OHS 2015-1 County Human Services Plan Guidelines
Appendix A Fiscal Year 2015-2016
COUNTY HUMAN SERVICES PLAN
ASSURANCE OF COMPLIANCE
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A. The County assures that services will be managed and delivered in accordance with the County Human Services Plan submitted herewith, B. The County assures, in compliance with Act 80, that the Pre-Expenditure Plan submitted herewith has been developed based upon the County officials' determination of County need, formulated after an opportunity for public comment in the County. C. The County and/or its providers assures that it will maintain the necessary eligibility records and other records necessary to support the expenditure reports submitted to the Department of Human Services. D. The County hereby expressly, and as a condition precedent to the receipt of state and federal funds, assures that in compliance with Title VI of the Civil Rights Act of 1964; Section 504 of the Federal Rehabilitation Act of 1973; the Age Discrimination Act of 1975; and the Pennsylvania Human Relations Act of 1955, as amended; and 16 PA Code, Chapter 49 (Contract Compliance regulations): 1. The County does not and will not discriminate against any person because of race, color, religious creed, ancestry, origin, age, sex, gender identity, sexual orientation, or handicap in providing services or employment, or in its relationship with other providers; or in providing access to services and employment for handicapped individuals. 2. The County will comply with all regulations promulgated to enforce the statutory provisions against discrimination.
COUNTY COMMISSIONERS/COUNTY EXECUTIVE
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Appendix B County Human Services Plan Template
PART I: COUNTY PLANNING PROCESS
Describe the county planning and leadership team and the process utilized to develop the plan for the expenditure of human services funds. Counties should clearly identify:
1. Washington County is well-positioned for the continued success of the Block Grant Initiative because of its human services infrastructure and organizational design. The directors of the categorical departments (Mental Health/Intellectual Disabilities; Children, Youth and Families; Child Care Information Services; and Aging Services report to the Human Services Department Director. Although the Single County Authority (SCA) for drug and alcohol services in the county operates under the private, Executive Commission model, a very strong working relationship exists between the SCA Director, the Directors of the county-affiliated categorical programs, and the county’s Human Services Director. Additionally, the Housing and Homeless Assistance Program and the Human Services Development Fund are administered directly out of the county’s Human Services Department.
2. Washington County has formed a Block Grant Leadership/Planning Team which consists of the top administrative staff of the program areas included in the Block Grant Initiative and the Department of Human Services. This team is responsible for consolidating the planning process, developing services/strategies in response to identified needs and evaluating outcomes under the Block Grant Initiative. This team will also be responsible for forming a large and diverse stakeholder group, tapping into already existing stakeholder committees from individual systems, to participate in the ongoing needs assessment process. Further, this team will be responsible for ensuring that continued progress is made in enhancing the effectiveness and efficiency of the County’s human services delivery system and the goals of the Block Grant Initiative are achieved.
3. The flexibility that is inherent in the Block Grant will enable Washington County to advance this philosophy even further and provide the opportunity for real and measurable progress towards the goals of system reform, services integration and administrative efficiencies. In the 2014-2015 fiscal year, efficiencies resulted in the ability to: a. Move $50,000 to the Drug and Alcohol Commission so they could continue to serve clients through the year end. b. Move $18,838 to the only family shelter in Washington County to allow uninterrupted service to homeless families. c. Move $20,000 to Domestic Violence Services of Southwestern PA to provide housing and support to women and children who are victims of domestic violence.
4. Many individuals and families throughout Washington County face challenges that they are unable to meet on their own. These people require the assistance and support of the county’s human service system to help them meet their needs, live safely in the
DHS Bulletin 2015-1 County Human Services Plan Guidelines
community, and enhance their quality of life. Washington County’s Human Services Department includes the offices of Behavioral Health and Developmental Services, Child Care Information Services, Children and Youth Services, Housing and Homeless Assistance Program, and the Washington Drug and Alcohol Commission. While many services and supports exist in the county for those who need them, individuals and families who access human services often receive services from multiple systems. In particular, it is quite evident from reviewing last year’s data with regard to consumer profiles and services provided, a significant percentage of the consumers served had multiple issues that needed to be addressed by the Child Welfare, Behavioral Health and Drug & Alcohol systems. Further, it was recognized that overlap and duplication exists in the delivery of needed services by these three (3) systems and there are certain parts of the county where service delivery is impeded due to a lack of transportation.
Another significant impetus for considering areas for improvement in the human services delivery system in the County came from the feedback received from stakeholder groups during the Block Grant planning process. Without question the consistent theme voiced by these stakeholder groups centered around the problems of confidentiality and information sharing, communication and collaboration between systems and a lack of services integration and coordination. Further, the stakeholder groups felt strongly that cross-systems training and perhaps a co-location of services would be ways to address these problems and bridge the gap between systems.
In response to what was learned over the past year, the Department of Human Services is creating a regional office location in a remote, yet highly consumer-concentrated area of the County to improve access to services as well as the efficiency and effectiveness of services to consumers with multiple problems. Initially, this regional office would be staffed by employees of Children and Youth Services, Behavioral Health and Developmental Services and the Washington County Drug and Alcohol Commission who can conduct their assessments and provide other services from this community-based location. In addition, this regional office concept will promote and facilitate inter-agency collaboration and communication, pilot ways to effectively address confidentiality issues and enhance information sharing between systems, and promote services integration and coordination.
After reviewing the outcomes and services provided in FY 14-15 we determined that two programs should be discontinued. That funding will allow us to secure a lease on a remote location to provide much needed services to a consumer –concentrated are of the County. The Adult Services programs under HSDF funding no longer had a need in Washington County based on the outcomes from last year. By moving funding from those providers we were able to free up funds to secure a lease on a remote location to provide much needed services to a consumer–concentrated area of the County.
The systems will work together to address the following items in order to meet the goal of opening a regional office within the next fiscal year: DHS Bulletin 2015-1 County Human Services Plan Guidelines
1. Identify physical location – The area of most need is in Charleroi, PA where we have identified office space for the regional office. We are in the process of securing the facility that will accommodate the needs of each agency and the clients they serve. Renovations and acquiring equipment needed for the staff stationed at this office in order to provide assessments and services will be completed in the first three to six months. Estimated timeframe for completion: 3 – 6 months
2. Designate staff – Identify staff from each department who will be working in the regional office and determine what assessments and services will be provided at this location. Estimated timeframe for completion: 3 – 6 months
3. Cross-train staff – Because each system has unique requirements, intake processes, confidentiality parameters, and regulations which govern services, it will be necessary to cross-train all staff who will be working in the regional office to better serve clients needing assistance. Estimated timeframe for completion: 6 months – Ongoing
4. Enhance communication and collaboration – Explore ways to enhance communication between and among systems, including the use of centralized electronic database. Identify areas for collaboration resulting in more effective service delivery and improved outcomes for clients. Estimated timeframe for completion: 6 months – Ongoing
PART II: PUBLIC HEARING NOTICE
Two (2) public hearings are required for counties participating in the Human Services Block Grant. One (1) public hearing is required for counties not participating in the Human Services Block Grant.
Please provide the following:
1. Proof of publication;
DHS Bulleti n 2015-1 County Human Services Plan Guidelines
Ch;erver-~rter. 122 S. M3.in Street, ~. PA 15301 Pnxlf ct Id 06/17/15
.1\cco..nt.: 7460 Jlci ID: 1493219 ~: Hearing Name: lll.tn Oltes: W19/15 to Company : WA SHI NGTON CO DEPT Class: 5 H UMAN 06/19/15 06/19/1~ Affichvit Q\3rges ircl.u:l:rl in coot. ($7 . 50 for e:ich) : Ohserver-REporter 06/19/15 $7 .50 kl Note: PUBLIC NOTICE The Washington County Department of Human Sen/Ices is solic· lting comments from the community regarding the Human services Block Grant Plan for Fiscal Year 2015·2016. which includes funding for Children and Youth Services, Behavioral He;:ilth and De•elopmental Ser\lces. Drug and Alcohol, Homeless Assist;:ince and Human Services. Public Hearings will be held on Tuesday, June JO, 2015 at 6:00 p.m. and Thursday, July 2, 2015 at Z:OO p.m. In Room 104 of the Courthouse Square Office Building, 100 W. Beau St.. washington, PA 15301. Comments will be accepted in writing by the Department of Human Services, 100 w. Beau St. Suite 703, Washington. PA 15301 on or before July 3, 2015. A copy of the plan will be available for plckuo as well as on the County website as of June 29. 2015 In the Department of Human Services. Interested parties can contact that department at 724.228.6863 or 724.228.6998 for additional Information. 6-19 (7?~J M-2200 DHS Bulleti n 2015-1 County Human Services Plan Guidelines -· Observer-Reporter 122 S. Main Street Washington, PA 15301 Phone:(724) 222-2200 Fax:(n4) 223-2639 Proof of Publication In compliance with the Newspaper Advcn1srng Act of July 9. 1976, P.l. 877. No. 160. :is amended COMMONWEALTH OF PE SYLVANIA, COU TY OF WASI llNGTON SS: Before me. a Notary Public in and for ~:11d County and State. personally appeared David F. Lvle who being duly sworn uccording to law, deposes and says that he is C FO of Ob>cl\c1 Publishing Company. a Pennsylvania corporation, ail that ne11her the alliunt nor the Observer Publishing Company i · tercsted in the subject matter of said nouce or ad,cnising and that all allegations of this a s to the umc, place and character of publication are true. Sworn lo and subscribed before me thisddday of 0/.. fQ~!JW L CCMMQNWEALTH OF PENNSYLVANIA NOTAll•AL S!:Al Eleanor B. Sm.1'. Notary Public ty of Washington. Washington County ~y Comm•ssion E>plres June 2, 2016 117 Ad Number: 1493219 DHS Bulleti n 2015-1 County Human Services Plan Guidelines Ad Number: 1493219 PUBLIC NOTICE The Washington COUnty Department of Human Services is sollc· iting comments from the community regarding the Human services Block Grant Plan for Fiscal Year 201S·2016. which includes funding for Children and Youth Services. Sehavloral Health and Developmental Services, Drug and Alcohol, Homeless Assistance and Human services. Public Hearings will be held on Tuesday, June 30. 201S at 6:00 p.m. and Thursday, July 2. 2015 at 2:00 p.m. In Room 104 of the Courthouse SQuare Office Building, 100 w. Seau St., washlnoton. PA 15301. Comments will be accepted In writing by the Department of Human Services. 100 W. Beau St. Suite 703. washington. PA 15301 on or before July 3, 2015. A copy of the plan will be available for pickup as well as on the County website as of June 29, 201 S In the Department of Human Services. Interested parties can contact that department at 724.228.6863 or 124.228.6998 for additional Information. f>-19 DHS Bulletin 2015-1 County Human Services Plan Guidelines 2. Actual date(s) of public hearing(s); The hearings were held on June 30, 2015 and July 2, 2015 3. A summary and/or sign-in sheet of each public hearing. Human Services Block Grant Public Hearing June 30, 2015 Washington County Human Services (HS) held a Public Hearing regarding its FY 15/16 plan and updates to the status of its transition to being a block grant county. Individuals in attendance: Cheryl Andrews, Washington Co. Drug & Alcohol Commission (WCDAC), Executive Director Jason Bercini, Washington Co. Human Services (HS) Fiscal Manager and moderator of this Hearing Dee Dee Blosnich-Gooden, Washington Co. Children & Youth Services (CY&S) Assistant Director David Day, Washington Communities Human Services Center Jennifer Johnson, Washington Co. HS Homeless Services Kimberly Rogers, Washington Co. CYS, Executive Director Selma Tansey, Washington Communities Human Services Center, Executive Director Gary Stout, Washington Communities Board Member Crystal Smith, Step-By-Step, Habilitation Services Manager Janice M. Taper, Washington Co. Behavioral Health and Developmental Services (BHDS), Administrator Michael Aulagne, Washington Co. BHDS, Administrative Assistant and Recorder for this Hearing Attachment to the minutes: Electronic, A Scanned signature sheet Jason Bercini introduced himself, what Department he represents and gave a welcome. He gave a brief overview of the Block Grant to date and how Washington County stands in its transition in our third year of participation. He also stated that this was the first of two public hearings that Washington County will be having in regards to this year’s Block Grant plan. He then described in more detail how Block Grant funding was used (for example mentioning how some funding was used for Drug and Alcohol program shortfall). He mentioned that they would not have been able to do this had they not been part of the Block Grant. He mentioned how they moved a little over eighteen thousand dollars was used to fund the services in the only family shelter in the county who provides homeless assistance and services to families in the County. They were also able to shift twenty thousand dollars in additional funding to domestic violence services to provide shelter and support to women and children that were victims of domestic violence. In addition to that, he mentioned savings that the Human Services Department had discovered by reviewing services in the County and discontinuing two prior existing services from FY 14/15. Lastly he looked at the needs and outcomes of the programs they do run and that there were DHS Bulletin 2015-1 County Human Services Plan Guidelines two programs discontinued based on needs and they felt that the funding was better utilized elsewhere. He stated that the funding would be used to secure a remote location in Charleroi. He described the search for a new HS remote location in Charleroi and that while the funding was ready no lease had been signed at this point. He mentioned that the funding from the savings of the program cuts would be used to pay for the lease at the remote location for the next year. He added this location would support BHDS, CYS and WCDAC services. Looking forward to Fiscal Year (FY) 15/16, which this plan is for, Jason said that they were planning to: The lease for the new remote location in Charleroi Staffing and training for the new location (with a 6 month timeframe) Increasing the number for people on their Advisory Board Evaluating and reducing costs where possible Expanding services Making entry to the system easier for the consumers Jason then asked that Cheryl, Jan and Kim introduce themselves and opened the floor for questions. Gary Stout, Washington Communities Board member Gary began by describing the trying year that Washington Communities went through in regards to their making a budget; due to lingering effects from the service system switch to fee-for service in FY 13/14. He detailed the staff shifting and difficulties they had in order to make the fee-for-service model work for them. He asked if other Agencies had difficulties in the fee-for service switch. Janice stated that the entire BHDS provider system is fee-for-service, not just Washington Communities. He stated that as being a mandated entity they he understood that CYS was not fee-for-service. Kim responded that while they are mandated that only certain units in her department are mandated departments (response to child abuse investigations, intake, and ongoing departments) while the rest were not. In response to Gary stating that the State cannot take money from CYS, she further stated that the State can take money from CYS. Kim described in more detail the funding terminology for CYS. Gary asked for solutions to their funding gaps due to people who do not pay or what to do when people do not show up for scheduled meetings etc. He asked if it would be possible to get a percentage estimate of those gaps over time and get a stipend from the Block Grant to cover their shortfall. He discussed various methods that they were debating to alleviate these gaps, including over-booking of meetings. He asked how they could get credit for these missing funds. He stated that they need a stipend to cover these gaps and inquired if the Block Grant could do this. Janice addressed the issues Gary brought up. She detailed how the Block Grant was not intended to cover funding gaps that Agencies may experience. She detailed the way the Block Grant works and mentioned that it’s intended more for one time funding of internal HS programs. She described that there are methods for the County BHDS to assist them (unit adjustments etc.) but this was a discussion to have with the BHDS Department and unrelated to the Block Grant. DHS Bulletin 2015-1 County Human Services Plan Guidelines Gary mentioned that he was confused as money from the Block Grant was used to cover WCDAC shortfalls. Jan responded that the funds were for a one time request and not a continued funding stream. This occurred at the end of a FY and they had data to justify their usage. Cheryl described that they are a Block Grant participant and that they help in part to fund the Block Grant. Cheryl also described how the WCDAC system has been fee-for-service for years and the travails that they and their providers have encountered. She described that the Block Grant money was not used to make them “whole” per se, but to enable people to access services that they did not have the money to obtain for themselves. She explained in those situations that internal quality improvement plans (e.g. how do you reduce no-shows, etc.) could be the solution. Finding solutions to these problems by making calls in advance, encouraging people to attend meetings is what her providers did. She also advised that they need to have hard data in order to understand how their system is working and make an argument for the future funding changes. They were advised of the need to have at least a year of data to track to start developing solutions with the County for these internal issues. Gary stated that no matter what the data suggests that if there is still a shortfall in the budget and if that money is needed to make the system go then either they don’t provide services or the County makes them whole. Janice stated that it is then an issue with rates etc., and then there needs to be a conversation, (after the data is there to back up these statements). Cheryl discussed previous funding for D&A programs and how much funding they lost when the Block Grant started. She discussed the way funding works in D&A (The Hub) and how they used to be able to access excess moneys from other Counties. They instituted cost saving measures and that it was a difficult transition for them, but they are now successful. Selma stated that it would be helpful to know how the appearance of the Block Grant Model implementation changes what used to be before (compared to the old system). Janice described again how the Block Grant works. It is the same base money that they used to have access to before, that’s used to fund the providers (like Washington Communities themselves). It is just using the money that is not part of the required services and how it is made from funds left over after existing services are funded. It is not additional State funding. It is what’s left over after the various Departments pay their required and other services. It is underutilized monies and it is taken from the existing programs pooled and redistributed among the HS Agencies. It is used to enhance or develop new programs, it is used on a one time basis; it’s not really to fund continuous and ongoing programs. It is used for mutual efforts among the Departments represented. It is trying to do new things, in more efficient ways, across the board as all these Department tend to serve the same individuals. Other Counties have done a lot of different things and they have done this for more years and may be further along the way in developing new programs etc. It is not being used as a supplemental piece of income for an Agency. Gary asked additional questions: What will the impact be of having a new Governor in office? To which Kim responded that currently there are two pieces of legislation being proposed, one which would expand the Block Grant and one which will remove it. There has been no decision from the Governor either way as yet. DHS Bulletin 2015-1 County Human Services Plan Guidelines The next question was regarding the possibility of making a combined Human Services System as there must be some overlap in the systems that could be combined (consumable expenses). Jan responded that this may be something that happens in the future but that we are far enough along this process to determine that. Gary asked if other Counties have done that and Jan responded that only counties with a distinct human services model can do that and the system would look completely different than hos it is now. Jason, Cheryl and Janice detailed that while there is some overlap, each of the systems in question reported to different State entities and each have vastly differing rules, regulations and licensing concerns. It creates a separation of the departments on the program side. Some overlap exists and that’s what the new location in the valley is an attempt to address, but it takes time and planning to design and implement a project of that size. Janice mentioned again that there is a belief that there is a separate part of money that is a Block Grant. The Block Grant is not additional funding. What the Block Grant tries to do is remove some silos on what the monies can be spent on. Of course all this funding is reportable and accountable to the State. Cheryl and Selma discussed how the Block Grant helped to remove the restrictions on how monies could be spent on services. Gary took a moment to describe actions that Washington Communities has taken and how they have been trying to find solution to their various internal issues (difficulties with staff retention, funding, hours worked and turnover, etc.). Kim described similar issues she had in CYS and how they try to resolve them. Jason asked for any other audience members to speak or present topics for discussion. The lack of public support and participation was discussed. Selma mentioned that the public had a lack of understanding of how good the various services in Washington County actually are. Gary discussed the possibility of using Block Grant funds for some kind of PR campaign, relating it to an experience with a previous employer and how it helped the public utilize their system. Crystal from Step-By-Step asked a question. She described her job title and her Agency and explained that they are attempting to expand into Washington County and asked if Block Grant funding could be used to facilitate this. Janice said that utilizing funds in this manner would be not necessary be an approved use of Block Grant funding. Janice explained that as Step-by-Step was one of the BHDS providers that if they are interested in obtaining help to expand that they would need to contact her office. It is not tied to the Block Grant. Janice went on to describe the complexities of the funding system and how nice it would be to truly remake the current HS system and the benefits it would bring. DHS Bulletin 2015-1 County Human Services Plan Guidelines Jason again asked for questions or comments. No one spoke. The meeting then adjourned at 6:45 p.m., with the HS representatives remaining behind to discuss the proceedings. Human Services Block Grant Public Hearing July 2, 2015 Washington County Human Services (HS) held a Public Hearing regarding the FY 15/16 Plan and a recap of the FY 14/15 Plan. Individuals in Attendance: Jason Bercini, Washington Co. Human Services, Fiscal Manager, and Moderator of this Hearing Cheryl Andrews, Washington Drug and Alcohol Commission, Executive Director Jennifer Johnson, Washington Co. Human Services Homeless Services Kimberly Rogers, Washington Co. Children & Youth Services, Executive Director Janice M. Taper, Washington County Behavioral Health and Developmental Services, Administrator Toni Contstabile, Centerville Clinics, Inc. Brean Fuller, Centerville Clinics Inc., Blended Case Manager Director Ann Gaydos, Centerville Clinics Inc., Mental Health Director Michael Smith, Lifesteps, Vice President, Intellectual and Developmental Disabilities Michael Gathage, Lifesteps, President Lynne Loresch, Mental Health Association, Executive Director Kellie McKevitt, Southwestern PA Human Services (SPHS), Executive Director Andrea Moore, Southwestern PA Human Services (SPHS), Assistant to Executive Director Peggi Fawcett, Transitional Employment Consultants, Executive Director Attachment to the minutes: Electronic, A Scanned Signature Sheet Jason Bercini, Human Services Department, gave a brief welcome and would act as moderator. Over the past year, the following funds were able to be moved due to the Block Grant: Funds moved to Drug and Alcohol to fill a gap due to funding needs lost due to Washington County becoming a Block Grant County. This was to supplement their revenue in order for them to be able to provide services for the entire year. Human Services was able to redirect a little more than $18,000 to a Washington County Family Shelter, the only one in the County, so that they could continue to provide housing services to families in the County. $20,000 of funding was shifted to Domestic Violence Services of Southwestern PA so that once again they could provide housing and support services to victims of domestic violence within our County. We also reviewed programs that were not being utilized within the County and eliminated two programs as they were shown not to be beneficial and/or not shown to have a need for these DHS Bulletin 2015-1 County Human Services Plan Guidelines programs in our County. The funding that these two programs were unable to use were transferred to support the two programs listed above. In the coming year these two programs will not be funded as there is no need within the County. With these funds, we will secure a remote site in Charleroi for use by Drug and Alcohol, Children and Youth Services, and Behavioral Health and Developmental Services to provide their services in this area of the County. Then people who live there do not have to travel to Washington for their services. Within the next six months, we will execute a lease on the property, remodel and furnish this location, and open this site for services. We also plan to increase our Advisory Board numbers over the next year. Lastly, we will continue to search for ways to reduce our costs and expenses while improving the ease of entry for individuals into our system. Introductions by the following were made: Cheryl Andrews, Washington Drug and Alcohol Jan Taper, Washington County Behavioral Health and Developmental Services Kim Rogers, Washington County Children and Youth Services Mr. Bercini then asked for comments or questions from those in attendance. Lynne Loresch, MHA asked what two programs had been eliminated. A Homemaker Program offered through SPHS has had no interest over the past three to four years and a counseling service within the County have both been eliminated. Funds for the counseling service were not applied for last year and they were able to self-fund this program. It was felt that the funds would be better utilized through the other three programs. Lynne Loresch, MHA, asked Cheryl Andrews, D&A, if the lost funds mentioned were out of the pool. Yes, the funds were lost two years ago. At that time, $150,000 was needed to supplement the shortfall; however, this past year only $50,000 in funding was needed to supplement the loss. Cost saving measures were put in place, especially this year with the move to true Medicaid Expansion and eliminating Healthy PA. This has enabled clients who were not eligible under Health PA to become eligible for residential rehabilitation; therefore, gap funding is needed less as more individuals are made active through HealthChoices. Another cost saving measure is through Expedited Enrollment for people that begin treatment but are not yet active in HealthChoices. We were able to submit these individuals for review to determine if their benefits could be retroactively placed back to the time of their entry into rehab. By doing this, we were able to recover $123,000. This amount helped to “back fill” what had been put out for these individuals. This provided a huge cost savings for Drug and Alcohol. Lynne Loresch, MHA commented that at previous Stakeholders’ meetings, she had inquired about the difficulty providers were having with the PCOs, regarding Drug and Alcohol services specifically, and she was wondering if there has been improvement. As of September, the PCOs will be phased out and all members will be entered into HealthChoices; DHS Bulletin 2015-1 County Human Services Plan Guidelines Healthy PA will be gone. Some individuals have not been switched yet, but they are being supported during this transition. Lynne Loresch clarified that she was questioning actual payments from the PCOs for Drug and Alcohol services. Drug and Alcohol has been working to try to assist providers in receiving their payments. Further discussion regarding the above: Is this issue concentrated to Drug and Alcohol services with fewer in Mental Health? Mental Health providers are experiencing the same difficulties. Some Drug and Alcohol individuals were incorrectly placed with PCOs. Drug and Alcohol reviewed each individual in order to remedy this situation. November of 2014 through February 2015 was a very hectic time for Drug and Alcohol. They are very thankful for the switch to Medicaid Expansion. Cheryl Andrews also mentioned that under the old Medicaid Program individuals had a limitation of nine months of Drug and Alcohol services throughout their lifetime. This has been eliminated under the current Medicaid Program; it may return someday, but for now, this has been removed. Michael Smith, Lifesteps commented that in reviewing the Plan, he noticed some information regarding the forthcoming final decision from the State regarding sheltered workshops. Lifesteps operates an Adult Training Facility (ATF), which they are very proud of, here in the County. He asked Jan if she had heard anything about a final decision regarding ATFs and individuals shadowing. Jan stated that with the retirement of Tom Jones, she has heard many things over the past several days, but she did not know of anything definite about the State moving forward on this particular subject other than that there is a move toward employment. Jan stated that should providers receive anything about this they can certain call to be sure she has also been made aware of the same information. She requested the assistance of all ID providers during this transition. Michael Smith, Lifesteps then commented that Lifesteps has an interest in becoming more involved with Life Sharing. Lifesteps has experienced difficulties in cultivating families, potential clients, and employees. This has not been their main focus, but they are very interested in the program and were pleased to see that a group will begin meeting regularly. Washington County is very interested in have more life sharing providers. We did have a few individuals that were interested some time ago and then there was no interest. It has been difficult to have staff ready at the same time families or potential clients have an interest in the program. As a County, we would like to highlight this program. Michael Smith lastly commented: Regarding employment first, he assumes that at some time in the future Lifesteps should become interested in providing supported employment as the transition moves away from the workshops, he would assume that the County would have an interest in their organization doing so. He stated that Lifesteps thanks the County for their support and they look forward to working with them on these programs in the future. Lynne Loresch asked how the search for a replacement for Tom Jones was going. As Human Services falls under Civil Service, the process is slow and when an individual is found, there is the question of will they qualify. It is a tough situation to find the right match. There is also a delay as Tom still had vacation time, so although he is no longer working, he is DHS Bulletin 2015-1 County Human Services Plan Guidelines still being paid for his vacation time further delay the search. There has been some interest, but we must ensure potential candidates qualify under Civil Service. Jan Taper then commented: We are moving forward with the Block Grant process in “baby steps”. We do not know the future of the Block Grant with the new Governor in office. We need additional committees and stakeholders to bring “new life” to let us know what the needs of our individuals are so that we can work on those needs. The opening of a remote site is just a beginning. Lynne Loresch then asked if a separate plan was included in the packet of information provided. Yes, all program areas are included in the information provided. She then asked if there were any priorities for mental health this year. Jan Taper commented that all systems are involved with the pilot, not just one system. Dollars used will benefit all programs; aging, homeless, and the others already mentioned. It is difficult to identify all areas of need or gaps in service when it comes to all of the systems and how we can benefit one another through mutual projects. Cheryl Andrews then commented that something else to keep in mind is that her entire budget is not tied up in the Block Grant. Only a portion previously received the Department of Public Welfare, now the Department of Human Services, went into the Block Grant. Her strategic plan for Drug and Alcohol is not wholly evidenced in the report provided as she is only asked to report on the dollars provided through the Block Grant. Precedents are set on what is required to be tracked and that is what is reported. Lynne Loresch asked if the Mental Health Plan would be a separate meeting. There is no longer a mental health plan. There has not been a mental health or intellectual disabilities plan for several years most likely due to the creation of the Block Grant. Should one be required, information could be pulled from the Plan provided today. The State asks for specific information across all services; efficiency of funds used, etc. The County has been charged to move forward as a group and they are doing so. Mr. Bercini thanked those in attendance and asked for any further questions or comments. There being none, the hearing ended at 2:30 PM. PART III: WAIVER REQUEST (applicable only to Block Grant Counties) If you are requesting a waiver from the 25% minimum expenditure level for any categorical area, please provide justification for the request. The justification must show that specific circumstances in the county create a local need for services that cannot be met without a waiver, and that adequate and appropriate access to other human services will be available in the county. It must also specify the amount of funds and the human services on which those funds will be transferred and expended. A waiver is not being requested at this time. DHS Bulletin 2015-1 County Human Services Plan Guidelines PART IV: HUMAN SERVICES NARRATIVE MENTAL HEALTH SERVICES Washington County Behavioral Health and Developmental Services (BHDS) will continue to offer a range of person-centered treatments and supports to all age groups within the system of care. Treatment services will be provided through traditional Outpatient, Intensive Outpatient, and Partial Hospitalization Programs in multiple sites throughout the County (including school based satellites); and to adults in the community who meet the criteria for the Assertive Community Treatment (ACT) Team. Additionally, the Mobile Medication Program ensures that consumers have the additional assistance they need to learn about their medications and how to take them properly. Treatment is also available to Children, Adolescents, and Transition Age Youth (18-21) through Family Based Services and through Parent-Child Interactional Therapy (PCIT) for children aged 2-7. Crisis and Emergency Services are available to adults via a centralized phone number and are delivered 24 hours a day, seven days a week with mobile, telephone, and walk in, as well as the newly relocated Crisis Stabilization/Diversion Unit which provides a safe, comfortable environment in an accessible location for individuals in need. Children and adolescents who meet the criteria are also able to access an identified Diversion and Stabilization (DAS) Unit. When consumers do need inpatient admissions, our Hospital Liaison is able to ensure that appropriate linkage and coordination occurs. Additionally, through our forensic initiatives, we provide services to mentally ill offenders who are Adults, Older Adults, and Transition Age Youth aged 18 years or older. The Forensic Liaison, as well as the BHDS office designee, coordinates with the County Correctional Facility and State Correctional Facilities to provide services to individuals involved with the legal system, or preparing for discharge from a correctional facility. Case Management Services are available to all individuals. The levels of Case Management vary according to levels of need. The Administrative Case Management Service, which is the most basic level of service, allows for linkage to services and supports. Blended Case Management is designed to be delivered in a fluid manner with the opportunity for more or less assistance based upon changes in the individuals’ needs and circumstance over time. The Forensic Case Manager position is also available to those with mental illness who become involved in the Criminal Justice System. Additionally, the Case Management portion of the multi disciplinary ACT Team is designed to meet the needs of our most severely ill individuals. Administrative and Blended Case Management are available to all age groups; however, Forensic Case Management and ACT are currently only available to Adults, Older Adults, and Transition Age Youth aged 18 years or older. Rehabilitation Services, designed to enhance skill development and role functioning, are provided through our Supported Employment Services, as well as two CRRs programs, one of which is specific to Transition Age Youth/Young Adults age 18-25. Additionally, both Mobile and Site-Based Psychiatric Rehabilitation Services are available. Enrichment services are provided through the two Social Rehabilitation Programs which serve the county. Finally, our services system includes the Representative Payee Program, which offers practical assistance in learning to manage one’s funds, and the Mental Health Court Program which offers interventions at multiple intercepts of the Sequential Intercept Model. Additionally, Behavioral Health Rehabilitation Services (BHRS) and Multisystemic Therapy (MST) are available to DHS Bulletin 2015-1 County Human Services Plan Guidelines service the rehabilitation needs of Children, Adolescents, and our Transition Age Youth (up to age 21). All other services indicated are available to Adults, Older Adults, and Transition Age Youth aged 18 years or older. Basic Support Services are provided in a variety of modalities to include Mental Health Supportive Housing Services, which provide both Housing Case Management and Housing Assistance funds. The Housing Case Management portion of Mental Health Supportive Housing assists individuals in locating and maintaining safe, decent, and affordable housing. Assistance funds are provided, as available, for security deposits, utilities, and furnishing. Additionally, the unique Mobile Housing Support Team assists individuals in a hands-on fashion to manage laundry, grocery shopping, meal preparation, and care of their apartment/home. Special funds, such as Family Support Services (FSS) dollars, provide practical assistance in meeting one’s basic needs. These services are available for individuals of any age with the exception of FSS which is devoted to families with children within the Mental Health System. Peer Services, such as the Medicaid Funded Certified Peer Specialists and the BHDS Base Funded Peer Mentors provide opportunities for self-help. Such help is also provided via the Community Support Program, the County’s Drop-In Centers (Alliance and the Circle Center), as well as the National Alliance on Mental Illness (NAMI) Support Group. Wellness activities will be facilitated through the Cameron Wellness Program and the Drop-In Centers’ Fitness Area. These services are available to Adults, Older Adults, and Transition Age Youth/Young Adults aged 18 years or older. In addition to the above services and supports, BHDS is pleased to be a part of the “Now is the Time” Pennsylvania SAMHSA Grant award. The following describes a list of the activities associated with our project: Development of a Stakeholder Advisory Panel comprised of youth, family members, providers, schools and other community agency representatives to help guide and inform our project objectives; development of a Care Coordinator position at Southwest Behavioral Care, Inc. to work with our youth in a cohesive, collaborative manner, including natural supports and members of the treatment team, to develop a Person Centered Community Support Plan which will address all applicable life domains. The Care Coordinator will also assist the youth in accessing resources and will monitor fidelity to the plan using an intensive tracking process; development of a Transition Age Peer Mentor Service, as well as specialized Supported Employment Services, which best meet the needs of our TA youth; utilization of the BH-Works Screening Tool at the SPHS Primary Care Center for the early identification of youth with or at risk for serious mental health conditions; expansion of the “Common Ground Teen Center” operated by Dr. Mary Jo Podgurski of the Academy for Adolescent Health to include separate hours and activities for those age 18-25 called the “Refresh Group”; training on youth culture and engagement strategies; as well as Cognitive Behavior Therapy specific to the needs of TA Youth. All of the services identified herein, (other than those indicated above specific to the SAMHSA Grant) are supported by a combination of Human Services Block Grant Funds, Behavioral Health Services Initiative Funds (BHSI), and County Match dollars. Many are supported through the HealthChoices Program or Medicaid Fee for Service. a) Program Highlights: DHS Bulletin 2015-1 County Human Services Plan Guidelines Children and Adolescent Initiatives BHRS Provider Meetings: Washington County continues to have quarterly BHRS Provider Meetings to work to develop quality indicators and to ensure staff retention and prescription fulfillment. Summer Resource Guide: Each year, the Child and Adolescent Department works to update its very comprehensive Summer Resource Guide for children and families served. Over 200 Resource Guides were given out to parents and caretakers. Additionally, in October, the resource booklet “A Phone Call Away” was also updated. Relocation: On August 4, 2014, Southwood Family-Based moved this program back to Washington County. For the past several years, they had been located at the RTF in Bridgeville. They are now located at the IDD/ASD RTF which is the former site of the Greenbriar/Bradley Center at 342 Linden Creek Road, Canonsburg. The building was refurbished with fresh paint and new furnishings were provided. Additionally, a large privacy fence was built in the front of the building. In order to ensure a smooth transition, Southwood engaged in multiple meetings with the two (2) home owners’ associations over the RTF being located in their community. New Provider of BHRS: Effective August 4, 2014, Glade Run began serving Washington County in response to an RFP issued in November. Additionally, Southwood and the Stern Center were also chosen. Capacity Increase: Due to an increase in referrals and creation of a waiting list, BHDS has increased the capacity of Centerville Clinic’s School Based Partial Hospitalization Program at Bentworth High School from 15 to 20. At the Claysville Program, which is operated out of the old Blaine Elementary School, capacity is being increased from 20 to 25. The Claysville Program is for children and adolescents from 12 school districts within Washington County. The School Based Program was proven to be successful. It enables the youth to remain in their home school district and be able to participate in other school activities and functions. Children’s Task Force / CASSP Advisory Board: A training was sponsored on Trauma Informed Care on October 21, 2014, and was presented by Marcy Kirkpatrick of Clarion Psychiatric Center. Continuing Education Credits were offered through a partnership with WPIC. Training: Youth Mental Health First Aid Training was held on May 4, 2015, in the Public Meeting Rooms of Courthouse Square. Twenty-eight (28) individuals attended this free training under the Healthy Transition SAMHSA Grant. The training was provided to community members to identify, understand, and respond appropriately to signs of mental illness. We had a very diverse group of attendees including law enforcement, school personnel, resident advisors from our two local colleges, and clergy from the religious community. The response for this training was overwhelming and we already have 15 individuals signed up for the September 16, 2015 training. DHS Bulletin 2015-1 County Human Services Plan Guidelines Mental Health Awareness: Our Mental Health Awareness Event was held on May 11, 2015, from 4:00 to 6:00 PM at the Vernon C. Neal Sportsplex. This event was planned by the Children’s Task Force and our office. Over 100 children, adults, and 29 child-serving agencies attended the event. The theme was “Find Your Path to Wellness.” When each child arrived, he/she was given a bag with themed items and resource directories. At each of the provider tables, a child played a game, received a prize, and had their maps stamped. After the child’s map was complete, he/she received a bottle of bubbles. Gift baskets were also given away. We had a D.J., balloon artist, and airbrush tattoos. The feedback has been very positive from the children/families who attended the event, as well as the provider agencies. Discussion with Children and Youth: BHDS participated in the Permanency Roundtables with Washington County Children and Youth to develop a permanent plan for youth that can be implemented over the next six months. The process helps to identify and address systematic barriers to youth with joint agency involvement so that they can achieve permanency. It is a brainstorming session to think “out of the box” and look to see what has and has not been tried, in order to develop concurrent planning and strengthen system integration, increasing positive outcomes for our youth. Adult and Combined Population Initiatives Trainings Co-Occurring Disorders: In October, Washington County BHDS was pleased to sponsor a training for all providers entitled “The Dilemma of Co-Occurring Disorders: A Practical Approach” conducted by Dr. Mark Fuller, CEO of Value Behavioral Health. The training was designed to help staff of all levels understand the nature and struggles of those diagnosed and to hopefully provide a more effective service, minimizing the risks of serious harm. Healthy PA: Washington County BHDS hosted two presentations for providers, consumers and family members, and the community at large on the topic of Healthy PA. Janice Meinert of the Pennsylvania Health Law Project conducted the trainings which were held in late November and early December. Recovery Prevention: Staff from the Adult Mental Health Department also teamed with staff from the Child and Adolescent Department on Friday, June 20, 2014, to participate in the 11th Annual “Prevention Fair in the Park” sponsored by the Washington Intervention Network in conjunction with the Washington Drug and Alcohol Commission. This year’s event is scheduled for June 19, 2015. Recovery Walk: Washington County BHDS participated in the Recovery Walk sponsored by the Washington Drug and Alcohol Commission on Friday, September DHS Bulletin 2015-1 County Human Services Plan Guidelines 5, 2014, through a donation of a healthy snack, beverage, and an informational display table. Mental Illness Awareness Month: BHDS also participated in Community Days at the Washington Crowne Center on Friday and Saturday, October 10 and 11 completing depression screenings (October is National Depression Awareness Month), and also promoting Mental Illness Awareness Week. Our mission is always to provide education and outreach to the public, as well as battle stigma. In addition to the multiple screenings that were available, we displayed an abundance of information on all of our system’s services. We also conducted mini demonstrations of “Hearing Voices” to help the public begin to understand the challenges facing our individuals with schizophrenia and other serious mental illness as they experience auditory hallucinations. Suicide Coalition: On April 30, 2015, BHDS participated in the Adult/Older Adult Suicide Prevention Coalition Conference in Clarion, PA. The conference hosted a number of speakers and provided information on the resources available to counties who wish to develop a task force. It is our hope and intent to begin development of a task force, perhaps in the later part of this year, with training on suicide prevention provided through the coalition as a kick-off. Provider Update: AMI, Inc., a provider of Washington County BHDS, previously provided its Certified Peer Specialist Service under a subcontract with SPHS to operate under its Case Management License. With changes to regulatory requirements in recent years, AMI, Inc. is now able to deliver the service directly under its own Psychiatric Rehabilitation License. This change is expected to improve cost efficiency in administrative services. Education & Outreach Awareness: On April 10 and 11, 2015, we participated in the Community Awareness Days at the Washington Crown Center as part of our ongoing efforts to dispel stigma and reach out to community members in need of information and/or services. On-site screenings were offered for a variety of Mood and Anxiety Disorders. Additionally, we were pleased to display our new brochures detailing the focus of our Transition Age Youth/Young Adult SAMHSA Grant. Art Show: The AMI, Inc. Sixth Annual Fine Art Show held on May 1 was co sponsored this year by Washington County BHDS. In addition to financial assistance, BHDS staff, along with a contracted consultant, helped to plan a VIP Paint and Sip Kick-off, as well as enhancements with media and public relations. The event was quite a success with approximately 150 participants. The Kick-off participants included Diana Irey Vaughan, Washington County Commissioner; Taylor Smith; Janice M. Taper, Washington County BHDS Administrator; President Judge Katherine Emery, Washington County Court of Common Pleas; Princess Johnson; Brandon Neuman, State Representative; Brenda Davis, Washington City Mayor; Dr. DHS Bulletin 2015-1 County Human Services Plan Guidelines Mary Jo Podgurski; Diana McKinney, AMI, Inc. Executive Director; and Spencer Richmond. Training: Two eight-hour Mental Health First Aid-Veterans trainings were provided through a successful grant application for “Mental Health Matters” funds. They were conducted on May 13 and May 18. The May 13 session had 30 participants and the May 18 session had 32. Attendees included system providers, staff of other community agencies such as the City Mission and Community Action Southwest, Veterans, Law Enforcement and Correction officers, as well as staff of the Washington Drug and Alcohol Commission. Course evaluations reveal that the majority of participants found the training to be beneficial. Recovery: “A Celebration of Recovery” co-hosted by Washington County BHDS and the Washington Drug and Alcohol Commission, was held on May 22, 2015, from 10:30 am – 2:00 pm at the Washington Park Stone Pavilion. The event, which was attended by over 200 individuals included a “Welcome” by Janice M. Taper, Behavioral Health and Developmental Services Administrator, and Cheryl Andrews, Director of the Washington Drug and Alcohol Commission; an address by State Representative, Brandon Neuman; and a proclamation provided by Washington County Commissioners Larry Maggi and Harlan G. Shober. Commissioner Diana Irey Vaughan was not able to attend but participated in the official proclamation delivered during the Board of Commissioners Meeting on May 21. Additionally, both a mental health testimonial and a drug and alcohol testimonial for recovery were provided. Following the testimonials, Ken Montrose, Director of Training and Publications for Greenbriar Treatment Center and acclaimed expert in Co-occurring Disorders, spoke on Recovery. All in attendance enjoyed a full picnic lunch provided largely through a $500 Walmart Grant and other donations. Lunch was followed by music and prize raffles. Additionally, participants were able to peruse the many provider vendor tables to gather resource information. PCH Risk Management Meeting: There continues to be active involvement at the PCH Risk Management Meeting from Washington County BHDS. A representative attends PCH licensing reviews to monitor findings and violations. This assists in the monitoring of any PCH within Washington County’s service area that is identified as being on provisional licensure and possible closure. Additionally, as part of their Olmstead Plan submission, Washington County BHDS has detailed policies and procedures for utilization and tracking of our individuals who reside in Personal Care Homes. Disaster, Crisis, Outreach Referral Team (DCORT) Disaster Drills: Our DCORT participated in the Region 13 three-day Hospital Drill on October 9, 2014. We also received and responded to a request for information from Monroe County DCORT to assist them and Monroe County EMA in providing information to the community during the Pennsylvania State Police Trooper shooting and manhunt operations. DHS Bulletin 2015-1 County Human Services Plan Guidelines DCORT Response: Our DCORT has engaged in ongoing successful response and collaboration with the Red Cross as demonstrated by participation in a recent local high rise fire. Additionally, earlier in the year, the team responded to assist students, parents, and staff following the standoff, lockdown, and eventual evacuation at a high school in the county. PA Prepared: Washington County participates in PA Prepared and its updates to the Learning Management System (LMS) to better track course participation and training opportunities. Other Crisis, Emergency, and Forensic Training: Washington County Delegates and Crisis Workers participated in training entitled “Helping the Older Adult in Crisis”. Workgroup Participation: Washington County BHDS has participated actively in the Department of Human Services Workgroup to develop standard training protocols for Crisis and Delegate services, as well as overall functions pertaining to the Mental Health Procedures ACT with the emphasis on Emergency Services. Relocation: Washington County BHDS has funded the renovation of a new site for the Crisis Stabilization and Diversion Unit operated by SPHS. The new site opened on June 1, 2015. Hospital Coordination: BHDS conducts regular meetings with Community Hospitals within the county and engages in active coordination with Emergency Departments in an effort to promote effective management and service provision for those Washington County residents with serious mental illness in need of emergency and inpatient behavioral health care. Additionally, active collaboration occurs with the local Drug and Alcohol SCA for the individual presenting with complex needs in the ER and on the Behavioral Health Units. MH Court, Forensic Liaison and Forensic Case Management: Washington County continues to work collaboratively with the Criminal Justice System to provide a 90 Day Magisterial District Justice Diversionary Program, as well as an 18 month Mental Health Court Program monitored by our Forensic Case Manager. Additionally, our Forensic Liaison continues to address the needs of individuals incarcerated in the Washington County Correctional Facility. An integral part of our initiatives is the active collaboration and communication with Adult Probation and Law Enforcement. Tracking: Beginning in July 2014, a new tracking mechanism was instituted to allow for ongoing data collection of outcomes such as treatment and service adherence following program completion for participants in all forensic endeavors. DHS Bulletin 2015-1 County Human Services Plan Guidelines Service Fidelity and Quality Assertive Community Treatment Team: Value Behavioral Health of Pennsylvania and Washington County continue to work to ensure fidelity of the Assertive Community Treatment Team under the guidance of Allegheny HealthChoices, Inc. (AHCI) in the performance of Tool for Measurement of Assertive Community Treatment (TMACT) annually. Additionally, Washington County BHDS, and provider administration participate with OMHSAS, VBH-PA, and Southwest Behavioral Health Management in their Regional Act Network Meetings. Quality Management: In addition to participation in the VBH Quality Management Committee, Washington County BHDS continues to utilize an intensive Incident Management process, provider monitoring, and the development of Standards of Care to ensure quality across our service system. SAMHSA Grant Part 1: BHDS was approached by the Department of Public Welfare to be one of three counties statewide to partner with them in applying for a grant through the Substance Abuse and Mental Health Services Administration (SAMHSA), which is the federal entity responsible for guiding the direction of behavioral health services toward quality standards. The grant entitled, “Now is the Time” Healthy Transitions (HT): Improving Life Trajectories for Youth and Young Adults with, or at Risk for, Serious Mental Health Condition” is designed to provide outreach and engagement, address service gaps and develop best practice guidelines for this unique population. The grant was submitted on Friday, June 13, 2014, and we were notified in September that we received the award which will provide substantial funds to pilot enhancements to our system of care for youth, potentially over the course of a five year period. Part 2: Four focus groups were conducted with in the County regarding the needs of transition-aged youth 16 to 25. Approximately 30 youth provided feedback regarding what supports they need as they are transitioning from the child/adolescent system to the adult system. Two more focus groups will be held and the responses will be complied to assist us with future planning for the SAMHSA “Now is the Time: Healthy Transitions” Grant. In addition, on May 1, 2015, we issued needs assessments for the transition of age youth and young adults. This comprehensive needs assessment looks at life domains and what areas the youth need assistance with as they transition from childhood to adulthood. This will be an ongoing survey to assist us with future planning needs of our youth. Part 3: We are pleased to announce that we are now able to move forward with implementation of the Behavioral Health-Works (BH-Works) Screening Tool: as part of the “Now Is the Time – Healthy Transitions” SAMHSA Grant. The SPHS Primary Care Center in Monessen will utilize this BH-Works software to screen our target population of Transition Age Youth/Young Adults (16-25) to detect suicidality, abuse, depression, trauma, bullying, psychosis, and other serious conditions and then refer individuals to our Behavioral Health System when applicable. BH-Works is an exceptional tool which produces real time outcome measures. It is also the selected DHS Bulletin 2015-1 County Human Services Plan Guidelines tool of the Garrett Lee Smith Youth Suicide Prevention Initiative. In addition to youth and young adult screening, BH-Works can be used for adults and older adults at no additional charge. Readiness preparation has begun to be followed by staff training and implementation. The previous section of this plan highlights the services and supports being developed as a result. b) Strengths and Needs: Please identify the strengths and needs for the following target populations served by the behavioral health system: Older Adults (ages 60 and above) . Strengths: Washington County BHDS generally has strong collaboration with Aging Services of Washington County which allows for access through the Ombudsman Program to older adults living in Personal Care Homes and other long term care arrangements. . Needs: Many Older Adults with serious mental illness cannot and/or do not want to live alone, but Personal Care Homes and Nursing Care Facilities are unwilling to accept or maintain them in those environments. We have attempted, and will continue to attempt, to provide training and outreach to these entities to maximize opportunities for individuals in this age group served through our system. Adults (ages 18 and above) . Strengths: Washington County BHDS offers a plethora of services designed to meet the needs of this target group as outlined in the information above. . Needs: BHDS recognizes the need to transform its system to one that provides for Trauma Informed Care throughout all services and supports. Additionally, there is always a need to develop affordable housing opportunities with enhanced services and supports as allowed by funding availability. There is also a great need to tailor all services to meet the very specialized needs of individuals with Co-occurring Mental Health and Autism Spectrum Disorders. Finally enhancements to the existing Supported Employment Program are necessary to provide greater access to benefits counseling. Transition-age Youth (ages 18-26) . Strengths: SAMHSA/PA Grant is an enormous opportunity and strength. Additionally, Washington County BHDS has both a Transitional Housing Program (Can-Do) designed to meet the needs of Transition Age Youth/Young Adults, aged 18-25. BHDS also offers a specialized transition age CRR to assist in the skilled development for those ages 18-25. The CRR provides a structured environment in which the youth can learn and grow. . Needs: At times youth culture can be a barrier to successful transition into society. BHDS must continue to find a way to mitigate this. Additionally, the challenges posed by Co-Occurring Mental Health and Autism Spectrum Diagnoses are even more pronounced for this age group as they attempt to fill adult roles and tackle adult responsibilities. DHS Bulletin 2015-1 County Human Services Plan Guidelines Children (under 18). Counties are encouraged to also include services like Student Assistance Program (SAP), Respite, and CASSP Coordinator Services and Supports in the discussion. . Strengths: Washington County’s Child and Adolescent Services support the belief that every individual and family has the ability to learn and grow. We support a philosophy of wellness that focuses on personal strengths, building hope, and offering choices. Our current children’s behavioral health system is based on the principles and framework developed more than 20 years ago through the Child and Adolescent Service System Program (CASSP). We offer a full continuum of services that are delivered in a comprehensive and coordinated manner. . Needs: Certainly an area of need is the recruitment and retention of qualified staff. It is becoming increasingly difficult to recruit and retain staff to work especially in the area of in-home services. Additionally, although BHDS works diligently in an effort to improve the quality of BHRS, ongoing work is needed as well as, perhaps, the identification of an Evidence-Based Alternative for Children/Adolescents. Identify the strengths and needs for the following special/underserved populations. If the county does not serve a particular population, please indicate. Individuals transitioning out of state hospitals Strengths: BHDS was one of five counties of the Mayview Regional Service Area that closed its state hospital in December of 2008, after much planning and infrastructure development. Since that time, we have continued to support individuals discharged, as well as those individuals who would have been considered as diversions, through our community based recovery-oriented system of services and supports. Needs: Loss of funds, dedicated from the closure, pose a challenge for the BHDS Administration as it strives to maintain the infrastructure created during the closure and to provide for individuals who have a high level of need and multiple challenges. Co-occurring Mental Health/Substance Abuse Strengths: Many years ago collaboration was developed with the Mental Illness Substance Abuse (MISA) movement, now referred to as the Co-Occurring Disorders Initiative, as we strive to create a Comprehensive Continuous Integrated System of Care (CCISC). Despite challenges that have occurred along the way, BHDS remains committed to the endeavor as evidenced by our recent “Celebration of Recovery” event co-sponsored by BHDS and Washington Drug and Alcohol Commission. Recently a meeting was held with key change agents and leadership to identify barriers which need to be addressed and future directions. Needs: Additional training is needed for all of the services system as well as Inpatient. Psychiatric and Drug and Alcohol Treatment Facilities are still falling short of welcoming individuals with significant Co-Occurring Disorders. Justice-involved individuals Strengths: Washington County BHDS provides several intercepts of the Sequential Intercept Model including a 90-Day Diversionary Program at the District Justice level and an 18 month Mental Health Court Program through the Washington County Court of Common Pleas. Additionally, future opportunities are on the horizon based upon planning DHS Bulletin 2015-1 County Human Services Plan Guidelines for a centralized booking center. In its effort to improve services for justice involved individuals, BHDS has also offered training for law enforcement such as Mental Health First Aid. Needs: Because of the complexity of cross system collaboration, there is always the need for additional training and communication. It is also the hope of BHDS that Washington County or a portion thereof will someday have a Crisis Intervention Team (CIT). Veterans: Strengths: BHDS and its Provider System have a sincere desire to serve our veterans. We understand the severity of PTSD and have recently offered two Mental Health First Aid-Veterans trainings. One of the Washington County licensed Out Patient facilities is now credentialed to offer specialized treatment for individuals actively or formally involved in the military. Needs: Despite the strengths indicated above, BHDS fully recognizes the need for increased and ongoing collaboration with all veterans groups and the need for additional training. Lesbian/Gay/Bisexual/Transgender/Questioning/Intersex (LGBTQI) consumers Strengths: Excellent supports are available for Adolescents, Transition Age Youth and Young Adults through the “Common Ground Teen Center” operated by Dr. Mary Jo Podgurski. Additionally, a chapter of PERSAD hosts regular support meetings. Needs: Although the supports indicated above are in place for our younger population, providers who typically serve Adults and Older Adults are in need of training to adequately support the needs of individuals of this target population. Racial/Ethnic/Linguistic minorities Strengths: Washington County has sponsored training in cultural competence for its provider system and most providers have developed a basic awareness of the needs. Needs: Despite the above, there is a significant need for training not only on awareness but the development of competence, particularly to serve individuals in the African- American and Hispanic populations since these two groups do present a significant presence in areas of the county. The Hispanic population continues to increase as the result of the natural gas and oil industry and the influx of workers and their families that have relocated to Washington County. Additionally, there is little competence in meeting the linguistic needs of minorities. Other, Individuals with Co-Occurring and Autism Spectrum Disorders. Strengths: Through our recognition of need, BHDS has reached out to individuals with expertise to assist in the creation of very specific, person-centered service plans. Additionally, an Autism Work Group has been in place for some time in order to explore and develop sustainable resources. Needs: The complexity of serving this group of individuals is truly very challenging. Very few providers have staff with the specialized knowledge and skill set to serve such individuals with any level of competence. *Assessment of need was based upon Base Service and HealthChoices data, Quality Management activities, provider quarterly reports, anecdotal reports, and stakeholder input from DHS Bulletin 2015-1 County Human Services Plan Guidelines a variety of meetings and other forums, as well as elements of data gathered from the list below. In order to continue monitoring the needs of the Mental Health System and to most objectively identify our future priorities and goals, we have targeted the following data collection and outcomes: Utilization of both HealthChoices and Base Service data for each service (Inpatient, RTF, BHRS, ACT, Case Management, Psych Rehab, Crisis, etc.) by distinct member and by dollar. Involuntary Commitments by type with relevant demographics. Early Warning and Critical Incidents by a variety of specifications including by type, by provider, etc. Inpatient re-admission rates. Number of individuals involved in MH Forensic initiatives (Mental Health Treatment Court, 90-Day Program, Forensic Crisis, etc.). Number of Law Enforcement staff trained in Mental Health First Aid and other Behavioral Health sponsored trainings. Number of individuals, served in our system, who reside in Personal Care Homes. Names of individuals with Serious Mental Illness (SMI) known to our service system who are in need of nursing care. Number of Transition Age Youth to utilize specialized housing and residential services. Gaps in BHRS Services whereby the prescribed service is delayed and/or unfulfilled. In addition to these outcome measures, Washington County BHDS intends to continue monitoring the progress of its Service Delivery System in a number of ways as follows: Both HealthChoices and base data are monitored monthly for changes and trends in service utilization by both distinct member and by dollars expended. Person and provider level data are monitored as part of the intensive incident management process which utilizes the Allegheny HealthChoices web-based application developed throughout the Mayview State Hospital closure. Monthly and/or quarterly reports required for each service as part of our Provider Agreements are monitored to give us a qualitative, as well as, quantitative picture of our system. Washington County BHDS works very closely with its Consumer Family Satisfaction Team to monitor member satisfaction with services delivered through the system of care. Through focus groups held as needed, and through collaboration with our local Community Support Program (CSP) and other cross system entities (Drug and Alcohol, Aging, Children and Youth, Criminal Justice, etc.) we are able to gain valuable input regarding the emergent needs and changes. DHS Bulletin 2015-1 County Human Services Plan Guidelines c) Recovery-Oriented Systems Transformation: In consideration of not only the needs identified above, but also the spirit and purpose of the Human Services Block Grant, and in consideration of the Affordable Care Act (ACA), Washington County BHDS will attempt to accomplish the following Recovery Oriented System Transformation Priorities: Priority 1- Trauma Informed Care The prevalence and impact of trauma on individuals with Mental Illness and/or Co- occurring Substance Abuse is formidable. The effects of trauma may also be found among other populations such as within CYS, Aging, Homeless Services, and the Criminal Justice Systems. Washington County BHDS recognizes the need to ensure that individuals receive services consistent with the principles of Trauma Informed Care. In an effort to ensure this BHDS has completed an application which is being submitted to SAMHSA for the provision of Technical Assistance and Training. The primary goal of this application is to secure assistance in transforming, not only the BHDS System of Care, but also that of our cross systems partners so that all policies, procedures, and protocols are consistent with the principles of Trauma Informed Care and that all levels of staff, from administrators to entry level employees, are able to recognize, understand, and mitigate the crippling effects of trauma on all populations served, therefore promoting opportunities for individuals to experience personal growth and wellness. Timeline June 2015- Application submitted to SAMHSA September 2015- Planning and coordination with SAMHSA October 2015 – May 2016 Implementation of training and technical assistance Resources Minimal funds will be needed if the SAMHSA application is fully funded. If it is not approved, or only partially approved, the cost of training and technical assistance could equal $500 per training session in addition to associated travel and miscellaneous costs. As such, a budget of up to $75,000 dollars maybe anticipated. Priority 2- Safe Affordable Housing Safe affordable housing opportunities for those with serious mental illness have become difficult to acquire in recent years due to the development of the gas and oil industry throughout Washington County. As industry workers have relocated to our region and consumed available housing, the existing supply of housing units has become scarce. Those which are now available lease at a premium rate which is not affordable to our population. As such, BHDS seeks to explore the development of a Fair-weather Lodge or SRO model of housing for our consumers. Timeline July – September 2015 Exploration and Planning DHS Bulletin 2015-1 County Human Services Plan Guidelines September 2015 Outreach to acquire funds and/or housing stock November 2015 – May 2016 Development of housing units Resources A minimum of $300,000 dollars will be needed for acquisition, as well as the purchase of furnishings and miscellaneous supplies. Additionally, $50,000 dollars maybe requested for staff support services. Priority 3 As stated in the “Other” category pertaining to underserved populations, those individuals with Co-Occurring Mental Illness and Autism Spectrum Disorder present a challenge to all providers within the BHDS system. As such, our intent is to provide training to all providers on the basic skills necessary to serve individuals with Autism and to support the enhancement/expansion of services with a local provider who possesses expertise in this area. Timeline July 2015 Accept provider proposal for service enhancement/expansion and prepare Reinvestment Plan for submission to OMHSAS September 2015 Submission of Plan October 2015 Planning of provider system training November 2015 – July 2016 Pending approval of Reinvestment Plan, provide support to provider to begin enhancement/expansion January 2016 - May 2016 Provision of multiple training sessions Resources A request will be made for approximately $250,000 in Reinvestment Funds to support provider enhancement/expansion. $15,000 of BHDS Block Grant Funds will be needed to provide for a minimum of five full-day training sessions. Tracking of Priorities: A monthly log will be maintained to track the progress and/or the barriers for each of the priorities listed above. INTELLECTUAL DISABILITY SERVICES Planning for services and supports has become increasingly more inclusive, effective, and targeted to meet each individual’s unique needs. Washington County Behavioral Health and Developmental Services (BHDS) remains committed to flexibility in funding services from various financial sources. Services can be funded through the use of Base funding, Medicaid Waiver capacity or Medical Assistance. The primary goals in the use of Base funding are to DHS Bulletin 2015-1 County Human Services Plan Guidelines promote individual independence, support life in the community in the least restrictive setting to meet individual needs, and reduce the cost of services, including residential placement. BHDS strives to provide a wide array of services and supports that ensure the highest level of individual choice, dignity and respect. Following the Principles of Everyday Lives, Person- Centered Planning, and Positive Approaches, BHDS has developed a multitude of service options, ranging from those provided in the community to those provided out-of-home. Services include Supports Coordination, Supported Employment, Day Services, Pre-Vocational Training, Community Based Supports and Residential Care. Lifesharing, Participant Driven Services, (AWC: Agency with Choice), and Behavior Support are among other specialized services. Supports Coordinators work with individuals to maximize familial support and community resources. Families are also linked to advocates and other service systems. Estimated Individuals served Projected Individuals to be in FY 14-15 served in FY 15-16 Supported Employment 2 4 Sheltered Workshop 5 3 Adult Training Facility 3 3 Base Funded Supports 470 (From all funding 180 (Base Funded only) Coordination streams) 160 Base Funded Residential (6400) 5 4 Life sharing (6500) 0 0 PDS/AWC 0 0 PDS/VF 0 0 Family Driven Family 0 0 Support Services Supported Employment: Washington County BHDS adheres to the concept of Employment First. This concept embraces the belief that individuals with intellectual disabilities want to be productive and are capable of working alongside non-disabled peers at real community based jobs for competitive wages. The school‐to‐work transition populations, as well as the adolescents coming to our Intellectual Disabilities (ID) Program from Children and Youth Services are candidates for employment supports. Employment options are presented to all individuals entering the ID Program. They are also prime topics during Individual Service Plan (ISP) meetings so that there is documentation available indicating a consumer’s preference/choice. Supported Employment is an important service that helps individuals with intellectual disabilities learn, find, and maintain employment, experience increased life fulfillment, and provide economic stability to the program participants. While five different agencies provide job support and supported employment services, the number of individuals being served has not met expectations. Unfortunately, statistics show that few of the individuals enrolled in the ID portion of Washington County BHDS (approximately 10%) do any kind of work for minimum wage. And only two are working full time. The uncertainty over the future of sheltered workshops (CMS Final Ruling 2014) makes improvement of employment services an essential goal in this planning cycle. These new requirements reflect CMS’ intent that individuals receiving services and supports through Medicaid Waivers receive services in settings which are integrated in and support full access to the greater community. DHS Bulletin 2015-1 County Human Services Plan Guidelines If individuals are to be integrated into community based jobs, funds need re-distributed from vocational settings to sponsorship of job finding, job support services, and transportation. This movement away from sub-minimum wage jobs in isolated settings puts the future of sheltered workshops in limbo. Can they be integrated enough to not be considered a segregated service. BHDS will actively participate in DPW’s 5-year transition plan for bringing services into Federal compliance. But, conversely, support must continue for the traditional Pre-Vocational Programs as they try to become community focused. Not all individuals currently participating in Pre-Vocational Services are capable of, or even interested in, competitive employment. Washington County BHDS will implement system change and expand choice for these individuals, but will not eliminate the “safety net” of current services if that is the most advantageous course of programming to meet their needs. ODP’S 2015-16 proposed Amendment to the Consolidated and Person/Family Waivers require ANY participant under the age of 24 may only have Pre-Vocational Services authorized as a new service in the ISP when documentation has been obtained that OVR has closed the participant’s case or that the participant has been determined ineligible for OVR services. Washington County BHDS will also utilize this process for any individual being served via Human Services funding. Over the last two years representatives from OVR and various employment provider agencies have attended supports coordination training meetings to discuss available resources and brainstorm about ways to successfully gain more individuals for competitive employment. Staff from the Supports Coordination Units and provider agencies routinely participates in School to Work Transition Fairs and Career/Job Fairs. They disseminate information regarding local supports and services. At these events they work with individuals, families, and employers to change perceptions about individuals’ capability to work. Washington County BHDS has engaged all day services providers to improve their service delivery. Regular quarterly meetings are held with local ID Providers. The focus of these meetings is developing and implementing sustainable strategies in the employment support system by combining the use of new community resources with existing employment programs in order to deliver employment services in a more efficient and effective manner. Part of Washington County’s Self-Advocacy Project is the development of “Peer Councils” of individuals receiving services at each agency. It is the AE’s (Administrative Entity) expectation that providers will meet routinely with these representatives to discuss their likes and dislikes of service delivery. Changes are occurring from these meetings. The individuals desire to learn new skills are being addressed. The individuals are challenging the providers to implement meaningful day activities and job opportunities. The Employment Sub-Committee of the Washington BHDS Quality Council and the Washington County Inter-Agency Council on School to Work Transition are working to improve employment opportunities for the individuals we serve. The focus continues to be ensuring services and supports are planned and effectively implemented to serve the individual’s unique needs, preferences, and life decisions regarding employment options. Employment is important to DHS Bulletin 2015-1 County Human Services Plan Guidelines helping individuals with ID increase life fulfillment. Washington County adheres to ODP’s philosophy of “Employment First” and will make every effort to see that individual’s transition into, and maintain, competitive employment at minimum wage or above. The current goals of the Employment Sub-Committee are: • Improve access to existing training and identify and support new training needs • Coordinate systems to facilitate access to services and training • Secure transportation for those who need it to get to work • Work with employers to change perceptions about individuals’ ability to work Another future factor, which will accelerate Washington County’s expansion of employment services, is the passage of the Federal Workforce Innovation and Opportunity Act (WIOA). When this Act becomes operational in July 2015, all individuals under the age of 24 will receive “Pre-Employment Transition Services”. WIOA increases individuals with disabilities access to high-quality workforce services to prepare them for competitive integrated employment. It requires better employer engagement and promotes physical and programmatic accessibility to employment and training services for individuals with disabilities. Youth with disabilities will receive extensive Pre-Employment Transition Services to obtain and retain competitive integrated employment, start the job search soon after a person expresses an interest in working, provide for continuous follow-along supports for as long as the person wishes, and respect individual preferences in assisting a person to pursue his/her vocational goals. Understanding the changing climate of competitive employment for individuals with disabilities at all levels (federal, state and local) is imperative if employment opportunities are to increase for individuals in Washington County. In order to insure that all team members (individuals, families, providers) have the most current and up-to-date policies and procedures related to employment, BHDS, the Quality Council, and Employment Sub-Committee, will host an "Employment Summit" in the early part of the up-coming fiscal year. Once the summit has been held, further meetings will take place on various levels: agency directors, job coaches/program specialists, families, etc. The intent of this method is to instill the same philosophy from top to bottom. The Sub-Committee will also prepare a brief survey to be sent to families regarding their perception of "barriers" they feel are preventing their family member from participating in employment opportunities. The results of this survey will be utilized to start to develop a broad framework that can be shared with Support Coordinators, who can then begin to work with the families to overcome the barriers. In the past, family members revealed that their fear of losing benefits and unreliable transportation have prevented their family member from working competitively. Meetings have been held with traditional and non-traditional transportation supports to improve after hour services through vehicle sharing, ride sharing, and transportation stipends to the family. Benefits counseling workshops through agencies like AHEDD have been presented to the individuals and their families. Continuing in the same vein with the Supports Coordinators, the Supervisors of the two units in Washington County will also monitor the Individual Support Plan Checklists to validate whether employment is being offered as a choice to all individuals being served. This area is clearly noted on the checklist and is included as an item to be signed by all team members present at DHS Bulletin 2015-1 County Human Services Plan Guidelines the annual ISP. This allows for employment discussion to be take place among all team members. This is an on-going objective. The Sub-Committee is working to develop a resource guide that will provide individuals entering the system with an overview of employment opportunities and availability of “benefits” counseling. The Sub Committee is reaching out to the Transition Council and “transition” teachers in the local schools to jointly plan activities to educate transition age students on the availability of services after graduation. This is an on-going objective. Some proposed employment initiatives BHDS will undertake during this planning cycle: A. Strengthen Relationship with District Office of Vocational Rehabilitation 1. Refine referral process 2. Develop mutually acceptable criteria for program participation 3. Liaisons from BHDS and OVR meet quarterly 4. Cross Systems Training for SCs and OVR Counselors B. Assess work readiness potential of individuals served in Pre-Vocational Programs 1. Provide participants and families with information on available competitive work opportunity 2. Sponsor community based employment assessments 3. Match work with individual’s experience, preferences, and strengths C. Provide individualized benefits counseling 1. Utilize liaison from AHEDD 2. Explore Special Needs Trusts to ensure continuation of MA eligibility D. Collaborate with, and train, Community Partners on work readiness of individuals 1. Local Transition Council 2. Career Links 3. Chamber of Commerce 4. Employers Supported Employment Placement opportunities Contract work for pre-vocational programs Establishment of Enclaves in Industry Projects In FY 15-16, BHDS estimates it will use Human Services Block Grant dollars to provide seven individuals with either sheltered or competitive employment opportunities. Base Funded Supports Coordination: One of the essential elements of Supports Coordination is Intake into the County Program. At the Base Service Unit (BSU) each individual presumed to require service shall be thoroughly assessed before a disposition is made of the referral. Individuals deemed “ineligible” for services will receive assistance in procuring other services and natural supports. Those found eligible for I.D. services will be provided Supports Coordination. Supports Coordination helps individuals become connected to and remain connected to their community. In FY 14-15, BHDS estimates that 160 individuals will receive assistance to help maintain their health and safety in the least restrictive environment by connecting them to the appropriate resources. Human Services funding is utilized to provide DHS Bulletin 2015-1 County Human Services Plan Guidelines locating, coordinating, and monitoring Supports Coordination for persons who qualify for ID services but are not enrolled in Medicaid Waivers. Through the first ten months of FY 14-15 there were 24 “intakes” of new individuals into the ID system. These individuals must have supports until such time as they can receive Medicaid Waiver Services. Supports Coordinators work with individuals as they participate in day programming, employment, habilitation, transportation, and residential services (e.g. group home and supported living) that help to keep individuals in the least restrictive environments appropriate to meet their needs. While the number of Medicaid funded “slots” remains static, the number of new individuals seeking supports and services continues to rise. All individuals actively participating in the Washington County ID Program will receive Supports Coordination Services to help maintain their health and safety in the least restrictive environment by connecting them to the appropriate resources. To ensure this goal, individuals receiving Supports Coordination Services will continue to receive at least a semi-annual review of their needs through the ISP process and PUNS review. ICF/ID Supports Coordination for Individuals residing in State and Privately operated ICF/IDs: The number of individuals originally from Washington County still residing in State Centers (12) continues to diminish thru attrition. There have been no admissions from Washington County to a State Center since the early 1990s. None of the current residents from Washington County are participants in current litigation, i.e. “Jimmy” or “Benjamin” lawsuits. Also, according to recent HCSIS data, an additional 40+ individuals receive services via Private Intermediate Care Facilities (ICF/ID). These individuals receive active Base Funded Supports Coordination via BHDS. OBRA Supports Coordination: Another segment of the ID population that has a unique need for Supports Coordination are those individuals who find themselves in long term placement at skilled nursing facilities. To address this need a collaborative project has been established between our Supports Coordination Unit and a local Peer Mentoring agency. Joint visits are conducted monthly to review individuals’ status, provide support and companionship and to address any unmet needs. Self-Advocacy/Peer Mentor: While Supports Coordination is a vital service, the most overlooked part of the ID Service System is empowering the individuals to speak for themselves. The individual’s ability to effectively communicate, convey, negotiate, or assert his or her own interests, desires, needs, and rights must be nurtured. It involves those individuals making informed decisions and taking responsibility for their decisions. To foster this endeavor Base funding has been committed to a project designed to teach individuals an array of skills, including self-awareness and assessment, self-advocacy, problem-solving and decision-making, goal-setting and teamwork, and group development. DHS Bulletin 2015-1 County Human Services Plan Guidelines In the 14/15 fiscal year the self-advocacy project established a leadership program that trains individuals to be Peer Support Mentors. These core groups of Mentors are available to assist any individual who is having difficulty navigating the Service System. These “mentors” build relationships with program participants and assist them in working through their individual concerns or issues. Life sharing Options: Washington County adheres to the principle that individuals should have choice and control over their daily living, including living arrangements. Lifesharing through Family Living is an opportunity for a person with a diagnosis of Intellectual Disability to share a home with a family or person to whom he/she is not related. Currently, three individuals are served in 6500 Licensed Lifesharing Homes with their support being funded via Consolidated Waiver dollars. Active efforts continue to expand the number of providers and participants in Lifesharing. Washington County BHDS has established an annual Quality Management Plan that details specific goals, outcomes, and objectives in this focus area, along with those who are accountable and responsible for the review of the appropriate QM activities. A workgroup has been established for this service and meets on a routine basis, insuring that key stakeholders are participating with improvement activities. The Lifesharing Workgroup reviews data that has been collected related to the goal/outcome/objective and work together to make recommendations as to how to achieve the increase of both demand and availability of this service. Cross Systems Communications and Training: The Developmental Services segment of BHDS routinely collaborates with Behavioral Health, Children and Youth Services, and Area Agency on Aging in an effort to create local options for individuals with complex, multi‐system needs. BHDS continues to implement system change and expand choice and will continue to do so whenever possible with the resources available. All generic resources and natural supports are explored before system funding is authorized. For FY 15-16, BHDS will use its Human Services Block Grant funding to meet the needs of those with intellectual disabilities whose services cannot be covered through alternate funding sources. In FY 15-16, BHDS will continue to engage in several collaborative efforts with local and regional counties and stakeholders to provide training and improve cross-system communication. Together, these efforts are designed to help stakeholders understand emerging needs as they occur and to increase the effectiveness of care delivered to individuals and families in the least restrictive environment. As mentioned previously, there have been no admissions from Washington County to a State Center since the early 1990s. BHDS takes a “hands on” approach to service delivery and utilizes a team approach to ensure individuals receive person-centered planning to keep them within the community. Washington County BHDS, as one of the Mayview Regional Service Area Counties, has had no dedicated State Hospital beds since the closure of Mayview in December 2007. Since there was no available SMH significant infrastructure, development occurred through the BHDS Services System for individuals who are dually diagnosed. This Cross Systems collaboration has achieved positive community based outcomes. For example: The last Washington County individual with dual diagnosis remaining at a State Hospital was successfully integrated back to DHS Bulletin 2015-1 County Human Services Plan Guidelines community placement in 2015. A comprehensive plan from both segments was developed and implemented to ensure both his safety and the safety of the community as he re-enters society after 30 years of restricted placements. In Behavioral Health, the majority of individuals having a “dual diagnosis” and needing supports and services are youngsters, adolescents, or young adults. It is not surprising that their expressed needs center on supports for families or transition to adult services. Individuals want to live where they choose, with whom they want to live, and have meaningful daily activities. They are seeking supports and services that will help them acquire and maintain the skills necessary to be active members of their community. The Intellectual Disability (ID) System collaborates with Blended Case Managers, Crisis Team members, and Administrative Staff from the Behavioral Health portion of BHDS to address both systemic and individual case issues. Integrating services for adults with complex needs: By the fall of 2015, Washington County shall have a functional Dual Diagnosis Treatment Team (DDTT). This is a collaborative effort between the MH and ID portions of BHDS and NHS Human Services. The DDTT is a recovery-oriented approach to supporting adults diagnosed with both mental illness and intellectual disability. The program will offer another comprehensive team approach to mental health treatment and services coordination for individuals with behavioral challenges who have not progressed in their recovery after receiving traditional behavioral health services. DDTT services will be provided in the community in all settings. The team consists of a Psychiatrist, Pharmacist Consultant, Behavioral Specialist, Registered Nurse, Licensed Mental Health Professional and Mental Health Service Coordinator. The DDTT will provide intensive training and technical assistance to all members of the individual support team. The team has the capacity to serve up to 20 individuals. Referrals and active cases will be monitored during bi-weekly phone calls; process discussions, and quarterly metrics reports are the topics of monthly implementation calls. Older Individuals with ID: Washington County has a strong relationship with the Protective Services and Care Management staff from the Southwestern PA Area Agency on Aging (AAA) that ensures effective and collaborative intervention strategies for older adults with ID. The Washington County Aging/Behavioral Health Partnership has been functioning for a number of years. The purpose of this collaborative effort is to expand the relationship among both Aging Care Managers and Supports Coordinators for Intellectual Disabilities, as well as service providers for both systems. This is done through the organization of trainings across systems, as well as producing and sharing resources. There are also on‐going efforts to work with current providers on ways in which they can be more inclusive of aging individuals who also have an intellectual disability. Individuals who have an intellectual disability routinely volunteer to deliver meals to AAA clientele and participate in local Senior Center events and activities. Two contracted providers of BHDS Adult Training Facilities programs are also licensed by the Department on Aging. DHS Bulletin 2015-1 County Human Services Plan Guidelines Under 21 populations: Significant effort is taken to address the unmet needs of transition age youth as they leave the education system into adult services. The Developmental Services Program is active with various local planning collaborative activities. The ID portion of BHDS routinely coordinates specialized supports and services thru the BHRS Health Choices Program. The Developmental Services staff also participates in joint Washington County Behavioral Health and Developmental Services, Children and Youth Services (CYS), and provider agencies meeting regularly to brainstorm unique solutions for the more complex cases within the county involving children and families. The expected result of these meetings is a written plan of action with designated parties responsible for specific follow‐through items. Additionally, both BHDS and CYS have held informational training events to clarify and enhance the understanding of their systems. Washington County BHDS also partners with the Washington County Transition Council to better prepare students with special needs for life after graduation. BHDS staff routinely attends Transition Council meetings to provide information and networking opportunities for school district transition and special education staff, OVR counselors, community rehabilitation agencies, students and families. Staff from the BHDS Administrative Office and the two local Supports Coordination Organizations attend local “transition fairs” to give students and parents information regarding system registration, as well as available supports and services. Emergency Supports: As emergencies arise, individual needs are assessed. All individuals with unmet needs are categorized through ODP’s Prioritization of Need for Services (PUNS). The BHDS Administrative Entity strategizes with the individual/family and Supports Coordination Organization to develop supports and services for those in immediate need (Emergency Category) Washington County utilizes several processes to ensure support when no waiver capacity is available. All alternate funding and resources are explored; such as alternative Waivers and services that might meet the individual’s needs, such as Independence Waiver, Autism Waiver. If out of home placement is needed Dom Care or Personal Care Boarding Homes are an option. The availability of planned or unanticipated emergency out of home respite is an unmet need in Washington County. Providers no longer keep “extra beds” that can be utilized for these situations. Provider capacity has been reduced and all available beds are committed to serving long term placements. Additionally, the passage of the Adult Services Protection (Act 70) legislation has provided additional strain upon the system. Unanticipated emergencies coming from APS must be addressed. Washington County BHDS is approaching local residential provider agencies with the concept of taking one of their existing sites and utilizing it as a “respite only” facility that can accommodate family needs for relief. Start-up is planned for 2015-16 with the intent of having a site licensed and fully operational by the early part of the 2016 calendar year. Crisis telephone, walk-in, and mobile crisis outreach are offered to all persons residing in Washington County or to anyone wanting assistance for such a person. Emergencies are addressed, whenever they should occur. All Supports Coordination Organizations in DHS Bulletin 2015-1 County Human Services Plan Guidelines Washington County are required to have after hours and weekend availability. The SCOs and MH Crisis Emergency response team have contact information for the AE administrative staff. BHDS does not routinely reserve any base dollars for emergencies. Allocations and expenditures are reviewed monthly. Contract adjustments are made, at least, semi-annually based upon projected need. As mentioned above, crisis supports are available to all persons residing in Washington County. If the individual is not known to the system, the crisis outreach workers will contact the AE at BHDS to start a process to resolve the person’s emergency need. Individuals who already have a Supports Coordinator and find themselves in an emergency situation utilizes their Supports Coordinator as their first point of contact. In either of the aforementioned situations, the Supports Coordination Organization in conjunction with the BHDS AE will be responsible for locating, coordinating, and monitoring services needed to resolve the emergency. Administrative Funding: Washington County BHDS functions as the local AE charged with ensuring proper delivery of services in the Consolidated and Person/Family Directed Services Medicaid Waivers. Multiple AE responsibilities are listed in the current approved Waivers and concurrent AE Operating Agreement. As the AE for Washington County, BHDS is responsible for monitoring and insuring the availability of services designed to meet the immediate needs of individuals with Intellectual Disabilities, authorizing and overseeing state and federally funded services such as Supports Coordination, Supported Employment, Transportation, adaptations to the home and/or vehicle, and other special therapies. BHDS adheres to the principles of Self Determination and Everyday Lives in administering its Waiver oversight responsibilities. BHDS personnel oversee delivery of all components of the AE Operating Agreement with the Pennsylvania Department of Human Services, including: • Financial process (including supporting cost report and other financial analysis). • Managing the Prioritization of Needs for Services (PUNS) and managing waiver capacity functions. • ISP development and authorization. • Provider monitoring. • System planning. • Quality management services. In order to continue monitoring the needs of the Intellectual Disabilities System and to most objectively identify our future priorities and goals, the following data collection and systems outcomes are targeted: • Refining services data for each service available through the ID System to ensure consistency and reliability. • Utilizing Incident Reporting Data for Risk Management improvement. • All relevant outcomes data specifically related to Quality Management Workgroup goals and priorities. DHS Bulletin 2015-1 County Human Services Plan Guidelines HOMELESS ASSISTANCE SERVICES The Washington County Department of Homeless Services provides a multitude of programs to assist near-homeless and homeless residents in need of housing. These programs strive to ensure that individuals and families at risk receive prevention and intervention services to address their various housing and supportive service needs. The County’s Continuum has three shelters serving individuals, women with children, families and those fleeing domestic violence. While in shelter, the participant is provided Case management, to help the participant identify and utilize a variety of community services and resources that are necessary to address their needs and improve their situation. Various life skills programs are also provided to help the participants learn the skills necessary to become better prepared for independent living. During their stay in Shelter, participants receive support and guidance, are linked with community- based services and receive assistance in securing permanent housing. Participants who are not prepared for independent living may be referred to Bridge/Transitional housing where they receive continued case management and supportive services in an apartment setting. Washington County offers three targeted bridge programs, Can Do, for youth 18-24, FRESH START for women and women with children fleeing domestic violence and Supportive Living for those without a disabling condition, currently there are 23 units of bridge/transitional housing available in the County. Participants who have a disabling condition and meet the HUD definition of homelessness and are in need of continued housing and supports may be referred to the permanent supportive housing program. Washington County has a total 86 units of permanent supportive housing through the permanent Supportive Housing Program and two Shelter plus Care Programs. Individuals and families facing eviction may be eligible for the Rental Assistance program. Clients requesting RAP services must: • Be homeless or near homeless (must have written notification that homelessness is imminent) • Have income below 200% of the federal poverty guidelines • Have sufficient income to sustain themselves in the future (or reasonable expectation for sufficient income within 90 days) • Have a written agreement with a landlord willing to rent to them • Have received all Title IV-A/ESA and FEMA assistance (written documentation required) • Agree to participate in a comprehensive case management and monthly budgeting program for the duration of services Additionally, clients are required to attend the Community Action WORKS program in order for clients to be eligible for assistance through RAP. Community Action WORKS’ niche is addressing the cycle of poverty through programming that resolves barriers to self-sufficiency. Addressing adult education, employability, skills development, housing and asset development, while creating opportunities and providing support for economic independence is the framework in which client success is realized. Eligibility for assistance through HAP will also be contingent on the following: • Unemployed or underemployed clients must first attend an individual session or at least one weekly class focused on Job Development. The Job Development DHS Bulletin 2015-1 County Human Services Plan Guidelines sessions and classes detail career options, help clients develop resumes and through case management link their skills and interests with leading local employers. • Clients receiving disability income and/or those who are unable to properly budget their income must first attend an individual session or at least one weekly class focused on Financial Literacy. Financial literacy classes Case management in the Rental Assistance Program The Caseworker will assess individual needs, work with clients to resolve the current housing crisis and develop a goal plan to avoid future housing crises. The HAP Caseworker will partner with the client to locate or retain safe and affordable housing, identify and remove any barriers to housing placement and provide long-range support and guidance to ensure self-sufficiency. Through HAP, the Caseworker will help clients address self-sufficiency barriers in areas such as life skills, financial management, job readiness skills and education, with the goal of helping them to resolve their housing crisis and avoid future crises. Budget assessment and direction in establishing a workable monthly budget will be provided to individuals seeking housing assistance. Estimated Individuals served Projected Individuals to in FY 14-15 be served in FY 15-16 Bridge Housing 58 60 Case Management 215 150 Rental Assistance 145 145 Emergency Shelter 191 200 Other Housing Supports For each of the following categories, describe the services provided, how the county evaluates the efficacy of those services, and changes proposed for the current year, or an explanation of why this service is not provided: Bridge Housing: During the 2015-2016 Fiscal Year, Washington County will fund the Domestic Violence Services of Southwestern Pennsylvania in the Bridge Housing Component. Domestic Violence Services of Southwestern Pennsylvania will provide match for its Fresh Start Program. Fresh Start is a scattered - site Supportive Housing Program that provides up to 24 months of transitional housing, extensive case management and supportive services, to women and women with children who are victims of domestic violence. Case Management: During the 2015-2016 Fiscal Year, Washington County will fund two programs under the case management component. The Washington County Department of Human Services will provide a full time case manager to provide countywide case management to homeless and near homeless individuals and families, to assist them in receiving the appropriate services available to them in Washington County’s Continuum of Care. The case manager also assists in coordinating the Homeless funds DHS Bulletin 2015-1 County Human Services Plan Guidelines received by the County, Supported Housing Program and Emergency Solutions Grant received by the County. Rental Assistance: During the 2015-2016 Fiscal Year, Washington County will fund Community Action Southwest under the Rental Assistance Program component. Community Action Southwest will provide homeless prevention services to low income residents of Washington County. Services will include assessment, advocacy, case management, goal development, budget counseling, direct rent and utility assistance and relocation services. Washington County residents in housing crises may self-refer to CAS for assistance or referrals will be accepted from all county providers. CAS caseworkers will work with each client to locate and/or retain safe and affordable housing on a long-range basis and will provide budget counseling and direction in establishing a workable monthly priority budget plan. The Homeless Assistance Program (HAP) will be administered by the Family Economic Success Program Service Area of the CAS. Emergency Shelter: During the 2015-2016 Fiscal Year, Washington County will fund a family shelter and a domestic violence shelter. The Washington Family Shelter to provide up to 60 days of emergency housing to families who don’t have a permanent legal residence of their own or are in need of temporary shelter because of a crisis situation. The Family Shelter provides families with a stable and structured living arrangement so they can assess their homeless situation and begin to make decisions regarding their future. Case management services are provided to help families identify and utilize a variety of community services and resources that are necessary to address their needs and improve their situation. Various life skills programs are also provided to help the families learn the skills necessary to become better prepared for independent living. During their stay at the Family Shelter, guest families receive support and guidance, are linked with community- based services and receive assistance in securing permanent housing. The Domestic Violence Shelter to provide safe, temporary shelter and support services for domestic violence victims and their children. Families and individuals are able to stay in the shelter for up to 30 days or until safe housing can be found. The Homeless Assistance Programs will be monitored through the use of tracking data collected at the point of service. Specifically, client exit data that is being collected during the discharge will be provided to Washington County on a quarterly basis. Providers will also track and present data on use of mainstream systems including employment services, enrollment in social security benefits, veterans benefits, healthcare, food stamps and unemployment compensation. Other Housing Supports: No other innovative supportive housing services were provided with Homeless Assistance funding. The funding was used to provide housing assistance with no surplus money to support additional innovative services. Describe the current status of the county’s Homeless Management Information System implementation. DHS Bulletin 2015-1 County Human Services Plan Guidelines The Homeless Management Information System, (HMIS), will continue to be supported throughout Washington County. Training will be conducted with homeless assistance providers and the County’s Human Services Department on the implementation of updated HMIS software through the Department of Community and Economic Development. The HMIS enhances the County’s ability to identify service needs and gaps, facilitate entry into the homeless assistance service delivery system, improve the use of available resources and enhance the coordination of needed services. CHILDREN and YOUTH SERVICES ***THE BELOW SECTION IS REQUIRED ONLY FOR COUNTIES PARTICIPATING IN THE BLOCK GRANT*** Briefly describe the successes and challenges of the county’s child welfare system and how allocated funds for Child Welfare in the Human Services Block Grant will be utilized in conjunction with other available funding (including those from the Needs Based Budget and Special Grants, if applicable) to provide an array of services to improve the permanency, safety and well-being of children and youth in the county. Washington County Children and Youth Social Service Agency remains committed to the preservation of families, timely reunification and child permanency. For the past three years, we have successfully reduced the number of children in placement through the implementation of the services provided under the HSBG. Additional funding in the Needs Based Plan and Budget and Special Grants Initiative, however, was necessary for purchased in-home service delivery to families and children, as the number of child abuse investigations received by the Agency continued to increase. Effective December 31, 2014, the child welfare field experienced a monumental and profound change in practice due to the implementation of over twenty newly enacted laws that directly impacted child welfare. As a result, WCCYS experienced an increased number of child abuse investigations and need for additional in-home services. The number of emergency responses at night and on weekends rose by 51%; the number of families accepted for services equally increased, taxing the Ongoing Department; and the number of children in placement started to increase in the last two months, now at 294. Prior to the last two months, with the implementation of the HSBG programs, placements slowly and safely reduced. In FY12/13, the average number of children in placement was over 300. In FY13/14, this reduced to 290. In FY14/15, this declined to an average of 280 children in care. Data collected revealed that 90% of the children in placement are in the least restrictive placement environment, foster care. Approximately 51% of these children were placed in DHS Bulletin 2015-1 County Human Services Plan Guidelines kinship care. Programs like Family Team Conferencing and Family Group Decision Making have assisted the Agency with this success. The HSBG for WCCYS is an opportunity for families to obtain the services they need, not in isolation with WCCYS, but with the collaboration of all departments. Allocated funds for Child Welfare in the Human Services Block Grant and additional funds in the NBPB are necessary to preserve and reunify families; to assure child safety; and to improve child well-being. Programs like MST, Promising Practice, ATP, Housing has aided in the preservation of families. To answer a consistent question about each program listed below, WCCYS does not anticipate an under-spending of any program. This is the reason that additional funding has been requested through the NBPB and SGI. Each program provided a level of reasonable efforts to preserve the family before placement was considered as an option. WCCYS believes it is these programs that have helped decrease the number of children in placement and increase preservation of families. Identify a minimum of three specific service outcomes from the list below that the county expects to achieve as a result of the child welfare services funded through the Human Services Block Grant with a primary focus on FY 2015-16. Explain how service outcomes will be measured and the frequency of measurement. Please choose outcomes from the following chart, and when possible, cite relevant indicators from your county data packets, Quality Service Review final report or County Improvement Plan as measurements to track progress for the outcomes chosen. When determining measurements, counties should also take into consideration any benchmarks identified in their Needs-Based Plan and Budget for the same fiscal year. If a service is expected to yield no outcomes because it is a new program, please provide the long-term outcome(s) and label it as such. Outcomes Safety 1. Children are protected from abuse and neglect. 2. Children are safely maintained in their own home whenever possible and appropriate. Permanency 1. Children have permanency and stability in their living arrangement. 2. Continuity of family relationships and connections are preserved for children. Child & Family 1. Families have enhanced capacity to provide for their Well-being children’s needs. 2. Children receive appropriate services to meet their educational needs. 3. Children receive adequate services to meet their physical and behavioral health needs. Outcome Measurement and The Specific Child Welfare Frequency Service(s) in the HSBG DHS Bulletin 2015-1 County Human Services Plan Guidelines Contributing to Outcome Safety: This will be measured with All identified programs in 1. Children are safely internal data collection the Block Grant maintained in their own and quarterly reports from home whenever possible and providers. appropriate. This will also be measured through the Quality Service Review which is conducted once every other year (2014, 2016 and 2018). Permanency: This will be measured with MST, FGDM, Alternatives to 1. Children have internal data collection Truancy “Why Try” and permanency and stability in and quarterly reports from Dependent Promising their living arrangement. providers. Practice 2. Continuity of family This will also be measured relationships and through the Quality connections if preserved for Service Review (QSR). children. Additional data will be collected in conjunction with Casey Family Programs via Permanency Roundtables. Child and Family Well-being: This will be measured with MST, FGDM, Alternatives to 1. Families have enhanced internal data collection Truancy “Why Try” and capacity to provide for their and quarterly reports from Dependent Promising children’s needs. providers. Practice This will also be measured through the QSR. For each program being funded through the Human Services Block Grant, please provide the following information. The County may copy the below tables as many times as necessary. DHS Bulletin 2015-1 County Human Services Plan Guidelines Program Multi-Systemic Therapy (MST) – Adelphoi Village Name: Please indicate the status of this program: Status Enter X Funded and delivered services in 2014-2015 but not renewing in N 2015-2016 Requesting funds for 2015-2016 New Continuing Expanding (new, continuing or expanding Y X from 2014-2015) Description of the program, what assessment or data was used to indicate the need for the program, and description of the populations to be served by the program. If discontinuing funding for a program from the prior FY, please explain why the funding is being discontinued and how the needs of that target population will be met. If services or activities will decrease, explain why this decision was made and how it will affect child welfare and juvenile justice services in your county. Multi-Systemic Therapy (MST) is a time-limited, intensive family intervention intended to stabilize the living arrangement, promote reunification, or prevent and reduce the utilization of out-of-home therapeutic resources. This approach focuses on the natural environment of the child and family and strives to change how the child functions within the context of his/her home, school, neighborhood and peer group. A major emphasis of MST is to empower the parents of caregivers with the skills and resources needed to become independent in addressing the difficulties that arise in raising adolescents, and to assist the youth in developing life-long coping skills. This program description was provided by Adelphoi Village. Washington County CYS collected internal data including the number of children preserved in their homes with MST implementation. The data outcomes projected include: 1. Prevention of child maltreatment 2. Reduction of incorrigible behaviors, and 3. Decrease of at risk behavior. Outcomes will be measured by monthly reports from the provider agency, reviews with Direct Practice Staff, along with yearly statistics. If there is additional funding being provided for this service through the Needs Based Budget and/or Special Grants, please provide information regarding the amount and how the HSBG money will be used in conjunction with those funds. WCCYS has established that there is a need for continued MST services. In the HSBG, additional monies were reallocated to MST to assist children with crisis services until funding was provided through BHDS, Value Behavioral Health. The HSBG will continue to provide monies for MST services while the SGI will provide additional monies to serve the increase in referrals and numbers of day that need to be covered. WCCYS received an additional $30,000 in SGI for MST in FY14/15. Another expansion is projected to DHS Bulletin 2015-1 County Human Services Plan Guidelines occur due to the utilization of MST by Juvenile Probation in lieu of child placement. The SGI should be adequate to fund the expansion. If an Evidence-Based Program other than FFT, MST, FGDM, HFWA, FDC, or MTFC is selected, identify the website registry or program website used to select the model. Not Applicable Complete the following chart for each applicable year. FY 14-15 FY 15-16 Description of Target Age 10 -18 with out of Age 10 -18 with out of Population control behaviors and at control behaviors and at risk of placement risk of placement # of Referrals 11 15 # Successfully completing 8 8 program Cost per year $10,000 $10,000 Per Diem Cost/Program $70.00 $70.00 funded amount Name of provider Adelphoi Village Adelphoi Village *The information provided in the above chart should reflect only funds being provided through the HSBG and the individuals/families served specifically with those funds. Were there instances of under spending or under-utilization of prior years’ funds? Yes X No If yes, explain reason for under spending or under-utilization and describe what changes have occurred or will occur to ensure that funds for this program/service are maximized and effectively allocated and managed. Program Family Group Decision Making (FGDM) Name: Please indicate the status of this program: Status Enter X Funded and delivered services in 2014-2015 but not renewing in 2015-2016 Requesting funds for 2015-2016 New Continuing Expanding (new, continuing or expanding X X from 2014-2015) DHS Bulletin 2015-1 County Human Services Plan Guidelines Description of the program, what assessment or data was used to indicate the need for the program, and description of the populations to be served by the program. If discontinuing funding for a program from the prior FY, please explain why the funding is being discontinued and how the needs of that target population will be met. If services or activities will decrease, explain why this decision was made and how it will affect child welfare and juvenile justice services in your county. Family Group Decision Making is an evidenced based model which empowers families to make decisions for the safety and well-being of the child. The Agency collects internal data, and is equally supplied with data from the service provider. The data includes the number of families engaged and preserved, child well-being and child safety. If there is additional funding being provided for this service through the Needs Based Budget and/or Special Grants, please provide information regarding the amount and how the HSBG money will be used in conjunction with those funds. FGDM conferences are now provided as an option for every family accepted for services. The Agency has an identified Family Conferencing CWIII to conduct FGDM conferences and a contracted provider. The HSBG is utilized for the program and additional funding provided through the SGI. WCCYS receives additional funding through the Special Grants Initiative, as there is an established need demonstrated for this model. The additional amount in SGI is $50,000. If an Evidence-Based Program other than FFT, MST, FGDM, HFWA, FDC, or MTFC is selected, identify the website registry or program website used to select the model. Not Applicable Complete the following chart for each applicable year. 14-15 15-16 Description of Target All families accepted for All families accepted for Population service. service. # of Referrals 64 64 # Successfully completing 48 53 program Cost per year $150,000.00 $150,000.00 Per Diem Cost/Program $2800 for a successful $2800 for a successful funded amount conference conference $800 for a successful $800 for a successful referral referral $250 for unsuccessful $250 for unsuccessful referral referral Name of provider WCCYS and Justice WCCYS and Justice Works Youth Care Works Youth Care DHS Bulletin 2015-1 County Human Services Plan Guidelines Were there instances of under spending or under-utilization of prior years’ funds? Yes × No If yes, explain reason for under spending or under-utilization and describe what changes have occurred or will occur to ensure that funds for this program/service are maximized and effectively allocated and managed. Program Pennsylvania Promising Practices Dependent (PaPP Dpnt) – Name: Justice Works Youth Care (STOPP and Just Care) Please indicate the status of this program: Status Enter X Funded and delivered services in 2014-2015 but not renewing in 2015-2016 Requesting funds for 2015-2016 New Continuing Expanding (new, continuing or expanding X X from 2014-2015) Description of the program, what assessment or data was used to indicate the need for the program, and description of the populations to be served by the program. If discontinuing funding for a program from the prior FY, please explain why the funding is being discontinued and how the needs of that target population will be met. If services or activities will decrease, explain why this decision was made and how it will affect child welfare and juvenile justice services in your county. Justice Works Youth Care’s STOPP® is a high impact short term service which has proven it can keep children safe in their own homes despite multiple challenges. They work to address multiple challenges in the home which imperil children. STOPP errs on the side of child safety by recommending children’s removal when necessary. STOPP® has demonstrated that it can successfully intervene amidst profound challenges including drug abuse, severe hygiene issues, impending eviction or homelessness, and others. JusticeWorks developed the JustCare® program with the goal of reducing the length of stay in residential placements for both delinquent and dependent youth and to ensure successful outcomes when youth return to the community. JustCare® insures that gains made in placement endure at home. Unlike most ‘aftercare’ programs, planning for the transition home is done throughout the residential stay, and includes input from family and other stakeholders. The above information for each program was borrowed directly from http://www.justiceworksyouthcare.com/programs. In reference to data collection for each program, the data is captured both internally and from provider reports. If there is additional funding being provided for this service through the Needs Based Budget and/or Special Grants, please provide information regarding the amount and how the HSBG money will be used in conjunction with those funds. DHS Bulletin 2015-1 County Human Services Plan Guidelines In addition to HSBG funding, WCCYS utilizes monies from the NBB to purchase this crisis and routine in-home service to preserve families, wherever possible. This program is most often provided to families when there is a crisis to advert placement. The HSBG is utilized first and then the NBPB monies is allocated for over $200,000 plus for this service. If an Evidence-Based Program other than FFT, MST, FGDM, HFWA, FDC, or MTFC is selected, identify the website registry or program website used to select the model. Not Applicable Complete the following chart for each applicable year. 14-15 15-16 Description of Target All Families in Crisis All Families in Crisis Population and/or Family and/or Family Reunification Reunification # of Referrals 35 STOPP 35 STOPP 165 Just Care 165 Just Care Total: 200 Total: 200 # Successfully completing 72.5% STOPP 72.5% STOPP program 78% Just Care 78% Just Care Cost per year $450,000.00 $450,000.00 Per Diem Cost/Program STOPP $80 STOPP $80 funded amount Just Care $70 Just Care $70 Name of provider Justice Works Youth Justice Works Youth Care Care Were there instances of under spending or under-utilization of prior years’ funds? Yes × No If yes, explain reason for under spending or under-utilization and describe what changes have occurred or will occur to ensure that funds for this program/service are maximized and effectively allocated and managed. Program Housing Initiative Name: Please indicate the status of this program: Status Enter X Funded and delivered services in 2014-2015 but not renewing in 2015-2016 Requesting funds for 2015-2016 New Continuing Expanding X (new, continuing or expanding X DHS Bulletin 2015-1 County Human Services Plan Guidelines from 2014-2015) Description of the program, what assessment or data was used to indicate the need for the program, and description of the populations to be served by the program. If discontinuing funding for a program from the prior FY, please explain why the funding is being discontinued and how the needs of that target population will be met. If services or activities will decrease, explain why this decision was made and how it will affect child welfare and juvenile justice services in your county. These monies were utilized for the preservation of families and prevention of children from entering out of home placement, as well as the promotion of reunification of children with their family when housing is the barrier. Internal data was collected to measure the outcomes. The Agency will measure the service outcomes through the internal collection of data by the Resource Coordinator Program Specialist. If there is additional funding being provided for this service through the Needs Based Budget and/or Special Grants, please provide information regarding the amount and how the HSBG money will be used in conjunction with those funds. The entirety of this money is utilized in the HSBG. When this is completely utilized, an additional $7,000 is allocated for housing in the SGI. WCCYS has seen a challenge of assisting families with locating housing due to the influx of out of state employees who can afford higher rental rates. This has adversely affected families who are in need of housing, therefore, these monies have been utilized to pay for rent and utilities in an attempt to preserve the family. If an Evidence-Based Program other than FFT, MST, FGDM, HFWA, FDC, or MTFC is selected, identify the website registry or program website used to select the model. Not Applicable Complete the following chart for each applicable year. 14-15 15-16 Description of Target All Families All Families Population # of Referrals 41 41 # Successfully completing Not Applicable Not Applicable program Cost per year $10,000.00 $10,000.00 Per Diem Cost/Program Not Applicable Not Applicable funded amount Name of provider WCCYS WCCYS Were there instances of under spending or under-utilization of prior years’ funds? Yes × No DHS Bulletin 2015-1 County Human Services Plan Guidelines If yes, explain reason for under spending or under-utilization and describe what changes have occurred or will occur to ensure that funds for this program/service are maximized and effectively allocated and managed. Program Truancy (Alternatives to Truancy) Why Try through Justice Name: Works Youth Care Please indicate the status of this program: Status Enter X Funded and delivered services in 2014-2015 but not renewing in 2015-2016 Requesting funds for 2015-2016 New Continuing Expanding (new, continuing or expanding X X from 2014-2015) Description of the program, what assessment or data was used to indicate the need for the program, and description of the populations to be served by the program. If discontinuing funding for a program from the prior FY, please explain why the funding is being discontinued and how the needs of that target population will be met. If services or activities will decrease, explain why this decision was made and how it will affect child welfare and juvenile justice services in your county. “WhyTry” is an internationally recognized, evidence-based intervention model targeting risk factors and issues related to academic engagement. “WhyTry” combines theoretical and empirical principles, solution-focused interventions, understanding social and emotional intelligence, and multisensory learning. It combines these attributes to address maladaptive patterns of behavior while promoting thinking skills essential to students’ success. This model has shown efficacy in reducing truancy through the use of ten pre-designed visual analogies. These visual cues help to explore social and emotional principles in ways that youth understand and recall by reinforcing those visuals with auditory or physical activities. The combination of these major learning styles (visual, auditory, and body-kinesthetic) are important in reaching each youth, and ultimately, to define the success of “WhyTry”. This Evidenced Based Program that is geared to eliminate truancy can be found on the following websites: www.JusticeWorksYouthCare.com and www.Whytry.org The Agency continued to collect data on the number of children referred to WCCYS for truancy, the number of children who participate in this program and the successful elimination of truancy. If there is additional funding being provided for this service through the Needs Based Budget and/or Special Grants, please provide information regarding the amount and how the HSBG money will be used in conjunction with those funds. DHS Bulletin 2015-1 County Human Services Plan Guidelines The Agency utilizes all allocated money in the HSBG. An additional $75,000 is in the SGI for this Evidence-Based Program to advert placement while improving and eliminating truancy of children. If an Evidence-Based Program other than FFT, MST, FGDM, HFWA, FDC, or MTFC is selected, identify the website registry or program website used to select the model. www.JusticeWorksYouthCare.com and www.Whytry.org Complete the following chart for each applicable year. 14-15 15-16 Description of Target 6yrs (enrolled in 1st 6yrs (enrolled in 1st Population grade)-16yrs youth with grade)-16yrs youth with truancy truancy # of Referrals 15 15 # Successfully completing 12 12 program Cost per year $25,000 $25,000 Per Diem Cost/Program $70 per hour $70 per hour funded amount Name of provider Justice Works Youth Justice Works Youth Care Care Were there instances of under spending or under-utilization of prior years’ funds? Yes × No If yes, explain reason for under spending or under-utilization and describe what changes have occurred or will occur to ensure that funds for this program/service are maximized and effectively allocated and managed. Program Promising Practice – Delinquency Name: Washington County JOBS Program Please indicate the status of this program: Status Enter X Funded and delivered services in 2014-2015 but not renewing in 2015-2016 Requesting funds for 2015-2016 New Continuing Expanding (new, continuing or expanding X X from 2014-2015) Research indicates that youth who have been successfully employed and have good relationships with employers and co-workers are at a lower risk to re-offend. The JOBS DHS Bulletin 2015-1 County Human Services Plan Guidelines Program will provide structure, curriculum, vocational skills, job readiness skills and practical training to all youth referred to the program. The JOBS Program strives to instill pro-social behaviors through the development of competencies that help the youth more appropriately manage themselves and their environment. Program Description The JOBS Program operates out of the Washington County Airport located at 205A Airport Road, Washington, PA 15301. The youth in the program are adjudicated delinquent or informally under the supervision of the Washington County Juvenile Probation Office. The youth are referred to the program based on their assessed need to acquire job-related skills. Program aims to assist participants to learn and build skills essential to obtaining and sustaining employment. The program consists of three phases: education, practical skills development, and employment. o Various services are available to participants, including resume building, assessments, and career counseling to encourage youth to pursue the career path best suited for their individual goals and interests. o During Phase I, education, the participant’s potential career interests are assessed while the youth increases his/her familiarity with the job application process, and interview skills. o During Phase II, Participants receive classroom instruction and hands-on skills practice in vocational areas such as Carpentry, Plumbing, Auto Mechanics, Auto Detailing, Fire Safety, Landscaping and Construction. o During Phase III, Participants will work on community based projects with the Jobs Program, as well as work with the Community Based Manager to assist them in finding employment. The program requires collaboration with local career service agencies and employers willing to work with participants to teach the skills essential to success. By building competency, the program’s main objective is to equip youth with the necessary skills to identify areas of interest, search for and maintain employment, to encourage long-term positive ties to local communities and society, and to prevent future contact with the justice system. Target Population Adjudicated and non-adjudicated youth that have come in to contact with the Juvenile Justice system. Ideally these youth would be in the Low to Moderate risk range according to the Youth Level of Service/Case Management Inventory assessment (YLS/CMI), however, the program is also equipped to work with High risk youth. Ages 15-21 (target ages 16-18) o Youth who are under the supervision of Washington County Probation prior to their 18th birthday are able to continue in the program up to the age of if they remain under supervision. If there is additional funding being provided for this service through the Needs Based Budget and/or Special Grants, please provide information regarding the amount and how the HSBG money will be used in conjunction with those funds. DHS Bulletin 2015-1 County Human Services Plan Guidelines N/A If an Evidence-Based Program other than FFT, MST, FGDM, HFWA, FDC, or MTFC is selected, identify the website registry or program website used to select the model. N/A Complete the following chart for each applicable year. FY 14-15 FY 15-16 Description of Target Delinquent youth ages Delinquent youth ages Population 15-20 years 15-20 years # of Referrals 52 75 # Successfully completing 55 33 program Cost per year $250,000 $250,000 Per Diem Cost/Program 0 0 funded amount Name of provider WCJPO WCJPO *The information provided in the above chart should reflect only funds being provided through the HSBG and the individuals/families served specifically with those funds. Were there instances of under spending or under-utilization of prior years’ funds? Yes X No If yes, explain reason for under spending or under-utilization and describe what changes have occurred or will occur to ensure that funds for this program/service are maximized and effectively allocated and managed. DRUG and ALCOHOL SERVICES The Mission of the Washington Drug and Alcohol Commission, Inc. is to Engage, Educate, and Empower individuals to live healthy, addiction-free lifestyles. The Washington Drug and Alcohol Commission, Inc. (WDAC) holds the contract with the PA Department of Drug and Alcohol Programs (DDAP) to function as the Single County Authority. The Single County Authority (SCA) of Washington County is an Independent Commission and has been for 10 years. (DDAP) oversees the network of SCAs throughout PA and performs central planning, management, and monitoring duties, while the SCAs provide planning and administrative oversight for the provision of drug and alcohol services at the local level. The Washington Drug and Alcohol Commission, Inc. is the designated non-profit agency designed to carry out the drug and alcohol treatment, prevention, and intervention needs of the county. DHS Bulletin 2015-1 County Human Services Plan Guidelines Under the option of an Independent Commission; the Department contracts directly with a non profit corporation organized in accordance with the Pennsylvania Non-profit Corporation Law, 15 Pa. C. S. §5101 et seq. DDAP provides state and federal funding to SCAs through grant agreements, as well as funding from the PA Department of Human Services and HealthChoices. The SCA will work collectively with the Washington County Human Services Department to assure a flow of information with the ultimate goal of completing a combined report that reflects the use of these respective funding streams. Naturally, dialogue will take place on a consistent basis in order to assure an integrated approach; to include planning, service delivery, assessment, and reporting. This agency is committed to being part of the solution. We will continue to work with individuals, communities, and social service entities in order to bring about healing and recovery to the lives and families who suffer from the disease of addiction. As the demand for treatment and recovery support services increase, the SCA continues to face the financial challenges to meet this demand. The SCA looks to state, federal and private grant opportunities. The SCA partners with the County of Washington to access funding for the criminal justice population. The SCA holds several reinvestment plans; these plans assist the SCA with mobilizing special initiatives to the local hospitals. The SCA accesses the HealthChoices funding through; billing for direct services, expediting clients who are in detox or non-hospital residential rehab, and billing for administrative and clinical work conducted by the SCA staff. This overview should include: Access to Services: Clients may access drug and alcohol services through a myriad of referrals. In-Service training sessions are held with various agencies to explain the referral process and the services available through the drug and alcohol program. Individuals may self-refer by calling our office or they may walk-in to the office. There are many points of entry by which a client may be screened and assessed for drug and alcohol treatment services, such as through the following referral sources: o Self-Referral o State or County Parole or Probation Offices o Children and Youth (CYS) referral o Driving Under the Influence (DUI) referral o Value Behavioral Health referral o Juvenile Probation o Hospitals o Other drug and alcohol treatment Facilities o Schools-Student Assistance Program referrals o Mental Health Services o Adult Probation o Office of Vocational Rehabilitation referrals DHS Bulletin 2015-1 County Human Services Plan Guidelines The Department of Drug and Alcohol Programs (DDAP) Case Management Guidelines regulate the structure of the WDAC Case Management Unit as it relates to assessments, referrals for treatment and continued stay reviews. The function of the case management unit is to screen clients, provide assessments for appropriate treatment referral within seven days of the client’s first contact, determine the appropriate level of care for the client and make referrals for treatment. No client is denied an assessment despite the number of past treatment experiences. WDAC case managers also conduct continued stay reviews with treatment providers at specific intervals during the client’s active participation in treatment to ensure that the client continues to participate at the least restrictive, but most appropriate level of care. Based on the information presented by the referent or the client, emergency care is ascertained in the areas of detoxification, medical care, pre-natal care and psychiatric care. If no emergent referral is needed, an appointment for the assessment is made within seven days (most clients are seen within 48 hours of the initial contact). If this is not possible, a WDAC contracted facility will be contacted to arrange for a provider to complete the assessment. If the provider completes the assessment, the Case Management Supervisor validates the level of care before the admission is arranged and assigns a case manager who conducts the continued stay reviews while the client is participating in treatment. The priority populations are: Pregnant injection drug users Pregnant substance users Injection drug users All others Waiting List Issues: The SCA has a waiting List policy and procedure. To date, the SCA has not had to implement a waiting list policy. The SCA currently has and strictly enforces its benefits and limitation policy throughout the entire fiscal year in order to afford all county residents the opportunity to access treatment. With Medicaid expansion, it is the hope of the SCA to be able to do away with our benefits and limitation policy and work with the client to engage and encourage a long-term in patient treatment stay, while adhering to a full continuum of care. This treatment plan can only be accomplished when supports are wrapped around the client through case coordination and recovery support services. The SCA has an after-hour policy whereby the SCA holds a memorandum of understanding with Gateway Rehab to complete client screenings during non-business hours. Our after-hours phone message indicates Gateway Rehab’s number and directs the caller to Gateway. If a client presents at WDAC during non-business hours, permanent signage is on the office door also directing clients to Gateway Rehab or the local hospital emergency room. DHS Bulletin 2015-1 County Human Services Plan Guidelines Gateway Rehab is monitored by WDAC per DDAP guidelines to ensure that staff persons conducting after-hours screenings are screening clients for the potential need for detoxification, prenatal care, perinatal care, and psychiatric care. Preferential treatment must be given to pregnant women. Pregnant women requesting any level of treatment services must be scheduled for an assessment with forty-eight hours from the point of initial contact. Coordination with the county human services system: The SCA is an independent 501 c3 non-profit entity. Though the SCA is not a County Government entity, it is an integral part of the overall human services delivery system within Washington County. The SCA has built a strong working relationship with Washington County Human Services Department as well as other respective programs that interface with the human services delivery system. This also includes the Offices of Adult and Juvenile Probation, the Washington County Correctional Facility, and the Judicial System. The majority of the individuals that are served have complex needs. They may have a primary substance abuse issue, but this disease is further complicated by a co-occurring illness or need; such as a mental health diagnosis, homelessness, criminal history, or an intellectual and developmental disability to name a few. Any emerging substance use trends that will impact services: There are 3 noteworthy trends this fiscal year that we are experiencing in our role as “first responder” to the drug and alcohol challenges of the county: 1. Prescription pain medication and increased heroin use Many clients that are screened and assessed by the case management unit got their start in drug use by following the advice of their doctor. Numerous referrals begin their story by telling our case managers of an accident at work, a car accident, or in at least one case, giving birth. The medical community has adopted the disease concept of pain, ironically, as they continue to struggle to view addictive disorders in the same light. Pain has become the problem, instead of simply the symptom of a problem, and nationally, pain management has become center stage for measuring outcomes and the effectiveness of healthcare providers. The result has been the over-availability of pain medication and the wholesale diversion of those medications for pleasure and profit. Washington County is situated just north of the state with the worst overdose death rate in the country (WV), and lies in a region where the population is approximately 7% older than the national average. This older population requires more pain medication. Add to that the fact that most of the employment opportunities in the county are blue-collar, physical types of careers, and you get a greater number of people who seek medical attention for pain relief. These legally prescribed drugs not only adversely affect the population for which they were intended (for example, Washington County has seen a 29% increase in county residents age 50 or older seeking substance abuse services since 2008), but often end up in the hands of others who use them, abuse them and become addicted. DHS Bulletin 2015-1 County Human Services Plan Guidelines Clients describe how they can no longer afford their “medications” and in desperation turned to heroin, a much cheaper albeit more illicit way to combat their pain or more importantly by that point, stave off the horrors of opiate withdrawal. Although Doctors are not the sole reason for this problem, overall, we are seeing the glut of legal, prescribed narcotics, drive an increase in the use of heroin on a daily basis. 2) Overdose deaths In 2014, County Coroner investigated 36 overdose deaths. This number is a significant decrease from 2013 of 58 overdose deaths. The heroin that is on the streets of Washington county today is a much purer form as drug dealers seek to control the market by branding their stamp bags and driving addicts to seek out their product at the exclusion of other, less potent formulations. Occasionally, Fentanyl will find its way into a batch and the lethality of the mixture is increased substantially. Unfortunately, this is an acceptable cost of doing business to those who benefit from the illicit drug trade as addicts will indeed seek out the “brand” that is killing their peers. Adding further complexity is the fact that when a using addict “falls out” or appears to be overdosing, often their peers will not call for help for fear of prosecution. Currently Pennsylvania ranks 14th in drug overdose mortality ranks nationally. In November 2014, the PA legislature enacted Act 139 allowing for the third part prescribing of Naloxone as well as a “Good Samaritan” piece that offers individuals who call to get help for someone experiencing an overdose some amnesty from criminal prosecution. Too many lives in our county are being lost as a result of the fear of prosecution. In an effort to prevention overdose deaths the SCA will continue to carry out the following initiatives and track the outcomes. The SCA has initiated a hospital program in order to combat the overdose epidemic. We employ one mobile case manager and one mobile certified recovery specialist that directly serve all three hospitals in Washington County. If an overdose victim presents in the Emergency Department, the medical staff may contact the SCA who will provide intervention services and facilitate a linkage to treatment, preferably at the hospital prior to discharge. The SCA will also provide services to individuals who have been admitted to the behavioral health unit or the medical unit. This initiative will not only provide the hospital staff a viable referral source, but will also engage those with substance-use disorders, who otherwise may never have had the opportunity to experience drug and alcohol treatment. These professional positions were covered through HealthChoices reinvestment plans that have depleted and moving forward into the new fiscal year, these positions and the initial days of treatment will have to be covered with SCA base funds. The SCA is a hub for training and distribution of Naloxone. The SCA has developed policy and procedures regarding the purchase and distribution of Naloxone. The SCA is working in collaboration with the District Attorney to get Naloxone into the hands of first responders—to include: Police, firemen, and EMS. The SCA will hold public forums on overdose prevention and educate the public on Act 139. The SCA has several mobile case managers and Certified Recovery Specialists designated to specific populations: Children and Youth Services, Adolescents referred through the Student Assistance Program, 3) Criminal Justice Referrals WDAC has seen a growing trend over the last two years. Data from fiscal year 2013/2014 will show that 39% of clients screened at WDAC were referred by a criminal justice agency. Management will confirm that the number is misleading because many clients will state that they DHS Bulletin 2015-1 County Human Services Plan Guidelines are self-referred during the screening process and then during the assessment it is uncovered that they are involved with a criminal justice entity, but because they aren’t seeking help in a mandated capacity, they are recorded as “self-referrals.” In reality, over half of our clients were involved in the criminal justice arena in some capacity. Remarkably, no criminal justice related funds flow through to the SCA, which then limits our ability to help those who are referred by other agencies, families, providers and self. The SCA has had to enforce benefit limitations and stretch the DHS funds in order to serve the greatest number of people possible. The SCA has established relationships with service providers, county agencies, the legal system, the prison system, non-profit agencies, and will continue to reach out to other sectors of the community to develop strategies that will lead us to a more integrated approach to drug and alcohol treatment services and a recovery oriented system of care. The SCA is in dialogue with the Washington County Correctional Facility, Probation, the District Attorney, and the County Court Judges in order to create collaborative programs where financial resources can be shared Drug and Alcohol Level of care assessments are being conducted in the probation office at the Washington County Correctional Facility and referral for treatment when criteria is met A “Recovery Plan” group is run bi-weekly for the both male and female inmates at the WCCF. This is an effort designed to prepare inmates for re-entry. A Certified Recovery Specialist assists the inmates in creating a recovery action plan that will be deployed upon release from the correctional facility. Inmates may continue to utilize recovery support services through the SCA upon release. 1. Waiting list issues; 2. County limits on services; 3. Coordination of care across the system; 4. Any emerging substance use trends that will impact the ability of the county to provide substance use services. This overview should not include guidelines for the utilization of ACT 152 or BHSI funding streams issued by DHS. The focus should be a comprehensive overview of the services and supports provided by the Single County Authority and challenges in providing services. Target Populations Older Adults (ages 55 and over) 143 Adults (ages 18-55) 1767 Transitional Youth ( ages 18-26) 831 Adolescents (under 18) 173 Individuals with co-occurring disorder (any 826 age) Criminal Justice 762 Minorities 194 The above referenced table indicates the target populations that were screened by the SCA. There were a total of 1,929 individuals screened/referred at the SCA from July 1, 2014 to June DHS Bulletin 2015-1 County Human Services Plan Guidelines 24, 2015. There has been a significant increase in the number of screening/referrals compared to last fiscal year. This is, in part, due to the number mobile services that the SCA offers. Of this total amount, you can see how the target populations break out. The SCA contracts with providers throughout the state who have specialized programs for these individuals. The Case Management staff is highly trained and receives continuing education in order to work appropriately with these segments of the population. The SCA continues to work to align its data system with the DPW target populations. Ideally, the target populations defined by DPW, would be extracted from the data system in a non- duplicative manner. Currently the data system has some overlap with the Adult and Transitional Youth population categories. Adolescents: The SCA provides a mobile case manager who conducts level of care assessments in each of the fourteen school districts located in Washington County. Appropriate referrals are made. If drug and alcohol treatment is founded, the SCA contracts with drug and alcohol treatment providers who provide treatment in the school setting. These identified students are student assistance program referrals or school policy violators The SCA subcontracts with a specific treatment provider for the LEADER Program; a program that is specifically designed for adjudicated minors and is operated by the Office of Juvenile Probation. The SCA spends $50,000 a year to support the treatment needs of this youth population. The SCA will be providing direct education and prevention services to the LEADER program in the new fiscal year. Transitional Youth: The SCA has a memorandum of understanding with Washington County Behavioral health and Developmental Services (BHDS) confirming our commitment to work together to improve outcomes for Transitional Age Youth and Young Adults in Washington County. BHDS has been awarded a SAMSHA grant, “Now is the Time: Healthy Transitions in PA: Improving Life Trajectories for Youth and Young Adults with, or at risk for, Serious Mental Health Conditions.” Many of these young people have substance-use disorders and our two offices remain committed to develop a strategy to address the needs of Transitional Youth and engage our local drug and alcohol providers to develop treatment/education that would address transition related needs. The SCA will add this specific categorical to our data system for 2015-2016, in order to track this population. Currently “Transitional Youth” are included in the overall general age breakouts. Adults and Older Adults: The SCA tracks both of these populations by age. Adults are considered 18-59 years of age and Older Adults are age 60 and above. Many individuals who are in these two populations also fall within one or more of the other sub-populations. We have treatment providers in place to address the needs of Adults. The SCA holds contracts with providers in order to serve all residents of Washington County to include the populations of older adults, adults, transitional youth, adolescents, and individuals with co-occurring psychiatric and substance use disorders, criminal justice, veterans, and minorities. The SCA continues to work with providers in order to establish program protocols as well as measurable outcomes. DHS Bulletin 2015-1 County Human Services Plan Guidelines Co-Occurring Population The SCA has four staff members who hold co-occurring certifications through the Pennsylvania Certification Board. Our screening and assessment tool provides a comprehensive overview and allows the case managers to identify any co-occurring mental health needs. The SCA holds contracts with treatment providers who specialize in co-occurring treatment. This level of care whether inpatient or outpatient, is at a higher rate than non-co-occurring. As you can see from the table above, almost 50% of the clients we screen/assess have a co- occurring issue, whether formally diagnosed or undiagnosed. WDAC also holds a service agreement with Washington Hospital for admission of drug and alcohol clients in need of psychiatric emergent care. If the client is admitted to the hospital and needs a drug and alcohol treatment assessment, the hospital social worker is to call WDAC on the next business day and a WDAC case manager can go to the hospital to complete the assessment and next level of care determination. Criminal Justice: The SCA provides two full-time case managers to a specialty court known as Restrictive Treatment Program (RTP). The treatment court side of this program is designed for level I and level II offenders. This portion of RTP is partially funded by Washington County Behavioral Health and Developmental Services (BHDS); all treatment costs for these individuals are assumed by the SCA. This fiscal year, $68,494.83 was expended for 41 participants in this mandated program. The other half of RTP is the Restrictive Intermediate Punishment Program participants. The treatment costs and the salary and benefits of the case manager are covered by a county PCCD grant. The SCA provides two full time mobile case managers to provide assessment and case coordination services to the Office of Adult Probation, Washington County Correctional Facility (MA Pilot), and the newly established Diversion Program. These outreach mobile services increases the referrals for drug and alcohol services and the SCA utilizes base funds for treatment costs if the client is not MA eligible. The SCA provides two Certified Recovery Specialists to the Washington County Correctional Facility to facilitate a group that works with inmates to develop recovery plans in an effort to prepare inmates for re-entry. These recovery specialists also work with the WCCF staff to implement an evidence-based program known as Thinking for a Change. None of these services are billable to HealthChoices due to the services being provided in the correctional facility. Additional dialogue has been occurring with the court system, district attorney, and the correctional facility in order to develop additional programs and perhaps share resources that would allow criminal justice clients access to drug and alcohol treatment. As the SCA reaches out and connects more people to treatment, it is anticipated that additional funding will be needed to cover the cost of SCA personnel and treatment. DHS Bulletin 2015-1 County Human Services Plan Guidelines Veterans Currently the data system for the SCA is unable to extract the number of clients who are veterans. We do conduct level of care assessments for Veterans and we work to coordinate treatment services. Washington County has local providers that accept Veterans insurance and will work collaboratively with the VA hospital to assure a continuity of drug and alcohol treatment. The SCA will work with this clientele to help them understand their individual veteran’s benefits as well as assist them with navigating the system in order to assure access to drug and alcohol treatment. Access to treatment can be problematic for veterans. Minorities Almost 10% of the total number of clients screened fall into the minority category. To this point, there have been no noted challenges appropriately serving minorities. All staff both at the SCA at the treatment provider must receive training on cultural competency. Policies and Procedures must reflect cultural competency. The SCA holds contracts with providers in order to serve all residents of Washington County to include the categoricals of older adults, adults, transitional youth, adolescents, and individuals with co-occurring psychiatric and substance use disorders, criminal justice, veterans, and minorities. The SCA continues to work with providers in order to establish program protocols as well as measurable outcomes. During the 2015-16 fiscal year the SCA will anticipate funding the following services: Inpatient Non-Hospital Treatment and Rehabilitation: A licensed residential facility that provides 24 hour professionally directed evaluation, care and treatment for addicted clients in acute distress, whose addiction symptomatology is demonstrated by moderate impairment of social, occupation, and/or school functioning. It is projected that 198 clients will be served. Partial Hospitalization: Services designed for those clients who would benefit from more intensive services than are offered in outpatient treatment projects, but do not require 24 hour in-patient care. Services consist of regularly scheduled treatment sessions at least 3 days per week with a minimum of 10 hours per week. It is projected that 25 clients will be served. Outpatient/Intensive Outpatient: A licensed organized, non-residential treatment service providing psychotherapy and substance use/abuse education. Services are usually provided in regularly scheduled treatment sessions for a maximum of 5 hours per week; IOP is an organized non-residential treatment service providing structured psychotherapy and client stability through increased periods of staff intervention. Services are usually provided in regularly scheduled sessions at least 3 days per week for at least 5 hours (but less than 10 hours). It is projected that 170 clients will be served. Medicated Assisted Therapy (MAT): Any treatment for opioid addiction that includes a medication approved by the U.S. Food and Drug Administration for opioid addiction DHS Bulletin 2015-1 County Human Services Plan Guidelines detoxification or maintenance treatment. This may include methadone, buprenorphine, naltrexone, or vivitrol. It is projected that 3 clients will be served. Case Management Services: The function of Case Management is to provide screening, assessment, and case coordination. Screening includes evaluating the individual’s need for a referral to emergent care including: detoxification, prenatal, perinatal, and psychiatric services. Assessment includes a level of care assessment and placement determination. Through case coordination, the Single County Authority (SCA) ensures that the individual’s treatment and non- treatment needs are addressed. The SCA is responsible for ensuring that individuals have access to available drug and alcohol treatment and treatment related services, which is facilitated through the case management system. It is projected that 393 clients will be served. Recovery Oriented Services In addition to our traditional services, WDAC is committed to providing recovery support services as we are well aware that they are an integral component to the overall wellness of our clients. Since the inception of recovery oriented services at the SCA, no DPW funds have been utilized to finance this service. Fiscal year 2012-2013 was the first time that DPW funds were utilized and most assuredly needed in order to fund this service. The SCA is already at a shortfall with all of the other levels of treatment and now this much needed service will have to share in the already “stretched too thin” allocation. Recovery support services have been providing peer to peer services to the community since 2011. We have opened up the referral sources to include all treatment providers and other county agencies. The SCA now employs three Certified Recovery Specialists (CRS). Our strategy is to provide the most vulnerable with the most support to reduce cost centers in other areas (criminal justice, mental health, homelessness, CYS, etc.). This strategy also affords us the reasonable expectation of making the most of the funds we are allocated. Our commitment to the development of a county-wide Recovery Oriented system of Care (ROSC) is one of great priority for the SCA. It is projected that 175 people will be served through this service. HUMAN SERVICES AND SUPPORTS/ HUMAN SERVICES DEVELOPMENT FUND For each of the five categories, Adult Services, Aging Services, Children and Youth Services, Generic Services and Specialized Services, please complete the chart below with current and next fiscal year’s individual information. Also for each of the five categories, please explain how allocated funding will be utilized by the county to support an array of services to meet the needs of county residents by providing the following in the format provided: The program name (if applicable) Changes, if any, in service delivery from previous year DHS Bulletin 2015-1 County Human Services Plan Guidelines Specific service(s) - from the list of allowable services under each category in Appendix D, describe how services are provided Planned expenditures for each service Note: Please ensure that the estimated individuals in the chart and planned expenditures in the narrative match what is included on the budget in Appendix C. Estimated Individuals Projected Individuals to be Served in FY 14-15 Served in FY 15-16 Adult Services 1 0 Aging Services 350 403 Children and Youth Services 130 120 Generic Services 1549 1645 Specialized Services 329 330 Adult Services: Please provide the following: Program Name/ Description: Homemaker Services which provides in home personal care and home support services. This can include instructional care if the consumer is functionally capable but lacks the knowledge and self-help skills necessary to complete the essential activities of daily living. Changes in Service Delivery from Previous Year: The lack of need in Washington County has forced this program to be discontinued. Only one client was served last year. Specific Service(s): Homemaker Planned Expenditures: None Program Name/ Description: Outpatient Therapy Program which provides mental health services to low income individuals, couples, families and groups in Washington County. The program addresses issues such as depression, anxiety, anger management, marital counseling and divorce, eating disorders and blended family adjustment. Changes in Service Delivery from Previous Year: The service provider did not request funding last year. They were still able to provide uninterrupted service to the residents of Washington County. As a result, this funding was reallocated for fiscal year 15-16. Specific Service(s): Counseling Planned Expenditures: None Aging Services: Please provide the following: Program Name/ Description: The Congregate Meals program provides a lunch for independent seniors. The lunches are prepared and served at nine Senior Community Centers throughout Washington County. This funding is used to pay for back-up chefs to prepare meals when the full time chefs are on leave Changes in Service Delivery from Previous Year: None Specific Service(s): Congregate Meals Planned Expenditures: $13,000 Program Name/ Description: The Home Delivered Meals program provides a meal to clients that have been assessed and provided with Care Management. Residents must be frail and DHS Bulletin 2015-1 County Human Services Plan Guidelines unable to prepare or obtain a meal in the community. This funding is used to pay for back up chefs to prepare meals when the full time chefs Changes in Service Delivery from Previous Year: None Specific Service(s): Home Delivered Meals Planned Expenditures: $16,000 Program Name/ Description: The Care Management program assists with keeping older residents at home and independent. Care plans are developed with consumers to determine the need for home-delivered meals, personal care, home support and adult daycare. This funding is used to pay for the Registered Nurse Consultant that is mandated by the Pennsylvania Department of Aging Changes in Service Delivery from Previous Year: None Specific Service(s): Care Management Planned Expenditures: $3,000 Program Name/ Description: Transportation services as part of the shared ride program. The transportation will be to medical appointments and to Senior Community Centers. This funding is used to pay a portion of the driver’s salary Changes in Service Delivery from Previous Year: None Specific Service(s): Transportation Planned Expenditures: $1,800 Children and Youth Services: Please provide the following: Program Name/ Description: Washington County Children and Youth Services for the provision of Counseling, Protective Services, Homemaker and Information and Referral services. • Counseling services will be provided to children ages six to seventeen and will focus on skill development as well as incorrigibility and runaway behavior. The funds will pay for the staff costs associated with this service and approximately 20 unduplicated clients will be served. • Protective Services include physical and sexual abuse investigation with appropriate treatment as well as forensic interviews. The funds will pay for the staff costs associated with this service and approximately 45 children ages infant to eighteen will be served. • Homemaker Services include educational programs focused on nutrition, budgeting, health and hygiene, laundry techniques and parenting skills. Approximately 35 clients will be served. • Information and Referral includes in-house evaluation of family’s needs and referral interagency or to another agency as appropriate. Changes in Service Delivery from Previous Year: None Specific Service(s): Counseling, Protective Services, Homemaker and Information and Referral services. Planned Expenditures: $89,503 DHS Bulletin 2015-1 County Human Services Plan Guidelines Generic Services: Please provide the following: Program Name/ Description: The Washington County Transportation Authority will provide the Veterans Transportation Program which provides transportation to and from the Veteran Hospitals in Pittsburgh. This funding is used to pay the driver of the veterans van. Changes in Service Delivery from Previous Year: None Specific Service(s): Transportation Planned Expenditures: $26,800 Specialized Services: Please provide the following: Program Name/ Description: The Greater Washington County Food Bank recruit and train volunteers. The volunteer coordinators must ensure all volunteers follow Food Bank, State and USDA regulations. The volunteers are vital to operation of established food pantries by assisting with the packaging, delivery and distribution of food to clients. 1,645 volunteers, providing approximately 32,052 hours of work, will be trained under this program. Changes in Service Delivery from Previous Year: None Planned Expenditures: $7,500 Interagency Coordination: During the 2015-2016 Fiscal Year, there are three (3) initiatives that will continue to be supported using HSDF funds in order to enhance the planning, delivery and coordination of services within Washington County’s human service system. The first initiative involves continuing to support a human services website, Washington Knows, to access pertinent information on available human service agencies and programs in the county. This website provides consumers, providers and the general public with real time information on service locations, hours of operation, eligibility criteria and other useful information to enhance the accessibility and delivery of human services. More than 70 categorical programs and community based non-profit agencies have their information on this website. Planned expenditures are $1,080. The second initiative involves the Department of Human Services, as the lead entity responsible for human service planning and coordination, meeting regularly with the categorical programs, private non-profit agencies, community organizations and stakeholders to ensure that planning efforts are well coordinated and to promote and facilitate agency collaboration. Planned Human Services expenditures are $10,600. The third initiative will be to secure a remote location in Charleroi, Pennsylvania and launch the regional office for Washington County. The implementation of a regional office will enable the Washington County to address the evolving needs of consumers as well as the providers. The office will house staff from Children and Youth Services, Drug and Alcohol and Behavior Health. The staff will be the first contact point for consumers to be referred to the services they need. This location will also be a receiving center for any consumer in Washington County with Human Service needs. This will also be a first step toward designing and testing a centralized intake system. Planned expenditures for the furniture are $13,320. In addition, funding will be used to pay for management and planning functions that will improve the efficiency and effectiveness of the human services Washington County is responsible for DHS Bulletin 2015-1 County Human Services Plan Guidelines providing. Administration funds will also be used for the monthly lease payments for the Charleroi Receiving Center. Administrative spending will be $21,900. Other HSDF Expenditures – Non-Block Grant Counties Only If you plan to utilize HSDF for Mental Health, Intellectual Disabilities, Homeless Assistance or Drug and Alcohol, please provide a brief description of the use and complete the chart below with individuals and expenditure information. The full description for these services funded by HSDF should be included in the narrative of the respective program. Category Estimated Individuals Planned HSDF Expenditures Mental Health Intellectual Disabilities Homeless Assistance Drug and Alcohol Note: Please refer to Appendix C -2, Planned Expenditures for reporting instructions. APPENDIX C-1 - BLOCK GRANT COUNTIES HUMAN SERVICES BLOCK GRANT PROPOSED BUDGET AND INDIVIDUALS SERVED Directions: Using this format, please provide the county plan for allocated Human Services expenditures and proposed numbers of individuals to be served in each of the eligible categories. 1). Estimated Individuals – Please provide an estimate in each cost center of the number of individuals to be served. An estimate must be entered for each cost center with associated expenditures. 2). HSBG Allocation - Please enter the county's total state and federal HSBG allocation for each program area (MH, ID, HAP, C&Y, D&A, and HSDF). 3). HSBG Planned Expenditures – Please enter the county's planned expenditures for HSBG funds in the applicable cost centers. The Grand Totals for HSBG Planned Expenditures and HSBG Allocation must equal. 4). Non-Block Grant Expenditures – Please enter the county's planned expenditures (MH& ID only) that are not associated with HSBG funds in the applicable cost centers. This does not include Act 148 funding or D&A funding received from the Department of Drug and Alcohol. 5). County Match - Please enter the county's planned match amount in the applicable cost centers. 6). Other Planned Expenditures – Please enter in the applicable cost centers, the county's planned expenditures not included in either the HSBG or Non-Block Grant allocations (such as grants, reinvestment, etc.). (Completion of this column is optional.) 7). County Block Grant Administration - Please provide an estimate of the county's administrative costs for services not included in MH or ID Services. NOTE: Fields that are grayed out are to be left blank. *Please use FY 14-15 Primary Allocations for completion of the budget. *If your county received a supplemental CHIPP allocation in FY 14-15, include the annualized amount in your FY 15-16 budget. *The Department will request your county to submit a revised budget if, based on the budget enacted by the General Assembly, the allocations for FY 2015/16 are significantly different than FY 2014/15. In addition, the county should submit a revised budget if and when it determines, at any point in the fiscal year, that expenditures in any cost centers/service categories will change by more than 20 percent. APPENDIX C-1 - BLOCK GRANT COUNTIES HUMAN SERVICES BLOCK GRANT PROPOSED BUDGET AND INDIVIDUALS SERVED 1. ESTIMATED 2. HSBG 3. HSBG PLANNED 4. NON-BLOCK 5. 6. OTHER County: INDIVIDUALS ALLOCATION EXPENDITURES GRANT COUNTY PLANNED SERVED (STATE AND FEDERAL) (STATE AND FEDERAL) EXPENDITURES MATCH EXPENDITURES MENTAL HEALTH SERVICES ACT and CTT 30 182,364 Administrative Management 2,800 556,618 Administrator's Office 1,041,670 Adult Developmental Training - Adult Day Care 0 0 Children's Evidence Based Practices 0 0 Children's Psychosocial Rehabilitation Services 0 0 Community Employment & Emplmt Rel Svcs 80 140,500 Community Residential Services 55 1,867,073 242,617 Community Services 346 171,858 Consumer-Driven Services 291 219,000 Emergency Services 1 142,975 Facility Based Vocational Rehabilitation 0 0 Family Based Mental Health Services 3 8,000 Family Support Services 5 32,000 Housing Support Services 343 1,097,620 Mental Health Crisis Intervention 124 46,984 Other 0 0 Outpatient 508 325,000 Partial Hospitalization 55 228,635 Peer Support Services 0 0 Psychiatric Inpatient Hospitalization 0 0 Psychiatric Rehabilitation 12 72,264 Social Rehabilitation Services 372 481,188 Targeted Case Management 246 239,429 Transitional and Community Integration 1,737 706,405 TOTAL MH SERVICES 7,008 7,559,583 7,559,583 0 242,617 0 APPENDIX C-1 - BLOCK GRANT COUNTIES HUMAN SERVICES BLOCK GRANT PROPOSED BUDGET AND INDIVIDUALS SERVED 1. ESTIMATED 2. HSBG 3. HSBG PLANNED 4. NON-BLOCK 5. 6. OTHER County: INDIVIDUALS ALLOCATION EXPENDITURES GRANT COUNTY PLANNED SERVED (STATE AND FEDERAL) (STATE AND FEDERAL) EXPENDITURES MATCH EXPENDITURES INTELLECTUAL DISABILITIES SERVICES Administrator's Office 494,656 Case Management 160 125,760 Community-Based Services 10 207,692 28,223 Community Residential Services 4 228,500 Other 0 0 TOTAL ID SERVICES 174 1,042,108 1,056,608 0 28,223 0 HOMELESS ASSISTANCE SERVICES Bridge Housing 60 18,371 Case Management 150 31,135 Rental Assistance 145 46,312 Emergency Shelter 200 106,600 Other Housing Supports TOTAL HAP SERVICES 555 224,501 202,418 0 0 CHILD WELFARE SPECIAL GRANT SERVICES Evidence Based Services 79 152,000 8,000 Promising Practice 275 627,750 72,250 Alternatives to Truancy 15 22,500 2,500 Housing 41 8,500 1,500 TOTAL CWSG SERVICES 410 810,750 810,750 84,250 0 APPENDIX C-1 - BLOCK GRANT COUNTIES HUMAN SERVICES BLOCK GRANT PROPOSED BUDGET AND INDIVIDUALS SERVED 1. ESTIMATED 2. HSBG 3. HSBG PLANNED 4. NON-BLOCK 5. 6. OTHER County: INDIVIDUALS ALLOCATION EXPENDITURES GRANT COUNTY PLANNED SERVED (STATE AND FEDERAL) (STATE AND FEDERAL) EXPENDITURES MATCH EXPENDITURES DRUG AND ALCOHOL SERVICES Case/Care Management 393 45,000 Inpatient Hospital Inpatient Non-Hospital 198 240,909 Medication Assisted Therapy Other Intervention Outpatient/Intensive Outpatient 170 80,000 Partial Hospitalization 25 41,500 Prevention Recovery Support Services TOTAL DRUG AND ALCOHOL SERVICES 786 452,409 407,409 0 0 HUMAN SERVICES AND SUPPORTS Adult Services Aging Services 403 33,800 Children and Youth Services 120 89,503 Generic Services 1,645 26,800 Specialized Services 330 7,500 Interagency Coordination 25,000 TOTAL HUMAN SERVICES AND SUPPORTS 2,498 219,003 182,603 0 0 7. COUNTY BLOCK GRANT ADMINISTRATION 0 88,983 0 GRAND TOTAL 11,431 10,308,354 10,308,354 0 355,090 0 DHS Bulletin 2015-1 County Human Services Plan Guidelines Appendix D Eligible Human Services Cost Centers Mental Health For further detail refer to Cost Centers for County Based Mental Health Services Bulletin (OMHSAS-12-02), effective July 1, 2012. Administrative Management Activities and administrative functions undertaken by staff in order to ensure intake into the county mental health system and the appropriate and timely use of available resources and specialized services to best address the needs of individuals seeking assistance. Administrator’s Office Activities and services provided by the Administrator’s Office of the County MH Program. Adult Development Training (ADT) – Adult Day Care Community-based programs designed to facilitate the acquisition of prevocational, behavioral activities of daily living, and independent living skills. Assertive Community Treatment (ACT) Teams and Community Treatment Teams (CTT) SAMHSA-recognized Evidence Based Practice (EBP) delivered to individuals with serious mental illness (SMI) who have a Global Assessment of Functioning (GAF) score of 40 or below and meet at least one other eligibility criteria (psychiatric hospitalizations, co-occurring mental health and substance abuse disorders, being at risk for or having a history of criminal justice involvement, and a risk for or history of homelessness). Children’s Evidence Based Practices Practices for children and adolescents that by virtue of strong scientific proof are known to produce favorable outcomes. A hallmark of these practices is that there is sufficient evidence that supports their effectiveness. Children’s Psychosocial Rehabilitation Services Activities designed to assist a child or adolescent (i.e., a person aged birth through 17, or through age 21 if enrolled in a special education service) to develop stability and improve capacity to function in family, school and community settings. Services may be delivered to the child or adolescent in the home, school, community or a residential care setting. Community Employment and Employment Related Services Employment in a community setting or employment-related programs, which may combine vocational evaluation, vocational training and employment in a non-specialized setting such as a business or industry. Community Residential Services Care, treatment, rehabilitation, habilitation, and social and personal development services provided to persons in a community based residential program which is a DHS-licensed or approved community residential agency or home. DHS Bulletin 2015-1 County Human Services Plan Guidelines Community Services Programs and activities made available to community human service agencies, professional personnel, and the general public concerning the mental health service delivery system and mental health disorders, in order to increase general awareness or knowledge of same. Consumer-Driven Services Services that do not meet the licensure requirements for psychiatric rehabilitation programs, but which are consumer-driven and extend beyond social rehabilitation services. Emergency Services Emergency related activities and administrative functions undertaken to proceed after a petition for voluntary or involuntary commitment has been completed, including any involvement by staff of the County Administrator’s Office in this process. Facility Based Vocational Rehabilitation Services Programs designed to provide paid development and vocational training within a community-based, specialized facility (sheltered workshop) using work as the primary modality. Family-Based Mental Health Services Comprehensive services designed to assist families in caring for their children or adolescents with emotional disturbances at home. Family Support Services Services designed to enable persons with serious mental illness (SMI), children and adolescents with or at risk of serious emotional disturbance (SED), and their families, to be maintained at home with minimal disruption to the family unit. Housing Support Services Services provided to mental health consumers which enable the recipient to access and retain permanent, decent, affordable housing, acceptable to them. Mental Health Crisis Intervention Services Crisis-oriented services designed to ameliorate or resolve precipitating stress, which are provided to adults or children and their families who exhibit an acute problem of disturbed thought, behavior, mood or social relationships. Other Services Activities or miscellaneous programs which could not be appropriately included in any of the cited cost centers. Outpatient Treatment-oriented services provided to a consumer who is not admitted to a hospital, institution, or community mental health facility for twenty-four hour a day service. Partial Hospitalization DHS Bulletin 2015-1 County Human Services Plan Guidelines Non-residential treatment services licensed by the Office of Mental Health & Substance Abuse Services (OMHSAS) for persons with moderate to severe mental illness and children and adolescents with serious emotional disturbance (SED) who require less than twenty-four hour continuous care but require more intensive and comprehensive services than are offered in outpatient treatment. Peer Support Services Refers specifically to the Peer Support Services which meet the qualifications for peer support services as set forth in the Peer Support Services Bulletin (OMHSAS 08-07-09), effective November 1, 2006. Psychiatric Inpatient Hospitalization Treatment or services provided an individual in need of twenty-four hours of continuous psychiatric hospitalization. Psychiatric Rehabilitation Services that assist persons with long-term psychiatric disabilities in developing, enhancing, and/or retaining: psychiatric stability, social competencies, personal and emotional adjustment and/or independent living competencies so that they may experience more success and satisfaction in the environment of their choice, and can function as independently as possible. Social Rehabilitation Services Programs or activities designed to teach or improve self-care, personal behavior and social adjustment for adults with mental illness. Targeted Case Management Services that provide assistance to persons with serious mental illness (SMI) and children diagnosed with or at risk of serious emotional disturbance (SED) in gaining access to needed medical, social, educational, and other services through natural supports, generic community resources and specialized mental health treatment, rehabilitation and support services. Transitional and Community Integration Services Services that are provided to individuals who are residing in a facility or institution as well as individuals who are incarcerated, diversion programs for consumers at risk of incarceration or institutionalization, adult outreach services, and homeless outreach services. Intellectual Disability Administrator’s Office Activities and services provided by the Administrator’s Office of the County ID Program. The Administrator’s Office cost center includes the services provided relative to the Administrative Entity Agreement, Health Care Quality Units (HCQU) and Independent Monitoring for Quality (IM4Q). DHS Bulletin 2015-1 County Human Services Plan Guidelines Case Management Coordinated activities to determine with the individual what services are needed and to coordinate their timely provision by the provider and other resources. Community Residential Services Residential habilitation programs in community settings for individuals with intellectual disabilities. Community Based Services Community-based services are provided to individuals who need assistance in the acquisition, retention, or improvement of skills related to living and working in the community and to prevent institutionalization. Other Activities or miscellaneous programs which could not be appropriately included in any of the cited cost centers. Homeless Assistance Bridge Housing Transitional services that allow individuals who are in temporary housing to move to supportive long-term living arrangements while preparing to live independently. Case Management Case management is designed to provide a series of coordinated activities to determine, with each individual, what services are needed to prevent the reoccurrence of homelessness and to coordinate their timely provision by administering agency and community resources. Rental Assistance Provides payments for rent, mortgage arrearage for home and trailer owners, rental costs for trailers and trailer lots, security deposits, and utilities to prevent and/or end homelessness or possible eviction by maintaining individuals and families in their own residences. Emergency Shelter Refuge and care services to persons who are in immediate need and are homeless; i.e., have no permanent legal residence of their own. Other Housing Supports Other supportive housing services outside the scope of existing Homeless Assistance Program components for individuals and families who are homeless or facing eviction. An individual or family is facing eviction if they have received either written or verbal notification from the landlord that they will lose their housing unless some type of payment is received. DHS Bulletin 2015-1 County Human Services Plan Guidelines Child Welfare Special Grants Promising Practice Dependency and delinquency outcome-based programs must include the number of children expected to be served, the expected reduction in placement, the relation to a benchmark selected by a county or a direct correlation to the county’s Continuous Quality Improvement Plan. Housing Activity or program designed to prevent children and youth from entering out of home placement, facilitate the reunification of children and youth with their families or facilitate the successful transition of youth aging out or those who have aged out of placement to living on their own. Alternatives to Truancy Activity or service designed to reduce the number of children referred for truancy, increase school attendance or improve educational outcome of student participants, increase appropriate advancement to the next higher grade level, decrease child/caretaker conflict or reduce percentage of children entering out of home care because of truancy. Evidence Based Programs Evidence-based programs use a defined curriculum or set of services that, when implement with fidelity as a whole, has been validated by some form of scientific evidence. Evidence-based practices and programs may be described as “supported” or “well-supported”, depending on the strength of the research design. For FY 2015-16, the CCYA may select any EBP (including, but not limited to Multi-Systemic Therapy (MST), Functional Family Therapy (FFT), Multidimensional Treatment Foster Care (MTFC), Family Group Decision Making (FGDM), Family Development Credentialing (FDC), or High-Fidelity Wrap Around (HFWA)) that is designed to meet an identified need of the population they serve that is not currently available within their communities. A list of EBP registries, which can be used to select an appropriate EBP, can be found at the Child Information Gateway online at: https://www.childwelfare.gov/topics/. Drug and Alcohol Care/Case Management A collaborative process, targeted to individuals diagnosed with substance use disorders or co-occurring psychiatric disorders, which assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual’s health needs to promote self-sufficiency and recovery. Inpatient Non-Hospital Inpatient Non-Hospital Treatment and Rehabilitation A licensed residential facility that provides 24 hour professionally directed evaluation, care, and treatment for addicted individuals in acute distress, whose addiction symptomatology is demonstrated by moderate impairment of social, occupation, and/or school functioning. Rehabilitation is a key treatment goal. DHS Bulletin 2015-1 County Human Services Plan Guidelines Inpatient Non-Hospital Detoxification A licensed residential facility that provides a 24-hour professionally directed evaluation and detoxification of an addicted individual. Inpatient Non-Hospital Halfway House A licensed community based residential treatment and rehabilitation facility that provides services for individuals to increase self-sufficiency through counseling, employment and other services. This is a live in/work out environment. Inpatient Hospital Inpatient Hospital Detoxification A licensed inpatient health care facility that provides 24 hour medically directed evaluation and detoxification of individuals diagnosed with substance use disorders in an acute care setting. Inpatient Hospital Treatment and Rehabilitation A licensed inpatient health care facility that provides 24 hour medically directed evaluation, care and treatment for addicted individuals with co-existing biomedical, psychiatric and/or behavioral conditions which require immediate and consistent medical care. Outpatient/ Intensive Outpatient Outpatient A licensed organized, non-residential treatment service providing psychotherapy and substance use/abuse education. Services are usually provided in regularly scheduled treatment sessions for a maximum of 5 hours per week. Intensive Outpatient An organized non-residential treatment service providing structured psychotherapy and stability through increased periods of staff intervention. Services are provided in regularly scheduled sessions at least 3 days per week for at least 5 hours (but less than 10) Partial Hospitalization Services designed for those individuals who would benefit from more intensive services than are offered in outpatient treatment projects, but do not require 24 -hour inpatient care. Treatment consists of the provision of psychiatric, psychological and other types of therapies on a planned and regularly scheduled basis at least 3 days per week with a minimum of 10 hours per week. Prevention The use of social, economic, legal, medical and/or psychological measures aimed at minimizing the use of potentially addictive substances, lowering the dependence risk in susceptible individuals, or minimizing other adverse consequences of psychoactive substance use. DHS Bulletin 2015-1 County Human Services Plan Guidelines Medication Assisted Therapy (MAT) Any treatment for opioid addiction that includes a medication approved by the U.S. Food and Drug Administration for opioid addiction detoxification or maintenance treatment. This may include methadone, buprenorphine, naltrexone, or vivitrol. Recovery Support Services Services designed and delivered by individuals who have lived experience with substance-related disorders and recovery to help others initiate, stabilize, and sustain recovery from substance abuse. These services are forms of social support not clinical interventions. This does not include traditional 12 step programs. Recovery Specialist An individual in recovery from a substance-related disorder that assists individuals gain access to needed community resources to support their recovery on a peer to peer basis. Recovery Centers A location where a full range of Recovery Support Services are available and delivered on a peer to peer basis. Recovery Housing A democratically run, self-sustaining and drug-free group home for individuals in recovery from substance related disorders. Human Services Development Fund / Human Services and Supports Administration Activities and services provided by the Administrator’s Office of the Human Services Department. Interagency Coordination Planning and management activities designed to improve the effectiveness of county human services. Adult Services Services for adults (a person who is at least 18 years of age and under the age of 60, or a person under 18 years of age who is head of an independent household) include: adult day care, adult placement, chore, counseling, employment, home delivered meals, homemaker, housing, information and referral, life skills education, protective, service planning/case management, transportation, or other service approved by DHS. Aging Services for older adults (a person who is 60 years of age or older) include: adult day care, assessments, attendant care, care management, congregate meals, counseling, employment, home delivered meals, home support, information and referral, overnight shelter/supervision, personal assistance service, personal care, protective services- intake investigation, socialization/recreation/ education/health promotion, transportation (passenger), volunteer services or other service approved by DHS. DHS Bulletin 2015-1 County Human Services Plan Guidelines Children and Youth Services for individuals under the age of 18 years; under the age of 21 years who committed an act of delinquency before reaching the age of 18 years or under the age of 21 years who was adjudicated dependent before reaching the age of 18 years and while engaged in a course of instruction or treatment requests the court to retain jurisdiction until the course has been completed and their families include: adoption service, counseling/intervention, day care, day treatment, emergency placement, foster family care (except room & board), homemaker, information & referral, life skills education, protective and service planning. Generic Services Services for individuals that meet the needs of two or more populations include: adult day care, adult placement, centralized information and referral, chore, counseling, employment, homemaker, life skills education, service planning/case management, and transportation services. Specialized Services New services or a combination of services designed to meet the unique needs of a specific population that are difficult to meet with the current categorical programs.