News of 2007

Events of 2006

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The Cleveland and Cuyahoga County Office of Homeless Services (OHS) sent results of the Review and Ranking Committee site visits to MHS and other organizations that provide homeless assistance services as part of the local Continuum of Care. Members of this Committee include representatives of funders of homeless assistance services, advocates, formerly homeless individuals, and members of the community at large. They are nominated and approved by an OHS advisory board.

In September 2007, MHS submitted to OHS a 33-page Renewal Information Form for six of the eight Supportive Housing Programs for which MHS is the applicant. These programs are awarded funds from the U.S. Department of Housing and Urban Development.  Each Form includes responses to 78 questions about the program, plus information on the program budget and management. Members of the Review and Ranking Committee review these Forms, and decide which programs to visit.

In October, four-member teams of the Review and Ranking Committee conducted visits to four MHS programs: Safe Haven II and III, the Young Adult Program, and the SPOT Supportive Services program. The teams complete a comprehensive evaluation of all programs (including those not visited), reviewing adherence to program design, quality of services and oversight, fiscal administration, and other factors. Reviewers rate each factor, using a numeric score. Review teams conducting site visits also conduct confidential client interviews. A composite score, reflecting the ratings of all three members, is then computed for each program, and these composite scores are used to determine if programs will be recommended for further funding, and to assign funding priorities.

All MHS programs reviewed earned high scores, as presented in the table below, and all programs were recommended for full approval. For the SPOT Supportive Services program, reviewers Deb Beckwith, Emily Carrabine-Amato, Erin Davis and Bill Kuehn reported they were "completely satisfied" with the results of the site visit, and commented: "Agency staff were prepared and thorough in their presentation, and addressed all the questions submitted prior to the site visit or raised during our meeting. The Review Team received a complete description of the many barriers affecting the target population and impacting service delivery efforts. Particularly appreciated was the description provided of the change intervention model (similar to the smoke cessation model) that provides interventions based on the stage a client is at and would therefore be more receptive to make a needed change. Also appreciated is the fact that change is slow for this population given the many barriers they face. Staff are patient and kind."

OHS will determine funding priorities later, and submit these priorities with the Cuyahoga County Continuum of Care application to the U.S. Department of Housing and Urban Development in June. HUD usually announces funding decisions the following December or January.

Review scores from the 2007 application.
Review scores from the 2006 application.

MHS encourges Cuyahoga County citizens to contribute to this year's United Way campaign. United Way of Greater Cleveland was the nation's first volunteer-driven system to study human care needs, raise funds from the community, allocate these funds, and monitor their use. This citizen review process has since become the model for United Way organizations across the country.

At MHS, United Way funds have helped those with serious mental illnesses and addictions to achieve recovery, stable housing, and independence, through their participation in the evidence-based Integrated Dual Disorder Treatment (IDDT) treatment model.

More than two-thirds of MHS staff members have contributed to this year's United Way campaign. United Way hopes to raise $42.3 million in Cuyahoga County to address the community's most urgent problems. Donations will serve 21 consumer groups identified by a multi-year Core Services Planning Project. This Project developed specific funding recommendations based on research that identified the most-urgent health and human service needs of Cuyahoga County citizens, as well as the most promising and evidence-based ways to meet those needs. The goal is to use donated funds to achieve the most impact, as efficiently as possible.

MHS held its Annual Meeting of the Board of Trustees on the evening of 24 October 2007, at Windows on the River.

The extraordinary work of staff members was the focus of the meeting. Learn about the staff members who received service awards during this meeting.

The Sisters of Charity Foundation awarded $87,000 to MHS to provide Supported Employment interventions for its severely mentally ill, homeless clients.

The evidence-based Supported Employment intervention model was chosen by the Ohio Department of Mental Health (ODMH) as a service model of choice for persons with severe mental illness, because more than 20 years of research shows that it promotes positive outcomes for consumers, service organizations and service systems. Supported Employment, developed by the New Hampshire-Dartmouth Psychiatric Research Center, is one of six evidence-based practices endorsed by the ODMH. Dale P. Svendsen, M.D., the ODMH medical director, stated that “Local mental health systems in Ohio who adopt and provide these practices in culturally-appropriate ways will have powerful tools at their disposal to help persons with mental illness achieve their individual recovery goals. The successful implementation of SE is vital to help many people reach these important goals.”

The Ohio Supported Employment Coordinating Center of Excellence (Ohio SE-CCOE) will work with MHS to implement the Supported Employment model. The Ohio SE-CCOE is a joint project of the Mandel School of Applied Social Sciences and the Department of Psychiatry at Case Western Reserve University.

Eric Morse, the MHS Director of Homeless Services, wrote the proposal to the Sisters of Charity Foundation, after learning that supportive housing was one of the Foundation's new initiatives. Supportive Employment interventions will help MHS homeless clients achieve and maintain housing. Many of those clients choose to live in one of the MHS supportive housing programs.

The grant funds will help MHS hire a Project Manager, and help pay for the Ohio SE-CCOE's evaluation and training activities. MHS is deeply grateful to the Sisters of Charity Foundation for this important award.

More than 200 people came to MHS on the evening of Thursday, 27 September 2007, to celebrate the 75th anniversary of Dave's Markets, and the contributions of its Chairman, Burt Saltzman, to MHS and the greater Cleveland, Ohio area. Dave's Markets serve urban communities throughout Cleveland and Cuyahoga County. Each store features foods and items of particular interest to the ethnic communities served by the store.

Learn more about the event, and the dignitaries who came to honor Mr. Saltzman and his family.

The Substance Abuse and Mental Health Services Administration named MHS as one of its new Community Treatment and Services Centers for the National Child Traumatic Stress Network (NCTSN). The Network's mission is "to raise the standard of care and improve access to services for traumatized children, their families and communities throughout the United States."

MHS received a Notice of Grant Award from SAMHSA on 13 September 2007, stating that SAMHSA "hereby awards a grant in the amount of $400,000" to MHS for its proposal "Transforming Care for Traumatized Youth in Child Welfare." The grant is renewable for four years. MHS was one of only ten healthcare organizations nationwide to receive this award.

"The plight of children in the child welfare systems of the United States of America could sound major alarm bells for our politicians, legislators, and policy makers..."¹ This quotation, by a leading child welfare researcher, was cited by MHS in the proposal's introduction. "The project proposed in this application is the response of MHS ... to the plight of these children."

The project will serve traumatized children of ages 4-18 years who are referred to the Department of Children and Family Services (DCFS) of Cuyahoga County. DCFS is the county agency with the statutory mandate to investigate claims of child abuse, neglect, and exploitation. The mission of DCFS is to "assure that children at risk of abuse or neglect are protected and nurtured within a family and with support of the community." MHS staff members will, on an annual basis, conduct trauma assessments for 600 children believed to be at risk for traumatic stress disorders, and subsequently provide evidence-based interventions for 400 of these children who have these disorders.

MHS and DCFS staff members will work with the National Child Traumatic Stress Network (NCTSN) to develop and implement a screening tool for use by members of the DCFS intake staff to identify at-risk children. During the course of the grant period, MHS would provide training for all 750 DCFS staff members and 100 DCFS supervisors, to help them integrate trauma-informed practices into their work. MHS will collaborate with the Cuyahoga County Tapestry System of are initiative to transform mental health care in our community for children experiencing traumatic stress. MHS would also utilize the talent and resources of the NCTSN to provide presentations on youth traumatic stress to professional and community groups, and to prepare and submit research findings for publication in professional journals.

Traumatic experiences of violence during childhood impair cognition, the capacity to regulate conduct, and the capacity to monitor and manage emotions. Although a few resilient children develop adaptive ways to surmount these developmental deficits, most do not, and face a lifetime of frustrating functional deficits. The plight of these children alarms us. MHS is excited to be able to again work with the NCTSN to promote the development, use, and study of trauma-informed practices and interventions in our community.

MHS first became a NCTSN Community Treatment Center in 2001, after being the lead provider for Cuyahoga County's Children Who Witness Violence (CWWV) program for two years. Police officers from seven communities participating in the CWWV program refer traumatized children at the scene of violent events by calling the 24/7 hotline operated by the MHS Mobile Crisis Team. MHS then travels to the home of the children to provide immediate crisis assessment and trauma-intervention services. Upon resolution of the crisis, MHS and other child-service organizations provide post-crisis care. These services are designed to preclude or minimize the developmental and psychological harm that the experience of violence has on children and families.

Although the program served more than 1,200 children each year, and published results of its services, it lost renewal funding from SAMHSA in 2005. Convinced of the program's need and merits, the Cuyahoga County Board of Commissioners provided funding to continue the pioneering program.

Reference
¹ Benoit, M.B. (2006). The view from the mental health system. In N.B. Webb (Ed.), Working with traumatized youth in child welfare (pp. 279-291). NY: Guilford Press.

The William J. and Dorothy K. O'Neill Foundation awarded MHS $30,000 to enhance its clinical information system. Grant funds will help MHS modify current database applications to conform to new operating system requirements, create new applications, and train staff members in their use. The O'Neill Foundation considers proposals that will help an organization "to achieve its vision through strong governance, sound management, and a persistent dedication to outcome achievement."

Raised in Cleveland, William J. O'Neill, along with his brothers, son, and nephews, developed Leaseway Transportation Corporation to become a pre-eminent physical distribution company with operations throughout the United States and other countries. Mr. O’Neill, also known for his philanthropy, died in 1983. In 1995, the Penske Truck Leasing Company purchased Leaseway. Mrs. O’Neill, whose "life was spent raising her children and nurturing her grandchildren and great grandchildren," according to the Foundation, died in 1998.

MHS operates a clinical information system created by its Executive Director, Steven M. Friedman, Ph.D., and further developed by its Director of Information Technology, Clark Maciag. It is a highly adaptive, reliable, and cost-effective system. The generous grant from the O'Neill Foundation will allow MHS to rewrite selected applications and create other applications. This builds on the strengths and versatility of the current system. The grant will help MHS achieve its mission, improve the performance of its programs, and sustain its capacity to develop new programs to meet emerging needs.

The Corporation for Supportive Housing (CSH) awarded $48,855 to MHS to help those with serious mental disorders who are returning to Cuyahoga County from prisons to achieve stable housing. The funds will provide case management and supportive services. MHS will partner with EDEN, Inc., in this CSH Ohio Returning Home Pilot program. The Ohio Department of Rehabilitation and Corrections (ODRC) is another project partner. Learn more about this initiative.

The Cleveland Foundation awarded MHS and Neighborhood Family Practice $49,605 to reduce rates of cardiovasular and metabolic diseases among MHS clients. The activities and goals of the proposal, "Integrating Behavioral Healthcare and Mental Health," are similar to an initiative (see the story, below) funded in June by the Woodruff Foundation. This project, however, will serve clients of the Emerald Commons permanent, supportive housing program.

The major goal of the project is to reduce the incidence of serious and untreated or undertreated obesity, diabetes, and high blood pressure among residents of Emerald Commons and other MHS clients living in nearby apartments. Outcomes will be measured by nursing staff of MHS, supervised by Deborah Harris, MSN, and by these staff members of Neighborhood Family Practice: Patricia Comodeca, RN; Kate Thomas, Nutritionist; and Erick Kaufmann, Physician.

The Cleveland Foundation is the nation's first community foundation, and MHS is honored to receive the award for this important program.

The David and Inez Myers Foundation made a generous award of $50,000 to the MHS capital campaign for the purchase and renovation of a building to serve as the MHS headquarters.

The David and Inez Myers Foundation was established in 1977 for general charitable purposes that are in furtherance of the purposes of the Jewish Community Federation. Within this framework, emphasis is given particularly to support of higher education and other activities to support health and welfare programs whose worthiness is of the highest character. S. Lee Kohrman is President of the Myers Foundation.

Total grants and donations made to the capital campaign are now more than $2 million. Total project costs are now estimated to be $6.9 million. Funds still required to fund the project are $603,000.   Learn more about the building and the project's objectives, project costs and revenues, and the status of the construction and renovation.

The Woodruff Foundation awarded MHS a grant award of $30,000 for a proposal on "Integrating Behavioral Healthcare and Mental Health."

Neighborhood Family Practice will be a partner with MHS in this project to reduce rates of cardiovascular and metabolic diseases among residents of our Kingsway Manor permanent housing program in Tremont. Of 13 applications, MHS was one of only four organizations to receive a grant award.

MHS submitted its proposal in response to research showing that individuals who have schizophrenia and other psychotic and persistent mental illnesses have much poorer health, and are two to three times more likely to have cardiovascular and metabolic diseases than members of the general population¹. They are also twice as likely to die, and have a 20% shorter life expectancy than individuals in the general population². Cardiovascular disease is the primary cause of this increased death rate and shorter life expectancy. Obesity and diabetes are significant risk factors for the development of cardiovascular disease, and both have increased substantially among those with serious mental illness during the past ten years. This is believed to be related in part to the use of newer antipsychotic medicines. An unfortunate side effect of these new medicines is weight gain, and with weight gain comes the increased risk of diabetes. High blood pressure is also highly prevalent among those with serious mental illness, and is a potent contributor to strokes, cardiovascular diseases, and early deaths.

The major goal of the project is to reduce the incidence of serious and untreated or undertreated obesity, diabetes, and high blood pressure among the 58 residents of Kingsway Manor, and other MHS clients living in nearby apartments. These three conditions, along with high cholesterol and triglyceride levels, comprise what is called "the metabolic syndrome" of interrelated risk factors for diabetes and coronary heart disease. Staff members of Neighborhood Family Practice and MHS will provide project participants with assessment, treatment, prevention, and wellness activities. Data to be gathered for project evaluation include measures of the participants' weight, glycohemoglobin, and blood pressure, in addition to emergency department visits and adherence to prescribed medicine.

Special thanks to Deborah Harris, M.S.N. and her fabulous Nursing staff, who came up with the project concept and gathered data that convincingly demonstrated the need.

References

¹McDermott, S., Moran, R., Platt, T., Isaac, T. Wood, H. & Dasari, S. (2005). Heart disease, schizophrenia, and affective psychoses: Epidemiology of risk in primary care. Community Mental Health Journal, 41 (6), pp. 747-755.

²Gelenberg, A.J., Levy, P., & Manoukian, S.V. (2006). Maintaining metabolic and cardiovascular health in patients with schizophrenia: Perspectives in long-term care. Medscape.

Factors leading to the success of a Cuyahoga County initiative to help homeless people achieve permanent housing with the help of supportive services are explored in a WCPN "Sound of Ideas" broadcast. Russell Spieth, who manages Emerald Commons, one of the permanent housing programs operated by MHS, is a participant in the interview. Get the podcast of the 90.3 WCPN broadcast, described by WCPN below.

"Just about every city deals with the same problem - what to do about the homeless. In Cleveland, some are getting their very own apartments. A new program called Housing First promises permanent homes for select homeless. They protect and support not only the newly housed, but neighbors as well. On The Sound of Ideas, we'll hear the stories of Emerald Commons and talk about how this project might be replicated."

Paula Geraciotti earned recognition from the Cuyahoga County Community Mental Health Board (CCCMHB) as Cuyahoga County's Outstanding Direct Service Worker of the first quarter of 2007. Ms Geraciotti is a Crisis Intervention Specialist for the Mobile Crisis Team. She specializes in crisis work with children.

The award recognizes outstanding advocacy, productivity, integrity, accountability, professionalism, quality of work, and caring in the performance of duties. MHS is proud of Ms Geraciotti's work, and is honored to have one of its staff members recognized by the Board.

Richard Oliver, LPCC, Director of Crisis Services, presented at a networking session for crisis centers at the 40th Annual Conference of the American Association of Suicidology (AAS) on 11 April 2007, in New Orleans, Louisiana, USA.

Mr. Oliver was invited to speak about the quality assurance acitivies of the MHS Mobile Crisis Team, one of only 140 AAS-certified crisis intervention programs in the U.S.A.   He will discuss the Program Manager's real-time review of each new crisis referral. Crisis workers who respond to calls can request help during the call, and must review the call with the Program Manager immediately after the call.   Cynthia Vrabel, M.D., the MHS Medical Director later reviews each call and the services that were provided in response to that call.  MCT staff members also conduct peer review of the services offered by all clinicians each year.

Surveys of client satisfaction and stakeholder satisfaction are conducted each year, and the entire record of services provided in response to each service request is also reviewed. Outcomes reviewed include the response time to referrals, staff productivity, and checking the monthly Coroner's report of suicidal deaths with our own client roster. When it is determined that a person who died by suicide had been a participant in MHS services, a more extensive review of services is conducted.

Richard Oliver, LPCC, Director of Crisis Services, made a Workshop Presentation to the 8th All-Ohio Institute on Community Psychiatry. This year's Institute took place 16-17 March 2007 at the Hilton Cleveland East/Beachwood, and was entitled "Dollars & Sense: The Business Case for Community-Based Mental Health Services."

He presented Project Assist, a SAMHSA-funded project serving older persons who have severe mental illnesses. The project's goal is to serve this vulnerable population more quickly, effectively, and efficiently by establishing collaborative relationships between the two systems that administer mental health services and adult protective services.

Project partners include the Cuyahoga County Community Mental Health Board, Adult Guardianship Services, the Benjamin Rose Institute, the Cuyahoga County Department of Senior and Adult Services, Recovery Resources, the Case Western Reserve University School of Medicine, the Center for Community Solutions, and MHS.

In response to referrals, a Crisis Assessment Team conducts a face-to-face crisis assessment. Team members include a staff member of the MHS Mobile Crisis Team, a Social Worker from the Department of Senior and Adult Services, and a Nurse from that Department. Crisis intervention services are also offered to reduce mental health symptoms and subjective distress. Other project partners offer specialized services to meet specific needs.

Mr. Oliver also made a presentation at the 65th Annual Human Services Institute of the Center for Community Solutions on 23 March 2007. This presentation, "Suicide is Preventable. Its Causes Are Treatable," described the suicide prevention awareness campaign of the Cuyahoga County Suicide Prevention Task Force, organized by the Cuyahoga County Community Mental Health Board. The number of suicidal callers to the MHS Mobile Crisis Team increased since the public information campaign begain in February 2005. Click here to review preliminary data.

References
Lester, T., Oliver, R., Brooks, B., Rahl, B., Pickens, C., Reid, B., Primetica, B., Dusseau, M., & Khabeer, B. (2007, March 17). Transforming silos into bridges. Project Assist: Senior integrated behavioral health system. Workshop Presentation W-8 at the 8th All-Ohio Institute on Community Psychiatry. Cleveland, OH: Case Western Reserve School of Medicine and University Hospitals Case Medical Center, pp. 122-131.

Oldham, T., Oliver, R., Osiecki, S., & Denihan, W.M. (2007, March 23). Suicide is preventable. Its causes are treatable. Presentation #10 at the 65th Annual Human Services Institute. Cleveland, OH: The Center for Community Solutions.

The Cleveland and Cuyahoga County Office of Homeless Services (OHS) sent results of the Review and Ranking Committee site visits to MHS and the other 16 organizations that provide homeless assistance services as part of the local Continuum of Care. Members of this Committee include representatives of funders of homeless assistance services, advocates, formerly homeless individuals, and members of the community at large. They are nominated and approved by an OHS advisory board.

In December 2006, MHS submitted to OHS a 35-page Renewal Information Form for each of the seven Supportive Housing Programs that MHS operates with funds from the U.S. Department of Housing and Urban Development.  Each Form includes responses to 70 questions about the program, plus information on the program budget and management. Members of the Review and Ranking Committee review these Forms, and decide which programs to visit. In February, three-member teams of the Review and Ranking Committee conducted visits to two MHS programs: Safe Haven I, and the Outreach & Representative Payee program. The teams complete a comprehensive evaluation of all programs (including those not visited), reviewing adherence to program design, quality of services and oversight, fiscal administration, and other factors. Reviewers rate each factor, using a numeric score. Review teams conducting site visits also conduct confidential client interviews. A composite score, reflecting the ratings of all three members, is then computed for each program, and these composite scores are used to determine if programs will be recommended for further funding, and to assign funding priorities.

All MHS programs reviewed earned high scores, as presented in the table below, and all programs were recommended for full approval. For the Outreach and Representative Payee program, Reviewers Scott Wells, Bob Paponetti, and Peter Daroczy recommended full approval, "accompanied with a mandate for further project monitoring for six (6) months..." They noted that "MHS responded satisfactorily to the concerns raised by the review team. However, members of the Review and Ranking Committee expressed unease that these concerns have been raised in the past, and apparently not adequately addressed. The review team is requesting another site visit to discuss the concerns." MHS looks forward to addressing the Committee's concerns, and welcomes further site visits by the review team at any time.

OHS will determine funding priorities later, and submit these priorities with the Cuyahoga County Continuum of Care application to the U.S. Department of Housing and Urban Development in June. HUD usually announces funding decisions the following December or January.

Dave Fifelski and Carolyn Nabakowski, program officers of the Cleveland and Cuyahoga County Office of Homeless Services help representatives of nonprofits providing homeless assistance services to understand application procedures for Supportive Housing Program grants from the U.S. Department of Housing and Urban Development.

The George Gund Foundation made a generous award of $100,000 to the MHS capital campaign for the purchase and renovation of a building to serve as the MHS headquarters.

George Gund estabished the Foundation in 1952 "with the sole purpose of contributing to human well-being and the progress of society."  Mr. Gund was president and chairman of the Cleveland Trust Company.  Upon his death in 1966, the Foundation's assets increased significantly.   In the Foundation's Annual Report of 2004, Geoffrey Gund, President and Treasurer, noted that "Those of us who have the privilege to engage in philanthropic work ... are able to cast our gaze into an imagined future and urge ourselves and others to move in that direction by thoughtful use of our grants and our relationships." MHS is honored to be a part of the future imagined by the Trustees of The George Gund Foundation.

Total grants and donations made to the capital campaign are now $1.96 million. Total project costs are estimated to be $6.125 million. Funds still required to fund the project are $1.6 million.   Learn more about the building and the project's objectives, project costs and revenues, and the status of the construction and renovation.

MHS earned conditional certification today from the Ohio Department of Alcohol and Drug Addiction Services (ODADAS), following an on-site evaluation by Certification Specialists Patricia Heffner and Tricia Howard.

ODADAS operates under the authority of Ohio law to coordinate a broad range of publicly-funded alcohol and drug addiction services throughout the state. Certification means that MHS meets the organizational and service standards established by the State of Ohio to ensure the quality and effectiveness of alcohol and drug addiction services.

With its certification, MHS will join more than 50 organizations providing alcohol and drug addiction services under contracts with the Alcohol and Drug Addiction Services Board of Cuyahoga County. According to its website, this Board "is a county government agency that administers federal, state, and local funding for substance abuse prevention and treatment services. Currently, the Board contracts with a network of over 50 agencies that provide over 100 programs for the residents of Cuyahoga County. Together, these agencies represent a continuum of care from prevention and early intervention to residential, outpatient, and aftercare treatment services."

Certification is important to MHS because more than 50% of homeless persons participating in MHS services have a substance-use disorder. These disorders include intoxication, withdrawal, abuse, and dependence, and the most frequent substances used are alcohol, cocaine, marijuana, and nicotine. The use of these substances is a major factor contributing to homelessness, and one of the most significant impediments to achieving and maintaining housing. Substance use also interferes with efforts to achieve recovery from schizophrenia, major depression, bipolar disorder, and other major mental disorders. MHS Executive Director Steven M. Friedman, Ph.D. stated that "ODADAS certification is an important step in the efforts of MHS to help its clients achieve recovery, housing, and self-determination."

For other news and information about MHS, click on the links below.

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