2020 was a year like no other, one that highlighted the strength and resilience of our communities as we faced daunting challenges and loss. Looking back across the year for Integral Care, I am heartened by the commitment, compassion and creativity of our teams. Through our first digital only FY2020 Annual Report, I invite you to learn about our work to improve the lives of adults and children living with mental illness, substance use disorder and intellectual and developmental disabilities (IDD) in Travis County.

As the Local Mental Health and Intellectual and Developmental Disability Authority for Travis County, our services are part of the publicly funded response to any disaster or crisis. We collaborated with other agencies and organizations to support our whole community as the COVID-19 global pandemic hit our communities. As dedicated public servants, our employees continued to provide face-to-face services as well as rapidly transitioning many to telehealth and telephone to support the health and safety of clients and staff.

As we personally and professionally tackled the pandemic, our nation faced a renewed call for racial justice and equity after the murder of George Floyd. In response, our Board of Trustees appointed a Board/Staff Ad Hoc Committee on Racial Equity and our staff initiated a town hall and other events to explore how our organization can learn about our own institutional racism and address structural inequities. Our board and staff together are exploring these issues with compassion for each other and a commitment to change.

Integral Care is committed to the health and well-being of our community every day – in good times and bad. If this year has taught us one thing, it’s that we are stronger together.

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Integral Care, the Local Mental Health and Intellectual and Developmental Disability Authority for Travis County, recently launched a new Assisted Outpatient Treatment (AOT) program, which will use practical, evidence-based interventions to build health and well-being for adults in Travis County who live with serious mental illness (SMI). The innovative AOT program is designed to improve adherence to mental health treatment plans, which reduces inpatient psychiatric stays and criminal justice involvement – and ultimately helps participants reach their full potential and thereby engage more fully in their communities. The program is a collaboration between Integral Care, Travis County Probate Court, Travis County Clerk’s Office and Dell Medical School’s Department of Population Health at the University of Texas at Austin. It will be funded by a U.S. Substance Abuse and Mental Health Services Administration grant award of $1 million per year, over the next 4 years. Together, these organizations will construct a framework of well-being through identification, referral, care and treatment of AOT clients who are weathering life’s storms.

“This grant brings together stakeholders across the community who are committed to building a healthier and stronger Travis County for all by ensuring that people living with serious mental illness are able to access and maintain the treatment they need,” said David Evans, CEO of Integral Care. “Together, we will provide intensive, specialized services that support the health, well-being and recovery of over 200 program participants.”

When experiencing a serious mental health condition, it can sometimes be difficult to maintain treatment that supports the ability to function in daily life and in the community. This can contribute to a range of challenges including alienation from family and friends, homelessness, and involvement with the criminal justice system. Studies show that by improving adherence to treatment services, AOT reduces arrests, hospitalization and incarceration of individuals living with serious mental illness by approximately 70%. These interventions save taxpayers 50% of the cost of care and most importantly improve the quality of life for individuals living with SMI. With this new grant funding, AOT will support individuals who have experienced multiple episodes of hospitalization, arrest, incarceration and homelessness due to the challenges of adhering to mental health treatment. Through this program, the Travis County Probate Court, presided over by Judge Guy Herman, which has primary jurisdiction over mental health hearings, will place individuals in court-supervised treatment while they continue to live in the community.

“The Travis County Probate Court is pleased to partner with Integral Care and the Dell Medical School to participate in the newly created Assisted Outpatient Treatment Program, which is designed to provide greater supervision for persons living with serious mental illness once they have left the hospital or jail and returned to the community, in the hopes of lowering the rates of recidivism in our hospitals and jails,” said Judge Guy Herman. “As the Presiding Judge of Travis County’s Probate Court, I am fully aware of the difficulty this population faces after being discharged from a hospital or jail, and I believe this program will fill a gap in service that could make a more stable life for our loved ones. The Probate Court has been attempting to establish an assisted outpatient treatment program for nearly ten years, and this grant will allow it to become a reality.“

Integral Care will monitor the individual’s treatment plan and help ensure their ongoing participation in the AOT program, facilitating their transition from inpatient hospitalization to community-based care through proactive relationship building, case management, therapy, medication, drug and alcohol treatment, and other services that support and maintain recovery. These tools will establish a foundation so clients have the stability to adhere to their treatment. Additionally, collaborative opportunities for clients will include the creation of Psychiatric Advanced Directives (PAD), facilitated by Dell Med. A PAD is a communication tool that promotes patient autonomy giving capacitated adults, living with serious mental illnesses, the legal authority to—in advance of a health care crisis – memorialize their preferences for care and to designate a proxy decision maker.

“Respecting the autonomy of persons living with serious mental illness is the principle upon which this project is built,” said Virginia A. Brown, Ph.D., Assistant Professor Department of Population Health at Dell Med. “Collaborating with Integral Care to help improve the lives of persons living with SMI brings us one step closer to creating a more just and equitable community for all,” Brown said.

Progress happens when partners from different specialties come together to provide the building blocks of health for everyone in our community. Other collaborators include Austin State Hospital, Disabilities Rights Texas, Housing Authority of the City of Austin, NAMI Central Texas, and Travis County Sheriff’s Office.

Integral Care has been awarded the full SAMHSA Assisted Outpatient Treatment (AOT) grant ($1M per year over 4 years). The funding will be used to develop an AOT program to bridge the gap between inpatient and outpatient mental health services, improve treatment outcomes and reduce incidence of inpatient psychiatric and reduce criminal justice involvement. The Austin AOT program presents a practice and evidence-based intervention designed to promote treatment adherence, empower client engagement in managing their care, reduce inpatient bed stays and involvement with the criminal justice system. The population of focus for the program will be adult clients in Travis County who are persistently struggle with adherence to needed treatment for their mental illness and meet criteria for AOT under Texas state law.

The program will bring together Integral Care, Travis County Probate Court, Travis County Clerk’s Office and Dell Medical School at the University of Texas at Austin to establish a framework for identification, referral and the care and treatment of clients living with serious mental illness. Other community partners include NAMI Central Texas, Austin State Hospital and Travis County Sheriff’s Office. All client treatment plans will employ a recovery-oriented approach. Specifically, plans will include motivational interviewing strategies, psychiatric advanced directives, and collaborative, individually tailored plans of recovery.

Our sincere thanks to the large group of stakeholders who supported the AOT application, including the Travis County Attorney’s Office, Austin Lakes Hospital, Housing Authority of the City of Austin and Disability Rights Texas.

Integral Care received $275,046 from FEMA and SAMHSA to provide Crisis Counseling Program (CCP) supports and interventions beginning April 8, 2020. Integral Care is currently providing CCP supports and interventions to two primary populations: (1) the community at large in Travis County and (2) Travis County citizens who are staying as guests at a City-run isolation facility, housed at various hotels. Individuals who are staying at these facilities have been identified as “high risk” for contracting or spreading COVID-19.

Primary services include outreach, individual counseling, public education, individual education, trauma supports, referrals, and linkage.  The majority of these primary services are delivered via telephone and videoconferencing. Some services are delivered in-person as needed. Public education is provided via local media and social media outreach.

In addition, Integral Care is providing communications support for a statewide education campaign aimed to support the emotional health of Texans during the COVID-19 pandemic. The State of Texas launched a COVID-19 Mental Health Support Line (833-986-1919) to help people who are feeling overwhelmed by the pandemic, connecting them to a mental health professional who will help them with anxiety, depression, stress, grief and worry. The goal of the campaign is to help the community feel connected, offer hope during, and provide mental health support during this time of stress and uncertainty.

Integral Care received $275,046 from FEMA and SAMHSA to provide Crisis Counseling Program (CCP) supports and interventions beginning April 8, 2020. Integral Care is currently providing CCP supports and interventions to two primary populations: (1) the community at large in Travis County and (2) Travis County citizens who are staying as guests at a City-run isolation facility, housed at various hotels. Individuals who are staying at these facilities have been identified as “high risk” for contracting or spreading COVID-19.

Primary services include outreach, individual counseling, public education, individual education, trauma supports, referrals, and linkage.  The majority of these primary services are delivered via telephone and videoconferencing. Some services are delivered in-person as needed. Public education is provided via local media and social media outreach.

In addition, Integral Care is providing communications support for a statewide education campaign aimed to support the emotional health of Texans during the COVID-19 pandemic. The State of Texas launched a COVID-19 Mental Health Support Line (833-986-1919) to help people who are feeling overwhelmed by the pandemic, connecting them to a mental health professional who will help them with anxiety, depression, stress, grief and worry. The goal of the campaign is to help the community feel connected, offer hope during, and provide mental health support during this time of stress and uncertainty.

In this time of uncertainty, Integral Care wants anyone who is feeling anxious or overwhelmed by the COVID-19 pandemic to call their 24/7 Helpline. A mental health professional will listen to them, support them without judgement and provide immediate emotional support. Call 512-472-HELP (4357) and press 1 for English, then 1 to talk to a mental health professional. The service is free, completely confidential, and available 24 hours a day, 7 days a week. Interpreters can provide support in multiple languages.

In response to the COVID-19 emergency, Integral Care’s 24/7 Helpline expanded its mental health support services. “During this time, we could all use some extra emotional support,” says Nicole Warren, Integral Care’s Helpline and Crisis Line Practice Manager. “You don’t have to wait for a crisis to call. If you’re worried about your emotional well-being or even someone else’s emotional well-being, give us a call anytime – day or night. We can work through it together.”

Integral Care continues to offer emergency mental health crisis response and intervention through the same Helpline number.

In April 2020, Integral Care received a grant of $20,000 from All Together ATX to help people with mental illness, substance use disorder, and intellectual and developmental disabilities weather the storm of the COVID-19 pandemic. The funds will allow Integral Care to provide gift cards for groceries, assistance with rent and utilities, and help with prescription costs.

• Integral Care will provide gift cards to HEB and Walmart so clients can purchase the food and supplies they need.
• Clients who have lost work due to COVID-19 and are requesting financial assistance will provide a copy of their rent or utility bills and Integral Care will make a payment directly to the vendors.
• Integral Care will cover the costs of prescriptions for established clients so they can continue their medications and stay healthy during this troubling time.

Through the All Together ATX grant program, our City leaders are using their nonprofit partners as a buffer against the worst impacts of the outbreak. They are relying on the expertise and experience of community-based institutions in the recovery effort that lies ahead. Integral Care is glad to be a part of this community-wide effort to help all members of our community weather the storm of COVID-19.

In April 2020, Integral Care received a $10,000 grant from the Alice Kleberg Reynolds Foundation that allows our intellectual and developmental disabilities and homeless services teams to provide short-term assistance to mitigate the negative impacts of the COVID-19 virus on the populations they serve.

In response to the COVID19 pandemic, Integral Care now provides most of its services via telehealth. However, many people experiencing homelessness do not own a phone and cannot access telehealth services. To ensure continuity of care, Integral Care is providing mobile phones to people experiencing homelessness. This means clients anywhere – even on the streets – can call in to a telehealth appointment and work with Integral Care staff to address their health needs. The grant will also allow Integral Care to deliver single occupancy tents and groceries to clients living on the street, allowing them to shelter in place and have their basic needs met.

Integral Care’s IDD Services Division provides people with intellectual and developmental disabilities the tools they need to live on their own while also offering extra help during times of crisis. Changes to grocery store and restaurant operations – including social distancing rules, modified schedules, and limited availability of certain products – may present unique challenges for this population. Staff have identified ten people with IDD who are currently struggling to get groceries, toiletries and cleaning supplies. The Alice Kleberg Reynolds Foundation grant allows staff to deliver groceries and other products during their regular visits throughout the shelter in place period.

Del Valle Independent School District (DVISD) received a Victims of Crime Act grant from the U.S. Department of Justice in the amount of $1,000,000.  DVISD contracted with Integral Care to expand its school-based mental health services. Integral Care has provided mental health services to students, families and staff in DVISD since 2013. With this grant, Integral Care will expand its services to nine elementary campuses and three alternative campuses, with a focus on supporting children and adults impacted by violent crime.

Integral Care will hire ten mental health professionals: six to serve students and four to provide support to family and school staff who are victims of crime. A program manager will provide oversight and supervise those providing direct mental health services. All staff will be trained to provide evidence-based psychotherapy that is trauma-informed and culturally competent.

In December 2019, Integral Care received a $523,413 grant from St. David’s Foundation to provide Mental Health First Aid (MHFA) training to 1,500 Central Texans annually for the next two years. MHFA is an evidence-based training that builds mental health literacy by teaching participants how to identify warning signs and symptoms of mental illness and apply a 5-step action plan to help individuals experiencing a mental health crisis.

St. David’s Foundation has supported Integral Care’s MHFA program since 2017. In 2018, Integral Care worked collaboratively with Bluebonnet Trails Community Services to provide MHFA training to 2,022 individuals in Travis, Williamson, and Bastrop Counties; last year, 2,059 individuals accessed MHFA training through Integral Care’s program.

Over the last several years, Integral Care has provided MHFA training to diverse audiences, including faith communities, nonprofit organizations, government agencies and departments, elected officials, and institutes of higher education. For this grant term, we plan to expand our outreach to focus on the private sector, increasing our community’s capacity to respond to a mental health crisis anywhere Central Texans live, learn, work, and play.

With a diverse corps of Mental Health First Aiders, we can reduce barriers to mental health care access throughout Central Texas. Building mental health literacy across our community – from nonprofit professionals and educators to business leaders and elected officials – helps to ensure that people living with mental illness and/or substance use disorder can get connected to the services they need.