Second,



Ohio Department of Mental Health and Addiction Services (OhioMHAS)Community Plan Instructions SFY 2017Enter Board Name: The Mental Health & Recovery Board of Wayne/HolmesNOTE: OhioMHAS is particularly interested in update or status of the following areas: (1) Trauma informed care; (2) Prevention and/or decrease of opiate overdoses and/or deaths; and/or (3) Suicide prevention.Environmental Context of the Plan/Current StatusDescribe the economic, social, and demographic factors in the board area that will influence service delivery. Note: With regard to current environmental context, boards may speak to the impact of Medicaid redesign, Medicaid expansion, and new legislative requirements such as Continuum of Care. The Mental Health & Recovery Board of Wayne and Holmes Counties serves a two county area - Wayne and Holmes Counties. The two counties share a contiguous east-west border in mid-north central Ohio. According to the most recent census, the two counties are home to a population of 159,818 people – Wayne 115,514 & Holmes 44,304 (2014 Census estimates) that are largely English speaking. Most of these descended from English, Irish, German and Scotch immigrants to America. Our largest ethnic minority is the Amish, an estimated 23,000–33,000 individuals, who speak English as a second language. The Amish culture is a separatist religious tradition. Amish people tend not to participate in the activities of non-Amish groups; however, their separation does not prevent alcohol/drug abuse addiction or mental illness. Their culture is very strong in southern Wayne and Eastern Holmes counties and has a significant influence on the values of the general area. The African American population is 1.34% of the total; the combined Hispanic group is 1.6%, and Asian, .07%. The area is peppered with small communities ranging from 300 – 25,000 in population and all of these have discrete family, church and community traditions built around community and for “taking care of our own.” The area is extremely scenic with many beautiful pastoral settings. Tourism focused on the Amish culture has become a major industry in eastern Holmes County. The people of the area keep up their properties, both from pride and in the interest of tourism. The horse and buggy culture, gentle rolling hills sprinkled with haystacks, quality farms, homes and efficient looking factories are a pleasure to view. Both counties have developed a significant amount of trade around the tourism business.Wayne and Holmes counties both include a significant proportion of Amish residents and encompass parts of at least seven separate Amish settlements, including the Greater Holmes County Settlement, which is the largest in the nation. The most recent census of Amish residents, published by the Ohio State University in 2013, estimated that there were 17,654 Amish people living in Holmes County (42.2 percent of the population) and 8,283 Amish in Wayne (8.1 percent of the population) in 2010.1 Researchers project that the Amish population is growing at a rate that will allow it to double once every 22 years, and that Holmes County could become the first majority‐Amish county in the country within the next two decades.Throughout the area, there are religious traditions that include conservative, liberal Christian and non-Christian denominations and Unitarian. The faith-based communities are strongly inclined toward church-centered lifestyles, particularly the Amish Culture.Recent reports by the Wayne County Economic Development Council confirm considerable growth in manufacturing locally with local employers struggling now to get enough quality workers to meet this growth. One of the commonly heard complaints is that employers cannot get enough drug free individuals through the hiring process to meet their employment needs. For the seventh consecutive year, Wayne County was named one of the top micropolitan areas in the country for new business growth by Site Selection?Magazine.? In four of these years, Wayne County was also the top micropolitan in the Midwest. Contrary to trends in Ohio and the Midwest in general, Wayne County’s manufacturing employment and income is now increasing.??The area is home to one of the nation’s top technology incubators and research parks. The magazine's selections are determined by new or expanded facility projects that either add 20,000 or more square feet of space, are worth $1 million or more in capital investment or create 50 or more new jobs. The Wayne County list included projects from Akron Brass, ABS Materials, Artiflex, Baekert, Certified Angus Beef, FEW, Frito Lay, Global Body, JLG, LuK, Metal Dynamics, Quality Casting, Seaman Corp., Tekfor, Venture Products, Wayne Insurance Group, Wholesome Pets and Wooster Brush. Daisy Brand, the nation’s largest sour cream manufacturer recently announced plans to locate a third production facility in Wooster, Ohio to serve the Midwest and east coast markets. With this decision, Daisy Brand joins a vibrant, global community of distinguished food production companies operating in Wayne County including J.M. Smucker, Smith Dairy, Frito Lay, Purina and Mars. The Ohio Agricultural Research and Development Center is currently completing the first phase of BioHio, an incubator and research park modeled after the Innovation Place Research Park in Saskatoon, Canada. The area is home to one of the highest ranked liberal arts colleges in the country, the College of Wooster, and two technical schools, the University of Akron, Wayne College, and the Agricultural and Technical Institute of Ohio State University. The academic recruitment done by these three educational institutions results in the recruitment of an internationally diverse group of individuals in our community.Economic Conditions and the Delivery of Behavioral Health Care ServicesThe history of our local economy is largely agricultural and Wayne and Holmes Counties’ economy continues to have a strong farm economy. However, only 1% of the workforce in the two counties is now employed directly in agriculture. Manufacturing and government are the largest employers in the region with 27% in Wayne and 36% listed for Holmes in manufacturing and 16% of the workforce in Wayne and 9% in Holmes being employed by the local, state and federal government. As we have stated before this shift from agriculture represents a profound change for the history of the area and family traditions. It creates a form of “Future Shock”, Alvin Toffler, 1970 i.e. “the change overwhelms people, he believed, the accelerated rate of technological and social change leaving people disconnected and suffering from "shattering stress and disorientation"—future shocked.”, in which the culture struggles for a new values foothold in a culture dominated by technological change and worldwide cultural influences from the internet/social media on these values.Young parents and children, disconnected from their historical roots and pressing to survive in an economy where the demand for talent is subject to shifts in the global economy struggle for ways to provide their children direction from their natural heritage. Often the alternative is to use electronic media as a substitute for activity and direction. This is a difficult proposition to face and a difficult population to serve. One which takes a caring and culturally sensitive team of caregivers to provide.There are at least three (3) commonly stated indicators relevant to the Board’s role in insuring access to mental health and addiction recovery services for those who cannot afford them. These are: 1) Unemployment - reflecting the relationship between employment and health coverage, 2) Poverty that can interfere with both maintaining health and access to health care and 3) Medicaid, eligibility for public insurance to reimburse eligible services. The Wayne-Holmes area statistics are generally lower than the state average in all of these areas, as listed below:UNEMPLOYMENT: Unemployment has gone down in both Wayne and Holmes Counties during the last year. The current unemployment rate in Wayne County is 4.2 %. The unemployment rate in Holmes County is 3.2%. Both counties are under the state averages with Holmes reflecting the lowest rate in the state mainly because of the large number of farm, household and cottage industries in the eastern half of Holmes County, where the Amish culture dominates. As of March of 2016, Ohio’s non-seasonally adjusted unemployment rate was 5.4 and the nation as a whole was 5.1 %, so the Wayne Holmes district is less than these two rates despite the cultural shifts mentioned above.POVERTY: According to the most recent census extrapolations published by the U.S Census Bureau, the poverty rate in Wayne County is currently 13.9% and 12.4 % in Holmes Co. while the state of Ohio as a whole is 11.7%. Many of these individuals have part time jobs or are underemployed and without insurance coverage from their employers.MEDICAID EXPANSION: The following information is taken from the Mental Health & Recovery Board of Wayne and Holmes County’s Need Assessment as produced by The Center For Community Solutions ( See Needs Assessment Description) below.Medicaid Extension Scenario The extension of Medicaid under the Affordable Care Act to any uninsured person under 138 percent of FPL and under age 65 brings a myriad of benefits to people living with mental illness and/or addiction.Statement from the Community Solutions Needs Assessment completed in FY 15. Given that the major provisions of ACA, including Medicaid extension, went into effect in 2014, a complete year of data on the impact of these provisions is not yet available. This analysis includes six months’ worth of caseload and expenditure data, from January through June, 2014, when the Medicaid extension was in effect. The change between SFY 2013 and SFY 2014 was used as an early snapshot to make projections of how the extension may impact WHMHRB clients and services. However, because SFY 2014 runs from July, 2013, through June, 2014, and the Medicaid extension was in effect for only the second half of the fiscal year, there is a very small amount of data available on which to base these projections. Therefore, we limit our projections to three years, making them only through 2017.Since it is likely that the impact of Medicaid extension could be greater in the future as people shift to different forms of health coverage based upon their income and insurance status, the projections in this scenario should be interpreted with extreme caution. It is also important to note that the baseline scenario relies, in part, on the same period, when Medicaid extension was already in effect. Therefore, the similarities between caseload projections under these two scenarios are not unexpected.Overall, the increase in unique clients between 2013 and 2014 was about 3 percent, while total costs increased around 4 percent. This includes both Medicaid and uninsured clients. The number of Medicaid clients increased by nearly 10 percent in one year, while the number of uninsured clients declined by nearly 4 percent. These numbers are consistent with the expectation that large numbers of the WHMHRB’s clients who are currently uninsured will become covered by Medicaid. In addition to the shift within the WHMHRB’s current clients, this scenario shows an influx of new clients, as evidenced by expanded caseloads.The actual experience of the local providers under contract with the Board with Medicaid has been greater than Community Solutions projected. The study below shows the growth in budgeted Medicaid at the Board’s principal providers indicates a total increase in projected amounts of a 33% increase in Medicaid since FY 15. This is substantial.Agency Medicaid Budget StudyFYCCWC48%TCC11%OneEighty71%ACP93% Total Increase33%17 $ 199,16532% $ 3,018,8962% $ 1,500,120.15% $ 695,72971% $ 5,413,910.48 12%16 $ 151,00012% $ 2,970,98610% $ 1,307,15349% $ 407,240 13% $ 4,836,379.71 18%15 $ 134,900 $ 2,713,224 $ 876,000 $ 359,560 $ 4,083,684.00 Paradoxically to local expectations, the Board’s Non-Medicaid Expenses have also increased at the same time. Rather than experiencing savings due to the increases in Medicaid Revenues and ACA Insurance coverage, the Board has experienced an average of a 5% increase in needed expenditures or a 14% increase since FY13 through FY16. It appears that the influence of the Health Care Reform process has led to more people seeking care at a greater expense than simply seeing an exchange between Medicaid and Insurance payers and the State and the Board. This paradox has not been complimented by any increases in local levy dollar or state per capita funding. FY17 $ 6,876,182.00 2%FY16 $ 6,723,523.00 6%14%FY15 $ 6,367,261.00 2%FY14 $ 6,213,952.00 6%FY13 $ 5,870,313.00 Assessment of Need and Identification of Gaps and DisparitiesDescribe needs assessment findings (formal & informal), including a brief description of methodology.? Please include access issues, gaps in services and disparities, if any. Needs Assessment Methodology: Describe how the board engaged local and regional planning and funding bodies, relevant ethnic organizations, providers and consumers in assessing needs, evaluating strengths and challenges and setting priorities for treatment and prevention [ORC 340.03 (A)(1)(a)].From July, 2014, through January, 2015, The Center for Community Solutions conducted research and analysis to complete a comprehensive assessment of the behavioral health needs of residents of Wayne and Holmes counties, Ohio. The Center for Community Solutions is a nonprofit, non‐partisan think tank with offices in Cleveland and Columbus, that identifies, analyzes, and explains key health, social, and economic data and issues, and proposes non‐partisan solutions to improve the lives of Ohioans.This work was commissioned by the Mental Health & Recovery Board of Wayne & Holmes Counties (WHMHRB), which is the local statutory substance abuse and mental health authority for those two counties. Much of its work is done collaboratively with other key elements of the community’s service delivery system.The research included consulting with the staff of the WHMHRB; reviewing existing reports from health and social service organizations in Wayne and Holmes communities; analyzing caseload, diagnosis, and spending information; surveying consumers of mental health and addiction recovery services; holding focus groups for consumers and the general public; conducting a series of key informant interviews with community leaders; and analyzing data from other sources. In general, our research found that the WHMHRB is ensuring that quality services are available to help Wayne and Holmes residents.Child service needs resulting from finalized dispute resolution with Family and Children First Council [340.03(A) (1)(c)]. The Board checked with the Family and Children Council Coordinators of both Wayne and Holmes Counties, i.e. Cameron Maneese of Wayne County; and Pamela Semenya of Holmes County, and they reported there were no disputes between the Council and the Board over the last several years. Outpatient service needs of persons currently receiving treatment in State Regional Psychiatric Hospitals [340.03(A)(1)(c)]. The Following Services have proven to be needed for individuals after their release from a state regional psychiatric unit. Individual. CounselGroup Counsel.AssessmentPharmacological ManagementCrisis/EmergencyMed SomaticCPSTRes. Care – SupportRes. Care - TreatmentIn addition there has been increasing interest during FY16 in Outpatient Commitments. The need that is driving this is a combination of the belief that a special docket through the Probate court can make a difference in the follow through by consumers in seeking services and the fact that that there was a small SAMHSA grant offering for this service.Service and support needs determined by Board Recovery Oriented System of Care (ROSC) assessments.First, we are citing a recommendation from The Community Solutions Needs Assessment regarding Administration and Recovery Oriented System of Care (ROSC) assessments. Administration: Continue to examine recovery‐oriented systems of care which may include developing strategic plans, expanding services, and a focus on ensuring that all services needed to provide a complete continuum of care are available and accessible.A recovery‐oriented system of care (ROSC) capitalizes on community strengths and encompasses the following five principles to guide action: (1) Focus on clients and families; (2) Ensure timely access to care; (3) Promote healthy, safe, and drug‐free communities; (4) Prioritize accountable and outcome‐driven financing; and (5) Manage systems of care locally.The “Recovery is Beautiful” movement launched by the Ohio Association of County Behavioral Health Authorities emphasizes that mental illness and addiction are chronic, not acute, illnesses, and that with treatment people can recover to be active and contributing members of their communities.Additionally, as attention on ROSCs in Ohio continues to develop, there are key actions the WHMHRB can consider to both address needs raised in this report and to move closer to a ROSC in Wayne and Holmes counties. As Ohio works to implement an ROSC, it can be instructive to look at what other jurisdictions have done.A relatively new concept, the recovery‐oriented system of care (ROSC), envisions a more comprehensive, individualized system of treatment and supports for people struggling with mental health and addiction issues and their families. Meanwhile, the Great Recession of the last decade strained funding sources and providers, while a growing opiate addiction problem throughout the state is reason for concernAs insurance coverage for mental health and addiction services expands in Medicaid and private insurance plans due to the Affordable Care Act, it is expected that money the WHMHRB currently spends on clinical services can be redirected to fund even more supportive services that are integral to a ROSC but are not covered by insurance.Additionally, as attention on ROSCs in Ohio continues to develop, there are key actions the WHMHRB can consider to both address needs raised in this report and to move closer to a ROSC in Wayne and Holmes counties. RECOMMENDED WHMHRB ACTIONS TOWARD A ROSCROSC ComponentsPotential WHMHRB ActionServices should be driven by individuals and their families, and be situated in consideration of the local context.Work strategically with consumers to understand service needs and facilitate a system of care that has the capacity to be responsive to individual preferences and control.Boards are the hub for community coordination of services.MHRB could work with providers (medical in addition to traditional MH/AOD service providers) to streamline referrals, educate providers about services and benefits available for clients, and possibly even facilitate shared satellite offices across the service area.Individuals in recovery are involved at all levels of the system.Work with the MH/AOD community to find and encourage leaders in recovery to play an important role in service provision in the community. This also addresses the desire of many of the consumer survey respondents to work with a provider that shares a similar background.Mental health and addiction are chronic conditions that can result in recovery. Relapses are part of recovery.Work with consumers, providers, and community members to better understand the chronic nature of mental illness/addiction and the potential for recovery. This will work to remove stigma, making it easier for clients to seek and receive services and feel supported in their recovery. Create systems and use available data on chronicity to track and manage the recovery process for optimal results.Recovery doesn’t end when you leave treatment.Work to support people after they leave treatment by connecting them to supportive services, including housing and employment assistance. Plan for a full continuum of available care with the understanding that recovery is a process that will require supports over a lifetime.Pages 79-80 of Needs AssessmentThe ROSC model has the potential for more individual‐centered, comprehensive services for people with mental illness and/or substance abuse disorders. There are other states and communities that have begun to implement aspects of ROSC, which could provide assistance or “lessons learned” if the WHMHRB moves closer to creating a ROSC. Reviewing WHMHRB vision, mission, and policies to assure that they are in line with ROSC principles could be valuable. However, a ROSC may prove difficult to put into practice because there is no one‐size‐fits‐all list of services that make up the system of care. Targeted areas of service expansion could include peer or consumer related services, housing for homeless people with mental illness and addiction leaving incarceration, expanded supported employment programs, and recovery housing. Research has shown that mental health and substance abuse issues can impact all aspects of a person’s life and family, so providing all the services an individual needs, regardless of the type of service, would be costly in the short term, require significant cooperation from all parts of the health and social service system both public and private, and be difficult to coordinate. On the other hand, the ROSC framework presents a picture of what care and services are available for the people in this district.Second, the Board used a state-structured survey to assess our compliance with core ROSC principles. The following target groups were identified to participate in the survey: Law enforcement/judicial Education, Provider executive directors & direct service staff; and WHMHRB Board staff and various executives from the board’s many community partners, advocates and consumers & family members. The survey was administered using an online survey tool and in discussion groups. Surveys were distributed to over 200 individuals. Staff of the Board analyzed the survey data and identified trends, strengths, and opportunities for improvement. The results were as follows: Strengths: The MHRB system offers a thorough continuum of services from prevention to treatment to recovery supports.Collaboration between WHMHRB and community partners is strong, and helps to facilitate access to services. There is a strong partnership between WHMHRB’s funded partner agencies and other local organizations to provide resources needed by clients. Opportunities for improvement:Resource access/awareness Too often, consumers, family members, and agency staff are unaware of available relevant services and don’t know how to access those services.Peer involvement Many would like to see an increase in peer recovery supporter services in treatment areas and for youth. An increase of age-appropriate, peer run leisure activities was a common theme. Other pieces in the “recovery puzzle”Transportation issues create challenges for consumers and families.Wait times for detox is up to 10 days in some cases which creates the opportunity for an individual to change their mind about accessing treatment.There is a need for interim services for people on a waiting list or those who are not ready for treatment.Existing workforce programs and supports need to be strengthened. Individuals in recovery would like to work alongside funded partner agencies as they develop new programs and services. EducationWe’re very good at collaboration. We use evidence- based practices. We employ careful, specific processes regarding the planning and funding of services. We actively engage in discussion with stakeholders to identify areas for growth. A focus has been placed on community education in an attempt to reduce stigma relatedNeeds and gaps in facilities, services and supports given the Continuum of Care definitions found in the Ohio Revised Code [ORC 340.03(A)(1)]. We have assumed that the expected answer to e. is the completion of 2A.2A. Complete Table 1: Inventory of Facilities, Services and Supports Currently Available to Residents of the Board Area. (Table 1 is an Excel spreadsheet accompanying this document) Attached with submissionStrengths and Challenges in Addressing Needs of the Local System of CareIn addressing questions 3, 4, and 5, consider service delivery, planning efforts, and business operations when discussing your local system. Please address client access to services and workforce development.Strengths:What are the strengths of your local system that will assist the Board in addressing the findings of the need assessment? The Board has a 10 year, 1 mil operating tax levy enabling continued, balanced operations during the state funding cuts over the past 6 years.Recovery Oriented System of Care: The Board’s current Mental Health & Recovery System Of Care (ROSC)is developed around a set of five non-profit Medicaid and Non-Medicaid professional service provider organizations with unique missions and approaches. Four of these agencies have been in operation from 40 – 60 years. These highly professional, value based organizations are (in alphabetical order): ANAZAO Community Partners of Wayne and Holmes Counties, 2587 Back Orrville Rd. Wooster, OH 44691Telephone:??330-264-9597 TDD:??330-264-9597 Website:?anazao.coOther Locations:Millersburg, OH 44654 212 N. Washington St., Suite 303, Telephone: 330-674-4608Orrville OH 44667 119 E. Market St., Telephone: 330-682-4800ANAZAO Community Partners is licensed by the State of Ohio as both a mental health and substance abuse outpatient treatment facility. Its programs are also nationally accredited by CARF (the Commission on the Accreditation of Rehabilitation Facilities). Recovery Oriented Services: counseling is available from qualified staff for a variety of problems including addiction concerns, emotional difficulties, and adolescent problems. Also offered are: psychological assessments; educational, treatment, and support groups; CPST/case management; and individual and family counseling. Other areas of expertise include a speaker’s bureau, services to schools, parenting skills training, children and divorcing parents, a wide variety of intervention programs, substance abuse prevention, low- and high-risk youth intervention, individuals recently released from incarceration, adult and adolescent theft, Holmes County youth employment and support, and urinalysis testing for drugs of abuse.Services:Substance abuse treatmentMental health treatment Education, prevention and support groups. Programs for children, adults and families. Rapid cycle access to services. CATHOLIC CHARITIES of Wayne County, 521 Beall Avenue, Wooster OH 44691 Telephone: 330-262-7836 Catholic Charities places special emphasis on Recovery Oriented services to children and families. Its goal is to provide service programs to help families, children, and individuals cope with long term social and personal problems which affect their daily lives. Help is available for school and behavior problems, parent-child conflict, adjustment to divorce and other family changes, grief and loss issues, abuse, chronic illness, etc. Special programs include juvenile court referred home based counseling for children and their families who are victims of sexual abuse. Services: Wraparound Services to persons with mental illness and developmental disabilities which includes trauma informed care.Mental health services for children, adults and families Home based counseling services for children and families are available on a selected basis THE COUNSELING CENTER of Wayne and Holmes Counties 2285 Benden Drive, Wooster OH 44691Telephone: 330-264-9029 TDD:?330-263-5473Other Locations:Millersburg: 212 North Washington Telephone:??330-674-6697Orrville:? 859 S. Main Street Telephone: 330-683-5106 Website: The Counseling Center provides comprehensive continuum mental health Recovery Oriented services to the residents of Wayne and Holmes Counties. It is certified as a mental health provider by the State of Ohio. The staff is comprised of professionals in the areas of psychiatry, psychology, social work, counseling and nursing. Services include counseling for children, adults, and families, crisis intervention, community support to assist individuals who have experienced psychiatric hospitalization, and community education on a variety of mental health topics including Trauma Informed Care. A group of several staff are participating in a yearlong Trauma Focused CBT training program that will lead to certification in trauma informed care. Other staff has attended day long training through Mary Vicario and Gina Patterson. The Center is also implementing strategies to become a trauma-informed culture, based on the SAMHSA trauma informed agency toolkit. Trauma information is assessed at intake, and included on treatment plans. Starting in July, the agency staff will begin receiving quarterly trauma informed training, and the new CCO will be responsible for implementing the 6 principles throughout the agency. Evidence based models and techniques are used such as intensive home-based treatment, cognitive behavioral treatment and trauma informed care. Services: Comprehensive mental health services including counseling for children, adults and families 24-hour crisis intervention Psychiatric services Specialized services for persons with persistent mental illness: Supported Employment services, Residential servicesHome-based services for at-risk youth. Prevention programs are also offered including: Community consultationsEarly childhood mental health programsSuicide preventionGeneral mental health education on a variety of topics. NAMI of Wayne and Holmes Counties 2525 Back Orrville Road, Wooster, OH 44691, Telephone: 330-264-1590 Website: Hours: MOCA House is open Mon-Fri 11:00 am-4:00 pm.NAMI offers Recovery Oriented educational programs and support groups for family members of persons with mental illness and training for law enforcement. MOCA House is a consumer-operated recovery center for consumers of mental health services. They offer free programs including support groups, wellness recovery activities, and discussion topics. Free transportation available. Suicide Prevention Coalition aims to reduce the number of suicides through education and support; PALS (People Affected by a Loved one’s Suicide) Support Group; LOSS Team (Local Outreach to Survivors of Suicide) supporting families immediately following a suicide event. Services:Educational programs and support groups for family members of persons with mental illness and Mental Health training for law enforcement officersMOCA House: Consumer-operated recovery center for consumers of mental health services offers free programs including:Support groups Wellness recovery activities Free transportation available. Suicide Prevention Coalition aims to reduce the number of suicides through education and support;PALS (people affected by a loved one’s suicide) Support Group; LOSS Team supporting families immediately following a suicide event OneEighty –Helping People Change Direction104 Spink St. Wooster, OH 44691Telephone:??330-264-8498 Toll Free:? 1-877-275-9277Website: ?Other Locations- Millersburg, OH 44654, 34C South Clay St.OneEighty is state certified through the Ohio Department of Mental Health and Addiction Services. The agency provides Recovery Oriented services for adults and youth through their staff of qualified chemical dependency counselors. Community services include chemical dependency screening, chemical dependency assessment, outpatient counseling, and intensive outpatient counseling. The agency also provides services at the Wayne County Jail and operates residential treatment facilities for men and women. OneEighty provides treatment for co-dependency, organizes special training opportunities and has staff who work in community education and prevention with youth and adults. Services are also available to families & victims of domestic violence and sexual assault. The agency provides individual and group counseling, emergency shelter on a 24-hour basis, and operates an emergency hotline. Support services, including Trauma Informed care is provided to all survivors of rape, incest and related offenses are also offered. OneEighty has specialized with working with persons who have experience trauma. Efforts have been made during the past year to better integrate addiction and mental health services. Dr. Gina Patterson, Director of Clinical Services, has led efforts to infuse a trauma informed care approach throughout the organization. OneEighty has participated in a research study being conducted by Boston College to create a scale for measuring the organization’s implementation of trauma informed care principles and the staff and Board have received training on this approach. Dr. Patterson will be attending a Trainer of Trainers training program that will permit her to provided additional education to staff and other in the communities. Currently, OneEighty has been conducting an assessment of how conducive the environment in each of our facilities is to cultivating trauma informed care. OneEighty has 3.5 FTE therapists that have received certification as trauma experts. Trauma screening is included in all assessments. TIC is an evidence based practice. The agency also provides counseling for children living in violent homes, victim advocacy services, and community education on domestic violence and sexual assault prevention. Other programs offered include the Another Way Program, which provides individual and group counseling for domestic violence offenders; group counseling for violent and abusive adolescents; life skills development education for shelter residents; consultation and referral services, and an extensive volunteer network.?OASIS Recovery Club?Provides a safe alcohol and other drug free environment to help bridge the gap between the solitude of addiction and the recovering individual’s return to our community. The club, although aimed at serving those in recovery from alcoholism and other types of addiction, is open to anyone.? Services:Comprehensive services for victims of domestic violence and sexual assaultIndividual and group counselingEmergency shelter Counseling for domestic violence offenders Counseling for children who witness violence or experience abuse The Housing Initiative Program: financial assistance and supportive services to assist individuals and families in obtaining and maintaining stable housing Chemical dependency screening, chemical dependency assessment Outpatient counseling and intensive outpatient counseling Residential treatment facilities for men and women OASIS Recovery Club: Provides a safe alcohol and other drug free environment to help bridge the gap between the solitude of addiction and the recovering individual’s return to our community. These agencies are strong and comprehensive resources that use Evidence Based Programs and Best Practices with protocols and two of them have used the NIATx quality improvement system to improve the programmatic soundness of their operations. The system of care delivers psychiatry, addictionology, supportive behavioral health care services and recovery support services through a methodology driven by best practice and evidenced based practices.Grantsmanship Success: The Board has been very successful in obtaining state, federal and private foundation grants for housing projects, juvenile justice, MH/DD collaborations and early childhood related programming and many other projects. In FY16 the Board’s system of care has received a total of $ 408, 247.00 of grants awards. Local agencies have also had much grant success,Comprehensive System Collaboration Systems: The Wayne/Holmes Board’s MH/SA Recovery Oriented System of Care (ROSC) is augmented by two very historically, effective Family and Children First Councils and a series of collaborations involving businesses, health department, courts and the schools. The Mental Health & Recovery system of care has provided services to a wide range of mental health, substance abuse and developmentally disabled consumer groups including the most seriously in need of both populations. Over the years, the Board has collaborated with providers in maintaining consistency and quality community efforts. Each of the contract agencies is nationally accredited and well respected in the community. Together, the Board and the providers have weathered severe budget cuts; yet continue to provide services through inventiveness and successful acquisition of grants and donations. The Wayne and Holmes Mental Health & Recovery (ROSC) includes positive minded, quality and experienced staff. This system of care has earned positive recognition from numerous foundations, state authorities, federal grantors and local organizations, i.e. Chambers of Commerce, for its consistent innovation and excellence. Strong fiscal management The Board has maintained financial stability during preceding years of funding reductions from the state and federal governments (30%), because the Board responded immediately, by making cuts to services when we received major cuts to our system in FY07-09 and FY10. In FY12 the Board flat funded its agencies, but in FY13 the Board felt that additional cuts were needed in order to contain deficit spending. The Board has decided to flat fund the agencies once more in FY17, but allowing them to carry some of their unexpended revenues from the Board from FY16 to FY17.Partnership and Collaboration with Neighboring Boards: The Wayne Holmes Board has collaborated with a group of Boards known as the Heartland Collaborative. During the FY14- FY16 time frame, these Boards were involved in regional collaboratives around the 505 and 507 grants from OHMHAS. Various regional projects were developed, and one to provide regional detox and sub-acute care has continued via Board to Board contracts during FY16 and beyond. The Heartland collaborative also developed “Heartland East” to serve as a behavioral health claims Administrative Service Organization (ASO) system. In FY17 a new claims system is being developed to replace the MACSIS claims system, which will enable contracting with managed care and producing quality service delivery information to monitor and improve services. Identify those areas, if any, in which you would be willing to provide assistance to other Boards and/or to state departments.FCFC CollaborationsAgency PartnershipsYouth Diversion System PlanningCultural Competence with Amish personsTransition To Independence (TIP)Mental Health First AidWrap-Around ServicesStrategic PlanningEmployment One Stop CollaborationsOhio Healthier Buckeye Council and the Wayne Common GoodWayne County Opiate Task ForceQuestion, Persuade and Refer (Suicide Prevention Gatekeeper Training).Multisystemic Therapy in Collaboration with the Juvenile Courts of Wayne and Holmes Counties.Evidence Based Supportive Employment ServicesCollaboration with the Strong Families and Safe Communities MH/DD collaboration.Identify those areas, if any, in which you would be willing to provide assistance to other boards and/or to state departments. Challenges:What are the challenges within your local system in addressing the findings of the needs assessment, including the Board meeting the Ohio Revised Code requirements of the Continuum of Care?Gaps and Unmet Needs- FY15 Community Needs Assessment by Community Solutions of ClevelandFunding and services for mental health and addiction are generally well-aligned with need. However, unmet needs and service gaps in the community remain, due in part to a decrease in public funding. Unmet need can be represented by individuals who are not part of the system of care, consumers who do not access the services they need and/or experience barriers to care, and limited provider capacity.The apparent unmet need derived by subtracting service utilization from estimated prevalence is that 4,691 adults and 2,915 children living below 200 percent of the FPL in both counties have a mental health issue and are not being served. An estimated 1,956 adults and 344 adolescents with substance use problems remain untreated, as are 1,029 adults and 129 adolescents with dual mental health and substance use issues. (There is some overlap between these categories.)In addition to the service gaps and barriers identified in the consumer survey, the need for mental health inpatient services that are closer to home was reported repeatedly in focus groups and interviews. Community leaders suggested additional psychiatric services, especially for youth; inpatient services; methadone and suboxone administration programs; and services for foster and transitional youth as key gaps in behavioral health services. A prior assessment completed by the WHMHRB found that an additional $700,000 to providers would be required to eliminate waiting lists and delays in accessing services in the system.Recommendations: FY15 Community Needs Assessment by Community Solutions of ClevelandThe needs assessment identifies 10 recommendations in three focus areas based on a synthesis of information collected throughout the study period. The recommendations are actionable responses based on needs of the clients, community input, and changes in the health policy arena that the WHMHRB should consider implementing.AdministrationPolicyServicesContinue to examine Recovery-Oriented Systems of Care (ROSC)which may include developing strategic plans, expanding services, and a focus on ensuring that all services needed to provide a complete continuum of care are available and accessible.Take full advantage of opportunities presented by Medicaid extension.Ensure that services continue to be available for Medicaid, uninsured, and insured consumers by developing quality reviews andLong-term projection of financial need.Monitor and maintain servicecapacity to ensure a quality (VB) workforce, availability of appropriate levels of service for insured and uninsured groups, and maintenance of high quality.Continue to pay close attention to deliberations in state government.Increase access to home-based service, telehealth, and other treatment options that address transportation and stigma/embarrassment issues.Develop culturally competent,strategic behavioral health promotion models targeted at thediverse population needs in thecommunity, which focus on recovery issues as chronic conditions.Seek improved integration between behavioral and physical health systems.Conduct a more detailedinvestigation on how to provide services to the Amish and similarcommunities.Work to fill identified gaps and address unmet needs.Since the time of the FY 17 Needs Assessment, OHMHAS has required that the Continuum of Care include Ambulatory Detoxification Services, and based on the OHMHAS definition, the Board does have this locally in that it’s our understanding that the outpatient service for MAT services at OneEighty meet the requirement for that gap. However the Board will continue to develop its ambulatory detoxification services at a local provider to fully meet the requirement. What are the current and/or potential impacts to the system as a result of those challenges? The difficulty, in addition to meeting the medical elements of the requirement, will be finding the dollars to support it, as the Board continues to budget from a deficit position even though Medicaid Expansion has had a dramatic impact on this Board area.Identify those areas, if any, in which you would like to receive assistance from other boards and/or state departments.Strategic Planning from the Ohio Association of Behavioral Health AuthoritiesTele Psych and Tele MAT servicesManaged Care ContractingGuardianships ( related to Community Outpatient Commitments)Cultural CompetencyDescribe the board’s vision to establish a culturally competent system of care in the board area and how the board is working to achieve that vision. The Board’s approach to cultural competence is one that connects the way that stigmatization infiltrates interpersonal relationships to create both personal and cultural barriers for persons in need of mental health and addiction services. These barriers inhibit persons with these needs from accessing services and inhibit the dominant cultures in the community from facilitating access when services are readily available. Cultural competence in this light is the use of a set of concepts to develop the skills necessary to liberate those in need and those who are able to help them from this stigmatizing process (National CLAS Standard 1). The Mental Health & Recovery Board of Wayne/Holmes FY17 plan for addressing the development of this competency at the Board level had its origins in a presentation at its FY14 Annual Dinner on Cultural Competency by LaVina Miller Weaver, RN, PCC-S the Executive Director of Springhaven Counseling Center, Inc. of Holmes County, a non-for-profit agency designed, supported and used by the Moravian (Amish) culture of Holmes County for the purpose of meeting the mental health population of that county (National CLAS Standard 4). According to Ms. Weaver, stigma is a pervasive issue in the fields of mental health and addiction - in fact, it is one of the top reasons that persons with mental illness will not pursue treatment. Stigma often is the result of miscommunication or the perpetuation of (incorrect) stereotypes. Equipped with this knowledge, it is important to understand that there are ways to decrease stigma and improve mental health and addiction service quality. Cultural competence, which refers to the ability one has to understand and appreciate those from other cultures, is one such way to decrease stigma (National CLAS Standard 1). By seeking to better understand other cultures, the stigma related to mental illness and addiction can be reduced considerably. The presentation to the Board provided a comprehensive overview of cultural competence for behavioral health and its relationship to stigma, quality of care, and community. The foundation of the presentation was an explanation of trans-cultural competency, exploring the notion that there are five stages of trans-cultural competence. Trans-Cultural Competence StageExplanationStage 1 – Ethnoentropy Understand little of one’s self or own culture; avoid other ethnic groups– alienated from self/othersStage 2 – Ethnocentrism Belief in own culture’s superiority/inferiority of others Stage 3 - EthnosyncretismBeginning awareness/acceptance; begin accepting perspectives and critiques on own culture Stage 4 – Transethnicity Move beyond own culture to significantly experience another ethnic group Stage 5 – Panethnicity Transcendent worldview; willing to dialogue and explore Trans-cultural competence reflects the idea that all persons are unique, worthy individuals regardless of their differences. Persons who are trans-culturally competent believe that all persons have the ability to develop to their highest capacity, and seek to inspire others to be the best that they can be. Ethnicity and cultural differences would be seen as an opportunity for growth rather than a hindrance. Cultural competence provides the opportunity for stigma reduction. When there is a lack of cultural understanding, there is a greater risk of unintentionally hurting clients. Clients who feel unsafe may choose to not seek out services. By exploring concepts unique to Amish culture such as Gellasenheit, Ms. Weaver emphasized how having a significant subculture (see Environmental Context) up to 20% of population, present in Wayne/Holmes provides the unique opportunity for learning to reduce stigmas related to the other cultures in the area as well.Wayne and Holmes counties are a multi-ethnic area, even though many of the cultures are small in number. These include Appalachian, African American, German, Hispanic, Iranian, and more. The academic community of the College of Wooster recruits international educators. New technological development in Wayne County at the Ohio State University Agricultural Technical Institute (OSU ATI), results in recruitment of international leaders in research and innovation and new businesses development in the Wooster area attracts worldwide expertise and diversity. It is interesting to note that the Board’s FY16 Annual Dinner featured a presentation by Amish mental health and drug addiction service providers with a very wide representation of the Amish Plain community in attendance. The Board also added a member of the Amish community to its Board for the first time in late FY15, who represented that community through FY16.Individuals learn best within the context of their culture. Cultural competence is a continuous learning process that builds knowledge, awareness and capacity to identify, understand and respect the unique beliefs, values, customs, languages, abilities and traditions of all Ohioans in order to develop policies to promote effective programs and services (National CLAS Standard 2-3).The Board budgets an annual allocation for interpreters that is used by the agencies when clients from non-English cultures present themselves for services. Our provider agencies strive to be linguistically competent and uses this allocation as needed (National CLAS Standards 5-8).National Standards of Cultural Competence: The Board acknowledges cultural competence as a priority not only at the local and state level, but also nationally. To this point, it is crucial that the standards of cultural competency with which the Board and its provider agencies operate also align with nationally regarded standards. Through discussion with Multiethnic Advocates for Cultural Competence (MACC), the Board chose to compare its program on cultural competency with the national standards which MACC endorses – the National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care. The National CLAS Standards reflect a commitment to cultural competence. The principal standard is to “provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs” (The Office of Minority Health, U.S. Department of Health and Human Services, 2013). Following this principal standard are fourteen other standards, categorized into sections such as “Governance, Leadership and Workforce; Communication and Language Assistance; and Engagement, Continuous Improvement and Accountability.” Among the standards that align the MHRB’s Annual Dinner presentation with the national standards endorsed by CLAS and MACC are those related to education and workforce development. By developing this program on cultural competence and making it readily available to local provider agencies and community members, the Board acknowledges its responsibility to provide education on this topic. This event provided the opportunity for agency staff development, which in turn promoted a culturally competent, educated system of care for Wayne and Holmes Counties. While ultimate cultural competence, or what Ms. Weaver referred to as Panethnicity, may not be fully achieved, it is the intent of the Wayne/Holmes MHRB that alignment with national and state standards of cultural competence will enable our system as a whole to continuously strive for cultural appropriateness; and complementing that, plan for on-going education, policy development, implementation and monitoring of these standards. -209550236220Considering the board’s understanding of local needs, the strengths and challenges of the local system, what has the board set as its priorities for service delivery including treatment and prevention and for populations? Increasing its capacity for long term service supports (LTSS), i.e. Recovery Oriented Systems of Care as supported by the findings of the Needs Assessment as included above).Creating a strategic plan for developing the value base (VB) of its contracted services as a means of further financing its system. This is consistent with the first recommendation of the Board FY15 Needs Assessment. Meeting all the elements noted in the Assessment of Need and Identification of Gaps and Unmet Needs section above. These were drawn from the major and minor needs assessments done by the Board over the last year and Input from service providers.The known needs of collaborative constituents/partners for Mental Health and Substance abuse services.Developing and implementing a complete, Ambulatory Detoxification LOC within Wayne or Holmes Counties continuum of care.Adding Certified Peer Supporters to strengthen the Board’s Recovery Oriented System of Care.Below is a table that provides federal and state priorities. Please complete the requested information only for those federal and state priorities that are the same as the board’s priorities, and add the board’s unique priorities in the section provided. For those federal and state priorities that are not selected by the board, please check one of the reasons provided, or briefly describe the applicable reason, in the last column.Most important, please address goals and strategies for any gaps in the Ohio Revised Code required service array identified in the board’s response to question 2.d. in the “Assessment of Need and Identification of Gaps and Disparities” section of the Community Plan [ORC 340.03(A)(11) and 340.033].00Considering the board’s understanding of local needs, the strengths and challenges of the local system, what has the board set as its priorities for service delivery including treatment and prevention and for populations? Increasing its capacity for long term service supports (LTSS), i.e. Recovery Oriented Systems of Care as supported by the findings of the Needs Assessment as included above).Creating a strategic plan for developing the value base (VB) of its contracted services as a means of further financing its system. This is consistent with the first recommendation of the Board FY15 Needs Assessment. Meeting all the elements noted in the Assessment of Need and Identification of Gaps and Unmet Needs section above. These were drawn from the major and minor needs assessments done by the Board over the last year and Input from service providers.The known needs of collaborative constituents/partners for Mental Health and Substance abuse services.Developing and implementing a complete, Ambulatory Detoxification LOC within Wayne or Holmes Counties continuum of care.Adding Certified Peer Supporters to strengthen the Board’s Recovery Oriented System of Care.Below is a table that provides federal and state priorities. Please complete the requested information only for those federal and state priorities that are the same as the board’s priorities, and add the board’s unique priorities in the section provided. For those federal and state priorities that are not selected by the board, please check one of the reasons provided, or briefly describe the applicable reason, in the last column.Most important, please address goals and strategies for any gaps in the Ohio Revised Code required service array identified in the board’s response to question 2.d. in the “Assessment of Need and Identification of Gaps and Disparities” section of the Community Plan [ORC 340.03(A)(11) and 340.033].PRIORITIESPriorities for (The Mental Health & Recovery Board of Wayne Holmes)Substance Abuse & Mental Health Block Grant PrioritiesPrioritiesGoalsStrategiesMeasurementReason for not selectingSAPT-BG: Mandatory (for OhioMHAS): Persons who are intravenous/injection drug users (IDU)To identify those using Opiates intravenously who have not previously been identified and enroll them in MAT services.To increase the availability of MAT servicesAll local Substance Abuse TX agencies are members of the Opiate Task Force, which is developing treatment strategies.Advocate for raised per doctor treatment limitsIncrease the number of addictionalogists MDs.Use Current Utilization rates as baselines to measure growthUse of the new referral arrangement with StarkMHAR for detoxification and MAT services__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe): SAPT-BG: Mandatory (for boards): Women who are pregnant and have a substance use disorder (NOTE:ORC 5119.17 required priority)Wean from Opiates with MAT (subutex)Managed WithdrawalAbstinenceDrug Free BabiesAssessmentAppropriate LOCEngage in Long term TXEngage in recovery communityStages of ChangePerformance Target Benchmarks and Milestones, Renesselaerville ModelNOMsRecovery Activities Record__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):SAPT-BG: Mandatory (for boards): Parents with SUDs who have dependent children (NOTE: ORC 340.03 (A)(1)(b) & 340.15 required consultation with County Commissioners and required service priority for children at risk of parental neglect/abuse due to SUDs)Referrals from Children Services Board of Wayne County and Holmes Children ServicesWean from Opiates with MAT (subutex only)Managed WithdrawalAbstinenceInvolvement with Recovery CommunitiesAssessmentAppropriate LOCEngage in Long term TXEngage in recovery communityStages of ChangePerformance Target Benchmarks and Milestones, Renesselaerville ModelNOMsRecovery Activities Record__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):SAPT-BG: Mandatory (for OhioMHAS): Individuals with tuberculosis and other communicable diseases (e.g., AIDS.HIV, Hepatitis C, etc.)Assessment Screening with contract service providersReferral to local Health DepartmentsInclusion in agency screening and assessment toolsClient literature and signageQuality Assurance reporting__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):MH-BG: Mandatory (for OhioMHAS): Children with Serious Emotional Disturbances (SED)Appropriate medical (including psychiatric) and physical health careSafe and stable living environmentInformed Parental Monitoring and actionDiagnosis and integrated health assessmentsInvolve Service coordination servicesMedical CareParental education and treatment (stages of change)Stabilization PlanningPlanning for Transitional planningImprovements in Ohio Scales and other Quality improvement indicatorsYouth NOMSMovement to Action Indicators on Stages of ChangeRestoration training for parents__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):MH-BG: Mandatory (for OhioMHAS): Adults with Serious Mental Illness (SMI)Appropriate medical (including psychiatric) and physical health careSafe and stable living environmentPost Treatment Involvement with Recovery Support/Communities, i.e. housing, supported employement, peer support.Diagnosis and integrated assessmentsMedical CareStabilization PlanningStages of change TXTransitional planning for employment and housingEngage in recovery communityNOMSMovement to Action Stage Indicators on Stages of ChangeInvolvement with Recovery Center__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):MH-Treatment: Homeless persons and persons with mental illness and/or addiction in need of permanent supportive housingAssess housing needs of homeless referrals.Treat homeless persons who request or need MI or SA services based on Intensity of NeedStudy general service flow to determine any special project needsStages of ChangePerformance Target Benchmarks and Milestones, Renesselaerville ModelNOMsOhio Scales(as appropriate)Stages of ChangePerformance Target Benchmarks and Milestones, Renesselaerville ModelNOMsOhio Scales(when appropriate)__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):MH-Treatment: Older AdultsDevelop data system to get better real time BH data.Evaluate population utilization for disparities if anyWork with Heartland East to develop and afford new BH systemDevelop standardized reports off of this system regarding services to older adultsAssess reports to study distribution patterns and make any necessary strategies through planning__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe)Additional Priorities Consistent with SAMHSA Strategic Plan and Reported in Block GrantPrioritiesGoalsStrategiesMeasurementReason for not selectingMH/SUD Treatment in Criminal Justice system –in jails, prisons, courts, assisted outpatient treatmentReduce the use of the criminal justice system for housing the mentally ill and chronically addicted by screening, identification and post release linkages.Join STEPPING Up (National)Work with Community Correction’s Boards on Stepping Up planning and strategizingUse current MH Service LOC as growth baseline.Standards for alignment with SteppingUp.__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describeIntegration of behavioral health and primary care servicesReview SAMHSA Model for current learnings.Facilitate conversations with managed care entities.Maintenance of the Board’s integrated care committee.Learn Care Coordination /Integrated Care Work Group between BH providers and representatives of local hospitals including Emergency Rooms.Evaluate current baseline of integrated Health and BH careEvaluate progress from the BaselineEncourage Partners to access arrangements facilitated by managed care.__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):Recovery support services for individuals with mental or substance use disorders; (e.g. housing, employment, peer support, transportation)Navigate Pathways to Recovery as Board ModelFocus on Board Recovery Business PlanConsumer Operated ServicesNAMIWorkforce ProgramWilliam White (Great Lakes Addictions)TrainingOASIS as nexus of AOD Community RecoveryCertified Peer Support TrainingGather quality assurance and improvement reports from all contractors on Recovery efforts.Work with NAMI of Wayne/Holmes to develop better measures of Recovery Supports__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):Promote health equity and reduce disparities across populations (e.g. racial, ethnic & linguistic minorities, LGBT)Develop data system to get better real time BH data.Evaluate population utilization for disparities.Work with Heartland East to develop and afford new BH systemDevelop standardized reports off of this systemAssess reports to study distribution patterns and make any necessary strategies through planning__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):Prevention and/or decrease of opiate overdoses and/or deathsContinue to arrange provisions of Naloxone to local city and village policeAssure that all local Treatment providers and first responders have Naloxone kits and trainingWork with OHMHAS Pharmacy services and both the Wayne and Holmes Health Departments to assure distribution.Work with local Sheriff’s, police and first responders collaboratively re: use of Naloxone.Spread and amount of distribution.__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describePromote Trauma Informed Care approachEvaluate current distribution of Trauma informed Care (TIC) EBP in the Recovery Oriented System of Care ( ROSC).Continue to hold localized trainings for different population targets.Utilization of EBP based which are trauma informed care (TIC).Evaluate treatment outcomes achieved by providers trained in Trauma informed Care.Fidelity Measure utilization validity of providers.__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describePrevention PrioritiesPrioritiesGoalsStrategiesMeasurementReason for not selectingPrevention: Ensure prevention services are available across the lifespan with a focus on families with children/adolescentsExamine Prevention Services distribution.Examine POPS, OlGA or their Replacements for ages of Participants.Develop lifespan strategies.Early Childhood Mental Health ServicesCulturally competent messagingDetermine what EBP allows for lifespan utilization.Develop reporting processTrack and report out Measurements through QA/QI meeting/reports__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):Prevention: Increase access to evidence-based preventionIdentify all evidence based prevention programming being used by contractorsIdentify Distribution process.Consider increases where feasibleCreate report outs on fidelity measures for identified EBP.Map distribution of EBP provision/utilization across Wayne/HolmesTrack and report out Measurements through QA/QI meeting/reports__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):Prevention: Suicide preventionInformed front line medical and treatment Early identification of suicide riskZero Suicide Focus.Train frontline medical and BH treatment staffFollow through on FY 14 strategy for middle aged menWork with Suicide Coalition around practical prevention and training strategies such as QPRRequest reports from the Suicide Coalition which includes membership from all agencies contracting with the Wayne/Holmes Board.Request QPR program reportMeasure fidelity to EBP measurements.__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):Prevention: Integrate Problem Gambling Prevention & Screening Strategies in Community and Healthcare OrganizationsInvest State Gambling Grant with agency providing the widest possible array of prevention strategies.Develop evidence based gambling prevention practicesImplement “Stacked Deck”, an evidenced based gambling preventioncurriculum designed for 9th – college aged individuals and use as part of our Life Skills curriculumpilot in two local high schools and one local university during FY17Measure fidelity to OHMHAS EBP measurements.__ No assessed local need__ Lack of funds__ Workforce shortage__ Other (describe):Board Local System Priorities (add as many rows as needed)PrioritiesGoalsStrategiesMeasurementAn Ambulatory Detoxification service Establish a complete Ambulatory Detox unit within the Wayne/Holmes Board districtDevelop a temporary site (1 year) for this LOC within one or two local agenciesCompletion.A combined 15 bed Women’s Non-Medical unit and an Ambulatory Detoxification Unit for men and womenReceive capital funding from OHMHAS for the new capital funding cycle for developing the UnitWork with local providers to develop a proposal for Capital funding and local match to develop the unit.Proposal and award.Increasing the number of trained Peer Supporters to strengthen the Board’s Recovery Oriented System of Care.Fund additional certified Peer Support Coordinators at NAMI and The Counseling CenterWork with Board, state and foundations for start-up funding for additional certified Peer Support CoordinatorsEmploymentA permanent Behavioral Health Medical Residential Unit (BHMR) for Crisis Intervention and Family Restoration Services to service Wayne and Holmes CountiesReduce out-of-home, out-of-county placement of SED youthIncrease available LOC to include Partial Hospitalization and day treatment.Better utilize existing local MH servicesRealize cost savings.Approach County Commissioners, Foundations and the capital grant process for fundingFind local provider that can develop the service economicallyBaseline current utilizationBenchmark utilization under new service arrangement over 3 yearsCompare 3 year running average to Benchmark.A permanent Mental Health and Recovery linkage and referral program in the Corrections Department of the Wayne and Holmes County Corrections Departments through Stepping Up planning processesReduce recidivism of mentally ill individuals through the local Corrections systemProvide appropriate post release treatment for individuals in the Wayne and Holmes Corrections who have been assessed as mentally ill. Create necessary planning teams from community criminal justice and mental health services teamIdentify barriers to the process of “closing the revolving door”Develop measurable outcomes and benchmarks to assist in evaluating the processResearch and state current recidivism of the mentally ill for a baseline.Set Performance Targets.Set benchmarks and learning process for ongoing address of benchmarks and targets.Systemization of a ROSC continuum of careContinue to build a Recovery Oriented System of Care around a expected chronicity of mental illness and addiction in Wayne and Holmes Counties.Identify gaps or shortages in the local ROSC system as reported in the Board FY17 Annual PlanIdentify additional gaps and shortages necessary to meet the chronic needs of the addicted and mentally ill.Develop unified plan with Board staff and all recovery service agencies under contract with the BoardUse OHMAS stated Continuum as baselineFill identified gaps in FY17.Examine local need for other gaps, particularly with respect to Chronicity and the W. White researchDevelop benchmarks to measure from these baselines. A multiple agency, two county evidence based Prevention program systemObtain financing for pilot projectCreate a prevention project with multiple agency partners.Develop a small strategic multiple agency plan in the monthly Director’s meeting.Develop a community wide mission using strength and urgency about the need for quality advertisement work on this subject.Measure effectiveness of multiple agency prevention effortMarket outcomes that are salable for future grant offerings. Priorities (continued)What priority areas would your system have chosen had there not been resource limitations, and why? If you provide multiple priority areas, please prioritize.Priority if resources were availableWhy this priority would be chosenOur list of current priorities (above) do all face barriers due to limited resources ( example) below. (2) A permanent Behavioral Health Medical Residential Unit (BHMR) for Crisis Intervention and Family Restoration Services to service Wayne and Holmes CountiesThis being the primary example. We believe this priority would improve services to children and their families, while saving money, but we do not have the funds to undertake it.(3)(4)(5)(13)(14)CollaborationDescribe the board’s accomplishments achieved through collaborative efforts with other systems, consumers and/or the general public during the past two years. (Note: Highlight collaborative undertakings that support a full continuum of care. Are there formal or informal arrangements regarding access to services, information sharing, and facilitating continuity of care at a systems level?)First it is important to note that the local Board plays a leadership/membership role in collaborations with a host of other community organizations, and to some extent that relationship involves sharing objectives with those of the collaborative partners, rather than being singularly focused on the Board’s. Historically this approach has opened many doors for the Board and enabled it to find the means to meet ORC 340 requirements. The Mental Health & Recovery Board of Wayne Holmes currently collaborates actively with the following:The Ohio Department of Mental Health and Addiction ServicesThe Ohio Department of Youth Services The Wooster Area Chamber of CommerceThe Orrville Area Chamber of CommerceThe Holmes County Chamber of CommerceThe Wayne County Economic Development CouncilThe Wayne County Common Good - Employment/Employer Service Providing OrganizationsThe Wayne County Healthier Buckeye CouncilThe Multi County Juvenile Attention System (five counties – Wayne, Tuscarawas, Carroll, Stark, Columbiana) Detention and Residential Treatment Services for youthThe Wayne County CommissionersThe Holmes County CommissionersThe Wayne County Health Department and Child Fatality Review CommitteeThe Holmes County Health Department and Child Fatality Review CommitteeThe Wayne and Holmes County Family and Children First CouncilsThe Wayne/Holmes County Behavioral Health Care ProvidersThe Holmes County Board of Developmental Disabilities The Wayne County Board of Developmental Disabilities Strong Families/Safe CommunitiesThe Wayne County Juvenile Court/MSTThe Holmes Juvenile Court/MSTThe Wayne County Sheriff’s DepartmentThe Holmes County Sheriff’s DepartmentThe Community Corrections Board of both Wayne and Holmes CountiesThe Wayne County Common Pleas and Municipal Court Mental Health HOPE CourtThe Wayne/Holmes Re-Entry Coalition The Wayne County Community FoundationThe Child and Family Health Services (CFHS) consortium (Wayne, Ashland, Holmes Cos.), The Wayne County Housing Coalition Wayne County Metropolitan HousingThe Suicide Prevention Coalition of Wayne/Holmes CountyThe Holmes County Child and Family Health ConsortiumNational Alliance for the Mentally Ill (NAMI) Wayne/Holmes Cos.The Ohio National Alliance for the Mentally IllThe Ohio House of Representatives, (Ron Amstutz, Dave Hall)The Ohio Senate (Senator LaRose)The Wayne/Holmes Emergency Coalition (includes emergency room services for Wooster, Orrville and Millersburg)Heartland Behavioral Health CollaborationHeartland East Data SystemsThe University of Akron- Wayne CollegeThe Wayne County Children Services BoardThe Wayne County Department of Job and Family Services/ Ohio Means JobsThe Holmes County Department of Job and Family Services/Children ServicesTri County Educational Services CenterThe Wayne County Transportation CoalitionWooster Community HospitalAultman Orrville HospitalJoel Pomerene HospitalThe Cleveland ClinicThe Vi Startzman ClinicMargaret Clark Morgan Foundation SUMMA Health SystemsThe Ohio Association of Community Behavioral Health AuthoritiesFamily and Children First Collaboration: The Mental Health & Recovery Board’s participation with Family and Children First Councils in Wayne and Holmes Counties is emblematic of the way in which this Board interacts with the community generally. The Council partners’ collaboration is exemplary in both counties. Attendance is always good and both Councils have a comprehensive system of working committees. Each Council has a unique format for revenue pooling and cost sharing for youth placement operations and projects.The AOD & MH agencies and the Board regularly take projects to the Council for endorsement and approval. For example, the Councils have both approved the Asset Development approach for prevention and treatment services for children, which is family based and multidisciplinary in scope. By working with the membership of the Family and Children First Councils in Wayne and Holmes Counties, the Board and the community have been able to institute a groundbreaking model for completing student surveys. The survey itself may be unparalleled in the United States and represents a substantial shift in the Board’s approach to prevention capacity building. The survey process uses an electronic survey tool, i.e. “survey monkey” paired with a doctoral research project, by one of the Board’s contracted agency Quality Assurance directors. The survey results are a valid measure of the value of asset building to prevent alcohol and drug use by school age students from the 6th to 12th grades. This survey combined an asset survey, with drug use data derived from the Search Institute’s work by a researcher in Oklahoma (Youth Asset Survey), and drug use questions from the Pride Instrument. The results, using these integrated tools, communicate increased data and information about the impact of an effective prevention strategy.The Family and Children First Councils value and coordinate alcohol & other drugs (AOD) and mental health (MH)) treatment services with other elements of the community service system structure in a collaborative, multidisciplinary manner. The Council endorses the perspective that youth with complex needs justify multidisciplinary planning. This communicates the value of a powerful treatment model. There is a managed tension between a provider’s need to practice via the information sharing regulations and ethical norms for MH and AOD treatment, while maintaining a multidisciplinary approach with the membership. The Family Council’s Executive Committee expects all members, including AOD & MH service providers, to be outcome focused, asset and family approach based, and collaborative team players. Historically, both the AOD and MH agencies are heavily utilized by the Councils to provide both prevention and treatment services. In Wayne County, each Family Council partner who contributes to a service coordination plan commits to a percentage contribution of the child’s placement costs. Typically, this involves the Juvenile Court, the local Children Services Board (CSB), County Department of Job & Family Services (DJFS), the Wayne/Holmes MHRB and the local schools. Developmental Disabilities (DD) and others, including parents, may contribute on a case-by-case basis. Agreements for each child’s treatment plan costs are developed and contributors sign a joint agreement that outlines the percentage of costs of care that each will cover. In Holmes County, the mandated treatment partners pool funds and then purchase services from the pool. The Family Councils in each county have designed Service Coordination agreements to coordinate cases and divert youth from high-end care by designing and purchasing wrap-around services, i.e. after school family assistance, respite care, day camp, YMCA memberships etc.Youth placements are collaboratively funded. The MHRB, Juvenile Court, Children Services and Developmental Disabilities have each historically contributed a percentage of the cost per case. Due to the state budget cuts in behavioral health care in FY09 and FY10 our Board worked collaboratively with our contributing partners to decrease the Board’s percentage of the placement costs, and more recently in FY13 our Board again had to decrease its placement contributions. In addition to the Family Councils, the Mental Health & Recovery Board has extensive formal and informal community collaborations, creating an integrated system of care. These broad community partnerships result in a public awareness and passion for overcoming the stigma and root causes of AOD or MH issues in the wider community.The Holmes and Wayne Juvenile Courts: Early in FY14, the Board created a partnership with the Holmes and Wayne Juvenile Courts and the respective Family and Children First Councils of both counties to meet the treatment and support needs of juvenile offenders with serious behavioral health disturbances. The project also targeted the youths’ families by using evidence-based practices, which are designed for effective assessment and treatment for troubled youth, and their families, i.e. Multi Systemic Therapy (MST) .The Target Population for the Holmes/Wayne MST Partnership is male and female youth ages 10 to 18 from either Holmes or Wayne County. The included youth will have diagnosed Axis I and/or Axis ll disorders, which create substantial disruption to their behavioral, cognitive and/or affective domains and a high intensity of the behavioral health need. These youth often have co-occurring mental illness and substance abuse diagnosis and records of violent behavior with criminal histories. They are juvenile court youth who are in danger of an out-of-home placement, or youth returning from an out-of-home placement. The partnership formed a Memorandum Of Understanding with the Crisis Intervention and Recovery Center in Canton, Ohio for two slots in an existing 4 person MST team, with one of the slot’s (MST) therapists to be active in Holmes County and the other in Wayne County.The County Board of Developmental Disabilities (both Wayne and Holmes). Starting in FY14 the Mental Health & Recovery Board of Wayne/Holmes Counties, through a multi county grant to Stark, Portage, Columbiana and Wayne-Holmes Counties, began to work with the County DD Boards on cases involving youth with both mental illness and developmental disabilities. The premise for this work is that youth with disabilities who also have mental health difficulties need collaborative care for this diagnosis that currently does not exist. Developmental disabilities may well increase the probability of some forms of mental illness and families with young people suffering these difficulties do need additional support. The project, Safe Families/Safe Communities was designed to develop cases on a wrap-around construct, as wrap-around builds on and strengthens the family’s natural ecology around the youth. The Board advocated and took measures to assure that the project would be active in both counties and contracted with a local provider with experience in both MI and DD to coordinate the program and services.Heartland East: The Board participates in an ASO/administrative service organization of Mental Health & Recovery Boards known as the Heartland East Administrative Services Center (HE) for claims payment to link to the State/Board-sponsored MACSIS system and to the new claims and information system that will be implemented to replace MACSIS during FY17. As part of this arrangement the contracted providers will maintain the capability to link with either system in accordance with the technical requirements and business rules to utilize the new claims or information system. This collaboration is an effective operation. The reports, research, innovations and efficient response of the HE organization decrease the MHRB’s administrative costs. The Board can receive same day report generation, if necessary, to prepare for grants, state data requests, partner data requests, or prepare planning documents. HE does data mapping and creates routine monitoring reports for the Board and their contract agencies and manages HIPAA privacy notices. Monthly claims reports monitor the contract agency claims. This multiple county ASO could easily be a model for all ADAMHS Boards to manage scarce resources regionally. Recently as well, the HE collaborative has been working on issues related to linking with provider EHR and developing an area wide utilization of a single Health Integration Exchange (HIE) as a way to find a new means to develop information for the system. Adult Criminal Justice System Services: Mental illness and drug addiction are neurobiological, psychosocial behaviors that include impaired judgment and anti-social behaviors that result in social problems. Eighteen years ago, local criminal justice programming became jail-based or jail related due to legal actions against the counties for not providing adequate care and services. As a result, service has grown since then to include various probation referral programs as well. The Board is not officially involved in any DUI programming since the courts handle these privately with various providers. The Board draws down funds from county-based funds created by H.B.131 legislation. The Board can charge this fund for service provided to individuals charged with more than one “Driving Under the Influence” (DUI) offense and a diagnosis of alcohol dependency, if the individual is indigent. The Board staff has seats on the County Corrections Boards of both Wayne and Holmes Counties. In conjunction with this, the Board has provided assistance for CIT (Crisis Intervention Training) for local law enforcement officials, a valued local program. Wayne County: Programs developed by this Board, in conjunction with the Ohio Office for Criminal Justice Services and the Wayne Co. Commissioners, provide for jail-based services, primarily funded by the Commissioners. Over the past few years, the Board has spearheaded an effort to develop a Re-Entry Coalition (Second Chance Act) in Wayne and Holmes Counties. The Board submitted and received two grants to develop a coalition to address the re-entry of juveniles from detention, state youth services and residential treatment programs. Adults in corrections, with children in the home, are an additional target for this coalition. An innovative aspect of this coalition includes addressing the various issues surrounding re-entry, including the stigma of a criminal history in addition to mental illness and addiction. The Re-Entry Coalition is now one of Ohio’s recognized re-entry coalitions.Starting in FY14, the Board has begun to work with the Corrections Departments of both the Wayne and Holmes Sheriff’s Departments. The focus of this work is to address those individuals in corrections with mental health or substance abuse issues. We collaborated with corrections on this due to the circumstance that corrections have become informal residential centers for the MH and SA populations, locally and nationally. It is our belief that as many as 20% of these individuals, which in total are 77% of the corrections population, are unintentional criminals, who will continue to recycle if no intervention occurs. We are intervening with case management, navigation and psychiatric services. This work continues in FY16 and FY17 when and after the Board was visited by former Supreme Court Justice Evelyn Stratton, who advocated for Stepping Up, a collaborative planning and problem solving approach for reducing the number of mentally ill who go in and out of the criminal justice system without securing lasting mental health care and the necessary service linkages that go with it.The Suicide Prevention Coalition: The Mental Health & Recovery Board of Wayne and Holmes Counties has made suicide prevention a top priority with the QPR (Question, Persuade, Refer) training process, which is considered a best practice by the Suicide Prevention Resource Center. QPR is used to train individuals to recognize the signs of suicide, persuade a suicidal individual to seek help, and refer persons in need to the appropriate services. This is possible through grants provided by the Margaret Clark Morgan Foundation, the Ohio Program for Campus Safety and Mental Health (SAMHSA funds), and the Wayne County Community Foundation. The Wayne/Holmes MHRB has been able to partner with three other area boards, the local Suicide Prevention Coalition, and many health service providers in the community to offer QPR trainings for medical professionals, school personnel, local college students, and community members. QPR training emphasizes that anyone could have the opportunity to intervene in the life of someone who is suicidal. While QPR is not the only method of suicide prevention that the Wayne/Holmes MHRB offers, it has proven incredibly successful and far-reaching in its effects. The Hard-to-Employ/Welfare Reform: Since the onset of Welfare Reform, which began before 1997, the Wayne and Holmes Departments of Job and Family Services (CDJFS) continues to work directly with the Mental Health & Recovery Board to create and fund service contracts with local agencies to address the complex needs of people struggling with poverty. Complications stemming from mental illness and alcohol and drug addiction can create additional poverty issues for clients and families. This creates a need for intersystem coordination between behavioral health and the local departments of job and family services. The Mental Health & Recovery Board values this partnership as an example of community members collaborating for improved client support. The implementation of AoD counseling, intervention services, and behavioral/cognitive treatment approaches is essential to improved client outcomes, increased employment and decreasing the costs to the communities for these disabilities. For the past four years, the Board has continued a supportive employment program started through the Recovery to Work RSC grant in FY12, including both MH and AoD treatment services and vocational services.Business and Commercial Ventures: The Board has provided leadership in the development of the Wayne County Common Good, a collaboration of agencies/services around employer/employee issues, which has led to many exciting ventures and spin off activities related to “results” work. The Board became involved with The Renesselaerville Institute’s Outcome Framework activity through the State Common Good team. The Common Good has been the local leader in promoting the Ohio Means Jobs One Stop as the Ohio Means Jobs of Ashland, Wayne and Holmes Counties. The Board played a key role in the design and continuation of this framework for ETC’s business,and job seeker networks. The Mental Health & Recovery Board has been involved with a voluntary collaborative known as the Common Good Team since. The Team established itself in 1995 to build a public employment services network with a mission to reduce the barriers to employment for their shared and chronically unemployed or underemployed clients by improving information sharing, providing access to an inter system network of needed employment assistance programs, and building working linkages with business-industry-and employers. The services provided by the members include: veterans services, disability services, mental health and addiction services, basic education and literacy, referral for skill set evaluation and required training, community development, employment and training services, career development, technical skills training, employment supports and readiness training library based employment/employers information, and services for a wide variety of disabled and barriered workers. In 2004, the county commissioners of Ashland, Wayne and Holmes Counties designated the Common Good of Ashland, Wayne and Holmes Counties designated the Common Good as the (RAC) Regional Advisory Committee to the Workforce Policy Board of the Ashland, Holmes Wayne Ohio Means Jobs One Stop service delivery system. The Common Good has: developed motivational workshops and an employer, employee mentoring program; partnered with local investors in assisting with the Hope Fund held a Lean manufacturing demonstration with the Will Burt Company in Orrville, Ohio conducted eighteen community job fairs; a Women’s empowerment grant from the Wayne County Community Foundation and is currently working with the Wayne County Economic Development Council and the Workforce Innovation Network for the purpose of helping with the development of workforce pipelines (means to create an ongoing source of drug free workers) for local industry. In 2016 this work has included the development of a Manufacturer’s Drug Testing survey on survey monkey to get a better picture of how companies are testing incoming employees and current staff as well as what their policies are about using referring employees or applicants to treatment.The Board meets regularly with the Wayne County Economic Development Council and has also met with the Wooster Area Chamber of Commerce, the Holmes County Chamber of Commerce, and the Holmes County Amish Safety Council and worked with the Orrville and Dalton Chambers to make the business case for behavioral health assisting with the goals of the business community. This role includes improving productivity, employee assistance, saving employers health care costs and collaborating with the public schools & universities regarding the preparation of the future workforce. The Board supports the local economy, commerce and future development in this area through this ongoing collaboration. The Wayne/Holmes County Behavioral Health Care Providers And Consumers: Collaboration as a word, does not predefine the act of working together. Historically, this Board has had a tradition of working with its contracting providers in a collaborative fashion. However, this working relationship has improved greatly over the past two years when the executive leadership of the Board identified the system of care model implemented through a collaborative business plan. The Board is working to assure that the system of care is based on intersystem trust and strong, collaborative working relationships between the Board, the contract providers and consumers. The executive staff implemented actions to build that understanding by developing relationships with local service providers utilizing regular meetings, joint planning and well-coordinated partnerships. This partnership development has been critical for achieving operational success in a wide variety of projects recently, and has become a trusted local model for approaching the uncertain future our field currently faces.Collaboration conclusion: In conclusion, the Board is able to address the stigma of mental illness and AoD abuse/addiction through these collaborations functionally by meeting needs, rather than simply distributing articles or making speeches on the subject. This collaborative work involves Children Services, Adult and Juvenile Courts, the schools, economic councils, Department of Job and Family Services, and ultimately the public, which is after all where stigma lives and takes its toll. This is a good example of collaboration empowering community interaction to address the major social issues of our time.Inpatient Hospital ManagementDescribe the interaction between the local system’s utilization of the State Hospital(s), Private Hospital(s) and/or outpatient services and supports. Discuss any changes in current utilization that is expected or foreseen. During FY13 and now into FY17, the Mental Health & Recovery Board of Wayne and Holmes Counties (WHMHRB) has worked very deliberately with both OHMHAS and the administration at Heartland Behavioral Healthcare (HBH) on several critical issues. These include finding agreement about the proper research based protocol and practices around medical clearance; in depth discussions about the pragmatics of the “pink slip” process and time use analysis regarding access to beds at HBH. HBH initiated time use study to discover unusual patterns in the progression from point of entry to arrival at HBH as a means of working in partnership with the Board to reduce dangerous delays in access. The results of this activity have been productive. The Board discovered that Medical Clearance was being attenuated by unnecessary procedures, which created unnecessary delays and expense, and as a result, the Board and HBH medical clearance process is more efficient. One of the results of the time study has been to discover that the most practical actions that could be taken in making the access time more efficient were not mechanical issues as much as case assistive. The Board discovered that when the staff at HBH worked with the referring agency at the case level, the result was that patients got the care they needed efficiently.The Board remains in contract with Heartland Behavioral Healthcare (HBH) (via the Continuity of Care Agreement), as the primary behavioral health inpatient treatment facility for the Wayne/Holmes region. Additional adult inpatient beds at a community hospital are contracted outside of our board counties and our local mental health provider, The Counseling Center (TCC), manages utilization.The Mental Health & Recovery Board of Wayne and Holmes Counties contracts, with The Counseling Center of Wayne & Holmes Counties, for provision of comprehensive behavioral health crisis services and hospital prescreening services for the two county region. The Counseling Center has outpatient offices in numerous outlying areas including two major offices in Wooster and Millersburg (Holmes County), with additional offices in Rittman and Orrville.TCC’s comprehensive hospital pre-screening assessments consider the most appropriate hospital placement, financial resources available, and hospital bed availability then TCC coordinates admission to treatment, considering the level of care needed to provide the best client outcome. The MHRB manages hospital utilization through a service broker fund, through which the Board provides financial allocations for TCC to pay for indigent clients in private hospitals, i.e. Summa Hospital in Akron, as clinically indicated. The Counseling Center’s role is to pre-screen, coordinate hospitalization, monitor and coordinate discharge planning for all admitted clients.TCC crisis staff responds to emergency clients at each of the medical surgical hospitals in the two county region including Wooster Community Hospital, Aultman Orrville Hospital, and Pomerene Hospital (in Millersburg). Prior to hospitalization at Heartland Behavioral Healthcare, medical clearance is coordinated via the appropriate medical hospital. TCC coordinates ambulance transport to HBH utilizing the broker fund.Utilization patterns have varied throughout the last year. The availability of beds at Heartland and the availability of psychiatry has decreased and is a concern. The Board manages the use of state beds by purchasing beds with the Summa system in Akron, Ohio. be The Board and its lead agency with the Hospital, monitored this daily and will continue to do so. Additionally, any increased program need, unmet need due to hospital capacity, out of county referrals due to bed unavailability (at HBH), will be addressed and a meeting with Heartland CEO arranged as needed. Innovative Initiatives (Optional)Many boards have implemented innovative programs to meet local needs. Please describe strategies, policy, or programs implemented during the past two years that increase efficiency and effectiveness that is believed to benefit other Ohio communities in one or more of the following areas:Service deliveryPlanning effortsBusiness operationsProcess and/or quality improvementPlease provide any relevant information about your innovations that might be useful, such as: How long it has been in place; any outcomes or results achieved; partnerships that are involved or support it; costs; and expertise utilized for planning, implementation, or evaluation.NOTE: The Board may describe Hot Spot or Community Collaborative Resources (CCR) initiatives in this section, especially those that have been sustained.SERVICE DELIVERYCulturally Competent Annual Dinner. The Board was able to hold its FY16 Annual Dinner in Holmes County. Its subject was the needs of the Amish in Holmes County in light of the cultural difference between our service delivery system and the Amish Culture. The Board had planning assistance from an Amish Bishop and other members of the Amish community. The speakers were all either Amish or NIMH Researchers who had addressed this need, both culturally and medically. The event received an editorial in The Budget, an Amish and conservative Mennonite Newspaper and was very well attended by Amish bishops and their families. The event was also attended by representatives of OHMHAS prevention services and cultural competence standards.Streamlined Detoxification. Building on a series of 507 regionalized programs after those OHMHAS grants ran out, the Board built a streamlined detoxification agreement in conjunction with the Crisis Intervention & Recovery Center, Quest Treatment and Prevention Services, Local agencies OneEighty, Anazao Community Partners and The Counseling Center for sub-acute crisis detoxification and recovery services. While the use & addiction to opiates is an epidemic and all attention has gone to them, the fact of the matter is that addicts are generally cross addicted to other drugs (alcohol, benzodiazepines, and amphetamines including methamphetamine) and will use each of these drugs through the loss of their jobs, families and their lives; and will use them in a poly drug fashion to meet their cravings. These addictions are just as fierce and destructive as opiates and require a creative approach that can be developed through this streamlined agreement. The agreement also allows for involvement of Peer Support Coordinators during detoxification for making connections prior to discharge. This agreement supplements local services in a needed way and has capitalized on the regional agreements originally established under the OHMHAS 507 regional grants as an important type of addiction treatment in our local continuum of care. It went into effect in early March of 2016. PREVENTION EFFORTS IN WAYNE AND HOLMES COUNTIESOpiates: The Wayne Board has been involved in a variety of prevention and treatment efforts with respect to the Opiate Crisis. In 2007 the Board noted a dramatic increase in requests for opiate detoxification and the costs soon escalated to 400% of the Board’s historical expense averages for this service. The Board did exhaustive research on this subject and quickly organized a training for seven local medical practioneers in brief suboxone detoxification procedures. Six of these doctors were certified by the DEA, but it was very difficult to maintain their interest in actually supply this form of care. In CY 2011 and in CY14 the Board focused on the subject of the Opiate epidemic and brought in speakers from Solace in Scioto County, a speaker who had a system to expedite OARRS in medical offices and ODADAS on the subject and then in a subsequent annual dinner brought in Brad Lander from OSU to address the Opiate addiction process in the brain.In the following years the Board took two groups, one from Wayne and one from Holmes to a statewide convention on Opiates sponsored by the Ohio Association of County Behavioral Health Authorities. This event was a team building event which lead to the creation of the Wayne County Opiate Task Force in FY 15 which has continued to meet on the subject through FY16 with functional committees on Community Support, Treatment, Intervention and Prevention. There was also a training offered to train physicians about safe prescribing policies for prescription pain killers.Despite all of this, opiate drug abuse in the form of Heroin, fentanyl and illegally obtained prescription drugs continues to increase. In FY15 the board responded to this continued trend by making Naloxone kits available for all the village police cars and the Wayne County Sheriff’s cruisers so that they could act effectively as first responders for opiate overdose calls. Suicide Prevention: The Mental Health & Recovery Board of Wayne and Holmes Counties has made suicide prevention a top priority. One of the programs successfully utilized over the past 4 years has been the use of QPR (Question, Persuade, Refer), which is considered a best practice by the Suicide Prevention Resource Center. QPR is used to train individuals who are identified as suicide prevention Gatekeepers to recognize the signs of suicide, persuade a suicidal individual to seek help, and refer persons in need to the appropriate services. Through grants provided by the Margaret Clark Morgan Foundation, the Ohio Program for Campus Safety and Mental Health, the Wayne County Community Foundation, and The Suicide Prevention of Wayne & Holmes Counties, the Wayne/Holmes MHRB has been able to partner with many health service providers in the community to offer QPR trainings for medical professionals, school personnel, local college students, and community members. The Board is also an active member of the Wayne/Holmes Suicide Prevention Coalition.Substance Abuse Prevention Coalitions: The agency OneEighty has been very successful with initiating and maintaining community based prevention coalitions. Wayne County is no home to four Community Coalitions that are dedicated to helping youth grow up drug-free and thrive. Community Coalitions are designed to empower the community to lead primary substance abuse prevention. They use community-based strategies that inform, educate, provide support, reduce youth’s access to substances, enhance youth access to services, change consequences, change physical design, or modify policy. As independent, volunteer organizations, each Coalition works in its respective community conducting strategies tailored to meet the unique needs of the local youth, families and community. They often work together to be an influence throughout Wayne County. Started in 1999, CIRCLE Coalition (CIRCLE) is the county’s oldest coalition and serves Wooster. Turning Point Coalition began in 2004 and serves the community of the Dalton Local, Green Local and Orrville City School Districts. The counties two younger Coalitions were formally launched in 2010. Chippewa Cares (CC) serves Chippewa Township, including Doylestown. Rittman SALT (RS) serves the Rittman area. OneEighty provides support through a Community Coalitions grant for all fourDuring January all the Coalitions marketed Turning Point’s Assets & Intentions community presentation with Jim Ryan through Parent Alerts, and other methods. The Coalitions also renewed efforts to advocate that legalizing marijuana as “medicine” is not in Ohio’s best interest, but rather following the science-based FDA process would be better. Turning Point held four events with presenter Jim Ryan, at Orrville High School. 270 youth learned how to build their own assets, framed as how to better achieve their dreams. In the evening, TPC presented, Assets & Intentions showing parents and other adults how to create more asset building opportunities for youth in the community. Turning Point also hosted a presentation for the Wayne County Career Center students. Nearly 400 students and 30 adults attended with topics such as; today’s headlines, substances most widely abused by youth and why, and how teens can build their own assets to achieve their dreams. Other Youth Education and Prevention Programs include special evidenced based prevention curriculum such as, Safe Dates. Which reaches9-12 grade students. The curriculum increases student knowledge on the qualities and aspects of healthy relationships and the prevention of sexual assault. The agency also provides Community Education and Outreach, Drug Free Safety Program (DFSP), Youth Mentoring, and the Wayne County Teen Institute (WCTI) and Wooster Teen Institute (WTI) Anazao Community Partners also provides Community Education and Prevention, Screening, Referral services, Life Skills Education, Community Awareness classes, Community Based Prevention processes, health fairs, Insight groups, A Speakers Bureau, Asset Building and Youth led Prevention. In FY15, the latest figures available to the Board, they provided at least one of each of these services to nearly 9000 people. Amish Health & Safety Days: Anazao Community Partners also conducts the Safe Communities’ Grant programming (Department of Public Safety) for both Wayne and Holmes Counties. Safe Communities has had great success working with the Amish churches and communities in both counties and has organized an Annual Amish Safety Day fair that is held in Holmes count and heavily attended by members of the various Amish and conservative Mennonite sects there. This event is built around traffic accident demonstrations, and other health & safety demonstrations as well as an assembly of table displays from area health care providers. In FY15 the Board put together a two table display with the Board featuring its agency materials and as second table put on by the Amish Drug and Alcohol Prevention Committee. This table was operated by members of this Amish committee as a way of introducing the committee to other Amish. A brochure was developed and handed out by this this Amish committee specifically for other Amish or Mennonites and a carry bag was provided that had been stuffed with a wide variety of substance abuse prevention information. This event was made possible by a grant from Ohio’s Partnership for Success Initiative. 160 bags were given out to Amish families. Subsequently the Board received another small grant from OHMHAS the Partnership for success and it too was used in a unique way in Holmes County.The “SPARK” During FY16 the Mental Health & Recovery Board of Wayne-Holmes Counties was a recipient of a small grant from the OHMHAS Strategic Prevention Framework Partnerships for Success (SPF-PFS). The Board arranged to use the grant for the development of a comprehensive set of community prevention messages to be developed collaboratively with the Holmes County Prevention Coalition. The idea originated with the Holmes County Commissioners who requested members of the community to do more to talk about preventing drug abuse. The Board proposed to review a series of effective, modern messages that have been developed around the U.S. for use in video, social media, and other electronic messaging systems. These messages were to include communications that are culturally relevant to all populations in Holmes County and would also be able to be an active set of messages suitable for use by the Holmes County Faith Community. The Board contracted with a well-known Collective Impact trainer to assist with this collaboration.The product of this work was the development of “the Spark” as a messaging symbol to be linked with activities and attitudes that are evidence based protective factors. It was taken from work already underway in the West Holmes Schools System, which gave it the value of social recognition with young people.The idea is to associate the Spark with protective factors against drug use.? Uniquely, the Board asked that the messages specifically not mention drugs or alcohol in these associations with the Spark as such references actually cue the subject in the minds of young people, particularly if they are carelessly associated with protective factors such as social activies or sports. Drug references also cue negatives which businesses would likely not want contained in their advertising. The Spark symbol is being used to associate/promote with purpose, personal passions, talents, positive interests, gifts and constructive life meaning.? It is hoped that these symbols can be developed so as to place them on regular business advertising by Holmes County businesses. The roll out of this is planned for August, September, and October of FY17. PLANNING EFFORTSShort Term Residential Crisis Stabilization and Restoration. One of the Board’s major responsibilities is its involvement in the collaboration of the Family and Children First Councils (FCFC) in Wayne and Holmes Counties. One dimension of that is the work that the Councils do with respect to multi need children who are seriously mentally disabled, victims of abuse or neglect or traumatized and involved with the courts. Historically, many of these children have required extensive inpatient and residential treatment. The Board utilizes its collaboration with FCFCs financially with shared and pooled funding agreements in Wayne and Holmes Counties respectively. These agreements are used to share in the costs of meeting the high end out-of-home placements for multi-need children and youth. This need and the expense to meet it have grown disproportionally to other needs met by this Board, to the extent that the expense has gone over budget for the past several years and required us to find better, more efficient methods to provide this needed care. In answer to this, the Board called together a meeting of the key partners involved in these cases and asked to local statewide residential care providers, i.e. The Village Network and Christian Children’s Home of North East Ohio them to consider developing a service that would both meet this need by creating a short term residential crisis stabilization and restoration to respond to local need while being marketed statewide for sustainability. This planning effort resulted in one of the two entities volunteering to meet this call and risk this market to provide this service. The Board has gone on to approach a foundation for assistance with this and is taking stock of all its purchased services/methodologies to utilize them in this mon Good, WIN and Ohio Healthier Buckeye. The Mental Health & Recovery Board has been involved with a voluntary collaborative known as the Common Good Team. The Team established itself in 1995 to build a public employment services network with a mission to reduce the barriers to employment for their shared and chronically unemployed or underemployed clients by improving information sharing, providing access to an inter system network of needed employment assistance programs, and building working linkages with business, industry and employers. The services provided by the members include: veterans services, disability services, mental health and addiction services, basic education and literacy, referral for skill set evaluation and required training, community development, employment and training services, career development, technical skills training, employment supports and readiness training library based employment/employers information, and services for a wide variety of disabled and barriered workers. In 2004, the county commissioners of Ashland, Wayne and Holmes Counties designated the Common Good of Ashland, Wayne and Holmes Counties as the (RAC) Regional Advisory Committee to the Workforce Policy Board of the Ashland, Holmes Wayne Ohio Means Jobs One Stop service delivery system. The Common Good has: developed motivational workshops and an employer/employee mentoring program; partnered with local investors in assisting with the Hope Fund held a Lean manufacturing demonstration with the Will Burt Company in Orrville, Ohio, conducted eighteen community job fairs; a Women’s empowerment grant from the Wayne County Community Foundation and is currently working with the Wayne County Economic Development Council and the Workforce Innovation Network for the purpose of helping with the development of workforce pipelines (means to create an ongoing source of drug free workers) for local industry. The Wayne County Commissioners resolved in October of 2015 that the Common Good take on the responsibilities of the Wayne County Ohio Healthier Buckeye Council. The purpose of the Ohio Healthier Buckeye Council, a piece of legislation drafted by Representative Ron Amstutz from Wayne County, is to assist people in getting off of public assistance. The Common Good has proposed creating a rehabbed workforce supply system to meet employer demand and modeled its proposal to do so on strict supply and demand business theory.The NAMI of Wayne and Holmes Counties – Anazao Community Partners Capital Funding project. This is an exemplary collaboration project that was completed with the assistance of the Ohio Department of Mental Health and Addiction Services in FY16. It is a perfect example of Departmental-Board-Provider partnering! In FY15 NAMI MOCA came to the Board and stated, for the record, that it had outgrown its facility, a former parsonage house by a local church. While the rent was reasonable, the space and amenities were not. In FY 16, Anazao Community Partners, a local AOD outpatient services based agency with a modern facility at the edge of Wooster, notified the Board and NAMI that a building formerly occupied by Hospice of Wayne County, next door to Anazao’ s facility was vacant and available for purchase. A quick response by eager minds was utilized to assist with purchasing this property to be shared by NAMI/MOCA and Anazao. Within a matter of days the Board and OMHAS held a constructive conversation about using OMHAS capital dollars and local donations and Anazao funds to purchase this building and transform it into a Consumer operated Recovery Center for the mentally ill and a an intervention service area for at risk youth. The pieces to the puzzle fell together quickly, and as of this past March of 2016, the building was occupied and in use. A true miracle action story that is perfectly timed for the Board’s movement into Recovery Oriented Systems of care. The State’s capital funding and capital office responsiveness was very helpful and appreciated. Innovation takes action, faith and commitment!Recovery Housing and Peer Coordinator ServicesThe Mental Health & Recovery Board of Wayne & Holmes Counties has worked very hard over the past seven years to cultivate a positive working environment with the local agencies that provide MH and AOD services. This effort has produced a yield of service creativity that is much admired throughout the community. The agency now known as OneEighty, formerly Liberty Center Connections has been very productive in this regard with respect to following through on recovery programming. The Board has worked hard to nurture that with assistance and advocacy. Two areas of this work should be noted:Recovery Housing: OneEighty now has five (5) recovery housing units, one of which dates back many years and started as an Oxford model type housing. Recently, OneEighty has added 4 additional Recovery housing units through grants and community donations. During FY16, the board assisted this effort by helping OneEighty secure a renovation grant from the Capital funding process to enable it to affect some needed repairs and restorations.Peer Recovery Coordinators: During the Regional 507 Board Collaboration process, the Mental Health & Recovery Board of Wayne and Holmes County advanced a Peer Recovery Coordinator position and was one of the first Boards in the state to do so. As this project took shape, OneEighty partnered with NAMI of Wayne and Holmes Counties and proposed a Peer Recovery Coordinator partnership between the two agencies that put the Board’s proposal in play to provide Peer Coordination Services for individuals with AOD recovery and MH recovery needs. The Board now funds that position without grant support. OneEighty also added Peer Supporters through the OASIS Center, which is a recovery club associated with OneEighty. .Together these two projects reflect the Board’s emphasis toward Recovery Oriented Services and the positive relationship building that has occurred between the Board and local providers.The Mental Health & Recovery Board of Wayne/Holmes Position on Outcomes:The Board is interested in outcome reporting that clearly indicates the results of the services the agency provides. Providers shall produce outcome reports on performance targets that the Board and the public it represents can understand. Providers should refrain from stating reports in language that only researchers and academic professionals can understand and evaluate. All Outcome reports shall:Use the Standardized Demographics & Outcome Reporting Grid by Level of Care (LOC) or Service for reporting, as developed within the QA/QI Committee in FY15.Evidenced Based Practices shall report on required fidelity measures as outcomes in and of themselves.Be based in (National Outcome Measures) NOMS (at a minimum) for social functioning, housing social connectedness, criminal justice involvement, consumer satisfaction Meet the Ohio MHAS Outcomes Rule 5122-28-04 Include initial baselines and progressive benchmarkingBe compared to outcomes taken from local and national studies on which to base performanceAll Qualifiers regarding outcomes, adjectives or phrases shall clearly indicate any biases implicit in them and in all cases be kept at a minimumAll outcome reports shall include a Results and Learnings section answering the question “What “Learnings” can be taken from the quarterly results?” that can suggest quality improvements or best practice as this process progresses *Be based in continuous roll outs from previous years if the service being reported is continued from the previous year.*The learning process is based in the logic of scientific inquiry. The Board does not believe that all efforts no matter how well intended, will succeed. Scientific study assumes that failed attempts ultimately lead to scientific discovery of meaningful results. The learning process should embrace scientific methodologies. Advocacy (Optional)Please share a story (or stories) that illustrate the vital/essential elements you have reported on in one or more of the previous sections. (Request sent out to agencies on this to be coordinated by Jean Boen)The following story illustrates a success in the Strong Family/Safe Communities grant as operated by Catholic Charities of Wayne Counties. The program uses a Wraparound service approach. The client in this story is referred to as C.= Client.While talking with her mom about camp options and explaining that we would be paying for C. to go to camp, her mom explained that they would likely figure out a way to pay to send C. for a second week since C. loves it so much.? Later on, I explained that we would actually be able to pay for both weeks of camp and C.’s mom became tearful.? She explained that Camp Nuhop is the one place that C. is not anxious about going to because C. has been going there for several years and really looks forward to it every year.? C.’s mom went on to explain that it is also the one week of the year that she does not worry about C. because C. enjoys it so much and knows many peers that have also been there for years.? At the end of the conversation, C.’s mom reported that it has been such a blessing to be involved with the Wraparound services and that the worker has been such a delight to work with, as well as everyone else.SUCCESS STORY #1 TCCA middle aged male veteran spent seven years in Navy. This man, diagnosed with schizophrenia, grew up in Ohio but moved to Florida. In Florida he became homeless, was not receiving mental health treatment and could not function in society. He bounced around to different shelters and hospitals and was very symptomatic. Client reports that he realized that he needed help and he returned to Ohio and settled in Wooster. Client was assigned a CPST staff, who helped him to: 1) get stabilized on medications; 2) receive benefits from the VA; and 3) find stable housing.Client currently lives independently with very good success. He had a very rewarding relationship with a significant other until her death. Client has a strong desire to give back to society. He has volunteered at a local agency for the last 10 years. He also holds events at a local VA home for July 4th and Christmas celebrations each year. He has the event catered and he acts as the DJ. The veterans’ families are invited for the event. Client puts the events on at his own initiative. He plans the menus and the activities, coordinates the event, as well as funds it.Client has learned that compliance with treatment has enabled him to function at his best. Client has difficulty remembering to take medication and uses a system where he puts a smiley face on his calendar after taking medication. He meets regularly with his CPST staff every two weeks and never misses his appointment. HIS CPST staff member states she would “have a heart attack” if he didn’t answer the door for his appointment with her.Client is known for his good heart, kindness and courtesy. He has flowers delivered to local businesses, family and people that have helped him in the past. He consistently remembers people on Valentine’s Day, Christmas and Mother’s Day. He never has a bad word to say about anyone.OneEighty (Addiction) Before I made steps to get help with my addiction I was an addict most of my life but at 30 my life became completely unmanageable. I hated who I’d become. I could not go on any longer the way things were and I didn’t want to. I was about to lose the only three things I cared for, my two sons and my husband. They deserved a sober wife and mother or me out of their lives. I knew I wanted to be sober but could not manage to do it alone since I had tried that countless times and failed. When I came to STEPS a counselor arranged for me to be on the Suboxone outpatient program which I will be forever grateful for. Through taking this medication I was able to do the things necessary for recovery including meetings, classes, counseling. I’ve learned about my addiction, met people going through similar struggles, I got a sponsor and continuing trying to be a good person and also trying to help others. In the beginning I thought after a couple months or so I’d be cured but the truth is even after 2 years I’ m still learning who I am. It’s a process and I’ve learned to take it day by day. There is no special day I will be normal or cured. I try to do the best I can daily. Some days are hard. I struggle with depression. I go to meetings and sometimes I don’t want to but I still make sure I go. I still try to isolate. I know when I’m doing it and recognize it. I have relapsed instead of trying to get away with it, I told on myself and I kept on trying to fight for my recovery. I know it’s a disease and nobody wants to be an addict but I am. I’ve had counselors that I couldn’t talk to or agree with but I found one I can. An important thing someone told me was ‘it’s my recovery and I’m responsible for it.” “Don’t let anyone impact badly with my recovery” This is so true. If someone or something is not helping you try something else. No one else can. All I know is the version of myself in recovery is way better than the addict version, so no matter what set- backs I have I will continue to try to be a sober me. Honesty is a huge part of it. I continue to get stronger everyday over my addiction because I understand it. That’s a good feeling. And if I can’t I know I can talk to someone about it. Recovery is not supposed to be easy if it was there wouldn’t be addicts. It’s a fight with good & bad times. I will continue to fight because I know if I don’t this disease will win.SUCCESS STORY #2 TCCA female client with psychosis and depression, as well as a personality disorder, came to the agency approximately 10 years ago. She was considered very dangerous and has a history of several very serious assaults. Client spent many days at Heartland Behavioral Healthcare due to danger to self and others. She attempted suicide by hanging, and nearly succeeded, while in one of The Counseling Center’s group homes. During her last lengthy stay at Heartland Behavioral Healthcare, client was introduced to DBT and made a choice that she wanted to change the way she lived her life. Careful planning for discharge was made, and client agreed to: 1) Home Place Housing; 2) weekly CPST visits; 3) DBT group; 4) regular counseling/therapy visits; and 5) medication compliance.Client followed this treatment until a mutual client and staff agreement was made to reduce services. Today, client is working, in addition to having her own side business. She is on the verge of going off of SSDI. Client now has occasional but regular CPST contact and continues with psychiatry. She gets along well with coworkers and is developing meaningful relationships. She got her driver’s license and purchased a car and a truck (for her business). She stated recently, “I never thought my life could be this great.”SUCCESS STORY #3TCCClient is a 14 year old male that was diagnosed with major depressive disorder, recurrent, severe, without psychotic features; anxiety d/o, NOS; oppositional defiant disorder and phonological disorder. Client’s GAF was between 15 and 20. Client has been hospitalized 4 times between 12/2013 – 6/2014. Client’s current diagnoses are ADHD, Autistic Spectrum and Major Depressive Disorder. Current GAF is 60.Each time, client presented with depressive symptoms and suicidal thoughts with various plans; drowning himself, jumping out of windows, hitting his head on concrete. Client was found to be a high risk for self-harm.Other incidents not reported to police include starting a fire in the family’s garage, stealing and smoking cigarettes, stealing money from a friend, breaking a building’s window, playing with steak knives, running away at night and also putting his hands around a friend’s neck hard enough to leave marks. Client had difficulty in social situations which increased his anxiety. Client had gotten out of control with his aggressive behaviors in a public place and the police were called. Client said he was sorry but did not appear to be remorseful.Client ended the last school year in the detention room. His academics declined due to his refusal to do his work and he would become violent or would try to run if made to do something he didn’t want to do. The school requested that client not return for the last week of school due to his behaviors and a disruption at the school that would have caused client great anxiety. Client had been known to make himself bleed in order to write letters to his dead lizard with his blood. Client has also drawn on himself in his blood and was seen talking to his blood. School personnel voiced their concern that client will end up severely harming himself.Client was placed in a residential facility where he stayed for 5 months, from August 2014 to December 2014. Client learned skills to help reduce anxiety and learned positive social skills. Client thrived during this time with the involvement of family and The Counseling Center staff. Client attended the agency programming from January 2015 through December 2015. Client then transitioned to the junior high school where he has thrived. Client is participating in a few general education classes. Client is able to function well in the school and in the community due to the skills he learned in residential treatment and with the support of his family, teachers and staff at The Counseling Center.NAMI of Wayne and Holmes CountiesHis StoryWhen I first started at the old MOCA House, I was an empty shell, I never talked to anyone and I would sign in and leave. But, one day it all changed, due to people at MOCA House. They started talking to me and I started to bloom like a flower. I am not the same person I use to be. I have begun a new life, I moved to Wooster, have my own apartment and I have more friends than I have ever had before in my life; and I can’t stop talking and joking around. If it wasn’t for MOCA I would be lost and alone. They helped me to help myself, the first step into recovery. Her StoryMy name is and when I first came to MOCA House I was depressed, mentally and emotionally abused. Since I have been at MOCA I have come out of my shell, I feel better, I am happy and away from the people who abused me. My goals are to find my own apartment and take care of myself. What I have learned for my recovery from MOCA is how to cope with my depression, I get encouragement from the peers and staff and they taught me the signs to watch for which allowed me to get away from my abusers. I am very proud to be part of MOCA, they are family to me. Anazao Community PartnersStarbucks recently partnered with Anazao to work with our youth development program. Store leaders/managers and Starbucks employees volunteered time and refreshments to present an employment/job skills program to participants in the agency's F.I.A.T. Program."We cannot begin to express our thanks to Starbucks for all their help," said Keith Waggoner, Youth Development Specialist. Following a brief introduction from Starbucks and an overview of the Starbucks brand, participants were then given samples of coffee, tea, and pastries.?After the brief intro and snack, youth were divided into four groups and went through a series of stations facilitated by Starbucks staff.? The stations introduced the youth to job interview skills, customer service, communication skills to deal with unsatisfied customers, and a discussion on each youth's career goal(s).?There was a lot of role playing at each station and Starbucks staff conducted mock interviews with each of the participants. "This was a great way for our agency and the FIAT program to network with a company in the community," said Tamara Galbaski, Youth Development Specialist.Starbucks closed the program with questions from the group and there was a lot of positive feedback from the group on what they learned.? Starbucks plans to return in a few months to do another program to enhance and sharpen skills that will help youth as they transition into a new job.Open Forum (Optional)Please share other relevant information that may not have been addressed in the earlier sections. Report any other emerging topics or issues, including the effects of Medicaid Expansion, which is believed to be important for the local system to share with the department or other relevant Ohio communities. – The Mental Health & Recovery Board of Wayne and Holmes County was instrumental in the State of Ohio early in the 21st Century in assisting the state to move toward an effective value based framework. During the ensuing years the State’s direction towards outcome-based programming varied. The outcome policy/practice process turned out to be difficult and the process was delayed due to a variety of national and statewide variances. From that time through the present, the Wayne/Holmes Board has maintained its pursuit of value based outcomes using this framework while adapting and varying it where necessary due to changes in the programmatic environment.As with all undertakings the learning process involved understanding the outcome language, concepts and logic. Ultimately the learnings are internalized. In FY14, the Board expressed a collaborative business model that was built on performance targets, baselines and benchmarks. In other words, it became the “organic” value based planning process.The Board has internalized the outcome framework and uses it daily to the extent that outcomes planning is now included in the common course of events and it produces results. The day to day business of the Board requires a planful set of day by day responses to unexpected crisis and emergencies stemming from the general public, collaborative partners, contract agencies and consumers.This planning that has gone into the Strong Families, Safe Communities program with both the Holmes and Wayne departments of Developmental Disabilities, the MHRB and the contracted services provider, Wayne County Catholic Charities is an example of this. The highlight of the year with the Strong Families and Safe Communities project was the provision of a workshop on Trauma Informed Care: Facilitating Healing, Resiliency and Hope by Mary Vicario. This training was sculpted for psychiatrists and those who provide Mental Health care to persons who are have co-occurring mental illness and developmental disabilities. The presentation was held near the offices of the psychiatrists working with The Counseling Center of Wayne Holmes Counties and three psychiatric staff attended. The collaboration process with the BHJJ, Multisystemic Grant with the Board is another. The Department of Youth Services, The Crisis Intervention and Recovery Center of Stark County and the Holmes and Wayne County Juvenile Courts. Both of these planning processes exhibit the respect that all of the parties named above have for the authority of the Board. “Stepping Up” is a new planning effort for the mentally ill in the criminal justice system that is being undertaken with many collaborative partners with similar expectations. There are many other examples that have been cited in the body of this plan. It seems relevant to note then that the nature of this planning is referenced in various parts of this community plan. The community plan is based on projections and meeting the required responses of the outline. While this involves planning, it isn’t the internalized process of sensing the cause and effect of crisis/emergencies, determining effective targets and addressing them measurably to realize a desired result.Over the past few years, there has been an ongoing discussion regarding the changing roles of Boards. The Mental Health & Recovery Board of Wayne/Holmes Counties continues to enjoy consumer’s admiration and the public’s respect for its value, long term planning and authority. While the Board’s role in the community is evolving, it continues to play a critical collaborative role in juvenile justice, the family council, the criminal justice system, workforce development and with children services. This will be very useful to the Board as it embarks on a strategic planning process in the coming year. The Mental Health & Recovery Board of Wayne and Holmes Counties remains ready to plan, work and collaborate with the public and the Ohio Department of Mental Health and Addiction Services to meet and surpass its expected role as the local mental health and addictions planning authority for Wayne and Holmes Counties. Community Plan Appendix 1: Alcohol & Other Drugs WaiversA. Waiver Request for Inpatient Hospital Rehabilitation ServicesFunds disbursed by or through OhioMHAS may not be used to fund inpatient hospital rehabilitation services. Under circumstances where rehabilitation services cannot be adequately or cost-efficiently produced, either to the population at large such as rural settings, or to specific populations, such as those with special needs, a board may request a waiver from this policy for the use of state funds.To request a waiver, please complete this form providing a brief explanation of services to be provided and a justification. Medicaid-eligible recipients receiving services from hospital-based programs are exempted from this waiver as this wavier is intended for service expenditure of state general revenue and federal block funds.A. HOSPITALUPID # ALLOCATIONB. Request for Generic ServicesGeneric services such as hotlines, urgent crisis response, referral and information that are not part of a funded alcohol and other drug program may not be funded with OhioMHAS funds without a waiver from the department. Each ADAMHS/ADAS board requesting this waiver must complete this form and provide a brief explanation of the services to be provided. B.AGENCYUPID # SERVICE ALLOCATIONSignature PageCommunity Plan for the Provision of Mental Health and Addiction Services SFY 2017212654334200Each Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board, Alcohol and Drug Addiction Services (ADAS) Board and Community Mental Health Services (CMHS) Board is required by Ohio law to prepare and submit to the Ohio Mental Health and Addiction Services (OhioMHAS) department a community mental health and addiction services plan for its service area. The plan is prepared in accordance with guidelines established by OhioMHAS in consultation with Board representatives. A Community Plan approved in whole or in part by OhioMHAS is a necessary component in establishing Board eligibility to receive State and Federal funds, and is in effect until OhioMHAS approves a subsequent Community Plan.The undersigned are duly authorized representatives of the ADAMHS/ADAS/CMHS Board. The Mental Health & Recovery Board of Wayne –Holmes CountiesADAMHS, ADAS or CMH Board Name(Please print or type)____________________________________________ ______________ADAMHS, ADAS or CMH Board Executive Director Date_____________________________________________ ______________ADAMHS, ADAS or CMH Board Chair Date[Signatures must be original or if not signed by designated individual, then documentation of authority to do so must be included (Board minutes, letter of authority, etc.)].Instructions for Table 1, “SFY 2017 Community Plan Essential Services Inventory”Attached are the SFY 17 Community Plan (ComPlan) Essential Services Inventory and some supporting files to enable the Inventory’s completion.Various service inventories have been included in the ComPlan in the past.? The current Essential Services Inventory included with the 2017 ComPlan requires a new element: the listing of services for which the board does not contract. This new element is necessary due to recent changes in the Ohio Revised Code to detail the behavioral health (BH) continuum of care in each board area. The department and constituent workgroups, in pilot studies, have found this information necessary for boards to meet the Ohio Revised Code CoC requirements. Some additional CoC information resources have been provided (Section VI) to assist in this process, but board knowledge is vitally important given the limitations of these included CoC resources.? For example, the attached resources will not address BH services provided by Children Service Boards and other key providers within the local behavioral healthcare system. Instructions for the Essential Services InventoryThe 1st file is the Services Inventory.? The goal is to provide a complete listing of all BH providers in the board area.? To be able to proceed, please click on the “Enable Editing” and/or the “Enable Content” buttons, if they occur on top of the spreadsheet, and enter the name of the board in the 1st row.The spreadsheet lists the ORC required Essential Service Categories in each row.? Also in each row are cells to collect information about how each category requirement can be met. The information requested includes:Provider Name.? Also included in some Provider Name cells are prompts for descriptions of services for which there are no FIS-040 or MACSIS definitions.? The prompts request that descriptions of how the Board provides for these services be put in the last column, “Board Notes”.? The prompts can be deleted to make room for a Provider Name.Mandatory individual service(s) that satisfy the ORC Essential Service CategoryServices related to the required category, but are needed to meet local BH needs, rather than the CoC mandate.“Yes” or “No” response indicating that the board contracts with the provider providing the service.Counties within the board where the provider provides the required “must be in the board area” service; or, out-of-board location when the required service is allowed to be provided outside the board area.Populations for which the service is intended to serve; or, for Prevention/Wellness services, the IOM Category.Except for “Provider Name” and “Board Notes” cells, in which information is manually entered, all the other cells have a drop down menu from which services are chosen, and typed data entry cannot occur.To use the drop down menu, click on a cell and a downward pointing arrow will appear.? Click on the arrow and a drop-down list of services will appear. Click on a service and it will appear in the cell.? Click on the service a 2nd time and it will erase the service entry in the cell; or highlight the unwanted service entry and click “Clear Content” from the right mouse button menu.? Click on as many services as are needed for each provider cell in the row.? Use the slide-bar on the right side of the drop down menu to see all available items in the list.To add additional providers in a particular Essential Service row, highlight all cells in the row below the needed Essential Service, and click “Insert” from the right mouse button menu. All of the instructions and drop down menus for that Essential Service will be included in the “Inserted” rows.Additional Sources of CoC InformationMACSIS Data Mart Client Counts by AOD and MH services for 2015.Explanation:? If a required service or support is not found in a Board’s budget, there may be a number of possible explanations, e.g.:Variation in how Boards account for services and supports in the budgeting process.? A check of the MACSIS Data Mart may reveal budgeted services or supports that haven’t been directly captured in the current budget.Required service or support is delivered by Providers serving Medicaid only clients.? The Data Mart will show that the Medicaid paid service or support is being provided within the Board service area even though the Board has no contract with that Provider.OhioMHAS 2015 Housing Survey.Explanation:? Certain required housing categories may not be budgeted, e.g., Recovery Housing, or there may be lack of clarity between required housing categories and 040 reporting categories or specified in the Community Plan.? The OhioMHAS Housing Survey brings greater clarity to classifications of housing services and environments and better track provision of those Continuum of Care (CoC) elements in Board service areas.SAMHSA 2014 National Survey of Substance Abuse treatment Services (N-SSATS), and the SAMHSA 2014 National Mental Health Services Survey (N-MHSS).Explanation:? SAMHSA annually surveys AOD and MH Providers irrespective of their OhioMHAS certification status. The surveys provide a broad spectrum of information, including the existence of some AOD or MH services or supports within a Board’s service district that are required essential CoC elements, but which are not found within the public behavioral health service taxonomy, or are not captured within the Board’s budget.? These surveys should be reviewed for existing required CoC elements delivered by Providers that are OhioMHAS certified (in network) and those Providers that are not (out of network).Service Crosswalks between ORC Required Essential Service Category Elements and the Additional Information SourcesEssential Service Category Elements(? = ORC 340.033 Required)2015 OhioMHAS Housing Survey2014 National Survey of Substance Abuse Treatment Services (N-SSATs)2014 Nation Survey of Mental Health Services Survey (N-NHSS)A-Ambulatory Detox ?OP Detox ASAM Level I.D & II.DA-Sub-Acute Detox ?Residential Detox ASAM Level III.2-DA-Acute Hospital DetoxInpatient DetoxIntensive Outpatient Services:A-IOP ?M-Assertive Community TreatmentM-Health HomesIntensive OP ASAM Level II.1 (9+ HRS/WK)Assertive Community Treatment (ACT)Primary Physical HealthcareEssential Service Category Elements(? = ORC 340.033 Required)2015 OhioMHAS Housing Survey2014 National Survey of Substance Abuse Treatment Services (N-SSATs)2014 Nation Survey of Mental Health Services Survey (N-NHSS)A-Medically Assisted Treatment ?NaltrexoneVivitrolMethadoneSuboxoneBuprenorphine (No Naltrexone)12 Step Approaches ? Clinical/therapeutic approaches Used:..12 step facilitationResidential Treatment:A-MCR-HospitalA-BHMCR-HospitalHospital IP Treatment ASAM IV & III.7Residential Treatment ?:A-MCR- Non-HospitalA-BHMCR-Non-HospitalResidential Treatment Medical Community ResidenceResidential Short-Term ASAM Level III.5 (High Intensity)Essential Service Category Elements(? = ORC 340.033 Required)2015 OhioMHAS Housing Survey2014 National Survey of Substance Abuse Treatment Services (N-SSATs)2014 Nation Survey of Mental Health Services Survey (N-NHSS)Residential Treatment ?:A-NMR-Non-AcuteA-BH-Non-Medical-Non-AcuteResidential Treatment Medical Community ResidenceResidential Long-Term ASAM Level III.3 (Low Intensity)Recovery Housing ?Recovery HousingM-Residential TreatmentResidential Treatment-MH24 Hour Residential (Non-Hospital)Locate & Inform:M-Information and ReferralMH Referral, including emergency servicesM-Partial HospitalizationSetting: Day Treatment/Partial HospitalizationM-Inpatient Psychiatric Services (Private Hospital Only)Inpatient ServicesRecovery Supports:M-Self-Help/Peer SupportM-Consumer Operated ServiceMH Consumer Operated (Peer Support)Recovery Supports:M-Employment/ Vocational ServicesSupported Employment ServicesMH Vocational Rehabilitation ServicesEssential Service Category Elements(? = ORC 340.033 Required)2015 OhioMHAS Housing Survey2014 National Survey of Substance Abuse Treatment Services (N-SSATs)2014 Nation Survey of Mental Health Services Survey (N-NHSS)Recovery Supports:M-Social Recreational ServicesActivities TherapyM-Crisis InterventionMH Psychiatric Emergency (walk-in)Wide Range of Housing Provision & Supports:M-Residential CareResidential Care:Adult Care Facility/ Group HomeResidential Care Facility (Health)Child Residential Care/Group HomeMH Supported Housing ServicesEssential Service Category Elements(? = ORC 340.033 Required)2015 OhioMHAS Housing Survey2014 National Survey of Substance Abuse Treatment Services (N-SSATs)2014 Nation Survey of Mental Health Services Survey (N-NHSS)Wide Range of Housing Provision & Supports:M-Community Residential M-Housing SubsidyPermanent Housing:Permanent Supportive HousingCommunity ResidencePrivate ApartmentsMH Housing ServicesWide Range of Housing Provision & Supports:M-Crisis BedM-Respite BedTemporary Housing TransitionalTime Limited/ Temporary:CrisisRespiteTemporaryTransitionalWide Range of Housing Provision & Supports:M-Foster CareTime Limited/ Temporary:FosterTherapeutic Foster CareWide Range of Housing Provision & Supports:AODSee Residential Treatment, above ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download