HomeMy WebLinkAboutResolutions - 1997.11.06 - 25163October 23, 1997
Miscellaneous Resolution 197223
BY: Shelley G. Taub, Chairperson, Public Services Committee
IN RE:Community Mental Health Approval of Annual Program Plan and Budget
Submission 97/98
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
WHEREAS the Department of Community Health (DCH) requires each Community
Mental Health Board to submit an annual Program Plan and Budget (Program
Plan); and
WHEREAS the information included in the Program Plan is aggregated and
used by the Department of Community Health in determining their annual budget
request; and
WHEREAS the Community Mental Health Board reviewed, held a public
hearing on, and approved the Program Plan on September 16, 1997, in accordance
with Department of Community Health guidelines; and
WHEREAS the DCH's deadline for submission of the Program Plan was
September 19, 1997
WHEREAS time did not permit for the Program Plan to complete the Oakland
County Board of Commissioners protocol for approval prior to the September 19,
1997 submission deadline; and
WHEREAS any changes approved by the Oakland County Board of
Commissioners will be forwarded to the Department of Community Health as
amendments to the Program Plan submitted on September 19, 1997.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners approves the Oakland County Community Mental Health Board's
Annual Program Plan and Budget submission for 97/98 to the Michigan Department
of Community Health.
On behalf of the Public Services Committee , I move the adoption of the
foregoing resolution.
\-Q2a
Publi Services Committee
Sincerely,
Sandra M. Lindsey
Director
Oakland County Community Mental Health . Board
1290 N. Telegraph Road, Suit* C-110
Pontiac, MI 40341-9047
810458-1221
Fax: 810475-9768
September 17, 1997
William J. Allen
Chief Executive Officer - Mental Health and Substance Abuse Services
do Office of Budget Development
Department of Community Health
6th Floor
Lewis Cass Building
Lansing, MI _ 48913_ _______ _ _ _ _ _
Dear Mr. Allen:
I am submitting the Oakland County Community Mental Health Service Board's Program Budget Plan
for FY 1997-1998. It includes our a certification of our needs assessment of current client need, an
updated community need and demand assessment, program revision requests, and all forms (with those
exceptions noted on the "Forms Submission Checklist").
axb
OAKLAND COUNTY
COMMUNITY MENTAL HEALTH
SERVICES BOARD
PROGRAM BUDGET PLAN
FY 1997-1998
,
=====e
OAKLAND COUNTY C/6/43P -Page I
TABLE GF CONTENTS
FORM SUBMISSION CHECKLIST - 1997 1
ASSESSMENT OF NEED
CERTIFICATION OF THE ACCURACY OF COMMUNITY NEED AS
TRANSMITTED IN 1996 2
ASSESSMENT OF COMMUNITY NEEDS NARRATIVE 3 METHODOLOGY AND GENERAL DISCUSSION 4
REFERENCES 5
ASSESSMENT OF COMMUNITY NEED - 1997 SUBMISSION 7
ADULTS WITH MENTAL ILLNESS - COMMUNITY NEED NARRATIVE 8
CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE - COMMUNITY
NEED NARRATIVE 9
PERSONS WITH DEVELOPMENTAL DISABILITIES - COMMUNITY NEED
NARRATIVE 10
AVERAGE WAIT FOR NON-EMERGENCY SERVICES 11
PERSONS WITH DEVELOPMENTAL DISABILITIES 11
CHILDREN WITH SERIOUS EMOTIONAL DISTRUBANCE 12
ADULTS WITH MENTAL ILLNESS 13
RESIDENTIAL BED CAPACITY 14
FULL MANAGEMENT TRADE-OFF DOLLARS PROJECTED
EARNED DURING FY 97-98 15
PERSONS WITH SERIOUS MENTAL ILLNESS
RECEIVING CLIENT SERVICE MANAGEMENT 17
CENSUS PROJECTIONS - HOSPITALS, CENTERS AND NURSING HOMES . . . 18
WAIVER CERTIFICATES PLANNED USE 19
FEDERAL BLOCK GRANT REPORTING REQUIREMENT SYSTEM OF CARE .
SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE 20
FEDERAL BLOCK GRANT PROGRAM REVISION REQUESTS 21
ESTIMATED FTE'S 40
CMHSP SUMMARY OF CURRENT CONTRACTS FOR MENTAL HEALTH SERVICES
DELIVERY 41
CMHSP PERSONS SERVED 42
RESPITE CARE - CONTINUATION FUNDING APPLICATION 43
RESPITE CARE - CONTINUATION FUNDING NARRATIVE 44
RESIDENTIAL DIRECT CARE WORKERS 45
OAKLAND COUNTY CNINIP • Page
CMHSP: Oakland County
FORM SUBMISSION CHECKLIST - 1997
CHECKLIS.WPD
The following forms/narrative must be included in the CMHSP's submission. Please enter an "X" to
indicate the information is provided.
Assessment of Need Certification form (CERTNEED.WPD)
Assessment of Current Client Need Summary form - one for each client population
(CLIENTND.WPD)
Assessment of Community Need form (COMMNEED.WPD)
CMHSP Waiting List—Movement Report (optional in 1996; required in 1997) (WAITOUT.WPD)
X Residential Bed Capacity - all client groups (BEDCAP.WPD)
Full Management Trade-Off Dollars Projected (FMTO.WPD)
X Persons with Serious Mental Illness Receiving Client Service Management (SMI.VVPD)
X Census Projections - Hospitals, Centers and Nursing Homes (CENPROJ.WPD)
X Summary--Waiver Certificates Planned Use (WAIVCERT.WPD)
X Federal Block Grant Reporting Requirement--System of Care Services for Children with
Serious Emotional Disturbance (FEDBG.WPD)
A_ Federal Block Grant Program Revision Request and Narrative (PRR-FBG.WPD)
(FBGNARR.VVPD)
X Estimated FTE's (FTES.WPD)
CMHSP Summary of Current Contracts for Mental Health Services Delivery
(CONTRACT.WPD)
Persons Served (SERVED.WPD)
Respite Care - Continuation Funding Application (RESPITE.WPD)
A_ Residential Direct Care Workers (RESID.WPD)
Certified:
(Narme)
Director
(Title)
(name)
phone number).
to: Alex Braitman
at: (248) 858-5478
OAKLAND COUNTY CROW • Pop 2
ASSESSMENT OF NEED ..•
CERTIFICATION OF THE ACCURACY OF COMMUNITY NEED AS TRANSMITTED IN 1996
CERTNEED.WPD
THE ASSESSMENT OF COMMUNITY NEED NARRATIVE AND THE ASSESSMENT OF COMMUNITY
NEED FORM, AS SUBMITTED IN 1996 FOR THE
Oakland County
FOLLOWING OBJECTIVES:
To satisfy the requirements of 330.1124(2) and 330.1226 of the Mental Health Code which require the
maintenance of waiting list information and an annual examination and evaluation of the mental health
needs of the CMHSP's catchment area.
• Accurately represents the service needs of persons currently receiving mental health services through
the CMHSP.
• Accurately represents the mental health service needs and associated costs of persons in the
community who are eligible for public mental health services.
Questions regarding the CMHSP's assessment of need should be directed
CMHSP) MEET THE
•Oakland County CMHSP is certifying that the Current Client Need Summary Form and Narrative from
FY96 has remained essentially the same since its submission. However, an Assessment of
Community Need Form and Narrative are being included because of improvements in the process of
identifying community need.
ASSESSMENT OF COMMUNITY NEEDS NARRATIVE
OAKLAND COUNTY CMNSP • Page 4
METHODOLOGY AND GENERAL DISCUSSION
This section deals with measuring community need for public mental health services. The sources of
information regarding these groups of people come from OCCMH's database on current users of
services, opinions of OCCMHSP staff, data from program waiting lists, and public testimony. A
primary source of need information is OCCMH's database on current users. With the database,
trends can be analyzed and results can be compared to expected information gathered from the
census information.
The database reveals that Oakland County has a very diverse population with wide differences in
social and economic characteristics among the various geographical areas. The availability of
community resources and human services varies greatly, although these differences are not always
apparent. Examining the mental health needs of this population involved detailed analyses of a
number of factors including poverty levels, age, race, marital status, educational attainment,
non-family households, female heads of household, and children not in two-parent families — many of
which have been used to estimate prevalence of emotional disorders in the Epidemiologic Catchment
Area Study (Regier and Burke, 1987). ,
OCCMHSP, with the assistance of the local Alliance for the Mentally III has distributed a survey to the
public to identify community needs information. Responses to this survey are being gathered and
this information will be submitted under separate cover to the department and/or included in next
year's program plan. Current needs are also being estimated using statistical estimation from the
findings of the Regier and Burke (1987). OCCMHSP assumes that the prevalence of diagnosable
disorders suffered at some time during one's lifetime would range between 28 and 38 percent of the
population.
Oakland County is also estimated to have a higher prevalence of emotional disorders. This is due, in
part, to the large number of patients that have been historically served at Clinton Valley Center that
were discharged into the local community.
OCCMHSP is also aware that there are a number of children that have not yet applied for services
and that its current waiting list may be an undercount of those in need of services. For example,
there are children obtaining assistance from the Oakland County Family Independence Agency (FIA)
(in various programs including foster care and delinquency) who are not receiving mental health
services. FIA refers children to OCCMHSP only if there is clearly expressed mental health need.
OCCMHSP also refers out families who have private insurance to private service providers.
In order to improve its needs assessment process, OCCMHSP has created a central
admission/screening unit that functions as a "clearing house" for all requests for noncrisis mental
health services from the community. This unit maintains a central waiting list, provides face-to-face
and phone assessments, and links individuals with appropriate service providers both within the
OCCMH and externally.
The bulk of the current wait list consists of persons with developmental disabilities requesting long
term supports--i.e., residential placement and day programs. OCCMH has convened a task force to
address this problem. It is composed of secondary consumers, families of persons on the wait list,
OANLANO COUNTY CAKIP • Psi, $
Board members, advocates, providers, and CMH staff.
The associated form depicts demand for services for all population groups served by OCCMH and is
based upon wait list data and agency surveys and information from our managed care program.
REFERENCES
Anderson, Carol M., Griffin, S., Rossi, A., Pagonis, I., Holder, D.P. and Treiber, R. (1986). A
comparative study of the impact of education vs. process groups for families of patients with affective
disorders. Family Process, 2.5, 185-205.
Anderson, C., Reiss, D., and Hogarty, G. (1986). Schizophrenia and the family: A practitioner's
ouide to psychoeducation and management. New York: Guilford Press.
Anthony, W. A. and Blanch, A. (1987). Supported employment for persons who are psychiatrically
disabled An historical and conceptual perspective. Psychosocial Rehabilitation Journal, 11, 5-23.
Cappel, L. (1976). An epidemiological assessment of untreated psychiatric impairment in Salt Lake
County. Ann Arbor, Michigan: University Microfilms.
Cummings, Fred A. (August 4, 1987). An assessment of the Oakland County CMH case
management program (based on the training materials). Unpublished manuscript, Oakland County
Community Mental Health Services, Pontiac, Michigan.
Edgarton, J. (1980). Demographic factors and response to stress among rural people. American
Journal of Public Health, 51, 1065-1069.
Falloon, I., Boyd, J., and McGill, C. (1984). Family care of schizophrenia: A problem solving
approach to the treatment of mental illness. New York: Guilford Press.
Fa'loon, I., et al. (1985). Family management of schizophrenia: A study of clini al. social. family and
economic benefits. Baltimore: Johns Hopkins University Press.
Hare, E., and Shaw, G. (1965). Mental health on a new housing estate. London, England: Oxford
University Press.
Hogarty, G., et al. (1986). Family psychoeducation, social skills training and maintenance
chemotherapy in the aftercare treatment of schizophrenia: One year effects of a controlled study on
relapse." Archives of General Psychiatry, 42, 633-642.
Langner, T. (1962). A twenty-two item screening score of psychiatry symptoms indicating
impairment. Journal of Health and Human Behavior, 2, 269-276.
Leighton, D. et al. (1963). Th- hr. -r •f • -n• -r - h- Min. • .n • V.1 - . New York:
Basic Books.
OAKLAND COUNTY COANSP • Page.
National Center for Health Statistics (1970). Selected symptoms of psychological distress. • ziaLansi
Health Statistics, Series 11, #37, Rockville, Maryland: Department of Health, Education, and Welfare.
Phillips, D. (1966). The "true prevalence' of mental illness in a New England state." Community
Mental Health Journal, 2, 35-40.
Regier, Darrel A., and Burke, Jack D. (1987). Psychiatric disorders in the community: The
epidemiologic catchment area study. In Hales, Robert E. and Frances, Allen J., (Eds.), American
Psychiatric Association Annual Review, Vol. 6, pp. 610-624. Washington, D.C.: American Psychiatric
Press, Inc.
Russert, M. G. and Frey, J. L. (1991). The PACT vocational model: A step into the future.
Psychosocial Rehabilitation Journal, 14, 7-18.
Sheldon, Ann W. (1987). Oakland County census-based information for program development and
evaluation purposes (report). Center for Urban Studies, Wayne State University, Detroit, Michigan.
Sheldon, Ann W. (1988). Meeting mental health needs in Oakland County, Michigan: Population and
community characteristics.. Center for Urban Studies, Wayne State University, Detroit, Michigan.
Sheldon, Ann W. (1989). The minority population of Oakland County. Center for Urban Studies,
Wayne State University, Detroit, Michigan.
Srole, L., et al. (1962). Mental health in the metropolis - the Midtown Manhattan Study. New York:
McGraw-Hill.
Strachen, A. (1987). Family intervention for the rehabilitation of schizophrenia: Toward protection
and coping. Schizophrenia Bulletin, 12(4), 678-698.
Strategic Planning Committee (1989). Report of the Strategic Planning Committee. Pontiac,
Michigan: Oakland County Community Mental Health Services.
Sue, Stanley (1988). Psychotherapeutic services for ethnic minorities:
Two decades of research findings. American Psychologist, 43(4), 301-308.
Taylor, L., and Chave, S. (1964). Mental health and environment. London, England: Longman,
Green, and Co.
Technical Assistance Collaborative (1994). Oakland County Community Mental Health: Assessment
of Existing Operations and Recommendations for Full Management - Final Report. Boston, MA.
Yarvis, Richard M., and Edwards, Daniel W. (1980). Planning: The design of mental health
programs. Sacramento, California: Pyramid Systems.
OAKLAND COUNTY CM143$1 • Pig.?
ASSESSMENT OF COMMUNITY NEED • 1991 SUBMISSION
COMMNEED WPO
CAMP Oakland County
4
No. of Persons No. of Persons the Estimated Cost Estimated Total
in the Catchment CMHSP Would Per Person Cost to Meet
Area Meeting the Propose to Serve (Maximum Service Need
Sub-population with Fully Matchable)
Criteria Operational to be Served •
Programs
Enter Sub-population:
Column A Column B Column C Column 0 _ _
..,
ADULTS WITH MENTAL ILLNESS ..
Residential Programs 215 215 $ 54.000 S 11,610,000 ,
2. Crisis Residential Program 600 600 $ 1,217 $ 730,000
3. Outpatient Services 450 450 $ 1,000 450,000 ,
4. Consumer Run Drop-In Center 250 250 $ 1,140 , i 285,000
5. African American Family Center 354 60 , $ 2,692 $ 511,534
6. Club House 170 170 $ 1,471 $ 250,000 ,
TOTAL _ 2,039 _ 1,745 _ $ 61,520 $ 13,838,534
-1
CHILORgN WITH MENTAL ILLNESS
1. Parent Helpers for Families receiving Infant 12 12 $ 4,680 $ 56,160
Mental Health Services
2. Specialized Foster Homes 26 . 26 $ 2,400 $ 62,400
3. Long Term Mentors for Adolescents 80 80 $ 2,340 , $ 187,200
4. Long Term Mentors for Parents 50 50 $ 2,340 $ 117,000
5. Crisis Residential Program 50 50 $ 2,760 $ 138,000
6. Summer Program (Therapeutic & Social Skill 60 60 $ 1,500 $ 90,000
Building)
7. Intensive Transitional Services (Bridge
30 30 5 43,800 5 1,314,000
Program)
TOTAL 308 308 _ 5 59,820 S 1,964,760
PERSONS WITH DEVELOPMENTAL DISABILITIES ,
1. Crisis Residential Program 122 122 S 1,951 S 238,000
2. Day Program 500 500 $ 14,000 S 7,000,000
3. Residential Placement 420 420 $ 31,025 $ 13,030,500
4. Planned Respite Program 136 136 5 2,206 5 300,000
- TOTAI 1_17R 1_17FI S 4-4W-.- 7 gfik On
(IRA r4n TC1TAI . 474 711 t. 17(022 _s_....,jusual.
OAKLAND COUNTY CPANSP • Prig •
ADULTS WITH MENTAL ILLNESS - COMMUNITY NEED NARRATIVE •
1. Residential Programs - To meet both community and institutional demand, more
residential placement options are needed for our consumers at all levels, from
SIPs to CLFs.
2. Crisis Residential Program - An additional 10 beds are needed to meet current
demand. This service is used as a diversion from inpatient hospitalization and
as a hospital length of stay reduction program for community reintegration post
discharge.
3. Outpatient Services - Outpatient services for therapy and medication
management are needed. Currently OCCMH refers these out or follows them in
the crisis clinic. It is estimated that there are 450 individuals who can benefit
from this service. This service is anticipated to help reduce demand for acute
care as well.
4. Consumer Run Drop-In Program - Since 1989 there has been a growing demand
in Oakland County for a consumer-run drop-in center like the FAIR Program in
Pontiac. The demand has come-from advocacy groups, consumers, mental
health clinicians and case managers. FAIR is dedicated to the ideal of mutual
support for persons suffering or recovering from emotional or mental illness
problems. The success of the program in Pontiac has only increased the
demand for the program in Southern Oakland County. OCCMHSP estimates
that 250 persons could be served through the development of consumer-run
drop-in centers in each quadrant. This would entail the development of three
additional programs.
5. African-American Family Center - Census data indicate that 7.2% of Oakland
County's population is African-American; yet this group represents 14% of the
persons served by OCCMH. African-Americans in the County have substantially
higher rates of poverty and family disruption than Whites. Sheldon (1988)
projected that psychoses for this group would occur at the rate of 1.7 per 100, or
1318. If the number of African-American individuals with serious mental illness
that OCCMHSP served (964) is subtracted from this figure, then there are an
estimated 354 individuals who are unserved. However she noted that this broad
estimate does indicate the magnitude of need that is compounded by poverty
and other community factors. Therefore, it is clear that an African-American
Family Center would be very useful in addressing the pressing mental health
needs of this group. The goal of this program is to provide an ethnic sensitive
service to psychiatrically impaired African-American families who are at risk of
becoming more dysfunctional and end up in out-of-home placements such as
foster care and inpatient psychiatric hospitalization. It is expected that as a
result of these interventions there will be a reduced incidence of family unit
separations in out-of-home placements, and a reduction in rehospitalizations and
length of stay.
6. Club House - Additional club houses are needed to serve consumers in the
South, North and West Quadrants. The club house model as proven an effective
model, but lack of access for all eligible consumers has been apparent.
OAKLAND COUNTY CMHSP - Page I
CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE - COMMUNITY NEED
NARRATIVE
1. Parent Helpers for families receiving infant mental health services would serve to
consolidate learning and enhance the psychoeducational opportunities provided
by the program.
2. Specialized Foster Homes - These are needed to reduce institutionalization of
children and serve to offer family unification opportunities for challenging
children.
3. Long Term Mentors for Adolescents - This program would aid greatly in
adjustment and transition to adulthood and independent functioning for many
troubled youth served by OCCMH.
4. Long Term Mentors for Parents - This program would greatly enhance current
services by promoting parenting skills and solidifying gains made through other
, treatment programs offered by CMH, or serve as an alternative in many cases to
more intensive services.
5. Crisis Residential Program - Six crisis residential beds are needed to serve the
child population in much the same way the adult beds serve the population with
SMI diagnoses.
6. Summer Program (Therapeutic & Social Skill Building) - This would serve
children enrolled in day treatment as well children receiving services from
OCCMH's Child and Family Mental Health Centers.
7. Intensive Transitional Services - For the so-called "bridge" or young adult
population exiting school/day or residential placement. This program is designed
to meet the needs of these youth to enable them to cope with daily life demands.
Some of these children currently resident in state residential placements who
have reached the age of eighteen and are no longer eligible for services as
children, but need additional preparation and training to successfully transition to
independent adulthood. A number of these have family who have refused to be
involved or take them back.
OAKLAND COUNTY CIANSP • Pogo 10
PERSONS WITH DEVELOPMENTAL DISABILITIES - COMMUNITY NEED '
NARRATIVE
1. Crisis Residential Program - This would meet the needs of many individuals who
cannot be managed in their current community setting due a crisis and would
otherwise need to be hospitalized or do not meet criteria for acute care. It would
serve as an alternative to institutionalization.
2. Day Program - Day Program continues to be a major request of the community.
This is true for those already graduated out of mandatory education and persons
planning for the future. The need to expand upon the funding for this service is
essential to assisting consumers to continue to live within the community and
increase independence. There are 500 adults with developmental disabilities
who are on the waiting list for this service.
3. Residential Placement - The requests for this support from the community is
overwhelming. The range of requests covers the full spectrum from traditional
/ options to those more unique such as "home of your own." OCCMHSP has
been working with MORC, Inc. to address consumers in emergent situations as
well as engage in some new activities using their development capacity and
OCCMHSP funding. OCCMHSP has begun to assist consumers in the transition
from group homes to SIPs. For many this is quite difficult due to the level of
comfort associated with the group environment which they are leaving. A
dramatic number of consumers on this list must be served in order to make an
impact on the daily growth of demand.
4. Planned Respite Home for Adults with Physical Challenges - Perhaps the most
utilized and requested service is that of Respite second only to residential.
Each year this service receives continuous growth. It crosses all ages and levels
of disability. Expansion is essential as this service in its varied forms. In-home,
out of home, respite and recreation programs, camps provides the necessary
break that often times stabilizes the home. OCCMHSP operates one adult
respite home. However, the need to establish additional homes is necessary to
serve consumers that are more physically involved.
OAKLAND COUNTY CIANSP -Page 11
CMHSP WAITING LIST - MOVEMENT REPORT
AVERAGE WAIT FOR NON-EMERGENCY SERVICES -- MANDATORY SUBMISSION IN 1997
WAITOUT.WPD
CLIENT GROUP: PERSONS WITH DEVELOPMENTAL DISABILITIES
CMHSP Oakland County
INFORMATION AS OF: July 31..1997 (date)
Persons Removed from Waking List
No.
No. Persons from 10/1/96 through July 31. 1997 date) Persons Currently
Persons Placed on on
Waiting Waiting Waiting List
for List Since (Number of Weeks) Requested Service Received Service 10/1/96 for Service Delivery
as of Removal Needs Requested
SERVICE 10/1/96 from List Changed Service Other Total
Outpatient - Clinic Services 39 31 70 70
Day Program Partial Hospitalization
Psychosocial Rehab.
Other 386 45 400(1624)
Residential Specialized Residential 478 52 20 2 18 38 250 (1734)
Crisis Residential
Semi-Independence
Support Services Assert.Comm.Treatment
_., Crises Stabilization Team
Community Treatment Team ,
Client Services Mgmt 17 25 34 34 68
Family Supp.Services 39 15 14 14 100(861)
Home Based
/ Integrated Employment
Community Integration
Respite Services 105 108 47 166 213
Prevention Direct Service -
OAKLAND COUNTY CIAHSP - Page 12
•nn
CMHSP WAITING LIST - MOVEMENT REPORT
AVERAGE WAIT FOR NON-EMERGENCY SERVICES — MANDATORY SUBMISSION IN 1997
WAITOUT.WPD
CLIENT GROUP: CHILDREN WITH SERIOUS EMOTIONAL DISTRUBANCE"
CMHSP Oakland County
INFORMATION AS OF: July 31. 1997 (date)
Persons Removed from Wailing List
No.
No. Persons from 10/1/96 through julv 11. 1997 date) Persons Currently
Persons Placed on _. on
Waiting Waiting Waiting List
for List Since (Number of Weeks) Requested Service Received Service 10/1/96 for Service Delivery Removal Needs Requested as of
SERVICE 10/1/96 from List Changed Service Other Total
i Outpatient - Clinic Services 96 98 98
Day Program , Partial Hospitalization
, Psychosocial Rehab.
Other
Residential Specialized Residential
Crisis Residential
L. Semi-Independence
Support Services
Assert.Comm.Treatment
Crises Stabilization Team
'
Community Treatment Team
Client Services Mgmt 35 31 31 —
Family Supp. Services ,
Home Based
Integrated Employment
Community Integration
Respite Services
Prevention Direct Service ,
"This information is preliminary and subject to change due refinements in the waiting list for Children's Services.
OAKLAND COUNTY CMHSP Pig* 13
CMHSP WAITING LIST - MOVEMENT REPORT
AVERAGE WAIT FOR NON-EMERGENCY SERVICES -- MANDATORY SUBMISSION IN 1997
WAITOUT.WPD
CLIENT GROUP: ADULTS WITH MENTAL ILLNESS
CMHSP Oakland County
INFORMATION AS OF: August 13.1997 (data)
. _ I
Persons Removed from Waiting List
No.
No. Persons from 10/1198 through Auaus113_1997 date) Persons Currently
Persons Placed on on
Waiting Waiting Waiting List
for List Since (Number of Weeks) Requested Service Received Service 10/1/96 for Service Delivery Removal Needs Requested as f o from List Changed Service Other Total SERVICE 1011/96
Outpatient - Clinic Services
Day Program Partial Hospitalization .
Psychosocial Rehab.
Other r ,
Residential : Specialized Residential 58 , 60 36 39 75 73 (37) r -...- 1
Crisis Residential _
.. Semi-Independence 5 33 16 21 37 1 (8)
_ Support Services . Assert.Comm.Treatment
,
Crises Stabilization Team ,
Community Treatment Team
Client Services Mgmt ,
Family Supp.Services
Home Based
Integrated Employment
Community Integration
r — ,
_ Respite Services — n ,
Prevention Direct Service _
OAKLAND COUNTY CIANSP • Psp 14
CMHSP Oakland County
-z
RESIDENTIAL BED CAPACITY - ALL CLIENT GROUPS
AVAILABLE BEDS AS OF AUGUST 31, 1997
BEOCAP WPO
ADULTS MN CHILDREN NABTH PERSONS WITH
MENTAL ILLNESS MENTAL ILLNESS DEVELOPMENTAL DISABILITIES
. ..
BED TYPE Actual Madam Bads Actual Motto* Sada Actual Avallablo Beds
as of 3/3t/97 as al saw as of 11/31/97
—
SEMI-INDEPENDENT "TYPE G" 264 2 130
IN-HOME SPECIALIZED "TYPE B"
All Type B Respite 22 6
In-Home Per Diem through $64.99 28 ,
In-Home Per Diem $65 through $94.99 6 39
In-Home Per Diem $95 through $124.99 72 , 115
In Home Per Diem $125 through $154.99 30 , 317
In-Home Per Diem $155 and Higher 158
I
TOTAL IN-HOME- gPECIALIZED "TYPE B"
FOSTER CARE, CCI, "TYPE A"
AU Type A Respite
In-Home Per Diem through $12.69
In-Home Per Diem $12.70 through $64.99 22 114
In-Home Per Diem $65 through $94.99 3 10
In-Home Per Diem $95 through $124.99 3
In-Home Per Diem $125 through $154.99 1 2
In-Home Per Diem $155 and Higher 15 5
All CC1 Regardless of Cost 22
TOTAL FOSTER CARE, CCI AND 'TYPE A" ,.
OTHER--Specify:
(A) CURRENT (AS OF 8-31-97) EARNED
CONTRACTS WITH STATE DCH PLACEMENT
UNITS OR AGENCIES
Mt. Pleasant 37 ' , ,
Caro . 12
(B) RESIDENTIAL CAPACITY NOT INCLUDED
ABOVE
TC's 34
1 i
I TOTAL CMHSP MANAGED BED CAPACITY I 466 1 32 973
FULL MANAGEMENT TRADE-OFF DOLLARS PROJECTED
EARNED DURING FY 97-96
STATE INPATIENT AND STATE RESIDENTIAL SERVICES
IN FY 91-97 STATE SHARE DOLLARS
FIATO.WPD
CIAISP_Claklant County
10 3,650 1,787 1 327,021 HAWTHORNE CENTER 0 (1,863) 667,950 f 10 (340,929)
10 1,787 10 3,650 667,950 327,021 (1,863) TOTAL - CHILDREN WITH EMOTIONAL
DISTURBANCE
(340,929)
15 6,858 973,836 10 351,876 2,478 4,380
362 1 365 1 0 (3) 60,454 (501)
1,813 279,202 13 1,825 (9) (12) (1,848)
4 621,960
60,955
281,050
CARO - ADULTS WITH DEVELOPMENTAL
DISABILITIES
SOUTHGATE
MT. PLEASANT
SUBTOTAL - INPATIENT FOR PERSONS WITH
DEVELOPMENTAL DISABILITIES
21 24 9,033 1,313,492 6,570 963,965 2,463 349,527
Utilization Projected for FY 96-97
OAKLAND COUNTY CMHSP • Page 15
Utilization Estimated for FY 97-98 Earned Trade-Offs During FY 97-98
State
Dollars
Col. 3
Client Group/
Fact* Program Detail
Col 1
Total
Days
in
FY 96-97
Col. 2
Total State
Days Dollars
in
FY 97-98
Col. 4 t Co1.5 Col. 6
CM. WITH MENTAILLNESS
Projected
Census
as of
9-30-98
Col 7
Days
Reduced
Col 8
Associated
State
Dollars
Col 9
Projected
Census
Change
FY 97-98
Col 10
Census
as of
9-30-97
KALAMAZOO 409 66,299 1 365 77,015 0 44 9,284 1
NORTHVILLE 1,194 274,620 2 365 83,950 1 829 190,670 1
CLINTON VALLEY 17,482 3,741,148 0 0 0 0 17,482 3,741,148 0
CARO - ADULTS WITH MENTAL ILLNESS 1,290 325,080 48 12,045 3,035,340 18 (10,755) (2,710,260) 30
WALTER REUTHER 3,524 623,748 15 4,745 839,865 10 (1,221) (216,117) 5
TOTAL ADULTS WITH MENTAL ILLNESS 23,899 5,050,895 66 17,520 I 4,036,170 29 6,379 I 1,014,725 37
t01,13)HOS WITH: EMOTIONAL.MSTUROANOE.
OHS WITH DEVELOPMENTAL DISABILITI
OAKLAND COUNTY CMHSP - Page 16
Utilization Projected for FY 96-97 Utilization Estimated for FY 97-98 Earned Trade-Offs During FY 97-98
Client Group/ Total State Census Total State Projected Days Associated Projected
Facility Program Detail Days Dollars as of Days Dollars Census Reduced State Census
, , in 9-30-97 in as of Dollars Change
FY 96-97 FY 97-98 9-30-98 FY 97-98
Col 1 Col. 2 Col. 3 Col. 4 Co1.5 Col. 6 Col. 7 Col 8 Col 9 Col 10 ........... ....... ................................................ ............ ... .... ... .... , . -, .. Ti.1 111.0sAti.1..E...5....1... ont,,IIII ,... ••• ":...::.
.:•••• . . 1
1 ' CARO - RESIDENTIAL 3,019 425,679 8 2,920 411,720 8 99 13,959 0
1 1
' CARO AIS 1,282 130,764 4 1,460 148,920 4 (178) (18,156) 0
,
' MT. PLEASANT RESIDENTIAL 3,056 281,152 16 5,840 537,280 16 (2,784) (256,128) 0
MT. PLEASANT AIS 7,661 743,117 29 10,585 , 1,026,745 29 (2,924) (283,628) 0 _ ,
SUBTOTAL - RESIDENTIAL SERVICES FOR 15,018 1,580,712 67 20,805 2,124,665 57 (5,787) (543,953) 0
PERSONS WITH DEVELOPEMENTAL
DISABILITIES
TOTAL FOR PERSONS WITH 24,051 2,894,204 78 27,375 3,088,630 81 (5,787) (543,953) (3)
DEVELOPEMENTAL DISABILITIES
, GRAND TOTAL 1 49,737 1 8,272,120 1 154 1 48,545 1 7,792,750 1 120 1 (1,271) 1 129,843 1
I ,
OAKLAND COUNTY CMHSP - Page 17
PERSONS WITH SERIOUS MENTAL ILLNESS
RECEIVING CLIENT SERVICE MANAGEMENT - PROJECTED FY 96-97
SMI WPD
CMHSP Oakland Countv
.. . i
(Col.0 + D = Col. B) - (Col. B - D = Col. C) (Col. B - C az Col. 0)
FY 96-97 Projected
FY 96-97 Projected FY 96-97 Projected FY 96-97 Projected Number of SMI
Total Number Total Number Number of SMI Who DID NOT
Population of MI Cases of SMI Cases Who Received CSM Receive CSM
Column A Column B Column C Column D
Child/Adolescents 1593.6 93.4.8 805.2 129.6
(ages 0-17)
Adults 6094.8 3337.2 3054 283.2
(ages 18-54)
Older Persons 1,348.8 816 735.6 80.4
(ages 55+) . .
9,037.2 5088 4594.8 493.2
Totals _ — -
KEY:
MI means total cases of persons with mental illness served by CMH.
SMI means total cases of persons with serious mental illness served by CMH.
CSM means client service management.
OAKLAND COUNTY CMH3P • Page 18
CENSUS PROJECTIONS - HOSPITALS, CENTERS AND NURSING HOMES - 1997 SUBMISSION
CENPROJ WPD
CMHSP Oakland County'
- _
EXPECTED RESIDENT CENSUS AS OF DATE SPECIFIED
.. ---- - ---- . — ' • - - _____
9/30/97 to 9/30/98 to
9/30/96 7/31/97 9/30/97 9/30/98 9/30/98 9/30/99 9/30/99
Actual Actual _ Expected _ Expected _ Change _ Expected _ Change
PSYCHIATRIC HOSPITALS FOR ADULTS _
Caro-MI 4 3 48 , 18 (30) 15 (3) ,
Clinton Valley 84 55 0 • 0 0 , 0 0
Detroit Psychiatric Institute o , o , o o o
Kalamazoo PH 2 , 1 1 0 (1) 0 o
Northville PH 5 1 2 0 (2) o o
Reuther 12 7 15 , 10 (5) 8 (2)
Subtotal 107 _ 67 _ 66 _ 28 (38) 23 _ (5)
PSYCHIATRIC HOSPITALS FOR CHILDREN
Detroit Psychiatric Institute 0 , 0 , o o o o 0
Hawthorn 3 7 10 10 0 10 0
Pheasant Ridge 0 0 0 0 0 0 0
Subtotal _ 3 7 _ 10 _ 10 . 0 10 0
CENTERS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
Caro 25 15 0 0 0 0 0
Mt. Pleasant 6 5 20 13 (7) 5 (8)
Southgate 1 1 1 1 0 0 (1)
Subtotal _ 32 21 21 _ 14 _ (7) 5 (9)
SPECIAL NURSING HOMES
Birchwood .1 I .1 I I I
GENERAL NURSING HOMES
Persons with DO Requiring Placement 18 7 7 25 18 50 25
Persons with MI Requiring Placement 5 3 6 4 (2) 4 0
Subtotal 23 10 13 29 16 54 25
'Data based on July, 1997 projections
SUMPARY-
WAIVER CERTIFICATES PLANNED USE
WAIVCERT.VVPD
CMHSP Oakland County
OAKLAND COUNTY CIANSP • Pap 111
Total Waiver Certificates Filled as of 7/31/97:
Approved/Authorized Certificates Not Filled 7/31/97:
New Waiver Certificates to be Filled by 9/30/97:
OAKLAND COUNTY CMHSP • Page 20
FEDERAL BLOCK GRANT REPORTING REQUIREMENT
SYSTEM OF CARE SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE
FEOBG.VVPD
CMHSP OAKLAND COUNTY
Contact Person (name, phone) Al Focoros. 248-304-0143
In order to comply with the federal conditions of approval for the block grant, specific information about certain children's
services must be provided to the federal government. The information requested below is essential to maintaining this
funding and should be reported regardless of the funding source for the programs listed.
Program Number of Estimated Estimated
Offered by Current Cases Cases to be
CMHSP Programs Served Served
Funded
. Y . Yes by/through 10/1/96- 10/1/97-
N . No the CMHSP 9/30/97 9/30/98
A. Home Based Y 2* 221 240
Ssrvices Programs
B. Wraparound Y 1* 21 30
Services
`Note: If the CMHSP reports cases served in either of the two subsequent columns, there must be an entry in this
column.
Description of the source of the information provided above; comments and/or explanation.
These figures include Infant Mental Health Services and were based on extrapolation from service activity data of 10/1/96
to 6/30/97.
FEDERAL BLOCK GRANT PROGRAM REVISION REQUESTS
OAKLAND COUNTY CMH3P • Page 22
FEDERAL BLOCK GRANT
PROGRAM REVISION REQUEST
PRR•FBG WPO
CMHSP
PRR Title: 4-H/CMH Community Collaborative Designed Especially for Childrens Time Required to Implement: Date Submitted: 9117/97
with Severe Emotional Disturbance (in months)
12 PRR ID Number: 98-01
Client Group: MI-A Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 1 of 7
FY97-98
Board Prevention Priority:
of — --- „Er. _
Prevention PRR Purpose:
_Wraparound Integrated Services
Aging Services ACT Teams Psychosocial Rehab (Clubhouses) Pilot for Young Children
Consumer Run or Directed Initiatives Other
Adults with Children with Board
A. FINANCING SUMMARY Mental Illness Mental Illness Other Administration Total
— • Estimated clients to be served by PRR _ 698 _ 698
PROJECTED FUNDING SUMMARY
Projected Gross Funding $ 148.996 S 148,996
SAMHSA (Federal) Block Grant S 65.207 $ 83.789 S 148.996
1st/3rd/SSI Reimbursement Estimate'
Other - Funding:
•
'Block grant funds may not be used to match other federal funds.
"Per PL. 102-3R1, Section 191613, administrative expenses may not exceed 5 percent.
Federal Block Grant PRR Purpose (check one):
Employment
OAKLANO COUNTY CMHSP • Page 23
CMHSP NARRATIVE FOR PROGRAM REVISION REQUESTS
FEDERAL BLOCK GRANT
FBGNARRAPO
PRR Title/Purpose 4•H/CMH Community Collaborative Designed Especially for Time Required to Implement: Date Submitted: 9/17/97
ChlWrens with Severe Emotional Disturbance (in months)
12 PRR 10 Number: 98-01
Client Group: MI-A MI-C DO Bd Admin. Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 1 of 7
FY97-98
Board Prevention Priority:
- of
Narrative (attach additional pages as necessary):
The following outline should be followed for the PAR narrative (attach additional pages as necessary):
1. Describe the need for services.
2. Discuss how the child and family will be involved in case planning.
3. Discuss how the services are designed to preserve children in their families or return them home form out-of-home placements.
4. Describe how this service will coordinate with other services (e.g., child welfare, juvenile justice, schools, etc.) delivered to children who have
multiple needs.
5. Describe the commitment of the Board (reflected by: level of CMH funds that will be directed at the initiative and plans for continuation of the
initiative). ,
6. Define the expectations or outcomes and resulting from this initiative.
7. Identify the relative priority of the proposal in the Board's future planning.
1. Describe the need for services:
It is estimated by Oakland County Community Mental Health that over 1000 families in Oakland
County are faced with the challenge of raising and coping with children who are diagnosed with
severe emotional disturbance. Many of these children are supported with special services from
education classes, day treatment programs, and mentors to guide them through their days.
Unfortunately, many emotionally impaired youth are unable to participate in typical childhood
experiences due to their level of impairment.
MSU-4H and Oakland County Community Mental Health have developed a camp program that
provides the SED consumer an extensive day camp experience, providing an educationally based,
developmentally appropriate, hands-on event. All activities focus on the social-emotional skill areas,
such as friendship building, understanding one's impact upon the greater society, and polite social
gestures. By providing campers with a typical childhood experience in a positive supported
environment, kids feel successful and free to explore the world and have great time at it!
The 4H/CMH summer day camp project has been successfully piloted for 3 years, serving
approximately 300 emotionally impaired youth in 1996-1997. Each year we have tripled in size, with
consumer surveys indicating a need to provide a year round program. This collaborative is unique to
our community, with proposed program components including: a 4week 4H day camp, weekly 4H
club meetings, Horseback Riding Club, seasonal Family Weekend camps, and 4 family highlight
activities. The efforts of existing 4H trained volunteers, a wealth of Michigan State University
Extension Program and in-kind support, and dedicated CMH staff serves to ensure the success of
this program and partnership.
2. Discuss how the child and family will be involved
4H and CMH are committed to serving the whole family. The program's focus is on creating an
overall support structure for youth and their families. Families will learn crucial coping skills while
engaging in positive experiences with their children. Families will also have opportunity to develop a
OAKLAND COUNTY WOW' • Pogo 24
cross family support system that can foster parental self esteem, parenting skills with someone who
can readily relate to their situation. Each program component has a unique, innovative way to
achieve outlined goals. Participation in the 4H programs will build skills in the social-emotional
learning domains while incorporating science, math, language, and technology education. For
parents, the project offers tools to learn valuable coping skills through team work, patience, and
family strength development.
3. Discuss how the services are designed to preserve children in their families:
This 4H/CMH collaborative is family oriented. 4H families will have opportunity to volunteer their
time, resources, and expertise to benefit all 4H clubs, events and activities. Encouragement for
parents to become trained volunteers to become leaders in their child's clubs, activities designed to
include siblings and parents, and highlight events where children can share their newly acquired
skills and talents with their families is the core of the project. Integrating parents into their child's
activities provides critical services to both the child and family. Interaction meetings, for example, will
create an avenue for parents to meet and form relationships with other parents and families in similar
circumstances. These meetings can help to foster cross family support networks and
communication.
4. Descfibe how this-service will coordinate with other services:
MSU-4H and Community Mental Health welcome the opportunity to share this model with other CMH
boards.
5. Describe the commitment of the Board:
The collaborative project between Michigan State University Extension-4H Youth Programs and
Oakland County Community Mental Health has been supported by the board and successfully piloted
for three years.
6. Describe the expectations or outcomes resulting from this initiative:
Every youth and family consumer of Oakland County Community Mental Health who participate in
this project will receive quality, innovative, person-centered, educational curricula. Each piogram
component will be facilitated by a trained 4H volunteer, program facilitator, or 4H Project Educator
and Coordinator. Each aspect of the planning, development, and attainment of goals has been
carefully reviewed and piloted before implementing in the core curriculum. 4H is recognized
nationally for its "hands on" approach to helping people of all populations explore the world around
them while maintaining the highest standards of learning activities. This collaboration not only
provides the SED youth and their families a positive, educational experience, but gives access to the
unlimited educational possibilities 4H programs have to offer.
FEDERAL BLOCK GRANT
PROGRAM REVISION REQUEST
PRR-FBG WPO
CMHSP Oakland County
Federal Block Grant PRR Purpose (check one): Prevention PRR Purpose:
Wraparound Integrated Services
OAKLAND COUNTY CMNSID - Page 25
--..,
PRR Title. Consumer-Run Businesses/Fairweather Lodge - Consumer Driven Time Required to Implement: Date Submitted: 9117/97
Transportation Business Plan (in months) ,
, PRR 10 Number 9802 2-3 months — .
Client Group PA& MI-C Prevention FY of Implementation: Board Block Grant Pnonty:
(circle one) 2 , of 7
FY97-98
Board Prevention Priority:
of
Aging Services
X Employment
_ACT Teams Psychosocial Rehab (Clubhouses) Pilot for Young Children
Consumer Run or Directed Initiatives Other
Adults with Children with Board
A. FINANCING SUMMARY Mental Illness Mental Illness Other Administration Total .,
Estimated clients to be served by PRR
PROJECTED FUNDING SUMMARY
I,
Projected Gross Funding $ 1,250 , 5 1,250 I
SAMHSA (Federal) Block Grant $ 1,250 $ 1,250 1
1st/3rd/SSI Reimbursement Estimate'
Other - Funding: .
I
SAMHSA 1st/3rd/SSI
(Federal) Block Reimbursement Other
B. BUDGET DETAIL Grant Estimate' Funding Total
Personnel salaries/wages and fringe benefits . ,
Equipment
Travel
Supplies. etc. ..
Contractual services (subcontract, etc.)—specify below*" $ 1,250 $ 1,250 — ..
Indirect"
—
•
TOTAL _ 5 1,250 1.250.
'Block grant funds may not be used to match other federal funds.
•*Per PL 102-3R1, Section 19168, administrative expenses may not exceed 5 percent.
*"50 hours at 525.00 per hour to consultant to develop the business plan
OAKLAND COUNTY CMHSP • Pig. 2$
NARRATIVE FOR PROGRAM REVISION REQUESTS
FEDERAL BLOCK GRANT
FBGNARR Vi/P0
CMHSP Oakland County
PRR Title/Purpose Consumer-Run Businesses/Fairweather Lodge - Consumer Time Required to Implement: Date Submitted: 9117197
Driven Transportation Business Plan (in months)
PRR ID Number: 98-02 2-3 months , .
Client Group: MI-A MI-C OD Bd Admin. Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 2 , of 7
FY97-98
Board Prevention Priority:
_ of
Narrative (attach additional pages as necessary):
The following outline should be followed for the PRA narrative (attach additional pages as necessary):
1. Descnbe the subpopulation (including its needs) and/or the proposed intervention.
2. Describe how the intervention is an enhancement an/or innovative relative to existing services.
3. Discuss the theoretical foundations of the model or intervention proposed (include relevant psychosocial principles if appropriate).
4. Describe the commitment of the Board (reflected by: level of CMH funds that will be directed at the initiative and plans for continuation of the
initiative).
5. Define the expectations or outcomes and resulting from this initiative.
6. Identify the relative priority of the proposal in the Board's future planning.
The subpopulation to be served by this proposal is adults with mental illness. Finding and
maintaining employment is known to be difficult for many individuals in this population group.
Transportation is often identified as one major barrier to employment. One outgrowth of the
specialized employment needs of adults with mental illness has been the development of consumer -
owned and operated businesses. OCCMH is seeking funding for the development of a business plan
that would explore and outline necessary components of a consumer-driven transportation service.
The service would be located in the northern quadrant of the county, where few transportation
options other than use of a personal vehicle exist. The plan would document the need for the service,
describe necessary components, and project a time line for implementation after operational funding
is secured.
By the development of a business plan, the clubhouse in the area proposed could enhance both the
number of participants, but also expand the employment opportunities for adults with mental illness.
The plan may also be utilized to enhance and/or improve the existing transportation business that
already exists as part of a clubhouse in another geographic quadrant of the county.
The plan proposed would emphasize the need for the transportation business not to change the
dynamics of the clubhouse or to compete with the order of the day in the clubhouse. As such,
options would be developed that could keep the business in close proximity to the clubhouse,
perhaps even in the same building but the location would utilize a separate entrance, and would have
space that is locked when not being utilized. As the business is implemented, rent payments to the
clubhouse would also be made.
The CMH Board would receive the business plan and assist in necessary activities to secure funding
for its implementation. CMH Program Development staff would be available, as needed, as
consultants to the individual developing the plan.
It is hoped that this proposal would result in a realistic consumer-driven transportation business plan
that would benefit both the clubhouse and its individual participants.
FEDERAL BLOCK GRANT
PROGRAM REVISION REQUEST
PRR-FBG WPO
CMHSP Oakland County
OAKLAND COUNTY DMNSP • Page 27
PRR Title Time Required to Implement: Date Submitted: 9/17/97 .
(in months)
ACT Expansion - Substance Abuse/Corrections Specialty PRR ID Number:98-03 2 months
Client Group MI-A MI-C Prevention FY of Implementation: Board Block Grant Pnonty:
(circle one) 3 , of 7
FY97-98
Board Prevention Priority:
of
Federal Block Grant PRR Purpose (check one):
Aging Services
Employment
Prevention PRR Purpose:
Wraparound Integrated Services
Psychosocial Rehab (Clubhouses) Pilot for Young Children
Consumer Run or Directed Initiatives Other
X ACT Teams
Adults with Children with Board
A. FINANCING SUMMARY Mental Illness Mental Illness Other Administration Total -
Estimated clients to be served by PRR 100 _ 100
PROJECTED FUNDING SUMMARY
Projected Gross Funding $ 75,500 $ 75,500
SAMHSA (Federal) Block Grant ,
1st/3rd/SSI Reimbursement Estimate*
Other - Funding: ,
,
SAMHSA 1st/3rd/SSI
(Federal) Block Reimbursement Other
B. BUDGET DETAIL Grant Estimate Funding ' Total
Personnel salaries/wages and fringe benefits $ 62,000 $ 62.000 '
Equipment (Office Fumiture=52000. Computer and $ 8,500 $ 8,500
Software=55000. Phone=$1500
Travel $ 5,000 $ 5.000 ,
Supplies. etc.
Contractual services (subcontract, etc.)-specify below
Indirect- -
...
TOTAL $ 75,500 $ 75.500
'Block grant funds may not be used to match other federal funds.
Per PL 102-3R1. Section 191613. administrative expenses may not exceed 5 percent.
OAKLAND COUNTY CMHSP • Pao, 21
NARRATIVE FOR PROGRAM REVISION REQUESTS
FEDERAL BLOCK GRANT
FBGNARR WPO
CMHSP Oakland County
PRR Title/Purpose Time Required to Implement: Date Submitted: 9/17197
(in months)
ACT Expansion - Substance Abuse/Corrections Specialty
2 months PRR ID Number: 98-03
Client Group: MI-A MI-C DO Bd Admin. Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 3 of 7
FY97-98
Board Prevention Priority:
of
Narrative (attach additional pages as necessary)
The following outline should be followed for the PRR narrative (attach additional pages as necessary):
1. Describe the subpopulation (including its needs) and/or the proposed intervention.
2. Describe how the intervention is an enhancement an/or innovative relative to existing services.
3. Discuss the theoretical foundations of the model or intervention proposed (include relevant psychosocial principles if appropriate).
4. Describe the commitment of the Board (reflected by: level of CMH funds that will be directed at the initiative and plans for continuation of the
initiatiye).
5. Define the expectations or outcomes and resulting from this initiative.
6. Identify the relative priority of the proposal in the Board's future planning.
Demonstrated need for the sub-population and/or intervention.
Oakland County Jail books 26,100 inmates per year. Using the first three quarters history to project
the number of inmates having serious and persistent mental illness receiving services in jail from
CMH we expect to serve 2,500 this fiscal year. Over 50% of these individuals have an additional
diagnosis of substance abuse. Most of these individuals take up or return to residency in the South
and Central districts, and receive services in the Central or South quadrant agencies and/or from the
ACE program. On an annual basis approximately 100 released inmates have at least one additional
incarceration and one or more psychiatric inpatient stays and one or more failed substance abuse
treatment program experiences.
The Quadrant District agencies have substance abuse components which provide a variety of
services to the dually diagnosed legal offender. The ACE Program (A Collaborative Effort) is a
collaboration between Oakland County Community Mental Health, the Health Division/Office of
Substance Abuse, Community Corrections, The Counseling Center, P.C. - Bloomfield Hills and
Eastwood Clinic - Royal Oak. The purpose of this program is to treat the seriously mentally ill
substance abuser who has been involved with the legal system (i.e. recently released from
incarceration, on probation or parole, or having frequent involvement with the legal system). The goal
of the program is to maintain community tenure thereby reducing recidivism to psychiatric hospitals,
substance abuse programs and/or jails and prisons by improving service delivery to this very needy
often non-compliant population. ACE staff and Quadrant agency ACT team staff share cases when
the individual's condition would seem to benefit from the higher level of intensity that such an
approach can provide.
Unfortunately, these approaches have not been sufficient for the approximately 100+ dually
diagnosed individuals with legal involvement who start and quit all services on a frequent basis and
also come to the frequent attention of our crisis unit, Common Ground, local emergency rooms,
police and judicial officers, and the admission screening units of substance abuse (PACE) and
mental health (ACCESS).
We hypothesize that the development of additional ACT team(s) with a specialized focus might meet
the needs of this population, however we realize that this target population has received much from
many with little success - so rather than going with supposition - we propose services utilization
program in the Central and South areas of the County which we believe will enable us to eventually
OAKLANO COUNTY CPANSP - Page 22
• effectively expand our service capacity to this population.
We request one FTE mental health clinician position, skilled in PARADOX software, and with a
corrections, substance abuse and mental health specialty background who will: review cases, gather
demographics and statistics, coordinate a small analysis/planning counsel comprised of psychosocial
and corrections staff from DCH, Department of Corrections staff and Oakland CMH, Substance
Abuse and Corrections staff, write a report outlining the outcomes of this project, and the resultant
proposal (which includes cost projections) for a "best practices" solution. We anticipate that with the
help of DCH and Department of Corrections staff the product of this project could become the
foundation for a state-wide approach for this population.
Demonstration that the intervention is an enhancement.
As mentioned above we already have the ACT and ACE and CMH in-jail programs in place. We are
requesting the first year costs of 1 FTE mental health/corrections/substance abuse specialist to
facilitate and coordinate the Service Utilization evaluation of current services to these consumers
identified from the caseloads of the Central and South Quadrant agencies, Common Ground, jail and
the ACE program who are also receiving substance abuse services, and who have had recent
psychiatric emergency room or inpatient services and incarceration experiences. It will also be the
expectation of this position to gather demographics and other statistics, organize PARADOX reports
from the State minimum data set, coordinate the counsel meetings for the purpose of identifying
systems, problems and best practice solutions and write the final report and proposal. •
Demonstrated knowledge and understanding of the sub-population, the principles of
intervention.
The ACE program provides group therapy and psycho educational sessions co-led by a mental
health clinician and a substance abuse therapist. Individual and support system substance abuse
and mental health counseling are available. Psychiatric evaluation and medication services are
provided as is laboratory testing for tracking medication compliance and abstinence from non-
prescribed mood-altering substances. Case management services are an important component of
this program as is weekly team consultation with Community Corrections staff. Ongoing
communication with appropriate probation and parole staff is also a crucial component of the
program.
Central and South agency ACT teams provide intensive case-management services, psychiatric and
medication services as well as substance abuse didactic and support groups.
CMH Jail services provide assessment and referral, counseling, case management/discharge
planning and medication evaluation and prescription.
Demonstrated commitment by CMH to the proposal.
Oakland County commits itself to implementing as many aspects of the finished product as is
possible.
Defined expectations or outcomes to be expected.
We expect to have a best practices proposal which will expand the effectiveness and service
capacity for this target population.
FEDERAL BLOCK GRANT
PROGRAM REVISION REQUEST
PRR-FBG WPD
CMHSP Oakland County
Federal Block Grant PRR Purpose (check one): Prevention PRR Purpose:
_Wraparound Integrated Services
OAKLANO COUNTY CMNSP - Page 30
PRR Title. Response to Expulsions or Proposed Expulsion of Young Children from Time Required to Implement: Date Submitted: 9/17/97
Child Care Settings (in months) .
12 PRR ID Number 98-04
Client Group: MI-A MIS Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 4 of 7
FY97-98
Board Prevention Priority:
of
Aging Services
Employment
ACT Teams Psychosocial Rehab (Clubhouses) A_ Pilot for Young Children
Consumer Run or Directed Initiatives Other
_
Adults with Children with . Board
A. FINANCING SUMMARY Mental Illness Mental Illness Other : . Administration Total , , _
Estimated clients to be served by PRR .
PROJECTED FUNDING SUMMARY ,
Projected Gross Funding $ 19,850 $ 19,850
SAMHSA (Federal) Block Grant $ 19,850 , $ 19,850
1st/3rd/SSI Reimbursement Estimate' .
Other - Funding:
>
SAMHSA 1st/3rd/SSI
(Federal) Block Reimbursement Other
, B. BUDGET DETAIL Grant Estimate Funding Total
Personnel salaries/wages and fringe benefits $ 17,000 17,000
Equipment $ 250 $ 250
Travel $ 200 $ 200
Supplies. etc. $ 650 $ 650
Contractual services (subcontract. etc.)—specify below
Indirect"' .
Occupancy 750 $ 750 ,
Communication
1,000 1,000
.
,
TOTAL $ 19,850 j $ 19.850 .
'Block grant funds may not be used to match other federal funds.
Per Pt. 102-3R1. Section 19168. administrative expenses may not exceed 5 percent.
OAKLAND COUNTY CMHSP -Pig. 31
NARRATIVE FOR PROGRAM REVISION REQUESTS
FEDERAL BLOCK GRANT
FSGNARR.WPO
CMHSP Oakland County
PRR Title/ Purpose: Response to Expulsions or Proposed Expulsion of Young Time Required to Implement: Date Submitted: 9/17/97
Children from Child Care Settings (in months)
12 PRR ID Number: 98-04
Client Group: MI-A M.. DO 8d Admin. Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 4 of 7
L FY97-98
Board Prevention Priority:
V .
Narrative (attach additional pages as necessary):
The following outline should be followed for the PRR narrative (attach additional pages as necessary):
1. Describe the need for services.
2. Discuss how the child and family will be involved in case planning.
3. Discuss how the services are designed to preserve children in their families or return them home form out-of-home placements.
4. Describe how this service will coordinate with other services (e.g., child welfare. juvenile justice, schools, etc.) delivered to children who have
multiple needs.
5. Describe the commitment of the Board (reflected by: level of CAtl funds that will be directed at the initiative and plans for continuation of the
initiative).
6. Define the expectations or outcomes and resulting from this initiative.
7. Identify the relative priority of the proposal in the Board's future planning.
1. Developing secure attachment relationships is among the most important developmental tasks
for young children. The child who forms an attachment relationship with an adult care giver
makes a smooth transition between home and child care and then uses the care giver as a
secure base during the day. Attachment formation is based in part on the availability and
predictability of the care giver. The loss of an attachment figure can be very painful to a young
child. The child who forms attachments to a series of care givers, all of whom leave, may find
it too painful to continue the cycle and conclude that human relationships are to be avoided.
("Quality Indicators In Child Care")
The Oakland County Community Coordinated Child Care (4C) Council will be the service
provider for this planning grant. The Council is a child care resource and referral agency and
processes over 5,500 child care referrals for families each year. In addition the Council
supports the 1700 registered/licensed Oakland County child care providers through training,
resource library, quarterly newsletter and technical assistance. Through Strong Families, Safe
Children the Council facilitates a child care scholarship program which assists low to moderate
income families in paying for child care. The Council also administers the Lekotek of Oakland
County which is a play center and toy lending library for families with children of special needs.
Currently, in our community there is no mechanism to track children who have been expelled
from child care, this initiative will establish data and anecdotal information regarding the issue.
This will be accomplished by accessing families through the child care referral process and the
Council's network of child care providers.
2. Two survey instruments will be developed: One for the purpose of completion by child care
providers, and the other for completion by families. The surveys will identify the factors
surrounding the expulsion and collect anecdotal information including historical context and
OAKLAND COUNTY ChINSP - Page 32
preventable issues. They will also contribute information to determine appropriateness of
placements.
3. Based on the needs assessment a service model of prevention will be developed. Possible
components of the model are:
• Child care provider training which is issue specific.
• A resource consultant to make site visits and provide a minimum of ten hours of
consultation support to the child care provider. The purpose of the consultation is to
help determine appropriateness of the placement, facilitate inclusion and access to
community resources.
• An enhanced support worker who would provide short-term additional staffing for the
child care provider. This would allow the child to remain in placement by supporting the
care giver while the issues are being resolved.
4. The data collection will involve families and child care providers and service agencies currently
working with families in child care. Using the results of the survey a collaborative of service
providers from child care providers would be developed. This would include but not be limited •
to; Community Mental Health, Family Independence Agency, Oakland Family Services,
Women's Survival Center, Oakland Schools and others in Oakland County. Services will be
coordinated through the Resource Consultant who would be the point of entry for the child
care providers.
5
6. This initiative will provide data which will create a service model of prevention. Child care
providers will be supported by ten hours of consultation, specialized training sessions to
address inclusion techniques and, in emergency situations, enhanced support workers to
increase staffing ratios. Children will therefore remain in appropriate placement longer and
have more consistent care. The model will involve matching children to needed services and
will become an access system for child care providers to community resources.
FEDERAL BLOCK GRANT
PROGRAM REVISION REQUEST
PRFt•FBG WPD
CMHSP Oakland County
OAKLAND COUNTY CMHSP • Page 33
PRR Title Development of New or Maintenance of Existing Drop-in Centers Time Required to Implement: Date Submitted: 9/17/97
(in months)
PRR ID Number 98-05 8- 12 months ,
Client Group. MI-A MI-C Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 5 , of 7
FY97-98
Board Prevention Priority:
of
Federal Block Grant PRR Purpose (check one):
Aging Services ACT Teams
Employment Consumer Run or Directed Initiatives
Prevention PRR Purpose:
Wraparound Integrated Services
X Psychosocial Rehab (Clubhouses) Pilot for Young Children
Other
Adults with Children with Board
A. FINANCIN9 SUMMARY Mental Illness Mental Illness Other Administration Total ..,
Estimated clients to be served by PRR 200 --200
PROJECTED FUNDING SUMMARY
Projected Gross Funding t 12,800 $ 12,800 ,
SAMHSA (Federal) Block Grant S 12,800 $ 12.800
1st/3rd/SSI Reimbursement Estimate'
Other - Funding:
•
SAMHSA 1st/3rd/SSI
(Federal) Block Reimbursement Other
B. BUDGET DETAIL Grant Estimate* Funding Total
Personnel salaries/wages and fringe benefits
Equipment*** $ 12,880 $ 12.880
Travel
.
, Supplies, etc.
Contractual services (subcontract. etc.)—specify below
Indirect— N
—
TOTAL $ 12,880 12,880
'Block grant funds May not be used to match other federal funds.
•*Per PL 102-3R1. Section 19168, administrative expenses may not exceed 5 percent.
*** 8 couches, 36 folding chairs. 8 arm chairs, 8 coffee tables, 4 refrigerators. 4 microwaves, 4 coffee-makers. 4 area rugs. assorted card and board games.
rental for 8 vending machines.
OAKLAND COUNTY CfAHSP • Page 141
NARRATIVE FOR PROGRAM REVISION REQUESTS
FEDERAL BLOCK GRANT
FBGNARR WPO
CMHSP Oakland County
wilmemen
PRR Title/Purpose . Time Required to Implement: Date Submitted: 9117197
(in months)
Development of New or Maintenance of Existing Drop-in Centers PRR ID Number: 98-05 8-12 months t
Client Group: MI -A MI-C 00 Bd Admin. Prevention FY of Implementation: Board Block Grant Priority:
(circle one) . 5 of . 7 .
FY97-98
Board Prevention Priority:
of
Narrative (attach additional pages as necessary):
The following outline should be followed for the PRA narrative (attach additional pages as necessary):
1. Describe the subpopulation (including its needs) and/or the proposed intervention.
2. Describe how the intervention is an enhancement an/or innovative relative to existing services.
3. Discuss the theoretical foundations of the model or intervention proposed (include relevant psychosocial principles if appropriate).
4. Describe the commitment of the Board (reflected by: level of CMH funds that will be directed at the initiative and plans for continuation of the
initiative).
5. Deflnedhe expectations or outcomes and resulting from this initiative.
6. Identify the relative priority of the proposal in the Board's future planning.
The population to be served is mentally ill adults attending a drop-in center. The drop-in center
model is an essential service for those individuals who choose not to or who are unable to participate
in a more structured day program or work activity. It provides the opportunity for socialization
experience that is frequently unavailable to this population.
These funds would enable OCCMH to enhance the furnishings available to one existing drop-in
center and would make it possible to provide the furnishings for the start-up of three additional drop-
in centers, in other parts of the county where this service is not currently available.
Isolation is very common among adults with mental illness. When exacerbations of illness occur,
many are unable to participate in programs with a structured schedule requirement. The drop-in
center fills a void by creating a comfortable, home-like atmosphere, where expectations for
participation are very flexible and where few demands are placed on the individual.
It is expected that by enhancing the environment of the current drop-in center and by the creation of
3 additional drop-in centers, the numbers of consumers taking advantage of this service would
increase, as the centers would provide inviting surroundings on the very important first impression.
The expectation is also that the new furnishings would enhance the self-esteem of the participants,
as the surroundings would send a message that the participants are valued. Drop-in centers are
often furnished with someone's second-hand, cast-off furnishings. What message does that send
about the value of those who come to the center? Participants would also be the ones who would
shop for and pick out the items to be purchased, again enhancing their self esteem, sense of
competence and increasing their emotional investment in continuing participation and in recruiting
others to attend.
FEDERAL BLOCK GRANT
PROGRAM REVISION REQUEST
PRR-FBG VVPO
CMHSP Oakland Count
OAKLAND COUNTY CMHSP • Pap 36
PRR Title Time Required to Implement: Date Submitted: 91161/97
Clubhouse Employment Specialist Training (in months): As training is
offered PRR ID Number 98-06
—
Client Group: MILA MI-C Prevention FY of Implementation: Board Block Grant Priority:
(circle one) _ 6 of 7
FY97-98
Board Prevention Priority:
of _____ ___
Federal Block Grant PRR Purpose (check one):
___ Aging Services ACT Teams
Employment Consumer Run or Directed Initiatives
Prevention PRR Purpose:
Wraparound Integrated Services
x Psychosocial Rehab (Clubhouses) Pilot for Young Children _
Other
,
Adults with Children with Board
A, FINANCING SUMMARY Mental Illness Mental Illness Other Administration Total
Estimated clients to be served by PRR 100 100 1
1
PROJECTED FUNDING SUMMARY ,
Projected Gross Funding 5 400 5 400
SAMHSA (Federal) Block Grant S 400 5 400
1st/3rd/SSI Reimbursement Estimate'
Other - Funding: .
ii.--
SAMHSA lst/3rd/SSI
(Federal) Block Reimbursement Other
B. BUDGET DETAIL Grant Estimate Funding Total —
• Personnel salarieshvages and fringe benefits
Equipment
Travel ,
Supplies. etc.
• Contractual services (subcontract, etc.)—specify below , $ 400 , S 400
Indirect"
•$50.00 certification fee for 8 clubhouse staff (2 staff from each of
the 4 proposed clubhouses)
TOTAL 400 _ 400
'Block grant funds may not be used to match other federal funds.
"Per PL 102-3R1, Section 19168, administrative expenses may not exceed 5 percent.
FEDERAL BLOCK GRANT
PROGRAM REVISION REQUEST
PRR-FBG WPO
CMHSP -Silidiatclkatr
OAKLANO COUNTY CMNSP • Page 37
PAR Title. Time Required to Implement: Date Submitted: 9/17/97
Family Adventure Program: An Oakland County CMH/YMCA Respite (in months) -
Collaborative PRR ID Number: 98-07
12 — .
Client Group MI-A MJS Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 7 of 7
Pf97-98
Board Prevention Priority:
— of
Federal Block Grant PRR Purpose (check one):
ACT Teams
Consumer Run Of Directed Initiatives
Prevention PRR Purpose:
Wraparound _Integrated Services
Psychosocial Rehab (Clubhouses) Pilot for Young Children
X Other
Aging Services
Employment
Adults with Children with Board
A. FINAN-CING SUMMARY Mental Illness Mental Illness Other Administration Total
Estimated clients to be served by PRR 90 90
PROJECTED FUNDING SUMMARY
Projected Gross Funding 83,276 83,276
SAMHSA (Federal) Block Grant S 83,276 83,276
lst/3rd/SSI Reimbursement Estimate*
Other - Funding:
SAMHSA 1st/3rd/SSI
(Federal) Block Reimbursement Other
B. BUDGET DETAIL Grant Estimate* Funding Total
Personnel salaries/wa•es and frin•e benefits $ 22,804 $ 22,804
Equipment $ 4.189 5 4,189
Travel 9,458 9,458
Supplies, etc. 5 36.725 $ 36,725
Contractual services (subcontract. etc.)—speci below* $ 10,100 $ 10,100
Indirect—: evaluation and lecturers
TOTAL $ 83.276 S 83.276
'Block grant funds may not be used to match other federal funds.
Per Pl. 102-3R1, Section 1916B. administrative expenses may not exceed 5 percent.
OAKLANO COUNTY CMHSP -Page 34
NARRATIVE FOR PROGRAM REVISION REQUESTS
FEDERAL BLOCK GRANT
FBGNARR WPO
CMHSP Oakland County
PRR Title/Purpose - Clubhouse Employment Training Specialist Time Required to Implement: Date Submitted: 9/17/97
(in months): As training is
offered. PRR ID Number 98-06
Client Group: MI-A MI-C DO Bd Admin. Prevention FY of Implementation: Board Block Grant Priority:
(circle one) . 6 of 7
FY97-98
Board Prevention Priority:
- of
Narrative (attach additional pages as necessary):
The following outline should be followed for the PRR narrative (attach additional pages as necessary):
1. Describe the subpopulation (including its needs) and/or the proposed intervention.
2. Describe how the intervention is an enhancement an/or innovative relative to existing services.
3. Discuss the theoretical foundations of the model or intervention proposed (include relevant psychosocial principles if appropriate).
4. Describe the commitment of the Board (reflected by: level of CMH funds that will be directed at the initiative and plans for continuation of the
initiative).
5. Define/he expectations or outcomes and resulting from this initiative.
6. Identify the relative priority of the proposal in the Board's future planning.
The sub-population to be served will be mentally ill adults consumers who attend clubhouse and
participate in a work-ordered day. Existing clubhouse staff (2) and new staff from the newly
proposed addition of a clubhouse will be required to attend a specialized training on Mentally III
Adults and their participation in clubhouses with an additional focus on transitional employment. The
Michigan Department of Community Health has contracted with Michigan State University to provide
this training to clubhouse staff.
Justification for this training comes from the fact that clubhouse staff turnover is an important issue
and Oakland County Community Mental Health is looking to expand it's TE (Transitional
Employment) capabilities. OCCMH would like to provide consumers with the benefit of an
Employment Instructor and Job Developer working closely as a terri with the consumer to prepare
him/her for employment. With this training, OCCMH would hope this would prepare staff adequately
for this task.
OCCMH is committed to continuing clubhouses as well as expanding the clubhouse model into other
quadrants. It is critical that staff be adequately trained to duplicate this model in other areas of the
county. OCCMH feels that this training is important to retain clubhouse staff while affirming the
interest and desire in becoming much more specialized and recognizing the importance of that.
Clubhouse staff will then be able to set goals for TE participation which will in turn measure success
of the training. OCCMH proposes to pay for the certification of two staff from each of the four
proposed clubhouses. Depending on the success of the training, OCCMH will continue to provide
updated training for clubhouse staff.
OAKLANO COUNTY CMHSP Page 38
NARRATIVE FOR PROGRAM REVISION REQUESTS
FEDERAL BLOCK GRANT
FBGNARR WPO
CMHSP Oakland County
weer
PRR Title/Purpose Time Required to Implement: Date Submitted: 9/17/97
Family Adventure Program. An Oakland County CMH/YMCA Respite (in months) .
Collaborative PRR 10 Number 98-07 12 — -
Client Group. MI-A MI-C DO Bd Admin. Prevention FY of Implementation: Board Block Grant Priority:
(circle one) 7 of 7
FY97-98
Board Prevention Priority:
.f
Narrative (attach additional pages as necessary):
The following outline should be followed for the PRA nanative (attach additional pages as necessary):
1. Describe the need for services.
2. Discuss how the child and family will be involved in case planning.
3. Discuss how the services are designed to preserve children in their families or return them home form out-of-home placements.
4. Describe how this service will coordinate with other services (e.g., child welfare, juvenile justice, schools. etc.) delivered to children who have
multiple needs.
5. DescriOe the commitment of the Board (reflected by: level of CMH funds that will be directed at the initiative and plans for continuation of the , initiative).
6. Define the expectations or outcomes and resulting from this initiative.
7. Identify the relative priority of the proposal in the Board's future planning.
1. Describe the need for service:
Presently there are over 1,300 families in Oakland County raising and coping with children who have
emotional/behavioral problems. These families are coping with issues of depression, suicidal
feelings, substance abuse, academic difficulties, law enforcement involvement, problematic
behaviors at home, school and in the community. Until recently, these issues were often dealt with in
the traditional therapeutic manner- individual, family and group therapy, residential placements, and
psychiatric hospitalizations. Treatment was problem oriented rather than solution focused. Children
with severe emotional disturbance were at times removed from their homes and placed in residential
facilities and hospitals, sometimes for long periods of time. These methods tended to identify the
child as the problem, separating them from their families, causing further disruption in theic lives.
Parents of SED children often come from family situations in which they did not develop personal
strengths, family supports, and community resources to cope with societal stress. The additional
stresses of attempting to parent a child with challenging behaviors often results in crisis for the family.
The Family Adventure Program proposes a cost effective, innovative approach to meeting the needs
of such families in Oakland County. We have begun a broad-based inter-organizational collaboration
with the YMCA of Metropolitan Detroit, combining .consumer involvement with clinical and YMCA
foundational programming. This program is based on the philosophy of Adventure Based
Counseling, which states that processes of learning and behavior change are more effective when
they include direct experience (Gass, 1993). Adventure Based Programs involve the use of
therapeutic games, initiatives, low and high ropes courses, camping, and other outdoor challenges-all
experiences designed to place family members in novel situations which break down barriers,
allowing change to occur. Group discussions following activities facilitate the transfer of the skills to
other life situations. Research to date focuses on adolescents and indicates that such programs can
produce changes in the self-concepts, personalities, behaviors and social functioning of the program
participants. Findings also indicate that for these changes to have long lasting impact, the programs
must be accompanied by follow up in the community. We believe that by bringing parents and
children together to share adventure based experiences the likelihood that lasting changes will occur
is increased.
OAKLAND COUNTY CIANSP • Page 39
The design for our proposed project utilizes the basic components of other successful adventure
programs, and adds some elements to strengthen the program for our targeted group. The Family
Adventure Program will recruit 90 participants (SED children ages 8-18 and their families) . The
program will consist of 2 weekend outings at the YMCA Camp Ohiyesa near Holly, Michigan, 1
weekend outing at Camp Nissokone near Oscoda, Michigan, monthly meetings for all family
members and a week long camping experience at Camp Nissokone solely for the SED adolescent.
2.Discuss how the child and family will be involved:
Adventure Based Programs motivate family members to address issues of trust, effective
communication, conflict resolution, self concept, goal setting and appropriate risk taking through
action-oriented problem solving activities. The acquisition of these skills will enable families to handle
the stresses and challenges of day to day life with an SED child in more productive and less costly
ways. The program design will connect families with the community and other families for mutual
support, a crucial component to strengthening families. We believe that these strategies will help
keep families intact and prevent children at risk from utilizing high cost, out of home services like
hospitalization, residential placement and foster care.
3. Discuss how the services are designed to preserve children in their families:
The goal of the project is to strengthen family relationships by using adventure based counseling
activities as an adjunct to outpatient treatment services already provided by Oakland County
Community Mental Health. In order to most effectively improve the overall functioning of the severely
emotionally disturbed child, We believe it is essential to develop strong, nurturing family relationships.
The specific focus of the Family Adventure Program will be on improving communication and conflict
resolution skills, building self-esteem, increasing trust and appropriate risk taking. Acquiring these
skills will serve to strengthen the families and provide the foundation from which the adolescents may
change within their family unit.
4. Describe how this service will coordinate with other services.
We believe that our Family Adventure Program model has potential to be a statewide demonstration
project that may be replicated by other agencies providing services to children with severe emotional
disturbances. In addition, a priority of this program is for a detailed evaluation process, focusing on
two dimensions: effort and effect. The advantage of this two dimensional approach is measured
outcomes can be compared to the organizational effort in achieving the outcomes. This analysis will
demonstrate the efficiency of the program along with evaluating what was done within the,project
parameters. Results of this innovative program will be shared with other agencies through the state.
5. Describe commitment of the board:
Oakland County is committed to supporting this project and has guaranteed in-kind supports.
Evidence of the commitment to this project is its present financial and staff support for an initial tryout
of this program during the '96-'97 fiscal year.
6. Define the expectations or outcomes resulting from this initiative:
To improve functioning of severely emotionally disturbed children by an amount assessed as
significant at the .05 level when measured on the CAFAS Scale and to strengthen family
relationships by an amount assessed as significant at the .05 level when measured on the Family
Adaptability and Cohesion Scales (FACESII).
Budget Analysis for 90 consumers:
Cost per person: $925.29
Cost per hour (442 hours) per consumer $2.09
Cost per person @ Camp Nissokone: $43.53
Cost per person @ Camp Ohiyesa $8.53
Total program cost: $83,276
-.... Tr
No.
ND COuNTY Catitip . par 40
CMMSP Oakland County
ESTIMATED ?TS'S
FTES.WPD
-
Estimated FTE's
as of 9/10/97
(A) Estimated number of FTE equivalent employees on the CMHSP payroll
as of 9/30/97 —11.1L-1--
Full-time equivalent employees are defined as 12
hours of paid (including sick/annual) work per week.
(8) The estimated FTE-equivalent of persons providing
services to the CMHSP through a personal services --12.11.1L—
contract with the CMHSP. Only persons providing approved mental
health program
.. For example, a contract. with a psychiatrist
for 20 hours of service per week 4 .5 PTE.
4 For contracts /or mental health services, provide
estimated FTE equivalents which are funded by the 2986.62 ._
Tri:I.,:de FTE's associated with residential services such as
group homes.
- '-
Exclude staff .4sociated with general AFC residential
room, board and supervision. If the contract pays for
additional staffing, provide the FTE equivalent. This
would include program add-on funding.
Exclude FTE's associated with all community
inpatient programs.
.. Exclude all state provided services.
.timate FTE equivalents based on data available
the CMHSP in relation to contract spending
no other information is available.
TOTAL .:MATED FTE'S 3398.2
Describe the methodology used to provide this information.
Full and part-time employees were totaled for each category.
CMHSP Oakland County - FY 97
OAKLANO COUNTY CMHSP • Page 41
CNNSF SUMMARY OF =RIR= CONTRACTS FOR MINTAL MULTI' SIRVICIS DELIVMRY
--EXCLUDING STATE PROVIDED SERVICES--
CONTRACT.WPO
Race paid per unit of service. Total FY 97
Provide range if more than one rate is Expected CMHSP
Number of paid. Contractual
Program Type Contracts Rate Paid (range) Obligation
-
ADULTS WITH MENTAL ILLNESS
Community Inpatient 4 295-498/day $ 2,000,000
Bd Managed Residential inc. 4 net cost $ 19,429,273
SIP subcontract
57 34.41-200/day
Day Programs 9 includes 20.68-47.59/day, 1 net cost $ 2,466,407
subcontracts
Outpatient Services 7 19.73-39.96/day, 5 net cost $ 16,110,028
Supportive Services 8 10.08-19/hour, 1 net cost $ 743,471
Prevention 1 13.75-170.85 $ 1,399,820
- .
Individual professional 9 35-90/hour $ 112,710
service contracts
CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE
Community Inpatient 1 355-358.51/day $ 380,428
Bd Managed Residential inc. 33 45.58-303.79/day $ 1,707,709
SIP
Day Programs
Outpatient Services 3 varied hourly rates, 1 net cost $ 501,964
Supported Services 42 varied hourly rates $ 1,752,052
Prevention
i
Individual professional 3 $ 10,000
service contracts
PERSONS WITH DEVELOPMENTAL DISABILITIES
Community Inpatient
Bd Managed Residential inc. 349 includes 11.98-37/hour $ 49,093,365
SIP subcontracts 13.26-342.83/day
Day Programs 27 includes 25.16-283.19 $ 15,398,987
subcontract
Outpatient Services 3 14.98-16.50 $ 123,500
Supportive Services 4 • numerous net cost, varied per diemm $ 2,033,742
vouchered
Prevention
, ,
Individual professional 15 18-79.32/hour $ 949,212
services contracts varied rates for transportation
CMHSP PERSONS SERVED
SERVED.WPO
CMHSP Oakland County
OAKLAND COUNTY ChlIHSP • Page 42
I FY 95-96 Actual 1 Projected FY 96-97 I Projected FY 97-98
PERSONS WITH MENTAL ILLNESS
0-17 years 1,241 1,593.6 1,753.0 ,
18-54 years 5,505 6,094.8 6,704.3 —
55 and over 1,639 1,348.8 1,483.7
,
Age unknown
Subtotal 8,385 _ 9,037.2 9,940.9
PERSONS WITH DEVELOPMENTAL DISABILITIES
0-17 years 564 685.2 753.7
—
18-54 years 1,643 2,118.0 2,329.8
55 and over 176 228.0 250.8
—
Age unknown
Subt6tal .2,3,83 3,031.2 3,334.3
OTHER PERSONS SERVED 356 427.2 469.9
GRAND TOTAL 11,124 12,495.6 13,745.2 ,
OAKLAND COUNTY CMHSP Page 43
RESPITE CARE - CONTINUATION FUNDING APPLICATION
RESPITE. upD
CMHSP Oakland County
A. SED RESPITE SERVICES EXPENDITURES/FUND USE PLAN
,
FUND SOURCE(S)
-
Other DCH/
CMHSP
Funding
Federal including
Tobacco Block Grant Local
Tax . Other Total
1. Number of Children Served. FY 97 Projected 230 230 . -
2. Number of Children to be Served - Pf 98 Plan 250 250
3. Projected Expenditures - FY 97 (Total) $ 207,466 $ 80,920 t 288,386
,
A. Direct services $ 201,800 $ 201,800
B. Respite services coordination $ 64,808 $ 64,808
-
C. Administration $ 16,112 $ 16,112 ..
D. Other (specify)
4. Projected Expenditures - FY 98 (Total) $ 320,000 $ 38,000 $ 358,000
A. Direct services $ 232,000 $ 22,000 $ 254,000
B. Respite services coordination $ 76,000 $ 76,000
C. Administration $ 12,000 t 16,000 $ 28,000
D. Other (specify)
5. FY 98 Estimated Spending by Quarter
A. 10/1/97 through 12/31/97 $ 110,000 $ 9,500 $ 119,500 /
B. 1/1/98 through 3/31/98 i 50,000 $ 9,500 $ 59,500
- ,
C. 4/1/98 through 6/30/98 $ 50,000 i 9,500 $ 59,500
D. 7/1/98 through 9130/98 $ 110,000 i 9,500 119,500
NARRATIVE
Provide an accompanying narrative which:
1. Describes the SED respite services program including all fund sources.
2. Documents the need for services.
3. Describes parent and family involvement in planning, development and oversight.
4. Describes training and outreach.
OAKLAND COUNTY CPANSP • Page 44
RESPITE CARE - CONTINUATION FUNDING NARRATIVE
The emotional and physical toll on parents of children with SED can be overwhelming, oftentimes
resulting in social isolation, and with negative impact on the total family. The past single option of
institutionalization for children with severe emotional disturbance is generally not in the best interest
of the child or the family and is not cost effective. Oakland County has been providing respite
services to these consumers since the summer of 1995, offering a resourceful alternative to out of
home placement. Two hundred and thirty children with severe emotional disturbances (SED)
received respite services in FY 97.
Currently, Oakland County respite services for SED children through the Respite Department (this
does not include services through WraparounD, Wrap Flex, Residential Respite, or Respite through
Waivers) fall into 3 categories: vouchered in home, 4H/CMH and YMCA Collaboratives, and
Community Education and Outreach.
Our vouchered in home respite program offers families flexible funds to purchase respite services
from their provider of choice, thus giving families complete autonomy in the planning, development,
and scheduling of their services. Ongoing assistance in identifying providers and utilization is
offered., A base amount of funding is allocated to each family at the beginning of the fiscal year.
Funding resources are amended as family need indicates. Camperships are offered separate from
the base in home respite fund, but provided within this vouchered program.
Children with severe emotional disturbances have participated for the third year in the 4H/CMH camp
collaborative. Offering the 4H educational camp experiences with therapeutic supports has afforded
both children and clinical staff unique fulfilling day camp experiences. 4H in-kind contributions to this
program will be $83, 788. We are also collaborating with the YMCA on a family activities/camp
program. The YMCA's in-kind contribution will be $8500. CMH's contribution is $51,000 worth of
staff time.
This past year Oakland County has supported and joined with the Association of Children's Mental
Health to start a local chapter. Respite services are provided to those families in attendance, and
CMH staff attend each meeting as well.
As per above, parent, family and community are involved in planning, development and oversight of
services. Families have full control in the voucher program and request assistance when they need
it. ACMH helps CMH to understand the needs of its constituency. We continue our networking with
the surrounding counties to develop, expand and implement innovative respite services through
attendance at bi-monthly respite roundtables.
This past quarter a collaborative effort with the Oakland County Child Care Coordinating Council
(4C's) has been initiated. Our projected plan is to provide training to 4C's providers in group as well
as 1:1, specific to the SED population. Our goal is to increase community awareness and provider
resources, resulting in an expansion of trained community providers to our consumers. In the next
year we will continue our needs assessment and perhaps pilot a limited plan to provide Latchkey
services to SED children through the existing school programs, providing training and any extra
funding which may be needed.
OAKLAND COUNTY C1AHSP • Per 411
• •
RESIDENTIAL DIRECT CARE WORKERS
RESID.WPD
CMHSP Oakland County
Residential Beds Number of FTE's
9/30/97 9/30/97
A. DLRECT OPERATED SERVICES (excluding earned
contracts C.)
Services for Persons with Mental Illness
Services for Children with Serious Emotional
Disturbance
Services for Persons with Developmental Disabilities
-.. -
B. CONTRACTED SERVICES
Services for Persons with Mental Illness 466 609
Services for Children with Serious Emotional 32 65
Disturbance
Services for Persons with Developmental Disabilities 973 1,721
C. EARNED CONTRACTS WITH CARO OR MT. PLEASANT AS OF 8/31/97
Services for Persons with Mental Illness
Services for Children with Serious Emotional
Disturbance
-
Services for Persons with Developmental Disabilities 37 98
GRAND TOTAL 1,508 2,493
Full time equivalent employees are defined as 2080 hours of paid (including sick/vacation)
work per week.
Contact person for questions about this form:
Name: Virginia Reed
Phone Number: (248) 858-1210
Na.
) OAKLAND COUNTY
COMMUNITY MENTAL HEALTH
SERVICES BOARD
PROGRAM BUDGET PLAN
)
FY 1996-1997
20
Summary - Adult with Mental Illness 21
For Adults With Mental Illness -Narrative 22
Summary - Childrent with Serious Emotional
24
For Children with Serious Emotional
Summary - Persons with Developmental Disabilities . .
For Persons With Developmental Disabilities - Narrative
25
27
28
OKLANO COUNTY CMNSP
TAB ,E QF CQATENTq
Form Submission Checklist - 1996
Base Program Description 1
Assessment of Current Client Need
Assessment of Current Client Need
Assessment of Current Client Need
Assessment of Current Client Need
Disturbance
Assessment of Current Client Need
Disturbance - Narrative . . .
Assessment of Current Client Need
Assessment of Current Client Need
Assessment of Community Needs Narrative 30
Methodology And General Discussion 31
Assessment of Community Need - 1996 Submission 34
Adults With Mental Illness 35
Children With Serious Emotional Disturbance 36
Persons With Developmental Disabilities 37
References 39
Planning Policy Submission Requirements 41
Managing Risk 42
Managing Access And Demand 44
Managing Performance ,.• - 45
Managing Interactions With Other Service Providers, Consumers and Stakeholders 47
Availability of Program Elements And Average Wait - Narrative 48
Availability of Program Elements - Adults with Mental Illness 49
Availability of Program Elements - Children Emotional Disturbance 50
Availability of Program Elements - Persons with Developmental Disabilities 51
Residential Bed Capacity - All Client Groups 51
Residential Bed Capacity - All Client Groups 53
Full Management Trade-off Dollars Projected 54
Full Management Trade-off Dollars Projected - Page 2 55
Persons With Serious Mental Illness Receiving Client Service Management 56
OMAN° COUNTY CMNSP
Program Revision Requests — Spending Detail And Narrative 57
Census Projections - Hospitals, Centers And Nursing Homes 71
Summary—Waiver Certificates Needed 72
Federal Block Grant Reporting Requirement 73
Federal Block Grant Program Revision Requests 74
Estimated FTE's 78
CMHSP Summary of Current Contracts For Mental Health Services Delivery 79
OKLANO COUNTY CMNSP
CMHSP: Oakland County
FORM SUBMISSION CHECKLIST - 1996
CHECKLIS.WPD
The following forms/narrative must be included in the CMHSP's submission. Please enter an "X" to
indicate the information is provided.
X Base Program Description Narrative
X Issue Analysis and Program Plan - Narrative
X Assessment of Community Need - Narrative
X Assessment of Current Client Need Summary form - one for each client population
(CLIENTND.WPD)
JL Assessment of Community Need form (COMMNEED.WPD)
X Availability of Program Elements Average Wait for Non-Emergency Services - one for each
client population (WAITIN.WPD)
CMHSP Waiting List--Movement Report (optional; required in 1997) (WAITOUT.WPD)
X Residential Bed Capacity - all client groups (BEDCAP.WPD)
X Full Management Trade-Off Dollars Projected (FMTO.WPD)
X Pecsons with Serious Mental Illness Receiving Client Service Management (SMI.WPD)
X Program Revision Requests--Spending Detail and Narrative (PRR.WPD)
(PRR-NARR.WPD)
X Census Projections - Hospitals, Centers and Nursing Homes (CENPROJ.WPD)
X Summary—Waiver Certificates Needed (WAIVCERT.WPD)
X Federal Block Grant Reporting Requirement—System of Care Services for Children with Serious
Emotional Disturbance (FEDBG.WPD)
X Federal Block Grant Program Revision Request and Narrative (PRR-FBG.WPD)
(FBGNARR.WPD)
Estimated FTE's (FTES.WPD)
CMHSP Summary of Current Contracts for Mental Health Services Delivery
(CONTRACT.WPD)
Ill
-yr
OAKLAND COUNTY CMHSP - PAGE 1
) BASE PROGRAM DESCRIPTION
)
OAKLAND COUNTY CMHSP • PAGE 2
BASE PROGRAM DESCRIPTION
Table of Contents
List of Major Organizational Components 3
Table of Organization 4
Ombudsperson 5
Residential Development 5
Office of Recipient Rights 6
Progam Design/Contract Management 6
Medical Services 7
Quality Assurance/Strategic Program Planning & Evaluation 8
Fiscal Servies 8
Central Admission and Evaluation - Intake (ACESS) 9
Central Admission and Evaluation - Hospital and Facility Liasion 10
Clinical/Client Services - MI Adult Services 10
•
Description of Special Needs Population 12
Clinical/Client Services - DD Adult Services 14
Clinical/Client Services - El/DD Children Services 16
Clinical/Client Services - El Centro La Familia 17
Clinical/Client Services - Correctional Activities 18
Community Education/Administrative Support 18
Note: Services to at-risk populations, where offered, are included under major categories
above.
OAKLAND COUNTY CMHSP - PAGE 3
s\
List of Major Organizational Components
)
Component
Ombudsperson
Residential Development
Office of Recipient Rights
Program Design/Contract Management
Contract Coordination
Program Development & Oversight
Medical Services
Quality Assurance/Strategic Program Planning
& Evaluation
Fiscal Services
Central Admission and Evaluation
Intake (ACCESS)
Hospital/Facility Liaison
Clinical/Client Services
MI Adult Services
D.D. Adult Services
E.I./D.D. Children
El Centro La Familia
Correctional Activities
Community Education/Administratrative
Support
Population Served
All populations, Administration
All populations, Administration
All populations, Administration
All populations, Administration
All populations, Administration
Administration
Administration
All populations, Administration
All populations, Administration
All populations, Administration
All populations
Adults with mental illness. -
Adults with developmental disabilities
Children with emotional impairment and
Children with developmental disabilities
Adults with mental illness and Children with
emotional impairment
Adults with mental illness
Administration
)
INTAKE
CM - Intake/Access
Svcs.
HOSPITAL/FACILITY
LIAISON
CM - Facility Liaison
Svcs.
MI ADULT SVCS.
Chf - 111 Adult Svcs.
DD ADULT SVCS.
Chf - MI/DO Svcs.
4_1011, , 4
Table of Organization
COUNTY EXECUTIVE'
OAKLAND COUNTY
BOARD OF
COMMISSIONERS
MANAGEMENT &
BUDGET
CITIZEN ADVISORY
COUNCIL
OMBUDSPERSON
CMH BOARD
CMH
ADMINISTRATION
Director - CMH Services
I.
CMH FINANCIAL
SERVICES
CM- CMH Financial
Svcs.
PURCHASING
OFFICE OF RECIPIENT
RIGHT S/ADMIN SUPPORT
CM - Office of Recipient Rights
—Recipient Rights Supv
1
COMMUNITY
EDUCATION/ADMIN
SUPPORT
Chf - Community
Education/Adrnin Support
PROGRAM DESIGN/CONTRACT
MANAGEMENT
Administrator - Contracted Svcs
Mgmt
CM - Contracted Svcs Mgt
Program Design/Contract Supv.
CENTRAL ADMISSION
EVALUATION
Chf - Central Admission
Eval.
1
CLINICAL/CLIENT
SERVICES
Administrator - CMH
Clinical Services
1
CMH RESIDENTIAL
DEVELOPMENT
CM - CMH Housing
Resources
CIAIS TRATEGIC
PROGRAM PLANNING
EVAL
- Duality Assurance
CIAH MEDICAL
SERVICES
CMH Medical Dreclor
El/DO CHILDREN
CM- El/DO Children.
Services
(North & South Units)
EL CENTRO LA
FAMILIA
Casework Supervisor
CMH CORRECTIONAL
ACTIVMES
CM - CMH Coma:lions
• Also includes Personnel Analyst functioning as a liaison with CMH.
• Functions as a liaison with Ombudsperson
OAKLAND COUNTY CMHSP - PAGE 5
Ombudsperson
A. Description of the Client Population or Administrative Function
The Ombudsperson is available for consumers of all populations to help resolve
complaints and grievances that are not covered by the Michigan Mental Health
Code. This person will assists consumers in negotiating the Oakland County
Community Mental Health Service Provider (OCCMHSP) system to facilitate a
mutually agreeable resolution of the complaint or grievance. The Ombudsperson
is responisble for ensuring the integrity of OCCMHSP's policy and procedure on
greivances.
B. Description of Services Provided
Board Administration
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff have a wide knowledge of the OCCMHSP system and community services
D. Program Goals
The goal of this service is to reduce the number of consumer complaints:
to improve consumer satisfaction with services.
) Residential Development
A. Description of the Client Population or Administrative Function
Although this function is primarily administrative, it provides indirect services and benefits
to all client population.
B. Description of Services Provided
Board Administration
C. Special Staff/Outreach Capacity and Interagency Coordination
The chief of this service works with OCCMHSP staff, contract agencies, and the
community in the development of new housing opportunities.
E. Program Goals
To increase the available housing stock for persons with psychiatric and/or
developmental disabilities in Oakland County.
OAKLAND COUNTY CMHSP • PAGE 6
Office of Recipient Rights
A. Description of the Client Population or Administrative Function
This function provides direct service to all client population. The Rights Office works with
all OCCMHSP and contract agenciesto protect the rights of those served, as defined in
the Michigan Mental Health Code
B. Description of Services Provided
Board Administration
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff are trained in how to protect and investigate the rights as defined in the Michigan Mental
Health Code.
D. Program Goals
The goal of this service is to reduce the number of rights complaints; and
to ensurethat the rights of all consumers are protected.
Progam Design/Contract Management
A. Description of the Client Population or Administrative Function
Although this is function is primarily administrative, it provides indirect services and benefits to
all client population. It is the philosophy of the contracts department to offer a broad array of
needed mental health and related services using contracted providers. Such providers of
service, selected through the competitive bidding process, represent those that can deliver the
most effective, highest quality services reasonable cost. Contracted services are provided
through a wide variety of contract vehicles including professional services contracts, agency
contracts, residential contracts, purchase orders, and vouchers.
B. Description of Services Provided
Board Administration
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff have combined backgrounds in mental health service delivery and buisness.
D. Program Goals
The goals of this service are to assure the delivery of needed mental health services to
qualified Oakland county residents, through the use of a variety of contracted service
providers;
to implement a competitive bidding schedule for mental health and related service providers;
to assure timely payment (net 30 days) to contracted providers;
to secure the highest quality of services for the best possible prices; and
to assure all contract documents are completed for review and approval by the CMH Board
and in effect for the identified contract period.
OAKLAND COUNTY CMHSP - PAGE 7
Medical Services
A. Description of the Client Population or Administrative Function
The philosophy of the Medical Services Department is to organize, develop, and maintain
psychiatric diagnostic, treatment, rehabilitation and medical services for the consumer
population of Oakland County Community Mental Health. The Medical Services Department,
therefore, shall provide and ensure psychiatric/medical treatment services for OCCMHSP
consumers county-wide.
B. Description of Services Provided
Clinic Services, Assertive community treatment, Client services management, and Board
Administration
C. Special Staff/Outreach Capacity and Interagency Coordination
Medical Services staff comprise physicians and nurses
Medical Services participates in:
• Tr-County policy and program planning
• Coordination of physical health care services with area Managed Care organizations
(such as Physician Sponsored Plans, Health Management Organizations and Clinic
Plans) and physicians.
• State wide planning and policy development through Michigan Department of Community
Health (DCH)
• Consultation regarding Managed Care issues with OCCMHSP monitoring agency
(MPRO)
• Psychiatric consultation and oversight with service providers contracted by OCCMHSP.
• Consumer and family education offered to voluntary community agencies and advocacy
groups on request
• Development of a Psychiatric Prescription Formulary in coordination with the policy
directives of DCH
• Coordination of Laboratory Services between OCCMHSP and the Contracted Lab:
Corning Lab
• Coordination of the indigent medication program with community agencies and
pharmaceutical companies
D. Program Goals
The goal of this service is to develop services to avert hospitalization and promote the
development of alternative community based services. Programs are evaluated,
treatments implemented and monitored, and education provided to consumers, families,
and staff. Outcomes are reflected in the quality of life goals unique to each consumer's
strengths and expressed interests as reflected in the person centered treatment plan.
OAKLAND COUNTY CMHSP•PAGE 8
Quality Assurance/Strategic Program Planning & Evaluation
A. Description of the Client Population or Administrative Function
The functions of Program Evaluation and Management Information Systems were merged into
one unit - Quality Assurance/Strategic Planning and Evaluation. Its purpose is to oversee
ongoing development, implementation and operations of managment information software
applications; ensure the integrity of management and clinical reports, and automated billing;
maintain consistency in coding service activity data and its capture; provide support and
training to staff; gather needs assessment information; conduct data collection and analysis;
evaluate OCCMHSP services, as needed; and assist in the implementation of OCCMHSP's
quality improvement plan.
B. Description of Services Provided
Boad Administration
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff have backgrounds in computer applications and total quality management
D. Program Goals
The goals of this service are to develop quality assurance/improvement committees that will
serve as the framework for monitoring operational activities of the organization which will
improve service delivery;
to achieve accreditation for its services to comply with the newly revised Michigan Mental
Health Code (section 232a Certification of Community Mental Health Service Program);
to transfer Managed Medicaid responsibilities to dedicated support staff in a an efficient, timely
manner.
to equip all staff with computers and coordinate adequate training;
to evaluate the cost-effectiveness of automating all remaining accoynts receivable billing by
9/30/96;
to provide Managers and Providers with the tools necessary to utilize data in making confident
decisions; and
to define and select instruments, based on research criteria, that measure consumer
outcomes for all populations served.
Fiscal Servies
A. Description of the Client Population or Administrative Function
This area is responsible for preparation and monitoring the annual budget, other-source
revenue generation, and all fiscal and support operations and procedures. Staff in this
function report both to the Executive Director and the Director of Oakland County'
Management and Budget.
B. Description of Services Provided
Board Administration
OAKLAND COUNTY CMHSP - PAGE 9
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff a fiscal background to carry out their tasks
D. Program Goals
The goal of this service is to prevent over expenditures and maintain fiscal operations within
current standards of practice.
Central Admission and Evaluation - Intake (ACESS)
A. Description of the Client Population or Administrative Function
The ACCESS Unit strives to refer any individual requesting Community Mental Health
Services to the most appropriate and least restrictive resource available. ACCESS works to
establish uniformity and consistency in referrals to all treatment agencies within the
OCCMHSP. ACCESS is the central screening unit to serve as the single entry point for
Oakland County residents who request services from Oakland County Community Mental
Health. ACCESS serves all client populations.
B. Description of Services Provided
Board Administration; and Intake, Assessment and Referral
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff are clinical social workers, psychologists, psychiatrist, nurses, counselors, specialists for
adults and children, with developmental disabilities, emotional impairment or mental illness.
This service develops and maintains referral relationships with all appropriate mental health
related organizations within the county, as well as on-going meetings with all OCCMHSP
providers.
D. Program Goals
The goals of this program are:
Screenings provided result in identification of each individual's needs and available service/
treatment as recorded on the ACCESS Screening Form and Disposition of Referral
/Follow-up Form;
screenings provide a determination of eligibility and linking to an available service/treatment
within two weeks;
medication management as an interim service to maintain an individual's stability in
functional status as measured by the Global Assessment of Functioning Scale (GAF)
until an opening is available at a treating agency; and
establishment and maintenance of a centralized data based wait list for those consumers
which CMH is not able to serve due to unavailablity of services.
OAKLAND COUNTY CMHSP - PAGE 10
Central Admission and Evaluation - Hospital ancfacility Liasion
A. Description of the Client Population or Administrative Function
The Hospital and Facility Liaison program advocates for appropriate services for all Oakland
County mental health consumers (adults and children) with emotional illness, mental illness
and/or developmental disability who are in hospital and/or residential facilities; represents and
advocates for consumers in probate court mental health proceedings; monitors OCCMHSP
consumers by gathering relevant statistical data, coordinating facility and community
cooperation; satisfies all Michigan Mental Health Code mandated activity; and oversees and
facilitates moves to the least restrictive environment.
B. Description of Services Provided
Board Administration; and other support services to consumers and their families
C. Special Staff/Outreach Capacity and Interagency Coordination
Specialists for adults and children who may have emotionally impairment, developemtnal
disability or mental illness. This service develops and maintains referral relationships with all
appropriate mental health related organizations within the county, as well as on-going
meetings with all OCCMHSP providers.
D. Program Goals
The goal of this program is to reduce length of stay in state and CMH contracted hospitals;
to advocate and ensure appropriate placement options for CMH consumers;
to perform length of stay evaluations for state and CMH contract hospitals;
to encourage District Agency involvement in hospitals so as to help reduce utilization;
to work with MEDASSIST in filing for entitlements;
to monitor consumer movement;
to advocate for least restrictive setting for CMH consumers; and
to review and approve/disapprove state billings for utilization.
Clinical/Client Services - MI AdultServices
A. Description of the Client Population or Administrative Function
The Oakland County Community Mental Health Service Program (OCCMHSP) has completed
a significant reogranization services to adults with mental illness after becoming a full
managed Boad. A new service delvery plan and implementation strategy were developed
after an intensive and controversial evaluation of existing services, comments of hundreds of
citizens, and an evaluation by the Oakland County Transition Team (comprised of
representation from the County Executive, Commissioners, and the Board). OCCMHSP has
been in the process of developing requests for proposal, evaluating proposals, awarding
contracts, and ensuring a successful transition to the new service delivery system in the last
18 months.
OAKLAND COUNTY CMHSP • PAGE It
Key to this system was a shift in emphasis from office to community based care, and
psychotherapy to case management as the core support to persons with severe and persistent
mental illness.
As a result of planning, OCCMHSP has reconfigured its service and added:
• Supported Housing using an ACT model of service delivery;
• Housing intermediary;
• County-wide mobile crisis unit; and
• Four new Client Services Management programs, created through the division of the
county into four quadrants with identical services offered in each (this replaced existing
case management, outpatient, and geriatric services).
OCCMHSP services to adults with mental illness (subject to limitations of resources and
necessary waiting lists) offer services to all adult residents of Oakland County who request
service and have a DSM-IV psychiatric diagnosis. However, some individuals who meet this
description are more appropriately referred to some other mental health care provider or
counseling program, and the following criteria are used by OCCMHSP staff in making a
suitable differential judgement in such situations:
• Persons with a GAF score less than 50 and those with a GAF of 50 or above who need
psychiatric medication, are generally served by OCCMHSP programs. Persons with a
GAF score of 50 or above who are not in need of psychiatric medication are usually
referred to a family service agency or other available counseling agency.
• Persons with a primary diagnosis of substance abuse (or who are actively abusing
substances) are referred to a substance abuse counseling program when their substance
abuse is expected to seriously interfere with mental health treatment. These individuals
may teceive OCCMHSP crisis intervention for a psychiatric emergency. Others who
have a primary diagnosis of substance abuse and/or are actively abusing substances are
served by OCCMHSP when their substance abuse is nor expected to interfere with
treatment. Being a current substance abuser is not, in and of itself, sufficient reason not
to open a citizen's case in a OCCMHSP agency, but in light of the substance abuse
problem the appropriateness of psychiatric medications and interventions for such cases
has to be reviewed.
• Persons with a dementing illness (Organic Brain Syndrome) are served by OCCMHSP as
long as their needs for physical medical care do not supersede their needs for psychiatric
care. If acute physical medical needs (medical management) do predominate, these
have to be addressed before mental health services are provided, by referring the
individual to a suitable public health agency, internist or other physical health care
provider.
• Persons who are dually diagnosed (mentally ill and mentally retarded/developmentally
disabled) who have a full-scale IQ score of 70 or lower are served by OCCMHSP
Services for the Developmentally Disabled. Those with an IQ of 80 or more are served
by the appropriate OCCMHSP MI-Adult Services agency. Those with an IQ in the 71-80
range are considered on a case-by-case basis, based on their particular service needs.
OAKLAND COUNTY CMHSP - PAGE 12
• Persons with Traumatic Brain Injury (closed-head injuries) are most appropriately referred
to a (non-CMH) program specializing in serving this condition. However, if another
mental illness is also present and the citizen is capable of cooperating with treatment,
service with OCCMHSP is considered appropriate.
Exceptions to the foregoing criteria are made on an individual basis, for valid clinical reasons.
Description of Special Needs Population
African-American/Black Population: African-Americans are the largest minority group in
Oakland County (at 7.2 percent) and account for 14 percent of the service population. This
"over representation" (indicated by population figures cited above) may result, in part,
because one of OCCMHSP larges providers is located and serves the City of Pontiac, where
African-Americans comprise 45 percent of the general population. This data may also
indicate an underservice to this population in other parts of the County.
Hispanic Population: Hispanics make up a significant minority in parts of Oakland County,
particularly in Pontiac. Based on demographic data, they would be expected to make up 1.8
percent of the OCCMHSP service population. A special program, El Centro "La Familia,"
has been providing services to adults, children and families for the last several years and
has a greater appeal to this community than traditional services, as evidenced by the greater
proportion of this population receiving OCCMHSP services (from 0.7 during 1990 to 2.3
percent during 1996). administered as part of the Board's Services to Adults with Mental
Illness.
Middle Eastern (Arab-American/Chaldean) Population: The Arab/Chaldean population has
become a significant minority in Oakland County; at present Oakland is second only to the
Dearborn-western Detroit area in -numbers of Chaldean and Arab-American residents. About
15,495 (1990 census figures) are reported to live in Oakland County, almost all in the
southern part of the county and most in Southfield. However, the Arab-Chaldean community
considers this a severe under count and estimates this population at over six times greater
than indicated. This group presents some special language and cultural barriers for mental
health services, while at the same time the Arab/Chaldean communities have the added
stress of adaptation to a culture foreign to them. The expected proportion of Chaldeans and
Arab-Americans in OCCMHSP services should be 1.4 percent, but is actually 3.4 percent
due to an ethnic-sensitive family counseling program provided for this population by
OCCMHSP through a contract with the Arab-American and Chaldean Social Services
Council. The service is located in Southfield with staff that are trilingual. It provides services
to adults, children and families. The program provides clinic servics and client services
management to adults and families with mental illness. Its program goals are to improve
stability in residential status, improve vocational status, reduce in-patient hospitalizations of
this population, and receive high client satisfaction with services.
Older Adult Population: Census data from 1990 indicated that 19.5 percent of the County's
population were aged 55 to 64, and another 8.9 percent were 65 and older. Further, the
OAKLAND COUNTY CMHSP - PAGE 13
number of older adults continues to increase at a higher rate than the overall population
increase, and a large proportion lives alone and/or has very limited financial resources. This
is particularly true of Pontiac and southeast Oakland County. OCCMHSP has traditionally
provided its full range of services to all persons with mental illness or developmental
disability who meet admission criteria, with no upper limit on age. However, older adults do
not usually seek these services, for both practical (i.e. lack of transportation) and
psychological reasons. OCCMHSP has geriatric specialist in each of the four quadrants,
and a contract with Oakland Family Services to proviede OBRA services and nursing home
monitoring.
Hearing-Impaired Population: The expected incidence of hearing-impaired persons, based
on the 1980 census, would be 0.9 percent. OCCMHSP's previous rate of service to
hearing-impaired persons, 0.2 percent (compared to 0.9 percent in the 1980 census) has
been significantly improved to 0.86 percent by the development of services to this population
through the North Oakland Child and Adolescent Clinic. The Clinic employs a hearing
impaired therapist who is proficient in American Sign Language (ASL) to work with
hearing-impaired adults and children. As needed, other OCCMHSP agencies make use of
signing interpreters who are scheduled and furnished by an outside contractual provider.
Crisis intervention services for the hearing-impaired are available through Common Ground,
the contractual emergency service for OCCMHSP, which has TDD capability and logs over
1,100 such calls per year. OCCMHSP enjoys a formal working relationship with Community
Services for the Hearing Impaired, a United Way agency in Pontiac offering information and
referral. OCCMHSP also has an informal relationship with the Center for Deaf Treatment at
Northville Regional Psychiatric Hospital for cross-referrals.
B. Description of Services Provided
Local (community) inpatient
alternatives
State inpatient/residential
All other residential
Supported independence
Psychosocial rehabilitation
center
Clinic services
Emergency services
Assertive community treatment
OCCMHSP has contracts for this service area
and is developing more
Clinton Valley Center
Hope Network, Inc. - Therapeutic Community
Alternative Living Systems, and Kadima
Dreams Unlimited, New Beginnings, and Our
House
Arab-American and Chaldean Mental Health
Services, El Centro La Familia, Training and
Treatment Innovations - North Quadrant, St.
Joseph Mercy Health Care Network - Central
and West Quadrants, and OCCMHSP -
South Quadrant
Common Ground
Training and Treatment Innovations - North
Quadrant, St. Joseph Mercy Health Care
Network - Central and West Quadrants,
OCCMHSP - South Quadrant, and Training
and Treatment Innovations - Supported
Housing
OAKLAND COUNTY CMHSP • PAGE 14
Client services management
Community integration services
Training and Treatment Innovations - North
Quadrant, St. Joseph Mercy Health Care
Network - Central and West Quadrants,
OCCMHSP - South Quadrant
Friends Assisting in Recovery
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff are social workers, psychologists, psychiatrists, nurses, consumers. OCCMHSP has
staff proficient in American Sign Language, and is able to secure interprters for the hearing
impaired whenever needed. Because of the wide variety of services and their placement
throughout the community, OCCMHSP participates in a number of collaborative bodies that
attempt to coordinate services whenever appropriate.
D. Program Goals
The overarching goals of this service are:
to improvement and/or maintain stability in a consumer's residential status;
to improve the vocational status of a consumer;
to improve and/or maintain stability in a consumer's functioning (GAF)
to increase the community tenure (i.e., reduce hospitalization) of a consumer;
to secure eligible entitlements for a consumer and/or help achieve increased income
to achieve high client satisfaction with services; and
to improve the symptomatic functioning of a consumer.
Clinical/Client Services - DD Adult Services
A. Description of the Client Population or Administrative Function .
This major component of Oakland County OCCMHSP Services is responsible forproviding a
wide range of care to individuals who have a developmental disability, defined as follows:
a severe, chronic disability of a person which:
1) is attributable to mental or physical impairment, or a combination of mental and
physical impairments;
2) is manifested before the person attains age 22;
3) results in substantial functional limitations in three or more of the following areas of
major life activity:
• self-care
• receptive and expressive language
• learning
• mobility
• self-direction
• capacity for independent living
• economic self-sufficiency; and
4) reflects the person's need for a combination and sequence of special,
interdisciplinary, or generic care, treatment or other services which are of lifelong or
extended duration and are individually planned and coordinated.
OAKLAND COUNTY CMHSP - PAGE 15
Within this definition, Board services are offered to persons of all ages, and their families.
However, day programs are offered only to those aged 26 and older who are no longer eligible
for public schools special education services.
In Services for People with Developmentally Disabilities, new cases come through referrals,
almost 90 percent from the schools and families. "Operation Find" is a Federal program
requiring intermediate school districts to aggressively search and identify children with
developmental disabilities early in their lives.
OCCMHSP provides a second opinion to families about the diagnosis. This program is also
effective as case-finding for the OCCMHSP system: it is a basis for planning to meet future
needs for day programming (when individuals exit the schools' Special Education classes) or
residential placement (when individuals can no longer be cared for by their natural families).
B. Description of Services Provided
State inpatient/residential
All other residential
Supported independence
Other day program
Clinic services
Emergency services
Client services management
Family support/home based
Integrated employment services
Community integration services
Respite residential services
MORC, Inc
OCCMHSP maintains contracts for this service
OCCMHSP maintains contracts for this service
OCCMHSP maintains contracts for this service
OCCMHSP services to persons with
developmental disabilities
Common Ground, OCCMHSP services to
persons with developmental disabilities
OCCMHSP services to persons with
developmental disabilities
OCCMHSP services to persons with
developmental disabilities
OCCMHSP maintains contracts for this service
OCCMHSP services to persons with
developmental disabilities
OCCMHSP maintains contracts for this service
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff are social workers, psychologists, psychiatrists, nurses, occupational therapists,
behaviorists, and speech therapists. OCCMHSP has staff proficient in American Sign
Language, and is able to secure interprters for the hearing impaired whenever needed.
Because of the wide variety of services and their placement throughout the community,
OCCMHSP participates in a number of collaborative bodies that attempt to coordinate services
whenever appropriate.
D. Program Goals
Although there may be unique goals for special programs, the overarching goals for this area
are:
to achieve high client satisfaction with services;
B. Description of Services Provided
Local (community) inpatient
alternatives
State inpatient/residential
All other residential
Other day program
Clinic services
Emergency services
Client services management
Family support/home based
Respite residential services
OAKLAND COUNTY CMHSP • PAGE 16
to improveme and/or maintain stability in a consumer's residential status; and
to improve the quality of life of individuals served.
Clinical/Client Services - El/DD Children Services
A. Description of the Client Population or Administrative Function
OCCMHSP serves a broad population of children, adolescents, and their families. A broad
spectrum of DSM-IV diagnostic categories is covered. The first includes those with Acute
Emotional Disturbance such as Adjustment Disorders, Neurotic Disorders, and Acute
Emotional Reactions to Stress. Generally this client population is made of up of those with
GAF scores of 60 or less. The second group includes those clients with Sustained Emotional
Disturbance. This population includes clients with such problems as Neurotic Disorders,
Sexual Deviations, Psychological Based Disorders, Depressive Disorders, Conduct Disorders,
Affective Disorders, and Thought Disorders. This group includes clients with GAF scores of 60
or less. The third group of clients served are those who are considered to be At Risk of
Emotional Disturbance. This population includes those with psycho/social/biological
predispositions to Acute or Sustained Emotional Disorders, e.g. post-adoption syndrome,
sexual or other physical abuse and neglect, alcoholism, drug abuse, disturbed situations in
family or school.
Priority of service distribution is given to those who present greater acuity and severity of
problems, chronicity, and circumstances that are likely to lead to quick and substantial levels
of functioning. This includes individuals who are at risk of such things as adoption disruption,
school dismissal, expulsion from home, and legal problems.
OCCMHSP maintains contracts with local
community hospitals for this servicd
Recent transfer of Fairlawn residential
OCCMHSP maintains contracts for this service
Child and Adolescent Day Treatment Program
North Oakland Family Mental Health Services
and South Oakland Family Mental Health
Services
Common Ground
North Oakland Family Mental Health Services
and South Oakland Family Mental Health
Services
North Oakland Family Mental Health Services
and South Oakland Family Mental Health
Services
OCCMHSP has contracts with local providers
for this service
OAKLAND COUNTY CIANSP - PAGE 17
Prevention - Direct service
models
North Oakland Family Mental Health Services
and South Oakland Family Mental Health
Services
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff are social workers, psychologists, psychiatrists, and infant mental health specialists.
Othet staff have been trained in the "wraparound" service delivery model. OCCMHSP has
staff proficient in American Sign Language, and is able to secure interprters for the hearing
impaired whenever needed. Because of the wide variety of services and their Placement
throughout the community, OCCMHSP participates in a number of collaborative bodies that
attempt to coordinate services whenever appropriate.
D. Program Goals
The overarching goals for this area are:
to achieve high client satisfaction with services;
to improve and/or maintain stability in a consumer's residential status; and
to improve and/or maintain stability in a consumer's functioning (measured by the Child and
Adolescent Functioning Scale); and
to increase the community tenure (i.e., reduce hospitalization) of a consumer.
Clinical/Client Services - El Centro La Familia
A. Description of the Client Population or Administrative Function
This program provides ethnic sensitive services mental health services to the Hispanic
population. In addition, they provide educational seminars and support groups conducted in
Spanish to increase community knowledge and awareness about mental health.
B. Description of Services Provided
Clinic services, client services management
C. Special Staff/Outreach Capacity and Interagency Coordination
Staff are bi-lingual and bi-cultural. They maintain close working ties with Hispanic community
service programs.
D. Program Goals
The goals of this program are:
to improvement and/or maintain stability in a consumer's residential status;
to improve the vocational status of a consumer;
to improve and/or maintain stability in a consumer's functioning (GAF)
to increase the community tenure (i.e., reduce hospitalization) of a consumer;
to secure eligible entitlements for a consumer and/or help achieve increased income
to achieve high client satisfaction with services; and
to improve the symptomatic functioning of a consumer.
OAKLAND COUNTY CMHSP • PAGE 18
Clinical/Client Services - Correctional Activities
A. Description of the Client Population or Administrative Function
These activities are structured to provide quality clinical (therapy, psychopharmacology and
case management) services to mentally ill offenders in the Oakland County Jail and ex-
offenders in the community. In this way it is expected that the high recidivism of the mentally
ill in jails and prisons will be reduced and that their overall level of functioning will be improved.
B. Description of Services Provided
Clinic Services, Client Services Management
C. Special Staff/Outreach Capacity and Interagency Coordination
In the Oakland County Jail the coordination is between Inmate Services (Jail Staff), the Health
Clinic (Oakland County Health Department), the Sheriff's deputies, Common Ground (crises
services and approval for hospitalization) and the Oakland County Client Services
Management Agencies. This coordination is to facilitate communication between multiple
services by different agencies so that the gamut of services are appropriate to client need.
This coordination is also necessary to facilitate and insure that proper follow-up services are
arranged.
In the community based program the coordination includes all jails and prisons with Oakland
County residents, Community Corrections, the Oakland County Office of Substance Abuse,
Eastwood Clinics:Royal Oak, the Counseling Center, Common Ground and all Oakland
County Client Services Management Agencies.
D. Program Goals
In the Oakland County Jail the program goals are:
to improve and/or maintain the stability in a consumer's functioning (GAF); and
to improve symptomatic functioning
In Community Based Services the goals are:
to improvement and/or maintain stability in a consumer's residential status;
to improve the vocational status of a consumer;
to improve and/or maintain stability in a consumer's functioning (GAF)
to increase the community tenure (i.e., reduce hospitalization) of a consumer;
to secure eligible entitlements for a consumer and/or help achieve increased income
to achieve high client satisfaction with services; and
to improve the symptomatic functioning of a consumer.
Community Education/Administrative Support
A. Description of the Client Population or Administrative Function
This is a proposed position and job specifications have not yet been finalized
V.
OAKLAND COUNTY CMHSP • PAGE 19
B. Description of Services Provided 1 ) This is a proposed position and job specifications have not yet been finalized
C. Special Staff/Outreach Capacity and Interagency Coordination
This is a proposed position and job specifications have not yet been finalized
D. Program Goals
This is a proposed position and job specifications have not yet been finalized
)
OAKLAND COUNTY CMHSP - PAGE 20
) ASSESSMENT OF CURRENT CLIENT NEED
)
ASSESSMENT OF CURRENT CUENT NEED SUMMARY
CLIENTND.WPD
CLIENT GROUP Adults with Mental Illness
CMHSP Oakland County
OAKLAND COUNTY CMHSP - PAGE 21
—,
Number of cases which
are partially served— Number of
different, additional cases which would benefit from receiving
Number Underserved service recommended services in a different
FY 96 Additional Amount of indicate
PROGRAM Expected Same Service Recommended Current Recommended ELEMENT Cases Served Required Service Program Service Program Service Program
,
INPATIENT
Local 781
State 252 _
OUTPATIENT
Emergency Services 1,917
Clinic Services 5,916 160 20 _
DAY PROGRAM .
Partial Hospitalization -.,..
Psychosocial Rehabilitation 184 50 _______
Other
RESIDENTIAL
CMHSP managed
State or other CMHSP managed 327
Crisis Residential 44
Residential-all other 49 311
Supported Independence 42 _
SUPPORTIVE SERVICES i
Assertive Community Treatment 355 76
Crises Stabilization Team
Comm. Treatment Team—CTT
Client Services Management 2,513 56 _
Family Support/Home Based Services
Integrated Employment
Community Integrated Services 288 50
Respite Services 44
PREVENTION
Direct Service
Other
TOTAL ALL ABOVE Rows 12,712 260 311 76 76
ATTACH COMMENTS OR OTHER EXPLANATORY INFORMATION ON A CLEARLY LABELED, SEPARATE PAGE.
OAKLAND COUNTY CMHSP - PAGE 22
ASSESSMENT OF CURRENT CLIENT NEED FOR ADULTS WITH MENTAL ILLNESS -
NARRATIVE
OCCMHSP has begun implementation on a new service delivery system. It has reorganized its
administrative system to promote better management of resources and services. This reorganization
included a centralized intake and admission/screening function, emphasized improved data collection
and utilization through a total quality improvement philosophy, added a much needed program
development and contract oversight function, and lastly, created a housing development function.
Current client need was assessed by conducting a survey of Board and contract staff and requiring
them to reexamine the needs of consumers served. This data was aggregated and reviewed by
administrative staff to be compiled for the present narrative.
Clinic Services
Board and contract staff have identified an increased request for this type of service.
Approximately 160 persons have been identified who would benefit from enhanced individual
therapy, medication reviews, and other treatment services in this area.
Day Program
Several years ago OCCMHSP converted the programs providing day treatment to the clubhouse
model of a work ordered day. Presently, there are three clubhouses in the county although they do
not cover the geography of the entire County. One is in the city of Pontiac and two are in the
southern quadrant of the county. Efforts in the last year resulted in three of the two programs being
enrolled in the Medicaid Rehabilitation Option for Psychosocial Rehabilitation Centers. However,
theTe remains a significant, unmet need in the west and most northern quadrant of th&county for
like programs.
Residential Services
OCCMHSP is acutely aware of the various and unique residential demands of the community.
Public Testimony has identified needs for increased housing development and a continuum of
housing options. During the past fiscal year, OCCMHSP sampled approximately 11% of its
consumers to identify housing preference. Over 50% reported that they would benefit, clinically,
from moving to a new, safer residence. A variety of housing situations was identified: 56% desired
independent living, 19% wanted group homes, 15% preferred supported independent settings, 6%
wished to remain with their families, and 3% had no preference. OCCMHSP staff supported the
results of this survey after careful clinical review. Extrapolating these percentages to other
consumers, 272 could benefit from a group home or supported independence placements. Since
40.7% (1482) of consumers served report less than $5,000 a year for income, this limits the type
and variety of housing situations available. OCCMHSP completed the "Expected Cases Served"
section of the form by adding current data with that based on the projected transfer of
MORC/Community Residential Services
OAKLAND COUNTY CNINSP - PAGE 23
) Geriatric Mental Health Services, a community outreach program that formally served the elderly
with mental illness prior to the reorganization, indicated that many still require specialized and type
A services for a number of persons they currently service. They require Type A residential
placements for 24 persons and Specialized Type B homes for 15 additional persons.
Assertive Community Treatment
There are six Assertive Community Treatment (ACT) teams in the county serving 241 persons.
Another 76 individuals have been identified who could use this service. Fifty-six (56) are currently
underserved in client services management. Another 20 have been identified through OCCMHSP's
Corrections Services. These are individuals with serious mental illness, who, after being released
from jail, do not follow through on treatment recommendations and end up being hospitalized or re-
incarcerated.
Community Integration Services
There also exists a need to begin a drop-in center for adults with serious mental illness in the very
most southern area of the county. The goal would be to seek out and develop consumer
leadership for this effort, find a suitable site, and begin start-up operations for 25 people by the
fourth quarter of FY 95-96.
ASSESSMENT OF CURRENT CLIENT NEED SUMMARY
CLIENTND.WPD
CLIENT GROUP Children with Serious Emotional Disturbance
CMHSP Oakland County
OAKLAND COUNTY CMHSP - PAGE 24
Number of cases which
are partially served— Number of
different additional cases which would benefit from receiving
Number Underserved service recommended services in a different proim
FY 96 Additional Amount of
PROGRAM Expected Same Service Indicate
ELEMENT Cases Served Required Recommended Current RecommProgramended Service Program Service Program Service
INPATIENT ,
Local 130
State 14 _
OUTPATIENT
Emergency Services 220
Clinic Services 865 (80) _
DAY PROGRAM
Partial Hospitalization 10
Psychosocial Rehabilitation
Other
RESIDENTIAL
CMHSP managed —
State or other CMHSP managed 37
Crisis Residential
Residential-all other 29 10 ,
Supported Independence 10
SUPPORTIVE SERVICES
Assertive Community Treatment .. .,„ 10 r
Crises Stabilization Team
Comm. Treatment Team—CTT 11 30
Client Services Management 560 . —
Family Support/Home Based Services 191 20
Integrated Employment
Community Integrated Services
Respite Services 41 _ 135 200
PREVENTION
Direct SWAP)
Other
TOTAL ALL ABOVE ROWS 1 2,098 I 145 I 200 1 (80) I 80
ATTACH COMMENTS OR OTHER EXPLANATORY INFORMATION ON A CLEARLY LABELED, SEPARATE PAGE.
ASSESSMENT OF CURRENT CLIENT NEED FOR CHILDREN WITH
OAKLAND COUNTY CMHSP - PAGE 25
SERIOUS EMOTIONAL DISTURBANCE - NARRATIVE
Current client need was assessed by conducting a survey of staff members of the OCCMHSP's
family mental health services and requiring them to reexamine the needs of consumers served. This
data was aggregated and reviewed by administrative staff to be compiled for the present narrative.
Day Program
OCCMHSP has addressed family needs with a broad array of alternatives to inpatient care in the
state facility. One component of service is the array of private hospital contracts that have been
developed for both inpatient (24 hour) and partial day treatment. There are 10 present consumers
who can benefit from partial day treatment, in a hospital setting, as an additional, different service
from that which they are presently getting.
Residential
There are currently 42 Oakland County children and adolescents in residential care served by State
facilities. The Board is directly providing residential services to an additional 6 children. The low
number of OCCMHSP residential placements for emotionally disturbed children and adolescents is
due to the fact that such services have historically been provided as a post-hospital plan for
children and adolescents exiting the state facility. Heretofore, direct placement of children and
adolescents into residential care has been minimally funded by the DMH. Treatment foster care,
group residential treatment facility placements, or other residential services are necessary for 10
consumers who require this service as a more intensive form of intervention than outpatient service.
Supported Independence Placements (SIP) are necessary for 10 consumer's Who require this form
of intervention as a more intensive service than their current outpatient intervention. These
consumers are youth who are not ready to be fully emancipated and require supervision while they
complete their high school education, work part time and attempt to maintain their emotional
adjustment outside of the family home. These are adolescents who are no longer able to reside
within their family environment, but have the functional skills for living in a semi-independent
situation.
Assertive Community Treatment
There are presently 10 consumers served in traditional outpatient methods who require service
under an Assertive Community Treatment model as a more intensive form of intervention. These
are children and adolescents who may not otherwise be adequately served through either a home-
based, school-based, or wraparound method of intervention.
,)
OAKLAND COUNTY CAAMSP - PAGE 26
Community Treatment Team
There are presently 16 consumers who are served through the wraparound method of intervention
utilizing a client and family empowering team of professionals and lay persons including relatives
and friends, to assist consumers in encountering a broad array of individual and family issues.
There are 30 additional consumers who can benefit from this form of service as a more intensive
form of intervention than outpatient services.
Family Support/Home Based Services
There are 20 outpatient families who would be more adequately served through home based
services as a shift to a more intensive form of service delivery.
Respite Services
Currently 135 children and their families receive some form of respite services provided by the
Board. These families would benefit from additional respite service. In addition 200 current cases
receive no respite and would benefit from respite as a different, additional service.
OAKLAND COUNTY CMHSP - PAGE 27
ASSESSMENT OF CURRENT CLIENT NEED SUMMARY
CLIENTNO.WPD
CMHSP gakiand County
CLIENT GROUP Persons with develoornentel disebilities
A
Number of cases
which are partially Number of
served—different, cases which would beneet from receiving
Number Undorserved additional service services in a different program
recommended
FY 96 Additional Amount
PROGRAM Expected of Same Service indicate
ELEMENT Cases Served Required Recommended Current Recommended
Service Program Service Program Service Program
INPATIENT
Local
State 35
OUTPATIENT
Emergency Services
Clinic Services 1,190 _
DAY PROGRAM
Partial Hospitalization
—,
Psychosocial Rehabilitation
—
Other 578
RESIDENTIAL
CMHSP managed
State or other CMHSP managed 1,213
Crisis Residential
Residential-all other 132 800
r
–Supported Independence 25 .
SUPPORTIVE SERVICES
Assertive Community Treatment
Crises Stabilization Team
Comm. Treatment Team–CTT
Client Services Management 437 800
Family Support/Home Based Services 104
Integrated Employment
Community Integrated Services
Respite Services 988 100 _
PREVENTION
Direct Service ,
Other
TOTAL ALL ABOVE ROWS I 4,702 I 0 i 1 ,7021 0 1 0
ATTACH COMMENTS OR OTHER EXPLANATORY INFORMATION ON A CLEARLY LABELED, SEPARATE PAGE.
OAKLAND COUNTY CMHSP - PAGE 28
ASSESSMENT OF CURRENT CLIENT NEED FOR PERSONS WITH DEVELOPMENTAL
DISABILITIES - NARRATIVE
Current client need was assessed by conducting a survey of staff members of OCCMHSP's services
for persons with developmental disabilities and requiring them to reexamine the needs of consumers
served. This data was aggregated and reviewed by administrative staff to be compiled for the
present narrative.
Day Program
Currently, 539 individuals participate in OCCMH's options for day programs. The need to expand
upon options in this area are strongly felt by individuals with severe physical and cognitive
disabilities. Often times these consumers are living at home with family that can continue to provide
for their care if options for day activity are able to be met. There are 386 persons, age 26 and over,
being served awaiting day program options which may include supported employment. These
consumers desperately need opportunities to experience personal growth in terms of functional and
social skill development.
) Residential
Long-term residential alternatives represent the most difficult area of service to families.
OCCMHSP has had a limited role in the development of residential beds, over the years due to
budget issues. Much remains to be done in residential development in the coming years. The
intake unit for this pobalation has, throughout this year, gradually been reassessing consumers in
order to get a more actuate picture of individual needs. They found that some consumers who
asked to be placed on the list were not, as yet, ready for residential assistance. As a result of this
effort, 786 consumers were identified as ready for residential placement. The transfer of
responsibility of over 1200 lives to OCCMHSP with the anticipated MORC, Inc. contract will also
require further needs assessment.
Client Services Management
There are 800 consumers who are partially served in a variety of programs that need the additional
service of client services management. They are primarily being served through respite services.
Respite Services
The need for temporary relief from the rigors of caring for a family member who is developmentally
disabled and living at home, is the number-one request of families. OCCMHSP currently serves
over 1000 respite consumers. Aside from in home respite, the service next requested by families is
)
N.
OAKLAND COUNTY CMHSP • PAGE 29
that of out-of-home respite. There are 91 consumers being served elsewhere in this system that
could benefit from out-of-home respite.
)
OAKLAND COUNTY CMHSP • PAGE 30
) ASSESSMENT OF COMMUNITY NEEDS NARRATIVE
OAKLAND COUNTY CMHSP - PAGE 31
METHODOLOGY AND GENERAL DISCUSSION
This section deals with measuring community need for public mental health services. The sources of
information regarding these groups of people come from OCCMH's database on current users of
services, opinions of OCCMHSP staff, data from program waiting lists, and public testimony. A
primary source of need information is OCCMH's database on current users. With the database,
trends can be analyzed and results can be compared to expected information gathered from the
census information.
The database reveals that Oakland County has a very diverse population with wide differences in
social and economic characteristics among the various geographical areas. The availability of
community resources and human services varies greatly, although these differences are not always
apparent. Examining the mental health needs of this population involved detailed analyses of a
number of factors including poverty levels, age, race, marital status, educational attainment,
non-family households, female heads of household, and children not in two-parent families — many of
which have been used to estimate prevalence of emotional disorders in the Epidemiologic Catchment
Area Study (Regier and Burke, 1987).
In the absence of house-to-house studies of incidents of emotional disorders, OCCMHSP has relied
upon surveys of consumers and reasonable speculations as a source of community needs
information. The most recent preliminary findings of the Epidemiologic Catchment Area Study
(Regier and Burke, 1987) report a greater prevalence of emotional disorders which meet DSM-IV
criteria than was originally assumed. OCCMHSP assumes that the prevalence of diagnosable
disorders suffered at some time during one's lifetime would range between 28 and 38 percent of the
population.
It is also important to note that the presence of State inpatient facilities in Oakland County contributes
to an increase in the prevalence of emotional disorders. This is due, in part, to the large number of
patients served because of a wide catchment area and that discharged patients tend choose housing
in the community nearest the Hospital.
In order to improve its needs assessment process, OCCMHSP is completing work on a central
admission/screening unit that will be a "clearing house" for all requests for mental health services
from the community. This unit will keep a central waiting list, provide face-to-face and phone
assessments, and link individuals to appropriate service providers.
Special consideration has been given to assessing the needs of children, adolescents, and their
families. Past practice estimated the need based on waiting list information and feed back from
advocacy groups. However, this year, OCCMHSP contacted each person on OCCMH's waiting list
for Child and Adolescent Services either by phone or letter and catalogued the specific services they
were seeking. This effort revealed that families are looking for much more than outpatient therapy
and that, if available, other services would be very desirable and is discussed in detail in the
Community Demand section for services to children with emotional disturbances.
)
OAKLAND COUNTY CMHSP - PAGE 32
OCCMHSP is also aware that there are a number of children that have not yet applied for services
and that its current waiting list may be an undercount of those in need of services. For example,
there are children obtaining assistance from the Oakland County Family Independence Agency (FIA)
(in various programs including foster care and delinquency) who are not receiving mental health
services. FIA refers children to OCCMHSP only if there is clearly expressed mental health need.
OCCMHSP also refers out families who have private insurance to private service providers.
As another important source of information, OCCMHSP used the forum of public hearings to gather
broader information on community need. Testimony was gathered from Oakland County citizens on
June 27 - June 29, 1995 Several themes were evident throughout the hearings. One theme is that
consumers and stakeholders would like an expanded role to participate in general service design in
addition to their own individual treatment planning process. Next, flexible and dependable respite
care was voiced as being essential for families who are caring for the sons and daughters with
disabilities. Finally, it was clear that the community wanted OCCMHSP to continue its efforts at
changing the way in which it provides services so that they are "user friendly" and sensitive to varying
and unique individual needs.
The comments ranged from being complimentary to critical of OCCMH. By far the greatest concern
to the community was the shift of funding for Community Supported Living Arrangements to a
potentially restrictive Medicaid Waiver program. Consumers and their families feared the loss of
flexible community supports in this change, and asked for assurance that this type of service could
continue in some format.
The next major area of public comment was residential services. Development of more residential
programs to create a continuum of placements was noted. Also desired are continued support of
existing residential programs, more flexibility for residential service providers, and enhancement of
staff wages to maintain reliable and dedicated caregivers.
Family and children's issues regardless of population area, (i.e., persons with developmental
disabilities and children with serious emotional disturbance) were the next most frequently
mentioned. Families requested increased in-home types of services, development of infant mental
health service ( which currently exists in both OCCMHSP family mental health programs), support for
"early on" prevention services, and increased respite care.
The following issues were individually identified by the public and are listed (without assigned
priority):
• Continuation of Psychosocial Rehabilitation Programs (e.g., Clubhouse);
• Request for OCCMHSP to participate on the Oakland Transition Council;
• Develop capacity to serve persons with dual diagnosis (i.e., mental illness and substance
abuse; and mental illness and developmental disabilities);
• Participate in the development and continuation of a Coordinated Community Planning project;
• Address transportation needs for all populations;
• Improve the quality of waiting list information to ensure fair treatment of those requesting
services;
• Improve perceived poor communication of OCCMHSP with RICC;
ViD
OAKLAND COUNTY CMHSP • PAGE 33
• Request for support for the SXI population (54 persons have been identified who are between
the ages of 21 and 25 years old);
• Increased capacity to provide psychotherapy;
• Increase funding for contracts;
• Provide programs that are less vocationally and more socially oriented to persons with severe
and persistent mental illness who may not have vocational interests;
• Expand vocational opportunities with greater individualization of services;
• Look for ways to provide assistance to individuals in the community who are taking care of the
majority of their mental health needs to enable them to remain in the community and not in a
publicly funded placement;
• Closer monitoring of community hospitals, state facilities, and crisis services;
• Ensure accessibility and equality of mental health services for deaf persons; and
• Request for support services for persons with developmental disabilities who are "aging out" of
public schools.
,)
No. of Persons
in the Catchment
Area Meeting the
Sub-population
Criteria
Column A
48
75
354
553
35
96
240
19
50
131
571
626
819
82
100
60
35
1,722
2,846
80
75
60
135
40
100
240
19
50
131
580
626
100
82
100
60
35
1,003
2,166
2,888
1,000
1,692
ZAU
1,444
3,466
400
8,246
1,819
23,471
346
11,180
21,150
2,888
33,271
170
3,852
72,511
we.
Estimated Cost
Per Person
(Maximum
Matchable)
to be Served
Column C
Estimated Total
Cost to Meet
Service Need
Column D
103,968
231,040
75,000
101,526
511.534
57,760
346,600
96,000
156,674
90,950
3,074,701
3.822.685
6,998,680
2,115,000
236,816
3,327,100
10,200
134,820
12,822,616
OAKLAND COUNTY CMHSP PAGE 34
ASSESSMENT OF COMMUNITY NEED - 1996 SUBMISSION
COMMNEED.WPD
Enter Sub-population:
ADULTS WITH MENTAL ILLNESS
1. Client Services Management Waiting List
2. Outpatient Waiting List
3. Consumer Run Drop-In Program
4. African American Family Center
SUB-TOTAL FOR ADULTS WITH MENTAL ILLNESS
CHILDREN WITH MENTAL ILLNESS
1. Case management Waiting List
2. Request for Outpatient Therapy
3. In-Home Respite
4. Out-of-home Respite
5. Recreational Respite
6. Bridge Program
SUB-TOTAL FOR CHILDREN WITH MENTAL ILLNESS
PERSONS WITH DEVELOPMENTAL DISABILITIES
1. Day Program Waiting List
2. Residential Waiting List
3. Case Management Waiting List
4. Respite Home for Adults with Physical Challenges
5. Respite and Recreation Services
6. Parent Trainer Services
SUB-TOTAL FOR PERSONS WITH DEVELOPMENTAL
DISABILITIES
GRAND TOTAL
CMHSP Oakland County
No. of Persons the
CMHSP Would
Propose to Serve
with Fully
Operational
Programs
Column B
1,718 I 114.049 1 17.156.1135
OAKLAND COUNTY CMHSP • PAGE 35
ADULTS WITH MENTAL ILLNESS
1. Client Services Management Waiting List - There are 48 individuals waiting for case management
services. One (1) case manager would be needed to eliminate this list.
2. Outpatient Waiting List - In order to eliminate this wait, 2 clinicians are need to be added to
existing staffing patterns.
3. Friends Assisting in Recovery (FAIR) South - Since 1989 there has been a growing demand in
southern Oakland County for a consumer-run drop-in center like the FAIR Program in Pontiac.
The demand has come from advocacy groups, consumers, mental health clinicians and case
managers. FAIR is dedicated to the ideal of mutual support for persons suffering or recovering
from emotional or mental illness problems. The success of the program in Pontiac has only
increased the demand for the program in Southern Oakland County. OCCMHSP estimates that
75 persons could be served through the development of this consumer-run drop-in center.
4. African-American Family Center - Census data indicate that 7.2% of Oakland County's population
is African-American; yet this group represents 14% of the persons served by OCCMH. African-
Americans in the County have substantially higher rates of poverty and family disruption than
Whites. Sheldon (1988) projected that psychoses for this group would occur at the rate of 1.7 per
100, or 1318. If the number of African-American individuals with serious mental illness that
OCCMHSP served (964) is subtracted from this figure, then there are an estimated 354
individuals who are unserved. However she noted that this broad estimate does indicate the
magnitude of need that is compounded by poverty and other community factors. Therefore,.it is
clear that an African-American Family Center would be very useful in addressing the pressing
mental health needs of this group. The goal of this program is to provide an ethnic sensitive
service to psychiatrically impaired African-American families wha are at risk of becoming more
dysfunctional and end up in out-of-home placements such as foster care and inpatient psychiatric
hospitalization. It is expected that as a result of these interventions there will be a reduced
incidence of family unit separations in out-of-home placements, and a reduction in
rehospitalizations and length of stay.
OAKLAND COUNTY CMHSP - PAGE 36
CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE
1. Case Management Waiting List - In order to eliminate the waiting list for case management of 35
persons, 1 case manager needs to be added to existing staffing patterns.
2. Request for Outpatient Therapy - In order to meet the demand of 96 seeking services, two full
time mental health clinicians would need to be hired.
3. In-Home Respite - Families Who Need Respite Services - When asked, virtually every family
indicated that a break from the rigors of raising a challenging child would be a welcome relief.
This demand comes from both those on currently opened and on waiting list. As such it is
estimated that all 131 families on the waiting list are in need of some level of in-home respite
services. This pertains in particular to families with severe ADHD children, children with
emotional disturbance associated with other handicapping conditions, and emotionally disturbed
children in foster care and adoptive family settings where a failure to resolve problems may
jeopardize the opportunity for remaining within a family setting.
4. Out-of-home Respite - Nineteen (19) families specifically identified the need for regular, longer
out-of-home respite care (up to two months per year).
5. Recreational Respite - A total of 50 families indicated that enrollment in the Boards Recreational
Respite program was a service from which both they and their emotionally challenged child could
benefit.
6. "Bridge" Program - A "bridge" program is required that will train older adolescents and youn
adults in the life skills necessary to enable them to cope with daily life demands and, ultimately,
enable them to move into independent and semi-independent living. Anpther group in need of
this type of program are those children currently in State residential placements whd have
reached the age of eighteen and who no longer are eligible for services as children but need
additional preparation and training to make a successful transition to independent adulthood.
There are currently 6 such cases. To serve the 131 adolescents identified, in addition to the
program costs, four (4) clinical/case management FTE's plus support staff are required to meet
this need.
OAKLAND COUNTY CMHSP - PAGE 37
PERSONS WITH DEVELOPMENTAL DISABILITIES
1. Day Program Waiting List - Day Program continues to be a major request of the community.
This is true for those already graduated out of mandatory education and persons planning for the
future. The need to expand upon the funding for this service is essential to assisting consumers
to continue to live within the community and increase independence. There are 626 adults with
developmental disabilities who are on the waiting list for this service.
2. Residential Waiting List - The requests for this support from the community is overwhelming. The
range of requests covers the full spectrum from traditional options to those more unique such as
"home of your own." OCCMHSP has been working with the Macomb-Oakland Regional Center
(MORC) to address consumers in emergent situations as well as engage in some new activities
using their development capacity and OCCMHSP funding. OCCMHSP has begun to assist
consumers in the transition from group homes to SIP's. For many this is quite difficult due to the
level of comfort associated with the group environment which they are leaving. Three new
programs have been funded that mirror the CSLA framework have been implemented and
currently serve 34 consumers. Of these, many are working toward establishing their own
residences in the community. In almost every circumstance these consumers came from the
waiting list and not the current residential system. However, with residential support, time is of
the essence. Therefore a dramatic number of consumers on this list must be served in order to
make an impact on the daily growth of demand.
3. Case Management Waiting List - In order to eliminate the waiting list for case management,
currently at 82, approximately two case managers need to be added to current staffing patterns.
4. Respite Home for Adults with Physical Challenges - One of the most utilized and requested
service is that of respite. Each year this service receives continuous growth. It crosses all ages
and levels of disability. Expansion is essential as this service in its varied forms. Inf-home, out-
of-home, respite and recreation programs, camps provides the necessary break that oftentimes
stabilizes the home. OCCMHSP operates one adult respite home. However, the need to
establish additional homes is necessary to serve consumers that are more physically involved.
Each of these homes must incorporate the capacity to set aside beds for emergency support.
OCCMHSP has been able to provide special funding that has eliminated the respite waiting list
until the end of this fiscal year. At that time additional funds will be necessary to support the
strong community demand for this service. An additional six bed respite home could serve 100
consumers.
5. Respite and Recreation Services - OCCMHSP operates an after school and week-end program,
in cooperation with the intermediate school district, that networks and collaborates with other
community service providers. It serves consumers with developmental disabilities under the age
of 26. There are 60 families whose sons and daughters are "aging out" of this support who wish
to continue this program, but for whom no alternatives exist.
6. Parent Trainer Services - This service has been quite successful in both its ability to remediate
difficult behavioral challenges within the consumers home and teach alternative methods from a
V.
OAKLAND COUNTY CMHSP • PAGE 38
positive perspective to the parents or family. The key to this service is its individualized
approach and its community implementation. This service requires the least amount of
intervention from a professional staff perspective and in many cases can eliminate both the need
for continuing agency involvement and residential placement. For the last several years
OCCMHSP was unable to bring this service back due to budget cuts. Last year a short term
program served 10 families. The goal would be to serve at least 35 families a year. It is
important to note in most cases this service runs for a period of 9 months.
)
OAKLAND COUNTY CMHSP - PAGE 39
REFERENCES
Altschuid, J. W., Yoon, J. S., and Cullen, C. (1993). The utilization of needs assessment results.
Evaluation and Program Planning, 16, 279-285.
Anthony, W. A. and Blanch, A. (1987). Supported employment for persons who are psychiatrically
disabled: An historical and conceptual perspective. Psychosocial Rehabilitation Journal, 11, 5-23.
Bickman, L. (1996). A continuum of care: More is not always better. American Psychologist, 5.1,
689-701.
Cummings, Fred A. (August 4, 1987). An assessment of the Oakland County CMH case
Management program (based on the training materials). Unpublished manuscript, Oakland County
Community Mental Health Services, Pontiac, Michigan.
Goldsmith, H. F., Manderscheid, R. W., Henderson, M. J., Sacks, A. J. (1993). Projections of
inpatient admissions to specialty mental health organizations: 1990 to 2010. Hospital and
Community Psychiatry, 44, 478-483.
Jarjoura, D., McCord, G., Holzer, C. E., Campney, T. F. (1993). Synthetic estimation of the
distribution of mentally disabled adults for allocations to Ohio's Mental Health Board areas.
) Evaluation and Program Planning, 16, 305-313.
National Center for Health Statistics (1970). Selected symptoms of psychological distress. Vital and
Health Statistics, Series 11, #37, Rockville, Maryland: Department of Health, Education, and Welfare.
Redick, R. W., VVitkin, M. J., Atay, J. E., and Manderscheid, R. W. (1994). Data highlights on:
Availability of psychiatric beds, United States: Selected years, 1970-1990. Mental Health Statistical
Note 213. Rockville, Maryland: Department of Health and Human Services.
Regier, Darrel A., and Burke, Jack D. (1987). Psychiatric disorders in the community: The
epidemiologic catchment area study. In Hales, Robert E. and Frances, Allen J., (Eds.), American
Psychiatric Association Annual Review, Vol. 6, pp. 610-624. Washington, D.C.: American Psychiatric
Press, Inc.
Russert, M. G. and Frey, J. L. (1991). The PACT vocational model: A step into the future.
Psychosocial Rehabilitation Journal, 14, 7-18.
Sheldon, Ann W. (1987). Oakland County census-based information for program development and
evaluation purposes (report). Center for Urban Studies, Wayne State University, Detroit, Michigan.
Sheldon, Ann W. (1988). Meeting mental health needs in Oakland County, Michigan: Population and
community characteristics. Center for Urban Studies, Wayne State University, Detroit, Michigan.
Sheldon, Ann W. (1989). The minority population of Oakland County. Center for Urban Studies,
OAKLAND COUNTY CMHSP • PAGE 40
Strachen, A. (1987). Family intervention for the rehabilitation of schizophrenia: Toward protection
and coping. Schizophrenia Bulletin, 12(4), 678-698.
Strategic Planning Committee (1989). Report of the Strategic Planning Committee. Pontiac,
Michigan: Oakland County Community Mental Health Services.
Sue, Stanley (1988). Psychotherapeutic services for ethnic minorities: Two decades of research
findings. American Psychologist, 43(4), 301-308.
Technical Assistance Collaborative (1994). Oakland County Community Mental Health: Assessment
of Existing Operations and Recommendations for Full Management - Final Report. Boston, MA.
OAKLAND COUNTY CMHSP - PAGE 41
) PLANNING POLICY SUBMISSION REQUIREMENTS
OAKLAND COUNTY CMHSP • PAGE 42
MANAGING RISK
Oakland County Community Mental Health (OCCMHSP) supports the potential for the consolidation
of funding streams so that the dollars follow the client, not the program. However, we are
approaching the matter with caution as we have no information regarding how the capitation rate will
be determined. We would advocate for risk adjusted rates based upon the target population as well
as the level of service expected. Rates should not be based on those who have accessed service
because OCCMHSP's waiting list suggests that demand exceeded capacity and, therefore, it
continues to limit the capacity to respond to the behavioral health care needs of the population. In
other words, we encourage funding based upon the defined population to be served as well as the
benefits to be offered under the plan. The potential for a partnership with an established Managed
Care Organization (MCO) will require careful consideration so that the MCO understands and is
comfortable with our mission.
The target population needs to be defined. The biggest issue is who will be eligible for services and
what kinds of services will be required. Next, we will need to agree to a funding base. The funding
should be based on past utilization. The use of fiscal year 1996/97 could be used to measure cost
experience. Ideally, we would start with a fixed budget ceiling wherein the savings, if any, would be
shared with OCCMHSP. This would allow for flexibility in sharing risk and gaining experience in
managing risk.
The potential target population for capitation, as we currently understand it, is estimated to comprise
approximately 47,000 currently managed Medicaid lives, additional Medicaid enrollees not in
managed care at this time, and uninsured individuals meeting the mental health code defined priority
populations encompassing children with serious emotional disturbance, adults with serious mental
illness and developmentally disabled individuals. Given the size of Oakland County, the potential for
spreading risk can be optimized by a geographically based capitation rate. This will offer the
opportunity to remedy some of the inherent problems associated with adverse (cost) selection of
individuals with serious mental illness, serious emotional disturbance and the developmentally
disabled.
Oakland County has already positioned itself to deliver services to all individuals based upon
geographical distribution via our established quadrant arrangement for adults. The risk pool
mechanism that most fits this scheme, once all populations are integrated into this quadrant
arrangement, is establishing a risk reserve to cover catastrophic cases. This risk withhold should be
at least fifteen (15%) percent of the annualized capitation payment. This would offer incentives to
providers who would in turn be subcapitated. A risk-reward system could be established so that a
win-win situation is engendered and savings are reinvested in expanded services for the community.
Our providers' own ability to bear risk will need to be carefully evaluated. It is anticipated that our
Director will recommend to the OCCMHSP Board that a phase-in of risk be implemented with partial
risk for services at the outset. For example, inpatient costs may not be part of the subcapitation to
start with, but utilization targets would be set (e.g., 30 days per 1000 enrollees) in order to help
providers learn to manage care and risk.
Just as we need to partner with our providers, we need to work closely with our primary partner in this
endeavor, namely the Department of Community Health (DCH). The move to a managed care
OAKLAND COUNTY CMHSP - PAGE 43
system is a massive undertaking that will require support, cooperation and a large capital investment
for technology and staffing. We anticipate this partnership with the DCH will allow for a shared risk
until CMH is fully capable of managing that risk. Just as we would gradually bring our contract
providers into risk to gain experience, we would expect the same from the DCH.
Current information system capacity has the ability to break down service utilization patterns and cost
data for populations based on current DCH guidelines, but would need to be enhanced to more
appropriately model a managed care data system. A segmentation approach is being considered
wherein high cost utilizers, moderate cost utilizers and low cost utilizers are targeted for varying
levels of services to reduce costs. The ability to coordinate benefits is in place, but the opportunities
for cost shifting from public to private systems and vice versa is rapidly disappearing. We are
currently gaining more experience with this in our work with Medicaid Health Maintainance
Organizations (HMOs).
Oakland County has a competitive bid procedure in place that allows us to function as a prudent
purchaser of services on behalf of our consumers with a dedicated department that has
demonstrated the ability to negotiate and selectively contract with providers. We are currently
targeting significant change in our relationships with hospitals in order to move them into the
managed care arena and partner with us in providing acute care services. While still within a fee-for-
service environment, we are restructuring our relationships with an eye toward future capitation.
Acute care providers will be requested to assist with episode management of chronic illness. We are
considering a select panel that is readily accessible to consumers; provider selection and control is
essential to managing care.
OAKLAND COUNTY CMHEP - PAGE 44
MANAGING ACCESS AND DEMAND
A broad array of services is already in place in Oakland County. Acute crisis services are available.
Services that fall within a basic benefit package are in place with the exception of the need to expand
time-limited outpatient counseling for low to moderate service users to reduce demand for high cost
acute care. Expanding this within our current quadrant system of care with existing or additional
panel providers is under consideration at present.
Oakland County has implemented a user friendly gatekeeping system to manage access into acute
care as well as other level of service. We have successfully diverted many consumers into subacute
treatment thereby shifting care to less restrictive levels.
A wait list policy is under development to address access and demand management. It is
anticipated that it will be implemented by October 1, 1996. Under a capitation financing scheme it is
anticipated that we will be able to provide an even broader array of services so that only long term
residential availability will pose the most challenge in terms of access. A missing piece of the
continuum is longer term residential services for subacute care as a replacement model for longer
term inpatient care currently provided by state facilities.
A Managed Care Workgroup was formed last year. Its sole task is to prepare the organization to
meet the responsibilities of managed care A number of policies related to managed care are
currently being formulated and existing policies are undergoing revision. A level of care workgroup
that involves providers of services is expected to have severity of illness/intensity of service criteria in
place by October 1, 1996 to compliment the acute care levels provided by DCH. This will lead to the
development of critical pathways within the next year. These will dovetail with our existing
assessment protocols. These protocols will be refined over the next year as more experience is
gained and objective measurement tools are evaluated for use in screening.
1
Our Central Admission and Evaluation Unit is currently undergoing the transformation toi a central
diagnostic referral unit (CDR). It is in the process of expanding its hours of operation and offering
enhanced services either on an interim basis or to handle immediate short term issues for
consumers. One division of this unit is working toward evolving into a utilization management
function to provide coordinated care management for acute care (inpatient and partial hospitalization)
with ultimate goal of coordination of care across a seamless, readily accessible continuum within the
next twelve months.
The primary concern for Oakland County has always been that demand is highly elastic, while supply
has not been. Managing demand is contingent upon managing supply. We anticipate that the
savings generated by use of least restrictive (and costly) levels of care will be used to fund other
services and expand the continuum offered thereby expanding supply. Our biggest challenges are
affordable housing, specialized residential settings for unremitting episodes of illness, vocational
opportunities, and transportation resources.
OAKLAND COUNTY CMHSP • PAGE 45
MANAGING PERFORMANCE
Provider panel selection is key to managing care effectively and efficiently. While consumer choice
will be maintained, it will be limited to panel providers, a hallmark of managed care. Starting with our
upcoming contracts for acute care, a new paradigm is being put into place. Providers will be selected
based on cost, quality and access. Provider selection criteria will include accreditation by a nationally
accepted body in addition to credentialing, quality and utilization management
Outcome monitoring will entail tracking of treatment outcome at various intervals during treatment
and post discharge looking at psychiatric symptoms, psychosocial functioning, global assessment of
functioning and readmission. For substance abuse consumers, abstinence, recovery and relapse will
be assessed. Consumer feedback mechanisms have been put into place and implemented. Included
are outcome data utilizing standardized tools for measurement. We have been gathering data
related to client satisfaction, symptomatology and level of functioning. Currently in use are a client
satisfaction questionnaire, the BASIS - 32, 045.11, and the Client Satisfaction Questionnaire - 8
(by Attkisson).
The one major weakness that needs to be addressed is the lack of a management information
system with real-time availability that integrates clinical with financial information. At present data
capture entails an arduous task of gathering information and making manual comparisons. We
currently have the capacity to review claims through our Reimbursement and Contracts units. The
specifications for the software have been documented and we are seeking consultative assistance in
securing the system that most meets our needs.
Our success will hinge upon relevant data capture including the following:
• number of admissions by diagnostic category
• number of admissions for inpatient, partial, outpatient therapy, etc.
• inpatient days per 1000 enrollees
• admissions per 1000 covered lives
• average length of stay for inpatient, partial, residential, outpatient therapy services
• clinical/professional services rendered
• readmission rate
• appointment availability
• complaints and grievances by type, time for resolution and outcome
• percentage of cases sent for reconsideration review
Data tracking in real time is required to:
• track consumers through episodes of care in inpatient, partial, residential and outpatient
services
• maintain facility and provider specific data that should facilitate identifying more cost-
effective providers
• observe and manage trends in admissions, utilization indices, grievances/appeal issues
and provider performance against established indicators
Provider performance will be measured by:
• the number of consumers admitted to psychiatric facilities
OAKLAND COUNTY CMHSP - PAGE 46
• the number of inpatient, partial hospital and residential days, outpatient visits used
• the number of inpatient days per thousand, admissions per thousand
• benchmark data for comparison with other OCCMHSP systems
• number of reauthorizations/readmissions
• readmission rate per provider
• the number of turnaround cases
• the number of recidivist turned around cases
• average length of response telephone time and case manager time ,
• grievance rate, type of grievance and outcome type
• consumer satisfaction survey
• treatment outcomes
An integrated data base with quality and utilization matrices will be maintained and periodically
updated. Each provider will be assigned a score that signifies compliance with quality and utilization
measures. These will be based on the following: number of denials and reconsiderations, consumer
survey responses, number of incidents and complaints, provider rating average, relapse rate, results
of professional review and results of pattern-of-practice review. A utilization index will profile a
provider's practice with evaluation of such factors as current activity and types of consumers
routinely treated as well as comparison to length of stay norms.
A sophisticated information system is required for these tasks. It is anticipated that technical
assistance will need to purchased and that it will take about a year to a year and a half to accomplish.
MIS enhancements will be not only a time intensive endeavor, but a costly one as well. However, the
process is needs to be fully automated for improved efficiency.
A formal process for screening and credentialing practitioners and facilities considered for panel
network inclusion is under development. Individual and group practitioners will be asked to submit a
resume, license, proof of malpractice insurance, and a completed provider profile form delineating
education, training, licensure, malpractice history, board certification, areas of specialization, years of
relevant clinical experience, hours of availability, management of emergencies, etc. Facilities must
submit copies of their most recent JCAHO/CARF/AOA accreditation inspection, health and safety
inspections and current state license. They must also forward proof of malpractice insurance and a
completed provider profile form (to be developed).
OCCMHSP will conduct on-site reviews of facilities and certify them on a program specific basis so
that the clinical components are assessed individually. It is our intent to involve panels of providers
in the planning process, setting up the criteria for measuring quality, and in the oversight and
monitoring process, as well as and in the credentialing.
OAKLAND COUNTY CMHSP • PAGE 47
MANAGING INTERACTIONS WITH OTHER SERVICE PROVIDERS. CONSUMERS AND
STAKEHOLDERS
Collaboration with all stakeholders is essential to managing care. The danger of a carve-out for
behavioral care is lack of integration with the medical side thereby losing the opportunity to take
advantage of the medical offset. We have already put into place the policy of primary care
physician/provider contact for hospitalization and are expanding our policy to include outpatient care
as well.
Our current provider partnerships in service delivery are being expanded. For example, reducing the
high cost of recidivist hospitalization for certain consumers has entailed establishing linkages with the
Oakland County Office of Substance Abuse Services. We are collaborating on coordinating the
gatekeeping to ensure that dually disordered consumers, especially those with tendencies toward the
revolving door of rehospitalization, have alternatives. This just one example of the many instances of
collaboration with a public agency. Numerous examples of our public-private partnerships abound as
well.
All stakeholders should be made aware of the core managed care technologies applied to the
population including, but not limited to, level of care criteria, triage, recertification, concurrent review
and retrospective review. Oakland County has welcomed stakeholder input at Board and committee
meetings and will continue to do so. There is much public comment on a variety of issues and it is
anticipated that managed care will engender much discussion. Holding public hearings on managed
care is an additional option. .
Functions for provider services and member (enrollee) relations will need to be firmly established. A
grievance policy has been put into place and a provider appeal policy is under review. A second
opinion policy has recently been enacted. A number of other managed care related policies and
procedures are in process. .
OAKLAND COUNTY CMHSP - PAGE 48
AVAILABILITY OF PROGRAM ELEMENTS AND AVERAGE WAIT - NARRATIVE
OCCMHSP has a process that requires both directly operated and contractual agencies to submit
monthly waiting list reports. The "raw" data includes names, addresses, phone numbers, date of
initial contact, and the date that the individual was assigned to a service component. This
information is gathered in a LOTUS Tm spreadsheet format which calculates how many are waiting
and for how long. For like programs reporting a waiting list, the numbers of individuals waiting are
added and a "weighted average" is calculated for length of weight using the formula:
Rin+ntotel .
OCCMHSP plans to transfer the responsibility of the waiting listin FY97 to its new intake unit
(ACCESS) where it will be closely managed and modified to ensure that it meets criteria established
by the new mental health code. This will improve OCCMHSP's confidence in the waiting list data
AVAILABILITY OF PROGRAM ELEMENTS
AVERAGE WAIT FOR NON-EMERGENCY SERVICES
WAITIN.WPD
DUMP Oakland County
OAKLAND COUNTY CMHSP - PAGE 49
CLINT GROUP: Adults with mental illnese
Service Avail. Average Average
Cases Wait Time Period
Yes No Waiting in Weeks of Wait Covered Service
Community Inpatient X
. . ..
Outpatient - Clinic Services X 76 37 Period ending June 30,1996
Day Program Partial Hospitalization X -.. .
Psychosocial Rehabilitation X
Other X
Residential Specialized Residential XI
Semi-Independence X
-
Support Services Assertive Community Treatment X
Crises Stabilization Team X
Community Treatment Team X
Client Services Management X 48 11 Period ending June 30,1996
Family Support Services/ X
Home Based
Integrated Employment X . .
Community Integration X ,
Prevention Direct Service X
xl When the transfer of MORC/Community Residential Services is complete.
AVAILABILITY OF PROGRAM ELEMENTS
AVERAGE WAIT FOR NON-EMERGENCY SERVICES
WAITIN.WPD
CMHSP Oakland County
OAKLAND COUNTY CMHSP - PAGE 50
CLIENT GROUP: Children with emotional disturbance
Service Avail. Average Average
Cases Wait Time Period
Service Yes No Waiting in Weeks of Wait Covered
Community Inpatient X
Outpatient - Clinic Services x 96 24 Period ending June 30,1996
Day Program Partial Hospitalization X - .
Psychosocial Rehabilitation X -
Other X -
Residential Specialized Residential, X -
Semi-Independence X
Support Services Assertive Community Treatment X
Crises Stabilization Team X
Community Treatment Team X
Client Services Management X 35 11 Period ending June 30,1996
Family Support Services/ X
Home Based
Integrated Employment X
Community Integration X
Prevention Direct Service X
AVAILABILITY OF PROGRAM ELEMENTS
AVERAGE WAIT FOR NON-EMERGENCY SERVICES
WAITINJOD
clouts:, Oakland County
OAKLAND COUNTY CMHSP - PAGE 51
CLIENT GROUP: Persons with developmental disabilities
Service Avail. Average Average
Cases Wait Time Period
Service Yes No Waiting in Weeks of Wait Covered
Community Inpatient X
Outpatient - Clinic Services x 8 96 Period ending June 30,1996
Day Program Partial Hospitalization X
Psychosocial Rehabilitation X
Other X1 626 197 Period ending June 30,1996
Residential Specialized Residential X2 819 224 Period ending June 30,1996
Semi-Independence X
Support Services Assertive Community Treatment X
Crises Stabilization Team X
Community Treatment Team X
Client Services Management X 82 180 Period ending June 30,1996
t Family Support Services/X
Home Based
Integrated Employment X
Community Integration X
Prevention Direct Service X
x1 This fiaure is based on the total number of individuals waitina for work activity, adult day activity.
x2 This figure is based on the total number of individuals waiting for any type of residential placement.
OAKLAND COUNTY CMHSP - PAGE 52
CMHSP Oakland County RESIDENTIAL BED CAPACITY - ALL CUENT GROUPS
AVAILABLE BEDS AS OF AUGUST 31, 1996
BEDCAP.WPD
ADULTS WITH CHILDREN WITH PERSONS WITH
MENTAL ILLNESS MENTAL ILLNESS DEVELOPMENTAL
BED TYPE DISABILITIES
Actual Avelable Beds Actual Avalable Beds Actual Available Beds
as of 8/31/96 as of 8/31/96 as of 8/31/96
SEMI-INDEPENDENT "TYPE G" 33 32
IN-HOME SPECIALIZED "TYPE B"
AU Type B Respite 6
In-Home Per Diem through $64.99 26
In-Home Per Diem $65 through $94.99 43
In-Home Per Diem $95 through $124.99 11 13
In Home Per Diem $125 through $154.99 1 12
In-Home Per Diem $155 and Higher 12" 2
TOTAL IN-HOME SPECIALIZED "TYPE El' 24 0 102
FOSTER CARE, CCI, "TYPE A"
All Type A Respite
In-Home Per Diem through $12.69
In-Home Per Diem $12.70 through $64.99 1 48
In-Home Per Diem $65 through $94.99 3
In-Home Per Diem $95 through $124.99
In-Home Per Diem $125 through $154.99 . _
/ In-Home Per Diem $155 and HOer
All CCI Regardless of Cost 27
TOTAL FOSTER CARE, CCI AND 'TYPE A" 0 28 51
OTHER—Specify:
(A) EARNED CONTRACTS WITH STATE DMH
PLACEMENT UNITS OR AGENCIES
Mt. Pleasant
Caro
JS-MORC
(B) (SPECIFY)
Therapeutic Community 31
Residential Respite 1
TOTAL OTHER 31 1 0
TOTAL CMHSP MANAGED BED CAPACITY 88 I 29 1 185 1
OAKLAND COUNTY CMHSP • PAGE 53
RESIDENTIAL BED CAPACITY - ALL CLIENT GROUPS
AVAILABLE BEDS AS OF AUGUST 31, 1996
BEDCAP.WPD
CMHSP Oakland County — Anticipated MORC Transfer
ADULTS WITH CHILDREN WITH PERSONS WITH
MENTAL ILLNESS MENTAL ILLNESS DEVELOPMENTAL
BED TYPE DISABILITIES
Actual Avalable Beds Actual Avalable Beds Actual Available Beds
as of 8/31/96 as of 8/31/96 as of 8/31/96
SEMI-INDEPENDENT "TYPE G" 203 127
IN-HOME SPECIALIZED "TYPE B"
All Type B Respite 6
In-Home Per Diem through $64.99 11 6
In-Home Per Diem $65 through $94.99 66 182
In-Home Per Diem $95 through $124.99 30 191
In Home Per Diem $125 through $154.99 2 354
In-Home Per Diem $155 and Higher 3 180
TOTAL IN-HOME SPECIALIZED "TYPE B" 112 _ 0 919
FOSTER CARE, CCI, "TYPE A"
All Type A Respite
In-Home Per Diem through $12.69
In-Home Per Diem $12.70 through $64.99 31 89
In-Home Per Diem $65 through $94.99 9
In-Home Per Diem $95 through $124.99 1
In-Home Per Diem $125 through $154.99
In-Home Per Diem $155 and Higher
All CCI Regardless of Cost
TOTAL FOSTER CARE, CCI AND "TYPE A' 31 0 95
OTHER—Specify:
(A) EARNED CONTRACTS WITH STATE DMH
PLACEMENT UNITS OR AGENCIES ,
Mt. Pleasant
Caro ,
JS-MORC
(B) (SPECIFY) ,
MSHDA 72
TOTAL OTHER 0 0 72
[TOTAL CMHSP MANAGED BED CAPACITY I_ 346 I 0 1 1213 I _
Source of information: Material submitted to OCCMHSP on 8/11/96 reflecting all bed capacity
in Oakland County regardless of consumer's county of origin.
OAKLAND COUNTY CIANSP - PAGE 54
FULL MANAGEMENT TRADE-OFF DOLLARS PROJECTED
EARNED DURING FY 96-97
STATE INPATIENT AND STATE RESIDENTIAL SERVICES
IN FY 95-96 STATE SHARE DOLLARS
FMTO.INPD
CMHSP Oakland County
,
Utilization Projected for FY 95-96 Utilization Estimated for FY 96-97 Earned Trade-Offs Dunn FY 96-97
Client Group/ Total State Census Total State Projected Days Associated Projected
Facility Program Detail Days Dollars as of Days Dollars Census Reduced State Census
in 9-30-96 in as of Dollars Change
FY 95-96 FY 96-97 9-30-97 FY 96-97
Col 9 Co1.10 Col. 1 Col. 2 Col. 3 Col. 4 _ Co1.5 Col. 6 _ Col. 7 Col. 8 _.
Adults with Mental Illness -
Kalamazoo 732 198,006 2 730 197,465 2 2 , 541 0
Northville 1,472 399,648 7 2,555 693,683 7 (1,083) (294,035) 0
Clinton Valley 36,442 9,292,710 65 19,165 4,887,075 40 17,277 . , 4,405,635 25
Caro - Adults with Mental Illness 2,481 801,363 7 2,555 825,265 , _ 7 (74) i_ (23,902) 0
Walter Reuther ._ 4,148 821,304 11 4,015 794,970 11 133 26,334 0.00
Subtotal - Inpatient for Adults 45,275 11,513,031 92 29,020 7,398,458 67 16,255 4,114,573 25
with Mental Illness
Clinton Valley Center - Residential* 108,563 11,724,804 328 N/A N/A N/A N/A N/A N/A :
Total - Adults with Mental Illness 153,838 23,237,835 420 29,020 7,398,458 67 16,255 4,114,573 25
Children with Emotional Disturbance ,
Fairlawn Center 2,173 771,415 0 0 0 0 , 2,173 , 771,415 0
Hawthorne Center 209 , 43,995 4 1,460 307,330 4 (1,251) , (263,336) 0
Subtotal - Inpatient for Children 2,382 815,410 4 1,460 307,330 4 922 508,079 0
with Emotional Disturbance - -
Fairlawn Center - Residential* 2,139 275,931 38 N/A N/A N/A N/A N/A N/A
,
Total - Children with Emotional Disturbance 4,521 s 1,091,341 42 1,460 307,330 4 922 508,079 0
-
%wow
OAKLAND COUNTY CMHSP - PAGE 55
FULL MANAGEMENT TRADE-OFF DOLLARS PROJECTED - Page 2
CMHSP Oakland County
Utilization Projected for FY 95-96 Utilization Estimated for FY 96-97 Earned Trade-Offs During FY 96-97
Client Group/ Total State Census Total State Projected Days Associated Projected
Facility Program Detail Days Dollars as of Days Dollars Census Reduced State Census
in 9-30-96 in as of Dollars Change
FY 95-96 FY 96-97 9-30-97 FY 96-97
Col. 1 Col. 2 Col. 3 Col. 4 _ Co1.5 Col. 6 _ Col. 7 Col. 8 _ Col. 9 Co1.10 .
Persons with Developmental Disabilities
Caro - Persons with Developmental Disabilities 8,468 1,007,692 18 6,570 781,830 18 1,898 225,862 0
Southgate 366 58,926 1 365 , 58,765 1 1 161 0
Mt. Pleasant 2,338 303,940 6 2,190 284,700 6 148 19,240 0
Subtotal - Inpatient for Persons with Developmental 11,172 1,370,558 25 9,125 1,125,295 25 2,047 245,263 0 i Disabilities
Caro - Residential 3,316 374,708 9 3,285 371,205 9 31 3,503 0
Caro AIS 1,371 122,019 3 1,095 97,455 3 276 24,564 o
MORO" 138,667 14,282,701 384 N/A N/A N/A N/A N/A N/A
MORC AIS* 88,825 7,816,600 247 N/A N/A N/A N/A N/A N/A
Mt. Pleasant Residential 7,686 707,112 21 7,665 705,180 21 21 1,932 0
Mt. Pleasant AIS 7,686 622,566 21 7,665 620,865 21 21 1,701
Subtotal - Residential Services for Persons with 247,551 23,925,706 686 19,710 1,794,705 64 349 31,700 0
Developmental Disabilities
Total for Persons with Developmental Disabilities 258,723 25,296,264 710 28,835 2,920,000 79 2,396 276,963 0
Total - Adults with Mental Illness (from previous 153,838 23,237,835 420 29,020 7,398,458 67 16,255 4,114,573 25
page)
Total - Children with Emotional Disturbance (from • 4,521 1,091,341 42 1,460 307,330 4 922 508,079 0
previous page) .
GRAND TOTAL 417,082 49,625440 1,172 _ 59,315 10,625,788 _ 150 19,573 _ 4,899,615 25
*Reflects transfer of management responsibility to Oakland County. Fairlawn Residential transfer effective December 1, 1995. MORC/CRS transfer
effective October 1, 1996.
OAKLAND COUNTY CMHSP - PAGE 56
PERSONS WITH SERIOUS MENTAL ILLNESS
RECEIVING CLIENT SERVICE MANAGEMENT - PROJECTED FY 95-98
SMI.WPD
CMHSP Oakland County
(Col.0 + D = Col. B) (Col. B - D = Col. C) (Col. B - C = Col. D)
Number of SMI
Total Number Total Number Number of SMI Who DID NOT
of MI Cases of SMI Cases Who Received CSM Receive CSM
Population Column A Column B Column C Column D —
Child/Adolescents 939 803 551 252
(ages 0-17)
Adults 3272 2498 1777 721
(ages 18-54)
Older Persons 863 718 434 284
(ages 55+)
5074 4019 2762 1257
Totals
KEY:
MI means total cases of persons with mental illness served by CMH.
SMI means total cases of persons with serious mental illness served by CMH.
CSM means client service management.
)
)
..119
I
OAKLAND COUNTY CIVIHSP - PAGE 57
) PROGRAM REVISION REQUESTS -- SPENDING DETAIL AND
NARRATIVE
)
OAKLAND COUNTY CMHSP • PAGE 58
CMHSP Oakland County PROGRAM REVISION REQUEST
SPENDING DETAIL
(NOT TO BE USED FOR BLOCK GRANT FUNDING REQUESTS)
RR.INPD
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
Family to Family Program 3 months PRR ID Number 97-01
Client Group: MI-A MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 of
Full Year Cost Full Year Cost
Full Year Cost Full Year Cost Outpatient/ Full Year Cost Other: Full Year Cost
FISCAL SUMMARY Residential Partial Day Clinical Support . Case Management Respite Services Total
I. Service Plan Summary
Number of Beds
Cases 25 25 , . I.-
Units 5,400 5,400
II. Source of Financing
G. Maximum Match
1. 103% State Match
-100% State Inpatient
-100% Residential
-100% MSHDA, TSW, Other — ..
a. Reimbursements
(1) Medicaid Federal Share ..
) (2) Client SSI
(3) Client Fees & Insurance
b. Net Cost (100% State)
(1) Medicaid State Match
(2) State Match
/ 2. State and Local Match $122,300 $122,300 , ..-
a. Reimbursements
(1) Medicaid Federal Share
(2) Client SSI
(3) Client Fees & Insurance
b. Net Matchable Cost
(1) Local Match Requirement $1,213 $1.213
(a) Title XIX Replacement
(b) Other
(2) State Match Requirement
(a) Medicaid State Share
(b) DMH Match
State Portion of CMH Budget
Line G113 plus Line G.2b(2)
Financing to be provided via
Full Management Trade-Offs
) $121,077 $121,077 v Not State Costs
OAKLAND COUNTY CMHSP - PAGE 59
CMHSP Oakland County NARRATIVE FOR PROGRAM REVISION REQUESTS
EXCEPT BLOCK GRANT FUNDING REQUESTS
Children's Respite respPRR.WPD
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
Family to Family Program 3 months PRR ID Number 97-01
Client Group: MI-A MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 2_ of
Narrative (attach additional pages as necessary):
The proposal for expansion funding of tobacco tax respite services should include the following:
•CMHSP has fully implemented respite services with previous tobacco tax respite funds and has spent to the maximum FY 96 authorization of these funds.
•Documented need for services.
•Parent/family involvement in planning, development, and on-going oversight.
•An array of options which are designed to be flexible and tailored to individual family needs and which are provided in a timely fashion.
•Provide for both regular, planned respite and crisis respite.
*Recognize the need for the whole family to benefit from respite and which does not require families to participate in other CMH services or be in crisis to
qualify.
•Assure training to respite providers and staff.
•Assure outreach to families and training for them.
•Assure easy access and minimal paperwork to obtain service.
•Creative use of existing community support centers and resources - churches, civic groups, day care centers, senior centers, camps, etc.
Oakland County Community Mental Health Services has allocated all tobacco tax respite
services for FY96. It is anticipated all will be spent by September 30, 1996. Oakland County
Community Mental Health Services is looking to expand respite services as explained in the
) following narrative.
It is estimated by Oakland County Community Mental Health Services that there are over 250
families in Oakland County who are faced with the challenge of raising and coping with
children who have severe emotional problems. tere are four aspects of this problem that
compound the issue even more: the need for respite, family isolation, crisis situations and lack
of parental role models. A solution to these problems would be an out-of-home respite care
which would increase social connectedness, provide time for parents/caregivers to rejuvenate
and for parents to enhance methods of child management. Additionally, this will assist in
joining the consumer family with the community and provide parents with support which will
create a more positive and cost-effective environment where children are in the least
restrictive setting and part of the community.
The goal of this project entitled Family to Family is to keep families with seriously emotionally
impaired children intact by avoiding out-of-home placement and planning for the special needs
children in their communities. This will be accomplished by identifying and training 25 paid
host families as parent mentors. The host families will provide respite care in their homes. It
is anticipated the each consumer will receive on average nine days or 216 hours of respite
care per month. Two outcomes will be measured for the duration of the grant period: effort
and effect. Project effort will define what was done within the project parameters. Effort will
be divided into project measures and client measures. Project measures include the kind and
extent of coordination between organizations and process involved in decision-making within
the context of community awareness of the project outcomes. Client measures will describe
the baseline characteristics of the emotionally/mentally impaired before contact with the
project. The effect evaluation will be a quantitative analyses of the project and will measure
)
,ir
OAKLAND COUNTY CMHSP - PAGE 60
baseline data. Three tools will be used to evaluate this data. The first is the Cleminsaw-
Guidubaldi Parent Satisfaction Scale and The Parent Stress Index, both of which will be used
as pre/post test measures. The third tool, The Child and Adolescent Functional Assessment
Scale (CAFAS) will be used to determine improvement in the emotional impaired childrens'
abilities in coping. This will be administered periodically throughout the project. Successful
attainment of the project objectives will be measured by the number of host/client matches.
)
OAKLAND COUNTY CMHSP - PAGE 61
PROGRAM REVISION REQUEST
SPENDING DETAIL
(NOT TO BE USED FOR BLOCK GRANT FUNDING REQUESTS)
RR.WPD
CMHSP Oakland County
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
4-H Program 3 months PRR ID Number: 97-02
Client Group: MI-A MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 _l_. of
Full Year Cost Full Year Cost
Full Year Cost Full Year Cost Outpatient/ Full Year Cost Other Full Year Cost
FISCAL SUMMARY Residential Partial Day Clinical Support Case Management BesOillnrvices Total
I. Service Plan Summary
Number of Beds
Cases 103 100
Units 14,000 hours 14,000 hours
II. Source of Financing
G. Maximum Match
1 100% State Match
-100% State Inpatient
-100% Residential
-100% MSHDA, TSW, Other
a. Reimbursements
(1) Medicaid Federal Share
) (2) Client SSI
(3) Client Fees 8, Insurance
b. Net Cost (100% State)
(1) Medicaid State Match
(2) State Match
2. State and Local Match 670,000 370,000
a. Reimbursements
(1) Medicaid Federal Share
(2) Client SSI
(3) Client Fees & Insurance
b. Net Matchable Cost
(1) Local Match Requirement $7,000 $7.000
(a) Title XIX Replacement
(b) Other
(2) State Match Requirement
(a) Medicaid State Share
(b) DMH Match
State Portion of CMH Budget
Line Gib plus Line G,2b(2)
Financing to be provided vie
Full Management Trade-Offs
)
163,000 $63.000 p Net Stele Costs
OAKLAND COUNTY CMHSP - PAGE 62
CMHSP Oakland County NARRATIVE FOR PROGRAM REVISION REQUESTS
EXCEPT BLOCK GRANT FUNDING REQUESTS
Children's Respite respPRR.VVPD
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
4-H Program 3 months PRR ID Number: 97-02
Client Group: MI-A MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 _•__ of •§...,
Narrative (attach additional pages as necessary):
The proposal for expansion funding of tobacco tax respite services should include the following:
*CMHSP has fully implemented respite services with previous tobacco tax respite funds and has spent to the maximum FY 96 authorization of these funds.
•Documented need for services.
•Parent/family involvement in planning, development, and on-going oversight.
*An array of options which are designed to be flexible and tailored to individual family needs and which are provided in a timely fashion.
•Provide for both regular, planned respite and crisis respite.
•Recognize the need for the whole family to benefit from respite and which does not require families to participate in other CMH services or be in crisis to
qualify.
•Assure training to respite providers and staff.
•Assure outreach to families and training for them.
*Assure easy access and minimal paperwork to obtain service.
•Creative use of existing community support centers and resources - churches, civic groups, day care centers, senior centers, camps, etc.
Oakland County Community Mental Health Services has allocated all tobacco tax respite
services for FY96. It is anticipated all funds will be spent by September 30, 196. With that,
Oakland County Community Mental Health Services is looking to expand respite services as
explained in the following narrative. •
It is estimated by Oakland County Community Mental Health Services that there are over 250
families in Oakland County who are faced with the challenge of raising and coping with
children who have severe emotional problems. There are four aspects of this problem that
compound the issue even more: the need for respite, family'isolation, crisis situations and lack
of parental role models. A solution to these problems would be an out-of-home respite care
which would increase social connectedness, provide time for parents/caregivers to rejuvenate
and for parents to enhance methods of child management. Additionally, this will assist in
joining the consumer family with the community and provide parents with support which will
create a more positive and cost-effective environment where children are in the least
restrictive setting and part of the community.
The goal of this project entitled 4-H Day Camp is to keep families with seriously emotionally
impaired children intact by avoiding out-of-home placement and planning for special needs
children in their communities. This will be accomplished by providing a year-round day camp
at Tollgate Education Center. The camp runs Tuesday-Thursday from 8:30 a.m. to 3:09 p.m.
Camp activities provide a positive and enjoyable experience for the consumers. The first-day
activities include a nature hike, a visit to the petting zoo, and fishing. Cooperative games
include such activities as watching ice cream being made. Second day activities include pond
dipping, mysterious masks and Skylab. Third -day activities include a dance, cooperative
quilts, yearbooks, and a campfire as well as cooperative games. In the spring and summer
activities are spread over a four-day period, while the fall and winter session are a three-day
session thus, encompassing the four seasons.
OAKLAND COUNT'', CMHSP - PAGE 63
PROGRAM REVISION REQUEST
SPENDING DETAIL
(NOT TO BE USED FOR BLOCK GRANT FUNDING REQUESTS)
RR.INPD
CMHSP Oakland County
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
The YMCA Program 3 months PRR ID Number 97-03
,
Client Group: MI-A MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 4 of j__
Full Year Cost Full Year Cost
Full Year Cost Full Year Cost Outpatient/ Full Year Cost Other Full Year Cost
FISCAL SUMMARY Residential Partial Day Clinical Support Case Management Res ite Sepf•ce Total
I. Service Plan Summary
Number of Beds
Cases 129 129
Units 2,709 hours 2.709 hours
II. Source of Financing
G. Maximum Match —
1. 100% State Match
., -100% State Inpatient
-100% Residential
-100% MSHDA, TSW, Other
a. Reimbursements
(1) Medicaid Federal Share
) (2) Client SSI
(3) Client Fees & Insurance
b. Net Cost (100% State)
(1) Medicaid State Match
(2) State Match .
v
2. State and Local Match $7,920 $7,920
a. Reimbursements
(1) Medicaid Federal Share
(2) Client SSI
(3) Client Fees & Insurance
b. Net Matchable Cost
(1) Local Match Requirement $792 $792
(a) Title XIX Replacement
(b) Other
(2) State Match Requirement
(a) Medicaid State Share
(b) DMH Match
State Portion of CMH Budget
Line Gib plus Line G,2b(2) • .
Financing to be provided vie
Full Management Trade-Offs .
)
$7,128 $7,128 0 Net State Costs
OAKLAND COUNTY CMHSP - PAGE 64
CMHSP Oakland County NARRATIVE FOR PROGRAM REVISION REQUESTS
EXCEPT BLOCK GRANT FUNDING REQUESTS
Children's Respite respPRR.WPD
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
The YMCA Program 3 months PRR ID Number: 97-03
Client Group: MI-A Mj& DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 , 4 of j....
Narrative (attach additional pages as necessary):
The proposal for expansion funding of tobacco tax respite services should include the following:
•CMHSP has fully implemented respite services with previous tobacco tax respite funds and has spent to the maximum FY 96 authorization of these funds.
•Documented need for services.
•Parent/family involvement in planning, development, and on-going oversight.
•An array of options which are designed to be flexible and tailored to individual family needs and which are provided in a timely fashion.
•Provide for both regular, planned respite and crisis respite.
•Recognize the need for the whole family to benefit from respite and which does not require families to participate in other CMH services or be in crisis to
qualify.
•Assure training to respite providers and staff.
•Assure outreach to families and training for them.
•Assure easy access and minimal paperwork to obtain service.
•Creative use of existing community support centers and resources - churches, civic groups, day care centers, senior centers, camps, etc.
Oakland County Community Mental Health Services has allocated all tobacco tax respite
services for FY96. It is anticipated all will be spent by September 30, 1996. With that,
Oakland County Community Mental Health Services is looking to expand respite services as
) explained in the following narrative.
It is estimated by Oakland County Community Mental Health Services that there are over 250
families in Oakland County who are faced with the challenge of raising and coping with
children who have severe emotional problems. There are four aspects o f this problem that
compound the issue even more: the need for respite, family isolation, crisis situations and lack
of parental role models. A solution to these problems would be an out-of-home respite care
which would increase social connectedness, provide time for parents/caregivers to rejuvenate
and for parents to enhance methods of child management. Additionally, this will assist in
joining the consumer family with the community and provide parents with support which will
create a more positive and cost-effective environment where children are in the least
restrictive setting and part of the community.
The goal of this project entitled Ropes Course/Team Building keeps families with seriously
emotionally impaired children intact by avoiding out-of-home placement and planning for
special needs children. The Low Ropes Training is a different approach to offering respite to
families. The Ropes Course/Team Building Program is offered through Camp Ohiyesa of the
YMCA of Metropolitan Detroit.
What makes this course unique is that it involves the entire family. The course is a series of
individual and group challenges that require a combination of teamwork skills and individual
commitment. It's designed to provide safe and environmentally sound adventure-based
learning experiences relevant to the participants personal and professional growth.
Constructed if rope, cable, and wood, the Ropes Course consists of activities that are indoors
)
\ la
OAKLAND COUNTY CMHSP - PAGE 65
or out. What is also very unique is that the family is participating and learning right along with
the consumer.
The Low Ropes Initiative elements are generally eighteen inches off the ground, although they
can be as high as eight feet. Participants are given a series of obstacles that must be
overcome using cooperation and teamwork. High Ropes Challenge look at issues of self-
concept. Through this course, participants will address issues of leadership, effective
communication, self-concept, trust, goal-setting, action-oriented problem solving risk-taking
and body awareness. The activities provide real-life drama and give examples that may be
relevant elsewhere in life. For example, these activities are processed to provide transfer of
meaning to school, home, and everyday life.
)
OAKLAND COUNTY CMHSP • PAGE 66
CMHSP Oakland County PROGRAM REVISION REQUEST
SPENDING DETAIL
(NOT TO BE USED FOR BLOCK GRANT FUNDING REQUESTS)
RR.WPD
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
The Grandparent Program 3 months PRR ID Number: 97-04
Client Group: MI-A M.& DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 _5__ of _§.....
....
Full Year Cost Full Year Cost
Full Year Cost Full Year Cost Outpatient/ Full Year Cost Other Full Year Cost
_ FISCAL SUMMARY Residential Partial Day Clinical Support Case Management Respite Services Total ,
I. Service Plan Summary
Number of Beds ,
Cases 30 30
Units 7,200 hours 7,200 hats ,
II. Source of Financing
G. Maximum Match .
1.100% State Match
„ ACC% State Inpatient
-100% Residential -.
-100% MSHDA. TSW, Other
a. Reimbursements
(1) Medicaid Federal Share
) (2) Client SSI
(3) Client Fees & Insurance
b. Net Cost (100% State)
(1) Medicaid State Match
(2) State Match — e
2. State and Local Match $72,00 $72.00
a. Reimbursements
(1) Medicaid Federal Share
(2) Client SSI
(3) Client Fees & Insurance
b. Net Matchable Cost
(1) Local Match Requirement $7,200 $7200
(a) Title XIX Replacement
(b) Other
(2) State Match Requirement
(a) Medicaid State Share
(b) DMH Match
State Portion of CMH Budget
Line Gib plus Line G,2b(2)
Financing to be provided via
Full Management Trade-Offs
) $64800 s64a00 IlLat_ state Costs
OAKLAND COUNTY CPANSP • PAGE 67
NARRATIVE FOR PROGRAM REVISION REQUESTS
EXCEPT BLOCK GRANT FUNDING REQUESTS
Children's Respite respPRR.VVPD
CMHSP Oakland County
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22/96
(in months)
The Grandparent Program 3 months PRR ID Number 97-04
,
Client Group: MI-A MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 _§.... of _§._
Narrative (attach additional pages as necessary):
The proposal for expansion funding of tobacco tax respite services should include the following:
"CMHSP has fully implemented respite services with previous tobacco tax respite funds and has spent to the maximum FY 96 authorization of these funds.
•Documented need for services.
•Parent/family involvement in planning, development, and on-going oversight.
*An array of options which are designed to be flexible and tailored to individual family needs and which are provided in a timely fashion.
•Provide for both regular, planned respite and crisis respite.
'Recognize the need for the whole family to benefit from respite and which does not require families to participate in other CMH services or be in crisis to
qualify.
eAssure training to respite providers and staff.
*Assure outreach to families and training for them.
•Assure easy access and minimal paperwork to obtain service.
•Creative use of existing community support centers and resources - churches, civic groups, day care centers, senior centers, camps, etc.
Oakland County Community Mental Health Services has allocated all tobacco tax respite
services for FY96. It is anticipated all funds will be spent by September 30, 1996. With that,
Oakland County Community Mental Health Services is looking to expand respite services as
explained in the following narrative.
It is estimated by Oakland County Community Mental Health Services that there are over 250
families in Oakland County who are faced with the challenge of raising and coping with
children who have severe emotional problems. With that there are four aspects of this
problem that compound the issue even more: the need for respite, family isolation, crisig
situations and lack of parental role models. A solution to these problems would be an out-of-
home respite care which would increase social connectedness, provide time for
parents/caregivers to rejuvenate and for parents to enhance methods of child management.
Additionally, this will assist in joining the consumer family with the community and provide
parents with support which will create a more positive and cost-effective environment where
children are in the least restrictive setting and part of the community.
The goal of this project entitled The Grandparent Program is to provide respite September 13,
1996 for grandparents who are the primary caregivers for the emotionally impaired
grandchildren. These families have been identified through agency referrals and this program
will provide an opportunity to keep families intact, avoiding out-of-home placement for children
experiencing abandonment and rejection from their parents. It is with that this request is for
enhanced in-home respite up to 20 hours per month for the grandparents. These families are
on a fixed income and not prepared to provide for these children. The emotional, physical and
financial toll on these grandparents can be overwhelming, however, they come with a
commitment to keep their family together. Isolation is often experienced as the grandparents
are often much older than the parents in support networks through schools and churches.
Crisis situations may occur more frequently due to health issues related to the caregivers, thus
OAKLAND COUNTY CMHSP - PAGE 68
creating a need for increased respite dollars. Being able to plan consistent and predictable
breaks may provide these very special caregivers the necessary support to keep their
grandchildren at home and out of residential placement.
OAKLAND COUNTY CMHSP • PAGE 69
CMHSP Oaklanuntm PROGRAM REVISION REQUEST
SPENDING DETAIL
(NOT TO BE USED FOR BLOCK GRANT FUNDING REQUESTS)
RR.WPD
PRR Title/Purpose: Time Required to Implement: Date Submitted: 10/22196
(in months)
Expansion of Arab-American and Chaldean Mental Health Services 0 PRR ID Number. 95-03
Client Group: Pm MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) FY96-97 •¢._ of ...6._
Full Year Cost Full Year Cost
Full Year Cost Full Year Cost Outpatient/ Full Year Cost Other Full Year Cost
FISCAL SUMMARY Residential Partial Day Clinical Support Case Management Total ,
I. Service Plan Summary
Number of Bids
Cases ao 40
Units 366 366
II. Source of Financing $50960 $50,230 $101,190
G. Maximum Match
1. 100% State Match $50,960 $50,230 $101,190 , -
-100% State Inpatient ,
-100% Residential -
-100% MSHDA, TSW, Other ,
a. Reimbursements $4,945 $4,945
(1) Medicaid Federal Share $4,945 $4,945
i (2) Client SSI
(3) Client Fees & Insurance .
b. Net Cost (100% State) $50,960 $45,266 $96,245 ,
(1) Medicaid State Match
$3,754 $3,754 ,
(2) State Match $50,960 $41,531 $92,491
r
2. State and Local Match
a. Reirnbursements .
(1) Medicaid Federal Share - .
(2) Client SSI ..-
(3) Client Fees & Insurance
b. Net Matchable Cost
(1) Local Match Requirement
(a) Title XIX Replacement
(b) Other
(2) State Match Requirement
(a) Medicaid State Share
(b) DMH Match
State Portion of CMH Budget $50,960 $45,285 $96,245
,
Line Gib plus Line G.21:(2)
Financing to be provided via
Full Management Trade-Offs
) $50,960 $45,285 $96,245
Net State Costs II =.
OAKLAND COUNTY CMHSP - PAGE 70
NARRATIVE FOR PROGRAM REVISION REQUESTS
EXCEPT BLOCK GRANT FUNDING REQUESTS
PRR-NARR.WPD
CMHSP Oakland County
PRR Title/Purpose: Time Required to Implement: Date SubMItted: 10/22/96
(in months)
Expansion of Arab-American and Chaldean Mental Health Services 0 PRR ID Number: 95-03
Client Group: EA MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 61almia_______ ...
Narrative (attach additional pages as necessary):
Because the Arab-Chaldean community is a family-oriented culture, clients have a tendency to
bring other members of their immediate or extended family. This phenomena is quite normal, but
it doubles the work load of the Arab-Chaldean Mental Health Program. As a result, treatment
methods must be modified to accommodate the unique needs of this population. In addition, the
stigma of mental health in the Arab-Chaldean Community is extremely high because it is a "shame
based culture;" and the phenomena of social work and the helping process is a brand new
experience. Finally, our clientele has to go through a pre-treatment stage were orientation
services are provided to engage them in the mental health treatment process. All these services
are provided in the client's native language and/or, quite often, in three languages: Arabic,
Chaldean, and English
The positions being requested are one (1) F.T.E. psychologist and 0.35 F.T.E. (14 hours per
week) psychiatrist to provide assessments, psychiatric evaluations, psychological testing,
psychotherapy, prevention services, and medication. The expected case load @or the
psychologist will be 40.
M this is a unique service it does not coordinate with other FY 96-97 PRR's.
OAKLAND COUNT/ CMHSP - PAGE 71
CENSUS PROJECTIONS - HOSPITALS, CENTERS AND NURSING HOMES - 1996 SUBMISSION
CENPROJ.VVPD
CMHSP Oakland County
EXPECTED RESIDENT CENSUS AS OF DATE SPECIFIED 1
9/30/96 to 9/30/97 to
9/30/95 7/31/96 9/30/96 9/30/97 9/30/97 9/30/98 9/30/98
_ Actual Actual Expected Expected Change Expected Change
Psychiatric Hospitals for Adults
Caro-MI 7 7 7 4 (3) 4 0
Clinton Valley . 137 116 65 40 (25) 20 (20)
Detroit Psychiatric Institute . 0 1 0 0 0 0 0
Kalamazoo PH . 2 2 2 0 (2) 0 0
Northville PH 0 5 7 6 (1) 5 (1)
Reuther 12 12 11 10 (1 ) 9 (1)
Subtotal 158 143 _ 92 60 (32) 38 (22)
Psychiatric Hospitals for Children
Detroit Psychiatric Institute .
Fairlawn 12 7 0
Hawthorn , 0 0 3 4 1 4 12
Pheasant Ridge .
Subtotal 12 7 _ 3 4 1 4 12
Centers for Persons with Developmental Disabilities
• —Caro 23 23 18 18 0 18, 0
Mt. Pleasant 7 6 6 6 0 6 0
Southgate 1 1 1 . 1 0 1 0
Subtotal 31 30 25 25 0 25 0
Special Nursing Homes
Birchwood 0 I 0 I 0 I 0 I 0 I 0 I 0
General Nursing Homes 11
DD Persons Requiring Placement 93 89 89 89 0 85 (4)
MI Persons Requiring Placement 37 35 35 29 (6) 26 (3)
Subtotal 130 - 124 124 118 •6) 111 (7) 1
11.31
51
OAKLAND COUNTY CMHGP • PAGE 72
SUMMARY—WAIVER CERTIFICATES NEEDED CMHSP Oakland County
WAIVCERT.VVPD
Part I.
Total Waiver Certificates Filled as of 7/31/96:
Approved/Authorized Certificates Not Filled 7/31/96:
New Waiver Certificates Requested FY 97:
New Waiver Certificates Requested FY 98:
Part II.
Intended Use of New Waiver Certificates
Approved Not
Planned Use Categories Filled 7/31/96 FY 97 FY 98 Total
1. DD Center Residents 0 9 9 18
2. Current AIS-MR Residents 0 0 0 0
3. General Nursing Home Residents 0 6 6 12
4. CLF or Other Group Home Residents/Conversion 0 0 0 0
5. Community Demand 9 36 36 72
6. Other Specify—
Total 9 51 51 102
Part Ill.
The federal requirements associated with the waiver make it necessary for the department to maintain information about the bed capacity of all
specialized CLF (congregate living facilities) settings providing in-home services to persons with developmental disabilities. EXCLUDE any CLF's
administered by the board through a contract with a state agency or placement unit.
Provide a count of the number of homes and beds of those CLF settings administered by the CMH board which satisfy the following criteria:
A resident capacity of at least four persons.
Bedroom space, for each residents, of at least 80 square feet (per person) in a private bedroom and 60 square feet per person
in shared bedrooms.
Planned New Between Planned New Between
Actual 7/31/96 Planned New by 9/30/96 10/1/96 and 9/30/97 10/1/97 and 9/30/98
Number of Homes 97
Number of Beds 350
OAKLAND COUNTY CMHSP - PAGE 73
FEDERAL BLOCK GRANT REPORTING REQUIREMENT
SYSTEM OF CARE SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE
FEDBG.WPD
CMHSP Oakland County
Contact Person (name, phone) Richard Deighton. 810-975-711
In order to comply with the federal conditions of approval for the block grant, specific information about certain
children's services must be provided to the federal government. The information requested below is essential to
maintaining this funding and should be reported regardless of the funding source for the programs listed.
-
Program Number of Estimated Estimated
Offered by Current Cases Cases to be
CMHSP Programs Served Served
Funded
Y = Yes by/through 10/1/95- 10/1/96-
N = No the CMHSP 9/30/96 9/30/97
A. Home Based
Services Y 2* 139 180
Programs -
B. Wraparound Y 1* 16 30-35 Services
*Note: If the CMHSP reports cases served in either of the two subsequent columns, there must be an entry
in this column.
Description of the source of the information provided above; comments and/or explanation.
Information is taken from service activity data
OAKLAND COUNTY CMHSP • PAGE 74
FEDERAL BLOCK GRANT PROGRAM REVISION
REQUESTS
nn•
)
FEDERAL BLOCK GRANT
,ROGFtAM REVISION REQUEST
AR-FBG.VVPD
CMHSP Oakland County
OAKLAND COUNTY CMHSP - PAGE 75
PRR Title/Purpose: lime Required to Implement: Date Submitted: 10/22/96
(in months)
Consultant on Aging 3 months PRR ID Number 97-05
Client Group: MI-A MI-C DD Bd Admin. Prevention FY of Implementation: Board Priority:
(circle one) 1996-1997 j_ of _IL •
PRR Purpose (check one):
X Aging Services
Employment
ACT Teams
Consumer Run or Consumer Directed Initiatives
___ Wraparound
Psychosocial Rehab (Clubhouses)
Other
Adults with Children with Board
A. FINANCING SUMMARY Mental Illness Mental Illness , Other . Administration Total
Estimated clients to be served by PRR
PROJECTED FUNDING SUMMARY
Projected Gross Funding $60,000 $3,000 $63,000
SAMHSA (Federal) Block Grant $60,000 $3,000 $63,000
1st/3rd/SSI Reimbursement Estimate*
)Other - Funding:
SAMHSA 1st/3rd/SSI
(Federal) Block Reimbursement Other
B. BUDGET DETAIL Grant Estimate* Funding Total
Personnel salaries/wages and fringe benefits
Equipment
Travel
Supplies, etc.
Contractual services (subcontract, etc.)—specify below ;60,000 $60,000
Indirect" - Administrative Expenses $3,000 63,000
Consultant costs for training on the aging population.
TOTAL $63,000 $63,000
*cllock grant funds may not be used to match other federal funds.
per PL 102-3R1, Section 1916B, administrative expenses may not exceed 5 percent.
1
OAKLAND COUNTY CMHSP • PAGE 77
Since this population is difficult to place into a residential situation after a psychiatric
hospitalization, this proposal is a priority.
)
OAKLAND COUNTY CMHSP - PAGE 78
CMHSP Oakland County
ESTIMATED FTE'S
FTES.WPD
Estimated FTE's
as of 9/30/96
(A) Estimated number of FTE equivalent employees on
the CMHSP payroll as of 9/30/96
339 Full-time equivalent employees are defined as 40
hours of paid (including sick/annual) work per week.
(3) The estimated FTE-equivalent of persons
providing
services to the CMHSP through a personal services
contract with the CMHSP. Only persons providing '11.65 approved mental health program
.. For example, a contract with a psychiatrist
for 20 hours of service per week = .5 FTE.
0 For contracts for mental health services, provide
estimated FTE equivalents which are funded by the
CMHSP
Include FTE's associated with residential services
such as staffed group homes.
.. Exclude staff associated with general AFC
residential room, board and supefvtsion. If the
contract pays for additional staffing, provide 613.05
the FTE equivalent. This would include program
add-on funding.
.. Exclude FTE's associated with all community
inpatient programs.
.. Exclude All state provided services.
Estimate FTE equivalents based on data available
to the CMHSP in relation to contract spending
if no other information is available.
TOTAL ESTIMATED FTE'S 972.7
Describe the methodology used to provide this information.
Professional Services Contract: TOTAL COST + AVERAGE RATE = TOTAL HOURS
TOTAL HOURS + 2080 = FTE'S
Agency and Residential Contracts: Taken from staffing patterns in contracts
24 HOUR STAFF +3 SHIFTS = FTE'S
AVERAGE RATIO OF STAFF TO CONSUMERS = 1:5
AVERAGE NUMBER OF CONSUMERS = 5
Child Caring Institutions:
CMHSP Oakland County - FY 96
OAKLAND COUNTY CMHSP • PAGE 79
CMHSP SUMMARY OF CURRENT CONTRACTS FOR MENTAL HEALTH SERVICES DELIVERY
--EXCLUDING STATE PROVIDED SERVICES--
CONTRACT.WPD
Rate paid per unit of service. Total FY 96
Provide range if more than one rate is Expected CMHSP
Number of paid. Contractual
Program Type Contracts Rate Paid (range) Obligation
ADULTS WITH MENTAL ILLNESS
Community Inpatient 4 $295/day - $490/day $3,145,565
Bd Managed Residential inc.
8 $22.15/DAY - $210/DAY $1,078,351 SIP
Day Programs 3 NET COST $1,015,496
Outpatient Services 1 NET COST $291,584
Supportive Services 10*
Prevention
Individual professional
5 $28.37/HOUR - $167.70 $50,804 service contracts
CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE
Community Inpatient 2 $358.51/day - $414/day $707,808
Bd Managed Residential inc. 16 $35.41/day - $182.43/day $1,496,156 SIP
Day Programs 6 $10.00/day - $16.67/day $8,150
Outpatient Services 188738 - NET 5 2 NET cost and 3 @$13.50/hr 100394 - hr
- -.
I
Supported Services
Prevention
Individual professional
service contracts
PERSONS WITH DEVELOPMENTAL DISABILITIES
Community Inpatient
Bd Managed Residential inc. 35 $13.26/hour - $156.87 $3,786,594 SIP
Day Programs 10 Net Cost /5512772
Outpatient Services
---
Supportive Services 43 $10.00/hr - $75.00/hr $1,368,932
Prevention
Individual professional $12.50/hr - $105.00/hr $734,699 services contracts
*Includes crisis contract which crosses all population. Contract located In "ADULTS WITH MENTAL ILLNESS" section because
estimated usage by populations (i.e., 89%, by adults with mental Illness, 9% by children with serious emotional Impairment, and 1%
by persons with developmental disabilities.
Resolution #97223 October 23, 1997
The Chairperson referred the resolution to the Finance and Personnel
Committee. There were no objections.
FISCAL NOTE (M.R. #97223) November 6, 1997
BY: FINANCE AND PERSONNEL COMMITTEE, SUE ANN DOUGLAS, CHAIRPERSON
IN RE: COMMUNITY MENTAL HEALTH APPROVAL OF ANNUAL PROGRAM PLAN AND BUDGET
SUBMISSION 97/98
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-F of this Board, the Finance and Personnel Committee
has reviewed the above referenced resolution and finds:
1. Public Act 258 (1974 as amended) and the Administrative Rules
which implement that act require that each community mental health
services program (CMHSP) examine and evaluate the mental health
needs of the county it represents and submit both an annual plan
and a budget for their program.
2. This submission provides the structure and mechanism for Oakland
County Community Mental Health to participate in: the development of
the Department of Community Health state budget for mental health;
to document the community demand for mental health
services; to identify technical assistance needs; and to receive DCH
direction for designing service delivery, consistent with the
anticipated appropriation for the fiscal year.
3. The Annual Program Plan is an assessment of need and a planning
document, with no current financial impact on the CMH budget. This
document will be used in future contract negotiations, and
justification for current appropriations, as well as the basis for
any additional funds requests.
FINANCE AND PERSONNEL COMMITTEE
Resolution #97223 November 6, 1997
Moved by Taub supported by Palmer the resolution be adopted.
Discussion followed.
AYES: Jacobs, Jensen, Johnson, Kingzett, Law, McCulloch, McPherson,
Millard, Palmer, Pernick, Powers, Schmid, Taub, Wolf, Amos, Coleman, Devine,
Dingeldey, Douglas, Garfield, Holbert, Huntoon. (22)
NAYS: None. (0)
A sufficient majority having voted therefor, the resolution was adopted.
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Lynn D. Allen, Clerk of the County of Oakland, do hereby certify that the
foregoing resolution is a true and accurate copy of a resolution adopted by the
Oakland County Board of Commissioners on November 6, 1997 with the original
record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the
County of Oakland at Pontiac, Michigan this 6th day dqepvembc;:19 1:!?,,,,
CICcA9
Lynn D. Allen, County Clerk