TRUMBULL COUNTY

Document Sample
TRUMBULL COUNTY Powered By Docstoc
					             Trumbull Lifelines ADAMHS Board for Trumbull County



                       Community Plan For SFY 2010-2011



                                March 27, 2009




Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
                                 Mission Statement
Trumbull LifeLines is the Alcohol, Drug Addiction and Mental Health Services Board
for Trumbull County.

The mission of Trumbull LifeLines is to improve the well–being of our community by
establishing and maintaining an effective, efficient, and quality system of
alcohol, drug and mental health services in Trumbull County.
                                 Vision Statement
•  We believe that mental illness and drug dependency are treatable diseases.
•  We believe treatment works and people can recover from mental illness and drug
dependency.
•  We work to build a system of care that has the best services, is recipient-
driven and encourages people to participate in their own care.
•  We fund services based on performance measures and outcomes.
•  We promote cooperation between Trumbull LifeLines, the community and provider
agencies.
•  The Board advocates for consumers and supports service accountability.
                                 Value Statements
(The Board has no separate statement of values.)




  Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                                5/7/2009 9:22:42 AM
Section I: Current Circumstances / "As-Is" State

  Legal Context of the Community Plan
  The Trumbull Lifelines ADAMHS Board for Trumbull County is required by Ohio
  law to prepare and submit to the Ohio Department of Alcohol and Drug Addiction
  Services (ODADAS) and/or the Ohio Department of Mental Health (ODMH) a plan
  for the provision of alcohol, drug addiction and mental health services in its
  service area. Four ADAS Boards submit plans to ODADAS, four CMH Boards submit
  plans to ODMH, and 46 ADAMHS Boards submit their community plan to both
  Departments. The plan, which constitutes the Board's application for funds, is
  prepared in accordance with procedures and guidelines established by ODADAS
  and ODMH. This plan covers state fiscal years (SFYs) 2010 – 2011 (July 1, 2009
  through June 30, 2011).
  The requirements for the community plan are broadly described in state
  statute. In addition, federal requirements that are attached to state block
  grant dollars regarding allocations and priority populations also influence
  community planning.

  Ohio Revised Code (ORC) 340.03 and 340.033 – Board Responsibilities

  Section 340.03(A) of the Ohio Revised Code (ORC) stipulates the Board's
  responsibilities as the planning agency for mental health services. Among the
  responsibilities of the Board described in the legislation are a follows:
  1) Identify community mental health needs
  2) Identify services the Board intends to make available including crisis
  intervention services
  3) Promote, arrange, and implement working agreements with social agencies,
  both public and private, and with judicial agencies
  4) Review and evaluate the quality, effectiveness, and efficiency of services
  5) Recruit and promote local financial support for mental health programs from
  private and public sources

  Section 340.033(A) of the Ohio Revised Code (ORC) stipulates the Board's
  responsibilities as the planning agency for alcohol and other drug addiction
  services. Among the responsibilities of the Board described in the legislation
  are as follows:
  1) Assessing service needs and evaluating the need for programs;
  2) Setting priorities;
  3) Developing operational plans in cooperation with other local and regional
  planning and development bodies;
  4) Reviewing and evaluating substance abuse programs;
  5) Promoting, arranging and implementing working agreements with public and
  private social agencies and with judicial agencies; and
  6) Assuring effective services that are of high quality.

  ORC Section 340.033(H) (H.B. 484)

  Section 340.033(H) of the ORC requires ADAMHS and ADAS Boards to consult with
  county commissioners in setting priorities and developing plans for services
  for Public Children Services Agency (PCSA) service recipients referred for
  alcohol and other drug treatment. The plan must identify monies the Board and
  County Commissioners have available to fund the services jointly. The
  legislation prioritizes services, as outlined in Section 340.15 of the ORC, to
  parents, guardians and care givers of children involved in the child welfare
  system.

  OAC Section 5122-29-10(B)

  An section of Ohio Administrative Code (OAC) addresses the requirements of
  crisis intervention mental health services. According to OAC Section 5122-29-
  10(B), crisis intervention mental health service shall consist of the
  following required elements:

  (1) Immediate phone contact capability with individuals, parents, and
  significant others and timely face-to-face intervention shall be accessible
  twenty-four hours a day/seven days a week with availability of mobile services
  and/or a central location site with transportation options. Consultation with
  a psychiatrist shall also be available twenty-four hours a day/seven days a
  week. The aforementioned elements shall be provided either directly by the
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
  agency or through a written affiliation agreement with an agency certified by
  ODMH for the crisis intervention mental health service;
  (2) Provision for de-escalation, stabilization and/or resolution of the
  crisis;
  (3) Prior training of personnel providing crisis intervention mental health
  services that shall include but not be limited to: risk assessments, de-
  escalation techniques/suicide prevention, mental status evaluation, available
  community resources, and procedures for voluntary/involuntary hospitalization.
  Providers of crisis intervention mental health services shall also have
  current training and/or certification in first aid and cardio-pulmonary
  resuscitation (CPR) unless other similarly trained individuals are always
  present; and
  (4) Policies and procedures that address coordination with and use of other
  community and emergency systems.


  HIV Early Intervention Services

  Eleven Board areas receive State General Revenue Funds (GRF) for the provision
  of HIV Early Intervention Services. Boards that receive these funds are
  required to develop an HIV Early Intervention Investor Target and include:
  Butler ADAS, Eastern Miami Valley ADAMHS, Cuyahoga ADAS, Franklin ADAMHS,
  Hamilton ADAMHS, Lorain ADAS, Lucas ADAMHS, Mahoning ADAS, Montgomery ADAMHS,
  Summit ADAMHS and Stark ADAMHS Boards.

  Federal Substance Abuse Prevention and Treatment (SAPT) Block Grant

  The federal Substance Abuse Prevention and Treatment (SAPT) Block Grant
  requires prioritization of services to several groups of recipients. These
  include: pregnant women, women, injecting drug users, clients and staff at
  risk of tuberculosis, and early intervention for individuals with or at risk
  for HIV disease. The Block Grant requires a minimum of twenty (20) percent of
  federal funds be used for prevention services to reduce the risk of alcohol
  and other drug abuse for individuals who do not require treatment for
  substance abuse.


  Federal Mental Health Block Grant

  The federal Mental Health Block Grant (MHBG) is awarded to states to establish
  or expand an organized community-based system for providing mental health
  services for adults with serious mental illness (SMI) and children with
  serious emotional disturbance (SED). The MHBG is also a vehicle for
  transforming the mental health system to support recovery and resiliency of
  persons with SMI and SED. Funds may also be used to conduct planning,
  evaluation, administration and educational activities related to the provision
  of services included in Ohio's MHBG Plan.

  Environmental Context for the Community Plan

    Board Area and Clients Served
       Board Area and Clients Served including recent trends such as changes in
       services and populations

      II.A.1 - Trumbull is Ohio’s only perfectly square county, measuring 25
      miles along each border and comprising 625 square miles, divided into 25
      square townships, containing six cities and seven villages, located on the
      Pennsylvania border and roughly bounded by the Youngstown, Cleveland and
      Akron corridors. The county's population, which peaked in 1980 at about
      242,000, currently stands at about 213,000, twelfth largest of Ohio’s 88
      counties. Racial and ethnic minorities comprise about 11 percent of
      Trumbull County's population, compared with about 16 percent statewide.
      African-Americans represent the county's largest minority population at
      about 8.2 percent, compared with about 11 percent statewide. About 23
      percent of Trumbull County's population are children under the age of 18;
      the comparable proportion for the state as a whole is about 25 percent.
      Finally, about 16 percent of Trumbull Countians are seniors 65 and older,
      compared with about 13 percent statewide.


Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
      A distinctive mix of urban and rural cultures and communities
      characterizes Trumbull County. In the southern part of the county, the
      cities of Warren, Niles, Girard, and Hubbard, along with Weathersfield and
      Liberty Townships, and McDonald Village form an urban belt that continues
      into Mahoning County and forms the core of the Youngstown-Warren
      Metropolitan Statistical Area, Ohio’s seventh-largest. Concentrated in
      this region are most of the county’s major employers, including Delphi
      Corporation, General Motors’ Lordstown Assembly Complex, WCI Steel, Forum
      Health, HM Health Services, Giant Eagle, West Corporation, and Sears
      Holdings/K-Mart. Virtually all of these enterprises have experienced
      closures and/or lay-offs in the last two years. In December 2008,
      Trumbull's unemployment rate stood at 9.8 percent, ranking it 26th among
      all Ohio counties and second only to Lucas among the state's urbanized
      counties. In January 2009, Trumbull's unemployment rate rose to 14.7
      percent of the labor force, eleventh-highest among Ohio's counties. None
      of the ten counties with higher rates has a labor force in excess of
      100,000 workers, as does Trumbull's. In terms of the number of unemployed
      workers in January 2009, Trumbull's 15,800 ranks eighth among Ohio's
      counties and exceeds several larger northeastern counties (Lake, Mahoning,
      and Lorain).

      The northern part of Trumbull County is largely agricultural and woodland,
      containing many of the county’s 990 farms and dominated by the Grand River
      and Mosquito Lake Wildlife Management Areas, Mosquito Lake State Park, and
      Mosquito Lake, one of Ohio’s largest. The northwestern part of the county
      houses a portion of the Geauga Settlement, the fourth largest Amish
      community in North America. The villages of Middlefield (Geauga County)
      and Mesopotamia (Trumbull County) form the hub of the settlement, which
      also extends into Ashtabula and Portage Counties. Trumbull County is the
      only ADAMHS, ADAS, or CMH Board Area in Ohio with significant African-
      American and Amish communities.

      The County's population has decreased 4.6 percent since 1990. The
      following indicators contribute to risk factors for abusing alcohol,
      tobacco and other drugs:

      •   Only 44% of the population earns a high school diploma or equivalent
      •   10% graduate from college, and another 4.4% earn a graduate degree
      •   17% of the population has some type of disability
      •   In 2000, 40% of persons 16 years of age and over were unemployed
      •   10.6 % live in poverty

      With reference to the Board's FY2009 Community Plans, the following
      accomplishments are noteworthy:

      • Our Shelter Plus Care housing voucher program survived the over-
      enrollment stresses it experienced in FY2008-09 and was renewed by HUD
      along with three other supported housing programs (Shelter Plus Care
      Chronic, Shelter Plus Care Additional, and Joey's Landing apartments)
      totaling $1,042,551. These resources will provide permanent supported
      housing for approximately 70 persons who are coping with homelessness,
      mental illness and/or addictions. These grants were made possible through
      the work of Coleman Behavioral Health.

      • In addition to housing, employment is a cornerstone of recovery from
      mental illness and/or addiction. In partnership with Ohio's Rehabilitation
      Services Commission, LifeLines has again established a Pathways project to
      provide supported employment and related services using local match and
      unencumbered federal RSA funds. We anticipate approximately 150 persons
      reaching the goal of competitive employment through Pathways each year.
      These employment and related services are provided by Burdman Group in
      Trumbull County.

      • To better understand the diversity and dynamics among adults with severe
      mental disabilities in Trumbull County, the Board's largest mental health
      provider has joined the Cluster-Based Service Package/UM Demonstration
      Project coordinated by Synthesis, Inc. The goals of the project focus on
      "getting the right services, supports, resources, and/or opportunities to
      the right people at the right time." The process of identifying which of
      the eight clusters consumers best fit and gathering utilization and
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
      outcomes data is underway at Valley Counseling Services, Inc.

      • For the past three years, over 60 percent of all persons served at our
      crisis diversion and step-down facility have been experiencing both mental
      illnesses and substance disorders. The facility is licensed by ODMH but
      ODADAS-certified services are also provided on site by the Board's primary
      provider of AoD treatment services, Community Solutions Association.

      As we concluded in our FY2009 Community Mental Health Plan:

      Unlike many smaller Board areas, we do not rely on a single provider for
      most services. And unlike many larger counties, we do not have multiple
      comprehensive agencies serving limited catchment areas. Rather our network
      features four core agencies, each of which receives more than $1 million
      annually in Medicaid and non-Medicaid funding and which provide the core
      mental health and substance abuse services in our county. It is not
      unusual for consumers to receive services from more than one of the “big
      four,” either sequentially or simultaneously. Given the nature of each
      agency’s specialties, overlapping clientele is essential. Such an
      arrangement might not work in some communities but it is perhaps the most
      important feature of our systems of care. Such an arrangement would not be
      possible without long-standing patterns of communication, coordination,
      and collaboration among providers and the Board.

      Boundaries are frequently blurry within our network. One example is the
      presence of workers from Community Solutions providing substance abuse
      services in Riverbend Center, a mental health crisis facility operated by
      Burdman Group. Structurally this can be thought of as one organization
      “hosting” another, as two interacting organizations, or as a single
      organizational network composed of elements of several provider
      organizations. Another example is the LifeLines Access Center, our
      24/7/365 crisis and screening agency. The Access Center, operated by
      Coleman Professional Services, is closely linked with Trumbull 211, the
      24/7/365 information and crisis hotline service operated by Community
      Solutions. Crisis calls to the latter are seamlessly switched to the
      former with no disruption to the caller. A third example is Burdman
      Group’s Assertive Community Treatment team and Valley Counseling Services,
      our largest community mental health agency. Some of Valley’s clients
      receive medication monitoring services from Burdman/ACT’s nurses and some
      of Burdman/ACT’s clients receive day services at Valley Counseling.

      Fuzzy boundaries and high levels of collaboration within inter-
      organizational networks are essential features of our systems of care. We
      will need to draw on these strengths as we face the many challenges
      confronting Ohio’s behavioral health system.

      The past year has also seen many successes in the Children’s System of
      Care in Trumbull County. We became a part of ODMH’s Maternal Depression
      Project. Through this project we’ve increased our collaboration with Help
      Me Grow and the County Health Department. We have also been successful in
      identifying mothers with postpartum depression that may not have been
      screened without the project, and have facilitated the mother’s receiving
      treatment. As a result of the project and the increased collaboration a
      large conference regarding postpartum depression is being planned for May
      2009. The presenter will be Dr. Jeanne Watson-Driscoll, a nationally
      recognized speaker. Over 150 people have already expressed an interest in
      attending and the venue for the workshop has been changed to accommodate
      the large demand.

      State Fiscal Year 2009 also showed a continued multi-system commitment to
      High Fidelity Wraparound. As a result of Wraparound only two children had
      to leave the county for mental health treatment and many more were able to
      be maintained in their home or in a foster home.

      Trumbull County’s Early Childhood Mental Health Program also thrived
      during the past fiscal year. The program was expanded through a grant from
      the Wean Foundation to help with the growing demand for consultation by
      daycares, preschools, and families. This grant not only enabled more
      consultation to be provided to day cares and preschools but also allowed
      consultants to be able to consult with Help Me Grow families. An early
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
      childhood mental health consultant attends a home visit with the Help Me
      Grow service coordinator after the coordinator administers the ASQ SE and
      finds consultation may be beneficial to the family. Twelve (12) families
      have been referred by Help Me Grow since August of 2008.

       Characteristics of Clients Receiving Substance Abuse Prevention Services

      II.A.2.a - Trumbull LifeLines purchases Substance Abuse Prevention
      Services from Community Solutions Association. According to the
      information that Community Solutions Association has entered into the
      ODADAS Web Based Prevention system, the population that they have served
      to date in fiscal year 2009 is 57% female and 43% male. The consumers are
      19% African-American, 81% Caucasian and less than 1% are more than one
      race. Forty-six (46) percent of those served are ages 12-14 years old, 25%
      are 5-11 years old, 21% are 15-17 years old, 4% are ages 25-44, and 2% are
      ages 45-64. The age groups 0-4 and 18-24 make up the remaining 3% when
      combined.

       Characteristics of Clients Receiving Substance Abuse Treatment and
       Recovery Support Services

      II.A.2.b - Table 1 presents a breakdown by age group, gender, and race of
      persons who received substance abuse treatment services in FY2005 through
      FY2008.

      TABLE 1: Characteristics of Persons Receiving Substance Abuse Treatment
      Services, FY2005-FY2008 (Data source: MACSIS Data Warehouse):

            FY05   FY05    FY06    FY06    FY07    FY07    FY08    FY08
            N      %       N       %       N       %       N       %
      AGE


      <18 110      9.9     80      7.6     97      8.3     89      7.1
      18-64        998     90.1    978     92.4    1,075   91.7    1,163 92.8
      >64 0        0.0     1       0.1     0       0.0     1       0.1
      TOTAL        1,108   100.0   1,059   100.0   1,172   100.0   1,253 100.0



      SEX


      Female       436   39.4  429   40.5  465   39.8  510   40.8
      Male         672   60.6  630   59.5  704   60.2  739   59.2
      TOTAL        1,108 100.0 1,059 100.0 1,169 100.0 1,249 100.0



      RACE


      White        899     82.8    857     82.7    964     83.0    1,053   85.0
      Black        177     16.3    172     16.6    188     16.2    175     14.1
      Other        10      0.9     7       0.7     9       0.8     11      0.9
      TOTAL        1,086   100.0   1,036   100.0   1,161   100.0   1,239   100.0
             


      Several trends in the data are noteworthy. First, the annual number of
      persons receiving services across this period follows a U-shaped curve:
      declining between years 1 and 2 and again between years 2 and 3, then
      increasing between years 3 and 4, and  between years 4 and 5. Second, an
      insignificant number of seniors (age 65 and over) received treatment
      services during the period, while the proportion of adolescents never
      exceeded 10 percent. Third, while the number of women receiving treatment
      increased across the period, their proportion changed little during this



Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
      time. Fourth, with only one exception (FY2005 to FY2006), the proportion
      of minorities served declined steadily across the five-year period.

       Characteristics of Clients Receiving Mental Health Prevention,
       Consultation & Education (P, C&E) Services including Crisis Intervention
       Teams

      II.A.2.c - Trumbull LifeLines has been facilitating the Trumbull County
      Suicide Prevention Coalition for two years.  The coalition is comprised
      of: survivors of suicides;  mental health providers; alcohol and drug
      providers; homelessness advocates; crisis intervention personnel; general
      hospital and private adolescent hospital psychiatric unit personnel;
      suicide hotline provider; Veterans Affairs suicide prevention coordinator;
      Yellow Ribbon Program provider; alcohol, drug addiction and mental health
      services board; local newspaper reporter; GM EAP; AFL-CIO representative;
      county coroner/nurse; Family and Children First coordinator; and YWCA
      representative.  For the past year, the focus of the prevention coalition
      has included completion of psychological autopsies with the coroner’s
      office in order to gain a better understanding of those who completed
      suicides; public service announcements targeting the geriatric population
      funded through a grant from the Ohio Suicide Prevention Foundation;
      outreach through presentations concerning senior citizens to senior
      service providers regarding the statistics, signs, symptoms and available
      resources for depression and suicide; various local newspaper articles
      regarding diverse aspects of suicide; collaboration in the local annual
      Survivors of Suicide Awareness Walk and LOSS/SOS program Candlelight
      Vigil; and development and implementation of a survivors of suicide follow
      up program through local community mental health center providing free
      outreach, assessment, intervention and referral for follow up services if
      indicated.  In addition, throughout the year, as additional members have
      joined the coalition, presentations as to their agency/organization
      programs have been shared to increase awareness of available resources.
       With the involvement of the county coroner’s office, we have developed a
      process in which the information (without names) of completed suicides is
      shared with the facilitators so that “real time” statistics can be
      aggregated and shared with the coalition and the community at large.  (See
      tables below for current statistics.)  In addition to the current
      activities, the coalition is continually focused on increasing participant
      involvement through outreach in the community.  Also, due to the
      continuing increase in unemployment rate due to lay-offs, the coalition is
      focusing on working with displaced workers, with the first initiative
      occurring on February 25, 2009 at a community-wide resource fair
      spearheaded by GM for all displaced workers (open to all community
      displaced workers, not just GM employees).  Area mental health agencies
      will be providing their respective agency information and information
      regarding signs, symptoms and resources on depression and suicide
      prevention will be distributed during this event.  Another initiative that
      is in development is the provision of a mental health therapist to present
      to the AFL-CIO counselors during their annual counselor training.  The
      therapist will share information as to the signs, symptoms and resources
      for depression and suicide.  This training is to occur during the spring
      of 2009.  Another event currently being planned collaboratively with the
      Trumbull, Mahoning and Columbiana County Suicide Prevention Coalitions is
      a Gatekeeper Training for Coaches.  The tentative date for the program is
      May 2009.  Mini-grants to help off-set the cost of the program and public
      service announcement production and airing have been awarded by the Ohio
      Suicide Prevention Foundation.  
      The facilitators of the Trumbull County Suicide Prevention Coalition are
      also participating members of the Northeast Ohio Suicide Prevention/Crisis
      Collaboration.  The group has had three meetings and share information
      regarding programs, fundraising, member recruitment, etc.  

      TABLE 2: Trumbull County Suicides by age group, 2001-2008 (Data source:
      Trumbull County Coroner's Office)

      Year       15-24 25-34 35-44 45-54 55-64      65-74 75-84 85+
          Total by year
      2001       3      1     8      4     6        2      3     0
          27
      2002       1      7     8      4     0        2      1      0
Community Plan · Trumbull Lifelines ADAMHS Board    for Trumbull County · Created
                              5/7/2009 9:22:42 AM
          23
      2003      1      6     4      7     1      2     2      0
          23
      2004      8      4     5      6     1      2     1      0
          27
      2005      3      4     3      13    4      0     2      1
          30
      2006      5      3     10     11    7      0     1      1
          38
      2007      10     6     8      7     4      3     3      0
          41
      2008      4      7     11     8     0      3     1      0
          34
      Total     35     38    57     60    23     14    14     2
          216



      In regard to mental health prevention for youth, Trumbull LifeLines
      (LifeLines) currently receives $44,348 from ODMH and $45,000 from the Wean
      Foundation to provide early childhood mental health consultation to
      children ages 0-6. Consultation is provided by four licensed clinical
      social workers/ counselors from four ODMH certified mental health
      agencies: Churchill Counseling, Homes for Kids, PsyCare, and Valley
      Counseling Services, Inc. Consultation is provided to daycare/preschool
      providers, directors, teachers, parents and Help me Grow staff regarding
      behavior problems, mental health issues, accessing additional needs, and
      implementing the Deveraux Early Childhood Assessment (DECA), the Early
      Childhood Environmental Rating Scale (ECERS) and/or the Infant Toddler
      Environmental Rating Scale (ITERS.). Consultants use a variety of
      evidence-based practices in their efforts. Such practices include the
      Incredible Years parenting program, the Georgetown Model of Consultation,
      and the DECA. During a typical consultation session, a consultant may
      observe a particular child in the classroom, observe an entire class,
      confer with a teacher or director over a particular child’s behavioral
      needs, discuss classroom strategies, provide referral information, address
      a parent’s concerns, or provide education to parents and/or staff
      regarding early childhood mental health. Every Ohio Department of Job and
      Family Services (ODJFS) licensed daycare/preschool in Trumbull County is
      offered consultation services. A small number of centers decided to
      participate initially. Through word of mouth, there has been a steady
      increase in the number of centers requesting consultation. Trumbull
      County’s Early Childhood Mental Health Program was expanded in fiscal year
      2008 through a grant from the Wean Foundation due to this increased
      demand. This grant enabled more consultation to be provided to day cares
      and preschools and allowed consultants to also be able to consult with
      Help Me Grow families. An early childhood mental health consultant attends
      a home visit with the Help Me Grow service coordinator after the
      coordinator administers the ASQ SE and finds consultation may be
      beneficial to the family. Twelve (12) families have been referred by Help
      Me Grow since August of 2008.
                 
      In the upcoming fiscal year, the LifeLines staff is committed to
      maintaining the success and integrity of the existing Early Childhood
      Mental Health Consultation program. This appears to be more of a challenge
      given the states current economic situation. Trumbull LifeLines will
      continue to enact cost saving measures and collaborate with local
      foundations and other potential funders to ensure that the mental health
      prevention needs of Trumbull County residents are met through fiscal year
      2010.



      Between 2006 and 2008, six Crisis Intervention Team (CIT) trainings were
      held in Trumbull County involving a total of 89 law enforcement officials
      and related personnel. Table 3 presents a breakdown of our first six
      training by jurisdiction.

      TABLE 3: Trumbull County CIT-Trained Officers by Departmental Jurisdiction
      (Data source: Trumbull County CIT Steering Committee)
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
                             CIT 1      CIT 2 CIT 3 CIT 4 CIT 5 CIT 6
          TOTAL


             02/06      10/06 04/07     11/07   04/08   11/08 06-08
      1  Warren City PD4      8         2       5       3     2     24
      2  Howland Twp PD2      2         3       2       1     2     12
      3  Trumbull  Sheriff              3       1       1           3
          8
      4  Hubbard Twp PD       2         2                      2      6
      5  Liberty Twp  PD      2                 2              1      1
          6
      6  Hubbard City PD                2       2       1
          5
      7  TCI (state prison)                                    1      4
          5
      8  Lordstown Vil PD               1                      2      1
          4
      9  Girard City PD       1                 1       1             3
      10 KSU Police Acad                                              3
          3
      11 Niles City PD        1                                1      2
      12 Trumbull 9-1-1                                        2      2
      13 Brookfield Twp PD                                     1
          1
      14 Champion Twp PD                                1
          1
      15 Cortland City PD                       1
          1
      16 Hartford Twp PD                        1
          1
      17 New Middletown Twp PD                  1
          1
      18 Ohio SH Patrol                                        1      1
      19 St Jos Hosp Security           1
          1
      20 Trum Mem Hosp Security                         1
          1
      21 Warren Twp PD                          1                     1

       TOTAL

            8      21     15     13     10      22      89

      Two trainings have been scheduled for 2009 (April and October). We have
      received invaluable material and financial support for the CIT program
      from numerous sources, including Astra Zeneca and Janssen Pharmaceutical
      companies, Newton Falls Veterans of Foreign Wars Post 3332, the Warren
      Family Mission, and NAMI Ohio.

          Characteristics of Clients Receiving Mental Treatment and Recovery
          Support Services

      II.A.2.d - Table 4 presents a breakdown by age group, gender, and race of
      persons who received mental health treatment services in FY2005 through
      FY2008.

      TABLE 4: Characteristics of Persons Receiving Mental Health Treatment
      Services, FY2005–FY2008 (Data source: MACSIS Data Warehouse)

            FY05   FY05   FY06   FY06   FY07    FY07    FY08   FY08
            N      %      N      %      N       %       N      %
      AGE


      <18 2,340    34.8  2,388 36.4    2,446 37.3       2,607 39.7
      18-64        4,164 61.9   4,042 61.6   4,249      64.7   4,831 73.6
      >64 220      3.3   133    2.0    151   2.3        241    3.7
      TOTAL        6,724 100.0 6,563 100.0 6,846        100.0 7,679 100.0
Community Plan ·   Trumbull Lifelines ADAMHS Board      for Trumbull County · Created
                                5/7/2009 9:22:42 AM
         SEX


         Male      3,174 47.2      3,093 47.5  3,231 49.6  3,676 56.5
         Female    3,493 51.9      3,417 52.5  3,550 54.5  3,938 60.5
         TOTAL     6,667 99.2      6,510 100.0 6,781 100.0 7,614 100.0



         RACE


         White     5,536   84.1    5,436   84.4    5,631   83.7    6,321   83.8
         Black     1,015   15.4    971     15.1    1,066   15.8    1,186   15.7
         Other     35      0.5     32      0.5     30      0.4     40      0.5
         TOTAL     6,586   100.0   6,439   100.0   6,727   100.0   7,547   100.0

         Several trends in these data are noteworthy. First, with the exception of
         FY05 to FY06, there has been a steady increase in the unduplicated number
         of persons receiving treatment services. Second, the number and proportion
         of seniors (ages 65 and over) changed little across the period, from 220
         persons (3.3 percent of all served) to 241 (3.7 percent). Third, the
         proportion of females increased steadily across the five-year period, from
         51.9 percent FY05 to 60.5 percent in FY2008. Fourth, the proportion of
         minorities served followed a curvilinear pattern of proportional increases
         and decreases.

         The Bridges Program was presented in Trumbull County twice in 2008 (once
         during FY 2008 and once during FY 2009).  During the first class, there
         were 8 students who both started and completed the course.  Eleven of 16
         students who began the second class successfully completed it—four with
         perfect attendance. The reasons of the five individuals dropping the class
         include: 1 student missed his cab 3 times, so he no longer had a ride; two
         students were homeless from the mission and both left the mission, hence
         they left the class; one student moved to a temporary housing facility and
         the last student began working an afternoon shift.

         A WRAP class was held at the end of FY 2008 with 8 students starting and
         finishing the course. A second WRAP class scheduled for November was
         cancelled due to illness of the presenter and was rescheduled for early
         2009.  

         A “Medication Management” educational seminar was held in October with an
         attendance of 37 consumers.  The presentation was delivered by a local
         psychiatrist, who discussed medications and their side effects.

         The Salvation Army Drop-In Center is a social/recreational service funded
         fully by Trumbull LifeLines, as is the transportation to and from the
         program.  This 5 day/week, 2 hour/day service has helped maintain many
         mental health clients in the community by providing a structured program
         for them to look forward to and attend.  If any signs/symptoms of
         decompensation are noted by the program coordinator, he contacts the
         client’s case manager directly.
          
         Unfortunately, due to the tremendous funding cuts, this is one of the
         programs that likely will no longer receive further funding after May 1
         (including transportation).  Because the program is 100 percent funded
         through Trumbull LifeLines, the Drop-In Center is scheduled to  close at
         that time without alternative funding sources.




       II.A.2.e Mental Health Crisis Care Services
                     Question                               Available      Planned For
                                                           In SFY 09?        SFY 10?
Community Resources & Coordination
  Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                                5/7/2009 9:22:42 AM
                     Question                            Available   Planned For
                                                        In SFY 09?     SFY 10?
24/7 Hotline                                                Yes          Yes
24/7 Warmline                                               Yes          Yes
Police Coordination/CIT                                     Yes          Yes
Disaster Preparedness                                       Yes          Yes
School Response                                             Yes          Yes
Respite Beds for Adults                                     Yes          Yes
Respite Beds for Children &amp; Adolescents
                                                            No           No
(C&amp;A)
Face-to-Face Capacity for Adult Consumers
24/7 On-Call Psychiatric Consultation                      Yes           Yes
24/7 On-Call Staffing by Clinical Supervisors              Yes           Yes
24/7 On-Call Staffing by Case Managers                      No            No
Mobile Response Team                                        No            No
Central Location Capacity for Adult Consumers
Crisis Care Facility                                       Yes           Yes
Hospital Emergency Department                              Yes           Yes
Hospital contract for Crisis Observation Beds              Yes           Yes
Transportation Service to Hospital or Crisis Care
                                                           Yes           Yes
Facility
Face-to-Face Capacity for C&A Consumers
24/7 On-Call Psychiatric Consultation                      Yes           Yes
24/7 On-Call Staffing by Clinical Supervisors              Yes           Yes
24/7 On-Call Staffing by Case Managers                      No            No
Mobile Response Team                                        No            No
Central Location Capacity for C&A Consumers
Crisis Care Facility                                       Yes           Yes
Hospital Emergency Department                              Yes           Yes
Hospital contract for Crisis Observation Beds               No            No
Transportation Service to Hospital or Crisis Care
                                                            No           No
Facility

Community Resources & Coordination - Other


Face-to-Face Capacity for Adult Consumers - Other


Central Location Capacity for Adult Consumers - Other


Face-to-Face Capacity for C&A Consumers - Other


Central Location Capacity for C&A Consumers - Other

          Board plans to address any gaps in the crisis care services indicated by
          ORC 5122-29-10(B):

         II.A.2.d.i - N/A; there are currently no gaps in services, nor will there
         be any gaps in services for the 2010-2011 fiscal year.

          Identification and prioritization of training needs for personnel
          providing crisis intervention services and how the Board plans to address
          those needs in SFY 2010-11.

         II.A.2.d.ii - Training needs were identified through focused discussions
         with crisis care supervisors and workers and through review of cases via
         Continuous Quality Improvement structures and processes. Needs were
         identified and prioritized as follows:

         1. clarification of procedures for transportation of persons in crisis
         between the Access Center, community hospitals, and regional state
         hospitals

         2. clarification of procedures for serving persons in crisis who are from
         outside Ohio, especially Pennsylvania

  Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                                5/7/2009 9:22:42 AM
      3. clarification of procedures for determining county of residency for
      persons from outside Trumbull County who are in crisis, especially those
      who may require an inpatient level of care

      4.  clarification of procedures for Trumbull County residents who are in
      crisis in another county

      These issues have been addressed in our bi-weekly Continuous Quality
      Improvement meetings and case reviews and through our periodic Health
      Officer Training sessions, conducted in conjunction with Trumbull County
      Probate Court.




    Capacity to Provide Services

       Access to Services
          Access to Alcohol and Drug Prevention and Treatment Services

        II.B.1.a - Of primary concern for those individuals attempting to access
        AOD treatment is accepting further expectations for change in the light
        of their lack of emotional and/or financial resources to effect any
        meaningful change in their lives under their own direction.  The vast
        majority are unemployed or underemployed and have been unable to
        establish a sense of meaningful direction in their lives.  Most are high
        school graduates but do not have trade or technical education allowing
        them to obtain more stable employment.  Of those that are employed, most
        are working for minimum wage or marginally above minimum wage. These
        issues only make the unmanageability of their substance use disorder
        that much more destabilizing as they lack recovery resources.

        Concerning levels of care, the greatest challenge to accessing services
        is for detoxification beds.  Outpatient services are available but
        customers have to wait several weeks to see a counselor.  In order to
        interrupt these recurrent cycles, our system of care would need to add
        both detoxification and 30-day beds.

          Access to Mental Health Prevention, Recovery Support, and Treatment
          Services

        II.B.1.b - Routine mental health services are generally accessible in
        Trumbull County at this time.  Clients can receive a diagnostic
        assessment (whether an urgent or routine need) within 48 hours at Valley
        Counseling Services.  Emergent assessments are available through
        LifeLines' Access Center.  The growing number of clients in need of
        mental health services is of concern.  Valley Counseling Services
        experienced a 4 percent increase in diagnostic assessments in 2008 and
        has experienced a 15 percent increase in FY 09 to date.  The number of
        indigent referrals is increasing each year despite a declining budget to
        accommodate them.

        Access problems include the length of time that it takes individuals who
        are not in crisis to see a psychiatrist.  Ongoing case management
        services are provided on a limited basis only and the lack of
        transportation options poses a major problem for accessing services.

       Workforce Development and Cultural Competence
         II.B.2.a - Community Solutions Association (CSA) has established a
         working relationship with two Departments at Youngstown State University
         and the agency regularly accepts graduate students for Counseling and
         Social Worker Internships.  CSA also participates in other activities in
         their Graduate Schools and in the Undergraduate Social Work Program.
          Senior staff has taught in the programs and also provide presentations
         in various classes. These departments are professionally accredited.
          Members of the faculty have served on CSA's Board of Trustees.  These
         activities give the agency many opportunities to present Chemical
         Dependency Counseling and AOD Prevention as viable specialty fields for
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
        well-trained candidates.  CSA regularly accepts Interns from other
        Universities and provides assistance in applying for entry level
        Certification.  The agency continues to be proactive in updating the
        knowledge and skills of current employees.  It has been their practice
        to hire only persons who are licensed or are eligible for certification
        and subsequent licensure.  In collaboration with Lifelines and YSU, CSA
        was able to secure EMDR certification training for over 30 local
        counselors at a significantly reduced rate based upon socio-economic
        data associated with the metropolitan area. Most recently CSA initiated
        discussions with a nationally recognized Web-based training organization
        to provide a broad base of on-demand professional training programs in
        all aspects of Behavioral Health Care.  The agency anticipates entering
        into an agreement with them at the beginning of FY 2010.  This will also
        reduce travel and related costs of training.

        Valley Counseling Services notes that a master’s degree in counseling or
        social work is the lowest paying Master’s one can obtain and that their
        particular challenge is finding LISW’s to meet the needs of its Medicare
        population.

        II.B.2.b.1 - As discussed more fully in Section II-Capacity Development,
        the Board has  supported a number of projects and processes that are
        intended to enhance the ability of our systems of care to provide
        culturally competent care. These have included:

        1. Improving the cultural diversity of the ADAMHS workforce and the
        cultural competence of workers through provider- or Board-sponsored
        workshops or training sessions:

        Although the Board has not held a system-wide cultural-competency
        training session in several years but a number of providers have held
        trainings for their own staff in the past year. African-American,
        Appalachian, and other cultural groups have been the focus of these
        trainings.

        2. Creating programs targeted at reaching and providing care for
        specific cultural populations:
         
        In Trumbull County, the African-American Youth and Family Program (now
        defunct) and Amish Outreach program were originally funded by special
        ODMH grants. Both programs addressed specific culture-based barriers to
        accessing care and relied on specially trained staff.

        3. Creating culturally competent organizations, procedures, and systems
        of care:

        This strategy requires an assessment of policies and practices within a
        focal organization (like an ADAMHS Board or provider agency). Prior to
        the establishment of the Amish Outreach Program, ODMH's C-CAT (Cultural
        Competence Assessment Tool) was piloted by the Boards and provider
        agencies involved. In addition, Trumbull County Board staff contributed
        to the resource materials on African-American and Amish cultures for the
        Ohio Mental Health Consumer Outcomes system (see the Resource Manual at
        http://b9962ed140049a571a710839f1f71c989aaf09ce.gripelements.com/oper
        /outcomes/planning_training/toolkit.handbook.culture.pdf).

         4. Making policy changes when needed:
              
         Sometimes cultural competence requires making changes in the way
         organizations do business. In the course of implementing the Amish
         Outreach program, a series of meetings was held with Amish Bishops in
         Geauga and Trumbull Counties. We learned that the Bishops were quite
         knowledgeable about mental illness and about medication-based treatments
         for brain disorders.  They had questions, however, about how to access
         services, especially since the Amish community was concentrated in rural
         townships far from the mental health centers in Chardon and Warren. As a
         result of these discussions, the Geauga County mental health center
         decided to open a satellite office in Middlefield. This village is in
         the center of Geauga County’s Amish population and just a few miles from
         Mesopotamia and Farmington Townships, where most of Trumbull County’s
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
        Amish population is concentrated. After geographic access was assured it
        was necessary to address financial access. Since the Amish do not use
        Medicaid and since ADAMHS Boards in Ohio are not responsible for non-
        crisis, non-Medicaid services provided out-of-county, we created a new
        policy under which claims for non-crisis, non-Medicaid services to
        members of Trumbull County's Amish communities would be paid to Geauga
        County's mental health center.

        II.B.2.b.2 - AoD treatment staff recognize the dynamics of poverty as a
        prevailing aspect of the culture of the region. The agency continues to
        sensitize staff to the dynamics of the culture of poverty and its
        influence on the choices and behaviors of our clients.  The majority of
        the staff has had repeated exposure to the “Bridges out of Poverty”
        model and the approaches to intervention and treatment that is
        recommended.  As the result of training that had taken place over 3
        years ago engagement and retention of clients has increased and even
        more so among minorities. This model emphasizes the need for the
        Behavioral Health Practitioner to be aware of and sensitive to the
        dynamics of their own socio-economic and cultural orientation/mindset
        and then gain an understanding of other’s.

        II.B.2.b.3 - Most of our providers of mental health P, C & E services
        also provide mental health treatment services. Thus, the strategies
        listed in II.B.2.b.1, above, apply to here as well. In addition, our
        Mental Health Services in Alternative Schools and Early Childhood Mental
        Health programs, both funded with special grants from ODMH, have
        included trainings geared toward better understanding of the cultural
        situations of their target populations, including workers in child care
        and school settings.

        II.B.2.b.4 - (Repeated from II.B.2.b.2, above) Like their treatment
        colleagues, AoD prevention staff recognize the dynamics of poverty as a
        prevailing aspect of the culture of the region. The agency continues to
        sensitize staff to the dynamics of the culture of poverty and its
        influence on the choices and behaviors of our clients.  The majority of
        the staff has had repeated exposure to the “Bridges out of Poverty”
        model and the approaches to intervention and treatment that is
        recommended.  As a result of training that had taken place over three
        years ago, engagement and retention of clients has increased and even
        more so among minorities. This model emphasizes the need for the
        Behavioral Health Practitioner to be aware of and sensitive to the
        dynamics of their own socio-economic and cultural orientation/mindset
        and then gain an understanding of others'.

       Capital Improvements
        II.B.3.a - In FY 2008, a strategic planning committee was organized
        between the local providers and Trumbull LifeLines to develop a plan to
        help reduce unnecessary hospitalizations (local psychiatric and state)
        and to reduce the incidence of re-hospitalizations.  We recognized that
        we were in need of a level of care that provided services for persons
        who were in short term crisis and needed stabilization.  The committee
        generated a plan, contacted an architect to design the vision, and
        discussed funding/programmatic opportunities.  The agencies and
        LifeLines agreed to jointly staff the facility in order to enable the
        system of care to respond, to treat people in crisis situations, and to
        engage them in longer term treatment focusing on recovery.  This vision
        and plan have been put on hold, due to budgetary constraints.  This is a
        shovel ready project and would be a tremendous benefit to the community
        system of care.

       Financial Status
          Impact of reduction in services.

         II.B.4.a - Trumbull LifeLines defines its core services as those
         services provided to people with a serious mental illness who are at
         risk of hospitalization. LifeLines is dedicated to preserving these
         programs, although this is not always in line with the goals of
         agencies. Therefore, it is a challenge for LifeLines to contract in ways
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
        that insure the continuation of the core services. Simply reducing the
        amount of funding to an agency does not accomplish this end. Therefore,
        all services not fulfilling this basic goal are at risk of being cut
        depending on several factors:
        1.  Cost of program
        2.  Number of people served by the program
        3.  The effectiveness of the program
        4.  The consequences of losing the program
        5.  Services that are duplicated elsewhere
        6.  Availability of alternative services
        7.  Overall community support for the program
        8.  Likelihood of continued support
        9.  The opportunity to use savings to fund other programs that are more
        effective
        10. Services that have not billed out the full contracted amount this
        year, and
        11. Ability of the agency to operate efficiently, lower overhead,
        strategically reshape their services and reduce personnel cost

        Providing Medicaid “match” is the #1 financial mandate of Ohio’s ADAMHS
        Boards, yet the Medicaid program does not support non-clinical needs
        (housing, employment, recreation, transportation, etc.). These services
        can be as important as psychiatric care or clinical treatment in
        supporting people who are recovering from severe mental illness or
        addictions. Additionally, many persons recovering from alcohol and other
        drug addiction are not eligible for the Medicaid program at all. We
        cannot alter Medicaid match requirements, nor can we control or limit in
        any way the amount of Medicaid-eligible services delivered by certified
        providers in our network and those located in other counties. Therefore,
        with declining revenues, we will reduce non-Medicaid-eligible services
        and eligible clinical services to non-Medicaid eligible consumers.

        Due to the current budget cuts, along with the additional impending
        budget cuts, the Salvation Army Drop-In Center will be impacted by a
        decrease in funding.  The program, which operates five days per week,
        two hours per day, is staffed by a full time worker and 3 part time
        assistants.  On average, there are approximately 30 to 35 persons per
        day that attend this program.  The total number of unduplicated persons
        who are served at the Drop-In Center is approximately 40 – 45, with days
        varying as to when they attend.  The population of people who attend are
        persons who are severally mentally disabled.  Most clients are actively
        involved with our community mental health agencies and have case
        managers.  Over the years, as the demand for this type of
        social/recreational program has grown, the number of days a week the
        Drop-In Center is open has increased from 3 days to 5 days.  During that
        time, there has been a decrease in hospitalizations of persons
        attending, possibly due to 1) the earlier detection of decompensation;
        2) client activity 3) social interaction with others.

        Other reductions could include the following:

        1.   Substance abuse counselor at Trumbull County Juvenile Justice
        Center

        Trumbull LifeLines financially supports a full time Substance Abuse
        Counselor located within the Juvenile Detention center. This position
        was originally created to decrease placements in out of county
        residential substance abuse treatment facilities. With the current
        budget cuts and levy revenue decreases, LifeLines will no longer be able
        to financially support this position. Children detained in juvenile
        detention will not receive substance abuse assessments, education or
        group treatment and in turn may be forced to seek more costly care, away
        from their families, out of county, upon their release.

        2.   Wraparound pooled funds

         During fiscal year 2008, Trumbull LifeLines contributed an additional
         $71,484 in levy revenues to the County’s Wraparound in addition to
         $71,751 in FAST funds and $94,977 in ABC funds that LifeLines also
         provides. The funding provided by Trumbull LifeLines, $238,212.00,
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
        represented 54% of the Wraparound program’s total budget for fiscal year
        2008.  Forty-seven families were provided with supportive services in
        order to maintain these high-risk children in the least restrictive
        environment. Without the additional levy revenues added to the pooled
        funds, non Medicaid eligible services (i.e. respite, recreational
        activities, etc.) will not be utilized to keep families together.

        3.   Maternal Depression Project

        Trumbull County joined ODMH’s Maternal Depression Project in FY 08.
        Since that time, five mothers have been identified as being at risk for
        post-partum depression that may have not been identified without the
        program. All of the mothers were referred for counseling. The referral
        follow-through rate for this program is 50 percent, which is a higher
        than many similar programs. When the original RFP was written, Trumbull
        LifeLines agreed to contribute local dollars to sustain the program
        after state funding ended. In light of current budget cuts, Trumbull
        LifeLines will not be able to contribute to the sustainability of this
        program. As a result, many mothers with post-partum depression may go
        untreated, a situation that we know has potential to lead to poor
        outcomes for children and families.

        4.   Incredible Years Program

        Trumbull County began offering The Incredible Years Parenting and Dina
        School Program free to Trumbull County families in FY 08 with support of
        a grant from ODMH. The Incredible Years is an award-winning program
        designed to decrease children’s disruptive behaviors, peer aggression
        and noncompliance with parents at home, and has been recommended by the
        American Psychological Division 12 Task Force, the U.S. Office of
        Juvenile Justice and Delinquency Prevention and the Center for Substance
        Abuse Prevention, as a well-established treatment for children with
        conduct problems. When the original RFP was written, Trumbull LifeLines
        committed $3,000 to the sustainability of the program in FY10. With the
        current budget cuts, Trumbull LifeLines will not be able to fulfill this
        obligation, and The Incredible Years Parenting and Dina School Program
        will no longer be offered free to Trumbull County families.

        5.   Non-clinical services for adults with severe and persistent mental
        illness

        In addition to the drop-in center activities at the Salvation Army
        described above, these services currently include employment and
        vocational services at Pine Industries, transportation services through
        a network of community providers,  Crisis Intervention Team training for
        law enforcement officials, BRIDGES and WRAP training for mental health
        consumers, out-of-county services for members of Trumbull County’s Amish
        community, Housing Support Funds for adults with severe mental illness,
        and representative payee services for adults recovering from severe
        mental illnesses and/or addictions.

        6.   Trumbull County Drug Court

        Originally funded by a Byrne Memorial grant, in recent years this
        innovative collaboration has been sustained with local levy funding.

        7.   LifeLines’ participation in collaborative activities

        Such activities currently include Family and Children First Council,
        Trumbull Advocacy and Protective Network, Trumbull County Domestic
        Violence Task Force, Trumbull County Suicide Prevention Task Force,
        Trumbull County Community Corrections Planning Board, Trumbull County
        Housing Collaborative, Trumbull County Human Services Planning
        Committee, Alliance for Substance Abuse Prevention, and Trumbull County
        Wraparound.

          Factors contributing to the costs of services.

         II.B.4.b - Many of the same factors that affect the cost of operations
         in other sectors  and specific costs associated with behavioral health
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
        have contributed to the expense of providing services: rising personnel
        cost including minimum wage; insurance cost; increase in travel
        reimbursement; increase expense in certification, auditing, and overhead
        in meeting compliance; loss of other funders or reduction in their
        share; match requirements and cost of supporting startup grants; costs
        associated with information technology; hospital and physician
        reimbursement increases; escalating cost of transportation; shifting of
        costs by jails; the expense of covering risk for hospitals and the
        court; and, in our area, lower reimbursement or loss of reimbursement as
        a result of people losing employment or being under employed.

        A core provider notes: Accrediting bodies and ODMH require a minimum of
        about 20 hours of mandatory training per year.  This equals $50,000 in
        lost productivity!  Staff salaries must increase annually at least by
        the cost of living standards to remain competitive.  18% turnover rate
        equals 10-15 new hires annually at a training cost of $18,000 each (this
        is lost productivity and does not include administrative time spent
        training/orienting).

        Our cost based reimbursement ceilings have not increased in 12 years.
         If we were a lemonade stand with no turnover or training issues we
        would have been insolvent many years ago.

        Another core provider notes: Significant costs have been incurred in the
        process of
        upgrading and updating Information Technology.  We also incurred
        increased training costs associated with training of key staff in the
        area of Women’s Gender Specific Issues and Trauma Informed Care with
        additional staff trained in EMDR.  Another factor is the cost of
        retaining a fully licensed and experienced staff.

        Another core provider notes the following factors: downtime accrued from
        traveling in a large county, training, no shows with a transient
        population, operating costs such as lawn care, snow removal, utilities,
        rent, technology to increase productivity such as laptops and electronic
        medical record, on line training.

          What cost-saving measures and operational efficiencies.

        II.B.4.c - The most ambitious program LifeLines implemented was the
        discount reimbursement rate for non-Medicaid services. Other cost
        savings initiatives have been: consolidation of services to one program
        eliminating overhead associated with multiple programs at different
        agencies; utilization of hospitals outside of our county to reduce state
        hospital usage and maximize Medicaid reimbursed hospital stays;
        concerted negotiation with purchased services like transportation,
        hospital contracts, etc.; and, strategic elimination of services.

        Another initiative has been through the development of our 24 hour
        Access Center. One of the goals of this program is to intervene with
        persons before they decompensate to a level requiring longer and more
        extensive services. Also, the Access Center maintains contact with
        clients when they transition from the hospital, or are newly accessing
        treatment, so we can reduce the pattern many people had in going from
        crisis to crisis.

        Internally, at LifeLines, we have identified a large number of saving
        initiatives. Some of these are small, like having people bring in their
        own Kleenex and tea bags, while others have identified major cost
        savings areas like giving up free drinks, printing on two sides with
        black ink, use of email versus costly mailings and giving up cell
        phones. We are looking into other initiative, like joint purchasing,
        seeking out better insurance rates, and review of costly memberships.
        Finally, one administrative position at the Board is currently vacant
        and there are no plans to fill it, a potential savings of approximately
        $60,000.

         A core provider notes: "Engagement techniques employed to bring clients
         into care
         at an earlier time to lessen use of ER, hospital based care or higher
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
        and more costly levels of care.  Increased collaboration within the
        system of care.  Consolidation of Med/Somatic services to potentially
        reduce cost of medication and increase efficiency of physician time.
        Training of staff to increase flexibility across programs. Increasing
        Family involvement in care to enhance efficacy of care.  Increasing
        efforts to collect self-pay.  Increased collaboration with other
        partners in the area to leverage funds.  SAMHSA Grant to refine cross
        system collaboration. Collaboration with Wean Foundation to
        support/supplement Prevention funds and further develop early childhood
        programs and leverage funding from other Foundations."  

        Another core provider notes: "Beginning in FY ’07, [we] and Board made a
        commitment to focus on assuring efficient, effective, and accessible
        services that meet the needs of our clients, funders, and other
        community stakeholders.  Immediate steps were taken to accomplish the
        following:

        •  Reduce fixed indirect overhead to bring administrative costs under
        12%.  The goal accomplished by elimination of 2 management FTE’s and 1.5
        clerical FTE’s.
        •  Restore depleted levels of clinical staff to “right size” caseloads
        •  Create 9 month positions to respond to volume variances.
        •  Implemented utilization management to assure appropriate level of
        BHCT service delivery.
        •  Implemented “rapid intake” to improve access and reduce no show
        rates.
        •  Created “walk in” psychiatric clinic.
        •  Increased psychiatrist hours to shorten wait for services.
        •  Implemented 45 minute therapy sessions to match industry standards.
        •  Implemented vacation buy-back program.
        •  Implemented retirement bridge program.
        •  Resumed use of student interns.
        •  Began conversion to “thin client” computer system to save on
        replacement costs.
        •  Replaced phone system for cost savings.
        •  Developed opportunities to diversify revenue sources; Portage and
        Mahoning Counties, New Beginnings Residential Treatment Center,
        increased insurance contracts etc.
        •  Establishment of Valley Community Mental Health Foundation
        •  Committed to writing/obtaining grant funding from 5 sources annually.

         Fiscal year ’08 and ‘09 Strategic Action Planning (initiated in ’08) and
         Fiscal Emergency Planning (initiated in 1/09) generated the following;
         •  Refine the Transitional Psychiatry Clinic and develop a Transitional
         Therapy Clinic to promote client responsibility and reduce no shows.
         •  Set implementation date for ONE Health partnership programs in
         Primary Care, Pharmacy and Adult Psychiatry services.
         •  Expand Portage County program presence.
         •  Complete leadership changes to improve revenue cycle function.
         •  Hire Director of Development (Wean funded and partnered with Family
         services Youngstown).
         •  Implement utilization review for CPST after 10 service hours.
         •  RN’s to cover for MD call offs.
         •  Increase student interns.
         •  Improve system displays of payor information to implement revenue
         cycle initiatives,
         •  Address productivity issues and sick time use with staff.
         •  Develop payor dashboards.
         •  Reinforce standards of care in length of time between psychiatry
         appointments.
         •  Cap REACH program and develop Client Operated Drop in Center to
         replace Salvation Army at no cost to Lifelines.
         •  Freeze management Salaries and benefits into FY ’10.
         •  Give union notice of potential lay offs and present opportunities for
         fiscal emergency responsibility sharing.
         •  Explore/implement expense savings including; bulk mailing, automated
         reminder calls, supply cost comparison, cancellation of water coolers,
         cancellation of courier services, copier use management, First Aid and
         CPR savings, conversion to city trash services and foundation support
         for HEARTS activities."
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
        And another core provider adds these measures: "reduction of
        administrative staff (HR, Fiscal, Operations), reduction of staff
        attending outside conferences and training, improved use/coordination of
        company cars to reduce mileage reimbursements, coverage of various
        positions with grant funds, more grant writing to cover/supplant funding
        sources."

          Other budgetary planning efforts.

        II.B.4.d - LifeLines sent out a 120-day notice warning agencies that
        major reductions are coming. We have followed up on this with meetings
        with agencies to get their feedback on where they can cut costs or
        eliminate programs that are under-performing. So far, this has not
        yielded any significant reduction efforts.
        The staff at LifeLines has systematically addressed each budget line
        looking for areas where we can cut cost, programs, or services. At this
        time we have identified where we can save approximately $200,000 and
        $600,000 for next year. A major part of this savings comes by way of
        reduced funding of our drop-in center and the transportation cost for
        this program.

        The Board of Directors has set a mandate that we will not expend more in
        FY 2010 than we expect to receive in revenues. This is primarily
        designed to protect our dwindling reserves and our need to maintain
        enough reserve and cushion to provide our match for Medicaid. Since
        Medicaid is a growing obligation with agencies chasing Medicaid
        reimbursement to make up for loss in Non-Medicaid allocations from
        Boards. More agencies are seeking to increase their Medicaid  in-county
        programs and expanding services to other counties.

        In the past, LifeLines has waited until the final allocation
        announcements before finalizing contracts with providers. Last year we
        did not settle on our allocations until September. This year we plan to
        finalize our budget in June based on anticipated revenues. Included in
        our contracts will be language protecting us if revenues fall short of
        expectations.

       Tables 1 and 2: Portfolio of Providers




Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
Section II: Capacity Development

  Access to Services
   One of the barriers identified by the Board and the agencies was the
   centralized location of central pharmacy for both AOD and MH clients.  After
   months of meeting to focus on problem identification, various options and
   final action plan, all central pharmacy services were relocated to the
   largest community mental health center, which is centrally located in
   downtown Warren.  Reconfiguration of the staffing, hours, and actual physical
   facility are in various stages of completion.  Clients have been very
   positive about the transition and the improvement to access.  In addition,
   due to the staffing reconfiguration, more clients have been identified as
   being eligible for patient assistance and have had aid in form completion.
    Also, many clients who had Medicaid or Medicaid pending but had not been
   identified as having this coverage are now able to access this benefit.  This
   helps to extend the central pharmacy dollars for those persons who do not
   have any medical coverage.

   Another access issue identified is transportation.  Unfortunately, Trumbull
   County does not currently have a public transportation bus system, which
   impedes the obtaining of services at times.  One way that the mental health
   and aod community has dealt with this is by having case managers transport
   clients and utilizing taxi service.  Both of these options tend to be quite
   costly and inefficient for our system, as it takes funding (and case manager
   time) out of direct care services.  The case managers attempt to utilize the
   time in transporting as effectively as possible, but often times, this can
   take away from other client contact.  Due to this ongoing issue, a
   Transportation Collaborative has been formed of various organizations and
   agencies (mental health, alcohol and drug, schools, JFS, group homes, Area
   Agency on Aging, and other types of community agencies) to develop and submit
   a grant for Mobility Management in the Trumbull County area.  At this time,
   the grant proposal has been submitted, and the collaborative is working on
   the details of the plan as they await the response as to whether the project
   will be funded.

  Workforce Development and Cultural Competence
   The challenge of effectively engaging and supporting the recovery of all
   persons who are struggling with mental illness, drug abuse or dependency may
   ultimately be the most important one we face. We know we are not touching
   many lives with serious needs, are not engaging many that we touch, and are
   not fully supporting the recovery of many that we engage. Culturally
   competent services and providers may turn out to be big parts of the answer
   to some of these challenges.

   The decade of the 1990s is frequently referred to in mental health circles as
   the “decade of the brain,” because of the major breakthroughs in our
   understanding how that most complex of human organs works. Generally less
   appreciated but no less important was the discovery (more accurately, the re-
   discovery) that “culture matters” in virtually every aspect of mental health
   and addiction prevention and treatment (ODPHP, 2002). The rather sizable
   literature on the subject can be boiled down to a few key points:

   •      American society is culturally diverse, with many, cross-cutting
   cultural dimensions, including race, ethnicity, language, religion, gender,
   sexual orientation, and age.
   •      Sociologically, minority–group status refers not to the relative size
   of a cultural group but to its subordinate position within society.
   •      The most recognized racial and ethnic minority groups in the US are
   African–Americans (12 percent of the US population, 33.9 million people),
   American Indian/Alaskan Natives (4.1 million), Hispanic/Latino Americans (13
   percent, 35.3 million), and Asian American/Pacific Islanders (4 percent, 11
   million). These are also the minorities for which the best data are
   available.
   •      There are clear disparities in the incidence and prevalence of mental
   health, drug abuse, and dependency problems. Many minority populations tend
   to have higher rates than non-minorities on most epidemiological indicators.
   •      Disparities have also been found in access to treatment, help-seeking
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
   behaviors, and what researchers call “idioms for communicating distress.”
   •      Among persons who enter treatment, disparities exist in diagnostic
   patterns, treatment modalities, responses to medications, and clinical
   outcomes. The additional cultural and linguistic barriers in communicating
   with professionals may serve as both cause and effect of some of these
   differences.
   •      Minority children and families face many of the same problems as do
   adults plus additional barriers and issues including parenting styles, child
   custody, and working with multiple systems at the same time.

   “Cultural competence” is a global term that has come to stand for the
   responses to the disparities in behavioral health care that systems of
   care—local, state, and national—have taken (or need to take). Many different
   kinds of activities fit under the heading of cultural competence. Over the
   years our activities have fallen into several general categories:

   1.  Improving the cultural diversity of the ADAMHS workforce and the cultural
   competence of workers
   Most often implemented through provider- or Board-sponsored workshops or
   training sessions, this strategy may be most effective when carried out in
   conjunction with the other approaches. Sometimes used in response to an
   identified problem within an organization, training programs can be very
   effective when used proactively. The Board has not held a system-wide
   cultural-competency training session in several years but a number of
   providers have held trainings for their own staff in the past year. African-
   American, Appalachian, and other cultural groups have been the focus of these
   trainings.

   2.  Creating programs targeted at reaching and providing care for specific
   cultural populations  
   These can be stand–alone programs (e.g., UMADAOPs) or they can be housed in
   larger organizations. In Trumbull County, the African-American Youth and
   Family Program and Amish Outreach program were originally funded by ODMH’s
   culturally competent services grants. Both programs addressed specific
   culture-based barriers to accessing care and relied on specially trained
   staff.

   3. Creating culturally competent organizations, procedures, and systems of
   care
   This strategy requires an assessment of policies and practices within a focal
   organization or across a system of care or provider network. ODMH’s
   Consolidated Culturalogical Assessment Tools (C-CAT) have been developed to
   help in the assessment process (also Roizner 1996). The C-CAT tool was
   piloted by the Amish Outreach program and Trumbull County contributed to the
   resource materials on African-American and Amish cultures for the Ohio Mental
   Health Consumer Outcomes system. (see Implementing the Ohio Consumer Outcomes
   System
   in a Culturally Competent Context, A Summary of Four Projects to Identify
   Perceptions of the Ohio Mental Health Consumer Outcomes System Among
   Representatives of Diverse Communities
   Funded by the Ohio Department of Mental Health through the federal Center for
   Mental Health Services Block Grant,
   http://b9962ed140049a571a710839f1f71c989aaf09ce.gripelements.com/oper/
   outcomes/planning_training/toolkit.handbook.culture.pdf)

    4.  Making Policy Changes When Needed      
    Sometimes cultural competence requires making changes in the way
    organizations do business. In the course of implementing the Amish Outreach
    program, a series of meetings was held with Amish Bishops in Geauga and
    Trumbull Counties. We learned that the Bishops were quite knowledgeable about
    mental illness and about medication-based treatments for brain disorders.
     They had questions, however, about how to access services, especially since
    the Amish community was concentrated in rural townships far from the mental
    health centers in Chardon and Warren. In part as a result of these
    discussions, the Geauga County mental health center opened a satellite office
    in Middlefield. This village is in the center of Geauga County’s Amish
    population and just a few miles from Mesopotamia and Farmington Townships,
    where most of Trumbull County’s Amish population is concentrated. After
    geographic access was assured it was necessary to address financial access.
    Since the Amish do not use Medicaid and since ADAMHS Boards in Ohio are not
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
   responsible for non-Medicaid services provided out-of-county, we established
   a new policy under which claims for non-Medicaid services to members of
   Trumbull's Amish communities would be paid to Geauga's mental health center.

   The Surgeon General’s 2001 report notes that “…cultural competence has been
   promoted largely on the basis of humanistic values and intuitive sensibility
   rather than empirical evidence” (p. 36). In its 2003 report, the Subcommittee
   on Cultural Competence of the New Freedom Commission on Mental Health notes a
   critical need to expand the science base for behavioral health treatment in
   ethnic and racial groups. “While critical indicators and standards for
   culturally competent care have been generated through expert consensus, these
   remain to be systematically applied, measured, and linked to effectiveness of
   services.” Evidence-based practices (EBPs) in cultural competency are coming
   and they have the potential to effectively counter at least some of the
   disparities we face. The Subcommittee’s report also recommends an interim
   strategy while we wait for EBPs. “Meanwhile, behavioral health systems can
   take steps to respond to the concerns of ethnic and racial populations by
   building trust, increasing cultural awareness, and responding to cultural and
   linguistic differences.” We have attempted to do these things and have found
   many resources to help in the effort. A few are listed below:

   Cross, Terry L., Barbara J. Bazron, Karl W. Dennis, and Mareasa R. Isaacs,
   Towards A Culturally Competent System of Care: A Monograph on Effective
   Services for Minority Children Who Are Severely Mentally Disturbed.
   Washington: CASSP Center, Georgetown University, 1989

   National Center for Cultural Competence, Getting Started . . . and Moving On
   . . . Planning, Implementing and Evaluating Cultural and Linguistic
   Competency for Comprehensive Community Mental Health Services for Children
   and Families. Washington: NCCC/Georgetown University Center for Child and
   Human Development. Available online at:
   http://gucchd.georgetown.edu/nccc/documents/Getting_Started_SAMHSA.pdf

   ODMH, Cultural Competence in Mental Health: A Study of Nine Mental Health
   Programs in Ohio, 1998

   ODPHP (Office of Disease Prevention and Health Promotion), Culture Counts in
   Mental Health Services and Research, Prevention Report, Vol 16, No 2, 2002
   Available online at:
   http://odphp.osophs.dhhs.gov/pubs/prevrpt

   Roizner, Monica, A Practical Guide for the Assessment of Cultural Competence
   in Children’s Mental Health Organizations, Boston: Judge Baker Children’s
   Center, 1996

   US PHS, Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental
   Health: A Report of the Surgeon General. Rockville, MD, 2001

   US PHS, Report of the Surgeon General’s Conference on Children’s Mental
   Health, Washington, 2000

  Capacity Development Targets
   C.1 - In SFY 2010–11, we will continue with the same two Capacity Development
   Targets that were identified in our Community Plan for SFY 2008–09:

   1.  Increase the use of evidence-based policies, practices, strategies, and
   programs in both AoD and MH subsystems

   2.  Increase the use of data within both AoD and MH subsystems to make
   informed decisions about planning and investment

   C.2 - 1.  Maintain/increase access to Assertive Community Treatment (ACT),
   Integrated Dual Disorder Treatment (IDDT) and Supported Employment (SE),
   service–enriched housing, peer support, community psychiatric supportive
   treatment (CPST),  and Wellness Management and Recovery (WMR)

   2.  Evaluation of services will be planned


Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
Section III: Prevention Services

  Prevention Needs
     Needs Assessment Methodology

   A.1 - The mental health and alcohol and other drug prevention, consultation
   and education needs have been determined through information gathered from
   various types of focus groups, consumer feedback, and evaluations.  Included
   in this process is information gathered from Family and Children First
   Council; parent representatives; WRAP and Bridges participants; Board Members
   of Trumbull LifeLines; feedback from Trumbull County’s four core provider
   agencies, staff and clients (through consumer/customer satisfaction surveys,
   evaluations and general client feedback); ASAP Coalition(Alliance for
   Substance Abuse Prevention), which includes community partners, students and
   school liaisons; and the Trumbull County Coroner’s office data of completed
   suicides.

     Needs Assessment Findings

   A.2.a - The findings of the American Drug and Alcohol Survey as referenced in
   A.1. are below.
   Figure 1 shows that the past 30 day use in all three substances has decreased
   in the 2007-08 school year compared to the 2005-06 school year.  Alcohol use
   in both years was reported as being used more than any other substance for
   all three grade levels in both years.  However, the trend in using Alcohol,
   Tobacco, and Marijuana increases significantly as students move into the
   upper grades.  
   Figure 2 shows the average age of onset among the target communities.  Some
   substances have seen a decrease in age of onset while others have seen an
   increase in onset when comparing both years.  In general, the rate of
   increase or decrease has been fairly small.  


   Figure 3 represents the perception of risk among students in the target
   areas.  The perception of risk for alcohol consumption is lower than both
   tobacco and marijuana use for both years students were surveyed.  A decreased
   percentage of 6th grade students indicated that they perceived alcohol to
   cause harm in 2007-8 compared to the previous year surveyed.  Otherwise,
   perception of risk actually increased in all other grades for both tobacco
   and marijuana.  In the 8th and 10th grade perception harm for consumption of
   alcohol also increased unlike 6th grade results.  



   Figure 4 illustrates the perception of parental disapproval among target
   communities in both areas.  Perception of parental disapproval for alcohol
   consumption increased among all grade levels from the 2005-6 school year to
   the 2007-8 school year.  Perception of parental disapproval for the use of
   tobacco and marijuana actually decrease from the 2005-6 to the 2007-8 school
   years for both 8th and 10th graders.  However, 6th grade results indicate
   that perception of parental disapproval for the use of tobacco and marijuana
   increased from the 2005-6 school year.  

   Areas of improvement based on findings:
   Past 30 day use
   Perception of risk for alcohol consumption increases as students become older

   Perception of parental disapproval increases as students become older
   Perception of risk for tobacco and marijuana consumption increases as
   students become older

   Areas to work on based on findings:
   Perception of parental disapproval
   Age of onset
   Alcohol consumption within the past 30 days
   Alcohol, Tobacco, and Marijuana use as students become older increases
   significantly


Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
   Perception of risk for consumption of alcohol is lower than tobacco and
   marijuana use

   A.2.b - Mental health prevention, consultation and education needs in
   Trumbull County are Suicide Prevention resources for Transition Aged youth
   (unmet), Early Childhood Mental Health Education (met), Adolescent Justice/
   Court Coordination (unmet), School Success (unmet), suicide prevention
   (unmet), Maternal Depression screenings (met), and Adolescent
   Diversion/Recidivism (unmet).

  Prevention Priorities
    Method for Determining Prevention Priorities

   B.1 - In determining prevention priorities LifeLines staff evaluated
   reoccurring themes from focus groups, consumer feedback, evaluations,
   information gathered from the Family and Children First Council, parent
   representatives, WRAP and BRIDGES participants, Trumbull LifeLines Board
   members, feedback from provider agencies staff and clients, the Alliance for
   Substance Abuse Prevention (ASAP) and data from the Trumbull County Coroner’s
   office regarding completed suicides, as well as the impact on other systems
   and stakeholders.

    Grouping of Priorities (High, Medium and Low)

   B.2.a - HIGH
   • Perception of parental disapproval
   • Age of onset

   MEDIUM
   • Perception of risk for consumption of alcohol is lower than tobacco and
   marijuana use
   • Alcohol, Tobacco, and Marijuana use as students become older increases
   significantly

   LOW
   • Alcohol consumption within the past 30 days

   B.2.b - HIGH
   • Suicide Prevention

   MEDIUM
   • Depression Screenings, include Maternal Depression Screenings
   • Early Intervention programs
   • School-based mental health services/programs
   • Crisis Intervention Training (CIT)

   LOW
   • Faith-based and culturally specific initiatives
   • Stigma Reduction activities

    Implications of Identified Priorities to Other Systems

   B.3 - Priorities that are either low on the board’s priority list or are not
   a current priority of the board may lead to increased criminal activity,
   hospitalizations, domestic violence and homelessness as our economy continues
   to decline.

  Prevention Investor Targets
   C.1 - Alcohol and Other Drug Prevention Targets:

   1.  Programs that increase the number of customers who avoid ATOD use and
   perceive non-use as the norm;
   2.  Programs that increase the number of customers who perceive ATOD use as
   harmful;


   Mental Health Prevention Targets:

Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
   1.  Programs that decrease the number of persons at risk of developing mental
   health problems and/or at risk for suicide;
   2.  Programs that increase the number of persons that receive mental health
   screenings, assessments or referrals to services;
   3.  Programs that increase the number of persons who demonstrate school
   bonding (success) and educational commitment;
   4.  Programs that increase the number of persons involved in the criminal
   justice system who receive mental health services.




Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
Section IV: Treatment and Recovery Support Services

  Treatment and Recovery Support Needs
     Needs Assessment Methodology.

   A.1 - The process utilized by Trumbull LifeLines to determine the treatment
   and recovery support needs include data collection through the database
   developed with our prescreening entity;  hospital data;  interactions and
   conversations with providers, consumer groups, community organizations and
   collaboratives; program evaluations and consumer satisfaction surveys.

   The adult mental health and alcohol and other drug treatment and recovery
   system stakeholders have a scheduled bi-monthly Continuous Quality
   Improvement (CQI) meeting, facilitated by Trumbull LifeLines.  During each of
   these meetings, there is a telephone conference call between Trumbull
   LifeLines, providers and Northcoast Behavioral Healthcare to discuss Trumbull
   County patients/clients and treatment, discharge and community plans.  In
   addition, after the call is completed, the group discusses high acuity
   clients currently placed in the community; gaps in services identified
   through the issues facing these clients; and current resources available for
   specific clients.  In addition, on an as needed basis, representatives from
   the MRDD system interface with CQI group for those clients who are dually
   diagnosed with MH and/or SA and MR/DD.  As part of the Heartland East
   Collaborative, a number of data reports are available and utilized to do
   modified focused discussions to identify system needs so as to continuously
   work to improve our system of care.

   Another regularly scheduled monthly meeting with a larger community base of
   stakeholders is the System Integration Meeting.  Currently, due to feedback
   from the participants, this meeting is now scheduled on a quarterly basis.
    We do, however, continue to meet monthly with our four core providers.
   Facilitated by Trumbull LifeLines, Heartland East reports are also used with
   this group to identify issues, gaps in services and possible options.

   Through the LifeLines Access Center (crisis pre-screening agency with whom
   Trumbull LifeLines contracts), a “real-time” data-base is continuously
   updated containing information related to crisis calls, information and
   referral calls, crisis pre-screenings, investigative reports, probates,
   dispositions, hospitalizations and length of stay.  Numerous queries have
   been accessed and reviewed in order to identify various issues.  In addition,
   the Access Center ‘utilization manages’ inpatient psychiatric hospitalization
   with several local hospitals with whom we have a contract, so we have data
   regarding number of clients admitted, lengths of stay, etc.

     Findings of the Needs Assessment

   A.2.a - Through discussion with the social workers at Northcoast Behavioral
   Healthcare on a bi-weekly basis and the on-going needs of the high acuity
   clients of Trumbull County, as well as data analysis of our pre-screening
   database, it is extremely obvious that some levels of care that are lacking
   within Trumbull County include structured group/boarding homes and
   residential facilities.  We do have a short-term crisis residential facility
   which is helpful in stepping down state hospital patients, which sometimes
   helps to decrease lengths of stay, however, with some clients, longer term,
   structured facilities would be a benefit to their recovery.  An additional,
   on-going issue is the inappropriate transfers from one of our local hospitals
   of psychiatric patients to the state hospital.  Many conversations along with
   data have been presented to the administrators of this specific entity, as
   well as to the Probate Court, but to no avail.  The court will do as the
   psychiatrist requests (expert).  The need in this situation is for hospital
   administrative intervention with the unit psychiatrists.  The concern of the
   administration is loss of psychiatrists since they are in much demand and in
   short-supply.

   A.2.b - Trumbull County has some very high acuity clients who have housing
   needs that are unmet, including structured group home living.  This is an
   unmet need of level of care in our community, and we find that many of our
   clients end up in the Emergency Departments of local hospitals, as well as
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
   the being hospitalized because of lack of structure and monitoring in their
   living environments.  In addition, with the impending decrease in funding for
   our drop-in center, this will be an unmet need, as SMD adults will be without
   socialization, recreation and some structure during the day.  This will
   contribute to the increase in decompensation and hospitalization of this
   population.

   A.2.c - Trumbull County Family and Children First Council has been successful
   in completing a community needs assessment through the Council retreat, Ohio
   Children's Trust Fund Allocation Committee, the Community Assessment
   Committee, organizing and facilitating Focus groups in community, and through
   Wraparound Oversight Committee.

   Stated unmet needs within Trumbull County:
   •  Alcohol and other drug treatment facility for women and girls in the
   county
   •  Intensive Home Based Treatment program
   •  More services for children on autism spectrum
   •  Accessible dental care for children on Medicaid
   •  Health insurance for families
   •  Pregnancy prevention programs
   •  More foster homes, especially therapeutic foster homes
   •  Developmental programming for the 3-5 year old population
   •  Day care for children with special needs
   •  TRANSPORTATION – This is always mentioned
   •  Clothing vouchers for transition aged kids pursuing employment
   •  Assistance with utilities, especially heating assistance
   •  Car repair assistance
   •  Legal assistance for divorces when custody is an issue – Legal Aid will
   not take these

   Wishes expressed by community:
   •  Affordable, accessible activities for children and families, e.g. cooking
   classes, book clubs for children/youth
   •  Budgeting/money management, reading labels and nutrition instruction –
   healthy foods cost more!

   Concerns expressed by community:
   •  Lengthy wait time to see psychiatrists
   •  Counselors canceling appointments
   •  “Competition” for payment for clinical services – when organization makes
   referral, new agency “sucks up” client.

   A.2.d - Currently, SAMI client needs are being met through a one year federal
   SAMHSA grant in which they are receiving specialized case management,
   psychiatric treatment and treatment with an addictionologist.  The
   sustainability of this program was based upon decrease in hospitalization of
   this population and the shifting of funds, however, because of the continual
   cuts in funding, the identified program sustainability is in question.
    Therefore, at this time, this need is met, however, it may end up being an
   unmet need in the future.

   A.2.e - Thus far in FY2009, Trumbull County residents have received community
   AoD and MH treatment from a range of providers including:
   (1)  our four core providers
   (2)  three additional AoD "niche" providers
   (3)  six Medicaid-only providers located within Trumbull County
   (4)  54 Medicaid-only providers located outside of Trumbull County

   The vast majority of persons receiving services in groups (3) and (4) receive
   general, outpatient services. By almost any measure and considering the
   extent of unmet need in the other categories, this population is over-served.
   Were it possible to divert some of the resources going into the duplications
   of effort represented by these two categories, we might be able to address
   some of the unmet needs in the other categories.

    A.2.f - Trumbull County lacks resources and funding for detoxification and
    rehabilitation for adults.  Due to this unmet need, many adults present to
    the local emergency departments and are placed on medical floors (with a huge
    price tag) or on psychiatric units which do not have the programs to address
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
   these problems/issues.  In addition, there is a lack of housing for this
   population to continue to assist in the recovery process.

  Treatment and Recovery Support Priorities
    Method for Determining Treatment Priorities

   B.1 - The Board used three general strategies to identify treatment needs: We
   used focused discussion-group techniques in sessions with key stakeholders to
   explore system strengths and weaknesses. These sessions were conducted as
   stand-alone activities and as parts of other cross-system mechanisms (e.g..,
   CQI). Second, we reviewed utilization and other quantitative data from
   MACSIS, the state-hospital system, and the Board’s various tracking systems
   to identify patterns of over- and under-utilization and possible gaps in our
   levels of care. Finally, we compared the current continuum of care with
   benchmark models such as those developed by Robert Drake and his colleagues,
   and inventories of evidence-based and other clinical best practices.

    Grouping of Priorities (High, Medium and Low)

   B.2 - AoD Priorities:

   HIGH
   • Adults with AoD dependency diagnosis
   • Adults with AoD and mental health diagnosis with history of inability to
   gain quality of life due to dual disorder
   • Adult and late adolescent females dealing with substance use disorders as
   well as family or relationship issues, abuse issues, and/or co-dependency
   issues, pregnancy and/or child rearing

   MEDIUM
   • Persons involved in the criminal justice system

   LOW
   • Psycho-educational services for adolescents and adults with substance abuse
   diagnoses
   • Services for adolescents


   MH Priorities:

   HIGH
   • Adult   crisis care
   • Adult   inpatient care
   • Adult   housing supports
   • Youth   wraparound

   MEDIUM
   • Adult employment supports
   • Adult residential care
   • Early childhood assessment
   • School success

   LOW
   • Social and recreational
   • Transitional care

    Implications of Identified Priorities to Other Systems

   B.3 - We have already seen small-scale increases in cases coming to our
   systems from prisons, nursing homes, and other sources. More than ever
   before, community service systems must recognize the need to work
   collaboratively.

  Treatment and Recovery Support Investor Targets
    Treatment and Recovery Support Investor Targets

   C.1 - ODADAS Treatment and Recovery Support Investor Targets:

Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
   1.  Number   of customers who are abstinent at the completion of the program.
   2.  Number   of customers who are gainfully employed at the completion of the
   program.
   3.  Number   of customers who incur no new arrests at the completion of the
   program.
   4.  Number   of customers who live in safe, stable, permanent housing at the
   completion   of the program.


   ODMH Treatment and Recovery Support Investor Targets:

   1.  Increase Access to Housing
   2.  Decrease number and duration of state hospital treatment episodes

    ORC 340.033(H) (HB 484) Investor Target

   C.2 - HB 484 Investor Target:

   1. The number of parents of children in the custody of the Trumbull County
   Children Services Board who begin addiction treatment
   2. The number of parents of children in the custody of the Trumbull County
   Children Services Board who complete addiction treatment
   3. The number of parents of children in the custody of the Trumbull County
   Children Services Board who successfully complete addiction treatment and
   have their children returned to their custody

    HIV Early Intervention Investor Target

   C.3 - N/A




Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
Section V: Collaboration
  Continuity of Care Agreements

 A - The process outlined in the Continuity of Care Agreement between Northcoast
 Behavioral Healthcare and Trumbull County has been in effect long before the
 agreement was signed.  The agreed upon language and amendments in the agreement
 reflect the procedures that all pre-screening staff of the LifeLines Access
 Center follow.  One hundred percent (n=15) of direct care staff have been
 trained to follow the outlined procedure.

 Because the agreement was more of a “working process in progress” and not an
 actual document, any kinks or issues that needed to be resolved were done so
 through communication between designated staff at Trumbull LifeLines and the
 appropriate staff at Northcoast Behavioral Health.

  Benefits/Results Derived from Collaborative Relationships

 B - Trumbull LifeLines has had numerous collaborations with various systems in
 order to improve and enhance the system of care.  The first major collaboration
 is the Continuous Quality Improvement meetings, which include core agencies
 (mental health, alcohol and other drug), Trumbull County’s forensic monitor,
 local psychiatric hospital administrator, MRDD (on as needed basis), social work
 staff at Northcoast Behavioral Healthcare and Trumbull LifeLines.  This
 collaboration has resulted in better communication regarding treatment and
 discharge planning for those patients at Northcoast, as well as shorter lengths
 of stay for a time – (however, this has changed within the last 6 months.  A
 meeting is in the planning stages with Northcoast Behavioral Healthcare in order
 to address this issue, as well as several other issues of concern.)  The
 collaboration and positive working relationship between all entities has
 contributed to non-confrontational, more productive problem solving/issue
 resolving meetings.  This has led to improved client transition back to the
 community, better understanding by NCBH staff/social workers as to resources
 available in Trumbull County and a more stream-lined referral process for the
 social workers in completing discharge planning.

 Another system in which collaboration has occurred is with our local jail.
  Originally, as part of the development of the LifeLines Access Center/pre-
 screening, if an inmate was flagged as being suicidal, having an identified
 mental illness or possibly being mentally ill, a pre-screener would assess the
 inmate.  As the jail was finding that more inmates were in need of on-going
 mental health/drug and alcohol intervention, it was agreed upon to shift
 resources to the jail system in order for them to employ a social worker to
 provide these services.  This shift in service began on March 16, 2009.  The
 benefit of this change will be the increased number of hours that a staff person
 is available to provide services to inmates so as to more effectively serve
 their mental health needs (including after-care planning and follow up), which
 will hopefully decrease the involvement in the criminal system.

 Trumbull LifeLines currently has four contracts with private hospitals to
 provide inpatient psychiatric care for indigent Trumbull County clients.  Each
 year, the contracts are renewed, and throughout the year, dialogue occurs
 between a Board representative and hospital representative to deal with any
 issues or concerns.  In addition, one of the local hospital representatives
 participates in our Continuous Quality Improvement meetings and also attends our
 quarterly System Integration meeting.  

 Trumbull LifeLines continues to be a major partner in the Trumbull Advocacy and
 Protective Network collaborative, a network of Trumbull County representatives
 from social services, government, medicine, law enforcement, the courts, etc.
 who serve seniors and share the common desire to provide system-level
 integration and coordination of programs, case-level coordination and
 integration of services and training/cross-training of service providers and
 network members.  TAPN provides on-going trainings for providers and the
 community at-large focusing on issues/resources/interventions for seniors.  A
 Clinical Committee meets on a monthly basis to discuss clinical issues, support
 fund requests and to share resource information.  Various speakers are asked to
 present to update/inform group of programs in the community for seniors. The
 clinical committee also addresses the special needs of older adults who are
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
being served by more than one system and whose situation warrants extraordinary
interventions.  The ongoing benefits of this collaborative is continuous updates
on resource availability for seniors, which then leads to appropriate referrals
to seniors for interventions, which then leads to improvement in senior living.

  Consultation with county commissioners regarding services for individuals
  involved in the child welfare system

C - The Board of Commissioners has expressed strong support for the joint
planning efforts involving the ADAMHS and Child Welfare systems. In addition to
our our partnerships around the use of 484 resources, these efforts include the
following:

In Trumbull County we have recently started a Family Drug Court with Judge Pam
Rintilla of Family Court.  The Drug Court is a community partnership consisting
of representatives from the Trumbull County Children Services Board, the
Juvenile Justice Center, Trumbull LifeLines, Community Solutions Association and
the school systems. Using the Wraparound model, families put together a
strength-based treatment plan with the court representative that includes
drug/alcohol treatment and a child welfare plan.  The Children’s Program
Coordinator of Trumbull LifeLines also participates in the Trumbull County
Wraparound Oversight Committee.  Trumbull LifeLines contributes $71,484 to
Wraparound Pooled Funds, the entire ABC allocation of $94,977 and all of the
FAST funding of $71,751 to work with children and families in the Wraparound
system of care.  The Oversight Committee makes referrals to and provides follow
up from Family Drug Court.

Additionally, Trumbull LifeLines paid $108,038.54 in Medicaid match for 23
children who received Wraparound services in FY08.  An additional $366,010 in
Medicaid match was paid for counseling and case management for sixty-six
children in CSB custody in FY08.  The county commissioners provide oversight and
board appointments to the Trumbull County Children Services Board and they
assist with levy language.  The CSB levy provides most of the funding for the
Children Services Board along with the funding from Wraparound and Medicaid
match for services for children in CSB custody.  

Trumbull LifeLines also funds Community Solutions Association with $1,654,090 of
ODADAS Treatment, Prevention and levy funds to maintain the Women’s Intervention
Program, Indigent Drivers Program, Adult Drug Court and treatment and prevention
services for individuals and families.

  Involvement of customers and the general public in the planning for service
  provision

D - The general public and customers have been involved in various levels of the
planning process with Trumbull LifeLines.  Much of the interaction and feedback
has been gathered through modified focus groups, as well as the Board’s
involvement in community coalitions and organizations.  The Board’s facilitation
of the Suicide Prevention Coalition has led to the interfacing with Survivors of
Suicide, some of whom not only can be classified as “general public” but are
also customers in the system.  Through this relationship, information has been
gleaned as to this groups thoughts/ideas.  Other relationships/interfacing that
involves the community and customers for on-going planning include NAMI,
Trumbull County Probate Court, Hearts and Reach (on-going groups at Valley
Counseling, Inc.), TAPN, the Alliance for Substance Abuse Prevention, Family and
Children First Council, Community Corrections Planning Board, etc.




Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
Section VI: Evaluation
  Board’s Approach to Evaluating the Effectiveness and Efficiency of Services in
  the Overall System of Care

 A - As noted in previous Community Plans, LifeLines' evaluation activities and
 products are conceptually distinct from, but operationally interconnected with,
 quality improvement activities and products. Both involve a continuous
 Plan—Monitor—Evaluate cycle.

 PLAN (use data to design changes which address needs with system and community)

 MONITOR  (use data to describe current states and to document changes in our
 systems of care and patterns of unmet needs in system and community)

 EVALUATE  (use data to explain/assess program development, impacts, or
 effectiveness and to establish value)

 We use a variety of methods to monitor and evaluate services and programs in our
 systems of care, including the following:

 •  Tracking systems: used to monitor daily and monthly client flows into and out
 of inpatient and residential levels of care, homeless shelter, permanent
 supported housing
 •  Heartland East utilization reports: drawing on data from a variety of sources
 (MACSIS, MH outcomes, BH module, PCS, etc.), these are used to routinely monitor
 key functions as well as to drill down into specific utilization/QI issues
 •  Heartland East cost analyses: used to quantify the price of change
 comparatively and over time
 •  Evaluability assessment: achieving Board and provider consensus on the design
 and key features (targets, goals, measurement) of programs the Board may wish to
 purchase
 •  Outcome evaluation of priority programs (see VI.C., below)
 •  Feedback from consumers, family members, and community stakeholders: in the
 past we conducted our own surveys of these constituencies and utilized the
 Consumer Quality Review Team project (now defunct) for some of these data. For
 several reasons we have chosen not to rely heavily on the "satisfaction surveys"
 conducted by many providers. We are currently re-evaluating our strategies and
 options in this area.

  Collaboration with the Agencies in Evaluating Services.

 B - LifeLines' provider network consists of four groups:

 1. CORE PROVIDERS: Burdman Group, Coleman Professional Services, Community
 Solutions Association, Valley Counseling Services

 2. HOSPITALS:  Ohio Department of Mental Health, Trumbull Memorial Hospital,
 Summa Health System, Windsor/Laurelwood Hospital

 3. SPECIALTY PROVIDERS: Meridian Services, Neil Kennedy Recovery Clinic, New
 Start Treatment Center, Christy House—Greater Warren-Youngstown Urban League,
 Salvation Army—Drop-In Center, Forensic Psychiatric Center

 4. MEDICAID—ONLY PROVIDERS (mandatory match):  Belmont Pines Hospital, Churchill
 Counseling, Greentree Counseling, Homes For Kids, PsyCare, Specialty Care
 Counseling, and 54 out-of-county Medicaid providers (in FY2009 through 1/31/09)

 Among the four core providers, our level of collaboration is very high. Most
 send monitoring/tracking data reports to the Board on a daily
 (crisis/residential), weekly (inpatient), or monthly (transitional) basis.
 Working collaboratively, we have identified key programs and/or target
 populations in each agency, program goals, how progress is measured, what
 results are being achieved, length of stay and cost parameters. Our Evaluation
 and QI efforts are greatly enhanced by our membership in Heartland East, the
 administrative service organization that handles MACSIS, BH, MH Outcomes, and
 PCS data tasks for its member ADAMHS Boards (Ashtabula, Columbiana, Portage,
 Stark, Trumbull, Wayne—Holmes). In addition to these efforts, we have detailed
 monitoring/tracking mechanisms in place for all hospitals and for most of the
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
specialty providers.

Very little monitoring or evaluation involving the within-county, Medicaid-only
agencies takes place beyond simple tallying of persons served and dollars spent.
Similarly, no such activities occur with the dozens of out-of-county Medicaid
providers we reimburse each year, as such activities are proscribed by Ohio's
contract with the Federal Centers for Medicare and Medicaid Services. This lack
of accountability is a major weakness of the current structure of behavioral
health care in Ohio.

    Services or Programs Having the Highest Priority for the Evaluation of
    Effectiveness and/or Efficiency

C - Priority has been given to the following programs/populations served by
LifeLines' core provider agencies:

A.  The eight clusters/populations among adults with severe and persistent
mental illness that have been identified by Valley Counseling Services through
its participation in the Ohio Cluster-Based Service Package/UM Demonstration
Project:

1     Adults with chronic physical health conditions and psychiatric
disabilities
2A    Adults with serious substance abuse, mental health and community living
problems
2B    Adults with severe substance abuse problems and less severe mental health
problems
3A    Adults who are severely disabled in many areas
3B    Younger adults who are severely disabled but are not convinced of the
usefulness of treatment
4A    Adults who struggle with anxiety and depression and who avoid growth
opportunities
4B    Adults who struggle with anxiety and tend to focus on their physical
health conditions
5     Adults who function well in their communities

B.  Specialized substance abuse treatment programs at Community Solutions
Association:

1       Primary care
2       Dual diagnosis
3       Drug court
4       Women's services
5       Psycho-educational services for adolescents and adults
6       Adolescent treatment program

C.  Evidence-based mental health treatment programs at Burdman Group:

1   Intensive community treatment team (ACT)
2   Employment and job retention (supported employment)

D.  Specialized crisis services at Coleman Behavioral Health:

1   Hospital diversion
2   Intensive case management

Each of these programs/clusters is undergoing an evaluability assessment
conducted collaboratively with provider and board staff. Programs that are
sufficiently well developed are gathering and submitting data and/or outcome
assessments. Programs lacking key elements (target populations, treatment
objectives, measurement strategies, program logic, etc.) are being asked to
develop evaluability capacities.

    Using the Results from the Evaluation of Programs/Services

D - As outlined in item VI.A, above, monitoring and evaluation data, reports,
and results have been used to enlighten a variety of planning tasks. These
include:

 1  identification of unmet program needs
Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
2  identification   of areas where improved coordination between programs is
needed
3  identification   of effective services
4  identification   of outliers in programs and clusters
5  identification   (with providers) of possible targets for budget reductions
6  identification   of unmet information needs (from providers)
 

Category 1 refers to population needs and not to unmet needs of individuals. We
have found pockets of unmet population needs among several
diagnostic/demographic groups, including young women with borderline personality
disorders and young adults with schizophrenia and co-occurring substance
disorders. Our SAMI programs fit what the SAMI CCOE calls the DDCAT model more
than the DDIT model and have been more effective with persons who fit the CAMI
(chemically abusive and mentally ill) profile than the MICA (mentally ill,
chemically abusive) profile.

A primary focus of our Continuous Quality Improvement structures and processes,
Category 2 issues concern the need for programs to work better together, on
referrals, step-ups, step-downs, collaborative care, etc. This has been
challenging in some cases, e.g., coordinating care provided by Medicaid-only
providers with inpatient, assertive community treatment, and other services
provided by others.

Category 3 uses changes in outcomes to document effective treatment. For
example, our ACT program has dramatically reduced inpatient episodes and days of
inpatient care for the persons its serves. Similar results have been achieved by
the Wraparound program for multi-need children and adolescents.

Even programs that achieve good, positive outcomes produce outliers—cases that
fall outside the "normal" range on some indicator (e.g., cost, length of stay,
re-admissions, etc.). Analysis of outliers, Category 4, is a major task for our
CQI system.

FY2009 will long be remembered as the fiscal year in which the budget ax fell as
never before on community behavioral health care in Ohio. Measures of
effectiveness and cost-effectiveness have potential utility as Board and staff
wrestle with the task of reducing the budgets of our core providers.

  Strategies to Evaluate Child & Adolescent Services Versus Adult Services

E - The board relies on the same general strategies to evaluate Child &
Adolescent services but involves children and families on more cross-system
committees. The children’s system of care includes the Alliance for Substance
Abuse Prevention, The Transition Aged Youth Committee and the Family and
Children First Council.

The Alliance for Substance Abuse Prevention (ASAP) includes a youth coalition
that meets separately from the full coalition. The youth coalition is often
called on to discuss trends in their schools/communities, evaluate the expected
impact of coalition activities on youth, and to develop substance abuse
prevention activities and messages.

Youth are also members of  Trumbull County’s Transition Aged Youth Committee.
Youth attend the meeting bi-monthly and provide valuable input on the unique
needs of that population and how our community is, or is not, meeting those
needs.

The effectiveness of our community in meeting consumer needs is also a strong
focus of The Family and Children First Council. Parent representatives are
present at nearly all Family and Children First Council meetings. The Council
has also facilitated a community needs assessment questionnaire and focus groups
that evaluate whether the current services in our system of care are adequate.




Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                              5/7/2009 9:22:42 AM
Section VII: Ohio Department of Alcohol and Drug Addiction Services Waivers


A. Waiver Request for Inpatient Hospital Rehabilitation Services
Funds disbursed by or through ODADAS 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.

Complete this form providing a brief explanation of services to be provided and a
justification for this requested waiver. Medicaid-eligible recipients receiving
services from hospital-based programs are exempt from this waiver.

         Agency            UPID    Allocation                 Services




  Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                                5/7/2009 9:22:42 AM
B. Request for Generic Services
Generic 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
ODADAS 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.

         Agency            UPID   Allocation                  Services




  Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created
                                5/7/2009 9:22:42 AM
    Prevention        a. Provider Name    b. Program Name       c. Population        d.       e. Evidence-Based   f. Number        g.     h. Funding Source   i. MACSIS
Strategy and Level                           (Provider              Served      Prevention      Practice (EBP)     of Sites     Located                          UPI
      of Care                                Specific)                             Level                                        outside
                                                                                                                               of board
                                                                                                                                  area
                                                                                (Universal,   (List the EBP                   (Check      ODADAS   Medicaid
                                                                                Selected or   name)                           the box              Only
                                                                                Indicated)                                    if yes)
Prevention
Information          Community           Trumbull 211         Entire county     Universal                         1           No          No       No         10503
Dissemination        Solutions
Alternatives         Alliance for        Youth Board          County            Universal                         2           No          No       No         0
                     Substance Abuse
                     Prevention (ASAP)
Education            Community           School based         County            Universal                         4           No          No       No         10503
                     Solutions
                     Association
Community-Based      Alliance for        ASAP                 County            Universal                         1           No          No       No         0
Process              Substance Abuse
                     Prevention (ASAP)
Environmental        Alliance for        Parents Who Host     County            Universal                         1           No          No       No         0
                     Substance Abuse     Lose The Most
                     Prevention (ASAP)
Problem              Community           Youth Intervention   County            Indicated                         1           No          No       No         10503
Identification and   Solutions           Program
Referral             Association
Pre-Treatment
(Level 0.5)
Pre-Treatment
Outpatient (Level
1)
Outpatient           Community           Drug Court           Adults with SA                                      1           No          No       No         10503
                     Solutions                                diagnosis
                     Community           Primary Care         Adults with AoD                                     1           No          No       No         10503
                     Solutions                                dependency
Intensive            Neil Kennedy        IOP                  County                                              1           No          No       Yes        1365
Outpatient           Recovery Clinic
Day Treatment
Community
Residential (Level
2)
Non-Medical          Meridian Services   NMD                  County                                              1           Yes         Yes      Yes        1366
Medical
Subacute (Level 3)


                               Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created 5/7/2009 9:22:42 AM
    Prevention        a. Provider Name    b. Program Name     c. Population          d.       e. Evidence-Based   f. Number        g.     h. Funding Source   i. MACSIS
Strategy and Level                           (Provider            Served        Prevention      Practice (EBP)     of Sites     Located                          UPI
      of Care                                Specific)                             Level                                        outside
                                                                                                                               of board
                                                                                                                                  area
                                                                                (Universal,   (List the EBP                   (Check      ODADAS   Medicaid
                                                                                Selected or   name)                           the box              Only
                                                                                Indicated)                                    if yes)
Ambulatory
Detoxification
23 Hour
Observation Bed
Sub-Acute            Meridian Services   SAD                County                                                1           Yes         Yes      Yes        1366
Detoxification
Acute Hospital
Detoxification
(Level 4)
Acute
Detoxification




                               Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created 5/7/2009 9:22:42 AM
  Promising, Best, or        Provider Name          MACSIS   Number of   Program Name   Funding Source (Check all that apply as         Est.        Est.
Evidence-Based Practice                               UPI      Sites                          funding source for practice)             Number      Number
                                                                                                                                     Served in    Planned
                                                                                                                                       SFY 09      for in
                                                                                                                                                   SFY 10
                                                                                        Medicaid   GRF (Not   Levy (Not   Other
                                                                                        + Match    as         as          (Not as
                                                                                                   Medicaid   Medicaid    Medicaid
                                                                                                   Match)     Match)      Match)
Integrated Dual            Community            10503        1                          Yes        Yes        Yes         Yes        200         200
Diagnosis Treatment        Solutions
(IDDT)
Assertive Community        Burdman Group        10088        1                          Yes        Yes        Yes         Yes        100         100
Treatment (ACT)            TICTT
Intensive Home-based
Treatment (IHBT)
Multi-Systemic Therapy
(MST)
Functional Family
Therapy (FFT)
Supported Employment       Burdman Group Pine   10088        1                          No         Yes        Yes         Yes        60          60
Supported Housing          Burdman Group        10088        1                          No         Yes        Yes         Yes        20          20
                           Riverbend
Wellness Management &      Help Hotline Mah     0            2                          No         No         Yes         No         24          24
Recovery (WMR)             Tru Recovery
Crisis Intervention        Trumbull LifeLines   0            1                          No         No         No          Yes        36          36
Training (CIT)
Therapeutic Foster Care    Homes For Kids       11022        1                          Yes        No         No          No         60          60
Therapeutic Pre-School
Transition Age Services    Valley Counseling    10120        1                          Yes        Yes        Yes         Yes        60          60
Integrated
Physical/Mental Health
Services
Older Adult Services       Trumbull Advocacy    0            1                          Yes        Yes        Yes         Yes        24          36
                           & Protection
                           Network
Sexual Offender Services   Homes For Kids       11022        1                          Yes        No         No          No         60          60
Consumer Operated
Service
Clubhouse
Peer Support Services
MI/MR Specialized
Services
Consumer/Family Psycho-    NAMI Trumbull        0            1                          No         No         Yes         Yes        20          20
Education                  County

                              Community Plan · Trumbull Lifelines ADAMHS Board for Trumbull County · Created 5/7/2009 9:22:42 AM

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:96
posted:11/9/2011
language:English
pages:40