
epidemic appears to be declining. In 1995, 44% of the
general public indicated that HIV/AIDS was the most
urgent health problem facing the nation, compared to only
6% in March 2009. iii While HIV transmission rates have
been reduced substantially over time and people with HIV
are living longer and more productive lives, approximately
56,000 people become infected each year and more
Americans are living with HIV than ever before. iv,v Unless
we take bold actions, we face a new era of rising infections,
greater challenges in serving people living with HIV, and
higher healthcare costs. vi
Page 36
NATIONAL HIV/AIDS STRATEGY
Goals of the National HIV/AIDS Strategy
Reducing New HIV infections
• By 2015, lower the annual number of new infections by
25% (from 56,300 to 42,225).
• Reduce the HIV transmission rate, which is a measure of
annual transmissions in relation to the number of people
living with HIV, by 30% (from 5 persons infected per 100
people with HIV to 3.5 persons infected per 100 people
with HIV).
• By 2015, increase from 79% to 90% the percentage of
people living with HIV who know their serostatus (from
948,000 to 1,080,000 people).
Increasing Access to Care and Improving Health Outcomes
for People Living with HIV
• By 2015, increase the proportion of newly diagnosed
patients linked to clinical care within three months of
their HIV diagnosis from 65% to 85% (from 26,824 to
35,078 people).
• By 2015, increase the proportion of Ryan White HIV/AIDS
Program clients who are in continuous care (at least 2
visits for routine HIV medical care in 12 months at least 3
months apart) from 73% to 80% (or 237,924 people in
continuous care to 260,739 people in continuous care).
• By 2015, increase the number of Ryan White clients with
permanent housing from 82% to 86% (from 434,000 to
455,800 people). (This serves as a measurable proxy of
our efforts to expand access to HUD and other housing
supports to all needy people living with HIV.)
Reducing HIV-Related Health Disparities
• Improve access to prevention and care services for all
Americans.
• By 2015, increase the proportion of HIV diagnosed gay
and bisexual men with undetectable viral load by 20%.
• By 2015, increase the proportion of HIV diagnosed Blacks
with undetectable viral load by 20%.
• By 2015, increase the proportion of HIV diagnosed Latinos
with undetectable viral load by 20%.
To accomplish the Strategy’s goals, we must undertake
a more coordinated national response to the epidemic.
This will require increasing the coordination of HIV
programs across the Federal government and between
Federal agencies and state, territorial, tribal, and local
governments, as well as developing improved mechanisms
to monitor and report on progress toward achieving
national goals. Towards these ends, accompanying the
release of the Strategy the White House also issued a NHAS
Federal Implementation Plan that outlines key, short-term
actions to be undertaken by the Federal government to
execute the recommendations outlined in the Strategy.
Additionally, the White House issued a Presidential
Memorandum directing agencies to take specific steps to
implement this Strategy.

Implementing the NHAS does not fall to the Federal
government alone. The release of the NHAS is just
beginning. Success will require the commitment of all
parts of society, including state, local and tribal
governments, businesses, faith communities, philanthropy,
the scientific and medical communities, educational
institutions, people living with HIV, and others.
Countless Americans have devoted their lives to fighting
the HIV epidemic and thanks to their tireless work we
have made real inroads. People living with HIV have
transformed how we engage community members in
setting policy, conducting research, and providing services.
Researchers have produced a wealth of information about
the disease, including a number of critical tools and
interventions to diagnose, prevent, and treat HIV.
Successful prevention efforts have averted more than
350,000 new infections in the United States. And
healthcare and other services providers have taught us
how to provide quality services in diverse settings and
develop medical homes for people with HIV. This moment
represents an opportunity for the nation. Now is the time
to build on and refocus our existing efforts to deliver
better results for the American people.
What You Can Do
• Read the Strategy and accompanying Federal
Implementation Plan available online at AIDS.gov.
• Follow updates on the Strategy on AIDS.gov and the
AIDS.gov blog (http://blog.aids.gov/) which features
posts from the Office of National AIDS Policy, HHS
officials, and others.
• Inform others about the Strategy and encourage their
engagement in activities that help achieve its goals.
• Discuss what your agency or organization can do in
new or different ways to better serve your constituents
and align your efforts with the Strategy.
Developing the Strategy
The Strategy and the action steps it contains are the result of
broad-based engagement with Federal and community partners.
Since taking office, the Obama Administration has taken
extraordinary steps to engage the public to evaluate what we are
doing right and identify new approaches that will strengthen our
response to the domestic epidemic.
The Office of National AIDS Policy hosted 14 HIV/AIDS
Community Discussions with thousands of Americans across the
country. They also reviewed suggestions from the public via the
White House website, organized a series of expert meetings on
several HIV-specific topics, and worked with Federal and
community partners who organized their own meetings to
support the development of a national strategy. The White House
also convened a panel of Federal officials from across
government to assist in reviewing the public recommendations,
assessing the scientific evidence for or against various
recommendations, and making their own recommendations for
the Strategy.
Page 37
Action Steps
Reducing New HIV Infections
• Intensify HIV prevention efforts in the communities where
HIV is most heavily concentrated
• Expand targeted efforts to prevent HIV infection using a
combination of effective, evidence-based approaches
• Educate all Americans about the threat of HIV and how to
prevent it
Increasing Access to Care and Improving Health Outcomes for
People Living with HIV
• Establish a seamless system to immediately link people to
continuous and coordinated quality care when they learn
they are infected with HIV
• Take deliberate steps to increase the number and diversity
of available providers of clinical care and related services for
people living with HIV
• Support people living with HIV with co-occurring health
conditions and those who have challenges meeting their
basic needs, such as housing
Reducing HIV-Related Disparities and Health Inequities
• Reduce HIV-related mortality in communities at high risk for
HIV infection
• Adopt community-level approaches to reduce HIV infection
in high-risk communities
• Reduce stigma and discrimination against people living with
HIV
Achieving a More Coordinated National Response to the HIV
Epidemic
• Increase the coordination of HIV programs across the
Federal government and between Federal agencies and
state, territorial, tribal, and local governments
• Develop improved mechanisms to monitor and report on
progress toward achieving national goals
• Participate in state and local discussions about how HIV
prevention, care and treatment efforts can be finetuned
to better serve vulnerable populations and
contribute to realizing the Strategy’s goals.
• Engage new partners in HIV prevention, care, treatment
and stigma-reduction efforts to strengthen our
collective efforts and reach more people.
The National HIV/AIDS Strategy provides a basic
framework for moving forward. With government at all
levels doing its part, a committed private sector, and
leadership from people living with HIV and affected
communities, the United States can dramatically reduce
HIV transmission and better support people living with
HIV and their families.
i Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA
2008;300(5):520-529.
ii CDC. HIV Prevalence Estimates—United States, 2006. MMWR 2008;57(39):1073-76.
iii Kaiser Family Foundation. 2009 Survey of Americans on HIV/AIDS: Summary of Findings on the
Domestic Epidemic. April 2009.
iv CDC. Estimates of new HIV infections in the United States. August 2008. Available at
http://www.kff.org/kaiserpolls/upload/7889.pdf
v CDC. HIV Prevalence Estimates—United States, 2006. MMWR 2008;57(39):1073-76.
vi If the HIV transmission rate remained constant at 5.0 persons infected each year per 100 people
living with HIV, within a decade, the number of new infections would increase to more than
75,000 per year and the number of people living with HIV would grow to more than 1,500,000
(JAIDS, in press).

ACOT Meeting Notes
Attendees: Brittony McNaughton, Judith Hunter, Renee Breazeale, Sherry Cusumano, Angie Byrd,
Jennifer Torres, Liam Mulvaney, and Dina Hooshyar
The group’s tasks were to identify ways to re‐energize the group, BHLT leadership needs and tasks for
the leadership, and the operation groups. The discussion began with the idea from FACT to merge the
operation groups into one operation group. FACT and ACOT would become a singular Operations group
for the BHLT. In addition, the group discussed that the Operations group would be task‐oriented and
would only come together as needed to accomplish a particular task. Members meeting would vary
depending on the task at hand. An example would be to form a task group to work on the DSRIP project
or the 1115 Waiver. The group discussed empowering itself to work on community needs such as the
Case Management definitions and best practices. These things were suggested by the BHLT but no one
was tasked with implementing these changes once the group suggested them. This conversation
developed into a more broad conversation about the work that has been done, approved, then stalled.
This opened the conversation about the BHLT’s ability to enforce changes once they’ve been approved.
Regarding the ability of the BHLT to enforce changes on member organizations, a suggestion was made
that the BHLT empower itself to implement changes by defining the process for that. The warm hand off
was an example of this process being stalled. The group discussed that the BHLT approved this and Ron
had stated that he would like to have everyone implement documentation of the information on the
form and then handing that off to the next provider of care when the patient leaves a facility. Even
though, many agencies are working toward this and some have implemented it, it has not been used
system wide. This led to a more specific question about whether a formalized agreement could be made
by the BHLT members and the organizations that they represent (i.e. PAC represents providers) that
they will implement the changes being approved. This brought up some concern about agencies with
boards or other governing bodies that must approve a change before it can be implemented. After much
discussion, the group unanimously approved the following motion.
Motion 1: Operations group suggests that we create a formal agreement that is signed by each
BHLT member representing the organization or stakeholder that they represent, that allows
the representatives of BHLT to have power to make changes in their own facilities (when
applicable) or to return a formal denial and rationale for inability to make the change.
ValueOptions was identified as the organization that really has the power to make the changes due to
the funding coming through them to us in order to administrate and manage the NorthSTAR Program.
However, a discussion revolved around the other funding opportunities that were referenced by the
TriWest/ Zia Partners report. It was proposed that one of the possible tasks for the BHLT leadership
would be to look at the other opportunities for funding, and to evaluate if any of this funding could any
be used to implement any of the ideas generated from the task oriented groups. The discussion evolved
into a conversation about leadership roles. Some ideas were that the people who do have the ability to
access funding like ValueOptions, Foundations, City officials, and County representatives hold the
leadership. However, the group felt that having these people, as representatives of the BHLT would be
sufficient. The overall discussion was that the BHLT needed to invite the various funding entities to the
table. Some ideas were all of the cities in Dallas County have a representative, private Insurance
companies, Medicare, and someone from the State. The group felt that this was just a starting list. After
this discussion, the group unanimously approved the following two motions.
Motion 2: Operations group would like to task the leadership to find the alternative funding
sources that were mentioned in the TriWest/ Zia report.
Page 38

ACOT Meeting Notes
Motion 3: Operations group would like to have the leadership roles more clearly defined and
implemented into the charter.
The group began to discuss who should be in the leadership roles. Many ideas were suggested including
potential people to fill open seats, types of representation that may be needed, and enriching the
leadership. However, the consensus was that until we address some of the issues mentioned previously,
it might not be productive at this time. This topic was tabled until the next group meeting so that the
charter may be reviewed and BHLT will have had time to respond.
Page 39

Minutes for June 21, 2012 @ 8:35 am
Behavioral Health Steering Committee
Thursday June 21, 2012
Ron Stretcher opened the meeting with discussion regarding the process for issuing and
scheduling bench warrants. There will be a new process in alerting the courts that a bench
warrant is needed. Terrell State Hospital will now email the bench warrant request to the
coordinator and chief clerk in each court. This should alleviate the issues that arise from the
mail and fax process.
60 defendants have been transferred from the VSH list to the Rusk State Hospital list. The
clearinghouse will still manage all defendants waiting for a bed. Hopefully this will decrease
wait times for state hospital admissions and decrease the jail population.
Feedback from BHLT:
Judge Wade discussed the boarding home ordinance. She feels it may decrease the number
of boarding homes available to the various diversion programs. The ordinance is still being
drafted but one of the requirements is anyone who works at the boarding home must have a
criminal background check. This could pose a problem because a number of these
employees are current/former diversion participants. Amongst other requirements, the
ordinance will not allow any boarding home owners to be payees and will charge at least a
$500 fee for licensure.
There are concerns this ordinance could have both a positive and negative effect on boarding
homes, the owners, and the residents. Better boarding home standards are desired but will
they be so strict the number of available homes will decrease? It may be difficult for owners
to comply with all the new standards and the ordinance may cause boarding home fees to
increase, employees jobs to be at risk due to criminal background checks, etc.
Please put all concerns regarding the boarding home ordinance in writing and email them to
Judge Wade at Kristen.Wade@dallascounty.org and she will forward them accordingly.
Page 40
Behavioral Health Steering Committee
Minutes from April 19, 2012
Page 1 of 2

SPN Reports:
Metrocare
Sherry Lockhart advised the minimum felony numbers will be met soon. 23 new felony
participants were added to post DDC. The residential program is now at capacity and there is
a small waiting list. Awesome news ~ keep up the good work!
Probation
Vonda Freeman stated their numbers look really good and beginning next month all new
participants will be triaged and included in next months stats. This increase should put the
number of active participants at 40. The numbers are up and this should have a positive
influence on TCOOMMI funding. Way to go!
Lifenet
Crystal Garland reported 13 participants in misdemeanor jail diversion, 6 in ATLAS and 2
pending referrals from each court.
ABC
Carolyn reported they have 4 participants in ATLAS and 6 in post DDC. Next month she will
provide the numbers for STARR program.
Discussions:
Lynn Richardson stated Austin will be looking at the outcomes of our programs and she
would like input on how we should go about saving data to support the outcomes. Ron
Stretcher stated we may need to look at the outcomes every 6 months and at that time, check
to see if the participants have been rearrested.
Sherri Lockhart stated Dallas County is no longer at the bottom of the TCOOMMI’s list for
recidivism for felony participants. Sherri will forward the statistics to those who would like to
see such data. Patricia Scali informed she keeps statistics on those who have worked with
jail diversion and were rearrested after completing the program.
Judge Wade stated Lynn has the best interns and some of them can be utilized to assist with
data collection.
Presentations:
Gerald Compton, Probation, provided and very informative and detailed presentation of
CATS (Comprehensive Assessment and Treatment Services). Thanks Gerald!
Announcements:
Vickie Rice, PD, will discuss her recent trips to mental health hospitals at the July meeting.
Adjourned @ 9:30 am
Page 41
Behavioral Health Steering Committee
Minutes from April 19, 2012
Page 2 of 2

ADDENDUM ITEM # 10
KEY FOCUS AREA: A Cleaner, Healthier City Environment
AGENDA DATE: June 27, 2012
COUNCIL DISTRICT(S): N/A
DEPARTMENT: City Attorney's Office
Code Compliance
CMO: Thomas P. Perkins, Jr., 670-3491
Joey Zapata, 670-1204
MAPSCO: N/A
________________________________________________________________
SUBJECT
An ordinance adding Chapter 8A and an amendment to Chapter 33 of the Dallas City
Code to provide: (1) licensing procedures, requirements, qualifications, and fees for
boarding home facilities; (2) requirements and procedures for inspection of boarding
home facilities; (3) construction, maintenance, reporting, record keeping, education, and
care requirements for boarding home facilities; (4) requirements for criminal background
history checks for the owners, operators, and employees of boarding home facilities; (5)
food handler requirements for boarding home facilities that serve community meals; and
(6) updated terminology in Chapter 33 to correspond with changes to Chapter 247 of
the Texas Health and Safety Code governing assisted living facilities - Financing: No
cost consideration to the City
BACKGROUND
State law allows cities to adopt ordinances to regulate boarding home facilities. A
boarding home facility is an establishment that furnishes lodging to three or more
persons who are unrelated to the owner by blood or marriage, and does not provide
personal care services; however, it may provide community meals, light housework,
meal preparation, transportation, grocery shopping, money management, laundry
services, or assistance with self-administration of medication.
The proposed ordinance requires owners or operators of boarding home facilities to
obtain a license annually and comply with the following standards: (1) comprehensive
inspections; (2) re-inspections based on complaints; (3) maintenance of certain records;
(4) posting of certain signs and documents; (5) compliance with certain housing and
health standards; (6) reporting of residents' injuries, incidents, and unusual accidents;
(7) reporting of residents' abuse, neglect, and exploitation; (8) prohibition on engaging in
specific activities with residents that result in conflicts of interests; (9) maintenance of
detailed records if they manage residents’ funds;
Page 42

BACKGROUND (Continued)
(10) annual training; and (11) prohibition on persons with specified criminal convictions
from serving as owners or operators. The proposed ordinance does not conflict with the
City's existing zoning requirements for boarding home facilities.
PRIOR ACTION/REVIEW (COUNCIL, BOARDS, COMMISSIONS)
The Housing Committee was briefed on April 30, 2012.
City Council was briefed on May 2, 2012 and June 20, 2012.
FISCAL INFORMATION
No cost consideration to the City.
Page 43
Agenda Date 06/27/2012 - page 2