Ms. Altum has:

• conducted a needs assessment with the staff of RSMC and
  
• developed procedures for referrals and other logistics of working collaboratively.
  

In the process of developing a collaborative model where professionals working side by side can provide mental health and primary care services, CMHC anticipates certain challenges. Initially, CMHC will need to evaluate the impact of stigma as an obstacle to utilization of mental health services and develop and assess ways to lessen stigma as an obstacle. Outcomes will be established to measure the effectiveness of the new model. Practical issues of unequal insurance coverage for primary care and mental health care will need to be addressed, as well as clarifying funding sources for home-based and office-based services.

Due to workforce challenges common to rural areas, a project coordinator was not hired until one year after this grant was awarded. It had been eighteen months since the first collaborative meeting.  The collaborative process was initially tenuous due to historically minimal coordination between the criminal justice and mental health systems, but the project coordinator’s hands-on responsiveness to the criminal justice system throughout the planning process led to increased trust and cooperation. The project coordinator linked the project with statewide strategic planning, facilitated cross training opportunities and was successful at enhancing services under the current environment.

Surveys were conducted with clinical staff to determine areas for improvement in communication with criminal justice.  Surveys of inmates at the Dearborn County jail revealed that 85% of the inmates were there because of mental illness and/or substance use related offenses.  Jail capacity and utilization data were gathered along with a review of services, indicating that the jails are operating at capacity and there is a lack of treatment alternatives for persons with substance use disorders.

Site visits were conducted at various programs in Indiana and Ohio, including the Ft. Wayne Indiana Crisis Intervention Team, the Brown County Boundary Spanner program, and the Psychiatric Assertive Identification and Referral project, a diversion program, in Marion County, Indiana.

A strategic plan was developed to improve services and health outcomes of individuals in five counties of southeastern Indiana who have mental health/substance abuse problems and are involved in the criminal justice system.  The plan is to hire a boundary spanner who will facilitate care coordination and program development, coordinate cross-system training events and work toward sustainability of services. The grantee has successfully applied to the HFGC for funding to achieve the goals of the strategic plan.

A boundary spanner position will be established and grant funding will pay for hiring, salary, benefits, travel, training, computer and office supplies needed for this position.

A business plan for implementation of the boundary spanner position has been submitted.

The grantee achieved all of the performance targets but not by the original target dates.  The start of the grant and programming was delayed by almost 9 months due to the difficulty the grantee had in recruiting the right candidate for the team leader position.  There were also challenges in recruiting for the substance abuse specialist and the registered nurse position.  The rural location of the Batesville office also was a factor in the delay of filling the positions and having the program up and running by the target date of October 2002.

A total of 38 individuals have been served over the grant period, with 35 currently active.

• 46% of the direct service was provided to clients in the community
• There were 2.9 contacts per week per client
• Clients are being seen an average of 10 hours per month and often by three or more of the team members. This is 2.3 hours per week per client.
• Adequate funding to sustain the program beyond the grant period was secured.  Funding for the ACT services in Ripley and Franklin counties is included in the agency’s budget.

Using the Consumer Satisfaction Survey for the pre-scores, the average score was 4 out of a possible 5.  Using the Quality of Life instrument for the post scores the average score was 3.2 out of a possible 5.  Even though the scores are not comparable, they do indicate an above average level of satisfaction with current life situation.

The data that was provided indicated that there were 16 clients who had 29 separate admissions pre-implementation and 11 clients who had 24 separate admissions post-implementation.  The number of clients admitted showed a 31% reduction.

99% of the consumers signed their treatment plans.

Pre-data indicated 2 clients with 32 hours of involvement; post- data indicated 13 clients with 347 hours of involvement (307 work and 40 education), a 91% increase in hours.