SPOKANE COUNTY COMMUNITY SERVICES, HOUSING, AND COMMUNITY DEVELOPMENT DEPARTMENT

Spokane County Regional Support Network

October 2010 to September 2011 Annual Report

May 1, 2012

Message from the RSN

The information provided in this Regional Support Network (RSN) Annual Report impacts everyone who lives in Spokane County. It describes the efforts of your RSN to fund and administer needed services for individuals in our community who experience mental illness. The facts, figures, and stories herein document how the RSN partners with community-based programs to provide treatment and support recovery of individuals seeking mental health services.

For several years now Washington State has struggled to balance its budget.

Public programs have continued to experience substantial budget cuts and we have been challenged to serve our clients with progressively decreased funding. With direction from our county commissioners, the cooperation of our mental health care providers, community representatives, and the individuals we serve, we have been able to continue funding a broad array of outpatient, hospital, and residential services for adults and children throughout Spokane County.

Despite the ongoing challenges, our staff and our community providers are working hard to develop new, innovative ways to effectively provide services to individuals as they progress toward recovery. All of us, everyday, seek ways to maximize the positive outcomes for those we serve. Our mission to promote health and improve lives through funding of needed public mental health services remains unchanged and is being accomplished each and every day in Spokane County.

Thank you for your trust and support.

Our RSN Team: Christine Barada Suzie McDaniel Joe Beckett Danielle Cannon Fred Buckles Gail Kogle Rik Godderz Kurt Beilstein Mike Reierson Kim Attwood The Fiscal & Administrative Support Staff If you have any questions or comments please call (509) 477-4510.

Spokane County Community Services, Housing, and Community Development Department Page 2 of 21

Our Mission

The mission of the Spokane County Regional Support Network is to promote health and improve lives by assuring that individuals and families experiencing mental illness have a choice of flexible, responsive community services that are both available and accessible.

These services are provided in a way that values:

* * Safety and health * Preservation of dignity * Individual and ethnic uniqueness * Community participation Personal growth, enrichment, and empowerment

What We Do

Major responsibilities:

       Plan and recommend how to maximize the available mental health funds we receive.

Community participation/assessment of current and future community needs.

Contract with providers and monitor for the cost effectiveness and quality of the programs provided.

Provide for psychiatric inpatient stays for Spokane County residents.

Provide residential care for mental health individuals enrolled in RSN funded mental health services.

Authorize each outpatient and voluntary inpatient service.

Provide quality oversight for existing programs.

Eligibility for RSN Services

Eligibility is subject to certain diagnostic criteria and authorization by the RSN

   All persons in Spokane County may receive emergency crisis intervention, disaster mental health services, and hospitalization.

Medicaid enrollees may receive all of the above plus outpatient and residential services.

Low income, non-Medicaid persons who are high utilizers of services may also receive outpatient care and residential services.

Spokane County Community Services, Housing, and Community Development Department Page 3 of 21

RSN Providers

Outpatient Care Providers

       Catholic Charities Counseling Children's Home Society of Washington Community Detox Services of Spokane Excelsior Youth Center Frontier Behavioral Health dba Family Service Spokane & Spokane Mental Health Institute for Family Development Lutheran Community Services Northwest            N.A.T.I.V.E. Project Partners with Families & Children Passages Family Support Providence Sacred Heart Medical Center Service Alternatives Spokane County Jail Spokane County Juvenile Probation & Detention Spokane County Supportive Living Program Spokane Public Schools Sunshine Health Facilities Tamarack Center           

Adult Residential Facilities

Bethany House Blair House Carlyle Care Suites Mallon Place Milford House Mirabeau House Moore’s Boarding Home Oakhill Home Sunshine Health Facilities Valley House Whitehouse Living Center

Other

   Community Colleges of Spokane – PACE Services Service Alternatives Youth Family and Adult Connections Spokane County Community Services, Housing, and Community Development Department Page 4 of 21

Mental Health Services OUTPATIENT CARE

Assessment and Psychiatric Evaluation Individual Treatment, Case Management, & Group Therapy Psychiatric, Medication Management/Monitoring, & Psychological Testing Residential Services & Resources High Intensity Treatment Crisis Triage and Stabilization Caregiver Respite Peer Support and Consumer Clubhouse

INPATIENT CARE

Children’s Long-term Inpatient Program (CLIP) Evaluation and Treatment Facilities (Adult) Inpatient Diversion Facilities (Child and Adult) Involuntary Detentions Adult Long-term Hospitalization (Eastern State Hospital) Community Hospital Psychiatric Inpatient (Child and Adult) Spokane County Community Services, Housing, and Community Development Department Page 5 of 21

RSN Individuals Served and the Number of Services Provided

Unduplicated Individuals by Age October 2010 – September 2011 Number of Services by Age October 2010 – September 2011

Age: 2-17 Children & Adolescent Served 3,641 28% Age: 2-17 Children & Adolescent Services 98,737 30% Age: 18+ years Adults Served 9,398 72% Age: 18+ years Adult Services 229,863 70% Total Individuals 13,039 Total Services 328,600 Spokane County Community Services, Housing, and Community Development Department Page 6 of 21

Adult Residential Facility Services and Individuals Served October 2010 – September 2011 Number of Beds Funded Number of Bed-Days Utilized

    Adult Residential Treatment Facility 40 Boarding Homes 185 Step-down Housing Clients 30 (Supervised/Supported Living) Boarding Home with Primary 50 Mental Health Treatment

TOTAL 305

   Number of Bed-Days Utilized 79,196 Number of Step-down Units Utilized 7,214 Total Bed Units Occupied 86,410 

Number of Individuals placed in 387 Residential Facility

Spokane County Community Services, Housing, and Community Development Department Page 7 of 21

Average State Hospital Bed Census

120 100 91 100 93 80 60 40 98 78 20 0 87 90 93 90 93 91 92 Maximum Allocation 85

October 2010 - September 2011

RSN paid DSHS an over-census reimbursement of $584 per day per bed when over 85 beds. The DSHS allocation has reduced every year since 2009, f or a total reduction of 16 beds per day.

Spokane County Community Services, Housing, and Community Development Department Page 8 of 21

Funding

Funding

Medicaid State Funds Local 1/10 of 1% MH/CD Sales Tax Property Tax, Interest, Grants Federal Programs

Total Revenue

Oct 2009 - Sept 2010 Oct 2010 - Sept 2011 % Amount % Amount

64% $ 36,677,000 67% $ 36,994,000 20% $ 11,272,000 17% $ 9,353,000 12% 2% $ 7,144,000 13% $ 885,000 2% 2% $ 957,000 1%

$ 56,935,000

$ 7,324,000 $ 846,000 $ 756,000

$ 55,273,000

Spokane County Community Services, Housing, and Community Development Department Page 9 of 21

Mental Health Expenditures

October 2010 through September 2011

ITA Judicial, County Jail, County Juvenile $1 481 000 Housing, Residential, and Homeless $5,743,000 PACT & SAMHSA $1,443,000 Mental Health & Drug Therapeutic Courts $969,000 Administration IS & UM $3,625,000 Community Hospital and E & T $13,138,000 Other Direct Services $969,000 ESH Census Reimbursement $1 164 000 Outpatient Treatment $19,656,000 Crisis Stabilization Services $5,613,000 ITA – Involuntary Treatment Act PACT – Program for Assertive Community Treatment SAMHSA – Substance Abuse Mental Health Services Administration IS – Information Systems UM – Utilization Management E&T – Evaluation and Treatment ESH – Eastern State Hospital Psych & Medication Services $5 513 000

Total Expenditures $ 59,314,000

Spokane County Community Services, Housing, and Community Development Department Page 10 of 21

Leveraged MH/CD Local 1/10 of 1% Sales Tax

October 2010 through September 2011 A portion of the sales tax is utilized as local match for federal Medicaid.

The RSN designated $1.7 million of the sales tax annually to generate approximately $2.3 million in new Medicaid funds that was utilized for Medicaid mental health programs.

Total Sales Tax Provided $8,755,000 Million for Treatment, Residential Beds, and Therapeutic Courts in Spokane County Spokane County Community Services, Housing, and Community Development Department Page 11 of 21

2011 RSN Accomplishments

     Opened a second Evaluation and Treatment (E&T) facility (Calispel E&T) in October 2011 Hired an RSN Mental Health Adult Services Coordinator to collaborate with providers, hospitals and E&Ts for continuous care and community reintegration for individuals with mental illness and substance abuse.

Combined the Ombudsman and Quality Review Team (QRT) role to assure individuals and families have a neutral person in order to voice concerns and to assist in evaluating the RSN system of care.

Expanded access to new mental health services by funding 10 FTEs to provide additional services in the community.

Expanded supported employment.

Spokane County Community Services, Housing, and Community Development Department Page 12 of 21

Success Stories

 Less restrictive community diversion programs for adults have always been an ongoing challenge. The RSN relies on several community programs to provide safe alternatives to inpatient care.

 The PACT (Program for Assertive Community Treatment) team, which is a high-intensity outreach program (now in its sixth year) continues to provide diversion from hospitalization. Through provision of comprehensive health services, by a multi-disciplinary clinical team, both the number and length of client hospitalizations for over 100 enrollees have been reduced substantially.

 Community Detox Services’ Enhancement Program (DEP) serves individuals who are chronically mentally ill and have substance abuse disorders, many of whom have had histories of multiple psychiatric hospitalizations. DEP was able to divert the majority of these clients from hospitalization, as well as admit over 50 individuals directly referred from Eastern State Hospital this past year  In its second year of operation, Foothills Evaluation and Treatment (E&T) Hospital served 268 involuntary admissions for a fraction of the time of an average long-term inpatient stay at Eastern State Hospital (12 days compared to 98 days). Spokane County Community Services, Housing, and Community Development Department Page 13 of 21

Little Miracles

 Spokane County RSN providers have again this past year delivered excellent and compassionate care to those in need. Following are just two of the many

little miracles

mental health system of care.

that occur daily within Spokane County’s  A teenage girl at risk, with self harming behaviors for mental health and substance abuse, had an unsuccessful suicide attempt and spent two and half years in psychiatric hospitals and treatment facilities. Following her last hospitalization she was referred to intensive in-home services. She struggled to adapt to the community. With her guardians and a stable home setting, she learned coping skills and structure for safety, in an intensive service program. The team networked closely with other RSNs and community providers to give her seamless care. She recently shared, “The last eight months are the longest time I ever stayed out of the hospital.” She stated three things that have made all the difference, “I have structure, rules, and my guardians are solid. They are always there to talk to anytime I need help to solve problems.” She also credits her success to “sticking with my counseling, even when I didn’t think I needed it.” Recent milestones include a near 4.0 grade-point average in high school and a happy and stable home life with her guardians. She says, “I will always need to use my coping tools, but I am happy now. I know I have help if I need it. I like my life. I have new friends and new values.”  An adult individual shared her wellness and recovery journey with a group of recent program graduates. When starting into therapy she faced parenting issues, respite care needs, and homelessness. Even after finding housing, an accidental house fire made her homeless again. While learning to cope with these and other challenges, her mother passed away. She attributes her ability to persevere through her troubles and now wants to help others facing the same difficulties. She has recently completed the 40-hour training to become a peer counselor by passing the certification test with an almost perfect score.

Spokane County Community Services, Housing, and Community Development Department Page 14 of 21

Evidence Based Practices (EBPs)

 EBPs are behavioral health interventions, which through research have demonstrated significant effectiveness as treatments for specific problems. EBPs promote outcomes that are consumer reported, clinician observed, and research driven. Spokane County RSN providers embrace the use of EBP-based treatment through the following EBPs:

CHILD

Aggression Replacement Therapy Cognitive Behavior Therapy Dialectical Behavioral Therapy Functional Family Therapy Gender-Specific Integrated Dual Disorders Treatment Homebuilders™ Model Motivational Interviewing Multisystem Care Planning Team Parent Child Interaction Therapy Trauma-Focused Cognitive Behavioral Therapy

ADULT

Assertive Community Treatment Clubhouse Cognitive Processing Therapy Dialectical Behavioral Therapy Family Psycho Education - Multifamily Group Treatment Gatekeeper for Older Adults Integrated Dual Diagnosis Treatment (IDDT) Psychoeducational Multifamily Group for adults with Schizophrenia Question, Persuade, Refer, Treat Supported employment Wellness Self-Management WRAP Groups - Wellness Recovery Action Planning Program Spokane County Community Services, Housing, and Community Development Department Page 15 of 21

Cultural Competency

Increasing Cultural Awareness through Training

   In 2011, Spokane County RSN and its contracted providers both attended and presented a variety of trainings to enhance cultural awareness and competency in the provision of treatment services. Participants included mental health professionals, social workers, and consumers ranging in age from youth to elderly.

Two examples of these trainings were:  Community Detox Services conducted in-house training for staff and associates, which promoted health services that are respectful and responsive to the beliefs, practices, and cultural and linguistic needs of diverse individuals to result in positive health outcomes. Emphasis was placed on health, healing, and wellness belief systems and the awareness of providers to overcome the limits of their own set of beliefs and values in addressing the needs of the individual.

 A session at the 2011 Washington State Behavioral Health Conference entitled “Cultural Competency in Organization Function & Professional Practice” was attended by RSN staff, clinicians and administration staff from a number of the provider agencies, community stakeholders, and consumers. Topics ranged from the role of clinical staff and administrators in supporting recovery efforts of consumers and the importance of community input in planning and providing services.

The RSN system of care provides services to individuals and families of all ethnic backgrounds. In 2011, the following ethnic backgrounds were self-identified by individuals receiving services: American Indian, Alaska Native, Asian, Black/African American, Cambodian, Chinese, Ethiopian, Guamanian and Chamorro, Hispanic, Japanese, Korean, Laotian, Native Hawaiian, Pacific Islander, Russian, Samoan, Somali, Sudanese, Ukrainian, and Vietnamese.

Spokane County Community Services, Housing, and Community Development Department Page 16 of 21

2011 Spokane County RSN Trainings

         Spokane County RSN provides and supports opportunities for network providers, consumers, staff, and allied systems to share knowledge, expertise, and experiences in the form of training, workshops, conferences, and other learning opportunities. In 2011, the RSN sponsored, presented, or sent individuals with mental illness or their family members, staff, and advisory board members to a number of trainings and conferences. The list below represents many of the diverse and important presentations offered in 2011. Mental Health First Aid Consumer Advocacy Fighting Stigma – Finding Solutions Legal Aspects of Landlord / Tenant Law Washington State Behavioral Health Conference Consumer Leadership Development Implementing a Peer-Support Recovery Program Washington State Co-Occurring Disorders Conference Bringing Hope to Every Interaction Spokane County Community Services, Housing, and Community Development Department Page 17 of 21

Provider Spotlight

CATHOLIC CHARITIES

Catholic Charities, after serving the Spokane community for almost 35 years with a variety of services, created its Counseling Program in 1973 to initially provide pre-marriage evaluation and talk therapy.

Over the 40 years since then, services have expanded to include, among many others, programs for women and children, mental health treatment, relationship and communication skills training. Licensed, professional counselors who work closely with interns from local universities and other service agencies in the community to help hundreds of our neighbors with everyday life challenges and to support recovery for those impacted by mental illness.

For more information call: (509) 358-4271

PASSAGES FAMILY SUPPORT

Operating as an independent Consumer Operated Service Program (COSP), Passages Family Support is on the leading edge of the Recovery Movement. Passages Family Support is a multi-service agency that provides peer counseling, educational and advocacy training, recovery support, and case management to individuals and families enrolled in the Spokane County RSN’s system of care.

Passages’ Certified Peer Specialists are uniquely qualified to communicate hope and support the development of skills that are integral to an individual’s ability to recover. Between October 2010 and September 2011, Passages’ Certified Peer Counselors provided 4,647 services to RSN enrollees.

For more information call: (509) 892-9241

NATIVE PROJECT

Since 1989, when several community leaders founded NATIVE Project to promote and support positive changes for Native American youth, their programs have grown to serve all members of our community with culturally appropriate behavioral services. Both adults and youth receive comprehensive health services from licensed professional staff which promote wellness and balance of mind, body, and spirit.

For individuals with alcohol/drug and/or mental illness issues, treatment and recovery support services are provided to both the client and family.

For more information call: (509) 325-5502 Spokane County Community Services, Housing, and Community Development Department Page 18 of 21

Provider Spotlight

LUTHERAN COMMUNITY SERVICES NORTHWEST

Lutheran Community Services has been primarily empowering and promoting the healing of children and their families in Spokane since 1956. Mental health services are provided for individuals and families, and include in-home hospital diversion and group therapy with a focus on children and their families.

Adults impacted by trauma are also a priority. The agency is designated as the Certified Sexual Assault Center for Spokane and the surrounding region, and our region’s Crime Victim Service Center for adults who have been impacted by homicide, suicide, and other violent deaths.

For more information call: (509) 343-5008

PARTNERS WITH FAMILIES AND CHILDREN

Partners serve the Spokane community as a Children’s Advocacy Center, utilizing a variety of resources to ensure a focus on the needs of abused and neglected children and their families. They offer expert, professional evaluation and treatment services to children and families in crisis, providing the knowledge, treatment, and caring necessary to restore broken children and families to healthy, productive lives. They provide a family-centered team-based approach with an emphasis on parent child relationships. In 2011, Partners received the Eva Lassman Take Action Against Hate Organization Award for their work on behalf of at-risk Spokane children and families.

For more information call: (509) 473-4810

FRONTIER BEHAVIORAL HEALTH dba SPOKANE MENTAL HEALTH

Since 1969, Spokane Mental Health (SMH) has provided comprehensive mental health services to individuals and families throughout Spokane County. For several years, the agency with its numerous and varied programs has provided integrated services to individuals and families each year. Working with community partners, SMH programs serve adults, seniors, and children and their families, with an emphasis on recovery, rehabilitation, and reintegration into the community. Their services are client centered and culturally appropriate. Some of the highlights of this past year include the progress toward incorporation of electronic medical records, the opening of a second Evaluation & Treatment facility on North Calispel street and the 30 th anniversary of the Evergreen Club, a rehabilitation and recovery support program and facility for adults living with mental illness.

For more information call: (509) 838-4651 Spokane County Community Services, Housing, and Community Development Department Page 19 of 21

Provider Spotlight

CHILDREN’S HOME SOCIETY of WASHINGTON (CHSW)

Founded in 1896, Children’s Home Society of Washington (CHSW) is one of Washington State’s oldest and largest private statewide nonprofit (501(c)(3)) organizations dedicated to promoting the wellbeing of children and families. CHSW’s mission is to develop healthy children, create strong families, build engaged communities, speak and advocate for children to accomplish its vision of a world where all children thrive. CHSW staff are highly trained and provide evidence and best practice models embedded in family support principles. They offer programming in the areas of child and family counseling, early learning, and family support. CHSW has a strong internal quality review process and its programs are accredited by Counsel of Accreditation (COA).

For more information call: (509) 747-4174

MENTAL HEALTH ADVISORY BOARD (MHAB)

The Mental Health Advisory Board is comprised of 10 voluntary individuals from the community. A minimum of 51% have or are receiving mental health services; or are a family member of a mental health person.

This year we are acknowledging our Vice Chair of the Board, Sara Clements-Sampson. Ms. Clements Sampson has been a member of the Mental Health Advisory Board for the past 2 ½ years. During that time she has been the Community Benefit Manager for Providence Health Care. She is also one of seven in the country to complete a first in the nation Graduate Certification in Community Benefits.

She is responsible for conducting a needs assessment and identifying ways for Providence to address these needs, including mental health.

For more information call: (509) 892-9241 Spokane County Community Services, Housing, and Community Development Department Page 20 of 21

2011 In Review

Although the RSN experienced a $1.6 million reduction in funding in 2011, the RSN was still able to accomplish the following through the efficiencies of our mental health treatment providers:

Percentage Increase/Decrease in 2011 from Fiscal Year 2010

Number of Children Served 9.6% Number of Children Services Number of Adults Served 13.9% 5.3% Number of Adult Services 2.3% Hospital Days for Children and Youth in Community Psychiatric Hospital 12.6% Hospital Days for Adults in Community and State Psychiatric Hospital 18.0% Spokane County Community Services, Housing, and Community Development Department Page 21 of 21