May 09 Open House

The Mental Health Recovery Center of Clinton & Warren Counties aka “The Center” Changing the Way Services to People with Severe Mental Disabilities (SMD) are Delivered in Our Communities

Who We Are: Clinton County From 1984 until July 1, 2008, we had been known as the Mental Health Recovery Center of Clinton County We were located in Wilmington (Clinton County) and served primarily the citizens of Clinton County

Who We Are: Warren County Starting July 1, 2008, we were asked by the Mental Health Recovery Service funding Board to assume responsibility for all services in Warren & Clinton Counties for people with severe mental disabilities (SMD) To that end, the Fujitec facilities represent that expansion into Warren County

Who We Are: Names are Changing With the move to Warren County, our agency is now doing business as: The Mental Health Recovery Center of Clinton & Warren Counties We are working with a local advisory group on an agency name change and longer term strategic planning process For simplicity, the agency is mostly known as “The Center”

MISSION : The Center supports the communities of Clinton and Warren Counties in responding to behavioral health issues through prevention, intervention, treatment, rehabilitation and asset building services. Our mission is sharing hope and caring to achieve recovery from mental illness, alcoholism, and drug addiction. Our expectations for recovery include the acquisition of meaningful roles, sobriety, healthy relationships with friends and family, and a joyful life…

MISSION SPECIFIC TO WARREN COUNTY : “ To help people function better so that they can become more successful and satisfied in their preferred living, learning, working, and/or social environments, with the least amount of ongoing assistance from agents of the mental health system...” The focus of the mission is on community outcomes for the clients A simple way to summarize the mission is that it is all about “Recovery” from mental illness. It is not merely enough to speak about Recovery. Our expectation is for active implementation and application of the principles, philosophy, and technology of Recovery.

VISION : The Center will set the standard for excellence in delivering behavioral healthcare. We will: Actively engage our talents to promote the common vision of recovery. Anticipate and respond to the emerging needs of our community. Offer services in the most clinically appropriate environment. Demonstrate abilities exceeding local, state and national standards

Values The Center believes in a stated set of standards and values consistent with professional conduct in the delivered with compassion and respect: Good stewardship. We believe that we are responsible to the Warren &Clinton County communities for providing quality services relevant to its needs. A foundation of integrity. Our integrity is expressed through our commitment to be open and honest with our community, employees and our clients. Investment in our employees. We promote continuous efforts to learn, improve and implement best practices to better address the needs of our customers.

GUIDING PRINCIPLES of RECOVERY Consumers of mental health services can identify realistic goals for themselves: Choice is fundamental to recovery and is expected to be reflected in all clinical and rehabilitative activities.

GUIDING PRINCIPLES of RECOVERY Improving client functioning, and not simply maintaining people in the community, is a part of the agencies' mission: A maintenance-only mission is yesterday’s mission and not part of the philosophy of our network of service.

GUIDING PRINCIPLES of RECOVERY Psychiatrically disabled persons’ skills and supports relate to community outcomes more strongly than do their symptoms: Our system ensures that services provide for skill development and support development, and not just symptom relief. The agency realizes that persons with psychiatric disabilities are limited not only by their major psychiatric symptoms but primarily by their persistent social and vocational deficits

GUIDING PRINCIPLES of RECOVERY Persons who are psychiatrically disabled need different services, at different times, and at different levels of intensity: Persons with psychiatric disabilities do not need the same kinds of services. The agency has developed a large range of service alternatives, packaged differently for different clients.

GUIDING PRINCIPLES of RECOVERY Agency personnel who work in programs serving persons with severe mental illness will be appropriately trained. Most staff are untrained in the new technology of rehabilitative service delivery. Our agency recognizes that skilled and dedicated personnel are our most important and costly resource. As a result, we have implemented a year-round training plan to acquire and utilize state of the art psychiatric rehabilitation skills for personnel

What Services We Provide in Warren County: Crisis & Emergency Mental Health Services Psychiatric Services including Pharmacological Management 3 Levels of Case Management for People with Severe Mental Illnesses Vocational Rehabilitation Housing Support Services Psychiatric Rehabilitation Services Transportation Intensive Rehabilitation Residential Services

Case Management: ACT Teams Assertive Community Treatment (ACT): a multidisciplinary team approach that shall include, at a minimum, behavioral health counseling and therapy service, mental health assessment service, pharmacologic management service, community psychiatric supportive treatment (CPST) service, self-help/peer support service, mental health crisis response service, substance abuse services, and supported employment services. System clients participating in the ACT program present high impairment/high to moderate disability challenges. Target Population: Eligible Warren & Clinton County SMD Caseload Limit: 10:1

Case Management: Intensive Case Management (ICM) Intensive Case Management (ICM): is an integrated Psychiatric Rehabilitation (PRCI) and Case Management service that is primarily focused on serving the moderate impairment/high disability client. As a standard, Intensive Case Managers will average at least 1 visit per client on their case load per week. Specifically, ICM services are targeted for clients: receiving residential services, Probated and Forensic Monitoring clients, Clients exceeding 10 days length of stays in hospitals, and/or Target Population: Eligible Warren & Clinton County SMD Caseload Limit: 30:1

Case Management: Standard Case Management (SCM) Standard Case Management (SCM): Standard Case Management in the MHRS system utilize the Role Recovery “case coordination” (vs. direct service) approach to assess, plan, and organize the provision of ancillary services to focus on attaining goals that reflect the consumer’s self-determined recovery aspirations. Target Population: Eligible Warren & Clinton County SMD Caseload Limit: 8 0:1

Agency Performance : Efficient Use of the Public Dollar #1 In State Fiscal Year 2008, Emergency & Case Management Services Provided by the Mental Health Recovery Center of Clinton/Warren Counties assisted in saving the County nearly $500,000 in Private Hospitalization costs (source: FY 08 MHRS Board Budget) This saving allows the system to re-invest those dollars in expanding local services such as residential programs

Agency Performance : Efficient Use of the Public Dollar #2 In State Fiscal Year 2008, Emergency & Case Management Services Provided by the Mental Health Recovery Center of Clinton/Warren Counties reduced State Hospital Bed Day usage by nearly 1,150 days from FY 2007. At $481/day, that represented a savings to the community of $ 553,000 . (source: FY 07 & 08 ODMH PCS) This saving allows the system to re-invest those dollars in expanding local services such as Outpatient Counseling programs

The Intensive Residential Rehabilitation (IRR) Facility “ Much More than Maintenance in the Community …”

Who Is the Target Population for Intensive Residential Rehabilitation? One of more of the following conditions: High Impairment : consumers meeting SMD criteria and ongoing moderate/high levels of symptomology but not requiring acute hospitalization High Disability : consumers with history of and/or current lack of role functioning in community residential environments High Risk : consumers determined to present (a) significant safety risk to the community and/or (b) significant fiscal risk to the system without IRR intervention

What is Intensive Residential Rehabilitation (IRR)? A comprehensive program specifically designed to assist persons with persistent mental illness to develop critical skills for full participation in the life of the community at the most facilitative level of residential care and/or support. The IRR is not “Transitional”, “Long-Term”, or even “Group Home” living as those terms limit the scope and system understanding of the core objectives of the program and it’s function in the SMD network. The IRR Program foundation is based on Psychiatric Rehabilitation Technology and Recovery principles and philosophy (Boston University, Anthony, 1990) There are 12 beds in the IRR Program, which are staffed by mental health professionals and technicians 24 hours a day, seven days a week. 10 beds are purchased by the Board for High Disability, Impairment, and Risk clients. 2 beds are purchased by the Board for non-medical Respite services and/or Emergency Housing. The IRR is/will be licensed by the Ohio Department of Mental Health as a Type 1 Residential facility (Provides room & board, personal care, & mental health services to one or more residents per OAC - Chapter 5122-30 Licensing of Residential Facilities.)

What is Intensive Residential Rehabilitation? I ntensive : denotes the high level of structure & consumer instruction present in the living environment R esidential : denotes the daily focus on improving functioning in the immediate living environment R ehabilitation : denotes the primary service delivery modality is developing skills and supports in both the current residential environment as well as choosing-getting-keeping future living, learning, and working environments

Why is Intensive Residential Rehabilitation Needed? Anticipating Further Growth in Warren County, the system must continually create resources that serve as alternatives to High Dollar State Hospitalization, Private Hospitalization, and Incarceration.

Where/When is Intensive Residential Rehabilitation to Be Implemented? 975 Fujitec Drive - Building B Lebanon, OH No Immediate Family/Residential Neighborhoods No Immediate Day Care/Schools in Area Walking Distance of Main Clinic IRR Target Admissions April 1 st , 2009

How is the Intensive Residential Rehabilitation Program Conducted? The “ The Teaching as Treatment” approach as developed by Robert Carkhuff indicated “that training clients directly in the skills that they need to function in society would be a potent treatment method” The heart of Teaching as Treatment skills training program is to systematically teach clients the same relationship skills that the effective helper/staff uses in the helping process. Teaching as Treatment has been further Refined for use in the IRR through the addition of Psychiatric Rehabilitation technology

Example #1: Master Functional Assessment Environment: Intensive Residential Rehabilitation Facility The Master Functional Assessment is completed within the first 3 months of client admission to the IRR facility. The Assessment consists of required behaviors to successful in the IRR environment and the skills underlying each behavior. Each skill listed has a corresponding Skill Evaluation Package and Lesson Plan. The four required behaviors are: (1) Manage Personal Budget, (2) Perform Household Chores, (3) Get Along with Others, and (4) Maintain Health & Safety. Comments: Individualized Skill: Individualized Skill: Monitoring Budget Evaluating Decisions Creating a Spending Plan Skills Programming Direct Skills Teaching Performance Prompted Spontaneous Use # or % day/wk/mo Needed: # or % day/wk/mo If Deficit, indicate Type of Intervention Needed Deficit (-) Strength (+) Critical Skills REQUIRED BEHAVIOR #1: MANAGE PERSONAL BUDGET

Example #2: EVALUATION MODULE FOR CREATING A SPENDING PLAN Summarize response  income and expenses identified?  expenses prioritized?  payments scheduled? Observer says : Please list income and expenses, prioritize expenses and schedule payments. If the person does not Create a Spending Plan by listing, prioritizing and scheduling items, then Summarize response  income and expenses identified?  expenses prioritized?  payments scheduled? Observer says : Please record the amount of money you are allocating to pay for items and services. If person does not Create a Spending Plan, then Summarize response  income and expenses identified?  expenses prioritized?  payments scheduled? Observer says : Please Create a Spending Plan now. If person does not Create a Spending Plan, then Summarize response  income and expenses identified?  expenses prioritized?  payments scheduled? Observer says : I’d like you to Create a Spending Plan for yourself by anticipating your financial situation for next month. Use these worksheets to help you. OBSERVER LOG SCRIPT

Teaching the Lesson Plan The lesson plan structure is a five-part format of a Review, an Overview, a Presentation, an Exercise, and a Summary, also known as ROPES (Cohen, Danley, and Nemec, l985; Carkhuff and Berenson, l976). The Review involves a discussion and exploration of the client's experiences and understanding of the skill. The Overview provides the information from the content outline, including what the skill is, why it is important, the steps of how the skill is performed, and a description of the general condition in which the skill is to be performed. In addition, the learner is given a correct image of the skill in an example. The Presentation provides opportunities for the client to hear about, see, and practice each of the critical skill behaviors separately. The Exercise is a chance for the learner to practice performing the critical skill behaviors together and to receive feedback on his/her performance. The Summary reviews the learner's understanding of the newly learned skill and provides an orientation to the client's future use of the skill.

Example #3: DIRECT SKILLS TEACHING LESSON PLAN Creating a Spending Plan Orient : Today I am going to teach you the skill of Creating a Spending Plan. First, I would like to ask you some questions about what you already know about Creating a Spending Plan, and to review what experiences you have had with the skill. Ask : What does the term “Spending Plan” mean to you? Discuss : Answers and respond . Tell : A spending plan is like a budget. It is a decision about how you are going to spend your money. Ask : When was the last time you saw someone Create a Spending Plan? What did he/she do? What happened when you tried to Create a Spending Plan? How does it feel to run out of money? How do you think you would feel if you did Create a Spending Plan? How might learning this skill of Creating a Spending Plan be important to you? Discuss : Answers and respond. Tell : Your Overall Rehabilitation Goal is to live at (name the place) by/until (name the date). Ask : How will learning this skill of Creating a Spending Plan help you to reach your goal of living successfully at (name the place)? Discuss : Answers and respond . Summarize : Main points from the Review.

What is the Success Standard for Intensive Residential Rehabilitation Program Service? To Teach Clients How To Respond To Others And Themselves In A Skillful Manner So That These Clients May Function More Effectively In Interpersonal Situations Both In And, Ultimately, Outside Of The IRR To Teach Clients The Most Critical Physical, Emotional, And Intellectual Skills Needed To Be Successful And Satisfied In The IRR Environment To Generalize The Most Critical Physical, Emotional, And Intellectual Skills Needed To Be Successful And Satisfied In Future Chosen Community Living Environments

How is Success Achieved through IRR Personnel? Unit personnel are trained and coached on utilizing Psychiatric Rehabilitation Technology, i.e. Functional Assessment Evaluation & Skill Teaching. Previous implementation of this approach in Role Recovery hospital and IRR sites in Florida and Alabama yielded a “halo” effect of a magnified staff commitment to the program by assuming greater responsibility for the accurate assessment and input towards the resident’s capabilities. Unit staff training is then enhanced with the addition of interpersonal Readiness Development techniques designed to help personalize the resident’s accomplishments of learning the skills. The result is continual staff/consumer focus of the requirements for success and continual staff/consumer focuses on the implications for Recovery as a result of skill acquisition.

What is the Standard for Discharge in the Intensive Residential Rehabilitation Program Service? One of more of the following conditions: Managed to Moderate Impairment : as indicated by documented ability to manage symptoms effectively through coping and medication regime. (This does not imply “symptom-free”.) Successful Role Functioning in IRR Environment : as indicated by achieving Skill Asset Status on Master Functional Assessment i.e. performing skill at or near the Needed level. Intended Role Choice & Functioning in Community Living Environment : as indicated by (a) Overall Residential Rehabilitation Goal and (b) Environmentally Specific Critical Skill & Support Assessment needed to achieve the Overall Rehabilitation Goal. Low Risk : consumers determined to present (a) no significant safety risk to the community and/or (b) no significant fiscal risk to the Board without continuing IRR intervention

IRR: Fiscal Reallocation through System Performance (-3) 2 5 Avg. Admissions per Month State Hospital Admissions (-96) 186 282 Avg. Bed Days per Month State Hospital Bed Days (-43) 6 49 Avg. # per Month SMD on Community Probate (-62) 12 (10% of all calls) 74 (21% of all calls) Avg. # per Month Hotline Calls Deemed “Immediate Crisis” (-238) 122 360 Avg. # per Month Total Hotline Calls Rec’d Monthly Net Change SFY 2008 SFY 2007 Measure Indicator

Did You Know? One in four adults — approximately 57.7 million Americans — experience a mental health disorder in a given year. One in seventeen lives with a serious mental illness, such as schizophrenia, major depression or bipolar disorder , and about one in ten children have a serious mental or emotional disorder.

Prevalence of Mental Illness About 2.4 million Americans, or 1.1 percent of the adult population, lives with schizophrenia Warren County population estimate for 2008 was 207,353 That would equate into nearly 2,280 citizens requiring psychiatric services during any given year

May 09 Open House

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May 09 Open House