GCB developed the infrastructure to provide culturally competent case management services:

• sought input on the project from several Hispanic groups in the community,
• formed an internal team to support the work of a Spanish-speaking case manager,
• translated key agency documents into Spanish,
• purchased for staff Spanish phrase books that focus on Spanish phrases for medical and behavioral health settings, and
• conducted five on-site training sessions that focused on basic Spanish language skills necessary to transfer calls or guide a person to a Spanish-speaking staff member.

Recruit and hire a Spanish-speaking case manager – GCB recruited and hired a Spanish-speaking case manager.

Provide mental health case management services to at least 10 people with mental illnesses whose primary language is Spanish – GCB and the new case manager make significant outreach efforts in the community. However, only one Spanish-speaking client is engaged in case management services.

Improve quality of life, rate of employment, and rate of independent living for those Spanish-speaking clients receiving case management services – The sole Hispanic client remained in treatment long enough to engage in services, complete outcome instruments, and achieve some of the planned treatment objectives. The client was able to maintain independent living, achieve employment, and report a decrease in symptoms.

Sustain the bi-lingual case manager position after grant funds end – GCB has sustained the case manager position through its annual budget for case management services. The Spanish-speaking case manager will work with Spanish-speaking clients as a priority, but will also serve English-speaking clients in order to complete his case load.

HomeLink provides housing information, referral, and brokerage to adults with severe mental illness in Hamilton County. HomeLink addresses its overarching goal to end homelessness among the mentally ill by focusing on two objective areas.

The primary objective of HomeLink is to provide direct assistance to clients and their case managers via a Residential and Housing Supermarket—a single comprehensive resource for information and linkage to the mental health system and community-based housing and residential services.

Secondary objectives focus on enhancing efficiencies in the mental health housing system through the management and coordination of housing resources and the collection, maintenance, and evaluation of data and information.

HomeLink’s outcomes include connecting unserved homeless, mentally ill individuals to mental health services. This is being achieved by reaching out to homeless individuals on the streets, in soup kitchens, shelters, etc. HomeLink also assists these clients and others who are already in mental health services to find and access transitional and permanent housing.

HomeLink is a new program that has been up and running since July 1, 2001. To date we have connected 97 homeless, mentally ill individuals to mental health services and have found housing placements for 70 clients.

The Greater Cencinnati Behavioral Health Services (GCB) In Home Stabilization Service (ISS):

• Received 200 referrals during the grant period
• Provided 148 episodes of care during the grant period
• Provided care at a per episode cost of $540, compared to $1,800 for the average hospital stay during crisis
• Provided 100% of services in the field

Project outcomes include:

• 94% of consumers were able to resolve crisis without disruption to housing
• 95% of consumers resolved crisis without use of residential or institutional care
• No consumers were incarcerated
• Only 13% of consumers used crisis facilities or hospitalization within 30 days of the ISS services
• 90% of case managers reported that ISS prevented use of more costly crisis services
• 97% of surveyed consumers were satisfied with ISS
• 95% of surveyed case managers were satisfied with ISS

GCB successfully implemented the ISS project with excellent client and cost effective outcomes. As result, the program received continuation funding from the Hamilton County Mental Health Board. The success of ISS contributed to the development of a similar support approach with hospitalized clients, that likewise has been very successful. There are opportunities to apply this model to other consumers in acute need including the homeless and those involved in the criminal justice system.

In terms of dissemination, ISS staff presented the program to:

• Hamilton County Mental Health Board
• Hamilton County Mental Health Coalition
• Hospital Alternatives Committee
• The National IAPSRS Conference in May 2000 in Washington, DC
• The State Recovery Conference in June 2000 in Columbus, Ohio

Study 120-150 people with severe mental illnesses who use the One-Stop Center to find employment – the study included 158 people

Answer the following questions:

What is the One-Stop mental health pathway process? – The One-Stop mental health pathway was a blend of services from Greater Cincinnati Behavioral’s supported employment program for people with severe mental illnesses and mainstream services from the One-Stop Center that included job search and placement and other employment-related services.

What are the employment outcomes of the mental health pathway? – Of the 158 study participants, 38 (24%) gained employment and 28 (18%) of the 38 maintained employment for a least 90 days. (In Ohio, more than 90% of people with severe mental illnesses are not employed.)

What combination of services work best for which type of client? – Participants who used One-Stop services had high employment rates only when they also used most of the specialized services offered through Greater Cincinnati Behavior’s supported employment program.

What are the predictors of successful employment? – For low users of the blend of services, the employment rate was 12%. For high users of the blend of services, the employment rate was 51%.

What policies or other community factors promote or impede employment? – Due to funding cuts, benefits and entitlement consultation services are not longer offered at the One-Stop. (Many people with severe mental illnesses are reluctant to work for fear of losing health and disability benefits.) Also, clients wanting to work less than 20 hours a week are given low priority for services at the One-Stop. (Many people with severe mental illnesses want to work, but are only able to work less than 20 hours a week.)

Compile study results into a final report – Greater Cincinnati prepared two reports, the full study report and an executive summary.>

Disseminate study results through publications and presentations - Over 400 executive summaries of the report have been mailed to mental health providers, policymakers, researchers, and other stakeholders. Greater Cincinnati Behavioral staff presented the study results to over 200 people at a meeting of the Ohio Employment Leadership Alliance.

Greater Cincinnati Behavioral did an excellent job in conducting this study. The results point to the importance of blending mental health employment programs with mainstream employment services for greater employment success for people with severe mental illnesses. The study results have been widely disseminated.