HomeMy WebLinkAbout2016-153 Reinvestment Grant#RFA06H16GS1
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3.8.4 Tab 4: Project Narrative
3.8.4.1 Statement of the Problem
Indian River County (IRC) is located in the Treasure Coast region of Florida and was
formed in 1925 from the northern portion of St. Lucie County. It was named for the Indian
River Lagoon which runs through the eastern portion of the county. Indian River County
comprises a land area of 617 square miles with a population of 147,919. The 2015 United
States Census Bureau population breakdown by race is: 87.1%White; 9.3% Black; 0.5%
American Indian; 1.5% Asian; 1.5% Two or More Races; with 12.1% of the overall
population being of Hispanic Origin. Indian River County has a Per Capita Income of
$31,089 and a Median Household Income of$44,645. The Poverty Rate of 14.7% reflects
an increase of 1.3% from 2013; and, 22.8% of the population under the age of 65 does
not have health insurance and 9.8% have a disability.
Despite the high Median income assessments, it is more accurate to interpret the
County's composite financial demographics as skewed due to several isolated pockets of
markedly elevated wealth. From a socio-economic perspective, Indian River County is a
severely dichotomous community with the affluent population of the eastern County's
coastal towns standing in stark contrast to the poverty in rural and urban parts of the
County. While the Indian River County Mental Health Court (IRCMHC) facilitates the
needs of mentally ill individuals with criminal justice involvement without regard for
economic variables, the reality is that the financially stable population in need of help will
be accessed to services that will be paid for by insurance or other means of private-
payment; therefore, rendering the majority of the proposed services that will be funded by
the Criminal Justice, Mental Health, and Substance Abuse (CJMHSA) Reinvestment
Grant program to be administered to the poor in Indian River County.
According to the CDC's Public Health Surveillance Fact Sheet on Mental
Health, approximately 25% of all U.S. adults have a mental illness and nearly 50% of
U.S. adults will develop at least one mental illness during their lifetime. In 2014, the
National Institute of Mental Health determined there is an estimated 9.8 million adults
aged 18 or older in the U.S. with Serious Mental Illness (SMI); this number represents
4.2%of all adults in the United States. Based on the 2014 Indian River County 18 years
and older adult population of 119,814, there are 5,032 adults in IRC with SMI. And,
the financially disadvantaged among this population are at the highest risk as research
has determined that poverty has a deleterious effect on both the causation and
opportunities for remediation of mental illness. According to the CDC's National Health
Interview Survey, 2009-2013, a total of 8.7% of adults with income below the federal
poverty level had serious psychological distress, compared with 1.2% of adults with
incomes at or above 400% of the poverty level. (Serious psychological distress defined
as having a score greater than or equal to 13 on the Kessler 6 (K6) nonspecific distress
scale. The six-question K6 was developed to identify persons with a high likelihood of
having a diagnosable mental illness and associated functional limitations, using as few
questions as possible.)
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Figure 2. Age-adjusted percentage of adults with serious psychological distress, by income
relative to federal poverty level and by race and ethnicity: United States, 2009-2013
10
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Federal poverty leveF Race and ethnicity
,Significantly lower than for other races and ethnicities.
2Significant decreasing linear trend by poverty level.
SOURCE:CDC/NCHS, National Health Interview Survey,2009-2013.
It is a continually presenting fact that a significant segment of the adult population
interfacing with the criminal justice system, many of whom live in poverty, have an
undiagnosed and untreated mental health, substance abuse or co-occurring disorder.
Many of these individuals and their families are unaware of how to obtain services for
their conditions, and their only options to receive treatment are by accessing care through
some of the costlier and less efficient points of entry into the healthcare delivery system
including emergency rooms, acute crisis services, and ultimately the adult criminal justice
system. These individuals have often had unsuccessful educational experiences and are
unemployed, both of which are factors often leading to homelessness or housing
instability, nutritional insecurity and limited access to transportation; and so, when this
population is released back into the community they are at significant risk of reentering
the facilities that have previously proven ineffective in assisting with their overall
challenges. This revolving door pattern accomplishes very little and often contributes to
increased recidivism for this population while draining the community's limited financial
resources that could instead represent funding for more appropriate and effective mental
health services.
Life circumstances become particularly difficult for individuals cycling in and out of the
jails as these institutions were never designed, equipped or funded to deal with the
behaviors associated with serious mental illness. It is documented that mentally ill
offenders typically spend twice as long in jail as non-mentally ill offenders, adding to what
is already a costly and inefficient way to address the needs of this population. In addition
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to high costs, it is important to recognize that this de facto approach to dealing with such
a compromised population does not reflect principled values of treating individuals
humanely whether they have either physical or behavioral health challenges. Mental
Health America, the oversite agency for Mental Health Courts, states that numerous
jurisdictions across the United States have created Mental Health Courts to respond to
the increasing number of defendants with serious mental health conditions caught up in
the criminal justice system Mental health courts hold offenders accountable while linking
them to the treatment services they need to address their mental illness. In addition to
being more compassionate, monitoring and treating offenders with SMI in a mental health
court is more effective, efficient and less expensive than the remedies available through
traditional justice system approaches.
Evidencing the lack of effective behavioral health services for the incarcerated
population who have mental health challenges, the Department of Justice's Survey of
Inmates in State and Federal Correctional Facilities (2004) and Survey of Inmates
in Local Jails (2002) indicate that the rate of mental health problems also differs by the
type of correctional facility. In this study, a mental health problem was defined as receiving
a clinical diagnosis or treatment by a mental health professional. Inmates in local jails had
the highest prevalence of mental problems, with nearly two thirds of jail inmates (64.2
percent) satisfying the criteria for a mental health problem currently or in the previous
year. The same Department of Justice surveys also indicate. that fewer than half of
inmates who have a mental health problem have ever received treatment for their
problem, a third or fewer received mental health treatment after admission; and, that
these rates differ depending upon the type of correctional facility with local jails having
the lowest post-incarceration treatment enrollments.
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Mental Health Treatment
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Despite the known systemic inadequacies, it is estimated that 125,000 individuals with
mental health disorders are booked into Florida jails and prisons each year. Data
concerning the jail population in Indian River County reflects this trend with at least 45%
of the jail population reporting a mental health disorder and 30% of them receiving
treatment with psychotropic medications. In IRC jails in 2015, there were 1,724 mental
health clinical evaluations and 1,411 mental health orders received; and, a total of 215
inmates were placed on withdrawal protocol upon entering jail. Many have still not been
properly diagnosed because they refuse to cooperate with mental health staff and,
therefore, cannot be properly assessed. And, in addition to the high occurrence rate of
mental illness, it is estimated that a minimum of 55% of all IRC inmates have a substance
abuse problem. Indian River County, being a smaller community, historically lacked the
necessary collaborative behavioral health and judicial infrastructure to divert individuals
requiring mental health services from entering the criminal justice system. Almost two
years ago, it was determined that a reliably viable solution would be to implement a Mental
Health Court- a system that has been successfully implemented in other counties in
Florida and throughout the United States. The Indian River County Mental Health Court
(IRCMHC) pilot program began in January 2015 and has served a total of 108 individuals
to date, with 81 of them still actively enrolled and 12 graduations. The success rate for
IRCMHC is 44%; with the proposed funding allocation from this grant application,
SEFBHN will work with local provider and stakeholder agencies to increase these
already substantial positive outcomes.
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3.8.4.1.2 Implementation and Expansion Applicants Only Provide a concise analysis of the Target
Population, including the projected number of individuals to be served. Demonstrate how the identified
needs are consistent with the priorities of the Strategic Plan.
The Criminal Justice, Mental Health, and Substance Abuse (CJMHSA) Reinvestment
Grant program will help Indian River County serve more adults with a mental illness,
substance abuse disorder or co-occurring disorders in the criminal justice system who
have been recommended for Mental Health Court. The CJMHSA Implementation and
Expansion grant will enable the IRCMHC to serve 175 clients per year. It was
anticipated at the outset that the IRCMHC would have 35-50 participants, with the
program originally designed to serve a maximum of 60 clients; with the current case load
of 81 clients exceeding the established ceiling, the need for IRCMHC is substantially
greater than estimated. The currently forecasted number of 175 is believed to more
accurately reflect the need.
The CJMHSA grant will help the IRCMHC meet their goals by diverting individuals
from the criminal justice system and linking them to community-based services and
supports in order to address root causes of criminal behavior through effective services
intervention. The primary needs and circumstances of the majority of this population are
as follows: often identifying as homeless or in need of stable housing; lacking
transportation; lacking a support system; unemployment and underemployment;
uninsured or underinsured; lacking stable financial resources; and, presenting mostly with
one or more of the following diagnoses- schizophrenic disorder, depression, bipolar
affective disorder, substance use disorder, co-occurring disorders of mental illness and
substance use disorder, and post-traumatic stress disorder. SEFBHN will help improve
the accessibility and effectiveness of treatment services which will in turn increase public
safety and avert increased spending in the criminal justice systems.
Incorporating the target population to be served by this grant application, SEFBHN's
overall priority population guidelines include: adults with a serious mental illness (SMI),
substance use disorder(SUD), or co-occurring disorders who demonstrate high utilization
of acute care services, including crisis stabilization, inpatient, and inpatient detoxification
services (for the purposes of this document, high utilization is defined as: adults with three
(3) or more acute care admissions within 180 days; or, adults with acute care admissions
that last 16 days or longer); adults with a SMI awaiting placement in a state mental health
treatment facility (SMHTF) or awaiting discharge from a SMHTF back to the community;
persons with a SMI, SUD, or co-occurring disorders who have a history of multiple arrests,
involuntary placements, or violations of parole leading to institutionalization or
incarceration; caretakers and parents with a SMI, SUD, or co-occurring disorders involved
with child welfare; and, individuals identified by SEFBHN, network providers, or the
Department, as potentially high risk due to concerns that warrant care coordination.
Providing further definition of the target population specific to this grant application,
the eligibility guidelines for the IRCMHC are as follows:
A. A defendant who is adjudicated incompetent to proceed, or not guilty by reason
of insanity and /or placed on conditional release will be transferred to Mental
Health Court. A defendant committed to a forensic facility for competency
restoration or treatment for insanity may be transferred to the Mental Health
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Court upon agreement of the assigned Judge, State Attorney and defense
counsel.
B. A defendant charged with a criminal offense (excluding driving or boating under
the influence) who is mentally ill, intellectually or developmentally disable or
autistic may be transferred to Mental Health Court, if the defendant and State
Attorney agree to the transfer.
C. A defendant who is mentally ill, intellectually disable or autistic who is placed
on probation and/or who is granted a downward departure sentence may be
transferred to Mental Health Court for monitoring or as a condition imposed by
the court in lieu of incarceration.
D. A defendant who is charged with a criminal offense and who is mentally ill,
developmentally or intellectually disable or autistic may be supervised by
Mental Health Court as a condition of bond, ROR, or pretrial supervision upon
order of the originating Court while awaiting disposition of case.
Eligibility and participation in Mental Health Court will be terminated in the following
circumstances: Cases transferred into Mental Health Court when a defendant is placed
on probation may have the defendant receiving instruction from the trial court that the
condition of probation is successful completion of mental health court. That defendant will
attend regular court hearings as ordered by the Court, participate in continued
assessment and treatment, and engage in discharge planning as directed by the Mental
Health Coordinator, team and/or Court. An unsuccessful termination from Mental Health
Court may be considered a violation of probation. Also, if the Mental Health Court judge
finds that the defendant is either determined not to be mentally ill, intellectually disable or
autistic, the defendant is no longer eligible for the Mental Health Court and will be
transferred back to the referring court. Additionally, if the Court determines that the
defendant is no longer participating or benefitting from the Mental Health Court, or that
they possess a threat to public safety, the defendant is no longer eligible for the Mental
Health Court and will be set for sentencing or other disposition. If the defendant is found
to violate probation and is arrested for a new offense, the defendant may no longer be
eligible for the Mental Health Court and the case will be transferred back to the referring
court.
3.8.5 Tab 5: Project Design and Implementation
3.8.5.1 For both Planning Grants and Implementation and Expansion Grants, a description of the
planning council or committee,including: Appendix K
3.8.5.1.1 Composition of the planning council or committee, including the role of each member
as stakeholder,consumer,etc.demonstrating compliance with s.394.657(2)(a), F.S. If the Council
does not currently meet the statutory requirements, provide a detailed explanation of how and
when the Council intends to rectify the deficiency; and
The composition of the Indian River County Public Safety Coordinating Council (PSCC)
demonstrates compliance with s.394.657(2)(a) F.S. by having the chairperson of the
Board of County Commissioners serve as its chairperson and including the following
members:
1. The state attorney, or an assistant state attorney designated by the state
attorney.
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2. A public defender, or an assistant public defender designated by the public
defender.
3. A circuit judge designated by the chief judge of the circuit.
4. A county court judge designated by the chief judge of the circuit.
5. The chief correctional office.
6. The sheriff, if the sheriff is the chief correctional officer, or a person designated
by the sheriff.
7. The police chief, or a person designated by the local police chief's association.
8. The state probation circuit administrator, or a person designated by the state
probation circuit administrator.
9. The local court administrator, or a person designated by the local court
administrator.
10.The chairperson of the Board of County Commissioners, or another county
commissioner designated by the chairperson; or, if the planning council is a
consortium of counties, a county commissioner or designee from each member
county.
11.The director of any county probation or pretrial intervention program, if the
county has such a program.
12.The director of a local substance abuse treatment program, or a person
designated by the director.
13.The director of a community mental health agency, or a person designated by
the director.
14.A representative of the substance abuse program office and the mental health
program office of the Department of Children and Families, selected by the
substance abuse and mental health program supervisor of the district in which
the county is located.
15.A primary consumer of mental health services, selected by the substance abuse
and mental health program supervisor of the district in which the primary
consumer resides. If multiple counties apply together, a primary consumer may
be selected to represent each county.
16.A primary consumer of substance abuse services, selected by the substance
abuse and mental health program supervisor of the district in which the primary
consumer resides. If the planning council is a consortium of counties, a primary
consumer may be selected to represent each county.
17.A family member of a primary consumer of community-based treatment
services, selected by the abuse and mental health program supervisor of the
district in which the family member resides.
18.A representative from an area homeless program or a supportive housing
program.
19.The director of the detention facility of the Department of Juvenile Justice, or a
person designated by the director.
20.The chief probation officer of the Department of Juvenile Justice, or an employee
designated by the chief probation officer.
See Appendix K for list of members.
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3.8.5.1.2 Planning council's activities, including the frequency of meetings for the previous 12
months and future scheduling of meetings.
On July 12, 2016, the Indian River County Board of Commissioners (the "Board")
authorized the County's Attorney's Office to monitor the membership of the Public Safety
Coordinating Council (PSCC) consistent with the requirements of Section 394.657, F.S.
The Board also authorized SEFBHN to file a Notice of Intent to Submit an Application to
the Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant
(CJMHSA) to the Florida Department of Children and Families (DCF).
On September 8, 2016, the Council met and discussed the CJMHSA grant program.
The Council voted unanimously to apply for the Grant and that the Program may be best
implemented in Indian River County by primarily using the Grant funds to meet the
diversionary goals of the mental health court using such tools as (including but not limited
to): peer counseling, therapists, and Crisis Intervention Team expansion, as appropriate
for the maximum benefit of the clients. Also, the PSCC voted that the funds should be
secondarily used for other needs such as housing for clients.
The application will be for $400,000 for three years. The Implementation and
Expansion grant under the Program requires a local match equal to the amount of the
grant. A cash match of five percent in the first year of the program, ten percent in the
second year of the program and fifteen percent in the third year of the program is required;
and, as the balance of the match may be made "in-kind", Indian River County Sheriffs
Office and Indian River County's funding of Mental Health Court can both be used to
provide the in-kind services match. Indian River County will thus be required to contribute
$20,000, $40,000 and $60,000 in years, one, two and three, respectively.
Prior to the July 2016 meeting, the PSCC had not met in the previous 12 months;
however, they have now agreed to meet quarterly. With the CJMHSA grant, SEFBHN will
encourage collaboration among key stakeholders in implementing and providing ongoing
oversight and quality improvement activities. We will help develop MOU's with agencies,
create sub-committees with regular meetings to assess progress, review goals and make
any necessary adjustments to the implementation of the program.
3.8.5.3 Implementation and Expansion Grants Only
3.8.5.3.1 Provide a copy of the existing Strategic Plan, which must include at minimum, all of the
elements in Appendix A. For the current Strategic Plan, see Appendix A
3.8.5.3.2 Provide a description of the Strategic Plan, including progress toward implementing the plan,
when the plan was last reviewed or updated,and any challenges or barriers toward implementation.
The Indian River County Mental Health Collaborative (the Collaborative) was formed
in 2004 to create a local coalition of top law enforcement, court officials, funders, mental
health care providers, community leaders and government organizations who were
interested in finding solutions to the unmet behavioral health needs within the community.
The Collaborative convenes on a quarterly basis. Four strategic planning groups were
developed with specific objectives in mind:
• Mental Health Promotion — Working on reducing stigma and promoting mental
health and well-being;
® Integrated Care—Working to increase access to mental healthcare by integrating
behavioral and primary health care; '
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® Mental Health Connections —Working to develop a centralized access point for
information, referral, and care coordination around mental health services;
® Diversion Strategies —Working on solutions and alternatives for the mentally ill
in the criminal justice system.
As the Diversion Strategies group began their assessment of the community, it was
quickly realized that a Mental Health Court was critically needed to increase access,
decrease client recidivism and facilitate county wide support surrounding incarcerated
individuals who present with mental health issues Strategic planning to implement a
Mental Health Court Program in Indian River County began in 2009 under the leadership
of Judge Cynthia Cox of the Circuit Court of the Nineteenth Judicial Circuit and Indian
River County Sheriff Deryl Loar. The Indian River County Mental Health Court began
operations on January 27, 2015, and the plan is reviewed quarterly. In the first year,
IRCMHC served 120 individuals when the capacity was set for 60. As a result of the
Mental Health Court pilot, there have been some improvements in the continuum of care
and services to the incarcerated. However, due to the higher than expected number of
referrals, timely coordinated access to mental health and substance abuse services has
not yet fully realized. Some of the biggest challenges, other than funding, that IRCMHC
faces are: the coordination of care, timely access to services, and the ability to track
services and outcomes for individuals throughout their involvement and up to one year
after discharge from the program and housing. SEFBHN excels in these areas and, with
this increased funding, we will be empowered to more rigorously implement our
coordination of care strategies to most effectively serve this fragile and challenging
population.
The SEFBHN coordination of care goals will directly impact the overall strategic plan
for creating positive outcomes for the individuals and the greater community served by
this grant award. The short-term goals of implementing care coordination are to: improve
transitions from acute and restrictive to less restrictive community-based levels of care
through education and training of network providers and activities by the SEFBHN
Coordination of Care and Quality Teams; increase diversions from state mental health
treatment facility admissions; decrease avoidable hospitalizations, inpatient care,
incarcerations, and homelessness; and, increase the focus on coordination of care
activities that support community integration and whole health and wellness and
empowering self-direction. And, the long-term goals of implementing care coordination
are to: shift from an acute care model of care to a recovery model; offer an array of
services and supports to meet an individual's chosen pathway to recovery; through
coordination of care activities and collaboration with network providers and stakeholders,
identify opportunities for enhancing or modifying services and supports that promote
recovery oriented care.
Sustainable changes are possible through access to timely, appropriate and monitored
services. One of the most significant impediments to the target population is mental illness
and/or co-occurring substance abuse, and the lack of access to social services and
treatment for these issues, particularly for individuals facing homelessness and without
medical insurance. Through active engagement with our network of providers and our
online data portal, SEFBHN is able to track each consumer's overall participation in
services creating opportunities to intervene with adaptive strategies when necessary in
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order to achieve our paramount objective of increasing positive outcomes for the high-
risk consumer and the greater IRC community. SEFBHN operates with a broad scope
and an expansive network of behavioral health agencies, allowing for comprehensive
care coordination services that remain fluid and reactive to the progressing or regressing
needs of the individuals in need of services. A consumer's successes are acknowledged
and we build on what is working, furthering the individual's functionality in society; while,
conversely, downward trending is identified and addressed as swiftly as possible in order
to augment care options with the targeted aim of redirecting the consumer towards a
successful outcome.
3.8.5.3.3 Provide a description of the project design and implementation,including:
3.8.5.3.3.1 Project goals,strategies,milestones,and key activities toward meeting the objectives outlined
in Section 2 2. Applicants must include at least one objective in addition to those outlined in Section 2.2
and may propose tasks in addition to those specified in the RFA;
3.8.5.3.3.2 Organization and key stakeholder responsible for each task or key activity necessary to
accomplish the objectives;
The primary goal of the CJMHSA Reinvestment grant is the expansion of the Indian
River County Mental Health Court program. SEFBHN will work in partnership with Indian
River County's Public Safety Coordinating Council, the Indian River County Sheriff's
Office and the Connections Center via Indian River Mental Health Collaborative to help
implement best practices and expand the Indian River County Mental Health Court
(IRCMHC) program. The purpose of this expansion program is: to increase public safety;
avert increased spending on criminal justice; and, to improve the accessibility and
effectiveness of treatments for adults with a mental illness, substance abuse disorder or
co-occurring disorders who are in or at risk of entering the criminal justice system. The
community providers note that in order to accomplish their desired outcomes they need
a better coordinated response and an improved delivery system for behavioral health
services for this target population. The program will focus on achieving the following
objectives:
Objective 1 — Establish programs and diversion initiatives that increase public safety,
avert increased spending on criminal justice and improve accessibility and effectiveness
of treatment services for the clients in IRC Mental Health Court. The proposed program
will:
A. Increase the number of partnerships formed as demonstrated by formal
Memoranda of Understanding (MOU) or other mechanism, including
partnerships about the exchange of information and data related to our clients
in MHC.
B. Implement our new web-based Coordination of Care data module that will track
all MHC clients during their involvement with the program and for at least one
year after discharge. The system will track all mental health and substance
abuse services received, including arrests, receipts of benefits, employment
and stable housing.
C. Implement Peer-Based Recovery Support which will utilize the Wellness
Recovery Action Plan (WRAP), an evidence-based practice along with Whole
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Health Action Management (WHAM) an integrated approach developed by
the SAMHSA-HRSA Center for Integrated Health Solutions.
D. Increase the number of Crisis Intervention Team (CIT) trained law enforcement
officers responding to mental health related crisis calls.
Objective 2 —To create and encourage collaboration among the key stakeholders, such
as the Public Safety Planning Council in implementing and providing ongoing oversight
and quality improvement activities for the CJMHSA grant program.
A. SEFBHN will meet quarterly with PSPC to assess the progress and review
performance measures and timelines associated with the CJMHSA grant
program and make necessary adjustments to implementation as needed.
B. Develop sub-committees that will meet monthly to provide oversight,
collaboration and continuous quality improvement.
Objective 3 —Create a Coordination of Care model specific for the IRCMHC.
A. Reduce access time to mental health and/or substance abuse treatment
services by providing immediate access (within 24 hours) to assessments with
our network providers.
B. Increase the number of SSUSSDI approvals through SOAR applications.
C. Increase connections to housing, employment and/or educational resources
SEFBHN will help IRCMHC meet their diversionary goals by developing and overseeing
a collaborative effort among key stakeholders with an array of services, and using the
Connections Center as the community access point. With SEFBHN's unique position as
an oversight agency and major funder for the network of local behavioral health agencies,
we can assure a comprehensive and consistent continuum of care that implements the
best evidence-based practices for all individuals. We will work to best address the overall
needs of the clients by coordination across the full spectrum of social services, behavioral
and physical health services, case management, housing, education and employment.
We emphasize and facilitate effective transitions and warm hand-offs between our
provider agencies preventing gaps in services which can derail effective treatment and
successful integration or reentry. One of the most significant impediments to our
incarcerated population is mental illness and/or co-occurring substance abuse, and the
lack of access to social services and treatment for these issues, particularly for individuals
facing homelessness and without medical insurance. SEFBHN has the capability to best
serve the needs of the criminal justice population who face these challenges by
coordinating our extensive network of service providers ensuring the most comprehensive
and effective levels of care for this high-risk population.
In its commitment to improve services and outcomes for their program participants,
the Mental Health Court proposes to use the "Sequential Intercepts for Change Model"
which identifies intercept points which reduce the criminalization of persons with Mental
Disorders. This model was developed as a collaboration between Summit County
Alcohol, Drug Addiction and Mental Health Services Board, and the National GAINS
Center for the People with Co-occurring disorders in the Justice System. The various
Intercept points are as follows:
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Intercept 1 — Law Enforcement/ Emergency services
Intercept 2 — Initial detention / Initial court hearings
Intercept 3 —Jails/courts
Intercept 4— Re-entry
Intercept 5 — Community corrections / Community support
It was determined for the startup of IRCMHC that the best intercept point to affect
change would be post booking at Intercept 2; and, at any time thereafter, through
Intercepts 3, 4, and 5. Intercept 2 became the focus, because: (1) established
collaborations and cooperation already existed with agencies that were involved with
mentally ill afterthey had been arrested; and, (2) the personnel who were interacting with
the mentally ill after the booking process were better trained to identify and divert the
mentally ill from the traditional court setting. Therefore, IRCMHC Program intercepts
arrested persons primarily at jail bookings, initial detention and initial hearings, and
through attorney referrals.
3.8.5.3.3.7 How law enforcement will assess their current process at intercept points, capacity, and how
they intend to implement or expand diversion initiatives(e.g., processes,training,etc.); and
Law Enforcement is interactive with potential MHC participants at Intercept points 1 and
2; therefore, will assess the individuals and implement or expand diversion initiatives in
the following ways:
Intercept 1 — Law Enforcement/ Emergency services:
Indian River County Sheriff's Office would like to increase their number of Crisis
Intervention Team (CIT) trained officers to help them decrease the number of arrests of
individuals with mental illness. CIT trains officers to understand mental illness and
provides them with tools needed to assess, de-escalate and refer/transport people
experiencing crisis to stabilization centers. The predictive impact with having more
officers CIT trained is:
1. Crisis response is immediate.
2. Officers are better trained and educated in verbal de-escalation techniques.
3. Officer and consumer injuries during crisis events decline.
4. Underserved consumers are identified by officers and provided with care.
5. Increase in pre-arrest diversion of mentally ill from the criminal justice system.
Indian River County currently has 267 law enforcement officers trained and certified, the
break down includes: Indian River Sheriffs Office (185); Vero Beach Police Department
(50); Sebastian Police Department (28); and, Fellsmere Police Department (4). One of
the goals with this project will be to provide CIT training for 30 law enforcement officers
each year of the grant; adding a total of 90 additional CIT trained officers in Indian River
County.
Mobile Crisis Team (MCT) can be utilized at both Intercept 1 and Intercept 5 to divert
mentally ill from the criminal justice system. *See Intercept 5 for details on our local MCT.
Intercept 2— Initial detention / Initial court hearings:
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Rapid identification and Referral — Identification and referral of potential clients to the
MHC occurs at several junctures post booking, beginning with arrest and first appearance
and then continuing throughout the criminal justice process:
1. Arresting officer may note on the arrest affidavit that the offender appears to have
a mental illness.
2. Booking officer may note an indication of mental illness.
3. Jail medical staff evaluates offenders within 24 hours of booking and may identify
a client.
4. First appearance staff, including Assistant Public Defender housed at the jail, may
identify a client.
5. Mental health professionals (including those receiving a daily list of new arrivals)
with knowledge of a client's arrest may refer the case to MHC.
6. Pre-Trial Release staff may identify certain behaviors.
7. Family member of defense attorney may make a referral
3.8.5.3.3.5 The plan to screen potential participants and conduct tailored, validated needs-based
assessments. Include the criteria to be used, specific screening tool(s) and validity specific to the Target
Population. If specific tool(s) have not yet been selected, describe the process by which tool(s) will be
selected;
Assessment and identification of needs — There are two steps to the IRCMHC
assessment process: 1. Pre-screen and 2. Forensic Assessment. The Pre-screen is
completed at the beginning of the referral process, prior to entry, to determine if the
candidate has a serious and persistent mental illness and, therefore, meets the
qualifications to participate in MHC. This can be completed either at the jail, if the person
is incarcerated; or, in the community if the person is out of jail on bond or conditional
release. The Forensic Assessment is completed upon entry into MHC as a tool to identify
needs. These MHC case managers assess each participant's needs and make
recommendations to the Court, based on this individual assessment. Timely access to a
MHC Case Manager is essential to assuring the success of the participants and
accelerating their return to the community.
IRCMHC will continue to work collaboratively with the IRC Sheriff's Office and other
local law enforcement agencies to assure rapid screening, identification and ease of
handoff for all identified cases being referred to MHC. The expansion plan would
implement the validated Referral Decision Scale (RDS)— Brief Jail Mental Health Screen
to replace an in-house tool.The Brief Jail Mental Health Screen (BJMHS)consists of eight
items that can be answered as yes or no. The BJMHS is organized into two sections: the
first section includes six items that ask about the occurrence of mental health symptoms
in the past six months; the second section of the BJMHS includes two items that address
whether a detainee was ever hospitalized for emotional or mental health problems and
whether he or she is currently taking psychotropic medication.
Ongoing identification of needs, with outlined opportunities and procedures for supportive
and referent actions, present through the following Intercept points:
Intercept 3—Jails /courts:
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Court monitoring — Clients in the MHC are under an Order Allowing Defendant to Be
Released ROR with MHC Conditions, and following discussion with their attorneys, have
agreed to and signed a "Conditions of Mental Health Court Agreement', which includes a
minimum of 6 month participation in MHC. Supervision typically includes status hearings
with the MHC judge and monitoring by mental health staff and probation officers. Initially,
a client is required to appear in court weekly. As he/she demonstrates progress through
the program, required court appearances may become less frequent. It is an important
beneficial feature of IRCMHC that clients are sincerely praised for doing well and
sanctioned when appropriate. Sanctions may include verbal reprimand, community
service hours, more frequent court appearance, and, less frequently, incarceration. Highly
restrictive conditions that cause more frequent minor violations are avoided when
possible. Eligible MHC clients have been shown to respond favorably to the immediate
attention, positive support and recognition that this supportive MHC setting provides.
Graduation —When a client has progressed successfully through the program by gaining
insight into his mental illness, establishing a stable environment, and maintaining sobriety,
he/she graduates from MHC. Graduation includes a certificate, recognition and a
courtroom ceremony that includes family and friends. The participant also may be eligible
for dismissal of charges.
Intercept 4— Re-entry:
Re-entry into the community is a critical time for intervention because mortality rates are
elevated during the weeks following release from a correctional facility. Upon entry into
MHC, a Case Manager helps the client either reestablish or implement client-centered
mental health services as quickly as possible. If a client already has services available to
him, the Case Manager assures that those services are not client-resistant and then helps
reestablish those services that may have been interrupted while he was incarcerated. If
indicated, the Case Manager makes an immediate appointment for the client to see a
psychiatrist prior to their release from jail. These appointments are critical in that the jail
only provides three days of medication when releasing a client. It currently takes 4-6
weeks to get appointments for mental health and substance abuse services for MHC
clients.
Intercept 5— Community corrections / Community support:
One of SEFBHN's goals would be to educate and access the community to the services
provided by the Mobile Crisis Teams in order to: create opportunities to divert mental
health clients prior to any criminal justice involvement; and, to assist in avoiding further
decompensation of existing behavioral health services participants experiencing a crisis.
Often preventing incarceration, SEFBHN can intervene to provide a responsive safety net
for the mentally ill or substance-impaired population by calling in an MCT who will de-
escalate the situation and supportively access the consumer to stabilizing, recovery-
oriented services.
Mobile Crisis Team: Crisis intervention and stabilization services are available to
individuals who are experiencing an urgent or emergent mental health crisis. On a 24/7
basis, via mobile field response and/or by telephone, the multi-disciplinary Crisis Team
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staff provide rapid mental health services that are supportive and strength-based in nature
with an emphasis on assisting the individual to remain in the most appropriate, least
restrictive level of care possible. The two Mobile Crisis Teams operating out of New
Horizons respond to all of the communities throughout Indian River County, working to
close gaps in the system of care and reduce unnecessary hospitalizations and
incarcerations. Focused on successful outcomes, the MCTs assist individuals and
families to de-escalate crisis situations, facilitate linkage to therapeutic services and other
needed resources, and unburden our emergency rooms and local law enforcement.
The MCTs manage a toll-free crisis phone line which serves as the access point to the
area's community-based behavioral health system. They address not only crisis matters,
but also general information inquiries and less-urgent requests from those seeking to
enroll in behavioral health services. Follow-up, outreach, support and linkage to needed
services are critical components of the MCT's mission. Those clients who are at risk of
"falling through the cracks" after their crisis situation has passed are followed closely and
the MCT continues to engage with them to facilitate connection to services which will help
them to avoid and better manage future mental health crises. Referrals are individually
customized to ensure that appropriate cultural and linguistic needs are accommodated.
Mobile mental health services are short-term,face to face services designed to restore
a person's functioning level to pre-crisis levels, helping people develop individualized
strategies for their future concerns. The benefits include: helping an individual to maintain
independence by learning to apply their coping skills; building confidence and skills which
help build resiliency; and, preventing recidivism into deeper end criminal justice or
medical services.
3.8.5.3.4 A description of the strategies an Applicant intends to use to serve the Target Population,
including a description of the services and supervision methods to be applied and the goals and
measurable objectives of the new interventions. Interventions may include, but are not limited to:
The purpose of CJMHSA grant expansion plan is to expand and improve access to
treatment and benefits, provide comprehensive evidence-based services, and expand
supportive services that help sustain recovery, such as supportive housing, education,
supportive employment and peer support. SEFBHN will implement a Coordination of Care
plan to improve transitions from jail to less restrictive community-based levels of care
through education, training and activities by our Care Coordinator. We will increase
diversions and decrease avoidable hospitalizations, inpatient care, incarcerations and
homelessness. We will increase the focus on Coordination of Care activities that support
community integration, whole health and wellness and empowering self-direction.
In partnership with IRCMHC, Indian River County Sheriff's Office, the Connections
Center, Legacy Behavioral Health, Mental Health Association, New Horizons of the
Treasure Coast and Substance Awareness Council of Indian River County, we will
cultivate a professional staff to provide an array of behavioral health services. All of our
behavioral health agencies provide trauma-informed approaches in programs, services,
and systems, including trauma-informed interventions that are designed to address the
consequences of trauma in the individual and to facilitate healing. This may include
assessments and interventions for emotional, sexual and physical abuse. The program
components described below will add additional services and personnel necessary to
match both the capacity needed to increase the number MHC cases, and to deliver the
scope of services necessary to maximize potential success for the MHC client.
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At SEFBHN, our staff and all contracted provider agencies utilize the most current and
appropriate tools and techniques when engaging with the mentally ill population involved
in the criminal justice system,with specific SEFBHN administered trainings and monitored
requirements for criminogenic assessments and motivational interviewing in order to most
effectively identify the higher-risk individuals while concurrently determining the most
appropriate dosage and intensity of services. SEFBHN will ensure the delivery of these
services through a Care Coordinator, directly employed by SEFBHN, who will coordinate
with the IRCMHC staff and the team directly funded by this grant to include the Program
Manager, Licensed Therapist, Care Manager and Certified Peer Specialists, employed
by contracted provider agencies; all of whom will be supported by the greater SEFBHN
management and staff. SEFBHN trains and monitors all contracted provider agencies
with regard to their required implementation and fidelity to the appropriate Evidence-
Based Practices (EBPs). The key EBPs to be utilized in fulfillment of this grant are:
Sequential Intercept Model; Brief Jail Mental Health Screen (BJMHS); the Wellness
Recovery Action Plan (WRAP); and, Cognitive Behavioral Therapy(CBT). For a complete
listing of EBPs that will be utilized by the contracted provider agencies in fulfillment of this
grant, please see Appendix B.
During the post-crisis or post-release transition periods, the consumer is at higher risk
of decompensation and engaging in behaviors which may require law enforcement
intervention. Immediate access to social services, which SEFBHN will initiate during the
transition period, is critical to stabilize this population and set them on a path for recovery
and wellness. Applying a detailed analysis of the consumer's assessment, a Care
Manager will work directly with the consumer in a client-centered approach to establish a
treatment plan. Components of this plan will include the following services, as deemed
appropriate: mental health and substance abuse treatment, recovery orientated support
groups, medical screening, WHAM, vocational training, family counseling, anger
management, peer support, WRAP, SOAR enrollment in social security disability and
other relevant assistance benefits. Creating recovery-oriented, supportive therapeutic
opportunities is essential for the success of the program participants and SEFBHN will
ensure availability and access to these opportunities.
The Care Manager acts as liaison for the consumer, families and other related
agencies involved in the transition process; provides information and support; assists
consumers in completing various forms and obtaining documents for transition, training,
education and employment; provides interventions when necessary; conducts a variety
of risk/needs assessments with consumer; and, participates in collaborative meetings
with staff and agencies to provide information and recommendations. Certified Peer
Specialists assist individuals to successfully transition back into the community following
crises or incarceration. The Certified Peer Specialist engages the individual while still
incarcerated or they can travel out in the field with the MCT, initiating contact and
establishing rapport. They participate in discharge planning and assist the person in
identifying community-based services and support needs while also helping them to build
self-directed recovery tools, such as a Wellness Recovery Action Plan (WRAP). They
then continue to actively provide support as the consumer transitions back into society.
The SEFBHN Care Coordinator will maintain responsibility for all aspects of the
SEFBHN Care Coordination Program, ensuring grant and contract compliance, data
entry, evaluation measures and the collaborative coordination of care with our network of
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provider agencies. They will participate in the development of a Responsive Action Plan
enhancing the community's efforts in preventing incarceration and recidivism.
3.8.5.3.3.6 How the Program will coordinate care to increase access to mental health, substance abuse
and co-occurring treatment and support services and ancillary social services(i.e., housing, primary care;
benefits,etc.);
The SEFBHN Care Coordination plan will start when a client is admitted into Mental
Health Court by effectively beginning to track, engage and link offenders with the
appropriate behavioral health services. As part of the Care Coordination plan, we will
have a block of open appointments to ensure MHC clients will receive a formal
assessment within 24-48 hours of referral. Later this month, SEFBHN will be rolling out a
new Coordination of Care computer module that will enable us to follow a client's
progress, review assessments and recommendations, and track service events or missed
appointments. The integrated web-based system will reduce phone time; and, with
greater efficiency, it will be secure and password protected which will facilitate
communication, allowing for the collaborative development of the best possible treatment
plan.
As there currently exist a variety of systemic obstacles to successful community-based
behavioral health service referral follow-up in Indian River County;_ SEFBHN will seek to
overcome these obstacles with practical and effective, short- and long-term solutions at
the individual, provider agency and systems level, positively impacting the recipients of
services and the community as a whole. The most immediate logistical obstacles for
individuals in need of referred, ongoing behavioral health services are: transportation to
and from provider agencies for services; access to services due to cost, as well as limited
agency capacities, bottlenecks in care and the resulting long wait times for treatment
engagement; and, the lack of safe, supportive housing needed to establish a level of
foundational domestic stability conducive to successful treatment participation and
longer-term positive outcomes. From a systems perspective, collaboration with local law
enforcement agencies will allow for earlier and more direct engagement with mentally ill
or substance use impaired individuals, directing them into the most suitable setting and
facilitating the most appropriate, least restrictive level of care for these populations.
Evidence-based screening and assessment processes will be conducted and case
management services will be established to best identify and address the individual's
needs in order to increase their level of ongoing commitment and length of time for
participation in follow-up services. As the oversight and funding agency for over 40 local
behavioral health agencies, SEFBHN's guiding participation in the administration of the
proposed grant activities will have a strong positive determination on the availability of
services at the time of need. Collaborating with the partnering stakeholder agencies and
the contracted behavioral health providers will greatly enhance the current coordinated
system of care within Indian River County; and, will best augment law enforcement and
judiciary efforts.
3.8.5.5.4 Proposed staff, including Project Director, key personnel, and subcontractors who will
participate in the project, showing the role of each and their level of effort and qualifications. Briefly
discuss the responsibilities of each participating organization and how the Applicant proposes to fill staff
positions and select subcontractors.
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SEFBHN will employ a full time Care Coordinator who will be located at the Connection
Center. The Care Coordinator will work closely with the entire IRCMHC team and our
behavioral health providers to improve transitions from jail to less restrictive community-
based levels of care. They will assist in navigating across systems, link them to needed
services and help remove any barriers to treatment. They will work closely with SEFBHN
Quality Improvement Staff to monitor provider data to ensure appropriate and consistent
diagnoses that support recommended and provided levels of care. The Care Coordinator
will also provide technical assistance and education for our providers.
There will be a Program Manager who will provide leadership, guidance and
administrative supervision to the MHC Case Managers, Licensed Therapist, Care
Manager and the Peer Specialists. The Program Manager's responsibilities will include:
responsibility for ensuring quality services are provided in all assigned programs, and that
program operations are in compliance and running efficiently; providing direct clinical
services to MHC clients, including biopsychosocial evaluations, treatment planning,
individual, group and multi-client counseling activities for clients with co-occurring
disorders; and, maintaining clinical and administrative documentation for assigned clients
as prescribed by agency policy and procedure and by governing law. This position will
require a Master's Degree and a current Florida license in Social Work, Mental Health or
Marriage and Family Counseling, will be employed.by Legacy Behavioral Health and will
be located within Mental Health Court offices
Two Case Managers employed by the IRC Sheriff's office will do both the Pre-screen
and the Forensic Assessments; and, based on their assessments, they will make a
determination of each person's needs and make recommendations to the Court. They will
also conduct an orientation that will include: the MHC program requirements, available
services and resources; and, carefully explain the Court's expectation that the client signs
an agreement to comply with the conditions stipulated in the Order Allowing Defendant to
Be Released ROR with MHC Conditions. In addition, they will make the initial appointment
with the behavioral health care service providers through the Connections Center; they
will problem solve any barriers to services, follow up after the appointment to determine
future steps, and coordinate with the service provider in cases that require more
intervention and planning.
There will be one Care Manager employed and located at the Connections Center.
The Care Manager will conduct a comprehensive needs assessment and make
recommendations to client and/or MHC Team. They will make the initial appointment with
the behavioral health care service providers through the Connections Center and problem
solve any barriers. The Care Manager will follow-up to ensure services are obtained,
determine future steps, and coordinate with the service provider in. cases that require
more intervention and planning. Care Manager will meet with their clients regularly, often
weekly, to monitor their well-being, address their questions or concerns, and connect
them with resources. They will help with transportation issues, housing, supported
employment, education and any other appropriate referrals. They will provide advocacy
and may also recommend support groups for clients or family members to help them cope
with their behavioral health issues. The Care Manager will maintain the appropriate
documentation with detailed notes of their visits with clients, noting their long-term
progress.
i
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There will also be a part-time Administrator at the Connections Center who will work
with the providers to maintain an on-going block of assessments, work with the case
managers to book appointments and place reminder calls about the appointment. The
Administrator will track the success of filling each appointment and the percentage of
attended appointments which will help measure the success of the program
The assessments will be done with a Licensed therapist (LMHC/LCSW/LMFT)
provided by Legacy Behavioral Health and may be done at one of their 3 locations
throughout Indian River or at the Connections Center in Vero Beach. The Therapist will
conduct outpatient services which may include individual, family or group therapy such
as anger management and art therapy. Legacy Behavioral Health will also conduct
psychiatric evaluations and medication management for IRCMGC clients. Legacy
Behavioral Health utilizes evidence-based practices such Cognitive behavioral therapy
(CBT) and Motivational Enhancement Therapy (MET). See Appendix B for details.
For those clients that require a Substance Abuse Assessment, they will be referred to
Substance Awareness Council of Indian River County (SAC). For those clients that are
eligible for medicated-assisted-treatment, SAC will be partnering with the Treasure Coast
Community Health Center to offer Vivitrol through the FADAA/OSCA Vivitrol Project
(Application is in process). SAC currently performs all drug testing that is required for
MHC and will continue to do so. SAC will continue to provide outpatient substance abuse
treatment services to the MHC clients. They also have a transitional living facility which
provides a safe, clean, sober home. The program primarily serves women of little or no
income, most frequently referred by the judicial system or the county jail re-entry program.
In addition to providing a stable living arrangements, the program includes, counseling,
social support, responsibility and accountability, structure and recovery integration. The
lack of safe, affordable, local housing is a continuous barrier for MHC clients and through
this grant SEFBHN will be looking to expand the current capacity.
Peer Specialists will also be part of the Care Coordination team. The Mental Health
Association of Indian River County will employ two part-time Peer Specialists to work with
the IRCMHC clients. The Peer Specialists will be trained in SOAR (SSI/SSDI Outreach,
Access, Recovery) so that they can begin to engage with the MHC client at Intercept 2.
They will meet with the MHC client for an initial consultation to determine if they meet the
criteria to obtain SSI/SSDI benefits. If yes, they move forward immediately with all SSA
required forms and requests for medical evidence. They will finalize and submit the
application online and copy, mail, drop off or fax all documents to SSA. The Peer
Specialist will then begin the follow through with DDS representative throughout this
process and going forward, and the Peer Specialist creates a relationship with participant
and follows up with participant regularly regarding the status of the claim.
Peer Specialists provide recovery support services, designed to improve access to
and retention in services delivered by people with lived experience in recovery from
mental illness and/or substance abuse. The Peer Specialists will use evidence-based
practices such as Well, Recovery, Action Plan (WRAP) and/or Whole Health Action
Management (WHAM). The Peer Specialist functions as a role model to peers by
exhibiting competency in personal recovery and use of coping skills. They serve as a
consumer advocate, providing consumer information and peer support for clients in
outpatient and inpatient settings. The Peer Specialist performs a wide range of tasks to
assist peers in regaining independence within the community and mastery over their own
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recovery process On both a one-to-one bases and in group sessions, they will assist
consumers in identifying and creating goals and also in developing recovery plans utilizing
the relevant skills, strengths, supports and resources necessary to aid them in achieving
those goals. They assist clients in working with their Case Manager or treatment team in
determining the steps he/she needs to take in order to achieve these goals and self-
directed recovery. The Peer Specialists share common problems in daily living and
methods they have employed to manage and cope with these problems. As one who has
availed themselves of behavioral health services, they will share their own experiences
and identify for the participant what skills, strengths, supports and resources they have
successfully employed. As much as possible, the Peer Specialist will share their own
recovery story and demonstrate how they have directed their own recovery. They help
consumers locate and join existing self-help and 12 step groups, they support their
vocational choices, and they help with transportation.
3.8.5.3.3.4 How the agencies and organizations involved will communicate throughout the lifetime of the
project, detailing the frequency of planned meetings, and the decision making process to ensure
successful implementation.
The IRCMHC Staffing Team also includes jail personnel,judiciary, local mental health
agencies, SAMH, State Attorney, Public Defender, local substance abuse agency, and
transitional housing partner. SEFBHN will be the lead on the CJMHSA grant; however,
the implementation and tasks associated with this project will be the result of the
collaboration of many stakeholders including Mental Health Collaborative of Indian River
County, Indian River County Mental Health Court, law enforcement, the criminal justice
system, behavioral health service programs and other community stakeholders. It is
critical that all organizations involved have frequent and reliable communications. The
MHC staffing. and CJMHSA program team will meet bi-weekly to reviews cases,
troubleshoot barriers, and assess progress to ensure successful implementation.
SEFBHN will meet quarterly with PSPC to assess the progress and review
performance measures and timelines associated with the CJMHSA grant program and
make necessary adjustments to the implementation as needed. We will also develop sub-
committees that will meet monthly to provide oversight, collaboration and continuous
quality improvement as previously
Opportunities exist in Indian River County to expand the existing collaborative
practices currently implemented between the stakeholder and provider agencies involved
in the IRCMHC and the CJMHSA grant in order to increase jail diversion services; in
addition, new opportunities exist to initiate and establish collaborative practices with
additional community stakeholders and agencies to best serve individuals experiencing
behavioral health crises. The relevant stakeholders, including law enforcement,
community behavioral health providers, the court system, and public officials, must
continue to develop a sentiment of joint ownership of these challenges with the committed
intention of pursuing viable means by which to establish expanded remedies. The
strategic plan in this grant proposal can work to address the overarching multi-facility and
multi-agency "systems" deficiencies by developing tangible solutions that will help keep
large numbers of mentally ill and substance impaired individuals who are in crisis out of
our jails.
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3.8.5.4 Performance Measures Applications must include a description of the manner in which the grant
will be monitored to determine achievement of performance measures outlined in Section 2.4, including:
3.8.5.4.1 A description of the process for collecting performance measurement data, and any
other state or local outcome data to measure project effectiveness;
3.8.5.4.2 Proposed targets and methodologies to address the measures specified in Section 2.4.1,
for Planning Grants,and Section 2.4.2,for Implementation and Expansion Grants;and.
3.8.5.4.3 At least one additional proposed performance measure unique to the tasks outlined in
the application, including proposed targets and methodologies.
SEFBHN recognizes that accurate data collection is essential to assessing the efficacy
of the program funded by this grant. We are well positioned to gather the required data
due to the infrastructure provided by our existing electronic data collection system.
SEFBHN has an established electronic data collection system that is currently used by
all of our contracted network providers. The system is maintained through a contractual
relationship with Concordia Behavioral Health and has been designed to capture data
required for SAMHSA Block Grant funding. SEFBHN has incorporated the National
Outcome Measures from Substance Abuse and Mental Health Block Grants into all of our
provider contracts, as well as the Performance Measures attached to our General
Revenue funding (GAA). Performance outcomes are established in each provider
contract, reporting is done on a monthly basis and the monitoring of these outcomes is
done through reports, the Continuous Quality Improvement process, Quality Assurance
process, and contract monitoring. SEFBHN takes a very proactive approach to monitoring
the performance of our network providers by providing technical assistance throughout
the year if a provider's data indicates they are not meeting their performance measures.
The following performance measures and targets will be monitored for the CJMHSA
Reinvestment grant:
0 40% of arrests or re-arrests among Program participants while enrolled in the
Program.
0 30% of arrests or re-arrests among Program participants within one year
following Program discharge.
a 67% of Program participants not residing in a stable housing environment at
Program admission who reside in a stable housing environment within 90 days
of Program admission.
0 90% of Program participants who reside in a stable housing environment one
year following Program discharge.
0 10% of Program participants not employed at Program admission who are
employed full or part time within 180 days of Program admission.
0 24% of Program participants employed full or part time one year following
Program discharge.
0 65% of Program participants the Grantee assists in obtaining social security or
other benefits for which they may be eligible but were not receiving at Program
admission.
0 15% of Program participants diverted from a State Mental Health Treatment
Facility.
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® 50% of Mental Health Court participants diverted from the Criminal Justice
system, referred to, entering, completing and graduating from the Program.
The SEFBHN Data Collection System provides reports on utilization management
reports and performance measures which will enable ongoing analysis of the project
funded by the grant. We will be able to drill down to the services provided to individual
consumers in addition to monitoring each performance measures referenced above for
the project as a whole.. Reports can be accessed from the SEFBHN Data Collection
System on a daily basis, if needed. It is anticipated that reports will be provided on a
quarterly basis to our collaborative partners, subcontracted providers and to the Public
Safety Coordinating Council. Reports will include the number of consumers served in the
reporting period both active and discharged, the services that have been provided during
the reporting period and current performance relating to the identified performance
measures. SEFBHN will then provide an analysis of both strengths and opportunities for
improvement to the collaboration, along with any technical assistance that may be
needed. An example of this would be that the project is having success coordinating and
scheduling services but the individuals may not be showing up and that additional case
management efforts are needed to engage them in the program.
3.8.5.5 Capability and Experience
3.8.5.5.1
3.8.5.5.2
Southeast Florida Behavioral Health Network
Southeast Florida Behavioral Health Network (SEFBHN) is a non-profit agency that
began operations in October 2012 as the Managing Entity for Behavioral Health Services
in Palm Beach, Martin, St. Lucie, Indian River and Okeechobee counties. SEFBHN
oversees a budget of more than $55,000,000.00 and contracts with over 40 private and
non-profit service agencies to ensure that quality services and best practices are provided
to eligible consumers and families. SEFBHN network providers employ principles of
recovery including: choice, hope, trust, personal satisfaction, life sustaining roles,
interdependence and community involvement. As the Managing Entity, we maintain an
oversight role in which we safeguard that each of our network providers responsibly fulfill
the terms of their individual contracts while ensuring that they maximize their coordinated
potential within our overall integrated system of care.We accomplish this through multiple
activities including: on-site contract validation that includes chart reviews and interviews
with staff & consumers, on-going review of provider's performance and utilization data,
contract negotiation that can result in changes to funding and the types of services that
will be included in the contract based on their prior performance, use of Corrective Action
Plans to improve deficiencies in a provider's performance, and regularly scheduled
Continuous Quality Improvement meetings with provider staff.
SEFBHN is headed by a Chief Executive Officer (CEO) and governed by a Board of
Directors. The Board is comprised of representatives from community stakeholder
agencies and provider agencies. SEFBHN directly employs 21 staff to provide
Network/Contract management, Quality Assurance & Improvement Guidance &
Oversight, Fiscal & Budget Oversight, Collaborative Program Development, Information
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Management, various Human Resources functions and Coordination of Training
Activities, Incident Reporting & Consumer Satisfaction Surveys. We have staff with
extensive expertise and experience that includes Mobile Crisis Response, Child Welfare,
Medicaid Regulations, Criminal and Juvenile Justice, Intensive Mental Health Treatment,
Substance Abuse Treatment, Prevention Services, SOAR and Wraparound Case
Management. Our CEO has over 20 years of experience in all facets of human services
that has allowed her to develop productive professional relationships statewide. A
contract with Concordia Behavioral Health provides Data Management and Invoicing
Services. SEFBHN is fully insured with coverage that includes general, automobile,
umbrella, and cyber liability.
Indian River County Sheriffs Department
The mission of the Indian River County Sheriff's Department is to serve the public with
dignity, integrity and professional service while enhancing their partnership with the
community in order to protect life and property, prevent crime and solve problems. Indian
River County Sheriff Loar has been part of the planning, development and launch of the
Indian River County Mental Health Court program. He's conferred and collaborated with
Judge Cynthia Cox, who successfully launched the St. Lucie County Mental Health Court
program, prior to planning and implementing the IRCMHC. Sheriff Loar brings the
capabilities and experience gained through his work with the comparable St. Lucie County
program, along with an extensive base of forensic knowledge, to the Indian River County
program implementation. He notes that that the IRC Sheriff's department is "only one of
eleven Sheriff's Offices in the state to be CALEA, FCAC and CFA accredited."
Legacy Behavioral Health Center, Inc.
Legacy Behavioral Health Center, Inc. is a community mental health center that has
been serving residents of Martin, Okeechobee, St. Lucie, Indian River and Palm Beach
Counties since 2005. They are committed to improving the quality of life and level of
performance of emotionally and behaviorally challenged infants, children, adolescents,
families and adults through an array of evidence based and diverse services. Legacy
Behavioral Health has staff psychiatrists who provide psychiatric evaluations, medication
management. They have licensed clinicians trained in Mental Health and Substance
Abuse Services;Therapeutic Behavior On-Site Services;Therapeutic Behavioral Support
Services On-Site; and Targeted Case Management. Additionally, having the license and
ability to provide psychological testing and evaluations, Legacy Behavioral Health is well-
prepared to be a partner on this diversion project.
Mental Health Association of Indian River County
Mental Health Association (MHA) of Indian River County utilizes two formats to provide
services to the Indian River Community. The walk-in is center designed to meet emerging
and imminent mental health needs of individuals and families in the community. The
Center provides crisis intervention and individual therapy services to children, adults and
families; case management, self-help groups, psycho-educational groups and group
therapy. The Mental Health Association also facilitates Drop-In Centers which are
available 365 days of the year and designed to empower consumers to change their lives.
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The Drop-In Centers' are peer-operated, recovery oriented environments in the
community that provide an accessible, safe, supportive and confidential place for care
and recovery. The Drop-In program already operates as part of the Mental Health Court
support network. A client shared that he regularly attends the Mental Health Association's
Drop-In Center and is looking forward to graduating from the program so he can pursue
employment. He was grateful for support he could depend on, so he could make better
choices in his life. The MHA has a long standing commitment and a vested interest in
diverting individuals with mental health disorders and substance abuse issues, away from
the criminal justice system and towards effective treatment programs and service
providers who can more effectively identify and treat the underlying causes that lead to
criminal behavior.
Mental Health Collaborative of Indian River County - The Connections Center
Mental Health Collaborative of Indian River County / The Connections Center has
formed a partnership between local philanthropists and the University of Florida College
of Medicine to establish the OF Center for Psychiatry and Addiction Medicine in Vero
Beach. This Collaborative is increasing community awareness of the importance of
mental health through education efforts directed at local government organizations and
positioning itself to serve as a resource. It also has been exploring the issue of the lack
of housing options for the mentally ill in Indian River County. Through efforts generated
in this Collaborative, the Mental Health Court was developed. The MHCIRC has chosen
to expand services and the Connections Center created. The Connections Center is a
collaboration of the service providers and various other social service entities and is
designed to support existing, effective billable services. The Connections Center is
designed to ensure access to mental health and substance abuse services, while
removing barriers to services for other social determinants that impact optimal mental
health and sobriety. A final hallmark of the Connections Center, as a central point of
access, is the provision of an ongoing unmet needs assessment. A data tracking system
will be put in place so that the following data can be gathered in real-time. This data will
include but not be limited to: Populations seeking services, identified service needs not
currently available within the county, Services with long wait times or insufficient capacity,
Gaps in culturally diverse service availability, Social determinant needs, Training &
education needs.
Mental Health Court
Mental Health Court is the hub for agencies providing Mental Health Court services.
Since January 27, 2015, The Mental Health Court has been diverting suspects away from
incarceration to a program that has been successful in turning lives around diagnosed
with mental health and / or substance abuse. After successfully implementing the same
diversion program in St. Lucie county Florida, Judge Cynthia Cox launched the program
in Indian River County. This program, which strives to keep participants out of jail by
providing mental health treatment has already graduated participants who have
successfully complete the six-month program. Exhibiting Collaboration within systems,
clients are referred to the court by the Sheriffs Office. A treatment plan is generated for
each client, which can include therapy sessions, drug or alcohol treatment or even
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residency programs. Most clients are on probation and must attend Mental Health Court
as a condition of their probation.
New Horizons of the Treasure Coast
New Horizons of the Treasure Coast delivers accessible behavioral and primary health
care services to children, adults and families to achieve mental and physical wellness,
thereby improving the quality of life in our community. New Horizons of the Treasure
Coast operates the Mobile Crisis Teams that respond to all of the communities throughout
Indian River County, working to close gaps in the system of care and reduce unnecessary
hospitalizations and incarcerations. They provide Mental Health, Substance Abuse,
Primary Care and Crisis Support services, such as crisis stabilization units, detox, all
levels of residential treatment, outpatient and case management services. New Horizons
of the Treasure Coast has years of experience working with all the Mental Health Courts
in Indian River, Martin and St. Lucie Counties.
Substance Abuse Council of Indian River County
Substance Abuse Council of Indian River County mission is to lead the community
toward a healthier lifestyle by reducing the incidence of substance abuse in Indian River
County, through prevention, treatment and recovery support. Their services include
Housing, Drug Testing, LifeSkills Training, and Outpatient Counseling. The Center
operates two houses for women in recovery, where clients receive housing, outpatient
counseling and support. SAC is part of the current IRCMHC staffing team and provides
discounted drug testing and a substance abuse assessment for all referred MHC clients.
For clients that are eligible for medicated-assisted-treatment, SAC will be partnering with
the Treasure Coast Community Health Center to offer Vivitrol through the FADAA/OSCA
Vivitrol Project (Application is in process). SAC currently performs all drug testing that is
required for MHC and will continue to do so.
3.8.5.5.3 Anticipated role of advocates,family members,and responsible partners;and
The Care Coordination Manager, the Care Manager and the Peer Specialists will be the
principle advocates for the participating clients and their family members. These team
members will work with the involved parties to help the clients achieve a positive outcome.
The IRC Connections Center will be the central access point for supporting the behavioral
health needs of the community and engaging consumers with underlying mental health
and/or substance use disorders who are experiencing quality of life issues and having
difficulty navigating appropriate services in the community. The Connections Center's
objective is to help consumers and their families get enrolled in the right service, with the
right provider, the first time; thereby, reducing inefficiencies and any duplication of
services. The Connections Center is designed to ensure access to mental health and
substance abuse services, while removing barriers to services for other social
determinants that impact optimal mental health and sobriety. The Connections Center is
a collaboration of the service providers and various other social service entities and is
designed to support existing, effective billable services.
3.8.5.6 Evaluation and Sustainability
3.8.5.6.1 Evaluation For both Planning and Implementation and Expansion Grants, describe how the
project's effectiveness will be demonstrated, including assessments of planning or implementation
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outcomes. Discuss how variables like stakeholder support and service coordination will be defined and
measured. Describe the process for collecting performance measurement data, and any other state or
local outcome data to measure project effectiveness in promoting public safety, reduction of recidivism
and access to services and supports for the Target Population(s).
3.8.5.6.1.1 Implementation and Expansion Grants Only Estimate the effect of the proposed
project on the Target Population related to the budget of the jail and juvenile detention center.
The information must include:
3.8.5.6.1.1.1 An estimate of how the Program will reduce the expenditures associated with the
incarceration of the Target Population;
3.8.5.6.1.1.2 The proposed methodology to measure the defined outcomes and the
corresponding savings or averted costs;
3.8.5.6.1.1.3 An estimate of how the cost savings or averted costs will sustain or expand the
mental health, substance abuse, co-occurring mental health and substance abuse treatment
services and supports needed in the community; and
3.8.5.6.1.1.4 How the county's proposed initiative will reduce the number of individuals judicially
committed to a state mental health treatment facility
3.8.5.6.2 Sustainability For both Planning and Implementation and Expansion Grants address
sustainability of the project. Describe the proposed strategies to preserve and enhance the community
mental health and substance abuse systems. Describe how sustainability methods will be used and
evaluated, including how collaborative partnerships and funding will be leveraged to build long-term
support and resources to sustain the project when the state grant ends.
As a result of reducing the population of mentally ill individuals in the Indian River
County Jail, it will reduce the average length of incarceration for their overall inmate
population due to the fact that mentally ill inmates have demonstrably longer incarceration
periods. Mentally ill inmates are also a_costlier population due to the following reasons:
special needs related to psychotropic medications; episodic stabilization requirements;
their high propensity towards co-occurring substance abuse disorders and the requisite
withdrawal management services upon arrival; and, all other physical and mental health
care related services that result from the decompensation triggered by incarceration.
Redirecting this population to the more suitable path provided by the IRCMHC, will
provide methodologies (see section 3.8.5.4) to track and measure outcomes for this
diversion population; those outcomes can be analyzed, in tandem with the estimated cost
savings that will be tracked by SEFBHN, as a means by which to establish future support
in the IRC community for sustainable funding for the continuation of the program.
SEFBHN will collect the data from the collaborating agencies on a monthly basis to
ensure the success of the program. The performance measures will be tracked through
the Care Coordination module. The success of the program will be measured by the
aforementioned performance measures including successful graduation from IRCMHC
and less recidivism. Tracking systems are established and ready to be implemented.
The demonstration of success and cost savings in the IRCMHC since inception has
prompted the Indian River County Sheriff to dedicate increased resources to the program.
By expanding and enhancing the services through the funding provided by this proposed
grant award, even greater success will be demonstrated and the funding needed from
stakeholder agencies to sustain the IRCMHC when the grant funding ends will be justified.
The SEFBHN data system allows us to track the utilization of services and the exact dollar
costs of those services per person across all agencies. We will be able to cross reference
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this with the realized savings for the Indian River County Jail and local crisis services
which will be calculated each year of the program based on the aggregate costs of those
services during the tracked time period.
In addition to the beneficial cost savings for the criminal justice system, there will be
concurrent benefits to IRC's mental health and substance abuse systems due to
increased funding that this proposed grant award will allocate for those services. The
strategic plan for this program will expand the behavioral health infrastructure of Indian
River County; and, it will also Enhance the efficacy and efficiency of care through the
improved functionality of the Coordination of Care system in the community. Greater
collaboration, and the resulting improvements from the increased partnering and
communication between agencies, will benefit the consumers as well as reduce
duplicated or ineffective service provision. This improvement in care will allow for high
risk utilizers to benefit from improved community-based services, reducing the numbers
of individuals requiring commitment to a state mental health treatment facility. Recidivism
of consumers back into the state facilities will also be reduced through improvements in
community-based care and through the implementation of intervening practices by
SEFBHN which provide a safety-net for the high risk consumer. Strong positive outcomes
for the overall program, the various stakeholder and provider agencies, as well the
individual consumers will motivate additional funding and provide the impetus for long-
term community support.
3.8.5.6.3 Project Timeline Provide a realistic and detailed timeline for each funding year proposed,
indicating goals,objectives,key activities,milestones,and responsible partners.The timeline must include
anticipated start and completion dates for each milestone, benchmark, and goal.
Objectives Month to Implementation Responsible Party
begin
Objective 1 — Establish Month 1 Hire and train staff SEFBHN, IRCMHC,
programs and diversion IRCSO, partners
initiatives that increase
public safety, avert
increased spending on
criminal justice and improve
accessibility and
effectiveness of treatment
services for the clients in
IRC Mental Health Court.
Increase the number of Month 1 and MOU template SEFBHN, IRCMHC,
partnerships formed as ongoing IRCSO, partners,
demonstrated by formal Identify partners Indian River Mental
Memoranda of Health Collaborative
Understanding (MOU) or Establish MOU
other mechanism, including
partnerships about the
xchange of information and
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data related to our clients in
MHC.
Implement our new web- Month 2 and Module completed SEFBHN, Connections
based Coordination of Care ongoing Center
data module that will track Train staff
II MHC clients during their
involvement with the Collect Data
program and for at least one
year after discharge. The Use tracking to
system will track all mental ensure clients are
health and substance abuse receiving timely
services received, including services
arrests, receipts of benefits,
employment and stable
housing.
Implement Peer-Based Month 1 Train staff MHAIRC, Connections
Recovery Support which will Center
utilize the Wellness Month 2 Implement practice
Recovery Action Plan
(WRAP), an evidence- Month 6 and Evaluate results
based practice along with ongoing
Whole Health Action
Management (WHAM) an
integrated approach
developed by the SAMHSA-
HRSA Center for Integrated
Health Solutions.
Increase the number of Month 3 Add additional IRCSO
Crisis Intervention Team training sessions
(CIT) trained law
enforcement officers
responding to mental health
related crisis calls.
Objective 2—To create and Months 1-3 Convene meetings SEFBHN, Connections
encourage collaboration and on-going Center
among the key
stakeholders, such as the
Public Safety Planning
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Council in implementing and
providing ongoing oversight
and quality improvement
activities for the CJMHSA
rant program.
SEFBHN will meet quarterly Month 2 and Provide reports for SEFBHN
with PSPC to assess the on-going subcommittees and
progress and review Council
performance measures and
timelines associated with
he CJMHSA grant program
and make necessary
adjustments to
implementation as needed.
Develop sub-committees Month3and Convene quarterly Public Safety
that will meet monthly to on-going meetings and Coordinating Council
provide oversight, Establish
collaboration and subcommittees
continuous quality
improvement. Establish goals for
subcommittees
Convene meetings
Objective 3— Create a Monthland Completed MHC Partners
Coordination of Care model on-going
or the IRCMHC.
Reduce access time to Month 2 and Establish treatment SEFBHN
mental health and/or on-going resources
substance abuse treatment
services by providing Establish schedule
immediate access (within 24 of appointments
hours) to assessments with coinciding with
our network providers Mental Health Court
hearings
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Increase the number of Month 1 and Train Peer SEFBHN,
SSI/SSDI approvals through on-going Specialists and
SOAR applications case managers
Process MHAIRC
applications
Track applications
and approvals
Increase connections to Month 3 and Identify resources SEFBHN, case
housing, employment and/o on-going managers, connections
educational resources Link to resources center
Utilize partnerships
o increase
resources
Begin to analyze data and Month 6 Utilizing the Care SEFBHN, Public
measure performance Coordination Safety Council
Module look at
initial outcome data
3.7.4 Tab 6: Letters of Commitment Include a summary list of all organizations that will be involved in the
implementation of the proposed project and a letter of commitment from each organization reflecting
the specific role of the individual or organization, signed by the Chief Executive Officer or equivalent for
each organization.
3.7.5 Tab 7: Line Item Budget and Budget Narrative Each application must include a detailed budget and
budget narrative for each year of the grant.All proposed expenses must be tied to the proposed activities.
The budget must show line item costs broken down by the proposed funding(grant and match), plus the
total amounts.See Appendix G for full instructions on completing this section.All proposed costs must be
in accordance with the Department of Financial Services Reference Guide for State Expenditures, which
may be located at: http://www.myfloridacfo.com/aadir/reference_guide/Applicants are required to use
the Commitment to Match Donation Forms found in Appendix H to verify cash and attach valuation to in-
kind contributions. A signed form from each match donor must accompany this application as an
attachment to the Budget Section.A Match Summary Sheet is to be used to show the proportions of cash
and in-kind match.
3.7.7 Tab 8: Certified Designation Letter If the Applicant is not a County,the application must include a
letter certified by the county planning council or committee designating the not-for-profit community
provider or managing entity to apply for the RFA on behalf of the county.
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