Value

Stakeholders, the Department of Community Health, and other residents of Van Buren County benefit from improved individual and population-based mental health outcomes.

Per Capita and Per Person Served Expenditures by Population for FY 2003-2004

Data provided by the Michigan Department of Community Health in June 2005

Percentage of Budget Spent by Population

Percentage of Residents Served

Summary

VBCMHA spends moreper capita than the state average on adults and children with mental illness and less per capita on persons with developmental disabilities and administrative costs. Administrative costs are the second lowest in the state. Costs per person served are lower than the staet average for adults with MI, persons with DD, and administrative costs. Costs per person served are higher than the state average for children with metnal illness. VBCMHA spends a higher percentage of its budget on adults and children with mental illness and a lower percentage on persons with developmental disabilities and on administrative costs. VBCMHA serves higher numbers of adults and children than the state average.

Narratives in response to Priorities from MDCH

Evidenced Based Practices:
           
During the past year, VBCMHA has worked in conjunction with Venture Behavioral Health and its affiliated CMHSPs to continue implementation of Evidenced Based Practices (EBPs).  Several initiatives to begin new EBPs and measure fidelity to the model are underway.  Additionally several models have been utilized for many years.
Since 1987, VBCMHA has had staff trained in the Assertive Community Treatment model.  We currently have two teams of trained staff providing services to over 90 adults with serious mental illness (SMI.)  One of the ACT teams specializes in serving adults with co-occurring disorders.  All current ACT staff have attended ACT 101 training.  Both ACT teams have been found in conformance with national CARF standards and are part of the organization’s three year accreditation award.  Both the DCH and the Venture Behavioral Health site surveys, completed in 2005, found high fidelity to the model by these programs. 
            An additional evidenced based practice that has been provided for many years is supported employment.   Supported Employment services have been provided by trained staff since the early 1990s.  In the current year more than 91 persons have been served with supported employment services. 
            In the last quarter of the 03-04 year, VBCMH, in partnership with Venture Behavioral Health, began training staff in the Comprehensive Continuous Integrated System of Care (CCISC) treatment model for Co-Occurring Disorders.  VBCMHA began training in substance abuse treatment for persons with SMI twelve years ago. In the 04-05 fiscal year more than 50 staff received more than 330 hours of training in the screening, assessment, and treating of persons with co-occurring disorders.  As part of a Venture performance improvement project, VBCMH demonstrated an increase from 2.5% of persons served to 18% of persons served as identified as having a co-occurring disorder.  It is believed the numbers of persons served with co-occurring disorders is even higher, but this increase represents the beginning results of increased staff training and awareness.  Additionally, the data indicate that VBCMHA treated more than 250 persons with co-occurring disorders in the third quarter of the fiscal year.  Van Buren CMH will continue to provide services to individuals with dual diagnoses through ACT and Outpatient Therapy programs (licensed Substance Abuse programs in the state of Michigan.) Additionally, through partnership with Venture Behavioral Health, VBCMHA will continue to train staff under the Comprehensive Continuous Integrated System of Care (CCISC) model to ensure ease of access to services and develop dual diagnosis competence in all service providers.  Although, Venture Behavioral Health chose to apply for the block grant dollars for implementation of another evidenced based practice rather than co-occurring disorders, Venture and its affiliates will continue to implement the CCISC model and continue the vital improvements to services for this vulnerable population.
            In the 03-04 year, through its partnership with Venture Behavioral Health, VBCMHA sent 4 staff for training in illness self management and recovery.  Additionally, in 04-05, 6 more staff received training.  A group meeting the SAMHSA criteria for evidenced based practice illness management and recovery was started, and to date has served 10 persons.    Additionally, the educational information on illness management and recovery is provided in many services throughout the continuum.
            Through its partnership with Venture Behavioral Health, VBCMHA in 03-04 sent 1 staff person for intensive training in Cognitive Behavioral Therapy (CBT.)   In 04-05, 12 staff received intensive training in CBT.  CBT is being utilized to serve both adults and children. We estimate that more than 50 persons are currently receiving CBT.
            With support from Venture Behavioral Health, in 03 04, VBCMHA had 5 staff receive intensive training in Dialectical Behavior Therapy (DBT.)  In 04 05, we served 20 persons using the DBT model.  Venture Behavioral Health completed a study of fidelity to the model for DBT services and VBCMHA was found to have very high fidelity to the model.  In instances where deviations from the model were found, we have made corrections to improve practice.  Three additional staff are beginning training in DBT services and we are planning to expand these services to adolescents and their families.
            In November 2005, VBCMHA is scheduled to send its first team of staff for training in Family Psychoeducation. We anticipate beginning to provide this service in March of 2006 and to serve 10 to 15 persons in the current fiscal year.
VBCMHA, in conjunction with Venture Behavioral Health and its affiliates shall continue to work together to implement Evidence Based Practice models. We shall continue to seek out training opportunities and send staff to training offered in these and other EBP models.

Employment:
           
VBCMHA served 91 individuals with supported employment services through our Career Connections Employment Service.  Of these 91 persons, 57 were persons with developmental disabilities and 34 were adults with serious persistent mental illness. Career Connections has a long and stable history of meeting the needs of persons who need support in attaining or maintaining employment.  Additionally, VBCMHA has operated a small but successful Fairweather Lodge program which employs on average 9 customers and provides a supported independent residence for up to 4 customers.  Both programs have the ability to increase hours of part time support staff in times of greater customer request for employment services, and both programs have close working relationships with staff in ACT, PSR, case management and supports coordination. 
Persons seeking employment services are assessed and assisted to find suitable employment through job development, job coaching, and follow-along services. CMH staff work closely with Michigan Rehabilitation Services and employers in our county to provide needed services. Within 14 days of referral for employment services, staff begin meeting with the customer to develop an employment plan. The average amount of time between referral and attainment of a job position is three months.  ACT, case management, supports coordination and PSR staff all work to support a customer in attaining needed skills that will help them be successfully employed, and these programs have long histories of supporting customers in maintaining employment after supported employment services are no longer needed.

Housing Options:
           
Case Managers and Support Coordinators have for years made it a priority to help customers attain their desired living arrangement.  During the last half of the 03-04 fiscal year, VBCMHA worked with a provider agency to develop supported independent housing.  In the 04 05 fiscal year, VBCMHA served five persons with serious and persistent mental illness through this newly created option.  These five persons were assisted in moving into their own apartments and received training in independent living skills.  Additionally in May 2005, VBCMHA began implementation of a PATH grant to place up to 5 adults who are homeless and have serious and persistent mental illness.  Thus far five persons have been assisted in moving from temporary, inadequate housing situations to a home of their own.
VBCMHA will continue to work with landlords in our county, government subsidization programs and the Southwest Michigan Community Action Agency to assist customers desiring to live in a more independent setting to attain this goal.  Case managers and supports coordinators will also continue to link persons served with services that will build skills necessary to maintain independent or semi-independent housing.

Jail Diversion:
           
 VBCMHA developed and continues to operate a collaborative jail diversion program within Van Buren County.  VBCMHA Jail liaisons co-ordinate with all shareholder staff; Sheriff’s Dept., Correctional staff, Road officers, Office of Community Corrections, (OCC), Adult Protective Services, Circuit Court Juvenile Division and District and Circuit judges to facilitate appropriate diversions and provide services to those not eligible for diversion. VBCMHA Jail liaisons also coordinate with other counties to assure appropriate evaluation and diversion if appropriate for residents of their respective communities.  Jail diversion evaluations are provided on an as needed basis 24/7, 365 days per year through VBCMHA Jail Liaisons, Crisis On-Call, ACT teams, Clinicians and Case Management. All diversion evaluations and diversions are monitored and reviewed by Jail Liaisons and Sheriff’s representative monthly.
Cross training for law enforcement is provided through consultation throughout the year with at least one joint annual training occurring. Jail Liaison(s) are members of and meet routinely with shareholders at quarterly OCC meetings.  Additional OCC meetings may occur as need is identified. 
During the 04-05 fiscal year, the VBCMHA Quality Improvement Coordinator identified confusion about the definition of a diversion evaluation and possibly, the definition of a subsequent jail diversion.  A common language was developed and distributed to all staff with instructions to address any questions to Jail Liaisons.  All shareholders will continue to monitor and review throughout the year and discuss possible areas for improvement.

Self Determination
           
VBCMHA began implementation of Self-determination in 1998 as a pilot site of the Robert Wood Johnson Self-Determination Grant to the State of Michigan. In the past 4 years VBCMHA has collaborated with Venture Behavioral Health and its affiliates to implement Self-Determination best practices via a Self Determination work group whose members include both staff and consumer representatives from each affiliate.  This work group developed policies and procedures to implement Self-Determination as well as materials to educate consumers, families, staff and other interested persons.  
Information regarding Self-Determination and how to pursue this means of receiving services is distributed to all persons seeking services through our Access Unit.  Current consumers are given at least annual opportunity to choose this method of service delivery. The Self-Determination Coordinator is responsible to track all persons requesting services via Self-Determination procedures. 
VBCMHA currently has two consumers receiving services through Self-Determination processes. We have the capacity to meet the need of a significant number of persons choosing this method of service delivery (50+) and will continue to pursue ensuring flexibility of fund allocation. 
Staff and consumers will continue to attend state offered conferences as well as local in-services offered.   .  
            VBCMHA will continue to seek technical assistance and support from DCH regarding the implementation of fiscal intermediaries including auditor acknowledgment and agreement to support this direction as evidenced by the removal of potential audit obstacles. 

Empowerment, Recovery and Inclusion:
           
VBCMHA has been actively involved for years in utilizing the philosophies of empowerment, recovery and inclusion. The evidence can be seen in long standing history of support of PsychoSocial Rehabilitation Services, ACT services and Consumer Run Drop In Centers. Additionally, in the past 3 years, DCH site reviewers have found that 92% of VBCMHA treatment plans addressed ways or methods to increase the inclusion of the consumer in the community.   Many staff received training in empowerment, recovery and inclusion prior to the past 3 fiscal years.  During the 03-04 fiscal year, the Board of Directors had a sub goal of supporting consumers in developing maximum self sufficiency.  The board was satisfied with the report of progress in this area to subsume this goal under regular ongoing processes. 
            During the 04-05 fiscal year VBCMHA a number of clinical policies and procedures were reviewed and revised to insure consistency with the philosophies of empowerment, recovery and inclusion.  A training on empowerment and recovery has been developed and will be provided through interactive computer learning to the majority of service providers in the 2006 fiscal year.