Ohio SSRP All Demonstration Site Meeting December16, 2016

Ohio SSRP AllDemonstration Site

Meeting

December16, 2016

Alabama Administrative Office of Courts

New YorkState Unified Court System

ColoradoJudicial Department

Judicial Branch of

IowaSupreme Court of

Ohio

2014 State System Reform Program

Welcoming Remarks

Michael L. Buenger, Esq.Administrative Director,Supreme Court of Ohio

State Team Introductions

LaTonya HarrisPolicy Analyst,

Supreme Court of Ohio

Introductions – Phase II Demonstration Sites

Expansion Sites• Hancock County• Hardin County• Summit County

Infusion Sites• Ross County• Wayne County

Hancock County

1. Project Team Members

2. Project Direction and Goals

Hardin County



Summit County



Ross County



Wayne County



Lack of Data = Lack of Fuel to Drive

Expansion or Infusion

Without it, you will not reach your destination

FOR EXPANSION AND INFUSION

OhioMHAS Data Expectations

Carol Carstens, Ph.D.Sr. Health Services Policy Analyst,Ohio Department of Mental Health

& Addiction Services

SSRP Data Dashboard

• Are you able to identify the extent to which families are being identified and referred for assessment and services?

• What data points can you track?

Demonstration Site Example:Union County

Systems Walk-Through

Screening

Assessment

Referral

Monitoring

What information is missing?What gaps are in current system? What process needs clarification?What are areas for improvement?

County Reports – 10 minutes per team

1. Identified Gaps/Barriers

2. Conflicting Practices/Policies

3. Lessons Learned

4. Questions

Hancock County



3. Lessons Learned

4. Questions

Hardin County



3. Lessons Learned

4. Questions

Summit County



3. Lessons Learned

4. Questions

Ross County



3. Lessons Learned

4. Questions

Wayne County



3. Lessons Learned

4. Questions

Take a Break (15 minutes)

Working Lunch

Family Identification and Screening: SACWIS Implications

Kristine Monroe, MSW, LSWProgram Administrator 1,Bureau of Systems & Practice Advancement, ODJFS

SACWIS Substance Abuse Screening Tool

SACWIS Intake Enhancements Lead to Improved Data

• SACWIS ‘Intake Usability’ Enhancements were Released into SACWIS Production on October 27, 2016

• The Enhancements included the addition of a required question, ‘Is parent or caregiver substance abuse being reported by the referent?’

• If the screener answers ‘Yes’ to this question, the screener is required to document how the reporter became aware of the substance abuse and to document the drug type(s) being abused.


Data for Intakes Received Between 10/28/2016-12/1/2016• 24,113 Intakes Received, of those

• 4958 had a ‘Yes’ value for the new substance abuse question (20.56%)• 19,155 had a ‘No’ value for the new substance abuse question (79.44%)

• 17,270 Child Abuse or Neglect Intakes Received, of those• 4211 had a ‘Yes’ value for the new substance abuse question (24.38%)• 13,059 had a ‘No’ value for the new substance abuse question (75.62%


Data for Intakes Received Between 10/28/2016-12/1/2016, Cont. • 7868 CA/N Intakes Screened In, of those

• 2232 had a ‘Yes’ value for the new substance abuse question (28.37%)• 5636 had a ‘No’ value for the new substance abuse question (71.63%)

• Multiple Drug Types can be Selected Per Intake. Most Commonly Selected Drug Types

• Marijuana - 798 Intakes• Alcohol - 495 Intakes• Heroin – 444 Intakes• Cocaine – 318 Intakes• Opiates – 276 Intakes

Sharing and Q&A

• Screening Implications – Coshocton County • Phase I sites share how they have engaged clients• Phase I sites share how they engaged defense counsel

Phase II Demonstration Site Charge and Expectations

• Documents Due by January 13, 2017• Budget

• Scope of Work

• Governance Structure (if not already complete)

• Action plan (if not already complete)

• Submit quarterly reports as required• Participation in the GRC evaluation• Continue participation in designated

workgroups

GRC Update on Data Analysis & Evaluation

Dushka Crane, Ph.D.Director of Healthcare Integration,Ohio Colleges of Medicine Government Resource Center

Daniel Weston II, MS, MBAConsulting Research Statistician,Ohio Colleges of Medicine Government Resource Center

Exploring Windows of Opportunity for Systems Change

• Expand scale and capacity of existing FDCs

• Expand number of FDCs

• Infuse FDC ingredients into all CWS cases impacted by parental substance use

Phase I Demonstration Site Analysis of Lessons:Expansion Sites

• Union County

• Lucas County

• Clermont County

Union County

1. Project Goals

2. Project Strategies Tested

3. Progress and Accomplishments

4. Identify Gaps & Barriers to

focus on during implementation

Union County Common Pleas Court, Juvenile Division

1. Project Goals





Union County Data• Third-fastest growing county in Ohio for 2010 census.

• 2000 Census: 40,909• 2010 Census: 52,300 (+27.8%)

• Unintentional Overdose Deaths from All Opioids.• From 2000 to 2002: 0.16 percent of deaths per 10,000• From 2011 to 2013: 0.32 percent of deaths per 10,000

• Persons in Treatment for Opiate Abuse/Dependence.• 2001: 3.3% of all admissions • 2013: 35.8% of all admissions

Union County Juvenile Court Data• New Abuse, Neglect, or Dependency Cases, 2010-2015: 483 (Avg. 80 per year)

• Permanent Custody, 2010-2015: 27 (Avg. 4 per year)

• Two drug courts in the Juvenile Division.• “Family Dependency Treatment Court,” initiated 2010, certified 2014• “Juvenile Treatment Court,” initiated 2007, certified 2014

• According to Union County DJFS/CPS, 57% of all Abuse, Neglect and Dependency cases filed in 2015 involved SUD.• This is before the implementation of UNCOPE.

Union County’s Challenges• Low program entry numbers• High case management needs, lack of in-home case management• Need for additional treatment options• Long waiting periods for participants in need of a higher level care (residential services)• Lack of local ambulatory detox; lack of local detox• Lack of adequate data• Lack of software to appropriately track data (all systems)• From removal/initial filing to adjudication/disposition to entrance into Treatment Court may

be too long

Union County’s Project Goals Engage in the SSRP process; trust the process to help us take a look at our system and push ourselves to improve Streamline entrance into Treatment Court to achieve earlier admission Improved outcomes for participants Enhance Treatment Team focus on recognized, drug court best practices Increased contact with Treatment Team Members Review current local programming, assess needs Increase frequency of visitation with children Focus on the Participant as an addict in recovery and as parent Communicate openly and quickly across systems Data collection and analysis

SSRP: Objective. Often.SSRP helped us look at our Treatment Court and its systems OBJECTIVELY and OFTEN.

What are we missing?Are we missing parents with SUD and co-occurring disorders?

Are some processes as tight as could be?Rapid responses to relapseImmediate entry into Treatment Court

Are some processes so tight they are rigid and inflexible?Incentives SanctionsEquality in response for all participantsImmediate response for true accountability

How do other Courts and Systems handle the problem we are having?

SSRP: Objective. Often.We were definitely missing parents with SUD – the implementation of UNCOPE by Children’s Services, which acted as a sieve to catch those parents who might otherwise be lost. CPS is continuing to increase use of UNCOPE. We now offer immediate entry into Treatment Court. Once parents are under the Court’s jurisdiction, they are ordered to meet with Dr. Ahern for immediate assessment.We track all sanctions and incentives to increase equal responses to non-compliance and compliance; participants can lose faith in treatment if they don’t feel it’s fair. Through SSRP-led phone conferences and meetings, our Court has been able to learn from other Courts handle various concerns.

Refocus on drug court best practices Trauma-Competent Training and Implementation Trainings – How often? Where? How can we afford them? Strength-based perspectives Incentives & Consequences Structure of Team Meetings Economy of Discussion Length of Meetings Structure of Status Hearings

Refocus on drug court best practices Trauma-Competent Training and Implementation Trainings Ohio Specialized Docket: Free NADCP Strength-based perspectives Incentives “Families Matter,” a non-profit organization, provides funding for incentives United Way Grant provided additional funding in 2015 Fishbowl implemented Structure of Team Meetings Revamped “Status Hearing” sheets allow Tx Team to focus discussion, leaving case management to case managers,

not the Court Preparation plowed the way for faster, more focused meetings Structure of Status Hearings

Streamline entrance into Treatment Court

Study of all Systems’ duties and timelines Use of SSRP documentation to chart all systems Universal screenings needed Bring parents into Treatment Court pre-adjudication

Streamline entrance into Treatment Court

Increased awareness of systems’ duties and timelines; with that mutual understanding comes respect, not frustration

SSRP documentation opened the door for the Treatment Team to improve the Treatment Court together

Children’s Services implementation of UNCOPE – unprecedented step forward in early detection, intervention

Maryhaven’s implementation of SBIRT Parents may now enter Treatment Court as soon as a complaint is filed, instead of

waiting

Focus on the parent as well as the recovering addict

Immediate access to treatment

Oversight of the parent as she/he travels through all three systems simultaneously

Focus on the parent as well as the recovering addict

Immediate access to recovery If UNCOPE indicates SUD, Children’s Services takes parent to Maryhaven for

immediate screening MAT available locally In-patient treatment as close as Franklin County Recovery Housing available locally Income-based medical care available locally Oversight of the parent as she/he travels through all three systems simultaneously Children’s Services, Maryhaven and the Court all provide parenting classes, supportMonitor progress of participant’s personal parenting goals, both short and long-term

Communication across systems Are we really talking? Or are we just meeting once a week to discuss participants?

Can we use SSRP to help us communicate openly about barriers and goals in our own system?

Communication across systemsJoint participation of all local systems sharpens system-wide response, mutual oversight

SSRP provided many opportunities to communicate across systems, to design responses as a true team Together we discussed our barriers and goals Together we generated solutions

Focus: Gaps and Barriers Relationships across systems is key – have meetings to discuss Treatment Court goals, and their barriers Carefully consider the number of meetings held locally; avoid fatigue in addressing critical

issues.Funding Identify strong community members who would be willing to organize, and fundraise for a

non-profit to support incentives, training, educationData compilation Start early. Turnover can slow progress in all systems Identify how goals will be accomplished if turnover occurs, because it will

Lucas County

1. Project Goals





Clermont County

1. Project Goals





Phase I Demonstration Site Analysis of Lessons:Infusion Sites

• Ashtabula County

• Coshocton County

• Henry County

Coshocton County

1. Project Goals





Coshocton County1. Project Goals


3. Progress and

Accomplishments

4. Identify Gaps & Barriers to focus

on during implementation

Coshocton County Juvenile Court = $20,000

Equipment / Technology Expanded Drug Testing Consultant & Professional Quarterly Training

$6,000

$4,500

$9,000

Coshocton County Job & Family Services = $20,000

Training, Equipment & Supplies Consultants & Professional Comrehensive Case Manager

$3,000

$2,000

$15,000

Project Goals

* Develop Local Governance Structure

* Continue Regular Core Team Meetings

* Involve Core Team in State Quarterly Meetings

* Develop a Mapping Template for Local Systems

* Create MOU’s with Community Partners

* Enhance Infusion Principals for Overall Child Welfare System, to benefit both A/N/D Cases and FDC involved clients

* Develop S/A Best Practice Training across systems

* Develop Uniform Data System for improved communications

COSHOCTON COUNTY SSRP

Project Strategies Tested

* Implement UNCOPE Screening Instrument July 1, 2016 on all cases screened into child welfare system

* Refer for Further S/A Assessment prior to Adjudication

* Early Engagement of child welfare clients prior to adjudication, and extraPeer support

* Implement 7-Day a week drug testing for Family Drug Court and Child Welfare cases

• Improve Efficiencies in Courtroom Proceedings:+ Service of JE on clients and partners+ Shared data exchange system – Team Meetings+ Neatness of Court Templates

Progress and Accomplishments

* FDC at capacity with 11 active cases, 14 pending = 25 possible cases!- 3 in Residential Treatment- 5 Accepted into Drug Court, awaiting Adjudication- 9 Potential Referrals Identified

* UNCOPE administered 192 times

* 7 Day a Week Drug Testing implemented 10-1-16

* JFS Case Manager assisting with support strategies for early referrals

* More frequent A/N/D Case reviews are occurring

* Community Center open with sober activities

* State Senator visited Coshocton County JFS, learned about:child protective challenges & went on home visits with caseworkers

- Funding, Staff Turnover, Opiate/Drug Crisis- 2016 = 368 intakes, 43% drug issues- 109 ongoing cases, 56% drug related- 30% children placed with kin- 42 children in foster care with 67% of their parents having S/A issues

* CIP Grant, Salary Subsidy Grants, JABG Grant, SSRP Project, Friends of Coshocton County Drug Court

Progress and Accomplishments Continued

Identify Gaps & Barriers to focus on during implementation

* Challenge to create database with limit on funding

* Training challenge to schedule with busy local schedules

* Capacity Issues with current FDC program

* Staff Turnover at child welfare system

* Access & Communication with Residential Treatment

* Local S/A Treatment System Stressed to handle volume, added 2 staff for assessments on an additional day

Actual Period

1.# of Referrals to Child Welfare Intake that were Accepted for Assessment 125

2. # of Parents Screened with Screening Tool 192

3. # of Parents Needing Further SUD Assessment as determined by screening tool 40

4. # of Parents Referred for SUD Assessment 295. # of Parents Completing SUD Assessment 266. # of Parents Receiving SUD Diagnosis 267. # of Parents Referred to SUD Treatment 268. # of Parents Referred to Other Interventions 38

9. # of AND Cases Filed18 /38 kids

10 # of Infusion Parents Reunified with Children 1 *

SSRP Infusion = UNCOPE SCREENING

COUNTY SPECIFIC NOTES:1. 125 = Actual Number of cases screened in for assessment2. 192 = Actual number of adults in the home that were screened with UNCOPE. May not have been a parent, but could have been paramour, relative, etc.3-8. This is the number of adults. This does not mean they were parents10. Is only cases involved in Family Drug Court

COSHOCTON COUNTY July 1, 2016 through November 30, 2016

THANKS TO OUR COMMUNITY PARTNERS!

ALLWELL BEHAVIORAL HEALTHCARE ATTORNEY JETTA MENCERATTORNEY CORIE LAHNACOSHOCTON BEHAVIORAL HEALTH CHOICESCOSHOCTON COUNTY JOB & FAMILY SERVICESCOSHOCTON COUNTY JUVENILE COURTCOSHOCTON COUNTY PROSECUTORS OFFICEFRIENDS OF COSHOCTON COUNTY DRUG COURT

Henry County

1. Project Goals





Ashtabula County

1. Project Goals





SSRP ASHTABULA County

Project Goals

1. To evaluate the current systems and learn what is working and

what is not working in regards to how the systems function

collaboratively to achieve common goals for the individuals they

serve.

2. To infuse evidence-based/best practice principles into the child

welfare process to improve outcomes for children and families (not

just what happens at CSB but what happens at BH agencies and

the court)

Project Strategies Tested

1. Universal screening for early identification

2. Immediate access as outlined in the American Standards to increase engagement in

treatment

3. Increased communication and collaboration

4. Data collection and data sharing

5. Shared goals

6. Family Drug Court

Progress and Accomplishments1. Implemented GAIN-SS screening tool at the beginning of a child welfare case

2. Trained CSB staff and community partners on the screening tool and the SSRP Infusion process

3. Assessed training needs of child welfare staff and CSB Director implemented training plan

4. Completed agency walks-throughs to determine current processes and opportunities for improvement

5. Developed a common referral form, release form and reporting form

6. Created and distributed flow charts based on the processes agreed upon in Ashtabula County

7. Implemented an MOU between Juvenile Court and CSB

8. Developed MOUs between behavioral health agencies and CSB and Juvenile Court (in Progress)

9. Agreed upon time frames for referring, scheduling assessments and exchanging progress reports

10. Completed communication flow chart to identify where exchange of information is needed and developed common language

11. Agreed upon standardization of drug screening process

12. Began work on the documents and plans for implementation of a Family Drug Court in Ashtabula County planned for the beginning of

calendar year 2017

Identify Gaps & Barriers to focus on during implementation1. Slow buy-in from line staff (clients will lie on screening, it will take too much time for little gain, referrals are

already being made why do a screening, etc.)

2. Communicating a complete understanding of what was meant by infusing evidence-based practices into the child

welfare system.

3. Identifying areas of practice where common agreement would need to drive the process. (Example: Walk-in

access great for most clients but did not work for CSB referrals as they could not be tracked by BH provider for

reporting back to the CSB worker that the client came or any results of assessments. End result was that all CSB

cases must be given and appointment.)

4. Ensuring we were using common language and common procedures due to limitations at some agencies.

SSRP Lucas County

1. Project Goals





Lucas County Project GoalsGoal 1:

Implement a universal screening tool for behavioral health disorders

Objectives:

By July, 2017 screen 100% of parents with an open LCCS investigation for behavioral health disorders with the GAIN-SS

By July, 2017 refer and link 100% of parents with an open LCCS investigation for a dual assessment as indicated by the GAIN-SS prior to referring the case to the on-going caseworkers

Lucas County Project GoalsGoal 2:

Implement a universal screening tool for identifying trauma in parents

Objectives:

By July, 2017 screen 100% of parents with an open LCCS investigation for trauma

By July, 2017 refer and link 100% of parents with an open LCCS investigation for a trauma assessment as indicated by the identified trauma tool

Lucas County Project Strategies Tested

Created a job description for the GAIN-SS Coordinator part-time contractual position

Posted the job description for the GAIN-SS Coordinator

Anticipate GAIN-SS Coordinator will be hired by January 2017

Met with the Lucas County Children Services Trauma Informed Champion group to discuss the potential of implementing a trauma screening tool for parents

Lucas County Progress and Accomplishments

Strengthened the Lucas County Advisory Committee this year by adding new partners

Increased recovery support financial resources for FDC clients through the Addiction Treatment Program Expansion through OMHAS

Partnering with other initiatives at the court and with our partners:Lucas County Healthy Babies CourtLucas County Children Services Trauma InitiativePreparing for conversion to the new Lucas County Case Management System

Lucas County Progress and Accomplishments

Submitted the Prevention and Family Recovery Initiative GrantIdentified Gaps in Parenting Services and Child Development/Therapeutic Services and Proposed Strategies to Address the Needs

Goals of the proposed Grant:1. Increase child and parent interactions through enhanced family/parenting time by

implementing a visitation coaching program2. Ensure all children ages 0-8 in Family Drug Court receive a child developmental assessment3. Improve the integration of parenting and therapeutic interventions within Family Drug

Court while transitioning from parent-focused to a family-centered approach4. Increase and create earlier access to evidence-based parenting programs for all families in

Family Drug Court

Lucas County Identified Gaps and Barriers

Delay in receiving the SSRP funding from the Supreme Court of Ohio

Turnover at Lucas County Children Services and the delay in identifying a new Assessment Manager

The multiple simultaneous initiatives occurring at Lucas County Juvenile Court and Lucas County Children Services

The slow wheels of the hiring process at Lucas County Juvenile Court

Lucas County Identified Gaps and Barriers

Specialized Docket Re-certification process this year

The Prevention and Family Recovery Initiative Grant- 4 month processLetter of InterestOn-site Consultative AssessmentRequest for Proposals

ACTION PLANNING1. GOALS - WHAT ARE THE THREE (3) MOST

CRITICAL ISSUES THAT NEED TO BE ADDRESSED FOLLOWING THE SITE VISIT?

2. ACTION STEPS - WHAT ARE THE NEXT STEPS?

3. WHAT ARE THE MOST PRESSING OR IMMEDIATE TA OR TRAINING NEEDS?

Transforming the Futures of Children and FamiliesOhio Demonstration Site Charge and Expectations

LaTonya Harris, Supreme Court of Ohio

Phase I Demonstration Site Charge and Expectations

Continue participation in monthly workgroups

Cooperate with GRC proof of concept work

Continue turning in quarterly report data

Continue with monthly reports

Closing Comments

On behalf of children and families, thank you for

the work you do!

Contact Information

LaTonya Harris | Policy Analyst | Supreme Court of Ohio65 South Front Street ■ Columbus, Ohio 43215-3431614.387.9453(telephone) ■ 614.387.9409 (fax) [email protected]

mailto:[email protected]

http://www.supremecourt.ohio.gov/

Ohio SSRP All Demonstration Site Meeting December16, 2016

Documents

Transcript of Ohio SSRP All Demonstration Site Meeting December16, 2016