John Ingram, MA, Joan B. Beasley, Ph.D., Ann Klein, MA
In the summer of 2004, leaders of several public and private child-serving organizations in Hamilton County (Greater Cincinnati area) Ohio embarked on a community-wide effort to improve local services for children and adolescents with co-occurring developmental and mental health disorders. The group identified this population as one of the largest currently served in facilities outside the county at a substantial cost, both financially and emotionally, to the community and to the families and children.
While there are providers in the community offering quality services to both the mental health and the DD populations, there is currently no comprehensive model of care for children with these co-occurring diagnoses in Hamilton County. Many of these children are subjected to a chronic cycle of inpatient psychiatric hospitalizations, multiple school suspensions, arrests, or out-of-home placements in a system that is not prepared to service them.
With the goal of addressing this lack of local system capacity, the group, now known as the DD/MH Partnership for Children used a planning grant awarded by the Health Foundation of Greater Cincinnati to develop a comprehensive, outcome-based practice model that offers a full range of therapeutic care, supports and services to promote individual and family success for these children and their families within the community.
The Partnership chose models that are based on systems linkages among coordinated services in a full wraparound continuum. The START model (Systematic Therapeutic, Assessment, Respite and Treatment) found in multiple venues throughout the United States, is based upon a primary philosophy of maintaining a systematic collaborative approach to individuals with co-occurring diagnoses. The Interface Program, Hamilton Countys own pioneer in co-occurring diagnosis, training, and consultation, earned national recognition, and in its initial, more comprehensive form, served as an early model for START and similar programs. Finally, the Judevine Center for Autism in Missouri has successfully provided in-home coaching, school supports and residential services.
These three outcome-based models, taken together, feature the coordination of three vital core therapeutic elements: assessment, crisis support/coaching, and planned therapeutic respite services. Within the framework of these three elements the Partnerships pilot will include the following features: collaborative community consultation, frequent team meetings with all partners, emergency and planned therapeutic respite, clinical best practice comprehensive assessment, development of behavioral treatment and crisis plans, parent and provider technical assistance and consultation, in-home coaching, school supports, and residential services. All providers in the Partnership will be trained in both a co-occurring diagnosis curriculum as well as each individuals specific intervention plan, in order to guarantee consistency of care for each person across all environments.
This demonstration project represents a major systemic change for both individual providers and local systems. Ohio has a system of local funding through voter-approved tax levies. In Hamilton County there are separate levies for Mental Health, MRDD, and Child Welfare. This separation of funding can be a barrier to working collaborative. Additional barriers include different legal mandates, different terminology, and different clinical expertise. Close collaboration between two public systems (mental health and developmental disabilities) to serve this population, both within and beyond this pilot project is a significant challenge. The state has already established a collaborative model through their DD/MH interagency agreement, but the local systems must work together to realize this potential in Hamilton County.
Ultimately, we are confident that our design will be an attractive alternative to the present inadequate system, both in terms of cost to the system and outcomes for families.
For further information, please contact:
Director of Outcomes and Evaluations, Hamilton Choices
The US Public Policy Update is an ongoing column in the NADD Bulletin. We welcome your comments and submissions for this column. To learn more or to contribute to this column you may contact Joan Beasley, Editor of the U.S. Public Policy Update and Chairperson of the U.S. Public Policy Committee, at email@example.com.