Prepared by : Patrick Kanary, M.Ed., Director Richard Shepler, Ph.D., PCC-S Jane Timmons-Mitchell, Ph.D.

1. Prepared by :Patrick Kanary, M.Ed., DirectorRichard Shepler, Ph.D., PCC-SJane Timmons-Mitchell, Ph.D. ODMH Lead: Linda Garrick, MSW, LISW-S Presentation to the Planning Council of the Ohio Department of Mental Health Center for Innovative PracticesCollege of Public HealthKent State University

2. Center for Innovative Practices • Founded in 2000 as part of the Ohio Department of Mental Health’s Coordinating Centers of Excellence approach to dissemination of evidence based practices • Publicly and privately funded technical assistance center • identifies and promotes the use of specific evidence based behavioral interventions (e.g., MST) for youth and their families • Develops partnerships and affiliations with EBP-BP developers and other relevant organizations in order to implement strategies • Increases awareness of and access to EBP • Assists communities in development of EBP • Participates in state , local and national program and policy discussions regarding child and family behavioral health

3. Purpose of the Project CIP Portfolio Purpose To provide local and state level assistance for the identification, dissemination, implementation, and evaluation of evidence based and promising practices for youth and families with behavioral health needs. • Multisystemic Therapy-MST • Intensive Home Based Treatment-IHBT • Integrated Co-occurring Treatment-ICT • Co-occurring Disorder consultation-COD • Education, dissemination on effective practices • Training, coaching • Resilience framework • Suicide Prevention initiative • Evaluation

4. PMW Deliverables

5. Impact and Evaluation Mechanism to Measure Impact MH System Stakeholder/Consumers Evidenced-based and promising practices are available to youth and families Enhance the quality of life for many of Ohio’s most challenged youth and families More youth stay at home and families stay together and positively participate in community life Enhanced resilience • Education and awareness at state and local levels, about strength based approaches to treatment and support • Availability of tools and resources to implement best practices • Advocate for the inclusion of children and families in key decisions • Compliance with Olmstead Act • Increase practitioners’ skill levels • Assists in fulfilling SAMHSA requirements

6. How We Achieve This • Training: IHBT; MST; ICT; Resiliency; wraparound • TA: implementation; best practices • Tool development • Clinical Consultation and Coaching • Staff development and training • Quality management through fidelity and outcomes, e.g., significantly increased teams’ ability to collect and manage with CIP help • Strategic planning, participation and facilitation • System level decision making: Policy (Medicaid)

7. Lucas Lake Ashtabula Williams Fulton Geauga Ottawa • Projects being implemented within Ohio's 88 counties • STATE WIDE IMPACT • IHBT; MST; ICT; and other Home-Based Sites • FY 09, 10, & 11 • 58 Counties Cuyahoga Wood Lorain Trumbull Defiance Henry Sandusky Erie Portage Seneca Huron Paulding Medina Mahoning Summit Putnam Hancock Crawford Wyandot Richland Ashland Allen Stark Columbiana Van Wert Wayne Hardin Carroll Auglaize Holmes Morrow Mercer Marion Jefferson Knox Tuscarawas Coshocton Logan Shelby Union Delaware Harrison Darke Champaign Licking Muskingum Miami Guernsey Belmont Clark Franklin Preble Montgomery Madison Noble Monroe Perry Fairfield Morgan Greene Fayette Pickaway Hocking Washington Warren Clinton Butler Ross Vinton Athens Hamilton Highland Clermont Pike Meigs Jackson Brown Adams Gallia Scioto Lawrence

8. Projects Being Implemented Within Ohio's 88 Counties: Resiliency Ohio-Statewide Reach • Resiliency Leadership Ohio began in 2005 and has included youth and families from around the state in Resiliency Leadership Ohio (Akron, Canton, Camden, Cincinnati, Cleveland, Delaware, Columbus, Jackson, Lebanon, Marion) • Statewide dissemination of youth, family, and provider resiliency forums in collaboration with the Ohio Federation for Children’s Mental Health • Website available to all throughout the state

9. Ability to Reach Culturally Diverse Populationsby Respecting Families • Rise Sally Rise collaboration • Incorporate culturally competent best practice principles into IHBT trainings • Participation in the deaf and hard of hearing youth services workgroup • All video products represent diverse populations and include captioning • Culturally diverse family story videos • All workgroups (e.g., Resilience) are culturally diverse

10. Ability to Reach Culturally Diverse Populations through Family Driven, Strength-based Home Based Treatments (MST, ICT, IHBT) • Developed culturally competent best practice principles for IHBT • Cultural competency training module for IHBT (also included in the Rules) • Understanding a youth’s culture is key to the social ecology within which the youth lives • Interventions are designed with cultural context in mind Effectiveness of MST with Minority Youth: • Meta-analysis of EBP’s for youth • Included 5 MST clinical trials • Ethnicity did not moderate outcomes • MST showed positive effects for African-American youth with externalizing disorders

11. Ethnicity of IHBT Youth FY 10 257 412 50

12. Progress on the incorporation of the agreed upon Planning Council Recommendation SFY 11 deliverables1. Continue to partner with ODMH and ODJFS to add IHBT to the state Medicaid plan • Assisted ODMH in the development of the IHBT Medicaid Project Charter • Appointed ODMH external project lead • Number of meetings (FY 10: Four meetings 10; FY 11: Three joint meetings with ODMH, ODJFS, CIP)

13. Progress on the incorporation of the agreed upon Planning Council Recommendation SFY 11 deliverables2. Expand services FY 10 FY 11 MST Cuyahoga Juvenile Court: July 1, 2010 Cuyahoga DCFS scheduled for expansion by w team January 2011 Hancock County tentatively scheduled for new team sometime in 2011 IHBT Hocking County: IHBT development and consultation First Learning Collaborative initiated: Northeast (Northeast) Integrated Co-Occurring Treatment: Franklin County collaboration with Juvenile Court , Nationwide Children’s Hospital and ODYS • Multisystemic Therapy • Lucas County • Intensive Home-Based Treatment • Summit County: Child Guidance and Family Solutions- Summit County IHBT certification and support • Lorain County: Applewood and Bellefaire certification and support • Ashtabula County

14. Progress on the incorporation of the agreed upon Planning Council Recommendation SFY 11 deliverables3. Demonstrate effectiveness of program • Maintain an MST data base for all teams and track all outcomes • IHBT data base used in FY 09 to collect, analyze and share outcomes for participating IHBT sites • IHBT certified teams all reviewed for fidelity in FY 09 • Developed a cost benefit calculation for in-home services • MST sites (in the aggregate) either meet or exceed adherence requirements • Ohio MST sites compare favorably to national and international outcomes

15. Demonstrate Program EffectivenessFindings from IHBT Grant, FY 09394 youth served Placements Avoided • 86% of youth served, all at-risk of out of home placement, were maintained at home and in the community at discharge School Success • Passing grades increased from 65 to 77%; • Disciplinary problems decreased from 68 to 49%; Juvenile Justice Outcomes • 50% drop in youth arrested (44% to 21%);youth on probation (27.5 to 13%);youth detained (13.5% to 7.1%)

16. Demonstrate Program EffectivenessFindings from IHBT Grant FY 09 (cont’d) Substance Use Outcomes • Alcohol use decreased from (11.9%) at admission to (1.9%) at discharge • Drug use decreased from (15.8 %) at admission to (4.2%) at discharge. Mental Health Outcomes • Youth functioning significantly improved; • Youth mental health significantly improved; • The results for all raters and all subscales were highly statistically significant and demonstrated reliable change (Ohio Scales)

17. Demonstrate Program EffectivenessMST Dashboard FY 09, FY 10, FY 11

18. Demonstrate Program EffectivenessAggregate Ohio Scales Scores At Admission and Discharge—Worker Ratings Based on 296 cases p<.0001 p<.0001

19. Youth Served in IHBT Gender Age

20. IHBT Ohio Scales: Workers’ Problem Severity and Functioning Scores at Intake and Discharge Total 88 workers across 5 sites

21. IHBT Ohio Scales: Parents’ Problem Severity and Functioning Scores at Intake and Discharge Total 56 parents across 3 sites

22. Cost Effectiveness of the Project • Reduced out of home placement cost • “Savings” across multiple systems

23. Cost Benefit AnalysisIHBT Grant (394 youth) • Over 16.4 million dollars in placement costs saved at the cost of approximately 3 million dollars (IHBT for 394 youth) • Total Cost Benefit over 13.4 million dollars saved for 394 youth served (IHBT grant 2009) • The total cost savings per youth is $34,154 • For everydollar spent in IHBT/MST there was a return of $5.55 or 555% in placement costs avoided.

24. Cost Benefit Analysis

25. Fiscal Impact for System Stakeholders

26. Leveraging FundsHow does the project leverage (use additional funds from another source) other funds to implement the project? • The Block Grant provides the foundational platform for CIP to attract additional resources in order to fully deliver the outcomes in this report. • CIP stakeholders benefit from all deliverables, regardless of funding source. • Every $1.00 of Block Grant funds helps generate $2.00 from other sources • Ohio Department of Mental Health- Block Grant and TSIG • Gund Foundation • Ohio Department of Youth Services • Contracts and consulting agreements with providers, counties, organizations

27. Collaborations (FY 09; 10; 11) • Ohio Federation for Children’s Mental Health • Ongoing statewide resiliency product development and dissemination • Ohio Mental Health Network for School Success • Resiliency: Archiving Youth Testimony • Nominated IHBT sites for consideration of their Quality and Effective Practice Registry • Integrate Resiliency Ohio work into schools. • Transformation State Incentive Grant Projects • Rise Sally Rise • Ohio Suicide Prevention Foundation • Collaborative video on suicide prevention and resiliency • Resiliency • Youth and Young Adults in Transition • SAMI CCOE • Presentation at their annual conference • Agencies are referred from SAMI to CIP for consultations on best practice for youth with co-occurring disorders

28. Challenges/Barriers • Challenging factors in getting IHBT Medicaid: • Time- federal movement is different than the state movement • Economy: need to craft argument that positions IHBT Medicaid as a cost savings to the state • Program level funding • Without required data collection it is difficult to demonstrate effectiveness to stakeholders • Broaden the appeal of IHBT beyond the Behavioral Health system

29. Plan to overcome challenges/barriers • Program level funding • Continue to move forward with IHBT Medicaid discussions • IHBT Medicaid • Develop cost benefit arguments for new administration • Keep discussion on the table • Advocate for inclusion of outcome requirements into IHBT rule • Continue to promote IHBT and its funding in other youth serving systems which benefit, particularly juvenile justice and child welfare

30. Lessons Learned: MST/IHBT Implementation Issues • Technical Assistance is needed to maximize effectiveness of IHBT • Agency/program level funding requires more than Medicaid • A uniform data collection system is necessary in order to provide timely clinical feedback and track quality improvement • Stakeholders/funders increasingly relying on data to make financial decisions • Multiple partners and multiple systems are needed to support implementation