Clermont County Mental Health & Recovery Board

1088 Wasserman Way, Suite B
Batavia, OH 45013
513-732-5407
http://www.ccmhrb.org

Project Title
Assesment and Specialized Treatment
Grant Description
To expand assessment and treatment options for diverted felony offenders with substance use disorders in Clermont County
Focus Area
Joint Substance Use Disorder/Severe Mental Illness\Criminal Justice
Region Served
Clermont County, OH
Award Amount
$298,000
Year Awarded
2006
Grant Duration
33 months

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Project Title
Clermont County Strategic Planning for Adolescent Substance Abuse Treatment
Grant Description
To conduct a comprehensive planning and development effort in Clermont County that will produce a plan to maximize the available adolescent treatment resources and develop new resources as needed
Focus Area
Substance Abuse
Region Served
Clermont County, OH
Award Amount
$30,399
Year Awarded
1999
Grant Duration
12 months
Results

The goal of the project was to plan adolescent substance abuse treatment services for Clermont County. The Clermont County Mental Health and Recovery Board hired a consultant to assist them in conducting the needs assessment and completing the strategic and business plans. The consultant developed a collaborative planning project team to provide input regarding the data collection and planning processes. Highlights of this planning process follow.

The team completed an assessment of adolescent substance abuse treatment services and gaps in the continuum of care for adolescents within Clermont County.

The project consultant surveyed 185 professionals and parents over a three-month period. Only 32 of 100 surveys sent to key stakeholders were returned, but those 32 represented a variety of stakeholder groups. In addition, 120 adolescents participated in focus groups. The key findings of the data collection included:

  • Clermont County is above the state averages in DUI arrests and suicide rates.
  • Overall youth substance use is slightly above the state average of 16%, and 6th and 8th graders are much more likely to use alcohol and other drugs compared to the state average.
  • Beer and marijuana are the most abused substances by teens in the county.
  • The county lacks intensive treatment services, family-oriented treatment services, and aftercare programs for youth.
  • Lack of parental involvement was most often mentioned by stakeholders as a barrier to improved treatment involvement and outcomes.
  • Clermont Recovery Center, the county's only public substance abuse treatment provider, was noted as a significant strength for the county.

The Mental Health and Recovery Board developed a three-year strategic plan. The plan focused on five critical success factors:

  • enhance the availability and accessibility of family-oriented services,
  • use multiple strategies to increase parental involvement in treatment,
  • expand early identification and intensive treatment services,
  • promote an holistic approach through formalized collaborative processes among all system entities, and
  • obtain additional funding for services.

The plan included goals, strategies, and outcome measures for each factor and times frames for each outcome. These factors and data from the needs assessment were included in a business plan for home-based adolescent treatment services (see the Clermont County Mental Health and Recovery Board grant titled "Home-Based Adolescent Substance Abuse Services" for more information. The project team enhanced collaboration in Clermont County.

Representatives from nine agencies were on the planning project team. The use of a diverse project planning team increased the knowledge of agencies and systems of each other's work. One of the critical success factors of the strategic plan focused on the need for the collaborative efforts to promote improved treatment for teens.

The facilitators of the planning process included:

  • use of a trained planning consultant;
  • conducting two needs assessments at the same time, thereby reducing duplication and increasing collaboration;
  • use of an open process, which led to dialogue regarding philosophical and legal differences among agencies and systems;
  • use of e-mail to keep in touch between the regularly scheduled meetings, which kept participants involved and energized; and
  • assistance of the Foundation staff through trainings, research, and roundtables for the group of grantees.

The barriers of the planning process included:

  • time limitations of project team members,
  • 32% rate of return for the key informant survey, and
  • time needed in team meetings to dispel misperceptions about roles and constraints of various agencies and systems.

The Foundation used the needs assessment from this project in a white paper entitled Substance Abuse Treatment Needs of Adolescents in Southwest Ohio.

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Project Title
Home-Based Adolescent Substance Abuse Services
Grant Description
To develop home-based adolescent substance abuse treatment services in Clermont County
Focus Area
Substance Abuse
Region Served
Clermont County, OH
Award Amount
$409,100
Year Awarded
2000
Grant Duration
36 months
Results

The Clermont County Adolescent Substance Abuse Treatment Services Strategic Plan identified three issues: lack of holistic intensive services in the current adolescent continuum of care; minimal family involvement in current services; and problems with access to adolescent treatment, especially for family members and other care givers. The "Home-Based Adolescent Substance Abuse Services" program addresses these issues while improving treatment efficacy and reducing the target populations' out of county placements. This intensive level of care improves family access and involvement by providing treatment in the home and natural community environment.

The goal of the "Home-Based Adolescent Substance Abuse Services" project is to improve the treatment outcomes of substance abusing adolescents in Clermont County using an ecological Multidimensional Family Therapy (MDFT) model (Liddle, Howard). The interventions include crisis activities, immediate problem solving, linkage to appropriate collaborative services and engagement in facility based out patient family treatment, with emphasis on case management roles of linking, brokering and problem solving strategies that draw on system strengths. Intensive supervision and training from Dr. Liddle are strong components of the project. MDFT allows interventions to occur in multiple ways, as it "views adolescent drug use is terms of a network of influences...and suggests that reducing unwanted behavior and increasing desirable behavior occur in multiple ways in different settings" (Principles Of Effective Treatment: A Research-Based Guide, NIDA 1999).

Treatment will be flexible and delivered under a case management model and include individual and family contracts in the home, the agency facility (transported by the case manager) or in other community locations. Interventions with all family members present may not be appropriate at all points.

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Project Title
Improving School-Based Mental and Behavioral Services
Grant Description
To expand the availability of school-based mental health services throughout Clermont County
Focus Area
School-Based Child Health Interventions
Region Served
Clermont County, OH
Award Amount
$171,067
Year Awarded
2000
Grant Duration
24 months
Results

Throughout the grant period, the Board has increased the amount of school-based services by reallocating funding streams and shifting service delivery toward the needs of children. Several clinicians provide crisis counseling, group counseling, and staff support services for students in 11 Clermont County schools. Schools and the Educational Service Center provide funding for specialized programs, and we plan to obtain funding from schools to expand supports to regular education students.

Providing consultation and training to school professionals has been a priority throughout the grant period, as this allows educators to become more aware of behavioral health issues and empowers them to promote positive mental health on a daily basis. A full day of free training was offered to school staff to address working with difficult youth. The development of a county-wide bully prevention curriculum is underway, involving nine elementary schools. A comprehensive training curriculum to increase awareness, sensitivity to mental health issues, and skills for promoting healthy development in youth is also being developed for all levels of school personnel.

Phase three involves a collaborative regional survey to assess students’ level of functioning, tendency to seek help from others, school connectedness, and family attachment.

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Project Title
Juvenile Offender Assessment and Treatment Initiative
Grant Description
To expand assessment and treatment options for youth in the Clermont County Justice System
Focus Area
Joint Substance Abuse/Severe Mental Illness\Criminal Justice
Region Served
Clermont County, OH
Award Amount
$270,500
Year Awarded
2004
Grant Duration
36 months

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Project Title
Mental Health Jail Diversion Program
Grant Description
To implement a jail diversion project for appropriate mentally ill persons
Focus Area
Joint Substance Abuse/Severe Mental Illness\Criminal Justice
Region Served
Clermont County, OH
Award Amount
$101,500
Year Awarded
2000
Grant Duration
24 months
Results The jail diversion team serves people with severe mental illnesses who normally would be incarcerated. A case manager provides mental health evaluation and coordinates treatment services and a probation officer provides intensive supervision. The program started in April 2001.

The team met the following objectives:

  • Clermont County MHR Board contracted with the Clermont County Municipal Court to hire a probation officer to work with people with severe mental illnesses.
  • The probation department hired and trained the probation officer and trained other members of the court system.
  • The jail diversion team served 142 clients over the grant period, exceeding the original goal of 120 clients.
  • MHR hired a program evaluator who collected data, performed data analysis, and completed a formal evaluation for the program.
  • The project secured ongoing funding from the Ohio Department of Mental Health, the Clermont County MHR Board, and the Clermont County Commissioners.

The program met the following targets:

  • During the grant period, 36,106 days were sentenced to clients and only 7,060 were served; thus, 29,046 days were suspended.
  • For 142 participants, the average number of days incarcerated three years before the program was 85 per person and 10 days per person at the end of the two-year grant period.
  • The project evaluator conducted a satisfaction survey of 11 referral sources in 2001. On a five-point scale, the respondents gave the program an overall satisfaction rating of 4.0. The project evaluation conducted a consumer satisfaction survey on three different occasions. The results showed consistently high satisfaction. On a five-point scale, the average scores were 4.58 (n=12) in May 2002, 4.28 (n=12) in August 2002, and 4.78 (n=14) in June 2003.
  • Total treatment costs during the grant period were $286,714. Suspended jail days resulted in a net savings of $1.4 million.

The project team noted the following learnings:

  • Collaboration among agencies and systems contributed significantly to the success of the project.
  • Data collection and the demonstration of a positive cost-benefit were critical in finding sustaining funds for the program.
  • Flexibility in the program design strengthened the program by allowing adaptations according to changes in the environment.
  • Many of the clients have co-occurring mental health and substance abuse problems.
  • Many of the clients had domestic violence related to their offenses.
  • The program's probation officer made four times as many collateral contacts on behalf of clients as regular probation staff make.
  • Treatment providers need to address co-occurring disorders more effectively.
  • Treatment providers need to consider treatment specifically focused on domestic violence.
  • Structured, intensive probation supervision is effective in transitioning offenders to less intensive supervision and avoiding incarceration. Probation might consider this model for other probation populations.

Due to the excellent outcomes, the program obtained ongoing funding from the Clermont County Commissioners, the Clermont County MHR Board, and the Ohio Department of Mental Health.

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Project Title
Strategic Planning for Mental Health and Substance Abuse Services
Grant Description
To accomplish tasks that will improve the service delivery system in the face of decreasing resources and increasing need
Focus Area
Joint Substance Abuse/Severe Mental Illness\Strategic Planning
Region Served
Clermont County, OH
Award Amount
$97,000
Year Awarded
1999
Grant Duration
18 months
Results The strategic planning grant funded four separate projects:

1. Strategic Planning Process Continuation

The Board developed a Personnel Policy Manual and a Policy and Procedure Manual, both priorities in the strategic plan. The Board also focused new methods for budgeting and contracting with providers. In FY 2002, the Board converted its method of funding contract agencies from advancing all funds on a monthly basis to advancing funds based on submitted claims. In addition, the Purchase of Service contract between the Board and its providers was reviewed, revised, updated, and streamlined for FY 2002.

2. Recovery Model Training

Foundation funds were used as the local match for a grant from the Ohio Department of Mental Health for training in the Recovery Model, a widely used treatment model developed by the Boston Center for Psychosocial Rehabilitation. All (over 85) mental health administrators, supervisors, clinicians, and case managers, as well as 47 staff from key social service agencies, received training in the Recovery Model. Over 35% of consumers have been trained, and more training is planned.

3. School-Based Behavioral Health Needs Assessment

The Board compiled a matrix of current mental health and substance abuse services for children and families that can be used by schools, treatment providers, and other social service and juvenile systems in Clermont County. The Board conducted a school-based behavioral health needs assessment. The assessment included distribution of 1,300 surveys to school professionals (587 were returned – 45%) and 13 focus groups attended by over 150 school administrators, counselors, teachers, parents, students, treatment providers, and Child Protective Services staff. The results of the surveys and focus groups were shared with other county system representatives such as juvenile court and law enforcement for additional input. Key findings include:

  • 41% indicated that students are more troubled now than they were five years ago
  • 229 respondents indicated that between 10-20% of their students displayed behavior or symptoms that indicated mental health problems
  • 22% of school professionals indicated that they were not involved with mental health professionals who are helping students, but 68% of these professionals would like to be involved
  • The top three priority areas selected were school-based mental health services (15%), parent training and involvement (12%), and training for school professionals in mental health issues (11%)

From the needs assessment, the following priorities were established:

  • Collaborative Body--Establish a collaborative body consisting of professionals from schools, agencies, courts, and others to continue discussions about the issues identified in the needs assessment; consult with front-line workers and make decisions about individual cases; and share information
  • School-Based Mental Health Services--Initiate programs such as specialized groups for at-risk students and mentor/peer support programs to meet mental health needs
  • Teacher Training and Consultation--Provide training for teachers about behavioral health issues
  • Parent Training and Involvement--Develop school-sponsored parent education programs and strategies to promote parental involvement in services

As a result of this needs assessment, the Board applied to the Foundation for a school-based mental health coordinator. The Foundation awarded the grant and the coordinator began work in January 2001. The coordinator is working on implementing the priorities developed from the needs assessment. Additionally, the Board is in the selection process for a federal grant to fund additional school-based mental health counselors.

4. Data Analysis for the Crisis Intervention Team

The Board experienced difficulty in finding a financially feasible way to analyze the data. When they finally found a person to do the analysis at a reasonable cost, the data were too old to be useful. Also, because of projected budget cuts, the Board decided not to pursue the crisis intervention team.

Key facilitators included the commitment of important project players and a consultant to coordinate the project. The major barriers were time constraints and Board of Trustee vacancies that hampered sustained planning efforts.

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Project Title
Transitional Community Treatment Team
Grant Description
To implement an Assertive Community Treatment (ACT) team to work with transition age youth (16-22) in Clermont County
Focus Area
Severe Mental Illness
Region Served
Clermont County, OH
Award Amount
$281,069
Year Awarded
2000
Grant Duration
24 months
Results Clermont County Mental Health and Recovery Board (MHR) met the following objectives:
  • MHR contracted with Clermont Counseling Center (CCC) to implement the ACT team. CCC hired the ACT team members, provided training to the team in Role Recovery and adolescent culture, and developed procedures and outcomes for the ACT program.
  • CCC implemented the ACT program and began providing services in April 2001. Over the two-year grant period, the ACT team served 56 clients and provided 2,400 hours of case management services, 600 hours of individual therapy, 300 hours of psychiatric care, and 200 hours of vocational services. No peer mentors joined the team because none of the clients were ready to take on this role during the grant period.
  • The ACT team completed an evaluation of the program.
  • CCC secured ongoing funding for the team through Medicaid billing and MHR Board dollars.

The ACT team achieved the following outcomes (n=56):

  • Housing -- 75% of the clients were living independently or with family at the end of the grant period.
  • Support System -- 64% had more than one social connection or ongoing activity in the community at the end of the grant period.
  • Engagement in treatment -- 100% of the ACT clients completed the diagnostic assessment and remained on the ACT team for at least one month.
  • Employment or school -- 59% of the ACT clients were employed or attending school at the end of the grant period.
  • Global functioning -- the ACT team administered the Global Assessment of Functioning at the end of the first year and at the end of the second year. There was no significant change in the scores. The ACT team speculates that it may take a longer period of treatment before functioning scores improve.
  • Stakeholder satisfaction -- 18 out of 41 stakeholders responded to a satisfaction survey in May 2002. Overall satisfaction was 77%.

CCC staff noted the following learnings:

  • Hiring staff with expertise in serving youth is difficult.
  • Transition-age youth had more substance use problems than anticipated.
  • Housing is a complex and troubling issue for youth.
  • More youth had Medicaid coverage than anticipated.
  • Fewer youth had histories of hospitalization than anticipated.
  • The ACT and Role Recovery models both work well with transition age youth.
  • Youth want caring adults in their lives and many had involved parents.
  • Socioeconomics and family functioning make a difference in treatment outcomes.
  • Youth are involved in multiple systems. To treat the youth effectively, these systems must have significant collaboration and coordination.
  • Youth were more difficult to engage in treatment than anticipated.
  • Many youth had involvement in the criminal justice system.
  • The most difficult clients to serve were those with a combination of mental illnesses, mental retardation, and antisocial personality traits.

The ACT team will continue operations supported by MHR and Medicaid. The ACT team is searching for grant opportunities for housing to supplement ACT services.

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Project Title
Year Three: Improving Mental and Behavioral Health Services for School Children
Grant Description
To improve access to mental and behavioral health services for school-aged children
Focus Area
School-Based Child Health Interventions
Region Served
Clermont County, OH
Award Amount
$83,000
Year Awarded
2002
Grant Duration
12 months
Results Clermont County Mental Health and Recovery Board (MHR) met the following objectives:
  • CCMHRB's coordinator presented the data from the student surveys (conducted during the second year of the grant) to school administrators and community members. CCMHRB distributed over 2,000 copies of the executive summary.
  • CCMHRB obtained feedback from administrators and community members through a data release workshop and from individual meetings with school administrators.
  • CCMHRB continues to advocate and plan a coordinated system of school-based mental health services. Throughout this panning effort, CCMHRB began paying for mental health services in every school district and giving the schools the option to purchase more service hours.
  • During the third year, CCMHRB included vocational schools in its school-based services program.
  • Two School districts increased their financial contributions to increase the number of services hours provided in their schools.
  • CCMHRB will sustain a Substance Abuse and Mental Health Services Administration (SAMHSA) grant through a financial commitment from West Clermont Schools of $60, 000 and $60, 000 from CCMHRB.
  • CCMHRB developed a comprehensive training curriculum that they implemented through a week long training program for school-based providers that will be held each August.
  • CCMHRB id currently implementing an outcomes assessment.
  • CCMHRB distrubuted satisfaction surveys to school personnel to assist in the design of services.

CCMHRB developed a collaborative team that included the child mental health provider, school personnel, and community members. This collaborative team existed before the grant, which provided the support for this planning effort and facilitated the implementation of the grant.

Local policy changes allowed for financial support for school-based mental and behavioral health services to increase. Since 1999, the amount of funding for school-based services has almost doubled from $925,600 to $1,725,600 in 2004. Also, through the efforts of this grant, CCMHRB will allow Child Focus, Inc. to bill for school-based services beginning in the 2004-05 school year.

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