ADM SYSTEM of€¦ · 11.09.2019 · ADM SYSTEM of CARE & Client’s Rights Chris Freeman-Clark,...
Transcript of ADM SYSTEM of€¦ · 11.09.2019 · ADM SYSTEM of CARE & Client’s Rights Chris Freeman-Clark,...
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ADM SYSTEM of CARE
& Client’s Rights
Chris Freeman-Clark, MPA, LISW-S Coordinator of Forensic Services
Co-Chair SC Hoarding Task Force
Sept 19, 2019
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“Successful, long term recovery is built on a foundation of hope.”
2017 Report to the Community, Summit County ADM Board
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Hopeful
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Hopeless
“SUBJECT NAKED IN STREET AND VERY DELUSIONAL. SUBJECT SAID HE WANTED TO DIE BY GETTING RUN OVER SO "IT" WOULD HAPPEN.” - CIT Narrative
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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
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…Hope through timely access to treatment
- 2017 ADM Report to the Community
The ADM System of Care offers…
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Timely Access
PAST
PRESENT
Central Assessment: 50 days avg from call to assessment
Decentralized assessment: most common wait is one day
No follow up system for opiate overdoses > lots of overdose > treatment > overdose/or death
QUICK RESPONSE TEAMS (9 TEAMS) follow up team contact within a week decreases cycling and intervenes when motivation is highest ; Naloxone distribution
Northcoast Forensic Discharges – 6-7 months
3 to 4 months
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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)
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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
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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?
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How does Summit County offer hope through timely access to
treatment?
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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, …By Beacon Journal/Ohio.com. Wednesday. Posted May 8, 2019 at 11:09 PM Updated
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Loc a l p roperty tax levy funds 78% of ADM Board d isbursements. (BALANCE= PRIMARILY STATE/ FED)
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Some AGENCIES/AFFILIATIONS
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ADM Board responsibilities: • Plan and identify service gaps • Distribute $$$ • Coordinate, collaborate, facilitate • Measure
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ADM
MENTAL HEALTH
UNIT SCJ (SPA) CSS
ORIANA HOUSE
NORTHCOAST HOSPITAL
MUNI AND CP COURTS
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Past Service Gaps: PAST SERVICE GAPS
First responders’ knowledge base re: SPMI
High incarceration rate for SPMI clients
Hoarded homes identified very late or not at all
Rising opiate overdoses leading to deaths
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Past Service Gaps: PAST SERVICE GAPS ADM Response
First responders’ knowledge base re: SPMI
CIT and education improved knowledge base
High incarceration rate for SPMI clients
Length decreased; quick hospitalizations = fewer bed days; MH Courts
Hoarding individuals unidentified (approx 22,000 in county); service/expensive very late
- Hoarding Task Force; Hoarding education; Hoarding Conference; Partnerships w Health Dept; early intervention focus
Rising opiate overdoses leading to deaths
- Awareness campaigns; overhaul assessment process; increased bed funding; Opiate Task Force; naloxone education and kit distribution
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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
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Some Evidenced Based Interventions
• CET - Cognitive Enhancement Therapy • CBT - Cognitive Behavior Therapy • PAX Good Behavior Games • Mental Health Courts • Drug Courts • Medication
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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.
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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 [email protected] > Ohio Dept. of Mental Health & Addiction Services
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WHO to call? CSS: Bruce Winer 330-253-9388 x461 [email protected] Portage Path: Adam Kulesza - 330-253-3100 x1229 [email protected] ADM: Holly Cundiff - (330) 564-4087 [email protected]
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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?
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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
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How often is an NGRI Defense raised in felony cases?
• 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8
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How often is an NGRI Defense successful in felony cases?
• 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8
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How often is an NGRI Defense raised in felony cases?
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How often is an NGRI Defense successful in felony cases?
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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)
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As an attorney why would I,or not, encourage an NGRI
defense?
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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)
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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.
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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
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LOWER RISK HIGHER RISK - Early detection and treatment - Years without treatment - Later onset of symptoms - Early onset of psychosis - Accepting of Injectable meds and tolerant
- Intolerant of injectable meds
- Supportive, high mental health IQ Family and friends
- Dysfunctional family; poor understanding of mental illness; member with serious mental illness
- Female, older - Male, young - Drug/alcohol abstinence - Drug use esp difficult to detect
(cocaine, alcohol , new drugs - HS completion + successful work hx - No vocational ability, poor work
history, - No antisocial; no antisocial friends - Antisocial PD + Antisocial friends
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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
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Resources for CIT First Responders
• Https://namisummit.org • https://nami.org • https://www.nimh.gov • https://samhsa.gov
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QUESTIONS??