FY2022-FY2023 Community Mental Health Services Block Grant Application

FY2022-FY2023 MH Block Grant - PDF Version
FY2022-FY2023 MH Block Grant - Word Version

TABLE OF CONTENTS	.
Section I - Executive Summary, Information, Assurance Forms
Planning Step I: Framework for Planning-Assessment of the Mental Health Service System
1. Strengths and Needs of the Service System
2. Unmet Service Needs
Planning Step II: Priorities, Goals, Strategies and Performance Indicators (Planning Tables)
Section IV: Environmental Factors and Plan
1. The Health Care System, Parity and Integration - Partly Required (Questions I and 2 only)
2, Health Disparities- Requested
3. Innovation in Purchasing Decisions- Requested
4. Evidence Based Practices for Early Intervention
4(a). FEP Programs (10 Percent Set-Aside)-Required
5. Person Centered Planning (PCP) and Self-Direction- Required
6 Program Integrity Required
7. Consultation with Tribes -Requested
8. Primary Prevention for Substance Abuse -DSUPR
9. Statutory Criteria for MHBG- Required
10. Substance Use Disorder Treatment -DSUPR
11. Quality Improvement Plan -Requested
12. Trauma- Requested
13. Criminal and Juvenile Justice -Requested
14. Medication Assisted Treatment-DSUPR
15. Crisis Services-Requested
16. Recovery Required
17. Community Living and Implementation of Olmstead- Requested
18. Children &Adolescents Behavioral Health Services Required
19. Suicide Prevention- Required
20. Support of State Partners Required
21. State Behavioral Health Advisory Council and Input on the Mental Health Block Grant Plan- Required
22. Public Comment on the State Plan- Required

COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT

FY2022-FY2023

STATE NAME: ILLINOIS

DUNS #: 067919071 Expiration: 8/11/2021 12:00AM

I. State Agency to be the Grantee for the Block Grant

AGENCY: Illinois Department of Human Services

ORGANIZATIONAL UNIT: Division of Mental Health

STREET ADDRESS: Iles Park Place, 600 East Ash St, Building 500, 3rd Floor

CITY Springfield STATE: Illinois ZIP: 62703

TELEPHONE: (217) 782-5700 FAX: (217) 785-3066

II. Contact Person for the Grantee of the Block Grant

NAME: David Albert

TITLE: Director, Division of Mental Health

AGENCY: Illinois Department of Human Services

ORGANIZATIONAL UNIT: Division of Mental Health

STREET ADDRESS: 401 S. Clinton, Second Floor

CITY: Chicago

STATE: Illinois _ZIP:60607

TELEPHONE: 312-793-1326_FAX: (312) 814 -2964

EMAIL: David.albert@illinois.gov

III. State Expenditure Period (Most recent State expenditure period that is closed out)

FROM: July 1, 2020 TO: June 30, 2021

FY 2022-23 MENTAL HEALTH BLOCK GRANT APPLICATION
Section I: Executive Summary

The Illinois Department of Human Services-Division of Mental Health (DMH) is responsible for facilitating, coordinating, and purchasing a comprehensive array of services that provide effective treatments to people most in need of publicly funded mental health care. The policies and practices of the DMH focus on fostering coordination and integration of services provided by DMH funded community agencies, private hospitals, and state hospitals across Illinois. A variety of collaborative initiatives serve to increase coordination with other state agencies whose services are accessed by individuals receiving mental health services. The FY2022-FY2023 Mental Health Block Grant Plan reflects these coordination efforts as well as an emphasis on developing and directing care which is consumer and family driven. DMH continues to transform the mental health service delivery system in Illinois to one that is recovery-oriented. These efforts include increasing consumer and family involvement in planning and implementation activities and expanding the focus on planning and implementation of evidenced-based practices. A wide array of stakeholders representing consumers, family members of individuals with mental illnesses, advocates and public service agencies purchasing or providing treatment to individuals with mental illnesses participate in these efforts. The anticipated outcome is the continued enhancement of activities that support the recovery-orientation of the mental health system and address the needs of consumers and their families.

During FY2021 and continuing into FY2022-FY2023, the priorities of the DMH include: (1) Facilitation and coordination of an effective array of clinical and support services. (2) The provision of services in the least restrictive manner including screening and crisis services for individuals at risk of hospitalization that contribute to reducing the use of hospitalization and identification of individuals who are experiencing psychosis for the first time as a priority population for community-based services.(3) Advancement of the recovery vision including Wellness Recovery Action Planning, expansion of the scope and quality of consumer and family participation, and promotion of the utilization of the Certified Recovery Support Specialist (CRSS) credential. (4) Continued support of System of Care concept and infrastructure for children, adolescents and their families in Illinois. (5) Enhancement of capacity for community living consistent with the Olmstead Decision, as stipulated in Implementation Plans of the Williams vs. Pritzker Consent Decree and the Colbert vs. Pritzker Consent Decree. (6) Partnership with state agencies and statewide organizations in initiatives which respond to ongoing consumer needs such as the criminal justice system, alcoholism and substance abuse services, vocational and employment services, housing opportunity, and services for military personnel. (7) Bi-directional Integration of Primary Health Care and Behavioral Health Care and the maximization of benefits to adults with SMI and children with SED through Affordable Care. (8) Continuing consultation and partnering with the state Medicaid agency, DHFS, the IDHS Community Health and Prevention Division (CHP) and the Illinois Children's Mental Health Partnership to address the behavioral health needs of women in pregnancy, single mothers with young children, and early childhood interventions. (9) Enhancement of collaborative efforts with state and local partners to address the mental health needs of adults involved with the criminal justice system and youth in the juvenile justice system. (10) Advancements in the use of data to inform and guide decision-making. The FY2022-23 Plan has been organized to comply with the priorities and format established by the SAMHSA.

Planning Step I:

Framework for Planning-Assessment of the Mental Health Service System

Description/Overview of the State's Mental Health System

The Illinois Department of Human Services Division of Mental Health (DMH) has a statutory mandate to plan, fund, and monitor community-based mental health services. Through collaborative and interdependent relationships with service system partners, the DMH is responsible for maintaining and improving an evidence-based, community-focused, and outcome-validated mental health service system that builds resilience and facilitates the recovery of individuals with mental illnesses. The DMH accomplishes this responsibility through the coordination of a comprehensive array of public/private mental health services for adults with/at risk of serious mental illnesses and children/adolescents with/at risk of serious emotional disturbances.

IDHS manages human service systems in the state, including management of the public mental health system through DMH. DMH has the statutory mandate to plan, fund, and monitor community-based mental health services and inpatient psychiatric services provided in state hospitals. As such, DMH is the federally recognized State Mental Health Authority for Illinois.

DMH contracts with approximately 210 community mental health agencies to provide community-based services. These organizations provide mental health services primarily reimbursed under the Medicaid Rehabilitation Option, including psychiatry, psychotherapy, medications, psychosocial rehabilitation, and case management to individuals eligible for Medicaid. A variety of additional supportive programs are funded through a grant mechanism. DMH also operates seven state operated psychiatric hospitals (SOPHs) and one treatment detention facility. In addition, DMH supports services provided through long term care facilities and in residential settings.

The state's geographic diversity, ranging from inner-city urban areas to sparsely populated rural areas, along with other factors such as stigma, result in mental health service delivery in non-traditional settings. These include physician offices, primary care clinics, general hospitals, emergency rooms, child welfare centers, schools, juvenile detention centers, jails, and prisons. With the onset of the COVID 19 Pandemic, the majority of services shifted to telehealth and virtual approaches, and providers have continued to operate in a more hybrid approach to maintain the flexibility that the continued public health uncertainty has required. While DMH provides some funding, the services provided in these diverse treatment settings are supported by a variety of other sources as well.

In addition to clinical services, DMH purchases non-clinical supports for adults, including the following:

Supportive housing. Access to supportive housing has been a focus for several years and includes a service model, identified funding sources, and a referral network for those transitioning from long-term care settings. Beginning in SFY22, the Division has been awarded additional funding by the Illinois General Assembly and has released a Notice of Funding Opportunity reflecting an additional $10M in permanent supportive housing resources. This investment in supportive housing demonstrates a commitment to helping individuals achieve their independent living goals, with community settings becoming the expected living situation for most adults who are diagnosed with serious mental illnesses.
Employment services. To help individuals access and maintain employment, Illinois has adopted the Individual Placement and Support (IPS) model, an evidence-based practice for which there is robust data indicating success. With the support of both DMH and the IDHS Division of Rehabilitation Services, the IPS model has demonstrated a 63 percent successful Federal Vocational Rehabilitation Rate (the percentage of people stably employed in a job of their choosing after 90 days), which is above the national average. Illinois leads the nation in its provision of technical assistance through certified IPS fidelity trainers, which are geographically based throughout the state to ensure access to support for all IPS providers. With the move to telehealth for many services as a result of the pandemic, the Illinois IPS leadership provided consultation to the teams who were transitioning to hybrid service delivery, and in consultation with the international IPS learning community, developed a remote approach to the provision of fidelity monitoring and technical assistance. In addition, members of the IPS leadership team were invited and are actively participating in a Diversity, Equity, Inclusion and Racial Justice initiative of the international IPS learning community.
Recovery supports. With input from individuals with lived expertise in recovery, DMH provides innovative recovery services and supports, including Wellness Recovery Action Planning (WRAP), regional recovery conferences, monthly consumer education calls that discuss a wide range of recovery-oriented topics, over twenty "Living Room" sites that provide a mutual learning approach to crisis respite, and twenty Recovery Drop-In Centers that provide non-clinical social supports. Both models are operated by recovery support specialists.

It is the vision of the Division of Mental Health that all persons with mental illnesses can recover and participate fully in life in the community. Within available fiscal resources, the priority for DMH is to provide access to clinically appropriate, effective and efficient mental health care and treatment for individuals who have serious mental illnesses and who have limited social and economic resources. Planning and budgeting decisions are guided by the basic principle that individuals will receive services in the least restrictive, most clinically appropriate environment, with the best possible qualityof evidence-based treatment and recovery-oriented care.

Statewide efforts to maintain and improve the system of care are coordinated through the Division of Mental Health Central Office based in both Springfield and Chicago. Planning and program implementation are accomplished in conjunction with seven regional administrators. The Central Office is responsible for oversight of the system, policy formulation and review, the operation of seven state hospitals, planning, service evaluation, and allocation of funds. Interagency collaborative efforts and leadership in initiatives such as activities related to transformation, participation and involvement of individuals with lived expertise of mental health recovery, the promotion of evidence-based practices, planning for clinical services, forensic services, and child and adolescent services are carried out by statewide administrative staff.

The Community-Based Mental Health Service System

Community services are considered the cornerstone of the mental health delivery system. Services provided and purchased by the DMH are geographically based. The DMH is geographically organized into five service regions. Through these regions, the DMH operates seven state hospitals and contracts with 210 community-based outpatient/rehabilitation provider agencies across the state. These Service Regions are responsible for coordination and general oversight of mental health services, assisting in developing the capacity and expertise of providers, and increasing the quality and the quantity of participation from persons who receive mental health services. Two regions are in the Chicago Metropolitan area and surrounding suburbs, and three regions cover the central, southern and metro-east southern (East St. Louis region) areas of the State.

The DMH continually seeks input from individuals, family members, advocates, and representatives of public and private organizations through the framework of the Illinois Mental Health Planning and Advisory Council (IMHPAC) to aid in planning efforts. The DMH uses emerging developments at the local, state and national levels as a basis for strategically setting statewide parameters and goals, with the regions carrying the responsibility for the development of congruent local systems of care. Ongoing strategic thinking and planning efforts with regional stakeholders are designed to uniquely meet local area needs within each Region. The regions work with local agencies, state agency partners, and stakeholders to integrate a comprehensive care system that includes mental health,rehabilitation, substance use, social services, criminal justice, and education. The DMH is able to improve linkage and insure that treatment occurs in the least restrictive and most cost-effective settings by integrating hospital-based services into a network of community outpatient services and supports that are coordinated across service providers and consumers. By building on the strengths of communities, the region administrators are able to manage DMH funds, and coordinate themost effectiveuse of the local tax dollars and private resources budgeted for public mental health services.

Being part of the IDHS umbrella has provided an opportunity for the DMH to address a number of challenges within the shared mission of one Department, including: disability determination for persons with serious mental illnesses (SMI), prevention, early intervention, integration of vocational and educational services for children with serious emotional disturbances (SED), coordination and development of Mental Illness and Substance Use (dual diagnosis) services, and, through the coordinated intake process, an opportunity to enhance case finding, early identification, and outreach efforts.

DMH's Forensic and Justice Services collaborates with a range of agencies in the criminal justice system to oversee and coordinate the inpatient and outpatient placements of adults remanded to DMH by Illinois county courts because they are found to be unfit to stand trial (UST) or not guilty by reason of insanity (NGRI). Inpatient services are provided at five state hospitals with secure forensic units. DMH has utilized grant funding to develop a pilot for community-based fitness restoration for individuals with low risk, which is reducing excess demand on our state hospitals system while meeting the needs of these individuals in the least restrictive setting possible. DMH also helps lead several programs to address other individuals with behavioral health needs in jails and prisons, including the Jail Data Link Program and other initiatives focused on recovery, diversion, reintegration, best practices, and the appropriate use of inpatient and community resources. Because of budgetary constraints, many community-based mental health services are available only if the individual has health benefits through private insurance, Medicaid, or Supplemental Security Income. These constraints also apply to individuals involved with the criminal justice and juvenile justice systems.

Mental health services are purchased or delivered by many other state agencies and local mental health authorities in some areas of the state (including 708 boards, the City of Chicago and other municipalities, and Cook County). Over the years, DMH has worked actively to establish and maintain relationships across these systems with the goal of integrating mental health services under its purview with the services provided or purchased by other agencies.

Description and Overview of Child and Adolescent Services

DMH's Child and Adolescent Services (C&A) consults and collaborates on the design and quality of services for children and adolescents with social, emotional, and behavioral disorders who depend on public funding. Statewide, children and adolescents receive services through a network of over 200 community-based mental health providers. The emphasis is on social, emotional, and behavioral skill development organized to meet the unique needs of children and youth with serious mental health needs and their families and on evidence informed practice as components in the systemic transformation process. C&A collaborates with the Illinois State Board of Education, the Department of Child and Family Services, the Illinois Department of Juvenile Justice, DHS/Division of Substance Use, Prevention and Recovery (DSUPR), the Illinois Department of Healthcare and Family Services, the Illinois Children's Mental Health Partnership, to implement Systems of Care statewide. The Illinois Departments of Children and Family Services (IDCFS), Illinois Department of Healthcare and Family Services (IDHFS) and Juvenile Justice (IDJJ) and the Illinois State Board of Education (ISBE), also have statutory responsibility to provide mental health services in some instances. No single agency has statutory responsibility for ensuring the integration of behavioral health care services across all child-serving systems.

The Growth of Community-Based Services

Within Illinois there are numerous private practitioners, community mental health agencies, community hospitals providing inpatient psychiatric care, and community long-term care facilities providing services to individuals with serious mental illnesses. Over the past 40 years, the locus of treatment for persons with mental illness has shifted from institutions to community-based settings. In FY1973, 8% of the DMH's budget was allocated for community services. Today 65% of DMH expenditures are being allocated for community-based services.

The Illinois Mental Health Collaborative for Access and Choice

DMH began contracting with an Administrative Services Organization (ASO) in FY2008 to assist with implementing DMH established policies and procedures in a variety of areas. The ASO known as the Illinois Mental Health Collaborative for Access and Choice, or The Collaborative serves as an administrative arm to the Division. Tasks performed by the Collaborative include:

Operating and maintaining a Warm Line and an "Individuals and Families" web page of wellness and recovery resources.
Collaborating with DMH on the development and maintenance of an integrated Management Information System (MIS).
Completion, dissemination, and posting of a variety of mental health reports, manuals, and a consumer and family handbook.

The work of the Collaborative has been very valuable to DMH in terms of performing administrative and supportive tasks that support the vision for a recovery-oriented service system.

Community Integration from Long Term Care

There are a substantial number of individuals with serious mental illnesses who require long-term care services. Some require this level of care because of functional limitations associated with their mental illnesses, and others require it for functional limitations associated with both mental illness and medical needs. In either case, the lack of viable community alternatives and supportive services for persons in this situation may necessitate their admission to and continued care in longer term care facilities. The Illinois Department of Public Health (DPH) is responsible for monitoring the licensing requirements of nursing facilities and the Department of Healthcare and Family Services (DHFS) oversees Medicaid funding. The DMH has made a concerted effort to assist community providers and these two state agencies to understand the service needs of persons with serious and disabling mental illnesses. DMH has been working to develop community-based alternatives to accommodate the needs of this population in transitioning to the community through the Williams Consent Decree and the Colbert Consent Decree. (See Section C-17 for further information.)

Collaborative Planning in Mental Health and Substance Use Prevention and Treatment

DMH and the DHS Division of Substance Use Prevention and Recovery (DSUPR) have worked together over the years to collaborate, develop and implement initiatives focusing on consumers with co-occurring disorders. These collaborations have included co-location projects at four state hospitals and sharing service delivery site resources, which allowed DSUPR-funded providers to perform screening and assessment for consumers on-site, and to provide consultation to DMH staff regarding the substance abuse treatment needs of consumers when these services were warranted. This approach resulted in the development of more hospital staff training and expansion of the role of the providers to perform linkage and engagement activities.

DMH continues to implement Wellness Recovery Action Planning (WRAP) which is seen as bridging the gap between traditional mental health treatment and traditional substance abuse treatment for individuals with co-occurring disorders. The use of WRAP principles of self-determination, personal responsibility, and empowering support are a means of addressing an individual's divergent needs. In reference to children and youth, DSUPR has been a leading participant in the DMH Family Driven Care initiative and has collaborated with DMH in providing training on trauma informed prevention, treatment and recovery as well as adolescent and family co-occurring disorders and their treatment.

Strengths and Needs in the Service System

The consistent vision for mental health services in Illinois is a well-resourced and transformed mental health system that is person centered and community driven; that provides a continuum of culturally inclusive programs which are integrated and effective; a range of direct and support services (including prevention, early intervention, treatment and supports) that support healthy lifelong development through equal access and promote recovery and resilience. The fundamental belief (credo) is that:

"All persons with mental illnesses can recover and participate fully in community life:
- The expectation is recovery
- The individual is central"

Accordingly, all children with a diagnosis of, or at risk for developing, an emotional disorder will have access to a family-driven, youth-guided, trauma-informed, culturally and linguistically competent, strengths-based system of care that supports optimal physical and mental health and social and emotional wellbeing. All adults with a diagnosis of, or at risk for developing, a mental illness will have access to a coordinated, integrated, well-funded mental health system that promotes recovery and social inclusion through timely access to prevention, treatment, and recovery support services.

Illinois has a strong foundation on which to create a behavioral health system grounded in recovery and built on the premise that mental health is essential to health. With support at the highest levels, DMH and its partners in state government, communities, and the private sector engage in collaborative problem-solving to address identified gaps and emerging needs. InChild and Adolescent services, the emphasis is on resilience and evidence informed practice as components in the systemic transformation process. Specific system strengths and gaps are noted below.

System Strengths

A person-centered, recovery focus

Illinois emphasizes the concept of recovery for all individuals experiencing mental illnesses. The State has shown a commitment to a recovery-oriented system of care by developing and supporting positions within state leadership, in the regions, and at the direct service level for Certified Recovery Support Specialists (CRSS). CRSS staff, who have lived expertise of mental illnesses, have a voice in directing policy, monitoring quality, and providing mental health services and supports.

Commitment to Evidence-Based and Evidence-Informed Practices in Illinois

Evidence-based practices are interventions for which there is consistent scientific evidence showing that, when implemented with fidelity to the model, individual outcomes improve. Evidence-informed practices refer to those practices determined by children, their families, and practitioners to be appropriate to the needs of the child and family, reflective of available research, and measurable with respect to meaningful outcomes.

Illinois has devoted resources to support the implementation and use of evidence-based practices for adults with mental illnesses in such areas as outreach, engagement and treatment (Assertive Community Treatment), housing (Permanent Supportive Housing), employment (Individual Placement Support), and recovery (Wellness Recovery Action Planning). Dollars also have been allocated to support the implementation and measurement of evidence-informed practices with child-serving agencies.

A pledge to work together

Collaborative efforts across state agencies that support adults and/or children with mental health conditions abound. Examples include a collaborative effort between IDCFS, DMH, and IDHFS to provide crisis services to youth with serious emotional disturbances and the Jail Data Link program, which was developed by DMH to identify and coordinate services between county jails and mental health agencies for individuals with mental health needs. The behavioral health and law enforcement systems work together in problem-solving courts and on law enforcement Crisis Intervention Teams. Support for Illinois service members, veterans, and their families comes from a broad range of community, faith-based, and fraternal organizations, as well as elected officials and the general public. The Illinois Joining Forces Foundation has established several Veterans Support Communities across the State for the purpose of local resource utilization that spans physical and behavioral healthcare, as well as broader social determinants of health for service members, veterans, and their families.

Transition to Managed Care

Medicaid Managed Care has been successfully implemented in Illinois. As the number of individuals whose care is reimbursed by Managed Care Organizations (MCOs) has grown, the amount of services reimbursed directly by the SMHA public mental health system has decreased. In February 2017, Illinois initiated a reboot of the Illinois managed care system which began in 2011-12. About two million Illinois residents - nearly two-thirds of Illinois residents on Medicaid - were part of managed care plans. The new plan extended managed care to approximately 85% of all Illinois residents. The managed care reboot also shifted managed care in Illinois to a more value-based system, and an overall decrease in managed care companies, in an attempt to reduce administrative burden through simplified processes for providers.

Coordination of Care

Illinois Public Act 096-1501 (Medicaid Reform) requires the provision of coordinated care for adults and children who receive Medicaid-funded services. This may spur the development of innovative service models to improve health care outcomes, use of evidence-based practices, and encourage meaningful use of electronic health records (EHRs)

A focus on technology

Technology isincreasingly being used to help drive both service provision and data collection and analysis. Telepsychiatry, e-prescribing, and other mobile and video tools are currently being used to make services accessible to Illinois residents with mental health needs who otherwise might not be served. Although Illinois behavioral health providers have exceeded the national average of 10 percent for implementation of EHRs, there is still much work to be done. (See the discussion of "gaps" below.)

System Weaknesses

Fragmentation of Services

One of the significant strengths of the Illinois mental health system- the diversity of agencies and providers serving adults with mental illnesses and children with emotional disorders-also creates the potential for a key weakness, as individuals and families may need to interact with a range of agencies to access various necessary services. This fragmentation results in some frustration for individuals and families, potential duplication of services, increased costs, and interruptions in care. The situation is especially acute for certain groups, including youth transitioning to the adult system of care and individuals with mental health conditions who encounter the criminal justice system for lack of more appropriate alternatives.

Insufficient resources

Insufficient funding for mental health programs results in gaps of specific services, such as permanent supportive housing, and for particular groups, such as transition-age youth and individuals currently ineligible for Medicaid. Moreover, the evidence-based practices the state promotes require a significant amount of training, supervision, and monitoring to ensure fidelity to the model, costs which are not reimbursed by Medicaid.

Workforce Challenges

Ultimately, behavioral health care is only as good as the workforce that provides it. Overall, the health care workforce in America is aging and insufficiently sized and trained to meet the growing demand for integrated physical and behavioral health care. Illinois has made strides in addressing the education of future behavioral health care workers through collaboration with some key universities on graduate and training programs in psychology and social work. The state also has advocated and developed employment for peers, family members, and veterans as service providers. However, there is an overall lack in Illinois, as elsewhere, of such specialists as child and adolescent psychiatrists, advanced practice nurses, physician assistants, and other behavioral health care workers. Workforce members need to be trained to provide trauma-informed, culturally competent services, especially to youth involved in the justice system and returning veterans. Recruitment and retention of a sufficient number of culturally competent/sensitive staff and those with the language proficiencies to meet the needs of the ethnic populations served is also an issue.

Assessing Needs in the Service System

Needs and gaps of mental health services in the context of COVID-19.

The Covid-19 pandemic has strengthened our resolve to provide statewide access to a comprehensive mental health service system that has both the ability and the capacity to serve all residents of Illinois regardless of where they may be living and what their financial status may be. We know that COVID-19 has not affected everyone in our state equally. It has drawn attention to existing inequities that have resulted in unequal access and unequal outcomes. We are committed to addressing these inequities and building a broader mental health system that works to ensure everyone of equitable access to comprehensive, high-quality mental healthcare across the lifespan.

Through careful design, planning and coordination, we believe that we can increase access through crisis response system development that is consistent with SAMHSA's assertion that: "A fully realized crisis response system will have the capacity to respond, deescalate, and follow-through crises so that individuals in crisis not only land safely but also transition well onto a path of recovery." We are committed to develop and support evidence-based crisis services and to increase access to evidence-based treatment and coordinated recovery support for those with SMI and SED.

A primary strategy will be to stress local access to crisis services and support for those whose lives, incomes, family relationships, and mental health have been impacted by COVID-19. A secondary strategy, but no less important, will be to identify a range of non-traditional ways of meeting mental health needs in the most impacted areas. The development of these new approaches will require thoughtful study and planning in how to innovatively use and enhance less costly more familiar resources available in the community to support and complement more traditional practices. DMH staff, working statewide, are in a position to convene stakeholders, provide technical assistance and consultation to local entities in needs assessment, planning and implementation of practical and innovative approaches in local service delivery and community support. Agencies that demonstrate ability and commitment to adequately serve areas which have previously been poorly covered or uncovered that have a population with a larger segment of unfunded, underfunded, and undocumented Illinoisans who have likely been underserved will be among those selected, to ensure access to a continuum of crisis services statewide.

The Covid19 Pandemic during FY2020 and into FY2021 has brought increased emphasis on the need for crisis services and with it, increased funding opportunities. Illinois appreciates and welcomes the current congressional action to set aside an additional 5 percent of states' Mental Health Block Grant allocations bringing the total set-aside to 10% to support evidence-based crisis systems.

The Illinois Department of Human Services, Division of Mental Health (DMH) has had regulatory responsibility for crisis response services. Collaboration among the agencies has always existed, with DMH staff actively participating in many of the statewide Suicide Prevention workgroups, including co-chairing the Illinois Governor's Challenge workgroup and the Illinois Suicide Prevention Alliance. As a result of the social and emotional impact of COVID-19, DMH was tasked with developing a Suicide Prevention Campaign to compliment the strategies already in development by IDPH. A multi-tiered strategy was developed that includes social messaging via multiple media platforms, development of a Suicide Prevention Application for download to smart phones, support for the National Suicide Prevention Lifeline 988 transition, and the Illinois Governor's Challenge (a suicide campaign specifically focused on our veterans, military service members, and their families.) DMH will be able to include a marketing plan for 988 within this plan and ensure that it is consistent with national/federal messaging. Requirements for this plan will further convey messages of help, hope and healing and this requirement will be relayed to the selected vendor. We anticipate that the social messaging will be reflective of the communities where the messaging is being presented, thus ensuring a cultural and linguistically responsive messaging is utilized.

People with lived expertise of mental illnesses, including suicidal ideation and suicide attempts, are at the center of the planning work of DMH, and their knowledge and experience is invaluable in guiding our way forward. We work toward ensuring that people's voices, concerns and ideas are heard, not only in the public domain but in every arena where decisions are being made, and DMH has developed multiple avenues for including the voices of people with lived expertise in the planning, development, and delivery of services, including through the Illinois Mental Health Planning & Advisory Council (51% people with lived experiences). The DMH Bureau of Wellness & Recovery Services, directed by a person with lived experience and staffed with 6 full-time employees with lived experience, has been central to the planning efforts behind the 988 project and the National Suicide Prevention Lifeline.

Certified Community Mental Health Centers (CMHCs) provide access to crisis intervention services across the state through the mental health safety net. The Medicaid State Plan includes reimbursement to CMHCs for crisis intervention services and for the provision of mobile crisis response, crisis stabilization and non-crisis community based mental health services. Services are provided by a combination of mental health professionals and licensed clinicians.

DMH has extended access to these crisis safety net services for unfunded, underfunded and undocumented Illinoisans, as well as developed additional crisis services and supports that are outside the Medicaid State Plan eligibility for reimbursement. Crisis residential programs provide 24/7 clinical services within communities to individuals regardless of funding stream. Within the past year, we funded the development and implementation of 21 Living Room Programs that offer crisis respite services in a non-clinical setting, and accept referrals from individuals, police, fire, and emergency departments with which an individual experiencing such a crisis may come into contact.

There are three domains of an infrastructure to provide quality crisis services:

(1) Someone to Call: 988 Call Center Expansion Planning

DMH has been working with staff from Vibrant Emotional Health since the summer of 2020, to expand statewide coverage for 988 calls, chats, and texts. Like most states, DMH was not involved in the design or operation of the Lifeline at the time of development or implementation, therefore has not had authority or responsibilities over the entities operating as Lifeline Call Centers (LCC) within Illinois. To expand coverage, the first task required was to identify a funding mechanism to increase the local LCC and hold them accountable for 24/7/365 statewide coverage that would meet the call volume for calls initiated within Illinois. DMH has secured funding that will be utilized for this purpose. During CY2021, DMH has undertaken extensive planning with a variety of key stakeholders consistent with the terms of a planning grant from Vibrant which will be instrumental in the development and implementation of this call center expansion.

(2) Someone to Respond: Mobile Crisis Response in Illinois

DMH has developed the Crisis Care System Program to develop capacity for mobile crisis team response statewide for anyone, regardless of funding source. The funding opportunity for this program was published in the spring of 2020, with contracts currently in the process of execution for 69 providers. Once developed, this program will ensure that community based providers are able to deploy trained responders that include recovery support specialists and other mental health professionals with access to a Qualified Mental Health Professional (QMHP) for supervision and consultation. In addition, the providers will participate with DMH in systems planning and analysis to ensure equitable access for individuals in need of these services. Once 988 is implemented, these teams will be able to respond to dispatch from the 988 call centers.

The Illinois Department of Healthcare and Family Services (DHFS) reimburses the service of Mental Health Mobile Crisis Response (MCR) for Medicaid-eligible Illinoisans receiving services through its Managed Care and fee for service systems which is reported to be serving nearly 50% of the state's population. As Medicaid Managed Care has grown, that system is serving an increasing number of adults with SMI and children with SED. To be eligible for Medicaid reimbursement, MCR services must be rendered by staff minimally meeting the qualifications of a Mental Health Professional with access to a Qualified Mental Health Professional and must be provided face-to-face, responding to the location of an individual in crisis. MCR services may be provided on an individual basis or by a team.

MCR service is accessed through the statewide CARES Crisis Help Line funded by Medicaid and managed by DHFS which responds to an individual in crisis and dispatches the Mobile Response team. Protocols and specified time lines assure that the MCR response is rapid and timely. Providers with a service area designation are required to accept all MCR referrals from the CARES line on a no-decline basis and respond to the crisis within 90 minutes. Since 2018 MCR services have been provided by DHFS on a statewide basis to Medicaid covered individuals.

(3) Place to Go: Expansion of Living Room Programs in Illinois

In May 2020, DMH issued a Notice of Funding Opportunity inviting grant applicants to develop and establish Living Room Programs across the State. Grant applicants were invited to submit proposals and obtain funding to either subcontract for or directly operate a crisis respite program within a safe, inviting, home-like atmosphere that offers services provided by recovery support specialists and is designed to proactively divert crises and break the cycle of psychiatric hospitalization. The NOFO proved to be very successful. By March 2021, 21 were awarded to establish LRP programs in strategic areas throughout the State.

Illinois has convened focus groups composed of a broad range of state agencies, legislative representatives and other stakeholders to address crisis planning and service system development. The DHS Division of Substance Use Prevention and Rehabilitation (DSUPR) is already working closely with us toward the 988 Expansion Roll-Out and the planning of behavioral health crisis services. In addition to a Statewide Coalition consistent with our 988 Planning Grant, we intend to facilitate local coalitions co-led by existing local call centers to focus on regional assessment and planning.

DMH is excited to continue our work of adapting the Statewide Mental Health System to better meet community needs, including the disparities that have come to light as a result of COVID-19, as well as the opportunities and challenges that lie before us with 988 Implementation. In order to succeed in these efforts, we must have an accurate understanding of the unique needs of the various communities that make up our state. Toward this end, we are committed to developing and implementing a variety of assessment tools and strategies, beginning with an essential gap analysis. In addition, we have already engaged in initial discussions with the Illinois Department of Healthcare and Family Services, which is our State Medicaid Authority, to identify available data and develop agreements to share this data in ways that will assist in our assessment and planning. Deepening our understanding of community needs, and tailoring our responses accordingly, will lower barriers to access and improve outcomes for all.

Independent Data Sources

Several independent sources of data suggested by members of the Illinois Mental Health Planning and Advisory Council (IMHPAC) are relevant to an assessment of the mental health service needs of individuals with mental illnesses and children and adolescents with serious emotional disturbances residing in Illinois:

The 2019 National Survey of Children's Health reports the following estimates for the State of Illinois:

23.9% of respondents reported that their child has 1 or more reported Mental, Emotional, Developmental or Behavioral problem.
0.7% of respondents reported being "ever told" that their child has ADD or ADHD, while 9.0 reported their child currently has the condition
28.5 of the respondents reported their child has been bullied 1-2 times in the past 12 months, while 7.6 report 102 time per month, 3.0 report 1-2 times per week and 2.7 report almost every day.

The Mental Health America Youth Data Report for 2021 reports that:

in the past year 2021 14.86% of youth age 12-17 report suffering from at least one major depressive episode of those youth, 62.1% did not receive any treatment.

The 2020 SAMHSA Behavioral Health Barometer

Behavioral Health Barometer: Illinois, Volume 6: Indicators as measured through the 2019 National Survey on Drug Use and Health, the National Survey of Substance Abuse Treatment Services, and the Uniform Reporting System is one of a series of national and state reports that provide a snapshot of behavioral health in the United States. This report presents national data about the prevalence of behavioral health conditions. The data includes the rate of serious mental illness, suicidal thoughts, substance use, and underage drinking. The Barometer provides data on mental health in Illinois limited to the following indicators:

Youth Mental Health and Service Use -Depression: In Illinois, an annual average of about 145,000 adolescents aged 12-17 (15.1% of all adolescents) in 2016-2019 had experienced a Major Depressive Episode in the past year. The annual average percentage in 2016-2019 was higher than the annual average percentage in 2004-2007when it was 7.5%.
Youth Mental Health and Service Use -Depression: Treatment for Depression: In Illinois, an annual average of about 62,000 adolescents aged 12-17 with past year MDE or 42.9% of all adolescents with past year Major Depressive Episode) during 2016 to 2019 received treatment for their depression in the past year.
Adult Mental Health and Service Use -Serious Thoughts of Suicide: Among all adults aged 18 or older in Illinois, the annual average percentage with serious thoughts of suicide in the past year did not significantly change between 2008-2010 and 2017-2019. During 2017-2019, the annual average prevalence of past-year serious thoughts of suicide in Illinois was 3.6% (or 345,000), lower than both the regional average (4.8%) and the national average (4.5%).
Among young adults aged 18-25 in Illinois, the annual average percentage with serious thoughts of suicide in the past year increased between 2008-2010 and 2017-2019. During 2017-2019, the annual average prevalence of past-year serious thoughts of suicide in Illinois was 11.1% (or 145,000), similar to both the regional average (12.2%) and the national average (11.1%). The annual average percentage with serious thoughts of suicide in the past year during 2008-2010 was 6.7%.
Mental Health and Service Use -Serious Mental Illness: Among all adults aged 18 or older in Illinois, the annual average percentage with SMI in the past year did not significantly change between 2008-2010 and 2017-2019. During 2017-2019, the annual average prevalence of past-year SMI in Illinois was 4.0% (or 391,000), lower than both the regional average (5.0%) and the national average (4.8%).
Among young adults aged 18-25 in Illinois, the annual average percentage with SMI in the past year increased between 2008-2010 and 2017-2019. During 2017-2019, the annual average prevalence of past-year SMI in Illinois was 8.7% (or 115,000), similar to both the regional average (8.7%) and the national average (7.9%).
Mental Health and Service Use-Mental Health Service Use Among Adults with Any Mental Illness (AMI): Among adults aged 18 or older in Illinois, the annual average percentage with AMI who received mental health services in the past year increased between 2008-2010 and 2017-2019. During 2017-2019, the annual average prevalence of past-year mental health service use among those with AMI in Illinois was 46.4% (or 827,000), similar to both the regional average (47.5%) and the national average (43.6%).

Homeless Persons with Mental Illness

In reference to homeless persons in the State, the HUD Continuum of Care Homeless Assistance Programs Point -In Time Count provides a count of sheltered and unsheltered homeless persons on a single night during the last ten days in January each year. In Illinois, the PIT Count in January 2019 identified 1,995 persons as being Severely Mentally Ill. Of these, 935 were domiciled in Emergency Shelters, 438 were in Transitional Housing, and 622 were Unsheltered.

Shortages of Mental Health Professionals

The Rural Health Information Hub (formerly the Rural Assistance Center) provides information on health professional shortages in rural areas. In a map of Illinois, showing Mental Health shortage areas by County as of April, 2021: only nine (9) of the 102 counties in Illinois were identified as not having a shortage of mental health professionals (McHenry, Lake, Kendall, Peoria, Tazewell, Woodford, Champaign, Boone and Winnebago), five counties were identified as having a shortage in parts of the county (Kane, DuPage, Cook, Will, and St. Clair). The remaining 88 counties in Illinois were entirely in a Mental Health Professional Shortage Area (HPSA).

FY2022-FY2023 Planning Tables

Please note that information about targets for FY2022 and FY2023 may be missing from some of the following tables. As we have not yet obtained substantive data prior to and during SFY2021 which is identified by SAMHSA as the year for establishing baseline measures, we may be currently unable to project FY2022 and FY2023 data targets at this time.

Plan Table 1-1 Crisis Services

Mobile Crisis Response

1. Priority Area:Continue to develop and improve the array of crisis services available for adults and children	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI, SED

4. Goal of the priority area: Statewide availability and comprehensiveness of crisis mental health services available for adults and youth in the public mental health service system so that the continuum of crisis service is available to all Illinois residents anywhere in the State, and at any time.	.
5. Objective: Establish a fully operational 988 crisis response line in Illinois that covers all areas of the State and has an answer rate of at least 90%.
6. Strategies to attain the objective: (a) Use Notice of Funding Opportunity (NOFO) to contract with current Lifeline Call Centers in the State to increase capacity for receiving calls from assigned areas. (b) Follow state procurement requirements to ensure local crisis call response in areas identified as lacking these services to address the disparities; (c) Convene meetings of stakeholders to assist in planning for the establishment of the 988 Crisis Line in Illinois by July 2022 and continuing expansion. (d) Continue utilizing technical assistance and consultation from Vibrant, the 988 National Contractor, to plan for expansion of call centers, evaluate ongoing effectiveness, and increasing performance value. (e) Pursue legislative action to ensure development and sustainability of infrastructure necessary for statewide implementation of the 988 Crisis Line in Illinois.
7. Annual Performance Indicators to measure goal success: Indicators: 1. The number of counties outside Cook County and the number of zip codes in Cook County covered by NSPL(988 Line) at the end of each fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): (1) 17 counties in Illinois and 14 zip codes in Cook County. First-year target/outcome measurement (Progress to end of SFY 2022): 85% of counties and zip codes have coverage Second-year target/outcome measurement (Final to end of SFY 2023):100% of counties and zip codes have coverage Data source: Vibrant Call Center reports Description of data: Counties identified with coverage; Data issues/caveats that affect outcome measures: Vibrant is currently in the process of a procurement of a new data system that could impact the data collected and timeframes for receipt of reports.
7. Annual Performance Indicators to measure goal success: Indicator #2: The Illinois answer rate as calculated by national formula in comparison with other states at the end of each fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): An answer rate of 19%. First-year target/outcome measurement (Progress to end of SFY 2022): Statewide Answer Rate= 50% Second-year target/outcome measurement (Progress to end of SFY 2022): Statewide Answer Rate = 90% Data source: Vibrant Call Center reports Description of data: Answer rates as calculated by Vibrant per call center Data issues/caveats that affect outcome measures: Vibrant is currently in the process of a procurement of a new data system that could impact the data collected and timeframes for receipt of reports.
5. Objective #2: Establish Mobile Crisis Response (MCR) coverage that ensures access for anyone, at anytime, anywhere in the State requiring the service.
6. Strategies to attain the objective: Develop statewide access to mobile crisis response through implementation of the newly funded Crisis Care System Program 590. Work collaboratively with DHFS to coordinate and integrate the newly established program with the existing MCR services which reimburse services to Medicaid-Eligible persons to ensure no duplication of state resources in payment.
7. Annual Performance Indicators to measure goal success: Indicators: 1. The number of new Mobile Crisis Teams established and operational in Illinois by the end of the fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): Indicator #1-Noneat the end of FY2021. This a new indicator. First-year target/outcome measurement (Progress to end of SFY 2022) Indicator #1 TBD - Estimated based on current contract negotiations with new grantees and a gap analysis to be completed to identify need. Second-year target/outcome measurement (Final to end of SFY 2023): To be determined (TBD) based upon data available by the end of FY2022. Data source: Needs assessment and gap analysis to be developed and completed in partnership with provider grantees. Description of data: Assessment/analysis will include population of area to be served, projected incident rates and additional projections related information gathered in the planning of the crisis continuum in consultation with academic partners, stakeholders, and other experts. Data issues/caveats that affect outcome measures: Data will be based on projections and plans may need to be adjusted as actual services begin/real data is able to be collected and analyzed.
7. Annual Performance Indicators to measure goal success: Indicator #2: The number of Counties in which new/additional Mobile Crisis Response services are available in all parts of the county, the number of counties in which new/additional MCR services are available in some parts of the county and not available in others, and the number of counties without access to new/additional MCR services at the end of each fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): Report of the current geographic coverage of the IDHFS managed Mobile Crisis Response system. First-year target/outcome measurement (Progress to end of SFY 2022): TBD Estimated-based on cost of a mobile crisis program and time needed to acquire and set up the necessary working components and infrastructure. (staff, equipment, etc.) Second-year target/outcome measurement (Final to end of SFY 2023): To be determined (TBD) based upon data available by the end of FY2022. Data source: Needs assessment and gap analysis to be developed and completed in partnership with provider grantees. Description of data: Assessment/analysis will include population of area to be served, projected incident rates and additional projections related information gathered in the planning of the crisis continuum in consultation with academic partners, stakeholders, and other experts. Data issues/caveats that affect outcome measures: Data will be based on projections and plans may need to be adjusted as actual services begin/real data is able to be collected and analyzed.
Living Rooms - Local Crisis Stabilization Resource
Objective #3: Increase the statewide availability of Living Room Programs. (and other local crisis stabilization services)
6. Strategies to attain the objective: Work with current Living Room programs to identify options for expanding capacity. Work with agencies receiving crisis funding to build their capacity to provide stabilization services or to coordinate/collaborate service delivery with local existing stabilization programs. including immediate outpatient services, peer run living rooms, 24-hour respite services, and hospital emergency rooms. Establish the requirement (standard) for follow up to assure that the crisis has been resolved and that the individual is receiving and will continue to receive needed clinical and support services that he chooses.
7. Annual Performance Indicators to measure goal success: Indicator: Number of persons receiving services from Living Room Programs operating statewide at the end of each fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): 7,972 First-year target/outcome measurement (Progress to end of SFY 2022): 9,000 Second-year target/outcome measurement (Final to end of SFY 2023): 10,000 Data source: Quarterly Reports from each grantee operating a living room program. Description of data: Grantee will provide the number of individuals served through the automated reporting system monitored by the DMH program manager. Data issues/caveats that affect outcome measures: None

Plan Table 1-2: FIRST.IL/MHBG FEP SET-ASIDE

1. Priority Area: FEP Set-Aside: Implementation of FIRST IL Specialized Programming and Evidence - Based Services for persons experiencing First Episode Psychosis/Early Serious Mental Illness	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) ESMI

4. Goal of the priority area: Sustain and expand the infrastructure for evidence-based clinical programs for persons with ESMI.	.
5. Objective: Sustain the 15 Coordinated Specialty Care teams currently in the State and increase the number of teams.
6. Strategies to attain the objective: Provide education, training, and ongoing consultation to staff involved in FEP programs that includes: Strategies for Outreach and community-based education to attract and retain clients who have recently begun experiencing symptoms of psychosis or serious mental illness; Assessment and individualized treatment planning with these individuals in the most supportive and least intrusive manner; Psychiatric evaluation and medication management Individual Placement and Support (IPS) programs geared towards accessing employment, job retention, and smooth transitional experiences in work life that can increase self-esteem, confidence, and stability in persons experiencing early episodes of serious mental illness. Supportive education that helps the individual to initiate or continue in his/her educational process. Family and Individual Psychoeducation Case Management/Recovery Support Specialists Cognitive Behavioral Therapy for Psychosis and Substance Use Disorder Analyze needs of geographic areas to identify the best location of a new program Determine the potential for success and the capacity of the candidate provider based upon criteria for Providers Selection previously formulated by the DMH FEP Team
7. Annual Performance Indicators to measure goal success: Indicator #1: (a) Number of sites in the State with funded ESMI Programs. Baseline measurement (Initial data collected prior to and during SFY 2021): 15 funded sites at the end of SFY2021. These sites will be maintained in FY2022-2023. First-year target/outcome measurement (Progress to end of SFY 2022) 5 new sites to be added for a total of 20 Funded sites by the end of FY2022 Second-year target/outcome measurement (Final to end of SFY 2023): An additional 5 sites to be added for a total of 25 Funded Sites by the end of FY2023 Data source: The DMH contractual process for this initiative included specified goals, performance measures and performance standards for each participating provider. Data is collected from participating FIRST.IL sites on an ongoing basis by statewide coordinators of the program using both the FEP Data Website and the Enrollee Outcomes Form in meetings with providers. Outcomes in terms of number of referrals and number of clients enrolled at each participating site are counted. Description of data: All active sites in the State are listed in the Enrollee Outcome Form. Records of contracts and funding awards for each agency are maintained by the DMH Fiscal Office. Statewide coordinators are able to track:Training, Referrals, Enrollees and their status, Marketing and Outreach methods, activities and results, Participation in Team Meetings; and Number of clients served with current staffing level from Quarterly Report Performance Forms. Employment, IPS, and Supported Education Involvement are tracked separately in the specialized Supported Employment /Education database. Quarterly Expenditure Reports are also completed by our FEP Set-Aside agencies and provided to DMH. Data issues/caveats that affect outcome measures: The full potential of the First.IL Program may be affected by federal restrictions on eligible diagnosis.
5. Objective #2: Improve and maintain quality of clinical services received by FIRST.IL clients
6. Strategies to obtain objective; (1) Continue training in key clinical approaches including CBT-p, and introduce CBT for Substance Use Disorder; Family Psychosocial Education (FPE) and provide ongoing technical assistance. (2) Provide advanced CBT-p training for experienced provider staff and team leaders to develop mentoring expertise and peer consultation. (3) Contingent on Pandemic conditions that would permit face-to-face group contact, provide training events in Fidelity to the CSC model with follow-up consultation.
7. Indicators: Number of training events held each year to increase clinical competence and expertise in the delivery of ESMI services in FIRST.IL sites. Baseline measurement (Initial data collected prior to and during SFY2021): 13 key training events First-year target/outcome measurement (Progress to end of SFY2022): Number of training sessions = 59 All virtual sessions- number includes five 4-hour Advanced Sessions in CBTp and 12 monthly follow-up TA and Consultation sessions for the year. Twelve Family Psychoeducation Training sessions with 30 hours of advanced consultation for the year. Second-year target/outcome measurement (Final to end of SFY 2023): To Be Determined. As in FY2022, this is a qualitative target depending on the training modules and events needed for sites beginning services during FY2022, sites coming on board in FY2023, and for the sites that had been active up to the end of FY2021. It is anticipated that the total should be at least or greater than the total number in SFY2022. (59) Data source: Records of teleconference calls and attendance are maintained by statewide coordinators. Description of data: See Above Data issues/caveats that affect outcome measures: None
Objective #3 Increase number of FIRST.IL enrollees statewide.
Strategies to obtain the objective: Expand outreach efforts and provide public information about FIRST.IL. Each FIRST.IL Site to achieve five Marketing and Outreach events per month. Each FIRST.IL Site will achieve a minimum of five new Enrollees per Fiscal Year.
Indicator #3: Number of clients meeting criteria for FIRST.IL enrolled in team services statewide. Baseline measurement (Initial data collected prior to and during SFY 2021): 346 in FY2021. First-year target/outcome measurement (Progress to end of SFY 2022): 400 Second-year target/outcome measurement (Final to end of SFY 2023): 450 Data source: Enrollment data from each participating site is entered in the FEP Data Base, Statewide coordinators meet twice a month with site managers to review the data that is retrieved from the Enrollee Outcome Form specific to each site and is cumulatively benchmarked at Baseline and every 6 months. Description of data: Number of persons meeting eligibility criteria for FEP program enrolled at each site. Minimum of 5 additional FEP Enrollees per Site Per year. Data issues/caveats that affect outcome measures: The full potential of the FIRST.IL Program may be affected by the federal restrictions on eligible diagnosis.

Plan Table 1-3 Integrated Care- PIPBHC Project

1. Priority Area #1: Continue work on accomplishing the integration of behavioral health and primary health treatment to expand and improve the array of health and support services available for adults and children within community settings	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI, SED, Other

4. Goal of the priority area: Assure the integration of physical health care with behavioral health services to adults having a serious mental illness and children with serious emotional disturbance to promote wellness, encourage prevention and support early intervention to address the current disparities in health outcomes experienced by individuals with SMI and SED.	.
5. Objective: Pilot the implementation of selected evidence-based, best practices aimed at achieving results that yield positive and lasting outcomes through the integration of primary health care with behavioral health treatment that also addresses wellness and prevention activities such as smoking cessation, nutrition/exercise, and other wellness interventions along with a range of traditional mental health services.
6. Strategies to attain the objective: Develop a partnership/full collaboration between three established community mental health centers and their respective Federally Qualified Health Centers to promote full integration and collaboration in clinical practice between primary and behavioral health care in three largely rural counties, each having at least one significant population center Support the improvement of integrated care treatment models for primary care and behavioral health care to improve the overall wellness and physical health status of adults with a serious mental illness (SMI) and children with a serious emotional disturbance (SED); Promote and offer integrated care services that include screening, diagnosis, prevention, and treatment of mental and substance use disorders, and co-occurring physical health conditions and chronic diseases. Use lessons learned throughout the five-year implementation project to support statewide planning and implementation of integrated health homes. By the end of five years (FY2024) identify experienced experts to provide support to all other Illinois providers who are interested in exploring and implementing PIPBHC-IL.
7. Annual Performance Indicators to measure goal success: Indicator: Number of clients receiving integrated treatment and support during the fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): Final to end of SFY 2020- 295 clients (Cumulative total served in the program to end of FY2020= 515) First-year target/outcome measurement (Progress to end of SFY 2022) Additional 277 individuals enrolled. Second-year target/outcome measurement Final to end of SFY 2023- An additional 388 individuals enrolled for a cumulative total served of 1180. Data source: Provider Quarterly Reports Description of data: Providers' reports of numbers served. Data issues/caveats that affect outcome measures: None
7. Annual Performance Indicators to measure goal success: (7-2) Number of staff persons trained and participating in the program each fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): FY2020 =40. In FY2021 = 260 First-year target/outcome measurement (Progress to end of SFY 2022): 300 Second-year target/outcome measurement (Final to end of SFY 2023): 300 Data source: Quarterly report from each provider citing number of staff trained and carrying out PIPBHC-IL programming. Description of data: Grantees report into the automated system that is monitored by the grant manager. Data issues/caveats that affect outcome measures: None
7. Annual Performance Indicators to measure goal success: (7-3) Number of collaborative interagency meetings convened to review and discuss progress and issues in developing Certified Community Behavioral Health clinics in Illinois and to evaluate the sustainability of service integration, delivery. and client impact of the PPBILHC-IL program in the CCBHC model beyond the time limit of the current grant. Baseline measurement (Initial data collected prior to and during SFY2021: This is a new indicator in FY2022-2023 to track joint planning for sustainability of the program beyond the life of the current grant. First-year target/outcome measurement (Progress to end of SFY 2022): 10 Second-year target/outcome measurement (Final to end of SFY 2023): 12 Data source: Records and minutes maintained by DMH Principal Investigators Description of data: See Above Data issues/caveats that affect outcome measures: None
7. Annual Performance Indicator to measure goal success: (7-4) An annual written report will identify the most successful practices, achievements, and lessons learned during each year. Baseline measurement (Initial data collected prior to and during SFY2021): N/A First-year target/outcome measurement (Progress to end of SFY 2022): Annual Report completed, reviewed, submitted to SAMHSA, and filed. Second-year target/outcome measurement (Final to end of SFY 2023): Annual Report completed, reviewed, submitted to SAMHSA, and filed. Data source: Providers' Quarterly Written reports submitted by the three partnering agencies and compiled into an Annual Report by DMH Description of data: See Above Data issues/caveats that affect outcome measures: None

Plan Table 1-4: Evidence Based Practices-Individual Placement and Support (IPS)

1. Priority Area #2: Promote Provision of Evidence Based and Evidence-Informed Practices	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI, SED

4. Goal of the priority area: Promote Evidence Based Practices for individuals served in DMH funded agencies and advance the implementation of evidence-informed practices in the child and adolescent service system.	.
5. Objective: During FY2022 and FY2023, maintain and support the statewide implementation of Evidence Based Supportive Employment.
6. Strategies to attain the objective: (1) During FY2022 and FY2023, continue the development of the state infrastructure required to support implementation and sustainability of Individual Placement and Support Evidence Based Supported Employment. (2) During FY2022 and FY2023, continue to develop the integration of physical and behavioral health with employment supports and peer support statewide. (3)By the end of FY 2022, through the provision of additional funding resources, continue the implementation of IPS Evidence Based Supportive Employment which targets an additional 229 consumers acquiring competitive employment in their local communities.
7. Annual Performance Indicators to measure goal success: Indicator: Number of consumers receiving supported employment in FY2022 and FY2023. (National Outcome Measure) Baseline measurement (Initial data collected prior to and during SFY 2021): In FY2020, 3,226 clients were served. The FY2021 target was: 3,514 -- however due to the pandemic, 3,021 clients were served IPS services in FY2021. First-year target/outcome measurement (Progress to end of SFY 2022): 3,250 Second-year target/outcome measurement (Final to end of SFY 2023): 3,450 Data source: Data for this indicator are generated through a special web-based database created specifically for the DMH SE initiative. Fidelity and outcomes data are submitted to the DMH SE coordinator. e) Description of data: As always, DMH has developed specifications for reporting that DMH funded providers must use when submitting data. f) Data issues/caveats that affect outcome measures: DMH only reports data for teams that have been found to exhibit fidelity to the evidenced based practice model. DMH is working to promote fidelity in all IPS agencies and thereby expand the database.

4. Goal of the priority area: Promote Evidence Based Practices for individuals served in DMH funded agencies and advance the implementation of evidence-informed practices in the child and adolescent service system.

5. Objective: During FY2022 and FY2023, maintain and support the statewide implementation of Evidence Based Supportive Employment.

6. Strategies to attain the objective: (1) During FY2022 and FY2023, continue the development of the state infrastructure required to support implementation and sustainability of Individual Placement and Support Evidence Based Supported Employment. (2) During FY2022 and FY2023, continue to develop the integration of physical and behavioral health with employment supports and peer support statewide. (3)By the end of FY 2022, through the provision of additional funding resources, continue the implementation of IPS Evidence Based Supportive Employment which targets an additional 229 consumers acquiring competitive employment in their local communities.

7. Annual Performance Indicators to measure goal success:
Indicator: Number of consumers receiving supported employment in FY2022 and FY2023. (National Outcome Measure)

Baseline measurement (Initial data collected prior to and during SFY 2021): In FY2020, 3,226 clients were served. The FY2021 target was: 3,514 -- however due to the pandemic, 3,021 clients were served IPS services in FY2021.
First-year target/outcome measurement (Progress to end of SFY 2022): 3,250
Second-year target/outcome measurement (Final to end of SFY 2023): 3,450

Data source: Data for this indicator are generated through a special web-based database created specifically for the DMH SE initiative. Fidelity and outcomes data are submitted to the DMH SE coordinator.

e) Description of data: As always, DMH has developed specifications for reporting that DMH funded providers must use when submitting data.

f) Data issues/caveats that affect outcome measures: DMH only reports data for teams that have been found to exhibit fidelity to the evidenced based practice model. DMH is working to promote fidelity in all IPS agencies and thereby expand the database.

Plan Table 1-5: Evidence Based Practices: Assertive Community Treatment (ACT)

1. Priority Area #2: Promote Provision of Evidence Based and Evidence-Informed Practices-Assertive Community Treatment (ACT)	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI

4. Goal of the priority area: Promote Evidence Based Practices for individuals served in DMH funded agencies and advance the implementation of evidence-informed practices in the child and adolescent service system.	.
5. Objective: Continue to reach expected outcomes for individuals in need through provision of Assertive Community Treatment (ACT).
6. Strategy to attain the objective: Reach full capacity by reducing the 25% current vacancy rate by serving individuals transitioning to the community from long-term care under Williams/Colbert consent decrees.
7. Annual Performance Indicators to measure goal success: Indicator: Number of persons with SMI receiving Assertive Community Treatment in FY2022 and FY2023 (National Outcome Measure). Baseline measurement (Initial data collected prior to and during SFY2021): In FY2020, DMH successfully maintained the FY2019 level of services of 33 ACT teams statewide. The statewide capacity of available and active ACT service slots as of 7/01/20 was 2,008 with a 23% (464) vacancy rate exceeding the FY2020 target of 1,764 active service slots at the end of the fiscal year by 244 (12%). The baseline vacancy rate of 25% has been reduced to 23% over the past two years. A continuing gradual decrease is anticipated after the Covid19 pandemic abates, allowing the number of referral sources to increase. Target for FY2021= 1996. Data is not yet available. b) First-year target/outcome measurement (Progress to end of SFY 2022): 2,000 c) Second-year target/outcome measurement (Final to end of SFY 2023): 2,000 Data Source: DMH funded providers by contract must submit demographic, clinical information and claims data for all individuals receiving services funded using DMH dollars. The DMH provides data specifications to assure consistency of reporting. e) Description of data: Providers of ACT services submit monthly reports of team capacity to DMH, which is monitored for system sufficiency. This information is used as a basis for developing reports, analytic purposes, and is the basis for reporting the data used to populate the URS tables. f) Data issues/caveats that affect outcome measures: Most ACT Teams currently operate within areas where individuals are served through Managed Care Contracts. The claims data related to MCO funded care is currently not available to the State Mental Health Authority, and thus individual outcomes from ACT cannot be accurately measured at this time. Through the State's work on the HHS transformation, plans are underway to improve the interoperability of the data systems and it is believed that DMH will in the future be able to track outcomes of individuals.

5. Objective: Continue to reach expected outcomes for individuals in need through provision of Assertive Community Treatment (ACT).

6. Strategy to attain the objective: Reach full capacity by reducing the 25% current vacancy rate by serving individuals transitioning to the community from long-term care under Williams/Colbert consent decrees.

7. Annual Performance Indicators to measure goal success:
Indicator:
Number of persons with SMI receiving Assertive Community Treatment in FY2022 and FY2023 (National Outcome Measure).

Baseline measurement (Initial data collected prior to and during SFY2021): In FY2020, DMH successfully maintained the FY2019 level of services of 33 ACT teams statewide. The statewide capacity of available and active ACT service slots as of 7/01/20 was 2,008 with a 23% (464) vacancy rate exceeding the FY2020 target of 1,764 active service slots at the end of the fiscal year by 244 (12%). The baseline vacancy rate of 25% has been reduced to 23% over the past two years. A continuing gradual decrease is anticipated after the Covid19 pandemic abates, allowing the number of referral sources to increase. Target for FY2021= 1996. Data is not yet available.

b) First-year target/outcome measurement (Progress to end of SFY 2022): 2,000

c) Second-year target/outcome measurement (Final to end of SFY 2023): 2,000

Data Source: DMH funded providers by contract must submit demographic, clinical information and claims data for all individuals receiving services funded using DMH dollars. The DMH provides data specifications to assure consistency of reporting.

e) Description of data: Providers of ACT services submit monthly reports of team capacity to DMH, which is monitored for system sufficiency. This information is used as a basis for developing reports, analytic purposes, and is the basis for reporting the data used to populate the URS tables.

f) Data issues/caveats that affect outcome measures: Most ACT Teams currently operate within areas where individuals are served through Managed Care Contracts. The claims data related to MCO funded care is currently not available to the State Mental Health Authority, and thus individual outcomes from ACT cannot be accurately measured at this time. Through the State's work on the HHS transformation, plans are underway to improve the interoperability of the data systems and it is believed that DMH will in the future be able to track outcomes of individuals.

Plan Table 1-6 EBP Conference Series

1. Priority Area: Promotion of Evidence-Based Practices in Illinois	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI, SED

4. Goal of the priority area: Advance Evidence-Based Practices in Illinois by conducting an annual virtual conference series that focuses on learning and improving practice in the array of Evidence Based Practices available in the State.	.
5. Objective: Conduct an annual virtual conference series with presentations on clinical services including treatment models and methods, evidence-based practices and initiatives, clients served, and other relevant subjects.
6. Strategies to attain the objective: Plan, organize, and produce a month-long conference series, two days each week, with presentations by creditable presenters on specific evidence-based and evidence -informed practices that are current and active in Illinois, including special features which are noteworthy and require an advanced knowledge base and competent practice skills.
7. Annual Performance Indicators to measure goal success: Indicators: 1. Number of presentations during the month-long conference series. Baseline measurement (Initial data collected prior to and during SFY2021): FY2021 Conference Series held in August 2020. Number of presentations: 23. First-year target/outcome measurement (Progress to end of SFY 2022): Number of presentations: 25; Second-year target/outcome measurement (end of SFY 2023): Number of presentations: 27; Data source: Number and list of presentations aggregated at the conclusion of the conference series. Description of data: See above Data Issues/caveats that affect outcome measures: None Indicator # 2. Number of persons attending sessions (duplicated) Baseline measurement (Initial data collected prior to and during SFY2021):2021 Conference Series held in August 2020. Number of persons attending sessions: 3,625; First-year target/outcome measurement (Progress to end of SFY 2022): Number of persons attending sessions: 3,800; Second-year target/outcome measurement (end of SFY 2023): Number of persons attending sessions: 3,900; Data source: Attendance registration record for each conference session aggregated at the conclusion of the series. Description of data: See above Indicator #3. Number of unduplicated attendees Baseline measurement (Initial data collected prior to and during SFY2021): FY2021 Conference Series held in August 2020. Number of unique attendees: 1,092. First-year target/outcome measurement (Progress to end of SFY 2022): Number of unique attendees: 1,180 Second-year target/outcome measurement (end of SFY 2023): Number of unique attendees: 1,200. Data source: Number of individuals registered for the series who attend at least one session of the conference. Description of data: See above Data Issues/caveats that affect outcome measures: None

4. Goal of the priority area: Advance Evidence-Based Practices in Illinois by conducting an annual virtual conference series that focuses on learning and improving practice in the array of Evidence Based Practices available in the State.

5. Objective: Conduct an annual virtual conference series with presentations on clinical services including treatment models and methods, evidence-based practices and initiatives, clients served, and other relevant subjects.

6. Strategies to attain the objective: Plan, organize, and produce a month-long conference series, two days each week, with presentations by creditable presenters on specific evidence-based and evidence -informed practices that are current and active in Illinois, including special features which are noteworthy and require an advanced knowledge base and competent practice skills.

7. Annual Performance Indicators to measure goal success:
Indicators:
1. Number of presentations during the month-long conference series.

Baseline measurement (Initial data collected prior to and during SFY2021): FY2021 Conference Series held in August 2020. Number of presentations: 23.
First-year target/outcome measurement (Progress to end of SFY 2022): Number of presentations: 25;
Second-year target/outcome measurement (end of SFY 2023): Number of presentations: 27;
Data source: Number and list of presentations aggregated at the conclusion of the conference series.
Description of data: See above
Data Issues/caveats that affect outcome measures: None

Indicator # 2. Number of persons attending sessions (duplicated)

Baseline measurement (Initial data collected prior to and during SFY2021):2021 Conference Series held in August 2020. Number of persons attending sessions: 3,625;
First-year target/outcome measurement (Progress to end of SFY 2022): Number of persons attending sessions: 3,800;
Second-year target/outcome measurement (end of SFY 2023): Number of persons attending sessions: 3,900;
Data source: Attendance registration record for each conference session aggregated at the conclusion of the series.
Description of data: See above

Indicator #3. Number of unduplicated attendees

Baseline measurement (Initial data collected prior to and during SFY2021): FY2021 Conference Series held in August 2020. Number of unique attendees: 1,092.
First-year target/outcome measurement (Progress to end of SFY 2022): Number of unique attendees: 1,180
Second-year target/outcome measurement (end of SFY 2023): Number of unique attendees: 1,200.
Data source: Number of individuals registered for the series who attend at least one session of the conference.
Description of data: See above
Data Issues/caveats that affect outcome measures: None

Plan Table 1-7 Recovery/Consumer Services

1. Priority Area: Expansion of the scope of consumer and family participation through advancement of the recovery vision and family driven care.	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI, SED ESMI:

4. Goal of the priority area: Establish and enhance the public mental health system of care based upon principles of Recovery and Resilience in which consumers and families are knowledgeable and empowered to participate and provide direction at all levels of the system and peer-run programs are increasingly utilized.	.
5. Objective #1: Continue work to increase the number of Certified Recovery Support Specialists and to facilitate their deployment statewide.
6. Strategies to attain the objective: Strategy #1: Support the role of Certified Recovery Support Specialists and their deployment statewide by hosting training for consumers and providers to help increase agencies' understanding of the role, value, function, and advantages of hiring CRSS professionals and by providing competency training events for individuals interested in the CRSS credential.
7. Annual Performance Indicators to measure goal success: Indicator #1: Number of training events held each year to increase stakeholder understanding of the CRSS credential and to increase competency in CRSS domains. Baseline measurement (Initial data collected prior to and during SFY2021: 9 unique training sessions were completed during the fiscal year. Each was held 3 times for a total 27 virtual sessions First-year target/outcome measurement (Progress to end of SFY 2022): 27 Second-year target/outcome measurement (Final to end of SFY 2023): 27 Data source: Document each training event and aggregate by year for comparison across years. Description of data: Training agenda and attendance sheets documenting participation for each training event held. Data issues/caveats that affect outcome measures: None 5. Objective #2: Increase the use and efficacy of the WRAP model 6. Strategy #2: Enhance competency and encourage WRAPtrained and certified facilitators to provide an increasing number of WRAP classes in the State. 7. Annual Performance Indicators to measure goal success: Indicator #2: (a) Number of WRAP Refresher trainings offered statewide each year (b) Number of WRAP participants each year Baseline measurement (Initial data collected prior to and during SFY2021: 4 refresher sessions, each repeated 3 times =12 First-year target/outcome measurement (Progress to end of SFY2022): 12 Second-year target/outcome measurement (Final to end of SFY 2023): 12 Data source: Document each training event and aggregate by year for comparison across years. Description of data: Training agenda and attendance sheets documenting participation for each training event held. Data issues/caveats that affect outcome measures: None 5. Objective #3: Continue to inform and empower consumers and families. 6. Strategy #3: Conduct a series of statewide teleconferences designed to disseminate important information to adult consumers and families across the State. 7. Annual Performance Indicators to measure goal success: Indicator #3: Number of statewide teleconferences held each year. Number of participants per teleconference. Baseline measurement (Initial data collected prior to and during SFY 2021): Ten (10) statewide teleconferences in SFY2020 and 10 targeted for FY2021. First-year target/outcome measurement (Progress to end of SFY 2022): 10 Second-year target/outcome measurement (Final to end of SFY 2023): 10 Data source: Document each teleconference event and aggregate by year for comparison across years. Description of data: Teleconference agendas Data issues/caveats that affect outcome measures: None

4. Goal of the priority area:
Establish and enhance the public mental health system of care based upon principles of Recovery and Resilience in which consumers and families are knowledgeable and empowered to participate and provide direction at all levels of the system and peer-run programs are increasingly utilized.

5. Objective #1: Continue work to increase the number of Certified Recovery Support Specialists and to facilitate their deployment statewide.

6. Strategies to attain the objective:
Strategy #1: Support the role of Certified Recovery Support Specialists and their deployment statewide by hosting training for consumers and providers to help increase agencies' understanding of the role, value, function, and advantages of hiring CRSS professionals and by providing competency training events for individuals interested in the CRSS credential.

7. Annual Performance Indicators to measure goal success:
Indicator #1:
Number of training events held each year to increase stakeholder understanding of the CRSS credential and to increase competency in CRSS domains.

Baseline measurement (Initial data collected prior to and during SFY2021: 9 unique training sessions were completed during the fiscal year. Each was held 3 times for a total 27 virtual sessions
First-year target/outcome measurement (Progress to end of SFY 2022): 27
Second-year target/outcome measurement (Final to end of SFY 2023): 27
Data source: Document each training event and aggregate by year for comparison across years.
Description of data: Training agenda and attendance sheets documenting participation for each training event held.
Data issues/caveats that affect outcome measures: None

5. Objective #2: Increase the use and efficacy of the WRAP model

6. Strategy #2: Enhance competency and encourage WRAPtrained and certified facilitators to provide an increasing number of WRAP classes in the State.

7. Annual Performance Indicators to measure goal success:
Indicator #2:

(a) Number of WRAP Refresher trainings offered statewide each year

(b) Number of WRAP participants each year

Baseline measurement (Initial data collected prior to and during SFY2021: 4 refresher sessions, each repeated 3 times =12
First-year target/outcome measurement (Progress to end of SFY2022): 12
Second-year target/outcome measurement (Final to end of SFY 2023): 12
Data source: Document each training event and aggregate by year for comparison across years.
Description of data: Training agenda and attendance sheets documenting participation for each training event held.
Data issues/caveats that affect outcome measures: None

5. Objective #3: Continue to inform and empower consumers and families.

6. Strategy #3: Conduct a series of statewide teleconferences designed to disseminate important information to adult consumers and families across the State.

7. Annual Performance Indicators to measure goal success:
Indicator #3:
Number of statewide teleconferences held each year. Number of participants per teleconference.

Baseline measurement (Initial data collected prior to and during SFY 2021): Ten (10) statewide teleconferences in SFY2020 and 10 targeted for FY2021.
First-year target/outcome measurement (Progress to end of SFY 2022): 10
Second-year target/outcome measurement (Final to end of SFY 2023): 10
Data source: Document each teleconference event and aggregate by year for comparison across years.
Description of data: Teleconference agendas
Data issues/caveats that affect outcome measures: None

Table 1-8 Community Integration - Williams/Colbert Consent Decrees

1. Priority Area: Advancement of Community Integration	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI, SED, OTHER:

4. Goal of the priority area: Complete the successful transition of residents of long-term nursing homes with diagnosed SMI from this level of care to the less restrictive settings, ideally, independent living in the communities with appropriate and necessary support services.	.
5. Objective: Transition up to 400 additional Williams Class Members annually before the sunset of the Consent Decree. Transition of an additional 450 Colbert Class Members.
6. Strategies to attain the objective: Through FY2023, and perhaps beyond, through the provision of open market rental units, and 24 hour supervised residential settings/Community Integrated Living Arrangements (CILA)implement transition of residents (Williams Class Members) from designated Specialized Mental Health Rehabilitation Facilities (SMHRFs) (statewide) and from Nursing Homes in Cook County(Colbert Consent Decree) to permanent supportive housing or other housing alternatives that are safe, affordable, housing and provide support services in communities of preference in a manner consistent with the national standards. In November 2019, by agreement of the parties and the Court, oversight and supervision of services for Colbert Class Members was moved from the Illinois Department on Aging (DOA) to the Illinois Department of Human Services (DHS). In February 2020, a unified team approach was implemented by DHS/DMH to serve class members of both Consent decrees. An evaluation of the diagnostic data of Colbert Class Members with SMI diagnoses somewhere in their assessments revealed that the overwhelming majority of Colbert Class members do have some sort of mental health diagnosis. In FY2020, 80% of Colbert class members recommended for transition had an SMI diagnosis (483 out of 604). Of Colbert class members transitioned in FY2020, 78% had an SMI diagnosis (222 out of 284). The primary difference between Colbert CMs and Williams CMs in that regard is that Colbert members are more likely to have physical disabilities or chronic physical conditions as well as SMI.
7. Annual Performance Indicators to measure goal success: Indicator: Number of consumers who transition from long term institutional settings who access appropriate permanent supportive housing or other housing options. (National Outcome Measure) Baseline measurement (Initial data collected prior to and during SFY 2021): Colbert Court Mandated Target= 450 Williams Mandated Target - 400. First-year target/outcome measurement (Progress to end of SFY 2022): 850 Second-year target/outcome measurement (Final to end of SFY 2023): 850NOTE: The Williams vs. Pritzker Consent Decree was originally slated to sunset in 2016. The activities of this Consent Decree continued through FY2021. Continuation after the FY2022 fiscal year will be dependent on negotiations between parties and the court decision. Data source: Individuals who receive a permanent supportive housing/bridge subsidy are not required to be registered, enrolled or engaged in mental health treatment services. Therefore, it was necessary to create a special database to track access to and receipt of permanent supportive housing bridge subsidy. The University of Illinois at Chicago Nursing School contracts with DMH to maintain a database, provide staff training, and other administrative assistance and support to the Colbert transition program. Data is provided by the UIC College of Nursing. Description of data: The data for this indicator will be generated from permanent supportive housing applications of individuals in longer term institutional settings which are stored in the special database, as well as a special PSH outcomes database.Data is provided by the UIC College of Nursing. Data issues/caveats that affect outcome measures: Continuation after the FY2022 fiscal year will be dependent on negotiations between parties and the Court decision.

Plan Table 1-9 Justice

1. Priority Area: Maintain effective systems to serve the forensic needs of justice-involved consumers of services.	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) SMI, SED, ESMI:

4. Goal of the priority area:
Maintain a system of care to address the mental health needs of consumers with criminal justice involvement.

5. Objective #1; Provide an alternative to incarceration for youth with SED and link them to community-based services that address unique needs and strengths

6. Strategies to attain the objective:
Strategy 1. Maintain the Mental Health Juvenile Justice Initiative.

7. Annual Performance Indicators to measure goal success:
Indicator: Number of youth served by the MHJJ Program statewide.

Baseline measurement (Initial data collected prior to and during SFY 2021): FY2021 final quarterly data reports not yet available.Estimate based on averages of previous data reports is currently 624 youths who were referred to the program and 560 who were successfully linked to an agency for service.
First-year target/outcome measurement (Progress to end of SFY 2022): 500 youth linked
Second-year target/outcome measurement (Final to end of SFY 2023): 500 youth linked
Data source: MHJJ Program Data Base maintained internally by DMH oversight staff
Description of data: Aggregate the number of youths receiving services from the Mental Health Juvenile Justice program across the year that will be compared to data from subsequent years.
Data issues/caveats that affect outcome measures: None

5. Objective: #2: Maintain and increase the number of outpatient mental health agencies providing competency restoration services in the community.

6. Strategies to attain the objective: Strategy 2. Continue to support the availability of 18 agencies statewide to provide competency restoration services to persons with SMI mandated by the Court to receive these services and, contingent on available funding, establish additional agencies in local areas where this service is demonstrably needed.

7. Annual Performance Indicators to measure goal success:

Indicator: Number of individuals served in the outpatient programs.

Baseline measurement (Initial data collected prior to and during SFY2021): 50
First-year target/outcome measurement (Progress to end of SFY 2022): 50
Second-year target/outcome measurement (Final to end of SFY 2023): 50
Data source: Database maintained internally by DMH oversight staff
Description of data: Aggregate the number of persons receiving outpatient competency restoration services across the year that will be compared to data from subsequent years.
Data Issues/caveats that affect outcome measures: None

table table

5. Objective #3 Expand Jail Data Link (JDL) access- a shared data program between Community Mental Health Centers and Jails/Detention Centers that re-connects mental health consumers who have been arrested and detained with a mental health agency in their community where they have previously received services

6. Strategies to attain the objective: Strategy 3: Contingent upon available funding and the participation of mental health programs and correctional facilities, utilize an on-line program to link justice- involved consumers with a mental health service history to appropriate services upon their release.

7. Annual Performance Indicators to measure goal success:
Indicator: Number of county jails that seek and are approved for connection to JDL

Baseline measurement (Initial data collected prior to and during SFY2021):Our baseline would be 7 jails (currently). We hope over the next year to add at least 5 additional jails. The number is modest because the legal & contractual approval process has historically not been very timely.
First-year target/outcome measurement (Progress to end of SFY 2022): 12 County Jails
Second-year target/outcome measurement (Final to end of SFY 2023): 17 County Jails
Data source: Jail applications for connection and officially documented contractual approvals maintained by the Forensic Program Manager.
Description of data: The number of county jails coming on board in the course of the state fiscal year.
Data Issues/caveats that affect outcome measures:

Plan Table 1-10 Governor's Challenge: Suicide Prevention and Reduction for Illinois Service Members, Veterans, and their Families

1. Priority Area: Coordination and facilitation of mental health crisis and suicide prevention services for Illinois Servicemembers, Veterans, and their Families (SMVF).	2. Priority Type: MENTAL HEALTH SERVICES
3. Population(s) OTHERService Members, Veterans, and their Families (SMVF) requiring mental health services:

4. Goal of the priority area: Collaborate with military and state agency partners to improve access to home and community-based mental health services for service members, veterans, and their families.	.
5. Objective #1: Build and sustain a coordinated system of suicide prevention and early intervention that addresses the needs of servicemembers, veterans, and their families with the aims reducing the incidence of suicide and providing crisis intervention services.
6. Strategies to attain the objective: Convene a state interagency military and civilian team of leaders to develop an implementation plan to prevent suicide among SMVF. Implement promising, best, and evidence -based practices that prevent and reduce suicide. Engage with city, county, and state stakeholders to enhance and align local and statewide suicide prevention efforts. Build a coordinated crisis service intervention system between the VA and community providers, with special emphasis on suicide prevention. Contract with qualified vendors to coordinate and provide needed training, education, and public messaging approaches. Provide training to hospitals on Suicide Prevention issues and Suicide Risk Screening. Provide virtual and face to face Military and Veteran 101Clinical Cultural Competency Workshops for service providers, groups, interested persons, and other stakeholders that can provide clinical services and/or supports. Provide training in Lethal Means Safety (LMS) and Safety Planning.
7. Annual Performance Indicators to measure goal success: Indicator #1: Percentage of hospitals statewide in which online Suicide Prevention and Suicide Risk training was provided at the end of the fiscal year. Indicator #2: Percentage of hospitals statewide in which Lethal Means Safety Counseling and safety planning training are completed each fiscal year. Baseline measurement (Initial data collected prior to and during SFY2021): Not Applicable. These are new indicators. First-year target/outcome measurement (Progress to end of SFY 2022): 50% of targeted hospitals Second-year target/outcome measurement (Final to end of SFY 2023): 80% of Illinois hospitals, Suicide Risk Screening and Lethal Means Safety counseling and safety planning are adopted as the standard of care in hospitals across the State. Data source: Training event minutes and records of contracting vendors and DMH staff members assigned to this collaborative task. Description of data: See Above. Data issues/caveats that affect outcome measures: None.

Section IV: Environmental Factors and Plan

1. The Health Care System, Parity and Integration

Responses to Questions 1 and 2 below are Required

Describe how the state integrates mental health and primary health care, including services for individuals with co-occurring mental and substance use disorders, in primary care settings or arrangements to provide primary and specialty care services in community -based mental and substance use disorders settings.
Describe how the state provides services and supports towards integrated systems of care for individuals and families with co-occurring mental and substance use disorders, including management, funding, payment strategies that foster co-occurring capability.

A co-occurring condition (COD) is a dual diagnosis of substance use and mental health. There is an overlap of 75 of the 225 community mental health centers certified by the Department of Mental Health also licensed by IDHS/SUPR for provision of substance use treatment. Integration of services for persons with COD occurs at the Provider's level utilizing Best and Evidence-based Practice trainings, resources, and supports that are available.

HealthChoice Illinois: Integration of Behavioral Health and Primary Health Care

The Illinois Department of HealthCare and Family Services is responsible for and oversees Medicaid Managed Care through the HealthChoice Illinois program and shares the following information on their website: There are six major Managed Care Organizations (MCOs) serving the State. HealthChoice Illinois offers a complete range of health services within the standards and criteria of Illinois' Medicaid program. These health plans are available in every county in the state. As of June1, 2021, 2,668,391 persons were enrolled in HealthChoice Illinois and 58,712 in the Medicare-Medicaid Alignment Initiative that funds care to persons with both Medicaid and Medicare benefits -seniors and those with disabilities - in 21counties. All of the MCOs are required to fund Behavioral Health Services through community-based provider panels who are certified. Care Coordination between MCOs and Behavioral Health providers has been of paramount importance for the past 5years. Meetings were held between the Health Plan organizations and community providers in September and October 2014 which ironed out the requirements and procedures for coverage of Medicaid clients. The MCOs performance is evaluated annually in the Illinois Plan Report Card. The HealthChoice Illinois Plan covers a range of services in Women's Health, Chronic Illnesses eg: Kidney Disease, Diabetes, Behavioral Health, Keeping Kids Healthy, Medical Services by Primary Care Physicians and a full range of Medical Specialties.

In Behavioral Health, specific performance measurements are reported for:

Follow-Up Care after a Hospital Visit Due to Mental Illness
Start of Addiction Treatment
Start and continuation of Addiction Treatment
Check-ups for kids/teenagers on mental health medications (antipsychotics)

Coordination of Care

Illinois Public Act 096-1501 (Medicaid Reform) requires the provision of coordinated care for adults and children who receive Medicaid-funded services.

The Illinois Department of HealthCare and Family Services (IDHFS), as the State's Medicaid Authority, has the continuing mandated responsibility to monitor access to Medicaid services, and the Illinois Department of Insurance is monitoring coverage for mental health services under healthcare reform. Continuing inter agency discussions regarding strategies and mechanisms to monitor the implementation of ACA, evaluate if Qualified Health Plans (QHPs) and Medicaid are offering sufficient services, and evaluate the consistency of services with the provisions of Mental Health Parity Addiction Equity Act (MHPAEA) are taking place. DMH continues to support this work by providing subject matter expertise consultation to both the Department of Insurance and the Department of Healthcare and Family Services. DMH collects enrollment/registration data for individuals enrolled in various Medicaid managed care initiatives. This data may permit DMH, at some point, to compare the services received by individuals under Medicaid Managed Care and other Medicaid programs to those individuals for whom DMH purchases services.

Behavioral Health/Primary Health Integration.

The importance of the integration of mental health and substance abuse services with primary health care has continued to be supported and advocated by DMH, DSUPR (the Division of Substance Use Prevention and Recovery) and HFS. All three entities have collaborated on various initiatives aimed at increasing integration across the state. These have included a focus on a State Plan Amendment to develop Integrated Health Homes, Brief Intervention and Referral to Treatment (SBIRT) as well as prior collaboration on an Emergency Room Diversion program and other initiatives. Some mental health agencies have demonstrated significant progress toward Primary Care Behavioral Health Integration and have plans that demonstrate expanding their integration across the child and adolescent and adult populations they serve. Screening and referral for prevention and wellness education, health risks, and recovery supports are largely dependent on the policies and practices of individual provider agencies. This information is not collected at the state level. However, the DMH Bureau of Wellness and Recovery reviews and monitors the level of support for recovery across agencies statewide, and advocates for employment of CRSS credentialed staff and the use of non-credentialed individuals with lived expertise in mental health treatment to provide recovery support.

In August 2018, the Department of Healthcare and Family Services (HFS) introduced the service of Integrated Assessment and Treatment Planning (IATP) into the community behavioral health service array. IATP is an integrated service that ensures an individual's assessment of needs and strengths are clearly documented and lead to specific treatment recommendations. Providers must minimally review and update clients' IATPs every 180 days. HFS has designated the Illinois Medicaid Comprehensive Assessment of Needs and Strengths (IM+CANS) as the approved IATP instrument for these reviews. HFS has partnered with the University of Illinois at Urbana-Champaign's School of Social Work (UIUC-SSW) to provide training and technical assistance to providers delivering IATP services. Staff must attend a one-day, in-person training and complete annual certification in order to utilize the IM+CANS.

The IM+CANS serves as the foundation of Illinois' efforts to transform its publicly funded behavioral health service delivery system. It was developed as the result of a collaborative effort between the Illinois Departments of Healthcare and Family Services (HFS), Human Services-Division of Mental Health (DHS-DMH), and Children and Family Services (DCFS). The comprehensive IM+CANS assessment provides a standardized, modular framework for assessing the global needs and strengths of individuals who require mental health treatment in Illinois.

Today, the IM+CANS incorporates:

complete set of core and modular CANS items, addressing domains such as Risk Behaviors, Trauma Exposure/Adverse Childhood Experiences, Behavioral/Emotional Needs, Life Functioning, Substance Use, Developmental Disabilities, and Cultural Factors;
fully integrated assessment and treatment plan;
physical Health Risk Assessment (HRA); and,
population-specific addendum for youth involved with the child welfare system.

At the core of the IM+CANS is the Child and Adolescent Needs and Strengths (CANS) and the Adult Needs and Strengths Assessment (ANSA); communimetric tools containing a set of core and modular items that identify a client's strengths and needs using a '0' to '3' scale. These items support care planning and level of care decision-making, facilitate quality improvement initiatives, and monitor the outcomes of services. Additional data fields were added to the CANS items to support a fully Integrated Assessment and Treatment Plan (IATP), placing mental health treatment in Illinois on a new pathway built around a client-centered, data-driven approach.

The IM+CANS also includes a Health Risk Assessment (HRA), developed to support a holistic, wellness approach to assessment and treatment planning by integrating physical health and behavioral health in the assessment process. The HRA is a series of physical health questions for the individual that is designed to: 1) assess general health; 2) identify any modifiable health risks that can be addressed with a primary health care provider; 3) facilitate appropriate health care referrals, as needed; and 4) ensure the incorporation of both physical and behavioral health needs directly into care planning.

The Illinois Medicaid - Crisis Assessment Tool (IM-CAT)

is a decision support and communication tool to allow for the rapid and consistent communication of the needs of individuals experiencing a crisis that threatens their safety or well-being or the safety of the community. It is composed of a crisis subset of items from the IM+CANS assessment and is intended to be completed by those who are directly involved with the individual. The form serves as both a decision support tool and as documentation of the identified needs of the individual served along with the decisions made with regard to treatment and placement at the time of the crisis.

Providers delivering Mobile Crisis Response (MCR) services are required to utilize the IM-CAT as a component of service delivery. In order to utilize the IM-CAT, staff must be certified annually in either the IM-CAT or the IM+CANS. Training and technical assistance for the IM-CAT is also coordinated with the UIUC-SSW.

Promoting Integration of Primary and Behavioral Health Care in Illinois (PIPBHC-IL)

The DMH is currently investigating best practices in the integration of Primary Health Care with Behavioral Health Care through a five-year SAMHSA grant funded initiative. In collaboration with Centerstone Illinois/Southern Illinois Healthcare Foundation, Chestnut Health Systems/Chestnut Family Health Center, and LifeLinks Mental Health/Southern Illinois Healthcare Foundation) this grant-funded project will integrate primary and behavioral health care for an estimated 1,635 of individuals with serious mental illness and a variety of co-occurring illnesses or disorders. Through this grant we will:

Promote full integration and collaboration in clinical practice between primary and behavioral health care in three largely rural counties, each having at least one significant population center
Support the improvement of integrated care models for primary care and behavioral health care to improve the overall wellness and physical health status of adults with a serious mental illness (SMI) and children with a serious emotional disturbance (SED);
Promote and offer integrated care services that include screening, diagnosis, prevention, and treatment of mental and substance use disorders, and co-occurring physical health conditions and chronic diseases.
Use lessons learned throughout the five-year implementation project to support statewide planning and implementation of integrated health homes.
Create a learning collaborative or Center of Excellence to support all Illinois providers who are interested in exploring PIPBHC-IL implementation.

It is anticipated that a total of 1180 individuals will be served during the life of the grant.

DMH/DSUPR Collaborative Efforts

Over the years, the SMHA, DHS/DMH and the SSA, DHS/DSUPR have co-located their Central Offices in both Chicago and Springfield, affording closer collaboration across the two divisions in policy and planning work. DHS/DMH requires a team member specializing in substance use services on every multi-disciplinary Assertive Community Treatment team and requires screening for substance use issues upon intake across its funded providers. DHS/DMH and DHS/DSUPR created a specialized crisis residential model for individuals with co-occurring mental illness and substance use disorders who experienced a crisis that required 24-hour supervision and created a braided funding model to support this approach. Treatment funded by DHS/DSUPR in Illinois emphasizes services that are consumer-oriented, geographically accessible, comprehensive, bridging continuing care responsibilities between all levels of an integrated system of care. Currently DHS/DSUPR is working closely with us toward the 988 Expansion Roll-Out and the planning of behavioral health crisis services.

Mental Health Parity in Illinois

In August 2011, the Governor signed the Illinois Behavioral Health Parity Law that brought state law into line with the federal MHPAEA requiring mental health coverage to be comparable with other physical health coverage. This law added addiction health care and autism health care to the definition of behavioral health care and is applicable to any plan of a small employer (with 2-50 employees) as well as larger employers required by federal law.

Insurance companies in Illinois must provide the same coverage for mental health and substance abuse disorders that they provide for all other conditions. Insurers are prevented from including additional barriers within the policy - such as financial requirements, treatment limitations, lifetime limits or annual limits - to treatments for mental, emotional, nervous, and substance abuse disorders if no such stipulations exist for other health conditions. Illinois' new law exceeded the requirements of the federal mental health parity law and was recommended by the Governor's Health Care Reform Implementation Council.

The Illinois Behavioral Health Parity Law:

Added substance use disorders to the list of mental illnesses covered by the parity law
Added that medical necessity criteria with regard to substance use disorders will be determined in accordance with criteria established by the American Society of Addiction Medicine.
Required insurers to cover treatment for Substance Use Disorders in a residential facility
Prohibited non-quantitative treatment limitations that are not used on a comparable basis for medical surgical benefits
Provided that lifetime limits on coverage can only be applied to mental health benefits if lifetime limits are also imposed on medical-surgical coverage and such lifetime limits are imposed in the same manner to mental health benefits as medical-surgical benefits; and that annual limits on coverage can only be applied to mental health benefits if annual limits are also imposed on medical-surgical coverage and such annual limits are imposed in the same manner to mental health benefits as medical-surgical benefits.
There can be only one deductible.

2. Health Disparities REQUESTED

Enrollment/registration data collected by DMH includes race, ethnicity, gender (binary), age, the primary language spoken by individuals accessing services and whether the individual requires an interpreter to receive services. LGBTQ status is not currently collected. DMH providers submit information as part of their agency profile regarding the languages spoken by agency staff and are required to submit claims for all DMH purchased services provided to enrolled/registered individuals. A special code has been developed to track individuals and services provided to individuals for whom oral interpretation (translation) and/or sign language is required to provide appropriate service to individuals accessing treatment. Under the Medicaid Community Mental Health Services Program Rule (59 Ill Admin Code132) Certified Comprehensive Community Mental Health Centers (CCMHCs) are required to "ensure the availability of services that are culturally and linguistically appropriate and responsive to the needs of clients served, including but not limited to children/youth, military families, those in the criminal justice system, and the LGBTQ population."

DMH continues to actively monitor access to services partitioned by race, ethnicity, gender(binary), age, and the match between primary language spoken by individuals accessing services and agency service staff. When disparities are identified, DMH can initiate planning to address these issues. One of the primary goals of DMH strategic planning is assuring that vendors providing mental health services are culturally and linguistically competent and at least minimally culturally and linguistically capable.

The state also requires all vendors to develop cultural competency plans to "comply with Title VI of the Civil Rights Act of 1964, Americans with Disabilities Act of 1990, Americans with Disabilities Act Amendments Act of 2008, Illinois Human Rights Act, the 1970 Constitution of the State of Illinois and any laws, regulations or orders, federal or state, which prohibit discrimination on the grounds of race, sex, color, religion, national origin, age, ancestry, marital status, disability, or the inability to speak or comprehend the English language".

3. Innovation in Purchasing Decisions

Evidence Based Practices are emphasized in purchasing and policy decisions. DMH regional staff work closely with provider agencies and are responsible for tracking and disseminating information about Evidence Based Practices (EBPs). The provision of evidence-based supportive employment through the Individual Placement Services (IPS) model, Assertive Community Treatment (ACT), and Permanent Supportive Housing (PSH) are consistently tracked. DMH policy requires adherence to national fidelity standards for EBPs and purchasing decisions are largely made in reference to local needs and the capacity of provider agencies to provide services at the level of fidelity required. DMH has used information about EBPs and fidelity standards educationally in working with partner agencies, such as IDHFS, the State Medicaid agency, in revising the Illinois Medicaid Rule accordingly. Services are purchased either directly or indirectly to maintain the EBP or to build provider capacity to meet fidelity standards and increase service delivery. For example, DMH closely monitors agencies that have ACT teams to ensure fidelity to the ACT model. As a result, some agencies that determined that they did not have the capacity to deliver the evidence-based ACT model, chose to adopt the step-down model of the Community Support Team (CST) instead. If teams do not meet fidelity standards, they are not reimbursed for delivering the Evidence Based Practice. Agencies not meeting fidelity for ACT must provide alternative modalities for less reimbursement.

The following value-based purchasing strategies are used in Illinois:

Leadership support, including investment of human and financial resources.
Use of available and credible data to identify better quality and monitor the impact of quality improvement interventions.
Provider involvement in planning value-based purchasing.
Gaining consensus on the use of accurate and reliable measures of quality.
Quality measures focused on consumer outcomes and also on process issues and care
Statewide teleconferences to educate consumers and empower them to select quality services
Emphasis on quality as a priority across the entire state infrastructure.
Ongoing assessment of the impact of purchasing decisions.

Relevant Highlights To This Section

DHS has recently undertaken a Diversity, Equity, Inclusion and Racial Justice initiative to increase the diversity of providers and improve access to underserved areas. This work involves a careful examination of our current procurement processes to identify and remediate areas of implicit bias that may have impacted selection of providers in previous grant making processes.

The Covid-19 Pandemic has negatively impacted our ability to conduct certification and fidelity reviews during FY2020 and FY2021, DMH relies heavily on these reviews for credible data to identify quality of services.

4. Evidence-Based Practices for Early Interventions to Address Early Serious Mental Illness (Required for MHBG)

The FIRST-IL Program (The 10% Set-Aside)

Planning and Implementation

The DMH First Episode Program Planning Workgroup began meeting on a weekly basis in May, 2015 to discuss and finalize an approach to implement evidenced based early intervention for persons who present with First Episode Psychosis. DMH engaged the Best Practices in Schizophrenia Treatment (BeST) Center, Department of Psychiatry, at Northeast Ohio Medical University (NEOMED) to provide technical assistance and consultation to the DMH First Episode Program Planning Workgroup on program design considerations and the feasibility of implementing the model in a practical manner that could meet the needs of individuals with FEP and result in successful outcomes. Since then, the BeST Center has continued to contract and work with DMH in providing education, training, and consultation to the programs both at the statewide level and to individual sites as needed. The actual roll-out of the FEP program in Illinois was completed and services were initiated in September 2016. The program was named FIRST.IL. at the time of its initiation.

The Illinois design was consistent with an understanding that FEP programs generally starting slowly because it takes time to identify individuals who experience FEP and then engage them in a treatment setting. This means that initially, most FEP programs do not require full-time staffing, and team members may have responsibilities in addition to the FEP program for a significant phase-up period. In addition, the ability to pull together diverse services that may be available in the community, but that are not currently offered in an integrated way, is a cost-effective way to begin an FEP program. Our design further allows agencies without a needed service to contract with other providers for specific treatment services and/or share personnel or other resources with other providers.

Outreach, engagement, treatment, and coordination of support services are currently ongoing at each site. Each participating agency site has an identified team leader, and a team that consists of at least one therapist, one case manager, one IPS/Supported Employment and Education specialist, and a medication prescriber. An administrative lead from agency administration oversees the activities of the team. Each agency has responded to uniform requirements of contracting with DMH while uniquely developing their team compositions and strengths in their service environments which range from the urban Chicago Metropolitan Area to county-based rural service agencies in Greater Illinois.

By the end of SFY2018 the program had expanded to 15 sites, and increased funding of some existing teams that were reporting greater demand than capacity. Illinois also appreciated the expansion of eligibility to include Early Serious Mental Illness, and adjusted our admission criteria accordingly, and now refer to eligibility for ESMI as opposed to FEP. Over the years of operation, 565 individuals have been served by our FIRST.IL teams, with 308 active in treatment at this time.

Use of Set-Aside Funding

From the outset, the intent of DMH was to introduce emerging evidence-based practices for Coordinated Specialty Care (CSC) as a component of the services and activities that reflected the values, goals, and objectives inherent in the Vision and Mission of the Division of Mental Health and the SAMHSA requirements for the use of the dollars.

Set-Asidedollars are paid for:

The time and costs of assigning a clinician to become the designated agency staff person with expertise in clinical content and service delivery of CSC services. Each agency was required to designate or hire at least a 0.5 FTE staff person with requisite clinical credentials to coordinate required service components for clients, to be able to reach out and engage clients in the community, and to provide therapeutic clinical services.
The time and costs of assigning a senior level agency staff member to a leadership role in ensuring that functions and operational integrity of the FIRST.IL program are carried out at the agency and in collaboration with the Division of Mental Health.
Training, technical assistance, consultation events and sessions to develop expertise in evidence-based clinical approaches most helpful to individuals with ESMI.
Development of marketing materials and tools to be used for outreach and engagement of persons with ESMI and their families.

Building upon the training, infrastructure, and service delivery established through the initial design phase, the dollars from the Ten Percent Set-Aside have been used to promote:

Expansion of programming (using the model described above) to agencies in Region 5 (southernmost in Illinois) and generally increasing the number of agencies in the State that will have FIRST.IL programs.
Providing additional funding to agencies to facilitate improved implementation of program components as needed.
Developing DMH staff expertise in CSC to furnish guidance in developing, monitoring, coordinating, and providing technical assistance to agencies in carrying out programming.
Increasing agency participation in: (1) ongoing focused training in CSC approaches and in related evidence-based components. (2) structuring technical assistance and consultation to meet emerging needs in the areas of program development, service delivery, outreach and engagement approaches, financial supports for treatment, and program sustainability.
Purchasing special services that are not Medicaid reimbursable.

Non-billable costs are covered by the Illinois Mental Health Block Grant Set-Aside

funds. Illinois pays agencies actual costs for those expenses related to training and non-billable time per their submitted invoices up to the maximum of their contract.

The DMH contractual process for this initiative included specified goals, performance measures and performance standards for each participating provider. This combination of data and measures is being utilized to determine the impact of the FIRST.IL initiative.

Several identified challenges that are being addressed in training and consultation include:

Working with participating providers to modify the treatment paradigm from a singular focus on agency services for persons with serious and continuous mental illness to include the engagement of persons in acute distress and encountering mental illness for the first time in their lives.
Assuring the financial support required for agencies to be able to sustain their programs and to serve those individuals who should be served but lack the resources to pay for their services.
Some programs did not have previous experience in conducting outreach and engagement activities that are required in CSC. Adaptation and the development of skill in these areas takes significant time and slows down the implementation process. In the past year, these agencies have shown growth through active marketing and outreach and their enrollment numbers have increased.
Coverage for CSC programming by private insurance has been problematic and only some treatment services have been reimbursed. Legislation has been passed in Illinois aimed at improving and streamlining coverage by private insurance to allow for billing of team services that include therapy and case management. The legislation went into effect in FY2020. Discussion of planning and implementation of this new law has been ongoing. The Illinois Department of Insurance has been working with a Provider Workgroup regarding the process for billing Insurance for bundled services such as FEP.

SAMHSA Questions:

Does the state have policies for addressing early serious mental illness (ESMI)? Yes
Has the state implemented any evidence-based practices (EBPs) for those with ESMI? Yes
If yes, please list the EBPs and provide a description of the programs that the state currently funds to implement evidence-based practices for those with ESMI.

Coordinated Specialty Care (CSC)

Cognitive Behavioral Therapy for Psychosis (CBT-p)-p,

Individual Placement Services-Supported Employment/Supported Education

Illinois is providing an early intervention Program for the treatment of persons experiencing their first psychotic episode. The majority of individuals served are in the young adult age range. This intensive Coordinated Specialty Care Program is an evidence-based practice, that includes 5 specialists as a Treatment Team: the Prescriber/Psychiatrist, the Team Leader who also provides Family Psychoeducation, the Individual Resiliency Training (IRT) Clinician, The Case manager/Recovery Support Specialist, the Supported Employment/Supported Education staff person (also Known as Individual Placement & Support or IPS). This Treatment Team provides intensive services to individuals ages 14- 40 who have experienced their first psychotic episode within the last 18 months. This program is a true early intervention Program that has as its goal, to assist individuals having their first psychotic episode in the recent past with multiple intervention services to allow for Recovery and resumption of work and or school for persons served, and to reduce number of hospitalizations, divert persons from requiring the support of Social Security Disability and possibly reduce the need for medications over time.
How does the state promote the use of evidence-based practices for individuals with ESMI and provide comprehensive individualized treatment or integrated mental and physical health services?
The 15 CSC Teams in the State do active marketing and outreach and are continuously educating health providers in their communities. They coordinate the services received by individuals with ESMI. Recovery support is also provided by Recovery Support Specialists across all 15 teams.
Does the state coordinate across public and private sector entities to coordinate treatment and recovery supports for those with ESMI? Yes - CSC Team Leaders coordinate treatment and recovery supports
Does the state collect data specifically related to ESMI? Yes
Does the state provide trainings to increase capacity of providers to deliver interventions related to ESMI? Yes
Please provide an updated description of the State's chosen EBPs for the 10 percent set-aside for ESMI.
We have growing expertise in CBT-p and are now undertaking advanced training for staff who have experience in using this practice to prepare them as experts and mentors to incoming staff who are at the beginning level. We are also initiating training in fidelity to the CSC model based on a fidelity scale developed for CSC.
Please describe the planned activities for FFY2022 and FFY2023 for your state's ESMI programs including psychosis?
Planned expansion: Illinois is appreciative of the opportunity that the additional set aside resulting from the increased mental health block grant awards will afford us in further expanding services to the ESMI population. We plan to utilize these funds to expand the number of teams operating in Illinois and will utilize data including gap analyses to identify areas where this expansion is needed. In addition, we intend to direct additional resources to existing teams to expand their reach into underserved locations within their respective service areas. As detailed in #2 in Table I, DMH is planning to add at least 5 new sites in FY2022 and an additional 5 sites in FY2023 to bring the number of sites statewide to 25.

Continuation of initiatives undertaken during FY2020 and FY2021: Additionally, the initiation of advanced training in CBT-p to accommodate those who are more experienced in this best practice and to develop available expertise to mentor team members who are joining at a beginning level. Increasing in-person training and consultation in Family Psychoeducation. Six training events in Fidelity to the Coordinated Specialty Care model are being planned. These sessions will be attended by members of all 15 teams in the State.
Please explain the state's provision for collecting and reporting data, demonstrating the impact of the 10 percent set-aside for ESMI.
A special web-based data system has been developed for the program with data definitions and criteria for provider reporting explained in an accompanying data manual. Agencies are now entering their into this system. A complete set of data for FY2021 should be available by the end of October.
Please list the diagnostic categories identified for your state's ESMI programs
Schizophrenia Spectrum Disorders,

Major Depression with Psychotic Features

Bipolar Disorder with Psychotic Features

Post-Traumatic Stress Disorder with Dissociative Symptoms

Since 2018, we have operated fifteen teams. Six teams serve the Chicago area, and nine operate in other areas throughout the state. The expansion of eligibility to include Early Serious Mental Illness resulted in inclusion of Bipolar Disorder with Psychotic Features, Major Depression Disorder with Psychotic Features and PTSD with Dissociative Symptoms to our diagnostic criteria. Currently we are serving 308 enrollees at our 15 FIRST.IL sites with 25% of persons served carry a diagnosis from the expanded eligibility list.

Please indicate area of technical assistance needed related to this section.

FIRST.IL staff have been attending Webinars that are relevant to the range of clinical issues being encountered. Consultation on advanced training in CBT-p and on training in fidelity to the CSC model would be appreciated.

5. Person Centered Planning (PCP) -Required for MHBG

The Wellness Recovery Action Plan (WRAP) model has been a keystone of person-centered planning and recovery in Illinois and is well-established and operational in the State. 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 evidence-based practice in recovery-oriented services. A recently recognized evidence-based practice, WRAP" is a multi-week program led by certified facilitators. WRAP teaches people living with mental illnesses how to identify and use illness self-management resources and skills that help them stay well and promote their recovery. Studies show that WRAP improves participants' quality of life and reduces their psychiatric symptoms. Increasing access to WRAP Facilitator Training in Illinois is an important priority. DMH Recovery Support Services (RSS) provides annual WRAP Facilitator Training, has trained over 400 people to deliver WRAP statewide since 2002, and is continuously working to increase the number of trained facilitators who are providing WRAP classes. The community support services WRAP facilitators provide are Medicaid-reimbursable, making WRAP an affordable program for many agencies. As of December 1, 2020, 558 individuals had been trained and certified as WRAP Facilitators in Illinois.

CCMHCs provide care to individuals with or at risk for SMI/SED by using a person- centered approach to care performed by an interdisciplinaryteam. They serve individuals who have complex needs resulting from child welfare, justice or multisystem involvement, medical co-morbidity,homelessness, dual disorders and ensure the connectivity of services in their service area forindividuals across the lifespan. Services are provided in the client's naturalsettings whenever possible. They are the dynamic core of Person-Centered Planning linking individuals and families with a comprehensive and supportive array of mental health services.

In the Illinois Administrative Rule 132 (59 Ill Admin. Code 132) Certified Comprehensive Community Mental Health Centers are defined as "specialty service providers embedded in the community with knowledge and expertise in providing services to adults with or at risk of serious mental illnesses (SMI) and/or children and youth with or at risk of serious emotional disturbances (SED). CMHCs respond to the unique mental health needs of the community with a continuum of services ranging from prevention/promotion through treatment and recovery. CMHCs collaborate with other social service and health careproviders to deliver integrated care to individuals in the identified geographic service area. CMHCs must be nonprofit or local governmententities."

CMHCs are required to:

Operate within a system of care that provides treatment, habilitation and support services.

Provide a comprehensive strengths-based array of mental health services within an identified geographic service area.

Provide care to individuals with or at risk for SMI/SED by using a person- centered approach to care performed by an interdisciplinary team.

Serve individuals who have complex needs as a result of child welfare, justice or multisystem involvement, medical co-morbidity,homelessness, dual disorders,etc.

Ensure the connectivity of services in the service area forindividuals across the lifespan.

Provide services in the client's natural settings.

Provide a safety net for individuals with SMI/SED who are indigent.

Provide evidence-based and evidence-informed developmentally appropriate practices in a proficient manner.

Provide for a screening prior to a referral to a more intensive level ofcare.

Provide education and resources to the public on mental health issues, including suicide prevention andwellness.

Prioritize principles of recovery, system of care, trauma informed care, and culturally relevantpractices.

Provide access or linkage to psychiatric services and other healthand socialservices.

Person Centered Planning is the cornerstone of the General Requirements for CCMHCs (Section 132.75):

Establish and maintain policies and procedures to be used by all CMHC staffin the administration of CMHC programs and the delivery of services from any CMHC site orlocation including:

Policies detailing the organization's clear commitment to person-centered recovery and resilience principles and the empowerment of families and individuals served. Programs and services should promote personal choice, self-help measures, the strengthening of natural supports, the use of education and interventions in natural settings, and the reduction of the utilization of institutional levels ofcare.
Policies detailing how clients will actively participate in the development, planning and oversight of programs andservices.
Policies and procedures to ensure co-morbid physical healthcare needs are addressed for clients as needed. A CMHC that is not licensed toprovide Level I and Level 2 Substance Use services and enrolled to participate in the Illinois medical assistance Program shall develop policies and procedures to ensure that clients receive referrals for services as needed.
Policies and procedures to ensure SAMHSA's principles of trauma informed approaches are embedded into the organizational structure and clinical practices of the CMHC.
Ensure the availability of services that are culturally and linguisticallyappropriate and responsive to the needs of clients served, including but not limited to children/youth, military families, those in the criminal justice system, and the LGBTQpopulation.
Ensure the availability of and/or linkage to a psychiatric resource for the purpose of consultation, evaluation, prescription and management of medication asneeded by clients served by the CMHC. This may be secured through various arrangements, including but not limited to employment, contractual relationship or mutualagreement.
Identify a specific geographic service area in which the CMHC will operate and organize the delivery of services and programs and provide interventions to clients.

In CMHCs Person Centered Planning occurs in the context of Individual Treatment Planning and Plans (ITPs)which are the center of ongoing clinical work with clients. In the Medicaid system it is an integral component of Integrated Assessment and Treatment Planning (IATP). DHFS has designated the Illinois Medicaid Comprehensive Assessment of Needs and Strengths (IM+CANS) as the approved IATP instrument. It is noteworthy that the IM+CANS also includes a Health Risk Assessment (HRA), developed to support a holistic, wellness approach to assessment and treatment planning by integrating physical health and behavioral health in the assessment process. The HRA is a series of physical health questions for the individual that is designed to: 1) assess general health; 2) identify any modifiable health risks that can be addressed with a primary health care provider; 3) facilitate appropriate health care referrals, as needed; and 4) ensure the incorporation of both physical and behavioral health needs directly into care planning.

Additionally, consumers and caregivers participate in planning and policy work groups and committees including the Illinois Mental Health Planning and Advisory Council (IMHPAC). They provide both formative ideas and feedback in a variety of planning venues in the State. Most recently, DMH has invited individuals with lived expertise as well as survivors of loss from suicide to join in the planning for the 988 Implementation, with multiple individuals serving significant roles on our Key Stakeholder Coalition as well as all subcommittees. We have implemented procedures that allow us to reimburse individuals with lived expertise who would otherwise be volunteering their time to participate in such activities, which puts them on par with individuals who are representing organizations that employ (and therefore pay) them for the time that they are spending on these various advisory activities.

Person Centered Planning (PCP)-SAMHSA Questions

Does your state have policies related to person centered planning? Yes
If no, describe any action steps planned by the state in developing PCP initiatives in the future. Please provide a narrative description. Not Applicable
Describe how the state engages consumers and their caregivers in making health care decisions, and enhance communication.
Individuals and families are engaged in assessment, treatment planning and evaluation of effectiveness and modification of treatment plans accordingly. The Bureau of Wellness and Recovery regularly shares a variety of communications with individuals served and those that support them.
Describe the person-centered planning process in your state.
Individual treatment planning begins with an assessment that includes input from the individual, family members and other identified supporters. This informs the course of treatment, and feedback is solicited throughout the course of care to drive changes in individual treatment.

On a systems basis, individuals who have/are being served in the system, as well as family members and other supportive people, are regularly engaged in planning activities by the Bureau of Policy, Planning and Innovation to contribute to identification of needs and development of programs.

Using the TA text box provided in BGAS, please indicate areas of technical assistance needed as it relates to this section.

None

6. Program Integrity-Required

The Division of Mental Health has a long history of targeting the use of mental health block grant dollars to purchase services for individuals who are uninsured and toward the purchase of services that are non-Medicaid reimbursable. Continuing capacity for purchasing mental health services covered under the state benchmark for the uninsured population will need to be evaluated as state projections regarding the uninsured population are finalized and as the budgets for FY2022 and FY2023 are established for the use of general revenue funds to purchase services for these individuals. Although Mental Health Block Grant funds have historically been utilized to serve this population, it is estimated that would not be sufficient to fully cover service provision.

All DMH vendors are required to register/enroll all individuals for whom services are purchased using DMH dollars. DMH contracts require vendors to utilize dollars associated with specified funding streams for specific services. Information regarding family and individual income and household size are required data elements. The use of block grant dollars is governed by contracts, called Community Service Agreements, that are executed with each provider with whom the Division contracts. The contracts clearly state the service for which block grant dollars are allocated and the rules for reporting expenses associated with the services purchased.

The state has a number of individuals that are responsible for program integrity activities:

DMH Fiscal Services is responsible for receiving expenditure reports with regard to how contracted vendors expense block grant dollars. All DMH vendors are required to submit audited financial reports to the DMH on an annual basis.
DMH clinical and community services managerial staff are responsible for developing policy with regard to the services purchased from DMH vendors.
Decision support staff develop policy regarding the reporting of services purchased from DMH vendors.

DMH certifies Specialty Programs and Comprehensive Community Mental Health Centers in accordance with the requirements and processes cited in Administrative Rule 132. Certification activities are ongoing.

7. Consultation with Tribes

This section is not applicable. Illinois has no Tribal reservations within its boundaries. Primary health care, community health and mental health services are provided to medically underserved members of federally recognized American Indian Tribes and family members residing in the City of Chicago area by the American Indian Health Service of Chicago, Inc. This agency operates as a non-profit charitable organization and is not funded through DMH.

8. Primary Prevention-Required for Substance Abuse Only

This section is not applicable to the MHBG. This section will be addressed in the SABG submission by the DHS Division of Substance Use Prevention and Recovery (DSUPR).

9. Statutory Criteria for MHBG (Required)

Criterion I: The Comprehensive Community Based Mental Health System:

The array of core services available to adults with serious mental illnesses and youth with serious emotional disturbance who are enrolled in Medicaid and the crisis services are available to all consumers.
Commitment to a recovery orientation by mental health system stakeholders.
The focus on individual and family driven care
Commitment to the implementation of evidence-based practices and, for children, commitment to evidence informed practices and the dissemination of information regarding the implementation of evidence-informed practices that lead to resilience.
Involvement of consumers and families in planning, implementing and evaluating the initiatives and ongoing activities of the public mental health system.
Successful efforts to reduce hospitalization. Screening and crisis services for individuals at risk of hospitalization that contribute to this success remain a high priority for DMH.
Collaborations with other divisions of the IDHS and with other state agencies have been a successful strategy for improving and enhancing services throughout the system.
Collaborative efforts, pilot projects, and vocational/employment supports to address the needs of youth with serious emotional disturbance transitioning to adulthood, including those transitioning from correctional settings and the child welfare system.
The state health care coverage program that offers comprehensive, affordable health insurance for children in Illinois assures that every uninsured child, regardless of income or medical condition has access to health care, including mental health services. Additionally, healthcare coverage is extended to parents living with their children 18 years old or younger and relatives who are caring for children in place of their parents.

For additional information focused on DHS/DMH organization and services, please refer to the Planning Step 1 section above.

1. Describe available services and resources to enable individuals with mental illness, including those with co-occurring mental and substance use disorders to function outside of inpatient or residential institutions to the maximum extent of their capabilities.

Provision of treatment services are mostly reimbursed through MCOs under Medicaid. The State funds community mental health centers for the provision of community-based treatment and rehabilitation services and supports for individuals with mental illnesses as well as individuals with co-occurring disorders. Clients are assisted through case management in obtaining those services not available on-site at CMHCs. DMH provides grant assistance to funds additional supports that are not covered by the Medicaid State Plan.

Describe your state's case management services

Case management is provided consistent with the Medicaid State Plan Amendment service agreement between HFS and CMS, and is based on a Targeted Case Management model. Individuals receiving case management services are linked to resources outside the treating agency by the mental health professional providing the service.

Describe activities intended to reduce hospitalizations and hospital stays.

Significant decreases of admissions in state hospitals are the result of attention to the issue of local area utilization of state hospital resources and continuity of care. The statewide reduction of bed utilization is based upon the principle that reduction must occur within a context that assures that clinically effective care remains continuous and that alternative and supportive community services are in place. A variety of strategies have resulted in a significant reduction in civil admissions to state hospitals. The reduction in admissions has allowed a reduction in the size of all facilities and closure of several with the concomitant increase in the provision of services in the community to persons who would otherwise have been hospitalized in state hospitals. Paralleling the downsizing of state hospitals, and fostering the movement to the community, Illinois has developed a network of community mental health agencies covering all geographic areas of the State. These providers share the goal of providing the necessary basic services to maintain persons with serious mental illness in the least restrictive setting possible. The reduction in admissions and bed utilization has largely been the result of a continuing impact of a succession of new initiatives.

A DMH initiative identified high utilizers of the state hospital system, and then an analysis was completed to identify factors leading to frequent admissions; most common was lack of Medicaid eligibility to cover ongoing services outside the hospital. DMH worked with our sister Division, Family and Community Services, to develop a mechanism to complete Medicaid applications for individuals prior to discharge, and this significantly reduced recidivism.
Building Community Services:Several initiatives have had a substantial and sustained impact on the public mental health system of care. When consumers are discharged or triaged from a state hospital they are enrolled with a care management provider to assure linkage to needed treatment and support services. Reductions in state hospital utilization have resulted in funds becoming available for the development of community-based services designed to maintain individuals in the community and to provide inpatient services when required in community hospitals.
DMH has focused significant resources on increasing the availability of permanent supportive housing, as lack of housing is another factor that contributes to many readmissions within the system.
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.

Criterion 2: Mental Health System Data Epidemiology

Consistent implementation of a Management Information System (MIS) and a data warehouse to provide improved and expanded access to data which is vital to support decision making.
Through external and internal resources our databases and analytic capabilities have steadily grown to an extensive array of computerized information that provides an important resource for analyzing service provision and service needs

The "Prevalence and Access" Gap

Prevalence estimates and access data are gathered and reported yearly and reflect the gap that exists between the probable number of adults in the state with SMI and children/youth with SED and the actual numbers of those receiving services in the public mental health system.

Adults

Illinois has followed the CMHS definition and methodology for prevalence estimation for adults that was published in final notice form in the Federal Register Volume 64, Number 121, June 24, 1999. The methodology provides a calibrated point estimate of the 12-month number of persons who have Serious Mental Illness, age 18 and older in Illinois. This does not include persons who are homeless and institutionalized. The prevalence estimate provided by CMHS is 5.4%. Based on the adult population for Illinois, it is estimated that in FY2019 there were 534,861 adults with serious mental illnesses residing in Illinois.

The 2020 Behavioral Health Barometer Volume 6-states that "an annual average of 4.0% or 391,000 of adults 18 and older in Illinois had serious mental illness in the past year during the years 2017-2019 with a 95% confidence interval ranging from 4.7% to 5.4%."

Children and Adolescents

For an estimate of Children and Adolescents with Serious Emotional Disturbance, Illinois has used the 7% estimate provided in the CMHS notice in the Federal Register, Volume 63, Number 137, July 17, 1998 based on the midpoint of the number estimated at the lower limit of a level of functioning of 50 (LOF=50) and the number estimated at the upper limit of that level of functioning (LOF=50 to 60). Based on this formula, there were 104,727 youth in Illinois with Serious Emotional Disturbance.

MHBG Estimate of statewide prevalence and incidence rates of individuals with SMI/SED

Target Population (A)	Statewide Prevalence (B)	Statewide Incidence (C)
Adults with SMI	532,236	396,320
Children with SED	103,275	59,844

Column B of the table is based on the most recent SAMHSA prevalence estimate received from SAMHSA on 9-11-2019.

Column C (as required) is the state's expected incidence rate of individuals with SMI/SED who may require services in the state's M/SUD system

Criterion 3: Children's Services

Collaboration with IDHS Divisions and state agencies to ensure continuity of care and service integration is a multifold strength of the DMH service delivery system for children and adolescents. The majority of children and adolescents in the public mental health service system are served through Medicaid Managed Care which benefits from the subject expertise provided by DMH.
The on-going collaboration with the Children's' Mental Health Partnership has been fruitful in providing the resources needed to advance several vitally needed initiatives including services to youth in transition, early intervention, and the promotion of Evidence Informed Practices.
The statewide Mental Health Juvenile Justice (MHJJ) program brings services to youth in county detention centers across the State in collaboration with juvenile justice.
Long-standing collaborations are in place with the DCFS, the ISBE and the DSUPR. The DMH has partnered with these agencies to implement the wraparound approach to the delivery of children's services as well as to provide or coordinate delivery of mental health services. More recently, collaboration with DCFS and DHFS expanded the provision of SASS services.

Criterion 4: Targeted Services to Homeless, Rural, and Elderly Populations.

Homeless

Illinois has had a continuing commitment to develop and implement service models for persons with mental illnesses who are homeless, such as the innovative use of PATH funds. Illinois has continually increased services including expanded intensive outreach to homeless individuals with serious mental illnesses.

In 1988, the Federal Stewart B. McKinney Act was enacted into legislation to address the crisis of homelessness among the nation's population of individuals who are homeless and who have serious mental illness. In 1991, this Block Grant evolved into a federal formula funding award titled Projects for Assistance in Transition from Homelessness (PATH). In FY2021 Illinois was awarded $2,705,316 and recently submitted an application for FY2022 for $2,705,195. Illinois currently has 13 agencies and 16 programs which are located in the cities of Rockford, Joliet, Chicago, East St. Louis, Peoria, Springfield, and Vienna. Based on the environmental landscape of the service providers' respective communities, a variety of strategies are utilized to identify and access individuals and families who are vulnerable and underserved, conducting outreach and engagement in the streets, and other services to aid in the fight to end homelessness. The number of persons served statewide in the past several years has steadily increased. In FY2022 we anticipate serving about 5,500 individuals.

PATH program services in the state are:

Outreach and engagement, including:

Two (2) Mobile Assessment Units, one of which is the Chicago Transit Authority Outreach Team
Involvement in city/federal initiatives to outreach and engage chronically homeless individuals
Street outreach on the streets, under viaducts, in parks/forest preserves, libraries, shelters, soup kitchens, food pantries, jails/prisons, hospitals, and abandoned buildings
Operating a daily Drop-in Center

Comprehensive community mental health services, case management and crisis intervention.

Screening and diagnostic assessments, individual/Family Counseling and group therapy.

Access to community resources (e.g.: dental, vision, clothing, food pantries, bus/train cards)

Connection with hospitals/clinics, transportation to appointments and benefits representatives
Referrals/linkage to primary healthcare services and substance abuse treatment programs
Securing personal documentation (e.g.: birth certificates, state ID's and social security cards)
Assistance in obtaining employment, educational and vocational opportunities
Provision of hygienic items, clothing and resources for survival in hot and inclement weather
Assistance in completion of applications for public entitlements and benefits (SSI/SSDI, Medicaid, SNAP)
Linkage w/landlords, moving expenses, 1x security deposits and payments to avoid eviction.

Additionally, since 2009, the Illinois PATH Program has provided outreach through the Illinois Department of Corrections, in response to the growing number of individuals returning to the community from periods of incarceration who met the criteria of eligibility. Individuals have been referred to the program and engaged in services upon release. PATH is also partnering with other stakeholders and receiving technical assistance to aid in assisting those individuals who have been affected by COVID.

Rural

Residents of rural areas face barriers not encountered by urban residents: There are fewer community mental health providers in rural areas which limits the individual's choice of a provider and may be difficult to reach due to lack of public transportation; access to inpatient psychiatric treatment is limited; and the stigma of mental illness is worse in rural areas due to it being nearly impossible to maintain privacy and anonymity. The DMH Region offices serving these areas are committed to developing and implementing service models for persons with mental illnesses who reside in rural areas. DMH participates in a range of collaborative initiatives such as the Governor's Rural Affairs Council and works with nearby universities to develop and evaluate programs designed for the needs of rural residents. Direct services that include crisis/emergency services, outpatient services, psychiatric services, care management, PSR, and residential services are provided in rural areas across the state. The State recognizes the value of advanced technology in communication to give Illinoisans living in rural communities increased access to psychiatric care. Public Act 95-16 requires the Illinois Department of Healthcare and Family Services to reimburse psychiatrists and federally-qualified health centers (FQHCs) for mental health services provided via telepsychiatry. During the pandemic, providers across the state saw significant increases in the use of telehealth for a variety of mental health services. While this did positively impact some service availability in rural areas, many of the providers in more rural areas struggled to reach individuals due to the lack of access to reliable internet/cell phone service in some places.

DMH Initiatives to Address Problems and Concerns in Rural Communities:

To augment the limited supply of psychiatrists, DMH is working with professional associations to make available the services of specialty professionals such as Psychologists with prescribing authority and Advance Practice Nurses with psychiatric specialization
DMH and sister agencies have pursued ways to expand broad band access, cell phone service, and other infrastructure necessary to provide telehealth services
DMH no longer restricts the Medicaid certification of mental health providers, resulting in the number of providers growing more than 20% in the last 5 years
DMH and DSUPR are coordinating to streamline their administration and eliminate unnecessary requirements for providers
DMH is looking at ways to improve partnerships and coordination among community mental health providers, state operated hospitals, and private hospitals to assure better access to appropriate treatment.
DMH is continuing to work with DSUPR and the Department of Healthcare and Family Services (HFS) on a new model for integrated behavioral health and general health care. This new model would consist of Integrated Health Homes coordinating behavioral health and primary health care.
DMH is including representation of rural providers and individuals living in those areas as plans for 988 Implementation are made
DMH is investing in the development of the crisis care system to ensure access to the full continuum of crisis services statewide, including significant development within rural areas.

Older Adults

The DMH collaborates with the Illinois Department on Aging (DOA) to increase training opportunities in the field of older adult mental health care and to improve the quality and accessibility of services for elderly persons with mental illnesses.

WRAP For Seniors -A Specialized PsychiatricService for Older Adults

Withfunding from the Administration for CommunityLiving of the U.S. Department of Health & Human Services(thegrantfunding agency), The WRAP for Seniors Project, based at the Center on Mental Health Services Research and Policy at UIC, is teaching WRAP virtually via Zoom and mobile phone to adults age 60 and older. This grant began on July 1, 2018, for $838,425 over three years was awarded to the Center on Mental health Services Research and Policy at the University of Illinois at Chicago. Since the beginning of the COVID-19 pandemic, 10 classes have been taught remotely to older adults through Rush University's Generations program, the Age Smart Triple A, Oasis Institute, Illinois Assistive Technology Program, Senior Services of Will County, and Chicago Hyde Park Village. This brings the total of older adults receiving WRAP since the start of the project to 262. UIC is continuing to plan new classes and enroll new participants for remote delivery of WRAP.

The grant has been extended and continues to offer WRAP services to seniors ages 60 and over. DMH WRAP Facilitators have been engaged in learning how to provide WRAP to seniors. The majority of seniors qualifying for services through this grant-funded program have mental illnesses which frequently go undiagnosed. Clients in the Illinois Department of Aging's Community Care Program as well as older adults served at the state's 13 Area Agencies on Aging are targeted for WRAP services. They are aiming to develop new funding sources, including a fee-for-service contract. It is anticipated that work on the grant will produce a culturally adapted version of WRAP tailored for seniors in English and Spanish. An important benefit of the grant is the expansion of employment opportunities for persons with lived experience and seniors who attain WRAP Facilitation skills and can provide peer support.

The purposes of the grant are: (1) to significantly increase the number of older adults and adults with disabilities who participate in evidence-based self-management education and support programs to improve their confidence in managing their chronic condition(s), and, (2) to implement innovative funding arrangements to support the proposed programs, while embedding the programs into an integrated sustainable program network. DMH is one of nine active partners with UIC CMHSRP in working towards achieving the goals of the grant which are to create a trained workforce of 120 WRAP facilitators across the State.

In a survey of satisfaction with the senior version of WRAP, conducted July to December 2020 (N=41), 100% were either very satisfied (88%) or somewhat satisfied (12%) with the class overall, and 95% were very satisfied with the instructors. Approximately 88% were very satisfied and 10% somewhat satisfied with the technology support that was provided to participants. All mostly or strongly agreed that they felt supported by the WRAP instructors and classmates (100%), were less alone now compared to before participating in WRAP (90%), liked hearing from their peers about how they stay well (97%), and continue to use what they learned in WRAP (95%).

The UIC project has been granted a 1-year no-cost extension through the end of June 2022.

Advocates for Human Potential (AHP) has released WRAP for Healthy Aging, based on the version of WRAP developed for the UIC project. This release included a WRAP for Healthy Aging Workbook, WRAP for Health Aging Co-Facilitator slide deck, and WRAP for Healthy Aging Co-Facilitation Guide. This represents a major impact that the project has had on WRAP and its introduction to the U.S. Department of Health and Human Services, Administration for Community Living's field of chronic disease self-management education programs for older adults.

Criterion 5: Management Systems:

The Division of Mental Health provides support and resources which aremade available through the DMH website for use with staff in a variety of subjects related to evidence-based practices. The state utilizes technology whenever possible to reduce the cost of participation for providers. This includes sponsoring learning collaboratives and communities that meet using resources such as WebEx to discuss various treatment approaches for specific populations. The Division has a staff person assigned to work on a weekly basis on an initiative with police around CIT training. The Division also utilizes its Regionally based staff to provide training and technical assistance in a geographically based way to reduce burden on providers with travel by locating these meetings closer to the providers' service region. This also allows for personalization/modifications based on the needs of the Region. During the pandemic, all regional meetings have been held virtually to eliminate the need for travel. This has had the unexpected benefit of further increasing attendance as more participants were able to join who might not have been able to dedicate the additional time in travel to a meeting, even one held in their region.

10. Substance Use Disorder Treatment (SABG Only)

This section is not applicable to the MHBG. This section will be addressed in the SABG submission by the DHS Division of Alcohol and Substance Abuse (DASA).

11. Quality Improvement - Requested (Not Required)

The DMH Quality Improvement Mission and Vision has been described in previous applications. A brief summary is provided below.

Quality Improvement Mission and Vision

The core values and concepts of continuous quality improvement include continuous assessment of key activities with an eye toward improving processes and outcomes, consumer service and focus, decisions based on facts, data and analysis, employee involvement/empowerment and teamwork. The Quality Management Committee partners with the various units within the Division to ensure that stated needs, issues and concerns are addressed. A DHS Quality Management Committee reviews and provides advice related to various quality improvement work products and engages in problem-solving to resolve issues and risk where needed. The Committee lends support to units within the Division to ensure successful implementation of continuous quality improvement efforts and ensure quality of service delivery.

Quality Reviews, Standards and Provider Audit Requirements

Quality standards and provider audit requirements are defined by Illinois Administrative Code (Title 19, Part 507). Quality improvement and program and financial decision-making rely on relevant, accurate data and insightful planning based on reliable data sources. A necessary and important ingredient of any system established to support management and program improvement activities is a system of monitoring and accreditation. The system for monitoring community providers includes the following activities:

Certification Reviews: Performed by the DHS Bureau of Accreditation, Licensure, and Certification (BALC). These reviews verify that the sites and services of providers are meeting standards for Medicaid certification. These reviews are performed at least every 3 years, more often if significant findings are discovered in an earlier review.
Fidelity Reviews: A review by DHS/DMH providing feedback to providers on fidelity to specific service definitions, with the goal of ensuring that providers are maintaining fidelity and identifying areas that need improvement.

12. Trauma-Requested Section

Currently DMH encourages providers to seek out education and training in the treatment of post-traumatic stress disorders, to provide trauma-informed care, and to develop appropriate screening tools and referral mechanisms. Statewide implementation would require substantive funding which is not currently available.

Trauma Initiatives

Consistent with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Core Measures, beginning in 2009, a trauma screening is administered upon admission to any DMH hospital. Results of this screening are incorporated into an individualized Personal Safety Plan that identifies potential triggers for the re-experience of trauma as well as types of interventions likely to be most helpful and effective. DMH hospitals have also adopted the trauma sanctuary model, which establishes a therapeutic milieu for information sharing, communication and problem solving.

Service Members, Veterans, and their Families

During FY2016, in coordination with collaboration partners an inventory of existing behavioral health system providers and services was developed and is being maintained. Work continued on evaluating the adequacy of the existing service network to ensure SMVF have access to needed services and facilitating a coordinated crisis service intervention system between the VA and community providers, with special emphasis on suicide prevention. Community provider capacity to serve SMVF was enhanced through Military and Veteran 101 Cultural Competency Training. Four workshops were planned, organized and convened which constitutes a labor-intensive major achievement for the collaborating agencies.

DMH collaborates with the Illinois Departments of Veterans Affairs' and Military Affairs (National Guard and Air Guard), to coordinate and improve services for service members, veterans, and their families throughout the state. Military personnel returning from the wars in Iraq and Afghanistan are at increased risk of traumatic brain injury, post-traumatic stress disorder, depression, anxiety and other mental health symptoms as well as new-onset heavy drinking, binge drinking and other alcohol-related problems. Anxiety, depression and engagement in high risk behaviors, such as substance use, are more likely among adolescents in families with a deployed parent than among similar adolescents in non-deployed families (Chandra et al., 2009) Given the increasing recovery needs among returning military personnel and their families, DMH and DSUPR have partnered with the Illinois National Guard and Illinois Department of Veterans Affairs in order to improve access to mental health services, alcohol and other drug treatment, and recovery support services among military personnel returning from deployment and their families.

DMH has worked to establish veteran contacts within each DMH regional office to facilitate coordination of SMVF services and continued relationships with the SAMHSA Service Members, Veterans, and their Families Technical Assistance Center. A Veterans' Care Management Referral System and a Veterans' Warm Line have been created to help ensure veteran referrals are properly accommodated.

During FY2018, efforts to build and maintain an effective system of care to meet the needs of service men and women, veterans, and their families has been ongoing.

DMH participated in collaborative meetings that had agendas aimed at maintaining partnerships with the Department of Veterans Administration, the Illinois Departments of Veterans' Affairs (IDVA), and Military Affairs (IDMA), and other agencies and organizations; completing the behavioral health inventory of existing providers; monitoring the ongoing coordination of services; and facilitating a coordinated system of care. Emphasis has been placed upon coordination of a crisis intervention system with a focus on suicide prevention. There is an ever-growing network of community providers in a collaborative system of care.

DMH conducted a survey that indicated a growing interest in the mental health provider network in veteran services and trainings to address questions regarding treatment for veterans as well as the availability of benefits. The survey was presented to the statewide network of community mental health providers that have a standing relationship with DMH.

Illinois Joining Forces

The Illinois Joining Forces(IJF) is a joint Department of Veterans' Affairs (DVA) and Department of Military Affairs (DMA) effort to better serve veterans, service members, and their families throughout the state. DMH has actively participated in the formation and implementation of the Illinois Joining Forces Initiative and was active in the legislative process that created the Illinois Joining Forces Foundation. IJF brings together, under a common umbrella; public, non-profit, and volunteer organizations to foster increased awareness of available resources and to better partner and collaborate with participating organizations. It has been estimated that Illinois alone has as many as 500 veteran- and military-related organizations but the lack of collaboration and coherence between them has resulted in veterans and service members being frustrated and unaware of the many resources available to them.

Building Veteran Support Communities (VSC) throughout the state that can ensure access to Behavioral Health Services is a continuing process. So far two Veterans Support Communities have been established in the state. Illinois Joining forces is the lead in addressing this initiative. Illinois Joining Forces, IDVA, IDHS/DMH and other community partners are working to get the VSC's up and running but the process has been slower than anticipated, especially in Greater Illinois.

13. Criminal and Juvenile Justice

DMH Forensic Services oversees and coordinates the inpatient and outpatient placement of adults remanded by Illinois County Courts to the Department of Human Services under the Statutes finding them Unfit to Stand Trial (UST) (725 ILCS, 104 -16) and Not Guilty by Reason of Insanity (NGRI) (730 ILCS, 5/5-2-4). Inpatient services are provided at 5 state hospitals with secure forensic Units. In FY19, 394 adults were adjudicated as NGRI, with 380 admitted to the state hospital. There were 637 referrals for individuals found UST in FY19. In regards to non-mandated justice involved individuals with behavioral health needs, DMH has also been centrally involved in several key programs and initiatives that have impacted large numbers of justice involved individuals including the Jail Data Link Program, All these efforts of DMH in working with both the forensic and justice involved population have laid the groundwork for a more comprehensive and effective system of care and treatment that stresses best practices, recovery, diversion, and appropriate use of inpatient and community resources.

Outpatient Fitness Restoration

The Illinois DHS/DMH has contracted with 18 providers to provide an Outpatient Fitness Restoration Program. This program provides community-based fitness restoration services, including psychiatric, mental health and substance abuse treatment services, as well as legal education, for individuals found Unfit to Stand Trial (UST). These programs are designed to (1) reduce the number of individuals determined to be UST, with mental illness and/or co-occurring psychiatric and substance use disorders, on the State Mental Health Hospital waiting list for inpatient fitness restoration services and, (2) increase prompt access to clinically appropriate outpatient fitness restoration services for individuals determined to be UST who do not require the restrictiveness of a hospital setting.

Jail Data Linkage Project

An innovative initiative referred to as the Jail Data Linkage Project that blends technological advancements and clinical systems integration by providing a 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 was initiated in 1999. This initiative was based on findings published by the Bureau of Justice Assistance and other national experts who found that 6.1% of male and 15% of female detainees in the Cook County Jail, suffered from mental illness. The cross match between DMH records and jail census data is based on an automated match between the two data sources which is performed on a regular basis. The program is currently unfunded continues to be active only in Cook County.

Mental Health Juvenile Justice (MHJJ)

is a DHS funded initiative to help identify community services for minors who have severe mentally illnesses being released from juvenile detention centers. This project is overseen through the DHS/DMH Forensic Services Program. Whenever any court personnel (Judge, attorney, probation officer, detention center staff) refers a minor who is in detention, a liaison (a masters level clinician from a community agency), with parental consent, will assess that child. Should that child have a major mental illness (with psychotic or affective disorders), the liaison will work with the family to identify appropriate community services (using a wraparound model that includes mental health, medication, substance abuse, special education and public health services). Next, the liaison identifies funding sources. MHJJ is funded from the state general revenue funds. DHS provides funding to the community agencies, with most agencies receiving funding for one liaison. The initial focus of the MHJJ program was to establish providers within the area of the state's Juvenile Detention Centers. As such, the program started through seven pilot sites in 2000 and as of FY22, it has expanded to 26 funded community agency liaisons servicing 52 counties. In addition, MHJJ funds juvenile justice mental health re-entry liaisons that provide linkage and case management for youths exiting Illinois Youth Centers in the Department of Juvenile Justice. Similar to the MHJJ model, the IYC liaison links youth to appropriate services in their home communities and provides ongoing monitoring for a period of six months. MHJJ is a simple model that can be expanded to these and other juvenile justice populations and is applicable in multiple settings (urban, suburban and rural) as it makes use of existing community services at no cost to the courts.

In FY2016, the MHJJ Program expanded its eligibility criteria to include youth who are "at risk" of encountering the criminal justice system. This expansion includes: (1) Youth who are wards of the Illinois Department of Children and Family Services (DCFS) that have become justice involved who otherwise meet eligibility criteria and need the kind of services and monitoring, particularly for the courts, that MHJJ provides. (2) Youth with mental illnesses who may have had ancillary contact with police (e.g., school resource officers, station adjustments) that were not getting services and/or any type of intervention that could divert them from becoming more involved in the criminal justice system. (3) Youth with trauma histories/symptoms that have come into contact with the justice system or are at risk for such in keeping with the growing concern over how trauma has impacted many youths (with and without mental illness) in the juvenile justice system.

"At risk" youth have a mental illness or symptoms and may have had ancillary contact with police (e.g., school resource officers, station adjustments. They are not receiving necessary services and/or any type of intervention that could divert them from becoming more involved in the criminal justice system. Many of the agencies had programs that could cross refer into MHJJ to capture those youth. The program anticipates a slight increase, perhaps 15-20% in the number of youths referred.

14. Medication Assisted Treatment

This section is not applicable to the MHBG. This section will be addressed in the SABG submission by the DHS Division of Substance Use Prevention and Recovery (DSUPR).

15. Crisis Services

The revision (Revised on 3/05/2021) of this section of the Illinois FY2020-FY2021 Community Services Mental Health Block Grant Plan served as both a modification of the Plan to include significant advances by DHS/DMH in the direction of planning and implementation of Crisis Services since the submission of this Plan on 9-1-2019 and a proposal for the use of the 5% Set-Aside funds allocated to our state. Details are now being included in the FY2022-FY2023 Plan as we are continuing our efforts through the next two years using the funding that we have received.

Illinois has been actively working on improving crisis services for individuals with mental illnesses and their families. Through the years, the array of services purchased by DMH have included crisis intervention as well as capacity grants for staffing to assure the availability of such services. As reported in other sections of this application, Illinois has been a leader in the implementation and adoption of Wellness Recovery Action Planning There has also been a tacit understanding that individuals have in place Psychiatric Advanced Directives that provide instructions with regard to actions to be taken in the event that reliance on a trusted individual to make decisions regarding psychiatric care on their behalf becomes necessary. DMH implemented warm lines, staffed with individuals with lived expertise in mental health and or substance use treatment, through its contract with Beacon-Value Options in 2007. The individuals operating these lines speak with literally thousands of individuals in a year. Policies and procedures determine when referrals to treatment are necessary and should be made. As also reported in another section of the application, DMH staff collaborate constructively with the Illinois Department of Public Health (IDPH) on the annual Illinois Suicide Prevention Plan.

Regarding crisis stabilization, DMH has funded providers to implement living room models, and DMH also purchases crisis residential beds for those individuals requiring these services. DMH has also been a leader in terms of working with law enforcement entities around CIT, crisis work with individuals with mental illnesses, training efforts for first responders encountering individuals in acute mental health crisis in the community, and the development and dissemination of information about available resources to maintain individuals in their communities, and, as necessary, to provide emergency inpatient care. NAMI Illinois has put into place family to family programs and has supported these activities over the years.

DMH also understands the importance of working with Emergency Departments with regard to individuals with mental illnesses in crisis situations who present for treatment. DMH crisis intervention funding may be used by contracted providers to provide crisis intervention services to individuals who present at Hospital Emergency Departments. Targeted funding in two areas in which DMH hospitals were closed was allocated to assure continued access to crisis intervention services in Emergency Departments as well as other locations, and to assure availability of crisis residential and substance use residential services as well as community- based services (e.g., acute community services) to individuals presenting with a crisis. These dollars were allocated in addition to the traditional crisis care services described previously. This work allowed DMH to develop a more detailed approach to crisis program contracting statewide in more recent years.

Suicide Prevention Activity and Crisis Services in Illinois:

In the Needs Assessment Section of this Plan developed with the assistance of the Illinois Mental Health Planning and Advisory Council, attention was paid to the 2017 SAMHSA Behavioral Health Barometer which cited that "an annual average of about 378,000 adults aged 18 or older (3.9% of all adults) in 2014-2015 had serious thoughts of suicide in the past year and that the annual average percentage in 2014-2015 was not significantly different from the annual average percentage in 2011-2012". Effective and consistent crisis intervention is necessary to address the ongoing risk of suicide in the State. The IDPH has been responsible for Suicide Prevention activities and, in collaboration with the Suicide Prevention Alliance- a coalition of state agencies and stakeholders, regularly updates the Illinois Suicide Prevention Plan. The 2018-2021 Illinois Strategic Suicide Prevention Plan was attached to the FY20-FY21 Plan. The Illinois 2020-2023 Suicide Prevention Strategic Plan with Updated Goals and Objectives is attached.

Progress in 988 Service Preparation

The Landscape Analysis required in 988 planning was completed by the 6 current Lifeline Call Centers, as required by that grant. At this time, there remain large, uncovered areas of the state. Our intention is to develop additional call centers and utilize a similar approach to identify and address any remaining gaps in the system.

DMH is excited to consider the impact of our final implementation plan that will include linkage of our LCC with a variety of community resources and other systems, including the Medicaid CARES line for Mobile Crisis Response dispatch to those Medicaid covered individuals identified as needing that level of response. DMH will also develop performance measures and standards for Lifeline member centers to develop relationships with the 11 Regional 911 dispatch centers in Illinois, and other community partners as identified through our local/regional planning efforts.

DMH worked collaboratively with all Lifeline member centers in Illinois to develop a key stakeholder's group for 988 roll out. This Coalition includes a variety of representatives and has been very active in the development of our 988 implementation plan.

DMH will be issuing a Notice of Funding Opportunity to expand LCC and this will include provisions for follow up services and other standards consistent with Vibrant and the National Suicide Prevention Lifeline policies. With the current six Lifeline member centers already adhering to this requirement, DMH is in a position to strengthen the array of services made available through our safety net services, based on the data reported by Lifeline member centers. DMH will require applicants to provide demographic data as part of their application and to include a staffing plan demonstrating that individuals answering calls are reflective of the call center's identified coverage area.

MCR responders must include the utilization of the HFS-approved crisis screening instrument, the Illinois Medicaid Crisis Assessment Tool. (IM-CAT) which is a decision support and communication tool to allow for the rapid and consistent communication of the needs of individuals experiencing a crisis that threatens their safety or well-being or the safety of the community. It is intended to be completed by those who are directly involved with the individual. The form serves as both a decision support tool and as documentation of the identified needs of the individual served along with the decisions made with regard to treatment and placement at the time of the crisis.

Proposed Use of Set-Aside Funds:

Illinois is committed to moving its crisis response system forward to eventually achieve the "air traffic control center" model for crisis services through employing the evidence-based practices described in the National Guidelines for Behavioral Health Crisis Care-Best Practices Toolkit. The 5% Set-Aside funds will be directed to crisis services that encompass the three core elements in the crisis continuum. Agencies receiving the funding will work on building their capacity to provide the following: 24/7 availability in responding to crisis calls originating from the area they cover. As necessary, they will either directly provide or will arrange for mobile crisis response to assess the individual's identified concerns, provide face-to-face diagnostic assessment and crisis intervention; and, if needed, connect and accompany the individual and family to local crisis stabilization resources including immediate outpatient services, peer run living rooms, 24-hour respite services, and hospital emergency rooms. They will also be required to follow up to assure that the crisis has been resolved and that the individual is receiving and will continue to receive needed clinical and support services that he chooses.

The Set-Aside dollars will be included in a Notice of Funding Opportunity (NOFO) published for competitive bid throughout the state. Once agencies are approved and awarded contracts, the funds will be allocated to agencies that can adequately serve areas which have previously been poorly covered or uncovered that have a population with a larger segment of unfunded, underfunded, and undocumented Illinoisans who have likely been underserved.

It is anticipated that the selected agencies will work with DMH towards identifying, implementing, and reporting on reasonable service targets that will be incorporated in the FY2022-2023 MHBG Application and Plan and subsequently reported to SAMHSA annually.

16. Recovery

The DMH vision is: Recovery is the expected outcome! With a vision, mission, and values based upon recovery, the provision of mental health care that is consumer and family driven is an important priority of the Illinois Division of Mental Health. The current emphasis is on involving consumers and families in orienting the mental health system towards recovery, and improving access to and accountability for mental health services.

A variety of initiatives are available to all individuals receiving services:

Under direction of the DMH, the Illinois Mental Health Collaborative for Access and Choice (Beacon Health Options), the DMH ASO, operates a statewide Warm Line as a cutting edge source of peer and family support.
Since the first call in July 2008, the Illinois Warm Line has responded to 127,096 calls. In its thirteenth year of operations, the Warm Line effectively responded to large increases in call volume to provide education, support, information, and referrals for the residents of Illinois as they navigated through the COVID pandemic. The Illinois Warm Line is a free support line staffed by individuals in recovery who role model wellness and recovery principles on every call. The team supports callers and creates a safe space to share. The Illinois Warm Line is characterized by strengths-based support that promotes holistic wellness through recovery oriented, trauma informed approaches. Callers are empowered to make self-directed, proactive decisions regarding their wellbeing based on the hope that recovery is the expectation!
After transitioning the Illinois Warm Line operations to remote work status in March 2020, Beacon Health Options continued remote operations throughout FY21. The DMH expanded Illinois Warm Line hours through an emergency contract and then the expanded hours were made permanent through a formal contract amendment in July 2020. The Warm Line expanded hours are Monday through Saturday, 8:00 a.m. - 8:00 p.m.
A concerted effort has been made to ensure that consumers are members of the Illinois Mental Health Planning and Advisory Council (IMHPAC) and play an important role in planning for mental health services. Representation by consumers and parents of children with serious emotional disturbances has increased. Consumers and/or family members co-chair the IMHPAC, as well as all IMHPAC sub-committees.
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 evidence-based practice in recovery-oriented services. An evidence-based practice, WRAP is a multi-week program led by certified facilitators. WRAP teaches people living with mental illnesses how to identify and use illness self-management resources and skills that help them stay well and promote their recovery. Studies show that WRAP improves participants' quality of life and reduces their psychiatric symptoms. Increasing access to WRAP Facilitator Training in Illinois is an important priority. Despite the challenges of the COVID-19 pandemic, DMH Bureau of Wellness and Recovery Services continued to offer continuing education for certified WRAP Facilitators virtually and technical assistance for facilitators to learn how to conduct their WRAP classes virtually. No authorization has been given for states to provide WRAP Facilitator Training virtually, putting those trainings on hold since the pandemic resulted in remote work. However, the community support services already-certified WRAP facilitators provide are Medicaid-reimbursable, making WRAP an affordable program for many agencies. As of December 1, 558 individuals had been trained and certified as WRAP Facilitators in Illinois.
DMH conducts a series of statewide teleconference calls designed to disseminate important information to consumers across the State. These calls provide a forum for discussion of service information, performance data, new developments, and emerging issues to promote consumers' awareness and knowledge and provide consumers with the tools they need to cogently and effectively participate in the development and evaluation of the service system. The goal of these Recovery and Empowerment calls 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.Ten teleconferences are conducted annually. Ten teleconferences were conducted in SFY2020 with an attendance ranging from 165 to 395 persons per call and an aggregate attendance of 2,943. Participation in the conference calls dropped significantly after March 2020 from an average of 355 per call to an average of 200 per call largely due to attendance now being limited to mostly individuals. Before then, groups of participants gathered in community settings to attend these calls.
CRSS is the professional credential for individuals providing peer recovery support services in Illinois. It is a competency-based credential, managed by the Illinois Certification Board. In order to obtain the CRSS, individuals must complete:
- 100 hours of training/education
- 2,000 hours on-the-job experience
- 100 hours of supervision
- CRSS exam

The CRSS is required for positions with the State of Illinois in state hospitals and region administration and as part of Medicaid reimbursed team services (ACT & CST) and BIP Enhanced Services. The CRSS credential assures competence in advocacy, professional responsibility, mentoring, and recovery support. Certified Recovery Support Specialists are persons with lived experience who provide mental health or co-occurring mental illness and substance abuse peer support to others using unique insights gained through personal recovery experience and have the ability to infuse the mental health system with hope and empowerment, and improve opportunities for others to:

Develop hope for recovery
Increase problem-solving skills
Develop natural networks
Participate fully in the life of the community

To adapt to the virtual environment forced upon us by the COVID-19 pandemic, the DMH Bureau of Wellness and Recovery Services modified all CRSS Training modules for interactive, online learning. In FY2021, CRSS Fundamentals Training, CRSS Competency Training, and CRSS Supervisor Training were all held online. In addition, two new modules were developed and delivered: CRSS: Minimum Competency Standards, and CRSS: Obtaining Education Hours.

Information regarding this credential can be found at http://www.iaodapca.org/forms/crss/CRSS_Model.pdf

Three new activities in Recovery Support Services for FY2020-2021 are:

A brief testimonial video about WRAP was produced, previewed for consumers and providers, and linked to the DHS website.
A new electronic process for collecting data from certified WRAP Facilitators was designed by DMH MIS and will be launched within the next quarter.
DMH is in conversation with the Illinois Certification Board about the possibility of developing a new CRSS credential for young adults (CRSS-YA).

The link to the Recovery Support Services website is:
http://www.dhs.state.il.us/page.aspx?item=36696roduction

17. Community Living and the Implementation of Olmstead

Background on the Williams and Colbert Consent Decrees

The Williams vs. Pritzker (previously Williams vs. Rauner) Consent Decree is based on a Class Action lawsuit filed in 2005. The state agencies named in the lawsuit are the Department of Human Services/Division of Mental Health and Division of Alcoholism and Substance Abuse; the Department on Aging; the Department of Public Health; and the Illinois Department of Healthcare and Family Services. The suit targeted 4,500 residents of nursing facilities designated as Institutes for Mental Disease (IMD), now known as Specialized Mental Health Rehabilitation Facilities (SMHRFs) - more than 50% of the residents had a diagnosed mental illness. The suit contended that the State violated the rights of residents by not affording them opportunities to move from these settings to the community, specifically to their own leased held apartments. The suit was settled in 2010, and as part of the settlement, the parties must file an implementation plan annually. The Williams Implementation Plans may be accessed at: http://www.dhs.state.il.us/page.aspx?item=56446.

The Colbert vs. Pritzker (previously Colbert vs. Rauner) Consent Decree is based on a Class Action lawsuit filed in 2007. The state agencies named in the lawsuit are the Department of Human Services, the Department on Aging, the Department of Public Health and the Illinois Department of Healthcare and Family Services. The suit targeted approximately 20,000 residents of skilled nursing facilities in Cook County, Illinois. The suit contended that the State violated the rights of residents by not affording them opportunities to move from these settings to the community, specifically to their own leased held apartments. The suit was settled in 2011, and as part of the settlement, the parties must file an implementation plan annually. The Colbert Implementation Plans may be accessed at: https://www.dhs.state.il.us/page.aspx?item=121712.

Prior to calendar year 2020, the Illinois Department of Human Services was the lead agency in implementing compliance with the Williams Consent Decree, and the Department on Aging led the implementation of the Colbert Consent Decree. Because both the Williams and Colbert Consent Decree seek to address the community integration mandate of the Olmstead Supreme Court decision and provide services in the least restrictive and most integrated setting possible, the State of Illinois believed that the operations of both programs should be combined to streamline and standardize processes across both consent decrees to improve service quality and heighten the state's compliance with the consent decrees. The Illinois Department of Human Services, Division of Mental Health, became the lead agency for both the Williams and Colbert Consent decrees, and in February of 2020, the Comprehensive Class Member Transition Program (CCMTP) was launched. The CCMTP is a pilot program that restructured the service delivery model for the consent decrees. The CCMTP aimed to minimize handoffs between providers and mandates that one provider works with a Class Member along the entire continuum of services, from outreach through post-transition. The new CCMTP model also increased provider capacity by providing expenditure-based funding coupled with outcome-based incentive payments. During February 2020, contracts with 13 provider agencies were signed, the provider agencies began to hire and onboard new staff, IDHS held orientations and trainings for the new service delivery model, and the CCMTP was operationalized.

The state is now entering into the eleventh year of the original five-year Williams settlement. Since implementation, 2,982 residents of SMHRFs/IMDs have been transitioned to the community under Williams. The state is now in the ninth year of the Colbert settlement. Since implementation, 2,868 residents of Cook County nursing facilities have transitioned to the community. The majority of Class Members moved into lease-held apartments made possible by the Permanent Supportive Housing model with a bridge subsidy. Others were transitioned to other housing options as appropriate to their needs.

In SFY2022, the Governor's Introduced Budget includes approximately $59.5 million to support the transition of Williams Class Members, and approximately $51 million to support the transition of Colbert Class Members. These funds are intended to support the development of permanent supportive housing with services and supports, expand home- and community-based services, and meet other transitional costs associated with implementing the consent decrees. In FY2020, the final spending across both consent decrees was approximately $77 million.

Housing

Illinois has expanded housing resources for individuals with mental illnesses by implementing Permanent Supportive Housing (PSH), a specific Evidence Based model in which a consumer lives in a house, apartment or similar setting, alone or with one other consumer upon mutual agreement. The criteria for supportive housing include: an income level at 30% or below Area Median Income, housing choice, functional separation of housing from service provision, the consumer's right to tenure, choice of services, service individualization, and service availability. Housing also incorporates affordable housing programs for persons who do not have mental illness (consumers pay no more than 30% of income on rent). Ownership or lease documents are maintained in the name of the consumer, so tenant-landlord relationships are maintained.

Permanent Supported Housing is provided in a manner consistent with the national standards for this evidence-based practice. The DMH Bridge Subsidy model provides tenant-based rental assistance designed to act as a "bridge" from 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. Consumers who have a serious mental illness or a co-occurring mental illness and substance abuse disorder, or who are Colbert or Williams Class Members, whose household income is at or below 30% of Area Median Income (AMI) as defined by HUD are eligible to apply to the program. DMH has targeted 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. The goal is to promote and stabilize consumer recovery by providing decent, safe, and affordable housing opportunities linked with voluntary DMH-funded community support services.

The number of individuals benefitting from permanent supported housing has steadily increased, due to the Williams and Colbert Consent Decrees. In total, more than 4,000 consumers of mental health services have received subsidies.

The Illinois Housing Development Authority (IHDA), the Corporation for Supportive (CSH) Housing and Governor's Housing Coordinators, in partnership with DHS, have worked with developers, real estate companies and landlords to increase housing stock to address the housing needs of Class Members. In the process of transitioning interested Class Members to community housing, it is expected that the chosen community service providers will assure the provision of transition coordination services that include: assistance with the housing search, developing a comprehensive individualized service plan that includes a risk mitigation plan and a 24-hour emergency back-up plan, assuring that entitlements are transferred and in effect, assistance with purchasing furniture and supplies and, most importantly, assuring linkages are completed for requisite services, including all needed mental health services as well as medical and other necessary services and supports.

IHDA currently manages the HUD Section 811 project-based vouchers. There are 265 HUD 811 units available for Class Members across the Consent Decrees, as well as individuals through the Front Door Diversion Project (diverting from admission to Long-Term Care).

Home and Community-Based Services

The state is responsible for ensuring the adequacy and appropriateness of treatment, services, supports, and housing necessary to offer Community-Based Services and supports to individuals transitioning from a SMHRF or SNF to the community, subject to the State-Plan and Medicaid service array. In FY22, the state is conducting a capacity and gaps assessment for a number of service areas, including but not limited to: Assertive Community Treatment/Community Support Teams, Substance Use Disorder services, Peer Supports, Employment Supports, In-Home Waiver Services, and Housing (including both overall capacity/need by type of housing and geographic preferences of Class Members). The state will then develop a written plan outlining strategies to close any identified gaps.

Currently, the CCMTP relies on 13 community providers to deliver all Consent Decree services to Class Members, from outreach, assessment, service planning, SOAR, employment, and housing services, to community placement, transitioning, and care management in the community. Additionally, the 13 community providers, most of which are community mental health centers, provide community support services, including Assertive Community Treatment (ACT) and/or Community Support Teams (CST) services.

Recovery Support Services

IDHS encourages its 13 community providers to employ people with lived expertise of mental illness or community transition to deliver services to Class Members. IDHS also continues to engage NAMI to provide recovery support services through two separate programs - Peer Ambassadors and In-Home Recovery Support Specialists (IHRS). Prior to FY22, NAMI's services were available only to Williams Class Members. Starting in FY22, NAMI's services are available to both Williams and Colbert Class Members.

NAMI's Peer Ambassadors (Class Members who have successfully transitioned from the SMHRFs to the community) work with Class Members under the CCMTP and operate in conjunction with the 13 provider agencies' outreach activity. The Ambassadors serve as liaisons between Class Members, provider agencies, and DMH. Class Members may approach Peer Ambassadors with questions or concerns regarding their status with the Comprehensive Program. Peer Ambassadors will consult with DMH or the assigned provider agency and provide feedback to the Class Member. Peer Ambassadors also host regular community meetings, at least once per quarter (held remotely during COVID-19), which provides them with a regular presence in the facilities to engage with Class Members and address concerns. The Peer Ambassadors work in facilities to share their stories of recovery, including their experience living in the community and advice on how to make independent living successful. These community meetings generate increased interest in transitioning out of the facility and facilitate access to Class Members who may not otherwise be reached by outreach activities. They receive training on how to effectively engage in outreach to Class Members, and their work provides important additional support for Class Members beyond the outreach and care management staff at the provider agencies.

Peer Ambassadors can accompany Class Members to Drop-In Centers and other leisure activities in the community, such as going to a museum or getting coffee. These community excursions help Class Members to become more comfortable with environments outside of the SMHRF and build skills related to navigating the community safely. Peer Ambassadors also support eligible Class Members in connecting to In-Home Recovery Services (IHRS) as part of their transition process.

There are 20 Drop-In Centers across the state, where Class Members and other consumers can communicate with others who have successfully moved to the community. Peer Ambassadors can assist Class Members in navigating public transportation to Drop-In Centers, although these excursions were curtailed by the COVID-19 pandemic. However, the Drop-In Centers continue to operate and are available to Class Members who live in the community.

NAMI's IHRS team works with Class Members during the pre and post transition phase to independent community living, for a maximum of six months. The assigned Prime Agency or RSP can request an extension (for a maximum of 2 additional months) for the Class Member after 6 months of service, if deemed necessary. When a Class Member is assigned to IHRS, the assigned RSP:

Develops a recovery model and work plan (updated quarterly), incorporating applicable supporting agencies who help to identify goals needed for Class Members to maintain and sustain long term independent living in the community, post transition.
Develops a Wellness Action Recovery Plan (WRAP) with the Class Member identifying areas of challenge or concern and areas where support is most needed.
RSPs are available between the hours of 9 a.m. - 10p.m., with support available in-person from 9 a.m.- 8p.m., and by telephone from 8 p.m. - 10 p.m.

Services Provided under the IHRS program include:

Budgeting & financing;
Fitness and workout support at local health clubs to enhance mental health, physical health and wellness;
Assistance with grocery shopping and meal planning and preparation;
Assistance with navigating the public transportation systems;
Connection to healthy, natural community social supports; and
Assistance with hygiene and Activities of Daily Living (ADL).

Employment Services: Individualized Placement and Support Employment Programs (IPS)

DRS and DMH IPS leaders presented to Prime Agencies regarding benefits of working and employment supports available to class members. An Employment Workgroup was formed, including Employment leaders in DHS, DRS, and DMH, to collaborate monthly to brainstorm and implement strategies to increase employment for Williams and Colbert class members. DHS, DRS and FCS partnered to access contact information for approximately 5000 class members who have transitioned to the community since 2012, and created a targeted communication to be sent in 2021. The Employment First Manager presented at each regional IPS meeting regarding Williams and Colbert Consent Decrees and efforts to increase employment for class members. The Employment First Manager partnered with UIC-CON, DMH and DRS, to create a monthly Employment Data Dashboard. The Employment First Manager also leads the effort to bring benefits counseling software to Illinois.

Front Door Diversion Program

The Front Door Diversion Program (FDDP) seeks to ensure that no individual with serious mental illness is admitted to a SMHRF without first being offered community-based services. The FDDP transitions individuals primarily from hospitals to community settings to prevent unnecessary long-term care admissions. Individuals can be diverted from other settings to the community. FDDP providers receive referrals from PASRR agencies, and conduct screenings to determine what housing and community-based services are needed. The FDDP agency then makes an offer, which includes housing, treatment, and other community-based services, which the consumer can accept or decline.

Six agencies conduct diversion activities at 40+ hospitals and are reimbursed based on a pay-for-performance model. The IDHS/DMH grant pays for staff and activities that cannot be reimbursed through Medicaid billing. Additional funds are paid for attaining the initial diversion, maintaining engagement with consumers at extended community intervals, attaining Permanent Supportive Housing, and achieving diversions over the target contractual number. The IDHS/DMH grant also funds the following services:

Consumer assistance actions: emergency contingencies (medication, clothing, food, cell phone, etc.) and some housing-related services;
Short-term housing: studio or one-bedroom apartments or other temporary housing (Single Room Occupancy "SRO" units, or long-term hotels) for immediate use by a discharged consumer while further stabilizing with prescribed treatments and applying for and securing a match for PAIRS/SRN or Section 811 units or Bridge Subsidies. Funds support rent, landlord fees, apartment set-up (furniture, furnishings, food, supplies), utility deposits/costs, re-stocking of unit for future occupants and other costs approved by the program contacts; and
Additional staff, such as on-board housing coordinators to assist consumers with all associated housing needs.

What efforts are occurring in the state or being planned to address the ADA community integration mandate required by the Olmstead Decision of 1999?

The state has identified several key priorities for State Fiscal Year 2022, including the following:

Transitioning Class Members: The state aims to transition 400 Williams Class Members and 450 Colbert Class Members during SFY22.
Front Door Diversion Program: The state has implemented a revised Front Door Diversion Program beginning July 1, 2021, that includes a requirement that the providers provide meaningful, written offers for Community-Based Services and Setting to eligible individuals prior to admission to a SMHRF. A meaningful offer includes the written offer of housing options in Community-Based Settings and specific Community-Based Services and support consistent with the individuals' preferences and clinical needs.
Rigorous CCMTP Management: The state will apply heightened oversight of the provider agencies contracted to provide services to Class Members, holding the providers accountable for all aspects of transition-related performance. Poor performance will be addressed via issuance of Performance Improvement Plans and Corrective Action Plans.
Improve Data Systems: The state implemented a new data management system beginning July 1, 2021. The new system allows for real-time data entry which will provide more accurate, timely, and reliable data for the CCMTP to inform further program development and compliance matters. Monthly data dashboards will be used to track ongoing performance and trends.

The state has also engaged the University of Illinois at Chicago Jane Addams College of Social Work (UIC-JACSW) to evaluate the progress and outcomes of the CCMTP pilot. The information from UIC-JACSW will inform policy and programmatic changes. Because the CCMTP pilot expires June 30, 2022, the services needed to comply with the community integration mandate must be competitively re-bid and purchased for an effective start date of July 1, 2022.

18. C&A Behavioral Health Services-(Required)

The DMH Bureau of Child and Adolescent Services (C&A Service) facilitates the delivery of the array of services for children and adolescents with SED and their families through the dissemination of knowledge, research, information, evidence-based practices, and data analytics. Since all six child serving systems in Illinois play some type of role in the provision of mental health services, our role is to work collaboratively across systems to ensure the successful implementation of a Systems of Care Philosophy while identifying gaps in services and developing programs to fill those gaps. The collaborative efforts in which we are currently engaged include:

The Governor's Office of Early Childhood has been focused on the implementation of many programs designed to improve outcomes for children under 5 and their families. C&A Services is part of the Illinois Infant/Early Childhood Mental Health Consultation workgroup, and recently began working on developing and implementing a plan to expand the use of the DC 0-5 within our local Community Mental Health Centers. Once we have build capacity in Illinois for our clinicians to utilize this developmentally appropriate diagnostic tool we will utilize data collected on the most frequent diagnoses to identify which evidence based practices would best treat the populations and then develop a training and technical assistance plan to increase the availability of these practices.

C&A Services has had a long-standing collaborative relationship with the Illinois State Board of Education. In 2007, we began working on the Interconnected Systems Model of School Based Mental Health. This model has experienced many changes over the years and is currently part of School Wellness and included in the Comprehensive System of Learning Supports for all schools. It was through this successful collaboration that ISBE applied for a Project AWARE grant that was successfully funded in 2020. We also worked in collaboration with ISBE and other systems rolled out the School Based Mental Health Resources database a requirement of Public Act 101-0045. When COVID resulted in the immediate closure of schools in 2019 the Infectious Disease Outbreak Resource page was added. However, it was quickly determined that this information while valuable was not sufficient to support the mental wellbeing needs of all Illinoisans, and the follow two pages were created and updated regularly. Customers including parents, caregivers, and many other can find resources on mental wellness, nation links, and resources to support families who found themselves at home together for the first time ever. The challenges that a professional faced as a result of COVID and the self-care needed to take care of oneself in order to take care of others was also identified as a high need, and therefore the DMH Resources for Providers page was also created.

Beginning before the COVID Pandemic and continuing C&A Services has been part of the Safe2Help Steering Committee. This collaboration is spearheaded by the Illinois Emergency Management Authority and the Illinois State Police. In September 2021 Safe2Help will go public. This talk and text line for students to reach a trusted adult where they can report unsafe school environments and issues that they are concerned about. To support schools personnel in the rollout of this resource ISBE has created 6 Mental Health Hubs linked Regional Office of Education that will provide training, technical assistance and most importantly age appropriate resource guides designed by experts in the field for PreK-4^th grade, 5^th-8^th grades, and 9^th-12^th grades. This work all resulted in Illinois applying for and being one of 4 States to be part of the National Governors Association Policy Academy on Preventing Targeted Violence in Schools.

Illinois has also been working on the implementation plan for the Early Periodic Screening Diagnosis and Treatment lawsuit that was filed in 2011 against HFS. The Pathways to Success, an Enhanced System of Care for Medicaid eligible individuals under the age of 21 launched on March 1, 2021. Child and Adolescent Services along with the other Child Serving systems have been involved in monthly collaborative meetings resulting in a plan to meet the goals of improving family functioning, increase the use of evidence-based practices, improve school attendance, increase family and youth involvement in services, and reduce the use of out-of-home treatment needs.

The Illinois Children's Mental Health Partnership (ICMHP) which was created as a result of the 2003 Children Mental Health Act https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2481) serves as a public/private partnership designed to ensure the development of a coordinated mental health service array for children from birth through age 19 focused on prevention, early intervention, and treatment across all child serving systems. The original plan was created in 2005. They are currently engaged in the strategic planning process to develop a new updated plan that will be completed by March 2022. The planning process is supported by the work of four workgroups focused on the Social Determinants of Health, Prevention, Early Intervention, and Treatment needs. The recommendations created by these workgroups will provide clarification of the needs and gaps in the Illinois Mental Health System that provides services including safety net services. C&A will utilize this plan to identify the unique needs and programs we will focus over the next five years.

The Specialized Family Support Program (SFSP) is a 90-day program of crisis stabilization, community mental health, and assessment services, developed in response to the Custody Relinquishment Prevention Act (Public Act 98-0808). It is a collaborative effort between the Illinois Departments of Healthcare and Family Services (HFS), Children and Family Services (DCFS), Human Services (DHS), Juvenile Justice (DJJ), Public Health (DPH), and the Illinois State Board of Education (ISBE), designed to identify the behavioral health needs of youth at risk of custody relinquishment and to link those youth to the most appropriate clinical services. SFSP is an expansion of the Illinois behavioral health crisis response system for youth, jointly utilizing the resources found in the Screening, Assessment and Support Services (SASS)"https://www.illinois.gov/hfs/MedicalProviders/behavioral/sass/Pages/default.aspx, Comprehensive Community-Based Youth Services (CCBYS) http://www.dhs.state.il.us/page.aspx?item=31868, and Intensive Placement Stabilization (IPS) programs. New legislation, the Children and Young Adult Mental Health Crisis Act (HB2154) requires the Department of Healthcare and Family Services to restructure the Family Support Program (SFSP) to enable early treatment of youth, emerging adults, and transition-age adults with a serious mental illness or serious emotional disturbance. Contains provisions on the new hallmarks of the Program including federal Medicaid matching dollars and a group or individual policy of accident and health insurance, or managed care plan that will be renewed after December 31, 2020 for the purpose of early treatment of a serious mental illness in a child or young adult under age 26 to provide coverage for: (i) coordinated specialty care for first episode psychosis treatment and (ii) assertive community treatment and community support team treatment. For further information about the SFSP Program see the website at: https://www.illinois.gov/hfs/MedicalProviders/behavioral/sass/Pages/sfsp.aspx

DMH C&A is currently implementing recent legislation, HB907, that requires the Department of Human Services to create and maintain an online database and resource page on its website. The website will contain mental health resources specifically geared toward school counselors, parents, and teachers with the goal of connecting those people with mental health resources related to bullying and school shootings and encouraging information sharing among educational administrators, school security personnel, and school resource officers. It is also being geared toward school social workers and school support personnel.

Since FY2016 when the six child serving systems in Illinois signed an Intergovernmental Agreement to address the mental health needs of Children and Adolescents that are at risk for psychiatric lock-out, efforts to address this problem have continued. This action was in support of Public Act 098-0808, and consistent with the unique population of focus that Illinois had identified in Systems of Care Expansion Implementation Cooperative Agreement. Two work groups were convened to meet the requirements under this Act. The first consists of content experts from the six child serving state agencies to put together the program plan and the second is a group of lawyers also representing the six child serving systems who are ensuring that the program plan is in line with current rules, so that any necessary changes can be initiated immediately. Their first accomplishment was to develop the Specialized Family Support Program Consent that allows the family to sign one consent to share information across the Departments. This "Universal Consent" is the first of its kind in Illinois and meets not only HIPPAA, but also FERPA and the Illinois Mental Health Confidentiality requirements. The roll-out of the Universal Assessment titled IM-CANS (Illinois Medicaid - Child and Adolescent Needs and Strengths Assessment) took place in September 2016. Please see Section C-1 for further information about the IM-CANS.

19. Suicide Prevention

The SAMHSA Behavioral Health Barometer for Illinois, Volume 5, reports that during 2013-2017, the annual average prevalence of past year serious thoughts of suicide in Illinois was 3.6% (or 349,000), lower than the Midwest regional average (4.2%) but similar to the national average (4.1%). The percentage did not change significantly between 2008-2012and 2013-2017. More than 1,000 persons die by suicide each year in the state and suicide fluctuates yearly between being the second or third leading cause of death for adolescents. In 2004, the Suicide Prevention, Education and Treatment Act (PA093-0907) was passed by the General Assembly and signed by the Governor directing the Illinois Department of Public Health (IDPH) to appoint the Illinois Suicide Prevention Strategic Planning Committee composed of representation of statewide organizations and local agencies that focus on the prevention of suicide and support services to survivors. To unify planning and suicide prevention efforts, an alliance was formed between a coalition of stakeholders and the strategic planning committee that was recognized in law by the General Assembly in 2008. The mission of the Illinois Suicide Prevention Alliance (the Alliance) as stated in the law is "to reduce suicide and its stigma throughout Illinois by collaboratively working with concerned stakeholders from the public and private sectors to increase awareness and education, provide opportunities to develop individual and organizational capacity in addressing suicide prevention, and advocate for access to treatment."

Recently, the thrust of Illinois suicide prevention has been to advocate for increased funding, develop training opportunities, increase public and professional awareness of state and local suicide prevention resources in Illinois, and increase opportunities for linkages. Several significant bills to increase resources to address suicide have been introduced in the General Assembly but are still pending. As funding has not been available, suicide prevention efforts have largely been voluntary and collaborative.

In the past few years, providing continuity of care for mental health consumers in state inpatient facilities transitioning to the community has been a priority. In state hospitals, formal suicidal risk evaluations have been employed both at the time of admission and prior to discharge. There has been an assertive effort to register and qualify consumers for Medicaid prior to their discharge so that they can access needed crisis services in community-based settings.

In reference to military personnel and their families, it is notable that representatives from the Veteran's Administration programs in Illinois have been active stakeholders and have attended Alliance meetings for the past several years. Recently, Illinois Joining Forces (IJF) has formally joined the Illinois Suicide Prevention Alliance (ISPA) and have become a standing committee of the Alliance in order to potentiate both ISPA and IJF resources.

Illinois joined the Governor's Challenge to Prevent Suicide, a national effort that champions mental health support and preventative services for Veterans in November 2020. The State is dedicating $2 million to the initiative. The Illinois Governor's Challenge Team has embarked on planning and implementing training in hospitals and other locations where veterans with suicidal thoughts and symptoms of PTSD and Depression could be speedily reached and supported to attain the necessary mental health and support services which could lower the risk of suicide. Outreach and public education approaches will be employed extensively to promote awareness of veterans and service members at risk. Trainings in hospital settings are focusing on Screening for Suicide Risk, counseling on lethal means safety, and effective safety planning for family members and the service members themselves. For more information, please see Table 1-Priority #10.

The Illinois 2020-2023 Suicide Prevention Strategic Plan with Updated Goals and Objectives is attached.

20. Support of State Partners (Required)

Interagency Partnering and Collaboration

DMH works regularly with the following state agencies:

The Illinois Department of Healthcare and Family Services (IDHFS). The state's Medicaid authority is the largest purchaser of mental health services in the state. Services are provided by individual practitioners, hospitals, and nursing facilities, including medication, psychiatry, inpatient services, and long-term care. It oversees the Medicaid Managed Care program in the State. Illinois Public Act 096-1501 (Medicaid Reform) required that a minimum of 50 percent of Medicaid clients be enrolled in coordinated care by 2015. Currently more than 85% of Medicaid clients are in Managed Care. This goal is being achieved through contracts with Coordinated Care Entities, Managed Care Community Networks, and Managed Care Organizations.

IDHS Division of Substance Use Prevention and Recovery (DSUPR) to address services for individuals with co-occurring mental and substance use disorders.

IDHS Division of Developmental Disabilities to address the needs of persons with autism spectrum disorders and individuals with co-occurring developmental disabilities.

IDHS Division of Rehabilitative Services to increase the access of individuals with serious mental illnesses to vocational rehabilitation services and to improve the coordination of psychiatric and vocational services through initiatives such as the IPS model of supported employment.

Illinois Housing Development Authority and IDHFS to implement the Williams Consent Decree and provide permanent supportive housing.

Illinois Department on Aging to increase training opportunities in the geriatric field and to improve the quality and accessibility of services for elderly persons with mental illnesses.

Illinois Department of Public Health (IDPH), in conjunction with IDHFS to support people with serious mental illnesses who require long-term care services. DMH also works with IDPH to develop the state's suicide prevention plan and related efforts.

Illinois Departments of Veterans Affairs and Military Affairs (National Guard and Air Guard), to coordinate and improve services for service members, veterans, and their families throughout the state.

Illinois Department of Corrections (IDOC) and IDJJ to address the needs of adults and juveniles involved with the justice system. It has been estimated by IDOC healthcare staff that 16% of 48,000 in the total DOC population have a mental health disorder. Fourteen percent of the detainees in reporting Illinois county jails have mental illnesses. IDJJ has reported that 17 percent of the youth under their purview were identified as having moderate mental health needs and 50 percent were identified as having mild mental health needs. All of them, representing 67 percent of the population, received some form of mental health treatment (group or individual).

Illinois Department of Children and Family Services (IDCFS) on a number of initiatives, including Screening, Assessment, and Support Services (SASS). Collaborative efforts have included training for child welfare staff and service providers to examine and respond to the trauma children and families experience as a result of physical abuse, neglect, sexual abuse, and domestic violence. IDCFS has noted that 50 percent of children in the child welfare system have mental health problems, often related to early trauma.

Illinois State Board of Education on the Interconnected Systems Model of School Based Mental Health and collaboration on the Illinois Positive Behavioral Interventions and Supports to facilitate the integration of community mental health providers in schools to address prevention and early intervention and provide for the social, emotional, and behavior supports for students, teachers and families.

21. The Illinois Behavioral Health Planning and Advisory Council and Input on the Mental Health Block Grant Application (Required)

Description of Role and Activities

The Illinois Mental Health Planning and Advisory Council (IMHPAC) advises the DMH on mental health issues. The Advisory Council currently is a body of 52 members, which includes individuals with lived expertise and representatives from public and private organizations that plan, operate, and advocate for mental health and support services for persons with serious mental illness. Established in 1992, the Advisory Council's participation in the analysis of Illinois' mental health system over time has yielded a significant public/private partnership that focused on restructuring public mental health services in Illinois and guided the development of a strategic plan for consumer-responsive, community-based, and cost-effective service delivery. The Council approved a set of By Laws at the end of FY2002 and has revised them periodically as needed.

Each DMH Community Comprehensive Service Region (CCSR) is represented on the Council. Providers, consumers, family members and parents of children with SED who are members of the Council may also act in an advisory capacity in the Regions. State employees representing principal state agencies with respect to mental health, education, criminal justice, vocational rehabilitation, housing, and a variety of social services as well as representatives of organizations that are significant stakeholders and advocates are full members of the Council. Expansion of the Council membership to encompass behavioral health including representation of the Substance Use Prevention and Recovery community of providers and consumers, representation of primary health care, and representation from the State Marketplace Agency (Department of Insurance) and the Department on Aging is currently being discussed.

The Advisory Council currently has several sub-committees including an Executive Committee, a Council Development Committee, and Substantive Committees. The Substantive Committees include: Adult Inpatient, Child and Adolescent Services, Justice and Adult Community Services. Other committees may be appointed as needed. The Council as a whole meets six times a year to review new developments, monitor the progress of initiatives, and discuss problematic issues in the mental health service system. Each subcommittee also meets at least six times a year, during alternating months of the full council meeting. Each subcommittee is co-chaired by a consumer or family member and a provider or other council member. The Council advises DMH on its policies and plans and advocates for improvements in the mental health system. The Council has identified critical funding needs in the public mental health service system, and members of the Council, privately and through their affiliations developed a Mental Health Summit to lobby for additional funding. The focus, coordination, and organization of their efforts have been instrumental in bringing mental health issues to public and legislative attention, founding an infrastructure for further advocacy, and participating in DMH efforts to generate more revenue for community mental health services.

The activities of monitoring, reviewing and evaluating the allocation and adequacy of mental health services within the state are an integral component of developing the state plan. During FY2021, the Council has placed the Mental Health Block Grant on its Agenda at several meetings. The discussions included brief presentations by the DMH Block Grant Planning staff to encourage participation in the development of the FY2022-FY2023 Application and Plan. Nine members of the Council volunteered to be members of a new Planning Committee that reviewed the FY2022-FY2023 Plan and will continue to work with DMH planners on an ongoing basis to review, comment and support planning activities. Along with DMH planners and program managers, they will report back to the Full council sharing issues, concerns and recommendations. These presentations will include an orientation to the Block Grant Plan and its content, a focus on Needs Assessment, the determination of Priorities for the next two years, and review of the Preliminary Drafts of Plans and Implementation Reports.

Members of the IMHPAC participate in a variety of statewide planning meetings convened by the Division of Mental Health. Based on feedback provided by a wide range of stakeholders, key priorities for the mental health service delivery system are identified. These priorities include expanding work in the areas of: workforce development, recovery, implementation of evidence-based practices, permanent supportive housing, children's mental health issues, and services for persons with mental health issues in the criminal and juvenile justice systems.

22. Public Comment on the State Plan (Required) Illinois Mental Health Block Grant Application:

The development of the state mental health block grant plan is made available for public comment in multiple ways. (1) The Illinois Mental Health Planning and Advisory Council (MHPAC) includes consumers of mental health services and family members who also participate in a range of advocacy groups such as the Mental Health Summit, the Mental Health Association, and NAMI-Illinois (National Alliance for the Mentally Ill-Illinois). Council members regularly consult with their respective advocacy groups during the development of the state plan. (2) All Council meetings are open to the public. Council meeting dates are set up a year in advance to facilitate participation. Persons with an interest in the state plan may attend meetings at which the plan is discussed and provide feedback and comments. (3) The final state block grant application and proposed plan will be posted on the web site for the Division of Mental Health (www.dhs.state.il.us). The public can access this DHS DMH Internet site. Interested parties have been instructed to contact Lee Ann Reinert, DMH Deputy Director of Policy, Planning, and Innovation to provide comment. Contact information will be provided on the website. Comments from the public submitted after the final draft of the plan is posted will be reviewed and discussed with Council membership in upcoming meetings. As always, DMH will be receptive to constructive comments and will move, with notification to SAMHSA, to modify the plan as needed.

FY2022-FY2023 Community Mental Health Services Block Grant Application

COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT

FY2022-FY2023

I. State Agency to be the Grantee for the Block Grant

II. Contact Person for the Grantee of the Block Grant

III. State Expenditure Period (Most recent State expenditure period that is closed out)

FY 2022-23 MENTAL HEALTH BLOCK GRANT APPLICATION Section I: Executive Summary

Planning Step I:

Framework for Planning-Assessment of the Mental Health Service System

Description/Overview of the State's Mental Health System

The Community-Based Mental Health Service System

Description and Overview of Child and Adolescent Services

The Growth of Community-Based Services

The Illinois Mental Health Collaborative for Access and Choice

Community Integration from Long Term Care

Collaborative Planning in Mental Health and Substance Use Prevention and Treatment

Strengths and Needs in the Service System

System Strengths

A person-centered, recovery focus

Commitment to Evidence-Based and Evidence-Informed Practices in Illinois

A pledge to work together

Transition to Managed Care

Coordination of Care

A focus on technology

System Weaknesses

Fragmentation of Services

Insufficient resources

Workforce Challenges

Assessing Needs in the Service System

Needs and gaps of mental health services in the context of COVID-19.

(1) Someone to Call: 988 Call Center Expansion Planning

(2) Someone to Respond: Mobile Crisis Response in Illinois

(3) Place to Go: Expansion of Living Room Programs in Illinois

Independent Data Sources

The 2020 SAMHSA Behavioral Health Barometer

Homeless Persons with Mental Illness

Shortages of Mental Health Professionals

FY2022-FY2023 Planning Tables

Plan Table 1-1 Crisis Services

Plan Table 1-2: FIRST.IL/MHBG FEP SET-ASIDE

Plan Table 1-3 Integrated Care- PIPBHC Project

Plan Table 1-4: Evidence Based Practices-Individual Placement and Support (IPS)

Plan Table 1-5: Evidence Based Practices: Assertive Community Treatment (ACT)

Plan Table 1-6 EBP Conference Series

Plan Table 1-7 Recovery/Consumer Services

Table 1-8 Community Integration - Williams/Colbert Consent Decrees

Plan Table 1-9 Justice

Plan Table 1-10 Governor's Challenge: Suicide Prevention and Reduction for Illinois Service Members, Veterans, and their Families

Section IV: Environmental Factors and Plan

1. The Health Care System, Parity and Integration

HealthChoice Illinois: Integration of Behavioral Health and Primary Health Care

Coordination of Care

Behavioral Health/Primary Health Integration.

The Illinois Medicaid - Crisis Assessment Tool (IM-CAT)

Promoting Integration of Primary and Behavioral Health Care in Illinois (PIPBHC-IL)

DMH/DSUPR Collaborative Efforts

Mental Health Parity in Illinois

2. Health Disparities REQUESTED

3. Innovation in Purchasing Decisions

4. Evidence-Based Practices for Early Interventions to Address Early Serious Mental Illness (Required for MHBG)

The FIRST-IL Program (The 10% Set-Aside)

Planning and Implementation

SAMHSA Questions:

5. Person Centered Planning (PCP) -Required for MHBG

Person Centered Planning (PCP)-SAMHSA Questions

6. Program Integrity-Required

7. Consultation with Tribes

8. Primary Prevention-Required for Substance Abuse Only

9. Statutory Criteria for MHBG (Required)

1. Describe available services and resources to enable individuals with mental illness, including those with co-occurring mental and substance use disorders to function outside of inpatient or residential institutions to the maximum extent of their capabilities.

Describe your state's case management services

Describe activities intended to reduce hospitalizations and hospital stays.

Criterion 2: Mental Health System Data Epidemiology

The "Prevalence and Access" Gap

Criterion 3: Children's Services

Criterion 4: Targeted Services to Homeless, Rural, and Elderly Populations.

Homeless

PATH program services in the state are:

Rural

DMH Initiatives to Address Problems and Concerns in Rural Communities:

FY 2022-23 MENTAL HEALTH BLOCK GRANT APPLICATION
Section I: Executive Summary