OH Discretionary Funding Fiscal Year 2018

The Warriors Supporting Wellness (WSW) project provides Mental Health First Aid (MHFA) trainings to individuals who interact with first responders, active military, veterans, and their families in a 10-county region located in the Mid-to-Southwestern portion of Ohio. Trainings will focus on the Youth, Public Safety, EMS/Fire, and Military/Veterans modules of the curriculum, training 300 people per year and 900 throughout the lifetime of the project. With Wright Patterson Air Force Base (WPAFB) located within the catchment area, this geographic region experiences higher than average rates of behavioral health issues, including higher rates of mental illness, major depressive episodes, unintentional drug overdoses, and suicides when compared to the state of Ohio’s rates. These data are attributed to the repeated exposure of stress experienced by community warriors, defined as first responders – law enforcement, Emergency Medical Services (EMS), dispatchers, and fire department personnel – as well as active military men and women, veterans, and their families. This recurring stress often leads to vicarious trauma, Post Traumatic Stress Disorder, other forms of anxiety and depression, co-occurring substance abuse, compassion fatigue, and burnout. WSW will implement a minimum of 12 MHFA trainings per year. The training model integrates multiple trainings to achieve a comprehensive plan for mental health awareness, including the Public Safety, EMS/Fire, and Veterans/Military modules of MHFA, Crisis Intervention Team (CIT) trainings, and Trauma Informed Policing. The Youth MHFA curriculum will target schools immediately contiguous to WPAFB. Individuals chosen to become MHFA instructors will be individuals who can speak to the unique experiences of this population, the traumas they have witnessed or experienced, and the challenges experienced by their families. Trainees will learn to identify the signs and symptoms of mental illnesses, and how to de-escalate incidences, access community resources, and address mental health crises. The project’s goals are to have a sufficient amount of certified Mental Health First Aiders in the catchment area who: 1) experience an increase in mental health literacy; 2) report an increased capacity to respond to community warriors’ mental health issues; 3) experience an increased awareness of mental health issues and mental wellness; 4) provide referrals and links to community based mental health services to community warriors; and 5) build collaborative partnerships between relevant community agencies and programs that are engaged with warriors. Measurable objectives include: 90% improvement in the knowledge of sign, symptoms, and risk factors of mental illnesses and substance use disorders; 90% increase in help-seeking behaviors; 75% improvements in their own mental wellness; 90% improvement in the knowledge of professional and self-help mental health resources; 80% improvement in the level of confidence in providing help to individuals experiencing mental health problems; and 80% reduction in perceived stigma towards mental health disorders.

Step-Based Care for Individuals at Clinical High Risk for Psychosis

The proposed project (Step-Based Care for Individuals at Clinical High Risk for Psychosis) will provide specialized clinical care to individuals in Franklin County, Ohio, who are showing the early warning signs of potential psychotic disorders. This care will be provided at The Ohio State University Early Psychosis Intervention Center (EPICENTER) and will include options for psychotherapy, medication, peer support, family services, and vocation/educational support. As part of the step-based care design, individuals presenting to the clinic will initially be provided with low intensity interventions and will continue to more intensive treatments until they meet predetermined criteria for symptomatic remission and functional stability. This specialized care will be provided to individuals living in Franklin County between the ages 12-25 who meet clinical high risk (CHR) criteria for psychosis as determined using the Structured Interview for Psychosis Risk States. During the course of this project, we anticipate enrolling 9 individuals in Year 1, and 18 individuals in Years 2-4, respectively, for a total enrollment of 60 unduplicated individuals over the course of the study. Based on the demographic profile of the population of Franklin County, we anticipate that the racial breakdown of individuals served at this clinical will be 63% White, 25% Black, 6% multiracial, 4% Asian, and 2% identifying as a racial group not specified in the US Census. With regard to ethnicity, we anticipate that approximately 5% will identify as Hispanic. In total, the proposed project will address three goals: (I) minimize the number of individuals meeting CHR criteria for psychosis who go on to develop a psychotic disorder; (ii) reduce the symptomatic distress--including anxiety and depression--experienced by individuals meeting CHR criteria; and (iii) promote improved functional outcomes with regard to work, school, and social relationships among individuals meeting CHR criteria.

The need for CIT training in Montgomery County (OH) continues to grow. For this Dayton Police Department Mental Health Awareness Training (DPD-MHAT) project, CIT training will be expanded to train more of the 367 employees on the DPD force as well as other community members, such as Dayton Public Library staff, Regional Transit Authority (RTA) bus drivers, Veterans Administration (VA) hospital staff, the downtown Dayton business community, Dayton city workers, and hospital Emergency Department (ED) staff, who have daily contact with individuals who may be experiencing or exhibiting symptoms of severe mental illness (SMI) and/or serious emotional disturbance (SED), the population of focus. Dayton and Montgomery County struggle with a number of challenges faced by poor, urban populations, including large numbers of untreated individuals with SMI and/or SED. Peer Support training is also needed for officers to help them identify when fellow officers need help and be able to offer access to resources and assistance, and Community Support services are needed by citizens exposed to traumatic events in the community. DPD-MHAT project goals include: obtain Peer Support train-the-trainer training for DPD-MHAT project staff; increase the capacity of DPD officers, police officers in other jurisdictions, Dayton Public Library staff, RTA bus drivers, VA hospital staff, hospital ED staff, and city workers to respond confidently, compassionately, and professionally in crisis situations created by persons with SMI and/or SED; increase the capacity of DPD officers to provide peer support for fellow officers and to provide community support to individuals who have been exposed to traumatic events in their community; and sustain the collaborative working relationship among the members of the DPD-MHAT CIT Advisory Board. Law enforcement officers will receive forty hours of training in an intensive five-day course. Personnel who frequently interact with citizens with SMI and SED, such as librarians, bus drivers, and hospital staff, will receive a shorter CIT curriculum that presents information on recognizing the signs and symptoms of mental illness, identifying resources available in the community for individuals with a mental illness, and safely de-escalating a crisis situation involving an individual with a mental illness. Advanced CIT training courses, lasting 1 – 4 hours, on special topics will also be scheduled regularly for police officers. Evidence-based Peer Support training will also be provided to DPD officers. GPRA-required reporting measures will be collected, including: a) the total number of people trained in CIT; b) the number of DPD officers, Public Library staff, RTA staff, VA staff the downtown Dayton business community, Greene County Career Center, Dayton city workers, Dayton city works, and non-DPD police officers who have been trained in CIT; c) the total number individuals who have received Peer Support training, d) the number of DPD officers and community stakeholders who have received Peer Support training; and e) the number of individuals referred for mental health or related services.

The Cleveland Department of Public Health (CDPH), in partnership with FrontLine Service, proposes to reduce family homelessness in Cuyahoga County and Cleveland, Ohio, by providing comprehensive, trauma-informed, evidence-based treatment and supportive services to families that are homeless and the head of household has a severe mental illness (SMI), substance use disorder (SUD), or co-occurring disorder. Utilizing the evidence-based practices of Permanent Supportive Housing, Motivational Interviewing, Trauma-Informed Care, Trauma-Adapted Family Connections, and Supported Employment, this program will serve 165 families during the three year grant term. Evidence strongly suggests that if families that are homeless receive wrap-around services designed to address their mental health, substance use, employment, and daily needs, these families have a decreased risk of returning to homelessness. This compelled CDPH to propose a collaborative program with FrontLine to provide housing services, case management, assertive outreach, access to mainstream benefits, and linkage to ongoing services for families who have not been able to become self-sufficient through Rapid Re-Housing or Transition In Place models, and are in need of Permanent Supportive Housing to end their housing insecurity. The CDPH will work with FrontLine personnel to develop protocols for service provision, protection of the privacy of participants' personal information, and training of direct service staff. Families in this program will largely be African-American, headed by a female between the ages of 25-34 who is diagnosed with SMI or SUD, living in poverty, have at least one dependent child, and have been engaged in the Progressive Engagement homeless program. Participants in this program will receive mental health and substance use treatment, supported employment, peer recovery services, linkage to mainstream benefits, and ongoing community resources, as needed.

The Cleveland State University Building Partners for Suicide Prevention project will build on campus and community partnerships to strengthen suicide prevention infrastructure. The project will expand gatekeeper training, promote awareness to decrease stigmatization of mental health concerns, engage student leaders, improve communication between providers, and provide follow up care for high risk students. The project focuses on suicide prevention for CSU students and will attend especially to outreach and prevention with two higher-risk groups: LGBTQ+ students and veteran students. In expanding and strengthening the infrastructure, the CSU Building Partners for Suicide Prevention project will meet the following goals: Goal 1: Increase capacity to deliver campus wide trainings that will increase the ability for students/campus members to take appropriate action when there is a mental health crisis. Objective: Train 3700 students and staff. Goal 2: Decrease stigma and encourage help-seeking behaviors and screenings. Objective: Reach 2900 students and staff with de-stigmatizing campaign and screenings. Goal 3: Increase the capacity of the Counseling Center to provide clinical case management and post-hospitalization follow-up care. Objective: Provide direct service for 200 high risk students. Goal 4: Create and maintain system for tracking student suicidal behavior, identifying trends, and measuring the success of suicide prevention efforts.

This project would take place in Cuyahoga County in northeast Ohio, in the first and second police districts of the City of Cleveland. The purpose of the project is to expand staffing and Peer Supporter services at the Crisis Stabilization Unit to create a diversion point for law enforcement when encountering persons with Serious Mental Illness/Co-Occurring Disorders who are in crisis. With a population of nearly 1.4 million, it's estimated that each year, as many as 52,000 persons in the county are challenged by an episode Serious Mental Illness (SMI). The county's population is 64% Caucasian, and 31% African American; 6% identify as Latino. Outside of a transport to the psychiatric ER for crises posing immediate danger, law enforcement lacks a consistent diversion point for a warm handoff to behavioral health providers who can provide a secure environment that is less restrictive than a hospital. An individual's behavior in the community then escalates over hours or days, leading to arrest and jail. This proposal is submitted by the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County (ADAMHSCC), in partnership with the Cleveland Division of Police and a provider of crisis behavioral health services, Frontline Service. The ADAMHSCC will contract with Case Western Reserve University for evaluation services. The ADAMHSCC and its partners propose adding the capacity for 2 dedicated diversion beds, after hours assessment, prescriber availability after hours, and rapid stabilization at the CSU. Before discharge, clients with SMI will be linked to a certified Peer Supporter for ongoing support in the community and navigation of the treatment system. Each year 50 persons would receive these services, or 250 people over the life of the project.

Summary: The Cuyahoga County Assisted Outpatient Treatment pilot project is designed to reduce the incidence and duration of inpatient psychiatric hospitalization, homelessness, and interactions with the criminal justice system among persons with Severe Mental Illness (SMI); and to improve the health and social outcomes of persons with SMI. Project Name: Cuyahoga County, Ohio Assisted Outpatient Treatment Pilot Project. Population to be Served: Persons with SMI who are civilly committed to the public mental health system are the population of focus they are individuals who are considered to be a danger to self or others, and will have been sent to the hospital for treatment. These are clients who have severe symptoms and impairments that are not effectively remedied by available treatment, or who resist or avoid involvement with behavioral health treatment. Most are indigent and eligible for Medicaid; approximately half are women, and approximately half are African American. The Board and its partners will endeavor to serve I 00 persons each year, or 400 throughout the life of the project. Goals: 1) Create awareness among jurists, hospitals, treatment agencies and the community of the availability of AOT and the requirements of Ohio law. 2) Build the infrastructure to monitor the progress of all clients in the AOT pilot program and facilitate communication among the Board, hospitals, clients, families, and the Court. 3) Expand treatment services to ensure a comprehensive, evidence-based continuum of treatment, wraparound recovery supports, monitoring and reporting to provide persons with SMI with the greatest opportunity to remain in the least restrictive setting.

The Holistic Health Integration Project - Clermont County (HHIP-CC) is a collaboration between Greater Cincinnati Behavioral Health Services (GCB), a community-based behavioral health agency, and The HealthCare Connection (THCC), a Federally Qualified Health Center. GCB and THCC have worked together for almost a decade to provide integrated care to the region's most vulnerable and underserved populations. The HHIP-CC will expand co-located, integrated primary and behavioral health for adults with serious mental illness (SMI) to Clermont County, OH a rural, Appalachian county with no integrated services. Persons living in Appalachian counties are more likely to live in poverty, be uninsured, have unmet health needs, experience poor quality care, and have worse health outcomes. The HHIP-CC will transform the county's healthcare environment by establishing a fully integrated practice that: 1) increases access to primary care, 2) enhances quality of integrated services 3) improves health outcomes for adults with serious mental illness and 4) develops a sustainable business model for fully integrated care.

Clermont County Assertive Community Treatment Project (CC-ACT) The Clermont County Assertive Community Treatment Project (CC-ACT) is a collaboration between Greater Cincinnati Behavioral Health Services (GCB), a comprehensive behavioral health agency, and community partners in Clermont County, OH (CC-OH). The Ohio Department of Mental Health & Addiction Services and the Department of Medicaid identified ACT as a critical practice for adults with serious mental illness (SMI) and encouraged state-wide adoption. ACT is currently not available in CC-OH, an Appalachian county located east of Cincinnati, despite extensive need. GCB is the only behavioral health provider for adults with SMI in CC-OH. 11% of GCB’s existing care management clients would be ACT-eligible if services were available. 2017 GCB data show these clients have greater psychiatric risk and service need: 21% are at risk for suicide, 9% are at risk for violence, 22% had 2+ inpatient psychiatric hospital admissions, and 14% were incarcerated. GCB has delivered ACT in adjacent Hamilton County since 2000 and operates 6 ACT teams. It has the experience and capacity to replicate the program in CC-OH and integrate these services into the county’s behavioral health system. GCB knows start-up funding is critical to establishing, implementing, and monitoring new teams. Therefore, GCB seeks funding to establish and maintain an ACT team at its CC-OH site to expand access to this service level and improve outcomes. CC-ACT will serve 100 persons over the 5-year grant. Enrollment will occur during the first two years – 40 enrolled in year 1 and 60 in year 2. Years 3-5 will focus on service provision to all 100 clients. CC-ACT will: Goal 1: Increase access to ACT in CC-OH to improve outcomes for persons with SMI. Grant objectives under this goal focus on the installation drivers that support successful adoption, including establish an Advisory Group, prepare space for implementation, hire/train staff, finalize protocols, provide ACT education, and identify clients. Goal 2: Sustain ACT in CC-OH to maintain a comprehensive behavioral health system for persons with SMI. Sustainability objectives include annual external fidelity reviews, benefits enrollment for uninsured clients, state certification to bill for ACT, contracts with OH managed care plans, and EHR modifications to support ACT service delivery and billing. Key evidence-based practices include: ACT, Housing First, Motivational Interviewing, Integrated Dual Disorder Treatment, Individual Placement and Support – Supported Employment, and Family Psychoeducation. CC-ACT’s population of focus is 92% White and includes more men (57%) than women. Average age is 43. Most identify as heterosexual (91%). 16% are uninsured. GCB is poised to impact an underserved county and population. It has the experience, capacity, and partnerships to successfully establish and maintain an ACT team in CC-OH that will build a complete continuum of care and provide persons with SMI access to the level of care needed to improve behavioral health outcomes, reduce service utilization, and promote recovery.