Treatment of Mental Illness and Recovery Support Services - 2010 Winners
Connecticut TF-CBT Learning Collaborative, Child Health and Development Institute of Connecticut
The Connecticut TF-CBT Learning Collaborative is a unique partnership between a state agency, the Department of Children and Families, which conceived of and funds the project, the Connecticut Center for Effective Practice (CCEP) of the Child Health and Development Institute (CHDI), the nonprofit organization that coordinates the initiative, and the sixteen community mental health agencies that were trained to provide Trauma Focused Cognitive Behavioral Therapy (TF-CBT). The central location of the TF-CBT Learning Collaborative is in Farmington, CT.
CHDI’s mission is to ensure that all children in Connecticut benefit from a comprehensive, effective, community-based health and mental health care system. CHDI’s mental health division is CCEP, a partnership of state agencies and academic institutions working to improve the effectiveness of services provided to all children through model development, training, dissemination, and evaluation. Since 2007, CCEP has coordinated the TF-CBT Learning Collaborative, including training 256 staff from the 16 community mental health agencies to provide TF-CBT. CCEP has utilized the Learning Collaborative methodology as a model of dissemination, including a year-long training period, extensive data collection and reporting for quality improvement, a focus on organizational change and capacity building to support implementation , and different training "tracks" for clinicians, supervisors, family partners, and senior leaders.
Over 1000 children have started TF-CBT and over 250 have completed treatment. Staff report an 89% fidelity rate to the model and actively include caregivers in 95% of completed cases. Despite a challenging community sample of children averaging exposure to 7.8 different traumatic events, children who completed TF-CBT reported a 43% reduction in PTSD symptoms and a 52% reduction in depression symptoms. Additionally, all 16 agencies have continued to maintain, and often expand, their TF-CBT programs following the end of formal training.
Greater Cincinnati Behavioral Health Services (GCBHS)
Greater Cincinnati Behavioral Health Services (GCB) is the most comprehensive mental health agency in Cincinnati, Ohio, serving adults with severe mental illness. GCB serves over 4,000 adults annually, is fully certified, nationally accredited and offers a comprehensive array of behavioral health and rehabilitation programs. GCB offers numerous evidence-based services including Integrated Dual Disorder Treatment (IDDT), Assertive Community Treatment (ACT), Housing First, Dialectical Behavioral Therapy and Illness Management and Recovery.
In 2004, GCB developed a team that implements the best practices of ACT and Housing First to serve individuals who are chronically homeless and severely mentally ill. The success of the ACT/Housing First Team has led to the expansion of homeless services at GCB including the development of an IDDT Team that uses Housing First for individuals who are homeless and have co-occurring disorders and a team that uses Housing First to serve chronic public inebriates, which is the first of its kind in Ohio.
Since the ACT/Housing First Team was developed, more than 110 individuals have been served. Outcomes have been excellent for this team, especially when considering that persons served have, on average, 3-5 years of homelessness prior to admission and 75% of participants are diagnosed with psychotic disorders. More than 86% of persons served achieved independent housing and 75% of those retained housing for at least twelve months. 51% of participants had an increase in income within six months of admission and 79% of participants remained engaged in services for at least twelve months. The ACT/Housing First Team has remained adherent to the philosophies of Housing First and is a high fidelity ACT Team, participating in regular fidelity review and technical assistance.
Henderson Mental Health Center, Inc
Henderson Mental Health Center (HMHC) in Fort Lauderdale, Florida, has been in operation for 57 years and is the largest non-profit provider of behavioral health services in South Florida. HMHC provides a continuum of community-based prevention, education, treatment and rehabilitation services utilizing best practice and evidence-based treatment models to over 18,000 individuals annually.
Wraparound is a means of delivering unconditional care to children and their families. It is aprocess that provides individualized, strength-based, needs-driven planning to meet the complex needs of children involved with multiple systems (e.g. mental health, child welfare, juvenile justice, special education). This system of care approach emphasizes family involvement at the highest level and drives the process for planning and service delivery. It requires collaboration between families, providers, and key members of the family’s social support network. The values associated with Wraparound require that the planning process itself as well as the services and supports provided are personalized, commitment and family driven, culturally competent and community based. This process increases the "natural support" available to a family by strengthening interpersonal relationships and utilizing other resources that are available in the family’s network of social and community relationships. Wraparound is effective in helping the child and family to recognize, utilize, and build talents, assets, and positive capacities.
According to a national evaluation pilot project through the National Wraparound Initiative, Henderson’s Wraparound process is one of the highest fidelity models when compared to other communities. As a result of utilizing the Wraparound model, the community has seen a dramatic decrease in out-of-home placements, as well as enhanced collaboration between direct service providers, better service coordination and improved quality of life for children and their families.
Mental Health Center of Denver
The Mental Health Center of Denver (MHCD) is a non-profit organization which has served as the mental health authority for the City and County of Denver, Colorado since its founding in 1989. Dedicated to its mission of enriching lives and minds by focusing on strengths and recovery, MHCD has become the recognized national center of excellence in community mental healthcare with a recovery rate of over 70 percent. Through its 36 community sites, operations in over 15 Denver public schools, collaborations with community partners and home-based outreach efforts, MHCD provides a comprehensive, innovative and accessible array of mental health and substance abuse treatment, housing, education and employment services to over 15,000 adults, children and families annually.
2Succeed is a pillar of MHCD’s recovery focused approach to mental health treatment. Using the evidence-based individual placement and support (IPS) model of supported employment, 2Succeed actively engages its consumers in identifying, preparing for and securing employment that will be meaningful to them and that will help them advance their economic self-sufficiency and recovery.
Over the past two years 25 percent of 2Succeed consumers have gained employment, and in just eight months from intake, on average. A subset of the 2Succeed population with primary impairments of affective disorder or schizophrenia that participated through MHCD in the Social Security Administration’s Mental Health Treatment Study (MHTS) had an employment rate of 50 percent.
MHCD is a leader in the recovery movement through its development and implementation of an array of recovery markers to guide individual treatment and evaluate programs. These markers, which incorporate assessments by both the clinicians and the consumers, indicate that 2Succeed consumers have shown substantial progress in their recovery.
The Center for Practice Innovations at Columbia Psychiatry
The Center for Practice Innovations (CPI) at Columbia Psychiatry is part of the Division of Mental Health Services and Policy Research at the New York State Psychiatric Institute and Columbia University, Department of Psychiatry in New York, New York. The Center was established in November of 2007 by the New York State Office of Mental Health to promote the widespread adoption and sustaining of evidence based practices for adults including Wellness Self-Management (WSM), an adaptation of the Illness Management and Recovery (IMR) model, a nationally recognized evidence-based practice. The CPI’s primary purpose is to create effective practice adoption methods that are broadly applicable, easily accessible and inexpensive such as web based and distance learning resources and tools.
WSM is a recovery-oriented, curriculum-based, and educationally focused practice that integrates 3 key areas: what helps and hinders recovery, mental health wellness and the importance of a physically healthy lifestyle. WSM includes the use of a 57 lesson comprehensive personal workbook for consumers and group facilitators along with a structured and easy-to-implement group facilitation framework.
Employing a formal learning collaborative methodology, a broad range of over 100 mental health service agencies in NYS successfully implemented the WSM program that involved over 4000 consumers. Feedback from participants and group leaders indicated that 75 % of participants reported significant progress with respect to self-identified goals over the course of the program. Interestingly, the two areas participants reported as having improved the most included "my use of alcohol, drugs and cigarettes" and "using medication in a way that works for me". WSM also appears to be a sustainable practice with over 85 % continuing to expand the service nearly a year after the initiative ended.
Weber Human Services
Weber Human Services in Ogden, Utah, has been a progressive leader in the State of Utah in promoting the effective implementation of evidence-based practices for adult and youth clients presenting with mental health and substance use disorders. Project Empower, a collaborative venture between Weber Human Services and Utah’s 2nd District Juvenile Court, was initiated in 1997 to provide high-risk youth access to mental health and substance abuse treatment as well as delinquency reduction services. In 1999 Project Empower implemented the model Aggression Replacement Training (ART)® to target the mental health problems and criminal behavior presented by participating youth.
With additional consulting, fidelity measures were developed and incorporated along with a specific "model fidelity guide. " A six year study on the treatment effects of Project Empower’s implementation of ART with more than 400 teens demonstrated statistically significant reductions in several mental health areas such as ADHD, depression, suicidality, and conduct. These results were sustained up to 4 months post-treatment. Risk-adjusted analyses were also conducted using this data comparing Project Empower outcomes to 500 other similar programs nationwide. These analyses revealed that as fidelity measures were incorporated into the service delivery, participant outcomes improved.
In 2009 the University of Utah Criminal Justice Center released the results of a constructed control group comparison of recidivism between Project Empower participants and juveniles not receiving the intervention. The results demonstrated a statistically significant 18% reduction in recidivism for the Project Empower group.
Wheeler Clinic, Inc. (860) 793-3500
Wheeler Clinic is a private non-profit community organization in Plainville, Connecticut providing a comprehensive continuum of mental health, substance abuse recovery, community justice, special education, and prevention and wellness services to over 30,000 individuals and families each year. The clinic, established in 1968, serves individuals of all ages and from all socio-economic and cultural backgrounds throughout central Connecticut. Wheeler Clinic’s continuum of care for youth at risk of or already exhibiting sexually reactive and problem sexual behaviors and their families includes Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Multi-Systemic Therapy for Problem Sexual Behavior (MST PSB). The clinic has provided TF-CBT since 2007 and MST PSB since 2005.
TF-CBT is a clinic-based, individual, short-term treatment for children and adolescents age four to 18 who experience significant behavioral or emotional problems that are related to traumatic life events. Parental involvement in treatment is paramount and the clinic’s program exceeded statewide averages for parental involvement in treatment sessions. Youth reported less overall problem severity following TF-CBT treatment; this was particularly evident in their decrease in avoidance behavior and arousal.
The MST intensive home-based model addresses the entire natural ecology of the youth recognizing that multiple systems and factors impact youth’s behavior and all family members can and must contribute to the youth’s well-being. Wheeler Clinic’s MST PSB team consistently exceeds the minimum model fidelity threshold measured by Therapist Adherence Measures (TAMs) and, over the past three years, has exceeded the MST targets for ultimate outcomes: 83% of youth served were living at home at discharge; 93% of youth were in school or working at discharge; and 81% of youth had no new arrests during treatment.
Last updated: 11/25/2010