Hamilton County Mental Health Board

Holiday Park West, Suite 500
801 A. West 8th Street
Cincinnati, OH 45023
513-621-3045

Project Title
Consumer Wellness Project: Consumer Employment
Grant Description
To employ two consumers in the Consumer Wellness project
Focus Area
Severe Mental Illness
Region Served
Hamilton County, OH
Award Amount
$8,600
Year Awarded
2003
Grant Duration
8 months
Results The Consumer Wellness Project grew out of a collaboration between consumers, providers, and the Health Foundation to provide quality primary care to people suffering from severe mental illness. The need for accessible primary care to be available to mental health consumers was first identified by the consumers themselves in a consumer-driven needs assessment.

The project, which began in 2001, has been staffed by two clinical nurse practitioners and two consumer clinical assistants. The staff serve consumers in four community mental health case management centers—Central Community Health Board, Core Behavioral, CRI, and QC/M. The consumer clinical assistants provide a variety of supportive functions in the management of the project, such as photocopying, faxing, signing in clients, filing, answering telephones, and contacting case managers.

In addition to providing clinical support for the project, these employment positions further the consumers’ recovery process by providing work experience, learning new skills, increasing employability, supplementing income, and increasing confidence.

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Project Title
Forensic Assertive Community Treatment (ACT) Team
Grant Description
To create an assertive community treatment team for the care and treatment of offenders with severe mental illnesses who are being released from Ohio correctional institutions
Focus Area
Joint Substance Abuse/Severe Mental Illness\Criminal Justice
Region Served
Hamilton County, OH
Award Amount
$300,000
Year Awarded
2002
Grant Duration
24 months
Results Out of the 73 clients served by the ACT team, GCB was able to collect data on 64 clients. GCB reported the following outcomes:
  • On the Symptom Distress Scale on the Ohio Outcomes, 38 out of 64 (59%) reported improvement in clinical symptoms
  • On the Quality of Life Scale on the Ohio Outcomes, 39 out of 64 (61%) reported improvement in quality of life
  • For housing stability, 42% of current clients are maintaining independent housing
  • Throughout the project, only 6 clients per year (8%) returned to incarceration either on new charges or for violation of parole (The Ohio Department of Rehabilitation and Correction recently compiled data that show that 58% of offenders with severe mental illnesses return to prison within one year.)
  • Out of active clients, 23% are employed
  • The ACT team provides 89% of its services in the community

GCB did an excellent job in developing and running an ACT team for offenders with severe mental illnesses who were returning to Hamilton County from prison. The mental health status of these clients improved and the recidivism rates were low. The team continues to operate with funds from billing for services, HCCMHB, and the Ohio Department of Rehabilitation and Correction. The team made numerous presentations including at the national ACT conference in 2003.

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Project Title
Hamilton County Mental Health Court
Grant Description
To implement a mental health court (pre-trial diversion) that will serve people with severe mental illnesses in Hamilton County
Focus Area
Joint Substance Abuse/Severe Mental Illness\Criminal Justice
Region Served
Hamilton County, OH
Award Amount
$300,000
Year Awarded
2002
Grant Duration
24 months

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Project Title
Improving Access to Mental and Behavioral Health Services for School-Age Children
Grant Description
To develop a strategic plan that will increase access to mental health services for school-age children
Focus Area
School-Based Child Health Interventions
Region Served
Hamilton County, OH
Award Amount
$299,008
Year Awarded
2004
Grant Duration
36 months

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Project Title
Levels of Care
Grant Description
To develop a system to measure the level of care needed and match it to the level of care given for persons with severe mental illnesses in Hamilton County
Focus Area
Severe Mental Illness
Region Served
Hamilton County, OH
Award Amount
$249,780
Year Awarded
2000
Grant Duration
14 months
Results Hamilton County Community Mental Health Board (HCCMHB) completed the following:
  • Trained Mental Health Access Point (MHAP) staff on the Level of Care Utilization System (LOCUS) instrument.
  • Implemented the use of LOCUS at MHAP and in provider agencies.
  • Redesigned services to provide appropriate levels of services: Overall, the results of the project indicate that there is no specific advantage to clients in using the LOCUS. As a result, HCCMHB will not use the LOCUS in redesign of services. However, other findings in the project will lead to service system change. The findings show a strong relationship between the amount of specific services (community support services and medical/somatic services) and improved functioning. This information will guide HCCMHB in focusing on services that produce the most client improvement.
  • Conducted a project evaluation using client outcomes: HCCMHB conducted a project evaluation that measured clinical status, quality of life, functional status, self-termination, satisfaction, hospitalization, incarceration, housing stability, employment, and violent behavior.
  • Conducted a project evaluation using system outcomes: HCCMHB conducted a project evaluation that measured staff turnover and cost-impact.

The project staff enrolled 220 clients in the project from May 2002 through October 2002. The project staff administered the LOCUS and outcome measures at intake and six months later. The number of clients who completed the various measures at intake and six months later ranged from 49 to 122. The clients were divided between those whose providers had access to the LOCUS results (LOCUS) and those who did not (non-LOCUS). Overall, the results showed no significant benefit for clients in using the LOCUS. In fact, results showed that the non-LOCUS group achieved more benefits in terms of symptom reduction and increase in functional status than the LOCUS group. HCCMHB reported the following specific outcomes:

  • Clinical status: The non-LOCUS group showed a significant reduction in symptom distress on the Ohio Outcome Scales, while the LOCUS group showed no difference.
  • Quality of life: Neither group experienced a significant change in 10 measures of quality of life on the Ohio Outcome Scales over the six-month study period.
  • Functional status: Clients in the non-LOCUS group showed more improvement in 23 measures of functional status on the Ohio Outcome Scales than the LOCUS group.
  • Self-termination: Of the 220 clients initially enrolled, 28 LOCUS and 33 non-LOCUS clients terminated services. No significant difference was found between the two groups on this measure.
  • Satisfaction: The project staff created a satisfaction survey specific to the project and administered it via mail or phone. A total of 120 clients responded to the survey. Analysis of the results showed overall favorable ratings with no significant difference between the non-LOCUS and the LOCUS groups.
  • Hospitalization: Of 152 clients, 19 (12.5%) required hospitalization by the end of six months of treatment. Analysis of the data showed no significant difference between the non-LOCUS and LOCUS groups.
  • Incarceration: The data available for 119 clients showed that 91 clients (76.5%) were not incarcerated during the study period. There was no significant difference between the non-LOCUS and LOCUS group.
  • Housing stability: The project team used two items on the Ohio Outcome Scales to measure housing stability. Analysis of the data showed no significant difference between the non-LOCUS and LOCUS groups.
  • Employment: On the Ohio Outcome Scales, 66-92 clients variously completed items that address work, school, volunteer activity, parenting, and homemaking. Analysis of the data showed no significant difference between the non-LOCUS and LOCUS groups.
  • Violent behavior: On the Ohio Outcome Scales, 115 clients completed the item related to violent behavior. Analysis of the data showed no significant difference between the non-LOCUS and LOCUS groups.
  • Staff turnover: Of the 64 case managers involved in the project cases, eight (12.5%) terminated their employment during the project. The project team did not find a relationship between staff turnover and non-LOCUS/LOCUS clients.
  • Cost-impact: A review of the costs of services showed no significant difference between the non-LOCUS and LOCUS groups.

HCCMHB staff noted the following learnings:

  • LOCUS requires considerable work to ensure reliability between raters.
  • The LOCUS, like any instrument, is limited by its reliance on historical data. The lives of clients are ever changing and this requires care providers to quickly make appropriate changes in service levels. It would be time consuming to make frequent LOCUS administrations. It seems best to rely on clinical judgment. In fact, the project results suggest that the LOCUS distracted agency staff from using their own clinical judgment.
  • The LOCUS may not provide sufficient consideration for the strengths and resources clients bring to treatment. Recovery involves more than an examination of symptoms.

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Project Title
Mental Health Court
Grant Description
To plan for a mental health court in Hamilton County
Focus Area
Joint Substance Abuse/Severe Mental Illness\Criminal Justice
Region Served
Hamilton County, OH
Award Amount
$65,000
Year Awarded
2001
Grant Duration
6 months
Results In June of 2001, a task force composed of key officials of the Hamilton County judicial, mental health, and criminal justice systems and consumers and family members met regularly and produced collaboratively a strategic plan for a mental health court for Hamilton County.

The strategic plan will provide effective and appropriate community treatment for offenders with severe mental illness who are charged with non-violent misdemeanor offenses. The plan carefully outlines the legal processes and intersystem roles and responsibilities for the court, public safety issues, education, training, and evaluation.

Expected outcomes for the Mental Health Court are:

  • increased identification of offenders with severe mental illness,
  • diversion of appropriate offenders with severe mental illness from jail to community-based treatment,
  • decreased arrests among the severely mentally ill offenders who cycle through the legal system, and
  • increased quality of life and level of functioning for the severely mentally ill offender who receives community-based treatment.

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Project Title
Mobile Crisis Team Expansion
Grant Description
to expand the Mobile Crisis/Police Program in Hamilton County
Focus Area
Severe Mental Illness
Region Served
Hamilton County, OH
Award Amount
$137,148
Year Awarded
2002
Grant Duration
18 months
Results HCCMHB met all of the grant objectives:
  • HCCMHB contracted with University Hospital to provide the Mobile Crisis Team (MCT) services at District 1. University Hospital hired and trained an MCT therapist, purchased and installed the necessary equipment, and established protocols with District 1 police.
  • The first six months of the project were spent putting the infrastructure in place, including the data collection process. MCT services began in District 1 in July 2002 and made 335 interventions over the course of 12 months. Of these 335 interventions, 207(62%) were conducted with police and 128(38%) were referred by police, but only MCT staff responded. Additionally, MCT staff made 58 follow-up visits and 34 follow-up phone contacts with clients in District 1 who had MCT intervention.
  • HCCMHB contracted with the University of Cincinnati Criminal Justice Research Center to conduct the program evaluation. The Research Center compared three police districts – District 5 that had established MCT services, District 1 that had the newly added MCT services, and District 4 that did not have on-site MCT services (the control district). The study compared the three districts over two time periods, July-December 2001 and July-December 2002.
    • Both districts with MCT services had an increase in repeat calls. District 5 increased from 11.96% to 16.35%(4.39% change) and District 1 increased from 13.67% to 19.05% (5.36% change). District 4, the control district without MCT services had a decrease from 14.18% to 13.02% (1.16% change) in repeat calls. The researchers speculate that the repeat calls increased because clients and their families learned that MCT was available at Districts 5 and 1 and chose to call the police instead of transporting or going to the hospital or mental health agency directly. In other words, it was a convenient way to access care.
    • Actual injuries to service providers and police officers on mental health calls are rare. Consumers suffer injuries in a limited number of instances due to police use of chemical irritants. All three districts experienced decreases in injuries during the study period. Due to the small number of injuries, no clear conclusions can be drawn.
    • Findings indicate that arrest is a rare event with or without MCT involvement on a mental health call. During the periods studied, there were only 10 criminal justice outcomes in all three districts without MCT involvement and none on runs with MCT. Again, the numbers are too small to make a clear conclusion. However, the police officers with more mental health training state that they are less likely to arrest or jail those with mental illnesses when working with MCT workers than police officers who had less training. Across all districts and both time periods, 96% of the runs involving mentally ill individuals resulted in transport of the individual to the hospital for further assessment and treatment rather than arrest.
    • 69 out of 128(54%) police officers responded to a survey about their perceptions of MCT. Over 60% of police officers preferred responding to a call involving a mentally ill individual alone or with another officer rather than a member of MCT. However, officers with mental health training believed that responding to a call with an MCT member made the response to the call more effective (61.9% of officers with advanced mental health training, 36.8% of officers with mental health training, and 20% with basic training.) 12 out of 14(87%) MCT workers responded to a survey about working with police. The results are equivocal – MCT members’ perceptions of effectiveness vary with the nature of the call, the individual police officer dispatched to the call, and the individual client.
    • Confidentiality issues prohibited MCT staff from releasing the names of clients and family members to the research team.
    • The quality of the police call data prevented addressing this fully. Survey data from police and MCT members indicated that MCT believes it takes less time to handle a call when an officer is present – officers tend to “rush” the call. Police believe the calls take longer with MCT – MCT staff want to spend time assessing the client.
  • HCCMHB picked up ongoing funding for MCT services at District 1. The other three police districts requested MCT services. However, due to financial constraints, HCCMHB cannot provide funding for further expansion, but will consider expansion when funds become available.

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