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Treatment of Mental Illness and Recovery Support Services
Carroll County Local Management Board (CCLMB) has been a part of local government since 1997 and is located within Carroll County Department of Citizen Services. CCLMB functions include: community needs assessment, strategic planning, interagency collaboration, grant development and management, contract management and monitoring and program evaluation. CCLMB is part of a statewide system to promote the well-being of Maryland’s children. CCLMB is central to the provision of consistently high quality evidence-based programs.
CCLMB contracted with Carroll County Youth Service Bureau, Inc. (CCYSB) as the Brief Strategic Family Therapy implementing agency. CCYSB is licensed as an outpatient mental health clinic by the Department of Health and Mental Hygiene and is certified by the Department of Juvenile Services in Maryland. CCYSB has provided a wide array of outpatient behavioral health services for children, youth and families since 1972.
Brief Strategic Family Therapy (BSFT) is a short-term (8-24 sessions) family-based therapeutic intervention model that targets children and adolescents aged six to 18 years. BSFT was designed to eliminate or reduce drug use and behavior problems by restructuring problematic family interactions. Pre post tests using the McMaster Model of Family Functioning (MMFF) Family Assessment Device (FAD) were administered to families and children. Forty-six matched pairs demonstrate that Problem Solving, Communication, Affective Responsiveness, and Behavior Control all show statistically positive changes from pre to post assessment. Most importantly, the General Functioning scale obtained a statistically significant change at the 0.01 level. This scale is the strongest overall indicator of family health.
LifeSpring Inc. is a community mental health center providing services in six southern Indiana counties. LifeSpring offers a full continuum of behavioral health and substance abuse care, including many evidence based curriculums.
The Assertive Community Treatment (ACT) Team is designed to support and address the needs of the seriously mentally ill by minimizing and eliminating the need for hospitalization through the provision of wraparound services to assist clients in learning skills for functioning in the community. Through placement of appropriate clients into the ACT program, there has been a significant reduction in hospitalizations and residential placements. Additionally, clients report increased employability and decreased substance abuse.
People Encouraging People, Inc.
People Encouraging People, Inc. (PEP) is a not-for-profit (501(c)3) corporation providing comprehensive and integrated behavioral health services throughout Maryland. For the past thirty years, PEP has been providing a full continuum of community support services and affordable housing to individuals with psychiatric disabilities and those experiencing other disabilities or disadvantages. PEP provides over $11 million in affordable housing choices as well as over $750,000 a year in flexible housing support funds. PEP has over 300 consumers in these affordable housing options across Maryland and serves 1600 consumers annually.
People Encouraging People, Inc. has developed five Assertive Community Treatment (ACT) Teams throughout Maryland serving approximately 500 consumers with significant barriers at any given time. The program has also grown an assertive homeless services outreach program in Baltimore City. The program is the Center of Excellence in Maryland for Assertive Community Treatment and the Training Resource Program for organizations who are developing ACT Teams.
Since October of 2005, PEP has transitioned 143 consumers from the State Hospital System who were unable to be placed in the community due to their complex needs. Half of these consumers are involved in the criminal justice system. The ACT Teams have been able to collaborate with these consumers in their recovery resulting in over 70% of consumers living in the community and staying out of the hospital. All five teams are scored by the Maryland Mental Hygiene Administration annually using the Dartmouth Assertive Community Treatment Scale to assess fidelity to this Evidenced Based Practice. Intensive two day site visits utilizing program data, interviews with consumers and staff, and chart reviews produce certification that all five teams have been scored as high fidelity ACT Teams.
The Family Center at Kennedy Krieger Institute
For 25 years, The Family Center at Kennedy Krieger Institute has provided quality, culturally relevant comprehensive clinical programs and community-based services for children and families that have experienced, or are at risk for, neglect, abuse and violence exposure. In 2003, The Center’s outpatient mental health program, which is located in an urban community in Baltimore, Maryland, began adopting several evidenced based trauma treatments, including Trauma Focused Cognitive Behavioral Therapy (TF-CBT). From the outset, a decision was made to utilize an implementation model that employed strategies that are known to increase the likelihood of successful integration and sustainability of new interventions at the organizational level. These included attending to needed shifts in agency culture; administrative support; adequate resource allocation; ongoing training, supervision and consultation; and consumer/community engagement. Currently, two-thirds of the therapy staff uses TF-CBT with their clients.
Forty children that received TF-CBT during a one-year period with baseline and 6-month evaluations established the following: 1) parents’ rating of their child’s depressive symptoms demonstrated statistically and clinically significant improvement; 2) there was a trend towards children’s self-report of depressive symptoms being improved; and 3) children’s self-report of post traumatic stress symptoms demonstrated statistically significant improvement.
In 2008, The Family Center began providing TF-CBT training and consultation to administrators and mental health providers in Baltimore City and the surrounding area. More recently, we have partnered in a state wide initiative to expand the model across Maryland. Strategic efforts aimed at spread and sustainability of TF-CBT as well as other evidenced based treatments are ongoing.
Thresholds Psychiatric Rehabilitation Services
Thresholds is a large, urban, psychosocial rehabilitation and recovery agency in the Chicagoland area offering a wide array of evidence-based services, including supported employment (SE), integrated dual disorders treatment, assertive community treatment, and illness management and recovery. Thresholds provides services to over 7,000 individuals with severe mental illness each year, over 3,500 of whom receive comprehensive long-term services. Service delivery modalities include outreach, intensive outpatient programs, and residential services.
SE was formally adopted by the agency in 2004 with seven employment specialists located at three pilot sites. Since that time, the program has grown substantially to include 22 employment specialists and five SE supervisors. The average fidelity score for all SE teams at the agency, using the 2008 revised fidelity scale, is currently 100 (good fidelity).
Thresholds is involved in a variety of SE research projects, including the Mental Health Treatment Study sponsored by the Social Security Administration. Based on agency intake statistics, an estimated 96% of individuals are unemployed at entry to Thresholds, roughly 50% have no work history, and 5% come to the agency homeless. Of the roughly 3,500 individuals served by the agency last year, 914 received supported employment services. Competitive employment rates for the agency’s SE teams ranged from 18 to 63%, with a total of 283 consumers working at 366 competitive jobs at over 120 businesses in the Chicagoland area. Feedback received from consumers of services illustrates the success of the SE program. As one consumer noted, “Working has given me a sense of responsibility. I am proud of my work and it makes me feel good about myself.”
Substance Abuse & Mental Health Services Administration • 1 Choke Cherry Road • Rockville, MD 20857