Bi-Lingual Mental Health Services

To hire a Spanish-speaking therapist to provide bilingual mental health and substance abuse counseling to Hispanic and Latino clients in one Ohio and three Kentucky counties

Joint Substance Abuse/Severe Mental Illness\Other

Hamilton County, OH; and Boone, Campbell, and Kenton Counties, KY

$47,940

2002

25 months

Family Service met all of the grant objectives:

• Family Service developed promotional materials about the program and marketed the program to community organizations with connections to the Hispanic and Latino population. Family Service also translated key agency documents into Spanish and designed an intake procedure so that Spanish-speaking clients could schedule appointments in Spanish.
• Family Service hired a Spanish-speaking therapist who later left the agency and had to be replaced.
• Family Service provided counseling to 43 Hispanic or Latino clients.
• Since few of the clients had insurance, Family Service did not generate enough income to support a full-time therapist in the downtown Cincinnati office. In order to retain the position, it was moved to Boone County, Kentucky where the County provides some financial support and the Hispanic and Latino population is growing.

Family Service measured two program outcomes:

• Appointments scheduled within two weeks of the initial call for help – 100% clients had appointments within two weeks (goal was 90%)
• Progress in accomplishing treatment goals – Of those clients who remained in treatment for five or more sessions (13), 92% (12) accomplished their goals.

Collaborative Connections

To expand mental health and substance abuse services into community health clinics

Severe Mental Illness

Hamilton County, OH

$10,750

2004

24 months

There was a delay in starting services due to difficulty in hiring a therapist. A therapist was placed at Babies Milk Fund (BMF) one day a week.  Family Service signed a memorandum of understanding with BMF.  There was an orientation with BMF staff and ongoing contact to deal with issues.  Family Service established a referral process, distributed brochures, and scheduled clients.

The Family Service therapist treated 10 clients during the grant period.  All of the clients were seen for mental health issues and none for substance abuse issues.  Client engagement was good (7 of the 10 clients were seen for 6 or more sessions).

For the first seven months of the program, services were conducted exclusively at BMF.  However, as parents identified the need for evening appointments, services shifted to Family Service because BMF could not accommodate evening appointments.  With 9 months remaining in the grant, administrative changes at BMF resulted in the resignation of the clinic supervisor, social worker, and two pediatricians.  The loss of these core collaborators at BMF resulted in a total lapse in requests for mental health services.

The number of clients scheduled ranged from 1-3 per week rather than the planned 6-7.  The show rate was on target at 66%. The project would have been sustained through fees for service if the projected number of clients served had been realized.

• Based on a sampling of peer review records, 85% (6 out of 7) clients met this outcome and developed treatment plans
• 7 clients were seen 5 or more times.  83% of clients (5 of 6 for whom there is information) met or partially met one of the goals identified in their plan
• 71% (5 out of 7) clients showed an improvement in their GAF scores ranging from a 3-point improvement to a 15- point improvement
• 6 clients were seen 8 or more times.  80% (4 of 5 for whom there is information) showed improved scores in symptom distress ranging from -2 to a -44 decrease in symptom distress. 1 client got worse.

Family Service maintains a relationship with BMF as a referral source for their children and families.  Clients referred are scheduled with the therapist originally assigned to the site.  At present, when a referral is made from BMF, the client is seen quickly.  If requested, the therapist will meet with clients on-site at BMF.

Compulsive Internet and Technology Behaviors Counseling Program

To expand services for compulsive internet and technology behavioral problems

Severe Mental Illness

Hamilton County, OH

$54,500

2008

12 months

Options for Adolescents with Substance Abuse

To determine the agency's readiness to provide evidence-based adolescent substance abuse treatment

Substance Use Disorders

Hamilton County, OH; Boone and Kenton County, KY

$35,300

2005

12 months

Parent-Child Interaction Therapy

To train staff in an evidence-based practice, Parent-Child Interaction Therapy, to treat emotionally disturbed children

Severe Mental Illness

Boone, Campbell, and Kenton Counties, KY

$42,000

2004

24 months

28 staff members, including all active supervisors, have been fully trained in PCIT.  While none of the original trainers remain on staff, a current supervisor is being trained to be the internal trainer.  All new staff members are encouraged to be trained in this modality despite the training fee; originally the training was provided at no cost.  All equipment has been purchased and one office has set up a family playroom to be utilized with PCIT, including the installation (at the grantee’s expense) of a one way mirror.  Fidelity to the model was high.  During the first year of the project, staff resistance to the model was significantly higher than expected. Several strategies from the Prosci Change Management seminar were successfully used to increase staff buy-in.  It was decided that while each site needed to have one or more therapists trained and willing to implement PCIT therapy, not every therapist had to utilize this modality.  Structured, ongoing consultation around PCIT is built into a monthly all-staff meeting.

Several obstacles were encountered during the first year of operation:

• Staff resistance to implementing the model
• Turnover of trained staff, particularly the two internal agency trainers
• Insufficient number of referrals for PCIT, and
• Low rates of client completion.

During the second year of operation, the project leader left Family Service.  Due to the above-mentioned factors, the new project director informed the Health Foundation that Family Service would not be able to provide services to 300 families.  The agency indicated the new goal would be to offer the PCIT intervention to a minimum of 75 families with 36 completing the program.  PCIT services were provided to 77 families with 34 fully completing the program. Although the original project goal was not met, the grantee believes that PCIT is a sound, evidenced-based practice and incorporates the practice into the treatment options of the agency.

The grantee continues to deliver PCIT to any client for whom it will be beneficial.  The current payer mix will sustain the program.

• The severity of SED children’s symptoms will decrease.  Research indicates that 54% of those completing PCIT show improvement.  Ohio Youth Severity Scale will decrease by at least 10 points. 77 clients were served with 34 families providing usable data. 59% (20 of the 34 clients) showed an improvement.  The mean change for the Severity Score for these 34 clients was -14.
• The functioning of SED children will improve for 54% of those children who complete the PCIT program.  Ohio Youth Functioning Scale will improve by at lease 8 points. 77 clients were served with 32 families providing usable data.  59% (19 of 32) of clients showed an improvement.  The mean change for the Severity Score for these 32 clients was +14.8.

It was difficultto implement the widespread change in an agency.  While staff had been informed of the project from the beginning and had (it was thought) been involved in the decision making, that was not the common perception of front line staff. An implementation team made up of all staff levels to insure early identification and quick resolution of problems. Staff supervisors were given clear messages about the expectations of coaching staff members in PCIT.

Performance Psychology Planning

To conduct market research and develop a business plan for a Performance Psychology social enterprise

Severe Mental Illness

Butler, Clermont,Hamilton, and Warren Counties, OH; Boone, Campbell, and Kenton Counties, KY

$70,500

2008

12 months

Social Enterprise for Growth

To convert existing programs into profitable social enterprise ventures

Severe Mental Illness

Butler, Clermont, and Hamilton County

$64,000

2007

9 months

The Foundation approved a grant of $64,000 on May 16, 2007 to convert existing programs into profitable social enterprise ventures. The Foundation approved a variance to extend the grant by one month. All of the grant funds were expended.

Financial, marketing, and technology assessments were performed for the Language Bank and EARN-EAP social enterprise programs.  A Business Advisory Team was created to oversee expansions and new social enterprise opportunities.  The analyses of both programs concluded that the EARN program could double its revenue by pursuing niche products targeted to specific market segments. For the Language Bank, the analysis showed significant competition and limited opportunities for growth. Family Service will continue to operate the Language Bank, but will not invest in growing that business.

Family Service developed a business plan for EARN that proposes that EARN will expand its services by offering  niche services, particularly a counseling program that is focused on compulsive internet and technology behaviors that account for significant losses in job productivity.  Existing staff will be trained by an international expert in the field of internet addiction and online behavior.  The program will be marketed broadly to businesses, schools, and individuals.  It is projected that this new program will be self-supporting after one year.

Family Service did not develop a business plan for the Language Bank.  Pricing and marketing were identified as major barriers to increasing Language Bank’s business.  Family Service’s costs for this enterprise are higher than competitors’, and they do not have the resources to promote services to new customers at this time.  In fact, service fees were actually reduced to prevent further loss of contracts.

The grantee has successfully met the objectives and financial requirements of this grant.  The Foundation awarded a grant to implement a Compulsive Internet and Technology Behaviors Counseling Program.

Working with Families

To plan for incorporating couples and families into substance abuse prevention and treatment

Substance Use Disorders

Hamilton County

$45,000

2008

12 months