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HomeMy WebLinkAbout Draft Block Grant Plan DHS Bulletin County Human Services Plan Guidelines Appendix B County Human Services Plan Template The County Human Services Plan is to be submitted using the template outlined below. It is to be submitted in conjunction with Appendices A and C (C-1 or C-2, as applicable) to the Department of Human Services (DHS) as directed in the Bulletin. PART I: COUNTY PLANNING PROCESS (Limit of 3 pages) Describe the county planning and leadership team and the process utilized to develop the plan for the expenditure of human services funds by answering each question below. 1. Please identify the critical stakeholder groups, including individuals and their families, consumer groups, providers of human services, and partners from other systems, involved in the county’s human services system. 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 __ includes a comprehensive list of the members of the planning team and their affiliations. The leadership team is comprised of key fiscal and human services administration staff and includes: Human Services Administrator, Fiscal Specialist, Human Services Fiscal Manager, MH/IDD/EI Administrator, Drug & Alcohol Administrator, Human and Health Services Planning and Development Director, County Grants Management Director, and the Assistant County Administrator. 2. Please describe how these stakeholders were provided with an opportunity for participation in the planning process, including information on outreach and engagement efforts. 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 Grant (HSBG) 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. Block Grant hearings were advertised in the newspaper, on the County website, and the County's Facebook page to elicit stakeholder feedback. 3. Please list the advisory boards that were involved in the planning process.  The Franklin/Fulton Drug & Alcohol Advisory Board holds reoccurring meetings throughout the fiscal calender year, on a rotating basis betweenFranklin and 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 7 DHS Bulletin County Human Services Plan Guidelines Block Grant plan, are informed of Block Grant impact, and are made aware of any Drug/Alcohol requests for funding, projects, or service enhancements.  The Franklin County Local Housing Options Team consists of individuals who meet monthly on issues around housing and homelessness. Representatives from the Franklin County Housing Authority, both County emergency shelters, as well as, the Homeless Assistance Program (HAP) attend regularly. In addition to these individuals, there are an array of representatives on the LHOT that also include Rapid Rehousing programs, Homeless Prevention programs, Permanent Supportive Housing programs, the Domestic Violence shelter, Veteran Housing Program, Legal Services, Connect to Home staff, the Self-Determination Housing Project of Pennsylvania, Inc. (SDHP), a Federally Qualified Health Center (FQHC), two Boroughs, and several religious organizations. They also receive updates on Block Grant plans and funding requests. • The Franklin/Fulton County Mental Health/Intellectual & Developmental Disabilities/Early Intervention Advisory Board meets bi-monthly, with 13 members, including one Commissioner from Fulton County and one from Franklin County. 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 & Developmental 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/IDD/EI Administrator provides HSBG updates as applicable during the Board meetings. They have impact on decisions related to MH/IDD/EI funding, which indirectly can impact the HSBG. 4. Please describe how the county intends to use funds to provide services to its residents in the least restrictive setting appropriate to their needs. (The response must specifically address providing services in the least restrictive setting.) Franklin/Fulton Drug & Alcohol provides prevention/intervention, treatment, and recovery services in the environment most appropriate for the individual receiving the services. Prevention services are delivered to youth in either a school-based or after-school based environment appropriate to their age and the selected evidence-based program. Interventio services are provided to individuals that meet program/service eligibility and occur through a variety of contracted service providers. Treatment services are delivered to individuals based on their substance use assessment's level of care recommendation. High levels of care (withdrawl management , and residential) include 24/7 monitoring and supervision as treatment services are delivered within the provider setting. Low levels of care (halfway housing, partial hospitalization, intensive outpatient, outpatient, and early intervention) services are delivered in a community-based setting by the provider of their choice. Recovery support/housing services are delivered to individuals based on their recovery needs which vary from ancillary treatment needs to direct treatment care in a community-based setting. Individuals are assisted by the department in discovering what recovery supports and services are the best fit for their current stage 8 DHS Bulletin County Human Services Plan Guidelines of recovery. Services are delivered in the least restrictive manner appropriate for the individual. Franklin/Fulton Mental Health/Intellectual & Developmental Disabilities follows the principle of least restrictive alternative when providing services. A full continuum of care from community based to inpatient hospitalization is provided. Tools such as the Strengths Intensity Scale (SIS) are utilized to match individual need with the least restrictive services. Multiple criteria such as disability, level of autonomy, individual's request, and potential harm to self or others are evaluated to assure the least restrictive alternative is utilized through all levels of care. 5. Please list any substantial programmatic and/or funding changes being made as a result of last year’s outcomes. No substantial changes are planned; new programs may be added as part of the reallocation process in 2019-2020. 9 DHS Bulletin County Human Services Plan Guidelines 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. 1. Proof of publication; a. Please attach a copy of the actual newspaper advertisement for the public hearing (see below). b. When was the ad published? c. When was the second ad published (if applicable)? Please attach proof of publication(s) for each public hearing. 2. Please submit 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 all counties. Please ensure that the notice is publicized in each county participating in the LCA. 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. Information regarding the 2 public hearings was published in the Public Opinion newspaper on_______ and posted on the County's website ____________________ with the opportunity for public review and comment on the Draft Block Grant Plan. Public hearings were held at __________, as part of the Human Service Block Grant Advisory Board meeting and ___________, as part of the Board of County Commissioners meeting. Appendix __ contains the proof of publication, sign-in sheets, and summaries of the public meetings. 10 DHS Bulletin County Human Services Plan Guidelines PART III: CROSS-COLLABORATION OF SERVICES (Limit of 4 pages) For each of the following, please explain how the county works collaboratively across the human services programs. Please explain how the county intends to leverage funds to link residents to existing opportunities and/or to generate new opportunities. Lastly, please provide any updates to the county’s collaborative efforts and any new efforts planned for the coming year. Employment:  The Franklin/Fulton IDD Program participates in the Transition Council with Office of Vocational Rehabilitation and the School Districts and providers to promote and support the Employment First Model. The Transition Council promotes employment as the first opportunity for students graduating from high school. The Transition Council has applied to be an Experience the Employment Connection Team to further promote the collaboration between these agencies to better support individuals with disabilities to obtain competitive integrated employment. Our Information and Referral Specialist can refer individuals calling 2-1-1 to employment programs such as CareerLink and United Way's Stepping Forward Works.  The Supporting Individuals Transitioning to Employment Success (SITES) serves to bridge gaps between case management, Vocational Rehabilitation (VR), Transitional Work (TW), and Extended Support Services (ESS) programs by providing individuals with another "stepping stone" toward successful competitive employment within the community. The program provides individuals with more intensive guidance and support on targeted issues than is available through other programs. When participating in other OSI programs, time limitations due to work demands and confidentiality issues due to program locations prevent intensive, focused guidance in "soft skills" and coping strategies. For those who have not worked for an extended period of time due to severe mental health related issues or who are coming out of institutional settings, the VR and TW programs may initially be intimidating or overwhelming. The SITES program provides a physical space separate from the VR or TW programs that is smaller and accommodates both individual and group activities. In addition, the maximum group size is six (6) individuals per one (1) staff person at any given time, with a maximum program enrollment of 12. Limits to the program size allow for structured group activities to develop employment readiness skills, as well as more opportunity to receive individualized attention.  Franklin Together, Franklin County's Reentry Coalition, is actively pursuing local employers engaging in the employment of returning citizen's to the community after their incarceration. To date the Outreach Committee has identified and linked with 62 local employers who will hire returning citizens and work with them in the employment field. The Committee has reached out to Parole Officers, Drug Court staff and the President Judge (who presides over Drug Court) to identify individuals in need of employment in this arena. The Outreach Committee has identified transportation as one of the barriers to successful employment in rural Franklin County and throughout the upcoming year will look for creative ideas to help overcome this barrier. 11 DHS Bulletin County Human Services Plan Guidelines Housing: The Franklin County Local Housing Options Team consists of individuals who meet monthly on issues around housing ·and homelessness. Representatives from the Franklin County Housing Authority, both County emergency shelters, as well as, the Homeless Assistance Program (HAP) attend regularly. In addition to these individuals, there are an array of representatives on the task force that also include Rapid Rehousing Programs, Permanent Supportive Housing programs, the Domestic Violence Shelter, Veteran Housing Program, Legal Services, Coordinated Entry Staff, Self-Determination Housing Project of Pennsylvania, Inc. (SDHP), a Federally Qualified Health Center (FQHC}, two Boroughs, and several religious organizations. They also receive updates on Block Grant plans and funding requests. Our Case Management staff works through the Coordinated Entry Process with the assistance of multiple housing providers to help ensure a good match for individuals in need.of housing. Through funds from the Homeless Assistance Program (HAP}, Projects for Assistance in Transition from Homelessness (PATH), Housing and Urban Development (HUD), the Emergency Solutions Grant (ESG}, 8-1-1 Housing and the Pennsylvania Commission on Crime and Delinquency (PCCD), we provide an array of housing options, transitional housing, master lease, rental assistance, rapid rehousing, and emergency housing supports, all of which are available to individuals/families meeting a range of specific criteria. Criteria are based on the completion of a Vulnerability Index- Service Prioritization Decision Assistance Tool (VI-SPDAT) assessment. The VI-SPDAT examines factors of current vulnerability and future housing stability ·and assists to identify what supports and housing interventions will be most beneficial. In 2019-2020, we will continue to work through the Coordinated Entry process with the intent that this will result in continued collaboration, streamlining of services, and increased leveraging of funding sources. Case management also works closely with the county contracted residential providers for MH/IDD/EI through attending meetings, email communications, etc. The County contracted residential providers have signed release of information forms with local outpatient mental health providers and will communicate with them if there are any changes in behaviors/functioning of the individuals in their programs. 12 DHS Bulletin County Human Services Plan Guidelines PART IV: HUMAN SERVICES NARRATIVE 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: (Limit of 6 pages) Highlight the achievements and other programmatic improvements that have enhanced the behavioral health service system in FY 18-19. Healthy Franklin County is composed of key community leaders from the education, health, faith, business, nonprofits and local government sectors. Our goal is to create and support healthy behaviors and lifestyles through education, awareness, programs, and access to services. These key leaders continue to identify value in identifying and strengthening efforts to address health and health care needs from a collective perspective. Mental health, substance use, and prevention is one of the priorities of this committee as a result of the community needs assessment. This has been tasked to the mental health task force. This task force has been successful at compiling a list of providers and it is currently being GPS mapped in order to prepare for a useable website to assist in the access of local mental health services. A Mobile Psychiatric Nurse is availabe to our Franklin/Fulton County communities. The primary functinos of this nurse include:  Education/Training – The nurse provides education and training no only to professional and agency staff, as well as individuals in the community including senior centers, civic organizations, school students, and current recipients of mental health services and their families. Topics of education include: medication, healthy eating, mental health diagnoses, anxiety, stress, coping skills, utilizing natural supports, behavioral concerns, bullying, self- care, etc.  Consultant - The nurse is available for consultation with professionals, agency staff, community members, organizations and law enforcement, regarding behavioral support plans, nutrition/healthy eating/living, and medication related issues.  Assessments - Medical/psychiatric assessements are provided upon request for individuals in various settings/locations. These assessments include blood pressure/pulse checks, etc. (examples: Franklin County Older Adult Triage Team \[FCOATT\]; in coordination with Aging Office staff; Senior Centers; Co-Responder; etc.) Recovery housing has been implemented with the support of reinvestment dollars. The target population is MA-eligible adults 18 and older who have successfully completed treatment in a rehabilitation program for substance abuse. This functions either as a step-down or an option to sustain their recovery after returning from a previous treatment stay. Recovery housing also serves persons at risk of requiring intensive treatment in a rehabilitation program, including individuals with a forensic history who may need a lower level of recovery support, as recommended by the ASAM. Currently, there are three (3) recovery houses within Franklin 13 DHS Bulletin County Human Services Plan Guidelines County that are contracted with TMCA, serving a total of 87 individuals through reinvestment funds. Franklin County has secured funding from OMHSAS for provisio of specialized services:  A Forensic Specialized Community Residence (SCR) will be contracted to Keystone Service System. It will provide long-term residential services to individuals with a persistent mental illness and functional impairments, with a possible history of involvement with the criminal justice system or current involvement with the criminal justice system, and/or who have histories of institutionalization and ineffective use of other services. This program will be licensed under requirements of the Pennsylvania Personal Care Home regulations and will not be considered a transitional housing program, but permanent housing. The program will provide quality recovery-oriented services to adults with serious mental illness, who may have current or recent connections with the criminal justice system. Individuals can remain at their housing location as long as it meets their needs. Keystone understands the unique issues that come with having mental illness and transitioning from the criminal justice system back into the community. Due to these unique needs, Keystone plans on utilizing the APIC model to assist the individual in making a smooth transition from the criminal justice system into the community. The residence is anticipated to be operational in 2019.  The Mental Health Co-Responder program has expanded to include Chambersburg,along with Greencastle, Washington Township and Waynesboro Police Departments. Having a mental health professional based in the police departments has proven successful in engaging individuals into the human service system, as well as diverting them from the criminal justice system. From July 1, 2018 to present, 165 persons have been engaged with a human service system in place of the criminal justice system. b) Strengths and Needs: (Limit of 8 pages) Please identify the strengths and needs of the county/joinder service system specific to each of the following target populations served by the behavioral health system. When completing this assessment, consider any health disparities impacting each population. Additional information regarding health disparities is available at https://www.samhsa.gov/health-disparities.  Older Adults (ages 60 and above)  Strengths:  Franklin County Older Adult Advocacy Team (FCOAAT) ,  Co-responders are interfacing with our over 60 population that come into contact with law enforcement. They are able to engage the individual with natural supports when there is not a system referral  Mobile Psychiatric Nurse outreach to senior centers, Area Agency on Aging, personal care homes.  The Commissioners are aware that May is Older Adult Awareness month and have signed a proclamation recognizing this. The proclamation 14 DHS Bulletin County Human Services Plan Guidelines reading/signing was held at the Chambersburg Senior Cente. Participants and staff of all Franklin County Senior Centers were invited to attend, as well as community human service agencies.  Needs:  It has been discovered that our law enforcement is being dispatched for many calls dealing with individuals over the age of 60. Some are being incarcerated, while others are left to find services on their own. We are in need of case management services for these individuals to engage and assist them in navigating the human services system. We are also looking to assist the 60- plus population in Franklin County Jail with service coordination in preparation for their transition back into the community.  We are in need of a mobile team that works collaboratively across systems to better serve our older adults, as there is a gap of services not available for individuals that may be accessing the systems for the first time; this would include support for individuals living with dementia.  Adults (ages 18 and above)  Strengths:  Critical Time Intervention (CTI) is a time limited, nine month empiricaly-based case management model. CTI works in two ways: (1) by providing emotional and practical support during the critical time of transitions and (2) by strengthening the member's long-term ties to community service, family, and friends. The CTI Specialist support is a non-office based position using both telephone and face-to-face contact with the identified person in distress.  The Nurse Navigator Program serves the target population of Adults 18 years of age and older with a Severe Mental Illness (SMI) that receive Medicaid and have been identified through the Physical Health Behavioral Health Integration Quadrant Analysis as having both high physical health and high behavioral health needs. The Nurse Navigator team is comprised of a licensed RN and an Intensive Case Manager (ICM) that work with the target population in the community, addressing both physical and mental health needs. To date, this program has served 43 individuals from Franklin and Fulton Counties.  Needs:  Supports/services available to those whose diagnosis does not meet the definition of serious mental illness; however, would benefit from some engagement. This engagement would be least restrictive and may prevent the need for more intensive services.  Transition-age Youth (ages 18-26)- Counties are encouraged to include services and supports assisting this population with independent living/housing, employment, and post- secondary education/training.  Strengths:  As of April 2019, Franklin/Fulton County has two agenciesapproved to provide Youth Certified Peer Specialist services. 15 DHS Bulletin County Human Services Plan Guidelines  Needs:  Supports are needed for those who do not have a serious mental illness diagnosis; there are a number of individuals who do not meet criteria and therefore, do not receive services or supports that may have prevented their health from detorioating.  Funds for prevention services and supports are needed.  Children (under 18)- Counties are encouraged to include services like Student Assistance Program (SAP), Respite, and CASSP Coordinator Services and Supports, as well as the development of community alternatives and diversion efforts to residential treatment facility placements.  Strengths:  The Mental Health task force is chairing a depression/adolescent depression coalition due to the PAYS and CHNA data. This task force is tasked with identifying services and supports that would decrease adolescent depression.  Student Assistance Program (SAP) are located in all secondary public schools.  Elementary Student Assistance Program (ESAP) is provided in most schools in the largest district (Chambersburg) and in several others: Waynesboro, Tuscarora, Greencastle, Fannett-Metal, Shippensburg, Central Fulton, Forbes Road,and Southern Fulton.  School-based counseling services through managed care are available in most public schools in both counties. Providers are Momentum, Laurel Life, Famly Behavioral Resouces, Laurel Life and TrueNorth.  CASSP services are available in all schools.  Schools are open to various agencies helping with students who are in need.  Strengthening Families Program 10-14 is available quarterly throughout Franklin County.  Needs:  The MH Task Force is planning a kick-off meeting during the summer of 2019 to encourage stake holders to invest in the task force.  Additional mental heath therapy is needed for all school grades. Therapy services are limited and contingent on insurance coverages.  Schools would benefit from social workers throughout the districts, as many districts no longer have social work staff.  There is a need for ongoing training for teachers in recognizing mental health issues and trauma in students. Parenting programs are needed to provide support and education to parents in the home.  Therapeutic treatment programs that are shorter in duration and closer to home, as compared to Residential Treatment Facilities that are long-term and further away.  Funding for summer programs for youth with behavioral need. 16 DHS Bulletin County Human Services Plan Guidelines Identify the strengths and needs of the county/joinder service system (including any health disparities) specific to each of the following special/underserved populations. If the county does not currently serve a particular population, please indicate and note any plans for developing services for that population.  Individuals transitioning out of state hospitals  Strengths:  Well-established, positive working relationship with the social services staff at the Danville State Hospital which allows for more efficient discharge planning.  Needs:  Additional appropriate residential placement options for the hard to serve, who languish at the state hospital.  Co-occurring mental health/substance use disorder  Strengths:  Through reinvestment dollars, D&A licensed outpatient substance abuse drug free providers were offered the opportunity to embed certified recovery specialists into their programs and 3 of Franklin County providers chose to accept.  Reinvestment dollars have also made it possible for several recovery housing options to become available in Franklin County.  D&A and MH will be working on a project that involves an envelope that is filled with resources for our local residents. These envelopes will be put into our Operation Save A Life leave behind kits and possibly placed throughout the community.  Needs:  Health literacy for family, friends, and professionals surrounding individuals living with mental illness and substance use disorder.  Justice-involved Individuals- Counties are encouraged to collaboratively work within the structure of County Criminal Justice Advisory Boards to implement enhanced services for justice-involved individuals to include diversionary services that prevent further involvement within the criminal justice system as well as reentry services to support successful community reintegration.  Strengths:  Our Crisis Intervention Team, (CIT), continues to grow and has reached over 150 members throughout Franklin and Fulton Counties. As CIT has grown, we have been fortunate enough to embed two co-responders inside four local police departments. Since the inception of MH Co-responders in May 2017, they have assisted over 450 individuals, all of whom had come into contact 17 DHS Bulletin County Human Services Plan Guidelines with law enforcement. 59% of those individuals were referred to other service systems as a diversion from the criminal justice system. 92% have not had further contact with the police after engagement with the MH Coresponder.  The CARE program will provide screening, risk assessment, case management, and support to individuals who have a mental health disorder who are involved in the criminal justice system. CARE can link participants to resources to help stabilize the person’s mental health condition by utilizing psychiatric consult, medication management, therapy, and peer support. The type of assistance offered is dependent on each person’s individual needs. CARE program resource linkages include mental health services, substance use services, medication management, peer support, educational/vocational assistance, transportation, and housing.  TARGET (Trauma Affect Regulation Guide to Education and Treatment) is an educational and therapeutic intervention for the prevention and treatment of traumatic stress disorders. TARGET teaches a 7 step sequence of skills designed to enable individuals to understand and gain control of trauma related reactions triggered by current daily life stressors. Interventions are delivered in a group therapy setting, but can also be used as part of individual therapy. TARGET does not require “exposure” therapy, but can serve as a preparation for safe and therapeutic memory work. The TARGET model has been extensively studied with the forensic population and is currently being utilized by four (4) clinicians within the Franklin County Jail. The TARGET intervention is also being utilized in the community via four (4) outpatient providers.  Needs:  More employment opportunities  Veterans  Strengths:  REACH  Our Veteran’s Adminstration staff have CIT members and are available to accompany law enforcement and emergency delegates on live calls. They respond to the hospital if a Veteran is transported there and is in need of assistance or linkage to services  Needs:  Transportation to Martinsburg VA center would be helpful for some of our Veterans. Also, it would be good to have more available therapists that focus on Vets and their issues. 18 DHS Bulletin County Human Services Plan Guidelines  Lesbian/Gay/Bisexual/Transgender/Questioning/Intersex (LGBTQI) Consumers  Strengths:  The Mental Health Assoication of Franklin/Fulton County hosts a bi-weekly support group in Chambersburg for LGBTQ individuals. The average attendance is 14 participants. The support group has assisted with outreach to other support organizations as well.  The Mental Health Association also provides supportive employment for people who are transitioning. Currently, 10.7% of their staff is transitioning.  Our community participated in the Pennsylvania 2018 LGBT Needs Assessment – a statewide assessment, which identifies health needs for the LGBT community. The needs assessment was conducted online and used a “snowball” method. There was participation from all 67 counties in PA.  The Franklin County Coalition for Progress (a nonprofit organization) conducted a needs assessment/acceptance survey in 2018; they have been working to write the report capturing the information/data. The survey was conducted online and used a snowball method. The FCCP coordinates Pride Franklin County. Pride is an event that will be happening August 4. The goal of Pride Franklin County is to increase the visibility of our LGBTQ community and their contributions to our community, as well as to bring the LGBTQ community and straight allies together to celebrate diversity, acceptance and respect in Franklin County. FCCP has been exploring other education and cultural awareness programming to support the LGBTQ community (we’re working with a local photographer on a project this June - #pose4pride – which will display portraits of the LGBTQ community in various businesses in downtown Chambersburg). These programs help to increase visibility and support of the LGBTQ community.  Shippensburg University, located in neighboring Cumberland County, has a PRIDE Center - http://www.ship.edu/Pride/  Needs:  Health literacy for our community surrounding the needs of the individuals identifing themselves as part of the LGBTQI community.  Racial/Ethnic/Linguistic Minorities (including Limited English Proficiency)  Strengths:  A few of our mental health outpatient providers have been able to secure bi- lingual staff that our able to provide clinical services to individuals speaking Spanish.  Needs:  Access to more bi-lingual professional staff is a need in our communit 19 DHS Bulletin County Human Services Plan Guidelines  Other (specify), if any (including Tribal groups, people living with HIV/AIDs or other chronic diseases/impairments, Traumatic Brain Injury, Fetal Alcohol Spectrum Disorders)  Strengths:  Keystone Health Services provides free HIV/AIDS testing throughout the community. They provide mobile pop-up testing sites due to transportation being an issue throughout our community. They also provide free education to anyone or group that requests.  Needs:  Services and supports for individuals living with traumatic brain injury is needed in our community.  Education for professionals regarding traumatic brain injury has been difficult to locate. Is the county currently utilizing Cultural and Linguistic Competence (CLC) Training? ☐ Yes ☒ No If yes, please describe the CLC training being used. Descriptions should include training content/topics covered, frequency training is offered, and vendor utilized (if applicable). If no, Counties may include descriptions of any plans to implement CLC Trainings in the future. (Limit of 1 page) Does the county currently have any suicide prevention initiatives? ☒ Yes ☐ No If yes, please describe. Counties without current suicide prevention initiatives may also describe plans to implement future initiatives in the coming fiscal year. (Limit of 1 page) The Suicide Prevention Coalition meets monthly and is currently working from a 3 year plan that was submitted as part of the 18-19 plan. A summary of that plan is as follows: our goals remain the same: 1. Increase access to the best practices in screening, support, assessment, and treatment for mental health disorders in order to achieve and maintain optimal health outcomes. 2. Increase access to quality mental health and substance use services for all Franklin County residents by increasing the percentage of adults 18 or older with mental health illness who receive treatment. 3. Improve access and availability to mental health and substance abuse counseling for all populations, including those individuals who are not English speaking. 4. Develop and implement a Zero Suicide Prevention initiative emphasizing the value and importance of each individual. Some of the highlights from this past year and some future events are as follows:  A Proclamation by the County Commissioners for Suicide Prevention Month.  Production of quarterly suicide updates and an annual suicide data information sheet. 20 DHS Bulletin County Human Services Plan Guidelines  Partnering with SCCAP on a Community Film Night and panel discussion about Suicide Prevention and Awareness  Promoting and facilitating QPR training (ongoing throughout the year)  Promoting suicide prevention and awareness resources through partners’ campaigns including Summit Health, Helathy Franklin County, and digital signs  Writing Letters to the Editor and setting up other free media opportunities to talk about suicide prevention, including local radio outlets WRGG, VerStandig Broadcasting, and the Progress Pod  Conducting grand rounds on the behavioral health unit at Chambersburg Hospital We are doing more research on coordinating an event, like the Out of Darkness, which may be feasible for 2020. Based on the Governor’s Employment First Initiative: 1. Do you use the Individual Placement and Support (IPS) model of supported employment for individuals with SMI? ☒ Yes ☐ No 2. Do you collaborate with the local PA Office of Vocational Rehabilitation and/or Careerlink to increase employment for individuals with SMI? ☒ Yes ☐ No If yes to the question above, in a sentence or two, can you please describe this/these relationship(s)? Our employment providers collaborate both with the Office of Vocational Rehabilitation (OVR) as well as Careerlink to assist individuals with obtaining competitive employment in the community. They regularly receive referrals from OVR to assess/place individuals into employment. The providers communicate regularly regarding these cases/referrals to aide in successful outcomes. Additionally, they have cubicle space at our local Careerlink Office. As a result of this, we are able to regularly interact and connect individuals with necessary/relevant supports at Careerlink to aide in successful outcomes. 21 DHS Bulletin County Human Services Plan Guidelines c) Supportive Housing: DHS’ five- year housing strategy, Supporting Pennsylvanians through Housing, is a comprehensive plan to connect Pennsylvanians to affordable, integrated and supportive housing. This comprehensive strategy aligns well with OMHSAS planning efforts, and OMHSAS is an integral partner in its implementation. Supportive housing is a successful, cost-effective combination of affordable housing with services that helps people live more stable, productive lives. Supportive housing works well for people who face the most complex challenges—individuals and families who have very low incomes and serious, persistent issues that may include substance use, mental illness, and HIV/AIDS; and may also be homeless, or at risk of homelessness. SUPPORTIVE HOUSING ACTIVITY Includes Community Hospital Integration Projects Program (CHIPP), Reinvestment, County base funded or other projects that were planned, whether funded or not. Include any program activity approved in FY 18-19 that is in the implementation process. Please use one row for each funding source and add rows as necessary. (Note: Data from the current year FY18-19 is not expected until next year) 1. Capital Projects for Behavioral Health ☐ Check if available in the county and complete the section. Capital financing is used to create targeted permanent supportive housing units (apartments) for consumers, typically, for a 15-30 year period. Integrated housing takes into consideration individuals with disabilities being in units (apartments) where people from the general population also live (i.e. an apartment building or apartment complex. Total $ Project Name *Funding Projected $ Actual or Projected Number of Term of Year Sources by Amount for Amount for Estimated Number to Targeted BH Targeted BH Project Type FY 17-18 FY 19-20 Number be Served in Units Units first (only County (only County (include grants, Served in FY FY 19-20 (ex: 30 started MH/ID MH/ID federal, state & 17-18 years) dedicated dedicated local sources) funds) funds) 22 DHS Bulletin County Human Services Plan Guidelines Notes: 2. Bridge Rental Subsidy Program for Behavioral ☐ Check if available in the county and complete the section. Health Short term tenant based rental subsidies, intended to be a “bridge” to more permanent housing subsidy such as Housing Choice Vouchers. Total $ *Funding Projected $ Actual or Projected Number of Average Number of Year Sources by Amount for amount for Estimated Number to Bridge Monthly Individuals Project Type (include FY 17-18 FY 19-20 Number be Served in Subsidies in Subsidy Transitioned first grants, federal, Served in FY FY 19-20 FY 17-18 Amount in to another started state & local 17-18 FY 17-18 Subsidy in sources) FY 17-18 Notes: 23 DHS Bulletin County Human Services Plan Guidelines 3. Master Leasing (ML) Program for Behavioral ☒ Check if available in the county and complete the section. Health Leasing units from private owners and then subleasing and subsidizing these units to consumers. Total $ *Funding Projected $ Actual or Projected Number of Number of Average Year Source by Type Amount for Amount for Estimated Number to Owners/ Units subsidy Project (include grants, FY 17-18 FY 19-20 Number be Served in Projects Assisted with amount in FY first federal, state & Served in FY FY 19-20 Currently Master 17-18 started local sources) 17-18 Leasing Leasing in FY 17-18 HUD Master Federal HUD $162,808 $227,443 24 23 14 10 $592.08 2006 landlords Lease PSH HTF $ 9,519 $12,943 Match Sec Dep Rtn $1,176 $0 In-Kind Match $39,763 $38,789 Notes: 4. Housing Clearinghouse for Behavioral Health ☐ Check if available in the county and complete the section. An agency that coordinates and manages permanent supportive housing opportunities. Total $ *Funding Projected $ Actual or Projected Number of Year Source by Type Amount for Amount for Estimated Number to Staff FTEs in Project (include grants, FY 17-18 FY 19-20 Number be Served in FY 17-18 first federal, state & Served in FY FY 19-20 started local sources) 17-18 24 DHS Bulletin County Human Services Plan Guidelines Notes: 5. Housing Support Services for Behavioral Health ☒ Check if available in the county and complete the section. HSS are used to assist consumers in transitions to supportive housing and/or services needed to assist individuals in sustaining their housing after move-in. Total $ *Funding Projected Actual or Projected Number of Year Sources by Amount for $ Amount Estimated Number to Staff FTEs Project Type FY 17-18 for Number be Served in FY 17-18 first (include grants, FY 19-20 Served in in FY 19-20 started federal, state & FY 17-18 local sources) PATH Program Federal $27,190 $49,725 23 25-30 30.45 2005 State HSBG $17,057 $16,575 Sec Dep Rtn $125 $0 County Match $473 $448 Notes: 25 DHS Bulletin County Human Services Plan Guidelines 6. Housing Contingency Funds for Behavioral ☒ Check if available in the county and complete the section. Health Flexible funds for one-time and emergency costs such as security deposits for apartment or utilities, utility hook-up fees, furnishings etc. Total $ *Funding Projected $ Actual or Projected Average Year Sources by Amount for Amount for Estimated Number to Contingency Project Type FY 17-18 FY 19-20 Number be Served in Amount per first (include grants, Served in FY FY 19-20 person started federal, state & 17-18 local sources) Family Housing State HSBG $18,000 Uncertain 25 Uncertain $724 per 2016 Grant re: re: funding person County Match $104 funding availability availability Housing State HSBG $14,614 $0 18 $0 $336 per 2006 Expansion person County Match $406 Utility Deposit $122 Return Notes: 7. Other: Identify the Program for Behavioral Health ☒ Check if available in the county and complete the section. Project Based Operating Assistance (PBOA is a partnership program with Pennsylvania Housing Finance Agency in which the County provides operating or rental assistance to specific units then leased to eligible persons); Fairweather Lodge (FWL is an Evidenced Based Practice where individuals with serious mental illness choose to live together in the same home, work together and share responsibility for daily living and wellness); CRR Conversion (as described in the CRR Conversion Protocol ), other. 26 DHS Bulletin County Human Services Plan Guidelines Total $ Project Name *Funding Projected $ Actual Projected Year Project first (include type of Sources by Amount for Amount for FY or Number to be started project such as Type (include FY 17-18 19-20 EstimatServed in FY grants, federal, PBOA, FWL, ed 19-20 state & local CRR Number sources) Conversion, Served etc.) in FY 17-18 HUD Shelter Federal $66,531 $86,568 12 10 2008 + Care In-Kind Match $35,360 $21,642 Sec Dep Rtn $1,636 Housing State HSBG $13,930 $$16,241 5 3 2006 Expansion County Match $387 $451 Specialized State HSBG $306,447 $366,951 9 8 2005 Community Federal $9,235 $9,084 Residence County Match $8,504 $10,183 Supportive State HSBG $641,379 $674,918 23 19-20 2005 Living Federal $17,484 $17,780 Program County Match $17,798 $18,728 Community State HSBG $305,063 $299,257 19 22-25 2003 Rehabilitative Federal $7,204 $7,408 Residential County Match $8,465 $8,304 27 DHS Bulletin County Human Services Plan Guidelines Notes: 28 DHS Bulletin County Human Services Plan Guidelines d) Recovery-Oriented Systems Transformation: (Limit of 5 pages) Based on the strengths and needs reported above in section (b), identify the top three to five priorities for recovery-oriented system transformation efforts the county plans to address in FY 18-19 at current funding levels. For each transformation priority, provide:  A brief narrative description of the priority including action steps for the current fiscal year.  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. Priority Narrative Action Steps Timeline Resources Needed Tracking Mechanism 1. Suicide a. Develop and implement December $10,000 may be This is monitored Create a scalable pilot program to promote a a Zero Suicide Prevention Prevention 2020 needed to support the through the Suicide zero suicide philosophy initiative emphasizing the education and prevention task force value and importance of awareness campaign. and Healthy Franklin continual Provide QPR, ASIST, and other suicide prevention each individual. County. The evidence-based trainings. coroner’s office will be September Implement Suicide Prevention Month a source of data 2019 Campaign initiatives collection. 2. Addressing health a. Increase the number i. Develop community consensus on a The dollar amount This is monitored Done literacy in both our of patients who are depression assessment instrument that can be needed will be through the MH residents and our screened for depression used by all Primary Care Providers, Hospital assessed as the task force and system within the primary care Physicians, and Mental Health Professionals. committee is Healthy Franklin setting by December The survey instrument should include questions researching a program. County. 2020. related to screening for and managing patients with depression, and identifying resources needed to assist primary care providers. ii. Create an action plan for educating and December gaining support on the use of the depression 2019 assessment tools, and compiling the assessment results at a centralized location for Primary Care Providers and Mental Health Providers. 29 DHS Bulletin County Human Services Plan Guidelines iii. Provide training and support for Primary Care January Providers and Mental Health Professionals on 2020 the use of the assessment tools, documentation of assessment results, and making appropriate referrals for support for individuals experiencing depression. iv. Identify a lead organization for coordinating Done 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. b. Improve access and i. Develop a model for integrating behavioral December Referral process This is monitored quality of care by health services, training and resources into 2021 through the MH designing a model by Primary Care offices to include education for task force and which behavioral health special populations such as older adults and Healthy Franklin services are integrated LGBTQI. County. with Primary Care ii. Conduct a pilot program in which behavioral This is monitored December offices. health therapists serve as a resource and provide through the MH task 2019 support to one or more (maximum of 3) Summit force and Healthy Physician Services offices. Franklin County. c. Increase community i. The Mental Health Task Force will develop a December $2500 may be needed This is monitored 2020 awareness about community awareness and education action plan for educational and through the MH depression and available for informing the community about depression resource material task force and resources within the and other mental illnesses. identified to assist with Health Franklin community community awareness County. ii. Continue and expand existing community campaign. campaigns that educate the public about effective ways to manage depression (i.e., physical activity, nutrition). As a result of Coalition ongoing Reentry Education 3. Re-entry of i. Create an awareness/education plan for the $1500 maybe individuals from our county, including plans for media. Stakeholders (faith Committee meetings Planning meetings and surveys, the Reentry organizations, jail, jail to our Coalition has established community. courts, human the following priorities for services, law the next steps of reentry enforcement, public) planning: ii. Educate employers about reentry and hiring ongoing $2000 may be needed. Reentry Education a. EDUCATION Stakeholders (faith individuals with criminal backgrounds. Committee meetings organizations, jail, courts, human services, law enforcement, public, employers) 30 DHS Bulletin County Human Services Plan Guidelines b. SUPPORT i. Identify all existing community resources and Done Stakeholders (jail, Reentry Advisory update the Reentry Resource Guide available in Board reassess courts, human print and digital formats. services, law as needed enforcement) ii. Identify inmate needs prior to release and craft ongoing Stakeholders (jail, Case Review Task individual release plan, providing the inmate with courts, human Force a resource directory and packet of materials. services) Offer guidance on how to connect with resources. iii. Develop a reentry discharge planning team Done Stakeholders (faith Case Review Task and/or follow up team to work with people before organizations, jail, Force and after release. courts, human services, law enforcement, public) c. INCREASE i. Complete a housing inventory to ensure Done Stakeholders (faith Housing Task Force / Intergrated Housing CAPACITY organizations, jail, affordable housing is available to returning Access Center citizens and craft a comprehensive housing plan courts, human for reentry. services, law enforcement, public) ii. Commit to keeping formerly incarcerated ongoing Stakeholders (faith Coalition Advisory people involved in Reentry Coalition meetings organizations, jail, Board and include on committee work. courts, human services, law enforcement, public) d. ADVOCATE FOR i. Examine reentry processes and protocols, ongoing Stakeholders (jail, Intercept Task Force CHANGE looking for opportunities to enhance or develop courts, law better processes and remove process barriers. enforcement, human services) 4. Data collection to County Human Begin upload of data for county HS County and This is monitored Done departments to compare and contrast for increase knowledge Services is working with HealthChoices have through the County developing services of quality of services our managed care committed funds to project planning in order to assist in organization to create a pursue the project. making better data warehouse to track decisions for service human services data delivery. across systems. Data scrubbing to ensure that the data is accurate County and This is monitored Done and all paths are uploading correctly. HealthChoices have through the County committed funds to project planning pursue the project. 31 DHS Bulletin County Human Services Plan Guidelines Creating dashboards and report to begin anaylsis. Fall County and This is monitored 2019 HealthChoices have through the County committed funds to project planning pursue the project. Begin data driven decision making Winter County and This is monitored 2019 HealthChoices through the County project planning have committed funds to pursue the project. . ii. 32 DHS Bulletin County Human Services Plan Guidelines e) Existing County Mental Health Services: Please indicate all currently available services and the funding source or sources utilized. Services By Category Currently Funding Source (Check all that Offered apply) Outpatient Mental Health ☒ ☒ County ☒ HC ☒ Reinvestment Psychiatric Inpatient Hospitalization ☒ ☐ County ☒ HC ☐ Reinvestment Partial Hospitalization Adult ☒ ☐ County ☒ HC ☐ Reinvestment Child/Youth ☒ ☐ County ☒ HC ☐ Reinvestment Family-Based Mental Health Services ☒ ☒ County ☒ HC ☐ Reinvestment ACT or CTT ☐ ☐ County ☐ HC ☐ Reinvestment Children’s Evidence Based Practices ☒ ☐ County ☒ HC ☐ Reinvestment Crisis Services Telephone Crisis Services ☒ ☒ County ☒ HC ☐ Reinvestment Walk-in Crisis Services ☒ ☒ County ☒ HC ☐ Reinvestment Mobile Crisis Services ☒ ☒ County ☒ HC ☐ Reinvestment Crisis Residential Services ☐ ☐ County ☐ HC ☐ Reinvestment Crisis In-Home Support Services ☐ ☐ County ☐ HC ☐ Reinvestment Emergency Services ☒ ☒ County ☐ HC ☐ Reinvestment Targeted Case Management ☒ ☒ County ☒ HC ☐ Reinvestment Administrative Management ☒ ☒ County ☐ HC ☐ Reinvestment Transitional and Community Integration Services ☐ ☐ County ☐ HC ☐ Reinvestment Community Employment/Employment Related Services ☒ ☒ County ☐ HC ☐ Reinvestment Community Residential Services ☒ ☒ County ☒ HC ☐ Reinvestment Psychiatric Rehabilitation ☐ ☐ County ☐ HC ☐ Reinvestment Children’s Psychosocial Rehabilitation ☐ ☐ County ☐ HC ☐ Reinvestment Adult Developmental Training ☐ ☐ County ☐ HC ☐ Reinvestment Facility Based Vocational Rehabilitation ☒ ☒ County ☐ HC ☐ Reinvestment Social Rehabilitation Services ☒ ☒ County ☐ HC ☐ Reinvestment Administrator’s Office ☒ ☒ County ☐ HC ☐ Reinvestment Housing Support Services ☒ ☒ County ☐ HC ☐ Reinvestment Family Support Services ☐ ☐ County ☐ HC ☐ Reinvestment Peer Support Services ☒ ☒ County ☐ HC ☒ Reinvestment Consumer Driven Services ☒ ☐ County ☐ HC ☒ Reinvestment Community Services ☒ ☒ County ☐ HC ☒ Reinvestment Mobile Mental Health Treatment ☐ ☐ County ☐ HC ☐ Reinvestment BHRS for Children and Adolescents ☒ ☐ County ☒ HC ☐ Reinvestment Inpatient D&A (Detoxification and Rehabilitation) ☒ ☐ County ☒ HC ☐ Reinvestment Outpatient D&A Services ☒ ☐ County ☒ HC ☐ Reinvestment Methadone Maintenance ☒ ☐ County ☒ HC ☐ Reinvestment Clozapine Support Services ☒ ☐ County ☒ HC ☐ Reinvestment Additional Services (Specify – add rows as needed) ☐ ☐ County ☐ HC ☐ Reinvestment *HC= HealthChoices 33 DHS Bulletin County Human Services Plan Guidelines f) Evidence Based Practices Survey: Evidenced Based Is the Current What fidelity Who How often Is SAMHSA EBP Is staff Additional Practice service number measure is measures is fidelity Toolkit used as specifically Information used? measured? available served in fidelity? an trained to and Comments in the the (agency, implementation implement guide? (Y/N) County/ County/ county, the EBP? (Y/N) Joinder? Joinder MCO, or (Y/N) (Approx) state) N N/A N/A N/A N/A N/A N/A N/A Assertive Community Treatment Y annually N Y Supportive County/sta Housing te Y Annually N N Supported Agency/coInclude # Employment unty Employed Y 145 CodeCat annually N Y Integrated Agency, Treatment for Co-county, HC occurring Disorders (MH/SA) N N/A N/A N/A N/A N/A N/A N/A Illness Management/ Recovery N N/A N/A N/A N/A N/A N/A N/A Medication Management (MedTEAM) Y annually N Y Therapeutic Agency/st Foster Care ate N N/A N/A N/A N/A N/A N/A N/A Multisystemic Therapy N N/A N/A N/A N/A N/A N/A N/A Functional Family Therapy N Family Psycho- Education *Please include both county and Medicaid/HealthChoices funded services. To access SAMHSA’s EBP toolkits: http://store.samhsa.gov/list/series?name=Evidence-Based-Practices-KITs 34 DHS Bulletin 2018-1 County Human Services Plan Guidelines g) Additional EBP, Recovery Oriented and Promising Practices Survey: Current Service Number Recovery Oriented and Promising Practices Additional Information and Comments Provided Served (Yes/No) (Approximate) Consumer/Family Satisfaction Team Yes 540 Compeer No 0 Fairweather Lodge Yes 8 No county or HC funds MA Funded Certified Peer Specialist- Total** CPS Services for Transition Age Youth Yes 0 Approved 4/19 CPS Services for Older Adults Yes 19 Included in total Other Funded Certified Peer Specialist- Total** 34 CPS Services for Transition Age Youth Yes 0 Approved 4/19 CPS Services for Older Adults Yes 0 Included in total Dialectical Behavioral Therapy Yes Mobile Meds No Wellness Recovery Action Plan (WRAP) Yes High Fidelity Wrap Around/Joint Planning Team No Shared Decision Making No Psychiatric Rehabilitation Services (including clubhouse) No 2 Closed as of 2019 Self-Directed Care No Supported Education No Treatment of Depression in Older Adults No Consumer Operated Services Yes 56 CRS/Peer Op.Rec. Center Parent Child Interaction Therapy Yes 5 Sanctuary No Trauma Focused Cognitive Behavioral Therapy Yes 30 Eye Movement Desensitization And Reprocessing (EMDR) Yes 4 First Episode Psychosis Coordinated Specialty Care No Other (Specify) TARGET Yes 25 5 providers *Please include both County and Medicaid/HealthChoices funded services. **Include CPS services provided to all age groups in Total, including those in the age break outs for TAY and OA below 35 DHS Bulletin 2018-1 County Human Services Plan Guidelines 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. http://www.nrepp.samhsa.gov/AllPrograms.aspx h) Certified Peer Specialist Employment Survey: “Certified Peer Specialist” (CPS) is defined as: An individual who has completed a 10-day Certified Peer Specialist training course provided by either the Institute for Recovery and Community Integration or Recovery Innovations/Recovery Opportunities Center. Please include CPSs employed in any mental health service in your county/joinder including, but not limited to:  case management  Medicaid-funded peer support programs  inpatient settings  consumer-run organizations  psychiatric rehabilitation centers  residential settings  intensive outpatient programs  ACT, PACT, or FACT teams  drop-in centers Total Number of CPSs Employed 13 Number Full Time (30 hours or more) 7 Number Part Time (Under 30 hours) 6 INTELLECTUAL DISABILITY SERVICES The Office of Developmental Programs (ODP), in partnership with the county programs, is committed to ensuring that individuals with an intellectual disability and autism 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’ teams. 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. With that in mind, describe the continuum of services to enrolled individuals with an intellectual disability and autism within the county. In a narrative format, please include the strategies that will be utilized for all individuals registered with the county, regardless of the funding stream. In completing 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 36 DHS Bulletin 2018-1 County Human Services Plan Guidelines 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 (PDS), individuals served means the individual used Vendor Fiscal/Employer Agent (VF/EA) or Agency with Choice (AWC) 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 & Developmental Disabilities/Early Intervention is to partner with the community to develop and assure the availability of quality MH/IDD/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 IDD 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 Intellectual & Developmental Disabilities program 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, 2019, there were 537 people registered in the Intellectual and Developmental Disabilities program in Franklin County. As of July 1, 2017, the Office of Developmental Programs opened the waivers to individuals with Autism only. In Fiscal Year 2018-2019, the IDD program registered 13 people in the Autism Only category. We also registered 3 people under the age of 9 who are likely to have an intellectual disability or autism. There are 146 people who have an Intellectual Disability Diagnosis but have Autism as a secondary diagnosis registered in Franklin County. The IDD program will continue to assist families in gathering the proper documentation needed and enroll them into the IDD program if they meet criteria. Individuals Served Estimated Percent of Projected Percent of Individuals total Individuals to total served in Individuals be served in Individuals FY 18-19 Served FY 19-20 Served Supported 23 4.3 25 4.7 Employment Pre-Vocational 0 0 0 0 Community 6 1.1 6 1.1 participation Base Funded Supports 73 13.6 75 14.0 Coordination Residential 0 0 0 0 (6400)/unlicensed 37 DHS Bulletin 2018-1 County Human Services Plan Guidelines Life sharing 0 0 0 0 (6500)/unlicensed PDS/AWC 0 0 0 0 PDS/VF 0 0 0 0 Family Driven Family Support 43 8 45 8.4 Services 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 competitive 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 assist the county in establishing employment growth activities.  Please add specifics regarding the Employment Pilot if your county is a participant. Employment First is a concept promoting competitive integrated employment. Franklin/Fulton IDD 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, community-based work assessments, and work incentive counseling. There are currently 24 students in the TALS program in Franklin County. The TALS program has a goal of placing ten (10) individuals into a competitive job. As of March 2019, six (6) individuals had 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.” Of the 23 people receiving base funded supported employment, 21 have competitive jobs. Providers continue to work on developing small group employment opportunities, becoming trained in the discovery process, as well as, obtaining the Association of Community Rehabilitation Educators (ACRE) or Certified Employment Support Professional (CESP) certifications. Small Group Employment services consist of supporting participants in transitioning to competitive integrated employment through work that occurs in a location other than a facility subject to 55 Pa. Code Chapter 2380 or Chapter 2390 regulations. The goal of Small Group Employment services is 38 DHS Bulletin 2018-1 County Human Services Plan Guidelines competitive integrated employment. Participants receiving this service must have a competitive integrated employment outcome included in their service plan and it must be documented in the service plan how and when the provision of this service is expected to lead to competitive integrated employment. Work that participants perform during the provision of Small Group Employment services must be paid at least minimum wage and the compensation must be similar to compensation earned by workers without disabilities performing the same work. Small Group Employment service options include mobile work force, work station in industry, affirmative industry, and enclave. Discovery is a targeted service for a participant who wishes to pursue competitive integrated employment but, due to the impact of their disability, their skills, preferences, and potential contributions cannot be best captured through traditional, standardized means, such as functional task assessments, situational assessments, and/or traditional normative assessments which compare the participant to others or arbitrary standards of performance and/or behavior. Discovery involves a comprehensive analysis of the participant in relation to the following:  Strongest interests toward one or more specific aspects of the labor market;  Skills, strengths and other contributions likely to be valuable to employers or valuable to the community if offered through self-employment; and  Conditions necessary for successful employment or self-employment. Community Participation Support is defined as “providing opportunities and support for community inclusion and building interest in and developing skills and potential for competitive integrated employment”. Services should result in active, valued participation in a broad range of integrated activities that build on the participant's interests, preferences, gifts, and strengths while reflecting his or her desired outcomes related to employment, community involvement and membership. Community Participation Support is intended to flexibly wrap around or otherwise support community life secondary to employment, as a primary goal. This service involves participation in integrated community settings, in activities that involve persons without disabilities who are not paid or unpaid caregivers. This service is expected to result in the participant developing and sustaining a range of valued social roles and relationships, building natural supports, increasing independence, increasing potential for employment, and experiencing meaningful community participation and inclusion.” The Franklin/Fulton IDD program will continue to support providers in providing Community Participation Support. There are currently six (6) individuals who utilize base dollars to fund Community Participation Support within a pre-vocational setting. The IDD department is concentrating on Competitive Integrated Employment which includes supported employment and small group employment for the Quality Management Goal (see Appendix E). The outcome for the Quality Management Plan/logic model is “people who choose to work are employed in the community.” As of April 1, 2019, there were 80 Franklin County individuals with IDD in competitive integrated employment. Franklin County’s QM objective is to increase the number of new hires in Competitive Integrated Employment by 10% (n=5) each plan year by June 30, 2018. There are eleven (11) new hires into Competitive Integrated Employment in this plan year which exceeds the objective. The Intellectual & Developmental Disability Program’s QM plan is measuring the number of new hires in Competitive Integrated Employment to align with the definition by the Department of Labor and with the Office of Developmental Program’s Quality initiative as set by the ISAC (Information Sharing and Advisory Committee). 39 DHS Bulletin 2018-1 County Human Services Plan Guidelines  Franklin County IDD program collaborates with OVR in identifying people who will benefit from Pre-employment Transition Service, Paid Work Experience, and job shadow within the school districts. The Franklin/Fulton IDD Program participates in the Transition Council which includes respresentatives from OVR, the School Districts, and providers to promote and support the Employment First Model. The OVR and IDD Program facilitate the STAR (Student Transition to Adult Review) meetings for students and their parents to focus on their plan for transitioning from high school. We discuss the student’s interests, goals, and present levels in relation to employment and independent living and supports needed. This also provides an opportunity to register with the IDD program and OVR if the person has not already done so. Franklin County IDD program also attends the transition fairs at the high school to provide information to students and families, as well as, funding and assisting in the organization of a County Transition Day for studnts at a local college. Supports Coordination:  Describe how the county will assist the supports coordination organization (SCO) to engage individuals and families in a conversation to explore the communities of practice /supporting families model using the life course tools to link individuals to resources available to anyone in the community.  Describe how the county will assist supports coordinators to effectively engage and plan for individuals on the waiting list. Describe the collaborative efforts the county will utilize to assist SCO’s with promoting self direction. Base Funded Supports Coordination includes home and community based case management for individuals in nursing facilities, MA eligible individuals who are admitted for psychiatric hospitalization and in community residential settings. These services are only paid for individuals who have had a denial of Medical Assistance Coverage. There are 58 people who have base funded Supports Coordination either because they are not eligible for MA or they lost their MA for part of the year. There are 9 people who have the OBRA Waiver and have base funded Supports Coordination. There are 6 people who reside in an ICF/ID or State Center and receive base funded Supports Coordination. Currently no one is interested in leaving the State Center system from Franklin or 40 DHS Bulletin 2018-1 County Human Services Plan Guidelines Fulton Counties, so transition services are not needed at this time. The program has MA denials for people who are receiving base services over $8,000. The IDD 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, Levels of Care, incident management and other items are part of the standing agenda discussed monthly. The SCO is also represented on the Transition Council and is encouraged to participate in State Employment Leadership Network (SELN) trainings to promote community integrated employment. The IDD Program and the SCO collaborate and participate in trainings with the Office of Vocational Rehabilitation on implementation of Workforce Innovation and Opportunity Act (WIOA). The IDD Program developed an OVR referral process to streamline, track, and facilitate in accessing OVR services. Franklin/Fulton County is one of the Regional Collaboratives for the Community of Practice. The SCO is represented on the Stakeholder Committee for the Regional Collaborative. The Regional Collaborative has decided to narrow their focus to transitioning youth. The Regional Collaborative has partnered with the PA Family Network to offer workshops in the community after community events or fairs. For example, a Transitioning to Adult Life workshop was held after the Transition Fair at the Waynesboro Senior High School. The flyers for the workshop were given out at the event. The Regional Collaborative also helped sponsor Al Condeluci at the Human Services Training Days to help reach Human Services Professionals. Supports Coordinators are using the life course tools in ISP meeting to help families plan for the future. And lastly, the Regional Collaborative is publishing a Community Resource Guide to give out at workshops, at intake, at ISPs where people are on the waiting list and at community events. Lifesharing and Supported Living:  Describe how the county will support the growth of Lifesharing and Supported Living as an option.  What are the barriers to the growth of Lifesharing/Supported Living in your county?  What have you found to be successful in expanding these services in your county despite the barriers?  How can ODP be of assistance to you in expanding and growing Lifesharing/Supported Living 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.” 41 DHS Bulletin 2018-1 County Human Services Plan Guidelines Satisfaction surveys have shown that people in life sharing living arrangements are more satisfied with their life. This, along with the QM plan’s outcome “that people choose where they wish to live”, has driven the objective for Life Sharing, “to increase the number of people in life sharing.” The Franklin/Fulton County Intellectual & Developmental Disabilities Program will support the growth of life sharing in the following ways:  The Administrative Entity (AE) and SCO will continue to work on providing information to individuals and families on the values and benefits of Life Sharing and correcting the “stigma” that is “adult foster care.” We will continue to help families understand that Life Sharing is a supportive, sharing, and mentoring environment that enhances the natural supports of the family.  The AE has encouraged local Life Sharing providers to develop new licensed homes to be used for periodic and emergency respite situations that can be available when needed. This has helped to expedite emergency respite placements which, in turn, has developed into a new life sharing connection.  The AE will work with providers with the expansion of the Life Sharing service definition to include individuals living in their own home or the home of a relative and receiving agency managed life sharing services. 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 37 people living in life sharing homes in Franklin County (Franklin/Fulton QM information). The funding that supports 36 of these individuals in their life sharing homes is waiver funding. The remaining person is private pay for his lifesharing home. The Intellectual and Developmental Disability Program’s Quality Management outcome is “people live where they choose.” The QM objective is to increase the number of new and unique people in life sharing in Franklin/ Fulton Counties by 10% (n=4) by June 30, 2019. There are currently eight (8) new people who have moved into lifesharing homes this QM plan. Some of the barriers to growth in life sharing in Franklin/Fulton County are the lack of families interested in life sharing. Another barrier is the complex needs of individuals that may be interested in life sharing. The final barrier is that caregivers that are life sharers are aging. As they age, their own needs increase and they cannot continue to provide the care required. While there are barriers to life sharing in Franklin/Fulton Counties, there are also successes. Many of the people in life sharing have lived in their life sharing homes for 20+ years. One provider of life sharing actively recruits life sharing families successfully. Finally, Franklin/Fulton has been successful in moving people from CRR (Community Rehabilitation Residential) facilities and Children’s Foster Care to life sharing when they age out of the children’s system. In July 2018 , ODP expanded their waiver offerings by adding the Community Living Waiver (CLW), this waiver has a funding cap of $70,000 dollars. This is enough funding to support an individual that has a low SIS Needs Group in a Life Sharing Home as long as that individual is either working or not attending a traditional day program. Franklin/Fulton has one individual in Life Sharing funded by CLW and is attending school. 42 DHS Bulletin 2018-1 County Human Services Plan Guidelines 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, especially medical 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 and promote the life course /supporting families paradigm.  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 community resources as well as formalized services and supports through ODP. The IDD program collaborates with the following agencies to increase the support for individuals with multiple needs. The IDD 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 IDD staff also has a working relationship with Home Health Aid Providers to support individuals in the home and community. Lastly, the Managed Care Organization Specialized Needs Unit is available for individuals who meet their criteria. The IDD program also collaborates with the school districts by offering information sessions to both parents and teachers. The IDD staff attend IEPs when requested to help problem-solve and/or to provide inake 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 IDD program partners with Children and Youth (C&Y) through CASSP. There are also individual cases where C&Y and the IDD Program are involved where communication between the two agencies resulted in the best outcome for the child while protecting the individual’s rights. The IDD program collaborates with Franklin County Office of Aging through participation in the Aging/IDD Meetings as well as reviewing PASSAR packets. The Mental Health and Intellectual & Developmental Disabilities program has a long history of communication and collaboration. IDD 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 Occupational Services, Inc. (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. WRAP® groups were held throughout the year. Franklin County IDD staff is scheduled to present the WRAP for People with Developmental Distinctions at a local provider October – December 2019. The County WRAP Facilitator has been asked to assist with the Keynote for the Dual Diagnosis Conference in August 2019. The IDD program also presents the module on Intellectual & Developmental Disabilities in the Crisis Intervention Team Curriculum. This curriculum helps police officers, MH professionals and first responders respond to someone with a disability in the course of their professions. 43 DHS Bulletin 2018-1 County Human Services Plan Guidelines The IDD program continues to collaborate with Mental Health, CASSP, Tuscarora Managed Care Alliance and Perform Care to support people who have a dual diagnosis. 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: o Does your county reserve any base or block grant funds to meet emergency needs? o 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? o Does your county provide mobile crisis? o If your county does provide mobile crisis, have the staff been trained to work with individuals who have an ID and/or autism diagnosis? o Do staff who work as part of the mobile crisis team have a background in ID and/or autism? o Is there training available for staff who are part of the mobile crisis team? o If your county does not have a mobile crisis team, what is your plan to create one within your county’s infrastructure?  Please submit the county 24-hour emergency crisis 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 Franklin County IDD 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 IDD Independent Apartment Program has 13 people living in their own apartments with less than 30 hours of support per week. Base funds are used to subsidize the rent. This program is the least restrictive housing option for individuals who wish to live independently. The AE has a Risk Management Committee that meets quarterly to discuss incident management, review restrictive procedures, discuss risk mitigation and any items that may arise to become a future emergency. Franklin County responds to emergencies outside of normal work hours in Procedure Statement IDD- 505 Risk Mitigation. In this procedure statement, all Program Specialists are listed as well as the MH/IDD/EI Administrator with their cell phone numbers. These contacts can be used after hours for any emergency. All providers have been trained in the policy. Initial incidents are reviewed daily to assure 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 Life sharing or 44 DHS Bulletin 2018-1 County Human Services Plan Guidelines Emergency Residential while the person is in respite. This provides for the safety of the person and finds a long term solution. The MH/IDD Department’s mission of essential functions are those critical processes the department must maintain, during the response and recovery phases of an emergency, to continue to serve its constituents. The department’s mission-essential functions must be able to be executed within 12 hours of a major emergency and be sustainable for up to 30 days during the recovery phase of the emergency. The Intellectual and Developmental Disabilities Program utilizes the current contract with Keystone Behavioral Health for Crisis Services. The Crisis Department is operated 24 hours per day, 7 days per week for 365 days. One aspect of this contracted service is Mobile Crisis. Mobile Crisis is available in Franklin County. Any of the Crisis workers can provide mobile crisis. Some of the crisis workers do have a background in working with individuals with Autism and/or Intellectual & Developmental Disabilities. They do have some trained staff; training is available for any staff as requested. As with the other crisis services offered, when an individual with an Intellectual Disability or Autism utilizes crisis services, the crisis staff will notify either the Supports Coordinator or the AE if the person is not registered with the IDD program. The co-responder program is also a way to divert people with disabilities from being incarcerated and seek the community resource help that they need. Please see Mental Health Section for details. The Franklin/Fulton IDD Program is piloting CSG’s Mobile MH/ID Behavioral Intervention Services to expand the Mobile Crisis service in Franklin/Fulton County. The service would be a “time limited service designed to evaluate the current situation, develop treatment strategies, provide direct interventions with the individual, deliver consultation, provide resources and develop skills so that existing supports can continue to implement the treatment strategies developed by the team” for individuals who have a dual diagnosis and are struggling to have an “Everyday Life.” The program has served 3 individuals this past year. The Couty 24-hour Emergency Response Plan, as required under the Mental Health and Intellectual Disabilities Act of 1966, is on file and will be provided if requested, due to the personal phone numbers published in it. 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 trainers.  Describe the county’s interaction to utilize the network 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 the above?  Describe how the county will engage with the Health Care Quality Units (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. 45 DHS Bulletin 2018-1 County Human Services Plan Guidelines  Describe how the county will engage the local Independent Monitoring for Quality (IM4Q) Program to improve the quality of life for individuals in your program.  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 the county’s support efforts of local providers?  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 the county in interacting with stakeholders in relation to risk management activities?  Describe how you will utilize the county housing coordinator for people with autism and intellectual disability.  Describe how the county will engage providers of service in the development of an Emergency Preparedness Plan. Franklin/Fulton IDD program is a Regional Collaborative for the Community of Practice. As part of the Community of Practice, the PA Family Network is part of our Stakeholder Group. The Stakeholder group decided to restructure to better meet the needs of families. The Regional Collaborative has decided to narrow their focus to transitioning youth. The Regional Collaborative has partnered with the PA Family Network to offer workshops in the community after community events or fairs. For example, a Transitioning to Adult Life workshop was held after the Transition Fair at the Waynesboro Senior High School. The flyers for the workshop were given out at the event. The Regional Collaborative also helped sponsor Al Condeluci at the Human Services Training Days to help reach Human Services Professionals. Supports Coordinators are using the life course tools in ISP meetings to help families plan for the future. And lastly, the Regional Collaborative is publishing a Community Resource Guide to give out at workshops, at intake, at ISPs where people are on the waiting list and at community events. The 2017-2019 Quality Management Plan has an outcome that families receive support to help make an Everyday Life possible. The objective for this outcome for 2017-2019 is to reach 20 families incollaboration with the PA Family Netowrk to disseminate the Communities of Practice Lifecourse Planning Tool in small group or 1:1 sessions by June 30, 2019. Currently the IDD program has reached 37 families which exceeded this goal. The most drastic increase was in the last quarter, which can be directly correlated to the start of the above activities. 46 2016-172017-18 030252015105 Medication Errors DHS Bulletin 2018-1 County Human Services Plan Guidelines The IDD 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 participates on both the Risk Management Committee and the QI Council. This is an outcome and objective in the 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 “people are healthy, Franklin Fulton Intellectual and Developmental Disabilities Program will use the objective of reducing the number of medication errors by 10% by June 30, 2019”. The baseline data is 291 medication errors from July 2015 - April 2017. As of March 31, 2019, there are 323 medication errors this 2017-2019 QM year. This is in increase in the number of medication errors. 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 47 DHS Bulletin 2018-1 County Human Services Plan Guidelines emergency during considerations or at ISPs when questions are raised. The QI Council also reviews Employment and Life sharing IM4Q data to determine satisfaction with services. Both of these outcomes are included in the QM Plan. 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. When a new QM plan is developed, IM4Q data is reviewed for Franklin/Fulton County to determine what the IDD program is either lagging behind the state average in or is a reoccurring issue for considerations. The IDD 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, Consumer Data Collection (CDCs), medication/pharmacy reviews and provide training. CDCs were being scheduled for all residential homes on a routine basis. Providers will begin utilizing the Health Risk Screening Tool moving forward to improve the quality of life for individuals. The AE continues to upport providers in developing relationships with the local hospital. As previously mentioned, the MH/IDD 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 (I- 2-I) abuse was an issue that needed addressed. The logic model and QM Plan both address the I-2-I abuse issue. The outcome, “People are abuse free,” is measured by the objective of reducing the number of I-2-I abuse incidents by 5%. The number of incidents of I-2-I 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. The baseline data is 157 incidents of I-2-I abuse for 2015-2017. As of March 31, 2019, there were 69 incidents of I-2-I abuse. The Risk Management Committee has found several trends over this year as evidenced by the peaks in the graph and worked to resolve these situations. Several of the trends were resolved by making residential moves as the target and victim were always the same. Some of the trends required Behavior Support Plans to be modified or training for the individual or direct support staff. The Risk Management Committee will continue to monitor the data for trends. The IDD Program partners with the County Housing Program to support an Independent Living Apartment Program for people living in their own apartments who need less than 30 hours of support a week. Because the County subsidizes the rent with base funds people are able to live in affordable and safer neighborhoods. There are currently 13 people in this program. 48 DHS Bulletin 2018-1 County Human Services Plan Guidelines The County engages providers of service by ensuring that all ISPs have backup/emergency plans included. As stated in the IM4Q paragraph, the county has developed Emergency Preparedness Folders for people who request them. A total of seven (7) folders were given out to individuals and their families in 2016-2017, seven (7) were given out in 2017-2018 and seven (7) have been given out in 2018-2019. Folders will continue to be updated and given to individuals and their families as requested. Participant Directed Services (PDS):  Describe how your county will promote PDS (AWC VF/EA) services including challenges and solutions.  Describe how the county will support the provision of training to SCO’s, individuals and families on self direction.  Are there ways that ODP can assist you in promoting/increasing self direction? Franklin/Fulton Counties have 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 ten families using AWC supports. All of their supports and services are paid with waiver funding including the administration fee. 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 IDD system and the service definitions. And finally, families get frustrated at the amount of documentation required of them. ODP 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 12 individuals in congregate settings. Three (3) of the indivduals resided at 2 State Centers. All have been given the choice to move into the community . They all have said that they are happy where they live and have no desire to move. One of the individuals is offered community placement annually and chooses to stay at the State Center. One (1) person in the nursing home expresses the wish to transition to the community where her needs could be met in a Residential Home. At 37 years old, she is too young to be residing long term in a nursing home. In the past she has repeatedly refused appropriate residential placements that were offered to her. The remaining eight (8) individuals reside in nursing homes. This is a generic support for htem due totheir need for a nursing home level of care. 49 DHS Bulletin 2018-1 County Human Services Plan Guidelines HOMELESS ASSISTANCE PROGRAM SERVICES Describe the continuum of services to individuals and families within the county who are experiencing homelessness or facing eviction by answering each question below. 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. Bridge Housing:  Please describe the bridge housing services offered. Include achievements and improvements in services to families experiencing or at risk for homelessness, as well as unmet needs and gaps.  How does the county evaluate the efficacy of bridge housing services?  Please describe any proposed changes to bridge housing services for FY 19-20.  If bridge housing services are not offered, please provide an explanation. Due to limited funds, Franklin County has not expanded into bridge housing support. Case Management:  Please describe the case management services offered. Include achievements and improvements in services to families experiencing or at risk for homelessness, as well as unmet needs and gaps.  How does the county evaluate the efficacy of case management services?  Please describe any proposed changes to case management services for FY 19-20.  If case management services are not offered, please provide an explanation. Every Rental Assistance applicant will be part of HAP Case Management. A service plan will be established and signed by each applicant that will include referrals to address factors that led to the housing crisis in addition to other factors that may have contributed to the problem. Specifically, case management will be available through referrals with regard to budgeting, parenting, hygiene, sanitary housekeeping, accessing resources, and life skills with a goal of working towards self-sufficiency. Individuals that consistently do not participate in the service plan may transition out of the program and become ineligible for the program for a period of up to two years. In this event the efforts will be made to refer the individual to other programs for alternative shelter assistance. The SCCAP HAP Program Coordinator will be responsible for completing all intakes and assessments for the Franklin County Homeless Assistance Program. This process will include assessment of other needs, especially those that brought the family to a housing crisis. Case management services/activities offered by SCCAP, as defined by the HAP Guidelines, may include but are not limited to the following: o Intake and assessments (service plan) for individuals who are in need of supportive services and who need assistance in accessing the service system. 50 DHS Bulletin 2018-1 County Human Services Plan Guidelines o Assessing service needs and eligibility and discussion with the individual of available and acceptable service options. o Referring individual to appropriate agencies for needed services. o Providing referrals to direct services such as budgeting, life skill training, job preparation, etc. o Providing advocacy, when needed, to ensure the satisfactory delivery of requested services. o Protecting the individual’s confidentiality. The SCCAP HAP Program Coordinator will refer the individual to appropriate agencies/resources as needed for services such as linkages to income supports, parenting skills, life skills, budgeting, hygiene, food, making appointments, priority setting, maintaining records, literacy training, adult basic education, etc. The case manager will establish linkages with the Housing Authority and other local housing programs for low-income housing and the County Assistance Office. Specifically, the HAP Program Coordinator will assure that individuals who are eligible have accessed Emergency Shelter Assistance (ESA) through the Title IV-A program at the CAO so long as the ESA program exists. The SCCAP HAP case manager will discuss with the individual any service needs and options and any goals the family has identified. Confidentiality of the individual will be protected, and all reasonable efforts will be made to coordinate service delivery and to avoid duplication of services. Therefore, Releases of Information will be required so that all other agencies offering housing services can be contacted to cross reference whether the family is receiving services elsewhere and to ensure coordination of services. After the individual has been approved, the HAP Program Coordinator will complete a payment agreement between the individual, landlord and SCCAP and will then complete a goal plan specific for the individual needs of the family and appropriate referrals will be made. Individuals will be informed in writing by SCCAP, of the right to appeal if service is denied to them as set forth per the HAP guidelines. The following will be provided in writing to any individual who is denied or terminated from service: o the action being taken; o the reason for the action; o the effective date of the action and o the availability of an appeal process at the County and State level. Written appeal may be made to the County of Franklin. The individual will be informed in writing of the result of the appeal. Further appeals will follow the guidelines as set forth by HAP which states that after exhausting the first level of appeal at the County, an individual may appeal to DHS to the Office of Hearings and Appeals. All individuals will be informed of the appeal process during their initial appointment. The appeal plan is explained at the first appointment and a copy is signed by the individual. Some notable successes for Case Management have been the intentional referral to Support Circles for all HAP clients. That has allowed both families from the shelter and families applying for rental assistance to be enrolled in a long-term program that will support the family on their journey out of poverty. While not a requirement, we have seen several families take advantage of this opportunity and they are receiving ongoing appropriate support. 51 DHS Bulletin 2018-1 County Human Services Plan Guidelines Another notable success is the creation of a housing landlord survey that is shared with families that can meet the needs of high barrier famililes (those who have had an eviction in the past or may have a non-violent criminal history). As we have evaluated the results of this program and the recidivism of families returning for help, we are also opening our case management opportunities to families after they receive help and promoting that as an ongoing opportunity so families can come back to talk through options before they are in another crisis. Another addition to this component for SCCAP is Rapid Rehousing through HUD and ESG funding. This allows us the opportunity to identify the appropriate program for the individual. SCCAP can now work with families before they become homeless through HAP dollars, if they are currently homeless through our Emergency Shelter to get them off the streets and then through HAP or Rapid Rehousing to help them get into safe affordable housing and then on an ongoing basis through Case Management or Support Circles. The addition of these services along with the coordination of internal and external supports provides a much better continuum of care for families experiencing the trauma of homelessness or near homelessness. Of notable success are two additional partnerships. HAP is currently working with individuals referred through the Veterans program and the Franklin Together Re-entry Coalition. Both of those county collaborative groups have a host of supports which assist the individual in having a better opportunity of long term success. In assessing the barriers to services the most common reasons we are unable to help individuals is due to individuals being over the income limit or not being a resident of Franklin County for six months. We also receive many calls about people wanting us to help before they have an eviction notice. Individuals are reaching out to receive help to prevent an eviction notice. If we are not able to help, there are not many other organizations in the community that are able to provide support. Many organizations have the same regulations; at times local churches can assist and we make those referrals as appropriate. Franklin County staff members complete an annual onsite monitoring visit to evaluate case management services to ensure that all program requirements are being met. This process includes an evaluation of fiscal and program requirements along with individual file chart reviews. Rental Assistance:  Please describe the rental assistance services offered. Include achievements and improvements in services to families experiencing or at risk for homelessness, as well as unmet needs and gaps.  How does the county evaluate the efficacy of rental assistance services?  Please describe any proposed changes to rental assistance services for FY 19-20.  If rental assistance services are not offered, please provide an explanation. HAP’s Rental Assistance program is used for rent and security deposits for eligible low-income applicants who are homeless or near homeless as defined below: 52 DHS Bulletin 2018-1 County Human Services Plan Guidelines Individuals or families are homeless if they: • Are residing in a group shelter; domestic violence shelter; hotel or motel paid for with public or charitable funds; a mental health; drug, or alcohol facility; jail; or hospital with no place to reside; or living in a home, but due to domestic violence; needs a safe place to reside; • Have received verification that they are facing foster care placement of their children solely because of lack of adequate housing, or need housing to allow reunification with children who are in foster care placement; • Are living in a “doubled-up” arrangement for six months or less on a temporary basis; • Are living in a condemned building; • Are living in housing in which the physical plant presents life and /or health threatening conditions; e.g. having dangerous structural defects or lacking plumbing, heat, or utilities; or • Are living on the streets, in cars, doorways, etc. 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). Actual Eviction notice is required in the file. Individuals served by the HAP program must have been a resident of Franklin County for six months prior to applying for assistance. Rental Assistance is only provided to Franklin County applicants who can demonstrate that they will be able to become self-sustaining after help is provided. Applicants are to engage with case management services and individuals will be required to sign a service plan showing areas of responsibility between the case manager and the individual. Individuals served by the HAP Rental Assistance Program will fall into one or more of the following categories: • Franklin County families with children who are homeless or near homeless and can show that with assistance they can be stable in the future. • Persons fleeing domestic violence. • Individuals who have fallen on hard times who need rental assistance and can show that with assistance they can be stable in the future. To receive financial assistance, the individual or family must be at or below 150% of the Federal Poverty Income Guidlines. Referrals to other agencies can provide needed services will be made available to those who do not meet the income or residency guidelines as appropriate. Income requirements will be waived for persons fleeing domestic violence and for those who are experiencing a housing crisis due to a disaster such as fire or flood (upon State approval by the State HAP Manager as stated in the guidelines). In cases where extenuating circumstances have been identified and a county based eligibility requirement is less than the States’ HAP guidelines (e.g. income eligibility of 150% of FPIG is a county guideline and is less than the HAP guideline of up to 200% of FPIG, or the six month county residency requirement which is a county determined regulation) the HAP Program Coordinator may request a waiver from SCCAP’s CEO or their designee to allow services to be provided to an otherwise eligible family or individual. SCCAP’s CEO or their designee may approve services, but under no circumstances can services be provided that violate State Eligibility Criteria for the HAP Program. In instances where a waiver was granted, a note must be added to the file with the reason for the waiver and who approved the waiver. 53 DHS Bulletin 2018-1 County Human Services Plan Guidelines The amount of Rental Assistance allocated will be determined by the facts of the case and the creation of a service plan for each household addressing the conditions which precipitated the housing crisis and addressing the acquisition of permanent housing including the schedule for disbursement of rental assistance funds. The service plan is signed and placed within the individual’s file. The service plan will address other services needed and referrals made. In all cases the goal for the family will be to acquire stability and permanent, affordable housing. The household must demonstrate through the service plan and their actions that they have the ability to become self- sufficient and a commitment to work toward that goal. All service plans will include an agreement to cooperate with the HAP Program Coordinator/Case Manager. Individuals that consistently do not participate in the service plan may be transitioned out of the program and ineligible for assistance for up to two years. Applicants will be expected to contribute financially towards the housing plan as determined by their individual service plan. The individual or family must have anticipated income sufficient to pay the rent in the future. Whenever possible and practical, payment plans will be established whereby the applicant retains part of the responsibility for current or back rent or utility payments. The maximum assistance available in a 24-month period is $1,500 for families with children, and $1,000 for adult only households. In most instances, households will not receive the maximum amount of assistance, but only the amount determined appropriate as stated in their service plan. Assistance given by Emergency Shelter Assistance (ESA) or Emergency Food and Shelter Program (EFSP) will be included in the maximum allowed per household, as per DHS. Applicants will be required to exhaust all other resources available through the County Assistance Office (CAO) or other local resources before being considered for HAP Rental Assistance. This includes but is not limited to Emergency Shelter Assistance (ESA), Low Income Home Energy Assistance Program (LIHEAP), fuel assistance, utility assistance, etc. Applicants who may to be eligible for Title IV-A Emergency Shelter Assistance must apply at the County Assistance Office, and receive a determination from the CAO before HAP can be considered. Families with a child under 21 whose income is below 80% of poverty will be referred for ESA before Rental Assistance is utilized. This requirement will end if the ESA program is discontinued. Individuals or families must have an agreement with the landlord to rent to them before financial assistance will be provided. Written agreements must be confirmed by the HAP Case Manager before funds can be released. Franklin County staff members complete an annual onsite monitoring visit to evaluate case management services to ensure that all program requirements are being met. This process includes an evaluation of fiscal and program requirements along with individual file chart reviews. Another addition to this component for SCCAP is Rapid Rehousing through HUD and ESG funding. SCCAP’s emergency shelter had attempted rental assistance in the past with limited success. With the implementation of the longer term supports of Rapid Rehousing, we have found we are better able to help families find and maintain housing. While a relatively new program, this addition is strengthening our continuity for families. This allows us the opportunity to identify the appropriate program for the individual. SCCAP can now work with families before they become homeless through HAP dollars, if they are currently homeless through our Emergency Shelter to get them off the streets, and then through HAP or Rapid Rehousing to help them get into safe affordable housing and then on an ongoing basis through Case Management or Support Circles. We feel the addition of these services along with the coordination of internal and external supports provides a much better 54 DHS Bulletin 2018-1 County Human Services Plan Guidelines continuum of care for families. We believe these supports will help families stabilize and maintain long-term, safe, affordable housing! Emergency Shelter:  Please describe the emergency shelter services offered. Include achievements and improvements in services to families experiencing or at risk for homelessness, as well as unmet needs and gaps  How does the county evaluate the efficacy of emergency shelter services?  Please describe any proposed changes to emergency shelter services for FY 19-20.  If emergency shelter services are not offered, please provide an explanation. 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 individual increase their income? - Did the individual obtain needed supportive services (mental health, job training, physical health needs, etc.)? - Did the individual achieve safe affordable housing? The Franklin County Shelter for the Homeless is located in downtown Chambersburg, at 223 South Main Street. The Shelter provides nine bedrooms with the capacity to house up to 18 individuals at one time. Two of the rooms are family rooms. The Franklin County Shelter for the Homeless is the safety net for the residents who may find themselves without a place to live. The Franklin County Shelter uses a Housing First Model and staff work diligently to get individuals into housing quickly and then work to help them stabilize and move forward. Our goal 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 during and after their stay. We also coordinate with other agencies within the County to direct residents to the available resources that will help them achieve their established goals and long term success. In order to receive services, the Franklin County Shelter for the Homeless, an individual/family must be legally homeless. Families either come to the shelter, where we work with the coordinated entry system to get them registered and evaluated for service, or we receive a referral from the coordinated entry system and a family or individual comes to the shelter referred through 211. Immediately we perform a housing barriers assessment to identify what will prevent the family or individual from getting housed quickly and then begin the work of finding safe, affordable, appropriate housing and stabilizing the family. Our work with the family continues after the family is housed so we can provide the best opportunity for long term success. Homeless Assistance Program funds are needed to support the daily operational costs of the Franklin County Shelter for the Homeless and the extensive case management needed to help families and individuals, many of who are chronically homeless or have extensive housing barriers, obtain and maintain long term housing. Another addition the Homeless Services Toolkit for SCCAP is Rapid Rehousing through HUD and ESG funding. SCCAP’s emergency shelter had attempted fragmented one time rental assistance in the past with limited success. With the implementation of the longer term supports of Rapid 55 DHS Bulletin 2018-1 County Human Services Plan Guidelines Rehousing, we have found we are better able to help families find and maintain housing. This addition is strengthening our continuity for families. This allows us the opportunity to identify the appropriate program for the individual. SCCAP can now work with families before they become homeless through HAP dollars, if they are currently homeless through our Emergency Shelter to get them off the streets, and then through HAP or Rapid Rehousing to help them get into safe affordable housing, and then on an ongoing basis through Case Management or Support Circles. We feel the addition of these services along with the coordination of internal and external supports provides a much better continuum of care for families. We believe these supports will help families stabilize and maintain long-term, safe, affordable housing! Franklin County staff members complete an annual onsite monitoring visit to evaluate case management services to ensure that all program requirements are being met. This process includes an evaluation of fiscal and program requirements along with individual file chart reviews. Innovative Supportive Housing Services:  Please describe the other housing supports services offered. Include achievements and improvements in services to families experiencing or at risk for homelessness, as well as unmet needs and gaps  How does the county evaluate the efficacy of other housing supports services?  Please describe any proposed changes to other housing supports services for FY 19-20.  If other housing supports services are not offered, please provide an explanation of why services are not offered. Franklin County has not used HAP funding for other housing support services. Independent living and forensic apartments are available through other funding sources. Homeless Management Information Systems:  Describe the current status of the county’s Homeless Management Information System (HMIS) implementation. Does the Homeless Assistance provider enter data into HMIS? Franklin County has actively participated in HMIS. With the change to the housing services systems that came January 24, 2018 via the Connect to Home Coordinated Entry Systems process. Franklin County has taken a lead role by providing an access center as a secondary option to the 211 system, for those who are seeking housing services. This process allows for individuals and families to be triaged, prescreened and assessed through HMIS so that appropriate services can assit in making individuals achieve permanent housing successfully. In addition, this system works as a starting point to connect individuals and familes with the Emergency Solutions Grant, HUD Permanent Supportive Housing Programs, PATH and one Shelter Plus Care Program. Individuals and familes are connected by use of referrals and/or the housing prioritization queue tools that are a part of HMIS.The goal is to have individuals enterd into HMIS immediately following enrollment in the housing programs. Multiple County employees are familiar with entering data into HMIS as well as running reports. 56 DHS Bulletin 2018-1 County Human Services Plan Guidelines SUBSTANCE USE DISORDER SERVICES (Limit of 10 pages for entire section) This section should describe the entire substance use service system available to all county residents regardless of funding sources. Please provide the following information: 1. Waiting List Information: # of Individuals Wait Time (days)** Withdrawal Management 37 1-2 days Medically-Managed Intensive 3 2-4 weeks Inpatient Services Opioid Treatment Services MAT = 13 Intake – 1 day st (OTS) 1 Tx Session - 2-4 days Clinically-Managed, High-55 1-7 days Intensity Residential Services Partial Hospitalization Program 0 *Individuals typically (PHP) Services step down from Residental to PHP versus directly admitted to PHP from the community Outpatient Services 193 Intake – 1 day st 1 Tx Session – 2-3 days **Use average weekly wait time *Reported numbers are representative of the number of SCA funded and/or case managed individuals that experienced a wait time and the average wait time for the specific level of care from the time of the request/need to the time of admission in FY18/19 year-to-date (7/1/18-3/31/19)  Withdrawal Management Services: In FY18/19, average wait for a detox bed in or out of county was 1-2 days from the time of the request and regardless of current environment of the individual. The primary substances for detox placement were opioids (prescription and illicit) and alcohol.  Medically Managed Residential Services: In FY 18/19, FFDA provided funding/case management services to three (3) individuals in need of complex medically managed/high intensity residential services, all of which were provided out of county. The average wait for the two primary medically managed residential facilities is 2-4 dependent on bed availability, priority population requests and complexities of comorbidity issues.  Opioid Treatment Services: In FY18/19, FFDA contracted with one methadone provider (closest in geographical proximity) as there aren’t any methadone providers within Franklin County. There are a total of three Buprenorphine prescribing providers within the county. There are a total of 3 prescribing physicians of oral naltrexone (Vivitrol) in the county with limited physician time. Same day/same week access hasn’t been obtainable. This is extremely important for individuals stepping down from a high level of care/secure environment (rehab, incarceration, psychiatric placement, etc.) where they received MAT to be able to 57 DHS Bulletin 2018-1 County Human Services Plan Guidelines engage in a community-based delivered process. FFDA continues to partner with a mobile Vivitrol provider, Positive Recovery Solutions (PRS) to assist in reducing this barrier for individuals that have started Vivitrol as their chosen MAT. In FY18/19, PRS provided mobile Vivitrol services in two locations, one time per month. In FY 18/19, FFDA also began providing funding for Buprenorphine, which allowed FFDA to provide three primary forms of MAT for individuals with opioid use disorder.  Clinically-Managed, High-Intensity Residential Services: In FY 18/19, the average wait for a residential bed was one-seven (1-7) days from the time of the request across all provider networks (in/out of Franklin County). There were a total of 55 individuals that received this level of care. Wait times were dependent on bed accessibility, priority population requests, unplanned discharges and time day that the request was made from FFDA.  Partial Hospitalization Services: In FY18/19, there was no indication of any wait to access this level of care (whether entry was a step-down from a higher level of care or direct entry), nor did FFDA fund/case manage any individuals in need of this level of care.  Outpatient Services: In FY18/19, there was no significant wait to access this Intensive Outpatient Program (IOP) or Outpatient Program levels of care (whether entry was a step- down from a higher level of care or direct entry). One outpatient treatment provider that operates two (2) sites in the county offers a same day intake which has allowed individuals to get into outpatient services more quickly, but also allowed individuals waiting for a detox or inpatient bed to engage in treatment services until the bed became available. 2. Overdose Survivors’ Data: Describe the SCA plan for offering overdose survivors direct referral to treatment 24/7 in your county. Indicate if a specific model is used. # of Overdose # Referred to # Refused # of Deaths from Survivors Treatment Treatment Overdoses 49 28 10 32 The reported numbers are based off of FY18/19 year-to-date data (representative of 7/1/18 through 3/31/19 only through Franklin County’s two hospitals’ admission and warm-hand off program data for any substance resulting in an overdose). Overdose death data is reflective of CY2018 in total. Franklin County’s Warm Hand Off process is the primary model to address overdose survivors’ linkages to treatment. It is implemented in two out of the two hospital emergency room departments (Chambersburg Hospital and Waynesboro Hospital) in the county; however, each set of protocols as well as resources look differently due to the lack of financial resources to support the process. FFDA is able to supply one full-time case management specialist to the Chambersburg Hospital to complete assessments, make appropriate level of care treatment placements and provide case management services to individuals entering through the Chambersburg ER onsite. Waynesboro Hospital utilizes FFDA to make referrals for a case manager or recovery support specialist (both current FFDA employees) to come onsite to provide assessments, placements and case management services. FFDA received approval to provide tele-conferencing for the case manager to complete the level of care assessments from Chambersburg Hospital to individuals receiving care at Waynesboro Hospital. FFDA needed to obtain a waiver from the Department of Drug & Alcohol Programs (DDAP) in order to engage in the practice to provide assessments and was granted the waiver to do so. FFDA works collaboratively with both hospital systems to leverage resources and to also offer these 58 DHS Bulletin 2018-1 County Human Services Plan Guidelines services to any individual that presents as needing substance use disorder treatment; however, overdose survivors are a prioritized population within this process. FFDA will be entertaining ways to extend the warm hand off process to EMS/first responders through the county’s Overdose Task Force in FY19/20 as a strategic plan goal. 3. Levels of Care (LOC): Please provide the following information for your contracted providers. # of # of Co- # of Co- LOC ASAM # of Providers Occurring/Enhanced Occurring/Enhanced Criteria Providers Located In-Programs Programs County 4 WM 0 2 2 2 4 2 0 2 2 3.7 WM 14 1 0 0 3.7 10 0 8 8 3.5 18 1 1 1 3.1 8 0 0 0 2.5 1 0 1 1 2.1 3 3 2 2 1 3 3 2 2 The reported number of providers is based upon the number of individual facilities that FFDA contracted with in FY18/19 to provide that level of care, regardless of the umbrella provider network the facility falls within. 4. Treatment Services Needed in County: Provide a brief overview of the services needed in the county to ensure access to appropriate clinical treatment services. Include any expansion or enhancement plans for existing providers or any use of HealthChoices reinvestment funds for developing new services. Tuscarora Managed Care Alliance (TMCA) oversees Franklin/Fulton County’s Behavioral Health HealthChoices Program. Reinvestment Plans that benefit Franklin County residents include two approved and currently implemented programs for Recovery Bridge Housing Subsidy and Certified Recovery Support Specialists. The Recovery Bridge Housing plan focuses on providing a rent subsidy for individuals who are Medicaid eligible/members to receive financial assistance for recovery housing rent. The recovery house must be PARR certified or an Oxford House Model in order to receive a contract from TMCA for this plan. TMCA’s Certified Recovery Specialist plan provides the opportunity for the in-network local outpatient drug/alcohol providers to employ a certified recovery specialist to provide peer support to individuals transitioning from a high level of care (detox/inpatient) to a lower, local level of care such as IOP or OP services. FFDA partners with TMCA on this endeavor by providing FFDA’s Recovery Support Specialist (RSS) to serve as the centralized referral hub. Inpatient providers make the referral on behalf of the individual to FFDA’s RSS who then reaches out to the individual’s provider choice. After the referral is accepted by the provider, the provider’s CRS makes face to face contact with the individual while still completing Inpatient treatment, prior to discharge. Once the individual is discharged, the CRS meets with the individual upon return to the community and begins providing peer and recovery case management support. The primary goal is to provide individuals with needed, yet voluntary peer support while in turn reducing the rate of re-admission into a higher level of care. A current need in Franklin County is the lack of drug/alcohol free pro-social activities for individuals who struggle with substance use disorders and their families/natural supports. 59 DHS Bulletin 2018-1 County Human Services Plan Guidelines TMCA and FFDA worked together in FY18/19 to submit a third reinvestment plan to focus on funding a recovery rec center with a primary/centralized center as well as satellite centers in both Franklin and Fulton counties, which was approved. In FY18/19, TMCA distributed a Request For Proposal (RFP) to the community for the Recovery Recreation Center. FFDA will assist in the RFP application review/selection process and assist when needed for implementation. Another community-based treatment need is funding/financial assistance for individuals that are under/un-insured to obtain assistance with medication-assisted treatment. FFDA will be continue to meet this need in FY19/20 by providing funding to provide financial assistance to those that meet the funding and clinical eligibility criteria. 5. Access to and Use of Narcan in County: Include what entities have access to Narcan, any training or education done by the SCA and coordination with other agencies to provide Narcan. Intra-nasal naloxone is available to both professionals as well as the general community in Franklin County without a prescription due to the current standing order status in which the medication has been made available. FFDA provides overdose response/naloxone administration training, known as “Operation Save A Life” (OSAL) to anyone that wishes to attend, free of charge. Individuals that are residents of Franklin County are eligible to receive a free dose of intra-nasal naloxone upon completion of the OSAL training. Trainings occur monthly in various geographic areas within Franklin County for easy accessibility. FFDA provides funding to contract with Healthy Communities Partnership (HCP) to deliver the majority of the community-based trainings. The SCA completes OSAL trainings for professionals as well as County of Franklin employees. Residents that wish to purchase the medication can do so at any Franklin County pharmacy, as 100% of them are carrying/dispensing the medication. Naloxone is also available and used by county first responders. Each of the six (6) law enforcement agencies in Franklin County are also carrying/administering intra-nasal naloxone. In FY17/18, FFDA began serving as the Centralized Coordinating Entity (CCE) through PCCD to provide free intra-nasal naloxone to agencies/organizations that serve as first responders in the county. Current partners include agencies within the following categories: EMS/BLS/ALS, Fire & Rescue, Treatment Providers, Prevention Providers, Recovery Houses, Wilson College, Penn State Mont Alto, Mental Health Association, Children & Youth Services, Juvenile Probation Office, Adult Probation Office, Hotels/Motels, Public School Districts (Nurses), South Central Community Action Council and the Private K-12 School Sector. FFDA will continue to serve as the CCE in FY19/20 as the project is a two-year project and will look to expand to offer Leave Behind Kits for EMS/BLS/ALS units that wish to participate. 60 DHS Bulletin 2018-1 County Human Services Plan Guidelines 6. County Warm Handoff Process: Provide a brief overview of the current warm handoff protocols established by the county. Include information on any challenges with implementation. Replaces ASAM Training section from 18-19 Plan guidelines Warm Handoff Data: Number Served 49 Number Entering 18 Treatment Number Completing unknown Treatment The reported figures are based upon the number of individuals that FFDA provided Warm Hand Off services to in FY18/19 (7/1/18 – 4/30/19) Franklin County’s Warm Hand Off process is the primary model to address overdose survivors’ linkages to treatment. It is implemented in two out of the two hospital emergency room departments (Chambersburg Hospital and Waynesboro Hospital) in the county; however, each set of protocols as well as resources look differently due to the lack of financial resources to support the process. FFDA is able to supply one full-time case management specialist to the Chambersburg Hospital to complete assessments, make appropriate level of care treatment placements and provide case management services to individuals entering through the Chambersburg ER onsite. Waynesboro Hospital utilizes FFDA to make referrals for a case manager or recovery support specialist (both current FFDA employees) to come onsite to provide assessments, placements and case management services. FFDA received approval to provide tele-conferencing for the case manager to complete the level of care assessments from Chambersburg Hospital to individuals receiving care at Waynesboro Hospital. FFDA needed to obtain a waiver from the Department of Drug & Alcohol Programs (DDAP) in order to engage in the practice to provide assessments and was granted the waiver to do so. FFDA works collaboratively with both hospital systems to leverage resources and to also offer these services to any individual that presents as needing substance use disorder treatment; however, overdose survivors are a prioritized population within this process. FFDA will be entertaining ways to extend the warm hand off process to EMS/first responders through the county’s Overdose Task Force in FY19/20 as a strategic plan goal. Please identify Challenges with Warm Handoff Process Implementation: Listed below are some of the Warm Hand Off process challenges and barriers for Franklin County: 1. The Warm Hand Off process was mandated by the Department of Drug & Alcohol Programs (DDAP) for Single County Authorities to develop a best-fit model for each Emergency Room within our jurisdiction. The primary focus of this mandate is opioid overdose survivors. Franklin County’s Emergency Rooms encounter admissions for this target population; however, the predominant population we encounter are non-opioid overdoses in this setting. We collect this data locally, however, DDAP excludes this data from their Warm Hand Off reports/data. We have aimed to build a model that addresses any overdose that presents through the Emergency Room versus one specific substance type. 2. The Warm Hand Off is an unfunded mandate for Single County Authorities. SCAs are able to use current funds to support the process; however, new/additional funding has not been provided. In participating in this process, we have discovered that best outcomes (engagement into treatment directly from the ER) are generated from utilizing Certified 61 DHS Bulletin 2018-1 County Human Services Plan Guidelines Recovery Specialists (CRS) to assist the client in engaging in treatment. Additional funds provided at the local level could provide a model that pays for CRS’s time versus using exciting staff. 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 fields and dropdowns to describe how the county intends to utilize HSDF funds on allowable expenditures (please refer to the HSDF Instructions and Requirements for more detail). Dropdown menu may be viewed by clicking on “please choose an item”. Copy and paste the template for each service offered under each categorical, ensuring each service aligns with the service category when utilizing Adult, Aging, Children and Youth, or Generic Services. Adult Services: Please provide the following: Program Name: Description of Services: Service Category: Please choose an item. No services are funded through the block grant. Aging Services: Please provide the following: Program Name: Description of Services: Service Category: Please choose an item. No services are funded through the block grant. Children and Youth Services: Please provide the following: Program Name: Description of Services: Service Category: Please choose an item. No services are funded through the block grant. Generic Services: Please provide the following: Program Name: Information and Referral (I&R) 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 Franklin County. The I&R department is also the contact point for PA 211 coordination. In addition, I&R serve as the local Connect to Home Coordinated Entry Systems Access Center as a secondary option to the 211 system for those who are seeking housing services. This process allows individuals to be triaged, prescreened, and assessed through HMIS so that appropriate services can assist in helping the individual achieve permanent housing successfully. 62 AdultHAPIDMHSUDCYSAging DHS Bulletin 2018-1 County Human Services Plan Guidelines Service Category: Information & Referral - The direct provision of information about social and other human services, to all persons requesting it, before intake procedures are initiated. The term also includes referrals to other community resources and follow-up. Please indicate which client populations will be served (must select at least two): Specialized Services: Please provide the following: (Limit 1 paragraph per service description) Program Name: Description of Services: No services are fnded through the block grant. Interagency Coordination: (Limit of 1 page) If the county utilizes funds for 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 both:  how the funds will be spent (e.g. salaries, paying for needs assessments, etc.).  how the activities will impact and improve the human services delivery system. Franklin County Human Services Training Days is a 1 day event, held in October and April of each year, as a format to provide up-to-date training for those who serve in the human services profession. The participants who attend, are from a wide array of human services agencies, faith-based organization, not-for-profits, and medical programs and range from case managers, to support staff, to directors and administrators. Our goal is to provide them with quality professional training that will enhance their skills, increase their professional development, and ensure that they are aware of the current trends in their profession. From the information they receive, agencies and staff can use the new tools as a way to take their existing and new programs and strengthen the delivery of the service. The event is held at the Rhodes Grove Conference Center, which is located in Chambersburg, Pennsylvania. The site is chosen because of the unique ability to provide space for 200 – 250 individuals to attend. All training is provided at no cost to those who are a part of the human services community. The Franklin County Human Services Training Days format provides the opportunity for individuals to learn from several different areas in the field of human services. The event is kicked off by having a Keynote Speaker, who will present for an hour. Afterwards individuals will attend one of the four 1.25 hour sessions/presentations that are occurring. A total of 12 session/presentations are held over the course of the one day. These sessions depending on the topics, are aslo established as a Continueing Education Credits for those in the social work field. Individuals are given the opportunity to register for the specific classes that they feel they will benefit most from. From this, we can expect approximately 20-50 participants for each session, unless there is a request for a limit due to the nature of the presentation. These sessions will cover areas of topics that relate to Veterans/Military, the Aging Community, Mental Health, Early Intervention, Intellectual Disabilities, Services to Children, as well as ways to take care of ourselves as the human service 63 DHS Bulletin 2018-1 County Human Services Plan Guidelines professionals. If funding becomes available, the exepenses associated with this event will be for the facility’s fees, trainers and supplies. Franklin County Intro to Human Services is a second training event that provides individuals the ability to become educated directly on the specific services that the Franklin County Human Services Administration departments offer to the residents of Franklin County. The event is open to the first 40 who register to attend. There is no cost associated with this training. Individuals are given an overview of each of the departments and how their services are able to benefit those in the Franklin County community. The session is held twice a year. The participants are from a wide array of human service agencies, faith-based organization, not-for-profits, and medical programs and range from case managers, to support staff, to directors and administrators who will be in attendance. Other HSDF Expenditures – Non-Block Grant Counties Only If you plan to utilize HSDF for Mental Health, Intellectual Disabilities, Homeless Assistance, or Substance Use Disorder, please provide a brief description of the use and complete the chart below. Only HSDF-allowable cost centers are included in the dropdowns. Category Allowable Cost Center Utilized Mental Health Intellectual Disabilities Homeless Assistance Substance Use Disorder Note: Please refer to Planned Expenditures directions at the top of Appendix C-2 for reporting instructions (non-block grant counties only). 64 DHS Bulletin 2018-1 County Human Services Plan Guidelines Appendix D Eligible Human Services Cost Centers Mental Health For further detail refer to Cost Centers for County Based Mental Health Services Bulletin (OMHSAS-12-02), effective July 1, 2012. Administrative Management Activities and administrative functions undertaken by staff in order to ensure intake into the county mental health system and the appropriate and timely use of available resources and specialized services to best address the needs of individuals seeking assistance. Administrator’s Office Activities and services provided by the Administrator’s Office of the County Mental Health (MH) Program. Adult Development Training (ADT) Community-based programs designed to facilitate the acquisition of prevocational, behavioral activities of daily living, and independent living skills. Assertive Community Treatment (ACT) Teams and Community Treatment Teams (CTT) ACT is a SAMHSA-recognized Evidence Based Practice (EBP) delivered to individuals with Serious Mental Illness (SMI) who meet multiple specific eligibility criteria such as psychiatric hospitalizations, co-occurring mental health and substance use disorders, being at risk for, or having a history of criminal justice involvement, and at risk for, or having a history of homelessness. CTT services merge clinical, rehabilitation and support staff expertise within one delivery team. Children’s Evidence Based Practices Practices for children and adolescents that by virtue of strong scientific proof are known to produce favorable outcomes. A hallmark of these practices is that there is sufficient evidence that supports their effectiveness. Children’s Psychosocial Rehabilitation Services Activities designed to assist a child or adolescent (e.g., a person aged birth through 17, or through age 21 if enrolled in a special education service) to develop stability and improve capacity to function in family, school and community settings. Services may be delivered to the child or adolescent in the home, school, community or a residential care setting. Community Employment and Employment Related Services Employment in a community setting or employment-related programs, which may combine vocational evaluation, vocational training and employment in a non-specialized setting such as a business or industry. Community Residential Services Care, treatment, rehabilitation, habilitation, and social and personal development services provided to persons in a community based residential program which is a DHS-licensed or approved community residential agency or home. 65 DHS Bulletin 2018-1 County Human Services Plan Guidelines Community Services Programs and activities made available to community human service agencies, professional personnel, and the general public concerning the mental health service delivery system and mental health disorders, in order to increase general awareness or knowledge of same. Consumer-Driven Services Services that do not meet the licensure requirements for psychiatric rehabilitation programs, but which are consumer-driven and extend beyond social rehabilitation services. Emergency Services Emergency related activities and administrative functions undertaken to proceed after a petition for voluntary or involuntary commitment has been completed, including any involvement by staff of the County Administrator’s Office in this process. Facility Based Vocational Rehabilitation Services Programs designed to provide paid development and vocational training within a community- based, specialized facility (sheltered workshop) using work as the primary modality. Family-Based Mental Health Services Comprehensive services designed to assist families in caring for their children or adolescents with emotional disturbances at home. Family Support Services Services designed to enable persons with serious mental illness (SMI), children and adolescents with or at risk of serious emotional disturbance (SED), and their families, to be maintained at home with minimal disruption to the family unit. Housing Support Services Services provided to mental health consumers which enable the recipient to access and retain permanent, decent, affordable housing, acceptable to them. Mental Health Crisis Intervention Services Crisis-oriented services designed to ameliorate or resolve precipitating stress, which are provided to adults or children and their families who exhibit an acute problem of disturbed thought, behavior, mood or social relationships. Other Services Activities or miscellaneous programs which could not be appropriately included in any of the cited cost centers. Outpatient Treatment-oriented services provided to a consumer who is not admitted to a hospital, institution, or community mental health facility for twenty-four hour a day service. Partial Hospitalization Non-residential treatment services licensed by the Office of Mental Health & Substance Abuse Services (OMHSAS) for persons with moderate to severe mental illness and children and adolescents 66 DHS Bulletin 2018-1 County Human Services Plan Guidelines with serious emotional disturbance (SED) who require less than twenty-four hour continuous care but require more intensive and comprehensive services than are offered in outpatient treatment. Peer Support Services Refers specifically to the Peer Support Services which meet the qualifications for peer support services as set forth in the Peer Support Services Bulletin (OMHSAS 08-07-09), effective November 1, 2006. Psychiatric Inpatient Hospitalization Treatment or services provided an individual in need of twenty-four hours of continuous psychiatric hospitalization. Psychiatric Rehabilitation Services that assist persons with long-term psychiatric disabilities in developing, enhancing, and/or retaining: psychiatric stability, social competencies, personal and emotional adjustment and/or independent living competencies so that they may experience more success and satisfaction in the environment of their choice, and can function as independently as possible. Social Rehabilitation Services Programs or activities designed to teach or improve self-care, personal behavior and social adjustment for adults with mental illness. Targeted Case Management Services that provide assistance to persons with serious mental illness (SMI) and children diagnosed with or at risk of serious emotional disturbance (SED) in gaining access to needed medical, social, educational, and other services through natural supports, generic community resources and specialized mental health treatment, rehabilitation and support services. Transitional and Community Integration Services Services that are provided to individuals who are residing in a facility or institution as well as individuals who are incarcerated, diversion programs for consumers at risk of incarceration or institutionalization, adult outreach services, and homeless outreach services. Intellectual Disabilities Administrator’s Office Activities and services provided by the Administrator’s Office of the County ID Program. The Administrator’s Office cost center includes the services provided relative to the Administrative Entity Agreement, Health Care Quality Units (HCQU) and Independent Monitoring for Quality (IM4Q). Case Management Coordinated activities to determine with the individual what services are needed and to coordinate their timely provision by the provider and other resources. Community Residential Services Residential habilitation programs in community settings for individuals with intellectual disabilities. 67 DHS Bulletin 2018-1 County Human Services Plan Guidelines Community Based Services Community-based services are provided to individuals who need assistance in the acquisition, retention, or improvement of skills related to living and working in the community and to prevent institutionalization. Other Activities or miscellaneous programs which could not be appropriately included in any of the cited cost centers. Homeless Assistance Program Bridge Housing Transitional services that allow individuals who are in temporary housing to move to supportive long-term living arrangements while preparing to live independently. Case Management Case management is designed to provide a series of coordinated activities to determine, with each individual, what services are needed to prevent the reoccurrence of homelessness and to coordinate their timely provision by administering agency and community resources. Rental Assistance Provides payments for rent, mortgage arrearage for home and trailer owners, rental costs for trailers and trailer lots, security deposits, and utilities to prevent and/or end homelessness or possible eviction by maintaining individuals and families in their own residences. Emergency Shelter Refuge and care services to persons who are in immediate need and are homeless; e.g., have no permanent legal residence of their own. Innovative Supportive Housing Services Other supportive housing services outside the scope of existing Homeless Assistance Program components for individuals and families who are experiencing homelessness 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. Substance Use Disorder Care/Case Management A collaborative process, targeted to individuals diagnosed with substance use disorders or co- occurring psychiatric disorders, which assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual’s health needs to promote self-sufficiency and recovery. Inpatient Non-Hospital Inpatient Non-Hospital Treatment and Rehabilitation A licensed residential facility that provides 24-hour professionally directed evaluation, care, and treatment for individuals with substance use disorder in acute distress, whose addiction 68 DHS Bulletin 2018-1 County Human Services Plan Guidelines symptomatology is demonstrated by moderate impairment of social, occupation, and/or school functioning. Rehabilitation is a key treatment goal. Inpatient Non-Hospital Detoxification A licensed residential facility that provides a 24-hour professionally directed evaluation and detoxification of an individual with a substance use disorder. Inpatient Non-Hospital Halfway House A licensed community based residential treatment and rehabilitation facility that provides services for individuals to increase self-sufficiency through counseling, employment and other services. This is a live in/work out environment. Inpatient Hospital Inpatient Hospital Detoxification A licensed inpatient health care facility that provides 24-hour medically directed evaluation and detoxification of individuals diagnosed with substance use disorders in an acute care setting. Inpatient Hospital Treatment and Rehabilitation A licensed inpatient health care facility that provides 24-hour medically directed evaluation, care and treatment for individuals with substance use disorder with co-existing biomedical, psychiatric and/or behavioral conditions which require immediate and consistent medical care. Outpatient/Intensive Outpatient Outpatient A licensed organized, non-residential treatment service providing psychotherapy and substance use/disorder education. Services are usually provided in regularly scheduled treatment sessions for a maximum of five hours per week. Intensive Outpatient An organized non-residential treatment service providing structured psychotherapy and stability through increased periods of staff intervention. Services are provided in regularly scheduled sessions at least three days per week for at least five hours (but less than ten). Partial Hospitalization Services designed for those individuals who would benefit from more intensive services than are offered in outpatient treatment projects, but do not require 24-hour inpatient care. Treatment consists of the provision of psychiatric, psychological and other types of therapies on a planned and regularly scheduled basis at least three days per week with a minimum of ten hours per week. Prevention The use of social, economic, legal, medical and/or psychological measures aimed at minimizing the use of potentially addictive substances, lowering the dependence risk in susceptible individuals, or minimizing other adverse consequences of psychoactive substance use. Medication Assisted Therapy (MAT) Any treatment for opioid addiction that includes a medication approved by the U.S. Food and Drug Administration for opioid addiction detoxification or maintenance treatment. This may include methadone, buprenorphine, naltrexone, or vivitrol. 69 DHS Bulletin 2018-1 County Human Services Plan Guidelines Recovery Support Services Services designed and delivered by individuals who have experience with substance-related disorders and recovery to help others initiate, stabilize, and sustain recovery from substance abuse. These services are forms of social support not clinical interventions. This does not include traditional 12 step programs. Recovery Specialist An individual in recovery from a substance-related disorder that assists individuals in gaining access to needed community resources to support their recovery on a peer to peer basis. Recovery Centers A location where a full range of Recovery Support Services are available and delivered on a peer to peer basis. Recovery Housing A democratically run, self-sustaining and drug-free group home for individuals in recovery from substance related disorders. Warm Handoff Direct transfer of overdose survivor from Emergency Department to drug treatment provider. Human Services Development Fund Administration Activities and services provided by the Administrator’s Office of the Human Services Department. Interagency Coordination Planning and management activities designed to improve the effectiveness of county human services. Adult Services Services for adults (a person who is at least 18 years of age and under the age of 60, or a person under 18 years of age who is head of an independent household) include: adult day care, adult placement, chore, counseling, employment, home delivered meals, homemaker, housing, information and referral, life skills education, protective, service planning/case management, transportation, or other service approved by DHS. Aging Services for older adults (a person who is 60 years of age or older) include: adult day service, assessments, attendant care, care management, congregate meals, counseling, employment, home delivered meals, home support, information and referral, overnight shelter, personal assistance service, personal care, protective services, socialization/recreation/education/health promotion, transportation (passenger), volunteer services or other service approved by DHS. Children and Youth Services for individuals under the age of 18 years; under the age of 21 years who committed an act of delinquency before reaching the age of 18 years or under the age of 21 years who was adjudicated dependent before reaching the age of 18 years and while engaged in a course of 70 DHS Bulletin 2018-1 County Human Services Plan Guidelines instruction or treatment requests the court to retain jurisdiction until the course has been completed and their families include: adoption services counseling/intervention, day care, day treatment, emergency placement services, foster family services (except room & board), homemaker, information and referral, life skills education, protective and service planning. Generic Services Services for individuals that meet the needs of two or more populations include: adult day care, adult placement, centralized information and referral, chore, counseling, employment, homemaker, life skills education, service planning/case management, and transportation services. Specialized Services New services or a combination of services designed to meet the unique needs of a specific population that are difficult to meet with the current categorical programs. 71