Ohio SCIP Application

Ohio Project Plan

 

As the State Administering Agency for the Byrne State Crisis Intervention Program (SCIP) grant number15PBJA-23-GG-00027-BSCI, the Ohio Office of Criminal Justice Service (OCJS) has been facilitating the meetings required of the Crisis Intervention Advisory Board (hereinafter CIAB or Board) for SCIP planning.

Behavioral Health Deflection programs:

Assertive Community Treatment (ACT) and/or Forensic Assertive Community Treatment (FACT)
Mobile Crisis Response programs
Crisis Intervention Teams and Training
Sequential Intercept Mapping

Specialized court-based programs:

Court technology
Specialized court-based programs (i.e. specialized dockets)
Sequential Intercept Mapping

Evaluation and Research

 

In addition to the previously approved projects, the CIAB has reviewed and approved the following projects for submission to BJA in the categories listed above.

 

  

Behavioral Health Deflection Programs

 

Mobile Crisis Teams (MCTs)

MCTs are groups of mental health professionals who respond to calls for service at the request of law enforcement as well as calls from community members or their families and friends. The Ohio CIAB has approved funding for ten Mobile Crisis Response Team projects and BJA has already approved six with the remaining four submitted herein.  Those MCTs cover twenty-one counties in Ohio with the goal of providing community-based services to decrease arrests of mentally ill individuals. The teams focus on de-escalation, stabilization, assessment, and treatment to those in crisis. The teams are composed of licensed therapists and/or psychiatrists, available 24/7, and open to any individual of all ages for urgent intervention.

 

Goal: To provide new or expanded in-person mental health (MH) services to those in crisis and at risk of harm to self or others.

 

Projects to meet this goal include:

 

Mental Health Recovery Board (MHRB) of Clark, Greene &Madison Counties

The increase in the need for mental health and substance use disorder treatment has grown significantly in the past several years in the city of Springfield, Ohio, located in Clark County. Contributing factors include inadequate crisis services, especially those available between 5pm and midnight, lack of alternatives to calling 911 emergency services, a lack of community and social supports for those struggling with untreated mental health conditions or substance use disorders.

 

This area has a higher number of adults with frequent mental distress (18.8%) than both the State of Ohio (16.8%) and the United States (15.8%). Of significant concern is the ranking of 90.1% for Deaths of Despair, when compared with Ohio – 61.8% and the U.S. at 47.5%. Data from the Ohio Department of Mental Health and Addiction Services shows that 23.3 percent of children within the county have had experience living with someone who was mentally ill, suicidal or severely depressed. This figure is significantly higher than the other two counties in the board’s catchment area. The Springfield Fire Rescue Division shared statistics from April of 2023 through March of 2024 showed that almost 13% of their calls were classified as mental health or substance use related calls, including: suicidal ideation, suicide attempts, anxiety, behavioral health, etc.

 

Efforts to increase understanding of MH and local access to related services resulted in expanding the Mental Health Recovery Board’s CIT training - included a broad definition of first responders, including EMTs, firefighters and dispatchers. A review of available data and anecdotal information showed that those persons experiencing a mental health or substance abuse crisis were transported to emergency departments or to jail with either option opening the door to less than desirable outcomes for the individual. The Mental Health Recovery Board, Mental Health Services and the Springfield Fire Rescue Division developed a steering committee and began discussing the need for a mobile crisis responder within the fire department in 2023. The committee focused on the SAMHSA Crisis Tool Kit as they established the foundation for their Mobile Crisis Response Team (MCRT). A mobile crisis worker was hired by Mental Health Services and after onboarding with this agency she began working alongside the EMS staff with Springfield Fire Rescue Division.

 

The MHRB project proposes to expand the current MCRT, to include a 3 pm to midnight shift. The two Mobile Crisis Responders schedules will overlap by two hours for documentation and shift change debriefing. In between crisis calls, MCRT staff would conduct outreach for calls completed outside their scheduled shifts to ensure connection with resources within the continuum of care. Enhanced training will also be provided to first responders on topics such as de-escalation, QPR, and other topics that would increase understanding and development of skills in the management of behavioral health related crisis. 

 

An acute detox facility is being established in Springfield which will allow needed services without causing strain on the currently overloaded hospital system. A local hospital is working to develop a Paramedicine position within the Springfield Fire Rescue Division, which would complement the existing Mobile Crisis Repose Team. Mental Health Services is looking to add a crisis stabilization unit to their existing continuum which includes an inpatient mental health unit. The MMHRB proposes to use funds to contract with a certified mental health provider to hire an additional full-time Mobile Crisis Responder. Both Mobile Crisis Responder positions will be supervised by an individual through Mental Health Services who possesses the appropriate licensure to provide such services.

 

Paint Valley Alcohol Drug Addiction and Mental Health Board (PVADAMH)

According to the Paint Valley Crisis System Assessment and Recommendations, reported by PVADAMH and TBD Solutions in 2022, mobile crisis services are not available in any of the PVADAMH region’s counties for adults or youth. Presently, individuals experiencing a behavioral health crisis in the region must present to the emergency department or PVMHC’s crisis center in Ross County.

 

Currently, the PVADAMH Board services a population of 235,573 residents among the 5 counties in their service area which includes Fayette, Highland, Pike, Pickaway, and Ross Counties. According to the Ohio Department of Health’s 2021 Suicide Demographics and Trends report, the age-adjusted rate for suicide deaths in Ohio from 2017 - 2021 is 14.8 per 100,000 population. Three of the five counties in the PVADAMH Board region exceeded Ohio’s rate for suicide fatalities which include Pike (23.4), Ross (16.1), and Pickaway (15.8). According to Ohio Department of Health’s 2020 Drug Overdose Fatality Data report, the age-adjusted rate of unintentional drug overdose deaths for Ohio for 2015-2020 is 37.4 per 100,000 population. Three of the five counties in the PVADAMH Board region exceed Ohio’s rate for unintentional overdose fatalities which include Pike (54.7), Fayette (53.4), and Ross (52.8). According to Ohio’s Behavioral Health Crisis Systems Landscape Analysis 2023, none of the 5 counties located in the PVADAMH region have a Crisis Residential Facility.

 

By providing community-based intervention, mobile crisis teams afford individuals the opportunity to receive behavioral health stabilization and assessment in their lived environment. Once a mobile crisis team has helped to stabilize the individual and conduct an assessment, the team coordinates follow-up care. A mobile crisis team will connect the individual to a service provider in the community, and when possible, complete a warm handoff to ensure a smooth transition of care. The goal of this project is to enhance the mobile response program in Paint Valley with an independently licensed therapist Crisis Counselor to provide faster response times and ensure improved services across the region. This individual would work the day or afternoon shift. Part of the job would be to cultivate relationships with local police departments. This trained crisis responder would also do some community-based education regarding the services available and respond to behavioral health crisis needs at the local hospital emergency department, schools, homes, workplaces, and other community settings.

 

            The project start date is July 1, 2024 and end date is June 30, 2026. The project is in             the BJA Required Local Pass-through (Less than $10,000) local funding purpose area.

 

Athens-Hocking-Vinton Alcohol, Drug Addiction and Mental Health Services Board

In 2019, frequent meetings began regarding the current crisis system of care and how to augment it.  Initial meetings included leadership of the AHV 317 ADAMHS Board (317 Board) and Hopewell Health Centers (HHC) – the lead agency for crisis services in the board region – then expanded to include local law enforcement and emergency medical services. Input was collected from the long-standing Jail Diversion Advisory Board (JDAB) which consists of regional law enforcement, judges, jail and emergency room personnel, and clinicians.  In 2020, the Hocking County Crisis System of Care group was established which mirrored the JDAB but focused on issues specifically to Hocking County.  

 

The crisis planning committee focused on expansion of the crisis line to include a partnership with 911 and Lifeline and careline certifications for 988 integration and implementation and a mobile crisis unit pilot in conjunction with the Athens County Emergency Management Team (EMS).  The mobile crisis unit pilot was deployed in mid-2021 but limited to a 9 AM to 5 PM schedule from Monday to Friday and within Athens County only.  

 

Since that time, ongoing meetings continue to identify system of care strengths, weaknesses, opportunities, and threats, as well as identifying data markers to aid in monitoring the program.  

 

In the fall of 2023, the AHV Board applied for and received funding through the OhioMHAS ARPA Investment in Ohio’s Crisis Continuum to support development of a Crisis Landscape Assessment by TBD Solutions and funding to support quality improvements at OhioHealth O’Bleness Hospital emergency department where 65% of all crisis prescreen assessments take place.

 

On January 2, 2024, OhioHealth/O’Bleness Hospital transitioned crisis prescreens to in-house reviews in lieu of utilizing HHC for this service. This transition allows for a shift in roles and responsibilities within the HHC crisis team to focus on diversion and stabilization programs with local law enforcement and within the community. 

 

There were 2481 mental health crisis prescreens conducted by HHC in Calendar Year 2023. 95% (n=2366) were standard prescreens that occurred in local emergency departments (73%), jails (19%), and mental health clinics (7%). Only 5% (n=114) of the crisis prescreens were conducted by the mobile crisis unit. The fledgling numbers are attributed to work force, limited hours, the current process. and transportation.

 

Regarding prescreen dispositions, 59% (n=1391) of standard prescreens returned to the community where only 48% (n=55) of the mobile crisis response remained in community and 37% (n=42) were diverted to EDs. 41% (n=972) of standard prescreens were placed in psychiatric hospitals after medical clearance and mobile crisis was able to directly admit 9 individuals to psychiatric hospitals, by-passing medical clearance in the ED.  Direct access to the local mental health rehabilitation center (Adam-Amanda) was minimal but mobile crisis had more success with 6 admits than standard prescreens at 3 admits. Two (2) mobile crisis responses required intervention from law enforcement.

 

The mobile crisis pilot is well-received by community and has buy-in from Athens County EMS but the current model is not cost effective for expansion into the rural areas of Hocking and Vinton Counties.  The data noted above reflects program limitations related to hours, the current process. and transportation. Direct admits by-pass the costly process of ED visits for medical clearance but at the cost of response volume.  The current process relies on a single team from beginning to end in a rural area of the state.  Transportation to in-patient care adds a minimum of four hours to a single call. The cost-savings at the consumer end requires a costly approach on the administrative side and reduces availability of the team.  

 

Opportunities for expansion are incurred by OhioHealth/O’Bleness moving prescreens in-house. This allows HHC to restructure current crisis team for more community in-reach and provide backup to current mobile crisis team. Reviewing the possibility of leveraging technology (iPads) to provide law enforcement with direct clinical access in the field and integrating with MRSS become more viable with the constraints of spending the majority of time within the OhioHealth O’Bleness ED. 

 

In 2022, HHC implemented a Mobile Response Stabilization Service (MRSS) in Vinton County and expanded services to Hocking County in 2023. MRSS served 29 individuals in CY2023 and expressed interest in: 1) expanding to Athens County, and 2) integrating with adult mobile crisis. The opportunities involve a strong child service system that values coordination will work well with managing MRSS-referred clients after MRSS services are provided. The challenges are the workforce and ensuring the size and composition of the team can meet area needs. Vinton county has seen steady referrals while Hocking has been rather low. Moving into Athens on a consistent basis and providing the service 8a-8p weekdays will be a challenge to the current team structure, and the number of referrals may not justify an additional team. This is where integrating with adult mobile crisis may be a valuable way to leverage current resources.

 

Given the above data, the AHV Board wants to develop an integrated, trauma-informed, welcoming and responsive crisis system that addresses both mental health and substance use crises and that offers a range of options to provide the most efficient and responsive care aligned to the nature of the presenting crisis – a comprehensive approach that provides: 

 

1.  Someone to Talk to— 988 fully staffed 24/7 with clinicians to de-escalate and guide individuals to the right services for their needs.

2.  Someone to Respond—telehealth support for first responders and MRSS for youth and adults Monday thru Friday from 8 AM to 8 PM.

3.  A place to Stabilize—in the community with a safety plan and follow-up supports, admission to Adam-Amanda Rehabilitation Center or admission to an emergency department with transfer to inpatient care.

4.  An opportunity to Thrive with excellent after-care and step-down supports until hand-off to on-going services.

 

In the AHV Board region, the project will provide greater outreach and enhance existing programs by providing additional services. HHC has implemented MRSS teams and Vinton and Hocking counties with plans to expand to Athens. The MRSS is a low-barrier mobile crisis model with crisis broadly defined as whatever the person/family view as a crisis.  The model provides timely response, access to follow-up supports and 4-6 weeks of follow-up support to make sure the presenting issue has been addressed.  This comprehensive, “upstream”, low-barrier model with follow-up would also be beneficial to adults.  In rural communities with relatively low-volume and sparse resources, the efficiency of a combined youth/adult MRSS model with staff who are cross-trained is another opportunity.

The Mobile Crisis and Mobile Response and Stabilization Services (MRSS) enhancements will include   after-hour services, greater use of the Adam-Amanda Crisis Rehabilitation Center, integration with 911 and 988, and focus on transportation solutions.

    

The project budget is $174,938.39, which includes personnel, equipment, travel, and supplies. The project start date is April 8, 2024 and end date is September 30, 2026. The project is in the BJA Required Local Pass-through (Direct) local funding purpose area and was approved by the CIAB on July 19, 2024.

 

Huron County Sheriff's Office

Over the past decade, Huron County has experienced consistently high levels of behavioral health related calls through 911 and individuals presenting to local emergency departments, leading to a variety of challenges for EMS, healthcare, law enforcement, and residents of Huron County.

The Huron County Jail often serves as the primary behavioral health provider in county as individuals are arrested and placed in jail who would be better served in a behavioral health facility. Approximately 80% of individuals in the jail have a behavioral health diagnosis with the majority of those having a substance use disorder. Increased arrests for behavioral health related issues contributes to overutilization of the jail as a behavioral health facility, while in many instances those individuals could be diverted to a certified treatment facility.

Huron County has implemented a variety of services over the past five years to help address the increasing numbers including:

• Quick Response Team: responds within 72 hours of an overdose

• Mobile Response and Stabilization Services: specific to youth and families

• CIT trainings for law enforcement

• Warm Handoff services: peer supporter responds to emergency room 24/7 for individuals in SUD crisis who are willing to go to treatment

• ALERT (Area Law Enforcement Recovery Team) where individuals with SUD who are interested in getting help can present to a local law enforcement agency 24/7 and be linked with a peer supporter

• 7 Project DAWN locations throughout the county

• Naloxone leave behind program with Fire/EMS

• Increased outreach and engagement to share resources

• Substance use peer support

 • Expansion of Medication Assisted Treatment

• Expansion of outpatient treatment services

 

Despite the implementation of the above-mentioned services, there hasn’t been a decrease in the number of behavioral health calls through 911 or individuals presenting to emergency departments for a behavioral health crisis. 911 behavioral health related data from 2022 and 2023 shows most of individuals experiencing behavioral health crises in Huron County are between the ages of 18 and 65, with the second largest age category being youth under the age of 18. The calls are close to evenly split between male and female, with 142 calls for females and 140 calls for males. Most of the calls occurred in Norwalk, the largest community in Huron County, with the second largest amount occurring in Willard which is the second largest community in Huron County.

 

A Crisis Response Committee was convened to discuss the needs and identify potential solutions. The committee determined that the implementation of a mobile crisis team (MCRT) would help address many of the issues listed above, reducing the strain on public safety, public health and residents. MCRT services will be available at no cost to all Huron County residents and the team will initially operate from 9am to 5pm, with the goal of expanding hours once established. MCRT anticipates serving at least 700 individuals in the first year.

 

The project will fill a gap in needed services through the implementation of a mobile response team, a community response pathway of diversion, which will respond to both mental health and substance use calls in the community. The team implementing MCRT in Huron County is Connections Recovery Services. Connections Recovery Services is a non-profit organization that was formed January 1, 2024.

For the past 2 years, the team has been operating under the umbrella of NAMI Northwest, showing marked improvements in the presented goals and in clients’ access to assistance. The team currently provides services in Seneca, Sandusky, Wyandot and Ottawa counties and will be expanding into Huron County.

 

The project budget is $ $184,583.75, which includes personnel, travel, and supplies. The project start date is September 30, 2024 and end date is September 29, 2026. The project is in the BJA Required Local Pass-through (Direct) local funding purpose area and was approved by the CIAB on July 19, 2024.

 

Specialized Court-based Programs

Specialized  Dockets

For the Specialized Dockets OCJS again worked with the Supreme Court to identify courts that would benefit from and have the capacity to begin or expand Mental Health Courts, Veteran’s Treatment Courts, and Juvenile Mental Health and Drug Treatment Courts. As of now the state of Ohio has 26 certified Juvenile Mental Health, Drug and Treatment Courts located in 22 of 88 Ohio counties, 29 certified Drug-Veterans Treatment, and 41 certified Mental Health (includes 5 juvenile).

 

Goal: Expand specialized dockets focused on mental health, juvenile mental health, drug treatment and veteran’s treatment throughout the state.

 

Additional projects approved by the CIAB to meet this goal for BJA’s consideration include:

 

*PROJECT MODIFICATION Hamilton County Juvenile Court – Judge Bloom

In a recently approved OCJS GAM submission, Hamilton County had proposed creating a Domestic Violence (DV) specialized docket for $87,500; however, subsequently Hamilton County Juvenile Court submitted a project proposal modification. The CIAB reviewed this proposal at its May 28, 2024 meeting and voted to put it through for BJA consideration.

 

Judge Kari Bloom was elected in 2020 to serve the Hamilton County Court of Common Pleas Juvenile Division for a six-year term, which began on February 14, 2021. On Jan. 1, 2023 she became the administrative judge. The new Hamilton County Juvenile Court project proposes to create a specialized docket specific to girls in the justice system who have been considered low-risk but high-need. Risk factors impacting girls’ contact with the juvenile justice system are diverse and require individual mitigation. While girls represent a small portion of total arrests in the juvenile justice system, the numbers of their encounters with law enforcement, removal from school, and instances of human trafficking, are on the rise. In 2022 and 2023, approximately 4700 girls came before Hamilton County Juvenile Court. GIRLs Court will target youth identifying as female, between the ages of twelve and eighteen, who are arrested in Hamilton County. First-time, low-level offenders, those with probations violations, victims of crime, and youth who are pregnant or young mothers will be served by GIRLs Court regardless of race, ethnicity, socio-economic status, or residential county.

 

Participants will first be screened to confirm they are not a candidate for the Safe Harbor (Human Trafficking) Court in Hamilton County. Assessment tools will be selected at the recommendation of peer judges who have ongoing girl’s courts, as well as from assessment professionals. The Court will work with community-based service providers to provide participants access to mental health services, healthy relationship resources, domestic violence resources, substance abuse counseling, career counseling and job training, and educational advocacy and coordination.

 

The project start date is June 3, 2024 and the end date is June 3, 2026.

 

The project is in the BJA Required Local Pass-through (Direct) category and was preliminarily approved by the CIAB on January 26, 2024 pending final submission. The modified project proposal was approved by the CIAB on May 26, 2024.

 

Evaluation and Research

Given that Ohio is not an ERPO state, the Board requested a research component be pursued for projects in both the specialized dockets and the mobile crisis response teams. As a result, OCJS staff worked with the SCO to identify two courts that have had a specialized docket in operation for some length of time with enough participants for an evaluation. The Board was presented at its October 2023 meeting with the possibility of funding research to evaluate a current mental health docket and a current juvenile docket.

 

If BJA approves of Ohio’s plan in the evaluation field, the mobile crisis response team evaluation and specialized court docket will be initiated as noted below.

 

On July 19, 2024, the board approved Sarah Manchak from the University of Cincinnati to conduct the evaluation of the mobile crisis response teams. She has previously studied mobile crisis response teams and is well situated to further her research and conduct the evaluation.

 

The proposal specifies that evaluation of the Mobile Crisis Response Teams (MCRTs) in Ohio will employ a mixed method approach to achieve two chief goals: (1) to better understand how OCJS-funded MCRTs in Ohio operate, where there are similarities and differences, and what impact they have had on the communities in which they are embedded, and (2) to conduct in-depth process and outcome evaluation of two different MCRTs in the state.

 

To achieve Goal 1, the evaluation team will design and administer a brief semi-structured interview with each MCRTs’ main point of contact. This interview will measure an extensive list of details about the program including but not limited to:

size and composition;
schedule; 
training and onboarding procedures; 
data collection and management; 
supervision; resources; 
sustainability model/plan; 
challenges and problem-solving strategies; 
community-level context; 
capacity; utilization; and any data they may have on hand to share about effectiveness (e.g., calls for service, etc). 

 

To achieve Goal 2, the evaluation team will conduct two site visits at two different MCRTs. 

The site visits will take place approximately 1 year apart, at the beginning and the end of the grant period. At the site visit, the evaluators will conduct observations of daily activities, including crisis responses, will meet with the MCRT personnel to discuss the team in-depth. These conversations will include the same items from the semi-structured interview that will be administered electronically to the other teams. Attempts will also be made to include relevant justice and mental health outcomes such as type of disposition (e.g., release, hospitalization, jail, etc.) and impact on the justice system, such as whether there is a reduction in the number of low-level calls and crimes in areas where mobile crisis response teams serve. 

 

The final evaluation report will include a summary of findings from the telephonic interviews and, separately, a detailed report of all data collected from the site visits with recommendations for how to programs can enhance the quality of implementation. Additionally, the evaluation team will provide a literature review about MCRTs and their effectiveness. 

 

Total Budget: $136,313.82

A majority of the work will be conducted on site with the mobile crisis response teams. Dr. Sarah Manchak and a supervised doctoral student (to be determined) will serve as the primary evaluator for this grant. This grant is 25 months and is expected to begin 8/1/24 and end 9/30/26. Dr. Manchak will designate 7% academic and 10% recess effort across the 25- month grant period.

 

Further, the board approved the specialized docket court evaluation be conducted by Ohio Colleges of Medicine Government Resource Center at the Ohio State University who works with Ohio’s seven medical colleges and 13 public universities. Healthcare and human services research and policy staff work directly with state government agencies including Ohio Mental Health and Addiction Services, Ohio Department of Education, Ohio Department of Higher Education, Department of Developmental Disabilities, Ohio Department of Aging, Ohio Department of Health, and the Ohio Medicaid. Their specializations include program design, implementation and evaluation, applied research and analysis, quality improvement science, and informatics. Additionally, the agency previously conducted research for the Supreme Court 2017-18 on family dependency treatment courts.

 

The Ohio Colleges of Medicine Government Resource Center (GRC) proposes to conduct a two-year embedded implementation, process, and outcome evaluation of two mental health courts in Ohio. Those courts are Franklin County Court of Common Pleas Mental Health Court, Judge Munson and Montgomery County Juvenile Court, Judge Wallace.

 

The evaluation will examine the courts’ design, original goals and activities, fidelity to the proposed model, reasons for any deviations, and differences between the two court programs, and ease of compliance with the Supreme Court of Ohio’s certification standards.

 

In the initial months of the evaluation, GRC will collaborate with the courts and OCJS to identify priority areas of need and interest, and to develop or expand each court’s existing logic model and sequential intercept map. These models would be based upon best practice standards from Bureau of Justice Affairs, AllRise, and Substance Abuse and Mental Health Services Administration (Bureau of Justice Affairs, 2007a and 2007b; AllRise, 2024; SAMHSA, n.d.). Methodology and key evaluation questions will be revised or expanded during work with the courts and state partners.

 

GRC will conduct a sequential, explanatory mixed methods evaluation that will begin with brief structured questionnaires with mental health court personnel, and follow-up with open-ended interviewing to inform the implementation and process evaluation questions. To understand client- and court-based outcomes, GRC will leverage existing data collected by staff or accessible administrative data.

 

Additionally, GRC will conduct a brief questionnaire with clients throughout the court process (contingent upon the data already available) to measure client outcomes such as mental health symptoms and social functioning that may not be readily available elsewhere. The analysis will describe similarities and differences between the two courts in terms of client characteristics, processes, outcomes, and fidelity to both the evidence-based mental health court model (Bureau of Justice Affairs, 2007b) as well the Ohio Supreme Mental Health Court Guidance (The Supreme Court of Ohio, n.d.). It will also answer questions about implementation, process, and outcome evaluation