HomeMy WebLinkAboutFY 16-17 Block Grant DRAFT Plan 5.16.16 Franklin County Human Services Plan
Fiscal Year 2016-2017
Submitted: June 2016
The Public is invited to review and comment on this Plan. Please
email comments to Rick Wynn, Human Services Administrator
(rcwynn@franklincountypa.gov), or Shalom Black, Grants Director
(seblack@franklincountypa.gov). Or, mail comments to: Human
Services Administrator, 425 Franklin Farm Lane, Chambersburg
PA 17202
PART I: COUNTY PLANNING PROCESS
Describe the county planning and leadership team and the process utilized to develop
the plan for the expenditure of human services funds. Counties should clearly identify:
1. Critical stakeholder groups including individuals and their families,
consumer groups, providers of human services, and partners from other
systems,-
Planning
ystems,Planning team members include human services providers and stakeholders as
well as consumers and advocate family members. In addition, the team includes
staff support from each of the departments included in the block grant. Appendix
D includes a comprehensive list of the members of the planning team and their
affiliations.
The leadership team is comprised of key fiscal and human service administration
staff and includes: Human Services Administrator, Fiscal Specialist, Human
Services Fiscal Director, MH/ID/EI Administrator, Drug & Alcohol Administrator,
County Grants Director, and the Assistant County Administrator.
2. How these stakeholders were provided with an opportunity for
participation in the planning process, including information on outreach
and engagement;
We have a small but active Planning Team that deliberates on the larger Block
Grant Plan, monitors implementation, and recommends adjustments
throughout the year. In addition to participating in the Human Services Block
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Grant (HSBC) meetings, program consumers and their families are often
asked for their input through surveys, evaluations, and informal feedback; this
feedback informs the operation of Block Grant-funded programs.
In addition, most of our categorical areas have their own advisory boards
which inform the direction of each department and Block Grant-funded
programs:
The Franklin/Fulton Drug & Alcohol Drug Advisory Board holds
eleven meetings per year, six in Franklin County and five in
Fulton County. The voting members of the Advisory Board
include the following sector representation: Criminal Justice;
Business/Industry; Labor; Education; Medicine; Psycho-Social;
Student; Elderly; Client and Community. They provide input into
the Block Grant Plan, are informed of Block Grant impact and
are made aware of any Drug/Alcohol requests for new funding,
projects or service enhancements.
o The Franklin County Housing Task Force consists of about 25
people who meet bi-monthly on issues around housing and
homelessness. Representatives from both County shelters and
the HAP program attend regularly, along with Housing Authority
staff, staff from the domestic violence shelter, Salvation Army,
an FQHC, two Boroughs, and several religious organizations.
They also receive updates on Block Grant plans and funding
requests. The Task Force now combines their meetings with
those of the Program Coordinating Committee hosted by the
County Housing Authority, a change which has engaged
additional community members and offered opportunities for
presentations on local housing resources.
o The Franklin/ Fulton County Mental Health/ Intellectual
Disabilities/ Early Intervention Advisory Board meets bi-monthly,
with 13 members, including one Commissioner from Fulton and
one from Franklin. The committee requires representation from
each county: four members from Fulton County; nine members
from Franklin County. At least two representatives appointed to
the Board are physicians (preferably, a psychiatrist and a
pediatrician). Four participants are consumers or family
members, of which half represent Intellectual Disabilities/ Early
Intervention. Additional representation comes from the following
areas of expertise: psychology, social work, nursing, education,
religion, local health and welfare planning organizations, local
hospitals, businesses and other interested community groups.
The MH/ID/EI Administrator provides HSBG updates as
applicable during the Board meetings. They have impact on
decisions related to MH/ID/EI funding and decisions, which
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indirectly can impact the HSBC.
o The Children & Youth Advisory Board meets five times each
year. Members come from various sectors, including the County
Commissioners, law enforcement, academia, school districts,
providers, and staff. They receive updates on the Family Group
Decision Making program funded by the Block Grant.
3. How the county intends to use funds to provide services to its residents in
the least restrictive setting appropriate to their needs. For those counties
participating in the County Human Services Block Grant, funding can
be shifted between categorical areas based on the determination of local
need and within the parameters established for the Block Grant;
Details of the services to be funded are provided under each categorical area. In
general, funding allocations have remained similar to last year, as we currently feel that
we have achieved a balance that provides for the basic needs in each categorical.
4. Substantial programmatic and/or funding changes being made as a result of
last year's outcomes.
County Planning Team members acknowledge that the existing data lacks the breadth
and depth to make critical decisions regarding comprehensive human services that are
responsive to local needs and the current service delivery environment. The County
Planning Team is working to establish an objective decision- making framework that
incorporates needs, outcomes and values when developing future human services
plans, starting with a data warehouse that we plan to develop next year.
The processes for establishing both meaningful outcomes (as opposed to outputs) and
for prioritizing our needs has taken much time and planning, as outcomes and needs
prioritization are intimately related. We have started by determining the current program
outputs and outcomes. We will use those outcomes as part of the process to determine
our priorities and needs, with the outcomes data collected in the data warehouse
serving as a foundation for determining needs. We have not settled on a model to
objectively assess needs, but we know that the model must include valid and reliable
data, quality community dialogue, and strategic thinking as we plan for the future. With a
solid foundation, we can forecast desired future outcomes and goals that will be
meaningful to the Block Grant programs and ultimately the community as a whole.
The collaborative nature of the Block Grant Plan process remains extremely beneficial
to the county, especially the inclusion of consumer and family perspectives. The
Planning Team is better able to take a holistic approach because they better understand
each department's mission and services. The process also yields more empathy among
planners. The County Planning Team still wrestles with the weighty question of, "How
can we be expected to pick certain human services over others when there is such
great need throughout all of the programs?" But, with the collaborative nature of
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Franklin County stakeholders, and the forward movement of integrating objective data
into the decision-making process, this task is no longer as daunting as County Planning
Team members perceived in the past.
5. Representation from all counties if participants of a Local Collaborative
Arrangement (LCA).
Franklin and Fulton Counties are joinders in Drug & Alcohol and MH/ID, and as
such have representation on each county's Block Grant committees. Jean Snyder
from Fulton County Human Services serves on the Franklin County HSBG
Planning Committee.
PART II: PUBLIC HEARING NOTICE
Two (2) public hearings are required for counties participating in the Human Services
Block Grant. One (1) public hearing is required for counties not participating in the
Human Services Block Grant.
Please provide the following.-
1.
ollowing:1. Proof of publication;
a. Actual newspaper ad
b. Date of publication
2. A summary and/or sign-in sheet of each public hearing. (This is required
whether or not there is public attendance at the hearing)
NOTE: The public hearing notice for counties participating in local collaborative
arrangements (LCA) should be made known to residents of both counties.
The Board of Commissioners approved the County's Human Services Plan, as
illustrated by their signatures found in Appendix A —Assurance of Compliance.
Pursuant to the Sunshine Act, 65 Pa.C.S. 701-716, the County conducted two public
hearings to receive input on the Human Services Plan detailed in this document. A
draft of the Block Grant Plan was posted on the County's website on May 16, 2016 for
public review and comments. Public hearings were held at 3:00 PM on May 26, 2016,
as part of the Block Grant Planning Committee, and 9:30 AM on June 2, 2016, as part
of the Board of County Commissioners meeting. Appendix B contains the proof of
publication and summaries of the public hearings.
PART III: MINIMUM EXPENDITURE LEVEL
(Applicable only to Block Grant Counties)
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For FY 2016/17, there is no minimum expenditure level requirement; however, no
categorical area may be completely eliminated. Please see the Fiscal Year 2016/17
County Human Services Plan Guidelines Bulletin for additional information.
PART IV: HUMAN SERVICES NARRATIVE
Created through a collaborative process utilizing local needs data and involving a
cross-section of community stakeholders, the goal of this plan is to provide a
comprehensive continuum of human services for residents in the least restrictive
setting appropriate to their needs. Franklin County collaborates as a joinder with Fulton
County in four of the seven funds included in the Block Grant. Both counties have
longstanding Human Services Administrative models. Both counties are participating in
the Block Grant and submit separate plans.
Franklin County's Human Services Block Grant Planning Committee has established
as its mission: To assist in identifying need-based program priorities for promoting the
health, well-being, and self-sufficiency for all people in Franklin County by and through
maximizing resources. The services described in this plan are an outflow of this
mission statement, and are measured against this guiding standard.
MENTAL HEALTH SERVICES
The discussions in this section should take into account supports and services funded
(or to be funded) with all available funding sources, including state allocations, county
funds, federal grants, HealthChoices, reinvestment funds, etc.
a) Program Highlights:
Highlight the achievements and other programmatic improvements that have
enhanced the behavioral health service system in FY 2015-2016.
The Franklin/ Fulton County Mental Health Program provides services to Franklin/
Fulton County adults with severe and persistent mental illness and children who have a
mental health diagnosis or who are at risk of developing a mental illness.
Through contracted case management, our agency provides intake, assessment, and
coordination of the following services: outpatient psychotherapy, psychiatric and
psychological evaluation, medication monitoring, residential programs, vocational and
social rehabilitation, short-term inpatient, partial hospitalization and 24- hour emergency
services.
Due to the budget issues faced this fiscal year, we focused on maintaining and
strengthening the current services already offered in our community. The following list
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describes program achievements and improvements:
Crisis Intervention Team (CIT) — This initiative is in its fourth year and continuing to
gain momentum. The team is now 59 strong with half of our members representing law
enforcement and first responders. The remainder of the team represents crisis, jail
officers/staff, probation officers, mental health professionals and advocates. We were
fortunate to have hospital staff join our team this year as well.
• South Central Region CIT continues to follow the fidelity of the Memphis Model of
CIT. During the 40 hours of training, we are fortunate to have a certified trainer
for the Veterans module. We also offer evidence based training such as QPR
(Question Persuade Refer) and Pat Madigan's Hearing Voices throughout the
week.
• Outcomes:
o To date we have held four (4) CIT trainings and have fifty nine (59)
members with half of our team being represented by law enforcement and
first responders:
Court Hospital
2%_\ 5%
Probation
7°%
■Law Enforcement
Jail ■First Responders
8°% Law Mental Health
Enforcement
41% Wail
Mental Health ■Probation
29°% ■Court
■Hospital
First
Responders
8°%
o The pre/post-test show considerable growth. The training continues to
show growth in learning, however, it shows a slight decline from previous
classes. It is possible that as we get more seasoned officers in the
training, they have more experience and exposure to working with
individuals and professionals in the mental health system. It is also
possible that they are learning from their peers who are already CIT team
members.
6
Avg G rowt h
2.5
2 6
1.5
1 Avg Growth 4
Seriesl
0.5 2
0 0
class 1 class 2 class 3 class 4 pre post
Mental Health First Aid
• Franklin/Fulton County is fortunate to have five (5) local trainers. Three (3) of
them are Adult Mental Health First Aid instructors and two (2) are both
Youth/Adult Mental Health First Aid instructors.
o In the past five years we have trained approximately 252 participants in
Adult Mental Health First Aid. Participants have come from a variety of
professional backgrounds including: social work, homeless shelter staff,
nursing home staff, administrative staff, corrections staff, business
partners, and many others.
o During our May celebration, there is opportunity for community members
to participate in Adult Mental Health First Aid as well as Youth Mental
Health First Aid.
Supportive Employment
• Continue to work towards increasing our supported employment opportunities for
those in the workforce.
• Outcomes: We tracked the number of employees engaged in Supportive
Employment and the percent change compared to last year. FY 14-15 doesn't
include individuals who are transitioning into supported employment and we are
still trending towards an increase.
Employment
Change
Fiscal *Fiscal 14-15
Year year to 15-
14-15 15-16 16
AHEDD 21 18 -14%
OSI 21 21 0%
Total 42 39 -7%
*15-16 data through April
Communities That Care
• Our community was the proud recipient of a grant to implement the evidence
based program, Communities That Care. We are in the implementation phase;
our data committee has just completed their needs assessment survey and the
resource committee is preparing to begin a mapping process in May. The student
committee began in February. We have been participating in local health and
resource fairs in order to gain membership and awareness in this startup phase.
Trauma-Informed Criminal Justice Strategic Plan
• In Spring of 2015, SAMHSA awarded Franklin County one of 10 Training and
Technical Assistance grants to assist in creating a Trauma-Informed Criminal
Justice Strategic Plan, and training criminal justice professionals on How Being
Trauma-Informed Improves Criminal Justice System Responses. The resulting
Strategic Plan has 20 Priority Areas and accompanying Action Steps that we
have been implementing over the course of the last year, including: staff training
and policies, client trauma screening, and EBP implementation.
System Service Needs
In a review of system service needs, MH/ID/EI recognized that historically, our system
has required improvements in data collection related to quality of care. In response,
MH/ID/EI partnered with other entities in our community to identify which areas should
be analyzed for our system. We created workgroups and assigned them to priority
areas for system indicators analysis. The following topics arose as needing
improvement; we detail what has been done since last year to improve these areas.
Readmission rates
• We continue to have a workgroup comprised of outpatient providers, behavioral
health unit, advocates, crisis, case management, HealthChoices, managed care,
and the County. The group is focused on identifying any commonalities and
discrepancies in our services compared to neighboring communities. The
information will be combined with results of a survey from individuals that have
experienced multiple admissions with the goal of creating an action plan.
• Outcomes: We tracked the annual readmission rates and the percent change
compared to previous years. Readmission rates have continued to decrease
since 2012, with a significant decrease from 2014 to 2015.
Hospital data
% Change 2015 % Change
2011 2012 2013 2014 (13 - 14) (14-15)
Admission 279 313 174 161 -7% 225 +40%
Unduplicated 160 165 98 89 -9% 131 +47%
Readmission 119 148 76 1 72 1 -5% 146 1 -36%
Bed Days 4927 4563 2480 12014 1 -19% 124291 +21%
s
b) Strengths and Needs:
Please identify the strengths and needs specific to each of the following target
populations served by the behavioral health system.-
Older
ystem:Older Adults (ages 60 and above)
• Strengths:
o Franklin County Mental Health has partnered with Link to create Franklin
County Older Adult Team. This team includes Crisis Intervention Staff and
Area Agency on Aging Staff. The goal is to assist older adults in diverting
from a mental health inpatient stay by accessing available services in the
community. Referral criteria has been established and implementation roll
out is currently in process.
o Continue to provide training regarding older adults and mental health to
law enforcement and first responders through the CIT program. This
includes multiple ways of engagement that includes utilization of several
senses. Recognizing the local resources and how to access.
• Needs:
o As the regulations are changing at the state level for the Area Agency on
Aging, it will be important for the county to provide multiple education
sessions.
Adults (ages 18 and above)
• Strengths
o WRAP® - Franklin/Fulton County has 21 WRAP®facilitators representing
different levels of services. We are fortunate to have three of our
facilitators certified to do WRAP®for Developmental Disabilities. Two of
them assisted in writing the workbook and were invited to present our
piloted WRAP® for developmental disabilities program at WRAP®Around
the World Conference in Washington DC. We were able to complete one
8-week WRAP® group this year with thirteen graduates. This program is
one that was not able to be expanded as much as we wanted due to the
budget restraint this fiscal year. Our hope is to offer a few groups
throughout this new fiscal year.
o The Community Support Program continues to host the Leadership
Academy. The program runs one day a week for eight weeks. It features
class sessions on such topics as: networking, meeting coordination,
dressing for success, and others. The sessions are conducted by various
professionals from our community who volunteer their time. The goal of
the academy is preparation of individuals with a mental illness to serve or
hold a position on local community advisory board councils and/or boards
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of directors. To date, 50 have graduated over the past 5 years. Currently,
the class will graduate 12 students at the end of May.
• Needs:
o Public transportation continues to be voiced as a need. For the past few
years, MH/ID/EI has had a contractual agreement with Franklin County
Integrated Transportation to provide funding for transportation to mental
health-related appointments for individuals who are not Medicaid eligible.
Recently, rabbittransit was awarded the contract for our County Shared
Ride transportation program. They are assessing community needs to
determine any creative transportation plans/programs that may be
implemented.
Transition-age Youth (ages 18-26)
• Strengths:
o The focus is on employment opportunities and skills training for transition-
age youth. Mental Health has partnered with Intellectual Disabilities to
host an employment fair in May. The day will start with an informational
presentation for the employers to learn the benefits available for hiring
individuals with a disability. This will include a panel presentation with local
employers who will share their experiences. School districts will be
bringing students 18 years and older to the fair. Local providers such as
the psychiatric rehab center, clubhouse, and supported employment will
also be bringing individuals. Family has also been invited as there will be
benefit education available on site.
• Needs:
o Employment and housing options are needed in our community for
transition-age youth.
o Independent living skills training is needed for this population. General
activities of daily living such as balancing a check book, paying bills,
grocery shopping, cooking, and cleaning are some examples.
Children (under 18). Counties are encouraged to also include services like Student
Assistance Program (SAP), Respite, and CASSP Coordinator Services and
Supports in the discussion.
• Community events:
o Kick-off Your Drug Free Summer will continue this year and has proved
successful not only with the amount of participation but in the fact the
communities have taken over the program and now we are a partner
instead of the organizer.
o Healthy Community Partnership hosted a ten week running program, Go
Girls Go, for elementary girls. Forty-five girls started the program and 38
finished by running a 5k community run for the local Cumberland Valley
Breast Cancer Alliance. The program was designed to work on increasing
self-esteem and body image. The data is still being compiled; however,
unexpected reports from the teachers have been received regarding the
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positive changes seen in the girls' behavior and socialization within the
classroom and school. Family support increase was also reported as an
unexpected outcome. Planning is continuing to determine funds and
staffing in order to continue this program.
o Summit Health, our community's largest health care provider, sponsors a
children's wellness day every spring for all third grade students in Franklin
County. It consists of seven stations, all focused on wellness, covering
everything from exercise, gun safety, fire safety, tobacco products,
kindness, and positive identity. Mental Health/Intellectual Disabilities is the
station leader for Positive Identity. We discuss with them the importance of
good character traits through positive self-esteem and the impact of
bullying. We have used the book "Have You Filled a Bucket Today" by
Carol McCloud as a guide. This year 1,358 third grade students
participated.
• Respite: The demand for overnight respite decreased this fiscal year. The
number of children served for FY 14-15 and 15-16 is unduplicated.
FY 12-13 FY 13-14 FY 14-15 FY 15-16
Overnight Hourly Overnight Hourly Overnight Hourly Overnight Hourly
Children Served 10 5 10 2 10 6 4 0
Hours of Respite 480 39 600 37 624 12 288 0
• Children and Adolescent Service System Program (CASSP): We tracked the
number of families and schools accessing service and supports:
Franklin CASSP Calendar year
2012 2013 2014 2015
Meetings Held 155 220 169 231
New Referrals 40 58 22 40
Higher level of care 1 14 18 18 27
Strengths:
o School-based mental health outpatient services are now present in all
secondary schools in Franklin County.
o Franklin County was fortunate to begin an elementary Student Assistance
Program (SAP) in two of our school districts. The referrals were
overwhelming. Elementary SAP has been able to engage family members
to participate and have assisted them in accessing services in the
community.
o Student Assistance Program (SAP) is now present in all of the secondary
schools in Franklin County.
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Franklin/Fulton combined
#students screened MH D/A CO
2015-2016 (through April) 328 80% 2% 18%
2014-2015 353 72% 6% 22%
2013-2014 337 82% 3% 15%
2012-2013 284 76% 3% 21%
2011-2012 285 73% 7% 20%
Franklin only
#students screened % MH % D/A %CO
15-16 (through April) 289 79% 2% 19%
Needs:
o Funding to provide SAP within all the elementary schools in both counties.
Identify the strengths and needs specific to each of the following special/underserved
populations. If the county does not serve a particular population, please indicate and
note any plans for developing services for that population.
• Individuals transitioning out of state hospitals
Strengths:
o Franklin County continues to partner with the state hospital to create a
community support plan with input from the individual, their treatment
team and family/friends. Prior to discharge, this plan is reviewed again by
the same group and follows the person into the community.
Needs:
o There is a committee currently working to identify needs and make
recommendations to decrease the number of hospitalizations.
o There appears to be a need for more supported housing to assist in the
transitions and also to provide some diversion from needing higher levels
of care.
• Co-occurring Mental Health/Substance Abuse
Strengths:
o The Implementation committee created a co-occurring credentialing
process for providers. It mirrors the OMHSAS bulletin that was created.
The managed care organization and the county mental health program
recognized the credentialing process and provided an enhanced rate to
any provider who successfully passed. This fiscal year we had two dually
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licensed outpatient providers pass the credentialing. As part of the
credentialing, the providers agreed to pilot a data collection survey. There
is an increase in identified persons with co-occurring disorders that we are
attributing to better diagnostic practices. Please refer to the transformation
priorities for further detail.
o Training related to co-occurring illness continues to be offered free to our
providers. We offer an on-line training series that is available for all
Franklin/Fulton County providers. It features training based on the Tip-42
to include motivational interviewing.
o Since our initiative began we have increased the number of persons
accessing services in both the mental health and drug & alcohol
programs.
Individuals with a COD
800
600 —
400 —
200 —
FY 10/11 FY 11/12 FY 12/13 FY 13/14 FY 14/15 FY 15/16
Individuals with a COD
o Our readmission rates are decreasing for both non-hospital and inpatient
hospital for individuals identified as someone with a co-occurring disorder.
30 Day Readmission Rate
Inpatient Psychiatric Hosp.
COD
15.00%
10.00%
5.00%
0.00%
FY 13/14 FY 14/15 FY 15/16
COD-NO COD-YES
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30 Day Readmission Rate
Non Hosp. Rehab- COD
15.00%
10.00%
5.00%
qq-
0.00%
13/14 14/15 15/16(to date
May)
30 day readmission rate rehab COD
Needs:
o Financial support is needed to afford clinicians the time to prepare for and
complete the Certified Co-Occurring Disorders Professional (CCDP)
credential. Our data shows a decrease in services and it is concluded that
clinicians having access to education and training has proven helpful in
identifying and making referrals to the most beneficial services.
• Justice-involved individuals
Strengths:
o In 2012, key criminal justice stakeholders in Franklin County met to update
a sequential intercept mapping model, first created in 2009, to detail the
intersection of local human services with the criminal justice system,
identifying gaps and developing objectives to address unmet needs.
Reentry from a jail environment into the community at large are the fourth
and fifth intercepts of this model (Munetz, M. & Griffin, P., 2006).
o In the CJAB Strategic Plan for 2016-2019, Franklin County identified the
enhancement and expansion of reentry initiatives to include housing and
treatment programs.
o In 2015, PCCD awarded Franklin County a grant to engage a consultant
who has worked extensively with reentry strategic planning throughout the
state. This process would served as a basis for continued development of
a reentry coalition, organized around the goal of cross-agency
collaboration to provide comprehensive services for reentering citizens
and their families, recognizing the difficulties inherent in the process and
helping people remove barriers to reentry wherever possible.
o The Reentry Strategic Planning Committee first convened on July 30,
2015 and became the Franklin County Reentry Coalition in November
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2015. MH/ID staff have been heavily involved in the Coalition and have
been able to provide a much-needed perspective on MH and criminality.
o Franklin County was one of 50 counties chosen to be part of the Stepping
Up Initiative's National Summit in Washington DC in April 2016, an event
that brought together jurisdictions of all sizes to learn from each other and
from experts in the ongoing push to reduce the number of people with
mental illnesses in local jails. The MH/ID Administrator served as the
Team Leader for the Franklin County delegation; we anticipate new
initiatives around MH and criminal justice-involved individuals will be
developed as a result.
Needs:
o Early identification and assessment of individuals with MH issues who
become involved in the criminal justice system.
o Increase the CIT team members as a method of better communication
between the departments/disciplines within our community.
o A program that would be available 24/7 to provide assessments for
individuals that do not need to go to jail but need some support or
diversion.
• Veterans:
Strengths:
o During the week of CIT training, law enforcement is continuing to be
educated about experiences of Veterans returning home after combat.
o Participating in the 2nd annual Veterans Conference being held locally to
share the services available and access information.
o When a person with military experience comes into contact with our local
emergency room, crisis intervention, or delegates, it is requested that the
Veterans Affairs department is offered as a resource and be contacted
immediately to assist in a diversionary plan.
Needs:
o A method of better engagement is needed. Stigma also seems to play a
role in lack of access.
•
Les bian/Gay/Bisexual/Transgender/Questioning/Intersex (LGBTQI)
consumers
Strengths:
o Through CIT, Law Enforcement is being educated about experiences of
persons identifying as transgendered.
Needs:
o List of local MH providers trained to understand the needs of LGBTQI
consumers
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• Racial/Ethnic/Linguistic minorities
Strengths:
o The county hosted an outreach day in the local Hispanic Center in our
community. Staff was on site to link and offer referrals to local services.
o MH/ID/EI does have a contractual agreement with an agency which
provides translation and interpretation services.
o During Children's Wellness Day, the presentation has posters and signs in
Spanish to assist in sharing the healthy message to those that are still
learning English.
Needs:
o SAP has identified a need for more services to be available in Spanish. As
they complete screenings for students, they are struggling to find services
to make referrals due to the language barrier. Services that would be
helpful are family-based, outpatient services (both MH and D&A), as well
as school-based outpatient.
• Other, if any (please specify)
None identified.
c) Recovery-Oriented Systems Transformation:
Based on the strengths and needs reported above, identify the top five priorities for
recovery oriented system transformation efforts the county plans to address in FY
2016-2017.For each transformation priority, provide:
• A brief narrative description of the priority
• A timeline to accomplish the transformation priorities including
approximate dates for progress steps and priority completion.
• Information on the fiscal and other resources needed to implement the
priorities (how much the county plans to utilize from state allocations,
county funds, grants, HealthChoices, reinvestment funds, etc., and any
non-financial resources).
• A plan/mechanism for tracking implementation of priorities.
TRANFORMATION PRIORITY
1 Comprehensive, Continuous, Integrated System of Care Model implementation
(CCISC) to develop a service system that is co-occurring capable.
2 Suicide Prevention
3 Addressing health literacy within our residents and community system
4 Re-entry
5 Data collection to increase knowledge of quality of services in order to assist in
making better decisions for service delivery.
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1 . Comprehensive, Continuous, Integrated System of Care Model implementation
(CCISC) to develop a service system that is co-occurring capable.
i. Implementation team has developed a credentialing process to
recognize local providers that have completed the criteria to be co-
occurring capable.
a. The certification program began the process in May 2015 with the
outpatient providers interested in becoming a recognized county
certified co-occurring program. The completion date target is Dec.
2015. We had two providers that the passed the test and are being
re-credentialed in May 2016. The process will be open to other
providers that are interested in becoming certified as co-occurring
capable as well.
b. On June 16, 2016 the program is hosting our second annual
Networking Day just for providers. The goal is to foster the
relationships between community providers and increase their
knowledge of each other's specialties to allow for better referrals.
c. A two percent incentive rate has been established to encourage
participation in the program. HealthChoices funds have been utilized
to assist with in-person training elements of the program and County
funds for an online training module.
d. This is monitored through the CCISC action plan and reviewed at
implementation team meetings. In addition, this is monitored during
HealthChoices monthly Quality Improvement/Utilization Management
meetings.
e. CCISC will be updating the action plan this summer to address the
needs identified in our local community health needs assessment.
The results of the assessment will be completed and available later
this summer. Target date is Dec. 2016.
ii. Change Agent Committee continues to meet on a quarterly basis. A
review of evidence based programs that focus on the co-occurring
population has just been completed and will be presented to the
committee at this next meeting.
a. The targeted completion date for the committee to recommend the
evidence based program is September 2016.
b. Once an assessment tool is identified, funds of $500 may be needed
to provide training.
c. This is monitored through the CCISC action plan and reviewed at
implementation team meetings. In addition, this is monitored during
HealthChoices monthly Quality Improvement/Utilization Management
meetings.
2. Suicide Prevention
i. Objective 2.1 : Develop a Zero Suicide Prevention philosophy statement
and community education program emphasizing the value and importance
of each individual by December 2018.
a. Strategy 2.1 .2: Identify key community influencers that share the
17
Zero Suicide Prevention and can work on behalf of this effort.
b. Strategy 2.2.2: Create a community awareness / education action
plan for spreading this message into the community
3. Addressing health literacy in both our residents and our system
i. Objective 1 .2: Increase the number of patients who are screened for
depression within the primary care setting by December 2020.
a. Strategy 1 .2.1: Develop community consensus on a depression
assessment instrument that can be used by all Primary Care
Providers, Hospital Physicians, and Mental Health Professionals. The
survey instrument should include questions related to screening for
and managing patients with depression, and identifying resources
needed to assist primary care providers.
b. Strategy 1 .2.2: Create an action plan for educating and gaining support
on the use of the depression assessment tools, and compiling the
assessment results at a centralized location from Primary Care
Providers and Mental Health Providers.
c. Strategy 1 .2.3: Provide training and support for Primary Care Providers
and Mental Health Professionals on the use of the assessment tools,
documentation of assessment results, and making appropriate
referrals for support for individuals experiencing depression.
d. Strategy 1 .2.4: Identify a lead organization for coordinating
assessment tool training, collecting assessment results, and providing
support and coaching for Primary Care Physicians and Mental Health
Professionals in the assessment of patients for depression.
ii. Objective 1 .3: Improve access and quality of care by designing a model by
which behavioral health services are integrated with Primary Care offices
by December 2018.
a. Strategy 1 .3.1: Develop a model for integrating behavioral health
services, training and resources into Primary Care offices.
b. Strategy 1 .3.2: Conduct a pilot program in which behavioral health
therapists serve as a resource and provide support to one or more
(maximum of 3) Summit Physician Services offices.
iii. Objective 1 .4: Increase community awareness about depression and
available resources within the community by December 2020.
a. Strategy 1 .4.1: The Mental Health Task Force will develop a
community awareness and education action plan for informing the
community about depression and other mental illnesses.
b. Strategy 1 .4.2: Continue and expand existing community campaigns
that educate the public about effective ways to manage depression
(i.e., physical activity, nutrition).
4. Re-entry of individuals from our jail to our community. Asa result of Coalition
Planning meetings and surveys, the Reentry Coalition has established the
following priorities for the next steps of reentry planning:
i. EDUCATION
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a. Create an awareness/education plan for the county, including plans for
media.
b. Educate employers about reentry and hiring individuals with criminal
backgrounds.
ii. SUPPORT
a. Identify all existing community resources and create a Reentry
Resource Guide available in print and digital formats.
b. Identify inmate needs prior to release and craft individual release plan,
providing the inmate with a resource directory and packet of materials.
Offer guidance on how to connect with resources.
c. Develop a reentry discharge planning team and/or follow up team to
work with people before and after release.
iii. INCREASE CAPACITY
a. Complete a housing inventory to ensure affordable housing is available
to returning citizens and craft a comprehensive housing plan for
reentry.
b. Commit to keeping formerly incarcerated people involved in Reentry
Coalition meetings and include on committee work.
iv. ADVOCATE FOR CHANGE
a. Examine reentry processes and protocols, looking for opportunities to
enhance or develop better processes and remove process barriers.
5. Data collection to increase knowledge of quality of services in order to assist in
making better decisions for service delivery.
i. Our local advocacy provider, Mental Health Association, has partnered
with Penn State Mont Alto to begin the development of a data warehouse.
A platform has been created for a warehouse. Training to the authorized
users is scheduled to begin this summer. Data entry should begin in late
October 2016.
ii. Collaboration with county providers will begin January 2017 to educate
and share the benefits to having a data warehouse for our community.
Actual use of the system is targeted for 2018.
iii. Franklin County Human Services is working with our managed care
organization to create a data warehouse to track human services data
across systems. We anticipate the platform will be created in 2017.
*On a quarterly basis, progress on each of the transformation priorities is reported to our
Community Support Program.
d) Evidence Based Practices Survey:
19
Evidence Is the Number What Who How often Is SAM HSA Is the staff Comments
Based service served fidelity measures is fidelity EBP Toolkit specifically
Practice available in the measure fidelity? measured? used as an trained to
in the County/ is used? (agency, implementation implement
County/ Joinder county, guide?(Y/N) the EBP?
Joinder? (Approx) MCO,or (Y/N)
(Y/N) state)
Assertive No
Community
Treatment
Supportive No
Housing
Supported No
Employment
Integrated No
Treatment for
Co—occurring
Disorders
(MH/SA)
Illness No
Management/
Recovery
Medication No
Management
(MedTEAM)
Therapeutic No
Foster Care
Multisystemic No
Therapy
Functional No
Family
Therapy
Family No
Psycho-
Education
*Please include both county and Medicaid/HealthChoices funded services
e) Recovery Oriented and Promising Practices Survey:
Recovery Oriented and Promising Practices Service Number Comments
Provided Served
(Yes/No) (Approximate)
Consumer Satisfaction Team Yes 300
Family Satisfaction Team Yes 228 Includes family and youth surveys
Compeer No 0
20
Fairweather Lodge Yes 10
MA Funded Certified Peer Specialist Yes 107 This number has been increasing over the last
3 years.
Other Funded Certified Peer Specialist Yes 20
Dialectical Behavioral Therapy Yes 25 Two providers that offer DBT group.
Mobile Services/In Home Meds No 0
Wellness Recovery Action Plan(WRAP) Yes 27 Count includes groups only
Shared Decision Making No 0
Psychiatric Rehabilitation Services(including Yes 179
clubhouse)
Self-Directed Care No 0
Supported Education No 0
Treatment for Depression in Older Adults No 0
Consumer Operated Services Yes 500 Mental Health Association(count would include
CPS
Parent Child Interaction Therapy Yes 13
Sanctuary No 0
Trauma Focused Cognitive Behavioral Therapy Yes 55
Eye Movement Desensitization and Yes 15 Franklin/Fulton County has 4 certified therapist
Reprocessing(EMDR) for EMDR
Other(Specify):
*Please include both County and Medicaid/Health Choices funded services
Reference: Please see SAMHSA's National Registry of Evidenced Based
Practice and Programs for more information on some of the practices at the
link provided below.
htta://www.nreaa.samhsa.aov/AllProarams.asax
INTELLECTUAL DISABILITY SERVICES
ODP in partnership with the county programs is committed to ensuring that individuals
with an intellectual disability live rich and fulfilling lives in their community. It is important
to also ensure that the families and other stakeholders have access to the information
and support needed to help be positive members of the individuals'team.
This year, we are asking you to focus more in depth on the areas of the county plan
that will help us achieve the goal of an Everyday Life for all individuals.
21
Describe the continuum of services to enrolled individuals with an intellectual disability
within the county. For the narrative portion, please include the strategies that will be
utilized for all individuals registered with the county, regardless of the funding stream.
For the chart below, regarding estimated numbers of individuals, please include only
those individuals for whom base or block grant funds have or will be expended.
Appendix C should reflect only base or block grant funds except for the Administration
category. Administrative expenditures should be included for both base/block grant
and waiver administrative funds.
*Please note that under Person Directed Supports, individuals served means the
individual used Vendor Fiscal/Employer Agent (VREA) or Agency with Choice (A WC)
for at least one service during the fiscal year. The percentage of total individuals
served represents all funding streams. The percentage might not add to 100 percent if
individuals are receiving services in more than one category.
The mission of Franklin/Fulton Mental Health/Intellectual Disabilities/ Early Intervention
is to partner with the community to develop and assure the availability of quality
MH/ID/EI services and supports for individuals and families. Through the use of a
person-centered planning approach and the utilization of Prioritization of Urgency of
Need for Services (PUNS), the ID program assists individuals in accessing services
and supports within their community regardless of the funding stream. The PUNS
gathers information from the person-centered planning approach to identify current
and anticipated needs. This information allows Franklin/Fulton Mental
Health/Intellectual Disabilities/Early Intervention to budget and plan for the continuum
of services and to develop programs to meet the needs of the community. Programs
support client engagement and provide access to services for employment, training,
housing and family support as appropriate. As of April 30, 2016, there were 528 people
registered in the Intellectual Disabilities program in Franklin County, of which 38 are
participants in the life sharing program.
Estimated Percent of Projected Percent of
Individuals total Individuals to total
served in FY Individuals be served in Individuals
15-16 Served FY 16-17 Served
Supported 22 4 24 4.5
Employment
Pre-Vocational 7 1 5 1
Adult Training 0 0 0 0
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Facility
Base Funded
Supports 57 11 60 11
Coordination
Residential (6400)/ 1 0.2 0 0
unlicensed
Life Sharing 0 0 0 0
(6500)/unlicensed
PDS/AWC 0 0 0 0
PDS/ VF 0 0 0 0
Family Driven
Family Support 21 4 25 5
Services
Franklin/ Fulton County ID Program has developed a logic model to reflect the
outcomes and objectives that are being accomplished in both counties. The desired
outcomes and objectives to be measured are the same as the Quality Management
Plan developed for ODP. Appendix E has details that outline the desired outcomes, the
objectives measured and the trends and baseline data. The narratives include more
details of the outcomes.
Supported Employment: "Employment First"is the policy of all Commonwealth
executive branch agencies under the jurisdiction of the Governor. Therefore, ODP is
strongly committed to Community Integrated Employment for all. Please describe the
services that are currently available in your county such as Discovery, customized
employment, etc. Identify changes in your county practices that are proposed for the
current year that will support growth in this area and ways that ODP may be of
assistance to you with establishing employment growth activities. Please add specifics
regarding the Employment Pilot if your County is a participant.
Employment First is a concept promoting community integrated employment. Franklin/
Fulton ID program is supporting this concept in a variety of ways.
The "Transition to Adult Life Success" program engages young adults with disabilities
in discussions and activities pertaining to areas of self-determination and career
exploration. The "Transition to Adult Life Success" program activities include
presentations on employability, community resources, and post-secondary
opportunities. One-to-one services include connecting with employers, job shadowing,
23
community-based work assessments, and work incentive counseling. There are
currently 50 students in the TALS program in Franklin County. The TALS program has
a goal of placing 12 individuals into a competitive job. As of March 2016, 5 individuals
have been placed into a competitive job.
Supported Employment Services include direct and indirect services provided in a
variety of community employment work sites with co-workers who do not have
disabilities. Supported Employment Services provide work opportunities and support
individuals in competitive jobs of their choice. Supported Employment Services enable
individuals to receive paid employment at minimum wage or higher from their
employer. Providers of Supported Employment Supports have outcomes of "placing
individuals with intellectual disabilities in a competitive job." They were expecting to
place 10 individuals in new jobs and as of March 2016, they have placed 5 individuals
in jobs not including the TALS program.
Transitional Work Services support individuals transitioning to integrated, competitive
employment through work that occurs at a location other than a facility subject to 55 Pa.
Code Chapter 2380 or Chapter 2390 regulations. Transitional work service options
include mobile work force, work station in industry, affirmative industry, and enclave.
Franklin/ Fulton County currently serves all individuals using Transitional Work Services
in the Waiver. There are currently 74 individuals in the Transitional Work Program. All
these individuals are waiver funded.
The ID department is concentrating on Community Employment which includes
supported employment and transitional work for the Quality Management Goal and logic
model. The outcome for the Quality Management Plan/ logic model is "people who
choose to work are employed in the community." As of April 1 , 2016, there were 142
Franklin County residents in community employment. Franklin County's QM/logic model
objective is to increase by 5% the number of people who want to work to achieve
community employment. FY 14-15 had baseline data of 56% of people who had an
employment goal were working in the community. The percentage of individuals working
the community is currently 60% (142/236).
24
Employment
31%
■#community employed
■#volunteer
60% #job finding
9%
The Franklin County ID Program is supporting a new program which is due to begin in
June 2016. The Pathways Program is a time-limited program that teaches independent
living skills and/or employment skills. The outcome of this program is for individuals to
complete this curriculum in a 2 year period and live independently in their own
apartment and/or have competitive employment at the end of the 2 years.
The Franklin County ID Program is also supporting an Employment Fair May 12, 2016.
The Fair's morning program is a speaker who informs local businesses of the benefits of
hiring individuals with disabilities followed by a panel discussion with businesses who
hire individuals with disabilities. The afternoon will be open to the public to apply for jobs
at these businesses. Success will be measured by whether businesses hire someone
with a disability and if individuals are hired by the businesses.
During the summer of 2016, the ID Program will also fund a summer youth work
program through Occupational Services, Inc. to provide paid work experience
opportunities to 16 students who have learning disabilities or intellectual disabilities. The
program will target students in Franklin County school districts who do not have the
opportunity for extended school year, transition activities or paid work during the
summer months. This will be the last year for this program as OVR is operating a Pre-
employment Transition Service (PETS). Franklin County ID Program will encourage
students to attend this program as appropriate. The Franklin/ Fulton ID Program also
partners with OVR to provide and attend Referral trainings.
The Franklin/Fulton ID Program participates in the Transition Council with OVR and the
School Districts and providers to promote and support the Employment First Model.
Supports Coordination: Describe how the county will assist the supports coordination
organization to engage individuals and families in a conversation to explore natural
support available to anyone in the community. Describe how the county will assist
supports coordinators to effectively plan for individuals on the waiting list. Describe how
the county will assist the supports coordination organizations to develop ISPs that
25
maximize community integration and Community Integrated Employment.
Base Funded Supports Coordination includes home and community based case
management for individuals in nursing facilities and in community residential settings.
These services are only paid for individuals who have had a denial of Medical
Assistance Coverage. There are 40 people who have base funded Supports
Coordination. There are 9 people who have the OBRA Waiver and have base funded
Supports Coordination. There are 5 people who reside in an ICF/ID or State Center and
receive base funded Supports Coordination. Currently no one is leaving a State Hospital
system from Franklin or Fulton Counties, so transition services are not needed at this
time. The program has MA denials for people who are receiving base services over
$8000.
The ID Program collaborates with the Supports Coordination Organization (SCO) by
holding monthly meetings with Supports Coordination Supervisors. During these
meetings, individuals who are deemed high profile or have Emergency PUNS are
discussed regarding natural supports and what supports are necessary for that person.
Any individual can be added to this list. At these meetings, PUNS, ISPs, Physicals,
Levels of Care and other items are part of the standing agenda discussed monthly. The
SCO is also represented on the Transitional Council and is encouraged to participate in
SELN trainings to promote community integrated employment.
Lifesharing Options: Describe how the county will support the growth of
Lifesharing as an option. What are the barriers to the growth of Lifesharing in your
county? What have you found to be successful in expanding Lifesharing in your
county despite the barriers? How can ODP be of assistance to you in expanding and
growing Lifesharing as an option in your county?
According to 55 Pa. Code Chapter 6500: "Family Living Homes are somewhat different
than other licensed homes as these settings provide for life sharing arrangements.
Individuals live in a host life sharing home and are encouraged to become contributing
members of the host life sharing unit. The host life sharing arrangement is chosen by
the individual, his or her family and team and with the life sharing host and Family Living
Provider Agency in accordance with the individual's needs. Licensed Family Living
Homes are limited to homes in which one or two individuals with an intellectual disability
who are not family members or relatives of the life sharing host reside." Satisfaction
surveys have shown that people in life sharing living arrangements are more satisfied
with their life. This, along with the QM plan/ Logic Model that people choose where they
wish to live, has driven the objective for the 2015-2017 Life Sharing, "to increase the
number of people in life sharing."
The Franklin County Intellectual Disabilities Program will support the growth of life
sharing in the following ways:
1 . The Administrative Entity (AE) and SCO will support people interested in a
residential placement to meet with life sharing providers and life sharers who
26
have openings to promote life sharing as the first option for residential
placement.
2. Once per year at the annual ISP meeting, the AE will review the ISP of anyone
who has a residential placement to assure the SCO has discussed moving to life
sharing from other residential placements. If the person would benefit from life
sharing or is interested in moving, the AE will follow up as in #1 above.
3. The AE Life Sharing Point Person will discuss with providers at least annually if
they
know of anyone who may benefit or want to move from a 6400 licensed home to
a life sharing home.
4. Franklin County has 38 people living in life sharing homes, representing 35% of
the
people in residential placement.
Life sharing is the first residential option offered to any person who needs a residential
placement. This is documented in the Individual Support Plan. Currently, there are 41
people living in life sharing homes in Franklin County (see chart below for Franklin/
Fulton QM/ logic model information). All 41 people have waiver funding to support the
services they need in the life sharing home. The Intellectual Disability Program's Quality
Management/ logic model outcome is "people live where they choose." The QM
objective is to increase the number of people in life sharing in Franklin/ Fulton Counties
by 10% (n=44) by June 30, 2017.
Some of the barriers to growth in lifesharing in Franklin/ Fulton County are the lack of
families willing to be lifesharers. Another barrier is the complex needs of individuals that
may be interested in lifesharing. The final barrier is that caregivers that are lifesharers
are aging. As they age, their own needs increase and they cannot continue to provide
the care required. While there are barriers to lifesharing in Franklin/ Fulton Counties,
there are also successes. Many of the people in lifesharing have lived in their lifesharing
homes for 20+ years. Franklin/ Fulton has an increase in lifesharing every year. And
one provider of lifesharing actively recruits lifesharing families successfully. Finally,
Franklin/Fulton has been successful in moving people from CRRs to lifesharing when
they age out of the Children's system.
Cross Systems Communications and Training: Describe how the county will use
funding, whether it is block grant or base, to increase the capacity of your
community providers to more fully support individuals with multiple needs.
Describe how the county will support effective communication and collaboration with
local school districts in order to engage individuals and families at an early age.
Describe how the county will communicate and collaborate with local children and
youth agencies, the Area Agency on Aging and the mental health system to ensure
individuals and families are provided with the information they need to access needed
community resources as well as formalized services and supports through ODP.
27
The ID program collaborates with the following agencies to increase the support for
individuals with multiple needs. The ID program staff attends Child and Adolescent
Service System Program (CASSP) meetings to discuss the supports needed for
individuals to be supported in their community and school. The ID staff also has a
working relationship with Home Health Aid Providers to support people in the home and
community. Lastly, the Managed Care Organization Specialized Needs Unit is available
for people who meet those criteria.
The ID program also collaborates with the school districts by offering information
sessions to both parents and teachers. The ID staff has attended IEPs when requested
to help problem solve and/or to provide intake information. The Administrative Entity
(AE) also is a member of the transition council and attends the Transition Fairs at all
High Schools county-wide.
The ID program partners with Children and Youth through CASSP. There are also
individual cases where C & Y and the ID Program are involved where communication
between the 2 agencies resulted in the best outcome for the child while protecting the
individual's rights.
The ID program participates in the Aging/ ID Meeting as well as collaborating with the
PASSAR. The ID staff also attends the Building Bridges Conference.
The Mental Health and Intellectual Disabilities program have a long history of
communication and Collaboration. ID collaborated with the Copeland Center for
Wellness and Recovery and Mental Health to pilot WRAP® for People with
Developmental Distinctions, which supports people with both a mental illness and
Developmental Disability. WRAP® is a recovery oriented evidence-based model that is
accepted internationally. Franklin/ Fulton County and Philadelphia are the pilot areas.
The first group was held at OSI in 2013. The County is also on the committee that wrote
the WRAP®for People with Developmental Distinctions curriculum in collaboration with
The Copeland Center, OMHSAS, NASDDDS and ODP. This curriculum is the next step
for WRAP®for People with Developmental Distinction to become evidenced-based.
The County has supported WRAP® efforts to explain this new program at conferences
and trainings. It was presented at the IM4Q Conference in July 2015 and the WRAP®
Around the World Conference in August 2015. WRAP® groups were held throughout
the year. See Mental Health Section.
The ID program also presents the module on Intellectual Disabilities in the Crisis
Intervention Team Curriculum. This curriculum teaches police officers, MH professionals
and first responders how to respond to someone with a disability in the course of their
professions.
The ID program is also a participant in the MH/ID Coordination Meetings with Tuscarora
Managed Care Alliance and Perform Care to develop policy and procedures for people
who have a dual diagnosis.
28
The Quality Management Plan/ Logic Model also includes an outcome to "collaborate
and implement promising practices to assist people in achieving outcomes." The
objective for the 2015-2017 QM Plan/ logic model will be to identify individuals who
have a dual diagnosis and/or a Behavior Support Plan, then develop a toolkit for them to
assist in recovery and achieve their outcomes. In 2015, the baseline data was gathered
and the toolkit started. This next year, the data will be prioritized and the toolkit finalized
and distributed for use.
Emergency Supports: Describe how individuals in an emergency situation will be
supported in the community (regardless of availability of county funding or waiver
capacity).
Provide details on your county's emergency response plan including:
Does your county reserve any base or block grant funds to meet emergency needs?
What is your county's emergency plan in the event an individual needs emergency
services, residential or otherwise, whether within or outside of normal working hours?
Please submit the county 24-hour Emergency Response Plan as required under
the Mental Health and Intellectual Disabilities Act of 1966.
If waiver capacity is unavailable, individuals will be supported out of funds in the
Block Grant. Base money will be provided to graduates for day programs and
transportation to maintain their residence at home, so their parents can maintain
their employment status. The ID Independent Apartment Program has 5 people
living in their own apartments with less than 30 hours of support per week. Base
funds are used to subsidize the rent. The Franklin County ID department will
increase the availability for combinations of Family Aide, Day Programs,
Transportation, Adaptive Equipment, Home modifications and Respite so that
individuals can continue to live at home instead of residential programs which
are more costly.
The AE has a Risk Management Committee that meets quarterly to discuss
incident management and any items that may arise to become a future
emergency.
Franklin County responds to emergencies outside of normal work hours in
Procedure Statement ID-2014-505 Incident Management. In this procedure
statement, all Program Specialists are listed as well as the MH/ID/EI
Administrator with their cell phone numbers. These contacts can be used after
29
hours for any emergency. All providers have been trained in the policy. The
Incident Management Program Specialist checks the HCSIS database on a daily
basis to assure that all the incidents provide for the health and safety of the
individuals served. This includes weekends and holidays. Franklin County
reserves base respite funds to authorize respite services as needed in an
emergency and works with providers and the Supports Coordination
Organization to set up these services, whether during normal business hours or
after. These services may become Emergency Lifesharing or Emergency
Residential while the person is in respite. This provides for the safety of the
person and finds a long term solution.
Please see attached, as Appendix F, the County 24-hour Emergency Response
Plan as required under the Mental Health and Intellectual Disabilities Act of 1966.
Administrative Funding: ODP has engaged the PA Family Network to provide
support and training in the community. The PA Family Network will be providing
individuals who are Person Centered Thinking trainers. Describe how the county will
utilize the trainers with individuals, families, providers and county staff.
Describe other strategies you will utilize at the local level to provide discovery and
navigation (information, education, skill building) and connecting and networking
(peer support) for individuals and families. What kinds of support do you need
from ODP to accomplish those activities?
Describe how the county will engage with the HCQU to improve the quality of life for
the individuals in your community. Describe how the county will use the data
generated by the HCQU as part of the Quality Management Plan process.
Describe how the county will engage the local IM4Q Program to improve the quality of
life for individuals in your program. Describe how the county will use the data
generated by the IM4Q process as part of your Quality Management Plan. Are there
ways that ODP can partner with you to utilize that data more fully?
Describe how the county will support local providers to increase their competency
and capacity to support individuals who present with higher levels of need related to:
aging, physical health, behavioral health, communication, etc. How can ODP assist
you with your support efforts?
Describe what Risk Management approaches your county will utilize to ensure a
high-quality of life for individuals. Describe how the County will interact with
individuals, families, providers, advocates and the community at large in relation to
risk management activities. How can ODP assist you?
30
Describe how you will utilize the county housing coordinator for people with an
intellectual disability.
Describe how the county will engage providers of service in the development of an
Emergency Preparedness Plan.
Franklin/ Fulton ID program is planning to use the PA Family Network to provide
trainings for individuals and families as well as providers and county staff. This
training will be scheduled as the Communities of Practice initiative develops. The
county will support and help coordinate these trainings and support future trainings
that they can provide. The county also coordinates Information sessions for families.
In the past ODP has provided technical assistance for these trainings; the AE also
refers people to Advocacy Agencies and the Disability Rights Network.
The ID program uses the vast experience of the HCQU. Monthly trainings by the HCQU
are held in Franklin County. They also provide individualized training that is requested
by providers and families. The AE attends the Positive Practices Committee Meetings
as well as Regional HCQU meetings. The HCQU is represented at our provider
meetings and sits on both the Risk Management Committee and the QI Council. As a
result of this collaboration, a Medication Error Task Force has been convened in
Franklin/Fulton Counties. This is an outcome and objective in both the Logic model and
QM Plan. The HCQU provides training to individuals, provider homes, staff or
individuals depending on the trends found while analyzing the data. This supports the
outcome to assure the health and safety of individuals receiving services, Franklin/
Fulton Intellectual Disabilities Program will use the objective of reducing the number of
medication errors by 10% by June 30, 2017. The baseline data is 270 medication errors
from July 2013- April 2015. As of March 31 , 2016, there are 89 medication errors this
fiscal year.
As with the HCQU, a representative for the IM4Q local program sits on the QI Council.
As a result of the IM4Q data, the local program realized that people did not know what
to do in an Emergency even though they had a backup plan in their ISP. So, the QI
Council recommended that a one page "What to do in an Emergency" form be
developed. This has turned into a folder with different Emergency Preparedness
information in it. This folder is given to individuals when reviewing what to do in an
emergency or at ISPs when questions are raised. The QI Council also reviews
Employment and Lifesharing IM4Q data to determine satisfaction with services. Both
of these Outcomes are included in the QM Plan and Logic Model. The biggest barrier
to reviewing IM4Q data is that the reports are not current. As a result, there is a lag in
developing QM outcomes and objectives.
The ID program supports local providers by encouraging them to develop a
relationship with the HCQU for trainings needed for their staff to support individuals
with higher levels of need. The HCQU can also do biographical timelines, CDCs,
medication/pharmacy reviews and provide training. The AE continues to support
providers in developing relationships with the local hospital. As previously mentioned,
31
the MH/ID Coordination Meetings help to support providers also.
The Risk Management Committee holds quarterly meetings to assess incidents to
establish a higher quality of life for individuals. The Risk Management Committee
realized that Individual to Individual (1-2-1) abuse was an issue that needed addressed.
The logic model and QM Plan both address the 1-2-1 abuse issue. The outcome, "People
are abuse free,"is measured by the objective of reducing the number of 1-2-1 abuse
incidents by 5%. The number of incidents of 1-2-1 abuse will be measured through
quarterly analysis of the HCSIS Incident Data and the target trends to prevent future
incidents will be analyzed by the Risk Management Team. For 2014-2015, ODP
redefined 1-2-1 abuse, to make sure the definition is consistent across the state. As a
result, the state expects to see 1-2-1 abuse reports sharply increase, followed by a
plateau which Franklin/Fulton will use as baseline data. The baseline data is 115
incidents of 1-2-1 abuse per year. As of March 31 , 2015, there were 80 incidents of 12 1
abuse. The Risk Management Committee has found several trends over this year and is
working to resolve the issues.
The ID Program partners with the County Housing Program to provide an Independent
Living Apartment Program. The people living in these apartments need less than 30
hours of support a week and the county helps subsidize the rent with base funds. There
are currently 5 people in this program.
The County engages providers of service by ensuring that all ISPs have emergency
plans included. As stated in the IM4Q paragraph, the county has developed Emergency
Preparedness Folders for people who request them. This is a new procedure and the
number of folders requested will be tracked over this plan year.
Participant Directed Services (PDS): Describe how your county will promote PDS
services. Describe the barriers and challenges to increasing the use of Agency with
Choice. Describe the barriers and challenges to increasing the use of VF/EA.
Describe how the county will support the provision of training to individuals and
families. Are there ways that ODP can assist you in promoting/increasing PDS
services?
Franklin/ Fulton County has no individuals or families using VF/EA. When the VF/EA
is explained to families, they choose Agency with Choice (AWC) instead. Franklin
County has 33 families using AWC supports. All of their supports and services are
paid with waiver funding. The county coordinates trainings for families through the
Arc of Franklin/ Fulton Counties (the AWC provider) and the HCQU.
The major challenge for AWC is that families have trouble finding staff especially in
the rural areas of the county. This is due to the low wage, lack of transportation and/
or locations far from any services, to name a few. Another challenge is that families
have a lack of knowledge of the ID system and the service definitions. And finally,
families get frustrated at the amount of documentation required of them. ODP
32
assistance could be used to find creative ways to address these issues and to
provider trainings to families.
Community for All: ODP has provided you with the data regarding the number of
individuals receiving services in congregate settings. Describe how the county will
enable these individuals to return to the community.
Franklin County has 5 individuals in congregate settings. Two of these individuals are
in Private ICF/ID. Both of the individuals have medical needs too complex to be
supported by current providers in the local community. Two of the people at State
Centers could leave and go to a Nursing Home but are happy where they currently
reside. The remaining person at a State Center is offered community placement
annually and chooses to stay at the State Center. The rest of individuals who could
be considered in a congregate setting reside in nursing homes. This is a generic
support for them due to their need for a nursing home level of care.
HOMELESS ASSISTANCE SERVICES
Describe the continuum of services to individuals and families within the county who
are homeless or facing eviction. An individual or family is facing eviction if they have
received either written or verbal notification from the landlord that they will lose their housing
unless some type of payment is received. Include achievements and improvements in
services to families experiencing or at risk for homelessness, as well as unmet needs
and gaps.
Homeless and near homeless assistance is provided through the County's Information
and Referral Coordinator, PATH, ESG and HAP. There are two main shelters within the
County, the Franklin County Shelter and the Waynesboro New Hope Shelter. South
Central Community Action Program (SCCAP) runs the Franklin County Shelter for the
Homeless and is contracted to administer the County's HAP funds.
Franklin County has been approved to administer the 2016-2017 Emergency Solutions
Grant, contracting with Waynesboro New Hope Shelter and SCCAP, which includes
short-term rental assistance under the rapid rehousing and homelessness prevention
programs, as well as shelter support. Franklin County also provides permanent
supportive housing through the Mental Health Program and offers an independent living
program through the Intellectual Disabilities funding.
Franklin County's Housing Task Force is coordinated by the Housing Program
Specialists and staff from the Franklin County Housing Authority. Numerous community
agencies are represented at the Task Force meetings with the goal of working together
to pinpoint community housing needs and develop action plans to address those needs.
Members of the Task Force also collaborate to organize homeless outreach events and
establish community collaboration for donations to the local homeless shelters.
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The MH Housing Program Specialists work closely with providers to ensure that
adequate housing assistance and supports are in place for PATH-funded individuals.
Case management is included as part of supportive services offered in two supportive
housing programs within Franklin County. Twenty individuals are able to participate in
the programs consecutively. Franklin County's Housing Program Specialists are able to
support these enrolled individuals with case management services and also work
collaboratively with the individual's case manager through the agency contracted to
provide mental health case management services
In FY 15-16 the Block Grant Committee approved to shift unspent funds into HAP for
the Rental Assistance program in the amount of $30,000 and $43,040 for Emergency
Shelter Support. Beginning in the new FY 16-17, the projected number of individuals to
be served is lower based upon the original funded amount under the HAP program.
For each of the following categories, describe the services provided, how the county
evaluates the efficacy of those services, and changes proposed for the current year, or
an explanation of why this service is not provided.-
-
rovided:• Bridge Housing
Due to the limited funds available, Franklin County has not expanded into bridge
housing support.
• Case Management
• Shelter Case Management —
o Staff at our homeless shelter are provided intensive case management
during their stay at the shelter and ongoing, if needed. Case
Management assists the individual in setting goals and meeting goals
that will lead to stability, including safe affordable housing.
This program is evaluated on a number of factors:
o Did the client increase their income?
o Did the client obtain needed supportive services (mental health, job
training, physical health needs, etc.)?
o Did the client achieve safe affordable housing?
• Homeless Prevention Case Management—
o Our Homeless Assistance Program Coordinator provides case
management for individuals needing rental assistance in order to
prevent eviction or in order to move out of homelessness. Case
Management assists the individual in setting goals and meeting their
goals, in evaluating the cost of housing they can afford, and identifying
other resources they might need.
This program is evaluated on two primary factors:
o Was the eviction prevented?
34
o Did the family move out of homelessness?
• Rental Assistance
Rental assistance is provided to families to prevent an eviction or in order to
move a family who is currently homeless into safe affordable housing.
This program is evaluated on two primary factors:
o Was the eviction prevented?
o Did the family move out of homelessness?
Individuals and families are near homeless if they are facing eviction (having
received either written or verbal notification from the landlord that they will lose their
housing unless some type of payment is received. Verbal notification must be followed
up with written documentation).
Individuals served by the HAP program must have been a resident of Franklin
County for six (6) months prior to applying for assistance.
Priority for Rental Assistance will be given to Franklin County applicants who can
demonstrate that they will be able to become self-sufficient within three (3) months with
regard to housing. Applicants are required to cooperate with case management services
and clients will be required to sign a service plan showing areas of responsibility
between the case manager and the client.
The amount of Rental Assistance allocated will be determined by the facts of the
case. A service plan is created for each household. The plan addresses the conditions
precipitating the housing crisis. It also addresses the acquisition of permanent housing,
including the schedule for disbursement of rental assistance funds.
Franklin County staff completes an annual onsite monitoring visit to evaluate case
management and shelter support to ensure that all program requirements are being
met.
• Emergency Shelter — Emergency Shelter is provided to families who are currently
homeless. Basic needs (shelter and food) are provided in conjunction with intensive
case management and effective referrals.
This program is evaluated on a number of factors:
■ Did the client increase their income?
■ Did the client obtain needed supportive services (mental health, job
training, physical health needs, etc.)?
■ Did the client achieve safe affordable housing?
The Franklin County Shelter for the Homeless is located centrally at 223 South Main
Street in Chambersburg, PA. The Shelter provides 10 bedrooms, two of which are
family rooms, with the capacity to house up to 18 individuals at one time. The Franklin
County Shelter for the Homeless is the last safety net for the residents who may find
35
themselves without a place to live. One of its major goals is to move homeless residents
back into permanent housing and toward self-sufficiency. In order to accomplish this,
the Shelter staff provides case management activities, setting goals with the residents
to be accomplished during and after their stay, and cooperates with other agencies
within the County to direct residents to the available resources that will help them
achieve their established goals. Clients are also required to participate in a basic life
skills program.
In order to become a client at the Franklin County Shelter for the Homeless, an
individual/family must be legally homeless. If legally homeless, the potential client
completes an Application for Assistance and Assessment package, which includes a
self-declaration of homelessness. A potential client will only be considered a client once
he/she has completed the intake forms. Upon completion of the form, the client/family
works with the staff to identify his/her/their particular causes for homelessness. Once
the causes have been identified, the client/family, in coordination with the staff,
develops a plan of action including specific goals to be achieved during their stay at the
Shelter. Long term goals that lead to the attainment of stable housing are also set. The
caseworker assesses the client's work history, medical history, and educational
background. This information becomes a permanent part of the client's file. The staff
identifies the client's family needs such as nutritional education, parenting classes, and
drug/alcohol treatment services. Using this information, staff, under the supervision from
the Program Coordinator, acquires the necessary information or services to address
that particular client/family's needs.
Homeless Assistance Program funds are needed to support the daily operational
costs of the Franklin County Shelter for the Homeless as it tries to adapt to the steady
increase in homeless needs and extensive supportive services. The shelter staff is
finding that an increasing number of homeless individuals need more than 30 days of
emergency shelter due to the lack of employment opportunities.
• Other Housing Supports
Franklin County has not used HAP funding for other housing support services.
Independent living and forensic apartments are available through other funding sources.
Describe the current status of the county's Homeless Management Information
System implementation.
Franklin County has actively participated in HMIS. The Emergency Solutions Grant,
HUD Permanent Supportive Housing Programs, PATH and one Shelter Plus Care
Program through Franklin County are currently entering data into the PA-HMIS. Intake
forms are organized to capture the information that needs to be entered into the PA-
HMIS system. The goal is to have individuals entered in to PA-HMIS immediately
following enrollment in the housing programs. Multiple staff members are familiar with
entering data into the system as well as running reports.
36
CHILDREN and YOUTH SERVICES
Briefly describe the successes and challenges of the county's child welfare system
and how allocated funds for child welfare in the Human Services Block Grant will be
utilized in conjunction with other available funding (including those from the Needs
Based Budget and Special Grants, if applicable) to provide an array of services to
improve the permanency, safety, and well-being of children and youth in the county.
The Franklin County Children and Youth Service (FCCYS) is the local public child
welfare agency responsible for ensuring that the children of Franklin County are safe
and receiving the essentials of life. The agency provides services to any child from birth
to 18 years of age who has been abused, neglected, exploited, is incorrigible and/or
truant, as well as services to their families. Additionally, youth who were determined to
be `dependent' prior to their eighteenth birthday and request to re-enter care are
provided child welfare services.
Services are provided to families who request and voluntarily accept services or who
have been ordered to participate in services by the Franklin County Courts. Services
are designed to promote the safety, permanency, and well-being of children and their
families. These are specialized services dealing with the problems of children whose
families need help in caring for them. Reports involving abused, neglected, exploited or
truant/incorrigible children are investigated and in-home services and/or placement
services are provided to families who meet Children and Youth legal criteria. Children
and Youth can help intervene in family disputes and crises; however, Children and
Youth does not have the authority to determine, mediate or change Court-ordered
custody or visitation agreements. Government intervention is justified when the family
cannot, or will not, provide for the child's safety and/or basic needs. Placement of a
child by Children and Youth can only occur if ordered by the Juvenile Court. FCCYS
provides an array of services (either in-house or through private contracted providers) to
accomplish the goals set forth above.
Block Grant funding is limited to only one of the many programs provided by FCCYS:
Family Group Decision-Making. The Needs-Based Budget supplies funding for most of
the other programs in FCCYS. The services provided by FCCYS provide a wide range
of options to meet the needs of the families we serve.
One of the key challenges facing FCCYS is the increase in referrals and subsequent
need for services. Our Intake Department is struggling to keep up with referrals to
FCCYS. The critical initial assessment of needs at the intake level put an enormous
37
amount of safety responsibility on the Intake Caseworkers and their supervisors. The
timeliness, volume of referrals, and paperwork demands are significant.
While the caseload numbers within the Intake Unit are high, we have been able to
sustain reasonable caseload numbers for our ongoing caseworkers and have seen
improved results in our casework practice. Workers are performing well within
recommended Best Practice Standards and continue to implement these
recommendations in their daily case management. We have implemented internal
checks and balances to assure that every worker is aware of and utilizing these
standards. State and Federal mandates are addressed and made a part of casework
practice.
The agency continues to enhance the quality of casework practice and provide in-house
trainings to the caseworkers on how to engage family members as resources for
children. FCCYS continually looks at casework practices in an effort to refine and
improve our services to children and their families. Our County has a very active
Children's Roundtable and our Juvenile Court Judges and County Commissioners are
actively involved with child welfare as well as juvenile delinquency matters. Our staff
attend relevant trainings and participate in regional meetings (Quality Assurance
meetings, regional supervisor meetings, IL meetings, PCYA conferences, etc.). FCCYS
staff are encouraged to "think outside the box" and are encouraged to bring new
practices/ideas that may improve our work with children & families to the attention of
management.
Identify a minimum of three specific service outcomes from the list below that the
county expects to achieve as a result of the child welfare services funded through the
Human Services Block Grant with a primary focus on FY 2016-17. Explain how
service outcomes will be measured and the frequency of measurement. Please
choose outcomes from the following chart, and when possible, cite relevant indicators
from your county data packets, Quality Service Review final report or County
Improvement Plan as measurements to track progress for the outcomes chosen.
When determining measurements, counties should also take into consideration any
benchmarks identified in their Needs-Based Plan and Budget for the same fiscal year.
If a service is expected to yield no outcomes because it is a new program, please
provide the long-term outcome(s) and label it as such.
38
Outcomes
Safety 1 . Children are protected from abuse and neglect.
2. Children are safely maintained in their own home
whenever possible and appropriate.
Permanency 1 . Children have permanency and stability in their living
arrangement.
2. Continuity of family relationships and connections are
preserved for children.
Child & Family 1 . Families have enhanced capacity to provide for their
Well-being children's needs.
2. Children receive appropriate services to meet their
educational needs.
3. Children receive adequate services to meet their
physical and behavioral health needs.
Outcome Measurement and The Specific Child
Frequency Welfare Service(s) in
the HSBG Contributing
to Outcome
Children are safely Percent of children who FGDM
maintained in their own were not placed in a
home whenever possible residential setting.
and appropriate.
Continuity of family Number of months FGDM
relationships and children are in
connections if preserved placement prior to
for children. reunification.
Families have enhanced Number of families FGDM
capacity to provide for participating in FGDM.
their children's needs.
Program Family Group Decision Making (FGDM)
Name:
For each program being funded through the Human Services Block Grant, please
provide the following information. The County may copy the below tables as many
times as necessary.
39
Please indicate the status of this program.-
Status
rogram:Status Enter X
Funded and delivered services in
2015-2016 but not renewing in
2016-2017
Requesting funds for 2016-2017 New Continuing Expanding
(new, continuing or expanding x
from 2015-2016)
Description of the program, what assessment or data was used to indicate the need for
the program, and description of the populations to be served by the program. If
discontinuing funding for a program from the prior FY, please explain why the funding is
being discontinued and how the needs of that target population will be met. If services or
activities will decrease, explain why this decision was made and how it will affect child
welfare and juvenile justice services in your county.
Family Group Decision Making (FGDM) is a process in which family members,
community members and others collaborate with the child welfare agency to create a
plan for a child or youth. The family members define who comprises their family group.
In FGDM, a trained coordinator, who is independent of the case, brings together the
family group and agency personnel to create and carry out a plan to safeguard children
and other family members. FGDM processes position the family group to lead decision
making, and the statutory authorities agree to support family group plans that
adequately address agency concerns. The statutory authorities also organize service
providers from governmental and non-governmental agencies to access resources for
implementing the plans.
The key to successful FGDM practice is engaging the family group — those people with
kinship and other connections to children, youth and their parents. This includes those
who may not be currently connected to children and youth — for example, paternal
relatives who are often excluded or marginalized.
FGDM affirms the culture of the family group, recognizes a family's spirituality, fully
acknowledges the rights and abilities of the family group to make sound decisions for
and with its young relatives and actively engages the community as a vital support for
families. FGDM has the potential to energize hope, guide change and foster healing.
Through FGDM, a broad support network is developed and strengthened, significantly
benefiting children and their family groups. Government, local and tribal programs also
benefit, learning from and relying on the family group and community as resources that
strengthen and support families in ensuring that their children have a clear sense of
identity, lasting relationships, healthy supports and limits, and opportunities for learning
and contributing.
• If there is additional funding being provided for this service through the Needs
Based Budget and/or Special Grants, please provide information regarding the
40
amount and how the HSBG money will be used in conjunction with those
funds.
• If an Evidence-Based Program other than FFT, MST, FGDM, HFWA, FDC,
or MTFC is selected, identify the website registry or program website used
to select the model.
Complete the following chart for each applicable year.
FY 15-16 FY 16-17
Description of Target Children & family Children & family
Population members members
# of Referrals 17* 35
# Successfully completing 7* 30
program
Cost per year $15,820* $59,349
Per Diem Cost/Program $30,625 $59,349
funded amount
Name of provider FCCYS FCCYS
*Note that numbers are for 7/1/15-5/12/16
*The information provided in the above chart should reflect only funds being
provided through the HSBG and the individuals/families served specifically
with those funds.
Were there instances of under spending or under-utilization of prior years'
funds?
❑ Yes X No
DRUG and ALCOHOL SERVICES
This section should describe the entire substance abuse service system available to all
county residents that is provided through all funding sources, including state
allocations, county funds, federal grants, HealthChoices, reinvestment funds, etc.
The Franklin/Fulton Drug and Alcohol Program (FFDA) provides funding for all levels of
care for substance abuse treatment. These levels include inpatient detoxification,
rehabilitation, halfway house, partial hospitalization, intensive outpatient, outpatient,
and early intervention outpatient services for Franklin and Fulton county residents.
FFDA also provides case management services and oversight of medication assisted
treatment.
41
This overview should include.-
1.
nclude:1. Waiting list issues,-
2.
ssues,2. Barriers to accessing treatment services,-
3.
ervices,3. Capacity issues,-
4.
ssues,4. County limits on services;
5. Impact of opioid epidemic in the county system
6. Any emerging substance use trends that will impact the ability of the county to
provide substance use services.
This overview should not include guidelines for the utilization of A CT 152 or BHSI
funding streams issued by DHS. The focus should be a comprehensive overview of the
services and supports provided by the Single County Authority and challenges in
providing services.
1. Waiting list issues
Treatment services are provided to any eligible resident despite age, gender, race, and
ethnicity. However, we serve individuals by our priority populations. These priority
populations are identified in the following order: Pregnant Injection Drug Users,
Pregnant Substance Abusers, Injection Drug Users, Overdose Survivors, Veterans and
all others. Individuals in need of substance use assessments are to receive an
assessment appointment within 7 days of the request. In Franklin/Fulton County,
individuals are able to be seen within 7 days of the request; however when
detoxification or inpatient treatment is needed, there are multiple variations of wait
times across the state due to state-wide treatment capacity issues.
2. Barriers to accessing treatment services:
An estimated 2,194 Franklin County residents will receive substance use assessments
in FY 2016-2017. Level of care assessments are completed by contracted outpatient
providers or FFDA Case Management staff. An estimated 276 adults/adolescents are
projected to be funded for treatment services through the drug and alcohol program in
Fiscal Year 2016-2017. Treatment services are inclusive of detoxification, short and
long-term inpatient, halfway house, partial hospitalization, intensive outpatient and
outpatient services. The primary barrier to accessing treatment services revolves
around the need for detoxification and long-term inpatient treatment beds when the
placement is needed. Current wait times to secure placement in these two levels of
care produces barriers to getting individuals engaged in treatment when it's needed
and when they're ready. This occurs state-wide with the inadequate numbers of detox
and inpatient beds available.
3. Capacity issues:
Franklin County continues to meet the need of completing level of care assessments
adequately and timely (within 7 days of the request); however, placement of individuals
into specific levels of care remains challenging due to the lack of beds across the
Commonwealth. Wait times for non-hospital based detoxification average between 2-5
days from the placement request. Wait times for non-hospital based long-term inpatient
treatment averages three to four weeks minimum. The increased need for long-term
42
treatment, yet the lack of long-term treatment bed expansion, makes it difficult to obtain
the clinically appropriate level of care treatment for individuals who need long-term
inpatient treatment. This creates a host of problems locally: longer jail days for
individuals waiting to go to inpatient treatment (additional per day costs to house
offenders); higher risk for individuals in the community waiting to go to treatment;
inability to place overdose survivors being discharged from the local emergency rooms;
and potentially undertreating individuals in a lower level of care to get them into
treatment while they wait for a bed to open.
Franklin County needs to implement service delivery for individuals qualifying for the
.05 level of care deemed "early intervention," yet current outpatient providers do not
provide this level of care due to it not being reimbursable. This level of care typically
comes from DUI assessments and adolescent assessments and is a current gap in our
community. Outpatient providers will be approached/ contracted to provide this level of
care by utilizing the same/ uniform evidence-based curriculum for adolescents and
adults in need of the service.
4. County limits on services:
Franklin County does not have halfway house options within either county for
individuals to access when being discharged from short or long-term inpatient
treatment. Franklin/Fulton Drug & Alcohol contracts with multiple providers across the
state who offers halfway house level of care; however, none are within either Franklin
or Fulton Counties. Franklin County does not have a provider for long-term inpatient
treatment with either county. Franklin County is experiencing a greater need for long-
term treatment beds, yet has to wait three to four weeks for bed placement availability.
5. Impact of opioid epidemic in the county system:
Franklin County is experiencing a high rate of opioid related overdoses, overdose
fatalities, crimes related to opioid dependence and DUls. This has significantly
impacted the Franklin County court system, Adult Probation, local emergency rooms,
employers, families, and of course, the Single County Authority. Franklin County is also
preparing for the implementation of the prescription monitoring program in August of
2016 and anticipated increase in heroin-related events. This has prompted Franklin
County to develop and implement an Overdose Prevention Task Force; put in place
additional resources and processes for the court system and jail; and equip the
community with naloxone training, medication and educating clinicians on proper
prescribing practices.
6. Any emerging substance use trends that will impact the ability of the
county to provide substance use services:
The implementation of the Commonwealth's Prescription Monitoring Program will
commence in August 2016. The implementation of this program may create higher
demand for treatment services within Franklin/Fulton County. With the reduction of
access to prescription opioids, it's anticipated for counties to see a rise in heroin use,
heroin related overdoses and heroin related overdose fatalities. With the current
treatment capacity issues across the Commonwealth, it's anticipated that detox and
43
inpatient beds will quickly fill up and remain consistently utilized.
Target Populations
Provide an overview of the specific services provided and any service gaps/unmet
needs for the following populations:
• Older Adults (ages 60 and above)
If indicated, older adults are eligible for all levels of care for substance use
treatment. These levels include detoxification, short and long term
rehabilitation, halfway house, partial hospitalization, intensive outpatient,
outpatient, and early intervention outpatient services for Franklin and Fulton
county residents. FFDA also provides case management services and
oversight of medication assisted treatment. Older adults covered by
Medicare qualify for county funding due to the lack of Medicare providers
within a 50 mile radius of Franklin and Fulton Counties.
• Adults (ages 18 and above)
If indicated, adults ages 18 to 55 are eligible for all levels of care for
substance use treatment. These levels include detoxification, short and long
terms rehabilitation, halfway house, partial hospitalization, intensive
outpatient, outpatient, and early intervention outpatient services for Franklin
and Fulton county residents. FFDA also provides case management services
and oversight of medication assisted treatment. It is anticipated that many of
our priority populations, including Pregnant Injection Drug Users, Pregnant
Substance Users, Overdose Survivors and Veterans will fall into this age
demographic.
• Transition Age Youth (ages 18 to 26)
If indicated, transition-age youth are eligible for all levels of care for
substance use treatment. These levels include detoxification, short and long
term rehabilitation, halfway house, partial hospitalization, intensive
outpatient, outpatient, and early intervention outpatient services for Franklin
and Fulton county residents. FFDA also provides case management services
and oversight of medication assisted treatment. It is anticipated that some of
our priority populations, including Pregnant Injection Drug Users, Pregnant
Substance Users and Overdose Survivors will fall into this age demographic.
• Adolescents (under 18)
If indicated, adolescents are eligible for all levels of care for substance use
treatment. These levels include detoxification, short and long term
rehabilitation, halfway house, partial hospitalization, intensive outpatient,
outpatient, and early intervention outpatient services for Franklin and Fulton
county residents. FFDA also provides case management services and
oversight of medication assisted treatment. Additionally, FFDA also contracts
with providers of prevention and intervention programs focusing on the
adolescent population.
44
• Individuals with Co-Occurring Psychiatric and Substance Use Disorders
In conjunction with Franklin/Fulton Mental Health and Tuscarora Managed
Care Alliance, the Franklin/Fulton Drug and Alcohol Program has
implemented a co-occurring initiative in both counties. This initiative uses the
Comprehensive Continuous Integrated Systems of Care Model. All local
providers participate in this initiative for co-occurring competency. There are
facilities that offer specialized treatment programming for individuals with co-
occurring conditions for providers outside of the two counties. To evaluate
the Comprehensive Continuous Integrated Systems of Care Model (CCISC),
we track the number of in-county facilities that offer specialized treatment
programming for individuals with co-occurring conditions.
• Criminal Justice-Involved Individuals
If indicated, criminal justice-involved individuals are eligible for all levels of
care for substance use treatment. These levels include detoxification, short
and long term rehabilitation, halfway house, partial hospitalization, intensive
outpatient, outpatient, and early intervention outpatient services for Franklin
and Fulton county residents. FFDA also provides case management services
and oversight of medication assisted treatment. All contracted treatment
providers have specialized programming for this population. In addition,
Franklin County is involved in the Restrictive Intermediate Punishment
Program that coordinates treatment needs for this population.
Franklin/Fulton Drug & Alcohol, in partnership with Tuscarora Managed Care
Alliance (TMCA) and PerformCare (BHMCO), participates in the Department
of Drug & Alcohol Programs (DDAP) Jail Project. This specific initiative is
designed to assist incarcerated individuals needing Inpatient substance use
treatment to obtain medical assistance when eligible, and for the medical
assistance to be activated within one week of discharge from the
jail/admission to the treatment facility. If medical assistance is denied, county
funding is utilized to pay for the treatment services needed. This partnership
will continue into FY16/17.
Franklin County has submitted the FY16/17 application to PCCD to
implement the Residential Substance Abuse Treatment grant to individuals
at the Franklin County Jail. This program requires participation in utilizing
Vivitrol as medicated assisted treatment to run parallel to providing
substance use treatment prior to release.
Franklin County will also be moving forward with planning and technical
assistance to begin an Adult Drug Court in FY16/17. Franklin/Fulton Drug &
Alcohol will assist with planning and development in coordination with the
Courts.
• Veterans
45
If indicated, veterans are eligible for all levels of care for substance use
treatment. These levels include detoxification, short and long term
rehabilitation, halfway house, partial hospitalization, intensive outpatient,
outpatient, and early intervention outpatient services for Franklin and Fulton
county residents. FFDA also provides case management services and
oversight of medication assisted treatment. The County provides drug and
alcohol treatment funding to a small number of veterans due to the majority
of this population having insurance to cover their costs.
• Women with Children
If indicated, women with children in need of substance use services are
eligible for all levels of care for treatment. These levels include detoxification,
short and long term rehabilitation, halfway house, partial hospitalization,
intensive outpatient, outpatient, and early intervention outpatient services for
Franklin and Fulton county residents. FFDA also provides case management
services and oversight of medication assisted treatment. The county
contracts with multiple providers with women with children specific services.
There will be a targeted focus placed on mothers of chemically dependent
newborns entering the NICU due to their chemical dependency at birth.
Services will focus on treatment as well as in-home support for non-
treatment, ancillary services.
• Recovery—Oriented Services
Franklin/Fulton Drug & Alcohol partnered with Tuscarora Managed Care
Alliance to allocate reinvestment funds to support Recovery Housing and
Recovery Support Specialists in both counties, starting in FY15/16 and
continuing through FY16/17. Development, planning and implementation of
both plans will result in county residents being able to access services to
help sustain long-term recovery in their local environment. Recovery Support
Specialists will be housed in local outpatient provider settings and will assist
individuals from short or long-term rehabilitation to transition to a lower level
of care (halfway, partial hospitalization, intensive outpatient and traditional
outpatient services). These positions will also assist individuals to engage in
recovery supports and long-term recovery. Recovery Housing will assist
individuals to engage in housing services during their recovery. Currently
neither Franklin nor Fulton Counties have available recovery housing
services. If there is additional Block Grant carry over from the 15-16 fiscal
year, it will be allocated to recovery support services.
HUMAN SERVICES AND SUPPORTS/ HUMAN SERVICES DEVELOPMENT FUND
For each of these categories (Adult Services, Aging Services, Children and Youth
Services, Generic Services and Specialized Services), please use the below format to
describe how the county intends to utilize HSDF funds.-
46
unds:46
• The program name.
• A description of the service offered by each program.
• Service category- choose one of the allowable service categories that are
listed under each section.
• Which client populations are served? (Generic Services only)
• Planned expenditures for each service.
Note: Please ensure that the total estimated expenditures for each categorical
match the amount reported for each categorical line item in the budget.
Adult Services: No services are funded through block grant
Aging Services: No services are funded through block grant
Children and Youth Services: No services are funded through block grant
Generic Services:
Program Name: Information and Referral
Description of Services: I&R provides a service that links
individuals and the community through a variety of
communication channels, including in-person presentations
to local agencies to help educate the community of the
various services throughout the County. The Information
and Referral Department is also the contact point for PA
211 coordination.
Service Category: Centralized Information & Referral /Adult
and Aging populations served
Planned Expenditures: $69,324
Specialized Services: No services funded through the Block Grant.
Interagency Coordination: Describe how the funding will be utilized by the county
for planning and management activities designed to improve the effectiveness of
categorical county human services. The narrative should explain how the funds will
be spent (e.g. salaries, paying for needs assessments, etc.) and how the activities
will impact and improve the human services delivery system.
The Information and Referral Coordinator organizes a two-day training event that is
available for Human Services professionals. Average number of attendees to this event
is 395. Funding is used to cover the expenses associated with the facility's fees and
trainers.
The coordinator also organizes the Introduction to Human Services training that is
available two times a year to new employees within the County government as well as
agencies within the community.
47
DHS 2015-1
County Human Services Plan Guidelines
Appendix A
Fiscal Year 2015-2015
COUNTY HUMAN SERVICES PLAN
ASSURANCE OF COMPLIANCE
COUNTY OF:
A. The County assures that services will be managed and delivered in accordance with the
County human Services Plan submitted herewith,
B. The County assures, in compliance with Act 80, that the Pre-Expenditure Plan submitted
herewith has been developed based upon the County officials' determination of County
need,formulated after an opportunity for public comment in the County.
C. The County and/or its providers assures that it will maintain the necessary eligibility
records and other records necessary to support the expenditure reports submitted to the
Department of Human Services.
D. The County hereby expressly, and as a condition precedent to the receipt of state and
federal funds, assures that in compliance with Title VI of the Civil Rights Act of 1964-
Section 504 of the Federal Rehabifitation Act of 1973; the Age Discrimination Act of
1975; and the Pennsylvania Human Relations Act of 1955, as amended; and 16 PA
Code, Chapter 49 (Contract Compliance regulations):
1.The County does not and will not discriminate against any person because of race,
color, religious creed,ancestry,origin, age,sex, gender identity,sexual orientation,or
handicap in providing services or employment,or in its relationship with other
providers; or in providing access to services and employment for handicapped
individuals.
2.The County will comply with all regulations promulgated to enforce the statutory
provisions against discrimination.
COUNTY COMMISSIONERS/COUNTY EXECUTIVE
Signatures Please Print
Date-
Date-
Date:
ate:Date:Date:
7
48
Appendix B: Minutes
49
1. ESTIMATED 2 HSBG 3. HSBG PLANNED 4. NON-BLOCK 5. 6. OTHER
County. INDIVIDUALS ALLOCATION EXPENDITURES GRANT COUNTY PLANNED
SERVED (STATE AND FEDERAL) (STATE AND FEDERAL) EXPENDITURES MATCH EXPENDITURES
MENTAL HEALTH SERVICES
ACT and CTT
Administrative Management 364 263,020 7,100
Administrators Office 611,768 2,700
Adult Developmental Training-Adult
Day Care
Children's Evidence Based Practices
Children's Psychosocial Rehabilitation
Services
Community Employment&Emplmt Rel 146 278,433 7,575
Svcs
Community Residential Services 55 1,517,179 40,015
Community Services 1,444 443,007 12,050
Consumer-Driven Services
Emergency Services 159 39,845 1,084
Facility Based Vocational Rehabilitation 27 61,092 1,700
Family Based Mental Health Services 1 12,245 300
Family Support Services 8 6,019 160
Housing Support Services 42 52,578 49,485 1,430
Mental Health Crisis Intervention 2,846 280,889 7,640
Other
Outpatient 237 147,524 4,000
Partial Hospitalization
Peer Support Services 20 55,188 1,500
Psychiatric Inpatient Hospitalization 1 48,092 1,310
Psychiatric Rehabilitation 12 95,516 2,600
Social Rehabilitation Services 123 252,758 6,875
Targeted Case Management 912 283,789 7,720
Transitional and Community Integration
TOTAL MH SERVICES 6,397 4,448,942 4,448,942 49,485 105,759 0
50
County. 1. ESTIMATED 2. HSBG 3. HSBG PLANNED 4. NON-BLOCK 5. 6. OTHER
INDIVIDUALS ALLOCATION EXPENDITURES GRANT COUNTY PLANNED
SERVED (STATE AND FEDERAL) (STATE AND FEDERAL) EXPENDITURES MATCH EXPENDITURES
INTELLECTUAL DISABILITIES SERVICES
Administrators Office 562,272
Case Management 60 68,809
Community-Based Services 276 319,797 46,500
Community Residential Services 5 24,308
Other
TOTAL ID SERVICES 341 975,186 975,186 0 46,500 0
HOMELESS ASSISTANCE SERVICES
Bridge Housing
Case Management 192 50,233
Rental Assistance 192 41,000
Emergency Shelter 53 15,000
Other Housing Supports
TOTAL HAP SERVICES 437 113,658 106,233 0 0
CHILD WELFARE SPECIAL GRANT SERVICES
Evidence Based Services 35 59,439
Promising Practice
Alternatives to Truancy
Housing
TOTAL CWSG SERVICES 35 59,439 59,439 0 0
51
County. 1. ESTIMATED 2. HSBG 3. HSBG PLANNED 4. NON-BLOCK 5. 6. OTHER
INDIVIDUALS ALLOCATION EXPENDITURES GRANT COUNTY PLANNED
SERVED (STATE AND FEDERAL) (STATE AND FEDERAL) EXPENDITURES MATCH EXPENDITURES
Case/Care Management
Inpatient Hospital
Inpatient Non-Hospital 29 75,000
Medication Assisted Therapy 12 15,600
Other Intervention 300 51,347
Outpatient/Intensive Outpatient 42 25,000
Partial Hospitalization
Prevention 570 30,000
Recovery Support Services 100 50,000
TOTAL DRUG AND ALCOHOL SERVICES 1,053 290,526 246,947 0 0
HUMAN SERVICES AND SUPPORTS
Adult Services
Aging Services
Children and Youth Services
Generic Services 3,237 69,324
Specialized Services
Interagency Coordination
TOTAL HUMAN SERVICES AND SUPPORTS 3,237 95,968 69,324 0 0
7.COUNTY BLOCK GRANT ADMINISTRATION B77648 0
GRAND TOTAL 1 11,500 1 5,983,7191 5,983,719 1 49,4851 152,259 0
52
DHS Bulletin 2016-1
County Human Services Plan Guidelines
Appendix D
Block Grant Planning Committee
Committee Members:
• Megan Shreve (HAP Provider)
• Sheldon Schwartz (Mental Health/Intellectual Disabilities Community Rep)
• Kim Wertz (MH Advocate)
• Anne Larew (ID Advocate)
• Manny Diaz (Drug and Alcohol Community Rep)
• Karen Johnston (Prevention Provider)
• Ann Spottswood(Summit Health)
Staff Members:
• Carrie Gray* (Assistant County Administrator)
• Jean Snyder(Fulton County)
• Rick Wynn* (Human Services Administrator)
• Stacy Rowe* (Fiscal)
• Christy Briggs* (Fiscal)
• Sharyn Overcash (Human Services)
• Tracy Radtke (Mental Health Housing Specialist)
• Steve Nevada* (Mental Health/Intellectual Disabilities/Early Intervention Director)
• Lori Young (Intellectual Disabilities)
• Shalom Black* (Grants Director)
• Doug Amsley (Children and Youth Services Director)
• Traci Kline (Aging Director)
• April Rouzer(Drug and Alcohol Director)
*denotes Leadership Team Members
53
DHS Bulletin 2016-1
County Human Services Plan Guidelines
Appendix E: Overview of 2015-2017 Quality Management Plan
Outcome Objective for 2015- Trends and baseline data
17
People are safe and Monitor the number of There have been 0 restraints since July 1,
restraint free. restraints and take action 2013.
immediately as warranted.
People live where Increase the number of IM4Q (satisfaction surveys) have shown
they choose. people in Lifesharing by that people are more satisfied with their life
10% (n=4) by June 30, in Lifesharing arrangements. As a result,
2017. Lifesharing is promoted as the first
residential option offered to individuals.
Lifesharing increased from 30 people on
July 1, 2013 to 35 people on April 30, 2015.
The 35 people in Lifesharing will be used
as baseline.
People are abuse Reduce the number of Individual to Individual Abuse has risen in
free. Individual to Individual the past 2 years. ODP has redefined
Abuse incidents by 5% by Individual to Individual Abuse and as a
June 30, 2017. result, there has been an increase. There
were 38 incidents per year in FY 2012-
2013. There were 71 incidents in FY 2013-
2014. There are 52 incidents as of April
30, 2015 for FY 2014-2015.
People are healthy Reduce the number of Medication errors are the most incidents in
and safe. medication errors by 10% any given quarter throughout the 2013-
by June 30, 2017. 2015 QM plan year. The baseline data is
270 medication errors for the 2013-2015
QM plan year.
The AE will Identify baseline data of The AE has concentrated the collaboration
collaborate and people who have a dual in the last plan year with the focus on
implement diagnosis and/or have a serving people who have both an
promising practices Behavior Support Plan. intellectual disability and a mental health
to assist people in challenge (dual diagnosis). Franklin/Fulton
achieving Develop a toolkit to offer to County is piloting the WRAP® for People
outcomes. people to continue to with Developmental Distinctions in
engage in recovery and collaboration with MH and the Copeland
educate them on achieving Center. The AE meets with the Tuscarora
their outcomes. Managed Care Alliance to discuss policy
changes to better serve people who have a
dual diagnosis.
People who choose Increase the percentage of The number of people who are
to work are people who want to work to competitively employed has increased to
employed in the achieve community 66 in QM Plan year 2013- 2015. The ID
community. employment (Supported program has decided to measure
Employment and community employment which will include
Transitional Work) by 5% supported employment and transitional
(n= 61%) by June 30, work. This will be compared to the number
2017. of people who have an employment goal
which indicates they want to work. The
DHS Bulletin 2016-1
County Human Services Plan Guidelines
baseline data that will be used is 66 people
are employed, 58 people are Transitional
work and 223 people have an employment
goal. This gives a baseline percentage of
56%.
55
DHS Bulletin 2016-1
County Human Services Plan Guidelines
56