The Brown County A.D.A.M.H.S. Board has signed a subcontract with Brown County Counseling (BCC) to implement the majority of the multi-dimensional family therapy (MDFT) grant. BCC is engaged in the challenging recruiting process for an individual to serve as the Multi-Dimensional Family Therapist for the project. BCC also plans to train additional clinical staff in MDFT once the therapist position has been filled.

Implementing an MDFT program is expected to result in the following outcomes:

• a reduction in adolescent substance abuse;
• improved participant and parental relationships;
• fewer adolescent arrests and convictions;
• increased school attendance; and
• reduction in adolescent residential care and hospitalizations.

The purpose of the grant is to identify the strengths and weaknesses of the available community services. Toward this end the Brown County Community Board of Alcohol, Drug Addiction and Mental Health Services is collecting indirect data to establish baseline demographics of service area residents. Examples of current data include Medicaid recipients, current and projected population trends, SMD (Severally Mentally Disabled) count and trends, past and current service utilization, health statistics and criminal justice figures. The Board members are evaluating the existing mission statement and developing a SWOT (Strengths/ Weaknesses/Opportunities/Threats) analysis. This process has assisted in re-focusing and re-energizing board members and service providers.

A series of focus groups is planned for this spring. A variety of participants will be invited. They include groups that represent consumers, family members, providers, law enforcement, medical personnel and other community leaders. It is anticipated that these groups will be candid in their responses as to strengths and weaknesses in the service delivery system. In addition, they have been selected to provide their unique expertise.

The objective and subjective data will be synthesized into the development of a strategic plan that will identify specific program priorities designed to improve clinical compliance and outcomes. Data based decision monitors will be put into place to evaluate the progress of the strategic plan.

Brown County developed the infrastructure for the crisis intervention team (CIT) and the jail services by hiring staff, writing policies and procedures, and developing training materials.

They trained 44 Brown County officers, 8 officers from other counties, 9 Brown County mental health personnel, 7 other county mental health personnel, 6 hospital personnel and 3 emergency medical technicians in the CIT approach. Video tapes were developed for on-going staff development.

During the 3-year grant period, 804 mental health screenings in the jail were completed. The Brown County Sherriff’s Office (BCSO) handled 260 mental health cases: 94 calls (36%) with the assistance of mental health crisis responders and 166 calls (64%) by the officers alone.  Inmates and diverted individuals were linked to appropriate mental health services. The ability to obtain follow-up results on referred individuals was severely hampered due to the financial problems and eventual closing of Brown County Counseling, the primary provider of mental health services.

The number of mentally ill incarcerated has increased compared to the baseline gathered during the planning process.  This is due to the way the data were collected.  The only means to gather the number of people with mental illnesses in jail was to compare 3 months of jail census lists to the known clients of the county mental health center.  That comparison reflected a baseline of 15%.  When qualified mental health professionals and a psychiatrist started doing assessments at the jail, many more inmates have been identified with mental illness diagnoses.  Snapshots taken along the way show that the percentage of people with mental illnesses in the jail ranged from 11% to 45%.

Of the 260 mental health cases handled by the BSCO, 93% (243) were linked to community treatment services.

Of the 260 mental health cases handled by the BSCO, 7% (17) resulted in an arrest.

With the positive outcomes and track record of success, the CIT philosophy has become an integral part of the law enforcement culture of the BCSO.  A grant from the Ohio Department of Mental Health (ODMH) has provided the financial resources to continue the CIT program.

The Brown County Community Board of Alcohol, Drug Addictions and Mental Health Services estimates that the jail component of the project saved the jail approximately $156,000 over the grant period.

The Brown County CIT program continues to be recognized as a model for rural CIT and is one of the first successful rural CIT programs in the United States. Notable achievements include:

• Presentations at several national GAINS Center and CIT conferences, Presentation at the National Association of Rural Mental Health Conference in Honolulu, Hawaii,
• Inclusion in the GAINS Center Spotlight on Innovation Programs,
• Featured in a national tele-net conference sponsored by the Technical Assistance & Policy Analysis Center for Jail Diversion (TAPA), and
• Consultation to the TAPA Center for the development of a toolkit for creating jail diversion programs.