FY 2010 Community Mental Health Services Block Grant Implementation Report

Helping Families. Supporting Communities. Empowering Individuals.

ILLINOIS DEPARTMENT OF HUMAN SERVICES

DIVISION OF MENTAL HEALTH

PART D OF THE FY2011 COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT APPLICATION AND PLAN

FY2010 IMPLEMENTATION REPORT
IMPLEMENTATION REPORT
NARRATIVE: SUMMARY OF PROGRESS IN FY2010
REPORT ON THE 2010 ADULT PLAN

INTRODUCTION

This report provides detailed information regarding the implementation of the Illinois DMH State Block Grant Plan for FY 2010. This first section of the Narrative for Adults summarizes Illinois' progress in addressing areas in need of improvement based upon the outcomes of the stated objectives in the FY 2010 Adult Services Plan. The following narrative description provides a statement of the level of attainment, information on how each objective was attained, and background information to provide context and purpose for each of the objectives. The objectives discussed in this section have been a crucial part of ongoing DMH planning and delivery of mental health service to adult consumers. The next Section provides a description of significant events that have impacted the mental health system in the past year. Information regarding specific allocation of block grant funds is provided in the last section of the Narrative.

CRITERION I:

Objective A1.1: Continue enhancement of the statewide system to educate consumers of mental health services in leadership, personal responsibility and self-advocacy through participation in Consumer Conferences, the use of Wellness Recovery Action Plans (WRAP), and through the Consumer Education and Support Initiative.

Indicators: 

  • Number of Regional consumer conferences held.
  • Number of participants in the quarterly regional WRAP continuing education/refresher trainings conducted in FY2010.

This objective has been accomplished. Consumer conferences were held in each DMH region during the Fiscal Year and two conferences were held in Region 5, the most expansive region of the State. More than 1,400 consumers, family members, providers, DMH and other state agency staff attended these conferences. Seven regional WRAP refresher trainings were conducted between July 1, 2009 and June 30, 2010. The average number of participants per session was 20.

Consumer Education

Consumer education is provided through a variety of venues in the state. DMH Recovery Support Specialists work with stakeholders to design, plan and convene annual consumer conferences in each DMH region. These conferences often have a well-known and /or national speaker who delivers the keynote address and who sets the "tone of recovery" for the conference. In FY2010, the following regional consumer conferences were held:

July 27, 2009 - Region 2 (Northwestern Illinois) West Conference: "Work & Wellness: Building a Meaningful Life" with 112 people attending;

Aug 13, 2009 - Region 5- South (Southern Illinois) Conference: "Recovery Opens Doors!" with 269 in attendance;

Oct 9, 2009 - Region 5-Metro East (Southeastern Illinois) Conference "Recovery: Think It! Believe It! Make It Happen!" with 310 people;

May 20, 2010 - Regions 3 & 4 (Central Illinois) Conference: "Empowerment 2010" with 363 people;

June 2, 2010 - Region 1 (Chicago Area) Conference: "The Art of Recovery" with an attendance of more than 400.

The Wellness Recovery Action Plan (WRAP) model is well established in Illinois. Through WRAP classes in community agencies and the introduction of the principles of WRAP at consumer forums and conferences, thousands of consumers throughout the state have benefited from receiving orientation and education in the principles and components of this emerging best practice in recovery-based services. Since the inception of the Wellness Recovery Action Plan (WRAP) Initiative in Illinois, more than 250 individuals (including consumers currently receiving services) have received Certificates of Achievement as WRAP Facilitators, through their completion of a 40-hour intensive course. Refresher/Continuing Education courses are held in each region bi-annually for Certified WRAP Facilitators. Currently, a toolkit for new WRAP Facilitators is being developed with the assistance of an intern from the University of Chicago. The toolkit will be submitted to the statewide WRAP Steering Committee for review and approval prior to its release to Certified WRAP Facilitators.

Objective A1.2: In FY2010, the DMH Office of Recovery Support Services will conduct a series of conference calls designed to disseminate important information to consumers across the State.

Indicators:

  • Number of conference calls completed in FY2010.
  • Number of participants in Consumer Education / Support teleconferences.

This objective was successfully achieved.

In FY2010, eleven statewide consumer education calls were held between July 1, 2009 and June 30, 2010 with a range of 300 to 700 participants at each consumer education teleconference. These calls provided a forum for discussion of service information, performance data, new developments, and emerging issues to promote consumers' awareness and knowledge.

Consumer Education and Support Initiative.

Dissemination of accurate information regarding services for consumers is the primary focus of the Consumer Education and Support Initiative. DMH has recognized the need for providing consumers with the tools they need to cogently and effectively participate in the development and evaluation of the service system. The goal of this project is to ensure that consumers of mental health services receive current, accurate and balanced information regarding changes in the service delivery system, empowering them to take an active, participatory role in all aspects of service delivery. With the themes of "Empowerment is Mine in 2009" and "New Perspectives for a New Decade" in 2010, these conference calls looked at empowerment through work, housing, and exercise of client rights in the latter part of FY2009 (April through June 2009) and have continued into FY2011 with topics appropriate to the current economic environment such as "New Perspectives on Employment", (July 2010), "Turning Challenges into Opportunities" (August 2010), New Perspectives on Living Independently"(September 2010), and "New Perspectives on Thriving in Times of Change" (October 2010).

The dates of the calls, the topics, and the number of participants in FY2010 (based on the reported number of lines) were:

  • 07/23/09: Empower Yourself With Your Doctor - 442
  • 08/27/09: Empower Yourself Through Participation - 452
  • 09/24/09: Empower Yourself With WRAP- 487
  • 10/22/09: Empower Yourself With Peer Support - 446
  • 01/28/10:Consumer Education: New Perspectives on Consumer Councils - 528
  • 02/25/10: New Perspectives on Hope in Recovery - 378
  • 03/25/10: New Perspectives on Self Determination - over 292 *
  • 04/29/10: New Perspectives on Whole Self Wellness - 545
  • 05/27/10: New Perspectives on Language and Empowerment - 343
  • 06/17/10: Consumer Education: FY11 Financial Eligibility Changes- 696
  • 06/24/10: New Perspectives on Financial Health - 367

Objective A1.3: In FY2010, continue to provide recovery-oriented training to all interested stakeholders and support the role of Certified Recovery Support Specialists (CRSS).

Indicator:

  • Number of recovery oriented training sessions provided to stakeholders.
  • Number of individuals obtaining the CRSS credential.

This objective has been successfully accomplished. Recovery oriented training has been provided and support for the Certified Recovery Support Specialist (CRSS) credential has shown gratifying results.

In FY2010, 37 recovery oriented training sessions were held for all interested stakeholders across the State. Audiences for these sessions included diverse stakeholder groups, educating consumers of mental health services, family members of consumers, mental health and addiction professionals, advocates, college students, occupational therapy professionals, and many others. Topics for these sessions have included the foundational principles of mental health recovery, Wellness Recovery Action Planning (WRAP), mentoring, advocacy, crisis planning, recovery support, spirituality, and others.

By the end of FY2010, a total of 130 individuals received competency training for the CRSS credential and were preparing for application and examination with the Illinois Certification Board (ICB). As of June 30, 2010, 132 individuals had received their CRSS certification in Illinois since examinations began, and all are in good standing with the Illinois Certification Board (ICB).

Recovery Education

Through Recovery - oriented events, persons served and staff of CMHCs were reached with the DMH recovery vision and education. These events were conducted from far northern to far southern Illinois and from highly urban to highly rural settings. The qualitative results of these events include:

  • Impact on persons receiving services who reported they found new hope, practical tools for recovery, and a sense of empowerment.
  • Impact on partnership among persons served, providers, DMH, and the Collaborative.
  • Impact on consumer and staff training approaches by modeling the role of persons with recovery experience in providing education and services.
  • Impact of modeling an adult social learning approach.
  • Impact of DMH CRSSs being trained in a consistent curriculum and approach to recovery education that can now be duplicated across the DMH regions.

The Certified Recovery Support Specialist (CRSS) Credential

In collaboration with the Illinois Certification Board (ICB), the Divisions of Mental Health, Rehabilitation, and Alcoholism and Substance Abuse developed the Illinois Model for Certified Recovery Support Specialist (CRSS). The CRSS, through collaboration with the ICB, is competency-based rather than curriculum-based. Individuals are certified as having met specific predetermined criteria for essential competencies and skills. The purpose of certification is to assure that individuals who meet the criteria for CRSS provide quality services. The credentials granted through the certification process will: (1) be instrumental in helping guide employers in their selection of competent CRSS professionals, (2) define the unique role of CRSS professionals as health and human service providers and (3) provide CRSS professionals with validation of, and recognition for their skills and competencies. Access to this new credential became available through the ICB beginning in July of 2007.

As a means of disseminating information regarding this new credential, the DHS/DMH has developed a brochure entitled "Employing Persons with the CRSS Credential." Additionally, the ICB has provided staff presence at each of the regional consumer conferences, to distribute information and respond to questions. Individuals attending consumer conferences, statewide consumer education and support teleconferences, and regional WRAP Refresher trainings, receive CEU's toward achieving or maintaining their credential through the ICB. DMH worked closely with the Mental Health Collaborative for Access and Choice to design a study guide for individuals seeking to obtain their certification. The study guide was completed and published online in November 2009.

In FY2011, the Office of Recovery Support Services is continuing to work with other system partners, including the ICB and the Mental Health Collaborative for Access and Choice (MHCAC), to develop training and study materials for persons seeking to obtain the CRSS credential. Additional information regarding this cutting edge approach in credentialing for mental health peer specialists can be found at: http://www.iaodapca.org/forms/crss/CRSS_Model.pdf

Objective A1.4: In FY2010, continue the public awareness campaign to reduce negative portrayals associated with mental illnesses. Complete an initial evaluation of the effects of the Campaign.

Indicators:

  • Materials developed for dissemination that address resource and access issues.
  • Completion of a report on the evaluation of the campaign with documented outcomes and lessons learned.
  • A report of the key achievements of the campaign and the significant public venues utilized to bring the message to all the citizens of Illinois.

This objective was met in FY2010. The campaign has continued, albeit in a limited manner and an evaluation through an outcome survey was completed early in the fiscal year.

Due to severe fiscal constraints in FY2010, funding for the Campaign was very limited. However, direct coordination by DMH staff and a Web-based approach were utilized to maintain the Campaign through the fiscal year. The campaign's Web site: www.mentalhealthillinois.org. and related activities are continuing in FY2011. New activities are on hold pending acquisition of funding. The campaign is continuing in a very basic maintenance mode with the existing website, materials, and resources.

As part of the overall campaign and in order to review the effects of the campaign on the public, DMH developed an outcome survey and engaged an independent vendor to complete the survey with a pool of Internet users. Initial survey data indicates that the campaign's strategy and messaging were effective in motivating changes in the knowledge and awareness about mental health issues and in the perceptions of persons with mental illnesses and their families. In addition, individuals who saw and heard the campaign's ads were more likely to express an intention to engage in behaviors consistent with the campaign's explicit calls to action. A report was completed on the results of the outcome survey that reflected the success of the campaign and suggested that Say It Out Loud can be a powerful tool in promoting good mental health and in reducing the stigma that too often inhibits people from seeking help for themselves or offering help to others.

"Say It Out Loud!"

The Report of the President's New Freedom Commission on Mental Health noted that the "stigma that surrounds mental illnesses is one of three major obstacles preventing Americans with mental illnesses from getting the excellent care that they deserve". One way in which to address this issue is to implement strategies geared toward reducing the stigma associated with mental illness. From FY2007 through FY2009, the Division of Mental Health allocated $200,000 every year to implement a public awareness campaign targeting adults. The DMH developed public service brochures, and T-shirts, buttons, and a variety of other items that carry the anti-stigma message and DMH phone and web contact information to access services. The campaign was targeted to the general public and a broad cross section of 'experts' or 'influencers' (providers), including Mental Health providers, Employers, Clergy, Pediatricians, Educators, etc in a position to assist consumers and families and provide them with greater information about up-to-date treatment regimens; screening mechanisms for early identification of persons at risk of developing mental illnesses, and listings of available resources with instructions for making referrals to mental health service providers. Authentic 'first person stories' were solicited for each of the target audiences with photo, story and promotional materials developed for each for inclusion on all subsequent distribution, media, venues, or marketing.

The Division also distributes materials developed and supported by SAMHSA for the national "What a Difference a Friend Makes" anti-stigma campaign. DMH contracted with a public relations firm to assist in the ongoing development of the campaign, oversee public service announcements and utilize opportunities to distribute public awareness information at large public entertainment events and through mass media outlets. The Department of Human Services has also expanded exposure of the public awareness message by insuring that the materials are distributed at the conferences and other public activities that are sponsored by other DHS Divisions.

The Survey (Evaluation) Report

The survey discussed in the report was designed to capture current knowledge and awareness, level of stigma/uniformed bias, intentions to discuss mental health and mental illness, and the extent of mental illness across all sectors of Illinois. Four representative groups from the total population of survey respondents were randomly selected to answer a specific set of questions prior to viewing a newspaper advertisement, then to listen to a corresponding radio advertisement for one of the four concepts. One representative group was randomly selected to respond to the questions without viewing or listening to an ad. After exposure to the ads, all respondents were asked to read three fictional vignettes and answer a series of questions about each character. They were also asked more questions related to mental health and mental illness.

The following findings were considered significant:

  • In terms of the campaign's impact on understanding, those exposed to the ads were more likely by a margin of almost 10% to believe that there is something they can do to prevent themselves from experiencing a mental health challenge.
  • The campaign's impact on behavioral intentions is even more impressive, with those exposed to the ads more likely (by a margin of almost six percent) to try to help someone they cared about who seems worried or sad, and (by a margin of almost 9 percent) to ask for help from someone they trust if they felt worried or sad themselves.
  • Those exposed to the campaign were far more likely than those who were not to express a willingness to visit a website for information to support either their own mental health (by a margin of 12 percent) or the mental health of someone they care about (by over 12 percent).
  • Survey participants who were exposed to the campaign's ads answered three questions asked both before and after exposure to test whether seeing or hearing the ads had any impact on the respondents subsequent answer when compared to their initial answer before exposure. After exposure to the ads, respondents were over six percent more likely to respond affirmatively to the question of whether they would seek help from someone they trust if they feel worried or sad than they had been prior to seeing and hearing the campaign's ads.

The survey provided support for the campaign's strategies of employing a strength-based approach that normalizes mental health as a core component of overall health and well being, and of utilizing real people to tell their own mental health promotion or recovery stories.

Objective A1.5: In FY2010, evaluate linkage services for individuals with serious mental illness released from Illinois jails.

Indicators:

  • Complete an evaluation of the performance and outcome goals of the Data-Link Phase II initiative.

This objective was accomplished. The final evaluation of this Project, funded by the Illinois Criminal Justice Information Authority and performed by the University of Illinois (Southern) was completed in FY2009 and subsequently posted on the ICJIA website. The report became available in FY2010 after the Block Grant Application was submitted. The objective was reported as completed in the FY2009 Implementation Report. However, as the objective was finalized in early FY2010, we are reporting on it again with an emphasis on the continued monitoring and activity that has occurred in FY2010. The evaluation findings recommended that this project should be enhanced and expanded throughout the State of Illinois.

Cook County Jail linkage continues to need dedicated case managers. Will, Peoria, Jefferson, Marion County, and Cook-Proviso are continuing to link individuals into community services. Low linkage percentages reflect limited case management staffing in each county jail. In FY2010 there were 111,018 jail admissions in the participating counties. Of these admissions, 6,158 detainees or 6% were determined to be eligible for linkage and 28% (1,703) were linked. Follow-up tracking at 30 and 60 days following release showed that 629 detainees or 37% of those who were linked to services were receiving services after thirty days of release from jail. 137 of those individuals linked, or 8% of the linked detainees remained in treatment after sixty days.

Phase 3, also funded by the Illinois Criminal Justice Information Authority, was implemented July 1, 2009, with the additions of Winnebago, St Clair and Rock Island counties and four (4) new participating mental health community providers. Specialized case managers hired by participating community mental health providers ensure continuity of care while a detainee is being held by beginning the immediate discharge aftercare planning process which includes, linkage back to their home community agency for mental health services, linkage services for substance abuse, housing initiatives, and, in Phase 3, the expansion of Supportive Employment and Community Support services. Eight case managers are covering Cook County (Proviso), Will, Peoria, Jefferson, Rock Island, Winnebago, St. Clair, and Marion Counties.

Jail Data Link Project:

The Division of Mental Health's Jail Data Link Project's inception was in 1999 as a result of Bureau of Justice Assistance and other national experts that published findings that 6.1% of male and 15% of female detainees in the Cook County Jail, suffered from mental illness. The project blends technological advancements and clinical systems integration, providing any County Jail and their respective community mental health providers with information as to which detainees have a history of mental illness, both inpatient and outpatient as documented by the Division of Mental Health. This cross match is provided on an automated technology basis and is performed on a daily basis, based on the jail's current census.

Phase I of the Project was limited to Cook County and 14 pilot mental health community providers. Phase 2, with grant awards provided by the Illinois Criminal Justice Information Authority, the system graduated both technologically (now an SSL Internet based platform) and expanded to the Illinois counties of Will, Jefferson, Peoria and Marion. An additional three (3) community mental health providers were participatory. Phase 3 (see above) was implemented in FY2010.

In view of the data on treatment compliance after 30 days, in 2011 Jail Data Link will be evaluating the types of services provided in the community to determine what factors help sustain linked individuals in treatment. Also in FY2011, data on continuation in treatment after 60 days will be included in the evaluation of linkage outcomes.

Objective A1.6. Maintain the tracking system for persons adjudicated Not Guilty by Reason of Insanity (NGRI) who have been conditionally released from DHS inpatient programs to the community.

Indicators:

  • Number of persons adjudicated as NGRI who have been released and maintained in the community
  • Number of persons adjudicated as NGRI who have completed conditions of release.
  • Number of persons adjudicated as NGRI who been subject to revocation of conditional release

This objective has been met. The tracking system for persons adjudicated Not Guilty by Reason of Insanity (NGRI) who have been conditionally released from DHS inpatient programs to the community was maintained. A total of 108 (75 Males, 33 Females) individuals adjudicated as NGRI were maintained in the community on Conditional Release (CR) status in FY2010.

During FY2010, seventeen persons (12 males, 5 females) were adjudicated as NGRI and released and maintained in the community during the year and 21 individuals were removed from the tracking system for various reasons such as discharge by the Court after reaching their maximum commitment date or early discharge from conditional release. Seven individuals (5 males, 2 females) were subject to revocation of conditional release by the Courts and return to inpatient status. As of June 30, 2010 there were 82 "active files" being maintained in the tracking system. Agency compliance with court reporting and service delivery requirements for this population has been 87%.

Forensic Services is mandated by law to monitor the community-based treatment services and status of individuals who have been court-ordered into treatment due to a finding of Not Guilty by Reason of Insanity (NGRI). Currently, two tracking systems are being maintained. One follows those NGRI consumers who have been conditionally released from DHS facilities by court order. The second tracking system monitors those NGRI consumers who are ordered directly into outpatient treatment by the Court. In FY2010 this tracking system was addressed separately in Objective A1.7.

Objective A1.7: Maintain the tracking system for persons adjudicated Not Guilty by Reason of Insanity (NGRI) who have been court ordered into Outpatient treatment.

Indicators:

  • Number of persons adjudicated as NGRI who have been court ordered into Outpatient treatment.
  • Number of persons removed from the monitoring database due to change in legal status.
  • Agency compliance with timely reporting

This objective has been met. The tracking system for persons adjudicated Not Guilty by Reason of Insanity (NGRI) who have been court ordered into outpatient treatment was maintained. In FY2010 44 individuals (31 males, 13 females) were ordered by the Courts into Outpatient NGRI treatment and were subject to tracking. Subsequently, 13 (10 males, 3 females) were removed from the tracking database due to a change in their legal status. Agency compliance with court reporting and service delivery requirements for this population has been at 89%.

Objective A1.8. Develop and maintain a tracking system for persons receiving outpatient fitness restoration services.

Indicators:

  • Number of adult persons receiving outpatient fitness restoration services in FY 2010.
  • Number of juveniles receiving outpatient fitness restoration services in FY2010.
  • Number of new cases referred for outpatient fitness restoration.
  • Agency compliance with timely court reporting.
  • Agency compliance with providing fitness restoration services for UST patients in FY2010.

This objective has been successfully accomplished. An effective tracking system for persons receiving outpatient fitness restoration services was fully developed and maintained by DMH Forensic services in FY2010. During FY 2010, a total of 110 individuals (60 Adults and 50 Juveniles) received Outpatient Fitness Restoration Services. There were 48 new cases referred for Outpatient Fitness Restoration Services during FY2010. The compliance rate for Community Service Provider Agency timeliness of reporting was 93% and rate of service provision was 100%.

Fitness Restoration

For individuals found to be unfit to stand trial (UST), DHS provides fitness restoration services on an inpatient and outpatient basis. These services are focused on providing treatment that will allow individuals found unfit to stand trial to be restored to fitness and complete their trial process. The service involves psycho-educational and clinical treatments that will assist a person in understanding the legal process of their trial and/or working with their attorney. The goal is to increase the amount of these services in least restrictive community settings and monitor the performance of outpatient providers that agree to provide fitness restoration services.

Objective A1.9: Provide continuity of care for individuals found unfit to stand trial (UST) that are restored to fitness in state operated inpatient forensic programs.

Indicators:

  • Number of discharged UST patients linked to community services.
  • Number of discharged UST patients that follow-through with appointments in community agencies within thirty days of release from jail custody.
  • Number of discharged UST reported in correctional custody.

The activities of this continuing objective were accomplished in FY2010. DMH Forensic Services successfully tracked continuity of care in the community for individuals found unfit to stand trial (UST) who were subsequently restored to fitness in state operated inpatient forensic programs. Nearly 53% were successfully transitioned and followed through with treatment services. Of the 296 individuals (242 males, 54 females) discharged from Inpatient UST status as "fit for trial" during FY 2010, 155 were reported by the referred Agency as following through with appointments while 15 were reported as remanded into correctional custody. Efforts to track continuity of care for this group are continuing in FY2011.

Continuity of Care

Forensic services tracks individuals discharged from DMH hospitals after inpatient fitness restoration services. In FY2010 Forensic Services continued to follow up on discharged UST consumers and work collaboratively to improve the flow of information between DHS, courts, corrections, law enforcement and local providers in order to increase the number of discharged UST consumers who follow up on continuity of care referrals. Given the fact of clients' right of choice in services and in engaging themselves with agencies, there is little control over whether or not the client goes to the linked agency, and, with the usual fluctuations in the numerous client, agency, and court variables over time, it is unlikely that continuity of care can ever be fully provided. Nonetheless, DMH Forensics remains committed to improving access of UST consumers to the aftercare treatment and services they sorely need.

Objective A1.10. Reduce the length of stay from the time that court orders are received to the discharge of patients referred to DHS/DMH under UST statutes.

Indicators:

  • The period of time between DHS receipt of court orders to placement of patients in forensic inpatient programs.
  • The period of time from inpatient admission to recommendation for a court hearing based on resolution of fitness issues.
  • The period of time between recommendation for a court hearing and discharge from the inpatient program.

This objective has been partially accomplished and is continuing in FY2011. This objective is being actively pursued. Forensic performance measures were completed and data collection was initiated in FY2010. Initial baseline data has been collected on length of stay in state-operated forensic programs.

Length of Stay Data

Monitoring the length of stay for inpatient restoration services in DHS facilities is required in order to maintain an adequate number of inpatient beds specialized to this service and to reduce the amount of time that a consumer with a UST finding needs to remain in this more restrictive level of care. Benchmarking was undertaken in FY2009 in to collect data with which to monitor length of stay. The performance measurements to address the objective below were developed with input from staff from all hospital forensic programs and central office quality management staff. Most notable in the data is the extended admission time (54 days on average) for one particular hospital. Extended Jail waiting time after a court order delays access to necessary hospital treatment and increase potential DHS exposure to a finding of contempt of court. Much of the delay can be attributed to inadequate bed capacity and slow movement of long-term NGRI patients. DMH continues to address this issue.

Initial baseline data for the above indicators has been collected on forensic program length of stay. For the four hospitals reporting, the average days for each quarter were averaged for the year and yielded the following information:

  • The average length of time between DHS receipt of court orders to the actual placement of patients in forensic inpatient programs ranged from 23 days to 54 days. Three of the four hospitals were at the higher end as two hospitals reported averages of 42 days and 51 days respectively.
  • The average length of time from inpatient admission to recommendation for a court hearing based on resolution of fitness issues ranged from 42 days at a hospital in Central Illinois to 125 days at a maximum security setting in Southern Illinois.
  • The time between recommendation for a court hearing and discharge from the inpatient program ranged from 18 to 27 days.

Next steps planned in this process include using the data as a management information tool to work with forensic hospitals on improving the processing of forensic remands from the court. This data also reflects and advocates for increasing forensic capacity to decrease admission delays.

Objective A1.11 (NOM): The percentage of consumers reporting positive outcomes through the Adult Consumer Survey will increase in FY2010.

Indicators:

Percentage of consumers reporting positively about outcomes with reference to the following national outcome measures:

  • Client Perception of Care (Outcomes Domain)
  • Decreased Criminal Justice Involvement
  • Increased Social Supports/Social Connectedness
  • Improved Level of Functioning

This objective is currently in process. During November 2010, the FY2010 Consumer Survey was mailed to a random sample of 2,600 consumers receiving services in June 2010. It is anticipated that an analysis of the responses will be completed by February 2011. The FY2009 Consumer Survey was completed during FY2010 and serves as the baseline from which to track consumer satisfaction with services and the newly developed national outcome measures for social connectedness and improved functioning.

In the FY2009 survey results, the percentage of adults reporting positive outcomes improved 8 percentage points from FY2008, from 60% to 68%, and well surpasses the FY2010 target of 61.4%; 78% showed decreased criminal justice involvement; Increased Social Supports/Social Connectedness significantly increased from 63% in FY2008 to 72% in FY2009; and Improved Level of Functioning increased slightly from 62% to 65% (the FY2010 target was 63%).

The MHSIP: Adult Consumer Survey

The Division has adapted the MHSIP: Adult Consumer Survey to collect feedback from adult recipients of community mental health services funded by the DMH. Information is collected on 7 domains including access to services and outcomes; with additional questions on the impact of services on criminal justice involvement. The Adult Consumer Survey is part of the Mental Health Statistics Improvement Program (MHSIP) Quality Report performance measures. The survey addresses two goals of the Division: data-based decision-making in a continuous quality improvement environment and to enhance and expand the involvement of consumers in the review, planning, evaluation and delivery of mental health services. Variables included in the analysis are: severity of emotional disturbance, race/ethnicity, and length of time in treatment. The information can be used for management, planning, quality improvement and feedback to providers, consumers and family members regarding state and federally funded services. The survey will be conducted again in FY2011.

The DMH uses the National Outcome Measures (NOMS) along with additional system indicators to track mental health system service delivery and outcomes to aid in service planning. A number of the National Outcome Measures (NOMS) are currently collected through the MHSIP Consumer Survey that has been completed annually since FY2007. The measures reported through the survey are: Client Perception of Care, Decreased Criminal Justice Involvement, Increased Social Supports/Social Connectedness, and Improved Level of Functioning.

The FY2009 Adult Consumer Survey

A random sample of consumers, stratified by race and ethnicity, was drawn from all adults, aged 18 and over, receiving services from DMH providers in June 2009. A response set of 385 was needed to achieve a 95% confidence level for reporting statewide. While the response set was not large enough for valid conclusions to be drawn based on small subgroups (like racial or age groups), it is useful in pointing to areas for further investigation when a larger sample can be assessed. The same sampling methods are used every year, which will enable additional analysis in the future: combining the data from several years making intra-group analysis - like comparing racial/ethnic and age groups possible; and comparing survey responses by year to detect shifts in consumer's perception of care.

The survey was administered via the mail to consumer's home address. An introductory letter was sent with the three-page survey and a postage paid return envelope. Consumers and caregivers were asked to indicate their response on a Likert scale of 1 to 5 whether they agreed or disagreed with the statements. Respondents were asked to think about the services they received in the last six months. 2600 surveys were sent out.

The number of consumers who responded to the survey was 521, yielding an adjusted response rate of 23%. A preliminary analysis of race and Hispanic ethnicity variables showed no significant differences between the sample and respondents race/ethnicity. Of the 521 consumers responding: 73% are considered "target" or "priority" population i.e. they have a serious mental illness; 35% percent are male; 55% female and 10% no response on gender. The majority of respondents (52%) were between the ages of 45 and 64; 37% were age 25-44; 7% (37) were over age 65, and 4% (20) were 18 through 24 years of age. In reference to Race/Ethnicity, 65% were White, 21% Black, 10% Hispanic, and 3% in the "Other" category. Eighty-four percent of respondents are currently receiving services; 13% received services for less than one year; 48% for five years or more.

The results are listed in descending order showing the greatest number of positive responses in the general satisfaction domain, the least in the functioning domain. This is consistent across the scores in three previous years and is an area of concern. Despite 48% reporting having been in services for more than 5 years, consumers consistently perceive, at a rate of 1 out of 3, that they are not functioning better as a result of services.

  • Reporting Positively about General Satisfaction 85%
  • Reporting Positively about Participation in Treatment Planning 84%
  • Reporting Positively about Quality and Appropriateness82%
  • Reporting Positively about Access80%
  • Reporting Positively about Social Connectedness72%
  • Reporting Positively about Outcomes68%
  • Reporting Positively about Functioning65%

Comparative survey results from FY2007 through FY2009 show significant increases in two domains: participation in treatment, from 73% to 84% and social connectedness from 63% to 72%. These two areas have been the focus for improvement efforts by DMH.

As an evaluation tool of DMH services, this consumer survey has created a picture of services where consumers feel positively about the quality and are generally satisfied with the services they receive. More consumers felt more involved in treatment planning and that services helped them connect to their natural supports than was reported in 2007. However, in questions pertaining to outcomes, more than a third of consumers did not feel better at handling daily life as a result of services in the past 6 months-even though 82% were in services for one year or more; and half of those were receiving services for five years or more. However, length of time in treatment significantly impacted 4 out of the 12 functioning and outcome questions. Consumers who received care for 5 or more years were more likely to say: " I am better able to take care of my needs; my symptoms are not bothering me as much; my housing situation has improved and I am better able to control my life" compared with those who were in service for less than 1 year. Generally, the survey results support the need for maintaining and improving an evidence-based, outcome driven mental health system.

Objective A1.12: Continue to expand the implementation of Evidence Based Supportive Employment.

Indicators:

  • Number of consumers receiving supported employment in FY2010. (National Outcome Measure)
  • Number of consumers in supported employment employed in competitive jobs in FY2010.
  • Number of technical assistance sessions provided to the IPS sites to increase fidelity to the SE model.

This continuing objective was successfully accomplished in a challenging economic environment during FY2010. In spite of fiscal challenges faced by providers, increased unemployment in the state, and the impact of state budget reductions, EBSE implementation has continued to expand. Two new sites reached fidelity and three new sites began implementation during the year. In the last quarter of FY2010, 365 consumers were in competitive jobs, 56 consumers were transitioned off the program when successfully employed, and 263 consumers joined the program. Cumulatively, 1,988 consumers received supportive employment services in FY2010. 1695 hours of technical assistance were provided to the IPS sites to increase fidelity to the IPS Supported Employment Model between July 1, 2009 and June 30, 2010.

Evidence Based Supportive Employment

Supported Employment is an evidence-based practice that has been shown to improve employment rates of persons with serious mental illness by as much as 60%. The DMH and the DHS/Division of Rehabilitation Services (DRS) are actively collaborating to implement this evidence-based practice initiative and have been supported by two grants: a NIH/SAMHSA Planning grant to address state infrastructure issues (which ended in September, 2007) and a Johnson & Johnson/Dartmouth Community Mental Health Program Grant to support implementation at four pilot sites ended in June 2009. In FY2009 the number of mental health agencies working to implement EBSE increased from 13 to 17. Twelve of those agencies reached fidelity to standards of EBSE based upon the Individual Placement and Support (IPS) model. One agency provided the service at 8 sites and another at 2 sites. Thus, the total number of locations where fidelity EBSE services were accessed was 20. There were four additional locations working to reach fidelity. During FY2010 two locations were eliminated due to budget reductions, but three new locations began implementation and the number of locations meeting fidelity standards increased to 21 by the end of the year.

Some noteworthy accomplishments toward expanding and improving implementation during FY2010 are:

  • 1695 hours of technical assistance were provided to the IPS sites to increase fidelity to the IPS Supported Employment Model between July 1, 2009 and June 30, 2010.
  • Consumers have participated on all fidelity reviews and have helped to craft recommendations
  • Two consumer think tanks (focus groups across the State, consumer leaders from state agencies and active IPS sites) began looking into how recovery supports and the CRSS can be used to improve employment outcomes for IPS programs.
  • A plenary session at the NAMI IL Conference in October 2009 focused on the role of employment in recovery and was so well received that NAMI has decided to have a full day track on IPS, and Work Incentives Planning and Assistance at their state conference in October 2010.
  • NAMI IL piloted a unit of the Family-to-Family Course on the role of work in recovery and IPS in Illinois. Other states have now decided to adopt this unit into their Family-to Family Course and the Family-to-Family IL state trainers have built this unit into their training for new Family-to-Family facilitators.
  • Two new sites reached fidelity.
  • Three new sites began implementation.
  • In Calendar Year 2009 IPS outcomes increased by 4% even though the state's unemployment rate increased by 3.6% during that same period. In other words, IPS is producing better outcomes than the general public with obtaining employment.
  • The IPS technical assistance team completed training in a new method of teaching job development to IPS sites that targets improvement of outcomes.

FY2010 IPS Activity Report

7/1 - 9/30, 20091 10/1 -12/31, 2009 01/1-3/31, 2010  4/1-6/30, 2010 
Number of locations at fidelity 18 20 19 21
Number of consumers receiving supported employment  1,119  1,087  1,104  1,112
Number employed in competitive jobs  357 335 330 365
Number of working people transitioned off the IPS Caseload successfully employed 50 48  47 56
Number of new enrollees 204 282 279  273
  • 1 Due to budget reductions, several agencies reduced the number of supported employment staff. One agency consolidated its Supported Employment Program and eliminated a location.
  • 2 Due to budget reductions, one agency reduced the number of supported employment staff and eliminated a location.

IPS is paid via a braided funding model. The DRS portion of the model is outcome driven i.e., providers are paid milestone payments when a person has been successfully working in a job that fits their preferences for 15 days, 45 days, and 90 days. Thus, a major portion of the funding for IPS is contingent on producing good employment outcomes. The loss of DMH capacity grants for IPS and the vocational services that cannot be provided under the Illinois Medicaid Rule (132) has been a setback. Medicaid eligible consumers will continue to receive Community Support and other funded employment -related services. Currently, DRS is working on the distribution of ARRA funds to ten adult sites and eight sites specializing in transitioning youth and young adults. Additionally three new sites are anticipated through available Title XX funds. These EBSE programs will be available to both Medicaid eligible and non-Medicaid consumers.

Objective A1.13: By the end of FY2010, through the provision of rental subsidies, implement a statewide permanent supportive housing initiative which targets 300 consumers acquiring decent, safe, and affordable housing and support services in a manner consistent with the national standards for this evidence based practice.

Indicators:

  • Number of consumers who acquire appropriate permanent supportive housing in FY2010.(National Outcome Measure)
  • Number of DMH-funded providers participating in the program.
  • Amount of money expended for the program in FY2010.

This continuing objective has been extraordinarily accomplished and the targeted number of consumers was significantly exceeded in FY2010.

The Permanent Supportive Housing Initiative continued to make noteworthy and successful progress during FY2010. As of 6-30-10 the DMH Permanent Supportive Housing Bridge Subsidy Initiative had approved 875 DMH bridge subsidies and 564 consumers had utilized their subsidy and moved into a PSH unit. Cumulatively, 450 consumers had been targeted by the initiative to enter PSH Housing options by the end of FY2010 (150 in FY2009 and 300 in FY2010). This target was exceeded by 25.3% (114 consumers). The target for FY2010 was surpassed as well. A total of 396 consumers were served this past fiscal year.

DMH utilized approximately $6 million of dedicated funding to this Permanent Supportive Housing expansion. At the conclusion of FY2010 approximately 100 agencies (about 63%) had applied for access to this Bridge Subsidy Initiative on behalf of the consumers they represented.

Permanent Supportive Housing

In FY2010 Illinois continued with expanded housing resources with DMH Permanent Supportive Housing (PSH), a specific Evidence Based program model in which a consumer lives in a house, apartment or similar setting, alone or with others (upon mutual agreement - no more than two consumers within a common unit). The criteria for supportive housing include: housing choice, functional separation of housing from service provision, affordability, integration (with persons who do not have mental illness), and right to tenure, service choice, service individualization and service availability. Housing should be integrated and affordable (consumers pay no more than 30 % of their income on rent). Ownership or lease documents are maintained in the name of the consumer, so tenant-landlord relationships are maintained. The goal of this initiative is to promote and stabilize consumer recovery by providing decent, safe, and affordable housing opportunities linked with voluntary DMH-funded community support services.

The success of this effort is based on the DMH Bridge Subsidy Initiative that provides rental assistance directly to eligible consumers who are capable of living in their own housing units within the community. The Bridge rental subsidy is designed to act as a "bridge" between the time the consumer is ready to move into his or her own housing unit until the time he or she can secure a permanent rental subsidy, such as Section 8 Housing Choice Voucher (HCV)) or comparable permanent rental subsidy. Consumers who have a serious mental illness or a co-occurring mental illness and substance abuse disorder whose household income is at or below 30% of Area Median Income (AMI) as defined by HUD are eligible to apply to the program. To facilitate transition to a permanent voucher as seamlessly as possible, the requirements and guidelines for the Bridge Subsidy Program are consistent with those of the Housing Choice Voucher (HCV) Program. The consumer must either already be on a Public Housing Authority (PHA) waiting list for a Section 8 HCV or agree to register/apply for a HCV or comparable subsidy and to accept the permanent subsidy when an opportunity becomes available. DMH is targeting a defined population of consumers, including: those in long term care facilities or at risk of being in a nursing facility, long-term patients in state hospitals, young adults aging out of the ICG/MI program or out of DCFS guardianship, residents of DMH funded supported or supervised residential settings, and those who are determined by DMH to be homeless.

In FY2010 DMH utilized approximately $6 million of dedicated funding to Permanent Supportive Housing expansion to approve 875 eligible consumers were approved for PSH in the Bridge Subsidy Initiative through four application rounds opened by DMH. These consumers are securing PSH opportunities on a statewide basis. DMH has partnerships (and contractual) with seven (7) service providers for the provision of PSH Bridge Subsidy Initiative Subsidy Administration duties. These seven Subsidy Administrators currently cover the entire state of Illinois. Their Subsidy Administration roles include: ensuring Housing Quality Standards (HQS) through timed inspections by trained staff, consumer income verification processing, timely payments for security deposits, utility deposits, and monthly rent portions, coordination of HAP contracting and lease agreements, transition funding for eligible household items, and other duties as deemed necessary by DMH to execute PSH activity. The DMH Permanent Supportive Housing (PSH) Bridge Subsidy Initiative is open and available to all DMH contracted service providers. At the conclusion of FY2010 approximately 100 agencies (about 63%) had applied for access to this Bridge Subsidy Initiative on behalf of the consumers they represented.

Individuals Approved and Eligible for PSH Housing By Priority Population Group (As of June 30, 2010)

All Approved Applications by DMH Priority Population

Priority Population Total
Aging out DCFS ward 6
Aging out ICG recipient 4
At risk of placement in long term care 45
Extended long term patient of state hospital 7
Experiencing homelessness 267
Resident of DMH funded residential 316
Resident of long term care 230
Grand Total 873

Objective A1.14. Continue provision of Assertive Community Treatment that meets national fidelity model requirements.

Indicators:

  • Number of persons with SMI receiving Assertive Community Treatment in FY2010 (National Outcome Measure)
  • Number of ACT teams meeting National fidelity standards by the end of FY 2010.

This objective has been satisfactorily achieved. Assertive Community Treatment (ACT) that meets national fidelity requirements was provided in Illinois in FY2010. There are ten ACT teams in Illinois and all of the ten had fidelity evaluations in monitoring visits during the year. Statewide, 707 individuals were served in ACT programs.

ACT in Illinois

During FY 2007, the Illinois ACT model was modified as part of the State Medicaid Plan amendment to bring it into line with the National ACT Model and a plan was developed to monitor the fidelity of ACT services. Subsequently, several agencies determined that they did not have the capacity to deliver the evidence-based ACT model, and chose to adopt the step-down model of the Community Support Team (CST) instead. During FY 2010, DMH continued to provide additional technical assistance utilizing the Dartmouth Fidelity tool to agencies that elected to provide ACT services to help them in meeting the National ACT fidelity requirements. This year, the teams were required to submit plans of improvement for any individual items on the fidelity tool when scores were below compliance standards. The FY2010 Statewide Evidence Based Practice Conference held 4 sessions aimed specifically at ACT and addressed issues of integrating recovery concepts and other EBPs in ACT services, as well as specific items in the fidelity tool which teams were being asked to address in plans of improvement. Technical assistance, including statewide calls, will continue in FY 2011.

Objective A1.15 (NOM): Continue efforts to decrease 30 day and 180 day readmission rates to DMH state hospitals.

Indicators:

  • Percentage of adults readmitted to state hospitals within 30 days of being discharged
  • Percentage of adults readmitted to state hospitals with 180 days of being discharged.

This objective continues to be addressed.

DMH continues to monitor the number of adults readmitted to state hospitals within 30 days of discharge and the number of adults readmitted to state hospitals within 180 days of discharge with the goal of maintaining or decreasing the level of re-hospitalization through the use of community based services that provide alternatives to hospitalization. However, it is to be expected that individuals with serious mental illnesses, may, at times of crisis and relapse, require access to inpatient services for evaluation and stabilization in a safe, structured, and supportive environment. See the Report on FY2010 Adult Performance Indicators section for data and information about these indicators that are a National Outcome Measure (NOM)

Decreased Rate of Civil Readmissions

DMH will continue to monitor the number of adults readmitted to state hospitals within 30 days of discharge and the number of adults readmitted to state hospitals within 180 days of discharge with a FY2011 goal of maintaining or decreasing the level of re-hospitalization through the use of community based services that provide alternatives to hospitalization. However, it is to be expected that individuals with serious mental illnesses, may, at times of crisis and relapse, require access to inpatient services for evaluation and stabilization in a safe, structured, and supportive environment. See the Adult-Goals, Targets, and Action Plans section for data and information about these indicators that are National Outcome Measures (NOM)

The trend for reduced rates in admissions and census has begun to reverse over the last few years. The number of adults (non-Forensic) admitted to state hospitals in FY2004 was 8,844 and increased slightly each year to 10,770 in FY2006 which was a number not seen since the mid-1990s. Civil adult (non-forensic) admissions for FY2010 were 10,122. The median length of stay for this same population has steadily decreased from 19 days in FY2000 to 11 days in FY2006 and remains steady there. At the present time, all civil state hospitals are quite small, with some having a census of less than 100, and the largest is under 150. For both admissions per 100,000 and beds per 100,000, this places Illinois below the U.S. average.

Objective A1.16: Continue and increase training and implementation of medication algorithms as an evidence-based practice through the following: (a) Continue and increase the training of State Operated Hospitals and Community Mental Health Centers. (b) Determine if current algorithms require updating based on recent advances in psychopharmacological research and complete appropriate updates. (c) Update the CIMA Website in a manner that fosters greater public awareness and understanding of medication algorithms and their usage. (d) Introduce documentation and reporting of the competency of participants in the use of medication algorithms.

Indicators:

  • Number of training sessions and agencies completing training at each level.
  • Number of training sessions and number of State Operated Hospitals, affiliated Community Mental Health Centers, and other Community Mental Health Centers who complete training at each level.
  • Number of algorithms updated.
  • Evidence of updates on the website.
  • An evaluation of the competence attained by participants based on documented findings is completed and disseminated

This objective was accomplished. However, economic circumstances diverted agencies from fuller participation in FY2010. Due to budget reductions, DMH has had to discontinue funding to CIMA in FY2011.

The following was accomplished in FY2010:

Eight training sessions were conducted by CIMA in FY2010. As of May 31, 2010, four agencies had completed level 1, one agency at level 2, and one agency completed at level 3. Two training sessions at Level 1 (Education) were provided to state operated hospitals and to the CMHCs affiliated with them. Additionally, CIMA was approached by general practitioners who care for the mentally ill, requesting education in evidence-based approaches and accordingly scheduled a Level 3 training session with a group of family medicine providers, educators, and residents-in-training in May 2010.

CIMA staff conducted reviews of clinical psychopharmacology literature during the past year. It was determined that the depression and schizophrenia algorithms were eligible for updates. These updates were completed and the training material revised to reflect them.

The CIMA Web site was updated in FY2010 and moved to a new address. The Website provides information to the public and profession consistent with the project including training opportunities, evidence-based psycho-pharmacotherapy practices, outcomes assessment and instruments, patient education materials, and links to other information resources. The new address is cited in the text below.

A new testing procedure to assess competency at the end of clinical (Level 3) training was developed this year but has not as yet been implemented. CIMA applied for and received permission to grant continuing medical education (CME) credit through the University of Illinois College of Medicine for physicians who successfully complete CIMA training. Reporting of the testing results is to be done in terms of CME credits granted.

Medication Algorithms

The Center for the Implementation of Medication Algorithms (CIMA) has been an initiative designed to disseminate empirically informed medication algorithms, patient and family education, and outcomes assessment systems that support the psychopharmacotherapeutic treatment of schizophrenia, major depression, and bipolar disorder, consistent with recommendations of the 2003 report of the President's New Freedom Commission on Mental Health. From its inception in July 2004, CIMA provided education, implementation planning, and clinical training to personnel in mental health treatment agencies across the state of Illinois.

  • The program has used a three-stage training model:
    • Level 1-Education: Introduces and informs potentially interested service providers about the role of CIMA and how agencies can participate in the project.
    • Level 2-Planning: This second stage of engagement involves meetings with specific, interested agencies. An assessment is made to determine what changes are required to convert the agency's existing service delivery system to one that supports algorithm use.
    • Level 3-Training: The third step in training involves clinical training of agency personnel in the use of the algorithms, outcomes, educational materials, and documentation practices that support algorithm use.

As shown in Table 1 and excepting the first year of the program in which there was a high level of participation in the program, the number of new trainings per level has historically averaged 6 at Level 1 and approximately 3 each at Levels 2 and 3.

Table 1: Cumulative and Per-year Agencies Trained by Level (2004-2009).  (Trainings per-year in parentheses)

FY Level 1 Level 2  Level 3
2005 18 12 7
2006 26 (8) 13 (1) 11 (4)
2007 31 (5) 15 (2) 14 (3)
2008 37 (6) 21 (6) 18 (4)
2009 43 (6) 24 (3) 20 (2)

FY2010 was a particularly challenging year for CIMA in engaging State-Operated Hospitals (SOH) and community mental health centers (CMHCs). Nearly all agencies contacted by CIMA requested to put any planning (Level 2) or training/implementation (Level 3) on hold until they have gained some certainty about their financial futures. Only one mental health agency expressed interest in Level 3 training. Compared to the data from previous years in the Table above, this represents a reduction in participation at these levels. An effort to engage SOHs and their affiliated CMHCs jointly failed when two of the five SOHs that completed CIMA training were unable to engage participation of their CMHCs. In all cases, representatives indicated that due to financial uncertainty they could not consider more than day-to-day operations and that new program development must be put on hold. However, CIMA has been able to provide continuing education and support in the form of several individual consultations to physicians employed at agencies that completed previous Level 3 training.

The CIMA Web site provides information to the public and profession consistent with the project including training opportunities, evidence-based psycho-pharmacotherapy practices, outcomes assessment and instruments, patient education materials, and links to other information resources. This year the site was updated and moved to a new address. The new address is as follows:

http://peoria.medicine.uic.edu/departments___programs/psychiatry___behavioral_medicine/PSY_Professional_Community_Education/PSY_CIMA/

CIMA is currently exploring attaining a new and simpler domain name.

For the past few years CIMA has been exploring the creation of incentives for agencies to participate in the program. This year CIMA received permission to grant continuing medical education (CME) credit through the University of Illinois College of Medicine for physicians who successfully complete CIMA training. CME is required for physicians to maintain their licenses and may serve as an incentive for participation. When CME is granted to a physician it reflects their successful completion of the training program. As such the metric of "CME credits granted" would be used as an indicator of competency.

Unfortunately, efforts in this best practice initiative have been halted due to budget reductions. The CIMA initiative remains on hold pending acquisition of funding.

Objective A1.17 (NOM): Continue efforts to increase the implementation of Family Psychoeducation and continue to study the feasibility of establishing the following Evidence Based Practices: Integrated Treatment of Co-Occurring Disorders, Illness Self-Management, and Medication Management.

Indicators:

  • Number of adults with SMI receiving Family Psychoeducation.
  • Number of adults with SMI receiving Integrated Treatment of Co-occurring Disorders.
  • Number of adults with SMI receiving Illness Self-Management.
  • Number of adults with SMI receiving Medication Management.

Family Psycho-education

Family Psycho-education implementation efforts have continued in DMH Region I and in Region II. The committee working to further this EBP has evolved into a public/private Family Psycho-education (FP) implementation group. The activities of this group have resulted in the formation of a number of family psycho-education programs. Currently, multiple providers in both Region I and Region II are continuing to implement varying models of family psycho-education. Several other agencies have developed programs in conjunction with these implementation teams. All of them report it as a positive experience and have cited the benefits to consumers as well as to families as a result of family involvement. Staff members from community agencies, private hospitals, and NAMI, along with DMH Region I and central office staff members, continue to meet and provide mutual consultation on clinical, financial, and implementation issues, and to report on progress in individual program growth.

Other Evidence-Based Practices

DMH administrative staff discussed implementation of Illness Management and Recovery (IMR) within the state. However, no active planning has as yet occurred. Illinois cannot report data for Medication Management. Although plans were made to collect data on the number of consumers enrolled in algorithm treatment, data collection was not undertaken because funding was not available to establish a database. The primary focus was on education and training in the implementation of medication algorithms. (See Objective A1.16 above.) For Integrated Treatment of Co-occurring Disorders, the primary focus has been on developing provider interest and capacity to meet the service challenges posed by this model. In FY2007, the Division of Mental Health completed its work on a three-year Training and Evaluation grant funded by SAMHSA/CMHS. Training and evaluation in the IDDT model were provided to nineteen agencies (17 community-based agencies and 2 state hospitals) located in Chicago. Participating agencies were provided with tailored technical assistance and consultation geared toward strengthening each agency's ability to move toward providing IDDT. The IDDT project emphasized statewide education and leadership to promote IDDT and established that consultation and technical assistance were the key means of strengthening the ability of agencies to move toward providing Integrated Dual Diagnosis Treatment services. The feasibility of realigning these activities with new funding is continuously being assessed.

Criterion II: There are no objectives for this criterion. See the Performance Indicator Section of this Report for the quantitative measures on access to services.

Criterion IV:

Objective A4.1: Utilizing an increase of $320,000 in the Illinois Federal PATH allocation, (1) increase the number of persons served in two key PATH funded programs, one in Chicago and one in Rockford and, (2) by the end of FY2010, with the collaboration of the Illinois Department of Corrections, establish two FTE positions targeted to the provision of services to sixty ex-offenders who are homeless with serious mental illness returning to their communities in Rockford and Chicago.

Indicators:

  • Number of persons receiving case management services under the PATH initiative by the end of FY2010.
  • Establishment of the two full-time positions to serve ex-offenders who are homeless with serious mental illness in Rockford and Chicago.
  • Number of ex-offenders who are homeless with serious mental illness served through this initiative by the end of FY2010.

This objective was successfully accomplished with a target exceeded.

In FY 2010 PATH funds were utilized to increase the allocations and numbers of families served by Beacon Therapeutic Diagnostic and Treatment Center in Chicago and the number of individuals served by Shelter Care Ministries' Drop-in Center in Rockford. A total of 5,070 individuals received PATH case management services throughout the state.?

FTE positions were developed for collaboration with the Illinois Department of Corrections (IDOC) to provide for case management and re-integration services to ex-offenders in Rockford and Chicago who meet the PATH eligibility criteria. The targeted number of full time positions established to serve ex-offenders was exceeded by 25% (0.5 FTEs). A total of 2.5 FTE's were developed. Janet Wattles Center in Rockford established 1.5 FTE's and Habilitative Systems, Inc. in Chicago established 1 FTE. These staff members work specifically with individuals returning to communities upon release from IDOC, and assist in the re-integration process.

As of the end of October 2010 a total of seventeen (17) ex-offenders have received services through the PATH Initiative since the inception of the program in December 2009. Please note that the initiative experienced bureaucratic challenges at the outset in obtaining the best constellation of management strategies to facilitate smooth operation of services. A recent collaboration with the correct exit source from IDOC, the Placement Resource Unit (PRU), is expected to provide a needed housing component/counterpart to PATH Case Management services.

PATH in Illinois

The State of Illinois has an extensive history of working with individuals and families who are experiencing homelessness. Since 1988, Illinois has been a recipient of federal funds provided by the Stewart B. McKinney Act, which was enacted into legislation to address the crisis of homelessness among the nation's population of individuals who are homeless or at imminent risk of homelessness with a serious mental illness who may have a co-occurring substance abuse disorder. In 1991, this block grant evolved into a federal formula funding award titled Projects for Assistance in Transition from Homelessness (PATH). The funds are governed by the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), and the Center for Mental Health Services (CMHS). Illinois providers have developed an array of services that include in vivo case management, crisis intervention services, a day center/drop-in-program, and two (2) mobile assessment units in the City of Chicago.

Allocations for the PATH program have fluctuated in recent years, and providers have diligently continued to use funds to expand and enhance services to homeless persons with mental illness. In the past three years the number of individuals served has steadily increased from 2,763 in FY2007, 3,071 in FY2008, 3,571 in FY 2009, and 5,070 in FY 2010. Currently, all PATH funding is used for the provision of case management services with the exception of $102,897 for a drop-in center (Rockford) and $653,000 in two Mobile Assessment Units (Chicago) operated by Thresholds - which do in vivo outreach and engagement. The State of Illinois' Federal PATH allocation was increased from $2,366,000 to $2,686,000 in FY 2010, and from $2,686,000 to $2,950,000 in FY 2011.

In FY 2010 the increased funds were utilized to:

  • Increase the allocations and numbers of families served by Beacon Therapeutic Diagnostic and Treatment Center (Chicago); and individuals by Shelter Care Ministries' Drop-in Center (Rockford);
  • Develop two (2) FTE positions at Janet Wattles Center (Rockford) and Habilitative Systems, Inc. (Chicago) for collaboration with the Illinois Department of Corrections (IDOC) to provide case management and re-integration services to ex-offenders returning to the communities who meet the PATH eligibility criteria.
  • Plan/develop the (biennial) statewide Illinois PATH Providers Conference, which took place in Springfield, IL September 09-10, 2010.

Illinois became a "SOAR State" in May 2010 - and the award includes strategic planning (for expansion/sustainability) and technical assistance through Policy Research Associates. In FY 2010, DMH allocated $44,000.00 to support SOAR Trainings, and seven (7) trainings took place in various parts of the State including Rockford, Hines, Joliet, Chicago, Springfield, and Mt. Vernon. As of November 2010 more than 230 people state-wide have attended and completed the two (2) day trainings. The State PATH Coordinator and three (3) PATH Staff members from Rockford, Springfield and Cairo are members of the Illinois SOAR Training Team and the advisory committee. Of the 20 PATH programs in Illinois, 15 programs have 1-4 staff members who have become SOAR-certified. DMH has allocated $44,000.00 to facilitate six (6) SOAR trainings, which are scheduled to take place in FY 2011.

In FY 2011, the Illinois PATH program is actively working to maintain and cultivate relationships with Veteran Centers and Veteran Administration Hospitals that help to faciliate referrals and advocacy - in an effort to increase the number of Veterans served who are homeless with serious mental illness and in need of emergency assistance. Currently, when Veterans are encountered in the process of outreach, the PATH Providers proactively collaborate with the individual and veterans' programs including the Illinois Department of Veterans Affairs to insure linkage with appropriate services, resources and assistance if the individual is not currently connected with public entitlement programs or VA Benefits. To facilitate this service approach, the $264,000 increase for FY2011 is anticipated to increase allocations to six PATH provider agencies aimed at expanding case management services to PATH eligible individuals as well as prioritizing linkage and support services to veterans who are PATH eligible and in need of additional supports.

Objective A4.2. In collaboration with the Illinois Department On Aging (IDOA), convene meetings with stakeholders to improve access to treatment by older adults.

Indicator:

  • Number of meetings convened in FY 2010.

This objective was accomplished in a very satisfactory manner. However, Geropsychiatry services have been eliminated in FY2011 due to severe budget constraints. Collaborative meetings with IDOA at the state level, and work with regional and local service systems to improve access to mental health services by older adults continued in FY2010.

Geropsychiatry specialists conducted 149 local service system meetings with a total of 1289 participants including providers of mental health services, IDOA funded services, substance abuse services, primary health care, and consumers. Additionally, they provided education and training and reported having made 87 presentations to a total aggregate attendance of 4,241 people. The termination of the Geropsychiatry Initiative at the end of the year has effectively reduced the extent of coordination, service planning, and educational opportunities in local areas, especially rural communities. At the State level, meetings have continued on a bi-monthly basis with both the Council on Aging and the Statewide Mental Health and Aging Coalition for a total of 12 meetings.

Mental Health and Aging Initiatives:

From FY2000 through FY2010, DMH maintained a mental health and aging systems initiative which established a Geropsychiatry Specialist in a comprehensive community mental health center with access to a psychiatrist, board certified in Geropsychiatry, to improve access, availability and quality of mental health services for older adults (age 60 and older) with mental health needs. The Geropsychiatric Initiative was designed to meet the needs of older persons in rural areas and was piloted in the rural areas of the DMH Southern and Metro-East Regions. Local coordinating councils which included representatives from primary health care, consumers, aging area offices, mental health agencies, and senior citizen centers were utilized in the 27 county service area to educate key stakeholders regarding available services, the process for accessing services, and identifying strategies for improving services. The initiative focused on three key areas: integration of mental health, aging, primary medical care and public health systems, mental health services/consultation and training/education. In FY2010 there were five funded positions for Geriatric Specialists that covered 27 counties throughout the southern part of the state and provided consultation and education resources for mental health services to the aging throughout the state. The initiative has received national recognition from the American Society on Aging and the National Technical Assistance Center for Older Adult, Mental Health, and Substance Abuse Services. Due to budget reductions, the initiative is not continuing in FY2011.

The Division of Mental Health convenes an Advisory Committee on Geriatric Services jointly with the Illinois Department on Aging (DOA). This Advisory Committee has focused its efforts on the assessment of the mental health needs of the elderly, identification of model programs, best practices and staff competencies, and increased awareness of geriatric mental health concerns. Training, consultation, and technical assistance in the area of mental health and aging continue to be provided through the efforts of the Advisory Committee. The Council promotes increased awareness of geriatric mental health concerns and has developed a position paper on issues of Self-Neglect that was used widely throughout the state including a Self-Neglect Forum and the Self-Neglect Task Force. The Division of Mental Health contributes staff to participate in the Self-Neglect Task Force, and the "Grandparents raising Grandchildren Task Force" project convened by the Illinois Department on Aging. The DMH also serves in an advisory capacity to the statewide, Northern and Southern Mental Health and Aging Coalition. The Division of Mental Health and the Illinois Department of Aging also collaborated with resources and expertise to develop, market and present three conferences. The Annual Statewide Mental Health and Aging Conference held in April 2009 was attended by well over 300 people-setting a record for the highest attendance for this yearly conference. The keynote theme of the conference was suicide prevention for older persons. A Statewide Conference was not held in FY2010 due to funding reductions. However, two regional conferences were held. One in the central part of the State (DMH Regions 3 and 4) with an attendance of 72 persons and one in the Southern Region (5) which was attended by 180 people.

Collaborative efforts and meetings with the Department on Aging and other stakeholders are continuing in FY2011. Two conference events are planned in the near future. The Director of DMH will be a keynote speaker at the DOA Case Coordination Management Conference in September 2010 on promoting positive public awareness of the mental health needs of older adults. The Governor's Conference on Aging will take place in December 2010 and a track on Mental Health and Aging will be included.

Criterion V: The FY2010 Application did not contain any objectives for this criterion which addresses financial resources and human resource development.

NARRATIVE: SIGNIFICANT EVENTS AND CHANGES IN FY2010

REPORT ON THE 2010 ADULT PLAN

Developments and Issues Affecting Mental Health Service Delivery

Impact of the Economic Recession

As in many states, Illinois experienced a serious economic downturn that began toward the end of FY2009 and extended through FY2010. State tax collections dropped by almost 8% between FY2008 and FY2009 and the unemployment rate increased from a low of 5.5% for January 2008 to 11.5% in March 2010. Cost containment and austerity have impacted all state services and the mental health service system has not been exempted from budget reductions.

Several programs previously described in the block grant such as: Qualified Mental Health Professional (QMHP) liaisons to DHS/DHCD Family Community Resource Centers, Screening Assessment and Support Service Flexible Funds, (discretionary funding for non-traditional support services such as special programming components of Wrap Around planning), the Multi-disciplinary Specialty Assessment program that funded specialty assessments such neurological testing and learning disability assessments, five of the ten Mental Health Transition pilot programs and five of the ten Mental Health Early Intervention pilots (See the Child-System of Integrated Services Section for further detail) were not funded in FY2010.

Serious fiscal challenges continue to confront the mental health service system. DMH was able to maintain the array of services that it purchased with minimal changes in FY2010 but projected budget reductions required the DMH to reassess and reshape the array of services that will be purchased in FY2011. The very limited funds that remain available were targeted by DMH to help those most clinically in need with limited ability to pay. As noted earlier in this Plan (ADULT-AVAILABLE SERVICES), a two-tiered system of public mental health services to begin on October 1, 2010 in which persons who are not enrolled in Medicaid receive limited service packages that will be subsidized by DMH based on financial status. Those individuals and families below 200% of federal poverty level (FPL) will be fully covered for the cost of the service packages, partially covered from 200 - 400%, and not covered at all when over 400%. Providers will now need to obtain information from clients regarding their household income and family size.

Due to reductions in the DMH FY2011 budget, the following DMH capacity grants were targeted for elimination in FY2011:

  • Consumer Centered Recovery Support
  • Supported Employment
  • Geropsychiatric Services
  • Client Transitional Subsidies

Additionally, certain non-Medicaid reimbursable services that had been paid on Fee-For-Service basis by DMH were also eliminated including:

  • Vocational engagement and Assessment, Job Finding Supports, Job Retention Supports and Job Leaving/Termination Supports;
  • Outreach and Engagement
  • Stakeholder Education

In spite of the serious erosion in the array of services available to persons who are not enrolled in Medicaid, DMH has made a firm commitment to provide crisis services to all individuals with mental illnesses accessing the public mental health system. The negative impact that has resulted from the State's recent inability to pay bills in a timely way is steadily increasing and becoming a serious concern to providers and consumers. The outlook for any new funding for mental health services is extremely bleak. In this environment, DMH is making every effort to maintain essential mental health services for persons with the most serious mental illnesses.

The overall impact of this year's budget reductions is described at various points in the plan narrative. The Division continues to work diligently to increase revenue from Medicaid and to seek grant funding to support programmatic efforts. In FY 2011, the emphasis will be on maintaining essential services to individuals with serious mental illnesses.

Consumer Support Lines

The Collaborative has established a statewide "warm line". The warm line is a cutting edge source of peer and family support. Staffed by five Peer and Family support specialists, the toll-free number receives 60 to 120 calls per week. These professionals are persons in recovery, or family members of persons in recovery, who are trained to effectively support recovery in other individuals' lives. The warm line has become a successful DHS/DMH investment by assuring the accessibility of a human connection at a time when it is needed now more than ever. In addition to the Warm Line, consumers and family members may contact the Collaborative's toll-free Consumer and Family Care Line with compliments and complaints about the mental health services they receive. Each complaint is reviewed by the staff, referred to the appropriate agency or authority for investigation or resolution, and followed up. Feedback is provided to consumers and family members in writing on the progress and resolution of their complaints. Assistance and coaching are offered to help an individual pursue a review of a complaint or to appeal a decision.

Williams Consent Decree

During FY2010 there was a Class Action Law Suit resulting in a Court Settlement that will be finalized in FY2011. The Williams' Suit targets individuals who are residents of Institutes for Mental Disease (IMD), Nursing Facilities in which more than 50% of the population is diagnosed with Serious Mental Illness. As such, an IMD cannot bill for federal Medicaid reimbursement and are 100% funded out of State General Revenue Funds. The premise of the Williams' suit is that individuals with serious mental illness have not been afforded due process to move out of these facilities when they no longer require or desire this level of nursing care. There are 4,500 class members involved in this suit.

Key terms in the Consent Decree include the following:

  • Development of community capacity. This requires the State to ensure the availability of services, supports, and other resources to meet its obligations under the Decree.
  • Development of a service plan. For individuals currently residing in IMDs who do not oppose moving to a community-based setting and who are otherwise appropriate for community placement, the State will develop a service plan specific to each person.

The settlement requires that all class members will be assessed and given the choice to transition to the most appropriate integrated community based options with support services over the course of 5 years. Additional financial resources are anticipated by the Department to meet these mental health service needs. The ultimate goal is to transition them into independent living/permanent supportive housing. As all the class members will not be ready for independent living when transitioning, the service system will be required to develop an array of residential options with onsite supports to best accommodate members' immediate transition needs. Concurrently, the state will have to ensure that transitioning consumers, who do qualify, based on clinical and functional criteria, for independent living can afford to live in units that are affordable. Expanding funding resources to ensure the availability of Bridge Subsidies (until permanent rental subsidies or Section 8 housing choice vouchers can be secured) for those who do qualify for Permanent Supportive Housing will be paramount.

A parallel Class Action Suit, Colbert, is currently being developed and targets nursing facilities that are not IMDs in the City of Chicago boundaries, only, and across disability populations. The total class for Colbert is 10,000. Potentially, there are an additional 5,000 individuals with mental illness in this Class. Like Williams, mental health services (including residential supports) and affordable housing will be necessary to ensure seamless and safe transitioning for this population. Accommodating the residential and support service needs of these legal settlements will necessitate extensive enhancement to the existing public mental health service delivery system.

Home & Community Based Services (1915-c) Waiver

In FY2010, DMH began joint work with the Illinois Department of Healthcare and Family Services (DHFS), the State Medicaid authority, to apply for a Home and Community-Based (1915(c)) Waiver. The Waiver would apply to persons residing in Nursing Homes or those persons who are at risk of going into a nursing home or other institutional long-term care if the appropriate and necessary community services are not available. The provision of services under the Waiver will be open to any qualified provider. During November a teleconference was held with 27 stakeholders across the State to discuss services under the Waiver and drill down on the direction of the application. The Draft document is due on 12/1/10 and will be posted on the DMH Website.

Mental Health Services to Veterans

In 2008, the Illinois Legislature enacted Public Act 095-0576 directing the Department of Veterans Affairs, in consultation with the Department of Human Services, to contract with professional counseling specialists to provide a range of confidential and direct treatment services to veterans. The Department of Veterans Affairs, in consultation with the Division of Mental Health, established the Illinois Warrior Assistance Program (IWAP), staffed by mental health professionals through Magellan Health Services. IWAP provides a 24-hour, toll free number for confidential assistance with emotional challenges veterans may face reintegrating into civilian life. Screenings for traumatic brain injury and post-combat trauma reactions are also available through IWAP. 

Public Act 095-0576 also directs the Department of Veterans Affairs, in consultation with the Department of Human Services, to:

  • Develop an educational program designed to train and inform primary health care professionals, including mental health care professionals, on the effects of war-related stress and trauma.
  • Provide informational and counseling services for the purpose of establishing and fostering peer support networks through the state for families of deployed members of the reserves and National Guard.
  • Provide veterans' families with a referral network of providers skilled in treating deployment stress, combat stress, and post-deployment stress.

Veterans Reintegration Initiative (VRI)

In 2008, the Division of Mental Health was awarded a $2 million grant (over 5 years) from the Substance Abuse Mental Health Services Administration. The grant, entitled Jail Diversion - Trauma Recovery (priority to veterans) is designed to divert individuals, with histories of trauma, from the criminal justice system, and into evidence-based trauma treatment in the community. The Illinois Project entitled Veterans Reintegration Initiative (VRI), targets veterans of Iraq and Afghanistan, with trauma symptoms, for jail diversion and enrollment in trauma treatment. The Directors of the Division of Mental Health and the Department of Veterans Affairs co-chair the project's Statewide Advisory Group, which is comprised of stakeholders from other state agencies, the Veterans Administration, the judiciary, community providers, private foundations and veterans with lived experience.

The VRI is expected to result in the delivery of trauma-informed, evidence-based treatment to 120 consumers per year over a 5-year program period, as well as specialized training for 1,000 police officers in street-level responses to veterans demonstrating mental illness. The VRI is a collaborative effort of stakeholders from the veterans, justice and treatment systems. The planning phase of the project has included the participation of key stakeholders in Cook County and Rock Island County and will culminate with a comprehensive strategic plan that establishes a formal link between veterans services and justice/treatment interventions in each of the project sites.

Permanent Supportive Housing

FY 2009 was the first year of actual implementation of the Permanent Supportive Housing (PSH) initiative designed to increase the supply of safe, decent, and affordable PSH units and improve the DMH capacity to help consumers obtain permanent housing that meets their preferences and needs. PSH refers to integrated permanent housing (typically rental apartments) linked with flexible community-based mental health services that are available to tenants/consumers when they need them, but are not mandated as a condition of occupancy. The PSH model is based on a philosophy that supports consumer choice and empowerment, rights and responsibilities of tenancy, and appropriate, flexible, accessible, and available support services that meet each consumer's changing needs. In most cases and for most individuals the support services necessary to assure successful tenancy are already reimbursable by Medicaid under the Community Support service definition or under other Medicaid plan services (e.g., medication management, psychiatry, outpatient counseling). DMH has provided extensive training to DMH staff members who serve as Regional Housing Support Facilitators (one for each Region), as well as all DMH community mental health providers, and participating subsidy administrators. A real time web-based housing search website (Ilhousingsearch.org) became active as of 6/15/09 and is open to everyone in Illinois to search for housing opportunities. Despite the elimination of a range of programs due to fiscal constraints, the funding commitment to Permanent Supportive Housing has been solid and continuing.

Evidence Based Practices

DMH continues to address SAMHSA'S National Outcome Measure of Implementing Evidence-Based Practices and strives to make EBPs available throughout the state by providing training and technical assistance to mental health agencies, and by involving mental health consumers and families in the expansion of such practices in Illinois. In April 2010, the DMH convened a third annual statewide conference on EBPs, entitled From Vision To Action: Evidence-Based Practice in Illinois. Presentations focused on the practical and philosophical aspects of organization, financing, and implementation issues to be considered in planning for implementation of EBPs. More than 200 individuals (consumers, family members, advocate, providers and state agency staff) attended the two-day conference.

Information Technology

DMH continues its efforts to refine and streamline data collection efforts to provide information that supports decision-making. As noted above, DMH, working with the Mental Health Collaborative for Access and Choice (MHCAC), has redesigned and implemented the management information system (MIS). This work included the development of a data warehouse that houses eligibility, registration, billing/services information, a provider database, and service authorization in one place.

Managed Care Pilot

DMH is fully collaborating with the state's Medicaid agency on an Integrated Care Project (ICP) that is currently in the pre-implementation phase. Planning for implementation began in FY2010. The pilot project addresses six counties in Illinois located in proximity to the Chicago Metropolitan Area. Medicaid AABD (aged, blind and disabled) recipients are being placed into a managed care arrangement with vendors who will be implementing a fully integrated delivery system. DMH is acting as subject matter expert for mental health matters.

Grants

DMH received continuation grants for the following areas: Data Infrastructure for Quality Improvement; Work Incentive and Planning Assistance Services for SSI/SSDI Beneficiaries, and Supported Employment. DMH is partnering with staff of the Illinois Department of Healthcare and Family Services (DHFS) in implementing a federal Medical Emergency Room Diversion (ERD) Grant from CMS. The grant provides $2 million over a two-year period to improve access and the quality of primary health care services. Illinois was one of six states awarded the Substance Abuse and Mental Health Services Administration Jail Diversion - Trauma Recovery (priority to veterans) grant. This grant, for approximately $2 million over 5 years has enabled the establishment of the Illinois Veterans Reintegration Initiative (VRI) to increase diversion for criminal justice-involved veterans with trauma histories in Cook and Rock Island counties. (See Above). Additionally, DMH was awarded a second SAMHSA Transformation Transfer Initiative grant for $105,450. This second grant will fund three initiatives. The initiatives will include pilot testing the mental health court database in the Winnebago and Cook County courts, continuing the planning efforts of the Statewide Mental Health and Justice Advisory group, and supporting the development of peer to peer support for justice involved individuals with serious mental illness.

Program Enhancement

The DMH continued work on a SAMHSA funded statewide initiative funded from 2004 to 2007 to move toward a violence-and-coercion-free hospital environment and reduce the need for seclusion and restraint as alternative person-centered interventions are established. Illinois utilized the NASMHPD National Technical Assistance model that included six core strategies:

  • Leadership Toward Organizational Change - elevation of oversight of every Seclusion/Restraint event to the involvement of the state hospital CEO and the development and implementation of a performance improvement action plan for the facility.
  • Use of Data To Inform Practice - includes identification of facility's baseline in the use of seclusion/restraint, gathering descriptive data, monitoring and setting improvement goals.
  • Workforce Development - creation of a treatment environment through training and staff recruitment that is based on the knowledge and principles of recovery and the characteristics of trauma informed systems of care.
  • Use of S/R Prevention Tools - such as Personal Safety Plans, Relaxation Comfort Rooms as calming environments, streamlining and simplifying milieu rules and procedures.
  • Consumer Role and Inclusion - in various roles and at all levels in the organization to assist in the reduction of seclusion and restraint.
  • Debriefing Techniques - thorough analysis of every event to inform policy, procedures, and practices, avoid repetitions, and to mitigate any adverse and traumatizing effects for involved staff, consumers, and witnesses.

These practices have resulted in a statewide reduction of 50% in seclusion / restraint events and a 40% reduction in the number of consumers in state hospitals requiring these most restrictive interventions for FY2010. Two state hospitals in Illinois, Elgin Mental Health Center and McFarland Mental Health Center, were recognized by SAMHSA as being among the top ten hospitals in the country that have shown exemplary effort, progress, and achievement in this initiative.

NARRATIVE: PURPOSE OF BLOCK GRANT EXPENDITURES AND ACTIVITIES IN FY2010

REPORT ON THE 2010 ADULT PLAN

Expenditure Of Block Grant Dollars In FY2010- Adults

The Illinois expenditure of the FY 2010 Community Mental Health Services Block Grant was directed at providing services in community settings for adults with serious mental illness and children and adolescents with serious emotional disturbances. Administrative expenses are capped at 5%. Block grant dollars were allocated (for adults and children combined) as follows in FY2010:

  • Community Consumer Support - $3,261,416
  • Psychiatrist Services In Mental Health Centers (Psychiatric Leadership)- $11,459,306
  • Special Projects - $180,000.00
  • To be Allocated - $321,895

A table detailing the allocation of dollars to agencies providing services to adults and children is included in Appendix A.

Block Grant Allocation - Adult Population

For adults, the allocation of block grant dollars has continued to be directed toward psychiatric leadership, community consumer support which is a component of psychosocial rehabilitation, and crisis care to serve individuals with serious mental illnesses. These programs are designed to provide the necessary intermediate and ongoing support and supervision for individuals who are transitioning from a state hospital to the community. The adult service funding allocation is consistent with the State Mental Health Plan, especially the need to provide community-based services as alternatives to hospitalization so that the need for state hospitals is reduced.

FY2010 SYSTEM PERFORMANCE INDICATORS -ADULT REPORT

Name of Performance Indicator: A-1:(NOM) Increased Access to Services (Number)

(1)  (2) (3)  (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

 Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage

Attained

Performance Indicator 142,492  129,419 142,492 126,883  89.05
Numerator N/A N/A -- N/A --
Denominator N/A N/A -- N/A  --
Table Descriptors:
Goal: To monitor access to services.
Target: Maintain or increase access to services for adults with mental illnesses at the FY2009 level.
Population: Adults with mental illnesses.
Criterion: 2: Mental Health System Data Epidemiology
Indicator: Number of adults served.
Measure: Number of adults receiving services from DMH-funded community-based providers.
Sources of Information: DMH ASO Community Reporting System and data warehouse. This indicator is generated from URS Table 2A excluding those whose age is unknown
Special Issues:
Significance: Adults with mental illnesses should have access to treatment.
Activities/ strategies: DMH will continue to collect data to track the number of persons receiving services from DMH-funded community-based providers in FY 2011. DMH community funded providers bycontract must submit registration and claims data for all individuals receiving services funded using DMH dollars. Data is submitted daily or weekly to the community reporting system maintained by the DMH's Administrative Services Organization (ASO), the Illinois Mental Health Collaborative For Access and Choice. Once this data is processed, it is then transferred to the DMH Data Warehouse for storage. This information is then used to develop reports that are the basis for the URS tables.
Target Achievement Not Achieved. There was approximately a 4% reduction in the number of individuals receiving treatment in FY2010. Uncertainty with regard to contract amounts at the start of FY2010 may have led to the reduction of the number of individuals receiving treatment. As the DMH budget continues to be reduced, we may see additional reductions in the number of individuals who access services.

Name of Performance Indicator: A-2:(NOM) Reduced Utilization of Psychiatric Inpatient Beds -30 days (Percentage)

(1) (2) (3)  (4)  (5) (6)
Fiscal Year

FY 2008

Actual 

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage

 Attained

Performance Indicator 13.39 13.19  12.39  13.24  93.58
Numerator 1,366  1,353  --  1,368  --
Denominator 10,205 10,256 --  10,330 --
Table Descriptors:
Goal: To decrease readmissions of individuals to state hospitals within 30 days by providing treatment that results in sufficient clinical stabilization such that subsequent treatment is provided in the least restrictive setting.
Target: Maintain or decrease readmissions within 30 Days to state hospitals.
Population:  Adults with serious mental illnesses.
Criterion: 1: Comprehensive Community-Based Mental Health Service Systems
 Indicator: Reduced Utilization of Psychiatric Inpatient Beds - 30 Days (Readmissions)
Measure:

Numerator: Number of adults readmitted to a DMH state hospital within 30 days of being discharged from a state hospital.

Denominator: Total number of civil discharges from state hospitals in a fiscal year.

Sources of Information:  DMH Inpatient Clinical Information System (CIS)
Special Issues:
Significance: Individuals with mental illnesses should receive services in the least restrictive settings possible.  However, there are times when access to inpatient services is required. Treatment provided in these settings however, should not result in an individual's return to the inpatient setting within a brief amount of time.
Activities/Strategies:

DMH will continue to monitor the number of adults readmitted to state hospitals within 30 days of discharge with the goal of decreasing the level of re-hospitalization by providing services in the community that are alternatives to hospitalization.

Please note that although the DMH has the goal of decreasing the utilization of state hospitals, individuals with serious mental illnesses may at times, need access to inpatient hospitalization.

Target Achievement: Not Achieved. Although the goal was to decrease utilization, the percentage was actually quite stable from FY2009 to FY2010. We have not as yet determined why the readmission rate at 30 days has remained essentially the same.

Name of Performance Indicator: A-3 (NOM): Reduced Utilization of Psychiatric Inpatient Beds -180 days (Percentage)

(1) (2) (3) (4) (5) (7)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage

Attained

Performance Indicator 23.37  22.86  21  22.27 94.30
Numerator 2,385  2,345  --  2,301  --
Denominator 10,205  10,256 -- 10,330 --
Table Descriptors:
Goal: To decrease readmissions of individuals to state hospitals within 180 days by providing treatment that results in sufficient clinical stabilization such that subsequent treatment is provided in the least restrictive setting.
Target: Maintain or decrease the percentage of readmissions within 180 Days to state hospitals.
Population: Adults with Serious mental illnesses.
Criterion: 1: Comprehensive Community-Based Mental Health Service Systems
Indicator: Reduced Utilization of Psychiatric Inpatient Beds- 180 Days. (Readmissions)
Measure:

Numerator: Number of civil readmissions to any state hospital within 180 days.

Denominator: Number of civil discharges in the year.

Sources of Information: DMH Inpatient Clinical Information System.
Special Issues: Please note that an incorrect value of 11.43 was reported for FY2007. The FY2008 actual reported value of 23.37 is however correct. FY2009 and FY2010 projections are based on this value.
Significance:
Activities/Strategies: DMH will continue to monitor the number of adults readmitted to state hospitals within 180 days of Discharge with a FY2011 goal of maintaining or decreasing the level of re-hospitalization by maintaining services in the community that provide alternatives to re-hospitalization.DMH continues to implement initiatives that provide community-based alternatives to inpatient hospitalization. However, individuals with serious mental illnesses may still require access to inpatient treatment.
Target Achievement: Not Achieved. The number of readmissions to state hospitals has remained stable from FY2009 to FY2010, despite the fact that the DMH target called for a slight reduction. There are a number of potential reasons for this stability. However, at this point in time, DMH staff are not sure of what accounts for this. DMH staff will continue to monitor this indicator.

Name of Performance Indicator:A-4 (NOM):-Evidence Based-Number of Practices (Number)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009  Actual

FY 2010

Target

FY 2010

Actual 

FY  2010

Percentage

Attained

Performance

Indicator

 2 3 3 3 100
Numerator N/A N/A -- N/A --
Denominator N/A N/A -- N/A --
Table Descriptors:
Goal: To maintain the availability of EBPs within the state
Target: Maintain/increase the number of EBPs available within the state.
Population: Adults with serious mental illnesses.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator:  Number of EBPs Implemented in Illinois
Measure: Number of EBPs Implemented in Illinois
Sources of Information: DMH ASO Community Reporting System and structured program reports collected by DMH staff from community agencies.
Special Issues: EBPs are very difficult to implement requiring the dedication of many resources. However, DMH has had a goal of increasing the number and type of EBPs provided within the state. During the past few years, DMH has focused on Supported Employment (SE), Assertive Community Treatment (ACT) and Permanent Supported Housing. Although there is much discussion with regard to Integrated Dual Diagnosis Treatment,Illness Self-Management, and Medication Algorithms there is still much work to do in this arena. 
Significance: Adults with serious mental illnesses should have access to evidence-based practices.
Activities/Strategies: As discussed in the narrative, DMH worked with its ASO to implement a new Community Services Reporting System in FY2009. DMH community funded providers by contract must submit registration and claims data for all individuals receiving services funded using DMH dollars. Data is submitted daily or weekly to the community reporting system maintained by the DMH's Administrative Services Organization (ASO), the Illinois Mental Health Collaborative For Access and Choice. Once this data is processed, it is then transferred to the DMH Data Warehouse for storage. This information is then used to develop reports. The DMH has created special codes for the reporting of ACT and to some extent, SE. Data related to PSH will be collected in FY2011.
Target Achievement: Target Achieved.

Name of Performance Indicator: A-5 Evidenced Based- Adults with SMI Receiving Permanent Supported Housing (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

 Target

FY 2010

Actual

FY 2010

Percentage

Attained

Performance

 Indicator

N/A N/A 200 N/A N/A
Numerator 303  --  396 --
Denominator N/A N/A -- N/A --
Table Descriptors
Goal: Provide Permanent Supported Housing (PSH) to adults needing these services.
Target: Increase the number of individuals with SMI receiving permanent supportive housing by 200 in FY2010.
Population: Adults with serious mental illnesses.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Number of adults with SMI residing in Permanent Supported Housing.
Measure: Number of adults with SMI residing in permanent supportive housing.
Sources of Information: This data will be generated from the DMH ASO community reporting system and a web-based database created especially for this initiative.
Special Issues: Measure uses CMHS definition of SMI.
Significance: Adults with serious mental illnesses who are in need of supported permanent housing should have access to it.
Activities/Strategies: The DMH has implemented Permanent Supportive Housing. DMH staff work with its ASO to receive and evaluate applications for permanent supportive housing. A web-based data base has been created to accept this data. Data is also being collected to track the services and clinical/demographic characteristics of individuals residing in permanent supported housing.
Target Achievement Target Achieved and Exceeded.

Name of Performance Indicator A-6: Evidence Based-Number of Persons Receiving Supported Employment (Number)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

 Target 

FY 2010

Actual

FY 2010

Percentage

Attained

Performance Indicator  N/A N/A 1,800 N/A
Numerator  1,738  2,026 -- 1,988 ---
Denominator N/A N/A -- N/A ---
Table Descriptors:
Goal: Provide Supported Employment to individuals with SMI who want to receive this service.
Target: Maintain the availability of SE to those individuals receiving it.
Population: Adults with serious mental illnesses
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator:  Number of adults with SMI receiving supported employment 
Measure:  Number of adults with SMI receiving supported employment
Sources of Information: Reports submitted by the DMH Central Office coordinator of supported employment by agencies providing this service.
Special Issues: All SE data has not yet been integrated into DMH ASO Community Reporting System. Data is being collected through a data base designed for this purpose.
Significance: Adults with serious mental illnesses who want to work should be able to secure competitive employment. Supported employment supports adults with SMI in their recovery. 
Activities/Strategies DMH staff have been working with DMH funded providers to streamline reporting of data and to report in a more consistent manner. Data regarding some key services has been integrated into the DMH ASO Community Reporting System, however, data for key indicators related to fidelity and outcomes has not. DMH Decision Support staff are working to develop a web-based reporting system to collect this data. It is expected that the design will be complete and available for data submission by late FY2011.
 Target Achievement: Target Achieved and Exceeded.

Name of Performance Indicator:A-7-Evidence Based -Number of Persons Receiving Assertive Community Treatment (Number)

Denominator

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

 FY 2010

Percent

 Attained

Performance

 Indicator

N/A N/A N/A N/A N/A
Numerator 674 653 -- 707 --
Denominator N/A N/A -- N/A --
Table Descriptors:
Goal: Provide access to assertive community treatment
Target: No target was established for FY 2010 due to the fact that ACT was revamped during FY2009 to ensure that this EBP has fidelity to the national model
Population: Adults with serious mental illnesses with multiple psychiatric hospitalizations
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Number of adults with SMI receiving ACT
Measure: Number of adults with SMI receiving ACT
Sources of Information: DMH ASO Community Reporting System.
Special Issues: During FY2009 DMH undertook an initiative to ensure that evidence-based assertive community treatment that comports with the national model is being provided. All teams underwent a fidelity assessment that was repeated during FY2010. This indicator uses CMHS definition of SMI.
Significance: ACT should be available to individuals who will benefit from this service.
Activities/ Strategies: DMH community funded providers by contract must submit registration and claims data for all individuals receiving services funded using DMH dollars. Data is submitted daily or weekly to the community reporting system maintained by the DMH's Administrative Services Organization (ASO), the Illinois Mental Health Collaborative For Access and Choice. Once this data is processed, it is then transferred to the DMH Data Warehouse for storage. This information is then used to develop reports. The DMH has created special codes for the reporting of ACT.
Target Achievement: Not Applicable. No target was established for FY2009 or FY2010 (see above).

Name of Performance Indicator:A-8: Evidenced Based- Adults with SMI Receiving Family Psycho-education (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage

 Attained

Performance

 Indicator

N/A N/A N/A N/A  N/A
Numerator N/A N/A -- N/A --
Denominator  N/A N/A --  N/A --
Table Descriptors
Goal: Not Applicable: DMH is currently not implementing this EBP.
Target: Not Applicable.
Population:  Adults with mental illnesses.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 
Indicator: Number of adults with SMI receiving family psychoeducation.
Measure: Number of adults with SMI receiving family psychoeducation.

Sources of

Information: 

Not currently implemented.
Special Issues: Planning is occurring-not yet implemented.
Significance:
Activities/Strategies Planning is ongoing. Several agencies in one DMH region are piloting this EBP.
 Target Achievement:  Not Applicable

Name of Performance Indicator:A-9: Evidenced Based- Adults with SMI Receiving Integrated Treatment of Co-Occurring Disorders (MISA) (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage

Attained

Performance

Indicator

 N/A N/A N/A  N/A N/A
 Numerator N/A N/A -- N/A --
Denominator N/A N/A -- N/A --
Table Descriptors:
Goal: Not Applicable: DMH is currently undertaking planning to continue implementation of Integrated Dual Diagnosis Treatment (IDDT).
Target:  Not Applicable.
Population: Adults with co-occurring serious mental illnesses and substance abuse disorders.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator:  Number of adults with SMI receiving IDDT services.
Measure: Number of adults with SMI receiving IDDT services.
Sources of Information: Not Applicable.
Special Issues: IDDT is one of the more difficult EBPs to implement. Although DMH worked on a pilot project with community agencies to implement this EBP, implementation has not occurred.
Significance: It has been estimated that 50% or more of individuals with serious mental illnesses have co-occurring substance abuse disorders. Integrated treatment is the most effective means of treating these disorders.
Activities/Strategies DMH will continue planning to implement IDDT.
Target Achievement: Not Applicable.

Name of Performance Indicator: A-10: Evidenced Based- Adults with SMI Receiving Illness Self-Management (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY2009

 Actual

FY 2010

 Target

FY 2010

 Actual

FY 2010

Percentage

Attained

Performance

Indicator

N/A  N/A N/A N/A  N/A
Numerator N/A N/A --  N/A --
Denominator N/A  N/A -- N/A --
Table Descriptors:
Goal: NOT APPLICABLE: Currently this EBP is not available in Illinois.
Target: No target; continuing efforts to implement this EBP.
Population: Adults with serious mental illnesses.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Number of individuals receiving Illness Self-Management.
Measure: Number of individuals receiving Illness Self-Management..
Sources of Information: Not currently collected.
Special Issues:
Significance: Illness self-management should be accessible to individuals with serious mental illnesses.
Activities/Strategies: Not Applicable.
Target Achievement: Not Applicable

Name of Performance Indicator:A-11 Evidenced Based- Adults with SMI Receiving Medication Management (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual 

FY 2009

 Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator N/A  N/A N/A N/A  N/A
Numerator N/A N/A -- N/A --
Denominator N/A N/A -- N/A --
Table Descriptors:
Goal: Not Applicable - Currently this EBP is not available in Illinois.
Target: No target; continuing efforts to strengthen work in this area.
Population: Adults with serious mental illnesses with specified diagnoses receiving psychotropic medication.
Criterion:  1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Number of individuals receiving Medication Management.
Measure:

Numerator: Number of individuals receiving Medication Management.

Denominator: Total unduplicated number of adults with SMI served by DMH funded care.

Sources of Information:  Not Applicable.
Special Issues:
Significance: Medication management is a key to the provision of service resulting in positive outcomes for certain diagnoses.
Activities/Strategies: The DMH continued its work to implement medication algorithms in state hospitals and community agencies during FY2010.
Target Achievement: Not Applicable.

Name of Performance Indicator: A-12 (NOM) Client Perception of Care Percentage)

(1) (2) (3) (5) (6) (7)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

 Actual 

FY 2010

Percentage Attained

Performance Indicator 60.42 67.98 61.40 N/A N/A
Numerator  258 327 -- N/A --
Denominator 427 481 -- N/A --
Table Descriptors:
Goal: Provide services that increase consumer perception of positive treatment outcomes.
Target:  Increase percentage of consumers with perception of positive treatment outcomes by 1%.
Population: Adults with mental illnesses receiving mental health treatment
Criterion:

1:Comprehensive Community-Based Mental Health Service Systems

3:Children's Services

Indicator:  Percentage of adult consumers reporting positively about outcomes.
Measure:

Numerator: Number of adults reporting positively about outcomes using the MHSIP Adult Survey

Denominator: Total number of adult responses regarding perception of outcomes completing the MHSIP Adult Survey

Sources of Information: MHSIP Adult Consumer Survey -Reported in Table 11 URS Tables
Special Issues:
Significance: Mental health services should result in positive outcomes.
Activities/Strategies: DMH has selected a random stratified sample of individuals receiving treatment in June 2010.  This sample is the basis for the survey that was disseminated in November 2010. Data will be available by February 2011.
Target Achievement: Not Applicable- Data will be available by February 2011.

Name of Performance Indicator: A-13 (NOM): Increase/Retained Employment

(1) (2) (3) (4)  (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

 Actual

FY 2010

 Target

FY 2010

Actual

FY 2010

 Percentage Attained

Performance Indicator 23.49 23.81 24 22.17 92.38
Numerator  28,199 26,172 -- 23,760 --
Denominator 120,058 109,924 -- 107,172 --
Table Descriptors:
Goal: Increase in competitive employment status by adults with mental illnesses receiving treatment
Target: General goal and target is to increase competitive employment rate of individuals receiving treatment. However, currently this data is only collected at intake prior to treatment, therefore there is no expectation that there will be an increase. Such a target will be set when we begin collecting data at T1 and T2.)
Population: Adults with mental illnesses receiving treatment.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percent of adult clients who are competitively employed.
Measure:

Numerator: Number of adult consumers competitively employed full or part time (includes supported employment).

Denominator: Number of adult consumers competitively employed full or part time (includes supported employment)plus number of persons unemployed plus number of persons not in the labor force (includes retired, sheltered employment, sheltered workshops, and other ). This does not include persons whose employment status is "not available".

Sources of Information: DMH ASO Community Reporting System.
Special Issues:

Change in status requires the ability to collect data at multiple points in time.

These issues are still being discussed by the states, NRI and CMHS.

Significance: Employment is an important variable contributing to recovery.
Activities/Strategies:  Although the states, CMHS and the DIG State Data Infrastructure Coordinating Center are still working to define measures for change in Employment status for individuals receiving treatment, the Illinois DMH has developed a policy to require 6 month updates of employment status for consumers. This new requirement will be instrumental in helping to track this important variable across time. Once the quality of data is ascertained through a data integrity plan which is in process of being implemented, DMH will be able to report change in employment status. Employment status will continue to be reported on URS Table 4.
Target Achievement: Not Applicable.

Name of Performance Indicator: A-14 (NOM) -Decreased Criminal Justice Involvement (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual

FY 2010

Target

FY 2010

 Actual

FY 2010

Percentage Attained

Performance Indicator 80.77 74.65 N/A N/A N/A
 Numerator  21 53 -- N/A --
Denominator 26 71 -- N/A --
Table Descriptors:
Goal: Decreased involvement with the justice system by adults with serious mental illnesses
Target: No target established due to developmental nature of the indicator.
Population: Adults with serious mental illnesses who have had involvement with the justice system
Criterion:  1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percent of adult consumers arrested in Year 1 who were not rearrested in Year 2.
Measure:

Numerator: Number of adult consumers arrested in T1 who were not rearrested in T2 (new and continuing clients combined)

Denominator: Number of adult consumers arrested in T1 (new and continuing clients combined)

Sources of Information: This indicator was collected using the MHSIP Survey in FY2009 and is being collected again by this method for FY2010.
Special Issues:
Significance: There is an expectation that adults receiving mental health services who have been involved with the justice system will decrease this involvement, however questions remain regarding the appropriateness of this measure.
Activities/Strategies Illinois will collect this data using the MHSIP Consumer Survey in 2010. However, due to the small response rate and the developmental nature of the measure no target has been established for FY2010. DMH has selected a random stratified sample of individuals receiving treatment in June 2010.  This sample is the basis for the survey that was disseminated in November 2010. Data will be available by February 2011
 Target Achievement: Not Applicable.

Name of Performance Indicator: A-15: (NOM) -Increased Stability in Housing (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

 Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 5.30 4.58 N/A 4.63   N/A
Numerator 7,121 5,554 -- 5,368 --
Denominator 134,288 121,392  -- 115,843 --
Table Descriptors:
Goal: Improve stability of housing for adults with serious mental illnesses
Target: Decrease the number of individuals in treatment who are homeless. However, since currently this data is collected only at intake prior to treatment we do not expect change to occur, therefore no target is projected Once we begin to track data at T1 and T2 we will specify a target. The data reported simply reflects status at intake.
Population: Adults with serious mental illnesses
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Increased Stability in Housing.
Measure: Numerator: Number of adult consumers who are homeless or living in shelters. Denominator: All adult consumers with living situation excluding persons with Living Situation reported as "Not Available". Measure excludes those whose age is unavailable.
Sources of Information: DMH ASO Community Reporting System
Special Issues: Although the states, CMHS and the DIG State Data Infrastructure Coordinating Center are still working to define measures for increased stability in housing, the Illinois DMH has developed a policy to require 6 month updates of living status for consumers. This new requirement will be instrumental in supporting DMH in its quest to measure change across time for this NOM. Once the quality of data is ascertained through a data integrity plan that is in process of being implemented, DMH will be able to report change in living status.
Significance: Adults with serious mental illnesses should have access to stable living environments.
Activities/Strategies DMH community funded providers by contract must submit registration and claims data for all individuals receiving services funded using DMH dollars. Data is submitted daily or weekly to the community reporting system maintained by the DMH's Administrative Services Organization (ASO), the Illinois Mental Health Collaborative For Access and Choice. Once this data is processed, it is then transferred to the DMH Data Warehouse for storage. This information is then used to develop reports. As noted above, DMH has established a policy requiring providers to update this information on a bi-annual basis. Once it has been determined that the quality of the data is good, DMH will begin to report change data for this variable.
Target Achievement: Not Applicable. Target specified reports only on consumers' status upon admission to treatment.

Name of Performance Indicator: A-16 (NOM) Adult -Increased Social Supports/Social Connectedness

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 62.79 72.11 N/A N/A N/A
Numerator 275 362 -- N/A --
Denominator 438 502 -- N/A --
Table Descriptors:
Goal: Increased perception of social support/connectedness by individuals participating in treatment.
Target: No target specified.
Population: Adults with serious mental illnesses
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percent of adult consumers reporting positively about social supports/social connectedness.
Measure:

Numerator: Number of adult consumers reporting positively about social connectedness.

Denominator: Total number of family responses regarding social connectedness.

Sources of

Information:

This information is being collected as a component of the FY2010 Adult MHSIP Survey.
Special Issues: This indicator is developmental and still being refined.
Significance: Availability of social support may be related to support for recovery.
Activities/Strategies:

The DMH will continue to work with CMHS, NRI and the states to refine this indicator.

DMH has selected a random stratified sample of individuals receiving treatment in June 2010.  This sample is the basis for the survey disseminated in November 2010. Data will be available by February 2011.

Target Achievement:  Not Applicable. Due to the developmental nature of this indicator no target was projected.

Name of Performance Indicator: A-17: (NOM) Adult -Improved Level of Functioning (Percentage)

(1) (2) (3)  (4) (5) (6)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 61.98 65.06 N/A N/A N/A
Numerator 269 324 -- N/A --
Denominator 434 498 -- N/A --
Table Descriptors:
Goal: Improved functioning for adults with mental illnesses receiving services
Target: None-Developmental Measure - No basis on which to set target
Population: Adults with mental illnesses receiving treatment
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 4:Targeted Services to Rural and Homeless Populations
Indicator: Percent of adult consumers reporting positively about functioning.
Measure:

Numerator: Number of adults receiving services reporting positively about functioning

Denominator: Total number of adult consumer responses regarding functioning

Sources of Information: Adult MHSIP Consumer Survey. This indicator is reported in URS Table 11.
Special Issues:
Significance: Mental health services should result in improved functioning and reduction in symptoms.
Activities/ strategies:  Continue working with the NRI, CMHS and the states to refine/develop this indicator.  DMH has selected a random stratified sample of individuals receiving treatment in June 2010 This sample is the basis for the survey that was disseminated in November 2010. Data will be available by February 2011.
Target Achievement: Not Applicable. Due to the developmental nature of this indicator, no target was projected for FY2010.

Name of Performance Indicator: A-18: ACT Service Hours In Community

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual 

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 63 68 63 72 114
 Numerator 38,034 42,651 -- 48,517  --
Denominator 60,714 62,302 --  67,088  --
Table Descriptors:
Goal: To assure that a significant portion of the service delivered within the (ACT) programs are provided in the most normalized settings possible in the individual's community, rather than within the provider's offices or clinics.
Target: Maintenance of the 67% level of ACT services delivered in community settings.
Population:  Adults with serious mental illnesses.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of ACT service hours provided in community settings for adults being served by the DMH-funded Assertive Community Treatment (ACT) Programs.
Measure:

Numerator: The number of hours of service provided by the DMH-funded (ACT) Programs which occur outside of the provider's offices or clinics.

Denominator: The total number of hours of service provided by the DMH-funded (ACT) Programs.

Sources of Information: DMH ASO Community Reporting System
Special Issues:
Significance: The ACT model emphasizes provision of services outside of traditional service settings.
Activities/Strategies: DMH will continue to monitor service provision of ACT programs in order to maintain current levels of services delivered in community settings.
Target Achievement Target Achieved.

 Name of Performance Indicator: A-19: Co-Occurring Substance Abuse Disorders -Adults

(1) (2) (3) (4)  (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual 

FY 2010

 Target

FY 2010

 Actual 

FY 2010

Percentage

Attained

Performance Indicator 13.60 9.50 N/A 12.30 N/A
Numerator 19,740 12,575 -- 15,591 --
 Denominator 144,845 131,702 -- 126,883 --
Table Descriptors:
Goal: To increase community-based mental health services for persons who have co-occurring mental Illness and substance abuse disorders.
Target:  No target specified. Tracking access to services by individuals with co-occurring disorders.
 Population: Adults with mental illness.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of adults served with a co-occurring disorder based on diagnostic category.
Measure:

Numerator: Number of adults served in the community with a co-occurring mental health and substance abuse diagnosis at intake.

Denominator: Total number of adults served in the fiscal year.

Sources of

Information:

DMH ASO Community Reporting System.
Special Issues: DMH notes that the percentage reported is likely an underestimate.
Significance: A little less than 13% of DMH consumers were identified at intake as having a substance abuse and a mental health diagnosis in FY2010. This is likely to be an under-estimate given national statistics and demonstrates the importance of ongoing training in identifying and treating persons with dual disorders (MISA).
Activities/Strategies DMH continues to encourage and support increased training for community mental health professionals in the identification, reporting and treatment of co-occurring disorders. DMH will continue to track the number of individuals reported with co-occurring disorders at intake.
 Target Achievement: Not Applicable. The figures displayed simply reflect consumer status at intake.

Name of Performance Indicator: A-20 Eligible Population -Adults

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 90.20 95.20 90.20 94.70  110.9
Numerator 130,675 123,175 -- 120,196 --
Denominator 144,845 129,419 -- 126,883 --
Table Descriptors:
Goal: To assure access to services by the DMH eligible population.
Target: Maintain/increase the percentage of individuals meeting DMH eligibility criteria receiving services from DMH community-based providers.
Population: Adults with mental illnesses.
Criterion:  2:Mental Health System Data Epidemiology
Indicator: Percent of adults receiving services from DMH-funded community-based providers who meet the established criteria for "eligible population" at the time of entry into services.
Measure:

Numerator: Number of individuals being served by DMH-funded community-based providers who meet the established criteria for "eligible population" at the time of entry into services.

Denominator: All individuals being served by DMH-funded community-based providers.

Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance: State mental health resources and services should be provided to the priority populations of thepublic mental health system.
Activities/Strategies: DMH aims to maintain or increase the proportion of persons served who meet the established criteria for "eligible population" at the time of entry into services.
Target Achievement: Target Achieved and Exceeded.

Name of Performance Indicator: A-21: Employment

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target 

FY 2010

 Actual

FY 2010

Percentage Attained

Performance Indicator 23.40  23 N/A 18.70 N/A
Numerator 28,199 26,172 -- 23,760 --
Denominator 120,058 129,419 -- 126,883 --
Table Descriptors:
Goal: Continue tracking employment status of consumers at case opening
Target: Track number of individuals employed at case opening
Population: Adults with mental illnesses
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of adults engaged in full or part time employment that is unsubsidized at case opening
Measure: Numerator: Number of adults reported as employed full or part time in unsubsidized employment at case opening Denominator: Total number of adults receiving services within the fiscal year.
Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance: Employment is a key issue relating to recovery and resilience. In FY2010, employment rates were slightly at 19% at point of intake. This descriptive data,collected before services are initiated, is not expected to change. These low levels are consistent with national findings and indicate the importance of further developing employment and supportive employment services. A drop in employment rate from 2008, can be attributed to the high overall unemployment rate due to the recession.
Activities/Strategies 
Target Achievement  Not Applicable.

 Name of Performance Indicator: A-22: Forensic Outpatient

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

 Actual

FY 2010

Percentage Attained

Performance Indicator 1.80 1.10 N/A 1.10 N/A
Numerator 2,665  1,442 -- 1,438  --
Denominator 144,845 129,419 --  126,883 --
Table Descriptors:
Goal: To track forensic status of adult clients served by the Mental Health System.
Target: Track the forensic status of consumers accessing mental health treatment through the DMH ASO Community Reporting System.
Population: Adults with mental illnesses.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of adult clients who had been court ordered into treatment due to a finding of Not Guilty by Reason of Insanity (NGRI), or Unfit to Stand Trial (UST), or by criminal court at the time of case opening.
Measure:

Numerator: Number of adults reported as unfit to stand trail, not guilty by reason of insanity or court ordered into treatment at the time of case opening.

Denominator: Total number of adults served in the fiscal year.

Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance: Community mental health staff track forensic outpatient status at the time of case opening.
Activities/Strategies: DMH plans to continue tracking forensic outpatient information at intake. DMH efforts to link mental health databases with county jails are ongoing and provide another means of identifyingpersons involved in the criminal justice system, as well as facilitating service provision.
Target Achievement Not Applicable. Numbers reported reflect status at intake.

Name of Performance Indicator: A-23: History Of Involvement With The Criminal Justice System

(1) (2) (3) (4) (5)  (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

 Target

FY 2010

Actual

 FY 2010

Percentage Attained

Performance Indicator 2.20 1.93 N/A 1.88 N/A
 Numerator 3,185 2,497 --- 2,382  ---
Denominator 144,845 129,419  --- 126,883 ---
Goal To track justice system involvement of adult consumers served by the Illinois Mental Health system.
Target: Track the justice system involvement of consumers accessing mental health services.
Population: Adults with mental illness.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of adult consumers reporting justice system involvement at thetime of case opening.
Measure:

Numerator: Number of adults reported as being involved with the justice system at the time of case opening.

Denominator: Total number of adults served in the fiscal year.

Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance: Identifying individuals involved with the justice system at time of case opening can increase coordination of services that increase the chances of recovery from mental illness and reduce the rate of recidivism and involvement with the criminal justice system. Slightly less than 2% of all persons served due to mental illness have had some involvement with the justice system.
Activities/strategies:  DMH plans to continue tracking justice system involvement information at intake. DMH efforts to link mental health databases with county jails are ongoing and provide another means of identifying persons with current involvement in the criminal justice system, as well as facilitating service provision and coordination.
Target Achievement: Not Applicable.

Name of Performance Indicator: A-24: Living Independently (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual 

FY 2010

Target

 FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 79 78.20 N/A 77.50  N/A
Numerator 114,101 101,199 -- 98,352 --
Denominator 144,845 129,419 -- 126,883 --
Table Descriptors:
Goal: To track demographic information on living arrangements of adult clients.
Target: Track number of individuals living independently at case opening. No increase is projected as this data is collected at intake prior to treatment.
Population:  Adults with mental illness.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of adults living in private residences, unsupervised, and considered to be living independently at the time of case opening.
Measure:

Numerator: Number of adults living in private residence, unsupervised, and considered to be living independently at the time of case opening.

Denominator: Total number of adults served in the fiscal year.

Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance: The proportion of individuals reported as living independently at intake has increased from about 63% to over 80% over the past several years. This demonstrates the need for ongoing attention to housing services for individuals with mental illnesses.
Activities/Strategies: DMH will continue to assess living arrangements at intake as a means of having baseline data on this indicator regarding the individuals who access DMH funded services.
Target Achievement: Not applicable. There is no established target for this indicator.

Name of Performance Indicator: A-25: Rural Residents Served -Adults

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual 

FY 2010

 Target

FY 2010

Actual 

FY 2010

Percentage Attained

Performance Indicator 35,146 28,166 35,000 26,046 74.4
Numerator N/A N/A -- N/A --
Denominator N/A N/A --- N/A  --
Table Descriptors:
Goal: To assure that individuals with mental illnesses who reside in rural areas have access to the DMH-funded community-based mental health services.
Target: DMH has set a target of identifying and providing services to 35,000 persons with mental illness in rural areas of the state.
Population: Adults with mental illness.
Criterion:  4:Targeted Services to Rural and Homeless Populations
Indicator: Number of individuals being served by DMH-funded community-based providers who are residents of rural areas at the time of entry into services.
Measure: Number of individuals reported by DMH-funded community-based providers who are residents of rural areas at the time of entry into services.
Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance: The geography of rural areas adds challenges to the timely and consistent access to services for both service providers and persons with mental illness.
Activities/Strategies: DMH aims to expand access to community mental health services for persons residing in rural areas. 
Target Achievement Not Achieved. There was an overall decrease in individuals receiving services in FY2010.

Name of Performance Indicator: A-26: Target Population -Adults

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual 

FY 2010

 Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 56.0 61.30 58.80  58 98.6
Numerator 81,144 79,321 -- 73,501 --
Denominator 144,845 129,419 -- 126,883 --
Table Descriptors:
Goal: To assure that resources and services are provided to the DMH priority population.
Target: Maintain or increase service level for persons with severe mental illness receiving mental health services.
Population: Adults with serious mental illnesses.
Criterion: 2:Mental Health System Data Epidemiology
Indicator: Percentage of individuals being served by DMH-funded community-based providers who meet the established criteria for "target population" at the time of entry into services.
Measure:

Numerator: Number of adults being served by DMH-funded community-based providers who meet the established criteria for "target population" at the time of entry into services.

Denominator: All adults being served by DMH-funded community-based providers.

Sources of Information: DMH ASO Community Reporting System.
 Special Issues:
Significance: The target group of adults with serious mental illnesses (SMI) is the priority population for the delivery of community mental health services.
Activities/Strategies: DMH will continue to monitor service provision to assure that individuals with severe mental illnesses receive priority services.
Target Achievement:  Target was basically achieved.

Name of Performance Indicator: A-27: Vocational Placement (Percentage of adults engaged in full or part-time employment in subsidized, supported or sheltered employment)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

 Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 2.30 2.0 N/A 2.0 N/A
Numerator 3,287 2,675 -- 2,468 --
Denominator 144,845 129,419 -- 124,231 --
Table Descriptors:
Goal: To track demographic information on vocational placement for adult consumers.
Target: Track vocational status of consumers as reported at intake.
Population: Adults with mental illnesses.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of adults who have a vocational placement at the time of case opening.
Measure: Numerator: Number of adults reported as having a vocational placement at case opening Denominator: Total number of adults served in the fiscal year.
Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance:
Activities/Strategies DMH plans to continue tracking this data while developing specialized employment services.
 Target Achievement: Not applicable. DMH has not established a target for this indicator.

 IMPLEMENTATION REPORT

NARRATIVE: SUMMARY OF PROGRESS IN FY2010

REPORT ON THE FY2010 CHILD AND ADOLESCENT (C&A) PLAN

INTRODUCTION

This report provides detailed information regarding the implementation of the Illinois DMH State Block Grant Plan for FY 2010. This first section of the Narrative for the Child Report summarizes Illinois' progress in addressing areas in need of improvement based upon the outcomes of the stated objectives in the FY 2010 Child & Adolescent Plan. The narrative description which follows addresses each objective and provides a statement of the level of attainment, information on how the objective was attained, and background information that provides context and purpose for the objective. The objectives discussed in this section have been a crucial part of ongoing DMH planning and service delivery. The next Section provides a description of significant events that have impacted the Child & Adolescent mental health service system in the past year. Information regarding specific allocation of block grant funds is provided in the last section of the Narrative.

Criterion I:

Family Participation

Objective C1.1. Continue to work with parents and parent-led organizations to facilitate parent-to-parent support through the use of Family Resource Developers and continue work with parents and parent-led organizations to encourage substantive feedback on enhancing the quality of services at all levels of care.

Indicators:

  • Number of FRDs hired by SASS programs to facilitate parent-to-parent support.
  • Percentage of FRD positions filled in FY 2010.
  • Number of FRD's hired in C & A programs other than SASS.
  • By the end of FY2010, maintain the five Family Consumer Specialists, one in each DMH region, to provide family voice to the DMH system and to increase the extent to which the DMH service system is family driven.

This objective has been accomplished.

In FY2010, DMH C&A Services worked with parents and parent-led organizations to facilitate parent-to-parent support through the use of Family Resource Developers and to encourage substantive feedback on enhancing the quality of services at all levels of care. Of the 44 Screening Assessment and Support Service programs currently operating in Illinois in which the presence of Family resource Developers is emphasized as very valuable, 36 of them, or 82%, reported FRD's on their staff. The total number of FRD's in SASS agencies was 44, as some agencies had more than one. There are three System of Care projects in Illinois that currently employ 20 FRDs. DMH continues to employ Family Consumer Specialists (FCS) as C & A staff members of DMH in each region of the state. As of the end of FY2010, all five of the DMH regions had a Family Consumer Specialist actively involved. The Family Consumer Specialists support and guide the development of policy and programs in the child and adolescent mental health system to ensure that parent consumer voice is driving planning, service delivery and evaluation efforts.

Parent/Caregiver Participation

The participation of parents/caregivers and adolescents in planning and evaluating the quality of mental health services is an important aspect of the Illinois public mental health system. DMH has maintained this effort as a priority with activities directed toward increasing family voice and participation in the provision of C&A services statewide and in DMH Regions. The utilization of parents/caregivers in service provision and as consultants has been ongoing through the employment of parents as Family Resource Developers and, at the state level, as Family Consumer Specialists. These staff provide support to parental and consumer advocacy groups and agencies serving families with children receiving mental health treatment, and provide a consumer voice in DMH child and adolescent services policy and program planning.

DMH continues to enhance the role of Family Resource Developers within Screening Assessment and Support Services (SASS) programs by contracting for assistance and training for FRD's through the Illinois Federation of Families, and through monthly regional meetings convened by the DMH Family Consumer Specialists. The purpose of these meetings is to provide education, resource development and support for the positions. DMH has emphasized the presence of Family Resource Developers (FRDs) in SASS agencies. The expertise the FRDs bring to the SASS teams has been increasingly valued and their support role has expanded. Some agencies are using FRDs to assist with Individual Care Grant application processes and service planning. Others have hired more than one FRD into their agency as they continue to recognize the value of the position.

FRDs are also employed in System of Care projects. The Egyptian System of Care, newly developed in FY2010, currently employs eleven (11) FRD's while Champaign County, also newly awarded, has not yet hired an FRD but is planning to do so. Nine (9) FRD's are employed in the McHenry County System of Care which has been ongoing for the past three years.

Objective C1.2.: In FY2010 advance Family Driven Care in Illinois by: establishing a Family Driven Care Commission; completing a needs assessment by quantitative survey and through utilizing the family advisory councils in each region to conduct focus groups for qualitative input; and, developing the competency requirements and curriculum for the certification of parent providers.

Indicators:

  • A Family Driven Care commission is established and operational by the end of FY2010.
  • Number of focus groups convened in FY2010 to complete a qualitative needs assessment.
  • A quantitative survey is conducted to determine baseline implementation of family driven care.
  • A proposal of a protocol for certification and an established curriculum by the end of the fiscal year.
  • Completion of a final report on the accomplishments of the grant-funded initiative.

This objective was partially accomplished in FY2010 and is still in process. The Family Driven Care initiative is well underway.

The Family Driven Care Commission (FDCC) has been operational throughout FY2010. One of the major accomplishments of the FDCC is the development of the Certified Family Partnership Professional (CFPP), a certification for parents functioning as peer providers in child serving organizations. It is expected that this credential will be officially recognized by the State of Illinois in early Spring 2011. Five focus groups were convened in FY2010 to complete a qualitative needs assessment. The quantitative survey to determine baseline implementation of family driven care has not yet been completed. This goal was re-prioritized for FY2011. A final report has not yet been completed as the initiative is still in process.

Family Driven Care

In 2009 Illinois was one of six states that received a SAMHSA award that paid expenses to participate in a policy academy focused on Family Driven Care. This project has supported collaboration with other child serving systems and supporters (DCFS, ISBE, CHP, DJJ, DASA, IFF, ICMHP) to address the extent to which the system is Family Driven. The project involves work towards goals of a qualitative and quantitative survey of families and providers, development of a multi-agency Family Driven Care Commission, and the beginning development of a state recognized certification for parent providers. The initiative was not finalized at the end of the year, and the expectation is that moving the system to truly family driven care will be an on-going effort for several years. The state currently operates five (5) 'Family Advisory Councils', one in each DMH region. These Family Councils include both parents and youth and are convened by the DMH Family Consumer Specialist in each region. The Councils are also part of the effort to move the system towards Family Driven Care.

The Family Driven Care Commission (FDCC) was developed following Illinois' receipt of a SAMHSA award to further Family Driven Care in the children's mental health system. The FDCC is made up of Family Consumer Specialists from DMH, family members, and administrative representatives from the Illinois Children's Mental Health Partnership, NAMI, ISBE, DCFS, DASA, JJ, DHS/CHP, and the Illinois Federation of Families. The FDCC is leading the development of the CFPP credential. The CFPP will assist in ensuring the quality of care that is provided to client families by peer parents in many of the child-serving systems. Certification will be accomplished through a mandatory training and experience protocol and the successful completion of a written examination. The goal for this credential is that it will be recognized in Illinois Medicaid Rule (Rule 132), and CFPP's will be authorized to provide services at the Mental Health Practitoner (MHP) level.

Qualitative survey results using key focus groups from each region have not yet been fully analyzed. However, initial results indicate a wide disparity in the extent to which families rate their care as being family driven. The development of the quantitative survey was suspended in order to prioritize the development of the CFPP credential with the limited resources that are available.

Objective C1.3. Continue to advance the implementation of evidence-informed practices in the child and adolescent service system:

  • In FY2010, introduce video based training methodologies in an effort to further disseminate the current training resources to the more rural areas of the state.
  • Broaden the impact of the EBP certification program by contracting with a fourth training University in the southern area of the state.
  • Continue to offer training opportunities on evidence-based engagement strategies
  • Continue consumer education through statewide 'Parent Empowerment Calls' to provide parents with information that allows them to both effectively drive and evaluate their children's care and the system at large

Indicators:

  • Number of training events provided in FY2010 that advance evidence-informed practices.
  • A virtual classroom system is operational by the end of the fiscal year.
  • A contract and curriculum is established with a fourth university to provide certification at the graduate level.
  • Number of statewide parent empowerment calls completed and the number of parents participating in the calls.

This objective has been substantially accomplished.

DMH has continued to advance the implementation of evidence-informed practices this year:

More than 45 training events were provided in FY2010 to advance evidence-informed practices and included 16 sessions on Cognitive Behavioral Therapy (CBT) and Behavioral Parent Training (BPT). There were 12 learning collaborative sessions on Engagement and 18 clinical measurement sessions (See objective C2.1).

Northern Illinois University has developed a virtual classroom that became functional in August 2010 can be used by all the community mental health providers serving children, and provides information for families. The virtual classroom, Project Educare, provides access to state-of-the-art information on children's mental health.

Seven statewide parent empowerment calls were held with over 180 participants.

Recruitment of a fourth university to provide a Masters level training program in the southern part of the state is continuing actively during FY2011. DMH C&A Services has approached and is currently negotiating with Southern Illinois University to establish the graduate certificate in their social work program. Three Masters level training programs across the state are continuing to graduate students with certifications in evidence based child and adolescent services. This initiative will increase the ability of the workforce to provide evidence-based intervention to youth in Illinois in the long term.

Evidence-Informed and Evidence-Based Practices

DMH has an evidence based practice subcommittee that is co-chaired by DMH staff and a leader of the Community Behavioral Healthcare Association, the trade organization of the mental health centers. This committee is comprised of a diverse membership; including parents, university professors, child advocacy organizations, community mental health agencies and DMH staff. Recognizing the extreme diversity of the population in Illinois and the narrow definition of specific EBP models, the EBP committee advised the DMH C&A Statewide Office to actively promote Evidence Informed Practice (EIP). Evidence Informed Practice is defined as "a collaborative effort by children, families and practitioners to identify and implement practices that are appropriate to the needs of the child and family, reflective of available research, and measured to ensure the selected practices lead to improved meaningful outcomes". Illinois is moving forward in its use of Evidence-Informed Practice for children and adolescents by:

  1. Educating the leadership of agencies providing C&A services on an Evidence Based Practice Paradigm.
  2. Training providers in specific evidence-based treatments.
  3. Developing partnerships with universities that train the C & A workforce in community provider agencies and developing the ability of training institutions to teach evidence-based practice during the early training of practitioners.
  4. Ongoing review and modification of DHS/DMH policies which support or impede evidence based practices.
  5. Providing education to consumers on evidence-based practice.

During FY2010 a significant amount of progress has been achieved in training efforts. As of the end of the year, 40 agency groups had participated in the EIP training series, a 12- month training experience for community mental health agencies on evidence-based skills, since it began. An important note here is that the evaluation of this project indicated that youth who were treated by clinicians who participated in this training improved at statistically superior rates versus those treated by comparison clinicians. The training model has been adapted, and outcomes for each cohort will continue to be evaluated to rate the impact of the model with youth outcomes.

In FY2009 Illinois initiated a Learning Collaborative pilot with 12 community mental health agencies that proved very successful. The learning collaborative group meets monthly for 6 months. Two additional learning collaborative groups were completed in FY2010, one on Evidence based engagement strategies and the other on evidence based group delivered services. In FY2011, plans are under development to support an additional Learning Collaborative group, on 'Engaging Families in Intensive Community Based Care'. The project will begin in January 2011. All topics for the Learning Collaborative have been recommended by the collaboration of stakeholders participating in the EBP subcommittee, and reflect state efforts to meet the emerging needs of the provider system.

Family Consumer Specialists host monthly statewide 'Parent Empowerment Calls' to provide parents with information that will allow them to more effectively drive and evaluate their children's care and the system at large.

The topics discussed at these monthly calls in FY2010 included:
January 7th "Why Not Use What Works? An Introduction to Evidence Based Practice.
February 4th  "Crafting the IEP"
March 4th "It's More Than ABC's" (What Illinois schools should be teaching children about Social & Emotional Skills.)
April 1st  "Can I Play, Too"-Helping Your Special Needs Child Find Recreational Opportunities
May 7th What Every Parent Can Do for Their Child - The Protective Factors
June 3rd Crisis Happens…Are You Prepared?
July 1st The Power of Parent to Parent Support

Additionally, consumer conferences for parents on evidence-based practices are regularly scheduled, and education campaigns for families on the use of outcome measures are being developed. The EBP committee has designed a brochure on Evidence Informed Practice for parents in order to help families know what to ask for and expect regarding care for their children.

Objective C1.4. In FY2010, continue to strengthen community service options in the DMH ICG program through increasing the number of youth served, implementation of outcome measures, and the introduction of a Child Family Team (CFT) approach.

Indicators: 

  • Number of children served through ICG community service options in FY 2010.
  • Completion of a report on the results of the first year of outcome measurement using the Ohio Scales and the Columbia Impairment Scale.
  • Number of training sessions provided on the CFT model
  • Number of functional Child and Family Teams by the end of FY2010.

This objective was largely accomplished in FY2010. The number of children served in the community was maintained and outcome measures were introduced and established in the program.

In FY2010, 150 youth were served in Community-Based care out of the 374 youth in the ICG Program, which represented 40% of the total population and is consistent with the percent served in Community-Based care in FY2009.

In FY2010, Residential ICG Providers entered 65 new youth into the Ohio Scales and Columbia Impairment Scale systems and outcome baselines utilizing the Ohio Scales and the Columbia Impairment Scale were obtained.

The ICG Program reports that the 32 residential providers who contract with DMH have adopted the Child Family Team Model and the Wraparound approach in their ongoing services and aftercare planning. Many SASS agencies have also employed child and family teams in clinical situations with multi-problem, cross-system features that can be addressed best with this approach. The ICG program has not tracked the number of child and family teams nor the number of training sessions conducted to educate providers in the implementation of the model in the past fiscal year.

The Individual Care Grant Program For Children With Mental Illness

The DMH Individual Care Grant (ICG) Program provides funds for residential treatment or intensive community treatment for children and adolescents with serious emotional disturbances who meet the criteria of severe mental illness and impaired reality testing. The Illinois Mental Health Collaborative for Access and Choice (the Collaborative) provides support for administrative procedures. The ICG program is family driven, meaning that families make the decision regarding whether they wish to utilize their grant for residential or community based services. These decisions are generally made with consultation from the mental health providers working with the family. Services provided include intensive, home-based support, treatment, and therapeutic stabilization services that allow the child to remain at home. The ICG program is unique in the sense that parents do not have to relinquish custody of their children to obtain these services. An ICG Advisory Council was established in FY2001 and continues to provide input to planning and service delivery.

Community-based ICG services are coordinated through agencies funded to provide SASS services and are available across the state. SASS agencies work with families to identify appropriate support services. As of April 1, 2009 the Collaborative began administering the community-based ICG program. The SASS agency serves as a fiscal agent by purchasing the services specified in the approved plan and monitoring their effectiveness in meeting the youth's clinical needs.

For some youth, the Community Based ICG program serves as an excellent "step down" transition from residential care, for others, the community-based services are effective in preventing the need for institutional placement. Community-based ICG services are also an effective transitional support for the movement from child and adolescent services to adult services. Considerable efforts have gone into providing up to twelve months of post ICG funding to facilitate transitional integration into the community and into the adult service system. The program offers a number of supports, including child support services, case coordination services, behavior management services, and therapeutic stabilization services. Collaborations have been developed between special recreation associations and community SASS programs to assist youth in developing supportive relationships and new behavior patterns in the community.

In FY2010, the ICG Program received 657 requests for applications. Of the 263 applications returned to the ICG Program for eligibility determination, 47 grants were awarded this fiscal year. This is consistent with the number of awards over FY2009. In FY2010, 150 youth were served in community-based care out of the 374 youth in the ICG Program, which represented 40% of the total population and is consistent with the percent served in community-based care in FY2009.

The ICG Program has initiated the use of the Ohio Scales and the Columbia Impairment Scale as outcome measures for ICG recipients. Residential and Community-Based providers continue to report this data on a quarterly basis. This information is available for provider review and analysis of treatment progress of ICG youth. In FY2010, Residential ICG Providers entered 65 new youth into the Ohio Scales and Columbia Impairment Scale systems and outcome baselines utilizing the Ohio Scales and the Columbia Impairment Scale were obtained.

The ICG program is striving for continuity and enhancement of services. In FY2010, transition to the Illinois Medicaid Rule (Rule 132) continued with oversight of administrative procedures by the Collaborative and required a focus on treatment practices and claiming practices. ICG Providers have begun billing all treatment encounters as fee-for-service and the Collaborative has conducted Post-Payment Reviews to monitor ICG Provider compliance with the Illinois Medicaid Rule.

Objective C1.5: In FY2010, continue the public awareness campaign to reduce negative portrayals associated with mental illnesses. Complete an initial evaluation of the effects of the Campaign.

Indicators:

  • Materials developed for dissemination that address resource and access issues.
  • Completion of a report on the evaluation of the campaign with documented outcomes and lessons learned.
  • A report of the key achievements of the campaign and the significant public venues utilized to bring the message to all the citizens of Illinois.-

This objective was met in FY2010. The campaign continued, albeit in a limited manner and an evaluation through an outcome survey was completed early in the fiscal year.

The DMH "Say It Out Loud" Campaign is directed to adults, children and families. This objective is the same as Objective A1.4 in the Adult Report. For a report of the campaign's progress in FY2010, see the Adult Report-Summary of Areas section.

"Say It Out Loud" Promotional Grants in Children's Services

The Illinois Children's Mental Health Partnership (ICMHP) and DMH are invested in educating the public and other key target audiences about the importance of children's social and emotional development and mental health and reducing the stigma of childhood mental illness through the implementation of the Say It Out Loud! Campaign. An interactive website provides information on mental health and well being to policymakers, health and mental health providers, educators, family members, consumers, and the general public. The campaign's Web site: www.mentalhealthillinois.org. and related activities are continuing in FY2011. ICMHP awarded fifteen grants in FY2009 and an additional ten in FY2010 to support community- based efforts which individualize strategies and tailor local messages to promote the Say It Out Loud Campaign. Planning is underway to fund an additional 10 sites in FY2011.

Objective C1.6 (NOM): The percentage of parents/caregivers reporting positive outcomes through the Youth Services Survey for Families will increase in FY2010. (Please note that an increase in return to/stay in school and a decrease in criminal justice involvement is not projected due to the developmental nature of these indicators. These indicators are however listed below.)

Indicators:

Percentage of parents/caregivers reporting positively about outcomes with reference to the following national outcome measures:

  • Client Perception of Care (Outcomes Domain)
  • Return To/Stay in School
  • Decreased Criminal Justice Involvement
  • Increased Social Supports/Social Connectedness
  • Improved Level of Functioning

This objective is currently in process. During November 2010, the FY2010 Consumer Survey was mailed to a random sample of 2,600 families of children ages 11 and under receiving services in June 2010. It is anticipated that an analysis of the responses will be completed in February 2011. The FY2009 Consumer Survey was completed during FY2010 and serves as the baseline from which to track consumer satisfaction with services and the newly developed national outcome measures for social connectedness and improved functioning.

The FY2009 survey results showed no change in Client Perception of Care (Outcomes Domain) from the previous years responses (52%) and 36% of caregivers reported an improvement in school attendance as a result of services. For Decreased Criminal Justice Involvement only one caregiver reported an arrest. Increased Social Supports/Social Connectedness also did not change (75% in FY08 and 76% in FY09) nor did Improved Level of Functioning (54% in FY08 and 53% in FY09)

The DMH uses the National Outcome Measures (NOMS) along with additional system indicators to track mental health system service delivery and outcomes to aid in service planning. The Division has adopted the MHSIP: Youth Services Survey for Families to collect feedback from caregivers of children ages 0 - 12 who are receiving community mental health services funded by the DMH. The survey has been successfully completed annually since FY2007. The measures reported through the survey are: Client Perception of Care, Increased Social Supports/Social Connectedness, and Improved Level of Functioning.

The Youth Services Survey for Families is part of the Mental Health Statistics Improvement Program (MHSIP) Quality Report performance measures. The annual surveys address two goals of the Division: data based decision-making in a continuous quality improvement environment and to enhance and expand the involvement of families and caregivers in the review, planning, evaluation and delivery of mental health services. Variables included in the analysis are: residence in Chicago, severity of emotional disturbance, race/ethnicity, and length of time in treatment. The information compiled in this report can be used for management, planning, quality improvement and feedback to providers, consumers and family members regarding state and federally funded services. The survey will be conducted again in FY 2011.

For children, the Division has adopted the MHSIP:Youth Services Survey for Families to collect feedback from caregivers of children ages 0 through 11 who are receiving community mental health services funded by the DMH. A random sample of children, stratified by race/ethnicity, was drawn from all children receiving services from DMH providers in June 2009. Only children aged 0-11 were chosen. The decision to exclude adolescents aged 12-17 was made because some adolescents seek help without their parent's knowledge and receiving a survey at home may compromise that decision

The FY2009 Survey

The number of caregivers who responded to the survey was 377 yielding an adjusted response rate of 16%. A preliminary analysis of race and Hispanic ethnicity shows no significant difference between the original sample and survey respondents. Differences by age group and region code were not significant. Of the 377 caregivers responding: forty-four percent of kids are considered as part of the DMH target or priority population i.e. they have a serious emotional disturbance (SED). Sixty-two percent are male; 36% female and 2% gave no response on gender. When asked about Medicaid eligibility, 85% of the caregivers reported that their children were receiving Medicaid. Seventy-six percent of respondents were currently receiving services at the time of the survey; 49% received services for less than 1 year; 51% for 1 year or more. Most children were living with one or both parents (81%) or with another family member (7%). Fourteen or 5% were living in a foster home.

The percent of positive responses to the 7 domains overall are listed below in descending order from the greatest number of positive responses (cultural sensitivity) to the least (Outcomes).

Reporting Positively About Cultural Sensitivity of Staff 83%
Reporting Positively about Participation in Treatment Planning 78%
Reporting Positively about Social Connectedness 76%
Reporting Positively about Access 71%
Reporting Positively about General Satisfaction 68%
Reporting Positively about Functioning 53%
Reporting Positively about Outcomes 52%

The primary findings of this survey are derived from the domain scores. The domain scores ranged from a high of 83% (positive perception of the cultural sensitivity of treatment providers) to a low of 52% (positive perception of the outcomes from the services.) This trend is evident over the past 3 years. A sub-analysis was done to see if length of time in treatment impacted the perception of outcome. The analysis shows no difference among caregivers whose children have been in care for over a year in 5 out of the 7 domain questions versus those in care for one year or less. Caregivers of children currently receiving services were much more satisfied with the care than those who were no longer getting care (71% vs. 54%). This could be a potential indicator that people are leaving services for reasons other than recovery. When looking at survey responses over time, it is evident that some domain areas are trending downward, specifically: Satisfaction, Cultural Sensitivity and Treatment Planning. This is an area of concern and will be addressed in planning and improvement strategies.

Overall, as an evaluation tool of DMH services, this consumer survey has drawn a picture of services where caregivers felt like they participated in their child's services and they also felt that the service providers were respectful and sensitive to their cultural/ethnic background. However, in questions pertaining to outcomes, only half of the parents agreed that their child is better at handling daily life, or is doing better in school as a result of services. This trend mirrors results seen nationally and presents further evidence of the need for evidence based, outcome driven mental health systems.

Objective C1.7(NOM): Continue efforts to decrease 30 day and 180 day readmission rates to DMH state hospitals.

Indicators:

  • Percentage of youth readmitted to state hospitals within 30 days of being discharged
  • Percentage of youth readmitted to state hospitals with 180 days of being discharged.

This objective continues to be addressed.

DMH continues to monitor the number of youth readmitted to state hospitals within 30 days of discharge and the number of youth readmitted to state hospitals within 180 days of discharge with the goal of maintaining or decreasing the level of re-hospitalization through the use of community based services that provide alternatives to hospitalization. However, it is to be expected that children and adolescents with serious emotional disturbances and mental disorders, may, at times of crisis and relapse, require access to inpatient services for evaluation and stabilization in a safe, structured, and supportive environment. See the Report on FY2010 Child Performance Indicators section for data and information about these indicators that are a National Outcome Measure (NOM)

Decreased Rate of Readmissions

DMH will continue to monitor the number of youth readmitted to state hospitals within 30 days of discharge and the number of youth readmitted to state hospitals within 180 days of discharge with a FY2011 goal of maintaining or decreasing the level of re-hospitalization through the use of community based services that provide alternatives to hospitalization. See the Child-Goals, Targets, and Action Plans section for data and information about these indicators that are a National Outcome Measure (NOM).

The Screening, Assessment, and Support Services (SASS) program has had a major impact on hospital admissions. SASS was initiated by the DMH in 1989 with a primary responsibility of screening adolescents prior to their admission to state hospitals. As DMH began to fund community hospitalization, SASS expanded its screening efforts for these services providers as well. The SASS program was expanded to a tri-agency funded program (DMH, DCFS and DHFS) in FY 2005. Wraparound funding, as described above, is also utilized in efforts to keep children twelve years of age and under out of state hospitals in several areas of Illinois. This initiative utilizes SASS and other specialized community-based services to maintain the child in the community.

Criterion II:

Child and Adolescent Outcomes Analysis

Objective C2.1: By the end of FY2010, provide training on the integration of the Web-based system into treatment planning and agency decision-making. Introduce the Devereux Early Childhood Assessment Scales (DECA) and provide training for all providers serving young children ages 0-5.

Indicators:

  • The number of agencies utilizing the web-based outcomes analysis system with technical assistance.
  • The number of training sessions devoted to integration of the web-based clinical outcomes system into clinical practice
  • The number of early childhood providers reporting DECA assessments.
  • The number of DECA assessments reported by the end of FY2010.

This objective has been accomplished.

The web-based outcomes analysis system is being utilized by 149 agencies. Eighteen (18) training sessions devoted to integration of the web-based clinical outcomes system into clinical practice were provided including both 7 outside expert consultant trainings with Mary Mackrain and Benjamin Ogles, and 11 monthly technical assistance on clinical use of the system were conducted by DMH staff. A total of 76 clinicians in 45 different community mental health agencies reported providing DECA assessments and 232 DECA assessments were reported as completed by the end of FY2010.

Child and Adolescent Outcomes Analysis:

The web-base Outcomes Analysis System was initiated in July of 2008. The system consists of four measures: (1) The OHIO Scale-Worker version; (2) The Columbia Impairment Scale for Parents; (3) The Columbia Impairment Scale for Youth; and (4) Goal Attainment Scaling methodology (optional). The instruments are used at case opening, quarterly thereafter, and at closing. Users of the web-based system will be able to generate immediate feedback reports at each level of service. Clinicians will be able to generate reports and graphic profiles on their individual clients across specified time periods that are shared with the client and family. Access to this data is a valuable benefit to the client and family as a means of being able to see, use, and share an objective assessment of progress and accomplishments as well as identification of issues to work on. A term coined to describe this aspect is "refrigerator art"- something posted in a common place for all the family to see. Agency site coordinators of the system will be able to generate agency wide service reports. DMH will be able to compile system-wide data from all the participating agencies. Implementation has gone well and has included training in the instruments and monthly Technical Assistance calls and Net meetings for users of the system.

As of the end of August 2010, the system reports that for FY2010, (July 1, 2009 through June 30, 2010) 34,061 youth participated in the outcomes system. There were 149 registered agencies and 2,048 clinical users of the system. The average initial score statewide on the Columbia Scale-Parent Version was 22.22 and 20.91 at the 90-day reassessment. On the Columbia Scale -Youth Version, the statewide initial score was 17.49 decreasing to 15.72 at 90 days. The Initial Ohio Problem Score was 23.26 decreasing to 19.80 at 90 days and 18.67 at 180 days. The Initial Ohio Functioning Score was 46.58 increasing to 48.60 at 90 days and to 49.52 at 180 days. Statewide, the outcomes of care look very positive, with a 15 percent reduction in symptoms reported by clinicians and a 10 percent reduction reported by parents and youth after 90 days of care. This represents children moving from scores indicating a clinical need to a score that is within the expected range for youth without serious emotional or behavioral problems. The accumulating data is clearly showing that the youth in the public mental health system in Illinois are overall making progress in their care.

In FY2010 the Outcomes system was expanded to include the Devereux Early Childhood Assessment Scales (DECA), an instrument to be used with children age 0 - 5. The DECA assessments for infants, toddlers and clinicians were added to the web system and trainings were held for providers on both use of the instruments and mental health work with young children. Two hundred thirty two (232) young children received DECA assessments in the first 6 months of the DECA inclusion in the outcomes system. This number is expected to increase significantly in FY2011 as providers and families become more familiar with its use.

Criterion III:

Objective C3.1. In FY2010, increase the number of youth receiving services through the Mental Health Juvenile Justice Initiative (MHJJ)

Indicators:

  • Number of youth served by the program statewide.
  • Number linked to services, and
  • Number of youth re-arrested

The activities of this continuing objective were substantively accomplished. However, an increase in the number of youth served was not realized. Budget related contract freeze issues, provider instability due to financial challenges, and an extended period of uncertainty (over 60 days) at the beginning of the fiscal year regarding continued funding negatively impacted the program. The number of those referred declined by nearly 10% from FY2009 and the number of those enrolled declined by 25%. In FY2010, 1193 youth were referred to the MHJJ Initiative, 517 were screened, 474 were determined eligible for program services, and 420 were actually enrolled. The initiative reported that 71.9% of the youth were linked to services and that 17.8% had been re-arrested in FY2010.

Mental Health and Juvenile Justice

The MHJJ program aims to strengthen the linkages among the courts, probation, detention, schools, mental health, and other community-based services. In addition, MHJJ recognizes family engagement at all levels is vital to achieving best outcomes. Consistent with this priority, a number of MHJJ agencies have been able to offer parent- to-parent support through their Family Resource Developers. Youth are referred to the MHJJ program from a variety of sources (judges, attorneys, probation officers, etc). Specially trained MHJJ liaisons then screen the youth for the presence of a serious mental illness such as a major affective disorder or psychosis. Once found eligible, a functional assessment is conducted. This assessment not only identifies areas of functional impairment, but also areas of strength that can be leveraged in the development of an individualized action plan. Based on the action plan, MHJJ liaisons link youth with appropriate community-based services and continue monitor the progress of each youth for a period of six months. Access to a flexible spending is available to supplement the youth's treatment ancillary services or family stabilization for which no other source of funding is available.

The data for the FY 2009 indicators and the data for FY 2010 are detailed below:

Fiscal Year Number of Referrals Number Screened  Number Eligible Number Enrolled Percent (%) Linked to Services Re-arrest Rate (%)
2009 1319 644 596 565 82.54 31.3
2010 1193 517 474 420 71.9 17.8

The program reports that the average number of youth enrolled in the years from 2004 through 2010 has been 595.

In FY2010, minority enrollment continued to increase. This trend is consistent with past findings. It is also reflective of the MHJJ program's targeted outreach to, and education of, referral sources regarding minority youth with serious mental illnesses. Continuously increasing the percentage of minority youth referred and percentage of minority youth enrolled will continue to be a priority objective for the program particularly in light of the overrepresentation of minority youth in the juvenile justice system.

In FY2011, the overall mission of MHJJ will remain unchanged and liaisons will continue their efforts to intercept youth at the earliest stages of their justice involvement. Since the number of service sessions is associated with positive outcomes maintaining and increasing the number of service sessions offered will continue to be a priority. MHJJ has continuously increased clinical services most strongly associated with positive outcomes. Ongoing evaluation of such correlations will facilitate efforts to provide services proven most effective in improving overall functioning of these youth. The annual evaluation and outcome analysis consistently demonstrates that completion of the MHJJ program is associated with overall clinical improvement, decreased functional impairment, and reduced rates of recidivism for youth.

Finally, ongoing MHJJ evaluation findings indicate that parent engagement is associated with the most positive outcomes. As part of program enhancement, increased focus of parent engagement was initiated last fiscal year, resulting in increased hiring of parent liaisons. Working with agencies to increase the number of parent liaisons available to promote family engagement will continue to be a central program objective to MHJJ.

Objective C3.2: During FY 2010, continue to monitor and evaluate each transitional service site with special emphasis on: determination of appropriate utilization rates and service outcomes; identification of effective intervention strategies; and identification of regional similarities or differences relevant to service need and delivery.

Indicators:

  • Total number of transitioning youth served at each site.
  • Total amount of services reported and Medicaid billed to DMH's electronic data reporting system.
  • Provider documentation of outcomes, lessons learned, gaps and challenges in the service system, networking, and successful or promising service delivery strategies and/or innovations.
  • Number of meetings held with all the providers to share experiences and solutions to problematic issues.

This objective was completed in FY2010. DMH C&A Services continued to monitor and evaluate the transitional service sites. Due to FY2010 budget constraints this project was reduced from ten grants in FY2009 to five grants in FY2010, one in each DMH region and served 150 youth, of whom at least 30 transitioned from correctional settings. These pilots have now ended and further activity in this direction is on hold pending the acquisition of funding. The ICMHP and DMH are evaluating the data and information gained from the pilots with the aim of developing plans for statewide services to transitional youth for implementation as funding becomes available.

During FY 2010 the focus of meetings with providers was adjusted from the group session goal to individualized meetings. Review of previous year's meeting's notes and accomplishments revealed that individualized technical assistance was a greater need. Therefore the group-meeting format was replaced by technical assistance teleconferences with each provider focusing on their unique program development and service delivery challenges. Twelve individualized technical assistance teleconferences occurred during the fiscal year.

Transitional Youth Pilot Projects

In FY2007 and FY2008, DMH, in collaboration with ICMHP, awarded a total of ten (10) pilot sites for $1,000,000 in statewide funding to provide mental health services that addressed the unique and special needs of older adolescents (16-17 years old) with SED who are transitioning from C&A services to adult services and for any youth with mental health needs and/or social/emotional impairment who is transitioning from correctional services to the community. In addition to providing an array of mental health services, the projects were expected to build community infrastructure and to facilitate expansion of transition services for youth. By the end of FY2009, the transitional pilot programs served a total of 435 youth. Of these, 320 were youth ages 16-18, with Serious Emotional Disturbance who required transitional services and 115 were transitioning from juvenile justice settings. Transition age and newly paroled youth and their families received 5,060 hours of direct clinical, case management and support services and a total of $175,000 was billed to Medicaid. Some reported challenges were: engaging families or other supports in the treatment process, maintaining youth in treatment, and obtaining financial resources to assist youth with daily expenses like transportation and housing. Some reported successes were: establishment of working relationship with local providers of adult mental health services, implementation of groups designed to assist youth develop adult life skills, and engaged youth demonstrate significant improvement in functioning. These pilot programs provided vital information as to the service models and intervention strategies that work best for the target population groups addressed.

During FY2010, more than 150 youth and their families were served and approximately 2,000 direct service hours were provided. Due to FY2010 budget constraints this project was reduced from ten grants in FY2009 to five grants in FY2010. The projects whose funding was continued were able to build upon previous years successes to further serve youth. Consistent with the literature on transition services for young adults, this project has demonstrated that significant improvement in functioning occurs when young adults receive social/emotional supports geared to their developmental level and specific needs. The ICMHP and DMH are evaluating the data and information gained from the pilots with the aim of developing plans for statewide services to transitional youth for implementation as funding becomes available.

Objective C3.3: In FY2010, continue to monitor and evaluate each early intervention site with special emphasis on: determination of appropriate utilization rates and service outcomes; identification of effective intervention strategies; identification of regional similarities or differences relevant to service need and delivery; identification of opportunities for additional expansion of the initiative to more providers and communities; and introduction of a uniform web-based mental health assessment or screening tool for young children age 0-5.

Indicators:

  • Total number of children and families served by the end of the fiscal year.
  • Total amount of services reported and Medicaid billed to the DMH electronic data reporting system.
  • Provider written reports that document outcomes, lessons learned, gaps and challenges in the service system, and networking outcomes.
  • Provider documentation of successful or promising service delivery strategies, innovations and/or service models.
  • A statewide report documenting outcomes, lessons being learned, gaps and challenges in the service structure, and successful innovations in early intervention services to children and families is drafted, reviewed, approved, and disseminated.
  • The number of web-based assessments/screenings completed by Mental Health Early Intervention programs during the fiscal year.

This objective was completed in FY2010. DMH C&A Services continued to monitor and evaluate the early intervention sites. During FY 2010 the number of awarded grants was reduced to five (5) due to funding cuts. More than 450 children and their families were served, resulting in more than 2,700 direct service hours. These pilots have now ended and further activity in this direction is on hold pending the acquisition of funding. The ICMHP and DMH are evaluating the data and information gained from the pilots with the aim of developing a plan for statewide early intervention services to be implemented as funding becomes available.

Mental Health Early Intervention Initiative

The Mental Health Early Intervention Initiative was aimed at identifying children and adolescents at risk, especially those at risk of mental health or social/emotional impairment, and to intervene early. Two agencies in each DMH region were funded and each agency developed its own plan and approach to early intervention based on the unique geographic, cultural, and interagency service environments in their region. Case finding in venues outside the normal service paths for children with serious disturbances was emphasized. During FY 2009, nearly 1500 children and families were served and more than 6,000 hours of direct services were provided by the agencies funded to provide early intervention services. They provided an array of clinical, case management, and support services. A total of $84,530 was billed to Medicaid. Successful engagement strategies identified in the quarterly reports included: (1) Services provided at daycares and pre-schools yield the best engagement outcomes for the 0 to 5 year old group. (2) For older children providing services within the school setting is the most successful approach but parent participation is frequently lacking, and (3) Addressing the parent-child relationship is the most successful strategy in treating the behavior issues of young children.

Objective C3.4: During FY 2010, through monitoring and program evaluation determine whether each Early Childhood Mental Health program is continuing to achieve the service and system development requirements of their grant. Introduce a uniform web-based assessment/screening tool such as the Devereux Early Childhood Assessment (DECA); and collaborate with providers to identify strategies to address needs and gaps in each service region, and to develop recommendations for the enhancement of Early Childhood Services.

Indicators:

  • The number of children ages 0-5 served in FY2010.
  • A description of services provided to children and their families/caretakers and the number of service hours provided for each service in FY2010.
  • Number of meetings convened with participating providers to share information on best practices, program outcomes, unmet needs, and strategies to address service gaps and needs.
  • The number of web-based assessments/screenings completed by Early Childhood programs during the fiscal year.

This objective has been met for FY2010. DMH C&A Services continued to monitor and evaluate the five Early Childhood Mental Health programs. During FY 2010 providers served nearly 220 registered consumers and 150 unregistered consumers, and provided more than 3,200 direct service hours. The Devereux Early Childhood Assessment (DECA) was introduced and established as an ongoing assessment tool. This initiative is continuing in FY2011.

The Early Childhood Mental Health Program

The Early Childhood Mental Health Program was established during FY2008. DMH Child and Adolescent Services and the Illinois Children's Mental Health Partnership (ICMHP) identified early childhood mental health as a priority in Illinois and collaborated in funding appropriate mental health services to children ages 0-5 experiencing mental health and/or social/emotional development problems. Five (5) child-serving mental health providers, one in each of the five regions, have been funded to: a) provide mental health assessment and treatment services to children age 0 - 5 years with psychological or social/emotional development needs; b) provide parent support services to families of eligible children; c) provide services that are child focused and family driven: and d) develop connections to referral systems/networks for early childhood. During FY2009 a total of 232 registered and 60 unregistered infants and young children and their families received clinical, case management and support services from providers funded by the initiative. More than 4,000 direct service hours were delivered and over $60,000 was billed to Medicaid. The five most reported services delivered in the order of prevalence were: therapy or counseling with families, community support to an individual, case management/collaboration, mental health assessment, and therapy or counseling to an individual. During FY 2010 providers served nearly 220 registered consumers and 150 unregistered consumers, and provided more than 3,200 direct service hours.

Criterion IV:

Objective C4.1: Continue to implement telepsychiatry services in six rural sites in Illinois. Establish baseline for service utilization and assess the need for further enhancement and expansion in FY2010.

Indicator:

  • Number of youth served in FY2010
  • Number of psychiatry hours provided in FY2010.

This objective was achieved.

Tele-psychiatry services were implemented in the six rural sites and an additional site was added in FY2010, bringing the number of sites to seven. In the beginning of FY2010, the project had to be put on suspension status, due to contractual freezes related to budget issues. Services were reinstated in November 2009. In FY2010, 121 youth were served from seven community mental health agencies and 653 hours of Tele-psychiatry services were provided to these youth.

C&A Tele-Psychiatry Pilot

Many rural and other geographic areas of the state lack access to mental health providers with expertise in serving children and their families, particularly child and adolescent psychiatrists. The Tele-Psychiatry project was designed to provide psychiatric services to children and youth in areas of the state where communities do not have access to a board certified child psychiatrist. DMH Regions 4 and 5 were targeted for the Tele-psychiatry pilot due to the paucity of child psychiatry resources in those areas. Families routinely had to travel 2-3 hours to see a child psychiatrist, and children were hospitalized or placed into residential care when they may have been able to remain in their home community with appropriate medical support. In FY2008, approximately $300,000 was budgeted for a pilot project which allowed six agencies to each purchase $50,000 of qualified psychiatric consultation time to be provided through a Tele-Psychiatry approach ranging from informal case discussions to formal case reviews, and a telemedicine approach in which the child is present for assessment. The Tele-psychiatry initiative was established in Regions 4 and 5. Seven agencies are now involved in the two regions. The project was awarded in February 2008, infrastructure and the needed equipment were set up, and services began in July 2008. Services include assessment, treatment and ongoing monitoring of youth. By the end of FY2009, 168 children/adolescents and their families had benefited from Tele-psychiatry services and 939 psychiatry hours had been provided. Due to budget issues, the service was only available for eight months in FY2010. The most common diagnoses of children who received these services were: Bipolar Disorders, Mood Disorders, Posttraumatic Stress Disorder and Attention Deficit Hyperactivity Disorder (ADHD).

In late FY2010, Tele-psychiatry became a billable service under Medicaid when provided under certain circumstances. The payment rates however are not sufficient to support the full cost of the service. Providers will be able to bill a portion of the cost of Tele-psychiatry in FY2011 and thus the expectation is that the pilot's services may be expanded to cover additional children and additional provider organizations. Although enhancement and expansion of Tele-psychiatry in Illinois is not currently realistic due to fiscal constraints, the needs assessment for these services is continuing with a vision for possible implementation when funding becomes available.

Criterion V: There were no objectives for this criterion.


NARRATIVE: CHILD- SIGNIFICANT EVENTS AND CHANGES IN FY2010

REPORT ON THE 2010 CHILD PLAN

Developments and Issues Affecting Mental Health Service Delivery

The following are significant events related primarily to Child & Adolescent Services.

Impact of the Economic Recession

See this section in the Adult Report for a discussion of how this event has negatively impacted services to both adults and children.

Family Driven Care

In FY2009, Illinois was one of six states to receive a limited award to develop an initiative addressing family driven care. Family Driven Care as defined by the Federation of Families for Children's Mental Health, means that families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation. This includes:

  • Choosing culturally and linguistically competent supports, services, and providers;
  • Setting goals;
  • Designing, implementing and evaluating programs;
  • Monitoring outcomes; and
  • Partnering in funding decisions.

Members of the C&A Statewide staff attended a policy academy in which planning and implementation approaches were discussed. The award covered travel expenses and technical assistance costs over a period of six months. So far, a commission on Family Driven Care has been established and efforts have been underway to conduct regional surveys of mental health needs and to assess family and provider satisfaction with the services currently available and the extent to which the system is responsive to the needs and issues encountered by families of youth with serious emotional disturbances. This project has supported collaboration with other child serving systems and supporters (DCFS, ISBE, CHP, DJJ, DASA, IFF, ICMHP) in addressing the extent to which the system is Family Driven.

Family Participation

In FY2009 Family Advisory Councils were established in each DMH Region. These councils are composed of family members and youth who provide both a regional and statewide voice for family and consumer needs. Convened by the Family Consumer Specialists, these councils are now providing input and feedback on a variety of issues confronted in the Child and Adolescent service system.

Systems Integration

The DMH continued collaborations with many system partners including collaboration with the Education system on the Positive Behavior Interventions and Support Model. The DMH continued its partnership with the Illinois Department of Healthcare and Family Services (the Illinois Medicaid agency) and the Illinois Department of Children and Family Services (the Illinois Child Welfare Agency) on the purchase of Screening, Assessment and Support Services (SASS) for children and adolescents and their families. As an active partner in the Illinois Children's Mental Health Partnership (ICMHP) DMH works closely with the ICMHP and its member agencies to advance mental health services to children across agencies and child-serving systems.

Children's Mental Health Consultation

In the past few years, collaborations have increasingly taken the form of developing, participating in, and providing mental health consultation programs, particularly for younger children. Children and their families come into contact with multiple systems - primary care, child care, education, child welfare, mental health and home visiting, to name a few - that are critical access points for promoting mental health, intervening early before problems become severe, and treating mental health issues. In Illinois, like many other parts of the country, there are insufficient numbers of adequately trained providers available to meet the myriad mental health needs of children, especially young children ages 0-7. Mental health consultation is seen as a key strategy for supporting and building the capacity of a variety of providers to respond to the social/emotional and mental health needs of children. The ICMHP reports on a number of a recently developed consultation projects that support providers and families such as:

  • The Children's Mental Health Consultation Project develops and enhances the capacity of community mental health agencies to address the mental health needs of young children ages 0-7 and their families. The Project, implemented by ICMHP, has provided early childhood mental health consultation, training and technical assistance to 12 community mental health agencies in each of the five DMH regions of the state.
  • The Healthy Families/Parents Too Soon Consultation Project develops and enhances the capacity of Healthy Families/Parents Too Soon programs (home visiting programs) from across the state to address the mental health needs of young children and their families.
  • The Caregiver Connections Project, administered by the Illinois Department of Human Services, provides early childhood mental health consultation to Illinois childcare providers who care for children ages birth to five years. In FY 10, over 1100 child care centers received services (e.g., programmatic consultation, technical assistance and training) from a mental health consultant through this Project. As a result, over 85 percent of participating child care centers reported an increase in positive behavior for children in their programs and nearly 90 percent of centers reported that they are better able to work with children with challenging behavior.
  • Illinois DocAssist is a psychiatric phone consultation initiative that supports primary care providers (e.g., pediatricians, family physicians) who serve children enrolled in Medicaid. Administered by the Department of Healthcare and Family Services in partnership with DMH and ICMHP, the initiative is designed to improve early detection and prompt initiation of treatment for psychiatric and substance use disorders in children and adolescents within primary care settings; increase access to mental health and substance use care; integrate mental health and substance use care with other medical care; and improve the quality of psycho-pharmacotherapy for psychiatric disorders prescribed by primary care providers, including appropriate doses and duration of medication trials, avoidance of unnecessary poly-pharmacy, and minimizing risks of adverse reactions. Since its inception in September 2008, the program has provided over 464 consultations to primary care providers and is working to increase contacts with primary care providers through direct consultations and provision of Continuing Medical Education activities. Illinois DocAssist has provided medical education training on children's mental health to over 626 healthcare professionals in Illinois. In follow-up studies, healthcare providers report that they continue to utilize what they have learned from both the consultations and the medical education activities in their work.

Additionally, DMH participates in the Illinois Childhood Trauma Coalition, a statewide coalition comprised of over 50 public and private agencies and organizations that address, through policy changes, research and professional development work, the impact of trauma on children. Key activities in FY 2010 included: training of over 800 professionals and other individuals (e.g., teachers; lawyers, judges, law students and other court officials; and youth); assistance with revisions to the mental health/juvenile justice curriculum of the MacArthur Foundation Models for Change Project; and continued work on the "Stories for Children that Grown-Ups Can Watch" series.

Juvenile Justice Mental Health Re-entry (JJMH-R)

JJMH-R provides services to youth with mental health issues in support of an aftercare program within Department of Corrections, Juvenile Justice Division. The program consists of two specially trained liaisons who assess a youth referred to the program while incarcerated, link the youth to appropriate services, and provide post release case management for all clients. Without the project, youth would be at risk without any formal aftercare plan in place and forced to navigate unfamiliar community mental health services in their area without assistance. The JJMH-R program has received 222 referrals to date; 162 of these youth have been released from the juvenile justice system and linked to aftercare mental health services.

Juvenile Forensic Trauma Project

The Juvenile Forensic Trauma Project provides trauma-specific services to youth involved in the juvenile justice system and supports the development of a trauma-sensitive climate within juvenile facilities. Given the high incidence of trauma exposure (e.g., violence) in justice-involved youth, trauma services are essential to adequately meet the clinical and rehabilitative needs of these youth. DMH Juvenile Forensic Trauma therapists provide these services to the youth and train facility staff in the areas of adolescent development, trauma, and adolescent brain development in two Illinois Youth Centers (Warrenville and Chicago). In addition, they provide training and consultation to juvenile justice staff on the nature of trauma and its impact on adolescents in particular.

Project LAUNCH

Project LAUNCH (Linking Actions for Unmet Needs in Children's Health) promotes the wellness of young children ages birth to 8 years of age by addressing the physical, emotional, social, and behavioral aspects of their development. The DHS Division of Community Health and Prevention is the state administrator with funding from the federal Substance Abuse and Mental Health Services Agency (SAMHSA). The Greater Westside of Chicago (encompassing the communities of North and South Lawndale and East/West Garfield) was awarded a Project Launch grant in September 2009. In the first year of Project Launch implementation, an environmental scan and strategic plan were developed to guide the enhancement of five areas of service need for the Greater Westside of Chicago. Plans for the delivery of evidence-based services in the areas of child developmental services, mental health consultation, behavioral health and primary care integration, home visiting, and parenting education are all underway. A community council was established as well as a state level council to oversee the Project's evaluation and statewide replication.

Early Intervention for Children of Incarcerated Parents (EICIP)

EICIP provides early intervention services (e.g., mental health services, supports, and referrals) to help children whose primary care-giving parent has been incarcerated. The Project, administered by DMH, is being implemented in the North Lawndale community to help families access mental health services that are sensitive to the unique needs and vulnerabilities of these children and their families. This project is providing significant interventions to children and families who would not normally receive mental health care, if ever, until the youth's problems were severe. Additionally, the project is teaching the system about the significant needs of these youth and families who have largely gone un-served, and of the difficulty in accessing and engaging these families. In FY 2010:

  • 24 youth received intensive, home-based mental health care;
  • 39 youth received early intervention and preventive care;
  • 13 caregivers received support in the form of assistance with completing job applications, advocacy, and housing;
  • 49 families received referrals to other service providers and resources;
  • More than 90 inmate parents received parenting assistance and education;
  • More than 40 prison staff were educated on supporting the parent/child relationship; and
  • More than 12 community organizations received education on the special needs of children of incarcerated parents.

A family resource developer has been added to the intervention team to further meet the needs of the children and families. Due to the success of the pilot in Chicago, a second site has been established in Southern Illinois outside of East St Louis, and will begin providing services to families in FY11.

Information Technology

DMH continues its efforts to refine and streamline data collection efforts to provide information that supports decision-making in children's services. DMH, working with the Mental Health Collaborative for Access and Choice (MHCAC), has redesigned and implemented a new management information system (MIS). All child-serving providers are now reporting data to this new system. This work included the development of a data warehouse that houses eligibility, registration, billing/services information, a provider database, and service authorization in one place.

Grants

A System of Care grant focusing on McHenry County originally awarded by SAMHSA in 2006 continues. In McHenry County, Family CARE stands for Child/Adolescent Recovery Experience and is a $9 million, six -year federal grant designed to involve families and youth in decision making related to treatment, goal-setting, designing and implementing programs, monitoring outcomes and determining the effectiveness of efforts that promote the well-being of children and youth. The grant is designed to improve access to services for five underserved populations who present with mental health and substance abuse issues: preschoolers with serious social/emotional problems, youth with mental disorders, youth with co-occurring mental health and substance abuse issues, young adults 18-21 years old, and Latino children.

Two new System of Care grants were awarded to Illinois in FY2010. The Division of Mental Health in collaboration with Champaign Mental Health Board (PROJECT ACCESS) and with the Egyptian Department of Health (PROJECT CONNECT) in southern Illinois will implement the system of care projects for youth with serious emotional disturbances and their families. Both grants are for $9 million each over a six-year period. The mission of these projects is to provide a system of care that is family-driven, youth-guided, strengths based, sustainable, culturally and linguistically competent. It is anticipated that these projects will result in expanding the array of services and improving the quality of services provided to children and families in these areas of Illinois.

Early Childhood Mental Health

The Early Childhood Mental Health Program was established through the collaboration of DMH Child and Adolescent Services and the Illinois Children's Mental Health Partnership (ICMHP) in January 2008 and continued in FY2010 with five funded pilot projects. The projects:

  1. Provide mental health assessment and treatment services to children age 0 - 5 years with psychological or social/emotional development needs;
  2. Provide parent support services to families of eligible children;
  3. Provide services that are child focused and family driven: and
  4. Develop connections to referral systems/networks for early childhood.

Child and Adolescent Outcomes Analysis:

A Web-based Clinical Outcomes Analysis system was completed and training of users had begun by the end of FY2008. The system became operational in FY2009 and aggregated data reports have been generated. See Objective C2.1 for a description of this initiative and its progress in FY2010. It is a significant breakthrough in developing and establishing outcome measures in children's mental health services.

Tele-psychiatry

Recent legislation supported the establishment of the tele-psychiatry pilot project for children and adolescents that had its first year of actual implementation in FY2009. (See Objective C4.1-this Report) The experience and results of this project are pointing the way toward further development of this valuable resource.

CHILD-PURPOSE OF BLOCK GRANT EXPENDITURES AND ACTIVITIES IN FY2010

Allocation Of Block Grant Dollars In FY2010

Allocations to specific agencies for service provision to Children and Adolescents are displayed in Appendix A.

The Illinois plan for the expenditure of the FY 2010 Community Mental Health Services Block Grant was directed at providing services in community settings for children and adolescents with serious emotional disturbances. Administrative expenses are capped at 5%. Block grant dollars were allocated (for adults and children combined) as follows in FY2010:

  • Community Consumer Support - $3,261,416
  • Psychiatrist Services In Mental Health Centers (Psychiatric Leadership)- $11,459,306
  • Special Projects - $180,000.00
  • To be Allocated - $321,895

Approximately 26% of block grant funds are allocated to C&A Services. For FY2010, block grant funds were directed toward the following community-based services for youths with serious emotional disturbances: psychiatric services and crisis services. The child and adolescent funding allocation of mental health block grant dollars is consistent with the State Mental Health Plan for Children and Adolescents.

SYSTEM PERFORMANCE INDICATORS -CHILD/ADOLESCENT SERVICES

Name of Performance Indicator:C-1 (NOM) Increased Access to Services (Number)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

 Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 40,313 36,768 40,313 36,242 89.90
Numerator N/A N/A -- N/A --
Denominator N/A N/A -- N/A --
Table Descriptors:
Goal: Increased access to services
Target: Maintain or increase access to services for children and adolescents with serious Emotional disturbances. ( FY2010 Target was based on FY2008 actual data. As FY2009 data was not available.)
Population: Children and adolescents with emotional and serious emotional disturbances
Criterion: 2:Mental Health System Data Epidemiology 3:Children's Services
Indicator: Number of children/adolescents receiving services from DMH-funded community-based providers.
Measure: Number of children/adolescents receiving services from DMH-funded community-based providers.
Sources of Information: DMH ASO Community Reporting System. This indicator is generated from URS Table 2A. Excludes those whose age is unknown.
Special Issues:
Significance: Services should be accessible to children and adolescents with mental health needs. 
Activities/Strategies:  DMH community funded providers by contract must submit registration and claims data for all individuals receiving services funded using DMH dollars. Data is submitted daily or weekly to the community reporting system maintained by the DMH's Administrative Services Organization (ASO), the Illinois Mental Health Collaborative For Access and Choice. Once this data is processed, it is then transferred to the DMH Data Warehouse for storage. This information is then used to develop reports.
Target Achievement: Target Not Achieved. Several reasons may account for this: (1) During the beginning of FY2010, there was some uncertainty with regard to provider contract amounts. Some agencies may have delayed the provision of some services until the budget/contractual issues were resolved. (2) DMH also refined its method of unduplicating counts of consumers.

Name of Performance Indicator:C-2 (NOM) Reduced Utilization of Psychiatric Inpatient Beds- 30 day Readmissions (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance indicator 5 4.23 5 5.88 85.03
Numerator 4 3 --  4 --
Denominator 80 71 -- 68 --
Table Descriptors:
Goal: To decrease readmissions of individuals to state hospitals within 30 days by providing treatment that results in sufficient clinical stabilization such that subsequent treatment is provided in the least restrictive setting.
Target: Maintain or decrease readmission rates of children and adolescents to DMH state hospitals
Population: Children and adolescents with serious emotional disturbances.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Decreased rate of civil readmissions to state psychiatric hospitals within 30 days.
Measure: Numerator: Number of civil readmissions to any state hospital within thirty days of being discharged. Denominator: Total number of civil discharges in the year.
Sources of Information: DMH Inpatient Clinical Information System.
Special Issues: The Illinois DMH contracts the majority of inpatient services for children and adolescents to community hospitals, therefore the number of admissions and readmissions reported are very small.  Data for private hospitals is not collected for the Inpatient Clinical Information System.
Significance: Individuals with mental illnesses should receive services in the least restrictive settings possible.  However, there are times when access to inpatient services is required. Treatment provided in these settings should not result in an individuals return to the inpatient setting within a short period of time.
Activities/Strategies: DMH continues to monitor the number of children and adolescents readmitted to state hospitals within 30 days of discharge with a goal of maintaining or decreasing the level of re-hospitalization by maintaining services in the community that provide alternatives to re-hospitalization.
Target Achievement: Not Achieved. However, the numbers reported are so small that this information may not be meaningful.

 Name of Performance Indicator:C-3 (NOM): Reduced Utilization of Psychiatric Inpatient Beds -180 day Readmissions (Percentage).

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual 

FY 2010

Target

FY 2010

 Actual

FY 2010

Percentage Attained

Performance Indicator 10 5.63 10 13.24 75.53
Numerator  8 4 --  9  --
Denominator 80 71 -- 68 --
Table Descriptors:
Goal: To decrease readmissions of individuals to state hospitals within 180 days by providing treatment that results in sufficient clinical stabilization so that subsequent treatment is provided in the least restrictive setting.
Target: Maintain or decrease level of readmission rate to state hospitals.
Population: Children and adolescents with serious emotional disturbances.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Decreased rate of civil readmissions to state psychiatric hospitals within 180 days.
Measure: Numerator: Number of civil readmissions to any state hospital within 180 days. Denominator: Total number of civil discharges in the year.
Sources of Information: DMH Inpatient Clinical Information System.
Special Issues: The Illinois DMH contracts the majority of inpatient services for children and adolescents to community hospitals, therefore the number of admissions and readmissions reported are very small. Data for private hospitals is not collected for the Inpatient Clinical Information System.
Significance: Individuals with mental illnesses should receive services in the least restrictive settings possible.  However, there are times when access to inpatient services is required.
Activities/Strategies: Data from FY2008 served as the baseline for this indicator. DMH will continue to monitor the number of children and adolescents readmitted to state hospitals within 180 days of discharge with a goal of maintaining or decreasing the level of re-hospitalization by maintaining services in the community that provide alternatives to re-hospitalization.
Target Achievement: Target Not Achieved. However, the numbers are so small that this indicator may not be meaningful.

Name of Performance Indicator:C-4 (NOM) Evidence Based -Number of Practices (Number)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator N/A N/A N/A N/A N/A
Numerator N/A N/A -- N/A --
Denominator  N/A N/A -- N/A --
Table Descriptors:
Goal: DMH is not currently implementing the EBPs that are part of the National Outcome Measures
Target: DMH is not currently implementing the EBPs that are part of the National Outcome Measures
Population:  Children with serious emotional disturbances
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Number of Child/Adolescent EBPs implemented
Measure: Number of Child/Adolescent EBPs implemented
Sources of Information: DMH ASO Community Reporting System
Special Issues: The DMH is focusing on an Evidence Informed Practice approach that is described in the narrative. As such, the EBPs identified as NOMS are not being implemented in Illinois.
Significance:
Activities/Strategies: DMH is not currently implementing the EBPs that are part of the National Outcome Measures
Target Achievement:  Not Applicable.

Name of Performance Indicator: C-5 (NOM) Evidence Based -Children with SED Receiving Therapeutic Foster Care (Percentage)

(1) (2) (3) (4) (5)  (6)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual

FY 2010

Target

FY 2010

 Actual 

FY 2010

Percentage Attained

Performance Indicator N/A  N/A N/A N/A N/A
Numerator N/A N/A  --  N/A --
Denominator  N/A N/A  -- N/A  --
Table Descriptors:
Goal: Not Applicable. Illinois is not implementing this EBP.
Target: DMH is not currently planning to implement therapeutic foster care.
Population: Children/adolescents with serious emotional disturbances
Criterion:  1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Number of children and adolescents receiving therapeutic foster care.
Measure: Number of children and adolescents receiving therapeutic foster care.

Sources of

Information:

Special Issues: Foster care is provided through the state welfare agency. The DMH does not anticipate that it will implement this EBP.
Significance:
Activities/Strategies: DMH has no current plans to implement therapeutic foster care as this service would be administered by the child welfare agency.
Target Achievement Not applicable

Name of Performance Indicator:C-6 (NOM) Evidence Based -Children with SED Receiving Multi-Systemic Therapy (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

 Actual

FY 2010

Percentage Attained

Performance Indicator N/A N/A N/A N/A  N/A
Numerator N/A N/A -- N/A --
Denominator N/A N/A -- N/A --
Table Descriptors:
Goal: NOT APPLICABLE. DMH has no plans to implement MST in Illinois.
Target:  DMH is not currently providing this EBP.
Population: Children/adolescents with serious emotional disturbances
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Number of children and adolescents receiving multi-systemic therapy
Measure: Number of children and adolescents receiving multi-systemic therapy
Sources of Information: Not Applicable - DMH is not collecting or reporting data on this EBP.
Special Issues: DMH is not currently implementing MST. Rather it is focusing on evidence-informed practices.
Significance:
Activities/Strategies:  While multi-systemic therapy is practiced by a few child-serving agencies, the DMH is not currently implementing multi-systemic therapy with children. DMH is focusing on evidence -informed practices.
Target Achieved: Not applicable

Name of Performance Indicator:C -7 (NOM) Evidence Based -Children with SED Receiving Family Functional Therapy. (Percentage)

(1) (2) (3)  (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

 Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator  N/A N/A N/A N/A N/A
Numerator N/A N/A -- N/A --
Denominator N/A N/A -- N/A --
Table Descriptors:
Goal: NOT APPLICABLE. DMH has no plans to implement this EBP.
Target: DMH is not currently providing this EBP.
Population: Children/adolescents with serious emotional disturbances
Criterion:

1:Comprehensive Community-Based Mental Health Service Systems

3:Children's Services

Indicator: Number of children and adolescents receiving family functional therapy.
Measure: Number of children and adolescents receiving family functional therapy.
Sources ofInformation:  
Special Issues: DMH is focusing on evidence -informed practices and has no specific plans to implement family functional therapy at this time.
Significance:
Activities: The DMH has no plans at this time to implement family functional therapy as it is focusing its effort on evidence -informed practices
Target Achievement: Not Applicable.

 Name of Performance Indicator:C-8: (NOM): Client Perception of Care (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 52.11  52.27 55  N/A N/A
Numerator 222  196 -- N/A --
 Denominator 426 375 -- N/A --
Table Descriptors:
Goal: To increase the perception of positive outcomes by caregivers of children served by the DMH-funded community-based mental health service system.
Target: Increase the percentage of caregivers reporting positive outcomes for their children/adolescents.
Population: Parents/caregivers of children/adolescents receiving DMH funded mental health services.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Percentage of families reporting positively about outcomes.
Measure:

Numerator: Number of caregivers reporting positively about outcomes of treatment

Denominator: Total number of family responses regarding perception of outcomes.

Sources of

Information:

This data is derived from the Youth Services Survey and is reported on URS Table 11.
Special Issues:  DMH currently surveys only caregivers of youth 11 and younger due to concerns of maintaining confidentiality of youth 12 to 17.
Significance: Individuals receiving treatment should report positive outcomes for treatment.
Activities/Strategies: DMH aims to increase the percentage of caregivers reporting positive outcomes for the Childand Adolescent services. As in previous fiscal years, DMH has selected a random stratified sample of individuals receiving treatment in June 2010. This sample is the basis for the survey that was disseminated in November 2010. Data will be available by February 2011.
Target Achievement: Not available until February 2011.

Name of Performance Indicator: C-9 (NOM) -Return to/Stay in School (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY2009

 Actual 

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 43.02 33.33 N/A N/A N/A
Numerator  77 58 -- N/A --
Denominator 179 174 -- N/A --
Table Descriptors:
Goal: Improve school attendance of children/adolescents with serious emotional disturbances receiving mental health treatment
Target:  No target set due to low response rate and developmental nature of the indicator.
Population: Children with emotional and serious emotional disturbances aged 0-11.
Criterion:  1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Percent of parents/caregivers reporting improvement in child's school attendance
Measure:

Numerator: Number of parents reporting improvement in child's school attendance. (Both new and continuing clients.)

Denominator: Total responses (excluding not available) new and continuing clients combined.

Sources of Information: Annual Youth Services Survey
Special Issues: Currently the data is derived from questions included on the Annual Youth Services Survey conducted by DMH. DMH is not projecting targets due to the low response rate for this variable as well as the developmental nature of the indicator. DMH currently surveys only caregivers of youth 11 and younger due to concerns of maintaining confidentiality of youth 12 to 17.
Significance: Children/adolescents with ED/SED should benefit from receiving mental health services.
Activities/Strategies: DMH has selected a random stratified sample of individuals receiving treatment in June 2010. This sample is the basis for the survey disseminated in November 2010. Data will be available by February 2011.
Target Achievement: Data for this indicator has been collected using the YSS/F MHSIP Survey. However, given the developmental nature of the indicator and the small numbers used for reporting, no target was established for FY2010 . Data will be available by February 2011.

Name of Performance Indicator: C-10: (NOM) Decreased Criminal Justice Involvement (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009 

 Actual

FY 2010

Target

FY 2010

Actual 

FY 2010

Percentage Attained

Performance Indicator 55.45 27.27 N/A N/A N/A
Numerator 61 6 -- N/A --
Denominator 110 22 -- N/A --
Table Descriptors:
Goal: Decrease Juvenile Justice Involvement for children/adolescent with SED who are involved in the justice system.
Target: Data for this indicator was collected in FY2008 and FY2009. However, due to the developmental nature of the measure and the low response rate we elected not to set a target for FY2010.
Population: Children/ with serious emotional disturbances aged 0-11 who are involved with the justice system and who are receiving mental health services
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Percent of children/youth consumers arrested in Year 1 who were not rearrested in Year 2.
Measure: Numerator: Number of children/youth consumers arrested in T1 who were not rearrested in T2. (new and continuing clients) Denominator: Number of children/youth consumers arrested in T1 (new and continuing clients combined).
Sources of Information: Youth Services Survey for Families (Caregivers)
Special Issues: This indicator is still developmental; as such DMH is not projecting targets.
Significance: The provision of mental health services should have an impact on the outcomes for Children/adolescents involved in the justice system
Activities/Strategies: DMH disseminated the FY2010 survey in November 2010. Data will be available for this indicator by February 2011.
Target Achievement: Not Applicable. Data for this indicator will be collected using the YSS/F MHSIP Survey.  However, given the developmental nature of the indicator and the small numbers used for reporting , no target was established for FY2010.

Name of Performance Indicator: C-11 -Increased Stability in Housing (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual 

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 0.77  0.71 N/A 0.59 N/A
Numerator 293 240 -- 197 --
Denominator 37,859 33,996 --- 33,604 --
Table Descriptors:
Goal: Increase stability in housing by reducing the number of children who are homeless or living in shelters. Indicator specifies increase, however, it is currently only a snapshot of consumers' status at admission; thus we would not project an increase.
Target: Track percentage of children who are homeless or living in shelters. This data is collected at one point in time at intake prior to treatment.
Population: Children/Adolescents with serious emotional disturbances who are homeless and living in shelters.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Percent of Child/Adolescent clients who are homeless and living in shelters.
Measure:

Numerator: Number of Child/Adolescent clients who are homeless and living in shelters.

Denominator: All child/adolescent clients with known living situation (excluding persons with Living Situation Not Available).

Sources of Information: DMH ASO Community Reporting System
Special Issues: The data currently reported is point in time and only reflects youth status at intake/admission. Currently there is not a mechanism to track change over time, thus at this point DMH can only report status at intake.
Significance: Children/Adolescents with serious emotional disturbances should have access to stable living environments.
Activities/Strategies: DMH community funded providers by contract must submit registration and claims data for all individuals receiving services funded using DMH dollars. Data is submitted daily or weekly to the community reporting system maintained by the DMH's Administrative Services Organization (ASO), the Illinois Mental Health Collaborative For Access and Choice.  Once this data is processed, it is then transferred to the DMH Data Warehouse for storage. This information is then used to develop reports. As noted above, DMH has established a policy requiring providers to update this information on a bi-annual basis. Once it has been determined that the quality of data is good, DMH will begin to report change data for this variable.
Target Achievement: No target established (see above).

Name of Performance Indicator: C-12: (NOM)Child -Increased Social Supports/Social Connectedness (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY2009

 Actual 

FY2010

 Target

FY2010

Actual

FY 2010

Percentage Attained

Performance Indicator 74.58 76.41 N/A N/A N/A
Numerator 311 285 -- N/A --
Denominator 417 373 -- N/A --
Table Descriptors:
Goal: Monitor caregivers' perception that their child's social connectedness has improved as a result of participating in treatment.
Target: Developmental Measure - No Target established.
Population: Children/adolescents with serious emotional disturbances aged 0-11.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems 3:Children's Services
Indicator: Percent of families responding positively about social connectedness.
Measure:

Numerator: Number of families of child/adolescent consumers responding positivePerception regarding social connectedness of their child.

Denominator: Total number of family responses regarding social connectedness.

Sources of

Information:

 Annual Youth Services Survey for Families (Caregivers)
Special Issues:

Currently the data is derived from questions included on the Annual Youth Services Survey conducted by DMH. DMH is not projecting targets due to the response rate for this variable as well as the developmental nature of the indicator.

DMH currently surveys only caregivers of youth 11 and younger due to concerns of maintaining confidentiality of youth 12 to 17.

Significance: Treatment should result in positive outcomes for children.
Activities/Strategies: DMH has selected a random stratified sample of individuals receiving treatment in June 2010. This sample is the basis for the survey that was disseminated in November 2010. Data will be available in February 2011.
Target Achievement: Data for this indicator is collected using the YSS/F MHSIP Survey.  However, given the developmental nature of the indicator and the small numbers used for reporting , no target was established for FY2010.

 Name of Performance Indicator: C-13: (NOM)-Improved Level of Functioning (Percentage)

(1) (2) (3) (4)  (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual 

FY 2010

 Target

FY 2010

Actual 

FY 2010

Percentage Attained

Performance Indicator 61.98 53.48 N/A N/A N/A
Numerator 269  200 -- N/A --
Denominator 434 374 -- N/A --
Table Descriptors:
Goal: Increase caregivers' perception of functioning as a result of treatment.
Target:  No target established.
Population: Children and adolescents with emotional/serious emotional disturbances.
 Criterion: 1:Comprehensive Community-Based Mental Health Service Systems

3:Children's Services

4:Targeted Services to Rural and Homeless Populations

Indicator: Percent of families reporting positively about functioning.
Measure:

Numerator: Number of caregivers of child/adolescent consumers reporting positive perceptions about their child's functioning.

Denominator: Total number of family/caregiver responses regarding functioning.

Sources of Information:  Annual Youth Services Survey for Families (Caregivers)
Special Issues: Currently the data is derived from questions included on the Annual Youth Services Survey conducted by DMH. DMH is not projecting targets due to the response rate for this variable as well as the developmental nature of the indicator. DMH currently surveys only caregivers of youth 11 and younger due to concerns of maintaining confidentiality of youth 12 to 17.
Significance: Treatment should result in positive outcomes for children.
Activities/Strategies: DMH has selected a random stratified sample of individuals receiving treatment in June 2010. This sample is the basis for the survey that was disseminated in November 2010. Data will be available in February 2011.
Target Achievement Not Applicable. Given the developmental nature of the indicator and the small numbers used for reporting a target has not been established.

Name of Performance Indicator:C-14 Corrections History -C&A

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 1.10 0.84 N/A 0.80  N/A
Numerator 456  310 -- 282 --
Denominator 40,313 36,768 --- 36,242 --
Table Descriptors:
Goal:  To track forensic status of children and adolescents served by the Illinois mental health system
Target:

Track increase/decrease in individuals involved in the justice system who access services.

This population is expected to remain relatively constant at approximately 1%.

Population: Children and adolescents with serious emotional disturbances.
Criterion:  1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of children and adolescent clients reporting involvement with the Department of Corrections/Juvenile Justice at the time of case opening.
Measure: Numerator: Number of children and adolescent clients reported as Department of Corrections clients (e.g. Probation, parole) at the time of case opening. Denominator: Total number of children and adolescents served in the fiscal year.
Sources of Information:  DMH ASO Community Reporting System
Special Issues:
Significance: Tracking this information helps to insure coordination of services between the mental health system and juvenile corrections.
Activities/Strategies Community mental health staff track the number of children and adolescents who are forensic outpatients as well as those who are on probation or parole at the time of case opening. This data is collected as part of clinical assessments. DMH will continue to track these percentages.
Target Achievement  Not Applicable.

Name of Performance Indicator:C-15: Co-Occurring Disorders-C&A

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

 FY 2010

Percentage Attained

Performance Indicator 1.10 N/A 1.50 N/A
Numerator 433 390 -- 543 --
Denominator 40,313 36,768 -- 36,242 --
Table Descriptors:
Goal: To increase community-based mental health service for persons who have co-occurring disorders of mental illnesses and substance use.
Target: Track the number of individuals with co-occuring disorders accessing services.
Population: Children and adolescents with mental illness and a co-occurring substance use disorders.
Criterion: 3:Children's Services
Indicator: Percentage of Child and Adolescents (C&A) served with a mental illness and substance use Diagnosis receiving services.
Measure:

Numerator: Number of clients served in the community with a substance abuse diagnosis.

Denominator: Total number of all child and adolescents receiving services.

Sources of Information: DMH ASO Community Reporting System.
Special Issues:  It is likely that identification of these individuals is under-represented.
Significance: Many individuals with serious mental illnesses and emotional disturbances have co-occurringsubstance abuse disorders.
Activities/Strategies: DMH will continue to track this information in FY2011with the goal of increasing the capacity for identification of dually diagnosed youth.
Target Achievement: Not Applicable.

 Name of Performance Indicator: C-16: Eligible Population-C&A

(1)  (2) (3) (4)  (5) (7)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual 

FY 2010

 Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 88.43 95  88 96.20 109.30
Numerator 35,648  34,959 -- 34,581  --
Denominator 40,313 36,768 -- 36,242 ---
Table Descriptors:
Goal: To provide access to services to children and adolescents meeting DMH eligibility criteria.
Target: Maintain the percentage of children and adolescents receiving mental health services who meet eligibility requirements.
Population: Children and adolescents with serious emotional disturbances
Criterion: 2:Mental Health System Data Epidemiology
Indicator: Percent of children and adolescents being served by DMH-funded community-based providers who meet the established criteria for "eligible population" at the time of entry into services.
Measure:

Numerator: Number of children and adolescents being served by DMH-funded community-based providers who meet the established criteria for "eligible population" at the time of entry into services.

Denominator: All children and adolescents being served by DMH-funded community-based providers.

Sources of Information: DMH ASO Community Reporting System
Special Issues:
Significance: This indicator is part of the monitoring process to insure that mental health services are accessible and accessed by those individuals who need them most.
Activities/Strategies: DMH has a goal of increasing the proportion of children and adolescents served who meet the criteria for eligible population.
Target Achievement: Target achieved and exceeded.

Name of Performance Indicator: C-17: Forensic Outpatient-C&A

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 1.20 0.55 1.20 0.43 36
Numerator 483 204 -- 157 --
Denominator 40,313 36,768 -- 36,242 --
Table Descriptors:
Goal: To track forensic status of children and adolescents served by the Illinois Mental Health System.
Target: Maintain access to services for children and adolescents who are involved with the juvenile justice system.
Population: Children and Adolescents with serious emotional disturbances.
Criterion:  1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of children and adolescent clients who have been court ordered into treatment due to not guilty by reason of insanity, found unfit to stand trial, or by criminal court at the time of case opening.
Measure: Numerator: Number of children and adolescent clients reported as unfit to stand a trial, not guilty by reason of insanity, criminal, or directed for court ordered treatment at the time of case opening. Denominator: Total number of children and adolescents served in the fiscal year.
Sources of Information: DMH ASO Community Reporting System
Special Issues:
Significance: The service needs of this small but high risk group require that assessment and adequate services are provided and tracked.
Activities/Strategies  Community mental health staff track the number of children and adolescents who are forensic outpatients as well as those who are on probation or parole at the time of case opening as part of clinical assessments. DMH will continue to track these percentages.
Target Achievement  Not Achieved. As noted previously, there has been an overall decrease in the number of individuals accessing services in FY2010. This may have had an impact on this indicator. However, DMH staff are further investigating issues related to this indicator.

 Name of Performance Indicator: C-18: Living Arrangements-C&A

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

 Actual

FY 2010

Percentage Attained

Performance Indicator 89 96 N/A 89.70 N/A
 Numerator 35,956 32,648 --- 32,511 --
Denominator 40,313 36,768 --- 36,242 --
Table Descriptors:
Goal: To track demographic information on living arrangements for child and adolescent clients.
Target: Track percentage of children and adolescents with serious emotional disturbances who live in private residences. No target established as information is only collected at intake.
Population: Children and adolescents with mental illness.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of children and adolescent clients living with parents or other relatives in private residences at the time of case opening.
Measure:

Numerator: Number of children and adolescents reported as living with parents or other relatives in private residence at the time of case opening.

Denominator: Total number of children and adolescents served in the fiscal year with known living arrangements.

Sources of Information: DMH ASO Community Reporting System.
Special Issues:
Significance: Community mental health staff report living arrangements at intake for children and adolescents to assess service needs. At the time of case opening in FY 2009, the vast majority of children and adolescents lived with parents or other relatives in a private residence (96%).
Activities/Strategies: DMH will continue to track this indicator in FY 2011.
Target Achievement Not Applicable.

Name of Performance Indicator: C-19: Rural Residents Served -C&A

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

 Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 12,430 10,354 12,000 9,793 81.60
Numerator N/A N/A  --- N/A ---
Denominator N/A N/A  -- N/A ---
Table Descriptors:
Goal: To assure that children with emotional disturbances who reside in rural areas are accessing the DMH-funded community-based mental health service system.
Target: Maintain the number of children/adolescents residing in rural areas who receive services by using Tele-psychiatry and other strategies.
Population: Children and adolescents with emotional disturbances who live in rural areas of the state.
Criterion: 4:Targeted Services to Rural and Homeless Populations
Indicator: Number of children being served by DMH-funded community-based providers who are residents of rural areas at the time of entry into services.
Measure: Number of children being served by DMH-funded community-based providers who are residents of rural areas at the time of entry into services.
Sources of Information: DMH ASO Community Reporting System
Special Issues:
Significance: The geography of rural areas adds challenges to the timely and consistent access to servicesfor both service providers and persons with mental illness.
Activities/Strategies: DMH aims to maintain or expand access to community mental health services for children and adolescents residing in rural areas.
Target Achievement Not Achieved. As noted previously, the total number of individuals receiving services decreased in FY2010. This may have an impact on this indicator.

Name of Performance Indicator: C-20: Sass Service Hours In Community

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Projected

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator N/A N/A N/A N/A N/A
Numerator N/A  N/A ---  N/A 
Denominator N/A N/A -- N/A
Table Descriptors:
Goal: To assure that a significant portion of services delivered within the SASS programs are provided in the most normalized settings possible in the individual's community, rather than within the provider's offices or clinics.
Target: A target is not set because the data source does not capture complete information at this point in time.
Population: Children and adolescents with serious emotional disturbances.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of children identified as members of the DMH "target" population being served by the DMH-funded community-based service system who receive SASS services.
Measure:

Numerator: Number of hours of service provided by the DMH-funded SASS Programs which occur outside of the provider's offices or clinics.

Denominator: Total number of hours of service provided by the DMH-funded SASS Programs.

Sources of Information:  DMH ASO Community Reporting System.
Special Issues: This data is no longer reported directly to the DMH. Data was not available for FY2008, FY 2009, and FY2010. We will retain this indicator as a placeholder because of its importance. We hope to reacquire the information in FY 2011.
Significance: SASS programs aim to provide services in the most normalized settings possible in the individual's community, rather than within the provider's offices or clinics.
ActivitiesStrategies: DMH is still working to retrieve this information and is retaining this indicator as a place holder pending the reacquisition of this data as it is important to monitor delivery of these critical services.
Target Achievement Not Applicable

Name of Performance Indicator:C-21: Target Population -C & A (Percentage)

(1) (2) (3) (4) (5) (6)
Fiscal Year

FY 2008

Actual

FY 2009

Actual

FY 2010

Target

FY 2010

Actual

FY 2010

Percentage Attained

Performance Indicator 40 40 40 38.50 97.50
Numerator 16,166 14,773 13,955  --
Denominator 40,313 36,768 36,242 --
Table Descriptors:
Goal: To assure that a significant portion of services delivered within the SASS programs are provided in the most normalized settings possible in the individual's community, rather than within the provider's offices or clinics.
Target: A target is not set because the data source does not capture complete information at this point in time.
Population: Children and adolescents with serious emotional disturbances.
Criterion: 1:Comprehensive Community-Based Mental Health Service Systems
Indicator: Percentage of children identified as members of the DMH "target" population being served by the DMH-funded community-based service system who receive SASS services.
Measure:

Numerator: Number of hours of service provided by the DMH-funded SASS Programs which occur outside of the provider's offices or clinics.

Denominator: Total number of hours of service provided by the DMH-funded SASS Programs.

Sources of Information: DMH ASO Community Reporting System.
Special Issues: Children and adolescents with severe emotional disturbances (SED) are the priority target for mental health services.
Significance:
Activities/Strategies: DMH aims to increase the proportion of children and adolescents served who meet the DMH criteria for the target population.
Target Achievement: Target Not Achieved. The total number of individuals seen for treatment in FY2010 decreased.

APPENDIX A

LETTER FROM PLANNING COUNCIL (pdf) 

APPENDIX B

TABLE OF BLOCK GRANT FUND AWARDS

FY10 Block Grant awards by Vendor

Adult Block Grant Dollar Allocation

VENDOR_NAME FY10 FY Award
ADAPT OF ILLINOIS INC 40CL001011 $1,726.00
ADVOCATE NORTHSIDE 10CL001608 $318,338.00
ALEXIAN CENTER FOR MENTAL HLTH 40CL001017 $214,843.00
ASIAN HMN SVCS OF CHICAGO INC 10CL001032 $56,244.00
ASSOCIATION FOR INDIVIDUAL DEV 10CL001035  $189,987.00
ASSOCIATION HOUSE OF CHICAGO 10CL001038 $35,234.00
BEN GORDON CENTER 10CL001052 $27,240.00
BOBBY E WRIGHT CCMHC 10CL001066 $401,709.00
BRIDGEWAY INC 10CL001074 $153,581.00
CENTER ON DEAFNESS INC 10CL001096  $2,805.00
CHESTNUT HEALTH SYSTEMS INC 10CL001796 $711,407.00
CHICAGO CITY OF 40CL001111 $135,669.00
CHRISTIAN CNTY MNTL HLTH ASSN 40CL001121 $36,390.00
CIRCLE FAMILY CARE INC 40CL001124 $61,971.00
COLES CO MENTAL HLTH ASSN INC 10CL001132 $95,074.00
COMMUNITY CNSLNG CTRS CHICAGO 10CL001143 $463,913.00
COMMUNITY COUNSELING CENTER OF 10CL001142 $59,759.00
COMMUNITY MENTAL HLTH CNCL INC 10CL001149  $387,933.00
COMMUNITY RESOURCE CENTER INC 10CL001151 $80,378.00
COMMUNITY WORKSHOP & TRAINING 40CL001158  $13,816.00
COMPREHENSIVE MENTAL HEALTH 10CL001160 $136,854.00
CORNERSTONE SERVICES 40CL001164 $14,050.00
COUNSELING CENTER OF LAKEVIEW 40CL001167 $185,051.00
COUNTY OF WILL 10CL001775 $243,098.00
CROSSPOINT HUMAN SERVICES 10CL001175 $7,666.00
DELTA CENTER INC 10CL001185 $51,888.00
DOUGLAS COUNTY MENTAL HEALTH & 10CL001197 $17,324.00
DUPAGE COUNTY 10CL001201 $375,978.00
ECKER CTR FOR MENTAL HLTH INC 10CL001213 $386,704.00
EGYPTIAN PUBLIC & MENTAL 10CL001217 $50,096.00
NORTHSHORE UNIVERSITY HEALTH 40CL001238 $11,394.00
FAMILY COUNSELING CENTER INC  10CL001242 $44,589.00
FAMILY SERVICE & CMNTY MENTAL 10CL001245  $627,028.00
FAMILY SERVICE & MENTAL HEALTH 40CL001246 $82,400.00
THRIVE COUNSELING CENTER 10CL001249 $58,033.00
THE H GROUP BBT INC 10CL001265 $266,616.00
GATEWAY FOUNDATION INC 10CL001275 $22,954.00
GRAND PRAIRIE SERVICES 10CL001628 $231,669.00
HABILITATIVE SYSTEMS INC 10CL001303 $52,000.00
HEARTLAND HEALTH OUTREACH INC  40CL001113 $36,103.00
HEARTLAND HUMAN SERVICES $50,710.00
HELEN WHEELER CENTER FOR 40CL001314 $126,975.00
HERITAGE BHVRL HEALTH CTR INC 10CL001319 $495,613.00
HUMAN RESOURCES DEV INST INC 10CL001329 $76,213.00
HUMAN SERVICE CENTER 10CL001330 $42,624.00
HUMAN SUPPORT SERVICES 10CL001332 $23,895.00
 INDEPENDENCE CENTER  40CL001349 $26,991.00
INSTITUTE FOR HUMAN RESOURCES 10CL001353 $21,248.00
IROQUOIS MENTAL HEALTH CENTER 40CL001359 $15,028.00
JANE ADAMS CMNTY MNTL HLTH CTR 10CL001368 $27,194.00
JANET WATTLES CENTER 40CL001369 $154,789.00
JEFFERSON COUNTY COMPREHENSIVE  10CL001373 $59,898.00
JEWISH VOCATIONAL SERVICE AND 10CL001376 $129,571.00
KENNETH YOUNG CENTER 10CL001716 $36,146.00
LAKE COUNTY 40CL001399 $40,060.00
LESTER AND ROSALIE ANIXTER CTR 10CL001416 $23,293.00
LEYDEN FAMILY SVCS & M H CTR 10CL001417 $93,882.00
LOCUST STREET RESOURCE CENTER 10CL001435 $66,971.00
LORETTO HOSPITAL 40CL001427 $64,480.00
LUTHERAN SOCIAL SERVICES OF IL 10CL001430 $84,456.00
MAINE CENTER INC 10CL001438 $19,730.00
MASSAC COUNTY MENTAL HEALTH 40CL001450 $9,723.00
MCLEAN COUNTY CTR HUMAN SRV IN 40CL001457 $80,122.00
MENTAL HEALTH CENTERS OF 10CL001075 $62,394.00
MENTAL HEALTH CTRS OF CNTRL IL 40CL001465 $139,923.00
METROPOLITAN FAMILY SERVICES 10CL001469 $117,348.00
MONTGOMERY COUNTY  10CL001476 $19,126.00
MOUNT SINAI HOSP MEDICAL CTR 40CL001480  $414,999.00
NORTH CENTRAL BEHAVIORAL 10CL001503 $151,918.00
NORTHPOINTE RESOURCES INC 10CL001508  $26,925.00
NORTHWESTERN MEMORIAL HOSPITAL 40CL001511 $492,318.00
PILLARS COMMUNITY SERVICES 10CL001256 $95,173.00
PILSEN-LITTLE VILLAGE MENTAL 10CL001555 $139,781.00
PROVISO FAMILY SERVICES INC 10CL001564 $108,489.00
ROBERT YOUNG CENTER FOR 40CL001597 $97,516.00
SAINT MARY & ELIZABETH MED CTR  40CL001675  $53,773.00
SERTOMA CENTRE INC 40CL001626 $16,189.00
SINNISSIPPI CENTERS INC 10CL001632 $80,697.00
SOUTHEASTERN IL COUNSELING 10CL001643 $137,329.00
SOUTHERN IL REGIONAL SOCIAL 10CL001646 $92,432.00
STEPPING STONES OF ROCKFORD IN 40CL001686 $17,488.00
TAZWOOD MENTAL HEALTH CTR INC 10CL001704 $114,083.00
THE THRESHOLDS 10CL001722 $191,779.00
TRANSITIONS NFP 40CL001019 $68,843.00
TRANSITIONS OF WESTERN IL INC 10CL001010 $72,450.00
TRI-COUNTY COUNSELING CENTER 10CL001730 $31,767.00
TRILOGY INC 10CL001733 $70,464.00
TRINITY SERVICES INC  40CL001734 $33,577.00
UNION CNTY COUNSELING SVCS INC  10CL001739 $18,149.00
 VICTOR C NEUMANN ASSOCIATION 10CL001752 $88,853.00
Approp 22876440A  $11,072,907.00

Child/Adolescent MH Block Grant Dollar Allocation

ADVOCATE NORTHSIDE  10CL001608 $54,064.00
ALEXIAN CENTER FOR MENTAL HLTH 40CL001017 $50,966.00
ASIAN HMN SVCS OF CHICAGO INC 10CL001032 $109,333.00
ASSOCIATION HOUSE OF CHICAGO 10CL001038 $125,182.00
BRIDGEWAY INC 10CL001074 $605,014.00
CENTER FOR CHILDRENS SERVICES 10CL001094 $36,526.00
CHILDRENS HOME ASSOCIATION OF 10CL001117 $55,539.00
CIRCLE FAMILY CARE INC 40CL001124 $109,249.00
COMMUNITY MENTAL HLTH CNCL INC 10CL001149 $55,179.00
COMPREHENSIVE MENTAL HEALTH 10CL001160 $31,914.00
DE PAUL UNIVERSITY 10CL001186 $27,891.00
DELTA CENTER INC 10CL001185 $13,529.00
EGYPTIAN PUBLIC & MENTAL 10CL001217 $13,529.00
FAMILY COUNSELING CENTER INC 10CL001242 $13,529.00
FAMILY SERVICE ASSOCIATION OF 40CL001248 $52,191.00
GATEWAY FOUNDATION INC 10CL001275 $10,862.00
GRAND PRAIRIE SERVICES 10CL001628 $361,440.00
HELEN WHEELER CENTER FOR 40CL001314 $108,934.00
HEPHZIBAH CHILDRENS HOME ASSN 40CL001318 $11,388.00
HERITAGE BHVRL HEALTH CTR INC 10CL001319  $31,119.00
JANET WATTLES CENTER 40CL001369 $512,847.00
LAKE COUNTY 40CL001399 $50,862.00
LOCUST STREET RESOURCE CENTER 10CL001435 $16,582.00
MCLEAN COUNTY CTR HUMAN SRV IN 40CL001457 $7,887.00
MENTAL HEALTH CENTER OF 10CL001463 $97,098.00
MENTAL HEALTH CTRS OF CNTRL IL 40CL001465 $15,841.00
METROPOLITAN FAMILY SERVICES 10CL001469 $109,239.00
PILLARS COMMUNITY SERVICES 10CL001256 $109,187.00
ROBERT YOUNG CENTER FOR 40CL001597 $628,144.00
SINNISSIPPI CENTERS INC 10CL001632  $79,154.00
THE THRESHOLDS 10CL001722  $287,183.00
NEW FOUNDATION CENTER INC 40CL001782 $36,413.00
Approp 22876440B $3,827,815.00
Total both approps $14,900,722.00