The Mental Health Recovery The Mental Health Recovery Center of Clinton & Warren Center of Clinton & Warren Counties Counties aka “The Center”aka “The Center”

Changing the Way Services to Changing the Way Services to People with Severe Mental People with Severe Mental

Disabilities (SMD) are Delivered in Disabilities (SMD) are Delivered in Our CommunitiesOur Communities

22

975 Fujitec Drive - Lebanon975 Fujitec Drive - Lebanon

33

Who We Are: Clinton CountyWho We Are: Clinton CountyFrom 1984 until July 1, 2008, we had been From 1984 until July 1, 2008, we had been

known as the Mental Health Recovery known as the Mental Health Recovery Center of Clinton CountyCenter of Clinton County

We were located in Wilmington (Clinton We were located in Wilmington (Clinton County) and served primarily the citizens County) and served primarily the citizens of Clinton Countyof Clinton County

44

Who We Are: Warren CountyWho We Are: Warren CountyStarting July 1, 2008, we were asked by Starting July 1, 2008, we were asked by

the Mental Health Recovery Service the Mental Health Recovery Service funding Board to assume responsibility for funding Board to assume responsibility for all services in Warren & Clinton Counties all services in Warren & Clinton Counties for people with severe mental disabilities for people with severe mental disabilities (SMD)(SMD)

To that end, the Fujitec facilities represent To that end, the Fujitec facilities represent that expansion into Warren Countythat expansion into Warren County

55

Who We Are: Names are ChangingWho We Are: Names are Changing

With the move to Warren County, our With the move to Warren County, our agency is now doing business as: agency is now doing business as: The Mental Health Recovery Center of Clinton & Warren Counties

We are working with a local advisory We are working with a local advisory group on an agency name change and group on an agency name change and longer term strategic planning processlonger term strategic planning process

For simplicity, the agency is mostly known For simplicity, the agency is mostly known as as “The Center”

66

MISSIONMISSION::The Center supports the communities of Clinton The Center supports the communities of Clinton

and Warren Counties in responding to and Warren Counties in responding to behavioral health issues through prevention, behavioral health issues through prevention, intervention, treatment, rehabilitation and asset intervention, treatment, rehabilitation and asset building services. Our mission is sharing hope building services. Our mission is sharing hope and caring to achieve recovery from mental and caring to achieve recovery from mental illness, alcoholism, and drug addiction. Our illness, alcoholism, and drug addiction. Our expectations for recovery include the acquisition expectations for recovery include the acquisition of meaningful roles, sobriety, healthy of meaningful roles, sobriety, healthy relationships with friends and family, and a joyful relationships with friends and family, and a joyful life…life…

77

MISSION SPECIFIC TO WARREN MISSION SPECIFIC TO WARREN COUNTYCOUNTY::

““To help people function better so that they can become To help people function better so that they can become more successful and satisfied in their preferred living, more successful and satisfied in their preferred living, learning, working, and/or social environments, with the learning, working, and/or social environments, with the least amount of ongoing assistance from agents of the least amount of ongoing assistance from agents of the mental health system...” mental health system...”

The focus of the mission is on community outcomes for The focus of the mission is on community outcomes for the clients the clients

A simple way to summarize the mission is that it is all A simple way to summarize the mission is that it is all about “Recovery” from mental illness. about “Recovery” from mental illness.

It is not merely enough to speak about Recovery. Our It is not merely enough to speak about Recovery. Our expectation is for active implementation and application expectation is for active implementation and application of the principles, philosophy, and technology of of the principles, philosophy, and technology of Recovery. Recovery.

88

VISIONVISION::The Center will set the standard for excellence in The Center will set the standard for excellence in

delivering behavioral healthcare. We will:delivering behavioral healthcare. We will: Actively engage our talents to promote the Actively engage our talents to promote the

common vision of recovery.common vision of recovery. Anticipate and respond to the emerging needs of Anticipate and respond to the emerging needs of

our community.our community. Offer services in the most clinically appropriate Offer services in the most clinically appropriate

environment.environment. Demonstrate abilities exceeding local, state and Demonstrate abilities exceeding local, state and

national standards national standards

99

ValuesValuesThe Center believes in a stated set of standards and values The Center believes in a stated set of standards and values

consistent with professional conduct in the delivered with consistent with professional conduct in the delivered with compassion and respect:compassion and respect:

Good stewardship. We believe that we are responsible Good stewardship. We believe that we are responsible to the Warren &Clinton County communities for providing to the Warren &Clinton County communities for providing quality services relevant to its needs.quality services relevant to its needs.

A foundation of integrity. Our integrity is expressed A foundation of integrity. Our integrity is expressed through our commitment to be open and honest with our through our commitment to be open and honest with our community, employees and our clients.community, employees and our clients.

Investment in our employees. We promote continuous Investment in our employees. We promote continuous efforts to learn, improve and implement best practices to efforts to learn, improve and implement best practices to better address the needs of our customers.better address the needs of our customers.

1010

GUIDING PRINCIPLES of GUIDING PRINCIPLES of RECOVERYRECOVERY

Consumers of mental health services can identify realistic goals for themselves:

Choice is fundamental to recovery and is Choice is fundamental to recovery and is expected to be reflected in all clinical and expected to be reflected in all clinical and rehabilitative activities.rehabilitative activities.

1111

GUIDING PRINCIPLES of GUIDING PRINCIPLES of RECOVERYRECOVERY

Improving client functioning, and not simply maintaining people in the community, is a part of the agencies' mission:

A maintenance-only mission is A maintenance-only mission is yesterday’s mission and not part of the yesterday’s mission and not part of the philosophy of our network of service. philosophy of our network of service.

1212

GUIDING PRINCIPLES of GUIDING PRINCIPLES of RECOVERYRECOVERY

Psychiatrically disabled persons’ skills and supports relate to community outcomes more strongly than do their symptoms:

Our system ensures that services provide for Our system ensures that services provide for skill development and support development, skill development and support development, and not just symptom relief. and not just symptom relief.

The agency realizes that persons with The agency realizes that persons with psychiatric disabilities are limited not only by psychiatric disabilities are limited not only by their major psychiatric symptoms but primarily their major psychiatric symptoms but primarily by their persistent social and vocational deficitsby their persistent social and vocational deficits

1313

GUIDING PRINCIPLES of GUIDING PRINCIPLES of RECOVERYRECOVERY

Persons who are psychiatrically disabled need different services, at different times, and at different levels of intensity:

Persons with psychiatric disabilities do not Persons with psychiatric disabilities do not need the same kinds of services. need the same kinds of services.

The agency has developed a large range of The agency has developed a large range of service alternatives, packaged differently for service alternatives, packaged differently for different clients. different clients.

1414

GUIDING PRINCIPLES of GUIDING PRINCIPLES of RECOVERYRECOVERY

Agency personnel who work in programs serving persons with severe mental illness will be appropriately trained.

Most staff are untrained in the new technology Most staff are untrained in the new technology of rehabilitative service delivery. of rehabilitative service delivery.

Our agency recognizes that skilled and Our agency recognizes that skilled and dedicated personnel are our most important dedicated personnel are our most important and costly resource. and costly resource.

As a result, we have implemented a year-As a result, we have implemented a year-round training plan to acquire and utilize state round training plan to acquire and utilize state of the art psychiatric rehabilitation skills for of the art psychiatric rehabilitation skills for personnel personnel

1515

What Services We Provide in What Services We Provide in Warren County:Warren County:

Crisis & Emergency Mental Health ServicesCrisis & Emergency Mental Health Services Psychiatric Services including Pharmacological Psychiatric Services including Pharmacological

ManagementManagement 3 Levels of Case Management for People with 3 Levels of Case Management for People with

Severe Mental IllnessesSevere Mental Illnesses Vocational RehabilitationVocational Rehabilitation Housing Support ServicesHousing Support Services Psychiatric Rehabilitation Services Psychiatric Rehabilitation Services TransportationTransportation Intensive Rehabilitation Residential ServicesIntensive Rehabilitation Residential Services

1616

Case Management: ACT TeamsCase Management: ACT Teams Assertive Community Treatment (ACT): Assertive Community Treatment (ACT): a a

multidisciplinary team approach that shall include, at a multidisciplinary team approach that shall include, at a minimum, behavioral health counseling and therapy minimum, behavioral health counseling and therapy service, mental health assessment service, service, mental health assessment service, pharmacologic management service, community pharmacologic management service, community psychiatric supportive treatment (CPST) service, self-psychiatric supportive treatment (CPST) service, self-help/peer support service, mental health crisis response help/peer support service, mental health crisis response service, substance abuse services, and supported service, substance abuse services, and supported employment services. System clients participating in the employment services. System clients participating in the ACT program present high impairment/high to moderate ACT program present high impairment/high to moderate disability challenges.disability challenges.

Target Population: Target Population: Eligible Warren & Clinton County SMD Eligible Warren & Clinton County SMD Caseload Limit: Caseload Limit: 10:110:1

1717

Case Management: Intensive Case Case Management: Intensive Case Management (ICM)Management (ICM)

Intensive Case Management (ICM):Intensive Case Management (ICM): is an integrated is an integrated Psychiatric Rehabilitation (PRCI) and Case Management Psychiatric Rehabilitation (PRCI) and Case Management service that is primarily focused on serving the moderate service that is primarily focused on serving the moderate impairment/high disability client. As a standard, Intensive impairment/high disability client. As a standard, Intensive Case Managers will average at least 1 visit per client on Case Managers will average at least 1 visit per client on their case load per week. Specifically, ICM services are their case load per week. Specifically, ICM services are targeted for clients: targeted for clients: receiving residential services, receiving residential services, Probated and Forensic Monitoring clients, Probated and Forensic Monitoring clients, Clients exceeding 10 days length of stays in hospitals, and/orClients exceeding 10 days length of stays in hospitals, and/or

Target Population: Target Population: Eligible Warren & Clinton County SMD Eligible Warren & Clinton County SMD Caseload Limit: Caseload Limit: 30:130:1

1818

Case Management: Standard Case Case Management: Standard Case Management (SCM)Management (SCM)

Standard Case Management (SCM):Standard Case Management (SCM): Standard Standard Case Management in the MHRS system utilize Case Management in the MHRS system utilize the Role Recovery “case coordination” (vs. direct the Role Recovery “case coordination” (vs. direct service) approach to assess, plan, and organize service) approach to assess, plan, and organize the provision of ancillary services to focus on the provision of ancillary services to focus on attaining goals that reflect the consumer’s self-attaining goals that reflect the consumer’s self-determined recovery aspirations. determined recovery aspirations.

Target Population: Target Population: Eligible Warren & Clinton County Eligible Warren & Clinton County SMD SMD

Caseload Limit: 8Caseload Limit: 80:10:1

1919

Agency PerformanceAgency Performance: Efficient Use : Efficient Use of the Public Dollar #1of the Public Dollar #1

In State Fiscal Year 2008, Emergency & In State Fiscal Year 2008, Emergency & Case Management Services Provided by Case Management Services Provided by the Mental Health Recovery Center of the Mental Health Recovery Center of Clinton/Warren Counties assisted in Clinton/Warren Counties assisted in saving the County nearly saving the County nearly $500,000 in in Private Hospitalization costs Private Hospitalization costs (source: FY 08 MHRS Board Budget)(source: FY 08 MHRS Board Budget)

This saving allows the system to re-invest This saving allows the system to re-invest those dollars in expanding local services those dollars in expanding local services such as residential programs such as residential programs

2020

Agency PerformanceAgency Performance: Efficient Use : Efficient Use of the Public Dollar #2of the Public Dollar #2

In State Fiscal Year 2008, Emergency & Case In State Fiscal Year 2008, Emergency & Case Management Services Provided by the Mental Management Services Provided by the Mental Health Recovery Center of Clinton/Warren Health Recovery Center of Clinton/Warren Counties reduced State Hospital Bed Day usage Counties reduced State Hospital Bed Day usage by nearly 1,150 days from FY 2007. At by nearly 1,150 days from FY 2007. At $481/day, that represented a savings to the $481/day, that represented a savings to the community of community of $ 553,000. . (source: FY 07 & 08 ODMH PCS)(source: FY 07 & 08 ODMH PCS)

This saving allows the system to re-invest those This saving allows the system to re-invest those dollars in expanding local services such as dollars in expanding local services such as Outpatient Counseling programs Outpatient Counseling programs

The Intensive Residential The Intensive Residential Rehabilitation (IRR) FacilityRehabilitation (IRR) Facility

““Much More than Maintenance in Much More than Maintenance in the Community …”the Community …”

2222

Who Is the Target Population for Who Is the Target Population for Intensive Residential Intensive Residential

Rehabilitation?Rehabilitation?One of more of the following conditions:One of more of the following conditions:

High ImpairmentHigh Impairment: : consumers meeting SMD criteria and ongoing consumers meeting SMD criteria and ongoing moderate/high levels of symptomology but not requiring acute moderate/high levels of symptomology but not requiring acute hospitalization hospitalization

High DisabilityHigh Disability: : consumers with history of and/or current lack of consumers with history of and/or current lack of

role functioning in community residential environmentsrole functioning in community residential environments High RiskHigh Risk: consumers determined to present (a) significant safety : consumers determined to present (a) significant safety

risk to the community and/or (b) significant fiscal risk to the system risk to the community and/or (b) significant fiscal risk to the system without IRR interventionwithout IRR intervention

2323

What is Intensive Residential What is Intensive Residential Rehabilitation (IRR)?Rehabilitation (IRR)?

A comprehensive program specifically designed to assist persons with persistent mental illness to A comprehensive program specifically designed to assist persons with persistent mental illness to develop critical skills for full participation in the life of the community at the most facilitative level develop critical skills for full participation in the life of the community at the most facilitative level of residential care and/or support. of residential care and/or support.

The IRR is not “Transitional”, “Long-Term”, or even “Group Home” living as those terms limit the The IRR is not “Transitional”, “Long-Term”, or even “Group Home” living as those terms limit the scope and system understanding of the core objectives of the program and it’s function in the scope and system understanding of the core objectives of the program and it’s function in the SMD network.SMD network.

The IRR Program foundation is based on Psychiatric Rehabilitation Technology and Recovery The IRR Program foundation is based on Psychiatric Rehabilitation Technology and Recovery principles and philosophy (Boston University, Anthony, 1990)principles and philosophy (Boston University, Anthony, 1990)

There are 12 beds in the IRR Program, which are staffed by mental health professionals and There are 12 beds in the IRR Program, which are staffed by mental health professionals and technicians 24 hours a day, seven days a week.  10 beds are purchased by the Board for High technicians 24 hours a day, seven days a week.  10 beds are purchased by the Board for High Disability, Impairment, and Risk clients. 2 beds are purchased by the Board for non-medical Disability, Impairment, and Risk clients. 2 beds are purchased by the Board for non-medical Respite services and/or Emergency Housing. Respite services and/or Emergency Housing.

The IRR is/will be licensed by the Ohio Department of Mental Health as a Type 1 Residential The IRR is/will be licensed by the Ohio Department of Mental Health as a Type 1 Residential facilityfacility (Provides room & board, personal care, & mental health services to one or more residents (Provides room & board, personal care, & mental health services to one or more residents per OAC - Chapter 5122-30 Licensing of Residential Facilities.)per OAC - Chapter 5122-30 Licensing of Residential Facilities.)

2424

What is Intensive Residential What is Intensive Residential Rehabilitation?Rehabilitation?

IIntensiventensive: denotes the high level of structure & : denotes the high level of structure & consumer instruction present in the living consumer instruction present in the living environmentenvironment

RResidentialesidential: denotes the daily focus on improving : denotes the daily focus on improving functioning in the immediate living environmentfunctioning in the immediate living environment

RRehabilitationehabilitation: denotes the primary service delivery : denotes the primary service delivery

modality is developing skills and supports in both modality is developing skills and supports in both the current residential environment as well as the current residential environment as well as choosing-getting-keeping future living, learning, and choosing-getting-keeping future living, learning, and working environmentsworking environments

2525

Why is Intensive Residential Why is Intensive Residential Rehabilitation Needed?Rehabilitation Needed?

Anticipating Further Growth in Warren County, the system must continually create resources that serve as alternatives to High Dollar State Hospitalization, Private Hospitalization, and Incarceration.

2626

Where/When is Intensive Where/When is Intensive Residential Rehabilitation to Be Residential Rehabilitation to Be

Implemented?Implemented? 975 Fujitec Drive - Building B Lebanon, OH975 Fujitec Drive - Building B Lebanon, OH

No Immediate Family/Residential NeighborhoodsNo Immediate Family/Residential Neighborhoods

No Immediate Day Care/Schools in AreaNo Immediate Day Care/Schools in Area

Walking Distance of Main ClinicWalking Distance of Main Clinic

IRR Target Admissions April 1IRR Target Admissions April 1stst, 2009, 2009

2727

How is the Intensive Residential How is the Intensive Residential Rehabilitation Program Conducted?Rehabilitation Program Conducted? The “The “The Teaching as Treatment”The Teaching as Treatment” approach as approach as

developed by Robert Carkhuff indicated developed by Robert Carkhuff indicated “that training “that training clients directly in the skills that they need to function in clients directly in the skills that they need to function in society would be a potent treatment method” society would be a potent treatment method”

The heart of Teaching as Treatment skills training The heart of Teaching as Treatment skills training program is to systematically teach clients the same program is to systematically teach clients the same relationship skills that the effective helper/staff uses in relationship skills that the effective helper/staff uses in the helping process.the helping process.

Teaching as Treatment has been further Refined for use Teaching as Treatment has been further Refined for use in the IRR through the addition of Psychiatric in the IRR through the addition of Psychiatric Rehabilitation technologyRehabilitation technology

2828

Example #1: Master Functional Assessment Example #1: Master Functional Assessment Environment: Intensive Residential Rehabilitation Facility Environment: Intensive Residential Rehabilitation Facility

The Master Functional Assessment is completed within the first 3 months of client admission to the IRR facility. The The Master Functional Assessment is completed within the first 3 months of client admission to the IRR facility. The Assessment consists of required behaviors to successful in the IRR environment and the skills underlying each Assessment consists of required behaviors to successful in the IRR environment and the skills underlying each

behavior. Each skill listed has a corresponding Skill Evaluation Package and Lesson Plan. The four required behaviors behavior. Each skill listed has a corresponding Skill Evaluation Package and Lesson Plan. The four required behaviors are: (1) Manage Personal Budget, (2) Perform Household Chores, (3) Get Along with Others, and (4) Maintain Health are: (1) Manage Personal Budget, (2) Perform Household Chores, (3) Get Along with Others, and (4) Maintain Health

& Safety.& Safety.

REQUIRED BEHAVIOR #1: MANAGE PERSONAL BUDGET

Critical Skills Strength(+)

Deficit(-)

If Deficit, indicate Type of Intervention Needed

Needed: # or %day/wk/

mo

Spontaneous Use

# or %day/wk/mo

Prompted Performance

DirectSkillsTeaching

SkillsProgramming

Creating a Spending Plan

Evaluating Decisions

Monitoring Budget

Individualized Skill:

Individualized Skill:

Comments:

2929

Example #2: Example #2: EVALUATION MODULEEVALUATION MODULEFORFOR

CREATING A SPENDING PLANCREATING A SPENDING PLANSCRIPT OBSERVER LOG

Observer says: I’d like you to Create a Spending Plan for yourself by anticipating your financial situation for next month. Use these worksheets to help you.

Summarize responseincome and expenses identified?expenses prioritized?payments scheduled?

If person does not Create a Spending Plan, then

Observer says: Please Create a Spending Plan now. Summarize responseincome and expenses identified?expenses prioritized?payments scheduled?

If person does not Create a Spending Plan, then

Observer says: Please record the amount of money you are allocating to pay for items and services. Summarize responseincome and expenses identified?expenses prioritized?payments scheduled?

If the person does not Create a Spending Plan by listing, prioritizing and scheduling items, then

Observer says: Please list income and expenses, prioritize expenses and schedule payments. Summarize responseincome and expenses identified?expenses prioritized?payments scheduled?

3030

Teaching the Lesson PlanTeaching the Lesson Plan

The lesson plan structure is a five-part format of a Review, an Overview, a Presentation, an The lesson plan structure is a five-part format of a Review, an Overview, a Presentation, an Exercise, and a Summary, also known as ROPES (Cohen, Danley, and Nemec, l985; Carkhuff Exercise, and a Summary, also known as ROPES (Cohen, Danley, and Nemec, l985; Carkhuff and Berenson, l976). and Berenson, l976).

The Review involves a discussion and exploration of the client's experiences and understanding The Review involves a discussion and exploration of the client's experiences and understanding of the skill. of the skill.

The Overview provides the information from the content outline, including what the skill is, why it The Overview provides the information from the content outline, including what the skill is, why it is important, the steps of how the skill is performed, and a description of the general condition in is important, the steps of how the skill is performed, and a description of the general condition in which the skill is to be performed. In addition, the learner is given a correct image of the skill in which the skill is to be performed. In addition, the learner is given a correct image of the skill in an example. an example.

The Presentation provides opportunities for the client to hear about, see, and practice each of the The Presentation provides opportunities for the client to hear about, see, and practice each of the critical skill behaviors separately. critical skill behaviors separately.

The Exercise is a chance for the learner to practice performing the critical skill behaviors together The Exercise is a chance for the learner to practice performing the critical skill behaviors together and to receive feedback on his/her performance. and to receive feedback on his/her performance.

The Summary reviews the learner's understanding of the newly learned skill and provides an The Summary reviews the learner's understanding of the newly learned skill and provides an orientation to the client's future use of the skill. orientation to the client's future use of the skill.

3131

IRR Teaching KitchenIRR Teaching Kitchen

3232

Example #3: DIRECT SKILLS TEACHING LESSON PLANExample #3: DIRECT SKILLS TEACHING LESSON PLANCreating a Spending PlanCreating a Spending Plan

OrientOrient: Today I am going to teach you the skill of Creating a Spending Plan. First, I would like to ask you some questions about what you : Today I am going to teach you the skill of Creating a Spending Plan. First, I would like to ask you some questions about what you already know about Creating a Spending Plan, and to review what experiences you have had with the skill.already know about Creating a Spending Plan, and to review what experiences you have had with the skill.

AskAsk:: What does the term “Spending Plan” mean to you? What does the term “Spending Plan” mean to you?

DiscussDiscuss: Answers and : Answers and respondrespond..

TellTell:: A spending plan is like a budget. It is a decision about how you are going to spend your money.A spending plan is like a budget. It is a decision about how you are going to spend your money.

AskAsk:: When was the last time you saw someone Create a Spending Plan?When was the last time you saw someone Create a Spending Plan?What did he/she do?What did he/she do?What happened when you tried to Create a Spending Plan?What happened when you tried to Create a Spending Plan?How does it feel to run out of money?How does it feel to run out of money?How do you think you would feel if you did Create a Spending Plan? How do you think you would feel if you did Create a Spending Plan? How might learning this skill of Creating a Spending Plan be important to you?How might learning this skill of Creating a Spending Plan be important to you?

DiscussDiscuss:: Answers and Answers and respond.respond.

TellTell:: Your Overall Rehabilitation Goal is to live at Your Overall Rehabilitation Goal is to live at (name the place)(name the place) by/until by/until (name the date).(name the date).

AskAsk:: How will learning this skill of Creating a Spending Plan help you to reach your goal of living successfully at How will learning this skill of Creating a Spending Plan help you to reach your goal of living successfully at (name the (name the place)?place)?

DiscussDiscuss:: Answers and Answers and respondrespond..

SummarizeSummarize:: Main points from the Review.Main points from the Review.

3333

IRR Living RoomIRR Living Room

3434

What is the Success Standard for What is the Success Standard for Intensive Residential Rehabilitation Intensive Residential Rehabilitation

Program Service?Program Service?1.1. To Teach Clients How To Respond To Others And To Teach Clients How To Respond To Others And

Themselves In A Skillful Manner So That These Clients Themselves In A Skillful Manner So That These Clients May Function More Effectively In Interpersonal May Function More Effectively In Interpersonal Situations Both In And, Ultimately, Outside Of The IRRSituations Both In And, Ultimately, Outside Of The IRR

2.2. To Teach Clients The Most Critical Physical, Emotional, To Teach Clients The Most Critical Physical, Emotional, And Intellectual Skills Needed To Be Successful And And Intellectual Skills Needed To Be Successful And Satisfied In The IRR EnvironmentSatisfied In The IRR Environment

3.3. To Generalize The Most Critical Physical, Emotional, To Generalize The Most Critical Physical, Emotional, And Intellectual Skills Needed To Be Successful And And Intellectual Skills Needed To Be Successful And Satisfied In Satisfied In FutureFuture Chosen Community Living Chosen Community Living EnvironmentsEnvironments

3535

How is Success Achieved through How is Success Achieved through IRR Personnel?IRR Personnel?

Unit personnel are trained and coached on utilizing Psychiatric Unit personnel are trained and coached on utilizing Psychiatric Rehabilitation Technology, Rehabilitation Technology, i.e. Functional Assessment Evaluation & Skill i.e. Functional Assessment Evaluation & Skill Teaching. Teaching.

Previous implementation of this approach in Role Recovery hospital and Previous implementation of this approach in Role Recovery hospital and IRR sites in Florida and Alabama yielded a “halo” effect of a magnified staff IRR sites in Florida and Alabama yielded a “halo” effect of a magnified staff commitment to the program by assuming greater responsibility for the commitment to the program by assuming greater responsibility for the accurate assessment and input towards the resident’s capabilities.accurate assessment and input towards the resident’s capabilities.

Unit staff training is then enhanced with the addition of interpersonal Unit staff training is then enhanced with the addition of interpersonal Readiness Development techniques designed to help personalize the Readiness Development techniques designed to help personalize the resident’s accomplishments of learning the skills. resident’s accomplishments of learning the skills.

The result is continual staff/consumer focus of the requirements for success The result is continual staff/consumer focus of the requirements for success and continual staff/consumer focuses on the implications for Recovery as a and continual staff/consumer focuses on the implications for Recovery as a result of skill acquisition.result of skill acquisition.

3636

What is the Standard for Discharge in the Intensive What is the Standard for Discharge in the Intensive Residential Rehabilitation Program Service?Residential Rehabilitation Program Service?

One of more of the following conditions:One of more of the following conditions:

Managed to Moderate ImpairmentManaged to Moderate Impairment: : as indicated by documented ability to as indicated by documented ability to manage symptoms effectively through coping and medication regime. (This manage symptoms effectively through coping and medication regime. (This does not imply “symptom-free”.)does not imply “symptom-free”.)

Successful Role Functioning in IRR EnvironmentSuccessful Role Functioning in IRR Environment: : as indicated by as indicated by

achieving Skill Asset Status on Master Functional Assessment i.e. achieving Skill Asset Status on Master Functional Assessment i.e. performing skill at or near the Needed level.performing skill at or near the Needed level.

Intended Role Choice & Functioning in Community Living Intended Role Choice & Functioning in Community Living EnvironmentEnvironment: : as indicated by (a) Overall Residential Rehabilitation Goal as indicated by (a) Overall Residential Rehabilitation Goal and (b) Environmentally Specific Critical Skill & Support Assessment and (b) Environmentally Specific Critical Skill & Support Assessment needed to achieve the Overall Rehabilitation Goal. needed to achieve the Overall Rehabilitation Goal.

Low RiskLow Risk: : consumers determined to present (a) no significant safety risk to consumers determined to present (a) no significant safety risk to the community and/or (b) no significant fiscal risk to the Board without the community and/or (b) no significant fiscal risk to the Board without continuing IRR interventioncontinuing IRR intervention

3737

IRR: Fiscal Reallocation through IRR: Fiscal Reallocation through System PerformanceSystem Performance

Indicator Measure SFY 2007 SFY 2008 Monthly Net Change

Total Hotline Calls Rec’d

Avg. # per Month 360 122 (-238)

Hotline Calls Deemed “Immediate Crisis”

Avg. # per Month 74 (21% of all calls)

12(10% of all calls)

(-62)

SMD on Community Probate

Avg. # per Month 49 6 (-43)

State Hospital Bed Days

Avg. Bed Days per Month

282 186 (-96)

State Hospital Admissions

Avg. Admissions per Month

5 2 (-3)

3838

Did You Know?Did You Know?One in four adults — approximately 57.7

million Americans — experience a mental health disorder in a given year.

One in seventeen lives with a serious mental illness, such as schizophrenia, major depression or bipolar disorder , and about one in ten children have a serious mental or emotional disorder.

3939

Prevalence of Mental IllnessPrevalence of Mental IllnessAbout 2.4 million Americans, or 1.1

percent of the adult population, lives with schizophrenia

Warren County population estimate for 2008 was 207,353

That would equate into nearly 2,280 citizens requiring psychiatric services during any given year