FY2021 Community Mental Health Services Block Grant Implementation Report

Introduction

This implementation report covers the second year of a two-year Mental Health Block Grant plan for FY2020-FY2021 which was submitted to SAMHSA on September 1, 2019. In general, this report describes our achievements, continuing progress, and documents the challenges we encountered during FY2021 as we worked on 19 strategies supported by performance measures that related to DMH priorities and goals.

In accordance with formatting requirements by SAMHSA, each strategy is presented separately in a table which provides information about the priority, the goal that is being addressed, the strategy itself, the performance measure evaluating achievement and outcome, a description of how the data for the performance measure is collected and how changes are measured, and, finally, the state's report as to whether or not the strategy was achieved. Following each table, a brief review of background information, a description of our progress in FY2021, and other pertinent data are provided.

Plan Table 1-1 Design of Public Mental Health Services

  1. Priority Area: Continue to develop and improve the array of clinical and support services available for adults and children. 
  2. Priority Type: MENTAL HEALTH SERVICES
  3. Population(s) SMI, SED
  4. Goal of the priority area: Address the statewide availability and comprehensiveness of community-based mental health services available for adults and youth in the public mental health service system.
  5. Objective: Identify gaps in the delivery of community-based services based on the service array provided and geographic location.
  6. Strategies to attain the objective:
    • Through ongoing certification processes that include periodic review, monitoring, and recertifications of Certified Community Specialty Providers and Certified Community Mental Health Centers, identify and evaluate service shortfalls.
    • Design and implement a database to process the components and data of the evaluation.
    • Analyze the resulting data to: (a) identify areas where access needs to be improved; (b) inform the publicly funded community service system; and (c) facilitate decision making and planning.
  7. Annual Performance Indicators to measure goal success: Indicator: The State will utilize data to inform the development of and ongoing support for the publicly funded mental health system
    1. Baseline measurement (Initial data collected prior to and during SFY2020): FY2019 -No system in place to do comprehensive analysis.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): In FY2020 the State will develop a comprehensive data collection platform.
    3. Second-year target/outcome measurement (Final to end of SFY 2021): FY2021 the State will utilize the comprehensive data platform to identify potential gaps in the service areas.
    4. Data source: Information provided by entities seeking certification.
    5. Description of data: Geographic area by zip code; Service types provided; Ages served.
    6. Data issues/caveats that affect outcome measures: We must first develop the system to collect the data, which will be dependent on work with agencies outside the Division.
  8. Report of Progress toward goal attainment Second year target: _____ Achieved ___X__ Not Achieved (If not achieved, explain why)

In FY2020 and FY2021, DMH has been unsuccessful in finalizing the comprehensive data collection platform that would have enabled movement forward in identifying the strengths and gaps in the mental health service system. This step was dependent on data collection based on the certification requirements in the State's Community Mental Health Rule (132). However, the DHS Bureau of Accreditation, Licensure and Certification (BALC) was unable to fully undertake the certifying process in FY2020 owing, in part due to internal delays and the development of the appropriate mechanisms for the new certification processes required in Rule 132, and partly due to the Coronavirus Pandemic which placed providing agencies under significant stress and also resulted in a delay of the Department of Human Services moving ahead with implementation of certification requirements in the second half of the fiscal year.

BALC was recently able to begin virtual certification reviews, but the data elements needed for the data platform have not yet been included in their processes. The Division is also undertaking a gap analysis with a subset of providers related to the efforts to build the crisis infrastructure and we expect this will inform our understanding of the needs of specific areas of the service system, but will not provide the comprehensive set of data anticipated from the BALC process yet to be developed.

Background:

The DHS Bureau of Accreditation, Licensure and Certification (BALC)is responsible for conducting certification reviews and certifying Medicaid Community Mental Health (MMH) programs in accordance with Rule 132. (59 Ill. Adm. Code 132 containing revised certification requirements and processes became effective on January 1, 2019. DHFS has filed a corresponding amendment- 89Ill. Admin. Code 140 - which provides service definitions.) BALC's role is to assure that community agencies conform to established standards which indicate their appropriateness to be included as partners in achieving the mission of Department of Human Services. BALC has a responsibility to the recipients of service, whether known as clients, customers or consumers to ensure to the best of its ability that: (1) individuals are receiving services from community agencies that have been reviewed according to licensure or certification rules and determined to be meeting those standards; and, (2) that community agencies are meeting reasonable expectations of providing quality services.

Plan Table 1-2: 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. 
    1. Baseline measurement (Initial data collected prior to and during SFY2020): 70 clients in initial 9-month period.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 220
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 295 clients (Aggregate total served to end of FY2021= 515)
    4. Data source: Provider Quarterly Reports
    5. Description of data: Providers' reports of numbers served.
    6. Data issues/caveats that affect outcome measures: None
  8. Report of Progress toward goal attainment Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

The FY2021 target of 295 clients served was successfully met and surpassed. The cumulative target by the end of FY2021was 515. The Division of Mental Health's Promoting Integration of Primary and Behavioral Health Care-Illinois (PIPBHC-IL) providers have enrolled and served 754 individuals (671 adults and 83 children) by the end of FY2021 surpassing the target by 46%!

  1. Annual Performance Indicators to measure goal success: (7-2) Number of staff persons trained and participating in the program each fiscal year.
    1. Baseline measurement (Initial data collected prior to and during SFY2020): N/A
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 40 staff
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 260
    4. Data source: Quarterly report from each provider citing number of staff trained and carrying out PIPBHC-IL programming.
    5. Description of data:
    6. Data issues/caveats that affect outcome measures: None
  2. Report of Progress toward goal attainment Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

The FY2021 target was successfully achieved. The three participating providers reported a total of 260 staff members who provided program services and were trained or received refresher training in PIPBHC expectations on Wellness and Recovery Action Plan (WRAP), wellness self-management and principles and practices of wellness and recovery, including all agency-selected evidenced based practices that were used with PIPBHC clients during FY2021.

  1. Annual Performance Indicators to measure goal success: (7-3) Number of collaborative meetings convened by DMH to review and discuss progress and issues in service integration and delivery, program evaluation, and client impact.
    1. Baseline measurement (Initial data collected prior to and during SFY2020): 3
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 5 on-site meetings per year
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 10 including fidelity reviews
    4. Data source: Records and minutes maintained by DMH Principal Investigators
    5. Description of data: See Above
    6. Data issues/caveats that affect outcome measures: None
  2. Report of Progress toward goal attainment Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

In FY2021, the target for this indicator was successfully achieved and exceeded. There were 29 virtual learning collaboratives that included the three PIPBHC grantees, TriWest which is the evaluating agency, and DMH. These learning collaboratives facilitated the sharing process between the three providers, served to enhance the quality of the services delivered to participants, and supported the results described below. Additionally, two meetings were conducted with each of the three agencies by DMH and Tri-West at mid- year and at the end of the year to evaluate and discuss fidelity issues. A total of 35 meetings were conducted during the year.

  1. 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.
    1. Baseline measurement (Initial data collected prior to and during SFY2020): N/A
    2. First-year target/outcome measurement (Progress to end of SFY 2020): Annual Report completed, reviewed, submitted to SAMHSA, and filed.
    3. Second-year target/outcome measurement (Final to end of SFY 2021): Annual Report completed, reviewed, submitted to SAMHSA, and filed.
    4. Data source: Providers' Quarterly Written reports submitted by the three partnering agencies and compiled into an Annual Report by DMH
    5. Description of data: See Above
    6. Data issues/caveats that affect outcome measures: None
  2. Report of Progress toward goal attainment Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

A full report is being compiled by TriWest, the contractor funded by DMH to evaluate and report on the progress of the PIPBHC Grant. The report will be submitted to SAMHSA in January, 2022.

We are introducing this new indicator in FY2022-2023 to track joint planning for sustainability of the program beyond the life of the current grant: 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.

In the past several years, five CCBHCs have been established in Illinois. One of the three providers in the PPBHC Project, Centerstone, is funded as a CCBHC and provides services within the CCBHC model. An interagency collaborative planning effort in Illinois to establish and implement CCBHC programs is required by legislation that was passed in July 2021. DHS/DMH, DHS/ SUPR, and the IL Dept of Healthcare and Family Services (IDHFS), the State Medicaid Agency, will be meeting during FY2022 to review programmatic and fiscal issues aimed at establishing a credentialing process for CCBHCs in Illinois consistent with the legislative mandate.

Background:

Behavioral Health/Primary Health Integration in Illinois.

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 Office of Recovery Support Services 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 experience to provide peer support.

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

SAMHSA PBHCI Grants have provided an opportunity to address the issues related to persons with SMI having a greater incidence of physical illness and death at younger ages than the general population. It has been noted that 88% of deaths and 83% of premature years of life lost in persons with SMI are due to natural causes like Cardiovascular Disease, Diabetes, Respiratory diseases, Infectious diseases. Mental illness can be a significant factor complicating the course of an individual's illness and medical treatment. The focus of integration in Behavioral Health and Primary Health Care in these grants has been to provide education and promote healthy activities for individuals with Serious Mental Illness.

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 is expected to integrate primary and behavioral health care for an estimated 1,635 individuals with serious mental illness and a variety of co-occurring illnesses or disorders. Through this grant:

  1. 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, is being promoted and advanced.
  2. Support is now being provided for the study and the improvement of integrated care models in primary care and behavioral health care that can improve the overall wellness and physical health status of adults with a serious mental illness (SMI) and children with a serious emotional disturbance (SED);
  3. Integrated care services that include screening, diagnosis, prevention, and treatment of mental health and substance use disorders along with co-occurring physical health conditions and chronic diseases are being offered and promoted.
  4. The lessons learned throughout the five-year implementation project will be used to support statewide planning and implementation of integrated health homes.
  5. The creation of learning collaboratives or, if funding permits, the establishment of a Center of Excellence designed to support all Illinois providers who are interested in exploring PIPBHC-IL implementation.

A minimum of 1,635 consumers will be served throughout the five - year project's lifespan.

The Division of Mental Health's Promoting Integration of Primary and Behavioral Health Care (IL-PIPBHC) providers have enrolled 754 participants (adult and children/youth) through FFY2021. The entire program has enrolled an average of 23 adult participants and three children/youth per month over the past two quarters. Overall, the Illinois PIPBHC program has cumulatively discharged 191 enrollees (adults, children, and youth) since its inception.

Outcomes through SFY2021-4th Quarter Report from Tri-West

The Grantee agencies have enrolled and conducted baseline interviews with 671 adult participants and 83 children and youth. The entire program has enrolled an average of 23 adult participants and four child and youth participants per month over the past two full quarters (January 2021-June 2021).

  • The following list summarizes key findings based on client-level enrollment data that were entered into SAMHSA's Performance Accountability and Reporting System (SPARS):
  • Grantees are serving people with chronic health conditions and who collectively have many other challenges, including high rates of:
    • A history of violence or trauma (65% of enrollees),
    • Tobacco use (59% of enrollees),
    • Unemployment (only 23% of enrollees were employed part-time or full-time),
    • Unstable housing (only 55% of enrollees lived independently in their own home or apartment), and/or
    • Nights spent unhoused (10% of enrollees).

On average, people with at-risk blood pressure readings at baseline achieved statistically significant improvements in systolic and diastolic blood pressure at the six-month and 12-month reassessments. Conversely, enrollees with normal blood pressure readings at baseline experienced statistically significant increases (or worsening) in blood pressure at six-month follow-up, while staying within normal levels.

  • On average, there was a statistically significant improvement in breath carbon monoxide (CO) levels between the baseline and six-month reassessment among people with at-risk levels at baseline (t(11) = -3.52, p = .005).
  • People with at-risk cholesterol levels at baseline experienced a statistically significant improvement in LDL cholesterol levels (t(10) = -2.66, p = .024) and as a group had an average LDL level that was within the normal range at six-month reassessment.
  • Among people served in the program for at least six months, 11 more people indicated they were working full-time, 17 more people indicated they were living in their own residence, and six fewer people indicated they were unhoused.
  • Among people served in the program for at least six months, 21 enrollees had reported 433 nights spent unhoused in the 30 days before enrollment; this decreased to 12 enrollees reporting a total of 318 nights spent unhoused at reassessment, a difference of 115 unhoused nights. As a group, participants also reported 31 fewer nights in hospitals for psychiatric conditions and 31 fewer nights in jail.
  • On average, functioning and levels of psychological distress improved for enrollees from baseline to six-month reassessment and from baseline to 12-month reassessment based on self-reports.
Twelve Month Outcomes

Among program enrollees who completed a 12-month reassessment, those with at-risk health indicators at enrollment had, as a group, statistically significant improvements in blood pressure and were within the normal range after 12 months of program participation. These findings provide evidence that programs are helping enrollees with physical health conditions improve their physical health. At the same time, program enrollees with normal body mass index scores at baseline experienced statistically significant increases (or worsening) in their average scores and measurements after 12 months of program engagement, though these values remained within the normal range.

Many enrollees appeared to have experienced important milestones related to employment and housing. For example:

  • Eight more enrollees indicated that they were working full-time at the 12-month reassessment.
  • Six more enrollees indicated that they were living independently in their own home or apartment, and six fewer enrollees reported that they were unhoused at reassessment.

Collectively, program participants reported 226 fewer troubled nights (nights unhoused, in a psychiatric hospital, or in jail) in the 30 days prior to their 12-month reassessment than they had reported in the 30 days prior to baseline assessment. Most of this decrease-168 nights- was due to fewer enrollees reporting nights spent unhoused in the last 30 days. Program enrollees also experienced improvements in psychological distress and in measures of functioning, including ability to manage life, quality of life, social connectedness.

Plan Table 1-3: Integrated Care: Integrated Health Home Model

  1. Priority Area #2: Work collaboratively with IL Dept. of HealthCare and Family Services (DHFS), the State Medicaid Agency, to develop policies, procedures and models for Integrated Health Homes to be sustained with Medicaid Funding.
  2. Priority Type: MENTAL HEALTH SERVICES
  3. Population(s)-SMI, SED,
  4. Goal: Develop models of care coordination utilizing the strengths of community mental health service agencies to ensure that persons with serious mental illness and their families can receive fully integrated and seamless services in their community.
  5. Objective: Establish criteria for an Illinois Integrated Health Home model through collaborative work with DHFS
  6. Strategy: Provide consultation and technical assistance to DHFS in the planning and the implementation of the Illinois Integrated Health Homes model.
  7. Annual Performance Indicators to measure goal success: Indicator: Number of consultations provided to DHFS by DMH administrative staff.
    1. a) Baseline measurement (Initial data collected prior to and during SFY 2020): 1 Meeting
    2. b) First-year target/outcome measurement (Progress to end of SFY 2020): 12 Meetings
    3. c) Second-year target/outcome measurement (Final to end of SFY 2021): TBD
    4. d) Data source: Agendas, minutes, and notes collected and maintained by DMH administrative staff
    5. e) Description of data: See Above
    6. f) Data issues/caveats that affect outcome measures:
  8. Report of Progress toward goal attainment Second year target: _____ Achieved __X___ Not Achieved (If not achieved, explain why)

During SFY 2019 and SFY2020, planning for the implementation of Integrated Health Homes underwent extensive review and consideration by IDHFS. DMH provided expertise, consultation, and support in working with IDHFS towards a practical and effective plan for integrated health homes in Illinois. During February and March of 2020 DHFS made a series of Town Hall presentations announcing the organization and operational details of implementing IHHs and providing information to providers regarding contracts. Enrollment in IHHs by eligible Medicaid beneficiaries was set for May. The anticipated start date was to be July 1, 2020. Then the Covid19 Pandemic struck! Collaborative planning meetings came to an abrupt halt as attention turned to staying safe and meeting the shelter-in place requirements of the Governor's Executive Order. Active discussion of Integrated Health Homes between IDHFS and DMH remains on hold at this time due to competing priorities.

Background

For further information about plans for Integrated Health Homes in Illinois, please see the IDHFS Website at: Illinois.gov/hfs/MedicalProviders/cc/Pages/IntegratedHealthHomes.aspx

Plan Table 1-4: 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) SMI, SED, OTHER:
  4. Goal of the priority area: Sustain and expand the infrastructure for evidence-based clinical programs for persons with ESMI.
  5. Objective: Sustain 15 Coordinated Specialty Care teams currently in the State.
  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;
    • 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. (b) The total FEP Set-Aside expenditures by the State for each site
    1. Baseline measurement (Initial data collected prior to and during SFY 2019): 15 funded sites at the end of SFY2019.
    2. First-year target/outcome measurement (Progress to end of SFY 2020) 15 Funded sites
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 15 Funded Sites 
    4. 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 the Enrollee Outcomes Form. Outcomes in terms of number of referrals and number of clients enrolled at each participating site are counted. A Web-based data reporting system was introduced in FY2019 and is now beginning to provide demographic and client level data.
    5. Description of data: The Enrollee Outcome Form lists all active sites in the State. Records of contracts and funding awards for each agency are maintained by the DMH Fiscal Office. Quarterly Report Performance Forms track Training, Module Advancement, and Employment and IPS/Supported Ed Involvement. Quarterly Expenditure Reports are also completed by our FEP Set-Aside agencies and provided to DMH.
    6. Data issues/caveats that affect outcome measures: The full potential of the First.IL Program may be affected by federal restrictions on eligible diagnosis

Report of Progress toward goal attainment: Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

This objective has been successfully accomplished. These fifteen funded sites have been successfully maintained and enhanced through FY2019, FY2020, and FY2021. The target of 15 funded sites being operational by the end of FY2021 has been met. With the additional funds that became available in FY2021, active planning began towards opening five additional FIRST.IL sites by the end of FY2022.

  1. Objective #2: Improve and maintain quality of clinical services received by FIRST.IL clients
  2. Strategies to obtain objective; (1) Continue training in key clinical approaches including CBT-p, Family Psychosocial Education (FPE), Case Management/Recovery Support Specialists, and ongoing technical assistance. (2) Provide advanced CBT-p training for experienced provider staff and team leaders to develop mentoring expertise and peer consultation. (3) Provide training events in Fidelity to the CSC model with follow-up consultation and supportive collaboration.
  3. Indicators: Number of training events held each year to increase clinical competence and expertise in the delivery of ESMI services in FIRST.IL sites.
    1. Baseline measurement (Initial data collected prior to and during SFY 2019): 12 key training events
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 13 Training Events
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 13 Training Events
    4. Data source: Records of teleconference calls and attendance are maintained by statewide coordinators.
    5. Description of data: See Above
    6. Data issues/caveats that affect outcome measures:
  4. Report of Progress toward goal attainment: Second year target: X Achieved _____ Not Achieved (If not achieved, explain why)

This objective was achieved and the target exceeded in FY2021. A total of 16 training events with follow-up technical assistance as needed were conducted during the year, including 3 Advanced Cognitive Behavioral Training for psychosis (CBT-p) Training Events for FIRST.IL Providers, 3 Family Psychoeducation training events were conducted; and 10 Monthly Advanced CBT-p Consultative training Events. Additionally, there were 73 Consultation meetings including 30 Family Psychoeducation Team Consults (15 Teams 2 quarterly consults each), 12 Monthly Team CBT-p consultative meetings,

and 31 special training events to provide introduction and orientation to FIRST.IL treatment modalities for beginning clinical staff who provide IRT, CM, RSS and SEE services as well as existing staff who had not yet used the particular modality. Additionally, training on the use of the newly established Web-based Data System was provided.

In FY2021, state coordinators also reported 360 TA contacts that included a once monthly conference call with all team leaders and CBT-p monthly follow-up consultation. Work on Fidelity was not undertaken this year due to the Pandemic but the Addington Fidelity Scale and the Columbia Fidelity Scale were reviewed and discussed. DMH is continuing to assess the right Fidelity tool for FIRST.IL.

The program reports a significant accomplishment towards additional clinical training: After the CSC teams identified the need for Substance Use Treatment as an important component for FIRST.IL enrollees, active planning for the introduction of this component began in FY2021. Two DMH staff have been trained in Cognitive Behavior Therapy for Substance Abuse and are currently preparing to provide this CBT-sa training to FIRST.IL teams.

  1. Objective #3 Increase number of FIRST.IL enrollees statewide.
  2. Strategies to obtain the objective:
    1. Expand outreach efforts and provide public information about FIRST.IL
    2. Each FIRST.IL Site to achieve five Marketing and Outreach events per month
    3. Each FIRST.IL Site will achieve a minimum of five new Enrollees per Fiscal Year.
  3. Indicator #3: Number of clients meeting criteria for FIRST.IL enrolled in team services statewide.
    1. Baseline measurement (Initial data collected prior to and during SFY 2019): 251
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 300
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 350
    4. Data source: Enrollment data from each participating site aggregated by statewide coordinator retrieved from Enrollee Outcome Form at Baseline and every 6 months.
    5. 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
    6. 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.
  4. 8. Report of Progress toward goal attainment: Second year target: ___X__ Achieved _____ Not Achieved (If not achieved, explain why)

The target for Objective #3 was achieved and exceeded in FY2021. 350 enrollees were targeted. A total of 358 clients were served in the course of the fiscal year. 310 were enrolled as of 9/30/21 reflecting a 36% growth in enrollment from year to year.

All of the strategies for this Objective were successfully employed. FIRST.IL averaged 6 new enrollees per month in FY2021. The operational target of 5 new enrollees per month was met.

COVID-19 negatively impacted face to face marketing and outreach, but FIRST.IL Teams continued to receive referrals. All FIRST.IL Teams have remained operational and have adapted to the use of telehealth during the Pandemic.

A significant achievement that has occurred during FY2021 in spite of limitations posed by the pandemic, is that a rural FIRST.IL provider successfully opened a satellite site in a close-by city which houses one of the largest university complexes in the State and is now serving six additional clients there.

Background

Early in FY2017, with technical assistance and consultation of the Best Center, DMH developed the basic infrastructure to initiate and sustain evidence-based clinical programs for persons with FEP in Illinois. By the end of October 2016, programs for persons having experienced an initial psychotic episode were established at 11 mental health agencies in the State. The statewide program has been named FIRST.IL. 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, an administrative lead from agency administration, and a medication prescriber. All teams have specialists that provide supported employment and supported education services. 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.

In the past four years of operation technical assistance, consultation, and formal trainings have been both intensive and extensive. Technical Assistance and Consultative meetings between DMH, the BeST Center, and the 15 provider agencies have continued at a steady pace. These meetings included Consultations with each team once every two weeks and a regular conference call with all the team leaders once a month. The BeST Center Consultant directly provides training sessions for all newly hired FEP agency staff twice monthly and weekly telephone consultation to the DMH statewide coordinators. The BeST Center's consulting psychiatrist provides teleconference training sessions and learning collaborative calls in psychiatric evaluation and medication management. All meeting calls and training are usually 1 hour in length.

Enrollment growth has also been steady. At the end of SFY2018 when the program had expanded to 15 sites, a cumulative enrollment of 201 clients who met criteria of eligibility for the program were enrolled. At the end of FY2019, 243 were enrolled and, as of 7/1/2020, 279 were enrolled, and 310 at the end of FY2021 reflecting a 36% growth rate.

The program expanded to serving an additional three diagnostic categories of the ESMI population as of January 1, 2018. By June 30, 2019, 36 individuals with Bipolar Disorder with Psychotic features, Major Depressive Disorder with Psychotic features, and Post Traumatic Stress Disorder with Dissociative Symptoms were enrolled. In FY2020, these three newer ESMI Diagnoses accounted for 18.5% of all enrollees.

The Web-based data reporting system has yielded is used to analyze demographic information. As of 9/30/2021, of the total number of 310 clients enrolled in FIRST.IL, 73% (226 clients) are under the age of 25. The average age of a FIRST.IL client is 24. Youth under age 18 have consistently made up 20% of population served. 70% of clients' families are actively involved with treatment of their loved ones with the FIRST.IL Teams. Nearly 74% of enrollees are either employed, looking for Work or attending school. 56% of FIRST.IL clients are male; 52% (161) identified themselves as White/Caucasian, 40% as Black/African American (124); and 15% self-identified as being of Hispanic Origin.

Use of Set-Aside Funding

From the outset, the intent of DMH was to introduce emerging evidence-based practices for FEP 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-Aside dollars are paid for:

  1. The time and costs of assigning a clinician to become the designated agency staff person with expertise in clinical content and service delivery of ESMI 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.
  2. 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 ESMI program are carried out at the agency and in collaboration with the Division of Mental Health.
  3. Training, technical assistance, consultation events and sessions to develop expertise in evidence-based clinical approaches most helpful to individuals with ESMI.
  4. 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 2015 funding, 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 ESMI programs.
  • Providing additional funding to agencies to facilitate improved implementation of program components as needed.
  • Providing for DMH staff person to furnish guidance and expertise in developing, monitoring, coordinating, and providing technical assistance to agencies in carrying out programming. In short to become the DMH experts for the provision of evidence-based services to individuals (and families as appropriate) who experience first and early episodes of a serious mental illness
  • Increasing agency participation in: (1) ongoing focused training in ESMI 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 perceived 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. The continuing clinical engagement of clients with ESMI has been problematic at times and remains a subject of active interest and planning.
  • 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.
  • Coverage for CSC programming by private insurance has been problematic and only some ESMI services have been paid. 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 on January 1, 2020. Planning and implementation are currently under discussion. The Illinois Department of Insurance is currently working with a Provider Workgroup regarding the implementation process for billing Insurance for bundled services such as FEP.

Plan Table 1-5: Evidence Based Practices-Individual Placement and Support (IPS)

  1. Priority Type: MENTAL HEALTH SERVICES
  2. Priority Area #2: Promote Provision of Evidence Based and Evidence-Informed Practices
  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 FY2020 and FY2021, maintain and support the statewide implementation of Evidence Based Supportive Employment.
  6. Strategies to attain the objective: (1) During FY2020 and FY2021, continue the development of the state infrastructure required to support implementation and sustainability of IPS Evidence Based Supported Employment. (2) During FY2020 and FY2021, continue to develop the integration of physical and behavioral health with employment supports and peer support statewide. (3) By the end of FY 2021, through the provision of additional funding resources, continue the implementation of IPS Evidence Based Supportive Employment which targets an additional 350 consumers acquiring competitive employment in their local communities.
  7. Annual Performance Indicators to measure goal success: Indicator: Number of consumers receiving supported employment in FY2020 and FY2021. (National Outcome Measure)
    1. Baseline measurement (Initial data collected prior to and during SFY 2019): 3,413 individuals were served in SFY2018. 3,228 were served in SFY2019.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 3,354 3,226 were served in SFY2020.
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 3,514
    4. 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.
    5. Description of data: As always, DMH has developed specifications for reporting that DMH funded providers must use when submitting data.
    6. 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.
  8. Report of Progress toward goal attainment Second year target: _ Achieved __X__ Not Achieved (If not achieved, explain why)

NOTE: This is one of two places in this Report in which the quantitative target for FY2021 was not achieved but the quality and integrity of the program was successfully maintained in face of the challenges presented by the Covid Pandemic.

Supported Employment has continued to be substantively addressed in FY2021 in spite of the impact of the COVID-19 pandemic and the rise of the COVID-19 Delta Variant which is documented below. The numerical target for FY2021 was 86% attained! 3,021 individuals received and benefitted from IPS services in FY2021. While we were not successful in achieving the numerical target of 3,514 to serve in IPS for FY2021, we still believe this is a very successful amount of service delivery as the entire world ultimately shut down because of COVID-19. COVID-19 had a major impact on not achieving our FY2021 goal for several reasons:

  1. Per Governor's orders to stop the spread of COVID-19, many employers and businesses during the outbreak of COVID-19 had to close and reduce their workforce for several months. Many of those employers a year later are still closed or still have a reduction in their workforce.
  2. Clients who may have been interested in IPS services did not feel safe going into the community during this period in fear of catching COVID-19. While vaccines have been developed to fight COVID-19, it has taken longer than expected for clients to take the vaccine. Some clients refuse to take the vaccine do to trust issues. This mistrust of the vaccine by clients has in some ways slowed down the IPS process of assisting these clients with employment.
  3. This new COVID-19 Delta Variant has shown with an increase in the number of hospitalizations again, which has started to slow the economy down again as businesses and venues have not fully opened, and summer and fall events are been cancelled.
  4. While IPS Providers and clinical staff themselves have been vaccinated, and have begun to go back into the office full-time to work, this new COVID-19 Delta Variant had caused IPS employment specialists to once again be very, very cautious and hesitant in going out into the community to network and job develop on behalf of clients. Job development in the community [being one of the core principles of IPS] is a major part of the success of IPS and how clients obtain employment. As job development continues to decrease, so will job starts of clients.
  5. COVID-19 continues to shift the job market. Job titles that were in demand before COVID-19 are now obsolete, while other job fields have grown. Jobseekers are making the shift in their job preferences as well - but it is taking a little longer than expected for clients to develop the new job skills required to perform these new job tasks.

In FY2021, a total of 44 IPS sites with fidelity to the model served 2,967 unduplicated consumers. An additional 4 sites that were working toward fidelity but had not yet met fidelity standards served 56 consumers. In all, 3,021 consumers received supported employment services. Given the COVID-19 Pandemic and the new COVID-19 Delta Variant, the accomplishments listed below that were directed to sustaining and improving the quality and delivery of IPS services may be regarded as significant achievements.

IPS FY2021:

Total unduplicated # of consumers receiving IPS services 3,021
Total unduplicated # of consumers who received IPS at the fidelity sites: 2967
Total unduplicated # of consumers who received IPS at the non-fidelity sites 56
Newly enrolled in FY2021 1079
FY2021 Job Starts 788
Average hours worked per week 27.37
Average hourly wage 13.73
Total # of IPS Teams (IL) 48
Total # of IPS Sites at Fidelity (IL) 44
Total # of IPS Sites not at Fidelity (IL) 4

Background

Since 2007, DMH and DHS/Division of Rehabilitation Services (DRS) have partnered in a joint effort to increase access to Individual Placement and Support (IPS) supportive employment for persons with serious mental illnesses and to improve the coordination of psychiatric and vocational services. Locally, services are obtained through joint planning and service efforts by community mental health centers (CMHCs) and local offices of DRS. Supported Employment Services in Illinois are based on the integration of DHS Division of Rehabilitation Services (DRS) funded vocational services/resources with DMH funded mental health treatment and supportive services.

Accomplishments in FY2021 included:

  1. With social distancing efforts in effect which resulted in IPS staff working from home, DMH IPS Trainers created and developed new techniques and processes for delivering and implementing IPS services during COVID-19. DMH IPS Trainers used WebEx and Zoom virtual platforms to train IPS Provider staff on many topics such as IPS and the 8 Principles of IPS, engaging IPS clients virtually, job developing with employers during COVID-19, and tips for job seekers interviewing virtually.
  2. While on-site IPS Fidelity Reviews have been suspended until further notice, DMH IPS Trainers have been performing "Virtual Surveys for IPS Quality Improvement" with IPS Providers in place of Fidelity Reviews. These surveys have gathered information about how IPS Providers have been implementing IPS during the COVID-19 Pandemic.
  3. DMH still maintains an IPS Statewide Program Manager and an IPS Data Analyst. Both positions continue to support the sustainability and scalability of IPS in Illinois.
  4. DMH continues to focus on engaging MCOs [in conjunction with DHFS] on the business case for IPS by demonstrating cost-savings and healthier outcomes credited to IPS.
  5. The Illinois Web Portal, "Pathways to Employment - Putting Illinois to Work" has continued to be an all access information center for IPS in Illinois -- http://www.illinoisips.org. More resources have been added to the Web Portal as we view it as a strong IPS workforce development tool and training resource for IPS providers to use in addition to the technical assistance they receive from Statewide DMH IPS Trainers. As the COVID-19 pandemic has made almost all face-to-face contact "virtual", the Illinois Web Portal has proven to be a main source of training available to providers, employers, state trainers, and other stakeholders.
  6. DMH IPS Trainers have been involved in national and international projects to enhance IPS service delivery:
    1. Illinois continues to be a member of the International IPS Learning Community which consists of 28 states and 7 international sites. Illinois is viewed as a national leader in implementing IPS services.
    2. DMH IPS Trainers have been involved in the International IPS Learning Community's Equity, Diversity and Inclusion Committee. Its mission is to promote a community of ongoing learning and sharing that increases equity, diversity, and inclusion throughout the IPS Learning Community and across all IPS stakeholders. Illinois has been a major contributor to this committee.
    3. DMH is collaborating with Boston University in a project to understand facilitators and barriers to providing access to good fidelity IPS services. Boston University [BU] is conducting the study in 4 states [including Illinois]. In each state, BU will be conducting interviews in two IPS programs. DMH is also in the beginning of collaboration with the Boston University Center for Psychiatric Rehabilitation to carry out a study to investigate the impact of performance-based incentives on IPS staff turnover and client employment outcomes. The project is focused on maintaining IPS staff at IPS provider agencies -- which would improve the employment outcomes among persons with psychiatric disabilities.
  7. Expanding on the success from 2020, DMH hosted its Second Annual Illinois Evidence-Based Practices Virtual Conference Series during the entire month of August 2021. Continuing with every Tuesday and Thursday in August, three virtual conference sessions [lasting 1.5 hours each] using the WebEx Events Platform were hosted by DMH. Speakers presented on various topics such as IPS, First Episode Psychosis, Infant and Early Childhood Mental Health, Wellness Recovery Action Planning, Community Reinforcement Approach, Motivational Interviewing, Trauma Informed Care, Best Practices on Racial Equity in Mental Health Organizations, Effective Supervision, Expanding Crisis Services in Rural Areas, Employment rights of People with Mental Illness in the Wake of COVID-19, Implicit Bias in the Workplace, Cannabis Legalization in Illinois and Opportunities for Expungement, and many other topics. The conference had over 5,270 registrations between 25 different sessions. Registrations and attendees with each virtual conference session ranged from 90 to 320 participants. This conference successfully continued the momentum and enthusiasm from last year's conference in Illinois with IPS Providers as well as other agencies continuing to establish and implement evidence-based practices around Illinois. Evaluations by attendees were overwhelmingly positive, and plans are underway to plan our third annual evidence-based practice virtual conference series in 2022.
  8. The Division of Mental Health continued to fund 3 DMH IPS Trainer Positions [through agency contracts] to provide IPS technical assistance to IPS Agencies in Regions 1 & 2 in FY2021 and FY2022. Two IPS Trainers continue to help implement and provide technical assistance in Regions1 & 2 and the other IPS Trainer continues to help Agency Drop-In Center Staff improve their skills on engagement on employment, and the role it plays in recovery as part of the Williams/Colbert Consent Decrees. In addition, we have 2 DMH state employees who are also trained and equipped to provide IPS technical assistance to IPS Agencies in Regions 3 and Region 4. The Region 5 IPS Trainer retired in July of 2021. Region 5 is currently being covered by the IPS Statewide Program Manager with assistance from the Region 1 & 2 DMH IPS Trainers. Illinois has a total of 5 IPS Trainers Statewide and one IPS Data Analyst who are all supervised by the IPS Statewide Program Manager. The Division of Mental Health is truly committed in making IPS a standard of care in Illinois with employment being an outcome of care.
  9. Technical assistance to increase fidelity to the IPS Supported Employment Model as well as to increase the sustainability and scalability of IPS has increased from 1,695 hours provided to the IPS sites in FY2010 to approximately 8,050 hours in FY2021. Over 2,400 staff [including agency IPS provider staff, clinical staff and support personnel, state employees of DHS, HFS, DCEO, DCFS, DJJ, IDOC, and community stakeholders] for IPS across the State in FY2021. IPS Technical Assistance Team activities have included:
    1. Providing virtual individual consultation, teleconference/phone, and large group virtual trainings. WebEx Meeting, WebEx Events, and the ZOOM virtual platforms have been used.
    2. Monitoring the performance of IPS Provider Agencies and providing feed-back to improve employment outcomes.
    3. Presenting at Virtual Statewide Behavioral Health Conferences and Virtual National IPS Conferences to increase the knowledge of IPS.
    4. Assisting with the development of the web-based IPS Web Portal to further extend training resources.
    5. Development of a CY2021 curriculum for Monthly State-wide Technical Assistance Calls and facilitating those calls with topics that focused on implementing IPS during COVID-19 and socially distancing.
    6. Working with Williams/Colbert Agency Drop-In Center Staff to better educate them on the IPS Model, educate them on the role IPS plays in recovery, and helping improve their engagement skills on talking to consumers about employment.
    7. Working to implement Nutrition and Exercise for Wellness and Recovery [NEW-R] statewide by training IPS providers and community mental health centers [CHMCs] to offer NEW-R groups.
    8. Collecting and analyzing IPS Data from IPS Providers entered on the DHH IPS/EBSE Web-Based Data System and using that data to improve IPS performance Statewide
  10. The Nutrition and Exercise for Wellness and Recovery [NEW-R] State Steering Committee has continued to develop and help implement NEW-R services throughout the entire State of Illinois. DMH IPS Trainers developed a virtual NEW-R training using the WebEx Platform and developed a way to do and implement NEW-R groups during social distancing.
  11. DMH continued to work with the Illinois Office of the Treasurer to promote Achieving a Better Life Experience [ABLE] accounts with IPS providers for working consumers in IPS. These accounts allow those with disabilities and their families to save for many daily, disability-related expenses on a tax-deferred basis - without limiting their ability to benefit from SSI, Medicaid and other federal programs. A representative from this program attended DMH/DRS/IPS Provider Regional meetings to share information and answer questions for all participants.

Evidence Based Supportive Employment (EBSE) is still confronting several challenges:

  1. COVID-19 has still made it impossible to provide on-site IPS trainings, provide one-to-one field mentoring of IPS, and to do job development in the community. On-site Fidelity Reviews have been completely suspended until further notice.
  2. State infrastructure issues continue to make it difficult to expand access to IPS, including its funding model, data systems, quality monitoring (fidelity reviews), training, and reaching at risk populations.
  3. Turnover at IPS provider agencies started to increase again due to COVID-19 and employment specialists being fearful of going out into the community. Turnover of IPS Supervisors who have had the extensive training and experience required to implement IPS successfully, as well as community support workers and case managers who are instrumental in integrating rehabilitation with mental health treatment thru regular team member contact remains a challenge to program sustainability.
  4. The DMH IPS Web-based Data System still needs modernization to keep up with growth and data needs.

Plan Table 1.6: 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 FY2020 and FY2021 (National Outcome Measure).
    1. Baseline measurement (Initial data collected prior to and during SFY2019): 1532
    2. First-year target/outcome measurement (Progress to end of SFY 2020: 1,764/2008
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 1,996/1487
    4. 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.
    5. 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.
    6. 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. DMH is currently in discussions with IDHFS to develop a data sharing agreement, and it is believed that DMH will in the future be able to track outcomes of individuals through Medicaid data.
  8. Report of Progress toward goal attainment Second year target: _____ Achieved __X_ Not Achieved (If not achieved, explain why) The overall capacity for ACT Teams was reduced during the most recent fiscal year as a result of workforce shortages, as described below.

The workforce shortage that is impacting the country has had a significant effect on ACT teams in Illinois, with providers experiencing staffing shortages particularly in individuals qualified to fill the role of team leader. As a result, providers have consolidated some teams at some of the largest community mental health centers in the state. This consolidation has resulted in a net reduction of 3 teams statewide, with 30 ACT teams currently in operation in Illinois with a current statewide capacity of 1.487 available and active ACT service slots. The teams reported vacancy rate is currently 13%. DMH and HFS have been actively involved with a group of providers attempting to identify solutions to the workforce shortage that would result in increased capacity. A number of proposals are being considered that could create incentives for retention of staff as well as recruitment and hiring, however current federal and state regulations, particularly as they relate to Medicaid payments, are proving to limit flexibility in the solutions considered. This work will continue throughout the current fiscal year, and DMH is also involved in some longer term work to address the workforce shortages on a larger scale which is expected to also impact ACT in coming years, although it is not anticipated that this impact will resolve the immediate needs for increased staffing on ACT teams.

In FY2020 DMH successfully maintained 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 13% over the past two years, attributed in part to a lower number of slots available. Addressing the workforce shortage is the most important step in increasing access to ACT.

Background:

Since FY2017 Medicaid Managed Care has grown and expanded rapidly in Illinois. Most ACT Teams currently operate within areas where services to individuals are reimbursed through Managed Care Contracts. The claims data related to MCO funded care has not been available to the State Mental Health Authority, and thus individuals served and associated outcomes from ACT cannot be accurately measured at this time. To be able to more accurately measure the number of persons in Illinois receiving ACT services, the State mental health authority was required to rely on service access capacity. In the FY2018-2019 plan the language of the indicator shifted from number of persons served to number of active service slots filled in the State for persons with SMI to receive Assertive Community Treatment in FY2018 and FY2019 (National Outcome Measure). Providers of ACT services submit monthly reports of team capacity to DMH, which are 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. The SMHA is able to track the number of active service slots in the State, which in 2017 totaled 1,321, and is a more accurate representation of individuals served through ACT. The number of active ACT service slots in the State has steadily increased. Planning to improve the interoperability of data systems is continuing and DMH is looking forward to being able to track outcomes with greater accuracy.

Illinois adopted and began to implement the Assertive Community Treatment (ACT) model in 1992. ACT is the most intensive specialized model of outpatient community mental health care in which a team of mental health professionals takes responsibility for a small group of program participants' day-to-day living and treatment needs. Often these consumers have a history of repeated admission to psychiatric inpatient services or excessive use of emergency services and typically require assertive outreach and support to remain connected with necessary community mental health services. Usually, previous efforts to provide linkage to necessary services have failed and their need for multiple services requires extensive coordination. The active participation of nurses, psychiatrists, and specialists trained in substance abuse is crucial to the success of the ACT model.

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 OTHER:
  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.
    1. Baseline measurement (Initial data collected prior to and during SFY 2020: Nine training events in FY2018; Nine targeted in FY2019. 12 actually completed.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 12
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 12
    4. Data source: Document each training event and aggregate by year for comparison across years.
    5. Description of data: Training agenda and attendance sheets documenting participation for each training event held.
    6. Data issues/caveats that affect outcome measures:
  8. Report of Progress toward goal attainment: Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

The continuing expansion of the Certified Recovery Support Specialist (CRSS) certification was effectively addressed in FY2021 with a total of 31 virtual training events. Due to state travel restrictions related to the Covid-19 pandemic, the IDHS/DMH Bureau of Wellness & Recovery Services completed its 2021 CRSS Competency Training Series in a virtual format. Nine unique training sessions were completed during the fiscal year. Each was held three times for a total of 27 virtual sessions that were available statewide.

Additionally, four virtual training sessions were provided for CRSS supervisors, one each quarter, during FY2021.

As of June 10, 2021, there were 236 active CRSS professionals in the State, all in good standing with the Illinois Certification Board (ICB). An additional 27 individuals are in the application process and six are waiting to take the exam.

On October 15, 2021 Governor Pritzker recognized the contribution and accomplishments of Recovery Support Specialists in Illinois by proclaiming October 2021 as RECOVERY SUPPORT CELEBRATION MONTH in Illinois.

The Certified Recovery Support Specialist (CRSS) is a credential for those persons with lived experience who provide mental health or co-occurring mental illness and substance use peer support to others using unique insights gained through their personal recovery experience. The CRSS credential assures competence in advocacy, professional responsibility, mentoring, and recovery support. Certified Recovery Support Specialists can 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.

The Illinois Model for Certified Recovery Support Specialist (CRSS) was developed through the collaboration of the Illinois Certification Board (ICB), the DHS Divisions of Mental Health (DMH), Rehabilitation (DRS), and Substance Use, Prevention, and Rehabilitation (DSUPR). The credential has been available through the ICB since July 2007. Individuals are certified as having met specific predetermined criteria for essential competencies and skills. Individuals attending consumer conferences, statewide consumer education and support teleconferences, and regional WRAP Refresher trainings, among other training opportunities, receive CEU's toward achieving or maintaining their credential through the ICB.

The DMH Bureau of Wellness & Recovery Services continues to work with other system partners, including the ICB and the Illinois Mental Health Collaborative for Access and Choice (IMHCAC), to:

  • Disseminate public information about the credential;
  • Develop training curricula, and study materials for those seeking to obtain their CRSS credential;
  • Plan and conduct webinars and other training events for provider agencies to help increase agencies' understanding of the role, value, function, and advantages of hiring CRSS professionals.

These efforts have proven to be fruitful. The number of individuals in the State possessing the credential, active in the State, and in good standing with the Illinois Certification Board (ICB) has steadily increased since October 2013. The aim of DMH is to continue to increase the number of Certified Recovery Support Specialists in Illinois.

CRSS Success Program

During FY2021, extensive planning occurred aimed at introducing a new program to support CRSS training and increase the number of CRSS credential holders in the state. Research has shown that individuals receiving recovery support services in addition to conventional mental health services have better outcomes in terms of:

  • Reduced rates of hospitalization and days spent inpatient
  • Decreased symptoms of depression and psychosis
  • Decreased substance use among individuals with co-occurring mental health and substance use disorders
  • Increased hope, self-care, and sense of wellbeing

To address the well-documented behavioral health workforce shortage in Illinois, and: (1) increase the number of individuals in Illinois who successfully obtain either the Certified Recovery Support Specialist (CRSS) or the Certified Peer Recovery Specialist (CPRS) credential through the Illinois Certification Board, and (2) to increase the number of CRSS or CPRS certified individuals employed by mental health and substance use providers that receive funding from the State of Illinois, either through grant funding or Medicaid reimbursement, DHS is investing $8,000,000 in grant funding and is partnering with 13 colleges and universities across the state to provide college-based education that meets the requirements for the credentials. Individuals who apply and qualify may get all their expenses paid for the following:

  • Classroom component: minimum of 110 clock hours of training (7 college credit hours)
  • Practical experience (internship) component: minimum 300 contact hours and minimum three months in length
  • Wraparound supports: grant funds will pay for supports for students to overcome practical barriers to full participation such as student tuition, books, and fees; credentialing fees; stipends for practical experience (internship) component; and stipends to cover costs of childcare, transportation, or other needs and/or accommodations essential for students to maintain participation in the program.

The CRSS Success Program is slated to roll out early in 2022!

  1. Objective #2: Increase the use and efficacy of the WRAP model
  2. Strategy #2: Enhance competency and encourage WRAP trained and certified facilitators to provide an increasing number of WRAP® classes in the State.
  3. Annual Performance Indicators to measure goal success: Indicator #2:
    • Number of WRAP Refresher trainings offered statewide each year
    • Number of WRAP participants each year
    1. Baseline measurement (Initial data collected prior to and during SFY2020: 20
    2. First-year target/outcome measurement (Progress to end of SFY2020): 20
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 20
    4. Data source: Document each training event and aggregate by year for comparison across years.
    5. Description of data: Training agenda and attendance sheets documenting participation for each training event held.
    6. Data issues/caveats that affect outcome measures: None
  4. Report of Progress toward goal attainment Second year target: _ X Achieved _____ Not Achieved (If not achieved, explain why)

In FY2021 twelve (12) virtual WRAP Refresher Training events were provided during the year. The target was changed from 20 to 12 due to the shift from in-person to virtual sessions. When sessions were provided in-person, more sessions were required to meet people at various locations across the state (5 geographic regions). By shifting to virtual sessions, fewer could be offered, as individuals can participate in a virtual session without having to travel. Three sessions were offered statewide each quarter, for a total of 12.

To date, 558 individuals have been trained and certified as WRAP Facilitators in Illinois. As WRAP is an evidence-based Practice, Facilitator certification requires in-person training which has been put on hold due to the pandemic. Virtual training sessions have not yet been authorized by the national training authority for WRAP, the Copeland Center for Wellness & Recovery. For this reason, the number of facilitators in the State did not increase in FY2021. A Work Group composed of facilitators, provider agencies and other stakeholders has been assigned the task of making recommendations for modification to the methodology for offering WRAP Facilitator Training in Illinois to meet State guidelines for in-person gatherings and still have the opportunity to train new facilitators.

Background

The Wellness Recovery Action Plan (WRAP) model is well established in Illinois. DMH Bureau of Wellness & Recovery Services provides annual WRAP® Facilitator Training and has trained over 500 people statewide how to deliver WRAP® since 2002. 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. Recognized as 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.

The community support services WRAP® facilitators provide are Medicaid-reimbursable, making WRAP® an affordable program for many agencies. However, many individuals who have completed WRAP® Facilitator Training have not gone on to provide WRAP® classes. DMH Bureau of Wellness & Recovery Services continues to work on increasing the number of trained facilitators who are providing WRAP® classes and increase access to WRAP® Facilitator Training in Illinois.

Consumer Education Teleconferences

  1. Objective #3: Continue to inform and empower consumers and families.
  2. Strategy #3: Conduct a series of statewide teleconferences designed to disseminate important information to adult consumers and families across the State.
  3. Annual Performance Indicators to measure goal success: Indicator #3: Number of statewide teleconferences held each year. Number of participants per teleconference.
    1. Baseline measurement (Initial data collected prior to and during SFY 2020): Ten (10) statewide teleconferences in SFY2018 and 10 targeted for FY2019.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 10
    3. Second-year target/outcome measurement (Final to end of SFY 2019): 10 
    4. Data source: Document each teleconference event and aggregate by year for comparison across years.
    5. Description of data: Teleconference agendas
    6. Data issues/caveats that affect outcome measures: None
  4. Report of Progress toward goal attainment Second year target: __ X_ Achieved _____ Not Achieved (If not achieved, explain why)

This strategy was successfully achieved in FY2021. Ten teleconferences were conducted in SFY2021 with an attendance ranging from 219 to 293 persons per call and an aggregate attendance of 2,213. The dates, topics, and number of participants of each teleconference are detailed in the table below. (Data is not available for one of the teleconferences (10/22/21) because attendance is collected in real time by ATT during the teleconference and ATT failed to report the data for that call which becomes unretrievable at a later point in time.)

Participation in the conference calls has dropped significantly since March 2020 from an average of 355 per call to an average of 246 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.

Adult Consumer Education Teleconferences in FY2021

Date of Call Topic Numberof Participants
07/23/20 Envisioning Wellness in Our Careers 219
08/27/20 Shifting Our Outlook 264
09/24/20 Finding the Positives in Our Challenges 236
10/22/20 Seeking a Healthy Lifestyle XXXXX
01/28/21 Using Laughter and Other Tools to Make Ourselves Happy 293
02/25/21 Diversity: Together We Can Do Great Things 244
03/25/21 Maintaining Wellness Through Clear Boundaries 223
04/22/21 How Words Influence Our Outcomes 248
05/27/21 The Power of Kindness and Gratitude 245
06/24/21 Put Our Lived Experience To Work 241

Background:

For many years, DMH has recognized the need for providing consumers with the tools they need to cogently and effectively participate in the development and evaluation of the service system. The primary focus has been to ensure that consumers of mental health services receive current, accurate, and balanced information regarding changes in the service delivery system that empowers them to take an active, participatory role in all aspects of service delivery. These calls provide a forum for discussion of information about a range of services and approaches that has included integrated health care, crisis planning, and personal wellness; new developments such as changes in service policies and procedures; and emerging issues such as thriving in challenging economic times have been discussed, using presentations that are designed to advance consumers' awareness and knowledge.

Plan Table 1-8 Access Data/ Consumer Satisfaction Survey

  1. Priority Area: Use of Data for Planning-Consumer Satisfaction Surveys
  2. Priority Type: MENTAL HEALTH SERVICES
  3. Population(s)-SMI, SED,
  4. Goal: Use Quantitative and qualitative data to assess access to care and perception of treatment outcomes to provide data for decision support.
  5. Objective: Continue to improve and maintain quality data collection and reporting.
  6. Strategies: (a) Conduct an annual consumer satisfaction survey that includes national outcome measures (NOMs) and report results. (b) Assess access to care through the Consumer Satisfaction Survey. (c) Establish and maintain a functional data sharing system that will include mental health service data for persons funded through Medicaid Managed Care system (MCOs).
  7. Annual Performance Indicators to measure goal success: Indicator #1: Percent of Adult Consumers and Parents/Caregivers surveyed who report positively about the services they received in response to the MHSIP Adult Consumer and MHSIP Youth Services Survey for Families perception of care surveys
    1. Baseline measurement (Initial data collected prior to and during SFY 2020): MHSIP Surveys were resumed in FY2018. On the adult Consumer Survey 83% of respondents reported positively about their satisfaction with services received and on the Youth Survey, 68% of parents-caregivers reported positively on their overall satisfaction with services.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): For Adults- 85% reporting positively. For Youth-70% of respondents reporting positively.
    3. Second-year target/outcome measurement (Final to end of SFY 2021): For Adults- 85% reporting positively. For Youth-70% of respondents reporting positively
    4. Data source: Survey responses to Satisfaction questions on the Mental Health Statistics Improvement Program (MHSIP) Adult Consumer Survey and the MHSIP Youth Services Survey for Families.
    5. Description of data: See Above
    6. Data issues/caveats that affect outcome measures: None
  8. Report of Progress toward goal attainment Second year target: _____ Achieved ___X__ Not Achieved (If not achieved, explain why)

The FY2020 MHSIP Surveys have not yet been conducted. As of mid-March 2020, all DMH offices were closed and most all employees have been working remotely from home. The survey has been completed annually by using a stratified random sample of all consumers and caregivers who had received services during the month of June. The mail survey has been completely produced, conducted and processed by DMH Central Office staff, which can only be done on site in the physical offices. In FY2019, surveys were mailed to approximately 4,500 individuals and over 450 responses were received. In FY2020 DMH staff have not been available to manage the survey process. The survey is considered a priority for immediate action upon staff returning to office. The process takes approximately 90 days so results should be available shortly after a return to almost normal conditions. The unfortunate resurgence of Covid19 in Illinois and the current implementation of the Tier 3 Mitigations to contain the pandemic poses a serious setback and new delays on many fronts.

DMH is currently exploring electronic and web-based approaches and methods to conducting the surveys and considering ways to streamline the survey process, make it less dependent on printing, mailing, fastidious data entry, and other clerical processes and still be able to obtain accurate results quickly.

Plan Table 1-9: Justice (Mental Health Juvenile 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, OTHER:
  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; Provide an alternative to incarceration for youth with SED and link them to community-based services that address their unique needs and strengths.
  6. Strategies to attain the objective: 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.
    1. Baseline measurement (Initial data collected prior to and during SFY 2021): In FY2020 960 youth were referred to the program and 662 were successfully linked to an agency for service.
    2. First-year target/outcome measurement (Progress to end of SFY 2022): 500 youth linked
    3. Second-year target/outcome measurement (Final to end of SFY 2023): 500 youth linked
    4. Data source: MHJJ Program Data Base maintained internally by DMH oversight staff
    5. 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.
    6. Data issues/caveats that affect outcome measures: None
  8. Report of Progress toward goal attainment Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

This program was successfully accomplished in FY2021. The target of 500 youths to be linked to services was surpassed by 11.6%! By the end of the fiscal year 558 individuals were linked to services.

Over the last fiscal year, the COVID pandemic had a significant effect on agencies across the state. As such, this resulted in a significant decrease of referrals and linkage. Nevertheless, the program was successful in meeting and exceeding its targets for the number of referrals, youth found eligible and those linked to services either directly or via an integrative health home. Furthermore, several MHJJ provider agencies have continued to utilize telehealth as a means to connect with youth as the COVID pandemic has evolved.

During FY2020-FY2021 there were 20 agencies operating the MHJJ program, up from the 14 agencies that had provided services earlier in FY2017. Several new agencies had begun providing MHJJ services and some legacy agencies that had more robust staffing than in previous fiscal years which contributed to the significant increase in MHJJ program activity. By the end of FY2020, of 960 referrals that were screened, 662 were found eligible for the program and received mental health and support services.

Number of Youth Served by Fiscal Year

Fiscal Year Eligible Enrolled
FY2017 Actual 214 209
FY2018 Actual 748 693
FY2019 Actual 789 618
FY2020Actual 960 662
FY2021 Actual 610 558

MHJJ continues to successfully identify youth in the juvenile justice system with serious emotional disturbances, treat them in the community, improve their overall functioning and support them from re-arrest.

Background

The Mental Health Juvenile Justice (MHJJ) program was designed to divert youth with serious emotional disturbances out of the juvenile justice system and into community-based care. Initially funded in CY2000 as a pilot project in just seven counties, the MHJJ program expanded to covering 29 Illinois counties, involving 20 community agencies statewide, and services provided by an estimated 60 clinicians in FY2015. The program has always sought to maintain the number of available providers.

The MHJJ program is overseen through the DHS/DMH Forensic Services Program, aims to strengthen the linkages among the courts, probation, detention, schools, mental health, and other community-based services, and recognizes that family engagement at all levels is vital to achieving best outcomes. 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. These specially-trained MHJJ liaisons screen the youth for the presence of a serious emotional disturbance and a functional assessment is conducted to identify areas of functional impairment as well as areas of strength that can be leveraged in the development of an individualized action plan. Should that child have a diagnosis that includes a psychosis or an affective disorder, 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). Based on this action plan, youth are linked with appropriate community-based services. MHJJ liaisons continue to monitor the progress of each youth for a period of six months. DHS provides funding for MHJJ to the community agencies from state general revenue funds (GRF). Most agencies receive funding for one liaison. Flexible spending funds may be budgeted to supplement the youth's ancillary treatment services or family stabilization if no other source of funding is available. Several MHJJ agencies have been able to offer parent to parent support through their Family Resource Developers. 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 FY2021, the MHJJ Program continued with expanded eligibility criteria to include youth who are "at risk" of contact with the criminal justice system. "At risk" youth have a diagnosis or symptoms, may have had ancillary contact with police (e.g., school resource officers, station adjustments, and are not receiving necessary services and/or any type of intervention that could divert them from becoming more involved in the criminal justice system. As a result of this expansion, wards of the Illinois Department of Children and Family Services (DCFS) who have become justice involved and need the kind of services and monitoring for the courts that MHJJ provides, youth with serious emotional disturbance who may have had ancillary contact with police (e.g., school resource officers, station adjustments) and would benefit from MHJJ services, and youth with significant trauma histories/symptoms who have come into contact with the justice system are now eligible.

MHJJ continues to emphasize targeted outreach to, and education of, referral sources of minority youth with serious emotional disturbances. As research has shown that an estimated 75% of children in the juvenile justice system have experienced traumatic victimization, the MHJJ program continues to guide agencies to be considerate of trauma informed practices in interacting with youth and in linking youth to trauma informed services.

In FY 2021, 741 youth were referred to the program, 610 were evaluated as being eligible for services, and 558 were linked to services directly and through an integrative health home.

Table 1-10 Community Integration

  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.
  6. Strategies to attain the objective: Through FY2020, FY2021, and potentially 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) 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. 
  7. Annual Performance Indicators to measure goal success: Indicator: Number of consumers transitioned from long term institutional settings who access appropriate permanent supportive housing or other housing options. (National Outcome Measure)
    1. Baseline measurement (Initial data collected prior to and during SFY 2020): 315 Class Members were transitioned in SFY2018. 256 Class Members were transitioned in SFY2019. 400 Class members are targeted for transition by the end of FY2021.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 400 targeted/167 were transitioned.
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 400 Class Members are targeted for transition in the SFY2021. However, this total is unlikely to be achieved due to COVID and will depend on how much transition work providers can perform while COVID in-person contact restrictions are in place. NOTE: The Williams vs. Pritzker Consent Decree was originally slated to sunset in 2016. The activities of this Consent Decree continued through FY2020 and will continue through FY2021. Continuation after the FY2021 will depend on negotiations between parties and the court decision.
    4. 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.
    5. 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.
    6. Data issues/caveats that affect outcome measures: Continuation after the FY2021 fiscal year will be dependent on negotiations between parties and the court decision.
  8. Report of Progress toward goal attainment Second year target: _____ Achieved __X___ Not Achieved (If not achieved, explain why)

Although the numerical target of 400 transitions per year which was established in the Court Order and has been standard for the past several years for this objective, was not achieved, it is nonetheless remarkable that the level of effort was maintained and still proved to be fruitful during this very difficult and complicated year for this program.

During FY2021 183 individuals were successfully transitioned to independent living in the community supported by clinical services. This reflects a 10% increase over the number transitioned in FY2020 (167) and is a significant achievement considering the effort and planning needed to overcome the challenging environment and obstacles encountered due to the Pandemic.

Transitions during the second six months of FY2020 and through FY2021 were significantly and negatively impacted by COVID-19, which coincided with IDHS' transformation of the Williams Class Member service delivery model.

In February of 2020, the Williams Consent Decree service delivery model was completed, restructured, and put into operation. The new model, called the Comprehensive Class Member Transition Program (CCMTP), minimizes 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, and IDHS held orientations and trainings for the new service delivery model. Just as the CCMTP pilot was getting off the ground, the COVID-19 pandemic struck. Due to the State's decision to ensure the safety of residents and restrict access to Long Term Care Facilities (LTCF's) around March 9th, 2020, the CCMTP came to a complete halt as providers were unable to continue to engage Class Members in the LTCF's. With rare exceptions, Prime Agencies were unable to transition any Class Members during the first few months of the pandemic, due to the complexities of staging a "no-contact" transition and concern for the safety of Class Members in the new environment created by COVID-19.

The CCMTP adapted by moving all of its services to telehealth. This pivot continues to evolve, as it is highly dependent on the time and commitment of LTCF staff to assist coordinating the virtual engagement between the Class Members and Prime Agency. There are a limited number of Class Members who have access to virtual equipment (smart phones, tablets, computers, etc.). IDHS shifted some funding previously targeted for transitions to allow provider agencies to purchase equipment to aid with telehealth and teleservices delivery. Class Member transitions continue, but at a slower pace when compared to pre-pandemic times. IDHS remains committed to researching and exploring ways of working towards compliance with the Williams Consent Decree, despite the COVID-19 pandemic - including new and progressive ways of enhancing the telehealth service delivery approach.

Even during "normal" times, successfully transitioning 400 individuals to the community is dependent on several factors. Class members can decline participation by disregarding outreach efforts or refusing to be evaluated. A Class Member may be evaluated and found to not be clinically appropriate or ready for independent or supported community residence. To be transitioned, an individual must have a stable source of income, such as employment or social security benefits. Housing resources to meet the specific needs of transitioning individuals in the desired neighborhood of the individuals may be limited, at least temporarily.

Background: The Williams Consent Decree

The Williams vs. Quinn (Williams vs. Pritzker) Class Action lawsuit was filed in 2005 and settled in 2010. The suit targeted an estimated 4,500 residents of former skilled nursing facilities (SNF) designated as Institutes for Mental Disease (IMDs), now classified as Specialized Mental Health Rehabilitation Facilities (SMHRFs), defined as having more than 50% of the residents with 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. While the State did not admit guilt, it entered into the Williams Consent Decree and annually adopts, with the agreement of the Court Monitor and Plaintiffs' Counsel, an Implementation Plan setting forth the State's targets and goals to obtain compliance with the Consent Decree. The FY2018 through FY2021 Williams Implementation Plans may be accessed at: https://www.dhs.state.il.us/page.aspx?item=112833.

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.

The Illinois Housing Development Authority (IHDA), the Corporation for Supportive Housing (CSH), and Governor's Housing Coordinators, in partnership with DHS, have worked with developers, real estate companies, and landlords to increase housing stock. In the process of transitioning interested Class Members to community housing, it is expected that the 13 chosen community providers will assure the provision of coordination services during transition that include: assistance with the housing search via in-house or subcontracted Housing Locators; 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 that linkages are completed for requisite services, especially needed mental health services as well as medical and other necessary services and supports.

The total Williams expenditures for FY2021 were $47,503,949, out of $60,312,699 allocated. Looking specifically at the transition program (the Comprehensive Class Member Transition Program), FY2021 expenditures were $16,542,671 out of an allocation of $21,602,571.

During FY2021, we planned, with our partners at UIC College of Nursing, a new data management system, which was implemented at the beginning of FY2022. This has allowed for more real-time performance management and identification of trends and issues.

We have also overcome significant barriers associated with the COVID-19 pandemic, including restrictions on access to facilities. Working with our sister agency, IDPH, we were able to issue clear guidance to long-term care facilities that transition program staff must be allowed to meet with Class Members despite the pandemic.

In addition, despite the pandemic, we were able to transition more Class Members during FY2021 (183) than in FY2020 (167).

Plan Table 1-11 Mental Health and the Military

  1. Priority Area: Coordination and facilitation of mental health services for Illinois Service members, Veterans, and their Families (SMVF).
  2. Priority Type: MENTAL HEALTH SERVICES
  3. Population(s) OTHER Service 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: Sustain a coordinated system of care
  6. Strategies to attain the objective:
    • Develop and maintain partnerships with the Department of Veterans Administration, the Illinois Departments of Veterans' Affairs (IDVA), and Military Affairs (IDMA), and other agencies and organizations meeting regularly to develop, establish and maintain a coordinated system of care.
    • Develop an inventory of existing behavioral health system providers and services to provide a referral system.
    • Build a coordinated crisis service intervention system between the VA and community providers, with special emphasis on suicide prevention.
  7. Annual Performance Indicators to measure goal success: Indicator #1: The number of collaborative meetings attended by DMH staff representatives that have agendas aimed at identifying and accomplishing strategies for coordination of services.
    1. Baseline measurement (Initial data collected prior to and during SFY2019): Twelve (12) meetings were attended in FY2019.
    2. First-year target/outcome measurement (Progress to end of SFY 2020): 12 20 meetings actually attended
    3. Second-year target/outcome measurement (Final to end of SFY 2021): 12
    4. Data source: Meeting Minutes and records of DMH staff members assigned to this collaborative task.
    5. Description of data:  See Above.
    6. Data issues/caveats that affect outcome measures: None.
  8. 8. Report of Progress toward goal attainment Second year target: __X___ Achieved _____ Not Achieved (If not achieved, explain why)

This objective was achieved and the numerical target largely surpassed. By the end of FY2021, sixty (60) virtual collaborative meetings had been attended by the DMH representatives that had agendas aimed at the coordination of services and expanding the inventory of behavioral health services available to service members and their families. The agendas of these meetings included planning and coordination for the Governors Challenge to End Suicide Among Veterans, maintaining partnerships with the Department of Veterans Administration, the Illinois Departments of Veterans' Affairs (IDVA), and Military Affairs (IDMA), and other agencies and organizations; work toward completing the behavioral health inventory of existing providers; monitoring the ongoing coordination of services; and facilitating a coordinated system of care. DMH representatives also attended two national conferences held virtually of the SAMHSA Policy Academy convened and conducted by the SAMHSA SMVF TA Center.

Background:

Key accomplishments envisioned for the Governor's Challenge teams include the following:

  • Reducing suicide among service members, veterans, and their families;
  • Increasing access to services and support;
  • Expanding state-wide capacity to engage SMVF in public and private services;
  • Enhancing provider and SMVF peer practices;
    • Implementing innovative best practices (e.g., Screening and Asking the Question - have you or a loved one ever served in the military?)
  • Forming cross-system military and civilian consensus on priorities and plan for action;
  • Identifying critical data elements to measure impact and quality of care;
  • Strengthening the continuum of care; and
  • Transferring knowledge on evidence-based practices, policies, and strategies that are effective across teams.

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.

This initiative has allowed DMH to collaborate with key stakeholders and service providers throughout Illinois and the country in an effort to end veteran suicide. There is an ever-growing network of community providers in Illinois participating in a collaborative system of care.

  1. Objective #2: Improve quality of community mental health services to servicemembers, veterans, and their families Improve quality of community mental health services to servicemembers, veterans, and their families
  2. Strategy to obtain the objective: Provide DMH expertise in the promotion and provision of education and training for community mental health providers in military and veteran clinical and cultural competence.
  3. Indicator #2. The provision of Military and Veteran 101 Clinical Cultural Competency Workshops. the number completed during the fiscal year, and the number of participants each year.
    1. Baseline measurement (Initial data collected prior to and during SFY 2020): N/A
    2. First-year target/outcome measurement (Progress to end of SFY 2020): Four (4) Workshops
    3. Second-year target/outcome measurement (Final to end of SFY 2021): Four (4) Workshops
    4. Data source: Calendar dates of these events and attendance records of each.
    5. Description of data:  See Above.
    6. Data issues/caveats that affect outcome measures: None.
  4. Report of Progress toward goal attainment Second year target: _____ Achieved __X__ Not Achieved (If not achieved, explain why)

The advent of COVID-19 made everything go virtual as it relates to meetings and gatherings and it has been no different for the SMVF population. Many events were cancelled in a time when the service needs were increased. Despite moving to an online platform, no additional MIL101 workshops were scheduled in the later months of FY2020 nor in FY2021because everyone's focus had shifted to managing and coping with COVID. Towards the end of the fiscal year discussion about resuming the MIL101 workshops re-emerged as part of the Governor's Challenge Training initiative in Illinois. It has been anticipated that a portion of the funds dedicated by the State to the Governor's Challenge will be spent on training, public education, and outreach.

Military and Veteran 101 Clinical Cultural Competency Workshops are included in the Governor's Challenge Illinois Action Plan under Priority Area 2 -Promoting Connectedness and Improving Care Transitions. Providing this type of training to educate and prepare providers and members of the public to engage veterans, servicemembers, and their families in a sensitive, competent and effective manner is a strategic necessity toward decreasing and avoiding negative outcomes. Contingent upon resources, constructive collaborative planning and implementation, and the continuing abatement of the Covid 19 pandemic, MIL101 workshops and/or similar support efforts will again become available.

It may be noted that two workshops were completed during FY2020 before the arrival of the pandemic with a total of 80 participants. Smart Policy Works and a host committee of Thresholds, Illinois Joining Forces, and the Illinois Department of Veteran Affairs on (IDVA) brought the She Served Conference into Springfield, IL on September 17, 2019. The theme of the Conference was: Reducing Barriers to Women Veterans' Health Care and it included free registration to panels with information regarding healthcare for Women veterans, a keynote panel, and continuing education credits. The event was attended by more than 50 people. A Veterans Benefits and Services Informational was held on December 3, 2019 as part of a Region I Central Provider Network Meeting.

Background

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 have experienced 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 abuse, 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.