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

“Successful, long term recovery is built on a foundation of hope.”

2017 Report to the Community, Summit County ADM Board

Hopeful

Hopeless

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

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

…Hope through timely access to treatment

- 2017 ADM Report to the Community

The ADM System of Care offers…

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

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)

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

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?

How does Summit County offer hope through timely access to

treatment?

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

Loc a l p roperty tax levy funds 78% of ADM Board d isbursements. (BALANCE= PRIMARILY STATE/ FED)

Some AGENCIES/AFFILIATIONS

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

ADM

MENTAL HEALTH

UNIT SCJ (SPA) CSS

ORIANA HOUSE

NORTHCOAST HOSPITAL

MUNI AND CP COURTS

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

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

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

Some Evidenced Based Interventions

• CET - Cognitive Enhancement Therapy • CBT - Cognitive Behavior Therapy • PAX Good Behavior Games • Mental Health Courts • Drug Courts • Medication

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.

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

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

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?

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

How often is an NGRI Defense raised in felony cases?

• 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8

How often is an NGRI Defense successful in felony cases?

• 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8

How often is an NGRI Defense raised in felony cases?

How often is an NGRI Defense successful in felony cases?

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)

As an attorney why would I,or not, encourage an NGRI

defense?

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)

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.

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

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

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

Resources for CIT First Responders

• Https://namisummit.org • https://nami.org • https://www.nimh.gov • https://samhsa.gov

QUESTIONS??