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Hopeful Hopeless: Timely Access to Treatment in the ADM System of Care

This report highlights the importance of timely access to evidence-based and cost-effective treatment in the Summit County ADM System of Care, offering hope for individuals in need. It also emphasizes the protection of client rights in the mental health and recovery programs.

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Hopeful Hopeless: Timely Access to Treatment in the ADM System of Care

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  1. ADM SYSTEM ofCARE& Client’s Rights Chris Freeman-Clark, MPA, LISW-SCoordinator of Forensic ServicesCo-Chair SC Hoarding Task Force Sept 19, 2019

  2. “Successful, long term recovery is built on a foundation of hope.” 2017 Report to the Community, Summit County ADM Board

  3. Hopeful

  4. Hopeless “SUBJECT NAKED IN STREET AND VERY DELUSIONAL. SUBJECT SAID HE WANTED TO DIE BY GETTING RUN OVER SO "IT" WOULD HAPPEN.” - CIT Narrative

  5. Hopeless “Officers dispatched… ref fight between girlfriend and boyfriend. Subject 2 blocks from her home… wearing tank top and barefoot..temperature around 0. She was crying…states she cut her leg earlier to make herself bleed…has thoughts of suicide..she was raped at 5 years old..tonight took 2 Vicoden and 5-7 beers.” APD CIT Jan 2010

  6. The ADM System of Care offers… …Hope through timely access to treatment - 2017 ADM Report to the Community

  7. Timely Access

  8. Treatment: but not just any kind of treatment: • Evidence based (studied, scientifically validated) • Cost Effective (for participant and tax payers • Minimally invasive (see Client’s Rights)

  9. Evidenced Based Practice: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual (patient/client/consumer).” - Dr. David Sackett

  10. EBP Fidelity and Outcomes • Is the EBP being implemented in the way that it was designed? • ADM Fidelity Reviews/ Dr. Ellington • Are we getting the expected + outcomes from implementation of the EBP?

  11. How does Summit County offer hope through timely access to treatment?

  12. Summit County ADM Board plans November renewal levy ... https://www.ohio.com › news › 20190508 › summit-county-adm-board-pl... • The levy would be used for mental health and recovery programs for children, adults and families in the county and for the acquisition, …ByBeacon Journal/Ohio.com. Wednesday. Posted May 8, 2019 at 11:09 PM Updated

  13. Local property tax levy funds 78% of ADM Board disbursements. (BALANCE= PRIMARILY STATE/FED)

  14. Some AGENCIES/AFFILIATIONS

  15. ADM Board responsibilities: • Plan and identify service • gaps • Distribute $$$ • Coordinate, collaborate, • facilitate • Measure

  16. MENTAL HEALTH UNIT SCJ (SPA) MUNI AND CP COURTS CSS ADM NORTHCOASTHOSPITAL ORIANA HOUSE

  17. Past Service Gaps:

  18. Past Service Gaps:

  19. Evidenced Based Practice: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual (patient/client/consumer).” - Dr. David Sackett

  20. Some Evidenced Based Interventions • CET - Cognitive Enhancement Therapy • CBT - Cognitive Behavior Therapy • PAX Good Behavior Games • Mental Health Courts • Drug Courts • Medication

  21. Client Rights see OAC 5122-26-18 Every individual is protected by a system of rights. Some: treated with consideration, respect for personal dignity, autonomy and privacy. To be treated in the least restrictive, feasible environment A listing of those rights is provided in your CIT Manual.

  22. Client Rights A listing of those rights is provided in your CIT Manual. Problem? • Caseworker > Supervisor > Dept. Director > Agency Client’s Rights Coordinator > • ADM Client’s rights coordinator (HOLLY CUNDIFF) 330-564-4087 HCUNDIFF@ADMBOARD.ORG > Ohio Dept. of Mental Health & Addiction Services

  23. WHO to call? CSS: Bruce Winer 330-253-9388 x461 Bruce.Winer@cssbh.org Portage Path: Adam Kulesza - 330-253-3100 x1229 Akulesza@portagepath.org ADM: Holly Cundiff - (330) 564-4087 hcundiff@admboard.org

  24. Contact with SPMI residents • Behaviorally descriptive is good; quotes are good. (specific unusual behaviors, dress, behavior, mood, speech, non-verbals) • Do you have a case manager (“community rehabilitation specialist” or CRS? (or SSA) • Where do you get your medicine? Do you get shots for your medicine?

  25. Competency- Unrestored? • For F3,4,5 and Misdemeanors: If unrestored, Dismiss or File Affidavit in Probate, then dismiss criminal charge • For incompetency: (1) must have mental disease or defect; (2) symptoms from (1) impede ability to understand the charges, or, assist defense

  26. How often is an NGRI Defense raised in felony cases? • 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8

  27. How often is an NGRI Defense successful in felony cases? • 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8

  28. How often is an NGRI Defense raised in felony cases?

  29. How often is an NGRI Defense successful in felony cases?

  30. 49 NGRI or ISTU-CJ clients 12 ISTUCJ and 37 NGRI 12 Female and 37 Male 1 Year (shortest) LIFE (longest) n=8 21 Hospital or DD Center 19 - Conditional Release (18 in Summit County)

  31. As an attorney why would I,or not, encourage an NGRI defense?

  32. Conditional Release • Common orders: • Medication compliance • 24/7 Supervised housing at discharge • No criminal activity • No drugs, alcohol • No out of state travel • Suzanne Hopper Act Registry (Form 95)

  33. Success?? “Most of the problems come when we don’t have anything to do. Keep us busy!” - Consumer Lisa Marie Griffin CIT training, 9/18/18 On CR, violence risk and recidivism factors are assessed and protective factors are encouraged.

  34. Violence Risk Assessment • 10 Historic Risk Factors • 5 Clinical • 5 Future • Increases Risk Lowers Risk • Command halluc A+ family • Fixed delusions  Compliant • ANY drug/ETOH use  Work/busy • Antisocial  Min. viol hx

  35. Successes • 1. Most on CR have dramatic decrease in criminal activity • 2. We tend to catch decompensation early • 3. John, 20 hour manager at Panera • 4. Mary, ¾ time at restaurant for 10 years • 5. Sean, 20 years public library job

  36. Resources for CIT First Responders • Https://namisummit.org • https://nami.org • https://www.nimh.gov • https://samhsa.gov

  37. QUESTIONS??

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