SFY18 Request for Proposal

SFY18 Request for Proposal

Guidance Document

Legislative Authority:

The role of StarkMHAR is defined by the Ohio Revised Code (ORC), Section 340. Particularly the role is to serve as the community mental health and alcohol and drug addiction services planning entity for Stark County and to evaluate, develop and assess for the community mental health and alcohol and drug addiction needs, services and programs under ORC. As such, StarkMHAR is considered a “safety net” for people with behavioral health needs in Stark County.

While the role of StarkMHAR is to ensure there is a “safety net” of services available for all people living in Stark County, meaning that StarkMHAR is obligated to prioritize risk to safety above all else. Within that context, priority is also given to certain populations who do not have access to alternative sources of services, and whose risk to self or others is highest. Services to reduce risk of harm are the first priority and are only limited by geographic domains.

Priority Populations for adults include SPMI/SMI/SEVERE/MODERATE SUD (excluding caffeine and nicotine) who does not have access to alternative sources of services. Priority Populations for youth and adolescents include SED/SEVERE/MODERATE SUD (excluding caffeine and nicotine) who does not have access to alternative sources of services. Smoking cessation programs may be considered only if they are integrated into the care of those priority populations and it can be demonstrated that it is improving the health outcomes of those with severe and persistent mental illnesses. Non-priority populations include youth, adolescents, and adults with mental illness and/or mild substance use disorders. Definitions for these populations are as follows:

SPMI -- ADULTS WITH SERIOUS AND PERSISTENT MENTAL ILLNESS

I. Must be 18 years of age or older; and

II. Individuals with any DSM-5 diagnosis, with the exception of the following exclusionary diagnoses:

· developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders)

· substance-related disorders

· conditions or problems classified in DSM-5 as other conditions that may be a focus of clinical attention (V codes)

· Dementia, mental disorders associated with known or unknown physical conditions such as hallucinosis, amnesic disorder or delirium and sleep disorders; and

III. Treatment history covers the client's lifetime treatment for the DSM-5 diagnoses other than those listed as exclusionary diagnoses specified in section II and meets one of the following criteria:

a. Continuous treatment of 12 months or more, or a combination of, the following treatment modalities: inpatient psychiatric treatment, partial hospitalization or 12 months continuous residence in a residential program (e.g., supervised residential treatment program, or supervised group home); or

b. Two or more admissions of any duration to inpatient psychiatric treatment, partial hospitalization or residential programming within the most recent 12 month period; or

c. A history of using two or more of the following services over the most recent 12 month period continuously or intermittently (this includes consideration of a person who might have received care in a correctional setting): psychotropic medication management, behavioral health counseling, CPST, crisis intervention.

d. Previous treatment in an outpatient service for at least 12 months, and a history of at least two mental health psychiatric hospitalizations; or

e. In the absence of treatment history, the duration of the mental disorder is expected to be present for at least 12 months.

I. Individuals with Global Assessment of Functioning Scale (GAF) ratings of 50 or below (highest level of care need, tier 1). Clinician discretion may be used in determining into which tier an individual with a GAF rating of 40-50 (either tier 1 or tier 2) should be placed.

SMI -- ADULTS WITH SERIOUS MENTAL ILLNESS

I. Must be 18 years of age or older; and

II. Individuals with any DSM-5 diagnosis, with the exception of the following exclusionary diagnoses:

· developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders)

· substance-related disorders

· conditions or problems classified in DSM-5 as other conditions that may be a focus of clinical attention (V codes)

· Dementia, mental disorders associated with known or unknown physical conditions such as hallucinosis, amnesic disorder or delirium sleep disorders; and

III. Treatment history covers the client's lifetime treatment for the DSM IV-TR diagnoses other than those listed as exclusionary diagnoses specified in section II and meets one of the following criteria:

a. Continuous treatment of 6 months or more, or a combination of, the following treatment modalities: inpatient psychiatric treatment, partial hospitalization or six months continuous residence in a residential program (e.g., supervised residential treatment program, or supervised group home); or

b. Two or more admissions of any duration to inpatient psychiatric treatment, partial hospitalization or residential programming within the most recent 12 month period; or

c. A history of using two or more of the following services over the most recent 12 month period continuously or intermittently (this includes consideration of a person who received care in a correctional setting): psychotropic medication management, behavioralhealth counseling, CPST, crisis intervention; or

d. Previous treatment in an outpatient service for at least six months, and a history of at least two mental health psychiatric hospitalizations; or

e. In the absence of treatment history, the duration of the mental disorder is expected to be present for at least 6 months.

IV. Individuals with Global Assessment of Functioning Scale (GAF) ratings between 40 and 60 (mid-range level of care need, tier 2)). Clinician discretion may be used in determining into which tier an individual with a GAF rating of 40-50 (either tier 1 or tier 2) should be placed.

MI -- ADULTS WITH A MENTAL ILLNESS, DISORDER OR DISEASE

I. Must be 18 years of age older; and

II. Individuals with any DSM-5 diagnosis, with the exception of the following exclusionary diagnoses:

· developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders)

· substance-related disorders

· conditions or problems classified in DSM-5 as other conditions that may be a focus of clinical attention (V codes)

· Dementia, mental disorders associated with known or unknown physical conditions such as hallucinosis, amnesic disorder or delirium

· sleep disorders; and

III. Individuals with Global Assessment of Functioning Scale (GAF) ratings between 60 and 100 (lowest level of care need, tier 3).

SED -- CHILDREN OR ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCE

I. 0 years of age through 17 years of age (youth aged 18-21 years who are enrolled in high school, in Department of Youth Services or Children Services custody or when it is otherwise developmentally/clinically indicated may be served to assist with transitioning to adult services), and

II. Individuals with any DSM-5 diagnosis, except developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders), substance-related disorders, or conditions or problems classified in DSM-5 as other conditions that may be a focus of clinical attention (V codes), unless these conditions co-occur with another diagnosable mental or emotional disorder, and

III. Assessment of impaired functioning at age appropriate levels and difficulty with age appropriate role performance with a Global Assessment of Functioning Scale (GAF score below 60. Clinical discretion may be used to place individuals with GAF scores between 50 and 60 in a lower intensity of services (Mental/Emotional Disorder), and

IV. Duration of the mental health disorder has persisted or is expected to be present for six months or longer.

MED -- CHILDREN OR ADOLESCENTS WITH MENTAL/EMOTIONAL DISORDERS

II. Individuals with any DSM-5 diagnosis, except developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders), substance-related disorders, or conditions or problems classified in DSM-5 as other conditions that may be a focus of clinical attention (V codes) unless these conditions co-occur with another diagnosable mental or emotional disorder, and

III. Assessment of impaired functioning at age appropriate levels and difficulty with age appropriate role performance with a Global Assessment of Functioning Scale (GAF score between 50 and 90. Clinical discretion may be used to place individuals with GAF scores between 50 and 60 in a higher intensity (Serious Emotional Disturbance)

V. Assessment of impaired functioning at age appropriate levels and difficulty with age appropriate role performance with a Global Assessment of Functioning Scale (GAF score below 60. Clinical discretion may be used to place individuals with GAF scores between 50 and 60 in a lower intensity of services (Mental/Emotional Disorder), and

VI. Duration of the mental health disorder has persisted or is expected to be present for six months or longer.

Substance Related and Addictive Disorders

Substance related and addictive disorders include 10 separate classes of drugs as referenced in the Diagnostic and Statistical Manual- 5th edition (DSM-5). Gambling disorders are also included. Substance use disorders can be mild, moderate or severe, as well as include substance intoxication and withdrawal and substance induced disorders. Refer to the DSM-5 for specific criterion for these disorders.

In terms of prioritization, however, certain substance use disorders pose a greater risk than others and are given higher priority. Programs and services for those with a severe substance use disorder will have priority over programs and services for those with a mild substance use disorder. Likewise, substances that are most likely to result in death without intervention will be given more attention and priority than those substances likely to be of mild severity. Substances such as opiates, alcohol, sedatives, hypnotics, anxiolytics and inhalants will have priority over substances such as amphetamine type substances- cocaine and other stimulants, hallucinogens, cannabis, caffeine and tobacco. Service demands will be determined by a variety of sources including community needs, and local trends and may change from funding cycle to funding cycle. While the STARKMHAR recognizes that all substances of abuse can have damaging effects on a person’s health and well-being, resources will be directed those populations people with life threatening disorders.

While gambling can trigger the reward system, as well as produce behaviors similar to those of people who are using substances, the direct and immediate threat to life is low. Additionally, community need is low; therefore, resources for gambling will only be based on mandates.

Safety Net of Services

The safety net of services includes not only those services mandated by Ohio Revised Code and other funding bodies, but services that without such, would negatively impact the lives of those in Stark County. Service mix is determined by community need and is included in the community plan, which serves as StarkMHAR’s application for funding from the Ohio Department of Mental Health and Addiction Services. Local need is determined by assessment of current conditions, forecasting emerging trends, and evaluating existing community resources. This results in a process that is not only fluid, but responsive to the needs of the community. All services, programs and populations have been prioritized according to the level of urgency and immediacy associated with the need. All services, programs and populations have been broken into six priority areas.

Priority Area / Target Population / Category Name / Definition
Priority 1 / Hard Mandates / Services we are legally required to provide
Priority 2 / Everyone in Behavioral Health population / Urgent Risk / 1) Risk of urgent and imminent harm includes need for emergency or urgent services due to danger to self/others or inability to care for self, 2) Potential life threatening symptoms resulting from withdrawal from substances.
Priority 3 / Priority Populations Only / High Risk / 1)Loss of basic self-care skills (secondary to Priority Population) which results in an inability to manage functioning 2) Likely degeneration of condition that would result in imminent risk, 3) Identified public safety risks
Priority 4 / Priority Populations Only / Serious Risk / Significant functional issues related to SPMI/SMI/SED/SEVERE SUD; that, without intervention, would likely result in degeneration to a higher level risk at some point in the non-imminent future
Priority 5 / Priority Populations Only / Important Needs / Needs re: social functioning, higher cognitive development, employment success
Priority 6 / Non-priority populations or general populations / Legitimate Needs / Services that increases the quality of non-urgent outcomes with regard to any of the issues addressed in other priorities

Expectations

The following are expectations of Stark County Mental Health and Addiction Recovery for any agency that receives a contract to provide services. These are non-negotiable and are required to receive funding from StarkMHAR.

All providers must meet all applicable federal, state and StarkMHAR contract requirements and any applicable standards for treatment.

The Substance Abuse Prevention and Treatment (SAPT) Block Grant requires prioritization of services to several groups of recipients. These include: pregnant women, women, injecting drug users, clients and staff at risk of tuberculosis, and early intervention for individuals with or at risk for HIV disease (AoD programs only). Provider agencies receiving funding through this source MUST demonstrate that these recipients have priority for services.

In accordance with the ORC, Section 3793.04, all alcohol or drug programs shall emphasize abstinence from the use of alcohol and other drugs (AoD programs only).

Services are to be compliant with Civil Rights, Equal Employment Opportunity and consistent with Health Insurance Portability and Accountability Act (HIPAA) and 42 CFR part II (where applicable).

The following expectations reflect StarkMHAR philosophy about mental health and/or AoD programs, services and customers and may serve as a guide for applicants to develop and/or maintain a quality services/programs. They reflect current national and state research and represent what has been learned over the years regarding best practices, science-based models and effective mental health and/or AoD programs and services.